The Commonwealth's tri-sector dialogue: W. David McIntyre reports on the Commonwealth Health Ministers' Meeting in Christchurch in November 2001 and finds that it exemplifies a growing trend in the Commonwealth.

• Author: McIntyre, W. David

The 13th Commonwealth Health Ministers' Meeting was held in Christchurch from 25 to 29 November 2001. Although it did not make headlines, it exemplified a growing trend in the Commonwealth and, in an unobtrusive way, encompassed several important innovations. In a nutshell: it pointed to ways of solving what has become known as the `tri-sector dilemma'.

The uniqueness of the Commonwealth as an international organisation is the width and depth provided by its voluntary, unofficial, and sporting aspects. This is a rich legacy with long established roots. The earliest Commonwealth non-governmental organisations (NGOs) were founded before the First World War. The Commonwealth Games dates from 1930. Over thirty professional associations came into being with the help of the Commonwealth Foundation, which started in 1966. By the 1990s, as the post-Cold War Commonwealth sought to redefine itself, the tri-sector dimension began to stand out. In 1991 the official Commonwealth adopted the Harare Declaration defining its `fundamental political values' as democracy, good governance, the rule of law, and human fights. These were seen as the concomitants of sustainable development, sound management, the market economy, free trade, and equality of opportunity. (1) In 1995, guidelines for good practice among non-governmental organisations were promulgated. These organisations -- increasingly referred to as civil society organisations -- were now defined as voluntary, independent, not-for-profit, and not self-serving. Good governance and accountability were sought from civil society as well as from government. (2) By 1997, after the re-discovery of the trading possibilities in the Commonwealth, there was talk of a `Commonwealth business culture'. (3) The first Commonwealth Business Forum preceded the 1997 Edinburgh CHOGM, where the Commonwealth Business Council was created. There was much optimistic talk of the role of private investment, public/private partnership, private sector management expertise, and fostering good corporate governance.

Yet there were signs of tension as governments slimmed down their provision of welfare services; de-regulated economies; relied on the operation of free market forces, and turned to private sector investment and management. Citizens were given a chance to have their say. The Commonwealth Foundation conducted a huge research project on `Civil Society in the New Millennium' in which 10,000 ordinary citizens in 47 countries were asked their views on the 'good society', the needs of citizens, and the role of the state. A gulf between recent trends in government policy and the expectations of citizens was revealed. (4) Thus in 2001 the Foundation defined the tri-sector dilemma in terms of the waxing and waning of the relative influence of the three sectors. Government activity was declining, civil society activity and expectations were growing, and the influence of private business operating in a free market was being pushed. (5) In its submission to the High Level Review Group (HLRG) led by President Mbeki, the Foundation advocated re-thinking tri-sector relationships. It hinted that Heads of Government, scheduled to meet in Brisbane in October 2001, needed to determine `who does what?'

Terrorist incidents

In the event, decisions were delayed. The 11 September incidents in the United States caused the postponement of the CHOGM, the Commonwealth Finance Ministers' Meeting, and the Commonwealth Business Forum. Consideration of the HLRG report was held over for the delayed mini-CHOGM to be held at Coolum Beach, Queensland, in March 2002. This meant that the triennial meeting of health ministers at Christchurch was the first major Commonwealth conclave after the 11 September incidents.

And as well as indicating that the Commonwealth was `back in business', the health ministers' meeting involved four innovations. First, it was preceded by a preliminary `NGO Consultation', held at the University of Canterbury. Secondly, there was a `Parallel Commonwealth Health Symposium and Trade Fair', where academic, trade, industry, health practitioner, and health administrator representatives considered health-care priorities, funding issues, and, in particular, the role of new technologies. Thirdly, the NGO Consultation and Parallel Symposium were integrated with the ministerial meeting by joint panel discussions, inter-sector reporting, and NGO and Symposium input into the Communique. Fourthly, the media were admitted (broadcasters for the first time) to all meetings, including ministerial committees. They were only excluded from discussions of one Communique item.

Opening ceremony

The opening ceremony in the Christchurch Town Hall on 25 November 2001 began with a welcome from Ngai Tahu. John Wyn Owen, Secretary of the Nuffield Trust and Chair of the symposium, pointed out this was the first Health Ministers' Meeting that had been organised with non-governmental organisations, professional, and private sector participation. Don McKinnon, the Secretary-General, put his finger on the Commonwealth's greatest health issue -- the HIV/AIDS pandemic, which involved 200 new infections every minute. He stressed the urgent role of education in combating it. The Governor-General, Dame Sylvia Cartwright, formally opened the conference, with a reminder of the problem of gender discrimination. In responding to the welcome, Dr Libertina Amathilia, Health Minister of Namibia, stressed the value of the informality of Commonwealth meetings. This was soon exemplified when the Te Ahikaaroa performance group put on an exuberant display of song and...