"On this World Aids Day, the Pan-African Treatment Access Movement (PATAM), a grassroots social movement for access to anti-retroviral therapy and other essential medicines extends a hand to our grandparents, brothers, sisters, friends and many others in our communities who relentlessly bear the brunt of the epidemic with unending fortitude. They are the ones whose attention does not stray away from those who lie immobile, as their bodies slowly succumb to the wiles of the HI virus. They are the young who are forced to stop attending school so that they can look after their even younger brothers and sisters because mum and dad have long died of Aids. We salute you!"
Governance and participation in health
PROVIDE ANTI-RETROVIRAL THERAPY TO ALL IN NEED
Pan-African Treatment Access Movement (PATAM) Statement
Further details: /newsletter/id/30130
Public Health a Major Priority in African Nations
The Kaiser/Pew Global Health Survey, May 2014
Concerns about public health are widespread in sub-Saharan Africa, and there is considerable support in the region for making public health challenges a top national priority. In particular, people want their governments to improve the quality of hospitals and other health care facilities and deal with the problem of HIV/AIDS. A Pew Research Center survey, conducted March 6, 2013 to April 12, 2013 in six African nations, also finds broad support for government efforts to address access to drinking water, access to prenatal care, hunger, infectious diseases, and child immunization. A median of 76% across six countries surveyed say building and improving hospitals and other health care facilities should be one of the most important priorities for their national government. The percentage of the public who holds this view ranges from 85% in Ghana to 64% in Nigeria. Similarly, a median of 76% believe preventing and treating HIV/AIDS should be one of government’s most important priorities, ranging from 81% in Ghana to 59% in Nigeria. A median of at least 65% also say the other issues included on the poll — ranging from access to drinking water to increased child immunization — should be among the most important priorities. In fact, majorities hold this view about all seven issues in all six nations.
Public health decision making: The way forward
AbouZahr C, Cleland J, Coullare F, Macfarlane SB, Notzon FC, Setel P, Szreter S: The Lancet 370(9601): 1791-1799, November 2007
Good public-health decisionmaking is dependent on reliable and timely statistics on births and deaths (including the medical causes of death). All high-income countries, without exception, have national civil registration systems that record these events and generate regular, frequent, and timely vital statistics. By contrast, these statistics are not available in many low-income and lower-middle-income countries, even though it is in such settings that premature mortality is most severe and the need for robust evidence to back decisionmaking most critical. Civil registration also has a range of benefits for individuals in terms of legal status, and the protection of economic, social, and human rights. However, over the past 30 years, the global health and development community has failed to provide the needed technical and financial support to countries to develop civil registration systems. There is no single blueprint for establishing and maintaining such systems and ensuring the availability of sound vital statistics. Each country faces a different set of challenges, and strategies must be tailored accordingly. There are steps that can be taken, however, and we propose an approach that couples the application of methods to generate better vital statistics in the short term with capacity-building for comprehensive civil registration systems in the long run.
Public services: Transformation or stasis?
Ruiters G: Public Services Yearbook 2005/2006
Although the South African state has shifted away from uncritical promotion of neo-liberal public management, the government continues to mesh limited welfarism with market-driven reforms. It has tried to use service delivery to win political loyalty, but this strategy has largely backfired. There is growing public awareness that the current failures and inequities in access to public services can no longer be blamed on the legacy of apartheid. According to the free basic water policy applied since 2001, poor South Africans are entitled to 6,000 litres of free water per month. Yet, according to the Department of Finance’s own numbers, most poor households use 25,000 of water per month. Consequently, most such households then fall into arrears. Free basic water, often seen as a big improvement, also has unintended effects. It is a way to increase state surveillance of citizens by requiring registration and its restrictive availability is used as a disincentive for poor people to use water. If poor people use more than their basic allocation, they are heavily penalised by higher tariffs.
Pushing back against linearity: Report of the Big Push Back
Eyben R: Institute of Development Studies, 29 September 2010
The Big Push Back, which took place on 22 September 2010, was convened by the Participation and Social Change team at the United Kingdom’s Institute of Development Studies. With over 70 attendees, the theme of the meeting was to reflect on and develop strategies for ’pushing back’ against the increasingly dominant bureaucratisation of the development agenda and the pressure to design projects/programmes and report on performance in a manner that assumes all problems are bounded/simple. This is reported to result in research that is linear (cause-effect) based, at the expense of research that is emergent, i.e. a complex, only partially controllable process in which local actors may have conflicting views on what is happening, why and what can be done about it, where complexity is recognised and accountability promoted to those people international funds are supposed to serve. The meeting also called for collaboration with people inside funding and development agencies who are equally dissatisfied with the prevailing ‘audit culture’, and communication to build public understanding that some aspects of development work that cannot be reduced to numbers are also valuable.
