Editorial: Back from Berlin, reflecting about paradigm shifts…
Dear reader,
Last week, I participated in the MMI Network meeting in Berlin which was linked to a conference by the German VENRO working group on health. Both meetings dealt with the changing nature of health cooperation and the increasing prominence of global health in international politics. And both referred to (the need for) a paradigm shift in global health and the transformative change required to attain the health related goals of the sustainable development (SDG) agenda.
The Berlin meetings obviously followed a certain trend: First, they confirmed that global health has become an issue of significance for both foreign and domestic policy development of countries, hence the need to take an integrated, inter-sectoral approach involving multiple actors, including the government. Secondly, the SDGs call for a universal, transformative approach to health, moving beyond working in silos and vertical programs, and the (now artificial) divide between “developed” and “developing” countries. Buse and Hawkes have eloquently described the implications of this in their paper Health in the sustainable development goals: ready for a paradigm shift?
The term “paradigm shift” was introduced by Thomas Kuhn in his essay ”The Structure of Scientific Revolutions” (1962). Kuhn defines a scientific paradigm as “universally recognized scientific achievements that, for a time, provide model problems and solutions for a community of practitioners”. Kuhn explains how scientific progress is not linear, nor cumulative, but rather occurs in phases – ‘normal science’, periods of crisis and revolutionary changes in world view, respectively. In the last phase, the crisis is resolved by a revolutionary change in world-view in which the now-deficient paradigm is replaced by a newer one. Moreover, he argued that competing paradigms are “incommensurable”, that is to say there is no objective way to assess their relative merits. Or, in more general words, contrasting paradigms and their merits cannot be compared with each other on the basis of scientific validation, as they are bound by the specific communities, moment in time, and societal conditions that structure them.
The question then is whether something similar is now going on in international health cooperation and the sustainable development agenda. This merits a longer discussion, but perhaps the answer is “yes”, as the current major focus on evidenced-based interventions in health development programs is increasingly being questioned. So let me use this “paradigm shift” angle to reflect on these two meetings.
The VENRO global health conference focused on the (increased) prominence of global health on the German foreign policy agenda and Germany’s global health leadership within the G7 and G20. Germany chaired the G7 in 2015 and will be chairing the G20 in 2017; global health expectations are high after the positive track record of the Merkel government in 2015. The German government has developed a roadmap of their policy approach called “Healthy Systems – Healthy Lives”. The seminar explored how actors such as NGOs could work in synergy with the German government to attain global health objectives. With global health having become more prominent at the UN (see the last UNGA71 meeting for example), and in the G7 and G20, the paradigm shift could be explained then as a next phase of the global health revolution, a concept elaborated by scholar David Fidler: “Global health has been lifted from political neglect into more prominence among States, intergovernmental organizations (IGOs), and non-State actors.”
The MMI workshop on Health cooperation beyond aid focused on the changing role of NGOs but also on health cooperation in general. A new MMI discussion paper (see below) critically analyzes the relevance, legitimacy and effectiveness of health cooperation and its actors in a fast changing environment. A central point in the paper – also discussed in the workshop – is that currently much attention goes to “output” legitimacy in the work of international NGOs and other health development actors (i.e. accountability, transparency and effectiveness) while “input” legitimacy – deliberation and representativeness – gets far less attention: What are international NGOs and who do they really represent in global health advocacy and policy shaping? How do they discuss and convene to come to their policy decisions and what are their values and own socio- political or even financial interests? The needed paradigm shift here consists of creating more (self)reflection and awareness in the agency of international NGOs and other health cooperation agencies as to strengthen their relevance in global health programs and UHC more specifically. To be taken up in the MMI working group on Effective Health Cooperation that also met in Berlin in order to plan its next year of activities (new members are welcome!).
Reflecting back, can we really speak of a “paradigm shift” in global health policies and international cooperation? There is certainly “discontent with the status quo” and an agreement that we have entered a period of crisis and “debate over fundamentals” of what is the appropriate conceptual framework to advance global health. My personal take on this is the following.
First, I hesitate whether a philosophy of science concept like “paradigm shift” can (easily) be translated to the politics of global cooperation for development goals. Second, I am in doubt (call it a personal scientific crisis) about the “phase” we are in, currently. The SDGs, in spite of their undeniable transformative language and universal potential, are still structured on the Western development model initiated after World War II. This follows the principles of economic growth (increase of production and consumption) based on capitalism, free trade, democratization, good governance and the rule of law via cooperation between sovereign nation states. However, there are analyses that health related human rights are undermined in the sustainable development agenda.
