Civil society activists say Uganda's presidential candidates have not placed sufficient emphasis on how they plan to tackle the HIV and AIDS epidemic should they come into office, despite rising HIV prevalence and major funding problems. Critics maintain there is not enough focus on HIV and AIDs in the election, with candidates’ manifestos mostly making general statements on health. Local civil society activists have lobbied all major political parties to commit to a ‘ten-point platform’ to fight HIV and AIDS, which includes commitments to fully fund the fight against HIV, increase the number of health workers and end corruption in the health sector.
Governance and participation in health
Pushing HIV on to the Uganda presidential candidates' agenda
Plus News: 16 February 2011
Building multisectoral partnerships for population health and health equity
Fawcett S, Schultz J, Watson-Thompson J, Fox M and Bremby R: Preventing Chronic Disease 7(6), November 2010
In this article, some of the factors that contribute to poor performance in achieving population health goals are examined, such as lack of shared responsibility for outcomes, lack of co-operation and collaboration, and limited understanding of what works. It also considers challenges to engaging stakeholders at multiple levels in building collaborative partnerships for population health. It outlines twelve key processes for effecting change and improvement, such as analysing information, establishing a vision and mission, using strategic and action plans, developing effective leadership, documenting progress and using feedback, and making outcomes matter. The article concludes with recommendations for strengthening collaborative partnerships for population health and health equity. These include establishing monitoring and evaluation systems, developing action plans that assign responsibility for changing communities and systems, facilitating natural reinforcement for people working together across sectors and ensuring adequate funding for collaborative efforts. Governments should also provide training and technical support for partnerships, establish participatory evaluation systems and arrange group contingencies to ensure accountability for progress and improvement.
From poverty to power: How active citizens and effective states can change the world
Green D: Oxfam, 2008
This book articulates a vision of women and men in communities everywhere who are equipped with education, enjoy good health, have rights, dignity and a voice – and are in charge of their own destinies. What is required to achieve that is nothing less than a global new deal – a redistribution of power, opportunities, and assets. The report considers the alternative of a world of ever-deepening gulfs between the ‘haves’ and the ‘have-nots’ as unsustainable. Based on its experience in more than 100 countries around the world, Oxfam argues that the necessary redistribution can best be accomplished through a combination of active citizens and effective nation states. Markets alone cannot meet the challenges of poverty, inequality and environmental degradation. Effective states and active citizens must ensure the market delivers growth that benefits poor people. An economics for the twenty-first century is needed that provides tools to enable countries to achieve growth that is environmentally sustainable. This new economics will recognise the importance of unpaid work, predominantly by women and target poverty and inequality. It discusses case studies, including the Treatment Action Campaign in South Africa.
State of the union South Africa report 2010
Continental Advisory Research Team: 2010
This report evaluates South Africa’s compliance with twelve selected African Union (AU) instruments to which it is a signatory. Eight of these twelve instruments are treaties while four are strategies, resolutions or plans of action. While treaties are legally binding on States Parties, resolutions are not. Seven of the treaties are already in force. Two await the required instruments of ratification to become effective and have not yet been signed or ratified by South Africa. Several health instruments are covered, including the Africa Health Strategy 2007-2015 (AHS), the Abuja Call for Accelerated Action towards Universal Access to HIV and AIDS, Tuberculosis and Malaria Services in Africa by 2010, and the Maputo Plan of Action for the Operationalisation of the Continental Sexual and Reproductive Health and Rights Policy Framework 2007-2010 (MPA). The audit of compliance indicates that South Africa has made significant strides to comply with the selected AU instruments, though much remains to be done. For example, in terms of the Abuja call, the country has a solid HIV and AIDS programme in place and is making progress towards treating tuberculosis and malaria, but the report points to lack of political will, lack of financial resources, and lack of public involvement and well-trained medical staff as factors impeding compliance with the AHS and the MPA. Many health workers are noted to not know about these health instruments because the government has failed to popularise them.
The international political economy of global universal health coverage
Ooms G, Hammonds R and van Damme W: World Health Organization, November 2010
This paper argues that the case for global universal coverage is strong, yet it is not pursued actively enough. Although there may be a problem of ‘free riders’ (countries hoping that other countries will pay for a global public good), the main obstacle would be that global universal health coverage reduces country autonomy and embraces a paradigm of managing mutual dependence. Even if mutual dependence in health is a reality, the paper notes, countries nonetheless try to preserve their autonomy: richer countries require assurances regarding how the assistance they provide will be used (in a manner that serves their interests too), while poorer countries want to have the freedom to address their own health priorities. Recent paradigm shifts in the practice of international health financing can be seen as attempts to manage mutual dependence in health while trying to preserve country autonomy. Over the past decades, these attempts to better manage mutual dependence in health have led to increasingly sophisticated governance mechanisms. The authors suggest that a combination of the best elements of these mechanisms could help progress the world towards global universal health coverage.
