Editorial

The roll out of Performance-based financing (PBF) in east and southern Africa is now widespread. Yet a recent study found cause for concern with this often ‘taken-for granted’ financing mechanism. As a result, there is a need to better understand and debate how PBF reinforces or contradicts other measures being used to build and strengthen universal health systems.

Performance-based financing has become increasingly popular in global health financing. It involves the transfer of money or goods based on implementation of a measurable action or achievement of a predetermined performance target. It is seen to increase accountability to both external funders and national stakeholders, by tracking of how money is spent. Having clear targets is argued to strengthen health systems by providing a way of assessing what programs are efficiently delivering ‘value for money’ and by rewarding good practice. Its proponents argue that external funders, generally large contributors to African heath systems, should transfer funds based on performance to achieve these gains.

In the past year we carried out research examining PBF in South Africa, Tanzania and Zambia, and with regional and global institutions (more fully reported in EQUINET discussion paper 102 at http://tinyurl.com/nudgky3). This work raised questions about how PBF affects the strength and equity of health systems, and what latitude African actors have to ‘reframe’ PBF mechanisms to address their concerns.

Certainly a majority of the African actors had a positive perception of PBF and its ability to strengthen health systems, a perception also evident in the general literature pertaining to PBF. In particular, evidence suggests that Africa actors believe that PBF is useful in curbing corruption, in incentivizing targeted health outputs, and in increasing accountability mechanisms. These benefits, where they have occurred, have generated support for and ownership of the approach.

Nevertheless, at the same time there were many concerns regarding the practice of PBF. Questions were raised about how performance criteria are selected and how far national input was factored into the design of PBF, a key principle in the Paris Declaration. We found that the space for genuine participation in the design of PBF was narrow, usually limited to high level personnel in national systems, and that it was affected by factors such as how much of the public budget is externally funded. Lower dependency on external funding appeared to give countries greater possibilities of setting their own targets and resisting funding conditions that potentially conflict with national strategic plans. We found, for example, that South Africa, with less than 10% of its health budget externally funded, had greater latitude to negotiate and resist unfavourable conditions. We also found that this ability to ‘push-back’ was less available in Tanzania and Zambia, where external funding contributes up to half of the health budget. Some African actors in health ministries and in service provision expressed weariness about the external conditions demanded by funders, and called for a more decisive national voice. As one senior African health official suggested, ‘when PBF is the result of national ownership then it has excellent potential to be a mechanism for change… however, if it is not, then it will certainly be doomed to…not deliver on its promises.’

We found that while there is great enthusiasm for monitoring and rewarding outcomes, in practice this needs substantive investment in health information systems. We found, as others have, that information systems lack the reliability, capacities and support to analyse and use evidence to evaluate performance. Unless this is recognized and addressed, use of performance indicators can cause weaker services (with poorer capacities to manage information) to do worse, reducing their PBF ‘score’ rating and thus restricting their funding. This causes considerable concern, since these services are usually the ones that are in more marginalized areas of highest need. In addition, many of the African actors we interviewed complained that the reporting systems required by funders are cumbersome, time-consuming and add considerable overhead costs. External funders, particularly the Global Fund, were reported to change reporting requirements and ‘goal posts’ mid-stream, without sufficient notification or technical assistance, leading to confusion and delays in programme reporting and roll out.

Furthermore, external auditing mechanisms were often found to be ‘not fit-for-purpose’, implemented by auditors with little health knowledge or understanding of the recipient country, with inadequate communication between auditors and recipients.. Audit processes were found to be inflexible on target satisfaction. For example, Local Fund Agents (LFA) of the Global Fund were reported to often refuse to answer recipient’s questions during report writing, to refuse to discuss reporting problems during the audit, or to allow the final LFA evaluations to be seen by recipients. This was argued to damage partnership and national input to PBF conditionalities.

Moreover, many African actors that we interviewed assumed the merits of PBF, without being able to refer to strong evidence to support this view. There is also a growing weariness about PBFs ability to ‘be all things to all people’ and an urge to have a more realistic national assessment of PBF as being one of many financing measures available.

