Is tobacco control a development issue? How will the WHO's Framework Convention on Tobacco Control (FCTC) affect developing countries? What new research is needed to explore these issues? What do YOU think? id21 Health's email discussion aims to bring a broader development perspective to the tobacco control debate. Participants will include international and national policy-makers, health professionals, tobacco control agencies, NGOs and researchers from diverse academic disciplines. A summary of the discussion will be distributed to participants at the next round of negotiations on the FCTC in late November. To join the discussion, send an email to lyris@lyris.ids.ac.uk, with the message: ''subscribe tobacco Firstname Lastname", e.g. "subscribe tobacco Emily Smith".
Governance and participation in health
It is now more than 3 weeks since widespread xenophobic terror against foreign nationals has erupted in provinces across South Africa. To date, over 20,000 people in the Western Cape have been displaced, some are staying in community halls and local shelters, but many have been taken to refugee camps, some against their will. Across our country more than 50 000 people were displaced. The displaced peoples' calls for the UN including (UNHCR) intervention have only grown louder, and were the main demand at a rally and press conference held by them in Cape Town. The groups are concerned that the UN seems to publicly take a position that they cannot assist unless and until the South African government requests their intervention and are unsure when that is likely to happen. TAC observes that the humanitarian crisis in South Africa continues to deepen.
The Treatment Action Campaign (TAC) and the Public Service Accountability Monitor (PSAM) call on the Eastern Cape Premier to follow the example of his Kwa-Zulu Natal counterpart and provide the anti-retroviral drug, nevirapine, to HIV-positive pregnant mothers in the province. This joint call is made after careful consideration of the resources available to the Department of Health in the province. Research published by the Eastern Cape Department of Health, in the journal Epidemiological Notes, recognises that over 20% of women attending antenatal clinics in the province tested HIV positive in 2000. As a result it is estimated that in excess of 10 500 babies are born HIV positive in the Eastern Cape each year. TAC/PSAM believe that on the strength of the pilot studies conducted in Kwa-Zulu Natal, which delivered a 100% success rate, the lives of these infants could have been saved through the provision of nevirapine to pregnant mothers in the Eastern Cape.
As debate intensifies on the future of the post-2015 sustainable development agenda, participating organisations in Beyond 2015 came together to develop this joint position paper to advance the concept of just governance. Just governance in the post-2015 era would first require a reconception of sustainable development goals not as needs and services but as rights accessible to all. Just governance likewise implies that the framework that replaces the Millennium Development Goals must include an explicit focus on equality and equity across all development goals, geared towards ensuring that those who are most marginalised participate in the benefits of development. Finally, just governance implies accountable governance for all relevant actors at all levels, based on a clear mandate regarding who is responsible for what post-2015 commitments.
Members of the Kenya Parliament, specifically women, have expressed the need to close the evidence gap currently curtailing effective legislation and policy formulation. Speaking at a workshop organised by African Institute for Development Policy (AFIDEP) and the Parliamentary Caucus on Evidence-Informed Decision-Making (PC-EIDM), the Members of Parliament (MPs) acknowledged the critical role evidence plays towards enhancing their effectiveness in legislation, representation and policy-making. The workshop, which specifically targeted members of the Kenya Women Parliamentary Association (KEWOPA), provided an excellent opportunity for the women Parliamentarians to speak out on the challenges they are grappling with as legislators. Hon Naisula Lesuuda, a nominated Senator, Samburu County and the Deputy Chairperson of KEWOPA in the Senate, said that through the Association, women in Parliament play a critical role since KEWOPA’s mandate is to ensure that policies are gender-responsive, and that programmes related to women’s affairs get adequate resource allocation. Evidence is therefore of essence as the Association needs to ensure that its recommendations are evidence-informed. The MPs expressed their desire to use evidence to debate policy issues but the evidence is not readily available. There were also calls to digitise all data in the custody of various government ministries and to have it uploaded to an online portal to enhance its accessibility by Parliamentarians when need arises. In addition, the MPs noted that they would have achieved more during their current tenure had relevant evidence on pressing socio-economic challenges in their areas of jurisdiction been presented immediately they took over office. In a bid to identify strategies to enhance evidence use in Parliament, the members called attention to the need for the training of research and personal assistants.
