This article sets out to discuss and analyze the described collapse of health services through a brief case study on provision of Emergency Obstetric Care in Northern Tanzania. The article argues that since the Alma Ata conference on Primary Health Care developments in global health initiatives have not been successful in incorporating population trust into the frameworks, instead focusing narrowly on expert-driven solutions through concepts such as prevention and interventions. The need for quantifiable results has pushed international policy makers and donors towards vertical programmes, intervention approaches, preventive services and quantity as the coverage parameter. Health systems have consequently been pushed away from generalised horizontal care, curative services and quality assurance, all important determinants of trust. The article proposes a new framework that places generalised services and individual curative care in the centre of the health sector policy domain. It concludes that an increased focus on quality and accountability to secure trust is an important precondition for enabling the political commitment to mobilise necessary resources to the health sector.
Governance and participation in health
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.
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.
This study aimed to determine noise exposure levels of spectators at a FIFA 2010 designated training stadium during a premier soccer league match and changes in auditory functioning after the match. This was a one-group pretest–post-test design of football spectators attending a premier soccer league match at a designated FIFA 2010 training stadium in Gauteng, South Africa. Individual spectator noise exposure for the duration of the football match and post-match changes in hearing thresholds were measured with pure-tone audiometry, and cochlear functioning was measured with distortion product oto-acoustic emissions (DPOAEs). The study found that average sound exposure level during the match was 100.5 LAeq (dBA), with peak intensities averaging 140.4 dB(C). A significant deterioration of post-match hearing thresholds was evident at 2,000 Hz, and post-match DPOAE amplitudes were significantly reduced at 1,266, 3,163 and 5,063 Hz. In conclusion, exposure levels exceeded limits of permissible average and peak sound levels. Significant changes in post-match hearing thresholds and cochlear responsiveness highlighted the possible risk for noise-induced hearing loss. Public awareness and personal hearing protection should be prioritised as preventive measures.
At a meeting in Addis Ababa in February 2010, African Heads of States reviewed the framework guiding the relationship between the two continents, namely, the Joint Africa-EU Strategy (JAES) and its associated Action Plan. The meeting noted that the JAES aims to upgrade European Union-Africa relations to a strategic political partnership based on joint interests and a common vision. It is meant to enable continent-continent cooperation, especially with a view to addressing global challenges such as climate change, terrorism etc., while fostering integration on both sides. It serves as an over-arching and inclusive framework for EU-Africa relations. However, three major challenges facing the JAES have been identified: lack of engagement of all stakeholders, lack of results from cooperation and dialogue in this framework so far, and the fact that political dialogue is not driving partnerships. According to this report, a genuine change in mentality has not yet taken place, and the JAES is currently not being used as a true partnership between the two players to address important global challenges. It further argues that most of the current cooperation could be done through other already existing frameworks. It concludes that there is a risk that the framework will lose credibility if its added value is not clarified.
Despite the significant success of global health programs, there is a continuing gap between policy analysis and action. This paper is the first in a series, cosponsored by Results for Development Institute and the Global Health Council, which presents examples and opportunities of how evidence-based research can be translated into policies and programmes that will improve the health of poor people in developing countries. The series includes six presentations that draw from Results for Development's expertise in transparency and governance, the role of the private sector in health, health ministry capacity building, health financing and the health workforce. The first of these talks, 'Civil Society: A Missing Link in Development' took place on 29 March 2010 and featured civil society leaders from India, South Africa and Uganda, who are participating in the Institute's Transparency and Accountability Programme. You can watch the presentations on the website given above.
This paper argues that parliaments and parliamentarians have a crucial role to play in ensuring that governments are accountable for the decisions that they make about how resources – including aid – are spent. The scope parliaments actually have to play this role varies widely. Some parliaments benefit from large resources and a legal framework that back them in playing their oversight and legislative role. Many other parliaments, especially in developing countries, lack resources or power to play an effective role in promoting development or the more effective use of aid. Parliamentarians themselves come from all walks of life and do not share the same knowledge on these issues, and there is no consensus among parliamentarians or across countries on the ways and means by which they can enhance oversight of development policies and how development resources are used. This guidance note addresses some of these challenges and seeks to provide parliamentarians and those who work with them with a common understanding and clear guidance on what they can do to promote more effective and accountable use of aid in particular and of development resources in general.
The purpose of this study was to determine the roles of educators in mitigating the impact of the HIV and AIDS pandemic, and to ascertain the skills and knowledge required by them to play such roles effectively. The study gathered data from 3,678 survey respondents to a questionnaire. Qualitative fieldwork showed that levels of concern among educators were polarised with respect to HIV and AIDS pandemic, ranging from lack of concern and denial of its importance to extreme concern and a strong sense of ethical responsibility to mitigate its impact. However, most respondents displayed a very high level of concern regarding the pandemic. They pointed to an urgent need for training and resources for future roles. The study made four recommendations. It urged for a resolution to South Africa's current strategic dilemma, namely whether to prescribe approaches to mitigating the impact of the pandemic or allow individuals and institutions to develop their own responses. It also called for curriculum interventions that meet the challenges of the pandemic, differentiated interventions that enable educators to meet the challenges of the pandemic and more time to develop appropriate resources and support, including training.
This guide explores a number of different themes related to youth participation in development: governance, voice and accountability, post-conflict transition and livelihoods, and sexual and reproductive health. In the sexual and reproductive health section, several examples of youth-focused health initiatives from Uganda are discussed, such as Uganda's National Development Plan and the Youth Empowerment Programme. Another health initiative, Young, Empowered and Healthy (Yeah) is a sexual health campaign for and by young people in Uganda was launched in 2004 under the auspices of the Uganda AIDS Commission and uses radio and other media to reach youth.
Mkanda, in central Malawi, is presented as a successful example of cholera control through the Community-Led Total Sanitation (CLTS) approach, with a fall from fourteen to zero cholera cases in a year. The article does not give adequate evidence to attribute the cause of the decline, but toilet availability and community awareness both improved in the year.