Governance and participation in health

African Awakenings: The Emerging Revolutions
Manji F, Ekine S (Editors), Fahamu publishers

The tumultuous uprisings of citizens in Tunisia, Egypt and Libya have seized the attention of media analysts who have characterised these
as 'Arab revolutions', a perspective given weight by popular demonstrations in Yemen, Bahrain, Syria and elsewhere. However, what have been given less attention are the concurrent uprisings in other parts of the African continent. The uprisings across Africa and in the Middle East, the book argues, are the result of common experiences of decades of declining living standards, mass unemployment, land dispossessions and impoverishment of the majority, while a few have engorged themselves with riches. Through incisive contributions from analysts and activists across the continent, the essays in ‘African Awakening’ provide an overview of the struggle for democratisation which goes beyond calls merely for transparent electoral processes and constitutes a reawakening of the spirit of freedom and justice for the majority.

African Civil Society Statement: Call for a ban on GM crops and food
African Centre for Biosafety: 15 November 2012

In the wake of the recent ban by Kenya on the importation of genetically modified (GM) products until proper health evaluation has been completed, African civil society in this paper is requesting the African Union (AU) discuss banning all GM products throughout the continent at the next AU summit in January 2013. Civil society represented by 400 African organisations consisting of small-scale farmers, social movements, non-governmental organisations, faith-based groups, organic producers and consumers, business people and ordinary citizens issued a statement pointing out the lack of safety data on GM foods, as well as condemning the patenting of life and privatisation of agriculture, which threatens to displace African food producer control over their production systems.

African countries must still ratify and implement AU agreements
State of the Union (SOTU): Pambazuka News (597), 12 September 2012

State of the Union (SOTU), a coalition of 10 civil society organisations, has urged national, regional and continental Parliaments to take a leading role in promoting the ratification and implementation of key African Union (AU) instruments and policy standards. SOTU says that the slow rate of ratification and domestication of key instruments is alarming and undermines the credibility of the AU and all its key organs, while denying millions of African citizens their fundamental freedoms and basic human rights as intended by the protocols. Although there has been some progress in the rate of ratification with a total of 118 new ratifications have been entered against the 43 instruments, more needs to be done to ensure the ratifications go hand in hand with domestication and implementation. In east, central and southern Africa, Zambia, Congo and Rwanda have performed best, having ratified five instruments each. By August 2012, only two countries, Kenya and Mauritius, had ratified the African Charter on the Values and Principles of Public Service & Administration (2011) and only 14 countries had ratified the Charter for Democracy, Elections and Governance. At this current rate, universal ratification of AU treaties would not be complete before 2053, says SOTU.

African Ethics, Health Care Research and Community and Individual Participation
Jegede S Journal of Asian and African Studies, Vol. 44, No. 2, 239-253 (2009)

This article discusses the appropriateness of western bioethics in the African setting. It focuses on the decision-making process regarding participation in health research as a contested boundary in international bioethics discourse. An ethnomethodological approach is used to explain African ethics, and African ethic is applied to the decision-making process in the African community. An HIV/AIDS surveillance project is used as a case study to explore the concept of communitarianism. The article argues that what exists in Africa is communal or social autonomy as opposed to individual autonomy in the West. As a result, applying the western concept of autonomy to research involving human subjects in the African context without adequate consideration for the important role of the community is inappropriate. It concludes that lack of adequate consideration for community participation in health research involving human subjects in Africa will prevent proper management and lack truly informed consent.

African governments, NGOs and civil society: A crisis of legitimacy?
Arrianna M: Future Challenges, 3 August 2011

The author of this article argues that, in Africa, some governments have dodged their responsibility to implement famine-prevention measures because they require a socio-political contract between the government and civil society that allows citizens to hold governments accountable for famine. Instead, through their inaction and acceptance of foreign aid, governments have ceded that responsibility to non-government organisations (NGOs) and ‘foreign technical experts’ with a narrower definition of social responsibility and far less vested interest in the well-being of citizens. In the last sixty years, well over a trillion dollars of ‘development aid’ has been transferred from the West to African nations, but the author cautions that this aid comes at a cost: donor dependency, corruption and lack of incentive for governments to govern well and efficiently. In fact, NGOs may well be in competition with African governments as they provide goods and services that the governments do not. As NGOs step in and fill the gaps with their foreign-funded resources and growing presence and capacities, the legitimacy of aid-recipient states is called into question. Arguably, the legitimacy crisis of NGOs is in tandem with the legitimacy crisis of African governments. Because the provision of public goods and resources is part of the socio-political contract between the government and civil society, NGOs do risk undermining the legitimacy of the government. On the flip side, the legitimacy of foreign-funded NGOs comes under question when the interests of their international and surpranational funders conflict with national interests.

