Governance and participation in health

O&M of urban water and sanitation systems: is there a role for the poor?

Urban services specialists are coming to realise that sustainability of infrastructure interventions depends on community engagement in operation and maintenance (O&M). But what progress has been made in getting urban communities involved in the planning, construction, repair and maintenance of water supply and sewerage systems? Are projects demand-driven and are communities willing to pay to look after them?

SWAZILAND: AIDS campaign to be led from the grassroots

Swaziland's mayors are adopting a novel method in the fight against HIV/AIDS. They are reversing the usual top-down approach and are being led instead by their constituents, ordinary Swazis. "The voice of the people will determine how we will combat AIDS in the towns," explained chairman of the Ezulwini town board, Nokuthula Mthembu. The first woman to hold the top government post in her municipality, Mthembu is chair of the Executive Council of the Alliance of Mayors' Initiative for Community Action on AIDS at the Local Level (AMICAALL). "There has never been a project like this one," Mthembu told PlusNews. "But we absolutely must have an innovative approach to combat the deadly disease that is attacking our municipalities. We desperately need fresh ideas."

'From Many Lands' - Final Volume in the Voices of the Poor Series

Narayan, Deepa and Patti Petesch, 2002. Voices of the Poor: From Many Lands. New York, N.Y: Published for the World Bank, Oxford University Press. "From Many Lands," the third and last volume of the Voices of the Poor series, presents 14 country case studies in Africa (Ghana, Malawi, Nigeria), South and East Asia (Bangladesh, India, Indonesia), Europe and Central Asia (Bosnia, Bulgaria, Kyrgyz Republic, Russia), and Latin America and the Caribbean (Argentina, Brazil, Ecuador, Jamaica). Using participatory and qualitative research methods, the study presents the realities of poor people's lives directly through their own voices, with a concluding chapter on an empowering approach to development.

'Irrelevant' WHO outpaced by younger rivals
Richter J: BMJ: 12 May 2014

The author reports her concern that WHO’s so-called reform will side-line those who work in the spirit of ‘Health for All’ and expand the influence of business corporations and venture philanthropies over global public health matters as well as reinforce the trend towards fragmented, plutocratic, global governance. In October 2013, after a change of terminology, WHO presented a Discussion paper on WHO engagement with non-State actors and draft outline of WHO’s plan to ensure Due diligence, management of risks & transparency at an informal consultation with Member States, NGOs and commercial actors. WHO leadership quashed considered criticisms by NGOs. Member States and public interest NGOs found both papers wanting and requested changes. The successor of the October papers, the Background document, was discussed in March 2014 in a second consultation, open to Member States only. Ten days before the 2014 World Health Assembly, the WHO Secretariat issued the latest version of the policy Framework on engagement of non-State actors (A67/6). The author observes that the previous shortcomings were not addressed and expresses concern that the reform will open the floodgates to corporate influence on global and national decision-making processes in public health matters.

Obenson TA: Shadow and Act, October 2015

"Sembene!" is a feature documentary on continental Africa's most celebrated filmmaker, the late Ousmane Sembene, from co-directors Samba Gadjigo (author of Sembene’s official biography) and Jason Silverman. SEMBENE! tells the true story of the self-taught novelist and filmmaker who fought, against enormous odds, a 50-year battle to give Africans the power to tell their own stories. SEMBENE! is told through the never-before-seen archival footage and verite footage. It follows an ordinary man who transforms himself from a manual labourer into a fearless and often polarizing spokesman for the marginalized, becoming a hero to millions. The film is about, not only Sembene, but also about the importance of reclaiming African stories.

'The one with the purse makes policy': Power, problem definition, framing and maternal health policies and programmes evolution in national level institutionalised policy making processes in Ghana.
Koduah A; Agyepong IA; van Dijk H, Social Science & Medicine 167, doi: 10.1016/j.socscimed.2016.08.051, 2016

This paper seeks to advance the authors’ understanding of health policy agenda setting and formulation processes in a lower middle income country, Ghana, by exploring how and why maternal health policies and programmes appeared and evolved on the health sector programme of work agenda between 2002 and 2012. The authors theorised that the appearance of a policy or programme on the agenda and its fate within the programme of work is predominately influenced by how national level decision makers use their sources of power to define maternal health problems and frame their policy narratives. National level decision makers used their power sources as negotiation tools to frame maternal health issues and design maternal health policies and programmes within the framework of the national health sector programme of work. The power sources identified included legal and structural authority; access to authority by way of political influence; control over and access to resources (mainly financial); access to evidence in the form of health sector performance reviews and demographic health surveys; and knowledge of national plans such as Ghana Poverty Reduction Strategy. The authors argue that understanding of power sources and their use as negotiation tools in policy development should not be ignored in the pursuit of transformative change and sustained improvement in health systems in low- and middle income countries.

