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Liwanag HJ, James O, Frahsa A. A review and analysis of accountability in global health funding, research collaborations and training: towards conceptual clarity and better practice. BMJ Glob Health 2023; 8:e012906. [PMID: 38084477 PMCID: PMC10711908 DOI: 10.1136/bmjgh-2023-012906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 10/21/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION Accountability is a complex idea to unpack and involves different processes in global health practice. Calls for accountability in global health would be better translated to action through a better understanding of the concept and practice of accountability in global health. We sought to analyse accountability processes in practice in global health funding, research collaborations and training. METHODS This study is a literature review that systematically searched PubMed and Scopus for articles on formal accountability processes in global health. We charted information on processes based on accountability lines ('who is accountable to whom') and the outcomes the processes were intended for ('accountability for what'). We visualised the representation of accountability in the articles by mapping the processes according to their intended outcomes and the levels where processes were implemented. RESULTS We included 53 articles representing a wide range of contexts and identified 19 specific accountability processes for various outcomes in global health funding, research collaborations and training. Target setting and monitoring were the most common accountability processes. Other processes included interinstitutional networks for peer checking, litigation strategies to enforce health-related rights, special bodies that bring actors to account for commitments, self-accountability through internal organisational processes and multipolar accountability involving different types of institutional actors. Our mapping identified gaps at the institutional, interinstitutional and broader system levels where accountability processes could be enhanced. CONCLUSION To rebalance power in global health, our review has shown that analysing information on existing accountability processes regarding 'who is accountable to whom' and 'accountability for what' would be useful to characterise existing lines of accountability and create lines where there are gaps. However, we also suggest that institutional and systems processes for accountability must be accompanied by political engagement to mobilise collective action and create conditions where a culture of accountability thrives in global health.
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Affiliation(s)
- Harvy Joy Liwanag
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Oria James
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Annika Frahsa
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
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Nascimento Neto P, Procopiuck M. COVID19 in Latin America: informal settlements and the politics of urbicide. GEOJOURNAL 2022; 88:2609-2622. [PMID: 36212198 PMCID: PMC9526205 DOI: 10.1007/s10708-022-10765-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 09/23/2022] [Indexed: 06/02/2023]
Abstract
Informal settlements in Latin America express pandemic idiosyncrasies, calling global attention to historical problems related to a specific urbanization pattern. This article stresses COVID19 implications in the main urban planning canon: the notion of densification as an urban solution. Traditionally invisible social groups and territories acquire relevance, but now as a source of biological risk. Urban density appears as a contradictory trigger point, outlining new debates about informal settlements and their metrics. Evidence shows that trends in health discourse are striving to legitimize and enhance "urbicides" in this scenario, already underway through State action or inaction.
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Affiliation(s)
- Paulo Nascimento Neto
- Graduate Program in Urban Management (PPGTU), Pontifícia Universidade Católica Do Paraná (PUCPR), Curitiba, Brazil
| | - Mario Procopiuck
- Graduate Program in Urban Management (PPGTU), Pontifícia Universidade Católica Do Paraná (PUCPR), Curitiba, Brazil
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Iemmi V. Establishing political priority for global mental health: a qualitative policy analysis. Health Policy Plan 2022; 37:1012-1024. [PMID: 35763373 PMCID: PMC9384251 DOI: 10.1093/heapol/czac046] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 04/09/2022] [Accepted: 06/10/2022] [Indexed: 11/21/2022] Open
Abstract
Mental disorders represent the leading cause of disability worldwide, yet they remain a low global health priority. This paper uses a case study methodology and different data sources (35 interviews and documents) to analyse factors that have shaped the generation of political priority for global mental health over the past three decades (1990-2020) and their changes over time. The Shiffman and Smith framework on determinants of political priority for global health issues is used to organize data into themes: actor power, ideas, political context and issue characteristics. Global mental health has gained political attention, especially over the past decade, yet support remains limited. Findings reveal that actor power is undermined by a fragmented policy community, the absence of one guiding institution or coordination mechanism and little civil society mobilization. Public portrayal of the issue is divided, hampered by the absence of a common understanding by the community and by stigma. Some policy windows have been missed and a strong global governance structure is lacking. Credible indicators and evidence on simple cost-effective solutions, especially in low- and middle-income countries, are scarce. However, opportunities are arising, including an increasing number of leaders and grassroots organizations, multiple arguments for action and integrated solutions resonating with broader audiences, widening political support at the national level, an emerging global governance structure and an expanding evidence base on the scale of the problem and available solutions. The results point to three technical and four political challenges that advocates need to address to increase political support over the next decade.
