NGO Consultation Report

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Introduction

1. Representatives of 41 Pan-Commonwealth, Pacific region and New Zealand NGOs held a Consultation at the University of Christchurch, 23-24 November 2001 to consider a number of key health issues that they are facing internationally, regionally and nationally within the context of the theme of the 13^th Commonwealth Health Ministers Meeting (CHMM) Priority setting in health. During the consultation sessions were held on the following topics: Issues and priority setting and quality service delivery from an indigenous and community perspective; Globalisation and mobility of health sector manpower from a health professional association perspective; Tobacco or health - the Framework Convention for Tobacco Control; Depression - to be included on the worldwide health agenda; and HIV/AIDS and sexual and reproductive health supplies security.

2. Input was also provided on HIV/AIDS and sexual and reproductive health supplies security from the Asia Pacific Alliance of NGOs and donors committed to furthering the Programme of action of the International Conference on Population and Development (ICPD).

3. Following presentations on each topic, participating NG0s developed the following recommendations for the consideration of Health Ministers:

4. In the deliberations the definition of 'indigenous' was considered to be those who identify as being the people from a country in which they draw their cultural origin.

5. The following factors were considered as pre-requisites in effectively prioritising and address quality service delivery, namely that:

• NGOs should work closely with people of high need and include their voices in the decision-making, planning and implementation of their work. It is therefore vital that the unique role of NGOs is developed and fully resourced;

• broad determinants of health should be included in health policy and public health and health promotion approaches should be fully recognised and supported. The following must therefore be acknowledged:

· peace as a priority health issue;

· the effects of colonisation and exploitation;

· the restoration of law and order;

· the impact of global economic policies on the health of people.

6. Until the hurdles associated with addressing health holistically are overcome it will not be possible to achieve the goal of quality health services for all.

7. Health Ministers in taking action are requested to recognise that NGOs are a key component of the delivery of quality health services. They should therefore take into account this message together with the outcomes of other meetings such as Ministerial Statement of the Fifth Global Conference on Health Promotion signed in Mexico City, June 2000 and the Peoples' Health Charter from the Peoples' Health Assembly held in Bangladesh, December 2000.

8. In determining health policy they are asked to ensure that:

• self determination by indigenous people is strongly supported. To achieve this it is necessary to move towards partnership through real cooperation, collaboration and consultation practices and through promoting health strategies focussing on outcomes;

• the place and focus of traditional medicine and healing methods are considered and resourced at the same level as western medical models of health service. This reflects the focus of the Commonwealth Working Group on Traditional and Complementary Health Systems, established by Health Ministers at 12th CHMM.

9. Many Commonwealth countries, both developed and developing, are experiencing shortages of skilled health workers. Pan-Commonwealth NGOs therefore support the development of a Commonwealth Code of Practice for International Recruitment of Health Workers whilst acknowledging the rights of individuals to work and live where they choose.

10. With respect to the proposed Code, NGOs ask Health Ministers to consider:

• inviting Commonwealth Health Professional Associations (CHPAs) to review the draft Code and submit comments on it in good time before the next meeting of Health Ministers;

• including a reference on the role of Health Professional Associations and registration bodies in gaining support for and compliance with the Code;

• identifying new sources of funding available, including resources from recruiting countries, for less developed countries to facilitate the future training of skilled health workers;

• ensuring that the differences in standards of training in Commonwealth countries are addressed in the Code;

• following its publication, reviewing the Code after a specific period of time and at regular intervals thereafter.

Tobacco or health - the Framework Convention for Tobacco Control

11. Of 300 million smokers in the Commonwealth, over 100 million are expected to die early if current smoking patterns persist, shortening the smokers' lives by an average seven years per smoker in developed countries, and by possibly less in developing countries. Tobacco use is costly, burning money needed for children's food, for education and other urgent health problems, such as HIV/AIDS. For example, US$ 50 billion is spent annually in Commonwealth countries on manufactured cigarettes alone. By the year 2020, tobacco will be the main cause of early preventable death and disability in the world.

