The May 2010 adoption of the World Health Organization Global Code of Practice on the International Recruitment of Health Personnel created a global architecture, including ethical norms and institutional and legal arrangements, to guide international cooperation and serve as a platform for continuing dialogue on the critical problem of health worker migration. Highlighting the contribution of non-binding instruments to global health governance, this article describes the Code negotiation process from its early stages to the formal adoption of the final text of the Code. Detailed are the vigorous negotiations amongst key stakeholders, including the active role of non-governmental organizations. The article emphasizes the importance of political leadership, appropriate sequencing, and support for capacity building of developing countries¹ negotiating skills to successful global health negotiations. It also reflects on how the dynamics of the Code negotiation process is evidence of an evolution in global health negotiations amongst the WHO Secretariat, civil society, and WHO Member States.
Governance and participation in health
The authors of this study evaluated community-based education and service (COBES) programmes at Makerere University College, Uganda, from a community perspective. A stratified random sample of eleven COBES sites was selected to examine the community’s perception of the programmes. Key informant interviews were held with 11 site tutors and 33 community members. Communities reported that the university students consistently engaged with them with culturally appropriate behavior and rated the student’s communication as very good even though translators were frequently needed. They also reported positive changes in health and health-seeking behaviours but remarked that some programmes were not financially sustainable. The major challenges from the community included community fatigue, and poor motivation of community leaders to continue to take in students without any form of compensation.
Led by the slogan ‘People First, Not Finance’, the People’s Forum held in November raised that the G20’s ‘cosmetic’ economic solutions to the global recession in 2008 would do little to ease the cyclical problems of the financial system, adding that much deeper, structural changes were required to address global inequity. It argued that the G20 will only increase the ‘financialisation’ of this world, instead of fundamentally changing it. The forum raised that social movements ranging from the ‘Occupy’ protests in Wall Street in the United States to the ongoing demonstrations in Tahrir Square need to ‘coordinate, exchange views' towards this deeper structural change.
Globally, increasingly vigilant and vocal civil society groups - important actors in the new multilateralism - are demanding openness, transparency and citizen participation in the discourse and practice of governance, which includes the right to information. This movement is facilitated by new technologies in the form of social media platforms like Twitter and Facebook and sources like Wikileaks. A new generation of technology-enabled applications and innovations for open government is also being developed in the South. Numerous examples are emerging including the use of mobile phones, SMS (short message service) technologies and web-based platforms for providing feedback on services, reporting on corruption, and accessing services. For example, Global Voices, a virtual organization of bloggers, tracks and shares many of the more innovative applications, emerging in both middle-income and poorer countries. Although the impetus for openness comes from civil society, open government is, at its core, an enterprise of government transformation, the author of this article argues. The author believes that, eventually, citizens will be able to participate actively in the governance ecosystem, but only if governments create the right enabling environment for transparency through appropriate policies and disclosure rules for making information available, and if it creates the kinds of processes that enable citizens to participate in policy making.
This Declaration of Commitment by Speakers of Parliament is based on the resolution to the Speakers from the fifth Session of the Second Pan African Parliament held on 3-14 October 2011, in Midrand, Johannesburg, South Africa, urging speakers of Parliament in the continent to prioritise the implementation of Maternal, Newborn and Child Health programmes with country reports on actions taken. The commitment promises high-level parliamentary support to hasten implementation of the Africa Parliamentary Policy and Budget Action Plan on Maternal, Newborn and Child Health, agreed by Chairs of Finance and Budget committees of national parliaments in October 2010.
According to this article, the recent G20 summit in France and the Commonwealth Heads of Government Meeting in Australia were both noteworthy for the continuing lack of substantive action on financial sector reform, climate negotiations, trade and the reform of international institutions. And the prognoses for the Fourth High Level Forum on Aid Effectiveness in South Korea and the 17th Conference of the Parties (COP17) to the United Nations Framework Convention on Climate Change (UNFCCC) in South Africa - scheduled for November 2011 - suggest more of the same will follow. The author argues that COP-17, originally billed as the People’s COP and the African COP, now appears unlikely to live up to either label. Nor, according to the author, does it appear likely that disagreements on the design of the new Green Climate Fund or on a second commitment phase for the Kyoto Protocol will be resolved in time for the conference. What will it take to break the deadlocks and spur leadership capable of responding to the crises, current and impending? As the 2011 movements in the Middle East and North Africa demonstrated, it is argued that civil society needs to challenge the legitimacy of the institutions charged with global governance and demand their radical overhaul or replacement.
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.
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.