Governance and participation in health

As New AU Chair Mahamat Takes Office: The African Union’s Financing Headache, In Two Charts
Mungai C: Africapedia, March 2017

The new chairperson of the African Union (AU) Commission Moussa Faki Mahamat formally took office in Addis Ababa in March, outlining his top priorities for his four-year tenure. Mahamat said he would focus on implementing structural and financial reforms at the AU, place women and youth at the centre of Africa’s development agenda, accelerate intra-African trade and free movement of people, goods and services in the continent, silence the guns by 2020 and strengthen Africa’s voice in the global arena. However, it is the financing plan that is likely to get the most attention in the short term. It was unveiled at the 2015 AU summit in Kigali by Donald Kaberuka, former president of the African Development Bank (AfDB). As of 2015, more than half of the African Union’s budget is funded by outside funders, compromising the independence of the organisation. The Kaberuka plan is intended to change that, and would see member states finance 100% of the AU’s operating budget, three-quarters of the programmes budget and a quarter of the peace and security budget, starting from January 2016 and phased in incrementally over five years.

Does health-related content in a major Ugandan newspaper reflect the changing burden of disease in East Africa?
Cooper M; Aiyer R; Sornalingam S; Lawrence D: International Journal of Communication and Health 10, 2016

The disease burden in urban sub-Saharan Africa is changing rapidly. Mortality and morbidity from chronic physical disease (heart, disease, stroke and cancer) is rising rapidly and believed to equal that from infections. Other increasing disease burdens in sub Saharan Africa include mental illness, substance abuse and accidents, especially road traffic collisions (RTC). Newspaper readership is rising in Uganda. This study used content analysis to examine health-related coverage in one major Ugandan newspaper (New Vision). Twenty-nine consecutive paper copies from September/October 2013 were examined independently by two researchers. Health-related articles were identified, counted and coded according to clinical content. Clinical and healthcare-related coverage was present in every edition and represented approximate proportions of 2.6% and 0.4% respectively of total newspaper content. Of 214 news articles identified, these covered the following clinical themes: general well-being (15.4%), healthcare services (14.5%), HIV (12.1%), violence/accidents (11.2%), chronic physical disease (11.2%), sexual, maternal and reproductive health (SMRH) (10.8%), non-HIV infective diseases (10.8), malnutrition (7.9%), substance misuse (3.3%) and mental health (2.8%). Coverage of RTCs, alcohol, smoking, and cancers other than of the breast and cervix was minimal. Health-related content was dominated by infections, healthcare quality, general wellbeing, SMRH and malnutrition. This does not represent the changing burden of disease in Uganda. There may be scope for targeted interventions with editors to promote coverage of growing challenges, including lifestyle advice to prevent chronic diseases.

Size of Cabinets in Africa, as Ghana’s Akufo-Addo Names ‘Elephant’ Team of 110 Ministers, and Counting
Mungai C: Africapedia, March 2017

Ghana’s president Nana Akufo-Addo came under fire for naming what has been described as an ‘elephant’ cabinet – with 31 cabinet portfolios, several ministries have two or more deputies, bringing the total size of cabinet to 110 ministers and perhaps more. Such a large team may have significant financial implications, in a country where the debt-to-GDP ratio is about 74%, with a $1 billion bailout from the International Monetary Fund (IMF) in 2015. Looking at Africa more broadly, the median size of cabinets is 30 (excluding deputies). The largest such cabinet is in Cameroon with 63 ministers. Uganda’s cabinet has 31 full cabinet ministers and 49 ministers of state, bringing the total number to 80. In Africa, larger cabinets are more common in post-conflict countries that are trying to build a broader national consensus, especially in countries with high political or ethnic fragmentation, as ministerial appointments are an easy way to build loyalty to the regime of the day. The author indicates that they are also common in resource-rich countries, and in those that have had long-serving heads of state, which tend to have heavy patronage networks. In that way, they serve an important political, if not economic or technocratic function – they create compromise and cohesion within the political class.

The conceptualization of family care during critical illness in KwaZulu-Natal, South Africa
de Beer J; Brysiewicz P: Health SA Gesondheid (22), 2017, doi: http://dx.doi.org/10.1016/j.hsag.2016.01.006

In recent years there has been a movement to promote patients as partners in their care. However, in the case of critically ill patients, who are often sedated and mechanically ventilated, family members may be more involved in the care of the patient. To date, this type of care has been represented by three dominant theoretical conceptualisations and frameworks one of which is family centred care. There is, however, a lack of consensus on the definition of family centred care. This study explored the meaning of family care within a South African context. This study adopted a qualitative approach and a grounded theory research design by Strauss and Corbin (1990). Participants from two hospitals: one private and one public were selected to participate in the study. There was a total of 31 participants (family members, intensive care nurses and doctors) who volunteered to participate in the study. Data collection included in-depth individual interviews. The findings of this study revealed that family care is conceptualised as togetherness, partnership, respect and dignity. During a critical illness, patients' families fulfil an additional essential role for patients who may be unconscious or unable to communicate or make decisions. Family members not only provide vital support to their loved one, but also become the "voice" of the patient.

