COMMISSION ON SOCIAL DETERMINANTS OF HEALTH. The Civil Society Regional Consultation Meeting DRAFT

Transcription

1 Report on: The Civil Society Regional Consultation Meeting Eastern Mediterranean Region Cyprus, 3-5 December 2005 DRAFT Submitted by: Association for Health and Environmental Development (AHED) December

2 List of Abbreviations WHA WHO SDH CSDH AHED EMR PHM ANND PMRS PHC WB IPHU World Health Assembly World Health Organization Social Determinants of Health Commission on Social Determinants of Health Association for Health and Environmental Development Eastern Mediterranean Region People s Health Movement Arab NGOs Network for Development Palestinian Medical Relief Society Primary Health Care World Bank International People s Health University that affiliated to the People s Health Movement 37

3 INTRODUCTION At the 2004 World Health Assembly, the WHO Director-General announced the launching of a three year initiative (from 2005 to 2008) to act upon the social causes of ill health and inequities by calling for a global Commission on Social Determinants of Health. The Commission's report emphasized the fact that social factors are the major determinants of health rather than health systems. Aimed at setting the foundation for sustained processes to profile and integrate the social determinants of health within policy and practice, the initiative could represent a new milestone since the Alma Ata Declaration of The initiative entails the development of a global mechanism whose aims as described by the WHO Secretariat on the SDH, are to" address the gross inequalities in health between countries and among social groups within countries and to promote a new health agenda oriented to social determinants at global, regional and country levels. The Commission s mission comprises four tracks of work: 1) action: by supporting partner countries to strengthen action on social determinants in public health policy and practice; 2) learning: by consolidating and disseminating knowledge on social determinants of health to inform policy and equitable interventions; 3) advocacy: by identifying and promoting opportunities for action on key social determinants by government and other actors; and 4) leadership: by supporting political, technical and institutional leaders to advocate and act on social determinants. The commission is formed of four main components which are: 1) Commissioners, 2) Knowledge Networks, 3) Civil Society, and 4) WHO s Commission Secretariat and WHO s Regional Offices. The WHO s Commission Secretariat considered that civil society is one of the major actors working within the CSDH. Their engagement is vital to the process of addressing the gross inequalities in health between countries and among social groups within countries. Their role is seen as an essential component to ensure people's priorities as well as sustainability of the process. Civil society engagement in the CSDH process is felt as a great opportunity. The CSDH will be able to use the experience of civil society organizations. For many of them, the missions are already developed to address the social determinants of health and the structural causes that stand behind. Civil Society engagement with the Commission aims to provide a global platform for civil society voice, advance civil society agendas relative to social determinants, strengthen capacities among participating civil society organizations, enhance learning from community level, promote country action shaped by civil society knowledge and concerns, broaden the political uptake of the Commission's messages, and 1 Additional information concerning the structure of the Commission and Civil Society s role and scope is provided on the final pages of this document, along with the Commission Secretariat s diagrammatic description of the pathway in which the SDH are produced and affect people's health. We are also attaching herewith certain background material quoted from the CSDH website of the WHO ( with pertinent links for your easy reference. 38

