This brief explores the relevance of civil society budget analysis and advocacy and its potential as a tool to hold governments accountable for their maternal mortality reduction commitments. It discusses three recent examples of civil society groups engaged with budget analysis and advocacy, including Women’s Dignity in Tanzania. Lack of real progress in reducing maternal mortality is unquestionably linked to the failure of governments to make maternal health a budgetary priority. Even though resources to address this issue exist, they are not necessarily being allocated correctly or spent effectively. Governments need to prioritise funding for family planning and prenatal care, skilled care during pregnancy and childbirth, and essential lifesaving interventions. In addition, citizens must actively monitor government spending on maternal health.
Governance and participation in health
The past two decades have seen dramatic shifts in power among those who share responsibility for leading global health. In 1990, development assistance for health – a crude, but still valid, measure of influence – was dominated by the United Nations (UN) system (the World Health Organization, the United Nations Children’s Fund and the United Nations Population Fund) and bilateral development agencies in donor countries. Today, while donor nations have maintained their relative importance, the UN system has been severely diluted. This marginalisation, combined with serious anxieties about the unanticipated adverse effects of new entrants into global health, should signal concern about the current and future stewardship of health policies and services for the least advantaged peoples of the world.
How can the recent change in global health policy to provide ‘health for all’ be translated into action, in order to achieve some real and sustained impact on the ground and successfully reduce inequities in health? The authors have three suggestions. Ask what is needed: the answers to what is really needed cannot be found in Geneva or Washington, but ultimately lie with the people and communities themselves. Put the money where the needs are: if we know what people are suffering from and match available human and financial resources accordingly, even a little money can go a long way. Work together: initiatives like the recently launched International Health Partnership aim to strengthen health systems and to ensure that resources invested are spent in equitable and sustainable manner. This represents a shift from vertical, disease-specific models of funding, to horizontal system-building according to long-term strategies.
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.
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.