In Zambia, as in other low-income countries, maternal health indicators have remained stubbornly resistant to improvement. This intervention involved revitalizing Safe Motherhood Action Groups to raise awareness of the need to prepare for pregnancy complications and delivery. The main aim was to improve both understanding of maternal health and access to maternal health-care services. The approach was predicated on the assumption that women require not only knowledge about when they should seek skilled help but also their husbands’ approval for care seeking, which can be encouraged by community leaders. The authors adopted a quasi-experimental approach to evaluating the effect of a complex community-based intervention that was devised to reduce barriers to the use of maternal health-care services and to increase deliveries involving a skilled birth attendant. The intervention was novel because it involved the whole community and emphasized social approval and its ability to bring about changes in behaviour. The intervention was associated with significant improvements in women’s knowledge of when they should receive antenatal care and of obstetric dangers signs, in the use of emergency transport, in deliveries involving a skilled birth attendant and in the use of modern contraception. However, the increase in the proportion of women who received four or more antenatal care visits and in those who received postnatal care within 6 days was not significant.
Governance and participation in health
134th session of the WHO's Executive Board 20-25 January 2014. The watching team in association with a number of PHM affiliate networks have published an 'Open Letter' to the delegates of the members of the Executive Board. The commentary includes analysis and comments on each of the items on the meeting's agenda.
A group of United Nations Special Rapporteurs today urged the Government of Kenya to reject legislation that would impose severe restrictions on civil society. “The Bill is an evidence of a growing trend in Africa and elsewhere, whereby governments are trying to exert more control over independent groups using so-called ‘NGO laws,’” the human rights experts warned. The Bill, which was presented to Parliament on 30 October, would amend Kenya’s Public Benefit Organization Act of 2012 and grant the Government sweeping powers to deny registration for such organizations, including non government organisations. It would also cap foreign funding at 15% of their total budgets and channel all their funding through a government body, rather than going directly to beneficiary organizations.
The spread and perpetuation of the HIV/AIDS epidemic in South Africa has hindered the country’s social and economic growth after apartheid. This paper documents experiences of interactions with the Treatment Action Campaign (TAC), an organization which has taken a multidimensional approach in order to educate people about HIV/AIDS and to provide access to medicines. It reports how TAC has used both traditional and non-traditional methods of advocacy to combat the epidemic and equate access to health care to a social justice issue by empowering marginalized communities. The author uses three dimensions of lawyering and equates TAC to a single cause lawyer, signifying that multi-dimensional activism is not limited to individuals, but can also be applied at the firm level. The three dimensions include: (a) advocacy through litigation, (b) advocacy in stimulating progressive change, and (c) advocacy as a pedagogic process. He suggests that TAC’s multi-dimensional approach and its inherent practice of the three dimensions has contributed to its success and may be useful for other processes.
The field of transparency is packed with vocabulary that suggests opposition or conflict, with labels that imply, somehow, that the watchers are above the watched, like white knights fighting the dark forces of development aid, the corrupt and incompetent. However collaboration between watched and watchers may also offers a better chance of generating positive change, by understanding the political context of the activities being monitored, targeting the right people, in a non-threatening way, offering solutions as much as identifying problems. In other words, being a successful ‘watchdog’ is argued to be all about knowing how to approach different people in different circumstances to achieve mutually beneficial goals. This article explores how to build the demand side of aid transparency. It raises that beyond accessing relevant, timely and accurate data, is to learn to make use of it in a strategic way, with a constructive mind, taking into consideration local political dynamics, and the reality and psychology of the people whose performance one aims to monitor and improve.
