English - World Federation of Public Health Associations
English - World Federation of Public Health Associations
English - World Federation of Public Health Associations
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12(1) Supervisor training program (1983), a partnering projectbetween the Sudanese Society <strong>of</strong> Social and Preventive Medicine(SSSPM) and CPHA.(2) Review & Evaluation Committee and CPHA staff meeting 1993:Back row: Dr. Jean Larivière (CPHA member and <strong>Health</strong> Canadarepresentative on the REC); Karen Mills (CPHA member on REC);Peter Rudermann (CPHA member on the REC);Middle row, left to right: Helen Musallem (CPHA member onREC); Keith Lansdell (CIDA rep on REC); Dr. John Hastings (CPHAmember on REC);Front row, left to right: James Chauvin (CIIP); Anne Wieler (CPHAmember on REC); Louise Galarneau (CIIP); Margaret Hilson(International <strong>Health</strong> Secretariat Director); Hélène Delisle (CPHAmember on REC); Dr. Pierre Duplessis (CPHA member on REC);Dr. Ed Ragan (CIIP Director).marked the beginning <strong>of</strong> global recognition <strong>of</strong> the need forhealthy physical and social environments and sound publicpolicy to reduce health inequities across communities. Theevent further confirmed CPHA’s commitment to being anactive advocate for and participant in global public health.The year 1986 also marked the beginning <strong>of</strong> CPHA’scontribution to the strengthening <strong>of</strong> national immunizationprograms and health systems as a means <strong>of</strong> improvingmaternal and child health. Canada’s InternationalImmunization Program (CIIP) became CPHA’s secondmajor global health initiative. With financial supportover the next 11 years from the Government <strong>of</strong> Canadathrough CIDA, CIIP would contribute to expanding theimmunization coverage <strong>of</strong> vaccine-preventable diseasesand strengthening the national Expanded Program onImmunization in over 80 countries. Since 1998, CPHA hasbeen managing the Technical Assistance and CanadianAwareness components <strong>of</strong> two phases <strong>of</strong> the CanadianInternational Immunization Initiative (CIII). Now in itssecond phase, this partnership <strong>of</strong> the Canadian governmentwith WHO, the Pan American <strong>Health</strong> Organization,UNICEF, CPHA and the Global <strong>Health</strong> Research Initiativeat the International Development Research Centre(IDRC) supports the eradication <strong>of</strong> polio, elimination <strong>of</strong>neonatal tetanus, control <strong>of</strong> measles, and strengthening<strong>of</strong> immunization and disease surveillance systems in lowandmiddle-income countries.6
© ACDI-CIDA/Dave Trattles3 4In 1989, CPHA’s Board <strong>of</strong> Directors convened a TaskForce on the Sustainable Development <strong>of</strong> Primary <strong>Health</strong>Care Services in Developing Countries. This initiative wasundertaken to address concerns about the direction <strong>of</strong>donor-driven health reform initiatives being implemented indeveloping countries in response to structural adjustmentstrategies endorsed by global financial institutions, such asthe <strong>World</strong> Bank.The output was the CPHA position paper entitledSustainability and Equity: Primary <strong>Health</strong> Care in DevelopingCountries. In it, CPHA reaffirmed its commitment to thegoals and values articulated in the Declaration <strong>of</strong> Alma Ataand embraced a broad-based strategy built on collaborationand community involvement as the way to achieve primaryhealth care goals in developing countries.In 1990, CPHA underwent a restructuring <strong>of</strong> its Board <strong>of</strong>Directors, which resulted in an increased commitment tointernational health activities. This included the creation<strong>of</strong> an elected representative on its Board specificallyresponsible for international health, as well as theestablishment <strong>of</strong> the National and International PolicyPlanning Committee, which reviewed emerging healthissues and recommendations for action to the Board.Over the next decade CPHA started implementing anumber <strong>of</strong> large international health projects. The first <strong>of</strong>(3) Community public health educators trained through theReproductive <strong>Health</strong> Project in Zambia (2001 – 2006);(4) A local vaccinator in India, pictured with vaccine carrier andnew born vaccination tracking booklet (CIII);(5) Dr. Gordon Lee (left) receives a map <strong>of</strong> Jamaica from Dr. LouGrant to commemorate the successful twinning program betweenthe Regional <strong>Health</strong> Unit <strong>of</strong> Haldimand-Norfolk, Ontario, and theSt. Ann Board <strong>of</strong> <strong>Health</strong> in Jamaica (1983).57
Key Milestones in CPHA’s International Programsthese was the CIDA-funded Southern AfricaAIDS Training Programme. The initiative’s goalwas to enhance the capacity <strong>of</strong> communityorganizations in southern Africa to design anddeliver effective HIV prevention and AIDS care,support and treatment activities. The projectwas carried out in three phases from August1990 until June 2008. Initially a regional initiativemanaged through a team located in Zimbabwe, itwas transformed in late 2003 into an autonomousAfrican regional NGO called the Southern AfricanAIDS Trust, based in South Africa.Other large projects managed by CPHA’s IHSfollowed. These included initiatives to createand nurture a civil society for public healththrough the creation <strong>of</strong> PHAs in Romania (1992–2000), the Palestinian Territories (1993–1999)and Russia (1994–2003); a maternal and childhealth project in Turkey, which resulted in thecreation <strong>of</strong> that country’s national public healthassociation (1991–1998); reproductive healthprojects in Malawi and Zambia (1996–2006);and the Romania Adolescent <strong>Health</strong> Project(1997–2000). CPHA also provided technicaladvice and assistance to UNICEF for a regionalHIV prevention and AIDS care and supportinitiative in the Balkans region (1999–2005) andto the Caribbean Epidemiology Centre for theCaribbean Regional HIV/AIDS Program (1996–2007). In the Americas region, CPHA supportedthe strengthening <strong>of</strong> health promotion capacityand the introduction <strong>of</strong> an intersectoral approachfor health in Brazil (1999-2010), and contributedto increasing access to and quality <strong>of</strong> maternal/child health services in a remote region <strong>of</strong>Argentina (2002-2006).CPHA has also played a leadership role ininternational tobacco control. This started in1996, when CPHA hosted the InternationalTobacco Workshop in Ottawa, an event thatwas co-sponsored by the IDRC and attendedby representatives from PHAs in Zimbabwe,Tanzania, Uganda, Costa Rica, Russia and Turkey.Since then, CPHA has partnered with more thana dozen countries on initiatives and strategies fortobacco control advocacy, policy and programs.It is also a partner with WHO and the US Centersfor Disease Control and Prevention in the Global8
Tobacco Surveillance System.Over the years, CPHA has played a leadershiprole within the WFPHA. It has been a member<strong>of</strong> the WFPHA’s Executive Board on severaloccasions, and on two occasions CPHA heldthe position <strong>of</strong> WFPHA President: Gerry Dafoe(CPHA’s Executive Director between 1973 and2004) from 1978 to 1980 and Margaret Hilson(Director <strong>of</strong> CPHA’s Global <strong>Health</strong> Programsbetween 1985 and 2005) from 1999 to 2001.CPHA has also played a major role in helpingto strengthen the <strong>Federation</strong>’s governance andoperational capacity, and has contributed toseveral WFPHA position papers and statementson public health issues.In May <strong>of</strong> 1992 CPHA was awarded theSasakawa <strong>Health</strong> Prize from the WHO for itswork on strengthening national PHAs and primaryhealth care in developing countries. This was thefirst and only time that a Canadian organizationhas received this prestigious award. The CPHA’snomination was presented to the WHO jointly byCanada’s federal and provincial governments.In 2007, in recognition <strong>of</strong> the changing internationalhealth environment, CPHA produced a 10-yearstrategic plan for its global health activities. A<strong>Public</strong> <strong>Health</strong> Approach for Global Development(CPHA’s Global <strong>Public</strong> <strong>Health</strong> Strategy 2007-2017) defines the goal <strong>of</strong> CPHA’s global programas building public health capacity in low- andmiddle-income countries with a strategy basedon four elements: strengthening the civil societyvoice for public health; enhancing and expandingpublic health leadership; fostering and managingeffective partnerships for public health; andmobilizing the Canadian public health communityfor the development <strong>of</strong> a strong, competent,international public health community. TheSOPHA Program remains the cornerstone <strong>of</strong>CPHA’s global health strategy.9
The History <strong>of</strong> theStrengthening <strong>of</strong> <strong>Public</strong><strong>Associations</strong> ProgramFor 25 years the Canadian <strong>Public</strong> <strong>Health</strong>Association (CPHA) has supported theestablishment and organizational development<strong>of</strong> national public health associations (PHAs) inlow- and middle-income countries worldwide asa means to create and strengthen civil society’svoice for public health. A non-governmental publichealth association brings a unique and objectiveperspective to national and international debateson health issues. PHAs provide sound, credibleevidence and represent a multidisciplinary,independent voice without the constraints <strong>of</strong>pr<strong>of</strong>essional licensing, certification or self-interest.They enhance and reinforce the role <strong>of</strong> civil societyand raise the level <strong>of</strong> awareness and understanding<strong>of</strong> the impact <strong>of</strong> public policy on human health andwell-being.The purpose <strong>of</strong> the SOPHA (Strengthening <strong>of</strong> <strong>Public</strong><strong>Health</strong> <strong>Associations</strong>) Program is to strengthen theorganizational and performance capacity <strong>of</strong> pr<strong>of</strong>essionalvoluntary membership associations to advocate for andprovide sound technical input to discussions aroundhealth policy and programs. SOPHA endeavors to nurturethe associations’ ability to function as effective nationalPHAs; take a leadership and advocacy role for health;promote and support broad public participation in healthissues and action; and build partnerships and allianceswith other agencies, organizations and pr<strong>of</strong>essionalassociations for action on important health issues.SOPHA’s goal is accomplished by working closely withthe PHAs to provide the training and support requiredto improve their ability to function as national healthresources. Moreover, support from the SOPHA Programhas successfully fostered and enabled PHAs to gaininternational visibility, and build networks and allianceswith other PHAs and organizations.10
