Despite several years of implementation, prevention of mother-to-child transmission (PMTCT) programmes in many resource poor settings are failing to reach the majority of HIV positive women. This study reports on a data-driven participatory quality improvement intervention implemented in a high HIV prevalence district in South Africa. The intervention consisted of an initial assessment undertaken by a team of district supervisors, workshops to assess results, identify weaknesses and set improvement targets and continuous monitoring to support changes. Routine data revealed poor coverage of all programme indicators except HIV testing. One year following the intervention, large improvements in programme indicators were observed. Coverage of CD4 testing increased from 40 to 97%, uptake of maternal nevirapine from 57 to 96%, uptake of infant nevirapine from 15 to 68% and six week polymerase chain reaction (PCR) testing from 24 to 68%. It is estimated that these improvements in coverage could avert 580 new infant infections per year in this district.
Governance and participation in health
The University of Oxford's Global Economic Governance Programme has launched an independent Expert Taskforce on Global Knowledge Governance to propose a set of principles and options for the future of global knowledge governance. The Taskforce's Honorary Advisors emphasised the scope of global knowledge governance challenges at hand. The Taskforce will be led by a small, core team of experts participating in a personal capacity, supported by several distinguished Honorary Advisors. The Taskforce will consult widely, interviewing a diversity of academics, policy experts, and stakeholder communities around the world. The report will be peer-reviewed by a group of leading international scholars working on the intersection of issues covered in the study. The findings of the Taskforce will be published in late 2010 and presented to governments, relevant international organisations, stakeholders and academics working to shape how the future of global knowledge governance unfolds.
Policy briefs are a relatively new approach to packaging research evidence for policymakers. Drawing on available systematic reviews makes the process of mobilising evidence feasible in a way that would not otherwise be possible if individual relevant studies had to be identified and synthesised for every feature of the issue under consideration. This article suggests questions that can be used to guide those preparing and using policy briefs to support evidence-informed policymaking: Does the policy brief address a high-priority issue and describe the relevant context of the issue being addressed? Does the policy brief describe the problem, costs and consequences of options to address the problem, and the key implementation considerations? Does the policy brief employ systematic and transparent methods to identify, select, and assess synthesised research evidence? Does the policy brief take quality, local applicability, and equity considerations into account when discussing the synthesised research evidence? Does the policy brief employ a graded-entry format? Was the policy brief reviewed for both scientific quality and system relevance?
Increasing interest in the use of policy dialogues has been fuelled by a number of factors, such as recognition that: there is a need for locally contextualised 'decision support' for policymakers and other stakeholders; research evidence is only one input into the decision-making processes of policymakers and other stakeholders; having many stakeholders can add significant value to these processes; and many stakeholders can take action to address high-priority issues, and not just policymakers. This article suggests questions to guide those organising and using policy dialogues to support evidence-informed policymaking: Does the dialogue address a high-priority issue? Does the dialogue provide opportunities to discuss the problem, options to address the problem, and key implementation considerations? Is the dialogue informed by a pre-circulated policy brief and by a discussion about the full range of factors that can influence the policymaking process? Does the dialogue ensure fair representation among those who will be involved in, or affected by, future decisions related to the issue? Are outputs produced and follow-up activities undertaken to support action?
This article addresses strategies to inform and engage the public in policy development and implementation. The importance of engaging the public (both patients and citizens) at all levels of health systems is widely recognised. They are the ultimate recipients of the desirable and undesirable impacts of public policies, and many governments and organisations have acknowledged the value of engaging them in evidence-informed policy development. The potential benefits of doing this include the establishment of policies that include their ideas and address their concerns, the improved implementation of policies, improved health services, and better health. Public engagement can also be viewed as a goal in itself by encouraging participative democracy, public accountability and transparency. The article suggests three questions that can be considered with regard to public participation strategies: What strategies can be used when working with the mass media to inform the public about policy development and implementation? What strategies can be used when working with civil society groups to inform and engage them in policy development and implementation? What methods can be used to involve consumers in policy development and implementation?
