Complementarity of formal and informal actors and their networks in support of vulnerable populations in informal settlements: Governance diaries approach.

Introduction: Beyond several interests and speculations on the relationship between formal and informal actors and their networks in support of vulnerable populations, most studies do not conclusively establish whether the two types of support are substitutes or complements. While informal care and formal care may be substitutes in general, they are complements among the vulnerable groups. Despite how some studies have described complementarity, further insights on the synergy between formal and informal actors and networks are needed to pinpoint how to maximize policy and interventions to alleviate the challenges facing vulnerable groups in informal settlements. Methods: We conducted an ethnography using governance diaries with 24 participants in Korogocho and Viwandani informal settlements in Nairobi, Kenya. The governance diaries approach involved conducting bi-weekly governance in-depth interviews (IDIs) with study participants for 4 months, complemented with observations, reflections, participant diaries and informal discussions. We used framework analysis approach. Findings: Informal actors identified include family, neighbors, friends, community groups and community members, and their direct networks. Formal actors on the other hand included government institutions, individuals and authorities that make policies and rules and their desired and possible networks. Both the formal and informal actors and their networks had complementary roles that were beneficial to the vulnerable populations living and working in informal settlements. The complementarities between formal and informal actors and networks in supporting vulnerable groups were portrayed in roles and responsibilities to the vulnerable groups; rules, regulations and governance in supporting vulnerable groups; knowledge, skills and dynamic workforces among formal and informal actors and their networks; information flow on health and wellbeing to the vulnerable populations; transition of actors in supporting vulnerable groups; availability, access and involvement of formal and informal actors and networks to support vulnerable groups. The complementarities allowed for maximum support of the vulnerable populations than otherwise. Conclusion: We conclude that informal social support is needed regardless of the availability of formal social support. Moreover, a combination of formal and informal actors and related networks are essential to support vulnerable persons. Formal actors should establish, support, or maintain the informal actors and related networks through goodwill and sundry incentives as a vital dimension of building with local community structures and enhancing inclusion, participation and ownership of policy and program interventions by marginalized and vulnerable groups.

On the margins of aid orthodoxy: the Brazil-Mozambique collaboration to produce essential medicines in Africa.

BACKGROUND: On the back of its recent economic development and domestic success in the fight against HIV/AIDS, Brazil is helping the Government of Mozambique to set up a pharmaceutical factory as part of its South-South cooperation programme. Until recently, a consensus existed that pharmaceutical production in Africa was not viable or sustainable. This paper looks into practicalities and evolution of this collaboration to illustrate the characteristics of Brazilian development cooperation in health, with the aim of drawing lessons for the wider debate on aid and local production of pharmaceuticals in Africa. DISCUSSION: We show that the project process has been very long and complex, has involved multiple public and private partners, and cost in excess of USD34 million. There have also been setbacks in the process, and although production has already started, it is unclear whether all the project's original objectives will be met. SUMMARY: The Brazil-Mozambique's pharmaceutical factory experience illustrates positives as well as limitations of Brazil's unorthodox approach to health development cooperation, highlighting its contribution to pushing the boundaries of the debate on local production of pharmaceuticals in resource-poor settings.

Engajamento com cidadãos: lições aprendidas na construção do Sistema Único de Saúde / Engagement with citizens: lessons learned in construction of the Unified Health System

O Sistema Único de Saúde (SUS) é um sistema universal, de financiamento público, baseado em direitos sociais à saúde, concebido e implantado em uma era em que as reformas neoliberais em outras partes do mundo têm impulsionado a mercantilização dos serviços de saúde, oferece lições importantes para os futuros sistemas de saúde. Neste artigo, focalizamos os mecanismos institucionais inovadores para a participação popular e prestação de contas (accountability) que fazem parte da arquitetura de governança do SUS. Nós argumentamos que esses mecanismos de participação pública têm o potencial de sustentar um pacto entre Estado e os cidadãos e assegurar o impulso político necessário para ampliar o acesso aos serviços básicos de saúde e, ao mesmo tempo, fornecer um quadro para o surgimento de "parcerias reguladoras", capazes de administrar a realidade complexa da assistência plural e de multiplicar as fontes de especialidades em saúde de uma forma que assegure que as necessidades e os direitos dos pobres e dos cidadãos marginalizados não sejam relegados para a periferia de um sistema de saúde segmentado.

Making the right to health a reality for Brazil's indigenous peoples: innovation, decentralization and equity.

This article provides an overview of governance arrangements and changes in the Brazilian public health system since 1988, when the "Citizen's Constitution" declared health to be a universal right. Since then, population coverage has grown substantially and health indicators have improved. Despite these achievements, inequities in access remain an important barrier to universal coverage, in particular for marginalized groups such as indigenous peoples. This article discusses the innovation cycle that produced the gains and recent efforts to guarantee more equitable access to health services for the indigenous population in a continent-sized country historically plagued by great inequalities.

Engaging citizens: lessons from building Brazil's national health system.

Brazil's Sistema Unico de Saúde (SUS), a universal, publicly-funded, rights-based health system, designed and put in place in an era where neo-liberal reforms elsewhere in the world have driven the marketization of health services, offers important lessons for future health systems. In this article, we focus on the innovative institutional mechanisms for popular involvement and accountability that are part of the architecture for governance of the SUS. We argue that these mechanisms of public involvement hold the potential to sustain a compact between state and citizens and ensure the political momentum required to broaden access to basic health services, while at the same time providing a framework for the emergence of "regulatory partnerships" capable of managing the complex reality of pluralistic provision and multiplying sources of health expertise in a way which ensures that the needs and rights of poor and marginalised citizens are not relegated to the periphery of a segmented health system.