Climate change and the current global economic crisis bring an unprecedented opportunity to transform global governance, which must start giving priority to human development and citizen engagement, civil society organisations said at the launch of Platform HD2010 in New York on 5 June, a partnership that will include civil society in addressing the current global crises in the poorest countries. The partnership’s recommendations will contribute to the 20-year review of the United Nations Development Programme’s (UNDP) Human Development Report. Civil society representatives have called on the UNDP to create and expand opportunities for citizen engagement in development initiatives and to work together in addressing the concerns of the poor, who have been the hardest hit by the current economic and climate crises. The partnership will also contribute to the ten-year review of the Millennium Declaration and the Millennium Development Goals, both of which are taking place next year.
Governance and participation in health
Non-state actors (NSAs) are systematically neglected in European Union (EU) development assistance programmes, according to this report. It identifies EU practices that are violating its European Consensus on Development policy statement. It found that, despite the European Community’s (EC’s) attempts, NSAs' involvement has been limited and falls short of the sustained and structured dialogue envisaged by the EU legislation and the Commission’s own guidelines. The EC often does not commit enough time and resources to ensure that its delegations involve relevant NSAs throughout the whole process. EC's development aid programmes are reported to often engage NSAs solely as service providers or short-term consultants, without the follow-up and impact needed for sustainability and effectiveness.
Thirty-two delegates participated in the global workshop that marked the first research phase of the Global Development Network’s (GDN’s) UK Department for International Development-funded project, ‘Strengthening Institutions to Improve Public Expenditure Accountability’, in Washington DC on 18–20 May. For the first year of the project, partners will conduct programme budget and benefit incidence analysis in the three programme sectors: education, health and water. Next year, partners will receive technical training on the subsequent programme analytical activity – cost effective analysis – and start implementing their communication plans in order to inform policymakers on their findings and budget reform proposals. Participating in the meeting were fifteen partner institutions, including from Kenya, Tanzania and Uganda.
The Global Development Network (GDN) and the African Economic Research Consortium (AERC) jointly organised a workshop for their United Nations Development Programme-funded project in Cape Town, South Africa, on 7–8 May 2009: Institutional Capacity Strengthening of African Public Policy Institutes to Support Inclusive Growth and the Millennium Development Goals. This was the third event for the project, following the workshop in Kuwait (February 2009) and the initial planning meeting held in Accra (June 2008). The objective of the project is to provide support to enhance knowledge management capacity for African Policy Research Institutes and networks with a particular focus on tackling the issues of poverty and hunger within the global Millennium Development Goals framework. It will seek to strengthen multi-disciplinary research capacity on poverty analysis and contribute to bridging the gap between research and policy on poverty reduction and sustainable development. Papers from the workshop are expected to be finalised by the end of July 2009. Policy briefs, based on the final papers, will be produced by the relevant institutions. The group also chalked out a dissemination strategy for the project. A concluding workshop has been scheduled for Kenya, in September 2009.
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.
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.