English - World Federation of Public Health Associations

12(1) Supervisor training program (1983), a partnering projectbetween the Sudanese Society of Social and Preventive Medicine(SSSPM) and CPHA.(2) Review & Evaluation Committee and CPHA staff meeting 1993:Back row: Dr. Jean Larivière (CPHA member and Health 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 Health Secretariat Director); Hélène Delisle (CPHAmember on REC); Dr. Pierre Duplessis (CPHA member on REC);Dr. Ed Ragan (CIIP Director).marked the beginning of global recognition of 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 of CPHA’scontribution to the strengthening of national immunizationprograms and health systems as a means of 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 of Canadathrough CIDA, CIIP would contribute to expanding theimmunization coverage of vaccine-preventable diseasesand strengthening the national Expanded Program onImmunization in over 80 countries. Since 1998, CPHA hasbeen managing the Technical Assistance and CanadianAwareness components of two phases of the CanadianInternational Immunization Initiative (CIII). Now in itssecond phase, this partnership of the Canadian governmentwith WHO, the Pan American Health Organization,UNICEF, CPHA and the Global Health Research Initiativeat the International Development Research Centre(IDRC) supports the eradication of polio, elimination ofneonatal tetanus, control of measles, and strengtheningof immunization and disease surveillance systems in lowandmiddle-income countries.6

© ACDI-CIDA/Dave Trattles3 4In 1989, CPHA’s Board of Directors convened a TaskForce on the Sustainable Development of Primary HealthCare Services in Developing Countries. This initiative wasundertaken to address concerns about the direction ofdonor-driven health reform initiatives being implemented indeveloping countries in response to structural adjustmentstrategies endorsed by global financial institutions, such asthe World Bank.The output was the CPHA position paper entitledSustainability and Equity: Primary Health Care in DevelopingCountries. In it, CPHA reaffirmed its commitment to thegoals and values articulated in the Declaration of 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 of its Board ofDirectors, which resulted in an increased commitment tointernational health activities. This included the creationof an elected representative on its Board specificallyresponsible for international health, as well as theestablishment of 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 of large international health projects. The first of(3) Community public health educators trained through theReproductive Health 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 of Jamaica from Dr. LouGrant to commemorate the successful twinning program betweenthe Regional Health Unit of Haldimand-Norfolk, Ontario, and theSt. Ann Board of Health 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 of 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 of 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 of that country’s national public healthassociation (1991–1998); reproductive healthprojects in Malawi and Zambia (1996–2006);and the Romania Adolescent Health 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 of health promotion capacityand the introduction of an intersectoral approachfor health in Brazil (1999-2010), and contributedto increasing access to and quality of maternal/child health services in a remote region ofArgentina (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 memberof the WFPHA’s Executive Board on severaloccasions, and on two occasions CPHA heldthe position of WFPHA President: Gerry Dafoe(CPHA’s Executive Director between 1973 and2004) from 1978 to 1980 and Margaret Hilson(Director of CPHA’s Global Health Programsbetween 1985 and 2005) from 1999 to 2001.CPHA has also played a major role in helpingto strengthen the Federation’s governance andoperational capacity, and has contributed toseveral WFPHA position papers and statementson public health issues.In May of 1992 CPHA was awarded theSasakawa Health 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 of the changing internationalhealth environment, CPHA produced a 10-yearstrategic plan for its global health activities. APublic Health Approach for Global Development(CPHA’s Global Public Health Strategy 2007-2017) defines the goal of 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 of a strong, competent,international public health community. TheSOPHA Program remains the cornerstone ofCPHA’s global health strategy.9

The History of theStrengthening of PublicAssociations ProgramFor 25 years the Canadian Public HealthAssociation (CPHA) has supported theestablishment and organizational developmentof 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 ofprofessional licensing, certification or self-interest.They enhance and reinforce the role of civil societyand raise the level of awareness and understandingof the impact of public policy on human health andwell-being.The purpose of the SOPHA (Strengthening of PublicHealth Associations) Program is to strengthen theorganizational and performance capacity of professionalvoluntary 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 professionalassociations 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

