The Regional Network for Equity in Health in Southern Africa (EQUINET), Oxfam GB in co-operation with SADC, government, UN, civil society, health sector and international agency partners met in February 2004 to review the options for a sustainable and equitable path to realising the urgent imperative of making antiretroviral therapy (ART) available to southern Africans and the long term imperative of universal treatment access. The organisations identified principles to guide a sustainable and equitable response that would address the urgency of the need to act and the demand to do this in ways that build and do no harm to the already fragile public health systems in southern Africa. There is an opportunity for a virtuous cycle where programmes aimed at delivering ART strengthen health systems and thus widen access to ART. There is also a threat of a vicious cycle of programmes aimed at delivering ART diverting scarce resources from wider health systems and undermining long term access both to ART and to other critical public health interventions. These principles are the basis for the virtuous cycle. They are presented as a discussion document for wider dissemination, discussion and feedback. Feedback is welcomed! Please email your feedback to admin@equinetafrica.org.
1. WHY TREATMENT ACCESS THROUGH SUSTAINABLE PUBLIC HEALTH SYSTEMS?
- Approximately 15 million adults and children in southern Africa are currently infected with HIV and an estimated 700 000 - 1million currently have AIDS. With only one eligible person in 25,000 currently on treatment with antiretroviral therapy (ART), the shortfall is enormous, and widest for the low income communities using peripheral and rural health services. Responding to this scale of disease and shortfall will not be possible through scattered programmes and projects. It requires a comprehensive and co-ordinated approach that embeds treatment within an effective, accessible health system.
- Treatment is only one of the multiple responses to the risk environments and factors that produce HIV and to the many areas of household vulnerability due to AIDS. Household food security, access to primary health care, social security, gender equity and income security are important factors linked to HIV and AIDS in southern Africa. Treatment programmes may excessively shift attention to drugs as the response to AIDS if they do not reinforce the prevention, care and socio-economic programmes that deal with these factors influencing HIV infection and the impacts of AIDS.
- After decades of macroeconomic measures weakening health systems, the capacities lost to public health systems, including the human resources for health, need to be systematically rebuilt to plan, manage and use the significant global and international resources for treatment of AIDS coming into Africa. Treatment activism has opened a real window of opportunity for meeting rights of access to treatment and overcoming unjust barriers to ART. It now needs to join with broader public health activism to ensure that these goals can be realised for all through sustainable, effective and equitable health systems.
- All southern African Development Community (SADC) member states have policies on AIDS and treatment guidelines and some are developing explicit treatment access policies. While legal, clinical and pharmaceutical aspects of these policies are now developed, there is a gap in the health system aspects. This gap needs to be filled if treatment policies are to be implemented in the practical conditions found in southern Africa health systems and to reinforce wider health and social goals.
The current situation does not lend itself to prescription. Southern African countries vary widely in socio-economic status, health system development and in the availability and organisation of resources for health. The choices around how scarce resources are used need to be made in an informed, transparent and participatory manner at the national level. These guiding principles are thus intended to support fair country level processes to develop strategies based on the capabilities, resources and demands of national health systems.
2. PROPOSED GUIDING PRINCIPLES
2.1 Fair, transparent processes to make informed choices.
The choices to be made around use of resources, around the clinical, social and systems criteria for rationing and around opportunity costs and trade-offs call for governments and relevant international and national non-government organisations to provide clear, transparent and accountable mechanisms for public and stakeholder consultation and debate to develop policy and to make policy choices.
2.2 Joint public health and HIV/AIDS planning.
Strategic and operational plans as well as monitoring and evaluation frameworks at national and district levels should be produced through a process that integrates HIV / AIDS planning into broader public health planning. This includes integrating AIDS treatment programmes into HIV/AIDS prevention and social care programmes. Integrated planning should be supported by investments in public health leadership and in the management and monitoring capacities needed to implement plans.
2.3 Integrating treatment into wider health systems.
Governments, international and national agencies should integrate HIV and AIDS prevention, treatment and care programmes into a programme of health systems strengthening and development. Key elements of this programme include:
Strengthening inclusive public health systems:
· Prioritising district and primary level facilities and services as points of entry for ART services over tertiary level services.
