‘Life is a series minor explosions whose echo, fading away, settles comfortably at the back of our minds’ - Dambudzo Marechera
By 2050, over 1.2 billion people will live in sub-Saharan Africa's cities, with a potential for growing differences on what people gain from them and in their quality of life. Young people today will be living that future and wonder what kind of healthy, or unhealthy futures the cities hold for them. Health literature is full of talk of targets and data, but speaks little of these dreams and fears.
When a fee hike of nearly 12% was proposed in South Africa this year, students took to the streets in protest. The protests against the exclusion the fees implied for poor families linked street action to social media using the hashtag ‘#feesmustfall’. They connected with student protests against racial inequalities in academia earlier in the year and ended with a statement from President Zuma that fee rises would be ruled out for the next year. Spread on twitter, facebook, blogs and news outlets, the images of protest by students, ’born frees’ who never experienced apartheid rule, evoked images of 1976 student protests against apartheid language policies. These protests, nearly 40 years apart, have very different contexts, notwithstanding the generational rift that some say has grown in these four decades in South Africa between those who fought the ‘struggle’ who are now in government, and those ‘born free’ after 1994, resisting policies of exclusion, new and old. However, both previous and current struggles appear to have been driven by imagining a different future. In a 2013 interview, Achille Mbembe noted how the promise and vision of a different, just future was a key driver in the anti-colonial struggle. Youth today continue to envision a just future, and protest where the actions of the present governing institutions take them away from it.
How we imagine, visualize, communicate and share the imaginings of our futures appears to be important for how we organise to realise them. One force affecting future wellbeing in east and southern Africa is urbanisation. Masterplans for many African cities were shaped by colonial policies of segregation, at a time where today’s growth and poverty levels were not anticipated. The way cities and people have grown in and around these initial urban plans can appear disorganised, violent and unhealthy, with infrastructural and social challenges, where formal institutions and services struggle to cope using current resources and tools. For example, Lusaka, Zambia was built to a colonial garden city plan that has been taken over by ‘unplanned’, and formerly illegal, settlements on its North, South and Western fringes. A new masterplan is being implemented in the city, drawn up in 2009 by the Japan International Cooperation Agency, commissioned by the Zambia Ministry of Local Government and Housing and Lusaka City Council. It seeks to address the challenges by restructuring the city and demolishing homes and businesses in the formerly ‘unplanned’ settlements, all of which are sites of Lusaka’s significant informal activity. Aspects of such plans, which include ‘multi-facility economic zones’ to attract foreign investment and low density gated developments, portray a vision of an African urban future which excludes some and privileges others.
Ironically, those engaged in informal waste recycling in the city are currently drawing some income from these developments, as they have created a source of construction waste which can be collected and recycled into further building materials in the city. Women, facing significantly lower earnings than men, play a significant role in recycling construction waste, innocently contributing to the construction of spaces that will ultimately exclude them, economically and physically, pushing them into less healthy and more marginal spaces. Filip De Boeck in ‘The Johannesburg Salon’ in 2011, highlights this irony, pointing to a similar process in Kinshasa. He adds that this not only affects peoples’ physical conditions, but also their imaginings of their cities and even their own self-image and perceived place within the cities. Farmers at risk of relocation due to a ‘Cité du Fleuve’ development commented to him, "Yes, we'll be the victims, but still it will be beautiful."
Alternative practices reflect and support different imaginings of urban futures and the power residents have to affect them. A recently formed Master’s in Spatial Planning program at the University of Zambia (UNZA) has, for example, investigated informal sites in Lusaka, home to nearly three quarters of the city’s inhabitants, according to C. Swope in 2014. The University is advancing a ‘Community Led Slum Upgrading and Planning Studio’ project in collaboration with the Lusaka City Council and the non- government organisation ‘People’s Process on Housing and Poverty in Zambia’. This work brings together students, local government officers, civil society members and residents to decentralise how urban plans are made, sharing and learning from their different experiences, capacities and visions of the city and its future. For example, in the Mahopo Enumeration Project in 2015, the university and the Peoples Process on Housing and Poverty in Zambia, Zambia Homeless and Poor Peoples Federation and Lusaka City Council collectively surveyed the Mahopo Informal Settlement in Lusaka. They engaged young people living in the area to survey their own environments and analyse the information gathered. Through this the community identified health and education facilities as priority areas of concern, followed by the quality of housing units and access to markets. The actions proposed by residents, students and council involve all stakeholders in their implementation.
