In this Call to Action, the People’s Health Movement (PHM) argues that the underlying cause of health inequities are the neoliberal economic policies that are the hallmark of present day capitalism. PHM says the global health crisis is a consequence of the failure to address the social, political and environmental determinants of health. Ironically, the response of national and international institutions to the current financial crisis has been merely to restore the confidence’ of the same institutions and financial markets that caused the crisis in the first place. Governments have meanwhile enacted an austerity agenda by cutting health and social spending, effectively deepening and reinforcing inequities between rich and poor. PHM puts forward an alternative vision in which a reformed economic system values individuals over capital, with just, fair and democratic political and economic processes and institutions, and better and transformed global heath governance that is free from corporate influence and the influence of unaccountable private actors. It calls for equitable public health systems that are universal, integrated and comprehensive, and also provide a platform for appropriate action on social determination of health.
Governance and participation in health
Since the Global Fund to Fight AIDS, Tuberculosis and Malaria announced its new model for allocating funds in September 2012, African civil society organisations have stated that they were not included in the process, arguing that consultations were held behind closed doors and that most non-governmental organisations (NGOs) on the continent are unaware that a new model exists. The Rights Alliance of Southern Africa (ARASA), the South Africa-based World AIDS Campaign and almost 40 African non-governmental organisations (NGOs) have called for the Fund to develop a more robust and inclusive communication and consultation process around the model's development, which is ongoing.
In this open letter to the World Bank, a group of 110 international civil society organisations (CSOs) call on the Bank to play a truly progressive and transformative role in health by supporting countries to achieve universal health coverage (UHC). The World Bank is well-placed to be a vocal champion of UHC by deploying its knowledge and experience in health system reform, as well as its financial support. However, the Bank must reform the approach of its programmes and policy advice in order to deliver on this potential, and ensure it positively impacts poor and vulnerable populations. The CSOs call on the Bank to actively support countries to offer care that is free at the point-of-use for all people, as well as scale up investment in public health systems in developing countries, by supporting them to expand public financing, and by offering balanced policy advice that does not privilege private sector solutions over publicly financed and delivered health systems. The Bank can take further steps to promote UHC by ensuring all Bank programs benefit the poorest two quintiles in the countries where it works, actively supporting involvement of civil society in national health policy development, in order to improve democratic oversight and accountability for improved health outcomes, and collaborating with the World Health Organization and other global health institutions in the push for UHC.
This cross-sectional study was carried out in Jinja Town in Uganda in order to assess the level of awareness of occupational hazards and the use of safety measures among small-scale industrial welders in a low-income setting. A total of 218 roadside welders with a mean age of 31 years participated in the study. The researchers found that these roadside welders had a high level of awareness of occupational hazards (83%), but their use of safety measures was less than optimal. Awareness was positively influenced by age, educational status, marital status, work experience, type of training and supervision. The researchers speculate that the great discrepancy between the level of awareness and the use of personal protective equipment could be attributed to factors such as discomfort of wear, not being aware that even ‘simple tasks’ require protection and the unavailability of personal protective equipment because of the high costs associated with their acquisition, leading to sharing of the equipment available among colleagues. Strategies are therefore needed not only to enforce policy but also to cover the informal work sector, in order to ensure the safety of welders. Generally, their high level of awareness may be used as a window of opportunity for involving welders in decision-making as regards their working conditions.
Implementation of policies (decisions) in the health sector is sometimes defeated by the system’s response to the policy itself. This can lead to counter-intuitive, unanticipated, or more modest effects than expected by those who designed the policy. The health sector fits the characteristics of complex adaptive systems (CAS) and complexity is at the heart of this phenomenon. Anticipating both positive and negative effects of policy decisions, understanding the interests, power and interaction between multiple actors and planning for the delayed and distal impact of policy decisions are essential for effective decision making in CAS. Failure to appreciate these elements often leads to a series of reductionist approach interventions or ‘fixes’. This in turn can initiate a series of negative feedback loops that further complicates the situation over time. In this paper, researchers use a case study of the Additional Duty Hours Allowance (ADHA) policy in Ghana to illustrate these points. Using causal loop diagrams, they unpack the intended and unintended effects of the policy and how these effects evolved over time. The overall goal is to advance our understanding of decision making in complex adaptive systems; and through this process identify some essential elements in formulating, updating and implementing health policy that can help to improve attainment of desired outcomes and minimise negative unintended effects.