4 improve the chances of sustainable impact for the CSDH. To achieve this, civil society actors in the Commission process need a comprehensive strategy that draws on the knowledge and experience present in civil society organizations and communities. AHED has been selected by the CSDH Secretariat to facilitate the involvement of civil society organizations within the Eastern Mediterranean Region 2. Three other organizations have also been selected to facilitate similar work in the other three regions, namely Africa, Asia and the Americas. During the first week of August 2005 in Geneva, delegates from the Regional Civil Society Facilitator organizations met for the first time to clarify and develop the role/s of civil society within the CSDH and its relationship to the other actors involved, at country, regional and global levels (refer to the meeting report at WHO website). Within the framework of its role as a civil society facilitator, AHED called for a civil society regional meeting that aimed generally at developing a regional strategy for engaging civil society to address SDH, incorporating as wide and diverse range of civil society partners in the process within the Eastern Mediterranean region. The meeting was held in Cyprus over three days from 3-5 December Cyprus, however outside the EM region, was selected after investigating other possibilities. This selection was made to avoid obstacles that would face the travel to other countries that were assigned beforehand. In addition, traveling to Cyprus from different included countries in the region was the most convenient to the available budget allocated due to its central location. PARTICIPANTS Upon several regional consultations, AHED identified 1-3 organizations in 13 countries out of the included twenty-two countries in the region. Potential participants were identified upon the following criteria: - Organizational-based representation rather than individual. - Balanced geographical representation. - Covering of the identified nine themes of the CSDH. - Balanced representation of community based organizations and intermediary ones. All invitees received invitation packages that included invitation letter, a working paper introducing the Commission (background, objectives, expected outcomes) as well as the meeting's provisional agenda. 2 The WHO s Eastern Mediterranean Region covers the following countries: Afghanistan, Bahrain, Djibouti, Egypt, Iran, Iraq, Jordan, Kuwait, Lebanon, Libyan Arab Jamahiriya, Morocco, Oman, Pakistan, Palestine, Qatar, Saudi Arabia, Somalia, Sudan, Syrian Arab Republic, Tunisia, United Arab Emirates, and Yemen 39

5 The WHO s Commission secretariat has been very supportive in facilitate all invitees to have the visas to Cyprus. However, we had 28 confirmations from people from 10 countries, only 16 participants out of 7 countries (Egypt, Iran, Iraq, Lebanon, Palestine, Tunisia, Bahrain) met in Cyprus. We were honored to have the Commissioner Prof. Ndioro Ndiaye in addition to Alexander Irwin from the WHO s Commission Secretariat. (Refer to Annex 2: List of Participants) MEETING S OBJECTIVES 1. To identify and further expand the network of civil society partners in the Eastern Mediterranean Region, and sensitize them to the process. 2. To identify and assess the various kinds of regional and country level agendas (policies and programs) addressing or affecting the social determinants of health at community and country levels, as well as the key actors within and outside the civil society. 3. To identify the mission, objectives and common strategies for working to address the social determinants of health. 4. To develop a regional strategy to identify types of required inputs in the region. a. Identifying different methods for identifying the priority issues related to different themes (the given themes). b. Identifying the strategies to address the social determinants (general strategies as well as specific strategies related to the different themes). c. Identifying the mechanisms of collaboration with different actors in each country within the region to the extent possible. 5. To identify appropriate structures and methods of interaction (how are we going to work together?). 6. To developing an outline of a work plan for the coming two years (identifying outputs and timeline). MEETING S PROCEDURES AND OUTPUTS Over 3 days, 16 participants from 7 countries in EM region beside a Commissioner and a representative of the WHO s Commission Secretariat met to share experience, discuss and work together to come out with a regional strategy and work plan addressing the social determinants of health within the region taken the diversities among these countries into consideration. Meeting s Procedures can be briefly described as the following: First Day Introduction and Expected meeting s outcomes During the opening session during which, Dr. Shukralla, the meeting facilitator from AHED, welcomed the participants and introduced them to the objectives, procedures and 40

6 expected outcomes of the meeting. Dr. Shukrallah summarized the expected outcomes as follows: 1. To be fully aware with the Commission, its objectives, its structure and its different tracks of work. 2. To identify the space within which, civil society can be engaged and contribute in the process. 3. To identifying some key social determinants in their country within their areas of work in the context of the 9 themes and add others. 4. To identify the role of civil society in addressing the SDH and different strategies they can work through. 5. To identify and develop appropriate strategies for civil society in the region to engage in the process and address S.D.H. 6. To draw up a regional work plan that can be further developed based on the country consultations that will take place later. 7. To agree on the mechanisms of widening participation of civil society actors from the region. 8. To agree on the suitable structure that ensures the expansion and the efficiency of the process. Dr. Shukrallah gave a short presentation discussing of the commission and described it as an opportunity rather than just a project. The presentation summarized several reasons that make the commission a real opportunity if taken seriously. Among these reasons were: 1) the inclusion of the civil society, 2) the structure and strategies that compile the knowledge generation with simultaneous action. Participants were then invited to introduce themselves and present briefly their organizations (main field of work, geographical coverage, current main programs). Presentations of participants showed: 1. Diversity in areas of work as well as rich experiences in addressing the social determinants of health. 2. Linkage of most of the organizations to local communities in their countries. However, some were working as expertise in different particular themes. Some participants were able to represent thematic as well as geographical networks in their countries or regions. 3. Commitment of all participant organizations to the work to address the social determinants of health. Mr. Alexander Irwin, representing the WHO Secretariat, gave a very informative yet analytical key-note speech to present the Commission on Social Determinants of Health 41

