In 2008 parliamentarians from Parliamentary Committees on Health in East and Southern Africa committed to raising the profile of health in all parliaments in the region, to strengthen their leadership, roles, capacities in and evidence for promoting, monitoring and advancing equity in health and health care. In this issue we have given attention to the role and work of African parliaments in health, both in the editorial and in various recently published items. Parliaments play a critical role in health, promoting public information and dialogue, scrutinising and reviewing laws, reviewing budget proposals and overseeing the implementation of policy and the functioning of the executive. There are numerous documents on the EQUINET site that report this parliamentary work in health since 2008, including on raising accountability on the Abuja commitment on domestic financing for health. This issue gives a glimpse into the more recent work and debates on health underway in African parliaments.
1. Editorial
One reason why many of our health policies fail to be fully implemented in our region is that we lack a robust mechanism to make sure of this. Parliaments play a key role in this. They provide a link between government and citizens on laws and treaties, budgets and in overseeing in implementation of national programmes. In the early 1990s, most African countries initiated reforms for their parliaments to play a more effective and visible role in these functions.
The idea to bring the Portfolio Committees on health in the region together was first mooted in 2003, in part due to falling budget allocations to health, to the devastating impact of AIDS and to evident inequalities in access to funds and services. We recognized that as members of parliament (MPs) we needed to use our representative mandate to communicate social expectations and strengthen social voice and power in health. A core group of MP used our own resources to visit other parliaments in the region to share the idea and listen to the feedback. The network was finally launched in 2005 as the Southern and East Africa Parliamentary Committees on Health (SEAPACOH). Today we have widened to all of Africa and are the Network of African Parliamentary Committees on Health (NEAPACOH). So far we have active participation from Angola, Botswana, Benin, Burkina Faso, Burundi, Ethiopia, Ivory Coast, Gambia, Ghana, Kenya, Kingdom of Lesotho, Malawi, Mali, Morocco, Mozambique, Namibia, Nigeria, Rwanda, South Africa, South Sudan, Swaziland, Tanzania, Uganda, Zambia and Zimbabwe and we welcome other parliamentary committees on health in the continent.
Since 2008 and with technical partners like EQUINET and Partners in Population and Development Africa Regional Office, the network has annually brought together the health committee chair, clerk and several other MPs from committees across the continent. This provides a forum for parliamentary committees on health to share concerns, unify voice on common concerns and calls for action, to advocate for health as a fundamental human right and promote democratic principles in health, including in our engagement with global processes. It also allows us to share promising practice and lessons learned. Strategically, we use the annual conference to identify common challenges and resolve on areas for action and on commitments that national health committees/delegations undertake to implement and report progress on at the next conference. We have found that identifying joint areas of action that brings us on the same ‘wave length’ strengthens our effectiveness, individually and collectively. The experiences, views and success stories that we share inspire and inform the individual committees. For example from 2005 we took up a common cause on advocating our Ministries of Finance to meet the Abuja commitment of 15% of the government budget going to health, that raised attention to this issue and contributed to improved allocation in a number of countries. We also raised issues that affect other sectors and committees, such as the positions on intellectual property that are needed to support access to medicines. We produced with EQUINET parliamentary briefs on international treaties affecting health and other health issues that are common for all parliaments in the region. We have in the process built solidarity and collaboration with civil society organisations and regional networks, and with health professionals, academics, non-state actors, research institutes and international agencies. This has enabled us to better understand and synergise our different but complementary roles across all actors to ensure we deliver on social values and policy commitments, such as on health equity.
In our recently held 2016 NEAPACOH conference we have identified some key areas of attention and work for the coming year. Some are platforms we are sustaining from prior years, including to: facilitate greater public participation in health; to pursue and monitor achievement of equity in health; to advocate for improved health budgets and financing (in line with the Abuja commitment); and to promote access to key reproductive health, family planning and HIV/AIDS services. We agreed, further, to evaluate how far our governments have ratified and domesticated health related treaties and to engage on how far actions have been institutionalized and implemented to advance Universal Health Coverage and other Sustainable Development Goals (SDGs) that affect health, including within parliament. We see a need to mainstream the SDGs within the diverse areas of work of parliament, including the public information and consultation for them, and would want to spearhead work on this in health. We also plan to develop a handbook for African parliamentary health committee members as a practical resource to support their role.
The 2016 conference also raised a proposal for NEAPACOH to work with technical partners to evaluate how effectively parliamentary committees are taking forward resolutions, to understand the barriers and support practice. We will do this by visiting a selection of member committees in their countries before the next meeting.
The process of building this network has itself been a learning experience. Indeed we understand that the longevity of this network of parliamentary committees is unique in the continent, outside the formal all parliament unions. We have grown stronger over the years building on our constitution and founding values, and have a board of serving MPs from all five African regions chosen in our annual conference and an office hosted by the Parliament of Uganda. Over the 13 years since we were formed we have benefited from perseverance of leadership and retention of key founding personnel, from sound founding principles, and from a consistent collaboration with key technical partners in the region. At the same time we still have much to do to deliver on our mandate, to be more robust and effective at national, regional and continental level to protect shared health values and to play our role in ensuring that they are delivered on in practice.
