This report evaluates South Africa’s compliance with twelve selected African Union (AU) instruments to which it is a signatory. Eight of these twelve instruments are treaties while four are strategies, resolutions or plans of action. While treaties are legally binding on States Parties, resolutions are not. Seven of the treaties are already in force. Two await the required instruments of ratification to become effective and have not yet been signed or ratified by South Africa. Several health instruments are covered, including the Africa Health Strategy 2007-2015 (AHS), the Abuja Call for Accelerated Action towards Universal Access to HIV and AIDS, Tuberculosis and Malaria Services in Africa by 2010, and the Maputo Plan of Action for the Operationalisation of the Continental Sexual and Reproductive Health and Rights Policy Framework 2007-2010 (MPA). The audit of compliance indicates that South Africa has made significant strides to comply with the selected AU instruments, though much remains to be done. For example, in terms of the Abuja call, the country has a solid HIV and AIDS programme in place and is making progress towards treating tuberculosis and malaria, but the report points to lack of political will, lack of financial resources, and lack of public involvement and well-trained medical staff as factors impeding compliance with the AHS and the MPA. Many health workers are noted to not know about these health instruments because the government has failed to popularise them.
Governance and participation in health
This paper argues that the case for global universal coverage is strong, yet it is not pursued actively enough. Although there may be a problem of ‘free riders’ (countries hoping that other countries will pay for a global public good), the main obstacle would be that global universal health coverage reduces country autonomy and embraces a paradigm of managing mutual dependence. Even if mutual dependence in health is a reality, the paper notes, countries nonetheless try to preserve their autonomy: richer countries require assurances regarding how the assistance they provide will be used (in a manner that serves their interests too), while poorer countries want to have the freedom to address their own health priorities. Recent paradigm shifts in the practice of international health financing can be seen as attempts to manage mutual dependence in health while trying to preserve country autonomy. Over the past decades, these attempts to better manage mutual dependence in health have led to increasingly sophisticated governance mechanisms. The authors suggest that a combination of the best elements of these mechanisms could help progress the world towards global universal health coverage.
The 2010 Corruption Perceptions Index shows that nearly three quarters of the 178 countries in the index score below five, on a scale from 10 (highly clean) to 0 (highly corrupt). These results indicate a serious corruption problem. To address these challenges, Transparency International recommends that governments integrate anti-corruption measures in all spheres, from their responses to the financial crisis and climate change to commitments by the international community to eradicate poverty. It also advocates stricter implementation of the UN Convention against Corruption, the only global initiative that provides a framework for putting an end to corruption.
This paper argues that the World Health Organization (WHO) should act as the directing and co-ordinating authority on future international health work, and its global health leadership must be earned through strategic and selective engagement. The authors caution that the focus of the paper is not the co-ordination of external development funders for health – which they do not consider WHO’s role – but the challenge of how WHO’s accountability to the global health community can be increased in the context of other normative and strategic dimensions of global health governance. WHO needs to provide mechanisms and instruments that link the new global health actors to the system of multilateral intergovernmental institutions, and it should engage in new ways with the many non-health actors that can influence health both positively and negatively, as well as improve its co-ordination function in relation to the development of legal instruments for health. The authors consider the World Health Assembly (WHA) as an inclusive forum that allows poorer countries to have a voice in global health. Consequently, they propose the establishment of a Committee C of the WHA, which will be legitimately represented and will deal with coherence, partnerships and the co-ordination of global health governance.
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.
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.