HealthThe 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 strengtheningof public health associations. This permitted CPHAto establish an International Health 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 of 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 of the PHAs and theirown public health projects, which dealt with occupationalhealth and safety, human resources training, reproductivehealth, care of the elderly and health promotion.At the end of this initial phase of the Block FundingProgram in 1988 CIDA applauded the successesachieved and the contribution that CPHA had made to theexpansion of the global community of PHAs. This wasjust the beginning.11

BOLIVIA 1986-1995The Sociedad Boliviana de SaludPública (SBSP) was created in1958 and was one of CPHA’sfirst public health associationpartners. CPHA received SBSP’sfirst project proposal in 1985 foran initiative designed to increasethe visibility of and improvelocal response to occupationalhealth and safety (OHS) in Bolivia.Studies done by the NationalInstitute of Occupational Health(INSO) found a high frequencyof occupational hazards andassociated ill health amongBolivian workers in the mining,agricultural and manufacturingindustries. The objectives of theproject were to respond to theseOHS challenges by establishingan educational network betweenthe higher education system andthe Ministry of Health; 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 of and meansto improve the OHS situation formany Bolivian workers.PALESTINIAN TERRITORIES1993- 1998The signing of the Oslo Accordsbetween Israel and the PalestinianLiberation Organization inSeptember 1993 created anew environment within whichinitiatives to enhance the capacityof Palestinians to improve thehealth and well-being of 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 of publichealth professionals 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 of 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 of partnerships and an expansion of 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 of the Congo). Another notable andnew element in the program was the support provided for the establishment ofa regional PHA in Africa. The Eastern, Central, Southern African Public HealthAssociation (ECSAPHA) was officially inaugurated in 1990 under the leadershipof the Tanzania Public Health Association with the technical and financialsupport of CPHA and the Commonwealth Secretariat.The third and final phase of 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 of this phase, 13 ofthe 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 of the World Federation of Public Health Associations(WFPHA), which brought them into the global public health movement.