A group of United Nations Special Rapporteurs today urged the Government of Kenya to reject legislation that would impose severe restrictions on civil society. “The Bill is an evidence of a growing trend in Africa and elsewhere, whereby governments are trying to exert more control over independent groups using so-called ‘NGO laws,’” the human rights experts warned. The Bill, which was presented to Parliament on 30 October, would amend Kenya’s Public Benefit Organization Act of 2012 and grant the Government sweeping powers to deny registration for such organizations, including non government organisations. It would also cap foreign funding at 15% of their total budgets and channel all their funding through a government body, rather than going directly to beneficiary organizations.
A new campaign has been launched, Kenyans for Tax Justice, speaking out against a new Value Added Tax (VAT) Bill, known popularly as the “Unga tax bill”. Activists are trying to raise awareness and compile a petition against the bill, which seeks to apply a 16% value added tax rate on basic commodities that have remained untaxed until now. When the bill was introduced to parliament in 2012, citizen welfare groups strongly opposed its adoption but it is now up for debate in parliament. The activists mobilising against the VAT bill say they want to use the campaign to highlight the government’s hypocrisy in increasing taxes for ordinary citizens, while at the same time giving multi-national companies major tax breaks. Government estimates place Kenya’s lost revenue from tax incentives to foreign investors at 100 billion Kenya shillings (1.1 billion dollars). Tax Justice Network Africa estimates that in 2010 and 2011, the government spent more than twice the country’s health budget on providing tax incentives.
Kenyan President, Mwai Kibaki, has assured members of the African Peer Review Mechanism (APRM) that his government is committed to undertaking far-reaching reforms in the management of public affairs and entrenchment in constitutionality. President Kibaki affirmed that Kenya’s process of reforming governance would continue and urged the APRM team to share their experiences, particularly positive developments realised in other parts of the world that would be of value to Kenya and other African nations. Prime Minister, Raila Odinga, noted that Kenya was a pioneer in the review mechanism and was keen to evaluate the status of the country’s governance and explore ways of improving weak areas. He added that Kenya was open to scrutiny by peers and looked forward to a full examination and recommendations for appropriate remedy for various challenges facing the nation and its people.
This article poses questions, challenges, and dilemmas for health system researchers striving to better understand how gender shapes accountability mechanisms, by critically examining the relationship between accountability and gender in health systems. It raises three key considerations, namely that: (1) power and inequities are centre stage: power relations are critical to both gender and accountability, and accountability mechanisms can transform health systems to be more gender-equitable; (2) intersectionality analyses are necessary: gender is only one dimension of marginalisation and intersects with other social stratifiers to create different experiences of vulnerability and there is a need to take account of how these stratifiers collectively shape accountability; and (3) empowerment processes that address gender inequities are a prerequisite for bringing about accountability. The authors suggest that holistic approaches to understanding health systems inequities and accountability mechanisms are needed to transform gendered power inequities, impact on the gendered dimensions of ill health, and enhance health system functioning.
In January the All Party Parliamentary Group (APPG) for Africa working in coalition with the APPG for Diaspora, Development and Migration and the APPG for Malawi hosted a meeting in parliament to hear oral evidence on UK visa refusals for African visitors. Participating organisations and individuals gave numerous accounts of conferences, festivals, collaborations and business and trade partnerships that had been undermined due to legitimate African participants being denied visas. Statistics show that UK visa refusals are issued at twice the rate for African visitors than for those from any other part of the world. Evidence strongly demonstrates that the UKVI system lacks consistency, intelligence and any accountability. The immediate cost, needing to access the internet and to pay in a foreign currency all present initial barriers. Other than the practical barriers faced by the applicants, the huge distances between the place of application and where the decisions are made means they are usually made away from local expertise, context and insight that would have previously be held at the High Commissions. The last report on visa services, from the Independent Chief Inspector in 2014 found that over 40% of refusal notices were “not balanced, and failed to show that consideration had been given to both positive and negative evidence”. The panel heard that applicants are often refused based on a lack of proof or information that was not required or even mentioned under the guidelines for the application. The meeting concluded that the current system was not designed but has organically grown into something that is not fit for purpose.