This article raises the question of whether the Gates Foundation’s underwriting of journalism, for example by funding radio health programmes in the United States (US) and health journals like Global Health, creates a conflict of interest for journalists, especially when the Foundation does not disclose its funding upfront. Although the Foundation might not have advocated for specific programmes, it does have distinct policy preferences and policy-shaping efforts, potentially influencing the media. The Kaiser Family Foundation (KFF), which was given a five-year, US$9.9 million grant last year by the Gates Foundation, is supposed to provide independent analysis of US global health policies, which have direct bearing on the Gates Foundation’s programmes. Prominent among these programmes is KFF’s US Global Health Policy portal, which selects and summarises global health news from more than 200 worldwide sources spanning mainstream media outlets to blogs. KFF sends a daily email news digest to policy makers, opinion leaders and journalists. The author argues that, not only does KFF have the power to choose what constitutes global health news but, in summarising the stories it selects, it can give them a construction of its own choosing. In key instances, the KFF’s global health news coverage suggests bias both in story selection and preferential treatment of the Gates Foundation. The author calls for increased transparency of funding sources for health programmes and health journalism.
Governance and participation in health
Community-led total sanitation (CLTS) is a participatory process focused on promoting change in sanitation behaviour through social action - stimulated by facilitators from within or outside the community. Aimed at empowering local communities this handbook is a source of ideas and experiences to be used for CLTS orientation workshops, advocacy to stakeholders as well as for implementing CLTS activities. It is intended as a tool for field staff, facilitators and trainers to plan, implement and follow up on CLTS activities. A sequence of possible steps and tools, including do’s and don’ts, are provided to help trigger CLTS in a community. They include pre-triggering, selecting a community, introduction and building rapport, triggering participatory sanitation, profile analysis, ignition moment, post-triggering action, planning by the community, follow up, scaling up and going beyond CLTS. Users are encouraged to use and modify the processes outlined in this handbook as they see fit for their given context.
This article poses reflections from two leads of Twaweza, an east African non government organisation, on their approaches and work, particularly in response to a series of blogs on this by D Green (Oxfam GB advisor. They reflect on learning on citizen action; and on the need to better articulate what is meant by citizen action, including private v public and individual v collective. "In essence, this is a move away from an unexplained “magic sauce” model where we feed some inputs (i.e. information) into a complex system, hope twaweza-logothat the (self-selecting, undifferentiated) citizens will stir it themselves, and voila – a big outcome (such as increased citizen monitoring of services, and improved service delivery) will somehow pop out on the other end".
Corruption holds development back. The author proposes that the aid community needs to be more open-minded and to think harder about what works to deal with corruption, rather than prescribing standard formulas. The author reviews of the things we understand and the things we don’t and thence suggests five ways of moving forward.
The Urban Action Lab of Makerere University Uganda, is a lead partner of Co-designing Energy Communities (CO-DEC), a collaborative research project in Kampala and Nairobi, which is fostering cross-sector learning amongst university students and local community members to scale up local energy solutions, such as briquette-making, and create highly accurate maps of risk-prone businesses, infrastructure and residential dwellings, in regards to the use of traditional and modern energy sources. The community co-researchers collaborated with academics from Makerere University to map their own neigbourhood of Kasubi-Kawaala, in order to address in-and outdoor air pollution associated with poor management of wastes, leaky toilet seals and sewer pits, the use of biomass and fossil fuels from the informal urban economy. The maps were boundary objects for community-led learning and action that linked participating organisations and individual co-researchers to local sustainability-oriented experiments around regenerative use of wastes for energy briquettes; planting of indigenous trees with leafy canopies that reduce air pollutants in homesteads and around business premises; while building consensus on the policy options for enabling actors from Kampala Capital City Authority to own and energetically pursue an agenda for scaling up alternative energy solutions that bring about co-benefits in the health and housing sector.
