There is a dire shortage of professional health care workers to deliver essential health services in sub-Saharan Africa, including life-saving antiretrovirals (ARVs) for people living with HIV and AIDS. Donor support for disease-specific interventions for AIDS, tuberculosis, and malaria has increased markedly in recent years. However, funding for recurrent costs for these interventions, such as increasing salaries and creating new posts, has remained taboo.
The Global Fund to Fight AIDS, TB and Malaria (GFATM) was created largely due to pressure from activists and non-governmental organisations (NGOs) who fought to have a global financing facility that would pay for ARVs – something that was considered off-limits to donors before 2002. In 2005, a specific "window" of funding was created to support health systems, including human resource costs. Since then the option has been integrated within specific disease components.
Although there is some degree of uncertainty about the scope of GFATM support for human resource costs in future rounds, country applicants have an opportunity to request such support in Round 7. The GFATM should provide unambiguous and continued support for funding salaries and other "recurrent" human resource costs. Bilateral donors should follow suit.
Lesotho is a case in point. The country has the third highest HIV prevalence in the world after Swaziland and Botswana – and is the poorest of the three. It is struggling with a catastrophic health worker situation that threatens to make it impossible for the country to scale-up and sustain HIV care and treatment for the more than 270 000 Basotho presently living with HIV and AIDS.
In January 2006, Doctors Without Borders/Médecins Sans Frontières (MSF), an international medical humanitarian organisation, launched a programme in Lesotho in Scott Hospital Health Service Area (HSA), a rural health district with a catchment population of 220 000. The programme provides decentralised HIV care and treatment, including ART, integrated into existing primary health care services. In the first year, more than 3 500 people were enrolled in HIV care and over 1 000 had initiated ART at Scott Hospital and 14 rural health centres.
Scott Hospital HSA has a higher than average health worker coverage rate. Still, according to an assessment of workloads in Scott Hospital HSA carried out by MSF in August 2006, there are up to 45 consultations per nurse per day not including HIV-related consultations. With the introduction of dedicated HIV services, the workload in the past year has increased dramatically. The World Health Organisation recommends that nurses should conduct no more than 20 consultations per day.
Between January and July 2006, at least 18 nurses left the HSA for "greener pastures". Ten new nurses were hired after July 2006, but six additional nurses left, leaving more than a quarter of nursing posts vacant.
With more than 35 000 people estimated to be living with HIV and AIDS in Scott Hospital HSA alone, at least 5 000 of whom are in urgent clinical need of ART, the needs far outstrip the capacity of health facilities and health workers. MSF has employed several strategies to cope with these shortages – from providing mobile MSF medical teams to bring "in-service" support to nurses to task-shifting to new cadres of community health workers to introducing measures to improve staff retention.
Ultimately, however, immediate measures will need to be put in place at the national level to recruit and retain skilled nurses and other professional health care workers, including as a necessary first step, increasing their salaries. Without major investments in retention of skilled staff, ART programmes – including the MSF-supported programme – are vulnerable to collapse.
The GFATM, bilateral donors, and all other relevant actors, must clearly state, with money on the table, their support for funding salaries and other interventions to support human resources for health. Affected-country governments must then meet this commitment with emergency plans to address the human resource crisis.
As for Lesotho, an emergency human resource plan needs to be developed and donors need to step up to the plate. The US Millennium Challenge Account is committing an unprecedented US $140 million for health infrastructure. "Brick and mortar" projects are welcome, but without support for health care workers, this construction/renovation programme will be tantamount to supplying computer hardware without software to run programmes.
Funding salaries on a recurrent basis and supporting other initiatives to stem the loss of health workers and bring relief to overburdened staff and the thousands of patients they serve is a critical requirement in order to expand and sustain HIV/AIDS care and treatment.
Please send feedback or queries on the issues raised in this briefing to the EQUINET secretariat, admin@equinetafrica.org. Further information on MSF and its programmes can be found at www.msf.org and on EQUINET work on AIDS and health systems www.equinetafrica.org.
1. Editorial
2. Latest Equinet Updates
A proposed Economic Partnership Agreement (EPA) between the eastern and southern African countries (ESA) and the European Union (EU) is currently under negotiation. The final agreement to be signed in December 2007 could have a profound impact on areas of health and health services. Recognising this, in this report we examine the health implications of this proposed EPA between the ESA and the EU. The report aims to inform government, civil society, parliaments and professionals working in health and in trade. It examines: • the key areas of the EPA; • the health implications of the EPA, specifically in terms of health inputs (examining food security) and health services (examining organisation of health services, health workers, and access to medicines); • the options that countries have to protect health in the current EPA; and • general issues and principles for protecting health in negotiating the EPA.
