At a meeting in Addis Ababa in February 2010, African Heads of States reviewed the framework guiding the relationship between the two continents, namely, the Joint Africa-EU Strategy (JAES) and its associated Action Plan. The meeting noted that the JAES aims to upgrade European Union-Africa relations to a strategic political partnership based on joint interests and a common vision. It is meant to enable continent-continent cooperation, especially with a view to addressing global challenges such as climate change, terrorism etc., while fostering integration on both sides. It serves as an over-arching and inclusive framework for EU-Africa relations. However, three major challenges facing the JAES have been identified: lack of engagement of all stakeholders, lack of results from cooperation and dialogue in this framework so far, and the fact that political dialogue is not driving partnerships. According to this report, a genuine change in mentality has not yet taken place, and the JAES is currently not being used as a true partnership between the two players to address important global challenges. It further argues that most of the current cooperation could be done through other already existing frameworks. It concludes that there is a risk that the framework will lose credibility if its added value is not clarified.
Governance and participation in health
Campaigners for Universal Health Coverage (UHC) camped at Mwananyamala Regional Hospital in Dar es Salaam in December 2017, raising voices for people who fail to access healthcare services due to financial constraints. Campaigns went out of the hospital as Kinondoni District residents and some health activists carried out peaceful demonstrations as a sign of solidarity for the UHC movement. The Universal Health Coverage Day, marked December 12 every year, is a time when health advocates around the globe join forces to demand action and results in healthcare access in every country.
Tanzania’s performance in recent international corruption surveys shows a mixed picture. In international ratings, the country has experienced recent set-backs as regards the supply side of good governance, but this is coming from a high level of earlier performance, according to this report. In a household survey, respondents were asked to assess the quality of health services in terms of staff, facilities and surroundings. The findings show that, in general, the quality of services provided by the health sector is favourably perceived by households, with over 65% of respondents rating these services as ‘good’ or ‘very good’. However, over 50% of respondents considered medical personnel as corrupt. The authors could not understand how such corrupt medical personnel can deliver good quality services and argue that this apparent contradiction merits further research. Respondents identified a number of barriers to quality health services as serious, namely poor working conditions for medical staff, inadequate coverage of medical services, inadequate infrastructure facilities and equipment, low professional capacity of medical staff, outdated health sector reform programmes and prohibitive cost of accessing health services.
This paper presents findings from a survey of a section of Tanzanian NGOs on their perceptions of their relationships with the government and donors, and their views on their roles and impacts on poverty reduction and development. Key findings of the study indicate that the relationship between NGOs and the government of Tanzania is expanding and improving, characterised by increased communication, interaction and trust. NGOs' relations with donors are seen by respondents as cordial and smooth, but with further probing, numerous frustrations were evident. NGOs view donors as more powerful than the government and the government often sees civil society as a competitor for resources. Despite many barriers, most NGOs felt their organisations have a largely positive impact on policy.
The WE ALL HAVE AIDS Campaign is a show of solidarity among, and an acknowledgment of, many of the world's most accomplished, devoted and inspiring AIDS activists and scientists of the last 20 years. Barefoot and determined, each participant has left a meaningful mark in cement, but more importantly in the fight against HIV/AIDS and the destructive STIGMA associated with this devastating disease. Visit the website to find out more.
Priority-setting decisions are based on an important, but not sufficient set of values and thus lead to disagreement on priorities. Accountability for Reasonableness (AFR) is an ethics-based approach to a legitimate and fair priority-setting process that builds upon four conditions: relevance, publicity, appeals, and enforcement, which facilitate agreement on priority-setting decisions and gain support for their implementation. This intervention study applied an action research methodology to assess implementation of AFR in one district in Kenya, Tanzania, and Zambia, respectively. The assessments focused on selected disease, program, and managerial areas. The values underlying the AFR approach were in all three districts well-aligned with general values expressed by both service providers and community representatives. There was some variation in the interpretations and actual use of the AFR in the decision-making processes in the three districts, and its effect ranged from an increase in awareness of the importance of fairness to a broadened engagement of health team members and other stakeholders in priority setting and other decision-making processes. District stakeholders were able to take greater charge of closing the gap between nationally set planning on one hand and the local realities and demands of the served communities on the other within the limited resources at hand. This study provided arguments for the continued application and further assessment of the potential of AFR in supporting priority-setting and other decision-making processes in health systems to achieve better agreed and more sustainable health improvements linked to a mutual democratic learning with potential wider implications.
