It is now more than 3 weeks since widespread xenophobic terror against foreign nationals has erupted in provinces across South Africa. To date, over 20,000 people in the Western Cape have been displaced, some are staying in community halls and local shelters, but many have been taken to refugee camps, some against their will. Across our country more than 50 000 people were displaced. The displaced peoples' calls for the UN including (UNHCR) intervention have only grown louder, and were the main demand at a rally and press conference held by them in Cape Town. The groups are concerned that the UN seems to publicly take a position that they cannot assist unless and until the South African government requests their intervention and are unsure when that is likely to happen. TAC observes that the humanitarian crisis in South Africa continues to deepen.
Governance and participation in health
TAC presents demands to the Cape Town City Council about the treatment of foreigners after the xenophobic attacks in the city.
It is widely believed that the recent overhaul of WHO’s publication policy is a response to recent pressures from some developed countries that were unhappy with some of its publications on the subject of IP and public health. There are serious concerns that the publications policy presented in the Secretariats Reports will result in 'self censorship' by WHO and its staff and will hamper timely advice and support by WHO HQ and regional offices to member states over important issues such as application of intellectual property rights and the use of TRIPS flexibilities, other trade and health matters, reproductive health care and other issues.
The first African workshop on governance, transparency and accountability processes in access to medicine attracted delegates from 30 civil society organisations in Uganda, Kenya, Zambia and Ghana. The participants benefited from an eight-day training held at Windsor Hotel Entebbe from 17-24 February 2008, ahead of the launch of Medicines Transparency Alliance (MeTA) project in London in May. The MeTA project is a global initiative by the UK Department for International Development (DFID) aiming to use a multi-stakeholder approach towards increasing transparency around the regulation, selection, procurement, sale, distribution and use of medicines in developing countries, thereby strengthening governance, encouraging responsible business practices and ultimately improving access to medicines, especially for the poor. The MeTA project is being piloted in Ghana and discussions are going on for it to be launched in Uganda as well. Funded by DFID, the workshop was hosted by HEPS-Uganda, working in partnership with Health Research for Action (www.herabelgium.com) and Healthlink Worldwide (www.healthlink.org.uk).
In Yumbe District of north-western Uganda, Village Health Teams (VHT) have been established in line with the national strategy for community involvement in health. This paper reviews aspects of the programme outlining its successes and challenges. Its success has been mainly due to integration of pre-existing volunteer cadres, intersectoral approach to the monitoring of the teams and involvement of the community in the selection of the top-up team members. Its challenges include the relatively young age of most volunteers and the likely loss of financial support for the activities of the volunteers. The paper concludes that the VHT programme is a delicate venture requiring both programme support through intersectoral inputs to the Community Action Plans developed by communities and sociological approaches to educate the communities to support the VHT for its sustainability.
The elaboration of Poverty Reduction Strategies has seen a promising amount of stakeholder participation in many PRS countries, even if considerable quality problems are recognisable, such as exclusion of marginalised groups, speed and depth and the ad hoc nature of participation events as well as macroeconomic and structural policies being off-limits. Most countries have started implementing their PRSP,with participation dwindling instead of being institutionalised. Some observers speak of a 'participation gap'. The situation seems to be slightly more promising for the issue of participation in monitoring and evaluation of PRS, as in many countries independent civil society monitoring or participatory monitoring arrangements are planned, although mostly not yet operational. Stakeholder participation in the revision process has been occurring in a number of countries, but not much is known about the way this is done. For most of these issues a systematic review of experience is not available at this stage. Work is planned to increase the current understanding of the status, practice and challenges of participation in PRS implementation (including monitoring, evaluation, revisions, policy reforms, and institutionalisation) and to make conceptual as well as 'good practice' contributions to the current discussion.
Accountability refers to the processes by which those with power in the health sector engage with, and are answerable to, those who make demands on it, and enforce disciplinary action on those in the health sector who do not perform effectively. This paper reviews the practice of accountability to citizens on gender and health, assesses gaps, and recommends strategies. Four kinds of accountability mechanisms have been used by citizens to press for accountability on gender and health. These include international human rights instruments, legislation, governance structures, and other tools, some of which are relevant to all public sector services, some to the health sector alone, some to gender issues alone, and some to gender-specific health concerns of women. However, there are few instances wherein private health sector and donors have been held accountable. Rarely have accountability processes reduced gender inequalities in health, or addressed 'low priority' gender-specific health needs of women. Accountability with respect to implementation and to marginalized groups has remained weak. This paper recommends that: (1) the four kinds of accountability mechanisms be extended to the private health sector and donors; (2) health accountability mechanisms be engendered, and gender accountability mechanisms be made health-specific; (3) resources be earmarked to enable government to respond to gender-specific health demands; (4) mechanisms for enforcement of such policies be improved; and (5) democratic spaces and participation of marginalised groups be strengthened.
There is increasing interest among health policymakers, planners and donors in how corruption affects health care access and outcomes, and what can be done to combat corruption in the health sector. Efforts to explain the risk of abuse of entrusted power for private gain have examined the links between corruption and various aspects of management, financing and governance. Behavioural scientists and anthropologists also point to individual and social characteristics which influence the behaviour of government agents and clients. This article presents a comprehensive framework and a set of methodologies for describing and measuring how opportunities, pressures and rationalizations influence corruption in the health sector. The article discusses implications for intervention, and presents examples of how theory has been applied in research and practice. Challenges of tailoring anti-corruption strategies to particular contexts, and future directions for research, are addressed.
There is growing concern that health policies and programmes may be contributing to disparities in health and wealth between and within households in low-income settings. However, there is disagreement concerning which combination of health and non-health sector interventions might best protect the poor. Potentially promising interventions include those that build on the social resources that have been found to be particularly critical for the poor in preventing and coping with illness costs. In this paper we present data on the role of one form of social resource— community-based organisations (CBOs)—in household ability to pay for health care on the Kenyan coast. Data were gathered from a rural and an urban setting using individual interviews (n = 24), focus group discussions (n = 18 in each setting) and cross-sectional surveys (n = 294 rural and n = 576 urban households). We describe the complex hierarchy of CBOs operating at the strategic, intermediate and local level in both settings, and comment on the potential of working through these organisations to reach and protect the poor. We highlight the challenges around several interventions that are of particular international interest at present: community-based health insurance schemes; micro-finance initiatives; and the removal of primary care user fees. We argue the importance of identifying and building upon organizations with a strong trust base in efforts to assist households to meet treatment costs, and emphasize the necessity of reducing the costs of services themselves for the poorest households.
The increasing use of participatory research (PR) approaches to address pressing public health issues reflects PR's potential for bridging gaps between research and practice, addressing social and environmental justice and enabling people to gain control over determinants of their health. This critical review of the PR literature culminates in the development of an integrative practice framework that features five essential domains and provides a structured process for developing and maintaining PR partnerships, designing and implementing PR efforts, and evaluating the intermediate and long-term outcomes of descriptive, etiological, and intervention PR studies. the paper reviews the empirical and nonempirical literature in the context of this practice framework to distill the key challenges and added value of PR. Advances to the practice of PR over the next decade will require establishing the effectiveness of PR in achieving health outcomes and linking PR practices, processes, and core elements to health outcomes.