Governance and participation in health

Aspirations and realities in a North-South partnership for health promotion: lessons from a program to promote safe male circumcision in Botswana
Katisi M; Daniel M; Mittelmark M: Globalization and Health 12(42), 2016, doi: 10.1186/s12992-016-0179-3

Government of Botswana partners with two international organisations: U.S. Centers for Disease Control and Prevention and Africa Comprehensive HIV/AIDS Partnership to implement Voluntary Medical Male Circumcision with the target of circumcising 80 % of HIV negative men in 5 years. This paper uses a systems model to establish how the functioning of the partnership on Safe Male Circumcision in Botswana contributed to the outcome. Data were collected using observations, focus group discussions and interviews. Thirty participants representing all three partners were observed in a 3-day meeting; followed by three rounds of in-depth interviews with five selected leading officers over 2 years and three focus group discussions. Financial resources, “ownership” and the target were found to influence the success or failure of partnerships. A combination of inputs by partners brought progress towards achieving set program goals. Although there were tensions between partners, they worked together in strategising to address some challenges of the partnership and implementation. The authors found that pressure to meet the expectations of the international funders caused tension and challenges between the in-country partners to the extent of Development Partners retreating and not pursuing the mission further. Target achievement, the link between financial contribution and ownership expectations caused antagonistic outcomes.

Assessing and strengthening civil society worldwide: An updated programme description of the CIVICUS Civil Society Index: Phase 2008 to 2010
CIVICUS: April 2010

This paper argues that it is necessary to conduct a participatory, cross-national assessment and action-planning programme on civil society in all developing and developed countries. It acknowledges the scarcity of sound empirical studies on civil society and identifies some of the causes for this situation, including the elusive and highly disputed nature of the concept of civil society and a lack of valid data in many regions of the world, as well as the trend of confusing the tasks of advancing the normative ideal of civil society with honestly assessing its current reality. CIVICUS believes that reflections on the current reality of civil society are necessary to strengthen civil society. In other words, only by knowing the current state of civil society, can one work to successfully improve it. The paper argues that cross-national research, covering a wide range of different contexts, is a conceptual, methodological, cultural and logistical minefield. But by designing an assessment tool based on context, and by designing it in a way which, in principle, should make it applicable in every country, the Civil Society Index aims to push the boundaries of existing comparative work on the topic.

Assessing community perspectives of the community based education and service model at Makerere University, Uganda: a qualitative evaluation
Mbalinda SN, Plover CM, Burnham G, Kaye D, Mwanika A, Oria H et al: BMC International Health and Human Rights 11(Suppl 1): S6, 9 March 2011

The authors of this study evaluated community-based education and service (COBES) programmes at Makerere University College, Uganda, from a community perspective. A stratified random sample of eleven COBES sites was selected to examine the community’s perception of the programmes. Key informant interviews were held with 11 site tutors and 33 community members. Communities reported that the university students consistently engaged with them with culturally appropriate behavior and rated the student’s communication as very good even though translators were frequently needed. They also reported positive changes in health and health-seeking behaviours but remarked that some programmes were not financially sustainable. The major challenges from the community included community fatigue, and poor motivation of community leaders to continue to take in students without any form of compensation.

Assessing Participation in Poverty Reduction Strategy Papers:
A Desk-Based Synthesis of Experience in Sub-Saharan Africa

This desk review provides an update on practice and experiences of civil society participation in the development of Poverty Reduction Strategy Papers (PRSPs). It was commissioned by Department for International Development (DFID) and conducted from August–October 2001 by the Participation Group at the Institute of Development Studies (IDS) in the UK.

Assessing the impact of health centre committees

This study sought to analyse and better understand the relationship between health centre committees in Zimbabwe as a mechanism of participation and specific health system outcomes, including: Improved representation of community interests in health planning and management at health centre level; Improved allocation of resources to health centre level, to community health activities and to preventive health services o improved community access to and coverage by selected priority promotive and preventive health interventions; Enhanced community capabilities for health (through improved health knowledge and health seeking behaviour; Appropriate early use of services); Improved quality of health care as perceived both by providers and users of services.