Although prepayment schemes are being hailed internationally as part of a solution to health care financing problems in low-income countries, literature has raised problems with such schemes. This paper reports the findings of a study that examined the factors influencing low enrolment in Tanzania’s health prepayment schemes (Community Health Fund). The paper argues that district managers had a direct influence over the factors explaining low enrolment and identified in other studies (inability to pay membership contributions, low quality of care, lack of trust in scheme managers and failure to see the rationale to insure). District managers’ actions appeared, in turn, to be at least partly a response to the manner of this policy’s implementation. In order better to achieve the objectives of prepayment schemes, it is important to focus attention on policy implementers, who are capable of re-shaping policy during its implementation, with consequences for policy outcomes.
Human rights approaches to health have been criticized as antithetical to equity, principally because they are seen to prioritise rights of individuals at the expense of the interests of groups, a core tenet of public health. The objective of this study was to identify how human rights approaches can promote health equity. The paper argues that Where it is clear that rights approaches are predicated upon understanding the need to prioritize vulnerable groups and where the way rights are operationalised recognizes the role of agency on the part of those most affected in realising their socio-economic rights, human rights
approaches appear to offer powerful tools to support social justice and health equity.
This student capacity building project aimed at comparing information on the knowledge and attitudes of intern doctors at two urban hospitals and three rural hospitals in Uganda regarding international migration. The key informant interviews suggested that the search for better pay is the most significant push factor for migration; while the most significant retention factor is feeling indebted to the government and family who sponsor their education. The respondents from both settings think that the workload and working conditions will affect their eventual specialty and location of practice.
3. Equity in Health
Equity has in many instances been framed around the notion of fairness. But the metric used to determine what is fair leaves some people at a disadvantage because the things that they value are not always taken properly into account. The debate about judging equity – about measuring fairness – needs to find the conceptual and methodological space to allow the voices and claims of the other to be heard.
The persistence of health inequities provides an ongoing challenge for health promotion. The dictum 'think globally, act locally' fails to recognise the significance of infrastructure and policy in linking global issues and local practices as a means of addressing health inequities. This article is in the form of a commentary and opinion, and final comments include that Health promotion needs to beg, borrow and build political and media advocacy skills if it is to go beyond local demonstration projects and have the capacity to promote population health and address health inequities.
4. Values, Policies and Rights
Advocates worldwide on International Women's Day on Thursday highlighted issues such as gender equality, discrimination and the need for justice for survivors of sexual violence, Reuters reports. United Nations Secretary-General Ban Ki-moon on Wednesday said that although world leaders reaffirmed the importance of gender equality in "almost all countries, women continue to be under-represented in decision-making positions." He also said that the majority of the more than 100 million children who are not in school are girls and that women's "work continues to be undervalued, underpaid or not paid at all." In addition, violence against women continues "in every continent, country and culture" because it is concealed or condoned, Ban said. UNICEF director added that "No one, including the UN itself, is doing enough to end this terrible situation. We fail to treat it as a crime".
PHM is embarking upon a global Right to Health and Healthcare campaign which involves coordinated national and international level action. The overall idea of the campaign is to change the international approach to health and development, and, via a ‘Global Action Plan on the Right to Health Care,’ convincingly show how quality essential health care services could be made available NOW to every human being on earth.
The purpose of the Convention is to promote, protect and ensure the full and equal enjoyment of all human rights and fundamental freedoms by all persons with disabilities, and to promote respect for their inherent dignity. Persons with disabilities include those who have long-term physical, mental, intellectual or sensory impairments which in interaction with various barriers may hinder their full and effective participation in society on an equal basis with others.
This year's International Women's Day was devoted to ending impunity for violence against women and girls. The Director General of the World Health Organisation, Dr Chan, began her speech with a reminder that women have particular needs and face specific health issues but, how the health needs of women are given neither the attention nor the prominence they deserve. Each year, for example, more than half a million women die from complications related to pregnancy and childbirth alone - a number that has hardly changed in 20 years.