Where PBF is seemingly most successful is in cases where there is a strong sense of national ownership and multi-sectoral partnership. PBF has had positive impacts where robust information systems exist, so that future targets can be based on valid data, where performance monitoring is possible, and where evaluations can be made reliably. It is seemingly most successful when targeted on tightly focused health interventions, like payment per patient seen, and not on broad whole-of-system targets, where it is difficult to isolate and track individual variables. A better understanding of the positive features can contribute to health system strengthening.

However our study also found evidence of negative consequences that can weaken national health systems. Reaching PBF targets can sometimes compromise quality of care, vertical PBF schemes can create ‘health silos’ that are not always fully integrated into comprehensive primary health care, and PBF schemes are often not well embedded into a sustainable long-term health strategy.

These are issues that partners can identify, negotiate on and attempt to resolve. So our findings on the weaknesses of partnerships and genuine national leadership of the PBF agenda – as raised in this editorial and detailed in the full report- are crucial issues to be discussed and debated; to build better partnerships between global and African institutions and to design better systems for strengthening African health systems. As one senior health official commented, ‘we should be accountable for the money we receive and we should try to get as much value for money as possible... this is the non-debated part of PBF and a reason why it is so popular… but exactly how to best generate value for money is still open for discussion and for PBF to work effectively it will be important to get its processes right and to then generate agreement by all those who have to deliver these processes.’

Please send feedback or queries on the issues raised in this briefing to the EQUINET secretariat: admin@equinetafrica.org. For more information on the issues raised in this op-ed please read the full report on the EQUINET website and visit www.equinetafrica.org

The Gates and Rockefeller Foundations propose to increase food production on the African continent, “eliminating hunger for 30-40 million people and sustainably moving 15-20 million people out of poverty,” through their initiative of an Alliance for a Green Revolution for Africa (www.agra.com).

We all share in the goal of eliminating hunger on the African continent. However, we are also aware of the risks to health and nutrition posed by the previous green revolution in Asia and Latin America. As farmers dedicated more and more land to growing new varieties of wheat, rice, and maize, less land was available to women to grow vegetables (vitamins, minerals), and the commercial production of pulses (protein) stagnated. How will this proposed “green revolution” affect production, food security and human health in Africa?

Similar to the green revolution of the 1960-70s, increasing yields of a few crops to provide food for the hungry remains the central justification for this proposed African green revolution. The 1960s varieties of seed required fertilisers, pesticides, and water at very specific times or the yield was worse than traditional varieties. Indian farmers, for example, did increase production of wheat ten-fold and of rice three-fold. Learning from this experience, the current AGRA initiative also includes training African scientists, setting up marketing networks of small seed companies, and credit schemes. Other major differences are that the seeds will be genetically modified (GMOs) and patented, in the 1960s in India, they remained in the public domain.

The benefit of increased yields, however, came with many environmental, economic and social costs in the green revolution on the 1960-70’s.. The massive increases in the use of fertilisers and pesticides contaminated the water and soil. Small-scale farmers could not sustain the purchase of all the inputs and had to sell their land. Studies in India show that only farmers with at least 6-8 hectares of land could afford the high-tech agricultural production. Inequality within villages increased, with many moving to the cities. As Secretary General U Thant summarised in 1970, “There is already a growing a body of relevant literature on the experience in various regions and localities which strongly suggests that the prosperity resulting from the Green Revolution is shared by a relatively few.”

The economic and social dangers of a “green revolution” for Africa are similar to those related to the commercialisation of health care: 1) piracy of both indigenous knowledge and plants (used for medicine and/or food); 2) privatisation of bioresources necessary for human health through patenting of plants; 3) privatisation of research which directs priorities and agendas. Rather than reducing hunger, these adverse outcomes could in fact reduce the food security of Africans, increase undernutrition and thus reduce immunity against disease.

