This introductory paper to a series suggests that rather than seeing governance as a normative health system goal addressed through the architecture and design of accountability and regulatory frameworks, it should be located in the real-world decision-making of health policy and system actors. Their multiple, routine decisions translate policy intentions into practice - and are filtered through relationships, underpinned by values and norms, influenced by organizational structures and resources, and embedded in historical and socio-political contexts. These decisions are also political acts - in that they influence who accesses benefits and whose voices are heard in decision-making, reinforcing or challenging existing institutional exclusion and power inequalities. In other words, the everyday practice of governance has direct impacts on health system equity. Analysis of governance can be viewed through diverse health policy and system issues, considers actors located at multiple levels of the system and draws on multi-disciplinary perspectives. This article introduces papers that present detailed examination of experiences in a range of African and Indian settings, led by authors who live and work in these settings, providing an empirical and embedded research perspective on governance and equity in health systems.
Governance and participation in health
In this assessment of the World Social Forum (WSF), which took place in Dakar, Senegal, from 6–11 February 2011, the author highlights an important trend in global activism: activists arrived already well prepared and networked among them and with local partners and with a key concern about further strengthening regional and global alliances on shared issues. Those convergences, at the heart of WSF’s mission, proved exceedingly successful, beyond activists’ expectations even, and for some seem to indicate a clear trend towards consolidation of struggles at the global level. The convergence of the Assembly of Social Movements, a regular event at the forums since the first edition, saw the participation of thousands of activists from all around the world. The success of the assemblies moved in the direction of addressing some of the long standing concerns of some WSF organisers and critics, namely the fragmentation of the programme and the atomisation of the different strands of global activism with the perceived outcome of weakening the resistance against neoliberalism and reducing the impact of imaginations and practices aimed at building a new, more equitable world.
BoLAMA report in a press statement that it has without much success made all efforts to engage and collaborate with the Government of Botswana on miners’ right to health, specifically for those suffering from TB and other occupational diseases. BoLAMA assert that TB rates in Botswana remain high and a multi-sectoral accountability framework is required. This framework which is aligned with the End TB Strategy and UN Political Declaration on TB requires key populations and civil society to work in collaboration with Governments. The regional TB/Silicosis class action is seen as an opportunity to reduce the economic hardships of ex-miners who due to contracting occupational lung diseases have been rendered redundant and not in gainful employment. The court case, to which BoLAMA has been party, is slated to be finalized in 2019. BoLAMA called on the Government of Botswana to; i) remember her commitments under the WHO EndTB Strategy from which the TB National Strategic Plan is aligned; ii) implement the UN Political Declaration on the fight against TB; iii) ensure an inter-ministerial committee including BoLAMA deal with ex-miners issues; and iv) provide support in the TB/Silicosis regional class suit.
The author of this paper argues that corruption in public procurement is the chief cause of poverty in Africa. It is fostered by poor governance and weak legislation and may be costing the continent up to US$148-billion a year. Yet it can be countered if there is the will and skill to do so. Combatting corruption in public procurement is a multi-faceted problem, which requires a comprehensive package of measures to be implemented concurrently. The author presents proposals for this: The first line of defence is to ensure a sound legal framework that incorporates an anti-corruption law with real authority and effective sanctions. An explicit commitment to eradicate corruption in all forms must be made at the highest level of government. To keep clients and officials accountable, a comprehensive legal and regulatory framework governing public procurement must be implemented. There should be transparency and accountability for all in the bidding process, as well as public service reforms.
The Students’ Health Advocacy Project (SHAP) is a community outreach programme of HEPS-Uganda, a health consumers' organisation advocating for health rights and responsibilities that is also a member of the EQUINET network. SHAP targets schools in Rubaga Division to make the students aware of their health rights and responsibilities. This has been going on since 2010. So far, SHAP activities have been conducted in a few schools and for some schools a follow up has been made from the previous outreach made to them, specifically Bright Angels College. The new members of the health club in this school showed great interest in the activities carried out by SHAP and HEPS Uganda. The two organisations are currently refining the programme to make it more focused on raising students’ awareness of their basic health rights. The SHAP team is also working on expanding its activities to various schools in Rubaga and this has been effected through delivering letters so that dates can be scheduled for SHAP to take their presentations to the targeted schools.
In this 2012 survey, the opinions on their social conditions of 1,360 young South Africans from various backgrounds of the country were gathered. Individuals across age groups (kids, teens and young adults) from Gauteng, KwaZulu Natal and the Western Cape responded to the survey and expressed their opinions on numerous issues and attributes relevant to South African society. Generally, respondents expressed high levels of nostalgia towards the country’s previous leaders, specifically Nelson Mandela, and were critical of the current leadership. Across all the regions, crime was ranked as the country’s biggest problem, and education was cited repeatedly as being crucial to ensure the future success of young South Africans. Freedom of expression was highlighted as a key issue throughout the interviews, yet many young people felt they were not given the opportunity to be heard. Many respondents argued that relying on the government to bring about change is not good enough, and expressed a desire for youth to play a greater role.
Activists from the People’s Health Movement met during the World Health Organisation’s 8th Global Conference on Health Promotion to critique the official Conference Statement (included in this newsletter) and develop a progressive call for action based on strong social justice principles. This draft reflects their deliberation and is being circulated for further comment and debate. They support the leadership of WHO Director-General Margaret Chan in condemning the economic power of large industries, including food, tobacco, soda and alcohol, and their destructive impact on the health of people around the globe. They note further that speakers and discussants in this Conference have highlighted the link between the “Health for All” Declaration of Alma Ata in 1978 and the unfinished agenda of health promotion, stemming from the Ottawa Declaration of 1986. They support the calls in this conference for a ‘whole‐of‐government’ approach that includes Health in All Policies, a social justice framework in monitoring and evaluation of health policies, and the health‐related human rights that promote health for all. They believe, however, that the Helsinki Statement does not sufficiently translate the analysis of the determinants of health inequities and poor health into specific actions which address the unfair economic system that underpins health inequities. They therefore issue this call to action, recognising that this entails both short and long term political struggle for social justice.
Most new HIV infections in Africa are acquired from cohabiting heterosexual partners. Couples Voluntary Counselling and Testing (CVCT) is an effective prevention strategy for this group. This paper presents experience with a community-based program for the promotion of CVCT in Kigali, Rwanda and Lusaka, Zambia. Predictors of successful CVCT promotion included strategies that can be easily implemented in Africa. As new resources become available for Africans with HIV, CVCT should be broadly implemented as a point of entry for prevention, care and support.
Civil society strengthening and movement building is not only an important element of democracy and democratisation; it is also a guarantee of the depth and effectiveness of democracy in our societies. One of the most high-profiled movements of this kind has been the World Social Forum (WSF). In 2007 the WSF will be hosted in Africa (Nairobi) for the first time in its history. This event gives African civil society organisations and social movements an opportunity to take stock of the process of solidarity and movement building on the continent and in its various regions. The Nairobi WSF also provides African civil society with the opportunity to exchange ideas on new ways of building solidarity and of strengthening civil society in Africa.
TAC presents demands to the Cape Town City Council about the treatment of foreigners after the xenophobic attacks in the city.