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.
Governance and participation in health
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.
Anti-tobacco mass media campaigns have had good success at changing knowledge, attitudes, and behaviors with respect to smoking in high-income countries provided they are sustained. Mass media campaigns should be a critical component of tobacco control programs in low- and lower-middle-income countries, the authors of this article argue. Mounting evidence shows that graphic campaigns and those that evoke negative emotions run over long periods of time have achieved the most influence. These types of campaigns are now being implemented in low- and middle-income countries. The authors provide three case studies of first-ever graphic warning mass media campaigns in China, India, and Russia, three priority high-burden countries in the global Bloomberg Initiative to Reduce Tobacco Use. In each of these countries, message testing of core messages provided confidence in messages, and evaluations demonstrated message uptake. The authors argue that given the initial success of these campaigns, governments in low- and middle-income countries should consider resourcing and sustaining these interventions as key components of their tobacco control strategies and programmes.
In this interview with Gino Govender, who recently joined Amnesty International’s International Mobilisation team, Govender reveals that Amnesty International has decided to grow in the global south and move closer to the communities and rights holders with whom the human rights organisation works. One of the outcomes of an extensive consultative process is the development of an Africa Growth Strategy, which involves the creation of three regional offices, one of which will be located in and responsible for Southern Africa. With regard to the current state of civil society in the Southern African Development Community (SADC) region and in South Africa in particular, Govender is optimistic, arguing that, regionally, civil society is undergoing an important stage of evolution. However, within SADC there are important political, social and economic challenges still to be confronted if the vision of a people-centred regional community that is thriving on the values of solidarity, social justice, equality, dignity, freedom, democracy and production that meets basic human needs are to be realised. He points to a general consensus on the need for a strong and effective civil society in the region and argues that collective leadership united under a common vision for the region is the key. The future for civil society in the region lies in a blend between historically vital sectors that have a wealth of organisational knowledge and experience - like the labour movement, faith-based organisations, womens’ organisations and intellectuals – and newly established organisations that are dedicated to a single campaign.
In this paper, the authors examine the potential role of civil society action in increasing state accountability for development in Sub-Saharan Africa. They build on the analytical framework of the World Development Report 2004 on accountability relationships, to emphasise the underlying political economy drivers of accountability and implications for how civil society is constituted and functions. The main argument is that the most important domain for improving accountability is through the political relations between citizens, civil society and state leadership. The evidence broadly suggests that when higher-level political leadership provides sufficient or appropriate powers for citizen participation in holding within-state agencies or frontline providers accountable, there is frequently positive impact on outcomes. However, the big question remaining for such types of interventions is how to improve the incentives of higher-level leadership to pursue appropriate policy design and implementation. The paper concludes that there is substantial scope for greater efforts in this domain, including through the support of external aid agencies. Such efforts and support should, however, build on existing political and civil society structures (rather than transplanting ‘best practice’ initiatives from elsewhere), and be structured for careful monitoring and assessment of impact.