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Affiliation(s)
- Valentina Iemmi
- Department of Health Policy, London School of Economics and Political Science, Houghton St., London WC2A 2AE, UK
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Tomsick E, Smith J, Wenham C. A gendered content analysis of the World Health Organization's COVID-19 guidance and policies. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000640. [PMID: 36962479 PMCID: PMC10021261 DOI: 10.1371/journal.pgph.0000640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 05/27/2022] [Indexed: 11/19/2022]
Abstract
As with previous global public health emergencies, the COVID-19 pandemic has had distinct and disproportionate impacts on women and their health and livelihoods. As the leader in global public health, it is incumbent upon the World Health Organization (WHO) to ensure gender is prioritized in pandemic response. We conducted a policy analysis of 338 WHO COVID-19 documents and found that only 20% explicitly discuss gender and over half do not mention women, gender, or sex at all. Considering the well documented gendered effects of pandemics and the WHO's commitment to gender mainstreaming, this paper: 1) asks to what degree and how the WHO incorporates a gender inclusive approach; 2) maps where and how gender considerations are included; and 3) analyses what this suggests about WHO's commitment to gender mainstreaming within its COVID-19 response and beyond. We demonstrate that WHO should increase its gender mainstreaming efforts and incorporate gender considerations related to health emergencies more often and in more policy areas.
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Affiliation(s)
- Emily Tomsick
- School of Public Policy, University of Maryland, College Park, Maryland, United States of America
| | - Julia Smith
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Clare Wenham
- Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
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Kalbarczyk A, Rodriguez DC, Mahendradhata Y, Sarker M, Seme A, Majumdar P, Akinyemi OO, Kayembe P, Alonge OO. Barriers and facilitators to knowledge translation activities within academic institutions in low- and middle-income countries. Health Policy Plan 2021; 36:728-739. [PMID: 33661285 PMCID: PMC8173595 DOI: 10.1093/heapol/czaa188] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2020] [Indexed: 11/13/2022] Open
Abstract
The barriers and facilitators of conducting knowledge translation (KT) activities are well-established but less is known about the institutional forces that drive these barriers, particularly in low resource settings. Understanding organizational readiness has been used to assess and address such barriers but the employment of readiness assessments has largely been done in high-income countries. We conducted a qualitative study to describe the institutional needs and barriers in KT specific to academic institutions in low- and middle-income countries. We conducted a review of the grey and published literature to identify country health priorities and established barriers and facilitators for KT. Key-informant interviews (KII) were conducted to elicit perceptions of institutional readiness to conduct KT, including experiences with KT, and views on motivation and capacity building. Participants included representatives from academic institutions and Ministries of Health in six countries (Bangladesh, Democratic Republic of the Congo, Ethiopia, India, Indonesia, Nigeria). We conducted 18 KIIs, 11 with members of academic institutions and 7 with policymakers. KIIs were analysed using a deductive and inductive coding approach. Our findings support many well-documented barriers including lack of time, skills and institutional support to conduct KT. Three additional institutional drivers emerged around soft skills and the complexity of the policy process, alignment of incentives and institutional missions, and the role of networks. Participants reflected on often-lacking soft-skills needed by researchers to engage policy makers. Continuous engagement was viewed as a challenge given competing demands for time (both researchers and policy makers) and lack of institutional incentives to conduct KT. Strong networks, both within the institution and between institutions, were described as important for conducting KT but difficult to establish and maintain. Attention to the cross-cutting themes representing barriers and facilitators for both individuals and institutions can inform the development of capacity building strategies that meet readiness needs.
