Civil society organisations24 play a critical role in mobilising communities to influence government policy. Sanders et al. (2005) suggest that to be successful, their starting point should be a different set of values to the prevailing norm. In other words, they should be stressing the importance of equity, social inclusion and human rights. The South African government in 1994 endorsed these values. However, so far in South Africa their actions have been influenced by forces greater than their good intentions.
Knowledge gaps, research needs and challenges
It appears that researchers have only started to examine the innovations in urban governance and the implications for health equity. Many experiences have not yet been identified in the academic literature. Ball (2005) observes that most existing evaluations of governance arrangements are incomplete and evidence is inconclusive. Also, critical issues such the advent of new powerful actors in the contested space of the city; the power asymmetries as well as the increasing influence of global processes on local policy and decision-making are so far neglected. A conceptual framework of governance and its inter-relation with governability is still lacking (Prats, 2001). Also, not much research has been conducted on the context-specific factors of best practices like participation (Gaventa & Valderrama, 1999). Whitman (2002) highlights that the current emphasis on process at the expense of detailed considerations of agency is problematic for democratic accountability and the delivery off global public goods; to this we might add a lack of evidence of outcomes, especially in terms of both health and health equity. These conclusions point to a potential research agenda. Harpham (2009) argues for the need to study resilience (adaptive capacity) rather than vulnerability of the urban poor. According to Beaumont (2008) researchers should assess the importance of socio-political contexts in giving institutions their actual meaning, roles and functions. Vianna (2007) points to the importance of historical narratives to better understand urban policy-making processes. Alazraqui et al., (2007) underline the relevance of the local production of epidemiological knowledge – ecological designs and georeference studies.
24 The Peoples Health Movement in South Africa (PHM SA), part of a global health advocacy movement, and the HIV/AIDS Treatment Action Campaign (TAC) are examples of organisations that are successfully mobilising communities to influence government bodies. PHM SA is actively campaigning for equity and the right to health for all, adopting various measures, including a joint submission to the South African Human Rights Commission. TAC is well known for its significant gains for people with HIV/AIDS through its campaigns against the Government’s former stance of AIDS denials, challenges to the pharmaceutical companies for affordable drugs, and the implementation of antiretroviral treatment programmes. Importantly, both include working through wider civil society networks and capacity building as part of their role.