Although decentralisation is often heralded as a means to promote democracy and poverty reduction, there is little reliable evidence to prove these claims. In fact, ruling parties and ethnic elites in Africa have used decentralisation to further strengthen their own power and influence at a local level. New research argues that on its own, decentralization will not reduce poverty. Just as important are an ideological commitment to the poor and democratic accountability. Research from the Institute of Development Studies looks at the politics of local-central relations in a selected number of African states which have adopted decentralisation.
Governance and participation in health
Decentralisation and poverty reduction: the reality in Africa
** Impact Of Participatory Mechanisms And Structures In Equity And Quality Of Health Service Delivery
Abstract of paper presented at the Equinet conference, Durban, 8-9 June 2004, by TJ Ngulube, R Loewenson, I Rusike, M Macwangi, C Njobu, A Ngwengwe, EQUINET GoVERN theme
In 2002/3 EQUINET implemented a multi-country research study to examine the impact of Health Centre Committees (HCCs) and District Health Boards (DHBs) in bringing about equity in the primary health care services in Zambia and Zimbabwe. The research work sought to examine equity from an EQUINET perspective, with emphasis that equity related work needs to define and build a more active role for important stakeholders in health, and to incorporate the power and ability people (and social groups) have to make choices over health inputs and their capacity to use these choices towards health.
Further details: /newsletter/id/30456
Community Assessment of the Socio-economic Situation in Zimbabwe: Health and Education
Civic organisations have through the monitoring Group of the National NGO Food Security Network (FOSENET) been monitoring food security in Zimbabwe since July 2002. In 2004 this monitoring has been widened to cover other social and economic conditions, recognizing the wide range of conditions influencing social and economic wellbeing. The Civic Monitoring Programme is implemented through NGOs based within districts and community based monitors. Monthly reports from all areas of the country are compiled to provide a monthly situation assessment of food security and social welfare to enhance an ethical, effective and community focussed response to the current situation. Quarterly reports such as this one complement the monthly monitoring and provide more detailed information on specific areas of social and economic conditions at community level. Queries and feedback on these reports is welcomed and should be directed to the Civic Monitoring Programme at fsmt2@mweb.co.zw This is the first round of such quarterly monitoring and continuous measures are being implemented to improve data quality and relevance, including training and peer review, so feedback is welcomed. For the full report, please contact fsmt2@mweb.co.zw.
Parliamentary Functions and Reforms and their application in promoting Health Equity
Equinet discussion paper
In response to demands by the public represented by Civil Society Organisations, Parliaments have been called upon to be more effective in carrying out their functions or representation, oversight and legislating. Beginning with the Parliament of South Africa in 1994 there has thus been a wave of Parliamentary reforms in the region with different levels of success. Parliaments have instituted changes in their committee systems and in the legislative process to allow greater participations from the public. In seeking to promote health equity and public health, legislatures, through their committees, have sought ways to engage with relevant stakeholders, and other organisations in order to broaden their knowledge base.
Health promotion through self-care and community participation
The concepts of health promotion, self-care and community participation emerged during the 1970s, primarily out of concerns about the limitation of professional health systems. Since then there have been rapid growth in these areas in the developed world, and there is evidence of effectiveness of such interventions. These areas are still in their infancy in the developing countries. There is a window of opportunity for promoting self-care and community participation for health promotion. This article proposes elements of a programme for health promotion in the developing countries following key principles of self care and community participation.
Campaign to support women's health rights
In 1987, May 28th was proclaimed the International Day of Action for Women's Health. Health is a human right for all and, as asserted in many international human rights covenants and agreements, the right to health cannot be fulfilled if women's sexual and reproductive rights are not addressed. However, health sector reforms and privatisation of health services around the world are jeopardising women's access to health and sexual and reproductive rights. Women's Global Network for Reproductive Rights (WGNRR) invites you to support promoting women's sexual and reproductive health and rights by organising your own activity or event on the 28th of May.
Further details: /newsletter/id/30348
NO War! NO WTO! Fight for people's health
International campaign information
"As health workers and health advocates, we are witness to the fact that unhampered economic globalization causes increasing poverty, while US-led wars of aggression maim and massacre millions of people and destroy social infrastructure and our planet Earth itself. We therefore call on the peoples of the world to junk the World Trade Organisation and regional trade agreements with a similar character. Key WTO agreements such as the Trade-Related Aspects of Intellectual Property Rights (TRIPS) and the General Agreement on Trade in Services (GATS) promote the commercialization of health care and deprive the people of much needed basic health services."
Further details: /newsletter/id/30290
Realizing rights: transforming approaches to sexual and reproductive well-being
Sexual and reproductive rights for all are fundamental to transforming the lives of millions of adults and young people. Changes in legislation, access to information and provision of services provide an essential route to bringing about wider change. But alone, they are not enough for the most vulnerable to see themselves as having rights to safer and more fulfilling sexual and reproductive lives and to be able to claim them. In a collection of experiences of using participatory approaches for work on sexual and reproductive health and rights, researchers from the UK's Institute of Development Studies and the International Community of Women Living with HIV and AIDS (ICW), show how involving vulnerable groups more directly in efforts to improve their well-being can make a real difference.
Democracy and the poor
Broad public services most important to the poor - health and education - are also the services most vulnerable to three distortions of the political marketplace: Lack of information among voters about politician performance; Social fragmentation among voters manifested as identity-based voting; and Lack of credibility of political promises to citizens. This is according to a World Bank Policy Research Working Paper. For decentralization to have a positive impact on social services, says the Paper, voters must be more likely to use information about the quality of local public goods in making their voting decisions for local elections, and political promises to voters at large must be more credible than when decision-making over local public goods was in the hands of regional or national governments. Support for better education and health outcomes, and support for political party development and the development of political institutions are important elements to enhance credibility in the political system.
How can the concept of community participation be effectively applied to improve health programmes?
Community participation is widely advocated as a mechanism to allow health service users to be involved in the design, implementation and evaluation of activities, with the aim of increasing the responsiveness, sustainability and efficiency of health programmes. This exploratory study conducted by the National Institute For Medical Research (NIMR), Tanzania reviews nearly 100 studies, mainly from the developing world. Topics covered include the link between community participation, governance and equity in health; and the factors explaining poor community involvement, despite increasing emphasis on decentralisation.