Sustainable Development Goal Three is rightly ambitious, but achieving it will require doing global health differently. Among other things, the authors argue that progressive civil society organisations will need to be recognised and supported as vital partners in achieving the necessary transformations. The authors argue, using illustrative examples, that a robust civil society can fulfil eight essential global health functions. These include producing compelling moral arguments for action, building coalitions beyond the health sector, introducing novel policy alternatives, enhancing the legitimacy of global health initiatives and institutions, strengthening systems for health, enhancing accountability systems, mitigating the commercial determinants of health and ensuring rights-based approaches. Given that civil society activism has catalysed tremendous progress in global health, there is a need to invest in and support it as a global public good to ensure that the 2030 Agenda for Sustainable Development can be realised. Given that civil society activism has catalysed tremendous progress in global health, the authors consider civic engagement as vital to the transformation promised by the SDGs. The authors recognise the need for further research on role of CSOs in health governance at national and global levels. Many of the leading civil society organisations in global health, as well as those providing direct services, are struggling for survival, due to decreased resources. The authors suggest that this trend will have to be reversed if SDG3 is to be achieved. The historic commitment to finance civil society, made in the 2016 UN Political Declaration on Ending AIDS, recognises both the essential functions CSOs fulfil and the need to support them in doing so.
Governance and participation in health
Closing space for African sexual and gender minority groups is argued by this author to affect access to critical services that no one else provides. In Kenya, for example, the Muslims of Human Rights (MUHURI) provide safe injection sites to prevent the sharing of needles among drug users, as studies show that needle sharing facilitates the spread of HIV. As a result, when the state froze the group's bank accounts, the crackdown also threatened the safety and wellbeing of people who need HIV treatment and care. To fight on their own, many GSM groups have been using the courts to help win victories. Whether it has been appealing the repressive Ugandan anti-gay law, or ordering the un-freezing of bank accounts in Kenya, or ruling against the denial of registration of LEGABIBO (an LGBT rights group in Botswana), most of these court victories are based on constitutionally guaranteed rights and freedoms of most open and democratic countries, and held under the International Declaration of Human Rights. Fostering partnerships with international organizations such as UNAIDS and the UN Human Rights Council has been very helpful for GSM organizations to facilitate their role in service access.
The accountability for reasonableness (AFR) concept has been developed and discussed for over two decades. Its interpretation has been studied in several ways partly guided by the specific settings and the researchers involved. Its potential use in health technology assessments (HTAs) has recently been identified another justification for AFR-based process guidance, but it has also raised concerns from those who primarily support the consistency and objectivity of more quantitative and reproducible evidence. With reference to studies of AFR-based interventions, the authors argue that increasing evidence and technical expertise are necessary but at times contradictory and do not in isolation lead to optimally accountable, fair and sustainable solutions. Technical experts, politicians, managers, service providers, community members, and beneficiaries each have their own values, expertise and preferences, to be considered for necessary buy in and sustainability. They suggest that legitimacy, accountability and fairness do not come about without an inclusive and agreed process guidance that can reconcile differences of opinion and differences in evidence to arrive at a decision.
The author argues that the proposed Framework Convention on Global Health (FCGH) could establish a nuanced, layered, and multi-faceted regime of compliance and accountability to the right to health and strengthen accountability for the health-related Sustainable Development Goals (SDGs). If legally binding, he argues that the FCGH could facilitate accountability through the courts and catalyze comprehensive domestic accountability regimes, requiring national strategies that include transparency, community and national accountability and participatory mechanisms, and an enabling environment for social empowerment. A “Right to Health Capacity Fund” could ensure resources for these strategies. Inclusive national processes could establish targets, benchmarks, and indicators consistent with FCGH guidance, with regular reporting to a treaty body, which could also hear individual cases. State reports could be required to include plans to overcome implementation gaps, subjecting the poorest performers to penalties and targeted capacity building measures. Regional special rapporteurs could facilitate compliance through regular country visits and respond to serious violations. And reaching beyond government compliance, from capacity building to the courts and contractual obligations, the author proposes that the FCGH could establish nationally enforceable right to health obligations on the private sector.