5. Health equity in economic and trade policies
Abbott's abrupt decision to withdraw seven pending registration applications, including one for a new heat-stable form of Kaletra, and its threat to make Thailand a no-drug zone for all new Abbott medicines is a truly appalling example of corporate hubris. After touting itself to the be the engine of new life-saving discoveries, Abbott is now willing to withhold medicines altogether in order to extract even greater intellectual property concessions from developing countries.
US drug giant Abbott Laboratories has banned its new drugs in Thailand in response to the Thai government's decision to protect the health of its citizens by issuing a compulsory license on Abbott's AIDS drug Kaletra. Abbott's decision could potentially deny access to lifesaving drugs to the more than 500,000 people living with HIV/AIDS in Thailand, as well as to others with serious health conditions. The company's move has sparked outrage throughout the global health community.
A bipartisan group of Senators today introduced the African Health Capacity Investment Act of 2007, a comprehensive bill to help sub-Saharan African nations confront the alarming shortage of health workers; thirteen countries on the continent have fewer than 5 physicians per 100,000 people. The United States has 549 physicians per 100,000 people. "Increased funding from governments and private donors to expand health services holds the promise of saving millions of lives in Africa. But, a severe shortage of health workers on the ground represents a tight bottleneck slowing the flow of resources to patients who need them," said Dr Paul Farmer, medical anthropologist and a founder of Partners In Health. "Sub-Saharan Africa faces a shortage of more than 800,000 doctors, nurses, and midwives and an overall shortage of 1.5 million healthcare workers. The bill introduced, particularly with its focus on harnessing the power of paid community health workers, is a much needed step toward closing this gap."
Christian Brothers Investment Services, Inc. (CBIS) and 15 other faith-based institutional investors with approximately $35 million in Abbott Laboratories (NYSE: ABT) holdings responded today to the pharmaceutical company's decision to withdraw new drug applications from Thailand with a request that Abbott immediately reverse its decision.
The global community has no hope of ending the AIDS pandemic as long as the interests of drug companies are rated higher than the lives of people in low- and middle-income countries. The innovations of the pharmaceutical industry have transformed AIDS, at least in the western world, from a virtual death sentence into a chronic, treatable disease. Our aim is not to destroy the geese that lay the golden eggs. However, a balance must—and can— be struck between protecting profits and protecting people’s lives. Drug companies are in the business of protecting profits. It is incumbent upon the citizens of the global community to protect people’s lives.
More than twenty technology companies are responding to a call to support the fight against counterfeit medicines spearheaded by the International Medical Products Anti-Counterfeiting Taskforce (IMPACT) set up by the World Health Organization (WHO) and partners. They were to join the IMPACT Working Group on Technology for a one-day meeting in Prague to assess technologies which could improve the global prevention, tracking and detection of counterfeit medicines. "In the case of anti counterfeiting, the challenges we face are finding technologies that cannot themselves be counterfeited and transferring them to resource poor settings at an affordable cost. While technology alone cannot solve the problem, some of these solutions could greatly enhance the ability to detect and deter the distribution of counterfeit medicines."
6. Poverty and health
The paper reviews: a) recent developments in global and national political relations, thinking, and related institutional changes, b) the effect of such developments on the incidence of hunger, c) the ability and willingness of governments to eradicate hunger, and d) the efforts to foster greater political will for food security.These four points are central to the argument presented here and appear across the subsequent sub-sections. They are intertwined and only offer a complete picture in combination. The paper starts with a short statement to set the context for a national perspective on political will. It then reviews and appraises examples where political will has either frustrated attempts to address food insecurity and examples where political will has been formulated into a cohesive set of policies and programs to address food insecurity. These case studies then set the foundation for articulating the key constructs to focus political will in a way conducive to reducing food and nutrition insecurity.
The Status Report for 2006 is produced in accordance with the MKUKUTA Monitoring Master Plan which calls for a short report on the status of growth and poverty in Tanzania in those years in which a full Poverty and Human Development Report (PHDR) is not produced. It provides an overview of the most recent data on indicators of progress towards the goals and targets of MKUKUTA’s three major clusters of desired outcomes for poverty reduction: growth and reduction of income poverty; improvement of quality of life and social well-being; and governance and accountability.
Hunger makes the international news during times of famine, yet chronic food shortages are a feature of everyday life for millions of people in Africa and Asia. What can be done to change this and what role can journalists play? This paper looks at the issues around food security and factors involved in making it worse, such as ill-advised and inadequate policy decisions, conflict and HIV/AIDS. Suggestions are given on ways in which food security can be improved. The article finishes by discussing the role the media could play in highlighting the food security issue by spotting trends and alerting both farmers and governments to potential problems. It also suggests questions journalists can ask with regard to the related issues.
