Work to increase Parliamentary Health committee effectiveness on ‘Advocacy; Legislative; Oversight; and Accountability”.

AUC & PAP Parliamentary Roundtable on AU Policy Frameworks, Midrand, Johannesburg, South Africa : 25 – 26 March 2014

HON Blessing Chebundo NEAPACOH Chairperson chebundobmc@yahoo.com +263 773014516

Network of African Parliamentary Committees on Health

On-Line Presentation

1. Observations2. Historical Background of NEAPACOH3. Institutional Arrangement4. NEAPACOH Activities/Modus Operandi5. Resolutions: Collective Undertaking: Country commitments6. Countries Participating Consistently7. Lessons Learnt: ‘Networking: Collaborating8. Challenges9. Conclusion

OBSERVATION

Globally, Parliaments generally have transformed from the traditional outlook and approach of ‘Going it

Alone’ when legislating on behalf of the electorate, to the more ‘Democratic processes of the modern

world’ that of including all the relevant governance institutions, i.e. civic society organizations;

development partners; professional bodies; the general populace and the executive arm of governments.

That these transformations are more significant in the developing countries, especially in Africa where

government changes from colonial rules had been the order of the day beginning late 1950s to the 1990s.

This presentation benefits from more than Ten years of accumulated experience across parliamentary

portfolio committees on health, and HIV and AIDS work that have been learned from, reviewed, and

documented.

The initiative to coordinate and focus the activities of Parliamentary Committees on health was mooted in August 2003 at a meeting held at Birchwood Hotel, Johannesburg, South Africa.

The theme of the meeting, jointly organized by EQUINET, GEGA and SADC-PF focused on “Parliamentary alliances for equity on health”.

The meeting discussed how to strengthen the work and capacities of Parliamentary Committees on Health to promote SADC and EAC objectives in health and HIV and AIDS, and to build cooperation with other relevant institutions. Five counties, Kenya, Malawi, South Africa, Zambia and Zimbabwe were represented at this meeting.

Initially, the network scope of focus was targeted at the ‘East and Southern Africa, hence the network’s initial acronym ‘SEAPACOH’

It graduated to NEAPACOH when some of the countries from all the regions of Africa showed interest, and realizing that the majority of ‘health challenges’ of the continent, and the trend of ‘Health Governance’ are almost common to all the countries of the continent

Historical Background of NEAPACOH

Highlights of NEAPACOH Background Cont..:• Inequity in resource allocations for the health and the • Non-impressive governmental attention to critical issues such as inadequate health funding;

Family Planning; exclusive health governance, and the devastating impact of the HIV and AIDS epidemic on the populations of countries in Africa were the most pressing reasons for the formation of the network.

• The network seeks to enhance the effectiveness of the portfolio committees on health in legislative oversight, budget oversight and other relevant activities through the coordination and networking role of a well-established NEAPACOH.

• NEAPACOH works closely, and in collaboration with ‘state, and non-state actors: CSO for health: health professionals; development partners for health.

• This enables the Network to benefit from the wealth of experiences of its partners such as from the research based evidence. The partners in turn benefit by directly ‘inputting’ their ideas into the policy making process. NEAPACOH activities are, in the main, based on the national member parliamentary committees’ initiatives.

Institutional Arrangement

• Membership of NEAPACOH is open to all national health and HIV and AIDS committees, of African States. • Member Committees are represented by their committee chairperson, committee clerk/secretary and at

least three MP members of the national committee, to all activities of the network.

• Other relevant Networks may become affiliates, and NEAPACOH can also affiliate to relevant Policy Institutions in the continent,

• NEAPACOH governance arrangement includes Annual General Meeting (AGM), Annual working conferences; and an Executive Committee and secretariat that spearhead the network activities.

• The Executive is made up of elected individual MPs who are serving members of a national Health Committee, or have been serving members of the executive and still holding vested interest in the Network.

• The broader values and aspirations of NEAPACOH are enshrined in its Constitution; the 5-year strategic document; and the subsequent annual ‘work-plans’ collectively produced and reviewed regularly.

Vision: Mission: Goal: Mandate:

Vision: Distinguished network empowering its members to effectively carry out their function of

‘Legislative, Oversight, Facilitative, Advocacy and promotion of good health governance

Mission: To provide consistent collaboration of the Parliamentary committees on Health in Africa in their

representational, legislative, and facilitative budgetary process including appropriation and oversight roles to achieve health for all.

Goal /Objective: To ensure sustained nurturing of culture of health as a basic human right and establish consistent

collaboration among Parliamentary committees on Health in Africa as a means of achieving National, Regional and continental equity in Health; and through working to empower communities and involving relevant organizations.

