In Tanzania, the policy of decentralisation and the health sector reform have placed an emphasis on community participation in making decisions in health care. The objective of this study was to explore challenges to fair decision-making processes in health care services with a special focus on the potential influence of gender, wealth, ethnicity and education. study was carried out in the Mbarali District of Tanzania. A qualitative study design was used, with in-depth interviews and focus group discussions conducted among members of the district health team, local government officials, health care providers and community members. Informal discussion on the topics was also of substantial value. The study findings indicate differences in influence on health care decision-making processes in terms of gender, wealth, ethnicity and education, as men, wealthy individuals, members of strong ethnic groups and highly educated individuals had greater influence. Opinions varied among the study informants as to whether such differences should be considered fair. The differences in levels of influence emerged most clearly at the community level, and were largely perceived as legitimate. The authors conclude that these inequalities in decision making in health care need to be addressed if greater participation is desired. There must be an emphasis on the right of all individuals to participate in decision-making processes, and role players should ensure that information, training and education is fairly distributed so individuals can participate fully in informed decision making.
Governance and participation in health
After two decades of marketizing, an array of national and international actors have become concerned with growing global inequality, the failure to reduce the numbers of very poor people in the world, and a perceived global backlash against international economic institutions. The essays in this volume explore what forms a new politics of inclusion can take in low- and middle-income countries. The contributors favor a polity-centered approach that focuses on the political capacities of social and state actors to negotiate large-scale collective solutions and that highlights various possible strategies to lift large numbers of people out of poverty and political subordination.
China’s growing involvement in countries where peace is fragile brings new responsibilities and policy choices for Beijing, as well as a new reality for Western funders and policy makers, according to this brief. This increased involvement brings risks and opportunities for peace and stability in conflict-affected states, SAFERWORLD argues. The brief summarises the impacts of China’s growing economic, diplomatic and military engagement in conflict-affected states and analyses the implications for peacebuilding. The briefing also offers recommendations for policy makers in China and the West focused on fostering a culture of dialogue, bridging the current policy gap regarding conflict-affected states, and creating an enabling international architecture. A key conclusion is that as Beijing’s approach towards conflict-affected countries evolves, there is an unprecedented opportunity for China and the West to develop more complementary approaches in support of peace and equitable development.
In this article, the author analyses China’s trade and diplomatic relations with Africa in terms of Joseph Nye’s concept of soft power. He argues that examining China's Africa Policy, there is a motivation to change cultural perceptions about China and to influence agenda's through co-option rather than economic or military coercion. Although Chinese leaders often refer to the importance of its soft power in the world, China's policy for engagement with African countries does not mention soft power directly. Instead, it speaks in very general terms of mutual cooperation and win-win strategies. The author argues that China’s well-disguised soft power approach is not very different from the soft power component of US foreign policy.
Mkanda, in central Malawi, is presented as a successful example of cholera control through the Community-Led Total Sanitation (CLTS) approach, with a fall from fourteen to zero cholera cases in a year. The article does not give adequate evidence to attribute the cause of the decline, but toilet availability and community awareness both improved in the year.
Ban Ki-Moon’s term as UN Secretary General ends this year and already political jostling is underway ahead of the selection of the new head of the world body. There are strong indications that favour a woman candidate. And how has Africa positioned itself for the unfolding contest? A number of African female candidates with the right credentials fit to lead the UN exist. The author discusses which African candidates could be in the running and whether a candidate from Kenya might have the diplomatic weight to lobby and get elected.
The Third Forum of the World Alliance of Cities against Poverty (WACAP) held in Huy, Belgium, from 10-12 April, provided an opportunity for representatives to develop partnerships. Participants from 96 countries shared experiences on how they are becoming increasingly involved in addressing the impact of HIV/AIDS, particularly on women. The Alliance of Mayors Initiative for Community Action on AIDS (AMICAALL), set up with support from UNAIDS to help translate the goals of the IPAA into concrete actions, is multisectoral and emphasises partnerships between local government, civil society, including the private sector and communities, mayors and municipal leaders in Africa. Through their strategy they are working through exiting cities' networks as well as with other partners and networks to ensure that HIV/AIDS is integrated into municipal agendas. For more information please contact Mina Mauerstein-Bail.
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.
Participation is important in developing countries as a means of improving the performance and accountability of bureaucracies and improving social justice. There are two basic criteria for participation: it should be broadly representative of the population and should involve meaningful discourse that affects public decision-making. Reviews of participation in Poverty Reduction Strategy Paper (PRSP) processes show that these criteria have not been met in most cases. However citizen involvement in budgeting has been more successful. Citizen participation made local service delivery more efficient and effective in the country cases reviewed. In most of the case studies, NGOs analysed the budget and mobilised citizens. These NGOs seek to represent the poor and disseminate their views to the government. They do not offer direct citizen involvement, but without their involvement participation would be reduced. Budget participation can influence governments even where they have not embraced direct involvement of citizens in decision-making. This depends on NGOs communicating analyses of spending choices, public service effectiveness, and budget execution to the public, media, and elected officials. A key policy implication for donors is therefore targeted support to civil society. However, donors and NGOs often overlook the importance of government administrations in implementing participation.
This study was designed to address the question of whether a community-led transparency and accountability program can improve health outcomes and community empowerment, and, if so, how and in what contexts. To answer this question, researchers and civil society organization partners co-designed a program that would activate community participation in improving maternal and newborn health outcomes. This report presents the design of the work that was implemented in 200 villages in Tanzania and Indonesia and studied using a mixed methods impact evaluation. The team faced challenges including how to best foster community participation, how to structure the information gathering and sharing component, how to facilitate social action in communities, and how to ensure communities review their successes and failures in implementing social actions.