In the battle for ideas, there is power in who draws, controls and shares visions, even more so with the expansion of information and social media. Beyond the statistics of mortality and disease, or the numbers of toilets and coverage rates, those who seek to build healthy cities should not forget to engage with our visions of the future, especially those we hold as young people. Edgar Pieterse of the African Centre for Cities described, at an International workshop on African cities in 2012, how imagined visions of the future in the speculative design of cities have been used in neoliberal discourse to assess risk and promote designs that contribute to social exclusion. But speculation of the future, in design, art, writing, science and politics, also provides a space that can be occupied by communities to imagine and share alternative futures. Speculation and visioning is by definition born from the inside, from one’s imagination. As seen with South Africa’s students or the alternative urban design in Lusaka, when residents, students and other social groups are given space to shape and communicate vision, it can be a potent motive force in bringing people together to resist harmful practice, and more importantly to realise fairer, more inclusive alternatives.
This issue of the newsletter highlights some of the spaces where this kind of imagining is taking place. For example, Justices Sachs and Cameron, of South Africa’s Constitutional Court, describe how the Court’s Art Collection provides a repository of visions of the ideals of human dignity, equality and freedom in the country. These pieces communicate the values of the court and engage the collective imagination in ways that words cannot. Jonathan Dotse, curator and writer on AfroCyberPunk, explores a future Accra in his short story ‘Virus!’ in which a young woman’s control of her health is mediated by an internal ‘biocore’ computer connected to a city wide digital grid, which 3bute hyperlink to videos, drawings and other imagined narratives from the continent on people’s scenarios of future urban epidemics. OpenParlyZW is an online non-partisan initiative created by a group of young people to demystify what is taking place in parliament for young people, using social media, opening new conversations around these ‘houses of power’ in their futures. These and other examples in the newsletter provide many ways in which sites of dreaming, counterfactual thinking and urban speculation are taking place, all aiming to reinvigorate the social and political imaginary and open opportunities for inclusion in the thinking about and struggle for healthy African urban futures.
Please send feedback or queries on the issues raised in this briefing to the EQUINET secretariat: admin@equinetafrica.org.
1. Editorial
2. Latest Equinet Updates
There has been significant documentation on the various international responses to the 2014/5 Ebola epidemic in West Africa. There is also evidence that the epidemic
triggered new developments in epidemic prevention and response from Africa. In April 2015 the AU called for the lessons learned to be identified for future responses. This brief summarises the publicly available documentation on the response of African countries to the epidemic. It is based on 63 documents accessed through key word search in July–August 2015 of online databases, supplemented by documents obtained from snowballing in September 2015. The brief presents evidence on
a. The actions taken by African governments and institutions at national, regional and continental level to support the response to the epidemic.
b. The identified positive features and challenges in the African response.
c. The links between the African emergency response to the EVD epidemic and health system strengthening.
3. Equity in Health
Obesity prevalence is increasing globally and contributes substantially to the burgeoning burden of non-communicable diseases. South Africa is particularly affected by this increasing trend and cross-sectional evidence suggests socioeconomic and behavioural variables as possible drivers. However, no large scale longitudinal study has attempted the direct identification of risk factors for progression towards obesity. This study analysed data on 10,100 South African adults (18 years and over) randomly selected in 2008 and successfully recontacted in 2010 and 2012. Latent Growth Modelling was used to estimate the average rate of change in body mass index (BMI) during the study period, and to identify baseline characteristics associated with different trajectories. The overall rate of change in BMI during the study period was +1.57 kg/m 2 per decade, and it was higher among women than among men. Female gender, younger age, larger waist circumference, white population group and higher household income per capita were baseline characteristics associated with higher rates of change. The association between tobacco use and obesity was complex. Smoking was associated with greater waist circumference at baseline but lower rates of increase in BMI during the study period. Quitting smoking was an independent predictor of BMI increase among subjects with normal weight at baseline. Among subjects with baseline BMI lower than 25 kg/m 2 , rates of changes were higher in rural than urban areas, and inversely related to the frequency of physical exercise. A strong positive trend in BMI remains in South Africa and obesity prevalence is likely to increase. Trends are not homogeneous, and high risk groups (subjects with high socioeconomic status, rural dwellers, young women) and modifiable risk factors (physical inactivity) can be targeted. Subjects quitting smoking should receive additional weight-loss support in order that the numerous health benefits of cessation are not reduced by increasing BMI. Centrally obese subjects should be targeted in campaigns.
