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.
Governance and participation in health
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.
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.
There has been intense public health debate in many parts of Africa to determine the most appropriate official policy towards traditional medicines for reproductive health care. The author of this editorial argues that because traditional practitioners work more closely with the grassroots compared to orthodox practitioners, traditional practitioners would be more able to advocate for changing behaviours that impact negatively on reproductive health in Africa.
The authors of this article argue that governments need to provide civil society organisations with more space and recognition to facilitate a stronger health response with a particular focus on tuberculosis (TB) prevention, care and control. They call on the World health Organisation (WHO) and its international partners to play a brokering and facilitative role to catalyse the process, and they provide a contextual framework to achieve this in the article. In many countries, civil society organisations have been responsible for handling the majority of resources to deliver services to individuals and have played a leading role in developing and implementing sustainable strategies to mitigate the impact of HIV and AIDS. In contrast, TB prevention, care and control activities face numerous challenges. A major problem is that one in three estimated TB cases globally is either not formally reported in the public system or not reached at all by existing services. TB is rarely recognised as a priority by national political authorities, United Nations agencies, development banks, the pharmaceutical industry and philanthropic organisations and often neglected within development, human rights and social justice agendas. Despite some efforts to engage civil society organisations in global TB activities, in many countries they still lack recognition as legitimate partners at national and local level even in established democracies.
Following the High-Level Meeting on Universal Health Coverage (UHC) UN member states are expected to show more financial and political commitment to accelerate progress towards UHC.. Different approaches have been taken by different countries in Africa for this. Rwanda has used affordable health finance and insurance mechanisms - financed by both the national government and individuals - as a crucial driver for UHC. In 2018, Kenya also unveiled a plan for reaching UHC by 2022 by piloting UHC in four counties. The prioritization of such policy options and the ways to implement them are seen to require a. context-dependent balancing act that should be grounded in the correct application of evidence in decision-making processes. This is obserbed to demand measures to build individual and institutional capabilities to generate and use evidence to support value-based design and implementation of relevant system-level policy reforms for UHC.
Effective management of public health emergencies demands open and transparent public communication. The rationale for transparency has public health, strategic and ethical dimensions. Despite this, government authorities often fail to demonstrate transparency. A key step in bridging the gap between the rhetoric and reality is to define and codify transparency to put in place practical mechanisms to encourage open public health communication for emergencies. The authors demonstrate this approach using the example of the development and implementation process of a public health emergency information policy.
December 2018 marked the 20th anniversary of the birth of the Treatment Action Campaign (TAC); a story that began with a T-shirt with the slogan “HIV-positive” and came to be a thorn in government’s side, a symbol of hope for people dying from HIV/Aids and an icon of activism still needed in an age of democracy. Days before the protest that founded the TAC, co-founder Zackie Achmat had spoken at the funeral of Aids activist Simon Nkoli. He vowed to fight for access to treatment, knowing from his own experience that if the right medicines were affordable and accessible people would not be dying. Four days after that protest action, activist Gugu Dlamini, who had disclosed her HIV status publicly, speaking on radio in Zulu on World Aids Day, was beaten to death in KwaMashu. “Those two events created the anger and passion that would become the momentum for organising and mobilising,” says co-founder Mark Heywood. As one more person put on an “HIV-positive” T-shirt and stood to challenge HIV stigma, more people joined. Recruitment and empowerment came through a strong treatment literacy programme rooted in spreading the word from neighbour to neighbour, patient to patient. This patient-driven, community activism would become a hallmark of the movement. It meant that people could see the power and the purpose in marching to the opening of Parliament each year, taking part in in civil disobedience campaigns and joining rallies for AZT for pregnant women and pushing big pharmaceutical companies to make drugs available.
In this article, the author evaluates developments in the field of community participation in health, arguing that in many national experiences, the distinction between the different forms of participation remains blurry. In particular, there is little distinction between community participation as a way to devolve services to community members and community participation as the community (co-)management of health centres. This confusion in part reflects two decades of debate on participation as either an end in itself or as a means for other purposes. Although free care and performance-based financing are two of the most popular health policies currently being developed in Africa, they have implications for participation. Performance-based financing strategies raise a need to ensure that the voice of the people continues to be heard when financial incentives drive the system. Free health care on a large scale also poses new challenges because, with the removal of user fees, the financial interest community members have in the health centre management disappears. Research about community participation has evolved in the last 25 years, with new methods for quantitative approaches mixed with qualitative insights, contrasting with the ethnographic and sociological approaches used in the past.
In this interview with Susan Rifkin of the London School of Economics and London School of Hygiene & Tropical Medicine, she talks about the past and future of community participation and community participation research. Community participation, she argues, cannot be limited to an intervention; the next big challenge of research will be to understand the processes that tie community participation and health outcomes. She points to a growing recognition by policy makers that community participation is critical and necessary but not sufficient for improvement of the health of the populations. As communities become aware of their rights and their obligations, they become in a much better position to negotiate policy and the provision of services with policy-makers, she argues. At this moment most research views community participation as an intervention and therefore uses a natural scientific paradigm to look at it linearly as a causal effect. This approach is inductive and very narrow; direct causes have effects. Instead, Rifkin calls for a closer investigation of processes and how community monitoring leads to better health outcomes. The other question about the research in this area is how we address issues around power and control, key to community ownership of health programmes.