This paper explores whether community participation through health committees can advance the right to health, and what constitutes best practice for community participation through South African health committees. It reports on a series of 32 in-depth interviews with members of three community health committees and health service providers in the Cape Metropolitan area. The interviews revealed that, even in resource-constrained settings, community participation through health committees can advance the right to health. This advance mainly occurs through reported improvements in the acceptability and accessibility of local health services. Still, progress is restricted by the amount of power held at different levels of decision-making. The most prominent barriers to participation mentioned by participants included underrepresentation of vulnerable and marginalised groups, and the absence of a formal mandate giving health committees clear objectives and the authority to achieve them, which undermined their ability to make any significant improvements.
Governance and participation in health
This article raises the question of whether the Gates Foundation’s underwriting of journalism, for example by funding radio health programmes in the United States (US) and health journals like Global Health, creates a conflict of interest for journalists, especially when the Foundation does not disclose its funding upfront. Although the Foundation might not have advocated for specific programmes, it does have distinct policy preferences and policy-shaping efforts, potentially influencing the media. The Kaiser Family Foundation (KFF), which was given a five-year, US$9.9 million grant last year by the Gates Foundation, is supposed to provide independent analysis of US global health policies, which have direct bearing on the Gates Foundation’s programmes. Prominent among these programmes is KFF’s US Global Health Policy portal, which selects and summarises global health news from more than 200 worldwide sources spanning mainstream media outlets to blogs. KFF sends a daily email news digest to policy makers, opinion leaders and journalists. The author argues that, not only does KFF have the power to choose what constitutes global health news but, in summarising the stories it selects, it can give them a construction of its own choosing. In key instances, the KFF’s global health news coverage suggests bias both in story selection and preferential treatment of the Gates Foundation. The author calls for increased transparency of funding sources for health programmes and health journalism.
This study first briefly reviews the historical evolution of global environmental diplomacy and governance. It then examines its dominant ideas, instruments, and institutions, including the key environment-economy connection, comparing them with the experience in health at every stage. Its analysis reveals that both environmental and health diplomacy are better at solving yesterday’s specific, acute, concentrated, deadly problems than today and tomorrow’s diffuse, silent, chronic, cumulative but more dangerous and deadly ones. The authors therefore advise caution when sharing lessons, in light of the significant failures in each field. The environmental field is seen as more progressive than health, which has relied largely on the 1948 World Health Organization (WHO) Constitution’s principles, with little added to elaborate and modernise it since. The authors argue that environmental diplomacy and governance is better integrated with the economy and peoples’ livelihoods, which depend on natural resources, while the global health sector still struggles to promote a socio-economic approach, amid the many incentives to focus on single, high-profile diseases. The paper calls for more civil society participation in health, referring to lessons from a long tradition of environmental activism. Health could engage more with groups, such as the G8 and G20, so that health issues are recognised and integrated within economic policy dialogue.
This article reports efforts of Civil Society Organisations (CSOs) to make South-South (SS) co-operation a vehicle for knowledge exchange. The article argues that SS co-operation must be aligned to national development strategies developed through broad-based processes with the participation of parliaments, CSOs, academic institutions, and independent media. It calls for mutual accountability between Southern external funders, countries and their citizens, and increased inclusion of affected actors in assessing aid and development effectiveness.
This article considers new opportunities for South-South co-operation, and proposes that the G20 is a good platform for African countries to leverage South-South (SS) exchange practices. African organizations, like the African Union (AU) and the New Partnership for Africa’s Development (NEPAD), offer mutual learning opportunities to other South countries, like Brazil, and have supported both South-South and North-South knowledge exchanges. The development priorities identified by the AU and NEPAD have been guided by sectoral policy frameworks encouraging innovative exchanges in multistakeholder collaborations and partnerships. If Africa is to be globally competitive, greater investment in this kind of knowledge and learning will be required, the article argues. Knowledge-based approaches to resolving Africa’s development challenges should be strengthened, with research and innovation helping to expand the SS co-operation policy frontiers. Strategically designed institutional arrangements can facilitate the participation of multiple stakeholders, thus fostering the formation of social capital by enhancing SS networks for the exchange of knowledge. Existing regional frameworks are critical in guiding and framing the knowledge and learning architecture in Africa, but innovations must be grounded in the realities of the continent to achieve their desired results. The article concludes that the success of this new development paradigm depends on the establishment of new partnerships to foster more inclusive, equitable and sustainable forms of development co-operation.
