Governments across Africa are clamping down on dissent, hiding their secrets and attacking the funding base of their critics. In this article the author points out that political movements that once fought for freedom and prosperity, having assumed power, are now undermining both by trying to restrict civil society. He argues that what these governments ignore at their peril is that debate and dissent are vital to both vibrant democracy and economic prosperity. Rather than seeing civil society as a threat, they should see it as a building block of a stable democracy; one that needs to be nurtured, not over-regulated. Community-based organisations can deliver grounded and cost-effective services, helping to educate and skill-up people to take advantage of economic opportunities. They are also big employers in their own right, and a new generation of social entrepreneurs across the continent is emerging with innovative and profitable ways of tackling intractable social problems.
Governance and participation in health
In late 2012, the board of the Global Fund to Fight Malaria, Tuberculosis and AIDS approved a new funding model (NFM), which significantly changes the manner in which funds are allocated, applied for, awarded, disbursed, and monitored. The NFM was formally launched on 28 February 2013, though it will remain in a transitional phase until 2014. While there is much promise in the NFM, there are many questions, some of which are raised in this report. The Fund has established a framework for the core aspects of grant funding under the NFM, but there remain countless details to be uncovered through real-world experience and regulated by Fund policy and protocol. This report reviews the key components of the NFM from a civil society and key population perspective, with a focus on its impact on AIDS programmes. Incorporating the views of leaders from key populations and civil society around the world, the report provides a summary of some current top-level concerns related to the roll-out of the NFM and offers recommendations on how to implement the NFM in a manner which is responsive to and inclusive of civil society and key populations, and ultimately which has the greatest impact on ending the AIDS epidemic globally.
Civil rights groups and communities have expressed concern about the failure of South Africa's Department of Health to release the National Aids Vaccine Strategic Plan (NAVSP) for 2013-2017. In 2012, the Department of Health requested the South African Aids Vaccine Initiative (SAAVI) to develop the NAVSP in collaboration with researchers all over the world and communities and Community Advisory Groups in South Africa. However, since its development the document has been embargoed for public scrutiny without any reason given. At a recent community roundtable on Aids Vaccine Research and Development indicated their dissatisfaction with the embargo on the document as they believe it contains clear objectives on community involvement in AIDS vaccine research that is happening in the country. Researchers from various organisation, including the Perinatal HIV Research Unit, the Aurum Institute for Health Research and the Desmond Tutu HIV Foundation agreed that the embargo creates suspicion about the department’s activities to reduce HIV infections through vaccines and ARVs prevention research.
The role of multilateral external funding agencies in global health is a new area of research, with limited research on how these agencies differ in terms of their governance arrangements, especially in relation to transparency, inclusiveness, accountability, and responsiveness to civil society. In this paper, the authors argue that historical analysis of the origins of these agencies and their coalition formation processes can help to explain these differences. They propose an analytical approach that links the theoretical literature discussing institutional origins to path dependency and institutional theory relating to proto institutions in order to illustrate the differences in coalition formation processes that shape governance within four multilateral agencies involved in global health. Two new multilateral donor agencies that were created by a diverse coalition of state and non-state actors, such as the Global Fund to Fight AIDS, Tuberculosis and Malaria and GAVI (‘proto-institutions’), were more adaptive in strengthening their governance processes. This contrasts with two well-established multilateral external funding agencies, such as the World Bank and the Asian Development Bank, what we call Bretton Woods (BW) institutions, which were created by nation states alone; and hence, have different origins and consequently different path dependent processes.