2010 Corruption Perceptions Index
Transparency International: 2010
The 2010 Corruption Perceptions Index shows that nearly three quarters of the 178 countries in the index score below five, on a scale from 10 (highly clean) to 0 (highly corrupt). These results indicate a serious corruption problem. To address these challenges, Transparency International recommends that governments integrate anti-corruption measures in all spheres, from their responses to the financial crisis and climate change to commitments by the international community to eradicate poverty. It also advocates stricter implementation of the UN Convention against Corruption, the only global initiative that provides a framework for putting an end to corruption.
Addressing global health governance challenges through a new mechanism: The proposal for a Committee C of the World Health Assembly
Kickbusch I, Hein W and Silberschmidt G: Global Health Diplomacy Network, 2010
This paper argues that the World Health Organization (WHO) should act as the directing and co-ordinating authority on future international health work, and its global health leadership must be earned through strategic and selective engagement. The authors caution that the focus of the paper is not the co-ordination of external development funders for health – which they do not consider WHO’s role – but the challenge of how WHO’s accountability to the global health community can be increased in the context of other normative and strategic dimensions of global health governance. WHO needs to provide mechanisms and instruments that link the new global health actors to the system of multilateral intergovernmental institutions, and it should engage in new ways with the many non-health actors that can influence health both positively and negatively, as well as improve its co-ordination function in relation to the development of legal instruments for health. The authors consider the World Health Assembly (WHA) as an inclusive forum that allows poorer countries to have a voice in global health. Consequently, they propose the establishment of a Committee C of the WHA, which will be legitimately represented and will deal with coherence, partnerships and the co-ordination of global health governance.
Community health committees as a vehicle for participation in advancing the right to health
Glattstein-Young G and London L: Critical Health Perspectives 2(1):1-2, September 2010
This paper explores whether community participation through health committees can advance the right to health, and what constitutes best practice for community participation through South African health committees. It reports on a series of 32 in-depth interviews with members of three community health committees and health service providers in the Cape Metropolitan area. The interviews revealed that, even in resource-constrained settings, community participation through health committees can advance the right to health. This advance mainly occurs through reported improvements in the acceptability and accessibility of local health services. Still, progress is restricted by the amount of power held at different levels of decision-making. The most prominent barriers to participation mentioned by participants included underrepresentation of vulnerable and marginalised groups, and the absence of a formal mandate giving health committees clear objectives and the authority to achieve them, which undermined their ability to make any significant improvements.
How Ray Suarez really caught the global health bug
Fortner R: Columbia Journalism Review, 7 October 2010
This article raises the question of whether the Gates Foundation’s underwriting of journalism, for example by funding radio health programmes in the United States (US) and health journals like Global Health, creates a conflict of interest for journalists, especially when the Foundation does not disclose its funding upfront. Although the Foundation might not have advocated for specific programmes, it does have distinct policy preferences and policy-shaping efforts, potentially influencing the media. The Kaiser Family Foundation (KFF), which was given a five-year, US$9.9 million grant last year by the Gates Foundation, is supposed to provide independent analysis of US global health policies, which have direct bearing on the Gates Foundation’s programmes. Prominent among these programmes is KFF’s US Global Health Policy portal, which selects and summarises global health news from more than 200 worldwide sources spanning mainstream media outlets to blogs. KFF sends a daily email news digest to policy makers, opinion leaders and journalists. The author argues that, not only does KFF have the power to choose what constitutes global health news but, in summarising the stories it selects, it can give them a construction of its own choosing. In key instances, the KFF’s global health news coverage suggests bias both in story selection and preferential treatment of the Gates Foundation. The author calls for increased transparency of funding sources for health programmes and health journalism.
Looking to the environment for lessons for global health diplomacy
Kirton JJ and Guebert JM: Global Health Diplomacy Programme, University of Toronto, May 2009
This study first briefly reviews the historical evolution of global environmental diplomacy and governance. It then examines its dominant ideas, instruments, and institutions, including the key environment-economy connection, comparing them with the experience in health at every stage. Its analysis reveals that both environmental and health diplomacy are better at solving yesterday’s specific, acute, concentrated, deadly problems than today and tomorrow’s diffuse, silent, chronic, cumulative but more dangerous and deadly ones. The authors therefore advise caution when sharing lessons, in light of the significant failures in each field. The environmental field is seen as more progressive than health, which has relied largely on the 1948 World Health Organization (WHO) Constitution’s principles, with little added to elaborate and modernise it since. The authors argue that environmental diplomacy and governance is better integrated with the economy and peoples’ livelihoods, which depend on natural resources, while the global health sector still struggles to promote a socio-economic approach, amid the many incentives to focus on single, high-profile diseases. The paper calls for more civil society participation in health, referring to lessons from a long tradition of environmental activism. Health could engage more with groups, such as the G8 and G20, so that health issues are recognised and integrated within economic policy dialogue.