In this study, researchers investigated use and understanding of nutrition labels on food packages among urban and rural consumers in Lilongwe, Malawi. They also examined the effect of socio-demographic factors and nutrition knowledge on use of nutrition labels. The researchers surveyed 206 consumers, approached randomly after they checked out at grocery stores. Shop managers and owners gave their consent to conduct the study outside the shops to avoid affecting customer behaviour and revenues. A pre-tested questionnaire was used to collect data for analysis and interpretation. The findings show that self-reported use and understanding of nutrition labels were low, suggesting much lower use and comprehension in real-life retail environments. Urban, educated and female consumers were more likely to read nutrition panels when purchasing food. Nutrition labels were seen as important, particularly when purchasing a product for the first time and when considering buying certain products. In terms of nutrition knowledge, rural consumers were as knowledgeable as urban consumers, but they were less likely to connect their knowledge to emerging non-communicable diseases. The researchers caution that the study had some limitations: for example, they surveyed a small sample of shoppers drawn from one geographical area, therefore their findings are not conclusive. Objective, cross-sectional and longitudinal investigations in future would improve understanding of actual consumer behaviour in retail shops and homes in Malawi, the researchers argue. As this study is the first of its kind in Malawi, it is intended to provide baseline information useful to the healthcare professionals, the government, the food industry and consumers.
Governance and participation in health
The World Health Organisation (WHO) Director-General’s proposal for reform of WHO has sparked controversy among WHO Member States, resulting in a meeting of the Executive Board (EB) convened on 1-3 November 2011. Member States expressed concern over the speed of the reform process; lack of information, analyses and independent evaluation to guide the reform; WHO's donor-driven approach and growing partnerships; the scope of independent evaluation; and proposals to limit WHO's scope. The EB meeting decided to establish a process for priority-setting of WHO's programme activities as part of the reform agenda, advocating a Member-driven process for priority-setting of the WHO programme, urging the Director-General not to be too hasty in pushing for the reforms until proper consultation with Member States had been made.
The author of this article argues that, in Africa, some governments have dodged their responsibility to implement famine-prevention measures because they require a socio-political contract between the government and civil society that allows citizens to hold governments accountable for famine. Instead, through their inaction and acceptance of foreign aid, governments have ceded that responsibility to non-government organisations (NGOs) and ‘foreign technical experts’ with a narrower definition of social responsibility and far less vested interest in the well-being of citizens. In the last sixty years, well over a trillion dollars of ‘development aid’ has been transferred from the West to African nations, but the author cautions that this aid comes at a cost: donor dependency, corruption and lack of incentive for governments to govern well and efficiently. In fact, NGOs may well be in competition with African governments as they provide goods and services that the governments do not. As NGOs step in and fill the gaps with their foreign-funded resources and growing presence and capacities, the legitimacy of aid-recipient states is called into question. Arguably, the legitimacy crisis of NGOs is in tandem with the legitimacy crisis of African governments. Because the provision of public goods and resources is part of the socio-political contract between the government and civil society, NGOs do risk undermining the legitimacy of the government. On the flip side, the legitimacy of foreign-funded NGOs comes under question when the interests of their international and surpranational funders conflict with national interests.
This report draws on the results of the 2011 Survey on Monitoring the Paris Declaration, building on similar surveys undertaken in 2006 and 2008. A total of 78 countries and territories volunteered to participate in the final round of surveys, which look at the state of play in 2010. The results indicate that, at the global level, only one out of the 13 targets established for 2010 – co-ordinated technical co-operation (a measure of the extent to which external funders co-ordinate their efforts to support countries’ capacity development objectives) – has been met, albeit by a narrow margin. Nonetheless, it is important to note that considerable progress has been made towards many of the remaining 12 targets. Globally, the survey results show much variation in the direction and pace of progress across external funders and partner countries since 2005. For the indicators where responsibility for change lies primarily with developing country governments, progress has been significant. For example, improvements have been made in the quality of tools and systems for planning and for financial and results management in a number of developing countries, often requiring deep reforms that go beyond aid management to broader aspects of government processes.
