Social accountability and health systems' change, beyond the shock of Covid-19: drawing on histories of technical and activist approaches to rethink a shared code of practice.

BACKGROUND: Recognition of the value of "social accountability" to improve health systems performance and to address health inequities, has increased over the last decades, with different schools of thought engaging in robust dialogue. This article explores the tensions between health policy and systems research and practice on the one hand, and health equity-focussed activism on the other, as distinct yet interacting processes that have both been impacted by the shock effects of the Covid-19 pandemic. This extended commentary brings multidisciplinary voices seeking to look back at health systems history and fundamental social-institutional systems' behaviors in order to contextualize these current debates over how best to push social accountability efforts forward. ANALYSIS: There is a documented history of tension between long and short processes of international health cooperation and intervention. Social accountability approaches, as a more recent strategy to improve health systems performance, intersect with this overarching history of negotiation between differently situated actors both global and local on whether to pursue sustained, slow, often community-driven change or to focus on rapid, measurable, often top-down interventions. Covid-19, as a global public health emergency, resulted in calls for urgent action which have unsurprisingly displaced some of the energy and aspiration for systemic transformation processes. A combination of accountability approaches and mechanisms have their own legitimacy in fostering health systems change, demanding collaboration between those that move both fast and slow, top-down and bottom-up. CONCLUSION: We argue that social accountability, much like all efforts to strengthen health systems, is "everybody's business" and that we must understand better the historical processes that have shaped the field of practice over time to move forward. These differences of perspective, knowledge-base and positioning vis-a-vis interventions or longer-term political commitment should not drive a conflict of legitimacy but instead be named, subsequently enabling the development of a shared code of conduct that applies to the breadth of actors involved in social accountability work. If we are concerned about the state of/status of social accountability within the context of "building back better" we must approach collaboration with a willingness to create dialogue across distinct disciplinary, technical and politically-informed ways of working.

Beyond command and control: A rapid review of meaningful community-engaged responses to COVID-19.

Responses to COVID-19 have included top-down, command-and-control measures, laissez-faire approaches, and bottom-up, community-driven solidarity and support, reflecting long-standing contradictions around how people and populations are imagined in public health-as a 'problem' to be managed, as 'free agents' who make their own choices, or as a potential 'solution' to be engaged and empowered for comprehensive public health. In this rapid review, we examine community-engaged responses that move beyond risk communication and instead meaningfully integrate communities into decision-making and multi-sectoral action on various dimensions of the response to COVID-19. Based on a rapid, global review of 42 case studies of diverse forms of substantive community engagement in response to COVID-19, this paper identifies promising models of effective community-engaged responses and highlights the factors enabling or disabling these responses. The paper reflects on the ways in which these community-engaged responses contribute to comprehensive approaches and address social determinants and rights, within dynamics of relational power and inequality, and how they are sometimes able to take advantage of the ruptures and uncertainties of a new pandemic to refashion some of these dynamics.

Diversidades e convergências nos indicadores de saúde no Brasil e em Moçambique / Diversity and Convergence in Health Indicators in Brazil and Mozambique

O artigo apresenta um panorama da trajetória recente das desi­ gualdades em saúde nos dois países. Partindo da sistematização de dados produzidos pelos órgãos oficiais, de estatística e saúde, mostra como evoluíram os indicadores de acesso à saúde. Observa­se a redução das desigualdades em período recente em ambos os países, sendo de forma mais acentuada em Moçambique, em função do aumento da atenção primária à saúde nas áreas rurais

The article presents an overview of the recent trends on health inequalities in two countries. It shows how service provision and social health related indicators have progressed using administrative data produced by official authorities. Both countries present reduction on health inequalities. Mozambique has produced further pronounced results due to increasing access to primary health care in rural areas

Diversidades e convergências nos indicadores de saúde no Brasil e em Moçambique1 / Diversity and convergence in health indicators in Brazil and Mozambique1

O artigo apresenta um panorama da trajetória recente das desigualdades em saúde nos dois países. Partindo da sistematização de dados produzidos pelos órgãos oficiais, de estatística e saúde, mostra como evoluíram os indicadores de acesso à saúde. Observa­se a redução das desigualdades em período recente em ambos os países, sendo de forma mais acentuada em Moçambique, em função do aumento da atenção primária à saúde nas áreas rurais.

Social participation in health in Brazil and England: inclusion, representation and authority.

AIM: This article offers a brief description and analysis of public participation in health in Brazil and England in order to highlight different motivators and tensions within an acceptance of participation as official policy. SOURCES/METHODS: The article draws on a range of research in both countries and an analysis of official documents relating to participation. It is based on collaboration between researchers deriving from broad programmes of work on public participation in which the authors are involved. ARGUMENT: There is a tension between different principles underpinning collective public involvement in health both within and between countries. Different aspirations or claims have been made about what such participation will achieve and there are trade-offs between design principles that have consequences for issues such as who takes part and thus also for what can be achieved. The democratic origins of public participation are more evident in the Brazilian situation than in England, but there are still questions about the inclusivity of the practices through which this is achieved. The English picture is both more diverse and dynamic, but formal decision-making power of participatory forums is less than in Brazil. Whilst social justice claims for participation have been made in both countries, there is as yet limited evidence that these have been realized.

Gestäo pública x gestäo privada do sangue: oposiçäo ou complementaridade? / Public management x private management of blood supply: opposed or complemental?

Breve relato da situaçäo do sistema hemoterápico público. Para analisar os sistemas hemoterápicos säo sugeridas como relevantes as variáveis: tipo de doaçäo, tipo de capital financeiro e tipo de organizaçäo dos serviços. Para aperfeiçoar a política nacional de sangue säo sugeridas e analisadas as possibilidades de ajustes na combinaçäo dessas variáveis

Os anos 80: a politizacao do sangue / The eighties: blood politicization

Focaliza o impacto da AIDS sobre os caminhos da hemoterapia brasileira sob dois pontos de vista: o das politicas publicas federais (Pro-Sangue e Planashe) e estaduais (grupos de desenvolvimento de programas); e o do surgimento de movimentos sociais e grupos de pressao que, atraves de manifestacoes junto a sociedade civil, conseguiram melhorias nos servicos hemoterapicos e de ordenamento e controle da producao industrial de hemoderivados.(AU)

A hemoterapia no Brasil de 64 a 80 / Blood therapy in Brazil from 1964 to 1980

Apresenta o quadro geral, historico e institucional, em que se delineou a hemoterapia, anteriormente a politizacao do sangue com o surgimento da AIDS transfusional, ate tornar-se uma questao de politica social.(AU)