To inform policy makers about the feasibility of facility-based SMS interventions, this national, cross-sectional, cluster sample survey was undertaken in 2012 at 172 public health facilities in Kenya. Outpatient health workers and caregivers of sick children and adult patients were interviewed about personal ownership of mobile phones and use of SMS. The analysis included 219 health workers and 1,177 patients’ respondents (767 caregivers and 410 adult patients). All health workers possessed personal mobile phones and 98.6% used SMS. Among patients’ respondents, 61.2% owned phones and 71.4% of phone owners used SMS. The phone ownership and SMS use was similar between caregivers of sick children and adult patients. Wealthier respondents who were male, more educated, literate and living in urban area were significantly more likely to own a phone and use SMS. Mobile phone ownership and SMS use is ubiquitous among Kenyan health workers in the public sector, the researchers conclude. Some of the disparities on SMS use can be addressed through the modalities of m-Health interventions and enhanced implementation processes while further growth in mobile phone penetration is needed to reduce the ownership gap.
PHM WHO watchers developed statements on many of the 2013 World Health Assembly WHA66 agenda items. This website provides statements read out by PHM during the WHA66 and links to daily reports prepared by the PHM WHO watchers. The statements are on WHO Reform; WHO General Program of Work; Social Determinants of Health; MDG's and Post 2015 Agenda; Universal Health Coverage and the Consultative Expert Working Group on Research and Development.
The South African government plans to launch a National Recordal System (NRS) to catalogue its indigenous knowledge. According to the South African Department of Science and Technology (CSIR) benefits could include community recognition, sustainable livelihood, economic value and improved quality of life. Most of the traditional knowledge in South Africa is oral, passed down from one generation to the next, and with older generations passing away, the need to record that knowledge is urgent. Much of this knowledge is medical and is based on traditional remedies and treatments for illnesses. The NRS includes the establishment of indigenous knowledge networks, provincial Indigenous Knowledge Systems Documentation Centers (IKSDCs) and an Information Communication Technology (ICT) knowledge platform. The NRS aims to enable and maintain a secure, accessible national repository for the management, dissemination and promotion of indigenous traditional knowledge, and achieve national intellectual property objectives for the protection of indigenous traditional knowledge.
The State of Civil Society 2013 Report presents insights from over 50 civil society experts from around the world. Alongside the report, CIVICUS is publishing a draft methodology for an Enabling Environment Index (EEI) that seeks to measure how well countries around the world are doing on creating positive conditions for civil society. Amidst the challenges facing civil society, the 2013 report highlights good practices around the world and challenges on the horizon for citizens and civil society around the world, such as: rising fundamentalism threatening women's and sexual minorities rights movements; challenges to democracy in Africa, with case studies from Burkina Faso, Central African Republic, Democratic Republic of Congo and Uganda; the state of the internet and access to information; threats to writers, journalists and trade unionists; and civil society successes.
This paper is aimed at those who work as health facilitators and activists at community level, civil society organisations, government personnel and anyone else interested in the rights of ordinary citizens to participate in decisions and have access to the resources that determine the way their country’s health system functions. The paper is divided into three sections: The first focuses on how the interaction between people’s participation, knowledge and power effects the functioning of health systems. The following section pays particular attention to approaches we can use to build a more just and equitable health system. The final section concludes by asking a series of questions to provoke and deepen our thinking on ways we can overcome obstacles to achieving this goal, at both community level and as we move from the local to the global as a strategy for change. Each section blends discussion on concepts and issues with descriptions of experiences and case studies from around the globe, especially from countries in Latin America, Asia and east and southern Africa, where a wealth of material describes the impact of neoliberalism and globalisation on health systems, and attempts to build alternatives.
The Sixty-fifth World Health Assembly requested the Director-General to report, through the Executive Board at its 132nd session, to the Sixty-sixth World Health Assembly, on progress in the implementation of WHO reform, on the basis of a monitoring and implementation framework. This report provides a comprehensive overview of progress up to the end of the first quarter of 2013 in the three broad areas of WHO reform: programmes and priority-setting; governance; and management, as well as a high-level implementation plan for reform. A comprehensive, detailed and budgeted implementation plan is the basis for managing change, monitoring progress, and mobilising resources to finance the proposed reform activities. The plan and report are structured around the 12 elements of reform that were identified in the monitoring and implementation framework considered by the Sixty-fifth World Health Assembly, and include an additional element on change management. The report provides a narrative describing action taken in each area, and a status update on the outputs and key deliverables.