Governance and participation in health

The State of Civil Society 2013 Report
CIVICUS: April 2013

The State of Civil Society 2013 Report presents insights from over 50 civil society experts from around the world. Alongside the report, CIVICUS is publishing a draft methodology for an Enabling Environment Index (EEI) that seeks to measure how well countries around the world are doing on creating positive conditions for civil society. Amidst the challenges facing civil society, the 2013 report highlights good practices around the world and challenges on the horizon for citizens and civil society around the world, such as: rising fundamentalism threatening women's and sexual minorities rights movements; challenges to democracy in Africa, with case studies from Burkina Faso, Central African Republic, Democratic Republic of Congo and Uganda; the state of the internet and access to information; threats to writers, journalists and trade unionists; and civil society successes.

The state of HIV sector local governance in Malawi and Zambia: Evidence from five districts
Steyn J: Commonwealth Journal of Local Governance 15, 128-140, 2014

This paper reports on a project that aimed to improve the levels of HIV governance at the district level in Malawi and Zambia by encouraging public participation in an effort to more effective use of local resources. The methodology for this project included a barometer which assessed perceptions among key stakeholders on effectiveness, efficiency, rule of law, accountability, participation and equity at district level. The stakeholders ranged from administrators, political representatives, community-based organisations and the private sector on the supply side and citizens on the demand or beneficiary side. Communication and transparency appear to be major issues underpinning the bottlenecks and shortcomings in the HIV sector governance at the district level. Information gaps have given rise to accountability deficits and coordination deficiencies. Addressing these matters would make more effective use of resources and lessen dependence on external funding sources.

The Sub-Saharan Media Landscape - Then, Now and in the Future
Balancing Act: August 2014

Focus groups, one-to-one interviewees and surveys in Ghana, Senegal and
Tanzania, Nigeria. Ethiopia and South Africa provided the evidence cited in this research report. They were asked what had changed most about media and communications in the last five years. Two responses were common to all those who took part: the greater amount of media available and the presence of the Internet. These key changes have created haves and the have-nots. On almost every media measure, those living in rural Africa are at a disadvantage to their urban counterparts. The research found that over five years Facebook has grown from practically no users in Sub-Saharan Africa to become the most widely used social media platform, and the number of Africans who own or have access to mobile phones, computers, laptops, smartphones and tablets has grown considerably. Based on trends the authors predict that smartphone use will grow to between 10-20% of the population depending on the country, as will phones with internet access. While the current pattern of mobile phone use in the countries in focus has largely been voice and SMS, the numbers accessing the internet and social media is projected to grow over the next five years to between 10-25% of the population depending on the country.

The treatment action campaign and the three dimensions of lawyering: Reflections from the rainbow nation
Ahmad H: Journal of Social Aspects of HIV/AIDS 10(1) 16-24: March 2013

The spread and perpetuation of the HIV/AIDS epidemic in South Africa has hindered the country’s social and economic growth after apartheid. This paper documents experiences of interactions with the Treatment Action Campaign (TAC), an organization which has taken a multidimensional approach in order to educate people about HIV/AIDS and to provide access to medicines. It reports how TAC has used both traditional and non-traditional methods of advocacy to combat the epidemic and equate access to health care to a social justice issue by empowering marginalized communities. The author uses three dimensions of lawyering and equates TAC to a single cause lawyer, signifying that multi-dimensional activism is not limited to individuals, but can also be applied at the firm level. The three dimensions include: (a) advocacy through litigation, (b) advocacy in stimulating progressive change, and (c) advocacy as a pedagogic process. He suggests that TAC’s multi-dimensional approach and its inherent practice of the three dimensions has contributed to its success and may be useful for other processes.

The Tunis Consensus: Targeting effective development: From aid effectiveness to development effectiveness
African Development Bank Group, NEPAD and African Union: December 2010

On 4 and 5 November 2010, representatives from across Africa met in Tunis to discuss an African agenda on development effectiveness to take to the Fourth High-Level Forum in Busan in 2011. The Tunis Consensus on an African development effectiveness agenda consists of the following main items: building capable states, with African countries taking leadership on capacity development; developing democratic accountability; promoting South-South co-operation; embracing new development partners; and outgrowing aid dependence.

