Governance and participation in health

Knowledge integration in One Health policy formulation, implementation and evaluation
Hitziger M; Esposito R; Canali M; et al: Bulletin World Health Organisation 96(3) 211–218, 2018

The One Health concept covers the interrelationship between human, animal and environmental health and requires multi-stakeholder collaboration across many cultural, disciplinary, institutional and sectoral boundaries. Yet, the implementation of the One Health approach appears hampered by shortcomings in the global framework for health governance. Knowledge integration approaches, at all stages of policy development, could help to address these shortcomings. The identification of key objectives, the resolving of trade-offs and the creation of a common vision and a common direction can be supported by multi-criteria analyses. Evidence-based decision-making and transformation of observations into narratives detailing how situations emerge and might unfold in the future can be achieved by systems thinking. Finally, transdisciplinary approaches can be used both to improve the effectiveness of existing systems and to develop novel networks for collective action. To strengthen One Health governance, the authors propose that knowledge integration becomes a key feature of all stages in the development of related policies and suggest several ways in which such integration could be promoted.

Lessons learnt from implementation of the International Health Regulations: a systematic review
Amitabh S; Allen L; Cifuentes S: Bulletin of the World Health Organisation 96(2)110-121E, 2017

While bi- and multilateral communication and collaboration are the foundation for global control of infectious disease epidemics, they are strengthened by the International Health Regulations (IHR). Although IHR (2005) describes what must be achieved by countries, there is limited knowledge on how countries should proceed in achieving the core capacities. To fill this gap and accelerate implementation of IHR (2005), the World Health Assembly in 2015 identified a need to evaluate and share the lessons learnt from countries that have implemented IHR (2005). This systematic review was conducted in accordance with Enhancing Transparency in Reporting the Synthesis of Qualitative Research guidelines, using a predefined protocol. The authors identified five global lessons learnt that related to multiple IHR (2005) core capacities. Some major cross-cutting themes included the need for mobilizing and sustaining political commitment; for adapting global requirements based on the local socio-cultural, epidemiological, health system and economic contexts; and for conducting baseline and follow-up assessments to monitor IHR (2005) status. The authors argue that despite considerable progress, countries that are yet to implement IHR (2005) core capacities may have insufficient human and financial resources to meet their obligations in the near future.

Factors influencing the capacity of women to voice their concerns about maternal health services in the Muanda and Bolenge Health Zones, Democratic Republic of the Congo: a multi-method study.
Mafuta E; De Cock Buning T; Lolobi D; et al: BMC Health Services Research, Biology 18(37), doi:, 2018

This paper aims to identify factors that influence the capacity of women to voice their concerns regarding maternal health services at the local level. A secondary analysis was conducted of the data from three studies carried out between 2013 and 2015 in the context of a WOTRO initiative to improve maternal health services through social accountability mechanisms in the Democratic Republic of the Congo. Data from 21 interviews and 12 focus group discussions were analysed using an inductive content analysis. The women living in the rural setting were mostly farmers/fisher-women or worked at odd jobs. They had not completed secondary school. Around one-fifth was younger than 20 years old. The majority of women could describe the health service they received but were not able to describe what they should receive as care. They had insufficient knowledge of the health services before their first visit. They were not able to explain the mandate of the health providers. The information they received concerned the types of healthcare they could receive but not the real content of those services, nor their rights and entitlements. They believed that they were laypersons and therefore unable to judge health providers, but when provided with some tools such as a checklist, they reported some abusive and disrespectful treatments. Factors influencing the capacity of women to voice their concerns in Democratic Republic of the Congo rural settings were found to be mainly associated with insufficient knowledge and a socio-cultural context. These findings suggest that initiatives to implement social accountability have to address community capacity-building, health providers’ responsiveness and the socio-cultural norms .

From Kisiizi to Baltimore: cultivating knowledge brokers to support global innovation for community engagement in healthcare
Ibe C; Basu L; Gooden R; et al: Globalization and Health 14(19), doi:, 2018

Reverse Innovation has been endorsed as a vehicle for promoting bidirectional learning and information flow between low- and middle-income countries and high-income countries, with the aim of tackling common unmet needs. One such need, which traverses international boundaries, is the development of strategies to initiate and sustain community engagement in health care delivery systems. In this commentary, the authors discuss the Baltimore “Community-based Organizations Neighborhood Network: Enhancing Capacity Together” Study. This randomized controlled trial evaluated whether or not a community engagement strategy, developed to address patient safety in low- and middle-income countries throughout sub-Saharan Africa, could be successfully applied to create and implement strategies that would link community-based organizations to a local health care system in Baltimore, a city in the United States. Specifically, the authors explore the trial’s activation of community knowledge brokers as the conduit through which community engagement, and innovation production, was achieved. Cultivating community knowledge brokers holds promise as a vehicle for advancing global innovation in the context of health care delivery systems. As such, further efforts to discern the ways in which they may promote the development and dissemination of innovations in health care systems is warranted.

