Governance and participation in health

Implementing Creative Methodological Innovations for Inclusive Sustainable Transport Planning
i-CMiiST,: Urban dialogue, Nairobi, 2018

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.

Patient-led active tuberculosis case-finding in the Democratic Republic of the Congo
André E; Rusumba O; Evans C; et al: Bulletin of the World Health Organization 96(8) 522–530, 2018

The paper seeks to investigate the effect of using volunteer screeners in active tuberculosis case-finding in South Kivu, the Democratic Republic of the Congo, especially among groups at high risk of tuberculosis infection. In order to identify and screen high-risk groups in remote communities, the authors trained volunteer screeners, mainly those who had themselves received treatment for tuberculosis or had a family history of the disease. A non-profit organization was created and screeners received training on the disease and its transmission at 3-day workshops. Screeners recorded the number of people screened, reporting a prolonged cough and who attended a clinic for testing, as well as test results. Data were evaluated every quarter during the 3-year period of the intervention (2014–2016). Acceptability of the intervention was high. Volunteers screened 650 434 individuals in their communities, 73 418 of whom reported a prolonged cough; 50 368 subsequently attended a clinic for tuberculosis testing. Tuberculosis was diagnosed in 1 in 151 people screened, costing 0.29 United States dollars per person screened and US$ 44 per person diagnosed. Although members of high-risk groups with poorer access to health care represented only 5.1% of those screened, they contributed 19.7% of tuberculosis diagnoses. The intervention resulted in an additional 4300 sputum-smear-positive pulmonary tuberculosis diagnoses, 42% of the provincial total for that period. Patient-led active tuberculosis case-finding represents a valuable complement to traditional case-finding, and should be used to assist health systems in the elimination of tuberculosis.

Standing up for our lives: A history of the access to medicines movement in South Africa
Section 27: South Africa, 2018

Twenty years ago, a group of activists came together to demand access to treatment for all people living with HIV. The introduction of highly effective combination antiretroviral (ARV) therapy offered hope. Yet their high price meant that they were entirely unavailable in the public health system and out of reach for millions of people. In 1998, ARVs cost US$10 000 per year. Demanding access to treatments, activists from the Treatment Action Campaign (TAC), Médecins Sans Frontières (MSF) and the AIDS Law Project, later incorporated as SECTION27 helped to spur a global movement that radically reduced the prices of HIV medicines. Using skilled legal advocacy, high-quality research, social mobilisation, and public education, these activists transformed the global conversation on drug pricing, making it possible for millions of people to access treatment. Yet despite the remarkable success in increasing access to HIV medicines, this paper notes that systemic problems remain entrenched. New medicines to treat drug-resistant TB, cancers, and many other conditions remain far too expensive. As South Africa develops its intellectual property framework, they argue that it is worth revisiting the strategies, successes, and shortcomings of the access to medicines movement for the insights they may offer. The authors observe that a battle that began nearly twenty years ago engaging pharmaceutical giants and recalcitrant governments continues today. This interactive website showcases their story.

Governance and Equity-oriented Policies for Urban Health
Shakim C: ECSA HC Best Practices Forum, Arusha, Tanzania, 2018

This presentation given at the ECSA HC Best Practices Forum 2018 provides an overview of urban poverty and global commitments to equity oriented policies for urban health; urban health challenges in Sub-Saharan Africa; examples of how youth and community engagement could inform change and how to support the development of governance and equity oriented policies. The author notes that unmanaged urban growth is linked with rising social and economic inequities that benefit the well off and negatively impact health and well-being of the poor and disadvantaged; and that densely packed areas with low levels of sanitation services offer a petri dish for infectious diseases. This contributes to higher cost of living, high risk of school dropout and teenage pregnancy and high rates of crime and violence. Shakim provides evidence of youth as agents of change in urban Tanzania through the Tandale Health Centre.

Digital Democracy, Analogue Politics
Nanjala N: Zed Books, 2018

From the upheavals of recent national elections to the success of the #MyDressMyChoice feminist movement, digital platforms have already had a dramatic impact on political life in Kenya – one of the most electronically advanced countries in sub-Saharan Africa. While the impact of the Digital Age on Western politics has been extensively debated, there is still little appreciation of how it has been felt in developing countries such as Kenya, where Twitter, Facebook, WhatsApp and other online platforms are increasingly a part of everyday life. Written by a respected Kenyan activist and researcher at the forefront of political online struggles, this book presents a unique contribution to the debate on digital democracy. For traditionally marginalised groups, particularly women and the disabled, digital spaces have allowed Kenyans to build new communities which transcend old ethnic and gender divisions. But the picture is far from wholly positive. Digital Democracy, Analogue Politics explores the drastic efforts being made by elites to contain online activism, as well as how ‘fake news’, a failed digital vote-counting system and the incumbent president's recruitment of Cambridge Analytica contributed to tensions around the 2017 elections. Reframing digital democracy from the African perspective, Nyabola’s work opens up new ways of understanding our current global online era.

