Following the High-Level Meeting on Universal Health Coverage (UHC) UN member states are expected to show more financial and political commitment to accelerate progress towards UHC.. Different approaches have been taken by different countries in Africa for this. Rwanda has used affordable health finance and insurance mechanisms - financed by both the national government and individuals - as a crucial driver for UHC. In 2018, Kenya also unveiled a plan for reaching UHC by 2022 by piloting UHC in four counties. The prioritization of such policy options and the ways to implement them are seen to require a. context-dependent balancing act that should be grounded in the correct application of evidence in decision-making processes. This is obserbed to demand measures to build individual and institutional capabilities to generate and use evidence to support value-based design and implementation of relevant system-level policy reforms for UHC.
Governance and participation in health
This study investigated how evidence used in the planning process affects decision-making and how stakeholders involved in planning perceived the use of evidence. Quantitative data was collected from district health annual work plans for 2012-2016 and from 'bottleneck analysis reports' for these years. Qualitative data was collected through semi-structured interviews with key informants from the two study districts. District managers reported that they were able to produce more robust district annual work plans when they used district-specific evidence. Approximately half of the prioritised activities in the annual work plans were evidence based. Procurement and logistics, training, and support supervision activities were the most prioritised activities. District-specific evidence and a structured process for its use to prioritise activities and make decisions in the planning process at the district level helped to systematise the planning process. However, the districts also reported having limited decision and fiscal space, inadequate funding and high dependency on external funding that did not always allow for the use of their own district evidence in planning .
In Sudan, the Tajamoo al-mihanyin al-sudaniyin or the Sudanese Professionals Association (SPA) is an alliance of independent professionals shrouded in mystery. Described as the “ghost battalion” by the now-deposed president Omar al-Bashir, the contemporary movement led by the SPA exerted influence on mobilizations and protest movements through sustained appeals, and built broad appeal and demonstrated a know-how of protests, applied within the social movement across the country. They initiated civil disobedience, rallies and marches in all parts of the country, focusing on women, displaced and exiled people, and on social justice and life on the margins. Moreover, they have taken the call to protest beyond the limits of major cities like Khartoum and across sectors—from resignation marches in outlying towns and provinces to the mobilization of dock workers in Port Sudan. The For a movement like the SPA there are challenges. Will its spirit remain strong or be exhausted? Will it be the guardian of this transition or its watchdog?
There is a growing push to include local voices in global health initiatives and policies to promote ownership of downstream implementation, but also to get a proper sense of the realities on the ground. Many governments gladly jump on the bandwagon. Yet when it comes to it, visa applications are often rejected on feeble grounds. Physicians and medical students with booked return flights, domestic hospital affiliations, formal invitation letters and even proof that they will not be a financial liability are rejected. Academia increasingly understands the need for local authorship and ownership of global health programmes, and rightfully so. However, a colonial trend persists in the wider community. Policies and resolutions are driven by high income country actors or government officials who are, by definition, detached from what is happening on the ground. Civil society actors who live among the realities of poverty are left behind.
The UK Home Office is reported to be accused of institutional racism and to be damaging British research projects through increasingly arbitrary and “insulting” visa refusals for African academics. In April, a team of six Ebola researchers from Sierra Leone were unable to attend vital training in the UK, funded by the Wellcome Trust as part of a £1.5m flagship pandemic preparedness programme. At the LSE Africa summit, also in April, 24 out of 25 researchers were missing from a single workshop. Shortly afterwards, the Save the Children centenary events were marred by multiple visa refusals of key guests. The article refers to a parliamentary inquiry into visa refusals hearing evidence that there is “an element of systemic prejudice against applicants”. In a letter in the Observer, 70 senior leaders from universities and research institutes across the UK warn that “visa refusals for African cultural, development and academic leaders … [are] undermining ‘Global Britain’s’ reputation as well as efforts to tackle global challenges”. The system is reported to be so difficult to predict or navigate that meetings, including conferences funded with British government money, are now being held in other countries.