7 (background, conceptual framework, objectives, components, roles, etc.). This presentation led to questions from the participants as well as an open discussion. The opening session ended by a rich open discussion among all participants. Focus was given to address ways of civil societies engagement and widening its base in country and in the region. The importance of the country-level work was highlighted by most of the participants during the discussion. Current Strategies and Programs Addressing the Social Determinants of Health in the Region This session which lasted with the end of the first day included a brief key note presentation on the social determinants of health then an open discussion in which participants gave examples on key social determinants for health as well as current policies, legislations and programs addressing them. Dr. Shukrallah started the session with a brief key note speech by showing the contradiction between positive developments in almost all health and some social development indicators with the growing inequalities within the country. The presentation also described the nature of the current interventions addressing the SDH as being vertical and patchy rather than comprehensive, addressing the symptoms rather than the causes, bureaucratic rather than responding to people s actual needs. The presentation finally emphasize the role of civil society in providing evidence-based alternative policies to address the SDH and to link knowledge with action and engage communities as primary stakeholders in the process. The presentation was followed by giving each participant a space to present the policies, strategies and interventions addressing the SDH in his/her own country. Generally, there was an agreement on that inequalities in health are increasing. Most of the participants referred the increasing inequalities to the dominant privatization trends, especially in the basic services. Dr. Barzgar (PHM-Iran) presented a very rich experience from Iran showing a comprehensive model addressing the social determinants of health in a poor catchment area. He also emphasized on the richness of the PHC model in Iran and the deterioration that is happening and is expected to increase as a result of the negative impact of the neo-liberal globalization policies. Mr. Abdul Samad (ANND-Lebanon) described the impact of the international agreements driven by the WTO, especially the Trips Gats as well as the bilateral agreements such as the Trips plus on people s access to basic services and medicines. He stated that ANND can contribute to the expansion of the regional coalition that will address the S.D.H. Dr. Shubita (PMRS - Palestine) gave very demonstrative examples of the impact of occupation on people s livelihood, hence, health. He described the vital role of the civil society organizations in addressing all maters related to people s health in absence of a national strategy and in the context of the weakness of the government.. 42

8 Mr. Attia (Iraq) described the sever impact of the war and violence on the people s health and people s access to health care. In addition, he described the destruction of basic services e.g. water supply and its effect on people s health and lives. Regarding the situation of civil society, he described it at the moment to be very weak, created in the aftermath of occupation and on the most donor driven. Mostly focus on issues related to the constitution and elections rather than other developmental issues. Ms. Jmour (Tunisia) emphasized the gender based inequalities. She also highlighted the role of authoritarian policies and lack of democracy in limiting the role of civil society, especially in addressing the underlying causes of ill-health as most of them are politicsrelated issues. Ms. Masry (Lebanon) expressed the deterioration of SDH in the Palestinian camps in Lebanon. Palestinian in Lebanon are second class population they don t even own the right to renew their houses to be more protective, she added. Mr. Mahmoud (Lebanon) emphasized the increasing inequalities in health among Lebanese and between them and the Palestinian in Lebanon. He referred the inequalities to the dominant privatization trends. Occupation, sanctions and conflicts were expressed by most of the participants as key determinants for people s lives and health in the entire region. Second and Third Days The meeting was opened by a welcoming and inspiring talk from the commissioner Prof. Ndioro Ndiaye. Prof Ndioro described the role of the commissioners and their relationship to civil society and emphasized the importance of the role of civil society in the process of the commission and in its relationship to other components of the commission such as the knowledge networks and the different organs of the WHO. Pro. Ndioro also emphasized the importance of the cooperation between civil society organization and the national governments to have stronger impact and sustainability. Group mission During the first session of the second day, participants discussed the nature of the group as well as its mission. As an outcome of the discussion, the following mission could be summarized as the following: We are a group of civil organizations, mainly non-governmental organizations, who are already involved in different ways in addressing several areas of the S.D.H through engaging local communities.. We see an important opportunity in the WHO s CSDH for addressing the social factors behind ill-health and in the causes of inequalities in health. The WHO initiative provides a more systematic, comprehensive manner to address these factors and better opportunities for stronger impact through the formation of national, regional and global coalitions. 43

