Governance and participation in health

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.

"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."

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.

The WHO 3 x 5 plan envisages that community-based organisations, including groups of people living with HIV, will play a key role in scaling up treatment. This is not just a measure to plug gaps in the health services of heavily affected countries, but a response to evidence from early pilot programmes. These programmes have demonstrated that community participation is a key element in ensuring the acceptability of treatment. Making treatment part of the social fabric rather than a hidden enterprise is the only way to ensure long-term adherence.