With external funders moving towards making randomised controlled trials (RCTs) yet another conditionality of aid, How Matters questions the rationale behind the trend and its implications for non-governmental organisations in least-developed countries. According to the article, most local organisations and grassroots movements in the developing world lack both resources and capacity, and will struggle to meet arduous requirements from external funders to provide evidence that their programmes work, as RCTs are complicated and costly to undertake. How Matters argues that development aid hasn’t reduced poverty, but instead has squashed local initiatives by not giving the due attention to how that aid (and the accompanying monitoring, surveys etc) makes people feel, largely because of prevalent, yet hidden, negative attitudes towards local people and organisations in the aid sector. How Matters calls for greater participation by communities and individuals who are on the receiving end of aid, rather than the current one-way approach whereby researchers and policy makers tell recipients what they need, without considering issues of dignity and respect.
Governance and participation in health
Sexual and reproductive rights for all are fundamental to transforming the lives of millions of adults and young people. Changes in legislation, access to information and provision of services provide an essential route to bringing about wider change. But alone, they are not enough for the most vulnerable to see themselves as having rights to safer and more fulfilling sexual and reproductive lives and to be able to claim them. In a collection of experiences of using participatory approaches for work on sexual and reproductive health and rights, researchers from the UK's Institute of Development Studies and the International Community of Women Living with HIV and AIDS (ICW), show how involving vulnerable groups more directly in efforts to improve their well-being can make a real difference.
The representatives of many economic justice networks, social development movements, women’s, workers, youth and small-scale farmers, human rights, educational and environmental organisations, and many others, from across the Southern African region gathered in Maseru, Lesotho under the auspices of the Southern African Peoples Solidarity Network (SAPSN). They held a People’s Summit to review their situation and share views on the state of regional development and cooperation, and so present their views to the Summit of the Heads of State and government ministers’ meeting in Maseru, 16-18 August 2006.
Members of Civil Society Organisations, trade unions, faith based organizations, student bodies and economic justice networks from the SADC region met in Lusaka, Zambia on August 15-16, under the auspices of the Southern Africa Peoples' Solidarity Network (SAPSN), to constitute the SADC People's Summit held parallel to the 27th Heads of State Summit. This document serves as the statement given on their regional theme with respect to civil society.
The NCD Alliance is calling for a global coordinating platform for non-communicable diseases (NCDs), housed within a United Nations agency, driven by Member State champions, with an independent Board and Secretariat, to be a catalyst for coordinated action on NCDs. The Alliance argues that key gaps in the current global and national response to NCDs are a result of a lack of multisectoral action, a problem which could be addressed by the proposed platform. In this paper, the Alliance lays out various partnership options for a global coordinating platform (GCP) on NCDs: simple affiliations, lead partners, secretariats and joint ventures. The Alliance recommends a secretariat structure, similar to platforms like the Partnership for Maternal, Newborn and Child Health and the Global Health Workforce Alliance. It argues that an effective GCP on NCDs should be based on a set of best practice principles in order to effectively catalyse action on NCDs and coordinate the multisectoral response needed to reduce preventable NCD deaths by 25% by 2025.
While the Consortium on ’Community Health Promotion’ is suggesting a definition of this new concept to qualify health practices, this article questions the relevance of introducing such a concept since no one has yet succeeded in really differentiating the three existing processes: public health, community health, and health promotion. Based on a literature review and an analysis of the range of practices, these three concepts can be distinguished in terms of their processes and their goals. Public health and community health share a common objective, to improve the health of the population. In order to achieve this objective, public health uses a technocratic process whereas community health uses a participatory one. Health promotion, on the other hand, aims to reduce social inequalities in health through an empowerment process, which is argued to be more effective.
This paper explores the different roles of male and female community health workers in rural Wakiso district, Uganda, using photovoice, as a community-based participatory research approach. The authors trained ten community health workers on key concepts about gender and photovoice. The community health workers took photographs for 5 months on their gender-related roles which were discussed in monthly meetings. The discussions from the meetings were recorded, transcribed, and translated to English, and emerging data were analysed using content analysis. Although responsibilities were the same for both male and female community health workers, they reported that in practice, community health workers were predominantly involved in different types of work depending on their gender. Social norms led to men being more comfortable seeking care from male community health workers and females turning to female community health workers. Due to their privileged ownership and access to motorcycles, male community health workers were noted to be able to assist patients faster with referrals to facilities during health emergencies, cover larger geographic distances during community mobilization activities, and take up supervisory responsibilities. Due to the gendered division of labour in communities, male community health workers were also observed to be more involved in manual work such as cleaning wells. The gendered division of labour also reinforced female caregiving roles related to child care, and also made female community health workers more available to address local problems. Community health workers reflected both strategic and conformist gendered implications of their community work. The authors argue that the differing roles and perspectives about the nature of male and female community health workers while performing their roles should be considered while designing and implementing community health workers programmes, without further retrenching gender inequalities or norms.
With the recent adoption of a new global development agenda for the next 15 years and negotiations on a new climate regime ongoing, what’s changed for governance of the global economy in the last two decades, and what have we learned? This article maps the shifting context for trade, investment, and sustainable development. It puts global governance efforts into historical context of a globalised economy with lesser attention paid to questions of equity and social inclusion, and an underestimation of persistent and deep-rooted asymmetries in capabilities among countries at different levels of development and perilous levels of inequality among and within most countries around the world. The author suggests that global governance will continue to be a matter of striking the balance between global direction-setting, monitoring the ongoing leadership role of government policy, and supporting the subsidiary implementation of commitments at ground level. The paper points to aligning national policies and ensuring trade and investment systems work for sustainable development rather than funding discrete projects. The author argues that policies, their frameworks and the institutions needed to implement them constitute the most powerful lever for change.
This blog reports on the Third People’s Health Assembly (PHA) held in Cape Town, South Africa, in July 2012. Participants reported on the extraordinary gains in human development occurring in Thailand and Brazil, where millions of people are moving out of poverty and for the first time accessing health care and social support, as well as the impotence of global leadership to effectively deal with climate change, and massive land grabs. Key strategies agreed on at the PHA were supporting countries to act on the PHM’s Right to Health Campaign; a global campaign on the adverse health and environmental effects of extractive industries; a food security campaign focusing on the health consequences of the growth of transnational food corporations, and a campaign against the privatisation of health services, which will document the ways in which public ownership and control of health services is being undermined by various forms of public private partnerships and by the outsourcing of previously publicly provided services.
In this commentary, the authors offer five proposals for re-establishing WHO’s leadership. First, WHO should give real voice to multiple stakeholders, including philanthropies, businesses, public/private partnerships, and civil society. Second, WHO should improve transparency, performance and accountability, as stakeholders demand clarity on how their resources will achieve improved health outcomes. Also, WHO should exercise closer oversight of regions, and exert legal authority as a rule-making body. Finally, WHO should ensure predicable, sustainable financing, reducing extra-budgetary funding, which now represents almost 80% of the agency's budget. The ideal solution would be for the World Health Assembly (WHA) to set higher member state contributions. Failing decisive WHA action, the WHO should consider charging overheads of 20-30% for voluntary contributions to supplement its core budget.