Ban Ki-Moon’s term as UN Secretary General ends this year and already political jostling is underway ahead of the selection of the new head of the world body. There are strong indications that favour a woman candidate. And how has Africa positioned itself for the unfolding contest? A number of African female candidates with the right credentials fit to lead the UN exist. The author discusses which African candidates could be in the running and whether a candidate from Kenya might have the diplomatic weight to lobby and get elected.
Governance and participation in health
Choosing the next UN boss: A political quagmire
Bochaberi D: Pambuzuka News, 12 May 2016
Community participation for transformative action on women’s, children’s and adolescents’ health
Marston C; Hinton R; Kean S; Baral S; Ahuja A; Costello A; Portela A: Bulletin of the World Health Organization 94(5) May 2016
The Global strategy for women’s, children’s and adolescents’ health (2016–2030) recognizes that people have a central role in improving their own health. The authors propose that community participation, particularly communities working together with health services (co-production in health care), will be central for achieving the objectives of the global strategy. Community participation specifically addresses the demand to transform societies so that women, children and adolescents can realize their rights to the highest attainable standards of health and well-being. This paper examines what this implies in practice. The authors discuss three interdependent areas for action towards greater participation of the public in health: improving capabilities for individual and group participation; developing and sustaining people-centred health services; and social accountability. They outline challenges for implementation, and provide policy-makers, programme managers and practitioners with illustrative examples of the types of participatory approaches needed in each area to help achieve the health and development goals.
Reports from WHO Watch
People’s Health Movement (PHM) and Medicus Mundi International: May 2016
WHO Watch is a civil society project, coordinated by People’s Health Movement (PHM) and Medicus Mundi International, directed both to supporting WHO and holding it accountable. WHO Watch involves a team of ‘watchers’ attending WHO governing body meetings, lobbying delegates, speaking from the floor, documenting and reporting on the debate and the decisions, and preparing commentaries on each of the agenda items. These commentaries are designed to support progressive delegations (in particular from smaller countries who have only limited human resources to devote to these issues) as well as arguing for progressive outcomes. The Sixty Ninth World Health Assembly (WHA69) convened in Geneva from 23 – 28 May 2016. The Watch reports on the debates on various items, including: managing conflicts of interest in global health; maternal, infant and young child nutrition; ending childhood obesity; ageing; air pollution; the ‘sound’ management of chemicals; antimicrobial resistance; polio; managing global health emergencies; the health of migrants; lessons from Ebola in West Africa; HIV, viral hepatitis, STIs; vaccination; global health workforce issues; medicines and intellectual property.
The slow shipwreck of the World Health Organization?
Velasquez G; Alas M: Third World Network Info Service, May 2016
In this article the authors argue that the World Health Organisation (WHO) Secretariat, Member States and observers should honestly admit that they have so far fallen very short of the WHO Mission. The authors argue that the organization has become a huge bureaucratic structure while at the same time under-resourcing its needs has made it incapable of providing a timely response to the urgent health needs happening in the world. The organization is argued to be being privatized with influence from small group of private funders. This authors observe that the limited participation sometimes turns into an uncomfortable position for many, when faced with the lack of progress in the debates or with the endless diplomatic language that is used without reaching any concrete agreements and with resolutions and decisions where that make it almost impossible to identify the substance and therefore difficult to see their real value. In the meantime millions of diseases and preventable deaths are happening far away from what is being discussed at “the highest levels” of international public health policy arena.
WHO: Health Assembly adopts framework for non-State actor engagement
TWN Info Service: Geneva, 31 May 2016
The 69th World Health Assembly (WHA) adopted the Framework of Engagement with Non-State Actors (FENSA) on the concluding day of Assembly. The adoption of FENSA is the conclusion of a process initiated as part of the WHO reform in 2011. FENSA consists of an overarching framework of engagement with Non-State Actors (NSAs) and four separate policies for governing the engagements with four categories, i.e. Non-Governmental Organisations (NGOs), private sector, philanthropic foundations and academic institutions. The overarching principles set out the common rules for all NSAs and treat all NSAs on an equal footing. The separate policies provide certain customised aspects of the overarching principles to the respective categories of NSAs. The framework regulates five types of engagements: participation, resources, advocacy, evidence, and technical collaboration. The WHA resolution that adopts the FENSA decides to replace the two existing policies governing WHO engagements with NGOs and the private sector. Further, the resolution requests the Director-General to start the implementation immediately and take all necessary measures to fully implement FENSA. Further, it requests the Director-General to expedite the full establishment of WHO’s NSA register.
