Governance and participation in health

Assessing the scalability of a health management-strengthening intervention at the district level: a qualitative study in Ghana, Malawi and Uganda
Bulthuis S; Kok M; Onvlee O; et al: Health Research Policy and Systems 20(85), 1-14, 2022

The scale-up of successfully tested public health interventions is critical to achieving universal health coverage. This study assessed the scalability of a tested health management-strengthening intervention (MSI) at the district level in Ghana, Malawi and Uganda. The MSI was seen as credible, as regional- and national-level Ministry of Health officials championed it and district- and national-level stakeholders seemed to be convinced of its value, due to observed positive results regarding management competencies, teamwork and specific aspects of health workforce performance and service delivery. While the relative advantages of the intervention were its participatory and sustainable nature, turnover within the district health management teams and limited (initial) management capacity complicated implementation. The authors propose from the findings that improved documentation of results of the intervention can facilitate scale-up, while embedding continuous assessment with all stakeholders involved can help to adapt to changing conditions..

Cities can care for people and enable them to care for others, making urban health possible
Obando F; Keith M: PEAK Urban Programme, University of Oxford, 2022

By creating the conditions for health in many ways - through healthcare, childcare, public safety, community and economic development, parks and recreation, among others - local governments care for people. In this paper, three significant ways are discussed. A closer look at the role of local governments in providing water, sanitation and hygiene (WASH), urban planning, and transport shows that the local government contribution to healthy urban lives and equity is unparalleled but faces significant challenges. A contestation of public goods and private interests make the role of a local arbitrator essential. With local governments key actors in collective wellbeing and in generating equity, the authors argue that when they fall short, the consequences for health are disastrous. They provide a framework for navigating complexity and present and draw lessons from the participation of local governments in urban governance during the COVID-19 pandemic.

The importance of prioritizing politics in Good Governance for Medicines Initiative in Zimbabwe: a qualitative policy analysis study
Mhazo AT; Maponga CC: Health Policy and Planning 37(5) 634–643, doi: https://doi.org/10.1093/heapol/czac007, 2022

In 2004, the World Health Organization (WHO) launched the Good Governance for Medicines (GGM) initiative, with the aim of fighting corruption in the pharmaceutical sector. In the case of Zimbabwe, implementation of the initiative slowed down after the development phase. Often, lack of funding and technical considerations are cited as major reasons for issue de-prioritization whilst ignoring the influence of politics in mediating policy diffusion. Between June and August 2021, an in-depth document review was conducted and individuals involved with GGM in Zimbabwe interviewed to understand the political determinants of GGM prioritization in Zimbabwe. The Shiffman and Smith framework was used to guide and direct the analysis. The authors found that the inception of GGM was facilitated by capable leaders, effective guiding institutions and resonance of the idea with the political environment. Prioritization from inception to implementation was constrained by limited citizen engagement, restriction of the issue to the pharmaceutical domain and a political transition that re-oriented policy priorities and reconfigured individual actor power. The portrayal of corruption as a priority problem requiring policy action has been hampered by the political sensitivity of the issue, lack of credible indicators on the prevalence and severity of the problem and challenges to measure the effectiveness of interventions such as the GGM. Despite the slowdown, from 2018 GGM actors have taken advantage of momentous policy windows to reconstitute their power by opportunistically framing GGM within the broader framework of access to essential medicines leading to the creation of new policy alliances and establishment of strategic political structures. To sustain the political prioritization, the author argues that actors need to lobby for the institutionalization of GGM within the Ministry of Health strategy, sensitize citizens on the initiative, involve multiple stakeholders and frame the issue as a strategic intervention that underpins pharmaceutical sector performance within the national developmental framework.

Africa CDC is Elevated to the Status of a Continental Public Health Agency
Adepoju P: Health Policy Watch, February 2022

The African Union (AU) has decided to elevate its African Centres for Disease Control and Prevention (Africa CDC) to the status of an autonomous public health agency for the continent – rather than operating simply as technical arm of the AU. The elevation of the Africa CDC – which will now report directly to Heads of State of AU Member Countries – is reported to signal the growing member state commitment to strengthening the continent’s response to current and future disease outbreaks.

Promoting social dialogue to improve working conditions for Community Health Workers in Malawi
Public Services International: PSI, Malawi, 2021

Community Health Workers (CHWs) occupy a unique position in-between the community and state bureaucracy, which the authors report to be challenging for CHWs to balance as they are accountable to both. This intermediary position poses disadvantages for CHWs when the expectations of the community and the state bureaucracy differ, leading to high workload and demotivation among CHWs. Nevertheless, given the acute shortage in the health workforce in Malawi, CHWs are an essential cadre in driving forward efforts to achieve universal health coverage. This publication aims to support efforts to understand the working conditions of CHWs and to achieve decent work for CHWs.