Mandate: To strengthen linkages with key stakeholders including CSOs and non-state professionals in health at

national; regional; and continental level in order to increase health promotion, strengthen public participation. Provide leadership and enhance the executive arms’ responses to health challenges

Core Values

NEAPACOH’s institutional values:• Shared concerns• Common voice• Commitment to equity and equality• Adherence to democratic principles• Sharing of lessons learnt and best practices• Solidarity and Collaboration

NEAPACOH Activities/Modus Operandi

At least three working meetings are held annually Viz:

1. NEAPACOH Leadership/Executive planning meetings beginning of the year: The NEAPACOH Executive meets at the beginning of the year to strategically set in-motion the work-plan

that will ‘set-the-pace’ for the activities of the network that enhances capacities of member committees to effect oversight and accountability on the part of Executive Arm of the Governments, and other relevant players.

2. NEAPACOH Women MPs meetings: With the assistance of NEAPACOH technical partners, women MPs meets annually prior to the NEAPACOH

conference to pursue ‘gender/female specific health challenges/issues’ such as family planning and reproductive health. Women’s action plans follow the same method as that of the main conference outlined further on under ‘2.3’.

3. Annual Working Conferences: Beginning 2008, the network, in conjunction with its technical partners, organizes annual working

conferences for representatives of the national parliamentary committees on health. The conferences have proved to be the most important platform for achievement of its objectives.

Proceedings of the Conference

• Conference delegates include the chairperson and at least three members of each national member committee, their committee clerks/researcher; and the network’s collaborative partners.

• Thus the Conferences are ‘Action Packed/Oriented’; in that national committees set relevant commitments/tasks for themselves for implementation during the year, and report implementation progress at next conference.

• As a strategy to ensure member committees benefits effectively, the conference identifies common challenges and produces resolutions. I

• individual member national health committees/delegation will then set-out country commitments which they will undertake to go and implement, and report back at the next conference.

• It has proven effective and so encouraging when all the committees collectively approach the health challenges of the continent through the same ‘wave length’, as one huge, loving family, strengthening the ‘oversight’ role of Parliamentary committees on health.

Resolutions: Collective Undertaking: Country commitments

1. Each year, at the end of the annual conference, the network produces three categories of

actionable undertakings/commitments that will be implemented during the course of the

year ahead, and as means to increase parliamentary oversight with the view to enhance

national and continental parliamentary work/results on health:

2. Actionable conference resolutions:

(e,g, 2012/2013 - Commit ourselves to the realization of the MDGs, the Maputo Plan of

Action and the Accra Agenda for Aid Effectiveness by identifying and undertaking concrete

actions under the following three major themes: a) Generate and Reinforce Political Will Within and Outside Parliament: b) Advocate/pressure executive to demonstrate increased funding commitment; (eg. Abuja)c) Increase collaboration/partnerships with civil society for health, non-state actors; health

professionals;

A ‘One size fit all’ activity

• An ‘All committee activity; common voice for common concern’:

• In addition to the resolutions; the committees will agree to pursue a uniform/common oversight health policy challenges cutting across all nations.

• An example of effective common approaches that were used to influence government positions or actions using the network platform is that of the resolution agreed at the conference. ‘All the portfolio committees were to put across questions in Parliament to their ministers responsible for trade’. The 5th ministerial conference on trade [WTO] was to take place in Cancun, Mexico and the common question and concern was for the ministers to refrain from making commitments that had negative impacts on health of the people in the developing regions.

• The ministers through the question and answer time in the respective Parliaments were to be asked to consult before going, and to make feedbacks to Parliament on return from the conference. Further, portfolio committees were to move that countries establish future defined consultative process by country delegation to trade forum of WTO before they leave for the conferences. This was to enable countries to protect their governments’ authority in all trade agreements to safeguard public health and to regulate services in the interest of public health.

• The above resolution was taken up by the committees and feedback revealed that although there was mixed

reaction from the Ministers what was common was the fact that the Ministers seem to have appreciated that their actions and decisions at the World Trade Forum had also implications on Health issues, other than just trade alone.

Specific Country commitments/Action Plans

• Another critical activity intended to enhance oversight capacities of committees at national level is the task for individual country committee delegates to the conference to craft at least three country specific activities to be accomplished during the year, and progress reported at the next conference.

• During the conference, a session for Individual country delegates to group together to work on priority advocacy/oversight action plans for the year is slotted:

• The produced country specific commitments are presented for sharing and appreciation by others during the conference:

• At the next conference, each country presents ‘progress, achievements and challenges regarding implementation of the previous NEAPACOH conference/meeting commitments, before crafting new commitments for the following year:

National Commitment

HOW: What kind of activities to undertake to implement the national commitment?

