There is a global trend towards the use of ad hoc participation processes that seek to engage grassroots stakeholders in decisions related to municipal infrastructure, land use and services. The authors present the results of a scholarly literature review examining 14 articles detailing specific cases of these processes to contribute to the discussion regarding their utility in advancing health equity. They explore hallmarks of compromised processes, potential harms to grassroots stakeholders, and potential mitigating factors. The authors conclude that participation processes in urban areas often cut off participation following the planning phase at the point of implementation, limiting convener accountability to grassroots stakeholders, and, further, that where participation processes yield gains, these are often due to independent grassroots action. Given the emphasis on participation in health equity discourse, this study seeks to provide a real world exploration of the pitfalls and potential harms of participation processes that is relevant to health equity theory and practice.
Governance and participation in health
Action for Global Health (AfGH) in partnership with the Network of West African NGO Platforms, (REPAOC) convened a conference in Dakar, Senegal, 17-19th February 2014, which brought together civil society actors from 23 countries and five continents. The main purpose of the workshop was to gain clarity and consensus on what Universal Health Coverage (UHC) incorporates, building upon Civil Society Organisation’s (CSO) country experiences from a grassroots level; develop a common understanding of the strengths of the UHC concept and the pitfalls of its implementation; define a clear position on how UHC should be framed to achieve the highest attainable standard of health for all; and outline a course of action for CSO advocacy on the right to health. The meeting concluded with a declaration – Ensuring UHC is fit for contributing to the right to health – which captured the main discussion points and reflections of the CSOs present.
Regional organisations can effectively promote regional health diplomacy and governance through engagement with regional social policy. Regional bodies make decisions about health challenges in the region, for example, the Union of South American Nations (UNASUR) and the World Health Organisation South East Asia Regional Office (WHO-SEARO). The Southern African Development Community (SADC) has a limited health presence as a regional organisation and diplomatic partner in health governance. This article identifies how SADC facilitates and coordinates health policy, arguing that SADC has the potential to promote regional health diplomacy and governance through engagement with regional social policy. The article identifies the role of global health diplomacy and niche diplomacy in health governance. The role of SADC as a regional organisation and the way it functions is then explained, focusing on how SADC engages with health issues in the region. Recommendations are made as to how SADC can play a more decisive role as a regional organisation to implement South–South management of the regional social policy, health governance and health diplomacy agenda.
At the entrance to the Constitutional Court of South Africa stands a sculpture of a large man yoked to a cart. His burden is a human one: a man and woman who themselves are seated on the back of a fourth figure kneeling on the cart. At first glance, the sculpture resonates with the history of servitude that marked the dehumanising institution of apartheid. On closer reflection, the sculpture reveals a more complex message. The sculptor, South African artist Dumile Feni, did not create any racial differentiation between the four figures, and the man drawing the cart is the only figure large and strong enough to accomplish this task. The title of the work is History, and the four figures carry each other in a way that reflects the dependence, the interconnectedness and the tension that have always characterised human relationships. History is the first of many artworks that challenge a visitor to the Constitutional Court to reflect on South Africa’s tortured past and the country’s transition to a constitutional order. The Constitutional Court Art Collection (CCAC)[1] is both a living monument to the ideals on which South Africa’s post-apartheid Constitution is based and a reminder of the work that remains.
There is now wide recognition that community responses must play an increasing role in addressing the HIV epidemic in the years ahead. The UNAIDS Strategic Investment Framework, published in 2011, identifies community responses as a “critical enabler” of service delivery. The Joint United Nations Programme on HIV/AIDS (UNAIDS) has estimated that to achieve bold HIV treatment and prevention targets set in 2014, investments in community mobilisation and services must increase more than threefold between 2015 and 2020. Much of the critically important work in making progress in the response to HIV and implementing a Fast-Track approach that lies ahead—including broadening the reach of services, supporting retention in care, increasing demand, monitoring quality, advancing human rights and combatting stigma and discrimination—can only be achieved with a strong community voice and presence. This report draws on multiple sources to document the many ways in which communities are advancing the response to AIDS, and the evidence for the effectiveness of these responses. Core areas of community-based activities include advocacy, service provision, community- based research and financing; each of these areas is illustrated by examples of community- based actions.
