At the final meeting of the United Nations Thematic Consultation on Governance and the Post-2015 Framework, held in Johannesburg at the end of February 2013, participants argued that human rights and accountability must be placed at the heart of governance at the national and global levels. A high point of the meeting was the address by High Level Panel member Graça Machel, who spoke of the panel´s commitment to ensuring that issues of governance, human rights and inequality were central to the new post-2015 framework. There was wide consensus at the meeting that weak and unaccountable governance, including at the global level, is one of the key issues that must be addressed in a future framework, and that democratic governance must be predicated on respect for the full range of human rights. Ultimately, it will be up to the international community to decide the parameters of the successor framework when it gathers for the Millennium Development Goal Review Summit in New York in September 2013. In this article, the author calls on global civil society to promote rights-based governance in the run up to this important event, which is likely to prove pivotal for the future of international development.
Governance and participation in health
Equality before the law, corruption-free government, inclusiveness, gender equality, and respect for the environment are among the priorities for any future set of development goals, as identified during four civil society and government meetings on the Millennium Development Goals (MDGs) and the targets that should replace them when they expire in 2015. Four "ground-level panels" were held in four developing countries, including Uganda. Respondents on the panel in Uganda agreed that no one should be left behind, urging a grassroots approach to policy. They proposed that bottom-up processes, where the people decide what is to be done by their government, must be a priority. The panel also felt foreign investment should create opportunities for Ugandans, and external investors should respect local customs and culture.
The Nyeleni 2007 Forum for Food Sovereignty in Mali was not your usual global conference of diplomats and policy makers; the six-day programme initiated by and for the underprivileged worldwide was marked by a spirit of international solidarity. The shabby conditions, however, seemed a perfect fit for the theme of the Nyeleni 2007 Forum for Food Sovereignty. The six-day programme was initiated by and for the underprivileged worldwide, whose major concern may be their next meal. Among the five hundred-plus in attendance were small-scale farmers and fishermen, indigenous peoples, landless migrant workers, pastoralists, and NGOs who have been working with the rural and urban poor.
The provision of appropriate reproductive health care remains one of the main health care challenges in developing countries. The delivery of reproductive health services is continually confronted by challenges from the changing environment, as health sector reforms are implemented, and particularly by decentralisation.
Rising powers such as Brazil, India and China have been criticised for their inputs in the negotiations on the post-2015 development agenda. The start of the United Nations (UN) negotiations saw high expectations for the role of these countries in shaping the Sustainable Development Goals (SDGs) that have not materialised. However, what appears to be a confrontational style of diplomacy is in fact an assertive affirmation of long-standing principles. The G77 and China have consistently
called for the reform of the UN Security Council, and of the Bretton Woods institutions, which resulted in International Monetary Fund reform being nominally approved in 2010 before being blocked by the United States (US) Congress. The issues defended by the Brazilian negotiators centred on poverty eradication, its relationship with inequality; sustainable production and consumption; financing and keeping climate change strictly within the UNFCCC process. Brazil is keen to avoid what it sees as the securitisation of development through the SDGs. It supports governance as a general principle guiding the SDGs, but is adamant in its refusal to consider security as a stand-alone goal. The Brazilians are prioritising the ‘how’ of the SDGs, concentrating on the means of implementation for sustainable development through data disaggregation and exploring how to reutilise the structure of the MDGs as well as Brazil’s experience of participatory development in implementation. The authors argue that a more nuanced understanding of these countries’ positions in the post-2015 process is required.
This briefing paper elicits the perspective of the African non-governmental organisations (NGOs) on the concept of universal health coverage (UHC). It defines the basic concepts and also explores the role NGOs can play to improve the definition and implementation of UHC to improve health outcomes for all. It describes some of the common misunderstandings and misgivings expressed by NGOs, such as the belief that UHC is limited in scope and does not address the social determinants of health. Examples from African countries that have successfully implemented UHC are provided. UHC does not only mean protection from catastrophic expenditure – it means that all people are able to access health services when they need them. In this regard it specifically targets the poorest and most vulnerable. In most instances, civil society organisations have played a significant role in ensuring that national policies reflect in the reality on the ground.