4. Values, Policies and Rights
Eduardo Gudynas looks at the main trends of the discourse around Buen Vivir in South America as a political platform for different visions of alternatives to development. He notes that any alternative to development must open paths to move beyond the modern Western culture. Buen Vivir, he argues gives that opportunity. Buen Vivir or Vivir Bien, are the Spanish words used in Latin America to describe alternatives to development focused on the good life in a broad sense. The term is actively used by social movements, and it has become a popular term in some government programs and has even reached its way into two new Constitutions in Ecuador and Bolivia. It is a plural concept with two main entry points. On the one hand, it includes critical reactions to classical Western development theory. On the other hand, it refers to alternatives to development emerging from indigenous traditions, and in this sense the concept explores possibilities beyond the modern Eurocentric tradition. The richness of the term is difficult to translate into English. It includes the classical ideas of quality of life, but with the specific idea that well-being is only possible within a community. Furthermore, in most approaches the community concept is understood in an expanded sense, to include nature. Buen Vivir therefore embraces the broad notion of well-being and cohabitation with others and with nature.
Pneumonia, diarrhoea and malaria remain leading causes of death for children under 5 years of age and access to effective and appropriate treatment for sick children is extremely low where it is needed most. Integrated community case management (iCCM) enables community health workers to provide basic lifesaving treatment for sick children living in remote communities for these diseases. While many governments in sub-Saharan Africa recently changed policies to support iCCM, large variations in implementation remain. As a result, the collaboration represented in this supplement examined the policy processes underpinning iCCM through qualitative case study research in six purposively identified countries (Niger, Burkina Faso, Mali, Kenya, Malawi and Mozambique) and the global context. The authors introduce the supplement, by reviewing how policy analysis can inform: (a) how to frame iCCM and negotiate its boundaries, (b) how to tailor iCCM for national health systems and (c) how to foster accountability and learning for iCCM. In terms of framing, iCCM boundaries reflect how an array of actors use evidence to prioritise particular aspects of child mortality (lack of access to treatment), and how this underpins the ability to reach consensus and legitimate specific policy enterprises. When promoted at national level, contextual health system factors, such as the profile of CHWs and the history of primary health care, cannot be ignored. Adaptation to these contextual realities may lead to unintended consequences not forseen by technical or managerial expertise alone. Further scaling up of iCCM requires understanding of the political accountabilities involved, how ownership can be fostered and learning for improved policies and programs sustained. Collectively these articles demonstrate that iCCM, although often compartmentalised as a technical intervention, also reflects the larger and messier real world of health politics, policy and practice, for which policy analysis is vital, as an integral component of public health programming.
Memory and African identity are of primordial importance to Jean Pierre Bekolo, who through his films, highlights the desire to “write from a particular place and not for an audience” because one can be easily manipulated by the expectations of an audience. Bekolo spends time in Europe, US and Africa. Travelling becomes a substantial part of his creative process.
Each of his movies stands out as a phase or the break with a phase of his artistic development: Quartier Mozart symbolises origins, family and identity, Aristotle’s Plot represents the identity of an African cineaste, while Les Saignantes is speculation or science fiction. Despite his numerous sojourns, Bekolo’s energy is always focused on Africa and Cameroon in particular, where he believes cinema has to go beyond representation and shed more light on questions which will lead to change, a concept noticeable in his latest movie Le President. Bloke, who describes himself as not just an artist but ‘a radiologist of the society’ emphasises the role that film and fiction has to play in affecting change, ‘we must not forget the aesthetic dimension, because the beauty and the real have a link: aesthetic and ethics.’
5. Health equity in economic and trade policies
In a joint statement released and endorsed by nearly 200 organisations across Africa and India on the occasion of the Third India-Africa Forum Summit taking place in New Delhi this week, African and Indian civil society reminds their governments of the key issues at stake at the forthcoming WTO Ministerial which will take place in Nairobi in December.
By the end of the 1990s, significant portions of the African debt had been written off or re-scheduled. Today this problem is re-emerging due to several factors including the decline in commodity prices, growing class divisions and reliance on foreign direct investment. In 2015, Africa’s sovereign debt levels rose to 44 percent of GDP, a 10 percent rise from 2010. The author argues this follows patterns of previous years which problems arising from several factors including the decline in commodity prices, growing class divisions and reliance on foreign direct investment. This financial crisis emanates from Wall Street and other centres of borrowing throughout capitalist states. Within the leading industrialised countries of the West, there has still not been a full recovery from the economic crisis of 2007-2009. Unemployment remains high and consumer spending is low due to the loss of wages and household wealth. Consequently, the availability of credit to African states will be far more limited during the second decade of the 21st century than what prevailed in the 1980s, 1990s and the 2000s. The continuing dependency on the neo-colonial system will serve as an impediment to not only national but regional and continental integration and economic planning. The author argues that these issues require more of a political response rather than economic and that genuine political independence and sovereignty of African states must lead to the rejection of the conditions established by the IMF and World Bank.