Mr. Ali Juma, Vice-President of theUnited Republic ofTanzania, opens theWFPHA 8 th PublicHealth Congress(Tanzania)October 13, 1997(LEFT) Membersof SOPHA publichealth associationpartners and CPHAstaff, WFPHA 7 thWorld 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 World 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 World Congressof the WFPHA, hosted by the Indonesian Public HealthAssociation). The theme of both workshops wasStrengthening our Associations. 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 of the third phase of the Block FundingProgram gave CPHA cause to reflect on what had beenachieved over the previous 10 years. This initiativehad succeeded in increasing the number of PHAs inAfrica, Asia, Latin America and the Caribbean. ThroughCanada’s support, the organizational and programmaticcapacity of 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 ofthis initiative was consistent with the aims of CPHA’sother international initiatives: to build local organizationalcapacity and competence for sustained, equitable and realimprovement in the health and well-being of all people,based upon the principles enunciated in the Alma AtaDeclaration and the CPHA position paper on Sustainabilityand Equity: Primary Health 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 PublicHealth Association (PPHA)was officially established as ademocratic, multi-disciplinary andmembership-based associationwith several branches. The PPHAorganized seminars, scientificconferences and meetings, anddisseminated information aboutdomestic and internationalpublic health issues. It developedprofessional relationships withother NGOs, academic institutionsand the Ministry of Health.It worked to raise awarenessof and assist in implementingservices to address the healthneeds of 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 Ministryof Health in its women’s healtheducation program.ETHIOPIA 1994- 2003Created in 1989 with amembership of 40 dedicatedhealth professionals, the EthiopiaPublic Health 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 of Health Development)and its newsletter (Felene Tega)was enhanced, and the qualityof EPHA’s Annual ScientificConference and continuingeducation programs wereimproved. EPHA conducted manyseminars and workshops on a widerange of 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 of the Tillaberi branch of the Association nigérienne pour la promotiion de la santé publiqueGiven the central focus of the initiative, CPHA changed the name to betterreflect its intention. The Strengthening of Public Health Associations (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 of interest. This strategyalso facilitated synergies in the Program and among partners as the number ofPHAs included in the Program increased.The first phase of 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 of SOPHAFaso, Ethiopia and Niger). This phase markedthe beginning of an increasing number ofAfrican 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 Public Health Association successfullyhosted the 8th WFPHA International PublicHealth 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 of many years of technicaland financial support to PHAs. Some partnershad clearly enhanced their organizationalcapacities, attracted other sources of 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 PublicHealth Association and the National HealthAssociation of 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 of “SOPHA Graduates” wasadopted to refer to the more mature andexperienced PHAs, which would mentoremerging ones. This strengthened the “southsouth”technical cooperation aspect of theProgram.The next phase of the SOPHA Program (1998–2001) saw new PHAs replace the SOPHAgraduates in the Program. They includedthe PHAs of Cuba, Haiti, Mozambique andPakistan. Nevertheless, the recently graduatedpartners continued to play a role in mentoringnew PHAs in their regions.In 2000, at the time of the 9 th WFPHAInternational Public Health Congress, heldin Beijing, a call to action was made thatemphasized the goal of a reduction of healthdisparities and the elimination of healthinequities. CPHA and its SOPHA partnersgained a renewed sense of purpose as globalactors to address these international healthchallenges and were inspired to adopt a globalfocus within the Program’s next phase.The third phase of the SOPHA Program(2001–2006) covered a 5-year period, allowingan expansion of the number of partner PHAs.This phase involved a total of 10 partnerPHAs, including emerging associations in theRepublic of Congo and Malawi. The continuedeffectiveness and relevance of SOPHA’ssupport and collaboration became evident withthe graduation of Ethiopia in 2003, Uganda in2005, and subsequently Burkina Faso and Cubain 2006. SOPHA had developed a set of toolsto assist PHA partners to assess and determineMembers of theTanzania PublicHealth Associationon an educationalfield trip to the locallandfill15

continued from page 14projects with other organizationsand institutions. In the mid-1990s,the Transitional Governmentof Ethiopia invited EPHA to beinvolved in the preparation ofseveral 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 WorldCongress on Public Health, 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 of 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 of the preparation of 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 of 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 of 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 of 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 ofhealth and international agencies. The SOPHAProgram has contributed to a strengthening ofthe global PHA movement by sponsoring andsupporting membership of PHAs from low- andmiddle-income countries in the WFPHA and theparticipation of PHA members at internationalpublic health fora. Although the current phaseof the SOPHA Program will come to an end inDecember 2011, its legacy will endure throughthe actions of many PHAs around the world.Strengthening Public Health Associationsin 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 of Foreign Affairs and InternationalTrade (DFAIT), IDRC and CIDA’s bilateralprogram funding mechanism. Although notmanaged directly under the rubric of theSOPHA Program, these initiatives were directlylinked to the Program’s objectives and modusoperandi.The first of these initiatives led to theestablishment in 1992 of the Turkish PublicHealth Association (HASAK). Originally formedas the public health section of the TurkishMedical Association, HASAK evolved quicklyas an independent multi-disciplinary PHA. Itidentified tobacco control and mother/childhealth promotion as two areas of focus. Overthe past 17 years, HASAK has evolved into animportant voice for public health in Turkey andis a member of several coalitions addressingpublic health issues. It became a memberof the WFPHA in the mid-1990s and in 2009hosted the 12 th WFPHA World Congress onPublic Health.The political and economic transformation inEastern and Central Europe in the early 1990soffered 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 memberof 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 Health Care (September 2008)UNACOH HOSTS MPHADELEGATES IN KAMPALAThe Uganda National Associationof Community and OccupationalHealth (UNACOH), a SOPHAgraduate, hosted three delegatesfrom the Executive Committeeof the Northern Branch of theMalawi Public Health Association(MPHA) in September 2008.The purpose of the visit was tostrengthen the organizationalcapacities of 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 deliveryof a paper on water and sanitationto an audience of 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 of the nascent non-governmental sector. In 1992, in collaborationwith a small group of public health professionals in Romania, CPHA launcheda project that would result in the establishment of the Romanian Public Healthand Health 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 Public Health 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 of the Oslo Accords, CPHA was engagedby Canada’s Department of 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. Health was the one topic that could bring the two sidestogether to look at areas of peace building. It was the start of CPHA’s interestand commitment to health as a catalyst for conflict resolution.Through this process, CPHA met several public health professionals18