Promoting social dialogue to improve working conditions for Community Health Workers in South Africa
Public Services International: PSI, South Africa, 2021

This manual looks at Community Health Workers (CHWs) in South Africa and their crucial role in the health system. The official health policy of the National Department of Health, “Restructuring the national health system for universal Primary Health Care (NDOH 1996) mentioned the important role of CHWs but did not incorporate them into the health system. More recent policies acknowledge CHWs as a vital part of the health team, for the success of Primary Health Care (PHC), but implementation has been delayed. The publication draws attention to the present working conditions of CHWs, their demands and how trade unions can assist them.

I don’t know when he will be back”: life-changing events challenge the community ART Group model– a qualitative research study, Tete, Mozambique
Tarquino IAP; Venables E; Simone RR; et al.: BMC Public Health 21:2004, 1-9, 2021

Since 2008 in Mozambique, patients stable on antiretroviral therapy (ART) can join Community ART Groups (CAG), peer groups in which members are involved in adherence support and community ART delivery. More than 10 years after the implementation of the first CAGs, this study explored the impact of changes in circumstances and daily life events of CAG members. The CAG dynamic was affected by life events and changing circumstances including a loss of geographical proximity or a change in social relationships. Family CAGs facilitated reporting and antiretroviral therapy distribution, but conflict between CAG members meant some CAGs ceased to function, pill counts were not carried out, members met less frequently or stopped meeting entirely and ART uptake declined. In a more positive contrast, some CAGs responded to adherence challenges by strengthening peer support through counselling and observed pill intake. Health care providers were reported to push people living with HIV to join CAGs, instead of allowing voluntary participation. They agreed that strengthening CAG rules and membership criteria could help to overcome the identified problems. The authors propose that changing life circumstances of, relationships between and participation by CAG members need to factored into a more flexible implementation model, including intensified peer support and feedback mechanisms between CAG members and health-care providers.

I have started the change I want: advocating for climate change in Zimbabwe
Nyathi N: Voices of Youth, 2020

This young writer explains: "What keeps me on the frontline for climate justice is the notion that I don't only represent my nation but my entire generation because climate justice concerns our future...We deserve to live happily as well, but to attain that healthy, happy living we will not stop speaking out for what we want and what we deserve, to bring about a child-safe and sustainable future. I have dedicated my voice as a voice of the voiceless, to call for immediate action and there is no better time for acting than now". UNICEF teamed up with 'Fridays for Future' to highlight young activists on the front lines of climate change, like Nyathi. Discover other climate activists and stories on how climate change is affecting young people today.

Patient-public engagement strategies for health system improvement in sub-Saharan Africa: a systematic scoping review
Ankomah S E; Fusheini A; Ballard C; et al.: BMC Health Services Research 21:1047, 1-16, 2021

This systematic review of 18 papers published between 1999 and 2019 describes Patient-Public Engagement (PPE) research in Sub-Saharan Africa in relation to theories of PPE; and identifies knowledge gaps to inform future PPE development. Five PPE strategies implemented were traditional leadership support, community advisory boards, community education and sensitisation, community health volunteers or workers, and embedding PPE within existing community structures. PPE initiatives were located at either the ‘involvement’ or ‘consultation’ stages of the engagement continuum, rather than higher-level engagement. Most PPE studies were at the ‘service design’ level of the health system or were focused on engagement in health research. No identified studies reported investigating PPE at the ‘individual treatment’ or ‘macro policy or strategic’ level. The authors suggest that the findings call expanding for PPE at all health system levels and different areas of health system improvement.

Report: Rebels, doctors and merchants of violence: How the fight against Ebola became part of the conflict in Eastern DRC
Congo Research Group; NYU Center on International Cooperation: Online, 2021

Between 2018 and 2020 in the eastern Democratic Republic of the Congo (DRC) the Ebola epidemic hit an area of ongoing hostilities among dozens of belligerents, including Congolese security forces. The Riposte, a combined national and international response to contain the disease, was not only affected by the violence, but the authors argue may have unintentionally contributed to the conflict. Despite the vast sums spent, Ebola continued to spread in North Kivu and Ituri provinces, which were already hard hit by decades of armed violence. On the ground, in an effort to protect itself from armed attacks and reduce community resistance, the Riposte through agents of the National Intelligence Agency (ANR), in collaboration with the Congolese Ministry of Health and the WHO (in contradiction with UN standard operating procedure), agreed to pay both government security forces and non-state armed groups. Over 20 months, between $489 million and $738 million was spent on Ebola in this part of the country. The authors describe the impact of these payments. By engaging with some armed groups in conflict with others the Riposte is reported to have become embroiled in the violence. The authors point to how this monetized the violence, with some armed groups seeking to prolong the epidemic to continue to profit from what has been called “Ebola Business.” The report cautions against making payments to parties to conflict in exchange for access so as not to inadvertently turn humanitarian operations into a source of profit for those involved in conflict and undermine the impartiality of humanitarian action.

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