This compilation includes peer reviews on government accountability from Kenya and South Africa. The Kenyan review concluded that, while the reviewing process yielded a lot of data it was not as empowering and inclusive as it should have been and did not foster significant dialogue between Kenya’s government and its people. This was in part due to the way the self-assessment was carried out and also because it was focused on the efficiency and effectiveness of government, and not democratic decision-making and human rights. The South African review concluded that, while the reviewing process had many strengths, it had too great a level of government control, an overly ambitious timetable, and lacked meaningful civil society input.
Almost a decade after its inception, the African Peer Review Mechanism (APRM) continues to be the continent’s major governance monitoring mechanism. According to this article, the APRM has raised awareness of governance issues, energised the African continent and taken small but significant steps to remedy big problems. It has brought benefits to those countries that have taken it seriously. Recognising this, it is clear that more countries need to be encouraged to be part of the APRM process, and that countries that have made commitments to improve governance be held accountable for promises and progress. However, there have been challenges. For example, the rate of reviews is relatively slow, with the first country (Ghana) only peer reviewed in January 2006, almost four years after the APRM was established. It has been seven years since the launch of the APRM, and so far only 13 of the 29 acceding member countries have been reviewed. In addition, recommendations in the reviews are not mandatory or enforceable and have generally gone unheeded by African governments. For example, the review for Kenya predicted post-election ethnic-related violence in 2007, yet the Kenyan government took no measures to prevent the violence.
Child-friendliness is a manifestation of the political will of governments to make the maximum effort to meet their obligations to respect, protect and fulfill children’s rights and ensure their wellbeing. This report has developed and used a Child-friendliness Index to assess the extent to which African governments are living up to their responsibilities to respect and protect children and to ensure their wellbeing. Three dimensions of child-friendliness were identified: protection of children by legal and policy frameworks; efforts to meet basic needs, assessed in terms of budgetary allocation and achievement of outcomes; and the effort made to ensure children’s participation in decisions that affect their wellbeing. Though child participation is important, it was not possible to obtain sufficient data on this dimension during the development of the Index. Mauritius and Namibia emerged as the first and second most child-friendly governments respectively in Africa, followed by Tunisia, Libya, Morocco, Kenya, South Africa, Malawi, Algeria, and Cape Verde. At the other extreme are the ten least child-friendly governments in Africa, the last being Guinea-Bissau preceded by Eritrea, Central African Republic, Gambia, São Tomé and Principe, Liberia, Chad, Swaziland, Guinea and Comoros.
This paper reports the findings of an atypical systematic review of 60 years of literature in order to arrive at a more comprehensive awareness of the constructs of participation for communicable disease control and elimination and provide guidance for the current malaria elimination campaign. Of the 60 papers meeting the selection criteria, only four studies attempted to determine the effect of community participation on disease transmission. The studies showed statistically significant reductions in disease incidence or prevalence using various forms of community participation. The use of locally selected volunteers provided with adequate training, supervision and resources is crucial to the success of the interventions in these studies, the authors argue. After a qualitative synthesis of all 60 papers, they elucidate the complex architecture of community participation for communicable disease control and elimination. The authors stress the importance of ensuring that current global malaria elimination efforts do not derail renewed momentum towards the comprehensive primary health care approach. They recommend that the application of the results of this systematic review be considered for other diseases of poverty in order to harmonise efforts at building 'competent communities' for communicable disease control and optimising health system effectiveness.