‘HEALTH FOR ALL IS POSSIBLE AND NECESSARY’
The participants of this Forum held in Porto Alegre – Brazil, January 29th and 30th, 2002, call on all the people of the world, who feel the imperative to build a fairer and more equitable societies to rally around this declaration to publicize it and to engage on sustained actions along its lines. We understand that this 2nd World Social Forum starts a new step on the fight for the universal respect of social rights, particularly the right to health since we understand health as the expression of the overall quality of life, and not only the issue of access to health services. We denounce to the world the devastating effects the macroeconomic adjustment policies and now the militarization of international relationships are having over the quality of people’s life. We affirm that these effects are not the neoliberal economic policies’ exceptional, accidental outcome, but the real essence of its logic that aims at maximizing profits, regardless of states’ aim at social welfare measures; these policies are dividing the world into a huge social apartheid where countries and regions are relegated to the condition of spectators of the immense accumulation of international capital; they invariably result in deep inequalities and a perpetuating social injustice. The rich ARE getting richer and the desperately poor poorer, more so women, children and the elderly. The poor of the world are left looking at the rich as ‘from the other side of the shopping mall windows’, searching for an elusive paradise which is denied to them by the economic order that socially segregates the world and ecologically disregards it.
Governance and participation in health
Conditional cash transfers (CCTs) provide mothers of school-age children in extreme poverty with a cash subsidy conditional on their children's attendance at school and health clinics. This paper assesses the evidence for the claim that these programmes empower women. It finds that, although CCTs are designed to target the extremely poor and the particularly vulnerable, they operate under a highly selective definition of social need, and these programmes privilege and target some needs over others even at household level, reinforcing social/gender inequalities within the family itself. Highly unequal gender relations were found to be central in the functioning of such programmes. The paper argues that cash transfers should be part of a broader effort to improve and strengthen the social sector while attending to the urgent needs of the most deprived. If they signal a move in the direction of residualist welfare policies designed as compensation for exclusionary economic development, then they represent a more worrying trend. If cash transfers are to enhance the life chances of seriously disadvantaged populations, their design needs to take into account the household as a whole, so that the needs of all members are met.
Despite frustration about why public health evidence does not influence policy decisions as much as it should, there has been little attention to a fundamental force in decision making: conflicts of interest. Conflicts of interest arise when the potential for individual or group gain compromises the professional judgment of policy makers or health-care providers, and underpin rent-seeking and informal practice across the world. The authors characterise three different types of conflicts of interest that are particularly pervasive in mixed or pluralistic health systems that need to be considered in health policy and research: The first type occurs when policy makers or regulators have multiple or dual roles.The second type occurs because of hidden financial relationships between formal and informal health-care providers. The third type occurs when policy makers are influenced into taking a course of action that is more likely to win political support, rather than following public health evidence.
Despite being some of the most taxed citizens of the world, Kenyans have so far had little say in how their economy is managed. The Constitution of Kenya (2010) has, however, given much impetus to ordinary citizens participate in the management and decision-making process in governance socially, economically and politically. Participatory budgeting is a mechanism that civil society can use to decide how to allocate part of a municipal or public budget. In collaboration with Fahamu, in September 2012, the Kwale community engaged in a needs assessment process after which the priority areas were identified before electing budget delegates at the ward level. Kwale County currently has 20 wards following the recent boundary demarcations by the Andrew Ligale-led Interim Independent Boundaries Commission. The 20 wards are in Matuga, Msambweni, Kinango and the newly created Lunga-Lunga constituencies. The ward delegates are charged with developing specific spending proposals which will later be presented to the community for validation. If the community approves of the proposals, the same are to be forwarded to the county government for consideration of implementation. If implemented, participatory budgeting is expected to raise the social and economic well-being of the two counties. Areas that are expected to benefit significantly include education, health, agriculture, roads and energy sectors.
This paper analyses the impact of corruption on the extent of trust in political institutions using data from surveys conducted in eighteen sub-Saharan African countries. The authors test the ‘efficient grease’ hypothesis that corruption can strengthen citizens’ trust since bribe paying and clientelism open the door to otherwise scarce and inaccessible services and subsidies, and that this increases institutional trust. The findings do not support this theoretical argument. The impact of corruption on institutional trust is never positive whatever the evaluation of public service quality. The study shows that the perceived level of corruption has a strong adverse effect on citizens’ trust in political institutions and that the scope of its negative effect increases with the quality of public services, while, in contrast, the negative effect of experienced corruption decreases with the ease of access to public services. These findings call for more detailed and expanded studies.
Corruption is eroding the benefits of good health projects in Africa and governments must look inwards for funding, the World Health Organisation (WHO), has said. In a meeting with African Ministers of Health and Ministers of Finance on 30 August 2011 in Yamoussoukro, Cote d’Ivoire, WHO said solving the problem of funding was necessary for the health sector to thrive in the continent. Director-General of WHO, Margaret Chan, said proper harnessing and utilisation of resources would reduce the dependence on external funders for sponsoring health projects. Chan said the inclusion of these funders in health budgets posed challenges as most of them would weigh options and zero in on areas of interest and priority, which did not necessarily align with government objectives. She said most external funders gave little notice before shifting their targets, thereby creating huge gaps for funding in the countries. She added that ‘health care has to be regulated so that the private sector provides good services without ripping the people off,’ emphasising that health care projects must not be built only on the principle of attracting funds from politicians, but on principles of effectiveness and sustainability.
Identifying new approaches to tuberculosis treatment that are effective and put less demand to meagre health resources is important. One such approach is community based direct observed treatment (DOT). The purpose of the study was to determine the cost and cost effectiveness of health facility and community based directly observed treatment of tuberculosis in an urban setting in Tanzania. The conclusion is that community based DOT presents an economically attractive option to complement health facility based DOT. This is particularly important in settings where TB clinics are working beyond capacity under limited resources.
All aid actors, whether donors, recipients or implementers, now talk of incorporating participation of the poor - but has there really been a paradigm shift? What do the major multilateral and bilateral donors mean when they talk about 'participation' and 'stakeholders'? What institutional and attitudinal changes are necessary to enable the poor to truly participate in decision-making?
This report presents the findings of a research and advocacy process that included consultative workshops with civil society organisations (CSOs) in all nine of South Africa’s provinces. The research found that the legislated ‘enabling environment’ for civil society was dysfunctional. The serious lack of current and reliable national data about the size, scope and activities of the sector negatively affects the ability of the sector and of government to support it. The sustainability and effectiveness of civil society to address poverty and equity is compromised by these problems. South African civil society sector is facing a funding crisis, which needs to be addressed on many fronts: the authors call for legislative reform and renewed work on an enabling policy environment for civil society, and for grant-making and other forms of investment in social development. International sources are now much less available, which means that local funding sources must be developed and leveraged, including private philanthropy, corporate social investment and the contributions from state-related agencies such as the National Lottery Board (NLB) and the national Development Agency (NDA). The authors urge these funding agencies to work with government leadership to commit to a cooperative process towards over-arching and systemic reform of the enabling environment for civil society. They further recommend that a cross-sectoral working group, which includes strong civil society representation, is established to plan the necessary changes.
The nature of Civil Society Organisations (CSOs) in development work is changing, but how successfully – and leading where? Surprisingly, there is very little systematic research on how CSOs all over the world are influencing policy processes, especially from the point of view of those actually involved in the policymaking process in the South. This paper was written as part of the Civil Society Partnerships Programme (CSPP) to improve the capacity of Southern CSOs to influence pro-poor policy.