This paper aims to provide insight into the practical challenges faced by parliaments and parliamentarians in addressing the issues of equity in health. It goes on to describe the attempts that have been made to address those challenges in southern Africa. A number of opportunities for parliaments to promote health equity are identified. Firstly, parliaments are in charge of their rules, which they can revise to become more efficient and effective when they commit themselves to reforms. Secondly, in the region there is a vibrant civil society that raises questions and compels parliaments to address issues.
Governance and participation in health
Parliamentary functions and reforms and their application in promoting health equity in southern Africa
Participation and the right to the highest attainable standard of health
Potts H: Essex University, December 2008
Active and informed participation is an integral component of health systems, as well as the right to the highest attainable standard of health. Despite its critical importance, health and human rights have not given participation the attention it deserves. While some health researchers have made more headway than those working in human rights, neither community has a widely accepted understanding of what the process of participation means in practice. This monograph is an accessible, practical, timely and original introduction to the process of participation; the need for a variety of participatory mechanisms; the relationship between fairness and transparency of the process; the relationship between participation and accountability and participation in accountability.
Participation in Different Fields of Practice: Using Social Theory to Understand Participation in Community Health Promotion
Stephens C: Journal of Health Psychology 12(6):949-960, November 2007
`Participation' by community members in health-related programmes is an appealing concept that has not always been easy to achieve. Such programmes are often directed towards communities defined on the basis of neighbourhood or group identity. This article aims to develop an account of participation and identity by drawing on Bourdieu's theory of practice to understand participation as the practice of social identities structured by habitus, capital and field. Examples from interviews with members of one deprived neighbourhood illustrate the theory by showing that people may identify with their neighbourhood for certain social purposes, but have different identity practices in different fields of practice. Implications for community-based health programmes are briefly outlined.
Participation of HIV positive women in policy making
This International Community of Women Living with HIV/AIDS (ICW) vision paper argues that, when HIV positive people are involved at all levels of decision-making, an organisation is better able to respond to the concerns of people living with HIV/AIDS. HIV positive women in particular need to be taken seriously by policy makers in order to tackle the HIV/AIDS epidemic effectively. Involvement in national policy making and in regional and local structures is one arena of policy making highlighted. However, ICW argues that other arenas also need to be more open to the views and involvement of HIV positive women. These include faith-based institutions, the private sector, trade unions, women’s organisations, mainstream AIDS organisations, employers’ organisations, political parties, nongovernmental and international organisations and educational institutions.
Participatory approaches in the health sector
Communities are no longer seen as passive recipients of healthcare. But what does this shift in emphasis mean? What kind of relationship between communities, service providers and managers is best? A workshop held at the Institute of Development Studies in 1999 asked three questions: What does accountability mean? How can health service providers be accountable to their users? What sorts of partnership will improve accountability and effectiveness? Studies from eleven countries illustrated experiences with participatory approaches and partnerships in enhancing accountability in the health sector.
Participatory health councils and good governance: healthy democracy in Brazil?
Saugues S, Madonko T: International Journal for Equity in Health 14:21 , 2015
The Brazilian Government created Participatory Health Councils (PHCs) to allow citizen participation in the public health policy process. PHCs are advisory bodies that operate at all levels of government and that bring together different societal groups to monitor Brazil’s health system. Today they are present in 98% of Brazilian cities, demonstrating their popularity and thus their potential to help ensure that health policies are in line with citizen preferences. Despite their expansive reach, their real impact on health policies and health outcomes for citizens is uncertain. The authors thus ask the following question: Do PHCs offer meaningful opportunities for open participation and influence in the public health policy process? Thirty-eight semi-structured interviews with health council members were conducted. Data from these interviews were analyzed using a qualitative interpretive content analysis approach. A quantitative analysis of PHC data from the Sistema de Acompanhamento dos Conselhos de Saude (SIACS) database was also conducted to corroborate findings from the interviews. The authors learned that PHCs fall short in many of the categories of good governance. Government manipulation of the agenda and leadership of the PHCs, delays in the implementation of PHC decision making, a lack of training of council members on relevant technical issues, the largely narrow interests of council members, the lack of transparency and monitoring guidelines, a lack of government support, and a lack of inclusiveness are a few examples that highlight why PHCs are not as effective as they could be. Conclusions Although PHCs are intended to be inclusive and participatory, in practice they seem to have little impact on the health policymaking process in Brazil. PHCs will only be able to fulfil their mandate when combined with good governance. This will require a rethinking of their governance structures, processes, membership, and oversight. If change is resisted, the PHCs will remain largely limited to a good idea in theory that is disappointing in practice.
Participatory Learning and Action 60: Community-based adaptation to climate change
International Institute for Environment and Development, 2009
The articles in this issue on participatory learning and action focus on the recent approaches to adaptation to climate change utilising the priorities, knowledge and capacities of local people. Community-based adaptation (CBA) draws on participatory approaches and methods developed in both disaster risk reduction and community development work and sectoral-specific approaches. The emphasis now leans to policy processes and institutionalisation, issues of difference and power, assessing the quality and understanding the impact of participation, rather than promoting participation. Participatory Learning and Action reflects these developments and recognises the importance of analysing and overcoming power differentials which work to exclude the marginalised. This issue is divided into three sections: reflections on participatory processes and practice in community-based adaptation to climate change; participatory tool-based case studies; and participatory tools, with step-by-step descriptions of how to use them. The report also presents two important tools: communication maps, which help participants to understand communication patterns and relationships, and a tool called Rivers of Life, where participants reflect on personal experiences that have motivated them in their personal lives.
Participatory Learning and Action: Ethiopia Project Shows How a Participatory Process with Youth can Help Shape National Policy
To begin planning its program, the new Ethiopian Ministry of Youth, Sports, and Culture turned to an approach called participatory learning and action, or PLA. Officials involved young people throughout the country in a learning and planning process for the Ministry. The youth developed a national youth charter and a 3-year action plan to mobilize youth for improved sexual health and HIV/AIDS preventive behavior. Plus, the process led to the creation of a dynamic network of young people committed to the health and future of the country.
Partnerships, Power and the SDGs
Faul M: UNRISD seminar, Geneva, March 2016
Partnerships, and their accompanying networks, are now presented as an essential ingredient for fair SDG implementation. But what happens in practice? Network analysis reveals how development ‘partners’ may in fact informally depart from established rules and relationships, with the end result that networks may amplify the very disparities of power they were intended to reduce. In this seminar, Moira Faul argues that with a better understanding of how partnership works, network members could rewire relationships for more inclusion, and ultimately better policy and practice solutions.
PASS presents: Revolting Songs with Neo Muyanga
Muyanga N: Pan African Space Station, Chimurenga Magazine, 2015
This Pan African Space Station (PASS) broadcast recorded at the Chimurenga headquarters features Neo Muyanga, Soweto-born composer and musician living in Cape Town. Revolting Music is a survey of the songs of protest that liberated South Africa. Muyanga argues that it often comes as something of a surprise to many visitors to find that people in South Africa, sang and danced throughout the decade of the 1980’s – a period many agree was one of the most violent phases in the struggle against the system of apartheid, and yet the people sang and made art fervently during this time. These acts were not merely stratagems for fun but the songs were a part of the arsenal in the fight to secure democratic rights for all and to overthrow the government. During his recording, Neo Muyanga presents a series of anecdotes and medleys of songs of protest from the era of the 80’s – songs of his youth – juxtaposed against new songs he has composed in response to the challenges of new socio-political realities in South Africa today.