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Building public health activism at the grassroots

Activism as a concept or a philosophy need not be extrapolated and matched with the otherwise popular terms to create unrest, to seek demands instantly or even to protest. The way I view public health activism is a call to do little and then a call to do more. However, this necessarily means coming out of the comfort zone, seeing public health as a calling and not as a profession and even less as an industry.

Building public health activism at the grassroots cannot really be understood by health professionals who do not go to the field and remain confined to the corridors of a medical school or hospital. Public health activism has more to do in creating interfaces of public-private partnerships, industry-institution interactions, private-private partnerships, inter-sectoral forms of service delivery and also negotiation at top tables of governments.

While I do see greater efforts translating into superior level of dedication, I also fear the dangerous disconnect with fragile commitment being exercised between grass-root level public health champions and those sitting at decision making platforms never willing to listen to the front-line voices.

Many a times, these fault lines are visible if not evident, because of limited understanding on the nature of work that takes place at the grass-roots. What people actually need is sidelined by what decision makers feel may be the need. This, in all fairness requires political engagement of public health processes. The behaviour of bureaucrats with civil society organisation leaders, academic institution representatives and those from small and medium size enterprises differs grossly with the way they behave with their political bosses. Barring few officers who remain ever so humble and grounded and know the moral obligation of their position bestowed more upon them by the Constitution and less by the people, the majoritarian class are difficult to convince, if not work with. Have a look at how many indicators were not achieved as per the Millennium Development Goals. Let me take you few decades back into history, look at the grand Ottawa Charter and how inequity still reigns supreme. Beautiful documents have been brought out on Universal Health Coverage. But the point I wish to make is, what this document means to the last man on the ground? It means nothing. What public health activism means today is to speak less, generate reports only if accompanied with field work and to dive into the field for the work there is to do. The 21st century is is redefining the way jobs are carried out and also re-prioritising human commitment to different exercises and sectors. Public health workers today will need to build activism through innovation, through behaviour change communication, to work across and beyond industries and not have defined job hours. Public health in no ways can be a 9am to 5pm job. The day can begin at 6am in the morning and end by mid day, or the day can begin even during late hours of evening and continue till tiredness brings them apart. There may be days also when public health workers might need to work from home which must be encouraged and respected.

Public health workers engaging in activism must fine tune their skills in communication and negotiation. Health diplomacy is a task public health workers must be exposed to and skill development in the entire process be supplemented. It is worth remembering that good health is not just good health services being carried out but more on what communities can do by themselves. It is therefore necessary that grass-root activism is the key to public health victories. Let us also remember that the trust society places in the hand of health workers are permanent and this loyalty must be respected. Engaging communities in transformatory solutions which will change their destinies permanently for good, requires activism. Civil society organisations must identify district level reformatory needs and begin one issue at a time. Even if the officers do not match the level of enthusiasm, keep pursuing. Remember you are not doing the job for yourself or for the officer concerned, but for the society and civilians who look at you as a doyen of hope and for the generations that would live meaningfully, because we were around.



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