With the fading of colonial memory in postcolonial Africa, dramatic changes are emerging and are shaping urban cities in quite significant ways. Urbanisation is exploding, and large numbers of Africans are becoming town dwellers, informal settlements alike are becoming the norm rather than the exception. Urban challenges have thus become complex, hence calling for an infrastructural rethink to urban governance and development in Africa. The interest for this paper, is to explore the governance and politics of urban space in the postcolonial African city. Guma’s research question, put in its most general form, asks what constitutes the governance and politics of urban space in the post-colonial African city? By taking three East African cities of Kampala, Nairobi and Dar es Salaam as his main analytical units, he focuses on: understanding urban structures and dynamics of urban governance and political frameworks and networks of survival, and exploring realities that shape urban governance within the global and neo-liberal context of post colonial Africa. To achieve this end, he draws from comparative, qualitative and reflective exploratory fieldwork research within the realm of socio-anthropological, legal-political, and architectural-geographical investigation.
Governance and participation in health
Malawi declared a state of national disaster due to the COVID-19 pandemic on 20th March 2020 and registered its first confirmed coronavirus case on 2 April 2020. This paper documents decisions made in response to the COVID-19 pandemic from January to August 2020. Malawi's response to the pandemic was found to have been multi-sectoral and implemented through 15 focused working groups termed clusters. Each cluster was charged with providing policy direction in their own area of focus. All clusters then fed into one central committee for major decisions and reporting to head of state. This led to a range of responses, including an international travel ban, school closures at all levels, cancellation of public events, decongesting workplaces and public transport, mandatory face coverings and testing symptomatic people. Supportive interventions included risk communication and community engagement in multiple languages and over a variety of mediums, as well as efforts to improve access to water, sanitation, nutrition and unconditional social-cash transfers for poor urban and rural households.
From 2013, the Zambian Corrections Service (ZCS) worked with partners to strengthen prison health systems and services. One component of that work led to the establishment of facility-based Prison Health Committees (PrHCs) comprising of both inmates and officers. The authors present findings from a nested evaluation of the impact of eight PrHCs 18 months after programme initiation. In-depth-interviews were conducted with 11 government ministry and Zambia Corrections Service officials and 6 facility managers. Sixteen focus group discussions were convened separately with Prison Health Committees members and non-members in 8 facilities. Memos were generated from participant observation in workshops and meetings preceding and after implementation. The authors sought evidence of Prison Health Committees impact, refined with reference to Joshi’s three domains of impact for social accountability interventions in state, society, and state-society relations. Further analysis considered how project outcomes influenced structural dimensions of power, ability and justice relating to accountability. Data pointed to a compelling series of short- and mid-term outcomes, with positive impact on access to, and provision of, health services across most facilities. Inmates reported being empowered via a combination of improved health literacy and committee members’ newly-given authority to seek official redress for complaints and concerns. Inmates and officers described committees as improving inmate-officer relations by providing a forum for information exchange and shared decision making. Contributing factors included more consistent inmate-officer communications through committee meetings, which in turn enhanced trust and co-production of solutions to health problems. Nonetheless, long-term sustainability of accountability impacts may be undermined by permanently skewed power relations, high rates of inmate turnover, variable commitment from some officers in-charge, and the anticipated need for more oversight and resources to maintain members’ skills and morale. The authors showed that Prison Health Committees do have potential to facilitate improved social accountability in both state and societal domains and at their intersection, for an extremely vulnerable population. However, sustained and meaningful change will depend on a longer-term strategy that integrates structural reform and is delivered through meaningful cross-sectoral partnership.
This article sets out to discuss and analyze the described collapse of health services through a brief case study on provision of Emergency Obstetric Care in Northern Tanzania. The article argues that since the Alma Ata conference on Primary Health Care developments in global health initiatives have not been successful in incorporating population trust into the frameworks, instead focusing narrowly on expert-driven solutions through concepts such as prevention and interventions. The need for quantifiable results has pushed international policy makers and donors towards vertical programmes, intervention approaches, preventive services and quantity as the coverage parameter. Health systems have consequently been pushed away from generalised horizontal care, curative services and quality assurance, all important determinants of trust. The article proposes a new framework that places generalised services and individual curative care in the centre of the health sector policy domain. It concludes that an increased focus on quality and accountability to secure trust is an important precondition for enabling the political commitment to mobilise necessary resources to the health sector.
