Governance and participation in health

What is the evidence on effectiveness of empowerment to improve health?
Wallerstein N, Health Evidence Network

A new report from the Health Evidence Network shows that empowering socially excluded populations is a viable strategy for improving health. While participatory processes make up the base of empowerment, strategies must also build community organizations and individuals capacity to participate in decision-making and advocacy.

What is the evidence on effectiveness of empowerment to improve health?
WHO Regional Office for Europe -Health Evidence Network Report

A new report from the Health Evidence Network shows that empowering socially excluded populations is a viable strategy for improving health. While participatory processes make up the base of empowerment, strategies must also build community organizations and individuals capacity to participate in decision-making and advocacy.

What is ‘global health diplomacy’? A conceptual review
Lee K and Smith R: Global Health Governance V(1) (Fall 2011), 21 November 2011

While global health diplomacy (GHD) has attracted growing attention, accompanied by hopes of its potential to progress global health and/or foreign policy goals, the concept remains imprecise. This paper finds the term has largely been used normatively to describe its expected purpose rather than distinct features. This paper distinguishes between traditional and “new diplomacy”, with the latter defined by its global context, diverse actors and innovative processes. The authors point to need to strengthen the evidence base in this rapidly evolving area.

What makes for effective anti-corruption systems?
Camerer M: South African Institute of International Affairs Paper 10, August 2008

Drawing on international best practice, this paper argues that a number of conditions are required to ensure that anti-corruption reforms in any context are effective, sustainable and not easily subverted. These conditions include having the necessary data to inform policy and strategy, comprehensive legal and institutional safeguards to prevent corruption and protect public interest, and the necessary political leadership and will to tackle corruption credibly and put in place long-term reforms. It is clear that to be effective, national anti-corruption/integrity systems require more than a single agency approach. Rather, they need to be supported by an institutional matrix of legal and oversight systems to ensure effective prosecution of offenders. Partnerships, including active engagement by civil society and the media, are also important. Above all, reforms need to be implemented by ethical leaders who scrupulously observe the rule of law.

What Matters Most? Evidence from 84 Participatory Studies with Those Living with Extreme Poverty and Marginalisation
Leavy J and Howard J: Institute for Development Studies, July 2013

This report draws on the experiences and views of people living in extreme poverty and marginalisation in 107 countries. The authors distil messages from 84 participatory research studies published in the last seven years. Forty-seven of these studies are based on creative material coming from visual participatory methods. Their findings show that a development framework post-2015 will have legitimacy if it responds to the needs of all citizens, in particular those who are most marginalised and face ongoing exclusion from development processes. The framework has to incorporate shared global challenges and have national level ownership if it is to support meaningful change in the lives of people living in poverty. The authors first focus on understanding the lessons learnt from people's experiences of predominantly international development assistance, before they merge these findings with learning from the second phase of the synthesis, adding a substantive focus on national and local level policy and development planning and how relationships, and accountability between citizens and governance institutions at these levels can be strengthened through the active engagement of those most marginalised in decision-making.

When ‘solutions of yesterday become problems of today’: crisis-ridden decision making in a complex adaptive system (CAS): the additional duty hours allowance in Ghana
Agyepong IA, Kodua A, Adjei S and Adam T: Health Policy and Planning 27 (suppl): Iv20–iv31, 27 September 2012

Implementation of policies (decisions) in the health sector is sometimes defeated by the system’s response to the policy itself. This can lead to counter-intuitive, unanticipated, or more modest effects than expected by those who designed the policy. The health sector fits the characteristics of complex adaptive systems (CAS) and complexity is at the heart of this phenomenon. Anticipating both positive and negative effects of policy decisions, understanding the interests, power and interaction between multiple actors and planning for the delayed and distal impact of policy decisions are essential for effective decision making in CAS. Failure to appreciate these elements often leads to a series of reductionist approach interventions or ‘fixes’. This in turn can initiate a series of negative feedback loops that further complicates the situation over time. In this paper, researchers use a case study of the Additional Duty Hours Allowance (ADHA) policy in Ghana to illustrate these points. Using causal loop diagrams, they unpack the intended and unintended effects of the policy and how these effects evolved over time. The overall goal is to advance our understanding of decision making in complex adaptive systems; and through this process identify some essential elements in formulating, updating and implementing health policy that can help to improve attainment of desired outcomes and minimise negative unintended effects.

