Governance and participation in health

The World Bank and extractives: A rich seam of controversy
Bretton Woods Project: 7 February 2012

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.

The World Bank’s private sector financing arm doesn’t know the environmental and social impacts of nearly half its portfolio
Oxfam: 8 February 2013

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.

The World Medicines Situation 2011: Good governance for the pharmaceutical sector
Kohler JC and Baghdadi-Sabeti G: World Health Organisation, 2011

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.

Theorising inequalities in the experience and management of chronic illness: Bringing social networks and social capital back in (critically)
Sanders C and Rogers A: Research in the Sociology of Health Care 25: 15-42, 2007

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.

Three case studies on civil society influence on national governance
Yemec E: Idasa, August 2007

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.

Time to listen: Hearing People on the Receiving End of International Aid
Anderson MB, Brown D and Jean I: CDA Collaborative Learning Projects, November 2012

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.

Towards a unified agenda and action for people’s health, equity and justice
Report of a Regional Meeting: Health civil society in east and southern Africa

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.

Towards good humanitarian government: The role of the affected state in disaster response
Harvey P: Humanitarian Policy Group Policy Brief 37, 2009

This brief asserts that research relating to humanitarian crises has largely focused on what international aid agencies and donor governments do in response to disasters. Instead, this paper focuses on the role of the affected state in responding to the needs of its own citizens. It found that one of the goals of international humanitarian actors should always be to encourage and support states to fulfil their responsibilities to assist and protect their own citizens in times of disaster. Too often, aid agencies have neglected the central role of the state, and neutrality and independence have been taken as shorthand for disengagement from state structures, rather than as necessitating principled engagement with them. States should invest their own resources in assisting and protecting their citizens in disasters, both because it is the humane thing to do and because it can be politically popular and economically effective. The roles and responsibilities of states in relation to humanitarian aid are four-fold: they are responsible for 'calling' a crisis and inviting international aid; they provide assistance and protection for themselves; they are responsible for monitoring and coordinating external assistance; and they set the regulatory and legal frameworks governing assistance.

Trade policy and civil society participation

This paper examines the way that a range of development actors view and engage with the arena of trade policy, focusing in particular on the challenges encountered by civil society actors participating in that arena. The dynamics of civil society participation in the trade arena – what might be achieved, and how – are very different from those that shape civil society participation in processes labelled poverty reduction; this paper explores the differences.

Tradition a force against HIV/AIDS?
Integrated Regional Information Network, 14 September 2007

Circumstance, rather than planning, has placed the battle against HIV/AIDS firmly in the hands of Swaziland's 355 chiefdoms. The decentralisation strategy has evolved from government's failure to command the fight against the disease, or even deliver healthcare at its urban hospitals, and much less so in rural areas, where four out of five Swazis live. Swaziland, ruled by sub-Saharan Africa's last absolute monarch, King Mswati III, has a well-established traditional hierarchy, and the use of it to coordinate efforts against HIV/AIDS is being seen as a grassroots-driven solution.

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