WHEN: Timeline- when will the activity be implemented?

WHO: Individuals assigned to implement each activity.

Advocate for national RH/FP policy

-sensitization & training of MP on RH/FP.-advocate for RH/FP service delivery

-Sep t. 2013-March 2014

-Committee chair engaging the, MOH and partners

Advocate for an increase in the MOH budget from 3% to 7%.

-review budget using Rwanda & Zimbabwe policy/model

-October 2013-March 2014

-Ctte in conjunction with MOH

Advocate for inclusion of RH/FP commodities in the essential drugs list.

-review & summon officials of MOH for inclusion of RH/FP commodities in essential drugs list.

-October-Dec 2013.

-Ctte,MOH & Partners ( funding agencies).

An Example of country specific commitment

REPUBLIC OF SOUTH SUDAN: Commitments made at the SEAPACOH Meeting; Sept. 2013.

Monitoring and Evaluation

• Sequel to the undertaking of commitments, and before the next conference, NEAPACOH leadership, in conjunction with its technical partners will carryout ‘sample monitoring and evaluation’ of the effectiveness on commitments implementation by visiting some of the member committees in their respective countries. These visits have helped to make national parliamentary leadership to appreciate NEAPACOH and its work.

Participating Member Committees

Country• Botswana • Burundi• DRC Congo• Ethiopia• Gambia• Ghana• Kenya• Kingdom of Lesotho• Malawi• Mali• Mozambique

Country• Namibia• Nigeria• Rwanda• Swaziland• South Sudan• Tanzania• Uganda• Zambia• Zimbabwe

Lessons Learnt: ‘Networking”

• Networks for Parliamentary Portfolio Committees on Health are essential for better understanding and influencing good Governance, public programmes, policies and their implementations at that level.

• Networking has an added advantage, which is not available to National Parliamentary Health committees. They can articulate their point of view, which has not been ‘cast in stone’ by individual governments [such decisions as influenced by political party whipping system], through broadening their Terms of reference to include any other things incidental to Health.

• These Networks are more important because they allow a greater focus on common issues affecting the region/continent since countries within the same region have shared history, ecology, health and cultural challenges and often face similar contributing factors to health challenges.

• A Parliament and Parliamentary alliance that collaborates with CSO and other professional institution are potent parliaments. This is one area where parliamentarians can learn a lot from each other’s experience

Lessons Learnt: ‘Networking” Cont…

• Networking and Collaboration with non-parliamentary health players creates a platform for stakeholders to ‘input unfettered ideas’ into health policies of the nations. ‘Enhances Global Health Governance’

• Engaging Civic society helps to foster a sense of collective ownership of parliamentary and health governance processes, and helps to improve relationships between these institutions. Overally, collaboration between Civil Society and Parliament have helped to remove ‘myths and other relationship obstacles’ and made it possible to sustain and achieve intended goals.

• Civil Society can provide independent research from a perspective that is not generally influenced by conventional analysis e.g. the impact of budget on vulnerable groups, thereby help to address the issue of “Equity in Health”.

• Government ministries will try as much as possible to operate and remain within their programmes and budgets, and to effect public and civic society recommendations when they are aware that their programmes and expenditures are scrutinized by the public in a formalized arrangement.

• Civil Society organizations act as bridges between government on one side, and the public and development partners on the other side in addressing Health issues. In fact, the emergency of civil society as an accountability force, made them a favored partner by development (Donors) agencies, and entrusted them in delivering health aid programmes especially in some of the democracies that are fragile

Challenges

• Participation by national member committees usual faces setbacks when there are changes in the committee membership due to national elections/turnover etc. Chairpersons of committee appear to have significant influence on the focus and interest of the committee as a whole. A change in the chairperson can result in either increase or decreased engagement with issues/network,

• The absence of or the inactive of national committee clerks/researchers in networks could affect those engaging with parliaments to feed in evidence on inequities in health and access to health. Committee clerks play an important bridging role and their capacities and orientation can be pivotal.

• The political role of parliaments in the design and functioning of health policy is thus generally located within a specific constitutional and values framework. This role may further be affected by other factors: resource constraints and inaccessibility of some areas may bias the opportunity people have to engage parliaments.

• MPs are quite frequently moved between committees or promoted to higher positions, and elections results in substantial changes in committee membership. These challenges calls for repeat strategies such as regular capacity building processes from time to time that are sometimes financial prohibitive.

Conclusion

• Networking of Parliamentary portfolio committees on health proved to be a strategy for strengthen Parliamentary oversight work on health, and ensuring 'equity in health' at national, regional and continental levels. Networking facilitates for, and encompasses all essential players for health within the wider societies.

Thank You for your attention.

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