9 Functional structure and expansion During the 3 rd session of the second day, participants discussed the mechanisms of group expansion as well as the functional structure of the civil society coalition that being built. Discussions can be concluded in the flowing: 1. Desired coalition should be very inclusive. Civil society coalition around the SDH should have a space for all types of non-for-profit, non-governmental civil society organizations, such as NGOs, people s organizations, academic institutes and research centers, syndicates, trade unions, etc. 2. AHED remains the civil society regional facilitators in the region. Focal points in each country should be named. All regional and country facilitator organizations are not representing all civil society organizations in the region or the entire countries, but rather they are facilitating the engagement with the commission and most important facilitating the expansion of the coalition to make it as inclusive as possible. 3. It was agreed that participant organizations are considered the country focal points during the first phase (till the end of February 2005). 4. It was agreed that all focal points who participated will facilitate country consultation meetings with other civil society groups in their countries. (Palestine, Lebanon, Iraq, Tunisia and Bahrain). Working groups After the proper introduction during the first day, participants were divided into three working groups to achieve a civil society regional strategy and work plan addressing key SDH. Participants were divided according to the 9 themes identified by the WHO into three groups. Group-1. a) Early Childhood Development, b) Social Exclusion, and c) Gender and Women. Group-2. a) Globalization, b) Employment Conditions, and c) Urban Settings. Group-3. a) Health Systems, b) Priority Public Health Conditions, and c) Measurements. The general expected outcomes of the process from the point of view of civil society, below, was used as a reference for strategizing. General expected outcomes of civil society engagement in the commission: 1- Civil society organizations will have better understanding of underlying causes of ill-health and particularly causes of inequity in ill-health in their communities, countries and region and have better understanding of the priority issues at country and regional levels. 2- Local communities will be more aware and engaged in the identification and prioritization of social determinants of health. 3- Social determinants will be placed on the national agendas. 44

10 4- Capacity of civil society will be built to address the issues, on the levels of knowledge generation, advocacy and action. 5- Some models will be built by civil society to inform policies. Before the division, previously prepared guidelines for the working groups has been discussed and the following guidelines were agreed: 1. What are the key issues (within the region) related to the themes each group is working on? 2. What are the changes we want to achieve in the context of the region (Regional Objectives of Civil Society in the region)? 3. What are the available opportunities and what are the challenges/obstacles the face the realization of the objectives? 4. Who are the possible stakeholders to work with? 5. What are the regional strategies addressing the SDH, in the following work areas? a. Knowledge generation b. Advocacy and lobbying, c. Networking d. In country interventions and community based models. 6. What are the main activity components civil society organization would tackle under identified strategies? Participants were divided into the groups upon their convenience according to the areas of work of their organizations. 45

11 GROUPS OUTPUTS 1- Globalization / Urban Settings / Employment Conditions a. Current situation in the region (Key issues of concern) Re- Globalization Militarization of the region Migration (Mobile population, Brain drain, Human rights) Trade issues, especially the international free trade agreements and their implications on access to basic services, access to food (impact on agriculture) and access to medicines (impact on national pharmaceutical industry). Aids and Debts (Conditionality, Quality and Coherence of aids, in addition to commitment to aid and debt cancellation. Re-Urban Settings MDGs (1 & 7) Infrastructures Livelihoods Slums Re-Employment Conditions Rising tends of unemployment. Privatization and structural adjustment policies. Lack of investments. Corruption Work conditions b. Objectives we want to achieve Re-Globalization Militarization Peaceful and sustainable solutions to conflicts Ensure people's rights to control their resources Migration Good management of migration policies Freedom of movement Policies to absorb expertise and workers Trade Fair trade for development Exclusion of basic services from trade agreements (Health education, water and sanitation, energy) Exclusion of biodiversity and medicines from the intellectual property rights agreements Aids and debts Debt cancellation Increase aid levels to meet promises of G8s Coherence in aid delivery at national and international levels 46

