The Regional Network for Equity in Health in East and southern Africa (EQUINET) identifies health equity as being affected by conditions and actions across multiple thematic areas. It sought to understand the intersect between climate change and health equity through the outcomes of five webinars and two rapid reviews and an online review meeting organised to explore these intersects. The webinars and briefs focused on selected thematic areas EQUINET has identified as central to health equity in the region, including health rights, food systems, urban health, extractives and health, trade and health, primary health care and tax justice. This synthesis report presents a thematic analysis of the briefs from the webinars and rapid reviews (separately available on the EQUINET website), and from an online review meeting on the findings. It outlines how climate change is intersecting with the various dimensions of health equity, including social inequalities and vulnerabilities in health, and the approaches underway or proposed to address these impacts and to promote health equity in the face of climate change, including for future work in EQUINET. It is shared as an interim product that we will update following EQUINET’s ongoing work in 2025.
Bibliography
Theme area
Equity in health, Values, policies and rights, Health equity in economic and trade policies, Equitable health services, Resource allocation and health financing, Governance and participation in health
Title of publication EQUINET Discussion paper 133: Synthesis report: EQUINET online dialogues and reviews on Climate justice and health equity in east and southern Africa
Date of publication
2024 September
Publication type
Report
Publication details
Publication status
Published
Language
Keywords
Climate, health, trade, rights, primary health care, extractive, urban, finance, tax, global, local east and southern Africa
Abstract
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Discussion paper
Theme area
Equity in health, Values, policies and rights, Health equity in economic and trade policies, Public-private mix, Governance and participation in health
Title of publication Scaling up promising practice to promote healthy urban people and ecosystems in east and southern Africa
Date of publication
2024 September
Publication type
Document
Publication details
EQUINET (2024) Scaling up promising practice to promote healthy urban people and ecosystems in east and southern Africa, EQUINET, Harare
Publication status
Published
Language
Keywords
urban, health, holistic, circular economy, waste, food, water, energy, climate, east and southern Africa
Abstract
There are many examples of healthy, equitable, climate-adapted urban food and waste management practices underway in the east and southern Africa region. These practices integrate waste management, clean energy and green urban ecosystems. They demonstrate multi-sector, multi-actor collaborative planning, informed by disaggregated evidence of different forms, building coalitions that share goals, ideas and ownership, and bring diverse resources and skills to processes. They show how a holistic, circular economy links the 3Rs (reduce, recycle, reuse) to reclaim vacant land with waste dumps for gardens that enable urban agriculture; that use bio-waste for energy and that develop and use local technology innovations. These initiatives integrate equity, incomes and food security to bring sustainable benefit and improved health and nutrition for often marginalised groups. They integrate health and climate justice in reduced air and water
pollution, reduce emissions from waste burning, reduce flooding from clogged drains, enrich soil through organic fertilisers, and climate proof infrastructures. In iterative steps, they assess, review and improve practice, and in so doing strengthen social respect for healthy ecosystems as a source of economic and social benefit and reduced ill health. An EQUINET community of practice on urban health proposed 10 areas of action for scaling up such practices. The recommendations to build, enable and amplify such practice are shown in the brief. In each there are examples of promising practice, guidance, methods, tools and experience to share, with hyperlinks to read further information on each example. Information is also given on where to submit your own examples, as the brief will be updated over time.
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Briefs
Theme area
Values, policies and rights, Health equity in economic and trade policies, Public-private mix, Monitoring equity and research to policy
Title of publication Institutionalising health impact assessment in East and Southern Africa
Date of publication
2024 July
Publication type
Document
Publication details
Publication status
Published
Language
Keywords
health impact assessment, commercial determinants, impact; social determinants of health, tool, east and southern Africa, multi-sector
Abstract
East and southern African (ESA) countries have achieved many gains in health, but also face many health challenges, including from commercial risks and the challenges of climate change. Poverty and inequality continues to affect opportunities to lead healthy lives. This context, the region’s
policy commitment to primary health care and the need for action by many sectors to address the drivers of ill health calls for authorities, approaches and tools that more firmly lever evidence, and multi-sectoral action to protect and improve health. In the same way as environmental impact assessment was institutionalized in the ESA region to play a role in protecting ecosystems, health impact assessment similarly needs to be institutionalized to embed evidence and health promoting changes in wider activities, systems and policies that raise health risks. Policy leaders in Africa recognized this in the WHO AFRO Regional Multi-sectoral Strategy to promote health and well-being, 2023–2030, with a target by 2030 to have institutionalized and integrated health impact assessment.
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Briefs
Theme area
Equity in health, Values, policies and rights, Equitable health services, Public-private mix
Title of publication Resolutions of the 73rd Health Ministers' Conference, Arusha, June 2024
Date of publication
2024 June
Publication type
Document
Publication details
Publication status
Published
Language
Keywords
ECSA HC, Minister, health, resolutions
Abstract
The East, Central and Southern Africa Health Community 73rd Health Ministers Conference was held in Arusha in the United Republic of Tanzania from June 20 -21, 2024. The Conference was attended by Honourable Ministers, Heads of Delegations, senior officials from ECSA Health Community Member States, partner organizations, research institutions, civil society organizations and other key stakeholders. The Conference was organized under the theme: 50 Years of Leadership and Excellence in Regional Health Collaboration. Deliberations at the Conference proceeded under the following sub-themes:
1. Human Resources for Health
2. Health Financing
3. Emerging and Re-emerging infectious diseases and health emergencies
4. Reproductive, Maternal, Neonatal, Child and Adolescent Health and Nutrition
5. Non-communicable, mental health and Substance use
6. Mitigating the effects of climate change on health
7. Technology and Innovations in health
At the end of the conference, the Ministers considered and passed the resolutions presented in each of these areas in this document.
Country
East and southern Africa region
Publisher
ECSA HC
Equinet Publication Type
Resolutions
Theme area
Values, policies and rights, Health equity in economic and trade policies, Public-private mix, Monitoring equity and research to policy
Title of publication Report of the Online capacity building on Health Impact Assessment in east and southern Africa, February to June 2024
Date of publication
2024 July
Publication type
Report
Publication details
Publication status
Published
Language
Keywords
Health impact assessment, skills, East and Southern Africa
Abstract
Assessing the effect of policies, strategies, corporate and economic activities on health is a core capability to protect public health. Health impact assessment (HIA) helps to identify where changes to project design or operation provide health benefits and mitigate health risks, adding economic value and wellbeing. HIA is a structured process that informs decision makers about the potential effects of a project, programme, economic activity or policy on the health and well-being of populations. In 2023, EQUINET -through TARSC with SATUCC and TalkAB[M]R) -in partnership with ECSA Health Community, Nossal Institute of Global Health and C Dora as international partners initiated work to provide online training and mentored case study work to build HIA capacities in multi-actor teams in ESA countries. TARSC through consultant support provided the IT platform for the course, and a media consultant provided input on writing skills. Institutional resources were provided by participating institutions, complemented by support from Open Society Policy Centre and Medico International. The course built understanding of the theoretical basis of HIA, and knowledge of the methods, evidence, analysis in an HIA, of reporting of and engagement on HIA, and implementation and monitoring of proposed actions. It provided mentored guidance of participant HIA practical work, using real HIA case studies. Towards the end of the course there was discussion on issues and strategies for scaling up and integrating HIA in key sectors and in public health law. This report prepared by TARSC briefly summarises the proceedings and issues raised.
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Reports, Toolkits and training materials
Theme area
PAR work, Governance and participation in health, Monitoring equity and research to policy
Title of publication Report of the Online skills session on Participatory Action Research in health and well-being, June 2024
Date of publication
2024 July
Publication type
Report
Publication details
Publication status
Published
Language
Keywords
Participatory Action Research, East and Southern Africa, methods, skills
Abstract
EQUINET has been implementing various training and research activities using participatory action research (PAR) for several decades. This reflected the understanding that the voice, power and self-determination that is inherent for equity should also be integrated in the production of knowledge, and that knowledge and its generation and use is a deeply sociopolitical activity. While some thematic areas of work in EQUINET had applied PAR approaches, not all had, and steering committee (SC) members felt that it would be important to widen understanding of the methods to see how they could be integrated within different areas of work, as a cross cutting process. This 2-hour online skills session was implemented on 20 June 2024. It was organized at the request of the EQUINET SC to give SC members and colleagues involved in EQUINET work from partners a brief introduction to PAR and how it can be used in EQUINET’s various thematic areas. The session aimed stimulate interest in and understanding of how PAR can deepen the research work in EQUINET, and build connections to supporting each other as we move forward and strategize for next steps. Participants then progressed into three groups to discuss how PAR could be better integrated within EQUINET work. A video of presentations in the session is available online at https://youtu.be/OR_lhxoSQuQ
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Reports
Theme area
Equity in health, Values, policies and rights, Health equity in economic and trade policies, Public-private mix, Governance and participation in health
Title of publication Scaling up promising practice to promote healthy urban food, waste and ecosystems in east and southern Africa, Report of an EQUINET Regional Workshop
Date of publication
2024 May
Publication type
Report
Publication details
Scaling up promising practice to promote healthy urban food, waste and ecosystems in east and southern Africa, Report of an EQUINET Regional Workshop, May 23-24 2024, Nairobi, Kenya
Publication status
Published
Language
Keywords
urban, health, health impact assessment, east and southern Africa, climate, circular economy, food, waste
Abstract
This EQUINET regional meeting, convened by TARSC, gathered people from institutions involved in the work on urban health and health impact assessment (HIA) and related expertise on May 23 and 24, 2024 in Nairobi, Kenya, to address particularly issues relating to scaling up promising, climate responsive practice to promote healthy urban food, waste and ecosystems in ESA. It built on work implemented in the region on urban health from 2020 and used a mix of presentation, discussion and participatory processes to: 1. Share and review experience and evidence from both urban health work and HIA in ESA on the laws, policies, systems, features, measures and tools that positively impact on and make linkages across economic, social, health and ecosystem wellbeing, including to respond to climate change. 2. Identify the implications for policy and practice at national, regional and global level. 3. Identify a theory of change and strategies to advance, support and scale-up in ESA the promising policies, practices and tools identified in the meeting. and 4. Identify issues from the meeting to communicate to policy, technical and wider audiences in and beyond the region on improving health (equity) and climate adaptation in urbanisation and in economic/ commercial activity in ESA. The report provides the information shared in and recommendations from the meeting.
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Reports
Theme area
Values, policies and rights, Health equity in economic and trade policies, Resource allocation and health financing
Title of publication Brief on climate justice, tax and climate financing for health equity
Date of publication
2024 May
Publication type
Document
Publication details
Publication status
Published
Language
Keywords
climate, finance, fund, tax, heaslth, equity, East and Southern Africa
Abstract
This brief provides a rapid review of literature and public evidence from various sources on the interface between financing climate justice, tax justice and health equity1. Prior EQUINET webinars on other areas of health equity raised growing concerns on the lack of delivery on commitments made for climate financing in the region. The brief thus complements the work done in previous EQUINET webinars on how climate justice interacts with different facets of health equity, available on the EQUINET website. All briefs from the webinars are being synthesised in a separate discussion document. This brief summarises key issues related to: climate financing in the region and the links to tax and economic justice and health equity; actions proposed to address these issues at local, national and regional level and in international/ global level processes; and issues for further research and discussion.
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Discussion brief
Theme area
Equity in health, Health equity in economic and trade policies, Governance and participation in health
Title of publication Joint Uganda cities stakeholders’ engagement workshop on the urban food-energy-water and waste nexus, Workshop Report
Date of publication
2024 March
Publication type
Report
Publication details
Publication status
Published
Language
Keywords
urban, local authority, health, food, water, energy, Uganda
Abstract
This document reports on an organised cities’ dialogue workshop held in March 2024 in Kampala convened by I4D on behalf of EQUINET to explore the links across food, energy, water and waste management systems, to identify evidence on the challenges and opportunities faced in ensuring equitable access to these resources and services, and to share experiences and analysis from dialogues held in Masaka and Kampala, Uganda. The meeting aimed to identify scalable policies, practices and strategies to tackle the challenges in the nexus between food, water, energy and waste, particularly barriers that make cross-sectoral collaboration and partnerships less feasible.
Country
Uganda
Publisher
I4D, EQUINET
Equinet Publication Type
Reports
Theme area
Equity in health, Values, policies and rights, Health equity in economic and trade policies, Poverty and health, Public-private mix, Governance and participation in health
Title of publication EQUINET Discussion paper 132: Promoting sustainable wellbeing in urban food and waste management systems in east and southern Africa: Learning from case studies of promising practice
Date of publication
2024 April
Publication type
Report
Publication details
EQUINET discussion paper 132 Promoting sustainable wellbeing in urban food and waste management systems in east and southern Africa: Learning from case studies of promising practice
Publication status
Published
Language
Keywords
urban, climate, food, waste, energy, ecosystems, circular economy, East and Southern Africa, case studiies
Abstract
Rising urbanisation in east and southern Africa (ESA) is associated with both opportunities and risks for health. The intersect of multiple risks in urban areas calls for holistic area-based and multi-sectoral approaches, that link food, waste, water, energy and waste management within regenerative, circular urban economies, that also respond to climate change. In 2023, the community of practice on urban health in EQUINET identified value in documenting case studies of initiatives that reflect features of such holistic approaches, particularly around food systems and waste management, to point to features of existing practice that may be amplified in the region. Analysis of such holistic approaches pointed to five key features that, with a more detailed conceptual framework, was used to gather evidence in 2023/4 in seven case studies from (i) Bembeke, Malawi; (ii) Korogocho and Viwandani informal settlements in Nairobi, Kenya; (iii)Kampala and Mbale in Uganda; (iv) Kibuye I Parish, Kampala, Uganda (v) Rimuke, Kadoma, Zimbabwe; (vi) Kariba, Zimbabwe and (vii) Kwekwe, Zimbabwe. This report presents a grounded thematic meta-analysis that included all case studies. It presents the common and different features and areas of shared learning across the seven case studies, including on gathering and using evidence; coalition building in multi-sectoral / multi-actor forums; whole of society and equitable circular economy approaches. It outlines the challenges, enablers and shared learning, including for sustainable development and just measures for climate change.
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Discussion paper
Theme area
Equity in health, PAR work, Governance and participation in health, Monitoring equity and research to policy
Title of publication Keeping an eye on Equity: Community Visions of equity in health
Date of publication
2016 February
Publication type
Document
Publication details
Publication status
Published
Language
Keywords
photovoice, skills, training, photography
Abstract
This documents provides a series of skills handouts to support photography work for photovoice in participatory research. It covers taking better pictures, common mistakes in photography, visual; literacy, designing photographs, captioning and communicating messages, ethical issues, and setting up the visual story.
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Toolkits and training materials
Theme area
Values, policies and rights, Health equity in economic and trade policies, Poverty and health, Public-private mix, Governance and participation in health
Title of publication REGIONAL MEETING May 23-24 2024 Nairobi Kenya: Strategies for tackling commercial determinants of health and for urban wellbeing in east and southern Africa
Date of publication
2024 March
Publication type
Document
Publication details
Publication status
Published
Language
Keywords
Meeting, Urban; health; HIA; East and Southern Africa
Abstract
This regional in-person meeting seeks to review the evidence, and share experiences and analysis to date. It aims to identify scaleable policies, practices and strategies to tackle these challenges, particularly those that make cross-sectoral links between inclusive economic and social benefit, that provide embedded responses to climate change, that are participatory, and that proactively generate evidence and prevent challenges, such as through health impact assessment (HIA). The meeting draws on and will deepen analysis and develop proposals from case study work carried out in the ESA region, as well as learning from work on health impact assessment. For both, the meeting will discuss how to scale-up positive experience, practices and lever support and policy change from higher levels. To enable effective and active participation the numbers in the meeting will be limited. EQUINET will support the daily meeting costs for all delegates and sponsor a limited number of delegates for travel and accommodation, and welcomes other self-sponsored delegates. Delegates are asked to email interest to admin@equinetafrica.org before 5pm Southern Africa time April 11th 2024 with REGIONAL MEETING in the subject line indicating in the email: their name, country, institution, outlining in a few sentences only work implemented relevant to the meeting aims; indicating prior involvement in EQUINET work and whether self-sponsored or seeking sponsorship for travel and accommodation for the meeting. Please attach a CV. Feedback will be provided by April 15th, with further details for accepted delegates.
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Briefs
Theme area
Values, policies and rights, Health equity in economic and trade policies, Public-private mix
Title of publication Brief from Webinar 5: 28 February 2024 Climate justice and health equity in extractives
Date of publication
2024 March
Publication type
Document
Publication details
Publication status
Published
Language
Keywords
Climate, extractive, mining, health, East and Southern Africa,
Abstract
This brief reports on the evidence and issues raised in the fifth webinar on Climate justice and equity on extractives in East and Southern Africa (ESA), convened by SATUCC with support from TARSC. The webinar was held on 28th of February 2024, with 57 participants from ESA Countries. It was moderated by Nathan Banda, SATUCC and EQUINET Steering Committee member and technical support was provided by Belinda Ncube, TARSC consultant. The three speakers were Dr M Dhliwayo, Executive Director Zimbabwe Environmental Lawyers Association, Mr. D Van Wyk, Researcher at Benchmarks Foundation and Mr. E Katema, Malawi Non-State Actors Union. The webinar video is available on the EQUINET website.
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Discussion brief
Theme area
Health equity in economic and trade policies, Governance and participation in health
Title of publication Masaka City stakeholders’ workshop on urban food, energy, water and waste: Workshop report
Date of publication
2024 March
Publication type
Report
Publication details
Publication status
Published
Language
Keywords
urban health; water, food, energy, waste, Uganda
Abstract
Within the EQUINET urban health community of practice, I4D organized a stakeholders’ capacity-building exercise in Kampala and Masaka cities as an avenue to strengthen mechanisms, processes and capacities of cities to build collaborations, partnerships and engagements that will realise the scale-up of promising practices to achieve equitable urban health and development in the sectors of food, water energy and waste management. This workshop in Masaka hosted 18 participants from the sectors of water-energy-food-waste in Masaka City and Masaka District Local Government. They participated in a series of sessions that introduced key concepts, knowledge and tools to build capacities to answer the challenging issues in their respective sectors.
Country
Uganda
Publisher
EQUINET
Equinet Publication Type
Reports
Theme area
Values, policies and rights, Health equity in economic and trade policies, Governance and participation in health
Title of publication EQUINET Policy Brief 51: Health-related standards in Economic Partnership Agreements in East and Southern Africa
Date of publication
2024 February
Publication type
Document
Publication details
Publication status
Published
Language
Keywords
Trade, agreements, health, East and Southern Africa
Abstract
The Economic Partnership Agreements (EPA) is a trade agreement between the European Union (EU) and the Africa, Caribbean and Pacific (ACP) countries signed
under different regional groupings. It aims to promote trade and investment between the EU and ESA countries by reducing tariffs and other trade barriers. In 2012 and
2016, some East and Southern African (ESA) countries signed the interim ESA-EU and SADC-EU EPA respectively after negotiations that started in 2002. Kenya,
Tanzania and Uganda (initially part of the ESA-EPA region are now negotiating under the East African Community (EAC). The SADC EPA has a revision clause
that requires the parties to review the entire agreement no later than five years after its entry into force. This brief seeks to contribute and strengthen the sustainable
development chapter of the agreement and proposes inclusion of standards that promote health in the ESA region.
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Policy brief
Theme area
Values, policies and rights, Health equity in economic and trade policies
Title of publication EQUINET Policy brief 50: Legal and policy frameworks governing business and human rights to health in east and southern Africa
Date of publication
2024 February
Publication type
Document
Publication details
Publication status
Published
Language
Keywords
business; rights; health; East and Southern Africa, CDOH
Abstract
Businesses can have both positive and negative impacts on health, through their practices, policies and influence on public sectors, as commercial determinants of
health (CDoH). This brief provides information to support an understanding of the obligations of states and responsibilities of business enterprises to respect, protect and
fulfil the right to health in east and southern Africa (ESA). The brief explores the extent to which international, regional and national standards on business and health rights
are protected and implemented in the ESA region. It outlines the standards that should apply, the extent to which they have been domesticated in law in specific ESA countries, and how these standards have been used in the region, including through public interest litigation on health rights violations. The brief identifies gaps in ESA laws
and standards that need to be addressed to meet international standards on business and human rights and recommends steps to better protect health in business practices through setting, raising awareness on, and implementing standards and through sharing learning across ESA countries on their implementation.
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Briefs, Policy brief
Theme area
Health equity in economic and trade policies, Governance and participation in health
Title of publication Implementing eco-health impact assessment of extractives in east and southern Africa
Date of publication
2024 February
Publication type
Report
Publication details
Publication status
Published
Language
Keywords
Extractives, mining, health impactsd assessment, health risks, East and Southern Africa
Abstract
To advance work on advancing equity in the extractive sectors and on corporate practices, SATUCC and EQUINET in association with Benchmarks Foundation held a side event during the 2024 Alternative Mining Indaba February 2024, Cape Town to share experiences from the implementation of health impact assessments in ESA within the extractive mining sector. This was aimed at building an overview understanding of health impact assessments (HIA), sharing experiences and learning from HIA implementation in the extractive mining sector in east and southern Africa and understanding the role of HIAs in pro-active and upstream management of health risks from the mining extractive sector.
Country
East and southern Africa region
Publisher
SATUCC, EQUINET
Equinet Publication Type
Reports
Theme area
Health equity in economic and trade policies, Governance and participation in health
Title of publication Kampala City stakeholders’ workshop on urban food, energy, water and waste: Workshop report
Date of publication
2024 March
Publication type
Report
Publication details
Publication status
Published
Language
Keywords
Urban health, Food, waste, water, energy, Uganda
Abstract
Within EQUINET's urban health community of practice, I4D organized a stakeholders’ capacity-building exercise in Kampala and Masaka cities in Uganda as an avenue to strengthen mechanisms, processes and capacities of cities to build collaborations, partnerships and engagements that will realise the scale-up of promising practices to achieve equitable urban health and development in the sectors of food, water energy and waste management. The workshop hosted 24 participants from the sectors of water-energy-food-waste in Kampala City Council. They participated in a series of sessions that introduced key concepts, knowledge and tools to build capacities to answer the challenging issues in their respective sectors. Participants were exposed to the framework developed by members of EQUINET. The framework was used as a blueprint to analyse critical bottlenecks, guidelines, enablers and possible strategies to build collaborative, multi-sectoral and multi-actor sustainable, equitable and people-centred solutions to the food-energy-water-waste challenges. This document reports the proceedings and recommendations of the workshop.
Country
Uganda
Publisher
EQUINET
Equinet Publication Type
Reports
Theme area
Equitable health services, Governance and participation in health
Title of publication Promoting comprehensive primary health care mental health interventions for young people: A Malawi case study
Date of publication
2024 February
Publication type
Report
Publication details
Promoting comprehensive primary health care mental health interventions for young people: A Malawi case study, REACH Trust, IWGHSS EQUINET, Harare
Publication status
Published
Language
Keywords
mental health, Malawi, case study, youth
Abstract
This study in Malawi aimed to assess the experiences of 15–24-year-old youth with regard to mental health problems, to evaluate the management of mental health issues and the responses to the issues they face, as well as to recommend interventions to address young people’s mental health challenges. The study employed a mixed methods approach. The 7% prevalence of depression identified in the study seems low compared to the 11–14% in youth in several other studies in Africa. Challenges identified relating to access to mental health services indicate the need for improved availability and accessibility of mental health services for young people faced with mental health problems. The COVID-19 pandemic further impacted youth by increased losses in education, income, employment and food security, as well as increased gender-based violence and sexual abuse. Based on the findings, recommendations are made on areas of primary health care, community, multisectoral, and youth interventions to better support mental health promotion, mental illness prevention, detection, counselling, care and wider responses for young people in Malawi. Although the sample size was small, these may also be relevant across other countries in sub-Saharan Africa.
Country
Malawi
Publisher
EQUINET
Equinet Publication Type
Reports
Theme area
Equity in health, Health equity in economic and trade policies, Public-private mix, Governance and participation in health
Title of publication Healthy urban food, waste management and energy systems:Lessons from scaling up the Longacres Market initiative
Date of publication
2024 February
Publication type
Document
Publication details
CPCR, TARSC, EQUINET (2024) Healthy urban food, waste management and energy systems:Lessons from scaling up the Longacres Market initiative, EQUINET, Harare
Publication status
Published
Language
Keywords
urban, health, market, recycle, circular economy, Zambia
Abstract
Zambia grapples with a challenge shared by many east and southern African countries of effectively managing waste. Longacres market in Lusaka, the capital city of Zambia, is engaging in sustainable solid waste practices through the inclusion of the three Rs (reduce, reuse and recycle). Following work in 2021 by BORDA Zambia, Lusaka City Council and other partners an efficient end-to-end waste management and disposal chain has now been established at the market. Solid waste from shops and market stands is collected, separated and disposed of in labelled waste bins at approved sites. Instead of accumulating at the dumpsite, waste is transferred from the bins to the material recovery facility, for onward recycling or reuse to generate revenue in an environmentally responsible way The methane gas produced by the biogas digester lights the neighbouring school and three other sites. The school's organic garden is irrigated with treated water, using organic waste serves as fertilizer. This paper seeks explores the learning from this pilot for the scale-up city wide. It has been produced within a series on integrated urban health in EQUINET to foster learning on promising approaches within east and southern Africa (ESA).
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Discussion brief
Theme area
Equity in health, Health equity in economic and trade policies, Poverty and health, Governance and participation in health, Monitoring equity and research to policy
Title of publication The Nairobi Urban Health and Demographic Surveillance System: Bringing community voice and evidence to urban health in slum communities
Date of publication
2024 January
Publication type
Document
Publication details
Talk AB[M]R, TARSC, EQUINET (2024) The Nairobi Urban Health and Demographic Surveillance System: Bringing community voice and evidence to urban health in slum communities, EQUINET, Harare
Publication status
Published
Language
Keywords
Urban health, information, surveillance, informal settlement, Case study, Nairobi, Kenya
Abstract
An EQUINET conceptual framework outlines the urban responses for food, environments, green spaces and waste management systems as key entry points to foster innovation, collaboration, accountability, literacy and system-wide change to support healthy people, healthy ecosystems and an inclusive,
productive, regenerative and circular urban economy. This case study was thus produced within a series of case studies in EQUINET in east and southern Africa to share practice and learning on integrated urban health systems. The intention was for the platform and process to generate evidence to inform dialogue on and proposals for improved health and livelihoods, to increase access to healthy urban food, and improve waste management systems, especially in the Viwandhani and Korogocho slums. The platform aimed to make the findings available and disseminate them to residents of these two informal settlements, community researchers, planners, policy makers, development agencies, and other local, national and international stakeholders. The Nairobi Urban Health and Demographic Surveillance System (NUHDSS) was the first African urban health and demographic site surveillance (HDSS) based in a slum. It seeks to address the health and social needs of urban slum dwellers. NUHDSS has generated the information and evidence needed, to strengthen and inform action and change on healthy food systems and green spaces, promoting equity, poverty reduction and
climate justice; facilitating the circular economy through reduced use, reuse, and recycling of waste. The NUHDSS data and nested studies were used to assess the impacts of interventions, to inform local and national policy-making and programmes to improve community health locally, in Kenya and in other African countries. As a tool for community voice and to support governance approaches and collective learning, the NUHDSS platform and process has strengthened the voice and involvement of residents of Viwandhani and Korogocho slums in their health and socioeconomic development bringing
community voice in a ‘whole of society’ approach that recognizes and engages all stakeholders.
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Briefs
Theme area
Equity in health, Values, policies and rights, Health equity in economic and trade policies, Resource allocation and health financing, Governance and participation in health
Title of publication Brief from Webinar 4: Climate justice and trade systems
Date of publication
2023 December
Publication type
Document
Publication details
Publication status
Published
Language
Keywords
Climate, health, trade, equity
Abstract
In 2023 – 24 EQUINET is organising a series of online dialogues to share knowledge and perspectives from community/local, national and international level on the impact of climate trends, the intersect with the other drivers/ determinants of inequity, the implications for policy and action that links climate to health equity and vice versa, and the proposals for policy, practice, research, and action. This brief reports on the issues raised in the fourth webinar in the series on climate justice and trade systems, convened by the Southern and Eastern Africa Trade Information an Negotiations Institute (SEATINI-Southern Africa). The webinar was held on Wednesday 6th December 2023, with 15 participants from seven different countries (Botswana, Malawi, Madagascar, Mauritius, USA, Uganda and Zimbabwe). It summarises information from the webinar on how climate features are impacting on trade and health systems; the actions that need to be taken to address these issues at local, national and regional level and in international/ global level processes and forums from a regional lens; and issues raised to be further discussed in the other thematic webinars.
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Briefs
Theme area
Equity in health, Values, policies and rights, Health equity in economic and trade policies, Poverty and health, Governance and participation in health
Title of publication Don’t waste the waste! A case study of promising approaches in managing organic solid waste in Manandriana Municipality, Antananarivo Avaradrano, Madagascar
Date of publication
2024 January
Publication type
Document
Publication details
Femmes en Action Rurales de Madagascar, E-TAntsoroka ho an’ny Fampandrosoana ny maha Olona, TARSC, EQUINET (2024) Don’t waste the waste! A case study of promising approaches in managing organic solid waste in Manandriana Municipality, Antananarivo Avaradr
Publication status
Published
Language
Keywords
Urban health, Food, waste, Climate, Case study, Madagascar
Abstract
Understanding how waste management systems are linked to and interact with other subsystems and the influence and moderation effects of contextual factors including climate change is important in informing actions and approaches that promote health and wellbeing. Waste management systems provide a potential entry point for fostering innovations, collaborations and system-wide changes for healthy communities and ecosystems, such as through strengthening their linkages with food systems and promotion of circular economies. This case study showcases experiences from the municipality of Manadriana in Antananarivo, Madagascar. It has been produced within a series on integrated urban health in EQUINET to foster learning on these promising approaches within east and southern Africa. This case study has been produced through an analysis of secondary evidence and primary data collected through observation, semi-structured focus group discussions and key informant interviews on waste management practices in the municipality of Manandriana between September and December 2023. The public dumpsite and waste management systems in the municipality of Manandriana present both opportunities and dangers to the local community’s health, livelihoods and to the environment. This case study illustrates the potential of waste management systems as sites for innovation, providing practical links between waste, food, and water systems. Composted waste provides farmers with fertilizer and offers employment for compost producers and sellers, earning them income and facilitating their integration in the local economy. The compost enhances ecosystem regeneration, food security and nutrition.
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Briefs
Theme area
Equity in health, Values, policies and rights, Health equity in economic and trade policies, Poverty and health, Public-private mix, Governance and participation in health
Title of publication Communities collaborating in the Kariba Integrated Solid Waste Management Programme: From urban litter-jungles into healthy environments
Date of publication
2024 January
Publication type
Document
Publication details
Municipality of Kariba, TARSC, EQUINET (2024) Communities collaborating in the Kariba Integrated Solid Waste Management Programme: From urban litter-jungles into healthy environments, EQUINET, Harare
Publication status
Published
Language
Keywords
Urban health, Food, waste, Climate, Case study, Kariba, Zimbabwe
Abstract
A number of initiatives that promote healthy urban food and waste management systems are underway within urban areas in the region, and an EQUINET conceptual framework outlines the urban responses for food and waste management systems as key entry points to foster innovation, collaboration, accountability, literacy and system-wide change to support healthy people, healthy ecosystems and an inclusive, productive, regenerative and circular
urban economy. This case study therefore seeks to document promising practices in Kariba. Integrated solid waste management was adopted by the Municipality in 2016, involving the community and all stakeholders in collaborative designing, planning and implementation of the programme. A Council resolution was adopted to facilitate the change in Council policy proposing that Integrated Solid Waste Management be adopted as an approach for the town. Interventions on urban waste have been integrated into one solid waste management programme in Kariba through multi-actor participation with high literacy, involving existing community structures and different age groups of people, and incorporating their aspirations for a clean town. Different interest groups select their own interventions on urban waste linking to food, energy and other urban needs, and deploy their own innovation, local knowledge systems. These are then integrated into the overall programme. The activities use affordable technologies and locally available materials, creating a demand for local goods. Information and communication technologies used in the programme have been important contributors to
successful outcomes. Bringing diverse social groups together contributes to system wide and holistic awareness and links action on urban waste systems to a circular economy and climate justice.
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Briefs
Theme area
Equity in health, Health equity in economic and trade policies, Poverty and health, Public-private mix, Governance and participation in health
Title of publication Waste is wealth: Small scale urban farming challenging food insecurity in informal settlements of Kibuye I Parish in Kampala, Uganda,
Date of publication
2024 January
Publication type
Document
Publication details
ACTogether Uganda, Urban Authority Association of Uganda, TARSC, EQUINET (2024) Waste is wealth: Small scale urban farming challenging food insecurity in informal settlements of Kibuye I Parish in Kampala, Uganda, EQUINET, Harare
Publication status
Published
Language
Keywords
Urban health, Food, waste, water, Climate, Case study, Uganda
Abstract
An EQUINET conceptual framework outlines the urban responses for food and waste management systems as key entry points to foster innovation, collaboration, accountability, literacy and system-wide change to support healthy people, healthy ecosystems and an inclusive, productive, regenerative and circular urban economy. This case study in Kibuye 1 Parish reflects experiences in these urban responses as part of a series in east and southern Africa. Poor waste disposal and management is an overwhelming environmental issue in Kibuye informal settlements. There are no designated communal garbage collection points, as land owners are unwilling to give land for it, citing poor maintenance of the sites. The littered waste clogs the existing drainage channels, gullies and wetlands exposing Kibuye
slums to frequent flooding. The small-scale urban farming initiative by SCINE Uganda is providing an foundation for urban food security and sustainable management of the environment in Kibuye I Parish.
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Briefs
Theme area
Equity in health, Health equity in economic and trade policies, Poverty and health, Public-private mix, Governance and participation in health
Title of publication Promoting the Three R’s -Reduce, Recycle and Reuse- in waste Management in Kadoma, Zimbabwe
Date of publication
2024 January
Publication type
Document
Publication details
Abdullah Dzinamarira Foundation Trust, Young Men Christian Association, TARSC, EQUINET (2024) Promoting the Three R’s -Reduce, Recycle and Reuse- in waste Management in Kadoma, Zimbabwe, EQUINET, Harare
Publication status
Published
Language
Keywords
Urban health, Food, waste, water, Climate, Case study, Zimbabwe
Abstract
An EQUINET conceptual framework outlines the urban responses for food and waste management systems as key entry points to foster innovation, collaboration, accountability, literacy and system-wide change to support healthy people, healthy ecosystems and an inclusive, productive, regenerative and circular urban economy. Drawing upon the EQUINET conceptual framework, the Rimuka case study explores the areas of shared learning for how to implement integrated and sustainable approaches to improve urban health and wellbeing and its key drivers. Waste reduction strategies can be low-cost and high-impact. They call for increased education and awareness on how waste management can create new industries and jobs. This work in Kadoma set up forums and interventions to involve local people and involved stakeholders to build awareness of the opportunities that waste reuse and recycling provides for jobs and inputs to local food and product. The programme generated interventions linking waste recycling to food production, plastic waste collection to incomes and renewal energy to improved urban conditions. Climate change affects health and is creating health inequalities. City efforts to reuse, recycle and reduce contribute to improved health climate change mitigation and adaptation.
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Briefs
Theme area
Equity in health, Values, policies and rights, Health equity in economic and trade policies, Poverty and health, Governance and participation in health
Title of publication Transforming Mbale City’s urban food system in the Good Food for Cities Programme
Date of publication
2024 January
Publication type
Document
Publication details
Food Rights Alliance, Rikolto, Global Consumer Centre, TARSC, EQUINET (2024) Transforming Mbale City’s urban food system in the Good Food for Cities Programme. EQUINET, Harare
Publication status
Published
Language
Keywords
Urban health, Food, waste, Climate, Case study, Kenya
Abstract
This brief outlines the experience of implementing the Good Food for Cities Programme (GF4Cs) in Kampala, Uganda, as one of an EQUINET series of case studies in east and southern Africa on integrated approaches to urban health. Rapid urbanization in Uganda especially in cities like Kampala and Mbale is reshaping the urban food systems, altering demand and introducing food related challenges. Despite the positive aspects of urban development, there is an increase in unregulated activities that lead to unsafe food practices. The Good Food for Cities programme recognizes these challenges as opportunities to establish more sustainable, fair and healthy food systems in Mbale and Kampala. The programme aims to forge coalitions involving businesses, consumers, local authorities and other food system actors to ensure inclusive, resilient and healthy food environments for all citizens. Two crucial mechanisms of the Good Food Council and the Good Food Parliament serve as platforms for consultation, dialogue, accountability and collective decision making. The programme adopts a three-tier intervention strategy of promoting sustainable production, inclusive urban food markets and an enabling environment. These areas give emphasis to regenerative agriculture, and multistakeholder participation, addressing climate change, and urban inequalities and food insecurity.
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Briefs
Theme area
Equity in health, Health equity in economic and trade policies, Poverty and health, Public-private mix, Governance and participation in health
Title of publication Health-promoting food and waste management systems in Kwekwe City: Turning waste into assets
Date of publication
2024 January
Publication type
Document
Publication details
City of Kwekwe, TARSC, EQUINET (2024) Health-promoting food and waste management systems in Kwekwe City: Turning waste into assets, EQUINET Brief, EQUINET, Harare
Publication status
Published
Language
Keywords
Urban health, Food, waste, Climate, Case study, Kwekwe
Abstract
This case study, within a series of EQUINET case studies in east and southern Africa explored local experiences in linking waste management to urban food systems, with mutual benefits for both, and for ecosystems, local incomes and climate mitigation. Harnessing treated wastewater for crop irrigation recycles nutrients and protects the environment. The food produced, sold and consumed locally in urban agriculture alleviates poverty, and promotes food security and health. Community participation, partnerships and collective decision-making in waste management applies local knowledge and assets for environmental protection and climate justice. Using solar energy protects urban environments, reducing dependence on polluting fossil fuels, and reducing the greenhouse gases that contribute to climate change and its negative impacts. Circular economic activities promote climate-proofing and inclusive economic development.
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Briefs
Theme area
Equity in health, Health equity in economic and trade policies, Poverty and health, Public-private mix, Governance and participation in health
Title of publication From a Waste Dumpsite into a Food Basket in Bembeke, Dedza, Malawi
Date of publication
2024 January
Publication type
Document
Publication details
Country Minders for Peoples Development (CMPD) , TARSC. EQUINET (2024) From a Waste Dumpsite into a Food Basket in Bembeke, Dedza, Malawi, EQUINET, Harare
Publication status
Published
Language
Keywords
Urban health, Food, waste, Climate, Case study, Malawi
Abstract
This case study, within a series of EQUINET case studies in east and southern Africa explored local experiences in linking waste management to urban food systems, with mutual benefits for both, and for ecosystems, local incomes and climate mitigation. Bembeke, Dedza has been transformed from one of the worst dumping sites to one of the cleanest urban sites in Malawi. CMPD, in partnership with the Environmental Affairs Department (EAD), and stakeholders in Bembeke Dedza, devised and implemented a waste management initiative to turn waste into manure, reducing waste and improving food security in Bembeke. Bembeke farmers were trained to produce manure from waste and theater campaigns were held in eight zones to sensitize communities on ‘waste to wealth.’ Urban waste and food security interventions succeed when all key stakeholders, including community members participate from conception to completion. Turning waste into fertilizer for food production contributes to food security, environmental protection, circular urban economies and mitigates the effects of climate change.
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Briefs
Theme area
Values, policies and rights, Health equity in economic and trade policies, Equitable health services
Title of publication EQUINET. Brief: Climate Change and Health Systems in East and Southern Africa: A Rapid Review
Date of publication
2023 December
Publication type
Document
Publication details
Climate Change and Health Systems in East and Southern Africa: A Rapid Review, EQUINET Brief, EQUINET, Harare
Publication status
Published
Language
Keywords
Climate, health system, review, East and Southern Africa
Abstract
Climate change is perceived to be one of the biggest global threats to health in the 21st century. African countries are more vulnerable to the impacts of global climate change, with their populations more susceptible to illness and injury from the natural emergencies and extreme weather events and to increased infectious diseases as a result of vector spread. Extreme weather events may compromise access to clean water and sanitation, food production, transport and energy infrastructures and other factors that affect health. This desk review was commissioned by the Regional Network for Equity in Health in Southern Africa (EQUINET), through Training and Research Support Centre, with support from the Open Society Policy Centre (OSPC), to explore: how climate change is affecting health systems in east and southern Africa (ESA); how the region’s health systems are adapting to climate change; and to identify the health system advocacy and policy issues raised in climate change negotiations by ESA countries, including in relation to issues of equity.
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Discussion brief
Theme area
Equity in health, Health equity in economic and trade policies, Equitable health services
Title of publication Brief from Webinar 3: Climate justice and primary health care systems
Date of publication
2023 November
Publication type
Document
Publication details
Publication status
Published
Language
Keywords
Climate, health system, primary health care, equity
Abstract
This brief reports on the issues raised in the third webinar in the series on climate justice and health rights, convened by the Research for Equity and Community Health (REACH) Trust, and the International Working Group for Health Systems Strengthening (IWGHSS). REACH Trust and IWGHSS are the EQUINET steering committee leads of work in ESA on primary health care (PHC) oriented health systems. The webinar was held on Wednesday 25th of October 2023, with 30 participants from nine different countries. It was moderated by Nadine Nanji of IWGHSS, with input from Joy Muhia IWGHSS, support from Kingsley Chikaphupha REACH Trust and technical support from Belinda Ncube, TARSC Consultant. The three panelists were Mr. Christopher Ogwang, Senior Program Officer, Community Empowerment Program at CEHURD, Uganda on the local experiences of the Impact of Climate change on local health systems, health equity and PHC; Mr. Allone Ganizani, Deputy Director of preventive Health services, MoH Malawi, on National issues and actions on climate justice and equitable, PHC-oriented health systems; Ms. Tatum Louw, Change researcher/consultant, Cape Town, South Africa, on Global policies, rules and forums climate and health systems. The presentations were followed by participant discussions and interaction with presenters in breakout sessions, including in the ‘chat’. The video of the webinar is available at https://youtu.be/BjUvKbb6OTo.
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Discussion brief
Theme area
Equity in health, Health equity in economic and trade policies
Title of publication Brief from the Webinar: Climate and Ecosocial justice in urban health in East and Southern Africa
Date of publication
2023 September
Publication type
Document
Publication details
Publication status
Published
Language
Keywords
urban, climate, east and southern Africa; food, waste
Abstract
This brief reports on the evidence and issues raised in the second webinar on Climate and Ecosocial justice in urban health in East and Southern Africa (ESA), convened by Innovations for Development (I4DEV) a non-profit organisation in Uganda working to champion innovations that solve society’s most intractable health challenges. The webinar was held on 29th August 2023, with 50 participants from 10 countries. It was moderated by I4DEV with speakers from Zimbabwe Chamber of Informal Economy Associations; Center for Food and Adequate Living Rights (CEFROHT) Uganda; Green-Peace Africa, Kenya and International Society for Urban Health ISUH. The presentations were followed by participant discussions and interaction with presenters in and out of the chat. The brief summarises issues raised on Climate impacts raised on health in urban food and waste systems; and actions proposed to address climate impacts on health in urban food and waste systems. It also highlights issues raised to carry forward to and discuss in future webinars. The webinar video is available on the EQUINET website at https://www.youtube.com/watch?v=OF7z_QgG8s8&t=5109s
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Discussion brief
Theme area
Health equity in economic and trade policies
Title of publication EQUINET Brief 49: Addressing health implications of the African Continental Free Trade Agreement in east and southern Africa
Date of publication
2023 September
Publication type
Document
Publication details
SEATINI, EQUINET (2023) Addressing health implications of the African Continental Free Trade Agreement in east and southern Africa, Policy brief 49, EQUINET, Harare
Publication status
Published
Language
Keywords
free trade, Africa, liberalisation, health
Abstract
The African Continental Free Trade Area (AfCFTA) is a flagship initiative of the African Union in line with Agenda 2063. It aims to establish a single market for a wide range of goods and services across the 55 countries in Africa. The AfCFTA could through its enhanced markets, trade and interaction across countries unlock potential growth and contribute to enhanced socio-economic wellbeing, and could facilitate production and trade in health promoting commodities. However liberalized trade, including in harmful products, falling public revenues from lost tariff income, illicit financial flows and migration of scarce skills from low to higher income African countries could also impact negatively on the health and well-being, on environment for health and health services, and widen inequalities within and between countries. The AfCFTA should thus be accompanied by measures to prevent and address such negative impacts. This policy brief summarises findings of a more detailed analysis in EQUINET discussion paper 131 on the impacts of the AfCFTA on health in East and Southern Africa and recommended measures for action by both state and non-state actors to address these impacts.
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Discussion brief
Theme area
Health equity in economic and trade policies
Title of publication EQUINET Diss 131: Addressing health implications of the African Continental Free Trade Agreement in east and southern Africa
Date of publication
2023 September
Publication type
Document
Publication details
Addressing health implications of the African Continental Free Trade Agreement in east and southern Africa, EQUINET discussion paper 131, EQUINET, Harare
Publication status
Published
Language
Keywords
trade, Africa, liberalisation, east and Southern Africa
Abstract
The adoption and implementation of the agreement establishing the African Continental Free Trade Area (AfCFTA) signals a new chapter in regional integration on the continent. This desk review on the health implications of the implementation of the AfCFTA within the ESA region was commissioned by EQUINET through TARSC, and implemented by the Southern and Eastern African Trade Information and Negotiations Institute (SEATINI) to support improved legal and policy frameworks for health in the negotiations on the AfCFTA in the East and southern Africa (ESA) region. Based on a desk review of public domain documents complemented by seven key informant interviews carried out in 2023, the paper outlines the health sector and health-related areas directly or indirectly covered by the ACTFA and the relevant subsidiary instruments. The paper identifies the AfCTA’s positive and negative actual and potential health sector and health- related impacts, including for health equity. It does this in terms of the products that will be subject to liberalisation, including those with potential benefit for health such as local production of health technologies and pharmaceuticals, as well as those that may be harmful to health such as tobacco and genetically modified and ultra-processed foods. It also explores the health implications of the AfCFTA on financial flows and public revenue and on the movement of people, including health personnel.
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Discussion paper
Theme area
Values, policies and rights, Health equity in economic and trade policies
Title of publication Brief from the webinar: Climate justice and the right to health and wellbeing
Date of publication
2023 August
Publication type
Document
Publication details
Publication status
Published
Language
Keywords
climate, equity, rights, health, east and southern Africa
Abstract
In 2023 – 24 EQUINET is organising a series of online dialogues to share knowledge and perspectives from community/local, national and international level on the impact of climate trends, the intersect with the other drivers/ determinants of inequity, the implications for policy and action that links climate to health equity and vice versa, and the proposals for policy, practice, research, and action. This brief reports on the issues raised in the first webinar in the series on climate justice and health rights, convened by the Center for Health, Human Rights and Development (CEHURD), and EQUINET steering committee member. The full webinar is available on the EQUINET site. This brief summarises key points raised by speakers and participants on how climate features are impacting on the right to health; the actions that need to be taken to address these issues at local, national and regional level and in international/ global level processes and forums from a regional lens; and issues raised to be further discussed in the other thematic webinars. The brief is shared to draw further comment and input on the issue.
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Discussion brief
Theme area
Values, policies and rights, Health equity in economic and trade policies, Public-private mix, Resource allocation and health financing
Title of publication Taxing for health: taxes on sugar-sweetened beverages in east and southern African countries
Date of publication
2023 July
Publication type
Document
Publication details
EQUINET discussion paper 130, TARSC, EQUINET, Harare
Publication status
Published
Language
Keywords
East and Southern Africa, financing, tax, sugar-sweetened beverage, ultra-processed food, NCD
Abstract
Sugar-sweetened beverages (SSBs) are one form of rapidly expanding ultra-processed foods associated with the rise in non-communicable diseases (NCDs) in east and southern Africa (ESA). The market for SSBs is growing and consumption of these beverages rising at all income levels, in ESA countries. Applying an excise tax on SSBs is one within the proposed measures – legal, marketing control, labelling and information outreach – for tackling these public health risks, and is within the range of earmarked taxes currently being explored for domestic health financing. This paper was commissioned by EQUINET and implemented through the Training and Research Support Centre to further explore SSB taxes and their role in a public health response to the challenges of rising consumption of SSBs. The paper outlines the global and regional standards, guidance and areas of legal or policy debate on the control of SSB health risks, particularly through taxation; it provides evidence on the design, taxation levels and products covered in SSB taxation in different regions globally and in ESA countries. It also discusses experiences of and issues around using SSB-related taxation for health in ESA countries. Drawing on the evidence identified, it proposes actions on SSB taxation and issues for further policy dialogue in ESA countries and in the region.
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Discussion paper
Theme area
Health equity in economic and trade policies, Governance and participation in health
Title of publication Effective Waste Management in a Local Food Market: The Longacres experience in Lusaka, Zambia
Date of publication
2023 July
Publication type
Document
Publication details
Publication status
Published
Language
Keywords
Lusaka,, urban health, food, waste, energy, markets
Abstract
This photojournalism brief produced in EQUINET's urban health programme tells a story of health promoting change in Lusaka, Zambia. An initiative in a Lusaka food market has installed a functional end-to-end chain for waste disposal and management at the market. Solid waste is being separated at the level of shops and market stands and waste in segregated and labelled waste bins. Waste is transferred from the bins to the material recovery facility instead of amassing at the dumpsite and moved to the biogas digester to provide energy and fertilizer, both supporting local incomes. These activities, and the improved sanitation facilities and hygiene in the market have led to a change in practices, and improved environments and public health in areas and communities related to the market.
Country
Zambia
Publisher
EQUINET
Equinet Publication Type
Discussion brief
Theme area
Health equity in economic and trade policies, Governance and participation in health
Title of publication Delving into the Cityscape: Transforming the connections between urban environments, social factors, and public health in Nairobi, Kenya
Date of publication
2023 July
Publication type
Document
Publication details
Publication status
Published
Language
Keywords
Nairobi, urban health, green environment, community
Abstract
This photojournalism brief produced in EQUINET's urban health programme tells a story of health promoting change in Nairobi, Kenya. An area once plagued by pollution and turned into a dumping site has had a remarkable transformation. Through collaborative efforts, the community has turned the space into a safe and habitable environment, with essential amenities such as a sanitation block, a public park, a farm, greenhouse, drainage channels, and a multipurpose
hall. The positive effects have been profound, significantly improving the health and well-being of community members, preventing flooding during the rainy season, strengthening social cohesion and bringing a heightened sense of belonging within the community. It demonstrates the power of co-designing
solutions with communities.
Country
Kenya
Publisher
Equinet Publication Type
Discussion brief
Theme area
Health equity in economic and trade policies, Governance and participation in health
Title of publication Enhancing sustainable access to safe clean water and gender-sensitive sanitation services in Epworth,Zimbabwe
Date of publication
2023 July
Publication type
Document
Publication details
Publication status
Published
Language
Keywords
Epworth, Harare, urban health, water, sanitation, technology
Abstract
This photojournalism brief produced in EQUINET's urban health programme tells a story of health promoting change in a low income area of Harare, Zimbabwe. It tells a story of change on improved water and sanitation in an area facing limited infrastructure, and water scarcity. It is possible to source, test and introduce health-promoting technology in disadvantaged communities,and doing so makes a large difference to people’s quality of life and health.
Water testing built community and stakeholder support for the initiative. The brief notes that technology is useful, but needs to be introduced in
a way that supports and strengthens community-based planning for its effective use.
Country
Zimbabwe
Publisher
EQUINET
Equinet Publication Type
Discussion brief
Theme area
Health equity in economic and trade policies, Governance and participation in health
Title of publication Solid waste management in Slum Communities of Bwaise III Parish: Transforming Solid Waste into Valuable Resources in Kampala, Uganda
Date of publication
2023 July
Publication type
Document
Publication details
Publication status
Published
Language
Keywords
Kampala, urban health, energy, waste, environment
Abstract
This photojournalism brief produced in EQUINET's urban health programme tells a story of health promoting change in a low income area of Kampala, Uganda. The inadequate management of solid waste in Bwaise, Kampala presents numerous difficulties, including sporadic flooding and outbreaks of diseases. Recognizing the need to address these challenges and the economic struggles faced by the community, this brief describes an initiative involving communities and local agencies that made waste as a valuable resource for creating household briquettes fuel for energy and cooking. Through the efforts of community solid waste enterprises and groups, the amount of waste disposed of haphazardly and in draining channels in the community has fallen, resulting in fewer cases of floods and related illnesses in the area.
Country
Uganda
Publisher
EQUINET
Equinet Publication Type
Discussion brief
Theme area
Health equity in economic and trade policies
Title of publication A conceptual framework for healthy urban systems for food and waste management in ESA countries
Date of publication
2023 June
Publication type
Document
Publication details
Publication status
Published
Language
Keywords
Urban health, food system, waste management, circular economy
Abstract
Urban food systems are drivers of health (in)equity. Rising food costs, food poverty, food import dependency and expanded marketing of ultra-processed foods are generating health, social and economic deficits, while urban agriculture and local food processing can offer opportunities for wellbeing, healthy ecosystems and urban green spaces, waste, water and climate management and for sustainable, affordable energy. Waste management in urban areas affects environment, social conditions and health, with potential for links to climate, urban green spaces, flood reclamation, and new energy sources through recycling and use. Globally, these intersecting issues relate to region-to-region exchanges on laws, technology and practice options, and to global instruments and practices, including by transnationals, and to aligning global resources to regional and local technology priorities.
Food and waste management systems are key entry points to foster innovation, collaboration, accountability, literacy and system-wide change to support healthy people, healthy ecosystems (including green spaces, energy and water) and an inclusive, productive, regenerative and circular urban economy. This document provides a conceptual framework being used in EQUINET work on urban health focusing on key features of health promoting food systems and waste management systems in East and Southern Africa.
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Briefs
Theme area
Equity in health
Title of publication Socioeconomic and geographical inequalities in health care coverage in Mozambique: a repeated cross-sectional study of the 2015 and 2018 national surveys
Date of publication
2023 June
Publication type
Journal Article
Publication details
BMC Public Health (2023) 23:1007 https://doi.org/10.1186/s12889-023-15988-y
Publication status
Published
Language
Keywords
Health care coverage, Health inequality, National surveys, Socioeconomic inequalities, Mozambique
Abstract
Over the past years, Mozambique has implemented several initiatives to ensure equitable coverage to health care services. While there have been some achievements in health care coverage at the population level, the effects of these initiatives on social inequalities have not been analysed. This study aimed to assess changes in socioeconomic and geographical inequalities (education, wealth, region, place of residence) in health care coverage between 2015 and 2018 in Mozambique. The study was based on repeated cross-sectional surveys from nationally representative samples: the Survey of Indicators on Immunisation, Malaria and HIV/AIDS in Mozambique (IMASIDA) 2015 and the 2018 Malaria Indicator survey. Data from women of reproductive age (15 to 49 years) were analysed to evaluate health care coverage of three indicators: insecticide-treated net use, fever treatment of children, and use of Fansidar malaria prophylaxis for pregnant women. Absolute risk differences and the slope index of inequality (SII) were calculated for the 2015 survey period and the 2018 survey period, respectively. An interaction term between the socioeconomic and geographical variables and the period was included to assess inequality changes between 2015 and 2018. The non-use of insecticide-treated nets dropped, whereas the proportion of women with children who were not treated for fever and the prevalence of women who did not take the full Fansidar dose during pregnancy decreased between 2015 and 2018. Significant reductions in the inequality related to insecticide-treated net use were observed for all socioeconomic variables. Concerning fever treatment, some reductions in socioeconomic inequalities were observed, though not statistically significant. For malaria prophylaxis, the SII was significant for education, wealth, and residence in both periods, but no significant inequality reductions were observed in any of these variables over time. The authors observed significant reductions of socioeconomic inequalities in insecticide-treated net use, but not in fever treatment of children and Fansidar prophylaxis for pregnant women. They suggest that decision-makers target underserved populations, specifically non-educated, poor people and rural women, to address inequalities in health care coverage.
Country
Mozambique
Publisher
Theme area
Health equity in economic and trade policies
Title of publication Health-promoting urban food systems in selected local authorities in Zimbabwe
Date of publication
2023 May
Publication type
Document
Publication details
Publication status
Published
Language
Keywords
food system, local authority, urban health, urban agricuture
Abstract
In 2022-2023 the Urban Councils Association of Zimbabwe (UCAZ) in association with the Training and Research Support Centre (TARSC) in EQUINET and focal persons in seven local authorities (P Ncube, City of Bulawayo; S Dzivai, I Jenje and K Salima, Chegutu Municipality; R Tapera and V Mavetera, Harare City Council; C Mutumbami, Kariba Municipality; S Ngwenya, Kwekwe City Council; SH Madamombe, City of Masvingo; BT Nyamande, Victoria Falls City Council) gathered and shared evidence on initiatives underway in these Zimbabwean cities/towns to promote healthy food systems, with review input from Ministry of Health and Child Care (MoHCC). The work aimed to share and promote wider uptake of promising practice in Zimbabwe and in the region, and to identify common challenges for policy dialogue. The seven case studies were from Bulawayo, Chegutu, Harare, Kariba, Kwekwe, Masvingo and Victoria Falls. The case studies in each local authority are documented and also available online. This document, co-authored by the institutions involved, provides a synthesis of the key areas of promising practice reported in the case studies. It discusses common enablers and challenges, and areas for further development to build on and strengthen current practice for health-promoting local food systems, integrating also feedback and recommendations from discussion of the findings at the May 2023 UCAZ Health Officers Forum.
Country
Zimbabwe
Publisher
EQUINET
Equinet Publication Type
Reports
Theme area
Health equity in economic and trade policies, Poverty and health, Governance and participation in health
Title of publication Case study on health-promoting urban food systems in Kariba
Date of publication
2023 March
Publication type
Document
Publication details
Publication status
Published
Language
Keywords
urban, food system, Kariba, Zimbabwe
Abstract
A number of initiatives promoting healthy urban food systems are underway in urban areas of Zimbabwe, but these promising approaches are not always systematically documented, known and shared to support exchange and learning. To address this, the Urban Councils Association of Zimbabwe in association with the Training and Research Support Centre in EQUINET, with review input from Ministry of Health and Child Care (MoHCC) is implementing work in 2022-23 to gather and share evidence on initiatives underway in Zimbabwean cities/towns to promote healthy food systems to share and promote uptake of promising practice through UCAZ in Zimbabwe and through EQUINET in east and southern Africa. Kariba is one of the urban case studies, using a collectively developed shared framework. This case study describes work implemented on food systems in the unique context of this town on Lake Kariba and in a national park to support fishing, hydroponics for food production and other activities to address the challenges of being in an area with wildlife city, with a discussion of the dialogue mechanisms that support these initiatives.
Country
Zimbabwe
Publisher
EQUINET
Equinet Publication Type
Briefs
Theme area
Health equity in economic and trade policies, Poverty and health, Governance and participation in health
Title of publication Case study on health-promoting urban food systems in Masvingo
Date of publication
2023 March
Publication type
Document
Publication details
Publication status
Published
Language
Keywords
urban, food system, Masvingo, Zimbabwe
Abstract
A number of initiatives promoting healthy urban food systems are underway in urban areas of Zimbabwe, but these promising approaches are not always systematically documented, known and shared to support exchange and learning. To address this, the Urban Councils Association of Zimbabwe in association with the Training and Research Support Centre in EQUINET, with review input from Ministry of Health and Child Care (MoHCC) is implementing work in 2022-23 to gather and share evidence on initiatives underway in Zimbabwean cities/towns to promote healthy food systems to share and promote uptake of promising practice through UCAZ in Zimbabwe and through EQUINET in east and southern Africa. Masvingo is one of the urban case studies, using a collectively developed shared framework. This case study describes work implemented on food systems in the city, and the policy, legal and consultative frameworks that the city has developed to support these initiatives.
Country
Zimbabwe
Publisher
EQUINET
Equinet Publication Type
Briefs
Theme area
Health equity in economic and trade policies, Poverty and health, Governance and participation in health
Title of publication Case study on health-promoting urban food systems in Bulawayo
Date of publication
2023 March
Publication type
Document
Publication details
Publication status
Published
Language
Keywords
urban, food system, Bulawayo, Zimbabwe
Abstract
A number of initiatives promoting healthy urban food systems are underway in urban areas of Zimbabwe, but these promising approaches are not always systematically documented, known and shared to support exchange and learning. To address this, the Urban Councils Association of Zimbabwe in association with the Training and Research Support Centre in EQUINET, with review input from Ministry of Health and Child Care (MoHCC) is implementing work in 2022-23 to gather and share evidence on initiatives underway in Zimbabwean cities/towns to promote healthy food systems to share and promote uptake of promising practice through UCAZ in Zimbabwe and through EQUINET in east and southern Africa. Bulawayo is one of the urban case studies, using a collectively developed shared framework. This case study describes work implemented on food systems in the city, to promote urban agriculture and marketing of healthy foods, and to monitor and control ultra-processed foods linked to chronic conditions, with a discussion of the dialogue mechanisms that support these initiatives.
Country
Zimbabwe
Publisher
EQUINET
Equinet Publication Type
Briefs
Theme area
Health equity in economic and trade policies, Poverty and health, Governance and participation in health
Title of publication Case study on health-promoting urban food systems in Harare
Date of publication
2023 March
Publication type
Document
Publication details
Publication status
Published
Language
Keywords
urban, food system, Harare, Zimbabwe
Abstract
A number of initiatives promoting healthy urban food systems are underway in urban areas of Zimbabwe, but these promising approaches are not always systematically documented, known and shared to support exchange and learning. To address this, the Urban Councils Association of Zimbabwe in association with the Training and Research Support Centre in EQUINET, with review input from Ministry of Health and Child Care (MoHCC) is implementing work in 2022-23 to gather and share evidence on initiatives underway in Zimbabwean cities/towns to promote healthy food systems to share and promote uptake of promising practice through UCAZ in Zimbabwe and through EQUINET in east and southern Africa. Harare is one of the urban case studies, using a collectively developed shared framework. This case study describes work implemented on food systems in the city, particularly to monitor and inspect food processing and retail activities, in urban agriculture and processing, and to promote health in food preparation and diets, with a discussion of the dialogue mechanisms that support these initiatives.
Country
Zimbabwe
Publisher
EQUINET
Equinet Publication Type
Briefs
Theme area
Health equity in economic and trade policies, Poverty and health, Governance and participation in health
Title of publication Case study on health-promoting urban food systems in Kwekwe
Date of publication
2023 March
Publication type
Document
Publication details
Publication status
Published
Language
Keywords
urban, food system, Kwekwe, Zimbabwe
Abstract
A number of initiatives promoting healthy urban food systems are underway in urban areas of Zimbabwe, but these promising approaches are not always systematically documented, known and shared to support exchange and learning. To address this, the Urban Councils Association of Zimbabwe in association with the Training and Research Support Centre in EQUINET, with review input from Ministry of Health and Child Care (MoHCC) is implementing work in 2022-23 to gather and share evidence on initiatives underway in Zimbabwean cities/towns to promote healthy food systems to share and promote uptake of promising practice through UCAZ in Zimbabwe and through EQUINET in east and southern Africa. Kwekwe is one of the urban case studies, using a collectively developed shared framework. This case study describes work implemented on food systems in the city, particularly those ensuring food safety and access and urban agriculture and marketing of locally produced food in the city, with a discussion of the dialogue mechanisms that support these initiatives.
Country
Zimbabwe
Publisher
EQUINET
Equinet Publication Type
Briefs
Theme area
Health equity in economic and trade policies, Poverty and health, Governance and participation in health
Title of publication Case study on health-promoting urban food systems in Chegutu
Date of publication
2023 March
Publication type
Document
Publication details
Publication status
Published
Language
Keywords
urban, food system, Chegutu, Zimbabwe
Abstract
A number of initiatives promoting healthy urban food systems are underway in urban areas of Zimbabwe, but these promising approaches are not always systematically documented, known and shared to support exchange and learning. To address this, the Urban Councils Association of Zimbabwe in association with the Training and Research Support Centre in EQUINET, with review input from Ministry of Health and Child Care (MoHCC) is implementing work in 2022-23 to gather and share evidence on initiatives underway in Zimbabwean cities/towns to promote healthy food systems to share and promote uptake of promising practice through UCAZ in Zimbabwe and through EQUINET in east and southern Africa. Chegutu is one of the urban case studies, using a collectively developed shared framework. This case study describes work implemented on food systems in the city, particularly the poultry production and peanut butter processing, implemented by the Shasha Community Group, with a discussion of the dialogue mechanisms that support these initiatives.
Country
Zimbabwe
Publisher
EQUINET
Equinet Publication Type
Briefs
Theme area
Equity in health, Values, policies and rights, Health equity in economic and trade policies, Poverty and health, Equitable health services, Public-private mix, Governance and participation in health
Title of publication EQUINET Regional workshop Report: Expanding promising practice for sustained urban and peri-urban wellbeing in east and southern Africa
Date of publication
2023 March
Publication type
Report
Publication details
Publication status
Published
Language
Keywords
urban, health, wellbeing, practice, food, waste, climate, commercial determinants, extractives, east and southern Africa
Abstract
This report is of an EQUINET regional meeting, held in Nairobi that gathered people from a range of institutions and disciplines involved in various roles in relation to health and wellbeing in urban and peri-urban areas, commercial practices and climate justice on March 15 and 16 2023 to: 1.Share and review evidence from those directly involved in various areas of promising practice on urban and peri-urban health; to discuss options for, factors affecting and capacities needed for urban health, and for the scale up of promising practices within and across countries. 2. Explore the implications of findings on health promoting practice in urban and peri urban areas for engaging on commercial practices and responses to climate change. 3. Review measures for assessing and areas for strengthening capacities for urban health and 4.Identify and inform follow up research, practices, policy reforms and exchanges arising from the above for work and multi-actor communities of practice within countries; regionally in the ESA region and in international collaborations. As an adjunct to the meeting, in parallel sessions on the 16th and a further half day on the 17th, cadres responsible for communication from selected organisations in the meeting were trained on photojournalism skills to strengthen accessible documentation and communication of promising practice. The report presents the evidence and insights shared on scaling-up promising practices in urban health and on better managing commercial factors and climate. with the priority themes and follow-up work proposed by delegates. Inequity in the burdens of climate change were identified to makes multi-actor, holistic approaches even more critical in urban health, "for our eyes to shift from effects to root causes, from a focus on technocrats to communities, and from reactive emergency responses to climate to sustained, integrated long term approaches".
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Reports
Theme area
Values, policies and rights, Health equity in economic and trade policies, Governance and participation in health
Title of publication EQ Policy Brief 48: Updating public health-related food laws in east and southern Africa
Date of publication
2023 February
Publication type
Document
Publication details
Publication status
Published
Language
Keywords
east and southern Africa, food, law
Abstract
This brief aims to inform policy dialogue on the protection of health in food law in east and southern Africa (ESA). A desk review in 2022 documented and analysed the features and provisions of health-related food laws, focusing primarily on enabling acts in the 17 countries of the ESA region covered by EQUINET. Referring to key provisions in international standards, this brief explores the extent to which these standards are included in ESA national laws. It provides information on gaps to be addressed and potential provisions that cover these gaps, with particular attention to general and specific food-related risks, and standards for health-promoting, governance and functions. The brief proposes areas for law reform to cover the range of health issues in current food systems. It calls for regional dialogue to harmonise food standards across ESA countries. Links to specific laws and standards are provided in the brief and the references for countries to more directly refer to source materials for law reform.
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Policy brief
Theme area
Equity in health, Values, policies and rights, Health equity in economic and trade policies, Equitable health services, Public-private mix, Resource allocation and health financing, Governance and participation in health, Monitoring equity and research to policy
Title of publication EQUINET Conference 2022 – Catalysing change for equity and social justice in health: Resolutions for action
Date of publication
2023 January
Publication type
Conference Proceedings
Publication details
Publication status
Published
Language
Keywords
EQUINET Conferebce, resolutions, health equity
Abstract
Delegates at the EQUINET Conference 2022 comprised representatives of civil society organisations, community
members, parliament, central and local government leaders and officials, trade unions, media, academia, researchers, and personnel from regional and international organisations. We came together virtually under the umbrella of EQUINET to deliberate the actions needed to Catalyse change for health and social justice in our region. This document provides the resolutions of the conference, drawn from the three thematic days of the conference, discussed and adopted on the final day.
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Resolutions
Theme area
Monitoring equity and research to policy
Title of publication Making Change Visible: Worksheets for the Implementer’s Resource
Date of publication
2023 January
Publication type
Document
Publication details
Publication status
Published
Language
Keywords
Evaluation, Social participation, health systems, training
Abstract
Users of the Making Change Visible Implementer’s Resource have asked us to make available the worksheets in a form that can be filled electronically, downloaded and printed. We have thus made each worksheet available online for this and provide the links to them in this document. Please download and fill as a team, or fill online (pasting into a google document). You can expand the rows or cells, add as much text as you need, modify, save and reopen and edit, and download and print as you need. Use the worksheets with the Resource to discuss the methods and evidence you will use, and save them as a record to use when you prepare your reports.
Country
International
Publisher
Theme area
Values, policies and rights, Health equity in economic and trade policies, Poverty and health
Title of publication Discussion paper 129: A review of public health-related food laws in east and southern Africa,
Date of publication
2023 January
Publication type
Report
Publication details
Publication status
Published
Language
Keywords
food; law; standards; systems; East and Southern Africa
Abstract
Food systems have a key role in promoting health and nutrition. National constitutions in many East and southern Africa (ESA) countries provide for a right to food or adequate nutrition and food law is increasingly important, given expanding food products, trade and risks to health. This report presenting findings from a desk review of current food-related laws in the ESA region was commissioned by EQUINET through TARSC, in association with the East Central and Southern Africa Health Community and Zimbabwe’s Ministry of Health and Child Care. The review documented and analysed provisions in food-related acts for 17 ESA countries. It aims to support policy dialogue and legal review of health-promoting food standards within countries and in the ESA region. At national level, the acts examined covered public health, food standards and safety and consumer protection, as well as specific acts on fisheries, animal diseases, dairy products, meat safety, plant protection, biosafety and genetically modified organisms. For each country, evidence was extracted on the scope, objectives and mission; principles, rights, duties and authorities, key areas of food safety; risk and standards; functions, mechanisms, and administration and governance and financing. The report identifies specific legal clauses in ESA laws that may serve as useful text for law reform. Some countries have more recently enacted laws that are covered in the report that may also be useful sources of specific inputs for law reform. The guidance in the 2003 WHO/FAO Model Food law and the specific standards contained in the Codex and International Health Regulations can also inform processes for reform and for harmonising standards in the region.
Country
East and southern Africa region
Publisher
Equinet Publication Type
Discussion paper
Theme area
Values, policies and rights, Health equity in economic and trade policies
Title of publication Brief 48: Trade policies and local pharmaceutical production in east and Southern Africa
Date of publication
2022 December
Publication type
Document
Publication details
Publication status
Published
Language
Keywords
pharmaceutical, trade, production, East and Southern Africa
Abstract
Manufacturing is affected by a number of policies and measures. Most countries in east and southern Africa (ESA) have policies affecting manufacturing and trade in Essential Health products (EHPs). Such policies include tariffs, non-tariff barriers (prohibitions, import and export licences, regulatory measures etc), trade facilitation measures, trade in services (transport, logistics, insurance), and intellectual property rights. This brief summarises trade policy measures implemented by ESA countries that may affect manufacture of medicines, vaccines, therapeutics, diagnostics and other health technologies/ equipment, such as personal protective equipment (PPE) and ventilation equipment. It draws on findings of research on local production of essential health products in ESA. The brief recommends options ESA countries can consider on trade policy measures that support local pharmaceutical production.
Country
East and southern Africa region
Publisher
Equinet Publication Type
Briefs
Theme area
Values, policies and rights, Health equity in economic and trade policies
Title of publication Policy Brief 47: What next for east and southern Africa after the TRIPs Waiver agreement?
Date of publication
2022 October
Publication type
Document
Publication details
Publication status
Published
Language
Keywords
TRIPS, intellectual propoerty, pharmaceuticals, East and Southern Africa
Abstract
Technology transfer in the manufacture of essential health products (EHPs) remains one of the critical enablers of local production. Eastern and Southern African (ESA) countries, together with others beyond the region have over the past two years intensified global demand for constraints to access of key health technologies to be addressed while the COVID-19 pandemic still puts their populations at risk, including at the World Trade Organisation (WTO). The 12th WTO Ministerial Conference (MC12) held from 12-17 June 2022 in Geneva, concluded with the adoption of the so called “Geneva package” that includes a waiver of certain requirements under the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) concerning the use of compulsory licences to produce COVID-19 vaccines. This brief unpacks the waiver and discusses some key options ESA countries may take following the adoption of the TRIPs waiver.
Country
East and southern Africa region
Publisher
Equinet Publication Type
Briefs
Theme area
Values, policies and rights, Health equity in economic and trade policies, Public-private mix
Title of publication Diss 128: Local production of essential health products in east and southern Africa
Date of publication
2022 November
Publication type
Report
Publication details
Publication status
Published
Language
Keywords
pharmaceutical; essential health products; intellectual property; trade; east and southern Africa
Abstract
Africa continues to rely on imports of Essential Health Products (EHPs) such as medicines, vaccines, therapeutics, diagnostics and health technologies/equipment. An overreliance on imports and an absence of distributed production within the region increases costs and impacts on citizens’ access to EHPs. This is especially so in the face of global supply chain challenges, as evidenced during the COVID-19 pandemic. It highlights the need for local production of EHPs as a step towards ensuring improved access to quality health for all. This paper by Southern and Eastern African trade Information and Negotiations Institute (SEATINI) under the umbrella of the Regional Network on Equity in Health in East and Southern Africa (EQUINET) maps the landscape of local EHP production in four selected east and southern Africa (ESA) countries, namely Kenya, South Africa, Uganda and Zimbabwe, and using the evidence gathered, presents proposals for promoting equitable access to EHPs by promoting capacities for local production of EHPs. In doing so, it builds on more than 15 years of EQUINET programming on local production of EHPs. The authors propose recommendations for the short, medium and longer term, including in relation to the TRIPS Waiver and to support expansion of the local pharmaceutical sectors in the region.
Country
East and southern Africa region
Publisher
Equinet Publication Type
Discussion paper
Theme area
Equity in health, PAR work, Values, policies and rights, Health equity in economic and trade policies, Equitable health services, Public-private mix, Resource allocation and health financing, Governance and participation in health, Monitoring equity and research to policy
Title of publication EQUINET Conference 2022: Videos of Day 1-4 Conference sessions
Date of publication
2022 November
Publication type
Electronic Source
Publication details
Publication status
Published
Language
Keywords
EQUINET Conference, east and southern Africa, health equity
Abstract
EQUINET conferences have provided an opportunity for different communities and areas of focus to interact, and have given guidance to our work, organisation and networking on health equity in East and Southern Africa. In 2022 EQUINET held a regional conference. Challenging a neoliberal mantra that there are no alternatives to policies that create social deficits and injustice, and sharing the ideas and creativity of our region, the 2022 conference shared and discussed experiences, evidence, analysis, successes and struggles from local to regional level and engagement globally to advance health and wellbeing in East and Southern Africa. Through the exchanges, delegates framed propositions to advance health equity and social justice in our region. The EQUINET Conference was held online in three and a half days, each day a month apart, with each of the three full days covering one of the EQUINET strategic directions - Reclaiming the resources for Health, Reclaiming the state, and Reclaiming collective agency and solidarity in health - with a final half-day - Organising regionally for health equity - on how EQUINET organises and what it does to take the strategic directions forward. You can now watch the videos of the presentations on each of the 4 conference days.
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Reports
Theme area
Values, policies and rights
Title of publication RECLAIM 2022!
Date of publication
2022 November
Publication type
Electronic Source
Publication details
Reclaim 2022! EQUINET conference poem
Publication status
Published
Language
Keywords
EQUINET, Health equity, poem, east and southern Africa
Abstract
This video of a poem by Desire Moyo presented on the last day of the EQUINET conference captured some of the aspirations and ideas covered in the three days of the conference and in the resolutions for action. Halala!
Country
East and southern Africa region
Publisher
Equinet Publication Type
Resolutions
Theme area
Equity in health, PAR work, Values, policies and rights, Health equity in economic and trade policies, Equitable health services, Resource allocation and health financing, Equity and HIV/AIDS, Governance and participation in health, Monitoring equity and research to policy
Title of publication EQUINET: the road travelled over 25 years
Date of publication
2022 November
Publication type
Electronic Source
Publication details
Pechakucha of EQUINET, 1998 to 2022 for the EQUINET Conference 2022
Publication status
Published
Language
Keywords
EQUINET, health equity, east and southern Africa
Abstract
This video pechakucha of photographic images tells the story of EQUINET's journey from its formation in 1998 to the current date. It shows the many places, people, areas and forms of work EQUINET has been involved in.
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Slide presentations
Theme area
Equity in health, Values, policies and rights, Health equity in economic and trade policies, Poverty and health, Public-private mix, Governance and participation in health
Title of publication Discussion paper 127: Learning from initiatives on equitable urban health and wellbeing in east and southern Africa,
Date of publication
2022 September
Publication type
Report
Publication details
Learning from initiatives on equitable urban health and wellbeing in east and southern Africa, EQUINET Discussion paper 127, EQUINET, ISUH, Harare
Publication status
Published
Language
Keywords
urban, equity, health, wellbeing, east and southern Africa, case study, document review
Abstract
An Accelerating City Equity Project led by the International Society for Urban Health aims to build a ‘community of practice’ for healthy urban societies, to exchange knowledge on and contribute to the implementation of those practices found to be most catalytic for equity in cities. Towards this, work was implemented in 2022 in EQUINET to gather evidence on promising practice aimed at addressing urban health equity and wellbeing document in east and southern Africa (ESA to contribute to learning within the ESA region and to share and exchange with other regions in the ACE Project. This report presents the work carried out in the ESA region through a desk review of online documents and case studies from selected cities, of areas of promising practice. It shares insights and learning from the findings on practices that promote urban wellbeing and health equity. Collectively, the initiatives have yielded a range of outcomes and changes. In terms of processes for equity-oriented change in urban wellbeing, the report outlines a mix of interventions and tools that promote both participatory and recognitional equity as pivotal to change. Many of the insights generated relate to the design of initiatives and the efforts made to stimulate cross sectoral, multi-stakeholder inputs as a response to the multi-dimensional nature of the drivers of inequality and deprivation. The report notes, however, that initiatives need to connect beyond the local level if they are to have more impact on the structural dimensions of equity, and points to national level inputs that appear to be important to sustain and support such local level practice.
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Discussion paper
Theme area
Values, policies and rights, Health equity in economic and trade policies, Resource allocation and health financing
Title of publication Financing universal public sectors through tax justice in east and southern Africa
Date of publication
2022 August
Publication type
Document
Publication details
TARSC and TJNA, EQUINET (2022) Financing universal public sectors through tax justice in east and southern Africa, Policy brief 46 EQUINET Harare, TJNA Nairobi
Publication status
Published
Language
Keywords
health financing, tax, public revenue, East and Southern Africa
Abstract
This brief presents evidence on key dimensions of adequacy and equity in public sector health financing in East and Southern Africa. It identifies the size of the funding ‘gap’ in relation to basic health service needs; entitlements; and state duties. Efforts to meet funding gaps from service privatisation and out of pocket spending carry negative implications for equity. Tax revenues are the most sustainable source of health financing for universal health coverage (UHC). Various innovative financing measures being explored provide some health funding, but the size of the financing gap calls for a wider focus on progressive tax financing. The brief thus presents losses from shortfalls in tax capacity, from global tax rules and illicit financial flows as three key areas of losses to public revenue in ESA countries. Addressing these tax losses could address the public sector health system funding gap. With COVID-19 having drawn attention to the need for investment in public sector health systems, there is an opportunity for a more ambitious alliance between the health and finance sectors to address these critical tax losses to increase public revenues for health.
Country
East and southern Africa region
Publisher
EQUINET, TJNA
Equinet Publication Type
Briefs
Theme area
Equity in health
Title of publication Information Sheet 8 on on COVID-19 Experience of the pandemic from a youth lens
Date of publication
2022 July
Publication type
Document
Publication details
Publication status
Published
Language
Keywords
COVID-19, pandemic, youth, East and Southern Africa
Abstract
We have heard many expressions of the time we are in in relation to COVID-19. Some talk about ‘getting back to normal’, some say now is the time to ‘build back better’, and others that we should be preparing for the next pandemic. For many the pandemic remains a current reality, whether in its direct health impact, or its more sustain impact on many dimensions of wellbeing and inequality. What does looking at the pandemic from a youth lens tell us about what we need to address now in our region? This brief focuses on this. EQUINET information sheets on COVID-19 summarise information from and provide links to official, scientific and other resources on east and southern Africa (ESA) covering selected themes related to equity in the pandemic. They complement and do not substitute information from public health authorities.
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Discussion brief
Theme area
Values, policies and rights, Health equity in economic and trade policies, Equitable health services, Public-private mix, Resource allocation and health financing
Title of publication Tax justice for universal public sector health systems in East and Southern Africa
Date of publication
2022 July
Publication type
Report
Publication details
Tax justice for universal public sector health systems in East and Southern Africa, TARSC, TJNA, EQUINET Discussion paper 126, EQUINET Harare, TJNA, Nairobi
Publication status
Published
Language
Keywords
east and southern Africa, tax, health financing,
Abstract
This paper jointly produced by Training and Research Support Centre / EQUINET and Tax Justice Network Africa outlines performance on key dimensions of public sector health financing in east and southern African (ESA) countries and assesses the size of the funding ‘gap’ in relation to basic health service needs; population entitlements; and state duties to health care. It provides brief discussion on the negative implications for equity of meeting this gap through out of pocket spending and privatisation of health services. With tax revenues the most progressive source of health financing for universal health coverage (UHC), it examines the level, sources and drivers of lost tax revenue in ESA countries, and relates the public sector health system funding gap to key sources and levels of lost tax revenue. The paper points to how the current global tax framework and its unfair allocation of taxing rights benefits high income countries to the significant detriment of low- and middle-income countries. The paper presents evidence that indicates that it is possible to meet the health financing gap for public sector health systems in the region through adequate funding from progressive taxation if tax losses are prevented and if proposals for a fairer global tax system are adopted, and suggests areas for follow up policy dialogue and engagement.
Country
East and southern Africa region
Publisher
EQUINET, TJNA
Equinet Publication Type
Discussion paper
Theme area
Values, policies and rights, Health equity in economic and trade policies, Equitable health services, Public-private mix, Resource allocation and health financing
Title of publication EQDiss 125: Protecting equity in the face of privatisation of health services in east and southern Africa
Date of publication
2022 May
Publication type
Document
Publication details
Theory of change driven equity analysis: Protecting equity in the face of privatisation of health services in east and southern Africa, Discussion paper 125, EQUINET, Harare
Publication status
Published
Language
Keywords
privatisation, health care, equity, east and Southern Africa
Abstract
Funding for public health services paid from general taxation, provided universally and free at the point of access, is considered the most effective way of redistributing resources from high to low income groups while contributing to improvements in health. Nonetheless, in recent decades the privatisation of health services has expanded, through the in privatisation of services and expansion of private sector services in parallel with the public system, or in various forms of commercialised market reforms within public sectors, and the growth of public-private partnerships. This paper outlines equity-related evidence on privatisation in the ESA region in terms of differential entitlements, assets, endowments, and capabilities; differentials in vulnerability; health outcomes; and in life course, long-term and wider system consequences. Drawing on this evidence, the paper suggests elements of the pathways for responding to the equity dimensions of privatisation of health services and reflections on which elements may have a broad impact on multiple dimensions of inequity. The presentation of areas for action on pathways for change is not intended to be prescriptive. It rather intends to stimulate and inform dialogue and advocacy, understanding that what may be relevant and feasible depends on the country context. Motivating actions to address the inequities inherent in privatisation implies countering a common narrative that limiting privatisation of services undermines development. In contrast it implies promoting the right to health care, as embedded in many constitutions of ESA countries, and the understanding that public sector health systems are central for universal health coverage.
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Discussion paper
Theme area
Equity in health
Title of publication EQUINET Conference 2022 Announcement: Catalysing change for health and social justice
Date of publication
2022 March
Publication type
Document
Publication details
Publication status
Published
Language
Keywords
EQUINET, Conference
Abstract
The 2022 EQUINET Regional Conference, held online, invites people from all levels, disciplines, sectors and institutions who contribute to health and social justice in east and southern Africa. Challenging a neoliberal mantra that there are no alternatives to policies that create social deficits and injustice, the 2022 conference will share and discuss experiences, ideas, evidence, analysis, successes and struggles from local to regional level and engagement globally to advance health and wellbeing in our region. Through the exchanges we will frame propositions to advance health equity and social justice in our region. We are a network of many – community members, workers, state personnel at all levels, civil society, parliamentarians, academics, trade unions, professionals, innovators and producers. We welcome the voices, lenses and different ways of communicating ideas that all bring to the conference. For further information visit the Conference website www.equinetafrica.org/conference/home
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Briefs
Theme area
Resource allocation and health financing
Title of publication EQUINET Diss 124: Health sector financing and COVID-19: East and Southern Africa trends and a Zambia case study
Date of publication
2022 January
Publication type
Report
Publication details
Health sector financing and COVID-19: East and Southern Africa trends and a Zambia case study, Discussion paper 124, EQUINET, Harare
Publication status
Published
Language
Keywords
health financing,COVID, public health; Zambia
Abstract
EQUINET commissioned this study from the author at University of Zambia to explore trends in equity-related healthcare expenditures in East and southern Africa (ESA) countries prior to the pandemic (2000–2019), and, through a deeper case study of expenditures in Zambia, how financing changed during the COVID-19 pandemic in 2020/21. The regional analysis reviewed selected indicators available from the WHO Global Health Expenditure database for 2000–2019 of the: extent to which governments prioritise health in domestic budget spending; level of financial protection; level of government pro-poor spending on primary health care; and the share of public versus private financing in total health expenditure. The financing trends for 2000–2019 in ESA countries raise issues around health system preparedness for the pandemic, while the Zambia case study demonstrates the consequent impact of the responses to COVID-19 on health system financing.
Country
Zambia
Publisher
EQUINET
Equinet Publication Type
Discussion paper
Theme area
Human resources for health
Title of publication Promoting social dialogue to improve working conditions for Community Health Workers in South Africa
Date of publication
2021 December
Publication type
Publication details
Publication status
Published
Language
English
Keywords
Community health workers, conditions, trade unions, South Africa, manual
Abstract
This manual has been developed to better understand and outline the history and work of CHWs in South Africa. It aims to provide trade unions with a better understanding, and methodology to organise CHWs and articulate their struggles.
Country
South Africa
Publisher
PSI
Theme area
Equity in health, Values, policies and rights, Health equity in economic and trade policies, Equitable health services, Governance and participation in health
Title of publication EQUINET Information sheet 7 on COVID-19: Turning vaccines to vaccination in the region
Date of publication
2022 January
Publication type
Document
Publication details
Publication status
Published
Language
Keywords
COVID, vaccine, equity, East and Southern Africa
Abstract
EQUINET information sheets on COVID-19 summarise information from and provide links to official, scientific and other resources on east and southern Africa (ESA) covering selected themes related to equity in the pandemic. They complement and do not substitute information from public health authorities. Brief 7 summarises pandemic developments in the region to December 2021, with a focus on equity in vaccination coverage. It covers: 1: Recent trends in COVID-19 in ESA countries; 2: Vaccine supply to the ESA region; 3: Storage and distribution of vaccines in the region; 4: Vaccine uptake and vaccination coverage; and 5: Addressing equity - from vaccines to vaccinated populations.
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Discussion brief
Theme area
Values, policies and rights
Title of publication Beyond Corporate Social Responsibility: Strengthening Human Rights Due Diligence through the Legally Binding Instrument on Business and Human Rights
Date of publication
2021 October
Publication type
Document
Publication details
Research paper 138, Geneva
Publication status
Published
Language
Keywords
Human rights; Corporate; commercial; transnational
Abstract
Mandatory human rights due diligence (HRDD) requirements can serve to promote the adoption of a strong international framework of corporate accountability and remedy for human rights violations in the context of business activities. This paper identifies the elements of a human rights due diligence and their implementation through analysing current regional and State practice in the adoption of mandatory HRDD legislation in different sectors. It discusses the principles that characterize the approach taken by the United Nations Open-ended Intergovernmental Working Group on the adoption of a Legally Binding Instrument on transnational corporations and other business enterprises and how it could serve as an important cornerstone for modern rule making on the issue of business and human rights.
Country
International
Publisher
South Centre
Theme area
Equity in health, Values, policies and rights, Health equity in economic and trade policies, Equitable health services, Public-private mix, Resource allocation and health financing, Governance and participation in health
Title of publication Report of the East and Southern Africa Regional People’s Health University
Date of publication
2021 December
Publication type
Report
Publication details
Publication status
Published
Language
Keywords
Health equity, East and Southern Africa, peoples health university, training
Abstract
The first East and Southern Africa Regional People’s Health University (ESA RPHU) jointly convened by the People’s Health Movement (PHM) and Regional Network for Equity in Health in East and Southern Africa (EQUINET) was held virtually between 29 July and 12 November 2021 with the theme ‘Past, present and future struggles for Health equity’. The course aimed to build and share evidence, experience, analysis, and knowledge on the drivers of health equity to support efforts and activism within countries, and regional co-operation and joint engagement, from local to global level, on shared priorities. The course further aimed to share evidence, practical experiences, insights and learning from action, including on the implications of the COVID-19 pandemic in the region. To widen uptake in the region, background readings and presentations from sessions are available on the ESA RPHU Resources page.
Country
East and southern Africa region
Publisher
EQUINET, PHM
Equinet Publication Type
Reports
Theme area
Equitable health services
Title of publication Comparison of the Response in Rwanda, South Africa and Zimbabwe
Date of publication
2021
Publication type
Academic paper
Publication details
MEDICC Review 23:3-4, 15-20, 2021
Publication status
Published
Language
Keywords
COVID, health services, Zimbabwe, Rwanda
Abstract
African countries have mounted different response strategies to COVID-19, eliciting varied outcomes. In this paper the authors compare these response strategies in Rwanda, South Africa and Zimbabwe and discuss lessons that could be shared. In particular, Rwanda has a robust and coordinated national health system that has effectively contained the epidemic. South Africa has considerable testing capacity, which has been used productively in a national response largely funded by local resources, while Zimbabwe has an effective point-of-entry approach that utilizes strategic information. The authors propose meetings between countries to share experiences and lessons learned during the COVD-19 pandemic.
Country
East and southern Africa region
Publisher
Theme area
Values, policies and rights, Health equity in economic and trade policies
Title of publication Nutrition related non-communicable diseases and sugar sweetened beverage policies: a landscape analysis in Zambia
Date of publication
2021
Publication type
Journal Article
Publication details
Global Health Action, 14:1, 1-11, 2021
Publication status
Published
Language
Keywords
Nutrition, tax, financing, sugar, public health, Zambia
Abstract
This study identified opportunities to strengthen policies relating to sugar-sweetened beverage taxation in Zambia, through: (1) understanding the policy landscape and political context in which policies for nutrition-related non-communicable diseases are being developed, particularly sugar-sweetened beverage taxation, and exploring the potential use of revenue arising from sugar-sweetened beverage taxation to support improved nutrition. The authors conducted a retrospective qualitative policy analysis and key informant interviews with 10 policy actors. Increased regulation of sugar-sweetened beverages was a priority for the health sector, in conflict with economic interests to grow the manufacturing sector, including the food and beverage industries. The authors suggest that this conflict between public health and economic priorities, poor public information and incoherent policy objectives might have contributed to the adoption of a weakened excise tax. The authors suggest that the fact that it did not prevent the introduction of a differential sugar tax on sugar-sweetened beverages implies that there are opportunities to strengthen the existing taxation of sugar-sweetened beverages in Zambia, especially if backed by inclusive in policy formulation and comprehensive monitoring of risk factors.
Country
Zambia
Publisher
Equinet Publication Type
Academic papers
Theme area
Equity in health, Values, policies and rights, Health equity in economic and trade policies, Public-private mix, Resource allocation and health financing, Governance and participation in health
Title of publication Video clips from the East and Southern Africa Regional Peoples Health University
Date of publication
2021 December
Publication type
Conference Proceedings
Publication details
Publication status
Published
Language
Keywords
East and Southern Africa, training, videos, health equity
Abstract
The first East and Southern Africa Regional People’s Health University (ESA RPHU) jointly convened by PHM and EQUINET was held virtually between July 29 and November 12 2021 with 10 weeks of interactive sessions to build and share evidence, experience, analysis and knowledge on health equity to support regional co-operation and joint engagement, from local to global level, on shared priorities. The course programme is at https://www.equinetafrica.org/rphu/rphu-programme with different issues affecting health equity in the region and learning from COVID-19. Open access online dissemination of plenary presentations and resources from the full course is available on the RPHU resources page.
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Slide presentations, Toolkits and training materials
Theme area
Governance and participation in health
Title of publication Making Change Visible: Evaluating Efforts to Advance Social Participation in Health, An Implementer’s Resource,
Date of publication
2021 November
Publication type
Document
Publication details
Publication status
Published
Language
Keywords
International, evaluation, social participation in health
Abstract
This Making change Visible: Implementers’ Resource is a user-friendly guide for people working to advance social power and participation in health (SPH). Whether you are a health practitioner, community leader, health system manager, researcher, trainer, planner, or serving in another role, the Resource shows you how to gather, analyse, use, and communicate evidence on the effectiveness of your SPH work. While there are a variety of resources available on SPH, there is limited comprehensive guidance on how to evaluate its effectiveness. The Implementers’ Resource aims to fill this gap. The Resource presents information on the measures, methods, and tools that have been used by practitioners and others involved with work on social power and participation in health to assess changes achieved by the work. It covers how to conduct a baseline assessment, creating a critical reference point at the start of the SPH programme to plan work and track changes as they are achieved. It guides implementers in carrying out a performance evaluation to assess if the SPH intervention is producing the intended actions and outputs for review and course correction. Finally, it explains how to conduct an outcome or impact evaluation, assessing the changes achieved, directly and indirectly, as a result of the SPH intervention.
Country
International
Publisher
Training and Research Support Centre, Shaping Health
Theme area
Equity in health
Title of publication Information sheet 6 on COVID-19: Long COVID in East and Southern Africa
Date of publication
2021 September
Publication type
Document
Publication details
Publication status
Published
Language
Keywords
COVID; chronic illness; East and Southern Africa
Abstract
This sixth information sheet comes after 18 months of the COVID-19 pandemic in east and southern African (ESA) countries, with many experiencing their third waves of infections and deaths. With such a prolonged pandemic, capacities and understanding have grown around various dimensions of the management of COVID-19, but so too has evidence of social inequities, including the ‘moral catastrophe’ of a global inequity in access to vaccines. There is now also growing evidence of people who continue experience symptoms more than 12 weeks after their initial infection, or ‘long COVID’. This sixth information sheet summarises information on long COVID, and its distribution in the ESA region, responses to it and the equity issues it raises.
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Discussion brief
Theme area
Equity in health
Title of publication PROGRAMME for the 2021 East and Southern Africa Regional Peoples Health University
Date of publication
2021 July
Publication type
Document
Publication details
Publication status
Published
Language
Keywords
RPHU; health equity; East and Southern Africa
Abstract
This document provides the programme of the first East and Southern Africa Regional People’s Health University (ESA RPHU) jointly convened by PHM and EQUINET being held virtually between 29 July and 12 November with the theme ‘Past, present and future struggles for Health equity’. The course aims to build and share evidence, experience, analysis and knowledge on the drivers of health equity to support efforts and activism within countries, as new and existing members of PHM and EQUINET, and in regional co-operation and joint engagement, from local to global level, on shared priorities.
Country
East and southern Africa region
Publisher
EQUINET and PHM
Equinet Publication Type
Toolkits and training materials
Theme area
Public-private mix
Title of publication Diss 123: Equity in the public and private health sector responses to COVID-19 in east and southern Africa
Date of publication
2021 July
Publication type
Report
Publication details
Equity in the public and private health sector responses to COVID-19 in east and southern Africa, EQUINET discussion paper 123, EQUINET, Harare
Publication status
Published
Language
Keywords
public sector, private sector, COVID-19; east and southern Africa; health
Abstract
The COVID-19 pandemic has strained the already stretched health systems in East and Southern Africa (ESA) countries, and was affected by previous levels of public leadership and engagement with the private sector. The response involved a range of collaborations between the public and private sectors. Country plans were public sector-led, in co-operation with international development partners, with partnerships between the public and private sectors in the response both in and beyond the health sector. This desk review commissioned by EQUINET presents evidence from online materials and EQUINET steering committee key informants on features of the public and private sector health system roles in the response to COVID-19. The work differentiates the private for-profit sector from the private not-for-profit sector. The review explores the equity implications of these responses, and suggests implications for (re)investing in strengthened public health system preparedness and functioning and private sector co-ordination in ESA countries.
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Discussion paper
Theme area
Equity in health, Poverty and health, Equitable health services, Governance and participation in health
Title of publication Diss paper 122: Youth mental health in the context of COVID-19 in East and Southern Africa: A desk review
Date of publication
2021 June
Publication type
Report
Publication details
EQUINET discussion paper 122, IWGHSS and TARSC, EQUINET, Harare
Publication status
Published
Language
Keywords
youth, mental health, east and southern Africa
Abstract
This desk review reports available published information relating to youth mental health in east and southern Africa (ESA). It was implemented within and informs collaborative work on youth mental health in the region in EQUINET between Training and Research Support Centre (TARSC), the International Working Group for Health Systems Strengthening (IWGHSS) and the pra4equity and PAROnline network, specifically Country Minders for Peoples Development (CMPD), Malawi, and the Centre for Youth Driven Development Initiative (CFYDDI), Uganda. The desk review explored patterns and determinants of youth mental health in the region; how the coronavirus (COVID-19) pandemic and responses to it have affected this; where youth seek and obtain support for mental health needs and the perceived challenges and gaps. It presents recommendations for improving the responses to mental health challenges. The COVID-19 lockdown and social distancing measures led to difficulties, with online learning and loss of work and rising costs intensifying some factors and increasing mental stress, as well as suicidal ideas and substance and alcohol abuse among youth. Youth mental health is a pertinent issue for the ESA region, more so due to the impact of the pandemic, but is not well recognised by formal services and policy. The review evidence points to a need, intensified by COVID-19, to co-create with young people strategies for preventing and responding to youth mental illness and its drivers and consequences.
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Discussion paper
Theme area
Equity in health, Governance and participation in health
Title of publication Dala Kitchen: More than a cookbook
Date of publication
2021
Publication type
Book
Publication details
Dala Kitchen: More than a cookbook, Editors: Eleanor Whyle, Manya van Ryneveld, and Leanne Brady
Publication status
In press
Language
Keywords
Solidarity; social network; food; Cape Town
Abstract
Dala Kitchen (More Than A Cookbook) is a celebration of the work of Cape Town Together. During 2020, in response to the Covid-19 pandemic, thousands of people came together to support one another in a range of creative and radically generous ways. Through a series of recipes, how-to's, articles and stories Dala Kitchen tells the story of Cape Town Together, the CANs that comprise it, and the people that are at the heart of the network. Together, these stories capture a moment in time and demonstrate that, in the words of Arundhati Roy "[a]nother world is not only possible, she is on her way.". The version on this website is a low resolution version- a higher resolution copy will replace this shortly.
Country
South Africa
Publisher
Cape Town Together CAN
Theme area
Equity and HIV/AIDS
Title of publication Rapid Assessment on the Impact of COVID-19 among Female Sex Workers, Adolescent Girls and Young Women, and Women Living with HIV & AIDS in Uganda
Date of publication
2020 October
Publication type
Report
Publication details
Rapid Assessment on the Impact of COVID-19 among Female Sex Workers, Adolescent Girls and Young Women, and Women Living with HIV & AIDS in Uganda
Publication status
Language
Keywords
COVID-19, Sex Workers, Adolescents, HIV,
Abstract
The Alliance of Women Advocating for Change (AWAC) Uganda conducted an assessment between 28th March and 20th May 2020 to examine the level of awareness of COVID-19 and its lockdown impact on the access and adherence to HIV treatment and preventive care, psychological and socioeconomic wellbeing of Female Sex Workers (FSWs), Mainstream Women Living With HIV&AIDS (MWLHIV) and Adolescent Girls and Young Women (AGYWs) in Uganda. This sampled 1124 respondents from 30 districts in Uganda. The assessment demystifies the impact of COVID-19 on the access and adherence to HIV treatment and preventive care, psychological and socioeconomic wellbeing of these social groups.
Country
Uganda
Publisher
Policies for Equitable Access to Health
Theme area
Health equity in economic and trade policies, Equitable health services
Title of publication Brief: Ensuring access to COVID-19 related vaccines and health technologies in East and Southern Africa
Date of publication
2021 February
Publication type
Document
Publication details
Brief: Ensuring access to COVID-19 related vaccines and health technologies in East and Southern Africa, Produced by EQUINET with financial support from OSISA, February 2021
Publication status
Published
Language
Keywords
CIVID-19, Vaccines, technology, East and Southern Africa
Abstract
The ability of African countries to mount effective and equitable responses to COVID-19 reflects in part the access that countries have to reliable, sustained, distributed supplies of diagnostics, medicines, vaccines and other health technologies. By 2021 significant inequality in access to vaccines has become clearly evident, a situation that the World Health Organisation director-general called a “catastrophic moral failure” in January 2021. While noting that vaccine roll out in East and Southern Africa (ESA) is a dynamic situation, this brief discusses the different vaccines and the distribution of vaccines in the region and issues involved in the development and production of vaccines and other health technologies in the region. It raises areas where regional co-operation is taking place and suggests where it could be strengthened.
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Briefs
Theme area
Values, policies and rights, Health equity in economic and trade policies, Human resources for health, Public-private mix, Governance and participation in health
Title of publication Information sheet 5 on COVID-19: Pandemic impacts on labour – experience and responses
Date of publication
2021 January
Publication type
Document
Publication details
Information sheet 5 on COVID-19: Pandemic impacts on labour – experience and responses January 2021
Publication status
Published
Language
Keywords
COVID-19, labour, East and Southern Africa, unions
Abstract
This fifth information sheet summarises information on how COVID-19 has affected working people in the ESA region, and the response by workers, unions, states and others, with recommendations for how to better address the impacts. Nearly a million African workers are estimated to have had COVID-19 in 2020, probably more given the low level of testing. Health workers (HWs), those in crowded or poorly protected workplaces or in crowded accommodation, those in common contact with the public and those in caring roles may be more at risk. Informal, migrant, young, disabled and female workers may be more vulnerable to COVID-related disease. Lockdowns and blocks in supply chains have disrupted key areas of employment, affecting working people’s livelihoods, jobs and mental health, and leading to stigma and social insecurity and falling remittances from African migrants and revenues for social protection. Possible responses include public health measures, including now equitable access and vaccines; workplace infection control; social protection to prevent impoverishment; protection of jobs and wage subsidies. Workers and unions have contributed to these responses, despite the pandemic undermining union operations. The brief outlines recommendations to protect workers and their rights at work, noting that not implementing such measures makes the whole of society vulnerable.
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Discussion brief, Policy brief
Theme area
Equitable health services, Monitoring equity and research to policy
Title of publication Using evidence and analysis for an adaptive health system response to COVID-19 in Uganda in 2020
Date of publication
2020 November
Publication type
Report
Publication details
'Using evidence and analysis for an adaptive health system response to COVID-19 in Uganda in 2020’, EQUINET Case study paper, Ministry of Health Uganda: Kampala, TARSC, EQUINET: Harare
Publication status
Published
Language
Keywords
Uganda, evidence, COVID-19; systems
Abstract
Uganda reported its first confirmed case of COVID-19 on 21 March 2020. The country has since implemented a series of public health measures to limit the spread of the virus. The pandemic has progressed from imported cases through sporadic community cases to stage four, with widespread community transmission. This paper documents how evidence and analysis were used to support decision-making for an adaptive health system response to COVID-19 in Uganda in 2020. A desk review was thus implemented using published and grey literature covering the period from February to October 2020 to document the nature and organisation of different data and related evidence used to support projections, planning and decision-making on the surveillance, prevention, care and health system response to COVID-19. The desk review also looked at how evidence was used and communicated across different actors to support adaptive responses. While there have been challenges, Uganda’s response to COVID-19 has been dynamic, responding to different sources of evidence, and through different institutional channels and actions, with the latter generating evidence and experience that feeds back to the response.
Country
Uganda
Publisher
EQUINET
Equinet Publication Type
Discussion paper
Theme area
Equity in health, Governance and participation in health
Title of publication Corona Warriors in Communities
Date of publication
2020 September
Publication type
Document
Publication details
Corona Warriors in Communities, Adolescent girls’ response to local problems in COVID times, SAHAJ, Gujarat, India
Publication status
Published
Language
Keywords
Gujarat, Adolescents, COVID-19, community engagement
Abstract
In response to COVID-19, SAHAJ, a non-profit organization in India, and community-based partners responded to various issues that emerged from the pandemic in Vadodara, working with young people and local leaders. They made masks, provided safety kits with various PPE, supported access to sanitary napkins and facilitated food distribution in a culturally appropriate manner that reached the most vulnerable families.
Country
India
Publisher
SAHAJ
Equinet Publication Type
Reports
Theme area
Equity in health, Governance and participation in health
Title of publication Pandemic, Social Mobilization and Primary Health Care in the City of São Paulo
Date of publication
2020 September
Publication type
Document
Publication details
Pandemic, Social Mobilization and Primary Health Care in the City of São Paulo, CEBRAP, Brazil
Publication status
Published
Language
Keywords
Brazil, COVID-19, community engagement
Abstract
In Brazil, residents of slums and urban periphery areas are mobilizing to define and implement strategies to combat Covid-19. The actions and goals guiding these initiatives vary, as does their style, which can be more autonomous or dependent, combative or collaborative. One of these initiatives is discussed , the Sapopemba Life Brigade. The authors recovered a bit of its history and actions, questioning whether and how they have articulated with health system authorities, within the SUS, the Brazilian public health care system and, especially, with Primary Health Care (PHC) workers present in the territory, to lessen the impacts of the pandemic.
Country
Brazil
Publisher
CEBRAP
Equinet Publication Type
Reports
Theme area
Equity in health, Values, policies and rights, Health equity in economic and trade policies, Poverty and health, Equitable health services, Governance and participation in health
Title of publication ‘We are subjects, not objects in health’: Communities taking action on COVID-19
Date of publication
2020 September
Publication type
Report
Publication details
‘We are subjects, not objects in health’: Communities taking action on COVID-19, Training and Research Support Centre in EQUINET and Shaping Health.
Publication status
Published
Language
Keywords
Global, case studies, community participation, community engagement, responses
Abstract
This document co-ordinated by TARSC in EQUINET and in the Shaping health consortium, and with input from co-authors from nine countries provides evidence of practical and affirmative options of people-centred, participatory forms of community organizing and engagement in diverse areas of prevention, care and wider social protection in responding to COVID-19. The 42 case studies from different regions intend to inspire, inform and support. The case studies are unique, diverse and rooted in widely different contexts and histories. In all, the people involved are subjects, full of life, with rights, ideas and rich experience. They report the creative development and use of social media platforms for action across all areas of response, connecting people within and across communities and countries, giving voice and visibility to community experiences and linking people to key resources and services. They show the role of an ICT that supports problem solving and expression of marginalized voices. Simple tools, norms and standards, and open data facilitate creative community engagement. The experiences show organization around symptom surveillance, testing, contact tracing and risk mapping, linking people to support and proposing feasible, less harmful ways of organizing risk settings or implementing lockdowns. Community volunteers have produced and distributed PPE and other health technologies; have self-organized medical, care and counselling support; and have organized food and other essentials for those in need, in ways that address psychosocial challenges and cultural and religious beliefs and that overcome stigma and social isolation. The initiatives have linked small scale farmers to household deliveries for food security, provided food through communal gardens, kitchens and ‘people’s’ restaurants and supported access to emergency lodging, benefit schemes and safe water. They demonstrate that a compassionate society enhances public health. While not without challenges and reversals, they are solution-focused and use their actions to negotiate and lever the resources and relationships that they expect from the state. Many build on histories, ideologies, structures, organization and relationships that began long before the pandemic, enabling a relatively rapid response to new challenges posed by COVID-19 and with an intention to sustain relevant innovations after the pandemic. They reach to socio-economically disadvantaged groups within communities, especially where organizing processes were participatory and democratic, strengthening collective organization, investing in capacities and leadership and making links with more powerful groups to address local priorities and negotiate delivery on state obligations. They build new relationships between communities and producers and between communities and health workers, and solidarity interactions with international agencies and diaspora communities. The relationships built show the value of productive capacities, economic and system interactions that were previously ignored. While some are a response to imposed measures insensitive to community realities, in others the state, especially at local level, provided enabling conditions and resources and was responsive to local initiative, especially where state capacities were decentralized or autonomous. In responding to deprivation or deficit, there was a caution not to take over state duties, nor to be dominated by the state, and an observation from service workers that community organization and advocacy is what makes the state move. The challenges presented by the pandemic are creating demand and space for innovation, and in many settings communities are rising to that demand. The mobilization of affirmative community effort and creativity needs to be recognized in the story of the 2020 pandemic. The authors hope that the case studies inspire the proactive efforts of other organizations and communities. They also carry a consistent message: The response to COVID does not need to generate fear and coercion. It can be inclusive, creative, equitable and participatory. Co-production and co-determination with affected communities are not an optional ‘add-on’ to COVID-19 responses. They are fundamental to a successful response.
Country
International
Publisher
Training and Research Support Centre in EQUINET and Shaping Health
Equinet Publication Type
Reports
Theme area
Health equity in economic and trade policies
Title of publication Economic and food-security implications of COVID-19: Did WHA73 address this double-burden?
Date of publication
2020 June
Publication type
Document
Publication details
Publication status
Language
Keywords
food security; international co-operation; COVID-19
Abstract
The Coronavirus outbreak has underpinned unprecedented economic instability and global food supply disruptions in Africa. This has put global cooperation (aid, partnerships and concession finance) on test after the economic downturn in the world economy performance. This article presents the damaging interruptions caused by the pandemic on socio-economic survival of countries and food security. It further demystifies the gaps therein interventions (in line with IHR core principles) presented by WHO member states and UN agencies at seventy-third World Health Assembly –which PHM closely followed through its WHO Watch program.
Country
Uganda
Publisher
PHM
Theme area
Equity in health, Poverty and health, Equitable health services, Monitoring equity and research to policy
Title of publication COVID-19 in East and Southern Africa: developments in the pandemic, July 2020
Date of publication
2020 July
Publication type
Document
Publication details
Brief: COVID-19 in East and Southern Africa: developments in the pandemic, July 2020, EQUINET and ECSA HC, Online
Publication status
Published
Language
Keywords
COVID-19; country data, East and Southern Africa
Abstract
This information sheet is the second presenting work summarising evidence as of July 17 2020 from official and scientific population data across countries in east and southern Africa (ESA) on the COVID-19 pandemic, the responses to it and the relationship with other indicators of population health, health systems and health determinants. In terms of the epidemic profile, increased testing has improved case detection, although still generally at low levels for an effective public health response. Reporting the share of tests that are positive will help to identify if transmission is rising and effective use of test resources. By July 17th most ESA countries had a rising pace of transmission and a sustained rise in total cases. As exceptions, Mauritius, Uganda and DRC show plateauing of cases. The pandemic thus continues to take different forms in different ESA countries. In terms of wider vulnerability, the slower, sustained increase in cases in the ESA region raises concern on the effects of sustained implementation of measures such as school and workplace closures. ESA countries with more rapid and stringent measures (such as Mauritius and Uganda) have lower case prevalence and in Mauritius, a shorter highly stringent response appears to have been effective in pandemic control. There is some evidence that there may be a ‘health debt’ in unmet management of other morbidity that would need to be further explored.
Country
East and southern Africa region
Publisher
EQUINET, ECSA HC
Equinet Publication Type
Briefs
Theme area
Equity in health, Poverty and health, Equitable health services, Monitoring equity and research to policy
Title of publication COVID-19 in East and Southern Africa – early evidence from population level data, June 2020
Date of publication
2020 June
Publication type
Document
Publication details
Brief: COVID-19 in East and Southern Africa – early evidence from population level data, June 2020, EQUINET, ECSA HC, online
Publication status
Published
Language
Keywords
COVID-19, country data, East and Southern Africa
Abstract
This information sheet presents a first output of work in progress summarising available population data from official sources across 16 countries in east and southern Africa (ESA) on the COVID-19 pandemic,the responses to it and the relationship with other relevant indicators of population health, health systems and health determinants. Notwithstanding the data challenges indicated and the dynamic nature of the epidemic, it shows a diversity across countries in the pandemic profile, risks, capacities and responses , pointing to factors that merit further exploration and potential areas for exchange on practice and raising a caution on making simple generalisations about the pandemic in the region. Equally, understanding the pandemic, the responses and impacts calls also for disaggregated, within-country evidence, given its changing transmission and its different effects on different social groups. A further round of analysis will be implemented in July, updating data and including other information gathered. Feedback is welcomed on this brief to improve and inform the future work.
Country
East and southern Africa region
Publisher
Equinet Publication Type
Briefs
Theme area
Public-private mix, Resource allocation and health financing
Title of publication A case study of Public Private Partnerships in the Health Sector in Malawi
Date of publication
2020 May
Publication type
Document
Publication details
A case study of Public Private Partnerships in the Health Sector in Malawi, Case study. EQUINET, Harare
Publication status
Published
Language
Keywords
public private partnership; Malawi; health services; CHAM
Abstract
A Public-Private Partnership (PPP) is a legally enforceable contract in which a contracting authority partners with a private sector partner to build, expand, improve, or develop infrastructure or service.This desk review was commissioned by the Regional network for Equity in Health in southern Africa (EQUINET) as a case study within wider regional work on PPPs in the east and southern Africa region. It explores PPPs in health sector in Malawi. It investigates the areas which government has used PPPs in the health sector, and their implications for equity in financing and access to services.
Country
Malawi
Publisher
EQUINET
Equinet Publication Type
Reports
Theme area
Values, policies and rights, Health equity in economic and trade policies, Public-private mix, Governance and participation in health
Title of publication Brief: Securing COVID-19 related diagnostics, health technology, medicines and vaccines for African public health
Date of publication
2020 May
Publication type
Document
Publication details
Publication status
Published
Language
Keywords
COVID-19, health technology, medicine, vaccine, diagnostics, international, global health
Abstract
The ability of African countries to mount effective and equitable responses to COVID-19 reflects in part the access that countries have to reliable, sustained, distributed supplies of diagnostics (antigen and antibody test kits and equipment for decentralised laboratories) and health technologies (personal protective equipment (PPEs), oxygen and constant positive airway pressure equipment). As medicines and vaccines are developed and approved for COVID-19 they too need to be available at mass scale and locally distributed. Currently, African countries, like many others, face shortfalls in all of these essential commodities relative to need. Various global, multilateral and bilateral arrangements have been proposed to address innovation in and access to these technologies. This brief shares information on initiatives related to diagnostics, health technologies, medicines and vaccines, the issues for African countries and options for addressing them in the dialogue and negotiations at global fora. It covers African interests and options in relation to (i) securing solidarity-based bilateral and multilateral resource streams for supply needs; (ii) using existing TRIPS flexibilities (iii) enabling open innovation and sharing of intellectual property and (iv) enabling open manufacturing and distributed and local production of these technologies. The pressure is thus growing for all COVID-19 related drugs, diagnostics, vaccines and health products, existing or future, to be considered global public goods, as expressed by the UN Secretary General on 24 April. At the same time, the brief argues that the way to make these products available to everyone, everywhere, must be by structurally linking open innovation and open manufacture to distributed production and access. Current experience suggests that any other approach may fall short on delivering timely and equitably distributed access for African countries.
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Briefs
Theme area
Equity in health, Values, policies and rights, Health equity in economic and trade policies, Governance and participation in health
Title of publication Trends in extraction of biodiversity and genetic resources in east and southern Africa
Date of publication
2020 May
Publication type
Document
Publication details
Publication status
Published
Language
Keywords
biodiversity, genetic resources, extractives, projections; east and southern Africa
Abstract
This brief is produced as part of the scoping work in EQUINET on the distributional consequences for current and future wellbeing of projected trends in selected extractives. This paper focuses on trends in biodiversity and genetic resources and presents: The current situation and projected trends related to biodiversity and genetic resources in east and southern Africa (ESA); the implications for the health of current and future generations of these trends and the policy choices and alternatives to respond to these trends and the factors that influence policy design and uptake of choices. The biodiversity, genetic diversity of plants, animals and forests in ESA countries are declining at alarming rates, risking the health and wellbeing of populations in the region.Losses of biodiversity and genetic resources have led to poorer diets, poorer living conditions, encroachment on areas with animal populations and an erosion of wild foods and medicinal plants that raise the risk of chronic and zoonotic diseases and pandemics. Current policies have not reversed these trends, nor met the targets of the Convention on Biodiversity (CBD). The brief outlines the paradigm shift and policy options needed to address these trends.
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Briefs
Theme area
Equity in health, Values, policies and rights, Health equity in economic and trade policies, Governance and participation in health
Title of publication Trends in water resources in east and southern Africa
Date of publication
2020 May
Publication type
Document
Publication details
Publication status
Published
Language
Keywords
water; extractives, projections; east and southern Africa
Abstract
This brief is produced as part of the scoping work in EQUINET on the distributional consequences for current and future wellbeing of projected trends in selected extractives. This paper focuses on water as a resource and presents: The current situation and projected trends related to water in east and southern Africa (ESA); the implications for the health of current and future generations of these trends and the policy choices and alternatives to respond to these trends and the factors that influence policy design and uptake of choices. Water resources are unevenly distributed in the region and maldistribution and water scarcity and stress are predicted to intensify in the region in coming decades. Inequality and stress is not inevitable, however. There is potentially adequate water to meet the basic needs of all in the region and for sustaining ecosystems if managed through co-operation, paying attention to equity, interdependence and long-term outcomes. It is already recognised that ‘business as usual’ will lead to potentially disastrous consequences and that policies and programmes need to balance environmental, social and economic objectives. The brief outlines some of these options.
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Briefs
Theme area
Equity in health, Values, policies and rights, Health equity in economic and trade policies, Governance and participation in health
Title of publication Trends in extraction of mineral resources in east and southern Africa
Date of publication
2020 May
Publication type
Document
Publication details
Publication status
Published
Language
Keywords
mining; extractives, projections; east and southern Africa
Abstract
This brief is produced as part of the scoping work in EQUINET on the distributional consequences for current and future wellbeing of projected trends in selected extractives. This paper focuses on trends in mining and health equity and presents: The current situation and projected trends related to extraction of mineral resources in east and southern Africa (ESA); the implications for the health of current and future generations of these trends and the policy choices and alternatives to respond to these trends and the factors that influence policy design and uptake of choices. The brief outlines how mineral extraction in ESA will undergo several changes in the coming decades, with potential implications for health, wellbeing and environmental degradation. Accruing greater and wider health and developmental benefits from any current and future mineral extraction raises several options outlined in the brief, in line with the demands of resurgent resource nationalism.
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Briefs
Theme area
Equity in health, Values, policies and rights, Health equity in economic and trade policies, Governance and participation in health
Title of publication Trends in climate, extractives and health equity in the east and southern Africa
Date of publication
2020 May
Publication type
Document
Publication details
Publication status
Published
Language
Keywords
Climate, extractives, projections; east and southern Africa
Abstract
This brief is produced as part of the scoping work in EQUINET on the distributional consequences for current and future wellbeing of projected trends in selected extractives. This paper focuses on climate change and its relations to extractives and health equity and presents: The current situation and projected trends related to climate change in east and southern Africa (ESA); the implications for the health of current and future generations of these trends and the policy choices and alternatives to respond to these trends and the factors that influence policy design and uptake of choices. ESA contributes the least of any world region to global greenhouse gas emissions yet will be more vulnerable to the impacts of climate change than any other region. The global focus on mitigation does not adequately address the policy concerns or resources for adaptation, which is the priority articulated in the region.
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Briefs
Theme area
Equity in health, Values, policies and rights, Health equity in economic and trade policies, Equitable health services, Resource allocation and health financing, Governance and participation in health
Title of publication EQUINET Information sheet 4 on COVID-19
Date of publication
2020 May
Publication type
Document
Publication details
EQUINET Information sheet 4 on COVID-19
Publication status
Published
Language
Keywords
COVID, epidemic, east and southern Africa, information, economy, equity
Abstract
This is the fourth information sheet on COVID-19 from EQUINET. It summarises information from and provides links to official, scientific and other resources as of end April 2020 on
1: Developments in the COVID-19 epidemic
2: Rolling back lockdowns- when and what next?
3: What COVID-19 has meant for the risks and returns from migration
4: An update on access to medicines and vaccines, and
5: Resources, COVID-19 and the creative economy
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Discussion brief
Theme area
Equity in health, Values, policies and rights, Health equity in economic and trade policies, Equitable health services, Public-private mix, Resource allocation and health financing, Governance and participation in health, Monitoring equity and research to policy
Title of publication EQUINET Information sheet 3 on COVID-19
Date of publication
2020 April
Publication type
Document
Publication details
EQUINET Information sheet 3 on COVID-19
Publication status
Published
Language
Keywords
COVID, epidemic, east and southern Africa, information, economy, equity
Abstract
This is the third information brief from EQUINET to summarise and provides links to official, scientific and other resources as of April 14 2020 to support an understanding of and individual to regional level responses to COVID-19. This brief complements and does not substitute information from your public health authorities. This brief covers: developments in the COVID-19 epidemic; a discussion on population evidence and models; initiatives on health technologies; an update on the African engagement on releasing resources from debt and various resources.
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Discussion brief
Theme area
Values, policies and rights, Health equity in economic and trade policies, Poverty and health, Equitable health services, Public-private mix, Monitoring equity and research to policy
Title of publication EQUINET Diss paper 121: Public health and mining in East and Southern Africa: A desk review of the evidence
Date of publication
2020 April
Publication type
Report
Publication details
Public health and mining in East and Southern Africa: A desk review of the evidence, EQUINET Discussion paper 121, EQUINET, Harare
Publication status
Published
Language
Keywords
mining, extractive, health, east and southern Africa
Abstract
This desk review was commissioned by the Regional Network for Equity in Health in East and Southern Africa (EQUINET) through Training and Research Support Centre, as part of the ongoing work in EQUINET on the extractive sector in the region. It aims to inform public sector professionals, policy-makers, civil society and parliamentarians on the population health impacts of large- and small-scale mining activities in East and Southern Africa. It presents evidence of the documented health outcomes of mining in ESA countries and gaps between what is known of health risks of mining and these documented outcomes. The paper specifies the known health risks for each type of mining in the ESA region. These risks, injuries and deaths have been reported in both small- and large-scale mines, with gender, income and race disparities in health impacts direct and indirect. Poor communities are likely to be more affected as they have limited choices for employment, sub-optimal housing and limited access to safe drinking water. People living close to mining sites or near mine dumps and those whose livelihoods are tied to rivers for domestic and agriculture water are exposed to polluted environments due to mining wastes and contaminated air and drinking water. Discrepancies exist between what is documented and known about the health risks of mining globally and documented levels of these health outcomes in the ESA region. There are various reasons for this. Health impacts assessments are not always done before mines are licensed. After mines are licensed, these health outcomes may be poorly monitored. Information on the numbers and health status many living and working in mining and of ex-miners remains limited.
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Discussion paper
Theme area
Equity in health, Values, policies and rights, Health equity in economic and trade policies, Poverty and health, Equitable health services, Resource allocation and health financing, Governance and participation in health, Monitoring equity and research to policy
Title of publication EQUINET Information sheet 2 on COVID-19
Date of publication
2020 April
Publication type
Document
Publication details
EQUINET Information sheet 2 on COVID-19
Publication status
Published
Language
Keywords
COVID, epidemic, east and southern Africa, information, economy, equity
Abstract
This is the second information brief from EQUINET to summarise and provides links to official, scientific and other resources as of April 1st 2020 to support an understanding of and individual to regional level responses to COVID-19. This brief complements and does not substitute information from your public health authorities. This brief covers:
1: Developments in the COVID-19 epidemic
2: The health system response
3: Policy, politics and rights
4: Support for and in different communities
5: The macro-economic challenges
6: What does this all mean for equity?
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Discussion brief
Theme area
Values, policies and rights, Health equity in economic and trade policies, Equitable health services, Human resources for health, Public-private mix, Resource allocation and health financing, Governance and participation in health, Monitoring equity and research to policy
Title of publication EQUINET Information sheet on COVID-19
Date of publication
2020 March
Publication type
Document
Publication details
EQUINET Information sheet on COVID-19
Publication status
Published
Language
Keywords
COVID; epidemic; health service; economy; public health
Abstract
The many reports and email messages on the Coronavirus pandemic can be somewhat overwhelming for people who are also trying to respond to the epidemic at different levels. Yet information is a key tool in managing the epidemic and its consequences from individual to international level. This information sheet aims to assist by bringing together information and links to resources from various sources on a range of issues related to COVID-19 covering:
1: Basic information on the virus and its health impact
2: The level and growth of the pandemic
3: What individuals and communities can do to prevent and respond to COVID-19
4: What workplaces and organisations can do to prevent and respond to COVID-19
5: Protection and support of health and other frontline workers
6: What countries are doing to prevent and respond to COVID-19
You can read the full information sheet, or go to the section that is most relevant to you. While the specific focus intends to be on east and southern Africa, this first information sheet provides information drawn from other regions and more mature epidemics that may be useful for those in the ESA region or that may raise issues to discuss and plan for in the region. The information is generally sourced from World Health Organisation (WHO), various official, public health and technical/ scientific sources. The source of information is cited/hperlinked. The WHO page on COVID-19 is at https://www.who.int/emergencies/diseases/novel-coronavirus-2019. This brief complements and does not substitute information from your public health authorities. Some of the information is technical but we have tried to make it accessible. This newsletter is produced under the principles of 'fair use', attributing sources by providing direct links to authors and websites, whose views do not necessarily represent those of EQUINET.
Country
International
Publisher
Equinet Publication Type
Discussion brief
Theme area
Health equity in economic and trade policies, Governance and participation in health
Title of publication Regional Meeting of the Extractives and Health Group, Meeting report, 1-2 February 2020, Cape Town, South Africa
Date of publication
2020 February
Publication type
Report
Publication details
Publication status
Published
Language
Keywords
mining; extractives; health; east and southern Africa
Abstract
EQUINET, SATUCC, SADC CNGO and Benchmarks Foundation have co-operated on regional engagement on extractives and health at the Alternative Mining Indaba, and with the Southern African ex mineworkers Association met in a regional meeting on health literacy in the mining sector in March 2019 to form a mining and health group to strengthen alliances and co-operation in the grassroots to regional and global engagement on the issue. The March 2019 meeting agreed to hold a follow up meeting at the time of the Alternative Mining Indaba (AMI) in February 2020 to follow up on the agreed actions, exchange information and widen the alliances and health literacy activities and processes in the region. The meeting was organised by TARSC / EQUINET and held in co-operation with SATUCC, SAMA and Benchmarks. It was held in Cape Town in the two days before the AMI to enable delegates to also engage in the AMI. It was supported by Medico International and OSF and by TARSC and all the organisations involved who also contributed own resources to their participation. The meeting aimed to i. Share information on mining and health in the region in terms of the risks, responses, rights and actions ii. Review activities on health literacy in mining and use of the EQUINET health literacy module on Mining and health iii. Review the work of the mining and health working group and its members in various platforms and proposed work on extractives and health equity in the region and identify priorities, alliances, actions and roles for follow up and iv. Identify issues to take forward in the AMI and other regional platforms. This report presents the information shared and discussions at the meeting and the plans for follow up work.
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Reports
Theme area
Equity in health, Monitoring equity and research to policy
Title of publication Research that supports health equity: Reflections and learning from EQUINET
Date of publication
2019 November
Publication type
Report
Publication details
EQUINET, Discussion paper 120, EQUINET Harare
Publication status
Not published
Language
Keywords
equity; research; EQUINET
Abstract
This paper reflects on experience from over two decades of EQUINET research practice to promote health equity in east and southern Africa. The paper was written by members of the EQUINET steering committee and the newsletter team. It draws examples and research features from EQUINET publications available online, a search of publications in the 221 issues of the EQUINET newsletter, and papers, reports, blogs, articles and editorials obtained from key word searches in Google. Despite policy commitments and gains in selected aspects of health, conditions in the region are increasingly driven by a global economy and a regional response that is generating instability, environmental and social costs; intense extraction of natural resources; rising levels of precarious labour, social deficits and weakened public institutions, disrupting social cohesion, solidarity and collective agency. These conditions call for certain features and forms of research.
The paper describes diverse research on the costs to health equity of social deficits, inequitable resource outflows and the commodification of public services, as well as research on alternatives and policies on food security, health services, environment and rights that confront these trends. The paper describes specific features of research that respond more directly to the understanding that power relations are central to inequities in health. These research processes explain and show alternatives to disempowering narratives of the inevitability of the status quo and generate knowledge in ways that intend to empower those affected. They pay attention to who defines the research questions, who designs, implements and uses the research. This implies designs and methods that involve people in affirming and validating their realities, generating reflection on causes and building analysis, self-confidence and organisation to act and to learn from action. It presents specific examples of research approaches and the role of a consortium network in advancing them, while noting the ways in which many researchers face the double task of investigating inequities, while also challenging inequity in a global research system.
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Discussion paper
Theme area
Resource allocation and health financing
Title of publication Ensuring that target-driven funding supports and does not harm comprehensive primary health care in east and southern Africa: Brief for international level
Date of publication
2019 November
Publication type
Document
Publication details
Publication status
Published
Language
Keywords
Primary health care; performance based financing; participatory action research; east and southern Africa
Abstract
Primary Health Care (PHC) has inspired and galvanized action on health. PHC affirms that health is a state of complete physical, mental and social wellbeing and not merely the absence of disease and that health is a fundamental human right. In the past decade, global institutions have promoted and channeled external funds through performance based financing (PBF), as a strategy to improve service delivery and access. While there have been studies on whether these particular services targeted under PBF have improved, there has been little systematic evaluation of its system-wide effects, nor of its impacts on comprehensive PHC. In EQUINET, we thus saw it to be important to ask: How is the use of targets in PBF affecting health workers’ professional roles, work and interaction with communities and their ability to deliver comprehensive PHC? In 2018-2019 the PAR involved 21 online participants from seven sites in five ESA countries, including health workers from primary health cent res, community members in HCCs and country site facilitators from seven national health civil society organisations in the region, referred to in this brief collectively as the ‘online participants’. We also included offline local discussions with an average of 19 community members and 15 health workers per site. Four major areas of action and ten proposals were made within them for PBF to enable and not detract from PHC. This brief presents the general findings and proposals and in addition those specifically for international agencies.
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Policy brief
Theme area
Resource allocation and health financing
Title of publication Ensuring that target-driven funding supports and does not harm comprehensive primary health care in east and southern Africa: Brief for regional level
Date of publication
2019 November
Publication type
Document
Publication details
Publication status
Language
Keywords
Primary health care; performance based financing; participatory action research; east and southern Africa
Abstract
Primary Health Care (PHC) has inspired and galvanized action on health. PHC affirms that health is a state of complete physical, mental and social wellbeing and not merely the absence of disease and that health is a fundamental human right. In the past decade, global institutions have promoted and channeled external funds through performance based financing (PBF), as a strategy to improve service delivery and access. While there have been studies on whether these particular services targeted under PBF have improved, there has been little systematic evaluation of its system-wide effects, nor of its impacts on comprehensive PHC. In EQUINET, we thus saw it to be important to ask: How is the use of targets in PBF affecting health workers’ professional roles, work and interaction with communities and their ability to deliver comprehensive PHC? In 2018-2019 the PAR involved 21 online participants from seven sites in five ESA countries, including health workers from primary health cent res, community members in HCCs and country site facilitators from seven national health civil society organisations in the region, referred to in this brief collectively as the ‘online participants’. We also included offline local discussions with an average of 19 community members and 15 health workers per site. Four major areas of action and ten proposals were made within them for PBF to enable and not detract from PHC. This brief presents the general findings and proposals and in addition those specifically for regional level organisations.
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Policy brief
Theme area
Resource allocation and health financing
Title of publication Ensuring that target-driven funding supports and does not harm comprehensive primary health care in east and southern Africa: Brief for district and national level
Date of publication
2019 November
Publication type
Document
Publication details
Publication status
Published
Language
Keywords
Primary health care; performance based financing; participatory action research; east and southern Africa
Abstract
Primary Health Care (PHC) has inspired and galvanized action on health. PHC affirms that health is a state of complete physical, mental and social wellbeing and not merely the absence of disease and that health is a fundamental human right. In the past decade, global institutions have promoted and channeled external funds through performance based financing (PBF), as a strategy to improve service delivery and access. While there have been studies on whether these particular services targeted under PBF have improved, there has been little systematic evaluation of its system-wide effects, nor of its impacts on comprehensive PHC. In EQUINET, we thus saw it to be important to ask: How is the use of targets in PBF affecting health workers’ professional roles, work and interaction with communities and their ability to deliver comprehensive PHC? In 2018-2019 the PAR involved 21 online participants from seven sites in five ESA countries, including health workers from primary health cent res, community members in HCCs and country site facilitators from seven national health civil society organisations in the region, referred to in this brief collectively as the ‘online participants’. We also included offline local discussions with an average of 19 community members and 15 health workers per site. Four major areas of action and ten proposals were made within them for PBF to enable and not detract from PHC. This brief presents the general findings and proposals and in addition those specifically for district and national health authorities and funders.
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Policy brief
Theme area
Resource allocation and health financing
Title of publication Ensuring that target-driven funding supports and does not harm comprehensive primary health care in east and southern Africa: Brief for local level
Date of publication
2019 November
Publication type
Document
Publication details
Publication status
Published
Language
Keywords
Primary health care; performance based financing; participatory action research; east and southern Africa
Abstract
Primary Health Care (PHC) has inspired and galvanized action on health. PHC affirms that health is a state of complete physical, mental and social wellbeing and not merely the absence of disease and that health is a fundamental human right. In the past decade, global institutions have promoted and channeled external funds through performance based financing (PBF), as a strategy to improve service delivery and access. While there have been studies on whether these particular services targeted under PBF have improved, there has been little systematic evaluation of its system-wide effects, nor of its impacts on comprehensive PHC. In EQUINET, we thus saw it to be important to ask: How is the use of targets in PBF affecting health workers’ professional roles, work and interaction with communities and their ability to deliver comprehensive PHC? In 2018-2019 the PAR involved 21 online participants from seven sites in five ESA countries, including health workers from primary health cent res, community members in HCCs and country site facilitators from seven national health civil society organisations in the region, referred to in this brief collectively as the ‘online participants’. We also included offline local discussions with an average of 19 community members and 15 health workers per site. Four major areas of action and ten proposals were made within them for PBF to enable and not detract from PHC. This brief presents the general findings and proposals and in addition those specifically for local health workers, health centre committees and facility managers.
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Policy brief
Theme area
PAR work, Values, policies and rights, Equitable health services, Resource allocation and health financing, Governance and participation in health
Title of publication How does target-driven funding affect comprehensive primary health care in east and southern Africa?
Date of publication
2019 September
Publication type
Report
Publication details
Loewenson R et al., How does target-driven funding affect comprehensive primary health care in east and southern Africa? EQUINET, Harare
Publication status
Published
Language
Keywords
performance based financing; health financing; primary health care; participatory action research; east and southern Africa
Abstract
Participatory action research (PAR) seeks to understand and improve the world by changing it, where those affected collectively validate experience and analysis, act and learn from action to produce new knowledge. While transformative, it is often local in nature. With African health systems influenced by global policies and funds, EQUINET sought to use the internet to implement PAR in multiple countries in east and southern Africa (ESA), as PARonline. Performance based financing (PBF) is one such global process. It is the transfer of money or material goods conditional upon taking a measurable action or achieving a predetermined performance target. There has been little systematic evaluation of the system-wide effects of PBF, nor of its impacts on comprehensive primary health care (PHC). Given the longstanding policy commitment to PHC in the region, this PARonline research thus asked: How is the use of health targets in PBF affecting health workers professional roles, work and interaction with communities and their ability to deliver comprehensive PHC? The research involved 21 online participants from seven sites in five ESA countries, including health workers from primary health centres, community members in health centre committees and country site facilitators from national health civil society. It also included offline local discussions with an average of 19 community members and 15 health workers per site. This report presents the experience and views of these primary care health workers, community members and local organisations on the implementation of PBF and its effects on PHC and the proposals for how to respond to both the positive and negative features found. There were positive features, such as in the increased funding and income for primary care services and health workers, and the investment in training and in strengthened service monitoring. There was some variation across countries that provide useful ideas for exchange, such as on the funding of community workers or flexibility for local use of funds. In general, however, the current application of PBF was found to fall short on delivering features of comprehensive PHC. While aiming to strengthen bottom-up accountability in services, neither health workers nor community members felt empowered by PBF, feeling their views and evidence to be disregarded and seeing themselves as implementers of targets defined at higher levels. We observed real trade-offs between PBF and the way comprehensive PHC is funded and delivered. Being selective can be efficient, but can also leave gaps in the system. The online participants viewed that unless the wider collective inputs for facilities and promotion and prevention in the community are funded, population health will not improve. This is noted to call for improved domestic funding to meet gaps in PHC. It also implies that PBF, as a significant funding stream, integrate resources and measures for these system inputs and for more holistic health services.
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Discussion paper, Reports
Theme area
Resource allocation and health financing
Title of publication EQUINET Discussion paper 119: Critical assessment of different health financing options in east and southern African countries
Date of publication
2019 June
Publication type
Report
Publication details
Critical assessment of different health financing options in east and southern African countries’. EQUINET Discussion paper 119. EQUINET: Harare.
Publication status
Published
Language
Keywords
health financing; domestic financing; UHC; east and southern Africa
Abstract
EQUINET commissioned this desk review paper. It aims to contribute to a regional understanding of the positive and negative implications of the different domestic health financing options being explored, advocated and implemented in the East and Southern African (ESA) region. It presents issues to be addressed in the implementation of these financing options from the perspective of equitable progression towards universal health coverage (UHC), to inform policy dialogue and decisions on domestic health financing in ESA countries. The paper considers only one aspect of health financing reform, namely, revenue collection. It distinguishes between policy instruments, i.e., the sources of finance, and policy strategies, i.e., how these instruments are deployed to achieve various objectives or to address contextual features. Non-contributory sources (essentially tax-financed) and contributory (employment-based) options are explored. The paper presents: a. A typology of domestic revenue instruments and strategies; b. Domestic financing trends and options in place, or under consideration, in ESA countries; c. A review of low- and middle-income country experiences of domestic financing options; and d. Conclusions on the findings and lessons for ESA countries.
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Discussion paper
Theme area
Resource allocation and health financing
Title of publication Policy brief 45: Features of domestic revenue sources for universal health systems: a contribution to policy dialogue
Date of publication
2019
Publication type
Document
Publication details
Features of domestic revenue sources for universal health systems: a contribution to policy dialogue, Policy brief 45, University of the Witwatersrand and Training and Research Support Centre, EQUINET, Harare
Publication status
Published
Language
Keywords
health financing, domestic financing, policy, east and southern Africa, UHC
Abstract
This brief aims to present the positive and negative implications of the different domestic revenue sources being explored, advocated and implemented in the East and Southern African (ESA) region. It presents issues to be considered in choosing between, and implementing, the different non-contributory and contributory options for revenue collection, given the policy commitments in the region to equity and universal health coverage (UHC). The brief draws information from experiences of other low and middle income countries globally, including on the fiscal, revenue, progressiveness and acceptability implications of different options. The brief highlights that revenue collection measures need to be accompanied by measures to strengthen strategic purchasing and access to equitable, effective, quality care.
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Policy brief
Theme area
Values, policies and rights
Title of publication EQUINET Discussion paper 118: Comparative review: Implementation of constitutional provisions on the right to healthcare in Kenya and Uganda
Date of publication
2019 March
Publication type
Report
Publication details
Comparative review: Implementation of constitutional provisions on the right to healthcare in Kenya and Uganda’, EQUINET Discussion paper 118, CEHURD, EQUINET: Uganda and Harare.
Publication status
Published
Language
Keywords
constitution; health rights; Kenya; Uganda
Abstract
This discussion paper is produced by the Centre for Human Rights and Development (CEHURD) as part of the theme work on health rights and law of the Regional Network for Equity in Health in East and Southern Africa (EQUINET). The paper examines the implementation of constitutional provisions on the right to healthcare in Kenya and Uganda, two countries in East Africa. It aims to identify factors and mechanisms that have facilitated implementation of constitutional provisions on the right to healthcare, including how the constitutions were developed and framed. It compares implementation in Kenya, where the right to healthcare is explicit in their 2010 Constitution, and in Uganda, where the right to healthcare is implicit in the National Objectives and Directive Principles of State Policy. The paper draws on two EQUINET case studies on implementation of constitutional provisions on the right to health, one each in Kenya and Uganda, published in 2018, a 2017 regional workshop that discussed the implementation of constitutional provisions on the right to health, and additional review of published literature. It presents a thematic analysis of the findings from the two case studies in terms of the judicial, political and popular implementation mechanisms, exploring further the factors and mechanisms that have facilitated or blocked their implementation. As the two constitutions address the right to healthcare differently, this analysis of their application provides insights into the factors and mechanisms for practice that may be useful in other settings.
Country
Uganda
Publisher
Equinet Publication Type
Discussion paper
Theme area
Equity in health, PAR work, Health equity in economic and trade policies, Poverty and health, Governance and participation in health, Monitoring equity and research to policy
Title of publication Responding to inequalities in health in urban areas in east and southern Africa: Brief 5: What does the evidence indicate for advancing urban health and wellbeing?
Date of publication
2018 December
Publication type
Document
Publication details
Brief 5: What does the evidence indicate for advancing urban health and wellbeing? December 2018, TARSC, EQUINET, Harare
Publication status
Published
Language
Keywords
urban health, east and southern Africa
Abstract
Training and Research Support Centre (TARSC) as cluster lead of the “Equity Watch” work in EQUINET implemented a multimethods approach to gather and analyse diverse forms of evidence and experience on inequalities in health and its determinants within urban areas. We explored current and possible responses to these urban conditions, from the health sector and the health promoting interventions of other sectors and of communities. We aimed to build a holistic under standing of the social distribution of health in urban areas and the distribution of opportunities for and practices promoting health and wellbeing from different perspectives and disciplines. We worked with Harare and Lusaka youth, the Civic Forum on Human Development and Lusaka District Health Office for the participatory validation This brief, the fifth in the series on urban health, reports on the combined findings and their implications for improving equity in urban health and wellbeing.
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Discussion brief
Theme area
Equity in health, PAR work, Health equity in economic and trade policies, Poverty and health, Public-private mix, Governance and participation in health, Monitoring equity and research to policy
Title of publication EQUINET Diss 117: Pathways to urban health equity: Report of multi-method research in east and southern Africa
Date of publication
2018 December
Publication type
Document
Publication details
EQUINET Discussion paper 117, TARSC, Working with Harare and Lusaka youth, Civic Forum on Human Development and Lusaka District Health Office, EQUINET, Harare
Publication status
Published
Language
Keywords
urban, health, wellbeing, indicators, participation, east and southern Africa
Abstract
By 2050, urban populations in Africa will increase to 62%. The World Health Organization (WHO) and UN-Habitat in their 2010 report ‘Hidden Cities’ note that this growth in the urban population constitutes one of the most important global health issues of the 21st century. In 2016-2018, Training and Research Support Centre (TARSC) in the Regional Network for Equity in Health in East and Southern Africa (EQUINET) explored the social distribution of health in urban areas and the opportunities for and practices promoting urban health and well-being. It focused on youth 15-24 years of age as an important group for both current and future well-being. The paper synthesises and reports evidence from a programme of work that unfolded iteratively over two years. The work involved desk reviews of published literature and analysis of data from international databases for east and southern African countries, and international evidence on practices supporting urban well-being in areas prioritised by urban youth. The findings were subject to cycles of participatory review and validation by young people from diverse urban settings and socio-economic groups in Harare and Lusaka. These methods were applied with an intention to draw on different disciplines, concepts and variables from different sectors and on the lived experience and perceptions of the youth directly affected by different urban conditions. Separate publications produced in the project give more detail on particular methods, and findings and are cited in this paper. A series of dissemination and dialogue activities have been carried out with youth, local authority and policy actors, supported by shorter briefs and technical reports.
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Discussion paper
Theme area
Values, policies and rights
Title of publication Mapping the constitutional provisions on the right to health and the mechanisms for implementation in Kenya. A case study report,
Date of publication
2018
Publication type
Report
Publication details
Mapping the constitutional provisions on the right to health and the mechanisms for implementation in Kenya. A case study report, KELIN, EQUINET, Kenya.
Publication status
Published
Language
Keywords
health rights; Kenya; constitution; law
Abstract
This case study is produced by the Kenya Legal and Ethical Issues Network on HIV and AIDS (KELIN), working with Charles Dulo as a contributor, in the theme work on health rights and law of the Regional Network for Equity in Health in East and Southern Africa (EQUINET). This Paper’s objective is to answer the question, “What difference have constitutional rights to health made in practice and what have been the issues affecting the capacity to claim and deliver on the rights in Kenya?” It is a follow up on the results of work on the right to health that highlighted a need to do further studies in countries that do not have expressed provision on the rights to health. It is a desk review of literature that explores the historical background on the right to health before the current constitution that was promulgated in 2010. This is followed by a review of the legislative framework after 2010 and jurisprudence on the right health, and concludes by highlighting key challenges in the realization of the right to health in Kenya.
Country
Kenya
Publisher
EQUINET
Equinet Publication Type
Reports
Theme area
Health equity in economic and trade policies, Equitable health services, Governance and participation in health
Title of publication Participatory meetings in Harare on health and wellbeing of urban youth, 2016-7
Date of publication
2018
Publication type
Report
Publication details
Participatory meetings in Harare on health and wellbeing of urban youth, 2016-7, EQUINET, Harare
Publication status
Published
Language
Keywords
urban health; youth; Harare; wellbeing; social determinants
Abstract
TARSC as cluster lead of the “Equity Watch” work in EQUINET has been exploring these questions in east and southern African (ESA) countries, gathering diverse forms of evidence from literature review, analysis of quantitative data, internet searches on practices and a participatory validation amongst different social groups of youth in Harare and Lusaka. In Harare, TARSC worked with Civic Forum on Human Development (CFHD) and youth living in low density, medium income suburbs; in formal employment; in tertiary education; unemployed youth; youth in informal employment and in informal settlements. Briefs and reports capturing some of this work are available on the EQUINET website.This report compiles in one document the several rounds of participatory review and validation carried out in Harare with young people from low density, medium income suburbs; youth in formal employment; youth in tertiary education; unemployed youth; youth in informal employment and youth in informal settlements on their perceptions of health and wellbeing, the drivers of wellbeing in their areas, the approaches and practices that are and could be implemented to improve their wellbeing and the implications for urban services, including for health systems.
Country
Zimbabwe
Publisher
Equinet Publication Type
Reports
Theme area
Values, policies and rights, Health equity in economic and trade policies, Equitable health services, Human resources for health
Title of publication EQUINET Discussion paper 116: The International Health Regulations and health systems strengthening in east and southern Africa: A desk review
Date of publication
2018
Publication type
Report
Publication details
The International Health Regulations and health systems strengthening in east and southern Africa: A desk review, EQUINET discussion paper 116, SEATINI, TARSC, EQUINET, Harare
Publication status
Published
Language
Keywords
International health regulations; health system strengthening; community health; food safety; pharmaceuticals; east and southern Africa
Abstract
This review paper examines the extent to which the core, public health capacities developed for the 2005 International Health Regulations (IHR). are also being applied in a manner that supports health systems strengthening (HSS). Produced under the Regional Network for Equity in Health in East and Southern Africa (EQUINET), the paper reviews evidence on the IHR 2005 design, capacities and implementation on HSS in east and southern African countries, particularly in relation to: a. Capacities of community health and primary-level health personnel and service capacities, including health
information systems to this level; b. Public health system capacities and functioning relevant to food safety; and c. Ensuring laboratory and pharmaceutical personnel capacities. The paper explores the synergies and opportunities being generated, or not, between investments in IHR implementations and these three areas of HSS in the 16 ESA countries covered by EQUINET. It identifies key weaknesses and challenges and highlights case studies of good practice within the region.
Country
East and southern Africa region
Publisher
URL:
Equinet Publication Type
Discussion paper
Theme area
Values, policies and rights, Health equity in economic and trade policies, Public-private mix, Governance and participation in health
Title of publication Mining and health: A Health Literacy Module
Date of publication
2018 October
Publication type
Document
Publication details
Mining and health: A Health Literacy Module, Training and Research Support Centre (TARSC) and EQUINET, Harare
Publication status
Published
Language
Keywords
mining; health literacy; extractive industries; east and southern africa
Abstract
This module aims to provide information and to support discussion in health literacy programmes on the duties of the mining sector in east and southern African countries in health and to protect the right to health. The module discusses the ways mining affects health in those working on the mines, ex-mineworkers and those in the surrounding and wider community; explains the policies, laws and programmes that should protect health and address the health effects of mining; discusses some of the shortfalls in current law and practice and what you can do about them and provides links to institutions and resources for further information. The module includes
• Text with information for unions and civil society
• Participatory activities to draw local experience and evidence and to encourage reflection on the findings
• Case studies from the region
• Discussion questions for participants.
• References and resources
• Appendices with more detailed information on selected areas
It aims to be used by facilitators from trade unions and civil society in the region within their health literacy / health education/ union education activities. The target groups are workers and communities living in and around the mines.
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Toolkits and training materials
Theme area
Values, policies and rights
Title of publication EQUINET Case study: Review of Constitutional Provisions on the Right to Health in Uganda
Date of publication
2018
Publication type
Document
Publication details
Review of Constitutional Provisions on the Right to Health in Uganda A case study report, CEHURD, EQUINET, Uganda
Publication status
Published
Language
Keywords
constitution; health rights; Uganda
Abstract
This case study is produced by the Centre for Human Rights and Development (CEHURD) in the theme work on health rights and law of the Regional Network for Equity in Health
in East and Southern Africa (EQUINET). It examines how the right to health is enforced in Uganda, how it was implemented, and how health rights advocates have suggested the provision be constitutionally interpreted. It is a follow up on the results of work on the right to health that highlighted a need to do further studies in countries that do not have expressed provision on the rights to health. While the right to health is yet to be explicitly incorporated in the Ugandan constitution, the case study points to a number of ways to implement it within judicial, political and popular measures. Several issues merit future attention to support this, including: developing increased measures and capacities for accountability; integrating a rights based approach in a multi-sectoral response; ensuring adequate resources to the health system; strengthening judicial understanding and implementation of health rights; and strengthening issue based civil society groups and processes that are focused on advancing the right to health with the intention to realize positive public and policy outcomes.
Country
Uganda
Publisher
Equinet Publication Type
Reports
Theme area
Human resources for health
Title of publication EQUINET Discussion paper 115: Literature review: Strategies for recruitment and retention of skilled healthcare workers in remote rural areas
Date of publication
2018 September
Publication type
Publication details
EQUINET discussion paper 115, EQUINET (Harare) and University of Limpopo (South Africa), 2018
Publication status
Language
Keywords
health workers; rural; retention; east and southern Africa; desk review
Abstract
This literature review, implemented within an EQUINET programme of theme work on health workers at the University of Limpopo, presents published evidence on the recruitment and retention of skilled healthcare workers in rural areas of east and southern Africa. It reviewed published documents in English with a focus on east and southern Africa from 2000-2017. From the literature reviewed the following strategies emerged as key for health worker retention: Education and training of healthcare workers; review of regulations and policies regarding provision of healthcare services in rural areas; provision of financial incentives; and personnel and professional support of healthcare workers. The report identified strategies relating to: Reviewing admission policies and criteria for health worker education; including rural practice issues and skills in health worker training and exposing students to rural areas during training; improving access to continuing professional development (CPD) in rural areas; ensuring that compulsory measures are accompanied by relevant support and incentives; ensuring that mitigatory strategies such as task shifting are not ‘task dumping’, do not replace more substantive solutions and that they are accompanied by suitable regulatory systems, training and management support; using financial and non-financial incentives to address issues prioritised by health workers, in a way that does not motivate some while demotivating others, and not as a substitute for a more substantive review of working conditions of healthcare workers and strategies to reduce the disparities in salaries between different health professionals; and improving health worker management and support, and the skills of HRH managers.
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Discussion paper
Theme area
Equity in health, PAR work, Health equity in economic and trade policies, Poverty and health, Equitable health services, Governance and participation in health
Title of publication Participatory meeting in Lusaka on health and wellbeing of urban youth, 26-27 June 2018, Lusaka, Zambia
Date of publication
2018 July
Publication type
Report
Publication details
EQUINET (2018) Participatory meeting in Lusaka on health and wellbeing of urban youth, 26-27 June 2018, Lusaka, Zambia
Publication status
Published
Language
Keywords
urban health; youth; Lusaka; Zambia; participatory
Abstract
TARSC as cluster lead of the “Equity Watch” work in EQUINET has been exploring urban health in east and southern African (ESA) countries, gathering diverse forms of evidence from literature review, analysis of quantitative data, internet searches on practices and a participatory validation amongst different social groups of youth. Lusaka District Health Authority (LDHO) has a history of over a decade of using participatory reflection and action (PRA) approaches to strengthen health literacy, working with TARSC and other organisations in EQUINET. In 2018, TARSC and LDHO colleagues involved with the Zambian health literacy programme identified that it would be important to explore the views of youth in the city on their health and wellbeing to better integrate this group within the health literacy programme. Involving Lusaka youth in a similar process as in Harare of identifying their experiences, perceptions and proposals on health and wellbeing added further grounded evidence in the work in EQUINET. Further, the Harare youth were interested in sharing experience with youth in Lusaka. A two day participatory process was thus held with young people from various social settings in Lusaka on 26-27 June 2018 hosted by LDHO and TARSC, with the objectives to: a. Hear from different groups of Lusaka urban youth their perceptions and experiences on urban health and wellbeing. b. Facilitate exchanges between Lusaka and Harare youth on urban health and wellbeing, and identify their similar and different experiences and priorities. c. Identify what implications the information gathered have for urban health literacy and urban primary health care, and share this with relevant authorities involved in health and wellbeing of urban youth in Lusaka. This report presents the proceedings of the meeting.
Country
Zambia
Publisher
EQUINET
Equinet Publication Type
Reports
Theme area
Equity in health, Health equity in economic and trade policies, Poverty and health, Governance and participation in health, Monitoring equity and research to policy
Title of publication EQUINET Discussion paper 114: Responding to inequalities in health in urban areas: How well do current data measure urban wellbeing in East and Southern Africa?
Date of publication
2018 May
Publication type
Report
Publication details
‘Responding to inequalities in health in urban areas: How well do current data measure urban wellbeing in East and Southern Africa?’ EQUINET discussion paper 114, TARSC, EQUINET: Harare.
Publication status
Published
Language
Keywords
Urban, health, wellbeing, data, statistics; east and southern Africa
Abstract
By 2050, urban populations in Africa will increase to 62%. The World Health Organisation (WHO) and UN Habitat in their 2010 report ‘Hidden Cities’ note that this growth constitutes one of the most important global health issues of the 21st century. TARSC as cluster lead of the ‘Equity Watch’ work in EQUINET implemented a multi-methods approach to gather and analyse diverse forms of evidence and experience of inequalities in health and its determinants within urban areas, and on current and possible responses to these urban conditions, from the health sector and the health-promoting interventions of other sectors and communities. We aimed to build a holistic understanding of the social distribution of health in urban areas and the responses and actions that promote urban health equity. The different stages and forms of evidence are presented in a set of reports and briefs and a final synthesis document. This report presents the findings of the separate search on holistic paradigms relevant to urban wellbeing, and an analysis of statistical evidence on health and wellbeing in east and southern Africa (ESA) countries using indicators drawn from these approaches. The findings indicated that ESA countries face a challenge if they seek to track progress in the multiple dimensions of wellbeing or to build an understanding from the quantitative data gathered. First, there are no data measured across the 16 ESA countries for many dimensions of a more holistic approach to wellbeing. Second, in ESA countries, the indicators that are measured are more commonly those of negative rather than positive wellbeing outcomes. This turns the focus away from the assets in society. It points out where the problems are, but not the progress in achievement of positive or affirmative goals. Third, where data do exist, they are poorly disaggregated to show urban areas separately or to show intro-urban inequalities or levels in specific social groups. Finally and importantly, the subjective views of people on their life satisfaction do not always match measured data, and needs to be elicited and taken into account more directly in planning for urban wellbeing, including for interpreting, validating, adding to or even challenging quantitative data.
Country
East and southern Africa region
Publisher
Equinet Publication Type
Discussion paper, Equity indicators
Theme area
Values, policies and rights
Title of publication Advancing the right to health in east and southern Africa Regional workshop report, Garuga Country Lake Resort, Entebbe, 30 August 2017
Date of publication
2017 August
Publication type
Report
Publication details
Publication status
Published
Language
Keywords
health rights, east Africa, advocacy; OPERA
Abstract
In 2015-2018, CEHURD, under the Regional Network for Equity in Health in East and Southern Africa (EQUINET) conducted a desk review of the implementation of constitutional provisions on the right to health in east and southern Africa. The objective of the workshop was to introduce the OPERA framework in the region, using evidence from Uganda. It aimed to 1. identify the main bottlenecks in implementing the right to health; 2. devise a common advocacy strategy that aims at removing the bottlenecks;. and 3 explore opportunities for applying this within the region. The workshop built on the previous validation of the Ugandan draft report on constitutional implementation of the right to health.
Country
Uganda
Publisher
Equinet Publication Type
Reports
Theme area
Equity in health, Values, policies and rights, Equitable health services
Title of publication EQUINET Policy brief 43: The role of an essential health benefit in health systems in east and southern Africa
Date of publication
2018 May
Publication type
Document
Publication details
with MoH, Uganda, President’s Office- Regional Admin and Local Govt and MoH Community Development Gender Elderly and Children, Tanzania, MoH, Tamunda Ass, Zambia, MoH, Swaziland
Publication status
Published
Language
Keywords
essential health benefit, east and southern Africa, universal health;
Abstract
This brief presents evidence, learning and recommendations from a regional programme of work in 2015-2017 on the role of essential health benefits (EHBs) in resourcing, organising and in accountability on integrated, equitable universal health systems. It outlines from the regional literature reviews and the case studies implemented in Swaziland, Tanzania, Uganda and Zambia the context and policy motivations for developing EHBs; and how they are being defined, costed, disseminated and used in health systems. EHBs can act as a key entry point and operational strategy for realizing universal health systems, for making clear the deficits to be met and to make the case for improved funding of health systems. The brief points to areas
where regional co-operation could support national processes and engage globally on the role of EHBs in building universal, equitable and integrated health systems.
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Briefs
Theme area
Equity in health, Health equity in economic and trade policies, Governance and participation in health
Title of publication Responding to inequalities in health in urban areas in east and southern Africa: Brief 4: What did we learn from experiences and innovations in other countries to improve youth health and wellbeing? May 2018, TARSC, EQUINET,
Date of publication
2018 May
Publication type
Document
Publication details
Publication status
Published
Language
Keywords
urban health, primary health care, youth, innovation, east and southern Africa, education, employment, shelter, information, wellbeing; governance
Abstract
Cities concentrate opportunities, jobs and services, but they also concentrate risks and hazards for health (WHO and UN Habitat 2010). How fairly are these risks and opportunities distributed across different population groups but also across generations? How well are African cities promoting current and future wellbeing? How far are health systems responding to and planning for these changes? TARSC as cluster lead of the “Equity Watch” work in EQUINET explored these questions in 2016-7, for east and southern African (ESA) countries. This brief covers the main features of practices found to be important for urban youth wellbeing from the literature, data and participatory validation reported in Briefs 1-3. In particular it explores practices relating to education, and ensuring access and responsiveness of the curriculum to youth needs; job creation and the measures to support job creation for youth; enterprise creation, and support of how health promoting activities support youth entrepreneurship; the creative and green economy, how it is being developed and organised to support youth employment and wellbeing; shelter/social conditions, including youth access to shelter and non-violent enabling community environments; information and communication, how youth are influencing debates, norms and practices and using social media to promote wellbeing, gender equality and solidarity and participatory government. The brief discusses what these findings suggest for urban primary health care systems to promote health and address the health and wellbeing of urban youth.
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Briefs
Theme area
Equity in health, PAR work, Values, policies and rights, Governance and participation in health
Title of publication Responding to inequalities in health in urban areas in east and southern Africa: Brief 3: What do Harare urban youth say? May 2018, TARSC, CFHD EQUINET, Harare
Date of publication
2018 May
Publication type
Document
Publication details
Publication status
Published
Language
Keywords
urban health; youth; participatory research; Harare
Abstract
By 2050, urban populations will increase to 62% in Africa. Cities concentrate opportunities, jobs and services, but they also concentrate risks and hazards for health. How fairly are these risks and opportunities distributed across different population groups but also across generations? How well are African cities promoting current and future wellbeing? How far are health systems responding to and planning for these changes? TARSC as cluster lead of the “Equity Watch” work in EQUINET explored these questions in 2016-7, for east and southern African (ESA) countries. We thus integrated many forms of evidence, including a review of literature, analysis of quantitative indicators, internet searches of evidence on practices, thematic content analysis and participatory validation by those more directly involved and affected. This brief covers the participatory validation by youth from six different suburbs in Harare facilitated by TARSC and the Civic Forum on Human Development (CFHD). The six groups of young people involved in the participatory validation came from youth living in northern higher income suburbs; youth in formal jobs (although noting that they may also be in insecure jobs); young people in tertiary education; young people in Epworth, as a suburb with informal settlements.; unemployed youth and youth in informal jobs. In this brief we summarise the findings of the participatory validation in the two meetings in 2016. We present how the views of the Harare youth related to the areas of health and wellbeing identified in the literature, and how far their experiences varied in the different groups. The findings indicate that there is diversity between young people in different parts of the city and different social contexts that affect which dimensions of wellbeing they perceive to be most important. It was evident, however, that the question preoccupying young people was not ‘how big is the gap between us?’ but ‘how, collectively do we close the gap’? The brief points to the policies for youth wellbeing in Harare that would be important to closing the gap.
Country
Zimbabwe
Publisher
EQUINET
Equinet Publication Type
Briefs
Theme area
Equity in health, Health equity in economic and trade policies, Poverty and health, Monitoring equity and research to policy
Title of publication Responding to inequalities in health in urban areas in east and southern Africa: Brief 2: What does the data tell us? May 2018, TARSC, EQUINET, Harare
Date of publication
2018 May
Publication type
Document
Publication details
Publication status
Published
Language
Keywords
urban health, data, monitoring, east and southern Africa
Abstract
Cities concentrate opportunities, jobs and services, but they also concentrate risks and hazards for health. How fairly are these risks and opportunities distributed across different population groups but also across generations? How well are African cities promoting current and future wellbeing? How far are health systems responding to and planning for these changes? TARSC as cluster lead of the “Equity Watch” work in EQUINET explored these questions in 2016-7, for east and southern African (ESA) countries. This brief reports what we found from analysis of data on indicators of wellbeing. Detail on the methods, findings and analyses of data can be found in full in Loewenson R, Masotya M (2018) Inequalities in health and wellbeing in urban areas in east and southern Africa: what does the data tell us? EQUINET Discussion paper 114, TARSC, EQUINET, Harare. Available at ht tps://tinyurl.com/y9nwy9oh. A number of holistic frameworks were found in the literature. They challenge the equation of progress in development with economic growth, when this is at the cost of intense exploitation of nature and significant social inequality. They thus focus on basic needs, wellbeing and quality of life (material, social and spiritual) of the individual and community, and of current and future generations, as a common good. While context dependent and with different terms in different regions, the buen vivir paradigm, (‘living well’ or ‘wellbeing’) best captures their key features. The brief presents evidence from data in several online databases with comparable data across ESA countries to see how far they measured these dimensions of wellbeing. ESA countries face a challenge in tracking progress in wellbeing, with data missing for many of its dimensions, limited disaggregation by social group or area, and more common measurement of negative than positive outcomes.
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Briefs
Theme area
Equity in health, Health equity in economic and trade policies, Poverty and health, Governance and participation in health
Title of publication Responding to inequalities in health in urban areas in east and southern Africa: Brief 1: What does the literature tell us? May 2018, TARSC, EQUINET, Harare
Date of publication
2018 May
Publication type
Document
Publication details
Publication status
Published
Language
Keywords
urban health, literature, east and southern Africa
Abstract
By 2050, urban populations will increase to 62% in Africa. The World Health Organisation (WHO) and UN Habitat in their 2010 report “Hidden Cities” note that this growth constitutes one of the most important global health issues of the 21st century. Cities concentrate opportunities, jobs and services, but they also concentrate risks and hazards for health (WHO and UN Habitat 2010). How fairly are these risks and opportunities distributed across different population groups but also across generations? How well are African cities promoting current and future wellbeing? How far are health systems responding to and planning for these changes? TARSC as cluster lead of the “Equity Watch” work in EQUINET explored these questions in 2016-7, for east and southern African (ESA) countries. This brief reports what we found from a review of published literature. It draws on an annotated bibliography of the literature can be found in Loewenson R, Masotya M (2015) Responding to inequalities in health in urban areas: A review and annotated bibliography, EQUINET Discussion paper 106, TARSC, EQUINET, Harare. The literature pointed to broad trends, but included less evidence on social inequalities in health within urban areas in ESA countries. The picture presented in the literature is not a
coherent one- it is rather a series of fragments of different and often disconnected facets of risk, health and care within urban areas. There is limited direct voice of those experiencing the changing conditions. There is also very limited report of the features of urbanisation that promote wellbeing.
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Briefs
Theme area
Health equity in economic and trade policies
Title of publication Mining and Public Health in Zambia Meeting report, 10 April 2018, Lusaka, Zambia
Date of publication
2018 April
Publication type
Report
Publication details
Publication status
Published
Language
Keywords
Zambia, mining, health impact assessment, health standards, law
Abstract
The Southern African Development Community (SADC) framework for harmonising mining policies, standards and laws, approved by the SADC Mining Ministers in 2006, specifies that member states develop, adopt and enforce appropriate and uniform health, safety and environmental guidelines for the sector and seeks to harmonized standardization in health as an immediate milestone area. The Ministry of Health in Zambia is in the process of improving public health in the mining sector in the country as part of its Universal Health Coverage policy, as well as to address the social determinants of health. A meeting was thus held to dialogue with key national level representatives of health and related sectors on evidence and actions related to public health in mining. The meeting aimed to 1. Share and dialogue with key national level representatives of health and related sectors on: evidence from Zambia on mining and health with a focus on population/public health issues and the current responses to health promotion, prevention and management, and on evidence from regional level on public health issues and health standards in mining, and their implications for regional responses. 2. To discuss follow up actions in relation to key areas of health and cross sectoral collaboration on mining and public health in Zambia and for regional co-operation and exchange on setting and implementing harmonised standards on mining and health.
Country
Zambia
Publisher
Equinet Publication Type
Reports
Theme area
Values, policies and rights, Equitable health services, Human resources for health, Public-private mix, Resource allocation and health financing, Governance and participation in health
Title of publication EQUINET discussion paper 113: The role of an essential health benefit in health systems in east and southern Africa: Learning from regional research’
Date of publication
2018 February
Publication type
Report
Publication details
‘The role of an essential health benefit in health systems in east and southern Africa: Learning from regional research’, EQUINET discussion paper 113, TARSC and IHI, EQUINET, Harare.
Publication status
Published
Language
Keywords
essential health benefit, east and southern Africa, universal health systems,
Abstract
An Essential Health Benefit (EHB) is a policy intervention defining the service benefits (or benefit package) in order to direct resources to priority areas of health service delivery to reduce disease burdens and ensure health equity. Many east and southern African (ESA) countries have introduced or updated EHBs in the 2000s. Recognising this in 2015-2017, the Regional Network for Equity in Health in East and Southern Africa (EQUINET), through Ifakara Health Institute (IHI) and Training and Research Support Centre (TARSC), with ministries of health in Swaziland, Tanzania, Uganda and Zambia, implemented desk reviews and country case studies, and held a regional meeting to gather and share evidence and learning on the role of EHBs in resourcing, organising and in accountability on integrated, equitable universal health systems. This report synthesises the learning across the full programme of work. It presents the methods used, the context and policy motivations for developing EHBs; how they are being defined, costed, disseminated and used in health systems, including for service provision and quality, resourcing and purchasing services and monitoring and accountability on service delivery and performance, and for learning, useful practice and challenges faced. This research pointed to the evidence within the region for policy dialogue on universal health systems. It raised the usefulness of designing, costing, implementing and monitoring an EHB as a key entry point and operational strategy for realising universal health coverage and systems and for making clear the deficits to be met.
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Discussion paper
Theme area
Health equity in economic and trade policies
Title of publication Advancing public health rights, claims and standards in mining, Report of a Side Session at the Alternative Mining Indaba, 6 February 2018, Cape Town South Africa
Date of publication
2018 February
Publication type
Report
Publication details
Publication status
Published
Language
Keywords
mining; health standards; community health; extractive industries
Abstract
The Alternative Mining Indaba has been held annually since 2010 at the same time as the Mining Indaba to provide a platform for communities affected by mining to voice their concerns and be capacitated to fight for their rights. The theme for the 2018 AMI was: “Making Natural Resources Work for the People: Towards Just Legal, Policy and Institutional Reform”. This report presents information on a side session at the Indaba that aimed to raise and discuss the key public health challenges facing workers and communities in the extractive sector / mining in east and southern Africa, the strategies for responding to them, including proposals for harmonised regional health standards, and the proposals made by civil society to advance them.
Country
South Africa
Publisher
EQUINET
Equinet Publication Type
Reports
Theme area
Equitable health services, Public-private mix, Resource allocation and health financing, Governance and participation in health
Title of publication The role of an essential health benefit in the delivery of integrated health services: Learning from practice in East and Southern Africa, Report of a regional research workshop, November 27-28 2017, Zanzibar, United Republic of Tanzania.
Date of publication
2017 December
Publication type
Report
Publication details
Publication status
Published
Language
Keywords
essential health benefit, east and southern Africa, universal health coverage
Abstract
An Essential Health Benefit (EHB) is a policy intervention designed to direct resources to priority areas of health service delivery to reduce disease burdens and ensure equity in health. Many east and southern Africa (ESA) countries have introduced or updated EHB in the 2000s. Recognising this, the Regional Network for Equity in Health in East and Southern Africa (EQUINET), through Ifakara Health Institute (IHI) and Training and Research Support Centre (TARSC), with country partners from Ministries of Health (MoH) in Swaziland, Tanzania, Uganda and Zambia, implemented research to understand the facilitators and the barriers in nationwide application of the EHB in resourcing, organising and in accountability on integrated, equitable universal health services. A regional review of literature on EHBs in the four country case study reports from the research programme are available on the EQUINET website. This report presents the proceedings of a regional consultative meeting convened on November 27-28, 2017 to present and discuss evidence from the research programme. The regional document review covering 16 east and southern African (ESA) countries, the findings from the country case studies in Swaziland, Tanzania, Uganda and Zambia, experiences from South Africa and Zanzibar and a regional synthesis of the evidence from across the programme were presented at the meeting, and background documents made available.
The meeting aimed to: a. Identify issues arising in the motivations for developing the EHB; the methods used to develop, define and cost them; their dissemination, communication and use within countries, including in budgeting, resourcing and purchasing health services; and, in monitoring health system performance for accountability; b. Identify policy-relevant and operational national and regional level recommendations on the role, design and use of EHB; and c. Propose areas for follow up policy, action and research.
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Reports
Theme area
Equitable health services, Governance and participation in health
Title of publication Brief: Strengthening health centre committees for people-centred health systems
Date of publication
2017 November
Publication type
Document
Publication details
EQUINET: CWGH, TARSC, LDHO, UCT (2017) Brief: Strengthening health centre committees for people-centred health systems, EQUINET, Harare
Publication status
Published
Language
Keywords
health centre committees; east and southern Africa
Abstract
Stakeholders working with Health Centre Committees (HCCs) in East and Southern Africa (ESA) raised proposals in EQUINET policy brief 37 to improve the functioning and impact of HCCs as potential contributors to equitable, people centred health services. These proposals advocated for legal, institutional and social measures to support and clarify HCC roles, composition, powers and duties, to ensure the capacities and resources for them to function. They also proposed that HCCs strengthen their communication with the communities they represent backed up by wider measures for health literate and informed communities. Since then, institutions in EQUINET have followed up to act on the recommendations, building on existing work. This brief shares information on these developments. It reports some progress in legal recognition and setting of clearer constitutions for HCCs, clearer guidelines for the functioning, use of community based processes like photovoice to connect them with communities and their conditions in their dialogue with health services and efforts to share resources for capacity building of HCCs. It highlights that HCCs continue to play a role in improved frontline health systems. However the potential of HCCs still needs to be realised and the work continues.
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Discussion brief
Theme area
Values, policies and rights, Health equity in economic and trade policies
Title of publication Resource curse or fair benefit: Protecting health in the extractive sector in east and southern Africa
Date of publication
2017 November
Publication type
Document
Publication details
Civil society brief: Resource curse or fair benefit? Protecting health in the extractive sector in east and southern Africa
Publication status
Published
Language
Keywords
extractive sector, mining, health standards, civil society
Abstract
The extractive (or mining) sector is a major economic actor in east and southern Africa. The mineral resources extracted are sought after globally,
and how the sector operates affects the lives of millions of people. This brief aimed mainly civil society discusses the health impacts of the sector, how far these risks are recognised in policy and controlled in practice, and what civil society can do to ensure that health is protected in EI activity. It presents the proposals made at the 13th Southern Africa Civil society Forum in 2017 to advocate for regional health standards for EIs and a bottom up local to regional campaign for civil society to advocate for these harmonised standards for health in the mining (extractive) sector in SADC.
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Discussion brief
Theme area
Values, policies and rights, Equitable health services, Resource allocation and health financing
Title of publication EQUINET Discussion paper 112: A case study of the Essential Health Care Package in Swaziland
Date of publication
2017 August
Publication type
Report
Publication details
‘A case study of the Essential Health Care Package in Swaziland’, EQUINET Discussion paper 112, MoH Swaziland, IHI and TARSC, EQUINET: Harare.
Publication status
Published
Language
Keywords
essential health benefit, Swaziland
Abstract
The Essential Health Benefit (EHB) is known as Essential Health Care Package (EHCP) in Swaziland. This desk review provides evidence on the experience of EHCPs in Swaziland and includes available policy documents and research reports. It was implemented in an EQUINET research programme through Ifakara Health Institute (IHI) and Training and Research Support Centre (TARSC), in association with the ECSA Health Community, supported by IDRC (Canada). The desk review presents the motivations for and methods used to develop, define and cost EHCP. It includes key informant input from a multi-disciplinary national task team through a workshop of key stakeholders with technical support from the World Health Organisation (WHO). It outlines how the EHCP has been disseminated and used in the budgeting and purchasing of health services and in monitoring health system performance for accountability. The paper also reports on the facilitators and barriers to development, uptake and use of the EHCP. In guiding the provision of services for all, the EHCP was envisaged to contribute towards the alleviation of poverty and as a tool for universal health coverage. Its implementation calls for a health service Infrastructure that is in good condition, competent health personnel, readiness to undergo training in new medical technology, supporting laws and capacity in the health financing unit. The EHCP in Swaziland was intended to guide the provision of health services. However, its costs were beyond the national resources to fund it. The adoption of a more restricted health service package currently being assessed in ten clinics in all four regions of the country suggests that a phased approach to delivery of an EHB may be more affordable financially for the country.
Country
Swaziland
Publisher
EQUINET
Equinet Publication Type
Discussion paper
Theme area
Equitable health services, Resource allocation and health financing, Governance and participation in health
Title of publication EQUINET discussion paper 111: A case study of the role of an Essential Health Benefit in the delivery of integrated health services in Zambia
Date of publication
2017
Publication type
Report
Publication details
A case study of the role of an Essential Health Benefit in the delivery of integrated health services in Zambia,’ EQUINET Discussion paper 111, Zambia Ministry of Health, EQUINET: Lusaka.
Publication status
Published
Language
Keywords
essential health benefit, Zambia
Abstract
This case study report compiles evidence on the experience of the Essential Health Benefit (EHB) in Zambia. The paper aims to contribute to national and regional policy dialogue regarding the role the EHB plays in budgeting, resourcing and purchasing of health services as well as monitoring health system performance for accountability. It outlines the motivations for developing the EHBs in Zambia, the barriers encountered in the process, the methods used to develop EHBs, and issues related to dissemination and communication of its content. The paper was done under the auspices of an EQUINET research programme through Ifakara Health Institute (IHI) and Training and Research Support Centre (TARSC), in association with the ECSA Health Community, supported by IDRC (Canada), and with the permission of the Ministry of Health of Zambia.
Country
Zambia
Publisher
EQUINET
Equinet Publication Type
Discussion paper
Theme area
Equitable health services, Public-private mix, Resource allocation and health financing, Governance and participation in health
Title of publication EQUINET Discussion paper 110: A case study of the Uganda National Minimum Healthcare Package
Date of publication
2017 September
Publication type
Report
Publication details
A case study of the Uganda National Minimum Healthcare Package,’ EQUINET Discussion paper 110, Ministry of Health, EQUINET, Uganda.
Publication status
Language
Keywords
essential health benefit; Uganda
Abstract
The Essential Health Benefit (EHB) policy interventions aim to optimize efficiency while extending coverage by increasing equity of access to the defined benefits. Uganda’s EHB is referred to as the Uganda National Minimum Healthcare Package (UNMHCP) introduced in the 1999 Health Policy. The UNMHCP is composed of cost efficient interventions against diseases or conditions most prevalent in the country. This report compiles evidence from published, grey literature and key informants on the UNMHCP since its introduction in Uganda’s health system, and findings were further validated during a oneday national stakeholder meeting. It includes information on the motivations for developing the EHBs, the methods used to develop, define and cost them, and how it has been disseminated, used in budgeting, resourcing and purchasing health services and in monitoring health system performance for accountability. It was implemented in an EQUINET research programme through Ifakara Health Institute (IHI) and Training and Research Support Centre (TARSC), in association with the ECSA Health Community, supported by IDRC (Canada).
Country
Uganda
Publisher
EQUINET
Equinet Publication Type
Discussion paper
Theme area
Equitable health services, Public-private mix, Resource allocation and health financing
Title of publication EQUINET discussion paper 109: A case study of the Essential Health Benefit in Tanzania mainland
Date of publication
2017 September
Publication type
Report
Publication details
A case study of the Essential Health Benefit in Tanzania mainland,’ EQUINET discussion paper 109, IHI, EQUINET, Tanzania
Publication status
Published
Language
Keywords
Essential health benefit; Tanzania
Abstract
An Essential Health Benefit (EHB) is a policy intervention designed to direct resources to priority areas of health service delivery to reduce disease burdens and ensure equity in health.
Mainland Tanzania’s most recent benefit package – the National Essential Health Care Interventions Package-Tanzania (NEHCIP-TZ) – describes the EHB as a minimum or “limited
list of public health and clinical interventions.” The package identifies where priorities are set for improved public health. This report shows the challenges of turning a policy ‘wish list’ and
package into a reality of services that can be accessed across different facility levels. This report describes the evolution of mainland Tanzania’s EHB; the motivations for
developing the EHBs, the methods used to develop, define and cost them; how it is being disseminated, communicated, and used; and the facilitators (and barriers) to its development,
uptake or use. Findings presented in this report are from three stages of analysis: literature review, key informant perspectives and a national consultative meeting. The case study on
Tanzania was implemented in a research programme of the Regional Network for Equity in Health in East and Southern Africa (EQUINET) through Ifakara Health Institute (IHI) and
Training and Research Support Centre (TARSC). The programme is being implemented in association with the East Central and Southern African Health Community, supported by IDRC
(Canada).
Country
Tanzania
Publisher
EQUINET
Equinet Publication Type
Discussion paper
Theme area
Governance and participation in health
Title of publication Are Health Centre Committees a Vehicle for Social Participation in Health? Report on a Regional HCC Review Meeting, June 2017
Date of publication
2017 June
Publication type
Report
Publication details
Report on a Regional HCC Review Meeting in the Strengthening Health Centre Committees as a Vehicle for Social Participation in Health Systems in East and Southern Africa programme, 21st June 2017, EQUINET. Harare
Publication status
Published
Language
Keywords
health centre committees; East and Southern Africa
Abstract
EQUINET through the Community Working Group on Health (CWGH) as the cluster lead for the work on social empowerment in health, in partnership with Training and Research Support Centre (TARSC), University of Cape Town (UCT) and Lusaka District Health Office (LDHO), with support from Open Society Initiative for Eastern Africa (OSIEA) have embarked on a regional programme, ‘HCCs as a vehicle for social participation in health systems in East and Southern Africa’ to address some of the outcomes mentioned above. This report documents the proceedings during the Regional HCC exchange visit held at Mwanza clinic, Goromonzi district on the 20th of June 2017 and the review meeting held in Harare on the 21st of June 2017. The meeting aimed to: discuss experiences with laws, policies, guidelines and constitutions on HCCs; share experiences in using Photovoice to enhance the role of HCCs; discuss current training materials and programmes for HCCs in the region and discuss strengthening of internal capacities of institutions working with HCCs through information exchange and skills inputs.
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Reports
Theme area
Governance and participation in health
Title of publication Using Policy dialogue to Strengthen Health Centre Committees as a Vehicle for Social Participation in Health System in East and Southern Africa. Report of Policy dialogue workshop
Date of publication
2016 January
Publication type
Report
Publication details
Using Policy dialogue to Strengthen Health Centre Committees as a Vehicle for Social Participation in Health System in East and Southern Africa. Report of Policy dialogue workshop 7th January, 2016, Lusaka
Publication status
Published
Language
Keywords
health centre committee; law; policy; volunteers
Abstract
In a regional EQUINET programme led by Community Working Group on Health (CWGH) on health centre committees as a vehicle for social participation in health system in east and southern Africa, Lusaka DHO is building capacities and learning for the district and the wider country programme on policy and legal guidelines to support the effective interaction of communities in health centre committees (HCCs) that can be shared regionally. A workshop was held on 7th January 2016 in Lusaka to support and inform the objectives for the Zambia work, viz:
1. To compile and exchange information on the current laws and legal guidelines on the role and functioning of HCCs.
2. To develop through regional dialogue a model HCC guideline to be tabled and reviewed regionally.
3. To analyse and document how current laws compare to this guideline.
4. To advocate for strengthening of law and guidelines in regional and national policy forum.
Country
Zambia
Publisher
Equinet Publication Type
Reports
Theme area
Health equity in economic and trade policies, Governance and participation in health
Title of publication Global Health Diplomacy and regional health standards in the extractive sector, Session Report, 10 April 2017,
Date of publication
2017 April
Publication type
Report
Publication details
Global Health Diplomacy and regional health standards in the extractive sector, Session Report, 10 April 2017, Arusha Tanzania
Publication status
Published
Language
Keywords
Regional; global health diplomacy
Abstract
This 2017 session within the Regional ECSA HC Best Practices Forum was convened by ECSA HC and EQUINET in line with HMC Resolution – ECSAHMC50/R2 and with proposals from the 2016 Regional meeting on GHD. The objectives of the meeting were to
a. To share information on progress in the ECSA HC GHD programme and issues for policy dialogue and follow up work
b. To present and discuss evidence supporting and proposals for harmonised regional standards on health in the extractive sector
c. To review and discuss positions on selected agenda items in the 2017 World Health Assembly (WHA) agenda
The meeting recommendations were further summarised and reviewed in the Best Practices Forum and then in the Directors Joint Consultative conference, where the outcome of what was formally recommended is separately reported by ECSA HC. Delegates were provided with specific background materials through distributed publications. The report is organised by theme, with the presentation and group discussions on each area shown together.
Country
East and southern Africa region
Publisher
Equinet Publication Type
Reports
Theme area
Health equity in economic and trade policies
Title of publication EQUINET Policy brief 42: Harmonising regional standards for extractive industry responsibilities for health in east and southern Africa
Date of publication
2017 February
Publication type
Document
Publication details
Harmonising regional standards for extractive industry responsibilities for health in east and southern Africa, TARSC, Policy brief 42 EQUINET, Harare
Publication status
Published
Language
Keywords
extractive industries, mining, health, laws, standards
Abstract
This brief aims to inform policy dialogue on the protection of health in extractive industries (EIs) in the mining sector in east and southern Africa (ESA). It outlines on pages 5-7 a proposal for a ‘Regional guidance on minimum standards for the duties and responsibilities of parties in the extractive sector for health and social protection’. EIs play a key economic role, but also bring health, environmental and social risks. International codes and guidance exist on the duties of corporate actors to control these risks and contribute to health. ESA country laws provide for some health protection in EIs, but all have gaps in legal provisions. In line with the intentions of the Southern African Development Community (SADC) and other regional economic communities, standards and laws for the sector should be harmonised and brought in line with international standards. The proposal for regional guidance draws clauses from current laws in ESA countries, suggesting the feasibility of their wider application across the region.