6. Poverty and health
The author argues that psychological violence of colonialism today only exists as a re-enactment, or a reframing of the original physical warfare between colonialist and colonized bodies. He argues that contemporary images and representation still repeat the violence within popular culture, within academic curricula, literature, mainstream music, art, architecture, theatre, that pervades the contemporary world in ways that continue to suppress imagination.
The author raises that the covert violence, the risk, the uncertainty and the possibility of daily life in Kinshasa resides in the gap between official visions and unofficial reality. Using two cases in which water is being turned into land, Filip De Boeck reveals the need to envision a ‘near future' that hyphenates dream and reality; a plan predicated on incremental transformation rather than destructive, radical, exclusionary change.
7. Equitable health services
Mozambique’s health system reconstruction supports the team’s conclusion that the reconstruction of health systems is mainly “gender blind”. In order to review whether the health system is gender equitable, the team assessed the country’s progress against the framework of WHO’s six aspirational building blocks of the health system. From the evidence the authors suggest that policy-makers in Mozambique have not adequately considered the role of gender in contributing to health or addressed women’s and men’s different health needs. Despite government commitment to gender mainstreaming, the health system is far from gender equitable. Donors have shied away from tackling the thorny issue of the social and cultural norms, including gender, which drive ill health.
The State of the World’s Antibiotics summarises the status of antibiotic use and resistance around the globe. The report challenges the prevailing argument that the biggest obstacle facing antibiotic resistance is a lack of new drugs in the “antibiotic pipeline.” New antibiotics are part of the solution, but only when coupled with conservation: strong antibiotic stewardship in its broadest sense, which involves limiting overuse of antibiotics in humans and livestock. CDDEP’s Global Antibiotic Resistance Partnership (GARP) of low- and middle-income countries provided both data and insight into the challenges in those countries and how they can be met successfully. Chapters cover human antibiotic resistance and use, resistance and use in agriculture and the environmental consequences of all use, maintaining the supply of antibiotic effectiveness and what works at the country level to minimise the spread of antibiotic resistance and maximise the positive impact of antibiotics.
8. Human Resources
In Mozambique, integrated community case management (iCCM) of diarrhoea, malaria and pneumonia is embedded in the national community health worker (CHW) programme, mainstreaming it into government policy and service delivery. Since its inception in 1978, the CHW programme has functioned unevenly, was suspended in 1989, but relaunched in 2010. To assess the long-term success of iCCM in Mozambique, this article addresses whether the current CHW programme exhibits characteristics that facilitate or impede its sustainability. The authors undertook a qualitative case study based on document review (n = 54) and key informant interviews (n = 21) with respondents from the Ministry of Health (MOH), multilateral and bilateral agencies and non-governmental organizations (NGOs) in Maputo in 2012. Interviews were mostly undertaken in Portuguese and all were coded using NVivo. A sustainability framework guided thematic analysis according to nine domains: strategic planning, organizational capacity, programme adaptation, programme monitoring and evaluation, communications, funding stability, political support, partnerships and public health impact. Government commitment was high, with the MOH leading a consultative process in Maputo and facilitating successful technical coordination. The MOH made strategic decisions to pay CHWs, authorize their prescribing abilities, foster guidance development, support operational planning and incorporate previously excluded ‘old’ CHWs. Nonetheless, policy negotiations excluded certain key actors and uncertainty remains about CHW integration into the civil service and their long-term retention. In addition, reliance on NGOs and donor funding has led to geographic distortions in scaling up, alongside challenges in harmonization. Finally, dependence on external funding, when both external and government funding are declining, may hamper sustainability. The authors’ analysis represents a nuanced assessment of the various domains that influence CHW programme sustainability, highlighting strategic areas such as CHW payment and programme financing. These organizational and contextual determinants of sustainability are central to CHW programme strengthening and iCCM policy support.
9. Public-Private Mix
In analysing the relationship between a “global public sphere” and social media on the African continent, the generalisations are argued to hide a far more interesting set of observations. Debates and discussions about what passes for a global public sphere often overlook and obscure dynamics of power. What is defined as the global public sphere by most observers and scholars is still very much limited to the industrial north and their public and private broadcasting systems, twitter handlers, and blogs. The term also refers, by default, it is argued, to debates and deliberation solely in English. This ignores the discussions in media in the Global South, especially social media.