Since 2008 in Mozambique, patients stable on antiretroviral therapy (ART) can join Community ART Groups (CAG), peer groups in which members are involved in adherence support and community ART delivery. More than 10 years after the implementation of the first CAGs, this study explored the impact of changes in circumstances and daily life events of CAG members. The CAG dynamic was affected by life events and changing circumstances including a loss of geographical proximity or a change in social relationships. Family CAGs facilitated reporting and antiretroviral therapy distribution, but conflict between CAG members meant some CAGs ceased to function, pill counts were not carried out, members met less frequently or stopped meeting entirely and ART uptake declined. In a more positive contrast, some CAGs responded to adherence challenges by strengthening peer support through counselling and observed pill intake. Health care providers were reported to push people living with HIV to join CAGs, instead of allowing voluntary participation. They agreed that strengthening CAG rules and membership criteria could help to overcome the identified problems. The authors propose that changing life circumstances of, relationships between and participation by CAG members need to factored into a more flexible implementation model, including intensified peer support and feedback mechanisms between CAG members and health-care providers.
This young writer explains: "What keeps me on the frontline for climate justice is the notion that I don't only represent my nation but my entire generation because climate justice concerns our future...We deserve to live happily as well, but to attain that healthy, happy living we will not stop speaking out for what we want and what we deserve, to bring about a child-safe and sustainable future. I have dedicated my voice as a voice of the voiceless, to call for immediate action and there is no better time for acting than now". UNICEF teamed up with 'Fridays for Future' to highlight young activists on the front lines of climate change, like Nyathi. Discover other climate activists and stories on how climate change is affecting young people today.
Published by the Center for Communication Programs (CCP), this report is the first in a new series entitled “Health and Communication Insights”. The author suggests that the use of information and communication technologies (ICTs) and e-health (electronic health) applications, such as interactive websites, can be effective in helping people manage diseases, access health services and obtain assistance with behaviour change. Acknowledging the rich-poor digital divide, he notes that access to new technologies is increasing rapidly in developing countries.
In 2008, South Africa’s National Tuberculosis Programme (NTP) implemented a community mobilisation programme in all nine provinces to trace TB patients that had missed a treatment or clinic visit. The objective of this study was to assess the impact of the NTP’s TB Tracer Project on treatment outcomes among TB patients. The study population included all smear positive TB patients registered in the Electronic TB Registry from Quarter 1 2007-Quarter 1 2009 in South Africa. Results for all provinces combined suggested that, in tracer districts, fewer patients defaulted on their treatment and there was an increase in successful treatment outcomes. However, the results were not consistent across all provinces, and significant differences in treatment default were observed between tracer and non-tracer sub-districts over time in five of nine provinces. The authors conclude that community mobilisation of teams to trace TB patients that missed a clinic appointment or treatment dose may be an effective strategy to mitigate default rates and improve treatment outcomes. Additional research is called for to identify best practices and elucidate discrepancies across provinces.
With evolving South African legislation supporting community involvement in the health system, early policy developments focused on Community Health Committees (HCs) as the principal institutions of community participation. Formally recognized in the National Health Act, the Act deferred to provincial governments in establishing the specific roles and functions of HCs. As a result, stakeholders developed a Draft Policy Framework for Community Participation in Health (Draft Policy) to formalize participatory institutions in the Western Cape province. With the Draft Policy as a frame of analysis, the researchers conducted documentary policy analysis and semi-structured interviews on the evolution of community participation policy. Moving beyond the specific and unique circumstances of the Western Cape, this study analyzes generalizable themes for community participation in the health system. Framing institutions for the establishment, appointment, and functioning of community participation, the Draft Policy proposed a formal network of communication – from local HCs to the health system. However, this participation structure has struggled to establish itself and function effectively as a result of limitations in community representation, administrative support, capacity building, and policy commitment. Without legislative support for community participation, the enactment of superseding legislation is likely to bring an end to HC structures in the Western Cape. The authors conclude that attempts to realize community participation have not adequately addressed the underlying factors crucial to promoting effective participation, with policy reforms necessary: to codify clearly defined roles and functions of community representation, to outline how communities engage with government through effective and accountable channels for participation, and to ensure extensive training and capacity building of community representatives. Given the public health importance of structured and effective policies for community participation, and the normative importance of participation in realizing a rights-based approach to health, this analysis informs researchers on the challenges to institutionalizing participation in health systems policy and provides practitioners with a research base to frame future policy reforms.