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Briefs
Theme area
Values, policies and rights, Governance and participation in health, Monitoring equity and research to policy
Title of publication Skills building on methods and tools for learning from action in participatory action research: Building action learning within affected actors and communities
Date of publication
2017 January
Publication type
Report
Publication details
Report of the workshop at the Global Symposium for Health Systems Research, Vancouver, Tuesday 15 November 2016
Publication status
Published
Language
Keywords
participatory action research; methods
Abstract
This three hour participatory skills session discussed methods/ tools to build learning from action as a key element of participatory action research (PAR) and briefly the implications for what this means for an understanding of ‘resilience’ in health systems. It was held as a satellite session at the 2016 Global Symposium on Health Systems Research. The session drew on approaches and experience from Africa, Latin America and participants globally to discuss the methods/tools, their application and their integration in health systems. It integrated input from two rounds of moderated discussion on these questions held on the pra4equity list prior to the Global Symposium. The EQUINET,TARSC, AHPSR, WHO, IDRC Methods Reader on PAR was also distributed. The session was attended by 62 delegates from all regions of the world.
Country
International
Publisher
EQUINET
Equinet Publication Type
Reports
Theme area
Values, policies and rights, Health equity in economic and trade policies, Public-private mix, Governance and participation in health
Title of publication Diss 108 Appendices for the report on Corporate responsibility for health in the extractive sector in East and Southern Africa
Date of publication
2016 November
Publication type
Academic paper
Publication details
Appendices for the paper on Corporate responsibility for health in the extractive sector in East and Southern Africa’, EQUINET Discussion paper 108, Training and Research Support Centre, EQUINET: Harare.
Publication status
Published
Language
Keywords
extractive industries, laws; regional guidance; east and southern Africa
Abstract
This document provides the legal frameworks and relevant legal clauses from 16 East and Southern African countries for Diss paper 108: Corporate responsibility for health in the extractive sector in East and Southern Africa produced by EQUINET through Training and Research Support Centre to inform policy dialogue to improve the legal frameworks for the duties and corporate social responsibility of EIs in the ESA region.
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Discussion paper
Theme area
Values, policies and rights, Health equity in economic and trade policies, Public-private mix, Governance and participation in health
Title of publication Diss paper 108: Corporate responsibility for health in the extractive sector in East and Southern Africa
Date of publication
2016 November
Publication type
Academic paper
Publication details
Corporate responsibility for health in the extractive sector in East and Southern Africa’, EQUINET Discussion paper 108, Training and Research Support Centre, EQUINET: Harare.
Publication status
Published
Language
Keywords
extractive industries, laws; regional guidance; east and southern Africa
Abstract
While international and global guidance documents set out health obligations for extractive industries (EIs), these standards, including UN conventions, may be voluntary if they are not included in national laws, unless the national constitutions specifically provide otherwise. Given the spread of EIs across the ESA region, it would be important to ensure that corporate duties in relation to health are upheld across the region, including through regional guidance to harmonise laws. This document was produced by EQUINET through Training and Research Support Centre and with support from Medico International. It aims to inform policy dialogue to improve the legal frameworks for the duties and corporate social responsibility of EIs in the ESA region. It presents evidence to support policy dialogue and health advocacy. It reviews the literature on EIs and health in ESA countries, explores key guidance principles/ standards on health in EIs, and analyses from review of laws how far they are contained in domestic legislation of ESA countries. Using good practice in existing ESA laws and international guidance, the document proposes the content for regional guidance for policy and law in the region. As is being implemented in other regions of Africa, there is scope for regional guidance and harmonisation of laws relating to EIs, including in relation to health. While no single law in ESA countries addresses all aspects of international guidance on protection and health and social welfare in EIs, in combination the laws in ESA countries provide clauses that could form the basis of such regional guidance. Drawing from different ESA laws legal guidance is proposed for health and social protection covering:
1. Award of prospecting rights/licenses and EI agreements;
2. Resettlement of affected communities due to mining activities;
3. OHS for employed workers and contractors in the mining sector;
4. Health benefits for workers, families and surrounding communities;
5. Environment, health and social protection for surrounding communities;
6. Fiscal contributions towards health and health services;
7. Stimulation of forward and backward links with local sectors and services supporting health;
8. Post-mine closure obligations for public health; and for
9. Governance of these issues, including for good corporate governance practices, public transparency and accountability, constructive dialogue, reporting and oversight, to foster a relationship of confidence and mutual trust between EIs and the societies in which they operate.
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Discussion paper
Theme area
Human resources for health
Title of publication EQUINET Policy Brief 41: Giving new momentum to strategies for retaining health workers
Date of publication
2016 September
Publication type
Document
Publication details
Dambisya Y (2016) Giving new momentum to strategies for retaining health workers, with ECSA HC, TARSC and U Limpopo, Policy brief 41 EQUINET, Harare
Publication status
Published
Language
Keywords
health workers, retention; migration, primary care, east and southern Africa
Abstract
This brief discusses the strategies used for attracting and retaining skilled health workers in ESA countries, especially to address underserved rural and remote areas, primary care settings and in the public sector. It reviews practice to date and identifies strategic options, given both regional learning and the opportunity of the 2016 Global Strategy on Human Resources for Health. Whereas ESA countries have implemented various attraction and retention regimes, the results have not been well documented, with still limited evaluation and reporting of impact of these strategies. The evidence suggests a need for a comprehensive, multi-sectoral and co-ordinated approach to planning and implementation, to make the case for improved funding and with greater use of information and monitoring systems.
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Policy brief
Theme area
Equitable health services, Resource allocation and health financing, Governance and participation in health
Title of publication EQUINET Information brief: Global emergency financing and health system strengthening
Date of publication
2016 July
Publication type
Document
Publication details
Global emergency financing and health system strengthening, Information brief, U Sheffield, TARSC, EQUINET, Harare
Publication status
Published
Language
Keywords
health emergencies, emergency funds, international health regulations, health financing, global
Abstract
The 2005 International Health Regulations (IHR) adopted by member states in the World Health Organization (WHO) require that all countries have the ability to detect, assess, report and respond to potential public health emergencies of international concern at all levels of government, and to report such events rapidly to the WHO to determine whether a coordinated, global response is required. Recent epidemics have strengthened the demand to improve the capacities to implement the IHR and the effectiveness of health system prevention and detection of and responses to epidemics. Evidence from ESA countries suggests that this demands effective communication between local levels of health systems and national responses, and capacities for prevention, detection and response at community, primary care and district level. In 2016 two new global financing mechanisms were introduced to support emergency responses, the WHO Contingency Fund for Emergencies (CFE), that aims to fill the gap from the beginning of a declared emergency and a World Bank Pandemic Emergency Facility (PEF), to support follow up measures after initial CFE funding. This report provides information on the new CFE and PEF financing mechanisms, to explore any stated or implied links with the IHR goals and health system strengthening in the response to emergencies. It is based on a desk review of available literature by the University of Sheffield and the Training and Research Support Centre, under the umbrella of EQUINET. The report aims to inform African policy-makers and stakeholders about the CFE and PEF financial mechanisms and their relationship to the IHR to locate areas where links could be more explicitly made between the new financial mechanisms, the IHR and the health system strengthening needed for longer-term preparedness for and prevention of emergencies.
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Discussion brief
Theme area
Values, policies and rights, Governance and participation in health
Title of publication Global health diplomacy in east and southern Africa, Report of a Regional Meeting, 8-9 April 2016, Nairobi Kenya
Date of publication
2016 May
Publication type
Report
Publication details
Global health diplomacy in east and southern Africa, Report of a Regional Meeting, 8-9 April 2016, Nairobi Kenya ECSA HC and EQUINET, Arusha
Publication status
Published
Language
Keywords
global health diplomacy, WHO, east and southern Africa
Abstract
This 2016 regional meeting was convened by ECSA HC with EQUINET in line with HMC Resolution – ECSAHMC50/R2 to prepare and discuss issues on the 69th World Health Assembly (WHA) Agenda and Regional GHD work. The objectives of the meeting were to
1. Update participants from ECSA-HC member states on Global Health Diplomacy (GHD) and its health impact.
2. Share information and discuss, from a GHD perspective, selected WHA agenda items and related issues from other key global health platforms.
3. Present and discuss research findings, recommendations on effective engagement on GHD and proposals for future work.
4. Discuss proposals for strengthened regional co-ordination and communication on GHD and a framework for monitoring progress.
The meeting included senior officials delegated or responsible for health diplomacy from ECSA HC member states and South Africa, diplomats from the Africa group from ECSA HC member states, technical personnel from EQUINET and other institutions, including regional organisations and partners.
Country
East and southern Africa region
Publisher
EQUINET, ECSA HC
Equinet Publication Type
Reports
Theme area
Equity in health
Title of publication EQUINET brief
Date of publication
2016 June
Publication type
Document
Publication details
Publication status
Published
Language
Keywords
EQUINET, briefing, east and southern Africa
Abstract
Founded in 1998, the Regional Network on Equity in Health in east and southern Africa (EQUINET) is a network of professionals, civil society members, policy makers, state officials and others within the region who have come together as an equity catalyst, to
promote and realise shared values of equity and social justice in health. This brief introduces EQUINET, our organisation, work and the lessons we have learned in the struggle for equity and social justice in health. EQUINET is a consortium network of institutions registered in different countries in the region, with its secretariat at TARSC, a non-profit organization registered in Zimbabwe.
The network constitution sets out its vision, principles, composition, structures, governance and procedures. The network is governed by a steering committee of institutions leading key areas of work from within and beyond east and southern Africa. The steering committee includes academic, government, civil society, parliament and non-profit institutions that co-ordinate different theme, process and country activities in the network and the secretariat. The five clusters of EQUINET work are:
1. Cross cutting equity analysis, integrating work in other clusters and the pra4equity network on PAR and
the newsletter, together with theme work on the equity watch and district health systems.
2. Health rights and the law, integrating work of the learning network on heath rights, theme work on law and
constitutional rights in health, and work in national networks.
3. Fairly resourcing health systems, integrating theme work on health financing and health workers.
4. Social empowerment for health, integrating theme work on health centre committees, and with
parliamentarians and civil society.
5. Global engagement, including work on trade and health and health diplomacy.
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Briefs
Theme area
Equitable health services, Resource allocation and health financing
Title of publication EQUINET Discussion paper 107: Literature Review: Essential health benefits in east and southern Africa
Date of publication
2016 May
Publication type
Report
Publication details
Literature Review: Essential health benefits in east and southern Africa, EQUINET Discussion paper 107, IHI, Tanzania, TARSC, EQUINET, Harare
Publication status
Published
Language
Keywords
essential health benefit, east and southern Africa, health services
Abstract
An Essential Health Benefit (EHB) is a policy intervention designed to direct resources to priority areas of health service delivery to reduce disease burdens and ensure equity in health. Many east and southern Africa (ESA) countries have introduced or updated EHBs in the 2000s. Recognising this, EQUINET, through Ifakara Health Institute (IHI) and Training and Research Support Centre (TARSC), is implementing research to understand the role of facilitators and the barriers to nationwide application of the EHB in resourcing, organising and in accountability on integrated health services. This literature review provides background evidence to inform the case study work and regional dialogue. It compiles evidence from published and public domain literature on EHBs in sixteen ESA countries, including information on the motivations for developing the EHBs; the methods used to develop, define and cost them; how they are being disseminated and communicated within countries; how they are being used in budgeting, resourcing and purchasing health services and in monitoring health system performance for accountability; and the facilitators and barriers to their development, uptake or use.
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Discussion paper
Theme area
Poverty and health
Title of publication Fair Shares: Is CAADP Working?
Date of publication
2013 May
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
Comprehensive Africa Agriculture Development Programme, agriculture, farming, governance, diplomacy, Africa
Abstract
The Comprehensive Africa Agriculture Development Programme (CAADP), launched by African heads of state in 2003, offered the prospect of a new, intensified focus on agriculture throughout the continent. Ten years on, how successful has CAADP been? This paper offers a brief assessment, with its authors examining if agricultural budgets have increased, if the focus of spending has improved, and if CAADP is providing ‘fair shares’ to the millions of smallholder farmers who do most of Africa’s farming and produce most of its food. The key CAADP commitment made by African states was to allocate 10% of public expenditure to agriculture. Yet, as of 2010, only eight countries have exceeded the 10% target. Although the adoption of CAADP-aligned national strategies has played a role in increasing agricultural investment in some (though not all) countries, there are serious problems with the focus of spending, especially in the lack of adequate support to the needs of smallholder farmers, notably women farmers. The authors note that CAADP is promoting a farming model associated with the Green Revolution, which promotes the use of expensive external inputs such as chemical fertilisers, pesticides and genetically modified or hybrid seeds bought from agribusiness companies; they argue this comes at the expense of promoting sustainable agriculture approaches that are likely to benefit poor farmers much more. One of the biggest failures for CAADP-aligned national investments is that they have not recognised the potential of smallholders’ own investments or their potential to build on their ‘fair share’, the authors conclude.
Country
Publisher
ActionAid
Theme area
Equitable health services
Title of publication Innovations for Health: Use of Appropriate Technologies in Primary Health Care in Zimbabwe - Report of an Assessment
Date of publication
2015
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
technology, innovation, primary health care, environmental health, rural, urban, Zimbabwe
Abstract
Zimbabwe has had a notable record of innovation and use of appropriate technologies in primary health care (PHC), particularly in environmental health. These technologies are generally defined as small-scale, decentralized, people centred, labour-intensive, energy-efficient, environmentally sound, and locally controlled. This pilot assessment aimed to explore and map specific appropriate technology innovations being developed and used at community level for health in rural and urban districts of Zimbabwe. The assessment looked at the technologies, their materials, purpose and use and related issues around their development and use, with the evidence gathered by community based researchers within three main themes (i) food safety and nutrition, (ii) water, sanitation, waste management and housing and (iii) prevention and control of diseases. The results are presented in tables, with pictures of the technologies. While noting the limited size of the sample, the results suggest the wealth of innovations and appropriate technologies that exist, and the possibilities that may be found from a more systematic and wider assessment.
Country
Publisher
Training and Research Support Centre (TARSC)
Theme area
Equitable health services
Title of publication Does the Distribution of Healthcare Utilisation Match Needs in Africa
Date of publication
2013 October
Publication type
Journal Article
Publication details
Health Policy and Planning 29 7 pp 921-937
Publication status
Published
Language
English
Keywords
healthcare, utilisation, health policy, inequality, Southern Africa, Africa
Abstract
An equitable distribution of healthcare use, distributed according to people’s needs instead of ability to pay, is an important goal featuring on many health policy agendas worldwide. However, relatively little is known about the extent to which this principle is violated across socio-economic groups in Sub-Saharan Africa (SSA). The authors examine cross-country comparative micro-data from 18 SSA countries and find that considerable inequalities in healthcare use exist and vary across countries. For almost all countries studied, healthcare utilization is considerably higher among the rich. When decomposing these inequalities wealth is found to be the single most important driver. In 12 of the 18 countries wealth is responsible for more than half of total inequality in the use of care, and in 8 countries wealth even explains more of the inequality than need, education, employment, marital status and urbanicity together. For the richer countries, notably Mauritius, Namibia, South Africa and Swaziland, the contribution of wealth is typically less important. As the bulk of inequality is not related to need for care and poor people use less care because they do not have the ability to pay, healthcare utilization in these countries is to a large extent unfairly distributed. The weak average relationship between need for and use of health care and the potential reporting heterogeneity in self-reported health across socio-economic groups imply that the findings are likely to even underestimate actual inequities in health care.
Country
Publisher
Health Policy and Planning
Theme area
Poverty and health
Title of publication The State of African Cities 2014
Date of publication
2014 March
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
urban, climate change, growth, Africa
Abstract
The African continent is currently in the midst of simultaneously unfolding and highly significant demographic, economic, technological, environmental, urban and socio-political transitions. Africa’s economic performance is promising, with booming cities supporting growing middle classes and creating sizable consumer markets. But despite significant overall growth, not all of Africa performs well. The continent continues to suffer under very rapid urban growth accompanied by massive urban poverty and many other social problems. These seem to indicate that the development trajectories followed by African nations since post-independence may not be able to deliver on the aspirations of broad based human development and prosperity for all. This report, therefore, argues for a bold re-imagining of prevailing models in order to steer the ongoing transitions towards greater sustainability based on a thorough review of all available options. That is especially the case since the already daunting urban challenges in Africa are now being exacerbated by the new vulnerabilities and threats associated with climate and environmental change.
Country
Publisher
UN Habitat
Theme area
Poverty and health
Title of publication Poverty Reduction and Regional Integration: A Comparative Analysis of SADC and UNASUR Health Policies (PRARI)
Date of publication
2015
Publication type
Electronic Source
Publication details
Publication status
Published
Language
English
Keywords
poverty reduction, regional integration, SADC, UNASUR, South America, Southern Africa
Abstract
The Open University and Southampton University, South African SAIIA FLACSO-Argentina and UNU-CRIS are currently involved in the Poverty Reduction and Regional Integration (PRARI) project, a two year project studying what regional institutional practices and methods of regional policy formation are conducive to the emergence of embedded pro-poor health strategies, and what can national, regional and international actors do to promote these, particularly in South America and Southern Africa.
Country
Publisher
Open University; Southampton University; FLASCO; SAIIA; UNU-CRIS
Theme area
Values, policies and rights
Title of publication Strengthening the Protection of Sexual and Reproductive Health Rights in the African Region Through Human Rights
Date of publication
2014
Publication type
Report
Publication details
Pretoria University Law Press
Publication status
Published
Language
English
Keywords
gender, HIV, AIDS, sexual and reproductive health, rights, SADC, Africa
Abstract
Strengthening the protection of sexual and reproductive health and rights in the African region through human rights uses rights-based frameworks seeks to address some of the serious sexual and reproductive health challenges that the African region is currently facing. The authors provide human rights approaches on how these challenges can be overcome. Human rights issues addressed by the book include: emergency obstetric care; HIV/AIDS; adolescent sexual health and rights; early marriage; and gender-based sexual violence.
Country
Publisher
Pretoria University Law Press
Theme area
Values, policies and rights
Title of publication SADC Gender Protocol 2015 Barometer: Botswana
Date of publication
2015 June
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
gender, HIV, Botswana, SADC
Abstract
Botswana has made good progress against the targets of the Southern African Development Community (SADC) Protocol on Gender and Development set for 2015, according to this report. However, President Ian Khama of the Republic of Botswana said that Botswana would not sign the SADC Gender Protocol because the government considers some its time frames unrealistic, and some of its measures to have serious resource implications that the state cannot guarantee. Progress is noted in the report on the health sector, with trained personnel delivering more than 90% of births and 84% of the population living within five kilometres of a quality health facility. However, the maternal mortality rate is noted to have increased and only 44% of the population access contraception. Although Botswana has one of the world's highest HIV prevalence more than 95% of HIV-positive pregnant women access the prevention of mother-to-child transmission programme. In spite of these achievements, this report also reveals obstacles for the country on the road to gender equality, including a failure to address contradictions between formal and customary laws, with the latter discriminating against women, especially widows and divorced women.
Country
Publisher
Botswana Council of NGOs
Theme area
Governance and participation in health
Title of publication Resolutions of the 62nd Health Ministers Conference
Date of publication
2015 December
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
Millennium Development Goals, Sustainable Development Goals, governance, health ministers, East, Central and Southern African Health Community, Africa
Abstract
The 62nd ECSA Health Ministers’ Conference (HMC) was held at InterContinental Resort Balaclava Fort, Republic of Mauritius under the theme: Transitioning from Millennium Development Goals to Sustainable Development Goals with the following sub-themes; Enhancing Universal Health Coverage Through Innovations in Health Financing for Risk Protection; Surveillance and Control of Emerging Conditions: (NCDs and Trauma); Regional Collaboration in the Surveillance and Control of Communicable Diseases; Innovations in Health Professional Training Using the ECSA College of Health Sciences Model. The Conference passed Resolutions on: Transitioning From MDGs to SDGs in the ECSA Region; Enhancing UHC through innovation in Health Financing for Risk Protection; Surveillance and Control of Non- Communicable Diseases and Trauma; Regional Collaboration in the Surveillance and Control of Communicable Diseases; Innovations in Health Professional Training using the ECSA College of Health Sciences Model; Global Health Diplomacy and Strengthening Ministries of Health Leadership and Governance Capacity for Health in the ECSA-HC Region; and Strengthening the Use of Evidence in Health Policy.
Country
Publisher
East, Central and Southern African Health Community
Theme area
Health equity in economic and trade policies
Title of publication Synergising Roles: Experiences of Civil Society Working Towards Promoting Local Generic Pharmaceutical Manufacturing in the EAC Region
Date of publication
2014 January
Publication type
Report
Publication details
PEAH – Policies for Equitable Access to Health
Publication status
Published
Language
English
Keywords
pharmaceuticals, generic, manufacturing, civil society, East African Community, Africa
Abstract
Due to a number of bottlenecks, the generic pharmaceutical manufacturers in the East African Community region produce at a cost disadvantage compared to their large-scale Asian counterparts. This article highlights some of the key areas where civil society has engaged and can still engage with local pharmaceutical industries to address these challenges. While the local manufacturing sector can play an important role in increasing access to and promoting the affordability of medicines in the region, a lot of support is needed for them to not only increase their production capacity but also to make a greater contribution to health care in the EAC region. the author argues that health civil society now needs to get into wider campaigns for the development of regulatory guidelines stating requirements for manufacturers of generic medicines to develop local capacity and undertake increased technology transfer into the region while at the same time lobbying EAC partner states to create subsidies and concessions that can boost the local pharmaceutical manufacturers’ capacity to adequately provide the much needed legitimate, affordable and quality medicines.
Country
Publisher
PEAH – Policies for Equitable Access to Health
Theme area
Health equity in economic and trade policies
Title of publication Honest Accounts? The True Story of Africa's Billion Dollar Losses
Date of publication
2014 July
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
finance, trade, governance, Africa
Abstract
The rest of the world takes from Africa much more than the continent receives. Almost $60 billion more. $192 billion flows out of Africa each year. This report outlines the range of different flows draining out of Africa, as well as the costs imposed on the continent as a result of climate change and explores the reasons for this. Curbing illicit financial flows is argued to demand greater transparency and accountability in the global financial system. This would involve clamping down on shell corporations; improved disclosure of beneficial owners of companies; stricter company reporting regulations on sales, profits and taxes; and exchanging tax information across borders. Instead of talking about ‘good governance in Africa’ the authors argue that Northern countries must take the lead to reduce the mass extraction of African capital that embeds poverty and inequality, including revenue leakages from extractive industries and fairer trade practices between African countries and MNCs.
Country
Publisher
Theme area
Health equity in economic and trade policies
Title of publication Promoting the Use of Climate Information to Achieve Long-Term Development Objectives in Sub-Saharan Africa: Results from the Future Climate for Africa Scoping Phase
Date of publication
2015 February
Publication type
Report
Publication details
Climate and Development Knowledge Network
Publication status
Published
Language
English
Keywords
climate, information, Malawi, Rwanda, Zambia, Ghana, Mozambique Southern Africa
Abstract
The impacts of climate change are currently being felt by people and communities. However, many of the most severe impacts will be felt in the decades to come. Significant barriers emerge in an effort to achieve long-term development objectives, particularly in sub-Saharan Africa, a region with low capacity to adapt to the future impacts of climate change. Factoring medium- to long-term climate information into investments and planning decisions is therefore an important component of climate-resilient development. We know little about how climate information is used in Africa to make decisions with long-term consequences, or how effective it is. We know even less about the barriers to – and opportunities for – using climate information in decision-making. How, then, should governments, businesses and donors strive for climate information to achieve Africa’s long-term development objectives? The Future Climate For Africa (FCFA) programme explores these questions and seeks to challenge many of the assumptions that underlie them. To guide the programme, six case studies investigated how climate information was being used in decision-making in sub-Saharan Africa. These comprised four country case studies: Malawi, Rwanda, Zambia and a combined study of Accra, Ghana and Maputo, Mozambique; and two desk-based studies focused on long-lived infrastructure in the ports sector and the large hydropower sector. This report presents the results of the scoping phase.
Country
Publisher
Climate and Development Knowledge Network
Theme area
Health equity in economic and trade policies
Title of publication Agenda 2063 Vision and Priorities
Date of publication
2015 May
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
governance, diplomacy, African Union, Pan-Africanism, SADC, Africa
Abstract
The African Union set out its vision of an Integrated, prosperous and peaceful Africa, driven by its own citizens and representing a dynamic force in the global arena. Aiming to encourage discussion among all stakeholders, Agenda 2063 is an approach to how the continent should effectively learn from the lessons of the past, build on the progress now underway and strategically exploit all possible opportunities available in the immediate and medium term, so as to ensure positive socioeconomic transformation within the next 50 years. Agenda 2063 emphasises the importance of Pan-Africanism, unity, self-reliance, integration and solidarity that was a highlight of the triumphs of the 20th century. It highlights the need to more effectively use African resources for the benefit of people in the continent. It raises regional political, institutional renewal and financing/resource mobilisation issues, as well as the changing nature of Africa’s relationships with the rest of the world. The AU is calling for input to the agenda.
Country
Publisher
African Union
Theme area
Governance and participation in health
Title of publication South African AIDS Activism and Global Health Politics
Date of publication
2013 March
Publication type
Book
Publication details
Publication status
Published
Language
English
Keywords
governance, diplomacy, AIDS, South Africa
Abstract
What did South African AIDS activists contribute, politically, to early international advocacy for free HIV medicines for the world's poor? Mandisa Mbali demonstrates that South Africa's Treatment Action Campaign (TAC) gave moral legitimacy to the international movement, which enabled it to effectively push for new models of global health diplomacy and governance. The TAC rapidly acquired moral credibility, she argues, because of its leaders' anti-apartheid political backgrounds, its successful human rights-based litigation and its effective popularisation of AIDS-related science. The country's arresting democratic transition in 1994 enabled South African activists to form transnational alliances. Its new Constitution provided novel opportunities for legal activism, such as the TAC's advocacy against multinational pharmaceutical companies for blocking access to affordable generics and the South African government when it failed to provided antiretrovirals. Mbali's history of the TAC sheds light on its evolution into an influential force for global health justice.
Country
Publisher
Palgrave Macmillan
Theme area
Values, policies and rights, Governance and participation in health
Title of publication EQUINET Policy brief 40: Implementing the International Health Regulations in east and southern Africa: Progress, opportunities and challenges
Date of publication
2016 May
Publication type
Document
Publication details
Implementing the International Health Regulations in east and southern Africa: Progress, opportunities and challenges, EQUINET Policy brief 40, EQUINET Harare
Publication status
Published
Language
Keywords
International Health Regulations, East and Southern Africa, implementation
Abstract
When the International Health Regulations (IHR) were adopted in 2005 by member states of the World Health Organisation (WHO), State Parties were given up to June 2012 to have developed minimum core public health capacities to implement them. This included having surveillance, reporting and response systems for public health risks and emergencies and measures for disease control at designated airports, ports and ground crossings. In East and Southern Africa (ESA), the IHR are being implemented within an Integrated Disease Surveillance and Response (IDRS), which is a comprehensive, evidence-based strategy for strengthening national public health surveillance and response systems in African countries. This policy brief outlines the progress made and deficits in ESA countries in achieving the core capacities to implement the IHR. It proposes national measures to strengthen public health systems to both meet gaps in the implementation of the IHR and to link responses to health emergencies and outbreaks to health systems strengthening in ESA countries.
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Policy brief
Theme area
Poverty and health, Equitable health services, Governance and participation in health
Title of publication EQUINET PRA paper: Reflections on actions and learning from participatory work on health in Cassa Banana, Zimbabwe.
Date of publication
2016 April
Publication type
Academic paper
Publication details
Reflections on actions and learning from participatory work on health in Cassa Banana, Zimbabwe. TARSC, ZADHR, Cassa Banana Community Health Committee, EQUINET PRA Paper. Harare
Publication status
Published
Language
Keywords
environmental health, informal settlement; participatory; reflection; action; Zimbabwe
Abstract
Over the last two years (2014-2015), the Training and Research Support Centre (TARSC), in cooperation with the Zimbabwe Association of Doctors for Human Rights (ZADHR), has been building a programme that aims to foster local and national dialogue to build active citizenship and public and private accountability on water and sanitation, as a key element of primary health care. The work draws on experiences and learning arising from the Health Literacy programme and pra4equity network within the Regional Network on Equity in Health in east and southern Africa (EQUINET).This paper explores the Cassa Banana residents’ response to their health situation over the last two years, with a particular focus on the role of the Community Health Committee (CHC) in meeting community health needs and in trying to strengthen relations with the HaCC and other key stakeholders. In doing so, the paper reflects on the successes and challenges faced by the CHC, and looks at issues of leadership, social cohesion and power within the community as key components to the successful mobilisation of a diverse and fractured community in trying to get its needs met. It ends by recommending possible actions to deal with the problems identified and comments on the extent to which the challenges faced in Cassa Banana can be generalised to other communities in Zimbabwe.
Country
Zimbabwe
Publisher
EQUINET
Equinet Publication Type
Discussion paper
Theme area
Governance and participation in health
Title of publication Monitoring pro-poor health-policy success in the SADC region
Date of publication
2015 April
Publication type
Document
Publication details
PRARI Policy Brief / / pp 1-5
Publication status
Published
Language
English
Keywords
policy, poverty, monitoring, SADC, southern Africa
Abstract
In the area of health, the Southern African Development Community (SADC) has conducted important work in understanding how poor health and poverty coincide, are mutually reinforcing, and socially-structured by gender, age, class, ethnicity and location, demonstrated by the key health policy documents that have been facilitated by the secretariat. Yet the time lapse between the formulation of guidelines and policies and their implementation has at times been uneven. This brief describes the Poverty Reduction and Regional Integration indicator-based monitoring system addressing health priorities for the region, under the institutional leadership of the SADC secretariat and with the support from its Member States that are the main beneficiaries of the process.
Country
Publisher
Poverty Reduction and Regional Integration
Theme area
Governance and participation in health
Title of publication Community participation in formulating the post-2015 health and development goal agenda: Reflections of a multi-country research collaboration
Date of publication
2015 October
Publication type
Journal Article
Publication details
International Journal for Equity in Health 13 66 pp /-DOI: 10.1186/s12939-014-0066-6
Publication status
Published
Language
English
Keywords
community, participation, Millennium Development Goals, SDGs, International
Abstract
Global discussion on the post-2015 development goals, to replace the Millennium Development Goals when they expire on 31 December 2015, is well underway. While the Millennium Development Goals focused on redressing extreme poverty and its antecedents for people living in developing countries, the post-2015 agenda seeks to redress inequity worldwide, regardless of a country’s development status. Furthermore, to rectify the UN’s top-down approach toward the Millennium Development Goals’ formulation, widespread negotiations are underway that seek to include the voices of people and communities from around the globe to ground each post-2015 development goal. This reflexive commentary, therefore, reports on the early methodological challenges the Go4Health research project experienced in its engagement with communities in nine countries in 2013. Led by four research hubs in Uganda, Bangladesh, Australia and Guatemala, the purpose of this engagement has been to ascertain a ‘snapshot’ of the health needs and priorities of socially excluded populations particularly from the Global South. This is to inform Go4Health’s advice to the European Commission on the post-2015 global goals for health and new governance frameworks. Five methodological challenges were subsequently identified from reflecting on the multidisciplinary, multiregional team’s research practices so far: meanings and parameters around qualitative participatory research; representation of marginalization; generalizability of research findings; ethical research in project time frames; and issues related to informed consent. Strategies to overcome these methodological hurdles are also examined. The findings from the consultations represent the extraordinary diversity of marginal human experience requiring contextual analysis for universal framing of the post-2015 agenda. Unsurprisingly, methodological challenges will, and did, arise. We conclude by advocating for a discourse to emerge not only critically examining how and whose voices are being obtained at the community-level to inform the post-2015 health and development goal agenda, but also how these voices are being translated and integrated into post-2015 decision-making at national and global levels.
Country
Publisher
International Journal for Equity in Health
Theme area
Governance and participation in health
Title of publication Multi-level pro-poor health governance, statistical information flows, and the role of regional organisations in South America and Southern Africa
Date of publication
2015
Publication type
Document
Publication details
PRARI Working Paper 15 1 pp 1-54
Publication status
Published
Language
English
Keywords
poverty, governance, regional organisations, information, SADC, Southern Africa
Abstract
In this paper, the authors analyse regional to national-level data flows with the use of two case studies focusing on UNASUR (Bolivia and Paraguay) and SADC (Swaziland and Zambia). Special attention is given to pro-poor health policies, those health policies that contribute to the reduction of poverty and inequities. The results demonstrate that health data is shared at various levels. This takes place to a greater extent at the global-country and regional-country levels, and to a lesser extent at the regional-global levels. There is potential for greater interaction between the global and regional levels, considering the expertise and involvement of UNASUR and SADC in health. Information flows between regional and national bodies are limited and the quality and reliability of this data is constrained by individual Member States’ information systems. Having greater access to better data would greatly support Member States’ focus on addressing the social determinants of health and reducing poverty in their countries. This has important implications not only for countries but to inform regional policy development in other areas. By serving as a foundation for building indicator-based monitoring tools, improving health information systems at both regional and national levels can generate better informed policies that address poverty and access to health.
Country
Publisher
Poverty Reduction and Regional Integration
Theme area
Governance and participation in health
Title of publication Regional health governance: A suggested agenda for Southern African health diplomacy
Date of publication
2015
Publication type
Journal Article
Publication details
Global Social Policy 15 3 pp 278-295
Publication status
Published
Language
English
Keywords
governance, regional, SADC, Southern Africa
Abstract
Regional organisations can effectively promote regional health diplomacy and governance through engagement with regional social policy. Regional bodies make decisions about health challenges in the region, for example, the Union of South American Nations (UNASUR) and the World Health Organisation South East Asia Regional Office (WHO-SEARO). The Southern African Development Community (SADC) has a limited health presence as a regional organisation and diplomatic partner in health governance. This article identifies how SADC facilitates and coordinates health policy, arguing that SADC has the potential to promote regional health diplomacy and governance through engagement with regional social policy. The article identifies the role of global health diplomacy and niche diplomacy in health governance. The role of SADC as a regional organisation and the way it functions is then explained, focusing on how SADC engages with health issues in the region. Recommendations are made as to how SADC can play a more decisive role as a regional organisation to implement South–South management of the regional social policy, health governance and health diplomacy agenda.
Country
Publisher
Global Social Policy
Theme area
Governance and participation in health
Title of publication Health Governance in Sub-Saharan Africa
Date of publication
2015 December
Publication type
Journal Article
Publication details
Global Social Policy 15 3 pp 345-348
Publication status
Published
Language
English
Keywords
governance, resourcing, non state actors, Africa
Abstract
The interdependence of states and increasing movement of people, the spread of contagious diseases and the heightened complexity of global health issues make cooperation among countries indispensable. Unfortunately resourcing remains a critical challenge to effective health governance. The authors argue that financial resources are not really a major challenge for Sub-Saharan Africa as it is usually perceived. According to the International Monetary Fund (IMF), Sub-Saharan Africa’s economic growth has been robust and capital inflows higher than the developing countries’ average. Notwithstanding threats to the region seems poised for better prospects. The authors argue that health governance should be given a higher significance if growth rates are to be sustained and strategies developed for collaboration between governments and non-state actors. Many Sub-Saharan Africa countries still view non-state actors with suspicion, but the authors argue that those that have embraced them as development partners have reaped some positive results in the provision of health services, such as in the role of mission services in health care provision in Botswana and Malawi. They suggest enhancing a multi-pronged cooperation between African state and non state actors and that the porous borders across countries necessitate regional cooperation to effectively combat the spread of diseases.
Country
Publisher
Global Social Policy
Theme area
Equity in health
Title of publication Universal Health Coverage Assessment: Zambia
Date of publication
2015 June
Publication type
Report
Publication details
Universal Health Coverage Assessment: Zambia, Global Network for Health Equity (GNHE), June 2015
Publication status
Published
Language
Keywords
Zambia, universal health coverage, health financing, health equity
Abstract
This document provides a preliminary assessment of the Zambian health system relative to the goal of universal health coverage, with a particular focus on the financing system and related aspects of provision. Zambia is making continuous progress in all the key areas of its health system. However, there are gaps which need to be resolved for the country to be able to realise the goal of universal coverage, including universal financial protection and access to care. First, a more equitable distribution of resources between urban and rural areas is required. Second, resources need to be allocated to promote access to, and utilisation of, health care by the poorer socio-economic groups. The higher consumption of public inpatient health care services by wealthier groups is a striking example of inequitable utilisation, as is the relatively greater levels of government subsidy received by wealthier groups, even for primary health care. Third, the impoverishing effect of out-of-pocket payments exposes poorer households to financial risk, driving households into poverty or further into poverty. This requires reconsideration of public hospital user fees, both in terms of the level of fees and the application of bypass fees (which are charged when patients bypass primary
health care facilities, including because of the severity of their conditions and their proximity to higher-level health facilities). Finally, Zambia’s ambition to introduce social health insurance as a mechanism for improving the pooling and purchasing of services needs to be scrutinised for its possible impacts on equity. The proposed social health insurance scheme would require co-payments and perhaps other contributions, which would increase the financial burden on households. This means that the proposed scheme could effectively run counter to the ambition of attaining universal health coverage. There should be a critical evaluation of the alternative option of simply continuing – and strengthening - the current tax-based financing system.
Country
Zambia
Publisher
Global Network for Health Equity
Theme area
Governance and participation in health
Title of publication Health Governance in Southern Africa
Date of publication
2016 January
Publication type
Journal Article
Publication details
Global Social Policy 15 3 pp 345-348
Publication status
Published
Language
English
Keywords
Africa, governance, region, collaboration
Abstract
The authors argue that while it is important for individual countries to adopt measures specific to their circumstances, the AU and sub-regional bodies should adopt a new approach to dealing with funders. A multipronged strategy of cooperation between the African states, regional bodies, religious organisations or civil society, the private sector and donors could most likely be the winning strategy and should be enhanced and encouraged by both the AU and influential funders. The porous borders in Africa and limited resources in terms of health services provision necessitate cooperation across national boundaries to effectively combat the spread of diseases.
Country
Africa
Publisher
Global Social Policy
Theme area
Equity in health, Health equity in economic and trade policies, Poverty and health, Equitable health services, Governance and participation in health, Monitoring equity and research to policy
Title of publication Discussion paper 106: Responding to inequalities in health in urban areas: A review and annotated bibliography
Date of publication
2015 December
Publication type
Report
Publication details
Responding to inequalities in health in urban areas: A review and annotated bibliography, EQUINET Discussion paper 106, TARSC, EQUINET, Harare
Publication status
Published
Language
Keywords
urban health; inequalities in health; east and southern Africa
Abstract
Training and Research Support Centre (TARSC) as cluster lead of the “Equity Watch” work in EQUINET is following up on the findings of the 2012 Regional Equity Watch and the country Equity Watch reports with a deeper systematic analysis of available evidence on inequalities in health and its determinants within urban areas and the responses to urban inequalities from the health sector and through health promoting interventions of other sectors and communities acting on public health and the social determinants of health. This document presents evidence from 105 published papers in English post 2000 on patterns of and responses to urban inequalities in health in east and southern African countries. The evidence is presented in an annotated bibliography and analysis. It is being used to identify key areas of focus and parameters for deeper review and analysis. The picture presented in the literature is not a coherent one- it is rather a series of fragments of different and often disconnected facets of risk, health and care within urban areas. There is also limited direct voice of those experiencing the changes and limited report of the features of urbanisation that promote wellbeing. The literature found was significantly more focused on the challenges than on the solutions. The papers sourced confirmed the relevance of primary care and community-based approaches, with CHWs, to carry out participatory assessments, promote new PHC approaches, use social media and support service uptake to address urban determinants. However the documented interventions made weak links between PHC services, urban public health and the work of other sectors. The rapid, diverse and multifactorial changes taking place in urban areas, some of
which are poorly documented, also call for participatory approaches that include the direct voice of those experiencing urban life.
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Discussion paper
Theme area
Governance and participation in health
Title of publication Remaking suffering in a South African township
Date of publication
2015 February
Publication type
Journal Article
Publication details
Global Public Health 10 4 pp 449-462
Publication status
Published
Language
English
Keywords
noncommunicable disease, diabetes, HIV, AIDS, urban, women, South Africa, qualitative
Abstract
Escalation of non-communicable diseases (NCDs) among urban South African populations disproportionately afflicted by HIV/AIDS presents not only medical challenges but also new ways in which people understand and experience sickness. In Soweto, the psychological imprints of political violence of the Apartheid era and structural violence of HIV/AIDS have shaped social and health discourses. Yet, as NCDs increasingly become part of social and biomedical discussions in South African townships, new frames for elucidating sickness are emerging. This article employs the concept of syndemic suffering to critically examine how 27 women living with Type 2 diabetes in Soweto, a township adjacent to Johannesburg known for socio-economic mobility as well as inequality, experience and understand syndemic social and health problems. For example, women described how reconstructing families and raising grandchildren after losing children to AIDS was not only socially challenging but also affected how they ate, and how they accepted and managed their diabetes. Although previously diagnosed with diabetes, women illustrated how a myriad of social and health concerns shaped sickness. Many related diabetes treatment to shared AIDS nosologies, referring to diabetes as 'the same' or 'worse'. Conclusions: These narratives demonstrate how suffering weaves a social history where HIV becomes ordinary, and diabetes new.
Country
Publisher
Global Public Health
Theme area
Resource allocation and health financing
Title of publication Bringing stakeholders together for urban health equity: hallmarks of a compromised process
Date of publication
2015 November
Publication type
Journal Article
Publication details
International Journal for Equity in Health 14 138 pp /-/
Publication status
Published
Language
English
Keywords
equity, participatory processes, community engagement, governance
Abstract
There is a global trend towards the use of ad hoc participation processes that seek to engage grassroots stakeholders in decisions related to municipal infrastructure, land use and services. We present the results of a scholarly literature review examining 14 articles detailing specific cases of these processes to contribute to the discussion regarding their utility in advancing health equity. We explore hallmarks of compromised processes, potential harms to grassroots stakeholders, and potential mitigating factors. We conclude that participation processes often cut off participation following the planning phase at the point of implementation, limiting convener accountability to grassroots stakeholders, and, further, that where participation processes yield gains, these are often due to independent grassroots action. Given the emphasis on participation in health equity discourse, this study seeks to provide a real world exploration of the pitfalls and potential harms of participation processes that is relevant to health equity theory and practice.
Country
Publisher
International Journal for Equity in Health
Theme area
Governance and participation in health
Title of publication Prevention of hypertension and diabetes in an urban setting in South Africa: Participatory action research with community health workers
Date of publication
2007
Publication type
Journal Article
Publication details
Ethnicity and Disease 17 1 pp 49-51
Publication status
Published
Language
English
Keywords
hypertension, diabetes, urban, South Africa, participatory action research
Abstract
The project aimed to identify factors that contribute to hypertension and diabetes and to design and implement appropriate local interventions to prevent these non-communicable diseases and promote healthy lifestyles. This was a community-based participatory action research project in which researchers and community health workers (CHWs) were the main participants. The triple A approach to planning interventions was used, that is, the process of assessing the situation, analyzing the findings, and taking action based on this analysis. Both qualitative and quantitative methods were employed. Twenty-two CHWs working in site C, Khayelitsha, a deprived urban area of Cape Town, South Africa, participated in the study. KEY FINDINGS: Findings from the situational assessment indicated a lack of knowledge among CHWs and the community about hypertension and diabetes and the risk factors for these non-communicable diseases. Economic constraints and cultural beliefs and practices influenced the community’s food choices and participation in physical activity. Conclusions: On the basis of these findings, a training program was proposed that would provide CHWs with the skills to prevent hypertension and diabetes in their community. A program was developed and piloted by the project team. A health club that focuses on promoting healthy lifestyles is currently being piloted. This paper illustrates the unique involvement of CHWs in a successful participatory action research project on the prevention of hypertension and diabetes and promotion of health in a deprived urban setting. The project emphasizes the importance of involving local people in community-based initiatives to promote health and identifies that the primary role of health services is to develop appropriate skills in the local community, monitor activities, and facilitate a link with primary health services.
Country
Publisher
Ethnicity and Disease
Theme area
Resource allocation and health financing
Title of publication Cost-effectiveness of essential newborn care training in urban first-level facilities
Date of publication
2011 May
Publication type
Journal Article
Publication details
Pediatrics 127 5 pp e1176-e1181
Publication status
Published
Language
English
Keywords
neonatal, urban, primary care, Zambia
Abstract
To determine the cost-effectiveness of the World Health Organization (WHO) Essential Newborn Care (ENC) training of health care providers in first-level facilities in the 2 largest cities in Zambia. Data were extracted from a study in which the effectiveness of the ENC training was evaluated (including universal precautions and cleanliness, routine neonatal care, resuscitation, thermoregulation, breastfeeding, skin-to-skin care, care of the small infant, danger signs, and common illnesses) at 5-day ENC training-of-trainers in Lusaka to certified 18 college-trained midwives as ENC instructors. The costs to train an ENC instructor for each first-level delivery facility and the costs of salary/benefits for 2 coordinators responsible for maintenance of the program were recorded in 2005 US dollars. The incremental costs per life gained and per disability-adjusted life-year averted were calculated. The instructors trained all clinic midwives working in their first-level facilities as part of a before-and-after study of the effect of ENC training on early neonatal mortality conducted from Oct 2004 to Nov 2006. All-cause 7-day (early) neonatal mortality decreased from 11.5 per 1000 to 6.8 per 1000 live births after ENC training of the clinic midwives (relative risk: 0.59; 95% confidence interval: 0.48-0.77; P < .001; 40 615 births). The intervention costs were $208 per life saved and $5.24 per disability-adjusted life-year averted. Conclusions: ENC training of clinic midwives who provide care in low-risk facilities is a low-cost intervention that can reduce early neonatal mortality in these settings.
Country
Publisher
Pediatrics
Theme area
Resource allocation and health financing
Title of publication Determinants for participation in a public health insurance program among residents of urban slums in Nairobi, Kenya: Results from a cross-sectional survey
Date of publication
2012 March
Publication type
Journal Article
Publication details
BMC Health Services Research 12 66 pp /-/
Publication status
Published
Language
English
Keywords
public health insurance, NHIF, urban, slum, Kenya, cross-sectional survey
Abstract
The government of Kenya is making plans to implement a social health insurance program by transforming the National Hospital Insurance Fund (NHIF) into a universal health coverage program. This paper examines the determinants associated with participation in the NHIF among residents of urban slums in Nairobi city. The study used data from the Nairobi Urban Health and Demographic Surveillance System in two slums in Nairobi city, where a total of about 60,000 individuals living in approximately 23,000 households are under surveillance. Descriptive statistics and multivariate logistic regression analysis were used to describe the characteristics of the sample and to identify factors associated with participation in the NHIF program. Only 10% of the respondents were participating in the NHIF program, while less than 1% (0.8%) had private insurance coverage. The majority of the respondents (89%) did not have any type of insurance coverage. Females were more likely to participate in the NHIF program (OR = 2.4; p < 0.001), while respondents who were formerly in a union (OR = 0.5; p < 0.05) and who were never in a union (OR = 0.6; p < 0.05) were less likely to have public insurance coverage. Respondents working in the formal employment sector (OR = 4.1; p < 0.001) were more likely to be enrolled in the NHIF program compared to those in the informal sector. Membership in microfinance institutions such as savings and credit cooperative organizations (SACCOs) and community-based savings and credit groups were important determinants of access to health insurance. Conclusions: The proportion of slum residents without any type of insurance is high, which underscores the need for a social health insurance program to ensure equitable access to health care among the poor and vulnerable segments of the population. As the Kenyan government moves toward transforming the NHIF into a universal health program, it is important to harness the unique opportunities offered by both the formal and informal microfinance institutions in improving health care capacity by considering them as viable financing options within a comprehensive national health financing policy framework.
Country
Publisher
BMC Health Services Research
Theme area
Resource allocation and health financing
Title of publication Access to health care: The role of a community based health insurance in Kenya
Date of publication
2012 June
Publication type
Journal Article
Publication details
The Pan African Medical Journal 12 35 pp /-/
Publication status
Published
Language
English
Keywords
access, health care, community based health insurance, urban, slums, Kenya
Abstract
Out-of-pocket payments create financial barriers to health care access. There is an increasing interest in the role of community based health insurance schemes in improving equity and access of the poor to essential health care. The aim of this study was to assess the impact of Jamii Bora Health Insurance on access to health care among the urban poor. Data was obtained from the household health interview survey in Kibera and Mathare slums, which consisted of 420 respondents, aged 18 and above who were registered as members of Jamii Bora Trust. The members of Jamii Bora Trust were divided into two groups the insured and the non-insured. KEY In total, 17.9% respondents were hospitalized and women (19.6%) were more likely to be admitted than men (14.7%). Those in the poorest quintile had the highest probability of admission (18.1%). Those with secondary school education, large household size, and aged 50 and above also had slightly greater probability of admission (p<0.25). 86% of admissions among the insured respondents were covered JBHI and those in the poorest quintile were more likely to use the JBHI benefit. Results from the logistic regression revealed that the probability of being admitted, whether overall admission or admission covered by the JBHI benefit was determined by the presence of chronic condition (p<0.01). Conclusions: Utilization and take up of the JBHI benefits was high. Overall, JBHI favoured the members in the lower income quintiles who were more likely to use health care services covered by the JBHI scheme.
Country
Publisher
The Pan African Medical Journal
Theme area
Resource allocation and health financing
Title of publication Accessibility, affordability and use of health services in an urban area in South Africa
Date of publication
2015 March
Publication type
Journal Article
Publication details
Curationis 38 1 pp 1-7
Publication status
Published
Language
English
Keywords
health services, access, affordability, South Africa, cross-sectional, quantitative
Abstract
The aim of the study was to explore and describe accessibility, affordability and the use of health services by the mixed race (coloured) population in the Western Cape, South Africa. A cross-sectional descriptive, non-experimental study with a quantitative approach was applied. A purposive convenient sample of 353 participants (0.6%) was drawn from a population of 63 004 economically-active people who lived in the residential areas as defined for the purpose of the study. All social classes were represented. The hypothesis set was that there is a positive relationship between accessibility, affordability and the use of health services. A pilot study was conducted which also supported the reliability and validity of the study. Ethics approval was obtained from the University of Stellenbosch and informed consent from respondents. A questionnaire was used to collect the data. The hypothesis was accepted. The statistical association between affordability (p = < 0.01), accessibility (p = < 0.01) and the use of health services was found to be significant using the Chi-square (χ2) test The study has shown how affordability and accessibility may influence the use of healthcare services. Accessibility is not only the distance an individual must travel to reach the health service point but more so the utilisation of these services. Conclusions: Continuous Quality Management should be a priority in healthcare services, which should be user-friendly.
Country
Publisher
Curationis
Theme area
Resource allocation and health financing
Title of publication Catastrophic health expenditure and its determinants in Kenya slum communities
Date of publication
2015 December
Publication type
Journal Article
Publication details
International Journal for Equity in Health 14 46 pp /-/
Publication status
Published
Language
English
Keywords
catastrophic health expenditure, slums, informal settlements, Kenya, quantitative
Abstract
In Kenya, where 60 to 80% of the urban residents live in informal settlements (frequently referred to as slums), out-of-pocket (OOP) payments account for more than a third of national health expenditures. However, little is known on the extent to which these OOP payments are associated with personal or household financial catastrophe in the slums. This paper seeks to examine the incidence and determinants of catastrophic health expenditure among urban slum communities in Kenya. The authors use a unique dataset on informal settlement residents in Kenya and various approaches that relate households OOP payments for healthcare to total expenditures adjusted for subsistence, or income. They classified households whose OOP was in excess of a predefined threshold as facing catastrophic health expenditures (CHE), and identified the determinants of CHE using multivariate logistic regression analysis. The results indicate that the proportion of households facing CHE varies widely between 1.52% and 28.38% depending on the method and the threshold used. A core set of variables were found to be key determinants of CHE. The number of working adults in a household and membership in a social safety net appear to reduce the risk of catastrophic expenditure. Conversely, seeking care in a public or private hospital increases the risk of CHE. Conclusions: This study suggests that a substantial proportion of residents of informal settlements in Kenya face CHE and would likely forgo health care they need but cannot afford. Mechanisms that pool risk and cost (insurance) are needed to protect slum residents from CHE and improve equity in health care access and payment.
Country
Publisher
International Journal for Equity in Health
Theme area
Equitable health services
Title of publication Addressing social determinants of health by integrating assessment of caregiver-child attachment into community based primary health care in urban Kenya
Date of publication
2012 October
Publication type
Journal Article
Publication details
International Journal of Environmental Research and Public Health 9 10 pp /-/
Publication status
Published
Language
English
Keywords
social determinants of health, community health workers, urban, Kenya, survey
Abstract
A principle strategic insight of the Final Report for WHO’s Commission on Social Determinants of Health (SDOH) is that the nurturant qualities of the environments where children grow up, live, and learn matter the most for their development. A key determinant of early childhood development is the establishment of a secure attachment between a caregiver and child. This paper reports on initial field-tests of the integration of caregiver-child attachment assessment by community health workers (CHWs) as a routine component of Primary Health Care (PHC), focusing on households with children under 5 years of age in three slum communities near Nairobi, Kenya. Households in the targeted communities with one or more children under five years of age were included in this project. Each CHW was assigned households in the specific area most familiar to the CHW, until the CHW reached a maximum of 100 assigned households, for a maximum total of 2,400 households. Regular visits to households with children under 5 years of age began in 2008, and included many components of typical PHC models that are used in similar settings. Of the 2,560 children assessed from July–December 2010, 2,391 (90.2%) were assessed as having a secure attachment with a parent or other caregiver, while 259 (9.8%) were assessed as being at risk for having an insecure attachment. Parent workshops were provided as a primary intervention, with re-enforcement of teachings by CHWs on subsequent home visits. Reassessment of attachment by CHWs showed positive changes. Conclusions: Assessment of caregiver-child attachment in the setting of routine home visits by CHWs in a community-based PHC context is feasible and may yield valuable insights into household-level risks, a critical step for understanding and addressing the SDOH.
Country
Publisher
International Journal of Environmental Research and Public Health
Theme area
Equitable health services
Title of publication Assessment of the uptake of neonatal and young infant referrals by community health workers to public health facilities in an urban informal settlement, KwaZulu-natal, South Africa
Date of publication
2013 February
Publication type
Journal Article
Publication details
BMC Health Services Research 13 47 pp /-/
Publication status
Published
Language
English
Keywords
maternal health, community health worker, South Africa
Abstract
Globally, 40% of the 7.6 million deaths of children under five every year occur in the neonatal period (first 28 days after birth). Increased and earlier recognition of illness facilitated by community health workers (CHWs), coupled with effective referral systems can result in better child health outcomes. This model has not been tested in a peri-urban poor setting in Africa, or in a high HIV context. The Good Start Saving Newborn Lives (SNL) study (ISRCTN41046462) conducted in Umlazi, KwaZulu-Natal, was a community randomized trial to assess the effect of an integrated home visit package delivered to mothers by CHWs during pregnancy and post-delivery on uptake of PMTCT interventions and appropriate newborn care practices. CHWs were trained to refer babies with illnesses or identified danger signs. The aim of this sub-study was to assess the effectiveness of this referral system by describing CHW referral completion rates as well as mothers' health-care seeking practices. Interviews were conducted using a structured questionnaire with all mothers whose babies had been referred by a CHW since the start of the SNL trial. Descriptive analysis was conducted to describe referral completion and health seeking behaviour of mothers. Of the 2423 women enrolled in the SNL study, 148 sick infants were referred between June 2008 and June 2010. 62% of referrals occurred during the first 4 weeks of life and 22% between birth and 2 weeks of age. Almost all mothers (95%) completed the referral as advised by CHWs. Difficulty breathing, rash and redness/discharge around the cord accounted for the highest number of referrals (26%, 19% and 17% respectively). Only16% of health workers gave written feedback on the outcome of the referral to the referring CHW. Conclusions: We found high compliance with CHW referral of sick babies in an urban South African township. This suggests that CHWs can play a significant role, within community outreach teams, to improve newborn health and reduce child mortality. This supports the current primary health care re-engineering process being undertaken by the South African National Department of Health which involves the establishment of family health worker teams including CHWs.
Country
Publisher
BMC Health Services Research
Theme area
Equitable health services
Title of publication Assessment of the uptake of neonatal and young infant referrals by community health workers to public health facilities in an urban informal settlement, KwaZulu-natal, South Africa
Date of publication
2013 February
Publication type
Journal Article
Publication details
BMC Health Services Research 13 47 pp /-/
Publication status
Published
Language
English
Keywords
maternal health, community health worker, South Africa
Abstract
Globally, 40% of the 7.6 million deaths of children under five every year occur in the neonatal period (first 28 days after birth). Increased and earlier recognition of illness facilitated by community health workers (CHWs), coupled with effective referral systems can result in better child health outcomes. This model has not been tested in a peri-urban poor setting in Africa, or in a high HIV context. The Good Start Saving Newborn Lives (SNL) study (ISRCTN41046462) conducted in Umlazi, KwaZulu-Natal, was a community randomized trial to assess the effect of an integrated home visit package delivered to mothers by CHWs during pregnancy and post-delivery on uptake of PMTCT interventions and appropriate newborn care practices. CHWs were trained to refer babies with illnesses or identified danger signs. The aim of this sub-study was to assess the effectiveness of this referral system by describing CHW referral completion rates as well as mothers' health-care seeking practices. Interviews were conducted using a structured questionnaire with all mothers whose babies had been referred by a CHW since the start of the SNL trial. Descriptive analysis was conducted to describe referral completion and health seeking behaviour of mothers. Of the 2423 women enrolled in the SNL study, 148 sick infants were referred between June 2008 and June 2010. 62% of referrals occurred during the first 4 weeks of life and 22% between birth and 2 weeks of age. Almost all mothers (95%) completed the referral as advised by CHWs. Difficulty breathing, rash and redness/discharge around the cord accounted for the highest number of referrals (26%, 19% and 17% respectively). Only16% of health workers gave written feedback on the outcome of the referral to the referring CHW. Conclusions: We found high compliance with CHW referral of sick babies in an urban South African township. This suggests that CHWs can play a significant role, within community outreach teams, to improve newborn health and reduce child mortality. This supports the current primary health care re-engineering process being undertaken by the South African National Department of Health which involves the establishment of family health worker teams including CHWs.
Country
Publisher
BMC Health Services Research
Theme area
Equitable health services
Title of publication Improving recognition of severe illness and patient pathways in primary health services using mHealth technology in urban Blantyre, Malawi
Date of publication
2013 December
Publication type
Journal Article
Publication details
Journal of Mobile Technology in Medicine 2 4s pp 2-3
Publication status
Published
Language
English
Keywords
primary care, children, Malawi, m-health
Abstract
Recent research into health seeking pathways in Malawi identified primary level barriers linked to service provision and misdiagnoses. In Malawi an Emergency Triage, Assessment and Treatment (ETAT) package, approved by the World Health Organisation (WHO) has been introduced at tertiary level and is being rolled out to district and primary clinics. mHealth technologies are likely to sustain quality in implementing clinical protocols, particularly when community-based health providers with limited formal training are increasingly working to offset primary level staff shortages. We aimed to develop and evaluate feasibility and acceptability of a prototype primary care level intervention to improve triage, assessment and referral of children with severe illness in Blantyre and to investigate whether this facilitates systematic and timely recognition and response to severe illness. All paediatric cases within five primary clinics in urban Blantyre were triaged and assigned Red for Emergency, Amber for Priority and Green for Queue using the mHealth triage algorithm. Phones were assigned to triage, to clinicians and the A&E department within the local tertiary, referral hospital (Queen Elizabeth Central Hospital (QECH)) for monitoring patient referrals. Seventy-four healthcare staff were trained across five urban primary clinics. A total of 41,358 patients were assessed using the mHealth triage algorithm from December 2012 to May 2013, of whom 1.56% were referred to QECH. Rates of concordance between triage and clinician assessment showed a good level of agreement above chance. Pre- and post-Patient Journey Modelling tools identified positive changes in patient flows. Overall patient and health worker satisfaction was high with indirect impact on quality of clinical assessment amongst health workers based at intervention clinics but not directly involved in the intervention. This study has shown that mHealth technologies have the potential to improve primary level health services in resource-poor contexts with high patient numbers and overburdened health staff. Conclusions: Working in collaboration with the Ministry of Health the data we present will inform the development of a cluster-randomised trial to rigorously evaluate the role of mHealth in the implementation of ETAT. This will aid policy decisions around ETAT implementation at primary health level.
Country
Publisher
Journal of Mobile Technology in Medicine
Theme area
Equitable health services
Title of publication Closing the poor-rich gap in contraceptive use in urban Kenya: Are family planning programs increasingly reaching the urban poor?
Date of publication
2013 August
Publication type
Journal Article
Publication details
International Journal for Equity in Health 12 71 pp /-/
Publication status
Published
Language
English
Keywords
family planning, contraceptives, Kenya, household survey , quantitative
Abstract
Kenya is characterized by high unmet need for family planning (FP) and high unplanned pregnancy, in a context of urban population explosion and increased urban poverty. It witnessed an improvement of its FP and reproductive health (RH) indicators in the recent past, after a period of stalled progress. The objectives of the paper are to: a) describe inequities in modern contraceptive use, types of methods used, and the main sources of contraceptives in urban Kenya; b) examine the extent to which differences in contraceptive use between the poor and the rich widened or shrank over time; and c) attempt to relate these findings to the FP programming context, with a focus on whether the services are increasingly reaching the urban poor. We use data from the 1993, 1998, 2003 and 2008/09 Kenya demographic and health survey. Bivariate analyses describe the patterns of modern contraceptive use and the types and sources of methods used, while multivariate logistic regression models assess how the gap between the poor and the rich varied over time. The quantitative analysis is complemented by a review on the major FP/RH programs carried out in Kenya. There was a dramatic change in contraceptive use between 2003 and 2008/09 that resulted in virtually no gap between the poor and the rich in 2008/09, by contrast to the period 1993-1998 during which the improvement in contraceptive use did not significantly benefit the urban poor. Indeed, the late 1990s marked the realization by the Government of Kenya and its development partners, of the need to deliberately target the poor with family planning services. Most urban women use short-term and less effective methods, with the proportion of long-acting method users dropping by half during the review period. The proportion of private sector users also declined between 2003 and 2008/09. Conclusions: The narrowing gap in the recent past between the urban poor and the urban rich in the use of modern contraception is undoubtedly good news, which, coupled with the review of the family program context, suggests that family planning programs may be increasingly reaching the urban poor.
Country
Publisher
International Journal for Equity in Health
Theme area
Equitable health services
Title of publication Treatment-seeking behaviour, cost burdens and coping strategies among rural and urban households in coastal Kenya: An equity analysis
Date of publication
2007 May
Publication type
Journal Article
Publication details
Tropical Medicine & International Health 12 5 pp 673-686
Publication status
Published
Language
English
Keywords
health services, urban, socioeconomic inequalities, Kenya, household survey
Abstract
Ill-health can inflict costs on households directly through spending on treatment and indirectly through impacting on labour productivity. The financial burden can be high and, for poor households, contributes significantly to declining welfare. This study investigated socio-economic inequities in self-reported illnesses, treatment-seeking behaviour, cost burdens and coping strategies in a rural and urban setting along the Kenyan coast. The authors conducted a survey of 294 rural and 576 urban households, 9 FGDs and 9 in-depth interviews in each setting. Key findings were significantly higher levels of reported chronic and acute conditions in the rural setting, differences in treatment-seeking patterns by socio-economic status (SES) and by setting, and regressive cost burdens in both areas. Conclusions: These data suggest the need for greater government and non-government efforts to protect poor people from catastrophic illness cost burdens. Promising health sector options are elimination of user fees, at least in targeted hardship areas, developing more flexible charging systems, and improving quality of care in all facilities. The data also support a multi-sectoral approach to protecting households. Potential interventions beyond the health sector include supporting the social networks that are key to household livelihood strategies and promoting micro-finance schemes that enable small amounts of credit to be accessed with minimal interest rates.
Country
Publisher
Tropical Medicine & International Health
Theme area
Equitable health services
Title of publication Patterns and determinants of health care utilization: An assessment of high density urban areas in Harare, Zimbabwe
Date of publication
2008 June
Publication type
Academic paper
Publication details
Master's Thesis / / pp /-/
Publication status
Published
Language
English
Keywords
determinants, patterns, health care utilization,urban, Zimbabwe, cross-sectional survey
Abstract
Zimbabwe has been well known, since independence in 1980, to have one of the best health care systems in Sub-Saharan Africa regardless of a low economic growth pattern. The gains in health status that have been reaped in the 1980s and early 1990s have now been reversed due to the combination of the effects of structural adjustments policies, intermittent drought, a decline in the quality of health care services and severe economic decline. The current economic environment places pressure on households, especially the poorest, to meet the rising costs of individual medical care. The study focused on the evaluation of the patterns and determinants of health care utilization, which can aid in understanding the responsiveness of individuals to the current health care system in light of the economic climate. A detailed assessment of health seeking behaviour and health care utilization was performed using a cross-sectional household community survey comprising of 527 households (2302 individuals) that were randomly selected in three high density suburbs in Harare, Zimbabwe. Information pertaining to demographics, socio-economic status, and health status in addition to the experiences in the use of health care services or health care providers was collected using a questionnaire. A tenth of the sample population suffering from a health problem or illness in the 4 weeks preceding the interviews. The majority of individuals either sought care at a facility (44%) or did not seek care at all (32%). Health issues ranged from fever to chronic disease. Females, large sized households, and those with more severe illness were more likely to seek care. The majority of individuals felt that the quality of health services is poorer than it was before the economic crisis ensued in 2002. Conclusions: The health care system needs to present viable solutions in order to maintain health care service delivery amidst the economic crisis. Of great concern to many was the availability and affordability of drugs (28%) and improved work environment and number of health workers (21%).
Country
Publisher
University of Cape Town
Theme area
Equitable health services
Title of publication For someone who’s rich, it’s not a problem”. insights from Tanzania on diabetes health-seeking and medical pluralism among Dar es Salaam’s urban poor
Date of publication
2010 May
Publication type
Journal Article
Publication details
Globalization and Health 6 8 pp /-/
Publication status
Published
Language
English
Keywords
diabetes management, Dar es Salaam, Tanzania, ethnographic study
Abstract
The prevalence of chronic non-communicable disease, such as type 2 diabetes mellitus (T2DM), is rising worldwide. In Africa, T2DM is primarily affecting those living in urban areas and increasingly affecting the poor. Diabetes management among urban poor is an area of research that has received little attention. Based on ethnographic fieldwork in Dar es Salam, the causes and conditions for diabetes management in Tanzania have been examined. In this paper, we focus on the structural context of diabetes services in Tanzania; the current status of biomedical and ethnomedical health care; and health-seeking among people with T2DM. Two months of ethnographic fieldwork was carried out in 2008 among urban poor with T2DM in Dar es Salaam, Tanzania. In 2009 a brief follow-up visit was conducted. We demonstrate that although Tanzania is actively developing its diabetes services, many people with diabetes and low socioeconomic status are unable to engage continuously in treatment. Conclusions: There are many challenges to be addressed to support people accessing diabetes health care services and improve diabetes management.
Country
Publisher
Globalization and Health
Theme area
Equitable health services
Title of publication Assessment of facilitators and barriers to maternal and child health services in four rural and urban districts of Zimbabwe
Date of publication
2012 May
Publication type
Report
Publication details
TARSC UNICEF CCORE / / pp /-/
Publication status
Published
Language
English
Keywords
maternal and child health, women, children under five, Zimbabwe, cross-sectional study
Abstract
This study aimed to assess the facilitators and barriers to access to maternal and child health services in women and in children under five years in Zimbabwe. It was commissioned by UNICEF and implemented by TARSC with guidance and peer review from Ministry of Health and Child Welfare. Using a cross sectional study design, interviews were implemented with 1018 households with at least one woman who was pregnant in the last year and with a live child less than 5 years of age as well as 24 key informants from community, health workers, local government and NGOs personnel. The widest gaps in health need were by residence (urban-rural) and economic/ wealth status, including for poorest groups within urban areas. Geographical targeting and the lifting of user fees in part address economic differentials in health, but further measures are needed to support uptake, such as social communication and interaction with community health workers. The association between absence of safe sanitation and elevated risk of diarrhoeal disease points to the need to invest in improved sanitation. The use of public services for MCH was high across all wealth groups. Distance to services, availability of supplies and costs (transport and service) were the major barriers to service uptake and coverage, more for maternal health services than for child health services. This calls both for fee barriers to be lifted and supplies and staffing to be funded. If supply side issues are not addressed, people incur high costs to travel to more distant services with supplies and staff, increasing catastrophic expenditure even after fees are lifted. The evidence suggests that the most critical measure is to bring the relevant staff and supplies needed for essential maternal and child health services to primary care level, to avoid the cost burdens and differentials in coverage that arise if people have to travel to reach services with supplies and staff. The service deficits identified at primary care level included vaccine supplies, contraceptives, midwives, waiting mother shelters and ambulances, with the latter two needed for referrals to district services. As follow up, comprehensive audit and gap analysis against service standards (essential benefits) at primary care level can inform resource allocation, while supply chain / bottleneck analysis can identify the causes of these shortfalls and stock-outs at primary care level. Cost was a key barrier. The finding that poorer groups in both urban and rural areas spend a higher share of their income on maternal health services is highly inequitable. Lower income households find the costs of maternal health services unaffordable, with high levels of asset sales in the poorest groups that may be contributing to further impoverishment. There was a consistent view across all groups that all charges for consultation, diagnostics and medicines should be removed at primary care level (backed by improved supplies), with funding to ensure that this is also applied in urban councils. There was less consistency in the views on charges at district level. The facilitators are the inverse of the barriers. In addition, community health cadres (VHWs, EHTs, CBDs) were found to support effective uptake, as do improved education and income in women and supportive family influence. Conclusions: These factors point to the need for measures that support women at both individual and social level, and that link women to community level actors and resources (community health workers, antenatal groups, early child education groups, waiting mother shelters) to support their decisions and actions on health.
Country
Publisher
TARSC UNICEF CCORE
Theme area
Equitable health services
Title of publication Determinants of maternal health services utilization in urban settings of the Democratic Republic of Congo--a case study of Lubumbashi City
Date of publication
2012 July
Publication type
Journal Article
Publication details
BMC Pregnancy and Childbirth 12 66 pp /-/
Publication status
Published
Language
English
Keywords
ANC, health care utilization, urban, DRC, indicator cluster survey
Abstract
This study was undertaken in order to determine the factors that influence the use of mother and child healthcare services in Lubumbashi, Democratic Republic of the Congo. This was transversal study of women residing in Lubumbashi who had delivered between January and December 2009. In total, 1762 women were sampled from households using indicator cluster surveys in all health zones. Antenatal consultations (ANC), delivery assisted by qualified healthcare personnel (and delivery in a healthcare facility) as well as postnatal consultations (PNC) were dependent variables of study. The factors determining non-use of maternal healthcare services were researched via logistic regression with a 5% materiality threshold. The use of maternal healthcare services was variable; 92.6% of women had attended ANC at least once, 93.8% of women had delivered at a healthcare facility, 97.2% had delivered in the presence of qualified healthcare personnel, while the rate of caesarean section was 4.5%. Only 34.6% postnatal women had attended PNC by 42 days after delivery. During these ANC visits, only 60.6% received at least one dose of vaccine, while 38.1% received Mebendazole, 35.6% iron, 32.7% at least one dose of Sulfadoxine Pyrimethamine, 29.2% folic acid, 15.5% screening for HIV and 12.8% an insecticide treated net.In comparison to women that had had two or three deliveries before, primiparous and grand multiparous women were twice as likely not to use ANC during their pregnancy. Women who had unplanned pregnancies were also more likely not to use ANC or PNC than those who had planned pregnancies alone or with their partner. The women who had not used ANC were also more likely not to use PNC. The women who had had a trouble-free delivery were more likely not to use PNC than those who had complications when delivering. Conclusions: In Lubumbashi, a significant proportion of women continue not to make use of healthcare services during pregnancy, as well as during and after childbirth. Women giving birth for the first time, those who have already given birth many times, and women with an unwanted pregnancy, made less use of ANC. Moreover, women who had not gone for ANC rarely came back for postnatal consultations, even if they had given birth at a healthcare facility. Similarly, those who gave birth without complications, less frequently made use of postnatal consultations. As with ANCs, women with unwanted pregnancies rarely went for postnatal visits. In addition to measures aimed at reinforcing women's autonomy, efforts are also needed to reinforce and improve the information given to women of childbearing age, as well as communication between the healthcare system and the community, and participation from the community, since this will contribute to raising awareness of safe motherhood and the use of such services, including family planning.
Country
Publisher
BMC Pregnancy and Childbirth
Theme area
Equitable health services
Title of publication Health status and socio-economic factors associated with health facility utilization in rural and urban areas in Zambia
Date of publication
2012 November
Publication type
Journal Article
Publication details
BMC Health Services Research 12 389 pp /-/
Publication status
Published
Language
English
Keywords
health facility utilization, HIV prevalence, HIV status, adults, quantitative
Abstract
With regards to equity, the objective for health care systems is "equal access for equal needs". The authors examined associations of predisposing, enabling and need factors with health facility utilization in areas with high HIV prevalence and few people being aware of their HIV status. The data is from a population-based survey among adults aged 15 years or older conducted in 2003. The current study is based on a subset of this data of adults 15-49 years with a valid HIV test result. A modified health behaviour model guided our analytical approach. We report unadjusted and adjusted odds ratios and their 95% confidence intervals from logistic regression analyses. Totals of 1042 males and 1547 females in urban areas, and 822 males and 1055 females in rural areas were included in the study. Overall, 53.1% of urban and 56.8% of rural respondents utilized health facilities past 12 months. In urban areas, significantly more females than males utilized health facilities (OR=1.4 (95% CI [1.1, 1.6]). Higher educational attainment (10+ years of schooling) was associated with utilization of health facilities in both urban (OR=1.7, 95% CI [1.3, 2.1]) and rural (OR=1.4, 95% CI [1.0, 2.0]) areas compared to respondents who attained up to 7 years of schooling. Respondents who self-rated their health status as very poor/ poor/fair were twice more likely to utilize health facilities compared to those who rated their health as good/excellent. Respondents who reported illnesses were about three times more likely to utilize health facilities compared to those who did not report the illnesses. In urban areas, respondents who had mental distress were 1.7 times more likely to utilize health facilities compare to those who had no mental distress. Compared to respondents who were HIV negative, respondents who were HIV positive were 1.3 times more likely to utilize health facilities. Conclusions: The health care needs were the factors most strongly associated with health care seeking. After accounting for need differentials, health care seeking differed modestly by urban and rural residence, was somewhat skewed towards women, and increased substantially with socioeconomic position.
Country
Publisher
BMC Health Services Research
Theme area
Equitable health services
Title of publication Patient and health system delay among patients with pulmonary tuberculosis in Beira City, Mozambique
Date of publication
2013 June
Publication type
Journal Article
Publication details
BMC Public Health 13 559 pp /-/
Publication status
Published
Language
English
Keywords
pulmonary TB, risk factors, prevalence, Beira, Mozambique, cross-sectional study
Abstract
The purpose of this study was to assess the prevalence of and identify risk factors associated with patient delay and health system delay among newly diagnosed patients with pulmonary TB. A cross sectional study was carried out in Beira city, Mozambique between September 2009 and February 2010. Patients in the first month of treatment were consecutively selected to this study if they had a diagnosis of pulmonary TB, had no history of previous TB treatment, and were 18 years or older and provided informed consent. Data was obtained through a questionnaire administered to the patients and from patients' files. Among the 622 patients included in the study the median age was 32 years (interquartile range, 26-40) and 272 (43.7%) were females. The median total delay, patient delay and health system delay was 150 days (interquartile range, 91-240), 61 days (28-113) and 62 days (37-120), respectively. The contribution of patient delay and health system delay to total delay was similar. Farming, visiting first a traditional healer, low TB knowledge and coexistence of a chronic disease were associated with increased patient delay. More than two visits to a health facility, farming and coexistence of a chronic disease were associated with increased health system delay. Conclusions: This study revealed a long total delay with a similar contribution of patient delay and health system delay. To reduce the total delay in this setting we need a combination of interventions to encourage patients to seek appropriate health care earlier and to expedite TB diagnosis within the health care system.
Country
Publisher
BMC Public Health
Theme area
Equitable health services
Title of publication Maternal health care utilization in Nairobi and Ouagadougou: Evidence from HDSS
Date of publication
2014 July
Publication type
Journal Article
Publication details
Global Health Action 7 24351 pp 1-10
Publication status
Published
Language
English
Keywords
ANC, maternal health care, slums utilization, DSS, Nairobi, Kenya
Abstract
Maternal mortality is higher and skilled attendance at delivery is lower in the slums of Nairobi (Kenya) compared to Ouagadougou (Burkina Faso). Lower numbers of public health facilities, greater distance to facilities, and higher costs of maternal health services in Nairobi could explain these differences. By comparing the use of maternal health care services among women with similar characteristics in the two cities, the authors produce a more nuanced picture of the contextual factors at play. Birth statistics were collected between 2009 and 2011 in all households living in several poor neighborhoods followed by the Nairobi and the Ouagadougou Health and Demographic Surveillances Systems (n=3,346 and 4,239 births). We compare the socioeconomic characteristics associated with antenatal care (ANC) use were compared with deliveries at health facilities, controlling for demographic variables. ANC use is greater in Nairobi than in Ouagadougou for every category of women. In Ouagadougou, there are few differentials in having at least one ANC visit and in delivering at a health facility; however, differences are observed for completing all four ANC visits. In Nairobi, less-educated, poorer, non-Kikuyu women, and women living in the neighborhood farther from public health services have poorer ANC and deliver more often outside of a health facility. Conclusions: These results suggest that women are more aware of the importance of ANC utilization in Nairobi compared to Ouagadougou. The presence of numerous for-profit health facilities within slums in Nairobi may also help women have all four ANC visits, although the services received may be of substandard quality. In Ouagadougou, the lack of socioeconomic differentials in having at least one ANC visit and in delivering at a health facility suggests that these practices stem from the application of well-enforced maternal health regulations; however, these regulations do not cover the entire set of four ANC visits.
Country
Publisher
Global Health Action
Theme area
Equitable health services
Title of publication Socio demographic characteristics, antenatal clinic attendance and PMTCT knowledge of postnatal HIV women at an urban public health facility in Nairobi, Kenya
Date of publication
2015
Publication type
Report
Publication details
/ / / pp /-/
Publication status
Published
Language
English
Keywords
PMTCT, ARV uptake, HIV+, women, Nairobi, Kenya, cross-sectional study
Abstract
Women who have inadequate or poor knowledge about Prevention of Mother to Child Transmission (PMTCT) of Human Immunodeficiency Virus (HIV) are more likely to default on antiretroviral treatment and less likely to implement MTCT preventive measures thus a sub-optimal viral suppression and an increase in MTCT rates. Early and frequent Antenatal Clinic (ANC) attendance integrated with PMTCT services increases MTCT knowledge and uptake of the services thus optimising intervention outcomes. The aim of this study was to determine the sociodemographic characteristic levels that influence Antenatal Clinic (ANC) attendance, PMTCT knowledge and Antiretroviral (ARV) drugs uptake among postnatal HIV+ women in Pumwani Maternity Hospital in Nairobi, Kenya. This was a cross-sectional descriptive study that was conducted at Pumwani Maternity Hospital which is in a low social income set up in Nairobi County. The hospital has active ANC and Postnatal Clinic (PNC) facilities that provide PMTCT and specialist referral obstetric services to more than 30,000 maternity clients annually. HIV+ positive postnatal women who were seeking health services at the hospital were identified using their health records and recruited into the study either while still in the postnatal ward after delivery or during post natal clinic visits within the period of the study. Standardized structured questionnaire was administered to collect the appropriate study data from the mothers. The main gaps that were observed in this study are the late initiation and low frequency of ANC attendance, low PMTCT knowledge and delayed first visit and uptake of ARV's among HIV+ women in this low socioeconomic set up. Conclusions: This calls for improvement of health services and community oriented PMTCT education in the peripheral health facilities where the bulk of ANC activities took place.
Country
Publisher
/
Theme area
Equitable health services
Title of publication Socio demographic characteristics, antenatal clinic attendance and PMTCT knowledge of postnatal HIV women at an urban public health facility in Nairobi, Kenya
Date of publication
2015
Publication type
Report
Publication details
/ / / pp /-/
Publication status
Published
Language
English
Keywords
PMTCT, ARV uptake, HIV+, women, Nairobi, Kenya, cross-sectional study
Abstract
Women who have inadequate or poor knowledge about Prevention of Mother to Child Transmission (PMTCT) of Human Immunodeficiency Virus (HIV) are more likely to default on antiretroviral treatment and less likely to implement MTCT preventive measures thus a sub-optimal viral suppression and an increase in MTCT rates. Early and frequent Antenatal Clinic (ANC) attendance integrated with PMTCT services increases MTCT knowledge and uptake of the services thus optimising intervention outcomes. The aim of this study was to determine the sociodemographic characteristic levels that influence Antenatal Clinic (ANC) attendance, PMTCT knowledge and Antiretroviral (ARV) drugs uptake among postnatal HIV+ women in Pumwani Maternity Hospital in Nairobi, Kenya. This was a cross-sectional descriptive study that was conducted at Pumwani Maternity Hospital which is in a low social income set up in Nairobi County. The hospital has active ANC and Postnatal Clinic (PNC) facilities that provide PMTCT and specialist referral obstetric services to more than 30,000 maternity clients annually. HIV+ positive postnatal women who were seeking health services at the hospital were identified using their health records and recruited into the study either while still in the postnatal ward after delivery or during post natal clinic visits within the period of the study. Standardized structured questionnaire was administered to collect the appropriate study data from the mothers. The main gaps that were observed in this study are the late initiation and low frequency of ANC attendance, low PMTCT knowledge and delayed first visit and uptake of ARV's among HIV+ women in this low socioeconomic set up. Conclusions: This calls for improvement of health services and community oriented PMTCT education in the peripheral health facilities where the bulk of ANC activities took place.
Country
Publisher
/
Theme area
Equitable health services
Title of publication Understanding inequities in child vaccination rates among the urban poor: Evidence from Nairobi and Ouagadougou health and demographic surveillance systems
Date of publication
2015 February
Publication type
Journal Article
Publication details
Journal of Urban Health : Bulletin of the New York Academy of Medicine 92 1 pp 39-54
Publication status
Published
Language
English
Keywords
child vaccination, Nairobi, Kenya, DDS, comparative study
Abstract
Studies on informal settlements in sub-Saharan Africa have questioned the health benefits of urban residence, but this should not suggest that informal settlements (within cities and across cities and/or countries) are homogeneous. They vary in terms of poverty, pollution, overcrowding, criminality, and social exclusion. Moreover, while some informal settlements completely lack public services, others have access to health facilities, sewers, running water, and electricity. There are few comparative studies that have looked at informal settlements across countries accounting for these contextual nuances. In this paper, we comparatively examine the differences in child vaccination rates between Nairobi and Ouagadougou's informal settlements. We further investigate whether the identified differences are related to the differences in demographic and socioeconomic composition between the two settings. We use data from the Ouagadougou and Nairobi Urban Health and Demographic Surveillance Systems (HDSSs), which are the only two urban-based HDSSs in Africa. The results show that children in the slums of Nairobi are less vaccinated than children in the informal settlements in Ouagadougou. Conclusions: The difference in child vaccination rates between Nairobi and Ouagadougou informal settlements are not related to the differences in their demographic and socioeconomic composition but to the inequalities in access to immunization services.
Country
Publisher
Journal of Urban Health : Bulletin of the New York Academy of Medicine
Theme area
Equitable health services
Title of publication Determinants of immunization inequality among urban poor children: Evidence from Nairobi's informal settlements
Date of publication
2015 February
Publication type
Journal Article
Publication details
International Journal for Equity in Health 14 24 pp 1-5
Publication status
Published
Language
English
Keywords
urban, children, disparities, immunization, Nairobi, Kenya, cross-sectional survey
Abstract
Despite the relentless efforts to reduce infant and child mortality with the introduction of the National Expanded Programmes on Immunization (EPI) in 1974, major disparities still exist in immunizations coverage across different population sub-groups. In Kenya, for instance, while the proportion of fully immunized children increased from 57% in 2003 to 77% in 2008-9 at national level and 73% in Nairobi, only 58% of children living in informal settlement areas are fully immunized. The study aims to determine the degree and determinants of immunization inequality among the urban poor of Nairobi. We used data from the Nairobi Cross-Sectional Slum Survey of 2012 and the health outcome was full immunization status among children aged 12-23 months. The wealth index was used as a measure of social economic position for inequality analysis. The potential determinants considered included sex of the child and mother's education, their occupation, age at birth of the child, and marital status. The concentration index (CI) was used to quantify the degree of inequality and decomposition approach to assess determinants of inequality in immunization. The CI for not fully immunized was -0.08 indicating that immunization inequality is mainly concentrated among children from poor families. Decomposition of the results suggests that 78% of this inequality is largely explained by the mother's level of education. Conclusions: There exists immunization inequality among urban poor children in Nairobi and efforts to reduce this inequality should aim at targeting mothers with low level of education during immunization campaigns.
Country
Publisher
International Journal for Equity in Health
Theme area
Equitable health services
Title of publication The impact of health service variables on healthcare access in a low resourced urban setting in the Western Cape, South Africa
Date of publication
2015 June
Publication type
Journal Article
Publication details
African Journal of Primary Health Care & Family Medicine 7 1 pp 1-11
Publication status
Published
Language
English
Keywords
service delivery, access, South Africa, qualitative
Abstract
Health care access is complex and multi-faceted and, as a basic right, equitable access and services should be available to all user groups. The aim of this article is to explore how service delivery impacts on access to healthcare for vulnerable groups in an urban primary health care setting in South Africa. A descriptive qualitative study design was used. Data were collected through semi-structured interviews with purposively sampled participants and analysed through thematic content analysis. Service delivery factors are presented against five dimensions of access according to the ACCESS Framework. From a supplier perspective, the organisation of care in the study setting resulted in available, accessible, affordable and adequate services as measured against the District Health System policies and guidelines. However, service providers experienced significant barriers in provision of services, which impacted on the quality of care, resulting in poor client and provider satisfaction and ultimately compromising acceptability of service delivery. Although users found services to be accessible, the organisation of services presented them with challenges in the domains of availability, affordability and adequacy, resulting in unmet needs, low levels of satisfaction and loss of trust. These challenges fuelled perceptions of unacceptable services. Conclusions: Well developed systems and organisation of services can create accessible, affordable and available primary healthcare services, but do not automatically translate into adequate and acceptable services. Focussing attention on how services are delivered might restore the balance between supply (services) and demand (user needs) and promote universal and equitable access.
Country
Publisher
African Journal of Primary Health Care & Family Medicine
Theme area
Values, policies and rights
Title of publication Towards spatial justice in urban health services planning: A spatial-analytic GIS-based approach using Dar es Salaam, Tanzania as a case study
Date of publication
2007
Publication type
Academic paper
Publication details
Dissertation Thesis / / pp /-/
Publication status
Published
Language
English
Keywords
urban, health services, equity, Tanzania, spatial analysis
Abstract
The overarching aim of this study is to develop a GIS-based planning approach that contributes to equitable and efficient provision of urban health services in cities in sub-Saharan Africa. Its prime concern is with (i) the identification of theoretical and methodological constructs that can be used to analyse and improve the spatial performance of public health service delivery systems, and (ii) the development of a corresponding spatial-analytic and GIS-based planning approach using Dar es Salaam as a case study. The context of the study is the 'urban health crisis'; a term that refers to the disparity between the increasing need for medical care in urban areas against the declining carrying capacity of existing public health systems. The evaluation framework appraises the performance of the existing Dar es Salaam governmental health delivery system on the basis of generic quantitative accessibility indicators. The intervention framework explores how existing health needs can better be served by proposing alternative spatial arrangements of provision using scarce health resources. It consists of a set of 'what if' type of planning instruments to support health planners to (i) detect spatial deficiencies of a given delivery system, (ii) propose priority spatial planning interventions and (iii) estimate the expected impact of potential interventions on spatial performance. Conclusions: When used in concert the developed planning instruments offer a flexible framework with which health planners can formulate and evaluate alternative intervention scenarios and deal with the most important problems involved in the spatial planning of urban health services. The planning instruments, finally, are designed to contribute to making informed spatial decisions; not to automate but rather to support part of the planning process. The guiding principles of the primary health care approach (equity, effectiveness and efficiency) form the point of departure of the research. They demonstrate that health care provision is inevitably tied up with issues of resource allocation, distribution and priority setting. Decisions have to be made about the nature and range of services to provide and how they are distributed amongst the members of society. Such decisions are informed by economic, political, medical and ethical considerations but - as this research underlines - should also consider the spatial dimension
Country
Publisher
International Institute for Geo-Information Science and Earth Observation, University of Utrecht
Theme area
Values, policies and rights
Title of publication Women empowerment and practices regarding use of dual protection among family planning clients in urban Zimbabwe
Date of publication
2014 April
Publication type
Journal Article
Publication details
The Pan African Medical Journal 17 300 pp 1-7
Publication status
Published
Language
English
Keywords
women, dual protection, family planning, Zimbabwe, quantitative
Abstract
Gender related vulnerability may increase women's susceptibility to HIV infection and unintended pregnancy. The purpose of the study was to examine the relationship between women empowerment and practices regarding use of dual protection. METHODS: A non-experimental descriptive correlational study design was conducted using systematic sampling method to recruit eighty women aged 18-49 years at an urban clinic in Zimbabwe. Data was collected using a structured interview schedule and was analysed and presented using descriptive and inferential statistics. A weak positive significant correlation existed between women empowerment and use of dual protection (r= .242, p=0.03). Findings demonstrated that as women empowerment levels increase practices regarding use of dual protection also increase. The coefficient of determination, R2=.0.058, b=0.293, indicated that the total amount of variation in utilization of dual protection explained by level of women empowerment was 5.8%. The major finding was that use of dual protection was very low (3.8%) and 67.5% had low levels of practices regarding use of dual protection. Additionally, 85.0% were not confident of using the female condom. Conclusions: Gender inequality within sexual relations was associated with low levels of practices regarding use of dual protection. The study provided evidence for the need for a proactive integrated approach to empower women so that they could negotiate for safer sex practices. To increase female condom utilization, manufacturers need to redesign the female condom so that it becomes user friendly. Health personnel need to involve men for any health reproductive program to succeed.
Country
Publisher
The Pan African Medical Journal
Theme area
Equity and HIV/AIDS
Title of publication Strong association between in-migration and HIV prevalence in urban sub-Saharan Africa
Date of publication
2010 December
Publication type
Journal Article
Publication details
Sexually Transmitted Diseases 37 4 pp 240-243
Publication status
Published
Language
English
Keywords
HIV prevalence, migration, urban, sub-Saharan Africa, quantitative
Abstract
Enormous variation exists in HIV prevalence between countries in sub-Saharan Africa. The contribution of migration to the spread of HIV has long been recognized, but its effect at the population level has never been assessed. In this ecological analysis, we explore how much variation in HIV prevalence in urban sub-Saharan Africa is explained by in-migration. We performed a linear regression to analyze the association between the proportion of recent in-migrants and HIV prevalence for men and women in urban areas, using 60 data points from 28 sub-Saharan African countries between 1987 and 2005. KEY FINDINGS: We found a strong association between recent in-migration and HIV prevalence for women (Pearson R = 57%, P < 0.001) and men (R = 24%, P = 0.016), taking the earliest data point for each country. For women, the association was also strong within east/southern Africa (R = 50%, P = 0.003). For both genders, the association was strongest between 1985 and 1994, slightly weaker between 1995 and 1999, and nonexistent as from 2000. The overall association for both men and women was not confounded by the developmental indicators GNI per capita, income inequalities, or adult literacy. Conclusions: Migration explains much of the variation in HIV spread in urban areas of sub-Saharan Africa, especially before the year 2000, after which HIV prevalences started to level off in many countries. Our findings suggest that migration is an important factor in the spread of HIV, especially in rapidly increasing epidemics.
Country
Publisher
Sexually Transmitted Diseases
Theme area
Equity and HIV/AIDS
Title of publication Are slum dwellers at heightened risk of HIV infection than other urban residents? evidence from population-based HIV prevalence surveys in Kenya
Date of publication
2012 September
Publication type
Journal Article
Publication details
Health & Place 18 5 pp 1144-1152
Publication status
Published
Language
English
Keywords
intra-urban differences, HIV prevalence, slums, Kenya, quantitative, household survey
Abstract
In 2008, the global urban population surpassed the rural population and by 2050 more than 6 billion will be living in urban centres. A growing body of research has reported on poor health outcomes among the urban poor but not much is known about HIV prevalence among this group. A survey of nearly 3000 men and women was conducted in two Nairobi slums in Kenya between 2006 and 2007, where respondents were tested for HIV status. In addition, data from the 2008/2009 Kenya Demographic and Health Survey were used to compare HIV prevalence between slum residents and those living in other urban and rural areas. The results showed strong intra-urban differences. HIV was 12% among slum residents compared with 5% and 6% among non-slum urban and rural residents, respectively. Generally, men had lower HIV prevalence than women although in the slums the gap was narrower. Among women, sexual experience before the age of 15 compared with after 19 years was associated with 62% higher odds of being HIV positive. There was ethnic variation in patterns of HIV infection although the effect depended on the current place of residence. Conclusions: Population based HIV surveys should include older people to help us understand the HIV situation at older ages. Addressing risky sexual practices such as early sexual debut is one strategy which could lead to lower HIV rates among slum dwellers. In addition, addressing the lack of security and sexual violence in the slums could confer protection among young girls and women. Contrary to what has been published in many reports, socioeconomic status was not positively associated with HIV status in these samples but found that current age, marital status, and ethnicity were the most important in explaining the differences in HIV rates. HIV prevention efforts and treatment programmes should target the urban poor and they should acknowledge that city dwellers are not a homogeneous group.
Country
Publisher
Health & Place
Theme area
Equity in health
Title of publication Progress towards the child mortality millennium development goal in urban Sub-Saharan Africa: The dynamics of population growth, immunization, and access to clean water
Date of publication
2007 August
Publication type
Journal Article
Publication details
BMC Public Health 7 218 pp /-/
Publication status
Published
Language
English
Keywords
urban, population growth, childhood mortality, sub-Saharan Africa, household survey
Abstract
Improvements in child survival have been very poor in sub-Saharan Africa (SSA). Since the 1990 s, declines in child mortality have reversed in many countries in the region, while in others, they have either slowed or stalled, making it improbable that the target of reducing child mortality by two thirds by 2015 will be reached. This paper highlights the implications of urban population growth and access to health and social services on progress in achieving MDG 4. Specifically, it examines trends in childhood mortality in SSA in relation to urban population growth, vaccination coverage and access to safe drinking water. Correlation methods are used to analyze national-level data from the Demographic and Health Surveys and from the United Nations. The analysis is complemented by case studies on intra-urban health differences in Kenya and Zambia. Only five of the 22 countries included in the study have recorded declines in urban child mortality that are in line with the MDG target of about 4% per year; five others have recorded an increase; and the 12 remaining countries witnessed only minimal decline. More rapid rate of urban population growth is associated with negative trend in access to safe drinking water and in vaccination coverage, and ultimately to increasing or timid declines in child mortality. There is evidence of intra-urban disparities in child health in some countries like Kenya and Zambia. Conclusions: Failing to appropriately target the growing sub-group of the urban poor and improve their living conditions and health status - which is an MDG target itself - may result in lack of improvement on national indicators of health. Sustained expansion of potable water supplies and vaccination coverage among the disadvantaged urban dwellers should be given priority in the efforts to achieve the child mortality MDG in SSA.
Country
Publisher
BMC Public Health
Theme area
Equity in health
Title of publication Trends in obesity, underweight, and wasting among women attending prenatal clinics in urban Tanzania
Date of publication
2006 June
Publication type
Journal Article
Publication details
The American Journal of Clinical Nutrition 83 6 pp 1387-1392
Publication status
Published
Language
English
Keywords
obesity, underweight, wasting, BMI, women, urban, Tanzania
Abstract
This study evaluated changes in the prevalence of obesity, underweight, and wasting in women of reproductive age from Dar es Salaam, Tanzania, during the past 10 years and to identify contemporary sociodemographic correlates of these indicators. We estimated the prevalence of obesity [body mass index (BMI; in kg/m2) > or = 30], underweight (BMI < 18.5), and wasting (mid upper arm circumference < 22 cm) in 73 689 women aged 14-52 y who attended antenatal care clinics in the city of Dar es Salaam, Tanzania, between 1995 and 2004. The prevalence of obesity rose steadily and progressively from 3.6% in 1995 to 9.1% in 2004 [adjusted prevalence ratio (PR): 1.97; 95% CI: 1.66, 2.33; P for trend for year < 0.0001]. Underweight showed only a modest decline from 3.3% in 1995 to 2.6% in 2004 (adjusted PR: 0.91; 95% CI: 0.75, 1.10; P for trend for year = 0.003), whereas no change was observed in the prevalence of wasting. In the most recent years (2003 and 2004), obesity was positively associated with age, parity, and socioeconomic status and inversely with HIV infection. Underweight was inversely related to socioeconomic status and positively to HIV status. Conclusions: The recent, rapid, and large increase in the prevalence of obesity in women represents a new competing public health priority in urban Tanzania, where underweight and wasting have not decreased substantially. Future studies need to examine the implications of the fast increase in obesity on the incidence of diabetes, hypertension, cardiovascular disease, cancer, and other noncommunicable diseases in this population. Increasing knowledge on the specific causes of obesity in this population, through research on patterns of dietary intake and physical activity, should provide clearer directions for the implementation of culturally tailored public health interventions. It is critical to promote and strengthen surveillance mechanisms to follow trends in the nutritional status of populations in sub-Saharan Africa.
Country
Publisher
The American Journal of Clinical Nutrition
Theme area
Equity in health
Title of publication Hypertension prevalence, awareness, treatment, and control in Mozambique: Urban/rural gap during epidemiological transition
Date of publication
2009 May
Publication type
Journal Article
Publication details
Hypertension 54 1 pp 77-83
Publication status
Published
Language
English
Keywords
hypertension, adults, urban, rural, Mozambique, quantitative
Abstract
The prediction of cardiovascular risk profile trends in low-income countries and timely action to modulate their transitions are among the greatest global health challenges. This study aimed to quantify the prevalence, awareness, treatment, and control of arterial hypertension in the Mozambican adult population and to compare these estimates between urban and rural areas of residence within the country.: In 2005, the authors evaluated a nationally representative sample of the Mozambican population (n=3323; 25 to 64 years old) following the Stepwise Approach to Chronic Disease Risk Factor Surveillance: Prevalence of hypertension (systolic blood pressure > or =140 mm Hg and/or diastolic blood pressure > or =90 mm Hg and/or antihypertensive drug therapy), awareness (having been informed of the hypertensive status by a health professional in the previous year), treatment among the aware (use of antihypertensive medication in the previous fortnight), and control among those treated (blood pressure <140/90 mm Hg) were 33.1% (women: 31.2%; men: 35.7%), 14.8% (women: 18.4%; men: 10.6%), 51.9% (women: 61.1%; men: 33.3%), and 39.9% (women: 42.9%; men: 28.7%), respectively. Urban/rural comparisons are presented as age- and education-adjusted odds ratios (ORs) and 95% CIs. Among women, hypertension and awareness were more frequent in urban areas. No urban/rural differences were observed in men and prevalence was not significantly different across urban/rural settings. Control was less frequent in urban women and more frequent in urban men. Conclusions: Our results illustrate the changing paradigms of "diseases of affluence" and the dynamic character of epidemiological transition. The urban/rural differences across sexes support a trend toward smaller differences, emphasizing the need for strategies to improve prevention, correct diagnosis, and access to effective treatment.
Country
Publisher
Hypertension
Theme area
Equity in health
Title of publication Child health in peri-urban communities of Kenya: Determinants and challenges
Date of publication
2010 June
Publication type
Journal Article
Publication details
International Journal of Medicine and Medical Sciences 2 6 pp 184-189
Publication status
Published
Language
English
Keywords
peri-urban, determinants, infant, child, mortality, morbidity, Kenya, cross sectional survey
Abstract
Infant and child death in developing countries constitute the largest age category of mortality. This is because children under the age of five years are the group most vulnerable to diseases caused by inadequate child care, health risks, and poor environmental conditions. The overall aim of this study was to explore the demographic, environmental, socio-economic and health seeking behavioural factors contributing to childhood mortality in peri-urban communities. A cross-sectional analytical study was undertaken between January and May 2007 adopting both quantitative and qualitative approaches. Quantitative data was collected using a semi-structured questionnaire administered to 384 mothers aged 15 - 49 years and having children aged below five years alive or dead. Qualitative data was collected through focus group discussions and key informant interviews with selected participants. The main outcome measure was identification of the main determinants of childhood mortality at household level in the peri-urban communities based on proportions of children dead, correlation coefficients and multiple regression analysis. The study revealed that the main determinants of child health in peri-urban communities are maternal occupation and immunizations uptake (t = -5.094, P = 0.000 and t = -3.888, P = 0.012 respectively). Treatment of drinking water, source of drinking water and maternal age also had strong influence on child health (t = -3.647, P = 0.028 and t = -3.111, P = 0.034 respectively). Maternal occupation emerged as the main determinant of child health in peri-urban communities. Conclusions: Overindulgence of mothers in small scale businesses and casual work in urban centers compromises child care hence the high infant and child morbidity and mortality reported in peri-urban settings. This calls for focused health education and services targeting the mothers.
Country
Publisher
International Journal of Medicine and Medical Sciences
Theme area
Equity in health
Title of publication Stroke incidence in rural and urban Tanzania: A prospective, community-based study
Date of publication
2010 August
Publication type
Journal Article
Publication details
The Lancet 9 8 pp 786-792
Publication status
Published
Language
English
Keywords
rural, urban, stroke incidence, Tanzania, household survey
Abstract
There are no methodologically rigorous studies of the incidence of stroke in sub-Saharan Africa. The Tanzania Stroke Incidence Project (TSIP) recorded stroke incidence in two well defined demographic surveillance sites (DSS) over a 3-year period from June, 2003. The Hai DSS (population 159,814) is rural and the Dar-es-Salaam DSS (population 56,517) is urban. Patients with stroke were identified by use of a system of community-based investigators and liaison with local hospital and medical centre staff. Patients who died from stroke before recruitment into the TSIP were identified via verbal autopsy, which was done on all those who died within the study areas.: There were 636 strokes during the 3-year period (453 in Hai and 183 in Dar-es-Salaam). Overall crude yearly stroke incidence rates were 94.5 per 100,000 (95% CI 76.0-115.0) in Hai and 107.9 per 100,000 (88.1-129.8) in Dar-es-Salaam. When age-standardised to the WHO world population, yearly stroke incidence rates were 108.6 per 100 000 (95% CI 89.0-130.9) in Hai and 315.9 per 100,000 (281.6-352.3) in Dar-es-Salaam. Age-standardised stroke incidence rates in Hai were similar to those seen in developed countries. However, age-standardised incidence rates in Dar-es-Salaam were higher than seen in most studies in developed countries; possibly due to a difference in the prevalence of risk factors and emphasises the importance of health screening at a community level. Conclusions: Health policy makers must continue to monitor the incidence of stroke in sub-Saharan Africa and should base future funding decisions on such data.
Country
Publisher
The Lancet
Theme area
Equity in health
Title of publication The Health of Women and Girls in Urban Areas with a Focus on Kenya and South Africa
Date of publication
2013
Publication type
Report
Publication details
Institute of Development Studies (IDS) Evidence Report 42 / pp /-/
Publication status
Published
Language
English
Keywords
women, girls, low income, urban, Kenya, South Africa, review
Abstract
This thematic review focuses on a range of health challenges faced in particular by women and girls living in low-income urban settlements in expanding cities in Kenya and South Africa. The review has been compiled as part of a larger body of work being conducted by the Institute of Development Studies (IDS) and its partners on gender and international development and financed by the UK Department for International Development (DFID). The review was preceded by a literature search of key databases of published literature, as well as a search for grey literature and documents describing interventions aimed at addressing these health challenges. An online discussion hosted by IDS gave a further indication of current debates and assisted in the identification of interventions. The literature points to ways in which residence in low-income urban areas is thus associated with particular health challenges for women and girls, such as those linked to: sexual, reproductive and maternal health; alcohol use; non-communicable diseases related to poor diet, tobacco and sedentary lifestyles; as well as an ongoing high prevalence of infectious diseases such as HIV and TB. There is also concern about the mental health burden arising from the stresses of surviving on the economic margins in large cities characterised by high levels of crime and violence, and more fragmented access to social support. These disease burdens occur at the intersections of different axes of socially constructed inequality. Conclusions: The authors suggest that it is important to generate robust evidence and evaluate existing interventions rather than encourage a constant proliferation of standalone projects. However, ‘evidence’ should include the voices of women themselves and their experience of life in these settlements.
Country
Publisher
Institute of Development Studies (IDS)
Theme area
Equity in health
Title of publication A comparison of urban-rural injury mortality rates across two South African provinces, 2007
Date of publication
2014 January
Publication type
Journal Article
Publication details
International Journal of Injury Control and Safety Promotion 22 1 pp 75-85
Publication status
Published
Language
English
Keywords
urban, mortality, injury, homicide, South Africa, surveillance
Abstract
This study explored urban-rural variations in the magnitude and patterns of fatal injuries in South Africa. METHODS: The National Injury Mortality Surveillance System was utilised to select South African mortality cases for the 2007 period and a cross-sectional methodology was employed in order to comparatively analyse injury mortality rates in the urban province of Gauteng and the rural province of Mpumalanga. The results reveal several differences in urban-rural injury trends across the two South African provinces. Overall, homicide and unintentional (non-transport) injury death rates were significantly higher in the urban province, whilst transport-related injury mortality rates were significantly higher in the rural province (66.57/100,000 versus 45.83/100,000; (RR = 0.69 [0.66-0.71])). Conclusions: The results could be attributed to economic, environmental, and infrastructural differences between urban-rural locations and suggest that injury control strategies could be better targeted to the needs of specific geographic populations in South Africa.
Country
Publisher
International Journal of Injury Control and Safety Promotion
Theme area
Equity in health
Title of publication Inequalities in child mortality in ten major African cities
Date of publication
2014
Publication type
Journal Article
Publication details
BMC Medicine 12 95 pp 1-11
Publication status
Published
Language
English
Keywords
child mortality, inequality, urban, Tanzania, Kenya, household survey
Abstract
The existence of socio-economic inequalities in child mortality is well documented. African cities grow faster than cities in most other regions of the world; and inequalities in African cities are thought to be particularly large. Revealing health-related inequalities is essential in order for governments to be able to act against them. This study aimed to systematically compare inequalities in child mortality across 10 major African cities (Cairo, Lagos, Kinshasa, Luanda, Abidjan, Dar es Salaam, Nairobi, Dakar, Addis Ababa, Accra), and to investigate trends in such inequalities over time. Data from two rounds of demographic and health surveys (DHS) were used for this study (if available): one from around the year 2000 and one from between 2007 and 2011. Child mortality rates within cities were calculated by population wealth quintiles. Inequality in child mortality was assessed by computing the rate ratio and the concentration index and two measures of absolute inequality (the difference and the Erreyger's index). Mean child mortality rates ranged from about 39 deaths per 1,000 live births in Cairo (2008) to about 107 deaths per 1,000 live births in Dar es Salaam (2010). Significant inequalities were found in Kinshasa, Luanda, Abidjan, and Addis Ababa in the most recent survey. The difference between the poorest quintile and the richest quintile was as much as 108 deaths per 1,000 live births in Abidjan in 2011-2012. When comparing inequalities across cities or over time, confidence intervals of all measures almost always overlap. Nevertheless, inequalities appear to have increased in Abidjan, while they appear to have decreased in Cairo, Lagos, Dar es Salaam, Nairobi and Dakar. Conclusions: Considerable inequalities exist in almost all cities but the level of inequalities and their development over time appear to differ across cities. This implies that inequalities are amenable to policy interventions and that it is worth investigating why inequalities are higher in one city than in another. However, larger samples are needed in order to improve the certainty of our results. Currently available data samples from DHS are too small to reliably quantify the level of inequalities within cities.
Country
Publisher
BMC Medicine
Theme area
Equity in health
Title of publication Trends in childhood mortality in Kenya: The urban advantage has seemingly been wiped out
Date of publication
2014 September
Publication type
Journal Article
Publication details
Health & Place 29 / pp 95-103
Publication status
Published
Language
English
Keywords
intra-urban differentials, child/infant/under-five mortality, Kenya, household survey
Abstract
This article describes trends in childhood mortality in Kenya, paying attention to the urban-rural and intra-urban differentials. The authors use data from the Kenya Demographic and Health Surveys (KDHS) collected between 1993 and 2008 and the Nairobi Urban Health and Demographic Surveillance System (NUHDSS) collected in two Nairobi slums between 2003 and 2010, to estimate infant mortality rate (IMR), child mortality rate (CMR) and under-five mortality rate (U5MR). Between 1993 and 2008, there was a downward trend in IMR, CMR and U5MR in both rural and urban areas. The decline was more rapid and statistically significant in rural areas but not in urban areas, hence the gap in urban-rural differentials narrowed over time. There was also a downward trend in childhood mortality in the slums between 2003 and 2010 from 83 to 57 for IMR, 33 to 24 for CMR, and 113 to 79 for U5MR, although the rates remained higher compared to those for rural and non-slum urban areas in Kenya. Conclusions: The narrowing gap between urban and rural areas may be attributed to the deplorable living conditions in urban slums. To reduce childhood mortality, extra emphasis is needed on the urban slums.
Country
Publisher
Health & Place
Theme area
Equity in health
Title of publication Prioritizing action on health inequities in cities: An evaluation of Urban Health Equity Assessment and Response Tool (Urban HEART) in 15 cities from Asia and Africa
Date of publication
2015 November
Publication type
Journal Article
Publication details
Social Science & Medicine 145 / pp 237-242
Publication status
Published
Language
English
Keywords
equity, urban planning, assessment, Kenya
Abstract
Following the recommendations of the Commission on Social Determinants of Health (2008), the World Health Organization (WHO) developed the Urban Health Equity Assessment and Response Tool (HEART) to support local stakeholders in identifying and planning action on health inequities. The objective of this report is to analyze the experiences of cities in implementing Urban HEART in order to inform how the future development of the tool could support local stakeholders better in addressing health inequities. The study method is documentary analysis from independent evaluations and city implementation reports submitted to WHO. Independent evaluations were conducted in 2011e12 on Urban HEART piloting in 15 cities from seven countries in Asia and Africa: Indonesia, Iran, Kenya, Mongolia, Philippines,Sri Lanka, and Vietnam. Local or national health departments led Urban HEART piloting in 12 of the 15 cities. Other stakeholders commonly engaged included the city council, budget and planning departments, education sector, urban planning department, and the Mayor's office. Ten of the 12 core indicators recommended in Urban HEART were collected by at least 10 of the 15 cities. Improving access to safe water and sanitation was a priority equity-oriented intervention in 12 of the 15 cities, while unemployment was addressed in seven cities. Cities who piloted Urban HEART displayed confidence in its potential by sustaining or scaling up its use within their countries. Engagement of a wider group of stakeholders was more likely to lead to actions for improving health equity. Indicators that were collected were more likely to be acted upon. Quality of data for neighbourhoods within cities was one of the major issues. As local governments and stakeholders around the world gain greater control of decisions regarding their health, Urban HEART could prove to be a valuable tool in helping them pursue the goal of health equity.
Country
Publisher
Social Science & Medicine
Theme area
Equity in health
Title of publication Prioritizing action on health inequities in cities: An evaluation of Urban Health Equity Assessment and Response Tool (Urban HEART) in 15 cities from Asia and Africa
Date of publication
2015 November
Publication type
Journal Article
Publication details
Social Science & Medicine 145 / pp 237-242
Publication status
Published
Language
English
Keywords
equity, urban planning, assessment, Kenya
Abstract
Following the recommendations of the Commission on Social Determinants of Health (2008), the World Health Organization (WHO) developed the Urban Health Equity Assessment and Response Tool (HEART) to support local stakeholders in identifying and planning action on health inequities. The objective of this report is to analyze the experiences of cities in implementing Urban HEART in order to inform how the future development of the tool could support local stakeholders better in addressing health inequities. The study method is documentary analysis from independent evaluations and city implementation reports submitted to WHO. Independent evaluations were conducted in 2011e12 on Urban HEART piloting in 15 cities from seven countries in Asia and Africa: Indonesia, Iran, Kenya, Mongolia, Philippines,Sri Lanka, and Vietnam. Local or national health departments led Urban HEART piloting in 12 of the 15 cities. Other stakeholders commonly engaged included the city council, budget and planning departments, education sector, urban planning department, and the Mayor's office. Ten of the 12 core indicators recommended in Urban HEART were collected by at least 10 of the 15 cities. Improving access to safe water and sanitation was a priority equity-oriented intervention in 12 of the 15 cities, while unemployment was addressed in seven cities. Cities who piloted Urban HEART displayed confidence in its potential by sustaining or scaling up its use within their countries. Engagement of a wider group of stakeholders was more likely to lead to actions for improving health equity. Indicators that were collected were more likely to be acted upon. Quality of data for neighbourhoods within cities was one of the major issues. As local governments and stakeholders around the world gain greater control of decisions regarding their health, Urban HEART could prove to be a valuable tool in helping them pursue the goal of health equity.
Country
Publisher
Social Science & Medicine
Theme area
Equity in health
Title of publication Rural, urban and migrant differences in non-communicable disease risk-factors in middle income countries: A cross-sectional study of WHO-SAGE data
Date of publication
2015 April
Publication type
Journal Article
Publication details
PloS One 10 4 pp e0122747-/
Publication status
Published
Language
English
Keywords
rural-urban migration, non-communicable disease, South Africa, community survey
Abstract
Understanding how urbanisation and rural-urban migration influence risk-factors for non-communicable disease (NCD) is crucial for developing effective preventative strategies globally. This study compares NCD risk-factor prevalence in urban, rural and migrant populations in China, Ghana, India, Mexico, Russia and South Africa. METHODS: Study participants were 39,436 adults within the WHO Study on global AGEing and adult health (SAGE), surveyed 2007-2010. Risk ratios (RR) for each risk-factor were calculated using logistic regression in country-specific and all country pooled analyses, adjusted for age, sex and survey design. Fully adjusted models included income quintile, marital status and education. Regular alcohol consumption was lower in migrant and urban groups than in rural groups. Occupational physical activity was lower (0.86 (0.72-0.98); 0.76 (0.65-0.85)) while active travel and recreational physical activity were higher (pooled RRs for urban groups; 1.05 (1.00-1.09), 2.36 (1.95-2.83), respectively; for migrant groups: 1.07 (1.0 -1.12), 1.71 (1.11-2.53), respectively). Overweight, raised waist circumference and diagnosed diabetes were higher in urban groups . Exceptions to these trends exist: obesity indicators were higher in rural Russia; active travel was lower in urban groups in Ghana and India; and in South Africa, urban groups had the highest alcohol consumption. Conclusions: Migrants and urban dwellers had similar NCD risk-factor profiles. These were not consistently worse than those seen in rural dwellers. The variable impact of urbanisation on NCD risk must be considered in the design and evaluation of strategies to reduce the growing burden of NCDs globally.
Country
Publisher
PloS One
Theme area
Equity in health
Title of publication Rural, urban and migrant differences in non-communicable disease risk-factors in middle income countries: A cross-sectional study of WHO-SAGE data
Date of publication
2015 April
Publication type
Journal Article
Publication details
PloS One 10 4 pp e0122747-/
Publication status
Published
Language
English
Keywords
rural-urban migration, non-communicable disease, South Africa, community survey
Abstract
Understanding how urbanisation and rural-urban migration influence risk-factors for non-communicable disease (NCD) is crucial for developing effective preventative strategies globally. This study compares NCD risk-factor prevalence in urban, rural and migrant populations in China, Ghana, India, Mexico, Russia and South Africa. METHODS: Study participants were 39,436 adults within the WHO Study on global AGEing and adult health (SAGE), surveyed 2007-2010. Risk ratios (RR) for each risk-factor were calculated using logistic regression in country-specific and all country pooled analyses, adjusted for age, sex and survey design. Fully adjusted models included income quintile, marital status and education. Regular alcohol consumption was lower in migrant and urban groups than in rural groups. Occupational physical activity was lower (0.86 (0.72-0.98); 0.76 (0.65-0.85)) while active travel and recreational physical activity were higher (pooled RRs for urban groups; 1.05 (1.00-1.09), 2.36 (1.95-2.83), respectively; for migrant groups: 1.07 (1.0 -1.12), 1.71 (1.11-2.53), respectively). Overweight, raised waist circumference and diagnosed diabetes were higher in urban groups . Exceptions to these trends exist: obesity indicators were higher in rural Russia; active travel was lower in urban groups in Ghana and India; and in South Africa, urban groups had the highest alcohol consumption. Conclusions: Migrants and urban dwellers had similar NCD risk-factor profiles. These were not consistently worse than those seen in rural dwellers. The variable impact of urbanisation on NCD risk must be considered in the design and evaluation of strategies to reduce the growing burden of NCDs globally.
Country
Publisher
PloS One
Theme area
Equity in health
Title of publication In urban South Africa, 16 year old adolescents experience greater health equality than children
Date of publication
2013 December
Publication type
Journal Article
Publication details
Economics and Human Biology 11 4 pp 502-514
Publication status
Published
Language
English
Keywords
nutrition, socio-economic status, black, urban, youth, South Africa, multivariate regression
Abstract
Despite the strongly established link between socio-economic status (SES) and health across most stages of the life-course, the evidence for a socio-economic gradient in adolescent health outcomes is less consistent. This paper examines associations between household, school, and neighbourhood SES measures with body composition outcomes in 16 year old South African Black urban adolescents from the 1990 born Birth to Twenty (Bt20) cohort. Multivariable regression analyses were applied to data from a sub-sample of the Bt20 cohort (n=346, 53% male) with measures taken at birth and 16 years of age to establish socio-economic, biological, and demographic predictors of fat mass, lean mass, and body mass index (BMI). Results were compared with earlier published evidence of health inequality at ages 9-10 years in Bt20. Consistent predictors of higher fat mass and BMI in fully adjusted models were being female, born post term, having a mother with post secondary school education, and having an obese mother. Most measures of SES were only weakly associated with body composition, with an inconsistent direction of association. This is in contrast to earlier findings with Bt20 9-10 year olds where SES inequalities in body composition were observed. Conclusions: Findings suggest targeting obesity interventions at females in households where a mother has a high BMI.
Country
Publisher
Economics and Human Biology
Theme area
Health equity in economic and trade policies
Title of publication Factors Influencing Implementation of Public Health Standards in Selected City Council Markets in Nairobi, Kenya
Date of publication
2011 May
Publication type
Report
Publication details
/ / / pp /-/
Publication status
Published
Language
English
Keywords
public health, disease prevention, city council market, Nairobi, Kenya, descriptive survey
Abstract
Public Health involves the organized efforts by societies to protect, restore and promote the health of the population. Public health programs and activities focus on the prevention of disease and enhancement of health. They are directed towards the population as a whole rather than individuals. Creation of healthy market places is part of the Healthy Cities Programs (HCP) strategy developed by World Health Organization. This approach aims to create environments that are supportive to good health. However, many market places set a poor example. Most of the Nairobi City Council markets have questionable public health standards but little is known about the factors leading to such state of affairs. No remedial measures can be taken if such conditions are not identified, hence the need to carry out this study. The purpose of the study was to find out the factors influencing implementation of public health standards in Nairobi City Council markets. The markets were conveniently selected due to their location. The study employed a descriptive survey research design because it allowed for extensive data collection on a large population within a short period of time. The study population consisted of three hundred customers, one hundred food vendors, six market administrators, four public health officers and two senior staff from the department of social services and housing. Pre-tested questionnaires and interview schedules were used for data collection, while observations were used as illustrations to major findings. Data was analyzed using Statistical Package for Social Sciences (SPSS) software. Majority of the food vendors (66%) were aware of the requirements of the public health act. A significant number of vendors (63%) underwent a medical check up in line with section 135 of the public health act. There was no significant association between medical examination and duration of operation in the market x2=2.384; df;= p³?0.05). Nuisance is prohibited in section 115 of the Act. Never the less, both customers and vendors acknowledged presence of nuisance in the market which included poor waste disposal, presence of pests, poor sanitary conditions and foul smell. Public health officers' visits to the markets are paramount to ensure public health requirements are maintained, in line with section 123 of the Act. However, the study revealed that the officers lacked official transport arrangements and security details, unless there was a disease outbreak or when conducting arrests. Five out of the six market administrators noted that inadequate finances posed a major challenge in implementation of public health standards, since all the money collected from the markets was submitted to the City Treasury. Conclusions: Decentralization of funds generated from the markets is thus recommended. These funds can then be re-invested in maintenance, expansion and offering better services within the markets. The results of this work could be useful to the city council of Nairobi in ensuring that public health standards are observed in the markets.
Country
Publisher
/
Theme area
Health equity in economic and trade policies
Title of publication Mortality and greenhouse gas impacts of biomass and petroleum energy futures in Africa
Date of publication
2005 April
Publication type
Journal Article
Publication details
Science 308 5718 pp 98-103
Publication status
Published
Language
English
Keywords
greenhouse gas, household energy, Africa
Abstract
The authors analyzed the mortality impacts and greenhouse gas (GHG) emissions produced by household energy use in Africa. METHODS: We developed a database of current fuel
use and a range of scenarios of household energy futures up to 2050 in SSA. Current national-level energy production and consumption were estimated from the UN Food and Agriculture Organization’s (FAO’s) forest products database and the International Energy Agency’s (IEA’s) statistical database of countries not in the Organisation for Economic Cooperation and Development Under a business-as-usual (BAU) scenario, household indoor air pollution will cause an estimated 9.8 million premature deaths by the year 2030. Gradual and rapid transitions to charcoal would delay 1.0 million and 2.8 million deaths, respectively; similar transitions to petroleum fuels would delay 1.3 million and 3.7 million deaths. Cumulative BAU GHG emissions will be 6.7 billion tons of carbon by 2050, which is 5.6% of Africa's total emissions. Large shifts to the use of fossil fuels would reduce GHG emissions by 1 to 10%. Conclusions: Charcoal-intensive future scenarios using current practices increase emissions by 140 to 190%; the increase can be reduced to 5 to 36% using currently available technologies for sustainable production or potentially reduced even more with investment in technological innovation. This integration of health outcomes into energy and resource technologies and policies offers an opportunity to reduce child mortality, promote gender equality, and improve environmental sustainability.
Country
Publisher
Science
Theme area
Health equity in economic and trade policies
Title of publication Health risks and benefits of urban and ‘peri-urban’ agriculture and livestock (UA) in Sub-Saharan Africa
Date of publication
2006 August
Publication type
Report
Publication details
Urban Poverty and Environment Series Report 1 / / pp /-/
Publication status
Published
Language
English
Keywords
health risks, urban, peri-urban, agriculture, disease transmission, sub-Saharan Africa
Abstract
This document sums up results from an IDRC-supported workshop held in Nairobi in 2003, where UPE activities related to health risks in UA were initiated (following up on previous CFP PI research experiences). Part I of this document includes six resource papers prepared by specialists working in various areas related to the health risks and benefits of UA. Part II contains the proceedings of the workshop activities in Nairobi, where academics and decision makers discussed the risks and benefits of UA from different perspectives. Part I - Resource papers These papers have been produced with the purpose of identifying the opportunities to enhance the benefits of UA, and to mitigate its associated health risks, based on risk assessments. The combination of different research topics aims to cover the diversity of issues that need to be considered in supporting UA development research. The paper on health impact assessment, risk mitigation and healthy public policy by D. Cole and colleagues provides several methodological concepts and strategies to further elaborate on the knowledge that links hazards, exposures and health effects, in the context of urban agriculture. The paper gives several examples of the way individual decisions for risk mitigation are based on subjective perceptions which stem from knowledge and culture. The paper concludes with useful recommendations for risk mitigation by identifying priorities in terms of critical hazards and counterfactual scenarios where benefits and risks are balanced. F. Yeudall’s paper on nutrition perspectives in UA gives an interesting picture of different patterns of diet, nutrition and health conditions, at different levels, in the context of worldwide urbanization processes. The paper concludes with recommendations related to the health risks and the nutritional benefits of UA, through participatory community food security strategies. Increased malaria transmission due to irrigation techniques has been considered an UA health risk. Report 1 9 by E. Klinkenberg and F. Amerasinghe. Community malaria risk factors are addressed in relation to vector ecology and the urban and rural features of water ponds as breeding sites. Engagement of stakeholders, including affected communities, decision makers, and researchers, is considered key for the implementation of these malaria control measures. Livestock production in Kampala has been addressed by G. Nasinyama and colleagues. Interesting notes on behavioural exposures to the transmission of zoonotic diseases (by keeping livestock in the living places to avoid thefts, for example), and especially the difficulties of managing animal waste are quoted among the challenges to be overcome in UA. The benefits of livestock at different levels (household, community, government) include food security, nutritional improvements, and income and job generation, which can be translated into improved well-being. Some major concerns in UA relate to wastewater use and solid waste recycling, some of the most challenging issues linked to UA. The paper by B. Keraita and colleagues provides a helpful typology of wastes, contents, practices and health issues. Transmission of pathogens is affected by factors that influence exposure. Policy guidance frameworks are discussed, especially in terms of feasibility and perspectives – such as the WHO guidelines for wastewater use in agriculture. The paper provides evidence about the links between disease transmission and UA practices with the purpose of management with policy support. Insights on risk perception for participatory approaches are given with several experiences derived from projects developed in urban areas of Ghana. Finally, a gender perspective on the health risks and benefits of UA, based largely on field research experience, is provided by D. Lee-Smith. Differences in risk perception in UA, based on the different roles and responsibilities of men and women, are highlighted. The roles of women in disaster mitigation worldwide, and opportunities to act on risk mitigation in the context of UA are considered in terms of resources, as well as knowledge, and perception of current health risks.
Country
Publisher
International Dispute Resolution Centre (IDRC)
Theme area
Health equity in economic and trade policies
Title of publication PCBs in air, soil and milk in industrialized and urban areas of KwaZulu-natal, South Africa
Date of publication
2009 February
Publication type
Journal Article
Publication details
Environmental Pollution 157 2 pp 654-663
Publication status
Published
Language
English
Keywords
environmental health, urban, PCB concentration, KwaZulu-Natal, South Africa
Abstract
Information regarding polychlorinated biphenyls (PCBs) in environmental media in Africa is limited. This paper presents results of a monitoring program conducted in KwaZulu-Natal Province, South Africa designed to characterize levels, trends and sources of airborne PCBs. Particulate and vapor samples were sampled over the 2004-2005 period at three sites. The total PCB concentration averaged 128+/-47 pgm(-3), and levels were highest in winter. Tri- through hexa-congeners predominated, and the vapor fraction was predominant. Several tetra- through hexa-chlorinated congeners had levels comparable to those at urban sites in the northern hemisphere, but hepta- through deca-congeners resembled levels at background sites. PCB source areas, deduced using spatial and temporal patterns, compositional information and trajectory analyses, likely included local, regional and global sources. Soils at three rural sites showed high PCB concentrations, and milk from a local dairy showed PCB concentrations comparable to USA levels in year 2000. Conclusions: While diet (especially meat, dairy products and fish) is the main source of human exposure to PCBs for most individuals, the elevated concentrations found in air and soil suggest the need for further identification and characterization. Follow-up studies sufficient to characterize PCB levels in fish and human milk would help to answer questions regarding human exposure.
Country
Publisher
Environmental Pollution
Theme area
Health equity in economic and trade policies
Title of publication Assessment of environmental and public health hazards in wastewater used for urban agriculture in Nairobi, Kenya
Date of publication
2010
Publication type
Journal Article
Publication details
Tropical and Subtropical Agroecosystems 12 1 pp 85-97
Publication status
Published
Language
English
Keywords
environmental hazards, contamination, urban agriculture, Kenya
Abstract
Thirty percent of residents in Nairobi practise urban agriculture (UA) with a majority of the farmers using untreated sewage to irrigate crop and fodder. Due to the environmental and health risks associated with wastewater irrigation, a study was carried out in partnership with farmers in Kibera and Maili Saba which are informal settlements along the Ngong River, a tributary of the Nairobi River Basin. Soil, water, crops and human faecal samples from the farming and non-farming households were analysed to elucidate sources, types and level of heavy metal pollutants in the wastewater and the pathogen loads in humans and vegetable crops. Heavy metal accumulation in soils collected from Kibera and Maili Saba were Cd (14.3 mg kg-1), Cr (9.7 mg kg-1) and Pb (1.7 mg kg-1) and Cd (98.7 mg kg-1), Cr (4.0 mg kg-1) and Pb (74.3 mg kg-1), respectively. This led to high phytoaccumulation of Cd, Cr and Pb in the crops that exceeded the maximum permissible limits. No parasitic eggs were detected in the vegetables but coliform count in the wastewater was 4.8 x108±2.2 x1011/100ml. Conclusions: Soils irrigated with this water had parasitic eggs and non-parasitic larvae counts of 54.62 and 27.5/kg respectively. Faecal coliform and parasitic eggs of common intestinal parasites increased in leafy vegetable sampled from the informal markets along the value chain.
Country
Publisher
Tropical and Subtropical Agroecosystems
Theme area
Poverty and health
Title of publication A review of health and hygiene promotion as part of sanitation delivery programmes to informal settlements in the city of Cape Town (South Africa)
Date of publication
2009 April
Publication type
Conference Proceedings
Publication details
Proceedings of the 2007 National Conference on Environmental Science and Technology / / pp /-/
Publication status
Published
Language
English
Keywords
sanitation, hygiene promotion, urban, South Africa, comparative review
Abstract
Good sanitation includes appropriate health and hygiene promotion. This implies that proper health and hygiene promotion would have the desired effect as part of sanitation service delivery. However, lessons learnt worldwide show that in the promotion of health and hygiene, it is not enough simply to provide facilities, because if people do not use the available facilities properly, conditions do not improve or the system breaks down. The Ottawa charter (WHO, 1986) suggests that effective health and hygiene promotion require the empowerment of local communities, collaborative partnerships and a supportive national policy environment. Against this background, the focus of this study is the extent to which health and hygiene promotion forms part of sanitation delivery programmes to informal settlements in the City of Cape Town. The investigation is confined to a comparative review of approaches to health promotion in 4 case study sites (Khayelitsha, Joe Slovo, Kayamandi and Imizamu Yetho) in respect of community and household capacity to take responsibility for community based programmes, role-players forming collaborative partnerships across departments and implementation of health and hygiene aligned with national policy. Conclusions: Analysis of the case studies highlights the ineffectiveness of once-off awareness campaigns and the need for a more comprehensive approach to health and hygiene promotion in line with the Ottawa Charter.
Country
Publisher
Theme area
Poverty and health
Title of publication Environmental health practices, constraints and possible interventions in peri-urban settlements in developing countries-a review of Kampala, Uganda
Date of publication
2010 July
Publication type
Journal Article
Publication details
International Journal of Environmental Health Research 20 4 pp 231-257
Publication status
Published
Language
English
Keywords
environmental health, peri-urban settlements, Uganda, quantitative, review
Abstract
Like most cities in developing countries, Uganda's capital city, Kampala, is experiencing urbanisation leading to an increase in population, and rapid development of peri-urban (informal) settlements. More than 60% of the city's population resides in these settlements which have the lowest basic service levels (sanitation, water supply, solid waste collection, stormwater and greywater disposal). A review of earlier studies on infrastructure development and sustainability within Kampala's peri-urban settlements, field surveys in a typical peri-urban settlement in the city (Bwaise III Parish), and structured interviews with key personnel from the National Water and Sewerage Corporation (NWSC), Kampala City Council (KCC), and the National Environment Management Authority (NEMA) were undertaken. Conclusions: Findings on current environmental health practices as well as perspectives of local communities and interviewed institutions on problems, constraints and possible solutions to basic service provision are presented. The implications of these viewpoints for possible environmental health interventions are presented.
Country
Publisher
International Journal of Environmental Health Research
Theme area
Poverty and health
Title of publication Spatial dimensions of access and public health implications: The case of Dar es Salaam city, Tanzania
Date of publication
2012 February
Publication type
Academic paper
Publication details
Thesis Dissertation / / pp /-/
Publication status
Published
Language
English
Keywords
water access, Dar es Salaam, Tanzania, spatial analysis
Abstract
Access to water is vital for human health and survival of other ecosystems. These requirements have been recognized across national, regional and local communities. Despite that there has been a progressive effort to improve access to water in order to achieve the Millennium Development Goals (MDGs) by 2015; the current level of access is largely insufficient. The disparities have been noted both geographically and economically. Using survey data and statistical analysis, the study identified the spatial disparities in water access in Dar es Salaam. The population that lives in close proximity to water sources and those whose water supply is more than three hours have been noted to have sufficient water access to meet the households' needs. Conclusions: Poor access to water prevails in low income households. The incidence of water related disease threatens public health especially for typhoid and diarrheal diseases.
Country
Publisher
State University of New York at Binghamton
Theme area
Poverty and health
Title of publication The Health and Sanitation Status of Specific Low-Cost Housing Communities as Contrasted with those Occupying Backyard Dwellings in the City of Cape Town, South Africa
Date of publication
2011
Publication type
Academic paper
Publication details
Thesis Dissertation / / pp /-/
Publication status
Published
Language
English
Keywords
health, sanitation, Cape Town, South Africa, dwelling inspection
Abstract
South Africa embarked on an ambitious program to rehouse the informally housed poor. These initiatives were formerly called the RDP and later the BNG programmes. This was aimed at improving the living conditions of the urban poor and consequently their health and poverty status. These low-cost houses were quickly augmented by backyard shacks in almost all settlements. The present study is an epidemiological assessment of the health and sanitation status of inhabitants of specific low cost housing communities in the City of Cape Town as contrasted with those occupying ‘backyard dwellings’ on the same premises. The study was undertaken in four low-cost housing communities identified within the City. A health and housing evaluation, together with dwelling inspections were carried out in 336 randomly selected dwellings accommodating 1080 inhabitants from Tafelsig, Masipumelela, Driftsands and Greenfields. In addition, the microbiological pollution of surface run-off water encountered in these settlements was assessed by means of Escherichia coli levels (as found by ColilertTM Defined Substrate Technology) as an indication of environmental health hazards. The study population was classified as ‘young’ - 43% of the study population was aged 20 years or younger. Almost a third of households were headed by a single-parent female. In all four communities combined, 47.3% of households received one or other form of social grant. At the time of inspection 58% of the toilets on the premises were non-operational, while all the houses showed major structural damage - 99% of homeowners reported not being able to afford repairs to their homes. In 32% of dwellings one or more cases of diarrhoea were reported during the two weeks preceding the survey. Five percent of the participants willingly disclosed that they were HIV positive, while 11% reported being TB positive (one of them Multiple Drug Resistant TB). None of the HIV positive or TB positive persons was on any treatment. The E. coli levels of the water on the premises or sidewalks varied from 750 to 1 580 000 000 organisms per 100 ml of water - thus confirming gross faecal pollution of the environment. Improvements in health intended by the re-housing process did not materialise for the recipients of low-cost housing in this study. The health vulnerability of individuals in these communities has considerable implications for the health services. Sanitation failures, infectious disease pressure and environmental pollution in these communities represent a serious public health risk. The densification caused by backyard shacks also has municipal service implications and needs to be better managed. Conclusions: Policies on low-cost housing for the poor need realignment to cope with the realities of backyard densification so that state-funded housing schemes can deliver the improved health envisaged. This is in fact a national problem affecting almost all of the state funded housing communities in South Africa. Public health and urban planning need to bridge the divide between these two disciplines in order to improve the health inequalities facing the urban poor.
Country
Publisher
Stellenbosch University
Theme area
Poverty and health
Title of publication Time-series analysis of weather and mortality patterns in Nairobi's informal settlements
Date of publication
2012 November
Publication type
Journal Article
Publication details
Global Health Action 5 / pp 23-32
Publication status
Published
Language
English
Keywords
urban, informal settlement, weather, mortality, Nairobi, Kenya, NUDSS
Abstract
Many studies have established a link between weather (primarily temperature) and daily mortality in developed countries. However, little is known about this relationship in urban populations in sub-Saharan Africa. The objective of this study was to describe the relationship between daily weather and mortality in Nairobi, Kenya, and to evaluate this relationship with regard to cause of death, age, and sex. The authors utilized mortality data from the Nairobi Urban Health and Demographic Surveillance System and applied time-series models to study the relationship between daily weather and mortality for a population of approximately 60,000 during the period 2003-2008. They used a distributed lag approach to model the delayed effect of weather on mortality, stratified by cause of death, age, and sex. Increasing temperatures (above 75th percentile) were significantly associated with mortality in children and non-communicable disease (NCD) deaths. We found all-cause mortality of shorter lag of same day and previous day to increase by 3.0% for a 1 degree decrease from the 25th percentile of 18 degrees C (not statistically significant). Mortality among people aged 50+ and children aged below 5 years appeared most susceptible to cold compared to other age groups. Rainfall, in the lag period of 0-29 days, increased all-cause mortality in general, but was found strongest related to mortality among females. Low temperatures were associated with deaths due to acute infections, whereas rainfall was associated with all-cause pneumonia and NCD deaths. Conclusions: Increases in mortality were associated with both hot and cold weather as well as rainfall in Nairobi, but the relationship differed with regard to age, sex, and cause of death. The authors findings indicate that weather-related mortality is a public health concern for the population in the informal settlements of Nairobi, Kenya, especially if current trends in climate change continue.
Country
Publisher
Global Health Action
Theme area
Poverty and health
Title of publication Elevation and cholera: An epidemiological spatial analysis of the cholera epidemic in Harare, Zimbabwe, 2008-2009
Date of publication
2012 June
Publication type
Journal Article
Publication details
BMC Public Health 12 422 pp /-/
Publication status
Published
Language
English
Keywords
cholera, topographical elevation, Harare, Zimbabwe, spatial analysis
Abstract
In highly populated African urban areas where access to clean water is a challenge, water source contamination is one of the most cited risk factors in a cholera epidemic. During the rainy season, where there is either no sewage disposal or working sewer system, runoff of rains follows the slopes and gets into the lower parts of towns where shallow wells could easily become contaminated by excretes. In cholera endemic areas, spatial information about topographical elevation could help to guide preventive interventions. This study aims to analyze the association between topographic elevation and the distribution of cholera cases in Harare during the cholera epidemic in 2008 and 2009. The authors developed an ecological study using secondary data. First, they described attack rates by suburb and then calculated rate ratios using whole Harare as reference. They illustrated the average elevation and cholera cases by suburbs using geographical information. Finally, we estimated a generalized linear mixed model (under the assumption of a Poisson distribution) with an Empirical Bayesian approach to model the relation between the risk of cholera and the elevation in meters in Harare. They used a random intercept to allow for spatial correlation of neighboring suburbs. This study identifies a spatial pattern of the distribution of cholera cases in the Harare epidemic, characterized by a lower cholera risk in the highest elevation suburbs of Harare. The generalized linear mixed model showed that for each 100 meters of increase in the topographical elevation, the cholera risk was 30% lower with a rate ratio of 0.70 (95% confidence interval=0.66-0.76). Sensitivity analysis confirmed the risk reduction with an overall estimate of the rate ratio between 20% and 40%. Conclusions: This study highlights the importance of considering topographical elevation as a geographical and environmental risk factor in order to plan cholera preventive activities linked with water and sanitation in endemic areas. Furthermore, elevation information, among other risk factors, could help to spatially orientate cholera control interventions during an epidemic.
Country
Publisher
BMC Public Health
Theme area
Poverty and health
Title of publication Status Report on the Sexual and Reproductive Health of Adolescents Living in Urban Slums in Kenya
Date of publication
2013 September
Publication type
Report
Publication details
Strengthening Evidence for Programming on Unintended Pregnancy / / pp /-/
Publication status
Published
Language
English
Keywords
slum, Nairobi, Kenya, DSS, quantitative, qualitative
Abstract
This report provides information on adolescents’ background characteristics, sexual and reproductive health knowledge, SRH attitudes, sexual behavior, reproductive life and unintended pregnancies. This report is based on secondary analysis of data from the Transition to Adulthood (TTA) project among 12-22 years olds living in two informal settlements, Korogocho and Viwandani, in Nairobi, Kenya. Findings presented are based on simple descriptive statistics and cross-tabulations of indicators by age, highest level of education, schooling status and current marital status. In addition, this report includes evidence based on qualitative data collected in 2009 through 75 in-depth interviews with adolescents aged 12-24 years in the two slums. Respondents for the in-depth interviews were purposively selected from participants in the baseline survey conducted in 2007-8. Respondents were selected to represent varying; universal knowledge of HIV/AIDS; substantial age and gender differences in HIV testing trajectories of experience with regard to the key markers of the transition from adolescence to adulthood which include; leaving school, getting a first job, leaving their parents’ home, entering into a union, and becoming a parent. The report highlights the SRH challenges faced by adolescents living in these slums, as well as the perceptions and strategies that adolescents adopt to deal with each of these challenges. Findings indicate poor knowledge of the menstrual cycle and fertility experiences; persistence of culturally normative attitudes; early initiation of sexual activity; low use of condoms and other contraceptives with condom use for dual protection; disconnect between adolescents’ sexual and reproductive health attitudes and their behavior; high burden of unwanted and mistimed pregnancies; and threat of unwanted, transactional and coercive sex. Conclusions: Targeted programs are needed to reach adolescents with sexual and reproductive health services at different stages of need. These programs should strengthen sexual and reproductive health education for very young adolescents while providing contraceptive services for adolescents. Poverty reduction strategies must be considered alongside sexual and reproductive health services. Holistic programs that consider the relationship between health and environment are needed to address the complex web of factors that contribute to SRH. Opportunities for income generating activities among adolescents may reduce poverty, empower disenfranchised youth, and provide a forum for integration of SRH education and services.
Country
Publisher
Strengthening Evidence for Programming on Unintended Pregnancy
Theme area
Poverty and health
Title of publication Public health and environmental challenges in Zimbabwe: The case of solid waste generation and disposal in the city of Masvingo
Date of publication
2014
Publication type
Journal Article
Publication details
Journal of Environments 1 2 pp 68-72
Publication status
Published
Language
English
Keywords
sanitation, solid waste, Masvingo, Zimbabwe, experiential observation
Abstract
This paper is mainly an overview of the challenge of solid waste management in the city of Masvingo. The paper is based on experiential observation. The researchers are residents of the city of Masvingo. The paper established that Masvingo residents generate waste when they throw away weeds and garden debris, construction debris, food left-overs and packages, old tyres, metal scraps, among many others. Although there are regulations and by-laws on how to handle solid waste, it seems in practice these are not enforced. People discard solid waste by throwing bottles, fast food containers, and other items on the street or out of car windows. This results in a lot of litter in the city. Residents use metal and plastic medium sized bins, plastic paper, cardboard boxes and sacks for temporary waste storage, as determined by their ability to purchase the waste containers. Most high density residents do not afford bins, cardboard or any other temporary storage equipment. Hence they store their waste in open areas. The Masvingo city council does not take measures on residents who do not store their solid waste as per their regulations and by-laws. This encourages the people to continue littering their residential area. Conclusions: Among other things, this paper recommends a programme in which the municipality joins hands with other stakeholders (EMA, NGOs, residents’ associations, government departments, the business community, and many others) in advocacy campaigns and training sessions to ensure that residents are aware of risks associated with mishandling of solid waste.
Country
Publisher
Journal of Environments
Theme area
Poverty and health
Title of publication Trends in access to water supply and sanitation in 31 major Sub-Saharan African cities: An analysis of DHS data from 2000 to 2012
Date of publication
2014 December
Publication type
Journal Article
Publication details
BMC Public Health 14 208 pp /-/
Publication status
Published
Language
English
Keywords
urban, water, sanitation, sub-Saharan Africa, household survey
Abstract
By 2050, sub-Saharan Africa's (SSA) urban population is expected to grow from 414 million to over 1.2 billion. This growth will likely increase challenges to municipalities attempting to provide access to water supply and sanitation (WS&S). This study aims to characterize trends in access to WS&S in SSA cities and identify factors affecting those trends. METHODS: DHS data collected between 2000 and 2012 were used for this analysis of thirty-one cities in SSA. Four categories of household access to WS&S were studied using data from demographic and health surveys--these included: 1) household access to an improved water supply, 2) household's time spent collecting water, 3) household access to improved sanitation, and 4) households reporting to engage in open defecation. An exploratory analysis of these measures was then conducted to assess the relationship of access to several independent variables. Among the 31 cities, there was wide variability in coverage levels and trends in coverage with respect to the four categories of access. The majority of cities were found to be increasing access in the categories of improved water supply and improved sanitation (65% and 83% of cities, respectively), while fewer were making progress in reducing the amount of time spent collecting water and reducing open defecation (50% and 38% of cities, respectively). The prevalence of open defecation in study cities was found to be, on average, increasing. Conclusions: Based on DHS data, cities appeared to be making the most progress in gaining access to WS&S along metrics which reflect specified targets of the Millennium Development Goals. Nearly half of the cities, however, did not make progress in reducing open defecation or the time spent collecting water. This may reflect that the MDGs have led to a focus on "improved" services while other measures, potentially more relevant to the extreme poor, are being neglected. This study highlights the need to better characterize access, beyond definitions of improved and unimproved, as well as the need to target resources to cities where changes in WS&S access have stalled, or in some cases regressed.
Country
Publisher
BMC Public Health
Theme area
Poverty and health
Title of publication Temporal trends and correlates of physical activity, sedentary behaviour, and physical fitness among school-aged children in Sub-Saharan Africa: A systematic review
Date of publication
2014 March
Publication type
Journal Article
Publication details
International Journal of Environmental Research and Public Health 11 3 pp 3327-3359
Publication status
Published
Language
English
Keywords
physical activity, children, sub-Saharan Africa, systematic review
Abstract
Recent physical activity (PA) and fitness transitions, identified as behavioural shifts from traditionally active lifestyles to more industralised and sedentary lifestyles, have been observed among school-aged children. There is a wealth of supporting evidence of such behavioural transitions in high income countries; however, a paucity of data on lower income countries exists. These transitions pose a particular threat to the welfare of children by accelerating the onset of chronic diseases. This systematic review investigated the evidence for a PA and fitness transition among Sub-Saharan Africa's school-aged children. Temporal trends and correlates of PA, SB, and fitness were examined. Studies were identified by searching the Medline, Embase, Africa Index Medicus, Global Health, Geobase, and EPPI-Centre electronic databases, and were included if they measured outcomes of interest in apparently healthy samples of children (517 years). A total of 71 articles met the inclusion criteria (40 informed PA, 17 informed SB, and 37 informed fitness). Vast heterogeneity in study methodology complicated analysis of transitions over time and no temporal trends were immediately discernible. However, higher socioeconomic status, urban living, and female children were found to engage in lower levels of PA, higher SB, and performed worse on aerobic fitness measures compared to lower socioeconomic status, rural living, and male children. Conclusions: Data revealed that urbanization was associated with a trend towards decreased PA, increased SB, and decreased aerobic fitness over time. Representative, temporally sequenced data examining a PA and fitness transition are lacking in this region.
Country
Publisher
International Journal of Environmental Research and Public Health
Theme area
Poverty and health
Title of publication Temporal trends and correlates of physical activity, sedentary behaviour, and physical fitness among school-aged children in Sub-Saharan Africa: A systematic review
Date of publication
2014 March
Publication type
Journal Article
Publication details
International Journal of Environmental Research and Public Health 11 3 pp 3327-3359
Publication status
Published
Language
English
Keywords
physical activity, children, sub-Saharan Africa, systematic review
Abstract
Recent physical activity (PA) and fitness transitions, identified as behavioural shifts from traditionally active lifestyles to more industralised and sedentary lifestyles, have been observed among school-aged children. There is a wealth of supporting evidence of such behavioural transitions in high income countries; however, a paucity of data on lower income countries exists. These transitions pose a particular threat to the welfare of children by accelerating the onset of chronic diseases. This systematic review investigated the evidence for a PA and fitness transition among Sub-Saharan Africa's school-aged children. Temporal trends and correlates of PA, SB, and fitness were examined. Studies were identified by searching the Medline, Embase, Africa Index Medicus, Global Health, Geobase, and EPPI-Centre electronic databases, and were included if they measured outcomes of interest in apparently healthy samples of children (517 years). A total of 71 articles met the inclusion criteria (40 informed PA, 17 informed SB, and 37 informed fitness). Vast heterogeneity in study methodology complicated analysis of transitions over time and no temporal trends were immediately discernible. However, higher socioeconomic status, urban living, and female children were found to engage in lower levels of PA, higher SB, and performed worse on aerobic fitness measures compared to lower socioeconomic status, rural living, and male children. Conclusions: Data revealed that urbanization was associated with a trend towards decreased PA, increased SB, and decreased aerobic fitness over time. Representative, temporally sequenced data examining a PA and fitness transition are lacking in this region.
Country
Publisher
International Journal of Environmental Research and Public Health
Theme area
Poverty and health
Title of publication Added sugar intake in South Africa: Findings from the adult prospective urban and rural epidemiology cohort study
Date of publication
2014 March
Publication type
Journal Article
Publication details
The American Journal of Clinical Nutrition 99 6 pp 1479-1486
Publication status
Published
Language
English
Keywords
obesity, sugar, nutrition, urban, South Africa, quantitative survey
Abstract
Obesity and other noncommunicable disease (NCD) risk factors are increasing in low- and middle-income countries. There are few data on the association between increased added sugar intake and NCD risk in these countries. We assessed the relation between added sugar intake and NCD risk factors in an African cohort study. Added sugars were defined as all monosaccharides and disaccharides added to foods and beverages during processing, cooking, and at the table. The authors conducted a 5-y follow-up of a cohort of 2010 urban and rural men and women aged 30-70 y of age at recruitment in 2005 from the North West Province in South Africa. Added sugar intake, particularly in rural areas, has increased rapidly in the past 5 y. In rural areas, the proportion of adults who consumed sucrose-sweetened beverages approximately doubled (for men, from 25% to 56%; for women, from 33% to 63%) in the past 5 y. After adjustment, subjects who consumed more added sugars (>/=10% energy from added sugars) compared with those who consumed less added sugars had a higher waist circumference [mean difference (95% CI): 1.07 cm (0.35, 1.79 cm)] and body mass index (in kg/m(2)) and lower HDL cholesterol. Conclusions: This cohort showed dramatic increases in added sugars and sucrose-sweetened beverage consumption in both urban and rural areas. Increased consumption was associated with increased NCD risk factors. In addition, the study showed that the nutrition transition has reached a remote rural area in South Africa. Urgent action is needed to address these trends. Increase in sugar and NCD in both urban and rural
Country
Publisher
The American Journal of Clinical Nutrition
Theme area
Poverty and health
Title of publication Geographical inequalities in use of improved drinking water supply and sanitation across Sub-Saharan Africa: Mapping and spatial analysis of cross-sectional survey data
Date of publication
2014 April
Publication type
Journal Article
Publication details
PLoS Medicine 11 4 pp e1001626-e1001626
Publication status
Published
Language
English
Keywords
water, sanitation, geographic inequalities, sub-Saharan Africa, household survey
Abstract
Understanding geographic inequalities in coverage of drinking-water supply and sanitation (WSS) will help track progress towards universal coverage of water and sanitation by identifying marginalized populations, thus helping to control a large number of infectious diseases. This paper uses household survey data to develop comprehensive maps of WSS coverage at high spatial resolution for sub-Saharan Africa (SSA). Analysis is extended to investigate geographic heterogeneity and relative geographic inequality within countries. Cluster-level data on household reported use of improved drinking-water supply, sanitation, and open defecation were abstracted from 138 national surveys undertaken from 1991-2012 in 41 countries. Spatially explicit logistic regression models were developed and fitted within a Bayesian framework, and used to predict coverage at the second administrative level (admin2, e.g., district) across SSA for 2012. KEY FINDINGS: Results reveal substantial geographical inequalities in predicted use of water and sanitation that exceed urban-rural disparities. The average range in coverage seen between admin2 within countries was 55% for improved drinking water, 54% for use of improved sanitation, and 59% for dependence upon open defecation. There was also some evidence that countries with higher levels of inequality relative to coverage in use of an improved drinking-water source also experienced higher levels of inequality in use of improved sanitation. Results are limited by the quantity of WSS data available, which varies considerably by country, and by the reliability and utility of available indicators. Conclusions: This study identifies important geographic inequalities in use of WSS previously hidden within national statistics, confirming the necessity for targeted policies and metrics that reach the most marginalized populations. The presented maps and analysis approach can provide a mechanism for monitoring future reductions in inequality within countries, reflecting priorities of the post-2015 development agenda.
Country
Publisher
PLoS Medicine
Theme area
Poverty and health
Title of publication Health and fitness attitudes and lifestyle habits of urban children in South Africa
Date of publication
2014 September
Publication type
Journal Article
Publication details
African Journal for Physical Health Education, Recreation and Dance: A Multi-Disciplinary Approach to Health and Well-being 20 Suppl 2 pp 102-112
Publication status
Published
Language
English
Keywords
urban, children, physical activity, fitness, nutrition, South Africa, quantitative survey
Abstract
South Africa is experiencing an ever-increasing incidence of hypokinetic diseases in both child and adult populations. As such, this study attempted to determine the health and fitness attitudes and lifestyle habits of children in South Africa since positive attitudes and habits have been shown to improve the health status of children. This is especially important since many childhood risk factors, such as childhood obesity, correlate with adult risk factors for common chronic diseases. Nine hundred and sixty children were randomly selected from three different socio-economic suburbs in KwaZulu Natal, South Africa to complete a questionnaire on exercise and sport, physical education classes and teachers, health education classes, nutrition and health and lifestyle habits. Statistical analysis consisted of descriptive statistics to determine frequencies and percentages in addition to computation of cross-tabulations. It is evident that in terms of health, fitness and lifestyle habits, the socio-economic backgrounds of the children played a pivotal role in the differences in the children's responses to the various questions. In this regard, differences were found in the availability of resources and facilities, children's attitudes towards exercise and sport, the frequency of the exercise they engaged in, their participation in school sport, nutritional habits, food preferences, snacking habits, breakfast and meal routines, their perceptions of how people stay healthy or get sick, the activities they would engage in during their free time and to enjoy a healthy lifestyle and their television viewing habits. The results obtained from the health and lifestyle habits of children revealed that children seem to know the various factors that influence their health and what they should or should not do in order to maintain a healthy lifestyle. However, children do not practise those positive attitudes and habits during their free time. Conclusions: The findings of the present study demonstrate that children cannot assume the responsibility of taking the knowledge they have gained during their health education lessons and putting them into practice in their everyday lifestyle. Based on these findings, the compulsory nature of Physical Education in schools must be ensured and the subject must be taught equally across the different socio-economic areas. This study also revealed that there is an urgent need for strategies that will ensure equal standard of sporting facilities at all schools.
Country
Publisher
African Journal for Physical Health Education, Recreation and Dance: A Multi-Disciplinary Approach to Health and Well-being
Theme area
Poverty and health
Title of publication Pediatric asthma and ambient pollutant levels in industrializing nations
Date of publication
2014 September
Publication type
Journal Article
Publication details
International Health 7 1 pp 7-15
Publication status
Published
Language
English
Keywords
asthma, pollution, urban, Africa, review
Abstract
Asthma is one of the most common chronic diseases in childhood and its prevalence has been increasing within industrializing nations. The contribution of ambient pollutants to asthma symptomatology has been explored in some countries through epidemiological investigations, molecular analysis and monitoring functional outcomes. The health effects of rising environmental pollution have been of increasing concern in industrializing nations with rising urbanization patterns. This review article provides an overview of the link between pediatric asthma and exposure to rising sources of urban air pollution. It primarily focuses on the asthma-specific effects of sulfur dioxide, nitrogen dioxide, ozone and particulate matter. Worldwide trends of asthma prevalence are also provided which detail the prominent rise in asthma symptoms in many urban areas of Africa, Latin America and Asia. The molecular and functional correlation of ambient pollutants with asthma-specific airway inflammation in the pediatric population are also highlighted. Conclusions: The final aspect of the review considers the correlation of motor vehicle, industrial and cooking energy sources, ascribed as the major emitters among the pollutants in urban settings, with asthma epidemiology in children.
Country
Publisher
International Health
Theme area
Poverty and health
Title of publication Secular trends in habitual physical activities of Mozambican children and adolescents from Maputo city
Date of publication
2014 October
Publication type
Journal Article
Publication details
International Journal of Environmental Research and Public Health 11 10 pp 10940-10950
Publication status
Published
Language
English
Keywords
youth, physical activity, urban, Mozambique, quantitative survey
Abstract
Social and economic changes occurring in the last two decades in Mozambique may have induced lifestyle changes among youth. This study aimed to document secular changes in habitual physical activities of Mozambican youth between 1992, 1999 and 2012. A total of 3393 youth (eight-15 years), were measured in three different time periods (1992, 1999, 2012). Habitual physical activity (PA) was estimated with a questionnaire, including items related to household chores, sport participation, traditional games and walking activities. Biological maturation was assessed. Analysis of Covariance (ANCOVA) was used to compare mean differences in PA across the years. Significant decreases between 1992-1999 and 1992-2012 were observed for boys in household chores, games and walking, and a significant decline between 1999 and 2012 was found in sport participation. Among girls, a significant and consistent decline (1992 > 1999 > 2012) was observed for household chores, a decline between 1992-1999 and 1992-2012 for games and walking, and a significant increase between 1992 and 1999 in sport participation. In general, a negative secular trend was found in habitual PA among Mozambican youth. Conclusions: Since more than 40% of the Mozambican population is under 15 years old [12,13], different PA/physical education/sports participation programs should be implemented as a potential strategy to reduce the health risks associated with an inactive lifestyle in later life. Moreover, attention to the urbanization process must be done in order to reduce the impact of activity barriers in the growing cities.
Country
Publisher
International Journal of Environmental Research and Public Health
Theme area
Poverty and health
Title of publication A longitudinal study of long-term change in contamination hazards and shallow well quality in two neighbourhoods of Kisumu, Kenya
Date of publication
2015 April
Publication type
Journal Article
Publication details
International Journal of Environmental Research and Public Health 12 4 pp 4275-4291
Publication status
Published
Language
English
Keywords
water quality, wells, urban, Kenya, longitudinal, mapping
Abstract
Sub-Saharan Africa is experiencing rapid urbanisation and many urban residents use groundwater where piped supplies are intermittent or unavailable. This study aimed to investigate long-term changes in groundwater contamination hazards and hand-dug well water quality in two informal settlements in Kisumu city, Kenya. Buildings, pit latrines, and wells were mapped in 1999 and 2013-2014. Sanitary risk inspection and water quality testing were conducted at 51 hand-dug wells in 2002 to 2004 and 2014. Pit latrine density increased between 1999 and 2014, whilst sanitary risk scores for wells increased between 2002 to 2004 and 2014 (n = 37, Z = -1.98, p = 0.048). Nitrate levels dropped from 2004 to 2014 (n = 14, Z = -3.296, p = 0.001), but multivariate analysis suggested high rainfall in 2004 could account for this. Thermotolerant coliform counts dropped between 2004 and 2014, with this reduction significant in one settlement. Hand-dug wells had thus remained an important source of domestic water between 1999 and 2014, but contamination risks increased over this period. Water quality trends were complex, but nitrate levels were related to both sanitary risks and rainfall. Conclusions: Given widespread groundwater use by the urban poor in sub-Saharan Africa, the study protocol could be further refined to monitor contamination in hand-dug wells in similar settings.
Country
Publisher
International Journal of Environmental Research and Public Health
Theme area
Poverty and health
Title of publication Seasonal variations in under-five mortality, stratified by neonatal, post-neonatal and child mortality, in Korogocho and Viwandani urban slums in Nairobi, Kenya: A time-series analysis on secondary data from the Nairobi Urban Health and Demographic Survei
Date of publication
2015
Publication type
Academic paper
Publication details
Degree project, Master of Medical Science in International Health, Spring 2015 / / pp /-/
Publication status
Published
Language
English
Keywords
Kenya, under-five mortality, urban slums, household survey
Abstract
This study aims at clarifying if seasonality can be associated with mortality in different child age spans i.e. neonatal, post-neonatal and children under five in two urban slum settlements in Nairobi, Kenya. Secondary seasonal mortality data from the Nairobi Urban Health and Demographic Surveillance System (NUHDSS), collected in the years 2008–2010 in Viwandani and Korogocho slums in Nairobi, Kenya was decomposed into seasonal components with a moving average comparison. Seasonal indices were created on disaggregated data for the different mortality groups and gender strata. The annual mean prevalence of under-five mortality [U5M] and neonatal mortality [NM] was 86 and 20 respectively. Overall U5M increased from April–August. Post-neonatal mortality [PM] had the earliest onset (April–May) followed by NM (May–August). Child mortality [CM] had two peaks, June–August and November. Conclusions: The displayed seasonal pattern in NM, PM, CM and U5M seemingly corresponded to the yearly fluctuation of temperature and precipitation, with a predominant intensification in the wettest and coldest months. CM seemed to be the only group with increased mortality also in the second rain period, not reflected in the overall mortality index. These findings could be used to set the agenda for preventative interventions aimed at reducing childhood mortality and morbidity.
Country
Publisher
Uppsala University – Medical faculty, Department of Women’s and Children’s Health, International Maternal and Child Health (IMCH)
Theme area
Poverty and health
Title of publication The nutrition and health transition in the north west province of South Africa: A review of the THUSA (transition and health during urbanisation of South Africans)
Date of publication
2005 August
Publication type
Journal Article
Publication details
Public Health Nutrition 8 5 pp 480-490
Publication status
Published
Language
English
Keywords
nutrition, health transition, urbanization, South Africa, cross-sectional survey
Abstract
This study aims to demonstrate how urbanisation influences the nutrition and health transition in South Africa by using data from the THUSA (Transition and Health during Urbanisation of South Africans) study. In the North West Province of South Africa, a total of 1854 apparently healthy volunteers, men and women aged 15 years and older, from 37 randomly selected sites in the North West Province of South Africa were enrolled in this cross-sectional, comparative, population-based survey study. Subjects were stratified into five groups representing different levels of urbanisation in rural and urban areas: namely, deep rural, farms, squatter camps, townships and towns/cities. Socio-economic and education profiles, dietary patterns, nutrient intakes, anthropometric and biochemical nutrition status, physical and mental health indicators, and risk factors for non-communicable diseases (NCDs) were measured using questionnaires developed or adapted and validated for this population, as well as appropriate, standardised methods for the biochemical analyses of biological samples. Subjects from the rural groups had lower household incomes, less formal education, were shorter and had lower body mass indices than those in the urban groups. Urban subjects consumed less maize porridge but more fruits, vegetables, animal-derived foods and fats and oils than rural subjects. Comparing women from rural group 1 with the urban group 5, the following shifts in nutrient intakes were observed: % energy from carbohydrates, 67.4 to 57.3; from fats, 23.6 to 31.8; from protein, 11.4 to 13.4 (with an increase in animal protein from 22.2 to 42.6 g day(-1)); dietary fibre, 15.8 to 17.7 g day(-1); calcium, 348 to 512 mg day(-1); iron from 8.4 to 10.4 mg day(-1); vitamin A from 573 to 1246 mug retinol equivalents day(-1); and ascorbic acid from 30 to 83 mg day(-1). Serum total cholesterol, low-density lipoprotein cholesterol and plasma fibrinogen increased significantly across groups; systolic blood pressure >140 mmHg was observed in 10.4-34.8% of subjects in different groups and diabetes mellitus in 0.8-6.0% of subjects. Women in groups 1 to 5 had overweight plus obesity rates of 48, 53, 47, 61 and 61%, showing an increase with urbanisation. Subjects from group 2 (farm dwellers) showed the highest scores of psychopathology and the lowest scores of psychological well-being. The same subjects consistently showed the lowest nutrition status. Conclusions: Urbanisation of Africans in the North West Province is accompanied by an improvement in micronutrient intakes and status, but also by increases in overweight, obesity and several risk factors for NCDs. It is recommended that intervention programmes to promote nutritional health should aim to improve micronutrient status further without leading to obesity. The role of psychological strengths in preventing the adverse effects of urbanisation on health needs to be examined in more detail.
Country
Publisher
Public Health Nutrition
Theme area
Poverty and health
Title of publication Determinants of under nutrition among school age children in a Nairobi peri-urban slum
Date of publication
2008 October
Publication type
Journal Article
Publication details
East African Medical Journal 85 10 pp 471-479
Publication status
Published
Language
English
Keywords
children, peri-urban, slum, malnutrition, Kenya, cross-sectional study
Abstract
The aim of this study was to establish the determinants of under nutrition among school age children between 6-12 years in a low-income urban community. A cross-sectional descriptive study was conducted in Kawangware peri-urban slum, Nairobi, Kenya. With 384 school children aged 6-12 years. A total of 4.5% were wasted, 14.9% underweight and 30.2% stunted. The children who were over nine years of age were more underweight and stunted than those below eight years. The girls were more wasted than the boys, whereas the boys were more stunted than the girls . The other variables found to have had significant association with the nutritional status of the children were: monthly household income (p = 0.008), food prices (p = 0.012), morbidity trends (p = 0.045), mode of treatment (p = 0.036) and school attendance (p = 0.044). Conclusions: The findings of this study show evidently that there is under nutrition among school age children, with stunting being the most prevalent. The Ministry of Education and Ministry of Health therefore need to develop policies which can alleviate under nutrition among school age children. We also recommend that awareness be created among the school age children, parents and teachers, on the dietary requirements of both boys and girls.
Country
Publisher
East African Medical Journal
Theme area
Poverty and health
Title of publication Overweight and obesity in urban Africa: A problem of the rich or the poor?
Date of publication
2009 December
Publication type
Journal Article
Publication details
BMC Public Health 9 465 pp /-/
Publication status
Published
Language
English
Keywords
overweight, obesity, urban, trends, sub-Saharan Africa, household survey
Abstract
The aim of this study was to shed light on the patterns of overweight and obesity in sub-Saharan Africa, with special interest in differences between the urban poor and the urban non-poor. The specific goals were to describe trends in overweight and obesity among urban women; and examine how these trends vary by education and household wealth.: The paper used Demographic and Health Surveys data from seven African countries where two surveys had been carried out with an interval of at least 10 years between them. Among the countries studied, the earliest survey took place in 1992 and the latest in 2005. The dependent variable was body mass index coded as: Not overweight/obese; Overweight; Obese. The key covariates were time lapse between the two surveys; woman's education; and household wealth. Control variables included working status, age, marital status, parity, and country. Multivariate ordered logistic regression in the context of the partial proportional odds model was used. Descriptive results showed that the prevalence of urban overweight/ obesity increased by nearly 35% during the period covered. The increase was higher among the poorest (+50%) than among the richest (+7%). Importantly, there was an increase of 45-50% among the non-educated and primary-educated women, compared to a drop of 10% among women with secondary education or higher. In the multivariate analysis, the odds ratio of the variable time lapse was 1.05 (p < 0.01), indicating that the prevalence of overweight/obesity increased by about 5% per year on average in the countries in the study. While the rate of change in urban overweight/obesity did not significantly differ between the poor and the rich, it was substantially higher among the non-educated women than among their educated counterparts. Conclusions: Overweight and obesity are on the rise in Africa and might take epidemic proportions in the near future. Like several other public health challenges, overweight and obesity should be tackled and prevented early as envisioned in the WHO Global strategy on diet, physical activity and health.
Country
Publisher
BMC Public Health
Theme area
Poverty and health
Title of publication Does socioeconomic inequality in health persist among older people living in resource-poor urban slums?
Date of publication
2011 June
Publication type
Journal Article
Publication details
Journal of Urban Health : Bulletin of the New York Academy of Medicine 88 Suppl 2 pp S381-S400
Publication status
Published
Language
English
Keywords
health inequality, older people, urban slums, socioeconomic position, cross-sectional survey
Abstract
Using self-reported health that assesses functionality or disability status, this paper investigates whether there are any differences in health status among older people living in a deprived area of Nairobi, Kenya. Data from a cross-sectional survey of 2,037 men and women aged 50 years and older are used to examine the association between socioeconomic position and self-reported health status across 6 health domains. Education, occupation, a wealth index, and main source of livelihood are used to assess the presence of a socioeconomic gradient in health. All the indicators showed the expected negative association with health across some, but not all, of the disability domains. Nonetheless, differences based on occupation, the most commonly used indicators to examine health inequalities, were not statistically significant. Primary level of education was a significant factor for women but not for men; conversely, wealth status was associated with lower disability for both men and women. Older people dependent on their own sources of livelihood were also less likely to report a disability. Conclusions: The results suggest the need for further research to identify an appropriate socioeconomic classification that is sensitive in identifying poverty and deprivation among older people living in slums.
Country
Publisher
Journal of Urban Health : Bulletin of the New York Academy of Medicine
Theme area
Poverty and health
Title of publication Monitoring of health and demographic outcomes in poor urban settlements: Evidence from the Nairobi urban health and demographic surveillance system
Date of publication
2011 June
Publication type
Journal Article
Publication details
Journal of Urban Health : Bulletin of the New York Academy of Medicine 88 Suppl 2 pp S200-S218
Publication status
Published
Language
English
Keywords
urban, poverty, interventions, slum, settlement, Kenya, household survey
Abstract
The Nairobi Urban Health and Demographic Surveillance System (NUHDSS) was set up in Korogocho and Viwandani slum settlements to provide a platform for investigating linkages between urban poverty, health, and demographic and other socioeconomic outcomes, and to facilitate the evaluation of interventions to improve the wellbeing of the urban poor. Data from the NUHDSS confirm the high level of population mobility in slum settlements, and also demonstrate that slum settlements are long-term homes for many people. Research and intervention programs should take account of the duality of slum residency. Consistent with the trends observed countrywide, the data show substantial improvements in measures of child mortality, while there has been limited decline in fertility in slum settlements. Conclusions: The NUHDSS experience has shown that it is feasible to set up and implement long-term health and demographic surveillance system in urban slum settlements and to generate vital data for guiding policy and actions aimed at improving the wellbeing of the urban poor. Given the growing importance of slum settlements and longitudinal research platform in Africa’s major cities and other urban areas, such comprehensive and time–series data are vital for guiding policy and program actions aimed at improving the wellbeing of the urban poor.
Country
Publisher
Journal of Urban Health : Bulletin of the New York Academy of Medicine
Theme area
Poverty and health
Title of publication Bringing sexual and reproductive health in the urban contexts to the forefront of the development agenda: The case for prioritizing the urban poor
Date of publication
2014 December
Publication type
Journal Article
Publication details
Maternal and Child Health Journal 18 7 pp 1572-1577
Publication status
Published
Language
English
Keywords
sexual and reproductive health, urban poor, review, quantitative
Abstract
Sexual and reproductive health (SRH) risks for the urban poor are severe and include high rates of unwanted pregnancies, sexually transmitted infections, and poor maternal and child health outcomes. However, the links between poverty, urbanization, and reproductive health priorities are still not a major focus in the broader development agenda. The authors identify key research, policy and program recommendations and strategies required for bringing sexual and reproductive health in urban contexts to the forefront of the development agenda. Building on theoretical and empirical data, we show that SRH in urban contexts is critical to the development of healthy productive urban populations and, ultimately, the improvement of quality of life. Conclusions: We posit that a strategic focus on the sexual and reproductive health of urban residents will enable developing country governments achieve international goals and national targets by reducing health risks among a large and rapidly growing segment of the population.
Country
Publisher
Maternal and Child Health Journal
Theme area
Poverty and health
Title of publication Trends in causes of adult deaths among the urban poor: Evidence from Nairobi urban health and demographic surveillance system, 2003-2012
Date of publication
2015 June
Publication type
Journal Article
Publication details
Journal of Urban Health : Bulletin of the New York Academy of Medicine 92 3 pp 422-445
Publication status
Published
Language
English
Keywords
mortality, informal settlements, Kenya, household survey
Abstract
The authors examine trends in the causes of death among the urban poor in two informal settlements in Nairobi by applying the InterVA-4 software to verbal autopsy data. Cause of death data is examined from 2646 verbal autopsies of deaths that occurred in the Nairobi Urban Health and Demographic Surveillance System (NUHDSS) between 1 January 2003 and 31 December 2012 among residents aged 15 years and above. The results are presented as annualized trends from 2003 to 2012 and disaggregated by gender and age. Over the 10-year period, the three major causes of death are tuberculosis (TB), injuries, and HIV/AIDS, accounting for 26.9, 20.9, and 17.3% of all deaths, respectively. In 2003, HIV/AIDS was the highest cause of death followed by TB and then injuries. However, by 2012, TB and injuries had overtaken HIV/AIDS as the major causes of death. HIV/AIDS was consistently higher for women than men across all the years generally by a ratio of 2 to 1. The authors find significant gender variation in deaths linked to injuries, with male deaths being higher than female deaths by a ratio of about 4 to 1 with a fifteen percent increase in the incidences of male deaths due to injuries between 2003 and 2012. Cardiovascular diseases mortality increased steadily with deaths consistently higher among women. We identified substantial variations in causes of death by age, with TB, HIV/AIDS, and CVD deaths lowest among younger residents and increasing with age, while injury-related deaths are highest among the youngest adults 15-19 and steadily declined with age. Also, deaths related to neoplasms and respiratory tract infections (RTIs) were prominent among older adults 50 years and above, especially since 2005. Emerging at this stage is evidence that HIV/AIDS, TB, injuries, and cardiovascular disease are linked to approximately 73 % of all adult deaths among the urban poor in Nairobi slums of Korogocho and Viwandani in the last 10 years. In sum, substantial epidemiological transition is ongoing in this local context, with deaths linked to communicable diseases declining from 66 % in 2003 to 53 % in 2012, while deaths due to noncommunicable causes experienced a four-fold increase from 5 % in 2003 to 21.3 % in 2012, together with another two-fold increase in deaths due to external causes (injuries) from 11 % in 2003 to 22 % in 2012. It is important to also underscore the gender dimensions of the epidemiological transition clearly visible in the mix. Recommendations: The elevated levels of disadvantage of slumdwellers in this analysis relative to other population subgroups in Kenya continue to demonstrate appreciable deterioration of key urban health and social indicators, highlighting the need for a deliberate strategic focus on the health needs of the urban poor in policy and program efforts toward achieving international goals and national health and development targets.
Country
Publisher
Journal of Urban Health
Theme area
Equitable health services
Title of publication African responses to the 2014/5 Ebola Virus Disease Epidemic
Date of publication
2015 October
Publication type
Document
Publication details
Publication status
Published
Language
Keywords
Ebola; emergency response; health services; global health
Abstract
The Ebola outbreak in West Africa in 2014/5 is the largest and most complex Ebola outbreak since the virus was first discovered in 1976 and was declared by WHO to be a Public Health Emergency of International Concern under the International Health Regulations (2005). There has been significant documentation on the various international
responses to the epidemic. There is also evidence that the epidemic triggered new developments in epidemic prevention and response from Africa. In April 2015 the AU called for the lessons learned to be identified for future responses. This brief summarises the publicly available documentation on the response of African countries to the
epidemic. It is based on 63 documents accessed through key word search in July–August 2015 of online databases, supplemented by documents obtained from snowballing in September 2015. The brief presents: a. The actions taken by African governments and institutions at national, regional and continental level to support the response to the epidemic; b. The identified positive features and challenges in the African response and c. The links between the African emergency response to the EVD epidemic and health system strengthening.
Country
Africa
Publisher
EQUINET
Equinet Publication Type
Discussion brief
Theme area
Public-private mix
Title of publication Achieving universal health coverage in East and Southern Africa: what role for for-profit providers?
Date of publication
2015 July
Publication type
Document
Publication details
Paper presented at the Panel session T03P13: Private sector and universal health coverage - examining evidence and deconstructing rhetoric International Conference on Public Policy, 1-4 July 2015, Milan, Italy
Publication status
Published
Language
Keywords
private health sector; health financing; health services; east and southern Africa
Abstract
This paper considers evidence on the effectiveness, equity and sustainability of for-profit private provision, and the effectiveness of government’s stewardship of the sector, in East and Southern Africa. It draws conclusions about policy and regulatory requirements to encourage for-profit providers to make a more useful contribution towards achieving universal health coverage in the region. The author observes a recent increase in the size of a formerly relatively small for-profit private sector in some countries in the region, but also the emergence of ‘boutique’ hospitals (targeted at the high-income local market, expats and foreign NGO workers, as well as medical tourism) in otherwise underdeveloped settings. As warned by the international literature that critiques the commercialisation of health care, such developments could worsen inequity and destabilise national health systems if inadequately regulated.
Country
East and southern Africa region
Publisher
School of Public Health, University of the Witwatersrand
Theme area
Resource allocation and health financing
Title of publication Guidance on using needs-based formulae and gap analysis in the equitable allocation of health care resources in East and Southern Africa
Date of publication
2015 October
Publication type
Document
Publication details
Guidance on using needs-based formulae and gap analysis in the equitable allocation of health care resources in East and Southern Africa’ EQUINET Discussion Paper 93 updated. Health Economics Unit (UCT), EQUINET: Harare.
Publication status
Published
Language
Keywords
Resource allocation; equity; health financing; methods
Abstract
The equitable allocation of limited public sector health care resources across population groups is a critical mechanism for promoting health system equity and efficiency. The population groups are often defined by geographic areas that correspond to administrative authorities. The use of
a needs-based resource allocation formula to calculate target allocations for each province or region and each district is becoming increasingly popular in countries where health care is publicly funded and provided. Target allocations are defined according to the relative need for health services in each geographic area, quantified using indicators such as population size, demographic
composition, levels of ill health and socio-economic status.
EQUINET has supported the development of needs-based resource allocation formulae in a number of east and southern African countries in the past. The methods for developing such a formula are summarised in this paper. Our work in the region has persuaded us that it is necessary to supplement the development of a formula with other initiatives to support the successful implementation of the resource allocation processes. To facilitate the gradual shifting of resources, the equity target allocations calculated through the formula must be linked explicitly to national and local planning and budgeting processes.
Country
East and southern Africa region
Publisher
Equinet Publication Type
Toolkits and training materials
Theme area
Equity in health, Values, policies and rights, Health equity in economic and trade policies, Equitable health services, Human resources for health, Resource allocation and health financing, Governance and participation in health
Title of publication Contributions of global health diplomacy to equitable health systems in east and southern Africa
Date of publication
2015 July
Publication type
Document
Publication details
Contributions of global health diplomacy to equitable health systems in east and southern Africa: Key findings and recommendations from a regional research programme 2012-2015, EQUINET Harare
Publication status
Published
Language
Keywords
global health, diplomacy, east and southern Africa
Abstract
Do global health platforms provide meaningful opportunities to advance equitable health systems and population health in east and southern Africa? What factors have supported effective negotiation of African policy goals on health systems within international and global health diplomacy? This brief outlines, with hyperlinks to the relevant reports, the findings and proposals for follow up policy review, action and research from a three year EQUINET led policy research programme with
government officials, technical institutions, civil society and other stakeholders and in association with the East, Central and Southern Africa Health Community (ECSA –HC). The first two pages provide the broad findings, proposed actions and research agenda. Subsequent text presents the findings and proposals from the specific themes investigated in the programme.
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Discussion brief
Theme area
Equitable health services, Governance and participation in health
Title of publication Case Study Brief: Health centre committees ensuring services respond to the needs of people living with HIV in Malawi
Date of publication
2015 March
Publication type
Document
Publication details
REACH Trust, TARSC in EQUINET (2015) Health centre committees ensuring services respond to the needs of people living with HIV in Malawi, EQUINET Case study brief, EQUINET Harare
Publication status
Published
Language
Keywords
Health centre committee; Malawi; community participation, HIV
Abstract
Malawi's 1994 Constitution obliges the state to provide adequate health care within the resources available, and guarantees equality in access to these health services. Community participation is a central pillar for implementing PHC in Malawi’s 2011-2016 Health Sector Strategic Plan, which
commits to ensuring that local communities have a voice and an opportunity to participate in issues that affect their health. This brief describes the role ad functioning of health centre advisory committees in supporting services to be responsive to the needs of people living with HIV. The committee members worked with volunteers, visiting villages with messages about prevention of vertical transmission and the services available for it.
Country
Malawi
Publisher
EQUINET
Equinet Publication Type
Discussion brief
Theme area
Governance and participation in health
Title of publication Case Study Brief: Health centre committee involvement in local government planning for health in Zambia
Date of publication
2015 April
Publication type
Document
Publication details
Health centre committee involvement in local government planning for health in Zambia , EQUINET Case study brief, EQUINET Harare
Publication status
Published
Language
Keywords
health centre committees;; Zambia; participation; primary health care
Abstract
Neighbourhood Health Committees (NHCs) have been set up in all ten provinces in Zambia and district community health offices. Their role is being strengthened across the country, and there are many examples of efforts that have been made to
promote their participation in planning, budgeting and health actions. This brief outlines these initiatives and the lessons from the work.
Country
Zambia
Publisher
EQUINET
Equinet Publication Type
Briefs
Theme area
Values, policies and rights, Health equity in economic and trade policies, Human resources for health, Governance and participation in health
Title of publication Contributions of global health diplomacy to equitable health systems in east and southern Africa, Report of a Regional Research Workshop, 13-14 March 2015, Johannesburg South Africa
Date of publication
2015 April
Publication type
Report
Publication details
Contributions of global health diplomacy to equitable health systems in east and southern Africa, Report of a Regional Research Workshop, 13-14 March 2015, Johannesburg South Africa EQUINET: Harare
Publication status
Published
Language
Keywords
Global health diplomacy; East and southern Africa; research
Abstract
This report presents the proceedings of a meeting held on March 13 and 14 a regional meeting was convened with objectives to
i. Present and discuss the findings from the EQUINET research programme and from related research in Africa, and the implications for policy, negotiations and programmes in east and southern Africa;
ii. Review methods and challenges for implementing research and analysis on global health diplomacy for policy relevance, from review of research and experience of the work;
iii. Discuss and propose areas for follow up policy, action and research, within ESA and through south-south collaboration. It included senior officials involved in health from national and regional organisations, health diplomats, researchers from the EQUINET work and others working on health diplomacy and on south-south co-operation in the region and internationally.
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Reports
Theme area
Equitable health services, Governance and participation in health
Title of publication Case study brief: Strengthening the capacities health centre committees as health advocates in Zimbabwe
Date of publication
2015 March
Publication type
Document
Publication details
Strengthening the capacities health centre committees as health advocates in Zimbabwe, EQUINET Case study brief, EQUINET Harare
Publication status
Published
Language
Keywords
health centre committees, Zimbabwe, participation, training
Abstract
Health Centre Committees (HCCs) in Zimbabwe have made a vital contribution to health services and community health. HCCs have supported health activities and played a role in discussing how funds including those from fee collections are used in the clinics. In 2011 training materials were developed jointly by TARSC, CWGH and MoHCC for an approximately three to four day training for HCCs on these roles using participatory tools. This case study brief outlines the training of HCC members and of community members in health literacy.
Country
Zimbabwe
Publisher
EQUINET
Equinet Publication Type
Briefs
Theme area
Equity in health, Values, policies and rights, Equitable health services, Resource allocation and health financing
Title of publication Zimbabwe Equity Watch 2014
Date of publication
2015 March
Publication type
Report
Publication details
Zimbabwe Equity Watch 2014, TARSC, MoHCC, EQUINET Harare
Publication status
Published
Language
Keywords
health equity; Zimbabwe; Equity Watch
Abstract
Equity Watch reports were produced in Zimbabwe in 2008 and 2011, using a framework developed by EQUINET in cooperation with the ECSA–HC and in consultation with WHO and UNICEF. This 2014 Zimbabwe Equity Watch updates the evidence using in the same framework, and including areas identified by stakeholders in Zimbabwe as important for achieving equity in Universal Health Coverage. The report introduces the context and provides evidence on selected parameters of: equity in health, household access to the resources for health, equitable health systems and global justice. It shows past levels (1980–2008), current levels (most current data publicly available for the past 5 years, 2009-2014) and comments on the level of progress made towards health equity.
Country
Zimbabwe
Publisher
TARSC, MoHCC, EQUINET
URL:
Equinet Publication Type
Reports
Theme area
Values, policies and rights, Equitable health services
Title of publication Case study brief: Communities shaping health centre committee roles and policy in Eastern Cape Province, South Africa,
Date of publication
2015 March
Publication type
Document
Publication details
EQUINET Case study brief, EQUINET Harare
Publication status
Published
Language
Keywords
health centre committee, South Africa, policy
Abstract
Communities in the Eastern Cape have played a role in formulating and implementing the guidance on their roles and functioning. In the Nelson Mandela Bay Health District, for example, health in 2006, a team from the Eastern Cape Provincial Department of Health invited health committee
members, health service, local government, community and other local stakeholders to a meeting to contribute and to provide substance to the policy on health committees. This workshop served to frame the draft policy, which was later
sent to all districts for discussion before further review and feedback by HCC representatives. The amendments made in this process were integrated into the final policy that was adopted in 2009 by the legislature in the province and published in 2010. This brief discusses this case study on the role of health centre committees as part of a series of case study briefs on the topic
Country
South Africa
Publisher
EQUINET
Equinet Publication Type
Briefs
Theme area
Equity in health, Values, policies and rights
Title of publication Investigación-Acción Participativa En Sistemas De Salud: Una Guía De Métodos
Date of publication
2015 March
Publication type
Book
Publication details
Investigación-Acción Participativa En Sistemas De Salud: Una Guía De Métodos TARSC, AHPSR, WHO, IDRC Canada, EQUINET, Harare, 2014
Publication status
Published
Language
Spanish
Keywords
Spanish; participatory action research; health systems
Abstract
En el siglo XXI hay una demanda creciente de canalizar la energía colectiva hacia la justicia y equidad en salud y comprender mejor los procesos sociales que afectan a la salud y los sistemas de salud. Las comunidades, los trabajadores de salud y otros actores de base tienen un papel crucial para responder a esta demanda y plantear problemas claves así como para construir conocimiento nuevo y estimular y emprender acciones encaminadas a transformar los sistemas de salud y a mejorar la salud. Existe una gama creciente de métodos, instrumentos y capacidades –viejos y nuevos—para aumentar la participación y el poder sociales y generar nuevo conocimiento mediante la investigación participativa. Simultáneamente necesitamos tener claridad sobre qué es la investigación participativa y qué puede ofrecer. Esta Guía de metodos promueve la comprensión del término ‘investigación-acción participativa’ y ofrece información sobre sus paradigmas, métodos y usos, particularmente en el ámbito de políticas y sistemas de salud. La Guía de metodos, ahora disponible en inglés y español, fue elaborado por Regional Network for Equity in Health in East and Southern Africa (EQUINET) junto con la Alianza por la investigación en Políticas y Sistemas de Salud (AHPSR en inglés) y el Centro Internacional de Desarrollo de la Investigación (IDRC en inglés) de Canada. La Guía, resultado del trabajo en equipo, recoge experiencias y trabajos publicados de todas las regiones del mundo y explica:
• las caracaterísticas claves de la investigación-acción participativa así como la historia y los paradigmas de conocimiento que la informan;
• los procesos y métodos utilizados en la investigación-acción participativa, incluyendo las innovaciones y desarrollos en este campo y las cuestiones éticas y metodológicas cuando se instrumenta y;
• asuntos de comunicación, informes, institucionalización y usos de la investigación-acción en política y sistema de salud.