SOPHAPROGRAM THEMESfrom 1995-2010PHASE I 1995-1998From the 1994 Partners Aroundthe World workshop PHApartners highlighted threepriority themes for action:health reform; health andthe environment; healthpromotion and social justice.This phase also placedemphasis on the theme ofWomen in Development.Beginning in this phase genderequity was to be incorporatedas a theme in the subsequentphases of the SOPHA Program.PHASE II 1998 -2001(TOP) Epi Info (statistical software for epidemiology) training by CDC’s Office on Smoking &Health 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 of contributing to building a publichealth movement for the Palestinian people. The Palestinian Public HealthAssociation (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 of military hostilities in the countries of theformer Yugoslavia, CPHA became one of several Canadian organizationsto provide technical assistance in the rebuilding of the Balkans region’shealth sector. Initially CPHA managed a program in Kosovo that contributedto the reconstruction of health facilities and the training of a new cadreof public health practitioners. The program also included the founding ofthe Kosovo Public Health Association. Shortly thereafter, CPHA launcheda new regional initiative to strengthen essential public health functions inSerbia, Montenegro, the UN-administered province of Kosovo, Bosnia andHerzegovina, and Albania. This CIDA-funded initiative, which came to an endin December 2009, supported the establishment and organizational nurturingof PHAs in the Republic of Serbia (the Public Health Association of Serbia,launched in October 2004) and in Bosnia and Herzegovina (the Partnership forPublic Health of the Federation of BiH and the Public Health Association ofRepublika 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 of the FrameworkConvention on Tobacco Control.PHASE III 2001-2006PHAs focused their workon transnational issues ofglobalization, tobacco controland essential public healthfunctions.PHASE IV 2006-2011The partner PHAs met duringthe WFPHA’s InternationalCongress in August 2006and selected the theme ofstrengthening the publichealth workforce for this phasein recognition that a strong,effective global health workforce is essential to achievethe Millennium DevelopmentGoals.19

African RegionalPublic Health AssociationNetworksRegional networks of 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 of 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 of 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 of two regionalnetworks of public health associations in Africa:The East, Central and Southern African PublicHealth Association (ECSAPHA) and more recently,the Réseau des associations de santé publiqued’Afrique francophone (RASPAF).The East, Central and Southern AfricanPublic Health 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 ofthis meeting, the official inauguration and adoptionof ECSAPHA’s constitution took place 2 yearslater in a meeting hosted by the Zimbabwe PublicHealth 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.Professor Wen Kilama of the Tanzania Public HealthAssociation (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 of Community and Occupational Health20

Participants of the ECSAPHA Revitalization Workshop in Entebbe, Uganda, April 2007. Shannon Turner (pictured front row, third from left), from the Public HealthAssociation of British Colombia was the main facilitator of 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 HealthSecretariat for East, Central and Southern Africa in orderto support the establishment of ECSAPHA and promotethe formation of national publichealth associations in theregion.The reason for the creationof 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 of 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 of 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 WorldPublic Health 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 organizationof 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 World Congress on PublicHealth 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 of a network of 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 of mutual interestin their own language and advocate for and support theexchange of resources in French. The first meeting ofPHAs 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 World Congress on PublicHealth, held in Brighton (UK), strategic discussionsfirst started about the formation of a francophone PHA21

