BEARR Trust Annual Conference 2011
So much, so little: progress and prospects in health, welfare and the role of NGOs
The theme of this year’s conference was chosen to reflect the 20th anniversary of the founding of the BEARR Trust and the collapse of the Soviet Union. The idea was to assess what had happened over those years in health and social welfare policies in the countries which emerged from the USSR and in the development of the non-governmental and voluntary sectors. BEARR invited speakers from Russia, Ukraine, Georgia and Central Asia, and focused on three fields: families, people with disabilities and the elderly.
The conference was opened by BEARR’s Chairman, Tony Longrigg. He warmly thanked the three sponsors who helped with some of the costs involved: the Great Britain Russia Society, Age UK, and Ukraine International Airlines; and the organisers and volunteers who made the conference possible.
Alastair McAuley, University of Essex, talked about the economic challenges which have faced policymakers in the successor states of the USSR since 1991. By 2006 the long recession they experienced was over in most of the countries concerned, but the recession of 2008 has affected them as well. Using World Bank criteria for poverty levels, he assessed that in 2002 47% of Ukraine’s population lived in poverty, whereas in 2007 only 12% lived at this level. The number has since risen again, however. Mr McAuley said the wealth gap had stopped growing, and a middle class is developing.
After 2000, reform of social welfare began. However, despite increased per capita incomes and a decline in poverty, many people still perceive themselves as worse off than in 1990. This is due to social exclusion. Inflation and unemployment have affected many people.There is inequality between regions and between urban and rural areas. A sharp decline in male life expectancy has not yet been reversed by improvements in healthcare. Meanwhile, healthcare reforms have not resulted in more efficient use of resources, and public dissatisfaction remains widespread. About 50% of the countries of the region have introduced social insurance systems (payroll tax) while the rest retain the old system. Insurance contributions are supplemented by state budget payments and personal (informal) payments for medical services. As for the future, much will depend on the economic situation and institutional reforms.
Elena Topoleva of the Agency for Social Initiatives (ASI), Moscow gave an overview of the development in the non-governmental sector in Russia. Of 342,000 NGOs that have been established, only about 17,000 are really active. Most NGOs were set up in 1991-2005, with a subsequent slowdown, mainly due to the decline in foreign funding over the past 5-6 years. 36% of NGOs are run exclusively by volunteers, but 23% of NGOs use no volunteers at all. In Russia only 3% of the public volunteer. Only 16% of NGO funding comes from government sources. While most NGOs see lack of funding as the main challenge, in reality the main problem is public indifference and lack of trust in NGOs. NGO influence and infrastructure are lower than 15 years ago –because of the fall in foreign funding.
Ms Topoleva described different forms of social involvement: at governmental level, there is the Public Chamber, which is controlled by the state but serves as a bridge between the public and the government, providing opportunities for issues to be raised with the government. It has helped to ensure that the legal framework and the taxation of NGOs have improved. At another level there is civic activism, which has been growing but is not institutionalised. Two thirds of people surveyed said they take part in informal activities, but these mainly take place in a parallel universe, and are not coordinated. 50% say they make donations; however, most donations are to individual needy people rather than to NGOs. Only 1-2% of the public donate to NGOs. New legislation provides for this, but NGOs need to explain to people how to donate and claim tax back. Then there are socially-oriented NGOs. The Russian government has begun to fund their work – in 2011 $30 million will be disbursed. Some of this has been for updating legislation and the regulative framework, some for professional training and some for the regions by competitive tender. NGOs are becoming interested in selling their services.
Looking at issues affecting families, Maryna Gutgarts from Ukraine talked about families with HIV. Ukraine has signed the UN Declaration on HIV/AIDS, but its implementation is patchy. Almost half of those infected with HIV are women, with 6000 new cases among women in 2010, but the state does not do much for the sexual and reproductive health of those concerned. In Ukraine there is no specific action to prevent infection among women, a lack of advice on prevention of infection among women and children, and in schools; and little effort to prevent mother to child infection. Training of medical staff in the care of people with HIV – some doctors and nurses refuse to treat them – is much needed, and while the international declaration guarantees the right of people with HIV to bear children, in Ukraine health workers often insist on a termination if an HIV positive women becomes pregnant. It is assessed that 70% of HIV positive people encounter discrimination and denial of their right to healthcare. Many also have to pay more for healthcare.
