In this paper, the authors examine the potential role of civil society action in increasing state accountability for development in Sub-Saharan Africa. They build on the analytical framework of the World Development Report 2004 on accountability relationships, to emphasise the underlying political economy drivers of accountability and implications for how civil society is constituted and functions. The main argument is that the most important domain for improving accountability is through the political relations between citizens, civil society and state leadership. The evidence broadly suggests that when higher-level political leadership provides sufficient or appropriate powers for citizen participation in holding within-state agencies or frontline providers accountable, there is frequently positive impact on outcomes. However, the big question remaining for such types of interventions is how to improve the incentives of higher-level leadership to pursue appropriate policy design and implementation. The paper concludes that there is substantial scope for greater efforts in this domain, including through the support of external aid agencies. Such efforts and support should, however, build on existing political and civil society structures (rather than transplanting ‘best practice’ initiatives from elsewhere), and be structured for careful monitoring and assessment of impact.
Governance and participation in health
Despite the significant success of global health programs, there is a continuing gap between policy analysis and action. This paper is the first in a series, cosponsored by Results for Development Institute and the Global Health Council, which presents examples and opportunities of how evidence-based research can be translated into policies and programmes that will improve the health of poor people in developing countries. The series includes six presentations that draw from Results for Development's expertise in transparency and governance, the role of the private sector in health, health ministry capacity building, health financing and the health workforce. The first of these talks, 'Civil Society: A Missing Link in Development' took place on 29 March 2010 and featured civil society leaders from India, South Africa and Uganda, who are participating in the Institute's Transparency and Accountability Programme. You can watch the presentations on the website given above.
According to this article by the secretary general and policy manager of CIVICUS, too little partnership and too little space for civil society is marring progress on the UN Millennium Development Goals (MDGs). The writers express their utmost concern that there is insufficient political will among governments to acknowledge the role of other stakeholders, including civil society, in charting a course for accelerated action on the Millennium Development Goals (MDGs) between now and 2015 and to work in partnership with them. They refer to the increasing trend to systemically restrict freedoms of expression, association and assembly — freedoms that are key to the work of civil society. Against this background, they argue that it is increasingly clear that civil society organisations – which include non-governmental organisations, social movements, think tanks, faith-based charities and community-based organisations – must play a key role in supplementing the efforts of governments and the private sector in order to make substantial progress towards achieving the MDGs.
Sustainable Development Goal Three is rightly ambitious, but achieving it will require doing global health differently. Among other things, the authors argue that progressive civil society organisations will need to be recognised and supported as vital partners in achieving the necessary transformations. The authors argue, using illustrative examples, that a robust civil society can fulfil eight essential global health functions. These include producing compelling moral arguments for action, building coalitions beyond the health sector, introducing novel policy alternatives, enhancing the legitimacy of global health initiatives and institutions, strengthening systems for health, enhancing accountability systems, mitigating the commercial determinants of health and ensuring rights-based approaches. Given that civil society activism has catalysed tremendous progress in global health, there is a need to invest in and support it as a global public good to ensure that the 2030 Agenda for Sustainable Development can be realised. Given that civil society activism has catalysed tremendous progress in global health, the authors consider civic engagement as vital to the transformation promised by the SDGs. The authors recognise the need for further research on role of CSOs in health governance at national and global levels. Many of the leading civil society organisations in global health, as well as those providing direct services, are struggling for survival, due to decreased resources. The authors suggest that this trend will have to be reversed if SDG3 is to be achieved. The historic commitment to finance civil society, made in the 2016 UN Political Declaration on Ending AIDS, recognises both the essential functions CSOs fulfil and the need to support them in doing so.
