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.
Governance and participation in health
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.
Almost a decade after its inception, the African Peer Review Mechanism (APRM) continues to be the continent’s major governance monitoring mechanism. According to this article, the APRM has raised awareness of governance issues, energised the African continent and taken small but significant steps to remedy big problems. It has brought benefits to those countries that have taken it seriously. Recognising this, it is clear that more countries need to be encouraged to be part of the APRM process, and that countries that have made commitments to improve governance be held accountable for promises and progress. However, there have been challenges. For example, the rate of reviews is relatively slow, with the first country (Ghana) only peer reviewed in January 2006, almost four years after the APRM was established. It has been seven years since the launch of the APRM, and so far only 13 of the 29 acceding member countries have been reviewed. In addition, recommendations in the reviews are not mandatory or enforceable and have generally gone unheeded by African governments. For example, the review for Kenya predicted post-election ethnic-related violence in 2007, yet the Kenyan government took no measures to prevent the violence.
Sex Workers Outreach Programme (SWOP) is a project run by the University of Nairobi and Canada's University of Manitoba, which trains sex workers to be peer educators for other sex workers and inform them about sexual health and rights. Through the SWOP programme, educators have enabled more than 3,000 of their Nairobi peers to get tested for HIV and other sexually transmitted infections. They have also taught them skills to negotiate condom use with their clients. Since 2008, the SWOP clinic in Nairobi, which is open 24 hours a day, has provided HIV prevention services to more than 7,000 commercial sex workers, 150 of them male. The HIV prevalence among those tested is 33 percent. The prevention package includes condom demonstration and provision, sexually transmitted infection screening and treatment, family planning and post-exposure prophylaxis.
In this statement, the Public Service Accountability Monitor (PSAM)points out that, by the end of the 2009/10 financial year, the Eastern Cape Department of Health had accrued debt of approximately US$ 245 million. PSAM argues that this overspending was largely as a result of underfunded and unbudgeted mandates relating to human resources, as well as higher than expected costs for pharmaceuticals and laboratory services. It notes that the debt has already resulted in stock-outs of basic medicines, but cautions that the issue is not only one of inadequate funding. Over the last ten years the Eastern Cape Department of Health has consistently received poor audit opinions from the Auditor General. These opinions have revealed that chronic financial mismanagement continues to result in the misuse and misappropriation of public funds. This means that even those resources which are available have not been used appropriately. The PSAM calls on the National Department of Health and the National Treasury to make public details of the Eastern Cape Department of Health’s financial status, and to publicly guarantee that no patients in the province will be refused basic treatments because of a shortage of medicines and medical supplies.
This report synthesises the results of the first evaluation of the early implementation of the Paris Declaration, from March 2005 to late 2007. It comprises extensive assessments in eight countries, together with ‘lighter’ studies on eleven development partner agencies, focusing at the headquarters level. It found that the principle of ownership has gained much greater prominence since 2005, although the evaluations show that the practical meaning and boundaries of country ownership and leadership often remain difficult to define. The evaluations do not suggest any backsliding on harmonisation, but neither do they indicate any overall trend toward progress. All the evaluations convey a sense that the joint processes for tracking progress and resolving problems fall short in terms of mutual accountability. Development agency and partner country evaluations reveal that, despite clear commitments to alignment, implementation of the various components of alignment set out in the Paris Declaration has been highly uneven.
This compilation includes peer reviews on government accountability from Kenya and South Africa. The Kenyan review concluded that, while the reviewing process yielded a lot of data it was not as empowering and inclusive as it should have been and did not foster significant dialogue between Kenya’s government and its people. This was in part due to the way the self-assessment was carried out and also because it was focused on the efficiency and effectiveness of government, and not democratic decision-making and human rights. The South African review concluded that, while the reviewing process had many strengths, it had too great a level of government control, an overly ambitious timetable, and lacked meaningful civil society input.
This study assessed community acceptability of the use of rapid diagnostic tests (RDTs) by Ugandan CHWs, locally referred to as community medicine distributors (CMDs). The study was conducted in Iganga district using 10 focus group discussions (FGDs) with CMDs and caregivers of children under five years, and 10 key informant interviews (KIIs) with health workers and community leaders. The study found that CMDs are trusted by their communities because of their commitment to voluntary service, access, and the perceived effectiveness of anti-malarial drugs they provide. Some community members expressed fear that the blood collected could be used for HIV testing, the procedure could infect children with HIV, and the blood samples could be used for witchcraft. Education level of CMDs is important in their acceptability by the community, who welcome the use of RDTs given that the CMDs are trained and supported. Anticipated challenges for CMDs included transport for patient follow-up and picking supplies, adults demanding to be tested, and caregivers insisting their children be treated instead of being referred. Use of RDTs by CMDs is likely to be acceptable by community members given that CMDs are properly trained, and receive regular technical supervision and logistical support.
Local East African programmes are discovering the benefits of bringing HIV services closer to rural communities, with mobile drug distribution improving HIV-positive patients' adherence to antiretroviral treatment (ART). Health facilities in rural areas are normally remote, but by using mobile care and treatment centres, it is easy to reach populations who may not otherwise have access to services, according to the Support for International Change (SIC), a local HIV-focused non-governmental organisation in Tanzania. SIC reports using mobile drug distribution in northern Tanzania and witnessing a reduction of cases lost to follow up, compared to local health facilities that are recording higher levels of drop-out amongst patients. Patients must visit a hospital for their initial diagnosis and ART prescription, and are required to visit the health centre periodically, but in between visits, SIC uses community-based volunteers and trained medical workers to drive around villages refilling prescriptions as well as providing education on condom use and the prevention of opportunistic infections. SIC in Tanzania reaches nearly 2,500 people with mobile ART clinics and has so far trained around 200 health workers in Babati District in northern Tanzania.