This article discusses the appropriateness of western bioethics in the African setting. It focuses on the decision-making process regarding participation in health research as a contested boundary in international bioethics discourse. An ethnomethodological approach is used to explain African ethics, and African ethic is applied to the decision-making process in the African community. An HIV/AIDS surveillance project is used as a case study to explore the concept of communitarianism. The article argues that what exists in Africa is communal or social autonomy as opposed to individual autonomy in the West. As a result, applying the western concept of autonomy to research involving human subjects in the African context without adequate consideration for the important role of the community is inappropriate. It concludes that lack of adequate consideration for community participation in health research involving human subjects in Africa will prevent proper management and lack truly informed consent.
Governance and participation in health
The author of this article argues that, in Africa, some governments have dodged their responsibility to implement famine-prevention measures because they require a socio-political contract between the government and civil society that allows citizens to hold governments accountable for famine. Instead, through their inaction and acceptance of foreign aid, governments have ceded that responsibility to non-government organisations (NGOs) and ‘foreign technical experts’ with a narrower definition of social responsibility and far less vested interest in the well-being of citizens. In the last sixty years, well over a trillion dollars of ‘development aid’ has been transferred from the West to African nations, but the author cautions that this aid comes at a cost: donor dependency, corruption and lack of incentive for governments to govern well and efficiently. In fact, NGOs may well be in competition with African governments as they provide goods and services that the governments do not. As NGOs step in and fill the gaps with their foreign-funded resources and growing presence and capacities, the legitimacy of aid-recipient states is called into question. Arguably, the legitimacy crisis of NGOs is in tandem with the legitimacy crisis of African governments. Because the provision of public goods and resources is part of the socio-political contract between the government and civil society, NGOs do risk undermining the legitimacy of the government. On the flip side, the legitimacy of foreign-funded NGOs comes under question when the interests of their international and surpranational funders conflict with national interests.
The AIDS and Rights Alliance for Southern Africa (ARASA), a Namibia-based partnership of health and human rights groups from the Southern African region, today launched a YouTube video clip entitled ‘Lords of the Bling’, linked to a public petition that presents a ‘moral challenge’ to African leaders regarding their commitments to funding health. The clip highlights the cost of lavish expenditure and corruption among various African leaders and calculates how many people could, for equivalent sums of money, have received life-saving treatment for HIV and TB, which jointly claim almost two million African lives every year. The video clip and petition are intended to serve as an awareness-raising campaign and a platform for solidarity on holding African governments accountable for their commitments to health. ARASA is seeking sign-ons from organisations and individuals, which will be presented to leaders on International Human Rights Day in December 2009. ARASA intends to mobilise civil society around this critical issue and claim the right to health.
Peasants across Africa are intensifying their struggles against land grabs and other harmful policies that promote industrial agriculture. At a recent international conference organised by the world’s largest peasants movement, Via Campesina, African peasants had opportunities to share their experiences of struggle and to learn. This conference happens at a time when Africa is undergoing a harsh moment, as indicated by Ibrahima Coulibaly from the National Coordination of Peasant Organizations (CNOP) in Mali. They note that land, mineral resources, seeds and water are increasingly being privatised due to the myriad of investment agreements and policies driven by new institutional approaches, imposed on the continent by western powers and Bretton Woods institutions. Elizabeth Mpofu, from the Zimbabwe Smallholder Farmers Forum, is a small-scale farmer who had access to land after she took part in the radical land occupation that resulted in the fast-track land reform in the early 2000s. According to her, building alternatives is to take direct action. Domingos Buramo, from the Mozambique Peasants Union (UNAC), brought to the conference the experience of the Mozambican peasants and other civil society organisations against land grabbing and large-scale investment projects in Mozambique. He mentioned that the resistance to ProSavana, a large-scale agricultural project proposed for Mozambique, is an example of how transformative articulated struggles could be. “Now the government is changing its vision as a result of our work. We can change our societies”, he said. Africa - including the Maghreb region - was the last continent to be part of Via Campesina. Since 2004 the number of African peasant movements joining La Via Campesina has been increasing. African movements consider their membership to the peasant movement as a strategic process of amplifying their struggles and reinforcing internationalism.
