Testimony of a convert / by Dame Nita Barrow

Testimony of a convert by Dame Nita Barrow "Leadership development for health for all " has been possi- bly the most unusual subject we have ever had for technical dis- cussions. Many people have been intrigued by this provocative topic, wondering what it was all about. Some were even sceptical about it. The spirit of these discussions, how- ever, was extremely valuable, and those who took part generated the positive force of a sense of involve- ment, together with the feeling of personal challenge and commit- 26 ment. I would compare what was happening in the working groups to fibres of cloth absorbing a dye, as the participants became more and more imbued with the vital necessi- ty of developing leadership. Instead of . rhetoric they were moving to doctrine. We have just about reached the mid-point between the time we made the historical decision to achieve Health for all through pri- mary health care and the turn of the century, the year 2000. That political commitment made by us in 1978 - I was privileged to be there - was based on a vision that fore- saw the reduction of inequalities in both health and health care (I stress this because of the often repeated injunction that we are not talking of illness interventions but of health and health care among the people we are privileged to serve); a vi- sion-not a mere dream and not wishful thinking - but a vision based on proven facts furnished by the pioneering leadership of many countries and of groups within those countries. Now, ten years later, we must ask ourselves whether we measure up to the covenant of that agree- ment, and that is an essential quali- ty of leadership itself: to be able to recognise our successes as well as to face up to our failures, to learn from them, capitalise on them and move forward with even greater determination and enthusiasm to- wards the vision we truly believe. Do not forget that the potential power of attitude is immense. "Nothing great was ever achieved without enthusiasm," said Ralph Waldo Emerson, and I might add that this spirit pervaded the Techni- cal Discussions as well. Our discussions addressed the gap and the need for leadership for Health for all, as well as the nature and the functions of such A traditional midwife in India checks her nursing kit before starting her house visits. Facing page : The panel of motivators at this year's Technical Discussions. "A social movement such as primary health care requires a collective leadership, encompassing all levels of society. " Photos WHO/J. Schytte and WHO WoRLD HEALTH, Aug./Sept. 1988 leadership, all from the point of view of moving forward effectively and more aggressively in order to reach the goal of Health for all through primary health care; and finally how such leadership could be enhanced and developed. In our discussions, there was a general consensus that in the world today we are facing a vacuum (some went as far as to use the term "crisis") of leadership - leadership which generates the kind of social conscience that is concerned with the prevailing social injustices. Dame ' Nita Barrow, General Chairman of the Technical Dis- cussions during the 41st World~ Health Assembly in Geneva last May, is the Permanent Representative of Barbados to the United Nations in New York. A former consultant with wHo in the field of maternal and child health, she has also had long experience in pursing and1 health care, working with sev..:~ era! non-governmental organ..:' izations including the World Y9ung W9men's Christian .• f:>..s- sociation (YWCA), the Inter-. national Council of Adult Edu-• cation and the World Council of Churches. Thisarticle is a slightlyshort- ened version of the address Qame Nita. Barroi/V gave to the 410 par,ticipations at the end of their discussions. The April sue of World Health examined the theme ofthe talks: t:eader~ ship Development for Health• for all. Some of us who have been in- volved in the Health for all move- ment since the beginning thought that the principles of primary health care provided the force or the vehicle for generating this moral leadership, starting within the smallest communities and reaching through the highest na- tional and international levels. We took it for granted that this message was clearly projected in the Decla- ration of Alma-Ata on primary health care. History, in some in- stances, proves us sadly wrong: it has not yet been generated right through all societies as we would have hoped. W ORLD HEALTH , Aug ./Sept. 1988 27 A new life in the making: a Venezuelan midwife checks the foetal heartbeat. Photo WHO/Zafar Now, ten years after Alma-Ata, it seems that perhaps we took too much for granted, that there was a sizeable gap between our commit- ment at Alma-Ata and what would be done back home. It has also be- come evident that managerial or technocratic approaches alone will not get us to our goals. Primary health care, above all, must become a social movement-a movement in which people in all walks of life are involved as active partners and not just as passive recipients of the so- called benefits. Such social move- ments demand leadership, there- fore, at all levels, thereby sharing the vision of Health for all and re- flecting certain essential qualities. And what are these essential qualities? First and foremost, hav- ing a social conscience which gener- 28 ates a genuine concern over social injustices. Furthermore a social movement, such as primary health care, cannot be dependent upon a single charismatic leader. It re- quires a collective leadership, en- compassing all levels of society, creating a collective force toward the goal. It must be an enabling and " empowering" type of leadership which believes in the inherent strength and ability of the people, thereby building self-reliance. One of the more critical functions of such leadership is to raise aware- ness and concern for the issues of equity and social justice in society as a whole. Some people would say "Why is that a health concern?" We can have no health equity un- less we are aware of the social in- justices and unless the society in which we live recognises these. We have to build and expand partner- ships and new alliances in support