Governance and participation in health

Assessing the impact of health centre committees on health system performance and health resource allocation

This study sought to analyse and better understand the relationship between health centre committees in Zimbabwe as a mechanism of participation and specific health system outcomes, including: Improved representation of community interests in health planning and management at health centre level; Improved allocation of resources to health centre level, to community health activities and to preventive health services; Improved community access to and coverage by selected priority promotive and preventive health interventions; Enhanced community capabilities for health (through improved health knowledge and health seeking behaviour, appropriate early use of services); Improved quality of health care as perceived both by providers and users of services.

Assessing the incremental effects of combining economic and health interventions: the IMAGE study in South Africa
Kim J, Ferrari G, Abramsky T, Watts C, Hargreaves J, Morison L, Phetla G, Porter J and Pronyk P: Bulletin of the world Health Organization 87(11):824-32, November 2009

This study's aim was to explore whether adding a gender and HIV training programme to microfinance initiatives can lead to health and social benefits beyond those achieved by microfinance alone. Cross-sectional data were derived from three randomly selected matched clusters in rural South Africa. Adjusted risk ratios (aRRs) employing village-level summaries compared associations between groups in relation to indicators of economic well-being, empowerment, intimate partner violence (IPV) and HIV risk behaviour. The magnitude and consistency of aRRs allowed for an estimate of incremental effects. A total of 1,409 participants were enrolled, all female, with a median age of 45. After two years, both the microfinance-only group and the IMAGE group showed economic improvements relative to the control group. However, only the IMAGE group demonstrated consistent associations across all domains with regard to women's empowerment, intimate partner violence and HIV risk behaviour. In conclusion, the addition of a training component to group-based microfinance programmes may be critical for achieving broader health benefits. Donor agencies should encourage intersectoral partnerships that can foster synergy and broaden the health and social effects of economic interventions such as microfinance.

Assessing the promise of user involvement in health service development: Ethnographic study
Fudge N, Wolfe CDA, Mckevitt C: British Medical Journal, 29 January 2008

This study set out to understand how the policy of user involvement is interpreted in health service organisations and to identify factors that influence how user involvement is put into practice. The design was that of an ethnographic study using participant observation, interviews, and collection of documentary evidence. Set in a multiagency modernisation programme to improve stroke services in two London boroughs, participants comprised of service users, National Health Service managers, and clinicians. Author conclusions include that user involvement may not automatically lead to improved service quality. Healthcare professionals and service users understand and practise user involvement in different ways according to individual ideologies, circumstances, and needs. Given the resource implications of undertaking user involvement in service development there is a need for critical debate on the purpose of such involvement as well as better evidence of the benefits claimed for it.


This is a handbook to help planners and implementors look at the effectiveness of their BCC interventions. Implementors can use the handbook to help them monitor, since the handbook can point out both strengths and potential weaknesses of an ongoing intervention. The handbook can also be used as a planning tool because it highlights important points for the design and development of effective BCC programming.

At G20 Summit, civil society demands 'People First, Not Finance'
Fatoorehchi C: Inter Press Services, 4 November 2011

Led by the slogan ‘People First, Not Finance’, the People’s Forum held in November raised that the G20’s ‘cosmetic’ economic solutions to the global recession in 2008 would do little to ease the cyclical problems of the financial system, adding that much deeper, structural changes were required to address global inequity. It argued that the G20 will only increase the ‘financialisation’ of this world, instead of fundamentally changing it. The forum raised that social movements ranging from the ‘Occupy’ protests in Wall Street in the United States to the ongoing demonstrations in Tahrir Square need to ‘coordinate, exchange views' towards this deeper structural change.