Charles Buxton from INTRAC spoke about women in extended families in Central Asia. There, the traditional family structure is under pressure because of the new capitalism, economic pressures and migration, but at the same time there are efforts to resist commercialisation, reassert patriarchy and tradition and revive religion. The Central Asian extended family is really a large joint enterprise. It is crowded, involves complex money and non-money transactions (loans, living with relatives in the cities etc.), and nowadays, many men work far from home and send money back only sporadically or not at all. For reasons of hierarchy in the family money does not always reach the wife. There has been a recent doubling of the rate of religious marriages, not registered with civil authorities. When this kind of marriage breaks down there is no protection for the woman. Bride kidnapping is re-emerging. The use of contraceptive devices halved between 2000 and 2009. Women have set up self-help groups, some of them involving micro-credit or dealing with domestic violence.
Looking at disability issues, Sergej Ljubownikow of Nottingham Trent University analysed three types of NGO in the disability field in Russia. All engage in advocacy, to influence both the state elites and public opinion. The first group – “marionette” organisations, include government-sponsored regional public chambers and the All-Russian Organisations of the Disabled, Blind, and Deaf. These are able to lobby officials to deal with individual issues and take part in consultations on new legislation. This allows the state to say that it has consulted civil society. They provide a cushion for public anger. The second category are professional health and social welfare NGOs which learned from and used to be funded by western partners. They now have strong links with countries like Poland. They engage in activities that the state refuses to provide, such as needle exchange. The advocacy they undertake is informing their constituency of their rights. For these NGOs lack of funds rather than government obstruction is the main challenge. They try to access regional funding rather than federal sources. The third group comprises grass roots NGOs. They are small with limited reach. They address administrative roadblocks and seek to establish relations with state authorities. The 2006 law on NGOs has helped them somewhat but they are under pressure not to engage in advocacy.
Ana Chakhava from Apra Georgia in Tbilisi, talked about art therapy work with people with mental disabilities. Examples of the art work produced by people her NGO works with were on display. The NGO started up in 2005. Apra also comprises a parents’ club with 60 members. They join in discussion of mental health reform and treatment, and exchange experience, all of which also helps reduce their sense of isolation. With BEARR’s help, they are now working in other regions, and art therapy is to be introduced in all mental health facilities in Georgia.
The final session of the conference focused on the elderly. First, Elizaveta Dzhirikova-Ustinova from Sostradanie (Compassion) in Moscow described the organisation and its long partnership with BEARR. Sostradanie is one of the oldest NGOs in Russia, and has worked closely with Memorial supporting elderly survivors of the Gulag and Nazi occupation. Initially, Sostradanie had about 5,000 clients in Moscow, and worked with 50 doctors, 50 nurses, 200 carers and psychiatric professionals. In the early 90s state welfare services were non-existent. Today, much has improved, but funding depends on how wealthy the region is, so Moscow can provide a range of services, while poor regions like Smolensk cannot.
In 1996 Ms Dzhirikova met a representative of BEARR, who helped to set up an exhibition of art work by victims of the Gulag. The following year, she attended a BEARR conference. In 1999 BEARR sent chiropodists to Moscow to teach local people how to care for elderly people’s feet. Then they obtained funding for a project to bring together NGOs and state services, and met with a group of British specialists to learn from their experience. They founded Rooms for Care – a scheme in which a student or a woman migrant from Central Asia lives in an elderly person’s home in exchange for a certain amount of care. Ms Dzhirikova cited a range of other British experience which had been useful and could be adapted for Russian circumstances. New possibilities include setting up networks such as Age UK in Russia.
Galina Poliakova of Turbota pro Litnikh (Age Concern) in Ukraine described how the World Health Organisation visited Ukraine and advised that an organisation for the elderly should be set up. They asked Age Concern UK to help. Age Concern Ukraine was set up in 1999, and now has ten branches, mostly in western and central Ukraine. Funding has come from the UK, Germany, the EC and UN. Funding from the Ukrainian government would have been subject to conditions which the organisation would find difficult to meet, so were not provided, but the Ministry for Social Policy works with Age Concern Ukraine in developing social policy. The organisation has 2,000 volunteers, most of them women over 55 years of age. The main challenges AC Ukraine are all connected with the Soviet heritage, mainly the lack of experience of volunteering, lack of experience of NGO activity, and lack of a tradition of charity. The main problem for elderly people is financial hardship. Depression is very common among older women. Surveys have been conducted into discrimination against the elderly, and abuse experienced by them, providing scope for further work.
BEARR trustee Nicola Ramsden drew some conclusions:
– researchers now have not just anecdotal evidence but 20 years of data collected since the fall of the Soviet system to direct their field work;
– following the period of economic decline, reform of the health and welfare sectors are in progress in most states in the region.
– advocacy (lobbying of the state) is not a major activity by NGOs in the region.
The BEARR Trust is grateful to the Great Britain – Russia Society and Age UK for their support for this conference.
The conference is also supported by Ukraine International Airlines, leading airline to Ukraine and beyond, including daily connections to Tbilisi, Georgia.
