This article presents a detailed description of a community mobilization intervention involving women's groups in Mchinji District, Malawi. The intervention was implemented between 2005 and 2010. The intervention aimed to build the capacities of communities to take control of the mother and child health issues that affect them. To achieve this it trained local female facilitators to establish groups and using a manual, participatory rural appraisal tools and picture cards guided them through a community action cycle to identify and implement solutions to mother and child health problems. The groups then catalysed community collective action to address mother and child health issues to improve te health and reduce the mortality of mothers and children. Their impact, implementation and cost-effectiveness have been rigorously evaluated through a randomized controlled trial design and the results of these evaluations will be reported in 2011.
Governance and participation in health
Dissatisfaction emerged among many Member States over the World Health Organisation’s (WHO) financial reform plans at the 129th session of the WHO Executive Board, held on 25 May 2011. They expressed concern over the lack of detail on the reforms proposed, the stress on "donor funding" to resolve the financial difficulties of the WHO, as well as proposals such as the convening of the World Health Forum, which is aimed at increasing the influence of the private sector and external funders in setting the health agenda in the WHO. They also emphasised that the WHO's reform process must be driven by Members States themselves. The discussion resulted in the adoption of a new decision EB 129(8), which sets out a more transparent and inclusive consultative process for the finalisation of a reform plan by November 2011, when the Executive Board will convene for a special session.
The author argues that European powers appear set on perpetuating their arbitrary ‘entitlement’ to the position of Managing Director of the International Monetary Fund in the wake of the controversy that precipitated the resignation earlier in May 2011 of Managing Director, Dominique Strauss-Kahn. Despite claims from the IMF that the selection this time around would ‘take place in an open, merit-based, and transparent manner‘ as well as a longstanding commitment to open the position to nationals of all member states, most developed country representatives had expressed clear preferences for European candidates even before nominations opened on 23 May, according to this article. Their stances raise fears among developing countries and civil society that pledges to address unrepresentative governance at the Bretton Woods institutions are mere window dressing. Developing countries and emerging economies that account for most of the world's population, over half the world's output and who are being pressed to increase their capital contributions, will have negligible influence in the decision on the Managing director unless they are willing to take a firm, collective stance behind a consensus candidate.
With external funders moving towards making randomised controlled trials (RCTs) yet another conditionality of aid, How Matters questions the rationale behind the trend and its implications for non-governmental organisations in least-developed countries. According to the article, most local organisations and grassroots movements in the developing world lack both resources and capacity, and will struggle to meet arduous requirements from external funders to provide evidence that their programmes work, as RCTs are complicated and costly to undertake. How Matters argues that development aid hasn’t reduced poverty, but instead has squashed local initiatives by not giving the due attention to how that aid (and the accompanying monitoring, surveys etc) makes people feel, largely because of prevalent, yet hidden, negative attitudes towards local people and organisations in the aid sector. How Matters calls for greater participation by communities and individuals who are on the receiving end of aid, rather than the current one-way approach whereby researchers and policy makers tell recipients what they need, without considering issues of dignity and respect.
Tanzania’s performance in recent international corruption surveys shows a mixed picture. In international ratings, the country has experienced recent set-backs as regards the supply side of good governance, but this is coming from a high level of earlier performance, according to this report. In a household survey, respondents were asked to assess the quality of health services in terms of staff, facilities and surroundings. The findings show that, in general, the quality of services provided by the health sector is favourably perceived by households, with over 65% of respondents rating these services as ‘good’ or ‘very good’. However, over 50% of respondents considered medical personnel as corrupt. The authors could not understand how such corrupt medical personnel can deliver good quality services and argue that this apparent contradiction merits further research. Respondents identified a number of barriers to quality health services as serious, namely poor working conditions for medical staff, inadequate coverage of medical services, inadequate infrastructure facilities and equipment, low professional capacity of medical staff, outdated health sector reform programmes and prohibitive cost of accessing health services.
The Joint Action and Learning Initiative on National and Global Responsibilities for Health (JALI) is a coalition of civil society organisations and academics researching key conceptual questions involving health rights and responsibilities, with the goal of securing a global health agreement and supporting civil society mobilisation around the human right to health. This agreement - such as a Framework Convention on Global Health - would inform post-Millennium Development Goal (MDG) global health commitments. Using broad partnerships and an inclusive consultation process, JALI seeks to clarify the health services to which everyone is entitled under the right to health, the national and global responsibilities for securing this right, and global governance structures that can realise these responsibilities and close major health inequities. Mutual benefits to countries in the Global South and North would come from a global health agreement that defines national and global health responsibilities. JALI aims to respond to growing demands for accountability, and to create the political space that could make a global health agreement possible.
