This Drum Beat is one of a series of commentary and analysis pieces. Getting communication included is an integral element in development programmes, for example improving maternal health. Addressing this challenge needs actions at many levels, all of which entail particular types of communication.
Governance and participation in health
This Agency for Co-operation and Research in Development (Acord) report features two country case studies (Uganda and Burundi) which explored the role of community-based research in responding to HIV stigma and discrimination. The research found that issues of stigma and discrimination reached all spheres of life, including the home, family, the workplace, school, health settings and the larger community. It also identified a number of key factors that contribute to stigma and discrimination. These include ignorance and fear, cultural norms and values, some religious teachings, the lack of legal sanctions, lack of rights awareness, the design of government and other programmes, and inaccurate or irresponsible media coverage.
This study took place in Northern Ghana to assess the impact of male involvement in reproductive health and Family Planning (FP) services. Twelve focus group discussions were held with both male and female community members, six in communities with functional community health-based planning and services strategy (CHPS) and six for communities with less/no-functional CHPS. Fifty-nine in-depth interviews were held with other stakeholders at both district and regional levels. The results revealed a general high perception of an improved health status of children in the last ten years in the communities; however, participants reported that malnutrition was still rife in the community. The results also revealed that women still needed to get spousal approval to use contraceptives; however, the matrilineal system appears to give more autonomy to women in decision-making. The CHPS strategy was perceived as very helpful with full community participation at all levels of the implementation process. Males were more involved in FP services in communities with functioning CHPS than those without functioning CHPS. The authors argue that involving males in reproductive health issues including FP is important to attain reproductive health targets.
There is growing concern that health policies and programmes may be contributing to disparities in health and wealth between and within households in low-income settings. However, there is disagreement concerning which combination of health and non-health sector interventions might best protect the poor. Potentially promising interventions include those that build on the social resources that have been found to be particularly critical for the poor in preventing and coping with illness costs. In this paper we present data on the role of one form of social resource— community-based organisations (CBOs)—in household ability to pay for health care on the Kenyan coast. Data were gathered from a rural and an urban setting using individual interviews (n = 24), focus group discussions (n = 18 in each setting) and cross-sectional surveys (n = 294 rural and n = 576 urban households). We describe the complex hierarchy of CBOs operating at the strategic, intermediate and local level in both settings, and comment on the potential of working through these organisations to reach and protect the poor. We highlight the challenges around several interventions that are of particular international interest at present: community-based health insurance schemes; micro-finance initiatives; and the removal of primary care user fees. We argue the importance of identifying and building upon organizations with a strong trust base in efforts to assist households to meet treatment costs, and emphasize the necessity of reducing the costs of services themselves for the poorest households.
The configuration of economic actors has shifted dramatically in recent decades as a consequence of the shift from an international to global economy, according to this article. The 21st century thus faces a fundamentally different economic landscape, with governance far less about formal nation-state negotiation, and far more about informal mechanisms of state and non-state negotiation. Although economic power has always played a role in defining international health governance, this changing global economic context has increased the role of economic power in the development of global health governance. To ensure the continued protection and enhancement of global health, the author argues it is imperative for the health profession to recognise and more actively engage with this changing economic context, in order to seize opportunities and minimise risks to global health. If it does not, the danger is that global health governance will increasingly be determined by economic organisations with the principle concern not of health but of market liberalisation, ultimately constraining the capacity of nation-states to undertake measures to protect and enhance the health of their populations.
Non-governmental organisations (NGOs) have become key actors in responding to poverty and related suffering. In Africa, NGOs play a leading role in providing health care and education. But NGOs also have their detractors who argue that they are receiving growing amounts of external aid, but aren’t the most suitable actors for really improving people’s lives. Some critics insist that the neoliberal policies advanced by international actors have limited the influence of the state and that NGOs have benefited as a result. NGOs are criticised for their focus on technical solutions to poverty instead of the underlying issues, and for being more dependent and accountable to their funders than those they serve. Instead of empowering local populations to organise themselves, the authors argue that there is a risk that NGOs empower people to attain licensed, rather than emancipatory, freedoms; these are freedoms achieved “within the system” which improve lives, but don’t dramatically change power dynamics.
The People's Health Movement (PHM) is a global network of people oriented health professionals and activists, academcis and researchers, campaigners and people organizations that have actively promoted the re endorsement of the 'Health for All' principles of the Alma Ata Declaration and the importance of social determinants of health and health care. The paper outlines a series of ongoing advocacy initiatives through a PHM - WHO advocacy circle that has consistently since 2001 nudged WHO to reaffirm the Alma Ata principles and focus on the social determinants of health. This has led to an evolving dialogue with PHM and the setting up of the WHO commission on social determiants of health, in which the PHM, is actively engaged.
The purpose of this study was to determine the roles of educators in mitigating the impact of the HIV and AIDS pandemic, and to ascertain the skills and knowledge required by them to play such roles effectively. The study gathered data from 3,678 survey respondents to a questionnaire. Qualitative fieldwork showed that levels of concern among educators were polarised with respect to HIV and AIDS pandemic, ranging from lack of concern and denial of its importance to extreme concern and a strong sense of ethical responsibility to mitigate its impact. However, most respondents displayed a very high level of concern regarding the pandemic. They pointed to an urgent need for training and resources for future roles. The study made four recommendations. It urged for a resolution to South Africa's current strategic dilemma, namely whether to prescribe approaches to mitigating the impact of the pandemic or allow individuals and institutions to develop their own responses. It also called for curriculum interventions that meet the challenges of the pandemic, differentiated interventions that enable educators to meet the challenges of the pandemic and more time to develop appropriate resources and support, including training.
A dominant theme at DENIVA’S 4th International Conference on NGO Accountability, Self Regulation and the Law at Kampala was the shrinking space for civil society. This global trend is reported to be affirmed by the findings of the CIVICUS Civil Society Index, given the particular context of the global “war on terror”. Sadly, even in well-entrenched democracies, where civil society space was hitherto considered safe, there are negative trends. In current circumstances, it is critical that the international community remains alive to the steady roll back on civil society space and hard fought civil liberties across the world. This imperative is underscored by the economic meltdown in ‘western democracies’ where much of the funding for democratic reform and civil society initiatives comes from. Ensuring the sustainability of civil society organisations working on the advancement of health, human and democratic rights is one such means.
In this article the authors argue that the World Health Organisation (WHO) Secretariat, Member States and observers should honestly admit that they have so far fallen very short of the WHO Mission. The authors argue that the organization has become a huge bureaucratic structure while at the same time under-resourcing its needs has made it incapable of providing a timely response to the urgent health needs happening in the world. The organization is argued to be being privatized with influence from small group of private funders. This authors observe that the limited participation sometimes turns into an uncomfortable position for many, when faced with the lack of progress in the debates or with the endless diplomatic language that is used without reaching any concrete agreements and with resolutions and decisions where that make it almost impossible to identify the substance and therefore difficult to see their real value. In the meantime millions of diseases and preventable deaths are happening far away from what is being discussed at “the highest levels” of international public health policy arena.