(LEFT) Participants of 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 of 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 of the publichealth movement in Francophone Africa, organize a PHAnetwork and develop a plan of action. This would alsobe an opportunity to address the under-representation offrancophone African PHAs in international meetings andin international organizations like the WFPHA.ECSAPHA and RASPAFjoin their effortsThe RASPAF aims to create an environmentfavouring the expansion of the publichealth movement in Francophone Africa.The Network also creates an opportunityto address the under-representation ofFrancophone Public Health Associations ininternational meetings and organizations.PHA meeting which resulted in a continental Declarationof Commitment of African Public Health AssociationNetworks for the revitalization of primary health care(PHC) signed by a total of 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 of PHC;and 4) empowering membersof the community to participatein their own public healthinterventions/initiatives.Members of 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 of 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 of governance, human resource, andconnectivity challenges, the regional PHAs are networksthat build collaboration in public health among Africancountries ...”The inauguration workshop of RASPAF and therevitalisation of 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 HealthCare and Health Systems in Africa, in Ouagadougouin April 2008. Representatives from both RASPAF andECSAPHA participated in this conference and parallelAt the end of 2009, both ECSAPHA and RASPAF werepursuing the goal of an African Public Health Federation.The next World Congress on Public Health will be hostedby the Ethiopian Public Health 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 Federationsince 1973. Over its 37 years ofinvolvement with the Federation, 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 ofCPHA’s Global Health Programs, MargaretHilson [1999–2001]). CPHA hasalso assisted WFPHA to develop andrevise its by-laws and recently has takenthe lead in establishing and chairingthe Federation’s Finance Committee.CPHA has been a member of WFPHA’sExecutive Board on several occasions,most recently over the period 2006–2011, and has played an important rolein the development of the Federation’sstrategic plan. It has also been activelyinvolved in the revitalization of the WF-PHA’s tobacco control working group.In 1978 the World Health Organization(WHO) and the United NationsChildren’s Fund (UNICEF) asked theWFPHA to prepare a position paperdiscussing the position of health sectornon-governmental organizations(NGOs) on the principles of primaryhealth care. CPHA collaborated withover 100 other NGOs to prepare thepaper, The Role of Non-GovernmentalOrganizations in Achieving Health for allby the Year 2000. Gerry Dafoe made aplenary presentation on this topic at theWHO/UNICEF International Conferenceon Primary Health Care in Alma Ata inSeptember, 1978. WFPHA’s presentationbecame an integral contribution tothe Declaration of Alma Ata, a majorlandmark document that set the globalgoal of Health for All.In its presidency of the Federation duringthe WFPHA Public Health Congressin Beijing, in 2000, CPHA hosted an invitationalhigh-level Leadership Forumwith 20 participants representing allregions of the world. The significanceof the global objective of Health for Allby Year 2000, as given in the Declarationof Alma Ata, the gains made since1978, the opportunities missed and thechallenges for the future were all debated.The Leadership Forum draftedthe Federation’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 Federation’s 38 th AGM in Brighton (UK), 2004was subsequently ratified by the entirebody of the Congress and disseminatedto all participating countries. Thislandmark event marked a turning pointin consolidating the Federation’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 World Congress on PublicHealth in Halifax, Canada. Over theyears, several national PHAs, whichwere also SOPHA partners, have hostedthis important international event. In1994, the WFPHA Global Public HealthCongress was hosted by the IndonesiaPublic Health Association, in Bali; in1997, the Tanzania Public Health Associationhosted the first WFPHA Congressin Africa, in Arusha; and in 2009,the Turkish Public Health Associationhosted the 12 th WFPHA Congress in Istanbul.The next congress, in 2012, willbe hosted in Addis Ababa by the EthiopianPublic Health Association, anotherSOPHA Program graduate.Through the SOPHA Program, CPHAhas made a substantial in-kind contributionto the Federation. 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 of the WFPHA through itslong-term commitment to the buildingof a global civil society voice for publichealth.The WORLD FEDERATION OFPUBLIC HEALTH ASSOCIATIONS(WFPHA), founded in 1967 inGeneva, Switzerland, is theonly worldwide professionalsociety representing andserving the broad area of publichealth and the community ofnational and regional publichealth associations (PHAs) andaffiliated organizations. Today,the WFPHA counts more than 50members, including national andregional PHAs as well as regionalassociations of schools of publichealth. For more information,please visit: www.wfpha.org23

