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RESEARCH
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National Policy, Standards, Legislation & Enforcement WORKSHOP ON THE ROLE OF NON-GOVERNMENTAL ORGANIZATIONS Moderator: Dr. Carol Pertowski; Panel: Dr. H. Needleman, Dr. P. Nair, Dr. Mukhopadhyay, Mr. James Rochow, Dr. M.S. Mahadeviah The workshop started with brief presentation by some of its members, followed by discussions. James Rochow Key points presented:
- Focus more efforts on source control rather than screening.
Dr. P.P. Nair As lead is present in a number of sources, public awareness of its toxic consequences is an important part of prevention strategies, particularly in the developing world. The mother, the child, and the home are part of this picture. Therefore, it is essential to reach out to this segment of society. In order to accomplish this goal, NGOs can undertake a campaign to raise the literacy among women in rural areas, emphasizing among other things the dangers of lead exposure from domestic and environmental sources. Leaded automobile fuels constitute a major source of urban atmospheric lead. A rapid changeover to unleaded fuel should be undertaken with the help of NGOs. A creative solution to this problem should be feasible, sustainable and driven by economic considerations. The introduction of oxygenated fuels using alcohol generated from agricultural waste (as a cottage industry - reinvent bootleg producers to form cooperatives to supply the petroleum refineries) is an idea that needs serious consideration. NGOs can be constituted to develop this sector of the economy with the help of established breweries for technical assistance. Benefits are: up to 25% reduction in fossil fuel consumption nationally; clean burning fuel without lead; source of legitimate employment for a segment of society that is now considered outside the law (producers of country bootleg liquor); major savings in hard currency outlays for imported petroleum; solution to an environmental problem of agricultural waste such as ‘bagasse’ in the sugarcane industry. The automobile industry should be asked to get involved in this issue as an active participant. Their support is essential for countries in the Asian region to move towards unleaded fuels. Their motivation should be their public image as a socially conscious industry. Improving quality of life in rural Asia can occur with the active cooperation of NGOs. Infants and children are at increased risk of lead toxicity because of the persistence of secondary iron deficiency anemia caused by intestinal parasites. Public health measures to combat this scourge should include the mobilization of NGOs and health department workers to institute preventive strategies. Workshop Discussion After the two presentations, the workshop participants discussed the role of NGOs, initially in a non-structured format. The group reviewed the charge to the workshop, "To develop a plan for the implementation of a national program for lead poisoning prevention and treatment in developing countries." The participants noted that the plan should have the following characteristics: be feasible (cheap and easy to implement), sustainable, and culturally acceptable. The group then reviewed the question, "What is an NGO?" The group considered the term to apply in a broad sense. However, some members of the group noted that in India, there was a legal definition to charter NGOs. It was thought that NGOs would encompass the following: neighborhood groups, registered public trusts, agricultural cooperatives, hospitals, social service organizations, unions (although it was noted that unions may be associated with a political party), professional societies (medicine, science, engineering, teaching, law), community groups (e.g. Rotary), religious organizations, women’s organizations, e.g. Mahila Mandel, Youth Mandel.. The groups noted that NGOs should be nonprofit and that special attention should be paid to women and children. NGOs may address a specific issue, such as agriculture. The group noted possible pitfalls for NGO participation in lead poisoning prevention activities. NGOs may not yet be fully aware of all the dimensions of lead poisoning as a public health problem. NGO dollars may be directed to other, specific problems. There may be duplication of effort or fragmentation of activity and resources among NGOs. NGOs, especially those in rural areas, may be isolated. . The group noted there are three levels of prevention: personal (such as avoiding traditional medicines), policy setting, e.g. legislation regarding lead in gasoline, and implementation of policies. The group also noted the need for a center point at the national level that can help coordinate activities of the different NGOs. This center point must address a comprehensive constituency, i.e. beyond medical approaches. The center point could be a group of NGOs and other sectors such as medicine and law. The group noted that NGOs can provide expertise and guidance, but people provide the energy. NGOs should be given the opportunity to participate in policy development and in implementation. The group spent the second half of the workshop addressing the specific questions posed to the workshop:
A summary of the discussion on each question follows.
