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.
Governance and participation in health
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.
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.