· Locating treatment programmes within an effective District Health System, supported by effective district health management structures that provide all basic services for HIV and non-HIV related illness in an integrated and locally appropriate manner.
· Ensuring adequate human resources for treatment programmes integrated within district health systems.
· Co-ordinating and building national networking of information and experience from district sites.
· Services provided by non-profit organisations should be integrated in the public sector framework.
· Private sector provision should complement public provision and not compete for public funding.
2.4 Realistic targets for treatment access with clear guidelines and monitoring systems for ensuring equity in access and quality of care.
The rapid expansion of ART can be achieved through targeting HIV positive current users of the health system, (particularly PMTCT, TB and VCT clients) and certain social and occupational groups (such as those with medical insurance or health workers). Such rapid expansion options should take place with simultaneous and equal investments to build the district health system and PHC infrastructure in areas without the current capacity to sustain effective ART services within clear time frameworks for wider rollout.
2.5 Treatment resources integrated into regular budgets, supported by long term external commitments and through fair financing approaches
Dedicated AIDS funding should be integrated into regular budgets and comprehensive health sector plans. The transfer and use of earmarked funds for AIDS should be transparent. ‘Emergency transfers’ to meet specific system shortfalls should be time-limited with plans for their integration into regular budgets and comprehensive health sector plans.
Additional funds and resources dedicated to HIV/AIDS should be system supporting (covering prevention, treatment, district health system and PHC responses) and include expenditure on broader health care infrastructure where required. This calls for longer term commitments from international agencies (minimum 5 years), in support of joint national HIV/AIDS and health plans, linked to budget and sector wide support with agreed exit strategies. Global and international funds should build predictable, consistent, long term and co-ordinated funding. African governments should increase their health budgets to 15% of total budgets in accordance with the Abuja declaration, and strengthen their governance and management capacities for resource planning and management. Ministries of finance should now integrate health systems demands into financial planning and budget frameworks and review their Medium Term Expenditure Frameworks with the IMF to take account of additional resource inputs demanded for system strengthening.
2.6 Prioritise human resource development in the health sector.
Strategic plans, developed in consultation with health personnel, are required for the health personnel needs and commitments for a health systems approach to treatment access. This should include effective and sustainable in-service and institutional training approaches, provisions for clear career paths, effective human resource management (payroll management, supervision and training), incentives for health workers to work in under-staffed areas and provisions for safe work. Plans for treatment access should not involve deliberate policies of recruitment of staff from other African countries or diversion of scarce personnel from broader health systems into vertical programmes. Any proposed new investment in HIV/AIDS or treatment expansion should include resources and measures for the training, sustaining and retaining of relevant health personnel and for their safe work environments and infection control.
2.7 Strengthen essential drugs policies and systems at national and regional level.
National legislation should now take full advantage of the TRIPS flexibilities and the Doha declaration, particularly provisions for parallel importation and compulsory licensing. Drug regulatory and medicine control authorities should be strengthened, together with drug procurement and distribution systems. The expansion of ART should be included within the essential drugs programmes, through review and update of the essential drugs list. The essential drugs policy should cover the private sector and provide where necessary for mandatory generic substitution (available generic equivalent drug provided when brand name drug prescribed). SADC as a regional body should use TRIPS flexibilities and the Doha commitments to support regional strategies for procurement, price monitoring and negotiation, and quality control of drug supplies. Southern African governments and civil society should promote monitoring, regulation and advocacy within the region and internationally to prevent excessive profiteering and unfair monopolies in the pharmaceutical sector.
3. CONCLUSION
These principles are proposed as central to ensuring that actions to expand access to ART are reinforced, sustained and meet equity policy goals through strengthened health systems. They are proposed:
- for national debate,
- for translation into practical strategies and programmes,
- to gather and share evidence on options for good practice,
- to provide a wider framework for understanding the costs and benefits of approaches to ART access,
- to inform international agency policy and practice and
- to inform advocacy and activism.
