After a series of multi-million-dollar scandals recently unearthed in Kenya, the Auditor General’s report for 2015 says only 1% of the national budget was properly accounted for. In this letter, civil society organisations (CSOs) in Kenya express deep concern and consternation for the worrying escalation of corruption scandals in Kenya in the recent past with little or no consequences for perpetrators, many of whom are reported by the author to have been heavily mentioned in a series of scandals and continue to unashamedly occupy, and therefore bring dishonour, to public office. The CSOs rebuke what they cite as the culture of impunity that continues owing to an apparent lack of political will to address corruption. They make 14 demands to the president and government including the immediate sacking of state and public officers within the Executive adversely mentioned in corruption scandals, initiating legal process of freezing of bank accounts of all those implicated in grand corruption scandals pending investigations, instantaneously stopping and recovering salaries paid illegally to officers who have been suspended or removed from public service on graft allegations
Governance and participation in health
As special-interest associations, community-based organisations fill an institutional vacuum, providing basic services to ensure a robust response to crises of poverty. It is at this local level that people, however limited their incomes or their assets, tend to reveal their true wealth: the ingenuity that they need to solve their own problems and those of their communities. Community based organisations (CBOs) are locally based membership organisations that work to provide services to their own communities. They have emerged in response to the need for collective social action. Their main characteristic is the importance that they attach to self-help, based on the principle of traditional communal values, reciprocity and interdependence. The author argues that CBOs can serve as a channel through which African governments can facilitate development at the grassroots level. While the CBOs need capacity-building to strengthen their skills in areas such as bookkeeping and accounts, experience indicates that the related needs assessments should be carried out jointly with communities. Examples show considerable grassroots enthusiasm for decentralisation within communities that can be mobilised by winning the confidence and trust of local and traditional communities and their leaders. CBOs are argued to provide the basis for a bottom-up approach in the fight against social exclusion and in national decision-making.
This paper aims at contributing to the debate on ways in which actors in development cooperation such as international NGOs or bilateral agencies could engage in a relevant, legitimate and effective way to achieving universal access to health. MMI identify that relevant, legitimate and effective health cooperation contributes to achieving universal access to health and is fully aware of its structural role, responsibilities and limitations; and continuously reflects on how to improve its approaches and practices. MMI argue that there is still a lack of platforms in which actors in health cooperation can critically reflect their own practices and approaches, share information and experiences, learn from each other and have an opportunity to further develop their institutional and personal skills and practices. They also suggest that a paradigm shift is required that breaks with the continuum process of development cooperation for health as it has been conducted during the last 50 years.
The author observes that the role and reach of the World Health Organisation has been contested since it was created in 1948. The debate is commonly couched in terms of whether the organisation is ‘fit for purpose’ although whose purpose is not always made clear. There have been several attempts at WHO reform since its establishment, directed to making it fitter for a still contested purpose. The current round of ‘WHO reform’ was launched in 2010 following a budget crisis and it continues as the new director‐general settles into the job. The current reform program addresses: funds mobilisation, budgeting, evaluation, relationships with non‐state actors, relationships within the secretariat (between headquarters, the regions and the country offices), WHO’s role in global health governance, the emergency program and the management of the WHO’s staff. The capacity, effectiveness and accountability of WHO is critical to the project of equitable health development globally. Nevertheless, there have been shortfalls. The root causes of WHO’s disabilities are argued to include the freeze on WHO revenues, the dysfunctions associated with WHO’s highly decentralised organisational structure, and the lack of accountability of member states for their contribution to WHO decision making and their implementation of WHO resolutions. In this paper the author reviews the evolution of the current reform program and some of the major elements of the reform, with the shortfalls, disabilities and reform options within the broader context of global health governance. The author argues that the reform of WHO, to realise the vision of its Constitution, will require a global mobilisation around the democratisation of global health governance.
Maternal and child health issues have gained global political attention and resources in the past 10 years, due in part to their prominence on the Millennium Development Goal agenda and the use of evidence-based advocacy by policy networks. This paper identifies key factors for this achievement, and raises questions about prospective challenges for sustaining attention in the transition to the post-2015 Sustainable Development Goals, far broader in scope than the Millennium Development Goals. The paper uses participant observation methods and document analysis to develop a case study of the behaviours of global maternal and child health advocacy networks during 2005–2015. The development of coordinated networks of heterogeneous actors facilitated the rise in attention to maternal and child health during the past 10 years. The strategic use of epidemiological and economic evidence by these networks enabled policy attention and promoted network cohesion. The time-bound opportunity of reaching the 2015 Millennium Development Goals created a window of opportunity for joint action. As the new post-2015 goals emerge, networks seek to sustain attention by repositioning their framing of issues, network structures, and external alliances, including with networks that lay both inside and outside of the health domain. Issues rise on global policy agendas because of how ideas are constructed, portrayed and positioned by actors within given contexts. Policy networks play a critical role by uniting stakeholders to promote persuasive ideas about policy problems and solutions. The author argues that the behaviours of networks in issue-framing, member-alignment, and strategic outreach can force open windows of opportunity for political attention -- or prevent them from closing.