OccupationalHealth and SafetyCPHA’s initial international projectsfocused on occupational health andsafety (OHS). Its first internationalpartnership with a public health associationbegan in 1982 with the Sudanese Societyof Preventive and Social Medicine (SSPSM).It was a 3-year project to examine theextent of workplace accidents and illnessesin small industries and farms, and to trainemployees as OHS supervisors. Anotherobjective of the project was to strengthenthe capacity of 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 of workplace safety legislation,the opening of on-site OHS clinics staffedby full-time physicians and nurses, thedelivery of seminars and training sessionsfor both employees and employers andthe provision of OHS resources and safetyequipment for workers. These projectsaddressed both urban industrial and ruralagricultural workplaces, and saw markedimprovements in the health and well-beingof labourers in both sectors.27

A Colombian textilesmanufacturing plant,one of the participantindustries in ANDI’s OHSprojectWorkplaceaccidentswereconsideredto beamong theleadingcauses ofdeath inColombiain the early1980s.COLOMBIAOccupational Health DevelopmentProgram for Industry(1983 - 1990)Workplace-related accidents wereconsidered to be among the leading causesof death in Colombia in the early 1980s.In addition, more than half of 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 Healthand Safety Committee of the AsociaciónNacional de Industriales (ANDI) beganimplementing an Occupational HealthDevelopment Project for Industries inColombia. This initiative was funded bythe Canadian International DevelopmentAgency. The major foci of the project wereto develop occupational health programs inseveral pilot sites, to provide professionaldevelopment opportunities for occupationalhealth personnel and to strengthenANDI’s organizational capacity to convinceindustries to develop and implement OHSprograms. All of these objectives wereachieved by the project’s completionin 1985. Dr. Jorge Segovia, a technicaladviser to the project, reported that “skilledprofessionals have been trained and arenow in place in Colombia, professionalswho are playing an increasingly importantrole in developing occupational health andsafety programs.”The second phase of the project, from1986 to 1990, focused on improving OHSconditions in the industrial sector throughorganizational development, manpowertraining and research. As a result of theproject’s first phase, several educationalinstitutions had introduced OHS elementsinto the teaching curriculum of healthrelatedprofessional 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 of 14 non-governmentalmembers of Colombia’s National RegulatoryHealth Commission (Comisión Reguladorade Salud).28

INDIAOccupational Health Development Project(1984 - 1987)CPHA’s third occupational health project beganin 1984 in India. The project was developedand implemented in partnership with theConfederation of 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 of health servicesin the workplace. Through the project CEIpromoted and facilitated the developmentand implementation of 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 of theproject in 1987 found that it had achievedmost of its objectives. A network of individualswith expertise in OHS, capable of pursuingOHS initiatives, was created and nurtured.Moreover, the INDAL Occupational Health 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 of OHS expertise andresources.1 Formerly known as the Association of Indian Engineering Industry.(TOP) The worker’s lunch room, prior tothe establishment of OHS practices andregulations. According to the trip reportof 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 of the Association ofIndian Engineering Industry at a ceremonycommemorating the opening of 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 Health Programsin Rural Communities(1992 - 1995)In its second partnership with the NationalHealth Association of Thailand (NHAT)through the Block Funding mechanism,CPHA supported a small project thataddressed occupational health in villagecottage industries. Development ofsmall enterprises had been encouragedin Thailand’s rural areas as a means todiversify and increase sources of revenue.Although income was being generated,workers were being exposed to healthhazards as a result of manufacturingprocesses in village-based cottageindustries. The NHAT initiative identifiedand addressed occupational healthproblems of 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 of newtools and technologies, as well as theanalysis of 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 of PublicHealth agreed to continue funding the pilotinitiative and scale it up after the CPHA-NHAT partnership concluded in 1995.30