In this article, the authors reflect on how efforts towards UHC could offer an opportunity to address those aspects within health systems that continue to hinder efforts to meaningfully engage with patients, their families and local communities. The backbone of these efforts should be a health workforce that is skilled in engagement, responsive to local context and to the needs and expectations of those using their services. Community engagement was introduced in the 2013–2016 Ebola virus disease outbreak in recognition of the important role of response staff and their ability to engage with communities, in contrast to social mobilization or behaviour-change interventions. Engagement and empowerment of health service users and community members also re-emerged as a core strategy in the WHO Framework on Integrated People-Centred Health Services, which was formally adopted by Member States in 2016. To move towards a more meaningful understanding of what community engagement is and how it works, the authors suggest that several changes need to take place. First, to recognize that health systems have a fundamental responsibility and obligation for engaging with patients, their families, local communities, as well as a range of stakeholders, partners and sectors, recognising the physiological, emotional, mental and social interconnection of people. Health systems and communities are observed to be in continuous and interdependent action. If community engagement becomes a focus for UHC efforts, it could promote approaches that recognize that health and well-being are co-produced, and that empowers both health-care providers and communities.
This paper reflects on gains, challenges and lessons learnt from working with communities to improve maternal and newborn health in rural Uganda. A participatory action research project was supported from 2012 to 2015 in three eastern districts. This project involved working with households, saving groups, sub county and district leaders, transporters and village health teams in diagnosing causes of maternal and neonatal mortality and morbidity, developing action plans to address these issues, taking action and learning from action in a cyclical manner. This paper draws from project experience and documentation, as well as thematic analysis of 20 interviews with community and district stakeholders and 12 focus group discussions with women who had recently delivered and men whose wives had recently delivered. Women and men reported increased awareness about birth preparedness, improved newborn care practices and more male involvement in maternal and newborn health. However, additional direct communication strategies were required to reach more men beyond the minority who attended community dialogues and home visits. Saving groups and other saving modalities were strengthened, with money saved used to meet transport costs, purchase other items needed for birth and other routine household needs. Saving groups required significant support to improve income generation, management and trust among members. Linkages between savings groups and transport providers improved women’s access to health facilities at reduced cost. Although village health teams were a key resource for providing information, their efforts were constrained by low levels of education, inadequate financial compensation and transportation challenges. Ensuring that the village health teams and savings groups functioned required regular supervision, review meetings and payment for supervisors to visit. This participatory program, which focused on building the capacity of community stakeholders, was able to improve local awareness of maternal and newborn health practices and instigate local action to improve access to healthcare. Collaborative problem solving among diverse stakeholders, continuous support and a participatory approach that allowed flexibility were essential project characteristics that enabled overcoming of challenges faced.
While “accountability” has become an increasingly popular buzzword in health systems debates and health service delivery, it has multiple – and contested – meanings. In July 2017, IDS brought together 80 activists, researchers, public health practitioners and policy makers to examine the forces that shape accountability in health systems, from local to global levels. This workshop report records the presentations and discussions on accountability for health equity that are emerging in different country contexts, exploring how accountability relationships develop and change over time.
Progress in analysing the instrumental view of governance as an engine for growth, poverty reduction, and inclusive development has been held back by the difficulty in framing governance. This essay seeks to address this problem by 1) reframing urban governance 2) evaluating its aims, processes, and outcomes, and 3) explaining those outcomes on the basis of which some lessons are teased out. Using examples from Africa and an institutional political economy approach the author argues that, overall, while urban economies are growing; both urban poverty and inequality levels have risen substantially. Urban governance has paved the way for new forms of urban development that only benefit the few, including in how differences in how urban services and resources are experienced, accessed, and controlled. The author argues that the underlying reasons for this disjuncture between “urban governance” in theory and “actually existing urban governance” are 1) difficulties in implementing urban governance theory consistently in practice, 2) problems arising because urban governance theory has been implemented in practice, 3) tensions that would entangle most policies which do not address historical and structural economic issues, 4) restrictive assumptions, and 5) incoherence among the different dimensions of urban governance. To resolve these contradictions, the author puts the case for major structural and institutional change involving: 1) the re-ordering of the roles of the state, market, and society as institutions of change; 2) re-working the relationships that bind together land, labour, capital, and the state, and 3) re-organising the channels for keeping the attainment of the ends of urban governance in check.