Please send feedback or queries on the issues raised in this briefing to the EQUINET secretariat: admin@equinetafrica.org. You can find out more on NEAPACOH at www.seapacoh.org
2. Latest Equinet Updates
This participatory skills session convened under the umbrella of the pra4equity network is being held at the Heath System Global Conference. In the session we will discusses methods and tools to build learning from action as a key element of participatory action research, directly engaging affected communities to build responsive health systems. The session draws on approaches and experience from Africa, Latin America and participants globally to discuss the methods/tools, their application and their integration in health systems. From prior global symposia, methods for learning from action were identified as weak in PAR practice. This session seeks to address this gap. It is targeted at researchers and practitioners. It uses methods resources and group discussions of case studies from health managers, policy actors, civil society and researchers in low and middle income countries to discuss the participatory processes and methods for learning from action at different levels, and the issues in applying and institutionalising these methods. We will also review what these participatory efforts to transform and build knowledge on health systems implies for the understanding of ‘resilience’. As the places are limited if you will be in Vancouver on the 15th November morning and would like to participate in this skills session please can you notify on the email shown with your name, institution and a line or two on any prior PAR experience.
This brief discusses the strategies used for attracting and retaining skilled health workers in ESA countries, especially to address underserved rural and remote areas, primary care settings and in the public sector. It reviews practice to date and identifies strategic options, given both regional learning and the opportunity of the 2016 Global Strategy on Human Resources for Health. Whereas ESA countries have implemented various attraction and retention regimes, the results have not been well documented, with still limited evaluation and reporting of impact of these strategies. The evidence suggests a need for a comprehensive, multi-sectoral and co-ordinated approach to planning and implementation, to make the case for improved funding and with greater use of information and monitoring systems.
3. Equity in Health
The Independent Accountability Panel (IAP) inaugural report '2016: Old Challenges, New Hopes' was launched September 18, 2016 in conjunction with the Partnership for Maternal Newborn and Child Health and Countdown to 2030 and formally submitted to the Secretary-General at the Every Woman Every Child high level reception on the 20th September 2016. The report details how inequalities within and between countries are leaving women, children and adolescents at a disadvantage. It argues that more must be done to give every woman, every adolescent, and every child the opportunity to survive and thrive. In a statement at http://tinyurl.com/hadb8np the O’Neill Institute for National and Global Health Law at Georgetown University Law Center endorsed the report noting "The IAP’s report encompasses remedies as a necessary part of an accountability framework, building on the earlier work of the Commission on Information and Accountability and its accountability framework of monitor, review, and act. The inclusion of remedies rounds out a cycle of accountability that is necessary to realize the right to health and other health-related rights, which must extend beyond the traditional emphasis on monitoring and evaluation. This report is intended to help catalyze the use of national, regional, and global accountability mechanisms – and vitally, to ensure that all people, with special attention to the most marginalized, have the resources and respect that empower their ability to access them".
After years of wrangling and debates among African leaders, the movement to end female genital mutilation (FGM) is gaining real momentum, with a new action plan signed in August by the Pan African Parliament (PAP) representatives and the U.N. Population Fund (UNFPA) to end FGM as well as underage marriage. The UNFPA has already trained over 100,000 health workers to deal specifically with aiding victims of FGM, while tens of thousands of traditional leaders have also signed pledges against the practice. In some African countries, girls as young as eleven and twelve are forced to marry much older men, leading to an increase in serious health problems, including cervical cancer and a host of social problems. UNFPA East and Southern Africa Deputy Regional Director Justine Coulson said if the current trend continues, the number of girls under 15 who had babies would rise by a million – from two to three million. There are believed to be at least seven million child brides in Southern Africa alone. While underage marriage and childbirth is a major health risk, the Pan African Parliament UNFPA workshop also heard how FGM had led to an increased likelihood girls and women would be exposed to sexually transmitted diseases such as HIV/AIDS. Globally, an estimated 200 million girls and women alive today have undergone some form of FGM. In Africa, FGM is practiced in at least 26 of 43 African countries, with prevalence rates ranging from 98 percent in Somalia to 5 percent in Zaire. The buy-in of African political leadership is argued to be crucial if this latest move is to succeed, with up to 140 million women and girls in sub-Saharan Africa who’ve been forced to submit to FGM. The aim is to influence people on the ground as well as effect legislation banning the practice. There are no health benefits in the process and it can cause severe bleeding, problems urinating, cysts, infections and a host of childbirth complications. The PAP also agreed to work with the UNFPA in seeking to overturn the practice of marrying off children under the age of sixteen. In June 2016, the UNFPA worked with Southern African Development Community Parliamentary Forum representatives at a meeting in Swaziland which voted through a Model Law on eradicating child marriage.
Independent monitoring and review of the implementation of the 2030 Agenda and its structural obstacles and challenges are key factors for the success of the SDGs. For this reason, the Reflection Group on the 2030 Agenda for Sustainable Development together with other civil society organisations and networks has produced the first annual Spotlight Report assessing the implementation of the 2030 Agenda and the structural obstacles in its realisation. The report puts a spotlight on the fulfilment of the 17 goals, with a particular focus on inequalities, responsibility of the rich and powerful, means of implementation and systemic issues. It raises the main obstacles to achieving the SDGs and explores transnational spill over effects that influence or even undermine the implementation of the goals. It comments on whether the current policy approaches, as reflected in the 2030 Agenda, are an adequate response to the challenges and obstacles or are part of the problem and discusses necessary policy changes.
