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.
Governance and participation in health
Between 2018 and 2020 in the eastern Democratic Republic of the Congo (DRC) the Ebola epidemic hit an area of ongoing hostilities among dozens of belligerents, including Congolese security forces. The Riposte, a combined national and international response to contain the disease, was not only affected by the violence, but the authors argue may have unintentionally contributed to the conflict. Despite the vast sums spent, Ebola continued to spread in North Kivu and Ituri provinces, which were already hard hit by decades of armed violence. On the ground, in an effort to protect itself from armed attacks and reduce community resistance, the Riposte through agents of the National Intelligence Agency (ANR), in collaboration with the Congolese Ministry of Health and the WHO (in contradiction with UN standard operating procedure), agreed to pay both government security forces and non-state armed groups. Over 20 months, between $489 million and $738 million was spent on Ebola in this part of the country. The authors describe the impact of these payments. By engaging with some armed groups in conflict with others the Riposte is reported to have become embroiled in the violence. The authors point to how this monetized the violence, with some armed groups seeking to prolong the epidemic to continue to profit from what has been called “Ebola Business.” The report cautions against making payments to parties to conflict in exchange for access so as not to inadvertently turn humanitarian operations into a source of profit for those involved in conflict and undermine the impartiality of humanitarian action.
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.
Despite frustration about why public health evidence does not influence policy decisions as much as it should, there has been little attention to a fundamental force in decision making: conflicts of interest. Conflicts of interest arise when the potential for individual or group gain compromises the professional judgment of policy makers or health-care providers, and underpin rent-seeking and informal practice across the world. The authors characterise three different types of conflicts of interest that are particularly pervasive in mixed or pluralistic health systems that need to be considered in health policy and research: The first type occurs when policy makers or regulators have multiple or dual roles.The second type occurs because of hidden financial relationships between formal and informal health-care providers. The third type occurs when policy makers are influenced into taking a course of action that is more likely to win political support, rather than following public health evidence.
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.
Malawi declared a state of national disaster due to the COVID-19 pandemic on 20th March 2020 and registered its first confirmed coronavirus case on 2 April 2020. This paper documents decisions made in response to the COVID-19 pandemic from January to August 2020. Malawi's response to the pandemic was found to have been multi-sectoral and implemented through 15 focused working groups termed clusters. Each cluster was charged with providing policy direction in their own area of focus. All clusters then fed into one central committee for major decisions and reporting to head of state. This led to a range of responses, including an international travel ban, school closures at all levels, cancellation of public events, decongesting workplaces and public transport, mandatory face coverings and testing symptomatic people. Supportive interventions included risk communication and community engagement in multiple languages and over a variety of mediums, as well as efforts to improve access to water, sanitation, nutrition and unconditional social-cash transfers for poor urban and rural households.
The authors investigated community and health-care workers’ perspectives on COVID-19 and on early pandemic responses during the first 2 weeks of national lockdown in Zimbabwe between March and April 2020. Phone interviews were done with with one representative from each of four community-based organizations and 16 health-care workers involved in a trial of community-based services for young people. In addition, information on COVID-19 was collected from social media platforms, news outlets and government announcements. Data were analysed thematically. It emerged that individuals were overloaded with information but lacked trusted sources, which resulted in widespread fear and unanswered questions; communities had limited ability to comply with prevention measures, such as social distancing, because access to long-term food supplies and water at home was limited and because income had to be earned daily; health-care workers perceived themselves to be vulnerable and undervalued because of a shortage of personal protective equipment and inadequate pay and other health conditions were side-lined because resources were redirected, with potentially wide-reaching implications. The authors recommend providing communities with basic needs and reliable information to enable them to follow prevention measures, health-care workers with personal protective equipment and adequate salaries and sustaining health-care services for conditions other than COVID-19.
This thematic brief discusses actions that governments, employers’ and workers’ organisations, can take to advance gender equality through social dialogue, drawing on case studies from around the world, in different sectors, in the formal or the informal economy, and during the pandemic. It identifies the circumstances and factors that can help bring about transformative change. The brief examines the role of social dialogue in the application of relevant International Labour Standards on gender equality, including the ground-breaking Violence and Harassment Convention, 2019 (No. 190) and Recommendation No. 206 on the same subject matter. It concludes with some key recommendations for governments and employers’ and workers’ organisations.
An emerging movement of self-organized, decentralized community action networks is responding to the local realities of COVID-19 in Cape Town, South Africa. It reflects an unprecedented city-wide response to COVID-19, based on principles of self-organizing, mutual aid and social solidarity. In early March 2020, just as South Africa was waking up to the spectacle of COVID-19 within its borders, a group of community organizers, activists, public health folk and artists came together and kick-started a community-led response to the pandemic. This became known as Cape Town Together, a growing network of neighbourhood-level Community Action Networks (CANs) spread across the city. The CANs act locally, while also sharing collective wisdom and various resources through the broader network of Cape Town Together. They work collaboratively, recognizing that everyone brings something to the table. Some are weavers and builders, others are storytellers, caregivers or healers. Some are disruptors whilst others are experimenters and guides. The CANs have galvanized a significant number of people from across the city around a shared experience. Many are seeing the inequality exposed by COVID-19 in a new light and will remain galvanized beyond the immediate crisis.
WHO has defined community engagement as “a process of developing relationships that enable stakeholders to work together to address health-related issues and promote well-being to achieve positive health impact and outcomes”. The organisation notes undeniable benefits to engaging communities in promoting health and wellbeing. This guide is intended for change agents involved in community work at the level of communities and healthy settings.