This is the story of the leaders of a women's organisation, Mahila Swasthya Adhikar Manch (Women’s Health Rights Forum) in the state of Uttar Pradesh in India. It recounts how a group of women from the extremely marginalised sections of society have become empowered and are monitoring their entitlements around health services and other services which are related to the social determinants of health. It describes the evolution of the group, its activities and some of the results of their advocacy action with a focus on their empowerment process. This story of women’s empowerment is closely inter-twined with that of a group of facilitating organisations, who have not only contributed to this process, but also gained in confidence and credibility to strengthen the overall call for greater state accountability at different levels. The case study also discusses how this process which has led to a series of gains for these marginalised women both at a personal level and in improving accountability processes at the local level; still remains incomplete in the context of their overall political empowerment and autonomy.
In this systematic review the authors assessed progress with climate change adaptation in the health sector in South Africa, providing useful lessons for other African countries. Very few of the studies found presented findings of an intervention or used high-quality research designs. Several policy frameworks for climate change have been developed at national and local government levels. These, however, pay little attention to health concerns and the specific needs of vulnerable groups. Systems for forecasting extreme weather, and tracking malaria and other infections appear well established. Yet, there is little evidence about the country’s preparedness for extreme weather events, or the ability of the already strained health system to respond to these events. Seemingly, few adaptation measures have taken place in occupational and other settings. To date, little attention has been given to climate change in training curricula for health workers. Overall, the authors note that the volume and quality of research is disappointing, and disproportionate to the threat posed by climate change in South Africa. This is surprising given that the requisite expertise for policy advocacy, identifying effective interventions and implementing systems-based approaches rests within the health sector. They suggest that more effective use of data, a traditional strength of health professionals, could support adaptation and promote accountability of the state. With increased health-sector leadership, climate change could be reframed as a health issue, one necessitating an urgent, adequately-resourced response.
The authors of this study conducted a print media analysis in 44 countries in Africa, the Americas, Asia and the Eastern Mediterranean to find out whether and how policymakers, stakeholders, and researchers talk in the media about three topics: policy priorities in the health sector, health research evidence, and policy dialogues regarding health issues. In their literature review, the authors identified approximately five times more articles describing health research evidence compared to the number of articles describing policy priorities. Few articles describing health research evidence discussed systematic reviews (2%) or health systems research (2%), and few of the policy dialogue articles discussed researcher involvement (9%). News coverage of these concepts was highly concentrated in several countries like China and Uganda, while few articles were found for many other jurisdictions. The authors conclude that, in many countries of the countries reviewed, the print media (as captured in a global database) are largely silent about these three topics central to evidence-informed health systems. These findings suggest the need for proactive-media engagement strategies.
When specifically viewed with Africa’s history in mind, administrative corruption, though rampant across Africa today, is an alien culture, argues the author of this article. Pre-colonial Africa, for the most part, was founded on strong ethical values sometimes packaged in spiritual terms, but with the end result of ensuring social justice and compliance. The author argues that colonialism introduced systemic corruption across much of sub-Saharan Africa, repudiating indigenous values, standards, checks and balances. The author makes several recommendations: restoration of indigenous values and institutions; improving access to formal, informal and non-formal education; promotion of the ‘African’ nation state; and strengthening of anti-corruption institutions. The author argues that African countries should not just seek the deceptive increment in Gross Domestic Product, but real development in terms of standard of living, with health, education, food security and infrastructural growth given prominence.
Commonwealth Good Governance 2011/12 is a comprehensive guide to public sector reform in the Commonwealth. Articles in this edition examine: the link between democracy and development; political-administrative relations; leadership in the public sector; strengthening local government; aid and governance; and building capacity in national assemblies. The report also contains governance profiles of the 54 Commonwealth member countries.
This 2009 edition of the Commonwealth Local Government Handbook is a complete reference book to local government in the Commonwealth. Updated and revised, it details the systems of local government in the 53 countries of the Commonwealth, looking at how local government is structured, how elections take place, what services local government is responsible for, how local government is financed and what reforms are envisaged. The profiles are in a format that allows easy country-to-country comparison. The 2009 Handbook includes a preface by CLGF Secretary-General Carl Wright, a foreword by CLGF Chairperson Basil Morrison, and an introduction by Hubert Ingraham, Prime Minister of the Bahamas.