“We will have to put poor people from affected communities at the centre of our response. We will have to organise and mobilise. And then be willing to hold our governments to account.”

~ Anele Yawa, General Secretary of the Treatment Action Campaign

A turning point for tuberculosis?

This could be a big year for tuberculosis. In November of last year, health ministers from over 100 countries convened in Moscow and produced “the Moscow Declaration to End TB,” a document that many saw as a potential turning point in an otherwise largely complacent response to one of the greatest human rights issues of our time.

The Moscow Declaration called for the United Nations to hold what is called a “High Level Meeting.” High Level Meetings have historically seen UN member states come together and make major commitments on various social issues. The High Level Meeting on TB will take place in September of this year and its outcomes will likely plot the course of the TB response for years to come.

The Moscow Declaration also called on the World Health Organisation to develop an “Accountability Framework for the TB Response;” the framework is meant to guide the next era of the TB response and ensure accountability for outcomes of the High Level Meeting. The WHO recently published its draft of the framework and invited public comment.

We were surprised to see that the draft framework does not make any mention of a role for people affected by TB. It does not understand accountability as being owed to and fought for by people and communities impacted by TB and so fails to include the very people it is meant to serve.

Rather, the draft framework sees accountability as existing primarily between the “global” and “national” levels; that is to say, between member states to the WHO and UN as a collective and member states individually. To its credit, the draft envisaged a role for “civil society,” but seemed to relegate that role to consultation, participation in review bodies, and reporting to the WHO and UN. Again, it did not see accountability as being owed to civil society.

The question of leadership

The history of all struggle for justice teaches that no person can give liberation to another. Thus, movements the world over must wrestle with whether and how to work with those outside their immediate struggles. Many find they must confront not only those who explicitly seek to oppress them but also those who purport to help them.

The conversation is relevant to the global response to tuberculosis, because, while it is the poor who are directly impacted, the response undeniably demands funding and other support from richer countries and global entities such as the United Nations and World Health Organisation.

Therefore, this is the question: Can the global health world imagine a TB response focused on lifting up and deepening relationships with those most affected by TB and committed to supporting and following their leadership?

Today’s great civil rights leader Rev. Dr. William J. Barber, II – known for the Moral Monday movement and now the Poor People’s Campaign; A National Call for A Moral Revival – shows an approach. He preaches the necessity of a “fusion movement” that brings everyone along in the struggle for justice, but that is led, as a matter of morality, by those most impacted by systemic racism, poverty, the war economy, and ecological devastation.

Following the lead of those most impacted does not abdicate the responsibility of international bodies, governments and civil society. Quite the opposite: it ensures real accountability. Anele Yawa, the great activist and General Secretary of the Treatment Action Campaign, a poor-people’s movement in South Africa, says that in order to win the fight against TB:

“We will have to put poor people from affected communities at the centre of our response. We will have to organise and mobilise. And then be willing to hold our governments to account.”

The role of the World Health Organisation

The O’Neill Institute’s submission on the WHO’s draft accountability framework encouraged the WHO to view accountability as being owed primarily to the affectedand therefore to put poor people from affected communities at the center of the framework and empower their efforts to hold their governments to account. An accountability framework that does this, we argue, must understand the affected as the leaders of the response and enable their efforts to seek accountability through advocacy, organizing, mobilization, whistleblowing, litigation, the use of other domestic enforcement mechanisms, and other uses of the law.

We also pointed out that communities and activists on the ground are the most effective in securing accountability, yet their efforts are desperately underfunded—as Yawa argues, we won’t win unless we fund the fight from the ground up. The WHO can help by producing an accountability framework that encourages funding commitments channeled to the local level, where rights are most directly fulfilled or violated and where communities struggle every day to claim rights and hold the TB response to account.

The accountability framework must, in other words, help people impacted by TB lead the fight against it.
Leader of the Student Nonviolent Coordinating Committee Stokely Carmichael wrote in his definitive 1966 essay on black power, What We Want:

“An organization which claims to be working for the needs of a community … must work to provide that community with a position of strength from which to make its voice heard.”

The WHO has an opportunity to do as Carmichael, Barber and Yawa advise. This could be a big year for tuberculosis—the WHO has a role in charting a new way forward for international public health. Those in charge of drafting the accountability framework will soon produce a new, finalized accountability framework for the TB response—we will soon know whom the WHO has chosen to put in a position of strength. Which voices will we hear?