EGYPTIndustrial Health 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 Health (ASOSH). The project’s goal wasto strengthen the organizational capacityof 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 developmentof a curriculum and training for industrialand agricultural safety supervisors; and thedevelopment of 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 of 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 of OHS issues through conferences and thepublication of several newsletters. ASOSH had alsoincreased its membership.Between 1992 and 1995 CPHA renewed its partnershipwith ASOSH under the Block Funding program insupport of a project to expand and strengthen trainingand advocacy for OHS legislation in the agriculturalsector. The project was particularly successful in thatit influenced the Ministry of Health to recognize theimportance of expanding OHS to agriculture sectorworkers.DOMINICAN REPUBLICOccupational Health 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 of workers in industrial tax-freezones as well as of Haitian sugar cane workersby advocating for workers’ rights and theformulation and application of 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 of 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 Publica, depicting an average day in the life of 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 of preventing tobaccouse among youth. After nearly four decades of work in thenational arena, CPHA took its tobacco control expertise tothe international sphere in the 1990s.In 1994, at the second Partners Around the World 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 ofthe groups represented at the workshop (in particular, thePHAs of Costa Rica, Russia and Tanzania) are acknowledgedin their respective nations as leaders in the field oftobacco control.CPHA subsequently expanded its involvement in internationaltobacco control. In 1999, it became an associatepartner with the World Health 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 of 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 World Federation of PublicHealth Associations (WFPHA) to organize an internationalworkshop on Tobacco and Smoking as a Public Health Issueat the 9 th World Congress on Public Health in Beijing.The workshop informed national PHAs around the worldabout the need for strong advocacy by the public healthcommunity for the adoption of the Framework Conventionon Tobacco Control (FCTC). Since FCTC’s implementationin February 2005, CPHA has been actively supportingthe efforts of PHAs in Africa, Asia and the Americas tostrengthen local advocacy for and action on the ratification,implementation and monitoring of the FCTC.Tobacco control was one of 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 ofPHAs in Central and Eastern Europe, most recently in theBalkans region.CPHA provided technical and financial support to researchteams in the Republic of Serbia and in the Federation ofBosnia and Herzegovina for the implementation of the pilotGlobal Health Professions 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 professional faculties.CPHA also supported the development of a methodologyand the implementation of 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 of 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 of 18 PHAs in the area of tobacco control. As part ofthese efforts, it has provided support for PHAs to designand implement tobacco control activities such as awarenesscampaigns; collection of quantitative and qualitativedata about youth tobacco use; strengthened advocacyfor the adoption and ratification of the FCTC and othertobacco-related policies; workplace surveys; research onpregnancy-associated smoking prevalence; and promotionof the role of 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 Federation’stobacco control working group as a means ofexpanding 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 ofawareness-raising andtraining sessions as wellas lobbying campaigns,highlighting tobacco as a keyhealth issue.Most notably, the Associationraised the awareness ofparliamentarians on theimportance of signing andratifying the FrameworkConvention on TobaccoControl (FCTC), contributingto the Government of theCongo finally signing theFCTC in March 2004 andratifying it three years later inFebruary 2007. In November2006, Mr. Georges Batala-Mpondo, Executive Directorof the ACSPC, received aWHO Tobacco Day Awardfor his successful tobaccocontrol lobbying efforts.34