Country
International
Publisher
EQUINET
Equinet Publication Type
Toolkits and training materials
Theme area
Governance and participation in health
Title of publication Discussion paper 105: Annotated literature review and reflections from practice: Conceptual frameworks and strategies for research on global health diplomacy
Date of publication
2015 March
Publication type
Report
Publication details
Annotated literature review and reflections from practice: Conceptual frameworks and strategies for research on global health diplomacy EQUINET Discussion paper 105 CTPL, EQUINET Harare.
Publication status
Published
Language
Keywords
health diiplomacy, global, research methods, annotated bibliography
Abstract
The first version of this review provided an annotated bibliography and a summary of key features of peer reviewed articles, books, book chapters and academic reports published between 1998 and 2012 on three case study areas: research on GHD, particularly in the areas of the WHO Code on International Recruitment of Health Workers; access to essential drugs through south-south partnerships; and involvement of African actors in global health governance. It focused on the theoretical and conceptual frameworks used in peer-reviewed literature on global health diplomacy and on the authors’ methodological choices to reach their conclusions. The report highlighted theories that guided the research, the types of conceptual frameworks used and the research strategy and research tools employed in the publications reviewed. The review was implemented in two stages: an interim external peer review and more specific searches linked to the three case study areas above. This updated version of the review keeps the structure from the first: sections 1 to 6 discuss the methods used in the review, drawing on the literature, the theoretical and conceptual frameworks and research strategies used in research on GHD. Added to the text are observations and reflections from the EQUINET-led research programme in 2013 and 2014.
Country
International
Publisher
EQUINET
Equinet Publication Type
Discussion paper
Theme area
Governance and participation in health
Title of publication Is time up for WHO? Reform, resilience, and global health governance
Date of publication
2014 May
Publication type
Document
Publication details
Future United Nations Development System Briefing 17 / pp /-1
Publication status
Published
Language
English
Keywords
WHO, reform, governance, global
Abstract
The World Health Organisation (WHO) provides a litmus test for reforming the UN development system (UNDS). While often praised as among the most competent and essential, it occupies an increasingly crowded institutional terrain. It must emphasise its comparative advantages. This article puts forward the case for, and debates surrounding, reform.
Country
Publisher
4
Theme area
Equitable health services
Title of publication Essential Medicines Are More Available than Other Medicines around the Globe
Date of publication
2014 February
Publication type
Journal Article
Publication details
PLoS ONE 9 2 pp 1-7
Publication status
Published
Language
English
Keywords
WHO, Medicines, access, global
Abstract
The World Health Organisation (WHO) promotes the development of national Essential Medicines Lists (EMLs) in order to improve the availability and use of medicines considered essential within health care systems. However, despite over 3 decades of international efforts, studies show an inconsistent pattern in the availability of essential medicines. The authors evaluated and compared the availability of essential medicines, and medicines not included in national EMLs, at global and regional levels. Medicine availability in the public and private sector were calculated based on data obtained from national and provincial facility-based surveys undertaken in 23 countries using the WHO/HAI methodology. The medicines were grouped according to their inclusion (‘essential’) or exclusion (termed ‘non-essential’) in each country’s EML current at the time of the survey. Availability was calculated for originator brands, generics and any product type (originator brands or generics) and compared between the two groups. Results were aggregated by WHO regions, World Bank country income groups, a wealth inequality measure, and therapeutic groups. Across all sectors and any product type, the median availability of essential medicines was suboptimal at 61·5% (IQR 20·6%–86·7%) but significantly higher than non-essential medicines at 27·3% (IQR 3·6%–70·0%). The median availability of essential medicines was 40·0% in the public sector and 78·1% in the private sector; compared to 6·6% and 57·1% for non-essential medicines respectively. A reverse trend between national income level categories and the availability of essential medicines was identified in the public sector.EMLs have influenced the provision of medicines and have resulted in higher availability of essential medicines compared to non-essential medicines particularly in the public sector and in low and lower middle income countries. However, the availability of essential medicines, especially in the public sector does not ensure equitable access.
Country
Publisher
PLoS ONE
Theme area
Equitable health services
Title of publication A quiet revolution in global public health: The World Health Organization’s Prequalification of Medicines Programme
Date of publication
2014 May
Publication type
Journal Article
Publication details
Journal of Public Health Policy 35 2 pp 137-161
Publication status
Published
Language
English
Keywords
WHO, medicines, quality, global
Abstract
Problems with the quality of medicines abound in countries where regulatory and legal oversight are weak, where medicines are unaffordable to most, and where the official supply often fails to reach patients. Quality is important to ensure effective treatment, to maintain patient and health-care worker confidence in treatment, and to prevent the development of resistance. In 2001, the WHO established the Prequalification of Medicines Programme in response to the need to select good-quality medicines for UN procurement. Member States of the WHO had requested its assistance in assessing the quality of low-cost generic medicines that were becoming increasingly available especially in treatments for HIV/AIDS. From a public health perspective, WHO PQP's greatest achievement is improved quality of life-saving medicines used today by millions of people in developing countries. Prequalification has made it possible to believe that everyone in the world will have access to safe, effective, and affordable medicines. Yet despite its track record and recognized importance to health, funding for the programme remains uncertain.
Country
Publisher
Journal of Public Health Policy
Theme area
Equity in health, Equitable health services
Title of publication Leveraging non-binding instruments for global health governance: reflections from the Global AIDS Reporting Mechanism for WHO reform
Date of publication
2014 January
Publication type
Journal Article
Publication details
Public Health 128 2 pp 151-160
Publication status
Published
Language
English
Keywords
global health, AIDS, governance, non binding, global
Abstract
As countries contend with an increasingly complex global environment with direct implications for population health, the international community is seeking novel mechanisms to incentivise coordinated national and international action towards shared health goals. Binding legal instruments have garnered increasing attention since the World Health Organisation adopted its first convention in 2003. This paper seeks to expand the discourse on future global health lawmaking by exploring the potential value of non-binding instruments in global health governance, drawing on the case of the 2001 United Nations General Assembly Special Session Declaration of Commitment on HIV/AIDS. In other realms of international concern ranging from the environment to human rights to arms control, non-binding instruments are increasingly used as effective instruments of international cooperation. The experience of the Global AIDS Reporting Mechanism, established pursuant to the Declaration, evidences that, at times, non-binding legal instruments can offer benefits over slower, more rigid binding legal approaches to governance. The global AIDS response has demonstrated that the use of a non-binding instrument can be remarkably effective in galvanising increasingly deep commitments, action, reporting compliance and ultimately accountability for results. Based on this case, the authors argued that non-binding instruments deserve serious consideration by the international community for the future of global health governance, including in the context of WHO reform.
Country
Publisher
Public Health
Theme area
Human resources for health
Title of publication Multipolarity, Intellectual Property and the Internationalization of Public Health Law
Date of publication
2014 January
Publication type
Book Section
Publication details
Selected Works of Sam Halabi / / pp 1-58
Publication status
Published
Language
English
Keywords
law, public health, intellectual property, Brazil, India, South Africa, Thailand
Abstract
This article critically examines the proliferation of international legal agreements addressing global health threats like the outbreak of infectious diseases, tobacco use and lack of access to affordable medicines. The conventional wisdom behind this trend is that a global normative shift has occurred which has caused states to regard health as “special” and less subject to the normal rules of international law making because health threats endanger all of humanity. This article challenges that thesis, arguing that at the same time the number and scope of international health law treaties has grown, developed states have subordinated health law to intellectual property protection for patents and trademarks, both of which erect substantial barriers to the objectives of public health law treaties. To the extent international health law has generated meaningful gains for global population health, it has not done so through a normative shift in how diplomacy works, but precisely because of politics as usual. International public health law gains have come largely from the efforts of an emerging group of middle-income, influential states like Brazil, India, Indonesia, South Africa and Thailand who have sufficient weight to force concessions from wealthier states. Using the parallel histories of international intellectual property treaties and global public health law, the article demonstrates that the normative force of health-based arguments is relatively weak. To the extent public health advocates urge the adoption of more treaties, as they are now poised to do, they must more squarely address the threat posed by international intellectual property protection and make strategic calculations as to the political feasibility of those agreements given the changing distribution of global economic and political power.
Country
Publisher
University of Tulsa, College of Law
Theme area
Human resources for health
Title of publication Job Satisfaction in the Healthcare Services in South Africa: Case of MPH
Date of publication
2014 March
Publication type
Journal Article
Publication details
Mediterranean Journal of Social Sciences 5 3 pp 94-102
Publication status
Published
Language
English
Keywords
health worker, job satisfaction, South Africa
Abstract
The ultimate goal in the health environment is quality service delivery it is imperative that employees perform optimally and maintain acceptable levels of job satisfaction. The aim of this study was to investigate how job satisfaction of healthcare personnel influence quality service delivery through productivity, work performance, employee loyalty and retention at Mafikeng Provincial Hospital (MPH) in the North-West Province. The study utilised a descriptive method in order to reach its aim and the results reveal that among the determinants of job satisfaction, the availability of sufficient resources to do the work was selected as the major determinant of employee job satisfaction at MPH and at least 56.3% of the MPH workers were not satisfied with sufficient resources available to do their work, which hindered the effectiveness of service delivery. Satisfaction with job done by immediate supervisor was the second determinant of job satisfaction on this aspect the organisation is doing very well with 66.0% of the respondents reported satisfaction with their immediate supervisor’s jobs. The findings from the study show that job satisfaction improves productivity and performance, this was evident from majority of respondents (83.5%) who agreed that job satisfaction affects the way they met their target quotas, this makes logic when evaluated in conjunction with the response rate of 79.6% of employees who agreed that they spent productive time working on the tasks assigned to them, rather than idling or doing other things which do not benefit the organisation.
Country
Publisher
Mediterranean Journal of Social Sciences
Theme area
Equity in health, Health equity in economic and trade policies
Title of publication Global Health and the Law
Date of publication
2014 May
Publication type
Journal Article
Publication details
New England Journal of Medicine 370 18 pp 1732-1740
Publication status
Published
Language
English
Keywords
global health, law
Abstract
The past two decades have brought revolutionary changes in global health, driven by popular concern over the acquired immunodeficiency syndrome (AIDS), new strains of influenza, and maternal mortality. International development assistance for health — a crucial aspect of health cooperation — increased by a factor of five, from $5.6 billion in 1990 to $28.1 billion in 2012, with the private and voluntary sectors taking on an ever-increasing share of the total. Given the rapid globalisation that is a defining feature of today's world, the need for a robust system of global health law has never been greater. Global health law is not an organised legal system, with a unified treaty-monitoring body, such as the World Trade Organisation. However, there is a network of treaties and so-called “soft” law instruments that powerfully affect global health, many of which have arisen under the auspices of the World Health Organisation (WHO). Global health law has been defined as the legal norms, processes, and institutions that are designed primarily to attain the highest possible standard of physical and mental health for the world's population.Global health law can affect multiple spheres, ranging from national security, economic prosperity, and sustainable development to human rights and social justice. Each global health problem is shaped by the language of rights, duties, and rules for engagement used in the law. This article discusses the implications of global health law and strategies and challenges towards it.
Country
Publisher
New England Journal of Medicine
Theme area
Human resources for health
Title of publication Realizing rights: the WHO global code of practice on the international recruitment of health personnel: analysis with nurses' perspectives
Date of publication
2014
Publication type
Academic paper
Publication details
Law and Public Policy Dissertations Paper 21 / pp 1-218
Publication status
Published
Language
English
Keywords
health workers, WHO Code of Practice, global
Abstract
The World Health Organization (WHO) acknowledged the scope of the issues that undermine the development of sustainable health workforces when it promulgated the WHO Global Code (Code) of Practice on the International Recruitment of Health Personnel in 2010. The Code supplies a template for policy solutions to the global health worker crisis. Its recommendations are based upon four principles: 1.) to recognise the right of all people to the highest attainable standard of health; 2.) to acknowledge the right of skilled health workers to legally migrate in search of life opportunity; 3.) to employ a global policy approach to address the root causes and effects of health personnel disparity, and; 4.) to give special consideration to the needs of developing health systems. These four references embody an international consensus framework for health workforce policy that links health personnel to realisation of the right to health, and well resourced to developing health systems. In this dissertation an analysis of the Code's literal and normative content is aligned with interview evidence obtained from internationally educated nurses (IENs) and health policy experts, to test its potential as a scaffold for nurse workforce policy that operationalises its human rights framework. Guiding principles, offered by the Code, address the way society, governments and all stakeholders, should respond to the health system issues impacted by the unequally distributed shortage of skilled health workers. Its broad implementation direction does not, however, delineate the specific practices that respect, protect and fulfill the right to health. Nor does it supply a blueprint for policy that gives special consideration to the most needy. It acknowledges, but does not resolve, the policy tension of competing obligations to the freedom rights of nurses and the universal right to health.
The Code connects realisation of the right to health, its central guiding principle, to the skilled health workforce. This supports the central argument of this thesis, that nurses are critical for fulfilling the right. Given this position, formal human rights governance obligations, directions and accountability mechanisms, derived from the International Covenant on Economic, Social and Cultural Rights (ICESCR) or domestic legislation apply to the responsibility to guarantee everyone access to nursing care. The global nursing marketplace links wealthy and developing health systems. Vacancies in well resourced countries present opportunities that attract nurses, adding to the critical shortages seen in fragile systems and further threatening realisation of the right to health. Health outcomes align with the concentration of health workers; invariably regions with fewer health workers manifest poorer health.The Code echoes the ICESCR when it directs wealthy States to assist under resourced ones and to consider the effects of their health workforce policies on developing health systems. The right to health also imposes responsibilities toward the underserved. Although the Code explicitly cites the..."right to the highest attainable standard of...health", nothing in its text prescribes any compensatory remedy for right to health abuses that are exacerbated when nurses trained in poor countries deliver care in well resourced systems. Without correcting the long-standing wrongs that subsidise the nurse workforces of wealthy systems, at the expense of developing ones, it is unlikely that global solutions that realise the right to health for the underserved will be found. In addition to State duties, the Code directs that all stakeholders play a role in its implementation. Member States are left to, on their own or in collaboration, forge laws and develop policies that oversee the activities of stakeholders. The author proposes a nurse workforce policy outline that uses the Code's guiding principles and objectives to operationalise human rights norms. The policy standards rest upon: 1) setting right to health as a core value; 2) accessing formal and informal accountability routes; 3.) using targeted incentives, specifically education and financial subsidy, to match the nurse workforce to health needs; and, 4.) sharing responsibility, research, resources, and best practices. Nurses and right to health are central to achieving the Code's purpose.
Country
Publisher
Law and Public Policy Dissertations
Theme area
Human resources for health
Title of publication Global supply of health professionals
Date of publication
2014
Publication type
Journal Article
Publication details
New England Journal of Medicine 370 10 pp 950-957
Publication status
Published
Language
English
Keywords
health workers, global health
Abstract
There is a global crisis of severe shortages and marked maldistribution of health professionals that is exacerbated by three great global transitions — demographic changes, epidemiologic shifts, and redistribution of the disability burden. Each of these transitions exerts a powerful force for change in health care systems, the roles of health professionals, and the design of health professional education.Every country will have to respond to these global pressures for change. This paper discusses the effect of this on health professionals and on education reform.
Country
Publisher
New England Journal of Medicine
Theme area
Human resources for health, Monitoring equity and research to policy
Title of publication The workforce for health in a globalized context – global shortages and international migration
Date of publication
2014
Publication type
Journal Article
Publication details
Global Health Action 7 23611 pp 1-7
Publication status
Published
Language
English
Keywords
health worker, migration, globalisation, WHO Code of Practice
Abstract
The ‘crisis in human resources’ in the health sector has been described as one of the most pressing global health issues of our time. The World Health Organization (WHO) estimates that the world faces a global shortage of almost 4.3 million doctors, midwives, nurses, and other healthcare professionals. A global undersupply of these threatens the quality and sustainability of health systems worldwide. This undersupply is concurrent with globalization and the resulting liberalization of markets, which allow health workers to offer their services in countries other than those of their origin. The opportunities of health workers to seek employment abroad has led to a complex migration pattern, characterized by a flow of health professionals from low- to high-income countries. This global migration pattern has sparked a broad international debate about the consequences for health systems worldwide, including questions about sustainability, justice, and global social accountabilities. This article provides a review of this phenomenon and gives an overview of the current scope of health workforce migration patterns. It further focuses on the scientific discourse regarding health workforce migration and its effects on both high- and low-income countries in an interdependent world. The article also reviews the internal and external factors that fuel health worker migration and illustrates how health workforce migration is a classic global health issue of our time. Accordingly, it elaborates on the international community’s approach to solving the workforce crisis, focusing in particular on the WHO Code of Practice, established in 2010.
Country
Publisher
Global Health Action
Theme area
Monitoring equity and research to policy
Title of publication Does Water Enter The Boat? – Families That Navigate Reflections of Enculturation
Date of publication
2013
Publication type
Report
Publication details
/ / / pp 1-7
Publication status
Published
Language
English
Keywords
participation, participatory research, indigenous research, Chile
Abstract
The environment in Chiloé island areas is in constant dialogue with the families. This dialogue is based on a connection and observation with sacred spaces and signs from nature that can prevent damage to the family and their surroundings. There is a kind of self-culture with customs and knowledge constantly modeling behavior that heavily influence risk prevention, which is transferred via enculturation, and sometimes, interacts in a two-way process with elements of other cultures via acculturation and transculturation. The existence of this cultural and environmental phenomenon in the island makes us wonder of the influences of modern biomedical, Judeo-Christian and neoliberal cultures on this set of customs and knowledge, and how we can protect the socio-cultural matrix of these land and sea territories. This paper discusses the implications of these themes for the inhabitants of the Chiloé island areas further.
Country
Publisher
/
Theme area
Monitoring equity and research to policy
Title of publication What do we mean by decolonizing research strategies? Lessons from decolonizing, Indigenous research projects in New Zealand and Latin America
Date of publication
2013
Publication type
Journal Article
Publication details
Decolonization: Indigeneity, Education & Society 2 1 pp 55-57
Publication status
Published
Language
English
Keywords
participation, participatory research, indigenous research, New Zealand, Latin America
Abstract
While Indigenous and Chicano scholars have articulated sound critiques of the colonizing agendas shaping what counts as legitimate research, their arguments for alternative methodologies are generally silent on the role grassroots research collectives play in forming a strategic response to colonialism in the present. Here, the author develops a positional review of existing bodies of work, in particular participatory action-research (PAR) projects, focusing on what can be learned from these experiments in community self-determination. Building from PAR projects in North America, the author argues for a renewed understanding of the primacy of grassroots structures in decolonizing, Indigenous research projects as they have taken form in New Zealand and Latin America. These lessons suggest that decolonizing research strategies are less about the struggle for method and more about the spaces that make decolonizing research possible. The review concludes with a discussion of the possibility in research undertaken by Chicano and Indigenous scholars, who find themselves as “outsiders-within” university spaces.
Country
Publisher
Decolonization: Indigeneity, Education & Society
Theme area
Human resources for health, Monitoring equity and research to policy
Title of publication "Community Health Workers Support Community-based Participatory Research Ethics: Lessons Learned along the Research-to-Practice-to-Community Continuum"
Date of publication
2013 March
Publication type
Journal Article
Publication details
Journal of Health Care for the Poor and Underserved 23 Suppl 4 pp 77-87
Publication status
Published
Language
English
Keywords
Colorectal cancer, community-based participatory research, ethics, community health workers
Abstract
Ethical principles of community-based participatory research (CBPR)— specifically, community engagement, mutual learning, action-reflection, and commitment to sustainability—stem from the work of Kurt Lewin and Paulo Freire. These are particularly relevant in cancer disparities research because vulnerable populations are often construed to be powerless, supposedly benefiting from programs over which they have no control. The long history of exploiting minority individuals and communities for research purposes (the U.S. Public Health Service Tuskegee Syphilis Study being the most notorious) has left a legacy of mistrust of research and researchers. The purpose of this article is to examine experiences and lessons learned from community health workers (CHWs) in the 10-year translation of an educational intervention in the research-to-practice-to-community continuum. The authors conclude that the central role played by CHWs enabled the community to gain some degree of control over the intervention and its delivery, thus operationalising the ethical principles of CBPR.
Country
Publisher
Journal of Health Care for the Poor and Underserved
Theme area
Equity in health
Title of publication Stressed and Fatigued on the Ground and in the Sky: Changes from 2000 – 2007 in civil aviation workers’ conditions of work: A global study of 116 countries in Africa, Asia/Pacific, Middle East, North America, Latin/South America, and Europe in the post –
Date of publication
2009
Publication type
Report
Publication details
International Transport Workers’ Federation, Civil Aviation Section / / pp 1-116
Publication status
Published
Language
English
Keywords
civil aviation, workers, occupational health
Abstract
This study highlights the changes in Civil Aviation workers’ conditions between 2000 and 2007 and is being published just as the Civil Aviation Section of the ITF turns 60 years old. The first Conference of the Section was held in October 1949 when the jet-propelled civil aircraft was still a few years away from being commercially exploited, and air travel for ordinary people was a prospect only a few visionaries could see. The ITF was just re-starting its activities in earnest following the end of the Second World War, and existing aviation affiliates were already demonstrating their long-term perspective by pressing the ITF to take a “close look not only at working conditions but at safety” in the aviation industry. This study, while valuable in itself, has a broader importance. The findings will help us to develop an international campaign that addresses the common concern of stress and fatigue but in a way that focuses effectively on the specific needs of each of the three very different groups of civil aviation industry workers: air traffic services and ground staff (whose work involves shift work), and crew members (whose work involves frequent changing of time zones). Many unions are already involved in national activities to address this problem. An ITF campaign would aim to support those activities and encourage action in countries that aren’t currently involved in such initiatives. An international campaign would also serve to focus international attention. National campaigns would benefit from the effects of major worldwide coordinated actions. Other solutions, such as international minimum standards, will require pressure at the relevant international level. A global campaign will illustrate the fact that this problem is not confined to one country or group of countries. It is experienced in all countries in all parts of the world.
Country
Publisher
International Transport Workers’ Federation, Civil Aviation Section
Theme area
Equity in health, Equity and HIV/AIDS
Title of publication Developing a Family-Based HIV Prevention Intervention in Rural Kenya: Challenges in Conducting Community-Based Participatory Research
Date of publication
2013 April
Publication type
Journal Article
Publication details
Journal of Empirical Research on Human Research Ethics 8 2 pp 119-128
Publication status
Published
Language
English
Keywords
HIV prevention, community-based participatory research, participation, Participation Action Research, PAR, PRA, mental health, Kenya
Abstract
Community-based participatory research (CBPR) introduces new ethical challenges for HIV prevention studies in low-resource international settings. The authors describe a CBPR study in rural Kenya to develop and pilot a family-based HIV prevention and mental health promotion intervention. Academic partners (APs) worked with a community advisory committee (CAC) during formative research, intervention development, and a pilot trial. Ethical challenges emerged related to: negotiating power imbalances between APs and the CAC; CAC members’ shifting roles as part of the CAC and wider community; and anticipated challenges in decision making about sustainability. Factors contributing to ethical dilemmas included low access to education, scarcity of financial resources, and the shortage of HIV-related services despite high prevalence.
Country
Publisher
Journal of Empirical Research on Human Research Ethics
Theme area
Governance and participation in health, Monitoring equity and research to policy
Title of publication Participatory Methods
Date of publication
2013
Publication type
Electronic Source
Publication details
/ / / pp /-/
Publication status
Published
Language
English
Keywords
participation, participatory research, mobile phone, Ghana, Kenya
Abstract
It’s an exciting time to be doing participatory communication work in development. An explosion of new methods, technologies, theories and approaches has taken place around the world, adding enormously to the range of available methods for participation. Nearly 90 per cent of the world’s population is now covered by a mobile phone signal, and nearly 40 per cent have access to the Internet. Increasingly sophisticated visual methods and tools for networking and data collection give us access to different forms of knowledge and political action. New technologies are being used not just to study reality, but also to open up other realms of the possible. This website is a repository of examples from all over the world. Researchers in The Chittagong Hill Tract region of Bangladesh are using computers to help women construct their own digital stories, allowing us an insight into their everyday realities. The events of the Arab Spring showed how bloggers reporting news from the streets can have more credibility than mainstream news sources. Mobile phone software allows farmers in rural Ghana to check on current crop prices before selling their produce. Digital mapping technology in Haiti and Palestine has been used to help relief workers to quickly access hard-hit communities. Mapping and crowd-sourcing technology have been used in Nairobi to create a citizen reporting system in the urban slum of Kibera.
Country
Publisher
Institute of Development Studies (IDS)
Theme area
Governance and participation in health, Monitoring equity and research to policy
Title of publication Research for Social Justice: Some North-South Convergences
Date of publication
1995 April
Publication type
Conference Proceedings
Publication details
Plenary Address at the Southern Sociological Society Meeting, Atlanta, April 8, 1995 / / pp /-/
Publication status
Published
Language
English
Keywords
participation, participatory research, Colombia
Abstract
This address was delivered by Dr. Fals Borda at a Plenary session of the Southern Sociological Society on Teaching and Research for Social Change. The address was both moving and inspirational for several reasons. Dr. Fals-Borda received his PhD in sociology in the U.S. South (University of Florida, 1955) and had attended a Southern Sociological Society meeting while a graduate student. Yet, though he has been widely recognised for his work in Latin America and in the International Sociological Association, this was the first time that he had returned to the United States to present to a major sociology gathering. His cutting-edge Participatory Action Research (PAR) in Colombia had been shunned by North American sociologists. His alliances with peasants movements in Colombia had caused the U.S. State Department to refuse him entry visas as well. As he points out, after forty years of being away the event symbolically represented a kind of "homecoming," and a "convergence" of experiences in two "Souths" - the Southern U.S., a poor region located in the in the Northern hemisphere and "the South" meaning the poorer countries of the world located primarily in the Southern hemisphere.
Country
Publisher
/
Theme area
Governance and participation in health, Monitoring equity and research to policy
Title of publication Assessing participation in a community-based health planning and services programme in Ghana
Date of publication
2013 June
Publication type
Journal Article
Publication details
BMC Health Services Research 13 233 pp /-/
Publication status
Published
Language
English
Keywords
participatory research, women, youth, participation, Ghana
Abstract
Community participation is increasingly seen as a pre-requisite for successful health service uptake. It is notoriously difficult to assess participation and little has been done to advance tools for the assessment of community participation. In this paper the authors illustrate an approach that combines a ‘social psychology of participation’ (theory) with ‘spider-grams’ (method) to assess participation and apply it to a Community-based Health Planning and Services (CHPS) programme in rural Ghana.They draw on data from 17 individual in-depth interviews, two focus group discussions and a community conversation with a mix of service users, providers and community health committee members. It was during the community conversation that stakeholders collectively evaluated community participation in the CHPS programme and drew up a spider-gram.Thematic analysis of the data shows that participation was sustained through the recognition and use of community resources, CHPS integration with pre-existing community structures, and alignment of CHPS services with community interests. However, male dominance and didactic community leadership and management styles undermined real opportunities for broad-based community empowerment, particularly of women, young people and marginalised men.The authors conclude that combining the ‘spider-gram’ tool and the ‘social psychology of participation’ framework provide health professionals with a useful starting point for assessing community participation and developing recommendations for more participatory and empowering health care programmes.
Country
Publisher
BMC Health Services Research
Theme area
Resource allocation and health financing, Monitoring equity and research to policy
Title of publication Community concepts of poverty: an application to premium exemptions in Ghana’s National Health Insurance Scheme
Date of publication
2013 March
Publication type
Journal Article
Publication details
Globalisation and Health 9 12 pp /-/
Publication status
Published
Language
English
Keywords
poverty, health Insurance, financing, participatory research, Ghana
Abstract
Poverty is multi dimensional. Beyond the quantitative and tangible issues related to inadequate income it also has equally important social, more intangible and difficult if not impossible to quantify dimensions. In 2009, the authors explored these social and relativist dimension of poverty in five communities in the South of Ghana with differing socio economic characteristics to inform the development and implementation of policies and programs to identify and target the poor for premium exemptions under Ghana’s National Health Insurance Scheme.The authors employed participatory wealth ranking (PWR) a qualitative tool for the exploration of community concepts, identification and ranking of households into socioeconomic groups. Key informants within the community ranked households into wealth categories after discussing in detail concepts and indicators of poverty. Community defined indicators of poverty covered themes related to type of employment, educational attainment of children, food availability, physical appearance, housing conditions, asset ownership, health seeking behaviour, social exclusion and marginalisation. The poverty indicators discussed shared commonalities but contrasted in the patterns of ranking per community. The in-depth nature of the PWR process precludes it from being used for identification of the poor on a large national scale in a program such as the NHIS. However, PWR can provide valuable qualitative input to enrich discussions, development and implementation of policies, programs and tools for large scale interventions and targeting of the poor for social welfare programs such as premium exemption for health care.
Country
Publisher
/
Theme area
Equity in health, Equitable health services
Title of publication Women's groups practising participatory learning and action to improve maternal and newborn health in low-resource settings: a systematic review and meta-analysis
Date of publication
2013 May
Publication type
Journal Article
Publication details
The Lancet 381 9879 pp 1736-1746
Publication status
Published
Language
English
Keywords
participation, participatory research, Bangaldesh, India, Malawi, Nepal, maternal health
Abstract
Maternal and neonatal mortality rates remain high in many low-income and middle-income countries. Different approaches for the improvement of birth outcomes have been used in community-based interventions, with heterogeneous effects on survival. The authors assessed the effects of women's groups practising participatory learning and action, compared with usual care, on birth outcomes in low-resource settings. The authors did a systematic review and meta-analysis of randomised controlled trials undertaken in Bangladesh, India, Malawi, and Nepal in which the effects of women's groups practising participatory learning and action were assessed to identify population-level predictors of effect on maternal mortality, neonatal mortality, and stillbirths. They also reviewed the cost-effectiveness of the women's group intervention and estimated its potential effect at scale in Countdown countries. Seven trials (119,428 births) met the inclusion criteria. Meta-analyses of all trials showed that exposure to women's groups was associated with a 37% reduction in maternal mortality (odds ratio 0.63, 95% CI 0.32-0.94), a 23% reduction in neonatal mortality (0.77, 0.65-0.90), and a 9% non-significant reduction in stillbirths (0.91, 0.79-1.03), with high heterogeneity for maternal (I(2)=58.8%, p=0.024) and neonatal results (I(2)=64.7%, p=0.009). In the meta-regression analyses, the proportion of pregnant women in groups was linearly associated with reduction in both maternal and neonatal mortality (p=0.026 and p=0.011, respectively). A subgroup analysis of the four studies in which at least 30% of pregnant women participated in groups showed a 55% reduction in maternal mortality (0.45, 0.17-0.73) and a 33% reduction in neonatal mortality (0.67, 0.59-0.74). The intervention was cost effective by WHO standards and could save an estimated 283,000 newborn infants and 41,100 mothers per year if implemented in rural areas of 74 Countdown countries.With the participation of at least a third of pregnant women and adequate population coverage, women's groups practising participatory learning and action are a cost-effective strategy to improve maternal and neonatal survival in low-resource settings.
Country
Publisher
The Lancet
Theme area
Equity in health, Monitoring equity and research to policy
Title of publication Guidance on the conduct of narrative synthesis in systematic reviews
Date of publication
2006 April
Publication type
Report
Publication details
ESRC Method Programme / pp 1-92
Publication status
Published
Language
English
Keywords
narrative synthesis, systematic reviews, methods
Abstract
The objectives of this study were to evaluate the impact of applying guidance on the conduct of narrative synthesis to a systematic review of effects and to compare the results and conclusions of this guidance-led narrative synthesis with those of a published Cochrane meta-analysis of the same group of studies. Initially the authors undertook a review of the methodological literature to develop draft guidance on the conduct of narrative synthesis in systematic reviews. After developing a draft of the guidance they applied it to a synthesis of 11 RCTs that had previously been included in a meta-analysis as part of a previous Cochrane review which investigated the effects of interventions for promoting smoke alarm ownership and function. The reviewers carrying out the new narrative synthesis were blinded to the findings of the original Cochrane review. The authors then compared the results and conclusions of the two different approaches. The framework laid out in the guidance provided a clear and easy to follow structure for the narrative synthesis. Then of the 19 “tools and techniques” described in the guidance were considered relevant and were used in the synthesis. Both the narrative synthesis and the meta-analysis led to the conclusion that educational interventions resulted in only modest increases in smoke alarm ownership and function and that there was insufficient data on injury/burn prevention.Both syntheses suggested that including previously-injured children in a trial might moderate the effectiveness of a safety education intervention. The narrative synthesis led to recommendations for future research relating to improvements in outcome measurement, description of interventions, use of theory in designing interventions, and adjusting for potential confounding from concurrent fire safety initiatives/policies. This contrasted with the meta-analysis, which had incorporated subgroup/sensitivity analyses to further evaluate the effects of interventions delivered as part of child health surveillance, discounted alarms and the impact of individual quality factors. For this example, the results and conclusions of meta- analysis and guidance-led narrative synthesis of the same effectiveness studies were broadly similar. The availability of point estimates in subgroup and sensitivity analyses may allow the meta-analyst greater confidence to draw ‘firm’ conclusions about moderators of effects. The detailed scrutiny of studies allowed by narrative synthesis may provide additional insights into implications for further research. The guidance provides a useful framework for the conduct of narrative synthesis, particularly for increasing transparency. Application of the guidance in the production of other reviews (especially those incorporating different types of primary research evidence) will further contribute to the development of transparent and reproducible approaches to narrative synthesis in systematic review.
Country
Publisher
ESRC
Theme area
Equity in health, Monitoring equity and research to policy
Title of publication An innovative method to involve community health workers as partners in evaluation research
Date of publication
2011 December
Publication type
Journal Article
Publication details
American Journal of Public Health 101 12 pp 2275-2280
Publication status
Published
Language
English
Keywords
community health workers, USA, participation, participatory research
Abstract
The authors developed a process through which community outreach workers, whose role is not typically that of a trained researcher, could actively participate in collection of qualitative evaluation data.Outreach workers for a community-based intervention project received training in qualitative research methodology and certification in research ethics. They used a Voice over Internet Protocol phone-in system to provide narrative reports about challenges faced by women they encountered in their outreach activities as well as their own experiences as outreach workers. Qualitative data contributed by outreach workers provided insights not otherwise available to the evaluation team, including details about the complex lives of underserved women at risk for poor pregnancy outcomes and the challenges and rewards of the outreach worker role. Lay health workers can be a valuable asset as part of a research team. Training in research ethics and methods can be tailored to their educational level and preferences, and their insights provide important information and perspectives that may not be accessible via other data collection methods. Challenges encountered in the dual roles of researcher and lay health worker can be addressed in training.
Country
Publisher
American Journal of Public Health
Theme area
Equity in health
Title of publication The political context of social inequalities and health
Date of publication
2001
Publication type
Journal Article
Publication details
Social Science & Medicine 52 3 pp 481-491
Publication status
Published
Language
English
Keywords
social inequalities, welfare state, political parties, international
Abstract
This analysis reflects on the importance of political parties, and the policies they implement when in government, in determining the level of equalities/inequalities in a society, the extent of the welfare state (including the level of health care coverage by the state), the employment/unemployment rate, and the level of population health. The study looks at the impact of the major political traditions in the advanced OECD countries during the golden years of capitalism (1945–1980) } social democratic, Christian democratic, liberal, and ex-fascist } in four areas: (1) the main determinants of income inequalities, such as the overall distribution of income derived from capital versus labor, wage dispersion in the labor force, the redistributive effect of the welfare state, and the levels and types of employment/ unemployment; (2) levels of public expenditures and health care benefits coverage; (3) public support of services to families, such as child care and domiciliary care; and (4) the level of population health as measured by infant mortality rates. The results indicate that political traditions more committed to redistributive policies (both economic and social) and full-employment policies, such as the social democratic parties, were generally more successful in improving the health of populations, such as reducing infant mortality. The erroneous assumption of a conflict between social equity and economic efficiency, as in the liberal tradition, is also discussed. The study aims at filling a void in the growing health and social inequalities literature, which rarely touches on the importance of political forces in influencing inequalities. The data used in the study are largely from OECD health data for 1997 and 1998; the OECD statistical services; the comparative welfare state data set assembled by Huber, Ragin and Stephens; and the US Bureau of Labor Statistics.
Country
Publisher
Social Science & Medicine
Theme area
Equity in health
Title of publication What we mean by social determinants of health
Date of publication
2009
Publication type
Journal Article
Publication details
International Journal of Health Services 39 3 pp 423-441
Publication status
Published
Language
English
Keywords
globalisation, social determinants, WHO, international
Abstract
This article analyses the changes in health conditions and quality of life in the populations of developed and developing countries over the past 30 years, resulting from neoliberal policies developed by many governments and promoted by the World Bank, International Monetary Fund, World Health Organization, and other international agencies. It challenges interpretations by the analysts of “globalisation,” including the common assumption that states are disappearing. The author shows that what has been happening is not a reduction of state interventions but a change in the nature and character of those interventions, resulting from major changes in class (and race and gender) power relations in each country, with establishment of an alliance between the dominant classes of developed and developing countries—a class alliance responsible for the promotion of its ideology, neoliberalism. This is the cause of the enormous health inequalities in the world today. The article concludes with a critical analysis of the WHO report on social determinants of health, applauding its analysis and many of its recommendations, but faulting it for ignoring the power relations that shape these social determinants. It is not inequalities that kill people, as the report states; it is those who are responsible for these inequalities that kill people.
Country
Publisher
International Journal of Health Services
Theme area
Equity in health, Monitoring equity and research to policy
Title of publication Who needs ‘pukka anthropologists'? A study of the perceptions of the use of anthropology in tropical public health research
Date of publication
2006 July
Publication type
Journal Article
Publication details
Tropical Medicine & International Health 11 8 pp 1264-1275
Publication status
Published
Language
English
Keywords
public health, anthropology, participation, participatory research, international
Abstract
Over the past 50 years, there have been considerable changes both in how medical anthropologists view their relationship to topical public health and in how tropical public health professionals view the role of anthropologists. In particular, in recent decades critical currents have emerged from an anthropology of medicine, calling for an examination of biomedicine and its conceptualisation of public health. There are parallel debates in public health about a narrow disease-focused or broader socio-cultural approach to improving population health. Based on a review of the literature and a qualitative study of the views of public health professionals and anthropologists working in tropical public health, the data presented in this paper suggest that public health professionals remain unaware of many of the contributions anthropology could make to tropical public health theory and practice. However, the objectives of a critical social science are not dissimilar to those of the broader concept of public health. We suggest that there are grounds for optimism. For those of us concerned not just with disease but also with inequities in health, the challenge is to work towards a critical tropical public health which draws as much from social science as from biomedicine, in theory and practice.
Country
Publisher
Tropical Medicine & International Health
Theme area
Equity in health, Monitoring equity and research to policy
Title of publication Community-based research partnerships: Challenges and opportunities
Date of publication
2005 June
Publication type
Journal Article
Publication details
Journal of Urban Health 82 Suppl 2 pp ii3-ii12
Publication status
Published
Language
English
Keywords
participation, participatory research, urban health
Abstract
The complexity of many urban health problems often makes them ill suited to traditional research approaches and interventions. The resultant frustration, together with community calls for genuine partnership in the research process, has highlighted the importance of an alternative paradigm. Community-based participatory research (CBPR) is presented as a promising collaborative approach that combines systematic inquiry, participation, and action to address urban health problems. Following a brief review of its basic tenets and historical roots, key ways in which CBPR adds value to urban health research are introduced and illustrated. Case study examples from diverse international settings are used to illustrate some of the difficult ethical challenges that may arise in the course of CBPR partnership approaches. The concepts of partnership synergy and cultural humility, together with protocols such as Green et al.’s guidelines for appraising CBPR projects, are highlighted as useful tools for urban health researchers seeking to apply this collaborative approach and to deal effectively with the difficult ethical challenges it can present.
Country
Publisher
Journal of Urban Health
Theme area
Equitable health services, Human resources for health
Title of publication Using Participatory Action Research to build Healthy Communities
Date of publication
2000 March
Publication type
Journal Article
Publication details
Public Health Reports 115 2 pp 191-197
Publication status
Published
Language
English
Keywords
participation, participatory research, USA
Abstract
The author contends that community-based Participatory Action Research (PAR) is ideally suited for use in Healthy Communities projects. The article begins by defining PAR and its principles and characteristics, then discusses the philosophical and methodological compatibility of PAR and Healthy Communities. After highlighting the challenges of expanding the Healthy Communities accent on participation to include PAR, the article describes the experiences of two Healthy Communities projects in the US that have successfully used PAR.
Country
Publisher
Public Health Reports
Theme area
Equity in health, Monitoring equity and research to policy
Title of publication White Privilege: Unpacking the Invisible Knapsack
Date of publication
Publication type
Document
Publication details
Working Paper 189 / / pp 1-4
Publication status
Published
Language
English
Keywords
participation, participatory research, race, tool
Abstract
This article is now considered a ‘classic’ by anti-racist educators. It has been used in workshops and classes throughout the United States and Canada for many years. While people of color have described for years how whites benefit from unearned privileges, this is one of the first articles written by a white person on the topics.
Country
Publisher
Amherst, MA: Centre for International Education
Theme area
Equity in health
Title of publication Dreaming the Future of Health in the Next 100 Years
Date of publication
2013 April
Publication type
Document
Publication details
White paper from the Global Health Summit Beijing China, January 26-27 2013 / / pp 1-31
Publication status
Published
Language
English
Keywords
futures, global health, global
Abstract
In 2013, as part of its Centennial, the Rockefeller Foundation is holding a series of gatherings that bring together the world’s leading thinkers, innovators, entrepreneurs, and political leaders to identify, understand, and solve problems in innovative new ways.Towards this, in January 2013, the Foundation and Peking Union Medical College (PUMC) held in Beijing China, a Global Health Summit: Dreaming the Future of Health for the Next 100 Years. The two hosts each brought a one hundred year track record in public health. The Summit gathered 112 prominent leaders from government, international organisations, academia, civil society and business and from numerous disciplines to discuss the question: “How will we enable the growth and development of healthy societies over the next 100 years?” A 100 year horizon lies beyond the boundaries of our knowledge and enters the realms of our imaginings. This White paper is thus a provocation to dream and act! It presents the key trends, debates and ideas that were raised in and after the Summit. Through this, it envisages the multiple potential futures that may emerge from these trends, the choices that determine them, and where we could act, even now, to shape futures of sustained health.The White paper seeks to stimulate reflection, debate and submission from a range of actors that play a role in sustained health. The paper seeks to engage young people on a future of health that they will both shape and live in. The ideas presented intend to enrich the activities and priorities of leaders and stakeholders who work for social change, especially for vulnerable people. They will also inform the Rockefeller Foundation’s goals, grant‐making priorities, and networks.
Country
Publisher
TARSC for Rockefeller Foundation, USA
Theme area
Governance and participation in health, Monitoring equity and research to policy
Title of publication Connecting the streams: using health-systems research knowledge in low- and middle-income countries
Date of publication
2010 November
Publication type
Document
Publication details
Health Systems Research / / pp 1-74
Publication status
Published
Language
English
Keywords
health systems, research, low and middle income countries, international
Abstract
Whether the knowledge from health systems research (HSR) is used in policy and practice in low- and middle-income countries (LMICs) depends on the political economy context, the policy environment, and institutional capacities and practice in the health system and in the research community. What happens within each of these four ‘streams’ affects whether HSR resources and evidence are recognized and used. When linkages are made across the four streams, there is a greater possibility of evidence from HSR leading to changes in policy or practice. What drives such linkages? Events, such as political change, may open windows of opportunity for them to happen. Various push, pull and exchange processes enhance the possibilities of links between political, policy, research and practice communities. Communicating research in accessible forms and actively using it in various forms of dialogue is essential, as are building capacities to use and produce HSR within the health system. While exchange may be increased by specific mandated units, a wider level of formal and informal networks and mechanisms involving policy, research and systems and civil society actors would better reflect and more widely tap into current processes for exchange. Individuals (activist researchers, research managers, knowledge brokers and others) play a pivotal role in communicating and engaging across streams, opening or framing strategic opportunities for links. The author argues that need to better understand, and support, the role of these knowledge- policy-practice (KPP) catalysts. Researchers are not passive in this. For example: Research evidence influences political, professional and social opinion and positions, especially when the public is engaged, raising political demand for and use of evidence.; Setting joint agendas with policy and systems personnel, getting and responding to clear policy signals, proactively building mechanisms for sustained links and dialogue across research and policy actors, using official data in HSR and having evidence available in accessible forms enhances policy uptake of HSR.; Systematic reviews provide important evidence for framing issues and for decision-making.; Aligning research to problems raised by implementers, building capacities and involving health system personnel and communities in gathering and/or using evidence at local level enhances local use of HSR, especially when it provides people with tools for change. Various forms of problem solving research more directly connect to action. Participatory action research more intrinsically links research, health workers and communities.This calls for technical quality in HSR, but also for strategic analysis and choices by researchers. Although not always well documented, there is experience within LMIC on the strategic use of HSR. There are also some conditions that appear to be a greater challenge for LMIC, especially in low income countries (LICs): International agencies have a more powerful influence on research agendas and resources in LIC; resources for sustained research programmes and interaction are limited; as are the incentives, time, resources and authority for local personnel to gather and use evidence. Much LIC research is poorly published in accessible databases; and a significant digital divide discourages HSR and its use. Local level personnel, especially in peripheral areas, face these constraints most sharply. There are many opportunities and processes for stimulating the dynamic interaction between political, policy, implementation and research systems. This raises a particular demand to address the constraints and inequities that alienate many in LIC from these opportunities.
Country
Publisher
First Global Symposium on Health Systems Research
Theme area
Governance and participation in health, Monitoring equity and research to policy
Title of publication Community based participatory research: a promising approach for increasing epidemiology's relevance in the 21st century.
Date of publication
2004 May
Publication type
Journal Article
Publication details
International Journal of Epidemiology 33 3 pp 499-506
Publication status
Published
Language
English
Keywords
participation, participatory research, global
Abstract
Despite the advances of modern epidemiology, the field remains limited in its ability to explain why certain outcomes occur and to generate the kind of findings that can be translated into programmes or policies to improve health. Creating community partnerships such that community representatives participate in the definition of the research problem, interpretation of the data, and application of the findings may help address these concerns. Community based participatory research (CBPR) is a framework epidemiologists can apply to their studies to gain a better understanding of the social context in which disease outcomes occur, while involving community partners in the research process, and insuring that action is part of the research process itself. The utility of CBPR principles has been particularly well demonstrated by environmental epidemiologists who have employed this approach in data gathering on exposure assessment and advancing environmental justice. This article provides examples of how popular epidemiology applies many of CBPR's key principles. At this critical juncture in its history, epidemiology may benefit from further incorporating CBPR, increasing the field's ability to study and understand complex community health problems, insure the policy and practice relevance of findings, and assist in using those findings to help promote structural changes that can improve health and prevent disease.
Country
Publisher
International Journal of Epidemiology
Theme area
Governance and participation in health, Monitoring equity and research to policy
Title of publication Barefoot Research: A workers manual for organising on work security
Date of publication
2002
Publication type
Report
Publication details
/ / / pp 1-93
Publication status
Published
Language
English
Keywords
participation, participatory research, workers, International
Abstract
This manual has been developed to help empower workers to increase their level of control over their own work situations, to protect their health and well being, and to improve their level of basic security. This is a practical guide, providing workers, and employers, with tools to: identify work security problems, tackle problems from a worker centred perspective, use barefoot research tools, use the results of Barefoot Research to improve their work security, organise for work security. The manual was developed by the International Labour Office, but is now hosted by the TUC. However it is for free distribution and the authors encourage groups to make their own wide distribution of this unique tool.
Country
Publisher
ILO; TUC
Theme area
Governance and participation in health, Monitoring equity and research to policy
Title of publication Participatory Decision Making for Sanitation Improvements in Unplanned Urban Settlements in East Africa
Date of publication
2012
Publication type
Journal Article
Publication details
Journal of Environment & Development 2 1 pp 98-119
Publication status
Published
Language
English
Keywords
participation, participatory research, environment, East Africa
Abstract
Solving the problem of inadequate access to sanitation in unplanned settlements in East Africa needs to combine social and technical dimensions in such a manner that they fit the local context. The modernized mixtures approach offers an analytical framework for identifying such solutions, but this approach requires effective methods for participatory decision making. This article intends to contribute to filling this gap by identifying and further elaborating an appropriate multicriteria decision- making tool. The multicriteria decision analysis methodology, Proact 2.0, offers an adequate solution as it creates the possibility to connect knowledge, experiences, and preferences from scientists, experts, and policy makers with those of the end users. The authors show in particular that users not always prefer the most optimal sanitation system, defined from an “expert” point of view. This article concludes that using Proact 2.0 can lead to substantial improvements in decision making in the field of sanitation in unplanned settlements in East Africa.
Country
Publisher
Journal of Environment & Development
Theme area
Governance and participation in health, Monitoring equity and research to policy
Title of publication Convergent evolution: the academic and policy roots of collaborative research
Date of publication
2003 November
Publication type
Journal Article
Publication details
Journal of Health Services Research & Policy 8 Suppl 2 pp 1-6
Publication status
Published
Language
English
Keywords
participation, participatory research
Abstract
Research, for all its claims to objectivity, cannot sit outside the in􏰝fluence of broader systems of norms and rules. For instance, the rise in popular credibility of opinion polls, deliberative dialogues and other new techniques of consultation to measure public values and beliefs, happened in counterpoint to the decline in both the credibility and feasibility of elected representatives performing this function. As the daily dynamic of interactions among individuals, groups and institutions gradually changes societal systems of rules and norms, so too does the research process change and accommodate accordingly. Some authors have recently argued that research has reached a sea-change in science and technology with the accumulation of these accommodations. Researchers have created a fundamental breakdown in the old differentiation of science experts from deferential non-experts. There is now a different and necessarily more cooperative relationship, they argue, between researchers, practitioners and lay persons in the production of scientifi􏰜c knowledge. A common trend in these scholarly works is the idea that research and knowledge production processes in society are evolving and departing from a monolithic and isolated view of science. Research and science have become contested terrain where multiple approaches and perspectives are legitimate and must learn to coexist. Such evolution blurs the frontiers between researchers, practitioners and citizens and pushes toward more interactions among these groups. This leads to an almost inevitable interest in collaborative research or partnerships in research. The authors of this editorial argue that the current popularity of collaborative research is a convergence between emerging forces and traditions within academia and changing rules and norms within policy and management, particularly the public management of health and social policy. First, they discuss brie􏰝y the converging streams of academic work behind collaborative research. They then describe how the 􏰜field of policy- making and management, through a commitment to evidence-based decision-making, has developed an interest in collaboration with researchers to produce knowledge. The authors position the papers in this supplement: three introductory case studies from the perspective of the collaborating investigators; three articles that evaluate, from the perspective of the research funding agency, the impact of grant programmes that encourage collaborative research; two papers analysing the impact of collaboration on research domains; and, 􏰜finally, a review of lessons for collaborative research from outside health care. Finally, the authors extract a few lessons that emerge from the collection of papers.
Country
Publisher
Journal of Health Services Research & Policy
Theme area
Governance and participation in health, Monitoring equity and research to policy
Title of publication Participatory photo mapping (PPM): Exploring an integrated method for health and place research with young people
Date of publication
2008 August
Publication type
Journal Article
Publication details
Health & Place 15 / pp 466-473
Publication status
Published
Language
English
Keywords
participation, participatory research, photovoice, USA
Abstract
In this manuscript the authors detail the application and utility of participatory photo mapping (PPM) for studying the implications of place for the health of children. PPM is a transdisciplinary approach that integrates digital tools, narrative interviewing and participatory protocols in order to produce knowledge that can be shared and acted upon by community-based health research partnerships. In discussing the application, strengths, and weaknesses of this method, the authors relate their own experiences with using PPM for a recent study of neighborhood health and safety that involved young people from a variety of age groups in Madison, Wisconsin. The resultant maps were persuasive presentation tools and provided guidance for community-based interventions.
Country
Publisher
Health & Place
Theme area
Governance and participation in health, Monitoring equity and research to policy
Title of publication Unpacking ‘Participation’: models, meanings and practices
Date of publication
2008 June
Publication type
Journal Article
Publication details
Community Development Journal 43 3 pp 269-283
Publication status
Published
Language
English
Keywords
participation, Participation Action Research, PAR, PRA, participatory monitoring and evaluation, qualitative, quantitative, research, Africa
Abstract
The world over, public institutions appear to be responding to the calls voiced by activists, development practitioners and progressive thinkers for greater public involvement in making the decisions that matter and holding governments to account for following through on their commitments. Yet what exactly ‘participation’ means to these different actors can vary enormously. This article explores some of the meanings and practices associated with participation, in theory and in practice. It suggests that it is vital to pay closer attention to who is participating, in what and for whose benefit. Vagueness about what participation means may have helped the promise of public involvement gain purchase, but it may be time for more of what Cohen and Uphoff term ‘clarity through specificity’ if the call for more participation is to realize its democratizing promise.
Country
Publisher
Community Development Journal
Theme area
Governance and participation in health, Monitoring equity and research to policy
Title of publication Who Counts? The Quiet Revolution of Participation and Numbers
Date of publication
2007 December
Publication type
Document
Publication details
IDS Working Paper 296 / pp 1-43
Publication status
Published
Language
English
Keywords
participation, participatory research, Africa
Abstract
Participatory approaches and methods can generate quantitative as well as qualitative data. Mainly since the early 1990s, a quiet tide of innovation has developed a rich range of participatory ways, many of them visual and tangible, by which local people themselves produce numbers. The approaches and methods have variously entailed counting, mapping, measuring, estimating, valuing and scoring, and scaling, together with comparing and combinations of these, and have had many applications. The methodological pioneers in going to scale in the 1990s rarely recognised the significance of what they had been doing. The pioneers of the 2000s have shown ingenuity, skill, patience and courage, sometimes in the face of opposition driven by conventional reflexes. Participatory numbers have been taken to scale most notably through participatory surveys with visuals and tangibles, through aggregation from focus groups and through wealth and wellbeing ranking. There have been break- throughs in producing national statistics, and also on subjects and with insights inaccessible through questionnaires. Statistical principles can be applied to participatory numbers. Ways have been found of overcoming the vexing problem of commensurability between communities. As with all ways of finding out, there are trade-offs, in this context notably between participatory open-endedness and standardisation for comparability. The question ‘who counts?’ raises issues of ownership and power. Participatory Monitoring and Evaluation (PM and E) has taken many forms, with varied degrees of ownership and empowerment. Whether participatory statistics empower local people is sensitive to official attitudes and acceptance and whether these lead to changes in policy and practice that make a real difference. Questions are raised of the mix and balance of extraction and empowerment, and whether and how the quiet revolution of participatory approaches and methods can get the best of both qualitative and quantitative worlds.
Country
Publisher
IDS Working Paper
Theme area
Governance and participation in health, Monitoring equity and research to policy
Title of publication Participatory rural appraisal (PRA): Analysis of experience
Date of publication
1994
Publication type
Journal Article
Publication details
World Development 22 9 pp 1253-1268
Publication status
Published
Language
English
Keywords
participation, participatory research, Africa
Abstract
The more significant principles of Participatory Rural Appraisal (PRA) concern the behaviour and attitudes of outsider facilitators, including not rushing, “handing over the stick”, and being self-critically aware. The power and popularity of PRA are partly explained by the unexpected analytical abilities of local people when catalysed by relaxed rapport, and expressed through sequences of participatory and especially visual methods. Evidence to date shows high validity and reliability of information shared by local people through PRA compared with data from more traditional methods. Explanations include reversals and shifts of emphasis: from etic to emic, closed to open, individual to group, verbal to visual, and measuring to comparing; and from extracting information to empowering local analysts.
Country
Publisher
World Development
Theme area
Monitoring equity and research to policy
Title of publication Ethical Principles for the Conduct of Research in the North
Date of publication
2003
Publication type
Document
Publication details
Association of Canadian Universities for Northern Studies / / pp 1-10
Publication status
Published
Language
English
Keywords
ethics, research, participatory research, Canada
Abstract
For over twenty years ACUNS’ statement of ethical principles for the conduct of research in the north has been one of the most widely disseminated and reproduced guide for research used in the Canadian North. Recently updated to reflect the changing social and political context, the document has achieved recognition from many international and circumpolar countries through its perspective that acknowledges scholarship and research take place among people with a stake in the work that is being undertaken. ACUNS’ ethics guide is currently available in English, French, Inuktitut, and Russian translations.
Country
Publisher
Association of Canadian Universities for Northern Studies
Theme area
Governance and participation in health
Title of publication PRA report: Community Strengthening for a People Centred Primary Health Care System: The Case of Cassa Banana Community in Zimbabwe
Date of publication
2015 February
Publication type
Report
Publication details
Community Strengthening for a People Centred Primary Health Care System: The Case of Cassa Banana Community in Zimbabwe. PRA Report on Phase One February – July 2014. EQUINET, COPASAH, TARSC. Harare
Publication status
Published
Language
Keywords
participatory reflection and action; community; primary health care; Zimbabwe
Abstract
This report documents work undertaken in Cassa Banana Community by the Zimbabwe Association of Doctors for Human Rights (ZADHR) and the Zimbabwe National Network of People Living with HIV (ZNNP+), with support from the Training and Research Support Centre (TARSC), from February – July 2014. The programme aimed to use Participatory Reflection and Action (PRA) methodologies in working with members of Cassa Banana to strengthen community focused, primary health care oriented approaches to social accountability. The work follows a PRA training facilitated by TARSC in October 2013 and undertaken in collaboration with the Community of Practitioners in Accountability and Social Action in Health (COPASAH) and EQUINET. It aimed to use Participation Reflection and Action (PRA) techniques to work with a representation of community members and health providers/authorities to explore and document the health challenges faced by the Casa Banana community and to formulate actions to solve these health challenges. The project also sought to support community action in demanding accountability from the relevant duty bearers in the formulation and delivery of health services, and to strengthen community/stakeholder engagement for the provision of people-centered Primary Health Care services to the Casa Banana community.
Country
Zimbabwe
Publisher
EQUINET
Equinet Publication Type
Reports
Theme area
Equitable health services, Public-private mix, Governance and participation in health
Title of publication Discussion paper 104: Medicines production and procurement in east and southern Africa and the role of south-south co-operation
Date of publication
2014 November
Publication type
Report
Publication details
Medicines production and procurement in east and southern Africa and the role of south-south co-operation, EQUINET Discussion paper 104, EQUINET: Harare.
Publication status
Published
Language
Keywords
medicines; local production; south-south co-operation; health diplomacy
Abstract
This work forms part of the Regional Network for Equity in Health in East and Southern Africa (EQUINET) programme of work on ‘Contributions of global health diplomacy to health systems in sub-Saharan Africa: Evidence and Information to support capabilities for health diplomacy in east and southern Africa’. This report compiles evidence from secondary and primary data collection on the role of south-south diplomacy, particularly the co-operation agreements with China, India and Brazil in overcoming bottlenecks to medicine production in ESA. The methods used were: a literature review of published materials relevant to medicine production in the region; a policy dialogue forum involving senior officials within the health services from countries in the ESA region; three country case studies carried out in Kenya, Uganda, and Zimbabwe; and consultations carried out with senior officials from ministries of health in the ESA region.
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Discussion paper
Theme area
Governance and participation in health
Title of publication Annotated bibliography of e- platforms used in participatory and peer to peer exchange and learning
Date of publication
2013 December
Publication type
Report
Publication details
Annotated bibliography of e- platforms used in participatory and peer to peer exchange and learning, December 2014. TARSC, EQUINET Harare.
Publication status
Published
Language
Keywords
internet, participatory research, global
Abstract
Visual and information technologies are now more diversified and widely accessible. Digital images and mapping enhance access and exchange on local realities; social media (blogs, tweets and others) provide new methods for communicating experience for collective analysis, mobile phones facilitate communication and pooling of evidence across wider social networks and mapping and crowd-sourcing technology provide systems for citizen reporting, including in poorest communities. internet based resources point to the possibilities for information technology to support peer to peer learning and participatory action research to overcome the ‘local’ nature of processes and link groups with shared interest. To support discussion on these areas this work aimed to provide an annotated description of existing internet resources that have features that may guide out thinking in developing an e platform for participatory reflection and action across similar groups in different areas.
Country
Zimbabwe
Publisher
EQUINET
Equinet Publication Type
Toolkits and training materials
Theme area
Governance and participation in health
Title of publication The Role of Health Committees in Equitable, People-centred Health Systems in the Southern and East African Region
Date of publication
2014 November
Publication type
Report
Publication details
Learning Network for Health and Human Rights and Centre for Health, Human Rights and Development: University of Cape Town, Cape Town with EQUINET
Publication status
Published
Language
Keywords
health centre committees; East and southern Africa
Abstract
A two-day consultation on health committees as vehicles for community participation was held in Cape Town on September 27th and 28th 2014 prior to the 3rd Global Health Systems Research Conference. The meeting, funded by the International Development Research Council (IDRC Canada), had 38 participants from 12 countries of which nine were African countries. The meeting build on previous regional networking to share experiences of health committees as vehicles for community participation from countries across the globe. The discussion focused particularly on health committees in the African region, but benefited from considerations of experiences from other countries of the South (Guatemala and India). The discussions also reaffirmed the importance of health committees for Health System responsiveness and highlighted the importance of health committees as autonomous structures able to enhance democratic governance of health systems through monitoring and evaluation of health service performance and holding the state accountable. This applies irrespective of how services are delivered. To achieve this, it is critically important for health committees to be capacitated to fulfil this role through appropriate training, health systems design and sustainable support. Government should recognize the importance of health committees for their health systems, and invest appropriate human and financial resources to ensure functional health committees. Such investments are part of state obligations with respect to realising the Right to Health. Further, strategies must be developed to obtain buy-in of health workers, managers and policy-makers in supporting meaningful participation by health committees.
Country
Publisher
UCT
Equinet Publication Type
Reports
Theme area
Equity in health, Values, policies and rights, Governance and participation in health, Monitoring equity and research to policy
Title of publication Participatory action research in people centred health systems: International Workshop Report, 4 October 2014
Date of publication
2014 November
Publication type
Conference Proceedings
Publication details
EQUINET: TARSC and ALAMES (2014) Participatory action research in people centred health systems International Workshop Report: Cape Town, South Africa, 4 October 2014
Publication status
Published
Language
Keywords
participatory action research; global
Abstract
Immediately following the 2014 Global Symposium on Health Systems Research, a one day workshop was held, convened by Training and Research Support Centre (TARSC) (www.tarsc.org) and the pra4equity network in the Regional Network for Equity in Health in east and southern Africa (EQUINET) with Asociación Latinoamericana de Medicina Social (ALAMES) . The workshop was held to deepen the discussion on the use of participatory action research (PAR) in health policy and people centred health systems, including in acting on the social determinants of health. While there are many forms of participatory research, the workshop specifically focused on PAR, that is on research that transforms the role of those usually participating as the subjects of research, to involve them instead as active researchers and agents of change, where those affected by the problem are the primary source of information and the primary actors in generating, validating and using the knowledge for action, and that involves the development, implementation of, and reflection on actions as part of the research and knowledge generation process. PAR seeks to understand and improve the world by changing it, but does so in a manner that those affected by problems collectively act and produce change as a means to new knowledge. The one day workshop was open to delegates from all regions globally to foster cross regional exchange and to include people from the pra4equity network in east and southern Africa. This report presents the proceedings of the workshop.
Country
International
Publisher
Equinet Publication Type
Reports
Theme area
Health equity in economic and trade policies, Governance and participation in health
Title of publication EQUINET Policy Brief 39: Enhancing local medicine production in east and Southern Africa
Date of publication
2014 September
Publication type
Document
Publication details
Enhancing local medicine production in east and Southern Africa, EQUINET Policy brief 39, EQUINET Harare
Publication status
Published
Language
Keywords
Abstract
This brief outlines the factors that affect medicines production in East and Southern Africa, drawing on the African Union, Southern Africa Development Community (SADC) and East African Community (EAC) pharmaceutical plans. It identifies the barriers to local production as: lack of supportive policies, capital and skills constraints, gaps in regulatory framework, small market size and weak research and development capacities. It highlights, from case study work in selected countries in East and Southern Africa the potential opportunities for strengthening local medicine production. In the brief we propose that African countries strengthen domestic capacities, co-operation between domestic private and public sectors within ESA countries, and regional co-operation across ESA countries to address bottlenecks. Some areas such as infrastructure development and training may be important groundwork for others, such as technology transfer and research and development. South-south cooperation in medicines production can play a role in this but it cannot be assumed. Negotiations on south-south arrangements should look not only at the immediate production investment, but at strengthening capacities for research and development, for regulation, medicines price and quality monitoring, prequalification, infrastructure and human resource development.
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Policy brief
Theme area
Equity in health, Governance and participation in health, Monitoring equity and research to policy
Title of publication Participatory action research in health systems: a methods reader
Date of publication
2014 September
Publication type
Book
Publication details
TARSC, AHPSR, WHO, IDRC Canada, EQUINET, Harare, 2014
Publication status
Published
Language
Keywords
participatory action research; global; methods
Abstract
In the 21st century there is a growing demand to channel collective energy towards justice and equity in health, and to better understand the social processes that influence health and health systems. Communities, frontline health workers and other grass-roots actors play a key role in responding to this demand, in raising critical questions, building new knowledge and provoking and carrying out action to transform health systems and improve health. There is a widening array of methods, tools and capacities – old and new – to increase social participation and
power in generating new knowledge through participatory research. At the same time, we need to be clear about exactly what participatory research is and what it can offer. This reader promotes understanding of the term ‘participatory action research’ (PAR) and provides information on its paradigms, methods, application and use, particularly in health policy and systems. This reader was produced through the Regional Network for Equity in Health in East and Southern Africa (EQUINET), with Alliance for Health Policy and Systems Research(AHPSR) and International Development Research Centre (IDRC) Canada. It will be launched at the Third Global Symposium on Health Systems Research in South Africa September 30 2014 after which the full reader will replace the leaflet on the site. The result of team work, the reader draws on experience and
published work from all regions globally and explains:
• key features of participatory action research and the history and knowledge paradigms that inform it;
• processes and methods used in participatory action research, including innovations and developments in the field and the ethical and methods issues in implementing it; and
• communication, reporting, institutionalization and use of participatory action research in health systems.
Country
International
Publisher
EQUINET
Equinet Publication Type
Book, Toolkits and training materials
Theme area
Governance and participation in health
Title of publication Policy brief 37: Health Centre Committees as a vehicle for social participation in health systems in east and southern Africa
Date of publication
2014 June
Publication type
Document
Publication details
TARSC with CWGH and Medico (2010) Health Centre Committees as a vehicle for social participation in health systems in east and southern Africa; Policy brief 37 EQUINET, Harare
Publication status
Published
Language
Keywords
health centre committees; east and southern Africa; participation
Abstract
The adoption of primary health care (PHC) in all east and Southern African (ESA) countries means that public participation is central to the design and
implementation of health systems. One mechanism for this is through Health Centre Committees (HCCs) that involve representatives of communities and primary-care level health workers in planning, implementing and monitoring health services and activities. Known by different names in different countries, they are a common mechanism for communities to ensure that health systems access and use resources to address their needs and are responsive and accountable to them. They have been found to have a positive impact on health outcomes. This brief presents information and experiences from document review and from the exchanges of people working with HCCs in ESA countries at a 2014 EQUINET regional meeting on how HCCs are functioning in the region. It presents proposals for improving their functioning and impact.
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Policy brief
Theme area
Human resources for health, Governance and participation in health
Title of publication Policy brief 38: Taking the WHO Global code of Practice on the International Recruitment of health Personnel in Africa from bottom drawer to negotiating table and action in Africa
Date of publication
2014 July
Publication type
Document
Publication details
U Limpopo, Mustang MC, ECSA, ACHEST, TARSC (2014) Taking the WHO Global code of Practice on the International Recruitment of health Personnel in Africa from bottom drawer to negotiating table and action in Africa, Policy brief 38 EQUINET, Harare
Publication status
Published
Language
Keywords
WHO Code; health workers; East and Southern Africa; global diplomacy
Abstract
ESA countries face many challenges in the absolute shortages, maldistribution, low production and poor utilisation of their health workforces. The World Health Organisation (WHO) Global Code of Practice on the International Recruitment of Health Personnel the “Code”) was unanimously adopted by the World Health Assembly in May 2010 to address recruitment and migration of health workers. However, its implementation has shown limited progress in east and southern Africa, according to a study in the EQUINET Research programme on global health diplomacy. Health worker migration is not seen to be the scale of problem it was a decade ago in the region. While concerns from the region were mostly included in the Code, the demand for “mutuality of benefit” and “compensation” were not. This was interpreted by some stakeholders to mean that the Code did not fully accommodate African interests. Implementation of the Code is reported to be impeded by lack of champions; of resources for implementation; by weak functional data (systems) on mobility of health personnel, and by limited domestication and dissemination of the Code in ESA countries. This brief presents opportunities to use the Code in negotiating bilateral agreements and suggests ways of strengthening its implementation.
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Policy brief
Theme area
Resource allocation and health financing, Governance and participation in health
Title of publication Policy brief 36: Increasing African agency in the design of Performance Based Financing
Date of publication
2014 July
Publication type
Document
Publication details
EQUINET, U Sheffield et al (2014) Increasing African agency in the design of Performance Based Financing Policy brief 36, EQUINET Harare
Publication status
Published
Language
Keywords
performance based financing; east and southern Africa; global fund; global financing
Abstract
Billions of dollars are channelled each year to African governments by external funders, from global institutions such as the World Bank and Global Fund to support health systems. Much of the money is provided in the form of “Performance Based financing” (PBF) schemes. In 2013/4 we reviewed the decision making on and design of these PBF schemes, including
through interviews with officials in Africa and at Africa regional and global levels. This brief explains what PBF schemes are and the reasons for their popularity. It presents the positive and negative features of and views expressed on PBF. It presents a set of questions national authorities should take into account when negotiating any PBF type scheme within health systems and makes recommendations for African officials who wish to improve the design and implementation of PBF schemes to support national
health system goals.
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Policy brief
Theme area
Equitable health services, Resource allocation and health financing, Governance and participation in health
Title of publication EQUINET Discussion paper 102: African participation and partnership in performance-based financing: A case study in global health policy
Date of publication
2014 June
Publication type
Report
Publication details
African participation and partnership in performance-based financing: A case study in global health policy’, EQUINET Discussion Paper 102, EQUINET: Harare.
Publication status
Published
Language
Keywords
global governance; health diplomacy; participation; performance based financing; global fund; world bank; South Africa; Tanzania; Zambia
Abstract
Participation is a key policy concept in global health, and relates to the ability of stakeholders to engage with and shape health policy at four intersecting levels: local, national, regional and global. Such engagement remains the key normative aim behind debates about furthering more equitable health diplomacy and has, as a result, been increasingly integrated into the agenda of global agencies, including the Global Fund to Fight AIDS, TB and Malaria and the World Bank. This report forms part of a research programme led by EQUINET focusing on the participation of African actors in global health diplomacy. The report focuses on the participation of African actors in global health governance. In an attempt to better understand the spaces and places within which participation can occur, and particularly the ways in which global actors such as the Global Fund and the World Bank provide such opportunities, the research explored the following questions:
• How do the Global Fund and World Bank provide spaces for participation in global health governance processes?
• To what extent can African actors nationally and regionally extend their agency within these participatory spaces?
• What role does the World Health Organisation (WHO) and its own governance play in the interface between African actors and the Global Fund and World Bank?
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Discussion paper
Theme area
Monitoring equity and research to policy
Title of publication Mutual Learning and Reverse Innovation - Where Next?
Date of publication
2014 March
Publication type
Journal Article
Publication details
Globalization and Health 10 14 pp /-/
Publication status
Published
Language
English
Keywords
reverse innovation; global health
Abstract
The papers argues for mutual learning in global health systems. The author argues that it is increasingly recognised that innovation needs to be sourced globally and that we need to think in terms of co-development as ideas are developed and spread from richer to poorer countries and vice versa. The Globalization and Health journal’s ongoing thematic series, “Reverse innovation in global health systems: learning from low-income countries” illustrates how mutual learning and ideas about so-called "reverse innovation" or "frugal innovation" are being developed and utilised by researchers and practitioners around the world. The path to truly “global innovation flow”, although not fully established, is argued to be under way. Global health learning laboratories, where partners can support each other in generating and sharing lessons, have the potential to construct solutions for the world. At the heart of this dialogue is a focus on creating practical local solutions and, simultaneously, drawing out the lessons for the whole world.
Country
Publisher
Globalization and Health
Theme area
Monitoring equity and research to policy
Title of publication Handbook on Health Inequality Monitoring: with a Special Focus on Low-and-Middle-Income Countries
Date of publication
2013
Publication type
Document
Publication details
/ / / pp /-/
Publication status
Published
Language
English
Keywords
inequality; monitoring; health status; health care; low and middle income countries; global
Abstract
The Handbook on health inequality monitoring: with a special focus on low- and middle-income countries is a user-friendly resource, developed to help countries establish and strengthen health inequality monitoring practices. The handbook elaborates on the steps of health inequality monitoring, including selecting relevant health indicators and equity stratifiers, obtaining data, analysing data, reporting results and implementing changes. Throughout the handbook, examples from low- and middle-income countries are presented to illustrate how concepts are relevant and applied in real-world situations; informative text boxes provide the context to better understand the complexities of the subject. The final section of the handbook presents an expanded example of national-level health inequality monitoring of reproductive, maternal and child health.
Country
Publisher
World Health Organisation
Theme area
Governance and participation in health
Title of publication Public Health a Major Priority in African Nations
Date of publication
2014 May
Publication type
Report
Publication details
The Kaiser/Pew Global Health Survey / / pp /-/
Publication status
Published
Language
English
Keywords
public health; HIV; water; nutrition; governance; Africa
Abstract
Concerns about public health are widespread in sub-Saharan Africa, and there is considerable support in the region for making public health challenges a top national priority. In particular, people want their governments to improve the quality of hospitals and other health care facilities and deal with the problem of HIV/AIDS. A Pew Research Center survey, conducted March 6, 2013 to April 12, 2013 in six African nations, also finds broad support for government efforts to address access to drinking water, access to prenatal care, hunger, infectious diseases, and child immunization. A median of 76% across six countries surveyed say building and improving hospitals and other health care facilities should be one of the most important priorities for their national government. The percentage of the public who holds this view ranges from 85% in Ghana to 64% in Nigeria. Similarly, a median of 76% believe preventing and treating HIV/AIDS should be one of government’s most important priorities, ranging from 81% in Ghana to 59% in Nigeria. A median of at least 65% also say the other issues included on the poll — ranging from access to drinking water to increased child immunization — should be among the most important priorities. In fact, majorities hold this view about all seven issues in all six nations.
Country
Publisher
The Kaiser/Pew Global Health Survey
Theme area
Equity and HIV/AIDS
Title of publication Strengthening the Enabling Environment for Women and Girls: What is the Evidence in Social and Structural Approaches in the HIV Response?
Date of publication
2014 January
Publication type
Journal Article
Publication details
Journal of International Aids Society 17 1 pp /-/
Publication status
Published
Language
English
Keywords
gender; HIV; responses; global
Abstract
There is growing interest in expanding public health approaches that address social and structural drivers that affect the environment in which behaviour occurs. Half of those living with HIV infection are women. The sociocultural and political environment in which women live can enable or inhibit their ability to protect themselves from acquiring HIV. This paper examines the evidence related to six key social and structural drivers of HIV for women: transforming gender norms; addressing violence against women; transforming legal norms to empower women; promoting women’s employment, income and livelihood opportunities; advancing education for girls and reducing stigma and discrimination. The paper reviews the evidence for successful and promising social and structural interventions related to each driver. This analysis contains peer-reviewed published research and study reports with clear and transparent data on the effectiveness of interventions. Structural interventions to address these key social and structural drivers have led to increasing HIV-protective behaviours, creating more gender-equitable relationships and decreasing violence, improving services for women, increasing widows’ ability to cope with HIV and reducing behaviour that increases HIV risk, particularly among young people.
Country
Publisher
Journal of International Aids Society
Theme area
Resource allocation and health financing
Title of publication Fiscal Capacity and Aid Allocation: Domestic Resource Mobilization and Foreign Aid in Developing Countries
Date of publication
2014
Publication type
Report
Publication details
UNRISD Working Paper 7 / pp /-/
Publication status
Published
Language
Keywords
Abstract
In their paper on Fiscal Capacity and Aid Allocation: Domestic Resource Mobilization and Foreign Aid in Developing Countries the authors look into the interaction between fiscal performance and donor aid allocation. The analysis reveals that there is hardly any correlation between overall aid and fiscal performance and capacity. Furthermore, the authors point to gaps in terms of external funders delivering on their commitments to align with recipient country priorities and providing aid through country Public Finance Management systems - despite promises to pay greater attention to DRM efforts of recipient countries.
Country
Publisher
UNRISD
Theme area
Human resources for health
Title of publication Placement, Support, and Retention of Health Professionals: National, Cross-Sectional Findings from Medical and Dental Community Service Officers in South Africa
Date of publication
2014
Publication type
Journal Article
Publication details
Human Resources for Health 12 14 pp /-/
Publication status
Published
Language
English
Keywords
retention; health workers; health services; South Africa
Abstract
In South Africa, community service following medical training serves as a mechanism for equitable distribution of health professionals and their professional development. Community service officers are required to contribute a year towards serving in a public health facility while receiving supervision and remuneration. Although the South African community service programme has been in effect since 1998, little is known about how placement and practical support occur, or how community service may impact future retention of health professionals. National, cross-sectional data were collected from community service officers who served during 2009 using a structured self-report questionnaire. A Supervision Satisfaction Scale (SSS) was created by summing scores of five questions rated on a three-point Likert scale (orientation, clinical advising, ongoing mentorship, accessibility of clinic leadership, and handling of community service officers’ concerns). Research endpoints were guided by community service programmatic goals and analysed as dichotomous outcomes. Bivariate and multivariate logistical regressions were conducted using Stata 12. The sample population comprised 685 doctors and dentists (response rate 44%). Although few participants planned to continue work in rural, underserved communities (n = 171 out of 657 responses, 25%), those serving in a rural facility during the community service year had higher intentions of continuing rural work. Those reporting professional development during the community service year were twice as likely to report intentions to remain in rural, underserved communities. Despite challenges in equitable distribution of practitioners, participant satisfaction with the compulsory community service programme appears to be high among those who responded to a 2009 questionnaire. An emphasis on professional development and supervision is crucial if South Africa is to build practitioner skills, equitably distribute health professionals, and retain the medical workforce in rural, underserved areas.
Country
Publisher
/
Theme area
Poverty and health
Title of publication Effects of Hazardous and Harmful Alcohol Use on HIV Incidence and Sexual Behaviour: A Cohort Study of Kenyan Female Sex Workers
Date of publication
2014 April
Publication type
Journal Article
Publication details
Globalization and Health 10 22 pp /-/
Publication status
Published
Language
English
Keywords
alcohol; sexual behaviour; HIV; sex workers; gender; Kenya
Abstract
The authors investigate links between alcohol use, and unsafe sex and incident HIV infection in sub-Saharan Africa. A cohort of 400 HIV-negative female sex workers was established in Mombasa, Kenya. Associations between categories of the Alcohol Use Disorders Identification Test (AUDIT) and the incidence at one year of unsafe sex, HIV and pregnancy were assessed using Cox proportional hazards models. Violence or STIs other than HIV measured at one year was compared across AUDIT categories using multivariate logistic regression. Participants had high levels of hazardous and harmful drinking, while 36% abstained from alcohol. Hazardous and harmful drinkers had more unprotected sex and higher partner numbers than abstainers. Sex while feeling drunk was frequent and associated with lower condom use. Occurrence of condom accidents rose step-wise with each increase in AUDIT category. Compared with non-drinkers, women with harmful drinking had 4-fold higher sexual violence and 8 times higher odds of physical violence. Unsafe sex, partner violence and HIV incidence were higher in women with alcohol use disorders. This prospective study, using validated alcohol measures, indicates that harmful or hazardous alcohol can influence sexual behaviour. Possible mechanisms include increased unprotected sex, condom accidents and exposure to sexual violence.
Country
Publisher
Globalization and Health
Theme area
Health equity in economic and trade policies
Title of publication Local Production of Pharmaceuticals in Africa and Access to Essential Medicines: ‘Urban Bias’ in Access to Imported Medicines in Tanzania and its Policy Implications
Date of publication
2014 March
Publication type
Journal Article
Publication details
Globalization and Health 10 12 pp /-/
Publication status
Published
Language
English
Keywords
local production; medicines; Tanzania
Abstract
International policy towards access to essential medicines in Africa has focused until recently on international procurement of large volumes of medicines, mainly from Indian manufacturers, and their import and distribution. This emphasis is now being challenged by renewed policy interest in the potential benefits of local pharmaceutical production and supply. However, there is a shortage of evidence on the role of locally produced medicines in African markets, and on potential benefits of local production for access to medicines. This article contributes to filling that gap. This article uses WHO/HAI data from Tanzania for 2006 and 2009 on prices and sources of a set of tracer essential medicines. It employs innovative graphical methods of analysis alongside conventional statistical testing. Medicines produced in Tanzania were equally likely to be found in rural and in urban areas. Imported medicines, especially those imported from countries other than Kenya (mainly from India) displayed 'urban bias?: that is, they were significantly more likely to be available in urban than in rural areas. This finding holds across the range of sample medicines studied, and cannot be explained by price differences alone. While different private distribution networks for essential medicines may provide part of the explanation, this cannot explain why the urban bias in availability of imported medicines is also found in the public sector. The findings suggest that enhanced local production may improve rural access to medicines. The potential benefits of local production and scope for their improvement are an important field for further research, and indicate a key policy area in which economic development and health care objectives may reinforce each other.
Country
Publisher
Globalization and Health
Theme area
Health equity in economic and trade policies
Title of publication Extractive Industries, Revenue Allocation
Date of publication
2014
Publication type
Document
Publication details
UNRISD Working Paper 4 / pp /-/
Publication status
Published
Language
English
Keywords
extractive industries; financing; governance; global
Abstract
The authors have done a comparative study of revenue allocation in mineral-rich contexts, looking at existing criteria and reform modalities adopted to allocate and use EI revenues and examining the political bargains that enabled such distribution. The authors contend that two factors are crucially important - and explanatory of - devolution of revenues to subnational jurisdictions: the bargaining power of subnational actors as well as their connectedness to the central politics.
Country
Publisher
UNRISD
Theme area
Monitoring equity and research to policy
Title of publication Identifying and Targeting Mortality Disparities: A Framework for Sub-Saharan Africa Using Adult Mortality Data from South Africa
Date of publication
2013 August
Publication type
Journal Article
Publication details
PLoS One / / pp /-/
Publication status
Published
Language
English
Keywords
mortality; inequality; South Africa; Africa
Abstract
Health inequities in developing countries are difficult to eradicate because of limited resources. The neglect of adult mortality in Sub-Saharan Africa (SSA) is a particular concern. Advances in data availability, software and analytic methods have created opportunities to address this challenge and tailor interventions to small areas. This study demonstrates how a generic framework can be applied to guide policy interventions to reduce adult mortality in high risk areas. The framework, therefore, incorporates the spatial clustering of adult mortality, estimates the impact of a range of determinants and quantifies the impact of their removal to ensure optimal returns on scarce resources. Data from a national cross-sectional survey in 2007 were used to illustrate the use of the generic framework for SSA and elsewhere. Adult mortality proportions were analysed at four administrative levels and spatial analyses were used to identify areas with significant excess mortality. An ecological approach was then used to assess the relationship between mortality “hotspots” and various determinants. Population attributable fractions were calculated to quantify the reduction in mortality as a result of targeted removal of high-impact determinants. Overall adult mortality rate was 145 per 10,000. Spatial disaggregation identified a highly non-random pattern and 67 significant high risk local municipalities were identified. The most prominent determinants of adult mortality included HIV antenatal sero-prevalence, low SES and lack of formal marital union status. The removal of the most attributable factors, based on local area prevalence, suggest that overall adult mortality could be potentially reduced by ~90 deaths per 10,000.
Country
Publisher
PLoS One
Theme area
Monitoring equity and research to policy
Title of publication Health Research for All: The Role of Innovation in Global Health in the Post-2015 Development Framework
Date of publication
2014 April
Publication type
Electronic Source
Publication details
COHRED blog / / pp /-/
Publication status
Published
Language
English
Keywords
research; development; global health
Abstract
The Council on Health Research for Development (COHRED), along with the Global Health Council (GHC), the Drugs for Neglected Diseases initiative (DNDi), the International AIDS Vaccine Initiative (IAVI), and the Global Health Technologies Coalition (GHTC) hosted an official nongovernmental organization (NGO) side session at the 67th annual World Health Assembly (WHA) to explore the role of R&D in the post-2015 development agenda. The event organizers developed a statement urging member states and delegates to support health research and related policies and capacity building as a core component of a post-2015 agenda for equitable health and sustainable development. WHA Member States approved a resolution on health in the post-2015 development agenda that called for completing the unfinished work of the health Millennium Development Goals (MDGs) and noted the importance of universal health coverage and stronger health systems.
Country
Publisher
Theme area
Governance and participation in health
Title of publication Mobile Health for Non-Communicable Diseases in Sub-Saharan Africa: A Systematic Review of the Literature and Strategic Framework for Research
Date of publication
2014 June
Publication type
Journal Article
Publication details
Globalization and Health 10 49 pp /-/
Publication status
Published
Language
English
Keywords
mobile health; non-communicable diseases; Africa
Abstract
Mobile health (mHealth) approaches for non-communicable disease (NCD) care seem particularly applicable to sub-Saharan Africa given the penetration of mobile phones in the region. The evidence to support its implementation has not been critically reviewed. The authors systematically searched PubMed, Embase, Web of Science, Cochrane Central Register of Clinical Trials, a number of other databases, and grey literature for studies reported between 1992 and 2012 published in English or with an English abstract available. The search yielded 475 citations of which eleven were reviewed in full after applying exclusion criteria. Five of those studies met the inclusion criteria of using a mobile phone for non-communicable disease care in sub-Saharan Africa. Most studies lacked comparator arms, clinical endpoints, or were of short duration. mHealth for NCDs in sub-Saharan Africa appears feasible for follow-up and retention of patients, can support peer support networks, and uses a variety of mHealth modalities. Whether mHealth is associated with any adverse effect has not been systematically studied. Only a small number of mHealth strategies for NCDs have been studied in sub-Saharan Africa. They report that there is insufficient evidence to support the effectiveness of mHealth for NCD care in sub-Saharan Africa and present a framework for cataloging evidence on mHealth strategies that incorporates health system challenges and stages of NCD care to guide approaches to fill evidence gaps in this area.
Country
Publisher
Globalization and Health
Theme area
Governance and participation in health
Title of publication Leadership from ‘Below’? Clinical Staff and Public Hospitals in South Africa
Date of publication
2014
Publication type
Report
Publication details
MSP Briefing Note 4 / pp /-/
Publication status
Published
Language
English
Keywords
health workers; health services; public sector; governance; South Africa
Abstract
This paper identifies the possibilities and challenges related to involving clinical staff in the leadership and management of district hospitals in South Africa. It couches findings and recommendations in terms that are applicable to other service sectors. This is because strengthening the leadership capacity of practitioners (as opposed to simply their line managers’), and facilitating participation in their organisations’ decision-making processes, might be one mechanism to restore responsiveness and quality in public services in general. The study also speaks to how to strengthen the public sector along lines that preserve its ‘publicness’ and enable it to meet its social objectives more effectively, as an alternative to more market-based approaches.
Country
Publisher
Municipal Services Project
Theme area
Resource allocation and health financing
Title of publication Progress Towards Universal Health Coverage in BRICS: Translating Economic Growth into Better Health
Date of publication
2014
Publication type
Journal Article
Publication details
Bulletin Of The World Health Organisation 92 / pp 429-435
Publication status
Published
Language
English
Keywords
universal health coverage; economic growth; health system; financing; BRICS; Brazil; Russia; India; China; South Africa
Abstract
Brazil, the Russian Federation, India, China and South Africa – the countries known as BRICS – represent some of the world’s fastest growing large economies and nearly 40% of the world’s population. Over the last two decades, BRICS have undertaken health-system reforms to make progress towards universal health coverage. This paper discusses three key aspects of these reforms: the role of government in financing health; the underlying motivation behind the reforms; and the value of the lessons learnt for non-BRICS countries. Although national governments have played a prominent role in the reforms, private financing constitutes a major share of health spending in BRICS. There is a reliance on direct expenditures in China and India and a substantial presence of private insurance in Brazil and South Africa. The Brazilian health reforms resulted from a political movement that made health a constitutional right, whereas those in China, India, the Russian Federation and South Africa were an attempt to improve the performance of the public system and reduce inequities in access. The move towards universal health coverage has been slow. In China and India, the reforms have not adequately addressed the issue of out-of-pocket payments. Negotiations between national and subnational entities have often been challenging but Brazil has been able to achieve good coordination between federal and state entities via a constitutional delineation of responsibility. In the Russian Federation, poor coordination has led to the fragmented pooling and inefficient use of resources. In mixed health systems it is essential to harness both public and private sector resources.
Country
Publisher
World Health Organisation
Theme area
Human resources for health
Title of publication Maximising the Benefit of Health Workforce Secondment in Botswana: An Approach for Strengthening Health Systems in Resource-Limited Settings
Date of publication
2014 May
Publication type
Journal Article
Publication details
Risk Management And Healthcare Policy 7 91 pp /-/
Publication status
Published
Language
English
Keywords
health workers; health services; Botswana
Abstract
To address health systems challenges in limited-resource settings, global health initiatives, particularly the President's Emergency Plan for AIDS Relief, have seconded health workers to the public sector. Implementation considerations for secondment as a health workforce development strategy are not well documented. This article presents outcomes, best practices, and lessons learned from a President's Emergency Plan for AIDS Relief-funded secondment program in Botswana. Outcomes are documented across four World Health Organisation health systems' building blocks. Best practices include documentation of joint stakeholder expectations, collaborative recruitment, and early identification of counterparts. Lessons learned include inadequate ownership, a two-tier employment system, and ill-defined position duration. These findings can inform program and policy development to maximise the benefit of health workforce secondment. Secondment requires substantial investment, and emphasis should be placed on high-level technical positions responsible for building systems, developing health workers, and strengthening government to translate policy into programs.
Country
Publisher
Risk Management And Healthcare Policy
Theme area
Equitable health services
Title of publication Learning from Holistic Thinking in Mental Health Programmes in Kenya
Date of publication
2013
Publication type
Report
Publication details
WHO Afro / / pp /-/
Publication status
Published
Language
English
Keywords
mental health; community; health services; participatory reflection and action; Kenya
Abstract
This case study describes three levels of intervention on mental health in Kenya that reflect a paradigm shift towards more holistic community centred thinking on mental health and associated intersectoral collaboration. The three levels are a (i) multi-faceted and intersectoral process for national policy development and implementation on mental health, (ii) a co-ordinated district programme on mental health and (iii)locally driven social action on mental health. Using a desk review of (limited) available literature, the case study describes the context for, inception, processes used, outcomes and impact of and lessons learned from each level. Each level was informed by collaborative situation appraisal to inform planning. The appraisal at local level was implemented using a participatory reflection and action approach to support communication and shared understanding across diverse actors, including those directly affected.
Country
Publisher
WHO Afro
Theme area
Values, policies and rights
Title of publication Hotspots of Climate Change Impacts in Sub-Saharan Africa and Implications for Adaptation and Development
Date of publication
2014 May
Publication type
Report
Publication details
Global Change Biology Online / / -/
Publication status
Published
Language
English
Keywords
climate change; sub-saharan Africa; water; resources
Abstract
A group of scientists in Germany report that, for the first time, they have identified the "hotspots of climate change in Africa," which cover three regions where people should prepare for multiple climatic problems over the next 20 years. According to scientists from the Potsdam Institute for Climate Impact Research (PIK), the three regions most at risk are parts of Sudan and Ethiopia, the countries around Lake Victoria, and the continent's south-eastern corner, especially parts of South Africa, Mozambique and Zimbabwe. "These regions are expected to see more severe dry seasons and reduced plant growth, with flooding in countries around Lake Victoria." The researchers say that globally Africa has already experience above average affects from the changing global climate - the continent's above average share of poor and undernourished people also increases the potential human impact of this situation.
Country
Publisher
/
Theme area
Values, policies and rights
Title of publication Labour and Community in Transition: Alliances for Public Services in South Africa
Date of publication
2014 June
Publication type
Report
Publication details
MSP Occasional Paper / / pp /-/
Publication status
Published
Language
English
Keywords
labour; public services; governance; South Africa
Abstract
While South Africa in the 1980s was rich in broad, politically independent labour-community alliances against the oppressive apartheid system and the ravages of neoliberal capitalism, following the 1994 democratic transition unions largely embraced the ANC-run state’s neoliberal corporatism, which increased social distance between employed workers and poor communities. Consistent attempts to repress community-led dissent in response to the failures of the ‘new’ democracy, and to delegitimise community struggles around public services, undermined further the bases for unity. This paper critically analyses the national context and practical experience of contemporary labour-community alliances to oppose privatisation and promote public services. It presents case briefs of existing labour-community alliances – the South Durban Environmental Community Alliance; the Cape Town Housing Assembly and South African Municipal Workers Union; and the Eastern Cape Health Crisis Action Coalition – as a means to raise their nature, challenges and successes.
Country
Publisher
Municipal Services Project
Theme area
Equity in health
Title of publication Socioeconomic Inequalities and Mortality Trends in BRICS, 1990 - 2010
Date of publication
2014 June
Publication type
Journal Article
Publication details
Bulletin Of The World Health Organization 92 6 pp /-/
Publication status
Published
Language
English
Keywords
mortality; health indicators; inequality;, BRICS; Brazil; Russia; India; China; South Africa
Abstract
This paper explores the presence and magnitude of – and change in – socioeconomic and health inequalities between and within Brazil, the Russian Federation, India, China and South Africa – the countries known as BRICS – between 1990 and 2010. Comparable data on socioeconomic and health indicators, at both country and primary subnational levels, were obtained from publicly available sources. Health inequalities between and within countries were identified and summarised by using standard gap and gradient metrics. Four of the BRICS countries showed increases in both income level and income inequality between 1990 and 2010. The exception was Brazil, where income inequality decreased over the same period. The paper finds that despite the economic prosperity and general improvements in health seen since 1990, profound inequalities in health persist both within and between BRICS. However, the substantial reductions observed – within Brazil and China – in the inequalities in income-related levels of infant mortality are encouraging.
Country
Publisher
World Health Organisation
Theme area
Health equity in economic and trade policies
Title of publication Africa Progress Report 2014- Grain, Fish Money, Financing Africa’s Green and Blue Revolutions
Date of publication
2014 May
Publication type
Report
Publication details
/ / / pp /-/
Publication status
Published
Language
English
Keywords
agriculture; economy; resources, Africa
Abstract
Africa is a rich continent. Some of those riches – especially oil, gas and minerals – have driven rapid economic growth over the past decade. The ultimate measure of progress, however, is the wellbeing of people – and Africa’s recent growth has not done nearly as much as it should to reduce poverty and hunger, or improve health and education. To sustain growth that improves the lives of all Africans, the continent needs an economic transformation that taps into Africa’s other riches: its fertile land, its extensive fisheries and forests, and the energy and ingenuity of its people. The Africa Progress Report 2014 describes what such a transformation would look like, and how Africa can get there. Agriculture must be at the heart that transformation. Most Africans, including the vast majority of Africa’s poor, continue to live and work in rural areas, principally as smallholder farmers. In the absence of a flourishing agricultural sector, the majority of Africans will be cut adrift from the rising tide of prosperity. To achieve such a transformation, Africa will need to overcome three major obstacles: a lack of access to formal financial services, the weakness of the continent’s infrastructure and the lack of funds for public investment.
The Africa Progress Report 2014 describes how African governments and their international partners can cooperate to remove those obstacles – and enable all Africans to benefit from their continent’s extraordinary wealth.
Country
Publisher
Africa Progress Panel
Theme area
Equitable health services, Human resources for health, Governance and participation in health
Title of publication EQUINET Discussion paper 103: The engagement of east and southern African countries on the WHO Code of Practice on the International Recruitment of Health Personnel and its implementation’
Date of publication
2014 June
Publication type
Report
Publication details
Publication status
Published
Language
Keywords
health workers; WHO Code; migration; retention; east and southern Africa
Abstract
The World Health Organisation (WHO) ‘Global Code of Practice on the International Recruitment of Health Personnel’ (hereinafter called the “Code”) adopted by the World Health Assembly (WHA) in May 2010 was the culmination of efforts by many different actors to address the maldistribution and shortages of health workers globally. African stakeholders influenced the development of the Code, but two years after its adoption only four African countries had designated national authorities, and only one had submitted a report to the WHO secretariat. This synthesis report is part of the Regional Network for Equity in Health (EQUINET) programme of work on Contributions of global health diplomacy to health systems in sub-Saharan Africa: Evidence and information to support capabilities for health diplomacy in east and southern Africa. The programme aims to identify factors that support the effectiveness of global health diplomacy (GHD) in addressing selected key challenges to health strengthening systems in eastern and southern Africa (ESA). The report compiles evidence from various research strategies undertaken to examine the above issues surrounding the WHO Code. These were:
i. an extensive review of literature on codes of practice, bilateral and multilateral agreements pertaining to human resources for health, and scientific papers relevant thereto in 2013;
ii. a ‘fast-talk’ session at the 66th World Health Assembly in May 2013 involving stakeholders from African countries to gauge views and concerns relating to the Code;
iii. a region-wide questionnaire survey implemented in 2013 to obtain views of government informants on issues affecting and measures for managing health workers, including migration of health workers in ESA countries; and
iv. three country case studies undertaken in Kenya, Malawi and South Africa concluded in 2014 to provide an in-depth exposition of perspectives on the Code and its implementation.
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Discussion paper
Theme area
Equity in health, Resource allocation and health financing
Title of publication Health insurance in Ghana: evaluation of policy holders' perceptions and factors influencing policy renewal in the Volta region
Date of publication
2013 July
Publication type
Journal Article
Publication details
International Journal of Equity in Health 12 50 pp /-/
Publication status
Published
Language
English
Keywords
health insurance; health financing; health policy; Ghana
Abstract
Health insurance is an important mechanism that succors individuals, states and the nation at large. The purpose of this study was to assess individual's attitude towards health insurance policy and the factors that influence respondents' decision to renew their health insurance policy when it expires. This cross sectional study was conducted in the Volta region of Ghana. A total of 300 respondents were randomly sampled and interviewed for the study. Data was collected at the household level and analysed with STATA software. Descriptive statistics was used to assess the demographic characteristics of the respondents while Logistic regression model was used to assess factors that influence respondents' decision to take up health insurance policy and renew it. The study results indicate that 61.1% of respondents are currently being enrolled in the NHIS, 23.9% had not renewed their insurance after enrolment and 15% had never enrolled. Reasons cited for non-renewal of insurance included poor service quality (58%), lack of money (49%) and taste of other sources of care (23%). The gender, marital status, religion and perception of health status of respondents significantly influenced their decision to enrol and remain in NHIS.NHIS has come to stay with clients testifying to its benefits in keeping them strong and healthy. Efforts therefore must be put in by all stakeholders including the community to educate the individuals on the benefits of health insurance to ensure all have optimal access.
Country
Publisher
International Journal of Equity in Health
Theme area
Equity in health
Title of publication The social determinants of multimorbidity in South Africa
Date of publication
2013 August
Publication type
Journal Article
Publication details
International Journal of Equity in Health 12 63 pp /-/
Publication status
Published
Language
English
Keywords
multimorbidity; social determinants; South Africa
Abstract
Multimorbidity is a growing concern worldwide, with approximately 1 in 4 adults affected. Most of the evidence on multimorbidity, its prevalence and effects, comes from high income countries. Not much is known about multimorbidity in low income countries, particularly in sub-Saharan Africa. The aim of this study was to determine the prevalence of multimorbidity and examine its association with various social determinants of health in South Africa.The data used in this study are taken from the South Africa National Income Dynamic Survey (SA-NIDS) of 2008. Multimorbidity was defined as the coexistence of two or more chronic diseases in an individual. Multinomial logistic regression models were constructed to analyse the relationship between multimorbidity and several indicators including socioeconomic status, area of residence and obesity.The prevalence of multimorbidity in South Africa was 4% in the adult population. Over 70% of adults with multimorbidity were females. Factors associated with multimorbidity were social assistance (Odds ratio (OR) 2.35; Confidence Interval (CI) 1.59-3.49), residence (0.65; 0.46-0.93), smoking (0.61; 0.38-0.96); obesity (2.33; 1.60-3.39), depression (1.07; 1.02-1.11) and health facility visits (5.14; 3.75-7.05). Additionally, income was strongly positively associated with multimorbidity. The findings are similar to observations made in studies conducted in developed countries. The findings point to a potential difference in the factors associated with single chronic disease and multimorbidity. Income was consistently significantly associated with multimorbidity, but not single chronic diseases. This should be investigated further in future research on the factors affecting multimorbidity.
Country
Publisher
International Journal of Equity in Health
Theme area
Equitable health services, Human resources for health
Title of publication Equity in maternal health in South Africa: analysis of health service access and health status in a national household survey
Date of publication
2013 September
Publication type
Journal Article
Publication details
PLoS One 8 9 pp /-/
Publication status
Published
Language
English
Keywords
maternal health; maternal mortality; access; HIV; South Africa
Abstract
South Africa is increasingly focused on reducing maternal mortality. Documenting variation in access to maternal health services across one of the most inequitable nations could assist in re-direction of resources. Analysis draws on a population-based household survey that used multistage-stratified sampling. Women, who in the past two years were pregnant (1113) or had a child (1304), completed questionnaires and HIV testing. Distribution of access to maternal health services and health status across socio-economic, education and other population groups was assessed using weighted data. Poorest women had near universal antenatal care coverage (ANC), but only 39.6% attended before 20 weeks gestation; this figure was 2.7-fold higher in the wealthiest quartile (95%CI adjusted odds ratio = 1.2-6.1). Women in rural-formal areas had lowest ANC coverage (89.7%), percentage completing four ANC visits (79.7%) and only 84.0% were offered HIV testing. Testing levels were highest among the poorest quartile (90.1% in past two years), but 10% of women above 40 or with low education had never tested. Skilled birth attendant coverage (overall 95.3%) was lowest in the poorest quartile (91.4%) and rural formal areas (85.6%). Around two thirds of the wealthiest quartile, of white and of formally-employed women had a doctor at childbirth, 11-fold higher than the poorest quartile. Overall, only 44.4% of pregnancies were planned, 31.7% of HIV-infected women and 68.1% of the wealthiest quartile. Self-reported health status also declined considerably with each drop in quartile, education level or age group. Aside from early ANC attendance and deficiencies in care in rural-formal areas, inequalities in utilisation of services were mostly small, with some measures even highest among the poorest. Considerably larger differences were noted in maternal health status across population groups. This may reflect differences between these groups in quality of care received, HIV infection and in social determinants of health.
Country
Publisher
PLoS One
Theme area
Equitable health services
Title of publication Lack of access to health care for African indigents: a social exclusion perspective
Date of publication
2013 November
Publication type
Journal Article
Publication details
International Journal of Equity in Health 15 12 pp /-/
Publication status
Published
Language
English
Keywords
access; health services; exclusion; Africa
Abstract
Lack of access to health care is a persistent condition for most African indigents, to which the common technical approach of targeting initiatives is an insufficient antidote. To overcome the standstill, an integrated technical and political approach is needed. Such policy shift is dependent on political support, and on alignment of international and national actors. The authors explore if the analytical framework of social exclusion can contribute to the latter. The authors produce a critical and evaluative account of the literature on three themes: social exclusion, development policy, and indigence in Africa-and their interface. First, the authors trace the concept of social exclusion as it evolved over time and space in policy circles. The authors then discuss the relevance of a social exclusion perspective in developing countries. Finally, they apply this perspective to Africa, its indigents, and their lack of access to health care. The concept of social exclusion as an underlying process of structural inequalities has needed two decades to find acceptance in international policy circles. Initial scepticism about the relevance of the concept in developing countries is now giving way to recognition of its universality. For a variety of reasons however, the uptake of a social exclusion perspective in Africa has been limited. Nevertheless, social exclusion as a driver of poverty and inequity in Africa is evident, and manifestly so in the case of the African indigents.The concept of social exclusion provides a useful framework for improved understanding of origins and persistence of the access problem that African indigents face, and for generating political space for an integrated approach.
Country
Publisher
International Journal of Equity in Health
Theme area
Equitable health services
Title of publication Strengthening health systems by health sector reforms
Date of publication
2014 February
Publication type
Journal Article
Publication details
Global Health Action / / pp /-/
Publication status
Published
Language
English
Keywords
global public health; health sector reforms
Abstract
The rising burden of disease and weak health systems are being compounded by the persistent economic downturn, re-emerging diseases, and violent conflicts. There is a growing recognition that the global health agenda needs to shift from an emphasis on disease-specific approaches to strengthening of health systems, including dealing with social, environmental, and economic determinants through multisectoral responses. A review and analysis of data on strengthening health sector reform and health systems was conducted. Attention was paid to the goal of health and interactions between health sector reforms and the functions of health systems. Further, the authors explored how these interactions contribute toward delivery of health services, equity, financial protection, and improved health. Health sector reforms cannot be developed from a single global or regional policy formula. Any reform will depend on the country's history, values and culture, and the population's expectations. Some of the emerging ingredients that need to be explored are infusion of a health systems agenda; development of a comprehensive policy package for health sector reforms; improving alignment of planning and coordination; use of reliable data; engaging 'street level' policy implementers; strengthening governance and leadership; and allowing a holistic and developmental approach to reforms. The process of reform needs a fundamental rather than merely an incremental and evolutionary change. Without radical structural and systemic changes, existing governance structures and management systems will continue to fail to address the existing health problems.
Country
Publisher
Global Health Action
Theme area
Equity in health
Title of publication Building Research Capacity in Africa: Equity and Global Health Collaborations
Date of publication
2014 March
Publication type
Journal Article
Publication details
PLoS Med 11 3 pp /-/
Publication status
Published
Language
English
Keywords
research capacity; knowledge equity; Africa
Abstract
Global health has increased the number of high-income country (HIC) investigators conducting research in low- and middle-income countries (LMICs). Partnerships with local collaborators rather than extractive research are needed. LMICs have to take an active role in leading or directing these research collaborations in order to maximise the benefits and minimise the harm of inherently inequitable relationships. This essay explores lessons from effective and equitable relationships that exist between African countries and HICs.
Country
Publisher
PLoS Med
Theme area
Equitable health services
Title of publication Inequalities in public health care delivery in Zambia
Date of publication
2014 March
Publication type
Journal Article
Publication details
International Journal of Equity in Health 13 1 pp /-/
Publication status
Published
Language
English
Keywords
public health care; universal coverage; primary care; Zambia
Abstract
Access to adequate health services that is of acceptable quality is important in the move towards universal health coverage. However, previous studies have revealed inequities in health care utilisation in the favour of the rich. Further, those with the greatest need for health services are not getting a fair share. In Zambia, though equity in access is extolled in government documents, there is evidence suggesting that those needing health services are not receiving their fair share. This study seeks therefore, to assess if socioeconomic related inequalities/inequities in public health service utilisation in Zambia still persist. The 2010 nationally representative Zambia Living Conditions and Monitoring Survey data are used. Inequality is assessed using concentration curves and concentrations indices while inequity is assessed using a horizontal equity index: an index of inequity across socioeconomic status groups, based on standardising health service utilisation for health care need. Public health services considered include public health post visits, public clinic visits, public hospital visits and total public facility visits. There is evidence of pro-poor inequality in public primary health care utilisation but a pro-rich inequality in hospital visits. The concentration indices for public health post visits and public clinic visits are -0.28 and -0.09 respectively while that of public hospitals is 0.06. After controlling for need, the pro-poor distribution is maintained at primary facilities and with a pro-rich distribution at hospitals. The horizontal equity indices for health post and clinic are estimated at -0.23 and -0.04 respectively while that of public hospitals is estimated at 0.11. A pro-rich inequity is observed when all the public facilities are combined (horizontal equity index = 0.01) though statistically insignificant.The results of the paper point to areas of focus in ensuring equitable access to health services especially for the poor and needy. This includes strengthening primary facilities that serve the poor and reducing access barriers to ensure that health care utilisation at higher-level facilities is distributed in accordance with need for it. These initiatives may well reduce the observed inequities and accelerate the move towards universal health coverage in Zambia.
Country
Publisher
International Journal of Equity in Health
Theme area
Equity in health
Title of publication Open access: academic publishing and its implications for knowledge equity in Kenya
Date of publication
2014 April
Publication type
Journal Article
Publication details
Globalization and Health 10 26 pp /-/
Publication status
Published
Language
English
Keywords
academic publishing; knowledge equity; Kenya
Abstract
Traditional, subscription-based scientific publishing has its limitations: often, articles are inaccessible to the majority of researchers in low- and middle-income countries (LMICs), where journal subscriptions or one-time access fees are cost-prohibitive. Open access (OA) publishing, in which journals provide online access to articles free of charge, breaks this barrier and allows unrestricted access to scientific and scholarly information to researchers all over the globe. At the same time, one major limitation to OA is a high publishing cost that is placed on authors. Following recent developments to OA publishing policies in the UK and even LMICs, this article highlights the current status and future challenges of OA in Africa. The authors place particular emphasis on Kenya, where multidisciplinary efforts to improve access have been established. The authors note that these efforts in Kenya can be further strengthened and potentially replicated in other African countries, with the goal of elevating the visibility of African research and improving access for African researchers to global research, and, ultimately, bring social and economic benefits to the region. The authors offer recommendations for overcoming the challenges of implementing OA in Africa and call for urgent action by African governments to follow the suit of high-income countries like the UK and Australia, mandating OA for publicly-funded research in their region and supporting future research into how OA might bring social and economic benefits to Africa.
Country
Publisher
Globalization and Health
Theme area
Equitable health services, Governance and participation in health
Title of publication Trust, accountability and performance in Health Facility Committee s in Orumba South Local Government Area, Anambra State
Date of publication
2011 June
Publication type
Document
Publication details
Consortium for Research on Equitable Health Systems (CREHS) / / pp /-/
Publication status
Published
Language
English
Keywords
primary health care; health committees; health workers; Nigeria
Abstract
Trust and accountability in the relationship between health service users and their healthcare facilities are important in the delivery of services and the functioning of the health system. The Government of Nigeria has recognised the importance of community participation in health services. The national guidelines for the development of the Primary Healthcare system established Health Facility Committees as one of a range of implementing structures to this end. Health Facility Committees operate at the village or ward level and are responsible for: determining drug pricing, supply and payment; ensuring financial accountability; monitoring health service performance and ensuring democratic accountability. Yet little is known about the effects of accountability on service delivery in Nigeria. This study examined why some Health Facility Committees are functional when others are not and also sought to trace the effects and impacts of Committees on health service delivery including human resource issues and financing. It also investigated the influence of trust on how well they functioned. The research was conducted in Orumba South, a rural Local Government Area. Orumba South is about 70 kilometres from the state capital and is comparable in general development terms to other rural Local Government Areas in the state. The case study material in the longer report that accompanies this brief draws a rich picture of the operating environment and structures which influence local health services. This brief will be of interest to Nigerian policy makers aiming to improve the delivery of healthcare and in exploring ways in which community involvement can leverage improved public services. It also provides learning for Health Facility Committee members and local communities who wish to develop and improve their performance. Finally this research may have utility for policy makers and health service implementers in other settings who wish to better understand the role of trust and accountability in improving health outcomes.
Country
Publisher
Consortium for Research on Equitable Health Systems (CREHS)
Theme area
Equitable health services
Title of publication Decentralisation and Health Service Delivery- Uganda Case Study
Date of publication
2008 February
Publication type
Academic paper
Publication details
Massachusetts Institute of Technology / / pp /-/
Publication status
Published
Language
English
Keywords
decentralisation; health services; Uganda
Abstract
Uganda has embarked on public sector reforms for the past decade. One of the most notable is the decentralisation policy, which seeks to devolve powers from the central government to the local governments. Local governments have been given financial, administrative, planning and implementation responsibilities; they have been empowered to deliver services to their respective communities. The rationale for decentralisation is that it is said to promote a more responsive and equitable service delivery; decision-makers are closer to the people and thus the community can demand services they need. One of the decentralised services that has received recent attention is health. This study focuses on the role of local governments in preventive health service delivery. The author assessed the successful performance of Nama sub-county in Mukono in the context of decentralisation policy. The study revealed remarkable improvements in vaccination rates. Successful implementation of the immunisation program resulted from the role of the sub-county health committees in making health-related information available; data on demographics and prevalence of diseases compiled by the health unit have provided the district with a guide to a more effective intervention. The findings also show that control, support and supervision from higher levels played a major role in effective preventive health service delivery. Finally, success was accomplished through extensive community mobilisation, and a high degree of flexibility and coordination in the use of alternative service providers.
Country
Publisher
Massachusetts Institute of Technology
Theme area
Equity in health
Title of publication Social Participation and the Right to Health: Report on a workshop at the 3rd People’s Health Assembly, Cape Town
Date of publication
2012 October
Publication type
Report
Publication details
People’s Health Movement / / pp /-/
Publication status
Published
Language
English
Keywords
participation; right to health; South Africa
Abstract
As part of the People’s Health Assembly, the Learning Network for Health and Human Rights in South Africa, the Center for the Study of Equity and Governance in Health Systems in Guatemala and the National Campaign on Health and Social Security as Fundamental Right in Colombia organised a workshop on Social Participation and the Right to Health. The workshop brought together speakers from countries in Latin America, Africa and Asia to share experiences of different spaces, structures and approaches to social participation aimed at realising the right to health.
Country
Publisher
People’s Health Movement
Theme area
Equitable health services, Governance and participation in health
Title of publication The Status of Clinic Committees in Primary Level Public Health Sector Facilities in South Africa, Health Systems Trust
Date of publication
2008
Publication type
Report
Publication details
Health Systems Trust / / pp /-/
Publication status
Published
Language
English
Keywords
primary care; health committees; health workers; participation; South Africa
Abstract
In South Africa, governance structures in the form of clinic committees, hospital boards and district health councils are intended to give expression to the principle of community participation at a local and district level. Clinic committees, hospital boards and district health councils are intended to act as a link between communities and health services and to provide a conduit for the health needs and aspirations of the community to be represented at various local, district, provincial and national levels. A tiered system of representation is envisaged in which the voice of ordinary community members eventually makes its way from the local to the provincial level. This study aimed to assess the functioning and effectiveness of health governance structures in the form of clinic committees in order to identify opportunities for strengthening their role in governance. The study sought to ascertain the number of clinic committees associated with public health facilities in all nine provinces in South Africa. In addition, the study intended to identify the factors that are perceived by clinic committee members to either facilitate or impede the effective functioning of clinic committees. The study was conducted in two phases: the first phase consisted of a cross sectional survey which was administered with the aim of collecting information on the nature, scope and extent of community participation through clinic committees at public health facilities in the nine provinces in the second phase of the study, three focus group discussions (FGDs) were undertaken with the members of three clinic committees and were directed at providing a more in-depth understanding of the information collected in phase one, as well as documenting the factors that are perceived as facilitating or impeding the effective functioning of clinic committees. While 57% of facilities reported having clinic committees, the study found that there are a range of factors that impact on the functioning of these structures. The results also suggest that more clinic committees exist in provinces where there has been explicit political support for the creation and building the capacity of these structures. The data also suggests that most clinic committees have come into existence since the promulgation of the National Health Act, 2003. Poor socio-economic conditions and a context of poverty are important determinants of whether clinic committees flourish as the study found that a failure to attend meetings (often due to transport costs) and the lack of a stipend for clinic committee members are some of the reasons why facilities do not have clinic committees. Encouragingly, in two provinces, more than 30% of those facilities which did not have clinic committees reported being in the process of establishing committees. The low level of local councillor membership (45%) in clinic committees is cause for concern as this is a statutory requirement that is not being complied with. This has important implications for the envisaged tiered system of representation articulated in the National Health Act, 2003. The results also suggest that while most clinic committees meet on a monthly basis, the activities of the clinic committees appear to be mostly confined to problem solving between the community and the health facility, health education and volunteering their services in the facility. The issue of the roles and responsibilities of clinic committee members needs attention as the research has highlighted the gap that exists in this regard. The results from this study indicate that while national legislation has created a political climate receptive to community participation, the lack of provincial guidelines, inadequate resource allocation, and the limited capacity of committees constrain their abilities to actively fulfil their intended roles and responsibilities.
Country
Publisher
Health Systems Trust
Theme area
Equity in health
Title of publication Power to the people: evidence from a randomised field experiment on community-based monitoring in Uganda
Date of publication
2009
Publication type
Journal Article
Publication details
The Quarterly Journal of Economics 124 2 pp 735-769
Publication status
Published
Language
English
Keywords
primary health care; community based monitoring; community participation; Uganda
Abstract
This paper presents a randomised field experiment on community-based monitoring of public primary health care providers in Uganda. Through two rounds of village meetings, localised nongovernmental organisations encouraged communities to be more involved with the state of health service provision and strengthened their capacity to hold their local health providers to account for performance. A year after the intervention, treatment communities are more involved in monitoring the provider, and the health workers appear to exert higher effort to serve the community. The authors document large increases in utilisation and improved health outcomes—reduced child mortality and increased child weight—that compare favourably to some of the more successful community-based intervention trials reported in the medical literature.
Country
Publisher
The Quarterly Journal of Economics
Theme area
Equitable health services
Title of publication The Implementation and Effects of Direct Facility Funding in Kenya’s Health Centres and Dispensaries, Consortium for Research on Equitable Health Systems, KEMRI-Welcome Trust Research Programme
Date of publication
2009 April
Publication type
Report
Publication details
/ / / pp /-/
Publication status
Published
Language
English
Keywords
health care financing; direct facility funding; Kenya
Abstract
Direct facility funding (DFF) is an initiative that was developed in response to concern that Ministry of Health funds allocated to districts rarely filter down to the health centres and dispensaries, and that these facilities have also lost revenue due to the reduction in official user fees in 2004. Piloted in Coast Province from late 2005, DFF involved facilities receiving funds for recurrent expenditure directly into their bank accounts. This report presents an evaluation of the implementation and effects of DFF in health centres and dispensaries. The findings in this report are based on data collected between October 2007 and March 2008, about 2 to 3 years after DFF implementation. A structured survey that included an interview with facility in-charges, records review, and outpatient exit interviews was conducted at a random sample of 15 facilities in each of the two purposively selected districts (Kwale and Tana River). In addition, focus group discussions with health facility committee (HFC) members and key informant interviews with in-charges and DHMTs were conducted in a subset of 6 facilities in each district. The study found that DFF accounted for an average of 56% of the facilities‟ annual income, while user- fees revenue accounted for 34%. DFF funds were particularly important for dispensaries, accounting for 62% of facility income. Wages for casual staff, travel allowances and construction and maintenance accounted for the bulk of DFF expenditure. DFF procedures were generally well-established: all facilities had opened bank accounts and funds had been transferred; HFCs were active in planning for and use of the funds; and accounting procedures were generally followed. A few initial problems were noted, especially in training of HFCs in one district, and, whilst these had mainly been resolved by the time of data collection, confusion persisted over some aspects of DFF operation, reflecting limited HFC training and a lack of DFF documentation at facility level. DFF was perceived to have had a highly positive impact by a great majority of the respondents. Utilisation of facilities was thought to have increased, especially through the expanded outreach programs, thus improving access to health services. Although this resulted in a heavy workload for staff, there were no complaints about this as the increased workload was offset by the improved working environment, namely the availability of supplies and a better infrastructure, and by the ability to hire more support staff. Health worker motivation was also improved through provision of allowances; and, as a result of these changes, it was felt that quality of care had improved. Despite the DFF funds, it was clear that facilities were not adhering to the user fees policy. Many continued to levy charges above the prescribed fees and failed to exempt groups of patients such as the under-fives and those with malaria. Interviewees attributed non-adherence to lack of official communication of the policy and the need for more resources at the facility level. The operations of HFCs were reported to have improved since the introduction of DFF; however, only a minority of people in the broader community had the information to participate actively in decision making and hold HFCs to account. Only 46% of exit interviewees had ever heard of a HFC, while community members had very little knowledge on DFF procedures, how decisions were made, how DFF funds could be used, and what user fees should be charged. Specially designed blackboards aimed at displaying utilisation data and a limited amount of financial information were available in most facilities but were rarely filled in completely. DFF is perceived to be a highly valuable intervention and the current system is generally working well. The Kenyan Government plans to scale up DFF nationwide under the Health Sector Services Fund and our findings indicate that this is warranted; however, scale up of DFF should include improved training and documentation; greater emphasis on community engagement; and insistence on user fee adherence as a prerequisite for receipt of funds.
Country
Publisher
Wellcome Trust; Kenya Medical Research Institute
Theme area
Equitable health services, Governance and participation in health
Title of publication Community health volunteers (CHVs) Basic Modules Manual- Facilitators Guide
Date of publication
2013
Publication type
Publication details
/ / / pp /-/
Publication status
Published
Language
English
Keywords
primary care; health committees; health workers; participation; Kenya
Abstract
One of the dominant themes in health policy and planning today is the need for interventions based on sound evidence of effectiveness. The responsibility of ensuring programmes are consistent with the best available evidence must be shared between providers, policy makers and consumers of services. Community Health Volunteers (CHVs) have been major players in the implementation of primary healthcare since the 1980s, and still continue to play a critical role in mobilising communities in taking care of their health, and providing basic healthcare at community level. To enable CHVs be more effective and efficient, there is need for appropriate training, not only in community mobilisation but also in the assessment of health-related issues in the community, and identification of appropriate actions at that level. Such training need be well planned and implemented using standard training manual that take into account the level of operation and capacity of CHVs. This also requires the support of well-trained and informed trainers and supervisors from the formal healthcare system. This training manual is meant to assist the healthcare system at all the four tiers to operationalise the community strategy by providing appropriate training for CHVs to enable them take charge of appropriate interventions at tier 1. The Government of Kenya is committed to supporting community health initiatives this way, and accelerating the achievement of the current NHSSP II goals, MDGs and providing support to Vision 2030. The CHV training manual is organised in Modules which should be applied incrementally to enable the CHVs develop adequate capacity for working with communities.
Country
Publisher
Ministry of Health Kenya
Theme area
Equitable health services
Title of publication Health Sector Strategic Plan 2011-2016-Moving Towards Equity and Quality
Date of publication
2011 September
Publication type
Report
Publication details
/ / / pp /-/
Publication status
Published
Language
English
Keywords
health sector plan; Malawi
Abstract
The Malawi Health Sector Strategic Plan (HSSP) 2011-2016 is the key policy document for the health sector in Malawi. Priority areas and an overview of current progress achieved in newborn, child and maternal health and other health-related Millennium Development Goals are highlighted. The HSSP has been expanded from the previous Program of Work to emphasise health promotion and disease prevention, community participation, quality assurance, establishing alternative financing and a renewed commitment to implementing quality and universal Essential Health Package services. The HSSP 2011-2016 is the successor to the Program of Work (PoW) which covered 2004-2010. Key achievements in the report show that during the PoW (according to the DHS) reduction in infant and child mortality rates from 76/1000 in 2004 to 66/1000 in 2010 and from 133/1000 to 112/1000 respectively; maternal mortality decreased from 984 per 100,000 in 2004 to 674 per 100,000 in 2010; women delivering at health centres increased from 57.2% in 2004 to 73% in 2010; immunisation coverage is high 81% of children 12-23 months fully vaccinated in 2010; increase in coverage of estimated population in need of ART from 3% in 2004 to 67% in 2011. Key outcomes and outputs include: increasing coverage of high quality EHP services; strengthened performance of health system to support delivery of EHP services; Reduced risk factors to health; improved equity and efficiency in the delivery of quality EHP services. The ideal total cost of implementing the strategic plan is estimated at $3.2 billion over 5 years, while plan based on projected resources costs $2.48 billion with an estimated gap over 5 years of HSSP of $754 million.
Country
Publisher
Ministry of Health Malawi
Theme area
Equitable health services
Title of publication Taking the Kenya Essential Package for Health to the Community: A Strategy for the Delivery of Level One Service
Date of publication
2006 June
Publication type
Report
Publication details
/ / / pp /-/
Publication status
Published
Language
English
Keywords
health sector plan; Kenya
Abstract
This publication is one of a series that the Ministry of Health will produce to support the achievement of the goals of the second National Health Sector Strategic Plan, 2005–2010 (NHSSP II). Aiming to reverse the declining trends in key health sector indicators, NHSSP II has five broad policy objectives. These are increase equitable access to health services; improve the quality and responsiveness of services in the sector; improve the efficiency and effectiveness of service delivery; enhance the regulatory capacity of MOH; foster partnerships in improving health and delivering services; and improve the financing of the health sector.
Country
Publisher
Ministry of Health Kenya
Theme area
Equitable health services, Governance and participation in health
Title of publication Primary health care in rural Malawi - a qualitative assessment exploring the relevance of the community-directed interventions approach
Date of publication
2012 September
Publication type
Journal Article
Publication details
Health Services Research 12 328 pp /-/
Publication status
Published
Language
English
Keywords
primary health care; community health; participation; Malawi
Abstract
Primary Health Care (PHC) is a strategy endorsed for attaining equitable access to basic health care including treatment and prevention of endemic diseases. Thirty four years later, its implementation remains sub-optimal in most Sub-Saharan African countries that access to health interventions is still a major challenge for a large proportion of the rural population. Community-directed treatment with ivermectin (CDTi) and community-directed interventions (CDI) are participatory approaches to strengthen health care at community level. Both approaches are based on values and principles associated with PHC. The CDI approach has successfully been used to improve the delivery of interventions in areas that have previously used CDTi. However, little is known about the added value of community participation in areas without prior experience with CDTi. This study aimed at assessing PHC in two rural Malawian districts without CDTi experience with a view to explore the relevance of the CDI approach. The authors examined health service providers’ and beneficiaries’ perceptions on existing PHC practices, and their perspectives on official priorities and strategies to strengthen PHC. The authors conducted 27 key informant interviews with health officials and partners at national, district and health centre levels; 32 focus group discussions with community members and in-depth interviews with 32 community members and 32 community leaders. Additionally, official PHC related documents were reviewed. The findings show that there is a functional PHC system in place in the two study districts, though its implementation is faced with various challenges related to accessibility of services and shortage of resources. Health service providers and consumers shared perceptions on the importance of intensifying community participation to strengthen PHC, particularly within the areas of provision of insecticide treated bed nets, home case management for malaria, management of diarrhoeal diseases, treatment of schistosomiasis and provision of food supplements against malnutrition. The study indicates that intensified community participation based on the CDI approach can be considered as a realistic means to increase accessibility of certain vital interventions at community level.
Country
Publisher
Health Services Research
Theme area
Equitable health services, Human resources for health, Governance and participation in health
Title of publication Strengthening Community Health Systems for HIV Treatment, Support and Care Kariba District – Zimbabwe
Date of publication
2010 May
Publication type
Report
Publication details
/ / / pp /-/
Publication status
Published
Language
English
Keywords
primary care; HIV; community health; participation; east and southern Africa
Abstract
The Community based systems in HIV treatment (CoBaSys) programme is empowering communities to support antiretroviral delivery programmes for patients with HIV infection in east and southern Africa (ESA). This is done through a regional network for policy advocacy targeting vulnerable groups in ESA and Europe with support from the European commission through the African Caribbean and Pacific (ACP) group of States. The project primarily focuses on building solid ‘community based systems that support the HIV treatment to benefit most vulnerable social groups at primary care level. The learning and evidence from this tier of the health system within the Kariba Urban District-Zimbabwe is collated, synthesized for national level advocacy and further integrated at regional level for global engagement. Zimbabwe is experiencing a decline in HIV AIDS prevalence and in new HIV infections, first of such kind in southern Africa. The estimated HIV and AIDS prevalence in adults in the 15-49 age groups was 14.1% in 2008 and declined to an estimated 13.7% in 2009 (MOHCW 2009). However, the prevalence remains high with more than one in seven Zimbabweans still infected with HIV. In Kariba District, HIV prevalence is estimated at 19.1% based on the Mashonaland west province statistics from Central Statistics Office (CSO 2008). The research used qualitative Participatory Reflection and Action (PRA) research methods. PRA research provides a powerful means of improving and enhancing practice by involving community dialogue at the very early stages of programme planning. Thus, it builds a basis for negotiation and partnership between researchers, resource holders and beneficiaries. However, PRA is often time-consuming and should not be used to provide detailed information about problems without a follow-up commitment to take action on the problems identified. A PRA study protocol used in the research was developed by TARSC; peer reviewed and pretested prior to implementation (Machingura F et al 2010). The Kariba PRA research participants were drawn from Ministry of health and Child Welfare (MOHCW), local authorities, health workers, community representatives, people living with HIVAIDS (PLWHA) and other key stakeholders. This report provides findings and an analysis from a PRA research held in Kariba in May 2010 to investigate and provide collective recommendations to community based systems in HIV treatment. The PRA research explored factors that facilitate and block access to, use and effective coverage of services and responses to HIV, and identified relevant and effective approaches to building community systems for responding to HIV /AIDS and services that support these systems.
Country
Publisher
TARSC; COBASYS
Theme area
Equitable health services, Governance and participation in health
Title of publication Examining the links between accountability, trust and performance in health service delivery in Tanzania
Date of publication
2011 June
Publication type
Report
Publication details
Ifakara Health Institute / / pp /-/
Publication status
Published
Language
English
Keywords
primary care; health committees; participation; Tanzania
Abstract
In Tanzania, health facility governing committees (HFGCs) were introduced at all levels of the health system as a mechanism for improving accountability between health care providers and communities. Health facility governing committee members have an official responsibility for community participation in the health system, improving quality of care, ensuring exemptions are respected, and mobilising resources from communities, such as in the case of the community health fund (CHF). Health facility governing committees typically consist of eight members and operate at the health facility level. Despite their longstanding existence, little is known about how facility-level governing committees function or the extent of their impact on health service delivery. One of the challenges faced by these committees is a lack of clarity in terms of their official role and the extent and nature of their interaction with existing local government committees. Therefore, the aim of this study was to examine the pre- conditions for the effective functioning of the committees, both in terms of representing community voice and in improving health worker performance and resource mobilisation in relation to the Community Health Fund, a voluntary health insurance scheme over which the committees have some responsibility. The role of interpersonal and institutional trust among and between health facility governing committee members and other groups/committee in the community were also considered in the effective operation of health facility governing committees.
Country
Publisher
Ifakara Health Institute
Theme area
Equitable health services, Human resources for health, Governance and participation in health
Title of publication Community-directed interventions strategy enhances efficient and effective integration of health care delivery and development activities in rural disadvantaged communities of Uganda
Date of publication
2005 April
Publication type
Journal Article
Publication details
Tropical Medicine & International Health 10 4 pp 312-321
Publication status
Published
Language
English
Keywords
primary care; health workers; participation; Uganda
Abstract
The community-directed interventions (CDI) strategy achieved a desired coverage of the ultimate treatment goal (UTG) of at least 90% with ivermectin distribution for onchocerciasis control, and filled the gap between the health care services and the communities. However, it was not clear how its primary actors – the community-directed health workers (CDHW) and community-directed health supervisors (CDHS) – would perform if they were given more responsibilities for other health and development activities within their communities. A total of 429 of 636 (67.5%) of the CDHWs who were involved in other health and development activities performed better than those who were involved only in ivermectin distribution, with a drop-out rate of 2.3%. A total of 467 of 864 (54.1%) of CDHSs who were involved in other health and development activities also maintained the desired level of performance. They facilitated updating of household registers (P < 0.05), trained and supervised CDHWs, and educated community members about onchocerciasis control (P < 0.001). Their drop-out rate was 2.6%. The study showed that the majority of those who dropped out had not been selected by their community members. Therefore, CDI strategy promoted integration of health and development activities with a high potential for sustainability.
Country
Publisher
Tropical Medicine & International Health
Theme area
Equitable health services, Human resources for health
Title of publication Factors influencing implementation of the Community Health Fund in Tanzania, Health Policy and Planning
Date of publication
2007 February
Publication type
Journal Article
Publication details
Health Policy and Planning 22 2 pp 95-102
Publication status
Published
Language
English
Keywords
health care financing; Community Health Fund; Tanzania
Abstract
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.
Country
Publisher
Health Policy and Planning
Theme area
Equitable health services, Governance and participation in health
Title of publication Vertical or holistic decentralisation of the health sector? Experiences from Zambia and Uganda
Date of publication
2000
Publication type
Journal Article
Publication details
International Journal of Health Planning and Management 15 4 pp 273-289
Publication status
Published
Language
English
Keywords
decentralisation; health sector reform; Uganda; Zambia
Abstract
Many countries in Africa have embarked on health sector reforms. The design of the reforms differs considerably. A key feature of the reforms is decentralisation, of which Uganda and Zambia are implementing two different models. This paper analyses the two models of health sector reform, and their implications for ultimate development goals. In Uganda, the whole government has been decentralised, with a wide range of powers and resources transferred to the districts. The health care system is part of the political set up of the country. In Zambia, only the health sector has been decentralised. Power and resources for health care have been divested to new parallel organisations. While useful lessons can be drawn from the managerial and administrative experience in the two countries, not least concerning donor coordination, it seems that neither form of decentralisation has so far led to a clear and appreciable improvement of health services and, ultimately, to a clear focus on development goals, such as poverty alleviation. The conditions for this to happen are discussed in this paper.
Country
Publisher
International Journal of Health Planning and Management
Theme area
Equitable health services, Human resources for health, Governance and participation in health
Title of publication Health Facility Committees: Are they working?
Date of publication
2011 August
Publication type
Report
Publication details
/ 7 / pp 1-4
Publication status
Published
Language
English
Keywords
primary care; health committees; participation; Kenya
Abstract
Health Facility Governing Committees (HFGCs) were first introduced in 1999, within health facilities of all levels of the health system alongside the introduction of the Community Health Fund (CHF). CHF is a voluntary scheme for rural populations, providing primary and, in some cases, secondary care in public facilities. The committees typically consist of five members from the community and three appointed members (the health facility in-charge, a member of the village government committee and Ward Development Committee). The committees meet four times a year. The main roles of the committee, according to the Ministry of Health and Social Welfare (2001) are to develop the plans and budget of the facility; mobilise the community to contribute to the CHF and ensuring the availability of drugs and equipment; responsible for reporting health provider employment and training needs to the district council, and ensuring their availability at the facility; and liaise with Dispensary Management Teams (DMT) and other actors to ensure the delivery of quality health services.
Country
Publisher
Ifakara Health Institute
Theme area
Equitable health services, Human resources for health, Governance and participation in health
Title of publication Extending participation- Challenges of health committees as meaningful structures for community participation: A study of health committees in the Cape Town Metropole
Date of publication
2011
Publication type
Report
Publication details
/ / / pp /-/
Publication status
Published
Language
English
Keywords
primary care; health committees; health workers; participation; South Africa
Abstract
Community participation in health has been a tenet of the primary health care approach since the Alma Ata declaration (1978). In South Africa, community participation in planning and provision of health care services has been outlined in The White Paper on Transformation of the Health System (Department of Health, 1997) and is seen as part of a wider reform of the health system. Community participation has been formalised in The National Health Act 61 of 2003 (Department of Health, 2004) with provisions for the establishment of health committees, hospital boards and district health councils. Health committees are intended to serve as a link between the health services and the communities they serve. With regard to health committees, the Act stipulates that each clinic/community health centre or a cluster of these should have a health committee. The Act stipulates that health committees should be constituted by one or more local government councillor(s), the head(s) of the health facility/facilities, and one or more members of the community in the area served by the health facility/facilities. The Act furthermore requires that the provincial governments must develop legislation that stipulates the functioning of health committees in the provinces. According to Padarath and Friedman (2008), provincial legislation is in varying stages of development. In the Western Cape, a Draft Policy Framework for Community Participation/Governance Structures for Health is yet to be implemented. Research has shown that health committees have the potential to impact positively on health and health care services and on the right to health (Loewenson et al 2004, Glattstein-Young 2010). Despite the importance of community participation, studies indicate that health committees in South Africa are not functioning optimally (Boulle et al 2008, Padarath and Friedman 2008). This study, conducted in partnership with the Cape Metro Health Forum (CMHF), aimed to obtain an overview of how health committees in the Cape Town Metro function, and to identify factors that impact on their functioning. Furthermore, it aimed to draw up recommendations on how to strengthen health committees and community participation, with a focus on identifying capacity and training needs. The study used multiple methods, including surveys, focus groups, participant observations and in-depth interviews.
Country
Publisher
Human Rights Division School of Public Health, University of Cape Town; The Learning Network on Health and Human Rights, Cape Town
Theme area
Equitable health services, Human resources for health, Governance and participation in health
Title of publication Health facility committees and facility management - exploring the nature and depth of their roles in Coast Province, Kenya
Date of publication
2011 September
Publication type
Journal Article
Publication details
BMC Health Services Research 11 229 pp 229-241
Publication status
Published
Language
English
Keywords
primary care; health committees; participation; Kenya
Abstract
Community participation has been emphasised internationally as a way of enhancing accountability, as well as a means to enhance health goals in terms of coverage, access and effective utilisation. In rural health facilities in Kenya, initiatives to increase community accountability have focused on Health Facility Committees (HFCs). In Coast Province the role of HFCs has been expanded with the introduction of direct funding of rural facilities. The authors explored the nature and depth of managerial engagement of HFCs at the facility level in two rural districts in this Coastal setting, and how this has contributed to community accountability. The authors conducted structured interviews with the health worker in-charge and with patients in 30 health centres and dispensaries. These data were supplemented with in-depth interviews with district managers, and with health workers and HFC members in 12 health centres and dispensaries. In-depth interviews with health workers and HFC members included a participatory exercise to stimulate discussion of the nature and depth of their roles in facility management. HFCs were generally functioning well and played an important role in facility operations. The breadth and depth of engagement had reportedly increased after the introduction of direct funding of health facilities which allowed HFCs to manage their own budgets. Although relations with facility staff were generally good, some mistrust was expressed between HFC members and health workers, and between HFC members and the broader community, partially reflecting a lack of clarity in HFC roles. Moreover, over half of exit interviewees were not aware of the HFC's existence. Women and less well-educated respondents were particularly unlikely to know about the HFC. There is potential for HFCs to play an active and important role in health facility management, particularly where they have control over some facility level resources. However, to optimise their contribution, efforts are needed to improve their training, clarify their roles, and improve engagement with the wider community.
Country
Publisher
BMC Health Services Research
Theme area
Equitable health services, Human resources for health, Governance and participation in health
Title of publication Community health committees as a vehicle for participation in advancing the right to health
Date of publication
2010
Publication type
Academic paper
Publication details
/ / / pp /-/
Publication status
Published
Language
English
Keywords
primary care; health committees; participation; South Africa
Abstract
The principles of Primary Health Care guided health system transformation in South Africa where community health committees represent formal structures for participation in health. While there is evidence to suggest that participation can assist the progressive realisation of the right to health, this link is not well established in the literature and Southern African studies underscore a serious deficit in the implementation of meaningful community participation. The present study used multiple methods to explore the relationship between participation and the right to health and to draw lessons on best practice for community participation from three health committees in South Africa’s Western Cape Province.
Country
Publisher
University of Cape Town
Theme area
Governance and participation in health
Title of publication Governing health service delivery in Uganda: A tracking study of drug delivery mechanisms
Date of publication
2009 August
Publication type
Report
Publication details
/ / / pp /-/
Publication status
Published
Language
English
Keywords
medicines; health sector; Uganda
Abstract
This study set out to produce evidence that will help the government of Uganda (GoU) and other relevant stakeholders understand (a) the challenges facing the health sector; (b) the obstacles that limit the efficient, effective and timely procurement, distribution and usage of medicines; and (c) what reforms or changes are needed to improve access to medicines to all Ugandans.
Country
Publisher
Economic Policy Research Centre (EPRC)
Theme area
Equitable health services
Title of publication Joint External Evaluation of the Health Sector in Tanzania: Draft Report
Date of publication
2007 October
Publication type
Report
Publication details
/ / / pp /-/
Publication status
Published
Language
English
Keywords
health sector; evaluation; Tanzania
Abstract
In 1999, the health sector in Tanzania entered into a sector-wide approach. This resulted in agreement on a joint monitoring and evaluation system replacing individual and separate review and evaluation activities in order to reduce transaction costs, to gain comprehensiveness and validity of lessons learned and thus to achieve greater credibility and broader ownership of results. Tanzania’s Joint Annual Health Sector Review is an excellent tool to measure the progress and achievements in the sector. However, in 2004 several members of OECD’s Development Assistance Committee proposed that a joint external evaluation of the health sector as a whole should supplement the reviews. In April 2006 – at the 7th Joint Annual Review – the Ministry of Health and Social Welfare pointed out that input from an external evaluation would need to be coordinated with the national health sector planning process to feed into the Third Health Sector Strategic Plan covering 2008-15. Eight government agencies, more than 20 development partners, many non-government organisations, faith-based organisations, civil society organisations as well as the private sector were engaged in the joint evaluation exercise. In addition, more than 300 community members took part in focus group discussions during the evaluation. The draft evaluation report was delivered on schedule on August 24, 2007 and all stake-holders were invited to comment in writing. This resulted in comments from a wide range of stakeholders. The draft report was then presented and discussed at Tanzania’s 8th Joint Annual Health Sector Review after which it was finalised.
Country
Publisher
Ministry of Foreign Affairs of Denmark
Theme area
Equitable health services
Title of publication Essential National Health Research and Priority Setting: Lessons Learned, Council on Health Research for Development
Date of publication
1997 June
Publication type
Report
Publication details
COHRED / / pp /-/
Publication status
Published
Language
English
Keywords
health research; global
Abstract
The health interests of developing countries have not been advanced enough. The proportion of global health R&D funds directed to health problems of developing countries has not increased, despite the overwhelming disease burden in these countries. The inequity calls for affirmative action by and for developing countries. A powerful strategy, as recommended by the Commission on Health Research for Development, is Essential National Health Research (ENHR). Many countries have responded to the Commission’s challenge by setting priorities for health research, a basic strategy for ENHR development. The competency to set priorities can be enhanced by learning from these previous country experiences and developing a systematic approach. This monograph reviews the past and proposes improved priority-setting processes for the future.
Country
Publisher
COHRED
Theme area
Governance and participation in health
Title of publication Regional meeting on heath system governance and community participation in health Report of Proceedings 28 February-1st March 2013
Date of publication
2013
Publication type
Conference Proceedings
Publication details
/ / / pp /-/
Publication status
Published
Language
English
Keywords
primary care; health committees; participation; health rights; east and southern Africa
Abstract
CEHURD, in partnership with the Learning Network for Health and Human Rights (South Africa), and with support from International Development Research Centre (IDRC), is implementing a project titled, Health system governance: Community participation as a key strategy for realising the right to health. The project is a pilot study implemented in Kiboga and Kyankwanzi districts in central Uganda. The project aims to develop models for community participation in health that advance health equity and strengthen governance systems for health by testing approaches and sharing experience gained in the project area using a rights-based approach to health and build the agency of community structures to articulate more strongly claims for health rights, with a view to proposing models for best practice. The meeting objectives were to share experiences of different models of community participation in health in the region, identifying strengths and weaknesses;to identify opportunities for networking and synergy under EQUINET; and to develop a dissemination strategy for this work in the region. The meeting brought together community leaders, community members, service providers, and civil society from Uganda, Kenya, Malawi, Zambia, Zimbabwe and South Africa.
Country
Publisher
CEHURD
Theme area
Resource allocation and health financing
Title of publication Community-based health insurance in developing countries: a study of its contribution to the performance of health financing systems
Date of publication
2005 August
Publication type
Journal Article
Publication details
Tropical Medicine and International Health 10 8 pp 799-811
Publication status
Published
Language
English
Keywords
health financing; community health insurance; developing countries
Abstract
The authors studied the potential of community-based health insurance (CHI) to contribute to the performance of health financing systems. The international empirical evidence is analysed on the basis of the three health financing subfunctions as outlined in the World Health Report 2000: revenue collection, pooling of resources and purchasing of services. The evidence indicates that achievements of CHI in each of these subfunctions so far have been modest, although many CHI schemes still are relatively young and would need more time to develop. The authors present an overview of the main factors influencing the performance of CHI on these financing subfunctions and discuss a set of proposals to increase CHI performance. The proposals pertain to the demand for and the supply of health care in the community; to the technical, managerial and institutional set-up of CHI; and to the rational use of subsidies.
Country
Publisher
Tropical Medicine and International Health
Theme area
Human resources for health, Governance and participation in health
Title of publication Hearing Community Voices: Grassroots Perceptions of an Intervention to Support Health Volunteers in South Africa
Date of publication
2008 December
Publication type
Journal Article
Publication details
Journal of Social Aspects of HIV/AIDS 5 4 pp 162-177
Publication status
Published
Language
English
Keywords
primary care; health committees; health workers; participation; South Africa
Abstract
With the scarcity of African health professionals, volunteers are earmarked for an increased role in HIV/AIDS management, with a growing number of projects relying on grassroots community members to provide home nursing care to those with AIDS - as part of the wider task-shifting agenda. Yet little is known about how best to facilitate such involvement. This paper reports on community perceptions of a 3-year project which sought to train and support volunteer health workers in a rural community in South Africa. Given the growing emphasis on involving community voices in project research, the authors conducted 17 discussions with 34 community members, including those involved and uninvolved in project activities - at the end of this 3-year period. These discussions aimed to elicit local people's perceptions of the project, its strengths and its weaknesses. Community members perceived the project to have made various forms of positive progress in empowering volunteers to run a more effective home nursing service. However, discussions suggested that it was unlikely that these efforts would be sustainable in the long term, due to lack of support for volunteers both within and outside of the community. The authors conclude that those seeking to increase the role and capacity of community volunteers in AIDS care need to make substantial efforts to ensure that appropriate support structures are in place. Chief among these are: sustainable stipends for volunteers; commitment from community leaders and volunteer team leaders to democratic ideals of project management; and substantial support from external agencies in the health, welfare and NGO sectors.
Country
Publisher
Journal of Social Aspects of HIV/AIDS
Theme area
Equitable health services, Governance and participation in health
Title of publication RMCH Situational Analysis: Baseline Report Strengthening Public Accountability Mechanisms to Improve Maternal and Child Health Services
Date of publication
2013 November
Publication type
Report
Publication details
Black Sash / / pp /-/
Publication status
Published
Language
English
Keywords
primary care; health committees; participation; South Africa
Abstract
The Black Sash is participating in an RMCH (Reproductive Maternal and Child Health) project that aims to improve access to and quality of care for maternal and child health (MCH) services through creating demand and strengthening the accountability mechanisms at a local level. The proposed intervention aims to build on the existing work of Black Sash, specifically through our Community Monitoring and Advocacy Project (CMAP). The intervention will focus on the potential of different public accountability mechanisms to foster multi-stakeholder dialogue, and will thus work with both: Public accountability mechanisms governed by the National Health Act – i.e. Clinic and Community Health Centre Committees. Alternative accountability mechanisms which are operating within sub-districts – both formal mechanisms (ward committees, NGOs/CBOs, SGBs, War Rooms, Imbizos etc) and informal mechanisms (community monitoring practices, women’s forums, stakeholder coalitions, community score cards, etc)
Country
Publisher
Black Sash
Theme area
Resource allocation and health financing
Title of publication Results Based financing at the World Bank, Democratic Republic of Congo
Date of publication
2013
Publication type
Report
Publication details
/ / / pp /-/
Publication status
Published
Language
English
Keywords
Millennium Development Goals; Results based financing; DRC
Abstract
Health-related MDGs in Democratic Republic of Congo (DRC) are very poor. Under-five mortality (2002-06) was 148 per 1,000 live births, the prevalence of chronic malnutrition among children under five is 45% and maternal mortality in 2001 was 1,289 per 100,000 live births. Administrative capacity is low. Not all health workers are salaried, salaries are often paid irregularly and health workers rely on user fees for a significant proportion of their remuneration. In many poor and rural areas, there are shortages of skilled workers. International support for the development of the health system, building on government experience with partnerships with church groups and other non-governmental organizations, is often channeled through contracts with NGOs. The health sector component (USD 60 million) of a multi-sectoral emergency project (2002-09) contracted NGOs to provide support to government and confessional health services in target areas. Similarly, the HSRSP (2005-11) contracts NGOs to provide technical assistance, training, and inputs in order to improve delivery of the government’s basic package of services which is designed to address the major causes of morbidity and mortality. The results based financing (RBF) component is in line with the overall Project Development Objective (PDO): to ensure that the target population of selected health zones has access to, and utilizes, a well-defined package of quality essential health services. This fact sheet discusses the Health Sector Rehabilitation Support project (HSRSP) conducted between 2006 and 2011.
Country
Publisher
World Bank
Theme area
Equitable health services, Governance and participation in health
Title of publication Developing an understanding of the factors related to the effective functioning of community health committees in Nelson Mandela Bay municipality
Date of publication
2007 November
Publication type
Academic paper
Publication details
/ / / pp /-/
Publication status
Published
Language
English
Keywords
primary care; health committees; South Africa
Abstract
As part of South Africa’s commitment to comprehensive primary health care, it has recognised that formal structures for community participation are an essential component of the health system. In terms of the operationalisation of this approach, Community Health Committees or Clinic Committees, outlined as statutory bodies in the National Health Act, 61 of 2003, serve to facilitate such participation. Given the policy framework, Community Health Committees ought to be supported by the Department of Health to become effective structures for community participation. However, those that exist within Nelson Mandela Bay Municipality, within the Eastern Cape Province, South Africa are perceived by the Municipal Health Directorate not to be functioning effectively. This research aimed to investigate the factors related to the functioning of Community Health Committees in Nelson Mandela Bay Municipality. It intended to elicit information on factors which promote and inhibit their effective functioning. It used the qualitative research methods of focus group discussions, conducted with a sample of Community Health Committee members, and in-depth, individual interviews with key informants. The contents of the transcriptions of all focus group discussions and in-depth individual interviews were analysed so as to identify the recurring themes and key suggestions made by respondents. The findings indicated that Community Health Committees are not functioning as per their original intention and that the relevant policies have not been accurately translated into practice. Their membership composition was found to be a major contributory factor inhibiting their effective functioning. Community Health Committees appear mostly to be composed of health volunteers who are in receipt of a stipend, and serve as an extension of the services of the health facilities. There was little evidence of the membership composition including local government councillors and health facility staff participation as required by legislation. The study highlighted other inhibiting factors which could broadly be categorised as a lack of institutional arrangements, co-ordination and support for Community Health Committees; an absence of operational guidelines; and a lack of resources for their effective functioning. It was also found that the current context within which these committees operate was considered to limit effective functioning. In relation to the context, two conditions were identified to be of particular importance: the poor socio- economic conditions within Nelson Mandela Bay Municipality; and secondly, a perceived change in the political terrain, which is considered not to sufficiently encourage and support community volunteerism. These factors collectively contribute towards the regularly reported perception of Community Health Committee members that they are not being afforded recognition for the contribution they make. Recommendations have been made at the end of the study. It is hoped that these will assist the Eastern Cape Department of Health to provide future support for Community Health Committees, both in Nelson Mandela Bay Municipality and in other parts of the Eastern Cape Province.
Country
Publisher
University of the Western Cape
Theme area
Governance and participation in health
Title of publication A Ladder Of Citizen Participation
Date of publication
2007 November
Publication type
Journal Article
Publication details
Journal of the American Institute of Planners 35 4 pp 216-224
Publication status
Published
Language
English
Keywords
primary care; health committees; Kenya
Abstract
This is the fourth of a series of ‘policy briefs’ produced by the Community Health Department of the Aga Khan Health Service in Kenya. It focuses on a number of issues related to the management of health facilities: the rational for decentralisation of health services, the role of the community in the management of health facilities, the membership of local management committees, selection criteria – and, finally, the involvement of local politicians. The brief is based on the experience of a pilot project in the Kwale District on the coast of Kenya that had as its key objective the strengthening of the dispensary health committees (DHCs) set up to share in the management of the local dispensaries. This was a project of Aga Khan Health Service in close collaboration with the Kenya Ministry of Health. These briefs are primarily intended for directors and managers of community-based health care programmes – whether working within ministries of health, international donor agencies or non-government organisations. For these people, at a time when there is an increasing interest in the decentralisation of health services, this fourth brief takes up three main questions: What is the rationale for public participation in health facility management? What should be the extent of a facility management committee’s authority? What relationship should the committee have with local government – and should local politicians have membership?
Country
Publisher
Journal of the American Institute of Planners
Theme area
Governance and participation in health
Title of publication Community Health Department, Policy Brief No.4 Health Facility Committees: The Governance Issue Best Practices in Community-Based Health Initiatives
Date of publication
Publication type
Report
Publication details
Aga Khan Health Service / / pp /-/
Publication status
Published
Language
English
Keywords
primary care; health committees; Kenya
Abstract
This is the fourth of a series of ‘policy briefs’ produced by the Community Health Department of the Aga Khan Health Service in Kenya. It focuses on a number of issues related to the management of health facilities: the rational for decentralisation of health services, the role of the community in the management of health facilities, the membership of local management committees, selection criteria – and, finally, the involvement of local politicians. The brief is based on the experience of a pilot project in the Kwale District on the coast of Kenya that had as its key objective the strengthening of the dispensary health committees (DHCs) set up to share in the management of the local dispensaries. This was a project of Aga Khan Health Service in close collaboration with the Kenya Ministry of Health. These briefs are primarily intended for directors and managers of community-based health care programmes – whether working within ministries of health, international donor agencies or non-government organisations. For these people, at a time when there is an increasing interest in the decentralisation of health services, this fourth brief takes up three main questions: What is the rationale for public participation in health facility management? What should be the extent of a facility management committee’s authority? What relationship should the committee have with local government – and should local politicians have membership?
Country
Publisher
Aga Khan Health Service
Theme area
Equity in health, Human resources for health
Title of publication Policy Brief No. 2 Preparing Nurses for Facility Management
Date of publication
Publication type
Publication details
Aga Khan Health Service / / pp /-/
Publication status
Published
Language
English
Keywords
primary care; health workers; Kenya
Abstract
In 1997 and in the Coast Province of Kenya the Aga Khan Health Services, working in close collaboration with the Kenya Ministry of Health, began the Kwale Health Systems Strengthening Project (KHSSP), which aims to improve the quality of health care at the dispensary level. One of the main concerns of the project has been to build the capacity of the committees of community representatives who now have a strong role in the management of the dispensaries This second of a series of ‘policy briefs’ focuses on a related, and most significant, issue – the changing role of the dispensary nurse as the committee members become more empowered. These briefs are primarily intended for directors and managers of community-based health care programmes – whether working within ministries of health, international donor agencies or non-government organisations. For such people this second brief takes up a number of likely questions about the management functions of the nurses in charge of small, local health facilities: How prepared are ‘nurses in charge’ for carrying out administrative and management functions?How should they relate to the new management committees? What additional training do they need?What are the lessons from the Kwale project – lessons about the training of nurses – that can be applied elsewhere?
Country
Publisher
Aga Khan Health Service
Theme area
Equitable health services, Governance and participation in health
Title of publication A Scorecard for Managing Functionality of Community units
Date of publication
2012
Publication type
Report
Publication details
AMREF / / pp /-/
Publication status
Published
Language
English
Keywords
primary care; health committees; Kenya
Abstract
The draft Health Sector Strategic Plan 2012-2017 aims to increase national coverage of community units by establishing 8000 functional Community Units (CUs). AMREF through the FHI360 led APHIAplus Nuru ya Bonde Project is scaling up implementation of the Community Strategy in Rift Valley Province by establishing new units and strengthening existing community units. The APHIAplus Nuru ya Bonde project is funded by USAID. In early 2012, the project encountered challenges in tracking and managing functionality of the large number of community units (more than 100) that it was supporting. This is a common challenge because in many areas of the country, community units have been established, but without a common standard for moving them towards functionality. As a result, the project team (in consultation with the local DHMT, PHMT and USAID) identified fundamental ingredients necessary to attain basic functionality of community units and used these to develop a Functionality Scorecard. The Functionality Scorecard has proven to be a valuable management tool in managing performance, resource allocation, and decision making by the APHIAplus Nuru ya Bonde project team when managing a large number of community units.
Country
Publisher
AMREF; MOH Kenya; APHIAplus; FHI360; USAID
Theme area
Equitable health services, Governance and participation in health
Title of publication Discussion paper 101: Health centre committees as a vehicle for social participation in health systems in east and southern Africa
Date of publication
2014 May
Publication type
Document
Publication details
EQUINET discussion paper 101, TARSC with CWGH and Medico, EQUINET: Harare.
Publication status
Published
Language
Keywords
Health centre committees; primary care; participation; east and southern Africa
Abstract
Health Centre Committees (HCCs) have provided one vehicle for social participation and accountability in health systems in east and southern Africa (ESA). Recognising this contribution and building on prior work on HCCs, EQUINET held a regional meeting involving those working with HCCs in ESA countries to exchange experiences and information on the laws, roles, capacities, training and monitoring systems that are being applied to HCCs in the ESA region. The meeting gathered 20 delegates representing seven countries from the region, all involved in training and strengthening HCCs. An interim desk review of existing published literature on HCCs was prepared for the meeting. The desk review covered all 16 ESA countries covered by EQUINET, that is Angola, Botswana, Democratic Republic of Congo (DRC), Kenya, Lesotho, Madagascar, Malawi, Mauritius, Mozambique, Namibia, South Africa, Swaziland, Tanzania, Uganda, Zambia and Zimbabwe. Delegates validated and added to the evidence presented. This discussion paper combines the evidence from the desk review and the further evidence that was presented at the regional meeting. It covers the legal frameworks, roles, composition, capacities and monitoring of HCCs in ESA countries.
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Discussion paper
Theme area
Equitable health services, Governance and participation in health
Title of publication Strengthening health centre committees as a vehicle for social participation in health in east and southern Africa: Regional Meeting Report, Harare, Zimbabwe 30 January - 1 February 2014
Date of publication
2014 March
Publication type
Report
Publication details
EQUINET: TARSC, CWGH, Medico Int (2014) Strengthening health centre committees as a vehicle for social participation in health in east and southern Africa: Regional Meeting Report, Harare, Zimbabwe 30 January - 1 February 2014: EQUINET Harare
Publication status
Published
Language
Keywords
health centre committees; participation; east and southern Africa
Abstract
EQUINET convened this Regional meeting on Health Centre Committees in East and Southern Africa to:
i. Provide a forum for exchange of experience and learning between partners doing work on training and strengthening HCCs in countries in the ESA region;
ii. Exchange and review information on the legal frameworks, capacities, training materials, and monitoring systems used in capacity building of HCCs, identify and discuss ways of advancing and documenting good practice in these aspects of HCCs; and iii. Develop a shared monitoring framework for assessment of the capacity, functioning and impact of HCCs, to apply to settings where HCCs are operating, and to discuss options for on-going exchange and documentation on the learning across settings. The meeting gathered 20 delegates representing seven countries from east and southern Africa, all of whom are involved in training and strengthening HCCs. The report provides the proceedings of the workshop.
Country
East and southern Africa region
Publisher
Equinet Publication Type
Reports
Theme area
Resource allocation and health financing, Monitoring equity and research to policy
Title of publication Performance-based financing as a health system reform: mapping the key dimensions for monitoring and evaluation
Date of publication
2013 September
Publication type
Journal Article
Publication details
BMC Health Services Research 13 367 pp 1-10
Publication status
Published
Language
English
Keywords
performance based financing; monitoring; global; health system;
Abstract
This paper aims to develop a framework for assessing the interactions between PBF and health systems, focusing on low and middle income countries. In doing so, it elaborates a general framework for monitoring and evaluating health system reforms in general. This paper is based on an exploratory literature review and on the work of a group of academics and PBF practitioners. The paper lays out a broad framework within which indicators can be prioritised for monitoring and evaluation of PBF or other health system reforms. It highlights the dynamic linkages between the domains and the different pillars. All of these are also framed within inter-sectoral and wider societal contexts. It highlights the importance of differentiating short term and long term effects, and also effects (intended and unintended) at different levels of the health system, and for different sectors and areas of the country. Outstanding work will include using and refining the framework and agreeing on the most important hypotheses to test using it, in relation to PBF but also other purchasing and provider payment reforms, as well as appropriate research methods to use for this task.
Country
Publisher
BMC Health Services Research
Theme area
Equitable health services, Resource allocation and health financing
Title of publication The simultaneous introduction of the district health system and performance-based funding: the Burundi experience
Date of publication
2013 February
Publication type
Journal Article
Publication details
The Journal of Field Actions Special Issue 8 / pp 1-7
Publication status
Published
Language
English
Keywords
performance based financing; district health system; Burundi
Abstract
Burundi recently introduced two fundamental reforms to its health system: a district health system (DHS) and performance-based financing (PBF) of the healthcare facilities. The authors of this article set out the salient points of a trial simultaneous implementation of DHS and PBF. The assessment refers to the six building blocks of health systems proposed by the WHO, and demonstrates that PBF can either have a leverage effect or hinder the following functional elements of the DHS: the group dynamics of the District Health Management Team (DHMT), the way the district hospital functions in relation to the primary health care level , the curative and preventive health services provided by health centers to provide health cover for a target population, the provision of essential medication by a fully-functional district pharmacy, the action-focused on the health management information system (HMIS) and funding that ensures fair provision and guaranteed resupply, supported by a transparent organization. The authors recommend that these aspects receive the attention they deserve as part of initiatives that combine both reforms, especially in the start-up stage. The health system regulator – the Ministry of Health – must remain vigilant to make any necessary adjustments and to avoid negative consequences.
Country
Publisher
The Journal of Field Actions
Theme area
Resource allocation and health financing, Governance and participation in health
Title of publication Exploring the potential for using results-based financing to address non-communicable diseases in low- and middle-income countries
Date of publication
2013 February
Publication type
Journal Article
Publication details
BMC Public Health 13 92 pp 1-9
Publication status
Published
Language
English
Keywords
performance based financing; low income countries; non communicable diseases
Abstract
Results-based financing (RBF) has been proposed as a strategy to increase aid effectiveness and efficiency through incentives for positive performance and results in health programs, but its potential for addressing NCDs has not been explored. Qualitative methods including literature review and key informant interviews were used to identify promising RBF mechanisms for addressing NCDs in resource-limited settings. Eight key informants identified by area of expertise participated in semi-structured interviews. The majority of RBF schemes to date have been applied to maternal and child health. Evidence from existing RBF programs suggests that RBF principles can be applied to health programs for NCDs. The authors suggest that RBF mechanisms should be tested for use in NCD programs through pilot programs incorporating robust impact evaluations.
Country
Publisher
BMC Public Health
Theme area
Health equity in economic and trade policies, Governance and participation in health
Title of publication Global health diplomacy: advancing foreign policy and global health interests
Date of publication
2013 March
Publication type
Journal Article
Publication details
Global Health: Science and Practice 1 1 pp 24-28
Publication status
Published
Language
English
Keywords
global; research; health diplomacy
Abstract
Attention to global health diplomacy has been rising but the future holds challenges, including a difficult budgetary environment. Going forward, both global health and foreign policy practitioners would benefit from working more closely together to achieve greater mutual understanding and to advance respective mutual goals. Recently, there has been a remarkable surge of interest in the topic of “global health diplomacy” (GHD). Official GHD offices have been established at the World Health Organization (WHO) and at the U.S. Department of State, and offices within governments of many countries now have a broad set of new GHD responsibilities. Academics have begun to publish articles on the subject in greater numbers; more than 70% of all peer-reviewed journal articles on GHD since 1970 were published in the last decade, according to a recent analysis. While international engagement on health issues has a history that extends back to at least the 19th century, the renewed emphasis is notable. What is driving this interest in—and support for—GHD, and what might it imply for the current and future practice of global health?
Country
Publisher
Global Health: Science and Practice
Theme area
Health equity in economic and trade policies, Governance and participation in health
Title of publication Medical R&D Convention Derailed: Implications for the Global Health System.
Date of publication
2013 July
Publication type
Journal Article
Publication details
Journal of Health Diplomacy 1 1 pp /-/
Publication status
Published
Language
English
Keywords
access to medicines; global; research and development; health diplomacy
Abstract
The authors argue that potentially game-changing proposals to improve access to medicines have been stalled by the member states of the World Health Organization. In April 2012, the WHO Consultative Expert Working Group on Research and Development (CEWG) concluded that one way to address market failures in medical research and development (R&D) for diseases affecting the poorest populations was to negotiate a Medical R&D Convention. This could lead to sustainable change within financing, monitoring and coordination of R&D rather than just trying to mend the existing system. To the disappointment of some states and many civil society actors, a recent meeting of the WHO suspended the negotiations. While some consider the global economic climate unable to support a convention that would require significant time and funding, the authors demonstrate that the current global health system has failed once more to address one of the most pressing global health challenges of our time. In this commentary, the authors aim to show how thwarted attempts to develop an R&D convention have spurred a call for fresh debate on the viability of the very foundations of the current global health system.
Country
Publisher
Journal of Health Diplomacy
Theme area
Health equity in economic and trade policies, Governance and participation in health
Title of publication Is Health Diplomacy Keeping Pace with Global Health Developments? Implications for Access to Medicines Strategies in the Post-2015 MDG Framework
Date of publication
2013 July
Publication type
Journal Article
Publication details
Journal of Health Diplomacy 1 1 pp /-/
Publication status
Published
Language
English
Keywords
Millennium Development Goals; medicines; diplomacy
Abstract
As the 2015 deadline to achieve the Millennium Development Goals (MDGs) draws near, efforts to ensure access to essential medicines face new challenges in light of new re- source constraints. To help assess those challenges, a summary analysis of published data was undertaken to examine the increasing discontinuity between the geographic focus of donor-country programs on low-income countries (LICs) and the geographic location of the increasing majority of the poor and the global burden of preventable disease within middle-income countries (MICs). This disconnect has put new pressure on both donor and government resources for essential medicines, prompting greater consideration of strate- gies through which global health investments can leverage market resources to achieve global health goals and benefit the poor in both LICs and MICs. To help assess the policy environment for strategy change, country-level health workers from low and middle-income countries with high burdens of disease who participated in the International AIDS Conference (AIDS 2012) in Washington, DC, were surveyed to examine their views of the respective responsibilities of various institutions to finance access to essential medicines in their countries. The survey finding of a limited understanding of the roles and reach of different global health institutions is raised as an impediment to improving access-to-medicines strategies because it likely constrains the ability of country level stakeholders to engage in the global health strategy dialogue.
Country
Publisher
Journal of Health Diplomacy
Theme area
Health equity in economic and trade policies, Governance and participation in health
Title of publication Using the Right to Health to Enforce the Corporate Responsibilities of Pharmaceutical Companies with Regard to Access to Medicines
Date of publication
2013 August
Publication type
Journal Article
Publication details
Journal of Health Diplomacy 1 1 pp /-/
Publication status
Published
Language
English
Keywords
access to medicines; South Africa; courts; right to health
Abstract
This paper seeks to determine how the corporate responsibilities of pharmaceutical companies in relation to access to medicines can be clarified and enforced. Two cases, one each from India and South Africa, are examined to determine how the domestic courts in both countries indirectly utilized the right to health to ensure that pharmaceutical companies did not impede access to affordable medicines through exercising their patent rights. There is a need to clarify and enforce the responsibilities pharmaceutical companies have to promote the right to health. The two cases from India and South Africa demonstrate the potentials of domestic courts as forums where these responsibilities can be effectively enforced. In the absence of a global enforcement mechanism for enforcing the right-to-health responsibilities of pharmaceutical companies, domestic courts can effectively fill this gap. In addition, this paper demonstrates that domestic courts can equally serve as forums for health diplomacy.
Country
Publisher
Journal of Health Diplomacy
Theme area
Health equity in economic and trade policies, Governance and participation in health
Title of publication ‘BRICS without straw’? A systematic literature review of newly emerging economies’ influence in global health
Date of publication
2013 April
Publication type
Journal Article
Publication details
Globalization and Health 9 15 pp /-/
Publication status
Published
Language
English
Keywords
BRICS, global health; health diplomacy
Abstract
What influence, if any, do the BRICS wield in global health, and, if they do wield influence, how has that influence been conceptualized and recorded in the literature? The authors conducted a systematic literature review in (March-December 2012) of documents retrieved from the databases EMBASE, PubMed/Medline, Global Health, and Google Scholar, and the websites of relevant international organisations, research institutions and philanthropic organisations. The results were synthesised using a framework of influence developed for the review from the political science literature. Two researchers using an agreed set of inclusion criteria independently screened the 94 documents found leaving just 7 documents. The authors found just one document that provided sustained analysis of the BRICS’ collective influence; the overwhelming tendency was to describe individual BRICS countries influence. Although influence was predominantly framed by BRICS countries’ material capability, there were examples of institutional and ideational influence - particularly from Brazil. Individual BRICS countries were primarily ‘opportunity seekers’ and region mobilisers but with potential to become ‘issue leaders’ and region organisers. Though small in number, the written output on BRICS influence in global health has increased significantly since a similar review conducted in 2010 found just one study. Whilst it may still be ‘early days’ for newly-emerging economies influence in global health to have matured, the authors argue that there is scope to further develop the concept of influence in global health, but also to better understand the ontology of groups of countries such as BRICS.
Country
Publisher
Globalization and Health
Theme area
Health equity in economic and trade policies, Governance and participation in health
Title of publication Improving Access to Innovative Medicines in Emerging Markets: Evidence and Diplomacy as Alternatives to the Unsustainable Status Quo
Date of publication
2013 August
Publication type
Journal Article
Publication details
Journal of Health Diplomacy 1 1 pp 1-19
Publication status
Published
Language
English
Keywords
health technology assessmemt; health diplomacy; global
Abstract
This work is a review of public sources including white papers, news and peer-reviewed literature with a focus on mainstream approaches used by the pharmaceutical industry (such as unaffordable price premiums for innovative medicines) and governments (such as denial of intellectual property rights) to support their interests. The authors also explore the implications of possible approaches on pharmaceutical policy in the context of global health diplomacy. The latter is a requirement for universal health coverage given the increasing power of state and non-state actors in emerging markets. The authors conclude that evidence and due processes, through inclusive and transparent priority-setting mechanisms, offer a reconciliatory way forward for both parties. Value-based pricing, underpinned by Health Technology Assessment (HTA), could leverage global health diplomacy to set priorities and resolve the perhaps unsustainable status quo. HTA is itself a diplomatic, consensus building and evidence-based approach that can help diffuse the current tension, enhance mutual understanding and perhaps help strengthen (or even mend) the current model of product development. Value-based pricing and HTA offer a potential priority setting mechanism that can serve as a transparent, non-adversarial platform for governments and the pharmaceutical industry to engage with each other and work towards enhancing access to medicines. Further quantitative research, exploring the impact of different policy-setting approaches by governments on medicine access using HTA, would strengthen this discourse.
Country
Publisher
Journal of Health Diplomacy
Theme area
Human resources for health, Governance and participation in health
Title of publication Health Workforce Brain Drain: From Denouncing the Challenge to Solving the Problem
Date of publication
2013 September
Publication type
Journal Article
Publication details
PLOS Medicine 10 9 pp 1-3
Publication status
Published
Language
English
Keywords
health workers; migration; low income countries; global
Abstract
Migration of health workers from low- and middle-income countries (LMICs) to high-income countries is one of the most controversial aspects of globalization, having attracted considerable attention in the health policy discourse at both the technical and political level. Some countries train health workers to export them overseas and reap the financial benefits of remittances; such investments should therefore be considered as driven primarily by economic—rather than population health—motives. In most cases, however, migration of health professionals is unplanned for and represents a “brain drain” for source countries, a result of enormous wage differences and poor working conditions, including lack of support, adequate infrastructure, and career development opportunities, in LMICs. The paper presents the policy options for both low income and OECD countries for addressing health worker migration.
Country
Publisher
PLOS Medicine
Theme area
Equitable health services, Governance and participation in health
Title of publication Training Workshop on Participatory methods for a people centred health system, 7-10 October 2013
Date of publication
2013 December
Publication type
Report
Publication details
Publication status
Published
Language
Keywords
primary health care; Participatory Reflection and Action; East and southern Africa
Abstract
In 2013 TARSC through COPASAH and EQUINET held a regional workshop on Participatory Approaches to Strengthening People-Centred Health Systems in the east and southern Africa (ESA) region. The training brought together 28 delegates from 7 countries in east and southern Africa to discuss and deepen understanding on ways to strengthen primary health care through improved public involvement and health service accountability.
The training came about because of a joint interest within all three lead organisations to explore how Participatory Reflection and Action (PRA) approaches could be used to raise community voice in strengthening the functioning and resourcing of primary health care (PHC) systems in the region.
Country
East and southern Africa region
Publisher
Equinet Publication Type
Reports
Theme area
Health equity in economic and trade policies, Governance and participation in health
Title of publication Brazil-Africa technical cooperation in health: what’s its relevance to the post-Busan debate on ‘aid effectiveness’?
Date of publication
2013
Publication type
Journal Article
Publication details
Globalization and Health 9 2 pp /-/
Publication status
Published
Language
English
Keywords
Brazil; development co-operation; diplomacy; Africa
Abstract
Brazil is rapidly becoming an influential player in development cooperation, also thanks to its high-visibility health projects in Africa and Latin America. The 4th High-level Forum on Aid Effectiveness held in Busan in late 2011 marked a change in the way development cooperation is conceptualised. The present paper explores the issue of emerging donors’ contribution to the post-Busan debate on aid effectiveness by looking at Brazil’s health cooperation projects in Portuguese-speaking Africa. The authors first consider Brazil’s health technical cooperation within the country’s wider cooperation programme, aiming to identify its key characteristics, claimed principles and values, and analysing how these translate into concrete projects in Portuguese-speaking African countries. Then study discuss the extent to which the Busan conference has changed the way development cooperation is conceptualised, and how Brazil’s technical cooperation health projects fit within the new framework. The authors conclude that, by adopting new concepts on health cooperation and challenging established paradigms - in particular on health systems and HIV/AIDS fight - the Brazilian health experience has already contributed to shape the emerging consensus on development effectiveness. However, its impact on the field is still largely unscrutinised, and its projects seem to only selectively comply with some of the shared principles agreed upon in Busan. Although Brazilian cooperation is still a model in the making, not immune from contradictions and shortcomings, it should be seen as enriching the debate on development principles, thus offering alternative solutions to advance the discourse on cooperation effectiveness in health.
Country
Publisher
Globalization and Health
Theme area
Health equity in economic and trade policies, Governance and participation in health
Title of publication Global governance and diplomacy solutions for counterfeit medicines.
Date of publication
2013 August
Publication type
Journal Article
Publication details
Journal of Health Diplomacy 1 1 pp 1-21
Publication status
Published
Language
English
Keywords
counterfeit medicines; diplomacy; governance; global
Abstract
This paper presents a comprehensive mapping of governance efforts by international organizations to address counterfeit medicines, including analysis of related international treaties and conventions that may be applicable to anticounterfeit efforts. The paper reviews governance and global health diplomacy proposals from the literature that addresses counterfeit medicines. A number of international organizations have become active in addressing the global trade of counterfeit medicines. However, governance approaches by international organizations, including the World Health Organization (WHO), the United Nations Office on Drugs and Crime (UNODC), Interpol and the World Customs Organization (WCO), have varied in scope and effectiveness. The authors argue that treaty instruments with applicability to counterfeit medicines have not been fully leveraged to combat this issue and argue that a formalized and multi-stakeholder governance mechanism is needed to address the issue, and that the UNODC should convene it.
Country
Publisher
Journal of Health Diplomacy
Theme area
Human resources for health, Governance and participation in health
Title of publication Monitoring the implementation of the WHO Global Code of Practice on the International Recruitment of Health Personnel
Date of publication
2013
Publication type
Journal Article
Publication details
Bulletin of the World Health Organisation 91 / pp 816-823
Publication status
Published
Language
English
Keywords
health workers; code; effectiveness; international
Abstract
To present the findings of the first round of monitoring of the global implementation of the WHO Global Code of Practice on the International Recruitment of Health Personnel (“the Code”), a voluntary code adopted in 2010 by all 193 Member States of the World Health Organization (WHO). WHO requested that its Member States designate a national authority for facilitating information exchange on health personnel migration and the implementation of the Code. Each designated authority was then sent a cross-sectional survey with 15 questions on a range of topics pertaining to the 10 articles included in the Code. A national authority was designated by 85 countries. Only 56 countries reported on the status of Code implementation. Of these, 37 had taken steps towards implementing the Code, primarily by engaging relevant stakeholders. In 90% of countries, migrant health professionals reportedly enjoy the same legal rights and responsibilities as domestically trained health personnel. In the context of the Code, cooperation in the area of health workforce development goes beyond migration-related issues. An international comparative information base on health workforce mobility is needed but can only be developed through a collaborative, multi-partnered approach. Reporting on the implementation of the Code has been suboptimal in all but one WHO region. Greater collaboration among state and non-state actors is needed to raise awareness of the Code and reinforce its relevance as a potent framework for policy dialogue on ways to address the health workforce crisis.
Country
Publisher
Bulletin of the World Health Organisation
Theme area
Human resources for health, Governance and participation in health
Title of publication Restructuring brain drain: strengthening governance and financing for health worker migration
Date of publication
2013 January
Publication type
Journal Article
Publication details
Global Health Action 6 19923 pp /-/
Publication status
Published
Language
English
Keywords
health workers; migration; policy; economic costs; global
Abstract
Health worker migration from resource-poor countries to developed countries, also known as ‘‘brain drain’’, represents a serious global health crisis and a significant barrier to achieving global health equity. Resource-poor countries are unable to recruit and retain health workers for domestic health systems, resulting in inadequate health infrastructure and millions of dollars in healthcare investment losses. Using acceptable methods of policy analysis, the authors first assess current strategies aimed at alleviating brain drain and then propose our own global health policy based solution to address current policy limitations. Although governments and private organizations have tried to address this policy challenge, brain drain continues to destabilise public health systems and their populations globally. Most importantly, lack of adequate financing and binding governance solutions continue to fail to prevent health worker brain drain. In response to these challenges, the establishment of a Global Health Resource Fund in conjunction with an international framework for health worker migration could create global governance for stable funding mechanisms encourage equitable migration pathways, and provide data collection that is desperately needed.
Country
Publisher
Global Health Action
Theme area
Human resources for health, Governance and participation in health
Title of publication Recruitment and Retention of Mental Health Workers in Ghana
Date of publication
2013 February
Publication type
Journal Article
Publication details
PLOS One 8 2 pp 1-8
Publication status
Published
Language
English
Keywords
health workers; migration; mental health; Ghana
Abstract
The lack of trained mental health workers is a primary contributor to the mental health treatment gap worldwide. Despite the great need to recruit and retain mental health workers in low-income countries, little is known about how these workers perceive their jobs and what drives them to work in mental health care. Using qualitative interviews, the authors aimed to explore factors motivating mental health workers in order to inform interventions to increase recruitment and retention. The authors conducted 28 in-depth, open-ended interviews with staff in Ghana’s three public psychiatric hospitals and used the snowballing method to recruit participants and the constant comparative method for qualitative data analysis, with multiple members of the research team participating in data coding to enhance the validity and reliability of the analysis. The use of qualitative methods allowed the authors to understand the range and depth of motivating and demotivating factors. Respondents described many factors that influenced their choice to enter and remain in mental health care. Motivating factors included 1) desire to help patients who are vulnerable and in need, 2) positive day-to-day interactions with patients, 3) intellectual or academic interest in psychiatry or behavior, and 4) good relationships with colleagues. Demotivating factors included 1) lack of resources at the hospital, 2) a rigid supervisory hierarchy, 3) lack of positive or negative feedback on work performance, and 4) few opportunities for career advancement within mental health. Because many of the factors are related to relationships, these findings suggest that strengthening the interpersonal and team dynamics may be a critical and relatively low cost way to increase worker motivation. The data also allowed the authors to highlight key areas for resource allocation to improve both recruitment and retention, including risk pay, adequate tools for patient care, improved hospital work environment, and stigma reduction efforts.
Country
Publisher
PLOS One
Theme area
Human resources for health, Governance and participation in health
Title of publication Empirical impact evaluation of the WHO global code of practice on the international recruitment of health personnel in Australia, Canada, UK and USA
Date of publication
2013 November
Publication type
Journal Article
Publication details
Globalization and Health 9 60 pp /-/
Publication status
Published
Language
English
Keywords
health workers; code; effectiveness; international
Abstract
The active recruitment of health workers from developing countries to developed countries has become a major threat to global health. In an effort to manage this migration, the 63rd World Health Assembly adopted the World Health Organization (WHO) Global Code of Practice on the International Recruitment of Health Personnel in May 2010. While the Code has been lauded as the first globally-applicable regulatory framework for health worker recruitment, its impact has yet to be evaluated. The authors offer the first empirical evaluation of the Code’s impact on national and sub-national actors in Australia, Canada, United Kingdom and United States of America, which are the English-speaking high income countries with the greatest number of migrant health workers. Forty two key informants from across government, civil society and private sectors were surveyed. Sixty percent of respondents believed their colleagues were not aware of the Code, and 93% reported that no specific changes had been observed in their work as a result of the Code. 86% reported that the Code has not had any meaningful impact on policies, practices or regulations in their countries. This suggests a gap between awareness of the Code among stakeholders at global forums and the awareness and behaviour of national and sub-national actors. Advocacy and technical guidance for implementing the Code are needed to improve its impact on national decision- makers.
Country
Publisher
Globalization and Health
Theme area
Human resources for health, Governance and participation in health
Title of publication Migration of Sri Lankan medical specialists
Date of publication
2013
Publication type
Journal Article
Publication details
Human Resources for Health 11 1 pp 1-6
Publication status
Published
Language
English
Keywords
health workers; migration; Sri Lanka
Abstract
The migration of health-care workers contributes to the shortage of health-care workers in many developing countries. This paper aims to describe the migration of medical specialists from Sri Lanka and to discuss the successes and failures of strategies to retain them. This paper presents data on all trainees who have left Sri Lanka for postgraduate training through the Post Graduate Institute of Medicine, University of Colombo, from April 1980 to June 2009. In addition, confidential interviews were conducted with 30 specialists who returned following foreign training within the last 5 years and 5 specialists who opted to migrate to foreign countries. From a total of 1,915 specialists who left Sri Lanka for training, 11% have not returned or have left the country without completing the specified bond period. The majority migrated to Australia. All participants identified foreign training as beneficial for their career. The top reasons for staying in Sri Lanka were: job security, income from private practice, proximity to family and a culturally appropriate environment. The top reasons for migration were: better quality of life, having to work in rural parts of Sri Lanka, career development and social security. This paper attempts to discuss the reasons for the low rates of emigration of specialists from Sri Lanka. Determining the reasons for retaining these specialists may be useful in designing health systems and postgraduate programs in developing countries with high rates of emigration of specialists.
Country
Publisher
Human Resources for Health
Theme area
Human resources for health, Governance and participation in health
Title of publication Stemming the impact of health professional brain drain from Africa: a systemic review of policy options
Date of publication
2013 June
Publication type
Journal Article
Publication details
Journal of Public Health in Africa 4 1 pp /-/
Publication status
Published
Language
English
Keywords
health workers; migration; policies; Africa
Abstract
Africa has been losing professionally trained health workers who are the core of the health system of this continent for many years. Faced with an increased burden of disease and coupled by a massive exodus of the health workforce, the health systems of many African nations are risking complete paralysis. Several studies have suggested policy options to reduce brain drain from Africa. This paper reviewed policies which can stem the impact of health professional brain drain from Africa through a systemic literature review. 23 articles met the inclusion criteria. The review identified nine policy options, which were being implemented in Africa, but the most common was task shifting which had success in several African countries.
Country
Publisher
Journal of Public Health in Africa
Theme area
Human resources for health, Governance and participation in health
Title of publication The Labor Market for Health Workers in Africa : New Look at the Crisis
Date of publication
2013 April
Publication type
Journal Article
Publication details
World Bank / / pp /-/
Publication status
Published
Language
English
Keywords
health workers; migration; data; Africa
Abstract
Health systems in Sub-Saharan Africa have changed profoundly over the last 20 years. The economic crisis of the 1980s and 1990s rattled public health care systems, which were largely holdovers from the colonial and postcolonial eras. The later wave of structural adjustments and public sector reforms wrought further change. As African economies opened to market based approaches, the private sector became a sizable source of health care service. This paper presents data from the World Bank's Africa Region Human Resources for Health Program.
