Reverse Innovation has been endorsed as a vehicle for promoting bidirectional learning and information flow between low- and middle-income countries and high-income countries, with the aim of tackling common unmet needs. One such need, which traverses international boundaries, is the development of strategies to initiate and sustain community engagement in health care delivery systems. In this commentary, the authors discuss the Baltimore “Community-based Organizations Neighborhood Network: Enhancing Capacity Together” Study. This randomized controlled trial evaluated whether or not a community engagement strategy, developed to address patient safety in low- and middle-income countries throughout sub-Saharan Africa, could be successfully applied to create and implement strategies that would link community-based organizations to a local health care system in Baltimore, a city in the United States. Specifically, the authors explore the trial’s activation of community knowledge brokers as the conduit through which community engagement, and innovation production, was achieved. Cultivating community knowledge brokers holds promise as a vehicle for advancing global innovation in the context of health care delivery systems. As such, further efforts to discern the ways in which they may promote the development and dissemination of innovations in health care systems is warranted.
Governance and participation in health
The Network of African Parliamentary Committees of Health (NEAPACOH), previously known as the Southern and Eastern Africa Parliamentary Alliance of Committees on Health (SEAPACOH)) is one of the active networks engaging members of parliament in Africa to strengthen the delivery of their functions of oversight, legislation and representation, in tackling health challenges in the region. This study sought to understand NEAPACOH’s contributions in strengthening parliamentary committees in Africa to tackle health and population challenges, and identify ways in which the network can become more effective in the delivery of its mandate. Given the integral role of information or evidence in the delivery of the parliamentary functions, the study had a special interest in understanding how the network promotes evidence-informed discharge of the health committee, to generate learning needed to strengthen NEAPACOH as well as inform future efforts aimed at strengthening the delivery of parliamentary functions in Africa.
The World Health Organization (WHO) and its Member States have committed, within the framework of the International Health Regulations 2005 (IHR), to detect, verify, assess and report events that may pose a risk to international public health. This report summarizes public health events detected, verified, assessed and reported in three WHO Regions, namely Africa, the Americas and Europe from 2001 to 2016, with a focus on 2016. This report illustrates the relevance and importance of conducting and sustaining epidemic intelligence activities in accordance to alleviate the burden and impact of epidemics and emergencies, and thus avoid interference with travel and trade. Achieving this early detection goal—to rapidly and effectively respond to emergencies—requires dedicated human resources, close collaboration across states, partners and other stakeholders, transparent information-sharing and sustained funding.
The author comments that Oxfam has been successful in highlighting the gross and rapidly growing inequalities in the world in international fora, but critiques the approach of asking rich elites and their allies in governments to do the right thing as perpetuating the myth that there are no alternatives other than to depend on large corporations. The author argues that it is in people’s everyday practices that it is far more likely to find meaningful solutions to inequality and the seeds of a more human economy. He raises, for example, the issue of redistribution of assets, such as to address land inequality, as a more pertinent pathway for peoples practices to address societal inequality and challenge the structural power of the drovers of inequality.
SATUCC held a successful 10th Delegates’ Congress in Dar-es-salaam Tanzania under the theme: Defending and promoting democracy, human and trade union rights and decent work for all in SADC Region. The Congress debated and adopted policies on corruption, procurement and ethical guidelines, and on the marginalisation of women and youth in the SADC Region and their exclusion in decision making structures, both within trade unions and in national and regional development processes.
This study was designed to address the question of whether a community-led transparency and accountability program can improve health outcomes and community empowerment, and, if so, how and in what contexts. To answer this question, researchers and civil society organization partners co-designed a program that would activate community participation in improving maternal and newborn health outcomes. This report presents the design of the work that was implemented in 200 villages in Tanzania and Indonesia and studied using a mixed methods impact evaluation. The team faced challenges including how to best foster community participation, how to structure the information gathering and sharing component, how to facilitate social action in communities, and how to ensure communities review their successes and failures in implementing social actions.
