These guidelines aim to assist practitioners and implementing partners to run community-based worker (CBW) systems more effectively, maximising impacts for clients of the service, empowering communities, empowering the CBWs themselves, and assisting governments to ensure that services are provided at scale to enhance livelihoods. They are aimed at practitioners in government, civil society or the private sector already involved or interested in the practical application of community-based worker models. Topics include the generic components of the CBW system, deciding where to use a CBW approach, preparing for implementation and operationalising the CBW system. Descriptions are provided for the different elements of the system, along with step-by-step guidance.
Governance and participation in health
The aim of the Round Table was to build upon the work of the Advisory Group on Civil Society and Aid Effectiveness (AG-CS). A first point of consensus to emerge from RT6 was recognition of the many roles of civil society, and of the importance and value of civil society organisations (CSOs) as development actors in their own right and as aid recipients, donors and partners. A way forward was proposed, involving donors, governments, and CSOs themselves, and shared leadership for different aspects of this work. It includes working together to provide a more enabling environment for CSOs, working on how CSOs can develop more effective partnerships with each other, including North- South, South-South, global networks and national umbrella organisations, offering support for the CSO-led Open Forum for CSO Development Effectiveness and preparing the ground for CSO engagement in the High-Level 4, ensuring that a multi- stakeholder perspective on CSO effectiveness is a major theme of HLF4.
Malawi is poised to drastically expand safety nets to orphans and their families, and this study will provide an important foundation for this process. The study analysed nationally representative data from 27,495 children in the 2004–2005 Malawi Integrated Household Survey. It found that friends and relatives provided assistance to over 75% of orphan households through private gifts, but organised responses to the orphan crisis were far less frequent. Over 40% of orphans lived in a community with support groups for the chronically ill and about a third of these communities provided services specifically for orphans and other vulnerable children. Public programmes, which form a final safety net for vulnerable households, were more widespread. Free/subsidised agricultural inputs and food were the most commonly used public safety nets by children's households in the past year and households with orphans were more likely to be beneficiaries.
Proposed reforms to the way the World Bank is governed tinker at the edges, promising only marginal improvements for developing countries; critics are stepping up the pressure for a fundamental rethink. The World Bank board will discuss a package of reforms to the way the Bank is governed at its annual meetings in October, hoping to agree a concrete set of actions by next spring. Despite calls from developing countries, civil society and others for root and branch change to address the Bank's gaping deficits in democracy, legitimacy and accountability, the proposals are uninspiring.
The Paris Declaration flags civil society organisations as potential participants in identifying priorities and monitoring development programmes. But it does not recognise them as development actors in their own right, with their own priorities, programmes and partnership arrangements and fails to take into account the rich diversity of social interveners in democratic societies. Human rights principles and standards should be upheld and promoted to achieve Paris Declaration targets and indicators, including scaling up aid, reorganisation of partner countries’ institutions, procedures and national priorities, and meaningful and inclusive citizen-based ownership. As nationally determined priorities become the centerpiece of development assistance, it becomes critical to assess which processes are needed to negotiate them and how legitimate and transparent such processes need be. This requires a focus on the quality of relationships between citizens and states, and the associated processes and mechanisms fundamental to achieving meaningful and inclusive national ownership.
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.
This paper explores the implications of the increasing role of informal as well as formal markets in the health systems of many low and middle-income countries. It focuses on institutional arrangements for making the benefits of expert medical knowledge widely available in the face of the information asymmetries that characterise health care. The paper argues that social arrangements can be understood as a social contract between actors, underpinned by shared behavioural norms, and embedded in a broader political economy. This contract is expressed through a variety of actors and institutions, not just through the formal personnel and arrangements of a health sector. Such an understanding implies that new institutional arrangements, such as the spread of reputation-based trust mechanisms can emerge or be adapted from other parts of the society and economy. The paper examines three relational aspects of health systems: the encounter between patient and provider; mechanisms for generating trust in goods and services in the context of highly marketised systems; and the establishment of socially legitimated regulatory regimes. This analysis is used to review experiences of health system innovation and change from a number of low income and transition countries.
The author of this paper argues that corruption in public procurement is the chief cause of poverty in Africa. It is fostered by poor governance and weak legislation and may be costing the continent up to US$148-billion a year. Yet it can be countered if there is the will and skill to do so. Combatting corruption in public procurement is a multi-faceted problem, which requires a comprehensive package of measures to be implemented concurrently. The author presents proposals for this: The first line of defence is to ensure a sound legal framework that incorporates an anti-corruption law with real authority and effective sanctions. An explicit commitment to eradicate corruption in all forms must be made at the highest level of government. To keep clients and officials accountable, a comprehensive legal and regulatory framework governing public procurement must be implemented. There should be transparency and accountability for all in the bidding process, as well as public service reforms.
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.
Improving quality of primary care is a key focus of international health policy. Two methods of improving the quality of interpersonal care in primary care have been proposed. One involves the feedback of patient assessments of interpersonal care to physicians, and the other involves brief training and education programmes. This study therefore reviewed the efficacy of (i) feedback of real patient assessments of interpersonal care skills, (ii) brief training focused on the improvement of interpersonal care and (iii) interventions combining both (i) and (ii). Nine studies were included (two patient based feedback studies and seven brief training studies). Of the two feedback studies, one reported a significant positive effect. The authors conclude that there is limited evidence concerning the effects of patient based feedback. There is reasonable evidence that brief training as currently delivered is not effective, although the evidence is not definitive, due to the small number of trials and the variation in the training methods and goals.