Key Considerations for Accountability and Gender in Health Systems in Low- and Middle-Income Countries
Waldman L; Theobald S; Morgan R: Institute of Development Studies (IDS) Bulletin 49(2), doi:, 2018

This article poses questions, challenges, and dilemmas for health system researchers striving to better understand how gender shapes accountability mechanisms, by critically examining the relationship between accountability and gender in health systems. It raises three key considerations, namely that: (1) power and inequities are centre stage: power relations are critical to both gender and accountability, and accountability mechanisms can transform health systems to be more gender-equitable; (2) intersectionality analyses are necessary: gender is only one dimension of marginalisation and intersects with other social stratifiers to create different experiences of vulnerability and there is a need to take account of how these stratifiers collectively shape accountability; and (3) empowerment processes that address gender inequities are a prerequisite for bringing about accountability. The authors suggest that holistic approaches to understanding health systems inequities and accountability mechanisms are needed to transform gendered power inequities, impact on the gendered dimensions of ill health, and enhance health system functioning.

Ugandan citizens unite against social media tax
Agence France Press: News24, July 2018

Politicians, clerics, feminists and others have formed a broad coalition of Ugandans calling for an end to a social media tax. In July, Uganda's communications regulator blocked access to social media including WhatsApp, Facebook and Twitter, as well as dating sites Tinder and Grindr, unless users pay a Shs200 ($0.05) daily tax. Mobile internet users now have to input a telephone code to pay the tax before they are able to access most social media sites, although implementation has proved patchy with some blocked services still available. Some have turned to virtual private networks (VPNs) to disguise their location and avoid the levy, a trick learned during elections two years ago when the government tried to shut down social media. President Yoweri Museveni - a Twitter user with 855 000 followers - is reported to have urged the imposition of the tax earlier this year, to put an end to "gossip". The protesters are resisting the measure and calling for it to be lifted.

Inverted State and Citizens’ Roles in the Mozambican Health Sector
Dias J; Tomé T: Institute of Development Studies (IDS) Bulletin 49(2), doi:, 2018

This article explores the inversion of roles between the state and citizens, by exploring its historical roots and current implications for processes of social accountability in Mozambique, particularly in the health sector. This is a practice-based reflection grounded in the evidence collected through the implementation of community scorecards in the health sector in 13 districts of Mozambique. The evidence reveals a transfer of responsibilities from local governance institutions and service providers to the communities; diluting the frontiers between the state and citizens’ duties and rights, resulting in the inversion of roles. This inversion results in the minimisation of the state’s performance of its duties and accountability in the health sector to respond to local communities’ needs, allegedly due to the lack of financial resources. The authors suggest that it leads to the overburdening of local communities, who assume the responsibility of meeting their own demands, risking participation fatigue.

Defining the global health system and systematically mapping its network of actors
Hoffman S; Cole C: Globalisation and Heath 14(38), doi:, 2018

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.

How Ugandans are mapping their neighbourhoods to Solve Energy and Health-Related Risks
Urban Action Lab, Makerere University Uganda, 2016

The Urban Action Lab of Makerere University Uganda, is a lead partner of Co-designing Energy Communities (CO-DEC), a collaborative research project in Kampala and Nairobi, which is fostering cross-sector learning amongst university students and local community members to scale up local energy solutions, such as briquette-making, and create highly accurate maps of risk-prone businesses, infrastructure and residential dwellings, in regards to the use of traditional and modern energy sources. The community co-researchers collaborated with academics from Makerere University to map their own neigbourhood of Kasubi-Kawaala, in order to address in-and outdoor air pollution associated with poor management of wastes, leaky toilet seals and sewer pits, the use of biomass and fossil fuels from the informal urban economy. The maps were boundary objects for community-led learning and action that linked participating organisations and individual co-researchers to local sustainability-oriented experiments around regenerative use of wastes for energy briquettes; planting of indigenous trees with leafy canopies that reduce air pollutants in homesteads and around business premises; while building consensus on the policy options for enabling actors from Kampala Capital City Authority to own and energetically pursue an agenda for scaling up alternative energy solutions that bring about co-benefits in the health and housing sector.