Governance and participation in health

The International Day of No Violence Against Women Campaign does not only concern those sections of civil society dealing feminist issues. Not true. Instead the campaign illustrates the need for all sections of civil society to unite around fundamental issues of human rights, democracy and good governance.

This report shows that developing countries will only achieve healthy and educated populations if their governments take responsibility for providing essential services. Civil society organisations and private companies can make important contributions, but they must be properly regulated and integrated into strong public systems, and not seen as substitutes for them. Only governments can reach the scale necessary to provide universal access to services that are free or heavily subsidised for poor people and geared to the needs of all citizens – including women and girls, minorities, and the very poorest. But while some governments have made great strides, too many lack the cash, the capacity, or the commitment to act.

The traditional top-down approach to development is widely criticised as being inappropriate to meet the needs of local populations, especially the very poor. In order to improve this situation, some development organisations and non-governmental organisations (NGOs) favour approaches that integrate local communities in policy formation and implementation. Health, an important aspect of development, necessitates active involvement of the local population. The community remains the key actor in improving its own health standards and communicating its requirements to governments.

In many communities the symptoms of malaria are widely recognised. Decisions about choice and order of treatment are often based on people's experience of the effectiveness of particular treatments and the availability and cost of medication. Research on managing malaria in communities has been largely concerned either with individual perceptions about the causes and symptoms of the disease or with the implementation of specific interventions. It fails to provide essential information on the context in which communities and households cope with their day-to-day problems, including malaria. Further research needs to: * focus on the 'normality' of malaria and the social and political environments that influence how interventions are chosen and how they are used; and * increase understanding of the social, economic, political and historical contexts that shape household and community beliefs and behaviours.