At the Regional Meeting of Parliamentary Committees on Health in Eastern and Southern Africa, held in Kampala, Uganda, on 28-29 September 2010, the Southern and East African Parliamentary Alliance of Committees On Health (SEAPACOH) committed themselves to the realisation of the Millennium Development Goals (MDGs), the Maputo Plan of Action and the Accra Agenda for Aid Effectiveness. SEAPACOH underscored its role in offering leadership to ensure good governance in all matters of health, as well as to continue providing stewardship on policy, legislation and budgetary oversight, and ensure that family planning and population issues are integrated into national development strategies, including the poverty reduction strategies and action plans. It also championed advocacy strategies to promote family planning as essential to the achievement of all MDGs, especially MDG4 and MDG5, in partnership with civil society organizations and the media, and promote gender equity. In terms of financing, SEAPACOH will advocate for increased government resources to health to realise the Abuja target of 15%, ensure accountability in public expenditures and continue support for strengthening health systems. It also aims to enhance partnerships with civil society organisations and learn from the best practices in countries in the region through South-South cooperation.
Governance and participation in health
This document reports efforts that were made across Africa to gather grassroots opinions to reflect the views and aspirations of ordinary Africans in shaping the policy agenda for the forthcoming decade. It found that Africa is endowed with natural and human resources whose development is in the interest of world security due to its global strategic importance. Meanwhile, the increasing return of the diasporas is raising the demand for accountable governance and economic development. The current so-called development is exclusionary and does not reach the intended beneficiaries - hence their minimal access to basic services such as health, education, water and sanitation. The report makes a number of recommendations, like replacing the current unjust and exclusionary development ideal with one that is values-based and sustainable, spelling out the Millennium Development Goals need to be spelt out properly for the African and Western public with the emphasis on detailing the public good, ensuring that African governments operate with financial transparency especially in the extractive sector, and making civil society, professional associations, social movements and business entrepreneurs catalysts for engendering accountability from governments, NGOs, donors and big businesses. Agriculture, food security and the informal sector should be prioritised by African governments and those who support Africa’s development, and the skills and remittances of the returning African Diaspora must be harnessed and used to ensure good governance on the continent.
The updated version of the Worldwide Governance Indicators, covering 213 countries over the 1996-2009 period, has found that the world continues to underperform on governance. Over the past decade, dozens of countries have improved significantly on such dimensions of governance such as rule of law and voice and accountability. But a similar number of countries have experienced marked deteriorations, while others have seen short-lived improvements that are later reversed, and scores of countries have not seen significant trends one way or the other. A number of key messages emerged. The most powerful economies are not always the best governed – likewise, good governance is also found in countries that are not wealthy. Governance can significantly improve over a relatively short period of time yet, on average, the world has not significantly improved in the quality of governance over the past dozen years. Sustained commitment to governance reforms is needed to avoid reversals. The authors warn that measuring governance is difficult, and all measures of governance are necessarily imprecise, requiring interpretative caution.
This article reports findings about the impact of the Poverty Reduction Strategy Paper (PRSP) process on Malawi’s National HIV/AIDS Strategic Framework (NSF). In 2007, researchers conducted a survey to measure perceptions of NSF resource levels, participation, inclusion, and governance before, during, and after Malawi’s PRSP process (2000–2004). They also assessed principle health sector and economic indicators and budget allocations for HIV and AIDS. These indicators are part of a new conceptual framework called shared health governance (SHG), which seeks congruence among the values and goals of different groups and actors to reflect a common purpose. Under this framework, global health policy should encompass: consensus among global, national, and sub-national actors on goals and measurable outcomes; mutual collective accountability; and enhancement of individual and group health agency. Indicators to assess these elements included: goal alignment; adequate resource levels; agreement on key outcomes and indicators for evaluating those outcomes; meaningful inclusion and participation of groups and institutions; special efforts to ensure participation of vulnerable groups; and effectiveness and efficiency measures. Results suggested that the PRSP process supported accountability for NSF resources. However, the process may have marginalised key stakeholders, potentially undercutting the implementation of HIV and AIDS Action Plans.
Indoor residual spraying (IRS) and insecticide-treated nets (ITNs), two principal malaria control strategies, are similar in cost and efficacy. This study aimed to describe recent policy development regarding their use in Mozambique, South Africa and Zimbabwe. Using a qualitative case study methodology, researchers undertook semi-structured interviews of key informants from May 2004 to March 2005, carried out document reviews and developed timelines of key events. They found that a disparate mix of interests and ideas slowed the uptake of ITNs in Mozambique and Zimbabwe and prevented uptake in South Africa. Most respondents strongly favoured one strategy over the other. In all three countries, national policy makers favoured IRS, and only in Mozambique did national researchers support ITNs. Outside interests in favour of IRS included manufacturers who supplied the insecticides and groups opposing environmental regulation. International research networks, multilateral organisations, bilateral donors and international non-governmental organisations (NGOs) supported ITNs. Research evidence, local conditions, logistic feasibility, past experience, reaction to outside ideas, community acceptability, the role of government and NGOs, and harm from insecticides used in spraying influenced the choice of strategy. The end of apartheid permitted a strongly pro-IRS South Africa to influence the region, and in Mozambique and Zimbabwe, floods provided conditions conducive to ITN distribution. The study concludes that both IRS and ITNs have a place in integrated malaria vector management, but pro-IRS interests and ideas have slowed or prevented the uptake of ITNs. Those intending to promote new policies such as ITNs should examine the interests and ideas motivating key stakeholders and their own institutions, and identify where shifts in thinking or coalitions among the like-minded may be possible.