Near the end of 2013, an outbreak of Zaire ebolavirus (EBOV) began in Guinea, subsequently spreading to neighbouring Liberia and Sierra Leone. As this epidemic grew, important public health questions emerged about how and why this outbreak was so different from previous episodes. This review provides a synthetic synopsis of the 2014–15 outbreak, with the aim of understanding its unprecedented spread. The authors present a summary of the history of previous epidemics, describe the structure and genetics of the ebolavirus, and review our current understanding of viral vectors and the latest treatment practices. They conclude with an analysis of the public health challenges epidemic responders faced and some of the lessons that could be applied to future outbreaks of Ebola or other viruses.
4. Values, Policies and Rights
The authors argue that leaving no one behind is the moral issue of our age, and is at the heart the Sustainable Development Goals (SDGs). One specific goal is ‘ending poverty, in all its forms, everywhere’, but the SDGs also aim to tackle marginalisation. The SDG outcome document specifies that the goals should be met for all segments of society, with an endeavour to reach those furthest behind first. Now the focus is on implementation, particularly at the national level. This report makes the case for early action, and quantifies its benefits. The report outlines the actions that governments can take in the first 1,000 days of the SDGs to respond to what poor people want and to deliver for the most marginalised people and groups. The evidence shows that achieving the SDGs and the ambition to leave no one behind will become far more difficult the longer governments delay. The report concludes that early action is critical for the achievement of the SDGs.
This meeting, organized under the auspices of the Network of Africa Parliamentary Committees on Health (NEAPACOH), and organised by PPD Aro, focused on implementation of regional and international commitments including the International Congress on Population and Development, Program of Action, the Maputo Plan of Action, the Millennium Development Goals (MDGs), and the FP2020 commitments, among others. The meeting provided a platform for building capacity and raising awareness of members of parliament on sustainable development. At the meeting parliamentarians from across the continent assessed progress made, challenges and lessons learned on achieving the country commitments made at its previous 2014 NEAPACOH meeting, built a common understanding of the challenges and opportunities for sexual and reproductive health in the post-2015 development agenda, shared experiences and innovative practices on the implementation of the 2030 Agenda for Sustainable Development, to enhance accountability, political leadership and stewardship for implementation over the coming 12 months. By the end of the meeting, a resolution (The Kampala Call for Action) was adopted by participants, on their commitments to address these issues.
5. Health equity in economic and trade policies
Vedanta Ltd is a mining company which various subsidiaries has operations in India, Zambia, Namibia, South Africa, Liberia, Ireland and Australia in copper, zinc, silver, aluminium, oil, gas, iron ore and power segments. This article reports on Vedanta’s annual general meeting in London and some of the debates that took place at the meeting, including in relation to the report back by shareholders who visited mine sites and reported on what they had seen on working and environmental conditions. The author comments that in part a promise of “zero harm” by large extractive corporations is illusory and can lead to real problems being hidden. The author argues for reports to rather be clearer about the real conditions and situation on the ground to include and allow debate on the improvements intended to manage them.
A new report published by Public Eye, 'Dirty Diesel' reports that Swiss commodity trading firms exploit lax regulatory standards to sell African customers fuel with high sulfur content that have been banned in Europe. Operating behind the Energy brands, trading companies have a dominant position in the import and distribution of petroleum products in many African countries. Public Eye researchers drew fuel at local pumps in eight countries, viz: Angola, Benin, the Republic of the Congo, Ghana, Côte d'Ivoire, Mali, Senegal and Zambia. The result revealed that the diesel samples contained up to 378 times more sulfur than is permitted in Europe. Furthermore, other toxic substances, such as benzene and polycyclical aromatic hydrocarbons, were also found in concentrations that are also banned in Europe. The 160-page report further indicates that the traders mix up a petrochemical cocktail from refinery products and other components known in the industry as "African Quality". These toxic fuels are reported to be mainly mixed in the ARA-Zone (Amsterdam-Rotterdam-Antwerp) where Swiss trading firms have their own refineries and storage facilities. Many West African countries that export high grade crude oil to Europe receive toxic low quality fuel in return. The authors indicate that these fuels investigated contribute to rising air pollution in African cities and jeopardise health, as noted in studies on rapidly increasing levels of air pollution and estimates that by 2030 Africa will have three times as many deaths from traffic-related particle dust than Europe, Japan, and the US combined. Respiratory illnesses are already a major health issue and diesel fumes can cause cancer. The authors argue that African governments need to set and enforce stricter standards. In a petition addressed to Trafigura, Public Eye and its West African partners call on the Geneva-based commodities giant to only sell fuel that meets European standards in all of its global operations, and the UN-Guiding Principles on Business and Human Rights adopted in 2011.
Members of the Ugandan Parliament (MPs) under the Parliamentary Committee on Science and Technology have tasked scientists at Kawanda Agricultural Research Institute(KARI) to educate the public more on Genetically Modified crops. The MPs raised concern over the unawareness of the public about genetically modified crops, the misconceptions people have concerning genetically modified organisms (GMOs) and problems in some of the genetically modified crops that have been introduced locally. This was during a meeting at the Agricultural Research Institute. Hon. Rose Mutonyi (Bubulo West) said the public is not convinced about genetically modified crops.
