Governance and participation in health

Conflicts of interest: an invisible force shaping health systems and policies
Rahman-Shepherd A; Balasubramaniam P; Gautham M; et al: The Lancet Global Health 9(8), E1055-E1056, 2021

Despite frustration about why public health evidence does not influence policy decisions as much as it should, there has been little attention to a fundamental force in decision making: conflicts of interest. Conflicts of interest arise when the potential for individual or group gain compromises the professional judgment of policy makers or health-care providers, and underpin rent-seeking and informal practice across the world. The authors characterise three different types of conflicts of interest that are particularly pervasive in mixed or pluralistic health systems that need to be considered in health policy and research: The first type occurs when policy makers or regulators have multiple or dual roles.The second type occurs because of hidden financial relationships between formal and informal health-care providers. The third type occurs when policy makers are influenced into taking a course of action that is more likely to win political support, rather than following public health evidence.

Cape Town in common: a handbook to reclaim local democracy in our city
Rossouw J: Bertha Foundation, South Africa

This handbook aims to support people across the city of Cape Town assert their democratic rights, and to come together to take charge of their wards. Unemployment, poverty and violence are deeply entrenched in the city which remains spatially divided and stubbornly unequal and the handbook discusses ways to bring everybody living in the ward together, across historical divides, to deliberate and get involved in finding practical solutions to the problems. This handbook supports this with a ‘manifesto of ordinary ideas’ and practical ideas and tactics to reclaim local democracy.

The health policy response to COVID-19 in Malawi
Mzumara G; Chawani M; Sakala M, et al: BMJ Global Health, 6:e006035, 2021

Malawi declared a state of national disaster due to the COVID-19 pandemic on 20th March 2020 and registered its first confirmed coronavirus case on 2 April 2020. This paper documents decisions made in response to the COVID-19 pandemic from January to August 2020. Malawi's response to the pandemic was found to have been multi-sectoral and implemented through 15 focused working groups termed clusters. Each cluster was charged with providing policy direction in their own area of focus. All clusters then fed into one central committee for major decisions and reporting to head of state. This led to a range of responses, including an international travel ban, school closures at all levels, cancellation of public events, decongesting workplaces and public transport, mandatory face coverings and testing symptomatic people. Supportive interventions included risk communication and community engagement in multiple languages and over a variety of mediums, as well as efforts to improve access to water, sanitation, nutrition and unconditional social-cash transfers for poor urban and rural households.

Community perspectives on the COVID-19 response, Zimbabwe
Mackworth-Young C; Chingono R; Mavodza C; Grace G; et al: Bulletin of the World Health Organisation 99(2) 85–91, 2021

The authors investigated community and health-care workers’ perspectives on COVID-19 and on early pandemic responses during the first 2 weeks of national lockdown in Zimbabwe between March and April 2020. Phone interviews were done with with one representative from each of four community-based organizations and 16 health-care workers involved in a trial of community-based services for young people. In addition, information on COVID-19 was collected from social media platforms, news outlets and government announcements. Data were analysed thematically. It emerged that individuals were overloaded with information but lacked trusted sources, which resulted in widespread fear and unanswered questions; communities had limited ability to comply with prevention measures, such as social distancing, because access to long-term food supplies and water at home was limited and because income had to be earned daily; health-care workers perceived themselves to be vulnerable and undervalued because of a shortage of personal protective equipment and inadequate pay and other health conditions were side-lined because resources were redirected, with potentially wide-reaching implications. The authors recommend providing communities with basic needs and reliable information to enable them to follow prevention measures, health-care workers with personal protective equipment and adequate salaries and sustaining health-care services for conditions other than COVID-19.

The Contribution of Social Dialogue to Gender Equality
International Labour Organisation: ILO, Geneva, 2021

This thematic brief discusses actions that governments, employers’ and workers’ organisations, can take to advance gender equality through social dialogue, drawing on case studies from around the world, in different sectors, in the formal or the informal economy, and during the pandemic. It identifies the circumstances and factors that can help bring about transformative change. The brief examines the role of social dialogue in the application of relevant International Labour Standards on gender equality, including the ground-breaking Violence and Harassment Convention, 2019 (No. 190) and Recommendation No. 206 on the same subject matter. It concludes with some key recommendations for governments and employers’ and workers’ organisations.

Cape Town Together: organizing in a city of islands
Writers’ Community Action Network: ROAR Mag, South Africa, June 2020

An emerging movement of self-organized, decentralized community action networks is responding to the local realities of COVID-19 in Cape Town, South Africa. It reflects an unprecedented city-wide response to COVID-19, based on principles of self-organizing, mutual aid and social solidarity. In early March 2020, just as South Africa was waking up to the spectacle of COVID-19 within its borders, a group of community organizers, activists, public health folk and artists came together and kick-started a community-led response to the pandemic. This became known as Cape Town Together, a growing network of neighbourhood-level Community Action Networks (CANs) spread across the city. The CANs act locally, while also sharing collective wisdom and various resources through the broader network of Cape Town Together. They work collaboratively, recognizing that everyone brings something to the table. Some are weavers and builders, others are storytellers, caregivers or healers. Some are disruptors whilst others are experimenters and guides. The CANs have galvanized a significant number of people from across the city around a shared experience. Many are seeing the inequality exposed by COVID-19 in a new light and will remain galvanized beyond the immediate crisis.

Community engagement: a health promotion guide for universal health coverage in the hands of the people
World Health Organization: WHO, Geneva, 2020

WHO has defined community engagement as “a process of developing relationships that enable stakeholders to work together to address health-related issues and promote well-being to achieve positive health impact and outcomes”. The organisation notes undeniable benefits to engaging communities in promoting health and wellbeing. This guide is intended for change agents involved in community work at the level of communities and healthy settings.

In, against, beyond, corona
Butler M, Church Land Programme: Daraja Press, October 2020

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.

None of us are safe, until we are all safe
Valley D; Brady L; Magiligwana A; Mgedle M: Cape Town Together, 2020

This video, accompanying a song by Mzikhona Mgedle from the Langa Community Action Network (CAN), captures the dynamism and energy of Cape Town Together and the Community Action Networks while highlighting the many ways in which COVID-19 has challenged South Africans to demonstrate new and better forms of solidarity. Across the geographic, economic and social barriers that are a consequence of Apartheid history, community-led COVID-response networks are forming partnerships based on trust, inter-personal connection and shared goals. The music video draws footage from a range of CAN projects, including community kitchens, medicine-delivery schemes and food gardens to demonstrate the power of collective action. As the song states, none of us are safe, until we are we are all safe

Parent-child communication about sexual issues in Zambia: a cross sectional study of adolescent girls and their parents
Isaksen K; Musonda P; Sandøy I: BMC Public Health 20(1120), doi:, 2020

This study from Zambia in 2018 examines the sociodemographic and psychosocial factors that are associated with whether parents communicate with their daughters about sexual issues, through structured, face to face interviews with 4343 adolescent girls and 3878 parents. Adolescent girls who felt connected to their parents and those who perceived their parents to be comfortable in communicating about sex were more likely to speak to their parents about sexual issues than those who did not. Girls whose parents used fear-based communication about sexual issues, and those who perceived their parents as being opposed to education about contraception, were less likely to do so. Girls enrolled in school were less likely to communicate with their parents about sex than those out of school. The authors suggest that parents can improve the chances of communicating with their children about sex by conveying non-judgmental attitudes, using open communication styles and neutral messages.