They are proposed as a framework for monitoring and evaluating our efforts to expand treatment access. They are as important as targets and are more directly linked to our longer term capacities and aspirations to sustain and expand access to treatment for all those who need it.
1. Editorial
2. Equity in Health
The long-awaited rollout of antiretroviral (ARV) drugs through public health systems is at last becoming a reality in a growing number of African countries. But the initial excitement greeting the announcement of each new AIDS treatment programme is often tempered by a closer examination of the figures, and the realisation that only a fraction of those in need will initially be able to access therapy.
The international humanitarian medical organisation Médecins Sans Frontières (MSF) has said that the battle against tuberculosis (TB) is being lost because of reliance on archaic diagnostic tests and drugs. "The HIV/AIDS pandemic has magnified this problem as TB often coincides with, and is made harder to treat by, HIV/AIDS. MSF calls for an urgent increase in worldwide investment in TB research and development," the organisation said.
The world's biggest AIDS treatment plan gets a boost this week as five pilot hospitals in South Africa's richest province roll out life-saving anti-retroviral medication. Officials say the April 01 launch in Gauteng, which includes Johannesburg, shows the government fulfilling a pledge to make ARVs available in South Africa - the country most battered by HIV/AIDS with some 5.3 million of its 45 million people infected.
The US, under pressure from its giant pharmaceutical companies, is trying to undermine the use in poor countries of cheap, copycat Aids drugs, made by "pirate", generic companies but validated by the World Health Organisation, campaigners claim. US drug companies want the money promised for President George Bush's Aids plan to be spent on their products.
3. Values, Policies and Rights
This report from Human Rights Watch details cases of abuse of women and girls that increase susceptibility to HIV/AIDS. It reviews regional and national legal regimes and makes recommendations for policy action against manifestations of HIV/AIDS human rights abuses against women and girls. The cases demonstrate that the illness, mortality, abuse, and stigma associated with HIV/AIDS are due, to a large extent, to a long tradition of subordination and violent abuse of women and girls in Africa. It argues that reformed national laws and policies to date have not been effective in counteracting this tradition and abusive practices condoned in customary law have exacerbated the problem.
Zackie Achmat, the leader of the Treatment Action Campaign (TAC), spoke at the Centre for Civil Society's first Harold Wolpe Memorial lecture for 2004. Achmat is famous for his passionate advocacy for wider access to HIV treatment in South Africa and globally. Strategic use of South Africa's Constitutional provision for the right to access to health care has always been key to TAC's campaigns. As South Africa moves towards celebrating ten years of a constitutional democracy, it was apt that such a high-profile civil society leader discussed the use of the constitution as a tactic to engage with the government on development issues. In this review, the authors summarise Achmat's talk, the interesting critiques from the floor and offer their own critical analysis of the lecture and discussion which followed it.
4. Health equity in economic and trade policies
This paper argues that the dollar-a-day poverty is pervasive and persistent in most Least Developed Countries because they are caught in an international poverty trap. It highlights the fact that poverty is perpetuated by vicious domestic circles through which the high incidence and severity of poverty constrain national economic growth, and that the current form of globalisation is tightening rather than loosening the international poverty trap. In response to this, the author states that policies underlying international development cooperation, focusing on Poverty Reduction Strategy Papers (PRSPs) have not changed sufficiently to enable countries to escape the trap and realise the opportunity for fast poverty reduction through economic growth.
The Monterrey Consensus recognises the strong links between trade, finance and development issues. The challenge is to make trade, trade policy and trade rules work for development. This is a big challenge because many trade rules, for example in the WTO, and many trade policies, for example in structural adjustment conditionalities, are not yet aligned with development needs in the South, says a discussion paper submitted by the Third World Network to an informal meeting on financing for development.
Civil Society for Poverty Reduction (CSPR) has said the glaring failure revealed in the Millennium Development Goal (MDG) report on Zambia justifies the call for more investment in the social sector. Commenting on the contents of the MDG report that was released recently, CSPR assistant co-ordinator Gregory Chikwanka said the report's revelations heralded the need for the government to revisit the resource allocation procedures. The report states that of the 10 MDG targets, Zambia could probably achieve one while possessing the potential to achieve only six others.