12 Re-Employment Conditions Ensuring the citizenship rights Integration policies Human rights Inclusion (housing, basic needs, etc.) Re-Employment Conditions Public sector reform Partnership of public sector with Civil Society and interest groups Create suitable environment for development c. Opportunities and challenges Militarization Political and economical reform Civil society capacities are weak and have to be strengthen. Using the reform trend to influence the process to enhance democracy and development and using emerging civil society groups is our strength. The Group affirmed that: National policy reform must be realized to enable civil society to play a major role. Civil society should work according to moral and ethical conditions for accountability to people and governments. d. Stakeholders Public sector Parliamentarians, National governmental authorities (Ministries), National governmental and public agencies (national councils, etc.), Local authorities, Local councils. Civil society Grass-root organizations Interest groups Trade Unions NGOs Business sector International organizations IMF, WB, WTO Donors International NGOs UN agencies e. Strategies Advocacy campaigns 47

13 Knowledge generation Awareness raising Networking (thematic networks and geographical networks) Direct service provision / Intervention models. f. Work plan Focus should be given to the country-level actions. However, some actions should be planned on both regional and even global levels, especially regarding the globalization and its impact on people s access and control on their own resources. Advocacy campaigns (issues of concern in most of the represented countries: trade, brain drain, aids and debts, citizenship rights, integration, public sector reform) Dissemination of knowledge on topics related to people s health and social determinants of health in local languages Building national network(s) / coalition(s) around the social determinants of health. Capacity building of civil society organizations on themes related to the globalization and its impact on people s livelihood (Trade, migration, militarization) Building models (participatory intervention models for improving living conditions in slums, for building capacities of unemployed, etc.). 2- Health systems / Primary health conditions / Measurements a. Current situation in the region (Key issues of concern) Dominant trends of privatization with government withdrawal from health care service provision. Tendency of the current health systems to provide curative rather than preventive cares Dominant trends of vertical programs rather than a comprehensive system. Centralization of the planning. It makes the system unable to deal with the different groups or populations in different areas. System does not respond to the most needy groups Systems are influenced and loyal to international monetary organizations as well the funding agencies rather than being loyal to people s health. Unequal geographical distribution of services Lack of community involvement in planning, monitoring the implementation and evaluation. Weak registration and information systems that affect the chance for evidence-based planning. Insufficient budget allocations by the governments. Lack of up-dating of curricula of training of health personal Lack of public education Inequality of distribution geographically Brain drain (migration of health care professionals). Lack of regulations for the private sector in health care provision. 48

14 Insufficiency of essential drugs Lack of legislation ensuring the right to health / they are not applied Lack of proper surveillance Absence of national health policies and lack of supportive environment. Lack of intra and inter-sectoral coordination. Key issues concerning people s health in each country (identified by participants) Iran: Health sector reform (with clear tendency to privatization) Bahrain: Inter sectorial integration (Coordination between health sector and other health related sectors) / Pollution, road safety, drug addiction Palestine: Lack of national health policies. Lebanon: Dominant private health services and their impact on cost and access / centralization of health related decisions. Egypt: Health sector reform / impact of international agreements. Principles to which health system should respond Health is a fundamental human right Equity Based on a nation health policy and plan responding to accurately identified needs Proper use of available resources People s health is a fundamental responsibility of governments. National priorities and not donor priorities Comprehensiveness based on Alma Alta declaration Ensuring enough resources. b. Objectives we want to achieve Health for all Good situation analysis Alternative policies by civil society (evidence-based policies and enabling environment for equity in health) Ensure the participation of local communities (all stakeholders). c. Stakeholders Parliament Government (Ministries of Health and other relevant Ministries) Civil Society (NGOs, Syndicates, Unions) Local communities International Organizations (WHO, UNICEF, World Bank, IMF, WTO) Donors Political parties Media. d. Strategies and work plan 49

