Governance and participation in health

From poverty to power: How active citizens and effective states can change the world
Green D: Oxfam International, 2008

From Poverty to Power, Oxfam International's new book, provides critical insights into the massive human and economic costs of inequality and poverty and proposes realistic solutions. It proposes that the best way to tackle them is through a combination of active citizens and effective nation states. Why active citizenship? Because people living in poverty must have a voice in deciding their own destiny, fighting for rights and justice in their own society, and holding states and the private sector to account. Why effective states? Because history shows that no country has prospered without a state structure than can actively manage the development process.

The shrinking space for civil society and changing donor dynamics
Tiwana M: CIVICUS Civil Society Watch, 26 July 2008

A dominant theme at DENIVA’S 4th International Conference on NGO Accountability, Self Regulation and the Law at Kampala was the shrinking space for civil society. This global trend is reported to be affirmed by the findings of the CIVICUS Civil Society Index, given the particular context of the global “war on terror”. Sadly, even in well-entrenched democracies, where civil society space was hitherto considered safe, there are negative trends. In current circumstances, it is critical that the international community remains alive to the steady roll back on civil society space and hard fought civil liberties across the world. This imperative is underscored by the economic meltdown in ‘western democracies’ where much of the funding for democratic reform and civil society initiatives comes from. Ensuring the sustainability of civil society organisations working on the advancement of health, human and democratic rights is one such means.

Citizen Participation in Budgeting: Prospects for Developing Countries
Moynihan DP: Participatory Budgeting, The World Bank, Washington DC: 55-87

Participation is important in developing countries as a means of improving the performance and accountability of bureaucracies and improving social justice. There are two basic criteria for participation: it should be broadly representative of the population and should involve meaningful discourse that affects public decision-making. Reviews of participation in Poverty Reduction Strategy Paper (PRSP) processes show that these criteria have not been met in most cases. However citizen involvement in budgeting has been more successful. Citizen participation made local service delivery more efficient and effective in the country cases reviewed. In most of the case studies, NGOs analysed the budget and mobilised citizens. These NGOs seek to represent the poor and disseminate their views to the government. They do not offer direct citizen involvement, but without their involvement participation would be reduced. Budget participation can influence governments even where they have not embraced direct involvement of citizens in decision-making. This depends on NGOs communicating analyses of spending choices, public service effectiveness, and budget execution to the public, media, and elected officials. A key policy implication for donors is therefore targeted support to civil society. However, donors and NGOs often overlook the importance of government administrations in implementing participation.

Civil society principles on the IHP+

Civil society members and advocates for health care from all over the world met to discuss the International Health Partnership and Related Initiatives (IHP+) 'Scaling Up for Better Health Plan', aimed at strengthening primary health care to achieve the health-related MDGs for developing countries around the world, including Africa. In order to deliver on its stated goals, they believe the IHP+ must commit to a minimum set of guidelines. These civil society member and advocates stand united on three key principles that they consider non-negotiable: 1) Comprehensive primary health care must be provided for all. 2) Governments must pay their fair share. 3) The people’s voices must be heard.

Joint appeal by civil society in South Africa to the UN & UNHCR
Treatment Action Campaign, 3 June 2008

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.

Protest at Cape Town Civic Centre: TAC's Demands
Treatment Action Campaign, 12 June 2008

TAC presents demands to the Cape Town City Council about the treatment of foreigners after the xenophobic attacks in the city.

CSOs express concern on WHO's publication policy
Third World Network Info Service on Intellectual Property Issues, 5 May 2008

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.

CSOs rally for transparency in medicine procurement
HEPS Newsletter 4(1), March 2008

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).

The experience of a village volunteer programme in Yumbe District, Uganda
Komakech I: Health Policy and Development 5(1): 21-27

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.

Accountability in Poverty Reduction Strategies: The Role of Empowerment and Participation
Eberlei W: Social Development Papers 104, Social Development Department of the Sustainable Development Network of the World Bank, May 2007

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.

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