The author of this paper develops select components of an alternative model of shared health governance (SHG), which aims to provide a ‘road map,’ ‘focal points’ and ‘the glue’ among various global health actors to better effectuate cooperation on universal ethical principles for an alternative global health equilibrium. Key features of SHG include public moral norms as shared authoritative standards; ethical commitments, shared goals and role allocation; shared sovereignty and constitutional commitments; legitimacy and accountability; country-level attention to international health relations. A framework of social agreement based on ‘overlapping consensus’ is contrasted against one based on self-interested political bargaining. A global health constitution delineating duties and obligations of global health actors and a global institute of health and medicine for holding actors responsible are proposed. Indicators for empirical assessment of select SHG principles are described. The author concludes that global health actors, including states, must work together to correct and avert global health injustices through a framework of SHG based on shared ethical commitments.
Governance and participation in health
This article evaluates progress in governance of Namibia since independence in 1990. Unemployment is high – estimated at 50% - and pass rates at schools are dropping, while the promised fruits of independence have not yet reached the broad spectrum of the population, and the government’s success in attracting investment has not paid much in terms of long-term dividends. However, there have been plenty of immediate and valuable gains, such as regular elections, much wider access to schooling, and government benefits that are available for ex-combatants and war orphans, and other vulnerable groups. While the courts are at times outspoken, they remain visibly understaffed. Despite the fact that democratic commitment remains fragile in the country, the so-called ‘born-frees’ (those people born after independence) are becoming increasingly vocal and more active in the debate over the country’s future, free speech is now more deeply entrenched and there are a number of vibrant public discussion platforms, including social media.
This paper examines the changing perceptions of Frelimo's nationalist project amongst members of the middle class in Maputo, Mozambique's capital. The author argues that nationalism in Mozambique has created a system of meaning and new forms of identity that are especially relevant for more privileged urbanites. However, growing urban poverty and inequality has had an effect throughout the social spectrum in Mozambique. and everyday life conflicts with the government's message of unity and progress for all.
Large-scale social mobilisation, including street protests and parallel activities, is the only thing can save the United Nations Conference on Sustainable Development (Rio+20) from ending in nothing but frustration, according to activists and analysts. A repeat of the failure of recent conferences to negotiate an international climate change pact seems inevitable, said Cândido Grzybowski, the director general of the Brazilian Institute of Social and Economic Analysis (IBASE) and one of the founders of the World Social Forum, the largest global civil society gathering. Grzybowski based his pessimistic outlook on a number of factors, such as the economic/financial crisis in the wealthy nations, combined with the fact that this a year of elections in many of them, including France and the United States, moving international commitments to the bottom of their leaders’ agendas. He also blamed what he calls the limited convening power of Brazilian President Dilma Rousseff, particularly when it comes to environmental issues. Civil society actions must not be limited to Rio de Janeiro, say activists. The Brazilian Forum of NGOs and Social Movements for the Environment and Development (FBOMS) is planning to promote demonstrations in many other cities around the world, with the aid of the internet and social networks. The Thematic Social Forum in Porto Alegre will help to coordinate these initiatives, with the participation of representatives of civil society movements like the Indignados (Indignant) movement in Spain and the Occupy movement in the United States.
The tumultuous uprisings of citizens in Tunisia, Egypt and Libya have seized the attention of media analysts who have characterised these
as 'Arab revolutions', a perspective given weight by popular demonstrations in Yemen, Bahrain, Syria and elsewhere. However, what have been given less attention are the concurrent uprisings in other parts of the African continent. The uprisings across Africa and in the Middle East, the book argues, are the result of common experiences of decades of declining living standards, mass unemployment, land dispossessions and impoverishment of the majority, while a few have engorged themselves with riches. Through incisive contributions from analysts and activists across the continent, the essays in ‘African Awakening’ provide an overview of the struggle for democratisation which goes beyond calls merely for transparent electoral processes and constitutes a reawakening of the spirit of freedom and justice for the majority.