BoLAMA report in a press statement that it has without much success made all efforts to engage and collaborate with the Government of Botswana on miners’ right to health, specifically for those suffering from TB and other occupational diseases. BoLAMA assert that TB rates in Botswana remain high and a multi-sectoral accountability framework is required. This framework which is aligned with the End TB Strategy and UN Political Declaration on TB requires key populations and civil society to work in collaboration with Governments. The regional TB/Silicosis class action is seen as an opportunity to reduce the economic hardships of ex-miners who due to contracting occupational lung diseases have been rendered redundant and not in gainful employment. The court case, to which BoLAMA has been party, is slated to be finalized in 2019. BoLAMA called on the Government of Botswana to; i) remember her commitments under the WHO EndTB Strategy from which the TB National Strategic Plan is aligned; ii) implement the UN Political Declaration on the fight against TB; iii) ensure an inter-ministerial committee including BoLAMA deal with ex-miners issues; and iv) provide support in the TB/Silicosis regional class suit.
This study explores how health facility committees monitor the quality of health services and how they demand accountability of health workers for their performance in Malawi. Documentary analysis and key informant interviews were complemented by interviews with purposefully selected health facility committees members and health workers regarding their experiences with health facility committees. The informal and constructive approach that most health facility committees use is shaped both by formal definition and expectations of their role and resource constraints. The primary social accountability role of health facility committees appeared to be co-managing the social relations around the health facility and promoting access to and quality of services. The results suggest that health facility committees can address poor health worker performance and the authors suggest that social accountability approaches with health facility committees be integrated in existing quality of care programs and that accountability arrangements and linkages with upward accountability approaches be clarified.
The G20 plays an important role in global rule-making. Africa is significantly under-represented in this body, with only South Africa a permanent member. This makes Africa a rule-taker. At the same time the G20 has started to pay more attention to Africa and the continent’s future development now occupies a somewhat more central position on the grouping’s agenda. The G20 Initiative on Supporting Industrialization in Africa and Least Developed Countries, launched under China’s G20 presidency of 2016, and the 2017 German presidency’s Compact with Africa offered unprecedented moments of engagement. However, the question remains how Africa can use these initiatives to deepen its engagement with the G20 and boost its own development. This paper draws on extensive interviews with key stakeholders to analyse G20–Africa engagement by focusing on three presidencies: China in 2016, Germany in 2017, and Argentina in 2018. It shows how China’s Industrialisation Initiative was crucially informed by its pre-existing African engagement, while Germany’s Compact with Africa both gained and suffered from a more narrowly focused commercial engagement. It then shows how Argentina, despite lacking a similar African initiative, managed to continue G20–Africa engagement through person-to-person diplomacy. The paper points out both the benefits and the limits of these engagements and suggests a series of further initiatives that could allow Africa a more significant say in the G20.
The authors write that definitions of “global health” are generally depoliticized and invoke trans-national health issues and collaboration. Yet they argue that global health is only the newest iteration of what was formerly “international health”, “tropical medicine” and “colonial medicine”, with historical roots lie in colonial endeavours and imperial interests. They report a widespread frustration with how global health is taught in universities in ways that create and perpetuate neo-colonial relations; and a desire for alternative conceptualizations of the “global” that fundamentally tackle structures of power. The authors observe in the paper the various issues that need to be tackled if there is an intent to 'decolonise' global health, commenting that it is not a one-day event or a checkbox. It is a process that leads to futures that are unknown, but that one should dare to imagine.
The ever increasing evidence and technical developments supporting population health have not yet reached the goal of health for all. The decision making for population health has not led to optimally accountable, fair and sustainable solutions. Technical experts, politicians, managers, service providers, community members, and beneficiaries each have their own values, expertise and preferences, to be considered for necessary buy in and sustainability. This presentation discusses Zambia as a case study country, finding that national governance results in policy based choices are not necessarily helpful at implementation and community levels. The authors present evidence that if one comprehensively addresses a particular disease burden it does decrease, but limits other action. The Sustainable Development goals included democratic cross sector processes in their formulation, but the targets applied in health still tend to receive funding from competing sectors and programs.