In this paper, researchers reviewed contemporary health sector frameworks which have focused on defining and developing indicators to assess governance in the health sector. Based on these, they propose a simplified approach to look at governance within a common health system framework which encourages stewards to take a systematic perspective when assessing governance. Although systems thinking is not unique to health, examples of its application within health systems has been limited. This approach is built largely on prior literature, but is original in that it is problem-driven and promotes an outward application taking into consideration the major health system building blocks at various levels in order to ensure a more complete assessment of a governance issue rather than a simple input-output approach. Based on an assessment of contemporary literature the authors propose a practical approach which we believe will facilitate a more comprehensive assessment of governance in health systems leading to the development of governance interventions to strengthen system performance and improve health as a basic human right.
Governance and participation in health
In this interview, Lilian Celiberti of Feminist Dialogues reports that the World Social Forum (WSF), held in Dakar, Senegal from 6–11 February 2011, was an opportunity for a variety of activists and other civil society stakeholders to take part in discussions across varying perspectives and experiences. She highlights the strong and active participation of African women and youth, and the barriers of poor logistics and translation. She comments that the Declaration of the Women's Organisations was heavily focused on international conventions and UN-Resolutions, despite multiple tensions and conflicts amongst African groups and regions. She recognises that although interpersonal exchanges enable the deepening of debates, ‘colonisation continues in the divisions that we experience in different parts of the world’, and questions remain unanswered about how to develop collective thinking and solidarity in social movements.
Capacity strengthening of rural communities, and the actors that support them, is needed to enable them to lead their own malaria control programmes. The existing capacity of a rural community in western Kenya was evaluated in preparation for a larger intervention. The study shows that culturally sensitive but evidence-based education interventions, utilising participatory tools, are urgently required which consider traditional beliefs and enable understanding of causal connections between mosquito ecology, parasite transmission and the diagnosis, treatment and prevention of disease.
The author argues that the proposed Framework Convention on Global Health (FCGH) could establish a nuanced, layered, and multi-faceted regime of compliance and accountability to the right to health and strengthen accountability for the health-related Sustainable Development Goals (SDGs). If legally binding, he argues that the FCGH could facilitate accountability through the courts and catalyze comprehensive domestic accountability regimes, requiring national strategies that include transparency, community and national accountability and participatory mechanisms, and an enabling environment for social empowerment. A “Right to Health Capacity Fund” could ensure resources for these strategies. Inclusive national processes could establish targets, benchmarks, and indicators consistent with FCGH guidance, with regular reporting to a treaty body, which could also hear individual cases. State reports could be required to include plans to overcome implementation gaps, subjecting the poorest performers to penalties and targeted capacity building measures. Regional special rapporteurs could facilitate compliance through regular country visits and respond to serious violations. And reaching beyond government compliance, from capacity building to the courts and contractual obligations, the author proposes that the FCGH could establish nationally enforceable right to health obligations on the private sector.
Fund the Fund have produced an advocacy kit aimed at civil society organisations (including nongovernmental, community-based, people living with the diseases, faith-based, and trade unions) to promote their advocacy for increased investment in the Global Fund.
This guide, produced by the EuropeAid Co-operation Office, offers guidance to European Community (EC) sector specialists on how to analyse and address governance in sector operations in a more systemic and comprehensive way, without being a compulsory blueprint. It aims to strengthen understanding of governance issues at sector level. It is divided into four chapters, which provide a broad definition of governance and overall EC policy on governance, experiences in dealing with governance at sector level reasons for strengthening efforts, a focus on an overall approach in addressing sector governance, and a methodology that can guide the process of analysing governance at sector level.
This book identifies four types of dynamics impact on reforms at the sector-level: sector-specific dynamics, cross-sectoral dynamics, the dynamics of the political process and country-wide dynamics. It divides approaches into two groups: sector-level political economy approaches; and country-level and politics-centred political economy approaches. Based on this analysis, the book found that sector-level political economy approaches can be characterised by a series of strengths, weaknesses and gaps. Strengths tended to be their focus on core development challenges, methodological diversity and dynamic evolution. Weaknesses, on the other hand, tended to be around having a very small number of empirical, comparable and publicly accessible sector studies; too few policy management-oriented action frameworks and an insufficient theoretical guidance on using some approaches, frameworks and matrices. Gaps were identified in the assessment of political viability of sector reforms; in the analysis of domestic decision making and subsequent implementation; and in the consideration of concrete operational implications. One of the sectors covered in this book is the health sector.
This bibliography presents studies from peer-reviewed and grey literature that used consultations and other participatory strategies to capture a community’s perspective of their health priorities, and of techniques used to elevate participation from the implementation phase to a more upstream phase of prioritisation, policymaking and agenda setting. It covers studies that worked with marginalised populations or sub-populations. It begins by first offering some philosophical and conceptual frameworks that link participatory interventions with inclusive policy making or agenda setting, and a rationale for prioritising marginalised populations in such an undertaking. It further looks at various participatory instruments for consultations, for reaching out to marginalised populations, and for communicating the results to policymakers. A final section presents a reflective and evaluative look at the recruitment, instruments and examples.
In response to the announcement that World Bank President Robert Zoellick will step down at the end of his term on 30 June 2012, a global coalition of campaigners has called for an open and merit-based process to elect the next World Bank leader, and for developing countries to determine the selection. The campaigners, including many major development organisations, have also asked the United States to announce that it will no longer seek to monopolise the Presidential position. A “gentlemen’s agreement” between Europe and the US dating back to World War II has so far ensured that the President of the World Bank is always an American, and the International Monetary Fund’s Managing Director is European. In this open letter, the campaigners demand that the new President is selected by a majority of World Bank member countries, not just a majority of voting shares, as most members are low- and middle-income countries. They also demand that the selection process be opened to anyone to apply, with interviews held in public and with open voting procedures. A clear job description and necessary qualifications should be set out, requiring candidates to have a strong understanding and experience of the particular problems facing developing countries.
The new chairperson of the African Union (AU) Commission Moussa Faki Mahamat formally took office in Addis Ababa in March, outlining his top priorities for his four-year tenure. Mahamat said he would focus on implementing structural and financial reforms at the AU, place women and youth at the centre of Africa’s development agenda, accelerate intra-African trade and free movement of people, goods and services in the continent, silence the guns by 2020 and strengthen Africa’s voice in the global arena. However, it is the financing plan that is likely to get the most attention in the short term. It was unveiled at the 2015 AU summit in Kigali by Donald Kaberuka, former president of the African Development Bank (AfDB). As of 2015, more than half of the African Union’s budget is funded by outside funders, compromising the independence of the organisation. The Kaberuka plan is intended to change that, and would see member states finance 100% of the AU’s operating budget, three-quarters of the programmes budget and a quarter of the peace and security budget, starting from January 2016 and phased in incrementally over five years.