Moreover, we are facing a deep financial, ecological and social crisis. Issues like widening global income inequalities, thinking on post-capitalist society, the notion of planetary boundaries and limits to growth, global demographic projections and their implications for mass migration, reflections on cosmopolitan realism and the erosion of national sovereignty, but also high-level political attention to health security threats like Antimicrobial Resistance all challenge traditional development thinking and the status quo. There is fierce debate on the fundamentals going on and because of these structural global drivers and challenges world views on global health concepts might actually enter a revolutionary new phase. For example, the recent ratification of the Paris Agreement on climate change by the EU, China, India and the US might trigger an energy revolution that will have a deep impact on global health outcomes in the years and decades to come. Hence, ecologically oriented frameworks such as the manifesto on planetary health would guide us, eventually, towards a new paradigmatic worldview.
Remco van de Pas, ITM Antwerp
MMI Board member
Extract from an article published in this week’s
IHP newsletter (ITM Antwerp), adapted and shortened
MMI Network: Events, news, papers and resources
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Discussion paper: Medicus Mundi International
Health Cooperation: Its relevance, legitimacy and effectiveness
as a contribution to achieving universal access to health
The MMI discussion paper on health cooperation and its relevance, legitimacy and effectiveness was discussed at the workshop “Health cooperation beyond aid” in Berlin, on 29 September 2016, and published afterwards: “The document is not intended to be a position paper representing a homogeneous view of the Network. It is a discussion paper that feeds a core activity of the MMI Network; to serve as a platform for critical reflection on the role and future direction of development cooperation for health. We invite the members of the MMI working group on Effective Health Cooperation (MMI EHC) and other Network members and partners to engage in this process.”
> Discussion paper (PDF): http://bit.ly/2dNwlFr
> Workshop in Berlin: http://www.medicusmundi.org
> Workshop pictures: https://www.flickr.com
> MMI EHC working group: http://www.medicusmundi.org/mmi-ehc
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Network project: MMI and various members and partners
“We are building a strong civil society space
in Geneva for more democratic global health”
The project of a Geneva Global Health Hub (G2H2) has been launched in a civil society side event to the 69th World Health Assembly in May 2016, after more than a year of preparatory work. The Geneva Global Health Hub is a membership-based association created in Geneva in 2016 to provide a space and enable civil society to meet, share knowledge and create initiatives to advocate for more democratic global health governance:
- “We follow and enable civil society discussions on Geneva global health processes through an interactive website and social media.
- We facilitate online and face-to-face networking and strategizing between member organizations.
- We disseminate information to members on health-related institutions in Geneva on the basis of mapping, networking and meeting attendance.
- We assist members to organize Geneva-based meetings with office space and infrastructure.
- We are exploring ways to assist resource-constrained organizations to raise funds for travel costs for meeting attendance.”
The strong support of the Medicus Mundi International Network for the G2H2 project is expressed by the facts that several of our members have joined the G2H2 association, the G2H2 Steering Committee is chaired by Mariska Meurs (Wemos) and the G2H2 secretariat is hosted by the Medicus Mundi International Network in our newly opened Geneva office.
> Website: www.g2h2.org
> Twitter: https://twitter.com/G2H2_Geneva
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Network event: Medicus Mundi Switzerland
Working in fragile contexts and building up resilient health systems
Basel, 2 November 2016
“To end preventable child and maternal deaths, create an AIDS-Free Generation, and protect communities against infectious diseases such as Ebola, we need effective, functional health systems that can deliver essential health services to those in need. International health organisations are more and more obliged to work in fragile contexts where the environment is marked by instability, the public structures are weak or quick to collapse and the rule of law is lacking. If we want to achieve the Sustainable Development Goals (SDGs) by 2030 we have to find better means to strengthen systems for health and to avoid leaving anyone behind. The MMS Symposium will address these challenges by reflecting different experiences and by having a closer look on building resilient systems for health in fragile contexts.” (Annual symposium of Medicus Mundi Switzerland)
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Network event: Doctors with Africa CUAMM
Mothers and children first
Padova, 5 November 2016
“We are all invited to renew our commitment to answer Pope Francis’s call – made during his special audience on May 7, 2016 – to guarantee healthcare access to the weakest among us, especially mothers and children. This year’s annual meeting will be a special occasion as we will present the final results of our project ‘Mothers and Children First’, about to conclude its first five-year cycle. We will also launch our next program to promote the health of mothers and children. This meeting will be an opportunity to rediscover together the care, passion, and wonder of taking concrete action for, and with, those who suffer and live at the farthest reaches of the land, ‘at the margins.’ Because the farthest reaches of distance, suffering, and need touch us all and demand new and urgent choices from us.” (Annual meeting of CUAMM.)