<strong>Health</strong>The support provided by CPHA has enabled PHAs tobecome strong advocates for evidence-informed soundpublic policy, to implement and manage public healthinterventions and research initiatives, to independentlypursue funding opportunities, to mentor other PHAs,and to effectively increase their impact and role in publichealth in their communities, countries and around theworld.The Early Years (1985-1994)In 1985, CPHA received its first multi-year financialcontribution from what is today known as the CanadianPartnership Branch at the Canadian InternationalDevelopment Agency (CIDA) for a 3-year project referredto as the Block Funding program for the strengthening<strong>of</strong> public health associations. This permitted CPHAto establish an International <strong>Health</strong> Secretariat (IHS)that could identify and support projects undertaken incollaboration with partner PHAs in developing countries.The program reconfirmed CPHA’s commitment to supportthe guiding principles <strong>of</strong> the Alma Ata Declaration throughtechnical and financial support for public health activitiescarried out by non-governmental organizations (NGOs) indeveloping countries.This inaugural block funding phase (1985–1988) includedpartnerships to support five PHAs in Bolivia, CostaRica, Egypt, Sudan and Indonesia. Support focused onimproving the operating capacity <strong>of</strong> the PHAs and theirown public health projects, which dealt with occupationalhealth and safety, human resources training, reproductivehealth, care <strong>of</strong> the elderly and health promotion.At the end <strong>of</strong> this initial phase <strong>of</strong> the Block FundingProgram in 1988 CIDA applauded the successesachieved and the contribution that CPHA had made to theexpansion <strong>of</strong> the global community <strong>of</strong> PHAs. This wasjust the beginning.11
BOLIVIA 1986-1995The Sociedad Boliviana de SaludPública (SBSP) was created in1958 and was one <strong>of</strong> CPHA’sfirst public health associationpartners. CPHA received SBSP’sfirst project proposal in 1985 foran initiative designed to increasethe visibility <strong>of</strong> and improvelocal response to occupationalhealth and safety (OHS) in Bolivia.Studies done by the NationalInstitute <strong>of</strong> Occupational <strong>Health</strong>(INSO) found a high frequency<strong>of</strong> occupational hazards andassociated ill health amongBolivian workers in the mining,agricultural and manufacturingindustries. The objectives <strong>of</strong> theproject were to respond to theseOHS challenges by establishingan educational network betweenthe higher education system andthe Ministry <strong>of</strong> <strong>Health</strong>; traininghuman resources; and creatinga permanent human resourceand information capacity in theINSO. The support to SBSP wasrenewed in 1991 with a focuson strengthening its institutionalcapacity. CPHA support endedin 1995. The SBSP had madean important contribution tobuilding awareness <strong>of</strong> and meansto improve the OHS situation formany Bolivian workers.PALESTINIAN TERRITORIES1993- 1998The signing <strong>of</strong> the Oslo Accordsbetween Israel and the PalestinianLiberation Organization inSeptember 1993 created anew environment within whichinitiatives to enhance the capacity<strong>of</strong> Palestinians to improve thehealth and well-being <strong>of</strong> theirpopulations could take place.It was in this context that, withfinancial support from CIDA, CPHAstarted a project whose goalwas to support Palestinian civilsociety in its response to publichealth issues. This initiative waspredicated on the belief that aPalestinian PHA would provide aneffective vehicle through whichto support the efforts <strong>of</strong> publichealth pr<strong>of</strong>essionals workingin the West Bank and Gaza toidentify, design and put into actioneffective disease prevention,health promotion and healthprotection programs. It would also12continued page 14A member <strong>of</strong> the Sociedad Boliviana de Salud Pública leading a local training workshop (circa 1990)The second 3-year Block Funding Program phase, from 1988 to 1991, resultedin an increase in the number <strong>of</strong> partnerships and an expansion <strong>of</strong> the program’sgeographic reach. It included the PHA partners supported through the initialphase as well as several new and emerging PHAs in the Caribbean, Chile,Mexico, Tanzania, Thailand and the first partner from a French-speakingcountry, Zaire (today’s Democratic Republic <strong>of</strong> the Congo). Another notable andnew element in the program was the support provided for the establishment <strong>of</strong>a regional PHA in Africa. The Eastern, Central, Southern African <strong>Public</strong> <strong>Health</strong>Association (ECSAPHA) was <strong>of</strong>ficially inaugurated in 1990 under the leadership<strong>of</strong> the Tanzania <strong>Public</strong> <strong>Health</strong> Association with the technical and financialsupport <strong>of</strong> CPHA and the Commonwealth Secretariat.The third and final phase <strong>of</strong> the Block Funding Program (1991–1994) included11 partner associations (eight from the previous two phases and three newpartners from Peru, Uganda and Zimbabwe). By the end <strong>of</strong> this phase, 13 <strong>of</strong>the original 15 partner PHAs were implementing public health related activitiesin their respective countries, acting as conveners for public health eventsand, in some cases, were influencing policy and programming. As well, theyhad become members <strong>of</strong> the <strong>World</strong> <strong>Federation</strong> <strong>of</strong> <strong>Public</strong> <strong>Health</strong> <strong>Associations</strong>(WFPHA), which brought them into the global public health movement.
Mr. Ali Juma, Vice-President <strong>of</strong> theUnited Republic <strong>of</strong>Tanzania, opens theWFPHA 8 th <strong>Public</strong><strong>Health</strong> Congress(Tanzania)October 13, 1997(LEFT) Members<strong>of</strong> SOPHA publichealth associationpartners and CPHAstaff, WFPHA 7 th<strong>World</strong> Congress, Bali(Indonesia), 1994(RIGHT) Hygiene andsanitation educationfor campesinos inOllyantambo, Peru(Asociación Peruanade Salud Pública)Over the three project phases, CPHA facilitatednetworking, knowledge exchange and collaborationamong national PHAs. This resulted in CPHA hostingtwo Partners around the <strong>World</strong> workshops. The firstone was held in Ottawa in June 1988, and the secondworkshop was held in Bali, Indonesia, in December1994 (held immediately before the 7 th <strong>World</strong> Congress<strong>of</strong> the WFPHA, hosted by the Indonesian <strong>Public</strong> <strong>Health</strong>Association). The theme <strong>of</strong> both workshops wasStrengthening our <strong>Associations</strong>. They were designedto provide partner PHAs with the skills and tools tostrengthen their organizational financial sustainability,governance processes and capacity to carry out publichealth programs. Ten PHAs attended the Ottawa meeting.The Bali meeting attracted more than 40 representativesfrom 18 public health associations. It was during thissecond workshop that participants identified tobaccocontrol as an emerging issue for PHAs in developingcountries.The SOPHA Program (1995-2010)The evaluation <strong>of</strong> the third phase <strong>of</strong> the Block FundingProgram gave CPHA cause to reflect on what had beenachieved over the previous 10 years. This initiativehad succeeded in increasing the number <strong>of</strong> PHAs inAfrica, Asia, Latin America and the Caribbean. ThroughCanada’s support, the organizational and programmaticcapacity <strong>of</strong> 15 PHAs had been enhanced. All the PHApartners had contributed in some way to improving theconditions that affect the public’s health, whether in thework place, the home or the community. The goal <strong>of</strong>this initiative was consistent with the aims <strong>of</strong> CPHA’sother international initiatives: to build local organizationalcapacity and competence for sustained, equitable and realimprovement in the health and well-being <strong>of</strong> all people,based upon the principles enunciated in the Alma AtaDeclaration and the CPHA position paper on Sustainabilityand Equity: Primary <strong>Health</strong> Care in Developing Countries.13
