The paper reports on a framework for health systems governance (HSG). Key issues considered included the role of the state vs. the market; role of the ministries of health vs. other state ministries; role of actors in governance; static vs. dynamic health systems; and health reform vs. human rights-based approach to health. The framework permits ‘diagnoses of the ills’ in HSG at the policy and operational levels and points to interventions for its improvement. The principles of the HSG framework are value driven and not normative and are to be seen in the social and political context. The framework relies on a qualitative approach and does not follow a scoring or ranking system. It does not directly address aid effectiveness but provides insight on the ability to utilise external resources and has the ability to include the effect of global health governance on national HSG.
Governance and participation in health
This resolution presents a Framework of Engagement with non-State actors to replace the Principles governing relations between the World Health Organization and nongovernmental organizations and Guidelines on interaction with commercial enterprises to achieve health outcomes;(1) to implement the Framework of Engagement with non-State actors; (2) to establish the register of non-State actors in time for the Sixty-ninth World Health Assembly; (3) to report on the implementation of the Framework of Engagement with non-State actors to the Executive Board at each of its January sessions under a standing agenda item, through the
Programme Budget and Administration Committee; (4) to conduct in 2018 an evaluation of the implementation of the Framework of Engagement
with non-State actors and its impact on the work of WHO with a view to submitting the results, together with any proposals for revisions of the Framework, to the Executive Board in January 2019,through the Programme Budget and Administration Committee.
HIV is rampant among young people in South Africa, despite sound knowledge about sexual health risks. Levels of perceived vulnerability among this group are low and unprotected sex is common. Researchers from the London School of Economics studied a participatory programme seeking to empower young people to change gender norms as an HIV prevention strategy.
In 2011, Publish What You Fund, the world’s biggest funding transparency monitoring body, ranked USAID in the bottom 36% of most transparent external funders, but by 2012 it had climbed into the top 37% . In the light of this improvement, the author of this article calls on USAID Administrator Raj Shah to commit USAID to joining the top 10% by the time he leaves his post in four years. He predicts, though, that it is more likely that “technological innovation” will continue to win out over “governance” issues like transparency in Shah’s priorities. Poverty, he argues, is a function of power imbalances as much as innovation deficits, which requires USAID’s leadership to start talking about governance, incentives and democratising “power” as much as helping people to get more and better “stuff”. Shah should explain why transparency is so important, and explicitly link transparency to making local institutions more politically accountable to their own citizens. Functioning, inclusive domestic institutions in developing countries are the indispensable foundation for innovations to take hold, the author concludes.
This case study describes a multisectoral adolescent sexual and reproductive health (ASRH) programme with three main components: clinical youth-friendly health services (YFHS), inschool interventions and community-based outreach. It has been written for programme and project managers at national, district and local levels interested in the implementation and scale-up of multisectoral programmes that encompass YFHS. It outlines the process used to design, implement, monitor and evaluate the Geração Biz programme in Mozambique. The steps taken during the pilot phase and subsequent scale-up of the programme are described, as well as key lessons learned. This case study is intended to provide an example of how to design and implement a multisectoral programme that is intended to be scaled up from the beginning. Although other countries have different political, social and cultural contexts, the experience and lessons learned here could be adapted and applied to help other countries that wish to establish or scale up YFHS within multisectoral programmes.
Reverse Innovation has been endorsed as a vehicle for promoting bidirectional learning and information flow between low- and middle-income countries and high-income countries, with the aim of tackling common unmet needs. One such need, which traverses international boundaries, is the development of strategies to initiate and sustain community engagement in health care delivery systems. In this commentary, the authors discuss the Baltimore “Community-based Organizations Neighborhood Network: Enhancing Capacity Together” Study. This randomized controlled trial evaluated whether or not a community engagement strategy, developed to address patient safety in low- and middle-income countries throughout sub-Saharan Africa, could be successfully applied to create and implement strategies that would link community-based organizations to a local health care system in Baltimore, a city in the United States. Specifically, the authors explore the trial’s activation of community knowledge brokers as the conduit through which community engagement, and innovation production, was achieved. Cultivating community knowledge brokers holds promise as a vehicle for advancing global innovation in the context of health care delivery systems. As such, further efforts to discern the ways in which they may promote the development and dissemination of innovations in health care systems is warranted.
This book articulates a vision of women and men in communities everywhere who are equipped with education, enjoy good health, have rights, dignity and a voice – and are in charge of their own destinies. What is required to achieve that is nothing less than a global new deal – a redistribution of power, opportunities, and assets. The report considers the alternative of a world of ever-deepening gulfs between the ‘haves’ and the ‘have-nots’ as unsustainable. Based on its experience in more than 100 countries around the world, Oxfam argues that the necessary redistribution can best be accomplished through a combination of active citizens and effective nation states. Markets alone cannot meet the challenges of poverty, inequality and environmental degradation. Effective states and active citizens must ensure the market delivers growth that benefits poor people. An economics for the twenty-first century is needed that provides tools to enable countries to achieve growth that is environmentally sustainable. This new economics will recognise the importance of unpaid work, predominantly by women and target poverty and inequality. It discusses case studies, including the Treatment Action Campaign in South Africa.
From Poverty to Power, Oxfam International's new book, provides critical insights into the massive human and economic costs of inequality and poverty and proposes realistic solutions. It proposes that the best way to tackle them is through a combination of active citizens and effective nation states. Why active citizenship? Because people living in poverty must have a voice in deciding their own destiny, fighting for rights and justice in their own society, and holding states and the private sector to account. Why effective states? Because history shows that no country has prospered without a state structure than can actively manage the development process.
In the capability approach to poverty, wellbeing is threatened by both deficits of wealth and deficits of agency. Sen describes that “unfreedom,” or low levels of agency, will suppress the wellbeing effects of higher levels of wealth. In this paper the authors introduce another condition, “frustrated freedom,” in which higher levels of agency belief can heighten the poverty effects of low levels of wealth. Presenting data from a study of female heads of household in rural Mozambique, they find that agency belief moderates the relationship between wealth and wellbeing, uncovering evidence of frustrated freedom.
The G20 plays an important role in global rule-making. Africa is significantly under-represented in this body, with only South Africa a permanent member. This makes Africa a rule-taker. At the same time the G20 has started to pay more attention to Africa and the continent’s future development now occupies a somewhat more central position on the grouping’s agenda. The G20 Initiative on Supporting Industrialization in Africa and Least Developed Countries, launched under China’s G20 presidency of 2016, and the 2017 German presidency’s Compact with Africa offered unprecedented moments of engagement. However, the question remains how Africa can use these initiatives to deepen its engagement with the G20 and boost its own development. This paper draws on extensive interviews with key stakeholders to analyse G20–Africa engagement by focusing on three presidencies: China in 2016, Germany in 2017, and Argentina in 2018. It shows how China’s Industrialisation Initiative was crucially informed by its pre-existing African engagement, while Germany’s Compact with Africa both gained and suffered from a more narrowly focused commercial engagement. It then shows how Argentina, despite lacking a similar African initiative, managed to continue G20–Africa engagement through person-to-person diplomacy. The paper points out both the benefits and the limits of these engagements and suggests a series of further initiatives that could allow Africa a more significant say in the G20.