African leaders challenged to meet their commitments to health
ARASA: 27 July 2009

The AIDS and Rights Alliance for Southern Africa (ARASA), a Namibia-based partnership of health and human rights groups from the Southern African region, today launched a YouTube video clip entitled ‘Lords of the Bling’, linked to a public petition that presents a ‘moral challenge’ to African leaders regarding their commitments to funding health. The clip highlights the cost of lavish expenditure and corruption among various African leaders and calculates how many people could, for equivalent sums of money, have received life-saving treatment for HIV and TB, which jointly claim almost two million African lives every year. The video clip and petition are intended to serve as an awareness-raising campaign and a platform for solidarity on holding African governments accountable for their commitments to health. ARASA is seeking sign-ons from organisations and individuals, which will be presented to leaders on International Human Rights Day in December 2009. ARASA intends to mobilise civil society around this critical issue and claim the right to health.

African peasants highlight their struggles at Via Campesina global conference
Monjane B: Pambuzuka News, July 2017

Peasants across Africa are intensifying their struggles against land grabs and other harmful policies that promote industrial agriculture. At a recent international conference organised by the world’s largest peasants movement, Via Campesina, African peasants had opportunities to share their experiences of struggle and to learn. This conference happens at a time when Africa is undergoing a harsh moment, as indicated by Ibrahima Coulibaly from the National Coordination of Peasant Organizations (CNOP) in Mali. They note that land, mineral resources, seeds and water are increasingly being privatised due to the myriad of investment agreements and policies driven by new institutional approaches, imposed on the continent by western powers and Bretton Woods institutions. Elizabeth Mpofu, from the Zimbabwe Smallholder Farmers Forum, is a small-scale farmer who had access to land after she took part in the radical land occupation that resulted in the fast-track land reform in the early 2000s. According to her, building alternatives is to take direct action. Domingos Buramo, from the Mozambique Peasants Union (UNAC), brought to the conference the experience of the Mozambican peasants and other civil society organisations against land grabbing and large-scale investment projects in Mozambique. He mentioned that the resistance to ProSavana, a large-scale agricultural project proposed for Mozambique, is an example of how transformative articulated struggles could be. “Now the government is changing its vision as a result of our work. We can change our societies”, he said. Africa - including the Maghreb region - was the last continent to be part of Via Campesina. Since 2004 the number of African peasant movements joining La Via Campesina has been increasing. African movements consider their membership to the peasant movement as a strategic process of amplifying their struggles and reinforcing internationalism.

African Speakers of Parliament commit to support maternal, newborn and child health: Resolution on Declaration of Commitment to Prioritize and Increase Budget Support to Maternal, Newborn and Child Health
The Partnership for Maternal, Newborn and Child Health: October 2011

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.

Africa’s Peer Review Mechanism: A seven country survey
Bing-Pappoe A: Partnership Africa Canada, March 2010

This report assesses the progress made in some of the major countries that have begun to implement the African Peer Review Mechanism (APRM) and address their governance problems, including two countries from east and southern Africa – South Africa and Kenya. The overall picture is generally positive, with dialogue between stakeholders occurring and changes being introduced in the ways policies are developed and implemented. There is peer learning, with experiences from a given country being introduced to others. But the report notes that the pace of learning and the pace of change are slow. It argues that the APRM itself has to be changed to make it more straightforward and more efficient. Human and financial resources must be increased at the national level to help countries carry out their evaluations successfully and, more importantly, implement the priority actions that are agreed on. The report argues that civil society is a key player in the APRM, but this is often forgotten by governments, by the continental APRM authorities and by external funders, and the inclusion of civil society representatives in the APRM process is often just an afterthought.

After Rio: Let's start moving towards the future we want
UHC Forward: 13 July 2012

The outcome of Rio+20, held in June 2012, with negotiating countries unable to reach consensus on most issues, left most commentators disappointed as the summit failed to live up to its ambitious title “The Future We Want”. However, UHC Forward argues that health activists have a minor victory to celebrate, as issues regarding health, absent in the initial drafts circulated in advance of the Summit, are now mentioned in the texts. Health has had its relationship with sustainable development firmly recognised in terms of Universal Health Coverage by: strengthening health systems; complying with Beijing, Cairo and TRIPs flexibilities to ensure access to essential medicines; reducing infant and maternal mortality; and providing universal access to family planning and sexual and reproductive health. However, UHC Forward acknowledges that the Rio+20 outcome text contains too many divergent viewpoints and no tangible political commitments. It does, though, mark the beginning of the next phase of negotiations, and UHC Forward calls on all activists to demand that new agreements must reflect the challenges of the new global landscape, accounting for new health challenges, widening inequality and the increased proportion of the world’s poor in middle-income countries.