A new time line with guidance from Member States has been proposed for improving a framework on engagement with non-State actors at the World Health Organization. Discussions on the framework document prepared by the WHO Secretariat were held at the meeting of the 136th session of the WHO Executive Board (EB). During the plenary session, many countries expressed their dissatisfaction with the current draft framework and Argentina proposed a draft decision to convene a working group for deciding on the way forward. This document provides the current draft of the framework.
Governance and participation in health
WHO: Members States propose guidance for engagement with non-State actors
TWN Info Service on Health Issues (Jan15/06), 2015
Annotated bibliography on participatory consultations to help aid the inclusion of marginalized perspectives in setting policy agendas
Siddiqui FR: International Journal for Equity in Health 13(124), December 2014
This bibliography presents studies from peer-reviewed and grey literature that used consultations and other participatory strategies to capture a community’s perspective of their health priorities, and of techniques used to elevate participation from the implementation phase to a more upstream phase of prioritisation, policymaking and agenda setting. It covers studies that worked with marginalised populations or sub-populations. It begins by first offering some philosophical and conceptual frameworks that link participatory interventions with inclusive policy making or agenda setting, and a rationale for prioritising marginalised populations in such an undertaking. It further looks at various participatory instruments for consultations, for reaching out to marginalised populations, and for communicating the results to policymakers. A final section presents a reflective and evaluative look at the recruitment, instruments and examples.
Attitudes of Gatekeepers Towards Adolescent Sexual and Reproductive Health in Ghana
Kumi-Kyereme A, Awusabo-Asare K, Darteh EKM: African Journal of Reproductive Health 18(3), September 2014
Adults constitute gatekeepers on adolescent sexual and reproductive health (ASRH). This qualitative paper discusses the views of adults on ASRH problems and challenges based on 60 in-depth interviews conducted among adults in Ghana in 2005. Adults were purposively selected based on their roles as parents, teachers, health care providers and community leaders. The major ASRH problems mentioned were teenage pregnancy and HIV/AIDS. The results indicated a number of challenges confronting ASRH promotion including resistance from parents, attitudes of adolescents, communication gap between adults and adolescents and attitudes of health care providers. Among health workers three broad categories were identified: those who were helpful, judgmental and dictators. Some adults supported services for young people while others did not. Some served as mediators and assisted to ‘solve’ ASRH problems, which occurred in their communities. It is argued that exploring the views of adults about their fears and concerns will contribute to the development of strategies and programmes which will help to improve ASRH,
The state of HIV sector local governance in Malawi and Zambia: Evidence from five districts
Steyn J: Commonwealth Journal of Local Governance 15, 128-140, 2014
This paper reports on a project that aimed to improve the levels of HIV governance at the district level in Malawi and Zambia by encouraging public participation in an effort to more effective use of local resources. The methodology for this project included a barometer which assessed perceptions among key stakeholders on effectiveness, efficiency, rule of law, accountability, participation and equity at district level. The stakeholders ranged from administrators, political representatives, community-based organisations and the private sector on the supply side and citizens on the demand or beneficiary side. Communication and transparency appear to be major issues underpinning the bottlenecks and shortcomings in the HIV sector governance at the district level. Information gaps have given rise to accountability deficits and coordination deficiencies. Addressing these matters would make more effective use of resources and lessen dependence on external funding sources.
A concept in flux: questioning accountability in the context of global health cooperation
Bruen C, Brigha R, Kageni A and Wafula F: Globalization and Health 10:73, 2014
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.
Food label reading and understanding in parts of rural and urban Zimbabwe
Chopera P, Chagwena DT, Mushonga NGT: African Health Sciences 14(3), September 2014
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.
Workshop report: Politicizing African urban ecologies: Enabling radical geographical research practices for African scholars
Duminy J: University of Pretoria, South Africa, November 2014
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.
Zinduka is a call to East Africans to wake up
Odhiambo T: Pambazuka News, 702, 11 November 2014
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.
Community participation in formulating the post-2015 health and development goal agenda: reflections of a multi-country research collaboration
Brolan CE, Hussain S, Friedman E, Ruano AL, Mulumba M, Rusike I, Beiersmann C, Hill PS: International Journal for Equity in Health, 13:66, 2014
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.
Examining the links between community participation and health outcomes: a review of the literature
Rifkin S: Health Policy and Planning 29, suppl 2 ii98-ii106, 2014
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.