Governance and participation in health

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.


In a response to pressures from civil society organisations (CSOs) internationally, especially through the People's Health Assembly held in Dhaka in December 2000, the World Health Organisation (WHO) has finally conceded the importance of engaging with CSOs. Commenting on the formation of the WHO Civil Society Intiative, Eva Wallstam, Director, said: "This is a time when the Health for All core values of equity, dignity and human rights, need to be more clearly articulated ... For WHO this means reaching out, beyond the formal health sector to other partners and to a wide range of civil society actors." The full text of her speech is available below.

Further details: /newsletter/id/28765
WHO criticised for not following policy on recognising NGOs
Rema Nagarajan: Times of India, Jan 31 2014

Civil society groups have expressed disappointment with the number of "industry groupings" that have "incorrectly gained NGO status" with the World Health Organization (WHO). There are 187 organizations or networks recognized as NGOs in official relations with the WHO. According to the International Baby Food Action Network (IBFAN), a new entrant into this WHO list of NGOs, industry groups which have been recognized as NGOs by WHO include Croplife International (representing Monsanto, Syngenta, Bayer, CropScience, Dow Agrosciences, DuPont and other companies promoting GMO technologies ) the International Federation of Pharmaceutical Manufactures and Associations, International Life Sciences Institute (representing Nestle, Coca Cola, Kellogg, Pepsi, Monsanto, Ajinomoto, Danone, General Mills and others) and the Industry Council for Development (representing Nestle, Mars, Unilever and Ajinomoto). "All are guided by market profit-making logic (whose primary interest clashes with that of WHO). Their inclusion goes against WHO's current NGO policy," said a statement issued by IBFAN.

Further details: /newsletter/id/38870
WHO debate over proposed reform agenda and priority-setting
Gopakumar KM and Wanis H: Third World Network, 2 November 2011

The World Health Organisation (WHO) Director-General’s proposal for reform of WHO has sparked controversy among WHO Member States, resulting in a meeting of the Executive Board (EB) convened on 1-3 November 2011. Member States expressed concern over the speed of the reform process; lack of information, analyses and independent evaluation to guide the reform; WHO's donor-driven approach and growing partnerships; the scope of independent evaluation; and proposals to limit WHO's scope. The EB meeting decided to establish a process for priority-setting of WHO's programme activities as part of the reform agenda, advocating a Member-driven process for priority-setting of the WHO programme, urging the Director-General not to be too hasty in pushing for the reforms until proper consultation with Member States had been made.

WHO Drafting Group established on “non-state actors” engagement
Gopakumar KM, Shashikant S: TWN Info Service, May14/05

A drafting group has been set up to finalize the draft framework for the World Health Organization’s engagement with non-state actors (NSA framework). This decision made by WHO Member States at the 67th session of the World Health Assembly (WHA) was due to the divergent opinions with regard to the way forward on the NSA framework. The session is meeting from 19 to 24 May at the WHO headquarters in Geneva. Many developing countries such as Brazil, Bolivia, India, Pakistan, and the Union of South American Nations (UNASUR) expressed the view that the draft policy does not contain details to address concerns related to conflict of interest issues, modalities in accepting resources from NSAs, or staff secondment from NSAs.

Further details: /newsletter/id/38996
WHO Framework of engagement with non-state actors (FENSA)
People's Health Movement: Youtube, 5 February 2016

This video shows a recording of the statement made by People's Health Movement and Medicus Mundi International at the Executive Board 138 of the World Health Organisation (WHO) in January 2016. In it they highlight their assertion that the FENSA proposal constitutes a Trojan horse, which will legitimise the influence of private sector interests in WHO decision-making. They argue that FENSA is symbolic of a more fundamental issue - that of WHO’s independence - which is compromised by its financial crisis, lack of member contributions and crippling dependency on tightly earmarked voluntary contributions. They call for the WHO to have strong safeguards to protect it from undue influence from funders and conflicts of interests on the part of industry partners and a robust conflict of interest policy should also include appropriate protection of whistleblowers.

Who Really Governs Urban Ghana?
Awal M; Paller J: Africa Research Institute, UK, 2016

In the past three decades in Ghana, the number of city dwellers has risen from four to 14 million; more than 5.5 million of whom live in slums. Urban growth exerts intense pressure on government and municipal authorities to provide infrastructure, affordable housing, public services and jobs. It has exacerbated informality, inequality, underdevelopment and political patronage. Some commentators warn of an impending urban crisis. Policymakers and international donors continue to prescribe better urban planning, slum upgrading, infrastructure investment and “capacity building” to “fix” African cities. While these are necessary, the authors argue that the success of any urban strategy depends on an informed appraisal of the political dynamics of urban neighbourhoods that define governance in Ghana’s cities and slums, in the interaction between politicians, entrepreneurs, traditional authorities and community leaders. The authors note that informal networks pervade formal political institutions and shape political strategy, and that political clientelism and the role of informal institutions are deepening alongside the strengthening of formal democratic institutions, but are often overlooked.

WHO reform undermines democratic participation and transparency
International Baby Food Action Network and the Third World Network: May 2012

The International Baby Food Action Network and the Third World Network review the World Health Organisation’s (WHO) reform process from a civil society perspective. (The WHO DG report on the reform is also included in this newsletter). The organisations argue that the reform process has not been transparent, as the Secretariat has withheld vital documents, such as the reports by consultants used to develop the reform agenda. With regard to stakeholders, they argue that it is important that WHO identifies the different types of social, political and economic actors with which it interacts and clearly distinguishes those that are related to commercial interests. The organisations refer to the WHO 12th General Programme of Work (GPW) as a sign of its direction, noting the unclear includion of work on the right to health, social determinants of health, primary health care and gender equality.

WHO reform: Consolidated report by the Director-General
Chan M: 25 April 2012

This report covering all aspects of World Health Organisation (WHO) reform was commissioned by the WHO for submission to the 65th World Health Assembly in May 2012. It addresses the three substantive areas of WHO reform: programmes and priority setting, governance and management. First,with regard to programmes and priority setting, the draft general programme of work, as it is developed over coming months, will demonstrate: how agreed criteria have been used to identify priorities; how high-level goals have been set; and how WHO’s core functions, comparative advantage and organisational position have been used to focus its the work. Guidance from Member States will influence the development of a first full draft for discussion by the regional committees later in 2012. Next, the section on governance consolidates proposals under four main headings: more rational scheduling, alignment and harmonisation of governance processes; strengthening oversight; more strategic decision- making by governing bodies; and more effective engagement with other stakeholders. The focus of recent work has been the internal governance of WHO by Member States. More detailed work and consultation is called for in relation to the streamlining of national reporting to WHO as well as engagement with other stakeholders. Finally, the management chapter has been reorganised to reflect the fact that stronger technical, normative and policy support for all Member States should be a key outcome of reform.