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.
Governance and participation in health
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.
Accountability in global health is a commonly invoked though less commonly questioned concept. Critically reflecting on the concept and how it is put into practice, this paper focuses on the who, what, how, and where of accountability, mapping its defining features and considering them with respect to real-world circumstances. Changing dynamics in global health cooperation - such as the emergence of new health public-private partnerships and the formal inclusion of non-state actors in policy making processes - provides the backdrop to this discussion. In mapping some defining features, accountability in global health cooperation is shown to be a complex problem not necessarily reducible to one set of actors holding another to account. Clear tensions are observed between multi-stakeholder participatory models and more traditional vertical models that prioritise accountability upwards to donors, both of which are embodied in initiatives like the Global Fund. For multi-constituency organisations, this poses challenges not only for future financing but also for future legitimacy.
Overweight and obesity prevalence is rapidly rising in developing countries. The reading and understanding of nutrition information on food packages has been shown to improve food choices and instill healthy eating habits in individuals. The aim of this study was to describe the prevalence of food label usage and understanding among urban and rural adults in Zimbabwe and its association with demographic and socio economic factors. A cross sectional study was conducted on 320 adults (147 urban and 173 rural) using a validated questionnaire. A high proportion (77%) of the respondents read food labels. Food label reading differed significantly by educational, employment status and locality. Only 41% of food label readers mostly understood the information on the food labels. More urban shoppers (86%) read food labels than their rural counterparts (67%). A significant number of participants (81%) indicated they would like to be educated on the meaning of food labels and 80% preferred the nutrition information on food labels to be simplified. The study found above average reported reading of nutrition information on food labels with partial understanding. The authors recommend that efforts be made to determine how all consumers could be made to understand the nutrition information on food labels and use it effectively in decision making.
The term “urban political describes a critical approach to studying cities across a number of areas, from environmental issues (such as climate change, air pollution, and nature conservation) to urban flows (such as sanitation and electricity provision). Many scholars believe that there is a need for a more explicitly political approach to these topics that draws attention to who wins and who loses as cities change, as well as to how urbanization as a process is shaped by power relations. These ideas informed the Urban Political Ecology in African Cities Workshop, Pretoria South Africa held in September 2014, organized by the Situated Ecologies collective (SUPE). The report presents discussions on options for scholars and residents in cities of Africa and the global South to integrate power relations in their work on urban change.