This briefing paper aims to distil the core questions which the fragile states literature and experiences in fragile states present, with the aim of structuring space for discussion of these issues in non-governmental organisation (NGO) practice and exploring directions for further research. It found that networks are not guaranteed to work better solely by having increased resources and in many cases are not a genuine solution. NGOs must work in and strive to ameliorate the environment of mistrust through building trust and social cohesion at a community level. Underlying all fragile states discussion must be a thorough and continuous contextual analysis, as cases of fragility vary greatly and are individually extremely dynamic. There is clearly a need for civil society to innovate and pursue alternative solutions in fragile states where traditional methods do not seem to be working. The challenge for civil society is to engage more effectively in policy dialogue on fragile stages, building on their programmatic experience of working directly with poor communities.
Governance and participation in health
This study sought to determine the best approach of integrating community interventions for TB control. It evaluated the records of 3,110 new TB patients registered in three Local Service Areas (LSAs), from quarter 1 2004 to quarter 4 2005. It found that bacteriological coverage, smear conversion and treatment success rates dropped in the interventional LSA, while the control LSAs remained consistent. The defaulter rates dropped in all LSAs, while the proportion of unevaluated cases increased in the interventional LSA. However, patients registered in the clinics had better chance of successful treatment outcome compared to their hospital counterparts. The study concluded that community participation by itself is not adequate to improve the performance of a TB control programme. Enhancement of the program’s technical and organisational capacity is crucial, prior to engaging purely community interventions. Failure to observe this logical relationship would ultimately result in suboptimal performance. Therefore, the process of entrusting communities with more responsibility in TB control should be gradual and take cognisance of the various health system factors.
In the last several years, a democratic boom has given way to a democratic recession. Between 1985 and 1995, scores of countries made the transition to democracy, bringing widespread euphoria about democracy's future, but more recently, democracy has retreated in some. These developments, along with the growing power of China and Russia, have led many observers to argue that democracy has reached its high-water mark and is no longer on the rise. The authors argue that that conclusion is mistaken and that the underlying conditions of societies around the world point to a more complicated reality. They note that it is unrealistic to assume that democratic institutions can be set up easily, almost anywhere, at any time. The conditions conducive to democracy, it is argued, can and do emerge – and the process of ‘modernisation’ advances them. Once set in motion, it tends to penetrate all aspects of life, creating a self-reinforcing process that transforms social life and political institutions, bringing rising mass participation in politics and – in the long run – making the establishment of democratic political institutions increasingly likely.
The People’s Health Movement (PHM), a world-wide civil society network, has a series of concerns about the World Health Summit (WHS), which is being planned as an annual event. Although the summit speaks of participation of nongovernmental organisations (NGOs), the costs ranging between 290–490 Euro for NGOs will exclude those that could legitimately reflect the voices and needs of grassroots and marginalised communities. The summit is also by invitation only, which suggests that NGO participation will be hand-picked and limited. PHM believes that, rather than creating a parallel policy forum, efforts and resources should be spent strengthening the World Health Organization (WHO) as the international coordinating body for issues related to people's health. WHO is one of the United Nation organisations in which each country has a voice. WHO thus provides a reasonably democratic decision making process, despite mechanisms used by powerful member states to direct the decisions. We are concerned that the declaration of the World Health Summit is likely to preferentially represent the interests of the Global North, corporations and those who financially sponsor the Summit.
Although the South African state has shifted away from uncritical promotion of neo-liberal public management, the government continues to mesh limited welfarism with market-driven reforms. It has tried to use service delivery to win political loyalty, but this strategy has largely backfired. There is growing public awareness that the current failures and inequities in access to public services can no longer be blamed on the legacy of apartheid. According to the free basic water policy applied since 2001, poor South Africans are entitled to 6,000 litres of free water per month. Yet, according to the Department of Finance’s own numbers, most poor households use 25,000 of water per month. Consequently, most such households then fall into arrears. Free basic water, often seen as a big improvement, also has unintended effects. It is a way to increase state surveillance of citizens by requiring registration and its restrictive availability is used as a disincentive for poor people to use water. If poor people use more than their basic allocation, they are heavily penalised by higher tariffs.
The Strengthening the AIDS Response Zambia (STARZ) programme marked a cutting edge multisectoral approach to HIV in the region. Non-governmental sectors (including civil society and the private sector) tend to be poorly organised, and authority tends to rest with government ministries. Not all sectors have incentives or welcome being coordinated, particularly by relatively young commissions claiming the mandate to do so. Coordination can also mean different things to different groups – for some it signifies regulation and control, while for others the emphasis is on participation and information exchange and even access to resources. The main aim of this project was to support the national AIDS commission, known locally as the National AIDS Council (NAC), in coordinating a multisectoral response to the epidemic. The report notes that coordination is improved when the roles and rules of engagement for key stakeholders are understood, and where accessible coordination structures are in place to enable public, civil society and private sector representatives to work effectively with the NAC. The STARZ programme has supported important processes that have focused on improved relationships between the NAC and the civil society and private sectors – including internal coordination.
This guide, produced by the EuropeAid Co-operation Office, offers guidance to European Community (EC) sector specialists on how to analyse and address governance in sector operations in a more systemic and comprehensive way, without being a compulsory blueprint. It aims to strengthen understanding of governance issues at sector level. It is divided into four chapters, which provide a broad definition of governance and overall EC policy on governance, experiences in dealing with governance at sector level reasons for strengthening efforts, a focus on an overall approach in addressing sector governance, and a methodology that can guide the process of analysing governance at sector level.
Like many other developing countries with forbidding landscapes and isolated communities, radio is to be the most effective way of communication in Nepal, where the majority of population lives in villages and the half of it cannot read and write. This manual draws from both the grassroots experience of community media and from international broadcast practices. It considers the issues that are the real basis for the success of community media: public accountability, community representation, locally relevant programming, diverse funding and acknowledgement of staff, including volunteers. It covers in details many key success factors, such as participation and ownership, content, management, volunteerism and networking. It can be applied across a wide range of contexts, from policy issues to the assessment of a local station.
This paper focuses on three crucial issues when analysing human rights and health: the importance of social class in community participation, the pivotal role of power and empowerment, and the role of the state, which refers to the concepts of claim holders and duty bearers included in a rights-based approach to health. The concept of ‘health through people's empowerment’ is proposed to identify and describe the core aspects of participation and empowerment from a human rights perspective and to put forward common strategies. If marginalised groups and classes organise, they can influence power relations and pressure the state into action. Such popular pressure through organised communities and people's organizations can play an essential role in ensuring adequate government policies to address health inequities and in asserting the right to health.
The twenty African countries included in the Afrobarometer include many of the most politically liberal countries on the continent, including seven countries ranked by Freedom House in 2008 as ‘free’. However, when one assesses the quality of these regimes based on popular attitudes and perceptions, one does not find any consolidated democracies among them (although Botswana comes close). In fact, some are consolidating as autocracies, but most countries are best understood as unconsolidated, hybrid regimes. They exhibit some key elements of democracy, such as regular elections and protection of core individual freedoms. But either the popular demand for democracy, or the perceived supply of democracy, or, in most cases, both, fall short of the standards of full democracy. But the trajectories of individual countries are extremely diverse, with some exhibiting sharp declines away from democratic consolidation, while others are steadily advancing.