The boundaries between scientific and technological knowledge are nebulous in some technical fields, such as the biological sciences and their applications. This has led to the appropriation under patents of knowledge (such as on specific genes) of scientific nature, which may not only have negative effects for the further development of science and new technological contributions, but also encroach on the fundamental right of access to science. The South Centre argues in this paper that the patenting policies adopted by some universities and other research institutions may aggravate this problem. Court decisions in the USA and Australia and some national laws (e.g. Brazil) have limited the possibility of that appropriation, but this is still feasible in many jurisdictions. The authors argues that other measures – such as a well formulated research exception, the limitation of the patent claims’ scope, and legislation mandating open access to research results achieved with public funding – may mitigate the effects of the exclusivity granted by patent rights, but more fundamental policy changes may be necessary in order to preserve scientific outcomes in the public domain for free use and follow-on research.
6. Poverty and health
The Rural Economy, Agriculture, Natural Resources and Environment Committee of the Pan-African Parliament (PAP) organized a joint workshop with the committees on gender, agriculture, justice and bureau of women on the 1st of March 2016 during the Committee Sittings in Midrand, South Africa. The Maputo Protocol ON “Protocol to the African Charter on Human and People’s Rights on the Rights of Women in Africa.” was originally adopted by the “Assembly of the African Union” in Maputo, Mozambique July 2003. It provides that women have access to opportunities as well as resources that are available in the country. The PAP aims to ensure that the policies and objectives of the AU are implemented. The members agreed that as a team they need to adopt laws to secure women’s access to land and ensure that they be given a chance to play productive roles with regards to economic development in the agriculture sector. Article 15 of the Maputo protocol raises women’s rights to food and security as well as land access. Granting women access to land was seen to not only improve their lives but to enable food security and sustainable development.
7. Equitable health services
The South African parliament’s social services select committee has welcomed the investigation into the death of 36 psychiatric patients in Gauteng. This comes after Gauteng Health MEC Qedani Mahlangu revealed during an oral reply to questions in the legislature that 36 psychiatric patients, who had been transferred from Life Healthcare Esidimeni, had died while in the care of NGOs. The psychiatric patients were relocated to 122 NGOs after the department cancelled its contract with Life Healthcare, which looked after almost 2 000 patients. Health Minister Aaron Motsoaledi has called for the Office of the Health Ombudsman to investigate the allegations. The committee conveyed its condolences to the families of the patients. "While the Committee is cognisant of the need to find alternative measures to care for patients, these measures should have been made with the clear understanding and guarantees that the care of patients will not deteriorate. Every decision that is made must have as its central pillar the delivery of quality care for our people," committee chairperson Cathy Dlamini said in a statement. The committee called for the investigation to be sped up, in order to avoid further loss of life. They would engage with the health department at national and provincial levels to ensure quality care of all patients, the committee said.
Malawi has been the only country in Sub-Saharan Africa to provide universal free health services throughout its public health system and never charge user fees – with the exception of some recent worrying user fee experiments. Conversely in Nigeria, which only spends 0.9% of its GDP in the form of public health financing and where user fees are charged at all levels, private out-of-pocket health financing accounts for 72% of total health expenditure – one of the highest rates in the world. Perhaps the most stark illustration of the difference in performance between these two countries at the opposite ends of this curve, is that whereas Nigeria is 8 times richer than Malawi, Nigeria’s child mortality rate (109 deaths per 1000 live births) is 70% higher than Malawi ’s (64 deaths). In reviewing these records, the obvious policy recommendation for Nigeria is that it too should increase its public health spending and abolish user fees in its public health system. And for Malawi, the authors argue that the lesson should be to build on this success and use further increases in public financing to improve the availability and quality of free services.
8. Human Resources
Although the female condom (FC) is viewed as an effective female controlled barrier contraceptive device that can be used by women to prevent them from contracting the Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS), other sexually transmitted infections (STIs) and unwanted or unintended pregnancy, the perception and attitude of healthcare workers (HCW) plays a key role in its effective use and distribution amongst women. This study aimed to identify and examine factors that influences the perception and attitude of HCWs towards the use and distribution FCs. A quantitative, explorative and descriptive design was used to conduct the study based on the Health Belief Model as a conceptual framework in June 2013 with a convenience sample of 164 HCWs. The results showed that 64% of the respondents perceived unavailability of FCs as contributing to lack of adequate use. Only 32% of them reported using the FC. There was an association with increasing use of a FC with age, marital status and training. The results revealed that lack of knowledge and training on the use of a FC might prevent its effective use and distribution. The results showed evidence that the FC was a safe method of contraception and protection against STIs and that it empowers women to make decisions related to sexuality. However, awareness campaigns, increased availability of FCs and training of HCWs are essential to enhance positive perception and attitudinal change to reduce sexual risks related infections and poor quality of life for women.
Many African countries were not able to meet their Millennium Development Goals (MDGs) by the 2015 deadline. While this poor performance can be attributed to several factors, many analyses have revealed the main cause to be the absence of systematic and coordinated action on the social determinants of health, which are in large part outside of the health sector. Today, in light of the Sustainable Development Goals (SDGs), it is absolutely necessary to address this shortcoming. The authors indicate that reaching the SDGs calls for action on the social determinants of health and reduction of social inequalities. However, the current way health systems in the region operate emphasise treatment of disease, as if health systems are waiting for people to fall ill before taking care of them. In light of the SDGs, they argue that it has grown urgent for the African region to accelerate training of professionals who are skilled in acting on the social determinants of health to help reorient health services and place health in all policies.
