In July 2018 i-CMiiST, a Nairobi based organisation held an Urban Dialogue for to discuss the development of two key areas of the city - Yaya junction and Luthuli avenue. The aim of the dialogue was to engage the general public on issues affecting Nairobi streets, transit and mobility to feed into future interventions and approaches in the development of these areas. The theme of the dialogue was ‘safety on our streets’ looked at from different perspectives: pedestrians, commuters, drivers and cyclist safety. The dialogue involved about 30 people from different professions and backgrounds – engineers, planners, cyclists, urban designers, state actors, NGOs, business people etc. It was also live streamed on various social media platforms to involve a wider public, viz: KPF, Naipolitans and Placemaking Network Nairobi pages. Views and contributions came from people watching locally and from other countries while the inputs were recorded and an illustrator documented what participants were saying in a visual form.
Governance and participation in health
This review seeks to detail recent initiatives by non-governmental organisations (NGOs) and civil society organisations in improving development practice. There are several attempts to provide a ‘civil society or NGO’ parallel to the Paris Declaration. These initiatives seek some form of standardisation and evidence that NGOs are as effective as they claim to be, and to counter criticism that they have not been diligent in ensuring the quality of their delivery. However, seeking to justify oneself is not the best use of time and resources. Accountability needs to be improved. The survey indicated that many of the initiatives do not go far down the route of participation, despite a theoretical (rhetorical) commitment to beneficiary participation. Improved quality control is also required. Some of the models now available seek to improve the quality of delivery rather than the quality of impact. Thus an emphasis on things like complaints procedures, transparent, consistent and shared procedures, deal with how aid is delivered not what is delivered and whether it has any real impact. Regular assessments of efficiency, effectiveness and impact should be done. However, efficiency is not the same as effectiveness or impact. Improved efficiency does not automatically lead to more effective development or greater impact.
In this paper, the author analyses governance gaps in healthcare systems in sub-Saharan Africa and how they could be overcome, with a particular focus on the areas of budget and resource management, individual provider performance, health facility performance and corruption. She attributes poor governance to the effects of a range of factors. Budget leaks, which refer to the discrepancy between the authorised health budget and the amount of funds received by intended recipients such as frontline providers, undermine service provision, as do high levels of health worker absenteeism. Job purchasing, which refers to payments made by job-seekers in exchange for employment in the public sector, a practice that often bypasses appointing on merit, is another common practice, which results in poor quality staff. On the financial side, chronic underfunding of health facilities and corruption at management levels are the other dimensions of poor governance in the health sector. The author urges governments and external funders to not only focus on the input and outputs, but also to ensure that these resources are used effectively to ensure maximum impact on health outcomes.
Despite several years of implementation, prevention of mother-to-child transmission (PMTCT) programmes in many resource poor settings are failing to reach the majority of HIV positive women. This study reports on a data-driven participatory quality improvement intervention implemented in a high HIV prevalence district in South Africa. The intervention consisted of an initial assessment undertaken by a team of district supervisors, workshops to assess results, identify weaknesses and set improvement targets and continuous monitoring to support changes. Routine data revealed poor coverage of all programme indicators except HIV testing. One year following the intervention, large improvements in programme indicators were observed. Coverage of CD4 testing increased from 40 to 97%, uptake of maternal nevirapine from 57 to 96%, uptake of infant nevirapine from 15 to 68% and six week polymerase chain reaction (PCR) testing from 24 to 68%. It is estimated that these improvements in coverage could avert 580 new infant infections per year in this district.
In this article, the authors describe how governance issues have influenced human resources for health (HRH) policy development and to identify governance strategies that have been used, successfully or not, to improve HRH policy implementation in low- and middle-income countries (LMIC). They performed a descriptive literature review of HRH case studies which describe or evaluate a governance-related intervention at country or district level in LMIC. In total 16 case studies were included in the review and most of the selected studies covered several governance dimensions. The dimension 'performance' covered several elements at the core of governance of HRH, decentralisation being particularly prominent. Although improved equity and/or equality was, in a number of interventions, a goal, inclusiveness in policy development and fairness and transparency in policy implementation did often not seem adequate to guarantee the corresponding desirable health workforce scenario. This review shows that the term 'governance' is neither prominent nor frequent in recent HRH literature. It provides initial lessons regarding the influence of governance on HRH policy development and implementation. The review also shows that the evidence base needs to be improved in this field in order to better understand how governance influences HRH policy development and implementation. Tentative lessons are discussed, based on the case studies.
The author argues that responses to the recent outbreak of Ebola in West Africa were varied and many ineffective. More generally, the author suggests that it stems from a failure of international health justice as articulated by a range of legal institutions and instruments, and that it should prompt us to question the state and direction of approaches to the governance of global public health. This paper queries what might be done to lift global public health as a policy arena to the place of prominence that it deserves. It presents critical reasons for the failings of the global public health regime, including the marginalisation of health and equity in current economic individualist, monetised, market-focussed models and goals, and a fragmented, patchwork and ad hoc nature of the global public health architecture, with wide dispersion of the authority to act and a treatment-oriented and disease-specific focus. The paper articulates a new way forward, identifying three courses of action that might be adopted in realising better health outcomes and global health justice, namely value, institutional and legal reform.
This report shows that developing countries will only achieve healthy and educated populations if their governments take responsibility for providing essential services. Civil society organisations and private companies can make important contributions, but they must be properly regulated and integrated into strong public systems, and not seen as substitutes for them. Only governments can reach the scale necessary to provide universal access to services that are free or heavily subsidised for poor people and geared to the needs of all citizens – including women and girls, minorities, and the very poorest. But while some governments have made great strides, too many lack the cash, the capacity, or the commitment to act.
In a penetrating analysis of events in South Africa, Jonathan Grossman writes a linked analysis of the student mobilisations and of the workers at Marikana. The author that an old legacy of struggle is being rediscovered and rescued, reflecting a solidarity between workers and students taking action. Grossman argues that the struggle for free education and against outsourcing in the public sector at the universities now needs to become the struggle for free education at all levels and free basic services, against outsourcing and for a living wage across the whole of the public sector. He argues that this is necessary for the renewal of the workers movement to tap into the vitality of a student-worker alliance that enriches both struggles in South Africa with a more holistic vision.
The authors raise that the COVID-19 pandemic reveals what is wrong and toxic — in ourselves, in relation with others, and in relation with the rest of non-human nature and ask: 'is it possible to also look for what is good and life-affirming?' The authors argue that the future must be founded on ‘kindness, social solidarity and an appropriate scale of time’, a future that cherishes life and the connections that transcend borders. This pamphlet, part of Daraja Press’s Thinking Freedom Series, distills learnings from the work of activists on the ground in the Church Land programme in KwaZulu-Natal province, South Africa.
Anti-tobacco mass media campaigns have had good success at changing knowledge, attitudes, and behaviors with respect to smoking in high-income countries provided they are sustained. Mass media campaigns should be a critical component of tobacco control programs in low- and lower-middle-income countries, the authors of this article argue. Mounting evidence shows that graphic campaigns and those that evoke negative emotions run over long periods of time have achieved the most influence. These types of campaigns are now being implemented in low- and middle-income countries. The authors provide three case studies of first-ever graphic warning mass media campaigns in China, India, and Russia, three priority high-burden countries in the global Bloomberg Initiative to Reduce Tobacco Use. In each of these countries, message testing of core messages provided confidence in messages, and evaluations demonstrated message uptake. The authors argue that given the initial success of these campaigns, governments in low- and middle-income countries should consider resourcing and sustaining these interventions as key components of their tobacco control strategies and programmes.