The Use Of Information And Communication Technology, And Social Networking Sites In Political Governance Of East African Legislative Assembly Parliament
Robert A; Namusonge G: International Journal of Scientific and Technology Research 4(6), June 2016

This research project was carried out to ascertain the use of Information and Communication Technologies (ICT) and Social Networking Sites (SNSs) in political governance of East African Legislative Assembly (EALA) Parliament. It was based on the conviction that in this era of globalisation use of ICTs and SNS‘s are fundamentally important and will have tremendous impact on governance, leadership and legislation. The findings showed that that all the parliamentarian respondents were subscribed to social networking sites and used them from time to time. The EALA parliamentarians had a disparity when it came to use of SNSs to interact with constituents, 73% indicated that they have used SNSs to interact with constituents on matters affecting the community from time to time however 27% did not. The use of ICTs and SNSs by EALA was argued by the authors to enable citizens to view Assembly proceedings in real time. The recommend that Parliamentarians in Africa embrace SNS‘s as major tools in interacting with and being accountable to their constituents.

The Value and Challenges of Participatory Research: Strengthening Its Practice
Cargo M and ­Mercer SL: Annual Review of Public Health 29: 325-350, 3 January 2008

The increasing use of participatory research (PR) approaches to address pressing public health issues reflects PR's potential for bridging gaps between research and practice, addressing social and environmental justice and enabling people to gain control over determinants of their health. This critical review of the PR literature culminates in the development of an integrative practice framework that features five essential domains and provides a structured process for developing and maintaining PR partnerships, designing and implementing PR efforts, and evaluating the intermediate and long-term outcomes of descriptive, etiological, and intervention PR studies. the paper reviews the empirical and nonempirical literature in the context of this practice framework to distill the key challenges and added value of PR. Advances to the practice of PR over the next decade will require establishing the effectiveness of PR in achieving health outcomes and linking PR practices, processes, and core elements to health outcomes.

The visa conundrum in global health
Vervoort D: The BMJ Opinion, June 2019

There is a growing push to include local voices in global health initiatives and policies to promote ownership of downstream implementation, but also to get a proper sense of the realities on the ground. Many governments gladly jump on the bandwagon. Yet when it comes to it, visa applications are often rejected on feeble grounds. Physicians and medical students with booked return flights, domestic hospital affiliations, formal invitation letters and even proof that they will not be a financial liability are rejected. Academia increasingly understands the need for local authorship and ownership of global health programmes, and rightfully so. However, a colonial trend persists in the wider community. Policies and resolutions are driven by high income country actors or government officials who are, by definition, detached from what is happening on the ground. Civil society actors who live among the realities of poverty are left behind.

The WHO Global Code of Practice on the International Recruitment of Health Personnel: The evolution of of Global Health Diplomacy
Taylor A and Dhillon I: Global Health Governance, Vol. V, Issue 1, 2011

The May 2010 adoption of the World Health Organization Global Code of Practice on the International Recruitment of Health Personnel created a global architecture, including ethical norms and institutional and legal arrangements, to guide international cooperation and serve as a platform for continuing dialogue on the critical problem of health worker migration. Highlighting the contribution of non-binding instruments to global health governance, this article describes the Code negotiation process from its early stages to the formal adoption of the final text of the Code. Detailed are the vigorous negotiations amongst key stakeholders, including the active role of non-governmental organizations. The article emphasizes the importance of political leadership, appropriate sequencing, and support for capacity building of developing countries¹ negotiating skills to successful global health negotiations. It also reflects on how the dynamics of the Code negotiation process is evidence of an evolution in global health negotiations amongst the WHO Secretariat, civil society, and WHO Member States.

The WHO’s new African leader could be a shot in the arm for poorer countries
Sanders D: The Conversation, May 2017

Dr Tedros Ghebreyesus is the first African to be elected as the Director-General of the World Health Organisation (WHO) in its 70 year history. The massive margin for Tedros – 133 votes vs 50 for the UK candidate – suggests that the entire Global South voted for him. Professor David Sanders in this interview suggests that the vote almost certainly represents a vote against big power domination and machinations in the WHO which often appears to ignore the main challenges and aspirations of low and middle income countries. Professor Sanders notes that Dr Ghebreyesus needs to use his strong mandate – notably from the Global South – to truly reform the WHO and its operations in favour of the world’s poor majority. To do this, he needs to push strongly for member states to honour their commitments to the WHO and to rapidly and significantly increase their financial contributions. He also needs to ensure that the influence of the food, beverage, alcohol and tobacco industries to control non communicable diseases is resisted. This will be difficult given that a framework has been passed that allows non-state actors to participate in WHO policy-making processes. Further he argues that Dr Ghebreyesus must ensure that the health systems of low and middle income countries are strengthened so that health emergencies such as infectious disease outbreaks can be contained. This will ensure that agenda for health security isn’t focused on securing the health of rich country populations against contagion from the poor but on protecting all, particularly the most vulnerable. Hi raises that what will be interesting to watch over the next five years is whether the evident solidarity between low and middle income counties in voting in Dr Ghebreyesus as their candidate is maintained during the debates and decisions about world health.

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