Governance and participation in health

Since 2008 in Mozambique, patients stable on antiretroviral therapy (ART) can join Community ART Groups (CAG), peer groups in which members are involved in adherence support and community ART delivery. More than 10 years after the implementation of the first CAGs, this study explored the impact of changes in circumstances and daily life events of CAG members. The CAG dynamic was affected by life events and changing circumstances including a loss of geographical proximity or a change in social relationships. Family CAGs facilitated reporting and antiretroviral therapy distribution, but conflict between CAG members meant some CAGs ceased to function, pill counts were not carried out, members met less frequently or stopped meeting entirely and ART uptake declined. In a more positive contrast, some CAGs responded to adherence challenges by strengthening peer support through counselling and observed pill intake. Health care providers were reported to push people living with HIV to join CAGs, instead of allowing voluntary participation. They agreed that strengthening CAG rules and membership criteria could help to overcome the identified problems. The authors propose that changing life circumstances of, relationships between and participation by CAG members need to factored into a more flexible implementation model, including intensified peer support and feedback mechanisms between CAG members and health-care providers.

This systematic review of 18 papers published between 1999 and 2019 describes Patient-Public Engagement (PPE) research in Sub-Saharan Africa in relation to theories of PPE; and identifies knowledge gaps to inform future PPE development. Five PPE strategies implemented were traditional leadership support, community advisory boards, community education and sensitisation, community health volunteers or workers, and embedding PPE within existing community structures. PPE initiatives were located at either the ‘involvement’ or ‘consultation’ stages of the engagement continuum, rather than higher-level engagement. Most PPE studies were at the ‘service design’ level of the health system or were focused on engagement in health research. No identified studies reported investigating PPE at the ‘individual treatment’ or ‘macro policy or strategic’ level. The authors suggest that the findings call expanding for PPE at all health system levels and different areas of health system improvement.

Are radical worker struggles, which waned as a result of protracted government efforts to infiltrate and co-opt organized labour, making a comeback in East Africa? The authors observe that internal and external challenges workers and unions face today do not lend themselves to simply calling strikes to force collective bargaining agreements, with traditional tools taking a backseat to the ingenuity of informally organized workers. They suggest that a 'development' narrative in East Africa must be challenged or communities will be fighting for incremental compensations for land and livelihoods instead of stopping expansionist projects that will pit them against one another in the long run. The authors argue that the hope emerging among organized labour in East Africa may not be found in the offices of general secretaries or even necessarily in registered unions, but in collectives of workers that exercise their agency, courage and creative power at the industry level and in their communities and workplaces.

This handbook aims to support people across the city of Cape Town assert their democratic rights, and to come together to take charge of their wards. Unemployment, poverty and violence are deeply entrenched in the city which remains spatially divided and stubbornly unequal and the handbook discusses ways to bring everybody living in the ward together, across historical divides, to deliberate and get involved in finding practical solutions to the problems. This handbook supports this with a ‘manifesto of ordinary ideas’ and practical ideas and tactics to reclaim local democracy.