Poor countries that fought to be able to import generic prescription drugs have failed to use changes to the WTO rules on intellectual property rights, reviving a row over who is to blame for the lack of treatment for millions of AIDS sufferers, reported Agence France Presse in March. According to Daniela Bagozzi, spokeswoman for the World Health Organisation in Geneva, "nothing much has changed since August," when a compromise between the 146 members of the WTO broke an eight-month deadlock over the changes. "From what we know and what we've heard, no country has issued a demand for a compulsory license as authorized within the agreement," she said.
This paper argues that the government of the United States is contravening its commitment under the "Doha Declaration" of 2001by using technical assistance, bilateral and regional trade agreements, and the threat of trade sanctions to ratchet up patent protection in developing countries. The paper states that the U.S. is pressuring developing countries to implement patent laws which go beyond TRIPS obligations and do not take advantage of its public-health safeguards in order to benefit the influential U.S. pharmaceutical industry.
In May 2003, at its annual World Health Assembly, the World Health Organisation (WHO) announced a modest proposal: that it would provide the technical and organisational support to provide 3 million people in poor countries with antiretroviral treatment by the year 2005. This "3-by-5 initiative" was minor in one sense, in that it would provide treatment to only about 5 percent of those in need. But in another sense, it was a major step forward, particularly because the WHO proposed a novel manner of delivering the anti-HIV medicines: combining the drugs into a "fixed-dose regimen", a combination pill containing three drugs in one capsule, allowing an infected person to take only one pill twice per day for a complete HIV-treatment regimen. Fixed-dose combinations are cheaper and easier to take than the existing HIV treatment protocol; taking two fixed-dose combination pills a day for a year costs $140 per patient, compared to about $600 per year for the normal regimen of six pills per day.
MSF is concerned that further proliferation of so-called 'TRIPS plus' provisions in free trade agreeements negotiated by the United States may jeopardise the progress that has been made on access to medicines. This may have enormous consequences for the health and life of millions of people, says MSF, and this is particularly so given the deadline of 1st January 2005 after which pharmaceutical product patent protection has to be provided by all non-Least Developing Country Members. MSF says in a letter to EU Trade Commissioner Pascal Lamy that the adequate protection of public health demands that WTO Members be permitted to give full effect to the letter and spirit of the Doha Declaration on TRIPS and Public Health (“Doha Declaration”) in their domestic and/or regional legislation.
5. Poverty and health
The paper examines the relationships between income inequality, social inequalities and individual health. The role of social cohesion is analysed vis-à-vis the status and provision of public goods as they foster the integration and formation of social capital. In such paradigms, equality and equity constitute fundamental dynamics to understand or comprehend well-being, and the needs for equitable income redistribution as mediums for growth and social developments.
The Population Reference Bureau has recently produced the report, "Improving the Health of the World's Poorest People." Despite the dramatic improvements in public health achieved in the 20th century, large disparities in health persist both within and between countries. Although governments widely agree that improving the health of poor people is a priority, programs designed to benefit the poor have not been entirely successful. This Bulletin examines facets of the poor-rich health divide, factors that play a role in health disparities, and approaches for improving the health of people living in extreme poverty.
6. Equitable health services
This volume, Challenging Inequities in Health, was conceived as a response to concerns about widening “health gaps” both between and within countries; A disproportionate research focus on inequalities in health in the “North” to the relative neglect of the “South”; and Inadequate analytic tools and pragmatic policies to redress health inequities. Through a collective effort of researchers and practitioners called the Global Health Equity Initiative (GHEI), a set of in-depth country studies and conceptual analyses on health equity were undertaken. The main findings of this effort are presented in this book with the central claim that issues of equity, or distributive justice, deserve primary consideration in health and social policy deliberations.
7. Human Resources
The authors surveyed workforces in southern Africa to determine HIV prevalence among formally employed, largely male populations. Voluntary, anonymous, unlinked seroprevalence surveys of 34 workforces with 44 000 employees were carried out in South Africa, Botswana, and Zambia in 2000-2001. Average HIV prevalence for the entire sample was 16.6%. Country-wide prevalence was 14.5% in South Africa, 17.9% in Zambia, and 24.6% in Botswana.
