Governance and participation in health

This study explored how community-based initiatives address the critical health literacy of older adults and their communities. A systematic literature search was conducted. Two reviewers independently screened titles and abstracts, as well as the quality of the methodological and community-based elements of the studies. In addition, a meta-synthesis was carried out, consisting of a qualitative text analysis of the results sections of the 23 included studies. The authors identified two main themes, which are practices that contribute to the critical health literacy of older adults as well as their communities: collaborative learning, and social support. In these practices they identified reciprocity as a key characteristic of both co-learning and social support. This study provides the first overview of community-based initiatives that implicitly address the critical health literacy of adults and their community. The results demonstrate that in the context of one’s own life collaborative learning and social support could contribute to people’s understanding and ability to judge, sift and use health information. The authors therefore suggest to add these two practices to the definition of critical health literacy.

Citizen-based accountability strategies to improve the lives of the poor and marginalised groups are increasingly being used in efforts to improve basic public services. The latest thinking suggests that broader, multi-pronged, multi-level, strategic approaches that may overcome the limitations of narrow, localised successes, hold more promise. This paper examines the challenges and opportunities, in theory and practice, posed by the integration of two such citizen-based accountability strategies—social accountability and legal empowerment. It traces the foundations of each of these approaches to highlight the potential benefits of integration. Consequently it examines whether these benefits have been realised in practice, by drawing upon five cases of organisations pursuing integration of social accountability and legal empowerment for health accountability in Macedonia, Guatemala, Uganda, and India. The cases highlight that while integration offers some promise in advancing the cause of social change, it also poses challenges for organisations in terms of strategies they pursue.

Peasants across Africa are intensifying their struggles against land grabs and other harmful policies that promote industrial agriculture. At a recent international conference organised by the world’s largest peasants movement, Via Campesina, African peasants had opportunities to share their experiences of struggle and to learn. This conference happens at a time when Africa is undergoing a harsh moment, as indicated by Ibrahima Coulibaly from the National Coordination of Peasant Organizations (CNOP) in Mali. They note that land, mineral resources, seeds and water are increasingly being privatised due to the myriad of investment agreements and policies driven by new institutional approaches, imposed on the continent by western powers and Bretton Woods institutions. Elizabeth Mpofu, from the Zimbabwe Smallholder Farmers Forum, is a small-scale farmer who had access to land after she took part in the radical land occupation that resulted in the fast-track land reform in the early 2000s. According to her, building alternatives is to take direct action. Domingos Buramo, from the Mozambique Peasants Union (UNAC), brought to the conference the experience of the Mozambican peasants and other civil society organisations against land grabbing and large-scale investment projects in Mozambique. He mentioned that the resistance to ProSavana, a large-scale agricultural project proposed for Mozambique, is an example of how transformative articulated struggles could be. “Now the government is changing its vision as a result of our work. We can change our societies”, he said. Africa - including the Maghreb region - was the last continent to be part of Via Campesina. Since 2004 the number of African peasant movements joining La Via Campesina has been increasing. African movements consider their membership to the peasant movement as a strategic process of amplifying their struggles and reinforcing internationalism.

The 2008–2009 Zimbabwe cholera epidemic resulted in 98,585 reported cases and caused more than 4,000 deaths. In this study, the authors used a mixed-methods approach that combined primary qualitative data from a 2008 Physicians for Human Rights-led investigation with a systematic review and content analysis of the scientific literature. Their initial investigation included semi-structured interviews of 92 key informants, which the authors supplemented with reviews of the social science and human rights literature, as well as international news reports. The authors investigation revealed that the 2008–2009 Zimbabwean cholera epidemic was exacerbated by a series of rights abuses, including the politicisation of water, health care, aid, and information. The authors argue that the failure of the scientific community to directly address the political determinants of the epidemic exposes the challenges to maintaining scientific integrity in the setting of humanitarian responses to complex health and human rights crises. While the period of the cholera epidemic is now a decade in the past, the findings remain relevant for contexts where health and rights interact and in contexts where governance concerns affect improvements in health.