Using Minecraft for Youth Participation in Urban Design and Governance
Banks N: Global Development Institute, 2015

UN-Habitat believes that ICT can be a catalyst to improve governance in towns and cities and help increase levels of participation, efficiency and accountability in public urban policies, provided that the tools are appropriately used, accessible, inclusive and affordable. Research shows that ICT use by youth can have a direct impact on increasing civic engagement, giving them new avenues through which to become informed, shape opinions, get organised, collaborate and take action. Youth are at the centre of the ICT revolution, both as drivers and consumers of technological innovation. They are almost twice as networked as the global population as a whole, with the ICT age gap more pronounced in least developed countries where young people are up to three times more likely to be online than the general population. This video shows UN-Habitat’s approach to using Minecraft to encourage youth participation in urban design and governance, to design and present their vision for public spaces in the city, as an input to planning. UN-Habitat’s experiences of using the video game Minecraft as a community participation tool for public space design is reported to show that providing youth with ICT tools can promote improved civic engagement.

How do community health committees contribute to capacity building for maternal and child health? A realist evaluation protocol
Gilmore B; McAuliffe E; Larkan F; Conteh M; Dunne N; Gaudrault M; Mollel H; Tumwesigye N; Vallières F: BMJ Open 6(11), 2016

This study aims to identify key context features and underlying mechanisms through which community health committees build community capacity within the field of maternal and child health. Since such groups typically operate within or as components of complex health interventions, they require a systems thinking approach and design, and thus so too does their evaluation. Using a mixed methods realist evaluation with intraprogramme case studies, this protocol details a proposed study on community health committees in rural Tanzania and Uganda to better understand underlying mechanisms through which these groups work (or do not) to build community capacity for maternal and child health. It follows the realist evaluation methodology of eliciting initial programme theories to inform the field study design.

Is social cohesion relevant to a city in the global South?
Barolsky V: SA Crime Quarterly 55, 2016, doi: http://dx.doi.org/10.17159/2413-3108/2016/v0n55a753

The concept of social cohesion is increasingly being used in local and international policy discourse and scholarship. The idea of collective efficacy, defined as ‘social cohesion among neighbours combined with their willingness to intervene on behalf of the common good’, has been posited as having an important protective effect against violence. This article investigates the relevance of international framings of social cohesion and collective efficacy, - largely conceptualised and tested in the global North - to the conditions of social life and violence prevention in a city in the global South. These circumstances are interrogated through an ethnographic study conducted in Khayelitsha township in the Western Cape, where a major internationally funded and conceptualised violence prevention intervention, Violence Prevention through Urban Upgrading (VPUU), has been implemented. The ethnographic material contests some of the key assumptions in international discourses on social cohesion and the manner in which social cohesion has been interpreted and effected in the violence prevention initiatives of the VPUU. Khayelitsha communitarian world views support forms of mutual sociality that are underpinned by a philosophy of ubuntu in which personhood is achieved through social relations rather than through individual empowerment. However, these communitarian networks and ‘ways of life’ are argued to be under social and structural strain and can be conduits not only for reciprocity, but also for violence.

Male circumcision in Uganda will only improve if local beliefs are considered
Mbonye M; Seeley J; Kuteesa M: The Conversation, 4 December 2016

For the past 10 years voluntary medical male circumcision has been recommended as a way of reducing female-to-male transmission of HIV. Estimates show that it could reduce infections by 60%. Several sub-Saharan African countries with high rates of HIV prevalence but low rates of male circumcision have rolled out the procedure as part of their HIV prevention initiatives. Since 2007 more than 9 million circumcisions have been performed in eastern and southern Africa. But to cover more than 80% of men on the continent by 2025, about 20 million more men need to be circumcised. If this happens about 3.4 million new HIV infections could be averted, reducing the number of people who would need HIV treatment and care. While circumcision has been encouraged there are many places where it has faced challenges. This is linked to misconceptions about the purpose of circumcision as well as religious and cultural concerns which prevent men from getting circumcised. Uganda is argued in this article to be a case in point. By the end of 2015 the country’s health ministry aimed to circumcise 80% – or 4.2 million – men aged between 15 and 49. But between 2008 to 2013 the country only managed to circumcise 50% of this population. Most of these were young boys. This research found that religious and cultural beliefs compete with the messages about the purpose of circumcision. The authors found that this got in the way of men deciding whether or not to be circumcised medically and also affected the way they behaved afterwards. When medical circumcision is introduced in settings where there are high rates of HIV, the authors argue that it must take into account local beliefs about circumcision and local religious and social group leaders and women must be involved in the roll-out.

Many Voices Make a City
Collaborative Media Advocacy Platform, Port Harcourt, 2016

Many Voices Make a City is a series of mini-dramas written, performed and produced by Chicoco Radio trainees, each explores an aspect of participatory urban design. This episode features a starchitect, a celebrity engineer and feisty market woman who knows what she wants. For those who need a little help with Pidgin English, this version is subtitled.

Social cohesion: The missing link in overcoming violence and inequality?
University of Western Cape: HumanSciencesRCSA, South Africa, 2016

The study reported in this video sought to understand the role of strong social cohesion in the cities of Cape Town and Rio de Janeiro, both of which suffer from high levels of inequality, poverty, and violence. In response, local governments and non-governmental organisations in both cities have tried to counteract these phenomena through a variety of strategies, programs, and projects. This work explored the role played by social cohesion in the cycle of inequality, poverty, and violence, noting that social cohesion can act as one of a number of violence-prevention factors. The project provides theoretical, methodological, and practical insights, which contribute to better public policies in the domain of poverty and violence reduction, replicable in other regions.

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