This study first briefly reviews the historical evolution of global environmental diplomacy and governance. It then examines its dominant ideas, instruments, and institutions, including the key environment-economy connection, comparing them with the experience in health at every stage. Its analysis reveals that both environmental and health diplomacy are better at solving yesterday’s specific, acute, concentrated, deadly problems than today and tomorrow’s diffuse, silent, chronic, cumulative but more dangerous and deadly ones. The authors therefore advise caution when sharing lessons, in light of the significant failures in each field. The environmental field is seen as more progressive than health, which has relied largely on the 1948 World Health Organization (WHO) Constitution’s principles, with little added to elaborate and modernise it since. The authors argue that environmental diplomacy and governance is better integrated with the economy and peoples’ livelihoods, which depend on natural resources, while the global health sector still struggles to promote a socio-economic approach, amid the many incentives to focus on single, high-profile diseases. The paper calls for more civil society participation in health, referring to lessons from a long tradition of environmental activism. Health could engage more with groups, such as the G8 and G20, so that health issues are recognised and integrated within economic policy dialogue.
Governance and participation in health
This article presents a detailed description of a community mobilization intervention involving women's groups in Mchinji District, Malawi. The intervention was implemented between 2005 and 2010. The intervention aimed to build the capacities of communities to take control of the mother and child health issues that affect them. To achieve this it trained local female facilitators to establish groups and using a manual, participatory rural appraisal tools and picture cards guided them through a community action cycle to identify and implement solutions to mother and child health problems. The groups then catalysed community collective action to address mother and child health issues to improve te health and reduce the mortality of mothers and children. Their impact, implementation and cost-effectiveness have been rigorously evaluated through a randomized controlled trial design and the results of these evaluations will be reported in 2011.
This paper argues that parliaments and parliamentarians have a crucial role to play in ensuring that governments are accountable for the decisions that they make about how resources – including aid – are spent. The scope parliaments actually have to play this role varies widely. Some parliaments benefit from large resources and a legal framework that back them in playing their oversight and legislative role. Many other parliaments, especially in developing countries, lack resources or power to play an effective role in promoting development or the more effective use of aid. Parliamentarians themselves come from all walks of life and do not share the same knowledge on these issues, and there is no consensus among parliamentarians or across countries on the ways and means by which they can enhance oversight of development policies and how development resources are used. This guidance note addresses some of these challenges and seeks to provide parliamentarians and those who work with them with a common understanding and clear guidance on what they can do to promote more effective and accountable use of aid in particular and of development resources in general.
Despite acknowledged curative and preventive measures, child malaria remains a concern in many countries. Does parental empowerment and participation in control efforts offer a way forward? This review of recent literature suggests a unique approach. Successful interventions met the health promotion strategies wholly or partly. Although these interventions were sometimes incomplete, the development took into account people’s perceptions and representations. The authors acted on the belief that empowerment of parents and their participation in the development of interventions to control child malaria, is likely to yield better results and assist in reducing the prevalence of malaria morbidity and mortality in children under 5 years.
This descriptive study reports on the feasibility, acceptability and appropriateness of health animator-led community workshops for malaria control. Quantitative data were collected from self-reporting and researcher evaluation forms. Qualitative assessments were done with health animators, using three focus groups in 2015 and seven in-depth interviews (October 2016–February 2017). Seventy seven health animators were trained from 62 villages. A total of 2704 workshops were conducted, with consistent attendance from January 2015 to June 2017, representing 10–17% of the population. Attendance was affected by social responsibilities and activities, relationship of the village leaders and their community and involvement of community health workers. Active discussion and participation were reported as main strengths of the workshops. Health animators personally benefited from the mind-set change and were proactive peer influencers in the community. Although the information was comprehended and accepted, availability of adequate health services was a challenge for maintenance of behaviour change. the authors argue that community workshops on malaria are a potential tool for influencing a positive change in behaviour towards malaria, and applicable for other health problems in rural African communities. Social structures of influence and power dynamics affect community response. they suggest that there is need for systematic monitoring of community workshops to ensure implementation and sustain health behaviour change.