This paper aimed to improve understanding about how district health managers perceive and use their decision space for human resource management (HRM) and how this compares with national policies and regulatory frameworks governing HRM. To assess the decision space that managers have in six areas of HRM (e.g. policy, planning, remuneration and incentives, performance management, education and information) the study compares the roles allocated by Uganda’s policy and regulatory frameworks with the actual room for decision-making that district health managers perceive that they have. Results show that in some areas District Health Management Team (DHMT) members make decisions beyond their conferred authority while in others they do not use all the space allocated by policy. DHMT members operate close to the boundaries defined by public policy in planning, remuneration and incentives, policy and performance management. However, they make decisions beyond their conferred authority in the area of information and do not use all the space allocated by policy in the area of education. DHMTs’ decision-making capacity to manage their workforce is influenced by their own perceived authority and sometimes it is constrained by decisions made at higher levels. The authors conclude that decentralization, to improve workforce performance, needs to devolve power further down from district authorities onto district health managers. DHMTs need not only more power and authority to make decisions about their workforce but also more control over resources to be able to implement these decisions.
This descriptive study reports on the feasibility, acceptability and appropriateness of health animator-led community workshops for malaria control. Quantitative data were collected from self-reporting and researcher evaluation forms. Qualitative assessments were done with health animators, using three focus groups in 2015 and seven in-depth interviews (October 2016–February 2017). Seventy seven health animators were trained from 62 villages. A total of 2704 workshops were conducted, with consistent attendance from January 2015 to June 2017, representing 10–17% of the population. Attendance was affected by social responsibilities and activities, relationship of the village leaders and their community and involvement of community health workers. Active discussion and participation were reported as main strengths of the workshops. Health animators personally benefited from the mind-set change and were proactive peer influencers in the community. Although the information was comprehended and accepted, availability of adequate health services was a challenge for maintenance of behaviour change. the authors argue that community workshops on malaria are a potential tool for influencing a positive change in behaviour towards malaria, and applicable for other health problems in rural African communities. Social structures of influence and power dynamics affect community response. they suggest that there is need for systematic monitoring of community workshops to ensure implementation and sustain health behaviour change.
Non-governmental organisations (NGOs) have become key actors in responding to poverty and related suffering. In Africa, NGOs play a leading role in providing health care and education. But NGOs also have their detractors who argue that they are receiving growing amounts of external aid, but aren’t the most suitable actors for really improving people’s lives. Some critics insist that the neoliberal policies advanced by international actors have limited the influence of the state and that NGOs have benefited as a result. NGOs are criticised for their focus on technical solutions to poverty instead of the underlying issues, and for being more dependent and accountable to their funders than those they serve. Instead of empowering local populations to organise themselves, the authors argue that there is a risk that NGOs empower people to attain licensed, rather than emancipatory, freedoms; these are freedoms achieved “within the system” which improve lives, but don’t dramatically change power dynamics.
Mobile instant messaging (MIM) tools, such as WhatsApp, have transformed global communication practice. In the field of global health, MIM is an increasingly used, but little understood, phenomenon. It remains unclear how MIM can be used by rural community health workers (CHWs) and their facilitators, and what are the associated benefits and constraints. To address this gap, WhatsApp groups were implemented and researched in a rural setting in Malawi. The multi-site case study research triangulated interviews and focus groups of CHWs and facilitators with the thematic qualitative analysis of the actual conversations on WhatsApp. The use of MIM was differentiated according to instrumental (e.g. mobilising health resources) and participatory purposes (e.g. the enactment of emphatic ties). The identified benefits were centred on the enhanced ease and quality of communication of a geographically distributed health workforce, and the heightened connectedness of a professionally isolated health workforce. Alongside minor technical and connectivity issues, the main challenge for the CHWs was to negotiate divergent expectations regarding the social versus the instrumental use of the space. Despite some challenges and constraints, the implementation of WhatsApp was received positively by the CHWs and it was found to be a useful tool to support distributed rural health work.