14continued from page 12help create a civil society voice toguide the Palestinian Authority onpublic health policy.In 1994 the Palestinian <strong>Public</strong><strong>Health</strong> Association (PPHA)was <strong>of</strong>ficially established as ademocratic, multi-disciplinary andmembership-based associationwith several branches. The PPHAorganized seminars, scientificconferences and meetings, anddisseminated information aboutdomestic and internationalpublic health issues. It developedpr<strong>of</strong>essional relationships withother NGOs, academic institutionsand the Ministry <strong>of</strong> <strong>Health</strong>.It worked to raise awareness<strong>of</strong> and assist in implementingservices to address the healthneeds <strong>of</strong> Palestinian refugees inGaza and the West Bank. Whenthe project ended in 1998, thePPHA had been very successful atdisseminating information throughits publications and newsletters.For example, the PPHA publicationon breast cancer and selfexaminationwas reported to beused extensively by the Ministry<strong>of</strong> <strong>Health</strong> in its women’s healtheducation program.ETHIOPIA 1994- 2003Created in 1989 with amembership <strong>of</strong> 40 dedicatedhealth pr<strong>of</strong>essionals, the Ethiopia<strong>Public</strong> <strong>Health</strong> Association (EPHA)was among the first PHAs to beestablished in Africa. The EPHAwas a CPHA partner from 1994until 2003, when it graduated fromthe SOPHA Program. Through thispartnership, EPHA’s organizationaland operational capacity wasstrengthened, its capacity topublish and disseminate itsscientific journal (the EthiopianJournal <strong>of</strong> <strong>Health</strong> Development)and its newsletter (Felene Tega)was enhanced, and the quality<strong>of</strong> EPHA’s Annual ScientificConference and continuingeducation programs wereimproved. EPHA conducted manyseminars and workshops on a widerange <strong>of</strong> public health issues.During its partnership with CPHAthe EPHA expanded significantlyits membership base anddeveloped several collaborativecontinued page 16By 1996,therewere 13nationalPHAs inexistencein Africa—almosttwice asmanyasthere hadbeen in1991Member <strong>of</strong> the Tillaberi branch <strong>of</strong> the Association nigérienne pour la promotiion de la santé publiqueGiven the central focus <strong>of</strong> the initiative, CPHA changed the name to betterreflect its intention. The Strengthening <strong>of</strong> <strong>Public</strong> <strong>Health</strong> <strong>Associations</strong> (SOPHA)Program was launched in 1995 when CIDA renewed funding for a new 3-yearphase. The Program would continue to receive CIDA funding for three additionalphases through to 2011 and would become CPHA’s flagship global healthinitiative.Along with a change in name, the SOPHA Program adopted some othermodifications. For instance, starting in 1995, public health themes wereidentified and adopted by the partner PHAs to encourage knowledge exchangeand collaborative thinking and action on common areas <strong>of</strong> interest. This strategyalso facilitated synergies in the Program and among partners as the number <strong>of</strong>PHAs included in the Program increased.The first phase <strong>of</strong> the SOPHA Program (1995–1998) would see continued workwith some previous PHA partners (Chile, Costa Rica, Dominican Republic,Peru, Tanzania, Uganda and Zimbabwe) as well as new partnerships (Burkina
History <strong>of</strong> SOPHAFaso, Ethiopia and Niger). This phase markedthe beginning <strong>of</strong> an increasing number <strong>of</strong>African PHAs in the program and particularlynewly established PHAs in French-speakingcountries. By 1996, there were 13 nationalPHAs in existence in Africa—almost twice asmany as there had been in 1991. In 1997, theTanzania <strong>Public</strong> <strong>Health</strong> Association successfullyhosted the 8th WFPHA International <strong>Public</strong><strong>Health</strong> Congress, the first time that the eventhad been held in Africa, with technical supportprovided through the SOPHA Program.From the mid to late 1990s, CPHA began tosee the results <strong>of</strong> many years <strong>of</strong> technicaland financial support to PHAs. Some partnershad clearly enhanced their organizationalcapacities, attracted other sources <strong>of</strong> fundingand demonstrated achievements in their publichealth activities at the community and nationallevel. This meant that these PHAs wouldno longer require support from the SOPHAProgram and that they would “graduate” fromthe Program. In 1995, the Indonesian <strong>Public</strong><strong>Health</strong> Association and the National <strong>Health</strong>Association <strong>of</strong> Thailand would become the firstSOPHA graduates. Shortly thereafter, in 1998,the PHAs in Costa Rica and Tanzania would alsograduate from the SOPHA Program.The concept <strong>of</strong> “SOPHA Graduates” wasadopted to refer to the more mature andexperienced PHAs, which would mentoremerging ones. This strengthened the “southsouth”technical cooperation aspect <strong>of</strong> theProgram.The next phase <strong>of</strong> the SOPHA Program (1998–2001) saw new PHAs replace the SOPHAgraduates in the Program. They includedthe PHAs <strong>of</strong> Cuba, Haiti, Mozambique andPakistan. Nevertheless, the recently graduatedpartners continued to play a role in mentoringnew PHAs in their regions.In 2000, at the time <strong>of</strong> the 9 th WFPHAInternational <strong>Public</strong> <strong>Health</strong> Congress, heldin Beijing, a call to action was made thatemphasized the goal <strong>of</strong> a reduction <strong>of</strong> healthdisparities and the elimination <strong>of</strong> healthinequities. CPHA and its SOPHA partnersgained a renewed sense <strong>of</strong> purpose as globalactors to address these international healthchallenges and were inspired to adopt a globalfocus within the Program’s next phase.The third phase <strong>of</strong> the SOPHA Program(2001–2006) covered a 5-year period, allowingan expansion <strong>of</strong> the number <strong>of</strong> partner PHAs.This phase involved a total <strong>of</strong> 10 partnerPHAs, including emerging associations in theRepublic <strong>of</strong> Congo and Malawi. The continuedeffectiveness and relevance <strong>of</strong> SOPHA’ssupport and collaboration became evident withthe graduation <strong>of</strong> Ethiopia in 2003, Uganda in2005, and subsequently Burkina Faso and Cubain 2006. SOPHA had developed a set <strong>of</strong> toolsto assist PHA partners to assess and determineMembers <strong>of</strong> theTanzania <strong>Public</strong><strong>Health</strong> Associationon an educationalfield trip to the locallandfill15
continued from page 14projects with other organizationsand institutions. In the mid-1990s,the Transitional Government<strong>of</strong> Ethiopia invited EPHA to beinvolved in the preparation <strong>of</strong>several health and health-relatedpolicies. The EPHA demonstratedits valuable leadership in publichealth when it published aposition paper on gender andhealth. Today, the EPHA hasmore than 3,000 members acrossEthiopia, continues to publish ascientific journal and a newsletterregularly and holds a scientificconference, hosted by its differentregional branches, each year.EPHA’s international recognitionhas also grown significantly. In2003, the EPHA was elected to theWFPHA’s Executive Board, and in2012 it will host the 13th <strong>World</strong>Congress on <strong>Public</strong> <strong>Health</strong>, inAddis Ababa.CHARACTERISTICS OF ANEFFECTIVE PUBLIC HEALTHASSOCIATION• Has a democratic organizationalgovernance structure;• Fosters voluntarism & activemembership engagement;• Undertakes strategic planning;• Active in key national publichealth issues;• Active in research, policy andadvocacy work;• Have annual meetings,workshops and/or conferences;• Maintains a small secretariatto establlish institutional andmanagement capacity.criteria for graduation. These included an institutional assessment, based ona model produced by the International Development Research Centre (IDRC),which examines PHA capacity in the areas <strong>of</strong> governance and leadership,mission and strategy, physical and human resources and internal operations,management policies and procedures, program development, resourcegeneration, membership engagement, and relations with government andother organizations.At the time <strong>of</strong> the preparation <strong>of</strong> this publication, the SOPHA Program is inits fourth phase (2006–2011) and continues to provide technical and financialsupport to eight PHAs in Africa and Latin America. The newest SOPHApartners included in this phase are the PHAs <strong>of</strong> Cameroon, Nicaragua andMali. This phase has placed specific emphasis on south-south technicalcollaboration through mentorship activities by graduated SOPHA partners(from Burkina Faso, Uganda and Costa Rica) with the newer SOPHA partners,as well as support for the development and revitalization <strong>of</strong> the two Africanregional networks, ECSAPHA and Réseau des associations de santé publiqued’Afrique francophone (RASPAF).The SOPHA Program has achieved much over the past 25 years. Today thereare vibrant PHAs in countries where few existed previously. It has placedissues such as tobacco control on the national and international agendaand has provided a venue for and supported the discussion <strong>of</strong> high-priorityand emerging public health topics. The SOPHA Program has also beeninstrumental in building strong civil society voices for public health in several16
countries, in many cases a voice welcomedand encouraged by national ministries <strong>of</strong>health and international agencies. The SOPHAProgram has contributed to a strengthening <strong>of</strong>the global PHA movement by sponsoring andsupporting membership <strong>of</strong> PHAs from low- andmiddle-income countries in the WFPHA and theparticipation <strong>of</strong> PHA members at internationalpublic health fora. Although the current phase<strong>of</strong> the SOPHA Program will come to an end inDecember 2011, its legacy will endure throughthe actions <strong>of</strong> many PHAs around the world.Strengthening <strong>Public</strong> <strong>Health</strong> <strong>Associations</strong>in the Middle East and Eastern EuropeIn the early 1990s, CPHA started developingand implementing projects for building a civilsociety voice for public health in the MiddleEast and in Central and Eastern Europe.These projects were supported through afinancial contribution provided by the CanadianDepartment <strong>of</strong> Foreign Affairs and InternationalTrade (DFAIT), IDRC and CIDA’s bilateralprogram funding mechanism. Although notmanaged directly under the rubric <strong>of</strong> theSOPHA Program, these initiatives were directlylinked to the Program’s objectives and modusoperandi.The first <strong>of</strong> these initiatives led to theestablishment in 1992 <strong>of</strong> the Turkish <strong>Public</strong><strong>Health</strong> Association (HASAK). Originally formedas the public health section <strong>of</strong> the TurkishMedical Association, HASAK evolved quicklyas an independent multi-disciplinary PHA. Itidentified tobacco control and mother/childhealth promotion as two areas <strong>of</strong> focus. Overthe past 17 years, HASAK has evolved into animportant voice for public health in Turkey andis a member <strong>of</strong> several coalitions addressingpublic health issues. It became a member<strong>of</strong> the WFPHA in the mid-1990s and in 2009hosted the 12 th WFPHA <strong>World</strong> Congress on<strong>Public</strong> <strong>Health</strong>.The political and economic transformation inEastern and Central Europe in the early 1990s<strong>of</strong>fered an opportunity for CPHA to support theA city-streetcleaning andsanitation activityorganized by MPHA,the City Assemblyand over a hundredschool children,teachers andparents from theMasasa Community,Mzuzu, Malawi(2009). VioletSichinga, ExecutiveCommittee member<strong>of</strong> MPHA, ispictured at right inorange; and EdwardKayange, MPHAMasasa ProjectCoordinator, is atleft in the dark suit17