Adequate rainfall in the last three months of 2006 improved food security in the parts of Kenya affected by the severe drought that hit the Horn of Africa last year, a famine warning agency reported. However, in some areas, outbreaks of diseases related to floods, as well as high HIV/AIDS prevalence, reversed the gains of a good harvest and pasture regeneration.
7. Equitable health services
This paper suggests a model for sustainable improvement of health system performance which takes into consideration historical lessons, and current opportunities and challenges facing Africans. The essential elements of the suggested model include decentralized governing structures linking the health system to communities; identification of an essential care package for health (ECPH) based on peoples’ priorities; an improved information system to provide evidence of improvement in service access, delivery, and outcomes; and regular dialogue among stakeholders to enhance informed demand, responsibility, and accountability. The model attempts to pay due regard to the people's own beliefs, knowledge, customs, experiences, practices, systems, and structures that give meaning to the ECPH and mitigate the discontinuity between people’s perceptions and the health intervention package through regular dialogue.
The availability of drugs to treat two leading killer diseases in the country's public health facilities still falls below the internationally recommended benchmark, a survey shows. On average, the availability of two anti-retrovirals meant to treat HIV/Aids and that of the newly launched anti-malarial drug fell at least 10 marks below the recommended 75 per cent.
The healthcare system in South Africa is based on the district health system through a primary healthcare approach. Although many vision and mission statements in the public healthcare sector in South Africa state that the service aspires to be holistic, it is at times unclear what exactly is meant by such an aspiration. The term ‘holism’ was coined in the 1920s and describes the phenomenon of the whole being greater than the sum of the parts. Over the past two decades the term has entered into many academic disciplines as well as popular culture. As part of a larger research study, the limitations to working holistically in the public sector in a rural sub-district in South Africa were explored. This study used a participatory action research design that allowed participants a large degree of influence over the direction of the study. The close relationship between difficulty in providing a holistic healthcare service and burnout was an important finding that deserves further exploration.
Influential women from all over the globe have come together in London to urge the world to redouble efforts and boost investments to reduce the global burden of maternal and newborn death. The policy makers and parliamentarians from developing and developed countries are meeting to mark UK Mother's Day on 18 March 2007. Key participants include Cherie Blair, wife of the UK Prime Minister and international lawyer, Hilary Benn, MP, Secretary of State, Department for International Development, UK, Liya Kebede, Supermodel and World Health Organization Goodwill Ambassador for Maternal, Newborn and Child Health, and the First Lady of Lesotho, Mrs Mathato S. Mosisilli. A Global Plan of Action agreed at the meeting calls for a universal right to health for mothers and their babies by ensuring equitable skilled care. The plan calls on governments to take the lead in fighting maternal and newborn illness and death.
This paper argues that general practice is potentially an important social determinant of health and health inequalities. The way it is influential is consistent with models of causal pathways in the way social and societal factors influence health. General practice clinical care can be thought of as a material resource. Evidence exists at many levels that this resource is inequitably distributed. But encounters in general practice are profoundly social processes, embedded in wider society. Debating and reflecting on the values underpinning relations between GP and patient may help challenge and illuminate wider inequitable processes in society that sustain inequalities in health.
Several countries in eastern Africa have a high incidence of tuberculosis but have yet to develop effective national strategies to curtail the disease, the United Nations World Health Organization said in its 2007 global TB report, ‘Global tuberculosis control - surveillance, planning, financing’. Citing Democratic Republic of Congo, Kenya and Tanzania as among the 22 countries with a high tuberculosis burden, WHO said their national plans were not effective enough to combat it. Nigeria and Mozambique are the other African countries on the list. While noting the provision of free TB the report cites constraints in plans for human resource development made by national TB control programmes, inadequate screening of HIV-positive people for TB, and limited facilities for diagnoses and treatment of multi-drug resistant TB.