12. NGOs recognise that international co-operation is essential for tobacco control and, noting that the Commonwealth has a crucial role in future negotiations, they ask the Health Ministers to support a Framework Convention on Tobacco Control (FCTC) that will:

• ban all tobacco advertising, promotion and sponsorship, internationally and within countries, the ban to apply to the total population (adults and children);

• provide for clear information on tobacco products, with forceful and effective tobacco product package warnings including pictorial warnings;

• adopt tax and price policies to discourage consumption and fund tobacco control programmes;

• enforce the prohibition of international smuggling, and end duty-free tobacco product sales;

• protect all peoples from exposure to second-hand smoke, through the provision of totally smoke-free environments;

• require that tobacco companies disclose all information relevant to the constituents and design of tobacco products, including their research, sale and marketing activities internationally and in all countries;

• ensure that with respect to tobacco products, the public health rights of nations and citizens take priority over trade objectives, economic or otherwise, in international trade and agreements. Specifically, the FCTC should provide that in the event of a conflict between the FCTC/any of its protocols and any other international agreement, the FCTC and its protocols will prevail;

• provide for developing Commonwealth countries to receive financial and technical assistance for tobacco control programmes;
• require tobacco industries to provide compensation for the harm caused by their products;

• provide for a global fund to support the implementation of the FCTC.

Depression - to be included on the worldwide health agenda

13. WHO predicts that depression will be the second leading disability by the year 2020. It is also estimated that one in seven people in New Zealand will experience a depressive disorder at some point in their lives.

14. However, this figure does not estimate the impact depression has on family, friends, the community or work life. Depression does not just impact on the individual but also on other people around them. Depression is by far the leading source of worker disability in the world today. It is therefore surprising that there is not greater awareness of depression nor support systems in developing and developed Commonwealth countries.

15. Health Ministers are asked to consider the establishment of a Commonwealth Inter-Sectoral Working Party on Depression, including the participation of NGOs.

16. The working party would be charged with:

• raising awareness of the broader determinants of health and issues that underlie depression. These should be addressed utilising collaborative health promotion approaches appropriate to different cultural contexts.

• supporting and advocating for multidisciplinary approaches to respond to depression across the continuum of care. These should incorporate primary health care principles and a commitment to existing concepts such as healthy islands and healthy communities.

• undertaking needs analysis and research into community mental health and services, given the increasing global impact of depression. These should underpin the development of a comprehensive workforce development plan for health and related sectors within each nation;
• promoting relationship development and information sharing across agencies involved in mental health and depression awareness work, within and across Commonwealth countries.

HIV/AIDS and reproductive health supplies security

17. The Commonwealth has under 30 percent of the world's population and over 60 percent of the global HIV/AIDS infectivity. HIV/AIDS does not respect ideology, religion or culture and requires concerted action from all concerned and necessitates a comprehensive, multi-sectoral approach. With population growth; decline in overseas development assistance; the entry of the largest youth generation into their reproductive years; and increased stress on infrastructure and services, the Commonwealth is now facing an ever-increasing emergency in sexual and reproductive health supplies, particularly condoms.

18. Commonwealth NGOs urge Health Ministers to:

• implement existing international agreements relating to sexual and reproductive health supplies, particularly condoms;

• implement the goals as set out in the ICPD Programme of Action, which establishes specific benchmarks on funding, timing and distribution of support for sexual and reproductive health services;

• adopt a rights-based approach to promoting sexual and reproductive health including HIV/AIDS using the principles embodied in the Ottawa Charter for Health Promotion, which enables individuals and communities to take control of improving their health and to exercise their sexual and reproductive health rights;

• support research which considers the potential value of traditional medicines and diet in the treatment of HIV/AIDS, in partnership with traditional health practitioners, while protecting this knowledge against commercial exploitation and the public against malpractice.

Commonwealth Secretariat
Marlborough House
LONDON SWIY 5 HX
November 2001

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Last modified: December 10, 2001