Developing countries have highlighted a number of concerns over the reform agenda of ‘The Future of Financing for WHO’, which was unveiled by the Director-General of the World Health Organization (WHO) at the 128th session of the organization's Executive Board held from 17-25 January. Several developing countries pointed out that health cannot be de-linked from socio-economic development, and voiced strong support for the WHO's role in development and its leadership on global health issues. There was also a call for a transparent process to discuss the reform. While the reform agenda was initially instigated by the need to ensure more predictable and sustainable financing for WHO, proposals for reform that are contained in Director-General Margaret Chan's report suggest a more far-reaching agenda that could lead to significant changes in the role of WHO on matters of public health at the global level. In depating the proposals representatives of several low and middle income countries pointed out that health cannot be de-linked from socio-economic development and WHO cannot be reduced to being a mere technical agency. They also expressed strong support for WHO's role in development and its leadership in global health issues. Civil society groups, including the People’s Health Movement cautioned that public health should not take a back seat to market-led initiatives. Mozambique, on behalf of the African group, stated that reform of the organisation should maintain WHO's leadership position in international health, adding that any debate on financial aspects deserves a wider discussion.
Governance and participation in health
The African Peer Review Mechanism (APRM), a tool designed to promote good governance on the continent, is built on the belief that the continent does not lack ideas to advance its development, but that states have struggled to live up to their principles and implement their policies. The APRM rests on the fundamental belief that good governance is a precondition for taking Africa out of its spiral of conflict, underdevelopment, poverty and increasing marginalisation in a globalised world. Looking back almost a decade after the APRM was first conceived, Grappling with Governance explores how this complex process has evolved from theory to practice in a variety of contexts. In a combination of case studies and transversal analysis, multiple voices from different African civil society actors - mainly analysts, activists and journalists - examine the process from their specialised perspective. The chapters tease out what can be learned about governance in Africa from these experiences, and the extent to which the APRM has changed the way that governments and civil society groups engage. This book demonstrates that undergoing review through the APRM can be messy, haphazard and full of reversals. Like any tool, the APRM’s effectiveness depends on the suitability of its design for the task at hand, the situation in which it is used, and the skill of its user. The different authors reflect on these characteristics as users of this tool. While it is ill-advised to draw universal conclusions, this book nevertheless demonstrates that the APRM has added value, sometimes in unexpected ways.
With the current World Health Organization (WHO) Director-General’s term of office ending in June 2012, WHO members have set up a drafting group to try to reconcile divergent views on the process leading to the election. At the WHO Executive Board meeting, which ran from 17-25 January 2011, some countries were in favour of geographical rotation, citing over 60 years of no representation from their regions, while others objected that rotation should not override more important selection criteria such as expertise and experience, as it could endanger the organisation’s future. A draft resolution on the rules of procedure for the appointment of the WHO Director-General (DG) was proposed by Burundi on behalf of the member states of the African region, asking for the Executive Board to approve the principle of geographical rotation of the post of DG among the six regions of WHO, namely Africa, the Americas, South-East Asia, Europe, the Eastern Mediterranean and the Western Pacific. In this draft resolution, Burundi stressed the need for further strengthening of guarantees of transparency and equity among the six geographical regions of the WHO in the process of nominating and appointing the DG. The proposed document stirred a debate that some countries said has been on the table since 2006.
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.
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.
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.
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.
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.
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.
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.