This article explores the inversion of roles between the state and citizens, by exploring its historical roots and current implications for processes of social accountability in Mozambique, particularly in the health sector. This is a practice-based reflection grounded in the evidence collected through the implementation of community scorecards in the health sector in 13 districts of Mozambique. The evidence reveals a transfer of responsibilities from local governance institutions and service providers to the communities; diluting the frontiers between the state and citizens’ duties and rights, resulting in the inversion of roles. This inversion results in the minimisation of the state’s performance of its duties and accountability in the health sector to respond to local communities’ needs, allegedly due to the lack of financial resources. The authors suggest that it leads to the overburdening of local communities, who assume the responsibility of meeting their own demands, risking participation fatigue.
Governance and participation in health
The global health system has faced significant expansion over the past few decades, including continued increase in both the number and diversity of actors operating within it. However, without a stronger understanding of what the global health system encompasses, coordination of actors and resources to address today’s global health challenges will not be possible. This study presents a conceptually sound and operational definition of the global health system. Importantly, this definition can be applied in practice to facilitate analysis of the system. The study tested the analytical helpfulness of this definition through a network mapping exercise, whereby the interconnected nature of websites representing actors in the global health system was studied. Using a systematic methodology and related search functions, 203 global health actors were identified, representing the largest and most transparent list of its kind to date. Identified global health actors were characterised and the structure of their social network revealed intriguing patterns in relationships among actors. These findings are argued to provide a foundation for future inquiries into the global health system’s structure and dynamics that are critical to better coordinate system activities and ensure successful response to pressing global health challenges.
The Urban Action Lab of Makerere University Uganda, is a lead partner of Co-designing Energy Communities (CO-DEC), a collaborative research project in Kampala and Nairobi, which is fostering cross-sector learning amongst university students and local community members to scale up local energy solutions, such as briquette-making, and create highly accurate maps of risk-prone businesses, infrastructure and residential dwellings, in regards to the use of traditional and modern energy sources. The community co-researchers collaborated with academics from Makerere University to map their own neigbourhood of Kasubi-Kawaala, in order to address in-and outdoor air pollution associated with poor management of wastes, leaky toilet seals and sewer pits, the use of biomass and fossil fuels from the informal urban economy. The maps were boundary objects for community-led learning and action that linked participating organisations and individual co-researchers to local sustainability-oriented experiments around regenerative use of wastes for energy briquettes; planting of indigenous trees with leafy canopies that reduce air pollutants in homesteads and around business premises; while building consensus on the policy options for enabling actors from Kampala Capital City Authority to own and energetically pursue an agenda for scaling up alternative energy solutions that bring about co-benefits in the health and housing sector.
The One Health concept covers the interrelationship between human, animal and environmental health and requires multi-stakeholder collaboration across many cultural, disciplinary, institutional and sectoral boundaries. Yet, the implementation of the One Health approach appears hampered by shortcomings in the global framework for health governance. Knowledge integration approaches, at all stages of policy development, could help to address these shortcomings. The identification of key objectives, the resolving of trade-offs and the creation of a common vision and a common direction can be supported by multi-criteria analyses. Evidence-based decision-making and transformation of observations into narratives detailing how situations emerge and might unfold in the future can be achieved by systems thinking. Finally, transdisciplinary approaches can be used both to improve the effectiveness of existing systems and to develop novel networks for collective action. To strengthen One Health governance, the authors propose that knowledge integration becomes a key feature of all stages in the development of related policies and suggest several ways in which such integration could be promoted.
While bi- and multilateral communication and collaboration are the foundation for global control of infectious disease epidemics, they are strengthened by the International Health Regulations (IHR). Although IHR (2005) describes what must be achieved by countries, there is limited knowledge on how countries should proceed in achieving the core capacities. To fill this gap and accelerate implementation of IHR (2005), the World Health Assembly in 2015 identified a need to evaluate and share the lessons learnt from countries that have implemented IHR (2005). This systematic review was conducted in accordance with Enhancing Transparency in Reporting the Synthesis of Qualitative Research guidelines, using a predefined protocol. The authors identified five global lessons learnt that related to multiple IHR (2005) core capacities. Some major cross-cutting themes included the need for mobilizing and sustaining political commitment; for adapting global requirements based on the local socio-cultural, epidemiological, health system and economic contexts; and for conducting baseline and follow-up assessments to monitor IHR (2005) status. The authors argue that despite considerable progress, countries that are yet to implement IHR (2005) core capacities may have insufficient human and financial resources to meet their obligations in the near future.