10. Resource allocation and health financing
The author argues that social protection is the most direct tool we have to combat poverty and inequality and that implementation can begin when countries are at a relatively early stage of development. However, there are today a few countries which need the solidarity of others to close the social protection gap. This think piece puts forward eight good reasons why a global fund for social protection is needed and can easily be initiated. Here are eight good reasons why a global fund for social protection floors is needed and can easily be initiated, which the author elaborates on more fully in his think piece: there already is a global consensus on social protection floors for all, the global community has already accepted that global solidarity may be needed to achieve social protection for all, there is no need to create a new fund, there already is one that can be used, the mandate and the supervisory mechanism for the fund do not have to be invented and the fund can start modestly, the potential direct impact on poverty could be huge.
Africa has enjoyed a growth momentum since 2000 after the wasted years of the 1980s and much of the 1990s. However, eradicating poverty will require huge resources, which existing funding strategies will be unable to generate. Global commodity prices have fallen sharply; capacity to mobilise domestic revenues is waning; and aid has been insufficient in plugging funding gaps. Revenue bargains in which states extract revenues from citizens in exchange for investments that impact positively on well-being may be key to financing Africa’s development. They can substantially increase revenues, nurture effective state-citizen relations, force companies to pay correct taxes, push fragmented systems of service provision in the direction of universalism, improve policy space and make aid more effective.
Commercialisation of health care has contributed to widening inequities between the rich and the poor, especially in settings with suboptimal regulatory frameworks of the health sector. Poorly regulated fee-for-service payment systems generate inequity and initiate a vicious circle in which access to quality health care gradually deteriorates. Although the abolition of user fees is high on the international health policy agenda, the sudden removal of user fees may have disrupting effects on the health system and may not be affordable or sustainable in resource-constrained countries, such as the Democratic Republic of Congo. Between 2008 and 2011, the Belgian development aid agency (BTC) launched a set of reforms in the Kisantu district, in the province of Bas Congo, through an action-research process deemed appropriate for the implementation of change within open complex systems such as the Kisantu local health system. Moreover, the entire process contributed to strengthen the stewardship capacity of the Kisantu district management team. The reforms mainly comprised the rationalisation of resources and the regulation of health services financing. Flat fees per episode of disease were introduced as an alternative to fee-for-service payments by patients. A financial subsidy from BTC allowed to reduce the height of the flat fees. The provision of the subsidy was made conditional upon a range of measures to rationalise the use of resources. The results in terms of enhancing people access to quality health care were immediate and substantial. The Kisantu experience demonstrates that a systems approach is essential in addressing complex problems. It provides useful lessons for other districts in the country.
11. Equity and HIV/AIDS
Early identification and entry into care is critical to reducing morbidity and mortality in children with HIV. The objective of this report is to describe the impact of the Tingathe programme, which utilises community health workers (CHWs) to improve identification and enrolment into care of HIV-exposed and -infected infants and children. Three programme phases are described. During the first phase, Mentorship Only (MO) (March 2007–February 2008) on-site clinical mentorship on paediatric HIV care was provided. In the second phase, Tingathe-Basic (March 2008–February 2009), CHWs provided HIV testing and counselling to improve case finding of HIV-exposed and -infected children. In the final phase, Tingathe-PMTCT (prevention of mother-to-child transmission) (March 2009–February 2011), CHWs were also assigned to HIV-positive pregnant women to improve mother-infant retention in care. The authors reviewed routinely collected programme data from HIV testing registers, patient mastercards and clinic attendance registers from March 2005 to March 2011. During MO, 42 children (38 HIV-infected and 4 HIV-exposed) were active in care. During Tingathe-Basic, 238 HIV-infected children (HIC) were newly enrolled, a six-fold increase in rate of enrolment from 3.2 to 19.8 per month. The number of HIV-exposed infants (HEI) increased from 4 to 118. During Tingathe-PMTCT, 526 HIC were newly enrolled over 24 months, at a rate of 21.9 patients per month. There was also a seven-fold increase in the average number of exposed infants enrolled per month (9.5–70 patients per month), resulting in 1667 enrolled with a younger median age at enrolment (5.2 vs. 2.5 months). During the Tingathe-Basic and Tingathe-PMTCT periods, CHWs conducted 44,388 rapid HIV tests, 7658 (17.3%) in children aged 18 months to 15 years; 351 (4.6%) tested HIV-positive. Over this time, 1781 HEI were enrolled, with 102 (5.7%) found HIV-infected by positive PCR. Additional HIC entered care through various mechanisms (including positive linkage by CHWs and transfer-ins) such that by February 2011, a total of 866 HIC were receiving care, a 23-fold increase from 2008. A multipronged approach utilising CHWs to conduct HIV testing, link HIC into care and provide support to PMTCT mothers can dramatically improve the identification and enrolment into care of HIV-exposed and -infected children.
