A group of leading international humanitarian, development, social justice, environmental, and workers' organisations have warned that June 2012’s UN Conference on Sustainable Development (Rio+20) looks set to add almost nothing to global efforts to deliver sustainable development. The warning from Development Alternatives, Greenpeace, the Forum of Brazilian NGOs and Social Movements for Environment and Development (FBOMS), International Trades Union Confederation (ITUC), Oxfam, and Vitae Civilis comes at the end of two weeks of negotiations between governments on the conference outcomes, with less than 50 days before the summit in Rio de Janeiro, Brazil, from 20 - 22 June. The group warns that the current negotiating text does not adequately capture human rights and principles of equity, precaution, and 'polluter pays', despite the urgency provided by the current financial crises, growing inequalities, broken food As a benchmark against which to assess the outcome of Rio+20, the organisations have set out a 10-point agenda that includes global goals for sustainable development, designed to eradicate poverty, reduce inequality and realise justice and human rights, while respecting the finite limits of Earth's natural resources.
Governance and participation in health
This research explored communities’ views on the elements of public health services that they find particularly problematic. It aimed to quantify the priority placed on each of these aspects of public service delivery that requires attention. Communities view the routine availability of effective medicines as the greatest priority for improved public sector health services; the least important priority is treatment by doctors. Routine availability of medicines is ten times more important than treatment by doctors. A thorough examination and clear explanation of a patient’s diagnosis and treatment by health professionals are also highly valued community priorities. Communities tolerate poor quality public sector service characteristics such as long waiting times, poor staff attitudes and the lack of direct access to doctors if they receive the medicine they need and a thorough examination and if a clear explanation of their diagnosis and treatment is provided.
The aim of this study was to examine the relationship between health systems outcomes and equity, and governance as a part of a process to extend the range of indicators used to assess health systems performance. Using cross sectional data from 46 countries in the African region of the World Health Organisation, an ecological analysis was conducted to examine the relationship between governance and health systems performance. Governance was found to be strongly associated with under-five mortality rate (U5MR) and moderately associated with the U5MR quintile ratio. After controlling for possible confounding by healthcare, finance, education, and water and sanitation, governance remained significantly associated with U5MR. Governance was not, however, significantly associated with equity in U5MR outcomes. This study suggests that the quality of governance may be an important structural determinant of health systems performance, and could be an indicator to be monitored. The association suggests there might be a causal relationship. However, the cross-sectional design, the level of missing data, and the small sample size, forces tentative conclusions. Further research will be needed to assess the causal relationship, and its generalisability beyond U5MR as a health outcome measure, as well as the geographical generalisability of the results.
The NCD Alliance is calling for a global coordinating platform for non-communicable diseases (NCDs), housed within a United Nations agency, driven by Member State champions, with an independent Board and Secretariat, to be a catalyst for coordinated action on NCDs. The Alliance argues that key gaps in the current global and national response to NCDs are a result of a lack of multisectoral action, a problem which could be addressed by the proposed platform. In this paper, the Alliance lays out various partnership options for a global coordinating platform (GCP) on NCDs: simple affiliations, lead partners, secretariats and joint ventures. The Alliance recommends a secretariat structure, similar to platforms like the Partnership for Maternal, Newborn and Child Health and the Global Health Workforce Alliance. It argues that an effective GCP on NCDs should be based on a set of best practice principles in order to effectively catalyse action on NCDs and coordinate the multisectoral response needed to reduce preventable NCD deaths by 25% by 2025.
A conference on Migration and Social Policy: Comparing European and African Regional Integration Policies and Practices was held on 19-20 April 2012 in Pretoria, South Africa. It brought together participants from the South African government, UN organisations, national research centres and NGOs to underscore the potentials to develop more effective regional social policy, improve policies for social protection and meet the social protection needs of cross-border migrants. Three main themes emerged. First, lessons can be drawn from cross-regional research experiences, in particular new directions of regionalism and its implications for migration and socioeconomic and political rights. Second, stakeholders should consider going beyond "migration management", toward more coherent governance systems that advance the social dimensions of migration. This approach could lead to more positive development outcomes of migratory processes. Third, looking at regional integration through the lens of the free movement concept was considered a useful approach to map out the advantages of advancing free movement in a regional context, for example with regard to already existing institutions and common regulations. Other issues raised during the conference included challenges presented by informal labour markets, irregular migration and insufficient formal social protection mechanisms; the lack of political will to promote free movement; and the need to construct a regional identity, in particular among civil society.