8. Human Resources
A new international Task Force was launched and met for the first time in March to tackle the global shortage of health workers. With a shortfall of 4.3 million health workers worldwide, including more than 1 million in Africa alone, there is an urgent need to increase the number of doctors, nurses, health managers and other health care workers needed to face immediate health crises. The new global Task Force is co-chaired by Bience Gawanas, the African Union Commissioner for Social Affairs, and includes African Ministers of Health from Uganda and Malawi, as well as senior health policy makers from across the globe, from the public and private sectors, and both developing and developed countries. Together these leaders in health and education will champion the need for significantly increased investment in the education and training of health workers in developing countries, and will build international commitment to practical action.
The World Health Organization (WHO) and the Office of the US Global AIDS Coordinator (OGAC) convened representatives from HIV Programmes and Human Resources for Health Departments from Ministries of Health, Professional Associations, Academic Institutions and representatives from workers associations in Geneva for a two day technical consultation about the need for a regulatory framework in support of Task Shifting. The meeting signaled the beginning of a new expert partnership for driving forward the Task Shifting Project in the context of the wider HIV/AIDS and health workforce plan “Treat, Train, Retain”.
9. Public-Private Mix
This policy research brief draws on the findings of a UNDP-supported book, Privatization and Alternative Public Sector Reform in Sub-Saharan Africa (Bayliss and Fine, forthcoming), to analyse the effects of privatisation on the delivery of water and electricity. Its chief conclusion? Privatisation has been a widespread failure. This has hampered progress on the MDGs for both water and sanitation, and on many other MDGs dependent on energy. Privatisation has failed on several counts. Contrary to expectations, private investors have shied away from investing in such utilities in the region. So it has been costly for governments to motivate them to invest. Moreover, the focus of investors on cost recovery has not promoted social objectives, such as reducing poverty and promoting equity. Thus, current realities dictate refocusing on building up the capacity of the public sector. It continues to dominate the provision of water and electricity, and will do so for the foreseeable future. But a dramatic scaling up of both external and domestic resources will be needed to finance more extensive public investment in these sectors. This approach is consistent with the current priority of adopting more ambitious MDG-based development strategies in the region.
The ability of health organizations in developing countries to expand access to quality services depends in large part on organizational and human capacity. Capacity building includes professional development of staff, as well as efforts to create working environments conducive to high levels of performance. The current study evaluated an approach to public-private partnership where corporate volunteers give technical assistance to improve organizational and staff performance. From 2003 to 2005, the Pfizer Global Health Fellows program sent 72 employees to work with organizations in 19 countries. This evaluation was designed to assess program impact.
This paper describes the context of health care provision in sub-Saharan Africa (SSA), analyses current mechanisms for public-private partnerships (PPP), and discusses emerging issues in strengthening partnerships to expand health coverage.
10. Resource allocation and health financing
This paper discusses the best monetary policy to manage the macroeconomic effects of an MDG-related scaling up of aid inflows to address the HIV/AIDS pandemic. Many economists have expressed concern that a substantial scaling up of aid inflows would lead to greater inflation and real exchange rate overvaluation. Thus, in such a context, they often advocate that central banks adopt restrictive monetary policies. However, such policies often make overvaluation worse by driving up the interest rate and reducing domestic liquidity. This paper suggests that the evidence on the overvaluation effects of aid inflows is thin, at best. Instead of advocating restrictive policies, this paper maintains that monetary policies should maintain low rates of interest, increase overall liquidity in the economy and maintain a relatively depreciated currency. Such policies will help support the expansion of fiscal space that will be necessary for reaching the MDG target of halting and reversing the HIV/AIDS pandemic. A substantial increase in ODA directed towards combating HIV/AIDS will lead to an expansion of government spending on domestic goods and services. But the impact of such spending will not necessarily be inflationary in economies, such as those of many low-income countries, which have significant excess capacity, i.e., underemployed labour and other productive factors.
This Guide was produced to assist members of Country Coordinating Mechanisms and other individuals and organizations involved in preparing proposals for Round 7 of the Global Fund to Fight AIDS, Tuberculosis and Malaria, which launched March 1, 2007. While the primary purpose of this Guide is to serve as a technical guide in thinking about and developing proposals that include health system strengthening activities, we also hope that it can help motivate countries to use the Global Fund to support such activities.
Price is one of the major barriers to reliable access to medicines while availability of medicines is also a major determinant of access. The Ministry of Health of Kenya and conducts surveys on a quarterly basis to monitor medicine prices in the countries. In these surveys information is collected on availability, affordability and price variation on a basket of medicines in the public private and mission sectors.