'Those were taken away and given money': power and reward expectations' influence in the selection of village health teams in rural Uganda
Turinawe E: Rural and Remote Health 16(3856), 2016

With the renewed call for community participation in health interventions after the Alma Ata Declaration, interest has been raised in volunteer community health workers (CHWs) acting as representatives of local communities. This study interrogates the dynamic interface between local communities and the government in the selection of CHW volunteers in a rural community. Data were collected through participant observation of community events, 35 in-depth interviews, 20 focus groups and 15 informal conversations and review of documents about Luwero district. Ambiguous national guidelines and poor supervision of the selection process enabled the powerful community leaders to influence the selection of village health teams (VHTs). Intended to achieve community involvement, the selection process was found to produce a disconnect in the local community where many members saw the selected VHTs as having been ‘taken away’. The authors argue that community involvement in the selection of VHTs took a form that, instead of empowering the local community, reinforced the responsibility of those in power and thus maintained the asymmetrical status quo.

** Impact Of Participatory Mechanisms And Structures In Equity And Quality Of Health Service Delivery
Abstract of paper presented at the Equinet conference, Durban, 8-9 June 2004, by TJ Ngulube, R Loewenson, I Rusike, M Macwangi, C Njobu, A Ngwengwe, EQUINET GoVERN theme

In 2002/3 EQUINET implemented a multi-country research study to examine the impact of Health Centre Committees (HCCs) and District Health Boards (DHBs) in bringing about equity in the primary health care services in Zambia and Zimbabwe. The research work sought to examine equity from an EQUINET perspective, with emphasis that equity related work needs to define and build a more active role for important stakeholders in health, and to incorporate the power and ability people (and social groups) have to make choices over health inputs and their capacity to use these choices towards health.

Further details: /newsletter/id/30456
.Amandla! Amandla! To People’s Health Assembly 3
Flores W: International Health Policy News 177, 13 July 2012

More than one thousand activists, academics and students from over 60 different countries gathered at the historic University of Western Cape for the third global assembly (PHA3). Walter Flores Gutaemala provided his insights on the Assembly in this opnion piece. He noted that the best plenary took place on the last day. Prof. Jaime Breilh from Ecuador gave a devastating account of how current public health programs and goals, such as the ones addressing nutrition and food security, are lagging so far behind of the ongoing acceleration of accumulation of capital that is destroying and contaminating water and food sources around the world. Large-scale land grabbing in the southern continents by large corporations is making the goal of food sovereignty implausible. The assembly concluded with a call for action that did not satisfy all participants. Clearly, some people wanted more concrete actions and less rhetoric. He comments that although a “call for action” is important, it does not mobilize people on its own, and notes that a clear goal and a path for action, combined with collective indignity and solidarity makes us move.

20 Years Later – The Role of Art and Justice in South Africa’s Democracy
Sachs A; Justice Cameron E: African Futures, Essays, 2015

At the entrance to the Constitutional Court of South Africa stands a sculpture of a large man yoked to a cart. His burden is a human one: a man and woman who themselves are seated on the back of a fourth figure kneeling on the cart. At first glance, the sculpture resonates with the history of servitude that marked the dehumanising institution of apartheid. On closer reflection, the sculpture reveals a more complex message. The sculptor, South African artist Dumile Feni, did not create any racial differentiation between the four figures, and the man drawing the cart is the only figure large and strong enough to accomplish this task. The title of the work is History, and the four figures carry each other in a way that reflects the dependence, the interconnectedness and the tension that have always characterised human relationships. History is the first of many artworks that challenge a visitor to the Constitutional Court to reflect on South Africa’s tortured past and the country’s transition to a constitutional order. The Constitutional Court Art Collection (CCAC)[1] is both a living monument to the ideals on which South Africa’s post-apartheid Constitution is based and a reminder of the work that remains.