Since the World Health Organisation declared Zika a global public health emergency in February of this year, much attention has been brought to bear on applying lessons learned during the Ebola crisis of 2014-15. This blog draws on the lessons for the health communication sector explored through a new practice briefing from BBC Media Action, Using media and communication to respond to public health emergencies - lessons learned from Ebola, and the unique role media and communications can play in effectively tackling Zika. BBC Media Action has responded to 28 humanitarian emergencies since 1994 – including Ebola. One recurring lesson has been that interventions are most effective if the formats and technologies used to communicate give affected communities a chance to participate and have a voice. This ensures that content reflects local realities, needs and concerns. People need to be told more than just what they should or should not do. They need to be engaged in a discussion around the ‘how’ and the ‘why’.
The Learning Network for Health and Human Rights is a network is a collection of 5 civil society organisations (The Women's Circle, Ikamva Labantu, Epilepsy South Africa, The Women on Farms Project and the Cape Metro Health Forum) as well as 4 higher education institutions (UCT, UWC, Maastricht University, in the Netherlands, and Warwick University in the UK). The network collaborates to explore how collective action and reflection can identify best practice with regard to using human rights to advance health issues. The work of the Learning Network seeks to operationalise the right to health as stated in South Africa’s Constitution and other international treaties and agreements. This is accomplished through a programme in which research, training and advocacy are linked to empower organisations and their members to assert rights for health. One of their latest training materials, this video explores the role of Health Committees from different perspectives – from that of a facility manager, a health care provider, health committee members and patients. It aims to enhance understanding of what Health Committees can do, what the challenges are in building effective health committees and how they can strengthen the health system.
Tech communities are booming all over Africa, says Nairobi-based Juliana Rotich, cofounder of the open-source software Ushahidi. But it remains challenging to get and stay connected in a region with frequent blackouts and spotty Internet hookups. So Rotich and friends developed BRCK, offering resilient connectivity for the developing world. Juliana Rotich is co-founder and executive director of Ushahidi, a nonprofit tech company, born in Africa, that develops free and open-source software for information collection, interactive mapping and data curation. Ushahidi builds tools for democratizing information, increasing transparency and lowering the barriers for individuals to share their stories. Through Crowdmap.com, Swiftly.org and accompanying mobile applications, Ushahidi is making crowdsourcing tools available and useful. Their latest product is BRCK, a tool for resilient connectivity -- anywhere.
Photovoice is an important participatory research tool for advancing health equity. This paper critically reviews how participant voice is promoted through the photovoice process of taking and discussing photos and adding text/captions. PubMed, Scopus, PsycINFO, and Web of Science databases were searched from the years 2008 to 2014 and reviewed for how participant voice was (a) analysed, (b) exhibited in community forums, and (c) disseminated through published manuscripts. Of 21 studies, 13 described participant voice in the data analysis, 14 described participants’ control over exhibiting photo-texts, seven manuscripts included a comprehensive set of photo-texts, and none described participant input on choice of manuscript photo-texts. The findings indicate that photovoice designs vary in the advancement of participant voice, with the least advancement occurring in manuscript publication. The authors indicate that future photovoice researchers should expand approaches to advancing participant voice.
This is an interview with Simon Njami, a curator responsible for many exhibitions of contemporary African art gathering artists from 20 different African countries. On African photography he notes ‘Photography is necessarily contextual. First, it’s about the gaze and who is taking the picture. In Africa, it’s also a matter of re-appropriating one’s own image. The South African photographer Santu Mofokeng questions the role of humanity in his work. Africa is only 50 years old. It has done a lot to rebuild the past, live the present and look towards the future.’ On art and politics on the continent he argues ‘Egyptian artists were at the forefront of the protest before the Revolution. Senegalese young rappers launched the movement Y’en a Marre (‘Enough is enough’) in 2011...Art has a dual function....It’s a space of relative freedom’ . He raises the huge social potential of art, but also says 'Having said that, one has to tickle an elephant for a while before it starts laughing. In practice, change takes a while, even if it seems inevitable'.
Sustainable, effective and successful partnerships need to be built on mutual trust, on an explicit programme, clearly defined responsibilities, champion figures and financial resources. In this article, Dr. Kakonge outlines positive and negative factors that influence development assistance partnerships in Africa. The article notes that partnership demands creativity, compromise, commitment, consistency, flexibility and fairness. Some scholars argue that partnerships do not work when there is poor coordination relating to external assistance. . The author reviews factors that are critical in making development assistance partnerships successful in Africa.