African Speakers of Parliaments and Presidents of Senate have unanimously adopted a landmark resolution on a Declaration of Commitment to prioritise parliamentary support for increased policy and budget action on Maternal, Newborn and Child Health in African countries. The milestone Declaration of Commitment was adopted at the 3rd Pan African Speakers Conference 17th – 18th October 2011, in Midrand, Johannesburg, South Africa. In the communiqué issued at the end of the conference, the speakers committed to “prioritise policy and budget support for implementation of African Union Summit Decisions, in particular the … Kampala July 2010 Summit Declaration on the Summit theme of “Actions on Maternal, Newborn and Child Health Development in Africa”. The Commitment was the first of its kind by African Speakers of Parliament, and marks a significant milestone in accelerating progress in Africa towards the attainment of the Millennium Development Goals (MDGs) 4 and 5 on Child and Maternal Health, respectively. It also promises high-level parliamentary support to hasten implementation of the Africa Parliamentary Policy and Budget Action Plan on Maternal, Newborn and Child Health, agreed by Chairs of Finance and Budget committees of national parliaments in October 2010.
This report assesses the progress made in some of the major countries that have begun to implement the African Peer Review Mechanism (APRM) and address their governance problems, including two countries from east and southern Africa – South Africa and Kenya. The overall picture is generally positive, with dialogue between stakeholders occurring and changes being introduced in the ways policies are developed and implemented. There is peer learning, with experiences from a given country being introduced to others. But the report notes that the pace of learning and the pace of change are slow. It argues that the APRM itself has to be changed to make it more straightforward and more efficient. Human and financial resources must be increased at the national level to help countries carry out their evaluations successfully and, more importantly, implement the priority actions that are agreed on. The report argues that civil society is a key player in the APRM, but this is often forgotten by governments, by the continental APRM authorities and by external funders, and the inclusion of civil society representatives in the APRM process is often just an afterthought.
The outcome of Rio+20, held in June 2012, with negotiating countries unable to reach consensus on most issues, left most commentators disappointed as the summit failed to live up to its ambitious title “The Future We Want”. However, UHC Forward argues that health activists have a minor victory to celebrate, as issues regarding health, absent in the initial drafts circulated in advance of the Summit, are now mentioned in the texts. Health has had its relationship with sustainable development firmly recognised in terms of Universal Health Coverage by: strengthening health systems; complying with Beijing, Cairo and TRIPs flexibilities to ensure access to essential medicines; reducing infant and maternal mortality; and providing universal access to family planning and sexual and reproductive health. However, UHC Forward acknowledges that the Rio+20 outcome text contains too many divergent viewpoints and no tangible political commitments. It does, though, mark the beginning of the next phase of negotiations, and UHC Forward calls on all activists to demand that new agreements must reflect the challenges of the new global landscape, accounting for new health challenges, widening inequality and the increased proportion of the world’s poor in middle-income countries.
This report draws on the results of the 2011 Survey on Monitoring the Paris Declaration, building on similar surveys undertaken in 2006 and 2008. A total of 78 countries and territories volunteered to participate in the final round of surveys, which look at the state of play in 2010. The results indicate that, at the global level, only one out of the 13 targets established for 2010 – co-ordinated technical co-operation (a measure of the extent to which external funders co-ordinate their efforts to support countries’ capacity development objectives) – has been met, albeit by a narrow margin. Nonetheless, it is important to note that considerable progress has been made towards many of the remaining 12 targets. Globally, the survey results show much variation in the direction and pace of progress across external funders and partner countries since 2005. For the indicators where responsibility for change lies primarily with developing country governments, progress has been significant. For example, improvements have been made in the quality of tools and systems for planning and for financial and results management in a number of developing countries, often requiring deep reforms that go beyond aid management to broader aspects of government processes.
Post-apartheid South Africa has witnessed the growth of social movements using on-the-ground and network-based modes of organisation that operate at the same time in local, national and global political environments. Networks across countries and grassroots mobilisation have allowed HIV/AIDS activists to use tactics confronting the state while supporting it to be more inclusive. Research from the University of Stellenbosch in South Africa explores the organisational practices and strategies of the Treatment Action Campaign (TAC), a Cape Town-based social movement.
Friends of the Global Fund Africa popularly referred to as Friends Africa, a new pan-African advocacy organisation, chose Kigali as the venue for the inauguration of its board and first board meeting to chart the way forward in the fight against HIV/Aids, tuberculosis and malaria, the three diseases it claimed have been dealing a great blow to African continent. In Kigali , Friends Africa brought together some of the most committed, credible and influential voices of Africa as an indication of African leaderships' determination to lead the fight against the three diseases.