Most Ugandans cannot readily access the medicines they need due to the high prices charged. To understand more about what people pay for medicines in Uganda, the Ministry of Health in collaboration with the World Health Organization (WHO) and Health Action International (HAI) Africa conducted a countrywide survey on medicine prices in 2004, and recommended a medicine price monitoring system for surveys to be conducted quarterly. This is the first price monitoring report, presenting the survey results for the October-December 2006 quarter.
11. Equity and HIV/AIDS
This report seeks to identify discernible trends through the measurement of new and existing data against a baseline used here for the first time in the areas of preventing mother-to-child transmission of HIV, providing paediatric treatment, preventing infection among adolescents and young people, and protecting and supporting children affected by HIV/AIDS – the ‘Four Ps’. Further, this report reviews progress towards support strategies identified as critical elements of a child-focused response. It seeks to illuminate some of the ways in which Unite for Children, Unite against AIDS has shown relevance and promise, as well as some of the ways it has failed to spur the global, regional and country mobilization required to address the problems facing children affected by AIDS. It will explore how Unite for Children, Unite against AIDS needs to move forward in the next year to achieve its ambitious goals.
Global funds available to combat HIV/AIDS are estimated to reach about US$ 9 billion in 2007. Although this amount will be only about half of what is needed, it is, nevertheless, substantial. Used effectively, such donor financing could help stem the pandemic’s spread and mitigate its effects. In fact, disbursing the balance of such financing early on - ‘front-loading’ it - should be a priority. But there is considerable resistance to doing so. Why is this the case?
The HIV and AIDS epidemic feeds on, and worsens, unacceptable situations of poverty, gender inequity, social insecurity, limited access to healthcare and education, war, debt and macroeconomic and social instability. This paper introduces a series of eight papers from a programme of work reported in this supplement of AIDS Care with an analysis of background evidence of community responses to HIV and AIDS. It explores how interventions from state institutions and non-governmental organizations (NGOs) support and interact with these household, family and community responses. Through review of literature, this background paper sets out the questions that the studies reported in this supplement have, in various settings, sought to explore more deeply.
A trial in Zimbabwe has shown that a programme of integrated peer education, condom distribution, and management of sexually transmitted infections did not reduce the overall incidence of HIV-1. The study, published in PLoS Medicine, by Simon Gregson and colleagues from Imperial College London, randomised different communities in eastern Zimbabwe over a 3 year period. Six pairs of communities in Eastern Zimbabwe were compared, each of which had its own health center. Control communities received the standard government services for preventing HIV. According to the author, the results are disappointing given the urgent need for control measures for HIV-1 in sub-Saharan Africa. The authors conclude that they “emphasise the need for alternative strategies of behaviour change promotion.”
The AIDS and Rights Alliance for Southern Africa (ARASA), a partnership of human rights and HIV/AIDS organisations in the 14 countries of Southern Africa, denounced American charlatan, Boyd E. Graves, for peddling false AIDS cures in Zamiba, where his claims to be able to treat HIV infection are creating mass confusion across the country among people living with HIV/AIDS. "We are hearing reports from our partner organisations that people are stopping their AIDS medications now that they are being led to falsely believe that a cure for AIDS has been found," said Michaela Clayton, the Director of ARASA. The article claims that in fact, the Treatment Advocacy and Literacy Campaign in Zamiba is reporting that individuals are being told by agents of Mr Graves to stop taking their antiretroviral drugs, stop using condoms and stop immunizing their children against infectious diseases.
This paper situates the findings of the diverse studies reported in this journal supplement in a global context that both fuels the epidemic through inequality and poverty and also provides new opportunities for global commitments, solidarity and resources. The studies in this issue signal that, while information and awareness about HIV and AIDS is now high, there is still poor access to services for people to know their own risk and a deeper need to address the asymmetries of power and access to resources that influence the control people have over their sexual relationships and lives.
Namibia is hailed as one of the front-runners in AIDS treatment rollout, yet there is growing fear that this success might be short-lived if services do not reach rural communities. The government has increased the number of sites offering antiretroviral (ARV) treatment from seven three years ago to 34 at present, but most of the clinics were set up in the densely populated northern regions, far from people living on farms and in rural villages.
The number of tuberculosis cases in Tanzania has risen from 39,000 a decade ago to 64,200 in 2005, a trend blamed on high HIV/AIDS prevalence, the Health Minister, David Mwakyusa, said on Thursday. "Research conducted in many parts of the country by the Ministry of Health between 2003 and 2004 established that HIV/AIDS contributes to increased TB cases by about 60 percent," the minister said.
