Governance and participation in health

‘Civil society needs to be vigilant’: interview with Elizabeth Thompson, Assistant Secretary-General and Executive Coordinator, Rio+20
CIVICUS: February 2012

In this interview the Assistant Secretary-General and Executive Coordinator for the United Nations Conference on Sustainable Development discusses issues related to the upcoming conference to be held in Rio de Jainero, Brazil on 20-22 June 2012 (Rio+). She identifies major sustainability challenges facing the world including economic sustainability, indicating that the global financial and economic system should not be characterised by boom and bust cycles, global, regional and local inequities, poor accountability and decreased civil society engagement, and the continuation of poverty, particularly among women and girls. She reported feeling positive about the potential for Rio+ to provide a platform for countries to evaluate environmental problems and craft solutions tailor-made for different countries. She argued that civil society’s role is invaluable in working at every level of society and educating companies and communities on the importance of sustainable development. Civil society needs to play a role in helping to develop new initiatives which will deliver on sustainability and most of all, civil society needs to be vigilant in ensuring that countries commit to sustainability and continue along the pathway they have defined to achieve it.

‘Health for all' must be people- and community-centred
Carasso B and Balabanova D: The Broker, 6 May 2009

How can the recent change in global health policy to provide ‘health for all’ be translated into action, in order to achieve some real and sustained impact on the ground and successfully reduce inequities in health? The authors have three suggestions. Ask what is needed: the answers to what is really needed cannot be found in Geneva or Washington, but ultimately lie with the people and communities themselves. Put the money where the needs are: if we know what people are suffering from and match available human and financial resources accordingly, even a little money can go a long way. Work together: initiatives like the recently launched International Health Partnership aim to strengthen health systems and to ensure that resources invested are spent in equitable and sustainable manner. This represents a shift from vertical, disease-specific models of funding, to horizontal system-building according to long-term strategies.

‘Prejudiced’ Home Office refusing visas to African researchers
Grant H: The Guardian, June 2019

The UK Home Office is reported to be accused of institutional racism and to be damaging British research projects through increasingly arbitrary and “insulting” visa refusals for African academics. In April, a team of six Ebola researchers from Sierra Leone were unable to attend vital training in the UK, funded by the Wellcome Trust as part of a £1.5m flagship pandemic preparedness programme. At the LSE Africa summit, also in April, 24 out of 25 researchers were missing from a single workshop. Shortly afterwards, the Save the Children centenary events were marred by multiple visa refusals of key guests. The article refers to a parliamentary inquiry into visa refusals hearing evidence that there is “an element of systemic prejudice against applicants”. In a letter in the Observer, 70 senior leaders from universities and research institutes across the UK warn that “visa refusals for African cultural, development and academic leaders … [are] undermining ‘Global Britain’s’ reputation as well as efforts to tackle global challenges”. The system is reported to be so difficult to predict or navigate that meetings, including conferences funded with British government money, are now being held in other countries.

“by seeing with our own eyes, it can remain in our mind.”: Evidence of participatory video's ability to reduce gender-based violence in conflict-affected settings
Gurman T, Trappler R, Acosta A, Cooper C, Goodsmith L: 141st APHA Annual Meeting, November 2013

Although gender-based violence (GBV) exists worldwide, it is especially pervasive and challenging in conflict-affected settings. The breakdown of the family unit, high population density, and lack of community safeguards pose obstacles to implementation of GBV prevention programs. Unfortunately, little evidence exists regarding effective GBV prevention interventions in these settings. Through Our Eyes (TOE), a multi-year participatory video project, addressed GBV by stimulating community dialogue and action in humanitarian settings in South Sudan, Uganda, Thailand, Liberia and Rwanda. The authors used evidence from transcripts from focus group discussions and key informant interviews with individuals who created the videos to those who attended video screenings. Data was analysed using a Grounded Theory approach. The assessment found that TOE contributed to a growing awareness of women's rights and gender equity. Furthermore, both men and women reported attitudinal and behavioural changes related to topics such as intimate partner violence. The fostered community dialogue helped de-stigmatize GBV and encourage survivors to access services. Participatory video is argued to have the ability to tailor messages to specific community needs, engage men as key players, foster community dialogue, and initiate social change related to GBV in a variety of conflict-affected settings. The authors argue that public health professionals should employ participatory video as an innovative technique to address GBV and promote positive gender norms within conflict-affected and other humanitarian settings.

“We are toothless and hanging, but optimistic”: sub county managers’ experiences of rapid devolution in coastal Kenya
Nyikuri M; Tsofa B, Okoth P; et al.: International Journal for Equity in Health 16(113)1-11, 2017

This study presents qualitative research to examine the early experiences of devolution in the health sector in Kenya in March 2013. The authors observed a diverse range of management meetings, support supervision visits and outreach activities involving sub-county managers between May 2013 and June 2015, and conducted interviews with purposively selected sub-county managers from three sub-counties. The authors found that sub county managers as with many other health system actors were anxious about and ill-prepared for the unexpectedly rapid devolution of health functions to the newly created county government. They experienced loss of autonomy and resources and confused lines of accountability within the health system. The study illustrates the importance in accelerated devolution contexts for: mid-level managers to adopt new ways of working and engagement with higher and lower levels in the system; clear lines of communication during reforms to these actors and anticipating and managing the effect of change on intangible software issues such as trust and motivation. More broadly, the authors show the value of examining organisational change from the perspective of key actors within the system, and highlight the importance in times of rapid change of drawing upon and working with those already in the system. These actors have valuable tacit knowledge, but tapping into and building on this knowledge to enable positive response in times of health system shocks requires greater attention to sustained capacity building within the health system.

“We come as friends”: approaches to social accountability by health committees in Northern Malawi
Lodenstein E; Molenaar J; Ingemann C; Botha K; et al: BMC Health Services Research 19(279) 1-14, 2019

This study explores how health facility committees monitor the quality of health services and how they demand accountability of health workers for their performance in Malawi. Documentary analysis and key informant interviews were complemented by interviews with purposefully selected health facility committees members and health workers regarding their experiences with health facility committees. The informal and constructive approach that most health facility committees use is shaped both by formal definition and expectations of their role and resource constraints. The primary social accountability role of health facility committees appeared to be co-managing the social relations around the health facility and promoting access to and quality of services. The results suggest that health facility committees can address poor health worker performance and the authors suggest that social accountability approaches with health facility committees be integrated in existing quality of care programs and that accountability arrangements and linkages with upward accountability approaches be clarified.