In Yumbe District of north-western Uganda, Village Health Teams (VHT) have been established in line with the national strategy for community involvement in health. This paper reviews aspects of the programme outlining its successes and challenges. Its success has been mainly due to integration of pre-existing volunteer cadres, intersectoral approach to the monitoring of the teams and involvement of the community in the selection of the top-up team members. Its challenges include the relatively young age of most volunteers and the likely loss of financial support for the activities of the volunteers. The paper concludes that the VHT programme is a delicate venture requiring both programme support through intersectoral inputs to the Community Action Plans developed by communities and sociological approaches to educate the communities to support the VHT for its sustainability.
Governance and participation in health
Community participation in health has been an elusive concept since the days of the Alma Ata Declaration. Many faltering steps have been taken towards genuine community participation only to be retraced because the programmes were either ill-conceived or derailed by the loss of the spirit of voluntarism. In Yumbe District of north-western Uganda, Village Health Teams (VHT) have been established in line with the national strategy for community involvement in health. The Yumbe VHT programme has won an award for innovative support to strengthening decentralisation. This paper reviews aspects of the programme outlining its successes and challenges. Its success has been mainly due to integration of pre-existing volunteer cadres, intersectoral approach to the monitoring of the teams and involvement of the community in the selection of the top-up team members. Its challenges include the relatively young age of the majority of the volunteers and the likely loss of financial support for the activities of the volunteers. The paper concludes that the VHT programme is a delicate venture requiring both programme support through intersectoral inputs to the Community Action Plans developed by communities and sociological approaches to educate the communities to support the VHT for its sustainability.
The purpose of this study was to explore and describe the challenges faced by people who are living with HIV or AIDS (PLWHAs) and their caregivers in resource-poor, remote South African villages. In-depth interviews were conducted with nine PLWHAs and their direct informal caregivers. Interviews explored the themes of physical, emotional and social wellbeing. Two focus groups were also conducted. The results of the study underscored the needs of PLWHAs and the needs of their direct informal caregivers, which include physical/medical, social, material, financial, instrumental and physiological/emotional needs, as well as gender issues. In developing home-based care programmes, the study argues that it is vital to consider the perceived needs of PLWHAs and their caregivers. The results from this study may serve as a basis for the development of a home-based care programme in similar remote and resource-poor settings.
Malawi is poised to drastically expand safety nets to orphans and their families, and this study will provide an important foundation for this process. The study analysed nationally representative data from 27,495 children in the 2004–2005 Malawi Integrated Household Survey. It found that friends and relatives provided assistance to over 75% of orphan households through private gifts, but organised responses to the orphan crisis were far less frequent. Over 40% of orphans lived in a community with support groups for the chronically ill and about a third of these communities provided services specifically for orphans and other vulnerable children. Public programmes, which form a final safety net for vulnerable households, were more widespread. Free/subsidised agricultural inputs and food were the most commonly used public safety nets by children's households in the past year and households with orphans were more likely to be beneficiaries.
The author raises questions in this paper about the operations of the Gates Foundation in public health and the impact of its work. These relate to the mechanisms for accountability and the considerable power in shaping health policy priorities and intellectual norms, in a context of a significant focus on technocratic solutions for the world’s health challenges and a demand for greater private sector influence in global health policy. Many health rights campaigners argue in contrast for a loosening of private interests, such as in intellectual property laws to increase access to technologies such as medicines - both in lowering prices through generic competition and in enabling innovation outside patent-hoarding companies.
This paper describes the Ghana Essential Health Intervention Project (GEHIP), a plausibility trial of strategies for strengthening Community-based Health Planning and Services (CHPS). The researchers found that GEHIP improves the CHPS model by: extending the range and quality of services for newborns; training community volunteers to conduct the World Health Organisation service regimen known as integrated management of childhood illness (IMCI); simplifying the collection of health management information and ensuring its use for decision making; enabling community health nurses to manage emergencies, particularly obstetric complications and refer cases without delay; adding $0.85 per capita annually to district budgets and marshalling grassroots political commitment to financing CHPS implementation; and strengthening CHPS leadership at all levels of the system. By demonstrating practical means of strengthening a real-world health system while monitoring costs and assessing maternal and child survival impact, GEHIP is expected to contribute to national health policy, planning, and resource allocation that will be needed to accelerate progress with the Millennium Development Goals.
In Sudan, the Tajamoo al-mihanyin al-sudaniyin or the Sudanese Professionals Association (SPA) is an alliance of independent professionals shrouded in mystery. Described as the “ghost battalion” by the now-deposed president Omar al-Bashir, the contemporary movement led by the SPA exerted influence on mobilizations and protest movements through sustained appeals, and built broad appeal and demonstrated a know-how of protests, applied within the social movement across the country. They initiated civil disobedience, rallies and marches in all parts of the country, focusing on women, displaced and exiled people, and on social justice and life on the margins. Moreover, they have taken the call to protest beyond the limits of major cities like Khartoum and across sectors—from resignation marches in outlying towns and provinces to the mobilization of dock workers in Port Sudan. The For a movement like the SPA there are challenges. Will its spirit remain strong or be exhausted? Will it be the guardian of this transition or its watchdog?
International capital mobility has long been associated with financial and banking crises. The Articles of Agreement of the International Monetary Fund (IMF) contain multi‐lateral rules to govern global capital flows. For some countries, especially those in the developing world, the IMF Articles of Agreement remain the core framework under which they have autonomy to regulate cross‐border capital flows. For others, these rules have been partly superseded by more recent trade and other economic integration agreements. Thus what used to be a regime of ‘cooperative decentralisation’ has become a patchwork of overlapping and inconsistent governance structures that pose significant challenges to nations attempting to regulate global capital flows for stability and growth, according to the author of this paper. He traces the history of governing global capital flows and presents a framework for understanding three distinct eras in the modern governance of global capital. The framework emphasises how power, interests, ideas, and institutions interact to shape each era in different combinations to yield different outcomes.
Antimicrobial resistance is a growing threat to public health the world over. Global health governance strategies need to address the erosion of antimicrobial effectiveness on three levels. Firstly, mechanisms to provide incentives for the pharmaceutical industry to develop antimicrobials for diseases threatening the developing world need to be sought out. Secondly, responsible use of antimicrobials by both clinicians and the animal food growing industry needs to be encouraged and managed globally. And lastly, in-country and international monitoring of changes in antimicrobial effectiveness needs to be stepped up in the context of a global health governance strategy.
In December 2011, the Global Health Security Initiative (GHSI) celebrated its 10th anniversary with a ministerial meeting in Paris, France. This article chronicles the achievements of the Initiative in global health security, namely the development of globally common methods for the assessment of global health threats and risks, such as the H1N1 flu virus, and the mainstreaming of a multidisciplinary approach on health security. The Initiative has been involved in: setting up information-sharing networks, such as a contact emergency network for communication among health officials; the establishment of general guidelines for risk communications; the design of a ‘risk incident scale’ for global health emergencies; and the development of evidence-based research for policy making related to human decontamination. Although the Initiative is limited to only the eight countries, the network is working with the World Health Organisation to share the best practices with the broader global health community.