Working with Parliamentary Committees of Health to Tackle Health Issues in Africa
African Institute for Development Policy (AFIDEP), Network of African Parliamentary Committees of Health (NEAPACOH): Kenya, 2017

The Network of African Parliamentary Committees of Health (NEAPACOH), previously known as the Southern and Eastern Africa Parliamentary Alliance of Committees on Health (SEAPACOH)) is one of the active networks engaging members of parliament in Africa to strengthen the delivery of their functions of oversight, legislation and representation, in tackling health challenges in the region. This study sought to understand NEAPACOH’s contributions in strengthening parliamentary committees in Africa to tackle health and population challenges, and identify ways in which the network can become more effective in the delivery of its mandate. Given the integral role of information or evidence in the delivery of the parliamentary functions, the study had a special interest in understanding how the network promotes evidence-informed discharge of the health committee, to generate learning needed to strengthen NEAPACOH as well as inform future efforts aimed at strengthening the delivery of parliamentary functions in Africa.

2016 Report of Acute public health events assessed by WHO Regional Offices for Africa, the Americas and Europe under the International Health Regulations (2005)
World Health Organization: WHO, Geneva, 2017

The World Health Organization (WHO) and its Member States have committed, within the framework of the International Health Regulations 2005 (IHR), to detect, verify, assess and report events that may pose a risk to international public health. This report summarizes public health events detected, verified, assessed and reported in three WHO Regions, namely Africa, the Americas and Europe from 2001 to 2016, with a focus on 2016. This report illustrates the relevance and importance of conducting and sustaining epidemic intelligence activities in accordance to alleviate the burden and impact of epidemics and emergencies, and thus avoid interference with travel and trade. Achieving this early detection goal—to rapidly and effectively respond to emergencies—requires dedicated human resources, close collaboration across states, partners and other stakeholders, transparent information-sharing and sustained funding.

People’s everyday practices, not the elites of Davos, hold the human economy answer to inequality
Wegerif M: Pambazuka News, February 2018

The author comments that Oxfam has been successful in highlighting the gross and rapidly growing inequalities in the world in international fora, but critiques the approach of asking rich elites and their allies in governments to do the right thing as perpetuating the myth that there are no alternatives other than to depend on large corporations. The author argues that it is in people’s everyday practices that it is far more likely to find meaningful solutions to inequality and the seeds of a more human economy. He raises, for example, the issue of redistribution of assets, such as to address land inequality, as a more pertinent pathway for peoples practices to address societal inequality and challenge the structural power of the drovers of inequality.

SATUCC Holds Its 10th Delegates Congress in Dar-es-salaam
SATUCC: SATUCC Blog, Botswana, December 2017

SATUCC held a successful 10th Delegates’ Congress in Dar-es-salaam Tanzania under the theme: Defending and promoting democracy, human and trade union rights and decent work for all in SADC Region. The Congress debated and adopted policies on corruption, procurement and ethical guidelines, and on the marginalisation of women and youth in the SADC Region and their exclusion in decision making structures, both within trade unions and in national and regional development processes.

Citizen Voices, Community Solutions: Designing Better Transparency and Accountability Approaches to Improve Health
Transparency for Development: Harvard Kennedy School, USA, 2017

This study was designed to address the question of whether a community-led transparency and accountability program can improve health outcomes and community empowerment, and, if so, how and in what contexts. To answer this question, researchers and civil society organization partners co-designed a program that would activate community participation in improving maternal and newborn health outcomes. This report presents the design of the work that was implemented in 200 villages in Tanzania and Indonesia and studied using a mixed methods impact evaluation. The team faced challenges including how to best foster community participation, how to structure the information gathering and sharing component, how to facilitate social action in communities, and how to ensure communities review their successes and failures in implementing social actions.

Decision space for health workforce management in decentralized settings: a case study in Uganda
Alonso-Garbayo A; Raven J; Theobald S: Health Policy and Planning 32(Suppl 3) iii59–iii66, 2017

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.