Three delegates from MPHA are preparing topresent their paper on water and sanitationat the UNACOH Scientific Conference onPrimary <strong>Health</strong> Care (September 2008)UNACOH HOSTS MPHADELEGATES IN KAMPALAThe Uganda National Association<strong>of</strong> Community and Occupational<strong>Health</strong> (UNACOH), a SOPHAgraduate, hosted three delegatesfrom the Executive Committee<strong>of</strong> the Northern Branch <strong>of</strong> theMalawi <strong>Public</strong> <strong>Health</strong> Association(MPHA) in September 2008.The purpose <strong>of</strong> the visit was tostrengthen the organizationalcapacities <strong>of</strong> the MPHA throughan exchange with an experiencedPHA in Africa, such as UNACOH.The delegates from Malawi wereable to fully participate in, andlearn from, the Annual UNACOHScientific Conference held inKampala. They were coached inthe preparation and oral delivery<strong>of</strong> a paper on water and sanitationto an audience <strong>of</strong> 100—a firstexperience for these delegatesfrom Malawi.SOPHA PROGRAMGRADUATE PUBLIC HEALTHASSOCIATIONS:• Have a strategic plan;• Are able to intervenesuccessfully in public healthpolicy and programs;• Have democratic, participatoryand functional governancestructure;• Have an open and multidisciplinarymembership ;• Hold regular national congressesand circulate publications;• Are known and recognizedby national and internationalhealth institutions.Kurdish women at a community water source, southeast Turkey (1992)emergence <strong>of</strong> the nascent non-governmental sector. In 1992, in collaborationwith a small group <strong>of</strong> public health pr<strong>of</strong>essionals in Romania, CPHA launcheda project that would result in the establishment <strong>of</strong> the Romanian <strong>Public</strong> <strong>Health</strong>and <strong>Health</strong> Management Association (RPHHMA). The RPHHMA becamea leader for tobacco control and also played important roles in HIV/AIDSprevention and reproductive health. It provided continuing education in healthpromotion for its members and held the country’s only annual conferencededicated to public health. The project relationship with CPHA ended in 2000.CPHA also helped launch the Russian <strong>Public</strong> <strong>Health</strong> Association (RPHA).Between 1994 and 2003, CPHA provided financial and technical support to theRPHA in its efforts to create a civil society voice for public health. The RPHAestablished several regional branches and became a leader in advocating forstrong tobacco control (a role it continues to play to this day).Following upon the signing in 1993 <strong>of</strong> the Oslo Accords, CPHA was engagedby Canada’s Department <strong>of</strong> External Affairs (known today as DFAIT) as atechnical adviser on public health issues related to Palestinian refugees. CPHAwas initially recruited by DFAIT, which held the gavel in the peace negotiationson refugee issues. <strong>Health</strong> was the one topic that could bring the two sidestogether to look at areas <strong>of</strong> peace building. It was the start <strong>of</strong> CPHA’s interestand commitment to health as a catalyst for conflict resolution.Through this process, CPHA met several public health pr<strong>of</strong>essionals18
SOPHAPROGRAM THEMESfrom 1995-2010PHASE I 1995-1998From the 1994 Partners Aroundthe <strong>World</strong> workshop PHApartners highlighted threepriority themes for action:health reform; health andthe environment; healthpromotion and social justice.This phase also placedemphasis on the theme <strong>of</strong>Women in Development.Beginning in this phase genderequity was to be incorporatedas a theme in the subsequentphases <strong>of</strong> the SOPHA Program.PHASE II 1998 -2001(TOP) Epi Info (statistical s<strong>of</strong>tware for epidemiology) training by CDC’s Office on Smoking &<strong>Health</strong> in the Balkans (2003); (BOTTOM) CPHA member Odette Laplante (left) co-facilitating astrategic planning workshop in Niamey, Niger (2009)from the Palestinian Territories, who voiced their interest in establishinga non-governmental PHA as a means <strong>of</strong> contributing to building a publichealth movement for the Palestinian people. The Palestinian <strong>Public</strong> <strong>Health</strong>Association (PPHA) was established in 1994, and for the next 6 years, withfinancial and technical support provided through CPHA, it advanced discussionabout and action on several important public health issues (environmentalhealth, health promotion, mother/child health and mental health).In 1999, following the cessation <strong>of</strong> military hostilities in the countries <strong>of</strong> theformer Yugoslavia, CPHA became one <strong>of</strong> several Canadian organizationsto provide technical assistance in the rebuilding <strong>of</strong> the Balkans region’shealth sector. Initially CPHA managed a program in Kosovo that contributedto the reconstruction <strong>of</strong> health facilities and the training <strong>of</strong> a new cadre<strong>of</strong> public health practitioners. The program also included the founding <strong>of</strong>the Kosovo <strong>Public</strong> <strong>Health</strong> Association. Shortly thereafter, CPHA launcheda new regional initiative to strengthen essential public health functions inSerbia, Montenegro, the UN-administered province <strong>of</strong> Kosovo, Bosnia andHerzegovina, and Albania. This CIDA-funded initiative, which came to an endin December 2009, supported the establishment and organizational nurturing<strong>of</strong> PHAs in the Republic <strong>of</strong> Serbia (the <strong>Public</strong> <strong>Health</strong> Association <strong>of</strong> Serbia,launched in October 2004) and in Bosnia and Herzegovina (the Partnership for<strong>Public</strong> <strong>Health</strong> <strong>of</strong> the <strong>Federation</strong> <strong>of</strong> BiH and the <strong>Public</strong> <strong>Health</strong> Association <strong>of</strong>Republika Srpska, both launched in mid-2007).In a workshop held during theWFPHA International Congressin 1997 in Tanzania, the SOPHApartners decided to continuewith the previous phase’sthemes and added tobaccocontrol, given its emergingimportance as a public healthissue and the global movementthat was beginning to takeform through WHO’s leadershipfor the development andratification <strong>of</strong> the FrameworkConvention on Tobacco Control.PHASE III 2001-2006PHAs focused their workon transnational issues <strong>of</strong>globalization, tobacco controland essential public healthfunctions.PHASE IV 2006-2011The partner PHAs met duringthe WFPHA’s InternationalCongress in August 2006and selected the theme <strong>of</strong>strengthening the publichealth workforce for this phasein recognition that a strong,effective global health workforce is essential to achievethe Millennium DevelopmentGoals.19
African Regional<strong>Public</strong> <strong>Health</strong> AssociationNetworksRegional networks <strong>of</strong> public health associations (PHAs) reinforce collaboration and consensusamong different organizations and across geographic and linguistic borders. They provide aconsultative forum through which PHAs can coordinate advocacy and action on public healthissues <strong>of</strong> common interest and urgency. These networks also improve institutional visibility andcreate a dynamic environment for both internal and external partners to push for common publichealth development strategies. The networks can also facilitate mentorship, mutual learningand technical cooperative support among associations. The regional public health associationsin Africa are more than just an association <strong>of</strong> associations. They provide a critical space for civilsociety actors to coordinate and prioritize global health action, transfer and integrate knowledge,and identify best practices.CPHA has played a key role in supporting thecreation and development <strong>of</strong> two regionalnetworks <strong>of</strong> public health associations in Africa:The East, Central and Southern African <strong>Public</strong><strong>Health</strong> Association (ECSAPHA) and more recently,the Réseau des associations de santé publiqued’Afrique francophone (RASPAF).The East, Central and Southern African<strong>Public</strong> <strong>Health</strong> Association (ECSAPHA)The ECSAPHA was created in August 1988 at aregional meeting in Lilongwe, Malawi, that broughttogether delegates from eight African countrieswith two CPHA representatives as facilitators.Although ECSAPHA was launched at the end <strong>of</strong>this meeting, the <strong>of</strong>ficial inauguration and adoption<strong>of</strong> ECSAPHA’s constitution took place 2 yearslater in a meeting hosted by the Zimbabwe <strong>Public</strong><strong>Health</strong> Association (ZPHA) in Harare, in June 1991,and held in conjunction with ZPHA’s first BiennialScientific Conference. In attendance were 60participants representing 14 different countries.Pr<strong>of</strong>essor Wen Kilama <strong>of</strong> the Tanzania <strong>Public</strong> <strong>Health</strong>Association (TPHA) was elected as Chairperson andDr. Godfrey Woelk (ZPHA) as Vice-Chairperson. Itwas agreed that TPHA would act as the Secretariatfor the network. Responsibility for the ECSAPHASecretariat was transferred to the Uganda NationalAssociation <strong>of</strong> Community and Occupational <strong>Health</strong>20