Pushing HIV on to the Uganda presidential candidates' agenda
Plus News: 16 February 2011
Civil society activists say Uganda's presidential candidates have not placed sufficient emphasis on how they plan to tackle the HIV and AIDS epidemic should they come into office, despite rising HIV prevalence and major funding problems. Critics maintain there is not enough focus on HIV and AIDs in the election, with candidates’ manifestos mostly making general statements on health. Local civil society activists have lobbied all major political parties to commit to a ‘ten-point platform’ to fight HIV and AIDS, which includes commitments to fully fund the fight against HIV, increase the number of health workers and end corruption in the health sector.
Putting words into action in Zambia
Dickinson C and Collins T: Compass 9, October 2009
The Strengthening the AIDS Response Zambia (STARZ) programme marked a cutting edge multisectoral approach to HIV in the region. Non-governmental sectors (including civil society and the private sector) tend to be poorly organised, and authority tends to rest with government ministries. Not all sectors have incentives or welcome being coordinated, particularly by relatively young commissions claiming the mandate to do so. Coordination can also mean different things to different groups – for some it signifies regulation and control, while for others the emphasis is on participation and information exchange and even access to resources. The main aim of this project was to support the national AIDS commission, known locally as the National AIDS Council (NAC), in coordinating a multisectoral response to the epidemic. The report notes that coordination is improved when the roles and rules of engagement for key stakeholders are understood, and where accessible coordination structures are in place to enable public, civil society and private sector representatives to work effectively with the NAC. The STARZ programme has supported important processes that have focused on improved relationships between the NAC and the civil society and private sectors – including internal coordination.
Questioning old certainties: Challenges for Africa-EU relations in 2012
Mackie J, Goertz S and de Roquefeuil Q: ECDPM Policy and Management Insights Series 3, 2011
With a range of new development actors at hand, such as China and Brazil, Africa’s position has been strengthened, according to this paper. Africans must decide which partner can best serve their various interests. The authors argue that the European Union (EU) is a good candidate to support capacity in financial administration, regional integration, good governance, and peace and security. To be recognised as such, the EU should stand by its partnership approach and avoid unilateral initiatives towards the continent. However, Africans may perceive EU support as coming at too high a price in terms of values conditionality. In that case, it may choose other partners to rely on. Some applaud an EU move to increase conditionality in its overseas development assistance (ODA). The depth of the euro crisis suggests that after a decade of rising European ODA, the world is now entering a period in which EU ODA will stagnate, though some member states may still manage increases. Further details regarding the Green Climate Fund to cover the costs of climate change also need to be clarified. At some stage Europe, along with other developed parts of the world, will need to meet that obligation. Funding requirements for environmental and other global public goods remains high, but the EU is unlikely to be able to contribute as much as in the past. Old certainties therefore are changing and those who have relied on European support will have little choice but to look elsewhere.
Questioning Photovoice Research: Whose Voice?
Evans-Agnew R; Rosemberg MA: Qualitative Health Research 26(8) 1019-1030, 2016
Photovoice is an important participatory research tool for advancing health equity. This paper critically reviews how participant voice is promoted through the photovoice process of taking and discussing photos and adding text/captions. PubMed, Scopus, PsycINFO, and Web of Science databases were searched from the years 2008 to 2014 and reviewed for how participant voice was (a) analysed, (b) exhibited in community forums, and (c) disseminated through published manuscripts. Of 21 studies, 13 described participant voice in the data analysis, 14 described participants’ control over exhibiting photo-texts, seven manuscripts included a comprehensive set of photo-texts, and none described participant input on choice of manuscript photo-texts. The findings indicate that photovoice designs vary in the advancement of participant voice, with the least advancement occurring in manuscript publication. The authors indicate that future photovoice researchers should expand approaches to advancing participant voice.
Radio Broadcasting for Health
DFID / Department for International Development (DFID), UK, 2004
This paper provides an overview of the role radio broadcasting can play in promoting better health for poor people. It has been conceptualised within the context of global efforts to reduce the burden of disease and ill health on poor people and advocates a people-centred and rights-based approach to health communications that emphasises: working with poor communities to gain an understanding of the full range of epidemiological, behavioural and risk taking factors that drive disease and ill health.