Social movements are key to achieving people-centred health systems
To the eyes of many, the Ebola epidemic was the dark background against which the collective failure of public health and health research became evident and undeniable, making the need for publicly owned health systems, nurtured and conceived by the people, as urgent as ever.
Since long time, the People's Health Movement (PHM) issued a collective call for a clear focus on public health systems, built around solidarity and justice, rather than the current dominant discourse on spliced and diced health systems, to be traded in the market. From this perspective, it has been refreshing (and quite unexpected) to see the terrain of Health Systems Research (HSR) opened up beyond the confines of the restricted and restricting dominant concept of Universal Health Coverage (UHC). It has promoted the use of the public health language of care and solidarity, equity and gender justice, of rights, rather than the insurance language of coverage. Power and the force of social movements were repeatedly mentioned including specific references to the PHM.
Criticism of segmented systems that offer poor services to the poor were raised by many. Perhaps one of the most relevant issues addressed was the recognition that many crucial drivers of health system change lie outside the traditional boundaries of the health system, and that social mobilization and social movements are critical for re-orienting health systems to be more people-centred.
In this respect, research aimed at understanding civil society and social movements that support people centredness was strongly advocated – a challenge that PHM is well positioned to respond to. In fact, the PHM-organised session presented an action-research project on civil society engagement for the right to health. Thanks to the inputs and contributions of many participants, key challenges in conducting research from within a social movement perspective were addressed and assisted in strengthening the project design.
The final conference statement declares that “health systems need to be reoriented to respond to people’s emerging health needs”, and that this process “should be led by citizens, and local and national governments rather than by external actors, and in line with the needs and priorities of communities and citizens”. Now these concerns need to be integrated into the praxis and priorities of the research community, or the phrases will remain empty and praxis will continue to be dominated by the current hegemonic discourse that legitimates injustice and inequity.
As suggested by Amit Sengupta in the closing plenary, this implies:
- naming and interrogating those institutions that perpetuate inequity on a grand scale
- bringing a focus on the role of social movements in catalysing change, and in research that is counter-hegemonic and led by social movements
- mainstreaming shadow reports by social movements and civil society as a much-needed tool for critically interpreting reality.