Almost a decade after its inception, the African Peer Review Mechanism (APRM) continues to be the continent’s major governance monitoring mechanism. According to this article, the APRM has raised awareness of governance issues, energised the African continent and taken small but significant steps to remedy big problems. It has brought benefits to those countries that have taken it seriously. Recognising this, it is clear that more countries need to be encouraged to be part of the APRM process, and that countries that have made commitments to improve governance be held accountable for promises and progress. However, there have been challenges. For example, the rate of reviews is relatively slow, with the first country (Ghana) only peer reviewed in January 2006, almost four years after the APRM was established. It has been seven years since the launch of the APRM, and so far only 13 of the 29 acceding member countries have been reviewed. In addition, recommendations in the reviews are not mandatory or enforceable and have generally gone unheeded by African governments. For example, the review for Kenya predicted post-election ethnic-related violence in 2007, yet the Kenyan government took no measures to prevent the violence.
Governance and participation in health
Sex Workers Outreach Programme (SWOP) is a project run by the University of Nairobi and Canada's University of Manitoba, which trains sex workers to be peer educators for other sex workers and inform them about sexual health and rights. Through the SWOP programme, educators have enabled more than 3,000 of their Nairobi peers to get tested for HIV and other sexually transmitted infections. They have also taught them skills to negotiate condom use with their clients. Since 2008, the SWOP clinic in Nairobi, which is open 24 hours a day, has provided HIV prevention services to more than 7,000 commercial sex workers, 150 of them male. The HIV prevalence among those tested is 33 percent. The prevention package includes condom demonstration and provision, sexually transmitted infection screening and treatment, family planning and post-exposure prophylaxis.
In this statement, the Public Service Accountability Monitor (PSAM)points out that, by the end of the 2009/10 financial year, the Eastern Cape Department of Health had accrued debt of approximately US$ 245 million. PSAM argues that this overspending was largely as a result of underfunded and unbudgeted mandates relating to human resources, as well as higher than expected costs for pharmaceuticals and laboratory services. It notes that the debt has already resulted in stock-outs of basic medicines, but cautions that the issue is not only one of inadequate funding. Over the last ten years the Eastern Cape Department of Health has consistently received poor audit opinions from the Auditor General. These opinions have revealed that chronic financial mismanagement continues to result in the misuse and misappropriation of public funds. This means that even those resources which are available have not been used appropriately. The PSAM calls on the National Department of Health and the National Treasury to make public details of the Eastern Cape Department of Health’s financial status, and to publicly guarantee that no patients in the province will be refused basic treatments because of a shortage of medicines and medical supplies.
This report synthesises the results of the first evaluation of the early implementation of the Paris Declaration, from March 2005 to late 2007. It comprises extensive assessments in eight countries, together with ‘lighter’ studies on eleven development partner agencies, focusing at the headquarters level. It found that the principle of ownership has gained much greater prominence since 2005, although the evaluations show that the practical meaning and boundaries of country ownership and leadership often remain difficult to define. The evaluations do not suggest any backsliding on harmonisation, but neither do they indicate any overall trend toward progress. All the evaluations convey a sense that the joint processes for tracking progress and resolving problems fall short in terms of mutual accountability. Development agency and partner country evaluations reveal that, despite clear commitments to alignment, implementation of the various components of alignment set out in the Paris Declaration has been highly uneven.
This compilation includes peer reviews on government accountability from Kenya and South Africa. The Kenyan review concluded that, while the reviewing process yielded a lot of data it was not as empowering and inclusive as it should have been and did not foster significant dialogue between Kenya’s government and its people. This was in part due to the way the self-assessment was carried out and also because it was focused on the efficiency and effectiveness of government, and not democratic decision-making and human rights. The South African review concluded that, while the reviewing process had many strengths, it had too great a level of government control, an overly ambitious timetable, and lacked meaningful civil society input.
