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.
Governance and participation in health
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.
This article evaluates progress in implementing the United Nation’s Global Strategy on Women and Children’s Health since it was released in September 2010. The Commission on Information and Accountability for Women’s and Children’s Health was created in December 2010 to oversee the implementation of the Global Strategy. Since then it has met with stakeholders twice and developed a strategic plan of action. Feedback from those meetings indicate that developing countries – in particular, African countries – face major obstacles in gathering birth and maternal mortality data. The future of the Commission remains uncertain, however, with stakeholders expressing skepticism about whether or not external funders will meet their commitments. In order to succeed in reducing maternal mortality, a combination of interventions is needed, including education on reproductive health issues; access to effective birth control and safe abortion; universal prenatal care; diagnosis and referral of high-risk pregnancies; a high percentage of births overseen by skilled attendants; and safe motherhood protocols for managing normal and high-risk births. However, reaching a consensus on which interventions should be funded is complicated, the article concludes, given the sensitive nature of maternal health issues, specifically family planning and safe abortion, which are opposed by conservatives.
Civicus argue that the Southern African Development Community (SADC) region is experiencing a major backslide in democratic freedoms. Recent restrictions on civil society in the region, whether through regressive laws, policies or vigorous persecution of activists, are argued to fly in face of the SADC treaty which calls upon its 14 members to uphold human rights and the rule of law and promote common political values through democratic, legitimate and effective institutions. The article cites examples from countries in the region, including from Zimbabwe, Malawi, Swaziland, Angola, DRC and South Africa.
According to CIVICUS, in 2011, the existing institutions of global governance failed to provide people-centred responses to the current global economic, social, political and environmental crises. Too often in key multilateral meetings and processes, the narrow national interests of states prevailed. The Durban climate change summit of 2011 (COP17) fell short of the decisive action required, as did the 2011 G20 meeting of the world’s most powerful economies. On the positive side was the launch of the new United Nations body, UN Women, as well as the Busan High-Level Forum on Aid Effectiveness, and many of the stances adopted by the UN Human Rights Council in Geneva, particularly during the Universal Periodic Review, its peer-reviewed assessment of human rights in UN member states. In Busan and in Geneva, the space guaranteed to civil society enhanced the credibility and quality of the process, and these procedures should be regarded as minimal standards that should be extended to other arenas. A predicament for both states and civil society alike is the fact that disconnected summits purport to address intertwined issues such as economic growth, development effectiveness, climate change and human rights in silos. Civil society organisations must combine to advocate for a multilateral system that has the reach and ambition to tackle connected challenges and the imagination to put global interests first.