Urbanisation is one of Africa’s most pressing issues, according to this publication by African Centre for Cities. However, most political and policy leaders remain in denial about its centrality and urgency. The phenomenon represents the most complex and intractable policy questions and as long as Africans do not take responsibility to shift the contemporary situation of policy failure, we are in for a crisis, says the African centre for Cities. This publication is intended to be a resource to policy activists in African governments, development agencies, social movements, universities and business sectors who are committed to addressing the current inertia surrounding urbanisation policy development and should be of help activists to develop a clear agenda on urbanisation on the continent.
Values, Policies and Rights
This editorial welcomes the World Health Organisation’s (WHO) update of its 2003 publication ‘Safe abortion: Technical and policy guidance for health systems’. In updating its guidance on safe abortion, WHO has responded to a major neglected public health need of women, Fathalla and Cook argue here. Unsafe induced abortion is not only a public health problem, it is also a human rights issue. As governments are obligated by their national constitutions or by legally binding international human rights conventions to protect the right to the highest attainable standard of health, they should be increasingly applying human rights principles to facilitate women’s transparent access to safe abortion services in their countries. The WHO update highlights the growing trend for national courts and regional and international human rights bodies, including the United Nations treaty monitoring bodies, to take a rights-based approach to this issue. The authors call for abortion to be decriminalised, as well as for further research aimed at developing simpler, improved methods for performing induced abortion.
On 4-5 July 2012, the African Development Bank (AfDB), as a key partner of the Harmonisation for Health in Africa (HHA) mechanism, organised a high-level dialogue on ‘Value for Money, Sustainability and Accountability in the Health Sector’ in Tunis. The conference gathered over African 50 Ministers of Finance and Health and their representatives from 33 African countries, Parliamentarians as well as over 400 participants from the public and private sectors, academia, civil society and media globally. The conference emphasised the urgent need for greater domestic accountability, reduced dependence on foreign aid and the role of Parliamentarians as well as using e-health in achieving greater value money in the delivery of health services in Africa. Participants also stressed the need to tackle critical shortages, maldistribution and inadequate performance of health workers in Africa. Ethiopia’s Health Extension Worker (HEW) Programme was put forward as a good example of innovative policy interventions to health worker shortages.
Three countries in Southern Africa have the highest adult HIV prevalence in the world: Swaziland (25.9%), Botswana (24.8%), and Lesotho (23.6%). Fiscal policy is crucial for addressing this HIV and AIDS crisis, the authors of this paper argue. Utilising a calibrated model, they investigated the impact of fiscal policy on reducing the HIV and AIDS incidence rates in these countries. In particular, they studied the welfare impact of different taxation and debt paths in reducing the HIV and AIDS prevalence rates. This is particularly important given the current concerns about dwindling foreign aid (especially the Global Fund), and fiscal deterioration and sustainability in these countries. The results show that acting optimally has not only positive societal welfare effect but also positive fiscal effects. For example, it will alleviate the debt burden by 5%, 1% and 13% of the GDP respectively for Botswana, Lesotho and Swaziland by the year 2020. Thus, at a time of fiscal crisis in developed countries and dwindling international HIV and AIDS resources, the future of effective and efficient HIV and AIDS intervention in Africa is clearly domestic, they conclude.
Understanding the health policy formulation process over the years has focused on the content of policy to the neglect of context. This had led to several policy initiatives having a still birth or ineffective policy choices with sub-optimal outcomes when implemented. Sometimes, the difficulty has been finding congruence between different values and interests of the various stakeholders. This paper attempts to conceptualise the levers of policy formulation using a qualitative participant observation case study based on retrospective recollection of the policy process and political levers involved in developing the Ghana National Health Insurance Scheme. The study finds that technical experts, civil society, academics and politicians all had significant influence on setting the health insurance agenda. Each of these various stakeholders carefully engaged in ways that preserved their constituency interests through explicit manoeuvres and subtle engagements. Where proposals lend themselves to various interpretations, stakeholders were quick to latch on the contentious issues to preserve their constituency. The paper provides lessons which suggest that in understanding the policy process, it is important that actors engage with the content as well as the context to understand viewpoints that may be expressed by interest groups.