ROMANIAThe Romanian Public Healthand Health ManagementAssociation’s (RPHHMA) antitobaccoefforts led to legislativechange on the advertising andsale of tobacco to minors andthe inclusion of health warningsin tobacco product advertising.The RPHHMA instigated itstobacco control efforts after itsPresident participated in theHealth Promotion Summer Schoolin Canada in 1997.This is an example of the resultsof RPHHMA’s lobbying efforts forthe inclusion of health warningmessages on tobacco advertisingin Romania.The message at the bottom ofthe sign reads: : “Smoking is veryharmful for your health”MOZAMBIQUEThe Associação Moçambicana deSaúde Pública (AMOSAPU) is a veryactive and influential association in thearea of tobacco control in Mozambiqueand in Africa. The Association hasconducted advocacy aiming to reduceyouth tobacco use, including thesuccessful removal of billboard tobaccoadvertisements targeting children.AMOSAPU has also worked withthe Government of Mozambique toadopt and enforce tobacco controlmeasures. For example, the Ministryof Health implemented a smoke-freeenvironment and imposed similarrestrictions in other Government offices.AMOSAPU has also encouraged theGovernment to participate in theIntergovernmental Negotiating Body(INB) of the WHO for the FrameworkConvention on Tobacco Control (FCTC).In June 2003, the Government ofMozambique signed the FCTC. A yearlater, AMOSAPU organized a workshopfor Parliamentarians to prepare for theratification of the FCTC. Later that year,AMOSAPU won an award from theWHO for its anti-tobacco lobbying work.35

Policy and AdvocacyPublic 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 of policiesand strategies by providing evidence-basedresearch and recommendations, representingthe views of a wide range of members andproviding an independent, non-partisan voiceon public health issues.The CPHA, through the SOPHA(Strengthening of Public Health Associations)Program, has sought not only to improvethe institutional capacity of 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 of the contributions of the SOPHAProgram to global public health has beenits capacity to bring a multi-country voiceto the discussion of 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 of theadvocacy efforts of 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 PublicHealth AssociationsIndonesiaIn the early 1990s, the Indonesian Public Health 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 Health. This innovative conceptpromoted health as a mainstream agenda item in thenational economic development planning process.Throughout 1992, IAKMI maintained discussions at variouslevels of government, as well as with private health sectorstakeholders. Its lobby efforts were aimed at reorienting alarger share of health resources towards health promotionAdvocacy is a corefunction of publichealth associationsAdvocacy is defined as theprocess of 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 ofHealth. 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 of ideas used bygovernment for consultation on public health issues”.Costa RicaThe Asociación Costarricense de Salud Pública (ACOSAP)has been active in the area of 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 of like-minded organizations.The result?—the launch of Costa Rica’s national tobaccocontrol coalition (RENATA) in 2007.This coalition successfully generated awareness andadvocated for the government’s ratification and applicationof 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 of the FCTC afteryears of unyielding advocacy efforts.Bosnia & Herzegovina (BiH)In 2009, the Partnership for Public Health (PPH), one oftwo PHAs in BiH active in tobacco control, released theresults of the second round of 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 ageof 10 years. The GYTS results also showed that youngpeople were exposed to high levels of tobacco productadvertising as well as to second-hand smoke.In reaction to these worrying trends, the PPH establisheda partnership with the Ministry of Health of the Federationof Bosnia and Herzegovina to design and implement aschool-based intervention program addressing some ofthe issues identified through the GYTS.PPH continues to use the results of the GYTS to advocatefor the implementation of tobacco control actions, suchas enforcing existing smoking bans in public places,supporting anti-smoking campaigns and banning the saleof tobacco to minors under the age of 18 years. The PHAof 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 of Health for other academic institutions.38

Port au Prince, HaitiSOURCESMost of the resources consulted in the writing of 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 Public Health Association. “A Public Health Approach for GlobalDevelopment: CPHA’s Global Public Health Strategy 2007-2017.” CPHA,2008 .CPHA Health Digest. Volumes 20-33 (Winter 1996 – Winter 2010).“Leadership in Public Health: A guide to advocacy for public healthassociations.” CPHA, 2009.Partners Around the World. Issues 1-14 (Winter 1989 – Fall 1996).Chauvin, J. et al. “Public Health Association and Civil Society’s Voicefor Public Health.” In Public Health 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 of Serbia): www.ujzs.orgUJZRS (Republika Srpska, BiH): www.ujzrs.orgT-HASAK (Turkey):www.t-hasak.orgUNACOH (Uganda): www.unacoh.org48