Governance and participation in health

South-South co-operation and knowledge exchange: A perspective from civil society
Cruz A: Development Outreach, October 2010:25-37, 2010

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.

South-South mutual learning: A priority for national capacity development in Africa
Mayaki IA: Development Outreach, October 2010:13-21, 2010

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.

2010 mutual review of development effectiveness in Africa
United Nations Economic Commission for Africa and the Organisation for Economic Co-operation and Development: 2010

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.

2010 Regional Meeting of Parliamentary Committees on Health in Eastern and Southern Africa: “Repositioning Family Planning and Reproductive Health in the Eastern and Southern Africa Region: Challenges and Opportunities
SEAPACOH: September 2010

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.

Citizens’ agenda for Africa’s development
African Monitor: 2010

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.

Governance Matters 2010: Worldwide Governance Indicators highlight governance successes, reversals, and failures
Kaufmann D: Brookings Institution, 24 September 2010

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.

National poverty reduction strategies and HIV/AIDS governance in Malawi: A preliminary study of shared health governance
Wachira C and Ruger JP: Social Science and Medicine, 9 June 2010

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.

Policy development in malaria vector management in Mozambique, South Africa and Zimbabwe
Cliff J, Lewin S, Woelk G, Fernandes B, Mariano A, Sevene E et al: Health Policy and Planning 25(5): 372-383, September 2010

Indoor residual spraying (IRS) and insecticide-treated nets (ITNs), two principal malaria control strategies, are similar in cost and efficacy. This study aimed to describe recent policy development regarding their use in Mozambique, South Africa and Zimbabwe. Using a qualitative case study methodology, researchers undertook semi-structured interviews of key informants from May 2004 to March 2005, carried out document reviews and developed timelines of key events. They found that a disparate mix of interests and ideas slowed the uptake of ITNs in Mozambique and Zimbabwe and prevented uptake in South Africa. Most respondents strongly favoured one strategy over the other. In all three countries, national policy makers favoured IRS, and only in Mozambique did national researchers support ITNs. Outside interests in favour of IRS included manufacturers who supplied the insecticides and groups opposing environmental regulation. International research networks, multilateral organisations, bilateral donors and international non-governmental organisations (NGOs) supported ITNs. Research evidence, local conditions, logistic feasibility, past experience, reaction to outside ideas, community acceptability, the role of government and NGOs, and harm from insecticides used in spraying influenced the choice of strategy. The end of apartheid permitted a strongly pro-IRS South Africa to influence the region, and in Mozambique and Zimbabwe, floods provided conditions conducive to ITN distribution. The study concludes that both IRS and ITNs have a place in integrated malaria vector management, but pro-IRS interests and ideas have slowed or prevented the uptake of ITNs. Those intending to promote new policies such as ITNs should examine the interests and ideas motivating key stakeholders and their own institutions, and identify where shifts in thinking or coalitions among the like-minded may be possible.

Pushing back against linearity: Report of the Big Push Back
Eyben R: Institute of Development Studies, 29 September 2010

The Big Push Back, which took place on 22 September 2010, was convened by the Participation and Social Change team at the United Kingdom’s Institute of Development Studies. With over 70 attendees, the theme of the meeting was to reflect on and develop strategies for ’pushing back’ against the increasingly dominant bureaucratisation of the development agenda and the pressure to design projects/programmes and report on performance in a manner that assumes all problems are bounded/simple. This is reported to result in research that is linear (cause-effect) based, at the expense of research that is emergent, i.e. a complex, only partially controllable process in which local actors may have conflicting views on what is happening, why and what can be done about it, where complexity is recognised and accountability promoted to those people international funds are supposed to serve. The meeting also called for collaboration with people inside funding and development agencies who are equally dissatisfied with the prevailing ‘audit culture’, and communication to build public understanding that some aspects of development work that cannot be reduced to numbers are also valuable.

Resolutions of the Governance Cluster of the Regional Coordination Mechanism of United Nations Agencies and Partner Organisations
Governance Cluster of the Regional Coordination Mechanism of United Nations Agencies and Partner Organisations: 15 September 2010

The Governance Cluster of the Regional Coordination Mechanism of United Nations Agencies and Partner Organisations held its annual retreat in Johannesburg South Africa on 14-15 September 2010, at which a number of resolutions were adopted. The Cluster resolved that UN agencies’ support to the African Union Commission (AUC), the NEPAD Planning and Coordinating Agency (NPCA) and the Regional Economic Communities (RECs) should be premised on the strategic orientation and priorities of these institutions as articulated in their strategic plans and other relevant documents. Horizontal interaction/links should be developed among the RECs for purposes of joint planning, programming, and sharing of information and experience. Also, AU member states should be encouraged to make efforts to sign, ratify, domesticate and apply existing charters, treaties, protocols, conventions and declarations on governance, democracy and human rights. They should also accelerate the ratification of the African Charter on Democracy, Elections and Governance, 2007. To date, about 38 AU member states have signed this historic democracy charter. Eight more signatories are required to ratify the charter. AU member states that have already signed and ratified the Charter must set in motion steps for its domestication and application, and a comprehensive mechanism should be established to monitor and evaluate implementation of existing African charters, protocols and treaties relating to governance. More AU member states should accede to the African Peer Review Mechanism, as well.

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