In this paper, researchers reviewed contemporary health sector frameworks which have focused on defining and developing indicators to assess governance in the health sector. Based on these, they propose a simplified approach to look at governance within a common health system framework which encourages stewards to take a systematic perspective when assessing governance. Although systems thinking is not unique to health, examples of its application within health systems has been limited. This approach is built largely on prior literature, but is original in that it is problem-driven and promotes an outward application taking into consideration the major health system building blocks at various levels in order to ensure a more complete assessment of a governance issue rather than a simple input-output approach. Based on an assessment of contemporary literature the authors propose a practical approach which we believe will facilitate a more comprehensive assessment of governance in health systems leading to the development of governance interventions to strengthen system performance and improve health as a basic human right.
The author of this article develops select components of an alternative model of shared health governance (SHG), which aims to provide a ‘road map,’ ‘focal points’ and ‘the glue’ among various global health actors to better effectuate cooperation on universal ethical principles for an alternative global health equilibrium. Key features of SHG include public moral norms as shared authoritative standards; ethical commitments, shared goals and role allocation; shared sovereignty and constitutional commitments; legitimacy and accountability; country-level attention to international health relations. A framework of social agreement based on ‘overlapping consensus’ is contrasted against one based on self-interested political bargaining. A global health constitution delineating duties and obligations of global health actors and a global institute of health and medicine for holding actors responsible are proposed. Indicators for empirical assessment of select SHG principles are described. The author concludes that global health actors, including states, must work together to correct and avert global health injustices through a framework of SHG based on shared ethical commitments.
While global health diplomacy (GHD) has attracted growing attention, accompanied by hopes of its potential to progress global health and/or foreign policy goals, the concept remains imprecise. This paper finds the term has largely been used normatively to describe its expected purpose rather than distinct features. This paper distinguishes between traditional and “new diplomacy”, with the latter defined by its global context, diverse actors and innovative processes. The authors point to need to strengthen the evidence base in this rapidly evolving area.
This paper presents the findings of a systematic literature review of: (a) the evidence of HFCs' effectiveness, and (b) the factors that influence the performance and effectiveness of HFCs. Four electronic databases and the websites of eight key organizations were searched. Out of 341 potentially relevant publications, only four provided reasonable evidence of the effectiveness of HFCs. A further 37 papers were selected and used to draw out data on the factors that influence the functioning of HFCs. The review found some evidence that HFCs can be effective in terms of improving the quality and coverage of health care, as well as impacting on health outcomes. However, the external validity of these studies is inevitably limited. Given the different potential roles and functions of HFCs and the complex and multiple set of factors influencing their functioning, the authors argue that there is no ‘one size fits all’ approach to CPH via HFCs, nor to the evaluation of HFCs. However, there are plenty of experiences and lessons in the literature which decision makers and managers can use to optimize HFCs.
On 1 December 2012, the final day of the Fourth High-level Forum for Aid Effectiveness held in Korea, the International Dialogue on Peace-building and State-building – consisting of the G7+ group of 19 fragile and conflict-affected countries, development partners and international organisations – signed a ‘New Deal’ of development architecture for fragile states. It builds on vision and principles from a range of international agreements, including the Paris Declaration on Aid Effectiveness, the Accra Agenda for Action and the Millennium Development Goals, and will be implemented in a trial period from 2012 to 2015. Signatories have agreed to use five peace-building and state-building goals (PSGs): foster inclusive political settlements and conflict resolution, establish and strengthen people’s security, address injustices and increase people’s access to justice, generate employment and improve livelihoods, and manage revenue and build capacity for accountable and fair service delivery. They further commit to support inclusive country-led and country-owned transitions out of fragility, using the PSGs to monitor progress, and to support inclusive and participatory political dialogue. Mutual trust will be fostered by providing reliable external funding, managing resources more effectively and transparently, and aligning resources for results.