Increased yields of one or two strains of one or two crops (“monoculture within monoculture,” as stated by a Tanzanian botanist) will not provide the basis for food security to support nutritional needs. The key to ending hunger is sustaining Africa’s food biodiversity, not reducing it to industrial monoculture. Currently, food for African consumption comes from about 2,000 different plants; in contrast, the US food base derives mainly from 12 plants. Narrowing plant diversity of food increases vulnerability for all because it a) reduces the variety of nutrients needed for human health, b) increases crop susceptibility to pathogens, and c) minimises the parent genetic material available for future breeding.

Manufacturing plants for food is very similar to manufacturing them for medicine. Indigenous knowledge designates a plant as important for nutrition or for medicinal purposes. But often, corporations simply take both the plants and the knowledge with no recognition, monetary or otherwise, to the original breeders of new medicine and foods. This biopiracy of food and medicinal plants is made legal by the patenting of living organisms, through international trade agreements.

Because African farmers will have to buy the new seeds, and the pesticides and fertilisers they require for increased yields, this green revolution initiative becomes a privatisation offensive against small-scale farmers who still retain control over their seeds. Of the seeds used for food crops in Africa, 80 percent is seed saved by the farmer herself or locally exchanged with family and neighbours. Farmers do not have to buy seed every season, with cash they do not have, for they possess a greater wealth in their indigenous seeds, freely shared and developed over centuries. The very best food seed breeders in Africa, the “keepers of seed,” are women who often farm less than one hectare of land. Across Africa, women are also the food producers, tending “gardens” full of diverse crops for local consumption, while the men concentrate on cash crop production. Even when the cash crop fails, food will most likely be available for the family, for those plots are intensively farmed and carefully watered.

The proposed green revolution would shift the food base away from this treasure of seed. Instead, African farmers would have to purchase patented seeds each season, thus putting cash into the hands of the corporations providing the seed, much as already has happened with plants used in medicinal compounds. Loss of control over seed reduces the control women farmers have over production, with risks to food security and nutrition. For AGRA, the seeds will not only be patented, but new varieties will undoubtedly be genetically modified organisms (GMOs). The perils of GMOs to environmental sustainability are well documented. Most African governments have ratified the biosafety protocol which allows them to deter research and production of GM food crops until sufficient data is available about its impact on human health and the environment, but AGRA is lobbying for governments to “fast track” approval for new varieties to be planted.

Research on African food crops certainly needs financing. The US National Research Council concluded in 19996 that a major African food crop, sorghum “is a relatively undeveloped crop with a truly remarkable array of grain types, plant types, and adaptability….most of its genetic wealth is so far untapped and even unsorted. Indeed, sorghum probably has more undeveloped genetic potential than any other major food crop in the world.”

As nutritious as maize is for carbohydrates, vitamin B6, and food energy, sorghum is even more nutritious in a range of essential nutrients for health. One of the most versatile foods in the world, sorghum can be boiled like rice, cracked like oats for porridge, baked like wheat into flatbreads, popped like popcorn for snacks, or brewed for nutritious beer. Because sorghum can tolerate dry areas and poor soil better than maize, it can provide nutritious food security in semi-arid regions and therefore, should become even more important under conditions of global warming.

Engaging African scientists to discover the potential genetic wealth of sorghum would assist African food security. In a first glimpse of foundation expenditures, however, we see funds directed to the Wambugu Consortium (founded by Pioneer Hi-Breed, part of DuPont) for experiments in genetically modified sorghum. By adding a gene, rather than mining the genetic wealth already there, the consortium can patent and sell the “new” sorghum at a premium price for DuPont.

Private expenditure on research and marketing of a few crops directs attention to crops that are profitable. Similar to health care, International Monetary Fund requirements for structural adjustment programs, supported by all donor governments, the World Bank, and the African Development Bank, have been removing African government expenditures on agricultural research and extension. Governments had to spend less on agriculture in order to repay their debts. Now, more two decades later, the private foundations step in to “save” food-deficit Africa.

