Governance and participation in health

A new twist in the conditionality tale: Using budget support to foster good political governance
Hayman R: Centre for African Studies, Edinburgh, April 2010

The provision of aid directly to government, known as direct budget support, has recently been promoted as the best possible tool for improving the impact of aid and ensuring governments take the lead in implementing national development strategies. However, this paper argues that nothing in the theory of budget supports suggests that it can or should be used as an instrument for influencing political processes. Yet over the last decade, budget support has repeatedly been subject to delays and halts, sometimes for political reasons. While these are often due to administrative problems on the funder's side, the number of incidents of budget support being halted in response to digression from democratic norms by recipient countries is on the rise. This paper questions the theories and conditions underpinning budget support. It appears that external funders are quite prepared to use conditionalities. However, to date, there is little evidence to suggest that these conditionalities bring about democratic change in the recipient country. Rather than budget support becoming a viable instrument for fostering better political practice, it would appear that there is a tightening of selectivity criteria in deciding who gets budget support and that these incidents represent the weeding out of a few 'bad apples'.

A realist review of mobile phone-based health interventions for non-communicable disease management in sub-Saharan Africa
Opoku D; Stephani V; Quentin W: BMC Medicine 15(24), 2017, doi: 10.1186/s12916-017-0782-z

The prevalence of non-communicable diseases (NCDs) is increasing in sub-Saharan Africa. At the same time, the use of mobile phones is rising, expanding the opportunities for the implementation of mobile phone-based health (mHealth) interventions. This review aims to understand how, why, for whom, and in what circumstances mHealth interventions against NCDs improve treatment and care in sub-Saharan Africa. Four main databases and references of included articles were searched for studies up to March 2015 reporting effects of mHealth interventions on patients with NCDs in sub-Saharan Africa. All studies published up until May 2015 were included in the review. Following a realist review approach, middle-range theories were identified and integrated into a 'Framework for Understanding the Contribution of mHealth Interventions to Improved Access to Care for patients with NCDs in sub-Saharan Africa'. The main indicators of the framework consist of predisposing characteristics, needs, enabling resources, perceived usefulness, and perceived ease of use. Studies were analysed in depth to populate the framework. The search identified 6137 titles for screening, of which 20 were retained for the realist synthesis. The contribution of mHealth interventions to improved treatment and care is that they facilitate (remote) access to previously unavailable (specialised) services. Three contextual factors (predisposing characteristics, needs, and enabling resources) influence if patients and providers believe that mHealth interventions are useful and easy to use. Only if they believe mHealth to be useful and easy to use, will mHealth ultimately contribute to improved access to care. The analysis of included studies showed that the most important predisposing characteristics are a positive attitude and a common language of communication. The most relevant needs are a high burden of disease and a lack of capacity of first-contact providers. Essential enabling resources are the availability of a stable communications network, accessible maintenance services, and regulatory policies. Policy makers and program managers should consider predisposing characteristics and needs of patients and providers as well as the necessary enabling resources prior to the introduction of an mHealth intervention. The authors argue that researchers would benefit from placing greater attention on the context in which mHealth interventions are being implemented instead of focusing (too strongly) on the technical aspects of these interventions.

A Resolve to Reform - A look at the Director-General's Opening Address at the 138th Meeting of the Executive Board (EB138)
People’s Health Movement: Geneva, 25 January 2016

The 138th Meeting of the Executive Board (EB138) of the World Health Organisation (WHO) taking place from 25 to 30 January 2016 in Geneva includes a host of issues, including reviews of the WHO’s governance, finance and emergency structure. In the opening remarks of WHO Director-General Margaret Chan, the topics touched on ranged widely from Ebola to Road Safety, with an emphasis on Universal Health Coverage in her final paragraph. A pointed reference to the “explosive spread of Zika virus in new geographical areas”, was a conscious effort to highlight the potential threats of infectious disease beyond Ebola, and the much needed reform of the WHO’s emergency structures. She commented on Universal Healthcare Coverage as “the most efficient way to respond to the rise of non-communicable diseases” , although the PHM note the debates on how the proposal for UHC has shifted the focus from how services should be provided to how services should be financed, with private sector providers and private insurance assumed to be part of the solution, despite evidence that this can lead to ‘health-defeating’ market failures. The Director General noted, however, that some policy recommendations on child obesity “pick a fight with powerful economic interests”. These remarks were welcomed by PHM if followed through with changes in the organisation’s relationship with big business.

A review of the role of civil society in advocacy and lobbying for enforcement of health policy in Kenya
Omungu PA: African Population Studies, 25, s1, 78-91, 2011

Advocacy and lobbying are more taking an ever more central place in health agendas of African countries. It is impossible to have a conversation about public policy these days without someone mentioning 'civil society'. The author argues that clarity and rigor are conspicuously absent within civil society. A States' first duty towards citizens is to respect the right to health by refraining from adopting laws or measures that directly impinge on people's health. The paper presents evidence from the literature of civil society organization (CSO) intervention in support of primary health care, equity in health and state health services covering 38 online documents and from interviews with key informants from government and civil society. They suggest from the findings that countries ensure that public health principles and priorities are clear and legally binding; that countries have a clear coordinating mechanism on issues of trade and health that involve government, particularly health ministries and civil society and that civil society disseminate health and trade information in accessible ways.