For the past 10 years voluntary medical male circumcision has been recommended as a way of reducing female-to-male transmission of HIV. Estimates show that it could reduce infections by 60%. Several sub-Saharan African countries with high rates of HIV prevalence but low rates of male circumcision have rolled out the procedure as part of their HIV prevention initiatives. Since 2007 more than 9 million circumcisions have been performed in eastern and southern Africa. But to cover more than 80% of men on the continent by 2025, about 20 million more men need to be circumcised. If this happens about 3.4 million new HIV infections could be averted, reducing the number of people who would need HIV treatment and care. While circumcision has been encouraged there are many places where it has faced challenges. This is linked to misconceptions about the purpose of circumcision as well as religious and cultural concerns which prevent men from getting circumcised. Uganda is argued in this article to be a case in point. By the end of 2015 the country’s health ministry aimed to circumcise 80% – or 4.2 million – men aged between 15 and 49. But between 2008 to 2013 the country only managed to circumcise 50% of this population. Most of these were young boys. This research found that religious and cultural beliefs compete with the messages about the purpose of circumcision. The authors found that this got in the way of men deciding whether or not to be circumcised medically and also affected the way they behaved afterwards. When medical circumcision is introduced in settings where there are high rates of HIV, the authors argue that it must take into account local beliefs about circumcision and local religious and social group leaders and women must be involved in the roll-out.
Male partner participation is a crucial component to optimize antenatal care/prevention of mother to child transmission of HIV(ANC/PMTCT) service. Involving male partners during HIV screening of pregnant mothers at ANC is key in the fight against mother to child transmission of HIV(MTCT). This study aimed to determine the level of male partner involvement in PMTCT and factors that affecting it. A Cross-sectional study was conducted among 473 pregnant mothers attending ANC/PMTCT in Mekelle town health facilities in January 2011 to identify factors that affect male involvement in ANC/PMTCT. Twenty percent of pregnant mothers have been accompanied by their male partner to the ANC/PMTCT service. Knowledge of HIV sero status, maternal willingness to inform their husband about the availability of voluntary counselling and testing services in ANC/PMTCT and previous history of couple counselling were found to be the independent predictors of male involvement in ANC/PMTCT service. Male partner involvement in ANC/PMTCT was found to be low and the authors argue that comprehensive strategies should be put in place to sensitize and advocate the importance of male partner involvement in ANC/PMTCT and reach out male partners.
Expectant mothers in Pallisa and Budaka districts have moved closer to realising their right to adequate reproductive health services, following the launch of HEPS Uganda's Community Empowerment and Participation on Maternal Health Project. The Project, falling within the empowerment, lobbying and advocacy themes of the EU's DSCBP, specifically targets expectant mothers, health care providers, district health officials and other local government leaders as well as community opinion leaders.
This Worldview International project is a youth Internet forum on global issues. Every fortnight, they cover pertinent issues, chosen by youth themselves through an offline and online poll. Recent discussions have included Sexuality Education: If Not Now, Then When?
While the official Rio+20 outcome from June 2012 was a disappointment, a smaller side event saw the initiation of a host of Peoples’ Sustainability Treaties, dealing with a range of issues and actions, starting from the very local, going all the way up to the global level. Peoples’ Sustainability Treaties are aimed at coalescing the thinking of civil society organisations in the direction of a strong social movement towards an alternative and desirable future. A network of Treaties is being created, with each Treaty being driven by a collaboration of partners, and with all the Treaty circles being linked together through a loose coalition structure. By the time Rio+20 commenced, 14 Treaties were already established and from these a common Manifesto emerged, which contained an action plan identifying the issues of equity and sustainability for all as the foundation of any collective global response. Localising our economic systems, decentralising governance, and advancing sustainable lifestyles and livelihoods are promoted in the Manifesto. Localism was a major theme emerging from stakeholders, linked to the principles of devolution and decentralisation, and they argued in favour of turning localism into a world-wide movement.