This paper aimed to improve understanding about how district health managers perceive and use their decision space for human resource management (HRM) and how this compares with national policies and regulatory frameworks governing HRM. To assess the decision space that managers have in six areas of HRM (e.g. policy, planning, remuneration and incentives, performance management, education and information) the study compares the roles allocated by Uganda’s policy and regulatory frameworks with the actual room for decision-making that district health managers perceive that they have. Results show that in some areas District Health Management Team (DHMT) members make decisions beyond their conferred authority while in others they do not use all the space allocated by policy. DHMT members operate close to the boundaries defined by public policy in planning, remuneration and incentives, policy and performance management. However, they make decisions beyond their conferred authority in the area of information and do not use all the space allocated by policy in the area of education. DHMTs’ decision-making capacity to manage their workforce is influenced by their own perceived authority and sometimes it is constrained by decisions made at higher levels. The authors conclude that decentralization, to improve workforce performance, needs to devolve power further down from district authorities onto district health managers. DHMTs need not only more power and authority to make decisions about their workforce but also more control over resources to be able to implement these decisions.
Governance and participation in health
This study investigated how evidence used in the planning process affects decision-making and how stakeholders involved in planning perceived the use of evidence. Quantitative data was collected from district health annual work plans for 2012-2016 and from 'bottleneck analysis reports' for these years. Qualitative data was collected through semi-structured interviews with key informants from the two study districts. District managers reported that they were able to produce more robust district annual work plans when they used district-specific evidence. Approximately half of the prioritised activities in the annual work plans were evidence based. Procurement and logistics, training, and support supervision activities were the most prioritised activities. District-specific evidence and a structured process for its use to prioritise activities and make decisions in the planning process at the district level helped to systematise the planning process. However, the districts also reported having limited decision and fiscal space, inadequate funding and high dependency on external funding that did not always allow for the use of their own district evidence in planning .
While many civil society activists continue to face traditional forms of repression, like imprisonment, some governments have become more subtle in their efforts to curb civil society organisation (CSO) space. This report provides illustrative examples of the legal barriers used to constrain this space. It also considers major challenges, such as restrictions on the use of new technologies, measures against public movements and peaceful assemblies, and the unintended consequences of efforts to enhance the effectiveness of foreign aid. After a discussion of the international principles protecting civil society, which are embedded in international law, ICNL calls on democratic governments and international organisations to recognise, protect, and promote fundamental rights to freedom of assembly and of association, and to raise the level of their engagement with CSOs in platforms such as the Community of Democracies’ Working Group on Enabling and Protecting Civil Society and the UN Special Rapporteur’s mandate. At the same time, CSOs are urged to deepen their understanding of legal frameworks governing them and build capacity to engage in reform of regressive frameworks.
Today, civil society is facing serious threats across the globe, according to this report. Civil society activists continue to face traditional forms of repression, such as imprisonment, harassment, disappearances and execution. In addition, many governments have increasingly become more subtle in their efforts to limit the space in which civil society organisations (CSOs), especially democracy and human rights groups, operate. In the report, the World Movement for Democracy (WMD) highlights the well-defined international principles protecting civil society and underscoring proper government-civil society relations, which are already embedded in international law. These principles include: the right of CSOs to entry (that is, the right of individuals to form and join CSOs); the right to operate to fulfill their legal purposes without state interference; the right to free expression; the right to communication with domestic and international partners; the right to freedom of peaceful assembly; the right to seek and secure resources, including the cross-border transfer of funds; and the state’s positive obligation to protect CSO rights. WMD calls for greater collaboration between civil society and government.
The global health system has faced significant expansion over the past few decades, including continued increase in both the number and diversity of actors operating within it. However, without a stronger understanding of what the global health system encompasses, coordination of actors and resources to address today’s global health challenges will not be possible. This study presents a conceptually sound and operational definition of the global health system. Importantly, this definition can be applied in practice to facilitate analysis of the system. The study tested the analytical helpfulness of this definition through a network mapping exercise, whereby the interconnected nature of websites representing actors in the global health system was studied. Using a systematic methodology and related search functions, 203 global health actors were identified, representing the largest and most transparent list of its kind to date. Identified global health actors were characterised and the structure of their social network revealed intriguing patterns in relationships among actors. These findings are argued to provide a foundation for future inquiries into the global health system’s structure and dynamics that are critical to better coordinate system activities and ensure successful response to pressing global health challenges.