In order to meet the target of delivering simplified, standardised antiretroviral treatment services to 3 million people by the end of 2005, it is estimated that up to 100,000 people need to be trained. These figures include those involved in managing and delivering antiretroviral treatment services; those working on testing and counselling and other entry points to antiretroviral treatment; and community treatment supporters assisting people who are receiving medication. This document from the World Health Organization (WHO) outlines their strategic plan to support the development, strengthening and sustaining of the workforce.
South Africa's health sector stands to lose a large percentage of its workforce to HIV/AIDS, warns a report by the country's Human Sciences Research Council and the Medical University of South Africa. The study was conducted in four South African provinces - KwaZulu-Natal, Free State, Mpumalanga and North West. "We found that an estimated 15.7 percent of health workers employed in the public and private health facilities located [in the four provinces] were living with HIV/AIDS in 2002," the report said.
This paper looks at different possible policy responses to the emigration of highly skilled persons from developing countries (the brain drain) with the goal of minimising its adverse effects and promoting the sharing of gains between source and host countries. It focuses on three policy approaches: retention, return and circulation of skills. It argues that the best strategy to deal with the problem of loss of skilled labour is one based on the concept of circulation of skills, which yields mutual benefits for both sending and host countries.
Norwegian Nurses Association International (NNAI) Secretary Per Godtland Kristensen has described as unethical the practice whereby rich countries rob poor nations of nurses through mass recruitment. Speaking at a joint Press briefing for NNAI, Zambia Nurses Association (ZNA) and International Council of Nurses (ICN) in Lusaka, Mr Kristensen said rich nations must not be allowed to recruit nurses from developing countries en-masse.
8. Public-Private Mix
The private sector exerts a significant and critical influence on child health outcomes in developing countries. This article in the Bulletin of the World Health Organization reviews the available evidence on private sector utilisation and quality of care. It provides a framework for analysing the private sector’s influence, extending its analysis to include nongovernmental organisations (NGOs), pharmacies, drug sellers, private suppliers, and food producers. The article analyses some of the most promising strategies for improving child health, and suggests a number of possible constraints to emulating these approaches more widely.
The purpose of this paper is to review a set of key policy options that aim to improve access to state-provided health care for poor households in low and middle income countries. It has been developed as part of a broader initiative that seeks to improve understanding of how to tackle the cost-related burdens influencing low income households’ access and use of health care.
9. Resource allocation and health financing
This paper by the Southern African Regional Poverty Network examines the backlog in the delivery of water and electricity services for the rural population in South Africa. It argues that considerable additional resources to those currently assigned by the government are needed to make these services available to the rural poor. The paper identifies the backlogs in the water and electricity sectors, their location, and the additional investment needed to meet backlogs. It says that the backlog in electricity has proved stubborn: although it was predicted that at the end of the year 2000 about 2,75 million households would be without electricity, the total in that year was 3,65m. In 1994 the backlog in water delivery was some 12m people - now it has been calculated at 10,554,306.
10. Equity and HIV/AIDS
A United Nations plan to provide three million HIV-infected patients in Africa with anti-retroviral drugs by 2005 is in danger of collapsing owing to lack of funds, UN and World Health Organisation officials said. Some countries, particularly the United States, are balking at supporting the project, Aids workers say, partly because the plan intends to use a form of medicine called fixed-dose combination antiretroviral drugs whose use is opposed by large pharmaceutical companies.
US officials attending a major conference on anti-AIDS drugs in Botswana this week have dismissed allegations that they want to use the meeting to question the quality and safety of more affordable generic fixed-dose combinations (FDCs) of antiretrovirals. "We want to see use of internationally accepted scientific principles that will be used in evaluation of Fixed Dose Combination drugs for HIV, tuberculosis and malaria. The concern is the risk of resistance, because good drugs are not good enough with this disease," said Dr Mark Dybul, head of the US government's President's Programme for AIDS Relief (PEPFAR).
