Actions and activism in fostering genuine grassroots participation in health and nutrition.

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Effective action requires not just an enthusiasm,
but calls for a close rapport with the disgruntled so
as to get them organized.  (A. Robbins)

1. You may often have asked yourself as to whether your individual contribution in the field of health and/or nutrition makes or is making any difference.  This, of course, depends.  Alone, each of us is indeed helpless to change very much.  Standing alone to-right-the-world’s-wrongs is a false ideal. We have thus plenty to learn from the lessons of mutuality or even of militancy.  Individual concern (let alone compassion…) is just clearly less powerful than organized solidarity. (Tikkun)   Or, to use an old adage, ‘divided we beg, united we demand’.

2. Sporadic, collective grassroots-organized acts are happening all the time   –mostly the result of non-political and personal leadership initiatives. To make these acts really count and add-up to something, they need to be progressively channeled into new patterns of higher political meaning and political impact. Human rights activists are needed to lead the way in such a transition.  This, because without continuity and follow-through actions, popular struggles will remain a heap of toothless words. (S. Ophir)

3. In the human rights (HR) context, two questions arise here: Are the fields of health and nutrition legitimate and good ports of entry for HR activism? And if the answer is yes: Are we ready for such a challenge?

4. If the answer is again yes, new forms of progressive HR learning and HR action are then needed in our line of work. Actually, to act effectively in the time before us, we need to first develop a more widely shared strategy that unequivocably points in the HR framework direction.  When adopting such a strategy, we cannot merely denounce; we must also announce a new order –an order with more empowering-health-and-nutrition-alternative-actions.  We must thus strive to become proactive, not merely reactive.

5. Today, together with the victims of health and nutrition rights violations, the inescapable challenge before us is to redefine the strategies we use in order to combat preventable ill-health, preventable malnutrition and preventable premature deaths. This invariably entails (simultaneously at the global, national and local levels) addressing and combating the social, economic and political determinants of the violations of the UN-sanctioned Right to Health and Right to Nutrition.  Only thus will we be able to overcome the present crisis in overall development thinking and praxis we now are stuck-in in these two domains.  (R. Boyte)

6. As an avant-garde, we not only need to reflect on new institutional ways of supporting grassroots HR initiatives, but we also need to become more proactive in organizing them, as well as helping generate new forms of HR knowledge and of practices-of-direct-democracy in local government. In the process, we also need to reassess the pertinence and the role of foreign aid and of private (non-official) international development cooperation in the fields of health and nutrition. This, to either reject both or to help redefine them so that they, once and for all, fit the demands of local communities.  (S. Padron)  If the latter cannot be done, yes indeed, it is high time poor countries begin considering turning down foreign aid.

7. Still proactively, we first need to help create a shared critical awareness of the immorality of the prevailing social, economic and political system responsible for the violations of the Right to Health and the Right to Nutrition we are basically left to deal with as health and nutrition professionals. For this, among other, we need to bring people both in the rich and the poor countries to a point where they become more vocal in their demands to change the mechanisms that lead to the conditions perpetuating ill-health, malnutrition, poverty and injustice. And this can only be achieved by creating a growing discontent that leads to a ‘constructive anger’ and to commensurate actions that address such injustice. Action along these lines is desirable (preferably preemptive rather than reactive), and should even be made an inescapable outcome of effective health, nutrition and development learning. The HR activist/educator thus has a key role in our midst.

8. If we are to be consequent with effective people’s empowerment, we will have to foster an authentic people-centered development (in our case using health and nutrition as a port of entry to HR issues). For this we will have to further:

i) move away from coercive or top-down practices involving any kind of ‘acceptance-as-a-fait-accompli’ (e.g., in family planning?), and move into consensus-building practices involving legitimate beneficiaries’ approval; ergo, do things departing from the-way-people-see-them in their own environment;

ii) revolutionize people’s expectations helping them to move away from fatalistic outlooks;

iii) help define a new type of collective, community sense of responsibility that replaces the prevailing individual identity;

iv) help legitimize and enforce all UN-sanctioned people’s rights;

v) increase the negotiation and bargaining capacity –or at least the defense capacity– of claim holders;

vi) as needed, aim at overcoming constraining local political structures (formal and informal);

vii) concentrate on changing the local inter-generational dynamics when required, and very specially concentrate on changing the role of women (our main contact in health and nutrition work) in overall development work;

viii) work with people towards the goal of ultimately controlling their own community resources, fighting for the resources they need from outside, and taking initiatives to shape their own future through a strengthened, militant organization;

ix) make sure people get access to relevant information, especially the type of information that will help them hold their government officials accountable; *

x) help redefine the roles and methods of so-called ‘participation’ shifting them towards methods of ‘empowerment’ –in our case in health and nutrition;

xi) constantly re-gather groups becoming marginalized, trying to make sure their special interests are accommodated in the general strategy;

xii) secure concrete short and long-term positive results for claim holders (with an initial emphasis on short-term results to foster self-confidence);

xiii) together with claim holders, monitor and evaluate said results, especially with regards to the degree of  popular empowerment being achieved, as well as probing the equality of the benefits accrued; and

xiv) promote self-education with the aim of achieving faster results.

*: Information given to people for use through the fashionable ‘social marketing’ approach is definitely not the type of information conducive to any meaningful participation; social marketing simply does not bring about the needed sustainable structural changes –at best, it allows people to tolerate and cope-with an unjust situation. Social marketing tells people what to do, but not what for  and why…

9. Only through the constant practice of such people-centered development activities –often through trial-and-error– will we overcome the limits of existing flawed development models and theories. (L. Padron)

10. In short, starting with/from our work in health and nutrition, we should all contribute, to the best of our abilities, to generate popular alternative development strategies with the corresponding set of tactics to implement them.  But to make a difference, remember that standing alone changes little; so: Network with other like-minded activists in the HR field!

Claudio Schuftan, Ho Chi Minh City

cschuftan@phmovement.org

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