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.
Governance and participation in health
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.
Mitchell Sutika Sipus is an urban planning advisor to the Mayor of Mogadishu. He also lives and works in Kabul, Afghanistan. Here he writes about the rebuilding of Mogadishu’s physical infrastructure and the need for ‘psychological healing’ amongst the residents of the city. He writes of the initiation of trauma workshops for residents. Rebuilding the physical landscape is only part of the struggle. How can the city heal psychologically? Mogadishu's deputy mayor, Iman Icar, believes that to transform the city it is essential to transform the minds of residents. The mayor set up a new initiative to provide training in trauma healing and reconciliation for 50 people in each district. On July 19, 2012, the program concluded with a grand ceremony attended by President Sharif Sheikh Ahmed. The first 800 graduates will train another group of 800. In a city of three million, 1600 people may not be much, but it is argued to be a ripple in the pond that, with continued effort and support, will grow ever wider.
The outcome of Rio+20, held in June 2012, with negotiating countries unable to reach consensus on most issues, left most commentators disappointed as the summit failed to live up to its ambitious title “The Future We Want”. However, UHC Forward argues that health activists have a minor victory to celebrate, as issues regarding health, absent in the initial drafts circulated in advance of the Summit, are now mentioned in the texts. Health has had its relationship with sustainable development firmly recognised in terms of Universal Health Coverage by: strengthening health systems; complying with Beijing, Cairo and TRIPs flexibilities to ensure access to essential medicines; reducing infant and maternal mortality; and providing universal access to family planning and sexual and reproductive health. However, UHC Forward acknowledges that the Rio+20 outcome text contains too many divergent viewpoints and no tangible political commitments. It does, though, mark the beginning of the next phase of negotiations, and UHC Forward calls on all activists to demand that new agreements must reflect the challenges of the new global landscape, accounting for new health challenges, widening inequality and the increased proportion of the world’s poor in middle-income countries.
Zambian civil society organisations, especially those devoted to women’s rights, have welcomed Zambia’s new Constitution, which contains progressive provisions on gender equality and the promotion of women’s rights. The public is expected to vote on the Constitution in a national Referendum in 2013. Women’s rights organisations are reported to be preparing for educational campaigns amongst women to vote in favour of the new Constitution in the proposed Referendum in 2013. The parties to the Women’s Declaration on Engendering the Republican Constitution include the labour movement, the private sector, traditional leaders and groups under the umbrella of the Non-Governmental Organisations Coordinating Council (NGOCC). The draft version will enshrine gender equity in the Constitution in terms of economic empowerment. Activists have further demanded for the recognition of education as an important tool for the empowerment of women and women’s political empowerment through proportional representation in all decision making structures.