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.
Governance and participation in health
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of medical services, inadequate infrastructure facilities and equipment, low professional capacity of medical staff, outdated health sector reform programmes and prohibitive cost of accessing health services.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.
In this article, the authors describe how governance issues have influenced human resources for health (HRH) policy development and to identify governance strategies that have been used, successfully or not, to improve HRH policy implementation in low- and middle-income countries (LMIC). They performed a descriptive literature review of HRH case studies which describe or evaluate a governance-related intervention at country or district level in LMIC. In total 16 case studies were included in the review and most of the selected studies covered several governance dimensions. The dimension 'performance' covered several elements at the core of governance of HRH, decentralisation being particularly prominent. Although improved equity and/or equality was, in a number of interventions, a goal, inclusiveness in policy development and fairness and transparency in policy implementation did often not seem adequate to guarantee the corresponding desirable health workforce scenario. This review shows that the term 'governance' is neither prominent nor frequent in recent HRH literature. It provides initial lessons regarding the influence of governance on HRH policy development and implementation. The review also shows that the evidence base needs to be improved in this field in order to better understand how governance influences HRH policy development and implementation. Tentative lessons are discussed, based on the case studies.
In this commentary, the authors offer five proposals for re-establishing WHO’s leadership. First, WHO should give real voice to multiple stakeholders, including philanthropies, businesses, public/private partnerships, and civil society. Second, WHO should improve transparency, performance and accountability, as stakeholders demand clarity on how their resources will achieve improved health outcomes. Also, WHO should exercise closer oversight of regions, and exert legal authority as a rule-making body. Finally, WHO should ensure predicable, sustainable financing, reducing extra-budgetary funding, which now represents almost 80% of the agency's budget. The ideal solution would be for the World Health Assembly (WHA) to set higher member state contributions. Failing decisive WHA action, the WHO should consider charging overheads of 20-30% for voluntary contributions to supplement its core budget.
This article is a review of the January 2011 Executive Board meeting of the World Health Organisation (WHO). The author identifies a new sense of purpose and willingness of member states to address politically complex issues head on and work towards acceptable compromises in the interest of global health. This was exemplified by the negotiation of a proposal from the African group of countries to institute a policy of rotation between geographic regions for the election of future WHO Director-Generals. The issue could have led to political deadlock on the board, the author argues, but it was artfully avoided through a deft show of statesmanship and above all a collective desire to see the board succeed in its work. The African group of countries also called for a greater involvement of developing nations and emerging economies in global health governance. Concrete proposals for how to move forward with a sense of urgency were raised, and Director General Margaret Chan received a clear mandate to develop reform proposals for discussions at the World Health Assembly in May 2011.