State of the Union (SOTU), a coalition of 10 civil society organisations, has urged national, regional and continental Parliaments to take a leading role in promoting the ratification and implementation of key African Union (AU) instruments and policy standards. SOTU says that the slow rate of ratification and domestication of key instruments is alarming and undermines the credibility of the AU and all its key organs, while denying millions of African citizens their fundamental freedoms and basic human rights as intended by the protocols. Although there has been some progress in the rate of ratification with a total of 118 new ratifications have been entered against the 43 instruments, more needs to be done to ensure the ratifications go hand in hand with domestication and implementation. In east, central and southern Africa, Zambia, Congo and Rwanda have performed best, having ratified five instruments each. By August 2012, only two countries, Kenya and Mauritius, had ratified the African Charter on the Values and Principles of Public Service & Administration (2011) and only 14 countries had ratified the Charter for Democracy, Elections and Governance. At this current rate, universal ratification of AU treaties would not be complete before 2053, says SOTU.
When specifically viewed with Africa’s history in mind, administrative corruption, though rampant across Africa today, is an alien culture, argues the author of this article. Pre-colonial Africa, for the most part, was founded on strong ethical values sometimes packaged in spiritual terms, but with the end result of ensuring social justice and compliance. The author argues that colonialism introduced systemic corruption across much of sub-Saharan Africa, repudiating indigenous values, standards, checks and balances. The author makes several recommendations: restoration of indigenous values and institutions; improving access to formal, informal and non-formal education; promotion of the ‘African’ nation state; and strengthening of anti-corruption institutions. The author argues that African countries should not just seek the deceptive increment in Gross Domestic Product, but real development in terms of standard of living, with health, education, food security and infrastructural growth given prominence.
Today, civil society is facing serious threats across the globe, according to this report. Civil society activists continue to face traditional forms of repression, such as imprisonment, harassment, disappearances and execution. In addition, many governments have increasingly become more subtle in their efforts to limit the space in which civil society organisations (CSOs), especially democracy and human rights groups, operate. In the report, the World Movement for Democracy (WMD) highlights the well-defined international principles protecting civil society and underscoring proper government-civil society relations, which are already embedded in international law. These principles include: the right of CSOs to entry (that is, the right of individuals to form and join CSOs); the right to operate to fulfill their legal purposes without state interference; the right to free expression; the right to communication with domestic and international partners; the right to freedom of peaceful assembly; the right to seek and secure resources, including the cross-border transfer of funds; and the state’s positive obligation to protect CSO rights. WMD calls for greater collaboration between civil society and government.
To address the research gap on health care leadership in low-income settings, researchers in this qualitative study documented the experiences of individuals in key health-care leadership roles in sub-Saharan Africa. They conducted in-person interviews with health care leaders in four countries in sub-Saharan Africa: Ethiopia, Ghana, Liberia and Rwanda. Individuals were identified by their country's minister of health as key leaders in the health sector and were nominated to serve as delegates to a global health leadership conference in June 2010, at Yale University in the United States. Five key themes emerged as important to participants in their leadership roles: having an aspirational, value-based vision for improving the future health of their countries, being self-aware and having the ability to identify and use complementary skills of others, tending to relationships, using data in decision making, and sustaining a commitment to learning. While current models of leadership capacity building only address the need for core technical and management competencies, skills relevant to managing relationships are also critical in the sub-Saharan African context, the authors argue. Developing such skills may require more time and a deeper level of engagement and collaboration than is typically invested in efforts to strengthen health systems.
Civil society space in Uganda is rapidly shrinking, says international civil society network, CIVICUS, and Uganda-based East and Horn of Africa Human Rights Defenders Project (EHAHRDP). Independent civil society organisations are being openly threatened and placed under excessive scrutiny by senior government officials. The Ugandan Parliament is currently considering the Public Order Management Bill, which would place a number of restrictions on the freedom of assembly, and violations of the proposed law carry a high penalty of two years’ imprisonment. Both CIVICUS and EHAHRDP urge the Ugandan government to respect the right of civil society actors to freely express, associate and assemble, in line with the country’s obligations under the Constitution and the International Covenant on Civil and Political Rights, to which Uganda is a party.