Five years remain for the achievement of the Millennium Development Goals (MDGs) and more needs to be done in Africa to meet the goals for governance and economic and social development. This document reports grassroots opinions from across Africa for shaping the policy agenda for the forthcoming decade, 2011–2020. African Monitor argues that the current development paradigm is exclusionary and does not reach the intended beneficiaries, hence their minimal access to basic services such as health, education, water and sanitation. The report provides a number of recommendations, proposing a values-based and sustainable development ideal to replace the current one and arguing that the MDGs need to be spelt out properly for the African and Western public, with the emphasis on public benefits. African governments should operate with financial transparency and civil society, professional associations, social movements and business entrepreneurs should be catalysts for engendering accountability. Agriculture, food security and the informal sector should also be prioritised by African governments and those who support Africa’s development.
Governance and participation in health
This report documents perspectives from civil society organisations (CSOs) on the performance of the health sector in Uganda, against the background of the government’s Health Sector Strategic and Investment Plan III (HSSIP). Researchers found that most priority areas are in the integrated health systems, including health workforce development, increasing production and equitable deployment of health workers, increasing financial resources, strengthening the role of civil society in monitoring and accountability, and ensuring reliable access to medicines and health supplies. They call for the Ministry of Health to demonstrate its leadership, stewardship, and political will to push forward the recommendations not only elucidated in this report, but also in the HSSIP. Specific critical areas of intervention are also highlighted, including mental health and non-communicable diseases (including cancer and sickle cell disease), malaria, HIV and AIDS, health promotion and human rights. The authors recommend critical interventions in health financing, human resources for health, essential medicines and health supplies, and delivery of the Uganda Minimum Health Care Package (UMHCP).
From 29 November to 3 December 2010, the Tenth Meeting of the States Parties to the Mine Ban Treaty took place in Geneva, Switzerland, to discuss implementation of the global Mine Ban Treaty of 1997. Twenty-three states parties with significant numbers of landmine survivors presented their activities and the challenges faced so far in implementing the victim assistance actions of the Cartagena Action Plan (CAP), which is the plan devised to help countries implement the requirements of the Ban Treaty. The CAP stresses the need to improve quality of and access to services – including health and rehabilitation services – by disabled people. Reports indicated that, by the end of 2009, most survivors had not experienced significant overall improvements in quality or access to a range of necessary services, while nearly as many countries reported a decline in services, due mostly to deteriorating security and the downturn in the global economy. A number of east, central and southern African countries participated in the meeting. Uganda reported that its victim assistance plans had been revised or redrafted according to CAP principles, while the Democratic Republic of Congo reported drafting victim assistance plans that were pending adoption and also noted establishing a national commission for the rehabilitation of survivors. Mozambique reported that survivors are assisted through the national disability framework but failed to describe its efforts to assist persons with disabilities in any detail.
Amadasun reviews several of the important international mechanisms which channel aid to Africa, finding that the many instruments developed outside Africa are ineffective because they have design, accountability and ownership flaws. These criticisms apply to International Monetary Fund (IMF) programmes, debt relief and also budget support. Despite some changes in the way that the IMF and other international agencies operate – for example linking their interventions to Poverty Reduction Strategies – their fundamental way of working remains to pressure governments to take certain actions even at the expense of citizens’ views. Amadasun suggests that new mechanisms that originate in Africa, for Africa, stand a better chance of enabling decisions that empower and support large numbers of impoverished people. These mechanisms include the Pan-African Parliament (PAP) and the African Peer Review Mechanism (APRM). However these institutions are nascent and have yet to fulfill their full potential. To reach their potential these African bodies must develop authority to scrutinise the interventions of the international financial institutions (IFIs). These bodies will have to overcome several challenges. These include improving who is selected to represent African citizens, increasing public awareness and discussion of the bodies, and developing an independent source of financing for their own operations. If they overcome these challenges the PAP and APRM may be able to prevent international agencies from imposing policies and pressures from outside the region and enable a flourishing of democracy from below.
If implemented, new provisions governing the registration of civil society organisations (CSOs) and non-governmental organisations (NGOs) under Zambia’s NGO Act will be extremely problematic, according to Lewis Mwape of the Zambia Council for Social Development. Under the law CSOs and NGOs must re-register every five years, creating a major administrative workload. Prior to registering, they must explicitly state their sources of funding and proposed activities, which Mwape regards as impractical. The NGO Act also greatly narrows the definitions of CSOs and NGOs, no longer recognising labour unions, faith-based organisations and professional groups. Distinguishing between civil society groups is divisive and will weaken cohesion among different sectors, says Mwape. Advocacy and human rights organisations can also be subjected to arbitrary and/or discriminatory application of the law, and the law gives the Minister too much discretionary power. Zambian civil society has initiated a campaign calling for the amendment of the law but they are facing major difficulties in accessing and mobilising the hundreds of NGOs and CSOs based in less accessible areas to engage in the campaign to re-evaluate the law.