> http://www.mediciconlafrica.org
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Network project: Cordaid
ARV treatment: Reaching the unreachables
“By air, by road and even canoe we are trying to reach tens of thousands of people in DR Congo whose lives depend on antiretroviral (ARV) treatment. In this epic work to counter the HIV/Aids epidemic, we are generously supported by the Global Fund.” (Cordaid news)
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Network paper: HealthNet TPO
Research report sociotherapy in Burundi
“At HealthNet we take a certain level of pride from the so-called action research that is part of the implementation of our programs in the field. We use this kind of research to monitor and evaluate our programs and their results. Recently, we’ve completed this latest report on our sociotherapy as part of the Sexual Reproductive Health and Rights project in Burundi.”
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Network member: action medeor
action medeor in 3 Minutes
If you understand a bit of spoken German, and if you have 3 Minutes time, this nice video shows how the German Medical Aid Organization works. Call it “action medor for beginners”, if you like. Look, listen and learn (also if you do NOT understand spoken German J). And eventually help us producing a similarly nice video on “Medicus Mundi International for beginners”.
> https://medeor.de/de/ueber-uns/action-medeor-in-3-minuten.html
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Network people: Wemos
Anke Tijtsma said farewell to Wemos
“Our director Anke Tijtsma will become a student. After 13 years at Wemos – the last 5 as director – she is leaving our organization in order to pursue a full time master study. Although we are sorry to miss her, we see in her decision another expression of her great drive for innovation and dedication to a better and healthier world. Her drive and optimism have given Wemos a lot; no doubt they will colour her next steps too.” Farewell, Dear Anke! MMI will miss your dedication and leadership, too.
> https://www.wemos.nl/en/anke-tijtsma-says-farewell-to-wemos/
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Network resource: Health Poverty Action
Tackling injustice with discussion and dialogue
“Speaking out about an injustice is often the first step towards change. It helps to raise awareness and understanding of the problem and galvanises people to advocate for a solution. We know words are powerful, which is why we often ask our supporters to ‘spread the word’ when we’re campaigning. And discussing an issue, with friends, family, or colleagues, can be more meaningful and have greater impact. Some of the issues that Health Poverty Action works on are not traditional development issues, and are therefore not in the mainstream consciousness. That means it is even more important that we bring them to light. That is why we’re launching a new action for our activists – the Justice Jabber.” (Read more about this tool for campaigners – and try it out!)
> https://www.healthpovertyaction.org/news/tackling-injustice-discussion-dialogue/
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Network conference report: Medicus Mundi Switzerland
Health in fragile contexts, Bern, 24 August 2016
“In an increasing number of countries the implementation of health programmes is challenged by fragile contexts. At the same time, fragility of a state is considered as one of the main causes for malfunctioning health services. Emergency situations aggravate such situation and reveal the weaknesses of the system. These settings evoke not only questions on how to adapt to shaking working environment or on sustainability, but also whether health programmes could make a contribution to reduce fragility.” Organizers: Swiss Red Cross, Swiss Agency for Development and Cooperation and Network Medicus Mundi Switzerland.
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Network conference reader: Medicus Mundi Switzerland
Applying Human Rights to Sexual and Reproductive Health – a Reality for All?
“Sexual and reproductive health is a fundamental human right. At this year’s MMS/aidsfocus.ch conference we addressed the issues of human rights to sexual and reproductive health. There is a renewed push for sexual and reproductive health and rights due to the adoption of the Sustainable Development Goals (SDGs) by 193 UN-member states. Safeguarding sexual and reproductive health and rights of women and men contributes significantly to achieving the global goals for sustainable development. The new issue of the MMS Bulletin unites presentations of this year’s MMS/aidsfocus.ch conference and reflects on the human rights based approach to sexual and reproductive health programming. “
MMI Network members: Please send us your eventual contributions for the MMI website (events, news, articles, resources) and the next issue of the newsletter!