Mining in southern Africa has amplified HIV and tuberculosis (TB) epidemics across the continent through social, political, and biological risks posed to miners and their communities, according to this article. Aware of these risks for decades, policymakers have done little to regulate the mining sector’s remarkable impact on Africa’s two largest epidemics, the authors note. They analyse the governance of mining in southern Africa to evaluate the sources of ineffective responses and identify mechanisms for ensuring effective cross-border care and global norms of responsible mining. Their primary argument is that international agencies need to take action to spur the development of effective governance systems currently being constrained by domestic vested interests.
Governance and participation in health
Much theorising about global health governance has taken a view from above and the authors of this article aimed to complement this with perspectives from grassroots organisations and service providers. Based on a qualitative field study conducted in 2009, they investigated the implications of multiple major international financing structures for HIV on local and district-level responses in Kenya, Malawi and Zambia. They conducted 130 interviews at national level and in six districts, triangulated across public and private sectors. The authors found positive as well as negative experiences of engagement with global health initiatives, concluding that these initiatives should engage with each other, with governments and with local stakeholders to develop a joint Code of Practice for more coherent systems down to community levels.
The configuration of economic actors has shifted dramatically in recent decades as a consequence of the shift from an international to global economy, according to this article. The 21st century thus faces a fundamentally different economic landscape, with governance far less about formal nation-state negotiation, and far more about informal mechanisms of state and non-state negotiation. Although economic power has always played a role in defining international health governance, this changing global economic context has increased the role of economic power in the development of global health governance. To ensure the continued protection and enhancement of global health, the author argues it is imperative for the health profession to recognise and more actively engage with this changing economic context, in order to seize opportunities and minimise risks to global health. If it does not, the danger is that global health governance will increasingly be determined by economic organisations with the principle concern not of health but of market liberalisation, ultimately constraining the capacity of nation-states to undertake measures to protect and enhance the health of their populations.
On 4 and 5 November 2010, representatives from across Africa met in Tunis to discuss an African agenda on development effectiveness to take to the Fourth High-Level Forum in Busan in 2011. The Tunis Consensus on an African development effectiveness agenda consists of the following main items: building capable states, with African countries taking leadership on capacity development; developing democratic accountability; promoting South-South co-operation; embracing new development partners; and outgrowing aid dependence.
Following the 11 September 2001 terrorist attacks, the United States (US) military expanded its global health engagement as part of broader efforts to stabilise fragile states, formally designating “medical stability operations” as use of Department of Defense (DoD) medical assets to build or sustain indigenous health sector capacity. Medical stability operations have included medical assistance missions launched by US Africa Command throughout Africa. The public health impact of such initiatives, and their effectiveness in promoting stability is unclear, the author notes. Moreover, humanitarian actors have expressed concern about military encroachment on the “humanitarian space,” potentially endangering aid workers and populations in need, and violating core principles of humanitarian assistance. The DoD should draw on existing data to determine whether, and under what conditions, health engagement promotes stability overseas and develop a shared understanding with humanitarian actors of core principles to guide its global health engagement.
The authors of this article argue that health is an important component of global security. However, the precise meaning and scope of global health security remains contested partly due to suspicions about clandestine motives underlying framing health as a security issue. Consequently, low and middle-income countries have not engaged global discourse on health security, resulting in an unbalanced global health security agenda shaped primarily by the interests of high-income countries, which focuses on a few infectious diseases, bioterrorism and marginalises health security threats of greater relevance to low and middle-income countries. Focusing primarily on African countries, the authors of this paper examine the implications of the participation deficit by the African Group of countries on their shared responsibility towards global health security. After analysing the potential benefits of regional health security co-operation, they conclude that, to ensure that global health security includes the interests of African countries, they should develop a regional health security co-operation framework.
World leaders should use the Organisation for Economic Cooperation and Development (OECD) 50th anniversary forum to press for concrete improvements in sustainable development and fighting poverty, CIVICUS said at the opening of the two-day summit in Paris, France, on 24 May 2011. The 34-member institution should make clear that real improvements in poverty eradication depend on countries living up to their aid commitments, CIVICUS said. The organisation stated that it is critical that OECD leaders assess the impact of their efforts and the policies being advanced by international financial institutions to tackle poverty and climate change. The gap between commitments and aid pledges in 2011 has widened. In 2005, members of the OECD Development Assistance Committee (DAC) collectively promised to commit 0.56% of gross national income to aid. However, in 2010 aid has reached just 0.32%. At current levels, there is little chance that more than a handful of countries will reach the agreed commitment of 0.7% by 2015, CIVICUS warns, arguing that aid effectiveness is being damaged by inflated budgets, a lack of transparency and the failure of several large countries – namely Germany, Italy and Spain - to honour their commitments laid out in the Accra Agenda for Action.
This article presents a detailed description of a community mobilization intervention involving women's groups in Mchinji District, Malawi. The intervention was implemented between 2005 and 2010. The intervention aimed to build the capacities of communities to take control of the mother and child health issues that affect them. To achieve this it trained local female facilitators to establish groups and using a manual, participatory rural appraisal tools and picture cards guided them through a community action cycle to identify and implement solutions to mother and child health problems. The groups then catalysed community collective action to address mother and child health issues to improve te health and reduce the mortality of mothers and children. Their impact, implementation and cost-effectiveness have been rigorously evaluated through a randomized controlled trial design and the results of these evaluations will be reported in 2011.
Dissatisfaction emerged among many Member States over the World Health Organisation’s (WHO) financial reform plans at the 129th session of the WHO Executive Board, held on 25 May 2011. They expressed concern over the lack of detail on the reforms proposed, the stress on "donor funding" to resolve the financial difficulties of the WHO, as well as proposals such as the convening of the World Health Forum, which is aimed at increasing the influence of the private sector and external funders in setting the health agenda in the WHO. They also emphasised that the WHO's reform process must be driven by Members States themselves. The discussion resulted in the adoption of a new decision EB 129(8), which sets out a more transparent and inclusive consultative process for the finalisation of a reform plan by November 2011, when the Executive Board will convene for a special session.
The author argues that European powers appear set on perpetuating their arbitrary ‘entitlement’ to the position of Managing Director of the International Monetary Fund in the wake of the controversy that precipitated the resignation earlier in May 2011 of Managing Director, Dominique Strauss-Kahn. Despite claims from the IMF that the selection this time around would ‘take place in an open, merit-based, and transparent manner‘ as well as a longstanding commitment to open the position to nationals of all member states, most developed country representatives had expressed clear preferences for European candidates even before nominations opened on 23 May, according to this article. Their stances raise fears among developing countries and civil society that pledges to address unrepresentative governance at the Bretton Woods institutions are mere window dressing. Developing countries and emerging economies that account for most of the world's population, over half the world's output and who are being pressed to increase their capital contributions, will have negligible influence in the decision on the Managing director unless they are willing to take a firm, collective stance behind a consensus candidate.