This recently published national policy document has eight chapters covering, inter alia, a multi-sectoral response to HIV/AIDS; issues of prevention, treatment and care; the empowerment of People Living with HIV/AIDS and of vulnerable populations; traditional and religious practices and services; HIV/AIDS in the workplace and research questions. Will also be of interest to organisations outside Malawi.
"We, members of the Pan African Treatment Access Movement (PATAM) who have gathered here in Harare from 3-5 March 2004 to draw up civil society strategies to ensure rapid scale-up of anti-retroviral therapy in Southern Africa understand that everyone in the world is vulnerable to HIV infection and know that HIV-positive people in Africa, particularly women and other vulnerable groups, experience great challenges that must be addressed urgently. We know and understand that there are numerous factors and actors that hamper the provision of affordable life-saving medicines. Some of these include profiteering by pharmaceutical companies, inequitable international trade relationships, poverty, extreme stigma, imbalance of power within patriarchal societies, macroeconomic policies that constrain spending for health care and other social services and a lack of commensurate political commitment by our governments and other leaders to match the scale of the HIV/AIDS pandemic."
The shortfall in extending antiretroviral therapy (ART) to HIV positive people in Southern Africa is "enormous", with mostly educated, urban males benefiting from existing programmes, says a new report. The report was compiled by the Regional Network for Equity in Health in Southern Africa (Equinet) and Oxfam GB, and focuses on equity in health sector responses to HIV/AIDS.
This report (April 2003) was commissioned by the National Emergency Response Committee on HIV/AIDS and UNAIDS. It examines various biologic, behavioural and socio-economic drivers and discusses the impact of the pandemic on health care, education, agriculture and the private sector. It concludes with some innovative responses. This report should be of interest to persons outside of the immediate Swaziland context.
11. Governance and participation in health
In 1987, May 28th was proclaimed the International Day of Action for Women's Health. Health is a human right for all and, as asserted in many international human rights covenants and agreements, the right to health cannot be fulfilled if women's sexual and reproductive rights are not addressed. However, health sector reforms and privatisation of health services around the world are jeopardising women's access to health and sexual and reproductive rights. Women's Global Network for Reproductive Rights (WGNRR) invites you to support promoting women's sexual and reproductive health and rights by organising your own activity or event on the 28th of May.
12. Monitoring equity and research policy
This article explores how health research can be improved to ensure that its results are translated into action. It is based on the author's experience of health research on HIV/AIDS in South Africa. The article argues that the question of how to translate health research into action should be broken down into four questions: How relevant is the project to health sector development in the short and in the long-term? Are all relevant stakeholders integrally involved in all stages of the research process? Are there skills development or capacity building aspects in the project? What are the strategies for dissemination of the research results?
How do health policies spread from one country to the next? Transfer without ownership may make implementation difficult. Researchers from the London School of Hygiene and Tropical Medicine look at the development of international policy on tuberculosis (TB) control over the last two decades. Do policy-makers adopt and adapt health policies voluntarily, after learning about experiences in other countries, or do international organisations or donors more often impose policies? The researchers posed these and other questions during interviews with 40 key players in TB policy development.
13. Useful Resources
This 78-page resource manual, produced by JSI(UK)-Zimbabwe and funded by DFID Zimbabwe, is designed to encourage and help groups of young people support either younger children or their peers who are living in communities and households affected by AIDS. It contains a Training Guide for facilitators to use to prepare young people to implement community activities, and a Community Activities section that suggests activities young people can undertake in their communities.
The International People's Health Council and Medact have launched a clearinghouse on the politics and economics of international health. This comprises a website (the global economics and health folder at www.medact.org) and a monthly e-mail bulletin. Associated resources are also available at www.iphcglobal.org.
The Organisation for Social Science Research in Eastern and Southern Africa (OSSREA) is offering Sabbatical Research Grants to successful applicants based in Eastern and Southern Africa. Proposals may be submitted by researchers from any of the disciplines in the social sciences involving applied social and economic analysis of contemporary development issues.
