This paper aims at contributing to the debate on ways in which actors in development cooperation such as international NGOs or bilateral agencies could engage in a relevant, legitimate and effective way to achieving universal access to health. MMI identify that relevant, legitimate and effective health cooperation contributes to achieving universal access to health and is fully aware of its structural role, responsibilities and limitations; and continuously reflects on how to improve its approaches and practices. MMI argue that there is still a lack of platforms in which actors in health cooperation can critically reflect their own practices and approaches, share information and experiences, learn from each other and have an opportunity to further develop their institutional and personal skills and practices. They also suggest that a paradigm shift is required that breaks with the continuum process of development cooperation for health as it has been conducted during the last 50 years.
Governance and participation in health
The interdependence of states and increasing movement of people, the spread of contagious diseases and the heightened complexity of global health issues make cooperation among countries indispensable. Unfortunately resourcing remains a critical challenge to effective health governance. The authors argue that financial resources are not really a major challenge for Sub-Saharan Africa as it is usually perceived. According to the International Monetary Fund (IMF), Sub-Saharan Africa’s economic growth has been robust and capital inflows higher than the developing countries’ average. Notwithstanding threats to the region seems poised for better prospects. The authors argue that health governance should be given a higher significance if growth rates are to be sustained and strategies developed for collaboration between governments and non-state actors. Many Sub-Saharan Africa countries still view non-state actors with suspicion, but the authors argue that those that have embraced them as development partners have reaped some positive results in the provision of health services, such as in the role of mission services in health care provision in Botswana and Malawi. They suggest enhancing a multi-pronged cooperation between African state and non state actors and that the porous borders across countries necessitate regional cooperation to effectively combat the spread of diseases.
The Kenya Partnership for Health (KPH) program began in 1999, and is currently one of the 12 field projects participating in the WHO's 'Towards Unity for Health initiative' implemented to develop partnership synergies in support of the Primary Health Care (PHC) approach. This paper illustrates how Program-linked Information Management by Integrative-participatory Research Approach (PIMIRA) as practised under KPH has been implemented within Trans-Nzoia District, Kenya to enhance community-based health initiatives. It shows how this model is strategically being scaled-up from one community to another in the management of political, social, cultural and economic determinants (barriers and enhancers) of health.
The concepts of health promotion, self-care and community participation emerged during the 1970s, primarily out of concerns about the limitation of professional health systems. Since then there have been rapid growth in these areas in the developed world, and there is evidence of effectiveness of such interventions. These areas are still in their infancy in the developing countries. There is a window of opportunity for promoting self-care and community participation for health promotion. This article proposes elements of a programme for health promotion in the developing countries following key principles of self care and community participation.
This paper proposes a broad outline for designing health promotion programmes in developing countries, based on the Ottawa Charter for health promotion and principles of self-care and community participation. There is now a window of opportunity for promoting self-care and community participation for health promotion in developing countries. It recommends that supportive policies are framed, with self-care clearinghouses set up at provincial level to co-ordinate the programme activities in consultation with district and national teams. Self-care should be promoted in schools and workplaces. For developing individual skills, self-care information, generated through a participatory process, should be disseminated using a wide range of print and audio-visual tools and information technology based tools.
The author of this article argues that the emerging global health diplomacy movement points to the need for core capacities in the public health and diplomatic arenas. Among these are an understanding of international relations among public health professionals and greater recognition by diplomats of the population health outcomes of foreign policy. More specifically, the author notes that their training should include perspectives on globalisation, social determinants of health and cultural competence, macro-economics and political negotiation. Communities and citizens are often not considered in the formal policy arena but play an important role in meeting foreign policy goals and in cultivating trust and friendship across national borders, particularly in times of crisis and emergency. Future foreign policy and global health efforts need to ensure dialogue with affected communities and be more intentional in engaging and citizens groups in defining needs and goals. While it is likely that health security will remain a prominent rationale for developed countries to invest in global health initiatives, a the author concludes that more coherent approach to foreign policy and health diplomacy could result in better alignment between the health security goals of developed countries and health equity and development goals of developing countries, while at the same time recognising and channelling the growing financial and technical contributions of private citizens, companies and organisations.
The aim of this study was to examine the relationship between health systems outcomes and equity, and governance as a part of a process to extend the range of indicators used to assess health systems performance. Using cross sectional data from 46 countries in the African region of the World Health Organisation, an ecological analysis was conducted to examine the relationship between governance and health systems performance. Governance was found to be strongly associated with under-five mortality rate (U5MR) and moderately associated with the U5MR quintile ratio. After controlling for possible confounding by healthcare, finance, education, and water and sanitation, governance remained significantly associated with U5MR. Governance was not, however, significantly associated with equity in U5MR outcomes. This study suggests that the quality of governance may be an important structural determinant of health systems performance, and could be an indicator to be monitored. The association suggests there might be a causal relationship. However, the cross-sectional design, the level of missing data, and the small sample size, forces tentative conclusions. Further research will be needed to assess the causal relationship, and its generalisability beyond U5MR as a health outcome measure, as well as the geographical generalisability of the results.
This paper focuses on three crucial issues when analysing human rights and health: the importance of social class in community participation, the pivotal role of power and empowerment, and the role of the state, which refers to the concepts of claim holders and duty bearers included in a rights-based approach to health. The concept of ‘health through people's empowerment’ is proposed to identify and describe the core aspects of participation and empowerment from a human rights perspective and to put forward common strategies. If marginalised groups and classes organise, they can influence power relations and pressure the state into action. Such popular pressure through organised communities and people's organizations can play an essential role in ensuring adequate government policies to address health inequities and in asserting the right to health.
South Africa’s Sex Workers Education and Advocacy Taskforce (SWEAT) and Sisonke have launched a helpline for commercial sex workers. The line was initiated to give commercial sex workers a platform to voice the concerns and fears they face at work. SWEAT noted that it was not easy for commercial sex workers to get adequate information because they are often scared of revealing what they do to earn a living. The line could also be used by anyone who wanted to get information about the industry. The line opened at the beginning of June and provides assistance on sexual health, drug and alcohol problems as well as emotional and work related matters. Those with e-mail access can also send e-mails. Commercial sex workers needing assistance would be assisted by trained counsellors from 9 am to 5pm with plans to upgrade the line to a 24-hour facility.
Each year at least 300 million cases of malaria result in more than a million deaths worldwide. Ninety percent of these deaths are in sub-Saharan Africa and most are children under five years old. Preventing and treating malaria are now firmly on the international public health and global poverty agendas. However, despite a considerable increase in funds over recent years the malaria burden in much of sub-Saharan Africa shows little sign of decreasing. Over recent years there has been emphasis on the idea that improving knowledge about malaria in communities will lead to better use of interventions. Research on managing malaria in communities has been largely concerned either with individual perceptions about the causes and symptoms of the disease or with the implementation of specific interventions. It fails to provide essential information on the context in which communities and households cope with their day-to-day problems, including malaria.