An Intellectual Property Laws Amendment Bill passed by Parliament is awaiting signature by South African President Jacob Zuma in order for it become the law. It is an ambitious piece of legislation that aims to provide protective mechanisms for indigenous knowledge in South Africa. The bill is far-reaching and aims to: improve the livelihoods of indigenous knowledge holders and communities, benefit the national economy, prevent bio-piracy, provide a legal framework for protection and empower local communities and prevent exploitation of indigenous knowledge. Despite this legal advance, there is another view on the issue of indigenous intellectual property rights which states that the issue will always remain on the margins, given the dominant system of knowledge production which in the main takes place in universities. The article concludes that the prevailing view is that given the history of persecution of indigenous peoples under colonialism, the fight to include their voices in the protection of indigenous knowledge systems is important and necessary to inform the way forward.
The conference gathered Ministers of Finance and Health and/or their representatives from 54 African countries, African parliamentarians as well as over 400 participants from the public and private sectors, academia, civil society and media globally. The conference recommended:
1. Intensified dialogue and collaboration between ministries of finance and health and with technical and financial partners; 2. Concrete measures to enhance value for money, sustainability and accountability in the health sector to reach universal health coverage; 3. Integrating socio-economic, demographic and health factors into broader development strategies and policies in an effective manner especially in the formulation of medium term strategic plans; 4. Designing effective investments in the health sector, based on evidence-based strategies leading to the prioritization of high impact interventions, which lead to results; 5. Promoting equitable investment in the health sector; ensure that health financing is pro-poor benefiting disadvantaged areas; strengthening regulatory capacity and developing of a strong African pharmaceutical sector as a growth and job creating sector in Africa; 6. Laying out the path to universal health coverage for each country; 7. Improving efficiency in health systems, including equitable access to skilled health workers; 8. Solidifying sustainable health financing systems; 9. Strengthening accountability mechanisms that align all relevant partners, build on the growing citizens’ voice and 10. Increasing domestic resources for health.
The 17th Conference of the Parties to the United Nations Convention on Climate Change (COP 17) that concluded in December 2011, in Durban, South Africa produced the Durban Platform for Enhanced Action that commits governments to developing a protocol, legal instrument, or an agreed outcome to cut greenhouse gas (GHG) emissions with legal force applicable to all countries by no later than 2015. Foreign ministers and environmental ministers set and drove the conference agenda, and economic considerations underpinned all discussions. Despite climate change posing grave risks to human health, the human health perspective on climate change was relegated to side-event, although it led to a parallel inaugural Global Climate and Health Summit, and the Durban Declaration on Climate and Health and Health Sector Call to Action. The report argues that the marginalisation of human health considerations at UN Fframework Convention on Climate Change conferences is untenable and that human health must be a core, not peripheral, focus at future meetings. The report states that the health community, led by health ministers, must play a central role in climate change deliberations and that health ethics principles must be afforded equal status to economics principles in climate change deliberations.
Health inequalities represent perhaps the most consequential global health challenge and yet they persist despite increased funding and innovative programmes. The United Nations is revising the Millennium Development Goals (MDGs) that will shape the world for many years to come. What would a transformative post-MDG framework for global health justice look like? A global coalition of civil society and academics - the Joint Action and Learning Initiative on National and Global Responsibilities for Health (JALI) - has formed an international campaign to advocate for a Framework Convention on Global Health (FCGH). Recently endorsed by the UN Secretary-General, the FCGH would reimagine global governance for health, offering a new post-MDG vision. This Special Communication describes the key modalities of an FCGH to illustrate how it would improve health and reduce inequalities. The modalities would include defining national responsibilities for the population’s health; defining international responsibilities for reliable, sustainable funding; setting global health priorities; coordinating fragmented activities; reshaping global governance for health; and providing strong global health leadership through the World Health Organisation.
An survey reported by the Zimbabwean on the Constitution found that 40% of those interviewed were in favour of the Constitution preserving full rights for women to have an abortion, while fewer(39%) believed it should be preserved only in certain instances which must be clearly stated by law. Only 19% were completely opposed to the Constitution preserving any rights for a woman to have an abortion. More men than women were in favour of full rights for women to seek an abortion. The government, which says it is aware of the practice of illegal abortions, promotes safe sex as a solution, but a spokesman for the Ministry of Health and Child Welfare admitted this was a huge challenge due to the unavailability of – and cultural resistance to – contraceptives. A largely Christian society, abortion in Zimbabwe is condemned by both the church and the state. Women who do choose the abortion route say that although a safe, legal abortion is exorbitant – around US$350 – it’s still a lot cheaper than the cost of giving birth to a child in a city hospital. Pregnant women who cannot afford the legal option are reported to resort to taking herbal remedies from traditional healers.