9. Public-Private Mix
This paper examines India's partnership with Africa in four sectors – medical tourism, tele-health, frugal innovations, and the pharmaceutical industry. It examines the nature of Indian private sector investments in African healthcare. It analyses their effectiveness in dealing with the issues around equity of access, the establishment of comprehensive 'prevention- based' health systems, and the creation of mutual benefit. The author reports that there is significant Indian commercial presence in Africa's health systems but the engagement needs a broader conception of the 'private sector' to include traditional healers and social entrepreneurs engaged in innovation for healthcare. Given their common health challenges, the authors argue that India and African countries must work towards crafting innovative low-cost healthcare models, and invest in the production and research of pharmaceutical products, especially for neglected diseases.
10. Resource allocation and health financing
The International AIDS Economics Network (IAEN) Preconference in Durban in July 2016 demonstrated the strong political will to prioritise financing and harness economics to sustain the global HIV response and end AIDS, with high-level participation by ministers of health from Lesotho, Namibia, Botswana, Uganda, and Zimbabwe, along with the heads of UNAIDS and PEPFAR and experts from the CDC and the World Bank. At the policy level, a high-level panel discussed how evidence generated by economists can help facilitate engagement between the ministries of health and treasury and with civil society to keep health and HIV as a top priority in many countries. They also argued that investment cases should be made alongside human rights cases. These messages were echoed throughout the main conference. The face of HIV economics has changed, with young researchers from low- and middle-income countries making most of the presentations. The community’s focus has also changed in other promising ways. In 2000 health economists were just starting to explain why it makes economic sense to introduce antiretroviral (ARV) medicines into low-resource settings, and responsibility for financing HIV programs was seen to lie squarely in the hands of rich countries. In contrast, today energy is channeled towards sustaining the response and striving toward the 90-90-90 targets as efficiently as possible. Critically, the International AIDS Economics Network are supporting countries to mobilize ever more domestic resources and take ownership of their national programs.
The author of this article suggests that the individual multi-billionaire philanthropists who control and define the work of their foundations are able to exert massive influence in public policy and political agendas far beyond the average citizen. He questions this significant entitlement that money gives to a few people to influence global health, environment, education, food, medical, housing policies, whilst benefiting from global and economic inequality, including from the tax exemption they obtain. He cautions on the regression of the power of the state that this may imply, and calls for the legacy of the liberation struggle to be redeemed by building countervailing options and influence that increase citizen voice and engagement.
Return on investment (ROI) is an economic measure used to indicate how much economic benefit is derived from a program in relation to its costs. Interest in the use of ROI in public health has grown substantially over recent years. Given its potential influence on resource allocation, it is crucial to understand the benefits and the risks of using ROI to defend public health programs. In this paper, the authors explore those benefits and risks. They present two recent examples of ROI use in public health and conclude with a series of proposals to minimise the risks associated with using ROI to defend public health interventions. ROIs are increasingly being calculated to demonstrate the value of investments and ultimately to reinforce funding. Consequently, they argue that careful reflection is needed on how their use influences allocation decisions, especially given their role as an advocacy tool in the political arena. It is therefore crucial to understand the basics of how ROIs are calculated and to know their limitations and risks, rather than blindly accepting black-box numbers.
11. Equity and HIV/AIDS
HIV-related mHealth interventions have demonstrable efficacy in supporting treatment adherence, although the evidence base for promoting HIV testing is inconclusive. Progress is constrained by a limited understanding of processes used to develop interventions and weak theoretical underpinnings. This paper describes a research project that informed the development of a theory-based mHealth intervention to promote HIV testing amongst city-dwelling African communities in the conditions. A community-based participatory social marketing design was adopted. Six focus groups (48 participants in total) were undertaken and analysed using a thematic framework approach, guided by constructs from the Health Belief Model. Key themes were incorporated into a set of text messages, which were pre-tested and refined. The focus groups identified a relatively low perception of HIV risk, especially amongst men, and a range of social and structural barriers to HIV testing. In terms of self-efficacy around HIV testing, respondents highlighted a need for communities and professionals to work together to build a context of trust through co-location in, and co-involvement of, local communities which would in turn enhance confidence in, and support for, HIV testing activities of health professionals. Findings suggested that messages should: avoid an exclusive focus on HIV, be tailored and personalised, come from a trusted source, allay fears and focus on support and health benefits. HIV remains a stigmatised and de-prioritised issue within African migrant communities in the UK, posing barriers to HIV testing initiatives. A community-based participatory social marketing design can be successfully used to develop a culturally appropriate text messaging HIV intervention. Key challenges involved turning community research recommendations into brief text messages of only 160 characters.
12. Governance and participation in health
African Speakers of Parliaments and Presidents of Senate have unanimously adopted a landmark resolution on a Declaration of Commitment to prioritise parliamentary support for increased policy and budget action on Maternal, Newborn and Child Health in African countries. The milestone Declaration of Commitment was adopted at the 3rd Pan African Speakers Conference 17th – 18th October 2011, in Midrand, Johannesburg, South Africa. In the communiqué issued at the end of the conference, the speakers committed to “prioritise policy and budget support for implementation of African Union Summit Decisions, in particular the … Kampala July 2010 Summit Declaration on the Summit theme of “Actions on Maternal, Newborn and Child Health Development in Africa”. The Commitment was the first of its kind by African Speakers of Parliament, and marks a significant milestone in accelerating progress in Africa towards the attainment of the Millennium Development Goals (MDGs) 4 and 5 on Child and Maternal Health, respectively. It also promises high-level parliamentary support to hasten implementation of the Africa Parliamentary Policy and Budget Action Plan on Maternal, Newborn and Child Health, agreed by Chairs of Finance and Budget committees of national parliaments in October 2010.
