Tuesday, November 23, 2010

The dominance of big powerful NGOs

Despite their rhetoric about the importance of the not-for profit, non-government sector, the reality is that Federal and State Government policy and funding is predominately biased towards large corporate and business oriented NGO's. 

When it comes to shaping public policy, attracting public funding or winning large contracts there is an inherent bias towards larger more influential NGO's and to certain powerful service provider interests.

As Gavin Mooney points out, in the health sector it is always the  interests and the voice of the medical profession and the powerful bodies that represent them, who dominate public policy making and shape funding distribution. Mooney points out that in current debates about the direction of primary health care policy in Australia, smaller community based health NGO's, such as the Aboriginal community controlled health sector, which has strong links into Aboriginal communities and represents and advocates for Aboriginal people, are being marginalized

This piece appeared in Crikey and we acknowledge Crikey as the source.
Are Medicare Locals Entrenching Institutional Racism
by Gavin Mooney*

A few years ago, together with two Aboriginal colleagues, I wrote about institutional racism in the Australian health care system.

In the last few months, reading some of the documentation around on the new Medicare Locals (or Primary Health Care Organisations -- PHCOs) from the Department of Health and Aging, the Minister and the Australian General Practice Network (AGPN), it is evident that today such institutional racism is alive and well.

Indeed it is being built into the future of these PHCOs. In the current discussions on primary health care for the future in this country, the Aboriginal community controlled sector and its voice are being ignored.

The concern of that sector at not being invited to be engaged adequately in deliberations about the PHCOs is reflected in a recent media release here in the west from the Aboriginal Health Council of WA. That states, for example: "We are alarmed that there has been so little effort made by the minister and the Divisions of General Practice to involve our sector."

I do not think this is sour grapes on their part. I share that view. The views of the Aboriginal community controlled sector are not being sought and not being heard by the Minister, by the department or by the AGPN.

The reason? The new PHCOs are being seen as just bigger if fewer GP Divisions, with a few bells and whistles (which have been forced to be?) added on. This is reflected in the fact that all 15 of the new PHCOs are to be GP Divisions-based and according to the recent discussion paper from the department on Medicare Locals the rest will be "largely" Divisions-based.

In her speech to the APGN Forum in Perth 10 days ago this Divisions-focus was confirmed by the Minister.

As one example (but there are many) in that speech, she stated that her department was engaging consultants "to develop a funding formula that will enable funding for Medicare Locals to be fairly distributed, taking into account the needs of different parts of Australia".

According to the Minister the only body that the government will consult "before finalising the funding formula" is … the AGPN! No others seemingly and certainly no mention of consulting the Aboriginal community controlled sector on this funding formula.

But then, as the funding formula, according to the Minister, is to take into account only differences geographically ("the needs of different parts of Australia") and there is no mention of the differing cultural needs of Australians, such as the special cultural needs of Aboriginal Australians, then maybe she feels no need to run the funding formula past the community controlled sector.

The discussion document is similarly neglectful of the community controlled sector.

Yes, it lists that sector as one of several with appropriate "skill-sets" that "complement those offered by the Divisions of General Practice Network". But where is the recognition beyond "skill-sets" of the need to embrace the cultural base of the community controlled sector? Where is the acknowledgment that AMSs already often have the breadth of primary care that Divisions currently lack and which PHCOs are being asked to embrace?

It is noteworthy that the AGPN has set out some good principles, including on equity and on Aboriginal health, in its ‘blueprint document’ on PHCOs.

It is most unfortunate, however, that when AGPN comes to the operational end of things, as in its paper on a framework for PHCOs, both equity and Aboriginal issues are sadly neglected. When push comes to shove, the principles in the AGPN blueprint document thus turn out to be empty rhetoric.
There is still time for Minister Roxon and for AGPN to think again.

There remains a wonderful opportunity to build an exciting, fair and inclusive primary care sector in Australia. This needs to start with the idea of caring for patients and their health, sharing the vision with all relevant parties, including the Aboriginal community controlled sector, and embracing more firmly both equity and the social determinants of health.

Indeed I’d like to switch the letters round and have PHCOs become COPHs -- Caring Organisations for People’s Health, even if not in name at least in principle and practice.
I suspect that is what Australian citizens want. It is just a pity they are not being asked.

*Gavin Mooney is a health economist with an honorary appointment at the University of Sydney

Saturday, November 20, 2010

Making protest visible: Public protest as a vehicle for ethical and moral action

Public protest is one outlet for citizens to express deeply held moral and ethical commitments. Protest actions provide people with a way to address critical moral and social questions and confront the injustices, small and big, that they see around them. Protest actions are are a vehicle for ethical visions and creative ideas for a better future.

All over Western Australia this week ordinary citizens participated in public protest actions.

The photo on the left is from one of these protest actions, a rally organized by the Human Rights Alliance in the Perth CBD to protest against Government law and order policies and the misuse of tasers and force against Aboriginal people in custody

On Tuesday this week environmental groups, Aboriginal groups, unions and civil society groups protested outside BHP's Perth Annual General Meeting  against BHP and the Barnett Government's plans to make WA a major nuclear mining

In the Kimberley a small group of protesters blockaded access roads to prevent Woodside rig contractors from drilling drill on the site of the proposed James Price Point gas plant. A large protest rally against the industrialization of the Kimberley will take place in Cottesloe on the 28th November.

As a reminder of the importance of public protests, big and small, the UK Guardian has run a series of photographs of important protest events in world history. I was particularly taken with this photo taken during the 1968 Prague Spring.

Friday, November 12, 2010

Civil society rising in the UK and Europe

In London this week 50,000 students protested against education cuts by the Conservative- Liberal coalition Government.

Media reports in Australia have focused only on the occupation of the Conservative Party headquarters and, unsurprisingly for the corporate media, have largely ignored the larger story. All over Europe there is rising militancy by civil society groups against government  imposed austerity measures.

As Nina Powers points out in this piece in The Guardian the 52,000 students who protested in London display the real meaning of "The Big Society" that David Cameron claims he wants to promote. But Cameron's vision is an illusion. The Tories and Liberal Democrats want to destroy that part of civil society that resists and protests, and  holds governments and the corporate and business elite to account.

In her Guardian piece Nina Powers writes:
The protest as a whole was extremely important, not just because of the large numbers it attracted, and shouldn't be understood simply in economic terms as a complaint against fees. It also represented the serious anger many feel about cuts to universities as they currently stand, and the ideological devastation of the education system if the coalition gets its way. It was a protest against the narrowing of horizons; a protest against Lib Dem hypocrisy; a protest against the increasingly utilitarian approach to human life that sees degrees as nothing but "investments" by individuals, and denies any link between education and the broader social good.

The protesters - students and others - who occupied Tory HQ will no doubt continue to be condemned in the days to come. But their anger is justified: the coalition government is ruining Britain for reasons of ideological perversity. The protests in France and Greece and the student occupations here, such as the recent takeover of Deptford Town Hall by Goldsmiths students on the day cuts were announced, are indicators of a new militancy