Accountability in global health is a commonly invoked though less commonly questioned concept. Critically reflecting on the concept and how it is put into practice, this paper focuses on the who, what, how, and where of accountability, mapping its defining features and considering them with respect to real-world circumstances. Changing dynamics in global health cooperation - such as the emergence of new health public-private partnerships and the formal inclusion of non-state actors in policy making processes - provides the backdrop to this discussion. In mapping some defining features, accountability in global health cooperation is shown to be a complex problem not necessarily reducible to one set of actors holding another to account. Clear tensions are observed between multi-stakeholder participatory models and more traditional vertical models that prioritise accountability upwards to donors, both of which are embodied in initiatives like the Global Fund. For multi-constituency organisations, this poses challenges not only for future financing but also for future legitimacy.
Governance and participation in health
Overweight and obesity prevalence is rapidly rising in developing countries. The reading and understanding of nutrition information on food packages has been shown to improve food choices and instill healthy eating habits in individuals. The aim of this study was to describe the prevalence of food label usage and understanding among urban and rural adults in Zimbabwe and its association with demographic and socio economic factors. A cross sectional study was conducted on 320 adults (147 urban and 173 rural) using a validated questionnaire. A high proportion (77%) of the respondents read food labels. Food label reading differed significantly by educational, employment status and locality. Only 41% of food label readers mostly understood the information on the food labels. More urban shoppers (86%) read food labels than their rural counterparts (67%). A significant number of participants (81%) indicated they would like to be educated on the meaning of food labels and 80% preferred the nutrition information on food labels to be simplified. The study found above average reported reading of nutrition information on food labels with partial understanding. The authors recommend that efforts be made to determine how all consumers could be made to understand the nutrition information on food labels and use it effectively in decision making.
The term “urban political describes a critical approach to studying cities across a number of areas, from environmental issues (such as climate change, air pollution, and nature conservation) to urban flows (such as sanitation and electricity provision). Many scholars believe that there is a need for a more explicitly political approach to these topics that draws attention to who wins and who loses as cities change, as well as to how urbanization as a process is shaped by power relations. These ideas informed the Urban Political Ecology in African Cities Workshop, Pretoria South Africa held in September 2014, organized by the Situated Ecologies collective (SUPE). The report presents discussions on options for scholars and residents in cities of Africa and the global South to integrate power relations in their work on urban change.
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.
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.