High-tech answers to Africa’s food crises are no answers at all if they undermine human nutrition, privatise both indigenous knowledge and bioresources through patenting of plants, and transform the genetic wealth of the continent into cash profits for a few corporations. Public policy choices around the AGRA proposals have not yet been made within Africa. There is thus still an opportunity to call for assessment and debate on the health and nutrition impacts of these proposals, including by civil society working in health, and by parliaments, and by UN agencies. We need to openly challenge its goals, motives and methodologies before Africa’s political leaders accept them, and before universities and research centres divert their agendas away from other applied research that may offer a more sustainable and nutritious future for African food production. The future of African health depends on it.

For references used in this editorial and a more detailed analysis of how Africa’s food biodiversity provides alternatives to chemical industrial agriculture, see Andrew Mushita and Carol B. Thompson, Biopiracy of Biodiversity (Trenton, NJ: Africa World Press, 2007), carol.thompson@nau.edu. Further information on nutrition and health issues can be found on the EQUINET website at www.equinetafrica.org or contact admin@equinetafrica.org

Recent media attention in South Africa has drawn attention to an outbreak of Extreme Drug Resistant (XDR) TB and the need to contain infectious diseases such as XDR TB by extraordinary methods such as quarantine. Such measures, typical of the public health approach to community health problems, involve the limitation of individual rights in the interests of the public good. In this case, the need to contain a costly, highly dangerous and virtually untreatable form of TB by forcibly quarantining patients with this form of TB, were said to outweigh the rights of the patient to autonomy and freedom of movement. Rightly, discussions in South Africa focused on whether the restrictions of the rights of the individual in the interests of the greater good could be justified.

At one level, this is an important debate because it is typical of many other public health conflicts (e.g. in relation to HIV or claims on scarce resources), where individual rights run into conflict with interests that represent a collective or social benefit. Resolving such conflicts in ways that retain respect for human rights whilst advancing public health is important for public health planners, and methods to do so have increasingly emerged in the human rights and public health literature that help public health practitioners negotiate these difficult trade-offs. Thus, in considering whether a limitation on individual autonomy could be justified in the public interest, one would expect that:
- the objective of the policy, such as quarantine, has an objective of legitimate interest and is provided for in terms of a due legal process;
- the policy will be effective in realising that objective;
- the policy is strictly necessary in a democratic society to achieve that objective;
- there are no less intrusive means available to achieve the same objective; and
- the policy’s application is not arbitrary, discriminatory or unreasonable.

Often many public health measures are applied routinely without careful reflection as to whether these criteria are met. Calls for HIV notification, for example, are often made without clear policy objectives, or, where objectives are intended, without any evidence that notification will meet these objectives better than any other methods that are less restrictive of individual autonomy.

However, it is the case that, under certain circumstances, and given certain requirements being met, limiting rights for the public interest can well be justified in terms of international human rights law. Indeed, the limitation of rights may well be viewed differently when one realises that states have obligations imposed by international human rights law to positively realise various obligations to control the spread of infectious diseases (ICESCR, article 12) and to meet requirements for general welfare (ICCPR, article 4).

However, on another level, the public health objective itself is often the expression of a rights obligation of government to realise, for example, an environment not harmful to health (Section 24 of South Africa’s Bill of Rights), or the right of access to health care. Such socio-economic rights obligations are themselves necessarily collective in nature, and the trade off is not so much between individual civil liberties and public health objectives, but between different kinds of rights, such as individualist rights to autonomy, and social rights such as the those relating to health care access or a safe environment, both of which are needed to realise health. Protecting individual autonomy is important for the effectiveness of treatment programmes to ensure patient adherence and build trust in the health service, as much as social measures being required to control the spread of infectious diseases.

Popular misconceptions of rights as being solely or predominantly about civil liberties and formal parliamentary democracy have been fostered by a combination of the ascendance of neo-liberal economic policies in international policy making, as well as the unopposed exercise of power by the USA and its allies in the post-Cold War period in ways that entrench narrow individualist views of rights. Indeed, recognition of the indivisibility of rights and the equal importance of socio-economic entitlements and equity run counter to market-oriented development policies fostered by international development agencies.

