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Editorial, volume 5, number 4, 1995
Poverty, according to the World Health Organisation (WHO), is the world's deadliest disease, and the greatest cause of human suffering. Its 1995 World Health Report puts it bluntly: `In the time it takes to read this sentence, somewhere in the world a baby has died in its mother's arms'. The deaths of almost every one of the estimated 33,500 children under five years of age who die each day can be traced back to poverty.
The 1995 World Summit for Social Development, held in Copenhagen, marked a turning-point in public attitudes to poverty and injustice. For the first time ever, the international community committed itself to eradicate -- not merely to alleviate -- poverty, and to promote full employment and social integration through respect for human rights, human security, and human development. Gender equity is at the heart of this commitment. The challenge is huge, the vision awe-inspiring -- some would say utopian. The fight against slavery must have seemed equally daunting in years gone by, as did the struggles against colonialism or apartheid in more recent times. Our task today is to make poverty both ethically and politically unacceptable. Believing that poverty and its causes can -- and must -- be wiped out is the first step to achieving this goal.
The Copenhagen Declaration stresses that the eradication of poverty cannot be achieved by governments alone. It also depends on a wide range of social actors -- trades unions, farmers' associations, women's groups, religious and cultural organisations, NGOs, human rights activists, academic and research bodies, the media, cooperatives, political parties, citizens' movements, and so on -- which it collectively terms 'civil society'. All such voluntary expressions of people's capacity to organise for the public good will be needed to mobilise to realise the vision of a world where poverty and oppression are no longer tolerated, or explained away as inevitable, a law of Nature or of macro-economics. The Social Summit put solidarity back on the political map.
The fight against poverty is also a fight against its causes, and for social and economic policies to bring about employment and equity. And this is where major differences arise between those who believe that, given enough time, the market can deliver social development and the growing number who do not. For instance, the Copenhagen Alternative Declaration, now signed by almost 10,000 organisations around the world, `[rejects] the notion of reducing social policy in developing countries to a 'social safety net', presented as the 'human face' of structural adjustment policies'.
The WHO makes a similar point. Arguing that the `failure of macroeconomic policies and the free market system to ensure equitable distribution of wealth has led to an active process of poverty creation', it spells out what such policies mean for poor people in terms of their health: `Human rights are not available for profit. Health care cannot be freely commercialised and sold to the highest bidder or dispensed according to the ability to pay. The experience of health care vividly demonstrates that what is profitable is not always what is good, and that those who need health care most are often those who cannot pay for it.' The point is that each person's health is necessarily both private and public. Ultimately, we all pay the price of each individual's illness and suffering -- arguments powerfully made in this issue of Development in Practice by Claudio Schuftan and by the Centro de Servicios y Asesorķa en Salud (CISAS) in their respective Viewpoints on the Decade of the African Child and health under structural adjustment in Nicaragua.
The current issue explores various aspects of the links between public policy and private action, particularly in the field of health-service provision. The problem of evaluating the true (and often unintended) impact of policy on people on the receiving end becomes more urgent in the context of programmes to eradicate poverty. Practitioners and policy makers need far better tools to understand the zig-zag processes of social change, and what these mean for individual women, men, and children. And people need more effective means of making their experiences known, and participating in policy-making. David Booth describes two such attempts in the context of structural adjustment policies in Tanzania and Zambia. He shows that there are a number of simple ways in which the lines of communication can be improved, and so (potentially) fed back into policy, given the will to do so. Dimbab Ngidang, writing about marginalised indigenous communities in Malaysia, demonstrates the opposite: a case where communication between people and policy-makers is often a sterile process of exchanging pre-packaged messages, rather than genuinely seeking to meet on common ground.
Andrew Green and Ann Matthias examine the role, or roles, of different kinds of NGO in health-service provision. Though many NGOs argue that they work best in the context of a strong and effective public sector, they are increasingly being used as alternatives to the state provision of basic services such as health care. This being so, the authors look at ways in which their relationship with government can be enhanced. Maurice Mitchell looks at a practical component of health-service delivery -- the physical infrastructure -- and at ways in which rural people and their community organisations can best be involved in the design, construction, and long-term maintenance of health facilities.
In practice, a great deal depends not so much on whether it happens to be a government department or an NGO that is involved in a particular development initiative, as on their interpretation of what is happening in people's lives. One way of using computers in trying to bring different views together, and to look at what these might mean if translated into policy terms, is presented by Stephen Connor. Maitrayee Mukhopadayay reminds us that the perspectives of men and of women within a household, a community, or even an institution will not be identical and are often conflicting, given their different relationship to power. Chris Roys describes work in Uganda with families of HIV/AIDS victims. He shows the sensitivity and patience required to help a devastated society draw on its own cultural strengths to deal with the practical issues that face widows and orphans in particular. Derek Summerfield puts forward some basic guidelines for aid workers who are dealing with civilians caught up in situations of armed conflict and political violence. He argues that to see people as automatically `traumatised' and in need of specialist counselling or psychiatric care is often to victimise them further. Rather, aid agencies should concentrate on enabling people to make their own sense of their situation, providing the means to draw on their own social, cultural, and emotional reserves -- the essence of development.
Finally, in a more ironic vein, Gino Lofredo pokes fun at the world of donors, NGOs, and projects -- and in so doing reminds us that there are rogues and fools in the 'development business' as in any other.
The WHO publication cited at the beginning of this Editorial is sub-titled `Bridging the Gaps'. One of the biggest gaps in the field of development is that between policy and practice, between what we (say we) want to do, and what actually happens. The pledge made in the name of every single human being to eradicate poverty demands not just that we bridge the gap between rhetoric and reality, but that we close it.
Deborah Eade
Oxfam (UK and Ireland)
November 1995
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