Talking to French magazine Esprit, theorist Achille Mbembe discusses a postcolonial thinking that has developed in a transnational, eclectic vein, enabling a specific take on globalization. He outlines three cardinal moments in the development of postcolonial thought. The first, of anti-colonial struggles, included the self-reflection by people of their colonization and debates on the relationship between class and race as factors. The discourse centred on the politics of autonomy, to acquire citizen status and, thereby, to participate in the universal. The second moment, around the 1980s, he outlines as the moment of "high theory", with new thinking on knowledge about modernity. This understood the colonial project beyond its military-economic system, to one that was underpinned by a discursive infrastructure and a whole apparatus of knowledge the violence of which was as much epistemic as it was physical. The second post colopnial discourse sought to recover the voices and capabilities of decolonization's rejects (peasants, women, underprivileged people) and to better understand why the anti-colonial struggle led not to a radical transformation of society. Mbembe argues also argues that it sought to expose the procedures by which individuals are subjugated to categories of race and class that block access to the status of subject in history. In the third moment, Mbembe argues that globalisation has, as for colonial capitalism, subjugated living spheres to economic appropriation, and that the "colony" was in fact a laboratory for the wider authoritarian destiny of today’s globalisation. He proposes that in this context the reinvention of politics in postcolonial conditions first requires people to reinvent their place in history, not in a logic of repeating the same violence as vengeance, but in a demand for a justice that supports an "ascent in humanity“.
Abahlali baseMjondolo formed in 2005 has more than 12,000 members in more than 60 shack settlements. The organisation campaigns against evictions, and for public housing: struggling for a world in which human dignity comes before private profit, and land, cities, wealth and power are shared fairly. The article by the founder of Abahlali baseMjondolo expresses people's frustration with lack of delivery on rights to free housing, free education and free healthcare in urban South Africa, and the consequent resolve to take direct action to move rights from paper to reality, from abstract to concrete. While they acknowledge that this brings risk to their members, the author raises frustration with political and civil society processes, they also argue that they no choice but to take their own place in the cities and in the political life of the country.
This article poses reflections from two leads of Twaweza, an east African non government organisation, on their approaches and work, particularly in response to a series of blogs on this by D Green (Oxfam GB advisor. They reflect on learning on citizen action; and on the need to better articulate what is meant by citizen action, including private v public and individual v collective. "In essence, this is a move away from an unexplained “magic sauce” model where we feed some inputs (i.e. information) into a complex system, hope twaweza-logothat the (self-selecting, undifferentiated) citizens will stir it themselves, and voila – a big outcome (such as increased citizen monitoring of services, and improved service delivery) will somehow pop out on the other end".
This blog discusses issues and seven lessions raised by evaluations of the theory of change and first four years of work by an East African NGO, Twaweza. The author comments that research by groups like the Africa Power and Politics Programme and Matt Andrews argues that both demand side (build the citizens) and supply side (build the state) have failed in generating change. What works, they think, is collective problem solving, bringing together citizens, states and anyone else with skin in the game, to build trust and find solutions. People on the ground, like Goreti Nakabugo, Twaweza’s Uganda coordinator, get this: ‘we know we need buy-in from the government, officials, local politicians. We are brokering relationships with them on a daily basis’. Not only that, but in practice, even differentiating between citizen and state can be problematic – neither category is a monolith, and in some cases, the most active citizens are themselves state employees, members of public trade unions etc.
Research has shown that mHealth initiatives, or health programs enhanced by mobile phone technologies, can foster womens empowerment. Yet, there is growing concern that mobile-based programs geared towards women may exacerbate gender inequalities. A systematic literature review was conducted to examine the empirical evidence of changes in men and women?s interactions as a result of mHealth interventions. Out of the 173 articles retrieved for review, seven articles met the inclusion criteria and were retained in the final analysis. Most mHealth interventions were SMS-based and conducted in sub-Saharan Africa on topics relating to HIV/AIDS, sexual and reproductive health, health-based microenterprise, and non-communicable diseases. Several methodological limitations were identified among eligible quantitative and qualitative studies. The current literature suggests that mobile phone programs can influence gender relations in meaningfully positive ways by providing new modes for couples health communication and cooperation and by enabling greater male participation in health areas typically targeted towards women. MHealth initiatives also increased womens decision-making, social status, and access to health resources. However, programmatic experiences by design may inadvertently reinforce the digital divide, and perpetuate existing gender-based power imbalances. Domestic disputes and lack of spousal approval additionally hampered women?s participation. Efforts to scale-up health interventions enhanced by mobile technologies should consider the implementation and evaluation imperative of ensuring that mHealth programs transform rather than reinforce gender inequalities. The evidence base on the effect of mHealth interventions on gender relations is weak, and rigorous research is urgently needed.