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Affiliation(s)
- Anna Kalbarczyk
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Yodi Mahendradhata
- Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Bulaksumur Yogyakarta, Indonesia
| | - Malabika Sarker
- BRAC James P. Grant School of Public Health, BRAC University, Dhaka, Bangladesh.,Heidelberg Global Institute of Health (HIGH), Heidelberg University, Heidelberg, Germany
| | - Assefa Seme
- Addis Ababa University School of Public Health, Ethiopia
| | - Piyusha Majumdar
- Indian Institute of Health Management Research, Bengaluru, India
| | - Oluwaseun O Akinyemi
- Department of Health Policy and Management, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Patrick Kayembe
- School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
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Jacobs T, George A, De Jong M. Policy foundations for transformation: a gender analysis of adolescent health policy documents in South Africa. Health Policy Plan 2021; 36:684-694. [PMID: 33852727 PMCID: PMC8248976 DOI: 10.1093/heapol/czab041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 02/26/2021] [Accepted: 03/23/2021] [Indexed: 12/02/2022] Open
Abstract
The Sustainable Development Goals (SDGs) and the United Nations Global Strategy
(2016–30) emphasize that all women, children and adolescents
‘survive, thrive and transform’. A key element of this global
policy framework is that gender equality is a stand-alone goal as well as a
cross-cutting priority. Gender inequality and intersecting social and structural
determinants shape health systems, including the content of policy documents,
with implications for implementation. This article applies a gender lens to
policy documents by national government bodies that have mandates on adolescent
health in South Africa. Data were 15 policy documents, authored between 2003 and
2018, by multiple actors. The content analysis was guided by key lines of
enquiry, and policy documents were classified along the continuum of gender
blind to gender transformative. Only three policy documents defined gender, and
if gender was addressed, it was mostly in gender-sensitive ways, at times gender
specific, but rarely gender transformative. Building on this, a critical
discourse analysis identified what is problematized and what is left
unproblematized by actors, identifying the key interrelated dominant and
marginalized discourses, as well as the ‘silences’ embedded in
policy documents. The discourse analysis revealed that dominant and marginalized
discourses reflect how gender is conceptualized as fixed, categorical
identities, vs as fluid social processes, with implications for how rights and
risks are understood. The discourses substantiate an over-riding focus on
adolescent girls, outside of the context of power relations, with minimal
attention to boys in terms of their own health or through a gender lens, as well
as little consideration of LGBTIQ+ adolescents beyond HIV. Dynamic and
complex relationships exist between the South Africa context, actors, content
and processes, in shaping both how gender is problematized and how
‘solutions’ are represented in these policies. How gender is
conceptualized matters, both for policy analysis and for praxis, and policy
documents can be part of foundations for transforming gender and intersecting
power relations.
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Affiliation(s)
- Tanya Jacobs
- School of Public Health, University of the Western Cape, Bellville, Robert Sobukwe Rd, Western Cape 7535, South Africa
| | - Asha George
- School of Public Health, University of the Western Cape, Bellville, Robert Sobukwe Rd, Western Cape 7535, South Africa
| | - Michelle De Jong
- School of Public Health, University of the Western Cape, Bellville, Robert Sobukwe Rd, Western Cape 7535, South Africa
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Clarke B, Kwon J, Swinburn B, Sacks G. Policy processes leading to the adoption of 'Jamie's Ministry of Food' programme in Victoria, Australia. Health Promot Int 2021; 37:6292205. [PMID: 34086910 DOI: 10.1093/heapro/daab079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This study investigated the policy processes related to the 2012 adoption of the Jamie's Ministry of Food programme by the Victorian Government in Australia. The aim was to provide insight into obesity prevention policy change processes to help strengthen future health promotion action. State-level government policy processes were examined through key informant interviews and a review of relevant documentation. Data were analysed using the Multiple Streams Theory and the Advocacy Coalition Framework in order to understand influences on relevant policy processes and strategies used by policy advocates to facilitate policy adoption. We found that policy adoption was facilitated by dedicated national funding for preventive health at that time, the relatively small number of stakeholders involved in the policy development process and the anticipated support for the programme by the general public due to the association with celebrity chef, Jamie Oliver. We identified that policy brokers aligned the policy with decision-maker ideologies and broader government objectives, and proactively managed potential criticisms. Evidence of intervention effectiveness was not a major driver of policy adoption. We conclude that, iven the complexity of policy processes for obesity prevention, multiple, reinforcing strategies are likely to be needed to facilitate policy change. Support for the adoption of obesity prevention policies is likely to increase when framing of policy options aligns with decision-maker values and has broad public appeal.
