On 4 and 5 November 2010, representatives from across Africa met in Tunis to discuss an African agenda on development effectiveness to take to the Fourth High-Level Forum in Busan in 2011. The Tunis Consensus on an African development effectiveness agenda consists of the following main items: building capable states, with African countries taking leadership on capacity development; developing democratic accountability; promoting South-South co-operation; embracing new development partners; and outgrowing aid dependence.
Governance and participation in health
The Tunis Consensus: Targeting effective development: From aid effectiveness to development effectiveness
African Development Bank Group, NEPAD and African Union: December 2010
US military global health engagement since 9/11: Seeking stability through health
Chretien J: Global Health Governance IV(2), 2011
Following the 11 September 2001 terrorist attacks, the United States (US) military expanded its global health engagement as part of broader efforts to stabilise fragile states, formally designating “medical stability operations” as use of Department of Defense (DoD) medical assets to build or sustain indigenous health sector capacity. Medical stability operations have included medical assistance missions launched by US Africa Command throughout Africa. The public health impact of such initiatives, and their effectiveness in promoting stability is unclear, the author notes. Moreover, humanitarian actors have expressed concern about military encroachment on the “humanitarian space,” potentially endangering aid workers and populations in need, and violating core principles of humanitarian assistance. The DoD should draw on existing data to determine whether, and under what conditions, health engagement promotes stability overseas and develop a shared understanding with humanitarian actors of core principles to guide its global health engagement.
Why African countries need to participate in global health security discourse
Hwenda L, Mahlathi P and Maphanga T: Global Health Governance IV(2), 2011
The authors of this article argue that health is an important component of global security. However, the precise meaning and scope of global health security remains contested partly due to suspicions about clandestine motives underlying framing health as a security issue. Consequently, low and middle-income countries have not engaged global discourse on health security, resulting in an unbalanced global health security agenda shaped primarily by the interests of high-income countries, which focuses on a few infectious diseases, bioterrorism and marginalises health security threats of greater relevance to low and middle-income countries. Focusing primarily on African countries, the authors of this paper examine the implications of the participation deficit by the African Group of countries on their shared responsibility towards global health security. After analysing the potential benefits of regional health security co-operation, they conclude that, to ensure that global health security includes the interests of African countries, they should develop a regional health security co-operation framework.
CIVICUS calls on world leaders to make countries accountable for failing aid commitments at OECD summit
CIVICUS: e-CIVICUS 538, 26 May 2011
World leaders should use the Organisation for Economic Cooperation and Development (OECD) 50th anniversary forum to press for concrete improvements in sustainable development and fighting poverty, CIVICUS said at the opening of the two-day summit in Paris, France, on 24 May 2011. The 34-member institution should make clear that real improvements in poverty eradication depend on countries living up to their aid commitments, CIVICUS said. The organisation stated that it is critical that OECD leaders assess the impact of their efforts and the policies being advanced by international financial institutions to tackle poverty and climate change. The gap between commitments and aid pledges in 2011 has widened. In 2005, members of the OECD Development Assistance Committee (DAC) collectively promised to commit 0.56% of gross national income to aid. However, in 2010 aid has reached just 0.32%. At current levels, there is little chance that more than a handful of countries will reach the agreed commitment of 0.7% by 2015, CIVICUS warns, arguing that aid effectiveness is being damaged by inflated budgets, a lack of transparency and the failure of several large countries – namely Germany, Italy and Spain - to honour their commitments laid out in the Accra Agenda for Action.
MaiMwana women's groups: a community mobilisation intervention to improve mother and child health and reduce mortality in rural Malawi
Rosato M, Mwansambo C, Lewycka S, Kazembe P, Phiri T, Malamba F, Newell MN, Osrin D, Costello A: Malawi Medical Journal 22 (4): 2010
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.
Members pressurise WHO to follow more inclusive reform process
Gopakumar K . and Shashikant S: Third World Network, 6 June 2011
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.
No silver lining to the IMF cloud
Srinath I: e-CIVICUS 538, 26 May 2011
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.
RCTs: A band-aid on a deeper issue?
How Matters: May 2011
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: National Governance and Corruption Survey, 2009
Prevention and Combating of Corruption Bureau: 2011
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: Towards a global agreement on national and global responsibilities for health
Gostin LO, Friedman EA, Ooms G, Gebauer T, Gupta N et al: PLoS Medicine 8(5), 10 May 2011
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.