12. Governance and participation in health
Social Movements and Human Rights Organisations marched from the Library Gardens to the Constitutional Court in Braamfontein. Formed in 2002, the Social Movements Indaba (SMI) and its affiliates have been at the center of struggle for reclaiming human rights as entrenched in the constitution of the country. The SMI and other organisations affiliated took part in a nation-wide protest in support of the demands for housing, land, water, electricity, HIV treatment and health care, jobs and a positive contribution to the human rights of people suffering in neighbouring countries and around the world.
This article evaluats opportunities for action on social determinants of health (SDH) requires a historical perspective. Plans for addressing SDH should be developed with an awareness of past similar efforts and factors that contributed to their success or failure. The study was a review of published historical literature on analysis and action on SDH, in particular from the Latin American social medicine movement. Concluding comments state that opportunities exist today for significant progress in addressing SDH through national action and global mechanisms such as the Commission on Social Determinants of Health. Historical analysis suggests that civil society participation will be crucial for the success of these efforts.
The People's Health Movement (PHM) is a global network of people oriented health professionals and activists, academcis and researchers, campaigners and people organizations that have actively promoted the re endorsement of the 'Health for All' principles of the Alma Ata Declaration and the importance of social determinants of health and health care. The paper outlines a series of ongoing advocacy initiatives through a PHM - WHO advocacy circle that has consistently since 2001 nudged WHO to reaffirm the Alma Ata principles and focus on the social determinants of health. This has led to an evolving dialogue with PHM and the setting up of the WHO commission on social determiants of health, in which the PHM, is actively engaged.
The Nyeleni 2007 Forum for Food Sovereignty in Mali was not your usual global conference of diplomats and policy makers; the six-day programme initiated by and for the underprivileged worldwide was marked by a spirit of international solidarity. The shabby conditions, however, seemed a perfect fit for the theme of the Nyeleni 2007 Forum for Food Sovereignty. The six-day programme was initiated by and for the underprivileged worldwide, whose major concern may be their next meal. Among the five hundred-plus in attendance were small-scale farmers and fishermen, indigenous peoples, landless migrant workers, pastoralists, and NGOs who have been working with the rural and urban poor.
13. Monitoring equity and research policy
This paper made publicly available by the Woodrow Wilson International Centre for Scholars describes trends in Africa in terms of African demographics; the unfinished agenda for maternal and child health; the widespread threat of HIV/AIDS, tuberculosis and malaria; the burden of natural disasters and conflict; system vulnerabilities; and, the demographic, epidemiologic, urban and nutrition transitions that will influence the health and health service delivery in Africa throughout the 21st century. The purpose of this paper is to present an overview of these trends and catalyze action to mitigate their adverse consequences.
The global tuberculosis (TB) epidemic has levelled off for the first time since WHO declared TB a public health emergency in 1993. The Global Tuberculosis Control Report released today by WHO finds that the percentage of the world's population struck by TB peaked in 2004 and then held steady in 2005. "We are currently seeing both the fruits of global action to control TB and the lethal nature of the disease’s ongoing burden," said United Nations Secretary-General Ban Ki-moon. "Almost 60 per cent of TB cases worldwide are now detected, and out of those, the vast majority are cured. Over the past decade, 26 million patients have been placed on effective TB treatment thanks to the efforts of governments and a wide range of partners. But the disease still kills 4400 people every day."
Malawi has launched a pilot project to investigate ways of reducing the number of mothers and children who die every year to help it reach its millennium development goals (MDGs) by 2015. Hudson Kubwalo, Health Information and Promotion Officer in the Malawi office of the UN's World Health Organisation (WHO), said a needs assessment had found that the unavailability of basic healthcare was one of the major causes of the high infant and maternal mortality in the three districts. Poor roads, a lack of transport to reach the nearest healthcare facility and a high illiteracy rate - around 58 percent among women - were other reasons given for the high level of maternal deaths.
14. Useful Resources
Women with disabilities often discover that the social stigma of disability and inadequate care are greater barriers to health than the disabilities themselves. A Health Handbook for Women with Disabilities will help women with disabilities overcome these barriers and improve their general health, self-esteem, and abilities to care for themselves and participate in their communities. This groundbreaking handbook was developed with the help and experience of women with disabilities in 42 countries-women with various disabilities. The book is full of useful advice on organising for disability-friendly health care, caring for daily needs with limited access to equipment, having healthy and safe sexual relationships, choosing family planning methods that work best with specific disabilities, preparing for pregnancy and childbirth, and defending against violence or abuse.
