Collective agency, the answer to health inequality


Demanding universal rights to health requires collective agency across different communities and agencies within and across African countries, a recent EQUINET Regional Conference on health in East and Southern Africa heard.

Delegates at the virtual conference agreed that building alliances and capacities within and across countries will be critical in bridging the widening health gap. 

The conference themed ‘Catalysing change for equity and social justice in health’, drew experts from health and trade unions.

While it remains a challenge for individual organisations to be heard globally, health justice can only be achieved through collective social health agency, Mavis Koogotsitse, executive secretary of the Southern African Trade Union Coordination Council (Satucc) said. 

“We cannot afford to have silos. It is time we work together in civil society,” she said, adding that a fragmented approach to demanding health rights would be detrimental.

“If we are to make strides in promoting health justice there have to be many voices from the people.

‘It is important that we work together so that these policies yield.”

She called upon civil society and trade unions across Eastern and Southern African (ESA) countries to build synergies with key stakeholders. 

There are heightened calls for state and non-state structures to organise as well as building alliances across the region to engage from local level to regional level and in global processes and platforms that affect rights to health to ensure that health rights claims are delivered in practice for all.   

The obligation of duty bearers for services and health inputs was also brought under the spotlight with delegates underscoring the need to empower stakeholders with critical information on health rights.

Running under the theme Reclaiming Collective Agency and Solidarity, the conference also shed the light on the need for the public voice. 

The voice of the ordinary citizens in the discourse on health rights and access has also been found to be important in improving participation. 

Delegates shared ideas on building conscious, active citizenship, agency, leadership and capacities at local, national, regional and global level, building on existing talents, institutional capacities and processes.  

Nakibuuka Noor Musisi from the Centre for Health, Human Rights and Development (CEHURD) underscored the need to respect health rights. 

“Rights are universal and the state should do what it can so that some rights do not outweigh others,” Musisi told delegates.

‘In a region of significant inequality, rights should not only be claimed by those who are more powerful or have the strongest voice.

‘In health, equity matters, and we need to reach the most vulnerable in society. 

“It is important that we do not discriminate against those with less voice when deciding which rights should take precedence over others.”

Building health literacy in communities 

While health rights can benefit from agency and collective voice, building health literate societies is also an important component.

“There is a need to promote health literacy in communities,” Itai Rusike, head of the Community Working Group, an organisation working to promote health rights in Zimbabwe said. 

Conference delegates agreed that there is a need for a concerted effort in educating communities about health rights, and that activist training is important for communities to actively engage with their services and with authorities, and for health systems to involve the voice of communities. 

Delegates suggested activist training, mentorship for small NGOs, young activists, and sharing of best practices from other regions including through exchange visits, profiling voices of artists, to build leadership and cadre ship.

While champions are needed, delegates proposed ways of promoting collective power, consciousness, self-determined action and agency, with values of solidarity and justice seen to be essential to address equity within the region. 

Delegates also shared experiences of ways of gathering, sharing evidence on and strengthening active participation, mandated representation, and input to decision-making by communities, marginalised social groups and by frontline workers in the system.

Experiences were shared on the role of health centre committees, health literacy programmes, community monitoring, peer support, and other processes/platforms that bring evidence and ideas from and share information with communities. 

Changing the narrative

One of the challenges identified on the day was of changing narratives for public support for health as a right.

For example, growing negative narratives on public sector systems which were discussed in previous conference days.

Building a ‘pro-public discourse’ showing the importance of public sector services in health was noted as an essential tool to change narratives while calling for improved domestic funding of these services. 

Through the African Union, African countries have had an improved voice, delegates argued citing the Covid-19 pandemic while individual countries also helped in bringing critical issues to the fore, especially with regards to Covid-19 vaccines. 

Conference delegates underscored the need to profile such successes, including those that are achieved locally, that show that communities can themselves be agents of change. 

As one delegate noted, “The more we profile the voice of the people on the ground the better. The voice of the people must be heard.”

Photo voice is one initiative that uses photos to highlight health challenges and changes brought by local people.

In the conference, five local health centre committee members from the community from the Eastern Cape in South Africa exhibited examples of how photography is used to profile grave health issues, for example the absence of spaces for children to play or the lack of transport for ill people to reach services, using this to negotiate for changes in the committees. 

This has helped communities monitor and evaluate change in their conditions and their health rights. 

Conference delegates endorsed the use of participatory action research, community monitoring and photo voice; social media to bring community evidence, ideas, critical analysis and learning from action into decision making on health at local, national, and regional levels.

While a network like EQUINET has helped bring local voices to regional processes, there is a need to organise effective ways of bringing local evidence and ideas into global processes and platforms. 

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