Governance and participation in health

Watch the GAP! A critical civil society perspective on the development, potential impact and implementation of the ‘Global Action Plan for Healthy Lives and Well-Being for All’
Koutsoumpa M; Nsibirwa; Schwarz T; et al: Kampala Initiative, July 2020

The authors review how the global plan fits with national health policies and ownership in Uganda, and global health governance. They report that despite a ‘whole-of-society’ approach, the decision-making power in the global plan remains with governments. Community and civil society participation are highlighted throughout the GAP and comprise one of its seven core themes. However, despite the announcement of the GAP plan in October 2018, it was not until June 2019 that a public consultation process started, seeking feedback from non-state and state actors to some chapters of the GAP. At the same time, the authors raise concern that a ‘whole-of-society’ approach opens the door for the private-for-profit corporate sector to engage in health, further encouraging a move to a privatised, undemocratic and inequitable global health governance. Without explicit and concrete frameworks for monitoring, mutual accountability and clear and effective participation to address ever-growing power imbalances, they question whether the goal of accelerating achievement of health for all by 2030 can be met, and suggest that the COVID-19 pandemic could be a first test case for the GAP.

We all have the same right to have health services: a case study of Namati’s legal empowerment program in Mozambique
Schaaf M; Falcao J; Feinglass E; Kitchell E; et all: BMC Public Health 20(1084) doi:, 2020

This paper is a case study of legal empowerment through community paralegals and Village Health Committees in Mozambique. The authors explored how community paralegals solved cases, the impact they had on health services, and how their work affected the relationship between the community and the health sector at the local level. Case resolution conferred a sense of empowerment to clients, brought immediate, concrete improvements in health service quality at the health facilities concerned and seemingly instigated a virtuous circle of rights-claiming. The program also engendered improvements in relations between clients and the health system. The authors identified three key mechanisms underlying case resolution, including: bolstered administrative capacity within the health sector, reduced transaction and political costs for health providers, and provider fear of administrative sanction.

Webinar: Africa and the Pandemic: Clampdown, Survival and Resistance
Review of African Political Economy: ROAPE, May 2020

The webinar, chaired by ROAPE’s Yao Graham in Ghana, asked what is happening across Africa since governments ordered the clampdown. The discussants looked at the impact on the continent of the Covid-19 pandemic and the measures taken against it. All the speakers addressed what was happening at grassroots and national level, and how the popular classes were being affected. Reporting from Kenya, Gacheke Gachihi and Lena Anyuolo asked if the state was really fighting Covid-19 or the poor? They argued that since the curfew was enforced across the country the police continue to brutalise and terrorise people living in informal settlements. Femi Aborisade reported a constant struggle for food and survival in Nigeria, and an intensification in the repression of the poor during the country’s lockdown. In South Africa, Heike Becker looked at the reaction of the government, the struggles of poor communities and the urgency of building new activist groups and politics in the country. Tafadwza Choto from Zimbabwe reported that the government was using the virus as a cover for wider repression. Taking on the broader political economy of the crisis, Gyekye Tanoh addressed how economies and politics are likely to be reshaped by the virus and its consequences, with a likely impact of the global recession on the continent, the IMF and IFI responses and the costs for workers, peasants, social movements, activists, and radical projects.

Action Voices: Bench Marks Foundation Community Monitoring School
Bench Marks Foundation: South Africa, 2013

The Bench Marks Foundation developed the concept of the Community Monitoring School because a vacuum of knowledge exists within communities when dealing with big corporations. The message of the Community Monitoring School is “nothing for us without us”. Tunatazama is a Kiswahili word that means “we are watching” and the 2013 school’s motto was “We are Watching You!” For any significant reform in the mines to occur, the present power and knowledge imbalances between corporations and communities need to be overcome. In Phase One of the school programme, the focus is on helping participants develop confidence and skills in documenting and analysing community problems. They write short articles on their observations and post these on the project’s website. Some of these articles appear in the first section of this publication. In Phase Two of the programme, direct action in the community is combined with school sessions on planning, review and evaluation. In the second section a reflective analysis is conducted on the process.