of health universally; and we have to communicate on health issues -they are no longer ours, they be- long to our total communities. And there is also the issue of the moral and social responsibility of the me- dia-very, very important in our present day world. Florence Nightingale-often regarded as the Mother of Nursing because of her work among wounded British sol- diers during the Crimean War of 1853-56- wrote a personal letter on 4 June 1867 to her relative, Mr Bonham Carter, a leading London barrister. In it, with remarkable prescience she wrote: " My view, you know, is that the ultimate destination of all nursing is the nursing of the sick in their own homes... I look to the abolition of all hospi- tals and workhouse infirmaries . But it is no use to talk about the year 2000!" WORLD HEALTH , Aug./Sept. 1988 Consensus was reached in the discussions that while leadership is needed across the board, leadership at the community level represented the most powerful potential to ac- celerate momentum towards the goal of Health for all; by the " com- munity" we mean every village, every household, every town and every city. In this context it was noted that women and youth groups could play a highly signifi- cant role. Young people were pre- sent in our Technical Discussions. Not only did they encourage us but they challenged us. After all we are talking of leadership for the future, and they are the future. Indeed, leadership development must begin in primary schools, not when we get to professional institu- tions. Furthermore, higher learning institutions, particularly for health professionals, require major modifi- cations which will allow students to learn in the communities and from the communities by working with them, rather than simply learning in institutions. My principal message and that of the working groups is that leader- ship development for health for all should become an integral part of all our activities aimed at achieving the goal of Health for all, and, for this, support will be universally needed. This is why we have drawn up a Declaration of personal com- mitment to which all can subscribe. My own personal commitment is based upon the experience of being converted from scepticism, because no professional nurse thought that the community could tell her what was required in health care; but then we watched as people without any facilities and with no access to health care, as we consider it, took charge of their own health, looked after their own committees and produced results. Today we are convinced that leadership development for Health for all is an imaginative and coura- geous initiative which provides new opportunities to inform and communicate, to empower people to take new responsibilities for their health, the health of their fam- ilies and of their communities. In short, to ensure that presently the peoples of the world will at least be able to say : "We have health care even if we have not been freed of all diseases." • W ORLD HEALTH , Aug ./Sept. 1988 Declaration of personal commitment We, the participants at the Technical Discussion on "Leadership Develop- ment for Health for All" (held in Geneva on 5-7 May 1988, during the Forty-First World Health Assembly), representing people from many walks of life, including governments, non-governmental organi- zations, universities, educational institu- tions, voluntary agencies and United Nations agencies, make the following declaration : I. We believe that : - There is a need for greater concern and commitment to achieve the goal of Health for All by the Year 2000 through primary health care, among political, pro- fessional and community leaders; - Building self-reliance and leadership capabilities at local level is the most im- portant ingredient for sustained develop- ment and progress in health; - The development of leadership that can be sustained as a continuing process at all levels is an important strategy to mobilise greater social and political com- mitment for the total Health-for-All movement. 11. We therefore commit ourselves and urge others in leadership and other strategic positions to adopt the following Five-point Personal Agenda for Action: 1. To inform ourselves, our col- leagues, fellow-workers, community members and others about the funda- mental values, principles and process- es to achieve Health for All by the Year 2000 through primary health care, and to generate a social conscience in "We pledge to inform ourselves and others about the needs of the under- served, socially deprived and vulner- able population groups. " Photo WHO/J. Litt lewood people to the health conditions and needs of the under-served, socially de- prived and vulnerable population groups; 2. To make a serious review of pro- gress towards the specific targets set in our respective countries, to identify where the critical needs and gaps are, and to provide leadership in identify- ing and implementing corrective actions; 3. To serve as prime movers for change, particularly in areas which fall within our respective roles, and to motivate others to accelerate the changes required in order to achieve the goal of Health for All; 4. To develop and promote partner- ships and new alliances of support fo r health, including the professional associations, institutions of higher education, religious leaders, people's organizations, concerned non-govern- mental organizations and individuals, philanthropic groups, the private sec- tor and the media ; 5. To promote self-reliance and en- able others, particularly within the home and at community level, to take greater responsibi lity for their own health and the health of their commu- nities, through informing and educat- ing them and developing their leader- ship potential. Ill. We are convinced that additional courageous and innovative strategies and tactics will be needed to ensure that all people of the world will be covered by primary health care. Leadership develop- ment is one such strategy which pro- vides new opportunities to inform and communicate, to expand partnerships among people- people who are empow- ered and motivated - who then take on new responsibilities for their health, the health of their families and of their communities. •