Government of Botswana partners with two international organisations: U.S. Centers for Disease Control and Prevention and Africa Comprehensive HIV/AIDS Partnership to implement Voluntary Medical Male Circumcision with the target of circumcising 80 % of HIV negative men in 5 years. This paper uses a systems model to establish how the functioning of the partnership on Safe Male Circumcision in Botswana contributed to the outcome. Data were collected using observations, focus group discussions and interviews. Thirty participants representing all three partners were observed in a 3-day meeting; followed by three rounds of in-depth interviews with five selected leading officers over 2 years and three focus group discussions. Financial resources, “ownership” and the target were found to influence the success or failure of partnerships. A combination of inputs by partners brought progress towards achieving set program goals. Although there were tensions between partners, they worked together in strategising to address some challenges of the partnership and implementation. The authors found that pressure to meet the expectations of the international funders caused tension and challenges between the in-country partners to the extent of Development Partners retreating and not pursuing the mission further. Target achievement, the link between financial contribution and ownership expectations caused antagonistic outcomes.
Members of the Kenya Parliament, specifically women, have expressed the need to close the evidence gap currently curtailing effective legislation and policy formulation. Speaking at a workshop organised by African Institute for Development Policy (AFIDEP) and the Parliamentary Caucus on Evidence-Informed Decision-Making (PC-EIDM), the Members of Parliament (MPs) acknowledged the critical role evidence plays towards enhancing their effectiveness in legislation, representation and policy-making. The workshop, which specifically targeted members of the Kenya Women Parliamentary Association (KEWOPA), provided an excellent opportunity for the women Parliamentarians to speak out on the challenges they are grappling with as legislators. Hon Naisula Lesuuda, a nominated Senator, Samburu County and the Deputy Chairperson of KEWOPA in the Senate, said that through the Association, women in Parliament play a critical role since KEWOPA’s mandate is to ensure that policies are gender-responsive, and that programmes related to women’s affairs get adequate resource allocation. Evidence is therefore of essence as the Association needs to ensure that its recommendations are evidence-informed. The MPs expressed their desire to use evidence to debate policy issues but the evidence is not readily available. There were also calls to digitise all data in the custody of various government ministries and to have it uploaded to an online portal to enhance its accessibility by Parliamentarians when need arises. In addition, the MPs noted that they would have achieved more during their current tenure had relevant evidence on pressing socio-economic challenges in their areas of jurisdiction been presented immediately they took over office. In a bid to identify strategies to enhance evidence use in Parliament, the members called attention to the need for the training of research and personal assistants.
The Olympic Games may go back 3,000 years to Ancient Greece, but the international sporting event that takes place every four years didn’t take on its modern form until 1896. And while the games claim to represent global sporting culture, as suggested by the Olympics’ logo, the author argues that many of the sports seem to have uniquely European aristocratic origins. He asks, what would the Olympics in Rio look like if traditional African sports were included? This article discusses seven traditional African sports that would be welcomed additions to the games: including Ngolo and capoeira, Afro-Brazilian and West African martial arts, Senegalese wrestling, donkey racing and Dambe boxing.
The Commonwealth Women Parliamentarians (CWP) which is an organ of the Commonwealth Parliamentary Association (Africa Region) held a two day East Africa Sub-Regional sensitization workshop in July 2016. Themed “Establishing CWP Chapters to Leverage Women Representation and Advocacy,” the CWP sensitization workshop is to encourage all branches to set up CWP Chapters and functional structures and adoption of the guidelines fully and to advocate for policies legislation and programmes that eradicate social, cultural and religious practices that are harmful to the women. Rt. Hon. Mukabalisa said that Rwanda’s achievements in gender equality and women empowerment have been made possible by the strong political will and the commitment from the highest level, accompanied by innovative, home-grown and people centered development approaches. Hon. Angela Thoko Didiza Vice Chairperson of CWP Africa Region and its current Acting Chairperson stated that despite the recognition of women’s rights and need for deliberate action towards the empowerment of women; there remains a marked difference in the status and access of men and women in political, social, economic domains. She confirmed that even where has been progress, there are still challenges in ensuring the full participation of women, “ensuring gender equality and participation of women in decision-making position is imperative to human development. There is a need to change the traditional roles that limit women’s potential, as well as acknowledge women’s full contribution to social and economic development.”
This research project was carried out to ascertain the use of Information and Communication Technologies (ICT) and Social Networking Sites (SNSs) in political governance of East African Legislative Assembly (EALA) Parliament. It was based on the conviction that in this era of globalisation use of ICTs and SNS‘s are fundamentally important and will have tremendous impact on governance, leadership and legislation. The findings showed that that all the parliamentarian respondents were subscribed to social networking sites and used them from time to time. The EALA parliamentarians had a disparity when it came to use of SNSs to interact with constituents, 73% indicated that they have used SNSs to interact with constituents on matters affecting the community from time to time however 27% did not. The use of ICTs and SNSs by EALA was argued by the authors to enable citizens to view Assembly proceedings in real time. The recommend that Parliamentarians in Africa embrace SNS‘s as major tools in interacting with and being accountable to their constituents.