Good governance is increasingly understood as necessary for improving access to medicines and contributing to health systems strengthening. This chapter reviews the findings of studies carried out in 25 countries that have examined governance of key functions of pharmaceutical systems within the framework of WHO’s Good Governance for Medicines (GGM) programme. The country studies, which are based on a common methodology, have revealed strengths and several weaknesses in existing pharmaceutical systems and have provided policy-makers with relevant information to help them better understand the nature of the problems facing the sector and where interventions need to take place. Common strengths in the pharmaceutical systems and procedures include the use of standard application forms in the registration process of medicines, use of national essential medicines lists, existence of standard operating procedures for procurement of medicines and well-established tender committees. Common weaknesses include a lack of access to information, poor enforcement and implementation of laws and regulations, absence of conflict of interest policies among members of various committees, and an inability to ensure that the proper incentives are in place to lessen the likelihood of corruption at both the individual and institutional levels. Governments can reduce corruption by promoting transparency and ethical practices, and by introducing simple measures, such as justification for committee membership, terms of reference, conflict of interest policies and descriptions of the purpose of the committees. International organisations, such as WHO, can provide technical support for these efforts.
On 8 April 2011 over 400 civil society activists gathered in New York for a one-day hearing with United Nations (UN) Member States on progress toward reaching Universal Access to HIV treatment, prevention, care, and support. This Civil Society Hearing took place as Member States began drafting a new Outcome Document on HIV, to be adopted at a UN High-Level Meeting on AIDS on 8 June 2011. Advocates are calling for a renewed and urgent commitment from member States to reach Universal Access goals by 2015. During the Hearing, civil society advocates stressed that in pursuing Universal Access goals the international community must prioritise public health over politics. They urged Member States to make available to their citizens the full complement of evidence-based HIV prevention, care, treatment, and support technologies and tools as a commitment to the human right to health. They called for the Outcome Document that will emerge from the UN High Level Meeting on HIV AND AIDS to acknowledge global failures to reach Universal Access by 2010, recommit to upholding and implementing priorities in the global AIDS response articulated by key existing global frameworks on HIV, including the UNAIDS 2011-2015 Outcome Strategy, and commit to bold, new targets.
Representatives of organisations working on campaigns for health and social justice, as well as academia, governments and multilateral institutions, gathered in New Delhi from 2-4 May 2011 to address the need for an effective and accountable global governance for health. They believe that WHO needs to rediscover its fundamental multilateral identity. Drawing on its strengths, the organization has to take advantage of its reform process to rethink and reassert itself as the leading actor in a broader governance for health that is coherent with the need for solid public policy responses to the neoliberal prescriptions, so that globalization be shaped around the core values of equality and solidarity. Beyond mere institutional approaches, issues related to public policies in health have to be democratically debated and tackled at the local, national and regional level. This entails the continued participation and meaningful contribution of communities, public opinions, and their direct empowerment through education and knowledge sharing. Health democracy, namely participation, transparency and accountability in health, is a pre-condition for countries to make an impact in the decision making processes at the global level, within WHO and in other multilateral fora.
In this report, the African Power and Politics Programme (APPP) argues that economic growth is slower and more inequitable than it could be, and has not necessarily produced the poverty reduction that might have been hoped for. There is a growing consensus around the world that this is due to failures in governance, to which the APPP adds the hypothesis that the immediate problem is in part due to the application of a ‘good governance agenda’ that is ideological rather than evidence-based. APPP presents four recommendations. First, moving from ‘best practice’ to ‘best fit’ in thinking about institutional development is necessary. Second, a more realistic take on elections and citizen empowerment as means of addressing problems of public goods insufficiency requires us to rely less on the congenial assumption that all good things go together. Third, the leadership factor and the politics thereof are perhaps the biggest influence on the extent to which particular regimes are developmental or not. Fourth, these findings have important implications for aid effectiveness ahead of the Fourth High Level Forum on Aid Effectiveness in Korea later in 2011. Specifically, the concept of country ownership is due to be revamped, and it should be tied explicitly to this leadership question rather than to democracy, parliamentary oversight, or civil society participation.