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.
Governance and participation in health
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.
As the centre of global geo-politics continues to shift, much attention is being focused on the BRICS (Brazil, Russia, India, China, South Africa) group of emerging economies and the IBSA (India, Brazil and South Africa) group of emerging democracies as their power in global political and economic affairs has increased substantially, the author notes in this article. He calls attention to the implications of the growing power of BRICS and IBSA countries both individually and collectively for global civil society and development cooperation. From civil society’s point of view, concerns have been raised about the fact that while aid is offered to other developing countries by BRICS countries, there is an overall lack of information about the basis on which aid is given by them. Civil society is notably absent from BRICS meetings and summits. Additionally, there is the question of BRICS countries’ limited participation in ongoing multi-lateral processes to ensure harmonisation and transparency of aid. Traditionally, external funder countries have been involved in multiple processes and discussions to reduce aid overlap, faulty prioritisation and wastage. The author recommends greater south-south cooperation led by the democratic trio of IBSA countries. Their civil societies are active and also well placed to connect with their peers in the developing world to promote sustainable development underpinned by democratic values. But this will require some key foreign policy shifts for which civil society needs to lobby hard.
In sub-Saharan Africa media coverage of reproductive health issues is poor due to the weak capacity and motivation for reporting these issues by media practitioners, the authors of this paper argue. They describe the experiences of the African Population and Health Research Centre and its partners in cultivating the interest and building the capacity of the media in evidence-based reporting of reproductive health issues in sub-Saharan Africa. The authors note that the Research Centre’s media strategy evolved over the years, including: enhancing journalists’ interest in and motivation for reporting on reproductive health issues through training and competitive grants for outstanding reporting; building the capacity of journalists to report reproductive health research and the capacity of reproductive health researchers to communicate their research to media through training for both parties and providing technical assistance to journalists in obtaining and interpreting evidence; and establishing and maintaining trust and mutual relationships between journalists and researchers through regular informal meetings between journalists and researchers, organising field visits for journalists, and building formal partnerships with professional media associations and individual journalists. The authors conclude that a sustained mix of strategies that motivate, strengthen capacity of, and build relationships between journalists and researchers can be effective in enhancing quality and quantity of media coverage of research.
Kenyan President, Mwai Kibaki, has assured members of the African Peer Review Mechanism (APRM) that his government is committed to undertaking far-reaching reforms in the management of public affairs and entrenchment in constitutionality. President Kibaki affirmed that Kenya’s process of reforming governance would continue and urged the APRM team to share their experiences, particularly positive developments realised in other parts of the world that would be of value to Kenya and other African nations. Prime Minister, Raila Odinga, noted that Kenya was a pioneer in the review mechanism and was keen to evaluate the status of the country’s governance and explore ways of improving weak areas. He added that Kenya was open to scrutiny by peers and looked forward to a full examination and recommendations for appropriate remedy for various challenges facing the nation and its people.
This paper reports the findings of an atypical systematic review of 60 years of literature in order to arrive at a more comprehensive awareness of the constructs of participation for communicable disease control and elimination and provide guidance for the current malaria elimination campaign. Of the 60 papers meeting the selection criteria, only four studies attempted to determine the effect of community participation on disease transmission. The studies showed statistically significant reductions in disease incidence or prevalence using various forms of community participation. The use of locally selected volunteers provided with adequate training, supervision and resources is crucial to the success of the interventions in these studies, the authors argue. After a qualitative synthesis of all 60 papers, they elucidate the complex architecture of community participation for communicable disease control and elimination. The authors stress the importance of ensuring that current global malaria elimination efforts do not derail renewed momentum towards the comprehensive primary health care approach. They recommend that the application of the results of this systematic review be considered for other diseases of poverty in order to harmonise efforts at building 'competent communities' for communicable disease control and optimising health system effectiveness.
The authors of this article argue that governments need to provide civil society organisations with more space and recognition to facilitate a stronger health response with a particular focus on tuberculosis (TB) prevention, care and control. They call on the World health Organisation (WHO) and its international partners to play a brokering and facilitative role to catalyse the process, and they provide a contextual framework to achieve this in the article. In many countries, civil society organisations have been responsible for handling the majority of resources to deliver services to individuals and have played a leading role in developing and implementing sustainable strategies to mitigate the impact of HIV and AIDS. In contrast, TB prevention, care and control activities face numerous challenges. A major problem is that one in three estimated TB cases globally is either not formally reported in the public system or not reached at all by existing services. TB is rarely recognised as a priority by national political authorities, United Nations agencies, development banks, the pharmaceutical industry and philanthropic organisations and often neglected within development, human rights and social justice agendas. Despite some efforts to engage civil society organisations in global TB activities, in many countries they still lack recognition as legitimate partners at national and local level even in established democracies.
Amid discussion of how global health governance should and could be strengthened, the potential role of civil society organisations has been frequently raised. In this paper, the author considers the role of civil society organisations (CSOs) in four health governance instruments under the auspices of the World Health Organisation – the International Code on the Marketing of Breastmilk Substitutes, Framework Convention on Tobacco Control, International Health Regulations and Codex Alimentarius. She draws several conclusions about CSO engagement for strengthening global health governance (GHG). First, CSOs have played the biggest roles in initiating, formulating and implementing formal rules in GHG. Second, CSOs cannot perform certain functions, which should be fulfilled by the state to ensure GHG instruments are effective, such as formal mechanisms for monitoring and enforcement by government institutions, with punitive measures for non-compliance embodied in national legislation. Third, GHG remains far from pluralist in a true sense. The case studies suggest that, like global governance as a whole, GHG is being characterised by greater, rather than lesser, concentration of power in fewer hands. CSOs can bring much-needed diversity to the GHG landscape.
Between 2007 and April 2011, 35 governments across Africa have either passed or are about to pass legislation restricting activities and the existence of civil society organisations (CSOs), according to this review. The trend is even more troublesome, the African Civil Society Platform on Principled Partnership (ACPPP) argues, when one considers that, in about 20 of these cases, the laws are similar in content. What began as a genuine call for mutual accountability and harmonisation of development effort between external funders, governments and CSOs has turned into a wave of legislation and policies targeting CSOs that do not appear to conform to government choices. The review draws from over 17 studies conducted between 2008-2011, discussions with CSOs from 30 countries across Africa, and review of work of several CSOs in conflict prevention and peace building. The ACPPP argues that neither the Paris Principles nor the CSO Principles for Development Effectiveness will be sufficient to deal with the current wave of legislation limiting CSOs. In seeking to reverse this trend, ACPPP proposes that the problem of shrinking space for civil society participation be addressed in its broader perspective, and not just as a violation of human rights, freedom of association or of CSO regulation. The attack on CSOs is about control of power and not regulation. This calls for support for democracy and good governance as drivers of development, the authors argue, particularly in situations of conflict and fragility.