Assessing the impact of health centre committees on health system performance and health resource allocation

This study sought to analyse and better understand the relationship between health centre committees in Zimbabwe as a mechanism of participation and specific health system outcomes, including: Improved representation of community interests in health planning and management at health centre level; Improved allocation of resources to health centre level, to community health activities and to preventive health services; Improved community access to and coverage by selected priority promotive and preventive health interventions; Enhanced community capabilities for health (through improved health knowledge and health seeking behaviour, appropriate early use of services); Improved quality of health care as perceived both by providers and users of services.

Assessing the incremental effects of combining economic and health interventions: the IMAGE study in South Africa
Kim J, Ferrari G, Abramsky T, Watts C, Hargreaves J, Morison L, Phetla G, Porter J and Pronyk P: Bulletin of the world Health Organization 87(11):824-32, November 2009

This study's aim was to explore whether adding a gender and HIV training programme to microfinance initiatives can lead to health and social benefits beyond those achieved by microfinance alone. Cross-sectional data were derived from three randomly selected matched clusters in rural South Africa. Adjusted risk ratios (aRRs) employing village-level summaries compared associations between groups in relation to indicators of economic well-being, empowerment, intimate partner violence (IPV) and HIV risk behaviour. The magnitude and consistency of aRRs allowed for an estimate of incremental effects. A total of 1,409 participants were enrolled, all female, with a median age of 45. After two years, both the microfinance-only group and the IMAGE group showed economic improvements relative to the control group. However, only the IMAGE group demonstrated consistent associations across all domains with regard to women's empowerment, intimate partner violence and HIV risk behaviour. In conclusion, the addition of a training component to group-based microfinance programmes may be critical for achieving broader health benefits. Donor agencies should encourage intersectoral partnerships that can foster synergy and broaden the health and social effects of economic interventions such as microfinance.

Assessing the promise of user involvement in health service development: Ethnographic study
Fudge N, Wolfe CDA, Mckevitt C: British Medical Journal, 29 January 2008

This study set out to understand how the policy of user involvement is interpreted in health service organisations and to identify factors that influence how user involvement is put into practice. The design was that of an ethnographic study using participant observation, interviews, and collection of documentary evidence. Set in a multiagency modernisation programme to improve stroke services in two London boroughs, participants comprised of service users, National Health Service managers, and clinicians. Author conclusions include that user involvement may not automatically lead to improved service quality. Healthcare professionals and service users understand and practise user involvement in different ways according to individual ideologies, circumstances, and needs. Given the resource implications of undertaking user involvement in service development there is a need for critical debate on the purpose of such involvement as well as better evidence of the benefits claimed for it.

ASSESSMENT AND MONITORING OF BEHAVIOR CHANGE COMMUNICATION (BCC) INTERVENTIONS

This is a handbook to help planners and implementors look at the effectiveness of their BCC interventions. Implementors can use the handbook to help them monitor, since the handbook can point out both strengths and potential weaknesses of an ongoing intervention. The handbook can also be used as a planning tool because it highlights important points for the design and development of effective BCC programming.

At G20 Summit, civil society demands 'People First, Not Finance'
Fatoorehchi C: Inter Press Services, 4 November 2011

Led by the slogan ‘People First, Not Finance’, the People’s Forum held in November raised that the G20’s ‘cosmetic’ economic solutions to the global recession in 2008 would do little to ease the cyclical problems of the financial system, adding that much deeper, structural changes were required to address global inequity. It argued that the G20 will only increase the ‘financialisation’ of this world, instead of fundamentally changing it. The forum raised that social movements ranging from the ‘Occupy’ protests in Wall Street in the United States to the ongoing demonstrations in Tahrir Square need to ‘coordinate, exchange views' towards this deeper structural change.

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