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.
Governance and participation in health
SATUCC Holds Its 10th Delegates Congress in Dar-es-salaam
SATUCC: SATUCC Blog, Botswana, December 2017
Citizen Voices, Community Solutions: Designing Better Transparency and Accountability Approaches to Improve Health
Transparency for Development: Harvard Kennedy School, USA, 2017
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.
Decision space for health workforce management in decentralized settings: a case study in Uganda
Alonso-Garbayo A; Raven J; Theobald S: Health Policy and Planning 32(Suppl 3) iii59–iii66, 2017
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.
Malaria control in rural Malawi: implementing peer health education for behaviour change
Malenga T; Kabaghe A; Manda-Taylor L; et al: Globalization and Health 13(84), doi: https://doi.org/10.1186/s12992-017-0309-6, 2017
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.
The role of NGOs in Africa: are they a force for good?
Sangonet Pulse, December 2017
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 for rural community health workers: a case from Malawi
Pimmer C; Mhango S; Mzumara A; et al: Global Health Action 10(1), doi: http://dx.doi.org/10.1080/16549716.2017.1368236, 2017
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.
Tanzania: Campaigners March Peacefully in Dar for Universal Health Coverage
Buguzi S: All Africa, 12 December 2017
Campaigners for Universal Health Coverage (UHC) camped at Mwananyamala Regional Hospital in Dar es Salaam in December 2017, raising voices for people who fail to access healthcare services due to financial constraints. Campaigns went out of the hospital as Kinondoni District residents and some health activists carried out peaceful demonstrations as a sign of solidarity for the UHC movement. The Universal Health Coverage Day, marked December 12 every year, is a time when health advocates around the globe join forces to demand action and results in healthcare access in every country.
Exploring how different modes of governance act across health system levels to influence primary healthcare facility managers’ use of information in decision-making: experience from Cape Town, South Africa
Scott V and Gilson L: International Journal for Equity in Health 16(159)1-15, 2017
This paper reports on work to explore how primary healthcare facility managers’ use of information for decision-making is influenced by governance across levels of the health system in Cape Town, South Africa. Central governance shaped what information and knowledge was valued – and, therefore, generated and used at lower system levels. The central level valued formal health information generated in the district-based health information system which therefore attracted management attention across the levels of the health system in terms of design, funding and implementation. This information was useful in the top-down practices of planning and management of the public health system. However, in facilities at the frontline of service delivery, there was a strong requirement for local, disaggregated information and experiential knowledge to make locally-appropriate and responsive decisions, and to perform the people management tasks required. Despite central level influences, modes of governance operating at the sub-district level had influence over what information was valued, generated and used locally. Strengthening local level managers’ ability to create enabling environments is an important leverage point in supporting informed local decision-making, and, in turn, translating national policies and priorities, including equity goals, into appropriate service delivery practices.
How does decentralisation affect health sector planning and financial management? a case study of early effects of devolution in Kilifi County, Kenya.
Tsofa B; Goodman C; Gilson L; et al.: International Journal for Equity Health 16(1)151-163, 2017
In 2010, Kenya passed a new constitution that introduced 47 semi-autonomous devolved county governments, with a substantial transfer of responsibility for healthcare from the central government to these counties. This study analysed the effects of this decentralization on health sector planning, budgeting and financial management at county level in Kilifi County. The authors found that the implementation of devolution created an opportunity for local level prioritisation and community involvement in health sector planning and budgeting, increasing opportunities for equity in local level resource allocation. However, this opportunity was not harnessed due to accelerated transfer of functions to counties before county level capacity had been established to undertake the decentralised functions. The authors also observed some indication of re-centralisation of financial management from health facility to county level. They conclude that to enhance the benefits of decentralised health systems, resource allocation, priority setting and financial management functions between central and decentralised units need to be guided by considerations around decision space, organisational structure and capacity and accountability.
Organisational culture and trust as influences over the implementation of equity-oriented policy in two South African case study hospitals
Erasmus E; Gilson L; Govender V; et al: International Journal of Equity in Health 16(1)164-177, 2017
This paper uses the concepts of organizational culture and organizational trust to explore the implementation of equity-oriented policies - the Uniform Patient Fee Schedule and Patients' Rights Charter - in two South African district hospitals. The hospitals' implementation approaches were similar in that both primarily understood it to be about revenue generation, that granting fee exemptions was not a major focus, and considerable activity, facility management support, and provincial support was mobilised behind the Uniform Patient Fee Schedule. The hospitals' Patients' Rights Charter paths diverged quite significantly, as Hospital A was more explicit in communicating and implementing the Patients' Rights Charter, while the policy also enjoyed stronger managerial support in Hospital A than Hospital B. Beneath these experiences lie differences in how people's values, decisions and relationships influence health system functioning and in how the nature of policies, culture, trust and power dynamics can combine to create enabling or disabling micro-level implementation environments. Achieving equity in practice requires managers to take account of "unseen" but important factors such as organisational culture and trust, as key aspects of the organisational context that can profoundly influence policies. In addition to putting in place necessary staff and resources, tasks such as relationship management, the negotiation of values and paying careful attention to how policies are practically framed and translated into practice are seen to be necessary to ensure equity aspects are not neglected.