Governance and participation in health

A ‘New Deal’ for engagement in fragile states
International Dialogue on Peace-building and State-building: Organisation for Economic Co-operation and Development, December 2011

On 1 December 2012, the final day of the Fourth High-level Forum for Aid Effectiveness held in Korea, the International Dialogue on Peace-building and State-building – consisting of the G7+ group of 19 fragile and conflict-affected countries, development partners and international organisations – signed a ‘New Deal’ of development architecture for fragile states. It builds on vision and principles from a range of international agreements, including the Paris Declaration on Aid Effectiveness, the Accra Agenda for Action and the Millennium Development Goals, and will be implemented in a trial period from 2012 to 2015. Signatories have agreed to use five peace-building and state-building goals (PSGs): foster inclusive political settlements and conflict resolution, establish and strengthen people’s security, address injustices and increase people’s access to justice, generate employment and improve livelihoods, and manage revenue and build capacity for accountable and fair service delivery. They further commit to support inclusive country-led and country-owned transitions out of fragility, using the PSGs to monitor progress, and to support inclusive and participatory political dialogue. Mutual trust will be fostered by providing reliable external funding, managing resources more effectively and transparently, and aligning resources for results.

Accountability in Poverty Reduction Strategies: The Role of Empowerment and Participation
Eberlei W: Social Development Papers 104, Social Development Department of the Sustainable Development Network of the World Bank, May 2007

The elaboration of Poverty Reduction Strategies has seen a promising amount of stakeholder participation in many PRS countries, even if considerable quality problems are recognisable, such as exclusion of marginalised groups, speed and depth and the ad hoc nature of participation events as well as macroeconomic and structural policies being off-limits. Most countries have started implementing their PRSP,with participation dwindling instead of being institutionalised. Some observers speak of a 'participation gap'. The situation seems to be slightly more promising for the issue of participation in monitoring and evaluation of PRS, as in many countries independent civil society monitoring or participatory monitoring arrangements are planned, although mostly not yet operational. Stakeholder participation in the revision process has been occurring in a number of countries, but not much is known about the way this is done. For most of these issues a systematic review of experience is not available at this stage. Work is planned to increase the current understanding of the status, practice and challenges of participation in PRS implementation (including monitoring, evaluation, revisions, policy reforms, and institutionalisation) and to make conceptual as well as 'good practice' contributions to the current discussion.

Achieving high coverage of larval-stage mosquito surveillance: Challenges for a community-based mosquito control programme in urban Dar es Salaam, Tanzania
Chaki PP, Govella NJ, Shoo B, Hemed A, Tanner M, Fillinger U and Killeen GF: Malaria Journal 8(311), 30 December 2009

Preventing malaria by controlling mosquitoes in their larval stages requires regular sensitive monitoring of vector populations and intervention coverage. The study assessed the effectiveness of operational, community-based larval habitat surveillance systems within the Urban Malaria Control Programme (UMCP) in urban Dar es Salaam, Tanzania. Cross-sectional surveys were carried out to assess the ability of community-owned resource persons (CORPs) to detect mosquito breeding sites and larvae in areas with and without larviciding. CORPs reported the presence of 66.2% of all aquatic habitats, but only detected Anopheles larvae in 12.6% of habitats that contained them. Detection sensitivity was particularly low for late-stage Anopheles, the most direct programmatic indicator of malaria vector productivity. Whether a CORP found a wet habitat or not was associated with their unfamiliarity with the area. Accessibility of habitats in urban settings presents a major challenge because the majority of compounds are fenced for security reasons. Furthermore, CORPs under-reported larvae especially where larvicides were applied. This UMCP system for larval surveillance in cities must be urgently revised to improve access to enclosed compounds and the sensitivity with which habitats are searched for larvae.

Action Voices: Bench Marks Foundation Community Monitoring School
Bench Marks Foundation: South Africa, 2013

The Bench Marks Foundation developed the concept of the Community Monitoring School because a vacuum of knowledge exists within communities when dealing with big corporations. The message of the Community Monitoring School is “nothing for us without us”. Tunatazama is a Kiswahili word that means “we are watching” and the 2013 school’s motto was “We are Watching You!” For any significant reform in the mines to occur, the present power and knowledge imbalances between corporations and communities need to be overcome. In Phase One of the school programme, the focus is on helping participants develop confidence and skills in documenting and analysing community problems. They write short articles on their observations and post these on the project’s website. Some of these articles appear in the first section of this publication. In Phase Two of the programme, direct action in the community is combined with school sessions on planning, review and evaluation. In the second section a reflective analysis is conducted on the process.