Country
Publisher
World Bank
Theme area
Human resources for health, Governance and participation in health
Title of publication Brain Drain: Advocating to Alleviate the Global Health Worker Migration Crisis.
Date of publication
2013 March
Publication type
Document
Publication details
Student Voices 5; McMaster Health Forum / / pp 1-77
Publication status
Published
Language
English
Keywords
health workers; migration; policies; low income countries; global
Abstract
In this paper, the authors evaluate various policy options to address the global health worker migration crisis, which include: financial and technical support from destination countries; bilateral and multilateral agreements between states; creation of self-sufficient healthcare systems; and collection of reliable migration data. Implementation requires the support of key stakeholders such as the World Health Organisation, member states, and other international organisations. However, there are many obstacles to policy change, including the power disparities between source and destination countries, ethical sensitivity of policies, financial incentives, lack of data collection, and limited international cooperation.
Country
Publisher
Student Voices 5; McMaster Health Forum
Theme area
Human resources for health, Governance and participation in health
Title of publication Understanding the factors influencing health-worker employment decisions in South Africa
Date of publication
2013
Publication type
Journal Article
Publication details
Human Resources for Health 11 15 pp 1-7
Publication status
Published
Language
English
Keywords
Health workers; Public sector; Private sector; incentives; South Africa
Abstract
The provision of health care in South Africa has been compromised by the loss of trained health workers (HWs) over the past 20 years. The public-sector workforce is overburdened. There is a large disparity in service levels and workloads between the private and public sectors. There is little knowledge about the nonfinancial factors that influence HWs choice of employer (public, private or nongovernmental organization) or their choice of work location (urban, rural or overseas). This paper aims to fill these gaps in the literature. The study utilized cross-sectional survey data gathered in 2009 in the province of KwaZulu-Natal from three public hospitals, two private hospitals and one nongovernmental organization hospital in urban areas, from professional nurses, staff nurses and nursing assistants. HWs in the public sector reported the poorest working conditions, as indicated by participants’ self-reports on stress, workloads, levels of remuneration, standard of work premises, level of human resources and frequency of in-service training. Health workers in the non state sector expressed a greater desire than those in the public and private sectors to leave their current employer. Innovative efforts are required to address the causes of HWs dissatisfaction and to further identify the nonfinancial factors that influence work choices of HWs. The results highlight the importance of considering a broad range of nonfinancial incentives that encourage HWs to remain in the already overburdened public sector.
Country
Publisher
Human Resources for Health
Theme area
Human resources for health, Governance and participation in health
Title of publication Health Workforce Brain Drain: From Denouncing the Challenge to Solving the Problem
Date of publication
2013 September
Publication type
Journal Article
Publication details
PLOS Medicine 10 9 pp 1-3
Publication status
Published
Language
English
Keywords
health workers; migration; low income countries; global
Abstract
Migration of health workers from low- and middle-income countries (LMICs) to high-income countries is one of the most controversial aspects of globalization, having attracted considerable attention in the health policy discourse at both the technical and political level. Some countries train health workers to export them overseas and reap the financial benefits of remittances; such investments should therefore be considered as driven primarily by economic—rather than population health—motives. In most cases, however, migration of health professionals is unplanned for and represents a “brain drain” for source countries, a result of enormous wage differences and poor working conditions, including lack of support, adequate infrastructure, and career development opportunities, in LMICs. The paper presents the policy options for both low income and OECD countries for addressing health worker migration.
Country
Publisher
PLOS Medicine
Theme area
Human resources for health, Governance and participation in health
Title of publication International codes of medical recruitment: evolution and efficiency
Date of publication
2012
Publication type
Journal Article
Publication details
Romanian Journal of Bioethics 10 1 pp 100-109
Publication status
Published
Language
English
Keywords
codes of practice, health workers, global
Abstract
The international migration of healthcare professionals has increased in the last decade, increasing the medical staff crisis in low income countries. The World Health Organisation adopted in 2010 The Global Code of Practice on the International Recruitment of Health Personnel to use it as a landmark for establishing and improving the necessary legal framework of medical staff international recruitment. This paper highlights analyses the effectiveness of codes on health worker recruitment, and the consequences that might result from disobeying them.
Country
Publisher
Revista Romana de Bioetica
Theme area
Equitable health services, Governance and participation in health
Title of publication Building empowered communities for health:_A film on health literacy and participatory approaches to health in Zambia
Date of publication
2013 October
Publication type
Electronic Source
Publication details
EQUINET Video: TARSC, Lusaka District Health Management Team, Ministry of Health Zambia September 2013
Publication status
Published
Language
Keywords
health literacy; participation; heath services; Zambia
Abstract
Health literacy is one process that empowers people to understand and act on health information to advance their health and improve their health systems. Based on participatory reflection and action approaches, it goes beyond just knowing about health and health care, to acting individually and collectively to advance health. It includes processes that support people driven action and engagement in health systems. Lusaka District Health Team in Zambia has implemented participatory reflection and action work since 2005 to strengthen detection of and action on health problems and their causes, and improve communication between health services and communities, working with TARSC in the pra4equity network in EQUINET. In 2012 the Ministry of Health adopted a proposal to scale up the work in Lusaka to national level. This video describes the origins and development of the work from the lens of the many different actors from communities, health workers and policy level that played a role in it. See at https://vimeo.com/72914294
Country
Zambia
Publisher
Equinet Publication Type
Toolkits and training materials
Theme area
Values, policies and rights, Resource allocation and health financing
Title of publication Discussion paper 100: Laws on management of public and private funds for health in Zimbabwe
Date of publication
2013 October
Publication type
Report
Publication details
Laws on management of public and private funds for health in Zimbabwe’, TARSC, MoHCC, EQUINET Discussion paper 100, EQUINET: Harare.
Publication status
Published
Language
Keywords
public funds; law; Zimbabwe
Abstract
This report provides a legal analysis of the provisions for institutional management of earmarked funds in health, drawing on the laws in Zimbabwe in terms of:
1. The legal definition and current law covering public funds;
2. Obligations in relation to the establishment of funds;
3. The oversight and governance of funds, including the powers, duties and responsibilities of the different parties involved in the control, management, protection and recovery of public funds, in relation to governance of funds and the measures and sanctions related to financial misconduct;
4. The collection, pooling, allocation and expenditure of funds, including duties and responsibilities in relation to collection, receipt, custody, control, issue or expenditure of public money, and in relation to management, audit and obligations of officers managing public funds; and
5. The reporting on funds and measures for transparency and accountability
Country
Zimbabwe
Publisher
Equinet Publication Type
Discussion paper
Theme area
Equitable health services, Public-private mix, Resource allocation and health financing, Governance and participation in health
Title of publication EQUINET Policy Brief 35: Legislation on the for-profit private health sector in East and Southern Africa
Date of publication
2013 October
Publication type
Document
Publication details
Doherty J (2013) Legislation on the for-profit private health sector in East and Southern Africa. EQUINET, with UCT HEU, TARSC. Wemos Foundation Policy brief 35, EQUINET, Harare
Publication status
Published
Language
Keywords
private sector; regulation; east and southern Africa; health financing
Abstract
While the private sector contributes new resources to the health system, international evidence shows that if left unregulated it may distort the quantity, distribution and quality of health services, and lead to anti-competitive behaviour. As the for-profit private sector is expanding in east and southern African (ESA) countries, governments need to strengthen their regulation of the sector to align it to national health system objectives. This policy brief examines how existing laws in the region address the quantity, quality, distribution and price of private health care services, based on evidence made available from desk review and in-country experts. It proposes areas for strengthening the regulation of individual health care practitioners, private facilities and health insurers.
Country
East and southern Africa region
Publisher
EQUINET
URL:
Equinet Publication Type
Policy brief
Theme area
Resource allocation and health financing
Title of publication EQUINET Discussion Paper 99: Legislation on the for-profit private health sector in east and southern Africa
Date of publication
2013 August
Publication type
Document
Publication details
EQUINET Discussion Paper 99, HEU, EQUINET: Harare
Publication status
Published
Language
Keywords
East and Southern Africa; laws; private sector
Abstract
International evidence shows that, if left unregulated, the for-profit health sector may lead to distortions in the quantity, distribution and quality of health services, as well as anti-competitive behaviour. As the for-profit private sector appears to be expanding in east and southern African (ESA) countries, governments need to strengthen regulations to ensure that the for-profit sector does not undermine national health system objectives. This report examines how existing regulation provides for objectives such as the quantity, quality, distribution and price of health care services and suggests priorities for strengthening legal frameworks in 16 countries in east and southern Africa. It draws on a desk-based review of legislation accessed through the internet or from in-country researchers and interviews with in-country experts.
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Discussion paper
Theme area
Health equity in economic and trade policies
Title of publication This Land Is My Land: The Detrimental Effects Of Land Grabs Across Africa
Date of publication
2013 May
Publication type
Academic paper
Publication details
Publication status
Published
Language
English
Keywords
Africa, land, nutrition, human rights,
Abstract
Wealthy states are currently purchasing millions of hectares of land in poor states throughout Africa. This is a problem for many reasons, including increasing rural poverty and driving millions of people off land that they have been farming for generations. These land purchases also have environmental effects and are resulting in food shortages and food insecurity across Africa. In this paper, the author discusses this controversial practice and concludes that these land purchases should be considered land grabs. He focuses on the environmental effects that such land grabs have and also discusses the social effects of these land grabs on the communities in which they are taking place. The author concludes that African states must immediately recognise that these deals have environmental repercussions that harm not only the natural resources, but their citizens as well; and should thus put measures in place to curb the incidences and conclusion of these deals. African governments should instead sell such land to African entities, or at the very least, entities that will be required to keep a portion of all grown food in the host state to feed the populace. They must also reform land tenure and land registration laws to ensure that their citizens are not forced off land that they have farmed for generations. Only when African states control their land can they ensure that their citizens do not go hungry.
Country
Publisher
Consultancy Africa Intelligence
Theme area
Values, policies and rights
Title of publication Equity And Core Concepts Of Human Rights In Namibian Health Policies
Date of publication
2013 February
Publication type
Academic paper
Publication details
Publication status
Published
Language
English
Keywords
http://africa.harvard.edu/apj/equity-and-core-concepts-of-human-rights-in-namibian-health-policies /
Abstract
This paper reports on an analysis of 11 African Union (AU) policy documents to ascertain the frequency and the extent of mention of 13 core concepts in relation to 12 vulnerable groups, with a specific focus on people with disabilities. The researchers applied the EquiFrame analytical framework to the 11 AU policy documents. The 11 documents were analysed in terms of how many times a core concept was mentioned and the extent of information on how the core concept should be addressed at the implementation level. The analysis of regional AU policies highlighted the broad nature of the reference made to vulnerable groups, with a lack of detailed specifications of different needs of different groups. This is confirmed in the highest vulnerable group mention being for ‘universal’. The reading of the documents suggests that vulnerable groups are homogeneous in their needs, which is not the case. There is a lack of recognition of different needs of different vulnerable groups in accessing health care. The authors conclude that the need for more information and knowledge on the needs of all vulnerable groups is evident. The current lack of mention and of any detail on how to address needs of vulnerable groups will significantly impair the access to equitable health care for all.
Country
Publisher
Africa Policy Journal, Harvard University
Theme area
Governance and participation in health, Monitoring equity and research to policy
Title of publication Reviewing Participatory Mapping - What Works And What Doesn't
Date of publication
2009
Publication type
Academic paper
Publication details
Publication status
Published
Language
English
Keywords
participatory research, mapping
Abstract
Participatory mapping, commonly used in participatory development, plays an important role in helping marginalised groups by making visible the association between land and local communities, highlighting important social, historical and cultural knowledge as well as presenting geographical feature information. This review is intended to provide a broad background in the use of participatory mapping processes and the range of tools available to practitioners. It is not exhaustive but aims to give readers a greater appreciaion of how participatory mapping has involved from a relatively simplistic participatory rural appraisal (PRA) tool into a community of practice spanning a range of sophisticated technologies and processes. It draws on a number of examples from around the world, with special attention given to projects supported by the International Fund for Agricultural Development (IFAD), as this organisation commissioned the review. However, it contains useful insights, lessons and pitfalls in both the processes and tools available for participatory mapping.
Country
Publisher
International Fund For Agricultural Development
Theme area
Equitable health services
Title of publication Strengthening Integrated Primary Health Care In Sofala, Mozambique
Date of publication
2012 May
Publication type
Journal Article
Publication details
BMC Health Services Research 13 Suppl 2 pp S4
Publication status
Published
Language
English
Keywords
Mozambique, health system; primary health care
Abstract
The Mozambique Population Health Implementation and Training (PHIT) Partnership focuses on improving the quality of routine data and its use through appropriate tools to facilitate decision making by health system managers; strengthening management and planning capacity and funding district health plans; and building capacity for operations research to guide system-strengthening efforts. This seven-year effort covers all 13 districts and 146 health facilities in Sofala Province. The Mozambique PHIT Partnership expects to provide evidence on the effect of efforts to improve data quality coupled with the introduction of tools, training, and supervision to improve evidence-based decision making. This contribution to the knowledge base on what works to enhance health systems is highly replicable for rapid scale-up to other provinces in Mozambique, as well as other sub-Saharan African countries with limited resources and a commitment to comprehensive primary health care.
Country
Publisher
Biomed
Theme area
Resource allocation and health financing, Governance and participation in health
Title of publication The Ghosts Of User Fees Past: Exploring Accountability For Victims Of A 30-Year Economic Policy Mistake
Date of publication
2013 June
Publication type
Journal Article
Publication details
Health And Human Rights 15 1 pp 175-185
Publication status
Published
Language
English
Keywords
International, user fees, accountability
Abstract
The new consensus towards universal health care (UHC) suggests that an evidence-based approach to policy may finally be prevailing over an ideologically driven approach. While the new consensus shifting in favour of UHC is to be welcomed, the author argues that the international health community cannot dismiss the unnecessary suffering and harm caused by the reckless adoption of ideologically driven user fees policies over the last 30 years. It is incumbent on the international health community to reflect and take stock of what went so badly wrong that led to the widespread application of user fees in the world’s poorest countries and take steps to determine accountability for those responsible. The past victims of user fees must have their voices heard and all potential avenues for compensation must be fully pursued, as their right to health was violated for so long. More broadly, the current lack of accountability and liability in the economics profession should be of concern to the international health community as it increasingly relies on the advice and direction of health economists.
Country
Publisher
Biomed
Theme area
Equitable health services, Human resources for health
Title of publication Vertical Funding, Non-Governmental Organisations, And Health System Strengthening: Perspectives Of Public Sector Health Workers In Mozambique
Date of publication
2013 June
Publication type
Journal Article
Publication details
Human Resources for Health 11 26
Publication status
Published
Language
English
Keywords
Mozambique, health system; primary health care, health workers
Abstract
In this paper, the authors explored the perspectives and experiences of key Mozambican public sector health managers who coordinate, implement, and manage the myriad donor-driven projects and agencies. Over a four-month period, they conducted 41 individual qualitative interviews with key Ministry workers at three levels in the Mozambique national health system, using open-ended semi-structured interview guides, as well as reviewed planning documents. All respondents emphasized the value and importance of international aid and vertical funding to the health sector and each highlighted program successes that were made possible by recent increased aid flows. However, three serious concerns emerged: 1) difficulties coordinating external resources and challenges to local control over the use of resources channeled to international private organizations; 2) inequalities created within the health system produced by vertical funds channeled to specific services while other sectors remain under-resourced; and 3) the exodus of health workers from the public sector health system provoked by large disparities in salaries and work. The vertical approach starved the Ministry of support for its administrative functions. Few studies have addressed the growing phenomenon of “internal brain drain” in Africa which proved to be of greater concern to Mozambique’s health managers.
Country
Publisher
Biomed
Theme area
Equitable health services
Title of publication Approaches To Ensuring And Improving Quality In The Context Of Health System Strengthening: A Cross-Site Analysis Of The Five African Health Initiative Partnership Programmes
Date of publication
2013 May
Publication type
Journal Article
Publication details
BMC Health Services Research 13 Suppl 2 pp s8
Publication status
Published
Language
English
Keywords
Africa, health system; primary health care
Abstract
In this study, researchers describe the approaches to defining and improving quality of health services across the five country programmes funded through the Doris Duke Charitable Foundation African Health Initiative. They describe the differences and similarities across the programmes in defining and improving quality as an embedded process essential for HSS to achieve the goal of improved population health. The programmes measured quality across most or all of the six WHO building blocks, with specific areas of overlap in improving quality falling into four main categories: 1) defining and measuring quality; 2) ensuring data quality, and building capacity for data use for decision making and response to quality measurements; 3) strengthened supportive supervision and/or mentoring; and 4) operational research to understand the factors associated with observed variation in quality. Learning the value and challenges of these approaches to measuring and improving quality across the key components of health system strengthening as the projects continue their work, the authors conclude.
Country
Publisher
Biomed
Theme area
Governance and participation in health
Title of publication Regionalism And The Reinvigoration Of Global Health Diplomacy: Lessons From Africa
Date of publication
2012 March
Publication type
Journal Article
Publication details
Asian Journal Of WTO & International Health Law And Policy 7 1 pp 49-76
Publication status
Published
Language
English
Keywords
Africa, global, health diplomacy
Abstract
In the era of the persisting global north-south health divide, regional integration organisations have emerged as significant legal and diplomatic spaces to advance health goals. In this context, African regionalism is evolving as important frameworks for promoting health diplomacy. This evolving regional health diplomacy is contributing to the reinforcement of social goals of new regionalism in Africa and shaping the drivers of health policy at the global, regional and domestic levels. With reference to case studies of African regional and sub-regional integration organisations, the author of this paper examines the drivers, nature and limits of their practice of health diplomacy. He also analyses the nature of engagement of African regional groupings with select international health regimes. The author identifies the strengths and limits of regionalism for health diplomacy that also advances the protection of public health. The paper concludes with options to foster health diplomacy and its implications for the advancement of health at the domestic, regional and global levels.
Country
Publisher
Asian Journal Of WTO & International Health Law And Policy
Theme area
Equity in health, Poverty and health
Title of publication More Than A Numbers Game: Ghana’s Progress On MDG 1
Date of publication
2013 February
Publication type
Electronic Source
Publication details
Publication status
Published
Language
English
Keywords
Millennium Development Goals, Ghana, poverty
Abstract
In Ghana, the United Nations Development Program (UNDP) estimates that the country is largely on track in achieving the MDG 1. Poverty has reduced from over 50 percent in 1992 to 28.5% in 2006, indicating that the poverty target could be achieved well ahead of time. Similarly, the proportion of people living below the extreme poverty line declined from 36% to 18% over the same period. But the author of this blog argues that these figures do not take into account regional disparities: hunger is still rife in Ghana's three northern regions. A key theme emerging from his own research suggests that policy makers tend to tout the aggregate "success story" and become preoccupied with hitting statistical targets rather than improving the overall welfare of all constituents. This highlights the risks when policy-makers focus too much on targets, implying that complex processes can be over-simplified and priorities skewed when policies aim solely at targets. The author argues that the use of targets can encourage a reductionist approach to complex problems, privilege quantitative indicators at the expense of qualitative ones, distort resource allocation, and undermine professional motivation and responsibility. He concludes that, while Ghana’s progress has been remarkable, much work still needs to be done in the northern regions.
Country
Publisher
Africa Portal
Theme area
Governance and participation in health
Title of publication Empowerment to reduce health disparities
Date of publication
2002
Publication type
Journal Article
Publication details
Scandinavian Journal of Public Health 30 pp 72-77
Publication status
Language
English
Keywords
Social power, social participation, New Mexico, health disparities
Abstract
This article presents a theoretical construct of empowerment and its importance for strategies to reduce health disparities. Powerlessness is explored as a risk factor in the context of social determinants, such as poverty, discrimination, workplace hazards, and income inequities. Empowerment is presented and compared with social capital and community capacity as strategies to strengthen social protective factors. A case study of a youth empowerment and policy project in New Mexico illustrates the usefulness of empowerment strategies in both targeting social determinants, such as public policies which are detrimental to youth, and improving community capacities of youth to be advocates for social change. Challenges for future practice and research are articulated.
Country
Publisher
Sage Publications, Ltd.
Theme area
Governance and participation in health
Title of publication Theorizing Participation: From Tyranny to Emancipation
Date of publication
Publication type
Academic paper
Publication details
Publication status
Published
Language
English
Keywords
Social power, global, participation
Abstract
This paper provides an in-depth discussion of the concept of participation and its relevance to power. Throughout the world, participation has become a buzz-word in the contemporary development lexicon, used synonymously with deliberative democracy, good governance and citizenship, with much optimism and fervor. New forms of participatory institutions and interactive spaces are emerging, as sites within which state and society can interact and engage in mutually reinforcing ways to address development challenges at the local level. The primary raison d'être for the practice of participation and public deliberation being heralded as indispensable to democratic nations is its role in legitimizing government actions and strengthening the political system. Extant discourse indicates mounting disillusionment with the nature and outcome of local state-society synergies. Numerous scholars are of the view that the very notion of participation is ambiguous and value-laden, surrounded by much conceptual confusion and inadequate grounding in development theory. Both practitioners and theorists are increasingly highlighting its marginalizing and divisive powers through its mechanistic use as a tool to validate pre-conceived policy initiatives. Despite this critique, however, the practice and acceptance of participatory approaches as the definitive solution for the challenges facing developing countries continues unabated. Within the bounds of this framework, this paper seeks firstly to conceptualize and locate participation within a more radical and politicized participatory discourse. Thereafter, the focus shifts to an analysis of participation as a spatial practice and an investigation into the dynamics of power relations which infuse spaces of public engagement. The final section explores the different levels of intensity and dimensions of participation to develop a framework that facilitates reflection of current institutionalized practices and the need to reshape spaces of interaction to enable empowered and meaningful participation.
Country
Publisher
Journal of African & Asian Local Government Studies
Theme area
Governance and participation in health
Title of publication Just politics: Women transforming political spaces
Date of publication
2008
Publication type
Book
Publication details
Publication status
Published
Language
English
Keywords
Social power, social participation, global, gender, politics
Abstract
This report focuses on two main themes: ways to increase women’s political participation and strategies for transforming political spaces. To increase women’s political participation it is necessary to address social and structural barriers to women’s participation in politics including poverty, policies of exclusion, women’s disproportionate responsibility for domestic labour, traditional gender roles and values, heightened security regimes and curtailed civil liberties, and the persistence of gender violence. And supporting initiatives to create safe spaces to enable women’s political participation is key to addressing such barriers. But while increasing the numbers of women in politics is crucial, it is not enough. Once in power, women need to become effective political actors so that they can transform political spaces and be held accountable alongside men for gender equity and social justice. Various support mechanisms can help elected women become effective political actors: training and mentoring programmes; creating safe political spaces; networking and political alliances; information-sharing initiatives; and meaningful engagement with the media. Accountability for addressing gender inequities cannot be demanded only from women representatives. Integrated and concerted action from governments, political parties, international institutions, civil society, social movements, and women’s and feminist groups is essential if political systems and processes are to become more transparent, participatory and accountable to women’s needs. For example, greater accountability can and has been achieved through effective lobbying of and engagement with policy makers and practitioners.
Country
Publisher
One World Action
Theme area
Governance and participation in health
Title of publication Towards an Actor Oriented Perspective on Human Rights
Date of publication
2002 October
Publication type
Academic paper
Publication details
ID Working Paper 169
Publication status
Published
Language
Keywords
Social power, social participation, global, human rights
Abstract
This paper argues that rights are shaped through actual struggles informed by people’s own understandings of what they are justly entitled to. Examining rights from the perspective of actual struggles makes it possible for analysis to transcend accepted normative parameters of human rights debates, question established conceptual categories and expand the range of claims that are validated as rights. The chapter draws out these ‘actor-oriented perspectives’ in the course of reviewing key debates in the field of international human rights to show how they question underlying assumptions in these debates, and offer the possibility of breaking through the impasse that some of them have reached.
Country
Publisher
Institute of Development Studies
Theme area
Governance and participation in health
Title of publication A planning framework for community empowerment goals within health promotion
Date of publication
2000
Publication type
Journal Article
Publication details
Health Policy and Planning 15 3 pp 255-262
Publication status
Published
Language
English
Keywords
Social power, Fiji, global, policy, health promotion, behaviour
Abstract
This article presents a framework to assist planners, implementers and evaluators to systematically consider community empowerment goals within health promotion programming. Health promotion often comprises a tension between 'bottom-up' and 'top-down' programming. The former, more associated with concepts of community empowerment, begins on issues of concern to particular groups or individuals, and regards some improvement in their overall power or capacity as the important health outcome. The latter, more associated with disease prevention efforts, begins by seeking to involve particular groups or individuals in issues and activities largely defined by health agencies, and regards improvement in particular behaviours as the important health outcome. Community empowerment is viewed more instrumentally as a means to the end of health behaviour change. The tension between these two approaches requires a different orientation on the part of those responsible for planning more conventional, top-down programmes. This article 'unpacks' the tensions in the conventional, top-down programme cycle, by presenting a parallel 'empowerment' track. It presents nine identified 'domains' that represent the organizational influences on the process of community empowerment.
Country
Publisher
Oxford University Press
Theme area
Governance and participation in health
Title of publication Our cities, our health, our future: Acting on social determinants for health equity in urban settings: Report to the Commission on Social Determinants of Health
Date of publication
2008
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
Social power, global, social determinants, poverty
Abstract
This report summarises the findings concerning the structural and intermediate social determinants of health in the urban setting, with a focus on slums and informal settlements. It has assembled a wealth of evidence; however, quantitative evidence of health inequalities within cities is seldom available and more research on this topic is needed to underpin policy development. There is evidence that investments in urban health can create major returns for the economy. Social systems based on democracy and strong equity policies have been successful in creating more equitable urban areas in a number of countries. Yet violence and crime affect the urban poor at all development levels and the stresses of poverty are a factor in poor mental health. Poor nutrition and lack of sufficient food is another challenge. Poor people often end up living in unsafe locations affected by flooding or industrial pollution. It is clear that, for people in slums and informal settlements, improving their living environment is essential. In order to ensure access to essential health care services, the health system needs to be designed on an equitable basis. Serious and sustained efforts must be made to give more decision-making powers to urban dwellers themselves rather than government officials or external support agencies. Healthy urban governance and integrated approaches to interventions are key pathways to reducing health inequity. Securing more resources for health investments in urban settings, coupled with fairer distribution of those resources, is vital. The report concludes with the sad fact that, if rich countries had met financial pledges they made over the last twenty years to tackle poverty, urban poverty would have already been eradicated.
Country
Publisher
World Health Organisation
Theme area
Governance and participation in health
Title of publication South Africa's Treatment Action Campaign: Combining Law and Social Mobilization to Realize the Right to Health
Date of publication
2009
Publication type
Journal Article
Publication details
Journal of Human Rights Practice 1 1 pp 14-36
Publication status
Published
Language
English
Keywords
Social power, South Africa, access, HIV, AIDS, right to health
Abstract
This article summarizes the experience and results of a campaign for access to medicines for HIV in South Africa, led by the Treatment Action Campaign (TAC) between 1998 and 2008. It illustrates how the TAC mobilized people to campaign for the right to health using a combination of human rights education, HIV treatment literacy, demonstration, and litigation. As a result of these campaigns, the TAC was able to reduce the price of medicines, prevent hundreds of thousands of HIV-related deaths, but also to force significant additional resources into the health system and towards the poor. The article asks whether the method of the TAC has a wider application for human rights campaigns and, particularly, whether the protection of the right to health in law, and the obligation that it be progressively realised by the State, provides an opportunity to advance human rights practice.
Country
Publisher
Oxford Press
Theme area
Governance and participation in health
Title of publication Take Two Aspirin and Tweet Me in the Morning: How Twitter, Facebook, And Other Social Media are Reshaping Health Care
Date of publication
2009 April
Publication type
Journal Article
Publication details
Health Affairs 28 2 pp 361-368
Publication status
Language
English
Keywords
Social power, United States of America, social media, health services
Abstract
This article discusses how technological advances, specifically social media, have revolutionised modern health-seeking behaviour and practice. The author also attempts to explore how these revolutionary changes impact on the quality, efficacy, and equitability of health care delivery. If you want a glimpse of what health care could look like a few years from now, consider “Hello Health,” the Brooklyn-based primary care practice that is fast becoming an emblem of modern medicine. A paperless, concierge practice that eschews the limitations of insurance-based medicine, Hello Health is popular and successful, largely because of the powerful and cost-effective communication tools it employs: Web-based social media. Indeed, across the health care industry, from large hospital networks to patient support groups, new media tools like weblogs, instant messaging platforms, video chat, and social networks are reengineering the way doctors and patients interact.
Country
Publisher
Project HOPE: The People-to-people Health Foundation, Inc.
Theme area
Governance and participation in health
Title of publication Governing Women: Women’s Political Effectiveness in Contexts of Democratization and Governance Reform
Date of publication
2008 December
Publication type
Book
Publication details
Publication status
Published
Language
Keywords
Social power, global, gender, governance, democracy
Abstract
This book tackles the discussion on how best to cater for gender inequalities when it comes to governance; through a series of case studies of countries around the world. Though the proportion of women in national assemblies still barely scrapes 16% on average, the striking outliers – Rwanda with 49% of its assembly female, Argentina with 35%, Liberia and Chile with new women presidents this year – have raised expectations that there is an upward trend in women’s representation from which one may expect big changes in the quality of governance. But getting women into public office is just the first step in the challenge of creating governance and accountability systems that respond to women’s needs and protect their rights. Using case studies from around the world, the essays in this volume consider the conditions for effective connections between women in civil society and women in politics, for the evolution of political party platforms responsive to women’s interests, for local government arrangements that enable women to engage effectively, and for accountability mechanisms that answer to women. The book’s argument is that good governance from a gender perspective requires more than more women in politics. It requires fundamental incentive changes to orient public action and policy to support gender equality.
Country
Publisher
Routledge, Taylor and Francis Group
Theme area
Governance and participation in health
Title of publication Finding the spaces for change: A power analysis
Date of publication
2006 November
Publication type
Journal Article
Publication details
IDS Bulletin 37 6 pp 23-33
Publication status
Published
Language
Keywords
Social power, global, participation, powercube
Abstract
This article forms a detailed analysis and discussion over the author’s perception of what social power means, what it implies to societies, and the ways in which, together with other aspects of social participation, can be optimised. Building on his previous work based on the ‘three dimensions’ of power developed by Steven Lukes, the author argues that Luke’s three forms of power must also be understood in relation to how spaces for engagement are created, and the levels of power (from local to global), in which they occur. Understanding each of these – the spaces, levels and forms of power – as themselves separate but interrelated dimensions, each of which had at least three components within them, these dimensions could be visually linked together into a ‘power cube’. By using this framework, the author argues that analysts could begin to assess the possibilities of transformative action in various political spaces. Moreover, the approach could be a tool for reflection by activists and practitioners to map the types of power which we sought to challenge, and to look at the strategies for doing so. Even if the power cube approach does not tell us how to align our efforts, if it can be used by actors seeking to change the world to reflect on where and how they do so, and how they work across boundaries with others who are also working for change, then perhaps the alignment of efforts for transforming power will become more possible. In this sense, reflections on power, and reflections by change agents on how their work affects power relationships in all of its dimensions, is perhaps the first step in making more visible, power’s most hidden and invisible forms.
Country
Publisher
Institute for Development Studies
Theme area
Governance and participation in health
Title of publication Health Through People’s Empowerment: A Rights-Based Approach to Participation
Date of publication
2009
Publication type
Journal Article
Publication details
Health and Human Rights 11 1 pp 23-35
Publication status
Published
Language
English
Keywords
Social power, Social participation, global, human rights, participation
Abstract
This paper focuses on three issues when analysing human rights and health: the importance of social class in community participation, the pivotal role of power, and the role of the state and concepts of claim holders and duty bearers in a rights-based approach to health. The concept of ‘health through people's empowerment’ is proposed to identify and describe the core aspects of participation and empowerment from a human rights perspective and to put forward common strategies. If marginalised groups organise, they can influence power relations and pressure the state into action. Such popular pressure through organised communities and people's organizations can play an essential role in ensuring adequate government policies to address health inequities and in asserting the right to health.
Country
Publisher
Health and Human Rights
Theme area
Governance and participation in health
Title of publication Spaces for Change? The Politics of Citizen Participation in New Democratic Arenas
Date of publication
2007
Publication type
Book
Publication details
Publication status
Published
Language
English
Keywords
Social power, Social participation, Latin America, Europe, Africa, democracy, case studies
Abstract
This book provides a clear and comprehensive introduction to the developments which have brought about a new, global wave of inclusiveness and democracy. From Brazil to Bangladesh, a new form of participatory politics is springing up. Featuring contributions detailing how such movements have worked in Latin America, Europe and Africa, the book analyses the impact they have had on the democratic process. By opening up the political sphere in this way, the authors contend, these grassroots movements truly have created "spaces for change".
Country
Publisher
Zed Books Limited
Theme area
Governance and participation in health
Title of publication The Politics of Rights: Dilemmas for Feminist Praxis
Date of publication
2007
Publication type
Book
Publication details
Publication status
Published
Language
English
Keywords
Social power, gender, global, human rights
Abstract
Since the late 1990s, development institutions have increasingly used the language of rights in their policy and practice. This special issue on feminist perspectives on politics of rights explores the strategies, tensions and challenges associated with ‘rights work’ in a variety of settings. Articles on the Middle East, Africa, Latin America, East and South Asia explore the dilemmas that arise for feminist praxis in these diverse locations, and address the question of what rights can contribute to struggles for gender justice. Exploring the intersection of formal rights – whether international human rights conventions, constitutional rights or national legislation – with the everyday realities of women in settings characterized by entrenched gender inequalities and poverty, plural legal systems and cultural norms that can constitute formidable obstacles to realizing rights. The contributors suggest that these sites of struggle can create new possibilities and meanings – and a politics of rights animated by demands for social and gender justice.
Country
Publisher
Institute for Development Studies
Theme area
Governance and participation in health
Title of publication Power, Knowledge and Political Spaces in the Framing of Poverty Policy
Date of publication
2001
Publication type
Book
Publication details
Publication status
Published
Language
English
Keywords
Social power, participation, research, global, poverty, policy
Abstract
This book explores the dynamics of the making and shaping of poverty policy. It takes as its starting point a critique of linear versions of policy-making, highlighting the complex interplay of power, knowledge and agency in poverty policy processes. The authors argue that the policy process involves a complex configuration of interests between a range of differently positioned actors, whose agency matters, but whose interactions are shaped by power relations. Making sense of contemporary poverty policy requires a closer exploration of the dynamics within and beyond the arenas in which policies are made and shaped. It also requires an understanding of how particular ways of thinking about poverty have gained ascendancy, coming to determine the frame through which poverty is defined, measured and tackled. To do so calls for an historical perspective, one that situates contemporary poverty policy with regard to antecedent visions and versions. The paper provides an overview of differing narratives on the causes of and solutions to poverty, especially as they have emerged in dominant development discourses. Making sense of participation in the policy process requires that the authors identify and explore ‘policy spaces’ in which alternative versions of poverty may be expressed by a variety of voices, and the dynamics of inclusion and exclusion that surround them. The authors examine two broad kinds of policy spaces – those that are found in invited forums of participation created ‘from above’ by powerful institutions and actors, and those more autonomous spaces created ‘from below’ through more independent forms of social action. By examining how different narratives of poverty and different actors interact in such spaces – as well as how they may be excluded from them – one can better understand the ways in which power and knowledge frame the policy process.
Country
Publisher
Institute for Development Studies
Theme area
Human resources for health, Governance and participation in health
Title of publication The health workforce: advances in responding to shortages and migration, and in preparing for emerging needs: Report by the Secretariat to the 132 Session of the Executive Board
Date of publication
2013
Publication type
Academic paper
Publication details
Publication status
Published
Language
English
Keywords
Global, WHO code, health worker, migration, recruitment, bilateral agreements
Abstract
In 2010 the Sixty-third World Health Assembly adopted the WHO Global Code of Practice on the International Recruitment of Health Personnel. Nearly three years after the adoption of the Code, the coverage with designated national authorities is incomplete. The main challenge is to ensure engagement of all stakeholders involved in decision-making processes on health personnel migration and international recruitment. Typically, the multitude of public and private stakeholders from different sectors complicates adherence to one core set of principles. Another challenge concerns health personnel migration: there is a lack of coordinated and comprehensive data. A clearer picture is also emerging in respect of the bilateral, multilateral and regional agreements on the recruitment of health personnel. Most of these preceded the Code; however, some have been developed or refined in the two and a half years since the Code was adopted. Political commitment is essential in order to tackle the health workforce crisis; such commitment must be matched with corresponding investments. Efforts to support institutional and individual capacity for planning and the creation of human resources for health observatories require time to produce significant effects.
Country
Publisher
WHO
Theme area
Human resources for health, Governance and participation in health
Title of publication Stemming the brain drain: a WHO global code of practice on international recruitment of health personnel
Date of publication
2011
Publication type
Journal Article
Publication details
New England Journal of Medicine 365 25 pp 2348-2351
Publication status
Published
Language
English
Keywords
Global, WHO Code, health worker, brain drain, migration, recruitment
Abstract
The WHO Global Code of Practice on the International Recruitment of Health Personnel, adopted by the 193 member states of the World Health Assembly (WHA) in May 2010, is a critical multilateral framework for tackling the shortage in the global health workforce and the migration of health care workers from low- and middle-income countries. The authors of this article argue that the crucial challenge now is ensuring that the Code's norms are implemented so that it can contribute to tangible improvements in health systems worldwide. A number of countries are already working to incorporate the Code into national law and practice. For example, Kenya has entered into bilateral agreements with certain countries (including Namibia, Lesotho, and Rwanda) regarding collaborative health workforce training and promotion of circular migration of health workers (involving the temporary or permanent return to their home countries). In a draft national policy currently awaiting parliamentary approval, Zimbabwe addresses factors contributing to health workforce shortages; supports mechanisms and processes for stakeholder coordination and collaboration; and defines stakeholders' roles and responsibilities in ensuring timely financing, implementation, and monitoring of national human resources for health and in promoting the development and retention of the health workforce. Although the Code doesn't provide solutions to all the complex problems of health worker migration, it offers needed guidance on possible policy and legislative approaches. There is growing evidence that its legal framework can work as a platform for cooperation to strengthen health workforce systems. Sixty-nine countries have thus far designated a national authority responsible for the exchange of information on health worker migration and Code implementation. However, greater efforts are needed to ensure effective implementation, the authors conclude.
Country
Publisher
New England Journal of Medicine
Theme area
Human resources for health, Governance and participation in health
Title of publication The WHO Global Code of Practice on the International Recruitment of Health Personnel: The evolution of global health diplomacy
Date of publication
2011
Publication type
Journal Article
Publication details
Global Health Governance 5 1 pp 1-25
Publication status
Published
Language
English
Keywords
WHO code, Global, health worker, migration,recruitment, diplomacy
Abstract
The May 2010 adoption of the World Health Organisation Global Code of Practice on the International Recruitment of Health Personnel created a global architecture, including ethical norms and institutional and legal arrangements, to guide international cooperation and serve as a platform for continuing dialogue on the critical problem of health worker migration. Highlighting the contribution of nonbinding instruments to global health governance, this article describes the Code negotiation process from its early stages to the formal adoption of the final text of the Code. Detailed are the vigorous negotiations amongst key stakeholders, including the active role of non-governmental organisations. The article emphasises the importance of political leadership, appropriate sequencing, and support for capacity building of developing countries’ negotiating skills to successful global health negotiations. It also reflects on how the dynamics of the Code negotiation process evidence an evolution in global health negotiations amongst the WHO Secretariat, civil society, and WHO Member States.
Country
Publisher
Georgetown University
Theme area
Human resources for health, Governance and participation in health
Title of publication Developing evidence-based ethical policies on the migration of health workers: conceptual and practical challenges
Date of publication
2003 January
Publication type
Journal Article
Publication details
Human Resources for Health 1 8
Publication status
Published
Language
English
Keywords
Global, health worker, migration, policy, costs
Abstract
Data to support claims on both the extent and the impact of migration in developing countries is patchy and often anecdotal, based on limited databases with highly inconsistent categories of education and skills.The aim of this paper is to examine some key issues related to the international migration of health workers in order to better understand its impact and to find entry points to developing policy options with which migration can be managed.The paper is divided into six sections. In the first, the different types of migration are reviewed. Some global trends are depicted in the second section. Scarcity of data on health worker migration is one major challenge and this is addressed in section three, which reviews and discusses different data sources. The consequences of health worker migration and the financial flows associated with it are presented in section four and five, respectively. To illustrate the main issues addressed in the previous sections, a case study based mainly on the United Kingdom is presented in section six. This section includes a discussion on policies and ends by addressing the policy options from a broader perspective.
Country
Publisher
Biomed
Theme area
Human resources for health, Governance and participation in health
Title of publication Employment of Foreign Health Professionals in the South African Health Sector
Date of publication
2010
Publication type
Document
Publication details
Publication status
Language
Keywords
South Africa, health worker, migration, recruitment
Abstract
The aim of this policy is to promote high standards of practice in the recruitment and employment of foreign health workers in South Africa. The policy recognises and incorporates principles of various international codes of recruitment issued by the World Health Organisation, as well as various multilateral and bilateral agreements and recruitment protocols within the context of the Southern African Development Community and the African Union. All active recruitment of foreign health professionals from developing countries shall be through specific government-to-government agreements only. Foreign health professionals may only be employed through fixed-term contracts and these may not exceed three years. They shall enjoy the same service benefits and be expected to comply with the same conditions of service as South African employees. The policy lays out the legal rights of foreign health workers, their spouses and foreign graduates.
Country
Publisher
Department of Health
Theme area
Human resources for health, Governance and participation in health
Title of publication Health worker migration and universal healthcare in sub-Saharan Africa
Date of publication
2011 December
Publication type
Journal Article
Publication details
Pan African Medical Journal 10 55
Publication status
Published
Language
English
Keywords
Africa, health worker, migration,universal coverage
Abstract
There is a more and more emerging consensus claiming universal access to health care in order to achieve the desired Millennium Development Goals related to health in Africa. Unfortunately, the debate of the universal coverage has focussed so far mainly on financial affordability, while it is also a human resource matter. Many countries in sub-Saharan Africa are experiencing severe shortages of skilled health care workers. There are several causes, the importance of which varies by country, but one of the most significant factors is brain drain. In those countries, scarcity of doctors increases the distance between a doctor and patients, and bridging that increased distance implies costs, both time and money. Adequate number of qualified health personnel is then vital to increase coverage and improve the quality of care. In as much as access to health services is also determined by access to qualified health workers, any reflection on the universal health coverage has to also consider the inequities in qualified health personnel distribution throughout the world, the author concludes.
Country
Publisher
African Journals Online
Theme area
Human resources for health, Governance and participation in health
Title of publication Lost investment returns from the migration of medical doctors from Malawi
Date of publication
2007 January
Publication type
Journal Article
Publication details
Tanzania Health Research Bulletin 9 1 pp 61-64
Publication status
Published
Language
English
Keywords
Malawi, health worker, migration, cost, education
Abstract
Migration of medical doctors from African countries to developed nations compromises the delivery of health care on the continent, argue the authors of this paper. They estimated the full cost of producing a medical doctor in Malawi by adding the costs of education from primary school through undergraduate medical education. The cost in fees for one medical doctor produced was US$ 56,946.79. The amount of lost investment returns for a doctor who migrated out and served for 30 years in the receiving country ranged from about US$ 433,493 to US$46 million at interest rates 7% and 25%, respectively. These quantitative assessments of the estimated loss in investment will allow for informed policy discussions and decisions, the authors argue.
Country
Publisher
African Journals Online
Theme area
Human resources for health, Governance and participation in health
Title of publication The financial cost of doctors emigrating from sub-Saharan Africa: human capital analysis
Date of publication
2011 September
Publication type
Journal Article
Publication details
British Medical Journal 343 d7031
Publication status
Published
Language
English
Keywords
Africa, health worker, migration, costs
Abstract
This paper estimated the lost investment of domestically educated doctors migrating from sub-Saharan African countries to Australia, Canada, the United Kingdom, and the United States. Nine sub-Saharan African countries were included with an HIV prevalence of 5% or greater or with more than one million people with HIV/AIDS and with at least one medical school (Ethiopia, Kenya, Malawi, Nigeria, South Africa, Tanzania, Uganda, Zambia, and Zimbabwe), and data available on the number of doctors practising in destination countries.
Results indicated that in the nine source countries the estimated government subsidised cost of a doctor’s education ranged from US$21,000 in Uganda to $58,700 in South Africa. The overall estimated loss of returns from investment for all doctors currently working in the destination countries was $2.17bn, with costs for each country ranging from $2.16m for Malawi to $1.41bn for South Africa. The ratio of the estimated compounded lost investment over gross domestic product showed that Zimbabwe and South Africa had the largest losses. The benefit to destination countries of recruiting trained doctors was largest for the United Kingdom ($2.7bn) and United States ($846m). The authors argue that destination countries should consider investing in measurable training for source countries and strengthening of their own health systems.
Country
Publisher
British Medical Journal
Theme area
Human resources for health, Governance and participation in health
Title of publication The ‘skills drain’ of health professionals from the developing world: a framework for policy formulation
Date of publication
2005 February
Publication type
Academic paper
Publication details
Publication status
Published
Language
English
Keywords
Ghana, health worker, migration, recruitment, policy
Abstract
In this paper, the authors examine policy towards health professionals’ migration from economic and governance perspectives. Their aims are conceptual and agenda-setting. They argue that current policy responses to migration of health professionals from low-income developing countries underestimate the pressures and misidentify the reasons for rising migration, overestimate the impact of recruitment policies on migration flows while ignoring unintended side effects, and mis-specify the ethical dilemmas involved. The paper employs as its central case study the migration of health professionals from Ghana, the home country of the lead author, to the UK. This case is typical neither of migration flows nor impact, and is not presented as such. Rather, Ghana-UK migration provides a good example of many of the worst problems and contradictions in the current situation and policy debate. The authors put forward a number of propositions and identify gaps in the research literature.
Country
Publisher
MedAct
Theme area
Human resources for health, Governance and participation in health
Title of publication The brain drain of health professionals from sub-Saharan Africa to Canada: Some findings and policy options
Date of publication
2007
Publication type
Academic paper
Publication details
African Migration and Development; Paper 2 pp 1-92
Publication status
Published
Language
English
Keywords
Africa, Canada,health worker, migration
Abstract
Canada is heavily reliant on foreign-trained health care workers, with at least 22% of physicians and 7% of nurses in the country being foreign trained. Most Canadian respondents in this study felt that, in order to diminish the exodus of health professionals from the sub-Saharan African region, source countries have to tackle the factors pushing their health workers out. Respondents thought first and foremost of acting on the home front to reduce pull factors through improved health human resources planning. Respondents were supportive of, but less enthusiastic toward, the idea of Canada adopting voluntary or mandatory codes for the ethical recruitment of foreign-trained health care professionals. This largely stemmed from the belief held by most respondents that foreign-trained health professionals are not being actively recruited; rather, individuals are self-migrating. The unique structure of Canada’s health care system makes it particularly difficult to determine where ultimate responsibility for the recruitment of health personnel lies and how it would be monitored. It is also the reason why it is difficult to obtain consensus on policy options to reduce reliance on foreign-trained health care workers. The authors of this study argue that any plausible chance for change likely lies in all stakeholders playing their own respective roles in reducing the brain drain, and encouraging a broader intersectoral or “whole of government” approach to removing “push” and reducing “pull” factors.
Country
Publisher
Idasa: South Africa and Queens University
Theme area
Human resources for health, Governance and participation in health
Title of publication The cost of health professionals’ brain drain in Kenya
Date of publication
2006
Publication type
Magazine Article
Publication details
BMC Health Services Research 6 89
Publication status
Published
Language
English
Keywords
Kenya, health worker, migration, cost
Abstract
The objectives of this study were: (i) to estimate the financial cost of emigration of Kenyan doctors to the United Kingdom (UK) and the United States of America (USA); (ii) to estimate the financial cost of emigration of nurses to seven OECD countries (Canada, Denmark, Finland, Ireland, Portugal, UK, USA); and (iii) to describe other losses from brain drain. The costs of primary, secondary, medical and nursing schools were estimated in 2005. The cost information used in this study was obtained from one non-profit primary and secondary school and one public university in Kenya. The cost estimates represent unsubsidised cost. The total cost of educating a single medical doctor from primary school to university is US$ 65,997; and for every doctor who emigrates, a country loses about US$ 517,931 worth of returns from investment. The total cost of educating one nurse from primary school to college of health sciences is US$ 43,180; and for every nurse that emigrates, a country loses about US$ 338,868 worth of returns from investment. Developed countries continue to deprive Kenya of millions of dollars worth of investments embodied in her human resources for health, the authors argue. If the current trend of poaching of scarce human resources for health (and other professionals) from Kenya is not curtailed, the chances of achieving the Millennium Development Goals would remain bleak. Such continued plunder of investments embodied in human resources contributes to further underdevelopment of Kenya and to keeping a majority of her people in the vicious circle of ill-health and poverty. Therefore, both developed and developing countries need to urgently develop and implement strategies for addressing the health human resource crisis.
Country
Publisher
Biomed
Theme area
Human resources for health, Governance and participation in health
Title of publication he Future Of Health Worker Migration
Date of publication
2010
Publication type
Academic paper
Publication details
Background Paper WMR 2010 pp 1-17
Publication status
Published
Language
English
Keywords
Global, health worker, migration, retention, policy
Abstract
This paper takes stock of the range of capacities that are already available, and speculating on those that need to be created to mitigate the continuing and emerging adverse effects of health worker migration. Migration‐related policies in origin countries that initially targeted more the push factors at the micro level are no longer relevant or effective in isolation, the author argues. In future, with ageing of populations in most destination countries pushing up aggregate demand for health workers, perhaps the policies ought to be more focused on moderating and stabilising the pull factors at the macro level in destination countries and coordinating them with long‐term supply of health workers through the expansion of education facilities in the origin countries. Policies should, in other words, be demand‐focused rather than supply‐centric. The underlying basic question, however, is whether these traditional supply–demand approaches will be sufficient in terms of analysing and addressing the issue of health worker migration in the future, or whether new paradigms are necessary to supplement or even replace the old ones.
Country
Publisher
International Organisation for Migration
Theme area
Human resources for health, Governance and participation in health
Title of publication Stopping Africa’s medical brain drain
Date of publication
2005 July
Publication type
Journal Article
Publication details
British Medical Journal 331 pp 2-3
Publication status
Published
Language
English
Keywords
South Africa, health worker, migration, retention, incentives
Abstract
Incentives have been tried to persuade doctors to remain in or return to their countries of origin - enhanced salaries, better pensions, cars, and housing allowances. Ethical recruitment codes may make us feel that we occupy the moral high ground. But, as long as the rich countries have plenty of vacancies, the flow of healthcare professionals from South to North will continue, according to this article. The most important element of the solution is self sufficiency. The BMA and the Royal College of Nursing have urged the prime minister and the chancellor of the exchequer to commit the UK to training enough people to become self sufficient in workforces of doctors and nurses. By deadly coincidence, the US wants to employ one million more healthcare workers in the next 15 years - exactly the extra number needed for sub-Saharan Africa to fulfil the millennium development goals. The US system regards healthcare professionals as a commodity to be purchased in the market and is making little provision currently to increase the number of doctors and nurses it trains at home.
Country
Publisher
British Medical Journal
Theme area
Human resources for health, Governance and participation in health
Title of publication Mobility of Health Professionals: Ghana Country Report. Mobility of Health Professionals (MoHProf) Project
Date of publication
2012
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
Ghana, health worker, migration, retention, policy
Abstract
This report contains information on health professionals in Ghana. In 2012 Ghana had no comprehensive migration policy document to manage migration in a coherent manner. However, the need for a comprehensive migration policy has been recognised with the establishment of a National Migration Unit (NMU) and an Inter-ministerial Steering Committee located in the Ministry of Interior. The NMU, together with the interministerial team and other stakeholders, is working on the formulation of national migration policy. Stakeholders interviewed suggested a number of strategies to address the brain drain/gain affecting the Ghanaian health sector: realistic incentive packages are needed - the advantages to be gained in staying in the urban areas far outweigh the rural incentive package; sponsorship of students by the District Assemblies and other stakeholders to ensure retention and equitable distribution of human resource for health; more proactive policies; expansion of training facilities to train more health professionals for the sub-regions; greater collaboration between MoH and all other stakeholders. The push factors that cause health professionals to leave Ghana or to want to stay in big cities must be addressed by a holistic migration policy. Such a policy must recognise peoples’ rights to move if they desire but also peoples’ right to stay, so that a decision to migrate will be taken out of choice and not out of a desperate need to meet the basic necessities of life.
Country
Publisher
Mobility of Health Professionals
Theme area
Human resources for health, Governance and participation in health
Title of publication South Africa appeals to Canada to stop recruiting its MDs
Date of publication
2001 February
Publication type
Journal Article
Publication details
Canadian Medical Association Journal 164 pp 387-388
Publication status
Language
English
Keywords
Canada, South Africa, health worker, migration
Abstract
South Africa's high commissioner to Canada has issued an unprecedented appeal to the country's health ministers, asking them to stop recruiting South African physicians. André Jaquet says South Africa has already made a commitment not to recruit doctors from other African countries and that the South African health minister had discussed Canada's overseas recruiting efforts with SA’s foreign affairs minister in 2000. However, the bluntest reaction from South Africa came later, after the federal government and provinces signed a health care accord in September 2000 that promised billions more in federal funding for health care. Jaquet expressed concern that, given the shortages of health care specialists in Canada, the additional funding might be used to recruit doctors, nurses, oncologists, radiologists, pharmacists and other specialists from South Africa. He has appealed to Canada’s health administrators to take South Africa’s health worker shortages into account as they prepare their plans for the coming years. There are close to 1,500 South African physicians in Canada, many of whom practise in underserved rural areas.
Country
Publisher
Canadian Medical Association
Theme area
Human resources for health, Governance and participation in health
Title of publication Empirical impact evaluation of the WHO global code of practice on the international recruitment of health personnel (2010) on government, civil society and private sectors in Australia, Canada, United Kingdom and United States of America
Date of publication
2010
Publication type
Academic paper
Publication details
Publication status
Published
Language
English
Keywords
WHO Code, health worker, migration, policy
Abstract
The active recruitment of health workers from developing countries to developed countries has become a major threat to global health and an obstacle to achieving the human right to health. In an effort to manage this migration, the 63rd World Health Assembly adopted the World Health Organisation (WHO) Global Code of Practice on the International Recruitment of Health Personnel in May 2010. While the Code has been lauded as the first globally-applicable regulatory framework for health worker recruitment, its impact as a non-binding declaration has yet to be evaluated. This paper offers the first empirical evaluation of the Code’s impact on national and sub-national actors in Australia, Canada, United Kingdom and United States of America, which are the English-speaking developed countries with the greatest number of migrant health workers. Forty-two key informants from across government, civil society and private sectors were surveyed to measure their awareness of the Code, knowledge of specific changes resulting from it, overall opinion on the effectiveness of non-binding codes, and suggestions to improve this Code’s implementation. Sixty percent of respondents believed their colleagues were not aware of the Code, and 93% reported that no specific changes had been observed in their work as a result of the Code. Eighty-six percent reported that the Code has not had any meaningful impact on policies, practices or regulations in their countries. This highlights a gap between awareness for the Code among stakeholders at global forums and the awareness and behaviour of national and sub-national actors. Advocacy and technical guidance for implementing the Code are needed to improve its impact on national decision-makers. At least in the context of health worker migration, this study suggests that soft law by itself may not be effective in protecting the human right to health unless it is complemented by other efforts.
Country
Publisher
Social Science Research Network
Theme area
Human resources for health, Governance and participation in health
Title of publication Loss of health professionals from sub-Saharan Africa: the pivotal role of the UK
Date of publication
2005
Publication type
Journal Article
Publication details
Lancet 365 pp 1893-1900
Publication status
Published
Language
English
Keywords
Health workers, migration, Africa
Abstract
The already inadequate health systems of sub-Saharan Africa have been badly damaged by the emigration of their health professionals, a process in which the UK has played a prominent part. In 2005, there are special opportunities for the UK to take the lead in addressing that damage, and in focusing the attention of the G8 on the wider problems of health-professional migration from poor to rich countries. We suggest some practical measures to these ends. These include action the UK could take on its own, with the African countries most affected, and with other developed countries and WHO.
Country
Publisher
Taylor & Francis, Ltd.
Theme area
Human resources for health, Governance and participation in health
Title of publication Report on a Round Table (Dissemination) Meeting for Partners, the Directors‘ Joint Consultative Committee, and the Human Resources for Health Technical Working Group (TWG) 2012
Date of publication
2012
Publication type
Document
Publication details
Publication status
Published
Language
Keywords
Health workers, migration, east and southern Africa, ECSA HC
Abstract
A workshop to disseminate and consult with countries in the ECSA sub-region on the implementation of the WHO Global Code of Practice on International Recruitment of Health Personnel was held at the Nairobi Hilton Hotel from the 26th to the 28th March 2012 in Nairobi, Kenya. The objectives of the workshop were: (i) to disseminate the WHO Code of Practice on international recruitment of health personnel; (ii) to hold consultations and reach consensus on strategies for implementation and; (iii) to launch the ECSA-HC Regional Experts Committee on Human Resources for Health for reoperationalisationasone of the vehicles for taking forward some of the outputs of the workshop. Consensus was reached on:(i) an action agenda to provide countries with technical support for disseminating andimplementing the Code;(ii) an action agenda for operational research required to support countries in implementing the Code; and (iii) an action agenda for ECSA-HC Secretariat to establish a mechanism for countries to share information on the minimum data set required to implement the Code and for countries to comply with the reporting requirements set out in the Code.
Country
Publisher
East, Central and Southern Africa Health Community (ECSA HC)
Theme area
Human resources for health, Governance and participation in health
Title of publication Resolutions of the Health Ministers Conference 2011
Date of publication
2011
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
financing, external funding, non-communicable diseases, Millennium Development Goals, information technology, Health workers, migration, east and southern Africa, ECSA HC
Abstract
The 54th Health Ministers’ Conference (HMC)was held at the Nyali International Beach Hotel, Mombasa, Republic of Kenya, under the theme: ‘Consolidating the Gains: Addressing High Impact Interventions for Improved Health Outcomes’. At the end of the Conference, the Ministers passed the following Resolutions: revisiting the Paris Declaration: greater investments in the health sector; on research capacity and utilisation; accelerating the response to non-communicable diseases (NCDs); on guidelines on clinical management of child sexual abuse; strengthen the integration of programmes, with a focus on attainment of MDGs 4, 5 and 6; on innovative uses of health information technologies and systems; expression of gratitude to partners of the ECSA Health Community; and expression of gratitude to the Government and the people of the Republic of Kenya.
Country
Publisher
East, Central and Southern Africa Health Community (ECSA HC)
Theme area
Human resources for health, Governance and participation in health
Title of publication Resolutions of the Health Ministers Conference 2009
Date of publication
2009
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
primary health care, non-communicable diseases, maternal health, child health, AIDS, TB, Health workers, migration, east and southern Africa, ECSA HC
Abstract
The 48th Health Ministers Conference took place from 16th to 20th March, 2009 at the Royal Swazi Convention Centre, Ezulwini, Kingdom of Swaziland, and adopted the following resolutions: revitalising primary health care and strengthening health systems; enhancing systems-based strategies and solutions to strengthen human resources for health; enhancing leadership and management; action-oriented research for health planning & decision making; sexual, reproductive health and family planning; gender-based violence (GBV); HIV and AIDS, TB and Malaria; prevention of non-communicable diseases; improving maternal, neonatal and child health and nutrition; implementation of Health Ministers Conference resolutions; expression of gratitude to partners of the ECSA Health Community; and expression of gratitude to His Majesty’s Government and people of the Kingdom of Swaziland.
Country
Publisher
East, Central and Southern Africa Health Community (ECSA HC)
Theme area
Human resources for health, Governance and participation in health
Title of publication Resolutions of the Health Ministers Conference 2008
Date of publication
2008
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
health services, non-communicable diseases, AIDS, occupational health, nutrition, information technology, Health workers, migration, east and southern Africa, ECSA HC
Abstract
The 46th ECSA Health Ministers’ Conference was held in Victoria, Mahe, Republic of Seychelles, from 25th – 29th February 2008, and adopted the following 12 resolutions: strengthening health systems to ensure equitable access to health care; improving human resources for health for effective health care services; increasing access to medicines and medical supplies; maternal and child health/reproductive health/family planning; HIV and AIDS; injury prevention and control; prevention and management of non-communicable diseases; strengthening monitoring and evaluation systems in ECSA; strengthening use of information technologies for health care; nutrition interventions for promoting health and survival; expression of gratitude to partners of ECSA Health Community; and expression of gratitude to the Government and the People of Seychelles.
Country
Publisher
East, Central and Southern Africa Health Community (ECSA HC)
Theme area
Human resources for health, Governance and participation in health
Title of publication Resolutions of the Health Ministers Conferences 1999 – 2007
Date of publication
1999
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
nutrition, AIDS, Health workers, migration, east and southern Africa, ECSA HC
Abstract
The theme for the 30th Health Ministers' Conference held at Plantation Club Hotel, Mahe, Seychelles, from 25 - 29 October 1999 was "Advancing Partnerships for Better Health in East, Central and Southern Africa (ECSA) into the New Millennium". Resolutions were adopted on the following: HIV and AIDS prevention and control; nutrition as a development issue; traditional birth attendants; allied health professionals; technical cooperation among members; Y2K compliance; health reforms; and an expression of appreciation to the government and the people of Seychelles. In adopting these Resolutions, the Conference took cognisance of the Resolutions of the 26th Commonwealth Regional Health Ministers' Conference held in Maputo, Mozambique in 1997. The Conference noted that these Resolutions are still valid and are currently being implemented by CRHCS and member states.
Country
Publisher
East, Central and Southern Africa Health Community (ECSA HC)
Theme area
Human resources for health, Governance and participation in health
Title of publication Not enough there, too many here:understanding geographical imbalances in the distribution of the health workforce
Date of publication
2006 May
Publication type
Journal Article
Publication details
Human Resources for Health 4 12
Publication status
Published
Language
English
Keywords
Health workers, migration, international, equity
Abstract
Access to quality health services is a critical factor for the improvement of many health outcomes, such as those targeted by the Millennium Development Goals (MDGs) adopted by the international community in 2000. The health related MDGs cannot be achieved if vulnerable populations do not have access to skilled personnel and to other necessary inputs, argue the authors of this paper. They focus on the geographical dimension of access and on one of its critical determinants, the availability of qualified personnel. The objective of this paper is to offer a better understanding of the determinants of geographical imbalances in the distribution of health personnel, and to identify and assess the strategies developed to correct them. The authors review the recent literature on determinants, barriers, and the effects of strategies that attempted to correct geographical imbalances, with a focus on empirical studies from developing and developed countries. An analysis of determinants of success and failures of strategies implemented, and a summary of lessons learned is included.
Country
Publisher
Biomed
Theme area
Human resources for health, Governance and participation in health
Title of publication Taking more than a fair share? The migration of health professionals from of health professionals from sub-saharan Africa: the pivotal role of the poor to rich countries
Date of publication
2005 May
Publication type
Journal Article
Publication details
PLoSMedicine 2 5 pp e109
Publication status
Published
Language
English
Keywords
Health workers, migration, sub-Saharan Africa, equity
Abstract
The migration of physicians and other trained health professionals undermines the ability of developing countries to meet agreed Millennium Development Goals and creates untenable health conditions for the poorer sections of their populations, according to this paper. Developing countries on their own cannot achieve effective moderation of migration and secure the integrity of health services without the cooperation and collaboration of the countries that receive their health workers. An international regimen is needed to manage and moderate the migration of health workers in order to minimise the deleterious effects this has on underdeveloped countries. Developing countries, on the other hand, need to evolve strategies that reflect their internal needs. This must include designing cadres of health professionals that are trained mainly for the purposes of local needs and are less prone to the attractions of migration. Countries have different experiences, and each country must develop strategies that reflect the needs of their particular situation. However, the authors caution that the appropriate international environment for managing human resources is necessary if the strategies of developing countries are to achieve meaningful results.
Country
Publisher
PLoS
Theme area
Human resources for health, Governance and participation in health
Title of publication Brain drain from developing world: how can brain drain be converted into wisdom gain?
Date of publication
2005 November
Publication type
Journal Article
Publication details
Journal of the Royal Society of Medicine 98 pp 487-491
Publication status
Published
Language
English
Keywords
global, health workers, migration
Abstract
Brain drain is defined as the migration of health personnel in search of the better standard of living and quality of life, higher salaries, access to advanced technology and more stable political conditions in different places worldwide. This migration of health professionals for better opportunities, both within countries and across international borders, is of growing concern worldwide because of its impact on health systems in developing countries. Why do talented people leave their countries and go abroad? What are the consequences of such migrations especially on the educational sector? What policies can be adopted to stem such movements from developing countries to developed countries? This article seeks to raise questions, identify key issues and provide solutions which would enable immigrant health professionals to share their knowledge, skills and innovative capacities and thereby enhancing the economic development of their countries.
Country
Publisher
Sage Publications, Ltd.
Theme area
Human resources for health, Governance and participation in health
Title of publication Effect of UK policy on medical migration: a time series analysis of physician registration data
Date of publication
2012 September
Publication type
Journal Article
Publication details
Human Resources for Health 10 35
Publication status
Published
Language
English
Keywords
health worker, migration, United Kingdom, Africa, bilateral agreements
Abstract
In this study, the authors report on the temporal association between trends in new professional registrations from doctors qualifying overseas and relevant United Kingdom government policy. Results showed that new United Kingdom professional registrations by doctors trained in Africa and south Asia more than doubled from 3,105 in 2001 to 7,343 in 2003, as NHS Trusts sought to achieve recruitment targets specified in the 2000 NHS Plan; this occurred despite ethical guidance to avoid active recruitment of doctors from resource-poor countries. Registration of such doctors declined subsequently, but in response to other government policy initiatives. A fall in registration of South African-trained doctors from 3,206 in 2003 to 4 in 2004 followed a Memorandum of Understanding with South Africa signed in 2003. Registrations from India and Pakistan fell from a peak of 4,626 in 2004 to 1,169 in 2007 following changes in United Kingdom immigration law in 2005 and 2006. Since 2007, registration of new doctors trained outside the European Economic Area has remained relatively stable, but in 2010 the United Kingdom still registered 722 new doctors trained in Africa and 1,207 trained in India and Pakistan. In conclusion, ethical guidance was ineffective in preventing mass registration by doctors trained in resource-poor countries between 2001 and 2004 because of competing NHS policy priorities. Changes in United Kingdom immigration laws and bilateral agreements have subsequently reduced new registrations, but about 4,000 new doctors a year continue to register who trained in Africa, Asia and less economically developed European countries.
Country
Publisher
Biomed
Theme area
Human resources for health, Governance and participation in health
Title of publication Vital foreign-qualified doctors face xenophobia
Date of publication
2011 November
Publication type
Journal Article
Publication details
South African Medical Journal 101 11 pp 788-792
Publication status
Published
Language
English
Keywords
South Africa, primary health care, health worker, migration
Abstract
Foreign doctors, the backbone of South African rural healthcare delivery, are being ‘thrown in the deep end’ with little support, supplementary training or supervision, resulting in serious miscommunication and sometimes even xenophobia from healthcare colleagues who treat them as professionally inferior. This emerged during a discussion at the 15th annual conference of the Rural Doctors Association of Southern Africa, RuDASA, entitled, ‘Foreign Qualified Doctors:An essential and globally mobile resource – Perspectives from healthcare workers and stakeholders in rural settings’. Held in the historic mountain village of Rhodes in the Eastern Cape from 8th – 10th September, the conference attracted public sector doctors from across South Africa and neighbouring countries to focus on the theme; ‘Making Primary Health Care Better’.
Country
Publisher
African Journals Online
Theme area
Equity in health, Equitable health services, Governance and participation in health, Monitoring equity and research to policy
Title of publication EQUINET Participatory Methods toolkit: Organising People’s Power for Health
Date of publication
2006 February
Publication type
Document
Publication details
EQUINET Participatory Methods toolkit: Organising People’s Power for Health
Publication status
Published
Language
Keywords
participatory; action; power; people centred; health systems; training
Abstract
For some time now, people working in the field of health at community level have expressed the
need for a toolkit specifically focusing on participatory approaches to working on health. This toolkit was produced in response to this need, drawing on the experiences and knowledge of individuals and institutions working in this field. The toolkit shows how participatory methods can be used to raise community voice, both through health research and by training communities to take effective action and become involved in the health sector. Generally, this toolkit aims to strengthen capacities in researchers, health workers and civil
society personnel working at community level to use participatory methods for research, training
and programme support. At the end of the course, we hope that the users of the toolkit will have learned and be able to use various methods for participatory approaches to research and training within various areas of work aimed at building people-centred health systems. The toolkit uses experiences from different countries in the east and southern African region.
Country
Zimbabwe
Publisher
EQUINET
Equinet Publication Type
Toolkits and training materials
Theme area
Resource allocation and health financing, Governance and participation in health
Title of publication Discussion paper 98: Annotated literature review: African actors, global health governance and performance-based funding
Date of publication
2013 June
Publication type
Document
Publication details
‘Annotated literature review: African actors, global health governance and performance-based funding’, EQUINET Discussion paper 98 EQUINET: Harare.
Publication status
Published
Language
Keywords
results based financing; global health; diplomacy; review
Abstract
Performance-based funding (PBF) has become increasingly popular in global health financing. It is defined essentially as the transfer of resources (money, material goods) for health on condition that measurable action will be taken to achieve predefined health system performance targets such as particular health outcomes, the delivery of effective interventions (such as HIV prophylaxis), utilisation of services (like HIV counselling and testing), or quality care. This annotated literature review has been prepared for the research programme led by the EQUINET on Global Health Diplomacy and the specific focus on African actors and global health governance. Despite the predominance of PBF within the global health lexicon, there remain several contentious and underdeveloped aspects related to its use in supporting health system strengthening as well as its ability to foster increased participation from stakeholders. This review highlights the key strengths and weaknesses associated with PBF schemes in their use in low- and middle-income countries. It illustrates the theoretical thinking behind PBF implementation. It also seeks to draw out analysis of the role of African actors in global health diplomacy and decision-making surrounding PBF.
Country
International
Publisher
EQUINET
Equinet Publication Type
Discussion paper
Theme area
Governance and participation in health, Monitoring equity and research to policy
Title of publication Photovoice: A Participatory Action Research Strategy Applied to Women's Health
Date of publication
1989 March
Publication type
Academic paper
Publication details
Journal of Women's Health 8 2 pp 185-192
Publication status
Published
Language
English
Keywords
participatory research, international, photojournalism, knowledge systems
Abstract
This report gives an overview of the origins, key concepts, methods, and uses of photovoice as a strategy to enhance women's health. Photovoice is a participatory action research strategy that may offer unique contributions to women's health. It is a process by which people can identify, represent, and enhance their community through a specific photographic technique. Photovoice has three main goals: to enable people (1) to record and reflect their community's strengths and concerns, (2) to promote critical dialogue and knowledge about personal and community issues through large and small group discussion of their photographs, and (3) to reach policymakers.
Country
Publisher
Journal of Women’s Health
Theme area
Governance and participation in health, Monitoring equity and research to policy
Title of publication Community-based participatory research contributions to intervention research: the intersection of science and practice to improve health equity
Date of publication
2010 April
Publication type
Academic paper
Publication details
American Journal of Public Health 100 S1 pp S40-S46
Publication status
Published
Language
English
Keywords
participatory research, international, knowledge systems
Abstract
In this article, the authors identify the barriers and challenges within the intervention and implementation sciences, discuss how community-based participatory research (CBPR) can address these challenges, provide an illustrative research example, and discuss next steps to advance the translational science of CBPR. CBPR has emerged in the last decades as a transformative research paradigm that bridges the gap between science and practice through community engagement and social action to increase health equity. The authors further elaborate on how CBPR expands the potential for the translational sciences to develop, implement, and disseminate effective interventions across diverse communities through strategies to redress power imbalances; facilitate mutual benefit among community and academic partners; and promote reciprocal knowledge translation, incorporating community theories into the research.
Country
Publisher
American Journal of Public Health
Theme area
Governance and participation in health, Monitoring equity and research to policy
Title of publication Using community-based participatory research to address health disparities
Date of publication
2006 July
Publication type
Academic paper
Publication details
Health Promotion Practice 7 3 pp 312-323
Publication status
Published
Language
English
Keywords
participatory research, international, social power, equity, knowledge systems
Abstract
Community-based participatory research (CBPR) has emerged in the past decades as an alternative research paradigm, which integrates education and social action to improve health and reduce health disparities. More than a set of research methods, CBPR is an orientation to research that focuses on relationships between academic and community partners, with principles of co-learning, mutual benefit, and long-term commitment and incorporates community theories, participation, and practices into the research efforts. As CBPR matures, tensions have become recognized that challenge the mutuality of the research relationship, including issues of power, privilege, participation, community consent, racial and/or ethnic discrimination, and the role of research in social change. This article focuses on these challenges as a dynamic and ever-changing context of the researcher-community relationship, provides examples of these paradoxes from work in tribal communities, discusses the evidence that CBPR reduces disparities, and recommends transforming the culture of academia to strengthen collaborative research relationships.
Country
Publisher
SAGE Publications, on behalf of Society for Public Health Education
Theme area
Governance and participation in health, Monitoring equity and research to policy
Title of publication The Challenge of Measuring Community Values in Ways Appropriate for Setting Health Care Priorities
Date of publication
1999 September
Publication type
Academic paper
Publication details
Kennedy Institute of Health Ethics Journal 9 3 pp 263-284
Publication status
Published
Language
English
Keywords
participatory research, international, ethics, priority-setting, community monitoring
Abstract
This article outlines a preliminary research agenda to bring together empirical research on community values with more traditional research on health care ethics; with the goal of identifying and measuring acceptable community values that are relatively consistent across measurement methods and, ultimately, developing ways to incorporate these values into health care priority decision making. The move from a notion that community values ought to play a role in health care decision making to the creation of health care policies that in some way reflect such values is a challenging one. No single method will adequately measure community values in a way appropriate for setting health care priorities. Consequently, multiple methods to measure community values should be employed, thereby allowing the strengths and weaknesses of the various methods to complement each other.
Country
Publisher
Kennedy Institute of Ethics Journal, The Johns Hopkins University Press
Theme area
Governance and participation in health, Monitoring equity and research to policy
Title of publication Case Studies in Community-Based Collaborative Research
Date of publication
2007 June
Publication type
Report
Publication details
/ / / pp /-/
Publication status
Published
Language
English
Keywords
community based research, USA
Abstract
This compilation of case studies in Community-Based Collaborative Research (CBCR) was developed to facilitate the sharing of ideas among community-based researchers, and to support the dissemination of research concepts, models and outcomes. It is a dissemination product of the Institute for Community Research’s three-day national conference, “Crossroads I: Critical Issues in Community-Based Research Partnerships” that took place June 10-13, 2004 in Hartford, CT. Conference participants submitted case studies, following an outline provided by ICR that described CBCR projects recently completed or on-going during the time of the conference. All of the included projects represent the principles of CBCR and illustrate a wide range of local and national partnership research in the U.S. and Canada on the topics of arts and cultural heritage, capacity building and evaluation, economic and community development, and youth development.
Country
Publisher
The Institute for Community Research
Theme area
Governance and participation in health, Monitoring equity and research to policy
Title of publication Participatory Community Monitoring for Water, Sanitation, and Hygiene The NicaSalud Experience
Date of publication
Publication type
Document
Publication details
Environmental Health Project, Activity Report 141 / / pp /-/
Publication status
Published
Language
English
Keywords
community monitoring, Nicaragua, sanitation
Abstract
This report summarizes the NicaSalud report, “Experiencias en la implementación de la Metodología de Monitoreo Comunitario Participativo para Agua, Higiene y Saneamiento,” (in Spanish) on the participatory community monitoring methodology and its application by three nongovernmental organizations (NGOs) in Nicaragua. The original report, as prepared by members of the NicaSalud Water, Sanitation, and Hygiene Working Group – ANASAM, PCI, and IMPRHU – documents the Participatory Community Monitoring (PCM) Initiative project that NicaSalud developed with funding and technical assistance from the United States Agency for International Development (USAID) through the Environmental Health Project (EHP). This summary highlights the PCM methodology for use by program planners and managers who would like to include PCM in their water, sanitation, and hygiene programs.
Country
Publisher
U.S. Agency for International Development
Theme area
Governance and participation in health, Monitoring equity and research to policy
Title of publication Community-Based Participatory Research in American Indian and Alaska Native Communities
Date of publication
2010 June
Publication type
Report
Publication details
NCAI Policy Research Center / / pp /-/
Publication status
Published
Language
English
Keywords
participatory research, Alaska, American Indian, community priorities
Abstract
This paper discusses the usefulness of CBPR for American Indian/Alaska Native (AI/AN) communities and presents several case studies of CBPR in tribal communities. CBPR prioritizes the community in research design: the community is involved in developing research questions and methods; collecting data; analysing data; and writing publications and disseminating data. CBPR is not simply a research method—it is a philosophy about how research should be conducted so that community needs are prioritized. The variety of approaches possible in CBPR projects is reflected in the case studies presented in this paper. The common link between diverse CBPR studies is their commitment to community needs and priorities. One outcome that follows from some CBPR projects is that communities and researchers work together to implement study results to improve community programs or services. There is a growing emphasis in research overall, not just among CBPR researchers, on the translation of research study findings into concrete strategies for improving practices, programs, and service provision.
Country
Publisher
NCAI Policy Research Center
Theme area
Governance and participation in health, Monitoring equity and research to policy
Title of publication Community-based participatory research: opportunities, challenges, and the need for a common language.
Date of publication
2003
Publication type
Academic paper
Publication details
Journal of General Internal Medicine 18 / pp 592-594
Publication status
Published
Language
English
Keywords
participatory research, international
Abstract
This article highlights the results of a January 2002 call for papers featuring community-based participatory research (CBPR) that was issued. While CBPR may seem somewhat straightforward in theory, as these articles demonstrate, the degree to which CBPR is applied and how it is represented are far more diverse and varied. The peer review process and several editor meetings for this Special Issue brought out many of the challenges inherent in CBPR. How do we define community? What is a meaningful impact? How do we distinguish between community-placed and community-based research? How do we balance the importance of the research process with the importance of the research product or findings? Is there a methodologic threshold with which to determine whether a project is or is not CBPR? What is evident from the submissions is how broadly CBPR is being applied, geographically, within specific population groups and clinical scenarios, and methodologically.
Country
Publisher
Journal of General Internal Medicine
Theme area
Governance and participation in health, Monitoring equity and research to policy
Title of publication Community-based participatory research as a tool to advance environmental health sciences.
Date of publication
2002 April
Publication type
Academic paper
Publication details
Environmental Health Perspectives 110 Suppl 2 pp 155-159
Publication status
Published
Language
English
Keywords
participatory research, USA, environment, knowledge systems
Abstract
In this article, the authors highlight six key principles of community-based participatory research (CBPR) and describe how these principles are met within specific NIEHS-supported research investigations. The past two decades have witnessed a rapid proliferation of CBPR projects. CBPR methodology presents an alternative to traditional population-based biomedical research practices by encouraging active and equal partnerships between community members and academic investigators. The National Institute of Environmental Health Sciences (NIEHS), the premier biomedical research facility for environmental health, is a leader in promoting the use of CBPR in instances where community-university partnerships serve to advance our understanding of environmentally related disease. The NIEHS-supported projects described within this article demonstrate that community-based participatory research can be an effective tool to enhance our knowledge of the causes and mechanisms of disorders having an environmental aetiology, reduce adverse health outcomes through innovative intervention strategies and policy change, and address the environmental health concerns of community residents.
Country
Publisher
Environmental Health Perspectives, National Institute of Environmental Science
Theme area
Governance and participation in health, Monitoring equity and research to policy
Title of publication Assessing Social Change Through Participatory Action Research: The Case of Kasighau Small-Scale Miners, Kenya
Date of publication
2007 February
Publication type
Report
Publication details
/ / / pp /-/
Publication status
Published
Language
English
Keywords
participatory research, Kenya, miners
Abstract
This case study describes the author’s experience with the use of PAR using a ‘resistance paradigm’. The case study aims to demonstrate the critical difference in using participatory methods, in this case PAR, not only with creativity and innovativeness in new circumstances but particularly in applying these methods in an alternative development paradigm outside the mainstream or conventional development paradigm.
Country
Publisher
Institute of Development Studies (IDS)
Theme area
Governance and participation in health, Monitoring equity and research to policy
Title of publication Community-based monitoring of safe motherhood in the United Republic of Tanzania
Date of publication
2003 April
Publication type
Report
Publication details
Bulletin of the WHO 81 2 pp 87-94
Publication status
Published
Language
English
Keywords
community monitoring, Tanzania, maternal mortality
Abstract
This article set out to examine the progress made towards the Safe Motherhood Initiative goals in three areas of the United Republic of Tanzania during the 1990s. The report presents the findings and argues that the use of community level monitoring in sentinel registration areas may be a cost-effective and accurate way for developing countries to monitor mortality indicators and causes, including for maternal mortality.
Country
Publisher
World Health Organisation
Theme area
Governance and participation in health, Monitoring equity and research to policy
Title of publication Community-based participatory research (CBPR) in South Africa: Engaging multiple constituents to shape the research question
Date of publication
2005 December
Publication type
Journal Article
Publication details
Social Science and Medicine 61 12 pp 2577-2587
Publication status
Published
Language
English
Keywords
participatory research, South Africa, social participation, health services
Abstract
In this paper, the authors explore the community-based participatory research (CBPR) model as a means to negotiate a mutual agenda between communities and researchers. This paper is focused on the (perceived) need for cervical cancer screening in an under-resourced community in Cape Town, South Africa. Cervical cancer is a significant health problem in this community and elsewhere in South Africa. Unlike HIV-AIDS, however, many Black South Africans have not been educated about cervical cancer and the importance of obtaining screening. Many may not consider screening a priority in their lives. This research included extensive consultations and informal interviews with diverse community and regional stakeholders. Following these, the conducted 27 focus groups and 106 demographic surveys with randomly selected youth, parents, local health care personnel, educators and school staff. Focus group data were summarized and analysed cross-sectionally. Community stakeholders were involved throughout this research. Community engagement is an on-going, arduous, and necessary process for developing effective health promotion programs. The challenges are amplified when the particular health issue or research question is not prominent in the consciousness of the targeted community. The authors’ consultations, interviews, and focus group data were key in identifying the concerns and priorities of the community. By engaging community stakeholders, they developed a research framework that incorporated the community’s concerns and priorities, and stressed the intersecting roles of poverty, violence, and other cultural forces in shaping community members’ health and wellbeing. Community members helped to refocus the authors’ research from cervical cancer to ‘cervical health,’ a concept that acknowledged the impact on women’s bodies and lives of HIV-AIDS and STDs, sexual violence, poverty, and multiple social problems. The authors conclude that the research agenda and questions in community-based health research should not be considered immutable. They need to be open to negotiation, creativity, and constant reinvention.
Country
Publisher
Social Science and Medicine
Theme area
Governance and participation in health, Monitoring equity and research to policy
Title of publication Assessing research impact: A case study of participatory research
Date of publication
2013 February
Publication type
Document
Publication details
Centre for Research on Families and Relationships Briefing 66 / pp /-/
Publication status
Published
Language
English
Keywords
participatory research, Ukraine, social action
Abstract
This briefing reports on findings from a JISC/ NCCPE funded project which tried to get to grips with some of these challenges. There is much current interest in how impacts of research on the wider economy and society can be analysed and documented, despite many methodological and practical challenges. The projects reported on used a framework developed by Sarah Morton – a knowledge exchange professional and impact analyst at The University of Edinburgh, to assess the impact of particular social action research developed by the Centre for Social Action (CSA) at De Montfort University, led by Jennie Fleming. The project focused on two case-studies; one of which looked at the de-institutionalisation of childcare in the Ukraine and is the focus of in this briefing.
Country
Publisher
Centre for Research on Families and Relationships, The University of Edinburgh
Theme area
Governance and participation in health, Monitoring equity and research to policy
Title of publication Community-Based Participatory Research: A Strategy for Building Healthy Communities and Promoting Health through Policy Change
Date of publication
2012
Publication type
Report
Publication details
/ / / pp /-/
Publication status
Published
Language
English
Keywords
participatory research, international, policy change
Abstract
This report focuses on Community-Based Participatory Research (CBPR), where the authors begin by first defining some terms and guiding principles derived from many years of observing and working on these kinds of projects. Next, the report explores a range of practices that have been shown to be valuable in carrying out CB PR in a way that supports efforts at policy and systems change. Throughout the report, examples of effective practices are drawn from both the six cases explored specifically for this project (the full case studies are presented in Section IV) and from many others. A number of resources published in print or available on the Internet, as well as descriptions of organizations whose work.
Country
Publisher
PolicyLink
Theme area
Governance and participation in health, Monitoring equity and research to policy
Title of publication Public governance indicators: a literature review
Date of publication
2007
Publication type
Report
Publication details
United Nations Publications / / pp /-/
Publication status
Published
Language
English
Keywords
participatory research, international, social accountability, governance
Abstract
This report intends to give an overview of performance indicators, focussing on those in the public sector, and discusses their pros and cons. “Good” governance, which establishes a framework for fighting poverty and inequality, has motivated many researchers to compute single or aggregated indicators. Part I of the paper evaluates existing methodologies, including data collection, sampling and ideological biases, the validity of proxy variables, aggregation methods, and applicability of results. The paper argues that new transforming factors such as the Information Age, globalization and decentralization should be better taken into account in the assessment process of governance. It also discusses the topic of accurately assessing citizen needs to better implement “good” governance mechanisms. It concludes with a discussion of future directions for data collection, particularly the need for more objective and geographically disaggregated indicators. Part II selects three core dimensions of governance and some economic indicators which can assist in monitoring governance in the public sector.
Country
Publisher
Department of Economic and Social Affairs, United Nations Publications
Theme area
Governance and participation in health, Monitoring equity and research to policy
Title of publication Participatory research maximises community and lay involvement
Date of publication
1999 September
Publication type
Academic paper
Publication details
British Medical Journal (BMJ) 319 7212 pp 774-778
Publication status
Published
Language
English
Keywords
participatory research, international
Abstract
This integrative review is based on a search of medical, nursing, and social science databases and ethical research codes. The material selected had to be significant theoretical works, source documents, or concrete examples of participatory research. It notes that such research stresses the relationship between researcher and community, the direct benefit to the community as a potential outcome of the research, and the community’s involvement as itself beneficial. A goal is that research subjects should “own” the research process and use its results to improve their quality of life.
Country
Publisher
British Medical Journal (BMJ)
Theme area
Governance and participation in health, Monitoring equity and research to policy
Title of publication From Clients to Citizens: Asset-Based Community Development as a Strategy for Community-Driven Development
Date of publication
2002 January
Publication type
Document
Publication details
Occasional Paper Series No. 4. The Coady International Institute / / pp /-/
Publication status
Published
Language
English
Keywords
community monitoring, social participation, international, assets
Abstract
In this document, asset-based community development (ABCD) is presented as an alternative to needs-based approaches to development. Following an overview of the principles and practice of ABCD, five major elements of ABCD are examined in the light of current literature on relevant research and practice. This involves exploring: the theory and practice of appreciative inquiry; the concept of social capital as an asset for community development; the theory of community economic development, such as the sustainable livelihoods approach; lessons learned from two decades of international development in the participatory paradigm; and the theory and practice of building active citizenship engagement and a stronger civil society. How ABCD both reflects recent trends in these areas and stands to benefit from the insights generated from this work is outlined.
Country
Publisher
The Coady International Institute, St. Francis Xavier University
Theme area
Governance and participation in health, Monitoring equity and research to policy
Title of publication Participatory Research and Gender Analysis: New Approaches
Date of publication
2010 August
Publication type
Book
Publication details
/ / / pp /-/
Publication status
Published
Language
English
Keywords
participatory research, international, agricultural development research, gender-sensitive
Abstract
This book was published as a special issue of Development in Practice, and it discusses opportunities afforded by effective knowledge pathways linking researchers and farmers, underpinned by participatory research and gender analysis. It sets out practices and debates in gender-sensitive participatory research and technology development, concentrating on the empirical issues of implementation, impact assessment, and institutionalisation of approaches for the wider development and research community. It includes six full-length chapters and eight brief practical notes and is enhanced by an annotated resources list of relevant publications, organisations, and websites adding to the portfolio of approaches and tools discussed by the contributors. Most of the 33 contributing authors work in the specialised agencies that form part of the Consultative Group on International Agricultural Research (CGIAR).
Country
Publisher
Development in Practice, Routledge
Theme area
Governance and participation in health, Monitoring equity and research to policy
Title of publication Some common questions about participatory research: a review of the literature
Date of publication
2008
Publication type
Academic paper
Publication details
/ 18 4-5 pp 479-488
Publication status
Published
Language
English
Keywords
participatory research, international, review, implementation
Abstract
This article reviews, through reference to the published literature, some key questions about participatory research. When should participatory research be used? How should participatory research be applied? What about quality of science in participatory research? Are there any institutional issues associated with the use of participatory research? And what are the benefits and costs of participatory research? The article is not a comprehensive literature review on participatory research, it is not meant to set standards for participatory research, nor to define what constitutes 'good' participatory research, but rather it seeks to summarise the realities of implementing participatory research, as discussed and debated by several published authors, and to provide some useful background for this special issue.
Country
Publisher
Routledge
Theme area
Governance and participation in health, Monitoring equity and research to policy
Title of publication Participatory Action Research: Communicative Action and the Public Sphere
Date of publication
2005
Publication type
Book Section
Publication details
Denzin, NK (Ed); Lincoln, YS (Ed), The Sage handbook of qualitative research 3rd ed / pp 559-603
Publication status
Published
Language
English
Keywords
participatory research, international, methods
Abstract
The authors’ present a view of participatory action research. They give a short overview of the evolution of action research and key approaches to action research, the sites and settings where they are most frequently used, several criticisms that have been advanced for each, and key sources to explore them.The approaches identified were a somewhat eclectic mix—participatory research, classroom action research, action learning, action science, soft systems approaches, and industrial action research. The authors summarize those approaches and the influence of each approach on the field. The papers presents “myths, misinterpretations, and mistakes” to move toward reconceptualising research itself as a social practice. Thinking about research as a social practice leads to an exploration of Habermas’s notion of the public sphere as a way of extending the theory and practice of action research. The authors hope that this argument shows more clearly how participatory action research differs from other forms of social inquiry, integrating more clearly its political and methodological intentions.
Country
Publisher
/
Theme area
Governance and participation in health, Monitoring equity and research to policy
Title of publication Community-based Participatory Research: Policy Recommendations for Promoting a Partnership Approach in Health Research
Date of publication
2001
Publication type
Academic paper
Publication details
Education for Health: Change in Learning and Practice 14 2 pp 182-197
Publication status
Published
Language
English
Keywords
participatory research, USA, global, policy, knowledge systems
Abstract
This article presents key principles of community-based participatory research (CBPR), discusses the rationale for its use, and provides a number of policy recommendations at the organizational, community and national levels aimed at advancing the application of CBPR. Community-based participatory research in public health focuses on social, structural, and physical environmental inequities through active involvement of community members, organizational representatives, and researchers in all aspects of the research process. Partners contribute their expertise to enhance understanding of a given phenomenon and integrate the knowledge gained with action to benefit the community involved. While the issues addressed in this article draw primarily upon experiences in the United States, the emphasis throughout this article on the establishment of policies to enhance equity that would serve both to increase the engagement of communities as partners in health research, and to reduce health disparities, has relevant applications in a global context.
Country
Publisher
Taylor and Francis Limited, London
Theme area
Governance and participation in health, Monitoring equity and research to policy
Title of publication Community-Based Participatory Research From the Margin to the Mainstream : Are Researchers Prepared?
Date of publication
2009
Publication type
Academic paper
Publication details
Circulation 119 / pp 2633-2642
Publication status
Published
Language
English
Keywords
participatory research, international, health services, equity
Abstract
This article reviews how, despite an increasing arsenal of effective treatments, there are mounting challenges in developing strategies that prevent and control cardiovascular diseases, and that can be sustained and scaled to meet the needs of those most vulnerable to their impact. Community-based participatory research (CBPR) is an approach to conducting research by equitably partnering researchers and those directly affected by and knowledgeable of the local circumstances that impact health. To inform research design, implementation and dissemination, this approach challenges academic and community partners to invest in team building, share resources, and mutually exchange ideas and expertise. CBPR has led to a deeper understanding of the myriad factors influencing health and illness, a stream of ideas and innovations, and there are expanding opportunities for funding and academic advancement. To maximize the chance that CBPR will lead to tangible, lasting health benefits for communities, researchers will need to balance rigorous research with routine adoption of its conduct in ways that respectfully, productively and equally involve local partners. If successful, lessons learned should inform policy and inspire structural changes in healthcare systems and in communities.
Country
Publisher
Circulation, American Heart Association
Theme area
Governance and participation in health, Monitoring equity and research to policy
Title of publication Implementing community‐based participatory research centres in diverse urban settings.
Date of publication
2001 September
Publication type
Academic paper
Publication details
Journal of Urban Health 78 3 pp 488-494
Publication status
Published
Language
English
Keywords
participatory research, international, urban health, implementation, Urban Research Centres
Abstract
This issue of the Journal of Urban Health contains descriptions of the implementation of community-based participatory research (CBPR) activities at three Urban Research Centres (URCs) funded through an initiative of the Centres for Disease Control and Prevention (CDC). Now in their sixth year, the URCs have each formed research partnerships among community-based organizations (CBOs), universities, private organizations, and public health agencies. The articles describe the first 4 years of the development of the URCs, the process of conducting participatory research and an overview of the urban health issues that are being addressed. The authors describe the implementation of CBPR-partnerships in the context of urban settings, demonstrating that this approach can be used both to establish new participatory research centres and to guide the transition of traditional research centres to more participatory entities. The goal is to provide community representatives, public health researchers, and funding agencies with information about how research can be done with equitable opportunities for all partners to contribute. Drawing on the expertise of all partners increases understanding of the factors and processes leading to poor health outcomes and informs the development of interventions to improve community health.
Country
Publisher
Journal of Urban Health
Theme area
Governance and participation in health, Monitoring equity and research to policy
Title of publication CDC Urban Research Centers: Community-Based Participatory Research to Improve the Health of Urban Communities
Date of publication
2001 January
Publication type
Academic paper
Publication details
Journal of Women's Health and Gender-Based Medicine 10 1 pp 9-15
Publication status
Published
Language
English
Keywords
participatory research, USA, violence, women
Abstract
This document primarily describes the Southwest Detroit Partnership to Prevent Intimate Violence Against Latina Women (LA VIDA) Partnership as an example of how the Urban Research Centres (URCs) identify and initiate prevention research on urban health problems affecting women.
Country
Publisher
Journal of Women's Health and Gender-Based Medicine, Mary-Anne Liebert Incorporated Publishers
Theme area
Governance and participation in health
Title of publication The community counts: a participatory approach to social audits
Date of publication
2011 December
Publication type
Academic paper
Publication details
BMC Health Services Research 11 Suppl 2 pp l1-/
Publication status
Published
Language
English
Keywords
community monitoring, Latin America, international, evolving methodology
Abstract
This Supplement marks CIET's 25 years of experience in developing and conducting social audits. Over this period, the methodology has evolved, from the early sentinel community surveillance and community-based service-delivery surveys, through reiterative survey and feedback cycles that propose service changes and monitor their effects, to randomised controlled trials - that measure the impact of interventions. The systematic and rigorous social audit methods provide evidence from communities that encourage health planners to plan with and for the communities. While the methods have evolved and matured over the past quarter century, with social audits covering a wide range of topics in many countries, the underlying philosophy of CIET's social audits has endured.
Country
Publisher
BioMedCentral
Theme area
Governance and participation in health
Title of publication Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness
Date of publication
2004
Publication type
Academic paper
Publication details
Nurse Education Today 24 / pp 105-112
Publication status
Published
Language
English
Keywords
participatory research, international, concepts
Abstract
This paper provides an overview of important concepts (manifest and latent content, unit of analysis, meaning unit, condensation, abstraction, content area, code, category and theme) related to qualitative content analysis; illustrates the use of concepts related to the research procedure; and proposes measures to achieve trustworthiness (credibility, dependability and transferability) throughout the steps of the research procedure. Qualitative content analysis as described in published literature shows conflicting opinions and unsolved issues regarding meaning and use of concepts, procedures and interpretation. Interpretation in qualitative content analysis are discussed.
Country
Publisher
Nurse Education Today, Elsevier Limited
Theme area
Governance and participation in health
Title of publication The quality of science in participatory research: a case study from eastern Zambia
Date of publication
2002
Publication type
Academic paper
Publication details
World Development 30 4 pp 523-543
Publication status
Published
Language
English
Keywords
participatory knowledge, Zambia, farmers
Abstract
Recent discourse in the development field has been directed to the question of how to maintain and enhance the quality of science in agricultural research using participatory methods. Discussion has also focused on the question of how to combine microlevel research/extension efforts using participatory methods with scientific methods employing rigorous and statistical testing techniques. Is there a tradeoff between researchers’ use of microlevel, gender-sensitive, ethnographic, participatory methods and a commitment to ‘‘the scientific method,’’ with its conventional assumptions about sampling, data collection, hypothesis testing, and use of standard measures of statistical significance? If there is such a tradeoff, which of the two methods should be given the greater attention? Should scientific and rigorous testing methods take precedence in the agricultural science community over use of farmer-sensitive participatory methods? Should scientific rigor be sacrificed for ethnographic accuracy, or vice versa?
Country
Publisher
Elsevier Science, Limited
Theme area
Governance and participation in health
Title of publication Participatory Action Research Approaches and Methods
Date of publication
2010 November
Publication type
Document
Publication details
International Journal of Community Research and Engagement, 3 / pp 185-186
Publication status
Published
Language
English
Keywords
participatory research, international, knowledge systems
Abstract
This book captures developments in Participatory Action Research (PAR), exploring the justification, theorisation, practice and implications of PAR. It offers a critical introduction to understanding and working with PAR in different social, spatial and institutional contexts. The authors engage with PAR’s radical potential, while maintaining a critical awareness of its challenges and dangers. The book explores the intellectual, ethical and pragmatic contexts of PAR; the development and diversity of approaches to PAR; recent poststructuralist perspectives on PAR as a form of power; the ethic of participation; and issues of safety and well-being. Part two is a critical exploration of the politics, places and practices of PAR. Contributors draw on diverse research experiences with differently situated groups and issues including environmentally sustainable practices, family livelihoods, sexual health, gendered experiences of employment, and specific communities such as people with disabilities, migrant groups, and young people. The principles, dilemmas and strategies associated with participatory approaches and methods including diagramming, cartographies, art, theatre, photovoice, video and geographical information systems are also discussed. It reflects on how effective PAR is, including the analysis of its products and processes, participatory learning, representation and dissemination, institutional benefits and challenges, and working between research, action, activism and change.
Country
Publisher
Gateways, International Journal of Community and Engagement
Theme area
Governance and participation in health
Title of publication Quarterly Community Assessment of the Socio-economic Situation in Zimbabwe: Health and Education
Date of publication
2013 March
Publication type
Report
Publication details
Community Monitoring Programme / / pp /-/
Publication status
Published
Language
English
Keywords
community monitoring, Zimbabwe, health, education
Abstract
This report is one of a series of quarterly monitoring of social and economic conditions at community level. This community based monitoring on health and education conditions was carried out in March 2013. It assessed the situation with respect to education, health care and conditions that affect health, including living and community environments. The report is compiled from community reports from 240 sentinel sites in 57 districts from all provinces of Zimbabwe, with an average 4.2 reports per district. Community monitoring of social and economic conditions has been carried out every three months since 2003. The quarterly rounds cover: Health and Education, Income and Employment, Production and Assets. All rounds also cover food security monitoring. Monitors based in sentinel wards from civil society organizations report on specific areas of social and economic conditions at community level. Information on a district is compiled from three to four sentinel sites. These reports are thus not statistical sample surveys, but regular community assessments of the social and economic conditions in sentinel sites. They provide information on how things are changing across time or how things differ across areas. The Community Monitoring is implemented through civil society organisations based within districts and community based monitors to inform the work of the organisations implementing it, to support informed civil society and public sector dialogue with evidence on conditions at community level. This round is the ninth time quarterly monitoring has been done of health and education, with previous rounds having been done annually from 2004 to 2012.
Country
Publisher
Training and Research Support Centre (TARSC)
Theme area
Governance and participation in health
Title of publication Relaxed and Participatory Appraisal : Notes on Practical Approaches and Methods
Date of publication
1993
Publication type
Document
Publication details
Institute of Development Studies / / pp /-/
Publication status
Published
Language
English
Keywords
participatory research, international, PRA, social anthropology
Abstract
These notes are an outline introduction to what has been called rapid (but is better relaxed!) and participatory rural appraisal (PRA). Some of the methods come from social anthropology. Some, especially diagramming, were developed and spread in Southeast Asia, as part of agroFcosystein analysis, originating in the University of Chiang Mai. For RRA, the University of Khon Kaen in Thailand has been a major source of innovation and inspiration. Other methods seem to be new, but may well be rediscoveries. What is new is the way they have all come together, and the way RRA/PRA seems (it is too early to know for sure) to know no boundaries either of discipline or of geography. Interesting1y, RRA/PRA technology is now being transferred from South to North, with these methods being used in Canada, Switzerland, the UK, Norway and Australia, and probably elsewhere as well.
Country
Publisher
Institute of Development Studies
Theme area
Governance and participation in health
Title of publication The use of participatory appraisal by veterinarians in Africa
Date of publication
2000 December
Publication type
Academic paper
Publication details
Revue Scientifique et Technique (Rev Sci Tech) 19 3 pp 702-714
Publication status
Published
Language
English
Keywords
participatory research, Africa, community monitoring
Abstract
This article reports on a questionnaire survey that was used to obtain information on the use of participatory appraisal (PA) from veterinarians working in Africa. The term 'participatory appraisal' refers to a range of methods for data collection, learning and facilitation, which enable local people to play an active role in defining, analysing and solving their problems. A low overall response rate of 28.6% was achieved. Within Africa, response rates varied from 15.6% from government veterinarians to 47.6% from veterinarians working with non-governmental organisations. Information is presented on preferred methods, specific uses, levels of training and perceived advantages and disadvantages of PA. While PA was considered by many informants to be a valuable approach to working with communities to analyse and solve local animal health problems, respondents also identified constraints to the wider use of PA. These constraints included lack of financial resources, low availability of relevant training courses and materials, lack of time to attend training courses, and negative attitudes among colleagues. The author concludes that greater institutional awareness of the role of PA in the development of Veterinary Services is required. Such awareness might be achieved by wider dissemination of experiences related to the use of PA and the development of veterinary-orientated training courses for centrally-based personnel and workers in the field. The latter should include attention to appropriate attitudes and behaviour for veterinary professionals who are attempting to develop services according to the priorities and capacity of the community.
Country
Publisher
Office international des epizooties revue scientifique et technique
Theme area
Governance and participation in health
Title of publication Modifying Photovoice for community-based participatory Indigenous research
Date of publication
2008 January
Publication type
Academic paper
Publication details
Social Science & Medicine 66 / pp 1393-1405
Publication status
Published
Language
English
Keywords
participatory research, Canada, photojournalism, social power, knowledge systems
Abstract
This paper reports on the experience of applying Photovoice to an Indigenous population in Canada. Scientific research occurs within a set of socio-political conditions, and in Canada research involving Indigenous communities has a historical association with colonialism. Consequently, Indigenous peoples have been justifiably sceptical and reluctant to become the subjects of academic research. Community-Based Participatory Research (CBPR) is an attempt to develop culturally relevant research models that address issues of injustice, inequality, and exploitation. The work reported here evaluates the use of Photovoice, a CBPR method that uses participant-employed photography and dialogue to create social change, which was employed in a research partnership with a First Nation in Western Canada. Content analysis of semi-structured interviews (n ¼ 45) evaluated participants’ perspectives of the Photovoice process as part of a larger study on health and environment issues. The analysis revealed that Photovoice effectively balanced power, created a sense of ownership, fostered trust, built capacity, and responded to cultural preferences. The authors discuss the necessity of modifying Photovoice, by building in an iterative process, as being key to the methodological success of the project.
Country
Publisher
Social Science and Medicine, Elsevier Limited
Theme area
Governance and participation in health
Title of publication Participatory Rural Appraisal as qualitative research: distinguishing methodology issues from participatory claims
Date of publication
2001
Publication type
Report
Publication details
Human Organization 60 4 pp 380-389
Publication status
Published
Language
English
Keywords
participatory research, international, social participation
Abstract
Anthropologists and many others are making increasing use of participatory research methods in a variety of applied contexts. While aware of the potential advantages of such methods, this paper outlines a number of methodological issues that need to be carefully considered. Such issues, when taken together with the problem of combining participatory with qualitative and quantitative research, argue strongly not only for caution in using the methods but also for the need to undertake basic research on participatory methods themselves. This paper looks at the development of participatory rural appraisal (PRA) in development research, and critically examines three methods-interviewing, visualisation, and ranking/scoring-in terms of their relation to established qualitative research. It then turns to the problems that arise from using PRA techniques. Finally, the validity and reliability of PRA are discussed in relation to arguments about sequencing/triangulating research techniques, an argument which is shown to be as problematic as the unexamined use of PRA.
Country
Publisher
Human Organization
Theme area
Governance and participation in health
Title of publication Ethical Issues in Community-Based Participatory Research: Balancing Rigorous Research with Community Participation in Community Intervention Studies
Date of publication
2006 December
Publication type
Academic paper
Publication details
/ / / pp /-/
Publication status
Published
Language
English
Keywords
community based research, international, intervention studies, ethics
Abstract
The purpose of this paper is to identify potential sources of tension between the values of scientific rigor and community participation in Community Based Participatory Research (CBPR). The paper highlights that CBPR lies at the nexus of two major underlying ethical concerns—respect for community autonomy and the fair allocation of limited public resources—which have generated considerable controversy about appropriate criteria for evaluating CBPR grant proposals. The complexity of evaluating CBPR proposals is compounded by the multiple purposes that it serves: (1) an ethical function of demonstrating respect for community autonomy; (2) a research method for eliciting ideas for interventions to improve population health; and (3) an intervention in itself, seeking to enhance the capacities of community participants. The authors conclude that growing use of CBPR raises two new ethical issues that deserve greater public attention: first, the problem of securing informed consent and demonstrating respect for community autonomy when the locus of research shifts from the individual to community level; and second, fair distribution of scarce public resources when practical constraints make the most rigorous research designs for assessing the effects of community interventions virtually impossible. In light of recent federal initiatives, it is critical to achieve a common understanding of appropriate ethical and scientific standards for assessing the merits of CBPR.
Country
Publisher
Policy and Practice
Theme area
Governance and participation in health
Title of publication Making a difference: Linking research and action in practice, pedagogy, and policy for social justice: Introduction
Date of publication
2012
Publication type
Academic paper
Publication details
Current Sociology 60 123 pp /-/
Publication status
Published
Language
English
Keywords
participatory research, international, equity, gender
Abstract
In this introductory article, the authors begin by briefly tracing the methodological background to linking research and action, focusing particularly on action research, participatory research, and feminist research. The authors provide an outline of the articles that showcase through specific case studies how sociologists link research and practice in diverse contexts including health, culture, education, labour, migration, violence against women, and polling. The authors comment that linking research and action has implications for knowledge creation, distribution, shifting power relations for achieving social change, and, ultimately, challenging social structures for social justice.
Country
Publisher
SAGE Publications
Theme area
Governance and participation in health
Title of publication The role of HIV/AIDS committees in effective workplace governance of HIV/AIDS in South African small and medium-sized enterprises (SMEs)
Date of publication
2008
Publication type
Academic paper
Publication details
SAHARA Journal 5 1 pp 2-10
Publication status
Published
Language
English
Keywords
social accountability, social participation, international, AIDS, committees, workplace governance
Abstract
This study assessed the role of workplace HIV/AIDS committees as a means of workplace governance on HIV/AIDS. In-depth qualitative case studies were conducted in five South African small and medium-sized enterprises (SMEs) that were actively implementing HIV/AIDS policies and programmes. Companies commonly implemented HIV/AIDS policies and programmes through a workplace committee dedicated to HIV/AIDS or a generic committee dealing with issues other than HIV/ AIDS. Management, through the human resources department and the occupational health practitioner often drove initial policy formulation, and had virtually sole control of the HIV/AIDS budget. Employee members of committees were mostly volunteers, and were often production or blue collar employees, while there was a notable lack of participation by white-collar employees, line management and trade unions. While the powers of workplace committees were largely consultative, employee committee members often managed in an indirect manner to secure and extend social protective rights on HIV/AIDS to employees, and to monitor their effective implementation in practice. Workplace committees represented one means to facilitate more effective workplace HIV/AIDS governance, but the increased demands on collective bargaining as a result of anticipated rises in AIDS-related morbidity and mortality might prove to be beyond the scope of such voluntary committees in the longer term.
Country
Publisher
SAHARA Journal (Journal of Social Aspects of HIV/AIDS Research Alliance), Africa Journals Online
Theme area
Governance and participation in health
Title of publication Social Audits for strengthening accountability: Building blocks of human rights based programming
Date of publication
2007
Publication type
Document
Publication details
Practice Note: Bangkok. UNESCO Bangkok / / pp /-/
Publication status
Published
Language
English
Keywords
social accountability, community monitoring, Thailand, development programmes, management techniques
Abstract
This note is an attempt to analyze the instrumental value of social audits in guiding programming from the perspective of human rights-based approaches (HRBAs). In the documentation of experiences and programmes1 that incorporated HRBAs in several Asia-Pacific countries between the years 2004-2005, it was found that various forms of social audits have been successfully employed to enlist duty bearer accountability and in claiming entitlements. In diverse situations relating to the State’s obligations in regard to policy planning/implementation, service providers’ responsibilities in relation to delivery of services, or in securing meso (middle)-level duty bearers’ accountability towards their stakeholders, it has been observed that social audits have been effectively deployed under various names and to varying effect. Some of the Lessons Learned Project (LLP) case studies that explicitly recorded the use of social audits are: the right to food and the campaign under the right to information in India; the strategies adopted by Action Aid Nepal (AAN) to empower dalits to mobilize against discrimination and exploitation; the role of media organisations in the Philippines in developing capacities to empower rights holders to claim rights; and the strategies used by Javanese farmers in Indonesia to analyze and influence local budgetary allocations. In this note, the attempt to analyze the use of social audits from the HRBA perspective includes setting boundaries on the definitions of social audits; offering a framework for categorization of different kinds of social audits; and then applying them via some illustrations and examples. Illustrations have been used primarily from documented case studies under the LLP, but globally available examples, where relevant, have also been reviewed.
Country
Publisher
UNESCO Asia and Pacific Regional Bureau for Education
Theme area
Governance and participation in health
Title of publication Accountability and Social Action in Health A case study on solid waste management in three local authority areas of Zimbabwe
Date of publication
2013 March
Publication type
Report
Publication details
/ / / pp /-/
Publication status
Published
Language
English
Keywords
social accountability, Zimbabwe, solid waste management
Abstract
This case study shares the evidence and experience of the research, activities and the lessons learnt by the Training and Research Support Centre (TARSC) and Civil Forum on Housing (CFH) during a participatory research project in Zimbabwe. Solid waste management is a major challenge to most urban local authorities in Zimbabwe. Rapid urbanisation in the last decade, coupled with economic decline and social disruption, placed considerable strain on local authorities’ resources, resulting in their failure to provide adequate services to residents. By 2009, residents were discontent about waste management and the social problems created by waste dumping. To build capacity, strengthen accountability and facilitate sustainable options at the local level on solid waste management, Training and Research Support Centre (TARSC) and Civil Forum on Housing (CFH) used participatory research in 2010 to map the situation. Training and working with community-based researchers, TARSC and CFH identified actions for communities, the private sector and service organisations in three local authority areas of Zimbabwe (Chitungwiza, Epworth and Mutare). Researchers and civil society organisations met with the local authorities and industry and identified areas for follow-up action. The community-based researchers implemented civic education on social waste management and clean-up campaigns. As civil society, the researchers also engaged with local authorities and the private sector on waste recycling and reuse, monitored and raised issues with the local authority on waste disposal and used community feedback meetings to raise awareness and provide feedback and review of actions.
Country
Publisher
Training and Research Support Centre (TARSC)
Theme area
Governance and participation in health
Title of publication Community views on the essential health benefit in Zimbabwe
Date of publication
2012
Publication type
Newspaper Article
Publication details
/ / / pp /-/
Publication status
Published
Language
English
Keywords
social accountability, Zimbabwe, health services
Abstract
This document reports on the results of a cross-sectional study conducted in Zimbabwe to understand the community’s views on the essential health benefit. An assessment was thus implemented in late 2012 by Training and Research Support Centre, working with community based researchers from various civil society organisations. The assessment aimed to determine community, local leaders and frontline workers views on key areas relevant to the framing of the Essential Health Benefit (EHB) as input to policy dialogue in this area so that the final design would be responsive to community views. The EHB is also a means to hold service providers accountable for their delivery on service entitlements. The assessment aimed more specifically to determine priority public health problems the EHB should address and any important features of their distribution by social and economic groups that services need to respond to. Also, it aimed to determine the services for health promotion, prevention, PHC, treatment and care, rehabilitation and palliative care that communities expect to see in place at community, primary and district level that would (i) address these priority health needs (ii) fulfill the constitutional right to health services. Lastly, it aimed to determine the roles and contributions of ministry of health, other ministries, other agencies and of communities (households, communities and leaders) in providing these services.
Country
Publisher
Training and Research Support Centre (TARSC)
Theme area
Governance and participation in health
Title of publication THEnet’s Evaluation Framework for Socially Accountable Health Professional Education
Date of publication
2011
Publication type
Report
Publication details
Version 1.0 – Monograph I (1 ed.) / / pp /-/
Publication status
Published
Language
English
Keywords
social accountability, international, health education
Abstract
This document provides the first version of THEnet’s Evaluation Framework for Socially Accountable Health Professional Education. It allows schools to get a sense of where they are on the road towards greater social accountability and in their ability to increase impact on health and health services. This first version of the Framework centers on medical education. However, the
Framework focuses on core common elements and was tested across health disciplines at two of THEnet schools, and the authors believe it can serve as a foundation to evaluate other health professional education as well. THEnet’s Evaluation Framework also serves as a starting point for its collaborative research activities. Hence, it also helps identify research and data gaps to strengthen the evidence base.
Country
Publisher
The Training for Health Equity Network
Theme area
Governance and participation in health
Title of publication Civic Engagement and Public Accountability: An Analysis with Particular Reference to Developing Countries
Date of publication
2010
Publication type
Academic paper
Publication details
Public Administration and Management (PAM), 15 2 pp 381-417
Publication status
Published
Language
English
Keywords
social accountability, low income countries, civil society
Abstract
This paper sets out to perform two tasks, namely to (a) explore and analyze cross-cultural evidence of social accountability in the developing world and (b) evaluate the claims of the advocates of social accountability in view of the socio-economic and political dynamics. The role of civic engagement in ensuring public accountability has become a catchword in recent years. There is a consensus that social accountability mechanisms based on civic engagement can hold public officials accountable by complementing state accountability mechanisms. However, there are a number of contextual factors facilitating as well as inhibiting the effectiveness of social accountability. These are explored by the authors as described above.
Country
Publisher
Southern Public Administration Education Funding (SPAEF)
Theme area
Governance and participation in health
Title of publication Community Based Monitoring System
Date of publication
Publication type
Document
Publication details
International Development Research Centre, Canada. CIVICUS / / pp /-/
Publication status
Published
Language
English
Keywords
social accountability, Africa, Asia, Latin America, toolkit
Abstract
This document provides a detailed description on the uses and challenges of The Community-Based Monitoring System (CBMS). The author begins by describing it as an organized way of collecting, analyzing, and verifying information at the local/community level to be used by local governments, national government agencies, non-governmental and civil society organizations for planning, budgeting, and implementing local development programs. CBMS also serves to monitor and evaluate the performance of government agencies. Piloted in the Philippines in 1994, with the support of International Development Research Centre (IDRC), CBMS is now being implemented in 14 countries of Africa, Asia, and Latin America. Through its report on the countries in the case studies provided, the author illustrates how informed public investment is a key to reducing poverty and addressing inequalities in society, and how CBMS requires timely and accurate data to measure progress and plans for investment. Accurate data is also necessary for scientific analysis and policy application.
Country
Publisher
PG Exchange
Theme area
Governance and participation in health
Title of publication Citizens and Service Delivery: Assessing the Use of Social Accountability Approaches in Human Development Sectors
Date of publication
2012
Publication type
Report
Publication details
The World Bank Publications / / pp /-/
Publication status
Published
Language
English
Keywords
social accountability, health, citizens, service delivery, international
Abstract
This report reviews international evidence on implementation of measures for social accountability. In many low and middle income countries, poor quality of public service delivery driven an agenda for better governance and accountability. This has raised interest in the idea that citizens can contribute to improved quality of service delivery by holding policy-makers and providers of services accountable. Various “social accountability” tools aim to inform citizens and communities about their rights, the standards of service delivery they should expect, and actual performance; and facilitate access to formal redress mechanisms to address service failures. This report reviews how citizens – individually and collectively – can influence service delivery through access to information and opportunities to use it to hold providers accountable. It focuses on measures that support the use of information and grievance redress mechanisms.. It synthesizes experience to date; and identifies what resources are needed to support more effective use of social accountability tools and approaches. The report concludes that the relationships between citizens, policy-makers, program managers, and service providers are complicated, not always direct or easily altered through a single intervention, such as an information campaign or scorecard exercise.
Country
Publisher
The World Bank Publications
Theme area
Governance and participation in health
Title of publication Community participation in local health boards in a decentralized setting: cases from the Philippines
Date of publication
2001 December
Publication type
Academic paper
Publication details
Health Policy and Planning 16 Suppl 2 pp 61-69
Publication status
Published
Language
English
Keywords
social accountability, Social participation, Philippines, health boards
Abstract
This study of four cases analyzed the role of local health boards in enhancing community participation and empowerment under a decentralized system in the Philippines. Local government units (LGUs) with functioning local health boards were compared with LGUs whose health boards were not meeting regularly as mandated by law. The study found that there were more consultations with the community, fund-raising activities, health initiatives and higher per capita health expenditure in LGUs with functioning local health boards. Only the mayors and municipal health officers felt empowered by devolution. In general, awareness of devolution and their potential roles in health decision-making was low among members of the community. These findings can be attributed to the socio-cultural and historical traditions of centralized governance with little popular participation, overall attitudes of the community and board members, perceptions of health as primarily a medical matter, economic circumstances of LGUs, and insufficient preparation for devolution. Recommendations are suggested in response to these findings.
Country
Publisher
Health Policy and Planning, Oxford University Press
Theme area
Governance and participation in health
Title of publication Practitioners Convening on Community Monitoring for Accountability in Health
Date of publication
2011
Publication type
Conference Proceedings
Publication details
Application for the 'Practitioners Convening on Community Monitoring for Accountability in Health'. Open Society Foundation - Public Health Program; Accountability and Monitoring in Health Initiative / / pp /-/
Publication status
Published
Language
English
Keywords
social accountability, international, Community monitoring
Abstract
This document informs readers about the legacy of the Accountability and Monitoring in Health Initiative1 (AMHI) supporting civil society groups to use community monitoring as a mechanism for ensuring greater government accountability and transparency in health care to its citizens at the local, national, regional and global levels. The absence of spaces and opportunities for practitioners of community monitoring for accountability in health to come together to share and collectively reflect on their experiences and to think creatively about the field and its future has been identified as a critical gap that is hampering the advancement of the field. The report presents deliberations at meeting to address this gap with experienced practitioners in community monitoring for accountability in health in July 18 – 20, 2011 in South Africa.
Country
Publisher
Affiliated Network for Social Accountability (ANSA)
Theme area
Governance and participation in health
Title of publication Strengthening accountability to citizens on gender and health
Date of publication
2008
Publication type
Academic paper
Publication details
Global Public Health 3 S1 pp 104-120
Publication status
Published
Language
English
Keywords
social accountability, international, gender, health
Abstract
This paper reviews the practice of accountability to citizens on gender and health, assesses gaps, and recommends strategies. Accountability refers to the processes by which those with power in the health sector engage with, and are answerable to, those who make demands on it, and enforce disciplinary action on those in the health sector who do not perform effectively. In this paper, four kinds of accountability mechanisms have been used by citizens to press for accountability on gender and health. These include international human rights instruments, legislation, governance structures, and other tools, some of which are relevant to all public sector services, some to the health sector, some to gender issues, and some to gender-specific health concerns of women. There are few instances wherein private health sector and donors have been held accountable. Rarely have accountability processes reduced gender inequalities in health, or addressed ‘low priority’ gender-specific health needs of women. Accountability with respect to implementation and to marginalized groups has remained weak. This paper recommends that: (1) the four kinds of accountability mechanisms be extended to the private health sector and donors; (2) health accountability mechanisms be engendered, and gender accountability mechanisms be made health-specific; (3) resources be earmarked to enable government to respond to gender-specific health demands; (4) mechanisms for enforcement of such policies be improved; and (5) democratic spaces and participation of marginalized groups be strengthened.
Country
Publisher
Global Public Health, Routledge, Taylor and Francis Group
Theme area
Governance and participation in health
Title of publication Participatory Budgeting
Date of publication
2007
Publication type
Report
Publication details
Public Sector Governance and Accountability Series, Edited by Shah, A. / / pp 55-87
Publication status
Published
Language
English
Keywords
social accountability, social participation, international, participatory budgeting
Abstract
This publication presents a series of case studies on the experiences of participatory budgeting across the different regions of the world. Participation is important in developing countries as a means of improving the performance and accountability of bureaucracies and improving social justice. There are two basic criteria for participation: it should be broadly representative of the population and should involve meaningful discourse that affects public decision-making. Reviews of participation in Poverty Reduction Strategy Paper (PRSP) processes show that these criteria have not been met in most cases. However citizen involvement in budgeting has been more successful. Citizen participation made local service delivery more efficient and effective in the country cases reviewed. In most of the case studies, NGOs analysed the budget and mobilised citizens. These NGOs seek to represent the poor and disseminate their views to the government. They do not offer direct citizen involvement, but without their involvement participation would be reduced. Budget participation can influence governments even where they have not embraced direct involvement of citizens in decision-making. This depends on NGOs communicating analyses of spending choices, public service effectiveness, and budget execution to the public, media, and elected officials. A key policy implication for donors is therefore targeted support to civil society. However, donors and NGOs often overlook the importance of government administrations in implementing participation.
Country
Publisher
The World Bank
Theme area
Governance and participation in health
Title of publication Community accountability at peripheral health facilities: a review of the empirical literature and development of a conceptual framework
Date of publication
2012
Publication type
Academic paper
Publication details
Health Policy and Planning 27 7 pp 541-554
Publication status
Published
Language
English
Keywords
social accountability, low and middle-income countries, public accountability
Abstract
This paper summarises the results of a systematic review of published material on public accountability in low and middle-income countries. Public accountability has re-emerged as a top priority for health systems all over the world, and particularly in developing countries where governments have often failed to provide adequate public sector services for their citizens. One approach to strengthening public accountability is through direct involvement of clients, users or the general public in health delivery, here termed ‘community accountability’. The potential benefits of community accountability, both as an end in itself and as a means of improving health services, have led to significant resources being invested by governments and non-governmental organizations. A systematic search identified 21 papers from low- or middle-income countries describing at least one measure to enhance community accountability that was linked with peripheral facilities. Mechanisms covered included committees and groups (n = 19), public report cards (n = 1) and patients’ rights charters (n = 1). The authors highlight from the evidence in the papers the lack of data on the impact of community accountability mechanisms linked to peripheral facilities and present a conceptual framework and a set of ideas that might contribute to future studies.
Country
Publisher
Oxford University Press
Theme area
Governance and participation in health
Title of publication Taking stock of the literature: Desk Review on Democratic Accountability and Service Delivery
Date of publication
2013 January
Publication type
Document
Publication details
International Institute for Democracy and Electoral Assistance / / pp /-/
Publication status
Published
Language
English
Keywords
social accountability, international, mechanisms
Abstract
This paper seeks documents how different modalities of democratic accountability are linked to improved service delivery. This paper addresses a double democratic challenge: to strengthen formal and legal mechanisms that allow citizens to articulate and voice their policy concerns, and to encourage elected and non-elected representatives to effectively respond to the provision of public services. The first part of the paper explores the concept of democratic accountability, and discusses the different approaches identified in the existing literature, including social and political accountability approaches. It also discusses the roles of different agents and multiple political arenas. The second, empirical part of the report offers a detailed review of 16 case studies in which citizens or politicians have held government officials accountable for the delivery of public services. These cases are analysed according to the proposed four dimensions of democratic accountability. Based on these evaluations, the paper highlights key accountability dimensions that contribute to improved delivery of government services and advances policy recommendations for democracy promotion.
Country
Publisher
International Institute for Democracy and Electoral Assistance
Theme area
Governance and participation in health
Title of publication Antiretroviral Therapy in Primary Health Care: Experience of the Khayelitsha Programme in South Africa. Case Study
Date of publication
2003 July
Publication type
Report
Publication details
Series on the Perspectives and Practice in Antiretroviral Treatment; Antiretroviral Therapy in Primary Health Care. The World Health Organisation / / pp /-/
Publication status
Published
Language
English
Keywords
social accountability, South Africa, AIDS, antiretroviral therapy
Abstract
This documents provides reports on the Khayelitsha experience with HIV and AIDS primary health care clinics. In April 2000, in collaboration with the Provincial Administration of the Western Cape, MSF set up three HIV/AIDS dedicated clinics within Khayelitsha’s primary health care centers. The Khayelitsha ARV treatment project was initiated to demonstrate that treating HIV/AIDS with antiretroviral (ARV) drugs in a primary health care setting and in a resource-limited environment is feasible and replicable. In addition, it aimed to prove that developing countries can provide affordable HIV/AIDS care with low-cost ARV drugs. After two years, the programme has produced invaluable lessons, which are outlined in this paper.
Country
Publisher
The World Health Organisation
Theme area
Governance and participation in health
Title of publication Allies unknown: Social accountability and legal empowerment
Date of publication
2010
Publication type
Academic paper
Publication details
Health and Human Rights; An International Journal 12 1 pp 83-93
Publication status
Published
Language
English
Keywords
social accountability, international, law
Abstract
This essay suggests that two strands of social action which have hitherto developed separately - legal empowerment and social accountability - ought to learn from one another. Legal empowerment efforts grow out of the tradition of legal aid for the poor; they assist citizens in seeking remedies to breaches of rights. Social accountability interventions employ information and participation to demand fairer, more effective public services. The two approaches share a focus on the interface between communities and local institutions. The legal empowerment approach includes the pursuit of redress from the wider network of state authority. The essay suggests that social accountability interventions should couple local community pressure with legal empowerment strategies for seeking remedies. Legal empowerment programs, for their part, often under-emphasize injustices related to essential public services such as health and education, perhaps in part because they tend to wait for communities and individuals to raise problems. Instead, legal empowerment programs should learn from social accountability practitioners' use of aggregate data as a catalyst for community action. Legal empowerment organizations would also benefit from adopting the attention to empirical impact evaluation that has characterized experimentation in social accountability.
Country
Publisher
Harvard School of Public Health François-Xavier Bagnoud Center for Health and Human Rights
Theme area
Governance and participation in health
Title of publication Voice and Accountability: The Role of Maternal, Neonatal and Child Health Committee
Date of publication
2011 September
Publication type
Report
Publication details
Neonatal and Child Health Committee / / pp /-/
Publication status
Published
Language
English
Keywords
social accountability, Bangladesh, maternal and child health
Abstract
This paper describes a qualitative survey of the Bangladeshi Maternal and Child Health (MNCH) committee’s role towards social participation and social power. The study aims to explore how the MNCH committee encouraged community participation and how its communication activities empowered the community people to ensure the healthcare needs of the poor and disadvantaged people. A range of qualitative method was used in the study. In-depth interview, focus-group discussion, informal discussion, observation and document review were used as data collection method. This study conducted in two sub-districts of Nilphamari and Mymensingh districts of Bangladesh during February-April 2010. Thematic content analysis technique was followed. Findings reveal that the committee members took necessary steps to solve the maternal complication by referral, follow-up of referred cases, and providing financial support to the extreme poor if needed, and the committee helped increase the availability of healthcare service providers and improve the nature of services accessible to the community people.
Country
Publisher
BRAC Education Programme
Theme area
Governance and participation in health
Title of publication Do They Work? Assessing the Impact of Transparency and Accountability Initiatives in Service Delivery
Date of publication
2012
Publication type
Document
Publication details
Development Policy Review / / pp /-/
Publication status
Published
Language
English
Keywords
social accountability, international, transparency initiatives
Abstract
This article sets out to review a variety of different transparency and accountability initiatives (TAIs), so as to assess their impact. The authors attempt to systematically examine the evidence on the impact of such TAIs in the field of public service delivery. TAI’s have emerged as a key strategy for improving public services, but the links between transparency and accountability and their impact on service delivery are often largely assumed. The main argument of the paper is that despite the popularity of such initiatives, there is little evidence to make emphatic claims about the conditions under which TAIs will lead to effectiveness and impact. The article reviews a range of TAIs to assess their impact. It finds a mass of evidence suggesting that a range of accountability initiatives have been effective in their immediate goals, and that there is also strong evidence of impact on public services in a range of cases, but that evidence of impact on the quality and accessibility of services is more mixed.
Country
Publisher
Department for International Development (DFID) - Research for Development
Theme area
Governance and participation in health
Title of publication Social Audit Manual: A Guide to Support ‘Beneficiaries’ to become ‘Right Holders’
Date of publication
2007 October
Publication type
Document
Publication details
International Planned Parenthood Federation (IPPF), South Asia Regional Office / / pp /-/
Publication status
Published
Language
English
Keywords
social accountability, community monitoring, Asia, Africa, Latin America
Abstract
This manual is prepared as a guidance note for preparing stakeholders to effectively participate in social audit of sexual and reproductive health and rights (SRHR) programmes in Asia, Africa and Latin America. This manual is meant for not only those who are involved in planning, implementing and evaluating SRHR programmes but also for those who are beneficiaries of such programmes. In Social Audit a set of tools are administered for conducting various investigations ranging from facility survey, mapping of services in a district, outcome documentation, exit interviews and focus group discussions with providers and users of SRHR services. Social audit, to be meaningful, should involve a cross section of civil society, partners from government and representatives of marginalized and vulnerable communities. To ensure participation of all stakeholders beyond tokenism, all of them should undergo orientation training in which they would be informed about the rationale and validity of the audit exercise. This manual will also help in conducting such training.
Country
Publisher
International Planned Parenthood Federation (IPPF), South Asia Regional Office
Theme area
Governance and participation in health
Title of publication Social Accountability: Tools, Techniques, Challenges and Learning
Date of publication
Publication type
Slide presentation
Publication details
The White Ribbon Alliance for Safe Motherhood / / pp /-/
Publication status
Published
Language
English
Keywords
social accountability, India, tools, maternal health
Abstract
This powerpoint presentation serves as a toolkit providing information on the uses, techniques, as well as the challenges of implementing social accountability in the maternal health delivery system in India.
Country
Publisher
The White Ribbon Alliance for Safe Motherhood
Theme area
Governance and participation in health
Title of publication Bringing Citizen voice and client focus into service delivery
Date of publication
2001 July
Publication type
Report
Publication details
IDS Working Paper 138 / pp /-/
Publication status
Published
Language
English
Keywords
social accountability, international, governance
Abstract
This paper examines over sixty studies of both public-sector reforms to foster stronger client focus in service delivery; and civil-society initiatives to demand improved services. This work was concerned to identify means of amplifying citizen 'voice' such that engagement with the state moves beyond consultative processes to more direct forms of influence over policy and spending decisions. The case studies upon which this research is based are drawn from around the world, from developing and developed countries. They are organised into 14 different types of 'voice' or 'responsiveness' mechanisms. Across different types of public service, the potential for citizen voice, and varying degrees of public sector responsiveness, can be surmised from features of service design and delivery such as the complexity of the technology involved in the service, the remoteness, geographical, social and educational, of providers, the extent to which the service is a shared good or an individually consumable product, or the social and environmental consequences of dramatic service break-down. Variations in voice and client focus are also explained by client characteristics: the social status of clients, their geographic concentration, and whether they have a sustained or one-off relationship with providers. The study concludes with policy-relevant findings on ways of enhancing citizen voice in decision-making, planning, and monitoring of public services. For citizen engagement with public service providers to move beyond consultation to real influence, citizens must enjoy rights to a more meaningful form of participation. This would include formal recognition for citizens' groups, their right to information about government decision-making and spending patterns, and rights to seek redress for poor-quality service delivery. Public sector providers, for their part, need assurances regarding the mandate and internal accountability of such groups.
Country
Publisher
Institute of Development Studies (IDS)
Theme area
Governance and participation in health
Title of publication Using Accountability to Improve Reproductive Health Care
Date of publication
2003
Publication type
Academic paper
Publication details
Reproductive Health Matters 11 21 pp 161-170
Publication status
Published
Language
English
Keywords
social accountability, international, reproductive health services
Abstract
Accountability is best understood as a referee of the dynamics in two-way relationships, often between unequal partners. The literature on accountability distinguishes between political, fiscal, administrative, legal and constitutional accountability. This paper focuses on accountability mechanisms in health care and how they mediate between service providers and communities and between different kinds of health personnel at the primary health care level. It refers to case studies of participatory processes for improving sexual and reproductive health service delivery. Information, dialogue and negotiation are important elements that enable accountability mechanisms to address problems by supporting change and engagement between participants. In order to succeed, efforts towards better accountability that broaden the participation of users must take into account the social contexts and the policy and service delivery systems in which they are applied, address power relations and improve the representation of marginalised groups within communities and service delivery systems.
Country
Publisher
Reproductive Health Matters, Elsevier Limited
Theme area
Governance and participation in health
Title of publication Community-based monitoring: Key to success of national health programs
Date of publication
2010 April
Publication type
Academic paper
Publication details
Indian Journal of Community Medicine 35 2 pp 214-216
Publication status
Published
Language
English
Keywords
social accountability, Community monitoring, India, accountability framework, National Rural Health Mission
Abstract
This paper discusses the performance and weaknesses in the existing health care monitoring system in India, including its strategic component of Community-Based Monitoring (CBM). The National Rural Health Mission (NRHM) was launched in 2005 by the UPA Government with the goal of improving the availability of and access to quality healthcare by people, especially for those in rural areas, the poor, women and children. In order to ensure that the services reach those for whom they are meant, the NRHM proposes an intensive accountability framework that includes CBM as a key strategy. The paper observes that the existing monitoring systems are inadequate to bring out optimal trend analysis of key performance indicators. Answers to these questions lie in community monitoring through involvement of local beneficiaries. At the moment, the monitoring of Health Programs suffers from numerous setbacks such as no dedicated cell for CBM at state or district level and lack of standardized reference manual for planning and monitoring. Multiplicity of registers and duplication of reports are still a common practice. Voluminous data are collected, which is rarely validated or used in planning. There is a mismatch between routine MIS and survey data. The 73rd and 74th amendments to the Constitution of India (April 1993) reiterates Government attempts to institutionalize CBM in health on a larger scale. Above all it is consistent with the right to health care approach till the grassroots level.
Country
Publisher
Indian Journal of Community Medicine
Theme area
Governance and participation in health
Title of publication Accountability and Principal-Agent Models
Date of publication
2012 August
Publication type
Book Section
Publication details
Oxford Handbook of Public Accountability / / pp /-/
Publication status
Published
Language
English
Keywords
social accountability, international, principal-agent theory
Abstract
This essay gives a basic overview of principal-agent theory and briefly reviews its application in two domains of political science: bureaucratic accountability to higher-level political actors, and electoral accountability of representatives to constituents. Principal-agent theory encapsulates a tradition of rational choice modelling, in which some actor(s) (the principal(s)) uses whatever actions are available, to provide incentives for some other actor(s) (the agent(s)) to make decisions that the principal most prefers. Because principal-agent theory focuses on the responsiveness of the agents decisions to the principal’s goals, and how this responsiveness is mediated by actions available to each actor as well as institutional settings in which they interact, it is a natural framework to study accountability in political institutions. In this essay, the author emphasizes that principal-agent theory is in fact a highly flexible family of models, rather than an overarching set of assumptions and results.
Country
Publisher
Oxford Handbook of Public Accountability
Theme area
Governance and participation in health
Title of publication Community participation in the Botswana Healthcare System
Date of publication
Publication type
Slide presentation
Publication details
/ / / pp /-/
Publication status
Published
Language
English
Keywords
social accountability, Social participation, Botswana, health care systems
Abstract
This poster presentation describes research which was conducted to investigate whether Botswana’s healthcare system incorporated community participation and to highlight the structures that the government has in the flow of information from its populace to the healthcare providers and the government and vice versa. Information concerning this ace to facilitate the research topic was sought through interviews with two medical health officers and one health promoter at the Ministry of Health in Botswana, Gaborone, Botswana. Results from this study show that, firstly, Botswana’s healthcare system does incorporate the views and opinions of it citizens and, secondly, that there is a structured system for information sharing between the society, healthcare providers and the government. This system of information sharing utilizes the traditional Kgotlasetting, health posts, clinics, local government, district officers and the ministry of Health. Overall, the presence of these structures to facilitate the involvement of the people, their views and opinions, illustrates the government’s understanding for a holistic approach to providing good healthcare and ensuring that the people have their health concerns addressed.
Country
Publisher
University of Botswana
Theme area
Governance and participation in health
Title of publication The Big Push Back [and push forward!]
Date of publication
2009 September
Publication type
Conference Proceedings
Publication details
/ / / pp /-/
Publication status
Published
Language
English
Keywords
social accountability, Community monitoring, international, development
Abstract
The Big Push Back, which took place on 22 September 2010, was convened by the Participation and Social Change team at the United Kingdom’s Institute of Development Studies. With over 70 attendees, the theme of the meeting was to reflect on and develop strategies for ’pushing back’ against the increasingly dominant bureaucratisation of the development agenda and the pressure to design projects/programmes and report on performance in a manner that assumes all problems are bounded/simple. This is reported to result in research that is linear (cause-effect) based, at the expense of research that is emergent, i.e. a complex, only partially controllable process in which local actors may have conflicting views on what is happening, why and what can be done about it, where complexity is recognised and accountability promoted to those people international funds are supposed to serve. The meeting also called for collaboration with people inside funding and development agencies who are equally dissatisfied with the prevailing ‘audit culture’, and communication to build public understanding that some aspects of development work that cannot be reduced to numbers are also valuable.
Country
Publisher
Aid on the Edge, Institute Of Development Studies
Theme area
Governance and participation in health
Title of publication Accountability in Poverty Reduction Strategies: The Role of Empowerment and Participation
Date of publication
2007 May
Publication type
Academic paper
Publication details
). The World Bank, Social Development Department Working Papers Series, Participation and Civic Engagement Paper No. 4 / pp /-/
Publication status
Published
Language
English
Keywords
social accountability, social power, international, poverty
Abstract
Poverty Reduction Strategies have promised stakeholder participation, but delivery has been weakened by exclusion of marginalised groups, the speed and depth and the ad hoc nature of participation events as well as macroeconomic and structural policies being off-limits. Most countries have started implementing their PRSP, with participation dwindling instead of being institutionalised. Some observers speak of a 'participation gap'. The situation seems to be slightly more promising for participation in the monitoring and evaluation of PRS, as in many countries independent civil society monitoring or participatory monitoring arrangements are planned, although mostly not yet operational.
Country
Publisher
The World Bank
Theme area
Governance and participation in health
Title of publication Methodology for Participatory Assessments: With communities, Institutions and Policy Makers. Linking Sustainability with Demand, Gender, and Poverty (Metguide)
Date of publication
2000
Publication type
Book
Publication details
World Bank Water and Sanitation Program and IRC International Water and Sanitation Centre / / pp /-/
Publication status
Published
Language
English
Keywords
social accountability, Asia, Africa, Latin America, participatory assessment
Abstract
This document is an update, supplemented with learning gained from MPAapplications worldwide during 1999-2002, of the original MPA Metguide published in March 2000.The Metguide (Methodology for Participatory Assessment with Communities, Institutions and Policy Makers) was developed by WSP and IRC in 1998 primarily for the purpose of investigating the links between the sustainability of community-marged water supply services and gender- and poverty-sensitivity of demand-responsive approaches used to establish the services. Since the completion of the global study in 1999, MPA has developed further as a tool for mainstreaming gender and social equity in large scale projects. Its applications have expanded from evaluation and monitoring to designing and planning new project interventions, and from dedicated water supply and sanitation projects into the realm of multi-sector project designs. This document presents the MPA as it is currently being used in Asia, Africa and Latin America. It consolidates the lessons learned in the process of its continuing development.
Country
Publisher
International Water and Sanitation Centre; The World Bank
Theme area
Governance and participation in health
Title of publication Participation and Accountability at the Periphery: Democratic Local Governance in Six Countries
Date of publication
2000
Publication type
Academic paper
Publication details
World Development 28 1 pp 21-39
Publication status
Published
Language
English
Keywords
social accountability, low and middle-income countries, local governance
Abstract
Democratic local governance (DLG), now a major subtheme within the overall context of democratic development, promises that government at the local level can become more responsive to citizen desires and more effective in service delivery. Based on a six-country study sponsored by USAID (Bolivia, Honduras, India, Mali, the Philippines and Ukraine), this paper analyzes the two topics of participation and accountability, finding that both show significant potential for promoting DLG, though there seem to be important limitations on how much participation can actually deliver, and accountability covers a much wider range of activity and larger scope for DLG strategy than initially appears.
Country
Publisher
World Development, Elsevier Science Limited
Theme area
Governance and participation in health
Title of publication Power to The People: Evidence From a Randomized Field Experiment On Community-Based Monitoring In Uganda
Date of publication
2009 May
Publication type
Academic paper
Publication details
Quarterly Journal of Economics 124 2 pp 735-769
Publication status
Published
Language
English
Keywords
social accountability, Community monitoring, Uganda, primary health care
Abstract
This paper presents a randomized field experiment on community-based monitoring of public primary health care providers in Uganda. Through two rounds of village meetings, localized nongovernmental organizations encouraged communities to be more involved with the state of health service provision and strengthened their capacity to hold their local health providers to account for performance. A year after the intervention, treatment communities are more involved in monitoring the provider, and the health workers appear to exert higher effort to serve the community. The authors document large increases in utilization and improved health outcomes-reduced child mortality and increased child weight-that compare favourably to some of the more successful community-based intervention trials reported in the medical literature.
Country
Publisher
Quarterly Journal of Economics, MIT Press
Theme area
Governance and participation in health
Title of publication Holding health providers in developing countries accountable to consumers: a synthesis of relevant scholarship
Date of publication
2011
Publication type
Academic paper
Publication details
Health Policy and Planning 27 4 pp 1-10
Publication status
Published
Language
English
Keywords
social accountability, Social power, international, health services
Abstract
This paper synthesizes relevant research on health provision in low-, middle- and
high-income countries with the aim of identifying factors that shape health provider accountability to consumers, and discerning promising interventions to enhance responsiveness. Health care providers in low-income countries often treat consumers poorly. Many providers do not consider it their responsibility to listen carefully to consumer preferences, to facilitate access to care, to offer detailed information, or to treat patients with respect. A lack of provider accountability to health
consumers may have adverse effects on the quality of health care they provide, and ultimately on health outcomes. Drawing on this scholarship, the authors develop a framework that classifies factors into two categories: those concerning the health system and those that pertain to social influences. Among the health systems factors that may shape provider accountability are oversight mechanisms, revenue sources, and the nature of competition in the health sector—all influences that may lead providers to be accountable to entities other than consumers, such as governments and external funders. Among the social factors explored by the authors are consumer power, especially information levels, and provider beliefs surrounding accountability. Evidence on factors and interventions shaping health provider accountability is thin. For this reason, the authors decide it not possible to draw firm conclusions on what works to enhance accountability. This being said, research does suggest four mechanisms that may improve provider responsiveness: (1) Creating official community participation mechanisms in the context of health service decentralization; (2) Enhancing the quality of health information that consumers receive; (3) Establishing community groups that empower consumers to take action; (4) Including non-governmental organizations in efforts to expand access to care. This synthesis reviews evidence on these and other interventions, and points to future research needs to build knowledge on how to enhance health provider accountability to consumers.
Country
Publisher
Oxford University Press
Theme area
Governance and participation in health
Title of publication Contextual environment and stakeholder perception of corporate social responsibility practices in Uganda
Date of publication
2011 March
Publication type
Academic paper
Publication details
Corporate Social Responsibility and Environmental Management 18 2 pp 102-109
Publication status
Published
Language
English
Keywords
social accountability, Uganda, corporate social responsibility
Abstract
The debate on dimensions of corporate social responsibility (CSR) is ongoing. This study was conducted to examine perceptions of stakeholders towards CSR activities in Uganda prompted by many questions from students undertaking a Business Administration course on the distinction between marketing activities and CSR. A cross-sectional qualitative survey found that many companies are involved in CSR activities, particularly multinationals. The public awareness of CSR is high, but there is confusion as to what it is about. The process of CSR and the influence of contextual environment factors are puzzling. The flagship of CSR through advertisements has resulted in the public perceiving it more as marketing than philanthropy or ethical action. The study provided insights for further research in other contexts.
Country
Publisher
John Wiley & Sons Ltd, Online Library
Theme area
Governance and participation in health
Title of publication Social movements and health insurance: critical evaluation of voluntary, non-profit insurance schemes with case studies from Ghana and Cameroon
Date of publication
1999 April
Publication type
Academic paper
Publication details
Social Science and Medicine 48 7 pp 881-896
Publication status
Published
Language
English
Keywords
social accountability, Ghana, Cameroun, health care financing
Abstract
This paper assesses the performance of voluntary, non-profit health insurance schemes and their potential contribution to health in the two African countries of Ghana and Cameroon. Based on fieldwork conducted in the two countries during the main rainy season (June-July) of 1996, the paper examines whether and in which way the presence or absence of a social movement component might affect the performance of voluntary, non-profit insurance schemes in attaining some key objectives of improving access to health care among the target population, as well as achieving equity, efficiency and financial viability. The paper makes this assessment by examining the performances of each of two case studies according to the criteria of social movement, efficiency, equity, access and financial results. Based on case studies of a community financing insurance scheme in Ghana and a mutual aid insurance association in Cameroon, the study concludes that the evidence is not sufficient to confirm that the presence or absence of such a social movement dynamic per se accounts for the perceived performance of either of the schemes. However, it is also argued that the dynamic of social movement could enhance the design and performance of a scheme, especially the efficiency and quality of health care. Such enhancement is possible provided that the scheme is set up in such a way as to benefit from the specific contribution of a movement component, in particular, if the scheme engages in direct negotiations with providers over the price and quality of care and makes direct payment contracts with such providers.
Country
Publisher
Social Science and Medicine, Science and Direct
Theme area
Governance and participation in health
Title of publication The Community Scorecard Approach For Performance Assessment: A WaterAid Ghana Briefing Paper
Date of publication
2004 November
Publication type
Report
Publication details
A WaterAid Ghana Briefing Paper 4 / pp /-/
Publication status
Published
Language
English
Keywords
social accountability, Ghana, community scorecard, water supplies
Abstract
This article describes Pro Net North’s experience of implementing a Community ScoreCard (CSC) process in five communities of Wa in Upper West region of Ghana while also giving a short introduction to the CSC methodology.
Country
Publisher
WaterAidGhana, WaterAid
Theme area
Governance and participation in health
Title of publication Interpreting public input into priority-setting: the role of mediating institutions.
Date of publication
2002 November
Publication type
Academic paper
Publication details
Health Policy 62 2 pp 173-194
Publication status
Published
Language
English
Keywords
social participation, international, health priority-setting
Abstract
This article is presented as a discussion about public participation in health priority-setting; and begins by highlighting how traditionally discussions on this have tended to assume that the best type of information about public values is that in which the public 'speaks for itself'. However, wherever public input has been used in priority-setting, the way in which it is used is far from transparent. Those jurisdictions that have initiated priority-setting processes have been characterised by the substantial involvement of 'mediating bodies that take on the role of interpreting information about public values. The information that they interpret is usually presented in a highly ambiguous form and does not 'speak for itself'. This article argues that these bodies are essential, but that their decision-making processes are necessarily opaque and should not be judged according to the criterion of transparency.
Country
Publisher
Health Policy, Elsevier
Theme area
Governance and participation in health
Title of publication Participatory Approaches in Health Promotion and Health Planning: A Literature Review
Date of publication
2000 June
Publication type
Report
Publication details
Health Development Agency / / pp /-/
Publication status
Published
Language
English
Keywords
social participation, UK, ethnic minority
Abstract
This document was commissioned by the Health Education Authority (HEA) as part of its Forward Research Programme to examine health inequalities, social capital, community participation and the evaluation of social action programmes. It gives a focus on particular population groups such as black and minority ethnic communities and older people.
Country
Publisher
Health Development Agency
Theme area
Governance and participation in health
Title of publication SUPPORT Tools for evidence-informed health Policymaking (STP) 15: Engaging the public in evidence-informed policymaking
Date of publication
2009 December
Publication type
Academic paper
Publication details
Health Research Policy and Systems, 7 Suppl 1 pp S15-/
Publication status
Published
Language
English
Keywords
social participation, international, health policy
Abstract
The importance of engaging the public (both patients and citizens) at all levels of health systems is widely recognised. They are the ultimate recipients of the desirable and undesirable impacts of public policies, and many governments and organisations have acknowledged the value of engaging them in evidence-informed policy development. The potential benefits of doing this include the establishment of policies that include their ideas and address their concerns, the improved implementation of policies, improved health services, and better health. Public engagement can also be viewed as a goal in itself by encouraging participative democracy, public accountability and transparency. The article suggests three questions that can be considered with regard to public participation strategies: What strategies can be used when working with the mass media to inform the public about policy development and implementation? What strategies can be used when working with civil society groups to inform and engage them in policy development and implementation? What methods can be used to involve consumers in policy development and implementation?
Country
Publisher
Health Research Policy and Systems, BioMedCentral
Theme area
Governance and participation in health
Title of publication Social Exclusion Meaning, measurement and experience and links to health inequalities: A review of literature
Date of publication
2008 September
Publication type
Publication details
WHO Social Exclusion Knowledge Network Background Paper 1 / / pp /-/
Publication status
Published
Language
English
Keywords
social participation international, literature review, WHO
Abstract
The objectives of this literature review have been to explore the meanings attaching to the concept of social exclusion and to start to consider their implications for policy/action in general and for the work of the WHO Commission in particular. In the first section of the review, explanations offered for the rise to prominence of the concept from the 1970s are considered. The next two sections focus on the ways in which social exclusion is defined highlighting how the concept takes on different – often ‘taken for granted’ - meanings, according to the theoretical, ideological, and personal perspectives in which it is embedded and the nature of some of the exclusionary processes at work around the globe. This is followed by two sections that consider in turn some of the quantitative approaches to measuring social exclusion and the insights offered by narratives or personal stories of social exclusion. The review then moves on to explore the relevance of the concept of social exclusion for our understanding of the causes of health inequalities and in particular for the theoretical model underpinning the work of the WHO Commission on Social Determinants of Health. The final section brings together the different strands of the review in order to outline a conceptual framework to guide the work of the WHO Social Exclusion Knowledge Network.
Country
Publisher
The World Health Organisation (WHO)
Theme area
Governance and participation in health
Title of publication How can participatory development be improved?
Date of publication
2013 March
Publication type
Report
Publication details
Devex / / pp /-/
Publication status
Published
Language
English
Keywords
social participation, community monitoring, international, decentralisation
Abstract
The paper notes that reviews of the effectiveness of local participatory development indicate that elite capture in such interventions is widespread. This commentary introduces an analysis of community development and decentralization projects, which shows that such projects often fail to be sensitive to complex contexts – including social, political, historical and geographical realities – and fall short in terms of monitoring and evaluation systems, which hampers learning. Citing numerous examples, the authors demonstrate that participatory projects are not a substitute for weak states, but instead require strong central support to be effective.
Country
Publisher
Devex
Theme area
Governance and participation in health
Title of publication From Consciousness Raising to Popular Education in Latin America and the Caribbean
Date of publication
1987
Publication type
Academic paper
Publication details
Comparative Education Review 31 2 pp /-/
Publication status
Published
Language
English
Keywords
social participation, participatory research, international, popular education
Abstract
This article documents the ways in which popular education has emerged and what is known about its efficacy in the region during the last decade. It begins with a brief discussion of consciousness raising that is based primarily on Polo Freire’s influence. That section ends by providing several reasons why consciousness raising has been criticized and ultimately combined with other interventions (primarily the economic and political organisation of the poor) and why it now exists as an important component of what is termed “popular education”. Following a discussion of the characteristics and origin of popular education, the author describes participatory-investigation activities as the typical first step beyond consciousness raising, linking the latter to popular-education strategies. The author then offers an assessment of what is known about popular education’s accomplishments relative to its goals and aspirations.
Country
Publisher
University of Chicago Press
Theme area
Governance and participation in health
Title of publication Public participation in health planning and priority setting at the district level in Uganda
Date of publication
2003 June
Publication type
Academic paper
Publication details
Health Policy and Planning 18 2 pp 205-213
Publication status
Published
Language
English
Keywords
social participation, Uganda, decentralisation, priority setting
Abstract
This study set out to explore the experiences of the public and leaders with participatory planning and priority setting in health, in a decentralized district in Uganda. An exploratory qualitative approach, involving in-depth interviews with health planners at the national, district and community levels (n = 12), and five group discussions at community level with women (two groups), men, youths and adolescents (n = 51). The analysis adapted some principles from grounded theory. The five levels of the participation framework by Rifkin (1991) were used to assess the actual level of participation in the study population. Uganda has established structures for participatory planning. Within this context, district level respondents reported to have gained decision-making powers, but were concerned about the degree of financial independence they had. The national level respondents were concerned about the capacity of the districts to absorb their new roles. Actual involvement of the public in priority setting and poor communication between the different levels of the decentralization system, despite the existing structures, were additional concerns. Public participation is mainly through representatives. Majority participation is mainly at health benefits and programme activity levels. Decision-making, monitoring and evaluation, and implementation are still dominated by the locally elected leaders due to reported economic, social and cultural barriers that hinder the participation of the rest of the public.
Country
Publisher
Health Policy and Planning, Oxford University Press
Theme area
Governance and participation in health
Title of publication Who Are We To Care? Exploring the Relationship Between Participation, Knowledge and Power In Health Systems
Date of publication
2013 April
Publication type
Document
Publication details
/ / / pp /-/
Publication status
Published
Language
English
Keywords
social participation, international, social power, health systems
Abstract
This paper is divided into three sections: The first focuses on how the interaction between people’s participation, knowledge and power effects the functioning of health systems. The following section pays particular attention to approaches that can be used to build a more just and equitable health system. The final section concludes by asking a series of questions to provoke and deepen our thinking on ways we can overcome obstacles to achieving this goal, at both community level and as we move from the local to the global as a strategy for change. Each section blends discussion on concepts and issues with descriptions of experiences and case studies from around the globe, especially from countries in Latin America, Asia and east and southern Africa, where a wealth of material describes the impact of neoliberalism and globalisation on health systems, and attempts to build alternatives.
Country
Publisher
TARSC, COPASAH
Theme area
Governance and participation in health
Title of publication Community Representatives: representing the community?
Date of publication
April
Publication type
Academic paper
Publication details
Social Science and Medicine 46 7 pp 843-858
Publication status
Published
Language
English
Keywords
social participation, international, health promotion, community representative
Abstract
This paper notes that meanings of "community" are a subject of extensive debate in literatures of social analysis and to some extent health. Given that the word's meaning is not agreed, those working to promote "community participation" in health are forced to adjudicate on competing meanings in order to operationalise the notion. This raises questions about how this is done and what are the implications of particular choices for what may be achieved by the participating "community". This paper presents the findings of an empirical study which examined the manner in which ideas of "community" are operationalised by people engaged in encouraging community participation in health promotion in the context of the selection of members for health for all steering groups in healthy cities projects in the United Kingdom. It argues that the demands of the role of the "community representative" are such that particular interpretations of "community" achieve ascendance. The paper explores the consequences of the interpretation of "community" as part of the "voluntary sector" and argues that this may compromise one of the stated desired outcomes of community participation i.e. extending democracy in health decision-making.
Country
Publisher
Social Science and Medicine, Elsevier
Theme area
Governance and participation in health
Title of publication Constitution emboldens citizens to take part in budgeting
Date of publication
2013 February
Publication type
Journal Article
Publication details
Pambazuka News / 615 pp /-/
Publication status
Published
Language
English
Keywords
social participation, Kenya, participatory budgeting
Abstract
In Kwale at the Indian Ocean coast, citizens draw up budgets for their priorities in public spending. Despite being some of the most taxed citizens of the world, Kenyans have so far had little say in how their economy is managed. The Constitution of Kenya (2010) has, however, given much impetus to ordinary citizens participate in the management and decision-making process in governance socially, economically and politically. Participatory budgeting is a mechanism that civil society can use to decide how to allocate part of a municipal or public budget. The Kwale community engaged in 2012 in a needs assessment process after which the priority areas were identified before electing budget delegates at the ward level. Kwale County currently has 20 wards following the recent boundary demarcations by the Andrew Ligale-led Interim Independent Boundaries Commission. The 20 wards are in Matuga, Msambweni, Kinango and the newly created Lunga-Lunga constituencies. The ward delegates are charged with developing specific spending proposals which will later be presented to the community for validation. If the community approves of the proposals, the same are to be forwarded to the county government for consideration of implementation. If implemented, participatory budgeting is expected to benefit education, health, agriculture, roads and energy sectors.
Country
Publisher
Pambazuka News
Theme area
Governance and participation in health
Title of publication Participation and poverty reduction: an analytical framework and overview of the issues
Date of publication
2002 January
Publication type
Academic paper
Publication details
Journal of African Economies 11 1 pp 146-168
Publication status
Published
Language
English
Keywords
social participation, international, poverty
Abstract
This paper examines the relationship between community participation and the efficacy of interventions designed to reduce poverty. It outlines a simple model that identifies three actors involved in the provision of anti-poverty interventions, financiers, providers and beneficiaries. The author uses the model to illustrate what happens when the poor move from being passive beneficiaries to being the providers of these interventions. Beneficiary participation has the potential to lower the cost of providing these interventions. It can ensure that they more closely reflect the preferences of the population that they are designed to serve. However, this benefit is contingent on the ability of communities to engage in collective actions. In fractionalized communities, or where trust and/or social capital are weak, there is a risk that community participation may result in the capture of benefits by local elites, to the detriment of the poor. Further, the author argues that the failure to delegate true decision making authority (allowing for de jure but not de facto participation), may result in beneficiaries being reluctant to act because of concerns that they will be subsequently overruled.
Country
Publisher
Journal of African Economies
Theme area
Governance and participation in health
Title of publication How do health workers see community participation
Date of publication
1993
Publication type
Academic paper
Publication details
World Health Forum 14 3 pp 253-257
Publication status
Published
Language
English
Keywords
social participation, Rwanda, health workers
Abstract
A survey of health workers in Rwanda suggested that they were reluctant to accept the involvement of lay people in the promotion and implementation of primary care programmes. Various obstacles to community participation were identified by the health workers. In a questionnaire survey of the 30 health centers of the Butare Health Region in southern Rwanda health workers' were asked about their perceptions on community participation. Asked to categorize various aspects of community participation on the basis of their importance, the workers gave the following order of priorities: identifying one's own problems, paying for drugs, community management of the ambulance, choosing basic health workers, suggesting a health program and helping to evaluate results, working on the environment, helping to manage the community health center, maintaining the health center, and suggesting better hours for consultations. 83% of health workers responded that communities should not take the initiative in health promotion activities. Poverty and a lack of financial resources for drugs, treatment, and environmental improvement; ignorance about the value of participation and of health care in general; and taboos, customs, and traditions producing resistance to change were cited by health workers as obstacles to community participation. Respondents endorsed continuing education for all people through discussions and home visits. Overall survey findings suggest that the respondents are rather opposed to the involvement of laypeople in promoting and implementing primary care programs. There was confusion about the notion of community, with the health workers tending to underestimate people's potential for action, and to insist upon the need for a hierarchical structure.
Country
Publisher
World Health Forum
Theme area
Governance and participation in health
Title of publication A glass half-full: How an asset approach can improve community health and well-being
Date of publication
2010 March
Publication type
Report
Publication details
Improvement and Development Agency Healthy Communities Team / / pp /-/
Publication status
Published
Language
English
Keywords
social participation, UK, community monitoring, health inequalities
Abstract
This publication is aimed at those working with communities to challenge health inequalities, particularly in areas where this gap has widened despite implementing a range of ‘evidence based’ interventions. It presents an asset approach as a method to challenge health inequalities.
Country
Publisher
Improvement and Development Agency
Theme area
Governance and participation in health
Title of publication From Users and Choosers to Makers and Shapers: Repositioning Participation in Social Policy
Date of publication
1999
Publication type
Document
Publication details
Eldis / / pp /-/
Publication status
Published
Language
English
Keywords
social participation, international, social policies
Abstract
This article explores approaches to participation in social policy, within broader debates on the rights and responsibilities of citizenship. Drawing on studies of participation in a range of social policy arenas north and south, it explores the implications of a shift from a focus on clients or consumers of social policies to a more active engagement of citizens as agents in shaping social policies.
Country
Publisher
Eldis
Theme area
Governance and participation in health
Title of publication Bridging the gaps: Citizens, organisations and dissociation Civil Society Index summary report: 2008-2011
Date of publication
2011 August
Publication type
Report
Publication details
CIVICUS / / pp /-/
Publication status
Published
Language
English
Keywords
social participation, international, civil society, activism
Abstract
This report sets out the aims and areas of focus of the Civil Society Index (CSI) and describes findings that emerge from an analysis of the various CSI Analytical Country Reports. The report suggests from the findings that the understanding by governments and external funders of the civil society sector needs to expand to encompass non-formal movements, both traditional and online activism; and that new processes need to be instigated which better connect formal CSOs with these under-explored forms of participation, offering citizens new pathways for effective civic activism.
Country
Publisher
CIVICUS: World Alliance for Citizen Participation
Theme area
Governance and participation in health
Title of publication Participatory Learning and Action 50: Critical reflections, future directions
Date of publication
2004 October
Publication type
Book
Publication details
International Institute for Environment and Development / / pp /-/
Publication status
Published
Language
English
Keywords
social participation, international, participatory research, equity
Abstract
This paper presents the outcomes of a writers workshop held in April 2004 at the Institute for Development Studies that brought together the Participatory Learning and Action editorial team and several previous guest editors to share their wealth of experience of using participatory approaches. It provides a critique of the current state of play in participatory development. The question of ‘where are we now?’ inevitably leads to ‘where do we go next?’ From natural resource management, rights-based approaches and well-being, to literacy and communications, the 18 themed articles in this issue come from personal reflections and analysis. Each author speaks from her or his own field of experience. The articles challenge us to see how we can work more effectively together, to build on the successes of the past and to engage continuously in a process of reflection and action towards social justice.
Country
Publisher
International Institute for Environment and Development
Theme area
Governance and participation in health
Title of publication Community Participation and Sexual Health – Is There a Relationship?
Date of publication
2002
Publication type
Report
Publication details
id21 Development Research Reporting Service / / pp /-/
Publication status
Published
Language
English
Keywords
social participation, South Africa, participatory research, sexual behaviour
Abstract
This article explores whether there is a relationship between people’s degree of community involvement and participation and their sexual behaviour? The authors discuss how, if indeed this is the case, it may help to identify possible areas of HIV/AIDS intervention at community level. Researchers from the London School of Economics (LSE) investigated this relationship in a mining town in South Africa. Whereas some forms of community participation were associated with safer sexual behaviour and lower levels of HIV infection, others acted in the opposite way. The authors conclude that the findings highlight the need for further research.
Country
Publisher
Institute of Development Studies
Theme area
Governance and participation in health
Title of publication Community mobilisation key to success of 3 x 5
Date of publication
2003 December
Publication type
Document
Publication details
/ / / pp /-/
Publication status
Published
Language
English
Keywords
social participation, Eastern and Southern Africa, community monitoring, HIV, community-based organisations
Abstract
The WHO 3 x 5 plan envisages that community-based organisations, including groups of people living with HIV, will play a key role in scaling up treatment. This is not just a measure to plug gaps in the health services of heavily affected countries, but a response to evidence from early pilot programmes. These programmes have demonstrated that community participation is a key element in ensuring the acceptability of treatment. Making treatment part of the social fabric rather than a hidden enterprise is the only way to ensure long-term adherence. Before treatment is introduced, developing community capacity to carry out counselling for HIV testing will be essential. Basic symptom relief must also be taught, alongside nutritional support and skills in home care. Most important of all, treatment literacy – the basic understanding of HIV treatment – will need to be promoted, in order to convince people of the potential benefits of learning their HIV status. An early activity in any national programme should be assessment of community capacity. Where are the community-based organisations, how many of them exist, and what are they doing? Health districts will be encouraged to develop plans for community training and a community coordination committee. Once antiretrovirals arrive in a community, adherence counselling will need to be carried out by community members. It is hoped that people with HIV will play a leading role in this education process, as they have at MSF projects such as Khayelitsha in South Africa’s in Western Cape province. Expanding the cadre of community health workers who possess basic skills in dispensing medicines will be necessary. These workers will also be involved in distributing drugs and monitoring for side-effects, as well as record keeping and HIV testing. WHO also plans to fund community-based advocacy organisations that can galvanise government, NGO and private sector towards nationally agreed treatment plans. WHO recognises the importance of treatment advocacy networks in South Africa, Kenya and Thailand in forcing governments to act, and in developing treatment literacy campaigns that are owned by the community. By the end of 2005, WHO believes that formal medical outlets will need to have formed partnerships with 30,000 community-based organisations in up to 60 countries delivering large-scale treatment programmes if the `3 x 5` target is to be reached.
Country
Publisher
NAM publications
Theme area
Governance and participation in health
Title of publication International Treatment Preparedness Summit, Cape Town, March 2003
Date of publication
2003 March
Publication type
Conference Proceedings
Publication details
GMHC Treatment Issues, Gay Men’s Health Crisis. / / pp /-/
Publication status
Published
Language
English
Keywords
social participation, South Africa, social accountability, HIV treatment
Abstract
This meeting gathered activists from all continents to discuss how communities could work to improve treatment literacy. The document includes recommendations on the types of treatment literacy activities that should be developed and funded.
Country
Publisher
GMHC Treatment Issues, Gay Men’s Health Crisis.
Theme area
Governance and participation in health
Title of publication Community participation as an interactive learning process: experiences from a schistosomiasis control project in Zimbabwe
Date of publication
2003 March
Publication type
Academic paper
Publication details
Acta Tropica 85 3 pp 325-338
Publication status
Published
Language
English
Keywords
social participation, Zimbabwe, disease control
Abstract
This article reports on a schistosomiasis control project undertaken from 1994 to 1998 in Guruve District, Zimbabwe, based on the active involvement of local communities in the growing and application of the molluscicidal plant Phytolacca dodecandra as a supplement to other control measures such as chemotherapy and health education. The berries of P. dodecandra are highly molluscicidal to the intermediate host snails of schistosomiasis and is rapidly degradable in water. It was observed that plant care fluctuated during the study period. Only a few households participated in snail control activities, although 97% of respondents in a baseline survey had stated a willingness to take part. This invoked an investigation to explore the reality from a user perspective. Focus group discussions, semi-structured interviews and observations were used to solicit information. In spite of a cultural inclination for collective work, many reasons for low-level involvement emerged, inter alia the low perceived value of the project, demands for tangible benefits, inaccessible fields and weak leadership. This study shows that community participation is a complex process upon which a multiplicity of social and cultural determinants have an impact. If community participation is to become successful in development programmes it ought to be viewed as a mutual learning process where obstacles are identified and discussed and solutions shared among community members and project staff.
Country
Publisher
Acta Tropica, Elsevier
Theme area
Governance and participation in health
Title of publication Effectiveness of community participation in tuberculosis control
Date of publication
2009 October
Publication type
Academic paper
Publication details
South African Medical Journal 99 10 pp 722-723
Publication status
Published
Language
English
Keywords
social participation, South Africa, participatory research, TB control, interventions
Abstract
This study sought to determine the best approach of integrating community interventions for TB control. It evaluated the records of 3,110 new TB patients registered in three Local Service Areas (LSAs), from quarter 1 2004 to quarter 4 2005. It found that bacteriological coverage, smear conversion and treatment success rates dropped in the interventional LSA, while the control LSAs remained consistent. The defaulter rates dropped in all LSAs, while the proportion of unevaluated cases increased in the interventional LSA. However, patients registered in the clinics had better chance of successful treatment outcome compared to their hospital counterparts. The study concluded that community participation by itself is not adequate to improve the performance of a TB control programme. Enhancement of the program’s technical and organisational capacity is crucial, prior to engaging purely community interventions. Failure to observe this logical relationship would ultimately result in suboptimal performance. Therefore, the process of entrusting communities with more responsibility in TB control should be gradual and take cognisance of the various health system factors.
Country
Publisher
South African Medical Journal
Theme area
Governance and participation in health
Title of publication Civil society influence on national governance
Date of publication
2008
Publication type
Report
Publication details
Civicus Participatory Governance Programme: How can we build political for participatory governance, 17-18 June 2008. Economic Governance Programme, Idasa / / pp /-/
Publication status
Published
Language
English
Keywords
social power, social participation, South Africa, participatory budgeting
Abstract
This report concerns the proceedings of a small working group session which involved three case studies which describe and analyse civil society organisation approaches to building political will for participatory governance. Although participatory governance offers important concrete benefits for citizens and state actors alike, there is often initial resistance from political actors and government officials who are unfamiliar with such approaches. The article report also discusses the benefits of participatory budgeting.
Country
Publisher
Institute for Democracy in Africa
Theme area
Governance and participation in health
Title of publication Democratisation and Development in Tanzania: Complimentary or Contradictory Forces?
Date of publication
2013 April
Publication type
Document
Publication details
e-International Relations / / pp /-/
Publication status
Published
Language
English
Keywords
social power, Tanzania, development, democracy
Abstract
This article uses Tanzania as a case study to discuss to what extent democratisation promotes development? Critics suggest the idea that democratisation fuels development has the relationship backwards. They feel that the authoritarian traits of newly developed states like South Korea, Taiwan, and Singapore played a critical part in explaining their development. Without denying such successes, this paper challenges the belief that democracy hampers development. In other words, development in authoritarian regimes is the exception and not the rule. The first section offers a brief overview of the terms development and democratisation. The second reviews the literature by comparing those who feel democratisation has a role to play in development and those who do not. Highlighting weaknesses found in the literature, the third section suggests that the best path to development in failed authoritarian states requires support for “bottom-up” democratisation. This approach is tested in the fourth section by looking at how well it explains Tanzania’s developmental challenges and successes. The conclusion discusses how bottom-up democratisation helps explain development in countries like Tanzania and offers a better road map even if the promised results fall short of the East Asian experience.
Country
Publisher
e-International Relations
Theme area
Governance and participation in health
Title of publication Using popular education for community empowerment: perspectives of Community Health Workers in the Poder es Salud/Power for Health program
Date of publication
2009 April
Publication type
Academic paper
Publication details
Critical Public Health 19 1 pp 11-22
Publication status
Published
Language
English
Keywords
social power, USA, equity, community health workers, popular education
Abstract
This paper seeks to document the self-reported perceptions of the effects of the use of popular education on community health workers (CHWs) and their communities within the city of Oregon. Empowerment has been advanced as a strategy for eliminating remaining health disparities. Popular education promotes community empowerment by increasing individuals’ and communities’ awareness of their capacity and providing a framework and strategies through which participants can identify and resolve problems. Poder es Salud/Power for Health, a community-based participatory research project, sought to improve health and decrease disparities in African American and Latino communities in Multnomah County, Oregon, through the intervention of CHWs who used popular education. In-depth interviews were conducted with five CHWs involved in the project to explore their perceptions of the effects of the use of popular education on the CHWs and their communities. Results suggested that CHWs possessed a shared understanding of popular education. Effects on the CHWs included increases in community participation and identification, desire to advocate for the community, and sense of personal potential. Similarly, among communities, CHWs observed increases in level of participation in community events, quality and quantity of leadership, and sense of community solidarity. These results suggest that popular education, when used consistently throughout a health promotion program, can promote empowerment and thus contribute to eliminating health disparities.
Country
Publisher
Taylor and Francis Groups
Theme area
Governance and participation in health
Title of publication What is the evidence on effectiveness of empowerment to improve health?
Date of publication
2006 February
Publication type
Report
Publication details
Health Evidence Network (HEN) / / pp /-/
Publication status
Published
Language
English
Keywords
social power, Europe, equity, health services
Abstract
This is a Health Evidence Network (HEN) synthesis report on the effectiveness of empowerment strategies to improve health and reduce health disparities. The report shows that empowering initiatives can lead to health outcomes and that empowerment is a viable public health strategy. The key message from this review is that empowerment is a complex strategy that sits within complex environments. Effective empowerment strategies may depend as much on the agency and leadership of the people involved, as the overall context in which they take place.
HEN, initiated and coordinated by the WHO Regional Office for Europe, is an information service for public health and health care decision-makers in the WHO European Region. Other interested parties might also benefit from HEN. This HEN evidence report is a commissioned work and the contents are the responsibility of the authors. They do not necessarily reflect the official policies of WHO/Europe. The reports were subjected to international review, managed by the HEN team.
Country
Publisher
Health Evidence Network (HEN), World Health Organisation
Theme area
Governance and participation in health
Title of publication A Framework Linking Community Empowerment and Health Equity: It Is a Matter of CHOICE
Date of publication
2003 September
Publication type
Academic paper
Publication details
Journal of Health and Population Nutrition 21 3 pp 168-180
Publication status
Published
Language
English
Keywords
social power, international, social participation, health equity
Abstract
This paper presents a framework to explore the relationship between health equity and community empowerment. It traces the progression of the concept of participation to the present term of empowerment and the links among empowerment, equity, and health outcomes. It argues that the relationship can best be described by using the acronym CHOICE (Capacity-building, Human rights, Organizational sustainability, Institutional accountability, Contribution, and Enabling environment). Based on the concept of development as freedom put forward by Amartya Sen, the paper describes how each factor illustrates the relationship between equity and empowerment in positive health outcomes, giving appropriate examples. In conclusion, it is suggested that these factors might form the basis of a tool to assess the relationship between equity and empowerment and its impact on health outcomes.
Country
Publisher
Journal of Health and Population Nutrition; Centre for Health and Population Research
Theme area
Governance and participation in health
Title of publication Ten best readings in community participation
Date of publication
2001 August
Publication type
Academic paper
Publication details
African Health Sciences 1 1 pp 42-45
Publication status
Published
Language
English
Keywords
social power, international, health, development
Abstract
This article reviews, in the opinion of the author, the 10 most influential reading on community participation and health development. The introduction notes that some of the articles do not address health directly but still do bring crucial interpretations to the topic. All articles view community participation as an intervention by which the lives of people, particularly the poor and marginalised can be improved. In addition, they all address the issue of the value of participation to equity and sustainability. The article considers the readings under four heading: concepts and theory; advocacy; critiques and case studies. It highlights the important contributions each reading makes to the understanding of participation in the wider context of health and health development. In conclusion, the article argues that participation has not met the objectives of planners and professionals, in good part, because it is questionable as to whether viewing participation as an intervention enables them to make correct assessments of its contribution to development. The bottom line is that participation is always about power and control, an issue planners and professionals do not want explicitly to address.
Country
Publisher
African Health Sciences
Theme area
Governance and participation in health
Title of publication Power in Community: A Research and Social Action Scoping Review
Date of publication
2011
Publication type
Document
Publication details
Connected Communities / / pp /-/
Publication status
Published
Language
English
Keywords
social power, international, scoping review
Abstract
This Scoping Review explores the academic debate on power and talks with communities about power. At a time when the state is proposing to „disengage‟ from society and hand „power‟ to communities, it reviews power in communities. The academic debate points to a paradigm shift in understanding power, from power over to power to. Although not all power over is dominating power, the latter remains the conventional form of power in practice. In talking to a range of groups in four socially varied communities across the north of England, it became clear that amongst those seeking change at the grass roots, most understand power in non-dominating forms, as about cooperation, listening, sharing and enabling others. Non dominating forms of power, it is argued, offer the best potential for building participation and connecting communities. However, they are not the most effective for acting on power. Those who use them reject the way power is conventionally exercised and can end up acting on the margins and giving up expectations of wider impacts. The Scoping Review asks, therefore, how can non dominating forms of power become effective in changing power and power structures without reproducing dominating power? This report forms just one from 44 different scoping studies. As a part of the development process for the Connected Communities programme, the AHRC supported 44 small scoping studies and research reviews in 2011 to address a wide range of underpinning issues. The aim of these reviews was to: stimulate debate and provide some early outputs from the programme; inform future discussions about its shape, focus and priorities; and be of value to researchers undertaking research under the programme in the future. These reviews were commissioned follow an open call to which over 130 applications were received by the closing date in 2010.
Country
Publisher
Connected Communities
Theme area
Governance and participation in health
Title of publication What Next for Power Analysis? A Review of Recent Experience with the Powercube and Related Frameworks
Date of publication
2012 August
Publication type
Report
Publication details
Institute of Development Studies / / pp /-/
Publication status
Published
Language
Keywords
social power, international, powercube
Abstract
This paper brings together documented experiences of applying power analysis for social change. The paper draws emerging lessons from this growing stream of practice by looking across the actors, organisations and methodologies involved in power analysis in a diverse range of contexts and issues. It reviews a significant number of case studies, reports and other documents with particular emphasis on the Powercube framework and related concepts, and provides reflections on the usefulness of these power frameworks and concepts in relation to four areas of application: 1) context analysis; 2) strategy and action; 3) monitoring and evaluation; and 4) facilitation and learning. It further aims to facilitate learning and sharing both between experienced practitioners and new-comers to power analysis and to this end, it provides an annotated list and table of all documents reviewed. Finally, the paper highlights some challenges lying ahead for power analysis and invites the reader to contest emerging lessons and embark on new explorations from which more nuanced and contextualised reflections will emerge.
Country
Publisher
Institute of Development Studies
Theme area
Governance and participation in health
Title of publication Internet access and empowerment: a community-based health initiative
Date of publication
2003 July
Publication type
Academic paper
Publication details
Journal of General Internal Medicine 18 7 pp 525-530
Publication status
Published
Language
English
Keywords
social power, international, internet
Abstract
This study set out to determine whether access to health information via in-home Internet technology can positively influence empowerment among residents of a low-income urban community. In-home Internet access and training were provided to volunteers, who, along with a comparison group, were interviewed prior to and 1 year after initiation of the program. Community-based participatory research methods were used to design and implement the intervention. The study was set in A 57-block area on the West Side of Chicago. Twenty-five community residents completed all phases of the technology intervention. Thirty-five randomly selected neighbours of these residents served as the comparison group. Members of the intervention group received Internet access via WebTV, training, technical support, and access to a community specific health-oriented web page during the course of the study. Intervention group members were similar to comparison group members in terms of empowerment at baseline. After receiving Internet access and training, empowerment related to health decision-making improved significantly in the intervention group. Similar changes did not occur in the comparison group. Affinity for and appreciation of information technology also increased in the intervention group but not in the comparison group. As a result, differences in attitudes toward technology increased between the 2 groups over time. Using community-based participatory research methods, the authors found that Internet access to community-specific and general health information can lead to increased empowerment and appreciation of information technology. These benefits accrued among the intervention group but not among a random group of their neighbours.
Country
Publisher
Journal of General Internal Medicine
Theme area
Governance and participation in health
Title of publication Narrating Survival and Change in Guatemala and South Africa: The Politics of Representation and a Liberatory Community Psychology
Date of publication
2003 March
Publication type
Academic paper
Publication details
American Journal of Community Psychology 31 1/2 pp 79-90
Publication status
Published
Language
English
Keywords
social power, Guatemala; South Africa, community psychology
Abstract
This paper explores selected roles that community psychologists have played in this process of remembering the past and constructing new identities towards creating a more just future. With reference to two community groups (in Guatemala and South Africa) the authors show how efforts to “speak out” about one’s own experiences of political and military repression involve complex representational politics that go beyond the simple binary opposition of silencing versus giving voice. The Guatemalan group consisted of Mayan Ixil women who, together with the first author, used participatory action research and the PhotoVoice technique to produce a book about their past and present struggles. The South African group, working within the ambit of the Truth and Reconciliation Commission and in collaboration with the third author and others, explored ways of speaking about their roles in apartheid and post-apartheid society. Although both these initiatives can be seen as moments in on-going struggles to overcome externally-imposed repressive practices that censor the voices of marginalized communities, they also serve to dispel overly romanticized notions of “univocal” communities now liberated to express themselves in an unmediated and unequivocal fashion. The paper discusses how each group of women instead entered into subtly nuanced relationships with community psychologists involving a continual interplay between the authenticity of their self-representational accounts and the requirements of the discursive technologies into which they were being inducted and the material conditions within their sites of struggle. In both cases the group’s agenda also evolved over time, so that what emerged was not so much a particular account of themselves, or even the development of a particular “voice” for speaking about themselves, but an unfolding process—for the groups and for the community psychologists who accompanied them—of becoming active players in the postmodern, mediated world of self-representational politics and social struggle.
Country
Publisher
American Journal of Community Psychology
Theme area
Governance and participation in health
Title of publication Improving health outcomes through community empowerment: a review of the literature
Date of publication
2006 March
Publication type
Academic paper
Publication details
Journal of Health, Population and Nutrition 24 1 pp 113-120
Publication status
Published
Language
English
Keywords
social power, international, empowerment domains, case studies
Abstract
This paper reviews the literature on how empowerment can lead to an improvement in the health status of an individual, group, or community. There is a broad body of literature on empowerment, and this review has been designed to identify material, particularly case studies, that can be included within the following 'empowerment domains': Participation; Community-based organizations; Local leadership; Resource mobilization; Asking 'why'; Assessment of problems; Links with other people and organizations; Role of outside agents; and Programme management. The paper discusses the results of the literature review and provides examples, from both developed and developing countries, of how each of the 'empowerment domains' has led to an improvement in health outcomes. The results of the review should be of interest to the planners and practitioners of health, population and nutrition programmes that have a particular focus on empowerment.
Country
Publisher
Journal of Health, Population and Nutrition
Theme area
Governance and participation in health
Title of publication Discovering Community Power: A Guide to Mobilizing Local Assets And Your Organization’s Capacity
Date of publication
2005
Publication type
Document
Publication details
A Community-Building Workbook, Asset-Based Community Development Institute, School of Education and Social Policy Northwestern University / / pp /-/
Publication status
Published
Language
English
Keywords
social power, international, community assets
Abstract
This guide is a framework for measuring the extent to which projects or organisations connect to assets in the community - whether they be physical assets, assets and skills in local organisations or the skills and knowledge of local people. It includes questions for evaluating project impacts on community capacity.
Country
Publisher
Kellog Foundation; Asset-Based Community Development (ABCD) Institute School of Education and Social Policy Northwestern University
Theme area
Governance and participation in health
Title of publication Power: A Practical Guide for Facilitating Social Change
Date of publication
2011 October
Publication type
Document
Publication details
Democracy and Civil Society Programme / / pp /-/
Publication status
Published
Language
English
Keywords
social power, international, handbook
Abstract
This handbook, which accompanies the report and videos, is about taking action. It is a practical guide, which draws on the methods and tools that the authors used to build the capacity of others and to achieve social change. It is designed to be used collaboratively with others, to explore what can be achieved when working together to combine a range of different strategies and ways of analysing the issue. The key findings of this work, as well as a broader discussion on the importance of examining power, can be found in this report, Power and Making Change Happen, which demonstrates the practical outcomes of analysing power. This report is supplemented by a series of short video case studies of how some of the organisations involved in the project benefited from the experience. The handbook is for people, within organisations, networks or within community groups, who want to explore power in relation to achieving change in the interests of the communities they are working with. Its purpose is to help facilitate discussions about issues concerning power in order to deepen our understanding of the causes of social problems and the various strategies that can be taken to achieve change.
Country
Publisher
Carnegie United Kingdom Trust
Theme area
Governance and participation in health
Title of publication Measuring Empowerment in Practice: Structuring Analysis and Framing Indicator.
Date of publication
2005 February
Publication type
Document
Publication details
World Bank Policy Research Working Paper Series 3510 / pp /-/
Publication status
Published
Language
English
Keywords
social power, international, community monitoring, measuring empowerment framework
Abstract
This paper presents an analytic framework that can be used to measure and monitor empowerment processes and outcomes. The measuring empowerment (ME) framework illustrates how to gather data on empowerment and structure its analysis. It can be used to measure empowerment at both the intervention level and the country level, as a part of poverty or governance monitoring. The paper defines empowerment as a person’s capacity to make effective choices; that is, as the capacity to transform choices into desired actions and outcomes. The extent or degree to which a person is empowered is influenced by personal agency (the capacity to make purposive choice) and opportunity structure (the institutional context in which choice is made). Asset endowments are used as indicators of agency. These assets may be psychological, informational, organizational, material, social, financial, or human. Opportunity structure is measured by the presence and operation of formal and informal institutions, including the laws, regulatory frameworks, and norms governing behaviour. Degrees of empowerment are measured by the existence of choice, the use of choice, and the achievement of choice. The paper illustrates how the ME framework can be applied, using examples from four development interventions.
