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.
Governance and participation in health
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.
A new time line with guidance from Member States has been proposed for improving a framework on engagement with non-State actors at the World Health Organization. Discussions on the framework document prepared by the WHO Secretariat were held at the meeting of the 136th session of the WHO Executive Board (EB). During the plenary session, many countries expressed their dissatisfaction with the current draft framework and Argentina proposed a draft decision to convene a working group for deciding on the way forward. This document provides the current draft of the framework.
This bibliography presents studies from peer-reviewed and grey literature that used consultations and other participatory strategies to capture a community’s perspective of their health priorities, and of techniques used to elevate participation from the implementation phase to a more upstream phase of prioritisation, policymaking and agenda setting. It covers studies that worked with marginalised populations or sub-populations. It begins by first offering some philosophical and conceptual frameworks that link participatory interventions with inclusive policy making or agenda setting, and a rationale for prioritising marginalised populations in such an undertaking. It further looks at various participatory instruments for consultations, for reaching out to marginalised populations, and for communicating the results to policymakers. A final section presents a reflective and evaluative look at the recruitment, instruments and examples.
Adults constitute gatekeepers on adolescent sexual and reproductive health (ASRH). This qualitative paper discusses the views of adults on ASRH problems and challenges based on 60 in-depth interviews conducted among adults in Ghana in 2005. Adults were purposively selected based on their roles as parents, teachers, health care providers and community leaders. The major ASRH problems mentioned were teenage pregnancy and HIV/AIDS. The results indicated a number of challenges confronting ASRH promotion including resistance from parents, attitudes of adolescents, communication gap between adults and adolescents and attitudes of health care providers. Among health workers three broad categories were identified: those who were helpful, judgmental and dictators. Some adults supported services for young people while others did not. Some served as mediators and assisted to ‘solve’ ASRH problems, which occurred in their communities. It is argued that exploring the views of adults about their fears and concerns will contribute to the development of strategies and programmes which will help to improve ASRH,
This paper reports on a project that aimed to improve the levels of HIV governance at the district level in Malawi and Zambia by encouraging public participation in an effort to more effective use of local resources. The methodology for this project included a barometer which assessed perceptions among key stakeholders on effectiveness, efficiency, rule of law, accountability, participation and equity at district level. The stakeholders ranged from administrators, political representatives, community-based organisations and the private sector on the supply side and citizens on the demand or beneficiary side. Communication and transparency appear to be major issues underpinning the bottlenecks and shortcomings in the HIV sector governance at the district level. Information gaps have given rise to accountability deficits and coordination deficiencies. Addressing these matters would make more effective use of resources and lessen dependence on external funding sources.