From the 9th of December 2012 to 11th January 2013, an online consultation on global health Theme in the Post-2015 UN Agenda was conducted. Researchers targeted a total of 785 institutions across partner organisations and networks and attracted participation from over 180 organisations active across 48 countries, notably community based and regional organisations in Africa, which constituted 69.5% of all participants. A number of key messages emerged. 1. There is no strong support for one health goal framed around Universal Health Care. 2. There is a very clear emphasis given to prioritising the needs of women and children. 3. There are strong calls to broaden the focus of the goals towards health systems strengthening and away from disease- and issue-specific interventions. 4. Strong support is given to the importance of a multisectoral action for health, alongside recognition of the need to address the socio-economic determinants and the rapidly evolving economic realities between countries. 5. The health-related post-2015 development goals should take into account the context in which action will be taken, and must be founded on guiding principles that are adaptable at the national level, and flexible for local implementation. They should also be based on shared, coherent understanding that enables global level solidarity and differentiated accountable action where necessary and appropriate.
In this 2012 survey, the opinions on their social conditions of 1,360 young South Africans from various backgrounds of the country were gathered. Individuals across age groups (kids, teens and young adults) from Gauteng, KwaZulu Natal and the Western Cape responded to the survey and expressed their opinions on numerous issues and attributes relevant to South African society. Generally, respondents expressed high levels of nostalgia towards the country’s previous leaders, specifically Nelson Mandela, and were critical of the current leadership. Across all the regions, crime was ranked as the country’s biggest problem, and education was cited repeatedly as being crucial to ensure the future success of young South Africans. Freedom of expression was highlighted as a key issue throughout the interviews, yet many young people felt they were not given the opportunity to be heard. Many respondents argued that relying on the government to bring about change is not good enough, and expressed a desire for youth to play a greater role.
According to this paper, the current widespread use of the term ‘resilience’ in development circles is at risk of being diluted by current ways of thinking about change because the term has not brought about genuine change in thinking about social systems. The author argues that if the term ends up being used in a very linear manner, where change is controllable from the outside and follows a linear path, it will have failed to achieve its mission. The author calls for a break from expert-led technocratic solutions and renewed focus on human agency as the main vehicle for change. Resilience-based thinking underlines the importance of leadership and reinvents the task of the international community as supporting constructive leadership rather than designing expert solutions. For leaders, it opens up space for creative thinking and hybrid, localised solutions.
Implementation of policies (decisions) in the health sector is sometimes defeated by the system’s response to the policy itself. This can lead to counter-intuitive, unanticipated, or more modest effects than expected by those who designed the policy. The health sector fits the characteristics of complex adaptive systems (CAS) and complexity is at the heart of this phenomenon. Anticipating both positive and negative effects of policy decisions, understanding the interests, power and interaction between multiple actors and planning for the delayed and distal impact of policy decisions are essential for effective decision making in CAS. Failure to appreciate these elements often leads to a series of reductionist approach interventions or ‘fixes’. This in turn can initiate a series of negative feedback loops that further complicates the situation over time. In this paper, researchers use a case study of the Additional Duty Hours Allowance (ADHA) policy in Ghana to illustrate these points. Using causal loop diagrams, they unpack the intended and unintended effects of the policy and how these effects evolved over time. The overall goal is to advance our understanding of decision making in complex adaptive systems; and through this process identify some essential elements in formulating, updating and implementing health policy that can help to improve attainment of desired outcomes and minimise negative unintended effects.
While Barack Obama’s re-election has been met with enthusiasm across Africa, the article reports that many are frustrated about a lack of delivery on past promises. Where does Africa fit into the new administration’s foreign policy? The author argues that Obama’s current rhetoric about Africa makes generalisations about common aspirations, opportunity and African potential. He asserts that future engagement with African countries may be focused on the New Alliance for Food Security and Nutrition, part of the G8 plan to boost food production in Africa by introducing large-scale, mechanised agriculture with genetically modified crops. The author poses that this is expected to impact negatively on small-scale farmers and possibly increase food insecurity.