Country
Publisher
The World Bank
Theme area
Governance and participation in health
Title of publication Applying Bourdieu’s framework of power analysis to IR: Opportunities and limits
Date of publication
2006 March
Publication type
Document
Publication details
Paper prepared for the 47th Annual convention of the International Studies Association in Chicago, 22-25 March 2006 / / pp /-/
Publication status
Published
Language
English
Keywords
social power, international, Bourdieu, power analysis
Abstract
This paper shows how Bourdieu’s framework of power analysis can be fruitfully used to keep a wider conceptualisation of power (‘Lukes-plus-Foucault’), and yet overcome a series of fallacies and problems that the analysis of power has encountered beforehand. More specifically, the paper shows that such a framework can accommodate both the agency-structure divide and the performative analysis of ‘power’. Bourdieu’s approach is not yet a guarantee to allow the two lineages of power analysis to meet in a more convincing way; the political theory lineage which stresses questions of governance, order and the ‘political’, and the social theory tradition which is interested in the role of power for understanding particular outcomes and modes of ‘domination’.
Country
Publisher
/
Theme area
Governance and participation in health
Title of publication Global health and foreign policy
Date of publication
2012
Publication type
Report
Publication details
United Nations (2012). Agenda item 123 - Global health and foreign policy. UN Resolution. United Nations, General Assembly, report A/67/377 / / pp /-/
Publication status
Published
Language
English
Keywords
health financing, international, equity, health diplomacy
Abstract
In June 2012, the participants in the United Nations Conference on Sustainable Development put the challenges of sustainable development, encompassing its three pillars — economic, social and environmental — high on the international development agenda. Ways to address development challenges beyond the Millennium Development Goals were examined, and health was recognized as an intrinsic element of any such development. This paper outlines UN General Assembly resolution 66/115 on the linkages between health and the environment and health and natural disasters. It elaborates on the challenges inherent in those issues and provides examples of actions at the national and international levels. The ongoing work to strengthen national capacity to cope with those challenges is highlighted, as are the mechanisms and inter-agency structures within the United Nations system. On the basis of consultations with Member States, universal health coverage is examined, including approaches to supporting and strengthening health systems, in particular in response to the challenges posed by climate change and natural disasters.
Country
Publisher
United Nations (UN)
Theme area
Equity and HIV/AIDS, Governance and participation in health
Title of publication 4th Meeting of the Steering Committee of the SADC HIV and AIDS Fund; 2013, Johannesburg, South Africa
Date of publication
2013
Publication type
Conference Proceedings
Publication details
/ / / pp /-/
Publication status
Published
Language
English
Keywords
AIDS, SADC, financing, health diplomacy
Abstract
SADC Secretariat facilitated the organization of the 4th Meeting of the Steering Committee of SADC HIV and AIDS Fund held on March 11 -12, 2013 in Johannesburg, South Africa. The objectives of the meeting were to assess the progress made in the implementation of the funds, review the report of year one of the implementation of the fund and define the modalities for the second round of the implementation. The Steering Committee approved the revised guidelines for submitting proposals and the road map for the implementation of the Round II of SADC HIV and AIDS Fund. The meeting also approved the Interim Report of the Implementation of the HIV and AIDS Fund produced by the Secretariat.
Country
Publisher
Southern African Development Community (SADC)
Theme area
Health equity in economic and trade policies, Governance and participation in health
Title of publication China's Oil Diplomacy in Africa
Date of publication
2006
Publication type
Academic paper
Publication details
International Affairs 82 5 pp 937-959
Publication status
Published
Language
England
Keywords
trade, China, Africa, oil diplomacy
Abstract
Within the next five years, Chinese trade with Africa is predicted to reach $100 billion per year. Much of this springs from China's growing expansion into Africa's oil markets. It is argued that Chinese oil diplomacy in Africa has two main goals: in the short-term to secure oil supplies to help feed growing domestic demand back in China; and in the long-term, to position China as a global player in the international oil market. China’s diplomacy emphasizes state sovereignty and ‘non-interference’ in domestic affairs and is wholly disinterested in transparency or human rights. The author argues the positive returns and challenges in this engagement.
Country
Publisher
International Affairs, John Wiley and Sons Incorporated
Theme area
Governance and participation in health
Title of publication Solidarity & Africa in the New Century
Date of publication
2004
Publication type
Journal Article
Publication details
Review of African Political Economy 31 102 pp 649-656
Publication status
Published
Language
English
Keywords
global health, Africa, solidarity, health diplomacy
Abstract
Solidarity is an awareness of a common humanity and global citizenship and the voluntary acceptance of the responsibilities that go with it. It is the conscious commitment to redress inequalities both within and between countries. It is based on recognition that in an interdependent world, poverty or oppression anywhere is a threat to prosperity and stability everywhere. The second half of the 20th century witnessed the most sustained upsurge in the process of national liberation and independence in the developing or ‘Third’ world. This upsurge reached a climax in the attainment of national liberation in such diverse countries as Vietnam in 1975, the Lusophone states also in the 1970s, in Africa, and in Zimbabwe in 1980. The transition to independence and democracy in Namibia and South Africa in the 1990s represented a fitting climax of this liberation and de-colonisation process. The last quarter of the century was similarly momentous in that it witnessed the flowering of the international solidarity movement. The struggles against United States imperialism in Vietnam and elsewhere in the world, and against apartheid in Southern Africa and Portuguese fascism took on a special resonance during this period.
Country
Publisher
Review of African Political Economy
Theme area
Governance and participation in health
Title of publication Global Financial Governance and the Problem Global Governance
Date of publication
2001
Publication type
Academic paper
Publication details
Global Governance 7 4 pp 411-426
Publication status
Published
Language
English
Keywords
global health, governance, financing, health diplomacy
Abstract
The author provides a framework for thinking about inclusion in the international financial architecture and the reciprocal relationship between inclusion and ownership as key prerequisites for an effective international financial architecture. The author explores how the post-Asia reform effort has addressed the "inclusion deficit" within the international financial architecture and the governance problems within the global financial system. Alongside political inclusion, technical reforms are also argued to be needed, such as timely data dissemination, transparency, private sector involvement, prudential regulation, capital account liberalization, and moral hazard.
Country
Publisher
Global Governance
Theme area
Governance and participation in health
Title of publication Global Attitudes Project: Global Unease with Major World Powers
Date of publication
2007
Publication type
Report
Publication details
/ / / pp /-/
Publication status
Published
Language
English
Keywords
globalisation, global, power
Abstract
This Pew report analyses how little evidence there is that discontent with the major nations of the world and their leaders is resulting in greater confidence in those who have challenged the global status quo. The polling finds that African publics are increasingly concerned about the growing gap between rich and poor. In addition, the belief that economic inequality represents a major global danger has become much more prevalent in South Korea and Russia. In the face of strong criticisms of its foreign policy, the U.S. is cited in many countries about as often as the U.N. as the entity that should be responsible for dealing with the problems that confront the world. This is particularly the case among people who are most concerned about the spread of nuclear weapons. But when it comes to AIDS and the gap between rich and poor, many who see these as important threats look to their own countries to provide solutions. Most people in the survey, conducted in 46 countries and the Palestinian territories, have a favourable view of the United Nations. Negative views of the U.N. are most prevalent in the Middle East.
Country
Publisher
Pew Research Center
Theme area
Health equity in economic and trade policies, Governance and participation in health
Title of publication Anti-Globalization Forces, the Politics of Resistance, and Africa: Promises and Perils
Date of publication
2004
Publication type
Academic paper
Publication details
Journal of Black Studies 34 4 pp 580-598
Publication status
Published
Language
English
Keywords
globalisation, Africa, health diplomacy
Abstract
Globalization, the current restructuring and reshaping of the contemporary global economy, is a powerful transformative process that has acquired hegemonic status as a result of its operative logic and ideological connotation. However, the widening reach and uneven nature of globalization has provoked a counterhegemonic resistance and political counter movements that challenge its exclusionary practices and its silencing of the voices of the people. This article interrogates the grassroots counterhegemonic process of “globalization-from-below,” as captured in the work of Richar Falk, and questions the extent to which this process incorporates the marginalized voices in African civil society.
Country
Publisher
Journal of Black Studies
Theme area
Health equity in economic and trade policies, Governance and participation in health
Title of publication Playing by the rules: using intellectual property and policy to improve access to essential medicines.
Date of publication
2008 July
Publication type
Report
Publication details
Open Society Institute / / pp /-/
Publication status
Published
Language
English
Keywords
Global, intellectual property, health diplomacy
Abstract
This OSI publication documents developments in the use of intellectual property law and policy in six countries: South Africa, Thailand, Brazil, the Philippines, Rwanda, and Kenya. This document highlights options that policymakers and civil society might pursue to reduce the prices of medicines and thereby improve availability. A growing number of people and governments find the disparities in access to such “essential” medicines to be inhumane and unfair. Spurred by civil society and public health groups, they have been seeking to identify the roots of the problem and devise effective and sustainable solutions. This publication considers developments around one increasingly common approach: the use of intellectual property law and policy as a tool to reduce drug prices and, by extension, increase access to essential medicines. Most notably, the report provides an overview of options available through provisions of a global trade agreement from the 1990s, the World Trade Organization’s Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS). It considers specific TRIPS-related strategies and steps taken by governments and their allies in different contexts around the world. The publication highlights the wide range of possible options that policymakers and civil society might pursue to improve the availability of essential medicines.
Country
Publisher
Open Society Institute
Theme area
Equitable health services, Governance and participation in health
Title of publication Traditional vs Western Medicine- African Context
Date of publication
2001
Publication type
Document
Publication details
Drury University / / pp /-/
Publication status
Published
Language
English
Keywords
Africa, governance, traditional medicine, western medicine
Abstract
In many parts of Africa, traditional healers are the most easily accessible health resource available to the community. In addition, they are most often the preferred option for the patients. For most of these people, traditional healers offer information, counselling and treatment to patients and their families in a personal manner as well as having an understanding of their client’s environment. This article discusses how "traditional healers have rarely been included in key decision making, action agendas and community programs in HIV/AIDS prevention and care" (National Council for International Health). The paper addresses questions such as whether it make sense to ignore traditional healers when trying to tackle epidemics such as HIV/AIDS, one of the most critical global issues of our century? What are the fears and difference in opinion of Western medicine and traditional healers that create barriers to forming equitable working relationships? What needs to happen in order for Western Medicine and traditional healers to bring together their unique resources to solve problems such as HIV/AIDS prevention and care?
Country
Publisher
Drury University
Theme area
Equity and HIV/AIDS, Governance and participation in health
Title of publication Surmounting challenges: procurement of antiretroviral medicines in low- and middle-income countries - The experience of Médecins Sans Frontières
Date of publication
2003
Publication type
Report
Publication details
MSF World Health Organization and UNAIDS / / pp /-/
Publication status
Published
Language
English
Keywords
health financing, international, HIV, health diplomacy, medicines
Abstract
This report analyses MSF's purchasing experience over the past two years in Cambodia, Cameroon, Guatemala, Honduras, Kenya, Malawi, Mozambique, South Africa, Thailand and Ukraine. The report examines ARV selection, pricing and procurement issues in general, as part of the medicines management cycle. Five issues of particular importance are highlighted: sources (quality); registration; prices; patents; and continuous availability of medicines. An important finding from the country case studies is that procurement works best when there is a national HIV/AIDS strategy that includes ARV treatment, and that is supported by government commitment and political will. Sufficient funding is crucial to implement national action plans. From MSF's perspective, the most effective and easiest procurement systems combine: strong public procurement agency (Cameroon); local drug production (Thailand); and/or dynamic private sector distributors (Malawi). It was also found that the following factors affected efficient procurement systems at country level: limited numbers of registered ARV products (generic and originator); unclear patent status of ARV medicines; lack of generic policies; limited information available about internationally publicized prices; and countries' eligibility for differential prices offered by pharmaceutical companies. The ability to use generics has been one critical factor for procurement success, to allow competition and guarantee a continuous supply of ARVs.
Country
Publisher
The World Health Organisation (WHO)
Theme area
Health equity in economic and trade policies, Governance and participation in health
Title of publication Amendment of the TRIPS Agreement
Date of publication
2005
Publication type
Document
Publication details
Amendment of the TRIPS Agreement / / pp /-/
Publication status
Published
Language
English
Keywords
global, TRIPS, trade, medicines
Abstract
This document reports the Declaration on the TRIPS Agreement and Public Health (WT/MIN(01)/DEC/2) and the instruction of the Ministerial Conference to the Council for TRIPS contained in paragraph 6 of the Declaration to find an expeditious solution to the problem of the difficulties that WTO Members with insufficient or no manufacturing capacities in the pharmaceutical sector could face in making effective use of compulsory licensing under the TRIPS Agreement. Eligible importing Members seek to obtain supplies under the system set out in the proposed amendment of the TRIPS Agreement, and the paper argues for a rapid response to those needs consistent with the provisions of the proposed amendment of the TRIPS Agreement.
Country
Publisher
The World Trade Organisation
Theme area
Governance and participation in health
Title of publication Vaccines as instruments of foreign policy
Date of publication
2001 October
Publication type
Academic paper
Publication details
EMBO Reports 2 10 pp 862-868
Publication status
Published
Language
English
Keywords
Global, vaccines, health diplomacy
Abstract
This article discusses how the new vaccines for tropical infectious diseases may have unanticipated uses beyond fighting diseases. History indicates that vaccines were powerful instruments of foreign policy in the 20th Century. The new philanthropy to develop tropical disease vaccines will ensure development of an extraordinary product line for combating some the Earth’s greatest plagues. The new vaccines will continue to expand the legacy of vaccine diplomacy—an emerging foreign policy theme for the 21st century. The developing economies of Asia offer attractive targets for implementing vaccine diplomacy. Analysis suggests that a possible relationship may exist between childhood death rates from vaccine-preventable infections and the probability of a nation becoming engaged in armed conflict. Nation states in both East and Central Asia are noted for their high rates of infectious diseases and yet they also benefit from advanced infrastructures that are capable of conducting complex diplomatic missions. Some Asian countries also nurture sophisticated biomedical research institutes with capacity for vaccine R&D and distribution.
Country
Publisher
EMBO Reports
Theme area
Governance and participation in health
Title of publication How the BRICS Are Reshaping Global Health and Development
Date of publication
2012 March
Publication type
Report
Publication details
Global Health Strategies initiatives (GHSi) / / pp /-/
Publication status
Published
Language
English
Keywords
global health, BRICS, health diplomacy
Abstract
Shifting Paradigm comprises part of a larger GHSi project focused on the intersections between major growth economies and global health. This report presents findings from a qualitative and quantitative survey of present and future efforts by Brazil, Russia, India, China and South Africa (BRICS) improve global health. It examines these roles within the broader context of international development and foreign assistance, though health remains the primary focus. This report also includes a brief look at other emerging powers beyond the BRICS that have potential to impact major global health issues. The goal was to examine existing BRICS assistance programs and contributions to health innovation in order to identify opportunities for the BRICS and other emerging powers to expand upon their achievements and increase their contributions to improving health in the poorest countries.
Country
Publisher
Global Health Strategies initiatives (GHSi)
Theme area
Governance and participation in health
Title of publication After the Revolution: Global Health Politics in a Time of Economic Crisis and Threatening Future Trends
Date of publication
2009
Publication type
Document
Publication details
Global Health Governance 11 2 pp 1-21
Publication status
Published
Language
English
Keywords
Global health, governance, health diplomacy
Abstract
This article probes global health’s prospects post 2008. It outlines what made the past 10-15 years revolutionary for global health. Unlike prior breakthroughs its engine was political rather than scientific and technological. The article also surveys the damage done to global health by four crises that emerged or worsened in 2008—the climate change, energy, food, and economic crises. The damage inflicted involved harm to health and to the reasons why global health had risen in prominence. The impact of these crises has left global health policy makers fighting rear-guard actions to ensure that recent progress is not overwhelmed and left in ruins. The crises of 2008 are not the only challenges with which global health policy needs to come to grips after its revolution. The article analyses trends expected to emerge over the next 20-25 years. These trends make the revolution in global health look incomplete, even without factoring in the setbacks produced by the crises of 2008. Individually and collectively, these trends describe potential shifts that could create greater challenges for global health but which global health strategies and policies have limited influence to affect. The conclusion steps back from the crises and the trends in order to assess the prospects for global health politics, diplomacy, and governance. The crises of 2008 may have revealed the political limitations of global health policies, but this development does not mean global health has become as neglected as it was in the past. A key question is whether global health policy can inform and shape the re-globalization that will occur once the global economic crisis subsides and the wheels of global commerce begin turning again. Global health’s role in that re-globalisation process will determine how global health policy, diplomacy, and governance fare in the next phase of world affairs.
Country
Publisher
Global Health Governance
Theme area
Governance and participation in health
Title of publication The globalization of public health: Emerging infectious diseases
Date of publication
1997
Publication type
Academic paper
Publication details
Indiana Journal of Global Legal Studies 5 1 pp 11-51
Publication status
Published
Language
English
Keywords
global health, governance, infectious diseases, health diplomacy
Abstract
Fidler explains how the processes of globalization have altered traditional distinctions between national and international public health. Globalization implies factors that infringe upon a sovereign state's ability to control what occurs in its territory and is also linked with emergence and re-emergence of certain emergent infectious diseases (EID). The current EID crisis has made the globalization of public health a permanent feature of international relations. In response to the challenges posed by the globalization of public health, three major international relations theories are explored-realism, liberalism, and critical international theory--to see what lessons these theories offer about dealing with the globalization of public health. While each theory provides insights into the globalization of public health, he argues that the EID crisis creates serious challenges to our traditional frameworks of understanding international relations.
Country
Publisher
Indiana Journal of Global Legal Studies
Theme area
Governance and participation in health
Title of publication The expanding global health agenda: A welcome development
Date of publication
2007
Publication type
Document
Publication details
Nature Medicine 13 10 pp 1169-1171
Publication status
Published
Language
English
Keywords
Global health, low-income countries, health diplomacy
Abstract
This article discusses the under-estimated impact of the burden of disease in low-income countries on high-income countries. Over the past decade, issues related to the health of people in resource-poor countries have captured the attention of world leaders, governments, philanthropies, policy makers and the general public as never before. This attention has focused on scientific, public health and humanitarian challenges, and involves biomedical research on vaccine and drug development, implementation of public health measures and a growing realization of the deleterious effects of disease on economic development and political stability. It is now clear that we live in a global society, with globalization of trade and economies leading to an unprecedented interdependency of nations that are thousands of miles apart. Thus, the health of one nation in the developing world can have an important impact on developed nations, the economy of which is related to the productivity and markets of the developing nation. In this regard, global health takes on an entirely new perspective.
Country
Publisher
The Lasker Foundation
Theme area
Governance and participation in health
Title of publication Colonialism and the Two Publics in Africa: A Theoretical Statement Comparative Studies in Society and History: A Theoretical Statement
Date of publication
1975
Publication type
Academic paper
Publication details
Comparative Studies in Society and History 17 1 pp 91-112
Publication status
Published
Language
English
Keywords
Governance, Nigeria, Africa, accountability
Abstract
This paper argues that the experiences of colonialism in Africa have led to the emergence of a unique historical configuration in modern post-colonial Africa: the existence of two publics – traditional and modern- instead of one public, as in the West. Many of Africa’s political problems are due to the dialectical relationships between the two publics. The author characterizes these two publics and attempt to explain some of Africa political features within the matrix of these publics. In order to give some empirical content to the distinction drawn here, the author illustrates the issues raised with examples from Nigeria.
Country
Publisher
Comparative Studies in Society and History, JSTOR
Theme area
Governance and participation in health
Title of publication Governing global health in the twenty-first century
Date of publication
2007
Publication type
Book Section
Publication details
Governing global health: Challenge, response, innovation. / / pp /-/
Publication status
Published
Language
English
Keywords
governance, global health, health diplomacy, medicines, research and development
Abstract
Compiled by renowned specialists in the field, this volume studies these global challenges and responses to these issues, as well as the central institutions such as the WHO, WTO and the G8. The section highlighted in the title above discusses in detail a number of global and international trade policies that influence health; particularly in low- and middle-income countries. One such problem discussed is that often referred to as the ‘10/90 gap’ in that only about 10 percent of the global drug research and development focusses on diseases that account for 90 percent of global problems. Profits are made from drugs developed for the wealthiest 10 percent of the world’s population.
Country
Publisher
Ashgate Publishing Ltd
Theme area
Governance and participation in health
Title of publication Speech at the opening session of the sixth Ministerial meeting of the Group of 77, Havana, 20 April 1987
Date of publication
1989
Publication type
Conference Proceedings
Publication details
United Nations Report on the sixth Ministerial meeting of the Group of 77, Havana, 20 April 1987 / / pp 89-90
Publication status
Published
Language
English
Keywords
Cuba, international, global health
Abstract
In this United Nations (UN) conference on trade and development held in the year 1987, Fidel Castro gave a speech emphasising his opinion that debt is unpayable. International protectionism, which contributed decisively to the great depression of the 1930s, has become a trend among the developed capitalist countries. The multilateral system initiated in the post-war period, based on the growing liberalization of world trade, has been replaced by barriers that nullify the GATT projections and threaten to unleash a chaotic struggle in world trade, with even greater disadvantages for our countries. In this intolerable situation, the external debt weighs oppressively on the third world. The hundreds of millions of children who die every year as a result of poverty will not allow their tragedy to be drowned in words. It is time for action, united action. If the nuclear death that threatens us all has to be and can be stopped by the efforts of all, the poverty that overwhelms most of the inhabitants of this earth also requires the united efforts of all.
Country
Publisher
United Nations
Theme area
Human resources for health, Governance and participation in health
Title of publication South-South development cooperation: Cuba’s health programmes in Africa
Date of publication
2008
Publication type
Academic paper
Publication details
The International Journal of Cuban Studies 1 1 pp 1-11
Publication status
Published
Language
English
Keywords
Governance, Cuba, Africa, health diplomacy
Abstract
Cuba’s health programmes in Africa, dating back some forty years, and its training of African doctors in Cuba itself, have made an original contribution to international development. Cuba’s programmes have focussed heavily on capacity building within the health sector, rather than large infrastructure projects. They have been located within a distinctive discourse of solidarity among developing countries, officially repudiating the self-interest and power imbalances usually implicit in donor-recipient relations; they have been largely free from political conditionality; and their core values are preventive and holistic medicine, rather than the medical conception of health commonly seen as a legacy of colonialism in Africa. Cuba made a significant contribution to the concept of south-south development cooperation well before this concept began to influence the professional field of development studies in the 1990s - when it was identified as an alternative form of globalisation and seen as a key driver of development effectiveness in meeting the Millennium Development Goals. This brief exploration of some of Cuba’s health programmes in Africa suggests that they exemplify both the strengths and limitations of south-south development cooperation, which currently accounts for between five and ten per cent of overseas development activity.
Country
Publisher
The International Journal of Cuban Studies
Theme area
Governance and participation in health
Title of publication The New South Africa's Foreign Policy: Principles and Practice
Date of publication
2005
Publication type
Academic paper
Publication details
International Affairs 81 5 pp 1079-1096
Publication status
Published
Language
English
Keywords
South Africa, diplomacy, principles
Abstract
This article outlines principles which, shortly before taking office in 1994, the ANC said would be the foundation for its future foreign policy. The ANC stated that their core concern was the pursuit of ‘human rights’, which were directly related to the promotion of democracy. Other principles included respect for international law, support for peace and disarmament, and universality. These were to be pursued in four settings. First, the global division between the First and Third Worlds as the government was concerned about economic inequality and unjust global trading systems. Second, international organizations as these were seen as central to the search for human rights, peace and equality. Third, demilitarisation resulting in South Africa's forces being used for self-defence and peacemaking and keeping only. The government believed that this would produce savings which could be redirected into social development. Finally, supporting the rest of Africa as the ANC believed South Africa could not flourish if surrounded by poverty. The article examines how far the ANC governments of Presidents Mandela and Mbeki have succeeded in implementing the principles, and how far they have fallen short.
Country
Publisher
International Affairs, John Wiley and Sons Incorporated
Theme area
Resource allocation and health financing, Governance and participation in health
Title of publication The Survival of “Global Health” - Part Two: The Future of Global Health Funding
Date of publication
2013 May
Publication type
Document
Publication details
Laurie Garrett (website) / / pp /-/
Publication status
Published
Language
English
Keywords
Global health, health financing
Abstract
Since 2008 there has been much debate about where agencies, NGOs, programs and countries might turn to for sustainable funding. One thing is very clear: Global Health, including HIV, no longer enjoys the same level of enthusiasm as before. As members of the World Health Assembly recently studied the budget proposal for the WHO, the author suggests that transformation of social contracts between governments and their people to achieve such targets as universal health coverage, guaranteed 24/7 health services for all, 100 percent safe deliveries for all babies and moms, and wellness programming requires planning. And planning requires predictable funding.
Country
Publisher
Laurie Garrett
Theme area
Human resources for health
Title of publication International Mobility of Nurses from Kerala (India) to the EU: Prospects and Challenges with special reference to the Netherlands and Denmark
Date of publication
2013
Publication type
Report
Publication details
Working Paper No. 405, Indian Institute of Management Bangalore (IIMB) / / pp /-/
Publication status
Published
Language
English
Keywords
Health workers, migration, India, European Union, health diplomacy
Abstract
The estimated six million nurses and midwives in the WHO European Region are inadequate to meet current and projected future needs. EU countries diversified strategies to remedy shortages and to minimize migration from developing countries citing 'ethical' concerns. This paper examines migration of nurses from Kerala to the Netherlands and Denmark - to understand better the challenges to the mobility of nurses to the EU. It records sporadic network driven migration of nurses mostly from Kerala vs evolution of a coordinated approach to migration from India i.e., between governments, recruiting agencies and employers. The paper also presents recommendations to enable a mutually beneficial and planned mobility of nurses to the EU.
Country
Publisher
Indian Institute of Management Bangalore (IIMB)
Theme area
Governance and participation in health
Title of publication Power politics in the WTO
Date of publication
2003 January
Publication type
Book
Publication details
Updated 2nd Edition; Bamford, A [Editor]. Focus on Global South; c/o CUSRI, Chulalongkorn University, Bangkok / / pp /-/
Publication status
Published
Language
English
Keywords
Governance, global, trade, health diplomacy
Abstract
This publication reviews decision making at the World Trade Organisation (WTO) and its legitimacy. After Seattle, there were expectations that reform of the decision-making process would be at the top of the WTO agenda. Instead, the Fourth Ministerial Conference of the WTO proceeded with the decision-making structure unreformed. This study is based on extensive interviews with low-income country delegates to the Doha ministerial and makes a case that the decision-making process is not inclusive of their interests.
Country
Publisher
Focus on the Global South, Bangkok
Theme area
Governance and participation in health
Title of publication The Politics of Global Health Governance: Whatever Happened to “Health for All by the Year 2000”
Date of publication
2004
Publication type
Academic paper
Publication details
Global Governance 10 / pp 187-205
Publication status
Published
Language
English
Keywords
Governance, global, health diplomacy
Abstract
In this article, the authors approach the problems of global health governance (GHG) by considering the competing political projects that underpin respective GHG conceptions, the actors that represent, defend, and advance them, and the structures that frame debates and policy initiatives. They briefly outline the scope and nature of the current global health situation, arguing that the main challenge for contemporary GHG is to re-establish within the policy environment the linkage between specific disease-oriented health care interventions and the underlying socioeconomic context. In the next part, the authors analyse the changing nature and orientation of GHG over the past twenty-five years, using the declarations made at Alma Ata in 1978 and Okinawa in 2000 as signposts indicating two very different trends in GHG. Within this section, we explore the political legacies of two phases of global governance, in broad-brush terms of social democracy and neoliberalism, as a backdrop against which to chart, analyse, and interpret shifts in the GHG discourses. In the final part of the article, we explore recent inputs into the GHG discourse from a wide spectrum of actors, ranging from the World Health Organization (WHO) through to activist nongovernmental organizations (NGOs). The authors suggest that these actors have attempted to reintroduce the wider social concerns constitutive of a more integrated approach to health care, which would locate specific interventions within a broader project of socioeconomic transformation.
Country
Publisher
Global governance
Theme area
Governance and participation in health
Title of publication Transforming South-South Technical Support to Fight Noncommunicable Diseases.
Date of publication
2012
Publication type
Report
Publication details
Global Heart 7 1 pp 35-45
Publication status
Published
Language
English
Keywords
Low-income countries, non-communicable diseases, south-south, health diplomacy
Abstract
At the UN High-Level Meeting on non-communicable diseases (NCD) in September 2011, each member state was challenged to create a multisectoral national policy and plan for the prevention and control of non-communicable disease by 2013. Few low-income countries, however, currently have such plans. Their governments are likely to turn for assistance in drafting and implementation to multilateral agencies and Contract Technical Support Organizations recommended by development partners. Yet because many NCD seen in the lowest-income countries differ significantly from those prevalent elsewhere, existing providers of external technical support may lack the necessary experience to support strategic planning for NCD interventions in these settings. This article reviews currently available mechanisms of technical support for health sector planning. It places them in the broader historical context of post- World War II international development assistance and the more recent campaigns for horizontal “South-South” cooperation and aid effectiveness. It proposes bilateral technical assistance by low income-countries themselves as the natural evolution of development assistance in health. Such programmes, it argues, may be able to improve the quality of technical support to low-income countries for strategic planning in the NCD area while directing resources to the regions where they are most needed.
Country
Publisher
Global Heart, Elsevier Limited
Theme area
Resource allocation and health financing
Title of publication “Paying for performance” in Rwanda: does it pay off?
Date of publication
2010 February
Publication type
Academic paper
Publication details
Tropical Medicine and International Health 15 2 pp 182-190
Publication status
Published
Language
English
Keywords
Resource allocation, Rwanda, results-based financing
Abstract
The study analyses strengths and weaknesses of the 'Paying For Performance' (P4P) approach rolled out in the Rwandan health sector since 2002. It uses three research methods: a cross-sector literature review; 69 mostly semi-structured interviews conducted in Rwanda; and an analysis of factors eventually confounding the impact evaluation of the Rwandan P4P approach. It is argued that P4P approaches can be traced backed in written form over four millennia and that considerable negative effects are reported throughout history. All side effects were found again in various forms in the Rwandan health sector. One particular side effect -'gaming'- seriously threatens to affect the quality of health services. It is argued that P4P implicitly (and unintentionally) promotes a questionable concept of human 'labour' and that its focus on improving indicators rather than systemic changes can be regarded as vertical and counter-productive. Two alternatives to the current P4P system are briefly depicted, and further research on the described challenges is recommended.
Country
Publisher
Tropical Medicine and International Health, John Wiley and Sons Incorporated
Theme area
Equitable health services, Governance and participation in health
Title of publication Health for all beyond 2000: the demise of the Alma-Ata Declaration and primary health care in developing countries
Date of publication
2003
Publication type
Academic paper
Publication details
Medical Journal of Australia 178 1 pp 17-20
Publication status
Published
Language
English
Keywords
primary health care, low income countries
Abstract
This article reviews the components of the Alma Ata Declaration, and raises the need to put political and economic ideology aside and determine the methodology that will yield the greatest gains and provide access to services for ‘All People Beyond the Year 2000’. Access to basic health services was affirmed as a fundamental human right in the Declaration of Alma-Ata in 1978. The model formally adopted for providing healthcare services was "primary health care" (PHC), which involved universal, community-based preventive and curative services, with substantial community involvement. PHC did not achieve its goals for several reasons, including the refusal of experts and politicians in developed countries to accept the principle that communities should plan and implement their own healthcare services. Changes in economic philosophy led to the replacement of PHC by "Health Sector Reform", based on market forces and the economic benefits of better health. The author reiterates that it is time to abandon economic ideology and determine the methods that will provide access to basic healthcare services for all people.
Country
Publisher
The Medical Journal of Australia
Theme area
Health equity in economic and trade policies, Public-private mix, Governance and participation in health
Title of publication Global public-private partnerships: Part II – what are the health issues for global governance
Date of publication
2000
Publication type
Report
Publication details
Bulletin of the World Health Organization 78 5 pp 699-709
Publication status
Published
Language
English
Keywords
Governance, public-private partnership, global
Abstract
The proliferation of public-private partnerships is rapidly reconfiguring the international health landscape. This article (part I of two on the subject) traces the changing nature of partnership, and discusses the definitional and conceptual ambiguities surrounding the term. After defining global public-private partnerships (GPPPs) for health development, we analyse the factors which have led to the convergence of public and private actors and discuss the consequences of the trend toward partnership between UN agencies (including the World Bank) and commercial entities in the health sector. Generic factors such as globalization and disillusionment with the UN, and factors specific to the health sector, such as market failure in product development for orphan diseases, are examined. Reviewed are the interests, policies, practices and concerns of the UN, the private-for-profit sector, bilateral organizations, and governments of low-income countries with respect to public-private partnership. While GPPPs bring much needed resources to problems of international health, the authors highlight concerns regarding this new organizational format. Part II, which will be published in the May issue of the Bulletin, presents a conceptual framework for analysing health GPPPs and explores the issues raised.
Country
Publisher
The World Health Organisation (WHO)
Theme area
Governance and participation in health
Title of publication Paying for performance to improve the delivery of health interventions in low- and middle-income countries
Date of publication
2012
Publication type
Academic paper
Publication details
Cochrane Database of Systematic Reviews / 2 pp /-/
Publication status
Published
Language
English
Keywords
Low-income countries, middle-income countries, results based financing
Abstract
This article sets out to assess the current evidence for the effects of paying for performance on the provision of health care and health outcomes in low- and middle-income countries; through a Cochrane systematic Review. The authors conclude that current evidence base is too weak to draw general conclusions; more robust and also comprehensive studies are needed. Performance-based funding is not a uniform intervention, but rather a range of approaches. Its effects depend on the interaction of several variables, including the design of the intervention (e.g. who receives payments, the magnitude of the incentives, the targets and how they are measured), the amount of additional funding, other ancillary components such as technical support, and contextual factors, including the organisational context in which it is implemented.
Country
Publisher
The Cochrane Library, John Wiley and Sons Incorporated
Theme area
Governance and participation in health
Title of publication Learning lessons on implementing performance based financing, from a multi-country evaluation: A Synthesis Report
Date of publication
2009
Publication type
Report
Publication details
Royal Tropical Institute / / pp /-/
Publication status
Published
Language
English
Keywords
Evaluation; DR Congo, Burundi, Tanzania, Zambia, Rwanda, results -based financing,, health financing
Abstract
This synthesis report explores lessons learned on design, implementation and effects of financial incentives in the form of performance-based financing in the health sector, as supported in sub–Saharan Africa by two Dutch NGOs Cordaid and HealthNet. To uncover these lessons, a multi-country study was carried out, led by KIT, in collaboration with WHO Geneva and the implementing agencies in DR Congo, Burundi, Tanzania and Zambia. Rwanda was also visited to study scaling-up from pilot projects to a national programme.
Country
Publisher
Royal Tropical Institute
Theme area
Governance and participation in health
Title of publication Why performance-based contracting failed in Uganda – An “open-box” evaluation of a complex health system intervention
Date of publication
2012
Publication type
Academic paper
Publication details
Social Science & Medicine 75 2 pp 377-383
Publication status
Published
Language
English
Keywords
health financing, Uganda, governance, international, results based financing, evaluation
Abstract
This paper reports a theory-based case study intended to clarify how and why performance-based contracting (PBC) failed to achieve its objectives. PBC is a tool that links rewards to attainment of measurable performance targets. Significant problems remain in the methods used to evaluate this tool. The primary focus of evaluations on the effects of PBC (black-box) and less attention to how these effects arise (open-box) generates suboptimal policy learning. A black-box impact evaluation of PBC pilot by the Development Research Group of the World Bank (DRG) and the Ministry of Health (MOH) concluded that PBC was ineffective. To explain the observed PBC implementation and responses of participants, this case study employed two related theories i.e. complex adaptive system and expectancy theory respectively. A prospective study trailed the implementation of PBC (2003–2006) while collecting experiences of participants at district and hospital levels. Significant problems were encountered in the implementation of PBC that reflected its inadequate design. As problems were encountered, hasty adaptations resulted in a de facto intervention distinct from the one implied at the design stage. For example, inadequate time was allowed for the selection of service targets by the health centres yet they got ‘locked-in’ to these poor choices. The learning curve and workload among performance auditors weakened the validity of audit results. Above all, financial shortfalls led to delays, short-cuts and uncertainty about the size and payment of bonuses. The lesson for those intending to implement similar interventions is that PBC should not be attempted ‘on the cheap’. It requires a plan to boost local institutional and technical capacities of implementers. It also requires careful consideration of the responses of multiple actors – both insiders and outsiders to the intended change process. Given the costs and complexity of PBC implementation, strengthening conventional approaches that are better attuned to low income contexts (financing resource inputs and systems management) remains a viable policy option towards improving health service delivery.
Country
Publisher
Social Science and Medicine, Elsevier Limited
Theme area
Governance and participation in health
Title of publication Assessing performance enhancing tools: experiences with the open performance review and appraisal system (OPRAS) and expectations towards payment for performance (P4P) in the public health sector in Tanzania
Date of publication
2012
Publication type
Academic paper
Publication details
Globalization and Health 8 33 pp 1-13
Publication status
Published
Language
English
Keywords
governance, health workers,, health financing, Tanzania, results based financing, evaluation
Abstract
This article addresses health workers’ experiences with the open performance review and appraisal system (OPRAS) in Tanzania, expectations towards pay for performance, and how lessons learned from OPRAS can assist in the implementation of pay for performance (P4P). Health workers’ motivation is a key determinant of the quality of health services, and poor motivation has been found to be an obstacle to service delivery in many low-income countries. In order to increase the quality of service delivery in the public sector in Tanzania, the Open Performance Review and Appraisal System (OPRAS) has been implemented, and a new results-based payment system, P4P is introduced in the health sector. The broader aim is to generate knowledge on health workers’ motivation in low-income contexts. A qualitative study design was employed to elicit data on health worker motivation at a general level and in relation to OPRAS and P4P in particular. Focus group discussions (FGDs) and in-depth interviews (IDIs) were conducted with nursing staff, clinicians and administrators in the public health sector in a rural district in Tanzania. The study found a general reluctance towards OPRAS as health workers did not see OPRAS as leading to financial gains nor did it provide feedback on performance. Great expectations were expressed towards P4P due to its prospects of topping up salaries, but the links between the two performance enhancing tools were unclear. The authors concluded that health workers respond to performance enhancing tools based on whether the tools are found appropriate or yield any tangible benefits. The importance placed on salary and allowances forms the setting in which OPRAS operates. The expected addition to the salary through P4P has created a vigorous discourse among health workers attesting to the importance of the salary for motivation. Lessons learned from OPRAS can be utilized in the implementation of P4P and can enhance our knowledge on motivation and performance in the health services in low-income contexts such as Tanzania.
Country
Publisher
Globalisation and Health
Theme area
Governance and participation in health
Title of publication Performance-based financing and changing the district health system: experience from Rwanda
Date of publication
2006
Publication type
Report
Publication details
Bulletin of the World Health Organization 84 / pp 884-889
Publication status
Published
Language
English
Keywords
health financing, low-income countries, Asia, Africa, governance, results based financing, health system
Abstract
The authors report a field experience from Rwanda demonstrating that performance-based financing is a feasible strategy in sub-Saharan Africa too. So far, it has been mostly evidence from low-income Asian countries that shows that performance-based financing (as a specific form of contracting) can improve health service delivery more successfully than traditional input financing mechanisms. Performance-based financing requires at least one new actor, an independent well equipped fundholder organization in the district health system separating the purchasing, service delivery as well as regulatory roles of local health authorities from the technical role of contract negotiation and fund disbursement. In Rwanda, local community groups, through patient surveys, verified the performance of health facilities and monitored consumer satisfaction. A precondition for the success of performance-based financing is that authorities must respect the autonomous management of health facilities competing for public subsidies. These changes are an opportunity to redistribute roles within the health district in a more transparent and efficient fashion.
Country
Publisher
The World Health Organisation (WHO)
Theme area
Governance and participation in health
Title of publication Pay for Performance (P4P) Programs in Health Services: What is the Evidence?
Date of publication
2010
Publication type
Document
Publication details
World Health Report Background Paper 31 pp 1-12
Publication status
Published
Language
English
Keywords
health systems, governance, health workers, international, health financing, results based financing
Abstract
This paper examines the different kinds of efficiency in health including allocative, technical, and dynamic efficiency. A framework is provided to look at pay for performance (P4P) programs in health services delivery. The measures used and the basis of reward and types of rewards are discussed. This is followed by a discussion of the types of rewards and the payments of rewards. The resulting problems that need to be addressed are explained and an assessment of evidence is presented.
Country
Publisher
The World Health Organisation (WHO)
Theme area
Governance and participation in health
Title of publication Can paying for results help to achieve the Millennium Development Goals? A critical review of selected evaluations of results-based financing
Date of publication
2009 August
Publication type
Academic paper
Publication details
Journal of Evidence-Based Medicine 2 3 pp 184-195
Publication status
Published
Language
English
Keywords
health financing, low-income countries, middle-income countries, results -based funding, global health, MDG
Abstract
Results-based financing (RBF) refers to the transfer of money or material goods conditional on taking a measurable action or achieving a predetermined performance target. RBF is being promoted for helping to achieve the Millennium Development Goals (MDGs). The authors undertook a critical appraisal of selected evaluations of RBF schemes in the health sector in low and middle-income countries (LMIC). In addition, key informants were interviewed to identify literature relevant to the use of RBF in the health sector in LMIC, key examples, evaluations, and other key informants. The use of RBF in LMIC has commonly been a part of a package that may include increased funding, technical support, training, changes in management, and new information systems. It is not possible to disentangle the effects of financial incentives as one element of RBF schemes, and there is very limited evidence of RBF per se having an effect. RBF schemes can have unintended effects. The authors conclude that when RBF schemes are used, they should be designed carefully, including the level at which they are targeted, the choice of targets and indicators, the type and magnitude of incentives, the proportion of financing that is paid based on results, and the ancillary components of the scheme. For RBF to be effective, it must be part of an appropriate package of interventions, and technical capacity or support must be available. RBF schemes should be monitored for possible unintended effects and evaluated using rigorous study designs.
Country
Publisher
Journal of Evidence-Based Medicine, John Wiley and Sons Incorporated
Theme area
Governance and participation in health
Title of publication Regionalism and the reinvigoration of global health diplomacy: Lessons from Africa
Date of publication
2012
Publication type
Document
Publication details
Asian Journal of WTO and International Health Law and Policy 7 1 pp 49-76
Publication status
Published
Language
English
Keywords
global health; Governance, participation, health diplomacy, Africa, regional integration
Abstract
In the era of the persisting global north-south health divide, regional integration organizations have provided legal and diplomatic spaces to advance health goals. In this context, African regionalism is evolving as an important frameworkfor promoting health diplomacy. This evolving regional health diplomacy is contributing to the reinforcement of social goals of new regionalism in Africa and shaping the drivers of health policy at the global, regional and domestic levels. This paper makes reference to case studies of African regional and sub-regional integration organizations examines the drivers, nature and limits of their practice of health diplomacy. It also analyzes the nature of engagement of African regional groupings with select international health regimes. The paper identifies the strengths and limits of regionalism for health diplomacy that also advances the protection of public health. It concludes by proposing options to foster health diplomacy and its implications for the advancement of health at the domestic, regional and global levels.
Country
Publisher
Social Science Research Network
Theme area
Human resources for health
Title of publication Bilateral Agreement: The Case of US and Ghana
Date of publication
2012
Publication type
Academic paper
Publication details
Health Worker Migration Policy Council – Council Conversation Series: Stories and Solutions pp 1-5
Publication status
Language
English
Keywords
Health workers, migration, recruitment, Ghana, governance
Abstract
Among Ghana’s efforts to address its health workforce challenges are the establishment of medical partnerships with countries where Ghanaian medical professionals often migrate, such as the United States. This case study highlights how the University of Michigan and a variety of stakeholders in the Ghanaian health community have made efforts to adhere to the World Health Organisation (WHO) Global Code through training health personnel, capacity-building and strengthening services and specialties. The particular focus of this case study is the Ghana Emergency Medicine Collaborative, a partnership aimed at developing Ghana’s first medical residency programme in emergency medicine.The first class of seven doctors to participate in the Collaborative is now in its third and final year of training. The second class of six doctors is currently in its second year. In addition, a one-year emergency nursing course is underway for 30 promising nurses. The Collaborative has played an important role in reducing the emigration of health workers by improving the education and training opportunities available in Ghana. By addressing a gap in the greater health system and offering medical professionals vital training and education, the Collaborative has helped facilitate economic and educational opportunities within Ghana, which mitigates the pull effect for health professionals to migrate to other countries.
Country
United States
Publisher
Aspen Institute: US
Theme area
Human resources for health
Title of publication Too Poor to Leave, Too Rich to Stay: Developmental and Global Health Correlates of Physician Migration to the United States, Canada, Australia, and the United Kingdom
Date of publication
2008 January
Publication type
Journal Article
Publication details
American Journal of Public Health 98 pp 148-154
Publication status
Published
Language
English
Keywords
health worker, south, migration, brain drain, governance
Abstract
In this study, the authors analysed the relationship between physician migration from developing source countries to more developed host countries (brain drain) and the developmental and global health profiles of source countries.They used a cross-section of 141 countries that lost emigrating physicians to the four major destinations: the United States, Canada, Australia, and the United Kingdom. Results showed that source countries with better human resources for health, more economic and developmental progress, and better health status appear to lose proportionately more physicians than the more disadvantaged countries. Higher physician migration density is associated with higher current physician, nurse, and public health workforce densities and more medical schools.The authors call on policymakers to realise that physician migration is positively related to better health systems and development in source countries. In view of the “train, retain, and sustain” perspective of public health workforce policies, physician retention should become even more important to countries growing richer, whereas poorer countries must invest more in training policies.
Country
United States
Publisher
Theme area
Human resources for health
Title of publication Why Pakistani Medical Graduates Must Remain Free to Emigrate
Date of publication
2008
Publication type
Journal Article
Publication details
PLoS Medicine 5 1
Publication status
Published
Language
English
Keywords
Health workers, migration, Pakistan, brain drain, governance
Abstract
The current debate about the brain drain of health professionals from low-income countries such as Pakistan to the rich world often demonises medical graduates who choose to leave their countries. According to this study, such graduates are sometimes considered to be insensitive to the plight of their country's struggling health sector. But what is forgotten in this debate is that some doctors who emigrate to the West have every intention of returning after their higher-level training overseas. And while the brain drain is often blamed for Pakistan's difficulty in meeting its people's health care needs, other factors play a major role, including the increasing demand for health care from the growing population and the adverse conditions that cause disease.There are no reliable statistics on the total numbers of students from low-income countries who receive higher-level training abroad, nor on what proportion of these students return to their home countries. And while it is true that large numbers of medical graduates leave Pakistan (about 13,000 in 2005), a proportion of these Pakistani graduates do return. For example, by 2004, Pakistan's Aga Khan University had produced 1,100 graduates, 900 of whom went on to higher-level training in the US—but about 40 alumni have so far returned.
Country
United States
Publisher
PLoS
Theme area
Human resources for health
Title of publication Trends in international nurse migration
Date of publication
2004 May
Publication type
Publication details
Health Affairs 23 3 pp 69-77
Publication status
Published
Language
English
Keywords
Nurses, international, migration, brain drain, governance
Abstract
Predicted shortages and recruitment targets for nurses in developed countries threaten to deplete nurse supply and undermine global health initiatives in developing countries. This paper explores emerging patterns of international nurse migration. The authors focused on English-speaking countries that are actively recruiting nurses from developing countries: the United States, Canada, the United Kingdom, Ireland, Australia, and New Zealand. These countries have comparable health care systems and predict needing more nurses than they are producing and retaining; their predicted nurse requirements are large enough to deplete the supply of qualified nurses throughout the developing world. Examination of recent patterns in nurse migration to these countries provides a glimpse to the future and the possible consequences on global health. The authors argue that a twofold approach is required, involving greater diligence by developing countries in creating a largely sustainable domestic nurse workforce and their greater investment through international aid in building nursing education capacity in the less developed countries that supply them with nurses.They also illuminate some of the areas in which more information is needed and policy choices that require attention.
Country
United States
Publisher
Millwood
Theme area
Human resources for health
Title of publication Brain drain: the flight of human capital
Date of publication
2004 October
Publication type
Journal Article
Publication details
Bulletin of the World Health Organisation 82 10 pp 797-798
Publication status
Published
Language
English
Keywords
Brain drain, south, health workers, recruitment, governance
Abstract
Is there an inexpensive way to discourage richer countries from poaching scientists and health workers from poorer ones? Unfortunately not, according to this article, as the issues involved are complex and almost all countries are affected to varying degrees. There is a variety of sending and receiving countries, each with a pattern of migration that reflects its level of social, political and economic development. Consequently, focusing solely on the "pull" factors that attract migrants may obscure the importance of the "push" factors encouraging them to leave, thereby diverting attention away from some important policy options.Finding a workable solution requires the cooperation of all countries. The aim should be to solve the legitimate manpower shortages of the developed countries without damaging the health systems of the developing countries. A three-pronged approach may offer a chance for such a solution: first, a series of measures to be undertaken by the developing countries on their own; second, a set of measures that the developed countries can unilaterally adopt; and third, the development of an international code of practice to regulate the ethics of international recruitment. The paper offers a brief outline of possible elements of these suggested strategies.
Country
Switzerland
Publisher
WHO
Theme area
Equity and HIV/AIDS, Governance and participation in health
Title of publication The Role of Southern Actors in Global Governance: The Fight against HIV/AIDS
Date of publication
2007
Publication type
Academic paper
Publication details
GIGA Working Papers, No. 46 pp 1-28
Publication status
Published
Language
English
Keywords
Governance, global, South, HIV, AIDS, policy, governance
Abstract
This paper analyses the role of actors from developing countries in global processes of policy making and governance. To systematically examine the channels of influence of Southern actors and the interactions in global governance it develops the concept of interfaces. It differentiates between organisational, discursive, legal and resource-transfer interfaces in global governance. This approach is exemplified in the analysis of a specific field of global governance, the global fight against HIV and AIDS. The paper examines the role of Southern governments and non-state actors in the central organisations of global health, their influence in debates and discourses on strategies to fight HIV and AIDS, and the financing mechanisms that were introduced to fight HIV and AIDS in the developing world. It shows that albeit actors from Northern countries dominate global governance in general, in particular areas the current institutional setting of global governance provides significant opportunities for rather weak actors such as civil society organisations and governments from the South to influence strategies and policies.
Country
Germany
Publisher
GIGA
Theme area
Resource allocation and health financing
Title of publication Promoting Country Ownership and Stewardship of Health Programmes: The Global Fund Experience
Date of publication
2009
Publication type
Journal Article
Publication details
Journal of Acquired Immune Deficiency Syndrome 52 Supplement 1 pp S67-S68
Publication status
Published
Language
English
Keywords
Financing, south, Global Fund, malaria, tuberculosis, HIV, AIDS, governance
Abstract
The Global Fund to Fight AIDS, Tuberculosis and Malaria was established in 2002 to provide large-scale financing to middle- and low-income countries to intensify the fight against the three diseases. Its model has enabled strengthening of local health leadership to improve governance of HIV programmes in five ways. First, the Global Fund has encouraged development of local capacity to generate technically sound proposals reflecting country needs and priorities. Second, through dual-track financing, the Global Fund has enabled civil society and other nongovernmental organisations to play a critical role in the design, implementation, and oversight of HIV programmes. Third, investments to strengthen community systems have enabled greater involvement of community leaders in effective mobilisation of demand and scale-up for services to reach vulnerable groups. Fourth, capacity building outside the state sector has improved community participation in governance of public health. Finally, an emphasis on inclusiveness and diversity in planning, implementation, and oversight has broadly enhanced country coordination capacity. Strengthening local leadership capacity and governance are critical to building efficient and equitable health systems to deliver universal coverage of HIV services, the authors conclude.
Country
United Kingdom
Publisher
Theme area
Health equity in economic and trade policies, Governance and participation in health
Title of publication Access to Medicines, BRICS Alliances, and Collective Action
Date of publication
Publication type
Journal Article
Publication details
American Journal of Law & Medicine 34 pp 345-394
Publication status
Published
Language
English
Keywords
Medicines, access, South Africa, intellectual property, alliances, governance
Abstract
This article begins by offering a brief discussion of each BRICS country in the area of international intellectual property protection. It advances the hypothesis that, if the BRICS countries are willing to join together to form a coalition, it is very likely that the resulting coalition will precipitate a negotiation deadlock similar to the historic stalemate between developed and less developed countries before the negotiation of the TRIPs Agreement.The article, nevertheless, questions whether the BRICS countries can build a sustained coalition in light of their very different historical backgrounds; the divergent levels of political, social, economic, and cultural developments; and the well-documented historical failures for less developed countries to build or maintain effective coalitions. Taking these challenges and potential hurdles into account, this article contends that it may be more realistic for less developed countries to enter into alliances with one or more of the BRICS countries.The article then highlights the role that the BRICS coalition or partial BRICS alliances can play in the international intellectual property regime. It discusses four coordination strategies through which less developed countries can strengthen their collective bargaining position, influence negotiation outcomes, and promote effective and democratic decision making in the international intellectual property regime. It concludes with a discussion of the various challenges confronting the creation and maintenance of partial BRICS alliances.
Country
United States
Publisher
Boston University School of Law
Theme area
Human resources for health, Governance and participation in health
Title of publication Literature review on codes of practice on international recruitment of health professionals in global health diplomacy
Date of publication
2013 May
Publication type
Report
Publication details
Publication status
Published
Language
Keywords
code, bilateral agreement, health worker, migration, Africa, global, health diplomacy
Abstract
This review is part of the Regional Network for Equity in Health (EQUINET) programme of work on Contributions of global health diplomacy to health systems in sub-Saharan Africa: Evidence and information to support capabilities for health diplomacy in east and southern Africa. This includes work on the Code that seeks to address:
• The extent to which the policy interests of African countries were carried (or not carried) into the Code in the negotiations around the code and the perceived factors affecting this;
• The extent to which countries in east and southern Africa view the Code and how they implement it as an instrument for negotiating foreign policy interests concerning health workers; and
• The motivations, capabilities and preparations for monitoring the code to engage in the diplomatic environment on African policy interests concerning health workers.
The paper presents a review of published and grey literature on relevant codes of practice, and on bilateral and multilateral agreements at the end of 2012, with a focus on implications for the health workforce. The information was analysed using the policy analysis triangle to capture the changing context, processes, content and major actors in the development of the WHO Code, and documentation on its progress and implementation since its adoption.
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Discussion paper
Theme area
Governance and participation in health
Title of publication Rewarding Safe Motherhood: How can Performance-Based Funding Reduce Maternal and Newborn Mortality in Tanzania
Date of publication
2007
Publication type
Report
Publication details
CMI Report R2007 17 pp /-/
Publication status
Published
Language
English
Keywords
health financing, Tanzania, governance, results -based funding, maternal health
Abstract
This report investigates the potential role of performance-based funding mechanisms in increasing maternal and new-born survival in Tanzania. Less than 50% of deliveries in Tanzania take place at a health facility. Some of the reasons are difficult transport, high costs (e.g., having to pay for delivery kits), and low quality of the services offered at health facilities. Performance-based funding can potentially address some of these challenges, but not all. Demand side issues, such as high costs, can be dealt with by conditional cash transfers to women who deliver at health facilities. Some of the quality issues at the health facilities may be addressed by rewarding health workers according to the number of deliveries, thus making it in their interest to improve the quality of the service. Performance-based funding cannot, however, fully address the challenges related to poor transport infrastructure, delayed supplies of drugs and equipment from the central level, and the shortage of skilled health workers. In addition, there are challenges related to reliable reporting of performance and timely payment of performance rewards that may undermine the effectiveness of a performance-based funding system. Knowledge of the effect of performance-based funding in the health sector is very limited. Thorough impact research therefore needs to be part of new initiatives of this kind.
Country
Publisher
Chr. Michelsen Institute
Theme area
Governance and participation in health
Title of publication Pay-for-performance and the Millennium Development Goals
Date of publication
2011 April
Publication type
Academic paper
Publication details
The Lancet 377 9775 pp 1383-1385
Publication status
Published
Language
English
Keywords
health financing, international, governance, results based financing, global health, material health
Abstract
This article discusses the pro’s and cons of the pay-for-performance approach in health care; using data from a recent study in Rwanda as an important example. Only 23 countries are on course to reach Millennium Development Goal (MDG) 5: to reduce the maternal mortality ratio by 75% by 2015. One reason for this slow progress is that, in many low-income and middle-income countries, most poor women deliver at home without skilled attendance, and thus face a high rate of obstetric complications. Our recent analysis, for example, found that in sub-Saharan Africa, from 2003 to the present, 78% of births among the poorest women occurred at home, of which 56% were unattended. Reasons for this high rate of unattended home births include poor availability of health facilities, and social and cultural preferences for home delivery. Increasing the proportion of poor women receiving skilled obstetric care is a complex public health challenge that defies easy solutions. Innovative approaches are desperately needed.
Country
Publisher
The Lancet
Theme area
Governance and participation in health
Title of publication Performance-based financing: just a donor fad or a catalyst towards comprehensive health-care reform?
Date of publication
2011
Publication type
Document
Publication details
Bulletin of the World Health Organisation 89 / pp 153-156
Publication status
Published
Language
English
Keywords
resource allocation, health care financing, Sub-Saharan Africa, performance-based financing, governance
Abstract
This article provides a detailed motivation for why the authors remain of the opinion that performance-based financing, as it is being developed in several sub-Saharan African countries, is a strategy that could help address the structural problems plaguing health systems.
Country
Publisher
The World Health Organisation
Theme area
Governance and participation in health
Title of publication The Role of a ‘Pay for Performance’ (P4P) Scheme in Motivating Health Workers at Different Levels of the Primary Health Care (PHC) System in Tanzania
Date of publication
2012
Publication type
Document
Publication details
Poster presented at the Second Global Symposium on Health Systems Research, Oct. 31st-Nov. 3rd, 2012, in Beijing, China. / / pp /-/
Publication status
Published
Language
English
Keywords
health financing, Tanzania, health workers, governance, results based financing , evaluation
Abstract
This presentation discusses the effect of pay-for-performance (P4P) on health worker motivation at different levels of care. Tanzania’s health system is currently coping with severe shortages of drugs, supplies and staff, and low worker motivation, threatening the achievements of Millennium Development Goals 4 and 5. A P4P pilot designed to improve maternal and newborn health (MNH) service use and quality is currently underway in Pwani region. The scheme provides bonus payments to all health workers in PHC facilities and to dedicated health workers in hospitals related to specific MNH service use indicators. Based on facility data, P4P reports, 54 in-depth interviews with health workers and district management team members conducted in 15 health facilities across 5 districts between December 2011 and September 2012. The findings showed that P4P can stimulate important changes within health facilities, and set incentives that improve health-care quality. The Scheme has the greatest positive effect in facilities that are adequately stocked, staffed, supervised and where all health workers receive performance payments. Health workers in such facilities are motivated, work together and use routine information towards improved planning to meet ‘targets’. The Scheme is divisive in hospitals with differential rates of payment for those providing ‘targeted’ and ‘non-targeted’ care, with less cooperation between the ‘MNH’ and ‘other’ health workers. However, PHC facilities remain challenged by existing health system constraints, including shortages of drugs, supplies and staff. Compared to the “poorer” facilities, the “better-off” facilities are more able to address some of these constraints, and meet performance targets that are system based, resulting in potential equity concerns. There is also a tendency for facilities to generate increasing revenue from user fees. P4P risks demotivating health workers most in need of support, of increasing inequities between facilities and of deepening the vulnerability of the poorest of the poor.
Country
Publisher
Second Global Symposium on Health Systems Research
Theme area
Governance and participation in health
Title of publication Paying for performance and the social relations of health care provision: An anthropological perspective
Date of publication
2012 November
Publication type
Academic paper
Publication details
Social Science and Medicine 75 10 pp 1778-1785
Publication status
Published
Language
English
Keywords
health financing, governance, international, results based financing
Abstract
While recognizing the potential of pay-for-performance (P4P), these authors argue for greater care in adapting schemes to particular local contexts. They suggest that insights from social science theory coupled with the focused ethnographic methods of anthropology can contribute to the critical assessment of P4P schemes and to their adaptation to particular social environments and reward systems. The authors highlight the need for monitoring P4P schemes in relation to worker motivation and the quality of social relations, since these have implications both for health sector performance over the long term and for the success and sustainability of a P4P scheme. Suggestions are made for ethnographies, undertaken in collaboration with local stakeholders, to assess readiness for P4P; package rewards in ways that minimize perverse responses; identify process variables for monitoring and evaluation; and build sustainability into program design through linkage with complementary reforms.
Country
Publisher
Social Science and Medicine, Elsevier Limited
Theme area
Governance and participation in health
Title of publication Making performance-based funding work for health
Date of publication
2007 August
Publication type
Academic paper
Publication details
PLoS Medicine 4 8 pp e219-/
Publication status
Published
Language
English
Keywords
health financing, low income countries, governance, results based funding, health systems
Abstract
In this article, the authors express their concerns that performance-based funding may penalize poorer countries and may not be flexible enough to contribute to health systems generally. Such concerns provoke two important questions: How are programs performing in countries at different levels of development, health systems strength, and disease burden? And what are the wider challenges of implementing performance-based funding to use health finances effectively, strengthen health systems, and achieve the Millennium Development Goals (MDGs)?
Country
Publisher
PLoS Medicine
Theme area
Governance and participation in health
Title of publication Global HIV/AIDS Funding and Health Systems: Searching for the Win-Win
Date of publication
2009
Publication type
Academic paper
Publication details
Journal of Acquired Immune Deficiency Syndrome 52 / pp S3-S5
Publication status
Published
Language
English
Keywords
health financing, governance, low-income countries, AIDS, global
Abstract
External funders, developing country governments, and NGOs are searching for ways to use funding for HIV/AIDS programs that strengthen the functioning of weak health systems. This is motivated both by the realization that a large share of external funding for global health is and will continue to be dedicated to HIV/AIDS, and that the aims of more and better treatment, prevention, and care can be achieved only with attention to systemic capacities. For AIDS resources to strengthen health systems, decision makers should: (a) mitigate the risks that AIDS spending may weaken the ability of health systems to respond to other health problems; (b) find ways for procurement, supply chain, management information, and other systems that are created to support AIDS treatment to be broadened to serve other types of services; and (c) build upon the ways in which AIDS programs have overcome some demand-side barriers to use of services. In pursuing this agenda, donors should recognize that health system development is a function of the national and local political economy and place respect for national sovereignty as a central tenet of their policies and practices.
Country
Publisher
JAIDS Journal of Acquired Immune Deficiency Syndromes (JAIDS), Lippincott Williams & Wilkins, Incorporated
Theme area
Governance and participation in health
Title of publication Funding for Civil Society Responses to HIV/AIDS in Tanzania: Status, Problems, Possibilities
Date of publication
2008 July
Publication type
Report
Publication details
Centre for Aids Development, Research and Evaluation / / pp /-/
Publication status
Published
Language
English
Keywords
governance, participation, Tanzania, resource allocation, health financing, AIDS, civil society
Abstract
This report presents the findings from a review of the funding environment in Tanzania from the perspective of local civil society organisations (CSOs) working on HIV/AIDS. Fieldwork for the review was conducted in October and November 2007. A detailed case study was undertaken of a Tanzanian non-governmental organisation (NGO) based in Morogoro, and interviews were conducted with 18 respondents from civil society bodies, donor and international institutions, and international NGOs in Dar es Salaam. A review of literature and documentation pertaining to funding and support for civil society responses to HIV/AIDS was also undertaken. The report addresses the role of civil society organisations in Tanzania’s HIV/AIDS response, with attention to the evolution and growth of CSO involvement in HIV/AIDS and the civil society structures that seek to coordinate and support local responses the epidemic. It explores the position of civil society within the HIV/AIDS funding environment in Tanzania, reviewing the major sources of funding for AIDS response in the country, the mechanisms used to support civil society initiatives, and the way in which support for civil society activity is incorporated into donor funding portfolios. Attention is also paid to the aid harmonisation processes underway in Tanzania and the implications of these for donor funding modalities in respect to support for HIV/AIDS. The report then discusses the ‘funding effects’ of the present funding environment on Tanzanian civil society organisations seeking to resource their HIV-related work. It considers the impact of this environment on the development of Tanzanian responses to AIDS, the availability of resources to support local CSOs’ work, and the suitability of these mechanisms for growing and developing more sustained civil society responses. It concludes with reflections on how civil society might work to strengthen its own effectiveness in AIDS responses in Tanzania, as well as how funding relationships and mechanisms could be re-oriented to build upon civil society’s natural assets and inherent strengths.
Country
Publisher
Centre for AIDS Development, Research, and Evaluation (CADRE)
Theme area
Governance and participation in health
Title of publication Linking local knowledge with global action: examining the Global Fund to Fight AIDS, Tuberculosis and Malaria through a knowledge system lens
Date of publication
2006
Publication type
Report
Publication details
Bulletin of the World Health Organization 84 8 pp 629-635
Publication status
Published
Language
English
Keywords
global health, governance, international, Global Fund; knowledge system
Abstract
New global public health institutions are increasingly emphasizing transparency in decision-making, developing-country ownership of projects and programmes, and merit- and performance-based funding. Such principles imply an institutional response to the challenge of bridging the "know-do gap", by basing decisions explicitly on results, evidence and best practice. Using a knowledge systems framework, we examine how the Global Fund to Fight AIDS, Tuberculosis and Malaria has affected the ways in which knowledge is used in efforts to combat these three diseases. The authors outline the formal knowledge system embedded in current rules and practices associated with the Global Fund's application process, and give three examples that illustrate the complexity of the knowledge system in action: human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) policy in China; successful applications from Haiti; and responses to changing research on malaria. These examples show that the Global Fund has created strong incentives for knowledge to flow to local implementers, but with little encouragement and few structures for the potentially valuable lessons from implementation to flow back to global best practice or research-based knowledge. The Global Fund could play an influential role in fostering much-needed learning from implementation. The authors suggest that three initial steps are required to start this process: acknowledging shared responsibility for learning across the knowledge system; analysing the Global Fund's existing data (and refining data collection over time); and supporting recipients and technical partners to invest resources in linking implementation with best practice and research.
Country
Publisher
The World Health Organisation
Theme area
Governance and participation in health
Title of publication The costs of performance-based financing. Bulletin of the World Health Organization
Date of publication
2011
Publication type
Document
Publication details
Bulletin of the World Health Organization 89 319 pp /-/
Publication status
Published
Language
English
Keywords
resource allocation, health financing, international, results based financing, governance
Abstract
This article provides a brief discussion on the author’s views on performance-based financing. In the March issue of the Bulletin of the World Health Organization, Meessen et al rightly raise the question of whether performance-based financing is just a donor fad or a catalyst for wider reform. Looking at the broader evidence, one finds the following arguments against performance-based financing, based on three main issues.
Country
Publisher
The World Health Organisation
Theme area
Governance and participation in health
Title of publication Can performance-based financing be used to reform health systems in developing countries?
Date of publication
2011
Publication type
Report
Publication details
Bulletin of the World Health Organization 89 9 pp 695-698
Publication status
Published
Language
English
Keywords
resource allocation, health financing, Burundi, Rwanda, governance, results based financing
Abstract
Over the past 15 years, performance-based financing has been implemented in an increasing number of developing countries, particularly in Africa, as a means of improving health worker performance. Scaling up to national implementation in Burundi and Rwanda has encouraged proponents of performance-based financing to view it as more than a financing mechanism, but increasingly as a strategic tool to reform the health sector. The authors resist such a notion on the grounds that results-based and economically driven interventions do not, on their own, adequately respond to patient and community needs, upon which health system reform should be based. The authors also think the debate surrounding performance-based financing is biased by insufficient and unsubstantiated evidence that does not adequately take account of context nor disentangle the various elements of the performance-based financing package.
Country
Publisher
The World Health Organisation
Theme area
Governance and participation in health
Title of publication Financing of health systems to achieve the health Millennium Development Goals in low-income countries
Date of publication
2010 January
Publication type
Academic paper
Publication details
The Lancet 375 9712 pp 419-426
Publication status
Published
Language
English
Keywords
resource allocation, health financing, low-income countries, governance, maternal health, health system, MDGs
Abstract
This report summarises the key challenges faced by the Taskforce on Innovative International Financing for Health Systems and its Working Groups. Concern that underfunded and weak health systems are impeding the achievement of the health Millennium Development Goals in low-income countries led to the creation of a High Level Taskforce on Innovative International Financing for Health Systems in September, 2008. Working Group 1 examined the constraints to scaling up and costs. Challenges included: difficulty in generalisation because of scarce and context-specific health-systems knowledge; no consensus for optimum service-delivery approaches, leading to wide cost differences; no consensus for health benefits; difficulty in quantification of likely efficiency gains; and challenges in quantification of the financing gap owing to uncertainties about financial commitments for health. Working Group 2 reviewed the different innovative mechanisms for raising and channelling funds. Challenges included: variable definitions of innovative finance; small evidence base for many innovative finance mechanisms; insufficient experience in harmonisation of global health initiatives; and inadequate experience in use of international investments to improve maternal, newborn, and child health. The various mechanisms reviewed and finally recommended all had different characteristics, some focusing on specific problems and some on raising resources generally. Contentious issues included the potential role of the private sector, the rights-based approach to health, and the move to results-based aid. The challenges and disagreements that arose during the work of the Taskforce draw attention to the many issues facing decision makers in low-income countries. International donors and recipient governments should work together to improve the evidence base for strengthening health systems, increase long-term commitments, and improve accountability through transparent and inclusive national approaches.
Country
Publisher
The Lancet, Elsevier Limited
Theme area
Governance and participation in health
Title of publication Reflections on the revolution in health and foreign policy
Date of publication
2007 March
Publication type
Academic paper
Publication details
Bulletin of the World Health Organization 85 3 pp 243-244
Publication status
Published
Language
English
Keywords
global health, governance, international, foreign policy, health
Abstract
The author observes that increasing interest in, and concern about, the relationship between health and foreign policysignals awareness of a transformation in this relationship that is leaving its imprint on the protection and promotion of health nationally and internationally. This transformation remains incompletely understood and raises difficult questions about how the making and implementation of foreign policy will deal with health in the future. These questions suggest that WHO and its members are experiencing a transition in the global politics of public health, a transition perhaps more profound than the one signalled by the establishment of WHO in 1946. The revolution in the relationship between health and foreign policy represents the nascent formation of a new global social contract for health.
Country
Publisher
The World Health Organisation
Theme area
Governance and participation in health
Title of publication Does Global Health Funding Respond to Recipients’ Needs? Comparing Public and Private Donors’ Allocations in 2005-2007
Date of publication
2011
Publication type
Academic paper
Publication details
World Development 39 8 pp 1271-1280
Publication status
Published
Language
English
Keywords
global health, international, private, governance
Abstract
This study offers the first comprehensive national-level analysis of global health aid responsiveness. Adding to official development assistance (ODA), private foundations have emerged as important donors to the global health agenda. Amid this increasing funder diversity and growing global health budgets, responsiveness to recipients’ needs is a central concern. This study merges datasets on ODA flows in 2005–07, over 2,800 foundation grants, disease burden, and perceived priorities in 27 low- and middle-income countries. The analysis shows that national patterns of disease burden explain neither public nor private aid flows during this period. While ODA committed during these years was weakly yet significantly correlated with health priorities, private grants’ responsiveness was even weaker and did not achieve ODA significance levels either.
Country
Publisher
World Development
Theme area
Governance and participation in health
Title of publication Pay-for-performance goes global
Date of publication
2012 May
Publication type
Document
Publication details
In section: International Comparisons, Pay for Performance (P4P), Quality / / pp /-/
Publication status
Published
Language
English
Keywords
resource allocation, health financing, international, results-based financing
Abstract
Policy makers seek to transform healthcare delivery at home and abroad by shifting payment from volume-based to quality-based methods. This study explores elements common across pay-for-performance in 13 countries.
Country
Publisher
Policy Prescriptions
Theme area
Governance and participation in health
Title of publication Performance-based payment: some reflections on the discourse, evidence and unanswered questions.
Date of publication
2009
Publication type
Academic paper
Publication details
Health Policy and Planning 24 / pp 160-166
Publication status
Published
Language
English
Keywords
resource allocation, health financing, international, governance, systematic review, results-based financing
Abstract
Performance-based payment (PBP) is increasingly advocated as a way to improve the performance of health systems in low-income countries. This study conducted a systematic review of the current literature on this topic and found that while it is a popular term, there was little consensus about the meaning or the use of the concept of PBP. Significant weaknesses in the current evidence base on the success of PBP initiatives were also found. The literature would be strengthened by multi-disciplinary case studies that present both the advantages and disadvantages of PBP, influential factors for success, and more details about the projects from which this evidence is drawn. Where possible, data from control facilities where PBP is not being implemented would be an important addition. This paper suggests a further agenda for research, including assessing optimal conditions for implementation of PBP schemes in less developed health systems, the impact of adopting measures of performance as targets, and the requirements for monitoring PBP adequately.
Country
Publisher
Health Policy and Planning, Oxford University Press
Theme area
Governance and participation in health
Title of publication Can “Pay for Performance” Increase Utiliziation by the Poor and Improve the Quality of Health Services?
Date of publication
2006 February
Publication type
Document
Publication details
Discussion Paper, first meeting of the Working Group on Performance-Based Incentives / / pp /-/
Publication status
Published
Language
English
Keywords
resource allocation, health care financing, international, results-based financing
Abstract
This paper begins by defining and describing “pay-for-performance” approaches designed for consumers, individual health care providers, service delivery institutions, and sub-national levels of countries. It follows with a section that presents evidence of two basic, related problems: first, health services are underutilized by the poor, relative both to what would be desirable from a public health perspective and to the utilization levels of individuals from better-off households; second, services available to the poor are of substandard quality. The subsequent section discusses determinants of demand and supply and principal agent theory to ground our discussion of incentives in the health system in economic theory. Following this, to place the pay-for-performance (P4P) approach within a systemic context, is a brief discussion of the relationship among elements of health systems, and the links between those elements and P4P applications. This section also suggests a framework that might be used to evaluate and categorize P4P interventions and their contributions to improving health system performance. Section six summarizes selected details of cases that are presented in the Annex. Some interventions are focused primarily on demand side constraints, others are designed to motivate providers, and others address both demand and supply side behaviour. The description provided only scratches the surface of what can be learned. Following this overview of cases is a brief section that is intended to focus future work, under the auspices of the working group, on the practical details of what it takes to move from the idea stage to implementation. The final section summarizes broad unanswered questions that constitute a possible agenda that the working group could address.
Country
Publisher
Center for Global Development
Theme area
Governance and participation in health
Title of publication Seven habits of highly effective global public-private health partnerships: Practice and potential
Date of publication
2007
Publication type
Academic paper
Publication details
Social Science and Medicine 64 2 pp 259-271
Publication status
Published
Language
English
Keywords
resource allocation, health financing, international, governance, public-private partnerships, global health
Abstract
Global public–private health partnerships (GHPs) have become an established mechanism of global health governance. Sufficient evaluations have now been conducted to justify an assessment of their strengths and weaknesses. This paper outlines seven contributions made by GHPs to tackling diseases of poverty. It then identifies seven habits many GHPs practice that result in sub-optimal performance and negative externalities. These are skewing national priorities by imposing external ones; depriving specific stakeholders a voice in decision-making; inadequate governance practices; misguided assumptions of the efficiency of the public and private sectors; insufficient resources to implement partnership activities and pay for alliance costs; wasting resources through inadequate use of recipient country systems and poor harmonisation; and inappropriate incentives for staff engaging in partnerships. The analysis highlights areas where reforms are desirable and concludes by presenting seven actions that would assist GHPs to adopt better habits which, it is hoped, would make them highly effective and bring about better health in the developing world.
Country
Publisher
Social Science and Medicine, Elsevier Limited
Theme area
Governance and participation in health
Title of publication The Global Fund: Managing great expectations
Date of publication
2004
Publication type
Academic paper
Publication details
The Lancet 364 9428 pp 95-100
Publication status
Published
Language
English
Keywords
low-income countries, governance, Global Fund
Abstract
This articles reports the interim findings, based on interviews with 137 national-level respondents that track early implementation processes in four African countries for the Global Fund to fight AIDS, Tuberculosis, and Malaria. This Global FundCountry coordinating mechanisms (CCMs) are country-level partnerships, which were formed quickly to develop and submit grant proposals to the Global Fund. CCM members were reported in this paper to be often ineffective at representing their constituencies and encountered obstacles in participating in CCM processes. Delay in dissemination of guidelines from the Global Fund led to uncertainty among members about the function of these new partnerships. Respondents expressed most concern about the limited capacity of fund recipients--government and non-government--to meet Global Fund conditions for performance-based disbursement. Delays in payment of funds to implementing agencies have frustrated rapid financing of disease control interventions. The Global Fund is one of several new global initiatives superimposed on existing country systems to finance the control of HIV/AIDS. New and existing donors need to coordinate assistance to developing countries by bringing together funding, planning, management, and reporting systems if global goals for disease control are to be achieved.
Country
Publisher
The Lancet, Elsevier Limited
Theme area
Governance and participation in health
Title of publication Multisectoralism, Participation, and Stakeholder Effectiveness: Increasing the Role of Non-State Actors in the Global Fund to Fight AIDS, Tuberculosis and Malaria.
Date of publication
2009 April
Publication type
Document
Publication details
Global Governance 15 / pp 169-177
Publication status
Published
Language
English
Keywords
governance, international, Global Fund
Abstract
The purpose of this essay is to discuss the role of non-state actors in the decision making processes of the Global Fund to Fight AIDS, Tuberculosis and Malaria; which was designed specifically to bring various stakeholders together to create a more coordinated mechanism to combat three of the world's most destructive diseases. The aim of this discussion is not to undermine the good work of the Global Fund, but to expose certain structural weaknesses in the current way non state actors are incorporated into the governance process and to illustrate how these structural processes might negate their effective participation. By doing so, this exploration will help expose various deficit gaps between the stated aims of multi-sectoral participation within the Global Fund and its actual practice. The goal is to encourage normative recommendations for increasing the real-world operation of stakeholder inclusiveness, ownership, partnership, and participation within the Global Fund.
Country
Publisher
Lynne Rienner Publishers
Theme area
Governance and participation in health
Title of publication Taking Stock: World Bank Experience with Results-Based Financing (RBF) for Health, World Bank
Date of publication
2009
Publication type
Document
Publication details
World Bank: Health, Nutrition and Population Unit / / pp /-/
Publication status
Published
Language
English
Keywords
governance, resource allocation, health financing, results-based financing
Abstract
This paper provides a summary of “Taking Stock: World Bank Experience with Results-Based Financing (RBF) for Health which is posted on this website. This summary describes the rationale for the exercise, methods used, major findings, and lessons learned from the review of World Bank project documents. The paper presents the findings of a review of 260 Health, Nutrition, and Population (HNP) projects with a health sector performance theme in order to understand the nature and extent of World Bank experience with RBF for Health. This paper reviews HNP project lending to identify the extent and nature of World Bank support for RBF for health in order to draw lessons for strengthening design, implementation, monitoring and evaluation of Bank projects with RBF activities in the future. Results-Based Financing (RBF) for health is a cash payment or non-monetary transfer made to a national or sub-national government, manager, provider, payer, or consumer of health services after predefined results have been attained and verified. Payment is conditional on measureable actions being undertaken. This review is expected to provide useful information for Bank staff interested in supporting countries in the design, implementation, monitoring and evaluation of RBF operations; and, to establish a baseline for monitoring progress in implementing the HNP Strategy, Healthy Development: The World Bank Strategy for Health, Nutrition and Population Results (2007).
Country
Publisher
World Bank
Theme area
Governance and participation in health
Title of publication The effects of global health initiatives on country health systems: A review of the evidence from HIV/AIDS control
Date of publication
2009
Publication type
Academic paper
Publication details
Health Policy and Planning 24 4 pp 239-252
Publication status
Published
Language
English
Keywords
governance, international, equity,, global health , health systems
Abstract
This paper reviews country-level evidence about the impact of global health initiatives (GHIs), which have had profound effects on recipient country health systems in middle and low income countries. The authors have selected three initiatives that account for an estimated two-thirds of external funding earmarked for HIV/AIDS control in resource-poor countries: the Global Fund to Fight AIDS, TB and Malaria, the World Bank Multi-country AIDS Program (MAP) and the US President's Emergency Plan for AIDS Relief (PEPFAR). This paper draws on 31 original country-specific and cross-country articles and reports, based on country-level fieldwork conducted between 2002 and 2007. Positive effects have included a rapid scale-up in HIV/AIDS service delivery, greater stakeholder participation, and channelling of funds to non-governmental stakeholders, mainly NGOs and faith-based bodies. Negative effects include distortion of recipient countries' national policies, notably through distracting governments from coordinated efforts to strengthen health systems and re-verticalization of planning, management and monitoring and evaluation systems. Sub-national and district studies are needed to assess the degree to which GHIs are learning to align with and build the capacities of countries to respond to HIV/AIDS; whether marginalized populations access and benefit from GHI-funded programmes; and about the cost-effectiveness and long-term sustainability of the HIV and AIDS programmes funded by the GHIs. Three multi-country sets of evaluations, which will be reporting in 2009, will answer some of these questions.
Country
Publisher
Health Policy and Planning, Oxford University Press
Theme area
Governance and participation in health
Title of publication Effect on maternal and child health services in Rwanda of payment to primary health-care providers for performance: An impact evaluation
Date of publication
2011
Publication type
Academic paper
Publication details
The Lancet 377 9775 pp 1421-1428
Publication status
Published
Language
English
Keywords
health workers, governance, Rwanda, resource allocation, health financing, performance-based payment, provider remuneration
Abstract
This article reports on an assessment of the effect of performance-based payment of health-care providers (payment for performance; P4P) on use and quality of child and maternal care services in health-care facilities in Rwanda. 166 facilities were randomly assigned at the district level either to begin P4P funding between June, 2006, and October, 2006 (intervention group; n=80), or to continue with the traditional input-based funding until 23 months after study baseline (control group; n=86). Randomisation was done by coin toss. The authors surveyed facilities and 2158 households at baseline and after 23 months. The main outcome measures were prenatal care visits and institutional deliveries, quality of prenatal care, and child preventive care visits and immunisation. The authors isolated the incentive effect from the resource effect by increasing comparison facilities' input-based budgets by the average P4P payments made to the treatment facilities. Facilities in the intervention group had a 23% increase in the number of institutional deliveries and increases in the number of preventive care visits by children aged 23 months or younger (56%) and aged between 24 months and 59 months (132%). No improvements were seen in the number of women completing four prenatal care visits or of children receiving full immunisation schedules. The P4P scheme in Rwanda had the greatest effect on those services that had the highest payment rates and needed the least effort from the service provider. P4P financial performance incentives can improve both the use and quality of maternal and child health services, and could be a useful intervention to accelerate progress towards Millennium Development Goals for maternal and child health.
Country
Publisher
The Lancet
Theme area
Governance and participation in health
Title of publication Health worker migration and bilateral agreements: Reflections on potential role
Date of publication
2011 November
Publication type
Slide presentation
Publication details
Presentation at Meeting of the Ibero American Network on the Migration of Health professionals / / pp /-/
Publication status
Published
Language
English
Keywords
health workers, international, governance, migration, bilateral agreements
Abstract
This slide presentation highlights the history and complexities of the brain drain in health care, as well as the influences of various global and international policies on this. The author begins by quoting statements, such as that stating that the flood of illegal unskilled migrants into rich countries and the “brain drain” of skilled citizens from the poorest countries are two of the most critical current issues in international migration today. These problems have highlighted a gaping hole in the international institutional architecture. There are only a fragmented set of institutions to deal with flows of humanity. The International Labour Organisation looks after workers’ rights. The
United High Commissioner for Refugees deals with forced migrants. The World Trade Organisation, under its services agreement, manages the temporary access of professional and semi-professional workers – from builders to doctors – to other countries. The International Organization of Migration is a cross between a consulting body and an altruistic group. Besides its status is not defined by a treaty. Indeed, we do not have a treaty-defined “World Migration Organisation” (WMO) that could oversee the whole phenomenon, according to internationally agreed objectives and procedures.
Country
Publisher
Ibero American Network on the Migration of Health Professionals
Theme area
Governance and participation in health
Title of publication WHO code of practice on the international recruitment of health personnel
Date of publication
2008 October
Publication type
Document
Publication details
Bulletin of the World Health Organization 86 10 pp 739-/
Publication status
Published
Language
English
Keywords
health workers, international, governance, code, recruitment
Abstract
This article briefly outlines a code of practice on the international recruitment of health personnel; developed by WHO Member States, and all relevant partners. The draft code sets out guiding principles and voluntary international standards for recruitment of health workers, to increase the consistency of national policies and discourage unethical practices, while promoting an equitable balance of interests among health workers, source countries and destination countries. Consistent with contemporary international legal practice, the initial draft of the code also aims to establish an international procedural structure to foster national dialogue, commitment and action on health worker migration. Importantly, this first draft does not aim to comprehensively address and resolve all of the issues raised by the international recruitment of health personnel. Rather, the text was purposefully kept brief. The goal of the first draft was to provide a straightforward framework and platform on which to launch negotiations.
Country
Publisher
The World Health Organization
Theme area
Governance and participation in health
Title of publication Foreign Advertisements for Doctors in the South African Medical Journal from 2006 to 2010
Date of publication
2012
Publication type
Academic paper
Publication details
South Africa Medical Journal 102 / pp 669-672
Publication status
Published
Language
English
Keywords
health worker, South Africa, international,migration, governance, recruitment
Abstract
This review sets out to establish the trends in foreign advertisements for doctors placed in the South African Medical Journal (SAMJ) from January 2006 to December 2010.There is much concern about the migration of health professionals from developing countries, and the contribution of active recruitment to the phenomenon. One active recruitment strategy is advertisements in professional journals and other media. A retrospective review was conducted of 60 issues of the SAMJ published in the preview years. Printed journals were scanned for foreign advertisements. The findings were compared with a review of 2000 - 2004 in the same journal. There were 1 176 foreign advertisements placed in the SAMJ in the review period, reducing from 355 in 2006 to 121 in 2010. The countries placing the most advertisements were Australia (n=428, 36.4%), Canada (n=286, 24.3%), New Zealand (n=191, 16.2%) and the UK (n=108, 9.2%). Compared with the earlier findings, there was a reduction in advertisements for the top countries, excepting Australia. The top 4 countries remained the same for the 2 review periods, but the order changed, with Australia superseding the UK. The number of foreign advertisements placed in the SAMJ declined over the period under review, and there was a change in ranking of the top 4 advertising countries. These findings are discussed from the perspective of global human resources for health initiatives.
Country
Publisher
South Africa Medical Journal
Theme area
Governance and participation in health
Title of publication Report of the Commonwealth Health Ministers’ Meeting: Memorandum of Understanding between the Government of the United Kingdom of Great Britain and Northern Ireland and the Government of the Republic of South Africa on the Reciprocal Educational Exchange
Date of publication
2006
Publication type
Conference Proceedings
Publication details
Commonwealth Secretariat Annex 1 / pp /-/
Publication status
Published
Language
English
Keywords
governance, South Africa, UK, health workers, migration, bilateral agreement
Abstract
This document narrates the Memorandum of Understanding between a former South African Minister of Health and the United Kingdom (UK) Department of Health on the education and migration of health care professionals. Specifically, the migration of health care professionals from South Africa to UK was increasingly becoming a concern for the Ministry of Health in South Africa. As a result constructive discussions were initiated between the two countries from 1998 onwards. In response to concerns raised, the Department of Health (England) published the International Recruitment Guidance in 1999 and a Code of Practice in 2001 based on ethical principles. In 2003, as part of this dialogue between the South African and the UK Departments of Health, the then Secretary of State for Health, England, Mr Alan Milburn and Dr Manto Tshabalala-Msimang, Minister of Health, South Africa agreed to formalise co-operation between the two countries. This resulted in the development of a Memorandum of Understanding (MOU) which was signed by both parties in October 2003. The MOU focuses on two main areas: the sharing of expertise and information on a range of key areas, and opportunities for time-limited placements in each other’s countries.
The sharing of skills and expertise between the two countries has led to the development of many links, based on requests and identified needs. There have also been a number of twinning arrangements between individual UK and South African institutions.
Country
Publisher
Commonwealth Secretariat
Theme area
Governance and participation in health
Title of publication No, British Medical Journal, the emigration of African doctors did not cost Africa $2 billion.
Date of publication
2011 November
Publication type
Document
Publication details
/ / / pp /-/
Publication status
Published
Language
English
Keywords
governance, low-income-countries, health workers, migration, cost
Abstract
This article, presented in the form of a blog, provides the author’s views on an article published by Mills et al 2011 on health worker migration in the British Medical Journal. The author describes the article as a back-of-the-envelope calculation, suggesting that the emigration of physicians from Africa cost the continent billions of dollars and saved billions for the countries of destination. The author describes how he shares and appreciates the authors’ concern for strengthening health care systems in Africa, but that the numbers they calculate are deeply flawed, and their unfortunate arithmetic should be ignored by policymakers. The author expresses his concern for the unscientific analysis in a respected scientific forum like the British Medical Journal, and proceeds to discuss in detail the reasons for his thinking.
Country
Publisher
Center for Global Development
Theme area
Governance and participation in health
Title of publication Fatal flows – doctors on the move
Date of publication
2005 October
Publication type
Report
Publication details
The New England Journal of Medicine 353 / pp 1850-1852
Publication status
Published
Language
English
Keywords
health workers, governance, international, migration
Abstract
This editorial in the New England Journal of Medicine presents a brief discussion on the impact and future of the brain drain in health care, from poorer societies to wealthier societies. The authors conclude that managing international medical migration ultimately will require global political consensus; and that, as the most powerful actor in multilateral agencies and funds, the United States must join other governments in crafting collective solutions. The authors bring the reader to the attention that in the last two annual meetings of the World Health Assembly, African health ministers pushed through resolutions calling for urgent action to dampen unplanned emigration of health care workers, and Commonwealth states recently enacted a code of conduct to curtail unethical recruitment.
Country
Publisher
The New England Journal of Medicine
Theme area
Governance and participation in health
Title of publication When Popular Participation Won't Improve Service Provision: Primary Health Care in Uganda
Date of publication
2005 March
Publication type
Academic paper
Publication details
Development Policy Review 23 2 pp 165-182
Publication status
Published
Language
English
Keywords
social power, social participation, Uganda, ethnographic research
Abstract
This article sets out to assess the views on participatory approaches to health care delivery in Uganda. Advocates of participatory approaches to service delivery see devolution as key to empowering people to take charge of their own affairs. Participation is portrayed as guaranteeing the delivery of services that are in line with user preferences. It is assumed that people are keen to participate in public affairs, that they possess the capacity to do so, and that all they need is opportunities. Using evidence from ethnographic research in Uganda, this article questions these views. It shows that, to succeed in the long term, devolution and participation must take place in the context of a strong state, able to ensure consistent regulation, and a well-informed public backed up by a participatory political culture.
Country
Publisher
Development Policy Review
Theme area
Governance and participation in health
Title of publication Community Health Committees as a vehicle for participation in advancing the right to health.
Date of publication
2010 September
Publication type
Journal Article
Publication details
Critical Health Perspectives 2 1 pp /-/
Publication status
Published
Language
English
Keywords
Social power, Social participation, South Africa, health committees
Abstract
This paper explores whether community participation through health committees can advance the right to health in South Africa. The paper reports on 32 in-depth interviews with members of three Community Health Committees and health service providers in the Cape Metropolitan area. The common barriers to participation mentioned by participants included under-representation of marginalised groups, and the absence of a formal mandate giving Health Committees clear objectives and the authority to achieve them. A number of characteristics of Health Committees were identified that promoted meaningful participation: a facility manager who helps tip the balance of power from health professionals towards the community by sharing decision-making with the Health Committee and by involving it in facility operations; a form of apprenticeship in which newer Committee members learn skills and procedures from more experienced members; intersectoral activity through the regular involvement of ward councilors and environmental health officers in Health Committee meetings and activities; a mechanism for the committee to be involved in reviewing and resolving patient complaints at health facilities; the use of media and information to increase their visibility in the clinic and in the community, to inform the community of Health Committee activities and broaden participation. Achieving small gains appeared to act as positive reinforcement to achieve bigger gains.
Country
Publisher
People’s Health Movement
Theme area
Governance and participation in health
Title of publication Social power, international, participatory research, health analysis action cycle, women’s health
Date of publication
Publication type
Report
Publication details
Sociological Research Online / / pp /-/
Publication status
Published
Language
English
Keywords
social power, international, participatory research, women’s health
Abstract
This paper analyses the health analysis cycle as an empowering approach to development. It discusses what the terms power and empowerment within the development discourse mean. It considers the factors that contribute to empowerment and those that hinder it. The study involved the use of a participatory action research approach in a community setting. The relationships between women's socio-economic circumstances, their ethnicity or caste and the process of empowerment are introduced through the use of case studies. The health analysis cycle is described in an annexe to this paper.
Country
Publisher
Sociological Research Online
Theme area
Governance and participation in health
Title of publication Power and Knowledge
Date of publication
2001
Publication type
Book Section
Publication details
SAGE Handbook of Action Research: Participative Inquiry and Practice 2nd edition / pp 70-80
Publication status
Published
Language
English
Keywords
social power, knowledge, action research
Abstract
This handbook has been updated to bring chapters in line with the latest qualitative and quantitative approaches in this field of social inquiry. Peter Reason and Hilary Bradbury have introduced new part commentaries that draw links between different contributions and show their interrelations. Participatory research has long held within it implicit notions of the relationships between power and knowledge. Advocates of participatory action research have focused their critique of conventional research strategies on structural relationships of power and the ways through which they are maintained by monopolies of knowledge, arguing that participatory knowledge strategies can challenge deep-rooted power inequities. Other action research traditions have focused more on issues of power and knowledge within organizations, while others still have highlighted the power relations between individuals, especially those involving professionals and those with whom they work. This chapter explores the relationship of power and knowledge. It begins by exploring some of the ways in which power is conceptualized, drawing upon the work of Lukes, Foucault and others. It then turns to considering the ways in which differing traditions of participatory research seek to transform power relations by challenging conventional processes of knowledge production.
Country
Publisher
SAGE Publications
Theme area
Governance and participation in health
Title of publication Transforming Power: From Zero-Sum to Win-Win?
Date of publication
2006 November
Publication type
Document
Publication details
IDS Bulletin 37 6 pp 99-110
Publication status
Published
Language
English
Keywords
social power, international
Abstract
This article serves as a platform on which the author (on invitation) describes in detail his approach to power. The key messages that emerged from this document are: that there is nothing inherently bad about power ‘over’ others – it depends on how it is used; that in many ways power over others does not have to be a zero-sum game; and that perspectives and strategies for transforming power from below, vital as they are, should not distract from the potentials for transformations from above. The approach to power as described by the author is based on an understanding of power as capability, and thus as potentially infinitely expanding, as well as on a normative preference for cooperation rather than competition. The author introduces concepts of ‘uppers’ (a person who in a context is dominant or superior to a lower in that same context) and ‘lowers’ (a person who in a context is subordinate or inferior to an upper in that same context).
Country
Publisher
Institute of Development Studies
Theme area
Governance and participation in health
Title of publication Community Empowerment Paradigm Drift and the Primary Prevention on HIV/AIDS
Date of publication
1998 April
Publication type
Academic paper
Publication details
Social Science and Medicine 46 7 pp 831-842
Publication status
Published
Language
English
Keywords
social power, international, HIV primary prevention
Abstract
This paper discusses the relevance of empowerment to community interventions for persons at risk for HIV, particularly women. Long discussed in the public health arena, the concept of empowerment has only recently entered the discourse on the primary prevention of HIV/AIDS in the United States. Despite its broad appeal, empowerment has not been systematically incorporated into theory-based interventions, which may reflect a lack of consensus on the meaning of empowerment, how to measure it, and the intervention strategies it implies. In this paper, the origins of empowerment are reviewed; community empowerment as an intervention framework is described and its core assumptions defined. There is some evidence of the growing influence of empowerment and related concepts in recent HIV-related policy, research, and programs funded through the Centers for Disease Control and Prevention. However, adoption of an empowerment framework for HIV prevention will require further theory and measurement development, as well as changes in how public health researchers and practitioners work with the communities they serve.
Country
Publisher
Social Science and Medicine
Theme area
Governance and participation in health
Title of publication Annotated bibliography: Social power, participation and accountability in health
Date of publication
2013 May
Publication type
Document
Publication details
Annotated bibliography: Social power, participation and accountability in health, TARSC, EQUINET with COPASAH, May 2013, Harare.
Publication status
Published
Language
Keywords
annotated bibliography, social power, social accountability, social participation, participatory action research
Abstract
This annotated bibliography was prepared as a resource for people working on different dimensions of social power, social participation and social accountability in health. A universal health system values and ensures the right to health care, entitling all citizens in a country to access the same range of services according to their need and pay for these services according to their income. Achieving this calls for more than technical solutions. It demands public leadership and people’s power to assert social needs and interests, to influence the allocation of societal resources towards health needs and to challenge the distribution of power and resources that block this. Social power, participation and accountability are thus central concepts in building people centred health systems. This social dimension of health systems is a central concern for the three organisations/ consortia involved in the production of this annotated bibliography. It was commissioned by the Community of Practitioners on Accountability and Social Action in Health (COPASAH) and prepared by Training and Research Support Centre (TARSC) within the Regional Network for Equity on Health in East and Southern Africa (EQUINET).
Country
International
Publisher
Equinet Publication Type
Toolkits and training materials
Theme area
Health equity in economic and trade policies, Governance and participation in health
Title of publication EQUINET Discussion paper 96: Literature review on co-operation in essential medicines production and procurement between Eastern and Southern Africa (ESA) and Brazil, India and China
Date of publication
2013 May
Publication type
Document
Publication details
Literature review on co-operation in essential medicines production and procurement between Eastern and Southern Africa (ESA) and Brazil, India and China', EQUINET Discussion paper 96, TARSC, CPTL, EQUINET Harare
Publication status
Published
Language
Keywords
essential medicines, local production, literature review, south-south, east and southern Africa, Brazil, India, China
Abstract
Access to essential medicines is one of the key requirements for achieving equitable health systems and better public health in east and southern Africa (ESA). One constraint to this is that the region’s medicine production capacity remains weak. In May 2007, the African Heads of State and Government adopted the Pharmaceutical Manufacturing Plan for Africa (PMPA) to maintain a sustainable supply of quality essential medicines to improve public health and promote industrial and economic development in Africa. The PMPA includes six priority areas: mapping productive capacity; situation analysis; developing a manufacturing agenda; addressing intellectual property issues; political, geographical, economic considerations; and financing. This review compiles from existing literature bottlenecks to local medicine production in the region. It seeks to inform follow-up case study work on the extent to which relationships and agreements with Brazil, India and China are addressing the bottlenecks identified in the African Union (AU), SADC and EAC plans for pharmaceutical manufacturing.
Country
East and southern Africa region
Publisher
Equinet Publication Type
Discussion paper
Theme area
Governance and participation in health
Title of publication China's Health Diplomacy in Africa
Date of publication
2010 March
Publication type
Journal Article
Publication details
China: An International Journal 8 1
Publication status
Published
Language
English
Keywords
health diplomacy, Africa, China, foreign policy, governance
Abstract
In recent years, Africa has regained a level of prominence in China's overall foreign policy strategy. Health diplomacy helps pave the way for Chinese oil companies to win mining rights for oil, platinum and other natural resources. However, a successful soft power strategy will need to consider public opinion and provide a means for connecting the health diplomacy with the larger goals, according to this paper.
Country
Singapore
Publisher
Theme area
Values, policies and rights, Health equity in economic and trade policies
Title of publication Trade Policy Review Reports: Zimbabwe
Date of publication
2011
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
trade, Zimbabwe, policy
Abstract
Zimbabwe's renewed commitment to fiscal discipline and its de facto adoption of the U.S. dollar as legal tender as a result of the implementation of its multi-currency system in February 2009 have brought some encouraging signs towards macroeconomic stabilisation. Nevertheless, Zimbabwe's economy is still in a fragile state with high unemployment, depleted international reserves, and unsustainably high external debt, including a major accrual of arrears. A fractious socio-political environment, combined with a controversial land reform and measures in favour of indigenisation, has triggered the withdrawal of support from the international community and cast a shadow over property rights, thereby undermining the business environment, with a devastating impact on Zimbabwe's economic performance and social indicators over the past decade.Zimbabwe's economy remains relatively diversified, with the services sector accounting for approximately half of its GDP. Despite its comparatively modest contribution to GDP, agriculture remains the principal source of employment and continues to have a multiplier effect on the economy. The mining sector has recently entered a phase of vigorous expansion and has the potential to develop into a major pillar of the economy.
Country
Switzerland
Publisher
WTO
Theme area
Health equity in economic and trade policies, Governance and participation in health
Title of publication Bridging the Atlantic: Brazil and Sub-Saharan Africa South-south partnering for growth
Date of publication
2011
Publication type
Academic paper
Publication details
Publication status
Published
Language
English
Keywords
trade, Africa, Brazil, South-South, medicines, governance
Abstract
This is a descriptive study about Brazil’s involvement with counterparts in Sub-Saharan Africa over the last decade through knowledge exchange, trade, and investments. The objective of the study is to understand these relations better with the intent to forge concrete and mutually beneficial partnerships between Brazil and Sub-Saharan Africa. Brazil and Sub-Saharan Africa are natural partners, and in the past decade the two areas are re-establishing connections that will affect each other’s prosperity and development in major ways. This renewed engagement reflects new, positive realities in the evolution of development cooperation; Africa’s rapid growth in recent years; and Brazil’s rise as a global economic power interested in intensifying its ties - cultural and commercial - with Africa.Countries in Sub-Saharan Africa have requested cooperation from Brazil in five key areas: tropical agriculture, tropical medicine, vocational training (to support the industrial sector), energy, and social protection. Since the turn of the twentieth century, Africa has become one of the major fronts of Brazil’s international agenda. Africa is rapidly changing and Brazil has expressed growing interest in supporting and taking part in African development. Brazil’s intensified engagement with Africa demonstrates both geopolitical ambition and economic interest, but its strong historical ties and affinities with Africa set it apart from the other original BRIC countries.
Country
United States
Publisher
World Bank
Theme area
Health equity in economic and trade policies, Governance and participation in health
Title of publication Pharmaceutical Production and Related Technology Transfer
Date of publication
2011
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
Medicines, Africa, technology transfer, pharmaceutical production, governance
Abstract
This report provides a description of the current landscape related to the local production of drugs in developing countries and related technology transfer. In Africa, a number of countries were identified as having substantial existing or potential production capacity, including Ethiopia, Ghana, Kenya, Rwanda, South Africa, Tanzania and Uganda.Supporting the development of local pharmaceutical production capacity is a complex endeavour involving many types of activity. The initiatives identified by this study undertook a broad range of activities and varied widely along a number of dimensions. The findings also point to a notable absence of initiatives in certain areas, such as vaccine production. The report identifies a wide range of actors transferring technology to local producers, ranging from individuals to non-profit-making institutions to multinational pharmaceutical companies to major public institutions. Technology was also transferred to less advanced generics firms in smaller or less-developed countries, with a wide distribution across sub-Saharan Africa, albeit with some concentration in east Africa (Kenya, Tanzania, Uganda), particularly for antimalarials. Transfers to African firms usually involved formulation, packaging, good manufacturing practices, training and documentation support, and seldom included production of active pharmaceutical ingredients.
Country
Switzerland
Publisher
WHO
Theme area
Health equity in economic and trade policies, Equitable health services, Governance and participation in health
Title of publication Baseline assessment of the Pharmaceutical situation in Southern African Development Community countries
Date of publication
2009
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
Medicines, southern Africa, procurement, intellectual property, governance
Abstract
This 2009 baseline assessment of the pharmaceutical situation in 15 SADC member states included Angola, Botswana, Democratic Republic of the Congo, Lesotho, Madagascar, Malawi, Mauritius, Mozambique, Namibia, Seychelles, South Africa, Swaziland, Tanzania, Zambia and Zimbabwe. The assessment found that the national annual per capita expenditure on health varies from US$ 10 to US$ 400. On average, public sector expenditure on health accounts for 60% of the total national expenditure on health. Only three countries devote 15% or more of their national budget to health as pledged by the Abuja Declaration of 2001. Eighty per cent of SADC countries have a National Medicines Policy, although some need updating. The total expenditure on medicines is 12.5% (median) of total health expenditure in SADC countries and average annual public sector per capita medicines expenditure is US$ 10. Fourteen out of 15 SADC countries are members of the World Trade Organisation (WTO) and 57% of countries have modified their legislation to comply with the TRIPS Agreement. Most countries have a procurement policy and give priority to domestic suppliers, while no country gives preferences to suppliers from other SADC countries. Twelve countries have updated their Essential Medicines Lists (EMLs) and Standard Treatment Guidelines (STGs) within the past five years.
Country
Switzerland
Publisher
WHO
Theme area
Health equity in economic and trade policies, Governance and participation in health
Title of publication Public health, innovation and intellectual property rights: report of the WHO Commission on Intellectual Property Rights, Innovation and Public Health
Date of publication
2006
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
Medicines, global, intellectual property, innovation, governance
Abstract
This report summarises the existing evidence on the prevalence of diseases of publichealth importance with an emphasis on those that particularly affect poor people and their social and economic impact. It reviews the volume and distribution of existing research, development andinnovation efforts directed at these diseases, and considers the importance and effectiveness of intellectual property regimes and other incentive and funding mechanisms in stimulating research and the creation of new medicines and other products against these diseases. The report also analyses proposals for improvements to the current incentive and funding regimes, including intellectual property rights, designed to stimulate the creation of new medicines and other products, and facilitate access to them. Finally, concrete proposals are outlined for action by national and international stakeholders.
Country
Switzerland
Publisher
WHO
Theme area
Health equity in economic and trade policies, Poverty and health, Governance and participation in health
Title of publication Industrial Development, Trade and Poverty Reduction through South-South Cooperation
Date of publication
2006
Publication type
Academic paper
Publication details
Publication status
Published
Language
English
Keywords
Trade, poverty reduction, South-South, governance
Abstract
According to this paper, South-South cooperation can become a major instrument for achieving the Millennium Development Goals (MDGs) agreed by the international community through the Millennium Declaration issued by the UN General Assembly in September 2000. The paper mainly focuses on the contribution of industry and trade to the realisation of MDG No. 1, poverty reduction, which is a particularly pressing issue in the least developed countries (LDCs) and Sub-Saharan Africa. The analysis presented in this paper demonstrates that South-South cooperation can make a great contribution to the further expansion of trade and the widening of its development impact, particularly in terms of poverty reduction. This cooperation should concentrate on four areas: developing common positions on global trade norms; developing productive capacities; formulating approaches to poverty reduction based on shared experience; and exchanges of knowledge and institutional networking.
Country
Switzerland
Publisher
UN
Theme area
Health equity in economic and trade policies, Resource allocation and health financing, Governance and participation in health
Title of publication Global Investments Trends Monitor No. 8
Date of publication
2012 January
Publication type
Electronic Source
Publication details
Publication status
Published
Language
Keywords
investment, trade, finance, governance
Abstract
Despite turmoil in the global economy, global foreign direct investment (FDI) inflows rose by 17% in 2011, to US$1.5 trillion, surpassing their pre-crisis average.FDI inflows increased in all major economic groupings −developed, developing and transition economies. Developing and transition economies continued to account for half of global FDI in 2011 as their inflows reached a new record high, at an estimated US$755 billion, driven mainly by robust greenfield investments. In this group, the 2011 increase in FDI flows was no longer driven by South, East and South-East Asia (which saw an increase of 11%), but rather by Latin America and the Caribbean (increase of 35%) and by transition economies (31%). Africa, the region with the most least developed countries (LDCs), continued its decline in FDI inflows.
Country
Switzerland
Publisher
UN
Theme area
Health equity in economic and trade policies, Governance and participation in health
Title of publication Local Production of Pharmaceuticals and Related Technology Transfer in Developing Countries
Date of publication
2011
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
medicines, Uganda, Ethiopia, technology transfer, pharmaceutical production, governance
Abstract
This compilation of case studies is designed to examine the transfer of technology and local production of pharmaceuticals in various developing countries, including Ethiopia and Uganda, highlighting different characteristics such as firm structure, the means by which local producers obtained and developed the technological capacity to produce medicines, and the types of product handled, among others. The case studies consider south-south co-operation, as well as north-south co-operation in the developments of Uganda’s and Ethiopia’s pharmaceutical sectors. They argue that local production is feasible in developing countries and least developed countries and may promote access to medicines. The results of the case studies show that the conditions under which technology transfer results in strengthening local production, and the ways and means in which this promotes greater access to medicines, are highly complex. Although access to medicines is being enhanced through local production, the project and its results suggest that a coherent framework that links local production to greater access from the onset within countries is urgently called for to harness the full potential of local production capacities. Improvement in access to medicines in the context of local production should not be incidental but should be an explicit goal.
Country
Publisher
UN
Theme area
Health equity in economic and trade policies, Governance and participation in health
Title of publication Investment in Pharmaceutical Production in the Least Developed Countries: A guide for Policy Makers and Investment Promotion Agencies
Date of publication
2011
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
medicines, Pharmaceutical production, investment, technology transfer, least developed countries, governance
Abstract
This report is a guide towards fostering foreign direct investment and technology transfer into the local pharmaceutical sector for less-developed countries (LDCs).It aims to provide a better understanding of the state of current global pharmaceutical production and the role that developing country production plays in it. It also examines the range of policy instruments that would enable developing countries to increase their chances of attracting the interest of investors. In order to have a serious chance at benefiting from the current changes and attracting foreign direct investment in the pharmaceutical sector, a number of important prerequisites need to be met, many of which are lacking in LDCs. It therefore may not make sense for all LDCs to aspire to be scaling up their local production of medicines. Furthermore, they will want to ensure that such efforts go beyond a mere industrial policy, and that the push to support the local production of pharmaceuticals through foreign direct investment and related technology transfer will address real public health needs in the relevant country and/or region. Finally, such countries will need to have an effective promotion strategy that appeals to potential investors. This guide outlines these recent trends, the basic prerequisites for the local production of pharmaceuticals and the key points that policymakers and investment negotiators, especially from investment promotion agencies, will need to keep in mind in efforts to support the pharmaceutical sector.
Country
Switzerland
Publisher
UN
Theme area
Resource allocation and health financing, Governance and participation in health
Title of publication Asian foreign direct investment in Africa: Towards a New Era of Cooperation among Developing Countries
Date of publication
2007
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
medicines, Asia, Africa, investment, south-south, governance
Abstract
This publication marks the completion of the project on “Needs Assessment to Attract AsianFDI into Africa”, undertaken with the financial support of the UNDP/Japan Human Resources Development Fund dedicated to South-South cooperation. This Report examines the various aspects of Asian foreign direct investment (FDI) in African economies with a view to improving understanding of the opportunities, constraints and steps needed to enhance Asian FDI in Africa. Understanding Asian experience and policies with respect to inward FDI could contribute to African countries’ capabilities to attract and benefit from FDI. Furthermore, since the late 1980s, outward FDI from the economies of developing Asia has become significant, and even though these cross-border flows have so far remained largely limited to the Asian region they arouse interest as potential sources of investment in Africa. This interest, which declined somewhat as a result of the Asian financial crisis of 1997-1998, was renewed following the recovery of the crisis-hit countries and the continuing steady growth of the Chinese and Indian economies. The fast-growing Asian economies could provide examples of development paths for African economies, also as economic partners, particularly for trade and investment. This volume focuses on the investment aspects of such South-South cooperation. While still small, FDI flows from Asia to Africa reached US$1.2 billion annually during the period 2002-2004, and they are set to increase further in the coming years.
Country
Switzerland
Publisher
UN
Theme area
Health equity in economic and trade policies, Governance and participation in health, Monitoring equity and research to policy
Title of publication The Structural Changes in the Global Pharmaceutical Marketplace and Their Possible Implications for Intellectual Property
Date of publication
2011
Publication type
Document
Publication details
ICTSD Policy Brief Number 10 pp 1-8
Publication status
Published
Language
English
Keywords
medicines, global, Research and development, intellectual property, governance
Abstract
A number of changes have taken place in the global pharmaceutical marketplace over the last decade that are putting pressure on the large research and development (R&D)-based pharmaceutical transnational corporations (TNCs) to change the way they do business. This policy brief examines how some of these changes interface with intellectual property (IP) policies, and suggests what that may mean for IP issues and pharmaceuticals in the years ahead. An emerging global strategy and presence is a high priority for most R&D-based pharmaceutical TNCs; this is borne out by the numerous deals and acquisitions of generic drug manufacturers that have taken place in the last five to 10 years as a result of the so-called ‘patent cliff’ and other competitive pressures. India promoter families are reviewing their wealth profiles and considering divesting their companies. It is possible that the younger new generation of CEOs will agree to a differentiated approach to IP issues/protection in developed country and emerging markets in a similar way to the dual pricing policies that have recently been introduced. Compulsory licences are likely to become more frequent once life saving medicines are manufactured in India but cannot be sold locally at low, generic prices following the introduction of pharmaceutical product patents in that country. If the large R&D-based TNCs do not change, they will probably be acquired by those companies that have changed and already moved into the emerging world with tiered pricing. These companies will have to come to accept an open, flexible approach to access to medicines in the developing world.
Country
Switzerland
Publisher
ICTSD
Theme area
Health equity in economic and trade policies, Governance and participation in health
Title of publication Unpacking the Technology Transfer Debate: Fifty Years and Beyond
Date of publication
2011 June
Publication type
Academic paper
Publication details
Publication status
Published
Language
English
Keywords
medicines, Technology transfer, intellectual property, governance
Abstract
On the occasion of fifty years of the international technology transfer debates and twenty years since the Rio Summit, this paper attempts to capture the political economy of technology transfer negotiations since the 1960s. It seeks to juxtapose issues of technological capacity, innovation and economic development with international technology transfer negotiations over the past decades. In doing so, the analysis places a particular emphasis on the technology transfer-intellectual property rights (IPRs) nexus which in many ways, has been at the heart of the international discourse on technology transfer. This paper aims to broaden our understanding of two key issues. First, do international negotiations on technology transfer and results achieved there undercorrespond to country level technological needs, and to the growing insights on how technological change takes place? Second, how and through what ways can international discussions on technology transfer be made to reflect both the lessons of different developing countries in building technological capabilities as well as the changing global environment for knowledge and technology globally? The authors conclude by identifying the main issues that remain outstanding in this discourse and propose some thoughts for the way forward.
Country
Switzerland
Publisher
UNCTD
Theme area
Health equity in economic and trade policies, Governance and participation in health
Title of publication SADC pharmaceutical business plan: 2007-2013
Date of publication
2007
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
medicines, SADC, pharmaceutical production, access, governance
Abstract
The overall goal of the SADC Pharmaceutical Business Plan is to ensure availability of essential medicines including African Traditional Medicines to reduce disease burden in the region. Its main objective is to improve sustainable availability and access to affordable, quality, safe, efficacious essential medicines including African Traditional Medicines. In line with the SADC Protocol on Health, the Implementation Plan for the Protocol and the SADC Health Policy Framework, the SADC Pharmaceutical Business Plan will be coordinated and implemented through the approved SADC structure. The Business Plan has spelt out clear roles and responsibilities of all stakeholders that will be involved in the implementation process. At the political level, the implementation of the Plan will be monitored through the established institutional framework. The implementation of the Plan will require substantial resources including human, material and financial from different sources. The Plan is estimated to cost US$16 million. To ensure ownership and sustainability, Member States will be required to budget for implementation of some of the interventions that need ongoing financial support. The SADC Secretariat will make all efforts to mobilise resources from key stakeholders including International Co-operating Partners. A monitoring and evaluation framework has been included in order to review activities during implementation process.
Country
Botswana
Publisher
SADC Secretariat
Theme area
Health equity in economic and trade policies, Governance and participation in health
Title of publication Chinese engagement with Africa: The case of Mozambique
Date of publication
2012
Publication type
Journal Article
Publication details
Portuguese Journal of International Affairs 4 pp 1-15
Publication status
Published
Language
English
Keywords
diplomacy, medicines, China, Mozambique, investment, south-south, governance
Abstract
This article examines China’s growing relations with Mozambique, to derive insights for wider arguments regarding China’s aims and impacts in Africa, and the trajectory of its growing global influence. It is argued that details of the China-Mozambique relationship support positions that China’s engagement with Africa is overwhelmingly economic and diplomatic, rather than military and strategic. Even in a non-oil producing country Chinese aid and investment is driven by acquisition of natural resources, and contrary to assertions China is not interested in Africa’s long-term development, China is attempting to foster general economic growth and social stability, and to maintain a positive public image. Evidence supports concerns that Chinese activities lessen Western leverage to induce reforms, and may undermine elements of the host economy and cause environmental degradation. However, China’s presence remains popular because of its perceived social and economic benefits, in contrast to neoliberal structural adjustment’s failure to significantly bolster social and economic progress. It is finally suggested that China’s relations with Mozambique support the wider diagnosis of declining US hegemony, but that China is not yet assuming that mantle.
Country
Portugal
Publisher
Theme area
Health equity in economic and trade policies, Public-private mix
Title of publication Quality Chemical Industries, Uganda
Date of publication
2013
Publication type
Electronic Source
Publication details
Publication status
Published
Language
English
Keywords
medicines, India, Uganda, pharmaceutical production, south-south
Abstract
In October 2007 a US$38 million pharmaceutical plant was set up in Uganda on a 15-acre site southwest of the capital Kampala, by the drug importer Quality Chemical Industries to produce antiretroviral drugs for the domestic market. The Indian pharmaceutical company Cipla holds a 42% stake in Quality Chemical Industries. Cipla provided the technology and the expertise to get the plant set up; the plant now provides an outlet for Cipla to produce these important drugs for the African market. In November 2009, TLG Capital acquired a 8.2% stake in the plant. Capitalworks Investment Partners of South Africa also owns an 8.2% stake. The active pharmaceutical ingredients to produce the drugs are imported from India at a lower import cost. In February 2011, Quality Chemicals Industries stated it plans to invest $80m in a two-phased expansion. The $30 m first phase of the project will expand the capacities at Quality Chemical Industries' generic AIDS and malaria-drug plants in Kampala. The remaining $50 m investment will be used to add a new production line for pharmaceutical ingredients during the second phase.
Country
Publisher
Theme area
Health equity in economic and trade policies, Equity and HIV/AIDS
Title of publication Brazil to produce ARVs in Mozambique
Date of publication
2012 July
Publication type
Electronic Source
Publication details
Publication status
Published
Language
English
Keywords
medicines, Brazil, antiretrovirals, Mozambique, pharmaceutical production, south-south
Abstract
The Brazilian government will soon begin producing antiretrovirals (ARVs) and other pharmaceuticals at a factory in Mozambique, according to a statement from the Brazilian presidency. Officially known as the Mozambican Medications Company (SMM), the plant is the first public institution in the pharmaceutical industry in Africa, and was made possible through a partnership between the governments of Brazil and Mozambique that is expected to benefit about 2.7 million people living with HIV and AIDS in Mozambique. Initially, three antiretroviral drugs will be produced - Lamivudine + Zidovudine, Nevirapine and Ribavirin - totalling 226 million pharmaceutical units per year that will be distributed to patients. Another five drugs will be added to the list in the future. In addition to the antiretrovirals, another 21 types of drugs are scheduled to be produced, including antibiotics, anti-anemias, antihypertensives, anti-inflammatories, hypoglycemiants, diuretics, antiparasitics and corticosteroid drugs. Overall, the factory is expected to produce about 371 million pharmaceutical units per year.
Country
Senegal
Publisher
Panapress
Theme area
Health equity in economic and trade policies
Title of publication Meaningful Technology Transfer to LDCs: A Proposal for a Monitoring Mechanism for TRIPS Article 66.2
Date of publication
2011
Publication type
Academic paper
Publication details
ICTSD Programme on Innovation, Technology, and Intellectual Property pp 1-13
Publication status
Published
Language
English
Keywords
medicines, Innovation, technology transfer, intellectual property, TRIPS
Abstract
This updated analysis of developed country reports has found little evidence that TRIPS Article 66.2 has resulted in significant additional incentives beyond business-as-usual for transferring technology to LDC Members. It also concludes that the existing reporting system does not function as an effective monitoring mechanism, and should be reviewed by the TRIPS Council, as required by its 2003 Decision. In order to operationalise Article 66.2 more effectively, the TRIPS Council should establish an effective monitoring system, the broad outlines of which have been sketched in this policy brief. While the precise composition and mandate of the monitoring mechanism would need to be decided by the TRIPS Council, the author suggests that the mechanism be tasked with carrying out informational and evaluative functions. Building an effective global system for genuine, meaningful technology transfer is therefore in the interests of all countries, and the case of TRIPS Article 66.2 is a compelling place to begin.
Country
United Kingdom
Publisher
ICTSD
Theme area
Health equity in economic and trade policies, Governance and participation in health
Title of publication Options for sustainable access to medicines in Africa: Moving beyond TRIPs flexibility toward local production capacity
Date of publication
2011 April
Publication type
Journal Article
Publication details
Health Diplomacy Monitor 2 2
Publication status
Published
Language
English
Keywords
medicines, Africa, TRIPS, pharmaceutical production, diplomacy, governance
Abstract
African countries have a widening array of options to improve regulatory approval and registration of new products in Africa, since prequalification has improved quality and lowered the monitored price cost of anti-malarials. However, these options partially, but not fully address African concerns. In particular, they do not address concerns about transfer of technology and strengthening local industrial capacity. Few of the pharmaceutical plants on the continent have been prequalified by the WHO.A number of policy options are emerging in support of local production. One of these options is to build partnership, including south-south public and private sector partnerships, noted above. Another is for regional level production agreements to concentrate the demand of various countries, generating economies of scale, better use of installed capacities, greater possibilities of local supply of active ingredients and other raw materials, and strengthening negotiating positions on prices. This paper calls for political agreement across countries on production, taxes and tariffs, medicines registration, and regulation. Using TRIPs flexibilities at the regional level raises additional issues of harmonising different national legal patent provisions, as not all may be LDCs. Advancing sustainable availability of quality drugs calls for a synergy between national, regional, and global level policies and negotiations across a number of platforms, and between short and longer term agendas.
Country
Canada
Publisher
Centre for Trade Policy and Law, Carleton University
Theme area
Health equity in economic and trade policies, Governance and participation in health
Title of publication The Global Politics of Intellectual Property Rights and Pharmaceutical Drug Policies in Developing Countries
Date of publication
2003 April
Publication type
Publication details
International Political Science Review 24 2 pp 181-197
Publication status
Published
Language
English
Keywords
medicines, Intellectual property rights, developing countries, TRIPS, diplomacy, governance
Abstract
One of the major characteristics of the emerging international economic order is the treatment of intellectual property rights (IPRs). Developing country Members are very concerned about the impact that the World Trade Organisation (WTO) Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) will have on their economies. Of particular concern are those aspects of the Agreement that relate to the issue of access to new pharmaceutical inventions. TRIPS emphasises a property rights approach whereby private “owners” of the inventions can restrict access on the basis of commercial considerations. As a consequence, higher prices for pharmaceuticals and other healthcare inventions can prevent low-income consumers in developing countries from obtaining life-saving medications and equipment. It is true, of course, that exploitative business practices are possible only to the extent that monopoly positions are tolerated. Many developing countries, however, lack the necessary financial resources and have not yet developed appropriate competition rules to deal effectively with the challenges presented by the TRIPS Agreement, the paper concludes.
Country
United States
Publisher
Sage Publications, Ltd.
Theme area
Values, policies and rights, Governance and participation in health
Title of publication Common Health Policy Interests and the Shaping of Global Pharmaceutical Policies
Date of publication
2010
Publication type
Journal Article
Publication details
Ethics & International Affairs 24 4 pp 395-414
Publication status
Published
Language
English
Keywords
medicines, diplomacy, policy, ethics, foreign policy, governance
Abstract
In order to achieve more ethical global health outcomes, health policies must be driven by health priorities and should take into account broader health policy requirements, including the needs of specific national health systems, according to this paper. It is thus important to recognise that the division of interests in key policy areas are not necessarily between the priorities of rich and poor countries, but between (1) pharmaceutical industry interests and health policy interests, and (2) national industrial and trade policy interests and public health policies. The paper focuses on two broad common interests for health policy officials. Both have become important in the context of current global negotiations relating to access to medicines; pandemic influenza; and public health, innovation, and intellectual property rights. These are (1) ensuring access, availability, and the safety of pharmaceuticals, and (2) ensuring that research-and-development efforts respond to public health needs. The author argues that these issues are not solely the concern of developing countries because the diminishing national policy space for health in pharmaceutical policies presents a challenge to all governments, including rich ones.
Country
United States
Publisher
Carnegie Council for Ethics in International Affairs
Theme area
Health equity in economic and trade policies, Equity and HIV/AIDS, Governance and participation in health
Title of publication Access to Medicines and the Transformation of the South African State: Exploring the Interactions of Legal and Policy Changes in Health, Intellectual Property, Trade, and Competition Law in the Context of South Africa’s HIV/AIDS Pandemic
Date of publication
2012
Publication type
Journal Article
Publication details
Law & Social Inquiry 37 2 pp 297-329
Publication status
Published
Language
English
Keywords
medicines, South Africa, access, AIDS, intellectual property, governance
Abstract
Access to essential medicines remains highly contested around the globe and a vital issue in South Africa. At the same time, the HIV and AIDS pandemic and the demand for medical services are having important political and social consequences in a society heavily impacted by the pandemic. Legal and institutional changes within the post-apartheid state in South Africa are in part a reflection of the interaction of opportunities and constraints both within and across the country's geographical boundaries. The transformation of state institutions in this context has been set in motion and shaped by different policy imperatives: from demands for medical care to the promotion of economic competition and the need to implement international trade commitments, including specific levels of intellectual property protection. Despite a strong commitment to social change, to address the legacies of apartheid, as well as the relative strength and political will of the dominant political party, the African National Congress, the transformation of a number of state institutions was significantly framed by the global environment in which the country found itself. In the context of South Africa's democratic transition and the devastating HIV and AIDS pandemic, the state responded to a range of shifting opportunities and constraints, whether real or perceived. As a result, impetus was given to different policies and competing political and economic factions, enabling particular institutions and rules to be embraced, created, reshaped, or simply foregone.
Country
Publisher
Theme area
Values, policies and rights, Health equity in economic and trade policies, Governance and participation in health
Title of publication Local Production of Pharmaceuticals: Industrial Policy and Access to Medicines – An overview of key concepts, issues and opportunities for future research
Date of publication
2005 January
Publication type
Academic paper
Publication details
Publication status
Language
English
Keywords
medicines, access policy, pharmaceutical manufacturing, governance
Abstract
Local production of pharmaceuticals in developing countries may be seen as helping to stimulate industrial policy and/or as stimulating pharmaceutical “access” to needed medicines. However, according to this paper, if a developing country with manufacturing facilities is able to finish off bulk active ingredients sourced from developed or other countries at high costs, such manufacture may have no impact whatever on patient access to needed medicines. There has been some critical thinking in the past regarding whether or not small developing countries should make their own pharmaceuticals, but no recent comprehensive summary of the issues and policy options. This paper summarises the issues surrounding “local production” from a policy and public health viewpoint. It provides four brief country-level case studies, and reviews the evidence supporting the industrial policy assumptions underlying the goal of local production. In brief, in many parts of the world, producing medicines domestically makes little economic sense. If many countries begin local production, the result may be less access to medicines, since economies of scale may be lost if there are production facilities in many countries. The document concludes by providing a research agenda specifically designed to test assumptions about local production of pharmaceuticals.
Country
United States
Publisher
World Bank
Theme area
Public-private mix, Governance and participation in health
Title of publication The Business of Health in Africa: Partnering with the Private Sector to Improve Peoples’ Lives
Date of publication
2008
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
medicines, Africa, private sector, governance
Abstract
Although the importance of the private sector varies by country in Africa, it is fairly large and constitutes an important, diverse component of the region’s health care systems. Of total health expenditure of $16.7 billion in 2005,roughly 60%- predominantly out-of-pocket payments by individuals- was financed by private parties, and about 50% was captured by private providers. This report makes several recommendations: develop and enforce quality standards; foster risk pooling programmes; mobilise public and external funding to the private sector; modify local policies and regulations to foster the role of the private sector; and improve access to capital. The vast range of financial and developmental opportunities that the health industry presents in Sub-Saharan Africa will require significant involvement by all segments of the investor community.
Country
United States
Publisher
World Bank
Theme area
Equitable health services, Governance and participation in health
Title of publication Improving Access to Medicines for Neglected Tropical Diseases in Developing Countries: Lessons from Three Emerging Economies
Date of publication
2012 February
Publication type
Journal Article
Publication details
PLoS Neglected Tropical Diseases 6 2
Publication status
Published
Language
English
Keywords
medicines, neglected diseases, developing countries, access, governance
Abstract
Currently, the dominant strategy for ensuring access to medicines for Neglected Tropical Diseases (NTDs) is drug donation from Western pharmaceutical companies. But this dependence upon profit-driven organisations is precarious, according to this article. Clearly, a more sustainable approach is required. Unlike many developing countries, the emerging economies not only have a large NTD burden, but they are also beginning to show us a means of improving access to medicines for NTDs in a more sustainable fashion. They are developing their own policies of innovation, their own pharmaceutical industries, and their own medical solutions to NTDs. Their experiential knowledge is surely invaluable and can help to guide developing countries towards sustainable strategies to control NTDs.
Country
United States
Publisher
PLoS
Theme area
Health equity in economic and trade policies, Equity and HIV/AIDS, Governance and participation in health
Title of publication Driving a decade of change: HIV and AIDS, patents and access to medicines for all
Date of publication
2011 March
Publication type
Journal Article
Publication details
Journal of the International AIDS Society 14 15
Publication status
Published
Language
English
Keywords
medicines, AIDS, access, patents, governance
Abstract
Since 2000, access to antiretroviral drugs to treat HIV infection has dramatically increased to reach more than five million people in developing countries. Essential to this achievement was the dramatic reduction in antiretroviral prices, a result of global political mobilisation that cleared the way for competitive production of generic versions of widely patented medicines. Since the 2001 Doha Declaration on the Agreement on Trade-Related Aspects of Intellectual Property Rights and Public Health, more than 60 low- and middle-income countries have procured generic versions of patented medicines on a large scale. Despite these changes, however, a "treatment timebomb" awaits. First, increasing numbers of people need access to newer antiretrovirals (ARVs), but treatment costs are rising since new ARVs are likely to be more widely patented in developing countries. Second, policy space to produce or import generic versions of patented medicines is shrinking in some developing countries. Third, funding for medicines is falling far short of needs. Expanded use of the existing flexibilities in patent law and new models to address the second wave of the access to medicines crisis are required, such as the UNITAID-supported Medicines Patent Pool, which seeks to facilitate access to patents to enable competitive generic medicines production and the development of improved products. However, the Pool is just one of a broad set of policies needed to ensure access to medicines for all; other key measures include sufficient and reliable financing, research and development of new products targeted for use in resource-poor settings, and use of patent law flexibilities. Governments must live up to their obligations to protect access to medicines as a fundamental component of the human right to health.
Country
Publisher
Journal of the International AIDS Society
Theme area
Values, policies and rights, Governance and participation in health
Title of publication Medicine as a Currency for Peace through Global Health Diplomacy
Date of publication
2007
Publication type
Journal Article
Publication details
Yale Law & Policy Review 26 1 pp 209-229
Publication status
Published
Language
English
Keywords
medicines, Global health, diplomacy, peace, foreign policy, governance
Abstract
In today's era of globalisation and interdependence there is an urgent need to broaden the scope of foreign policy. The world faces a number of pressing challenges that require concerted responses and collaborative efforts. This article argues that we must encourage new ideas, seek and develop new partnerships and mechanisms, and create new paradigms of cooperation. Health is one of the most important, yet still broadly neglected, long-term foreign policy issues of our time. Life and health are our most precious assets. There is a growing awareness that investment in health is fundamental to economic growth and development. It is generally acknowledged that threats to health may compromise a country's stability and security. The author calls for health as a foreign policy issue to have a stronger strategic focus on the international agenda.
Country
United States
Publisher
Yale Law & Policy Review, Inc.
Theme area
Health equity in economic and trade policies, Governance and participation in health
Title of publication TRIPS and Public Health What Should African Countries Do?
Date of publication
2007
Publication type
Academic paper
Publication details
ATPC Work in progress No. 49 pp 1-47
Publication status
Published
Language
English
Keywords
medicines, Africa, TRIPS, public health, governance
Abstract
The purpose of this paper is to discuss the TRIPS Agreement (Agreement on Trade- Related Aspects of Intellectual Property Rights) and public health from an African perspective. Section I of the paper presents a background about the international pharmaceutical market and the situation in Africa, the TRIPS Agreement and patents on drugs, The Doha declaration on TRIPS and public health, examples of flexibility in the TRIPS Agreement, TRIPS Plus, and the arguments for and against the TRIPS Agreement. Section II discusses what should African countries do through presenting some solutions to protect these countries such as compulsory licenses, generic drugs, parallel imports and differential pricing.
Country
Ethiopia
Publisher
Economic Commission for Africa
Theme area
Health equity in economic and trade policies, Governance and participation in health
Title of publication TRIPS and Public Health What Should African Countries Do?
Date of publication
2007
Publication type
Academic paper
Publication details
ATPC Work in progress No. 49 pp 1-47
Publication status
Published
Language
English
Keywords
medicines, Africa, TRIPS, public health, governance
Abstract
The purpose of this paper is to discuss the TRIPS Agreement (Agreement on Trade- Related Aspects of Intellectual Property Rights) and public health from an African perspective. Section I of the paper presents a background about the international pharmaceutical market and the situation in Africa, the TRIPS Agreement and patents on drugs, The Doha declaration on TRIPS and public health, examples of flexibility in the TRIPS Agreement, TRIPS Plus, and the arguments for and against the TRIPS Agreement. Section II discusses what should African countries do through presenting some solutions to protect these countries such as compulsory licenses, generic drugs, parallel imports and differential pricing.
Country
Ethiopia
Publisher
Economic Commission for Africa
Theme area
Health equity in economic and trade policies, Governance and participation in health
Title of publication East African Community Regional Pharmaceutical Manufacturing Plan of Action: 2012-2016
Date of publication
2011
Publication type
Publication details
Publication status
Published
Language
English
Keywords
medicines, East Africa, pharmaceutical manufacturing, TRIPS, governance
Abstract
The objective of this Plan is the development of a regional roadmap to guide the East African Community towards evolving an efficient and effective regional pharmaceutical manufacturing industry that can supply national, regional and international markets with efficacious and quality medicines. The plan recommends strategic interventions to be applied at firm, institutional, national and regional levels to improve the business environment for pharmaceutical manufacturing, strengthen associated regulatory capacity and further develop human resource capacity through a programmatic approach. Specifically, the plan has set out the following primary strategic objectives: 1. Promotion of competitive and efficient pharmaceutical production regionally. 2. Facilitation of increased investment in pharmaceutical production regionally. 3. Strengthening of pharmaceutical regulatory capacity in the region. 4. Development of appropriate skills and knowledge on pharmaceutical production in the region. 5. Utilisation of TRIPS flexibilities towards improved local production of pharmaceuticals. 6. Mainstreaming innovation, research and development within regional pharmaceutical industry. The anticipated cost of implementation of the plan of action is approximately US$45 million, to be raised from EAC Partner States, development partners as well as the regional pharmaceutical industry.
Country
Tanzania
Publisher
EAC Secretariat
Theme area
Values, policies and rights, Governance and participation in health
Title of publication Increasing access to essential medicines in the developing world: UK Government policy and plans
Date of publication
2004
Publication type
Publication details
Publication status
Published
Language
English
Keywords
medicines, Developing countries, access, United Kingdom, governance
Abstract
This paper sets out the UK Government’s assessment of the key challenges that must be addressed to increase access to medicines in the developing world. It aims to communicate clearly both this assessment and DFID’s own plans and will serve to co-ordinate activity across relevant government departments. This paper sets out an ambitious programme of action for the UK Government and others in four areas: support to developing countries through the UK development assistance Programme; trade policy, where the top priority is to support developing countries in understanding and making use of the flexibilities within World Trade Organisation rules governing intellectual property; engagement with the business community to ensure the longer term supply of affordable medicines to developing countries and to stimulate ‘best practice’ by companies as they engage in developing country markets; and stimulate increased research and development into new medicines and other healthcare products relevant to developing country health needs.
Country
United Kingdom
Publisher
DFID
Theme area
Health equity in economic and trade policies, Governance and participation in health
Title of publication Strengthening Pharmaceutical Innovation in Africa: Designing strategies for national pharmaceutical innovation: choices for decision makers and countries
Date of publication
2009
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
medicines, NEPAD, pharmaceutical innovation, governance
Abstract
This report results from a study highlighting the tremendous momentum currently focused on pharmaceutical innovation in Africa. Political momentum has started with the recent endorsement of essential policy directions and plans, and African countries now need to translate these into national policies, strategies and action. This document marks the beginning of a process to bring the practical changes needed to move forward an African agenda for health innovation – that is crafted by African countries. To put these mechanisms into action in countries, national decision makers need perspectives, tools and skills to assess their needs and make the right choices to support their pharmaceutical development. The Pharmaceutical Innovation Framework and Grid tools developed as a part of this study were designed to support countries in moving forward. The tools and approaches are designed to inform thinking and support strategic planning for decision makers who are interested in improving access to medicines in their country or region. They outline the process of ‘pharmaceutical innovation’ – covering the local research, development, production and delivery of essential drugs and other medical products that help countries meet their pressing public health needs. This report advocates for a systems and evidence-based approach to help countries ensure that they determine their innovation priorities and set realistic targets for the level and sector of innovation they can realistically put into action.
Country
Ethiopia
Publisher
AU
Theme area
Health equity in economic and trade policies, Public-private mix, Governance and participation in health
Title of publication Indian Generic Companies, Affordability of Drugs and Local Production in Africa with Special Reference to Tanzania
Date of publication
2008 September
Publication type
Academic paper
Publication details
IKD Working Paper No. 37
Publication status
Published
Language
English
Keywords
medicines, India, Tanzania, generics, pharmaceutical manufacturing, TRIPS, governance
Abstract
Indian generic companies have played a major role in reducing the prices of HIV and AIDS drugs for the benefit of the people of Africa. However Indian companies in general display more interest in the larger and more lucrative markets of North America and Europe. Although the pharmaceutical industry has quite a long history in Tanzania, financial condition and growth have not been satisfactory, and, as in many other developing countries, Tanzanian industry suffers from some inherent cost disadvantages. However this paper argues that it is important for Tanzania to develop the industry further to take care of her drug needs, since there are problems with relying on foreign sources such as India. The government does provide some incentives to local manufacturers, but these are inadequate, and the paper argues for a proper industrial policy in Tanzania with both push and pull incentives. Abolishing product patents in pharmaceuticals operated as an important pull incentive in India, yet Tanzania has never abolished such patent protection. She can still do so: under TRIPS, Tanzania, as a least developed country is not required to introduce such protection in pharmaceuticals till 2016. Even if she chooses not to abolish product patents, there are other TRIPS flexibilities which Tanzania can use to develop her industry and enhance access to medicines.
Country
India
Publisher
Open University Research Centre on Innovation Knowledge and Development
Theme area
Governance and participation in health, Monitoring equity and research to policy
Title of publication BRICS and South-South Cooperation in Medicine: Emerging Trends in Research and Entrepreneurial Collaborations
Date of publication
2012 March
Publication type
Academic paper
Publication details
Publication status
Published
Language
English
Keywords
medicines, diplomacy, BRICS, South-South, research and development, governance
Abstract
Though there is huge spectrum of South-South collaboration, led by the economies from the BRICS countries in the medical field there is a lack of studies examining the extent and characteristics of these collaborations and evaluating their benefits. The authors’ research on South-South research and entrepreneurial collaboration in health biotechnology shows relatively strong involvement of the emerging economies BRICS, apart from some of the other economies such as Cuba, also actively pursues South-South collaboration. This collaboration is generally mutually beneficial for both participating countries, and aimed at shared health needs. As a result the collaboration does not necessarily consist of external funder-recipient relationships but heavily reflect capacity-building efforts, where capacity in health biotechnology research and development was extended through South-South collaboration.
Country
India
Publisher
RIS-DP
Theme area
Health equity in economic and trade policies, Public-private mix
Title of publication Local Pharmaceutical Production in Developing Countries: How economic protectionism undermines access to quality medicines
Date of publication
2008
Publication type
Academic paper
Publication details
Publication status
Published
Language
English
Keywords
medicines, Developing countries, local pharmaceutical production, access to medicines
Abstract
The international health community is debating another idea to improve access: local production of pharmaceuticals. Political support aside, does local production make economic sense? This article argues that it does not. Local production that is supported by foreign aid but owned by local governments is worrisome because it rigs the market by protecting a local producer – all too often a political crony – against a more efficient and competent importer. The author says that such interventions are detrimental to the groups they are supposed to help, and frequently put more money in the pockets of local elite. Furthermore, where domestic capacity is lacking, substandard drugs may result. Many developing countries simply lack the technical capacity and regulatory structures to efficiently and consistently produce high quality pharmaceutical drugs. Drugs from India, China or Western countries are generally easy to obtain and relatively cheap, thanks to tiered pricing.
Country
United Kingdom
Publisher
Campaign for Fighting Diseases
Theme area
Health equity in economic and trade policies, Public-private mix
Title of publication Tide turns for drug manufacturing in Africa
Date of publication
2010 May
Publication type
Journal Article
Publication details
The Lancet 375 9726 pp 1597-1598
Publication status
Published
Language
English
Keywords
medicines, Sub-Saharan Africa, Uganda, pharmaceutical manufacturing, governance
Abstract
With several efforts underway to increase the local production of drugs in developing countries, this article assesses the pros and cons of manufacturing medicines in Africa. A drugs producer in Uganda has become the first least developed country (LDC) to achieve WHO pre-qualification for its manufacturing standards. The Quality Chemicals plant, in the Ugandan capital Kampala, is the first to get this far along the pre-qualification process, a stringent quality check imposed on manufacturers of drugs. There are around 37 manufacturers in sub-Saharan Africa. The next step is to gain approval, or pre-qualification, for each malaria and HIV and AIDS drug the firm produces, before international agencies, such as UNICEF, are allowed to buy from the company. Pharmaceutical companies from Democratic Republic of the Congo to Ethiopia are being helped to reach international standards too. German development agency GTZ is even sending individual inspectors from the German regulator to Africa to do personal plant assessments. Although no substitute for a full WHO pre-qualification, the process helps identify improvements necessary to reach international standards. Improving access to good, affordable drugs requires more research into drugs and vaccines for diseases that disproportionately hurt poor people, stronger regulators, and improved drug distribution systems. For local manufacturing to work, say proponents, governments must be prepared to coordinate, harmonise legislation of drugs within regions and if manufacturing does not make sense from a public health viewpoint, to step away.
Country
United Kingdom
Publisher
Theme area
Values, policies and rights, Health equity in economic and trade policies
Title of publication The New Diplomacy of the South: South Africa, Brazil, India and Trilateralism
Date of publication
2005
Publication type
Journal Article
Publication details
Third World Quarterly 26 7 pp 1077-1095
Publication status
Published
Language
English
Keywords
diplomacy, South Africa, Brazil, India, trilateralism, foreign policy, governance,
Abstract
In the aftermath of 9/11, the South-North divide has been re-asserted as a defining axis of the international system, according to this article. In this context the emergence of a coterie of Southern countries actively challenging the position and assumptions of the leading states of the North is an especially significant event. The activism on the part of three middle-income developing countries in particular - South Africa, Brazil and India - has resulted in the creation of a 'trilateralist' diplomatic partnership, itself a reflection of broader transformations across the developing world in the wake of globalisation. This article examines the rise of the co-operative strategy known as 'trilateralism' by regional leaders within the South. Specifically it looks at the relationship between emerging regional powers in the context of multilateralism, as well as at the formulation and implementation of trilateralism. As with previous co-operative efforts in the developing world, the prospects of success are rooted in overlapping domestic, regional and international influences on South African, Brazilian and Indian foreign policies. The article concludes with an assessment of these influences over the trilateral agenda.
Country
United Kingdom
Publisher
Taylor & Francis, Ltd.
Theme area
Health equity in economic and trade policies, Equity and HIV/AIDS
Title of publication South-South cooperation: Intellectual property and AIDS medicines
Date of publication
2011
Publication type
Publication details
Publication status
Language
English
Keywords
governance, South-South cooperation, Intellectual property,antiretrovirals, TRIPS
Abstract
Global governance of AIDS is a complex phenomenon in an asymmetrical international system with inequalities and disparities between under-developed, developing and industrialised countries, as well as divergent interests between nation-states and transnational corporate actors. While these disparities and divergences are not peculiar to AIDS diplomacy, as they are embedded in the orthodoxy of global governance architecture as a whole, they nonetheless raise complicated questions for policy coherence within the mandates of multilateral institutions like WHO and WTO.The “trade versus health” tensions in global health governance require the creation of sufficient policy space to enable weaker nation-states to strengthen their institutional capacity to generate and promote public goods, taking into account each country’s specific socio-economic context. Within this framework, the emergent “Southern” global economic players with thriving pharmaceutical sectors, such as Brazil and India, would partner with the less developed countries of the South to boost access to ARVs. The operational framework should be pursued in ways that are TRIPS compliant because, as the Doha Declaration proclaimed, TRIPS and public health are not mutually exclusive.
Finally, a South-South cooperative framework to boost access to ARVs in developing countries should be subject to one important caveat: the solution to the AIDS crisis in most developing countries is not just access to drugs, because the healthcare infrastructure (health systems) in most of these countries is simply dysfunctional. Availability of drugs without a functioning healthcare system to administer them would not offer a sustainable solution to the HIV crisis. While it is desirable to aggressively pursue access to ARVs, it is also equally important to focus on a pragmatic healthcare reform in order to sustain treatment therapies.
Country
Japan
Publisher
United Nations University
Theme area
Public-private mix
Title of publication Pharmaceutical Manufacturing Plan for Africa: Business Plan
Date of publication
2012
Publication type
Publication details
Publication status
Published
Language
English
Keywords
medicines, Africa, pharmaceutical manufacturing, plan, governance
Abstract
The African pharmaceutical industry faces serious challenges, according to this Business Plan, which include limited access to finance; limited availability of skilled human resources; inability to access the detailed know-how necessary to implement an upgrading programme or design a new plant; significant costs involved in the proper development of new products; policy incoherence; and underdeveloped supporting industries. In addition to the challenges faced by the industry, there are underutilised opportunities like the Trade Related Aspects of Intellectual Property Rights (TRIPS) flexibilities, which have generally not been utilised, limited links between industry and academia and little collaboration between companies in Africa. These underutilised opportunities offer substantial potential benefits, including expansion of the current range of locally manufactured products.Given the diverse range of contexts and the array of aspects that need to be addressed to a greater or lesser extent in each country, this Business Plan proposes an approach where a generic package of solutions is developed. This can then be tailored to the specific needs of each of our countries. The solutions package includes guidance on incentives in support of the sector; a Good Manufacturing Practice (GMP) road map and associated risk assessment of WHO’s Essential Medicines List (EML); a syllabus for developing the human resources required for the long term sustainability of the industry; various mechanisms for accessing know-how in the short term, including a Partnership and Business Linkages Platform (that would also assist companies to, for example, establish relationships with local, regional and international players in order to increase product ranges, mobilise investment, etc.); and includes technical assistance to enable regulators to devise and implement organisational development plans. It also proposes a process by which the different stakeholders in a country can come together to develop a shared strategy for the sector and a means by which this strategy can be implemented.
Country
Ethiopia
Publisher
AUC-UNIDO
Theme area
Public-private mix
Title of publication Pharmaceutical Manufacturing Plan for Africa, CAMH/MIN/7(III)
Date of publication
2007
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
Medicines, Africa, pharmaceutical manufacturing, plan, governance
Abstract
According to the analysis in this Plan, local production of pharmaceuticals can be successfully done in the continent. However there is need for the African countries to reassess the realities, possibilities and the feasibility of the programme so that it moves from being a political slogan to a reality after good ground work.The time needed to do thorough scientific analyses in the continent, together with WHO and other bodies that can add value, will be longer than two years. An economic analysis however needs to be done to ensure appropriate planning. It may be recommended for the African Union Conference of Ministers of Health to mandate a technical body well versed with manufacturing to do a “skill search” and appoint all the relevant expertise (taking care of all the regional groupings i.e. geographical, linguistic) to study the detailed implications and come out with a suggested plan to advise the ministers in the following areas: CAMH/MIN/7(III); capabilities of the regions;legislative reforms needed –TRIPS;products and level of manufacturing ( primary ,secondary and tertiary);infrastructure, capital and market analysis;issues of equitable benefits for all countries per region; and sustainability possibility of new inventions.
Country
Ethiopia
Publisher
AU
Theme area
Monitoring equity and research to policy
Title of publication Strategic and business plan for the African Network for Drugs and Diagnostics Innovation (ANDI)
Date of publication
2009
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
Medicines, Africa, research and development, governance
Abstract
The World Health Organisation (WHO), in conjunction with several African institutions and the African Diaspora, proposes the creation of the African Network for Drugs and Diagnostics Innovation (ANDI). ANDI’s chief objective is to promote and support health product research and development (R&D) led by African institutions for diseases of high prevalence in the continent. The expected outcome is the discovery, development and delivery of affordable new health tools including those based on traditional medicine, as well as the development of capacity and establishment of centres of research excellence. In driving its chief objective, ANDI faces three major challenges: a significant research gap; little collaboration between biomedical R&D centres across Africa; and insufficient investment in African R&D with overall yearly R&D spend of 0.3% of total African GDP, US$14 billion below the world median. It is estimated that US$1 to 2.4 billion per year alone would be needed to support health product discovery and development. This Strategic Business Plan has three key dimensions : i) foster the formation of health product R&D networks between African research centres; ii) fund networks for African-led and owned research aligned to local health needs; and iii) advocate for increased investment and priority-driven health product R&D agenda setting.
Country
Switzerland
Publisher
WHO
Theme area
Resource allocation and health financing
Title of publication Financing Incidence Analysis of Health Financing in Zimbabwe: Report of a skills workshop, Harare February 18-22 2013
Date of publication
2013 April
Publication type
Report
Publication details
Publication status
Published
Language
Keywords
financing incidence analysis, Zimbabwe, skills workshop
Abstract
A skills workshop was held to review the experiences internationally of financial incidence of various financing sources and the methods for assessing the incidence, drawing on work that has been carried out regionally by Dr John Ataguba of the University of Cape Town Health Economics Unit, including the local consultant team from ZEPARU and delegates from TARSC, GNHE, colleagues from the University of Nigeria, Ministry of Health and other institutions in the Technical Working Group (TWG). Specifically the workshop sought to explore ways of realise additional funding from different progressive financing sources draw input from Health Economics Unit, University of Cape Town, on methodologies for analyzing the progressivity and regressivity of different financing sources; draw lessons from international and local experiences on financial incidence analysis of different financing sources; answer questions on how to address challenges with data collection and analysis, review of tools, preliminary results and reporting. The workshop was jointly organised by the Training and Research Support Centre and the Ministry of Health and Child Welfare.
Country
Zimbabwe
Publisher
TARSC, MoHCW, EQUINET and GHNE
Equinet Publication Type
Reports
Theme area
Health equity in economic and trade policies, Equitable health services
Title of publication Policy brief 34: Overcoming barriers to medicines production through south-south cooperation in Africa
Date of publication
2013 May
Publication type
Document
Publication details
EQUINET Policy brief 34, EQUINET, ECSA HC Harare
Publication status
Published
Language
Keywords
medicines, south-south, local production
Abstract
Access to essential medicines is one of the key requirements for achieving equitable health systems and better population health. The number of people with regular access to essential medicines increased from 2.1 billion to about 4 billion between 1997 and 2002. However, access to medicines in sub-Saharan Africa remains low. One reason for this is the low level of domestic production on the continent. This brief outlines the factors that affect medicines production in East and Southern Africa, drawing on the African Union, Southern Africa Development Community (SADC) and East African Community (EAC) pharmaceutical plans. It identifies the barriers to local production as: lack of supportive policies, capital and skills constraints, gaps in regulatory framework, small market size and weak research and development capacities. There are potential opportunities available through south-south cooperation in medicines production. Negotiations on such south-south arrangements would need to look not only at the immediate production investment, but at strengthening capacities for research and development, for regulation, medicines price and quality monitoring, prequalification, infrastructure and human resource development.
Country
East and southern Africa region
Publisher
EQUINET, ECSA HC
Equinet Publication Type
Policy brief
Theme area
Equity in health, Values, policies and rights, Health equity in economic and trade policies
Title of publication Policy Brief 33: Equity in health in the post 2015 development goals
Date of publication
2013 May
Publication type
Document
Publication details
TARSC (2013) Equity in health in the post 2015 development goals. EQUINET, ECSA HC TARSC Policy brief 33, EQUINET, Harare
Publication status
Published
Language
Keywords
health equity, development goals
Abstract
This policy brief reviews how far the promises of fair globalisation; rights to sustainable development, equity and global solidarity in the 2000 UN Millennium declaration were delivered for East and Southern Africa. It raises key issues for the post 2015 agenda: There is an unfinished agenda in the MDGS, with wide inequalities in some areas, and monitoring of progress must be socially disaggregated. An agenda for universal health coverage should explicitly address equity in access and investment in strong primary health care services. Thirdly, economic growth is not enough, and public policies should also close wide gaps in access to resources for health, Finally, beyond development aid, global solidarity needs to more explicitly accelerate measures for wider benefit from markets, innovation and wealth in globalisation.
Country
East and southern Africa region
Publisher
Equinet Publication Type
Policy brief
Theme area
Resource allocation and health financing
Title of publication Policy Brief 32: Financing universal coverage in east and Southern Africa
Date of publication
2013 April
Publication type
Document
Publication details
EQUINET, ECSA HC with UCT HEU, TARSC Policy brief 32, EQUINET, Harare
Publication status
Published
Language
Keywords
health financing; universal health coverage; health insurance; tax financing
Abstract
Financing universal health coverage (UHC) is not only about how to generate funds for health services. It is also about how these funds are pooled and used to purchase services. This policy brief explores options for financing UHC in East and Southern Africa (ESA). It presents learning from countries that have made progress towards UHC, including the need to increase
domestic funding and to use mandatory pre-payment (tax and other government revenue, possibly supplemented by mandatory health insurance
contributions) as the main mechanism for funding health services. The brief indicates the problems associated with introducing or expanding health
insurance to fund UHC. With tax funding often the most equitable and efficient option, there is scope for increasing government revenue and health expenditure in many ESA countries.
Country
East and southern Africa region
Publisher
URL:
Equinet Publication Type
Policy brief
Theme area
Governance and participation in health
Title of publication EQUINET discussion paper 96: Concepts in and perspectives on global health diplomacy
Date of publication
2013 January
Publication type
Academic paper
Publication details
Concepts in and perspectives on global health diplomacy, Interim Working paper EQUINET Discussion paper 96, EQUINET: Harare.
Publication status
Not published
Language
Keywords
global health diplomacy; Africa
Abstract
The Regional Network for Equity in Health in East and Southern Africa (EQUINET) is implementing a three year policy research programme to address selected challenges to health and strengthening health systems within processes of global health diplomacy (GHD). In the June 2012 inception workshop for the programme, delegates called for a paper that explains the concepts and emergence of global health diplomacy, the different approaches being taken in GHD, including African approaches. Given the de facto rise in health diplomacy, this paper explores questions on GHD, to inform debate and dialogue in Africa on raising health within global diplomacy. We briefly present the roots and emergence of GHD, and the debates on raising public health within global diplomacy. We outline how the concepts of and approaches to GHD differ across countries and regions. We explore the perspectives that have informed diplomacy in Africa, and ask what this means for African engagement in GHD, and for public health in Africa. At various points in this paper we raise questions on what implications the developments described have for health diplomacy in Africa. Given the limitations of documented evidence on African approaches or analysis of health diplomacy from an African lens, it is difficult to draw conclusions. We thus raise questions that we hope will provoke dialogue, debate and response.
Country
East and southern Africa region
Publisher
Equinet Publication Type
Discussion paper
Theme area
Equity in health, Values, policies and rights, Health equity in economic and trade policies, Equitable health services, Human resources for health, Resource allocation and health financing, Equity and HIV/AIDS, Governance and participation in health, Monitoring equity and research to policy
Title of publication Equity Watch: Assessing progress towards equity in health in Tanzania, 2012
Date of publication
2013 February
Publication type
Report
Publication details
Equity Watch: Assessing progress towards equity in health in Tanzania, December 2012, EQUINET Dar es Salaam and Harare
Publication status
Published
Language
Keywords
equity watch; equity analysis; health system; health; social determinants of health; Tanzania
Abstract
Ifakara Health Institute, Ministry Of Health And Social Welfare, Training And Research Support Centre: December 2012. An Equity Watch is a means of monitoring progress on health equity by gathering, organising, analysing, reporting and reviewing evidence on equity in health. Equity Watch work is being implemented in countries in eastern and southern Africa in line with national and regional policy commitments. In February 2010 the Regional Health Ministers' Conference of the ECSA Health Community resolved that countries should 'report on evidence on health equity and progress in addressing inequalities in health'. This report provides an array of evidence on the responsiveness of Tanzania’s health system in promoting and attaining equity in health and health care, using the Equity Watch framework. The report introduces the context and the evidence within four major areas: equity in health, household access to the resources for health, equitable health systems and global justice. It shows past levels (1980–2005), current levels (most current data publicly available) and comments on the level of progress towards health equity.
Country
Zimbabwe
Publisher
Equinet Publication Type
Reports, Discussion paper, Equity indicators
Theme area
Governance and participation in health
Title of publication Uganda Health Literacy Training Report, Entebbe, September 24-26 2012
Date of publication
2012 December
Publication type
Report
Publication details
Uganda Health Literacy Training Programme Report, 24-26 September 2012, TARSC, HEPS, with AGHA, CEHURD, NAFOPHANU, UNHCO EQUINET, Zimbabwe
Publication status
Published
Language
Keywords
health literacy, Uganda
Abstract
Participatory Reflection and Action work in EQUINET has shown that health workers suffer problems of poor work environments, poor remuneration, lack of growth opportunities and motivational incentives. This may pose a barrier to their interaction with communities, despite the role that communication plays in patient-centred care. Communities on their side may not possess the skills and capacities to negotiate or communicate with service providers, leading to misunderstanding, lack of knowledge and even anger. In 2011, building on work done on health literacy1 in Zimbabwe, Malawi and Botswana, and in the EQUINET pra4equity network2to strengthen communication between health workers and communities, TARSC implemented a one year programme with HEPS Ugandaand,with Cordaid support, to extend health literacy in Uganda and use the skills built to promote dialogue and accountability between health workers and communities. In 2012-2014 TARSC and HEPS-Uganda are building on this work to widen and deepen CSO capacities for Health Literacy (HL) in Uganda. This report outlines a meeting that was a first step in this two year programme. It brought together five CSOs working within districts on health. The workshop trained facilitators, education and lead personnel from 5 CSOs in Uganda to plan, implement and monitor health literacy (HL) programmes at district level, including a specific focus on women’s health.
Country
Uganda
Publisher
TARSC/EQUINET
Equinet Publication Type
Reports
Theme area
Values, policies and rights
Title of publication Discussion paper 95: Health service financing for universal coverage in east and southern Africa
Date of publication
2012 December
Publication type
Report
Publication details
EQUINET Discussion Paper 95. Health Economics Unit (UCT), EQUINET, Harare
Publication status
Published
Language
Keywords
universal coverage, design, health systems, east and southern Africa
Abstract
This paper considers elements of the design of health systems and how these relate to
moving towards UC in the context of Africa. It focuses particularly on health financing issues (revenue collection, pooling and purchasing), but also raises health service delivery and management issues. In relation to revenue collection, the global consensus is that in order to pursue universal coverage, it is critical to reduce reliance on out-of-pocket payments as a means of funding health services. It notes that the key focus in moving towards universal coverage should be on mandatory prepayment
mechanisms and discusses the options for these. The common assumption of limited fiscal space for increased government spending on the health sector should be challenged and the fiscal space envelop pushed. While mandatory health insurance
schemes can also contribute to generating additional revenue for health services, these
funds should be pooled with funds from government revenue. Although there is limited evidence in relation to purchasing in ESA countries, introducing active purchasing of services, as well as addressing service delivery and management challenges, will be essential if universal access to services of appropriate quality is to be achieved.
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Discussion paper
Theme area
Resource allocation and health financing
Title of publication Discussion paper 94: Resource Mobilisation for Health under the Zimbabwe Investment Case 2010-2012
Date of publication
2012 November
Publication type
Report
Publication details
EQUINET Discussion Paper Series 94. Training and Research Support Centre, EQUINET: Harare
Publication status
Published
Language
Keywords
resource mobilisation, health financing, Zimbabwe
Abstract
The review assesses the resource mobilisation and
allocation performance and challenges faced by the MoHCW in meeting the target set out in its Investment Case. As the Investment Case was meant to complement the annual government budget and resource mobilisation efforts by other players, the review took these resources into account in assessing the level and direction of funding. The review specifically looked at the response from funders of the health sector to the
Investment Case, in terms of what resources were raised and the successes and challenges associated with raising the intended resources. It assesses the resources raised and some of the health outputs from these resources. The study included interviews with key informants in the Ministry, review of policy documents and analysis of
financial data from government and external funders.
Country
Zimbabwe
Publisher
EQUINET
Equinet Publication Type
Discussion paper
Theme area
Values, policies and rights
Title of publication Policy brief 31: Implementing the International Health Regulations in Africa
Date of publication
2012 November
Publication type
Document
Publication details
Implementing the International Health Regulations in Africa, EQUINET Policy brief 31
Publication status
Published
Language
Keywords
international health regulations; capacities; Africa
Abstract
The notification and prevention of the spread of diseases and other public health risks across borders is a longstanding area of health diplomacy. The International Health Regulations (IHR) (2005) were adopted by the 58th World Health Assembly in May 2005 to control the spread of diseases and
public health risks across borders. The IHR (2005) are global standards that become legally binding in countries once they have been incorporated
into domestic public health law (unless country constitutions specifically state that such international standards automatically apply). Member states of WHO, who are “States Parties” to the IHR, were given up to 2007 to assess their capacity and develop national action plans on the regulations. Countries were given up to 2012 to meet the requirements of the IHR regarding their national surveillance, reporting and response systems to public health risks and emergencies and to provide the measures set for disease control at designated airports, ports and ground crossings. Progress toward attainment of these goals depends on eight core capacities, to be in place by the year 2012. This policy brief outlines the context and content of the IHR and how far the provisions have been implemented in east and southern Africa.
Country
East and southern Africa region
Publisher
EQUINET
URL:
Equinet Publication Type
Policy brief
Theme area
Resource allocation and health financing
Title of publication The growth of the private for profit health sector in East and Southern Africa
Date of publication
2012 October
Publication type
Document
Publication details
Publication status
Published
Language
Keywords
private for profit financing; east and southern Africa
Abstract
There has been recent growth in the private for-profit health sector in East and Southern African countries. The growth of the private sector is being promoted by organisations such as the World Bank. African governments are being encouraged to facilitate private sector growth through changing their policies and laws and providing funding for the private sector. This poster - leaflet explores what parts of the private sector are growing, the consequences of a growing private health sector and what civil society organisations and Ministries of Health should be doing to protect the integrity of their health systems
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Briefs
Theme area
Title of publication Discussion paper 93: Guidance on using needs based formulae and gap analysis in the equitable allocation of health care resources in East and Southern Africa
Date of publication
2012 September
Publication type
Report
Publication details
Guidance on using needs based formulae and gap analysis in the equitable allocation of health care resources in East and Southern Africa’ EQUINET Discussion Paper 93. Health Economics Unit (UCT), EQUINET: Harare.
Publication status
Published
Language
Keywords
resource allocation; health financing; gap analysis; needs analysis
Abstract
EQUINET has supported the development of needs-based resource allocation formulae in a number of east and southern African countries in the past, and the methods for developing such a formula are summarised in this paper. Our work in the region has persuaded us that it is necessary to supplement the development of a formula with other initiatives to support the successful implementation of resource allocation processes. We believe that for real progress to be made the equity target allocations calculated through the formula must be linked explicitly to planning and budgeting processes to facilitate the gradual shifting of resources. EQUINET through UCT HEU has been developing such an approach in collaboration with the Ministry of Health in Mozambique. A broad overview of this approach, which may be of value to other countries, is outlined in this paper. A needs-based formula is used to identify the provinces and districts that are furthest from their equity targets and that should receive priority for the allocation of additional budgetary resources. A detailed ‘gap analysis’ focuses on comparing the current physical and human resources in each of these provinces and districts to national norms (developed by the Ministry of Health based on what is regarded as the ideal or good practice).
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Discussion paper
Theme area
Resource allocation and health financing
Title of publication Provider Purchasing and Contracting for Health Services: The Case of Zambia
Date of publication
2008 October
Publication type
Document
Publication details
Results for Development Institute 12 / pp /-/
Publication status
Published
Language
English
Keywords
health financing, contracting, Zambia
Abstract
The objective of this study was to identify and characterize contracting models that have existed in the Zambian health sector and their consequences on access to health care. The study was aimed at assessing the extent to which the identified contracting models have been successful in achieving their intended goals and at determining their potential to be scaled up to the entire health sector, including the private sector.
Country
Publisher
Results for Development Institute
Theme area
Equitable health services
Title of publication Assessment of Health Workforce Competency and Facility Readiness to Provide Quality Maternal Health Services in Kenya
Date of publication
2012
Publication type
Report
Publication details
East, Central and Southern Africa Health Community / / pp /-/
Publication status
Published
Language
English
Keywords
health worker, competency, maternal health, Kenya
Abstract
In Kenya, as in many East, Central and Southern Africa countries, the maternal and newborn mortalities and morbidities are high but the proportion of births attended to by a skilled provider is less than 50%. This is despite the fact that skilled attendance at labor, delivery and postpartum period is necessary to prevent these mortalities and morbidities. There has been no assessment of competency of birth attendants as well as their working environment in Kenya and the ECSA countries with an exception of Rwanda. Recognizing this, the East, Central and Southern Africa Health Community (ECSA-HC) with partners MOH/Kenya, the Quality Assurance Project, and the University of Nairobi; and with support from USAID East Africa (USAID/EA) conducted this study. The study was conducted between November 30 and December 22, 2006. The aim of the study was to assess the competency levels of the birth attendants providing care in health facilities, and functionality of key support systems in their working environments. The study objectives were to determine the current competency levels of the workforce attending women during labor, delivery, and the early postpartum period; examine environmental and organizational factors that affect workforce productivity and performance; and assess implications for quality improvement at the workplace. The study was cross sectional and assessed factors that influence competency of birth attendants. These factors included knowledge, skills and the environment where the birth attendants worked.
Country
Publisher
East, Central and Southern Africa Health Community
Theme area
Equity in health, Values, policies and rights
Title of publication Health Policy and Systems Research: A Methodology Reader
Date of publication
2012
Publication type
Report
Publication details
World Health Organisation / / pp /-/
Publication status
Published
Language
English
Keywords
health policy, health systems, research, HPSR, global
Abstract
Health Policy and Systems Research (HPSR) is often criticized for lacking rigour, providing a weak basis for generalization of its findings and, therefore, offering limited value for policy-makers. This Reader aims to address these concerns through supporting action to strengthen the quality of HPSR. The Reader is primarily for researchers and research users, teachers and students, particularly those working in low- and middle-income countries (LMICs). It provides guidance on the defining features of HPSR and the critical steps in conducting research in this field. It showcases the diverse range of research strategies and methods encompassed by HPSR, and it provides examples of good quality and innovative HPSR papers.
Country
Publisher
World Health Organisation
Theme area
Equitable health services
Title of publication MHealth4CBS in South Africa: A Review of the Role of Mobile Phone Technology for Monitoring and Evaluation of Community-Based Health Services
Date of publication
2012 January
Publication type
Report
Publication details
Medical Research Council, University of Western Cape / / pp /-/
Publication status
Published
Language
English
Keywords
mobile phone, technology, community based, South Africa
Abstract
Against a background of growing access to,and increasing enthusiasm for the use of mobile phone technology in health services (mHealth) in low and middle income countries (LMICs), the authors reviewed the potential usefulness of mHealth for monitoring and evaluation (M&E) of the planned integration of community based health services (mHealth4CBS) in South Africa. It forms part of a portfolio of support for the development of M&E systems for community based PHC outreach teams currently being implemented as part of the PHC re-engineering process. This study sought to understand what the field of mHealth had to offer, to explore how mHealth is implemented in practice and to use these two sources of information to reflect on the lessons and implications for implementing mHealth at scale for monitoring and evaluation of community based services and community health workers.
Country
Publisher
Medical Research Council, University of Western Cape
Theme area
Equitable health services
Title of publication Difficult Relationship Between Faith-Based Health Care Organisations and the Public Sector in Sub-Saharan Africa: The Case of Contracting Experiences in Cameroon, Tanzania, Chad and Uganda
Date of publication
2012 April
Publication type
Book
Publication details
Studies in Health Services Organisations and Policy 29 / pp /-/
Publication status
Published
Language
English
Keywords
faith based, health care, public sector, Africa, Cameroon, Tanzania, Chad, Uganda
Abstract
This book is a presentation of the principal findings of a study conducted between September 2007 and March 2009 on contractual arrangements between faith-based hospitals and public health authorities in four sub-Saharan African countries. Contracting can conveniently be defined as "a voluntary alliance of independent or autonomous partners who enter a commitment with reciprocal obligations and duties, in which each partner expects to obtain benefits from the relationship" (WHO 1997). This book aims at sharing the core findings of the study with a larger audience interested in knowing more about the current interface between faith-based facilities and public health authorities.
Country
Publisher
ITG Press
Theme area
Equity and HIV/AIDS
Title of publication Impact of Organizational Factors on Adherence to Laboratory Testing Protocols in Adult HIV Care in Lusaka, Zambia
Date of publication
2012 May
Publication type
Journal Article
Publication details
BMC Health Services Research 12 106 pp /-/
Publication status
Published
Language
English
Keywords
laboratory services, HIV, Zambia
Abstract
Previous operational research studies have demonstrated the feasibility of large-scale public sector ART programs in resource-limited settings. However, organizational and structural determinants of quality of care have not been studied. Using data on 13 urban HIV treatment facilities in Zambia, we use multivariate regression models to assess the impact of structural determinants on health workers’ adherence to national guidelines for conducting laboratory tests such as CD4, hemoglobin and liver function and WHO staging during initial and follow-up visits as part of Zambian HIV care and treatment program. The study found that CD4 tests were more routinely ordered during initial history and physical (IHP) than follow- up (FUP) visits (85.5 % vs. 93.0 %; p < 0.01). More physical space, higher staff turnover and greater facility experience with ART was associated with greater odds of conducting tests. Higher staff experience decreased the odds of conducting CD4 tests in FUP (OR 0.93; p < 0.05) and WHO staging in IHP visit (OR 0.90; p < 0.05) but increased the odds of conducting hemoglobin test in IHP visit (OR 1.05; p < 0.05). Higher staff burnout increased the odds of conducting CD4 test during FUP (OR 1.14; p < 0.05) but decreased the odds of conducting hemoglobin test in IHP visit (0.77; p < 0.05) and CD4 test in IHP visit (OR 0.78; p < 0.05). The authors conclude that physical space plays an important role in ensuring high quality care in resource-limited setting. In the context of protocolized care, new staff members are likely to be more diligent in following the protocol verbatim rather than relying on memory and experience thereby improving adherence. Future studies should use prospective data to confirm the findings reported here.
Country
Publisher
BMC Health Services Research
Theme area
Human resources for health
Title of publication Understanding Intrinsic Motivation and Performance Factors for Public Sector and Faith-based Facility Health Workers in Uganda
Date of publication
2011 June
Publication type
Journal Article
Publication details
Health Systems 20/20 / / pp /-/
Publication status
Published
Language
English
Keywords
faith based, health workers, Uganda
Abstract
At the core of every health system are the health workers who care for patients, provide essential services, and translate health knowledge into action. While changing demographics, emerging epidemics, and the rising burden of disease drive the need for motivated and appropriately skilled personnel, there continues to be a persistent global health worker shortage (Africa Working Group 2006). In 2006, the World Health Organization (WHO) announced that 57 countries had a critical deficit of health professionals and that there was a global shortage of 2.4 million doctors, nurses, and midwives (WHO 2006). Of the 57 countries identified, 36 were located in Africa (WHO 2006) where the shortage is so severe that the workforce in many countries must be tripled to achieve the Millennium Development Goals (Dubois and Singh 2009). Compounding the issue are inappropriate skill mixes within facilities, unequal distribution of workers between and within countries, and poor working conditions that create additional health system bottlenecks (Dambisya 2007). This study in Uganda aimed to untangle the intrinsic motivation, retention, and performance factors for health workers faith-based facilities compared to public sector health workers.
Country
Publisher
Health Systems 20/20
Theme area
Human resources for health, Resource allocation and health financing
Title of publication Analysis of GAVI, the Global Fund and World Bank Support for Human Resources for Health in Developing Countries
Date of publication
2011 December
Publication type
Journal Article
Publication details
Health Policy and Planning 1 9 pp /-/
Publication status
Published
Language
English
Keywords
GAVI, Global Fund, health workers Africa
Abstract
Shortages, geographic imbalances and poor performance of health workers pose major challenges for improving health service delivery in developing countries. In response, multilateral agencies have increasingly recognized the need to invest in human resources for health (HRH) to assist countries in achieving their health system goals. In this paper the authors analyse the HRH-related activities of three agencies: the Global Alliance for Vaccines and Immunisation (GAVI); the Global Fund for Aids, Tuberculosis, and Malaria (the Global Fund); and the World Bank. First, the authors reviewed the type of HRH-related activities that are eligible for financing within each agency. Second, the authors reviewed the HRH-related activities that each agency is actually financing. Third, a review was undertaken of the literature to understand the impact that GAVI, Global Fund and World Bank investments in HRH have had on the health workforce in developing countries. Analysis found that by far the most common activity supported across all agencies is short-term, in-service training. There is relatively little investment in expanding pre-service training capacity, despite large health worker shortages in developing countries. The authors also found that the majority of GAVI and the Global Fund grants finance health worker remuneration, largely through supplemental allowances, with little information available on how payment rates are determined, how the potential negative consequences are mitigated, and how payments are to be sustained at the end of the grant period. Based on the analysis, the authors argue there is an opportunity for improved co-ordination between the three agencies at the country level in supporting HRH-related activities. Existing initiatives, such as the International Health Partnership and the Health Systems Funding Platform, could present viable and timely vehicles for the three agencies to implement this improved co-ordination.
Country
Publisher
Health Policy and Planning
Theme area
Human resources for health, Equity and HIV/AIDS
Title of publication Task Shifting and HIV/AIDS: Opportunities, Challenges and Proposed Actions for Sub-Saharan Africa
Date of publication
2008 November
Publication type
Journal Article
Publication details
Transactions of the Royal Society of Tropical Medicine and Hygiene 103 / pp 549-558
Publication status
Published
Language
English
Keywords
task shifting, HIV, AIDS, Africa
Abstract
Sub-Saharan Africa is facing a crisis in human health resources due to a critical shortage of health workers. The shortage is compounded by a high burden of infectious dis- eases; emigration of trained professionals; difficult working conditions and low motivation. In particular, the burden of HIV/AIDS has led to the concept of task shifting being increasingly promoted as a way of rapidly expanding human resource capacity. This refers to the delegation of medical and health service responsibilities from higher to lower cadres of health staff, in some cases non-professionals. This paper, drawing on Médecins Sans Frontières’ experience of scaling-up antiretroviral treatment in three sub-Saharan African countries (Malawi, South Africa and Lesotho) and supplemented by a review of the literature, highlights the main opportunities and challenges posed by task shifting and proposes specific actions to tackle the challenges. The opportunities include: increasing access to life-saving treatment; improving the workforce skills mix and health-system efficiency; enhancing the role of the community; cost advantages and reducing attrition and international ‘brain drain’. The challenges include: maintaining quality and safety; addressing professional and institutional resistance; sustaining motivation and performance and preventing deaths of health workers from HIV/AIDS. Task shifting should not undermine the primary objective of improving patient benefits and public health outcomes.
Country
Publisher
Transactions of the Royal Society of Tropical Medicine and Hygiene
Theme area
Human resources for health, Governance and participation in health
Title of publication Searching for Common Ground on Incentive Packages for Community Workers and Volunteers in Zambia
Date of publication
2009 July
Publication type
Report
Publication details
National HIV/AIDS STI, TB Council, Zambia / / pp /-/
Publication status
Published
Language
English
Keywords
incentive, community health workers, volunteers, Zambia
Abstract
Zambia is at the epicentre of the HIV and AIDS pandemic, with an adult prevalence rate of 14.3% in a population of 12 million. Currently there are an estimated1.2 million people living with HIV (PLHIV) and approximately 350,000 needing treatment and care at present. Most of the burden of care is borne by the public health services, itself beset with chronic human resource shortages, inadequate funding and an unsuitable infrastructure. This situation is made worse by the inequitable distribution of health services in favour of urban areas. This study reviews experiences and lessons learned regarding monetary and non-monetary incentives for community workers. It includes indicative costings and recommendations for further policy and development with regard to the effective recruitment, training and deployment of community workers in Zambia.
Country
Publisher
National HIV/AIDS STI, TB Council, Zambia
Theme area
Equity and HIV/AIDS
Title of publication Baseline Assessment of HIV Service Provider Productivity and Efficiency in Tanzania
Date of publication
2011 March
Publication type
Report
Publication details
Health Care Improvement Project / / pp /-/
Publication status
Published
Language
English
Keywords
HIV, service provider, efficiency, Tanzania
Abstract
Tanzania, like many other countries in Africa, is facing a severe shortage of qualified health professionals. Only 35% of positions in government health facilities have been filled, leaving Tanzania in the wake of burgeoning human resources for health crisis. According to the Annual Health Statistical Abstract from 2008, the national average population per medical officer was 64,000; 31,000 per assistant medical officer; and 7,000 per clinical officer. The shortage of health professionals has been exacerbated by the HIV/AIDS pandemic and other communicable diseases, such as malaria and tuberculosis. This report is a baseline assessment of HIV/AIDS service providers gathered information on productivity and engagement to develop a set of improved human resource practices that will be integrated into ongoing HIV service delivery.
Country
Publisher
Health Care Improvement Project
Theme area
Human resources for health, Monitoring equity and research to policy
Title of publication Struggling and Coping to Serve: The Zambian Health Workforce as Depicted in the Public Expenditure Tracking and Quality of Service Delivery Survey
Date of publication
2008
Publication type
Report
Publication details
Health Systems for Outcomes / / pp /-/
Publication status
Published
Language
English
Keywords
health workers, budget monitoring, Zambia
Abstract
This paper reports the findings of the Zambian study pertaining to human resources for health, including issues with high staff vacancies, high rates of absenteeism and tardiness, impact on patients and the coping mechanisms health workers are employing to augment their incomes. High staff vacancies (33.5 percent) especially of clinical workers (41.4 percent) are crippling hospital and clinic operations. These health facilities are increasingly relying on expatriate staff (especially hospitals) and volunteer staff (especially health centres). Lack of staff is exacerbated by high rates of absenteeism (21 percent self-reported) and tardiness (43 percent self-reported), reducing the amount full- time equivalent (FTE) workers. As a result, patient queues and waiting times are long (average of 65 minutes). More seriously, the length of time spent on patient care is being compromised. Workers are also resorting to various coping mechanisms (both inside and outside the facilities where they work) to augment their incomes. Heavy official workloads and income-augmenting activities take their toll on workers' time, and possibly well-being, contributing to high rates (44 percent of staff) of dissatisfaction among staff.
Country
Publisher
Health Systems for Outcomes
Theme area
Human resources for health
Title of publication Human Resources for Health Crisis in Zambia: An Outcome of Health Worker Entry, Exit and Performance within the National Labor Health Market
Date of publication
2011
Publication type
Report
Publication details
Africa Human Development Series 214 / pp /-/
Publication status
Published
Language
English
Keywords
health workers, Zambia
Abstract
This paper compiles recent evidence on the Zambian health labor market and provides baseline information on HRH to support the government address its HRH challenges. In addition, the paper analyzes the available evidence on the national health labor market to better understand the number, distribution, and performance of HRH in Zambia and explains HRH outcomes by mapping, assessing, and analyzing pre-service education and labor market dynamics and well as the core factors influencing these dynamics.
Country
Publisher
World Bank
Theme area
Human resources for health
Title of publication Survey of Sub-Saharan African Medical Schools
Date of publication
2012
Publication type
Journal Article
Publication details
Human Resources for Health 10 4 pp /-/
Publication status
Published
Language
English
Keywords
medical school, health workers, Africa
Abstract
Sub-Saharan Africa suffers a disproportionate share of the world’s burden of disease while having some of the world’s greatest health care workforce shortages. Doctors are an important component of any high functioning health care system. However, efforts to strengthen the doctor workforce in the region have been limited by a small number of medical schools with limited enrolments, international migration of graduates, poor geographic distribution of doctors, and insufficient data on medical schools. The goal of the Sub-Saharan African Medical Schools Study (SAMSS) is to increase the level of understanding and expand the baseline data on medical schools in the region. This survey is a descriptive study of Sub-Saharan African medical schools to increase the level of understanding and expand the baseline data on medical schools in the region.
Country
Publisher
Human Resources for Health
Theme area
Human resources for health
Title of publication Supporting Healthcare Professionals Where They Are Needed: The RAFT Telemedicine Network in Africa
Date of publication
2010
Publication type
Slide presentation
Publication details
Cure 4 Kids / / pp /-/
Publication status
Published
Language
English
Keywords
telemedicine, health workers, Africa
Abstract
This presentation discusses de-isolating health care professionals through the RAFT telemedicine network that provides a network of health professionals, low-bandwidth distance education, teleconsulations with communities of experts, an expertise centre and a virtual internet patient simulator.
Country
Publisher
Cure 4 Kids
Theme area
Human resources for health
Title of publication Human Resources for Health Care Delivery in Tanzania: A Multifaceted Problem
Date of publication
2012
Publication type
Journal Article
Publication details
Human Resources for Health 10 3 pp /-/
Publication status
Published
Language
English
Keywords
health workers, Tanzania
Abstract
Recent years have seen an unprecedented increase in funds for procurement of health commodities in developing countries. A major challenge now is the efficient delivery of commodities and services to improve population health. With this in mind, the authors documented staffing levels and productivity in peripheral health facilities in southern Tanzania. A health facility survey was conducted to collect data on staff employed, their main tasks, availability on the day of the survey, reasons for absenteeism, and experience of supervisory visits from District Health Teams. In- depth interview with health workers was done to explore their perception of work load. A time and motion study of nurses in the Reproductive and Child Health (RCH) clinics documented their time use by task. The authors found that only 14% (122/854) of the recommended number of nurses and 20% (90/441) of the clinical staff had been employed at the facilities. Furthermore, 44% of clinical staff was not available on the day of the survey. Various reasons were given for this. Amongst the clinical staff, 38% were absent because of attendance to seminar sessions, 8% because of long-training, 25% were on official travel and 20% were on leave. RCH clinic nurses were present for 7 hours a day, but only worked productively for 57% of time present at facility. Almost two-third of facilities had received less than 3 visits from district health teams during the 6 months preceding the survey. This study documented inadequate staffing of health facilities, a high degree of absenteeism, low productivity of the staff who were present and inadequate supervision in peripheral Tanzanian health facilities. The implications of these findings are discussed in the context of decentralized health care in Tanzania.
Country
Publisher
Human Resources for Health
Theme area
Human resources for health
Title of publication Creating Incentives to Work in Ghana: Results from a Qualitative Health Worker Study
Date of publication
2011
Publication type
Document
Publication details
HNP Discussion Paper / / pp /-/
Publication status
Published
Language
English
Keywords
health workers, retention, incentives, Ghana
Abstract
The Ministry of Health, Ghana, is engaged in developing a new Human Resources for Health (HRH) Strategy (2001–15); one that tries to draw on some of the evidence pertaining to the dynamics of the health labor market. This study is one of several efforts by the World Bank to support the Ministry of Health in its endeavour to develop a new evidence- based HRH strategy. Using qualitative research (focus group discussions), this study carries out a microeconomic labor analysis of health worker career choice and of job behaviour. The study shows how common problems related to distribution or performance of HRH are driven by the behaviour of health workers themselves and are determined largely by select monetary and non monetary compensation. Such findings generate insights that provide a starting point for further analysis and a basis for the development of effective human resources for health policies.
Country
Publisher
World Bank
Theme area
Human resources for health
Title of publication Transforming Human Resources for Health in Kenya
Date of publication
2012
Publication type
Report
Publication details
Capacity Kenya / / pp /-/
Publication status
Published
Language
English
Keywords
health workers, Kenya
Abstract
Kenya’s human resources for health (HRH) crisis is characterized by a severe shortage of health workers, with an average of 1.3 health workers per 1,000 population, 43% below the WHO benchmark of 2.3. In addition, Kenya is challenged with an inability to attract and retain health workers—especially in the public sector—as well as with performance management issues, unequal distribution of staff, and diminishing productivity among the health workforce. This situation is further aggravated by the migration of health workers to countries in the region and internationally. This project brief describes the HRH challenges in Kenya, and the work being done to strengthen HRH policies and practices, build the knowledge and skills of health workers, and improve workforce performance systems.
