Framing the tax and health nexus: a neglected aspect of public health concern

Previous studies have described various associations between tax policy and health. Here we propose a unifying conceptual framework of ‘Five R’s’ to stimulate awareness about the importance of tax to health improvement. First, tax can improve representation and democratic accountability, and help make governments more responsive to the needs of its citizens. Second, tax can create a revenue stream for a universal pool of public finance for health care and other public services. Third, progressive taxation when combined with appropriate public spending can help redistribute wealth and income and mitigate social and health inequalities. Fourth, the re-pricing of harmful products (e.g. tobacco, alcohol and unhealthy food) can help reduce their consumption. Fifth, taxation provides a route by which certain harmful industries can be regulated. The paper also discusses the barriers that hinder the full potential for taxation to be used to improve health, including: weak tax administrations, large ‘shadow economies’, international trade liberalisation, tax avoidance, transfer pricing by transnational corporations and banking secrecy. We suggest that a greater awareness of the manifold associations between tax and health will encourage health practitioners to actively promote fairer and better taxation, thereby helping to improve health and reduce health inequalities

The role of leadership in people-centred health systems: a sub-national study in The Gambia

Recently, increasing attention has been given to behavioural and relational aspects of the people who both define and shape health systems, placing them at the core. A growing refrain includes the assertion that important decisions determining health system performance, including agenda setting, policy formulation and policy implementation, are made by people. Within this actor-oriented approach, good leadership has been identified as a key contributing factor in health systems strengthening. However, leadership remains ill-defined and under-researched, especially in resource-limited settings, and understanding the links between leadership and health outcomes remains a challenge. We explore the concept and practice of healthcare leadership at sub-national level in a low-income country setting, using a people-centric research methodology. In June and July 2013, 15 in-depth interviews were conducted with key informants in formal healthcare leadership roles across urban, peri-urban and rural settings of The Gambia, West Africa. Participants included the entire spectrum of Regional Health Team (RHT) Directors and Chief Executive Officers of all government hospitals, as well as one clinical officer-in-charge in a secondary-level major health centre. We found reference to several important aspects of, and approaches to, leadership, including (i) setting a clear vision; (ii) engendering shared leadership; and (iii) paying attention to human relations in management. Participants described attending to constituencies in government, international development agencies and civil society, as well as to the populations they serve. By illuminating the multi-polar networks within which these leaders are embedded, and through which they operate, we provide insight into the complex ‘organizational ecology’ of the Gambian health system. There is a need to further research and develop healthcare leadership across all levels, within various political, socio-economic and cultural contexts, in order to better work with a range of health actors and to engage them in identifying and acting upon opportunities for health systems strengthening

Mind the gap? Civil society policy engagement and the pursuit of gender justice: critical discourse analysis of the implementation of the Beijing Declaration and Platform for Action in Africa 2003–2015

This article presents critical discourse analysis of state and civil society organisations’ efforts to implement the gender mainstreaming goals set out in the United Nations’ Beijing Declaration. It is argued that the latter represents a generational opportunity to apply a Feminist Political Economic Framework to development in Africa. However, the research findings show how current practice falls short of the sought-after participative democratic model of mainstreaming. Instead, analysis reveals significant differences in state and civil society organisations’ policy framing, issues over conceptual clarity and a disjuncture in state and civil society prioritisation of key gendered issues such as poverty, economic inequality and conflict resolution. This matters because it indicates that the capacity of the civil sphere to act as a political arena from which NGOs may challenge the traditionally male-dominated power structures is being undermined by a ‘disconnect’ between state and civil society as they pursue contrasting agendas

The idea of a new Zimbabwe post- Mugabe

Zimbabwe has gone through deep political, economic and social challenges for close to three decades. Once known as the shining light of Africa, Zimbabwe is now often known for dominating international headlines for the wrong reasons. In November 2017, the country experienced a radical change to the constitutional and political order, which brought an end to former President Robert Mugabe’s 37-year reign. Emmerson Mnangagwa, who was once Mugabe’s right-hand man, assumed leadership of both the country and the ruling Zimbabwe African National Union–Patriotic Front (ZANU–PF). He was reelected in the July 2018 harmonised elections, although under disputed circumstances. The removal of Robert Mugabe has provided the country an opportunity to break from the past, and hopes have been raised for the birth of a new Zimbabwe. This chapter explores some of the measures that the administration post-Mugabe should implement to set the country on a new path. Thus, the purpose of this chapter is not to argue for a particular political formation or political leaders to govern. Rather, its objective is to explore whether the idea of a new Zimbabwe is possible and what it would take to realise this objective. Before discussing the prospects for this desired state of affairs, it is important to examine the current situation, which is explored in the first part of the chapter. A brief overview of the fall of Mugabe and rise of Mnangagwa is then provided to show how a leader who commanded respect beyond the shores of our continent could exit in such an undignified manner. The core section is dedicated to a discussion of the prospects for a new Zimbabwe, and concluding remarks end the chapter

The politics of cholera, crisis and citizenship in Zimbabwe: ‘People were dying like flies’

Zimbabwe’s catastrophic cholera outbreak of 2008/09 resulted in an unprecedented 100,000 cases and nearly 5,000 deaths. In the aftermath of the epidemic, questions of suffering and death and of rescue, relief, and rehabilitation have persisted in on-going processes of meaning-making through which people come to terms with the epidemic as a ‘man-made’ disaster. Based on extensive fieldwork, I examine the views of residents in Harare’s high-density townships that were epicentres of the disease. I argue that cholera was experienced by township residents as many crises at the same time. It was not only a public health crisis; it was also a political-economic crisis, a social crisis as well as a crisis of expectations, history and social identity. As such, I argue that the cholera outbreak was intensely generative of political subjectivities that reveal important shifts in the fraught relations between state and society in Zimbabwe’s urban politics. Finally, I argue that the government’s perceived causal role in, and failure to respond to, the cholera outbreak occasioned intense public outrage among township residents, which speaks to a much deeper aspiration for substantive citizenship based on political rights, social recognition, and access to high-quality public services delivered by a robust, responsible state

The politics of cholera, crisis and citizenship in urban Zimbabwe: 'People were dying like flies'

Zimbabwe’s catastrophic cholera outbreak of 2008/09 resulted in an unprecedented 100,000 cases and nearly 5,000 deaths. In the aftermath of the epidemic, questions of suffering and death and of rescue, relief, and rehabilitation have persisted in on-going processes of meaning-making through which people come to terms with the epidemic as a ‘man-made’ disaster. Based on extensive fieldwork, I examine the views of residents in Harare’s high-density townships that were epicentres of the disease. I argue that cholera was experienced by township residents as many crises at the same time. It was not only a public health crisis but also a political–economic crisis, a social crisis as well as a crisis of expectations, history and social identity. As such, I argue that the cholera outbreak was intensely generative of political subjectivities that reveal important shifts in the fraught relations between state and society in Zimbabwe’s urban politics. Finally, I argue that the government’s perceived causal role in, and failure to respond to, the cholera outbreak occasioned intense public outrage among township residents, which speaks to a much deeper aspiration for substantive citizenship based on political rights, social recognition, and access to high-quality public services delivered by a robust, responsible state