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Affiliation(s)
- Brydie Clarke
- Deakin University, Geelong, Global Obesity Centre, Institute for Health Transformation, 75 Pigdons Road, Waurn Ponds, Victoria 3216, Australia
| | - Janelle Kwon
- Deakin University, Geelong, Global Obesity Centre, Institute for Health Transformation, 75 Pigdons Road, Waurn Ponds, Victoria 3216, Australia
| | - Boyd Swinburn
- School of Population Health, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
| | - Gary Sacks
- Deakin University, Geelong, Global Obesity Centre, Institute for Health Transformation, 75 Pigdons Road, Waurn Ponds, Victoria 3216, Australia
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Clarke B, Swinburn B, Sacks G. Understanding the LiveLighter® obesity prevention policy processes: An investigation using political science and systems thinking. Soc Sci Med 2019; 246:112757. [PMID: 31927475 DOI: 10.1016/j.socscimed.2019.112757] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 12/05/2019] [Accepted: 12/18/2019] [Indexed: 11/19/2022]
Abstract
The health and economic burden associated with overweight and obesity warrants comprehensive policy action; however, to date, there has been limited policy progress globally. This study sought to advance obesity prevention policy research and practice by applying theories of the policy process to study decision-making processes involved in the adoption of the contentious LiveLighter® social marketing campaign by the Victorian government in Australia. Through analysis of documents and interviews with policy makers, this qualitative study aimed to gain a better understanding of the dynamic influences on policy decision-making. Multiple theories of the policy process were used to elucidate policy drivers and Causal Loop Diagramming methods were used to illustrate the LiveLighter® policy decision-making systems. Findings highlighted a number of key influences including: various external events, evidence of the problem and intervention effectiveness, resistance from various stakeholders and the political capabilities of central policy makers. The policy systems map provided insight into the difficulties experienced by policy actors in achieving policy change, as well as to develop a conceptual framework for identifying potential leverage points to influence future obesity prevention policy decisions. Together the findings can inform future advocacy efforts for improving the implementation of obesity prevention policy action.
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Affiliation(s)
- Brydie Clarke
- Deakin University, Global Obesity Centre, Institute for Health Transformation, 221 Burwood Highway, Burwood, Victoria, 3125, Australia; Population Health and Prevention Strategy Branch, Department of Health and Human Services, 50 Lonsdale Street, Victoria, 3000, Australia.
| | - Boyd Swinburn
- School of Population Health, University of Auckland, Victoria Street West, Auckland, 1142, New Zealand.
| | - Gary Sacks
- Deakin University, Global Obesity Centre, Institute for Health Transformation, 221 Burwood Highway, Burwood, Victoria, 3125, Australia.
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Danhoundo G, Nasiri K, Wiktorowicz ME. Improving social accountability processes in the health sector in sub-Saharan Africa: a systematic review. BMC Public Health 2018; 18:497. [PMID: 29653531 PMCID: PMC5899409 DOI: 10.1186/s12889-018-5407-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 04/04/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Social accountability is a participatory process in which citizens are engaged to hold politicians, policy makers and public officials accountable for the services that they provide. In the Fifteenth Ordinary Session of the Assembly of the African Union, African leaders recognized the need for strong, decentralized health programs with linkages to civil society and private sector entities, full community participation in program design and implementation, and adaptive approaches to local political, socio-cultural and administrative environments. Despite the increasing use of social accountability, there is limited evidence on how it has been used in the health sector. The objective of this systematic review was to identify the conditions that facilitate effective social accountability in sub-Saharan Africa. METHODS Electronic databases (MEDLINE, PsycINFO, Sociological Abstracts, Social Sciences Abstracts) were searched for relevant articles published between 2000 and August 2017. Studies were eligible for inclusion if they were peer-reviewed English language publications describing a social accountability intervention in sub-Saharan Africa. Qualitative and quantitative study designs were eligible. RESULTS Fourteen relevant studies were included in the review. The findings indicate that effective social accountability interventions involve leveraging partnerships and building coalitions; being context-appropriate; integrating data and information collection and analysis; clearly defined roles, standards, and responsibilities of leaders; and meaningful citizen engagement. Health system barriers, corruption, fear of reprisal, and limited funding appear to be major challenges to effective social accountability interventions. CONCLUSION Although global accountability standards play an important guiding role, the successful implementation of global health initiatives depend on national contexts.
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Affiliation(s)
- Georges Danhoundo
- Faculty of Health (York University), 435 Health, Nursing & Environmental Studies Bldg, 4700 Keele St., Toronto, ON, M3J 1P3, Canada.
| | - Khalidha Nasiri
- Faculty of Health (York University), 435 Health, Nursing & Environmental Studies Bldg, 4700 Keele St., Toronto, ON, M3J 1P3, Canada
| | - Mary E Wiktorowicz
- Dahdaleh Institute for Global Health Research, Community and Global Health, Health Policy and Management, Faculty of Health, York University, Toronto, Canada
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Storeng KT, Béhague DP. Policy ideals and everyday politics in the Partnership for Maternal, Newborn and Child Health-the role of ethnography. Health Policy Plan 2017; 32:1077-1078. [PMID: 28402437 DOI: 10.1093/heapol/czx019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Katerini T Storeng
- Centre for Development and the Environment, University of Oslo, Oslo, Norway.,Department of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Dominique P Béhague
- Department of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London, UK.,The Center for Medicine, Health and Society, Vanderbilt University, Nashville, TN, USA.,Department of Social Science, Health and Medicine, King's College London, London, UK
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