Country
Publisher
Capacity Kenya
Theme area
Human resources for health
Title of publication Human Resources for Health Situation in Zambia: Deficit and Maldistribution
Date of publication
2011
Publication type
Journal Article
Publication details
Human Resources for Health 9 30 pp /-/
Publication status
Published
Language
English
Keywords
health workers, distribution, Zambia
Abstract
Current health policy directions in Zambia are formulated in the National Health Strategic Plan. The Plan focuses on national health priorities, which include the human resources (HR) crisis. In this paper the authors describe the way the HRH establishment is distributed in the different provinces of Zambia, with a view to assess the dimension of shortages and of imbalances in the distribution of health workers by province and by level of care. The authors used secondary data from the “March 2008 payroll data base”, which lists all the public servants on the payroll of the Ministry of Health and of the National Health Service facilities. The highest relative concentration of all categories of workers was observed in Northern, Eastern, Lusaka, Western and Luapula provinces (in decreasing order of number of health workers). The ratio of clinical officers (mid-level clinical practitioners) to general medical officer (doctors with university training) varied from 3.77 in the Lusaka to 19.33 in the Northwestern provinces. For registered nurses (3 to 4 years of mid-level training), the ratio went from 3.54 in the Western to 15.00 in Eastern provinces and for enrolled nurses (two years of basic training) from 4.91 in the Luapula to 36.18 in the Southern provinces. This unequal distribution was reflected in the ratio of population per cadre. The provincial distribution of personnel showed a skewed staff distribution in favour of urbanized provinces, e.g. in Lusaka’s doctor: population ratio was 1: 6,247 compared to Northern Province’s ratio of 1: 65,763. The authors observed significant shortages in most staff categories, except for support staff, which had a significant surplus. This case study documents how a peaceful, politically stable African country with a longstanding tradition of strategic management of the health sector and with a track record of innovative approaches dealt with its HRH problems, but still remains with a major absolute and relative shortage of health workers. The case of Zambia reinforces the idea that training more staff is necessary to address the human resources crisis, but it is not sufficient and has to be completed with measures to mitigate attrition and to increase productivity.
Country
Publisher
Human Resources for Health
Theme area
Human resources for health, Equity and HIV/AIDS
Title of publication Caring for the Caregivers: Models of HIV/AIDS Care and Treatment Provision for Health Care Workers in Southern Africa
Date of publication
2007
Publication type
Journal Article
Publication details
Journal of Infectious Diseases 196 3 pp S500-S504
Publication status
Published
Language
English
Keywords
HIV/AIDS, care, treatment, health workers, South Africa, Botswana
Abstract
Rollout of antiretroviral therapy (ART) has been successfully initiated in many countries, but concerns have been raised about the ability to meet treatment needs in areas where there is a high prevalence of human immunodeficiency virus (HIV) infection/acquired immunodeficiency syndrome (AIDS) and where there are severe deficits in human-resource capacity. Many health care workers in resource-poor areas are experiencing burnout, struggling with external and internal stigma, failing to access HIV testing and treatment early, and subsequently becoming sick and dying of AIDS. Although the human-resource deficit is a well-recognized problem, little has been written about the programs that have been established to provide treatment for HIV- infected health care workers. In the present article, the authors describe staff care programs at McCord Hospital in Durban, South Africa; Mseleni Hospital in northern KwaZulu-Natal, South Africa; and the Tshedisa Institute in Gaborone, Botswana. These programs provide convenient, confidential, and holistic care for HIV-infected health care workers and health care workers affected by caring for HIV-infected patients. All 3 programs have noted that, among health care workers, there is increasing acceptance of counseling, testing, and treatment. The authors propose that there is an urgent need for the development of HIV/AIDS care and treatment programs for health care workers that remove barriers to access, provide confidentiality in testing, are conveniently located, and are integrated with tuberculosis programs and other treatment services.
Country
Publisher
Journal of Infectious Diseases
Theme area
Human resources for health, Equity and HIV/AIDS
Title of publication We Are Also Dying Like Any Other People, We Are Also People: Perceptions of the Impact of HIV/AIDS on Health Workers in Two Districts in Zambia
Date of publication
2007 January
Publication type
Journal Article
Publication details
Health Policy and Planning 22 / pp 139-148
Publication status
Published
Language
English
Keywords
HIV/AIDS, health workers, Zambia
Abstract
In countries with a high AIDS prevalence, the health workforce is affected by AIDS in several ways. In Zambia, which has a prevalence rate of 16.5%, a study was carried out in 2004 with the aim to: explore the impact of HIV/AIDS on health workers, describe their coping mechanisms and recommend supportive measures. The qualitative study was complemented by a survey using self-administered questionnaires in four selected health facilities in two rural districts in Zambia, Mpika and Mazabuka. It is one of the few studies to have explored the impact of HIV/AIDS from the perspective of health workers and managers in the region. Thirty-four in-depth interviews and five group discussions were conducted with health workers, managers and volunteers, and 82 self-administered questionnaires were filled out by health workers. In addition, burnout among 42 health workers was measured using the Maslach Burnout Inventory (MBI). The MBI measures three components that contribute to burnout: emotional exhaustion, depersonalization and personal accomplishment. The results show that in both districts, HIV/AIDS has had a negative impact on workload and has considerably changed or added tasks to already overburdened health workers. In Mpika, 76% of respondents (29/38), and in Mazabuka, 79% (34/ 44) of respondents, expressed fear of infection at the workplace. HIV-positive health workers remained ‘in hiding’, did not talk about their illness and suffered in silence. Despite the fact that health workers were still relatively motivated, emotional exhaustion occurred among 62% of the respondents (26/42). The interviews revealed that counsellors and nurses were especially at risk for emotional exhaustion. In each of the selected facilities, organizational support for health workers to deal with HIV/ AIDS was either haphazardly in place or not in place at all. AIDS complicates the already difficult work environment. In addition to health workers, management also needs support in dealing with AIDS at the workplace.
Country
Publisher
Health Policy and Planning
Theme area
Equitable health services, Governance and participation in health
Title of publication Voices from the Field: Perspectives from Community Health Workers on Health Care Delivery in Rural KwaZulu-Natal, South Africa
Date of publication
2007
Publication type
Journal Article
Publication details
Journal of Infectious Diseases 196 Suppl 3 pp S505-S511
Publication status
Published
Language
English
Keywords
community health workers, health care, rural, South Africa
Abstract
As the primary link between the formal health care sector (clinics, physicians, and nurses) and the household level in South Africa, community health workers (CHWs) provide a critical perspective on barriers that exist in rural health care delivery. A 30-question written questionnaire assessing CHW perspectives on human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS), tuberculosis (TB), and potential CHW program improvement was administered to 120 CHWs in the Outer West Region of KwaZulu-Natal, South Africa. Interviews with CHWs, administrators of the CHW program, physicians, and nurses from district clinics were also conducted. CHWs identify TB, HIV/AIDS, and poverty as the greatest challenges facing the community and suggest stigma, denial, and lack of education as the primary reasons for failure to complete TB treatment and avoidance of HIV counseling and testing. Additionally, the results highlight inadequate support and monitoring for the program as a result of a lack of administrative supervision and of basic work-related supplies. These results suggest that CHWs recognize the need for HIV/AIDS- and TB-related interventions but are unable to provide a response commensurate to this need. To fully enable the existing CHW program to effectively fight the HIV/AIDS and TB coepidemics, substantial improvements in supervision and collaboration must be made in KwaZulu-Natal.
Country
Publisher
Journal of Infectious Diseases
Theme area
Equitable health services
Title of publication Community-Based Mental Health Care in Africa: Mental Health Workers' Views
Date of publication
2008 January
Publication type
Journal Article
Publication details
World Pyschiatry 7 / pp 54-57
Publication status
Published
Language
English
Keywords
community based, mental health, health workers, Africa
Abstract
The World Health Organization (WHO) has for long proposed the development of community-based mental health services worldwide. However, the progress toward community mental health care in most African countries is still hampered by a lack of resources, with specialist psychiatric care essentially based in large, centrally located mental hospitals. The authors argue that it is again time to reconsider the direction of mental health care in Africa. Based on a small inquiry to a number of experienced mental health professionals in sub-Saharan Africa, the authors discuss what a community concept of mental health care might mean in Africa. There is a general agreement that mental health services should be integrated in primary health care. A critical issue for success of this model is perceived to be provision of appropriate supervision and continuing education for primary care workers. The importance of collaboration between modern medicine and traditional healers is stressed and the paper ends in a plea for WHO to take the initiative and develop mental health services according to the special needs and the socio- cultural conditions prevailing in sub-Saharan Africa.
Country
Publisher
World Pyschiatry
Theme area
Resource allocation and health financing
Title of publication Pay for Performance in Tanzania
Date of publication
2009
Publication type
Report
Publication details
Health Systems 20/20 P4P Case Study / pp /-/
Publication status
Published
Language
English
Keywords
health financing, performance based financing; Tanzania
Abstract
Pay for performance (P4P), consisting of bonuses to health facilities linked to attainment of performance targets, is being implemented in the United Republic of Tanzania with the goal of improving maternal and child health outcomes; strengthening information systems and the use of information for management decisions; and motivating health care providers. After discussions between the government of Tanzania and development partners, the government chose to implement a nationwide P4P program. This decision – to begin on a national scale rather than with a pilot – along with donor concerns about weaknesses in the program, resulted in development partners declining to fund the bonuses out of the health basket. This case study explores the process between donors and the government of moving P4P from concept to design to implementation. It describes key areas of disagreement, and highlights the political tensions inherent in translating high-level interest in P4P into on-the-ground action.
Country
Publisher
Health Systems 20/20
Theme area
Equitable health services
Title of publication Use Pattern of Maternal Health Services and Determinants of Skilled Care During Delivery in Southern Tanzania: Implications for Achievement of MDG-5 Targets
Date of publication
2007 December
Publication type
Journal Article
Publication details
BMC Pregnancy and Childbirth 7 29 pp /-/
Publication status
Published
Language
English
Keywords
maternal health, uptake, Tanzania
Abstract
Almost two decades since the initiation of the Safe motherhood Initiative, Maternal Mortality is still soaring high in most developing countries. In 2000, WHO estimated a life time risk of a maternal death of 1 in 16 in Sub- Saharan Africa while it was only 1 in 2800 in developed countries. This huge discrepancy in the rate of maternal deaths is due to differences in access and use of maternal health care services. It is known that having a skilled attendant at every delivery can lead to marked reductions in maternal mortality. For this reason, the proportion of births attended by skilled health personnel is one of the indicators used to monitor progress towards the achievement of the MDG-5 of improving maternal health. The authors interviewed 974 women who gave birth within one year prior to the survey. Although almost all (99.8%) attended ANC at least once during their last pregnancy, only 46.7% reported to deliver in a health facility and only 44.5% were assisted during delivery by a skilled attendant. The study concludes that use of skilled care during delivery in this district is below the target set by ICPD + of attaining 80% of deliveries attended by skilled personnel by 2005. The authors recommend the following in order to increase the pace towards achieving the MDG targets: to improve coverage of health facilities, raising awareness for both men and women on danger signs during pregnancy/delivery and strengthening counseling on facility delivery and individual birth preparedness.
Country
Publisher
BMC Pregnancy and Childbirth
Theme area
Human resources for health, Monitoring equity and research to policy
Title of publication Lehmann U; Friedman I; Sanders D Review of the Utilization and Effectiveness of Community-Based Health Workers in Africa
Date of publication
2004
Publication type
Report
Publication details
University of the Western Cape / / pp /-/
Publication status
Published
Language
English
Keywords
community health workers, review, Africa
Abstract
This review examines the use of various categories of Community Health Workers (CHWs) as first line health workers in dealing, for example, with maternal and child health, tuberculosis, HIV/AIDS, malaria and other issues throughout Africa. It attempts to address key questions such as: What has happened to Community Health Worker programs over the past two decades in Africa? What models are being used? What type of work do CHWs undertake? In which countries is work being undertaken? How are programs structured and managed? What kind of training are CHWs given? How effective are CHWs? What problems, challenges and obstacles have they faced? Case studies have been included to illustrate success stories and experiences. These provide vivid insight into the types of CHW models being used, the relevance of CHWs, their recruitment, training, and roles. They illuminate issues related to their supervision and accountability, and types of incentives or remuneration offered and how these are impacting on sustainability, tenure of service and career path, obstacles, problems and challenges encountered, amongst other issues.
Country
Publisher
University of the Western Cape
Theme area
Human resources for health, Governance and participation in health
Title of publication Promoting Health Lifestyles: Community Health Workers' Intervention Programme for Primary Prevention of Non-Communicable Diseases in Khayelitsha, an Urban Township in Cape Town
Date of publication
2007
Publication type
Report
Publication details
University of the Western Cape / / pp /-/
Publication status
Published
Language
English
Keywords
community health workers, prevention, non communicable diseases, South Africa
Abstract
A community-based project to increase community awareness about primary prevention of non-communicable diseases (NCDs) was implemented in an urban township of Cape Town. The aims of project were to utilise community health workers as change agents in their community and to develop a NCD model for an urban township community. The document describes the process undertaken with community health workers (CHWs) to plan and implement community interventions, and the evaluation of the interventions.
Country
Publisher
University of the Western Cape
Theme area
Human resources for health
Title of publication Ugandan Health Workers Speak: The Rewards and the Realities
Date of publication
2009
Publication type
Report
Publication details
Voluntary Service Overseas / / pp /-/
Publication status
Published
Language
English
Keywords
health workers, Uganda
Abstract
This report is based on the accounts of 90 Ugandan health workers at the front line. The research explored with them the rewards and the challenges, explanations for perceived poor practices and promising solutions. The interim findings focus on the rewards of being a health worker and how low pay affects them. The authors conducted the majority of the research with government health workers. They also spoke with health workers and some managers in not-for-profit hospitals and health centres and in a private hospital, to explore their working experiences and management practices. The participants were encourage to speak freely within a framework of open questions. This report draws on interviews and small group discussions at 17 health facilities in six geographical regions and in Kampala, the capital city, held between June and November 2010. Participants worked in large urban hospitals, in small town and rural hospitals, and in rural and town health centres. In five of six district the authors interviewed the local government District Health Officer. Many participants drew on their prior experiences from training or working in different sectors and levels of healthcare facility.
Country
Publisher
Voluntary Service Overseas
Theme area
Human resources for health, Governance and participation in health
Title of publication Community Health Workers and Health Educators: Building Understanding and Partnerships in Education
Date of publication
2010
Publication type
Slide presentation
Publication details
Society for Public Health Education / / pp /-/
Publication status
Published
Language
English
Keywords
community health workers, health education, global
Abstract
This webinar’s presentation includes: defining the community health worker (CHW), case study of a CHW, CHW core roles and competencies, core values and code of ethics, and CHW-health educator partnership opportunities.
Country
Publisher
Society for Public Health Education
Theme area
Human resources for health
Title of publication Addressing the HRH Crisis in Countries: How Far Have We Gone? What Can We Expect to Achieve by 2015
Date of publication
2011 May
Publication type
Journal Article
Publication details
Revista Peruana de Medicina Experimental y Salud Publica 28 2 pp 327-336
Publication status
Published
Language
English
Keywords
Health workers, World Health Organisation, Millennium development goals, global
Abstract
The World Health Report 2006 identified 57 countries world-wide whose health worker to population density fell below a critical threshold of 2.3 per 1,000 population. This meant that below this critical threshold, a country could not provide the basic health services to its population, defined here as 80% immunization coverage and 80% skilled birth attendance at delivery. Of the 57 countries, 36 are located in Africa.This article reviews the progress countries have made in addressing their health workforce crisis. It cites 3 of the most recent global studies and the indicators used to measure progress. It also features the experiences of 8 countries, namely Malawi, Peru, Ethiopia, Brazil, Thailand, Philippines, Zambia, Mali. Their situations provide a diverse picture of country efforts, challenges, and successes. The article asks the question of whether the target of 25% reduction in the number of crisis countries can be achieved by 2015. This was a goal set by the World Health Assembly in 2008. While the authors wish to remain optimistic about the striving towards this target, their optimism must be matched by an adequate level of investment in countries on HRH development. The next four years will show how much will really be achieved.
Country
Publisher
Revista Peruana de Medicina Experimental y Salud Publica
Theme area
Human resources for health, Equity and HIV/AIDS
Title of publication Listening to Health Workers: Lessons from Eastern Uganda for Strengthening the Programme for the Prevention of Monther-to-Child Transmission of HIV
Date of publication
2012 January
Publication type
Journal Article
Publication details
BMC Health Services Research 12 3 pp /-/
Publication status
Published
Language
English
Keywords
health workers, mother to child, transmission, HIV, Uganda
Abstract
The implementation and utilization of programmes for the prevention of mother-to-child transmission (PMTCT) of HIV in most low income countries has been described as sub-optimal. As planners and service providers, the views of health workers are important in generating priorities to improve the effectiveness of the PMTCT programme in Uganda. The authors explored the lessons learnt by health workers involved in the provision of PMTCT services in eastern Uganda to better understand what more needs to be done to strengthen the PMTCT programme. A qualitative study was conducted at Mbale Regional Referral Hospital, The AIDS Support Organisation (TASO) Mbale and at eight neighbouring health centres in eastern Uganda, between January and May 2010. Data were collected through 24 individual interviews with the health workers involved in the PMTCT programme and four key informants (2 district officials and 2 officials from TASO). Data were analyzed using the content thematic approach. Study themes and sub-themes were identified following multiple reading of interview transcripts. Relevant quotations have been used in the presentation of study findings. The key lessons for programme improvement were: ensuring constant availability of critical PMTCT supplies, such as HIV testing kits, antiretroviral drugs (ARVs) for mothers and their babies, regular in-service training of health workers to keep them abreast with the rapidly changing knowledge and guidelines for PMTCT, ensuring that lower level health centres provide maternity services and ARVs for women in the PMTCT programme and provision of adequate facilities for effective follow-up and support for mothers. The voices of health workers in this study revealed that it is imperative for government, civil society organizations and donors that the PMTCT programme addresses the challenges of shortage of critical PMTCT supplies, continuous health worker training and follow-up and support for mothers as urgent needs to strengthen the PMTCT programme.
Country
Publisher
BMC Health Services Research
Theme area
Equity and HIV/AIDS
Title of publication Positive Spill-Over Effects of ART Scale Up on Wider Health Systems Development: Evidence from Ethiopia and Malawi
Date of publication
2011 July
Publication type
Journal Article
Publication details
Journal of the International AIDS Society 14 Suppl 1 pp /-/
Publication status
Published
Language
English
Keywords
antiretroviral treatment,health systems, development, Ethiopia, Malawi
Abstract
Global health initiatives have enabled the scale up of antiretroviral treatment (ART) over recent years. The impact of HIV-specific funds and programmes on non-HIV-related health services and health systems in genera has been debated extensively. Drawing on evidence from Malawi and Ethiopia, this article analyses the effects of ART scale-up interventions on human resources policies, service delivery and general health outcomes, and explores how synergies can be maximized. Data from Malawi and Ethiopia were compiled between 2004 and 2009 and between 2005 and 2009, respectively. We developed a conceptual health systems framework for the analysis. The authors used the major changes in human resources policies as an entry point to explore the wider health systems changes. In both countries, the need for an HIV response triggered an overhaul of human resources policies. As a result, the health workforce at health facility and community level was reinforced. The impact of this human resources trend was felt beyond the scale up of ART services; it also contributed to an overall increase in functional health facilities providing curative, mother and child health, and ART services. In addition to a significant increase in ART coverage, the authors observed a remarkable rise in user rates of non-HIV health services and an improvement in overall health outcomes. Interventions aimed at the expansion of ART services and improvement of long-term retention of patients in ART care can have positive spill-over effects on the health system. The responses of Malawi and Ethiopia to their human resources crises was exceptional in many respects, and some of the lessons learnt can be useful in other contexts. The case studies show the feasibility of obtaining improved health outcomes beyond HIV through scaled-up ART interventions when these are part of a long-term, system-wide health plan supported by all decision makers and funders.
Country
Publisher
Journal of the International AIDS Society
Theme area
Human resources for health
Title of publication Increasing Health Worker Capacity Through Distance Learning: a Comprehensive Review of Programmes in Tanzania
Date of publication
2010
Publication type
Journal Article
Publication details
Human Resources for Health 8 30 pp /-/
Publication status
Published
Language
English
Keywords
health worker, distance learning, Tanzania
Abstract
Tanzania, like many developing countries, faces a crisis in human resources for health. The government has looked for ways to increase the number and skills of health workers, including using distance learning in their training. In 2008, the authors reviewed and assessed the country’s current distance learning programmes for health care workers, as well as those in countries with similar human resource challenges, to determine the feasibility of distance learning to meet the need of an increased and more skilled health workforce. Data were collected from 25 distance learning programmes at health training institutions, universities, and non-governmental organizations throughout the country from May to August 2008. Methods included internet research; desk review; telephone, email and mail-in surveys; on-site observations; interviews with programme managers, instructors, students, information technology specialists, preceptors, health care workers and Ministry of Health and Social Welfare representatives; and a focus group with national HIV/AIDS care and treatment organizations. Challenges include lack of guidelines for administrators, instructors and preceptors of distance learning programmes regarding roles and responsibilities; absence of competencies for clinical components of curricula; and technological constraints such as lack of access to computers and to the internet. Insufficient funding resulted in personnel shortages, lack of appropriate training for personnel, and lack of materials for students. Nonetheless, current and prospective students expressed overwhelming enthusiasm for scale-up of distance learning because of the unique financial and social benefits offered by these programs. Participants were retained as employees in their health care facilities, and remained in their communities and supported their families while advancing their careers. Space in health training institutions was freed up for new students entering in-residence pre-service training. The report concludes that a blended print-based distance learning model is most feasible at the national level due to current resource and infrastructure constraints. With an increase in staffing; improvement of infrastructure, coordination and curricula; and decentralization to the zonal or district level, distance learning can be an effective method to increase both the skills and the numbers of qualified health care workers capable of meeting the health care needs of the Tanzanian population.
Country
Publisher
Human Resources for Health
Theme area
Human resources for health
Title of publication Evaluation of the Capacity Project's Human Resources Information Systems (HRIS) Strengthening Process in Swaziland, Uganda and Rwanda
Date of publication
2009 July
Publication type
Report
Publication details
Capacity Project / / pp /-/
Publication status
Published
Language
English
Keywords
health workers, health information, Swaziland, Uganda, Rwanda
Abstract
The Capacity Project worked to strengthen human resources information systems (HRIS) in several low-resource countries to assist decision-makers and human resources (HR) managers in identifying and responding to critical gaps in human resources for health (HRH). This included a focus on five key elements: developing participatory HRIS stakeholder leadership; strengthening information and communication technology (ICT) infrastructure; developing and deploying software; enhancing skills in data-driven decision-making; and building in- country capacity to ensure sustainability and continuous improvement. The findings and recommendations in this report cover the Capacity Project’s implementation of HRIS in Swaziland, Rwanda and Uganda. This report is a synthesis of detailed technical findings documented in three country case study reports that were based on a series of key informant interviews in each of the countries between November 2008 and April 2009, and provides guidance to inform future HRIS planning and implementation.
Country
Publisher
Capacity Project
Theme area
Human resources for health
Title of publication Evaluation of a Rapid Workforce Expansion Strategy: the Kenya Emergency Hiring Plan
Date of publication
2009 July
Publication type
Report
Publication details
Capacity Project / / pp /-/
Publication status
Published
Language
English
Keywords
health workers, Kenya
Abstract
A shortage of skilled health workers in high-need areas dangerously limits access to care and impedes global goals such as scaling up antiretroviral therapy distribution and providing access to family planning. Those with the highest need are often left without adequate care because of cumbersome, inefficient and sometimes distorted systems to hire, train and deploy health workers. In Kenya the Capacity Project, along with the Ministry of Health, African Medical and Research Foundation, Deloitte and Touche, Kenya Institute of Administration and Kenya Medical Training Colleges, formulated and used an emergency hiring plan (EHP) to quickly hire, train and deploy workers to high-need areas. The EHP consisted of open recruiting, fair interviewing, candidate short-listing and transparent hiring. Hired workers received orientation and a two-week HIV skills training and were deployed to districts with identified severe workforce gaps. Workers hired under this plan received the same salaries as those hired by the Government of Kenya (GOK). This evaluation presents the results of a Kenyan emergency hiring plan (EHP) to quickly hire, train and deploy workers to high-need areas. The report presents the tracked hiring, training and deployment of all new hires compared to identified gaps. It also contains facility statistics and new hire and coworker feedback in a sample of ten facilities at baseline and every six months for period of three years.
Country
Publisher
Capacity Project
Theme area
Public-private mix, Equity and HIV/AIDS
Title of publication Who Goes Where and Why? Examining HIV Counseling and Testing Services in the Public and Private Sectors in Zambia
Date of publication
2009 November
Publication type
Report
Publication details
PSP-One / / pp /-/
Publication status
Published
Language
English
Keywords
HIV, counselling, private sector, Zambia
Abstract
The objectives of this study include documenting the role of the private for-profit sector in voluntary counseling and testing (VCT) service delivery; establishing whether there are significant differences in the quality of VCT services, particularly in counseling and referral practices, between public, private for-profit, NGO, and mission providers; measuring key VCT service statistics at facilities within each sector; and identify best practices from each sector.
Country
Publisher
PSP-One
Theme area
Resource allocation and health financing
Title of publication Macroeconomic and Fiscal Issues in Scaling Up Human Resources for Health in Low-Income Countries
Date of publication
2005 October
Publication type
Report
Publication details
World Bank / / pp /-/
Publication status
Published
Language
English
Keywords
health financing, health workers, Africa, global
Abstract
This background paper to the World Health Report 2006 discusses the fiscal and macroeconomic implications associated with scaling up health workforce capacity. While these general issues and concepts are relevant in all setting, the focus of the discussion is on low-income countries and sub-Saharan Africa in particular.
Country
Publisher
World Bank
Theme area
Human resources for health
Title of publication Who Are Health Managers? Case Studies from Three African Countries
Date of publication
2009
Publication type
Journal Article
Publication details
Human Resources for Health Observer 1 / pp /-/
Publication status
Published
Language
English
Keywords
health managers, health workers, Ethiopia, Ghana, Tanzania
Abstract
Health managers are considered essential at both the strategic and operational levels of health systems. Health sector managers at central or national levels oversee the strategic direction of the sector as policy makers, managing overall resource allocation and monitoring policy targets and outcomes. At operational levels, managers are responsible for converting health systems input and resources such as finance, staff, supplies, equipment and infrastructure, into effective services that produce health results. A continuing emphasis on decentralization in developing countries makes the need for managers with the right skills even more essential. However, health systems in developing countries lack data and information regarding health service managers. While most health workforce statistics record the availability of various cadres of health professionals, as currently structured, they do not provide information on the actual roles played by health professionals, many of whom play management and other roles in addition to their professional tasks. The managerial function is rarely a part of human resources for health management (HRH) development plans. This report outlines a rapid descriptive assessment to gain an initial understanding of the management workforce for service delivery in Ethiopia, Ghana and Tanzania and to test selected criteria for assessing managers as part of the health workforce.
Country
Publisher
/
Theme area
Human resources for health
Title of publication International Flow of Zambian Nurses
Date of publication
2009 November
Publication type
Journal Article
Publication details
Human Resources for Health 7 84 pp /-/
Publication status
Published
Language
English
Keywords
international migration health workers, nurses, Zambia
Abstract
This commentary paper highlights changing patterns of outward migration of Zambian nurses. The aim is to discuss these pattern changes in the light of policy developments in Zambia and in receiving countries. Prior to 2000, South Africa was the most important destination for Zambian registered nurses. In 2000, new destination countries, such as the United Kingdom, became available, resulting in a substantial increase in migration from Zambia. This is attributable to the policy of active recruitment by the United Kingdom's National Health Service and Zambia's policy of offering Voluntary Separation Packages: early retirement lump-sum payments promoted by the government, which nurses used towards migration costs. The dramatic decline in migration to the United Kingdom since 2004 is likely to be due to increased difficulties in obtaining United Kingdom registration and work permits. Despite smaller numbers, enrolled nurses are also leaving Zambia for other destination countries, a significant new development. This paper stresses the need for nurse managers and policy-makers to pay more attention to these wider nurse migration trends in Zambia, and argues that the focus of any migration strategy should be on how to retain a motivated workforce through improving working conditions and policy initiatives to encourage nurses to stay within the public sector.
Country
Publisher
Human Resources for Health
Theme area
Equitable health services, Equity and HIV/AIDS
Title of publication Strengthening the Capacity of Traditional Health Practioners to Respond to HIV/AIDS and TB in Kwazulu Natal, South Africa
Date of publication
2009
Publication type
Report
Publication details
African Medical and Research Foundation / / pp /-/
Publication status
Published
Language
English
Keywords
traditional health, HIV/AIDS, TB, South Africa
Abstract
HIV and TB have added an increasing demand to the health system. According to the KwaZulu Natal annual report (2007), the ability of the province’s health system to cope with demand is compounded by high (17%) nurse vacancy rate, high attrition rates for both doctors and nurses (60% and 13%, respectively), an average recruitment rate of 72% for nurses and doctors and an unsustainable 50% nurse absenteeism. The burden posed by both diseases is further compounded by unequal distribution of resources, inability to access health facilities (long distances travelled for over two hours) and shortage of health care workers. This paper presents the experiences, impact and lessons of the innovative approach of working with traditional healers in HIV and TB prevention and control programmes, especially at the primary health care level.
Country
Publisher
African Medical and Research Foundation
Theme area
Equity in health
Title of publication Joint External Evaluation of the Health Sector in Tanzania: Draft Report
Date of publication
2007
Publication type
Report
Publication details
COWI; Goss Gilroy Inc; EPOS Health Consultants / / pp /-/
Publication status
Published
Language
English
Keywords
health sector, evaluation, Tanzania
Abstract
This evaluation focused on the relevance of the health sector strategic and implementation plans to the achievement of the the MDGs in health; the extent of progress and achievements in the health sector reform process; achievements in improving access, service quality and health outcomes; and changes in partnership activities. The study examines how effectively the health sector has dealt with important issues in HRH during the evaluation period.
Country
Publisher
COWI; Goss Gilroy Inc; EPOS Health Consultants
Theme area
Equity and HIV/AIDS
Title of publication Alleviating the Burden of Responsibility: Men as Providers of Community-Based HIV/AIDS Care and Support in Lesotho
Date of publication
2009
Publication type
Report
Publication details
Capacity Project Gender Research Brief 2 / pp /-/
Publication status
Published
Language
English
Keywords
men, community health, HIV/AIDS, Lesotho
Abstract
The desired outcomes of all gender-related actions in human resources for health (HRH) are improved service delivery and health equity, both for workers and for the communities they serve. As it worked to strengthen HRH systems to implement quality health programs in developing countries, the Capacity Project—a USAID-funded global project that focused on planning, developing and supporting the health workforce— examined how gender inequalities affect women’s and men’s opportunities for education, training and occupational choice and participation in the health workforce. Occupational segregation by gender has been recognized worldwide as a major source of inequality, labor market rigidity and inefficiency (Anker, 1997; Anker et al., 2003) that impedes the development of robust health workforces. In the era of HIV/AIDS, this makes for inequities, inefficiencies and missed opportunities by creating barriers to health workforce entry and limiting the possible pool of formal and nonformal health workers. In Lesotho, as in many other countries, the HIV and AIDS care burden falls on the shoulders of women and girls in unpaid, invisible household and community work. This gender inequity in HRH needs to be addressed to ensure fair and sustainable responses to the need for home- and community-based HIV/AIDS care and support. The Capacity Project addressed these issues through a study of men as providers of HIV/AIDS care and support.
Country
Publisher
Capacity Project Gender Research Brief
Theme area
Equity and HIV/AIDS
Title of publication Increasing Leadership Capacity for HIV/AIDS Programs by Strengthening Public Health Epidemiology and Management Training in Zimbabwe
Date of publication
2009 August
Publication type
Journal Article
Publication details
Human Resources for Health 7 69 pp /-/
Publication status
Published
Language
English
Keywords
leadership, public health, training, HIV/AIDS, Zimbabwe
Abstract
Increased funding for global human immunodeficiency virus prevention and control in developing countries has created both a challenge and an opportunity for achieving long-term global health goals. This paper describes a programme in Zimbabwe aimed at responding more effectively to the HIV/AIDS epidemic by reinforcing a critical competence-based training institution and producing public health leaders. The programme used new HIV/AIDS programme-specific funds to build on the assets of a local education institution to strengthen and expand the general public health leadership capacity in Zimbabwe, simultaneously ensuring that they were trained in HIV interventions. The programme increased both numbers of graduates and retention of faculty. The expanded HIV/AIDS curriculum was associated with a substantial increase in trainee projects related to HIV. The increased number of public health professionals has led to a number of practically trained persons working in public health leadership positions in the ministry, including in HIV/AIDS programmes. Investment of a modest proportion of new HIV/AIDS resources in targeted public health leadership training programmes can assist in building capacity to lead and manage national HIV and other public health programmes.
Country
Publisher
Human Resources for Health
Theme area
Human resources for health
Title of publication Retention of Health Workers in Malawi: Perpectives of Health Workers and District Management
Date of publication
2009 July
Publication type
Journal Article
Publication details
Human Resources for Health 7 65 pp /-/
Publication status
Published
Language
English
Keywords
health workers, retention, Malawi
Abstract
Shortage of human resources is a major problem facing Malawi, where more than 50% of the population lives in rural areas. Most of the district health services are provided by clinical health officers specially trained to provide services that would normally be provided by fully qualified doctors or specialists. As this cadre and the cadre of enrolled nurses are the mainstay of the Malawian health service at the district level, it is important that they are supported and motivated to deliver a good standard of service to the population. This study explores how these cadres are managed and motivated and the impact this has on their performance. A quantitative survey measured health workers' job satisfaction, perceptions of the work environment and sense of justice in the workplace, and was reported elsewhere. It emerged that health workers were particularly dissatisfied with what they perceived as unfair access to continuous education and career advancement opportunities, as well as inadequate supervision. These issues and their contribution to demotivation, from the perspective of both management and health workers, were further explored by means of qualitative techniques. Focus group discussions were held with health workers, and key-informant interviews were conducted with members of district health management teams and human resource officers in the Ministry of Health. The focus groups used convenience sampling that included all the different cadres of health workers available and willing to participate on the day the research team visited the health facility. The interviews targeted district health management teams in three districts and the human resources personnel in the Ministry of Health, also sampling those who were available and agreed to participate. The results showed that health workers consider continuous education and career progression strategies to be inadequate. Standard human resource management practices such as performance appraisal and the provision of job descriptions were not present in many cases. Health workers felt that they were inadequately supervised, with no feedback on performance. In contrast to health workers, managers did not perceive these human resources management deficiencies in the system as having an impact on motivation. The study concludes that a strong human resource management function operating at the district level is likely to improve worker motivation and performance.
Country
Publisher
Human Resources for Health
Theme area
Equity and HIV/AIDS
Title of publication Impact of HIV/AIDS on Human Resources for Health in Tanzania
Date of publication
2006 July
Publication type
Report
Publication details
Ministry of Health and Social Welfare, Tanzania / / pp /-/
Publication status
Published
Language
English
Keywords
HIV/AIDS, health workers, Tanzania
Abstract
This study sought to document the impact of HIV/AIDS on the human resources in the health sector in Tanzania. Its specific objectives were to assess the impact of HIV/AIDS on the human resources in the health sector in Tanzania, to provide up to date and specific data on the needs and the supply of human resources in the health sector, and to inform the formulation of strategies for strengthening human resources in the health sector. This is the third, in a series of studies of this kind supported by the East, Central and Southern Africa – Health Secretariat. The other studies were done in Malawi and Kenya in 2004. The assessment covered 66 health facilities in 8 regions of Tanzania Mainland. Data collection was done in December 2005. The regions were selected purposively to reflect the range of the magnitude of the HIV/AIDS burden in the country, and the health facilities were in turn selected to provide a cross section of the health services structure in the regions. These comprised 7 Regional Hospitals, 17 District Hospitals, 16 other types of hospitals mainly within the private sector, 19 Health Centres and 7 Dispensaries.
Country
Publisher
Ministry of Health and Social Welfare, Tanzania
Theme area
Equity and HIV/AIDS
Title of publication Involving Expert Patients in Antiretroviral Treatment Provision in a Tertiary Referral Hospital HIV Clinic in Malawi
Date of publication
2012 June
Publication type
Journal Article
Publication details
BMC Health Services Research 12 140 pp /-/
Publication status
Published
Language
English
Keywords
expert patients, HIV, Malawi
Abstract
Current antiretroviral treatment (ART) models in Africa are labour intensive and require a high number of skilled staff. In the context of constraints in human resources for health, task shifting is considered a feasible alternative for ART service delivery. In 2006, Dignitas International in partnership with the Malawi Ministry of Health trained a cadre of expert patients at the HIV Clinic at a tertiary referral hospital in Zomba, Malawi. Expert patients were trained to assist with clinic tasks including measurement of vital signs, anthropometry and counseling. A descriptive observational study using mixed methods was conducted two years after the start of program implementation. Semi-structured interviews were conducted with 20 patients, seven expert patients and six formal health care providers to explore perceptions towards the expert patients’ contributions in the clinic. Structured exit interviews with 81 patients, assessed whether essential ART information was conveyed during counseling sessions. Vital signs and anthropometry measurements performed by expert patients were repeated by a nurse to assess accuracy of measurements. Direct observations quantified the time spent with each patient. There were minor differences in measurement of patients’ weight, height and temperature between the expert patients and the nurse. The majority of patients exiting a counseling session reported, without prompting, at least three side effects of ART, correct actions to be taken on observing a side-effect, and correct consequences of non-adherence to ART. Expert patients carried out 368 hours of nurse tasks each month, saving two and a half full-time nurse equivalents per month. Formal health care workers and patients accept and value expert patients’ involvement in ART provision and care. Expert patients felt valued by patients for being a ‘role model’, or a ‘model of hope’, promoting positive living and adherence to ART. The study concludes that expert patients add value to the ART services at a tertiary referral HIV clinic in Malawi. Expert patients carry out shifted tasks acceptably, saving formal health staff time, and also act as ‘living testimonies’ of the benefits of ART and can be a means of achieving greater involvement of People Living with HIV in HIV treatment programs.
Country
Publisher
BMC Health Services Research
Theme area
Equitable health services, Equity and HIV/AIDS
Title of publication Implementing Nurse-Initiated and Managed Antiretroviral Treatment (NIMART) in South Africa: A Qualitative Process Evaluation of the STRETCH Trial
Date of publication
2012 July
Publication type
Journal Article
Publication details
Implementation Science 7 66 pp /-/
Publication status
Published
Language
English
Keywords
nurse, antiretroviral treatment, HIV, South Africa
Abstract
The STRETCH (Streamlining Tasks and Roles to Expand Treatment and Care for HIV) program was an intervention implemented in South Africa to enable nurses providing primary HIV/AIDS care to expand their roles and include aspects of care and treatment usually provided by physicians. The effects of STRETCH on pre-ART mortality, ART provision, and the quality of HIV/ART care were evaluated through a randomised controlled trial. This study was conducted alongside the trial to develop a contextualised understanding of factors affecting the implementation of the program.
Country
Publisher
Implementation Science
Theme area
Governance and participation in health, Monitoring equity and research to policy
Title of publication Building a National Model for Knowledge Exchange in Malawi: Findings From a Health Information Needs Assessment
Date of publication
2012 June
Publication type
Journal Article
Publication details
Journal of Health Communication: International Perspectives 17 Suppl 2 pp 64-78
Publication status
Published
Language
English
Keywords
health information, Malawi
Abstract
Getting the right information into the right hands at the right time is a challenge for many health systems in developing countries. Health workers need access to reliable and up-to-date health information in order to support their clients. This health information needs assessment, conducted in the capital city and 3 districts of Malawi from July 2009 to September 2009, aimed to determine access to, and need for, health information in HIV/AIDS and family planning/reproductive health at all levels of the health system. Using qualitative research methods, the study showed the need to build the capacity of government technical working groups to collect and store information and to promote information exchange at all levels of the health system; improve information synthesis and packaging, particularly for users at peripheral levels; strengthen the district level to serve as an information hub for district- and community-level providers; and explore mobile technologies to increase provider access to knowledge and information.
Country
Publisher
Journal of Health Communication: International Perspectives
Theme area
Equitable health services, Human resources for health
Title of publication Even if You Know Everything You Can Forget: Health Worker Perceptions of Mobile Phone Text-Messaging to Improve Malaria Case Management in Kenya
Date of publication
2012 June
Publication type
Journal Article
Publication details
Plos ONE 7 6 pp /-/
Publication status
Published
Language
English
Keywords
mobile phone, malaria, health workers, Kenya
Abstract
This paper presents the results of a qualitative study to investigate the perceptions and experiences of health workers involved in a a cluster-randomized controlled trial of a novel intervention to improve health worker malaria case management in 107 government health facilities in Kenya. The intervention involved sending text-messages about paediatric outpatient malaria case-management accompanied by ‘‘motivating’’ quotes to health workers’ mobile phones. Ten malaria messages were developed reflecting recommendations from the Kenyan national guidelines. Two messages were delivered per day for 5 working days and the process was repeated for 26 weeks (May to October 2009). The accompanying quotes were unique to each message. The intervention was delivered to 119 health workers and there were significant improvements in correct artemether-lumefantrine (AL) management both immediately after the intervention (November 2009) and 6 months later (May 2010). In-depth interviews with 24 health workers were undertaken to investigate the possible drivers of this change. The results suggest high acceptance of all components of the intervention, with the active delivery of information in an on the job setting, the ready availability of new and stored text messages and the perception of being kept ‘up to date’ as important factors influencing practice. Applying the construct of stages of change we infer that in this intervention the SMS messages were operating primarily at the action and maintenance stages of behaviour change achieving their effect by creating an enabling environment and providing a prompt to action for the implementation of case management practices that had already been accepted as the clinical norm by the health workers. Future trials testing the effectiveness of SMS reminders in creating an enabling environment for the establishment of new norms in clinical practice as well as in providing a prompt to action for the implementation of the new case-management guidelines are justified.
Country
Publisher
Plos ONE
Theme area
Human resources for health
Title of publication Wages and Health Worker Retention in Ghana: Evidence from Public Sector Wage Reforms
Date of publication
2012 February
Publication type
Document
Publication details
The World Bank 69107 / pp /-/
Publication status
Published
Language
English
Keywords
health workers, retention, financing, Ghana
Abstract
This paper investigates whether governments in developing countries retain skilled health workers by raising public sector wages. The authors investigate this question using sudden, policy-induced wage variation, in which the Government of Ghana restructured the pay scale for government health workers. They argue that a ten percent increase in wages decreases annual attrition from the public payroll by 1.5 percentage points (from a mean of eight percentage points) among 20-35 year-old workers from professions that tend to migrate. As a result, the ten-year survival probability for these health workers increases from 0.43 to 0.52. The effects are concentrated among these young workers, and the authors did not detect effects among older workers or among categories of workers that do not tend to migrate. Given Ghana’s context as a major source of skilled health professional migrants and high correlation of our attrition measure with aggregate migration, the authors interpret these results as evidence that wage increases in Ghana improve retention mainly through reducing international migration.
Country
Publisher
The World Bank
Theme area
Human resources for health
Title of publication Perceived Barriers and Motivating Factors Influencing Student Midwives' Acceptance of Rural Postings in Ghana
Date of publication
2012 July
Publication type
Journal Article
Publication details
Human Resources for Health 10 17 pp /-/
Publication status
Published
Language
English
Keywords
midwives, health workers, rural, Ghana
Abstract
Research on the maldistribution of health care workers has focused mainly on physicians and nurses. To meet the Millennium Development Goals Five and the reproductive needs of all women, it is predicted that an additional 334,000 midwives are needed. Despite the on- going efforts to increase this cadre of health workers there are still glaring gaps and inequities in distribution. The objectives of this study are to determine the perceived barriers and motivators influencing final year midwifery students’ acceptance of rural postings in Ghana, West Africa. An exploratory qualitative study using focus group interviews as the data collection strategy was conducted in two of the largest midwifery training schools in Ghana. All final year midwifery students from the two training schools were invited to participate in the focus groups. A purposive sample of 49 final year midwifery students participated in 6 focus groups. All students were women. Average age was 23.2 years. Glaser’s constant comparative method of analysis was used to identify patterns or themes from the data. Three themes were identified through a broad inductive process: 1) social amenities; 2) professional life; and 3) further education/career advancement. Together they create the overarching theme, quality of life, we use to describe the influences on midwifery students’ decision to accept a rural posting following graduation. In countries where there are too few health workers, deployment of midwives to rural postings is a continuing challenge. Until more midwives are attracted to work in rural, remote areas health inequities will exist and the targeted reduction for maternal mortality will remain elusive.
Country
Publisher
Human Resources for Health
Theme area
Equitable health services, Human resources for health
Title of publication Enabling Solutions, Ensuring Healthcare: The Global Health Workforce Alliance 2011 Annual Report
Date of publication
2012
Publication type
Report
Publication details
Global Health Workforce Alliance / / pp /-/
Publication status
Published
Language
English
Keywords
health workers, global
Abstract
The Global Health Workforce Alliance, a partnership dedicated to identifying and coordinating solutions to the health workforce crisis, produced this report of the HRH activities and progress of the last five years and the refocusing of its efforts for the next five years. Topics include: health workforce at the heart of global agendas; accelerating country actions; promoting evidence-based HRH solutions; and supporting core health management functions.
Country
Publisher
Global Health Workforce Alliance
Theme area
Resource allocation and health financing, Governance and participation in health
Title of publication Value for Money, Sustainability and Accountability in Health: A New Governance Framework for Africa Towards and Beyond the MDGs: Financing Human Resources for Health
Date of publication
2012
Publication type
Report
Publication details
Global Health Workforce Alliance / / pp /-/
Publication status
Published
Language
English
Keywords
health financing, governance, health workers, Africa
Abstract
Health costs are spiralling out of control all over the world in context of global financial crisis while some countries are still struggling to offer basic health services. The health sector in Sub- Saharan Africa is most often unfunded, including the health workforce, which represents the single largest item in health budgets. On the other hand, countries do not meet the minimum health staffing levels to provide essential care. This brief outlines the the need for ministries of finance and health to allocate additional financial resources for HRH to maximize the efficiency and effectiveness of current capital and recurrent expenditures.
Country
Publisher
Global Health Workforce Alliance
Theme area
Equitable health services, Human resources for health
Title of publication Towards a Collective Understanding of the Information Needs of Health Care Providers in Low-Income Countries, and How to Meet Them
Date of publication
2012 June
Publication type
Journal Article
Publication details
Journal of Health Communication: International Perspectives 17 Suppl 2 pp /-/
Publication status
Published
Language
English
Keywords
health information, health workers, Africa
Abstract
Poor knowledge among health care providers (including health workers and citizens) leads to poor health outcomes. This article discusses current linear research-to-practice paradigms and argues that these approaches are not meeting the needs of health care providers in low- and middle-income countries. It suggests a broader, needs-led approach. This approach must look beyond perceived needs and identify actual needs in relation to knowledge and practice, including learning needs and point-of-use needs. The article argues that systems thinking is required. The availability of reliable, appropriate health care information for providers is dependent on the integrity of the global health care knowledge system, which embraces health professionals, policymakers, researchers, publishers, librarians, information specialists, and others. Three intrinsic weaknesses of the system need to be addressed: communication among stakeholders; an evolving, collective understanding of the system's components and how they interrelate; and effective advocacy to raise awareness of this issue and the need for funders and governments to support collective efforts to strengthen the knowledge system. This can be done at the country level but must be accompanied by an international effort including knowledge networks such as Healthcare Information for All by 2015 involving diverse individuals and organizations.
Country
Publisher
Journal of Health Communication: International Perspectives
Theme area
Human resources for health
Title of publication Meeting the Health Information Needs of Health Workers: What Have We Learned?
Date of publication
2012 June
Publication type
Journal Article
Publication details
Journal of Health Communication: International Perspectives 17 Suppl 2 pp /-/
Publication status
Published
Language
English
Keywords
health information, health workers, Malawi
Abstract
The information challenges facing health workers worldwide include lack of routine systems for seeking and sharing information, lack of high-quality and current health information, and lack of locally relevant materials and tools. This issue of Journal of Health Communication presents three studies of health information needs in India, Senegal, and Malawi that demonstrate these information challenges, provide additional insight, and describe innovative strategies to improve knowledge and information sharing. Results confirm that health workers' information needs differ on the basis of the level of the health system in which a health worker is located, regardless of country or cultural context. Data also reveal that communication channels tailored to health workers' needs and preferences are vital for improving information access and knowledge sharing. Meetings remain the way that most health workers communicate with each other, although technical working groups, professional associations, and networks also play strong roles in information and knowledge sharing. Study findings also confirm health workers' need for up-to-date, simple information in formats useful for policy development, program management, and service delivery. It is important to note that data demonstrate a persistent need for a variety of information types—from research syntheses, to job aids, to case studies—and suggest the need to invest in multifaceted knowledge management systems and approaches that take advantage of expanding technology, especially mobile phones; support existing professional and social networks; and are tailored to the varying needs of health professionals across health systems. These common lessons can be universally applied to expand health workers' access to reliable, practical, evidence-based information.
Country
Publisher
Journal of Health Communication: International Perspectives
Theme area
Equity in health
Title of publication Gender-Based Violence, Health and the Role of the Health Sector
Date of publication
2009
Publication type
Report
Publication details
World Bank / / pp /-/
Publication status
Published
Language
English
Keywords
violence, health sector, gender, global
Abstract
Gender-Based Violence (GBV) occurs as a cause and consequence of gender inequities. It includes a range of violent acts mainly committed by males against females, within the context of women and girls subordinate status in society, and often serves to retain this unequal balance (Human Rights Watch, 1996). GBV includes, but is not limited to: Domestic Violence (DV) by an intra family member and Intimate Partner Violence (IPV) including physical, sexual or psychological harm by a current or former partner or spouse; Sexual Violence (SV) including rape, sexual abuse, forced pregnancies and prostitution; Traditional harmful practices including female genital mutilation (FGM), honor killing and dowryrelated violence; and Human trafficking. This brief focuses on DV, IPV and SV against females in their reproductive years. It provides insight into the magnitude of the problem, the risk factors and the health effects, as well as the costs to society and impact on economic growth. This brief provides insight into the magnitude of gender-based violence, the risk factors and the health effects, as well as the costs to society and impact on economic growth. It outlines some recommendations for health sector interventions, which the World Bank believe would minimize the prevalence and impact on the individual and the society.
Country
Publisher
World Bank
Theme area
Values, policies and rights
Title of publication Violence against Women: The Health Sector Responds
Date of publication
2003
Publication type
Report
Publication details
Pan American Health Organization, World Health Organization / / pp /-/
Publication status
Published
Language
English
Keywords
violence, health sector, gender, global
Abstract
Gender-based violence (GBV) is one of the most widespread human rights abuses and public health problems in the world today, affecting as many as one out of every three women. It is also an extreme manifestation of gender inequity, targeting women and girls because of their subordinate social status in society. The consequences of GBV are often devastating and long term, affecting women’s and girls’ physical health and mental well-being. At the same time, its ripple effects compromise the social development of other children in the household, the family as a unit, the communities where the individuals live, and society as a whole. Violence against Women: The Health Sector Responds provides a strategy for addressing this complex problem and concrete approaches for carrying it out, not only for those on the front lines attending to the women who live with violence, but also for decision-makers who may incorporate the lessons in the development of policies and resources.
Country
Publisher
Pan American Health Organization, World Health Organization
Theme area
Human resources for health
Title of publication Already We See the Difference: Strengthening District Health Workforce Leadership and Management in Uganda
Date of publication
2012
Publication type
Journal Article
Publication details
CapacityPlus 11 / pp /-/
Publication status
Published
Language
English
Keywords
district, health workers, leadership, Uganda
Abstract
In Uganda, as in many other countries, critical shortages of health workers, low pay, and poor working conditions often contribute to low morale among health workers and inadequate access to quality health services for communities. This situation, in turn, can leave district health workforce managers feeling powerless and defeated. To address this issue, health teams from 19 Ugandan districts are taking the Human Resources for Health (HRH) Leadership and Management Course, which is being conducted by the USAID-funded Uganda Capacity Program. Participants in the Human Resources for Health Leadership and Management Course in Uganda share some perspectives on a program designed to help them address health workforce challenges at the district level.
Country
Publisher
CapacityPlus
Theme area
Human resources for health
Title of publication Boosting Laboratory Workers' Contribution to Providing Quality Patient Care in Low Income Countries
Date of publication
2012 February
Publication type
Report
Publication details
Royal Tropical Institute / / pp /-/
Publication status
Published
Language
English
Keywords
laboratory workers, patient care, global
Abstract
Medical laboratories -as support services for clinical decision taking- are an essential part of the health system. Since the release of the “World Health Report” in 2006, attention has been paid to the Human Resources for Health crisis in low and middle income countries. Although the aim was to include the entire health workforce, little attention has been provided to laboratory staff. This paper provides an overview of the issues related to the improvement of the functioning of the laboratory workforce, of the position of the laboratory worker in the health services and the implications of this position for optimal use of the laboratory services by clinicians in low income countries.
Country
Publisher
Royal Tropical Institute
Theme area
Human resources for health, Monitoring equity and research to policy
Title of publication Closing the Gap: From Evidence to Action
Date of publication
2012 May
Publication type
Report
Publication details
International Council of Nurses / / pp /-/
Publication status
Published
Language
English
Keywords
tool kit, interventions, evidence based, global
Abstract
The availability of information and the growth of science have led to significant improvements in health outcomes throughout the world. However differences in outcomes, health inequalities and poorly performing health services continue to present a real challenge to all nurses. Half of the world’s deaths could be prevented with simple cost effective interventions but as the World Health Organization (WHO 2004) acknowledges not enough is known about how to make these more widely available to the people who need them. Stronger emphasis needs to be placed not just on the discovery of new products, drugs and diagnostics but on how to put knowledge into use; on how to close the gap between evidence and action. This tool kit has been specifically designed to present an overview of the key aspects of a complex area of development need: how the gap between evidence and action may be closed to encourage nurses to use an evidence-based approach to their practice.
Country
Publisher
International Council of Nurses
Theme area
Equitable health services
Title of publication Can Volunteer Community Health Workers Decrease Child Morbitiy and Mortality in Southwestern Uganda? An Impact Evaluation
Date of publication
2011 December
Publication type
Journal Article
Publication details
Plos ONE 6 12 pp /-/
Publication status
Published
Language
English
Keywords
community health workers, child health, evaluation, Uganda
Abstract
The potential for community health workers to improve child health in sub-Saharan Africa is not well understood. Healthy Child Uganda implemented a volunteer community health worker child health promotion model in rural Uganda. An impact evaluation was conducted to assess volunteer community health workers' effect on child morbidity, mortality and to calculate volunteer retention. Two volunteer community health workers were selected, trained and promoted child health in each of 116 villages (population ~61,000) during 2006–2009. Evaluation included a household survey of mothers at baseline and post-intervention in intervention/control areas, retrospective reviews of community health worker birth/child death reports and post-intervention focus group discussions. Retention was calculated from administrative records. Main outcomes were prevalence of recent child illness/underweight status, community health worker reports of child deaths, focus group perception of effect, and community health worker retention. After 18–36 months, 86% of trained volunteers remained active. Post-intervention surveys in intervention households revealed absolute reductions of 10.2% [95%CI (−17.7%, −2.6%)] in diarrhoea prevalence and 5.8% [95%CI (−11.5%, −0.003%)] in fever/malaria; comparative decreases in control households were not statistically significant. Underweight prevalence was reduced by 5.1% [95%CI (−10.7%, 0.4%)] in intervention households. Community health worker monthly reports revealed a relative decline of 53% in child deaths (<5 years old), during the first 18 months of intervention. Focus groups credited community health workers with decreasing child deaths, improved care-seeking practices, and new income-generating opportunities. A low-cost child health promotion model using volunteer community health workers demonstrated decreased child morbidity, dramatic mortality trend declines and high volunteer retention. This sustainable model could be scaled-up to sub-Saharan African communities with limited resources and high child health needs.
Country
Publisher
Plos ONE
Theme area
Equitable health services, Equity and HIV/AIDS
Title of publication Evaluation of a Task-Shifting Strategy Involving Peer Educators in HIV Care and Treatment Clinics in Lusaka, Zambia
Date of publication
2012 January
Publication type
Journal Article
Publication details
The Journal of Public Health in Africa 3 1 pp /-/
Publication status
Published
Language
English
Keywords
peer educators, task shifting, HIV, evaluation Zambia
Abstract
Rapid expansion of antiretroviral therapy (ART) and a shortage of health care workers (HCWs) required the implementation of a peer educator (PE) model as part of a task-shifting strategy in Lusaka District clinics. The purpose of this study was to evaluate patient and staff perceptions regarding whether the PE program: a) relieved the workload on professional HCWs; and b) delivered services of acceptable quality. Qualitative and quantitative data were gathered from five primary care clinics delivering ART in Lusaka, Zambia. Closed surveys were conducted with 148 patients receiving ART, 29 PEs, and 53 HCWs. Data was imported into Microsoft Excel to calculate descriptive statistics. Six focus group discussions and eight key informant (KI) interviews were conducted, recorded, transcribed, and coded to extract relevant data. Survey results demonstrated that 50 of 53 (96.1%) HCWs agreed PEs reduced the amount of counseling duties required of HCWs. HCWs felt that PEs performed as well as HCWs in counseling patients (48 of 53; 90.6%) and that having PEs conduct counseling enabled clinical staff to see more patients (44 of 53; 83%). A majority of patients (141 of 148; 95.2%) agreed or strongly agreed that PEs were knowledgeable about ART, and 89 of 144 (61.8%) expressed a high level of confidence with PEs performing counseling and related tasks. Focus group and KI interviews supported these findings. PEs helped ease the work burden of HCWs and provided effective counseling, education talks, and adherence support to patients in HIV care. Consideration should be given to formalizing their role in the public health sector.
Country
Publisher
The Journal of Public Health in Africa
Theme area
Human resources for health
Title of publication Human Resources Information System for the Health Sector
Date of publication
2012
Publication type
Document
Publication details
IntraHealth International 2 / pp /-/
Publication status
Published
Language
English
Keywords
health workers, public health sector, Kenya
Abstract
Kenya’s health sector continues to face challenges in human resources for health (HRH), including an insufficient number of skilled workers and suboptimal distribution of these health workers. In an effort to reverse these trends and improve health service delivery, the Ministry of Medical Services (MOMS) and the Ministry of Public Health and Sanitation (MOPHS) have put in place strategies for addressing the constraints to human resource development and management. Addressing these challenges requires accurate and up- to-date information on the availability and capacity of Kenya’s human resources. A comprehensive human resources information system (HRIS) to support human resources management functions in the public health sector is being implemented by the Ministries of Health. The HRIS, supported by the USAID-funded Capacity Kenya project, is integrated with existing human resources (HR) and other health sector information systems. This brief outlines a comprehensive human resources information system to support management functions in the public health sector that is being implemented by the Ministries of Health in Kenya.
Country
Publisher
IntraHealth International
Theme area
Equitable health services, Human resources for health
Title of publication Performance of Community Health Workers Under Integrated Community Case Management of Childhood Illnesses in Eastern Uganda
Date of publication
2012 August
Publication type
Journal Article
Publication details
Malaria Journal 11 282 pp /-/
Publication status
Published
Language
English
Keywords
community health workers, childhood illness, Uganda
Abstract
Curative interventions delivered by community health workers (CHWs) were introduced to increase access to health services for children less than five years and have previously targeted single illnesses. However, CHWs in the integrated community case management of childhood illnesses strategy adopted in Uganda in 2010 will manage multiple illnesses. There is little documentation about the performance of CHWs in the management of multiple illnesses. This study compared the performance of CHWs managing malaria and pneumonia with performance of CHWs managing malaria alone in eastern Uganda and the factors influencing performance. A mixed methods study was conducted among 125 CHWs providing either dual malaria and pneumonia management or malaria management alone for children aged four to 59 months. Performance was assessed using knowledge tests, case scenarios of sick children, review of CHWs' registers, and observation of CHWs in the dual management arm assessing respiratory symptoms. Four focus group discussions with CHWs were also conducted. CHWs in the dual- and single-illness management arms had similar performance with respect to: overall knowledge of malaria (dual 72 %, single 70 %); eliciting malaria signs and symptoms (50 % in both groups); prescribing anti-malarials based on case scenarios (82 % dual, 80 % single); and correct prescription of anti-malarials from record reviews (dual 99 %, single 100 %). In the dual-illness arm, scores for malaria and pneumonia differed on overall knowledge (72 % vs 40 %, p < 0.001); and correct doses of medicines from records (100 % vs 96 %, p < 0.001). According to records, 82 % of the children with fast breathing had received an antibiotic. From observations 49 % of CHWs counted respiratory rates within five breaths of the physician (gold standard) and 75 % correctly classified the children. The factors perceived to influence CHWs' performance were: community support and confidence, continued training, availability of drugs and other necessary supplies, and cooperation from formal health workers. CHWs providing dual-illness management handled malaria cases as well as CHWs providing single-illness management, and also performed reasonably well in the management of pneumonia. With appropriate training that emphasizes pneumonia assessment, adequate supervision, and provision of drugs and necessary supplies, CHWs can provide integrated treatment for malaria and pneumonia.
Country
Publisher
Malaria Journal
Theme area
Equitable health services
Title of publication Strengthening Management and Leadership Practices to Increase Health-Service Delivery in Kenya: An Evidence-Based Approach
Date of publication
2012 August
Publication type
Journal Article
Publication details
Human Resources for Health 10 25 pp /-/
Publication status
Published
Language
English
Keywords
leadership, health service delivery, Kenya
Abstract
The purpose of the study was to test the hypothesis that strengthening health systems, through improved leadership and management skills of health teams, can contribute to an increase in health-service delivery outcomes. The study was conducted in six provinces in the Republic of Kenya. The study used a non-randomized design comparing measures of key service delivery indicators addressed by health teams receiving leadership and management training (the intervention) against measures in comparison areas not receiving the intervention. Measurements were taken at three time periods: baseline, endline, and approximately six months post intervention. At the district level, health-service coverage was computed. At the facility level, the percentage change in the number of client visits was computed. The t-test was used to test for significance. Results showed significant increases in health-service coverage at the district level (p = <0.05) in the intervention teams compared to the comparison teams. Similarly, there were significant increases in the number of client visits at the facility level in the intervention group versus comparison facilities (P < 0.05). Strengthening the leadership and management skills of health teams, through team-based approaches focused on selected challenges, contributed to improved health service delivery outcomes and these improvements were sustained at least for six months.
Country
Publisher
Human Resources for Health
Theme area
Equitable health services
Title of publication Systematic Review of the Effectiveness of Alternative Cadres in Community Based Rehabilitation
Date of publication
2012 August
Publication type
Journal Article
Publication details
Human Resources for Health 10 20 pp /-/
Publication status
Published
Language
English
Keywords
community health worker, rehabilitation, systematic review, global
Abstract
The Millennium Development Goals (MDGs) aim to improve population health and the quality and dignity of people's lives, but their achievement is constrained by the crisis in human resources for health. An important potential contribution towards achieving the MDGs for persons with disabilities will be the newly developed Guidelines for Community Based Rehabilitation (CBR), launched in 2010. Given the global shortage of medical and nursing personnel and highly skilled rehabilitation practitioners, effective implementation of the CBR guidelines will require additional health workers, with improved distribution and a new skill set, allowing them to work across the health, education, livelihoods, social, and development sectors. The authors conducted a systematic review to evaluate existing evidence regarding the effectiveness of alternative cadres working in CBR in low and middle income countries. The authors also searched the following databases: PUBMED, LILACS, SCIE, ISMEAR, WHOLIS, AFRICAN MED IND. We also searched the online archive of the Asia Pacific Disability Rehabilitation Journal (available from 2002 to 2010), which was not covered by any of the other databases. There was no limit set on inclusion with regard to how recent a publication was in the general search. The search yielded 235 abstracts, only 6 of which addressed CBR through some type of evaluative component. Three of the studies explored the effects of CBR interventions, mainly related to physical disabilities, while three explored issues concerned with the work performance of rehabilitation workers. Altogether the studies covered four different countries. All six studies related to specific service delivery in local contexts, using outcome measures that were not comparable across studies. The authors conclude that the current results do not provide adequate methodology or evidence for reliably generalizing their results. Due to the dearth of evidence regarding the effectiveness of alternative cadres in CBR, systematic research is needed on the training, performance and impacts of rehabilitation workers, including their capability of working across sectors and engaging with and making use of health systems research.
Country
Publisher
Human Resources for Health
Theme area
Poverty and health, Equitable health services
Title of publication Engagement of Non-Government Organizations and Community Care Workers in Collaborative TB/HIV Activities Including Prevention of Mother to Child Transmission in South Africa: Opportunities and Challenges
Date of publication
2012
Publication type
Journal Article
Publication details
BMC Health Services Research 12 233 pp /-/
Publication status
Published
Language
English
Keywords
participation, Community health workers, TB, HIV, South Africa
Abstract
The implementation of collaborative TB/HIV activities may help to mitigate the impact of the dual epidemic on patients and communities. Such implementation requires integrated interventions across facilities and levels of government, and with communities. Engaging Community Care Workers (CCWs) in the delivery of integrated TB/HIV services may enhance universal coverage and treatment outcomes, and address human resource needs in sub-Saharan Africa. Using pre-intervention research in Sisonke district, KwaZulu-Natal, South Africa as a case study, the authors report on three study objectives: (1) to determine the extent of the engagement of NGOs and CCWs in the implementation of collaborative TB/HIV including PMTCT; (2) to identify constraints related to provision of TB/HIV/PMTCT integrated care at community level; and (3) to explore ways of enhancing the engagement of CCWs to provide integrated TB/HIV/PMTCT services. Our mixed method study included facility and NGO audits, a household survey (n = 3867), 33 key informant interviews with provincial, district, facility, and NGO managers, and six CCW and patient focus group discussions. Most contracted NGOs were providing TB or HIV support and care with little support for PMTCT. Only 11 % of facilities’ TB and HIV patients needing care and support at the community level were receiving support from CCWs. Only 2 % of pregnant women reported being counseled by CCWs on infant feeding options and HIV testing. Most facilities (83 %) did not have any structural linkage with NGOs. Major constraints identified were system- related: structural, organizational and managerial constraints; inadequate CCW training and supervision; limited scope of CCW practice; inadequate funding; and inconsistency in supplies and equipment. Individual and community factors, such as lack of disclosure, stigma related to HIV, and cultural beliefs were also identified as constraints. The study concludes that NGO/CCW engagement in the implementation of collaborative TB/HIV/PMTCT activities is sub-optimal, despite its potential benefits. Effective interventions that address contextual and health systems challenges are required. These should combine systematic skills-building, an enhanced scope of practice and consistent CCW supervision with a reliable referral and monitoring and evaluation system.
Country
Publisher
BMC Health Services Research
Theme area
Human resources for health
Title of publication African Health Profession Regulatory Collaborative
Date of publication
2012
Publication type
Journal Article
Publication details
Human Resources for Health 10 26 pp /-/
Publication status
Published
Language
English
Keywords
health workers, regulation, Africa
Abstract
More than thirty-five sub-Saharan African countries have severe health workforce shortages. Many also struggle with a mismatch between the knowledge and competencies of health professionals and the needs of the populations they serve. Addressing these workforce challenges requires collaboration among health and education stakeholders and reform of health worker regulations. Health professional regulatory bodies, such as nursing and midwifery councils, have the mandate to reform regulations yet often do not have the resources or expertise to do so. In 2011, the United States of America Centers for Disease Control and Prevention began a four-year initiative to increase the collaboration among national stakeholders and help strengthen the capacity of health professional regulatory bodies to reform national regulatory frameworks. The initiative is called the African Health Regulatory Collaborative for Nurses and Midwives. This article describes the African Health Regulatory Collaborative for Nurses and Midwives, a four-year initiative to increase the collaboration among national stakeholders and help strengthen the capacity of health professional regulatory bodies to reform national regulatory frameworks, and discusses its importance in implementing and sustaining national, regional, and global workforce initiatives.
Country
Publisher
Human Resources for Health
Theme area
Governance and participation in health, Monitoring equity and research to policy
Title of publication Community-Based Monitoring Programs in the Health Sector: A Literature Review
Date of publication
2012
Publication type
Report
Publication details
Health Systems 20/20 / / pp /-/
Publication status
Published
Language
English
Keywords
community monitoring, literature review, international, Uganda
Abstract
This paper summarizes the literature on community-based monitoring programs in developing countries, with particular focus on the health sector. It presents prominent examples of community-based monitoring approaches, highlights common design features and parameters, discusses challenges faced by these programs, and outlines knowledge gaps and areas of future focus. In particular it focuses on two recent successful community-based health sector monitoring projects, in India and in Uganda, and suggests that they provide promising models for future programs.
Country
Publisher
Health Systems 20/20
Theme area
Equitable health services, Human resources for health
Title of publication Experiences of Action Learning Groups for Public Health Sector Mangers in Rural KwaZulu-Natal, South Africa
Date of publication
2012 August
Publication type
Journal Article
Publication details
Rural and Remote Health 12 2026 pp /-/
Publication status
Published
Language
English
Keywords
management, health services, implementation research, South Africa
Abstract
The World Health Organisation identifies strengthening leadership and management as an essential component in scaling up health services to reach the UN’s Millennium Development Goals. There is an identified need for informal, practically based management training programs, such as action learning, which allow trainees to reflect on their own work environment. Action learning, in essence, is learning by sharing real problems with others, as opposed to theoretical classroom learning. The objective of this study was to pilot an action learning group program with managers in a rural public health setting and to explore participants’ experience of the program. An eleven-month action learning group program was conducted for public health sector managers in a rural health district in northern KwaZulu-Natal. On conclusion of the action learning group program, a qualitative study using focus group discussions was conducted to explore participants’ experience of the action learning groups and their potential usefulness as a development opportunity. Respondents’ commitment to the project was evident from the high attendance at group meetings (average of 95%). On conclusion of the program, all participants had presented a work related problem to their respective groups and all participants had developed an action plan, and provided feedback on their action plan. Ten participants were still actively working on their action plans and seven participants had completed their action plans. The main themes that emerged from the qualitative data were understandings of action learning; elements that enabled the program; perceived benefits; and reported changes over the course of the program. The major benefits reported by participants were enhanced teamwork and collaboration, and providing participants with the skills to apply action learning principles to other challenges in their working lives. From the participants’ shared perspectives, although the findings cannot be generalised, this study showed that the use of action learning groups may help managers resolve problems in their institutions, develop managers’ skills of working within teams, and provide a vital form of support for managers. Action learning groups may well be a useful method for improving the skills of public health sector managers in rural health settings.
Country
Publisher
Rural and Remote Health
Theme area
Poverty and health, Human resources for health
Title of publication Labour Market for Human Resources for Health in Low- and Middle-Income Countries
Date of publication
2012
Publication type
Report
Publication details
Human Resources for Health Observer 11 / pp /-/
Publication status
Published
Language
English
Keywords
labour markets, health workers, Africa
Abstract
All low- and middle-income countries (LMIC) have health worker labour markets. Some of these countries’ markets function better than others and all can be improved. What does it mean when experts say there is a “shortage” of health workers? Is there more than one definition of a shortage and if so, how do we measure it? What is the difference between the need and demand for a health worker? What factors influence wages paid in the public and private health sectors, and how do we know if the wages are adequate to employ workers in rural areas? Why do some LMIC have “ghost workers” in health labour markets? The authors explore these and other questions using the basic tools of labour market analysis. This paper provides an introduction to the terms and tools of labour market analysis, connects these labour market principles to real-world case studies from low- and middle-income countries. The data needed to examine labour markets is also noted to allow human resource practitioners to begin their own empirical examination of health worker labour markets in LMIC.
Country
Publisher
Human Resources for Health Observer
Theme area
Human resources for health, Governance and participation in health
Title of publication Health Workforce Governance and Leadership Capacity in the African Region: Review Human Resources for Health Units in the Ministries of Health
Date of publication
2012
Publication type
Report
Publication details
Human Resources for Health Observer 9 / pp /-/
Publication status
Published
Language
English
Keywords
health workers, governance, leadership, Africa
Abstract
Human resources for health (HRH) are an integral part of the health system. Functioning health systems are the key to effective service delivery in any country regardless of its level of development, within which it is important to mobilize competent and motivated health workers to become key drivers for primary health care. The HRH element is thus recognized as one of the six building blocks of the health system. Despite the multiple sectors and stakeholders involved in building, deploying and maintaining a health workforce offering high performance, the HRH unit in the ministry of health is considered to be key to moving forward the HRH agenda. This report provides an overview of an intercountry review and analysis of the present capacity, current status and functionality of HRH departments or units responsible for HRH actions in the ministries of health at the national level in the African Region of the World Health Organization.
Country
Publisher
Human Resources for Health Observer
Theme area
Equity in health
Title of publication South African Health Review 2001
Date of publication
2002 March
Publication type
Report
Publication details
Health Systems Trust / / pp /-/
Publication status
Published
Language
English
Keywords
health review, governance, South Africa
Abstract
Among significant events that affected the health system during 2001 are the process of decentralisation of health services, greater attention to proper corporate governance especially with regard to financial reporting, and the increasingly profound impact of HIV/AIDS. Decentralisation of health care, the treasured policy goal of health services being managed by the sphere of government closest to the people, is, albeit slowly, becoming a reality to South Africans. The 2001 South African Health Review reflects on this process of transformation, including the necessary enabling legislation and funding of local government for health care delivery at this level. A series of chapters commissioned for this Review, based on qualitative research with managers working in the health system, provide insights to some of the day-to-day pleasures and frustrations in managing the South African health service. Many health sector developments during 2001 were overshadowed, at least in the media, by the contested nature of our response to HIV/AIDS. Understanding that HIV/AIDS is but one of the important priority programmes in a comprehensive health care system, the Review singles out financing of HIV/AIDS and implementation of the national HIV/AIDS and STD strategic plan for comment. Providing an informative and reliable review of progress in the health sector year-by-year is a demanding task. It would indeed be impossible without the assistance provided by numerous health workers who although overburdened by the day-to-day responsibilities of providing quality health care, still managed to pause and reflect on the important questions that the Review sought to answer.
Country
Publisher
Health Systems Trust
Theme area
Monitoring equity and research to policy
Title of publication Challenges of Sustainability of Health Information Systems in Developing Countries: Comparative Case Studies of Mozambique and Tanzania
Date of publication
2007 December
Publication type
Journal Article
Publication details
Journal of Health Informatics in Developing Countries 1 1 pp /-/
Publication status
Published
Language
English
Keywords
health information, Mozambique, Tanzania
Abstract
Given that IT projects may take a long time to be fully institutionalized, sufficient resources are required to build the local capacity to support and sustain the project after the withdrawal of donors. Inadequate donor support often contributes to weakening rather than strengthening human resource capacity and effective system design, since it emphasizes the technology itself at the expense of the needs of the users. These factors contribute to the design and implementation of unsustainable health information systems in developing countries.
Country
Publisher
Journal of Health Informatics in Developing Countries
Theme area
Equity in health
Title of publication South African Health Review 2002
Date of publication
2003 March
Publication type
Report
Publication details
Health Systems Trust / / pp /-/
Publication status
Published
Language
English
Keywords
health review, health financing, health care, South Africa
Abstract
The 2002 Review looks at issues related to transformation such as legislation and financing of health care, human resources, and support systems for health care delivery. Other key public health issues covered in the Review include HIV/AIDS, sexually transmitted infections, tuberculosis, malaria and nutrition. In addition the Review contains comprehensive information on key health and related indicators.
Country
Publisher
Health Systems Trust
Theme area
Equity in health
Title of publication South African Health Review 2003/04
Date of publication
2003
Publication type
Report
Publication details
Health Systems Trust / / pp /-/
Publication status
Published
Language
English
Keywords
health review, health policy, South Africa
Abstract
The promotion of equity in health is one of the basic ideologies underlying South African health policy. Therefore, it is befitting after ten years of democracy to gauge how far the health system has moved towards providing equitable health services to all citizens is concerned. This 2003/04 SAHR, the 9th edition, consists of an overview and 24 chapters, each describing a key health concern. Unlike many of the previous Reviews, this year's is data driven. It uses different sources of information to measure and assess the health and well-being of South Africans quantitatively. An overview of the key achievements and challenges is given in the chapter Ten years on have we got what we ordered?
Country
Publisher
Health Systems Trust
Theme area
Equity in health
Title of publication South African Health Review 2005
Date of publication
2005 August
Publication type
Report
Publication details
Health Systems Trust / / pp /-/
Publication status
Published
Language
English
Keywords
health review, South Africa
Abstract
This, the 10th edition of the South African Health Review, has the major theme of Human Resources for Health (HRH). South Africa has made significant progress in producing policies supportive of a good quality of health for all residents. However, there are challenges and gaps in translating these policies into action. Probably the most important of these challenges is the lack of adequate human resources.
Country
Publisher
Health Systems Trust
Theme area
Resource allocation and health financing
Title of publication Getting by on Credit: How District Health Managers in Ghana Cope with the Untimely Release of Funds
Date of publication
2006 August
Publication type
Journal Article
Publication details
BMC Health Services Research 6 105 pp /-/
Publication status
Published
Language
English
Keywords
health financing, Ghana
Abstract
District health systems in Africa depend largely on public funding. In many countries, not only are these funds insufficient, but they are also released in an untimely fashion, thereby creating serious cash flow problems for district health managers. This paper examines how the untimely release of public sector health funds in Ghana affects district health activities and the way district managers cope with the situation. A qualitative approach using semi-structured interviews was adopted. Two regions (Northern and Ashanti) covering the northern and southern sectors of Ghana were strategically selected. Sixteen managers (eight directors of health services and eight district health accountants) were interviewed between 2003/2004. Data generated were analysed for themes and patterns. The results showed that untimely release of funds disrupts the implementation of health activities and demoralises district health staff. However, based on their prior knowledge of when funds are likely to be released, district health managers adopt a range of informal mechanisms to cope with the situation. These include obtaining supplies on credit, borrowing cash internally, pre-purchasing materials, and conserving part of the fourth quarter donor-pooled funds for the first quarter of the next year. While these informal mechanisms have kept the district health system in Ghana running in the face of persistent delays in funding, some of them are open to abuse and could be a potential source of corruption in the health system. Official recognition of some of these informal managerial strategies will contribute to eliminating potential risks of corruption in the Ghanaian health system and also serve as an acknowledgement of the efforts being made by local managers to keep the district health system functioning in the face of budgetary constraints and funding delays. It may boost the confidence of the managers and even enhance service delivery.
Country
Publisher
BMC Health Services Research
Theme area
Equity in health
Title of publication South African Health Review 2006
Date of publication
2006 October
Publication type
Report
Publication details
Health Systems Trust / / pp /-/
Publication status
Published
Language
English
Keywords
health review, national health system, health policy, South Africa
Abstract
An important purpose of the South African Health Review (SAHR) is to serve as a knowledge resource on the development of the national health system, and to contribute to the assessment of the implementation of health policies. The Review seeks to reflect on achievements made and challenges and gaps that impact on the transformation and strengthening of the South African health system. In 1996, the SAHR posed the question: What has changed for the poor, rural woman or child who presents to the clinic? Ten years on, this 2006 Review attempts to answer that question in some depth with a specific focus on Maternal, Child and Women's Health.
Country
Publisher
Health Systems Trust
Theme area
Poverty and health
Title of publication Caring from Within: Key Findings and Policy Recommendations on Home-Based Care in Zimbabwe
Date of publication
2008
Publication type
Report
Publication details
Health & Development Networks; Southern Africa HIV and AIDS Information Dissemination Service / / pp /-/
Publication status
Published
Language
English
Keywords
health policy, home based care, Zimbabwe
Abstract
In Zimbabwe, as in many parts of sub-Saharan Africa, home-based care (HBC) plays a vital role in the response to HIV as overwhelmed public health and welfare systems fail to cope with the demands of the epidemic. HBC organizations have evolved and grown relatively organically throughout Zimbabwe in response to the epidemic, supporting and directing the activities of caregivers as the epidemic has dictated. To understand more about the development of HBC in Zimbabwe and its future potential, Irish Aid engaged Health & Development Networks (HDN) and the Southern Africa HIV and AIDS Information Dissemination Service (SAfAIDS) to assess and document lessons from HBC interventions. This document details a project designed to contribute to better understanding and evidence-based decision-making in the implementation of HBC interventions in Zimbabwe and beyond.
Country
Publisher
Health & Development Networks; Southern Africa HIV and AIDS Information Dissemination Service
Theme area
Equity in health
Title of publication South African Health Review 2011
Date of publication
2011 December
Publication type
Report
Publication details
Health Systems Trust / / pp /-/
Publication status
Published
Language
English
Keywords
health review, primary health care, South Africa
Abstract
The SAHR 2011 provides valuable policy and empirical information on a range of issues that are related to and impact on the Negotiated Service Delivery Agreement and primary health care re-engineering as envisaged by the National Department of Health (NDoH). A range of experts provide commentary on topics ranging from rural health, health technology to human resources. SAHR 2011 also contains a section on core health issues, where developments in health information systems, financing health care, and health legislation and policy are discussed. The Review concludes with the Indicators chapter which presents a selection of the best available data on the functioning and performance of the health system.
Country
Publisher
Health Systems Trust
Theme area
Human resources for health, Monitoring equity and research to policy
Title of publication Measuring Inequalities in the Distribution of Health Workers: the Case of Tanzania
Date of publication
2009 January
Publication type
Journal Article
Publication details
Human Resources for Health 7 4 pp /-/
Publication status
Published
Language
English
Keywords
health workers, distribution, Tanzania
Abstract
The overall human resource shortages and the distributional inequalities in the health workforce in many developing countries are well acknowledged. However, little has been done to measure the degree of inequality systematically. Moreover, few attempts have been made to analyse the implications of using alternative measures of health care needs in the measurement of health workforce distributional inequalities. Most studies have implicitly relied on population levels as the only criterion for measuring health care needs. This paper attempts to achieve two objectives. First, it describes and measures health worker distributional inequalities in Tanzania on a per capita basis; second, it suggests and applies additional health care needs indicators in the measurement of distributional inequalities. There are significant inequalities in the distribution of health workers per capita. Overall, the population quintile with the fewest health workers per capita accounts for only 8% of all health workers, while the quintile with the most health workers accounts for 46%. Inequality is perceptible across both urban and rural districts. Skill mix inequalities are also large. Districts with a small share of the health workforce (relative to their population levels have an even smaller share of highly trained medical personnel. A small share of highly trained personnel is compensated by a larger share of clinical officers (a middle-level cadre) but not by a larger share of untrained health workers. Clinical officers are relatively equally distributed. Distributional inequalities tend to be more pronounced when under-five deaths are used as an indicator of health care needs. Conversely, if health care needs are measured by HIV prevalence, the distributional inequalities appear to decline. The measure of inequality in the distribution of the health workforce may depend strongly on the underlying measure of health care needs. In cases of a non-uniform distribution of health care needs across geographical areas, other measures of health care needs than population levels may have to be developed in order to ensure a more meaningful measurement of distributional inequalities of the health workforce.
Country
Publisher
Human Resources for Health
Theme area
Equity in health
Title of publication South African Health Review 2010
Date of publication
2010 December
Publication type
Report
Publication details
Health Systems Trust / / pp /-/
Publication status
Published
Language
English
Keywords
health review, Millennium Development Goals, Health Insurance, South Africa
Abstract
The 2010 edition of the SAHR focuses on two main issues: Reflections on the Millennium Development Goals (MDGs) and the Perspectives on a National Health Insurance (NHI) for South Africa. As is customary, the Review ends with the Indicators section which provides a range of indicators relevant to the MDGs and NHI. In the section on the MDGs, a series of overview chapters on selected MDGs are presented. These overview chapters are accompanied by companion chapters or profiles which illustrate examples of successful methods or case studies in achieving the MDGs. The profiles also highlight problems and issues in relation to either achieving the MDG or measuring the related indicators.
Country
Publisher
Health Systems Trust
Theme area
Equitable health services
Title of publication Health Sector in Malawi
Date of publication
2008
Publication type
Report
Publication details
Public Service International HIV/AIDS Southern Africa Project / / pp /-/
Publication status
Published
Language
English
Keywords
essential health benefit, health sector, Malawi
Abstract
The Essential Health Package (EHP) is the primary health strategy for the Ministry of Health. It aims to address the major causes of morbidity and mortality among the general population focusing particularly on medical conditions and service gaps that disproportionately affect the rural poor. Its objectives are to improve technical services and allocate efficiency in the delivery of health care; to ensure universal coverage of health services and to provide cost-effective interventions that can control the main causes of disease burden in Malawi. This report summarizes elements of the primary health strategy and the health sector goals established by the Malawi Ministry of Health.
Country
Publisher
Public Service International HIV/AIDS Southern Africa Project
Theme area
Equity in health
Title of publication South African Health Review 2008
Date of publication
2008
Publication type
Report
Publication details
Health Systems Trust / / pp /-/
Publication status
Published
Language
English
Keywords
health review, primary health care, South Africa
Abstract
The theme of this 13th edition of the Review, launched in December 2008, is Primary Health Care in South Africa: A review of 30 years since Alma Ata. The SAHR 2008 chapters focus on critical issues in Primary Health Care. The Review includes a national and international perspective of Primary Health Care, and focuses on areas such as policy and legislation, determinants of health, lifestyle, infectious diseases, mental health, maternal and child health, nutrition and environmental health. The SAHR reviews issues around human resources, finance, and information. It also looks at research on health systems, the role of the private and non-governmental organisations in Primary Health Care, and ends with the relevant health and related indicators chapter.
Country
Publisher
Health Systems Trust
Theme area
Governance and participation in health
Title of publication Hearing Community Voices: Grassroots Perceptions of an Intervention to Support Health Volunteers in South Africa
Date of publication
2008 October
Publication type
Journal Article
Publication details
Journal of Social Aspects of HIV/AIDS 5 4 pp 162-177
Publication status
Published
Language
English
Keywords
community health workers, volunteers, South Africa
Abstract
With the scarcity of African health professionals, volunteers are earmarked for an increased role in HIV/AIDS management, with a growing number of projects relying on grassroots community members to provide home nursing care to those with AIDS – as part of the wider task shifting agenda. Yet little is known about how best to facilitate such involvement. This paper reports on community perceptions of a three -year project which sought to train and support volunteer health workers in a rural community in South Africa. Given the growing emphasis on involving community voices in project research, the authors conducted 17 discussions with 34 community members, including those involved and uninvolved in project activities – at the end of this three year period. These discussions aimed to elicit local peoples’ perceptions of the project, its strengths and its weaknesses. Community members perceived the project to have made various forms of positive progress in empowering volunteers to run a more effective home nursing service. However, discussions suggested that it was unlikely that these efforts would be sustainable in the long-term, due to lack of support for volunteers both within and outside of the community. The authors conclude that those seeking to increase the role and capacity of community volunteers in AIDS care need to make substantial efforts to ensure that appropriate support structures are in place. Chief amongst these are: sustainable stipends for volunteers; commitment from community leaders and volunteer team leaders to democratic ideals of project management; and substantial support from external agencies in the health, welfare and NGO sectors.
Country
Publisher
Journal of Social Aspects of HIV/AIDS
Theme area
Equity in health
Title of publication South African Health Review 2000
Date of publication
2000 December
Publication type
Report
Publication details
Health Systems Trust / / pp /-/
Publication status
Published
Language
English
Keywords
health review, South Africa
Abstract
The year 2000 was a significant one in terms of developments affecting the health sector. Local Government elections in December heralded the beginning of the final stage of the transformation of Local Government, paving the way for the full implementation of the District Health System. The National Health Accounts were undertaken, providing an overview of financing and expenditure in both private and public sector care. And, as can be evidenced by the frequent references to HIV/AIDS in many chapters of this Review, the impact of the epidemic began to be felt in almost every aspect of the health system. This first South African Health Review of the millenium aims to provide a combination of detailed information on health status and health care coupled with in-depth analysis of policies and practices affecting the provision of health services in South Africa. Recent Reviews have been characterised by a particular focus on policy implementation and this is maintained, as is an emphasis on equity, especially in regards to financing and expenditure. In 1997, again in 1998, and most recently in 2000, the Health Systems Trust commissioned a survey of primary health care facilities. The survey forms part of an ongoing monitoring of progress in implementing Primary Health Care. Key findings from the Survey are provided in the Review, and they provide a unique insight to quality of care in public sector clinics in South Africa. The HIV/AIDS epidemic does not only affect those with living with HIV, their families and carers, it also places a huge burden on staff in clinics and hospitals who are providing care, often in less than ideal circumstances, and on health service planners and managers faced with competing demands for resources. The successes identified in this Review are testament to the commitment, dedication and hard work of health service staff.
Country
Publisher
Health Systems Trust
Theme area
Human resources for health
Title of publication Scaling Up, Saving Lives
Date of publication
2008
Publication type
Report
Publication details
Global Health Workforce Alliance / / pp /-/
Publication status
Published
Language
English
Keywords
health workers, training, global
Abstract
Health workers are the cornerstone and drivers of health systems. And yet the world is facing a serious shortage of health workers – a shortage that is identified as one of the most critical constraints to the achievement of health and development goals. This report – Scaling Up, Saving Lives – calls for a rapid and significant scaling up of the education and training of health workers as part of a broader effort to strengthen health systems. It highlights the importance of training to meet a country’s own health needs and the great opportunity represented by the increased use of community and mid-level workers.
Country
Publisher
Global Health Workforce Alliance
Theme area
Equity in health
Title of publication South African Health Review 1998
Date of publication
1998 December
Publication type
Report
Publication details
Health Systems Trust / / pp /-/
Publication status
Published
Language
English
Keywords
health review, South Africa
Abstract
The 1998 Review concentrates on equity and attempts to highlight progress that has been made as well as identify blocks to providing equitable public sector services throughout South Africa. Research commissioned specifically for the Review sheds light on the health status of South Africa's population and key areas of the health system including finance and expenditure, human resources, information systems, pharmacy, and service delivery in clinics and district hospitals. This provides a comprehensive, authoritative and independent review of South Africa's health system.
Country
Publisher
Health Systems Trust
Theme area
Equity in health, Human resources for health
Title of publication Ghana: Implementing a national human resources for health plan
Date of publication
2008
Publication type
Report
Publication details
Global Health Workforce Alliance / / pp /-/
Publication status
Published
Language
English
Keywords
health workers, health services, Ghana
Abstract
Ghana has recognised the need to address its serious health workforce shortage, and consequent issues with health service delivery. A new human resources strategic plan has been developed to guide scale-up from 2007 to 2011. This fits into the broader health sector plan, which prioritises general health system development, promotion of healthy lifestyles and environment, improving healthy reproduction and nutrition services and governance and financing . It is also consistent with the President’s vision to bring the country to middle- income status by 2015 – a goal that requires a healthy population. A review of the 2004 programme of work in the health sector found that failure to achieve improved health outcomes was often tied to issues of poor morale and distribution of the health workforce. After an in-country health workforce forum in 2005, the Ministry of Health carried out a needs assessment, which underpins the current plan.
Country
Publisher
Global Health Workforce Alliance
Theme area
Equity in health
Title of publication South African Health Review 1996
Date of publication
1996 October
Publication type
Report
Publication details
Health Systems Trust / / pp /-/
Publication status
Published
Language
English
Keywords
health review, South Africa
Abstract
The South African Health Review 1996 documents the degree to which structural reform and policy formulation within the health sector has translated into real improvements in service delivery and the quality of peoples lives. In summary, the Review reveals a mixed scorecard. Progress has been excellent in some areas, whereas others show little movement. This, the Review argues, is the nature of health reform.
Country
Publisher
Health Systems Trust
Theme area
Human resources for health
Title of publication Malawi’s Emergency Human Resources Programme
Date of publication
2008
Publication type
Report
Publication details
Global Health Workforce Alliance / / pp /-/
Publication status
Published
Language
English
Keywords
emergency, health workers, health sector, Malawi
Abstract
Human resource shortages in Malawi’s health sector are among the severest in sub- Saharan Africa, even though political commitment to address the crisis has been strong since the late 1990s. Limited financial support of the country’s 1999-2004 human resource development plan prompted the Ministry of Health to focus specifically on pre-service education with an emergency training plan beginning in 2002.
Country
Publisher
Global Health Workforce Alliance
Theme area
Human resources for health
Title of publication Ethiopia's Human Resources for Health Programme
Date of publication
2008
Publication type
Report
Publication details
Global Health Workforce Alliance / / pp /-/
Publication status
Published
Language
English
Keywords
health workers, Ethiopia
Abstract
Ethiopia suffers from an acute shortage of health workers at every level, and rural areas, in which 85% of the population live, have been particularly chronically under-served. In working out the best approach to tackle health workforce issues, the Ministry of Health calculated that 60-80% of the country’s annual mortality rate is due to preventable communicable diseases such as malaria, pneumonia and TB. HIV and AIDS are also growing concerns. They therefore chose to begin by focussing on community level provision, initiating the Health Extension Programme in 2004. This is outlined in the current Health Sector Development Plan (2005-10), which focuses on both human resource development and the construction and rehabilitation of facilities.
Country
Publisher
Global Health Workforce Alliance
Theme area
Human resources for health
Title of publication Inequities in the Global Health Workforce: the Greatest Impediment to Health in Sub-Saharan Africa
Date of publication
2007 June
Publication type
Journal Article
Publication details
International Journal of Environmental Research and Public Health 4 2 pp 93-100
Publication status
Published
Language
English
Keywords
health workers, distribution, global, Africa
Abstract
Health systems played a key role in the dramatic rise in global life expectancy that occurred during the 20th century, and have continued to contribute enormously to the improvement of the health of most of the world’s population. The health workforce is the backbone of each health system, the lubricant that facilitates the smooth implementation of health action for sustainable socio-economic development. It has been proved beyond reasonable doubt that the density of the health workforce is directly correlated with positive health outcomes. In other words, health workers save lives and improve health. About 59 million people make up the health workforce of paid full-time health workers world-wide. However, enormous gaps remain between the potential of health systems and their actual performance, and there are far too many inequities in the distribution of health workers between countries and within countries. The Americas (mainly USA and Canada) are home to 14% of the world’s population, bear only 10% of the world’s disease burden, have 37% of the global health workforce and spend about 50% of the world’s financial resources for health. Conversely, sub-Saharan Africa, with about 11% of the world’s population bears over 24% of the global disease burden, is home to only 3% of the global health workforce, and spends less than 1% of the world’s financial resources on health. This article discusses the gaps exist between the potential of health systems and their actual performance. Best practices from various countries are discussed. The author concludes that the crisis can be tackled if there is global responsibility, political will, financial commitment and public-private partnership for country-led and country-specific interventions that seek solutions beyond the health sector.
Country
Publisher
International Journal of Environmental Research and Public Health
Theme area
Equity in health
Title of publication African Regional Health Report: the Health of the People
Date of publication
2007
Publication type
Report
Publication details
World Health Organization / / pp /-/
Publication status
Published
Language
English
Keywords
region; health indicators; health services; public health; Africa
Abstract
This report provides an overview of the public health situation across the 46 Member States of the African Region of the World Health Organization. The report charts progress made to date in fighting disease and promoting health in the African Region. It reviews the success stories and looks at areas where more efforts are needed to improve people’s health. It also includes a discussion of the human resources for health crisis and approaches to filling the gap as well as health information systems.
Country
Publisher
World Health Organization
Theme area
Governance and participation in health
Title of publication The Copernican shift in global health
Date of publication
2008
Publication type
Report
Publication details
Global Health Programme Working Paper No 3 / / pp /-/
Publication status
Published
Language
English
Keywords
governance, health diplomacy, global health, global
Abstract
The author argues in this paper that the current economy and trade- centred world is shifting towards a more health-centred world. He draws parallels with the radical mind shift provoked by Nicolaus Copernicus in putting the sun at centre stage, which had unforeseen impact in areas unconnected to astronomy. Despite the fact that economy and trade remain central to foreign policy, the social cluster has gained growing influence and importance. The 13th International AIDS Conference, held in Durban in 2000, laid the foundations for incorporating health into foreign policy. As a result, the link between human rights and access to medicines was established. This had an impact on trade negotiations. The Ministerial Declaration on the TRIPS Agreement and Public Health (the Doha Declaration) states that nothing in the TRIPS Agreement should prevent members of the World Trade Organization from taking measures to protect public health. The author analyses this Copernican shift in the diplomatic arena from trade to health, and highlights the important role played by Brazil in these developments, which resulted in the Millennium Declaration, the Doha Declaration and the Oslo Declaration giving health precedence over trade.
Country
Publisher
The Graduate Institute
Theme area
Governance and participation in health
Title of publication Rethinking the 'global' in global health: a dialectic approach
Date of publication
2010 October
Publication type
Journal Article
Publication details
Globalization and Health 6 19 pp 1-19
Publication status
Published
Language
English
Keywords
governance, health diplomacy, global health, global
Abstract
Current definitions of 'global health' lack specificity about the term 'global'. This debate presents and discusses existing definitions of 'global health' and a common problem inherent therein. It aims to provide a way forward towards an understanding of 'global health' while avoiding redundancy. The attention is concentrated on the dialectics of different concepts of 'global' in their application to malnutrition; HIV, tuberculosis & malaria; and maternal mortality. Further attention is payed to normative objectives attached to 'global health' definitions and to paradoxes involved in attempts to define the field. The manuscript identifies denotations of 'global' as 'worldwide', as 'transcending national boundaries' and as 'holistic'. A fourth concept of 'global' as 'supraterritorial' is presented and defined as 'links between the social determinants of health anywhere in the world'. The rhetorical power of the denotations impacts considerably on the object of 'global health', exemplified in the context of malnutrition; HIV, tuberculosis & malaria; and maternal mortality. The 'global' as 'worldwide', as 'transcending national boundaries' and as 'holistic' house contradictions which can be overcome by the fourth concept of 'global' as 'supraterritorial'. The 'global-local-relationship' inherent in the proposed concept coheres with influential anthropological and sociological views despite the use of different terminology. At the same time, it may be assembled with other views on 'global' or amend apparently conflicting ones. The author argues for detaching normative objectives from 'global health' definitions to avoid so called 'entanglement-problems'. Instead, it is argued that the proposed concept constitutes an un-euphemistical approach to describe the inherently politicised field of 'global health'. While global-as-worldwide and global-as-transcending-national-boundaries are misleading and produce redundancy with public and international health, global-as-supraterritorial provides 'new' objects for research, education and practice while avoiding redundancy. Linked with 'health' as a human right, this concept preserves the rhetorical power of the term 'global health' for more innovative forms of study, research and practice. The dialectic approach reveals that the contradictions involved in the different notions of the term 'global' are only of apparent nature and not exclusive, but have to be seen as complementary to each other if expected to be useful in the final step.
Country
Publisher
Globalization and Health
Theme area
Governance and participation in health
Title of publication Foreign policy and global public health: working together towards common goals
Date of publication
2008 July
Publication type
Journal Article
Publication details
Bulletin of the World Health Organization 86 7 pp 497-576
Publication status
Published
Language
English
Keywords
governance, health diplomacy, global health, global
Abstract
Pandemics, emerging diseases and bioterrorism are readily understood as direct threats to national and global security. But health issues are also important in other core functions of foreign policy, such as pursuing economic growth, fostering development, and supporting human rights and human dignity. Health is today a growing concern in foreign policy.
Country
Publisher
Bulletin of the World Health Organization
Theme area
Governance and participation in health
Title of publication Health and foreign policy: A conceptual overview
Date of publication
2006 September
Publication type
Journal Article
Publication details
Bulletin of the World Health Organization 84 9 pp 685-764
Publication status
Published
Language
English
Keywords
governance, health diplomacy, global health, global
Abstract
In the past decade, health issues have become more prominent in foreign policies of countries.1–6 Health challenges now feature in national security strategies, appear regularly on the agenda of meetings of leading economic powers, affect the bilateral and regional political relationships between developed and developing countries, and influence strategies for United Nations reform. Although health has long been a foreign policy concern, such prominence is historically unprecedented.
Country
Publisher
Bulletin of the World Health Organization
Theme area
Governance and participation in health
Title of publication Global health and foreign policy-strategic opportunities and challenges: Background paper for the Secretary-General's report on global health and foreign policy
Date of publication
2009 May
Publication type
Report
Publication details
World Health Organisation / / pp /-/
Publication status
Published
Language
English
Keywords
governance, health diplomacy, global health, global
Abstract
This Background Paper analyzes the rise of global health issues in foreign policy, examines key challenges facing global health as a foreign policy objective, describes initiatives and activities that attempt to improve how foreign policy processes incorporate and advance global health concerns, and provides examples of possible recommendations for strengthening global health as a strategic foreign policy interest of UN Member States.
Country
Publisher
World Health Organisation
Theme area
Governance and participation in health
Title of publication Health and foreign policy: A conceptual overview
Date of publication
2005
Publication type
Report
Publication details
Nuffield Trust / / pp /-/
Publication status
Published
Language
English
Keywords
governance, health diplomacy, global health, global
Abstract
This paper provides a concise analysis of the interaction between health and foreign policy, which is one of the key themes of the Nuffield Trust's work on globalisation. The paper's insight into the dynamics of US policy provides an important point of reference for UK policy and for those with an interest in health as a global policy challenge. This paper was first delivered by Professor Fidler at a conference on “Health in Foreign Policy Forum” sponsored by Academy Health, February 4, 2005, in Washington, DC.
Country
Publisher
Nuffield Trust
Theme area
Governance and participation in health
Title of publication Global Health Diplomacy: Understanding how and why health is integrated into foreign policy
Date of publication
2012
Publication type
Academic paper
Publication details
/ / / pp /-/
Publication status
Published
Language
English
Keywords
governance, health diplomacy, global health, global
Abstract
This study explores the global health diplomacy phenomenon by focusing on how and why health is integrated into foreign policy. Over the last decade or so, precipitated primarily by a growing concern about the need to strengthen global health security and deliver on the Millennium Development Goals, foreign policymakers have been paying more attention to health as a foreign policy concern and several countries have adopted formal global health policy positions and/or strategies. To elucidate a deeper and clearer understanding of how and why health is integrated into foreign policy, this thesis used a case study research design that incorporated literature and document review and interviews with twenty informants to conduct an in-depth analysis of the United Kingdom’s (UK) Health is Global: A UK Government Strategy 2008-13. Health is Global represents the first example of a formal national global health strategy developed using a multi-stakeholder process. Briefer background case reviews of three nations that are leaders in global health diplomacy - Brazil, Norway and Switzerland, were also conducted to inform the analysis of the in-depth case. Policy analysis included categorizing data into five areas: context (why?), content (what?), actors (who?), process (how?) and impact (so what?). The Multiple Streams Model of Policymaking and Fidler’s health and foreign policy conceptualizations - revolution, remediation and regression - were used to analyze the findings.
Country
Publisher
/
Theme area
Governance and participation in health
Title of publication Strengthening global health diplomacy in Canada's foreign policy architecture: literature review and key informant interviews
Date of publication
2011 August
Publication type
Journal Article
Publication details
Canadian Foreign Policy Journal 16 3 pp 17-41
Publication status
Published
Language
English
Keywords
governance, health diplomacy, global health, Canada
Abstract
Health has increasingly been called a national strategic interest and global political priority. Its absence in one part of the world is often said to affect the peace, security and prosperity of people everywhere. Global health diplomacy aims to respond to this challenge by integrating leadership across the health and foreign policy spheres. Based on a literature review and 12 in- depth interviews with senior government officials, this paper (1) canvasses comparative advantages for Canada to invest in global health diplomacy, (2) assesses the country's existing architecture that supports these activities, and (3) proposes tangible strategies for strengthening them in the future. Canada is found to enjoy numerous comparative advantages in the health field, such as its stellar international reputation, technical expertise, and disproportionate membership in leading multilateral forums. While Canada already demonstrates considerable strength in global health diplomacy, the interviewed officials emphasized the need to strengthen certain elements of its architecture, including leadership, coordination, and the political interface for global health. To do this, Canada can (1) prioritize health in its foreign policy, (2) promote collaboration across government departments, and (3) engage key partners and stakeholders. The development of a government-wide global health strategy could be a relatively quick win and would help achieve considerable progress.
Country
Publisher
Canadian Foreign Policy Journal
Theme area
Governance and participation in health
Title of publication Global health diplomacy: How foreign policy can influence health
Date of publication
2011 April
Publication type
Journal Article
Publication details
BMJ 342 3154 pp 1-3
Publication status
Published
Language
English
Keywords
governance, health diplomacy, global health, Canada
Abstract
The author argues that public health experts need to work with diplomats in order to achieve global health goals In a speech on the US global health initiative, Secretary of State Hillary Clinton recently asked, “What exactly does maternal health, or immunisations, or the fight against HIV and AIDS have to do with foreign policy?” Her answer was “everything.” The question that arises from this statement is, does foreign policy serve health or does health serve foreign policy? There are four ways in which foreign policy and health can interact. Foreign policy can endanger health when diplomacy breaks down or when trade considerations trump health; health can be used as an instrument of foreign policy in order to achieve other goals; health can be an integral part of foreign policy; and foreign policy can be used to promote health goals. These approaches cannot always be sharply differentiated and are better visualised as a continuum.
Country
Publisher
BMJ
Theme area
Governance and participation in health
Title of publication Global health diplomacy: The need for new perspectives, strategic approaches and skills in global health
Date of publication
2007 March
Publication type
Journal Article
Publication details
Bulletin of the World Health Organization 85 3 pp 230-232
Publication status
Published
Language
English
Keywords
governance, health diplomacy, global health, Canada
Abstract
“In the past” — said Robert Cooper, one of Europe’s pre-eminent diplomats — “it was enough for a nation to look after itself. Today it is no longer sufficient.” This is particularly true in the health arena. There is an increasing range of health issues that transcend national boundaries and require action on the global forces that determine the health of people. The broad political, social and economic implications of health issues have brought more diplomats into the health arena and more public health experts into the world of diplomacy. Simple classifications of policy and politics — domestic and foreign, hard and soft, or high and low — no longer apply. Diplomacy is frequently referred to as the art and practice of conducting negotiations. It is usually still understood to mean the conduct of international relations through the intervention of professional diplomats from ministries of foreign affairs with regard to issues of “hard power”, initially war and peace, and — as countries compete economically — economics and trade. But in recent years there has also been an increase in the number of international agreements on “soft issues”, such as the environment and health; it is now recognized that some of these issues have significant “hard” ramifications on national economies. The term “global health diplomacy” aims to capture these multi-level and multi-actor negotiation processes that shape and manage the global policy environment for health.
Country
Publisher
Bulletin of the World Health Organization
Theme area
Governance and participation in health
Title of publication What is 'global health diplomacy'? A conceptual review
Date of publication
2011 August
Publication type
Journal Article
Publication details
Global Health Governance 1 / pp 1-12
Publication status
Published
Language
English
Keywords
governance, health diplomacy, global health, Canada
Abstract
While global health diplomacy (GHD) has attracted growing attention, accompanied by hopes of its potential to progress global health and/or foreign policy goals, the concept remains imprecise. This paper finds the term has largely been used normatively to describe its expected purpose rather than distinct features. This paper distinguishes between traditional and “new diplomacy”, with the latter defined by its global context, diverse actors and innovative processes. A more concise definition of GHD supports the development of a research agenda for strengthening the evidence base in this rapidly evolving area.
Country
Publisher
Global Health Governance
Theme area
Governance and participation in health
Title of publication Why we need a commission on global governance for health
Date of publication
2011 December
Publication type
Journal Article
Publication details
The Lancet / / pp /-/
Publication status
Published
Language
English
Keywords
governance, health diplomacy, global health, Canada
Abstract
Five years ago, the foreign ministers of Brazil, France, Indonesia, Norway, Thailand, Senegal and South Africa, launched the Global Health and Foreign Policy Initiative in recognition of the central importance of health and its connection to multiple global governance processes in which we were engaged. In many ways, protecting and enhancing the health of its population is one of the most important goals and duties of any state. With globalization and increased interdependency among countries, health issues have become even more central to states’ interests. This is a statement by those ministers on why a Commission on Global Governance for Health is necessary.
Country
Publisher
The Lancet
Theme area
Governance and participation in health
Title of publication Can foreign policy make a difference to health?
Date of publication
2010 May
Publication type
Journal Article
Publication details
PLoS Medicine 7 5 pp 1-3
Publication status
Published
Language
English
Keywords
governance, health diplomacy, global health, Canada
Abstract
In 2006 seven foreign ministers from Brazil, France, Indonesia, Norway, Senegal, South Africa, and Thailand initiated a dialogue on the inter-linkages between health and foreign policy, with a focus on how health matters to foreign policy and whether foreign policy can make a difference to health. What brought the ministers together was the realization that the state of global health has a profound impact on all nations and is deeply interconnected with trade and environment, economic growth, social development, national security, human rights, and dignity. These are challenges that go beyond the scope of ministries of health, and represent areas for which WHO (as the UN specialized agency for health) must have broader political support from member countries. Based on the ministers' analysis, the Oslo Ministerial Declaration in 2007 stated a commitment to “make impact on health a defining lens that each of the countries would use to examine key elements of foreign policy and development strategies”. The ministers also decided to engage in a dialogue on how to deal with policy options from this perspective.
Country
Publisher
PLoS Medicine
Theme area
Values, policies and rights, Health equity in economic and trade policies
Title of publication A WHO/UNICEF Global Code of Practice on the Marketing of Unhealthy Food and Beverages to Children
Date of publication
2012 June
Publication type
Journal Article
Publication details
Global Health Governance / / pp /-/
Publication status
Published
Language
English
Keywords
food marketting, children, global code, WHO, global
Abstract
The authors call for the prompt adoption of a WHO/UNICEF Global Code of Practice on the Marketing of Unhealthy Foods and Beverages to Children. Such a non-binding international legal instrument has significant advantages over an treaty approach at the present time. It would provide a much-needed step towards advancing meaningful engagement with and holding to account all relevant actors, including national governments, private industry, and UN agencies, in protecting children everywhere from harm. The WHO Framework Convention on Tobacco Control (“FCTC”) addresses one of the major risk factors contributing to NCDs by establishing a global legal framework to counter the tobacco pandemic; the global community should now act collectively to establish a legal architecture to regulate a central component of these two other major risk factors.
Country
Publisher
Global Health Governance
Theme area
Health equity in economic and trade policies
Title of publication An analysis of complaints with selected sanitary and phytosanitary measures in Eastern and Southern Africa
Date of publication
2012
Publication type
Report
Publication details
Forum for Agricultural Research in Africa / / pp /-/
Publication status
Published
Language
English
Keywords
WTO, trade, sanitary, phytosanitary, Malawi, Tanzania
Abstract
Trade is a driver of development; therefore, in countries like Malawi and Tanzania, where agriculture is a mainstay of the economy, agricultural exports need to increase significantly. The Comprehensive Africa Agriculture Development Program (CAADP) envisages intensified, market oriented agriculture, but acknowledges that meeting market standards “remains a challenge for all African countries”. There are risks associated with trade, so the World Trade Organisation’s (WTO) Sanitary and Phytosanitary (SPS) Agreement allows countries to use SPS measures to protect their animal, plant and human life and health, provided they do not constitute an unjustifiable restriction to trade. This desk study reviews compliance with selected SPS measures in Tanzania and Malawi. For each country, the policy and institutional context is summarised, and SPS compliance is analysed in two sub-sectors: (i) fisheries and horticulture in Tanzania; and (ii) tobacco and groundnuts in Malawi. The authors find that SPS capacity development should be based on an assessment of needs, and a participatory prioritisation process. Effective collaboration between the private and public sector is essential for defining priorities, and for implementing successful initiatives to improve SPS compliance.
Country
Publisher
Forum for Agricultural Research in Africa
Theme area
Values, policies and rights, Human resources for health
Title of publication Negotiating global health at the World Health Organization: The case of the Global Code of Practice on the International Recruitment of Health Personnel
Date of publication
2012 April
Publication type
Report
Publication details
Get Involved in Global Health / / pp /-/
Publication status
Published
Language
English
Keywords
global code, recruitment, health workers, WHO, global
Abstract
The Global Code of Practice on the international Recruitment of Health Personnel (COP) is a successful tool of modern global health diplomacy and demonstrates how health governance with a different network and range of actors can be conducted under coordination by WHO. The COP considers (global) health workforce development and health systems, but fails to include other crucial determinants that have an impact on migration and the development of health systems in both source and destination countries. The ongoing WHO reform demonstrates how important global health has become. Member states currently position themselves in what the future role of the organisation should be.
Country
Publisher
Get Involved in Global Health
Theme area
Values, policies and rights, Human resources for health
Title of publication The WHO Global Code of Practice on the International Recruitment of Health Personnel: The Evolution of Global Health Diplomacy
Date of publication
2011 November
Publication type
Report
Publication details
Global Health Governance / / pp /-/
Publication status
Published
Language
English
Keywords
global code, recruitment, health workers, WHO, global
Abstract
The May 2010 adoption of the World Health Organization Global Code of Practice on the International Recruitment of Health Personnel created a global architecture, including ethical norms and institutional and legal arrangements, to guide international cooperation and serve as a platform for continuing dialogue on the critical problem of health worker migration. Highlighting the contribution of non-binding instruments to global health governance, this article describes the Code negotiation process from its early stages to the formal adoption of the final text of the Code. Detailed are the vigorous negotiations amongst key stakeholders, including the active role of non-governmental organizations. The article emphasizes the importance of political leadership, appropriate sequencing, and support for capacity building of developing countries’ negotiating skills to successful global health negotiations. It also reflects on how the dynamics of the Code negotiation process evidence an evolution in global health negotiations amongst the WHO Secretariat, civil society, and WHO Member States.
Country
Publisher
Global Health Governance
Theme area
Governance and participation in health
Title of publication Global Health Actors Claim To Support Health System Strengthening—Is This Reality or Rhetoric?
Date of publication
2009 April
Publication type
Journal Article
Publication details
PLoS Medicine 6 4 pp /-/
Publication status
Published
Language
English
Keywords
health system strengthening, global
Abstract
The author argues that health system strengthening (HSS), the new buzzword in discussions about international health, is in danger of becoming a container concept that is used to label very different interventions. Many global health initiatives and agencies (termed “global health actors”) claim that their activities support HSS. Most current HSS strategies are in fact selective, disease-specific interventions, and their effects may undermine progress towards the long-term goal of an effective, high-quality, inclusive health system. To make use of the window of opportunity for redefining HSS, a number of obstacles must be overcome. These include defining the exact objective of HSS strategies and finding the right balance between a health system's role in disease prevention versus treatment.
Country
Publisher
PLoS Medicine
Theme area
Governance and participation in health
Title of publication Uneven Patterns of Governance: How Developing Countries Are Represented in the IMF
Date of publication
2006 August
Publication type
Journal Article
Publication details
Review of International Political Economy 13 3 pp /-/
Publication status
Published
Language
English
Keywords
IMF, governance, Africa
Abstract
The IMF is governed by a 24-member Executive Board which represents 184 countries. Although often prized as a small and efficient decision-making body, the Board represents some countries more effectively than others. This is due to the institutional structure and incentives within which the Board operates. Prime among them is a system of constituencies which have formed and evolved as countries have sought to improve their position in the organization. These groups vary in size, shared interests, and distribution of power. Their effectiveness is not only affected by these attributes. It is also determined by decision-making rules across the institution, by the lack of formal accountability of Board members, and by the strength of other coalitions of countries acting informally within the institution. The analysis implies that representation on the IMF Board could be improved without altering the size of the Board.
Country
Publisher
Review of International Political Economy
Theme area
Health equity in economic and trade policies, Governance and participation in health
Title of publication Economics, health and development: some ethical dilemmas facing the World Bank and the international community
Date of publication
2001
Publication type
Journal Article
Publication details
Journal of Medical Ethics 27 4 pp 262-267
Publication status
Published
Language
English
Keywords
poverty, development, World Bank, global
Abstract
The World Bank is committed to “work[ing] with countries to improve the health, nutrition and population outcomes of the world's poor, and to protect[ing] the population from the impoverishing effects of illness, malnutrition and high fertility”. Ethical issues arise in the interpretation of these objectives and in helping countries formulate strategies and policies. It is these ethical issues—which are often not acknowledged by commentators—that are the subject of this paper. It asks why there should be a focus on the poor, and explores the link between improving the health of the poor, and reducing health inequalities between the poor and better-off. It discusses difficult ethical issues at both the global level (including debt relief and the link between country ownership and donor commitment) and the country level (including user fees and whether providing assistance to the non-poor may in the long run be a way of helping the poor).
Country
Publisher
Journal of Medical Ethics
Theme area
Governance and participation in health
Title of publication THEORY AND METHODS : Ethics and governance of global health inequalities
Date of publication
2006 May
Publication type
Journal Article
Publication details
Journal of Epidemiology and Community Health 60 / pp 998-1003
Publication status
Published
Language
English
Keywords
ethics, governance, inequality, global
Abstract
A world divided by health inequalities poses ethical challenges for global health. International and national responses to health disparities must be rooted in ethical values about health and its distribution; this is because ethical claims have the power to motivate, delineate principles, duties and responsibilities, and hold global and national actors morally responsible for achieving common goals. Theories of justice are necessary to define duties and obligations of institutions and actors in reducing inequalities. The problem is the lack of a moral framework for solving problems of global health justice. The aim was to study why global health inequalities are morally troubling, why efforts to reduce them are morally justified, how they should be measured and evaluated; how much priority disadvantaged groups should receive; and to delineate roles and responsibilities of national and international actors and institutions. Duties and obligations of international and state actors in reducing global health inequalities are outlined. The ethical principles endorsed include the intrinsic value of health to well-being and equal respect for all human life, the importance of health for individual and collective agency, the concept of a shortfall from the health status of a reference group, and the need for a disproportionate effort to help disadvantaged groups. This approach does not seek to find ways in which global and national actors address global health inequalities by virtue of their self-interest, national interest, collective security or humanitarian assistance. It endorses the more robust concept of ‘‘human flourishing’’ and the desire to live in a world where all people have the capability to be healthy. Unlike cosmopolitan theory, this approach places the role of the nation-state in the forefront with primary, though not sole, moral responsibility. Rather shared health governance is essential for delivering health equity on a global scale.
Country
Publisher
Journal of Epidemiology and Community Health
Theme area
Poverty and health, Governance and participation in health
Title of publication Governance and poverty reduction in Africa
Date of publication
2007 June
Publication type
Journal Article
Publication details
Proceedings of the National Academy of Sciences of the United States of America 104 43 pp 16751-16756
Publication status
Published
Language
English
Keywords
governance, poverty reduction, Africa
Abstract
A careful review of the literature in political science and neighboring social science disciplines shows that prevailing assumptions in the international development policy community about improved governance as a principal mechanism to reduce poverty in Africa rests more on faith than science. Conventional policy models for tackling poverty fail to take into account the peculiar socioeconomic and political conditions in Africa, where the vast majority of those living on one dollar a day or less are only marginally captured by market and state institutions and instead rely on solving their problems “outside the system.” Poverty reduction through formal institutions therefore becomes ineffective. Although political science and other neighboring social science disciplines offer insights into these peculiarities, these contributions have been largely ignored to date. One reason is that economists continue to dominate the international development policy agenda. Another is that political scientists have typically looked at how economic variables shape political ones, rather than the other way around, as implied in the current governance agenda. Governance remains an undertheorized area of research held back by two chasms, one between economists and other social scientists and another between the scientific and the policy communities, to the detriment of gaining a better understanding of how it may help reduce poverty in Africa.
Country
Publisher
Proceedings of the National Academy of Sciences of the United States of America
Theme area
Governance and participation in health
Title of publication Depreciating African Political Culture
Date of publication
2007 March
Publication type
Journal Article
Publication details
Journal of Black Studies 38 2 pp 288-307
Publication status
Published
Language
English
Keywords
politics, development, Africa
Abstract
The global arena is dominated by the popular conviction that Africans require foreign direction in the socioeconomic management of their own societies. This essay challenges the belief that economic development in contemporary Africa is impeded by bad governance.
Country
Publisher
Journal of Black Studies
Theme area
Health equity in economic and trade policies, Poverty and health
Title of publication Operation of the market study: land access in urban areas - the case of Maputo
Date of publication
2012 February
Publication type
Report
Publication details
Urban LandMark / / pp /-/
Publication status
Published
Language
English
Keywords
urban, land, informal sector, Mozambique
Abstract
In 2010, Urban LandMark together with partners from Universidade Eduardo Modlane and Universidade Pedagógica undertook a survey to understand how ordinary urban dwellers access, hold and transact land in two peri-urban sites in Maputo. The study used both qualitative and quantitative data sources, which consist of survey material collected from 568 households located in two peri-urban sites in Maputo - Hulene B and Luis Cabral. Survey data was complemented with key informant interviews held with municipal officials, secretarios de bairros, officials at the National Directorate of Geography and Cadastre (DINAGECA) and ward secretaries. The findings challenge conventional understandings of the formal and informal sector in African cities.
Country
Publisher
Urban LandMark
Theme area
Health equity in economic and trade policies, Poverty and health
Title of publication Urban land markets in Zimbabwe: scoping study
Date of publication
2011 November
Publication type
Report
Publication details
Urban LandMark / / pp /-/
Publication status
Published
Language
English
Keywords
urban, land, market, Zimbabwe
Abstract
Land is an issue of central economic and political importance in Zimbabwe. During the recent years of economic decline, the specific importance of urban land has received greater prominence. Many of the formal processes for land transfer have been weakened or even abandoned, local government has faced a rolling crisis of sustainability and the collapse of the national currency ascribed a new value to urban land as a commodity. Simultaneously there are many signs emerging of community-driven innovation and participation in urban management. The need to revive and renew human resources within local government has been widely supported, while UN-Habitat has recommended that the Town and Country Planning Acts should be reviewed, and various donors are considering future assistance to the reform of legal and policy frameworks for urban development. There is thus a strong probability that fundamental changes to the systems and structures of urban land governance in Zimbabwe will be implemented in the foreseeable future. This study, commissioned by Urban LandMark, was conducted by researchers at the Centre for Applied Social Sciences Trust, University of Zimbabwe, to undertake a scoping study on the governance of urban land markets in Zimbabwe, using Harare as a case study.
Country
Publisher
Urban LandMark
Theme area
Health equity in economic and trade policies, Poverty and health
Title of publication Urban land markets in Lesotho: scoping study
Date of publication
2012 February
Publication type
Report
Publication details
Urban LandMark / / pp /-/
Publication status
Published
Language
English
Keywords
urban, land, market, Lesotho
Abstract
Lesotho has had a particular history of land administration, arising from the country's status as indirectly ruled British protectorates rather than directly ruled colonies. This has accentuated the continued role of traditional leaders in land management and administration, even in urban centres such as Maseru. The formal system of land supply in Lesotho is notoriously limited, with the bulk of new land coming into the market via traditional leaders. The Lesotho government, with the support of international development partners, has for many years tried to rationalise the land administration system. In 2010, these efforts came to a head with the enactment of two key laws - the Land Administration Authority Act and the Land Act. These statutes fundamentally reshape the legislative context for the supply, development and transacting of land in the country. A new Land Administration Authority has also been set up, and considerable technical support is to be provided to the new Authority through support from the Millennium Challenge Corporation. This report is a scoping study to identify those issues around Lesotho's modernisation of its governance systems for land administration where organisations working in this field could provide support in the medium term.
Country
Publisher
Urban LandMark
Theme area
Health equity in economic and trade policies
Title of publication A Handbook on Urban Land Markets for Africa
Date of publication
2010
Publication type
Report
Publication details
Urban LandMark / / pp /-/
Publication status
Published
Language
English
Keywords
urban, land, market, Africa
Abstract
The handbook introduces key economic and related concepts explaining the functioning of urban land markets. By introducing key classical economic concepts, the handbook provides foundational economic terms that are often referred to in relation to urban land markets. The handbook is intended to provide the tools for engaging in a critical analysis of conventional economics, particularly in our understanding of African urban land markets. It is intended for use by people in government, private firms and non-governmental organisations involved in the fields of housing, urban planning, engineering, architecture and related areas. It provides a basis for strengthening urban policy in ways that enable poorer people in African cities to access well-located living and work spaces. The reader of this handbook should come away with an understanding of how interventions affect the market, and also how markets affect, enable, constrain and shape interventions by governments, developers, traditional authorities, banks, micro-lenders or any of its actors. It provides a sense of the dynamics of the urban land market – how particular decisions in one sector affect other sectors. This understanding gives practitioners in the field a framework to make more informed decisions when formulating policies or making recommendations. The handbook is a beginner’s guide to the economy, especially those aspects of the economy that are relevant to urban land markets, and to questions about land use, supply and demand as they unfold on the African continent.
Country
Publisher
Urban LandMark
Theme area
Health equity in economic and trade policies, Poverty and health
Title of publication Incrementally securing tenure: an approach for informal settlement upgrading in South Africa
Date of publication
2010 December
Publication type
Report
Publication details
Urban LandMark / / pp /-/
Publication status
Published
Language
English
Keywords
informal, settlement, housing, South Africa
Abstract
This document summarises Urban LandMark's approach to incrementally securing tenure in informal settlements. This approach emphasises practical mechanisms that allow land rights to be upgraded over time. It has been developed from a range of activities, including input from research papers, a considerable number of interviews, and the testing of different processes with municipalities.
Country
Publisher
Urban LandMark
Theme area
Health equity in economic and trade policies, Poverty and health
Title of publication State of African Cities Report 2010
Date of publication
2010 November
Publication type
Report
Publication details
UN Habitat / / pp /-/
Publication status
Published
Language
English
Keywords
urban, land, markets, housing, Africa
Abstract
The State of African Cities 2010: Governance, Inequality and Urban Land Markets report is the second in a series of regional, Africa-focused reports produced by UN- HABITAT. The current report focuses particularly on urban processes and themes relevant to Africa, illustrating them with recent data and relevant examples. While much of the scope does focus on cities, no specific settlement size threshold is used and this report addresses urbanization and urban areas in general. The report examines urban growth, social conditions in slums, environmental and energy issues and, especially, the role of urban land markets in accessing land and housing.
Country
Publisher
UN Habitat
Theme area
Health equity in economic and trade policies, Poverty and health
Title of publication Municipal rates policies and the urban poor
Date of publication
2009 October
Publication type
Report
Publication details
Urban LandMark / / pp /-/
Publication status
Published
Language
English
Keywords
urban, land, markets, housing, poverty, South Africa
Abstract
Commissioned by the SA Cities Network and Urban Landmark, this paper examines how municipal property rates policies are, or could be, used as an instrument to promote access by the poor to urban land markets. Buffalo City Municipality and the City of Johannesburg are used as case studies to probe implementation issues and highlight some of the key trade-offs made and approaches taken by municipalities to balance municipal revenue concerns with pro-poor policy intentions.
Country
Publisher
Urban LandMark
Theme area
Equitable health services, Human resources for health
Title of publication Improving CHW Program Functionality, Performance and Engagement: Operations Research Results from Zambia
Date of publication
2012
Publication type
Report
Publication details
USAID Health Care Improvement Project / / pp /-/
Publication status
Published
Language
English
Keywords
community health workers, operations research, Zambia
Abstract
The United Nations Millennium Project identified the large-scale training and deployment of community health workers (CHWs) as an important strategy to fill the human resources gap and achieve the Millennium Development Goals (MDGs). However, CHW programs are known to be fraught with significant human resources challenges. The USAID Health Care Improvement Project (HCI) developed the Community Health Worker Assessment and Improvement Matrix (CHW AIM) to help assess CHW program functionality and to provide benchmarks against which to measure program improvements. Zambia’s large number and wide range of CHWs and the government’s openness to CHWs and recognition of their value made it an ideal country in which to conduct the CHW AIM operations research (OR). The OR focused on CHWs supported by five different implementing partners in Zambia. The CHWs included in the assessment fell under the category of “community health volunteer” identified by the Zambian National CHW Strategy, but also met a broader definition embraced by the CHW AIM tool that included: “any health worker that performs a set of essential health services who receives standardized training outside the formal nursing or medical curricula and has a defined role within the community and the larger health system”.Three key questions thus formed the foundation for the CHW AIM operations research activity: Does application of the CHW AIM tool contribute to CHW program functionality improvement? What is the relationship among program functionality, CHW engagement and CHW performance? What are the costs associated with implementing the CHW tool and what is the incremental cost effectiveness associated with its use? The Community Health Worker Assessment and Improvement Matrix (CHW AIM) was designed to help assess communtiy health worker program functionality and to provide benchmarks against which to measure program improvements. This operations research activity was designed as a field intervention study that applied the CHW AIM process.
Country
Publisher
USAID Health Care Improvement Project
Theme area
Poverty and health, Equitable health services
Title of publication Evaluation of General Practitioners' Routine Assessment of Patients with Diabetes in Tshwane, South Africa
Date of publication
2012 January
Publication type
Journal Article
Publication details
South African Family Practice 54 1 pp 68-71
Publication status
Published
Language
English
Keywords
diabetes, assessment, South Africa
Abstract
Diabetes mellitus is a composite disease that, if not well managed and controlled, may lead to severe complications. To avoid or delay these debilitating complications, it is necessary for the practitioner to implement adequate management of the disease by using currently available clinical guidelines. The authors wished to establish the use of existing diabetes management guidelines by general practitioners (GPs) in the City of Tshwane (Pretoria) Metropolitan Municipality of South Africa. A cross-sectional and descriptive study was conducted. A total of 50 randomly selected general practitioners participated in the survey. A large majority of the participants (92%) was aware of the existence of the latest guidelines for the management of diabetes in South Africa. The assessments performed by most GPs were body mass index and lipid profile, as reported by 96% of the respondents, followed by foot examination, microalbumin (88%) and glycated haemoglobin (84%) measurements. The practice of eye specialist referrals was found adequate in 22% of the participants. Fifty-four per cent reported that they did not undertake any continuing professional development activity regarding diabetes in the preceding year. Although the GPs surveyed in the Tshwane district were aware of the existence of guidelines for the assessment of patients with diabetes, their implementation was not satisfactory. Training institutions play a pivotal role in guiding future practitioners to improve such implementation. Also, the improvement of the quality of primary health care systems is of great importance.
Country
Publisher
South African Family Practice
Theme area
Poverty and health, Human resources for health
Title of publication Tobacco and Alcohol Use among Healthcare Workers in Three Public Hospitals in KwaZulu-Natal, South Africa
Date of publication
2012 January
Publication type
Journal Article
Publication details
South African Family Practice 54 1 pp 61-67
Publication status
Published
Language
English
Keywords
health worker, tobacco, alcohol, South Africa
Abstract
Tobacco use is a risk factor for most of the leading causes of death in the world. Healthcare workers (HCWs) can play an important role in assisting patients to stop smoking, but this role is undermined if they themselves smoke. The study determined the prevalence of tobacco smoking and alcohol use among HCWs in public hospitals in KwaZulu-Natal, South Africa. In a cross-sectional study, 650 self-administered anonymous questionnaires (primary and secondary questionnaires) were administered to participants between December 2009 and June 2010. Six hundred and twenty primary questionnaires (on smoking) and 630 secondary questionnaires (on alcohol use) were returned, giving a response rate of 95% and 97% respectively. The Pearson chi-square test was used to test for statistical significance. Eleven per cent of the participants were current smokers and 7.1% former smokers, while 27% of never smokers were constantly exposed to second-hand smoke. Males were 13 times more likely to smoke than their female counterparts (P < 0.001). Never-smokers more frequently counselled their smoking patients to quit compared to former and current smokers (47.5%, 39.5% and 25.8% respectively). Alcohol use problems were reported by 22% of participants (P < 0.001). Current smokers were six times more likely to drink excessively than never-smokers (P < 0.001) and males were ten times more likely than females to drink excessively (P < 0.001). The smoking rate among HCWs is still high, although lower than the national average of 21.4%. A large number of participants reported exposure to second-hand smoke and alcohol use problems. Less than half of the HCWs counselled smoking patients to quit smoking.
Country
Publisher
South African Family Practice
Theme area
Public-private mix
Title of publication Private Healthcare Sector Doctors and HIV Testing Practices in the eThekwini Metro of KwaZulu-Natal
Date of publication
2011 March
Publication type
Journal Article
Publication details
South African Family Practice 53 6 pp 573-578
Publication status
Published
Language
English
Keywords
private healthcare, HIV testing, South Africa
Abstract
Human immunodeficiency virus (HIV) testing has many logistic and ethical challenges. The UNAIDS/WHO policy statement states that the testing of individuals must be confidential, be accompanied by counselling, and be conducted with informed consent. HIV testing is integral to the management of the epidemic, and since KwaZulu-Natal (KZN) has the highest prevalence of AIDS in South Africa, it is vital that doctors in this province are knowledgeable about HIV testing practices. This study was undertaken in view of the lack of data on private sector doctors’ HIV testing practices in KwaZulu-Natal. A descriptive cross-sectional study was conducted among private sector doctors who manage HIV and AIDS patients in the eThekwini Metro of KZN. One hundred private practitioners were randomly selected from a sample of 175 consenting private sector doctors. These doctors were asked to fill in an anonymous questionnaire. The questionnaires were collected and analysed using SPSS version 15. A response rate of 60% was obtained, with 57 (95%) indicating that they do HIV testing after obtaining patients’ consent. Over 96% of the doctors carried out pre-test counselling, while over 98% did post-test counselling. Eighty-one per cent did a confirmatory test if the patient tested positive, while 49% performed a confirmatory test if the patient tested negative; over 50% did the test after three months. Forty-seven per cent did not know or failed to indicate what confirmatory test they used. The majority did not disclose patient status or do counselling in the presence of others. However, if it was done, it was done with the consent of the patient or the parents in cases where the patient was a minor. The majority stated that they follow the guidelines when testing. The HIV testing practices of private sector doctors who participated in the study are compliant with the UNAIDS/WHO policy statement regarding confidentiality, informed consent and counselling. However, doctors’ knowledge of confirmatory test appears to be inadequate.
Country
Publisher
South African Family Practice
Theme area
Health equity in economic and trade policies, Poverty and health
Title of publication Access to Urban Land: a handbook for community organisations
Date of publication
2008 August
Publication type
Report
Publication details
Urban LandMark / / pp /-/
Publication status
Published
Language
English
Keywords
urban, land, community, housing, poverty, South Africa
Abstract
This report present the findings of the experiences and views of community organisations with regard to urban land issues in South Africa. This booklet consists partly of an overview of the outcomes of these workshops and other research undertaken by Urban LandMark, and partly of information prepared in response to the information gaps identified in the workshops. The booklet examines the causes of the urban land problem in South Africa, and the human rights that are of relevance to accessing land. Practical steps that could potentially be used by community organisations to make these rights real are then discussed. Finally, policy solutions for addressing the urban land problem are suggested.
Country
Publisher
Urban LandMark
Theme area
Poverty and health, Equity and HIV/AIDS
Title of publication Cold Comfort for Healthcare Workers? Medico-Ethical Dilemmas Facing a Healthcare Worker after Occupational Exposure to HIV
Date of publication
2011 March
Publication type
Journal Article
Publication details
South African Family Practice 53 6 pp 610-614
Publication status
Published
Language
English
Keywords
health worker, exposure, HIV, South Africa
Abstract
Following exposure to the human immunodeficiency virus (HIV) it is advisable for the healthcare worker (HCW) to take post exposure prophylaxis. A prerequisite for this is the establishment of the HIV status of the HCW and the patient. Ordinarily, this would be preceded by the ascertainment of the HIV status of the HCW and the patient. This should be done as soon as possible after exposure, usually within 24 hours. If the exposure takes place when the patient is under anaesthetic, which is often the case, consent for HIV testing is not readily forthcoming and this poses an ethical dilemma. A similar dilemma is posed by a patient who, having awoken, is not in a position or is unwilling to give consent. This paper discusses the ethical and legal constraints on the HCW and the employer in circumstances where the patient is not in a position to give consent. The paper concludes by restating the need to respect confidentiality and the autonomy of the patient and that informed consent is paramount in testing for HIV status. The paper proffers the view that testing the patient will not substantially alter the course of action open to the HCW and, in any event, will do little to allay the fears of HCWs. This paper discusses the ethical and legal constraints on a healthcare worker who has been occupationally exposed to possible HIV infection in circumstances where the patient will not/is not in a position to give consent to be tested to establish his/her HIV status, which is a prerequisite for the health worker to receive post exposure prophylaxis in South Africa.
Country
Publisher
South African Family Practice
Theme area
Health equity in economic and trade policies, Poverty and health
Title of publication Competing for Urban Land: improving the bidding power of the poor
Date of publication
2008 June
Publication type
Report
Publication details
Urban LandMark / / pp /-/
Publication status
Published
Language
English
Keywords
urban, land, community, development, South Africa
Abstract
The development planning vision of equitable and integrated cities, and the achievement of slum-free cities, remain unrealised. This paper looks at this conundrum in the South African context and suggests ways in which poor people can be spatially and economically integrated into cities by increasing their bidding power, including improving the intensity of land utilisation.
Country
Publisher
Urban LandMark
Theme area
Poverty and health, Equity and HIV/AIDS
Title of publication Acceptance and Uptake of Voluntary HIV Testing among Healthcare Workers in a South African Public Hospital
Date of publication
2011 February
Publication type
Journal Article
Publication details
South African Family Practice 53 5 pp 488-494
Publication status
Published
Language
English
Keywords
voluntary HIV testing, acceptance, uptake, public hospital, healthcare workers, South Africa
Abstract
Healthcare workers are seen as being at the centre of human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS management. They are also at risk of HIV infection from occupational exposure to blood-borne pathogens during their daily work activities. Although many studies on HIV/AIDS and its management have been carried out globally, only a few address HIV counselling and testing among healthcare workers. The aim of this study is to determine factors associated with the acceptance and uptake of voluntary HIV testing among healthcare workers in a public hospital in KwaZulu-Natal. A cross-sectional quantitative descriptive survey was conducted among healthcare workers in a public hospital, by means of self-administered questionnaires. Written informed consent was obtained from each participant prior to participation in the study. A response rate of 239 (59.4%) was achieved from a targeted population of 402 healthcare workers. Of the 239 participants, 208 (87.0%) indicated that they would accept having an HIV test, while 217 (90.7%) reported having had HIV counselling and testing. There were positive associations between participants’ having had HIV counselling and testing and having a close relative living with HIV/AIDS (p-value = 0.032), previous accidental exposure to blood-borne pathogens (p-value = 0.003) and the number of years of their work experience (p-value = 0.0006). No significant associations were noted between participants who reported having undergone HIV counselling and testing in the previous year, and their demographic variables, such as age (0.766), gender (0.876), marital status (0.715), and knowledge of hospital policy on post-exposure prophylaxis (0.5669). The findings of this study showed high levels of acceptance (208, 87.0%) and uptake (217, 90.7%) of HIV counselling and testing among healthcare workers in the designated public hospital. Several factors influenced this.
Country
Publisher
South African Family Practice
Theme area
Health equity in economic and trade policies, Poverty and health
Title of publication How the poor access, hold and trade land: findings revisited
Date of publication
2008 June
Publication type
Report
Publication details
Urban LandMark / / pp /-/
Publication status
Published
Language
English
Keywords
urban, land, community, development, South Africa
Abstract
A 2007 project commissioned by Urban Landmark investigated how the poor access, hold and trade land in different types of settlements in three metropolitan areas in South Africa (Cape Town, Ekurheleni and eThekwini). As a follow-up to this project, additional qualitative and quantitative analyses of the original project data were carried out to increase understanding of the issues, particularly in respect of the way in which the poor transact, trade and develop land and the costs thereof.
Country
Publisher
Urban LandMark
Theme area
Human resources for health
Title of publication Preparing the Next Generation of Community Health Workers: The Power of Technology for Training
Date of publication
2012
Publication type
Report
Publication details
Dalberg Global Development Advisors / / pp /-/
Publication status
Published
Language
English
Keywords
community health workers, technology, training, Africa
Abstract
For several years, stakeholders across the global health sector have recognized and expressed enthusiasm about the potential of mobile technology to improve health outcomes. That story is not new. Today, there are many mobile health (mHealth) deployments. Most remain small scale, but efforts are underway to understand their specific operational and health impacts, and to scale applications that work. However, while mHealth applications proliferate, technology has not been greatly deployed in the training of community health workers, whose work is essential to reaching Millennium Development Goals (MDGs) 4, 5, and 6 as well as to reducing the associated burdens of child and maternal mortality and HIV/AIDS. This extensive report gathered evidence and research to see if technology could be harnessed in transformative ways to address critical gaps in community health worker (CHW) training in Sub-Saharan Africa. It covers: the importance of CHW, current approaches to CHW training, emerging evidence and opportunities.
Country
Publisher
Dalberg Global Development Advisors
Theme area
Health equity in economic and trade policies, Poverty and health
Title of publication Voices of developers and municipalities: Creating more inclusive cities through cooperation
Date of publication
2008 November
Publication type
Report
Publication details
Urban LandMark / / pp /-/
Publication status
Published
Language
English
Keywords
urban, land, community, development, governance, South Africa
Abstract
This study by the University of Pretoria, commissioned by Urban Landmark, provides an in-depth understanding of how urban land development and governance work in practice; the political, economic, and social factors that influence urban land development and governance; and the interaction between developers and municipalities. The study also reveals that truly inclusive cities are unlikely to become a reality in South Africa without the development of greater synergy, cooperation and mutual understanding between municipalities and developers, and municipal attention to developmental outcomes.
Country
Publisher
Urban LandMark
Theme area
Human resources for health
Title of publication Quality Healthcare and Workers on the Move
Date of publication
2011 September
Publication type
Report
Publication details
Public Services International / / pp /-/
Publication status
Published
Language
English
Keywords
migration, health workers, South Africa
Abstract
This report on South Africa is part of a global research project on the origin and destination countries for migration of health workers around the world. It contends that the health and social worker migration must be considered in the broader context of the human right to health and decent work, ethical migration and recruitment processes, global human resources for health and the health related Millennium Development Goals. The report points to how informed migration choices, and better investment in healthcare, can help retain valuable health workers, create high quality healthcare services and improve working conditions.
Country
Publisher
Public Services International
Theme area
Health equity in economic and trade policies, Poverty and health
Title of publication Land as Commodity in South Africa
Date of publication
2007 June
Publication type
Report
Publication details
Urban LandMark / / pp /-/
Publication status
Published
Language
English
Keywords
urban, land, community, development, governance, South Africa
Abstract
This report proposes useful categories for the categorisation of urban land in South Africa and records the current trends and patterns of land ownership in South Africa's towns and cities. It also identifies the main actors influencing urban land transactions and the individuals, institutions or groups that benefit from the current operation of the urban land market, as well as those who do not, providing possible explanations of why this may be the case.
Country
Publisher
Urban LandMark
Theme area
Human resources for health
Title of publication Brain Gain: Making Health Worker Migration Work for Rich and Poor Countries
Date of publication
2010
Publication type
Report
Publication details
Voluntary Service Overseas / / pp /-/
Publication status
Published
Language
English
Keywords
migration, cost, health workers, Africa
Abstract
Fifty-seven countries worldwide suffer from a severe shortage of health workers. Thirty-six of these are in Africa, which has just three per cent of global health workers but bears 24 per cent of the global burden of disease. In Malawi, for example, it is estimated that there are just two doctors for every 100,000 people. These shortages have been exacerbated by tens of thousands of health workers leaving Africa to find employment in the world’s rich countries. It is estimated that 23 per cent of doctors trained in sub-Saharan Africa are now working in OECD countries. The UK has historically been an important destination country for migrant health workers from all over the world. In 2007, an estimated 31 per cent of NHS medical staff had qualified outside the European Economic Area, while migrants were estimated to make up 35 per cent of the nursing workforce in older adult care in 2008. The migration of health workers also has considerable implications for international aid efforts, particularly those focused on scaling up the recruitment and training of health workers in developing countries. According to WHO estimates, in 2002 Ghana had already lost around $60 million in investment and training of health workers. Other estimates suggest that each emigrating professional represents a loss of $184,000 for an African source country. Reducing the permanent loss of trained health workers is therefore critical to building confidence of donors and governments at a time when investing in scaling up the recruitment and training of Africa’s health workforce is urgently needed. This paper is the outcome of a series of in-depth interviews and group discussions with over 100 African health workers and others at the grassroots to understand their experiences of migration and their ideas for solutions to it.
Country
Publisher
Voluntary Service Overseas
Theme area
Health equity in economic and trade policies, Poverty and health, Governance and participation in health
Title of publication Voices of the Poor: community perspectives on accessing urban land
Date of publication
2007 October
Publication type
Report
Publication details
Urban LandMark / / pp /-/
Publication status
Published
Language
English
Keywords
urban, land, community, development, governance, South Africa
Abstract
The aim of this 2007 initiative was to analyse the perspectives and experiences of civil society organisations about access to urban land by the poor. The study was based on a series of workshops undertaken in Port Elizabeth, Cape Town, Pietermaritzburg and Johannesburg and hosted by urban development NGOs active in the region. Some of the findings that came out of the Voices of the Poor workshops were expected, such as the importance of urban land for livelihoods. Other findings were more surprising, such as the number of informal settlement communities still struggling for basic services and the right to stay close to jobs and social networks, and the deep mistrust of certain sectors of local government. This study presents and analysis these findings.
Country
Publisher
Urban LandMark
Theme area
Human resources for health, Resource allocation and health financing
Title of publication Financial Cost of Doctors Emigrating from Sub-Saharan Africa: Human Capital Analysis
Date of publication
2011 November
Publication type
Journal Article
Publication details
BMJ 343 / pp /-/
Publication status
Published
Language
English
Keywords
migration, cost, health workers, Africa
Abstract
The aim of the study was to estimate the lost investment of domestically educated doctors migrating from sub-Saharan African countries to Australia, Canada, the United Kingdom, and the United States. The investigation was conducted through a human capital cost analysis using publicly accessible data. This was done in nine sub-Saharan African countries with an HIV prevalence of 5% or greater or with more than one million people with HIV/AIDS and with at least one medical school (Ethiopia, Kenya, Malawi, Nigeria, South Africa, Tanzania, Uganda, Zambia, and Zimbabwe), and data available on the number of doctors practising in destination countries. The financial cost of educating a doctor (through primary, secondary, and medical school), assuming that migration occurred after graduation, using current country specific interest rates for savings converted to US dollars; cost according to the number of source country doctors currently working in the destination countries; and savings to destination countries of receiving trained doctors. In the nine source countries the estimated government subsidised cost of a doctor’s education ranged from $21 000 (£13 000; €15 000) in Uganda to $58 700 in South Africa. The overall estimated loss of returns from investment for all doctors currently working in the destination countries was $2.17bn (95% confidence interval 2.13bn to 2.21bn), with costs for each country ranging from $2.16m (1.55m to 2.78m) for Malawi to $1.41bn (1.38bn to 1.44bn) for South Africa. The ratio of the estimated compounded lost investment over gross domestic product showed that Zimbabwe and South Africa had the largest losses. The benefit to destination countries of recruiting trained doctors was largest for the United Kingdom ($2.7bn) and United States ($846m). The authors conclude that among sub-Saharan African countries most affected by HIV/AIDS, lost investment from the emigration of doctors is considerable. Destination countries should consider investing in measurable training for source countries and strengthening of their health systems.
Country
Publisher
BMJ
Theme area
Health equity in economic and trade policies, Poverty and health, Governance and participation in health
Title of publication Towards effective state interventions to improve access by the poor to urban land markets
Date of publication
2006
Publication type
Report
Publication details
Urban LandMark / / pp /-/
Publication status
Published
Language
English
Keywords
urban, land, community, development, services, South Africa
Abstract
The main objective of this paper is to investigate and discuss ways in which the state should intervene around urban land issues, within the context of its relationship to the private sector, in order to improve the access of poorer and excluded sectors of South African urban society to land, housing, and services.
Country
Publisher
Urban LandMark
Theme area
Human resources for health
Title of publication Career Intentions of Medical Students Trained in Six Sub-Saharan African Countries
Date of publication
2011 December
Publication type
Journal Article
Publication details
Education for Health 11 / pp /-/
Publication status
Published
Language
English
Keywords
migration, medical students, retention, sub-Saharan Africa
Abstract
Sub-Saharan Africa (SSA) is the world region worst affected by physician migration. Identifying reasons why medical students wish to stay or leave Africa could assist in developing strategies which favour retention of these graduates. This study investigated the career intentions of graduating students attending medical schools in SSA to identify interventions which may improve retention of African physicians in their country of training or origin. Final year medical students attending nine medical schools in SSA were surveyed – students from four schools in South Africa and one school each in the Democratic Republic of Congo, Kenya, Nigeria, Tanzania and Uganda. The response rate was 78.5% (990 of 1260 students); data from the 984 students who indicated they were remaining in medicine were entered into a database, and descriptive statistics were obtained.Most of the 984 responding students were African by birth. The majority (91.2%) intended to undertake postgraduate training; the top three specialty choices were surgery (20%), internal medicine (16.7%), and paediatrics (9%). Few were interested in family medicine (4.5%) or public health (2.6%) or intended to practice in rural areas (4.8%). Many students (40%) planned to train abroad. About one fifth (21%) intended to relocate outside sub-Saharan Africa. These were about equally divided between South Africans (48%) and those from the other five countries (52%). The top perceived career-related factors favouring retention in Africa were career options and quality and availability of training opportunities. Several factors were reported significantly more by South African than the other students. The top personal factors for staying in Africa were a desire to improve medicine in Africa, personal safety, social conditions and family issues. The top career-related factors favouring relocation outside Africa were remuneration, access to equipment and advanced technology, career and training opportunities, regulated work environment and politics of health care in Africa. Several of these were reported significantly more by students from the other countries as compared with South Africans. The top personal factors favouring relocation outside Africa were personal safety, opportunity for experience in a different environment, social conditions and greater personal freedom. The career intentions of African medical students are not aligned with the continent’s health workforce needs. A number of interventions that warrant further attention were identified in this study.
Country
Publisher
Education for Health
Theme area
Poverty and health, Monitoring equity and research to policy
Title of publication Working Paper 21: Making Sense of 'Evidence' - Notes on the Discursive
Date of publication
2012 August
Publication type
Report
Publication details
Institute for Poverty, Land and Agrarian Studies / / pp /-/
Publication status
Published
Language
English
Keywords
poverty reduction, policy, evidence, South Africa
Abstract
Exploring some of the assumptions underlying ‘evidence based’ approaches to poverty reduction, this paper argues that the discourse of Evidence-Based Policy (EBP) offers poor guidance to those who seek to ensure that social policy making is informed by the findings of social science. EBP discourse relies on a technocratic, linear understanding of the policy making process and on a naïve empiricist understanding of the role of evidence. This renders it unable to engage with the role of the underlying discursive frameworks and paradigms that render evidence meaningful and invest it with consequence: EBP discourse does not help us understand either how policy changes, or what is at stake in dialogue across the ‘research-policy divide’. Rather than simply focusing on evidence, approaches to policy change need to focus on how evidence is used in the politically loaded and ideologically compelling ‘policy narratives’ that contest rival policy frameworks. The paper considers an example from the South African context – the shift to the ‘two economies’ framework and the policy interventions associated with ASGISA – and explores the implications for approaches to research more attuned to the realities of the policymaking process. It concludes with a discussion of the implications for social researchers and policy makers.
Country
Publisher
Institute for Poverty, Land and Agrarian Studies
Theme area
Human resources for health
Title of publication Brain Drain and Health Workforce Distortions in Mozambique
Date of publication
2012 April
Publication type
Journal Article
Publication details
Plos ONE 7 4 pp /-/
Publication status
Published
Language
English
Keywords
international migration, brain drain, health workers, Mozambique
Abstract
Trained human resources are fundamental for well-functioning health systems, and the lack of health workers undermines public sector capacity to meet population health needs. While external brain drain from low and middle-income countries is well described, there is little understanding of the degree of internal brain drain, and how increases in health sector funding through global health initiatives may contribute to the outflow of health workers from the public sector to donor agencies, non-governmental organisations (NGOs), and the private sector. An observational study was conducted to estimate the degree of internal and external brain drain among Mozambican nationals qualifying from domestic and foreign medical schools between 1980–2006. Data were collected 26-months apart in 2008 and 2010, and included current employment status, employer, geographic location of employment, and main work duties. The authors argue that internal migration is an important contributor to capital flight from the public sector, accounting for more cases of physician loss than external migration in Mozambique. Given the urgent need to strengthen public sector health systems, frank reflection by donors and NGOs is needed to assess how hiring practices may undermine the very systems they seek to strengthen.
Country
Publisher
Plos ONE
Theme area
Human resources for health
Title of publication Is There Really a Pot of Gold at the End of the Rainbow? Has the Occupational Specific Dispensation, as a Mechanism to Attract and Retain Health Workers in South Africa, Leveled the Playing Field?
Date of publication
2012 August
Publication type
Journal Article
Publication details
BMC Public Health 12 613 pp /-/
Publication status
Published
Language
English
Keywords
migration, health workers, South Africa
Abstract
South Africa is experiencing a critical shortage of human resources for health (HRH) at a time when the population and the burden of ill-health, primarily due to HIV, AIDS and TB, are on the increase. This shortage is particularly severe within the nursing profession, which has witnessed significant emigration due to poor domestic working conditions and remuneration. Salaries and other benefits are an obvious pull factor towards foreign countries, given the often extreme international wage differentials. The introduction of the Occupation Specific Dispensation (OSD) in 2007 sought to improve the public services’ ability to attract and retain employees thereby reducing incentives to emigrate. Using a representative basket of commonly bought goods (including food, entertainment, fuel and utilities), a purchasing power parity (PPP) ratio is an exchange rate between two currencies that equalises the international price of buying that basket. Our study makes comparisons, using such a PPP index, and allows the identification of real differences in salaries for our selected countries (South Africa, United States, United Kingdom, Canada, Australia and Saudi Arabia) for the same HRH professions. If PPP adjusted earnings are indeed different then this indicates an economic incentive to emigrate. Salaries of most South African HRH, particularly registered nurses, are dwarfed by their international counterparts (notably United States, Canada and Saudi Arabia), although the OSD has gone some way to reduce that disparity. All selected foreign countries generally offer higher salaries on a PPP adjusted basis. The United Kingdom ($43202) and Australia ($38622), in the category of Medical Officer, are the only two examples where the PPP adjustment brings the salary below what is being offered in South Africa ($50013 post OSD). The PPP adjusted salary differences between registered nurses is very slight for South Africa ($18884 post OSD), Australia ($21784) and the United Kingdom ($20487). All other foreign countries show large salary advantages across the HRH categories examined. Whilst South African salaries remain lower than their foreign counterparts by and large, the introduction and implementation of the OSD has made significant progress in reducing the gap between salaries of HRH in South Africa and the rest of the world. Given that the OSD has narrowed the gap between SA and overseas salaries whilst in the context of continued out migration of SA HRH, further research into push factors effecting migration needs to be undertaken.
Country
Publisher
BMC Public Health
Theme area
Human resources for health
Title of publication Migration of health workers
Date of publication
2010 July
Publication type
Document
Publication details
World Health Organisation / / pp /-/
Publication status
Published
Language
English
Keywords
migration, health workers, global
Abstract
There are about 60 million health workers worldwide. Many health workers migrate to high-income countries for greater income, job satisfaction, career opportunities and management quality. Demand for health workers is increasing in high-income countries, where health systems can depend heavily on doctors, nurses and other health workers who have been trained abroad. Migration of health workers may result in financial loss and weakens health systems in the countries of origin. WHO has developed a Global Code of Practice on the International Recruitment of Health Personnel to achieve an equitable balance of the interests of health workers, source countries and destination countries.
Country
Publisher
World Health Organisation
Theme area
Human resources for health
Title of publication International Migration of Health Workers. Improving international cooperation to address the global health workforce crisis
Date of publication
2010 February
Publication type
Document
Publication details
Organisation for Economic Co-operation and Development / / pp /-/
Publication status
Published
Language
English
Keywords
migration, health workers, global
Abstract
In 2006, the World Health Organization estimated that there was a shortage of more than 4.3 million health personnel across the world. Low-income countries were particularly hard-hit by shortages: of the 57 countries with a critical shortage, 36 were sub-Saharan African countries. This Policy Brief provides new insights on recent migration trends for doctors and nurses up to 2008, and discusses the main causes and consequences for destination and origin countries. It presents possible policy responses stressing the importance of international co-operation to address the worldwide scarcity of health workers.
Country
Publisher
Organisation for Economic Co-operation and Development
Theme area
Values, policies and rights, Human resources for health
Title of publication WHO Code of Practice
Date of publication
2010 May
Publication type
Report
Publication details
World Health Organisation / / pp /-/
Publication status
Published
Language
English
Keywords
WHO Code, health workers, global
Abstract
The WHO Global Code of Practice on the International Recruitment of Health Personnel was adopted by the 63rd World Health Assembly on 21 May 2010. The Code, which is voluntary in nature, sets forth ten articles advising both source and destination countries on how to regulate the recruitment of health personnel in a way that mitigates damage to low-income countries struggling to meet the basic health needs of their populations in a setting of serious workforce deficits.
Country
Publisher
World Health Organisation
Theme area
Human resources for health
Title of publication International Migration of Doctors, and Its Impact on Availability of Psychiatrists in Low and Middle Income Countries
Date of publication
2010 February
Publication type
Journal Article
Publication details
Plos ONE 5 2 pp /-/
Publication status
Published
Language
English
Keywords
migration, health workers, global
Abstract
Migration of health professionals from low and middle income countries to rich countries is a large scale and long-standing phenomenon, which is detrimental to the health systems in the donor countries. The authors sought to explore the extent of psychiatric migration. In the study, the authors use the respective professional databases in each country to establish the numbers of psychiatrists currently registered in the UK, US, New Zealand, and Australia who originate from other countries. The authors also estimate the impact of this migration on the psychiatrist population ratios in the donor countries. Within the study, there is a documentation of the large numbers of psychiatrists currently registered in the UK, US, New Zealand and Australia originating from India (4687 psychiatrists), Pakistan (1158), Bangladesh (149) , Nigeria (384) , Egypt (484), Sri Lanka (142), Philippines (1593). For some countries of origin, the numbers of psychiatrists currently registered within high-income countries' professional databases are very small (e.g., 5 psychiatrists of Tanzanian origin registered in the 4 high-income countries we studied), but this number is very significant compared to the 15 psychiatrists currently registered in Tanzania). Without such emigration, many countries would have more than double the number of psychiatrists per 100, 000 population (e.g. Bangladesh, Myanmar, Afghanistan, Egypt, Syria, Lebanon); and some countries would have had five to eight times more psychiatrists per 100,000 (e.g. Philippines, Pakistan, Sri Lanka, Liberia, Nigeria and Zambia). Large numbers of psychiatrists originating from key low and middle income countries are currently registered in the UK, US, New Zealand and Australia, with concomitant impact on the psychiatrist/population ratio n the originating countries. The authors suggest that creative international policy approaches are needed to ensure the individual migration rights of health professionals do not compromise societal population rights to health, and that there are public and fair agreements between countries within an internationally agreed framework.
Country
Publisher
Plos ONE
Theme area
Human resources for health
Title of publication The International Migration of Health Professionals. IZA Discussion Paper No. 6517
Date of publication
2011 April
Publication type
Document
Publication details
Institute for the Study of Labour 6517 / pp /-/
Publication status
Published
Language
English
Keywords
migration, health workers, global
Abstract
Health workforce shortages in developed countries are perceived to be central drivers of health professionals’ international migration, one ramification being negative impacts on developing nations’ healthcare delivery. After a descriptive international overview, selected economic issues are discussed for developed and developing countries. Health labour markets’ unique characteristics imply great complexity in developed economies involving government intervention, licensure, regulation, and (quasi-)union activity. These features affect migrants’ decisions, economic integration, and impacts on the receiving nations’ health workforce and society. Developing countries sometimes educate citizens in expectation of emigration, while others pursue international treaties in attempts to manage migrant flows.
Country
Publisher
Institute for the Study of Labour
Theme area
Values, policies and rights, Health equity in economic and trade policies, Equity and HIV/AIDS
Title of publication Access to Medicines and the Transformation of the South African State: Exploring the Interactions of Legal and Policy Changes in Health, Intellectual Property, Trade, and Competition Law in the Context of South Africa’s HIV/AIDS Pandemic
Date of publication
2012 April
Publication type
Journal Article
Publication details
Law & Social Inquiry 37 2 pp 297-329
Publication status
Published
Language
English
Keywords
Access to medicines, intellectual property, trade, law, HIV/AIDS, South Africa
Abstract
Access to essential medicines remains highly contested around the globe and a vital issue in South Africa. At the same time, the HIV/AIDS pandemic and the demand for medical services are having important political and social consequences in a society heavily impacted by the pandemic. Legal and institutional changes within the post apartheid state in South Africa are in part a reflection of the interaction of opportunities and constraints both within and across the country’s geographical boundaries. The transformation of state institutions in this context has been set in motion and shaped by different policy imperatives: from demands for medical care to the promotion of economic competition and the need to implement international trade commitments, including specific levels of intellectual property protection. Despite a strong commitment to social change, to address the legacies of apartheid, as well as the relative strength and political will of the dominant political party, the African National Congress, the transformation of a number of state institutions was significantly framed by the global environment in which the country found itself. In the context of South Africa’s democratic transition and the devastating HIV/ AIDS pandemic, the state responded to a range of shifting opportunities and constraints, whether real or perceived. As a result, impetus was given to different policies and competing political and economic factions, enabling particular institutions and rules to be embraced, created, reshaped, or simply foregone.
Country
Publisher
Law & Social Inquiry
Theme area
Health equity in economic and trade policies, Equitable health services
Title of publication Improving Access to Medicines for Neglected Tropical Diseases in Developing Countries: Lessons from Three Emerging Economies
Date of publication
2012 February
Publication type
Journal Article
Publication details
PloS Neglected Tropical Diseases 6 2 pp /-/
Publication status
Published
Language
English
Keywords
neglected tropical diseases, access to medicines, South Africa, Uganda
Abstract
Neglected tropical diseases (NTDs) are those largely ignored by medical science, partly because they do not represent a viable commercial market for private pharmaceutical companies. These diseases are endemic in developing countries and have a significant impact at both personal and national levels. Globally, NTDs affect an estimated 2.7 billion people living on less than US$2 per day and potently reinforce the poverty cycle. At present, the prevailing strategy for improving access to medicines for these NTDs is drug donation programmes, which, despite providing some of the highest economic returns of public health programmes at 15%–30% have uncertain sustainability. Countries in demographic and economic transition are uniquely poised to be leaders in a shift towards a more sustainable, affordable means of providing access to medicines for NTDs.
Country
Publisher
PloS Neglected Tropical Diseases
Theme area
Health equity in economic and trade policies, Equity and HIV/AIDS
Title of publication Driving a decade of change: HIV/AIDS, patents and access to medicines for all
Date of publication
2011 March
Publication type
Journal Article
Publication details
Journal of the International AIDS Society 14 15 pp /-/
Publication status
Published
Language
English
Keywords
HIV/AIDS, access to medicines, patents, Africa
Abstract
Since 2000, access to antiretroviral drugs to treat HIV infection has dramatically increased to reach more than five million people in developing countries. Essential to this achievement was the dramatic reduction in antiretroviral prices, a result of global political mobilization that cleared the way for competitive production of generic versions of widely patented medicines.Global trade rules agreed upon in 1994 required many developing countries to begin offering patents on medicines for the first time. Government and civil society reaction to expected increases in drug prices precipitated a series of events challenging these rules, culminating in the 2001 World Trade Organization's Doha Declaration on the Agreement on Trade-Related Aspects of Intellectual Property Rights and Public Health. The Declaration affirmed that patent rules should be interpreted and implemented to protect public health and to promote access to medicines for all. Since Doha, more than 60 low- and middle-income countries have procured generic versions of patented medicines on a large scale.Despite these changes, however, a "treatment timebomb" awaits. First, increasing numbers of people need access to newer antiretrovirals, but treatment costs are rising since new ARVs are likely to be more widely patented in developing countries. Second, policy space to produce or import generic versions of patented medicines is shrinking in some developing countries. Third, funding for medicines is falling far short of needs. Expanded use of the existing flexibilities in patent law and new models to address the second wave of the access to medicines crisis are required.One promising new mechanism is the UNITAID-supported Medicines Patent Pool, which seeks to facilitate access to patents to enable competitive generic medicines production and the development of improved products. Such innovative approaches are possible today due to the previous decade of AIDS activism. However, the Pool is just one of a broad set of policies needed to ensure access to medicines for all; other key measures include sufficient and reliable financing, research and development of new products targeted for use in resource-poor settings, and use of patent law flexibilities. Governments must live up to their obligations to protect access to medicines as a fundamental component of the human right to health.
Country
Publisher
Journal of the International AIDS Society
Theme area
Values, policies and rights
Title of publication Development of a Mental Health Policy and System in Tanzania: An Integrated Approach to Achieve Equity
Date of publication
2010 October
Publication type
Journal Article
Publication details
Psychiatric Services 61 / pp 1028-1031
Publication status
Published
Language
English
Keywords
mental health, health policy, Tanzania
Abstract
Although most donor and development agency attention is focused on communicable diseases in mainland Tanzania, the importance of noncommunicable diseases, including mental illness, is increasingly apparent. This report describes a ten-year collaborative project (1999—2009) to meet these challenges through a sustainable mental health policy introduced across Tanzania. The country used an integrated approach, combining situation appraisal, integrated mental health policy and planning, mechanisms for sustainable implementation with largely local resources integrated into local systems, and monitoring to fine-tune the implementation. The project led to inclusion of mental health in relevant health policy instruments, treatment at the primary care level, stronger referral and intersectoral coordination, and a focus on rehabilitation and public education. Although much remains to be done, Tanzania's commitment to mental health is now sustainedly embedded within its policies, national and local budgets, and training activities.
Country
Publisher
Psychiatric Services
Theme area
Resource allocation and health financing, Monitoring equity and research to policy
Title of publication Progressivity and horizontal equity in health care finance and delivery : What about Africa?
Date of publication
2007 January
Publication type
Journal Article
Publication details
Health Policy 80 1 pp 51-68
Publication status
Published
Language
English
Keywords
health financing, equity analysis, West Africa
Abstract
This paper applies concentration curves and indices, that have been previously used to analyze progressivity in health care finance and horizontal equity in health care delivery in developed countries, to a 1998-1999 household survey about health care expenditures and utilization carried out in four francophone West African capitals (Abidjan, Bamako, Conakry and Dakar). The paper also uses statistical inference for testing stochastic dominance relationship between curves, a technique already applied in the literature about equity in taxation, as the criterion for making rigorous inequality comparisons. In all four capitals, the results strongly suggest a regressive pattern of payments for health care, with lower income groups bearing an higher burden of health expenditures as a proportion of their income than do the higher income segments of the population. As soon as dominance between concentrations curves is statistically tested, results appear less conclusive, notably for the groups of population affected by severe morbidity, on the issue of horizontal inequity in health care delivery, which requires that persons with similar medical need be treated equally. Some recommendations are made for the use of equity measurements in access to care for future evaluations of the impact of health care reforms in Africa.
Country
Publisher
Health Policy
Theme area
Equitable health services
Title of publication Why do health workers in rural Tanzania prefer public sector employment?
Date of publication
2012 April
Publication type
Journal Article
Publication details
BMC Health Services Research 12 92 pp /-/
Publication status
Published
Language
English
Keywords
health workers, health services, Tanzania
Abstract
Severe shortages of qualified health workers and geographical imbalances in the workforce in many low-income countries require the national health sector management to closely monitor and address issues related to the distribution of health workers across various types of health facilities. This article discusses health workers' preferences for workplace and their perceptions and experiences of the differences in working conditions in the public health sector versus the church-run health facilities in Tanzania. The broader aim is to generate knowledge that can add to debates on health sector management in low-income contexts. The study has a qualitative study design to elicit in-depth information on health workers' preferences for workplace. The data comprise ten focus group discussions (FGDs) and 29 in-depth interviews (IDIs) with auxiliary staff, nursing staff, clinicians and administrators in the public health sector and in a large church-run hospital in a rural district in Tanzania. The study has an ethnographic backdrop based on earlier long-term fieldwork in Tanzania. The study found a clear preference for public sector employment. This was associated with health worker rights and access to various benefits offered to health workers in government service, particularly the favourable pension schemes providing economic security in old age. Health workers acknowledged that church-run hospitals generally were better equipped and provided better quality patient care, but these concerns tended to be outweighed by the financial assets of public sector employment. In addition to the sector specific differences, family concerns emerged as important in decisions on workplace. The preference for public sector employment among health workers shown in this study seems to be associated primarily with the favourable pension scheme. The overall shortage of health workers and the distribution between health facilities is a challenge in a resource constrained health system where church-run health facilities are vital in the provision of health care in rural areas and where patients tend to prefer these services. In order to ensure equity in distribution of qualified health workers in Tanzania, a national regulation and legislation of the pension schemes is required.
Country
Publisher
BMC Health Services Research
Theme area
Governance and participation in health
Title of publication National launch meeting of the Zambia Health Literacy Programme, Workshop report, Lusaka, 26 July 2012
Date of publication
2012 August
Publication type
Report
Publication details
National launch meeting of the Zambia Health Literacy Programme, Workshop report, Lusaka, 26 July 2012 LDHMT, TARSC, EQUINET, Zambia
Publication status
Published
Language
Keywords
health literacy; Zambia
Abstract
In 2006-2009, as part of the regional learning network, LDHMT used participatory action
research (PAR) to strengthen joint planning and communication, co-operation and trust
between communities and health workers. In 2010, building on positive changes found,
LDHMT with TARSC and with Cordaid support piloted a programme to train health literacy
facilitators and hold community health literacy sessions in 3 areas of Lusaka. The positive
feedback from that programme led to dialogue with the Ministry of Health and the proposal
for national level implementation of the healthy literacy HL) programme. This national
workshop was thus held with lead stakeholders to review the work done to date and discuss the content, approach and steps towards implementing the programme at national level.
Country
Zambia
Publisher
LDHMT, TARSC, EQUINET
Equinet Publication Type
Reports
Theme area
Human resources for health
Title of publication Report of a Consultation on Improving Access to Health Worker at the Frontline for Better Maternal and Child Survival, Intercontinental Hotel, Nairobi, Kenya; 25-27 June 2012
Date of publication
2012 September
Publication type
Report
Publication details
Report of a Consultation on Improving Access to Health Worker at the Frontline for Better Maternal and Child Survival, Intercontinental Hotel, Nairobi, Kenya; 25-27 June 2012, U Limpopo, EQUINET, South Africa
Publication status
Published
Language
Keywords
health workers, maternal and child health, Africa
Abstract
The objective of the consultation was ‘to speed up and scale up country responses to the human resource needs of both the UN Global Strategy for Women’s and Children’s Health (Every Woman Every Child), and the Global Plan towards the Elimination of New HIV Infections Among Children by 2015 and Keeping their Mothers Alive (Global Plan) as a key aspect of both plans’. The intended outcomes of this consultation were broadly stated as:a. Identification of concrete opportunities for progress as well as obstacles to such progress
b. Documentation of experiences on successes and failures. Through a combination of interactive sessions, the Consultation reviewed progress at country level, what technical support exists, and good practices within the countries. The Consultation underscored the need for ministries of health, continental mechanisms such as the AUC, regional organisations such as ECSA HC, SADC, WAHO and OCEAC, development partners, FBOs, funding agencies, academic and research institutions, and civil society organisations to give priority to efforts towards increasing access to health workers at the frontline for better maternal and child survival and provided a communique of recommendations on actions to achieve this.
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Reports
Theme area
Equity in health, Values, policies and rights, Health equity in economic and trade policies, Poverty and health, Equitable health services, Human resources for health, Public-private mix, Resource allocation and health financing, Equity and HIV/AIDS, Governance and participation in health, Monitoring equity and research to policy
Title of publication Regional Equity Watch 2012: Assessing progress towards equity in health in East and Southern Africa PART 2
Date of publication
2012 August
Publication type
Book
Publication details
EQUINET (2012) Regional Equity Watch 2012: Assessing progress towards equity in health in East and Southern Africa, EQUINET, Harare
Publication status
Published
Language
Keywords
health equity, east and southern Africa, equity watch
Abstract
PART TWO OF A BOOK IN TWO PARTS. An Equity Watch is a means of monitoring progress on health equity by gathering, organizing, analysing, reporting and reviewing evidence on equity in health. This 2012 Regional Equity Analysis updates the 2007 EQUINET Regional analysis of equity in health, drawing on the Equity Watch framework developed by EQUINET in cooperation with the East, Central and Southern African Health Community and in consultation with WHO and UNICEF, with some modifications given its regional nature. The report provides evidence from 16 countries in East and Southern Africa, including more detailed evidence from the country Equity Watch reports, on: Policy, political and legal commitments to equity in health; The current situation with respect to equity in health outcomes; Economic opportunities and challenges for health equity; Household access to the resources for health and the social determinants of health; Challenging inequities through redistributive health systems and global (in)justice and the issues for global engagement. The analysis shows past levels and current levels (most current data publicly available) and comments on the level of progress towards health equity. It raises the factors affecting progress and the challenges to be addressed. The analysis intends to be a comprehensive resource. As the report watches and supports progress, and not simply problems, it includes brief outlines of approaches being taken within the region to advance equity that appear to be yielding progress, with references where further information can be found. Finally, the report presents reflection on the experience of implementing equity analysis at country and regional level and on the experience of the Country Equity Watch work in institutionalising planning and monitoring for health equity.
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Book, Equity indicators
Theme area
Equity in health, Values, policies and rights, Health equity in economic and trade policies, Poverty and health, Equitable health services, Human resources for health, Public-private mix, Resource allocation and health financing, Equity and HIV/AIDS, Governance and participation in health, Monitoring equity and research to policy
Title of publication Regional Equity Watch 2012: Assessing progress towards equity in health in East and Southern Africa PART 1
Date of publication
2012 August
Publication type
Book
Publication details
EQUINET (2012) Regional Equity Watch 2012: Assessing progress towards equity in health in East and Southern Africa, EQUINET, Harare
Publication status
Published
Language
Keywords
health equity, east and southern Africa; equity watch
Abstract
PART ONE OF A BOOK IN TWO PARTS. An Equity Watch is a means of monitoring progress on health equity by gathering, organizing, analysing, reporting and reviewing evidence on equity in health. This 2012 Regional Equity Analysis updates the 2007 EQUINET Regional analysis of equity in health, drawing on the Equity Watch framework developed by EQUINET in cooperation with the East, Central and Southern African Health Community and in consultation with WHO and UNICEF, with some modifications given its regional nature. The report provides evidence from 16 countries in East and Southern Africa, including more detailed evidence from the country Equity Watch reports, on: Policy, political and legal commitments to equity in health; The current situation with respect to equity in health outcomes; Economic opportunities and challenges for health equity; Household access to the resources for health and the social determinants of health; Challenging inequities through redistributive health systems and global (in)justice and the issues for global engagement. The analysis shows past levels and current levels (most current data publicly available) and comments on the level of progress towards health equity. It raises the factors affecting progress and the challenges to be addressed. The analysis intends to be a comprehensive resource. As the report watches and supports progress, and not simply problems, it includes brief outlines of approaches being taken within the region to advance equity that appear to be yielding progress, with references where further information can be found. Finally, the report presents reflection on the experience of implementing equity analysis at country and regional level and on the experience of the Country Equity Watch work in institutionalising planning and monitoring for health equity.
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Book, Equity indicators
Theme area
Equitable health services
Title of publication Malaria control in Malawi: Are the poor being served?
Date of publication
2007 December
Publication type
Journal Article
Publication details
International Journal for Equity in Health 6 22 pp /-/
Publication status
Published
Language
English
Keywords
malaria, control, Malawi
Abstract
In Africa, national governments and international organizations are focusing on rapidly "scaling up" malaria control interventions to at least 60 percent of vulnerable populations. The potential health and economic benefits of "scaling up" will depend on the equitable access to malaria control measures by the poor. This paper analyses the present inequalities in access to malaria interventions in Malawi. Equity in access to malaria control measures was assessed using the Malawi Demographic Health Survey (DHS) 2000 and the 2004 national survey on malaria control. Utilisation of malaria control methods was compared across the wealth quintiles, to determine whether the poor were being reached with malaria control measures. Overall ITN coverage increased from 5% in 2000 to 35% in 2004. However, there was a disproportionate concentration of ITNs amongst the least poor compared to the poorest group. Effective treatment of fever remains unacceptably low with only 17% of the under-five children being promptly treated with an effective antimalarial drug. And only 29 percent of pregnant women received the recommended dose of at least two doses during the pregnancy. No income related inequalities were associated with prompt treatment and IPT use. The present distribution strategies for ITNs are not addressing the needs of the vulnerable groups, especially the poor. Increasing access to ITNs by the poor will require innovative distribution models which deliberately target the poorest of the poor.
Country
Publisher
International Journal for Equity in Health
Theme area
Monitoring equity and research to policy
Title of publication Exploring health systems research and its influence on policy processes in low income countries
Date of publication
2007 October
Publication type
Journal Article
Publication details
BMC Public Health 7 309 pp /-/
Publication status
Published
Language
English
Keywords
research to policy, Africa
Abstract
The interface between research and policymaking in low-income countries is highly complex. The ability of health systems research to influence policy processes in such settings face numerous challenges. Successful analysis of the research-policy interface in these settings requires understanding of contextual factors as well as key influences on the interface. Future Health Systems (FHS): Innovations for Equity is a consortium conducting research in six countries in Asia and Africa. One of the three cross-country research themes of the consortium is analysis of the relationship between research (evidence) and policy making, especially their impact on the poor; insights gained in the initial conceptual phase of FHS activities can inform the global knowledge pool on this subject. This paper provides a review of the research-policy interface in low-income countries and proposes a conceptual framework, followed by directions for empirical approaches. First, four developmental perspectives are considered: social institutional factors; virtual versus grassroots realities; science-society relationships; and construction of social arrangements. Building on these developmental perspectives three research-policy interface entry points are identified: Firstly, recognising policy as complex processes; Secondly, engaging key stakeholders: decision-makers, providers, scientists, and communities; and thirdly, enhancing accountability. A conceptual framework with three entry points to the research-policy interface – policy processes; stakeholder interests, values, and power; and accountability – within a context provided by four developmental perspectives is proposed. Potential empirical approaches to the research-policy interface are then reviewed. Finally, the value of such innovative empirical analysis is considered. The purpose of this paper is to provide the background, conceptual framework, and key research directions for empirical activities focused on the research-policy interface in low income settings. The interface can be strengthened through such analysis leading to potential improvements in population health in low-income settings. Health system development cognizant of the myriad factors at the research-policy interface can form the basis for innovative future health systems.
Country
Publisher
BMC Public Health
Theme area
Equitable health services, Equity and HIV/AIDS
Title of publication Rationing access to public-sector antiretroviral treatment during scale-up in South Africa: Implications for equity
Date of publication
2008 May
Publication type
Journal Article
Publication details
African Journal Of AIDS Research 7 1 pp 19-27
Publication status
Published
Language
English
Keywords
antiretroviral therapy, rationing, South Africa
Abstract
The authors argue that as with other large-scale antiretroviral therapy (ART) programmes initiated in developing countries, rationing of ART in South Africa was inevitable in the face of limited human and infrastructural resources. This paper discusses rationing of ART and its implications for equity in South Africa, with a particular emphasis on the national programme in the Free State Province. The authors examine both the explicit and implicit dimensions of ART rationing, while considering the content of policy, programme design and implementation processes. The explicit rationing criteria included in the national comprehensive plan, as well as the associated treatment guidelines, direct and influence rationing decisions practised locally. However, implicit processes of rationing, which limit demand, are also wittingly and unwittingly introduced in several ways, and at all levels of the health service. Consequences of rationing manifest in the high numbers of patients lost to the system and the difficulties faced by the most impoverished clients in gaining access to ART services on an ongoing basis. Not losing sight of the equity element within rationing is important, and this aspect will have to be formally monitored for eventual success of the country's ART programme. ART roll-out processes also require ongoing efforts to build consensus and confidence in rationing, accomplished with a view to optimal fairness.
Country
Publisher
African Journal Of AIDS Research
Theme area
Values, policies and rights, Monitoring equity and research to policy
Title of publication Equity and health policy in Africa: Using concept mapping in Moore (Burkina Faso)
Date of publication
2008
Publication type
Journal Article
Publication details
BMC Health Services Research 8 / pp /-/
Publication status
Published
Language
English
Keywords
health policy, concept mapping, Burkina Faso
Abstract
This methodological article is based on a health policy research project conducted in Burkina Faso (West Africa). Concept mapping (CM) was used as a research method to understand the local views of equity among stakeholders, who were concerned by the health policy under consideration. While this technique has been used in North America and elsewhere, to the authors knowledge it has not yet been applied in Africa in any vernacular language. Its application raises many issues and certain methodological limitations. The objective in this article is to present its use in this particular context, and to share a number of methodological observations on the subject. Two CMs were done among two different groups of local stakeholders following four steps: generating ideas, structuring the ideas, computing maps using multidimensional scaling and cluster analysis methods, and interpreting maps. The local perception of equity seems close to the egalitarian model. The actors are not ready to compromise social stability and peace for the benefit of the worst-off. The discussion on the methodological limitations of CM raises the limitations of asking a single question in Moore and the challenge of translating a concept as complex as equity. While the translation of equity into Moore undoubtedly oriented the discussions toward social relations, we believe that, in the context of this study, the open-ended question concerning social justice has a threefold relevance. At the same time, those limitations were transformed into strengths. The authors understand that it was essential to resort to the focus group approach to explore deeply a complex subject such as equity, which became, after the two CMs, one of the important topics of the research.
Country
Publisher
BMC Health Services Research
Theme area
Equitable health services, Equity and HIV/AIDS
Title of publication Can a developing country support the welfare needs of children affected by AIDS? A perspective from Tanzania
Date of publication
2008 November
Publication type
Journal Article
Publication details
IDS Bulletin 39 5 pp 88-93
Publication status
Published
Language
English
Keywords
targetting, child welfare, AIDS, Tanzania
Abstract
Analysis of the prevalence of HIV/AIDS in Tanzania shows a poor match between poverty and HIV/AIDS. Targeting AIDS orphans for assistance is therefore not appropriate on the grounds of equity, even if it were feasible and not stigmatising. The programme costed here would support the 'most vulnerable children' defined using criteria including orphanhood, disability and poverty, affecting 5 per cent of all children (nearly 1 million). Costings are estimated on the basis of bringing children living 30 per cent below Tanzania's national poverty line (which is below $1 a day) to that poverty line. The total cost is estimated at 1 per cent of the government budget and 11 per cent of the funds provided for HIV/AIDS - clearly an affordable sum, While this level of support is acknowledged to be minimal, it would support more equitably than current programmes the most pressing welfare needs of the most destitute children, including many orphaned as a consequence of AIDS.
Country
Publisher
IDS Bulletin
Theme area
Poverty and health, Equity and HIV/AIDS
Title of publication Women's health, HIV/AIDS and the workplace in South Africa
Date of publication
2008 November
Publication type
Journal Article
Publication details
African Journal Of AIDS Research 7 3 pp 341-352
Publication status
Published
Language
English
Keywords
women's health, HIV/AIDS, workplace, gender equity, South Africa
Abstract
This work explores the connections between gender inequality, HIV/AIDS and women's health in the world of work in South Africa. These connections are located within a context of significant reversals in development, specifically declining life expectancy and premature mortality for South Africans - particularly for women. By relying on the existing literature and interviews with 33 key informants, the paper examines the extent to which South African workplaces are recognising women's social and biological vulnerability to HIV. In particular, the paper considers the potential role of the workplace in responding to growing evidence that links gender and health by establishing targeted HIV/AIDS interventions. The findings suggest that the vast majority of company representatives do not recognise women's social and biological vulnerability and related social norms vis-à-vis HIV and AIDS. Importantly, most workplaces are not initiating programmes that specifically address women's or men's health. The author briefly identifies factors that may help explain the current state of knowledge and practice in the realm of HIV and women's health in the workplace, and puts forward suggestions for future research.
Country
Publisher
African Journal Of AIDS Research
Theme area
Equitable health services
Title of publication A rapid assessment of district Health Systems in six countries of the WHO African region
Date of publication
2009 January
Publication type
Journal Article
Publication details
East African Medical Journal 86 Suppl 1 pp S13-S24
Publication status
Published
Language
English
Keywords
primary health care, district health systems, Africa
Abstract
This paper reviews the adequacy of inputs and processes at district level to support outputs and outcomes of service delivery at district level using a rapid assessment. The outputs included in this study are those considered essential for the attainment of the Health related Millennium Development Goals(MDGs). A questionnaire based rapid District Health Systems assessment was conducted among six African countries during the year 2007. The study took place in a random sample of six out of 19 English speaking countries of the WHO African region. These countries are Ghana, Liberia, Namibia, Nigeria, Sierra Leone and Uganda. The data was extracted from the questionnaires, entered and analysed in Excel spreadsheet. In spite of the variability in quality and completeness of reporting on the selected parameters, this paper does indicate that according to country norms and standards, the inputs and processes are insufficient to lead to acceptable outputs and outcomes, especially those related to the MDGs. An important point to note is that comparability across countries is made on the basis of individual country norms and standards. Implicit in this assessment is that country norms and standards are reasonable and are appropriate for the attainment of the MDGs. However reasonable the country norms and standard are, it is unlikely that the low resource base as well as weak organisational and managerial capacities in most countries will support effectively the attainment of the MDGs. Most countries manage to offer the essential health services at all levels of care despite the relatively low level of inputs. However, their level of quality and equity is debatable. The general trend is that provision of the essential health services is more at the higher levels of care prompting concerns for the populations served at lower levels of care. There is also a tendency to have wide variations in the performance of service delivery geographically as well as at the different levels of the health systems. This paper recommends further exploration of the impact of focusing on improving quality of existing health services while increasing quantity of service delivery points to achieve higher coverage of essential health services.
