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.
Governance and participation in health
Who should control the Bank? Rich countries keep their thumbs on the scales
Heighwaybury R: Bretton Woods News, 29 September 2008
A critical appraisal of the Paris Declaration
Mutasa C: e-CIVICUS 404, 29 August 2008
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.
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.
Markets, information asymmetry and health care: Towards new social contracts
Bloom G, Standing H and Lloyd R: Social Science and Medicine 66(10):2076-87, May 2008
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.
Preventing corruption in African procurement
Mawenya AS: South African Institute of International Affairs Paper 9, August 2008
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.
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.
Can the feedback of patient assessments, brief training, or their combination, improve the interpersonal skills of primary care physicians? A systematic review
Cheraghi-Sohi S, Bower P: BMC Health Services Research 8(179), 21 August 2008
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.
Civil society influence on national governance
Idasa, Economic Governance Programme, August 2008
This report covers the Civicus Participatory Governance Programme: How can we build political for participatory governance, 17-18 June 2008. Although participatory governance offers important concrete benefits for citizens and state actors alike, there is often initial resistance from political actors and government offiicals who are unfamiliar with such approaches. This small working group session involved three case studies which describe and analyse Civil Society Organisation approaches to building political will for participatory governance.
Community approaches to preventing mother-to-child HIV transmission: Perspectives from rural Lesotho
Towle M and Lende DH: African Journal of AIDS Research 7(2): 219–228, 2008
This paper examines the cultural and structural difficulties surrounding effective prevention of mother-to-child HIV transmission (PMTCT) in rural Lesotho. It argues for three strategies to improve PMTCT interventions: community-based research and outreach, addressing cultural and structural dynamics, and working with the relevant social groups that impact on HIV prevention. These conclusions are based on interviews and participant observation conducted within the rural Mokhotlong district and capital city of Maseru, involving women and men of reproductive age, grandmothers serving as primary caretakers, HIV and AIDS programme staff and medical professionals. Qualitative analysis focused on rural women's socio-medical experience with the four measures of PMTCT (educational outreach, voluntary counselling and testing, antiretroviral interventions and safe infant feeding). Based on these results, the paper concludes that intervention models must move beyond a myopic biomedical ‘best-practices' approach to address the social groups and contextual determinants impacting on vertical HIV transmission. Given the complexities of effective PMTCT, our results show that it is necessary to consider the biomedical system, women and children, and the community as valuable partners in achieving positive health outcomes.
How to facilitate community-led total sanitation
Kar K and Chambers R: Plan International, 2008
Community-led total sanitation (CLTS) is a participatory process focused on promoting change in sanitation behaviour through social action - stimulated by facilitators from within or outside the community. Aimed at empowering local communities this handbook is a source of ideas and experiences to be used for CLTS orientation workshops, advocacy to stakeholders as well as for implementing CLTS activities. It is intended as a tool for field staff, facilitators and trainers to plan, implement and follow up on CLTS activities. A sequence of possible steps and tools, including do’s and don’ts, are provided to help trigger CLTS in a community. They include pre-triggering, selecting a community, introduction and building rapport, triggering participatory sanitation, profile analysis, ignition moment, post-triggering action, planning by the community, follow up, scaling up and going beyond CLTS. Users are encouraged to use and modify the processes outlined in this handbook as they see fit for their given context.