Addressing global health governance challenges through a new mechanism: The proposal for a Committee C of the World Health Assembly
Kickbusch I, Hein W and Silberschmidt G: Global Health Diplomacy Network, 2010

This paper argues that the World Health Organization (WHO) should act as the directing and co-ordinating authority on future international health work, and its global health leadership must be earned through strategic and selective engagement. The authors caution that the focus of the paper is not the co-ordination of external development funders for health – which they do not consider WHO’s role – but the challenge of how WHO’s accountability to the global health community can be increased in the context of other normative and strategic dimensions of global health governance. WHO needs to provide mechanisms and instruments that link the new global health actors to the system of multilateral intergovernmental institutions, and it should engage in new ways with the many non-health actors that can influence health both positively and negatively, as well as improve its co-ordination function in relation to the development of legal instruments for health. The authors consider the World Health Assembly (WHA) as an inclusive forum that allows poorer countries to have a voice in global health. Consequently, they propose the establishment of a Committee C of the WHA, which will be legitimately represented and will deal with coherence, partnerships and the co-ordination of global health governance.

Africa Malaria Day: Mobilized communities and use of effective new drug combinations vital

25 April 2002 | Geneva | To meet the 2010 target of cutting malaria deaths in half - agreed in Abuja by African leaders on this day two years ago - community mobilization is essential in controlling the disease and providing prompt access to treatment. Powerful new combination therapies, including the Chinese herb derivative artemisinin, are highly effective against malaria and the parasite does not easily develop resistance to them. New financial arrangements are needed so that developing countries can make use of these medicines, which are much more expensive than conventional, increasingly ineffective ones.

Further details: /newsletter/id/29152

His skin itches madly from shingles, the thrush in his mouth makes it difficult to talk or eat and he has had chronic diarrhea for weeks, but South Africa's most prominent AIDS activist fights on. "There is no holiday from HIV," said Zackie Achmat, chairman of the Treatment Action Campaign, a group lobbying for affordable treatment for the 4.7 million South Africans infected by the epidemic. While 3,000 health experts, politicians and scientists gathered at the United Nations in New York this week to discuss ways to fight AIDS, Achmat and other activists remained on the ground in Africa, prodding their governments and their people into tackling the pandemic.

Africa's liberators should embrace civil society as an ally
Sriskanarajah D: Mail and Guardian, 3 May 2013

Governments across Africa are clamping down on dissent, hiding their secrets and attacking the funding base of their critics. In this article the author points out that political movements that once fought for freedom and prosperity, having assumed power, are now undermining both by trying to restrict civil society. He argues that what these governments ignore at their peril is that debate and dissent are vital to both vibrant democracy and economic prosperity. Rather than seeing civil society as a threat, they should see it as a building block of a stable democracy; one that needs to be nurtured, not over-regulated. Community-based organisations can deliver grounded and cost-effective services, helping to educate and skill-up people to take advantage of economic opportunities. They are also big employers in their own right, and a new generation of social entrepreneurs across the continent is emerging with innovative and profitable ways of tackling intractable social problems.

Africa: Ask the women
Daniel P: Opendemocracy, 3 August 2006

To address Africa's deep-rooted problems, it's time to reject the superficial male charisma embodied by the likes of Tony Blair and Bob Geldof and instead mobilise the dynamic energies of African and Africa engaged women. The author discusses how Africa at its simplest already has a handful of problems, including, amongst others, HIV/AIDS and gender inequality. For example, the attempt to strengthen national systems in Africa continues to be thwarted by the high incidence of HIV/AIDS which is thinning out cohort after cohort of dynamic young professionals.

Africa: Right to health campaign
Africa Action

Africa Action will fight for the following goals:
1. unconditional cancellation of Africa’s illegitimate foreign debt, 2. equal access to drugs and treatment, 3. an end to IMF/ World Bank colonialism, 4. an end to discrimination on the basis of race, gender, and HIV status, and 5. promotion of a public discourse on reparations (the need for the West to invest in Africa’s health care as an obligation— not charity). For a wide range of campaign resources, visit the Africa Action website.