This resolution presents a Framework of Engagement with non-State actors to replace the Principles governing relations between the World Health Organization and nongovernmental organizations and Guidelines on interaction with commercial enterprises to achieve health outcomes;(1) to implement the Framework of Engagement with non-State actors; (2) to establish the register of non-State actors in time for the Sixty-ninth World Health Assembly; (3) to report on the implementation of the Framework of Engagement with non-State actors to the Executive Board at each of its January sessions under a standing agenda item, through the
Programme Budget and Administration Committee; (4) to conduct in 2018 an evaluation of the implementation of the Framework of Engagement
with non-State actors and its impact on the work of WHO with a view to submitting the results, together with any proposals for revisions of the Framework, to the Executive Board in January 2019,through the Programme Budget and Administration Committee.
Governance and participation in health
In an initiative to promote the decentralizing of the health system, the government of Uganda through Ministry of Health called for an establishment of Health Unit Management Committees (HUMCs) at each government health facility as a way of empowering community members to participate in influencing health system for better service delivery. As part of an action research process, the Center for Health Human Rights and Development (CEHURD) carried out a case study on two HUMCs in Kikoolimbo health center III in Kyankwanzi district and Nyamiringa health center II Kiboga district. The purpose of this case study was to provide an understanding of the experiences of HUMCs in performing their roles and what role Civil Society can play to support them perform their roles and responsibilities as well as advancing health rights and addressing health inequities using the human rights based approach. The findings revealed that these two health unit management committees had limited knowledge of the HUMCs guidelines. The committee members were trained by CEHURD and community dialogues held to inform community members about the existence of these committees as well as their roles and responsibilities. The author noted that when communities are empowered, they can differentiate between performing and non-performing committees.
Mutual trust and respect, real commitment to collaboration and flexibility are all essential elements to be responsibly equipped to work with a marginalised community. And they are not even enough. The authors write in this paper about the experience of working with marginalised communities on using data and technology in advocacy as they think it could greatly help other practitioners planning to collaborate with groups struggling to get their rights honoured and their voices heard. The authors summarise advice emerging from the case study as to: listen to and learn from the community, keeping assumptions at bay; give ownership of the work to the community itself; build capacity tailored to its needs and abilities, accessibly and sustainably; provide people with the tools and methodologies that equip them to work independently on more successful initiatives in the future.
In Uganda, community services for febrile children are expanding from presumptive treatment of fever with anti-malarials through the home-based management of fever (HBMF) programme, to include treatment for malaria, diarrhoea and pneumonia through Integrated Community Case Management (ICCM). To understand the level of support available, and the capacity and motivation of community health workers to deliver these expanded services, the authors interviewed community medicine distributors (CMDs), who had been involved in the HBMF programme in Tororo district, shortly before ICCM was adopted. Between October 2009 and April 2010, 100 CMDs were recruited to participate by convenience sampling. The survey included questionnaires to gather information about the CMDs’ work experience and to assess knowledge of fever case management, and in-depth interviews to discuss experiences as CMDs including motivation, supervision and relationships with the community. CMDs faced multiple challenges including high patient load, limited knowledge and supervision, lack of compensation, limited drugs and supplies, and unrealistic expectations of community members. CMDs described being motivated to volunteer for altruistic reasons; however, the main benefits of their work appeared related to ‘becoming someone important’, with the potential for social mobility for self and family, including building relationships with health workers. At the time of the survey, over half of CMDs felt demotivated due to limited support from communities and the health system. Community health worker programmes rely on the support of communities and health systems to operate sustainably. When this support falls short, motivation of volunteers can wane. If community interventions, in increasingly complex forms, are to become the solution to improving access to primary health care, greater attention to what motivates individuals, and ways to strengthen health system support are required.
After three decades of often catastrophic results, many cities, regions and countries are closing the book on water privatisation. A quiet citizen revolution is reported to be unfolding as communities across the world reclaim control of their water services to manage this crucial resource in a democratic, equitable and ecological way. Over the last 15 years, 235 cases of water remunicipalisation have been recorded in 37 countries. More than 100 million people have been affected by this global trend, whose pace is accelerating dramatically. From Jakarta to Paris, from Germany to the United States, this book draws lessons from this vibrant movement to reclaim water services. The authors show how remunicipalisation offers opportunities for developing socially desirable, environmentally sustainable and quality water services benefiting present and future generations. The book aims to engage citizens, workers and policy-makers in the experiences, lessons and good practices for returning water to the public sector.
