Governance and participation in health

WHO Watch is an intervention in global health governance. It provides a current account of global policy dynamics in relation to a wide and growing range of health issues. The links enable local activists to keep in touch with the global policy movements which shape the context for such local struggles. They also help to ensure that policy analysis and policy advocacy at the regional and global levels is informed by the reality of grass roots activism, both in health systems and around the conditions which shape health. This link provides the WHO Watch notes from the World Health Assembly May 19-26 2015. It covers the discussions on 23 major items at the Assembly.

On 9 February 2012, 16 prominent human rights activists were arrested in Dar es Salaam, Tanzania, on the grounds of unlawful assembly. The human rights defenders, who included the executive directors of the Legal and Human Rights Centre and the Tanzania Media Women's Association, were arrested at the Muhimbili National Hospital following a doctor’s strike that had paralysed the provision of health services. The police authorities allege the small group had gathered illegally and were intending to hold an illegal demonstration, although the group maintains that they were not there to protest but to observe the dialogue between the government and health officials. The activists were detained and then later released on bail, pending confirmation of charges. The question is, did the 16 activists cause a breach of the peace, or prejudice public safety and the maintenance of public order? Crucially, were the police, by prohibiting the alleged assembly and subsequently arresting the activists, using their discretion appropriately? The authors’ answer is “No”. A public assembly held to observe (or allegedly protest) negotiations about health sector issues is unlikely to breach public order or public safety. The authors call on the Tanzanian government and police to use their discretion to limit public assemblies wisely and ensure that public assemblies called for a political purpose, which are a common and indeed vital aspect of a healthy democracy, are not arbitrarily restricted or prohibited.

Indoor residual spraying (IRS) and insecticide-treated nets (ITNs), two principal malaria control strategies, are similar in cost and efficacy. This study aimed to describe recent policy development regarding their use in Mozambique, South Africa and Zimbabwe. Using a qualitative case study methodology, researchers undertook semi-structured interviews of key informants from May 2004 to March 2005, carried out document reviews and developed timelines of key events. They found that a disparate mix of interests and ideas slowed the uptake of ITNs in Mozambique and Zimbabwe and prevented uptake in South Africa. Most respondents strongly favoured one strategy over the other. In all three countries, national policy makers favoured IRS, and only in Mozambique did national researchers support ITNs. Outside interests in favour of IRS included manufacturers who supplied the insecticides and groups opposing environmental regulation. International research networks, multilateral organisations, bilateral donors and international non-governmental organisations (NGOs) supported ITNs. Research evidence, local conditions, logistic feasibility, past experience, reaction to outside ideas, community acceptability, the role of government and NGOs, and harm from insecticides used in spraying influenced the choice of strategy. The end of apartheid permitted a strongly pro-IRS South Africa to influence the region, and in Mozambique and Zimbabwe, floods provided conditions conducive to ITN distribution. The study concludes that both IRS and ITNs have a place in integrated malaria vector management, but pro-IRS interests and ideas have slowed or prevented the uptake of ITNs. Those intending to promote new policies such as ITNs should examine the interests and ideas motivating key stakeholders and their own institutions, and identify where shifts in thinking or coalitions among the like-minded may be possible.

"Advocates of participatory approaches to service delivery see devolution as key to empowering people to take charge of their own affairs. Participation is portrayed as guaranteeing the delivery of services that are in line with user preferences. It is assumed that people are keen to participate in public affairs, that they possess the capacity to do so, and that all they need is opportunities. Using evidence from ethnographic research in Uganda, this article questions these views. It shows that, to succeed in the long term, devolution and participation must take place in the context of a strong state, able to ensure consistent regulation, and a well-informed public backed up by a participatory political culture."