The word ‘Zinduka’ means re-awaken or stir up in Kiswahili – more or less like ‘pambazuka’. In Kirundi it simply means wake up. It is a call to prepare to work; to do something for the day. The Zinduka Festival that was held in Arusha, Tanzania, between 6 and 8 November was a call on ordinary East Africans to wake up, to be alert about the slow pace by politicians in integrating the region. Zinduka – sponsored by the akibaUhaki and other regional partners and hosted at the Sheikh Amri Abeid Stadium – was meant to celebrate the common people’s efforts and intensify those efforts to bring the different communities together. The theme was: People’s Voices, Sustainable Development, through Arts, Culture and Conversations. The author argues that Kiswahili can be a key driver of regional integration but that it will need massive efforts to systemize or standardize this lingua franca; integrate it in businesses, schools, offices and in their spiritual and personal life.
Governance and participation in health
Global discussion on the post-2015 development goals, to replace the Millennium Development Goals when they expire on 31 December 2015, is well underway. While the Millennium Development Goals focused on redressing extreme poverty and its antecedents for people living in developing countries, the post-2015 agenda seeks to redress inequity worldwide, regardless of a country’s development status. Furthermore, to rectify the UN’s top-down approach toward the Millennium Development Goals’ formulation, widespread negotiations are underway that seek to include the voices of people and communities from around the globe to ground each post-2015 development goal. This reflexive commentary, therefore, reports on the early methodological challenges the Go4Health research project experienced in its engagement with communities in nine countries in 2013. Led by four research hubs in Uganda, Bangladesh, Australia and Guatemala, the purpose of this engagement has been to ascertain a ‘snapshot’ of the health needs and priorities of socially excluded populations particularly from the Global South. This is to inform Go4Health’s advice to the European Commission on the post-2015 global goals for health and new governance frameworks. Five methodological challenges were subsequently identified from reflecting on the multidisciplinary, multiregional team’s research practices so far: meanings and parameters around qualitative participatory research; representation of marginalization; generalizability of research findings; ethical research in project time frames; and issues related to informed consent. Strategies to overcome these methodological hurdles are also examined. The findings from the consultations represent the extraordinary diversity of marginal human experience requiring contextual analysis for universal framing of the post-2015 agenda. Unsurprisingly, methodological challenges will, and did, arise. We conclude by advocating for a discourse to emerge not only critically examining how and whose voices are being obtained at the community-level to inform the post-2015 health and development goal agenda, but also how these voices are being translated and integrated into post-2015 decision-making at national and global levels.
As a key principle of Primary Health Care (PHC) and Health Systems Reform, community participation has a prominent place in the current global dialogue. Participation is not only promoted in the context of provision and utilization of health services. Advocates also highlight participation as a key factor in the wider context of the importance of social determinants of health and health as a human right. However, the evidence that directly links community participation to improved health status is not strong. Its absence continues to be a barrier for governments, funding agencies and health professionals to promote community participation. The purpose of this article is to review research seeking to link community participation with improved health status outcomes programmes. It updates a review undertaken by the author in 2009. The search includes published articles in the English language and examines the evidence of in the context of health care delivery including services and promotion where health professionals have defined the community’s role. The results show that in most studies community participation is defined as the intervention seeking to identify a direct causal link between participation and improved health status modeled on Randomized Control studies (RCT). The majority of studies show it is not possible to examine the link because there is no standard definition of ‘community’ and ‘participation’. Where links are found, they are situation-specific and are unpredictable and not generalizable. In the discussion, an alternative research framework is proposed arguing that community participation is better understood as a process. Once concrete interventions are identified (i.e. improved birth outcomes) then the processes producing improved health status outcomes can be examined. These processes may include and can lead to community uptake, ownership and sustainability for health improvements. However, more research is needed to ensure their validity.
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.
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.