Country
Publisher
East African Medical Journal
Theme area
Equitable health services, Monitoring equity and research to policy
Title of publication Towards building equitable health systems in Sub-Saharan Africa: lessons from case studies on operational research
Date of publication
2009 November
Publication type
Journal Article
Publication details
Health Research Policy and Systems 7 25 pp /-/
Publication status
Published
Language
English
Keywords
equitable health systems, research to policy, Africa
Abstract
Published practical examples of how to bridge gaps between research, policy and practice in health systems research in Sub Saharan Africa are scarce. The aim of the study was to use a case study approach to analyse how and why different operational health research projects in Africa have contributed to health systems strengthening and promoted equity in health service provision. Using case studies the authors collated and analysed practical examples of operational research projects on health in Sub-Saharan Africa which demonstrate how the links between research, policy and action can be strengthened to build effective and pro-poor health systems. To ensure rigour, case studies were selected using pre-defined criteria, their characteristics mapped systematically using a case study development framework, and analysed the research impact process of each case study using the RAPID framework for research-policy links. This process enabled analysis of common themes, successes and weaknesses. Three operational research projects met the case study criteria: HIV counselling and testing services in Kenya; provision of TB services in grocery stores in Malawi; and community diagnostics for anaemia, TB and malaria in Nigeria. Political context and external influences: in each case study context there was a need for new knowledge and approaches to meet policy requirements for equitable service delivery. Collaboration between researchers and key policy players began at the inception of operational research cycles. Critical in these operational research projects was the development of partnerships for capacity building to support new services or new players in service delivery. Evidence was used to promote policy dialogue around equity in different ways throughout the research cycle, such as in determining the topic area and in development of indicators. Building equitable health systems means considering equity at different stages of the research cycle. Partnerships for capacity building promotes demand, delivery and uptake of research. Links with those who use and benefit from research, such as communities, service providers and policy makers, contribute to the timeliness and relevance of the research agenda and a receptive research-policy-practice interface. The study highlights the need to advocate for a global research culture that values and funds these multiple levels of engagement.
Country
Publisher
Health Research Policy and Systems
Theme area
Governance and participation in health
Title of publication Education and religious beliefs: Supportive determinants in the understanding of health issues in Sub-Saharan Africa
Date of publication
2010 August
Publication type
Journal Article
Publication details
Studies on Ethno-Medicine 4 2 pp 81-94
Publication status
Published
Language
English
Keywords
Social determinants, religion; primary health care; Cameroon
Abstract
In the aftermath of the 1978 WHO conference where the Alma Ata Declaration on primary health care was issued, the Cameroonian government was striving to guarantee equity in health care by developing a policy targeting social justice and assurance of "health for all" by 2000s. From this, a research programme based on health in the urban milieu was conceived in 2000 to address the population's state of health. The epidemiological and transversal study was carried out in April-May 2005 on children aged between 6 and 59 months in Yaoundé (Cameroon). The objectives of this study were to identify risk factors predisposing people to diarrheas in the city, to measure their prevalence, and ascertain their spatial distribution, all in a bid to evaluate the progress made in infant health since 1978. The microbiological analyses carried out revealed an average diarrhea prevalence rate of 14.4% (437 cases of diarrhea on the 3034 infants tested). Amongst many other factors, the level of education and the religious belief of the household head were seen to be associated with the occurrence of infants' diarrhea. In addition, it was acknowledged that the level of diarrhea infection in the city varies considerably from one household to another.
Country
Publisher
Studies on Ethno-Medicine
Theme area
Equity in health, Values, policies and rights
Title of publication The millennium development goals: A cross-sectoral analysis and principles for goal setting after 2015
Date of publication
2010 September
Publication type
Journal Article
Publication details
The Lancet 376 9745 pp 991-1023
Publication status
Published
Language
English
Keywords
Millenium Development Goals, cross sectoral analysis, global
Abstract
The Millennium Development Goals (MDGs) represent an unprecedented global consensus about measures to reduce poverty. The eight goals address targets to increase incomes; reduce hunger; achieve universal primaryeducation; eliminate gender inequality; reduce maternal and child mortality; reverse the spread of HIV/AIDS, tuberculosis, and malaria; reverse the loss of natural resources and biodiversity; improve access to water, sanitation, and good housing; and establish eff ective global partnerships. Progress in some goals has been impressive; however, global targets will not be met in some regions, particularly sub-Saharan Africa and south Asia. As we approach the 2015 target date, there is considerable interest in assessment of the present goals and in consideration of the future of development goals after 2015. This Commission has brought together sectoral experts on different MDGs from the London International Development Centre to identify cross-cutting challenges that have emerged from MDG implementation so far. This interdisciplinary approach differs from previous MDG studies that have either examined individual goals or made broad sociopolitical assessments of the MDGs as a development mechanism. The authors used their analysis of crosscutting challenges as the basis to identify a set of principles for future goal development, after 2015. This report is therefore not an assessment of the MDGs; instead the authors focus deliberately on challenges with the implementation of the MDGs so as to inform future goal setting.
Country
Publisher
The Lancet
Theme area
Equity in health, Equity and HIV/AIDS
Title of publication Equity in HIV testing: Evidence from a cross-sectional study in ten Southern African countries
Date of publication
2010 September
Publication type
Journal Article
Publication details
BMC International Health And Human Rights 10 1 pp /-/
Publication status
Published
Language
English
Keywords
equity, HIV, testing, East and Southern Africa
Abstract
HIV testing with counseling is an integral component of most national HIV and AIDS prevention strategies in southern Africa. Equity in testing implies that people at higher risk for HIV such as women; those who do not use condoms consistently; those with multiple partners; those who have suffered gender based violence; and those who are unable to implement prevention choices (the choice-disabled) are tested and can have access to treatment. The authors conducted a household survey of 24,069 people in nationally stratified random samples of communities in Botswana, Lesotho, Malawi, Mozambique, Namibia, South Africa, Swaziland, Tanzania, Zambia, and Zimbabwe. Participants were asked about testing for HIV in the last 12 months, intention to test, and about HIV risk behaviour, socioeconomic indicators, access to information, and attitudes related to stigma. Across the ten countries, seven out of every ten people said they planned to have an HIV test but the actual proportion tested in the last 12 months varied from 24% in Mozambique to 64% in Botswana. Generally, people at higher risk of HIV were not more likely to have been tested in the last year than those at lower risk, although women were more likely than men to have been tested in six of the ten countries. In Swaziland, those who experienced partner violence were more likely to test, but in Botswana those who were choice-disabled for condom use were less likely to be tested. The two most consistent factors associated with HIV testing across the countries were having heard about HIV/AIDS from a clinic or health centre, and having talked to someone about HIV and AIDS. HIV testing programmes need to encourage people at higher risk of HIV to get tested, particularly those who do not interact regularly with the health system. Service providers need to recognise that some people are not able to implement HIV preventive actions and may not feel empowered to get themselves tested.
Country
Publisher
BMC International Health And Human Rights
Theme area
Poverty and health
Title of publication How much water is enough? Domestic metered water consumption and free basic water volumes: The case of Eastwood, Pietermaritzburg
Date of publication
2010 October
Publication type
Journal Article
Publication details
Water SA 36 5 pp 595-606
Publication status
Published
Language
English
Keywords
safe water, South Africa
Abstract
This article is based on an in-depth case study of urban water services to poor households in the community of Eastwood, Pietermaritzburg, in the province of KwaZulu-Natal, South Africa, for the period 2005-2007. The article adopts a mixedmethodological approach. Despite government progress in delivering water infrastructure post-1994, ability to pay for the service limited access. The free basic water policy, initiated by national Government in 2001, sought to provide all citizens, but particularly the poor, with a basic supply of free water. The concessions were envisaged to improve public health, gender and equity, affordability, and as an instrument of post-apartheid redress and poverty alleviation. Once free basic water (FBW) was declared a new imperative for local government the debate on exactly how much was enough, why 6 kℓ was chosen, the structure of the offering and broader state intentions opened up. This article positions the FBW offering within the prevailing international discourse on 'need' calculation. Through the exploration of actual water consumption patterns of urban poor households, the ideological assumptions and 'scientific' calculations underpinning this discourse were found to have ignored the fluidness of use as well as the value of water beyond mere physiological need. In this regard, access to FBW was conditioned on a small household size and further predicated the modification of normal water activities and lifestyle and carried a disproportionate social cost. The free basic volume of 6 kl was found to have no resonance with actual water volumes consumed by the majority of Eastwood households.
Country
Publisher
Water SA
Theme area
Equitable health services, Public-private mix
Title of publication Canada's health care system: A relevant approach for South Africa?
Date of publication
2010 August
Publication type
Journal Article
Publication details
South African Medical Journal 100 8 pp 516-520
Publication status
Published
Language
English
Keywords
national health programs, health care systems, South Africa
Abstract
While countries such as the USA, South Africa and China debate health reforms to improve access to care while rationalising costs, Canada's health care system has emerged as a notable option. In the USA, meaningful discussion of the advantages and disadvantages of the Canadian system has been thwarted by ideological mudslinging on the part of large insurance companies seeking to preserve their ultra-profitable turf and backed by conservative political forces stirring up old fears of 'socialised medicine'. These distractions have relegated the possibility of a 'public option' to the legislative dustbin, leaving tens of millions of people to face uninsurance, under-insurance, bankruptcy and unnecessary death and suffering, even after passage of the Obama health plan. While South Africa appears to experience similar legislative paralysis, there remains room for reasoned health reform debate to address issues of equity, access, and financing. Objective. Our aim is to contribute to the debate from a Canadian perspective, setting out the basic principles of Medicare (Canada's health care system), reviewing its advantages and challenges, clarifying misunderstandings, and exploring its relevance to South Africa. The authors periodically refer to the USA because of the similarities to the South African situation, including its health care system, which mirrors South Africa's current position if left unchanged. Conclusion. While Medicare is neither flawless nor a model worthy of wholesale imitation, the authors contend that open discussion of Canada's experience is a useful component in South Africa's current policy and political efforts.
Country
Publisher
South African Medical Journal
Theme area
Resource allocation and health financing, Governance and participation in health
Title of publication Cost-effectiveness analysis for priority-setting in South Africa - what are the possibilities?
Date of publication
2010 December
Publication type
Journal Article
Publication details
South African Medical Journal 100 12 pp 816-821
Publication status
Published
Language
English
Keywords
cost-benefit analysis, health policy, South Africa
Abstract
Priority-setting in the health system is necessary because resources are constrained. The role of cost-effectiveness analysis in supporting decision-making around health care priorities in South Africa is explored by referring to South African studies that have provided clinical and policy guidance at the levels of the patient, the service and the population. Cost-effectiveness evidence is positioned in relation to other concerns such as equity and the overall performance of the health system.
Country
Publisher
South African Medical Journal
Theme area
Resource allocation and health financing
Title of publication The essence of governance in health development
Date of publication
2011 March
Publication type
Journal Article
Publication details
International Archives of Medicine 4 1 pp /-/
Publication status
Published
Language
English
Keywords
governance, health development, health policy, Millenium Development Goals, Africa
Abstract
Governance and leadership in health development are critically important for the achievement of the health Millennium Development Goals (MDGs) and other national health goals. Those two factors might explain why many countries in Africa are not on track to attain the health MDGs by 2015. This paper debates the meaning of 'governance in health development', reviews briefly existing governance frameworks, proposes a modified framework on health development governance (HDG), and develops a HDG index. Discussion. The authors argue that unlike 'leadership in health development', 'governance in health development' is the sole prerogative of the Government through the Ministry of Health, which can choose to delegate (but not abrogate) some of the governance tasks. The general governance domains of the UNDP and the World Bank are very pertinent but not sufficient for assessment of health development governance. The WHO six domains of governance do not include effective external partnerships for health, equity in health development, efficiency in resource allocation and use, ethical practises in health research and service provision, and macroeconomic and political stability. The framework for assessing health systems governance developed by Siddiqi et al also does not include macroeconomic and political stability as a separate principle. The Siddiqi et al framework does not propose a way of scoring the various governance domains to facilitate aggregation, inter-country comparisons and health development governance tracking over time. This paper argues for a broader health development governance framework because other sectors that assure human rights to education, employment, food, housing, political participation, and security combined have greater impact on health development than the health systems. It also suggests some amendments to Siddigi et al's framework to make it more relevant to the broader concept of 'governance in health development' and to the WHO African Region context. Summary. A strong case for broader health development governance framework has been made. A health development governance index with 10 functions and 42 sub-functions has been proposed to facilitate inter-country comparisons. Potential sources of data for estimating HDGI have been suggested. The Governance indices for individual sub-functions can aid policy-makers to establish the sources of weak health governance and subsequently develop appropriate interventions for ameliorating the situation.
Country
Publisher
International Archives of Medicine
Theme area
Equity in health, Governance and participation in health
Title of publication Health systems performance in Sub-Saharan Africa: Governance, outcome and equity
Date of publication
2011 April
Publication type
Journal Article
Publication details
BMC Public Health 11 237 pp /-/
Publication status
Published
Language
English
Keywords
health systems, governance, equity, Africa
Abstract
The literature on health systems focuses largely on the performance of healthcare systems operationalised around indicators such as hospital beds, maternity care and immunisation coverage. A broader definition of health systems however, needs to include the wider determinants of health including, possibly, governance and its relationship to health and health equity. The aim of this study was to examine the relationship between health systems outcomes and equity, and governance as a part of a process to extend the range of indicators used to assess health systems performance. Using cross sectional data from 46 countries in the African region of the World Health Organization, an ecological analysis was conducted to examine the relationship between governance and health systems performance. The data were analysed using multiple linear regression and a standard progressive modelling procedure. The under-five mortality rate (U5MR) was used as the health outcome measure and the ratio of U5MR in the wealthiest and poorest quintiles was used as the measure of health equity. Governance was measured using two contextually relevant indices developed by the Mo Ibrahim Foundation. Governance was strongly associated with U5MR and moderately associated with the U5MR quintile ratio. After controlling for possible confounding by healthcare, finance, education, and water and sanitation, governance remained significantly associated with U5MR. Governance was not, however, significantly associated with equity in U5MR outcomes. This study suggests that the quality of governance may be an important structural determinant of health systems performance, and could be an indicator to be monitored. The association suggests there might be a causal relationship. However, the cross-sectional design, the level of missing data, and the small sample size, forces tentative conclusions. Further research will be needed to assess the causal relationship, and its generalizability beyond U5MR as a health outcome measure, as well as the geographical generalizability of the results.
Country
Publisher
BMC Public Health
Theme area
Values, policies and rights, Equitable health services
Title of publication Carework and caring: A path to gender equitable practices among men in South Africa?
Date of publication
2011 May
Publication type
Journal Article
Publication details
International Journal For Equity In Health 10 17 pp /-/
Publication status
Published
Language
English
Keywords
gender equity, health care work, South Africa
Abstract
The purpose of this study was to examine the relationship between men who engage in carework and commitment to gender equity. The context of the study was that gender inequitable masculinities create vulnerability for men and women to HIV and other health concerns. Interventions are being developed to work with masculinity and to 'change men'. Researchers now face a challenge of identifying change in men, especially in domains of their lives beyond relations with women. Engagement in carework is one suggested indicator of more gender equitable practice. A qualitative approach was used. 20 men in three South African locations (Durban, Pretoria/Johannesburg, Mthatha) who were identified as engaging in carework were interviewed. The men came from different backgrounds and varied in terms of age, race and socio-economic status. A semi-structured approach was used in the interviews. Men were engaged in different forms of carework and their motivations to be involved differed. Some men did carework out of necessity. Poverty, associated with illness in the family and a lack of resources propelled some men into carework. Other men saw carework as part of a commitment to making a better world. 'Care' interpreted as a functional activity was not enough to either create or signify support for gender equity. Only when care had an emotional resonance did it relate to gender equity commitment. Engagement in carework precipitated a process of identity and value transformation in some men suggesting that support for carework still deserves to be a goal of interventions to 'change men'. Changing the gender of carework contributes to a more equitable gender division of labour and challenges gender stereotypes. Interventions that promote caring also advance gender equity.
Country
Publisher
International Journal For Equity In Health
Theme area
Poverty and health, Equity and HIV/AIDS
Title of publication Violence and Abuse Among HIV-Infected Women and Their Children in Zambia
Date of publication
2006 August
Publication type
Journal Article
Publication details
Journal of Nervous and Mental Disease 194 8 pp 610-615
Publication status
Published
Language
English
Keywords
HIV, violence, Zambia
Abstract
HIV and violence are two major public health problems increasingly shown to be connected and relevant to international mental health issues and HIV-related services. Qualitative research is important due to the dearth of literature on this association in developing countries, cultural influences on mental health syndromes and presentations, and the sensitive nature of the topic. The study presented in this paper sought to investigate the mental health issues of an HIV-affected population of women and children in Lusaka, Zambia, through a systematic qualitative study. Two qualitative methods resulted in the identification of three major problems for women: domestic violence (DV), depression-like syndrome, and alcohol abuse; and children: defilement, DV, and behavior problems. DV and sexual abuse were found to be closely linked to HIV and alcohol abuse. This study shows the local perspective of the overlap between violence and HIV. Results are discussed in relation to the need for violence and abuse to be addressed as HIV services are implemented in sub-Saharan Africa.
Country
Publisher
Journal of Nervous and Mental Disease
Theme area
Equitable health services, Equity and HIV/AIDS
Title of publication Rapid Scale-up of Antiretroviral Therapy at Primary Care Sites in Zambia
Date of publication
2006 August
Publication type
Journal Article
Publication details
Journal of the American Medical Association 296 7 pp 782-793
Publication status
Published
Language
English
Keywords
antiretroviral therapy, primary health care, Zambia
Abstract
The Zambian Ministry of Health has scaled-up human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) care and treatment services at primary care clinics in Lusaka, using predominately nonphysician clinicians. The objective of this study was to report on the feasibility and early outcomes of the program. The study was conducted through an open cohort evaluation of antiretroviral-naive adults treated at 18 primary care facilities between April 26, 2004, and November 5, 2005. Data were entered in real time into an electronic patient tracking system. Those meeting criteria for antiretroviral therapy (ART) received drugs according to Zambian national guidelines. The authors enrolled 21,755 adults into HIV care, and 16,198 (75%) started ART. Among those starting ART, 9864 (61%) were women. Of 15,866 patients with documented World Health Organization (WHO) staging, 11,573 (73%) were stage III or IV, and the mean (SD) entry CD4 cell count among the 15,336 patients with a baseline result was 143/microL (123/microL). Of 1142 patients receiving ART who died, 1120 had a reliable date of death. Of these patients, 792 (71%) died within 90 days of starting therapy (early mortality rate: 26 per 100 patient-years), and 328 (29%) died after 90 days (post-90-day mortality rate: 5.0 per 100 patient-years). In multivariable analysis, mortality was strongly associated with CD4 cell count between 50/microL and 199/microL (adjusted hazard ratio [AHR], 1.4; 95% confidence interval [CI], 1.0-2.0), CD4 cell count less than 50/microL (AHR, 2.2; 95% CI, 1.5-3.1), WHO stage III disease (AHR, 1.8; 95% CI, 1.3-2.4), WHO stage IV disease (AHR, 2.9; 95% CI, 2.0-4.3), low body mass index (<16; AHR,2.4; 95% CI, 1.8-3.2), severe anemia (<8.0 g/dL; AHR, 3.1; 95% CI, 2.3-4.0), and poor adherence to therapy (AHR, 2.9; 95% CI, 2.2-3.9). Of 11,714 patients at risk, 861 failed therapy by clinical criteria (rate, 13 per 100 patient-years). The mean (SD) CD4 cell count increase was 175/microL (174/microL) in 1361 of 1519 patients (90%) receiving treatment long enough to have a 12-month repeat. The study concludes that massive scale-up of HIV and AIDS treatment services with good clinical outcomes is feasible in primary care settings in sub-Saharan Africa. Most mortality occurs early, suggesting that earlier diagnosis and treatment may improve outcomes.
Country
Publisher
Journal of the American Medical Association
Theme area
Equitable health services, Equity and HIV/AIDS
Title of publication Adherence in antiretroviral therapy: A review of qualitative studies
Date of publication
2007 January
Publication type
Journal Article
Publication details
AIDS 21 3 pp 271-281
Publication status
Published
Language
English
Keywords
adherence, antiretroviral therapy, HIV, qualitative studies, Africa
Abstract
This review intended to lay bare the processes that are at play in adherence and a number of these processes have been highlighted. Most of the included studies, however, did not uncover underlying processes. In the majority of these studies, such factors were simply enumerated. Little attention was devoted to the relationship between the identified themes and factors related to adherence. These studies, often using limited data, fall short as qualitative studies. Only one study led to the development of an integrated theory of adherence behaviour. Furthermore, subgroup factors need more attention as does the influence of hardship and vulnerability. Further qualitative studies can make an important contribution in this field, particularly when the research approaches deal with the respondents' own perspective. Such methods are essential given the complexity of adherence.
Country
Publisher
AIDS
Theme area
Equitable health services, Equity and HIV/AIDS
Title of publication Barriers to acceptance and adherence of antiretroviral therapy in urban Zambian women: a qualitative study
Date of publication
2009 January
Publication type
Journal Article
Publication details
AIDS Care 21 1 pp 78-86
Publication status
Published
Language
English
Keywords
antiretroviral therapy, adherence, HIV, Zambia
Abstract
Sub-Saharan Africa contains over 60% of the world's HIV infections and Zambia is among the most severely affected countries in the region. As antiretroviral programs have been rapidly expanding, the long-term success of these programs depends on a good understanding of the behavioral determinants of acceptance and adherence to antiretroviral therapy (ART). The study used qualitative methods to gain local insight into potentially important factors affecting HIV-infected women's decision to accept or continue with ART. Some of the barriers identified by this study are consistent with factors cited in the existing adherence literature from both developed and developing nations such as side effects, hunger and stigma; other factors have not been previously reported. One major theme was unfamiliarity with the implications of having a chronic, potentially deadly disease. Other emerging themes from this study include the complicated effect of ART on interpersonal relationship, particularly between husbands and wives, the presence of depression and hopelessness, and lack of accurate information. The results suggest that the reasons for non-uptake of treatment include issues related to local cultural frameworks (e.g., illness ideology), mental and behavioral health (e.g., depression and/or interpersonal challenges), stigma, and motivating factors (e.g., values of church or marriage) of different cultures that affect the ability and willingness to take life-saving medicine for a long period of time. Qualitative studies are critical to better understand why ART eligible individuals are choosing not to initiate or continue treatment to achieve needed adherence levels.
Country
Publisher
AIDS Care
Theme area
Equitable health services, Equity and HIV/AIDS
Title of publication Explaining adherence success in sub-Saharan Africa: An ethnographic study
Date of publication
2009 January
Publication type
Journal Article
Publication details
PloS Medicine 6 1 pp 39-47
Publication status
Published
Language
English
Keywords
HIV/AIDS, antirertoviral therapy, adherence, Africa
Abstract
Individuals living with HIV/AIDS in sub-Saharan Africa generally take more than 90% of prescribed doses of antiretroviral therapy (ART). This number exceeds the levels of adherence observed in North America and dispels early scale-up concerns that adherence would be inadequate in settings of extreme poverty. This paper offers an explanation and theoretical model of ART adherence success based on the results of an ethnographic study in three sub-Saharan African countries. Determinants of ART adherence for HIV-infected persons in sub-Saharan Africa were examined with ethnographic research methods. 414 in-person interviews were carried out with 252 persons taking ART, their treatment partners, and health care professionals at HIV treatment sites in Jos, Nigeria; Dar es Salaam, Tanzania; and Mbarara, Uganda. 136 field observations of clinic activities were also conducted. Data were examined using category construction and interpretive approaches to analysis. Findings indicate that individuals taking ART routinely overcome economic obstacles to ART adherence through a number of deliberate strategies aimed at prioritizing adherence: borrowing and "begging" transport funds, making "impossible choices" to allocate resources in favor of treatment, and "doing without." Prioritization of adherence is accomplished through resources and help made available by treatment partners, other family members and friends, and health care providers. Helpers expect adherence and make their expectations known, creating a responsibility on the part of patients to adhere. Patients adhere to promote good will on the part of helpers, thereby ensuring help will be available when future needs arise. The authors conclude that adherence success in sub-Saharan Africa can be explained as a means of fulfilling social responsibilities and thus preserving social capital in essential relationships.
Country
Publisher
PloS Medicine
Theme area
Equitable health services, Equity and HIV/AIDS
Title of publication The prevention of mother-to-child HIV transmission programme in Lilongwe, Malawi: why do so many women drop out.
Date of publication
2009 May
Publication type
Journal Article
Publication details
Reproductive Health Matters 17 33 pp 143-151
Publication status
Published
Language
English
Keywords
mother to child transmission, HIV, adherence, Malawi
Abstract
Mother-to-child transmission of HIV constitutes a substantial burden of new HIV infections in sub-Saharan Africa, and losses to follow-up continue to undermine prevention of mother-to-child transmission of HIV (PMTCT) programmes. This qualitative study sought to clarify why some women who were enrolled in a PMTCT programme in Lilongwe, Malawi, did not fully participate in follow-up visits in the first six months after testing HIV-positive. Twenty-eight women, 14 who participated fully in the programme and 14 who dropped out, were purposively selected for in-depth interview at two clinics. Focus group discussions with 15 previously interviewed and 13 newly recruited women were also conducted. Discussions with 12 of the women's husbands were also carried out. Although the proportion of women being tested has reportedly increased, losses to follow-up have shifted and are occurring at every step after testing. Major emerging themes associated with dropping out of the PMTCT programme within six months after delivery were to avoid involuntary HIV disclosure and negative community reactions, unequal gender relations, difficulties accessing care and treatment, and lack of support from husbands. The whole approach to the delivery of the PMTCT programme and home visits must be reconsidered, to improve confidentiality and minimise stigmatization. Women need to be empowered economically and supported to access HIV treatment and care with their partners, to benefit their whole family.
Country
Publisher
Reproductive Health Matters
Theme area
Equity in health, Equitable health services
Title of publication A comparative risk assessment for South Africa in 2000: towards promoting health and preventing disease.
Date of publication
2007 August
Publication type
Journal Article
Publication details
South African Medical Journal 97 8 pp 637-641
Publication status
Published
Language
English
Keywords
burden of disease, South Africa
Abstract
A landmark project of the Medical Research Council, the first South African National Burden of Disease (SA NBD) study, identified the underlying causes of premature mortality and morbidity experienced in South Africa in the year 2000. These estimates were recently revised on the basis of additional data to estimate the disability-adjusted life years (DALYs) for single causes for the first time in South Africa. This study is a national assessment of the burden of disease and risk factor data can provide valid information for health service planning. In combination with information on the effectiveness and cost-effectiveness as well as the local applicability and appropriateness of interventions, it can contribute to the more rational use of limited resources to impact on the risk factors that determine the health of the nation.
Country
Publisher
South African Medical Journal
Theme area
Equitable health services
Title of publication Why do some hospitals achieve better care of severely malnourished children than others? Five-year follow-up of rural hospitals in Eastern Cape, South Africa
Date of publication
2008 September
Publication type
Journal Article
Publication details
Health Policy & Planning 23 6 pp 428-437
Publication status
Published
Language
English
Keywords
child health, nutrition, health care, South Africa
Abstract
Staff at 11 rural hospitals in an under-resourced region of Eastern Cape Province, South Africa, participated in an intervention to improve the quality of care of severely malnourished children through training and support aimed at implementing the WHO case-management guidelines. Despite similar intervention inputs, some hospitals reduced their case-fatality rates by at least half, whereas others did not. The aim of this study was to investigate reasons for this disparity. Two successful and two poorly performing hospitals were purposively selected based on their case-fatality rates, which were <10% in the successful hospitals and >30% in those performing poorly. Comparative data were collected during June to October 2004 through structured observations of ward procedures, compilation of hospital data on case-loads and resources, and staff interviews and discussions related to attitudes, teamwork, training, supervision, managerial support and leadership. The four study hospitals had broadly similar resources, infrastructure and child:nurse ratios, and all had made changes to their clinical and dietary management following training. Case-management was broadly in line with WHO guidelines but the study revealed clear differences in institutional culture which influenced quality of care. Staff in the successful hospitals were more attentive and assiduous than staff in the poorly performing hospitals, especially in relation to rehydration procedures, feeding and the recording of vital signs. There was a strong emphasis on in-service training and induction of incoming staff in the successful hospitals and better supervision of junior staff and carers. Nurses had more positive attitudes towards malnourished children and their carers, and were less judgmental. Underlying factors were differences in leadership, teamwork, and managerial supervision and support. The authors conclude that unless there are supportive structures at managerial level, the potential benefits of efficacious interventions and related training programmes to improve health worker performance can be thwarted.
Country
Publisher
Health Policy & Planning
Theme area
Equitable health services, Public-private mix
Title of publication Involving private health care providers in delivery of TB care: Global strategy
Date of publication
2003
Publication type
Journal Article
Publication details
Tuberculosis 83 1 pp 156-164
Publication status
Published
Language
English
Keywords
private healthcare, tuberculosis, global
Abstract
Most poor countries have a large and growing private medical sector. Evidence suggests that a large proportion of tuberculosis patients in many high TB-burden countries first approach a private health care provider. Further, private providers manage a significant proportion of tuberculosis cases. Surprisingly though, there is virtually no published evidence on linking private providers to tuberculosis programmes. As a part of global efforts to control tuberculosis through effective DOTS implementation, the World Health Organization has recently begun addressing the issue of private providers in TB control through an evolving global strategy. As a first step, a global assessment of private providers' participation in tuberculosis programmes was undertaken. The findings of the assessment were discussed and debated in a consultation involving private practitioners, TB programme managers and policy makers. Their recommendations have contributed to the evolving global strategy called Public-Private Mix for DOTS implementation (PPM DOTS). This paper presents the guiding principles of PPM DOTS and major elements of the global strategy. These include: informed advocacy; setting-up "learning projects"; scaling-up successful projects and formulation of regional, national and local strategies; developing practical tools to facilitate PPM DOTS and pursuing an operational research agenda to help better design and shape PPM DOTS strategies. Encouraging results from some ongoing project sites are discussed. The paper concludes that concerted global efforts and local input are required for a sustained period to help achieve productive engagement of private practitioners in DOTS implementation. Such efforts have to be targeted as much towards national tuberculosis programmes as towards private providers and their associations. Continued apathy in this area could not only potentially delay achieving global targets for TB control but also undo, in the long run, the hard-earned achievements of National TB Programmes.
Country
Publisher
Tuberculosis
Theme area
Equitable health services, Public-private mix, Resource allocation and health financing
Title of publication Financing and cost-effectiveness analysis of public-private partnerships: provision of tuberculosis treatment in South Africa
Date of publication
2006 June
Publication type
Journal Article
Publication details
Cost Effectiveness and Resource Allocation 4 11 pp /-/
Publication status
Published
Language
English
Keywords
public-private, tuberculosis, health financing, South Africa
Abstract
Public-private partnerships (PPP) could be effective in scaling up services. The authors estimated cost and cost-effectiveness of different PPP arrangements in the provision of tuberculosis (TB) treatment, and the financing required for the different models from the perspective of the provincial TB programme, provider, and the patient. Two different models of TB provider partnerships are evaluated, relative to sole public provision: public-private workplace (PWP) and public-private non-government (PNP). Cost and effectiveness data were collected at six sites providing directly observed treatment (DOT). Effectiveness for a 12-month cohort of new sputum positive patients was measured using cure and treatment success rates. Provider and patient costs were estimated, and analysed according to sources of financing. Cost-effectiveness is estimated from the perspective of the provider, patient and society in terms of the cost per TB case cured and cost per case successfully treated. The authors conclude that there is a strong economic case for expanding PPP in TB treatment and potentially for other types of health services. Where PPPs are tailored to target groups and supported by the public sector, scaling up of effective services could occur at much lower cost than solely relying on public sector models.
Country
Publisher
Cost Effectiveness and Resource Allocation
Theme area
Equitable health services, Equity and HIV/AIDS
Title of publication Seizing the Big Missed Opportunity: Linking HIV and Maternity Care Services in Sub-Saharan Africa
Date of publication
2007 November
Publication type
Journal Article
Publication details
Reproductive Health Matters 15 30 pp 190-201
Publication status
Published
Language
English
Keywords
HIV, maternal and child health, mother to child transmission, Africa
Abstract
This paper draws on two reviews commissioned by the UK Department for International Development in 2006-2007 that explore progress in linking HIV prevention and maternity services in sub-Saharan Africa. Although pilot and demonstration projects have been successful, progress in scaling up PMTCT has been slow, reaching just 11% of pregnant HIV positive women in much of Africa, less than half the percentage of coverage achieved by antiretroviral treatment programmes for adults in need. Despite ongoing efforts to promote comprehensive approaches, significant policy, financing and institutional barriers, and weak co-ordination and leadership, continue to hamper progress. Maternal health services face human and financial resource shortages which affect their capacity to integrate HIV prevention. Both HIV and maternal health programmes often receive targeted financial and technical assistance that does not take the other into account. However, proposals in 2007 from a number of countries to the Global Fund to Fight AIDS, TB and Malaria incorporate sexual and reproductive health programming that will have an impact on HIV, including certain maternity services. Moreover, Botswana, Kenya and Rwanda have shown that progress can be made where national commitment and increased resources are enabling maternal and newborn care to address HIV.
Country
Publisher
Reproductive Health Matters
Theme area
Equitable health services, Resource allocation and health financing, Equity and HIV/AIDS
Title of publication Investment in HIV/AIDS programs: Does it help strengthen health systems in developing countries?
Date of publication
2008 September
Publication type
Journal Article
Publication details
Globalization And Health 4 8 pp /-/
Publication status
Published
Language
English
Keywords
HIV/AIDS, health systems, health financing, Africa
Abstract
There is increasing debate about whether the scaled-up investment in HIV/AIDS programs is strengthening or weakening the fragile health systems of many developing countries. This article examines and assesses the evidence and proposes ways forward. Considerably increased resources have been brought into countries for HIV/AIDS programs by major Global Health Initiatives. Among the positive impacts are the increased awareness of and priority given to public health by governments. In addition, services to people living with HIV/AIDS have rapidly expanded. In many countries infrastructure and laboratories have been strengthened, and in some, primary health care services have been improved. The effect of AIDS on the health work force has been lessened by the provision of antiretroviral treatment to HIV-infected health care workers, by training, and, to an extent, by task-shifting. However, there are reports of concerns, too - among them, a temporal association between increasing AIDS funding and stagnant reproductive health funding, and accusations that scarce personnel are siphoned off from other health care services by offers of better-paying jobs in HIV/AIDS programs. Unfortunately, there is limited hard evidence of these health system impacts. Because service delivery for AIDS has not yet reached a level that could conceivably be considered "as close to Universal Access as possible," countries and development partners must maintain the momentum of investment in HIV/AIDS programs. At the same time, it should be recognized that global action for health is even more underfunded than is the response to the HIV epidemic. The real issue is therefore not whether to fund AIDS or health systems, but how to increase funding for both. The evidence is mixed - mostly positive but some negative - as to the impact on health systems of the scaled-up responses to HIV/AIDS driven primarily by global health partnerships. Current scaled-up responses to HIV/AIDS must be maintained and strengthened. Instead of endless debate about the comparative advantages of vertical and horizontal approaches, partners should focus on the best ways for investments in response to HIV to also broadly strengthen the primary health care systems.
Country
Publisher
Globalization And Health
Theme area
Equitable health services, Monitoring equity and research to policy
Title of publication Integration of targeted health interventions into health systems: A conceptual framework for analysis
Date of publication
2010 March
Publication type
Journal Article
Publication details
Health Policy & Planning 25 2 pp 104-111
Publication status
Published
Language
English
Keywords
health systems, integration of services, research methods, global
Abstract
The benefits of integrating programmes that emphasize specific interventions into health systems to improve health outcomes have been widely debated. This debate has been driven by narrow binary considerations of integrated (horizontal) versus non-integrated (vertical) programmes, and characterized by polarization of views with protagonists for and against integration arguing the relative merits of each approach. The presence of both integrated and non-integrated programmes in many countries suggests benefits to each approach.While the terms 'vertical' and 'integrated' are widely used, they each describe a range of phenomena. In practice the dichotomy between vertical and horizontal is not rigid and the extent of verticality or integration varies between programmes. However, systematic analysis of the relative merits of integration in various contexts and for different interventions is complicated as there is no commonly accepted definition of 'integration' - a term loosely used to describe a variety of organizational arrangements for a range of programmes in different settings. The authors present an analytical framework which enables deconstruction of the term integration into multiple facets, each corresponding to a critical health system function. The conceptual framework of the paper builds on theoretical propositions and empirical research in innovation studies, and in particular adoption and diffusion of innovations within health systems, and builds on our own earlier empirical research. It brings together the critical elements that affect adoption, diffusion and assimilation of a health intervention, and in doing so enables systematic and holistic exploration of the extent to which different interventions are integrated in varied settings and the reasons for the variation. The conceptual framework and the analytical approach the authors propose are intended to facilitate analysis in evaluative and formative studies of - and policies on - integration, for use in systematically comparing and contrasting health interventions in a country or in different settings to generate meaningful evidence to inform policy.
Country
Publisher
Health Policy & Planning
Theme area
Equitable health services, Resource allocation and health financing
Title of publication Factors influencing performance of Global Fund-supported tuberculosis grants.
Date of publication
2010 September
Publication type
Journal Article
Publication details
The International Journal of Tuberculosis and Lung Disease 14 9 pp 1097-1103
Publication status
Published
Language
English
Keywords
global fund, tuberculosis, health financing, global
Abstract
The aim of the study was to explore grant and country characteristics associated with the performance of tuberculosis (TB) grants supported by the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund), which uses performance-based funding of grants. The authors used Global Fund grant data to compute the average programmatic performance of 108 TB grants in 88 countries. Using stepwise regression models, the authors examined the correlation of grant performance with a range of grant and country characteristics. Funding duration and funding per estimated smear-positive TB case were positively correlated with grant performance (partial correlations of 0.386-0.416 for the former, 0.200 for the latter). Successful completion of an evaluation of a grant during the second year of funding was linked to higher performance (0.357). Performance was further influenced by the independent organisation hired by the Global Fund to provide ongoing monitoring of the grants (0.197-0.243). Two country-specific factors were significantly correlated with performance: political stability (0.197-0.234) and disease burden (-0.211). The study found that successful evaluation that leads to continued funding predicts higher performance of TB grants, even in challenging settings such as weak health services. However, other contextual factors affect grant performance and should be considered when assessing grants to ensure that countries that have a high disease burden and are politically unstable are not penalised.
Country
Publisher
The International Journal of Tuberculosis and Lung Disease
Theme area
Equity in health, Equity and HIV/AIDS
Title of publication Sexual and reproductive health activities in HIV programmes: can we monitor progress?
Date of publication
2011 March
Publication type
Journal Article
Publication details
Journal of Epidemiology and Community Health 65 3 pp 199-204
Publication status
Published
Language
English
Keywords
sexual reproductive health, HIV, monitoring, Millenium Development Goals, Africa
Abstract
Resource allocation and integration of services have been of interest recently to achieve healthrelated Millennium Development Goals. This paper analyses the extent to which countries receiving funding in HIV were able to invest in activities in the area of sexual and reproductive health (SRH). The authors screened the Global Fund grants data with an aggregate investment of US$16 billion in 140 countries to identify indicators revealing typical SRH services. The analysis focused on the 'Top Ten' internationally agreed indicators and used international guidelines and frameworks to define services for SRH and opportunities for 'linkage' between HIV and SRH services. As of December 2008, 238 of all HIV grants (n=252) from 133 countries included 1620 service delivery indicators related to SRH. The budgets amounted to US$9.1 billion with US$5.9 billion committed and US$4 billion disbursed. Services included (1) prevention of mother to child transmission for 445 000 HIV-positive pregnant women, (2) 5.7 million care and support services, (3) 1.2 billion condoms delivered, (4) 4.4 million episodes of sexually transmitted infections treated, (5) 61 million counselling and testing encounters, and (6) 11.6 million behavioural change communication (BCC) outreach services for people at high risk and 64.5 million BCC activities for the general population, including youth. Information on the linkage and integration of SRH-HIV services was limited. Around 94% of HIV programmes supported SRH-related activities. However, there is a need to systematically capture data on SRH-HIV service integration to understand the benefits of linking these services.
Country
Publisher
Journal of Epidemiology and Community Health
Theme area
Equity in health, Equitable health services
Title of publication Effect of investment in Malaria control on child mortality in Sub-Saharan Africa in 2002-2008
Date of publication
2011
Publication type
Journal Article
Publication details
Plos ONE 6 6 pp /-/
Publication status
Published
Language
English
Keywords
malaria, child mortality, health financing, Africa
Abstract
Around 8.8 million children under-five die each year, mostly due to infectious diseases, including malaria that accounts for 16% of deaths in Africa, but the impact of international financing of malaria control on under-five mortality in sub-Saharan Africa has not been examined. The authors combined multiple data sources and used panel data regression analysis to study the relationship among investment, service delivery/intervention coverage, and impact on child health by observing changes in 34 sub-Saharan African countries over 2002-2008. The authors used Lives Saved Tool to estimate the number of lives saved from coverage increase of insecticide-treated nets (ITNs)/indoor residual spraying (IRS). As an indicator of outcome, we also used under-five mortality rate. Global Fund investments comprised more than 70% of the Official Development Assistance (ODA) for malaria control in 34 countries. Cumulatively Global Fund investments that increased ITN/IRS coverage in 2002-2008 prevented an estimated 240,000 deaths. Countries with higher malaria burden received less ODA disbursement per person-at-risk compared to lower-burden countries ($3.90 vs. $7.05). Increased ITN/IRS coverage in high-burden countries led to 3,575 lives saved per 1 million children, as compared with 914 lives in lower-burden countries. Impact of ITN/IRS coverage on under-five mortality was significant among major child health interventions such as immunisation showing that 10% increase in households with ITN/IRS would reduce 1.5 [95%CI: 0.3-2.8] child deaths per 1000 live births. The study concludes that along with other key child survival interventions, increased ITNs/IRS coverage has significantly contributed to child mortality reduction since 2002. ITN/IRS scale-up can be more efficiently prioritized to countries where malaria is a major cause of child deaths to save greater number of lives with available resources.
Country
Publisher
Plos ONE
Theme area
Equitable health services, Resource allocation and health financing
Title of publication Allocating scarce resources strategically - an evaluation and discussion of the Global Fund's pattern of disbursements
Date of publication
2012 May
Publication type
Journal Article
Publication details
Plos ONE 7 5 pp /-/
Publication status
Published
Language
English
Keywords
health care financing, global fund, health systems, global
Abstract
The Global Fund is under pressure to improve its rationing of financial support. This study describes the GF's pattern of disbursements in relation to total health expenditure (THE), government health expenditure (GHE), income status and the burden of HIV/AIDS, TB and malaria. It also examines the potential for recipient countries to increase domestic public financing for health. This is a cross-sectional study of 104 countries that received Global Fund disbursements in 2009. It analyses data on Global Fund disbursements; health financing indicators; government revenue and expenditure; and burden of disease. Global Fund disbursements made up 0.37% of THE across all 104 countries; but with considerable country variation ranging from 0.002% to 53.4%. Global Fund disbursements to government amounted to 0.47% of GHE across the 104 countries, but again with considerable variation (in three countries more than half of GHE was based on Global Fund support). Although the Global Fund provides progressively more funding for lower income countries on average, there is much variation at the country such that here was no correlation between per capita GF disbursements and per capita THE, nor between per capita GF disbursement to government and per capita GHE. There was only a slight positive correlation between per capita GF disbursement and burden of disease. Several countries with a high degree of 'financial dependency' upon the Fund have the potential to increase levels of domestic financing for health. The Global Fund can improve its targeting of resources so that it better matches the pattern of global need. To do this it needs to: a) reduce the extent to which funds are allocated on a demand-driven basis; and b) align its funding model to broader health systems financing and patterns of health expenditure beyond the three diseases.
Country
Publisher
Plos ONE
Theme area
Resource allocation and health financing
Title of publication Inequalities in health care use and expenditures: Empirical data from eight developing countries and countries in transition
Date of publication
2000
Publication type
Journal Article
Publication details
Bulletin of the World Health Organisation 78 1 pp 55-65
Publication status
Published
Language
English
Keywords
health financing, Africa
Abstract
This paper summarizes results from eight country studies of inequality in the health sector. The analyses included household data to examine the distribution of service use and health expenditures. In each case, the results were presented by income quintiles, estimated using consumption expenditures. Results revealed that the rich groups have a higher probability of obtaining care when sick, to be more likely to be seen by physicians, and have a higher probability of receiving medicines, than the poor groups. The rich also spend more in absolute terms on care. There was no consistent pattern in the use of private providers. Wealthier households do not devote a consistently higher percentage of their consumption expenditures to health care. The analyses indicated that intuition concerning inequalities could result in misguided decisions. Thus, it would be worthwhile to measure the direction and extent of inequality in order to identify problems and to gauge the success of policy-making. Implications for further research are discussed.
Country
Publisher
Bulletin of the World Health Organisation
Theme area
Poverty and health
Title of publication Poverty and health sector inequalities
Date of publication
2002
Publication type
Journal Article
Publication details
Bulletin of the World Health Organisation 80 2 pp 97-105
Publication status
Published
Language
English
Keywords
poverty, income inequality, global
Abstract
Poverty and ill-health are intertwined. Poor countries tend to have worse health outcomes than better-off countries. Within countries, poor people have worse health outcomes than better-off people. This association reflects causality running in both directions: poverty breeds ill-health, and ill-health keeps poor people poor. The evidence on inequalities in health between the poor and non-poor and on the consequences for impoverishment and income inequality associated with health care expenses is discussed in this article. An outline is given of what is known about the causes of inequalities and about the effectiveness of policies intended to combat them. It is argued that too little is known about the impacts of such policies, notwithstanding a wealth of measurement techniques and considerable evidence on the extent and causes of inequalities.
Country
Publisher
Bulletin of the World Health Organisation
Theme area
Health equity in economic and trade policies
Title of publication Spatial development initiatives in Southern Africa: The Maputo development corridor
Date of publication
2001
Publication type
Journal Article
Publication details
Tijdschrift voor Economische en Sociale Geografie 92 3 pp 324-346
Publication status
Published
Language
English
Keywords
regional integration, South Africa, Mozambique
Abstract
Spatial development initiatives (SDIs) are becoming a critical feature in the planning for reconstruction in post-apartheid South (and Southern) Africa. The SDI programme marks a fundamental break with the trajectories and initiatives for economic and spatial planning of the apartheid past. The objective in this paper is to examine the record and developmental impact of SDI planning in South (ern) Africa through the lens of the most well-known SDI, the Maputo Development Corridor or Maputo SDI. The cross-border nature of the Maputo SDI makes it an important case study in terms of a recent shift in focus of the SDI programme towards a greater role for strengthening the regional Southern African economy. It is argued that the case of the Maputo SDI represents one illustration of the construction or configuring of a 'new regionalism' in Southern Africa.
Country
Publisher
Tijdschrift voor Economische en Sociale Geografie
Theme area
Equity in health
Title of publication A glossary for health inequalities
Date of publication
2002 September
Publication type
Journal Article
Publication details
Journal of Epidemiology and Community Health 56 9 pp 647-652
Publication status
Published
Language
English
Keywords
health inequality, global
Abstract
In this glossary, the authors address eight key questions pertinent to health inequalities: (1) What is the distinction between health inequality and health inequity ?; (2) Should we assess health inequalities themselves, or social group inequalities in health?; (3) Do health inequalities mainly reflect the effects of poverty, or are they generated by the socioeconomic gradient?; (4) Are health inequalities mediated by material deprivation or by psychosocial mechanisms?; (5) Is there an effect of relative income on health, separate from the effects of absolute income?; (6) Do health inequalities between places simply reflect health inequalities between social groups or, more significantly, do they suggest a contextual effect of place?; (7) What is the contribution of the lifecourse to health inequalities?; (8) What kinds of inequality should we study?
Country
Publisher
Journal of Epidemiology and Community Health
Theme area
Poverty and health
Title of publication Safe drinking water still a dream in rural areas of South Africa. Case study: The Eastern Cape Province
Date of publication
2006
Publication type
Journal Article
Publication details
Water SA 32 5 pp 715-720
Publication status
Published
Language
English
Keywords
safe water, South Africa
Abstract
The impact of water-borne disease in South Africa is significant. An estimated 43,000 deaths per annum, including 20% of deaths in the 1-5 years age group, are directly attributable to diarrhoeal diseases. Drinking water quality provision in many rural areas is substandard. This paper describes the results of sampling drinking water supplies in rural communities in the Western and Eastern Cape, South Africa. The majority of samples collected failed microbial drinking water quality standards. Overall, schemes dependent on ground-water provided a worse quality water at point of use than surface-water-dependant schemes. This is thought to be the result of pump breakdown, deterioration of the storage and reticulation system, and insufficient monitoring and management of the schemes. Importantly, it is shown that the implementation of well-considered, community accepted drinking-water quality management procedures can effectively change an unacceptable water quality to one that satisfies drinking-water specifications.
Country
Publisher
Water SA
Theme area
Equitable health services
Title of publication The health and health system of South Africa: historical roots of current public health challenges
Date of publication
2009 August
Publication type
Journal Article
Publication details
The Lancet 374 9692 pp 817-834
Publication status
Published
Language
English
Keywords
health system, public health, health policy, South Africa
Abstract
The roots of a dysfunctional health system and the collision of the epidemics of communicable and non-communicable diseases in South Africa can be found in policies from periods of the country's history, from colonial subjugation, apartheid dispossession, to the post-apartheid period. Racial and gender discrimination, the migrant labour system, the destruction of family life, vast income inequalities, and extreme violence have all formed part of South Africa's troubled past, and all have inexorably affected health and health services. In 1994, when apartheid ended, the health system faced massive challenges, many of which still persist. Macroeconomic policies, fostering growth rather than redistribution, contributed to the persistence of economic disparities between races despite a large expansion in social grants. The public health system has been transformed into an integrated, comprehensive national service, but failures in leadership and stewardship and weak management have led to inadequate implementation of what are often good policies. Pivotal facets of primary health care are not in place and there is a substantial human resources crisis facing the health sector. The HIV epidemic has contributed to and accelerated these challenges. All of these factors need to be addressed by the new government if health is to be improved and the Millennium Development Goals achieved in South Africa.
Country
Publisher
The Lancet
Theme area
Equitable health services
Title of publication Increasing Coverage and Decreasing Inequity in Insecticide-Treated Bed Net Use among Rural Kenyan Children
Date of publication
2007 August
Publication type
Journal Article
Publication details
PloS Medicine 4 18 pp 1341-1348
Publication status
Published
Language
English
Keywords
malaria, bed nets, child health services, Kenya
Abstract
The authors undertook a study of annual changes in ITN coverage among a cohort of 3,700 children aged 0–4 y in four districts of Kenya (Bondo, Greater Kisii, Kwale, and Makueni) annually between 2004 and 2006. Cross-sectional surveys of ITN coverage were undertaken coincidentally with the incremental availability of commercial sector nets (2004), the introduction of heavily subsidized nets through clinics (2005), and the introduction of free mass distributed ITNs (2006). The changing prevalence of ITN coverage was examined with special reference to the degree of equity in each delivery approach. ITN coverage was only 7.1% in 2004 when the predominant source of nets was the commercial retail sector. By the end of 2005, following the expansion of heavily subsidized clinic distribution system, ITN coverage rose to 23.5%. In 2006 a large-scale mass distribution of ITNs was mounted providing nets free of charge to children, resulting in a dramatic increase in ITN coverage to 67.3%. With each subsequent survey socioeconomic inequity in net coverage sequentially decreased: The free mass distribution method achieved highest coverage among the poorest children, the highly subsidised clinic nets programme was marginally in favour of the least poor, and the commercial social marketing favoured the least poor. The paper concludes that rapid scaling up of ITN coverage among Africa's poorest rural children can be achieved through mass distribution campaigns. These efforts must form an important adjunct to regular, routine access to ITNs through clinics, and each complimentary approach should aim to make this intervention free to clients to ensure equitable access among those least able to afford even the cost of a heavily subsidized net.
Country
Publisher
PloS Medicine
Theme area
Equitable health services
Title of publication Integration of insecticide-treated net distribution into routine immunization services in Malawi: A pilot study
Date of publication
2009 July
Publication type
Journal Article
Publication details
Tropical Medicine & International Health 14 7 pp 792-801
Publication status
Published
Language
English
Keywords
malaria, bed nets, child health services, Malawi
Abstract
The aims of the study were to determine the feasibility of distributing insecticide-treated nets (ITNs) through routine immunization services, to increase ownership and use of ITNs among high-risk groups, whereas maintaining or improving timely completion of routine vaccinations. Free ITNs were provided with timely completion of routine vaccinations in two intervention districts in southern Malawi for 15 months. Cross-sectional baseline and follow-up household surveys were conducted in the two intervention districts and one control district. Insecticide-treated nets utilization among children aged 12-23 months roughly doubled in the two intervention districts and did not change in the control district. Timely vaccination coverage increased in all three districts. The percentage of children aged 12-23 months who were both fully vaccinated by 12 months and slept under an ITN the night prior to the interview increased from 10-14% at baseline to 40-44% at follow-up in the intervention districts (P < 0.001), but did not change significantly in the control district. This study is the first to evaluate the provision of free ITNs at completion of a child's primary vaccination series, demonstrating that such a linkage is both feasible and can result in improved coverage with the combined services. Additional studies are needed to determine whether such a model is effective in other countries, and whether integration of other health services with immunization delivery could also be synergistic.
Country
Publisher
Tropical Medicine & International Health
Theme area
Equitable health services, Resource allocation and health financing
Title of publication Costs and cost-effectiveness of malaria control interventions - A systematic review
Date of publication
2011 November
Publication type
Journal Article
Publication details
Malaria Journal 10 337 pp /-/
Publication status
Published
Language
English
Keywords
malaria, systenatic review, health financing, global
Abstract
The control and elimination of malaria requires expanded coverage of and access to effective malaria control interventions such as insecticide-treated nets (ITNs), indoor residual spraying (IRS), intermittent preventive treatment (IPT), diagnostic testing and appropriate treatment. Decisions on how to scale up the coverage of these interventions need to be based on evidence of programme effectiveness, equity and cost-effectiveness. A systematic review of the published literature on the costs and cost-effectiveness of malaria interventions was undertaken. All costs and cost-effectiveness ratios were inflated to 2009 USD to allow comparison of the costs and benefits of several different interventions through various delivery channels, across different geographical regions and from varying costing perspectives. A transparent evidence base on the costs and cost-effectiveness of malaria control interventions is provided to inform rational resource allocation by donors and domestic health budgets and the selection of optimal packages of interventions by malaria control programmes.
Country
Publisher
Malaria Journal
Theme area
Public-private mix
Title of publication Firm-level perspectives on public sector engagement with private healthcare providers: Survey evidence from Ghana and Kenya
Date of publication
2011 November
Publication type
Journal Article
Publication details
Plos ONE 6 11 pp /-/
Publication status
Published
Language
English
Keywords
public-private mix, private healthcare, Ghana, Kenya
Abstract
In this study the authors surveyed private health facilities in Kenya and Ghana to understand the extent to which and how governments interact and engage with these facilities. The results suggest that government engagement with private health facilities is quite limited. The primary focus of this engagement is "command-and-control" type regulations to improve the quality of care.
Country
Publisher
Plos ONE
Theme area
Equitable health services, Equity and HIV/AIDS
Title of publication Mind the gap: Access to ARV medication, rights and the politics of scale in South Africa
Date of publication
2012 January
Publication type
Journal Article
Publication details
Social Science and Medicine 74 1 pp 28-35
Publication status
Published
Language
English
Keywords
HIV/AIDS, anti-retroviral therapy, human rights, South Africa
Abstract
Global access to anti-retroviral medication (ARVs) has increased exponentially in recent years. As a relatively recent phenomenon for the global South, much knowledge is being added, but analysis of ‘access’ to ARVs remains partial. The main research objective of this article is to gain a fuller picture of the range of forces constituting ‘access’ to ARVs by providing a local community case study from Hammanskraal, South Africa. A qualitative and relational approach situates specific points of ‘local’ access to ARVs within relations stretched over space. Spatial awareness enables us to consider the reinforcing effects of local geographies upon access to health care but also simultaneously sees this in relation to non-local geographies. The concept of scale is pivotal to creating linkages across space and reveals a number of ‘gaps’ in access that otherwise might not be shown. Elaborating on the meaning of “access” to treatment produces a more rounded picture of the context that people-living-with-AIDS encounter. A multi-scale and multi-disciplinary analysis of ‘access’ is therefore also highly informative in a related sense, namely, for closing the gap between human rights standards and actual implementation. A geographical imagination is useful not only to ‘mind’ but also to close the ‘gap’ in both senses.
Country
Publisher
Social Science and Medicine
Theme area
Equitable health services, Equity and HIV/AIDS
Title of publication A pilot study of food supplementation to improve adherence to antiretroviral therapy among food-insecure adults in Lusaka, Zambia
Date of publication
2008 October
Publication type
Journal Article
Publication details
Journal of Acquired Immune Deficiency Syndromes 49 2 pp 190-195
Publication status
Published
Language
English
Keywords
food supplementation, HIV, Zambia
Abstract
The provision of food supplementation to food insecure patients initiating antiretroviral therapy (ART) may improve adherence to medications. The method of the study is a home-based adherence support program at 8 government clinics assessed patients for food insecurity. Four clinics provided food supplementation, and 4 acted as controls. The analysis compared adherence (assessed by medication possession ratio), CD4, and weight gain outcomes among food-insecure patients enrolled at the food clinics with those enrolled at the control clinics. Between May 1, 2004, and March 31, 2005, 636 food insecure adults were enrolled. Food, supplementation was associated with better adherence to therapy. Two hundred fifty-eight of 366 (70%) patients in the food group achieved a medication possession ratio of 95% or greater versus 79 of 166 (48%) among controls (relative risk = 1.5; 95% confidence interval: 1.2 to 1.8). This finding was unchanged after adjustment for sex, age, baseline CD4 count, baseline World Health Organization stage, and baseline hemoglobin. The authors did not observe a significant effect of food supplementation on weight gain or CD4 cell response. This analysis suggests that providing food to food insecure patients initiating ART is feasible and may improve adherence to medication. A large randomized study of the clinical benefits of food supplementation to ART patients is urgently needed to inform international policy.
Country
Publisher
Journal of Acquired Immune Deficiency Syndromes
Theme area
Equitable health services, Equity and HIV/AIDS
Title of publication Patient-reported barriers and drivers of adherence to antiretrovirals in sub-Saharan Africa: A meta-ethnography
Date of publication
2010 April
Publication type
Journal Article
Publication details
Tropical Medicine and International Health 15 Suppl 1 pp 16 -33
Publication status
Published
Language
English
Keywords
adherence, antiretroviral, ethnography, sub-Saharan Africa
Abstract
This meta-ethnography study synthesised and interpreted the findings of recent social science research on the questions of retention in antiretroviral therapy (ART) programmes in sub-Saharan Africa (SSA). The literature reviewed ethnographic studies of the barriers to adherence to ART in various cultural settings. The results show that the quality of services, treatment-related costs, as well as the need to maintain social support networks - which can be negatively affected by HIV-related stigma - are important barriers to adherence. In addition, they show how African concepts of personhood are incompatible with the way services are conceived and delivered, targeting the individual. In SSA, individuals must balance physical health with social integrity, which is sometimes achieved by referring to traditional medicine. The ability of local concepts of illness to address social relations in addition to health, together with a historically grounded distrust in Western medicine, explains why traditional medicine is still widely used as an alternative to ART.
Country
Publisher
Tropical Medicine and International Health
Theme area
Resource allocation and health financing
Title of publication Financing tuberculosis control: The role of a global financial monitoring system
Date of publication
2007 May
Publication type
Journal Article
Publication details
Bulletin of the World Health Organisation 85 5 pp 334-340
Publication status
Published
Language
English
Keywords
health care financing, tuberculosis, World Health Organization, global
Abstract
To sustain tuberculosis (TB) control at current levels and to make further progress so that global targets can be achieved, information about funding needs, sources of funding, funding gaps and expenditures is important at global, regional, national and sub-national levels. This paper in the Bulletin of the World Health Organization (WHO) discusses a global system for financial monitoring of TB control that was established by the WHO in 2002. The system assess the extent to which financial needs estimated by countries, and related resource mobilisation and spending, are sufficient to achieve global targets for TB control. Major findings produced by the global financial monitoring system suggest that national tuberculosis programme budgets have grown in the 22 high-burden countries over the last six years from around US$0.5 billion in 2002 to US$1.25 billion in 2007. Most of the funding has come from the governments of these countries, but the contribution from the Global Fund has steadily grown since 2002. The paper concludes that whilst the system has limitations and related areas for improvement, it provides an example of how financing can be routinely monitored that has relevance to other health-care programmes, particularly those concerned with disease control.
Country
Publisher
Bulletin of the World Health Organisation
Theme area
Public-private mix, Resource allocation and health financing
Title of publication Global Fund financing of public-private mix approaches for delivery of tuberculosis care
Date of publication
2011 June
Publication type
Journal Article
Publication details
Tropical Medicine and International Health 16 6 pp 685-692
Publication status
Published
Language
English
Keywords
public-private mix, health financing, tuberculosis, Global fund, global
Abstract
The authors reviewed the Global Fund’s official documents and data to analyse the distribution, characteristics and budgets of private-public mix (PPM) approaches within Global Fund supported TB grants in recipient countries between 2003 and 2008. The authors supplemented this analysis with data on contribution of PPM to TB case notifications in 14 countries reported to World Health Organization in 2009, for the preparation of the global TB control report. Fifty-eight of 93 countries and multi-country recipients of Global Fund-supported TB grants had PPM activities in 2008. Engagement with ‘for-profit’ private sector was more prevalent in South Asia while involvement of prison health services has been common in Eastern Europe and central Asia. In the Middle East and North Africa, involving non-governmental organizations seemed to be the focus.
Country
Publisher
Tropical Medicine and International Health
Theme area
Equitable health services, Resource allocation and health financing
Title of publication Cost and cost-effectiveness of increased community and primary care facility involvement in tuberculosis care in Machakos District, Kenya
Date of publication
2003 September
Publication type
Journal Article
Publication details
The International Journal of Tuberculosis and Lung Disease 7 Suppl 1 pp S14-S20
Publication status
Published
Language
English
Keywords
community-based care, cost effectiveness, cost-benefit analysis, tuberculosis, Kenya
Abstract
Machakos District, Kenya, is a rural area 50 km east of Nairobi. This study aimed to assess the cost and cost-effectiveness of new treatment strategies for tuberculosis patients, involving decentralisation of care from hospitals to peripheral health units and the community, compared to the conventional approaches to care used until October 1997. Costs were analysed in 1998 US$ from the perspective of health services, patients, family members and the community, using standard methods. The cost per patient treated for new smear-positive patients was $591 with the conventional hospital-based approach to care, and $209 with decentralised care. Costs fell from all perspectives, and by 65% overall. Cost-effectiveness improved by 66%. The cost per patient treated for new smear-negative/extra-pulmonary patients was $311 with the conventional approach to care, and $197 with decentralised care. Costs fell from all perspectives, and cost-effectiveness improved by 61%. There is a strong economic case for expansion of decentralisation and strengthened community-based care in Kenya. The National Tuberculosis and Leprosy Control Programme will require new funds for start-up training and community mobilisation costs in order to do this.
Country
Publisher
The International Journal of Tuberculosis and Lung Disease
Theme area
Equitable health services, Resource allocation and health financing
Title of publication Cost and cost-effectiveness of community-based care for tuberculosis patients in rural Uganda
Date of publication
2003 September
Publication type
Journal Article
Publication details
The International Journal of Tuberculosis and Lung Disease 7 Suppl 1 pp S72-S79
Publication status
Published
Language
English
Keywords
cost effectiveness, community-based care, tuberculosis, Uganda
Abstract
The cost and cost-effectiveness of community-based care for new smear-positive pulmonary tuberculosis patients was compared with conventional hospital-based care. Costs were analysed from the perspective of health services, patients, and community volunteers in 1998 US dollars, using standard methods. Cost-effectiveness was calculated as the cost per patient successfully treated. The study found that the cost per patient treated for new smear-positive patients was dollars 510 with the conventional hospital-based approach to care (dollars 419 for the health system and dollars 91 for patients), and dollars 289 with community-based care (dollars 227 for health services, dollars 53 for patients and dollars 9 for volunteers). Important new costs associated with community-based care included programme supervision (dollars 18 and dollars 9 per patient at central and district levels, respectively) and training (dollars 18 per patient). The cost per patient successfully treated was dollars 911 with the hospital-based strategy and dollars 391 with community-based care, reflecting both lower costs and higher effectiveness (74% vs. 56% successful treatment rate) with community-based care. Length of hospital stay fell from an average of 60 to 19 days. There study concluded that there is a strong economic case for the implementation of community-based care in Uganda.
Country
Publisher
The International Journal of Tuberculosis and Lung Disease
Theme area
Equitable health services, Resource allocation and health financing
Title of publication Cost and cost-effectiveness of community-based care for tuberculosis in Cape Town, South Africa
Date of publication
2003 September
Publication type
Journal Article
Publication details
The International Journal of Tuberculosis and Lung Disease 7 Suppl 1 pp S56-S62
Publication status
Published
Language
English
Keywords
tuberculosis, cost-benefit analysis, health financing, South Africa
Abstract
The purpose of the study was to evaluate the affordability and cost-effectiveness of community involvement in tuberculosis (TB) care. The method for the study was a cost-effectiveness analysis comparing treatment for new smear-positive pulmonary and retreatment TB patients in two similar townships, one providing clinic-based-care with community-based observation options available for its TB patients (Guguletu) and one providing clinic-based care only, with no community-based observation of treatment (Nyanga). Costs were assessed from a societal perspective in 1997 US$, and cost-effectiveness was calculated as the cost per patient successfully treated. The authors found that TB treatment in Guguletu was more cost-effective than TB treatment in Nyanga for both new and retreatment patients ($726 vs. $1201 and $1419 vs. $2058, respectively). This reflected both lower costs ($495 vs. $769 per patient treated for new cases; $823 vs. $1070 per patient treated for retreatment cases) and better treatment outcomes (successful treatment rate 68% vs. 64% and 58% vs. 52% for new and retreatment patients, respectively). Within Guguletu, community-based care was more than twice as cost-effective as clinic-based care ($392 vs. $1302 per patient successfully treated for new patients, and $766 vs. $2008 for retreatment patients), for similar reasons (e.g., for new cases, $314 vs. $703 per patient treated, successful treatment rate 80% vs. 54%). The paper concludes that community involvement in TB care can improve the affordability and cost-effectiveness of TB treatment in urban South Africa. Expansion in the Western Cape and in similar areas of the country is worthy of serious consideration by planners and policy-makers.
Country
Publisher
The International Journal of Tuberculosis and Lung Disease
Theme area
Resource allocation and health financing
Title of publication Financial resources required for tuberculosis control to achieve global targets set for 2015
Date of publication
2008 July
Publication type
Journal Article
Publication details
Bulletin of the World Health Organisation 86 7 pp 568-576
Publication status
Published
Language
English
Keywords
health financing, tuberculosis, Millennium Development Goals, Africa
Abstract
This study estimated the financial resources required to achieve the 2015 targets for global tuberculosis (TB) control, set within the Millennium Development Goals (MDGs). The Global Plan to Stop TB, 2006-2015 was developed by the Stop TB Partnership. Plan costs were estimated using spreadsheet models that included epidemiological, demographic, planning and unit cost data. A total of US$ 56 billion was found to be required during 2006-2015 (93% for TB-endemic countries, 7% for international technical agencies), increasing from US$ 3.5 billion in 2006 to US$ 6.7 billion in 2015. The single biggest cost (US$ 3 billion per year) was for the treatment of drug-susceptible cases in DOTS programmes. Other major costs are treatment of patients with multi-and extensively drug-resistant TB (MDR-TB and XDR-TB), collaborative TB/HIV activities, and advocacy, communication and social mobilization. Low-income countries account for 41% of total funding needs and 65% of funding needs for TB/HIV. Middle-income countries account for 72% of the funding needed for treatment of MDR-TB and XDR-TB. African countries require the largest increases in funding. The study concludes that achieving the 2015 global targets set for TB control requires a major increase in funding. To support resource mobilization, comprehensive and costed national plans that are in line with the 1. Global Plan to Stop TB are needed, backed up by robust assessments of the funding that can be raised in each country from domestic sources and the balance that is needed from donors.
Country
Publisher
Bulletin of the World Health Organisation
Theme area
Equity in health, Resource allocation and health financing, Equity and HIV/AIDS
Title of publication Cost, affordability and cost-effectiveness of strategies to control tuberculosis in countries with high HIV prevalence
Date of publication
2011
Publication type
Journal Article
Publication details
BMC Health Services Research 11 Suppl 2 pp /-/
Publication status
Published
Language
English
Keywords
health financing; health equity; South Africa
Abstract
After elections in 1994, the South African government implemented national and regional programmes, such as the Wild Coast Spatial Development Initiative (SDI), to provoke economic growth and to decrease inequities. CIET measured development in the Wild Coast region across four linked cross-sectional surveys (1997-2007). The 2007 survey was an opportunity to look at inequities since the original 1997 baseline, and how such inequities affect access to health care. The 2000, 2004 and 2007 follow-up surveys revisited the communities of the 1997 baseline. Household-level multivariate analysis looked at development indicators and access to health in the context of inequities such as household crowding, access to protected sources of water, house roof construction, main food item purchased, and perception of community empowerment. Individual multivariate models accounted for age, sex, education and income earning opportunities. While there have been some improvements, the Wild Coast region still falls well below provincial and national standards in key areas such as access to clean water and employment despite years of government-led investment. Inequities remain prominent, particularly around access to health services.
Country
Publisher
BMC Health Services Research
Theme area
Equitable health services
Title of publication Can universal insecticide-treated net campaigns achieve equity in coverage and use? the case of northern Nigeria
Date of publication
2012 February
Publication type
Journal Article
Publication details
Malaria Journal 11 32 pp /-/
Publication status
Published
Language
English
Keywords
malaria treatment, bednets, Nigeria
Abstract
Insecticide-treated nets (ITNs) are effective tools for malaria prevention and can significantly reduce severe disease and mortality due to malaria, especially among children under five in endemic areas. However, ITN coverage and use remain low and inequitable among different socio-economic groups in sub-Saharan Africa, particularly in Nigeria. Several strategies have been proposed to increase coverage and use and reduce inequity in Nigeria, including free distribution campaigns recently conducted by the Nigerian federal government. Using data from the first post-campaign survey, the authors investigated the effect of the mass free distribution campaigns in achieving equity in household ownership and use of ITNs. A post-campaign survey was undertaken in November 2009 in northern Nigeria to assess the effect of the campaigns in addressing equity across different socio-economic groups. The survey included 987 households randomly selected from 60 clusters in Kano state. Using logistic regression and the Lorenz concentration curve and index, the authors assessed equity in ITN coverage and use. The campaign had a significant impact by increasing ITN coverage and reducing inequity in ownership and use. Free ITN distribution campaigns should be sustained to increase equitable coverage. These campaigns should be supplemented with other ITN distribution strategies to cover newborns and replace aging nets.
Country
Publisher
Malaria Journal
Theme area
Equitable health services, Equity and HIV/AIDS
Title of publication NGO-provided free HIV treatment and services in Burkina Faso: Scarcity, therapeutic rationality and unfair process
Date of publication
2012 March
Publication type
Journal Article
Publication details
International Journal for Equity in Health 11 11 pp /-/
Publication status
Published
Language
English
Keywords
antiretrovirals, user-fees, Burkina Faso
Abstract
Until 2010, Burkina Faso was an exception to the international trend of abolishing user fees for antiretroviral treatment (ART). Patients were still expected to pay 1,500F CFA (2 Euros) per month for ART. Nevertheless, many non-governmental organizations (NGOs) exempted patients from payment. The objective of this study was to investigate how NGOs selected the beneficiaries of payment exemptions for government-provided ART and rationed out complementary medical and psychosocial services. Results of this qualitative study indicate that there are no concrete guidelines for identifying patients warranting payment exemptions. Formerly, ART was scarce in Burkina Faso and the primary criterion for treatment selection was clinical. The results suggest that this scarcity, mediated by an approach we call sociotherapeutic rationality (i.e. maximization of clinical success), may have led to inequities in the provision of free ART. This approach may be detrimental to assuring equity since the most impoverished lack resources to pay for services that maximize clinical success (e.g. viral load) that would increase their chances of being selected for treatment. However, once selected into treatment, attempts were made to ration-out complementary services more equitably. This study demonstrates the risks entailed by medication scarcity, which presents NGOs and health professionals with impossible choices that run counter to the philosophy of equity in access to treatment. Amid growing concerns of an international funding retreat for ART, it is important to learn from the past in order to better manage the potentially inequitable consequences of ART scarcity
Country
Publisher
International Journal for Equity in Health
Theme area
Equitable health services, Resource allocation and health financing
Title of publication Implementing the global plan to stop TB, 2011-2015 - optimizing allocations and the global fund's contribution: A scenario projections study
Date of publication
2012 June
Publication type
Journal Article
Publication details
Plos ONE 7 6 pp /-/
Publication status
Published
Language
English
Keywords
health financing; tuberculosis, global fund, Africa
Abstract
The Global Plan to Stop TB estimates funding required in low- and middle-income countries to achieve TB control targets set by the Stop TB Partnership within the context of the Millennium Development Goals. The authors estimate the contribution and impact of Global Fund investments under various scenarios of allocations across interventions and regions. Using Global Plan assumptions on expected cases and mortality, the authors estimate treatment costs and mortality impact for diagnosis and treatment for drug-sensitive and multidrug-resistant TB (MDR-TB), including antiretroviral treatment (ART) during DOTS for HIV-co-infected patients, for four country groups, overall and for the Global Fund investments. In 2015, China and India account for 24% of funding need, Eastern Europe and Central Asia (EECA) for 33%, sub-Saharan Africa (SSA) for 20%, and other low- and middle-income countries for 24%. Scale-up of MDR-TB treatment, especially in EECA, drives an increasing global TB funding need - an essential investment to contain the mortality burden associated with MDR-TB and future disease costs. Funding needs rise fastest in SSA, reflecting increasing coverage need of improved TB/HIV management, which saves most lives per dollar spent in the short term. The Global Fund is expected to finance 8-12% of Global Plan implementation costs annually. Lives saved through Global Fund TB support within the available funding envelope could increase 37% if allocations shifted from current regional demand patterns to a prioritized scale-up of improved TB/HIV treatment and secondly DOTS, both mainly in Africa - with EECA region, which has disproportionately high per-patient costs, funded from alternative resources. These findings, alongside country funding gaps, domestic funding and implementation capacity and equity considerations, should inform strategies and policies for international donors, national governments and disease control programs to implement a more optimal investment approach focusing on highest-impact populations and interventions
Country
Publisher
Plos ONE
Theme area
Values, policies and rights, Health equity in economic and trade policies
Title of publication Where are WEEE in Africa? Findings from the Basel Convention E-waste Africa Programme
Date of publication
2012 February
Publication type
Report
Publication details
The United Nations Environment Program; UNEP / / pp /-/
Publication status
Published
Language
English
Keywords
e-waste, Africa
Abstract
Information Communication Technology (ICT) has revolutionized modern living, international business, global governance, communication, entertainment, transport, education, and health care. This has been driven by unprecedented high volumes of production and usage of consumer electronic products, in particular, personal computers, mobile phones, and television sets. Access to ICT has been identified as an indicator of a country’s economic and social development. The difference in access to ICT between developed and developing countries is commonly referred to as the “digital divide”. Africa has been undergoing rapid ICT transformation in recent years, attempting to bridge this divide by importing second-hand or used computers, mobile phones, and TV sets from developed countries. The countries of the region, however, lack the infrastructure and resources for the environmentally sound management (ESM) of electrical and electronic waste (e-waste) arising when such imports reach their end-of-life. The report analyses the flows of electrical and electronic equipment and e-waste and makes recommendations for African countries, particularly in West Africa, to prevent the import of e-waste and near-end-of-life equipment without hampering the socio-economically valuable trade of EEE of good quality.
Country
Publisher
Theme area
Values, policies and rights, Health equity in economic and trade policies
Title of publication How Well Does Climate Change and Human Health Research Match the Demands of Policymakers? A Scoping Review
Date of publication
2012 August
Publication type
Journal Article
Publication details
Environ Health Perspect 120 8 pp /-/
Publication status
Published
Language
English
Keywords
climate change, health policy, research, Africa
Abstract
In 2008, the World Health Organization (WHO) Member States passed a World Health Assembly resolution that identified the following five priority areas for research and pilot projects on climate change and human health: health vulnerability, health protection, health impacts of mitigation and adaptation policies, decision-support and other tools, and costs of health protection from climate change. To assess the extent to which recently published research corresponds to these priorities, the authors undertook a scoping review of original research on climate change and human health. Scoping reviews address topics that are too broad for a systematic review and commonly aim to identify research gaps in existing literature. The study also assessed recent publication trends for climate change and health research. The authors identified 40 eligible studies. Compared with other health topics, the number of climate change publications has grown rapidly, with a larger proportion of reviews or editorials. Recent original research addressed four of the five priority areas identified by the WHO Member States, but found no eligible studies of health adaptation interventions, and most of the studies focused on high-income countries. The study concludes that climate change and health is a rapidly growing area of research, but quantitative studies remain rare. Among recently published studies, the authors found gaps in adaptation research and a deficit of studies in most developing regions. Funders and researchers should monitor and respond to research gaps to help ensure that the needs of policymakers are met.
Country
Publisher
Environ Health Perspect
Theme area
Health equity in economic and trade policies
Title of publication Integrating Climate Change Adaptation into Public Health Practice: Using Adaptive Management to Increase Adaptive Capacity and Build Resilience
Date of publication
2011 February
Publication type
Journal Article
Publication details
Environ Health Perspect 129 2 pp /-/
Publication status
Published
Language
English
Keywords
climate change, public health, global
Abstract
Climate change is expected to have a range of health impacts, some of which are already apparent. Public health adaptation is imperative, but there has been little discussion of how to increase adaptive capacity and resilience in public health systems. The authors explored possible explanations for the lack of work on adaptive capacity, outline climate–health challenges that may lie outside public health’s coping range, and consider changes in practice that could increase public health’s adaptive capacity. For the study, the authors conducted a substantive, interdisciplinary literature review focused on climate change adaptation in public health, social learning, and management of socioeconomic systems exhibiting dynamic complexity. There are two competing views of how public health should engage climate change adaptation. Perspectives differ on whether climate change will primarily amplify existing hazards, requiring enhancement of existing public health functions, or present categorically distinct threats requiring innovative management strategies. In some contexts, distinctly climate-sensitive health threats may overwhelm public health’s adaptive capacity. Addressing these threats will require increased emphasis on institutional learning, innovative management strategies, and new and improved tools. Adaptive management, an iterative framework that embraces uncertainty, uses modeling, and integrates learning, may be a useful approach. The authors illustrate its application to extreme heat in an urban setting. Increasing public health capacity will be necessary for certain climate–health threats. Focusing efforts to increase adaptive capacity in specific areas, promoting institutional learning, embracing adaptive management, and developing tools to facilitate these processes are important priorities and can improve the resilience of local public health systems to climate change.
Country
Publisher
Environ Health Perspect
Theme area
Health equity in economic and trade policies, Governance and participation in health
Title of publication Self-Help Groups and Mutual Assistance: Evidence from Urban Kenya
Date of publication
2012 July
Publication type
Journal Article
Publication details
Economic Development and Cultural Change 60 4 pp /-/
Publication status
Published
Language
English
Keywords
self help, income, Kenya
Abstract
This article examines the incomes of individuals who have joined self-help groups in poor neighborhoods of Nairobi. Self-help groups are often advocated as a way of facilitating income pooling. The authors find that incomes are indeed more correlated among individuals in the same group than among individuals who belong to different groups. Using an original methodology, the authors test whether this correlation is due to self-selection of similar individuals into the same groups. The article suggests that this correlation is not driven by positive assortative matching. If anything, selection works in the opposite direction: incomes from group activities would be more correlated if individuals were matched at random. These findings are consistent with the idea that self-help groups play a mutual assistance role.
Country
Publisher
Economic Development and Cultural Change
Theme area
Governance and participation in health, Monitoring equity and research to policy
Title of publication Discussion paper 92: Annotated literature review: Conceptual frameworks and strategies for research on global health diplomacy
Date of publication
2012 July
Publication type
Report
Publication details
Annotated literature review: Conceptual frameworks and strategies for research on global health diplomacy, EQUINET Discussion paper 92 CTPL\EQUINET, July 2012.
Publication status
Published
Language
Keywords
global health diplomacy; research methods; annotated bibliography
Abstract
This annotated literature review was prepared as a resource for the policy research programme led by EQUINET that is examining the role of global health diplomacy (GHD), including south–south diplomacy, in addressing selected key challenges to health and strengthening health systems. This review provides an annotated bibliography and a summary of key features of peer-reviewed articles, books, book chapters and academic reports published between 1998 and 2004 on three case study areas: research on GHD, particularly in the areas of the WHO Code on International Recruitment of Health Workers; access to essential drugs through south-south partnerships; and involvement of African actors in global health governance. It focuses on the theoretical and conceptual frameworks used in peer-reviewed literature on global health diplomacy and on the authors’ methodological choices to reach their conclusions. The report highlights theories that guided the research, the types of conceptual frameworks used and the research strategy and research tools employed in the publications reviewed.
Country
Global
Publisher
EQUINET
Equinet Publication Type
Discussion paper
Theme area
Equitable health services, Governance and participation in health
Title of publication Community preferences for improving public sector health services in South Africa
Date of publication
2012 March
Publication type
Document
Publication details
Health Economics Unit Policy Briefing / pp /-/
Publication status
Published
Language
English
Keywords
community preferences; primary care services; South Africa
Abstract
For some time, there has been criticism of the quality of public sector health services. Various aspects of public services have been raised as areas of concern, but these have largely been based on anecdotal evidence. There has been limited research to identify what communities regard as the greatest problems with public sector health services. This research explored communities views on the elements of public health services that they find particularly problematic. It aimed to quantity the priority placed on each of these aspects of public service delivery that requires attention.
Country
Publisher
Health Economics Unit
Theme area
Human resources for health
Title of publication Extension workers drive Ethiopia’s primary health care
Date of publication
2010 September
Publication type
Journal Article
Publication details
The Lancet 372 9642 pp /-/
Publication status
Published
Language
English
Keywords
community health workers, primary health care, Ethiopia
Abstract
Thousands of community workers are helping Ethiopia to deliver primary health-care services to people living in rural areas. But critics say the training these workers receive is not adequate for them to attend many of the health problems they encounter. Wairagala Wakabi reports. Although it still has some of the worst health indicators in the world, Ethiopia is fast registering impressive successes in extending affordable primary health-care services across the country. These achievements are largely attributable to the Health Extension Programme which has been implemented since 2003, and through which the country hopes to achieve universal access to primary health care by 2009. Coverage of publicly-funded health care has risen from 61% in 2003 to 87% in 2007, whereas total coverage—including services provided by private health facilities—has grown from 70% to 98% over the same period. The Health Extension Programme, which has enabled this success, aims to improve access and equity through provision of essential health interventions at the village and household level, with a focus on sustained preventive health actions and increased awareness. The initiative deploys two salaried health extension workers at each village health post. Most of these workers are women who are recruited from the local communities in which they will work. New recruits complete a 1-year training course, which includes fieldwork, before taking up their posts.
Country
Publisher
The Lancet
Theme area
Equitable health services, Equity and HIV/AIDS
Title of publication Strengthening Health Systems at Facility-Level: Feasibility of Integrating Antiretroviral Therapy into Primary Health Care Services in Lusaka, Zambia
Date of publication
2010 July
Publication type
Journal Article
Publication details
Plos ONE 5 7 pp /-/
Publication status
Published
Language
English
Keywords
antiretroviral therapy, primary health care, Zambia
Abstract
HIV care and treatment services are primarily delivered in vertical antiretroviral (ART) clinics in sub-Saharan Africa but there have been concerns over the impact on existing primary health care services. This paper presents results from a feasibility study of a fully integrated model of HIV and non-HIV outpatient services in two urban Lusaka clinics. Integration involved three key modifications: i) amalgamation of space and patient flow; ii) standardization of medical records and iii) introduction of routine provider initiated testing and counseling (PITC). Assessment of feasibility included monitoring rates of HIV case-finding and referral to care, measuring median waiting and consultation times and assessing adherence to clinical care protocols for HIV and non-HIV outpatients. Qualitative data on patient/provider perceptions was also collected. The paper concludes that integrating vertical ART and OPD services is feasible in the low-resource and high HIV-prevalence setting of Lusaka, Zambia. Integration enabled shared use of space and staffing that resulted in increased HIV case finding, a reduction in stigma associated with vertical ART services but resulted in an overall increase in patient waiting times. Further research is urgently required to assess long-term clinical outcomes and cost effectiveness in order to evaluate scalability and generalizability.
Country
Publisher
Plos ONE
Theme area
Equitable health services, Human resources for health
Title of publication Contraceptive injections by community health workers in Uganda: a nonrandomized community trial
Date of publication
2007 October
Publication type
Journal Article
Publication details
Bulletin Of The World Health Organization 85 10 pp 7668-7673
Publication status
Published
Language
English
Keywords
community health workers, reproductive health, Uganda
Abstract
To compare the safety and quality of contraceptive injections by community-based health workers with those of clinic- based nurses in a rural African setting. A nonrandomized community trial tested provision of injectable Depo Provera (DMPA) by community reproductive health workers and compared it with routine DPMA provision at health units in Nakasongola District, Uganda. The primary outcome measures were safety, acceptability and continuation rates. A total of 945 new DMPA users were recruited by community workers, clinic-based nurses and midwives. Researchers successfully followed 777 (82% follow-up): 449 community worker clients and 328 clinic-based clients. Ninety-five percent of community-worker clients were “satisfied” or “highly satisfied” with services, and 85% reported receiving information on side-effects. There were no serious injection site problems in either group. Similarly, there was no significant difference between continuation to second injection (88% among clients of community-based workers, 85% among clinic-going clients), nor were there significant differences in other measures of safety, acceptability and quality.The study concludes that community-based distribution (CBD) of injectable contraceptives is now routine in some countries in Asia and Latin America, but is practically unknown in Africa, where arguably the need for this practice is greatest. This research reinforces experience from other regions suggesting that well-trained community health workers can safely provide contraceptive injections.
Country
Publisher
Bulletin Of The World Health Organization
Theme area
Equity in health, Public-private mix
Title of publication Assessing public and private sector contributions in reproductive health financing and utilization for six sub-Saharan African countries
Date of publication
2011 May
Publication type
Journal Article
Publication details
Reproductive Health Matters 19 37 pp 62-74
Publication status
Published
Language
English
Keywords
private sector, reproductive health, health financing, Africa
Abstract
The present study provides evidence to support enhanced attention to reproductive health and comprehensive measures to increase access to quality reproductive health services. The authors compare and contrast the financing and utilization of reproductive health services in six sub-Saharan African countries using data from National Health Accounts and Demographic and Health Surveys. Spending on reproductive health in 2006 ranged from US$4 per woman of reproductive age in Ethiopia to US$17 in Uganda. These are below the necessary level for assuring adequate services given that an internationally recommended spending level for family planning alone was US$16 for 2006. Moreover, reproductive health spending shows signs of decline in tandem with insufficient improvement in service utilization. Public providers played a predominant role in antenatal and delivery care for institutional births, but home deliveries with unqualified attendants dominated. The private sector was a major supplier of condoms, oral pills and IUDs. Private clinics, pharmacies and drug vendors were important sources of STI treatment. The findings highlight the need to commit greatly increased funding for reproductive health services as well as more policy attention to the contribution of public, private and informal providers and the role of collaboration among them to expand access to services for under-served populations.
Country
Publisher
Reproductive Health Matters
Theme area
Equitable health services, Equity and HIV/AIDS
Title of publication Implementation of clinic-based modified-directly observed therapy (m-DOT) for ART; experiences in Mombasa, Kenya
Date of publication
2010 February
Publication type
Journal Article
Publication details
AIDS Care 22 2 pp 187-194
Publication status
Published
Language
English
Keywords
tuberculosis; directly observed therapy, primary care; Kenya
Abstract
The effectiveness of modified-directly observed therapy (m-DOT), an adherence support intervention adapted from TB DOTS programmes, has been documented. Describing the implementation process and acceptability of this intervention is important for scaling up, replication in other settings and future research. In a randomised trial in Mombasa, Kenya, patients were assigned to m-DOT or standard of care for 24 weeks. m-DOT entailed twice weekly visits to a health centre for medication collection, ongoing adherence counselling and nurse-observed pill ingestion. Community health workers (CHWs) traced non-attendees, observing pill taking at participant's home. Using process indicators and a semi-structured questionnaire, implementation of m-DOT was evaluated among 94 participants who completed 24 weeks m-DOT (81%; 94/116). Two-thirds of m-DOT recipients were female (64%; 74/116) and a mean 37 years (SD = 7.8). Selection of the m-DOT observation site was determined by proximity to home for 73% (69/94), with the remainder choosing sites near their workplace, or due to perceived high-quality services. A median 42 of 48 scheduled m-DOT visits (IQR = 28-45) were attended. Most found m-DOT is very useful (87%; 82/94) and had positive attitudes to the services. A high proportion received CHWs home visits (96%; 90/94) and looked forward to these. Use of CHWs and several satellite observation sites facilitated provision of services closer to patient's homes. A substantial number, however, thought 24 weeks of m-DOT was too long (43%; 42/94). Our experience suggests that m-DOT services could be implemented widely and are acceptable if delivered with adequate attention to coordination, provision of a broad set of interventions, shifting tasks to less-specialised workers and integration within the health system. m-DOT programmes should utilise existing resources while simultaneously expanding capacity within communities and the public sector. These findings could be used to inform replication of such services and to improve the design of m-DOT in future studies.
Country
Publisher
AIDS Care
Theme area
Equitable health services
Title of publication Malaria Rapid Testing by Community Health Workers Is Effective and Safe for Targeting Malaria Treatment: Randomised Cross-Over Trial in Tanzania
Date of publication
2011 July
Publication type
Journal Article
Publication details
Plos ONE 6 7 pp /-/
Publication status
Published
Language
English
Keywords
malaria treatment, community health workers, Tanzania
Abstract
Early diagnosis and prompt, effective treatment of uncomplicated malaria is critical to prevent severe disease, death and malaria transmission. The authors assessed the impact of rapid malaria diagnostic tests (RDTs) by community health workers (CHWs) on provision of artemisinin-based combination therapy (ACT) and health outcome in fever patients. Twenty-two CHWs from five villages in Kibaha District, a high-malaria transmission area in Coast Region, Tanzania, were trained to manage uncomplicated malaria using RDT aided diagnosis or clinical diagnosis (CD) only. Each CHW was randomly assigned to use either RDT or CD the first week and thereafter alternating weekly. Primary outcome was provision of ACT and main secondary outcomes were referral rates and health status by days 3 and 7. The CHWs enrolled 2930 fever patients during five months of whom 1988 (67.8%) presented within 24 hours of fever onset. ACT was provided to 775 of 1457 (53.2%) patients during RDT weeks and to 1422 of 1473 (96.5%) patients during CD weeks (Odds Ratio (OR) 0.039, 95% CI 0.029–0.053). The CHWs adhered to the RDT results in 1411 of 1457 (96.8%, 95% CI 95.8–97.6) patients. More patients were referred on inclusion day during RDT weeks (10.0%) compared to CD weeks (1.6%). Referral during days 1–7 and perceived non-recovery on days 3 and 7 were also more common after RDT aided diagnosis. However, no fatal or severe malaria occurred among 682 patients in the RDT group who were not treated with ACT, supporting the safety of withholding ACT to RDT negative patients. The study concludes that RDTs in the hands of CHWs may safely improve early and well-targeted ACT treatment in malaria patients at community level in Africa.
Country
Publisher
Plos ONE
Theme area
Equitable health services, Equity and HIV/AIDS
Title of publication Does accessibility to antiretroviral care improve after down-referral of patients from hospitals to health centres in rural South Africa?
Date of publication
2012 January
Publication type
Journal Article
Publication details
African Journal Of AIDS Research 10 4 pp 393-401
Publication status
Published
Language
English
Keywords
adherence, antiretroviral therapy, primary care, evaluation, South Africa
Abstract
The authors conducted an evaluation of healthcare accessibility among patients taking antiretroviral treatment (ART) after they were ‘down-referred’ from hospital-based programmes to primary healthcare (PHC) centres in a rural South African setting. A cross-sectional design was used to study 109 PHC users compared to a randomly selected control group of 220 hospital-based users. Both groups were matched for a minimum duration on ART of six months. Using a comprehensive healthcare-accessibility framework, the participants were asked about availability, affordability and acceptability of their ART care in structured exit interviews that were linked to their ART-clinic record reviews. Unadjusted and adjusted regression models were used. Down-referral was associated with reduced transportation and meal costs (p ≤ 0.001) and travel time to an ART facility (p = 0.043). The down-referred users were less likely to complain of long queues (adjusted odds ratio [AOR] 0.06; 95% confidence interval [95% CI]: 0.01–0.29), were more likely to feel respected by health providers (AOR 4.43; 95% CI: 1.07–18.02), perceived lower stigma (AOR 0.25; 95% CI: 0.07–0.91), and showed a higher level of ART adherence (AOR 8.71; 95% CI: 1.16–65.22) than the hospital-based users. However, the down-referred users preferred to consult with doctors rather than nurses (AOR 3.43; 95% CI: 1.22–9.55) and they were more likely to visit private physicians (AOR 7.09; 95% CI: 3.86–13.04) and practice self-care (AOR 4.91; 95% CI: 2.37–10.17), resulting in increased health-related expenditure (p ≤ 0.001). Therefore, the results indicate both gains and losses in ART care for the patients, and suggest that down-referred patients save time and money, feel more respected, perceive lower stigma and show better adherence levels. However, unintended consequences include increased costs of using private physicians and self-care, highlighting the need to further promote the potential gains of down-referral interventions in resource-poor settings.
Country
Publisher
African Journal Of AIDS Research
Theme area
Equitable health services, Resource allocation and health financing
Title of publication Equity in financing and use of health care in Ghana, South Africa, and Tanzania: implications for paths to universal coverage
Date of publication
2012 July
Publication type
Journal Article
Publication details
The Lancet 380 9837 pp 126-133
Publication status
Published
Language
English
Keywords
health financing, universal health coverage, health care, Ghana, South Africa, Tanzania
Abstract
Universal coverage of health care is now receiving substantial worldwide and national attention, but debate continues on the best mix of financing mechanisms, especially to protect people outside the formal employment sector. Crucial issues are the equity implications of different financing mechanisms, and patterns of service use. The authors report a whole-system analysis—integrating both public and private sectors—of the equity of health-system financing and service use in Ghana, South Africa, and Tanzania. The authors used primary and secondary data to calculate the progressivity of each health-care financing mechanism, catastrophic spending on health care, and the distribution of health-care benefits and collected qualitative data to inform interpretation. Overall health-care financing was progressive in all three countries, as were direct taxes. Indirect taxes were regressive in South Africa but progressive in Ghana and Tanzania. Out-of-pocket payments were regressive in all three countries. Health-insurance contributions by those outside the formal sector were regressive in both Ghana and Tanzania. The overall distribution of service benefits in all three countries favoured richer people, although the burden of illness was greater for lower-income groups. Access to needed, appropriate services was the biggest challenge to universal coverage in all three countries. Analyses of the equity of financing and service use provide guidance on which financing mechanisms to expand, and especially raise questions over the appropriate financing mechanism for the health care of people outside the formal sector. Physical and financial barriers to service access must be addressed if universal coverage is to become a reality.
Country
Publisher
The Lancet
Theme area
Equitable health services, Resource allocation and health financing
Title of publication Beyond fragmentation and towards universal coverage: insights from Ghana, South Africa and the United Republic of Tanzania
Date of publication
2008 November
Publication type
Journal Article
Publication details
Bulletin of the World Health Organisation 86 11 pp 817-908
Publication status
Published
Language
English
Keywords
health financing; universal health coverage, Ghana, South Africa, Tanzania
Abstract
Over the past few decades, health sector reforms in many African and other low- and middle-income countries have increased inequities in access to affordable health care. A growing reliance on out-of-pocket payments and privately organized care has resulted in health care provided on the basis of ability-to-pay, which has disadvantaged lower-income socioeconomic groups. The aim of this analysis is to explore the extent of fragmentation within the health systems of three African countries (Ghana, South Africa and the United Republic of Tanzania); how this developed; how each country has attempted to address the equity challenges arising from this fragmentation and what remains to be done to promote universal coverage. This paper draws on the results of the first phase of a three-year project analysing equity in the finance and delivery of health care in Ghana, South Africa and United Republic of Tanzania.
Country
Publisher
Bulletin of the World Health Organisation
Theme area
Resource allocation and health financing
Title of publication Reaching universal coverage by means of social health insurance in Lesotho? Results and implications from a financial feasibility assessment
Date of publication
2011 April
Publication type
Journal Article
Publication details
International Social Security Review 64 2 pp 45-63
Publication status
Published
Language
English
Keywords
universal health coverage, social health insurance, Lesotho
Abstract
This article discusses the process, results and implications of a financial feasibility assessment of social health insurance (SHI), as one part of Lesotho’s exploration of how to move towards achieving universal health care coverage. Quantitative data from government and other sources, and qualitative data from discussions with stakeholders, were entered into SimIns, a health insurance simulation software, through which SHI revenue and expenditure for 11 years was projected. In principle, the assessment reveals that through a mix of tax financing and SHI contributions, all citizens of Lesotho could be covered with a defined benefit package of health services under the defined policy assumptions. Such a financing scheme would provide financial risk protection and enhance equity in access and health financing.
Country
Publisher
International Social Security Review
Theme area
Equitable health services, Human resources for health
Title of publication Lay health workers in primary and community health care for maternal and child health and the management of infectious diseases
Date of publication
2010 March
Publication type
Journal Article
Publication details
Cochrane Database of Systematic Reviews 17 3 pp /-/
Publication status
Published
Language
English
Keywords
community health workers, primary health care, maternal and child health; Africa
Abstract
Lay health workers (LHWs) are widely used to provide care for a broad range of health issues. Little is known, however, about the effectiveness of LHW interventions. To assess the effects of LHW interventions in primary and community health care on maternal and child health and the management of infectious diseases. The authors reviewed randomised controlled trials of any intervention delivered by LHWs (paid or voluntary) in primary or community health care and intended to improve maternal or child health or the management of infectious diseases. A 'lay health worker' was defined as any health worker carrying out functions related to healthcare delivery, trained in some way in the context of the intervention, and having no formal professional or paraprofessional certificate or tertiary education degree. There were no restrictions on care recipients. The study concludes that LHWs provide promising benefits in promoting immunisation uptake and breastfeeding, improving TB treatment outcomes, and reducing child morbidity and mortality when compared to usual care. For other health issues, evidence is insufficient to draw conclusions about the effects of LHWs.
Country
Publisher
Cochrane Database of Systematic Reviews
Theme area
Equitable health services
Title of publication Supporting the delivery of cost-effective interventions in primary health-care systems in low-income and middle-income countries: an overview of systematic reviews
Date of publication
2008 September
Publication type
Journal Article
Publication details
The Lancet 372 9642 pp 928-939
Publication status
Published
Language
English
Keywords
cost effective, primary health care, systematic review Africa
Abstract
Strengthening health systems is a key challenge to improving the delivery of cost-effective interventions in primary health care and achieving the vision of the Alma-Ata Declaration. Effective governance, financial and delivery arrangements within health systems, and effective implementation strategies are needed urgently in low-income and middle-income countries. This overview summarises the evidence from systematic reviews of health systems arrangements and implementation strategies, with a particular focus on evidence relevant to primary health care in such settings. Although evidence is sparse, there are several promising health systems arrangements and implementation strategies for strengthening primary health care. However, their introduction must be accompanied by rigorous evaluations. The evidence base needs urgently to be strengthened, synthesised, and taken into account in policy and practice, particularly for the benefit of those who have been excluded from the health care advances of recent decades.
Country
Publisher
The Lancet
Theme area
Equitable health services, Human resources for health
Title of publication Lay health workers in primary and community health care: A systematic review of trials
Date of publication
2006 November
Publication type
Report
Publication details
World Health Organisation / / pp /-/
Publication status
Published
Language
English
Keywords
community health workers, primary health care, systematic review Africa
Abstract
Increasing interest has been shown in the use of lay health workers (LHWs) for the delivery of a wide range of maternal and child health (MCH) services in low and middle in- come countries (LMICs). However, robust evidence of the effects of LHW interventions in improving MCH delivery is limited. The objective of this study is to review evidence from randomized controlled trials (RCTs) on the effects of LHW interventions in improving MCH and addressing key high burden diseases in LMICs. Three methods were used in this study. Firstly, search strategy: multiple databases and reference lists of articles were searched for RCTs of LHW interventions in MCH. RCTs identified in an earlier systematic review were included in this report where appropriate. Secondly, selection criteria: a LHW was defined by the authors of this report as a health worker delivering health care, who is trained in the context of the intervention but has no formal professional certificate or tertiary education degree. RCTs were included of any intervention delivered by LHWs (paid or voluntary) in primary or community health care and intended to promote health, manage illness or provide support to patients. Interventions needed to be relevant to MCH and/or high burden diseases in LMICs. No restrictions were placed on the types of consumers. Lastly, data collection and analysis: data were extracted for each study and study quality assessed. Studies comparing broadly similar types of interventions were grouped together. Where feasible, the results of the included studies were combined and an estimate of effect obtained. The study found that the use of LHWs in health programmes shows promising benefits, compared to usual care, in promoting immunization and breastfeeding uptake; in reducing mortality and morbidity from common childhood illnesses; and in improving TB treatment outcomes. Little evidence is available regarding the effectiveness of substituting LHWs for health professionals or the effectiveness of alternative training strategies for LHWs.
Country
Publisher
World Health Organisation
Theme area
Equitable health services, Equity and HIV/AIDS
Title of publication Antiretroviral Treatment for HIV in Rural Uganda: Two-Year Treatment Outcomes of a Prospective Health Centre/Community-Based and Hospital-Based Cohort
Date of publication
2012 July
Publication type
Journal Article
Publication details
PLoS ONE 7 7 pp /-/
Publication status
Published
Language
English
Keywords
antiretroviral treatment, primary care; Uganda
Abstract
In sub-Saharan Africa, a shortage of trained health professionals and limited geographical access to health facilities present major barriers to the expansion of antiretroviral therapy (ART). The authors tested the utility of a health centre (HC)/community-based approach in the provision of ART to persons living with HIV in a rural area in western Uganda. The HIV treatment outcomes of the HC/community-based ART program were evaluated and compared with those of an ART program at a best-practice regional hospital. The HC/community-based cohort comprised 185 treatment-naïve patients enrolled in 2006. The hospital cohort comprised of 200 patients enrolled in the same time period. The HC/community-based program involved weekly home visits to patients by community volunteers who were trained to deliver antiretroviral drugs to monitor and support adherence to treatment, and to identify and report adverse reactions and other clinical symptoms. Treatment supporters in the homes also had the responsibility to remind patients to take their drugs regularly. ART treatment outcomes were measured by HIV-1 RNA viral load (VL) after two years of treatment. Adherence was determined through weekly pill counts. The study concludes that acceptable rates of virologic suppression were achieved using existing rural clinic and community resources in a HC/community-based ART program run by clinical officers and supported by lay volunteers and treatment supporters. The results were equivalent to those of a hospital-based ART program run primarily by doctors.
Country
Publisher
PLoS ONE
Theme area
Equitable health services, Equity and HIV/AIDS
Title of publication An evaluation of the impact of a community-based adherence support programme on ART outcomes in selected government HIV treatment sites in South Africa
Date of publication
2011 February
Publication type
Journal Article
Publication details
AIDS Care 23 2 pp 231-236
Publication status
Published
Language
English
Keywords
antiretroviral therapy, community health; primary care; South Africa
Abstract
This study assessed the impact of a community-based adherence support service on the outcomes of patients on antiretroviral therapy (ART). The evaluation was a retrospective study based on patient clinical records. This study noted that a significantly higher proportion of patients with a community-based adherence supporter (also known as a patient advocate, PA) had viral load (VL) of less than 400 copies/ml at six months of treatment (70%, p=0.001); a significantly higher proportion of patients with PAs (89%) attained a treatment pickup rate of over 95% (67%; p=0.021). Patients at health facilities with PA services maintained a suppressed VL for a longer period as opposed to patients at health facilities without PA services (p=0.001), also patients at health facilities with PA services remained in care for longer periods (p=0.001). Therefore, the study concludes that integrated community-based adherence support is crucial in ensuring that patients remain in care, regularly pickup their treatment from ART clinics and are virologically suppressed. The study also underscores the importance of access to health services and the presence of an enabling environment in the treatment of AIDS.
Country
Publisher
AIDS Care
Theme area
Equitable health services
Title of publication Moving from vertical to integrated child health programmes: experiences from a multi-country assessment of the Child Health Days approach in Africa
Date of publication
2010 March
Publication type
Journal Article
Publication details
Tropical Medicine & International Health 15 3 pp 296-305
Publication status
Published
Language
English
Keywords
vertical programmes; primary health care; child health, Africa
Abstract
To assess the effect of child health days (CHDs) on coverage of child survival interventions, to document country experiences with CHDs and to identify ways in which CHDs have strengthened or depleted primary health care (PHC) services. Programme evaluation was done in six countries in sub-Saharan Africa using both quantitative (review of routine child health indicators) and qualitative (key informant interviews) methods. The authors found that CHDs have raised the profile of child survival at different levels from central government to the community in all six countries. The approach has increased the coverage of vitamin A supplementation and immunizations, especially in previously poorly performing countries. However, similar improvements have not occurred in non-CHD interventions, most notably exclusive breastfeeding. There were examples of duplication, especially in the capturing and use of health information. There was widespread evidence that PHC staff were being diverted from their usual PHC functions, and managers reported being distracted by the time required for the planning and execution of CHDs. Finally, there were examples of where the routine PHC system is becoming distorted through, for example, the payment of health worker incentives during CHD activities only. The study concludes that interventions such as CHDs can rapidly increase coverage of key child survival interventions; however, they need to do so in a manner that strengthens rather than depletes existing PHC services. Our findings suggest that stand alone child health day interventions may gradually need to be integrated with routine PHC through more general health system strengthening.
Country
Publisher
Tropical Medicine & International Health
Theme area
Equitable health services, Resource allocation and health financing
Title of publication The impact of reducing financial barriers on utilisation of a primary health care facility in Rwanda
Date of publication
2011 May
Publication type
Journal Article
Publication details
Global Public Health 7 1 pp 71-86
Publication status
Published
Language
English
Keywords
user fees, primary care; community based health insurance, Rwanda
Abstract
This study investigates the impact of subsidising community-based health insurance (mutuelle) enrolment, removing point-of-service co-payments, and improving service delivery on health facility utilisation rates in Mayange, a sector of rural Rwanda of approximately 25,000 people divided among five ‘imidugudu’ or small villages. While comprehensive service upgrades were introduced in the Mayange Health Centre between April 2006 and February 2007, utilisation rates remained similar to comparison sites. Between February 2007 and April 2007, subsidies for mutuelle enrolment established virtually 100% coverage. Immedi- ately after co-payments were eliminated in February 2007, patient visits levelled at a rate triple the previous value. Regression analyses using data from Mayange and two comparison sites indicate that removing financial barriers resulted in about 0.6 additional annual visits for curative care per capita. Although based on a single local pilot, these findings suggest that in order to achieve improved health outcomes, key short-term objectives include improved service delivery and reduced financial barriers. Based on this pilot, higher utilisation rates may be affected if broader swaths of the population are enrolled in mutuelle and co-payments are eliminated. Health leaders in Rwanda should consider further studies to determine if the impact of eliminating co-payments and increasing subsidies for mutuelle enrolment as seen in Mayange holds at greater levels of scale. Broader studies to better elucidate the impact of enrolment subsidies and co-payment subsidies on utilisation, health outcomes, and costs would also provide policy insights.
Country
Publisher
Global Public Health
Theme area
Equitable health services
Title of publication Thirty years after Alma-Ata: a systematic review of the impact of community health workers delivering curative interventions against malaria, pneumonia and diarrhoea on child mortality and morbidity in sub-Saharan Africa
Date of publication
2011 October
Publication type
Journal Article
Publication details
Human Resources for Health 9 1 pp 27-37
Publication status
Published
Language
English
Keywords
community health workers, child health; Africa
Abstract
Over thirty years have passed since the Alma-Ata Declaration on primary health care in 1978. Many governments in the first decade following the declaration responded by developing national programmes of community health workers (CHWs), but evaluations of these often demonstrated poor outcomes. As many CHW programmes have responded to the HIV/AIDS pandemic, international interest in them has returned and their role in the response to other diseases should be examined carefully so that lessons can be applied to their new roles. Over half of the deaths in African children under five years of age are due to malaria, diarrhoea and pneumonia - a situation which could be addressed through the use of cheap and effective interventions delivered by CHWs. However, to date there is very little evidence from randomised controlled trials of the impacts of CHW programmes on child mortality in Africa. Evidence from non-randomised controlled studies has not previously been reviewed systematically. The authors searched databases of published and unpublished studies for RCTs and non-randomised studies evaluating CHW programmes delivering curative treatments, with or without preventive components, for malaria, diarrhoea or pneumonia, in children in sub-Saharan Africa from 1987 to 2007. The impact of these programmes on morbidity or mortality in children under six years of age was reviewed. A descriptive analysis of interventional and contextual factors associated with these impacts was attempted. The review identified seven studies evaluating CHWs, delivering a range of interventions. Limited descriptive data on programmes, contexts or process outcomes for these CHW programmes were available. CHWs in national programmes achieved large mortality reductions of 63% and 36% respectively, when insecticide-treated nets and anti-malarial chemoprophylaxis were delivered, in addition to curative interventions. CHW programmes could potentially achieve large gains in child survival in sub-Saharan Africa if these programmes were implemented at scale. Large-scale rigorous studies, including RCTs, are urgently needed to provide policymakers with more evidence on the effects of CHWs delivering these interventions.
Country
Publisher
Human Resources for Health
Theme area
Equitable health services, Equity and HIV/AIDS
Title of publication Outcome assessment of decentralization of antiretroviral therapy provision in a rural district of Malawi using an integrated primary care model
Date of publication
2010 June
Publication type
Journal Article
Publication details
Tropical Medicine & International Health 15 Suppl 1 pp 90-97
Publication status
Published
Language
English
Keywords
antiretroviral therapy,primary care, Malawi
Abstract
To assess the effect of decentralization (DC) of antiretroviral therapy (ART) provision in a rural district of Malawi using an integrated primary care model. Between October 2004 and December 2008, 8093 patients (63% women) were registered for ART. Of these, 3440 (43%) were decentralized to health centres for follow-up ART care. The authors applied multivariate regression analysis that adjusted for sex, age, clinical stage at initiation, type of regimen, presence of side effects because of ART, and duration of treatment and follow-up at site of analysis. Patients managed at health centres had lower mortality [adjusted OR 0.19 (95% C.I. 0.15-0.25)] and lower loss to follow-up (defaulted from treatment) [adjusted OR 0.48 (95% C.I. 0.40-0.58)]. During the first 10 months of follow-up, those decentralized to health centres were approximately 60% less likely to default than those not decentralized; and after 10 months of follow-up, 40% less likely to default. DC was significantly associated with a reduced risk of death from 0 to 25 months of follow-up. The lower mortality may be explained by the selection of stable patients for DC, and the mentorship and supportive supervision of lower cadre health workers to identify and refer complicated cases. Decentralization of follow-up ART care to rural health facilities, using an integrated primary care model, appears a safe and effective way to rapidly scale-up ART and improves both geographical equity in access to HIV-related services and adherence to ART.
Country
Publisher
Tropical Medicine & International Health
Theme area
Equitable health services
Title of publication Alma-Ata: Rebirth and Revision 6 Interventions to address maternal, newborn, and child survival: what difference can integrated primary health care strategies make?
Date of publication
2008 September
Publication type
Journal Article
Publication details
The Lancet 372 9642 pp 972-989
Publication status
Published
Language
English
Keywords
primary health care, maternal and child health; international
Abstract
Several recent reviews of maternal, newborn, and child health (MNCH) and mortality have emphasised that a large range of interventions are available with the potential to reduce deaths and disability. The emphasis within MNCH varies, with skilled care at facility levels recommended for saving maternal lives and scale-up of community and household care for improving newborn and child survival. Systematic review of new evidence on potentially useful interventions and delivery strategies identifies 37 key promotional, preventive, and treatment interventions and strategies for delivery in primary health care. Some are especially suitable for delivery through community support groups and health workers, whereas others can only be delivered by linking community-based strategies with functional first-level referral facilities. Case studies of MNCH indicators in Pakistan and Uganda show how primary health-care interventions can be used effectively. Inclusion of evidence-based interventions in MNCH programmes in primary health care at pragmatic coverage in these two countries could prevent 20-30% of all maternal deaths (up to 32% with capability for caesarean section at first-level facilities), 20-21% of newborn deaths, and 29-40% of all postneonatal deaths in children aged less than 5 years. Strengthening MNCH at the primary health-care level should be a priority for countries to reach their Millennium Development Goal targets for reducing maternal and child mortality.
Country
Publisher
The Lancet
Theme area
Equitable health services, Human resources for health
Title of publication Can Volunteer Community Health Workers Decrease Child Morbidity and Mortality in Southwestern Uganda? An Impact Evaluation
Date of publication
2011 December
Publication type
Journal Article
Publication details
Plos ONE 6 12 pp 1-9
Publication status
Published
Language
English
Keywords
community health workers, child health, child mortality, Uganda
Abstract
The potential for community health workers to improve child health in sub-Saharan Africa is not well understood. Healthy Child Uganda implemented a volunteer community health worker child health promotion model in rural Uganda. An impact evaluation was conducted to assess volunteer community health workers' effect on child morbidity, mortality and to calculate volunteer retention. Two volunteer community health workers were selected, trained and promoted child health in each of 116 villages (population ~61,000) during 2006–2009. Evaluation included a household survey of mothers at baseline and post-intervention in intervention/control areas, retrospective reviews of community health worker birth/child death reports and post-intervention focus group discussions. Retention was calculated from administrative records. Main outcomes were prevalence of recent child illness/underweight status, community health worker reports of child deaths, focus group perception of effect, and community health worker retention. A low-cost child health promotion model using volunteer community health workers demonstrated decreased child morbidity, dramatic mortality trend declines and high volunteer retention. This sustainable model could be scaled-up to sub-Saharan African communities with limited resources and high child health needs.
Country
Publisher
Plos ONE
Theme area
Equitable health services, Equity and HIV/AIDS
Title of publication Implementing Antiretroviral Therapy in Rural Communities: The Lusikisiki Model of Decentralized HIV/AIDS Care
Date of publication
2007
Publication type
Journal Article
Publication details
Journal of Infectious Diseases 196 Suppl 3 pp S464-S468
Publication status
Published
Language
English
Keywords
antiretroviral therapy, decentrlisation, Primary care, South Africa
Abstract
Health worker shortages are a major bottleneck to scaling up antiretroviral therapy (ART), particularly in rural areas. In Lusikisiki, a rural area of South Africa with a population of 150,000 serviced by 1 hospital and 12 clinics, MÉdecins Sans FrontiÈres has been supporting a program to deliver human immunodeficiency virus (HIV) services through decentralization to primary health care clinics, task shifting (including nurse-initiated as opposed to physician-initiated treatment), and community support. This approach has allowed for a rapid scale-up of treatment with satisfactory outcomes. Although the general approach in South Africa is to provide ART through hospitals—which seriously limits access for many people, if not the majority of people—1-year outcomes in Lusikisiki are comparable in the clinics and hospital. The greater proximity and acceptability of services at the clinic level has led to a faster enrollment of people into treatment and better retention of patients in treatment (2% vs. 19% lost to follow-up). In all, 2200 people were receiving ART in Lusikisiki in 2006, which represents 95% coverage. Maintaining quality and coverage will require increased resource input from the public sector and full acceptance of creative approaches to implementation, including task shifting and community involvement.
Country
Publisher
Journal of Infectious Diseases
Theme area
Resource allocation and health financing
Title of publication Health Expenditures and Health Outcomes in Africa
Date of publication
2009 September
Publication type
Journal Article
Publication details
African Development Review 21 2 pp 400-433
Publication status
Published
Language
English
Keywords
health expenditures, health outcomes, Africa
Abstract
This paper provides econometric evidence linking African countries’ per capita total as well as government health expenditures and per capita income to two health outcomes: infant mortality and under-five mortality. This relationship is examined using data from 47 African countries between 1999 and 2004. Health expenditures have a statistically significant negative effect on infant and under-five mortality rates. The magnitude of our elasticity estimates are in consonance to those reported in the literature. For African countries, the results imply that total health expenditures (as well as the public component) are certainly important contributors to health outcomes. In addition, the authors find that both infant and under-five mortality are positively and significantly associated with sub-Saharan Africa. The reverse is true for North Africa. While ethnolinguistic fractionalization and HIV prevalence positively and significantly affect the health outcomes, higher numbers of physicians and female literacy significantly reduce these health outcomes. These results have important implications for attaining the targets envisioned by the Millennium Development Goals. The data implications are also discussed.
Country
Publisher
African Development Review
Theme area
Resource allocation and health financing
Title of publication Progressivity of health care financing and incidence of service benefits in Ghana
Date of publication
2012 August
Publication type
Journal Article
Publication details
Health Policy & Planning 27 5 pp i13-i22
Publication status
Published
Language
English
Keywords
Health financing, financing incidence, benefit incidence, Ghana
Abstract
The National Health Insurance (NHI) scheme was introduced in Ghana in 2004 as a pro-poor financing strategy aimed at removing financial barriers to health care and protecting all citizens from catastrophic health expenditures, which currently arise due to user fees and other direct payments. A comprehensive assessment of the financing and benefit incidence of health services in Ghana was undertaken. These analyses drew on secondary data from the Ghana Living Standards Survey (2005/2006) and from an additional household survey which collected data in 2008 in six districts covering the three main ecological zones of Ghana. Findings show that Ghana’s health care financing system is progressive, driven largely by the progressivity of taxes. The national health insurance levy (which is part of VAT) is mildly progressive while NHI contributions by the informal sector are regressive. The distribution of total benefits from both public and private health services is pro-rich. However, public sector district-level hospital inpatient care is pro-poor and benefits of primary-level health care services are relatively evenly distributed. For Ghana to attain an equitable health system and fully achieve universal coverage, it must ensure that the poor, most of whom are not currently covered by the NHI, are financially protected, and it must address the many access barriers to health care.
Country
Publisher
Health Policy & Planning
Theme area
Health equity in economic and trade policies
Title of publication Foreign policy, trade and health: At the cutting edge of global health diplomacy
Date of publication
2007 March
Publication type
Report
Publication details
Bulletin of the World Health Organisation 85 3 pp /-/
Publication status
Published
Language
English
Keywords
foreign policy, World Health Organisation, global health diplomacy, global
Abstract
Under its Constitution, the World Health Organization (WHO) works with its members towards the attainment by all peoples of the highest possible level of health. The context in which WHO and its Members pursue this goal has radically changed since 1946. The interdependence produced by globalization has broken down traditional ways of conceptualizing and organizing the medical, economic, political and technological means to improve health. Nowhere is this transformation more apparent than in the rise of health as a foreign policy concern.
Country
Publisher
Bulletin of the World Health Organisation
Theme area
Governance and participation in health
Title of publication The Rise of China's State-Led Media Dynasty in Africa
Date of publication
2012 June
Publication type
Report
Publication details
South Africa Institute of International Affairs Occassional Paper 117 pp /-/
Publication status
Published
Language
English
Keywords
media, China, Africa
Abstract
China is no exception to the global rise of developing media, who are challenging dominant traditional players. China's state-owned media are increasing their influence in the world as an instrument of its grander soft power engagement. The paper seeks to understand this new trend, particularly in the case of Africa. It traces China's media engagement on the continent, explains how strategies have changed in the 2000s and seeks to understand some of the challenges of transferring a global strategy to Africa.
Country
Publisher
South Africa Institute of International Affairs
Theme area
Health equity in economic and trade policies, Governance and participation in health
Title of publication Friends and Interests: China's Distinctive Links with Africa
Date of publication
2007 December
Publication type
Journal Article
Publication details
African Studies Review 50 3 pp 75-114
Publication status
Published
Language
English
Keywords
diplomacy, trade, development, China, Africa
Abstract
China’s presence in and other links to Africa have expanded greatly during the current decade. An international discourse that has emerged with this expansion focuses on how to characterize China-Africa relations and ranges from presenting China as the new colonialist to depicting her as Africa’s benefactor. Not unexpectedly, Western (especially US and UK) political forces and media are China’ chief accusers, while the PRC, with substantial support from Africans, has mounted a spirited, if not always unfeigning, defense. The study uses a comparative perspective to examine two sets of factors that make China’s links with Africa distinctive: the China Model & Beijing Consensus and Aid & Migration. It argues that the differing ways in which China’s links have developed with Africa make the PRC appear as the distinctly lesser evil in comparison with the West, particularly with regard to questions vital to Africa’s development and African dignity.
Country
Publisher
African Studies Review
Theme area
Governance and participation in health
Title of publication Rising Powers, South– South Co-operation and Africa
Date of publication
2012 March
Publication type
Report
Publication details
South Africa Institute of International Affairs Policy Briefing 47 pp /-/
Publication status
Published
Language
English
Keywords
South-South, cooperation, aid, diplomacy, Africa
Abstract
Following the Fourth High Level Forum on Aid Effectiveness, the briefing finds it is an ideal time to reflect on the changing nature of development co-operation that is an outcome of the significant geopolitical and geo-economic shifts the world has witnessed in the last decade. The High Level Forum, held in Busan, aimed to bring emerging powers into the fold of aid effectiveness. Their incorporation was only partially achieved; yet the Forum’s outcomes signalled the start of a more inclusive dialogue around issues of development not only between traditional donors and recipients but also the private sector, civil society and new development actors. Busan’s most significant outcome was the agreement to establish a new, inclusive and representative Global Partnership for Effective Development Cooperation and the phasing out of the Working Party on Aid Effectiveness. While this development is promising, the briefing argues that Africa in particular must use this opportunity to make a significant contribution to the crafting of new codes and principles around development co-operation that can act as building blocks for a new, inclusive, international development architecture that also incorporates South–South co-operation (SSC). This policy briefing focuses on SSC and makes a number of recommendations to African countries.
Country
Publisher
South Africa Institute of International Affairs
Theme area
Health equity in economic and trade policies
Title of publication India and South Africa as Partners for Development in Africa?
Date of publication
2011 March
Publication type
Report
Publication details
Chatham House Briefing Paper / / pp /-/
Publication status
Published
Language
English
Keywords
diplomacy, development, India, South Africa, Africa
Abstract
The author states that the engagement of India and South Africa in Africa can be explained as much by the shifts in global power and realpolitik as by their desire to be seen to be playing a positive developmental role and shouldering global responsibilities. India articulates its Africa policy through a national-interest prism, especially with regard to energy security, trade and terrorism. Development cooperation is a by- product of its engagement in Africa rather than a central driving force. South Africa is currently reassessing how it articulates its national interest in the context of its African agenda. It sees India’s engagement in Africa in a positive light, especially its focus on human-resource development, ICT and agriculture. While cooperation between the two countries may be possible in certain areas such as the India Brazil South Africa Forum (IBSA), in others it may be too politically sensitive for them to be perceived to be working together. Both aim to advance their commercial interests on the continent, which implies an element of rivalry. The study finds that there is scope for deepening the substance of political and economic relations between India and South Africa, which has been hampered by capacity constraints on both sides and differing priorities. The paper argues that development cooperation between the two in Africa is not a priority for either but using the private sector in this field is an important potential model.
Country
Publisher
Chatham House Briefing Paper
Theme area
Health equity in economic and trade policies
Title of publication Before and Beyond Energy: Contextualising the India–Africa Partnership
Date of publication
2012 February
Publication type
Report
Publication details
South Africa Institute of International Affairs Occassional Paper 77 pp /-/
Publication status
Published
Language
English
Keywords
energy, trade, diplomacy, Africa, India
Abstract
Although the India–Africa relationship is not new, what is relatively new is the range of areas now covered by the partnership, in particular energy. Energy has played, and will play, a critical role in bringing India and Africa closer together in the future. However, while synergy in the field of energy is an incredibly important aspect of the partnership, it cannot alone seal the deal. Forces, both within and beyond the area of energy, simultaneously drive and thwart the larger relationship. Four such forces help contextualise the India–Africa partnership, and analysing how these forces interact and diverge helps to explode some of the myths that surround the geopolitics of energy in Africa and identify the issues that require both deeper analysis and determined policy interventions.
Country
Publisher
South Africa Institute of International Affairs
Theme area
Health equity in economic and trade policies
Title of publication Africa and the Geopolitics of the Indian Ocean
Date of publication
2012 February
Publication type
Report
Publication details
South Africa Institute of International Affairs Occassional Paper 78 pp /-/
Publication status
Published
Language
English
Keywords
trade, diplomacy, Africa, Indian Ocean
Abstract
Throughout the history of the Indian Ocean, littoral, island and extra-regional states have vied to secure their trade routes, which in turn affects Africa. By reviewing the stakeholders’ dynamics in the Indian Ocean, the implications and challenges for Africa can be analysed. The stakeholder review analyses the attributes and constituency of the Indian Ocean, develops a common position for definitions and gives a select history of the world’s third- largest ocean. Countries that have historically frequented the Indian Ocean continue to do so, but the intensity of their activities has increased, as their objectives centre on the common denominator of ensuring energy security and advancing maritime trade. These issues are critical not only for their survival in a world of diminishing resources and increased globalised competition, but also for emerging countries’ economies to continue to grow exponentially. In contrast to the Indian Ocean’s increased dynamics, continental Africa’s position appears to be characterised by a passive approach. This inert position does not allow Africa to set the agenda for events that are changing the dynamics in its zone of influence, yet for which there are normative developmental imperatives. It is critical that Africa change its attitude and determines its own schedule for maritime development. Africa needs to manage these challenges pro-actively at various levels – continentally, regionally and bilaterally. The paper argues that by partnering with those powers that affect the forces in the Indian Ocean, Africa can be more in charge of its destiny.
Country
Publisher
South Africa Institute of International Affairs
Theme area
Health equity in economic and trade policies
Title of publication Perspectives on Trade, Investment and Competition Policy in South Africa
Date of publication
2012 March
Publication type
Report
Publication details
South Africa Institute of International Affairs 111 / pp /-/
Publication status
Published
Language
English
Keywords
trade, diplomacy, competition policy, South Africa
Abstract
In a liberalised trade and investment environment, trade, investment and competition policies together form a specific nexus. South Africa needs foreign direct investment to help address its need for employment creation, growth and development. Trade can lead foreign direct investment or follow on from it, and it may well be that a merger transaction leads to increased import competition in domestic markets. Competition policy can address different aspects of this issue. First, pre-merger notification and merger review provide an opportunity to assess a priori the competitive impact of a proposed transaction, to determine whether a substantial lessening of competition will result, or whether any specified public interests are likely to be adversely affected. Secondly, Competition Act provisions on restrictive practices and abuse of a dominant position can be invoked to check the effects of unfair trade practices. Although at this stage South Africa is reluctant to include new generation issues in regional trade agreements, there are already regional instruments that embrace them and it is also probable that these questions will feature on the agendas of South Africa's negotiating partners. World Trade Organisation agreements also include provisions on 'new generation' issues such as competition. Obligations entered into in this multilateral forum, as well as in regional agreements, are binding and cannot subsequently be revoked citing domestic policy imperatives. The proposed Walmart-Massmart merger is a reminder that international obligations must be considered carefully prior to, and at the time of, negotiations, and no matter how worthy domestic policy aims might be, they cannot justify attempts to skirt around international legal obligations.
Country
Publisher
South Africa Institute of International Affairs
Theme area
Governance and participation in health
Title of publication Building a Better World: The Diplomacy of Ubuntu
Date of publication
2011 May
Publication type
Document
Publication details
/ / / pp /-/
Publication status
Published
Language
English
Keywords
diplomacy, foreign policy ubuntu, South Africa
Abstract
This white paper outlines the South African concept of Ubuntu as a way of defining foreign policy. The philosophy of Ubuntu means ‘humanity’ and is reflected in the idea that humanity is affirmed when affirming the humanity of others. The white paper argues that this has played a major role in the forging of a South African national consciousness and in the process of its democratic transformation and nation-building. The white paper states that this philosophy translates into an approach to international relations that respects all nations, peoples, and cultures and recognises that it is in national interest to promote and support the positive development of others. Similarly, that national security would therefore depend on the centrality of human security as a universal goal, based on the principle of Batho Pele (putting people first).
Country
Publisher
/
Theme area
Governance and participation in health
Title of publication The character and growth of Indian Diplomacy
Date of publication
2005
Publication type
Document
Publication details
/ / / pp /-/
Publication status
Published
Language
English
Keywords
diplomacy, India
Abstract
Despite all its diverse regional contradictions it is often acknowledged that India holds together a unique Indian integrity. The paper looks at the evolution of Indian diplomacy in close connection with ancient history and literature of the land. It attempts to bring out the psyche of Indian approach towards the foreign through the years and tries to analyse the reasons that has made the country 'adaptive' in the treatment of foreigners and her foreign-rulers. It summarises on three-core focal points shaping the growth of India's cross-border dealings after the country's independence and 'democracy'.
Country
Publisher
/
Theme area
Governance and participation in health
Title of publication Current developments in South African diplomacy
Date of publication
1998
Publication type
Book Section
Publication details
Modern Diplomacy. Ed by J. Kurbalija / / pp /-/
Publication status
Published
Language
English
Keywords
diplomacy, South Africa
Abstract
South Africa underwent historic and radical change both in its domestic political and social structures and in its objective and perceived role and position in the world since the beginning of the nineteen-nineties. These changes have been reflected in South African external relations and in the conduct of South African diplomacy. The country has made an impressive transition from one of the most isolated in contemporary history to a fully integrated member of the international community conducting what its foreign policy makers term a "universal foreign policy." The conduct of South African diplomacy has also been changed in many ways: whereas it was previously an interesting case study of "pariah diplomacy," it has now become more conventional though no less interesting. In the interim between the historic February 1990 speech by President De Klerk and the April 1994 democratic elections and the coming to power of the ANC led government under President Mandela, changes were already beginning to occur. However, the more thorough-going changes would come after May 1994. The situation more than three years hence remains dynamic. Current developments, as the new South Africa adapts to an ever-changing regional, continental and global environment, are reviewed against the background of the historic situation and of the evolution of diplomacy world-wide.
Country
Publisher
Modern Diplomacy. Ed by J. Kurbalija
Theme area
Governance and participation in health
Title of publication Implementing Community Participation Through Legislative Reform: A Study of the Policy Framework for Community Participation in the Western Cape Province of South Africa
Date of publication
2012 July
Publication type
Journal Article
Publication details
BMC International Health And Human Rights / / pp /-/
Publication status
Published
Language
English
Keywords
community participation, law; community health committees; South Africa
Abstract
With evolving South African legislation supporting community involvement in the health system, early policy developments focused on Community Health Committees (HCs) as the principal institutions of community participation. Formally recognized in the National Health Act, the Act deferred to provincial governments in establishing the specific roles and functions of HCs. As a result, stakeholders developed a Draft Policy Framework for Community Participation in Health (Draft Policy) to formalize participatory institutions in the Western Cape province. With the Draft Policy as a frame of analysis, the researchers conducted documentary policy analysis and semi-structured interviews on the evolution of community participation policy. Moving beyond the specific and unique circumstances of the Western Cape, this study analyzes generalizable themes for community participation in the health system. Framing institutions for the establishment, appointment, and functioning of community participation, the Draft Policy proposed a formal network of communication – from local HCs to the health system. However, this participation structure has struggled to establish itself and function effectively as a result of limitations in community representation, administrative support, capacity building, and policy commitment. Without legislative support for community participation, the enactment of superseding legislation is likely to bring an end to HC structures in the Western Cape. The authors conclude that attempts to realize community participation have not adequately addressed the underlying factors crucial to promoting effective participation, with policy reforms necessary: to codify clearly defined roles and functions of community representation, to outline how communities engage with government through effective and accountable channels for participation, and to ensure extensive training and capacity building of community representatives. Given the public health importance of structured and effective policies for community participation, and the normative importance of participation in realizing a rights-based approach to health, this analysis informs researchers on the challenges to institutionalizing participation in health systems policy and provides practitioners with a research base to frame future policy reforms.
Country
Publisher
BMC International Health And Human Rights
Theme area
Values, policies and rights, Equity and HIV/AIDS
Title of publication HIV and the Law: Risks, rights and health
Date of publication
2012 July
Publication type
Report
Publication details
Global Commission On HIV And The Law / / pp /-/
Publication status
Published
Language
English
Keywords
HIV, law, rights, global
Abstract
Punitive laws and human rights abuses are costing lives, wasting money and stifling the global AIDS response, according to a report by the Global Commission on HIV and the Law, an independent body of global leaders and experts. The Commission report, "HIV and the Law: Risks, Rights and Health," finds evidence that governments in every region of the world have wasted the potential of legal systems in the fight against HIV. The report also concludes that laws based on evidence and human rights strengthen the global AIDS response - these laws exist and must be brought to scale urgently."Bad laws should not be allowed to stand in the way of effective HIV responses," said Helen Clark, United Nations Development Programme Administrator. "In the 2011 Political Declaration on HIV and AIDS, Member States committed to reviewing laws and policies which impede effective HIV responses."
Country
Publisher
Global Commission On HIV And The Law
Theme area
Resource allocation and health financing
Title of publication The State of Health Financing in the African Region Discussion Paper for the Interministerial Conference: Achieving Results and Value for Money in Health
Date of publication
2012 July
Publication type
Report
Publication details
World Health Organisation / / pp /-/
Publication status
Published
Language
English
Keywords
health financing, Abuja Declaration, universal health coverage; Africa
Abstract
African States are on average far from meeting key health financing goals such as the Abuja Declaration target of allocating 15% of the government budget to health. Out-of-pocket expenditure is still higher than 40% of the total health expenditure in 20 of 45 African countries, and in 22 countries the total health expenditure does not reach even the minimal level of US$ 44 per capita defined by the High Level Task Force on Innovative International Financing for Health Systems (HLTF). Only three countries have attained the Abuja Declaration and HLTF targets. Many countries have limited capacity of raising public revenue mainly because the informal nature of their economies makes collection of tax and contributions difficult. This limits their opportunities for investing in health. The paper presents trends in health financing in African countries and calls for close collaboration between the ministries of finance and health and inter-ministerial dialogue to develop a health financing strategy that supports efforts to strengthen all the other health system dimensions to move towards universal health coverage.
Country
Publisher
World Health Organisation
Theme area
Public-private mix, Resource allocation and health financing
Title of publication The role of insurance in the achievement of universal coverage within a developing country context: South Africa as a case study
Date of publication
2012 June
Publication type
Journal Article
Publication details
BMC Public Health 12 Suppl 1 pp /-/
Publication status
Published
Language
English
Keywords
insurance, universal health coverage, private sector, South Africa
Abstract
Using South Africa as a case study, this review examines whether private health systems are susceptible to regulation and therefore able to support an extension and deepening of coverage when complementing a pre-existing publicly funded and delivered health system. The study finds that the private health system in South Africa has played an important supplementary role in achieving universal coverage throughout its history, but more especially in the post-Apartheid period. However, the quality of this role has been erratic, influenced predominantly by policy vacillation. The objective of universal coverage can be seen in two dimensions, horizontal extension and vertical deepening. Private systems play an important role in deepening coverage by mobilising revenue from income earners for health services over-and-above the horizontal extension role of public systems and related subsidies. South Africa provides an example of how this natural deepening occurs whether regulated or unregulated. It also demonstrates how poor regulation of mature private systems can severely undermine this role and diminish achievements below attainable levels of social protection. When measures to enhance risk pooling are introduced, coverage is expanded and becomes increasingly fair and sustainable. When removed, however, the system becomes less stable and fair as costs rise and people with poor health status are systematically excluded from cover.
Country
Publisher
BMC Public Health
Theme area
Resource allocation and health financing
Title of publication Report of the dialogue on health financing in Africa at the 15th Ordinary Assembly of the African Union, Kampala, 24 July 2010
Date of publication
2012 July
Publication type
Report
Publication details
African Union / / pp /-/
Publication status
Published
Language
English
Keywords
health financing, Global Fund, African Union
Abstract
The dialogue found that countries challenges of high turnover of Health Ministers, shortage of human and financial resources for scaling up action, and weak health information systems. The dialogue recommended flooding health systems with low and middle level staff. The meeting called for resourcing of the Global Fund, which should also “open a window” for maternal, newborn and child health. Mobilization of more domestic resources, accountability, ownership and good coordination were reported as essential for “more money for more health”. The Assembly recommended the development and adoption of national policies, to ensure health is integrated in national development strategies and also costing of national development plans with appropriate economic and other expertise. It was concluded that national and district health accounts should be institutionalized, to track expenditures and ensure decentralization to reach to the communities. Harmonization of health initiatives by development partners was recommended to support and strengthen national plans and programmes, under national ownership and leadership.
Country
Publisher
African Union
Theme area
Resource allocation and health financing
Title of publication Promising Mechanisms to Strengthen Domestic Financing for Women’s and Children’s Health Report
Date of publication
2012 July
Publication type
Report
Publication details
Global Health Insights / / pp /-/
Publication status
Published
Language
English
Keywords
domestic financing; universal health coverage; low and middle income countries
Abstract
This paper discusses the range of mechanisms to improve domestic financing that have been utilized worldwide, from which Ministries of Health and Finance can draw a context-specific toolkit for strengthening domestic financing for women’s and children’s health. While evidence exists about how mechanisms have been used in different settings, there remains limited cost-effectiveness data to help guide decision-makers in low and middle income countries on when and where such mechanisms are most effectively and efficiently deployed. Financing mechanisms must be carefully coordinated and integrated to promote universal coverage and avoid fragmentation of health systems.
Country
Publisher
Global Health Insights
Theme area
Equitable health services
Title of publication Differences in health care seeking behaviour between rural and urban communities in South Africa
Date of publication
2012 June
Publication type
Journal Article
Publication details
International Journal For Equity In Health 11 31 pp /-/
Publication status
Published
Language
English
Keywords
health care, health seeing behaviour, inequalities, South Africa
Abstract
This study explored possible differences in health care seeking behaviour among a rural and urban African population. Four rural and urban SetTswana communities which represented different strata of urbanisation in the North West Province, South Africa, were selected. Structured interviews were held with 206 participants. Data on general demographic and socio-economic characteristics, health status, beliefs about health and (access to) health care was collected. The results illustrated differences in socio-economic characteristics, health status, beliefs about health, and health care utilisation. Inhabitants of urban communities rated their health significantly better than rural participants. Although most urban and rural participants consider their access to health care as sufficient, they still experienced difficulties in receiving the requested care. Rural participants had significantly lower employment and available weekly budget for health care and transport costs. Urban participants were more than 5 times more likely to prefer a medical doctor in private practice.
Country
Publisher
International Journal For Equity In Health
Theme area
Poverty and health
Title of publication Africa Human Development Report 2012: Towards a food secure future
Date of publication
2012 May
Publication type
Report
Publication details
United Nations Development Programme / / pp /-/
Publication status
Published
Language
English
Keywords
Human Development, sub Saharan Africa
Abstract
The 2012 Africa Human Development Report argues that sustainable increases in agricultural productivity protect food entitlements— the ability of people to access food. Furthering human development requires nutrition policies that unleash the potential of today’s and future generations. Also, communities must be resilient enough to absorb shocks and have the power to make decisions about their own lives. The Report shows that the basic right to food and the right to life itself is being violated in sub-Saharan Africa to an intolerable degree. Building a food secure continent requires transformative change— change that will be most effective if accompanied by a shift of resources, capacities and decisions to smallholder farmers, poor communities and women. When women and other vulnerable groups gain a voice in the decisions affecting their lives and livelihoods, their capacity to produce,trade and use food is materially enhanced.
Country
Publisher
United Nations Development Programme
Theme area
Health equity in economic and trade policies
Title of publication The make or buy debate: Considering the limitations of domestic production in Tanzania
Date of publication
2012 June
Publication type
Journal Article
Publication details
Globalization And Health 8 20 pp /-/
Publication status
Published
Language
English
Keywords
pharmaceutical production, TRIPS, Tanzania
Abstract
In order to ensure their population's regular access to essential medicines, many countries are faced with the policy question of whether to import or manufacture drugs locally. For domestic manufacturing to be viable and cost-effective, the local industry must be able to compete with international suppliers of medicines. This paper considers the 'make-or-buy' dilemma by using Tanzania as a case study. Key informant interviews, event-driven observation, and purposive sampling of documents were used to evaluate the case study. The case study focused on Tanzania's imitation technology transfer agreement to locally manufacture a first-line ARV (3TC + d4T + NVP), reverse engineering the ARV. The study finds that Tanzania is limited by weak political support for the use of Trade-Related Aspects of Intellectual Property Rights (TRIPS) flexibilities, limited production capacity for ARVs and limited competitiveness in both domestic and regional markets. The Ministry of Health and Social Welfare encourages the use of flexibilities while others push for increased IP protection. Insufficient production capacity and lack of access to externally -financed tenders make it difficult to obtain economies of scale and provide competitive prices. Within the "make-or-buy" context, it was determined that there are significant limitations in domestic manufacturing for developing countries. The case study highlights the difficulty governments face to make use of economies of scale and produce low-cost medicines, attract technology transfer, and utilize the flexibilities of the WTO Agreement on TRIPS. The results demonstrate the importance of evaluating barriers to the use of TRIPS flexibilities and long-term planning across sectors in future technology transfer and manufacturing initiatives.
Country
Publisher
Globalization And Health
Theme area
Resource allocation and health financing, Governance and participation in health
Title of publication Policy initiation and political levers in health policy: lessons from Ghana’s health insurance
Date of publication
2012 June
Publication type
Journal Article
Publication details
BMC Public Health 12 Suppl 1 pp /-/
Publication status
Published
Language
English
Keywords
health policy, health insurance, policy analysis; Ghana
Abstract
Understanding the health policy formulation process over the years has focused on the content of policy to the neglect of context. This had led to several policy initiatives having a still birth or ineffective policy choices with sub-optimal outcomes when implemented. Sometimes, the difficulty has been finding congruence between different values and interests of the various stakeholders. This paper attempts to conceptualise the levers of policy formulation using a qualitative participant observation case study based on retrospective recollection of the policy process and political levers involved in developing the Ghana National Health Insurance Scheme. The study finds that technical experts, civil society, academics and politicians all had significant influence on setting the health insurance agenda. Each of these various stakeholders carefully engaged in ways that preserved their constituency interests through explicit manoeuvres and subtle engagements. Where proposals lend themselves to various interpretations, stakeholders were quick to latch on the contentious issues to preserve their constituency. The paper provides lessons which suggest that in understanding the policy process, it is important that actors engage with the content as well as the context to understand viewpoints that may be expressed by interest groups.
Country
Publisher
BMC Public Health
Theme area
Equity in health
Title of publication Socioeconomic inequality in the prevalence of noncommunicable diseases in low- and middle-income countries: Results from the World Health Survey
Date of publication
2012 June
Publication type
Journal Article
Publication details
BMC Public Health 12 474 pp /-/
Publication status
Published
Language
English
Keywords
noncommunicable disease, survey, inequalities in health; global
Abstract
Noncommunicable diseases are an increasing health concern worldwide, but particularly in low- and middle-income countries. This study quantified and compared education- and wealth-based inequalities in the prevalence of five noncommunicable diseases (angina, arthritis, asthma, depression and diabetes) and comorbidity in low- and middle-income country groups, using 2002-04 World Health Survey data from 41 low- and middle-income countries. Wealth and education inequalities were more pronounced in the low-income country group than the middle-income country group. Both wealth and education were inversely associated with angina, arthritis, asthma, depression and comorbidity prevalence, with strongest inequalities reported for angina, asthma and comorbidity. Diabetes prevalence was positively associated with wealth and, to a lesser extent, education. Adjustments for confounding variables tended to decrease the magnitude of the inequality.
Country
Publisher
BMC Public Health
Theme area
Equity in health
Title of publication Health Equity from the African Perspective
Date of publication
2012 April
Publication type
Document
Publication details
13th World Congress of Public Health / / pp /-/
Publication status
Published
Language
English
Keywords
health equity; Africa
Abstract
The World Federation of Public Health Associations honooured the author with the Leavell Lectureship Award and this paper is the speech given by the awardee on “Health Equity, from the African Perspective” at the Congress. He raises that addressing equity calls for African countries to break the vicious cycle of poverty and ill-health; to urgently address the water, sanitation and hygiene crisis; to mobilize adequate budget allocation to the health sector and provide social protection for poor people; to strengthen the capacity of health systems to provide effective and equitable quality health care services; to stabilise health personnel; to generate evidence and build transparency and accountability in the use of domestic and externally generated resources allocated for health. All these issues he noted need to be backed by political commitment to make health equity a priority.
Country
Publisher
13th World Congress of Public Health
Theme area
Equity in health
Title of publication Assessing Progress in Africa toward the Millennium Development Goals
Date of publication
2012
Publication type
Report
Publication details
Millenium Development Goals / / pp /-/
Publication status
Published
Language
English
Keywords
Millenium Development Goals; Africa
Abstract
According to this report, steady economic growth and improvements in poverty reduction on the continent are reported to have had a positive impact on MDG progress, with sustained progress toward several MDGs. Africa is on track to achieve the targets of: universal primary education; gender parity at all levels of education; lower HIV/AIDS prevalence among 15-24 year olds; increased proportion of the population with access to antiretroviral drugs; and increased proportion of seats held by women in national parliament by 2015. However, the report acknowledges that more needs to be done to address inequalities, including between women and men. It highlights the need to address the sub-standard quality and unequal distribution of social services between rural and urban areas. It suggests active steps to ensure that economic growth translates into new and adequate employment opportunities for Africa’s youthful and rapidly growing population, and supports social protection systems. The report urges policymakers to put greater emphasis on improving the quality of social services and ensuring that investments yield improved outcomes for the poor for MDG progress.
Country
Publisher
Millenium Development Goals
Theme area
Equity in health
Title of publication Africa Progress Report 2012 - Jobs, Justice and Equity
Date of publication
2012 May
Publication type
Report
Publication details
Africa Progress Panel / / pp /-/
Publication status
Published
Language
English
Keywords
Millenium Development Goals; economic policy; Africa
Abstract
The Africa Progress Report 2012 is the Africa Progress Panel’s flagship publication. Its purpose is to provide an overview of the progress Africa has made over the previous year. The report draws on the best research and analysis available on Africa and compiles it in a refreshing and provocative manner. Through the report, the Panel recommends a series of policy choices and actions for African policy makers who have primary responsibility for Africa’s progress, as well as vested international partners and civil society organisations. The report warns that Africa’s strong economic growth trajectory – which will see the region increase the pace of growth well beyond 5 per cent over the next two years – is at risk because of rising inequality and the marginalisation of whole sections of society. The report calls for a “relentless focus” by policymakers on jobs, justice and equity to ensure sustainable, shared growth that benefits all Africans. Failure to generate equitable growth could result in “a demographic disaster marked by rising levels of youth unemployment, social dislocation and hunger.” Africa’s governments and development partners must urgently draw up plans for a big push towards the 2015 Millennium Development Goals, the report says.
Country
Publisher
Africa Progress Panel
Theme area
Health equity in economic and trade policies
Title of publication Chinese Engagement with Africa: The Case of Mozambique
Date of publication
2012 March
Publication type
Journal Article
Publication details
Portuguese Journal Of International Affairs 1 15 pp /-/
Publication status
Published
Language
English
Keywords
economic co-operation; south-south; China, Mozambique
Abstract
This article examines China’s growing relations with Mozambique, to derive insights for wider arguments regarding China’s aims and impacts in Africa, and the trajectory of its growing global influence. It is argued that details of the China-Mozambique relationship support positions that: China’s engagement with Africa is overwhelmingly economic and diplomatic, rather than military and strategic; that even in a non-oil producing country Chinese aid and investment is driven by acquisition of natural resources; but that, contrary to assertions China is not interested in Africa’s long-term development, China is attempting to foster general economic growth and social stability, and to maintain a positive public image. The Mozambican case shows a clear tendency towards extractive industries being the primary driver of engagement – but the author argues that the diversified strategy of the Chinese government to build infrastructure, improve agriculture, and win the political approval of both elites and the populace seems to point to a long-term approach to promoting Mozambican economic growth.
Country
Publisher
Portuguese Journal Of International Affairs
Theme area
Governance and participation in health
Title of publication Rhetoric and Reality of Community Participation in Health Planning, Resource Allocation and Service Delivery: a Review of the Reviews, Primary Publications and Grey Literature
Date of publication
2012 May
Publication type
Journal Article
Publication details
Rwanda Journal of Health Sciences 1 1 pp 51-65
Publication status
Published
Language
English
Keywords
community, participation, priority-setting, developing countries
Abstract
This paper synthesises reports on community participation (CP) concept and its practicability in countries’ health service systems, much focus being on developing countries. The authors narratively reviewed the published and grey literature traced from electronic sources and hard copies as much as they could be accessed. CP is a concept widely promoted, but few projects/programmes have demonstrated its practicability in different countries. In many countries, communities are partially involved in one or several stages of project cycles - priority setting, resource allocation, service management, project implementation and evaluation. There is tendency of informing communities to implement the decisions that have already been passed by elites or politicians. In most of the project/programmes, professionals dominate the decision making processes by downgrading the non-professionals or non-technical people’s knowledge and skills. CP concept is greatly misinterpreted and sometimes confused with community involvement. In some cases, the community participates in passive manner. There is no common approach to translate CP into practice and this perpetuates debates on how and to what extent to which the community members should participate. Persistent misconceptions about CP perpetuate inequalities in many countries’ health systems, suggesting more concerted measures towards making a desired difference.
Country
Publisher
Rwanda Journal of Health Sciences
Theme area
Governance and participation in health
Title of publication Lessons from over Four Decades of African Diplomacy
Date of publication
1999 March
Publication type
Document
Publication details
Speech to the Conference on African Diplomacy in the 21st Century, London, UK / / pp /-/
Publication status
Published
Language
English
Keywords
global health diplomacy, Africa
Abstract
Speech to the Conference on African Diplomacy in the 21st Century on the history of lessons learnt from over four decades of African diplomacy. The Secretary General, Chief Emeka Anyaoku highlighted the original sources of African diplomacy as the leaders of African nationalism and independence. The paper argues that overthrowing colonial rule was critical to reinstate Africans in the "circle where world events take place" and that two main temperaments of African nationalism would emerge and begging to influence the course of African diplomacy soon after independence. The speech concludes that African diplomacy is as effective as the governments behind it; and it cannot be effective if the governments behind it are either unstable or lack legitimacy or are infirm of purpose. The task of achieving African unity, the historic goal of pan-Africanism and the object of intra-African diplomacy, has still to begin in earnest. Further that only democratic governments, freely elected by the people and accountable to them, will enable Africa to assume its proper role on the international stage and to play a role commensurate with its resources.
Country
Publisher
Conference on African Diplomacy in the 21st Century
Theme area
Governance and participation in health
Title of publication The Fiocruz experience in Global Health and Health Diplomacy capacity building: conceptual framework, curricular structure and first results
Date of publication
2010 March
Publication type
Journal Article
Publication details
Revista Electronica de Comunicacao Informacao & Inovacao em Saude (RECIIS) 4 1 pp 139-155
Publication status
Published
Language
English
Keywords
global health diplomacy, Brazil
Abstract
Developing an International Health capability and training professionals to work with health at the international level have been concerns of the Fiocruz for over a decade. This process culminated in its setting up a Global Health and Health Diplomacy area in 2007 and embarking on other initiatives, including a postgraduate specialisation course. This paper examines the theoretical frames of reference that orient the human resource capacity building in Global Health and Health Diplomacy pursued by Sergio Arouca National School of Public Health (ENSP/Fiocruz) in collaboration with a number of internal and external partners. Following a brief conceptual review, which delimits these areas as new objects of study in collective health, the paper examines the central issue – relations between globalisation and health – that organises the content and presents the structure of the 1st Specialisation Course in Global Health and Health Diplomacy, given in 2008-2009, in Brasilia. It is concluded that, in spite of advances identified in the past decade, these fields are in need of greater conceptual refinement and development of sound analytical frameworks. Meanwhile, the impacts of globalisation processes on the health of populations also pose new challenges to international cooperation. In view of the priority given to health by current Brazilian foreign policy, there is still insufficient knowledge production and human resource capacity-building to address these new realities.
Country
Publisher
Revista Electronica de Comunicacao Informacao & Inovacao em Saude (RECIIS)
Theme area
Governance and participation in health
Title of publication Asia's participation in global health diplomacy and global health governance
Date of publication
2010 September
Publication type
Journal Article
Publication details
Asian Journal of WTO & International Health Law and Policy 5 2 pp 269-300
Publication status
Published
Language
English
Keywords
global health diplomacy, governance, Asia, China, India
Abstract
This article provides a framework for thinking about Asian approaches to and impact on global health diplomacy and governance that might contribute to more sophisticated analyses on Asia in global health politics, diplomacy, and governance. First, the article examines the “rise of Asia” and “rise of health” as overlapping but unconnected developments in international relations. Second, it analyzes how the shift of power and influence towards Asia, largely caused by China’s and India’s emergence as great powers, affects global health politics and potential Asian contributions to global health diplomacy and governance in the future. Third, the article looks at normative ideas that characterize Asian approaches to international cooperation and how these ideas affect Asian participation in global health diplomacy and governance. Fourth, the article considers Asian practices on international health cooperation, which include bilateral relations, regional activities, and participation in multilateral organizations. The article ends with conclusions about Asian conceptualizations of and contributions to global health diplomacy and governance.
Country
Publisher
Asian Journal of WTO & International Health Law and Policy
Theme area
Governance and participation in health
Title of publication What is ‘Global Health Diplomacy’? A Conceptual Review
Date of publication
2011 November
Publication type
Document
Publication details
Global Health Governance / / pp /-/
Publication status
Published
Language
English
Keywords
global health diplomacy
Abstract
While global health diplomacy (GHD) has attracted growing attention, accompanied by hopes of its potential to progress global health and/or foreign policy goals, the concept remains imprecise. This paper finds the term has largely been used normatively to describe its expected purpose rather than distinct features. This paper distinguishes between traditional and “new diplomacy”, with the latter defined by its global context, diverse actors and innovative processes. A more concise definition of GHG supports the development of a research agenda for strengthening the evidence base in this rapidly evolving area.
Country
Publisher
Global Health Governance
Theme area
Health equity in economic and trade policies, Equitable health services
Title of publication Markets and policy challenges in access to essential medicines for endemic disease
Date of publication
2008 November
Publication type
Journal Article
Publication details
Journal of African Economies 19 Suppl 3 pp iii166-iii2000
Publication status
Published
Language
English
Keywords
essential medicines, Tanzania
Abstract
Access to essential medicines is a core element of the effective health systems that are required to deal with endemic disease. Cost-effective access relies in turn on efficient market functioning and on appropriate polices towards the role of markets at national and international levels. This article argues that current international policy frameworks for promoting access to essential medicines lack coherence and display weak empirical foundations for proposed market interventions. A study of medicines markets in Tanzania questions some assumptions about market functioning underlying international policy, and shows how exploratory field studies can reduce the knowledge gap. Medicines policy should aim for rational use of essential medicines and for universal access free at the point of use to medicines essential to treat endemic diseases and other major causes of death. Unregulated retail market competition in essential medicines should be progressively constrained by government and NGO action. Wholesale market competition, in contrast, should be promoted, while the rebuilding of African pharmaceutical manufacturing is important for promoting and sustaining access. At each market level, public and non-governmental non-profit traders and providers can play a regulatory role alongside greater citizen information and civic activism.
Country
Publisher
Journal of African Economies
Theme area
Health equity in economic and trade policies
Title of publication Indian generics producers, access to essential medicines and local production in Africa: An argument with reference to Tanzania
Date of publication
2010
Publication type
Journal Article
Publication details
European Journal of Development Research 22 4 pp 451-468
Publication status
Published
Language
English
Keywords
local pharmaceutical production, access to medicines, India, Tanzania
Abstract
Much analysis of the supply chain for essential medicines to Africa assumes broad sustainability of low-cost generics supply from Indian manufacturers. The authors use Indian data and interviews to question this assumption. In a case study of Tanzania, and argue for the necessity and feasibility of enhanced local production of essential medicines. The study identifies key industrial policy interventions, including industrial protection and active government purchasing; public goods including legislative and regulatory frameworks and training; and encouragement and facilitation of joint ventures. The authors show that a basis has been laid for these activities, and identify the urgency and difficulty of the policy challenge. There are lessons for the Tanzanian case from Indian industrial history, and policy space is provided by Tanzania's Least Developed Country status. Industrial and health policy can be further integrated to the benefit of Tanzania's citizens. The Tanzanian case has broader implications for African policymakers.
Country
Publisher
European Journal of Development Research
Theme area
Health equity in economic and trade policies, Public-private mix, Governance and participation in health
Title of publication Social Enterprise as Market Regulation: non-governmental interventions in essential medicines wholesaling to low income countries
Date of publication
2008 March
Publication type
Document
Publication details
Innovation Knowledge Development Working Paper 30 / pp /-/
Publication status
Published
Language
English
Keywords
social enterprise, essential medicines, markets, regulation, competition, quality,
Abstract
The private market for medicines, considered as a supply chain from manufacturers to end users, is notoriously subject to market failure; in rich countries it is therefore subject to stringent regulation. Yet the empirically based policy literature on access to essential medicines remains limited on how these market problems can be overcome in the supply of medicines from developing country manufacturers to the dangerously unregulated retail medicines markets suffered by the very poor across the world. This paper explores the under-studied role of social enterprise as traders and regulatory actors in the international wholesale markets for essential medicines and their impact on accessibility, quality and prices in these perverse markets, drawing on an interview survey of European-based socially oriented wholesalers supplying the medicines market for sub-Saharan Africa. The paper argues that these enterprises play an important role in regulating price and quality and hence in improving access to medicines by the poor. However they face challenging market and political conditions. The paper analyses the motivations and organisational structures that sustain social and ethical commitment in this market, drawing on theories of social enterprise and non-profit business, and surveys the challenges and constraints. It then examines the formal international and national regulatory interventions in the international markets and their effects on social enterprise, in the context of a substantial institutional divide between the medicines-related campaigning of the large international NGOs and the activities of these market-oriented social enterprises.
Country
Publisher
The Open University
Theme area
Health equity in economic and trade policies, Public-private mix
Title of publication Pricing and competition in essential medicines markets : the supply chain to Tanzania and the role of NGOs
Date of publication
2008 July
Publication type
Document
Publication details
Innovation Knowledge Development Working Paper 32 / pp /-/
Publication status
Published
Language
English
Keywords
medicine access; medicine pricing; Tanzania; private health sector
Abstract
It is now widely argued that many of the problems of pricing and accessibility of essential medicines in Africa lie in market structure and regulation failures within African countries. This paper presents new findings on pricing, margins and competition along the supply chain from manufacturers of essential medicines, in India, Kenya and Tanzania, to medicines buyers in Tanzanian rural areas. Based on these findings the paper considers the extent to which current faith-based and secular NGO non-profit actors are playing a beneficial role in promoting access to reliable medicines, and discusses whether and how that role might be strengthened. While it is often argued that NGOs can be reliable and trustworthy actors in problematic low income private health care markets, the role of NGOs in low income countries’ medicines supply is less studied, and policy proposals on NGOs’ roles are rarely rooted in an understanding of their market contexts.
Country
Publisher
The Open University
Theme area
Health equity in economic and trade policies
Title of publication Indian Generic Companies, Affordability of Drugs and Local Production in Africa with Special Reference to Tanzania
Date of publication
2008 September
Publication type
Document
Publication details
Innovation Knowledge Development Working Paper 37 / pp /-/
Publication status
Published
Language
English
Keywords
generic, pharmaceutical, drugs, production, India, Tanzania
Abstract
Indian generic companies have played a major role in reducing the prices of HIV/AIDS drugs for the benefit of the people of Africa. However Indian companies in general display more interest in the larger and more lucrative markets of North America and Europe. Although the pharmaceutical industry has quite a long history in Tanzania, financial condition and growth have not been satisfactory, and, as in many other developing countries,Tanzanian industry suffers from some inherent cost disadvantages. However this paper argues that it is important for Tanzania to develop the industry further to take care of the country's drug needs, since there are problems with relying on foreign sources such as India. The government does provide some incentives to local manufacturers, but these are inadequate, and the paper argues for a proper industrial policy in Tanzania with both push and pull incentives. Abolishing product patents in pharmaceuticals operated as an important pull incentive in India, yet Tanzania has never abolished such patent protection. The paper highlights the fact that the country can still do so: under TRIPS, Tanzania, as a least developed country is not required to introduce such protection in pharmaceuticals till 2016. Even if the country chooses not to abolish product patents, there are other TRIPS flexibilities which Tanzania can use to develop the industry and enhance access to medicines.
Country
Publisher
The Open University
Theme area
Values, policies and rights, Health equity in economic and trade policies, Governance and participation in health
Title of publication Consumer Rights and Non-Governmental Action in Medicines Markets: Knowledge, Risk and Trust in Rural Tanzania
Date of publication
2008 October
Publication type
Document
Publication details
Innovation Knowledge Development Working Paper 39 / pp /-/
Publication status
Published
Language
English
Keywords
consumer rights, medicines, dispensing, regulation, Tanzania
Abstract
If access to medicines is obtained by a population largely through market exchange, then consumer rights become a key aspect of the right to health. Medicines markets are dangerously subject to perverse incentives and asymmetric information, and in low income countries are largely unregulated. Research in rural Tanzania explored the information received by those buying medicines at the time of purchase, and the extent to which buyers knew the information they should receive. It also examined the extent to which dispensers were aware of good dispensing practice, and compared nongovernmental non-profit dispensing with private sector practice in this regard. This paper argues for a shift in the framework of analysis of medicines markets from sources of trust to methods of strengthening implementation of rights; for a clearer incorporation of consumer rights into efforts progressively to implement the right to health; and for a strengthening of NGOs’ activity in this regard.
Country
Publisher
The Open University
Theme area
Health equity in economic and trade policies, Governance and participation in health
Title of publication Global public action in health and pharmaceutical policies: politics and policy priorities
Date of publication
2009 February
Publication type
Document
Publication details
Innovation Knowledge Development Working Paper 45 / pp /-/
Publication status
Published
Language
English
Keywords
pharmaceutical policy, global, governanceon
Abstract
This paper analyses and discusses global public action in the context of global health policies. It discusses how public action on pharmaceuticals has influenced on the one hand global health, and on the other the institutional basis of global health governance. It argues that while nongovernmental public action has been effective in terms of influencing agenda-setting in global policies, its role in influencing solutions to the problems has been more limited. In contrast to trade policies, more substantial changes have taken place within global health policies and global health governance. Furthermore, some of the directions supported by global public action may not be conducive to the democratic accountability of global health governance, the wise use of public resources, health systems development, and longer term access to health care within developing countries. The scope for nongovernmental public action is further challenged by the changing context and commercialisation of global public action itself, whereby calls for access to medicines can also be seen as a means of demand creation for new and more expensive medicines in developed countries too, with further articulation of requests for more public funds in support of innovation and clinical trials to tackle the issue of lack of research and development (R&D).
Country
Publisher
The Open University
Theme area
Health equity in economic and trade policies
Title of publication Common health policy interests between North and South in pharmaceutical policy and global public policies
Date of publication
2009 May
Publication type
Document
Publication details
Innovation Knowledge Development Working Paper 47 / pp /-/
Publication status
Published
Language
English
Keywords
pharmaceutical policy, global, medicine regulation
Abstract
Global pharmaceutical policies are currently dominated by debates on access to medicines and in support of research and development for neglected diseases in developing countries. This paper argues that, between ‘North’ and ‘South’, there are more common health interests in pharmaceutical policies, within broader global public policies, than are currently articulated. Moreover, the current global policy focus may as well undermine the importance of these common health policy interests as well as conflicts of interest between health policy interests and corporate interests at international and national level in both developing and high income countries. The divisions concerning global regulatory issues and intellectual property rights do not fall neatly between rich and poor countries. Rather, they cut across corporate and commercial policy interests, and health and pharmaceutical policy interests within countries, and concern global regulatory processes and the interface between commercial policies and health policy. The issues of concern include pricing of and access to medicines, but also the broader public health issues of rational use or medicines and appropriate incentives for research and development so as to guarantee research efforts on key health policy areas as well as support access to knowledge and data. There is a danger that, if common health policy interests and concerns are not better understood and more strongly articulated, then global policy making on access to medicines and support for R&D will become increasingly guided by commercial policy priorities across countries. This can not only undermine effective global public health policies as well as reduce policy space for health and pharmaceutical policies at national level.
Country
Publisher
The Open University
Theme area
Equity in health
Title of publication Measuring health gains from sustainable development
Date of publication
2012 June
Publication type
Report
Publication details
World Health Organisation / / pp /-/
Publication status
Published
Language
English
Keywords
sustainable development, World Health Organisation, health indicators,
Abstract
These briefings present initial findings from a WHO Expert Consultation, 17–18 May 2012 in Geneva. The consultation included over 40 participants with expertise in health, equity, development and environment from research institutions, government, and multi-lateral/ bilateral development agencies. The briefings also draw upon previous work by WHO and WHO regional offices on health in the green economy; urban transport and housing; healthy cities; social determinants of health; gender; traffic injury; diet and physical activity; disaster management; as well as frameworks for indicators and assessment of health equity; health risks and environmental burden of disease.
Country
Publisher
World Health Organisation
Theme area
Resource allocation and health financing
Title of publication Discussion paper 91: What progress has been made towards the equitable allocation of health care resources in South Africa?
Date of publication
2011 August
Publication type
Report
Publication details
EQUINET Discussion Paper 91
Publication status
Published
Language
Keywords
resource allocation; South Africa; health financing
Abstract
This report provides an overview of resource allocation decision making in South Africa as it impacts on the distribution of health budgets. It also looks at changes in the allocation of public health care resources since the early 1990s across provinces. Finally, it considers whether resources are allocated equitably between health districts. The report finds that while considerable progress has been made towards the equitable allocation
of public sector health care resources among provinces, substantial disparities in spending on primary health care (PHC) services remain among
health districts. It is critical that provincial health departments pay more attention to the equitable allocation of resources for primary health care
services among the districts within their province. In the absence of such efforts, many South Africans will continue to be disadvantaged in their access to primary care services simply because of their place of residence.
Country
South Africa
Publisher
EQUINET
Equinet Publication Type
Discussion paper
Theme area
Resource allocation and health financing
Title of publication Policy brief 30: Progress in fair financing for health in East and Southern Africa
Date of publication
2012 July
Publication type
Document
Publication details
EQUINET: HNC, UCT HEU (2012) Progress in fair financing for health in East and Southern Africa Policy brief 30, EQUINET, Harare
Publication status
Published
Language
Keywords
fair financing; Abuja commitment; East and Southern Africa
Abstract
Fair financing of health services requires that countries reduce their reliance on out-of-pocket (OOP) funding for health services and improve their pre-payment financing through general tax revenue and health insurance (particularly mandatory health insurance). While many countries in east and southern Africa (ESA) receive high levels of external funding, it is critical to increase domestic government funding for the health system to support this move away from out-of-pocket funding to provide effective financial protection from the costs of health care. This policy brief reviews progress in reducing out-of-pocket payments in ESA countries and in increasing government funding for health, particularly in terms of meeting the Abuja target of 15% of the government budget being devoted to the health sector and a target of government spending of US$60 per capita. While there has been some progress in some countries, most ESA countries are still far from achieving these fair financing targets. The brief highlights areas that merit action to meet policy commitments on fair financing.
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Policy brief
Theme area
Human resources for health
Title of publication Communiqué of the Consultation on Improving Access to Health Workers at the Frontline for Better Maternal and Child Survival
Date of publication
2012 July
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
health workers; maternal and child health; primary care; Africa
Abstract
The Consultation on Improving Access to Health Workers at the Frontline for Better Maternal and Child Survival was held at the InterContinental Hotel in Nairobi, Kenya from 25 to 27 June 2012. The objective of the consultation was ‘to speed up and scale up country responses to the human resource needs of both the UN Global Strategy for Women’s and Children’s Health (Every Woman Every Child), and the Global Plan towards the Elimination of New HIV Infections Among Children by 2015 and Keeping their Mothers Alive (Global Plan) as a key aspect of both plans’. The communique presents the key proceedings and opportunities, experiences and challenges to guide further action. The Consultation underscored the need for ministries of health, continental mechanisms such as the AUC, regional organisations such as ECSA HC, SADC, WAHO and OCEAC, development partners, FBOs, funding agencies, academic and research institutions, and civic society organisations to give priority to efforts towards increasing access to health workers at the frontline for better maternal and child survival. Recommendations were made to achieve this.
Country
Africa
Publisher
EQUINET
Equinet Publication Type
Policy brief
Theme area
Governance and participation in health
Title of publication Policy brief 29: Global Actors in health policy
Date of publication
2012 March
Publication type
Document
Publication details
EQUINET Policy brief number 29, EQUINET, ECSA HC Harare
Publication status
Published
Language
Keywords
global health; global health institutions; global
Abstract
In 1948, the World Health Organisation (WHO) was established as the agency for directing and coordinating authority on international health work, particularly in setting norms and standards and policies in public health , establishing and maintaining effective collaboration with the United Nations, specialised agencies, governmental health administrations, professional groups and such organisations as may be deemed appropriate, furnishing appropriate technical assistance in emergencies, necessary upon request or acceptance of governments (WHO Constitution Chapter II Art 2) By 2011 many new institutions exist in global health, with different governance mechanisms and funding, powers and mandates. This brief explores the range and influence of global health actors and the implications for health diplomacy within east and southern Africa.
Country
Global
Publisher
EQUINET
Equinet Publication Type
Policy brief
Theme area
Health equity in economic and trade policies, Governance and participation in health
Title of publication Shifting Paradigm: How the BRICS are Reshaping Global Health and Development
Date of publication
2012 March
Publication type
Report
Publication details
Global Health Strategies Initiatives / / pp /-/
Publication status
Published
Language
English
Keywords
global health financing, development, Brazil, Russia, India, China, South Africa
Abstract
This report examines the increasing influence of the BRICS countries (Brazil, Russia, India, China and South Africa) in many areas including economics, politics and culture. The economies of the BRICS have expanded significantly, and in 2011 China overtook Japan to become the second largest global economy. Brazil and India are now sixth and ninth, respectively. While growth in the BRICS has recently begun to slow, to date these countries have shown much greater resilience than the US and Europe in the face of the global financial crisis. Within this context, BRICS foreign assistance spending has been growing rapidly. Through platforms like the BRICS forum, these countries are also exploring opportunities for more formal collaboration among themselves and with other developing countries. This report presents findings from a qualitative and quantitative survey of present and future efforts by Brazil, Russia, India, China and South Africa to improve global health. It examines these roles within the broader context of international development and foreign assistance, though health remains the primary focus. This report also includes a brief look at other emerging powers beyond the BRICS that have potential to impact major global health issues.
Country
Publisher
Global Health Strategies Initiatives
Theme area
Health equity in economic and trade policies, Governance and participation in health
Title of publication The WTO TRIPS Agreement, the Right to Health and Access to Medicines in Africa
Date of publication
2011
Publication type
Report
Publication details
AFSAAP Conference / / pp /-/
Publication status
Published
Language
English
Keywords
WTO, TRIPS, Right to Health, access, medicines, Africa
Abstract
The aim of this paper is to consider the extent to which the TRIPS patent regime has exacerbated the access to medicines problem in Africa and the flexibilities that are available within TRIPS to address the problem. It examines the significance of the right to health to the debate and highlights the need for African nations to form a common front under the African Union to address this problem.
Country
Publisher
/
Theme area
Equitable health services, Equity and HIV/AIDS, Governance and participation in health
Title of publication Changing global essential medicines norms to improve access to AIDS treatment: Lessons from Brazil
Date of publication
2009
Publication type
Journal Article
Publication details
Global Public Health 4 2 pp 131-149
Publication status
Published
Language
English
Keywords
global health, essential medicines, AIDS, antiretroviral therapy, Brazil
Abstract
Brazil's large-scale, successful HIV/AIDS treatment programme is considered by many to be a model for other developing countries aiming to improve access to AIDS treatment. Far less is known about Brazil's important role in changing global norms related to international pharmaceutical policy, particularly international human rights, health and trade policies governing access to essential medicines. Prompted by Brazil's interest in preserving its national AIDS treatment policies during World Trade Organisation trade disputes with the USA, these efforts to change global essential medicines norms have had important implications for other countries, particularly those scaling up AIDS treatment. This paper analyses Brazil's contributions to global essential medicines policy and explains the relevance of Brazil's contributions to global health policy today.
Country
Publisher
Global Public Health
Theme area
Governance and participation in health
Title of publication Health diplomacy in China
Date of publication
2011 March
Publication type
Journal Article
Publication details
Global Health Governance 4 2 pp /-/
Publication status
Published
Language
English
Keywords
global health diplomacy, China
Abstract
China has been actively involved in health diplomacy since the founding of the People's Republic of China (PRC) in 1949. In addition to the changing international environment, dominant ideologies, and foreign policies over the past sixty years, health diplomacy in China has also experienced strategic shifts, which can be categorized by different periods: 1. Period of “Leaning to one side” diplomacy and the advent of health cooperation between China and the Soviet Union (from the founding of PRC to the end of the 1950s); 2. Period of “Fight against the hegemony of two superpowers,--the US and the Soviet Union” and the initiation of medical teams to Africa (from the end of 1950s to the end of the 1960s); 3. Period of “Uniting with the US against the Soviet Union” and the beginning of multilateral health diplomacy (from the end of the 1960s to the end of the 1970s); 4. Period of “Pragmatism” in foreign policy and pushing forward of comprehensive health diplomacy (from the end of the 1970s to the end of the 1990s); and 5. Period of “harmonious world” mentality and thriving of comprehensive health diplomacy (from the year 2000 until now). At present, China is actively involved in international health affairs, activities including cooperating with international health organizations, expanding inter-governmental health cooperation, and pioneering - non-governmental health diplomacy. Such shifts indicate that health is occupying an increasingly important role in diplomacy, and that diplomatic tools are being utilized to solve health issues. China, with its growing national strength, should attach more priority to the development of health diplomacy, and should be more responsive and active in the global health arena.
Country
Publisher
Global Health Governance
Theme area
Governance and participation in health
Title of publication The Domestic Roots of Reagan's Global Gag Rule: A Case Study in Global Health Diplomacy
Date of publication
2009
Publication type
Report
Publication details
Centre for the Study of the Presidency and Congress / / pp /-/
Publication status
Published
Language
English
Keywords
global health diplomacy, Global Gag Rule, ethics, United States of America
Abstract
The Mexico City Policy, also known as the Global Gag Rule, is a US government policy that restricts the eligibility for federal funding to foreign non-governmental organizations (NGOs) that promote or provide abortion-related services. Enacted by Ronald Reagan in 1984, the policy has sparked controversy for over two decades. After examining the history of US global abortion policy, this paper examines the ways in which domestic politics influenced President Reagan’s decision to enact the Gag Rule using two organizing paradigms, rational choice and symbolic politics. It is determined that Reagan’s Gag Rule can best be described as a reaction to pressure groups and the symbolic power of the pro-life narrative. The case of the Mexico City Policy shows both the power of the president to establish wide reaching policy via the executive order as well as the limits of presidential power when politics are entrenched in legislation. The ethics of using international forums to accomplish domestic policy goals and the implications for global health are considered.
Country
Publisher
Centre for the Study of the Presidency and Congress
Theme area
Governance and participation in health
Title of publication Are existing governance structures equipped to deal with today's global health challenges-towards systematic coherence in scaling up
Date of publication
2008
Publication type
Report
Publication details
Global Health Governance 2 2 pp /-/
Publication status
Published
Language
English
Keywords
global health diplomacy, governance, WHO, global
Abstract
The global financial crisis and a new political era shaped by the new US administration have led to a revival of interest in effective global health governance, and provide an opportunity to review existing mechanisms in the context of contemporary global health challenges. On the underlying premise that “global governance is actually global problem solving” it is proposed that the primary objective of good global health governance is to strengthen healthcare delivery systems in the developing world with an emphasis on the importance of primary health care. In order to achieve this objective, innovations which take into account new global political and economic realities are needed. A multi-level, multi-party and multi-purpose partnership framework of global health governance (global, regional, national) is put forward which includes all the key players and attempts to integrate the key functions needed to achieve an inclusive, equitable, flexible, democratic and sustainable mechanism. Based on shared values of solidarity, democracy and equity, and fully acknowledging the sovereignty of countries and other stakeholders, the proposed framework consists of a multilateral governance platform coordinated by the World Health Organization supported by highlevel political commitment and policy coherence, and ultimately operationalised by effective implementation mechanisms through global action networks (GANs). GANs are a mode of governance involving authoritative negotiations between state and non-state players which have interests and capacities to influence and shape outcomes in specific issue areas.
Country
Publisher
Global Health Governance
Theme area
Values, policies and rights, Governance and participation in health
Title of publication Global Health Governance and Multi-Level Policy Coherence: Can the G8 Provide a Cure?
Date of publication
2009 July
Publication type
Report
Publication details
CIGI Working Paper 35 / pp /-/
Publication status
Published
Language
English
Keywords
global healh diplomacy, MDGs, global
Abstract
This paper highlights the ailing state of global health governance as evidenced by the lack of progress on the Millennium Development Goals (MDGs), in particular the goals related to health. Policy coherence within the global health governance system is not evolving fast enough to ensure that trade and development issues related to public health, particularly concerning access to medicines, are effectively aligned at national, regional and multilateral levels. The paper briefly reviews the WTO Trade-Related Aspects of Intellectual Property Rights (TRIPS) Agreement and the 2001 Declaration on the TRIPS Agreement and Public Health. A case study outlines the manner in which "TRIPS-plus" provisions in selected US free trade agreements (FTAs) have undermined multi-level policy coherence in trade, development and public health. The discussion then identifies three unique governance mechanisms of the G8 that make the group a potentially powerful catalyst for innovation in global health governance, and assesses the opportunities that the 2008 G8 Hokkaido Summit may offer. The paper concludes by offering recommendations for enhancing multi-level policy coherence and for strengthening the system of global health governance.
Country
Publisher
CIGI Working Paper
Theme area
Health equity in economic and trade policies, Governance and participation in health
Title of publication The role of non-governmental organizations in global health diplomacy: negotiating the Framework Convention on Tobacco Control
Date of publication
2009 November
Publication type
Journal Article
Publication details
Health Policy and Planning 27 3 pp 405-412
Publication status
Published
Language
English
Keywords
non-governmental organisations, global health diplomacy, tobacco control, global
Abstract
The Framework Convention on Tobacco Control (FCTC) is an exemplar result of global health diplomacy, based on its global reach (binding on all World Health Organization member nations) and its negotiation process. The FCTC negotiations are one of the first examples of various states and non-state entities coming together to create a legally binding tool to govern global health. They have demonstrated that diplomacy, once consigned to interactions among state officials, has witnessed the dilution of its state-centric origins with the inclusion of non-governmental organizations (NGOs) in the diplomacy process. To engage in the discourse of global health diplomacy, NGO diplomats are immediately presented with two challenges: to convey the interests of larger publics and to contribute to inter-state negotiations in a predominantly state-centric system of governance that are often diluted by pressures from private interests or mercantilist self-interest on the part of the state itself. How do NGOs manage these challenges within the process of global health diplomacy itself? What roles do, and can, they play in achieving new forms of global health diplomacy? This paper addresses these questions through presentation of findings from a study of the roles assumed by one group of non-governmental actors (the Canadian NGOs) in the FCTC negotiations. The findings presented are drawn from a larger grounded theory study. Qualitative data were collected from 34 public documents and 18 in-depth interviews with participants from the Canadian government and Canadian NGOs. This analysis yielded five key activities or roles of the Canadian NGOs during the negotiation of the FCTC: monitoring, lobbying, brokering knowledge, offering technical expertise and fostering inclusion. This discussion begins to address one of the key goals of global health diplomacy, namely ‘the challenges facing health diplomacy and how they have been addressed by different groups and at different levels of governance’.
Country
Publisher
Health Policy and Planning
Theme area
Health equity in economic and trade policies, Governance and participation in health
Title of publication Brazil and the Framework Convention on Tobacco Control: Global health diplomacy as soft power
Date of publication
2010 April
Publication type
Journal Article
Publication details
PLoS Medicine 7 4 pp /-/
Publication status
Published
Language
English
Keywords
global health diplomacy, tobacco control, Brazil
Abstract
This paper examines the process by which Brazil asserted influence in the negotiation of the Framework Convention on Tobacco Control (FCTC) as an example of soft power. Implemented under the bylaws of the World Health Organization (WHO), the FCTC has been the product of multi-level and multi-actor negotiation processes that define “global health diplomacy” . A fuller understanding of Brazil's contribution to the FCTC provides insights into the pursuit of global health cooperation alongside broader foreign policy objectives, as well as the emerging practice of global health diplomacy.
Country
Publisher
PLoS Medicine
Theme area
Governance and participation in health
Title of publication Global health diplomacy: how foreign policy can influence health
Date of publication
2009 March
Publication type
Journal Article
Publication details
Canadian Foreign Policy Journal 15 3 pp 85-105
Publication status
Published
Language
English
Keywords
global health diplomacy, foreign policy, Canada
Abstract
This study shows that since 1980 the G8 summits have increasingly made health commitments across a broadening agenda, especially since the Canadian-hosted Kananaskis Summit in 2002. Canada has helped generate G8 commitments on SARS, polio, access to affordable medicines, and African development. However, compliance has varied widely, with Canada, the United States, Britain, and the European Union having higher rates of compliance than the rest of the G8 members. Health compliance has also varied from summit to summit, with the last Canadian-hosted meeting in 2002 producing a below average score. Evidence suggests that G8 leaders can improve their compliance by crafting forward-looking commitments and calling on the World Health Organization (WHO) to help implement them. However, because each G8 member responds to a distinctive combination of catalysts, Canada needs to use a comprehensive array of them, in a country-specific strategy, to successfully address global health at its G8 in 2010.
Country
Publisher
Canadian Foreign Policy Journal
Theme area
Health equity in economic and trade policies, Governance and participation in health
Title of publication Indonesia, H5N1, and global health diplomacy
Date of publication
2010 March
Publication type
Journal Article
Publication details
Global Health Governance 3 2 pp /-/
Publication status
Published
Language
English
Keywords
global health diplomacy, H5N1, Indonesia
Abstract
The World Health Organization (WHO) is mandated to be the United Nations specialized agency for health. However, in light of changing disease trends, the increased “globalization” of health, and the entry of other actors into the health arena, much of the current discourse in global health research discusses the future of the WHO and its current role in governing global health, and how this should, or can change. This paper examines the role of the WHO in global health diplomacy and the promotion of global health security by examining the Indonesian virus-sharing case. In 2007, the Indonesian government pulled out of the Global Influenza Surveillance Network (GISN), concerned that its strains of H5N1 would be used to make vaccines in the high-income countries which would then be “resold” to Indonesia at what they considered to be unaffordable prices. They were also concerned that scientists in high-income countries would be able to take out patents based on these strains, which they asserted was their sovereign property. This paper discusses to what extent the International Health Regulations (IHR) and other agreements are applicable to this case and why countries have chosen to address this issue through an intergovernmental process rather than invoking the IHR. It also questions the enforceability of international agreements and their role in promoting equity. This paper then examines why current negotiations over virus-sharing have not reached an agreement. In doing so the authors argue it is possible to use this case to ask broader question about what “effective” global health diplomacy is, how global health governance architecture could, and should change – and what should the WHO’s role in promoting global health security be, and what other actors could, and should be involved.
Country
Publisher
Global Health Governance
Theme area
Governance and participation in health
Title of publication Global health and foreign policy
Date of publication
2010 April
Publication type
Journal Article
Publication details
Epidemiologic Reviews 32 1 pp 82-92
Publication status
Published
Language
English
Keywords
global health diplomacy, global
Abstract
Health has long been intertwined with the foreign policies of states. In recent years, however, global health issues have risen to the highest levels of international politics and have become accepted as legitimate issues in foreign policy. This elevated political priority is in many ways a welcome development for proponents of global health, and it has resulted in increased funding for and attention to select global health issues. However, there has been less examination of the tensions that characterize the relationship between global health and foreign policy and of the potential effects of linking global health efforts with the foreign-policy interests of states. In this paper, the authors review the relationship between global health and foreign policy by examining the roles of health across four major components of foreign policy: aid, trade, diplomacy, and national security. For each of these aspects of foreign policy, the authors review current and historical issues and discuss how foreign-policy interests have aided or impeded global health efforts. The increasing relevance of global health to foreign policy holds both opportunities and dangers for global efforts to improve health.