When ‘solutions of yesterday become problems of today’: Crisis-ridden decision making in a complex adaptive system (CAS): The Additional Duty Hours Allowance in Ghana
Agyepong IA, Kodua A, Adjei S and Adam T: Health Policy and Planning 27 (suppl): iv20–iv31, 27 September 2012

Implementation of policies (decisions) in the health sector is sometimes defeated by the system’s response to the policy itself. This can lead to counter-intuitive, unanticipated, or more modest effects than expected by those who designed the policy. The health sector fits the characteristics of complex adaptive systems (CAS) and complexity is at the heart of this phenomenon. Anticipating both positive and negative effects of policy decisions, understanding the interests, power and interaction between multiple actors and planning for the delayed and distal impact of policy decisions are essential for effective decision making in CAS. Failure to appreciate these elements often leads to a series of reductionist approach interventions or ‘fixes’. This in turn can initiate a series of negative feedback loops that further complicates the situation over time. In this paper, researchers use a case study of the Additional Duty Hours Allowance (ADHA) policy in Ghana to illustrate these points. Using causal loop diagrams, they unpack the intended and unintended effects of the policy and how these effects evolved over time. The overall goal is to advance our understanding of decision making in complex adaptive systems; and through this process identify some essential elements in formulating, updating and implementing health policy that can help to improve attainment of desired outcomes and minimise negative unintended effects.

Where do the three candidates for the next WHO Director General stand on the most challenging global health issues of the decade?
AE Birn, YG Pillay, TH Holtz: PLOSBLOGS, 4 May 2017

PLOSBLOGS hosted a question and answer with the three final candidates for the World Health Organisation (WHO) Director General being directly elected by countries in the 2017 World Health Assembly. The article provides the questions and interview responses in full. The authors note in an analysis of the candidates’ responses that none of the candidates discussed issues of social justice in their responses regarding the societal determinants of health or mentioned the recommendations of the WHO Commission on Social Determinants of Health on global power asymmetries, specifically the need to “tackle the inequitable distribution of power, money, and resources.” In terms of the role of non-state actors in neutering public accountability at WHO, none of the candidates articulated the intrinsic differences in power and access between public-interest entities and corporate/philanthropic actors under the non-state actor rubric. All three seem to think FENSA will resolve the problems of private influence on the WHO agenda, which the authors of the article doubt. To improve health and health equity, all three candidates invoked Universal Health Coverage without specifying the role of public provision, comprehensive coverage, and equity in access, quality, and financing for health care systems. In relation to health equity and social determinants of health, all three candidates mentioned intersectoralism and social inclusion, partnerships, and WHO technical expertise, but did not give attention to the political context of these challenges.

Where next? US-Africa foreign relations under a second term
This is Africa: 16 January 2013

While Barack Obama’s re-election has been met with enthusiasm across Africa, the article reports that many are frustrated about a lack of delivery on past promises. Where does Africa fit into the new administration’s foreign policy? The author argues that Obama’s current rhetoric about Africa makes generalisations about common aspirations, opportunity and African potential. He asserts that future engagement with African countries may be focused on the New Alliance for Food Security and Nutrition, part of the G8 plan to boost food production in Africa by introducing large-scale, mechanised agriculture with genetically modified crops. The author poses that this is expected to impact negatively on small-scale farmers and possibly increase food insecurity.

Who Are We To Care? Exploring the Relationship between Participation, Knowledge and Power in Health Systems
Kaim B: TARSC and COPASAH, April 2013

This paper is aimed at those who work as health facilitators and activists at community level, civil society organisations, government personnel and anyone else interested in the rights of ordinary citizens to participate in decisions and have access to the resources that determine the way their country’s health system functions. The paper is divided into three sections: The first focuses on how the interaction between people’s participation, knowledge and power effects the functioning of health systems. The following section pays particular attention to approaches we can use to build a more just and equitable health system. The final section concludes by asking a series of questions to provoke and deepen our thinking on ways we can overcome obstacles to achieving this goal, at both community level and as we move from the local to the global as a strategy for change. Each section blends discussion on concepts and issues with descriptions of experiences and case studies from around the globe, especially from countries in Latin America, Asia and east and southern Africa, where a wealth of material describes the impact of neoliberalism and globalisation on health systems, and attempts to build alternatives.

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