This report delivers a summary of the impact and results the Global Fund partnership was able to achieve by 2015, showing cumulative progress since the Global Fund was created in 2002. It is a collective effort, combining the strong contributions made by governments, civil society, the private sector and people affected by HIV, TB and malaria. Here are the cumulative highlights: 17 million lives saved; on track to reach 22 million lives saved by the end of 2016, a decline of one-third in the number of people dying from HIV, TB and malaria since 2002, in countries where the Global Fund invests, 8.1 million people on antiretroviral treatment for HIV, 13.2 million people have received TB treatment and 548 million mosquito nets distributed through programs for malaria. Building resilient and sustainable systems for health is critically important to end HIV, TB and malaria as epidemics. Overall, more than one-third of the Global Fund’s investments go to building resilient and sustainable systems for health. The Global Fund estimates that approximately 55 to 60 percent of its investments benefit women and girls, with a positive impact on reproductive health.
12. Governance and participation in health
At the entrance to the Constitutional Court of South Africa stands a sculpture of a large man yoked to a cart. His burden is a human one: a man and woman who themselves are seated on the back of a fourth figure kneeling on the cart. At first glance, the sculpture resonates with the history of servitude that marked the dehumanising institution of apartheid. On closer reflection, the sculpture reveals a more complex message. The sculptor, South African artist Dumile Feni, did not create any racial differentiation between the four figures, and the man drawing the cart is the only figure large and strong enough to accomplish this task. The title of the work is History, and the four figures carry each other in a way that reflects the dependence, the interconnectedness and the tension that have always characterised human relationships. History is the first of many artworks that challenge a visitor to the Constitutional Court to reflect on South Africa’s tortured past and the country’s transition to a constitutional order. The Constitutional Court Art Collection (CCAC)[1] is both a living monument to the ideals on which South Africa’s post-apartheid Constitution is based and a reminder of the work that remains.
There is now wide recognition that community responses must play an increasing role in addressing the HIV epidemic in the years ahead. The UNAIDS Strategic Investment Framework, published in 2011, identifies community responses as a “critical enabler” of service delivery. The Joint United Nations Programme on HIV/AIDS (UNAIDS) has estimated that to achieve bold HIV treatment and prevention targets set in 2014, investments in community mobilisation and services must increase more than threefold between 2015 and 2020. Much of the critically important work in making progress in the response to HIV and implementing a Fast-Track approach that lies ahead—including broadening the reach of services, supporting retention in care, increasing demand, monitoring quality, advancing human rights and combatting stigma and discrimination—can only be achieved with a strong community voice and presence. This report draws on multiple sources to document the many ways in which communities are advancing the response to AIDS, and the evidence for the effectiveness of these responses. Core areas of community-based activities include advocacy, service provision, community- based research and financing; each of these areas is illustrated by examples of community- based actions.
When faced with a complex public health problem there is a natural urge to find solutions. People hire consultants, gather data, test hypotheses and examine P-values to identify risk factors: data-driven technological fixes get implemented every day. In the right situation, there is nothing wrong with solutionism – the belief that all difficulties have technical solutions. Solutionism works well for circumscribed problems involving a small number of motivated individuals, where every element of the prescribed solution can be implemented as planned. However, complex problems in public health usually have elements that defy planning, because health involves people, and people are unpredictable. Recent research has shown that integrating community participation in the planning and implementation of health reforms is a key factor in supporting health improvements. The approach has been applied in a variety of areas including: the control of infectious disease; reducing maternal deaths and improved birth outcomes; enabling better health seeking behaviours; improving quality of life by promoting healthy environments through improvements to housing, reducing crime and building social cohesion. Critical factors for achieving trust include allowing participants to see their common concerns and building strong relationships within health committees or participatory groups. There must be a commitment to sustain long-lasting relationships between the community, local health workers and managers. Technical solutions for health problems are still needed. The authors argues there is still need the familiar P-value because biological evidence is necessary, but public health practice also needs to recognize the value of people. Regardless of the political environment, the power of the state to alter health decisions inside the home has limits. Only an approach that values, honours and engages people can alter how they make decisions about their health.
This Pan African Space Station (PASS) broadcast recorded at the Chimurenga headquarters features Neo Muyanga, Soweto-born composer and musician living in Cape Town. Revolting Music is a survey of the songs of protest that liberated South Africa. Muyanga argues that it often comes as something of a surprise to many visitors to find that people in South Africa, sang and danced throughout the decade of the 1980’s – a period many agree was one of the most violent phases in the struggle against the system of apartheid, and yet the people sang and made art fervently during this time. These acts were not merely stratagems for fun but the songs were a part of the arsenal in the fight to secure democratic rights for all and to overthrow the government. During his recording, Neo Muyanga presents a series of anecdotes and medleys of songs of protest from the era of the 80’s – songs of his youth – juxtaposed against new songs he has composed in response to the challenges of new socio-political realities in South Africa today.