Attitudes of Gatekeepers Towards Adolescent Sexual and Reproductive Health in Ghana
Kumi-Kyereme A, Awusabo-Asare K, Darteh EKM: African Journal of Reproductive Health 18(3), September 2014

Adults constitute gatekeepers on adolescent sexual and reproductive health (ASRH). This qualitative paper discusses the views of adults on ASRH problems and challenges based on 60 in-depth interviews conducted among adults in Ghana in 2005. Adults were purposively selected based on their roles as parents, teachers, health care providers and community leaders. The major ASRH problems mentioned were teenage pregnancy and HIV/AIDS. The results indicated a number of challenges confronting ASRH promotion including resistance from parents, attitudes of adolescents, communication gap between adults and adolescents and attitudes of health care providers. Among health workers three broad categories were identified: those who were helpful, judgmental and dictators. Some adults supported services for young people while others did not. Some served as mediators and assisted to ‘solve’ ASRH problems, which occurred in their communities. It is argued that exploring the views of adults about their fears and concerns will contribute to the development of strategies and programmes which will help to improve ASRH,

AU Summit reaches hard-won consensus on a new African Union Authority
African Union: July 2009

At their meeting in Sirte, Libya, held from 1–3 July, nearly half of the 53 African Union (AU) heads of state and government reached consensus to establish the African Union Authority to replace the African Union Commission. Libyan Leader Mouamar Kadhafi, supported by Senegal’s President Abdoulaye Wade, argued to speed up continental integration but others, notably Nigeria and Tanzania, argued against it. Commenting on the consensus reached, Jean-Marie Ehouzou, the Benin Foreign Minister noted, ‘African leaders are in agreement with ceding a little of their sovereignty to the AU Authority’. To enter into force, the AU Authority must be approved by the Parliaments of all AU countries. African leaders also discussed the integration of the New Partnership for Africa’s Development (NEPAD) into the organs of the AU and adopted a resolution ending cooperation with the International Criminal Court in the Hague. They also decided to reinforce agriculture and food security and to enlarge the powers of the AU Commission into foreign, trade and defence areas.

Barriers to the participation of people with psychosocial disability in mental health policy development in South Africa: a qualitative study of perspectives of policy makers, professionals, religious leaders and academics
Kleintjes S, Lund C and Swartz L: BMC International Health and Human Rights 13(17), 2013

This paper outlines stakeholder views on environmental barriers that prevent people who live with psychosocial disability from participating in mental health policy development in South Africa. The authors conducted 56 semi-structured interviews with national, provincial and local South African mental health stakeholders between August 2006 and August 2009. Respondents included public sector policy makers, professional regulatory council representatives, and representatives from non-profit organisations (NPOs), disabled people’s organisations (DPOs), mental health interest groups, religious organisations, professional associations, universities and research institutions. Respondents identified three main environmental barriers to participation in policy development: stigmatisation and low priority of mental health, poverty, and ineffective recovery and community supports. The authors conclude that a number of attitudes, practices and structures undermine the equal participation of South Africans with psychosocial disability in society. They call for a human rights paradigm and multi-system approach to enable full social engagement by people with psychosocial disability, including their involvement in policy development.

Better Aid: Civil society position paper for the 2008 Accra High Level Forum on Aid Effectiveness
International Civil Society Steering Group: e-CIVICUS 404, 29 August 2008

Civil society organisations (CSOs) were present in 2005 when the Paris Declaration (PD) on Aid Effectiveness was signed. Since then, diverse national and international CSOs have engaged in tracking this agreement, raised a range of issues and brought in different perspectives, to ensure the framework translates into effective and accountable development processes. In this paper, they argue that the only true measures of aid effectiveness are its contribution to the sustained reduction of poverty and inequality, and its support of human rights, democracy, environmental sustainability and gender equality. Ownership is essential, but must be democratic. They recommend putting an end to all donor-imposed policy conditionality. Donors and Southern governments must adhere to the highest standards of openness and transparency, and support reforms to make procurement systems more accountable, not more liberalised. Finally, the Accra Agenda for Action must recognise CSOs as development actors in their own right and acknowledge the conditions that enable them to play an effective role in development.

Beyond 2008: Global civil society tells UN to fix international drug policy
Drug War Chronicle 543, 18 July 2008

About 300 delegates representing organisations from across the drug policy spectrum met in Vienna for the Beyond 2008 NGO Forum, an effort to provide civil society input on global drug policy. Building on a series of regional meetings last year, the forum was part of an ongoing campaign to reshape the United Nations' drug policy agenda as the world organisation grapples with its next 10-year plan. The NGO meeting, which included drug treatment, prevention, education and policy reform groups, harm reduction groups and human rights groups from around the world, resulted in a resolution that will be presented to the UN Commission on Narcotic Drugs (CND) at its meeting in March 2009. At that meeting, the CND will draft the next UN 10-year global drug strategy.