The group noted the following: hospitals and universities, unions (not all agreed), Rotary, Lions, environmental groups and women’s groups, consumer groups (not all agreed), professional societies, political groups (not all agreed), youth groups, and agricultural cooperatives. In addressing how NGOs might be engaged, the group considered the following: send a mailing to NGOs about this conference and the seriousness of lead poisoning as a public health problem; use the environmental NGO directory; establish a core group of larger NGOs that can in turn engage the smaller organizations; and use existing networks, e.g. science, awareness about AIDS, especially those at the grass roots level.
The group noted that the computer industry may have a particular interest in lead poisoning as the detrimental effects of lead on children may impact the adequacy of the workforce. The group noted that physicians may be able to mobilize and encourage lead poisoning prevention. The media can raise the legitimacy of the issue and bring a human face to the problem. The film industry may be an important partner and has already had a successful involvement in immunization promotion. The group discussed that a range of professionals, including lawyers, teachers, engineers, and industry and research associations may also be interested. The group noted that it is important to find out what the issues are for industries that use or produce lead. Some industries may be potential allies. Regarding how to engage efforts, the group cautioned that there should not be diffuse activities that do accomplish little. Access to various groups could occur through expositions or meetings sponsored by industries, and through occupational health groups.
The group discussed that NGOs can act as a bridge between people and government. The NGO infrastructure may already exist and may be well placed to provide grass-root training. Expertise gained by NGOs working in other public health areas such as immunization may be used in lead poisoning prevention efforts at the grass-root level. NGOs can serve as advocates for lead poisoning prevention activities, help determine priorities, and monitor the progress of prevention and treatment activities. NGOs can also help evaluate other sources of lead exposure such as pesticides and toxic waste (either domestic or imported waste). NGOs can help harness market forces and help address the Indian system of medicines that use lead. They can provide education to practitioners directly. Other roles for NGOs include: resource mobilization, serving as a "watch-dog" or "pressure group", information dissemination, and sentinel surveillance. An important role for NGOs is education and training. Educational activities can include both health care providers and general public. For specific risk areas such as cottage industries, NGOs can provide information for policy development at local, state, and national levels. NGOs have also played a role in public interest litigation. NGOs can help explain economic benefits to the general population. NGOs can also serve as a liaison to other influential groups such as the film industry. NGOs can play a role in networking with international counterparts. The group noted that through planning and implementation of this conference, The George Foundation has already shown the ability to assemble experts in lead poisoning prevention. The George Foundation could possibly play a role in coordinating NGO activities at the national level, but it should broaden its constituency and cover comprehensive activities in lead poisoning prevention.
The private sector has a crucial role to play in the implementation of government policy. They may be able to interact more directly with politicians. Private organizations may also be able to develop specific control measures affecting their constituents. The workshop participants noted that the private sector may have resources that are not available to those in the public sector. Private organizations may also be able to support research directly and to explore alternatives to lead such as oxygenated fuels. They may be able to involve themselves in environmental and social auditing of prevention measures. As with NGOs, the private sector has a role in educational activities at both local and national levels. They may be able to raise public awareness directly. Certain private groups may be able to pursue occupational health activities and to encourage industry to publicize good practices. What is the best mechanism for coordinating NGO, foundation, and private sector activities with government initiatives? The group noted that NGOs should coordinate their activities among themselves. They can then engage the government and private organizations, as well as other partners in prevention. The group envisioned the government, the private sector, and the NGOs as three points of a triangle, with each having its own activities, but working in a coordinated manner with the other two. The group stated a need for a coordinating agency or core group to facilitate the interaction and provide feedback to the groups. A directory of involved organizations would be a helpful start for the collaboration. Also, some type of system to monitor the progress and effectiveness of the coordination should be developed. |