Participants <strong>of</strong> the ECSAPHA Revitalization Workshop in Entebbe, Uganda, April 2007. Shannon Turner (pictured front row, third from left), from the <strong>Public</strong> <strong>Health</strong>Association <strong>of</strong> British Colombia was the main facilitator <strong>of</strong> the workshop. Manjula Alles (front row, fourth from right) represented CPHA and the SOPHA Program.(UNACOH) in 1997, when it assumed the ECSAPHApresidency.CPHA partnered with the Commonwealth <strong>Health</strong>Secretariat for East, Central and Southern Africa in orderto support the establishment <strong>of</strong> ECSAPHA and promotethe formation <strong>of</strong> national publichealth associations in theregion.The reason for the creation<strong>of</strong> ECSAPHA, as stated inits constitution, was therealization and consensusby members “that countriesin the East, Central andSouthern Africa have similarhealth problems that couldbe solved through commonand concerted strategies, and that they could benefitfrom each other’s experience in the establishment andorganization <strong>of</strong> voluntary public health institutions...”Over the next 4 years, ECSAPHA held four conferencesjointly with national PHA conferences. However, otherthan the conferences ECSAPHA was unable to implementany additional activities, principally because <strong>of</strong> thedifficulty in securing funding over and above that providedthrough CPHA. The last formal ECSAPHA conferencewas held in Arusha in 1997, during the 8 th WFPHA <strong>World</strong><strong>Public</strong> <strong>Health</strong> Congress.ECSAPHA remained dormant for 10 years. In 2007,UNACOH, with CPHA’s support, hosted the ECSAPHA“...countries in the East, Centraland Southern Africa have similarhealth problems that could be solvedthrough common and concertedstrategies, and ...they could benefitfrom each other’s experience in theestablishment and organization<strong>of</strong> voluntary public healthinstitutions...”Revitalization Workshop in Entebbe. This meetingreunited ECSAPHA members from nine countries,including representation from Botswana. That same yeara presentation was made about the plan to revitalizeECSAPHA at the WFPHA Annual General Meeting.Another presentation on ECSAPHA was made at the 12 thWFPHA <strong>World</strong> Congress on <strong>Public</strong><strong>Health</strong> in Istanbul, in April 2009.With these initiatives ECSAPHAonce again has begun to gainregional visibility and assert itsimportance.Réseau des associations de santépublique d’Afrique francophone(RASPAF)The concept <strong>of</strong> a network <strong>of</strong> FrenchspeakingPHAs dates back to a 1994 workshop organizedby CPHA and hosted by the Association burkinabé desanté publique (ABSP). French-speaking PHAs wanted aforum where they could discuss issues <strong>of</strong> mutual interestin their own language and advocate for and support theexchange <strong>of</strong> resources in French. The first meeting <strong>of</strong>PHAs in Francophone Africa took place in Ouagadougou(Burkina Faso). Participants from Benin, Rwanda, BurkinaFaso, Mali, Chad, Niger and Zaire attended the meeting,as well as four representatives from CPHA who facilitateddiscussions.In 2004, at the 10th WFPHA <strong>World</strong> Congress on <strong>Public</strong><strong>Health</strong>, held in Brighton (UK), strategic discussionsfirst started about the formation <strong>of</strong> a francophone PHA21
(LEFT) Participants <strong>of</strong> the April 2007 RASPAF workshop, hosted by the Association burkinabé de santé publique; (RIGHT) CPHA Technical Assistant, HélèneValentini, facilitator for the inaugural RASPAF meeting.network, which would require the moral and technicalsupport <strong>of</strong> the WHO Africa Regional Office. In 2006,the foundational stones were laid for RASPAF duringan international training workshop for health promotionhosted by the Réseau francophone international pour lapromotion de la santé held in Yaoundé, Cameroon.In April 2007, the RASPAF was launched inOuagadougou after a workshop meeting with PHAs fromsix African French-speaking countries. This meeting,organized and hosted by the ABSP, was supported byCPHA and facilitated by a CPHA technical adviser. Sincethe inaugural RASPAFmeeting in 2007,several new PHAshave been createdin French-speakingAfrica, in Cameroon,Cote d’Ivoire, Chad,Mali and Senegal.RASPAF, through itsmission and goals,aims to create anenvironment favouring the expansion <strong>of</strong> the publichealth movement in Francophone Africa, organize a PHAnetwork and develop a plan <strong>of</strong> action. This would alsobe an opportunity to address the under-representation <strong>of</strong>francophone African PHAs in international meetings andin international organizations like the WFPHA.ECSAPHA and RASPAFjoin their effortsThe RASPAF aims to create an environmentfavouring the expansion <strong>of</strong> the publichealth movement in Francophone Africa.The Network also creates an opportunityto address the under-representation <strong>of</strong>Francophone <strong>Public</strong> <strong>Health</strong> <strong>Associations</strong> ininternational meetings and organizations.PHA meeting which resulted in a continental Declaration<strong>of</strong> Commitment <strong>of</strong> African <strong>Public</strong> <strong>Health</strong> AssociationNetworks for the revitalization <strong>of</strong> primary health care(PHC) signed by a total <strong>of</strong> 17 PHAs from both ECSAPHAand RASPAF networks.The declaration outlined a strategy and visibly positionedAfrican PHAs and civil society, for 1) advocating forequity in health services delivery and utilization; 2)strengthening operational research and evaluation tomake public health systems more vigilant; 3) carrying outsocial and community mobilization in support <strong>of</strong> PHC;and 4) empowering members<strong>of</strong> the community to participatein their own public healthinterventions/initiatives.Members <strong>of</strong> ECSAPHA andRASPAF are motivated tomake a real difference andcollaborate. As Luis Caceres, aformer SOPHA Project Officerand advisor who worked withthe African regional networks,writes: “The regional public health associations inAfrica are more than just an association <strong>of</strong> associations.They provide a critical space for civil society actors tocoordinate and prioritize global health action, transferand integrate knowledge, and identify best practices.Despite a range <strong>of</strong> governance, human resource, andconnectivity challenges, the regional PHAs are networksthat build collaboration in public health among Africancountries ...”The inauguration workshop <strong>of</strong> RASPAF and therevitalisation <strong>of</strong> ECSAPHA in 2007 served as a steppingstone for subsequent joint efforts and collaboration. Thefirst opportunity was the WHO and CPHA supportedregional workshop in Burkina Faso which coincidedwith the International Conference on Primary <strong>Health</strong>Care and <strong>Health</strong> Systems in Africa, in Ouagadougouin April 2008. Representatives from both RASPAF andECSAPHA participated in this conference and parallelAt the end <strong>of</strong> 2009, both ECSAPHA and RASPAF werepursuing the goal <strong>of</strong> an African <strong>Public</strong> <strong>Health</strong> <strong>Federation</strong>.The next <strong>World</strong> Congress on <strong>Public</strong> <strong>Health</strong> will be hostedby the Ethiopian <strong>Public</strong> <strong>Health</strong> Association (EPHA)in 2012 which will provide an exciting opportunityfor African PHAs to demonstrate and discuss on theoutcomes resulting from their efforts to support theAfrican and global public health movement.22
THE WORLD FEDERATION OFPUBLIC HEALTH ASSOCIATIONSCPHA has been an active and engagedmember in the <strong>Federation</strong>since 1973. Over its 37 years <strong>of</strong>involvement with the <strong>Federation</strong>, CPHAhas played a leadership role in contributingto WFPHA’s organizational development.CPHA has held the WFPHApresidency on two occasions (CPHA’sformer Executive Director, Gerry Dafoe[1978–1980] and the former Director <strong>of</strong>CPHA’s Global <strong>Health</strong> Programs, MargaretHilson [1999–2001]). CPHA hasalso assisted WFPHA to develop andrevise its by-laws and recently has takenthe lead in establishing and chairingthe <strong>Federation</strong>’s Finance Committee.CPHA has been a member <strong>of</strong> WFPHA’sExecutive Board on several occasions,most recently over the period 2006–2011, and has played an important rolein the development <strong>of</strong> the <strong>Federation</strong>’sstrategic plan. It has also been activelyinvolved in the revitalization <strong>of</strong> the WF-PHA’s tobacco control working group.In 1978 the <strong>World</strong> <strong>Health</strong> Organization(WHO) and the United NationsChildren’s Fund (UNICEF) asked theWFPHA to prepare a position paperdiscussing the position <strong>of</strong> health sectornon-governmental organizations(NGOs) on the principles <strong>of</strong> primaryhealth care. CPHA collaborated withover 100 other NGOs to prepare thepaper, The Role <strong>of</strong> Non-GovernmentalOrganizations in Achieving <strong>Health</strong> for allby the Year 2000. Gerry Dafoe made aplenary presentation on this topic at theWHO/UNICEF International Conferenceon Primary <strong>Health</strong> Care in Alma Ata inSeptember, 1978. WFPHA’s presentationbecame an integral contribution tothe Declaration <strong>of</strong> Alma Ata, a majorlandmark document that set the globalgoal <strong>of</strong> <strong>Health</strong> for All.In its presidency <strong>of</strong> the <strong>Federation</strong> duringthe WFPHA <strong>Public</strong> <strong>Health</strong> Congressin Beijing, in 2000, CPHA hosted an invitationalhigh-level Leadership Forumwith 20 participants representing allregions <strong>of</strong> the world. The significance<strong>of</strong> the global objective <strong>of</strong> <strong>Health</strong> for Allby Year 2000, as given in the Declaration<strong>of</strong> Alma Ata, the gains made since1978, the opportunities missed and thechallenges for the future were all debated.The Leadership Forum draftedthe <strong>Federation</strong>’s Call to Action, whichDr. Allen Jones, former WFPHA Secretary-General(†2008), presents a plaque to honour Dr. Theo Abelinand Margaret Hilson’s