Governance and participation in health

The provision of aid directly to government, known as direct budget support, has recently been promoted as the best possible tool for improving the impact of aid and ensuring governments take the lead in implementing national development strategies. However, this paper argues that nothing in the theory of budget supports suggests that it can or should be used as an instrument for influencing political processes. Yet over the last decade, budget support has repeatedly been subject to delays and halts, sometimes for political reasons. While these are often due to administrative problems on the funder's side, the number of incidents of budget support being halted in response to digression from democratic norms by recipient countries is on the rise. This paper questions the theories and conditions underpinning budget support. It appears that external funders are quite prepared to use conditionalities. However, to date, there is little evidence to suggest that these conditionalities bring about democratic change in the recipient country. Rather than budget support becoming a viable instrument for fostering better political practice, it would appear that there is a tightening of selectivity criteria in deciding who gets budget support and that these incidents represent the weeding out of a few 'bad apples'.

This publication is a response to the critical need for, and contribution of, collaborative partnerships with the World Health Organization (WHO) to achieve global health outcomes. It refers to WHO’s Constitution, the Eleventh General Programme of Work, 2006–2015 and the medium-term strategic plan 2008–2013, which describe collaboration and coordination as core functions of the Organization, while noting that the growth of health partnerships and other forms of collaboration have increased greatly in the past decade. It recommends that WHO develop a policy governing its engagement in, and hosting of, partnerships in a manner that avoids duplication of WHO’s core responsibilities in its partnership activities. Collaboration of WHO with stakeholders should be based on clear distinction of roles that creates added value, synergies and coordination among different programmes that support achievement of global and national health outcomes and reduce transaction costs. It calls upon United Nations member states to take the policy into account when seeking engagement by the Director-General in partnerships, in particular with regard to hosting arrangements.

Child-friendliness is a manifestation of the political will of governments to make the maximum effort to meet their obligations to respect, protect and fulfill children’s rights and ensure their wellbeing. This report has developed and used a Child-friendliness Index to assess the extent to which African governments are living up to their responsibilities to respect and protect children and to ensure their wellbeing. Three dimensions of child-friendliness were identified: protection of children by legal and policy frameworks; efforts to meet basic needs, assessed in terms of budgetary allocation and achievement of outcomes; and the effort made to ensure children’s participation in decisions that affect their wellbeing. Though child participation is important, it was not possible to obtain sufficient data on this dimension during the development of the Index. Mauritius and Namibia emerged as the first and second most child-friendly governments respectively in Africa, followed by Tunisia, Libya, Morocco, Kenya, South Africa, Malawi, Algeria, and Cape Verde. At the other extreme are the ten least child-friendly governments in Africa, the last being Guinea-Bissau preceded by Eritrea, Central African Republic, Gambia, São Tomé and Principe, Liberia, Chad, Swaziland, Guinea and Comoros.

This report assesses the progress made in some of the major countries that have begun to implement the African Peer Review Mechanism (APRM) and address their governance problems, including two countries from east and southern Africa – South Africa and Kenya. The overall picture is generally positive, with dialogue between stakeholders occurring and changes being introduced in the ways policies are developed and implemented. There is peer learning, with experiences from a given country being introduced to others. But the report notes that the pace of learning and the pace of change are slow. It argues that the APRM itself has to be changed to make it more straightforward and more efficient. Human and financial resources must be increased at the national level to help countries carry out their evaluations successfully and, more importantly, implement the priority actions that are agreed on. The report argues that civil society is a key player in the APRM, but this is often forgotten by governments, by the continental APRM authorities and by external funders, and the inclusion of civil society representatives in the APRM process is often just an afterthought.