Governance and participation in health

What communities want: Putting community resilience priorities on the agenda for 2015
Community Practitioners Platform for Resilience: May 2013

This action research is an effort to capture the voices of community leaders and bring the resilience priorities of poor, disaster-prone communities into debates that will shape the new policy frameworks on disaster risk reduction to be launched in 2015. For the most part members of poor, disaster-prone neighbourhoods worst affected by natural hazards and climate change are absent from current consultations. Yet, it is these communities whose survival and wellbeing will be most affected by the policies and programmes that emerge from these debates. Five recommendations emerged from this study. 1. Invest in community-led transfers to scale up effective resilience practices. 2. Incentivise community-led, multi-stakeholder partnerships; create mechanisms that formalise community roles in government programmes to make them more responsive and accountable to community resilience priorities. 3. Foster community organising and constituency building in addition to technical know-how for building resilience. 4. Set aside decentralised, flexible funds to foster multi-dimensional community resilience building efforts. 5. Recognise grassroots women’s organisations and networks as key stakeholders in planning, implementing and monitoring resilience programmes.

What is postcolonial thinking? An interview with Achille Mbembe
Mbembe A: African Health Sciences 11(1):2011

Talking to French magazine Esprit, theorist Achille Mbembe discusses a postcolonial thinking that has developed in a transnational, eclectic vein, enabling a specific take on globalization. He outlines three cardinal moments in the development of postcolonial thought. The first, of anti-colonial struggles, included the self-reflection by people of their colonization and debates on the relationship between class and race as factors. The discourse centred on the politics of autonomy, to acquire citizen status and, thereby, to participate in the universal. The second moment, around the 1980s, he outlines as the moment of "high theory", with new thinking on knowledge about modernity. This understood the colonial project beyond its military-economic system, to one that was underpinned by a discursive infrastructure and a whole apparatus of knowledge the violence of which was as much epistemic as it was physical. The second post colopnial discourse sought to recover the voices and capabilities of decolonization's rejects (peasants, women, underprivileged people) and to better understand why the anti-colonial struggle led not to a radical transformation of society. Mbembe argues also argues that it sought to expose the procedures by which individuals are subjugated to categories of race and class that block access to the status of subject in history. In the third moment, Mbembe argues that globalisation has, as for colonial capitalism, subjugated living spheres to economic appropriation, and that the "colony" was in fact a laboratory for the wider authoritarian destiny of today’s globalisation. He proposes that in this context the reinvention of politics in postcolonial conditions first requires people to reinvent their place in history, not in a logic of repeating the same violence as vengeance, but in a demand for a justice that supports an "ascent in humanity“.

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 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 ‘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.

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