Focus groups, one-to-one interviewees and surveys in Ghana, Senegal and
Tanzania, Nigeria. Ethiopia and South Africa provided the evidence cited in this research report. They were asked what had changed most about media and communications in the last five years. Two responses were common to all those who took part: the greater amount of media available and the presence of the Internet. These key changes have created haves and the have-nots. On almost every media measure, those living in rural Africa are at a disadvantage to their urban counterparts. The research found that over five years Facebook has grown from practically no users in Sub-Saharan Africa to become the most widely used social media platform, and the number of Africans who own or have access to mobile phones, computers, laptops, smartphones and tablets has grown considerably. Based on trends the authors predict that smartphone use will grow to between 10-20% of the population depending on the country, as will phones with internet access. While the current pattern of mobile phone use in the countries in focus has largely been voice and SMS, the numbers accessing the internet and social media is projected to grow over the next five years to between 10-25% of the population depending on the country.
Governance and participation in health
With an estimated population of 1.1 million, Maputo is the most densely populated city in Mozambique. The city is sharply divided into two areas: ’the cement city’, or the old colonial centre with paved roads and high-rise buildings, and the bairros – largely underserved, congested areas that house the majority of the city’s population. Situated on the Indian Ocean, the city is highly vulnerable to climate change impacts such as cyclones, flooding and sea level rise. Poverty and inequality, which are concentrated in the bairros, further exacerbate climate change vulnerabilities in the city. Chamanculo C is one such bairro where vulnerabilities have become evident during recent flood events. Responding to the urgent need to address urban deprivation, the municipality is currently implementing a neighbourhood upgrading programme in a participatory manner in Chamanculo C.
The author writes that the suffering inflicted by the Ebola outbreak - and the ineffective reactions to it - reveals a massive failure of global health governance. States and international organizations are scrambling, from the Security Council to the streets of Monrovia, to triage the damage to social order and human dignity from the outbreak of Ebola in West Africa. It remains to be seen whether scaled-up responses can control the epidemic. But, he argues, there awaits another reckoning—the challenge of identifying what went wrong, where mistakes were made, why we ended up in crisis and how to ensure a similar failure does not happen again. He proposes that the UN Security Council should establish an independent investigation into the outbreak and the international community’s responses. The investigation should probe what happened from the local level to the office of the director-general of the World Health Organization. It should gather information on when and how other actors in global health—countries, regional organizations, NGOs and airlines and other corporations—responded.
The democratic legitimacy of transnational arrangements for global health is contested. The traditional United Nations’ body for health, the World Health Organization (WHO), is subject to severe criticism regarding its focus, effectiveness, and independence from country specific, and private sector interests. It is confronted by budget cuts and a fundamental reorganization. Other major actors, such as the Global Alliance for Vaccines and Immunization (GAVI), Global Fund and the Bill and Melinda Gates Foundation (hereafter The Gates), make significant contributions to international health projects, but they can be criticized for not being representative and accountable. The global health landscape in general has become an intransparent patchwork of organizations and interests, where objectives of public health, development, economy, security, and foreign policy dominate to various degrees, and sometimes clash. This paper discusses the principal arrangements for transnational governance in the area of global health, and analyses their democratic legitimacy using five different prisms: (1) representation; (2)accountability; (3) transparency; (4) effectiveness; and (5) deliberation.
Priority-setting decisions are based on an important, but not sufficient set of values and thus lead to disagreement on priorities. Accountability for Reasonableness (AFR) is an ethics-based approach to a legitimate and fair priority-setting process that builds upon four conditions: relevance, publicity, appeals, and enforcement, which facilitate agreement on priority-setting decisions and gain support for their implementation. This intervention study applied an action research methodology to assess implementation of AFR in one district in Kenya, Tanzania, and Zambia, respectively. The assessments focused on selected disease, program, and managerial areas. The values underlying the AFR approach were in all three districts well-aligned with general values expressed by both service providers and community representatives. There was some variation in the interpretations and actual use of the AFR in the decision-making processes in the three districts, and its effect ranged from an increase in awareness of the importance of fairness to a broadened engagement of health team members and other stakeholders in priority setting and other decision-making processes. District stakeholders were able to take greater charge of closing the gap between nationally set planning on one hand and the local realities and demands of the served communities on the other within the limited resources at hand. This study provided arguments for the continued application and further assessment of the potential of AFR in supporting priority-setting and other decision-making processes in health systems to achieve better agreed and more sustainable health improvements linked to a mutual democratic learning with potential wider implications.
In this article, the author shares few tips on sustainability, leadership and everything that could help NPOs to sustain their development interventions Money in the bank does not necessarily mean that an organisation will be sustainable. The author argues that a strong sense of being mission-driven, measuring impact and sharing results is what leaders of charities and nonprofit organisations (NPOs) should strive to embed into the consciousness of everyone involved in the organisation, this is how an organisation can shift the status quo from fretting over money to creating future plans. Using the seven dimensions for nonprofit sustainability as a guideline, leaders can embrace these characteristics for determining board competencies and delegation of duties for oversight, good governance and quality performance that will ensure continuity. The seven dimensions encompass the following; legal good standing and compliance; organisational capacity and expertise to do the work; financial viability of the organisation; advocacy for the work undertaken that will make a difference; quality and professionalism of service provision; stable infrastructure and building of a brand that portrays a positive public image.