15 Knowledge Generation Creating evidence from the already existing information o Gathering the existing information relevant to social determinants of health. This would include official statistics, literature (researches, reports and reviews) o Documenting civil society experience, especially the successful community models. o Conducting conferences, seminars and round table discussions on selected key issues related to the health systems and public health conditions on both regional and national levels. o Producing and publishing a regional health watch as well as national health watches. This can be achieve in collaboration with the People s Health Movement. These health watches should be able to provide an evidence-based analysis for health situation as well as providing alternative policies for better health. Implementing new studies on both national and regional levels. o A Regional (multi-site, multi-dimensional, multi-sectorial) study on selected social health determinants across the region with same methodology and tools for comparison (KAP). o A multi-site (across the region) study on discrimination against women in health o National studies on people's access to health services and their satisfaction. Interacting and collaborating with the Knowledge Networks o Ensuring the representation of civil society in the Knowledge Networks. o Ensuring the feed-in and out by the civil society representatives within the Knowledge Networks. o Disseminating available information to different components of the Commission. Promoting the collaboration between the civil society organizations and academica. Advocacy and lobbying Organizing campaigns on: community, national, regional and global levels. o Issues of these campaigns should be identified through a participatory process ensuring that they are evidence-based, liable to make an impact and culturally acceptable. o Campaigns should be organized in coordination with different concerned national, regional and global civil society networks. Production a civil society newsletter on social determinants of health. o To be hosted by a capable civil society organization in the region. o Recruiting focal point in each country in the region to feed-in the newsletter and translate the newsletter to the local language.. o It provides news about the Commission (different components), publishing the findings of the meetings, announcing for the relevant national, regional or global events. 50

16 Capacity building Dissemination of information to civil society organizations in the region. This includes the collected evidence on both national and regional levels as well as the knowledge generated by the Knowledge Networks. Inclusion of all possible civil society organization of different types into the process Organizing training courses on both country and regional levels on relevant issues. Two training courses are suggested on the regional level which are: o A training course on Primary Health Care and Political Economy of Health. This training course can be implemented in collaboration with the PHM as a part of IPHU o A training course on Social Determinants of Health. A training curriculum needed to be made may be through a regional workshop. o These two training course can be also, replicated in different countries within the region. Developing and regularly update a database for relevant events and training opportunities and disseminate it to all 9included organization. This can be the responsibility of the regional coordinating organization as well as the country focal points. Community-based Intervention Models Implementing surveillance systems with the local communities combining the assessment of the status with planning for appropriate actions. This can be replicated in some selected countries across the region. Communication strategy Activating the utilization of electronic communication ( groups, the Commission website, etc.). Developing a regional website for the civil society network around the CSDH. Developing a periodical electronic newsletter (host organization translated to local languages by the country focal organization). 3- Social exclusion / Gender and Women / Early childhood development a. Current situation in the region (Key issues of concern) Re-Social exclusion Who are the most excluded? o Some of the most excluded groups identified were: Disabled, immigrants (legal and illegal), refugees, women, ethnic minorities, elderly people. o Extent of exclusion is influenced by carrying on exclusion parameters, i.e. a woman is considered socially excluded by being a woman, but she can be more socially excluded if poor, unemployed, from ethnic minority, etc. Elements of social exclusion 51