Developed countries turning against non-State actor WHO engagement framework
Gopakumar K: Third World Network (TWN) Info Service on Health Issues 5, 21 April16
Developed countries are reported to be turning against the World Health Organization’s framework of engagement with non-State actors (FENSA), by putting conditions for its adoption as negotiations on it enter into the last stage. Member States from Europe are reported to be raising three issues to block the adoption of FENSA. First, that the adoption of FENSA is possible only when there is a clear understanding on the implications of its implementation, especially financial and human resource implications. Secondly, that the Secretariat be given flexibility to suspend FENSA norms while engaging with non-State actors to respond to emergencies, and thirdly that the implementation of FENSA be at all three levels of WHO viz. headquarters, regional and national.
Exploring perceptions of community health policy in Kenya and identifying implications for policy change
Mccollum R; Otiso L; Mireku M; Theobald S; de Koning K; Hussein S; Taegtmeyer M: Health Policy and Planning 31(1),10, 2016
Kenya is currently revising its community health strategy (CHS) alongside political devolution, revisioning responsibility for local services. This explores drivers of policy change from key informant perspectives and perceptions of current community health services from community and sub-county levels, including perceptions of what is and what is not working well. It highlights implications for managing policy change. The authors conducted 40 in-depth interviews and 10 focus group discussions with a range of participants to capture plural perspectives from policymakers, sub-county health management teams, facility managers, community health extension worker (CHEW), community health workers (CHWs), clients and community members in two purposively selected counties: Nairobi and Kitui. There was widespread community appreciation for the existing strategy. High attrition, lack of accountability for voluntary CHWs and lack of funds to pay CHW salaries, combined with high CHEW workload were seen as main drivers for strategy change. Areas that informants felt should change included: lack of clear supervisory structure and adequate travel resources, uneven coverage and inequity in community health services, limited community knowledge about the strategy and home-based HIV testing and counselling. The recommendations point towards a more people-centred health system for improved equity and effectiveness, if the policy is to be effectively implemented.
Partnerships, Power and the SDGs
Faul M: UNRISD seminar, Geneva, March 2016
Partnerships, and their accompanying networks, are now presented as an essential ingredient for fair SDG implementation. But what happens in practice? Network analysis reveals how development ‘partners’ may in fact informally depart from established rules and relationships, with the end result that networks may amplify the very disparities of power they were intended to reduce. In this seminar, Moira Faul argues that with a better understanding of how partnership works, network members could rewire relationships for more inclusion, and ultimately better policy and practice solutions.
A Resolve to Reform - A look at the Director-General's Opening Address at the 138th Meeting of the Executive Board (EB138)
People’s Health Movement: Geneva, 25 January 2016
The 138th Meeting of the Executive Board (EB138) of the World Health Organisation (WHO) taking place from 25 to 30 January 2016 in Geneva includes a host of issues, including reviews of the WHO’s governance, finance and emergency structure. In the opening remarks of WHO Director-General Margaret Chan, the topics touched on ranged widely from Ebola to Road Safety, with an emphasis on Universal Health Coverage in her final paragraph. A pointed reference to the “explosive spread of Zika virus in new geographical areas”, was a conscious effort to highlight the potential threats of infectious disease beyond Ebola, and the much needed reform of the WHO’s emergency structures. She commented on Universal Healthcare Coverage as “the most efficient way to respond to the rise of non-communicable diseases” , although the PHM note the debates on how the proposal for UHC has shifted the focus from how services should be provided to how services should be financed, with private sector providers and private insurance assumed to be part of the solution, despite evidence that this can lead to ‘health-defeating’ market failures. The Director General noted, however, that some policy recommendations on child obesity “pick a fight with powerful economic interests”. These remarks were welcomed by PHM if followed through with changes in the organisation’s relationship with big business.
Health governance in Sub-Saharan Africa
Mooketsane K; Phirinyane M: Global Social Policy15(3): 345–348, December 2015
The interdependence of states and increasing movement of people, the spread of contagious diseases and the heightened complexity of global health issues make cooperation among countries indispensable. Unfortunately resourcing remains a critical challenge to effective health governance. The authors argue that financial resources are not really a major challenge for Sub-Saharan Africa as it is usually perceived. According to the International Monetary Fund (IMF), Sub-Saharan Africa’s economic growth has been robust and capital inflows higher than the developing countries’ average. Notwithstanding threats to the region seems poised for better prospects. The authors argue that health governance should be given a higher significance if growth rates are to be sustained and strategies developed for collaboration between governments and non-state actors. Many Sub-Saharan Africa countries still view non-state actors with suspicion, but the authors argue that those that have embraced them as development partners have reaped some positive results in the provision of health services, such as in the role of mission services in health care provision in Botswana and Malawi. They suggest enhancing a multi-pronged cooperation between African state and non state actors and that the porous borders across countries necessitate regional cooperation to effectively combat the spread of diseases.