A new project ‘woman, rise’ is a special collaboration project with Ghanaian muralist, Ayambire Faustina Nsoh, who descends from a tradition of women-led painting that carries lessons and messages around ethics and social relations, as well as a practice in space and design making daily life more beautiful. Visually, ‘woman, rise’, draws on how Nsoh learned how to paint from her grandmother in Sirigu, northern Ghana, and the global activist tradition of political murals, graffiti and stenciling. Horn’s project asks some critical probing by asking these questions: When we dream of African freedom, do we dream in the colours of our grandmothers’ cloths? Do we dream in the voice of young women rallying in a public square for an end to tyranny? And as we dream, do we hear the sound of women spirit mediums fortifying our souls by humming the ancestors into our midst? These women crafters of our liberation- do we know their names? These women who have offered heartbeat and intellect and magic to clear space in the world so all of us can breathe, do we know their faces? ‘Woman, rise’ explores the spirit of African women’s dynamic contributions to shaping selves, communities and a world that is equal. It invokes the history of African women who have worked against the grain of social expectations and offered their spiritual, intellectual and emotional power to the work of social change.
13. Monitoring equity and research policy
The African Institute for Development Policy AFIDEP conducted a training workshop for more than 15 parliament staff from 10 African countries on evidence-informed decision-making (EIDM) on June 27-28, 2016 in Munyonyo, Uganda. The parliamentary staff included researchers and clerks who support parliamentary health committees. These staff provide committees with briefings on issues to inform their debates and decisions, and therefore play a crucial role in the ecosystem of evidence use in parliament. The workshop equipped the parliamentary researchers and clerks with knowledge and skills in: the critical place of evidence in the legislature; knowledge of where and how to effectively search for evidence, assess its quality, and synthesise and package it appropriately for use by MPs.
The Global Forum 2015 panel session dialogue entitled “From evidence to policy – thinking outside the box” was held on 26 August 2015 in the Philippines to debate why evidence was not fully translated into policy and practice and what could be done to increase its uptake. This paper reports the reasons and possible actions for increasing the uptake of evidence, and highlights the actions partners could take to increase the use of evidence in the African Region. The Global Forum 2015 debate attributed African Region’s low uptake of evidence to the big gap in incentives and interests between research for health researchers and public health policy-makers; limited appreciation on the side of researchers that public health decisions are based on multiple and complex considerations; perception among users that research evidence is not relevant to local contexts; absence of knowledge translation platforms; sub-optimal collaboration and engagement between industry and research institutions; lack of involvement of civil society organisations; lack of engagement of communities in the research process; failure to engage the media; limited awareness and debate in national and local parliaments on the importance of investing in research and innovation; and dearth of research and innovation parks in the African Region. The actions needed in the Region to increase the uptake of evidence in policy and practice include strengthening national health research governance; bridging the motivation gap between researchers and health policy-makers; restoring trust between researchers and decision-makers; ensuring close and continuous intellectual intercourse among researchers, ministry of health policy-makers and technocrats during the life course of research projects or programmes; proactive collaboration between academia and industry; regular briefings of civil society, media, relevant parliamentary committees and development partners; development of vibrant knowledge translation platforms; development of action plans for implementing research recommendations, preferably in the context of the Sustainable Development Goals; and encouragement of competition on health research strengthening and research output and uptake among the countries using a barometer or scorecard to review their performance at various regional ministerial forums and taking into account the lessons learned from the MDG period.
The need for legislative information and research, especially in developing and transition countries, is growing as policy-making processes become more complex, particularly in the context of globalisation, regional integration and decentralisation. Since the executive branch of governments generally has access to a larger pool of knowledge and expertise than the national legislature, there is a need to address the imbalance in access to knowledge between the executive, legislature and judiciary in order to promote better quality policy-making. Better access to information and research can help empower legislatures to formulate and pass effective legislation and perform effective scrutiny of government. Using the Research and Policy in Development (RAPID) framework, this study maps the links between researchers and legislators in a number of transition and developing countries; explores the role of politics in influencing researcher–legislator linkages; and comments on the type of research produced as well as the credibility of the research/researchers. Civil society organisations (CSO) particularly in Sub-Saharan Africa, perhaps because of weak political parties, play a key role in representing grassroots constituencies in legislative processes. Legislative committee hearings across all legislatures tend to be a key mechanism through which researchers’ voices can be heard in the processes of law-making and oversight. Some legislatures, particularly those in East Asia, have substantial in-house technocratic capacity, including library and research services and the capacity to commission research. In Sub-Saharan Africa, a number of (donor-funded) organisations have been set up to provide the legislature with input and capacity, particularly on management of public finances. Researcher–legislator linkages, particularly in Sub-Saharan Africa, tend to be stronger or more visible in areas that are perceived to require hard data, such as quantitative analyses. These include public financial management, particularly budgeting and budget control. In Sub-Saharan Africa, these formal mechanisms were found in the study to be externally funded and/or -inspired. Where hard data is concerned, research tends to be demand-oriented; in the softer sectors, CSOs have tended to take the initiative to engage legislators. The relationship between political context factors and researcher–legislator links was found to be complex. Legislators’ personal motivations, such as the desire for political advancement, to influence policy, for power in a legislative body and for private gain, can affect the way they view or use evidence in the policy process. The capacity provided by a legislature’s procedures, structures and support mechanisms also influences the role of research in law-making and oversight processes. They propose that researchers work harder to ensure evidence is accessible by legislators and related to legislative decisions, that fits tightly with legislative processes. Legislators emphasised the need for researchers to go beyond stating research findings to actually narrate a compelling story with practical policy recommendations. Moreover, evidence is more likely to be taken up if messages resonate with broader national policy agendas, such as economic growth. Given the pressures on their time and relatively low research literacy levels, research intended for legislators needs to be presented in short summaries, where possible illustrated by pictures and/or charts. Nevertheless, Legislators’ staff prefer formats that present more detail.