service to the WFPHA atthe <strong>Federation</strong>’s 38 th AGM in Brighton (UK), 2004was subsequently ratified by the entirebody <strong>of</strong> the Congress and disseminatedto all participating countries. Thislandmark event marked a turning pointin consolidating the <strong>Federation</strong>’s capacityto convene the world’s public healthleaders and to develop a global advocacystrategy for equitable access tohealth.The triennial global public health congressis the WFPHA’s flagship event.In 1978, CPHA organized and hostedthe second <strong>World</strong> Congress on <strong>Public</strong><strong>Health</strong> in Halifax, Canada. Over theyears, several national PHAs, whichwere also SOPHA partners, have hostedthis important international event. In1994, the WFPHA Global <strong>Public</strong> <strong>Health</strong>Congress was hosted by the Indonesia<strong>Public</strong> <strong>Health</strong> Association, in Bali; in1997, the Tanzania <strong>Public</strong> <strong>Health</strong> Associationhosted the first WFPHA Congressin Africa, in Arusha; and in 2009,the Turkish <strong>Public</strong> <strong>Health</strong> Associationhosted the 12 th WFPHA Congress in Istanbul.The next congress, in 2012, willbe hosted in Addis Ababa by the Ethiopian<strong>Public</strong> <strong>Health</strong> Association, anotherSOPHA Program graduate.Through the SOPHA Program, CPHAhas made a substantial in-kind contributionto the <strong>Federation</strong>. CPHA hashelped WFPHA increase its membershipto include representation fromlow- and middle-income countries, especiallyfrom francophone, anglophoneand lusophone Africa. Many SOPHAProgram graduates have taken leadershiproles in the WFPHA and its ExecutiveBoard and committees.CPHA remains an active member andsupporter <strong>of</strong> the WFPHA through itslong-term commitment to the building<strong>of</strong> a global civil society voice for publichealth.The WORLD FEDERATION OFPUBLIC HEALTH ASSOCIATIONS(WFPHA), founded in 1967 inGeneva, Switzerland, is theonly worldwide pr<strong>of</strong>essionalsociety representing andserving the broad area <strong>of</strong> publichealth and the community <strong>of</strong>national and regional publichealth associations (PHAs) andaffiliated organizations. Today,the WFPHA counts more than 50members, including national andregional PHAs as well as regionalassociations <strong>of</strong> schools <strong>of</strong> publichealth. For more information,please visit: www.wfpha.org23
Occupational<strong>Health</strong> and SafetyCPHA’s initial international projectsfocused on occupational health andsafety (OHS). Its first internationalpartnership with a public health associationbegan in 1982 with the Sudanese Society<strong>of</strong> Preventive and Social Medicine (SSPSM).It was a 3-year project to examine theextent <strong>of</strong> workplace accidents and illnessesin small industries and farms, and to trainemployees as OHS supervisors. Anotherobjective <strong>of</strong> the project was to strengthenthe capacity <strong>of</strong> the SSPSM to undertakeother primary health care activities.Throughout the 1980s and into the 1990s,CPHA partnered with health organizationsin Colombia, India and Egypt on OHSrelatedprojects. It also supported, throughthe Block Funding and SOPHA programs,OHS activities initiated by its publichealth association partners in Bolivia, theDominican Republic, Thailand, Turkey,Uganda and Ethiopia.Several important results were achievedthrough these initiatives: the formulationand passing <strong>of</strong> workplace safety legislation,the opening <strong>of</strong> on-site OHS clinics staffedby full-time physicians and nurses, thedelivery <strong>of</strong> seminars and training sessionsfor both employees and employers andthe provision <strong>of</strong> OHS resources and safetyequipment for workers. These projectsaddressed both urban industrial and ruralagricultural workplaces, and saw markedimprovements in the health and well-being<strong>of</strong> labourers in both sectors.27
A Colombian textilesmanufacturing plant,one <strong>of</strong> the participantindustries in ANDI’s OHSprojectWorkplaceaccidentswereconsideredto beamong theleadingcauses <strong>of</strong>death inColombiain the early1980s.COLOMBIAOccupational <strong>Health</strong> DevelopmentProgram for Industry(1983 - 1990)Workplace-related accidents wereconsidered to be among the leading causes<strong>of</strong> death in Colombia in the early 1980s.In addition, more than half <strong>of</strong> non-fatalworkplace accidents resulted in lifelongdisablement. Despite this situation therewas no OHS policy in place at the time inColombia.In 1983, CPHA and the Occupational <strong>Health</strong>and Safety Committee <strong>of</strong> the AsociaciónNacional de Industriales (ANDI) beganimplementing an Occupational <strong>Health</strong>Development Project for Industries inColombia. This initiative was funded bythe Canadian International DevelopmentAgency. The major foci <strong>of</strong> the project wereto develop occupational health programs inseveral pilot sites, to provide pr<strong>of</strong>essionaldevelopment opportunities for occupationalhealth personnel and to strengthenANDI’s organizational capacity to convinceindustries to develop and implement OHSprograms. All <strong>of</strong> these objectives wereachieved by the project’s completionin 1985. Dr. Jorge Segovia, a technicaladviser to the project, reported that “skilledpr<strong>of</strong>essionals have been trained and arenow in place in Colombia, pr<strong>of</strong>essionalswho are playing an increasingly importantrole in developing occupational health andsafety programs.”The second phase <strong>of</strong> the project, from1986 to 1990, focused on improving OHSconditions in the industrial sector throughorganizational development, manpowertraining and research. As a result <strong>of</strong> theproject’s first phase, several educationalinstitutions had introduced OHS elementsinto the teaching curriculum <strong>of</strong> healthrelatedpr<strong>of</strong>essional programs, such asnursing and oral hygiene.The CPHA-ANDI project concluded in early1990 and was considered a success. ANDIwould continue to grow as an associationand is today one <strong>of</strong> 14 non-governmentalmembers <strong>of</strong> Colombia’s National Regulatory<strong>Health</strong> Commission (Comisión Reguladorade Salud).28
INDIAOccupational <strong>Health</strong> Development Project(1984 - 1987)CPHA’s third occupational health project beganin 1984 in India. The project was developedand implemented in partnership with theConfederation <strong>of</strong> Engineering Industry (CEI) 1and the Indian Aluminum Company (INDAL).The project’s goal was to promote and sustaina healthy workforce through improvements inthe availability and quality <strong>of</strong> health servicesin the workplace. Through the project CEIpromoted and facilitated the developmentand implementation <strong>of</strong> OHS programs withinits membership, while INDAL developed anoccupational health program, including a pilotsite in its Alupuram smelter in Kerala State, forits workers and for workers in other smallerindustries in the area.An evaluation conducted at the end <strong>of</strong> theproject in 1987 found that it had achievedmost <strong>of</strong> its objectives. A network <strong>of</strong> individualswith expertise in OHS, capable <strong>of</strong> pursuingOHS initiatives, was created and nurtured.Moreover, the INDAL Occupational <strong>Health</strong> andSafety Centre was established and deliveredprograms and services for INDAL plant workers,their families and to small- and medium-scaleindustries in the surrounding area. The Centredeveloped into a hub <strong>of</strong> OHS expertise andresources.1 Formerly known as the Association <strong>of</strong> Indian Engineering Industry.(TOP) The worker’s lunch room, prior tothe establishment <strong>of</strong> OHS practices andregulations. According to the trip report<strong>of</strong> a technical consultant: “even thoughthese workers handled insecticide, they didnot wear (nor were they provided with)any protective equipment or gloves, norcould I observe any handwashing facilitiesthey could use before they ate theirmeals. Apparently, these workers digest asmuch insecticide dust as they breath or isabsorbed through their skin.”(ABOVE) Margaret Kerr (Alcan) andrepresentatives <strong>of</strong> the Association <strong>of</strong>Indian Engineering Industry at a ceremonycommemorating the opening <strong>of</strong> the INDALhealth centre.(LEFT) The INDAL Hearing ConservationProgram stated that high noise areas bedesignated and warned with prominent signboards in order to reduce hearing damage.29
THAILANDOccupational <strong>Health</strong> Programsin Rural Communities(1992 - 1995)In its second partnership with the National<strong>Health</strong> Association <strong>of</strong> Thailand (NHAT)through the Block Funding mechanism,CPHA supported a small project thataddressed occupational health in villagecottage industries. Development <strong>of</strong>small enterprises had been encouragedin Thailand’s rural areas as a means todiversify and increase sources <strong>of</strong> revenue.Although income was being generated,workers were being exposed to healthhazards as a result <strong>of</strong> manufacturingprocesses in village-based cottageindustries. The NHAT initiative identifiedand addressed occupational healthproblems <strong>of</strong> rural workers in villageagricultural and cottage industry in fourprovinces. It developed an innovativemodel for an occupational health programthat could be easily integrated into thecountry’s primary health care system. Themodel included the development <strong>of</strong> newtools and technologies, as well as theanalysis <strong>of</strong> managerial and organizationalissues. The pilot program addressedissues such as repetitive strain injuriesand workplace safety in cottage industriessuch as mat weaving, wood milling,stone cutting, market gardening and fishprocessing. The project was deemed verysuccessful, and the Ministry <strong>of</strong> <strong>Public</strong><strong>Health</strong> agreed to continue funding the pilotinitiative and scale it up after the CPHA-NHAT partnership concluded in 1995.30