In a penetrating analysis of events in South Africa, Jonathan Grossman writes a linked analysis of the student mobilisations and of the workers at Marikana. The author that an old legacy of struggle is being rediscovered and rescued, reflecting a solidarity between workers and students taking action. Grossman argues that the struggle for free education and against outsourcing in the public sector at the universities now needs to become the struggle for free education at all levels and free basic services, against outsourcing and for a living wage across the whole of the public sector. He argues that this is necessary for the renewal of the workers movement to tap into the vitality of a student-worker alliance that enriches both struggles in South Africa with a more holistic vision.
Progress in analysing the instrumental view of governance as an engine for growth, poverty reduction, and inclusive development has been held back by the difficulty in framing governance. This essay seeks to address this problem by 1) reframing urban governance 2) evaluating its aims, processes, and outcomes, and 3) explaining those outcomes on the basis of which some lessons are teased out. Using examples from Africa and an institutional political economy approach the author argues that, overall, while urban economies are growing; both urban poverty and inequality levels have risen substantially. Urban governance has paved the way for new forms of urban development that only benefit the few, including in how differences in how urban services and resources are experienced, accessed, and controlled. The author argues that the underlying reasons for this disjuncture between “urban governance” in theory and “actually existing urban governance” are 1) difficulties in implementing urban governance theory consistently in practice, 2) problems arising because urban governance theory has been implemented in practice, 3) tensions that would entangle most policies which do not address historical and structural economic issues, 4) restrictive assumptions, and 5) incoherence among the different dimensions of urban governance. To resolve these contradictions, the author puts the case for major structural and institutional change involving: 1) the re-ordering of the roles of the state, market, and society as institutions of change; 2) re-working the relationships that bind together land, labour, capital, and the state, and 3) re-organising the channels for keeping the attainment of the ends of urban governance in check.
African Speakers of Parliaments and Presidents of Senate have unanimously adopted a landmark resolution on a Declaration of Commitment to prioritise parliamentary support for increased policy and budget action on Maternal, Newborn and Child Health in African countries. The milestone Declaration of Commitment was adopted at the 3rd Pan African Speakers Conference 17th – 18th October 2011, in Midrand, Johannesburg, South Africa. In the communiqué issued at the end of the conference, the speakers committed to “prioritise policy and budget support for implementation of African Union Summit Decisions, in particular the … Kampala July 2010 Summit Declaration on the Summit theme of “Actions on Maternal, Newborn and Child Health Development in Africa”. The Commitment was the first of its kind by African Speakers of Parliament, and marks a significant milestone in accelerating progress in Africa towards the attainment of the Millennium Development Goals (MDGs) 4 and 5 on Child and Maternal Health, respectively. It also 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.
Government of Botswana partners with two international organisations: U.S. Centers for Disease Control and Prevention and Africa Comprehensive HIV/AIDS Partnership to implement Voluntary Medical Male Circumcision with the target of circumcising 80 % of HIV negative men in 5 years. This paper uses a systems model to establish how the functioning of the partnership on Safe Male Circumcision in Botswana contributed to the outcome. Data were collected using observations, focus group discussions and interviews. Thirty participants representing all three partners were observed in a 3-day meeting; followed by three rounds of in-depth interviews with five selected leading officers over 2 years and three focus group discussions. Financial resources, “ownership” and the target were found to influence the success or failure of partnerships. A combination of inputs by partners brought progress towards achieving set program goals. Although there were tensions between partners, they worked together in strategising to address some challenges of the partnership and implementation. The authors found that pressure to meet the expectations of the international funders caused tension and challenges between the in-country partners to the extent of Development Partners retreating and not pursuing the mission further. Target achievement, the link between financial contribution and ownership expectations caused antagonistic outcomes.
Members of the Kenya Parliament, specifically women, have expressed the need to close the evidence gap currently curtailing effective legislation and policy formulation. Speaking at a workshop organised by African Institute for Development Policy (AFIDEP) and the Parliamentary Caucus on Evidence-Informed Decision-Making (PC-EIDM), the Members of Parliament (MPs) acknowledged the critical role evidence plays towards enhancing their effectiveness in legislation, representation and policy-making. The workshop, which specifically targeted members of the Kenya Women Parliamentary Association (KEWOPA), provided an excellent opportunity for the women Parliamentarians to speak out on the challenges they are grappling with as legislators. Hon Naisula Lesuuda, a nominated Senator, Samburu County and the Deputy Chairperson of KEWOPA in the Senate, said that through the Association, women in Parliament play a critical role since KEWOPA’s mandate is to ensure that policies are gender-responsive, and that programmes related to women’s affairs get adequate resource allocation. Evidence is therefore of essence as the Association needs to ensure that its recommendations are evidence-informed. The MPs expressed their desire to use evidence to debate policy issues but the evidence is not readily available. There were also calls to digitise all data in the custody of various government ministries and to have it uploaded to an online portal to enhance its accessibility by Parliamentarians when need arises. In addition, the MPs noted that they would have achieved more during their current tenure had relevant evidence on pressing socio-economic challenges in their areas of jurisdiction been presented immediately they took over office. In a bid to identify strategies to enhance evidence use in Parliament, the members called attention to the need for the training of research and personal assistants.