14. Useful Resources
The Drama for Conflict Transformation (DCT) methodology introduced in this toolkit is used to create community conversation about conflict issues, piloted in conflict-prone areas in Kenya, amongst other countries. Since 2010, participants have collaborated with more than 50,000 audience members to talk about solutions to bullying in schools, labour migration, bride kidnapping, resource scarcity, and substance abuse. The idea is that, "when youth are engaged positively and given a voice, they can play vital roles in building peace. This toolkit is designed to introduce young people to an innovative theatre methodology that creatively examines and transforms conflict. After working through the exercises in this manual, youth will be equipped to lead community dialogue as agents of positive change.” This toolkit guides facilitators in creating a custom workshop to introduce youth to the DCT methodology. The material can be adapted by the facilitator to be culturally or regionally specific and to integrate various themes important to the participant group. Many options for workshop modules - including lead-in activities, warm-up modules, main sessions, energisers, and closing activities - are included to allow the facilitator to craft workshops that best fit their local context and needs. After working through these exercises, participants are expected to be able to analyse conflicts in their communities using theatre exercises, create a Forum Theatre performance based on a community conflict issue, and engage with their local communities through DCT. The toolkit is divided into two sections. Section I: Introduction to DCT Methodology and Facilitation includes hints on organising a DCT workshop, structuring exercises, and establishing group dynamics, as well as an illustration of good facilitation to create a safe, fun, and informative space for participants. Section II: DCT Activities and Theatre Techniques includes a toolbox of DCT activities, arranged by type (warm-up, lead-in, main activity, energiser, or closing activity). Notations on sequencing indicate when certain exercises should be used to build upon earlier trust-building or skill-building work. A glossary of terms, bibliography of relevant works, and selection of handouts are found at the end of the manual.
ECOWAS Centre for Renewable Energy and Energy Efficiency ( ECREEE) presents “Think Again”, a film on women who have made it as leaders in the energy sector in West Africa. The video documentary goes beyond the common understanding of gender and energy issues by replacing the traditional story of women as victims in energy development with stories of women as influential contributors to improving energy access. If you thought women were only end-users of energy, Think Again.
15. Jobs and Announcements
The African Health Economics & Policy Association (AfHEA) was set up in March 2009 as a membership-based non-profit association of Africans and non-Africans including students working on Africa-related issues in the fields of health economics, financing and policy. The theme of the 2016 AfHEA conference will be: “The Sustainable Development Goals (SDGs), the Grand Convergence and Health in Africa". The conference aims to: help define the research agenda and identify research gaps regarding the conference theme; ensure a minimum of 20 African countries and 200 participants from Africa (both Francophone and Anglophone) attend conference; attendance from at least 10 globally recognised experts on African health economics and policy; at least 120 abstracts presented; publish all abstracts and posters of conference both in hard copy and electronically (online); identify currently emerging and priority research areas for African countries and regional bodies; outputs from the AfHEA conference are translated into policy notes and communicated to decision makers. The target audience is researchers, policy makers, health professionals, academics and students, practitioners from Ministries of Health, Finance and related agencies, individuals from the NGO and community-based organisations, and others with a research or policy interest in the subject areas covered by AfHEA.
The Council for the Development of Social Science Research in Africa (CODESRIA) invites applications from African scholars to fill a vacant position of Programme Officer (Research) in its pan-African Secretariat located in Dakar, Senegal. This position is categorized as belonging to the senior staff of the Council and as such is filled on the basis of an international announcement. The successful candidate will work as a member of the Secretariat under the overall supervision of the Executive Secretary of the Council. For further details see the website.
The recurrent allusion to the “globalisation of the social sciences” validates the idea of the dominance of Western scientific norms and practices over those of “the rest of the world”. In preparation for the next issue of Méthod(e)s, CODESRIA invites colleagues to critically engage with the production of methods and knowledge in the social sciences: that explore modes of domination and resistance in the social sciences. The editors are particularly interested in seeing contributions based on experiences in the field, using empirical materials. Various formats are invited. For further information visit the website.
The International Center for Research on Women (ICRW) is soliciting nominations for the second annual Paula Kantor Award for Excellence in Field Research. The 2016 award will be given to a young female researcher who is a citizen of a sub-Saharan African country in order to recognise and honour outstanding achievement in the fields of gender and empowerment of women and girls. The 2016 Paula Kantor Award for Excellence in Field Research will be conferred to the winner at the launch of ICRW’s Africa Regional Office in December in Kampala, Uganda. Nominations must be made by a third-party. The 2016 award will again be given as part of ICRW’s annual Champions for Change awards, which honours the work of thought-leaders and visionaries. The award will provide the recipient recognition and bring greater visibility to the researcher’s work and to the populations on which they focus. At the awards ceremony, the recipient of the award will have the opportunity to present in front of an esteemed global audience, comprising those in the development, business, NGO, and government sectors, and will receive opportunities to promote their research.
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