DevInfo is a database system that harnesses the power of advanced information technology to compile and disseminate data on human development. In particular, the system has been endorsed by the UN Development Group (UNDG) to assist countries in monitoring achievement of the Millennium Development Goals (MDGs). It facilitates data sharing at the country level across government departments, UN agencies and development partners by providing methods to organise, store and display data in a uniform way. By the end of 2006, more than 90 national, regional and global DevInfo adaptations had been developed around the world. DevInfo has been adapted by several UN agencies for the dissemination of regional and global databases.
The Forum on the Future of Aid (FFA) website has recently been re launched. The FFA can make it easier for you to voice your opinions in the international aid debate. By accessing and contributing to the FFA website, you and others can share and generate new ideas, and help promote collective action for genuine reform of the international aid system. The website primarily provides exposure to work from developing countries (Africa, Asia and Latin America). For example, the FFA website includes research written by the Community Development Resource Network (CDRN) in Uganda, the Centre for Policy Dialogue (CPD) in Bangladesh and the Centre for Development Studies and Promotion (CDSP) in Peru.
DevInfo is often used by UN Country Teams as an umbrella data system for creating a UN Common Database for the CCA-UNDAF, and further to help governments in the collation and dissemination of human development data. As a common data repository containing baseline and other information, the DevInfo database facilitates monitoring change and progress over time towards achieving the MDGs and other objectives in the UNDAF or other national plans. Following the need to have a common database in the country which would enhance accessibility of existing data, especially those related to sustainable human development issues, and facilitate wider use of newly collected data, the National Bureau of Statistics in Tanzania adapted DevInfo to develop the Tanzania Socio Economic Database (TSED). The database is very user-friendly.
15. Jobs and Announcements
PATAM would like to invite applications to the Global Women's Leadership in HIV/AIDS Workshop to be held July 16 – August 10 in Washington, DC. It is the first in a series of international, regional and country-level workshops under the new Advancing Women's Leadership and Advocacy for AIDS Action initiative. Funded by the Ford Foundation, partners include CEDPA, the UNAIDS/Global Coalition on Women and AIDS, International Center for Research on Women, International Community of Women Living with HIV and AIDS, and the National Minority AIDS Council.
The Global Health Watch would like to ensure that people's health issues and indigenous health issues are reflected within the second edition of Global Health Watch, and would like assistance and input in writing and sourcing human interest stories written in a simple narrative style. Where it is not possible to integrate stories submitted within chapters, they will put them on the web site. They would like both positive and negative stories, successes and failures, etc.
The Researching Work and Learning Conference (RWL5) will be held in Cape Town, South Africa from 2 – 5 December 2007. The aim of the RWL5 conference will be to promote a truly global conversation about researching work and learning which enables us to rethink the `centre` and rethink the `margins` from a variety of countries and perspectives. At the same time the conference will strive to inject local southern African research issues and debates into the discussions, not in order to be parochial, but to deepen and enrich our understandings about `work` and `learning` globally. The deadline for the submission of abstracts is 15 May 2007.
The Global Forum for Health Research and The Lancet are sponsoring their second joint essay competition on the occasion of Forum 11, the 2007 annual meeting of the Global Forum for Health Research in Beijing, People's Republic of China, 29 October to 2 November 2007. Entries relating to some aspect of the overall theme of Forum 11: Equitable access, research challenges for health in developing countries are invited from young professionals working in or interested in the broad spectrum of health research for development. The deadline for submissions is 20 April 2007.
Do you think the world is doing enough to stop AIDS? Join a groundswell of civil society voices from across the world during the week of 20-26 May to demand a stronger response, greater accountability and more resources in the fight against HIV/AIDS. WHY: Last year, activists from 30 countries took coordinated action during the first ever Global AIDS Week of Action. It was the defining mobilisation before world leaders reported back to the UN on the progress they had made to meet their 2001 commitment on HIV/AIDS. So while in New York our governments boasted of the small gains made, in cities from Abuja to Phnom Penh and Delhi to Lilongwe citizens reminded them of the big losses.
This is to provide advance notification that there will be an exciting workshop on the political economy of health on 8 July 2007 just before the iHEA conference in Copenhagen.
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