THEMES AND PERSPECTIVES

Perspectives behind themes: Citizenship, Governance and Accountability
The health systems in developing nations include the public health systems as well as a whole array of private health care providers. The public health systems, which are constitutionally mandated to protect and promote wellbeing of communities are increasingly rendered fragile, weak, fragmented and shrunk. Alongside, the burgeoning private health care system has set itself progressively

 on the path of commercialization and corporatization, resisting its accountability neither to the constitutional principles nor to patients. Meanwhile, the accountability to the health and wellbeing of citizens and communities has suffered a setback due to State's evasion of responsibility and the overpowering yet unaccountable presence of the non-state actors in health and health care policy and provisioning. The global and national actors from both the health and non-health sector actors who are operating in this field have contributed to making accountability chains more complex. Such accountability deficits and complexities are created in the upstream and global alignments of private and non-state actors that wield undue influence on global health governance. (For the context of the GS, please click here)

In addition, the accountability discourse itself is fret with its own challenges and limitations. The discourses of accountability have been delinked from the policy contexts and the experiences of the community. Some of the predominant approaches are overwhelmingly expert led and instrumental and narrow in their outlook as a tool (ticking a box) or a digital drive for accountability with an overemphasis on efficiency and outcomes simultaneously undermining 

transformative potential perspectives of equity. It also undermines the centrality of community and the understanding of the power imbalances that the overarching policy processes create. Such limited, instrumental and reductionist accountability perspectives have further exacerbated the alienation of communities and tend to absolve global actors of their influence on the continuing indignities and violations of rights that the communities are confronted with.

COPASAH has positioned health, wellbeing and dignity for all and community's claim for human right to health at the core of social accountability discourse. Such a discourse is also located in the overarching framework of citizenship, governance and accountability in health. In the same vein, the understanding of health itself is broadened to include wellbeing, dignity and social justice, within which health care forms a significant part. It is driven by the belief in and engagement with the transformative potential of community's power in demanding accountability from the state and non-state actors and for realizing such a right. Such understanding of accountability is a process of changing power equations of communities with various actors and national-global policy processes, most importantly the state which is vested with the constitutional obligation to ensure condition for communities be healthy. Realizing that such a process of social accountability is only possible in a strong bond of community to global solidarity, the community of practitioners of COPASAH encompasses various actors ranging from people-oriented community leaders, organic intellectuals and institutions committed to such an equitable vision of society.

Themes:

With such a perspective mentioned above, through the global symposium, COPASAH will deliberate on the following themes:

• Community action in governance and accountability for health systems strengthening: Through the themes the Symposium attempts to position communities and civil society at large as central to the governance and accountability of health systems (both public and private). It emphasises on community empowerment and transformation of the iniquitous power relations between the community and health systems.
• Improving access to quality health services for the indigenous, excluded, vulnerable communities and those in fragile contexts: Several indigenous, vulnerable and marginalised communities, and those in fragile contexts such as those affected by conflict, displacement or natural disasters face exclusion and discrimination from the policies, programme and health care services. The modalities of exclusion, non-inclusiveness and discrimination are reflected in the health care programmes and policies that are designed and the kind of health care that is made available.
• Moving forward the agenda for Sexual and Reproductive Health Rights: Sexual and Reproductive health rights are indivisible aspects of human rights, and deeply linked with the fulfilment of all other civil, political, economic, and social rights. Social action for accountability towards sexual and reproductive health rights is gaining momentum; however, it continues to be challenged by marginalisation and repercussions on the basis of gender, caste, disability, and sexuality.
• Setting the framework and agenda for people centred accountability of private and corporate health care sectors: In an environment where private providers are largely unregulated, and hence are unaccountable either to the citizens or to the government, the accountability deficit continues to deepen, creating significant challenges for patient's access to quality and affordable care, and preventing redressal of grievances from such powerful institutions. There is a growing demand for ensuring social accountability of the private health care sector, and developing accountable regulatory frameworks to achieve this.
• Forging alliances between the community and the health care workers: Frontline health care workers – traditional birth attendants, community health workers (CHW), nurses and midwives the foundational building blocks of the health care systems. More often than not, communities and health care workers are made to relate to each other in hostility and antagonism, instead of solidarity, and such fragmentation cumulatively affects the rights of both the communities and health care workers.