The Ebola virus disease outbreak in West Africa was unprecedented in both its scale and impact. It drew renewed attention to global health security—its definition, meaning, and the practical implications for programmes and policy. For example, how does a government begin to strengthen its core public health capacities, as demanded by the International Health Regulations? What counts as a global health security concern? This paper describes some of the major threats to individual and collective human health, as well as the values and recommendations that should be considered to counteract such threats in the future. Many different perspectives are proposed but their common goal is a more sustainable and resilient society for human health and wellbeing.
Governance and participation in health
In the area of health, the Southern African Development Community (SADC) has conducted important work in understanding how poor health and poverty coincide, are mutually reinforcing, and socially-structured by gender, age, class, ethnicity and location, demonstrated by the key health policy documents that have been facilitated by the secretariat. Yet the time lapse between the formulation of guidelines and policies and their implementation has at times been uneven. This brief describes the Poverty Reduction and Regional Integration indicator-based monitoring system addressing health priorities for the region, under the institutional leadership of the SADC secretariat and with the support from its Member States that are the main beneficiaries of the process.
In this paper, the authors analyse regional to national-level data flows with the use of two case studies focusing on UNASUR (Bolivia and Paraguay) and SADC (Swaziland and Zambia). Special attention is given to pro-poor health policies, those health policies that contribute to the reduction of poverty and inequities. The results demonstrate that health data is shared at various levels. This takes place to a greater extent at the global-country and regional-country levels, and to a lesser extent at the regional-global levels. There is potential for greater interaction between the global and regional levels, considering the expertise and involvement of UNASUR and SADC in health. Information flows between regional and national bodies are limited and the quality and reliability of this data is constrained by individual Member States’ information systems. Having greater access to better data would greatly support Member States’ focus on addressing the social determinants of health and reducing poverty in their countries. This has important implications not only for countries but to inform regional policy development in other areas. By serving as a foundation for building indicator-based monitoring tools, improving health information systems at both regional and national levels can generate better informed policies that address poverty and access to health.
WHO Watch is an intervention in global health governance. It provides a current account of global policy dynamics in relation to a wide and growing range of health issues. The links enable local activists to keep in touch with the global policy movements which shape the context for such local struggles. They also help to ensure that policy analysis and policy advocacy at the regional and global levels is informed by the reality of grass roots activism, both in health systems and around the conditions which shape health. This link provides the WHO Watch notes from the World Health Assembly May 19-26 2015. It covers the discussions on 23 major items at the Assembly.
Meaningful accountability can shift power imbalances that prevent sustainable development for people living in poverty and marginalisation. Accountability consists of both the rights of citizens to make claims and demand a response, and the involvement of citizens in ensuring that related action is taken. However, for the poorest and most marginalised people accountability is often unattainable. They face multiple barriers in influencing social, political and economic decision-making processes and accessing the services they are entitled to. This briefing draws on research by the Participate initiative to highlight the key components necessary for processes of accountability to be meaningful for all.
Although there is a general agreement on the benefits of evidence informed health policy development given resource constraints especially in Low-Income Countries (LICs), the definition of what evidence is, and what evidence is suitable to guide decision-making is still unclear. The authors’ explored health policy actors’ views regarding what evidence they deemed appropriate to guide health policy development, with 51 key informants interviewed. Different stakeholders lay emphasis on different kinds of evidence. While external funders preferred international evidence and Ministry of Health officials looked to local evidence, district health managers preferred local evidence, evidence from routine monitoring and evaluation and reports from service providers. Service providers on the other hand preferred local evidence and routine monitoring and evaluation reports whilst researchers preferred systematic reviews and clinical trials. Although policy actors look for factual information, they also require evidence on context and implementation feasibility of a policy decision.
This resolution presents a Framework of Engagement with non-State actors to replace the Principles governing relations between the World Health Organization and nongovernmental organizations and Guidelines on interaction with commercial enterprises to achieve health outcomes;(1) to implement the Framework of Engagement with non-State actors; (2) to establish the register of non-State actors in time for the Sixty-ninth World Health Assembly; (3) to report on the implementation of the Framework of Engagement with non-State actors to the Executive Board at each of its January sessions under a standing agenda item, through the
Programme Budget and Administration Committee; (4) to conduct in 2018 an evaluation of the implementation of the Framework of Engagement
with non-State actors and its impact on the work of WHO with a view to submitting the results, together with any proposals for revisions of the Framework, to the Executive Board in January 2019,through the Programme Budget and Administration Committee.
In an initiative to promote the decentralizing of the health system, the government of Uganda through Ministry of Health called for an establishment of Health Unit Management Committees (HUMCs) at each government health facility as a way of empowering community members to participate in influencing health system for better service delivery. As part of an action research process, the Center for Health Human Rights and Development (CEHURD) carried out a case study on two HUMCs in Kikoolimbo health center III in Kyankwanzi district and Nyamiringa health center II Kiboga district. The purpose of this case study was to provide an understanding of the experiences of HUMCs in performing their roles and what role Civil Society can play to support them perform their roles and responsibilities as well as advancing health rights and addressing health inequities using the human rights based approach. The findings revealed that these two health unit management committees had limited knowledge of the HUMCs guidelines. The committee members were trained by CEHURD and community dialogues held to inform community members about the existence of these committees as well as their roles and responsibilities. The author noted that when communities are empowered, they can differentiate between performing and non-performing committees.
Mutual trust and respect, real commitment to collaboration and flexibility are all essential elements to be responsibly equipped to work with a marginalised community. And they are not even enough. The authors write in this paper about the experience of working with marginalised communities on using data and technology in advocacy as they think it could greatly help other practitioners planning to collaborate with groups struggling to get their rights honoured and their voices heard. The authors summarise advice emerging from the case study as to: listen to and learn from the community, keeping assumptions at bay; give ownership of the work to the community itself; build capacity tailored to its needs and abilities, accessibly and sustainably; provide people with the tools and methodologies that equip them to work independently on more successful initiatives in the future.
In Uganda, community services for febrile children are expanding from presumptive treatment of fever with anti-malarials through the home-based management of fever (HBMF) programme, to include treatment for malaria, diarrhoea and pneumonia through Integrated Community Case Management (ICCM). To understand the level of support available, and the capacity and motivation of community health workers to deliver these expanded services, the authors interviewed community medicine distributors (CMDs), who had been involved in the HBMF programme in Tororo district, shortly before ICCM was adopted. Between October 2009 and April 2010, 100 CMDs were recruited to participate by convenience sampling. The survey included questionnaires to gather information about the CMDs’ work experience and to assess knowledge of fever case management, and in-depth interviews to discuss experiences as CMDs including motivation, supervision and relationships with the community. CMDs faced multiple challenges including high patient load, limited knowledge and supervision, lack of compensation, limited drugs and supplies, and unrealistic expectations of community members. CMDs described being motivated to volunteer for altruistic reasons; however, the main benefits of their work appeared related to ‘becoming someone important’, with the potential for social mobility for self and family, including building relationships with health workers. At the time of the survey, over half of CMDs felt demotivated due to limited support from communities and the health system. Community health worker programmes rely on the support of communities and health systems to operate sustainably. When this support falls short, motivation of volunteers can wane. If community interventions, in increasingly complex forms, are to become the solution to improving access to primary health care, greater attention to what motivates individuals, and ways to strengthen health system support are required.