EGYPTIndustrial <strong>Health</strong> and Safety Survey andHuman Resources Development Project(1984 - 1988)In 1984, CPHA began another occupationalhealth project in partnership with the EgyptbasedArab Society for Occupational Safetyand <strong>Health</strong> (ASOSH). The project’s goal wasto strengthen the organizational capacity<strong>of</strong> ASOSH to act as an influential voice foroccupational safety and health issues inEgypt. Specifically, the project supporteda survey about industrial and agriculturalsafety and health problems; the development<strong>of</strong> a curriculum and training for industrialand agricultural safety supervisors; and thedevelopment <strong>of</strong> ASOSH’s leadership capacity inoccupational health and safety.When the project ended in 1988, it hadsucceeded in meeting its objectives andhad visibly contributed to improvementsin occupational health, particularly in theagriculture sector. Notably, ASOSH hadcompleted for the first time surveys onindustrial and agricultural issues; trained alarge number <strong>of</strong> industrial and agriculturalGraduates from ASOSH’s Women in Agriculture Course, 1987.safety supervisors as well as field specialists for injuryprevention; trained nurses in OHS; and increased thevisibility <strong>of</strong> OHS issues through conferences and thepublication <strong>of</strong> several newsletters. ASOSH had alsoincreased its membership.Between 1992 and 1995 CPHA renewed its partnershipwith ASOSH under the Block Funding program insupport <strong>of</strong> a project to expand and strengthen trainingand advocacy for OHS legislation in the agriculturalsector. The project was particularly successful in thatit influenced the Ministry <strong>of</strong> <strong>Health</strong> to recognize theimportance <strong>of</strong> expanding OHS to agriculture sectorworkers.DOMINICAN REPUBLICOccupational <strong>Health</strong> Project(1994-1999)In 1994 CPHA began a partnership through theSOPHA program with the Asociación para laPromoción de la Salud Pública (ASAP) in theDominican Republic. ASAP sought to improvethe health <strong>of</strong> workers in industrial tax-freezones as well as <strong>of</strong> Haitian sugar cane workersby advocating for workers’ rights and theformulation and application <strong>of</strong> OHS regulations.The specific objectives were to ensure thatworkers had access to health informationin order to improve their living and workingconditions; to upgrade environmental and healthconditions in selected municipalities; and towork with the national and local governmentsto address shortcomings in legislation thataffected workers’ health.ASAP advocated for new social security andoccupational health and safety legislation;provided training on OHS and OHS leadershipamong the workers in free trade zones andpromoted the creation <strong>of</strong> local health and safetycommittees; provided health information toworkers; and advocated for better workingconditions among sugar cane workers.A comic published in ASAP’s Journal, Salud <strong>Public</strong>a, depicting an average day in the life <strong>of</strong> afactory worker. Translation: At 6am, I wake; I prepare breakfast; and I leave for work hurryingto arrive on time; once there I work without breaks: “I kill myself all day for 35 cents anhour!”31
Tobacco Control EffortsCPHA has been involved in tobacco controlsince 1959. That year saw CPHA pass a pioneeringresolution urging health agencies to support anti-tobaccoeducational campaigns in the hope <strong>of</strong> preventing tobaccouse among youth. After nearly four decades <strong>of</strong> work in thenational arena, CPHA took its tobacco control expertise tothe international sphere in the 1990s.In 1994, at the second Partners Around the <strong>World</strong> workshopin Bali, Indonesia, representatives from 18 publichealth associations (PHAs) concluded that tobacco usewas a pressing issue. Consequently, CPHA took the initiativeto convene the first International Tobacco Workshopfor public health associations in Ottawa in 1996. Theworkshop brought together international representativesfrom six PHAs (Costa Rica, Uganda, Tanzania, Russia,Turkey and Zimbabwe), Canadian health sector representativesand experts in tobacco control to develop nationalframeworks for future action on smoking and tobacco inthe PHA partner countries. Eight years later, several <strong>of</strong>the groups represented at the workshop (in particular, thePHAs <strong>of</strong> Costa Rica, Russia and Tanzania) are acknowledgedin their respective nations as leaders in the field <strong>of</strong>tobacco control.CPHA subsequently expanded its involvement in internationaltobacco control. In 1999, it became an associatepartner with the <strong>World</strong> <strong>Health</strong> Organization (WHO) andthe US Centers for Disease Control and Prevention in theGlobal Youth Tobacco Survey (GYTS), bringing into thesurvey framework partner PHAs from several countries asparticipating organizations. The survey was used as a firststep in the development <strong>of</strong> tobacco control programs andas a tool to monitor youth tobacco use. There are currently17 PHAs that have been involved in carrying outthe GYTS, some for a second time in order to generatetime-series results on smoking prevalence, knowledge,attitudes and behaviour among school-aged children.In 2000, CPHA worked with the <strong>World</strong> <strong>Federation</strong> <strong>of</strong> <strong>Public</strong><strong>Health</strong> <strong>Associations</strong> (WFPHA) to organize an internationalworkshop on Tobacco and Smoking as a <strong>Public</strong> <strong>Health</strong> Issueat the 9 th <strong>World</strong> Congress on <strong>Public</strong> <strong>Health</strong> in Beijing.The workshop informed national PHAs around the worldabout the need for strong advocacy by the public healthcommunity for the adoption <strong>of</strong> the Framework Conventionon Tobacco Control (FCTC). Since FCTC’s implementationin February 2005, CPHA has been actively supportingthe efforts <strong>of</strong> PHAs in Africa, Asia and the Americas tostrengthen local advocacy for and action on the ratification,implementation and monitoring <strong>of</strong> the FCTC.Tobacco control was one <strong>of</strong> the SOPHA Program’s thematicfoci for the 2001–2006 period. CPHA extended itssupport for the GYTS by providing financial and technicalbacking for PHAs in Burkina Faso, Niger, Haiti and Cuba toparticipate. Through another CIDA-funded initiative, CPHAhelped develop and enhance the tobacco control efforts <strong>of</strong>PHAs in Central and Eastern Europe, most recently in theBalkans region.CPHA provided technical and financial support to researchteams in the Republic <strong>of</strong> Serbia and in the <strong>Federation</strong> <strong>of</strong>Bosnia and Herzegovina for the implementation <strong>of</strong> the pilotGlobal <strong>Health</strong> Pr<strong>of</strong>essions Student Survey (GHPSS). Thiswas the first time that data had been collected through aninternational survey methodology to assess smoking prevalenceand knowledge/attitudes about tobacco controlamong students enrolled in health pr<strong>of</strong>essional faculties.CPHA also supported the development <strong>of</strong> a methodologyand the implementation <strong>of</strong> both a pilot and subsequent nationalstudy in Serbia on smoking prevalence and the factorsthat influence smoking behaviour and smoking cessationrelapse among pregnant and post-partum women.Carried out in association with the Ontario Tobacco ResearchUnit, this was the first project <strong>of</strong> its kind in EasternEurope, and the results are being used to develop effectivesmoking prevention and cessation programs for women.Since becoming involved in international tobacco con-33
continued from page 33trol in 1996, CPHA has supported and strengthened thework <strong>of</strong> 18 PHAs in the area <strong>of</strong> tobacco control. As part <strong>of</strong>these efforts, it has provided support for PHAs to designand implement tobacco control activities such as awarenesscampaigns; collection <strong>of</strong> quantitative and qualitativedata about youth tobacco use; strengthened advocacyfor the adoption and ratification <strong>of</strong> the FCTC and othertobacco-related policies; workplace surveys; research onpregnancy-associated smoking prevalence; and promotion<strong>of</strong> the role <strong>of</strong> traditional healers in tobacco control.In 2008, CPHA provided technical and financial supportto the PHA in Mozambique (Associação Moçambicanade Saúde Pública), which held a regional conference forPHAs in East and Southern Africa to develop a commonframework for action on tobacco control. CPHA is nowtaking a lead role within the WFPHA to revitalize the <strong>Federation</strong>’stobacco control working group as a means <strong>of</strong>expanding and strengthening efforts to involve PHAs intobacco control and support their efforts in this regard.The public health association movement has played animportant leadership and advocacy role in tobacco control.It has galvanized the public health community on theissue; conducted important research and transformedthe knowledge generated into policy and program inputs;helped to initiate and nurture alliances among diversegroups; and given voice to civil society’s perspective ontobacco control issues. Many PHA partners have pursuedsuccessful anti-tobacco efforts, among the most notablesuccess stories being Mozambique, Congo and Romania.REPUBLIC OF CONGOThe Association congolaisepour la santé publique etcommunautaire (ACSPC)organized a series <strong>of</strong>awareness-raising andtraining sessions as wellas lobbying campaigns,highlighting tobacco as a keyhealth issue.Most notably, the Associationraised the awareness <strong>of</strong>parliamentarians on theimportance <strong>of</strong> signing andratifying the FrameworkConvention on TobaccoControl (FCTC), contributingto the Government <strong>of</strong> theCongo finally signing theFCTC in March 2004 andratifying it three years later inFebruary 2007. In November2006, Mr. Georges Batala-Mpondo, Executive Director<strong>of</strong> the ACSPC, received aWHO Tobacco Day Awardfor his successful tobaccocontrol lobbying efforts.34