Rising powers such as Brazil, India and China have been criticised for their inputs in the negotiations on the post-2015 development agenda. The start of the United Nations (UN) negotiations saw high expectations for the role of these countries in shaping the Sustainable Development Goals (SDGs) that have not materialised. However, what appears to be a confrontational style of diplomacy is in fact an assertive affirmation of long-standing principles. The G77 and China have consistently
called for the reform of the UN Security Council, and of the Bretton Woods institutions, which resulted in International Monetary Fund reform being nominally approved in 2010 before being blocked by the United States (US) Congress. The issues defended by the Brazilian negotiators centred on poverty eradication, its relationship with inequality; sustainable production and consumption; financing and keeping climate change strictly within the UNFCCC process. Brazil is keen to avoid what it sees as the securitisation of development through the SDGs. It supports governance as a general principle guiding the SDGs, but is adamant in its refusal to consider security as a stand-alone goal. The Brazilians are prioritising the ‘how’ of the SDGs, concentrating on the means of implementation for sustainable development through data disaggregation and exploring how to reutilise the structure of the MDGs as well as Brazil’s experience of participatory development in implementation. The authors argue that a more nuanced understanding of these countries’ positions in the post-2015 process is required.
This video shows a recording of the statement made by People's Health Movement and Medicus Mundi International at the Executive Board 138 of the World Health Organisation (WHO) in January 2016. In it they highlight their assertion that the FENSA proposal constitutes a Trojan horse, which will legitimise the influence of private sector interests in WHO decision-making. They argue that FENSA is symbolic of a more fundamental issue - that of WHO’s independence - which is compromised by its financial crisis, lack of member contributions and crippling dependency on tightly earmarked voluntary contributions. They call for the WHO to have strong safeguards to protect it from undue influence from funders and conflicts of interests on the part of industry partners and a robust conflict of interest policy should also include appropriate protection of whistleblowers.
The Brazilian Government created Participatory Health Councils (PHCs) to allow citizen participation in the public health policy process. PHCs are advisory bodies that operate at all levels of government and that bring together different societal groups to monitor Brazil’s health system. Today they are present in 98% of Brazilian cities, demonstrating their popularity and thus their potential to help ensure that health policies are in line with citizen preferences. Despite their expansive reach, their real impact on health policies and health outcomes for citizens is uncertain. The authors thus ask the following question: Do PHCs offer meaningful opportunities for open participation and influence in the public health policy process? Thirty-eight semi-structured interviews with health council members were conducted. Data from these interviews were analyzed using a qualitative interpretive content analysis approach. A quantitative analysis of PHC data from the Sistema de Acompanhamento dos Conselhos de Saude (SIACS) database was also conducted to corroborate findings from the interviews. The authors learned that PHCs fall short in many of the categories of good governance. Government manipulation of the agenda and leadership of the PHCs, delays in the implementation of PHC decision making, a lack of training of council members on relevant technical issues, the largely narrow interests of council members, the lack of transparency and monitoring guidelines, a lack of government support, and a lack of inclusiveness are a few examples that highlight why PHCs are not as effective as they could be. Conclusions Although PHCs are intended to be inclusive and participatory, in practice they seem to have little impact on the health policymaking process in Brazil. PHCs will only be able to fulfil their mandate when combined with good governance. This will require a rethinking of their governance structures, processes, membership, and oversight. If change is resisted, the PHCs will remain largely limited to a good idea in theory that is disappointing in practice.
With the fading of colonial memory in postcolonial Africa, dramatic changes are emerging and are shaping urban cities in quite significant ways. Urbanisation is exploding, and large numbers of Africans are becoming town dwellers, informal settlements alike are becoming the norm rather than the exception. Urban challenges have thus become complex, hence calling for an infrastructural rethink to urban governance and development in Africa. The interest for this paper, is to explore the governance and politics of urban space in the postcolonial African city. Guma’s research question, put in its most general form, asks what constitutes the governance and politics of urban space in the post-colonial African city? By taking three East African cities of Kampala, Nairobi and Dar es Salaam as his main analytical units, he focuses on: understanding urban structures and dynamics of urban governance and political frameworks and networks of survival, and exploring realities that shape urban governance within the global and neo-liberal context of post colonial Africa. To achieve this end, he draws from comparative, qualitative and reflective exploratory fieldwork research within the realm of socio-anthropological, legal-political, and architectural-geographical investigation.
Healthcare user fees present an important barrier for accessing services for the poorest in Burkina Faso and selective removal of fees has been incorporated in national healthcare planning. However, establishing fair, effective and sustainable mechanisms for the removal of user fees presents important challenges. A participatory action-research project was conducted in Ouargaye, Burkina Faso, to test mechanisms for identifying those who are poorest in implementing user fee removal. The authors explore stakeholder perceptions of ethical considerations relating to participation and partnership arising in the action-research in 39 in-depth interviews in the affected community, local healthcare professionals, management committees of local health clinics, researchers and regional or national policy-makers. Using constant comparative techniques, the authors carried out an inductive thematic analysis of the collected data. Stakeholder perceptions and experiences relating to the participatory approach and reliance on multiple partnerships in the project were associated with a range of ethical considerations related to 1) seeking common ground through communication and collaboration, 2) community participation and risk of stigmatisation, 3) impacts of local funding of the user fee removal, 4) efforts to promote fairness in the selection of the indigents, and 5) power relations and the development of partnerships.The investigation illuminated the distinctive ethical terrain of a participatory public health action-research project. The authors indicate that careful attention and effort is needed to establish and maintain respectful relationships amongst those involved, acknowledge and address differences of power and position, and evaluate burdens and risks for individuals and groups.