In this review, the authors highlight the silos that currently characterise transparency and accountability initiatives (TAIs). The authors argue that a decade on from their inception, and notwithstanding a growth in litigation-based social accountability that invokes popular mobilisation and democratic rights, there is much to suggest that TAIs in aid and development are increasingly being used within an efficiency paradigm, with scant attention to underlying issues of power and politics. Many TAIs focus on the delivery of development outcomes, neglecting or articulating only superficially the potential for deepening democracy or empowering citizens, overemphasising tools to the detriment of analysis of context, of forms of mobilisation and action, and of the dynamics behind potential impact. Many TAIs focus on achieving‘downstream’ accountability –the efficient delivery of policies and priorities – bypassing the question of how incorporating citizen voice and participation at earlier stages of these processes could have shaped the policies, priorities and budgets ‘upstream’. The authors contrast new public management approaches with rights based approaches. The paper examines ways of assessing effectiveness of TAIs.
This paper argues that the case for global universal coverage is strong, yet it is not pursued actively enough. Although there may be a problem of ‘free riders’ (countries hoping that other countries will pay for a global public good), the main obstacle would be that global universal health coverage reduces country autonomy and embraces a paradigm of managing mutual dependence. Even if mutual dependence in health is a reality, the paper notes, countries nonetheless try to preserve their autonomy: richer countries require assurances regarding how the assistance they provide will be used (in a manner that serves their interests too), while poorer countries want to have the freedom to address their own health priorities. Recent paradigm shifts in the practice of international health financing can be seen as attempts to manage mutual dependence in health while trying to preserve country autonomy. Over the past decades, these attempts to better manage mutual dependence in health have led to increasingly sophisticated governance mechanisms. The authors suggest that a combination of the best elements of these mechanisms could help progress the world towards global universal health coverage.
The Joint Action and Learning Initiative on National and Global Responsibilities for Health (JALI) is a coalition of civil society organisations and academics researching key conceptual questions involving health rights and responsibilities, with the goal of securing a global health agreement and supporting civil society mobilisation around the human right to health. This agreement - such as a Framework Convention on Global Health - would inform post-Millennium Development Goal (MDG) global health commitments. Using broad partnerships and an inclusive consultation process, JALI seeks to clarify the health services to which everyone is entitled under the right to health, the national and global responsibilities for securing this right, and global governance structures that can realise these responsibilities and close major health inequities. Mutual benefits to countries in the Global South and North would come from a global health agreement that defines national and global health responsibilities. JALI aims to respond to growing demands for accountability, and to create the political space that could make a global health agreement possible.
Established in Sept 2001, this is a global movement that seeks to reduce the incidence of diseases like AIDS, tuberculosis, and malaria among poor people. The campaign's goal is to advocate for and communicate best practices to stimulate social and political change. The campaign supports networks of existing organisations by providing strategic information, best practices, prototype messages, opportunities for collaboration and co-ordination. A website facilitates this exchange of information.
"In the next 24 hours, over 30,000 children will die from preventable diseases on our planet earth. Today, while the world is writing a collective obituary of the future generation, we know why they are dying and we know who are responsible for these deaths. We also know how these deaths can be stopped. We urge you to join 'The Million Signature Campaign', - a march demanding health for all."
This brief explores the relevance of civil society budget analysis and advocacy and its potential as a tool to hold governments accountable for their maternal mortality reduction commitments. It discusses three recent examples of civil society groups engaged with budget analysis and advocacy, including Women’s Dignity in Tanzania. Lack of real progress in reducing maternal mortality is unquestionably linked to the failure of governments to make maternal health a budgetary priority. Even though resources to address this issue exist, they are not necessarily being allocated correctly or spent effectively. Governments need to prioritise funding for family planning and prenatal care, skilled care during pregnancy and childbirth, and essential lifesaving interventions. In addition, citizens must actively monitor government spending on maternal health.