Since independence, Parliament and its processes have been treated by young people as something alien to them, their needs, views and aspirations. As a result, for years the youth has had certain conceptions, some true and some false over the business that is conducted within the walls of parliament in Harare. As such, the author argues that Zimbabwean youths’ views were never put into consideration, decisions with a direct bearing on them were made without their input, simply put, the youth saw Parliament business in Zimbabwe as having nothing of interest to them and as a mere preserve for the older generation. However, all this is set to be a thing of the past. Parliament debates, bills, thrills, spills and lighter moments will soon be easily accessible in just a few clicks on a smartphone, anywhere, anytime, thanks to OpenParlyZW, an online non-partisan initiative created by a group of enthusiastic youths with the aim of bridging the gap and demystifying misconceptions existing between the youth and Parliamentarians. The group believes that to move forward the youth need to be a part of this conversation and should at least know what’s going on in the houses of power and participate in the future of the nation. OpenParlyZW will run as a standalone platform but also on Twitter and Facebook among other social media platforms capturing events each time Parliament sits and providing young people with vital information.
13. Monitoring equity and research policy
The annually published District Health Barometer (DHB) in South Africa is designed and compiled to assist South Africa’s National Department of Health in making health and related information available for monitoring progress in health service delivery at district level. The Barometer provides current information on functioning and associated fluctuations in all the country’s health districts, describing performance over time in relation to previous years as well as between districts. Each edition highlights problem areas, data quality issues, sustained and notable progress, and aspects requiring deeper research into underlying factors contributing to the indicator values and trends. This 10th edition of the DHB presents data on 44 indicators, with trend illustrations and health profiles for South Africa as a whole, the nine provinces and the 52 districts, as well as a chapter on the country’s burden of disease. As in previous years, a varied picture emerges in terms of the national profile. Significant gains are noted in the rates of stillbirth; early mother-to-child transmission of HIV; cure among new pulmonary smear-positive TB patients; couple year protection; women under age 18 delivering babies in hospital; case fatality among children under five years of age from diarrhoea with dehydration and from pneumonia; and antenatal clients initiated on ART. However, persistent challenges prevail with regard to the Caesarean section rate in district hospitals, the school Grade 1 screening coverage, the measles 2nd dose coverage, and the case fatality rate for severe acute malnutrition in children under five years of age.
14. Useful Resources
Artist Bunmi Oloruntoba and editor Emmanuel Iduma collaborate with reporters and creative writers to furnish “the contexts often missing when African stories are reported.” Every two weeks, 3bute [pronounced “tribute”] publishes a three-page comic from a different African country in which readers tag the images like a wiki page with links to videos, articles, slide shows, twitter posts, music tracks, and other media. The resulting comic is dotted with icons that appear as you touch or move your mouse over its surface. The interactive features blink and pop as you shift from panel to panel in the site’s effort to undermine “the single, one-dimensional story of poverty, sickness, conflict” that far too often disparages the continent. 3bute uses new technology to explore the contours of African modernity through “multifaceted stories”. This review includes excerpts of 3bute comics, worth reading while the 3bute website is temporarily being reconstructed.
AfroCyberPunk is a blog dedicated to exploring the future of Africa through various expressions of Afrofuturism in science and speculative fiction across all forms of media, relevant news and current events about ongoing socioeconomic, political, and technological developments, as well as academic discourses on issues and trends concerning the future of this incredibly diverse continent. As Africa enters a new phase of accelerated development, this blog aims to create a unique conceptual space in which to explore the various scenarios the continent is likely to encounter in the near and distant future, and to imagine how people might begin to address the enormous challenges and incredible opportunities that may soon become reality.
This video production/story is about women and female gentital mutilation (FGM). The video narrative is an amalgamation of many women's stories. The story is created under the notion that "it takes a village to tell a woman's story; it takes a village for a woman's voice to be heard." The work is part of a wider project entitled "Dear Mother" created by Daapo Reo.