This essay begins by describing various areas of volunteering, such as volunteering to build social capital and skills-based volunteering, where volunteers offers specific skills, such as medical skills. It goes on to outline the benefits of volunteering. Volunteering contributes to the development agenda by strengthening the voice of civil society organisations so they can influence policy, both at local and national levels, for the promotion of sustainable development and the improvement of livelihood security. Volunteering also helps to support communities to participate in development at local and national levels, as well as support communities to gain access to resources for local development and the improvement of essential services and to respond effectively to the HIV pandemic through programmes of prevention, care and support. Volunteering can support communities to realise their human rights, especially those of women and children.
In varying degrees, most developing regions have formally embraced the democracy and development agenda and recognised the ‘democratic advantage’ in terms of delivering development. In Africa, a stream of policy declarations have been issued, pointing to the positive links between democracy and development. Both the NEPAD and the Africa Peer Review Mechanism (APRM) are premised on this belief. This analysis confirms that there are few dissenting voices when it comes to formally recognising the potential added value of democracy for development. Yet do these high expectations resist the test of reality? How do democratic processes actually operate in third countries? Admittedly, the impact of democracy on development is not simple and straightforward. Challenges include the current trend for democracy to be on the defensive, doubts about the delivery capacity of democracy and the difficulty of initiating and continuing dialogue on democracy. This paper offers key insights on the link between democracy and development.
This review seeks to detail recent initiatives by non-governmental organisations (NGOs) and civil society organisations in improving development practice. There are several attempts to provide a ‘civil society or NGO’ parallel to the Paris Declaration. These initiatives seek some form of standardisation and evidence that NGOs are as effective as they claim to be, and to counter criticism that they have not been diligent in ensuring the quality of their delivery. However, seeking to justify oneself is not the best use of time and resources. Accountability needs to be improved. The survey indicated that many of the initiatives do not go far down the route of participation, despite a theoretical (rhetorical) commitment to beneficiary participation. Improved quality control is also required. Some of the models now available seek to improve the quality of delivery rather than the quality of impact. Thus an emphasis on things like complaints procedures, transparent, consistent and shared procedures, deal with how aid is delivered not what is delivered and whether it has any real impact. Regular assessments of efficiency, effectiveness and impact should be done. However, efficiency is not the same as effectiveness or impact. Improved efficiency does not automatically lead to more effective development or greater impact.
The 2009 edition of the Right to Food and Nutrition Watch focuses on the question: ‘Who controls the governance of the world food system?’ For the first time in history, the number of undernourished people in the world has surpassed the tragic figure of one billion. The gap between promises and reality is increasing as the international community and national governments are far from realising the World Food Summit targets to halve the proportion of chronically hungry people in the world by the year 2015. It is clear that the global governance of the world food system needs to be remodelled in order to effectively overcome hunger and its causes. As an evidence-providing monitoring tool, this book pursues two aims: to put public pressure on policy makers at national and international levels to take the human right to food seriously and to provide a systematic compilation of best practices for the realisation of the right to food, while documenting where violations take place.
This brief asserts that research relating to humanitarian crises has largely focused on what international aid agencies and donor governments do in response to disasters. Instead, this paper focuses on the role of the affected state in responding to the needs of its own citizens. It found that one of the goals of international humanitarian actors should always be to encourage and support states to fulfil their responsibilities to assist and protect their own citizens in times of disaster. Too often, aid agencies have neglected the central role of the state, and neutrality and independence have been taken as shorthand for disengagement from state structures, rather than as necessitating principled engagement with them. States should invest their own resources in assisting and protecting their citizens in disasters, both because it is the humane thing to do and because it can be politically popular and economically effective. The roles and responsibilities of states in relation to humanitarian aid are four-fold: they are responsible for 'calling' a crisis and inviting international aid; they provide assistance and protection for themselves; they are responsible for monitoring and coordinating external assistance; and they set the regulatory and legal frameworks governing assistance.