The Big Push Back, which took place on 22 September 2010, was convened by the Participation and Social Change team at the United Kingdom’s Institute of Development Studies. With over 70 attendees, the theme of the meeting was to reflect on and develop strategies for ’pushing back’ against the increasingly dominant bureaucratisation of the development agenda and the pressure to design projects/programmes and report on performance in a manner that assumes all problems are bounded/simple. This is reported to result in research that is linear (cause-effect) based, at the expense of research that is emergent, i.e. a complex, only partially controllable process in which local actors may have conflicting views on what is happening, why and what can be done about it, where complexity is recognised and accountability promoted to those people international funds are supposed to serve. The meeting also called for collaboration with people inside funding and development agencies who are equally dissatisfied with the prevailing ‘audit culture’, and communication to build public understanding that some aspects of development work that cannot be reduced to numbers are also valuable.
The Governance Cluster of the Regional Coordination Mechanism of United Nations Agencies and Partner Organisations held its annual retreat in Johannesburg South Africa on 14-15 September 2010, at which a number of resolutions were adopted. The Cluster resolved that UN agencies’ support to the African Union Commission (AUC), the NEPAD Planning and Coordinating Agency (NPCA) and the Regional Economic Communities (RECs) should be premised on the strategic orientation and priorities of these institutions as articulated in their strategic plans and other relevant documents. Horizontal interaction/links should be developed among the RECs for purposes of joint planning, programming, and sharing of information and experience. Also, AU member states should be encouraged to make efforts to sign, ratify, domesticate and apply existing charters, treaties, protocols, conventions and declarations on governance, democracy and human rights. They should also accelerate the ratification of the African Charter on Democracy, Elections and Governance, 2007. To date, about 38 AU member states have signed this historic democracy charter. Eight more signatories are required to ratify the charter. AU member states that have already signed and ratified the Charter must set in motion steps for its domestication and application, and a comprehensive mechanism should be established to monitor and evaluate implementation of existing African charters, protocols and treaties relating to governance. More AU member states should accede to the African Peer Review Mechanism, as well.
According to this article by the secretary general and policy manager of CIVICUS, too little partnership and too little space for civil society is marring progress on the UN Millennium Development Goals (MDGs). The writers express their utmost concern that there is insufficient political will among governments to acknowledge the role of other stakeholders, including civil society, in charting a course for accelerated action on the Millennium Development Goals (MDGs) between now and 2015 and to work in partnership with them. They refer to the increasing trend to systemically restrict freedoms of expression, association and assembly — freedoms that are key to the work of civil society. Against this background, they argue that it is increasingly clear that civil society organisations – which include non-governmental organisations, social movements, think tanks, faith-based charities and community-based organisations – must play a key role in supplementing the efforts of governments and the private sector in order to make substantial progress towards achieving the MDGs.
This paper explores whether community participation through health committees can advance the right to health, and what constitutes best practice for community participation through South African health committees. The paper reports on a series of 32 indepth interviews with members of three Community Health Committees and health service providers in the Cape Metropolitan area and provides some valuable insight into these areas. The most prominent barriers to participation mentioned by participants, included underrepresentation of vulnerable and marginalised groups, and the absence of a formal mandate giving Health Committees clear objectives and the authority to achieve them. A number of characteristics of Health Committees were identified that promoted more meaningful participation: a facility manager who helps tip the balance of power from health professionals towards the community by sharing decision-making with the Health Committee and by involving the Committee in facility operations; a form of apprenticeship in which newer Health Committee members learn skills and procedures from more experienced members; intersectoral activity through the regular involvement of ward councillors and environmental health officers in Health Committee meetings and activities; a mechanism for the Health Committee to be involved in the reviewing and resolution of patient-based complaints at health facilities; the use of the media and written sources of information by Committees to increase their visibility in the clinic and in the community, disseminate important health-related information, inform the community of Health Committee activities and broaden participation. Achieving small gains appeared to act as positive reinforcement and strengthen the Health Committees to achieve bigger gains.
Social Watch’s report calls for justice of all kinds, including climate justice, financial, fiscal and economic justice, and social and gender justice. The report addresses various thematic issues, and looks at international and national progress made on the Millennium Development Goals (MDGs). It notes with concern that progress on poverty reduction has slowed down since the MDGs were set and notes that social progress does not automatically follows economic growth. It highlights that better (non-monetary) indicators are needed to more accurately monitor the evolution of poverty in the world. The report further calls for a complete transformation of society along the lines of a new logic that prioritises human needs over corporate profits; in other words, it calls for ‘a new social deal.’ Besides, it underlines the need to rethink macroeconomics and recognise the role of women in an extensive care economy; and addresses civil society concerns regarding the fundamental ambiguity surrounding the status of public banks such as the European Investment Bank (EIB). A new approach in the advocacy work of civil society organisations is recommended, called ‘critical shareholding’, which will allow civil society organisations and networks buy shares in companies that have negative social and environmental impacts, after which they can criticise these firms from the inside.