The single most important message of this paper is that development outcomes in poor countries depend fundamentally on the political incentives facing political elites and leaders. Political will has usually been treated as an inexplicable ‘black box’. The authors seek in this paper open up the black box, to say some definite things about the specific contexts in which political ambitions are shaped and policy choices are made in different parts of the world and at different stages of countries’ development processes. They argue that economic growth without economic transformation is limited. The authors raise the case that democracy depends on the formation of social classes, including productive capitalists, and organised professional groups and wage-earning workers. This only happens as a result of economic diversification and the accumulation of technological capacities. If the formal sector cannot generate adequate incomes and taxes for state revenues, the ruling elites draw resources to meet the demands of crucial coalition groups from various kinds of off-budget transfers and informal sharing of rents. The paper explores country contexts in Africa where there is evidence of diversity in the relationship between ruling elites and state bureaucracies, to better understand the reasons for this diversity and its implications for development aid.
The International Baby Food Action Network and the Third World Network review the World Health Organisation’s (WHO) reform process from a civil society perspective. (The WHO DG report on the reform is also included in this newsletter). The organisations argue that the reform process has not been transparent, as the Secretariat has withheld vital documents, such as the reports by consultants used to develop the reform agenda. With regard to stakeholders, they argue that it is important that WHO identifies the different types of social, political and economic actors with which it interacts and clearly distinguishes those that are related to commercial interests. The organisations refer to the WHO 12th General Programme of Work (GPW) as a sign of its direction, noting the unclear includion of work on the right to health, social determinants of health, primary health care and gender equality.
This report covering all aspects of World Health Organisation (WHO) reform was commissioned by the WHO for submission to the 65th World Health Assembly in May 2012. It addresses the three substantive areas of WHO reform: programmes and priority setting, governance and management. First,with regard to programmes and priority setting, the draft general programme of work, as it is developed over coming months, will demonstrate: how agreed criteria have been used to identify priorities; how high-level goals have been set; and how WHO’s core functions, comparative advantage and organisational position have been used to focus its the work. Guidance from Member States will influence the development of a first full draft for discussion by the regional committees later in 2012. Next, the section on governance consolidates proposals under four main headings: more rational scheduling, alignment and harmonisation of governance processes; strengthening oversight; more strategic decision- making by governing bodies; and more effective engagement with other stakeholders. The focus of recent work has been the internal governance of WHO by Member States. More detailed work and consultation is called for in relation to the streamlining of national reporting to WHO as well as engagement with other stakeholders. Finally, the management chapter has been reorganised to reflect the fact that stronger technical, normative and policy support for all Member States should be a key outcome of reform.
This independent evaluation of the World Health Organisation’s (WHO) proposed reform package found that WHO had responded adequately to challenges pointed out by stakeholders in the area of internal governance by using a Member State-driven consultative process to re-set its priorities and programme areas. Issues regarding resource allocation and the strengthening of governing bodies, however, need further amplification. A number of recommendations were made. As the proposed reform has highly interdependent components, the report calls on WHO to establish and maintain links among governing bodies at headquarters and regional offices to promote coherence and strategic focus, and adopt an approach that recognises this interdependence. Accountability and responsibility structures for three layers of governance would need to be redesigned, with results-based management and effective performance management and development. To generate acceptance at various levels, an advocacy plan should be developed, and regular communication should be maintained with all stakeholders. The report also calls for desired outputs, outcomes and impact to be identified, the designing of indicators to measure these, and a monitoring and feedback mechanism. As the reform programme is comprehensive and involves action on a large number of fronts, the report recommends that WHO develop a prioritisation plan to allow a smooth and gradual shift.
Utilisation of long-lasting insecticide-treated bed nets (LLITNs) by under-five children has been reported as unsatisfactory in many sub-Saharan African countries due to behavioural barriers. Previous studies have focused exclusively on coverage and ownership of LLITNs, so to address this research gap, researchers examined the effect of skill-based training for household heads on net utilisation. The study included 22 villages in southwest Ethiopia, with totals of 21,673, 14,735 and 13,758 individuals at baseline, sixth and twelfth months of the project period. At the baseline survey, 47.9% of individuals in the intervention villages (which received training) and 68.4% in the control villages (which did not) reported that they had utilised a LLITN the night before the survey. At six months, 81% of individuals in the intervention villages and 79.3% in the control villages had utilised LLITNs. Among under-five children, net utilisation increased by 31.6% at six months and 38.4% at twelve months. The researchers conclude that household level skill-based training demonstrated a marked positive effect in the utilisation of LLITNs. The effect of the intervention steadily increased overtime. Therefore, distribution of LLITNs should be accompanied by a skill-based training of household heads to improve its utilisation.