When faced with a complex public health problem there is a natural urge to find solutions. People hire consultants, gather data, test hypotheses and examine P-values to identify risk factors: data-driven technological fixes get implemented every day. In the right situation, there is nothing wrong with solutionism – the belief that all difficulties have technical solutions. Solutionism works well for circumscribed problems involving a small number of motivated individuals, where every element of the prescribed solution can be implemented as planned. However, complex problems in public health usually have elements that defy planning, because health involves people, and people are unpredictable. Recent research has shown that integrating community participation in the planning and implementation of health reforms is a key factor in supporting health improvements. The approach has been applied in a variety of areas including: the control of infectious disease; reducing maternal deaths and improved birth outcomes; enabling better health seeking behaviours; improving quality of life by promoting healthy environments through improvements to housing, reducing crime and building social cohesion. Critical factors for achieving trust include allowing participants to see their common concerns and building strong relationships within health committees or participatory groups. There must be a commitment to sustain long-lasting relationships between the community, local health workers and managers. Technical solutions for health problems are still needed. The authors argues there is still need the familiar P-value because biological evidence is necessary, but public health practice also needs to recognize the value of people. Regardless of the political environment, the power of the state to alter health decisions inside the home has limits. Only an approach that values, honours and engages people can alter how they make decisions about their health.
This Pan African Space Station (PASS) broadcast recorded at the Chimurenga headquarters features Neo Muyanga, Soweto-born composer and musician living in Cape Town. Revolting Music is a survey of the songs of protest that liberated South Africa. Muyanga argues that it often comes as something of a surprise to many visitors to find that people in South Africa, sang and danced throughout the decade of the 1980’s – a period many agree was one of the most violent phases in the struggle against the system of apartheid, and yet the people sang and made art fervently during this time. These acts were not merely stratagems for fun but the songs were a part of the arsenal in the fight to secure democratic rights for all and to overthrow the government. During his recording, Neo Muyanga presents a series of anecdotes and medleys of songs of protest from the era of the 80’s – songs of his youth – juxtaposed against new songs he has composed in response to the challenges of new socio-political realities in South Africa today.
Since independence, Parliament and its processes have been treated by young people as something alien to them, their needs, views and aspirations. As a result, for years the youth has had certain conceptions, some true and some false over the business that is conducted within the walls of parliament in Harare. As such, the author argues that Zimbabwean youths’ views were never put into consideration, decisions with a direct bearing on them were made without their input, simply put, the youth saw Parliament business in Zimbabwe as having nothing of interest to them and as a mere preserve for the older generation. However, all this is set to be a thing of the past. Parliament debates, bills, thrills, spills and lighter moments will soon be easily accessible in just a few clicks on a smartphone, anywhere, anytime, thanks to OpenParlyZW, an online non-partisan initiative created by a group of enthusiastic youths with the aim of bridging the gap and demystifying misconceptions existing between the youth and Parliamentarians. The group believes that to move forward the youth need to be a part of this conversation and should at least know what’s going on in the houses of power and participate in the future of the nation. OpenParlyZW will run as a standalone platform but also on Twitter and Facebook among other social media platforms capturing events each time Parliament sits and providing young people with vital information.
"Sembene!" is a feature documentary on continental Africa's most celebrated filmmaker, the late Ousmane Sembene, from co-directors Samba Gadjigo (author of Sembene’s official biography) and Jason Silverman. SEMBENE! tells the true story of the self-taught novelist and filmmaker who fought, against enormous odds, a 50-year battle to give Africans the power to tell their own stories. SEMBENE! is told through the never-before-seen archival footage and verite footage. It follows an ordinary man who transforms himself from a manual labourer into a fearless and often polarizing spokesman for the marginalized, becoming a hero to millions. The film is about, not only Sembene, but also about the importance of reclaiming African stories.
This paper explores the extent, nature and quality of community participation in health systems intervention research in low- and middle-income countries.
It used peer-reviewed, English language literature published between January 2000 and May 2012 through four electronic databases. Search terms combined the concepts of community, capability/participation, health systems research and low- and middle-income countries. Most articles were led by authors in high income countries and many did not consistently list critical aspects of study quality. Articles were most likely to describe community participation in health promotion interventions (78%, 202/260), even though they were less participatory than other health systems areas. Community involvement in governance and supply chain management was less common (12%, 30/260 and 9%, 24/260 respectively), but more participatory. Articles cut across all health conditions and varied by scale and duration, with those that were implemented at national scale or over more than five years being mainstreamed by government. Most articles detailed improvements in service availability, accessibility and acceptability, with fewer efforts focused on quality, and few designs able to measure impact on health outcomes. With regards to participation, most articles supported community’s in implementing interventions (95%, n = 247/260), in contrast to involving communities in identifying and defining problems (18%, n = 46/260). Many articles did not discuss who in communities participated, with just over a half of the articles disaggregating any information by sex. Articles were largely under theorized, and only five mentioned power or control. Majority of the articles (57/64) described community participation processes as being collaborative with fewer describing either community mobilization or community empowerment. Intrinsic individual motivations, community-level trust, strong external linkages, and supportive institutional processes facilitated community participation, while lack of training, interest and information, along with weak financial sustainability were challenges. Supportive contextual factors included decentralization reforms and engagement with social movements. Despite positive examples, community participation in health systems interventions was variable, with few being truly community directed. Future research should more thoroughly engage with community participation theory, recognize the power relations inherent in community participation, and be more realistic as to how communities participate and cognizant of who decides that.