ROMANIAThe Romanian <strong>Public</strong> <strong>Health</strong>and <strong>Health</strong> ManagementAssociation’s (RPHHMA) antitobaccoefforts led to legislativechange on the advertising andsale <strong>of</strong> tobacco to minors andthe inclusion <strong>of</strong> health warningsin tobacco product advertising.The RPHHMA instigated itstobacco control efforts after itsPresident participated in the<strong>Health</strong> Promotion Summer Schoolin Canada in 1997.This is an example <strong>of</strong> the results<strong>of</strong> RPHHMA’s lobbying efforts forthe inclusion <strong>of</strong> health warningmessages on tobacco advertisingin Romania.The message at the bottom <strong>of</strong>the sign reads: : “Smoking is veryharmful for your health”MOZAMBIQUEThe Associação Moçambicana deSaúde Pública (AMOSAPU) is a veryactive and influential association in thearea <strong>of</strong> tobacco control in Mozambiqueand in Africa. The Association hasconducted advocacy aiming to reduceyouth tobacco use, including thesuccessful removal <strong>of</strong> billboard tobaccoadvertisements targeting children.AMOSAPU has also worked withthe Government <strong>of</strong> Mozambique toadopt and enforce tobacco controlmeasures. For example, the Ministry<strong>of</strong> <strong>Health</strong> implemented a smoke-freeenvironment and imposed similarrestrictions in other Government <strong>of</strong>fices.AMOSAPU has also encouraged theGovernment to participate in theIntergovernmental Negotiating Body(INB) <strong>of</strong> the WHO for the FrameworkConvention on Tobacco Control (FCTC).In June 2003, the Government <strong>of</strong>Mozambique signed the FCTC. A yearlater, AMOSAPU organized a workshopfor Parliamentarians to prepare for theratification <strong>of</strong> the FCTC. Later that year,AMOSAPU won an award from theWHO for its anti-tobacco lobbying work.35
Policy and Advocacy<strong>Public</strong> health associations (PHAs) play acritical role in the public health systemand in successful community and socialdevelopments by acting as a strong civilsociety voice for public health throughadvocacy activities. In their role as advocates,PHAs participate in the formulation <strong>of</strong> policiesand strategies by providing evidence-basedresearch and recommendations, representingthe views <strong>of</strong> a wide range <strong>of</strong> members andproviding an independent, non-partisan voiceon public health issues.The CPHA, through the SOPHA(Strengthening <strong>of</strong> <strong>Public</strong> <strong>Health</strong> <strong>Associations</strong>)Program, has sought not only to improvethe institutional capacity <strong>of</strong> new and existingPHAs but also to enhance their ability toparticipate in a transparent, democratic wayas civil society voices for public health. Thecontributions PHAs have made to buildingstrong and vibrant democratic societies andsound health governance should not beunderestimated.One <strong>of</strong> the contributions <strong>of</strong> the SOPHAProgram to global public health has beenits capacity to bring a multi-country voiceto the discussion <strong>of</strong> global public healthissues through strengthening PHAs andencouraging their participation in internationaldiscursive action. However, equally importanthave been the guidance and supportprovided to partner PHAs to undertakeadvocacy activities in their countries.Over the past 25 years, many <strong>of</strong> theadvocacy efforts <strong>of</strong> CPHA’s partner PHAshave resulted in policy changes and otheractions taken by public sector decisionmakersat the municipal, regional andnational levels.36
Boys Smoking, Romania. Photo credit: Matthew MoorePolicy Advocacy Initiatives by <strong>Public</strong><strong>Health</strong> <strong>Associations</strong>IndonesiaIn the early 1990s, the Indonesian <strong>Public</strong> <strong>Health</strong> Association(IAKMI) gained considerable credibility at the national levelby contributing to public health policy debate, advocacyand consensus building.In 1992, IAKMI’s commitment to providing nationalleadership and advocating for public health developmentled to its involvement in lobbying for a strategy calledthe New Paradigm in <strong>Health</strong>. This innovative conceptpromoted health as a mainstream agenda item in thenational economic development planning process.Throughout 1992, IAKMI maintained discussions at variouslevels <strong>of</strong> government, as well as with private health sectorstakeholders. Its lobby efforts were aimed at reorienting alarger share <strong>of</strong> health resources towards health promotionAdvocacy is a corefunction <strong>of</strong> publichealth associationsAdvocacy is defined as theprocess <strong>of</strong> influencing outcomes,including public policy andresource allocation decisions withpolitical, economic and socialsystems and institutions thatdirectly affect people’s lives.37
A student in the Balkans, completing the Global Youth Tobacco Survey (GYTS).and disease prevention. IAKMI’s proactive advocacywas successful in gaining support within the Ministry <strong>of</strong><strong>Health</strong>. The concept was presented to a parliamentarysub-committee that same year. In 1994 a new law waspassed that incorporated public health indicators into preinvestmentenvironmental assessment studies.IAKMI’s advocacy work contributed to building a positiveconsultative relationship with the government forpolicy analysis and development while maintaining itsindependence to debate and advocate on public healthissues. A 1994 CIDA evaluation remarked that IAKMIhad become “a highly respected source <strong>of</strong> ideas used bygovernment for consultation on public health issues”.Costa RicaThe Asociación Costarricense de Salud Pública (ACOSAP)has been active in the area <strong>of</strong> tobacco control formany years. In fact, it was the first non-governmentalorganization in Costa Rica to tackle this issue. However,ACOSAP realized that civil society group action would benecessary to build consensus and to move the nationaltobacco control agenda forward. It therefore set out todevelop a national coalition <strong>of</strong> like-minded organizations.The result?—the launch <strong>of</strong> Costa Rica’s national tobaccocontrol coalition (RENATA) in 2007.This coalition successfully generated awareness andadvocated for the government’s ratification and application<strong>of</strong> the Framework Convention on Tobacco Control (FCTC)in Costa Rica. ACOSAP’s efforts through RENATA cameto fruition on June 1, 2008, when the National Congressunanimously approved the ratification <strong>of</strong> the FCTC afteryears <strong>of</strong> unyielding advocacy efforts.Bosnia & Herzegovina (BiH)In 2009, the Partnership for <strong>Public</strong> <strong>Health</strong> (PPH), one <strong>of</strong>two PHAs in BiH active in tobacco control, released theresults <strong>of</strong> the second round <strong>of</strong> the WHO Global YouthTobacco Survey (GYTS). This international survey collectsdata on smoking prevalence, and knowledge, attitudesand practice with respect to tobacco use among youngteenagers attending school. The findings showed anincrease in smoking prevalence among youth. Forexample, between 2003 and 2008, tobacco use increasedfrom 11.9% to 14.3% among students under the age<strong>of</strong> 10 years. The GYTS results also showed that youngpeople were exposed to high levels <strong>of</strong> tobacco productadvertising as well as to second-hand smoke.In reaction to these worrying trends, the PPH establisheda partnership with the Ministry <strong>of</strong> <strong>Health</strong> <strong>of</strong> the <strong>Federation</strong><strong>of</strong> Bosnia and Herzegovina to design and implement aschool-based intervention program addressing some <strong>of</strong>the issues identified through the GYTS.PPH continues to use the results <strong>of</strong> the GYTS to advocatefor the implementation <strong>of</strong> tobacco control actions, suchas enforcing existing smoking bans in public places,supporting anti-smoking campaigns and banning the sale<strong>of</strong> tobacco to minors under the age <strong>of</strong> 18 years. The PHA<strong>of</strong> Republika Srpska played a leadership role by introducinga smoking cessation program in the medical faculty at theuniversity in Banja Luka. This program has since expandedthroughout the university and is held up as a model by theMinistry <strong>of</strong> <strong>Health</strong> for other academic institutions.38
Port au Prince, HaitiSOURCESMost <strong>of</strong> the resources consulted in the writing <strong>of</strong> this publication areunpublished documents found in the SOPHA and CPHA archives.The SOPHA team reviewed project and funding proposals, evaluations,agreements, reports and newsletters. Other information was generouslyprovided by SOPHA partners and technical advisers.For additional information, please see the published resources used inthis publication, listed below:Published Resources:Canadian <strong>Public</strong> <strong>Health</strong> Association. “A <strong>Public</strong> <strong>Health</strong> Approach for GlobalDevelopment: CPHA’s Global <strong>Public</strong> <strong>Health</strong> Strategy 2007-2017.” CPHA,2008 .CPHA <strong>Health</strong> Digest. Volumes 20-33 (Winter 1996 – Winter 2010).“Leadership in <strong>Public</strong> <strong>Health</strong>: A guide to advocacy for public healthassociations.” CPHA, 2009.Partners Around the <strong>World</strong>. Issues 1-14 (Winter 1989 – Fall 1996).Chauvin, J. et al. “<strong>Public</strong> <strong>Health</strong> Association and Civil Society’s Voicefor <strong>Public</strong> <strong>Health</strong>.” In <strong>Public</strong> <strong>Health</strong> Strategies: A Tool for RegionalDevelopment, eds. S. Scintee, et al. Lage: Hans Jacob Publishing Co.,2005.For additional information, please consult the followingPHA websites:SOPHA:sopha.cpha.caCPHA:www.cpha.caWFPHA:www.wfpha.orgSBSP (Bolivia):saludpublica.bvsp.org.bo/sbspABRASCO (Brazil): www.abrasco.org.brABSP (Burkina Faso): www.absantep.orgEPHA (Ethiopia):www.epha.org.etPJZ (FBiH, BiH):www.pjz-pph.baIPHA (Indonesia):www.iakmi.orgSMSP (Mexico):www.smsp.org.mxAMOSAPU (Mozambique): www.amosapu.org.mz/2009ANSAP (Nicaragua): www.ansap.orgUJZS (Republic <strong>of</strong> Serbia): www.ujzs.orgUJZRS (Republika Srpska, BiH): www.ujzrs.orgT-HASAK (Turkey):www.t-hasak.orgUNACOH (Uganda): www.unacoh.org48