At least 750,000 people are stateless in West Africa, according to the UN Refugee Agency (UNHCR), which is calling for governments to do more to give or restore the nationality of stateless individuals, and improve national laws to prevent statelessness. Many in the region are both stateless and refugees, said Emmanuelle Mitte, senior protection officer on statelessness with UNHCR in Dakar, but the overwhelming majority of stateless persons in West Africa are stateless within their own country, lacking proof of the criteria required to guarantee their nationality. Statelessness can block people’s ability to access health care, education or any form of social security. In the case of children who are separated from their families during emergencies, the lack of official documentation makes it much harder to reunite them, says the UN Children’s Fund (UNICEF). Lack of official identification documents can mean a child enters into marriage, the labour market, or is conscripted into the armed forces, before the legal age. Statelessness can also render people void of protection from abuse. Denied the right to work or move, they risk moving into the invisible underclass, said UNHCR’s West Africa protection officer, Kavita Brahmbhatt, who gave the example of a group of stranded non-documented Sierra Leonean migrants living in the slums of Liberia’s capital, Monrovia, selling charcoal as they were too poor to do anything else, and too scared to return home for fear of being punished. “They became a member of Monrovia’s underclass,” she said. “Birth registration is more than just a right. It’s how societies first recognize and acknowledge a child’s identity and existence,” said Geeta Rao Gupta, UNICEF deputy executive director in a late 2013 communique launching the report Every Child’s Birth Right: Inequities and trends in birth registration.
Mobile health (mHealth) approaches for non-communicable disease (NCD) care seem particularly applicable to sub-Saharan Africa given the penetration of mobile phones in the region. The evidence to support its implementation has not been critically reviewed. The authors systematically searched PubMed, Embase, Web of Science, Cochrane Central Register of Clinical Trials, a number of other databases, and grey literature for studies reported between 1992 and 2012 published in English or with an English abstract available. The search yielded 475 citations of which eleven were reviewed in full after applying exclusion criteria. Five of those studies met the inclusion criteria of using a mobile phone for non-communicable disease care in sub-Saharan Africa. Most studies lacked comparator arms, clinical endpoints, or were of short duration. mHealth for NCDs in sub-Saharan Africa appears feasible for follow-up and retention of patients, can support peer support networks, and uses a variety of mHealth modalities. Whether mHealth is associated with any adverse effect has not been systematically studied. Only a small number of mHealth strategies for NCDs have been studied in sub-Saharan Africa. They report that there is insufficient evidence to support the effectiveness of mHealth for NCD care in sub-Saharan Africa and present a framework for cataloging evidence on mHealth strategies that incorporates health system challenges and stages of NCD care to guide approaches to fill evidence gaps in this area.
The author reports her concern that WHO’s so-called reform will side-line those who work in the spirit of ‘Health for All’ and expand the influence of business corporations and venture philanthropies over global public health matters as well as reinforce the trend towards fragmented, plutocratic, global governance. In October 2013, after a change of terminology, WHO presented a Discussion paper on WHO engagement with non-State actors and draft outline of WHO’s plan to ensure Due diligence, management of risks & transparency at an informal consultation with Member States, NGOs and commercial actors. WHO leadership quashed considered criticisms by NGOs. Member States and public interest NGOs found both papers wanting and requested changes. The successor of the October papers, the Background document, was discussed in March 2014 in a second consultation, open to Member States only. Ten days before the 2014 World Health Assembly, the WHO Secretariat issued the latest version of the policy Framework on engagement of non-State actors (A67/6). The author observes that the previous shortcomings were not addressed and expresses concern that the reform will open the floodgates to corporate influence on global and national decision-making processes in public health matters.
Concerns about public health are widespread in sub-Saharan Africa, and there is considerable support in the region for making public health challenges a top national priority. In particular, people want their governments to improve the quality of hospitals and other health care facilities and deal with the problem of HIV/AIDS. A Pew Research Center survey, conducted March 6, 2013 to April 12, 2013 in six African nations, also finds broad support for government efforts to address access to drinking water, access to prenatal care, hunger, infectious diseases, and child immunization. A median of 76% across six countries surveyed say building and improving hospitals and other health care facilities should be one of the most important priorities for their national government. The percentage of the public who holds this view ranges from 85% in Ghana to 64% in Nigeria. Similarly, a median of 76% believe preventing and treating HIV/AIDS should be one of government’s most important priorities, ranging from 81% in Ghana to 59% in Nigeria. A median of at least 65% also say the other issues included on the poll — ranging from access to drinking water to increased child immunization — should be among the most important priorities. In fact, majorities hold this view about all seven issues in all six nations.