Representatives of over seventy national, regional and global civil society organisations met at the CIVICUS World Assembly held in Montreal, Canada, on 11 September 2011. A number of key points arose from the meeting including the need for civil society leadership to frame the discussion and guide the process on the post-2015 global agenda, and the need for a new global vision for the people and the planet that is radical, ambitious and universal. The vision should be strongly rooted in and use International Human Rights instruments as the basis for accountability, and should also be universal in its application across the north and the south and address the redistribution of wealth. It should empower communities on the ground to claim their entitlements and should aim at equity, with explicit commitments towards women and traditionally excluded groups. Furthermore, the vision should be holistic and address the issues of human rights, inequality, gender justice and environmental sustainability. Participants at the Assembly called on the United Nations (as opposed to other global fora such as the G20) to lead the process, with the UN Secretary General providing personal leadership on the post-2015 agenda. Until the end of 2015, civil society will aim to work together to develop a unifying, coherent global agenda and take action to influence the positions of national governments and the UN, participants concluded.
Corruption is eroding the benefits of good health projects in Africa and governments must look inwards for funding, the World Health Organisation (WHO), has said. In a meeting with African Ministers of Health and Ministers of Finance on 30 August 2011 in Yamoussoukro, Cote d’Ivoire, WHO said solving the problem of funding was necessary for the health sector to thrive in the continent. Director-General of WHO, Margaret Chan, said proper harnessing and utilisation of resources would reduce the dependence on external funders for sponsoring health projects. Chan said the inclusion of these funders in health budgets posed challenges as most of them would weigh options and zero in on areas of interest and priority, which did not necessarily align with government objectives. She said most external funders gave little notice before shifting their targets, thereby creating huge gaps for funding in the countries. She added that ‘health care has to be regulated so that the private sector provides good services without ripping the people off,’ emphasising that health care projects must not be built only on the principle of attracting funds from politicians, but on principles of effectiveness and sustainability.
The current financial crisis in Swaziland is so severe that aid agencies are predicting that in the absence of major new loan, a humanitarian crisis could develop within the next few months. Stocks of antiretrovirals have fallen dramatically, reportedly standing at one month's supply, despite Swaziland having the world's highest prevalence of HIV (26.1%), with 70% of the population below the poverty line. However the author reports that loans and other resources are not reaching those with greatest need, and that wide inequalities in wealth exist.
The Students’ Health Advocacy Project (SHAP) is a community outreach programme of HEPS-Uganda, a health consumers' organisation advocating for health rights and responsibilities that is also a member of the EQUINET network. SHAP targets schools in Rubaga Division to make the students aware of their health rights and responsibilities. This has been going on since 2010. So far, SHAP activities have been conducted in a few schools and for some schools a follow up has been made from the previous outreach made to them, specifically Bright Angels College. The new members of the health club in this school showed great interest in the activities carried out by SHAP and HEPS Uganda. The two organisations are currently refining the programme to make it more focused on raising students’ awareness of their basic health rights. The SHAP team is also working on expanding its activities to various schools in Rubaga and this has been effected through delivering letters so that dates can be scheduled for SHAP to take their presentations to the targeted schools.
There is a long history of advocacy to place non-communicable diseases higher on the global public health agenda. Although attempts have been made and action is well under way, there is still no co-ordinating mechanism that helps identify action, tracks progress, and stimulates multistakeholder collaboration while preventing duplication of efforts. The September 2011 United Nations High Level Meeting on Non-Communicable Diseases and the call by all parties for more efficient responses to the growing problems of non-communicable diseases presents a unique opportunity to create an institutional mechanism that incentivises coordination. The authors argue that an apex coordinating arrangement would allow efficient global information exchange, mapping existing gaps in action, and identifying and catalysing collaboration across sectors and regions of the world.
The Inaugural Conference of the Global Health Diplomacy Network was held on 28 June 2011 in London, United Kingdom. More than 190 diplomats, health professionals, senior government officials, academics, and representatives of business and non-governmental organisations gathered to discuss contemporary issues in global health diplomacy and outlooks for the future of the Network. After the presentations were held, the Network made a number of resolutions, concluding that the Network should help the health sector understand that the top priorities of foreign policy are national security and economic growth, not health. The health sector must not view the link between health and foreign policy as an opportunity to exploit the foreign policy sector to reach health goals. Instead, it must think how it can advance foreign policy goals and be aware and acknowledge that health policy can have a positive or negative impact on foreign policy and its goals, just as foreign policy can have positive or negative impacts on health. Participants acknowledged that much health diplomacy in Geneva focuses on trade and about intellectual property issues, while there is a wider lack of coherence across the different global institutions and their goals, a problem which has been exacerbated by the proliferation of global actors.