17 o These groups are excluded from the decision making, access to economic resources, access to education, legal rights, in addition to culture exclusion. o It was emphasized that they don't really know their rights to citizenship. Exposure o These socially excluded groups are exposed to: discrimination, segregation, sexual exploitation, violence, forced labor which all lead to increased vulnerability and increased specific exposures to ill-health. Levels of impacting o Social exclusion has a great impact on several determinants such as: housing, nutrition, safe water, hygiene, health services, morbidity, mortality, etc. Re-Gender and Women In the entire region, women suffer from violence, oppression and discrimination in domestic and work domains, in rural and urban areas. What are the forms of violence, oppression and discrimination? o Women are exposed to a wide range of violence, oppression and discrimination, starting from rearing practices and social roles at the domestic level to exclusion, discrimination and abuse in the workplace and in the street. Sexual abuses constitute one the form of violence women have to deal with in their daily life. Issues of concern o oppression, violence and discrimination o women under occupation o impact on health o relationship of this oppression to policies, such as privatization.. o rise of fundamentalist discourse on women's discrimination o impact of this oppression on women daily life and in the street o lack of social assistance, early and forced marriages o FGM o legal discrimination Levels of impacting o This violence impacts on women's health, isolation (streets' behaviors). Re-Early childhood development Rearing practices within the families are on the most either overprotective or authoritarian, they do not encourage the development of creative, independent thinking. Social and gender roles are encouraged early in the family through existing rearing practices Differentiation in access to facilities and basic needs such as health care Exposure to violence Development of fear inside the child Exposure to disabilities Exposure to physical and sexual abuses 52

18 b. Objectives we want to achieve Re-Gender and Women / Social Exclusion Expose all forms of violence and their impact on the health of women and the family Show linkages between forms of oppression, lack of opportunities, discrimination in access and prevalent policies and social attitudes Identify priority these in the communities and engage communities in the process Place theses issues on the national, regional and global agendas through advocacy and campaigning Provide a legal protection to those women Re-Early childhood development Show the link between rearing practices and the health outcomes in childhood development Identify those practices and document them Identify and document best rearing practices Identify factors that cause inequalities in access to basic needs and basic services Identify factors and causes for exposure of infants and young children to ill-health and accidents c. Opportunities and challenges Re-Social exclusion Opportunities o Presence of international conventions signed by governments. o Presence of governmental institutions national bodies (Department of Migration, Department of Childhood) o The Current Commission (CSDH) o Participation in social forums o Utilization of the existing networks in the Arab region (Aicha, Worker's union, etc.) o Presence of linkages between NGOs Challenges o Increase the awareness among communities and even NGOs in order to increase the number of interventions o Have the capacity to address these issues o Have women more included in the decision making at home an outside. o Lobby for more access for women to knowledge, education, work, etc. Weakness o Actors of the civil society are often isolated from the local culture. On the contrary, fundamentalists are really close to the population, listening to their needs. So the space for NGOs tends to be limited. o Local governments use legislation to oppress the civil society. o Islamophobia is increasing in Western countries, creating a feeling of fear. 53

19 d. Stakeholders International bodies National governments research institutes Local communities Civil society actors Legislators Employment bodies Private sector e. Strategies Knowledge generation o Collecting information from secondary resources o Providing evidence through conducting community-based surveys. Those surveys will have to involve the social-excluded groups. Capacity building of civil society o Utilizing the cooperation with the Commission components to help the capacity building of civil society. Lobbying and advocacy o Organize campaigns, sensitizing the media, increasing the general awareness o Placing those issues on the agendas of all stakeholders o Lobbying resources. o Conduct seminars and meetings o Developing mechanisms for accountability o Activating the utilization of the international conventions (CEDAW for example), and monitoring their implementation (Independent NGO reporting). o Expand the civil society network on both national and regional levels o Intervention models o Build successful models to address social determinants of health through communities f. Work plan First phase (until February 2006) o Mapping of key civil society actors (organizations and networks including research institutions, NGOs, peoples organizations, trade unions etc) and processes relevant to social determinants within the region and the countries o Coalition (networking, national and regional) o In each country of the region, sensitization, dissemination of information, communication o Organizing a national consultation meeting in each country. Second phase ( ) 54

20 o General monitoring meetings twice a year o Regional conference at the end 2006 with the other actors o Lobbying other resources o Collection of available information from other NGOs o Conduct campaigns (media, documents, conferences, meetings ) o Identify 2 major regional campaigns at the end Country level action o Coordination o Meetings every 4 months for monitoring the action o A national conference once a year o A community model for comprehensive knowledge and intervention. 55