Representatives of organisations working on campaigns for health and social justice, as well as academia, governments and multilateral institutions, gathered in New Delhi from 2-4 May 2011 to address the need for an effective and accountable global governance for health. They believe that WHO needs to rediscover its fundamental multilateral identity. Drawing on its strengths, the organization has to take advantage of its reform process to rethink and reassert itself as the leading actor in a broader governance for health that is coherent with the need for solid public policy responses to the neoliberal prescriptions, so that globalization be shaped around the core values of equality and solidarity. Beyond mere institutional approaches, issues related to public policies in health have to be democratically debated and tackled at the local, national and regional level. This entails the continued participation and meaningful contribution of communities, public opinions, and their direct empowerment through education and knowledge sharing. Health democracy, namely participation, transparency and accountability in health, is a pre-condition for countries to make an impact in the decision making processes at the global level, within WHO and in other multilateral fora.
Broad public services most important to the poor - health and education - are also the services most vulnerable to three distortions of the political marketplace: Lack of information among voters about politician performance; Social fragmentation among voters manifested as identity-based voting; and Lack of credibility of political promises to citizens. This is according to a World Bank Policy Research Working Paper. For decentralization to have a positive impact on social services, says the Paper, voters must be more likely to use information about the quality of local public goods in making their voting decisions for local elections, and political promises to voters at large must be more credible than when decision-making over local public goods was in the hands of regional or national governments. Support for better education and health outcomes, and support for political party development and the development of political institutions are important elements to enhance credibility in the political system.
In varying degrees, most developing regions have formally embraced the democracy and development agenda and recognised the ‘democratic advantage’ in terms of delivering development. In Africa, a stream of policy declarations have been issued, pointing to the positive links between democracy and development. Both the NEPAD and the Africa Peer Review Mechanism (APRM) are premised on this belief. This analysis confirms that there are few dissenting voices when it comes to formally recognising the potential added value of democracy for development. Yet do these high expectations resist the test of reality? How do democratic processes actually operate in third countries? Admittedly, the impact of democracy on development is not simple and straightforward. Challenges include the current trend for democracy to be on the defensive, doubts about the delivery capacity of democracy and the difficulty of initiating and continuing dialogue on democracy. This paper offers key insights on the link between democracy and development.
Between 2007 and April 2011, 35 governments across Africa have either passed or are about to pass legislation restricting activities and the existence of civil society organisations (CSOs), according to this review. The trend is even more troublesome, the African Civil Society Platform on Principled Partnership (ACPPP) argues, when one considers that, in about 20 of these cases, the laws are similar in content. What began as a genuine call for mutual accountability and harmonisation of development effort between external funders, governments and CSOs has turned into a wave of legislation and policies targeting CSOs that do not appear to conform to government choices. The review draws from over 17 studies conducted between 2008-2011, discussions with CSOs from 30 countries across Africa, and review of work of several CSOs in conflict prevention and peace building. The ACPPP argues that neither the Paris Principles nor the CSO Principles for Development Effectiveness will be sufficient to deal with the current wave of legislation limiting CSOs. In seeking to reverse this trend, ACPPP proposes that the problem of shrinking space for civil society participation be addressed in its broader perspective, and not just as a violation of human rights, freedom of association or of CSO regulation. The attack on CSOs is about control of power and not regulation. This calls for support for democracy and good governance as drivers of development, the authors argue, particularly in situations of conflict and fragility.
Local democracy and the involvement of local communities in the provision of social services are central issues in the local government reforms that are presently being implemented in many developing countries. At the same time, institutions that run parallel to local authorities, such as social funds and various user-committees, are established to improve accountability and participation. By focusing on actual political processes rather than administrative, legal, and fiscal aspects of decentralisation, this article traces the breakdown of two development projects in Tanzania to the existence of parallel structures, and suggests that user-committees and social funds should be integrated in local authority structures to avoid fragmentation of participation and to enhance local democracy.