15. Jobs and Announcements
Formed in 2006, the One in Nine Campaign is a network of organisations and individuals driven by feminist principles and the desire to live in a society where women are the agents of their own lives, including their sexual lives. The Campaign supports and advocates for the rights of women who speak out against sexual violence as well as other survivors in five ways: Solidarity in Action and Building Feminist Activism, Feminist Knowledge Production and Research, Media Advocacy, Justice and Legal Transformation and Direct Action. The One in Nine Campaign is calling for application from all interested individuals/service providers in the following fields: Organisational Development, Strategic planning and reviews, Resource Mobilisation /Fundraising for NGOs, Research, Documentation (written and/or visual), Monitoring and Evaluation, Staff development/Team building, Creative Arts for social change (all art forms welcomed), Health and Wellness, Marketing (especially for small businesses, NGOs, Cooperatives) and Setting up and registering of Cooperatives. The organisation seeks to update its Consultants database and preference will be given to individuals who identify as Women and feminists and registered service providers that are led by Women.
DENOSA is hosting the Third South African Nurses’ Conference from the 24th to the 26th February 2016.This is a biannual event born out of a need to build capacity and create an enabling environment for South African nurses to effectively and positively influence health policy. It further affords the cadre an opportunity to critically analyse the South African health system and propose solutions. The Third South African Nurses’ Conference 2016 explores the theme: Together we can strengthen the theory and the clinical practice; inspire unity in seeking solutions to challenges facing the profession. The theme will be explored according to the following track of interest: Advancing a Holistic Nursing practice; Investing in Nursing: The Human Capital in health; Contemporary Nursing Issues; The Threshing floor: Teaching and learning; Students voice as the rising nurse leaders. The 3rd Conference intends to showcase the critical role nurses play in delivering holistic quality care. The Conference promises thought provoking plenary sessions, workshops and networking opportunities; with focus on the following tracks of interest: Advancing a Holistic Nursing practice; Investing in Nursing: The Human Capital in health; Contemporary Nursing Issues; The Threshing floor: Teaching and learning; Students voice as the rising nurse leaders.
Health System Global announces the Call for Abstracts for the Fourth Global Symposium on Health Systems Research on the Symposium website. The theme is Resilient and responsive health systems for a changing world. Submissions are invited for both organized sessions and individual abstracts. Please visit the site to find out about: key dates and deadlines, how to submit your abstract and other details on taking part in the Symposium. Please also make sure to visit the site regularly as HSG will keep updating it with announcements and relevant resources in the coming months. Please share the call with colleagues and anyone else who might be interested. The deadline to submit a proposal for an Organized Session at the Fourth Global Symposium on Health Systems Research is 24 January 2016. If you haven’t already, please have a look at the Call for Abstracts page on the Symposium website. Proposals can be submitted for Participatory Sessions and Panel Presentations.
Health Systems Trust (HST) is hosting a conference from 4-6 May 2016 at the Birchwood Conference Centre, Boksburg, Gauteng. Under the banner of Health for all through strengthened health systems: sharing, supporting, synergising, the event is designed to advance the global public health agenda in improving health outcomes. The conference will provide a forum in which those who contribute in various ways to the South African health system can exchange ideas, develop support mechanisms for common challenges, and foster synergies between interested groups. The vision of the organisers is of a vibrantly non-conventional conference experience. The three-day conference will convene approximately 300 healthcare workers from the public and private sectors as well as policy- and decision-makers, civil society groupings and academics. The past decade has seen an unprecedented wave of change and reform in order to strengthen the effectiveness of health systems, primarily through the introduction of primary health care re-engineering, National Health Insurance, and quality improvement and assurance. In addition, a range of programmatic activities designed to move towards increasing life expectancy, decreasing maternal and child mortality and combating HIV and AIDS and decreasing the burden of disease from TB have been implemented on a wide scale. New initiatives such as the 90-90-90 targets and attainment of the Sustainable Development Goals bring a further dimension to health systems strengthening. Collaborations among healthcare workers and stakeholders have researched, devised and applied a range of strategies and models to translate these reforms into reality. The HST conference will provide an opportunity to discuss challenges faced and solutions adopted at various levels in the health system. To avoid losing the opportunity to share these lessons and curate related good practice as broadly as possible, the organisers encourage interested parties to be a part of this conference. Applications for pre-conference workshops, individual and poster abstracts, and for media submissions close Sunday 10 January 2016.
In deep sorrow we mourn the sudden and untimely death of Sam Moyo, profound scholar and progressive activist, beloved comrade, Member of the Executive Committee of IDEAs. Sam was in New Delhi, India to participate in a conference on "Labour Questions in the Global South" when a car he was travelling in was involved in a terrible accident. Sam was critically hurt and passed away on 22 November 2015. We send sympathies to his family. The words below are by Bella Matambanadzo. "An unimaginable loss has happened. Our phenomenal intellectual pan African giant on land issues, Professor Sam Moyo, has died following injuries sustained during a terrible car accident in New Delhi, India. We are in disbelief. We are waiting for him to come home. We feel ripped apart with pain...."
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