A synthesis of institutional arrangements of National AIDS Commissions in seven African countries
Dickinson C, Mundy J, Jones JW: HLSP, 2007

This paper presents a synthesis of institutional arrangements and issues currently facing National AIDS Commissions (NACs) in 2007. The paper is a work in progress and is based on a literature review and informant interviews with agency-based and NAC staff and independent consultants familiar with NAC issues. It reviews the common features and emerging themes on the following topics: the background to the establishment of NACs, their governance, structure and function, financing arrangements and their role in harmonising and aligning country responses to HIV. To date, many African countries with NACs have experienced significantly improved access to, and coordination of, financial and other resources, and there is a growing diversity of funding mechanisms and a substantial increase in funding.The authors conclude that the increased pressure placed on NACs means that clarity in roles and relationships, and enabling political, legislative, policy and institutional environments are more important than ever.

A systematic review of the literature for evidence on health facility committees in low- and middle-income countries
McCoy D, Hall J and Ridge M: Health Policy and Planning December 8, 2011

This paper presents the findings of a systematic literature review of: (a) the evidence of HFCs' effectiveness, and (b) the factors that influence the performance and effectiveness of HFCs. Four electronic databases and the websites of eight key organizations were searched. Out of 341 potentially relevant publications, only four provided reasonable evidence of the effectiveness of HFCs. A further 37 papers were selected and used to draw out data on the factors that influence the functioning of HFCs. The review found some evidence that HFCs can be effective in terms of improving the quality and coverage of health care, as well as impacting on health outcomes. However, the external validity of these studies is inevitably limited. Given the different potential roles and functions of HFCs and the complex and multiple set of factors influencing their functioning, the authors argue that there is no ‘one size fits all’ approach to CPH via HFCs, nor to the evaluation of HFCs. However, there are plenty of experiences and lessons in the literature which decision makers and managers can use to optimize HFCs.

A turning point for global health governance
Kickbusch I: Global Health Europe Task Force, 3 February 2011

This article is a review of the January 2011 Executive Board meeting of the World Health Organisation (WHO). The author identifies a new sense of purpose and willingness of member states to address politically complex issues head on and work towards acceptable compromises in the interest of global health. This was exemplified by the negotiation of a proposal from the African group of countries to institute a policy of rotation between geographic regions for the election of future WHO Director-Generals. The issue could have led to political deadlock on the board, the author argues, but it was artfully avoided through a deft show of statesmanship and above all a collective desire to see the board succeed in its work. The African group of countries also called for a greater involvement of developing nations and emerging economies in global health governance. Concrete proposals for how to move forward with a sense of urgency were raised, and Director General Margaret Chan received a clear mandate to develop reform proposals for discussions at the World Health Assembly in May 2011.

A user's guide to measuring corruption
June R, Laberge M and Nahem J: UNDP Oslo Governance Centre, September 2008

Over the past few years, a flood of new work has emerged challenging the validity of the traditional measurements of corruption and arguing for new and improved tools for national policy makers, civil society and donors alike. This guide suggests ways of measuring corruption promoting a multiple data sourcing approach and a focus on actionable measurements. It is aimed at national stakeholders, donors and international actors involved in corruption measurement and anti-corruption programming. This guide is based on more than thirty interviews with individuals from dozens of countries who are working on corruption and governance reforms. It explains the strengths and limitations of different measurement approaches, and provides practical guidance on how to use the indicators and data generated by corruption measurement tools to identify entry points for anti-corruption programming.

A ‘New Deal’ for engagement in fragile states
International Dialogue on Peace-building and State-building: Organisation for Economic Co-operation and Development, December 2011

On 1 December 2012, the final day of the Fourth High-level Forum for Aid Effectiveness held in Korea, the International Dialogue on Peace-building and State-building – consisting of the G7+ group of 19 fragile and conflict-affected countries, development partners and international organisations – signed a ‘New Deal’ of development architecture for fragile states. It builds on vision and principles from a range of international agreements, including the Paris Declaration on Aid Effectiveness, the Accra Agenda for Action and the Millennium Development Goals, and will be implemented in a trial period from 2012 to 2015. Signatories have agreed to use five peace-building and state-building goals (PSGs): foster inclusive political settlements and conflict resolution, establish and strengthen people’s security, address injustices and increase people’s access to justice, generate employment and improve livelihoods, and manage revenue and build capacity for accountable and fair service delivery. They further commit to support inclusive country-led and country-owned transitions out of fragility, using the PSGs to monitor progress, and to support inclusive and participatory political dialogue. Mutual trust will be fostered by providing reliable external funding, managing resources more effectively and transparently, and aligning resources for results.

Accountability in Poverty Reduction Strategies: The Role of Empowerment and Participation
Eberlei W: Social Development Papers 104, Social Development Department of the Sustainable Development Network of the World Bank, May 2007

The elaboration of Poverty Reduction Strategies has seen a promising amount of stakeholder participation in many PRS countries, even if considerable quality problems are recognisable, such as exclusion of marginalised groups, speed and depth and the ad hoc nature of participation events as well as macroeconomic and structural policies being off-limits. Most countries have started implementing their PRSP,with participation dwindling instead of being institutionalised. Some observers speak of a 'participation gap'. The situation seems to be slightly more promising for the issue of participation in monitoring and evaluation of PRS, as in many countries independent civil society monitoring or participatory monitoring arrangements are planned, although mostly not yet operational. Stakeholder participation in the revision process has been occurring in a number of countries, but not much is known about the way this is done. For most of these issues a systematic review of experience is not available at this stage. Work is planned to increase the current understanding of the status, practice and challenges of participation in PRS implementation (including monitoring, evaluation, revisions, policy reforms, and institutionalisation) and to make conceptual as well as 'good practice' contributions to the current discussion.

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