This study assessed community acceptability of the use of rapid diagnostic tests (RDTs) by Ugandan CHWs, locally referred to as community medicine distributors (CMDs). The study was conducted in Iganga district using 10 focus group discussions (FGDs) with CMDs and caregivers of children under five years, and 10 key informant interviews (KIIs) with health workers and community leaders. The study found that CMDs are trusted by their communities because of their commitment to voluntary service, access, and the perceived effectiveness of anti-malarial drugs they provide. Some community members expressed fear that the blood collected could be used for HIV testing, the procedure could infect children with HIV, and the blood samples could be used for witchcraft. Education level of CMDs is important in their acceptability by the community, who welcome the use of RDTs given that the CMDs are trained and supported. Anticipated challenges for CMDs included transport for patient follow-up and picking supplies, adults demanding to be tested, and caregivers insisting their children be treated instead of being referred. Use of RDTs by CMDs is likely to be acceptable by community members given that CMDs are properly trained, and receive regular technical supervision and logistical support.
Local East African programmes are discovering the benefits of bringing HIV services closer to rural communities, with mobile drug distribution improving HIV-positive patients' adherence to antiretroviral treatment (ART). Health facilities in rural areas are normally remote, but by using mobile care and treatment centres, it is easy to reach populations who may not otherwise have access to services, according to the Support for International Change (SIC), a local HIV-focused non-governmental organisation in Tanzania. SIC reports using mobile drug distribution in northern Tanzania and witnessing a reduction of cases lost to follow up, compared to local health facilities that are recording higher levels of drop-out amongst patients. Patients must visit a hospital for their initial diagnosis and ART prescription, and are required to visit the health centre periodically, but in between visits, SIC uses community-based volunteers and trained medical workers to drive around villages refilling prescriptions as well as providing education on condom use and the prevention of opportunistic infections. SIC in Tanzania reaches nearly 2,500 people with mobile ART clinics and has so far trained around 200 health workers in Babati District in northern Tanzania.
The community-directed intervention (CDI) strategy is an approach in which communities themselves direct the planning and implementation of intervention delivery. This CDI study involved multi-disciplinary research teams from seven sites in three African countries, including Uganda. Integrated delivery of different interventions through the CDI strategy proved feasible and cost-effective where adequate supplies of drugs and other intervention materials were made available. Communities, health workers, policy-makers and other stakeholders were quite supportive and their buy-in to the CDI approach increased significantly over time. Since intervention coverage also increased as more interventions were gradually included in CDI delivery, the results of the study are promising in terms of the sustainability of the CDI approach. Based on its findings, the study recommends that CDI approaches be adopted for integrated, community-level delivery of appropriate health interventions in the 16 African countries with experience in community-directed treatment for onchocerciasis control. This may comprise the interventions tested in this study, especially for malaria, or other intervention packages chosen on the basis of the lessons learnt.
South Africa’s Sex Workers Education and Advocacy Taskforce (SWEAT) and Sisonke have launched a helpline for commercial sex workers. The line was initiated to give commercial sex workers a platform to voice the concerns and fears they face at work. SWEAT noted that it was not easy for commercial sex workers to get adequate information because they are often scared of revealing what they do to earn a living. The line could also be used by anyone who wanted to get information about the industry. The line opened at the beginning of June and provides assistance on sexual health, drug and alcohol problems as well as emotional and work related matters. Those with e-mail access can also send e-mails. Commercial sex workers needing assistance would be assisted by trained counsellors from 9 am to 5pm with plans to upgrade the line to a 24-hour facility.
Civil society activists and anti-poverty campaigners from around the world have personally delivered a letter containing recommendations for a breakthrough plan to end poverty and inequality to United Nations (UN) Secretary-General, Ban Ki-moon. The open letter was signed by more than 120 civil society organisations, including Global Call to Action Against Poverty (GCAP), the Feminist Task Force, CIVICUS, End Water Poverty and the International Trade Union Confederation. It contains nine key recommendations, including calls for greater accountability, measures to increase gender equality and reduce social exclusion and the provision of quality affordable public services. GCAP affirmed that signatories to the letter were determined to ensure that the breakthrough plan is developed further and implemented to meet the Millennium Development Goals (MDGs). The campaign is intended to be extended to all UN member states, as well as to the United Nations Summit, which will be held in September and is expected to produce additional pledges to achieve the MDGs.