Aliens’ on the Copperbelt: Zambianisation, Nationalism and Non-Zambian Africans in the Mining Industry
Money D: Journal of Southern African Studies 45(5), 859-875, 2019

Following Zambia’s independence in 1964, several thousand non-Zambian Africans were identified and progressively removed from the Copperbelt mines as part of a state-driven policy of ‘Zambianisation’. Curiously, this process has been overlooked among the multitude of detailed studies on the mining industry and Zambianisation, which is usually regarded as being about the removal of the industrial colour bar on the mines. This article challenges that perspective by examining the position and fate of non-Zambian African mineworkers, beginning with patterns of labour recruitment established in the colonial period and through the situation following independence to the protracted economic decline in the 1980s. Two arguments are made by the author. First, Zambian nationalism and the creation of Zambian citizenship were accompanied on the Copperbelt by the identification and exclusion of non-Zambians, in contrast to a strand in the literature which stresses that exclusionary nationalism and xenophobia are relatively recent developments. Second, one of the central and consistent aims of Zambianisation was the removal of ‘alien’ Africans from the mining industry and their replacement with Zambian nationals as a key objective of the Zambian government, supported by the mineworkers’ union.

Farmworkers want 67 pesticides banned
Hendricks A: Ground up, August 2019

Over 200 women farm workers from across the Western Cape marched to Parliament on Wednesday demanding that the Department of Agriculture, Forestry & Fisheries (DAFF) and the Department of Labour work together to ban 67 pesticides to protect the health of farm workers. They also want farmers to be held accountable if they disobey labour practices. Research done by the 'Women on Farms' project showed that 73% of women seasonal workers interviewed did not receive protective clothing and 69% came into contact with pesticides within an hour after it had been sprayed. For safety, different pesticides have their own “re-entry period” that has to be adhered to. The WFP campaign to ban pesticides is also being supported by Oxfam South African and Oxfam Germany. With the memorandum, members from Oxfam Germany handed over a placard with 29,302 signatures on it from German consumers supporting the ban.

Key findings from parliamentary meeting on UK Visa refusals for African visitors to the UK
Bailey H: Royal African Society, February 2019

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.

Translating political commitment to real action to achieve universal health coverage in Africa
Badejo O: Health Systems Global, October 2019

Following the High-Level Meeting on Universal Health Coverage (UHC) UN member states are expected to show more financial and political commitment to accelerate progress towards UHC.. Different approaches have been taken by different countries in Africa for this. Rwanda has used affordable health finance and insurance mechanisms - financed by both the national government and individuals - as a crucial driver for UHC. In 2018, Kenya also unveiled a plan for reaching UHC by 2022 by piloting UHC in four counties. The prioritization of such policy options and the ways to implement them are seen to require a. context-dependent balancing act that should be grounded in the correct application of evidence in decision-making processes. This is obserbed to demand measures to build individual and institutional capabilities to generate and use evidence to support value-based design and implementation of relevant system-level policy reforms for UHC.

Decision-making in district health planning in Uganda: does use of district-specific evidence matter?
Henriksson D; Peterson S; Waiswa P; Fredriksson M: Health Research Policy and Systems 17(57), 1-11, 2019

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 .

The ghost battalion: On the Sudanese Professionals Association (SPA) the organized force behind the revolutionary uprising in Sudan
Majdoub S: Africa is a Country, August 2019

In Sudan, the Tajamoo al-mihanyin al-sudaniyin or the Sudanese Professionals Association (SPA) is an alliance of independent professionals shrouded in mystery. Described as the “ghost battalion” by the now-deposed president Omar al-Bashir, the contemporary movement led by the SPA exerted influence on mobilizations and protest movements through sustained appeals, and built broad appeal and demonstrated a know-how of protests, applied within the social movement across the country. They initiated civil disobedience, rallies and marches in all parts of the country, focusing on women, displaced and exiled people, and on social justice and life on the margins. Moreover, they have taken the call to protest beyond the limits of major cities like Khartoum and across sectors—from resignation marches in outlying towns and provinces to the mobilization of dock workers in Port Sudan. The For a movement like the SPA there are challenges. Will its spirit remain strong or be exhausted? Will it be the guardian of this transition or its watchdog?