This paper aims to identify factors that influence the capacity of women to voice their concerns regarding maternal health services at the local level. A secondary analysis was conducted of the data from three studies carried out between 2013 and 2015 in the context of a WOTRO initiative to improve maternal health services through social accountability mechanisms in the Democratic Republic of the Congo. Data from 21 interviews and 12 focus group discussions were analysed using an inductive content analysis. The women living in the rural setting were mostly farmers/fisher-women or worked at odd jobs. They had not completed secondary school. Around one-fifth was younger than 20 years old. The majority of women could describe the health service they received but were not able to describe what they should receive as care. They had insufficient knowledge of the health services before their first visit. They were not able to explain the mandate of the health providers. The information they received concerned the types of healthcare they could receive but not the real content of those services, nor their rights and entitlements. They believed that they were laypersons and therefore unable to judge health providers, but when provided with some tools such as a checklist, they reported some abusive and disrespectful treatments. Factors influencing the capacity of women to voice their concerns in Democratic Republic of the Congo rural settings were found to be mainly associated with insufficient knowledge and a socio-cultural context. These findings suggest that initiatives to implement social accountability have to address community capacity-building, health providers’ responsiveness and the socio-cultural norms .
Reverse Innovation has been endorsed as a vehicle for promoting bidirectional learning and information flow between low- and middle-income countries and high-income countries, with the aim of tackling common unmet needs. One such need, which traverses international boundaries, is the development of strategies to initiate and sustain community engagement in health care delivery systems. In this commentary, the authors discuss the Baltimore “Community-based Organizations Neighborhood Network: Enhancing Capacity Together” Study. This randomized controlled trial evaluated whether or not a community engagement strategy, developed to address patient safety in low- and middle-income countries throughout sub-Saharan Africa, could be successfully applied to create and implement strategies that would link community-based organizations to a local health care system in Baltimore, a city in the United States. Specifically, the authors explore the trial’s activation of community knowledge brokers as the conduit through which community engagement, and innovation production, was achieved. Cultivating community knowledge brokers holds promise as a vehicle for advancing global innovation in the context of health care delivery systems. As such, further efforts to discern the ways in which they may promote the development and dissemination of innovations in health care systems is warranted.
The Network of African Parliamentary Committees of Health (NEAPACOH), previously known as the Southern and Eastern Africa Parliamentary Alliance of Committees on Health (SEAPACOH)) is one of the active networks engaging members of parliament in Africa to strengthen the delivery of their functions of oversight, legislation and representation, in tackling health challenges in the region. This study sought to understand NEAPACOH’s contributions in strengthening parliamentary committees in Africa to tackle health and population challenges, and identify ways in which the network can become more effective in the delivery of its mandate. Given the integral role of information or evidence in the delivery of the parliamentary functions, the study had a special interest in understanding how the network promotes evidence-informed discharge of the health committee, to generate learning needed to strengthen NEAPACOH as well as inform future efforts aimed at strengthening the delivery of parliamentary functions in Africa.
The World Health Organization (WHO) and its Member States have committed, within the framework of the International Health Regulations 2005 (IHR), to detect, verify, assess and report events that may pose a risk to international public health. This report summarizes public health events detected, verified, assessed and reported in three WHO Regions, namely Africa, the Americas and Europe from 2001 to 2016, with a focus on 2016. This report illustrates the relevance and importance of conducting and sustaining epidemic intelligence activities in accordance to alleviate the burden and impact of epidemics and emergencies, and thus avoid interference with travel and trade. Achieving this early detection goal—to rapidly and effectively respond to emergencies—requires dedicated human resources, close collaboration across states, partners and other stakeholders, transparent information-sharing and sustained funding.
The author comments that Oxfam has been successful in highlighting the gross and rapidly growing inequalities in the world in international fora, but critiques the approach of asking rich elites and their allies in governments to do the right thing as perpetuating the myth that there are no alternatives other than to depend on large corporations. The author argues that it is in people’s everyday practices that it is far more likely to find meaningful solutions to inequality and the seeds of a more human economy. He raises, for example, the issue of redistribution of assets, such as to address land inequality, as a more pertinent pathway for peoples practices to address societal inequality and challenge the structural power of the drovers of inequality.