Thirdly, human rights are not just about limits to state power but also speak to realising human potential in ways that confer agency.

When faced with public outcry or a health emergency, public health responses frequently fall back on traditional population interventions that obviate any role for individual and community action. The resort to autocratic traditions of central command and control has a strong anti-democratic history in public health and is based on a deep suspicion that humans can be trusted to make decisions in their own collective interest. It is not surprising, therefore, that many of the pioneering anti-smoking public health measures originated in the health programmes of Germany’s Nazi government and were entirely compatible with the ferociously anti-democratic and inhumane ideology of the Nazi regime. What a human rights approach brings to public health, therefore, is to ensure that social justice is a counterbalance to unchallenged utilitarianism, and that checks on power serve to protect the vulnerable, in ways that confer agency on communities to determine the policies and programmes that affect their health.

Increasingly, human rights advocates are realising that the sources of power in society who must be held accountable are not just states, but non-state actors, including multilateral agencies and multinational corporations whose de facto control of resources determines access to the conditions required for health to a far greater extent than does that of many states. International human rights law is increasingly providing “soft” law guidance through issuing of codes of conduct, norms and standards to ensure non-state actor accountability for human rights. Given that human rights are a product of developmental struggles, these frameworks will only be translated into meaningful instruments for accountability through strong civil society pressure on governments to turn such codes and standards into law.

Rights are not just about empowering vulnerable groups, but are themselves the products of contestation of power, at local, national and international level. And where power is contested, we should expect that the products of this contestation will reflect the relative balance of forces of different actors. For this reason, the exclusive emphasis on good governance, parliamentary democracy and civil liberties that has emerged as the dominant paradigm in some development discourses driven by Western governments has ironically contributed to a depoliticisation of rights and of development, because it strips struggles for health of any dimensions that challenge power imbalances – at local, regional and international levels. Yet power imbalances are what underlie health inequalities. This has led many to question “Why rights, why rights now?” since when the language of rights becomes denuded of power, it is turned into a technical exercise of compliance with norms.

Unchallenged, therefore, we should not be so naïve as to imagine that human rights will of necessity benefit poor people, poor communities or poor countries. Rather, by using and shaping rights towards pro-poor choices, human rights become transformative rather than simply easing human suffering. When human rights discourses, for example, begin to challenge and overturn obstacles posed by trade commitments to the realisation of the right to health, then the transformative nature of human rights emerges.

In this paradigm, the role of civil society organisation (CSOs) is absolutely central to realizing the agency that makes human rights approaches transformative. Yet many CSOs undertaking work in the health sector may 'do' human rights work, but are often not aware of the rights implications of their work on the ground. Is 'doing' human rights enhanced by 'acting' (i.e. conscious awareness of) human rights as well? Pilot research in the Western Cape with three health CSOs points to the multiplicative effect that a rights paradigm adds to their impact. By framing (health) needs as rights to which duty-bearers can be held accountable, not only is the demand for pro-poor services strengthened but beneficiaries of these services are enabled to be active agents in securing the conditions for their health, rather than passive recipients of state or NGO services. Moreover, placing demands in a right framework challenges service providers to see their role as realising states’ human rights obligations rather than simply delivering services. It is particularly in the field of socio-economic rights that the duality of service provision as fulfillment of human rights is evident and where it is clearest that human rights are more than just civil liberties.

CSOs engaging with rights approaches can build much stronger advocacy through sharing experiences and learning best practice. EQUINET, through its health rights theme, plans to explore the establishment of a learning network for CSOs in the region using rights approaches as a mechanism for enhancing civil society participation in the development of national health systems that are comprehensive, people-led and people-centred. We invite participation from CSOs and activists throughout the region in developing this network and look forward to your input and contribution to this debate.

Please send feedback or queries on the issues raised in this briefing to the EQUINET secretariat, email admin@equinetafrica.org for attention to School of Public Health, University of Cape Town, Leslie London. Further information and publication on EQUINET work on health rights as a tool for health equity is available at the EQUINET website at www.equinetafrica.org.

‘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.