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.
Governance and participation in health
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.
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.
As World Bank projects fail to reduce corruption in the mining sector in the Democratic Republic of Congo (DRC), International Finance Corporation (IFC) investments in extractive industries are provoking complaints and protests around the world, according to this article. In 2012 the Bank will launch its new extractives for development (E4D) initiative, a “knowledge sharing platform” aimed at transforming extractives into a force for development, but critics argue that the Bank needs to first take action against corruption and unethical behaviour in the mining projects it funds. In late 2010, the Bank suspended all new programmes in the DRC after allegations of corruption but resumed lending in June 2011 when it judged the government to be in compliance with the economic governance matrix (EGM), a new transparency framework agreed by the government and the Bank. However, only a month later it came to light that state-owned mining companies had again been secretly selling stakes in mining operations, in one case at a sixteenth of their market price. The author notes that the ombudsman set up by the IFC has been inundated with complaints of irregularities, lack of local consultation, mistreatment of miners, environmental degradation and illusory promises of job creation. Critics argue that the Bank and the IFC should take greater ownership of projects they fund and demand more accountability.
Oxfam is calling for a fundamental overhaul of World Bank lending to financial markets actors, following the publication of an Ombudsman audit that revealed the International Finance Corporation (IFC), the Bank’s private lending arm, “knows very little” about the environmental or social impacts of its financial market lending. Oxfam is calling on the IFC to improve transparency and ensure its loans do not put poor people at risk of land grabs. The fact that many projects technically meet IFC policies ignores the finding that the policies themselves are fundamentally and fatally flawed, the article says, calling for a commitment by the IFC to review its approach to lending to the financial market. The audit shows that the World Bank must not adopt the IFC model, which fosters a culture of client self-monitoring, self-assessment and zero oversight. This would leave communities and the environment vulnerable to harm. The CAO audit also reveals that IFC policies are not industry best practice and that IFC is not above using legal loopholes in financial intermediary policies that other financiers would consider ethically dubious.
Good governance is increasingly understood as necessary for improving access to medicines and contributing to health systems strengthening. This chapter reviews the findings of studies carried out in 25 countries that have examined governance of key functions of pharmaceutical systems within the framework of WHO’s Good Governance for Medicines (GGM) programme. The country studies, which are based on a common methodology, have revealed strengths and several weaknesses in existing pharmaceutical systems and have provided policy-makers with relevant information to help them better understand the nature of the problems facing the sector and where interventions need to take place. Common strengths in the pharmaceutical systems and procedures include the use of standard application forms in the registration process of medicines, use of national essential medicines lists, existence of standard operating procedures for procurement of medicines and well-established tender committees. Common weaknesses include a lack of access to information, poor enforcement and implementation of laws and regulations, absence of conflict of interest policies among members of various committees, and an inability to ensure that the proper incentives are in place to lessen the likelihood of corruption at both the individual and institutional levels. Governments can reduce corruption by promoting transparency and ethical practices, and by introducing simple measures, such as justification for committee membership, terms of reference, conflict of interest policies and descriptions of the purpose of the committees. International organisations, such as WHO, can provide technical support for these efforts.
Social networks have been a central focus of sociological research on inequalities but less has focused specifically on chronic illness and disability despite a policy emphasis on resources necessary to support self-management. The study sought to unpack overlaps and distinctions between social network approaches and research on the experience and management of chronic illness. We outline four main areas viewed as central in articulating the potential for future work consistent with a critical realist perspective: (1) body–society connections and realist/relativist tensions; (2) the controversy of ‘variables’ and accounting for social and cultural context in studying networks for chronic illness support; (3) conceptualising social support, network ties and the significance of organisations and technology; and (4) translating theory into method.
Malawi was the only sub-Saharan African country examined in these case studies. The Malawian presenter recommended follow-up programmes for monitoring political party manifestos vs their actual delivery in government, with independent budget analyses. Independent civil society budget research for evidence-based advocacy and continued strong advocacy around political and socio-economic developments in the country are also required. In conclusion, the author asserts that the greatest danger facing democracy is the exclusion of the people from real power. Citizens cannot wait passively for the government to educate them. They need to be active and critical: at a local level, organised community groups, with the help of civil society organisations, should engage in controlling local government decision making.
This book captures the experiences and voices of over 6,000 people who have received international assistance, observed the effects of aid efforts or been involved in providing aid. More than 125 international and local aid organisations in 20 aid-recipient countries were interviewed about their experiences with, and judgments of, international assistance. The researchers also spoke with people who represented broad cross-sections of their societies, ranging from fishermen on the beach to government ministers with experience in bilateral aid negotiations. The voices reported here convey four basic messages: first, international aid is a good thing that is appreciated; second, assistance as it is now provided is not achieving its intent; third, fundamental changes must be made in how aid is provided if it is to become an effective tool in support of positive economic, social, and political change; and fourth, these fundamental changes are both possible and doable. What people want is an international assistance system that integrates the resources and experiences of outsiders with the assets and capacities of insiders to develop contextually appropriate strategies for pursuing positive change. The idea of international assistance needs to be redefined away from a system for delivering things and reinvented to support collaborative planning.
This report, of a Regional Meeting of Health civil society in east and southern Africa: 'Towards a unified agenda and action for people's health, equity and justice' held in Lusaka 17-19 February 2005 outlines the proceedings of the meeting and the resolutions and plans for future work made by the health civil society groups at the meeting. The meeting was hosted by CHESSORE, the theme co-ordinator in EQUINET on participation in health, with support from TARSC.