In this report, the African Power and Politics Programme (APPP) argues that economic growth is slower and more inequitable than it could be, and has not necessarily produced the poverty reduction that might have been hoped for. There is a growing consensus around the world that this is due to failures in governance, to which the APPP adds the hypothesis that the immediate problem is in part due to the application of a ‘good governance agenda’ that is ideological rather than evidence-based. APPP presents four recommendations. First, moving from ‘best practice’ to ‘best fit’ in thinking about institutional development is necessary. Second, a more realistic take on elections and citizen empowerment as means of addressing problems of public goods insufficiency requires us to rely less on the congenial assumption that all good things go together. Third, the leadership factor and the politics thereof are perhaps the biggest influence on the extent to which particular regimes are developmental or not. Fourth, these findings have important implications for aid effectiveness ahead of the Fourth High Level Forum on Aid Effectiveness in Korea later in 2011. Specifically, the concept of country ownership is due to be revamped, and it should be tied explicitly to this leadership question rather than to democracy, parliamentary oversight, or civil society participation.
Governance and participation in health
The updated version of the Worldwide Governance Indicators, covering 213 countries over the 1996-2009 period, has found that the world continues to underperform on governance. Over the past decade, dozens of countries have improved significantly on such dimensions of governance such as rule of law and voice and accountability. But a similar number of countries have experienced marked deteriorations, while others have seen short-lived improvements that are later reversed, and scores of countries have not seen significant trends one way or the other. A number of key messages emerged. The most powerful economies are not always the best governed – likewise, good governance is also found in countries that are not wealthy. Governance can significantly improve over a relatively short period of time yet, on average, the world has not significantly improved in the quality of governance over the past dozen years. Sustained commitment to governance reforms is needed to avoid reversals. The authors warn that measuring governance is difficult, and all measures of governance are necessarily imprecise, requiring interpretative caution.
The current financial crisis in Swaziland is so severe that aid agencies are predicting that in the absence of major new loan, a humanitarian crisis could develop within the next few months. Stocks of antiretrovirals have fallen dramatically, reportedly standing at one month's supply, despite Swaziland having the world's highest prevalence of HIV (26.1%), with 70% of the population below the poverty line. However the author reports that loans and other resources are not reaching those with greatest need, and that wide inequalities in wealth exist.
Mining in southern Africa has amplified HIV and tuberculosis (TB) epidemics across the continent through social, political, and biological risks posed to miners and their communities, according to this article. Aware of these risks for decades, policymakers have done little to regulate the mining sector’s remarkable impact on Africa’s two largest epidemics, the authors note. They analyse the governance of mining in southern Africa to evaluate the sources of ineffective responses and identify mechanisms for ensuring effective cross-border care and global norms of responsible mining. Their primary argument is that international agencies need to take action to spur the development of effective governance systems currently being constrained by domestic vested interests.
The health sectors of most countries focus almost exclusively on health care services. The potential of multi-sectoral collaboration thus remains untapped in many low- and middle-income countries. Different sectors have different contributions to make towards solving specific health problems. The authors argue that in each case, the profile, interests, incentives, and relationships of key individuals and sectors must be mapped and analysed to inform the design of approaches and systems to tackle a shared problem. The authors argue that collaborative and distributed leadership is key for effective governance of multi-sectoral action, with a need to build leadership capacity across sectors and levels of government and cultivate champions in different sectors who can agree on common objectives. They present options for countries to take a multi-sectoral approach for health, including ensuring that the universal health coverage agenda addresses the capacity of the health sector to work with other sectors, learning from multi-sectoral efforts that do not involve the health sector, improving the capacity of global institutions to support countries in undertaking multi-sectoral action, and developing a clear implementation research agenda for multi-sectoral action for health.
This review identifies an agenda for global health by highlighting the current 'grand challenges' related to governance. Sources included literature from the disciplines of health policy and medicine, conference presentations and documents, and materials from international agencies (such as the World Health Organization). The present approach to global health governance has proven to be inadequate and major changes are necessary. There are a number of areas of controversy. The source of problems behind the current global health governance challenges have not always been agreed upon, but this paper attempts to highlight the recurrent themes and topics of consensus that have emerged in recent years. Growing points and areas timely for developing research are identified. A solution to the 'grand challenges' in global health governance is urgently needed to serve as an area for developing research.
There is no standard definition of a community. The term “community” has been used to describe interactions among people in primarily geographic terms. But it is now accepted that people who live in close proximity to one another do not necessarily constitute a community, since they may differ with respect to value systems and other cultural characteristics that are more relevant to the social concept of community. Some have argued that the defining feature of a community is the common identity shared by its members. Thus, a single individual may belong simultaneously to different religious, vocational, or ethnic communities, or communities with distinct values and aspirations may inhabit a single geographic area. Even though community is determined largely by shared traditions and values, communities are not static and may accommodate multiple and even conflicting interpretations of their own traditions and values. Outsiders may also define community differently from insiders. The extent to which a community reflects these features is a measure of its cohesiveness. The authors argue that different levels of community cohesiveness or specific features may warrant different research protections.
The African Peer Review Mechanism (APRM), a tool designed to promote good governance on the continent, is built on the belief that the continent does not lack ideas to advance its development, but that states have struggled to live up to their principles and implement their policies. The APRM rests on the fundamental belief that good governance is a precondition for taking Africa out of its spiral of conflict, underdevelopment, poverty and increasing marginalisation in a globalised world. Looking back almost a decade after the APRM was first conceived, Grappling with Governance explores how this complex process has evolved from theory to practice in a variety of contexts. In a combination of case studies and transversal analysis, multiple voices from different African civil society actors - mainly analysts, activists and journalists - examine the process from their specialised perspective. The chapters tease out what can be learned about governance in Africa from these experiences, and the extent to which the APRM has changed the way that governments and civil society groups engage. This book demonstrates that undergoing review through the APRM can be messy, haphazard and full of reversals. Like any tool, the APRM’s effectiveness depends on the suitability of its design for the task at hand, the situation in which it is used, and the skill of its user. The different authors reflect on these characteristics as users of this tool. While it is ill-advised to draw universal conclusions, this book nevertheless demonstrates that the APRM has added value, sometimes in unexpected ways.
The newly appointed chief of UNICEF has come under heavy criticism from health activists worldwide. People's Health Movement, a global coalition of grass roots activists and academics, is launching a "UNICEF WATCH" to monitor the new director's 'anti-children' activities and thus defend UNICEF and the rights of children. Ms. Ann Veneman, former US Secretary of Agriculture, is set to begin a 5-year term as the Executive Director of UNICEF on May 2, 2005. "We will be monitoring her every move" said Todd Jailer, a spokesperson for the UNICEF WATCH.
Every day 37,000 people die from preventable diseases such as HIV/AIDS, malaria, and tuberculosis.* Most of these deaths are in the developing world where many life-saving drugs are unaffordable because they are patented under rules set by the World Trade Organisation (WTO). There is now a strong movement of governments, charities, churches, activist groups and health bodies urging the WTO to change these rules to allow countries the right to make vital medicines more cheaply. However a few rich WTO members - particularly the United States - are blocking these moves, and pressurising developing countries to apply even more restrictive rules at national level. Oxfam, Third World Network and Health Gap Coalition are part of a global alliance which is urging WTO members, in particular the US, to demonstrate their commitment to put people's health before the profits of powerful drugs companies. Will you help us change the WTO rules? Add your name to our petition which we will present to the WTO at its forthcoming summit.