According to this review, the achievements of African governments on political and economic governance, and peace and security have been an important factor in helping the continent weather the impact of the crisis over 2009–2010. Improvements to macroeconomic frameworks have created the fiscal space for counter-cyclical policies, which have helped partly to cushion the impact of the crisis and provide a foundation for recovery. Improvements in political governance have helped to maintain political stability in the face of economic shocks. External financial support has held up in the face of fiscal pressures, even if at a level below earlier commitments. And trade is recovering dramatically, enabled in part by success in resisting protectionism during the crisis, even though discussions on further trade liberalisation on a global basis remain stalled. At the same time, the impact of the crisis has still been severe. Although the picture varies significantly by sub-region, growth rates for the continent as a whole fell from an average of about 6% in 2006–2008 to 2.2% in 2009, meaning that the growth of per capita gross domestic product came to a near standstill. Although forecasts for 2010 and 2011 are more positive, the loss of growth in 2009 and its impact over the next two to three years have set back the impressive progress that Africa had started to make towards the Millennium Development Goals, and has left the legacy of significantly greater challenges over the five-year period remaining, to 2015. The review makes nine recommendations. Recommendations for Africa itself include improved political and economic governance, working towards peace and security, increased regional integration, and domestic revenue mobilisation and allocation. For Africa’s partners, the paper recommends improvements in economic governance, and greater trade and official development assistance. Global recommendations include addressing climate change and climate change finance, as well as enhanced participation in global governance for Africa.
At the Regional Meeting of Parliamentary Committees on Health in Eastern and Southern Africa, held in Kampala, Uganda, on 28-29 September 2010, the Southern and East African Parliamentary Alliance of Committees On Health (SEAPACOH) committed themselves to the realisation of the Millennium Development Goals (MDGs), the Maputo Plan of Action and the Accra Agenda for Aid Effectiveness. SEAPACOH underscored its role in offering leadership to ensure good governance in all matters of health, as well as to continue providing stewardship on policy, legislation and budgetary oversight, and ensure that family planning and population issues are integrated into national development strategies, including the poverty reduction strategies and action plans. It also championed advocacy strategies to promote family planning as essential to the achievement of all MDGs, especially MDG4 and MDG5, in partnership with civil society organizations and the media, and promote gender equity. In terms of financing, SEAPACOH will advocate for increased government resources to health to realise the Abuja target of 15%, ensure accountability in public expenditures and continue support for strengthening health systems. It also aims to enhance partnerships with civil society organisations and learn from the best practices in countries in the region through South-South cooperation.
This document reports efforts that were made across Africa to gather grassroots opinions to reflect the views and aspirations of ordinary Africans in shaping the policy agenda for the forthcoming decade. It found that Africa is endowed with natural and human resources whose development is in the interest of world security due to its global strategic importance. Meanwhile, the increasing return of the diasporas is raising the demand for accountable governance and economic development. The current so-called development is exclusionary and does not reach the intended beneficiaries - hence their minimal access to basic services such as health, education, water and sanitation. The report makes a number of recommendations, like replacing the current unjust and exclusionary development ideal with one that is values-based and sustainable, spelling out the Millennium Development Goals need to be spelt out properly for the African and Western public with the emphasis on detailing the public good, ensuring that African governments operate with financial transparency especially in the extractive sector, and making civil society, professional associations, social movements and business entrepreneurs catalysts for engendering accountability from governments, NGOs, donors and big businesses. Agriculture, food security and the informal sector should be prioritised by African governments and those who support Africa’s development, and the skills and remittances of the returning African Diaspora must be harnessed and used to ensure good governance on the continent.
The updated version of the Worldwide Governance Indicators, covering 213 countries over the 1996-2009 period, has found that the world continues to underperform on governance. Over the past decade, dozens of countries have improved significantly on such dimensions of governance such as rule of law and voice and accountability. But a similar number of countries have experienced marked deteriorations, while others have seen short-lived improvements that are later reversed, and scores of countries have not seen significant trends one way or the other. A number of key messages emerged. The most powerful economies are not always the best governed – likewise, good governance is also found in countries that are not wealthy. Governance can significantly improve over a relatively short period of time yet, on average, the world has not significantly improved in the quality of governance over the past dozen years. Sustained commitment to governance reforms is needed to avoid reversals. The authors warn that measuring governance is difficult, and all measures of governance are necessarily imprecise, requiring interpretative caution.
This article reports findings about the impact of the Poverty Reduction Strategy Paper (PRSP) process on Malawi’s National HIV/AIDS Strategic Framework (NSF). In 2007, researchers conducted a survey to measure perceptions of NSF resource levels, participation, inclusion, and governance before, during, and after Malawi’s PRSP process (2000–2004). They also assessed principle health sector and economic indicators and budget allocations for HIV and AIDS. These indicators are part of a new conceptual framework called shared health governance (SHG), which seeks congruence among the values and goals of different groups and actors to reflect a common purpose. Under this framework, global health policy should encompass: consensus among global, national, and sub-national actors on goals and measurable outcomes; mutual collective accountability; and enhancement of individual and group health agency. Indicators to assess these elements included: goal alignment; adequate resource levels; agreement on key outcomes and indicators for evaluating those outcomes; meaningful inclusion and participation of groups and institutions; special efforts to ensure participation of vulnerable groups; and effectiveness and efficiency measures. Results suggested that the PRSP process supported accountability for NSF resources. However, the process may have marginalised key stakeholders, potentially undercutting the implementation of HIV and AIDS Action Plans.