This presentation given at the ECSA HC Best Practices Forum 2018 provides an overview of urban poverty and global commitments to equity oriented policies for urban health; urban health challenges in Sub-Saharan Africa; examples of how youth and community engagement could inform change and how to support the development of governance and equity oriented policies. The author notes that unmanaged urban growth is linked with rising social and economic inequities that benefit the well off and negatively impact health and well-being of the poor and disadvantaged; and that densely packed areas with low levels of sanitation services offer a petri dish for infectious diseases. This contributes to higher cost of living, high risk of school dropout and teenage pregnancy and high rates of crime and violence. Shakim provides evidence of youth as agents of change in urban Tanzania through the Tandale Health Centre.
Governance and participation in health
From the upheavals of recent national elections to the success of the #MyDressMyChoice feminist movement, digital platforms have already had a dramatic impact on political life in Kenya – one of the most electronically advanced countries in sub-Saharan Africa. While the impact of the Digital Age on Western politics has been extensively debated, there is still little appreciation of how it has been felt in developing countries such as Kenya, where Twitter, Facebook, WhatsApp and other online platforms are increasingly a part of everyday life. Written by a respected Kenyan activist and researcher at the forefront of political online struggles, this book presents a unique contribution to the debate on digital democracy. For traditionally marginalised groups, particularly women and the disabled, digital spaces have allowed Kenyans to build new communities which transcend old ethnic and gender divisions. But the picture is far from wholly positive. Digital Democracy, Analogue Politics explores the drastic efforts being made by elites to contain online activism, as well as how ‘fake news’, a failed digital vote-counting system and the incumbent president's recruitment of Cambridge Analytica contributed to tensions around the 2017 elections. Reframing digital democracy from the African perspective, Nyabola’s work opens up new ways of understanding our current global online era.
This article poses questions, challenges, and dilemmas for health system researchers striving to better understand how gender shapes accountability mechanisms, by critically examining the relationship between accountability and gender in health systems. It raises three key considerations, namely that: (1) power and inequities are centre stage: power relations are critical to both gender and accountability, and accountability mechanisms can transform health systems to be more gender-equitable; (2) intersectionality analyses are necessary: gender is only one dimension of marginalisation and intersects with other social stratifiers to create different experiences of vulnerability and there is a need to take account of how these stratifiers collectively shape accountability; and (3) empowerment processes that address gender inequities are a prerequisite for bringing about accountability. The authors suggest that holistic approaches to understanding health systems inequities and accountability mechanisms are needed to transform gendered power inequities, impact on the gendered dimensions of ill health, and enhance health system functioning.
Politicians, clerics, feminists and others have formed a broad coalition of Ugandans calling for an end to a social media tax. In July, Uganda's communications regulator blocked access to social media including WhatsApp, Facebook and Twitter, as well as dating sites Tinder and Grindr, unless users pay a Shs200 ($0.05) daily tax. Mobile internet users now have to input a telephone code to pay the tax before they are able to access most social media sites, although implementation has proved patchy with some blocked services still available. Some have turned to virtual private networks (VPNs) to disguise their location and avoid the levy, a trick learned during elections two years ago when the government tried to shut down social media. President Yoweri Museveni - a Twitter user with 855 000 followers - is reported to have urged the imposition of the tax earlier this year, to put an end to "gossip". The protesters are resisting the measure and calling for it to be lifted.
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.
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 .