As the centre of global geo-politics continues to shift, much attention is being focused on the BRICS (Brazil, Russia, India, China, South Africa) group of emerging economies and the IBSA (India, Brazil and South Africa) group of emerging democracies as their power in global political and economic affairs has increased substantially, the author notes in this article. He calls attention to the implications of the growing power of BRICS and IBSA countries both individually and collectively for global civil society and development cooperation. From civil society’s point of view, concerns have been raised about the fact that while aid is offered to other developing countries by BRICS countries, there is an overall lack of information about the basis on which aid is given by them. Civil society is notably absent from BRICS meetings and summits. Additionally, there is the question of BRICS countries’ limited participation in ongoing multi-lateral processes to ensure harmonisation and transparency of aid. Traditionally, external funder countries have been involved in multiple processes and discussions to reduce aid overlap, faulty prioritisation and wastage. The author recommends greater south-south cooperation led by the democratic trio of IBSA countries. Their civil societies are active and also well placed to connect with their peers in the developing world to promote sustainable development underpinned by democratic values. But this will require some key foreign policy shifts for which civil society needs to lobby hard.
Governance and participation in health
In sub-Saharan Africa media coverage of reproductive health issues is poor due to the weak capacity and motivation for reporting these issues by media practitioners, the authors of this paper argue. They describe the experiences of the African Population and Health Research Centre and its partners in cultivating the interest and building the capacity of the media in evidence-based reporting of reproductive health issues in sub-Saharan Africa. The authors note that the Research Centre’s media strategy evolved over the years, including: enhancing journalists’ interest in and motivation for reporting on reproductive health issues through training and competitive grants for outstanding reporting; building the capacity of journalists to report reproductive health research and the capacity of reproductive health researchers to communicate their research to media through training for both parties and providing technical assistance to journalists in obtaining and interpreting evidence; and establishing and maintaining trust and mutual relationships between journalists and researchers through regular informal meetings between journalists and researchers, organising field visits for journalists, and building formal partnerships with professional media associations and individual journalists. The authors conclude that a sustained mix of strategies that motivate, strengthen capacity of, and build relationships between journalists and researchers can be effective in enhancing quality and quantity of media coverage of research.
Kenyan President, Mwai Kibaki, has assured members of the African Peer Review Mechanism (APRM) that his government is committed to undertaking far-reaching reforms in the management of public affairs and entrenchment in constitutionality. President Kibaki affirmed that Kenya’s process of reforming governance would continue and urged the APRM team to share their experiences, particularly positive developments realised in other parts of the world that would be of value to Kenya and other African nations. Prime Minister, Raila Odinga, noted that Kenya was a pioneer in the review mechanism and was keen to evaluate the status of the country’s governance and explore ways of improving weak areas. He added that Kenya was open to scrutiny by peers and looked forward to a full examination and recommendations for appropriate remedy for various challenges facing the nation and its people.
This paper reports the findings of an atypical systematic review of 60 years of literature in order to arrive at a more comprehensive awareness of the constructs of participation for communicable disease control and elimination and provide guidance for the current malaria elimination campaign. Of the 60 papers meeting the selection criteria, only four studies attempted to determine the effect of community participation on disease transmission. The studies showed statistically significant reductions in disease incidence or prevalence using various forms of community participation. The use of locally selected volunteers provided with adequate training, supervision and resources is crucial to the success of the interventions in these studies, the authors argue. After a qualitative synthesis of all 60 papers, they elucidate the complex architecture of community participation for communicable disease control and elimination. The authors stress the importance of ensuring that current global malaria elimination efforts do not derail renewed momentum towards the comprehensive primary health care approach. They recommend that the application of the results of this systematic review be considered for other diseases of poverty in order to harmonise efforts at building 'competent communities' for communicable disease control and optimising health system effectiveness.
The authors of this article argue that governments need to provide civil society organisations with more space and recognition to facilitate a stronger health response with a particular focus on tuberculosis (TB) prevention, care and control. They call on the World health Organisation (WHO) and its international partners to play a brokering and facilitative role to catalyse the process, and they provide a contextual framework to achieve this in the article. In many countries, civil society organisations have been responsible for handling the majority of resources to deliver services to individuals and have played a leading role in developing and implementing sustainable strategies to mitigate the impact of HIV and AIDS. In contrast, TB prevention, care and control activities face numerous challenges. A major problem is that one in three estimated TB cases globally is either not formally reported in the public system or not reached at all by existing services. TB is rarely recognised as a priority by national political authorities, United Nations agencies, development banks, the pharmaceutical industry and philanthropic organisations and often neglected within development, human rights and social justice agendas. Despite some efforts to engage civil society organisations in global TB activities, in many countries they still lack recognition as legitimate partners at national and local level even in established democracies.
Amid discussion of how global health governance should and could be strengthened, the potential role of civil society organisations has been frequently raised. In this paper, the author considers the role of civil society organisations (CSOs) in four health governance instruments under the auspices of the World Health Organisation – the International Code on the Marketing of Breastmilk Substitutes, Framework Convention on Tobacco Control, International Health Regulations and Codex Alimentarius. She draws several conclusions about CSO engagement for strengthening global health governance (GHG). First, CSOs have played the biggest roles in initiating, formulating and implementing formal rules in GHG. Second, CSOs cannot perform certain functions, which should be fulfilled by the state to ensure GHG instruments are effective, such as formal mechanisms for monitoring and enforcement by government institutions, with punitive measures for non-compliance embodied in national legislation. Third, GHG remains far from pluralist in a true sense. The case studies suggest that, like global governance as a whole, GHG is being characterised by greater, rather than lesser, concentration of power in fewer hands. CSOs can bring much-needed diversity to the GHG landscape.
Between 2007 and April 2011, 35 governments across Africa have either passed or are about to pass legislation restricting activities and the existence of civil society organisations (CSOs), according to this review. The trend is even more troublesome, the African Civil Society Platform on Principled Partnership (ACPPP) argues, when one considers that, in about 20 of these cases, the laws are similar in content. What began as a genuine call for mutual accountability and harmonisation of development effort between external funders, governments and CSOs has turned into a wave of legislation and policies targeting CSOs that do not appear to conform to government choices. The review draws from over 17 studies conducted between 2008-2011, discussions with CSOs from 30 countries across Africa, and review of work of several CSOs in conflict prevention and peace building. The ACPPP argues that neither the Paris Principles nor the CSO Principles for Development Effectiveness will be sufficient to deal with the current wave of legislation limiting CSOs. In seeking to reverse this trend, ACPPP proposes that the problem of shrinking space for civil society participation be addressed in its broader perspective, and not just as a violation of human rights, freedom of association or of CSO regulation. The attack on CSOs is about control of power and not regulation. This calls for support for democracy and good governance as drivers of development, the authors argue, particularly in situations of conflict and fragility.
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.
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.