The main institutions responsible for governing international trade and health - the World Trade Organization (WTO), which replaced the General Agreement on Tariffs and Trade (GATT) in 1995, and WHO - were established after World War 2. For many decades the two institutions operated in isolation, with little cooperation between them. The growth and expansion of world trade over the past half century amid economic globalisation and the increased importance of health issues to the functioning of a more interconnected world, brings the two domains closer together on a broad range of issues. Foremost is the capacity of each to govern their respective domains, and their ability to cooperate in tackling issues that lie at the intersection of trade and health. This paper discusses how the governance of these two areas relate to one another, and how well existing institutions work together.
Governance and participation in health
This review identifies an agenda for global health by highlighting the current 'grand challenges' related to governance. Sources included literature from the disciplines of health policy and medicine, conference presentations and documents, and materials from international agencies (such as the World Health Organization). The present approach to global health governance has proven to be inadequate and major changes are necessary. There are a number of areas of controversy. The source of problems behind the current global health governance challenges have not always been agreed upon, but this paper attempts to highlight the recurrent themes and topics of consensus that have emerged in recent years. Growing points and areas timely for developing research are identified. A solution to the 'grand challenges' in global health governance is urgently needed to serve as an area for developing research.
This article discusses the appropriateness of western bioethics in the African setting. It focuses on the decision-making process regarding participation in health research as a contested boundary in international bioethics discourse. An ethnomethodological approach is used to explain African ethics, and African ethic is applied to the decision-making process in the African community. An HIV/AIDS surveillance project is used as a case study to explore the concept of communitarianism. The article argues that what exists in Africa is communal or social autonomy as opposed to individual autonomy in the West. As a result, applying the western concept of autonomy to research involving human subjects in the African context without adequate consideration for the important role of the community is inappropriate. It concludes that lack of adequate consideration for community participation in health research involving human subjects in Africa will prevent proper management and lack truly informed consent.
The paper reports on a framework for health systems governance (HSG). Key issues considered included the role of the state vs. the market; role of the ministries of health vs. other state ministries; role of actors in governance; static vs. dynamic health systems; and health reform vs. human rights-based approach to health. The framework permits ‘diagnoses of the ills’ in HSG at the policy and operational levels and points to interventions for its improvement. The principles of the HSG framework are value driven and not normative and are to be seen in the social and political context. The framework relies on a qualitative approach and does not follow a scoring or ranking system. It does not directly address aid effectiveness but provides insight on the ability to utilise external resources and has the ability to include the effect of global health governance on national HSG.
Active and informed participation is an integral component of health systems, as well as the right to the highest attainable standard of health. Despite its critical importance, health and human rights have not given participation the attention it deserves. While some health researchers have made more headway than those working in human rights, neither community has a widely accepted understanding of what the process of participation means in practice. This monograph is an accessible, practical, timely and original introduction to the process of participation; the need for a variety of participatory mechanisms; the relationship between fairness and transparency of the process; the relationship between participation and accountability and participation in accountability.
This paper from Oxfam focuses on how the right-to-be-heard concept can strengthen public participation in policy making and accountability. Recommendations for those supporting poor and marginalised people to lobby for changes in their situation include recognising that change is long-term, understanding that attitudinal change is important, putting local priorities first, working at a number of levels and building alliances, bringing people face to face, taking different perspectives into account, recognising that international agencies can play an advocacy role, understanding that NGOs are important as role models of accountability and integrity. A number of case studies are used to illustrate these points including the fostering of local accountability in Malawi.
This paper describes an innovative knowledge translation project involving researchers and key stakeholders commissioned by the World Health Organization (WHO) for the Commission on Social Determinants of Health (CSDH). The project aimed to develop 'cameo' reports of evidence-based policies and interventions addressing social determinants of health, intended for use by leaders and advocates, as well as policy and programme decision makers, to advance global action. The iterative process of developing the framework and content of the cameos, in the context of a limited evidence base, is described, and a number of issues related to the integration of multiple sources of evidence for knowledge translation action are identified.
Malawi was the only sub-Saharan African country examined in these case studies. The Malawian presenter recommended follow-up programmes for monitoring political party manifestos vs their actual delivery in government, with independent budget analyses. Independent civil society budget research for evidence-based advocacy and continued strong advocacy around political and socio-economic developments in the country are also required. In conclusion, the author asserts that the greatest danger facing democracy is the exclusion of the people from real power. Citizens cannot wait passively for the government to educate them. They need to be active and critical: at a local level, organised community groups, with the help of civil society organisations, should engage in controlling local government decision making.
Over the past few years, a flood of new work has emerged challenging the validity of the traditional measurements of corruption and arguing for new and improved tools for national policy makers, civil society and donors alike. This guide suggests ways of measuring corruption promoting a multiple data sourcing approach and a focus on actionable measurements. It is aimed at national stakeholders, donors and international actors involved in corruption measurement and anti-corruption programming. This guide is based on more than thirty interviews with individuals from dozens of countries who are working on corruption and governance reforms. It explains the strengths and limitations of different measurement approaches, and provides practical guidance on how to use the indicators and data generated by corruption measurement tools to identify entry points for anti-corruption programming.
This paper analyses the impact of corruption on the extent of trust in political institutions using data from surveys conducted in eighteen sub-Saharan African countries. The authors test the ‘efficient grease’ hypothesis that corruption can strengthen citizens’ trust since bribe paying and clientelism open the door to otherwise scarce and inaccessible services and subsidies, and that this increases institutional trust. The findings do not support this theoretical argument. The impact of corruption on institutional trust is never positive whatever the evaluation of public service quality. The study shows that the perceived level of corruption has a strong adverse effect on citizens’ trust in political institutions and that the scope of its negative effect increases with the quality of public services, while, in contrast, the negative effect of experienced corruption decreases with the ease of access to public services. These findings call for more detailed and expanded studies.