14. Jobs and Announcements
The Open Society Institute (OSI) and Public Library of Science (PLoS) has announced a new grants program to support open access publishing in developing and transition countries. The grants will make it much easier for scientists based in developing and transition countries to submit articles to the premiere peer-reviewed research journals published by PLoS. "Scientists in poorer countries have been virtually excluded from the journal publishing world," said Darius Cuplinskas, director of OSI's Information Program. "Open access journals will remove barriers and make these scientists full members of the international scientific community.
The director should be a national leader in health systems research with a strong vision to 'improve the impact of health care on health'. The unit currently focuses on evaluating healthcare interventions; but the mandate could be expanded beyond this scope. Developing methodology and capacity in health systems research are key objectives. The Unit collaborates widely with scientists in South Africa and overseas.
The Health Economics & HIV/AIDS Research Division (HEARD) is based at the University of Kwa-Zulu Natal. HEARD conducts research on the socio-economic aspects of public health, especially the HIV/AIDS pandemic. The intent is to inspire health and development strategies that improve the welfare of people in and beyond Africa. HEARD's ethos is to share knowledge and transfer skills. This is accomplished by having a dedicated team of multi-skilled staff and a commitment to training African researchers.
A new global campaign, launched on March 18th, calls for throwing out the occupying forces in Iraq and Afghanistan and dismantling of the World Trade Organisation. “Wars and WTO are the greatest threat to health and peace,” said a spokesperson. “Under the guise of a ‘war on terror’, the United States is trying to enforce global hegemony at a terrifying cost to people’s health,” she said. Wars, military interventions, occupation and militarization devastate public health and also waste precious resources - at the expense of health and other basic services.
The HIV/AIDS in the Workplace Research Symposium has opened registration for those interested. This symposium will provide an opportunity for researchers in these fields to present and share their work.
The Municipal Services Project (MSP) is a multi-partner research, policy and educational initiative examining the restructuring of municipal services in Southern Africa. Research partners are the International Labour Research and Information Group (Cape Town), the University of the Witwatersrand (Johannesburg), the Human Sciences Research Council (Durban), Equinet (Harare), the South African Municipal Workers Union, the Canadian Union of Public Employees, and Queen's University (Canada). The project is funded by the International Development Research Centre (IDRC) of Canada. During the first phase of the project (2000 - 2003), the primary focus of our research was on the impact of policy reforms such as privatization and cost recovery on the delivery of basic municipal services (specifically water, sanitation, waste management and electricity). Most of this research was conducted in South Africa. We are now entering a second phase, which will focus more specifically on the impact of policy 'reform' on health and will expand the research to include more countries in Southern Africa.
The 3rd International Conference of the International Society for Equity in Health will be hosted by the Health Systems Trust (HST), a South African-based NGO, the Southern African Regional Network on Equity in Health (EQUINET) and the Global Equity Gauge Alliance (GEGA), an international consortium of initiatives to support health equity. The meeting will bring together, researchers, policy-makers, practitioners and others concerned with equity in health to develop an international health agenda for governments, universities and organisations all over the world. The 3rd International Conference theme is “Pathways to equity in health: Using research for policy and advocacy”. The Conference will explore this theme through a varied program of plenary sessions, forums, poster sessions and scientific sessions.
The trend towards privatization and "public-private partnerships" (PPPs) in the delivery of basic municipal services and in primary and district level health service provision has received enormous research attention over the past two decades. Less well studied (and less common in practice) are "public-public partnerships" (PuPs). This research is intended to act as a baseline "concept paper" for additional research by the MSP and EQUINET. It aims to provide information on the state of research on PuPs, an analysis of the conceptual and logistical framework of PuPs that have been implemented, and a discussion of the lessons to be learned from PuPs in SADC countries and elsewhere.
The International Network for Scientific Publications (INASP) launched AJOL in 1998 with only 14 journals. By January 2004 it had over 175 African journals covering most subject areas. It is now being re-launched on its own website that continues to provide free access to tables of contents and abstracts for all titles - but also provides a number of additional facilities. AJOL offers a document delivery service, and full (improved) searching and browsing facilities, as well as a new Email alert function. The service remains free to both users and participating journals (with charges only for document delivery requests from outside developing countries).
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