Dear All,
I cross post the following snippets from the 'Health Systems Reporter' eldis-healthsystems@lyris.ids.ac.uk as it once again clearly illustrate that imposing health systems and ignoring the 'community voice' (top down) as is happening all too often everywhere (again) after brief spells of bottom up rhetoric (and some action) when there is a change in government / regime in countries.
Hopefully in the not too distant future there will be some sustained effort in this mode, not in isolation, but widespread enough in a region to make the lessons impossible to ignore to result in a rollout - still too idealistic?
Best wishes,
Jakes Rawlinson
Public Health, Limpopo Province, South Africa
When asked, community answer!
Publisher: Health and Development Networks, 2009
The Commission on AIDS in Asia (CAA) was an independent body established in 2006. Over a period of 18 months, the Commission conducted a thorough analysis of the developmental consequences of the AIDS epidemic in the region, and its medium- to long-term implications on the socio-economic environment. The Civil Society Representative of the Commission on AIDS in Asia aimed to help ensure that civil society opinion and input from the region was fully incorporated into the work it was mandated to accomplish. This document outlines the CAA from the perspective of Frika Chia Iskandar, who was the only civil society representative on the Commission and was entrusted to give the civil society voice and perspective into the CAA recommendations.
The author outlines the process of the Consultation and provides information on the methodology and survey findings. The document explains how the CAA report provided a unique opportunity to lobby for the inclusion of advocacy points and community perspectives to be included into the report. The civil society chapter and inclusion was different and significant because the community discussions and viewpoints went beyond the simplistic ''include community' stage to inclusion and discussion at a high-level. The following recommendations were made:
* civil society consultation is necessary to ensure that policy and programming planning is representative of the needs of affected communities
* broad civil society participation provides valuable contributions to enhance civil society representatives' ability to represent in bodies such as the CAA, UNAIDS Programme Coordinating Board, Global Fund to fight AIDS, Tuberculosis and Malaria and UNITAID
* civil society consultations can be simple, effective and replicable
* strong civil society consultations need to be fed back to the constituent base
* networks are effective mechanisms for engaging a broad range of stakeholders.
Available online at: www.eldis.org/go/topics/resource-guides/health-systems <http://www.eldis.org/go/topics/resource-guides/health-systems&id=41792&type=Document> &id=41792&type=Document
A literature review of district health systems in East and Southern Africa: facilitators and barriers to participation in health
Authors: L. L. Levers; F. I. Magweva; E. Mpofu
Publisher: EQUINET: Network for Equity in Health in Southern Africa, 2007
This Equinet paper reviews evidence on community voice, roles and participation in primary health care and district health systems in sub-Saharan Africa, and examines facilitators and barriers to participation. The paper finds that governments developed policies for dealing with community participation in local health care, but there was little, if any, implementation of these policies. Both national and international efforts to implement public health strategies often ignore local input and the delivery of 'decentralised' health care has often lost touch with local communities.
The paper concludes that community-orientated healthcare systems that are responsive to the needs of citizens are likely to be more successful in primary health care than those systems that have externally imposed mandates or are serving the needs of a distant provider. Local consultation is essential, and power relations among communities, health worker, bureaucrats and politicians need further analysis. The authors recommend that health systems need to be designed in a way that ensures social protection and universal coverage. Health services need to be delivered in systematic ways, but also in ways that systematically include the perspectives of those who receive services. Achieving this goal requires practical measures for empowering all people, including the poorest. [adapted from author]
Available online at: www.eldis.org/go/topics/resource-guides/health-systems <http://www.eldis.org/go/topics/resource-guides/health-systems&id=24680&type=Document> &id=24680&type=Document
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Jakes Rawlinson
Public Health, Limpopo Province, South Africa
Mailtol:RawlinsonJ@dhw.norprov.gov.za