Country
Publisher
Epidemiologic Reviews
Theme area
Health equity in economic and trade policies, Governance and participation in health
Title of publication Framing health and foreign policy: lessons for global health diplomacy
Date of publication
2010 August
Publication type
Journal Article
Publication details
Globalisation and Health 6 14 pp /-/
Publication status
Published
Language
English
Keywords
foreign policy, global health diplomacy, global
Abstract
Global health financing has increased dramatically in recent years, indicative of a rise in health as a foreign policy issue. Several governments have issued specific foreign policy statements on global health and a new term, global health diplomacy, has been coined to describe the processes by which state and non-state actors engage to position health issues more prominently in foreign policy decision-making. Their ability to do so is important to advancing international cooperation in health. In this paper we review the arguments for health in foreign policy that inform global health diplomacy. These are organized into six policy frames: security, development, global public goods, trade, human rights and ethical/moral reasoning. Each of these frames has implications for how global health as a foreign policy issue is conceptualized. Differing arguments within and between these policy frames, while overlapping, can also be contradictory. This raises an important question about which arguments prevail in actual state decision-making. This question is addressed through an analysis of policy or policy-related documents and academic literature pertinent to each policy framing with some assessment of policy practice. The reference point for this analysis is the explicit goal of improving global health equity. This goal has increasing national traction within national public health discourse and decision-making and, through the Millennium Development Goals and other multilateral reports and declarations, is entering global health policy discussion. Initial findings support conventional international relations theory that most states, even when committed to health as a foreign policy goal, still make decisions primarily on the basis of the 'high politics' of national security and economic material interests. Development, human rights and ethical/moral arguments for global health assistance, the traditional 'low politics' of foreign policy, are present in discourse but do not appear to dominate practice. While political momentum for health as a foreign policy goal persists, the framing of this goal remains a contested issue. The analysis offered in this article may prove helpful to those engaged in global health diplomacy or in efforts to have global governance across a range of sectoral interests pay more attention to health equity impacts.
Country
Publisher
Globalisation and Health
Theme area
Values, policies and rights, Health equity in economic and trade policies, Governance and participation in health
Title of publication Making health an imperative of foreign policy: The value of a human rights approach
Date of publication
2010
Publication type
Journal Article
Publication details
Health and Human Rights 12 1 pp /-/
Publication status
Published
Language
English
Keywords
foreign policy, human rights, global health diplomacy, global
Abstract
Health is increasingly seen as relevant to foreign policy; nevertheless, it remains subordinate to other interests. In particular, the interests of security and economics are often presented as more critical than health. This is due to a failure to sufficiently recognize the legal obligations that states have undertaken to ensure the human right to health.This article argues that health should be an imperative of foreign policy, equally valid, and prioritized in resource allocation. The study suggests application of the human rights approach with attention to the legal duty of cooperation and the necessity of ensuring broad participation. Further the study suggests that the human rights approach to health can contribute to achieving this result and is compatible with, and beneficial to, other foreign policy concerns. Finally, the study concludes that the human rights approach to health requires that health be an imperative in foreign policymaking processes.
Country
Publisher
Health and Human Rights
Theme area
Health equity in economic and trade policies, Governance and participation in health
Title of publication Access to Medicines, BRICS Alliances, and Collective Action
Date of publication
2008
Publication type
Journal Article
Publication details
American Journal of Law and Medicine 3 / pp 345-394
Publication status
Published
Language
English
Keywords
Access, collective action, BRICS, Brazil, Russia, India, China, South Africa
Abstract
Most discussions on the public health implications of the WTO Agreement on Trade-Related Aspects of Intellectual Property Rights focus on the right of less developed countries to issue compulsory licenses and the need for these countries to exploit flexibilities within the TRIPs Agreement. However, there are other means by which countries can enhance access to essential medicines. To provide an illustration of these other means, this article explores the possibility for greater collaboration among the BRICS countries (Brazil, Russia, India, China, and South Africa) and between these countries and other less developed countries. This article begins by offering a brief discussion of each BRICS country in the area of international intellectual property protection. It advances the hypothesis that, if the BRICS countries are willing to join together to form a coalition, it is very likely that the resulting coalition will precipitate a negotiation deadlock similar to the historic stalemate between developed and less developed countries before the negotiation of the TRIPs Agreement. The article, nevertheless, questions whether the BRICS countries can build a sustained coalition in light of their very different historical backgrounds; the divergent levels of political, social, economic, and cultural developments; and the well-documented historical failures for less developed countries to build or maintain effective coalitions. Taking these challenges and potential hurdles into account, this article contends that it may be more realistic for less developed countries to enter into alliances with one or more of the BRICS countries.The article then highlights the role that the BRICS coalition or partial BRICS alliances can play in the international intellectual property regime. It discusses four coordination strategies through which less developed countries can strengthen their collective bargaining position, influence negotiation outcomes, and promote effective and democratic decisionmaking in the international intellectual property regime. It concludes with a discussion of the various challenges confronting the creation and maintenance of partial BRICS alliances.
Country
Publisher
American Journal of Law and Medicine
Theme area
Equity in health, Health equity in economic and trade policies, Equity and HIV/AIDS, Governance and participation in health
Title of publication AIDS, Access to Medicines, and the Different Roles of the Brazilian and South African Governments in Global Health Governance
Date of publication
2008
Publication type
Report
Publication details
German Institute of Global and Area Studies (GIGA) Working paper 86 / pp /-/
Publication status
Published
Language
English
Keywords
Global health governance, AIDS, access, Brazil, South Africa
Abstract
The report illustrates how the main actors in global health governance (GHG)— governments, nongovernmental organizations (NGOs), intergovernmental organizations (IOs), and transnational pharmaceutical companies (TNPCs)—have been interacting and, as a result, modifying the global health architecture in general and AIDS treatment in particular. Using the concept of “power types” (Keohane/Martin) and “interfaces” (Norman Long), the authors examine the conflicts among major GHG actors that have arisen surrounding the limited access to medicines for fighting HIV/AIDS basically as a result of the Agreement on Trade Related Intellectual Property Rights (TRIPS), in force since 1995. They then analyze the efforts of Brazil and South Africa to obtain fast and low-cost access to antiretroviral medication against AIDS. They conclude that while policy makers in the two countries have used different approaches to tackle the AIDS problem, they have been able, with the support of NGOs, to modify TRIPS and change some WTO rules at the global level along legal interfaces. At the national level the results of the fight against AIDS have been encouraging for Brazil, but not for South Africa, where authorities denied the challenge for a prolonged period of time. The authors see the different outcomes as a consequence of Brazil’s ability to combine discoursive, legal, administrative, and resource-based interfaces.
Country
Publisher
German Institute of Global and Area Studies (GIGA) Working paper
Theme area
Health equity in economic and trade policies, Governance and participation in health
Title of publication Why African Countries Need to Participate in Global Health Security Discourse
Date of publication
2011 March
Publication type
Journal Article
Publication details
Global Health Governance 4 2 pp /-/
Publication status
Published
Language
English
Keywords
global health security, Africa
Abstract
The concept of human security is increasingly accepted as being integral to contemporary notions of national security because of a growing awareness of the importance of individual and societal well-being to national, regional and global peace and stability. Health is thus considered an important component of the predominant vision of human security. However, the precise meaning and scope of global health security remains contested partly due to suspicions about clandestine motives underlying framing health as a security issue. Consequently, low and middle-income countries have not engaged global discourse on health security. This has resulted in an unbalanced global health security agenda shaped primarily by the interests of high-income countries. It narrowly focuses on a few infectious diseases, bioterrorism and marginalizes health security threats of greater relevance to low and middle-income countries. Focusing primarily on countries in the WHO-AFRO region (the African Group), this paper examines the implications of the participation deficit by the African Group of countries on their shared responsibility towards global health security. The potential benefits of regional health security cooperation are analyzed using selected critical health security threats in the Southern African Development Community (SADC). This paper concludes that the neglect of the African Group health security interests on the global health security agenda is partly due to their disengagement. Ensuring that multilateral health security cooperation includes the African Group’s interests require that they participate in shaping the global health security agenda, as proposed in a putative SADC health security cooperation framework.
Country
Publisher
Global Health Governance
Theme area
Health equity in economic and trade policies, Governance and participation in health
Title of publication Human Rights in Global Health Diplomacy: A Critical Assessment
Date of publication
2011 May
Publication type
Journal Article
Publication details
Journal of Human Rights 10 2 pp 189-213
Publication status
Published
Language
English
Keywords
human rights, global health diplomacy, global
Abstract
There is no question that health has risen higher in foreign policy, with health aid quadrupling in the past 20 years and most Millennium Development Goals (MDGs) directly (or indirectly via determinants) addressing critical health inequities. The idea that governments should consider health seriously within their foreign policy became an official UN General Assembly Resolution in early 2009. Several countries have already issued formal statements on health as a foreign policy issue while others are crafting thought pieces that are nudging health forward in foreign policy discussions. There is even a new movement combining academia and bureaucracy under the rubric of global health diplomacy; the process by which government, multilateral, and civil society actors attempt to position health higher in foreign policy arguments. But for global health diplomacy (the “how”) to have traction in foreign affairs, it needs a clear articulation of the “why.” In looking more closely at country statements, what is apparent is the confusing mix of interconnections between wildly differing motives and drivers for the integration of health into foreign policy, not all of which cohere with one another. What arguments exist for why health (and notably health equity, the reduction of preventable inequalities in health within and between nations) should be a prominent foreign policy concern? Within the polyphony of possible arguments, where is there reference to human rights and have invocations to human rights by governments with stated commitments to health in their foreign policy mattered in how they actually behave? This article begins to address these questions.
Country
Publisher
Journal of Human Rights
Theme area
Health equity in economic and trade policies, Governance and participation in health
Title of publication Influenza Virus Samples, International Law, and Global Health Diplomacy
Date of publication
2008 January
Publication type
Journal Article
Publication details
Emerging Infectious Diseases 14 1 pp 88-94
Publication status
Published
Language
English
Keywords
global health diplomacy, international law, influenza, Indonesia
Abstract
Indonesia’s decision to withhold samples of avian influenza virus A (H5N1) from the World Health Organization for much of 2007 caused a crisis in global health. The World Health Assembly produced a resolution to try to address the crisis at its May 2007 meeting. The study examines how the parties to this controversy used international law in framing and negotiating the dispute. Specifically, Indonesia’s use of the international legal principle of sovereignty and its appeal to rules on the protection of biological and genetic resources found in the Convention on Biological Diversity is analysed. In addition, The study considers how the International Health Regulations 2005 applied to the controversy. The incident involving Indonesia’s actions with virus samples illustrates both the importance and the limitations of international law in global health diplomacy.
Country
Publisher
Emerging Infectious Diseases
Theme area
Health equity in economic and trade policies, Governance and participation in health
Title of publication Negotiating equitable access to influenza vaccines: Global health diplomacy and the controversies surrounding avian influenza H5N1 and pandemic influenza H1N1
Date of publication
2010 May
Publication type
Journal Article
Publication details
PLoS Med 7 5 pp /-/
Publication status
Published
Language
English
Keywords
global health diplomacy, influenza vaccine, global
Abstract
One of the most controversial areas of global health diplomacy over the past five years has involved negotiations to increase equitable access to vaccines for highly pathogenic avian influenza A (H5N1) (HPAI-H5N1) and pandemic 2009 influenza A (H1N1) (2009-H1N1). The limited results produced by these negotiations have stimulated calls for a new global framework to improve equitable access to influenza vaccines. The prospects for such a framework are not, however, promising, because the national interests of most developed states vis-à-vis dangerous influenza strains favor retaining the existing imbalanced, reactive, and ad hoc approach to vaccine access. This article examines why negotiating equitable access to influenza vaccines in the context of HPAI-H5N1 and 2009-H1N1 has been, and promises to continue to be, a difficult diplomatic endeavor.
Country
Publisher
PLoS Med
Theme area
Health equity in economic and trade policies, Governance and participation in health
Title of publication Health Diplomacy and the Enduring Relevance of Foreign Policy Interests
Date of publication
2010 April
Publication type
Journal Article
Publication details
PLoS Med 7 4 pp /-/
Publication status
Published
Language
English
Keywords
global health diplomacy, health policy, global
Abstract
The rise of global health issues within the world of foreign policy is precipitating great interest in the concept and practice of health diplomacy. Much discussion of this new field, particularly within the global health community, has narrowly focused on how diplomatic negotiations and foreign policy can be used to support global health goals. Recent articles claim, for example, that “foreign policy is now being driven substantially by health”, and that health can move “foreign policy away from a debate about interests to one about global altruism”. New and unprecedented opportunities to bolster global health through diplomacy have emerged, but claims that health now drives foreign policy fail to appreciate how significantly traditional foreign policy interests continue to shape health diplomacy. Foreign policy interests play a critical role in determining which global health issues achieve political priority and attract funding. In addition, an important, but less analyzed trend involves the increasing use of health interventions as instruments to advance foreign policy interests. Countries are increasingly using health initiatives as a means to improve security, project power and influence, improve their international image, or support other traditional foreign policy objectives. This paper provides an introduction to the PLoS Medicine series on global health diplomacy. Our paper reviews recent research in the field of global health diplomacy, discussing why only select global health issues rise in political priority, examining health diplomacy initiatives driven primarily by foreign policy interests, and seeking to illuminate the constellation of interests involved in health diplomacy. The principal message is that, despite recent commentary to the contrary, foreign policy interests are of primary and enduring importance to understanding the potential and limits of health diplomacy.
Country
Publisher
PLoS Med
Theme area
Health equity in economic and trade policies
Title of publication Four lessons for developing countries from the trade negotiations over access to medicines
Date of publication
2007
Publication type
Journal Article
Publication details
Liverpool Law Review 28 1 pp 11-39
Publication status
Published
Language
English
Keywords
trade, universal access, intellectual property, TRIPS, global
Abstract
After the Agreement on the Trade-Related Aspects of Intellectual Property Rights (TRIPS) came into operation in 1995 developing countries have found themselves in a process of continual negotiation over intellectual property rights and access to medicines. These negotiations have taken place in the World Trade Organization and in the context of free trade agreements. The paper suggests that the only real win for developing countries has been the Doha Declaration on the TRIPS Agreement and Public Health in 2001. What have been the lessons for developing countries in a decade of negotiations over access to medicines? Drawing on themes of rule complexity and regulatory ritualism the paper discusses four key lessons for developing countries. It concludes by arguing that developing countries will do better if they adopt a networked governance approach to negotiation rather than continuing to rely on traditional coalition formation.
Country
Publisher
Liverpool Law Review
Theme area
Health equity in economic and trade policies, Governance and participation in health
Title of publication The Impossible Dream? Codes of Practice and the International Migration of Skilled Health Workers
Date of publication
2011
Publication type
Journal Article
Publication details
World Medical & Health Policy 3 3 pp /-/
Publication status
Published
Language
English
Keywords
migration, skilled health workers, global health diplomacy
Abstract
The international migration of skilled health workers has increased significantly from the 1990s. Many source countries have expressed concern over losses of health workers, resulting in regional Codes of Practice and bilateral Memoranda of Understanding being established since 1999 to achieve more effective, equitable and ethical international migration. The finalisation of a Global Code in 2010 drew attention to continued migration concerns. Codes have three key objectives – protecting rights of migrant workers, adequate workplace support for migrant workers and ensuring that migration flows do not disrupt health services in source countries. There is no agreed definition of ethical international recruitment, and no consensus on the significance and location of harmful recruitment practices. Most codes have covered relatively few regions and exhibit a high degree of generality. Several source countries encourage rather than discourage migration. Migration is a right and occurs in contexts that do not necessarily involve health issues. There are no incentives for recipient countries and agencies to be involved in ethical international recruitment. All codes are voluntary which has restricted their impact. Substantial migration and recruitment have occurred outside their scope, and codes have diverted skilled health workers beyond regulation. The private sector is effectively excluded from codes. Bilateral agreements and memoranda have a greater chance of success, enabling managed migration and return migration, but are more geographically limiting. The most effective constraints to the unregulated flow of skilled health workers are the production of adequate numbers in present recipient countries and provision of improved employment conditions in source countries.
Country
Publisher
World Medical & Health Policy
Theme area
Health equity in economic and trade policies, Governance and participation in health
Title of publication Global health diplomacy for obesity prevention: Lessons from tobacco control
Date of publication
2010
Publication type
Journal Article
Publication details
Journal of Public Health Policy 31 / pp 244-255
Publication status
Published
Language
English
Keywords
global health diplomacy, chronic disease, tobacco control
Abstract
To date the global health diplomacy agenda has focused primarily on infectious diseases. Policymakers have not dedicated the same level of attention to chronic diseases, despite their rising contribution to the global burden of disease. Negotiation of the Framework convention on tobacco control provides an apt example from global health diplomacy to tackle diet-related chronic diseases. What lessons can be learned from this experience for preventing obesity? This article looks at why a global policy response is necessary, at the actors and interests involved in the negotiations, and at the forum for diplomacy.
Country
Publisher
Journal of Public Health Policy
Theme area
Health equity in economic and trade policies
Title of publication Brazil's conception of South-South "structural cooperation" in health
Date of publication
2010 March
Publication type
Journal Article
Publication details
Revista Electronica de Comunicacao Informacao & Inovacao em Saude (RECIIS) 4 1 pp 23-32
Publication status
Published
Language
English
Keywords
South-South, cooperation, Brazil
Abstract
At the dawn of the new millennium, not only have poor countries’ health needs not diminished, but they seem to have worsened due to a complex interplay among many factors that result in huge inequities within and between countries. This critical situation calls international development cooperation into question once again and prompts new thinking. In this process, South-South cooperation has steadily gained importance. At the start of the 21st century, international – particularly South-South – cooperation has come to occupy a strategic place in Brazilian foreign policy, and health is a priority item on this agenda. This paper examines the Brazilian conception of horizontal “structural cooperation in health”. It presents a brief historical review of international development cooperation and health cooperation, explores the concept of “structural cooperation in health”, and discusses the Brazilian proposal formulated over the past decade and its implementation to date. This Brazilian approach centers on the concept of “capacity building for development”, but innovates in two respects: by integrating human resource development with organisational and institutional development and by breaking with the traditional passive transfer of knowledge and technology. It is still early to evaluate its impact, but this cooperation has been implemented on the basis of five interrelated strategic, political and technical considerations: (a) priority for horizontal cooperation; (b) focus on developing health capabilities; (c) coordinated initiatives in the regional context; (d) strong involvement of health ministers in building strategic and political consensus; and (e) encouraging partnership between ministries of health and foreign relations.
Country
Publisher
Revista Electronica de Comunicacao Informacao & Inovacao em Saude (RECIIS)
Theme area
Health equity in economic and trade policies
Title of publication Global Health Governance, Intellectual Property and Access to Essential Medicines
Date of publication
2010 December
Publication type
Journal Article
Publication details
Global Health Governance 4 1 pp /-/
Publication status
Published
Language
English
Keywords
intellectual property, governance, essential medicines
Abstract
Intellectual property “rights,” in many complex ways, impede access to Anti-Retroviral (ARV) drugs in most developing countries with heavy burdens of AIDS-related mortality and morbidity. This article argues that developing countries that lack the necessary pharmaceutical capacity should exploit emerging opportunities for South-South cooperation. While countries like Brazil and India have produced generic ARV drugs, most developing countries either do not have the technology to do so or they are “pressured” against doing so because of the consequences of violation of the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) enforced by the Word Trade Organization. Most recently, Uganda entered into an agreement with Cipla, an Indian generic manufacturer of ARV drugs to open a drug plant in Uganda. Because such opportunities for South-South cooperation abound in contemporary global AIDS diplomacy, developing countries should ingeniously exploit them in ways that do not violate TRIPS. The impediments to this framework would include circumventing the hurdles posed by TRIPS as well as the pressure by global pharmaceutical corporate giants against such initiatives.
Country
Publisher
Global Health Governance
Theme area
Equitable health services
Title of publication Assessing the use of an essential health package in a sector wide approach in Malawi
Date of publication
2011 January
Publication type
Journal Article
Publication details
Health Research Policy and Systems 9 4 pp /-/
Publication status
Published
Language
English
Keywords
essential health package, Malawi
Abstract
The sector wide approach (SWAp) used in many developing countries is difficult to assess. One way is to consider the essential health package (EHP) which is commonly the vehicle for a SWAp's policies and plans. It is not possible to measure the impact of an EHP by measuring health outcomes in countries such as Malawi. But it is possible to assess the choice of interventions and their delivery in terms of coverage. This paper describes an attempt to assess the Malawi SWAp through its EHP using these available measures of technical efficiency. A burden of disease model was used to identify the priority diseases and their estimated incidence. Data from the health management information system (HMIS) were used to measure the coverage of these interventions. A review of the cost-effectiveness of the chosen and potential interventions was undertaken to assess the appropriateness of each intervention used in the EHP. Expenditure data were used to assess the level of funding of the EHP. The SWAp had invested in some very cost-effective health interventions. In terms of numbers of patients treated, the EHP had delivered two thirds of the services required. This was despite serious under-funding of the EHP, an increase in the population and shortage of staff. The study concludes that identification of interventions of proven effectiveness and good value for money and earmarked funding through a SWAp process can produce measurable improvement in health service delivery at extremely low cost.
Country
Publisher
Health Research Policy and Systems
Theme area
Values, policies and rights
Title of publication An assessment of mental health policy in Ghana, South Africa, Uganda and Zambia
Date of publication
2011 April
Publication type
Journal Article
Publication details
Health Research Policy and Systems 9 17 pp /-/
Publication status
Published
Language
English
Keywords
mental health policy, Ghana, South Africa, Uganda, Zambia
Abstract
Approximately half of the countries in the African Region had a mental health policy by 2005, but little is known about quality of mental health policies in Africa and globally. This paper reports the results of an assessment of the mental health policies of Ghana, South Africa, Uganda and Zambia. The WHO Mental Health Policy Checklist was used to evaluate the most current mental health policy in each country. Assessments were completed and reviewed by a specially constituted national committee as well as an independent WHO team. Results of each country evaluation were discussed until consensus was reached. All four policies received a high level mandate. Each policy addressed community-based services, the integration of mental health into general health care, promotion of mental health and rehabilitation. Prevention was addressed in the South African and Ugandan policies only. Use of evidence for policy development varied considerably. Consultations were mainly held with the mental health sector. Only the Zambian policy presented a clear vision, while three of four countries spelt out values and principles, the need to establish a coordinating body for mental health, and to protect the human rights of people with mental health problems. None included all the basic elements of a policy, nor specified sources and levels of funding for implementation. Deinstitutionalisation and the provision of essential psychotropic medicines were insufficiently addressed. Advocacy, empowerment of users and families and intersectoral collaboration were inadequately addressed. Only Uganda sufficiently outlined a mental health information system, research and evaluation, while only Ghana comprehensively addressed human resources and training requirements. No country had an accompanying strategic mental health plan to allow the development and implementation of concrete strategies and activities. The study concludes that six gaps which could impact on the policies' effect on countries' mental health systems were: lack of internal consistency of structure and content of policies, superficiality of key international concepts, lack of evidence on which to base policy directions, inadequate political support, poor integration of mental health policies within the overall national policy and legislative framework, and lack of financial specificity. Three strategies to address these concerns emerged, namely strengthening capacity of key stakeholders in public (mental) health and policy development, creation of a culture of inclusive and dynamic policy development, and coordinated action to optimize use of available resources.
Country
Publisher
Health Research Policy and Systems
Theme area
Equitable health services, Monitoring equity and research to policy
Title of publication Aligning vertical interventions to health systems: a case study of the HIV monitoring and evaluation system in South Africa
Date of publication
2012 January
Publication type
Journal Article
Publication details
Health Research Policy and Systems 10 2 pp /-/
Publication status
Published
Language
English
Keywords
health systems, HIV, monitoring, evaluation, South Africa
Abstract
Like many low- and middle-income countries, South Africa established a dedicated HIV monitoring and evaluation (M&E) system to track the national response to HIV/AIDS. Its implementation in the public health sector has however not been assessed. Since responsibility for health services management lies at the district (sub-national) level, this study aimed to assess the extent to which the HIV M&E system is integrated with the overall health system M&E function at district level. This study describes implementation of the HIV M&E system, determines the extent to which it is integrated with the district health information system (DHIS), and evaluates factors influencing HIV M&E integration. The study was conducted in one health district in South Africa. Data were collected through key informant interviews with programme and health facility managers and review of M&E records at health facilities providing HIV services. Data analysis assessed the extent to which processes for HIV data collection, collation, analysis and reporting were integrated with the DHIS. The study concludes that parallel systems that bypass the DHIS represent a missed opportunity to strengthen system-wide M&E capacity. Integrating HIV M&E (staff, systems and process) into the health system M&E function would mobilise ear-marked HIV funding towards improving DHIS capacity to produce quality and timely HIV indicators that would benefit both programme and health system M&E functions. This offers a practical way of maximising programme-system synergies and translating the health system strengthening intents of existing HIV policies into tangible action.
Country
Publisher
Health Research Policy and Systems
Theme area
Equitable health services, Governance and participation in health
Title of publication Developing lay health worker policy in South Africa: a qualitative study
Date of publication
2012 March
Publication type
Journal Article
Publication details
Health Research Policy and Systems 10 8 pp /-/
Publication status
Published
Language
English
Keywords
health policy, community health worker, South Africa
Abstract
Over the past half decade South Africa has been developing, implementing and redeveloping its Lay Health Worker (LHW) policies. Research during this period has highlighted challenges with LHW programme implementation. These challenges have included an increased burden of care for female LHWs. The aim of this study was to explore contemporary LHW policy development processes and the extent to which issues of gender are taken up within this process. The study adopted a qualitative approach to exploring policy development from the perspective of policy actors. Eleven policy actors (policy makers and policy commentators) were interviewed individually. Data from the interviews were analysed thematically. The study concludes that LHW policy redevelopment focused on resolving issues of LHW working conditions through an active process involving many actors and strong debates. Within this process the issue of gender had no champion and never reached the LHW policy agenda. Future research may consider how to incorporate the voices of ordinary women into the policy making process.
Country
Publisher
Health Research Policy and Systems
Theme area
Monitoring equity and research to policy
Title of publication Investing in African research training institutions creates sustainable capacity for Africa: the case of the University of the Witwatersrand School of Public Health Masters programme in epidemiology and biostatistics
Date of publication
2012 April
Publication type
Journal Article
Publication details
Health Research Policy and Systems 10 11 pp /-/
Publication status
Published
Language
English
Keywords
training, Public Health, South Africa
Abstract
The study argues that inadequate research capacity to produce local, relevant research has been identified as a limitation to improved population health. Increasing attention is being paid to the higher education sector in Africa as a method of addressing this; evidence that such investment is having the desired impact is required. A 1998 3-year investment by the Special Programme for Research and Training in Tropical Diseases (TDR) in research training at the School of Public Health, University of the Witwatersrand, South Africa was reviewed to assess its' impact. A descriptive cross-sectional survey of the 70 students registered for the Masters programme in epidemiology & biostatistics from 2000-2005 was conducted. Data were collected from self-administered questionnaires. The paper finds that investing in African institutions to improve research training capacity resulted in the retention of graduates in Africa in research positions and produced research output. Training programmes can be sustained when national governments invest in higher education and where that funding is judiciously applied. Challenges remain if funding for students bursaries is not available.
Country
Publisher
Health Research Policy and Systems
Theme area
Equitable health services
Title of publication Emergence of biopharmaceutical innovators in China, India, Brazil, and South Africa as global competitors and collaborators
Date of publication
2012 June
Publication type
Journal Article
Publication details
Health Research Policy and Systems 10 18 pp /-/
Publication status
Published
Language
English
Keywords
biopharmaceuticals, China, India, Brazil, South Africa
Abstract
Biopharmaceutical innovation has had a profound health and economic impact globally. Developed countries have traditionally been the source of most innovations as well as the destination for the resulting economic and health benefits. As a result, most prior research on this sector has focused on developed countries. This paper seeks to fill the gap in research on emerging markets by analyzing factors that influence innovative activity in the indigenous biopharmaceutical sectors of China, India, Brazil, and South Africa. Using qualitative research methodologies, this paper a) shows how biopharmaceutical innovation is taking place within the entrepreneurial sectors of these emerging markets, b) identifies common challenges that indigenous entrepreneurs face, c) highlights the key role played by the state, and d) reveals that the transition to innovation by companies in the emerging markets is characterized by increased global integration. It suggests that biopharmaceutical innovators in emerging markets are capitalizing on opportunities to participate in the drug development value chain and thus developing capabilities and relationships for competing globally both with and against established companies headquartered in developed countries.
Country
Publisher
Health Research Policy and Systems
Theme area
Monitoring equity and research to policy
Title of publication Developing a national health research system: participatory approaches to legislative, institutional and networking dimensions in Zambia
Date of publication
2012 June
Publication type
Journal Article
Publication details
Health Research Policy and Systems 10 17 pp /-/
Publication status
Published
Language
English
Keywords
health research, participatory, Zambia
Abstract
The study argues that for many sub-Saharan African countries, a National Health Research System (NHRS) exists more in theory than in reality, with the health system itself receiving the majority of investments. However, this lack of attention to NHRS development can, in fact, frustrate health systems in achieving their desired goals. In this case study, the authors discuss the ongoing development of Zambia's NHRS. They reflect on their experience in the ongoing consultative development of Zambia's NHRS and offer this reflection and process documentation to those engaged in similar initiatives in other settings. The authors argue that three streams of concurrent activity are critical in developing an NHRS in a resource-constrained setting: developing a legislative framework to determine and define the system's boundaries and the roles all actors will play within it; creating or strengthening an institution capable of providing coordination, management and guidance to the system; and focusing on networking among institutions and individuals to harmonize, unify and strengthen the overall capacities of the research community.
Country
Publisher
Health Research Policy and Systems
Theme area
Equitable health services, Human resources for health
Title of publication Linking public health training and health systems development in sub-Saharan Africa: Opportunities for improvement and collaboration
Date of publication
2011 June
Publication type
Journal Article
Publication details
Journal of Public Health Policy 32 51 pp S44-S51
Publication status
Published
Language
English
Keywords
health systems strengthening; public health curriculum; research; Africa
Abstract
The report finds that in sub-Saharan Africa previous health gains have been reversed and many countries are not on track to achieving the Millennium Development Goals. The reasons are multifaceted but relate fundamentally to poorly functioning health systems and the HIV, AIDS, and tuberculosis epidemics. Although population health can be improved through specific health interventions that target high burden diseases, these interventions must be offered within a functional health system for optimal effectiveness. Schools of Public Health in Africa should respond to the many systemic issues that confound improvements in population level health through reviewing approaches to health professional training that incorporates a public health approach, focusing on health systems research; collaboration, advocacy and networking; and strengthening health systems management. The report argues that onstitutional mechanisms to define joint research agendas and two-way exchanges between universities and national health systems are required.
Country
Publisher
Palgrave Macmillan
Theme area
Equity and HIV/AIDS
Title of publication Masculinity as a barrier to men's use of HIV services in Zimbabwe
Date of publication
2011 May
Publication type
Journal Article
Publication details
Global Health 7 1 pp /-/
Publication status
Published
Language
English
Keywords
gender, HIV services, Zimbabwe
Abstract
A growing number of studies highlight men's disinclination to make use of HIV services. This suggests there are factors that prevent men from engaging with health services and an urgent need to unpack the forms of sociality that determine men's acceptance or rejection of HIV services. Drawing on the perspectives of 53 antiretroviral drug users and 25 healthcare providers, the authors examine qualitatively how local constructions of masculinity in rural Zimbabwe impact on men's use of HIV services. Informants reported a clear and hegemonic notion of masculinity that required men to be and act in control, to have know-how, be strong, resilient, disease free, highly sexual and economically productive. However, such traits were in direct conflict with the 'good patient' persona who is expected to accept being HIV positive, take instructions from nurses and engage in health-enabling behaviours such as attending regular hospital visits and refraining from alcohol and unprotected extra-marital sex. This conflict between local understandings of manhood and biopolitical representations of 'a good patient' can provide a possible explanation to why so many men do not make use of HIV services in Zimbabwe. However, once men had been counselled and had the opportunity to reflect upon the impact of ART on their productivity and social value, it was possible for some to construct new and more ART-friendly versions of masculinity. The study concludes by urging HIV service providers to consider the obstacles that prevent many men from accessing their services and argue for community-based and driven initiatives that facilitate safe and supportive social spaces for men to openly discuss social constructions of masculinity as well as renegotiate more health-enabling masculinities.
Country
Publisher
Global Health
Theme area
Resource allocation and health financing, Governance and participation in health
Title of publication Global Health Initiatives and aid effectiveness: insights from a Ugandan case study
Date of publication
2011 July
Publication type
Journal Article
Publication details
Globalisation and Health 7 20 pp /-/
Publication status
Published
Language
English
Keywords
Global Health Initiatives, aid effectiveness, Uganda
Abstract
The emergence of Global Health Initiatives (GHIs) has been a major feature of the aid environment of the last decade. This paper seeks to examine in depth the behaviour of two prominent GHIs in the early stages of their operation in Uganda as well as the responses of the government. The study adopted a qualitative and case study approach to investigate the governance of aid transactions in Uganda. Data sources included documentary review, in-depth and semi-structured interviews and observation of meetings. Agency theory guided the conceptual framework of the study. The Ugandan government had a stated preference for donor funding to be channelled through the general or sectoral budgets. Despite this preference, two large GHIs opted to allocate resources and deliver activities through projects with a disease-specific approach. The mixed motives of contributor country governments, recipient country governments and GHI executives produced incentive regimes in conflict between different aid mechanisms. Notwithstanding attempts to align and harmonize donor activities, the interests and motives of the various actors (GHIs and different parts of the government) undermine such efforts.
Country
Publisher
Globalisation and Health
Theme area
Equity and HIV/AIDS
Title of publication The increasing chronicity of HIV in sub-Saharan Africa: Re-thinking "HIV as a long-wave event" in the era of widespread access to ART
Date of publication
2011 October
Publication type
Journal Article
Publication details
Globalisation and Health 7 41 pp /-/
Publication status
Published
Language
English
Keywords
HIV, AIDS, antiretroviral therapy, chronic diseases, sub Saharan Africa
Abstract
HIV was first described as a "long-wave event" in 1990, well before the advent of antiretroviral therapy (ART). The pandemic was then seen as involving three curves: an HIV curve, an AIDS curve and a curve representing societal impact. Since the mid-2000's, free public delivery of life-saving ART has begun shifting HIV from a terminal disease to a chronic illness for those who can access and tolerate the medications. This increasing chronicity prompts revisiting HIV as a long-wave event. First, with widespread availability of ART, the HIV curve will be higher and last longer. Moreover, if patterns in sub-Saharan Africa mirror experiences in the North, people on ART will live far longer lives but with new experiences of disability. Disability, broadly defined, can result from HIV, its related conditions, and from side effects of medications. Individual experiences of disability will vary. At a population level, however, we anticipate that experiences of disability will become a common part of living with HIV and, furthermore, may be understood as a variation of the second curve. In the original conceptualization, the second curve represented the transition to AIDS; in the era of treatment, we can expect a transition from HIV infection to HIV-related disability for people on ART. Many such individuals may eventually develop AIDS as well, but after a potentially long life that includes fluctuating episodes of illness, wellness and disability. This shift toward chronicity has implications for health and social service delivery, and requires a parallel shift in thinking regarding HIV-related disability. A model providing guidance on such a broader understanding of disability is the World Health Organization's International Classification of Functioning, Disability and Health (ICF). In contrast to a biomedical approach concerned primarily with diagnoses, the ICF includes attention to the impact of these diagnoses on people's lives and livelihoods. The ICF also focuses on personal and environmental contextual factors. Locating disability as a new form of the second curve in the long-wave event calls attention to the new spectrum of needs that will face many people living with HIV in the years and decades ahead.
Country
Publisher
Globalisation and Health
Theme area
Equity and HIV/AIDS
Title of publication HIV/AIDS, chronic diseases and globalisation
Date of publication
2011 August
Publication type
Journal Article
Publication details
Globalisation and Health 7 31 pp /-/
Publication status
Published
Language
English
Keywords
HIV, AIDS, chronic diseases, globalisation, global
Abstract
HIV/AIDS has always been one of the most thoroughly global of diseases. In the era of widely available anti-retroviral therapy (ART), it is also commonly recognised as a chronic disease that can be successfully managed on a long-term basis. This article examines the chronic character of the HIV/AIDS pandemic and highlights some of the changes we might expect to see at the global level as HIV is increasingly normalised as "just another chronic disease". The article also addresses the use of this language of chronicity to interpret the HIV/AIDS pandemic and calls into question some of the consequences of an uncritical acceptance of concepts of chronicity.
Country
Publisher
Globalisation and Health
Theme area
Equity and HIV/AIDS
Title of publication The first decade of antiretroviral therapy in Africa
Date of publication
2011 September
Publication type
Journal Article
Publication details
Globalisation and Health 7 33 pp /-/
Publication status
Published
Language
English
Keywords
antiretroviral therapy, Africa
Abstract
The past decade has seen remarkable progress in increasing access to antiretroviral therapy in resource-limited settings. The study argues that early concerns about the cost and complexity of treatment were overcome thanks to the efforts of a global coalition of health providers, activists, academics, and people living with HIV/AIDS, who argued that every effort must be made to ensure access to essential care when millions of lives depended on it. The high cost of treatment was reduced through advocacy to promote access to generic drugs; care provision was simplified through a public health approach to treatment provision; the lack of human resources was overcome through task-shifting to support the provision of care by non-physicians; and access was expanded through the development of models of care that could work at the primary care level. The challenge for the next decade is to further increase access to treatment and support sustained care for those on treatment, while at the same time ensuring that the package of care is continuously improved such that all patients can benefit from the latest improvements in drug development, clinical science, and public health.
Country
Publisher
Globalisation and Health
Theme area
Equity and HIV/AIDS
Title of publication Outcomes and associated risk factors of patients traced after being lost to follow-up from antiretroviral treatment in Lilongwe, Malawi
Date of publication
2011 January
Publication type
Journal Article
Publication details
BMC Infectious Diseases 11 31 pp /-/
Publication status
Published
Language
English
Keywords
antiretroviral therapy, follow up, Lilongwe, Malawi
Abstract
Loss to follow-up is a major challenge of antiretroviral treatment (ART) programs in sub-Saharan Africa. The paper's objective was to determine true outcomes of patients lost to follow-up (LTFU) and identify risk factors associated with successful tracing and deaths of patients LTFU from ART in a large public sector clinic in Lilongwe, Malawi. Patients who were more than 2 weeks late according to their last ART supply and who provided a phone number or address in Lilongwe were eligible for tracing. Their outcomes were updated and risk factors for successful tracing and death were examined. The paper concludes that ascertainment of contact information is a prerequisite for tracing, which can reveal outcomes of a large proportion of patients LTFU. Having a phone contact number is critical for successful tracing, but further research should focus on understanding whether phone tracing is associated with any differential reporting of mortality or LTFU.
Country
Publisher
BMC Infectious Diseases
Theme area
Equity and HIV/AIDS
Title of publication To use or not to use a condom: A prospective cohort study comparing contraceptive practices among HIV-infected and HIV-negative youth in Uganda
Date of publication
2011 May
Publication type
Journal Article
Publication details
BMC Infectious Diseases 11 114 pp /-/
Publication status
Published
Language
English
Keywords
antiretroviral therapy, HIV, youth, unwanted pregnancy, contraception, Uganda
Abstract
Unwanted pregnancy and HIV infection are issues of significant concern to young people. Limited data exists on contraceptive decision-making and practices among HIV-infected and HIV-negative young people in low resource settings with generalized HIV epidemics. From July 2007 until April 2009, we recruited, and followed up over a one year period, a cohort of 501 HIV-negative and 276 HIV-infected young women and men aged 15-24 years residing in Kampala and Wakiso districts. We compared contraceptive use among HIV-infected and HIV-negative young people and assessed factors associated with contraceptive decision-making and use, using multivariate logistic regression modelling to estimate odds ratios (OR) and 95% confidence intervals (CI). Contraceptive use among sexually active HIV-infected young people was 34% while it was 59% among the HIV-negative group. The condom was the most frequently used method of contraception. At multivariate analysis, the HIV-infected young people were less likely to maintain contraceptive use. Other factors independently associated with sustained contraceptive use were age of the respondent, marital status and being a male. Conversely, HIV-infected young people were less likely to initiate use of contraception. Being married or in a relationship was associated with higher odds of initiating contraceptive use. Compared to the HIV-negative group, sexually active HIV-infected young people are less likely to use contraception and condoms. Initiating or sustaining contraceptive use was also significantly less among the HIV-infected group. Strengthening family planning services and developing new innovative ideas to re-market condom use are needed. Policy and guidelines that empower health workers to help young people (especially the HIV infected) express their sexuality and reproduction should urgently be developed.
Country
Publisher
BMC Infectious Diseases
Theme area
Equity and HIV/AIDS
Title of publication Treatment outcomes in HIV-infected adolescents attending a community-based antiretroviral therapy clinic in South Africa
Date of publication
2012 January
Publication type
Journal Article
Publication details
BMC Infectious Diseases 12 21 pp /-/
Publication status
Published
Language
English
Keywords
antiretroviral therapy, HIV, adolescent, South Africa
Abstract
Very few data are available on treatment outcomes of adolescents living with HIV infection (whether perinatally acquired or sexually acquired) in sub-Saharan Africa. The present study therefore compared the treatment outcomes in adolescents with those of young adults at a public sector community-based ART programme in Cape Town, South Africa. Treatment outcomes of adolescents (9-19 years) were compared with those of young adults (20-28 years), enrolled in a prospective cohort between September 2002 and June 2009. Kaplan-Meier estimates and Cox proportional hazard models were used to assess outcomes and determine associations with age, while adjusting for potential confounders. The treatment outcomes were mortality, loss to follow-up (LTFU), immunological response, virological suppression and virological failure. The study concludes that despite lower virological suppression rates and higher rates of virological failure, immunological responses were nevertheless greater in adolescents than young adults whereas rates of mortality and LTFU were similar. Further studies to determine the reasons for poorer virological outcomes are needed.
Country
Publisher
BMC Infectious Diseases
Theme area
Equitable health services, Resource allocation and health financing
Title of publication Health financing reform in Uganda: How equitable is the proposed National Health Insurance scheme?
Date of publication
2010 October
Publication type
Journal Article
Publication details
International Journal for Equity in Health 9 23 pp /-/
Publication status
Published
Language
English
Keywords
health financing, health insurance, Uganda
Abstract
Uganda is proposing introduction of the National Health Insurance scheme (NHIS) in a phased manner with the view to obtaining additional funding for the health sector and promoting financial risk protection. In this paper, The authors have assessed the proposed NHIS from an equity perspective, exploring the extent to which NHIS would improve existing disparities in the health sector. They review the proposed design and other relevant documents that enhance understanding of contextual issues. The study utilises the Kutzin and fair financing frameworks to critically assess the impact of NHIS on overall equity in financing in Uganda. The introduction of NHIS is being proposed against the backdrop of inequalities in the distribution of health system inputs between rural and urban areas, different levels of care and geographic areas. In this assessment, the study finds that gradual implementation of NHIS will result in low coverage initially, which might pose a challenge for effective management of the scheme. The process for accreditation of service providers during the first phase is not explicit on how it will ensure that a two-tier service provision arrangement does not emerge to cater for different types of patients. If the proposed fee-for-service mechanism of reimbursing providers is pursued, utilisation patterns will determine how resources are allocated. This implies that equity in resource allocation will be determined by the distribution of accredited providers, and checks put in place to prohibit frivolous use. The current design does not explicitly mention how these two issues will be tackled. Lastly, there is no clarity on how the NHIS will fit into, and integrate within existing financing mechanisms.The study concludes that under the current NHIS design, the initial low coverage in the first years will inhibit optimal achievement of the important equity characteristics of pooling, cross-subsidisation and financial protection. Depending on the distribution of accredited providers and utilisation patterns, the NHIS could worsen existing disparities in access to services, given the fee-for-service reimbursement mechanisms currently proposed. Lastly, if equity in financing and resource allocation are not explicit objectives of the NHIS, it might inadvertently worsen the existing disparities in service provision.
Country
Publisher
International Journal for Equity in Health
Theme area
Public-private mix
Title of publication Effect of an expansion in private sector provision of contraceptive supplies on horizontal inequity in modern contraceptive use: evidence from Africa and Asia
Date of publication
2011 August
Publication type
Journal Article
Publication details
International Journal for Equity in Health 10 33 pp /-/
Publication status
Published
Language
English
Keywords
private sector, contraception, Nigeria, Uganda, Bangladesh, Indonesia
Abstract
One strategic approach available to policy makers to improve the availability of reproductive and child health care supplies and services as well as the sustainability of programs is to expand the role of the private sector in providing these services. However, critics of this approach argue that increased reliance on the private sector will not serve the needs of the poor, and could lead to increases in socio-economic disparities in the use of health care services. The purpose of this study is to investigate whether the expansion of the role of private providers in the provision of modern contraceptive supplies is associated with increased horizontal inequity in modern contraceptive use. The study is based on multiple rounds of Demographic and Health Survey data from four selected countries (Nigeria, Uganda, Bangladesh, and Indonesia) in which there was an increase in the private sector supply of contraceptives. The methodology involves estimating concentration indices to assess the degree of inequality and inequity in contraceptive use by wealth groups across time. In order to measure inequity in the use of modern contraceptives, the study uses multivariate methods to control for differences in the need for family planning services in relation to household wealth. The results suggest that the expansion of the private commercial sector supply of contraceptives in the four study countries did not lead to increased inequity in the use of modern contraceptives. In Nigeria and Uganda, inequity actually decreased over time; while in Bangladesh and Indonesia, inequity fluctuated. The study results do not offer support to the hypothesis that the increased role of the private commercial sector in the supply of contraceptive supplies led to increased inequity in modern contraceptive use.
Country
Publisher
International Journal for Equity in Health
Theme area
Equitable health services, Resource allocation and health financing
Title of publication Modelling the affordability and distributional implications of future health care financing options in South Africa
Date of publication
2012 May
Publication type
Journal Article
Publication details
Health Policy and Planning 27 Suppl 1 pp i101-i112
Publication status
Published
Language
English
Keywords
health financing,universal health coverage, South Africa
Abstract
South Africa is considering introducing a universal health care system. A key concern for policy-makers and the general public is whether or not this reform is affordable. Modelling the resource and revenue generation requirements of alternative reform options is critical to inform decision-making. This paper considers three reform scenarios: universal coverage funded by increased allocations to health from general tax and additional dedicated taxes; an alternative reform option of extending private health insurance coverage to all formal sector workers and their dependants with the remainder using tax-funded services; and maintaining the status quo. Each scenario was modelled over a 15-year period using a spreadsheet model. Statistical analyses were also undertaken to evaluate the impact of options on the distribution of health care financing burden and benefits from using health services across socio-economic groups. Universal coverage would result in total health care spending levels equivalent to 8.6% of gross domestic product (GDP), which is comparable to current spending levels. It is lower than the status quo option (9.5% of GDP) and far lower than the option of expanding private insurance cover (over 13% of GDP). However, public funding of health services would have to increase substantially. Despite this, universal coverage would result in the most progressive financing system if the additional public funding requirements are generated through a surcharge on taxable income (but not if VAT is increased). The extended private insurance scheme option would be the least progressive and would impose a very high payment burden; total health care payments on average would be 10.7% of household consumption expenditure compared with the universal coverage (6.7%) and status quo (7.5%) options. The least pro-rich distribution of service benefits would be achieved under universal coverage. Universal coverage is affordable and would promote health system equity, but needs careful design to ensure its long-term sustainability.
Country
Publisher
Health Policy and Planning
Theme area
Equitable health services, Resource allocation and health financing
Title of publication Social solidarity and willingness to tolerate risk- and income-related cross-subsidies within health insurance: experiences from Ghana, Tanzania and South Africa
Date of publication
2012 May
Publication type
Journal Article
Publication details
Health Policy and Planning 27 Suppl 1 pp i55-i63
Publication status
Published
Language
English
Keywords
health insurance, health financing, Ghana, Tanzania, South Africa
Abstract
The importance of ill-health in perpetuating poverty is well recognized. In order to prevent the damaging downward spiral of poverty and illness, there is a need for a greater level of social protection, with greater cross-subsidization between the poor and wealthy, and the healthy and those with ill-health. The aim of this paper is to examine individual preferences for willingness to pre-pay for health care and willingness to cross-subsidize the sick and the poor in Ghana, South Africa and Tanzania. Household surveys in the three countries elicited views on cross-subsidization within health care financing. The paper examines how these preferences varied by socio-economic status, other respondent characteristics, and the extent and type of experience of health insurance in the light of country context. In South Africa and Ghana, 62% and 55% of total respondents, respectively, were in favour of a progressive financing system in which richer groups would pay a higher proportion of income than poorer groups, rather than a system where individuals pay the same proportion of income irrespective of their wealth (proportional). In Tanzania, 45% of the total sample were willing to pay for the health care of the poor. However, in all three countries, a progressive system was favoured by a smaller proportion of the most well off than of less well off groups. Solidarity has been considered to be a collective property of a specific socio-political culture, based on shared expectations and developed as part of a communal, historical learning process. The three countries had different experiences of health insurance and this may have contributed to the above differences in expressed willingness to pay between countries. Building and ‘living with’ institutions that provide affordable universal coverage is likely to be an essential part of the learning process which supports the development of social solidarity.
Country
Publisher
Health Policy and Planning
Theme area
Equitable health services, Resource allocation and health financing
Title of publication Factors influencing the burden of health care financing and the distribution of health care benefits in Ghana, Tanzania and South Africa
Date of publication
2012 May
Publication type
Journal Article
Publication details
Health Policy and Planning 27 Suppl 1 pp i46-i54
Publication status
Published
Language
English
Keywords
health financing, benefit incidence, Tanzania, Ghana, South Africa
Abstract
The paper argues that in Ghana, Tanzania and South Africa, health care financing is progressive overall. However, out-of-pocket payments and health insurance for the informal sector are regressive. The distribution of health care benefits is generally pro-rich. This paper explores the factors influencing these distributions in the three countries. Qualitative data were collected through focus group discussions and in-depth interviews with insurance scheme members, the uninsured, health care providers and managers. Household surveys were also conducted in all countries. Flat-rate contributions contributed to the regressivity of informal sector voluntary schemes, either by design (in Tanzania) or due to difficulties in identifying household income levels (in Ghana). In all three countries, the regressivity of out-of-pocket payments is due to the incomplete enforcement of exemption and waiver policies, partial or no insurance cover among poorer segments of the population and limited understanding of entitlements among these groups. Generally, the pro-rich distribution of benefits is due to limited access to higher level facilities among poor and rural populations, who rely on public primary care facilities and private pharmacies. Barriers to accessing health care include medical and transport costs, exacerbated by the lack of comprehensive insurance coverage among poorer groups. Service availability problems, including frequent drug stock-outs, limited or no diagnostic equipment, unpredictable opening hours and insufficient skilled staff also limit service access. Poor staff attitudes and lack of confidence in the skills of health workers were found to be important barriers to access. Financing reforms should therefore not only consider how to generate funds for health care, but also explicitly address the full range of affordability, availability and acceptability barriers to access in order to achieve equitable financing and benefit incidence patterns.
Country
Publisher
Health Policy and Planning
Theme area
Equitable health services, Public-private mix, Resource allocation and health financing
Title of publication Paying for and receiving benefits from health services in South Africa: is the health system equitable?
Date of publication
2012 May
Publication type
Journal Article
Publication details
Health Policy and Planning 27 Suppl 1 pp i35-i45
Publication status
Published
Language
English
Keywords
health financing, health systems, benefit incidence, South Africa
Abstract
The study argues that there is a global challenge for health systems to ensure equity in both the delivery and financing of health care. However, many African countries still do not have equitable health systems. Traditionally, equity in the delivery and the financing of health care are assessed separately, in what may be termed ‘partial’ analyses. The current debate on countries moving toward universal health systems, however, requires a holistic understanding of equity in both the delivery and the financing of health care. The number of studies combining these aspects to date is limited, especially in Africa. An assessment of overall health system equity involves assessing health care financing in relation to the principles of contributing to financing according to ability to pay and benefiting from health services according to need for care. Currently South Africa is considering major health systems restructuring toward a universal system. This paper examines together, for both the public and the private sectors, equity in the delivery and financing of health care in South Africa. Using nationally representative datasets and standard methodologies for assessing progressivity in health care financing and benefit incidence, this paper reports an overall progressive financing system but a pro-rich distribution of health care benefits. The progressive financing system is driven mainly by progressive private medical schemes that cover a small portion of the population, mainly the rich. The distribution of health care benefits is not only pro-rich, but also not in line with the need for health care; richer groups receive a far greater share of service benefits within both public and private sectors despite having a relatively lower share of the ill-health burden. The importance of the findings for the design of a universal health system is discussed.
Country
Publisher
Health Policy and Planning
Theme area
Equitable health services, Resource allocation and health financing
Title of publication Who pays and who benefits from health care? An assessment of equity in health care financing and benefit distribution in Tanzania
Date of publication
2012 May
Publication type
Journal Article
Publication details
Health Policy and Planning 27 Suppl 1 pp i23-i34
Publication status
Published
Language
English
Keywords
health care financing, benefit incidence, Tanzania
Abstract
This study argues that little is known about health system equity in Tanzania, whether in terms of distribution of the health care financing burden or distribution of health care benefits. The study undertook a combined analysis of both financing and benefit incidence to explore the distribution of health care benefits and financing burden across socio-economic groups. A system-wide analysis of benefits was undertaken, including benefits from all providers irrespective of ownership. The analysis used the household budget survey (HBS) from 2001, the most recent nationally representative survey data publicly available at the time, to analyse the distribution of health care payments through user fees, health insurance contributions [from the National Health Insurance Fund (NHIF) for the formal sector and the Community Health Fund (CHF), for the rural informal sector] and taxation. Due to lack of information on NHIF and CHF contributions in the HBS, a primary survey was administered to estimate CHF enrolment and contributions; assumptions were used to estimate NHIF contributions within the HBS. Data from the same household survey, administered to 2224 households in seven districts/councils, was used to analyse the distribution of health care benefits across socio-economic groups. The health financing system was mildly progressive overall, with income taxes and NHIF contributions being the most progressive financing sources. Out-of-pocket payments and contributions to the CHF were regressive. The health benefit distribution was fairly even but the poorest received a lower share of benefits relative to their share of need for health care. Public primary care facility use was pro-poor, whereas higher level and higher cost facility use was generally pro-rich. The study concludes that health financing reforms can improve equity, so long as integration of health insurance schemes is promoted along with cross-subsidization and greater reliance on general taxation to finance health care for the poorest.
Country
Publisher
Health Policy and Planning
Theme area
Equitable health services, Governance and participation in health
Title of publication Progress towards universal coverage: the health systems of Ghana, South Africa and Tanzania
Date of publication
2012 May
Publication type
Journal Article
Publication details
Health Policy and Planning 27 Suppl 1 pp i4-i12
Publication status
Published
Language
English
Keywords
universal health coverage, Ghana, South Africa, Tanzania
Abstract
A desire to enhance protection against health care costs and improve equity of access to health care lies at the core of many health sector financing initiatives. Until recently, international debates about financing and health equity have focused primarily on mechanisms to promote equity in relation to very specific elements of health systems. However, in recent years there has been growing interest in considering these equity challenges from a more systemic perspective. In this context, universal health coverage is becoming a rallying call, with a focus on how best universal coverage can be financed. This paper is the first in a special issue which presents a body of research whose overall aim was to critically evaluate existing inequities in health care financing and provision in Ghana, South Africa and Tanzania, and the extent to which health insurance mechanisms (broadly defined) could address financial protection and equity of access challenges. In this first paper we introduce the countries’ health systems, with a special emphasis on existing mechanisms for financial protection. The paper also identifies in broad terms the key challenges for universal coverage, setting the scene for the subsequent papers.
Country
Publisher
Health Policy and Planning
Theme area
Governance and participation in health, Monitoring equity and research to policy
Title of publication Influencing policy change: the experience of health think tanks in low- and middle-income countries
Date of publication
2011 May
Publication type
Journal Article
Publication details
Health Policy and Planning 27 3 pp /-/
Publication status
Published
Language
English
Keywords
health policy, think tanks, South Africa, Uganda
Abstract
In recent years there has been a growth in the number of independent health policy analysis institutes in low- and middle-income countries which has occurred in response to the limitation of government analytical capacity and pressures associated with democratization. This study aimed to investigate the contribution made by health policy analysis institutes in low- and middle-income countries to health policy agenda setting, formulation, implementation and monitoring and evaluation; and assess which factors, including organizational form and structure, support the role of health policy analysis institutes in low- and middle-income countries in terms of positively contributing to health policy. Six case studies of health policy analysis institutes in Bangladesh, Ghana, India, South Africa, Uganda and Vietnam were conducted including two NGOs, two university and two government-owned policy analysis institutes. Some of the institutes had made major contributions to policy development in their respective countries. All of the institutes were actively engaged in providing policy advice and most undertook policy-relevant research. Several factors were critical in supporting effective policy engagement. These included a supportive policy environment, some degree of independence in governance and financing, and strong links to policy makers that facilitate trust and influence. The study found that while the formal relationship of the institute to government was not found to be critical, units within government faced considerable difficulties.
Country
Publisher
Health Policy and Planning
Theme area
Monitoring equity and research to policy
Title of publication Aging, Transition, and Estimating the Global Burden of Disease
Date of publication
2011 May
Publication type
Journal Article
Publication details
PLoS One 6 5 pp /-/
Publication status
Published
Language
English
Keywords
aging, disease estimates
Abstract
The World Health Organization's Global Burden of Disease (GBD) reports are an important tool for global health policy makers, however the accuracy of estimates for countries undergoing an epidemiologic transition is unclear. The authors attempted to validate the life table model used to generate estimates for all-cause mortality in developing countries. Data was obtained for males and females from the Human Mortality Database for all countries with available data every ten years from 1900 to 2000. These provided inputs for the GBD life table model and served as comparison observed data. These results show that the GBD mortality model did not accurately estimate survival at older ages as developed countries transitioned in the twentieth century and may be similarly flawed in developing countries now undergoing transition. The report concludes that estimates of the size of older-age populations and their attributable disease burden should be reconsidered.
Country
Publisher
PLoS One
Theme area
Equity and HIV/AIDS
Title of publication High Incidence of Unplanned Pregnancy after Antiretroviral Therapy Initiation: Findings from a Prospective Cohort Study in South Africa
Date of publication
2012 April
Publication type
Journal Article
Publication details
PLoS One 7 4 pp /-/
Publication status
Published
Language
English
Keywords
unplanned pregancy, antiretroviral therapy, South Africa
Abstract
The report indicates that increased fertility rates in HIV-infected women receiving antiretroviral therapy (ART) have been attributed to improved immunological function; it is unknown to what extent the rise in pregnancy rates is due to unintended pregnancies. Non-pregnant women ages 18–35 from four public-sector ART clinics in Johannesburg, South Africa, were enrolled into a prospective cohort and followed from August 2009–March 2011. Fertility intentions, contraception and pregnancy status were measured longitudinally at participants' routine ART clinic visits. Rates of unintended pregnancies among women on ART are high, including women recently initiating ART with lower CD4 counts and higher viral loads. A substantial burden of pregnancy loss was observed. Integration of contraceptive services and counselling into ART care is necessary to reduce maternal and child health risks related to mistimed and unwanted pregnancies. The authors conclude that further research into injectable contraceptive failures on ART is warranted.
Country
Publisher
PLoS One
Theme area
Equity and HIV/AIDS
Title of publication Multiple Measures Reveal Antiretroviral Adherence Successes and Challenges in HIV-Infected Ugandan Children
Date of publication
2012 May
Publication type
Journal Article
Publication details
PLoS One 7 5 pp /-/
Publication status
Published
Language
English
Keywords
antiretroviral therapy, HIV, Uganda
Abstract
The report states that adherence to HIV antiretroviral therapy (ART) among children in developing settings is poorly understood. To understand the level, distribution, and correlates of ART adherence behavior, the authors prospectively determined monthly ART adherence through multiple measures and six-monthly HIV RNA levels among 121 Ugandan children aged 2–10 years for one year. The report finds that adherence success depends on a well-established medication taking routine, including caregiver support and adequate education on medication changes. Caregiver-reported depression and shame may reflect fear of poor outcomes, functioning as motivation for the child to adhere. Further research is needed to better understand and build on these key influential factors for adherence intervention development.
Country
Publisher
PLoS One
Theme area
Equity and HIV/AIDS, Monitoring equity and research to policy
Title of publication The (Mis)Reporting of Male Circumcision Status among Men and Women in Zambia and Swaziland: A Randomized Evaluation of Interview Methods
Date of publication
2012 May
Publication type
Journal Article
Publication details
PLoS One 7 5 pp /-/
Publication status
Published
Language
English
Keywords
male circumcision, interview methods, Zambia, Swaziland
Abstract
To date, male circumcision prevalence has been estimated using surveys of men self-reporting their circumcision status. HIV prevention trials and observational studies involving female participants also collect data on partners' circumcision status as a risk factor for HIV/STIs. A number of studies indicate that reports of circumcision status may be inaccurate. This study assessed different methods for improving self- and partner reporting of circumcision status. The study was conducted in urban and rural Zambia and urban Swaziland. Participants were recruited from HIV counseling and testing sites, health centers, and surrounding communities. The study experimentally assessed methods for improving the reporting of circumcision status, including: a) a simple description of circumcision, b) a detailed description of circumcision, c) an illustration of a circumcised and uncircumcised penis, and d) computerized self-interviewing. Self-reports were compared to visual examination. For men, the error in reporting was largely unidirectional: uncircumcised men more often reported they were circumcised (2–7%), depending on setting. Fewer circumcised men misrepresented their status (0.05–5%). Misreporting by women was significantly higher (11–15%), with the error in both directions. A sizable number of women reported that they did not know their partner's circumcision status (3–8%). Computerized interviewing did not improve accuracy. Providing an illustration, particularly for illiterate participants, significantly improved reporting of circumcision status, decreasing misreporting among illiterate participants from 13% to 10%, although misreporting was not eliminated. Study results suggest that the prevalence of circumcision may be overestimated in Zambia and Swaziland; the error in reporting is higher among women than among men. Improved reporting when a description or illustration is provided suggests that the source of the error is a lack of understanding of male circumcision.
Country
Publisher
PLoS One
Theme area
Values, policies and rights
Title of publication Filling the gap: A Learning Network for Health and Human Rights in the Western Cape, South Africa
Date of publication
2012 June
Publication type
Journal Article
Publication details
Health and Human Rights 14 1 pp /-/
Publication status
Published
Language
English
Keywords
right to health, civil society, South Africa
Abstract
The authors of this study draw on the experience of a Learning Network for Health and Human Rights (LN) involving collaboration between academic institutions and civil society organisations in the Western Cape, South Africa. The network aimed at identifying and disseminating best practice related to the right to health. The LN's work in materials development, participatory research, training and capacity-building for action, and advocacy for intervention illustrates lessons for human rights practice. Evidence from evaluation of the LN is presented to support the argument that civil society can play a key role in bridging a gap between formal state commitment to creating a human rights culture and realising services and policies that enable the most vulnerable members of society to advance their health. Through access to information, the creation of space for participation and a safe environment for learning to be turned into practice, the agency of those most affected by rights violations can be redressed, supported by civil society.
Country
Publisher
Health and Human Rights
Theme area
Equitable health services, Human resources for health
Title of publication Policy and programmatic implications of task shifting in Uganda: a case study
Date of publication
2012 March
Publication type
Journal Article
Publication details
BMC Health Services Research 12 61 pp /-/
Publication status
Published
Language
English
Keywords
health workers, task shifting, Uganda
Abstract
Uganda has a severe health worker shortage and a high demand for health care services. This study aimed to assess the policy and programmatic implications of task shifting in Uganda. This was a qualitative, descriptive study through 34 key informant interviews and eight focus group discussions, with participants from various levels of the health system. The report finds that policy makers understood task shifting, but front-line health workers had misconceptions on the meaning and intention(s) of task shifting. There were both positive and negative views on task shifting: the positive ones cast task shifting as one of the solutions to the dual problem of lack of skills and high demand for service, and as something that is already happening; while negative ones saw it as a quick fix intended for the poor, a threat to quality care and likely to compromise the health system. The findings show widespread examples of task in Uganda, and task shifting was mainly attributed to HRH shortages coupled with the high demand for healthcare services. It concludes that there is need for clear policy and guidelines to regulate task shifting and protect those who undertake delegated tasks.
Country
Publisher
BMC Health Services Research
Theme area
Equitable health services
Title of publication The difficult relationship between faith-based health care organisations and the public sector in sub-Saharan Africa: The Case of Contracting Experiences in Cameroon, Tanzania, Chad and Uganda
Date of publication
2012
Publication type
Report
Publication details
Studies in Health Services Organisations and Policy 29 / pp /-/
Publication status
Published
Language
English
Keywords
faith-based organisations, contracting, public sector, Cameroon, Tanzania, Chad, Uganda
Abstract
This book presents the principal findings of a study on contractual arrangements between faith-based hospitals and public health authorities in four sub-Saharan African countries. Contracting is defined as "a voluntary alliance of independent or anonymous partners who enter a commitment with reciprocal obligations and duties, in which each partner expects to obtain benfits from the relationship" (WHO 1997). The book shares findings about the current interface between faith-based facilities and public health authorities in Cameroon, Tanzania, Chad and Uganda.
Country
Publisher
ITG Press
Theme area
Equity in health
Title of publication Report of the session at Forum 2012 on “Bringing evidence on equity to health policy in Africa: Experiences of the Equity Watch”
Date of publication
2012 May
Publication type
Report
Publication details
Publication status
Published
Language
Keywords
equity in health; research; equity monitoring; east and southern Africa
Abstract
Convened by EQUINET, in association with the ECSA Health Community and IDRC Canada, this session presented evidence and experience from work carried out in 2010-2012 in five countries and at regional level in East and Southern Africa to assess progress in key areas of equity in health outcomes, in social determinants of health and in redistributive health systems. The session reviewed the learning from the work, particularly in relation to monitoring policy commitments to equity in health, and discuss the opportunities and the challenges for institutionalising and using equity analysis within health policy and planning. This report summarises the presentations and issues raised at the session.
Country
East and southern Africa region
Publisher
Equinet Publication Type
Reports
Theme area
Equity in health
Title of publication Review of the Equity Watch work in East and Southern Africa: Regional review and skills workshop, April 26-28
Date of publication
2012 May
Publication type
Report
Publication details
Publication status
Published
Language
Keywords
Equity Watch
Abstract
From 26-28 April 2012, EQUINET’S regional methods workshop was held in Cape Town, South Africa. It gathered the lead institutions of country teams in the Equity Watch work, the EQUINET steering committee, regional and international agencies and networks involved in work on health equity. The workshop aimed to: provide training on equity analysis and discuss future approaches to capacity building on equity analysis; review Equity Watch work at country level and the learning and implications from the work for future monitoring of health equity within countries; and review and discuss the draft regional Equity Watch and the follow up and dissemination. Equity Watch presentations were delivered at the meeting for five of the countries in east, central and southern Africa included in the EQUINET network, namely Kenya, Uganda, Zambia, Zimbabwe and Mozambique. Results were mixed from the various countries, indicating success in reducing maternal mortality in most countries, but wide rural-urban disparities in health were found to persist, with rural areas being severely underserved. Delegates argued that aggregated data obscured inequities in health in the region, and expressed a preference for disaggregated data. They identified decreases in public health spending as a major problem in giving ministries the leverage over other sources of spending on health. They also called for ‘mainstreaming’ health equity into the national and regional health agendas, as well as for the dissemination of the Equity Watch results to all stakeholders, identifying champions who will take Equity Watch forward, putting effective monitoring and evaluation in place to measure progress in health equity in the region, and conducting district-level analysis (so far Equity Watch analysis has been on regional and national levels only). Presentations were also given on various aspects of equity analysis, such as disaggregating health expenditure, analysing the social determinants of health equity and universal health coverage and linking equity analysis to the Millennium Development Goals.
Country
East and southern Africa region
Publisher
Equinet Publication Type
Reports
Theme area
Equity in health, Values, policies and rights
Title of publication Discussion paper 90: Dimensions of gender equity in health in East and Southern Africa
Date of publication
2012 April
Publication type
Report
Publication details
Publication status
Published
Language
Keywords
gender equity; east and southern Africa; health equity
Abstract
This report was commissioned by the Regional Network for Equity in Health in East and Southern Africa (EQUINET). It highlights areas of concern for gender equity in health in East and Southern Africa (ESA), based on a review of published literature. The report provides examples of key areas of gender equity in health drawn from the literature. It does not provide a systematic analysis using household data and is not a comprehensive assessment of all dimensions of gender equity. Rather by presenting key dimensions of gender inequity, it raises the argument for more systematic audit and mainstreaming of gender within health systems in ESA countries. It raises dimensions of gender equity in health in relation to the contexts for and social determinants of health; in health outcomes; in health systems and options for acting on gender equity in health.
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Discussion paper
Theme area
Equity in health, Health equity in economic and trade policies, Equitable health services, Governance and participation in health, Monitoring equity and research to policy
Title of publication Stakeholders meeting on the Zimbabwe Equity Watch Harare, February 23rd 2012
Date of publication
2012 March
Publication type
Report
Publication details
Stakeholders meeting on the Zimbabwe Equity Watch Harare, Zimbabwe February 23 2012, EQUINET, Harare
Publication status
Published
Language
Keywords
Equity Watch, Universal Health Coverage; social determinants of health
Abstract
The Ministry of Health and Child Welfare and Training and Research Support Centre/ EQUINET hosted a one day meeting on Thursday 23rd February in Harare to report on and review the findings of the 2011 Zimbabwe Equity Watch; involve health and non health sector actors in identifying priorities and actions to strengthen equity in universal health coverage and action on the social determinants of health; and propose how to institutionalise health equity monitoring. The meeting involved 52 delegates from different sectors of government, parliament, civil society, private sector, technical institutions and international organisations. The meeting identified a number of recommendations and areas of follow up action flowing from the discussions on the Equity Watch report and the presentations in the plenary and parallel sessions that are presented in the report. Stakeholders endorsed equity as a guiding principle for UHC, as well as health in all policies. They called for strengthened consistent co-ordination of the institutions and agencies that influence the determinants of health and delivery on UHC. It was proposed that the Equity Watch be institutionalized and repeated in future with the involvement of other sectors, with indicators also identified for annual monitoring in the routine information system. Specific additional areas for equity analysis were identified.
Country
Zimbabwe
Publisher
Equinet Publication Type
Reports, Equity indicators
Theme area
Resource allocation and health financing
Title of publication Discussion paper 89: Private sector involvement in health services in East and Southern Africa
Date of publication
2012 March
Publication type
Report
Publication details
EQUINET Discussion paper 89
Publication status
Published
Language
Keywords
private financing, health services, east and southern Africa
Abstract
This report was commissioned by EQUINET to look at the characteristics and extent of private sector involvement in health financing and provision in East and Southern African countries. It synthesises available information on the private health sector in the following ESA countries: Angola, Botswana, the Democratic Republic of the Congo (DRC), Kenya, Lesotho, Madagascar, Malawi, Mauritius, Mozambique, Namibia, South Africa, Swaziland, the United Republic of Tanzania, Uganda, Zambia and Zimbabwe. For each country the core health financing issues, including available NHA data, are briefly discussed. As external financial resources play a key role in the funding of private sector initiatives (both for-profit and not-for-profit), the extent of external funding is also considered. Thereafter, an overview is provided of the presence (or not) of private health insurance, and different types of private providers. A trend observed in this review is the expansion of South African private health care organisations into other African countries.
Country
Zimbabwe
Publisher
EQUINET
Equinet Publication Type
Discussion paper
Theme area
Equity and HIV/AIDS, Monitoring equity and research to policy
Title of publication Swaziland HIV Estimates and Projections
Date of publication
2010 July
Publication type
Report
Publication details
The Kingdom of Swaziland
Publication status
Published
Language
English
Keywords
HIV, AIDS, statistics, Swaziland
Abstract
The data contained in this report was generated using two software packages, namely the Estimates and Projections Package (EPP) and SPECTRUM, as recommended by the UNAIDS/WHO Working Group on Global HIV and STI Surveillance. SPECTRUM is a demographic model used for making national HIV estimates and projections of the demographic impact of HIV. It is designed to produce information useful for policy formulation and dialogue on a number of areas including antiretroviral treatment (ART) needs, prevention of mother-to-child (PMTCT) needs, orphan hood status, the rate of new infections and AIDS deaths, among others. The EPP software is used to build models of the national epidemic using ANC surveillance prevalence data as well as data from the national prevalence surveys such as the DHS. The purpose is to generate information essential for policy and planning purposes. The projections show the magnitude of the AIDS epidemic and the demographic, social and economic consequences.
Country
Swaziland
Publisher
The Kingdom of Swaziland
Theme area
Equity in health, Monitoring equity and research to policy
Title of publication 2007 Population and Housing Census: Household and Living Conditions
Date of publication
2010 June
Publication type
Report
Publication details
Central Statistical Office Swaziland
Publication status
Published
Language
English
Keywords
population, housing, census, household, living conditions, Swaziland
Abstract
The main focus of this report is to discuss households and their living conditions including household typology in Swaziland, using 2007 Population and Housing data to answer a series of issues. The discussions in this report are restricted only to Regular Households. Section 1 focuses on the introduction issues of general relevance of the topic. The relevance of the topic uses in different institutions in Swaziland is discussed. The contribution of the 2007 Swaziland census data provided Central Statistical Office (CSO) and its potential usage is elaborated. Section 2 focuses on the Household characteristics, Household size, and Household composition. The report uses primary data collected from individuals and households in Swaziland. Section 3 explores the analysis of the topic theme according to the 2007 Census Data, to describe characteristics of heads of households. Section 4 uses a simple analysis of Housing unit characteristics in Swaziland. This addresses the sources of Acquisition of housing unit, Tenure of housing unit and Quality of housing unit. In Section 5 the emphasis is on exploratory analysis of Capacity of housing. The relevance of the differential selected are investigated. Summary of key results of the analysis of differentials are presented in this section. Section 6 attempts to do special analysis on access to Water for drinking. The analysis of the distribution of main source of drinking water, travel time to the source and safe or not safe sources is investigated. In Section 7 the emphasis is on analysis of Toilet facility used by households’ differentials. The relevance of the differential selected are investigated. In Section 8 the emphasis is on Source of energy analysis of differentials. The relevance of the differential selected are investigated, to add to the initial earlier findings. Summary of key results of the analysis of differentials are presented in this section. Section 9 attempts to do special analysis of Assets of household’s ownership. The analysis of the differential investigated. Section 10 the emphasis is on analysis of Agricultural activities used by household’s differentials. The relevance of the differential selected are investigated, to add to the initial earlier findings. Summary of key results of the analysis of differentials are presented in this section. Section 11 discusses conclusion recommendations for the next census.
Country
Swaziland
Publisher
Central Statistical Office Swaziland
Theme area
Values, policies and rights, Equitable health services
Title of publication Creating a healthy environment for health care workers and their families: Policy
Date of publication
2008
Publication type
Report
Publication details
Swaziland Wellness Centre for Health Care Workers and Their Families
Publication status
Published
Language
English
Keywords
health workers, health services, Swaziland
Abstract
All health care workers are vulnerable to the effects of the prevalent infections in their day to day work. They are challenged by increasing clientele, psychological effects and ill health, but strive for excellence and achievement of the improvement of the health situation in the country. The programme’s prime target is health care workers who are in the front line of health care service delivery in the country. The policy document outlines plans for a Wellness Centre for health care workers and their immediate families. It is a place where the health care workers will be able to find refuge to deal with psychological, physical and emotional challenges, resulting in a strengthened health workforce that is better able to deliver the quality health services needed in Swaziland. This Policy document is a product of a participatory consultative effort led by the Swaziland Nurses Association, with contributions from a number of key stake holders including; the Wellness Centre Board, relevant Swaziland government ministries, intergovernmental and non-governmental organizations and private institutions. This Policy gives direction to the Wellness Centre, Wellness Centre Board, staff, SNA board members, stakeholders and partners on how to support the activities of the centre.
Country
Swaziland
Publisher
Swaziland Wellness Centre for Health Care Workers and Their Families
Theme area
Equity in health, Poverty and health, Monitoring equity and research to policy
Title of publication 2007 Swaziland Population and Housing Census Fact Sheet on Selected Indicators
Date of publication
2007
Publication type
Report
Publication details
Ministry of Health and Social Welfare Swaziland
Publication status
Published
Language
English
Keywords
population, housing, census, fertility, mortality, life expectancy, literacy, statistics, Swaziland
Abstract
Swaziland population and housing census fact sheet on selected indicators: population, fertility, mortality, life expectancy, literacy and households.
Country
Swaziland
Publisher
Ministry of Health and Social Welfare Swaziland
Theme area
Values, policies and rights, Equitable health services
Title of publication Guidelines for the Operation of Decentralised Health Services in Swaziland
Date of publication
1990 September
Publication type
Report
Publication details
Ministry of Health and Social Welfare Swaziland
Publication status
Published
Language
English
Keywords
decentralised, health services, health policy, Swaziland
Abstract
This publication is a revision of the “Guidelines for Future Operation of Health Services in Swaziland” published in 1986. This revised and updated version focuses solely on the decentralization process and the title more accurately reflects this. There are a number of changes from the original version. The more significant ones include, a definition of decentralization as it relates to the Swazi Health System, an update on the current status of decentralization, clarification of supervisory relationships, authority, responsibility and accountability with have been major areas of misunderstanding, revised organizational structure and organograms dealing with the centre, regions and vertical programmes. In this revision, there is an elimination of two of the former headquarters committees – the Principal Secretary’s Management Committee, and the Headquarters – Region Joint Management Committee, revised and updated membership and terms of reference for the remaining headquarters committees –Policy and Planning Committee, Training and Personnel Management Committee, and Budget Preparation and Management Committee. There is also revised and updated membership and terms of reference for the Decentralization Task Force(incorporating the functions of the former Headquarters‐region Joint Management Committee), a presentation of the team concept with revised and updated terms of reference for the Regional Health Management Team. For the first time – terms of reference for the three standing SubCommittees of the RHMTs: Planning and Budgeting Sub‐Committee, Personnel and Training SubCommittee and Information SubCommittee. Special attention has been paid to the vertical programmes, their organization and function within a decentralized systemand there is a special section on Communication considered of relevance since this has been a major problem in the implementation of decentralization. Communication guidelines are spelled out and revised and updated job descriptions for the Senior Health Administrator and Regional Health Administrator. This version of the Guidelines is somewhat shorter than the original version. Material has been eliminated which is felt to be irrelevant and redundant.
Country
Swaziland
Publisher
Ministry of Health and Social Welfare Swaziland
Theme area
Values, policies and rights, Equitable health services
Title of publication Swaziland National Health Policy
Date of publication
2007
Publication type
Report
Publication details
Ministry of Health and Social Welfare Swaziland
Publication status
Published
Language
English
Keywords
health policy, primary health care, Swaziland
Abstract
The previous National Health Policy was published in 1983 and was founded on the concepts and principles of Primary Health Care. Specifically, it sought to provide health education, promote food supply and proper nutrition, improve access to clean water and basic sanitation, promote maternal and child health (including family planning, immunization, prevention and control of endemic diseases), improve treatment of common diseases and injuries, and provide essential drugs. The policy also sought to promote equitable distribution of health services and to coordinate the public and private sectors. After twenty-four years of implementation, it was deemed necessary to update the policy so as to align it with new national and global developments that have an impact on the health status of the country, including the Millennium Development Goals (MDGs), and for the purpose of enhancing the Ministry's ability to effectively deal with emerging health challenges. Revision of the policy was also dictated by the Constitution of the Kingdom of Swaziland, National Development Strategy (NDS), Poverty Reduction Strategy Action Plan (PRSAP), Regional Health Policy for All for the 21st Century in the African Region: Agenda 2020, and SMART Programme on Economic Empowerment and Development (SPEED). The process for developing this policy involved an in-depth analysis of the national health system's responsiveness in the context of the burden of many global disease challenges. Key policy issues, which needed to be addressed urgently, were identified and defined. The process also involved the engagement of consultants, several in-house technical meetings, consensus-building meetings and approval by Cabinet.
Country
Swaziland
Publisher
Ministry of Health and Social Welfare Swaziland
Theme area
Equity in health, Equitable health services, Monitoring equity and research to policy
Title of publication Swaziland Demographic and Health Survey 2006-07
Date of publication
2008
Publication type
Report
Publication details
Central Statistical Office and Macro International Inc
Publication status
Published
Language
English
Keywords
demographic health survey, health policy, Swaziland
Abstract
The 2006-07 Swaziland Demographic and Health Survey (SDHS) is a nationally representative survey of 4,843 households, 4,987 women age 15-49, and 4,156 men age 15-49. The SDHS also included individual interviews with boys and girls age 12-14 and older adults age 50 and over. The survey of persons age 12-14 and age 50 and over was carried out in every other household selected in the SDHS. Interviews were completed for 459 girls and 411 boys age 12-14, and 661 women and 456 men age 50 and over. The 2006-07 SDHS is the first national survey conducted in Swaziland as part of the Demographic and Health Surveys (DHS) programme. The data are intended to furnish programme managers and policymakers with detailed information on levels and trends in fertility; nuptiality; sexual activity; fertility preferences; awareness and use of family planning methods; breastfeeding practices; nutritional status of mothers and young children; early childhood mortality and maternal mortality; maternal and child health; and awareness and behavior regarding HIV/AIDS and other sexually transmitted infections. The survey also collected information on malaria prevention and treatment. The 2006-07 SDHS is the first nationwide survey in Swaziland to provide population-based prevalence estimates for anaemia and HIV. Children age 6 months and older as well as adults were tested for anaemia. Children age 2 years and older as well as adults were tested for HIV.
Country
Swaziland
Publisher
Central Statistical Office and Macro International Inc
URL:
Theme area
Health equity in economic and trade policies, Poverty and health
Title of publication Current Climate Variability and Future Climate Change: Estimated Growth and Poverty Impacts for Zambia
Date of publication
2011 December
Publication type
Report
Publication details
UNU-WIDER WP85
Publication status
Published
Language
English
Keywords
climate change, economic growth, poverty, Zambia
Abstract
Economy-wide and hydrological-crop models are combined to estimate and compare the economic impacts of current climate variability and future anthropogenic climate change in Zambia. Accounting for uncertainty, simulation results indicate that, on average, current variability reduces gross domestic product by four percent over a ten-year period and pulls over two percent of the population below the poverty line. Socio-economic impacts are much larger during major drought years, thus underscoring the importance of extreme weather events in determining climate damages. Three climate change scenarios are simulated based on projections for 2025. Results indicate that, in the worst case scenario, damages caused by climate change are half the size of those from current variability. We conclude that current climate variability, rather than climate change, will remain the more binding constraint on economic development in Zambia, at least over the next few decades.
Country
Zambia
Publisher
UNU-WIDER
Theme area
Health equity in economic and trade policies, Poverty and health
Title of publication Agriculture and Trade Opportunities for Tanzania: Past Volatility and Future Climate Change
Date of publication
2011 December
Publication type
Report
Publication details
UNU-WIDER WP91
Publication status
Published
Language
English
Keywords
climate change, agriculture, maize, Tanzania
Abstract
Given global heterogeneity in climate-induced agricultural variability, Tanzania has the potential to substantially increase its maize exports to other countries. If global maize production is lower than usual due to supply shocks in major exporting regions, Tanzania may be able to export more maize at higher prices, even if it also experiences below-trend productivity. Diverse destinations for exports can allow for enhanced trading opportunities when negative supply shocks affect the partners’ usual import sources. Future climate predictions suggest that some of Tanzania’s trading partners will experience severe dry conditions that may reduce agricultural production in years when Tanzania is only mildly affected. Tanzania could thus export grain to countries as climate change increases the likelihood of severe precipitation deficits in other countries while simultaneously decreasing the likelihood of severe precipitation deficits in Tanzania. Trade restrictions, like export bans, prevent Tanzania from taking advantage of these opportunities, foregoing significant economic benefits.
Country
Tanzania
Publisher
UNU-WIDER
Theme area
Health equity in economic and trade policies, Poverty and health
Title of publication Climate Change and Infrastructure Investment in Developing Countries: The Case of Mozambique
Date of publication
2011 December
Publication type
Report
Publication details
UNU-WIDER WP92
Publication status
Published
Language
English
Keywords
climate change, transport, economic growth, Mozambique
Abstract
Climate change may damage road infrastructure to the potential detriment of economic growth, particularly in developing countries. To quantitatively assess climate change’s consequences, the study constructs a climate-infrastructure model based on stressor-response relationships and links this to a recursive dynamic economy-wide model to estimate and compare road damages to other climate change impact channels. Mozambique is applied to this framework and simulates four future climate scenarios. The results indicate that climate change through 2050 is likely to place a drag on economic growth and development prospects. The economic implications of climate change appear to become more pronounced from about 2030. Nevertheless, the implications are not so strong as to drastically diminish development prospects. An adaptation policy of gradual evolution towards road designs that accommodate higher temperatures and follows rainfall trends (wetter or dryer) improves outcomes. At the same time, a generalized policy of upgrading all roads does not appear to be merited at this time. The findings suggest that impact assessments should include the damages on long-run assets, such as infrastructure, imposed by climate change.
Country
Mozambique
Publisher
UNU-WIDER
Theme area
Resource allocation and health financing
Title of publication Aid and Government Fiscal Behaviour: What Does the Evidence Say?
Date of publication
2012 January
Publication type
Report
Publication details
UNU-WIDER WP1
Publication status
Published
Language
English
Keywords
aid, fiscal polocy taxation, International
Abstract
Donors are concerned about how their aid is used, especially how it affects fiscal behaviour by recipient governments. This study reviews the recent evidence on the effects of aid on government spending and tax effort in recipient countries, concluding with a discussion of when (general) budget support is a fiscally efficient aid modality. Severe data limitations restrict inferences on the relationship between aid and spending, especially as the government is not aware of all the aid available to finance the provision of public goods. Three generalizations are permitted by the evidence: aid finances government spending; the extent to which aid is fungible is over-stated and even where it is fungible this does not appear to make the aid less effective; and there is no systematic effect of aid on tax effort. Beyond these conclusions the fiscal effects of aid are country-specific.
Country
United Kingdom
Publisher
UNU-WIDER
Theme area
Equity in health, Health equity in economic and trade policies
Title of publication Policy Regimes, Inequality, Poverty and Growth: The Chilean Experience, 1973-2010
Date of publication
2012 January
Publication type
Report
Publication details
UNU-WIDER WP4
Publication status
Published
Language
English
Keywords
income distribution, macroeconomic policy, Chile
Abstract
Since the 1970s, Chile has exhibited a highly skewed income distribution accompanied with strong fluctuations over time. Although income distribution worsened notably in the 1970s-80s, a significant improvement was recorded in the first half of the 1990s, resulting from better economic and social policies in the return to democracy. Nonetheless, Chile still faces significant challenges to improve development. There must be an active macroeconomic policy focused on the real economy. Chile also needs profound microeconomic reforms, including (i) capital markets, developing long-term financing channels for small businesses; (ii) radical progress in quality of education and labour training; and (iii) vigorous public support for innovation.
Country
Chile
Publisher
UNU-WIDER
Theme area
Resource allocation and health financing
Title of publication How to Spend it: The organization of public spending and aid effectiveness
Date of publication
2012 January
Publication type
Report
Publication details
UNU-WIDER WP5
Publication status
Published
Language
English
Keywords
aid, public expenditure, International
Abstract
As aid diminishes in importance, donors need a capacity that enables governments to improve the quality of their public spending. In this study the author suggests three such organizational innovations: independent ratings of spending systems, Independent Public Service Agencies, and Sovereign Development Funds. These constitute a new donor instrument of influencing the modalities of public spending, alongside the volume of aid. With an additional instrument donors can escape the dilemma of having more objectives than instruments. How aid is spent may become more important than how much of it is spent.
Country
United Kingdom
Publisher
UNU-WIDER
Theme area
Health equity in economic and trade policies, Resource allocation and health financing
Title of publication Impact of Foreign Aid on Economic Growth in Sierra Leone: Empirical Analysis
Date of publication
2012 January
Publication type
Report
Publication details
UNU-WIDER WP7
Publication status
Published
Language
English
Keywords
ecnomic growth, foreign aid, conflict, Sierra Leone
Abstract
This paper examines the impact of foreign aid on economic growth in Sierra Leone, a country where an empirical econometric study on aid effectiveness is yet to exist. Using a triangulation of approaches involving the ARDL bounds test approach and the Johansen maximum likelihood approach to cointegration for the period 1970-2007, the study finds that foreign aid has a significant contribution in promoting economic growth in the country. This finding is found to be robust across approaches and specifications. Whilst aid may have been associated with improvement in economic growth in the country, its impact during the period of war is found to be either weak or non-existent. Further, aid during the pre-war period is found to be marginally more effective than aid during the post-war period. The latter results suggest that the impact of aid may change with time.
Country
Sierra Leone
Publisher
UNU-WIDER
Theme area
Health equity in economic and trade policies, Resource allocation and health financing
Title of publication Background on the Debates and Documentation of Research on Climate Change and Food Security in Southern Africa
Date of publication
2009 February
Publication type
Report
Publication details
Danish Development Research Network
Publication status
Published
Language
English
Keywords
climate change, food security, southern Africa
Abstract
The report is structured into seven main sections. Section 2 gives a broad overview of climate change, focusing on the evidence, impacts and projected future changes; and then gives a conceptualisation of food security and charts how thinking around food security has broadened over time. Section 3 elaborates on this information by showing how climate change and food security have been brought together under the food systems approach, and outlining some research programmes in southern Africa which have taken this approach. Section 4 provides a synthesis of research to date, highlighting the gaps and opportunities for involvement of the Danish Development Research Network (DDRN). Section 5 summarises the conclusions and recommendations for next steps. Further programme outputs are included in section 6a and 6b, which outline research programmes/knowledge platforms/networks and institutions respectively, that are/have been concerned with climate change and food security in southern Africa from 2000 to the present. Section 7 is the reference list for materials cited in this
document.
Country
Publisher
Danish Development Research Network
Theme area
Health equity in economic and trade policies, Poverty and health
Title of publication The African Green Revolution moves forward
Date of publication
2009 January
Publication type
Journal Article
Publication details
Food Security
Publication status
Published
Language
English
Keywords
Green Revolution, food security, agriculture, Millennium Development Goals, Africa
Abstract
The African Green Revolution is starting to gain momentum and there is now optimism about sub-Saharan Africa’s ability to rapidly increase its agricultural productivity. This is partly due to some key successes—at the local and national levels—of policies that support smallholder farmers. The 80 Millennium Villages, which comprise approximately 400,000 people in ten countries of sub-Saharan Africa, have drastically increased production of staple food crops, transforming food deficits into crop surpluses. Maize yields more than doubled at the village scale, from 1.7 to 4.1 tons ha−1. In Malawi, because of a smart input subsidy program implemented by the government, maize harvests have greatly surpassed those of previous years, turning that country from a recipient of food aid into a food exporter and food aid donor to neighboring countries. Other countries are beginning to implement similar efforts. They will require novel financial mechanisms from the donor community to support them adequately. There is little question that sub-Saharan Africa can greatly improve food security with an ecologically-sound African Green Revolution supported by science-based policies, community mobilization, gender empowerment and effective governance.
Country
Publisher
Food Security
Theme area
Health equity in economic and trade policies, Poverty and health
Title of publication Sustainable intensification in African agriculture
Date of publication
2011
Publication type
Journal Article
Publication details
International Journal of Agricultural Sustainability 9 1 pp 5-24
Publication status
Published
Language
English
Keywords
agriculture, Africa
Abstract
Over the past half-century, agricultural production gains have provided a platform for rural and urban economic growth worldwide. In African countries, however, agriculture has been widely assumed to have performed badly. Foresight commissioned analyses of 40 projects and programmes in 20 countries where sustainable intensification has been developed during the 1990s–2000s. The cases included crop improvements, agroforestry and soil conservation, conservation agriculture, integrated pest management, horticulture, livestock and fodder crops, aquaculture and novel policies and partnerships. By early 2010, these projects had documented benefits for 10.39 million farmers and their families and improvements on approximately 12.75 million ha. Food outputs by sustainable intensification have been multiplicative – by which yields per hectare have increased by combining the use of new and improved varieties and new agronomic–agroecological management (crop yields rose on average by 2.13-fold), and additive – by which diversification has resulted in the emergence of a range of new crops, livestock or fish that added to the existing staples or vegetables already being cultivated. The challenge is now to spread effective processes and lessons to many more millions of generally small farmers and pastoralists across the whole continent. These projects had seven common lessons for scaling up and spreading: (i) science and farmer inputs into technologies and practices that combine crops–animals with agroecological and agronomic management; (ii) creation of novel social infrastructure that builds trust among individuals and agencies; (iii) improvement of farmer knowledge and capacity through the use of farmer field schools and modern information and communication technologies; (iv) engagement with the private sector for supply of goods and services; (v) a focus on women’s educational, microfinance and agricultural technology needs; (vi) ensuring the availability of microfinance and rural banking; and (vii) ensuring public sector support for agriculture. This research forms part of the UK Government’s Foresight Global Food and Farming project.
Country
Publisher
International Journal of Agricultural Sustainability
Theme area
Health equity in economic and trade policies, Poverty and health
Title of publication Grain marketing policy at the crossroads: Challenges for Eastern and Southern Africa
Date of publication
2007
Publication type
Report
Publication details
"Paper prepared for the FAO workshop on “Staple Food Trade and Market Policy Options for Promoting Development in Eastern and Southern Africa”,"
Publication status
Published
Language
English
Keywords
food security, agriculture, trade, east and southern Africa
Abstract
Driven mostly by fiscal crises, many countries in eastern and southern Africa since the early 1990s have initiated erratic transitions from controlled food marketing systems to dual systems in which the government and private sector both operate directly in food markets. There is an emerging consensus that the status quo food marketing situation in most African countries is not going to catalyze small farm productivity growth, and that new approaches will need to be found quickly. This paper addresses nine major issues to guide future discussions on alternative food marketing and trade policy options in the region: (1) how historical and political factors constrain the feasible set of agricultural marketing and trade policy options in many countries of the region; (2) how public expenditure patterns have exacerbated the policy dilemmas associated with underdeveloped food markets; (3) how governments can make the demand for staple food more elastic and hence mitigate the price instability problem; (4) the implications of both eastern and southern Africa’s transition toward structural grain deficits; (5) how the emerging bio-fuels industry and other world market changes will affect import parity prices in the region; (6) why a relatively small proportion of smallholder farmers will be able to benefit from the likely rise in regional food prices; (7) why much of the rapid growth in urban food demand is being met by food imported from outside the region; (8) how the rise of cassava production is likely to affect grain price stability; and (9) the importance of understanding the implementation details in empirical analysis attempting to link alternative policy choices to outcomes.
Country
East and southern Africa region
Publisher
"Paper prepared for the FAO workshop on “Staple Food Trade and Market Policy Options for Promoting Development in Eastern and Southern Africa”,"
Theme area
Values, policies and rights, Health equity in economic and trade policies, Poverty and health
Title of publication Gender vulnerabilities, food price shocks and social protection responses
Date of publication
2009 August
Publication type
Report
Publication details
Overseas Development Institute
Publication status
Published
Language
English
Keywords
gender, food prices, social protection, International
Abstract
The first half of 2008 saw the peak of the international food price spike: food prices had risen dramatically, with effects on domestic and local food prices in many countries. Since then, the global economic crisis has further compounded the situation, with concerns that the contagion effects could reverse decades of progress in developing countries, with hundreds of millions of people experiencing worsening impoverishment and destitution (McCord, 2009). Although food prices have now fallen at the international level, they have not returned to pre-crisis levels, and prices remain high in many domestic markets.1 In this publication it is argued that two important features of the food price crisis have received inadequate attention. First – as has been the case in previous crises – women are bearing a disproportionate share of the burden of the food price crisis, both as producers and consumers. Second, responses at the international and national levels have not taken sufficient consideration of gender dynamics into crisis responses. The authors argue that it is not too late to put in place gender-sensitive policy measures that will improve the effectiveness of policy responses to the crisis as well as address ongoing food insecurity.
Country
Publisher
Overseas Development Institute
Theme area
Health equity in economic and trade policies, Poverty and health
Title of publication Declining global per capita agricultural production and warming oceans threaten food security
Date of publication
2009 June
Publication type
Journal Article
Publication details
Food Security 1 pp 271-289
Publication status
Published
Language
English
Keywords
globalisation, food security, agriculture, climate change, Africa
Abstract
Despite accelerating globalization, most people still eat food that is grown locally. Developing countries with weak purchasing power tend to import as little food as possible from global markets, suffering consumption deficits during times of high prices or production declines. Local agricultural production, therefore, is critical to both food security and economic development among the rural poor. The level of local agricultural production, in turn, will be determined by the amount and quality of arable land, the amount and quality of agricultural inputs (fertilizer, seeds, pesticides, etc.), as well as farm-related technology, practices and policies. This paper discusses several emerging threats to global and regional food security, including declining yield gains that are failing to keep up with population increases, and warming in the tropical Indian Ocean and its impact on rainfall. If yields continue to grow more slowly than per capita harvested area, parts of Africa, Asia and Central and Southern America will experience substantial declines in per capita cereal production. Global per capita cereal production will potentially decline by 14% between 2008 and 2030. Climate change is likely to further affect food production, particularly in regions that have very low yields due to lack of technology. Drought, caused by anthropogenic warming in the Indian and Pacific Oceans, may also reduce 21st century food availability in some countries by disrupting moisture transports and bringing down dry air over crop growing areas. The impacts of these circulation changes over Asia remain uncertain. For Africa, however, Indian Ocean warming appears to have already reduced rainfall during the main growing season along the eastern edge of tropical Africa, from southern Somalia to northern parts of the Republic of South Africa. Through a combination of quantitative modeling of food balances and an examination of climate change, this study presents an analysis of emerging threats to global food security.
Country
Publisher
Food Security
Theme area
Health equity in economic and trade policies, Poverty and health
Title of publication Climate change and Africa
Date of publication
2008
Publication type
Journal Article
Publication details
Oxford Review of Economic Policy 24 2 pp 337-353
Publication status
Published
Language
English
Keywords
climate change, agriculture, private sector, Africa
Abstract
The impact of climate change on Africa is likely to be severe because of adverse direct effects, high agricultural dependence, and limited capacity to adapt. Direct effects vary widely across the continent, with some areas (eg eastern Africa) predicted to get wetter, but much of southern Africa getting drier and hotter. Crop yields will be adversely affected and the frequency of extreme weather events will increase. Adaptation to climate change is primarily a private sector response and should involve relocation of people, changes in the sectoral structure of production, and changes in crop patterns. The role of government is primarily to provide the information, incentives and economic environment to facilitate such changes. Adaptation will be impeded by Africa’s fragmentation into small countries and ethnic groups, and by poor business environments. On the mitigation side, there is a need to design emissions trading frameworks that support greater African participation than at present, and that include land-use change. Mitigation undertaken elsewhere will have a major impact on Africa, both positive (eg new technologies) and negative (eg commodity price changes arising from biofuel policies).
Country
Publisher
Oxford Review of Economic Policy
Theme area
Equity in health
Title of publication Sub-Saharan Africa's Mothers, Newborns, and Children: Where and Why Do They Die?
Date of publication
2010 June
Publication type
Journal Article
Publication details
PloS One 7 6
Publication status
Published
Language
English
Keywords
maternal health, child health, mortality, Millennium Development Goals, Africa
Abstract
Every year 4.4 million children—including 1.2 million newborns—and 265,000 mothers die in sub-Saharan Africa. This amounts to 13,000 deaths per day or almost nine deaths every minute. Sub-Saharan Africa has half of the world's maternal, newborn, and child deaths. The five biggest challenges for maternal, newborn, and child health in sub-Saharan Africa are: pregnancy and childbirth complications, newborn illness, childhood infections, malnutrition, and HIV/AIDS. Many scientifically proven health interventions are available for maternal, newborn, and child health such as medicines, immunizations, insecticide-treated bed nets, and equipment for emergency obstetric care. Yet many African governments are currently underutilizing existing scientific knowledge to save women's and children's lives. A scientific approach based on local epidemiological and coverage data is needed to prioritize the highest impact and most appropriate interventions in a given context. Most countries in sub-Saharan Africa are behind in achieving the Millennium Development Goals (MDGs) for maternal and child health by 2015. However, progress in several low-income countries demonstrates that the MDGs could still be attained through immediate strategic investments in selected evidence-based interventions and targeted health systems strengthening. Many countries are at a tipping point and now is the critical time to use local data to set priorities and accelerate action.
Country
Publisher
PloS One
Theme area
Equity and HIV/AIDS
Title of publication HIV/AIDS Drugs for Sub-Saharan Africa: How Do Brand and Generic Supply Compare?
Date of publication
2007 February
Publication type
Journal Article
Publication details
PloS One 2 3
Publication status
Published
Language
English
Keywords
AIDS, medicines, Africa
Abstract
Significant quantities of antiretroviral drugs (ARVs) to treat HIV/AIDS have been procured for Sub-Saharan Africa for the first time in their 20-year history. This presents a novel opportunity to empirically study the roles of brand and generic suppliers in providing access to ARVs. An observational study of brand and generic supply based on a dataset of 2,162 orders of AIDS drugs for Sub-Saharan Africa reported to the Global Price Reporting Mechanism at the World Health Organization from January 2004-March 2006 was performed. Generic companies supplied 63% of the drugs studied, at prices that were on average about a third of the prices charged by brand companies. 96% of the procurement was of first line drugs, which were provided mostly by generic firms, while the remaining 4%, of second line drugs, was sourced primarily from brand companies. 85% of the generic drugs in the sample were manufactured in India, where the majority of the drugs procured were ineligible for patent protection. The remaining 15% was manufactured in South Africa, mostly under voluntary licenses provided by brand companies to a single generic company. In Sub-Saharan African countries, four first line drugs in the dataset were widely patented, however no general deterrent to generic purchasing based on a patent was detected. Generic and brand companies have played distinct roles in increasing the availability of ARVs in Sub-Saharan Africa. Generic companies provided most of the drugs studied, at prices below those charged by brand companies, and until now, almost exclusively supplied several fixed-dose combination drugs. Brand companies have supplied almost all second line drugs, signed voluntary licenses with generic companies, and are not strictly enforcing patents in certain countries. Further investigation into how price reductions in second line drugs can be achieved and the cheapest drugs can actually be procured is warranted.
Country
Publisher
PloS One
Theme area
Equity and HIV/AIDS
Title of publication Allocating funds for HIV/AIDS: a descriptive study of KwaDukuza, South Africa
Date of publication
2010 March
Publication type
Journal Article
Publication details
Health Policy and Planning 21 1 pp 33-42
Publication status
Published
Language
English
Keywords
resource allocation, priority setting, HIV, AIDS, South Africa
Abstract
Through a descriptive study, factors influencing the decision-making process for allocating funds to HIV/AIDS prevention and treatment programmes were determined, and the extent to which formal decision tools are used in the municipality of KwaDukuza, South Africa. Thirty five key informant interviews were conducted in KwaDukuza. The interview questions addressed specific resource allocation issues while allowing respondents to speak openly about the complexities of the HIV/AIDS resource allocation process. Donors have a large influence on the decision-making process for HIV/AIDS resource allocation. However, advocacy groups, governmental bodies and local communities also play an important role. Political power, culture and ethics are among a set of intangible factors that have a strong influence on HIV/AIDS resource allocation. Formal methods, including needs assessment, best practice approaches, epidemiologic modelling and cost-effectiveness analysis are sometimes used to support the HIV/AIDS resource allocation process. Historical spending patterns are an important consideration in future HIV/AIDS allocation strategies. Several factors and groups influence resource allocation in KwaDukuza. Although formal economic and epidemiologic information is sometimes used, in most cases other factors are more important for resource allocation decision-making. These other factors should be considered in any attempts to improve the resource allocation processes.
Country
Publisher
Health Policy and Planning
Theme area
Resource allocation and health financing
Title of publication The private sector role in HIV/AIDS in the context of an expanded global response: expenditure trends in five sub-Saharan African countries
Date of publication
2011 March
Publication type
Journal Article
Publication details
Health Policy and Planning 26 Suppl 1 pp i72-i84
Publication status
Published
Language
English
Keywords
health financing, private sector, HIV, Africa
Abstract
Global financing for the HIV response has reached unprecedented levels in recent years. Over US$10 billion were mobilized in 2007, an effort credited with saving the lives of millions of people living with HIV (PLHIV). A relatively unexamined aspect of the global HIV response is the role of the private sector in financing HIV/AIDS services. As the nature of the response evolves from emergency relief to long-term sustainability, understanding current and potential contributions from the private sector is critical. This paper examines trends in private sector financing, management and resource consumption related to HIV/AIDS in five sub-Saharan African countries, with a particular emphasis on the effects of recently scaled-up donor funding on private sector contributions. The paper analyses National Health Accounts HIV/AIDS subaccount data for Kenya, Malawi, Rwanda, Tanzania and Zambia between 2002 and 2006. HIV subaccounts provide comparable data on the flow of HIV/AIDS funding from source to use. Findings indicate that private sector contributions decreased in all countries except Tanzania. With regards to managing HIV/AIDS funds, non-governmental organizations are increasingly controlling the largest share of resources relative to other stakeholders, whereas private for-profit entities are managing fewer HIV/AIDS resources since the donor influx. The majority of HIV/AIDS funds were spent in the public sector, although a considerable amount was spent at private facilities, largely fuelled by out-of-pocket (OOP) payments. On the whole, OOP spending by PLHIV decreased over the 4-year period, with the exception of Malawi, demonstrating that PLHIV have increased access to free or subsidized HIV/AIDS services. The findings suggest that the influx of donor funding has led to decreased private contributions for HIV/AIDS. The reduction in private sector investment and engagement raises concerns about the sustainability of HIV/AIDS programmes over the long term, particularly in light of current global economic crisis and emerging competing priorities.
Country
Publisher
Health Policy and Planning
Theme area
Resource allocation and health financing
Title of publication Removing user fees in the health sector: a review of policy processes in six sub-Saharan African countries
Date of publication
2011 July
Publication type
Journal Article
Publication details
Health Policy and Planning 26 Suppl 2 pp ii16-ii29
Publication status
Published
Language
English
Keywords
user fees, health policy, health financing, Africa
Abstract
In recent years, governments of several low-income countries have taken decisive action by removing fully or partially user fees in the health sector. In this study, the authors review recent reforms in six sub-Saharan African countries: Burkina Faso, Burundi, Ghana, Liberia, Senegal and Uganda. The review describes the processes and strategies through which user fee removal reforms have been implemented and tries to assess them by referring to a good practice hypotheses framework. The analysis shows that African leaders are willing to take strong action to remove financial barriers met by vulnerable groups, especially pregnant women and children. However, due to a lack of consultation and the often unexpected timing of the decision taken by the political authorities, there was insufficient preparation for user fee removal in several countries. This lack of preparation resulted in poor design of the reform and weaknesses in the processes of policy formulation and implementation. Our assessment is that there is now a window of opportunity in many African countries for policy action to address barriers to accessing health care. Mobilizing sufficient financial resources and obtaining long-term commitment are obviously crucial requirements, but design details, the formulation process and implementation plan also need careful thought. The report contends that national policy-makers and international agencies could better collaborate in this respect.
Country
Publisher
Health Policy and Planning
Theme area
Resource allocation and health financing
Title of publication Removing user fees for health services in low-income countries: a multi-country review framework for assessing the process of policy change
Date of publication
2011 July
Publication type
Journal Article
Publication details
Health Policy and Planning 26 Suppl 2 pp ii5-ii15
Publication status
Published
Language
English
Keywords
user fees, health policy, Africa
Abstract
Several authors have stressed the fact that many policy reforms fail because of poor formulation or implementation. On the other hand, the health financing literature provides little guidance to policy makers in low-income countries on how to implement a health care financing reform in ways that enhance its chance of achieving policy objectives, even less so for a user fee removal reform.This paper presents the framework used for a multi-country review of the policy process of removing user fees in six sub-Saharan African countries. The review aimed at developing operational guidance for health managers involved in user fee removal reform. Drawing broadly on Walt and Gilson's ‘health policy analysis triangle’ (context—actor—process—content), the study focuses particularly on understanding the process of planning and implementing the reform led by central-level policy actors. The core analytic strategy was the verification of a list of ‘good practice hypotheses’ that might be expected in a health financing policy reform against experience. This framework offers an approach for how to analyse health financing policy reform processes in low-income countries. It allows for an explicit and transparent review of multiple experiences against a set of clear hypotheses. This approach might be a step in the direction of research that supports better formulation and implementation of policies in resource-poor settings.
Country
Publisher
Health Policy and Planning
Theme area
Resource allocation and health financing
Title of publication Claims on health care: a decision-making framework for equity, with application to treatment for HIV/AIDS in South Africa
Date of publication
2010 September
Publication type
Journal Article
Publication details
Health Policy and Planning 26 6 pp 464-470
Publication status
Published
Language
English
Keywords
resouce allocation; South Africa
Abstract
Trying to determine how best to allocate resources in health care is especially difficult when resources are severely constrained, as is the case in all developing countries. This is particularly true in South Africa currently where the HIV epidemic adds significantly to a health service already overstretched by the demands made upon it.This paper proposes a framework for determining how best to allocate scarce health care resources in such circumstances. This is based on communitarian claims. The basis of possible claims considered include: the need for health care, specified both as illness and capacity to benefit; whether or not claimants have personal responsibility in the conditions that have generated their health care need; relative deprivation or disadvantage; and the impact of services on the health of society and on the social fabric. Ways of determining these different claims in practice and the weights to be attached to them are also discussed. The implications for the treatment of HIV/AIDS in South Africa are spelt out.
Country
Publisher
Health Policy and Planning
Theme area
Equitable health services
Title of publication A task shifting approach to primary mental health care for adults in South Africa: human resource requirements and costs for rural settings
Date of publication
2012 January
Publication type
Journal Article
Publication details
Health Policy and Planning 27 1 pp 42-51
Publication status
Published
Language
English
Keywords
primary mental health care, task shifting, human resources, South Africa
Abstract
A recent situational analysis suggests that post-apartheid South Africa has made some gains with respect to the decentralization and integration of mental health into primary health care. However, service gaps within and between provinces remain, with rural areas particularly underserved. This study aims to calculate and cost a hypothetical human resource mix required to populate a framework for district adult mental health services. This framework embraces the concept of task shifting, where dedicated low cost mental health workers at the community and clinic levels supplement integrated care. The expected number and cost of human resources was based on: (a) assumptions of service provision derived from existing services in a sub-district demonstration site and a literature review of evidence-based packages of care in low- and middle-income countries; and (b) assumptions of service needs derived from other studies. For a nominal population of 100 000, minimal service coverage estimates of 50% for schizophrenia, bipolar affective disorder, major depressive disorder and 30% for post-traumatic stress disorder and maternal depression would require that the primary health care staffing package include one post for a mental health counsellor or equivalent and 7.2 community mental health worker posts. The cost of these personnel amounts to £28 457 per 100 000 population. This cost can be offset by a reduction in the number of other specialist and non-specialist health personnel required to close service gaps at primary care level. The adoption of the concept of task shifting can substantially reduce the expected number of health care providers otherwise needed to close mental health service gaps at primary health care level in South Africa at minimal cost and may serve as a model for other middle-income countries.
Country
Publisher
Health Policy and Planning
Theme area
Governance and participation in health
Title of publication A systematic review of the literature for evidence on health facility committees in low- and middle-income countries.
Date of publication
2011 December
Publication type
Journal Article
Publication details
Health Policy and Planning
Publication status
Not published
Language
English
Keywords
community, participation, health facility committee, systematic review, international
Abstract
Community participation in health (CPH) has been advocated as a health-improving strategy for many decades. However, CPH comes in many different forms, one of which is the use of health facility committees (HFCs) on which there is community representation. This paper presents the findings of a systematic literature review of: (a) the evidence of HFCs' effectiveness, and (b) the factors that influence the performance and effectiveness of HFCs. Four electronic databases and the websites of eight key organizations were searched. Out of 341 potentially relevant publications, only four provided reasonable evidence of the effectiveness of HFCs. A further 37 papers were selected and used to draw out data on the factors that influence the functioning of HFCs. A conceptual model was developed to describe the key factors. It consists of, firstly, the features of the HFC, community and facility, and their interactions; secondly, process factors relating to the way HFCs are established and supported; and finally, a set of contextual factors. The review found some evidence that HFCs can be effective in terms of improving the quality and coverage of health care, as well as impacting on health outcomes. However, the external validity of these studies is inevitably limited. Given the different potential roles/functions of HFCs and the complex and multiple set of factors influencing their functioning, there is no ‘one size fits all’ approach to CPH via HFCs, nor to the evaluation of HFCs. However, there are plenty of experiences and lessons in the literature which decision makers and managers can use to optimize HFCs.
Country
Publisher
Health Policy and Planning
Theme area
Values, policies and rights, Health equity in economic and trade policies, Poverty and health
Title of publication Impact of maize storage on rural household food security in Northern Kwazulu-Natal
Date of publication
2004
Publication type
Journal Article
Publication details
Journal of Family Ecology and Consumer Sciences 23 pp 8-15
Publication status
Published
Language
English
Keywords
food security, food crops, livelihoods, South Africa
Abstract
This paper reports the findings of a study conducted in 1999 to investigate the efficiency of maize storage practices employed by a sample of 134 small scale farmers from three communal areas of KwaZulu-Natal and the impact of these storage systems on household food security. The paper is divided into three sections. The first section includes the methodology followed by sample characteristics. The second section presents and discusses the results of the study which include the maize storage practices of the sample households, an analysis of the efficiency of storage and a description of their food security status (as inferred by nine selected indicators). Finally, conclusions and recommendationsare presented.
Country
Publisher
Journal of Family Ecology and Consumer Sciences
Theme area
Values, policies and rights, Health equity in economic and trade policies, Poverty and health
Title of publication Women trading in food across the Zimbabwe–South Africa border: experiences and strategies
Date of publication
2010 November
Publication type
Journal Article
Publication details
Gender and Development 18 3 pp 465-477
Publication status
Published
Language
English
Keywords
gender, livelihoods, agriculture, Zimbabwe
Abstract
This article focuses on Zimbabwean women who are responding to the economic problems at home by trading food in South Africa. It explores the crops the women market, the strategies they use to access these markets, the challenges they face in South Africa, and the way they handle and resolve conflicts of various kinds which arise in the course of their activities. Ensuring household survival by engaging in international trade presents women with the challenge of conquering gender stereotypes, and this potentially enhances their independence. The article is based on research undertaken in a new resettlement area in Zimbabwe.
Country
Zimbabwe
Publisher
Gender and Development
Theme area
Values, policies and rights, Health equity in economic and trade policies, Poverty and health
Title of publication Agricultural livelihoods and nutrition – exploring the links with women in Zambia
Date of publication
2010 November
Publication type
Journal Article
Publication details
Gender and Development 18 3 pp 387-409
Publication status
Published
Language
English
Keywords
gender, agriculture, nutrition, Zambia
Abstract
This article examines food security, nutrition, and women's agricultural livelihoods in Western Province, Zambia. It draws on data from field research supported by Concern Worldwide UK. The research aimed to explore links between food procurement, livelihoods and care at the household level, and recognises the role of institutions and access to assets in shaping livelihood choices by women. Women describe agriculture as the principal route out of food insecurity, and also as a means to a stable livelihood. However, more support is required for women's livelihood activities including agriculture, to enable women to produce enough food to feed themselves and their families.
Country
Zambia
Publisher
Gender and Development
Theme area
Values, policies and rights, Health equity in economic and trade policies, Poverty and health
Title of publication Investing in women farmers to eliminate food insecurity in southern Africa: policy-related research from Mozambique
Date of publication
2008 March
Publication type
Journal Article
Publication details
Gender and Development 16 1 pp 147-159
Publication status
Published
Language
English
Keywords
gender, food security, Mozambique
Abstract
About 70 per cent of the population in Southern Africa depends on agriculture as the main source of food, income, and employment. Women produce an estimated 70 per cent of the food in the region. Recent studies have pointed to governments’ failure to invest in women farmers as one of the major contributing factors to food insecurity in Southern Africa (Drimmie and Mousseaux 2004). This article shares the findings of some Oxfam GB research, conducted in 2006, into government policy towards women farmers in Southern Africa, focusing on Mozambique.
Country
Publisher
Gender and Development
Theme area
Values, policies and rights, Equity and HIV/AIDS
Title of publication Women's Rights and Women's Health During HIV/AIDS Epidemics: The Experience of Women in Sub-Saharan Africa
Date of publication
2009 July
Publication type
Journal Article
Publication details
Healthcare for Women International 30 8 pp 690-706
Publication status
Published
Language
English
Keywords
women's rights, women's health, HIV, AIDS, Africa
Abstract
Twenty-five years have passed since HIV/AIDS was recognized as a major public health problem. Although billions of dollars are spent in research and development, there is still have no medical cure or vaccination. In the early days of the epidemic, public health slogans suggested that HIV/AIDS does not discriminate. Now it is becoming clear that HIV/AIDS spreads most rapidly among poor, marginalized, women, colonized, and disempowered groups of people more than others. The HIV/AIDS epidemic is exacerbated by the social, economic, political, and cultural conditions of societies such as gender, racial, class, and other forms of inequalities. Sub-Saharan African countries are severely hit by HIV/AIDS. For these countries the pandemic of HIV/AIDS demands the need to travel extra miles. The author's objective in this article is to promote the need to go beyond the biomedical model of “technical fixes” and the traditional public health education tools, and come up with innovative ideas and strategic thinking to contain the epidemic. In this article, it is argued that containing the HIV/AIDS epidemic and improving family and community health requires giving appropriate attention to the social illnesses that are responsible for exacerbating biological disorders.
Country
Publisher
Healthcare for Women International
Theme area
Values, policies and rights, Health equity in economic and trade policies, Poverty and health
Title of publication Gender, large-scale development, and food insecurity in Lesotho: an analysis of the impact of the Lesotho Highlands Water Project
Date of publication
2010 November
Publication type
Journal Article
Publication details
Gender and Development 18 3 pp 453-464
Publication status
Published
Language
English
Keywords
gender, food security, Lesotho
Abstract
This article investigates the effects of development policy on gender and food security. It analyses how one policy instituted by a large-scale multi-dam development project, the Lesotho Highlands Water Project (LHWP), affected women's food security in the rural highlands of Lesotho, southern Africa. This was a mitigation policy, aiming to ensure that the LHWP did not negatively impact on the people living in the area where the dams were constructed. However, ethnographic research suggests that the policy itself reinforced and exacerbated gender inequalities that affected women's ability to secure food, and put women at risk of food insecurity within their households. It is argued that gender issues must be central to the constitution and implementation of development projects.
Country
Lesotho
Publisher
Gender and Development
Theme area
Health equity in economic and trade policies, Poverty and health
Title of publication High Food Prices in the Eastern, Central and Southern Africa: Assessing Impact and Tracking Progress Towards Meeting the Comprehensive Framework for Action Objectives
Date of publication
2008 December
Publication type
Report
Publication details
World Food Programme
Publication status
Published
Language
English
Keywords
food prices, Africa
Abstract
Based on detailed literature review and discussions with selected key informants, this paper presents a summary of current evidence and understanding of the impact of high food prices in Africa. It provides an analysis of how various stakeholders have responded within the context of the Comprehensive Framework for Action and finally recommendations on how to better understand and address the issue are outlined. In addition, several country level case studies have been prepared that summarize the array of issues and responses to high food prices in Africa.
Country
Publisher
World Food Programme
Theme area
Values, policies and rights, Health equity in economic and trade policies
Title of publication Globalisation and Health: The Gender Dimension
Date of publication
2008 September
Publication type
Report
Publication details
International Labour Organisation
Publication status
Published
Language
English
Keywords
globalisation, gender equality, global
Abstract
This paper focuses only on two aspects of the global economy that particularly illuminate women’s position and issues related to gender equality: first, global supply chains and production networks that reflect the current nature and pattern of international trade and investment; and second, the international migration of care services workers. These have an impact on labour markets and on women and men in both the South and the North, in developing and developed countries. For example, there is widespread concern in developed countries that trade with low-wage countries and labour migration are responsible for job losses and growing wage inequality in developed countries. This paper gives particular attention to issues in developing countries.
Country
Publisher
International Labour Organisation
Theme area
Equity in health, Monitoring equity and research to policy
Title of publication EQUITY WATCH: Assessing progress towards equity in health, Kenya, 2011
Date of publication
2012 January
Publication type
Report
Publication details
Publication status
Published
Language
Keywords
Equity Watch; equity analysis; Kenya
Abstract
The Equity Watch monitors progress in areas of equity in health, household access to the resources for health, equitable health systems and global justice. This report provides evidence on the performance of Kenya's public policies and systems in promoting and attaining equity in health using the Equity Watch framework. The evidence presented in this report indicates progress towards closing geographical, rural–urban, wealth and other social disparities in some health outcomes, such as in immunisation coverage, access to primary education, contraceptive use, access to antiretrovirals and access to safe sanitation. Nevertheless, other areas are reported on that have made less progress or now have wider differentials. The report suggests that the health care system cannot make progress on its own. It will be difficult to achieve health equity unless we also address the social and economic determinants of health. However the health sector does also play a role. For example, the report shows the progress made in areas where health workers have been capacitated suggesting that the role health workers play in health equity needs more attention and support.
Country
Kenya
Publisher
KEMRI, EQUINET
Equinet Publication Type
Equity indicators
Theme area
Equity in health, Monitoring equity and research to policy
Title of publication ‘Delivering’ on the MDGs? : Equity and maternal health in Ghana, Ethiopia, and Kenya
Date of publication
2008 December
Publication type
Journal Article
Publication details
East Africa Journal of Public Health 5 3 pp 133-141
Publication status
Published
Language
English
Keywords
millenium development goals, maternal health, Ghana, Ethiopia, Kenya
Abstract
The Millennium Development Goals (MDGs) have put maternal health in the mainstream, but there is a need to go beyond the MDGs to address equity within countries. We argue that MDG focus on maternal health is necessary but not sufficient. This paper uses Demographic and Health Survey (DHS) data from Kenya, Ethiopia and Ghana to examine a set of maternal health indicators stratified along five different dimensions. The study highlights the interactive and multiple forms of disadvantage and demonstrates that equity monitoring for the MDGs is possible, even given current data limitations. We analyse DHS data from Ghana, Kenya and Ethiopia on four indicators: skilled birth attendant, contraceptive prevalence rate, AIDS knowledge and access to a health facility. We define six social strata along five different dimensions: poverty status, education, region, ethnicity and the more traditional wealth quintile. Data are stratified singly (e.g. by region) and then stratified simultaneously (e.g. by region and by education) in order to examine the compounded efect of dual forms of vulnerability. Almost all disparities were found to be significant, although the stratifier with the strongest effect on health outcomes varied by indicator and by country. In some cases, urban-dwelling is a more significant advantage than wealth and in others, educational status trumps poverty status. The nuances of this analysis are important for policymaking processes aimed at reaching the MDGs and incorporating maternal health in national development plans. The article highlights the following key points about inequities and maternal health: Firstly; measuring and monitoring: inequity in access to maternal health is possible even in low resource settings—using current data. Secondly, statistically significant health: gaps exist not just between rich and poor, but across other population groups as well, and multiple forms of disadvantage confer greater risk and lastly policies must be aligned with reducing health gaps in access to key maternal health services. The authors declare that there are no conflicts of interest.
Country
Publisher
East Africa Journal of Public Health
Theme area
Equity in health, Monitoring equity and research to policy
Title of publication Monitoring health equity in the MDGs: A practical guide
Date of publication
2006 January
Publication type
Report
Publication details
CEISIN and UNICEF publication
Publication status
Published
Language
English
Keywords
millenium development goal, health equity,monitoring
Abstract
The global consensus represented by the MDGs is a new point of departure for the development community. The UN Millennium Project and scores of other decision-makers, activists, bilateral aid organizations, and communities are already deeply immersed in efforts to reach the (Sachs et al. 2004, UNDP 2003). Yet this global effort could still benefit from explicit and systematic commitment to equity at the country level. Well-defined, equity-sensitive targets—linked to relevant data sources—are necessary to ensure that poor, marginalized, and vulnerable groups are given opportunities for improved health and access to health services (Freedman et al. 2004, Gwatkin 2003). The original purpose of this analysis was to show how to monitor the maternal and child health MDGs1 in an equity-sensitive manner. Using data from broad-scale, international household level surveys—the Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS)—that analysis (which examined six countries using 20 health indicators and six social strata to ground recommendations in current data) demonstrated that in order to understand and promote equity, it is necessary and feasible to establish a baseline using a variety of indicators and stratifiers, even in very low-income, data-poor countries. This Practical Guide builds on the previous work and addresses a wider audience, providing specific technical advice on how to undertake a simple equity analysis using population-based surveys.
Country
Publisher
CEISIN and UNICEF publication
Theme area
Equity in health, Monitoring equity and research to policy
Title of publication Setting the stage for equity-sensitive monitoring of the maternal and child health MDGs
Date of publication
2006 July
Publication type
Report
Publication details
Bulletin of the World Health Organization 84 7 pp 519-527
Publication status
Published
Language
English
Keywords
millennium development goals; indicators; equity; disparities; social determinants; gender; ethnicity; wealth quintiles; poverty; poor; maternal and child health
Abstract
This analysis seeks to set the stage for equity-sensitive monitoring of the health-related Millennium Development Goals (MDGs). The authors use data from international household-level surveys (DHS and MICS) to demonstrate that establishing an equity baseline is necessary and feasible, even in low-income, data-poor countries. They examine six countries using 11 health indicators and six social strata to ground our recommendations in current data. Simple bivariate stratification is complemented by simultaneous stratification to expose the compound effect of multiple forms of vulnerability. The data reveals that inequities are complex and interactive: one cannot draw inferences about the nature or extent of inequities in the health outcomes from a single stratifier or indicator. The MDGs and other development initiatives must become more comprehensive and explicit in their analysis and tracking of inequities. And based upon these country-specific inequities, policies must be designed to narrow health gaps.
Country
Publisher
Bulletin of the World Health Organization
Theme area
Equity in health, Monitoring equity and research to policy
Title of publication Briefing paper: The MDG fundamentals: improving equity for development.
Date of publication
2010 April
Publication type
Report
Publication details
Overseas Development Institute ODI Briefing papers
Publication status
Published
Language
English
Keywords
millenium development goals, development
Abstract
Five years from the Millennium Development Goals (MDGs) deadline, there is growing debate on how to accelerate progress in human development - particularly around the 2010 MDG review process. Historically, progress in development has been seen in terms of economic conditions. A more complete understanding of development is captured by the MDGs, which include indicators for health, gender equality, education and the environment. This paper argues that promoting equity in human development by reducing the gap between the haves and the have-nots will accelerate progress towards the MDGs.
Country
Publisher
Overseas Development Institute
Theme area
Equity in health, Monitoring equity and research to policy
Title of publication Drivers of Inequality in Millennium Development Goal Progress: A Statistical Analysis
Date of publication
2010 March
Publication type
Journal Article
Publication details
PloS Med 7 3 pp 1-13
Publication status
Published
Language
English
Keywords
inequality, millenium development goals, statistical analysis
Abstract
Many low- and middle-income countries are not on track to reach the public health targets set out in the Millennium Development Goals (MDGs). We evaluated whether differential progress towards health MDGs was associated with economic development, public health funding (both overall and as percentage of available domestic funds), or health system infrastructure. We also examined the impact of joint epidemics of HIV/AIDS and noncommunicable diseases (NCDs), which may limit the ability of households to address child mortality and increase risks of infectious diseases. Unequal progress in health MDGs in low-income countries appears significantly related to burdens of HIV and NCDs in a population, after correcting for potentially confounding socioeconomic, disease burden, political, and health system variables. The common separation between NCDs, child mortality, and infectious syndromes among development programs may obscure interrelationships of illness affecting those living in poor households—whether economic (e.g., as money spent on tobacco is lost from child health expenditures) or biological (e.g., as diabetes or HIV enhance the risk of tuberculosis).
Country
Publisher
PloS Med
Theme area
Equitable health services, Equity and HIV/AIDS
Title of publication Free care at the point of service delivery: a key component for reaching universal access to HIV/AIDS treatment in developing countries
Date of publication
2008 July
Publication type
Journal Article
Publication details
AIDS 22 Suppl 1 pp S161-S168
Publication status
Published
Language
English
Keywords
free care, universal access, HIV/AIDS
Abstract
User fees are a common feature of health system financing in low and middle-income countries. In the context of universal access to HIV/AIDS treatment and care, the advantages of user fees for funding at country and local level should be balanced with their clinical and public health impact. We reviewed the literature on user fees and the impact of user fees on HIV/AIDS service delivery. Empirical evidence gathered since the 1980s shows that sustainability, efficiency and equity challenges faced by health systems have persisted with and have often been exacerbated by the introduction of user fees. The evidence on HIV/AIDS suggests that free care at the point of service fosters uptake and helps to extend access for the poorest users. User fees are currently the main barrier to adherence to antiretroviral therapy (ART). Their abolition is associated with better virological results and increased survival. Such abolition should be carried out in parallel with the implementation of financing mechanisms, such as prepayment and risk pooling, which are able to gather funds from the sectors of the population who are able to pay for healthcare and to promote equity towards the poorest. WHO has included free access to HIV/AIDS treatment at the point of service delivery as a component of its public health approach for reaching universal access. Implementation of free HIV/AIDS care should, however, be linked to efforts to strengthen healthcare systems, ensure long-term sustainability of funding and monitor equity of access to care.
Country
Publisher
AIDS
Theme area
Equitable health services, Equity and HIV/AIDS
Title of publication Task Shifting for Scale-up of HIV Care: Evaluation of Nurse-Centered Antiretroviral Treatment at Rural Health Centers in Rwanda
Date of publication
2009 October
Publication type
Journal Article
Publication details
PloS Med 6 10
Publication status
Published
Language
English
Keywords
HIV care, nurse centred, antiretrovirl treatment, Rwanda
Abstract
The shortage of human resources for health, and in particular physicians, is one of the major barriers to achieve universal access to HIV care and treatment. In September 2005, a pilot program of nurse-centered antiretroviral treatment (ART) prescription was launched in three rural primary health centers in Rwanda. The authors retrospectively evaluated the feasibility and effectiveness of this task-shifting model using descriptive data. Medical records of 1,076 patients enrolled in HIV care and treatment services from September 2005 to March 2008 were reviewed to assess: (i) compliance with national guidelines for ART eligibility and prescription, and patient monitoring and (ii) key outcomes, such as retention, body weight, and CD4 cell count change at 6, 12, 18, and 24 mo after ART initiation. Of these, no ineligible patients were started on ART and only one patient received an inappropriate ART prescription. Patient outcomes in the pilot program compared favorably with other ART cohorts in sub-Saharan Africa and with those from a recent evaluation of the national ART program in Rwanda. These findings suggest that nurses can effectively and safely prescribe ART when given adequate training, mentoring, and support.
Country
Publisher
PloS Med
Theme area
Equitable health services, Equity and HIV/AIDS
Title of publication Health Systems and Access to Antiretroviral Drugs for HIV in Southern Africa: Service Delivery and Human Resources Challenges
Date of publication
2006 May
Publication type
Journal Article
Publication details
Reproductive Health Matters 14 27 pp 12-23
Publication status
Published
Language
English
Keywords
health systems, antiretroviral drugs, southern Africa, human resources
Abstract
Without strengthened health systems, significant access to antiretroviral (ARV) therapy in many developing countries is unlikely to be achieved. This paper reflects on systemic challenges to scaling up ARV access in countries with both massive epidemics and weak health systems. It draws on the authors' experience in southern Africa and the World Health Organization's framework on health system performance. Whilst acknowledging the still significant gap in financing, the paper focuses on the challenges of reorienting service delivery towards chronic disease care and the human resource crisis in health systems. Inadequate supply, poor distribution, low remuneration and accelerated migration of skilled health workers are increasingly regarded as key systems constraints to scaling up of HIV treatment. Problems, however, go beyond the issue of numbers to include productivity and cultures of service delivery. As more countries receive funds for antiretroviral access programmes, strong national stewardship of these programmes becomes increasingly necessary. The paper proposes a set of short- and long-term stewardship tasks, which include resisting the verticalisation of HIV treatment, the evaluation of community health workers and their potential role in HIV treatment access, international action on the brain drain, and greater investment in national human resource functions of planning, production, remuneration and management.
Country
Publisher
Reproductive Health Matters
Theme area
Equity in health, Monitoring equity and research to policy
Title of publication The Millennium Development Goals and human rights-based approaches: moving towards a shared approach
Date of publication
2009 January
Publication type
Journal Article
Publication details
International Journal of Human Rights 13 1 pp 72-85
Publication status
Published
Language
English
Keywords
millennium development goals, human rights based approach, development
Abstract
The Millennium Development Goals (MDGs) have become the international community's shared framework for development. Since the Goals focus on national averages and do not refer explicitly to human rights, a long debate has ensued since the adoption of the MDGs in 2001 on whether the Goals are consistent with the progressive realisation of human rights. This paper reviews the history of the MDGs and outlines how developing countries can achieve the Goals. It shows that the MDGs are consistent with Human Rights Based Approaches. Yet, efforts aimed at integrating Human Rights Based Approaches into strategies to achieve the MDGs have primarily focused on normative questions. Too little progress has been made in applying Human Rights Based approached to inform the day-to-day decisions that development practitioners and Governments need to make. In response, the paper outlines a practical approach for how Human Rights Based Approaches could be systematically integrated into five common stages involved in the design and implementation of national development strategies to achieve the MDGs. The five stages cover: (i) the choice of interventions to meet the MDGs; (ii) establishment of corresponding coverage targets and an explicit monitoring framework; (iii) the programming of public expenditures; (iv) the prioritisation and sequencing of interventions over time; and (v) the design of supporting policy frameworks. For each stage, the paper outlines how Human Rights-Based Approaches can inform the choices and decisions that policymakers need to make.
Country
Publisher
International Journal of Human Rights
Theme area
Equity in health, Monitoring equity and research to policy
Title of publication Beyond the Millennium Development Goals: Public health challenges in water and sanitation
Date of publication
2006 August
Publication type
Journal Article
Publication details
Global Public Health 1 1 pp 31-48
Publication status
Published
Language
English
Keywords
water, sanitation, hygiene, equity, Millennium Development Goals
Abstract
Over 1 billion people lack access to improved water sources and 2.6 billion lack access to appropriate sanitation, greatly contributing to the global burden of disease. The international community has committed to reducing by half the proportion of the world's population lacking access to water and sanitation as a part of the Millennium Development Goals (MDGs). However, the disease burden due to poor access, is borne primarily by the poorest countries and the poorest people within them. Simply reducing the proportion of people without adequate access will not automatically result in proportional reductions in the related disease burden. The public health challenge inherent in meeting the MDG targets is ensuring that improvements result in access to water and sanitation for the critical at-risk populations. Innovative approaches are required to ensure the availability of low-cost, simple, and locally acceptable water and sanitation interventions and integrating these approaches into existing social institutions, such as schools, markets, and health facilities.
Country
Publisher
Global Public Health
Theme area
Equity in health, Monitoring equity and research to policy
Title of publication The Millennium Development Goals Fail Poor Children: The Case for Equity-Adjusted Measures
Date of publication
2009 April
Publication type
Journal Article
Publication details
PloS Med 6 4
Publication status
Published
Language
English
Keywords
millenium development goals, under five mortality rate, equity adjusted measures
Abstract
The Millennium Declaration is a statement of principles about the kind of future that world governments seek; a future that they envisage to be more equitable and more responsive to the socially most vulnerable. The Millennium Development Goals represent the operational targets by which we may judge their actions. The reduction of the under-five mortality rate (U5MR) by two-thirds by 2015 is one of the Millennium Development Goals (MDG4). The reduction in U5MR can, however, be achieved through a diversity of policy interventions, some of which could leave the children of the poor worse off. A celebrated MDG4 success can, thus, be a Millennium Declaration failure. Health policy informed by composite outcome measures that take account of both the U5MR and the distribution of the burden of mortality across social groups would help to overcome this.
Country
Publisher
PloS Med
Theme area
Equitable health services, Equity and HIV/AIDS
Title of publication Barriers to access to antiretroviral treatment in developing countries: a review
Date of publication
2008 July
Publication type
Journal Article
Publication details
Tropical Medicine and International Health 13 7 pp 904-913
Publication status
Published
Language
English
Keywords
HIV/AIDS, developing countries, anti retroviral therapy, access, barriers to health care, review
Abstract
The paper sets out to present a review of barriers impeding people living with HIV/AIDS in developing countries from accessing treatment, and to make recommendations for further studies. Electronic databases, websites of main global agencies and international AIDS conferences were searched for relevant articles published between 1996 and 2007. Articles were reviewed using the Andersen and May framework of access to health services and barriers were categorized as either population-level or health system-level barriers. A total of 19 studies (7 articles and 12 abstracts) in English were reviewed. The barriers most frequently cited at the population level were lack of information about antiretroviral therapy (ART), perceived high costs for ART and stigma. Barriers most frequently cited at the health system level were long distance from home to the health facility, lack of co-ordination across services and limited involvement of the community in the programme planning process. Dissemination of information about HIV/AIDS and alternative related care, and alternative health financing policies seem to be the most relevant policy measures to remove barriers. In view of the paucity of evidence on barriers to access to ART, research should address the relative importance of barriers, include a mix of qualitative and quantitative research methods and evaluate barriers in different settings.
Country
Publisher
Tropical Medicine and International Health
Theme area
Equity in health, Monitoring equity and research to policy
Title of publication Equity Analysis: Identifying Who Benefits from Family Planning Programs
Date of publication
2010 June
Publication type
Journal Article
Publication details
Studies in Family Planning 41 2 pp 101-108
Publication status
Published
Language
English
Keywords
family planning, sub saharan Africa, contraceptive use
Abstract
This study examines current disparities in access to family planning services in developing countries with data drawn from 64 Demographic and Health Surveys conducted between 1994 and 2008. The percent of demand satisfied is used as a proxy measure for access to family planning. In all regions, married women aged 15–19 have greater difficulty than older women in meeting their need for contraceptive services. Inequities in the percent of demand satisfied among individuals of varying economic status, area of residence, and education are observed in all regions except Central Asia. These gaps are larger and more common in sub-Saharan Africa. Strategies that seek to increase contraceptive use rapidly without consideration for disadvantaged groups are likely to increase observed inequities in percent of demand satisfied in the short term. Efforts to monitor progress toward the goals enumerated in 1994 at the International Conference on Population and Development and toward other development goals must go beyond global, regional, and national averages to address the needs of population groups that are at greatest risk of adverse health outcomes.
Country
Publisher
Studies in Family Planning
Theme area
Equitable health services, Equity and HIV/AIDS
Title of publication Equity in access to ARV drugs in Malawi
Date of publication
2007 May
Publication type
Journal Article
Publication details
Journal des Aspects Sociaux du VIH/SIDA 4 1 pp 564-574
Publication status
Published
Language
English
Keywords
access, antiretroviral drugs, Malawi
Abstract
This paper discusses the issue of equity in the distribution of ARV drugs in the Malawi health system. Malawi is one of the countries most severely affected by HIV/AIDS in southern Africa. It is also one of the poorest countries in the world. ARV drugs are expensive. The Malawi government, with assistance from the Global Fund on Tuberculosis, Malaria and HIV/AIDS, started providing free ARV drugs to eligible HIV-infected people in September 2004.The provision of free drugs brought the hope that everyone who was eligible would access them. Based on data collected through a qualitative research methodology, it was found that achieving equity in provision would face several challenges including policy, operational and socio-economic considerations. Specifically, the existing policy framework, shortage of medical personnel, access to information and inadequacy of effective community support groups are some of the key issues affecting equity.
Country
Malawi
Publisher
Journal des Aspects Sociaux du VIH/SIDA
Theme area
Equity in health, Monitoring equity and research to policy
Title of publication How does progress towards the child mortality millennium development goal affect inequalities between the poorest and least poor? Analysis of Demographic and Health Survey data
Date of publication
2005 November
Publication type
Journal Article
Publication details
British Medical Journal 331 7526 pp 1180-1182
Publication status
Published
Language
English
Keywords
health policy, health service research, millenium development goals, child mortality
Abstract
The millennium development goals (MDGs) have been widely accepted as a framework for improving health and welfare worldwide. Child mortality is one of the most crucial and avoidable global health concerns. In many low income countries, 10-20% of children die before reaching 5 years (compared with, for example, 0.7% in England and Wales). The child mortality MDG (to reduce the under 5 mortality rate by two thirds between 1990 and 2015) is formulated as a national average. The World Health Report 2003 posed an important question: how does progress towards the MDGs affect equity? The authors investigate this by examining, across a range of settings, how inequality in the under 5 mortality of the poorest and least poor changes as progress is made towards the MDG.
Country
Publisher
British Medical Journal
Theme area
Values, policies and rights, Human resources for health
Title of publication EQUINET Policy brief 28: Implementing the WHO Global code of Practice on the International Recruitment of health Personnel in Africa
Date of publication
2011 December
Publication type
Document
Publication details
EQUINET, ECSA HC Policy Brief
Publication status
Published
Language
Keywords
WHO; Health worker migration; Global code of Practice on the International Recruitment of health Personnel; east and southern Africa
Abstract
The World Health Organisation (WHO) Global Code of practice on the international recruitment of health personnel was adopted by the 63rd World Health Assembly in May 2010 in response to the intensifying movement of health workers, especially from low to high income countries.
This movement of health workers aggravates inequity, particularly with regard to the number of health workers relative to health need. The WHO Code is a voluntary ethical framework. This policy brief looks at the developments in Sub-Saharan Africa since the adoption of this code with regards to its implementation. It presents the activities required to monitor its implementation and what actions have so far been implemented.
Country
East and southern Africa region
Publisher
EQUINET, ECSA HC
URL:
Equinet Publication Type
Policy brief
Theme area
Equity in health, Values, policies and rights, Health equity in economic and trade policies, Equitable health services, Resource allocation and health financing, Monitoring equity and research to policy
Title of publication EQUITY WATCH: Assessing progress towards equity in health, Uganda, 2011
Date of publication
2011 November
Publication type
Report
Publication details
Publication status
Published
Language
Keywords
Equity Watch; equity analysis; Uganda
Abstract
The Equity Watch monitors progress in areas of equity in health, household access to the resources
for health, equitable health systems and global justice. This report provides evidence on the performance of Uganda’s public policies and systems in promoting and attaining equity in health using the Equity Watch framework. The evidence presented in this report indicates progress in some key areas, such as in closing social and geographical gaps in access to education, safe water, immunisation and other areas of primary health care. It also highlights challenges, including in coverage of maternal health services and in the distribution of health workers.
Country
Uganda
Publisher
Equinet Publication Type
Equity indicators
Theme area
Title of publication EQUINET Discussion Paper 88: Research to Support Strategic leadership in Global Health Diplomacy in east, central and southern Africa
Date of publication
2011 December
Publication type
Report
Publication details
TARSC, SEATINI (EQUINET) and ECSA HC, Discussion Paper 88. EQUINET and ECSA HC: Harare and Arusha.
Publication status
Published
Language
Keywords
global health; diplomacy; east and southern Africa, research
Abstract
This publication thus reports from stakeholders the information and knowledge gaps and research priorities on GHD in Africa to inform regional discussion on a research agenda for GHD. The findings indicate that research on GHD should identify factors that support the effectiveness of GHD in addressing selected key challenges to health strengthening systems in Eastern and Southern Africa, in a way that strengthens the capacity of key African policy actors and stakeholders within processes of health diplomacy.
. The findings indicate a preference from officials and policy makers to do this in three broad areas:
i. Firstly, to explore the implementation of existing global commitments in the region, to learn lessons from the current experience, generate evidence for input to monitoring and review of the commitments, and to inform future health negotiations.
ii. Secondly, to explore the extent to which African interests are advanced in areas under global health negotiation, to assess the implications, costs and benefits of specific issues for the diverse countries in the region, and the different negotiating positions of countries in and beyond the region.
iii. Thirdly to explore how effectively interests in the region are being represented in the current global architecture and governance, including of the global initiatives that fund health, to inform African engagement on global governance reforms.
Country
Publisher
Equinet Publication Type
Discussion paper
Theme area
Equitable health services, Equity and HIV/AIDS
Title of publication Re-thinking global health sector efforts for HIV and tuberculosis epidemic control: promoting integration of programme activities within a strengthened health system
Date of publication
2010 July
Publication type
Journal Article
Publication details
BMC Public Health 10 394
Publication status
Published
Language
English
Keywords
AIDS; tuberculosis; health system; global
Abstract
The global financial crisis threatens global health, particularly exacerbating diseases of poverty. The paper reconsiders established practices and policies for HIV and tuberculosis epidemic control. It argues that better value may be achieved by promoting greater integration of HIV and tuberculosis control programme activities within a strengthened health system. HIV and tuberculosis share many similarities in terms of their disease burden and the recommended stratagems for their control. HIV and tuberculosis programmes implement similar sorts of control activities, e.g. case finding and treatment, which depend for success on generic health system issues, including vital registration, drug procurement and supply, laboratory network, human resources, and financing. However, the current health system approach to HIV and tuberculosis control often involves separate specialised services. Despite some recent progress, collaboration between the programmes remains inadequate, progress in obtaining synergies has been slow, and results remain far below those needed to achieve universal access to key interventions. A fundamental re-think of the current strategic approach involves promoting integrated delivery of HIV and tuberculosis programme activities as part of strengthened general health services: epidemiological surveillance, programme monitoring and evaluation, community awareness of health-seeking behavior, risk behaviour modification, infection control, treatment scale-up (first-line treatment regimens), drug-resistance surveillance, containing and countering drug-resistance (second-line treatment regimens), research and development, global advocacy and global partnership. Health agencies should review policies and progress in HIV and tuberculosis epidemic control, learn mutual lessons for policy development and scaling up interventions, and identify ways of joint planning and joint funding of integrated delivery as part of strengthened health systems. As both a danger and an opportunity, the global financial crisis may entail disaster or recovery for global health sector efforts for HIV and tuberculosis epidemic control. Review of policies and progress in control paves the way for identification of synergies between the two programmes, within strengthened health services.
Country
Publisher
BMC Public Health
Theme area
Equity in health
Title of publication Countdown to 2015: will the Millennium Development Goal for child survival be met?
Date of publication
2007 October
Publication type
Journal Article
Publication details
Bulletin of the World Health Organisation 85 10 pp 745-754
Publication status
Published
Language
English
Keywords
maternal health; Millennium Development Goals; equity; developing countries; Africa
Abstract
Progress towards the Millennium Development Goals for maternal health has been slow, and accelerated progress in scaling up professional delivery care is needed. This paper describes poor–rich inequalities in the use of maternity care and seeks to understand these inequalities through comparisons with other types of health care. Demographic and Health Survey (DHS) data from 45 developing countries were used to describe poor–rich inequalities by wealth quintiles in maternity care (professional delivery care and antenatal care), full childhood immunization coverage and medical treatment for diarrhoea and acute respiratory infections (ARI). Poor–rich inequalities in maternity care in general, and professional delivery care in particular, are much greater than those in immunization coverage or treatment for childhood illnesses. Public-sector inequalities make up a major part of the poor–rich inequalities in professional delivery attendance. Even delivery care provided by nurses and midwives favours the rich in most countries. Although poor–rich inequalities within both rural and urban areas are large, most births without professional delivery care occur among the rural poor. Poor–rich inequalities in professional delivery care are much larger than those in the other forms of care. Reducing poor–rich inequalities in professional delivery care is essential to achieving the MDGs for maternal health. The greatest improvements in professional delivery care can be made by increasing coverage among the rural poor. Problems with availability, accessibility and affordability, as well as the nature of the services and demand factors, appear to contribute to the larger poor–rich inequalities in delivery care. A concerted effort of equity-oriented policy and research is needed to address the huge poor–rich inequalities in maternity care.
Country
Publisher
Bulletin of the World Health Organisation
Theme area
Equity in health
Title of publication Progress towards the child mortality millennium development goal in urban sub-Saharan Africa: the dynamics of population growth, immunization, and access to clean water
Date of publication
2007 August
Publication type
Journal Article
Publication details
BMC Public Health 7 218
Publication status
Published
Language
English
Keywords
child mortality; urban areas; immunization; safe water; Kenya; Zambia
Abstract
Improvements in child survival have been very poor in sub-Saharan Africa (SSA). Since the 1990s, declines in child mortality have reversed in many countries in the region, while in others, they have either slowed or stalled, making it improbable that the target of reducing child mortality by two thirds by 2015 will be reached. This paper highlights the implications of urban population growth and access to health and social services on progress in achieving MDG 4. Specifically, it examines trends in childhood mortality in SSA in relation to urban population growth, vaccination coverage and access to safe drinking water. Correlation methods are used to analyze national-level data from the Demographic and Health Surveys and from the United Nations. The analysis is complemented by case studies on intra-urban health differences in Kenya and Zambia. Only five of the 22 countries included in the study have recorded declines in urban child mortality that are in line with the MDG target of about 4% per year; five others have recorded an increase; and the 12 remaining countries witnessed only minimal decline. More rapid rate of urban population growth is associated with negative trend in access to safe drinking water and in vaccination coverage, and ultimately to increasing or timid declines in child mortality. There is evidence of intra-urban disparities in child health in some countries like Kenya and Zambia. Failing to appropriately target the growing sub-group of the urban poor and improve their living conditions and health status – which is an MDG target itself – may result in lack of improvement on national indicators of health. Sustained expansion of potable water supplies and vaccination coverage among the disadvantaged urban dwellers should be given priority in the efforts to achieve the child mortality MDG in SSA.
Country
Publisher
BMC Public Health
Theme area
Equitable health services
Title of publication Antiretroviral therapy in resource-poor settings: scaling up inequities?
Date of publication
2005 June
Publication type
Journal Article
Publication details
International Journal of Epidemiology 34 3 pp 509-512
Publication status
Published
Language
English
Keywords
AIDS; antiretroviral therapy; South Africa; Malawi
Abstract
This editorial from the International Journal of Epidemiology questions the effect in equity of scaling up antiretroviral therapy (ART) in resource poor settings. In Africa, Asia, and Latin America, where 90 percent of people with HIV/AIDS live, access to ART has so far been limited to a minority of patients, due to the high cost of drugs and lack of infrastructure capable of delivering ART on a large scale. However, the debate in developing countries has moved from the question of whether the introduction of ART is feasible, to questions of how effective ART and care can best be delivered. An important concern is whether it is possible to reduce AIDS deaths without reinforcing socioeconomic inequalities in health, and the differences in ART provision between genders, urban and rural populations, and between affluent and poor or marginalised populations, or geographical areas? Experiences from Brazil, South Africa, Malawi and Thailand are considered in the context of the ‘inverse equity hypothesis’, which states that health inequities get worse as new public health interventions reach those of higher socioeconomic status first and the poor later. The authors conclude that despite the lack research or of models for implementing ART programmes in resource poor settings, this should not constrain efforts to scale up ART programmes; research and evaluation efforts are urgently needed and must be synchronised so that treatment programmes can be modified and improved over time.
Country
Publisher
International Journal of Epidemiology
Theme area
Monitoring equity and research to policy
Title of publication What you count is what you target: the implications of maternal death classification for tracking progress towards reducing maternal mortality in developing countries
Date of publication
2009 July
Publication type
Report
Publication details
Bulletin of the World Health Organization 88 2 pp 147-153
Publication status
Published
Language
English
Keywords
maternal mortality; Millennium Development Goals; Ghana; Rwanda; South Africa
Abstract
The first target of the fifth United Nations Millennium Development Goal is to reduce maternal mortality by 75% between 1990 and 2015. This target is critically off track. Despite difficulties inherent in measuring maternal mortality, interventions aimed at reducing it must be monitored and evaluated to determine the most effective strategies in different contexts. In some contexts, the direct causes of maternal death, such as haemorrhage and sepsis, predominate and can be tackled effectively through providing access to skilled birth attendance and emergency obstetric care. In others, indirect causes of maternal death, such as HIV/AIDS and malaria, make a significant contribution and require alternative interventions. Methods of planning and evaluating maternal health interventions that do not differentiate between direct and indirect maternal deaths may lead to unrealistic expectations of effectiveness or mask progress in tackling specific causes. Furthermore, the need for additional or alternative interventions to tackle the causes of indirect maternal death may not be recognized if all-cause maternal death is used as the sole outcome indicator. This article illustrates the importance of differentiating between direct and indirect maternal deaths by analysing historical data from England and Wales and contemporary data from Ghana, Rwanda and South Africa. The principal aim of the paper is to highlight the need to differentiate deaths in this way when evaluating maternal mortality, particularly when judging progress towards the fifth Millennium Development Goal. It is recommended that the potential effect of maternity services failing to take indirect maternal deaths into account should be modelled.
Country
Publisher
Bulletin of the World Health Organization
Theme area
Monitoring equity and research to policy
Title of publication Tracking progress toward the Millennium Development Goals: Reaching consensus on child mortality levels and trends
Date of publication
2006 July
Publication type
Report
Publication details
Bulletin of the World Health Organization 84 3 pp 225-232
Publication status
Published
Language
English
Keywords
monitoring; Millennium development; goals; health information systems; Africa
Abstract
The increased attention to tracking progress towards the Millennium Development Goals (MDG), including Goal 4 of reducing child mortality, has drawn attention to a number of interrelated technical, operational and political challenges and to the underlying weaknesses of country health information systems upon which reliable monitoring depends. Assessments of child mortality published in 2005, for almost all low-income countries, are based on an extrapolation of the trends observed during the 1990s, rather than on the empirical data for more recent years. The validity of the extrapolation depends on the quality and quantity of the data used, and many countries lack suitable data. In the long run, it is hoped that vital registration or sample registration systems will be established to monitor vital events in a sustainable way. However, in the short run, tracking child mortality in high-mortality countries will continue to rely on household surveys and extrapolations of historical trends. This will require more collaborative efforts both to collect data through initiatives to strengthen health information systems at the country level, and to harmonize the estimation process. The latter objective requires the continued activity of a coordinating group of international agencies and academics that aims to produce transparent estimates— through the consistent application of an agreed-upon methodology— for monitoring at the international level.
Country
Publisher
Bulletin of the World Health Organization
Theme area
Equity and HIV/AIDS
Title of publication Obstacles and proposed solutions to effective antiretroviral therapy in resource-limited settings
Date of publication
2009 July
Publication type
Journal Article
Publication details
Journal of the International Association of Physicians in AIDS Care 8 4 pp 253-268
Publication status
Published
Language
English
Keywords
AIDS; antiretroviral therapy; Africa
Abstract
More than 3 million people were receiving antiretroviral therapy (ART) at the end of 2007, but this number represents only 31% of people clinically eligible for ART in resource-limited settings. The primary objective of this study is to summarize the key obstacles that impede the goal of universal access prevention, care, and treatment. We performed a systematic literature search to review studies that reported barriers to diagnosis and access to treatment of HIV/AIDS in resource-limited countries. Persons living with HIV/ AIDS commonly face economic, sociocultural, and behavioral obstacles to access treatment and care for HIV. A variety of programs to overcome these barriers have been implemented, including efforts to destigmatize HIV/AIDS, enhance treatment literacy, provide income-generation skills, decentralize HIV services, promote gender equality, and adopt a multisectoral approach to optimize limited resources. An understanding of these obstacles and suggested methods to overcome them must be addressed by global policy makers before universal ART access can be achieved.
Country
Publisher
Journal of the International Association of Physicians in AIDS Care
Theme area
Equity and HIV/AIDS
Title of publication Antiretroviral therapy in resource-limited settings 1996 to 2006: patient characteristics, treatment regimens and monitoring in sub-Saharan Africa, Asia and Latin America
Date of publication
2008 July
Publication type
Journal Article
Publication details
Tropical Medicine & International Health 13 7 pp 870-879
Publication status
Published
Language
English
Keywords
AIDS; antiretroviral therapy; barriers; Sub - Saharan Africa
Abstract
The paper describes temporal trends in baseline clinical characteristics, initial treatment regimens and monitoring of patients starting antiretroviral therapy (ART) in resource-limited settings. The authors analysed data from 17 ART programmes in 12 countries in sub-Saharan Africa, South America and Asia. Patients aged 16 years or older with documented date of start of highly active ART (HAART) were included. Data were analysed by calculating medians, interquartile ranges (IQR) and percentages by regions and time periods. Not all centres provided data for 2006 and 2005 and 2006 were therefore combined. A total of 36,715 patients who started ART 1996-2006 were included in the analysis. Patient numbers increased substantially in sub-Saharan Africa and Asia, and the number of initial regimens declined, to four and five, respectively, in 2005-2006. In South America 20 regimes were used in 2005-2006. A combination of 3TC/D4T/NVP was used for 56% of African patients and 42% of Asian patients; AZT/3TC/EFV was used in 33% of patients in South America. The median baseline CD4 count increased in recent years, to 122 cells/microl (IQR 53-194) in 2005-2006 in Africa, 134 cells/microl (IQR 72-191) in Asia, and 197 cells/microl (IQR 61-277) in South America, but 77%, 78% and 51%, respectively, started with <200 cells/microl in 2005-2006. In all regions baseline CD4 cell counts were higher in women than men: differences were 22cells/microl in Africa, 65 cells/microl in Asia and 10 cells/microl in South America. In 2005-2006 a viral load at 6 months was available in 21% of patients Africa, 8% of Asian patients and 73% of patients in South America. Corresponding figures for 6-month CD4 cell counts were 74%, 77% and 81%. The public health approach to providing ART proposed by the World Health Organization has been implemented in sub-Saharan Africa and Asia. Although CD4 cell counts at the start of ART have increased in recent years, most patients continue to start with counts well below the recommended threshold. Particular attention should be paid to more timely initiation of ART in HIV-infected men.
Country
Publisher
Tropical Medicine & International Health
Theme area
Monitoring equity and research to policy
Title of publication Achieving the Millennium Development Goals in Sub-Saharan Africa: A Macroeconomic Monitoring Framework
Date of publication
2006 November
Publication type
Journal Article
Publication details
The World Economy 29 11 pp 1519-1547
Publication status
Published
Language
English
Keywords
Millenium Development Goals; Sub-Saharan Africa; macroeconomic approach; Poverty reduction
Abstract
This paper presents a macroeconomic approach to monitoring progress toward achieving the Millennium Development Goals (MDGs) in Sub-Saharan Africa. At the heart of the framework is a macro model which captures key linkages between foreign aid, public investment (disaggregated into education, infrastructure and health), the supply side and poverty. The model is then linked through cross-country regressions to indicators of malnutrition, infant mortality, life expectancy and access to safe water. A composite MDG Indicator is also calculated. The functioning of our framework is illustrated by simulating the impact of an increase in foreign aid to Niger at the MDG horizon of 2015, under alternative assumptions about the degree of efficiency of public investment. The approach can serve as the building block for Strategy Papers for Human Development (SPAHD), a more encompassing concept than the current ‘Poverty Reduction’ Strategy Papers.
Country
Publisher
The World Economy
Theme area
Equity in health, Values, policies and rights, Equitable health services, Resource allocation and health financing, Monitoring equity and research to policy
Title of publication Equity Watch: assessing progress towards equity in health in Zimbabwe
Date of publication
2011 October
Publication type
Report
Publication details
TARSC, MoHCW (2011) Equity Watch: EQUINET Harare
Publication status
Published
Language
English
Keywords
equity analysis; equity watch; health equity; Zimbabwe
Abstract
This report updates the 2008 Zimbabwe Equity Watch report using a framework developed by EQUINET in cooperation with the eastern, central and southern African health community and in consultation with WHO and UNICEF. The report introduces the context and the evidence within four major areas: equity in health, household access to the resources for health, equitable health systems and global justice. It shows past levels (1980–2005), current levels (most current data publicly available) and comments on the level of progress towards health equity.
Country
Zimbabwe
Publisher
EQUINET
Equinet Publication Type
Reports, Equity indicators
Theme area
Health equity in economic and trade policies, Public-private mix, Resource allocation and health financing
Title of publication Policy Brief 26: Expansion of the private for-profit health sector in East and Southern Africa
Date of publication
2011 November
Publication type
Document
Publication details
EQUINET, with UCT HEU and TARSC Policy brief 26, EQUINET, Harare
Publication status
Published
Language
English
Keywords
private for profit health sector; health financing; east and souuthern Africa
Abstract
In recent years there has been increased private for-profit health sector activity in certain countries in East and Southern Africa. External funders and governments have subsidised some of these activities. Private ‘high-end’ hospitals have begun to service wealthy groups, even in very low income countries. A report published in 2007 by the World Bank’s International Finance Corporation (IFC) encouraged governments to facilitate further private sector growth. This policy brief explores these developments in East and Southern Africa. In contrast to the IFC report, it raises concerns about the adverse consequences of growth in the private for-profit sector, and proposes steps that Ministries of Health should take to protect the integrity and equity of their health systems.
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Policy brief
Theme area
Equity in health, Values, policies and rights, Governance and participation in health
Title of publication Policy Brief 27: Constitutional provisions for the right to health in east and southern Africa
Date of publication
2011 November
Publication type
Document
Publication details
EQUINET Policy Brief 27, CEHURD, TARSC, EQUINET
Publication status
Published
Language
English
Keywords
right to health; constitution; east and southern Africa
Abstract
The extent to which health rights are neglected or promoted is a major factor in the promotion of health equity in Africa. Central to this is the incorporation of the right to health in the national Constitution, as the supreme law of the country. Including the right to health as a constitutional right provides a bench mark for government, private sector and society to respect, protect, fulfil and promote it. In many countries in east and southern Africa (ESA) there is advocacy and debate on inclusion in the constitution of the right to health. This brief presents a review of how the constitutions of 14 countries covered by EQUINET include the right to health. It uses as a framework the six core obligations spelt out in General Comment 14 of the International Covenant on Economic and Social Rights (ICESR).
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Policy brief
Theme area
Equitable health services
Title of publication Linkage to HIV Care and Antiretroviral Therapy in Cape Town, South Africa
Date of publication
2010 November
Publication type
Journal Article
Publication details
PLoS One 5 11
Publication status
Published
Language
English
Keywords
HIV and AIDS; health systems; integration of care; VCT, South Africa
Abstract
Antiretroviral therapy (ART) has been scaled-up rapidly in Africa. Programme reports typically focus on loss to follow-up and mortality among patients receiving ART. However, little is known about linkage and retention in care of individuals prior to starting ART. Data on adult residents from a periurban community in Cape Town were collected at a primary care clinic and hospital. HIV testing registers, CD4 count results provided by the National Health Laboratory System and ART registers were linked. A random sample (n = 885) was drawn from adults testing HIV positive through antenatal care, sexual transmitted disease and voluntary testing and counseling services between January 2004 and March 2009. All adults (n = 103) testing HIV positive through TB services during the same time period were also included in the study. Linkage to HIV care was defined as attending for a CD4 count measurement within 6 months of HIV diagnosis. Linkage to ART care was defined as initiating ART within 6 months of HIV diagnosis in individuals with a CD4 count ≤200 cells/µl taken within 6 months of HIV diagnosis. Linkage to ART care was highest among antenatal care clients. It improved in patients tested in more recent calendar period. Linkage to HIV and ART care was low in this poor peri-urban community despite free services available within close proximity. More efforts are needed to link VCT scale-up to subsequent care.
Country
South Africa
Publisher
PLoS One
Theme area
Public-private mix
Title of publication Private Sector Participation and Health System Performance in Sub-Saharan Africa
Date of publication
2010 October
Publication type
Journal Article
Publication details
PLoS One 5 10
Publication status
Published
Language
English
Keywords
private sector; health system performance; Africa
Abstract
The authors examine the association between private sector for profit and not for profit participation and self-reported measures of utilization and equity in deliveries and treatment of childhood respiratory disease using regression analysis, across a sample of nationally-representative Demographic and Health Surveys from 34 SSA economies. They also examine the correlation between private sector participation and key background factors (socioeconomic development, business environment and governance) and use multivariate regression to control for potential confounders. Private sector participation is positively associated with greater overall access and reduced disparities between rich and poor as well as urban and rural populations. The positive association between private sector participation and improved health system performance is robust to controlling for confounders including per capita income and maternal education. Private sector participation is positively correlated with measures of socio-economic development and favorable business environment.While these results do not establish a positive causal link between private sector participation and health system performance, they also suggest no negative link.
Country
Publisher
PLoS One
Theme area
Equity and HIV/AIDS
Title of publication Gender, Migration and HIV in Rural KwaZulu-Natal, South Africa
Date of publication
2010 July
Publication type
Journal Article
Publication details
PLoS One 5 7
Publication status
Published
Language
English
Keywords
migration, gender, HIV, Africa
Abstract
Research on migration and HIV has largely focused on male migration, often failing to measure HIV risks associated with migration for women. The study aimed to establish whether associations between migration and HIV infection differ for women and men, and identify possible mechanisms by which women's migration contributes to their high infection risk. Data on socio-demographic characteristics, patterns of migration, sexual behavior and HIV infection status were obtained for a population of 11,677 women aged 15–49 and men aged 15–54, resident members of households within a demographic surveillance area participating in HIV surveillance in 2003–04.Logistic regression was conducted to examine whether sex and migration were independently associated with HIV infection in three additive effects models, using measures of recent migration, household presence and migration frequency. Multiplicative effects models were fitted to explore whether the risk of HIV associated with migration differed for males and females. Further modeling and simulations explored whether composition or behavioral differences accounted for observed associations. Relative to non-migrant males, non-migrant females had higher odds of being HIV-positive (adjusted odds ratio [aOR] = 1.72; 95% confidence interval [1.49–1.99]), but odds were higher for female migrants (aOR = 2.55 [2.07–3.13]). Female migrants also had higher odds of infection relative to female non-migrants (aOR = 1.48 [1.23–1.77]). The association between number of sexual partners over the lifetime and HIV infection was modified by both sex and migrant status: For male non-migrants, each additional partner was associated with 3% higher odds of HIV infection (aOR = 1.03 [1.02–1.05]); for male migrants the association between number of partners and HIV infection was non-significant. Each additional partner increased odds of HIV infection by 22% for female non-migrants (aOR = 1.22 [1.12–1.32]) and 46% for female migrants (aOR = 1.46 [1.25–1.69]). Higher risk sexual behavior in the context of migration increased women's likelihood of HIV infection.
Country
Publisher
PLoS One
Theme area
Monitoring equity and research to policy
Title of publication Prospects for Malaria Eradication in Sub-Saharan Africa
Date of publication
2008 March
Publication type
Journal Article
Publication details
PLoS One 3 3
Publication status
Published
Language
English
Keywords
malaria, epidemiology, Africa
Abstract
Accumulating epidemiological data constitute a valuable resource that must be intensively explored and interpreted as to effectively inform control planning for malaria. Here the authors apply a mathematical model to clinical data from eight endemic regions in sub-Saharan Africa. The model provides a quantitative framework within which differences in age distribution of clinical disease are assessed in terms of the parameters underlying transmission. The shorter infectious periods estimated for clinical infections induce a regime of bistability of endemic and malaria-free states in regions of mesoendemic transmission. The two epidemiological states are separated by a threshold that provides a convenient measure for intervention design. Scenarios of eradication and resurgence are simulated. In regions that support mesoendemic transmission, intervention success depends critically on reducing prevalence below a threshold which separates endemic and malaria-free regimes.
Country
Publisher
PLoS One
Theme area
Equity and HIV/AIDS
Title of publication The Challenge of AIDS-Related Malignancies in Sub-Saharan Africa
Date of publication
2010 January
Publication type
Journal Article
Publication details
PLoS One 5 1
Publication status
Published
Language
English
Keywords
AIDS, cancer, sub - Saharan Africa
Abstract
With the lengthening of life expectancy among HIV-positive subjects related to the use of highly active antiretroviral treatments, an increased risk of cancer has been described in industrialized countries. The question is to determine what occurs now and will happen in the future in the low income countries and particularly in sub-Saharan Africa where more than two-thirds of all HIV-positive people live in the world. The objective of the paper is to review the link between HIV and cancer in sub-Saharan Africa, putting it in perspective with what is already known in Western countries. Studies conducted in sub-Saharan Africa show that HIV infection is not only strongly associated with AIDS-classifying cancers but also provided some evidence of association for other neoplasia. African countries need now to implement well designed population-based studies in order to better describe the spectrum of AIDS-associated malignancies and the most effective strategies for their prevention, screening and treatment.
Country
Publisher
PLoS One
Theme area
Equitable health services
Title of publication Barriers to Initiation of Antiretrovirals during Antituberculosis Therapy in Africa
Date of publication
2011 May
Publication type
Journal Article
Publication details
PLoS One 6 5
Publication status
Published
Language
English
Keywords
antiretrovirals, tuberculosis, South Africa
Abstract
In the developing world, the principal cause of death among HIV-infected patients is tuberculosis (TB). The initiation of antiretroviral therapy (ART) during TB therapy significantly improves survival, however it is not known which barriers prevent eligible TB patients from initiating life-saving ART. A South African township clinic with integrated tuberculosis and HIV services is the setting for the research. Logistic regression analyses of a prospective cohort of HIV-1 infected adults (≥18 years) who commenced TB therapy, were eligible for ART, and were followed for 6 months. Of 100 HIV-1 infected adults eligible for ART during TB therapy, 90 TB patients presented to an ART clinic for assessment, 66 TB patients initiated ART, and 15 TB patients died. 34% of eligible TB patients (95%CI: 25–43%) did not initiate ART. Male gender and younger age (<36 years) were associated with failure to initiate ART (adjusted odds ratios of 3.7 [95%CI: 1.25–10.95] and 3.3 [95%CI: 1.12–9.69], respectively). Death during TB therapy was associated with a CD4+ count <100 cells/µL. In a clinic with integrated services for tuberculosis and HIV, one-third of eligible TB patients – particularly young men – did not initiate ART. Strategies are needed to promote ART initiation during TB therapy, especially among young men.
Country
Publisher
PLoS One
Theme area
Equitable health services
Title of publication Pregnancy and Virologic Response to Antiretroviral Therapy in South Africa
Date of publication
2011 August
Publication type
Journal Article
Publication details
PLoS One 6 8
Publication status
Published
Language
English
Keywords
pregnancy, antiretroviral therapy, South Africa
Abstract
Although women of reproductive age are the largest group of HIV-infected individuals in sub-Saharan Africa, little is known about the impact of pregnancy on response to highly active antiretroviral therapy (HAART) in that setting. The authors examined the effect of incident pregnancy after HAART initiation on virologic response to HAART. They evaluated a prospective clinical cohort of adult women who initiated HAART in Johannesburg, South Africa between 1 April 2004 and 30 September 2009, and followed up until an event, death, transfer, drop-out, or administrative end of follow-up on 31 March 2010. Women over age 45 and women who were pregnant at HAART initiation were excluded from the study; final sample size for analysis was 5,494 women. Main exposure was incident pregnancy, experienced by 541 women; main outcome was virologic failure, defined as a failure to suppress virus to ≤400 copies/ml by six months or virologic rebound >400 copies/ml thereafter. Incident pregnancy after HAART initiation was associated with modest increases in both relative and absolute risks of virologic failure, although uncontrolled confounding cannot be ruled out. Nonetheless, these results reinforce that family planning is an essential part of care for HIV-positive women in sub-Saharan Africa.
Country
South Africa
Publisher
PLoS One
Theme area
Governance and participation in health
Title of publication Alames, Cebes, Cut et al: October 2011
Date of publication
2011 October
Publication type
Publication details
Publication status
Language
Keywords
Abstract
According to this statement by a number of civil society organisations from Brazil, the fundamental cause of the inequalities within and between nations is the capitalist economy in its neoliberal form, infused with an exclusively speculative desire for unlimited profit. Capitalism grabs profits and socialises losses, they argue, resorting to new and more cruel neoliberal measures that further reduce the fundamental social rights of people. There are abundant resources for all of us on the earth, but the ‘logic’ of the market prevents people from obtaining what they need. In the area of public health, neoliberalism translates into the commercialisation of life, legal protections for intellectual property for the benefit of the medical industrial complex, control of the media in order to create ‘need’ through shock, damage to public health systems, manipulation of civil society, multiple forms of violence and other strategies to colonise the ‘collective thought’. The current dominant societal model, using the lifestyle of affluent Americans as a basis, is not unique or definitive, and it is not sustainable. The statement concludes with a call for the establishment of global alliances between progressive governments and social movements, and proper social participation, as well as support for the creation and consolidation of health systems and social security systems that are universal, free, integral, and public; with coverage for all people for all services.
Country
Publisher
URL:
Theme area
Human resources for health
Title of publication Global discourses and experiential speculation: secondary and tertiary graduate Malawians dissect the HIV/AIDS epidemic.
Date of publication
2011 October
Publication type
Journal Article
Publication details
Journal of the International AIDS Society 14 47
Publication status
Published
Language
English
Keywords
education graduates, Malawi, AIDS
Abstract
Qualitative data was collected in this study to discover the perspectives of secondary and tertiary school graduates on the HIV/AIDS epidemic. Thirty-eight secondary and tertiary graduate Malawians took part in semi-structured interviews. Data was analysed using an early grounded theory approach and subsequent themes of "global discourses" and "experiential knowledge of HIV/AIDS" emerged. This group of Malawians frequently responded to questions regarding healthcare and access to medicine, sexual behaviours and methods of reducing the spread of HIV/AIDS by citing widespread, international and "proper" responses. The secondary and tertiary graduate Malawians also gave experiential responses, citing views against circumcision and use of condoms, overestimating HIV prevalence, and calling for more authoritarian policing of commercial sex work, views that were divergent from international discourse. The opinions of this group of secondary and tertiary graduate Malawians do not always coincide with current literature and policies.
Country
Publisher
Journal of the International AIDS Society
Theme area
Equity in health
Title of publication Progress towards Millennium Development Goals 4 and 5 on maternal and child mortality: an updated systematic analysis
Date of publication
2011 September
Publication type
Journal Article
Publication details
The Lancet 378 9797 pp 1139-1165
Publication status
Published
Language
English
Keywords
Millennium Development Goals, sub Saharan Africa, maternal mortality, child mortality
Abstract
With 4 years until 2015, it is essential to monitor progress towards Millennium Development Goals (MDGs) 4 and 5. Although estimates of maternal and child mortality were published in 2010, an update of estimates is timely in view of additional data sources that have become available and new methods developed. The aim of the study was to update previous estimates of maternal and child mortality using better data and more robust methods to provide the best available evidence for tracking progress on MDGs 4 and 5. The authors update the analyses of the progress towards MDGs 4 and 5 from 2010 with additional surveys, censuses, vital registration, and verbal autopsy data. For children, they estimate early neonatal (0—6 days), late neonatal (7—28 days), postneonatal (29—364 days), childhood (ages 1—4 years), and under-5 mortality. The authors use an improved model for estimating mortality by age under 5 years. For maternal mortality, our updated analysis includes greater than 1000 additional site-years of data. They tested a large set of alternative models for maternal mortality; used an ensemble model based on the models with the best out-of-sample predictive validity to generate new estimates from 1990 to 2011. Under-5 deaths have continued to decline, reaching 7·2 million in 2011 of which 2·2 million were early neonatal, 0·7 million late neonatal, 2·1 million postneonatal, and 2·2 million during childhood (ages 1—4 years). Comparing rates of decline from 1990 to 2000 with 2000 to 2011 shows that 106 countries have accelerated declines in the child mortality rate in the past decade. Maternal mortality has also continued to decline from 409 100 (uncertainty interval 382 900—437 900) in 1990 to 273 500 (256 300—291 700) deaths in 2011. The authors estimate that 56 100 maternal deaths in 2011 were HIV-related deaths during pregnancy. Based on recent trends in developing countries, 31 countries will achieve MDG 4, 13 countries MDG 5, and nine countries will achieve both.Even though progress on reducing maternal and child mortality in most countries is accelerating, most developing countries will take many years past 2015 to achieve the targets of the MDGs 4 and 5. Similarly, although there continues to be progress on maternal mortality the pace is slow, without any overall evidence of acceleration. Immediate concerted action is needed for a large number of countries to achieve MDG 4 and MDG 5.
Country
Publisher
The Lancet
Theme area
Resource allocation and health financing
Title of publication Taxation and Development in Ghana, Finance, Equity and Accountability
Date of publication
2009 April
Publication type
Academic paper
Publication details
Publication status
Published
Language
English
Keywords
tax, health financing, tax justice, accountability
Abstract
This report is the first report in an initiative to create a comprehensive, and globally representative series of country reports that touch on diverse tax justice issues. The intent is to analyse the national tax systems, the distribution of the tax burden, the incentive structure and explore emerging national or regional themes including existing and proposed tax related advocacy issues among stakeholders. The production of this report is the collective effort of both of the organisations involved. This report is intended to be a starting point for developing local advocacy campaigns around issues of taxation, equity and public accountability. The report itself draws on a month of research conducted in February-March 2009 by Wilson Prichard and Isaac Bentum.
Country
Publisher
Institute of Development Studies
Theme area
Human resources for health
Title of publication A grander challenge: the case of how Makerere University College of Health Sciences (MakCHS) contributes to health outcomes in Africa
Date of publication
2011 March
Publication type
Journal Article
Publication details
BMC International Health and Human Rights 11 Suppl 1
Publication status
Published
Language
English
Keywords
University, institutional change, health outcomes, Uganda
Abstract
“Grand challenges” in global health have focused on discovery and development of technologies to save lives. The “grander challenge” involves building institutions, systems, capacity and demand to effectively deliver strategies to improve health. In 2008, Makerere University began a radical institutional change to bring together four schools under one College of Health Sciences. This paper’s objective is to demonstrate how its leadership in training, research, and services can improve health in Uganda and internationally, which lies at the core of the College’s vision. A comprehensive needs assessment involved five task forces that identified MakCHS’s contribution to the Ugandan government health priorities. Data were collected through analysis of key documents; systematic review of MakCHS publications and grants; surveys of patients, students and faculty; and key informant interviews of the College’s major stakeholders. Four pilot projects were conducted to demonstrate how the College can translate research into policy and practice, extend integrated outreach community-based education and service, and work with communities and key stakeholders to address their priority health problems.MakCHS inputs to the health sector include more than 600 health professionals graduating per year through 23 degree programs, many of whom assume leadership positions. MakCHS contributions to processes include strengthened approaches to engaging communities, standardized clinical care procedures, and evidence-informed policy development. Outputs include the largest number of outpatients and inpatient admissions in Uganda. From 2005-2009, MakCHS also produced 837 peer-reviewed research publications (67% in priority areas). Outcomes include an expanded knowledge pool, and contributions to coverage of health services and healthy behaviors. Impacts include discovery and applications of global significance, such as the use of nevirapine to prevent HIV transmission in childbirth and male circumcision for HIV prevention. Pilot projects have applied innovative demand and supply incentives to create a rapid increase in safe deliveries (3-fold increase after 3 months), and increased quality and use of HIV services with positive collateral improvements on non-HIV health services at community clinics. The paper concludes that MakCHS has made substantial contributions to improving health in Uganda, and shows great potential to enhance this in its new transformational role – a model for other Universities.
Country
Publisher
BMC International Health and Human Rights
Theme area
Monitoring equity and research to policy
Title of publication Research Translation To Inform National Health Policies: Learning From Multiple Perspectives In Uganda
Date of publication
2011 March
Publication type
Journal Article
Publication details
MC International Health and Human Rights 11 Suppl 1
Publication status
Published
Language
English
Keywords
research translation, national health policy, Uganda
Abstract
Research and evidence can have an impact on policy and practice, resulting in positive outcomes. However, research translation is a complex, dynamic and non-linear process. Although universities in Africa play a major role in generating research evidence, their strategic approaches to influence health policies and decision making are weak. This study was conducted with the aim of understanding the process of translating research into policy in order to guide the strategic direction of Makerere University College of Health Sciences (MakCHS) and similar institutions in their quest to influence health outcomes nationally and globally. A case study approach using 30 in-depth interviews with stakeholders involved in two HIV prevention research project was purposively selected. The study sought to analyze the research-to-policy discourses for the prevention of mother-to-child transmission (PMTCT) and safe male circumcision (SMC). The analysis sought to identify entry points, strengths and challenges for research-to-policy processes by interviewing three major groups of stakeholders in Uganda – researchers (8), policy makers (12) and media practitioners (12). Among the factors that facilitated PMTCT policy uptake and continued implementation were: shared platforms for learning and decision making among stakeholders, implementation pilots to assess feasibility of intervention, the emerging of agencies to undertake operations research and the high visibility of policy benefits to child survival. In contrast, SMC policy processes were stalled for over two years after the findings of the Uganda study was made public. Among other factors, policy makers demanded additional research to assess implementation feasibility of SMC within ordinary health system context. High level leaders also publicly contested the SMC evidence and the underlying values and messages – a situation that reduced the coalition of policy champions. This study shows that effective translation of PMTCT and SMC research results demanded a “360 degree” approach to assembling additional evidence to inform the implementation feasibility for these two HIV prevention interventions. MakCHS and similar institutions should prioritize implementation research to guide the policy processes about the feasibility of implementing new and effective innovations (e.g. PMTCT or SMC) at a large scale in contexts that may be different from the research environments.
Country
Publisher
MC International Health and Human Rights
Theme area
Resource allocation and health financing
Title of publication Global health funding: how much, where it comes from and where it goes
Date of publication
2009 April
Publication type
Journal Article
Publication details
Health Policy and Planning 24 6
Publication status
Published
Language
English
Keywords
health financing, global health funding
Abstract
Global health funding has increased in recent years. This has been accompanied by a proliferation in the number of global health actors and initiatives. This paper describes the state of global heath finance, taking into account government and private sources of finance, and raises and discusses a number of policy issues related to global health governance. A schematic describing the different actors and three global health finance functions is used to organize the data presented, most of which are secondary data from the published literature and annual reports of relevant actors. In two cases, we also refer to currently unpublished primary data that have been collected by authors of this paper. Among the findings are that the volume of official development assistance for health is frequently inflated; and that data on private sources of global health finance are inadequate but indicate a large and important role of private actors. The fragmented, complicated, messy and inadequately tracked state of global health finance requires immediate attention. In particular it is necessary to track and monitor global health finance that is channelled by and through private sources, and to critically examine who benefits from the rise in global health spending.
Country
Publisher
Health Policy and Planning
Theme area
Health equity in economic and trade policies
Title of publication Unmasking the New Green Revolution in Africa: Motives, Players and Dynamics
Date of publication
2007
Publication type
Academic paper
Publication details
Publication status
Language
English
Keywords
New Green Revolution, agriculture, biosafety
Abstract
The author argues that since the late 1990s, the development discourse in Africa has been dominated by the mantra on the “New Green Revolution in Africa”. The call has been trumpeted by no less than the United Nations, hailed by governments in Africa and beyond, funded by moneyed private philanthropic foundations, and supported by agricultural transnational corporations. Like its predecessor in Asia half a century ago, the New Green Revolution in Africa is collectively being pushed by a myriad of players all claiming to be committed to Africa’s development. This report provides an analysis of the key players promoting the New Green Revolution in Africa and the dynamics among them. It is hoped that by understanding the forces behind the push for this externally led development paradigm, African civil society would have a better handle on tackling the challenges ahead and on providing locally available, environmentally sustainable, socially acceptable and culturally sensitive alternatives based on equity and justice.
Country
Publisher
Third World Network; Church Development Service; African Centre for Biosafety
Theme area
Health equity in economic and trade policies
Title of publication Unmasking the New Green Revolution in Africa: Motives, Players and Dynamics
Date of publication
2007
Publication type
Academic paper
Publication details
Publication status
Language
English
Keywords
New Green Revolution, agriculture, biosafety
Abstract
The author argues that since the late 1990s, the development discourse in Africa has been dominated by the mantra on the “New Green Revolution in Africa”. The call has been trumpeted by no less than the United Nations, hailed by governments in Africa and beyond, funded by moneyed private philanthropic foundations, and supported by agricultural transnational corporations. Like its predecessor in Asia half a century ago, the New Green Revolution in Africa is collectively being pushed by a myriad of players all claiming to be committed to Africa’s development. This report provides an analysis of the key players promoting the New Green Revolution in Africa and the dynamics among them. It is hoped that by understanding the forces behind the push for this externally led development paradigm, African civil society would have a better handle on tackling the challenges ahead and on providing locally available, environmentally sustainable, socially acceptable and culturally sensitive alternatives based on equity and justice.
Country
Publisher
Third World Network; Church Development Service; African Centre for Biosafety
Theme area
Values, policies and rights
Title of publication Community views on public health law and practice in Zimbabwe TARSC Harare
Date of publication
2011 August
Publication type
Document
Publication details
TARSC, CWGH, CFH, ZCTU (2011) Community views on public health law and practice in Zimbabwe TARSC Harare
Publication status
Published
Language
English
Keywords
public health; law; community views, Zimbabwe
Abstract
This assessment sought to determine views of communities, local leaders and public sector and non government organization workers at community level on discussion questions raised in the White Paper on the Review of the Public Health Act. A cross sectional survey design was implemented in May 2011 covering 33 focus group discussions and 991 likert scale questionnaires in eleven rural and urban districts of Zimbabwe. There was strong support for public health, for a strong legal framework to protect public health and for communities and frontline workers across all sectors to play an active role in promoting public health. There was support for public health to be given higher priority in relation to other socio-economic goals than at present. The key recommendation emerging from the assessment is that government as a whole should be giving higher priority to public health, to make known and implement current law, even while it undertakes the review to update it.
Country
Zimbabwe
Publisher
Theme area
Monitoring equity and research to policy
Title of publication What Shapes Research Impact on Policy? Understanding Research Uptake in Sexual and Reproductive Health Policy Process in Resource-Poor Contexts
Date of publication
2011 June
Publication type
Journal Article
Publication details
Health Research Policy And Systems 9 Suppl 1
Publication status
Published
Language
English
Keywords
research impact, policy, sexual and reproductive health, resource poor contexts
Abstract
Assessing the impact that research evidence has on policy is complex, the authors of this paper argue, and they review some of the main conceptualisations of research impact on policy, including generic determinants of research impact identified across a range of settings, as well as the specificities of sexual and reproductive health (SRH) in particular. They identify aspects of the policy landscape and drivers of policy change commonly occurring across multiple sectors and studies to create a framework that researchers can use to examine the influences on research uptake in specific settings, to guide attempts to ensure uptake of their findings. The framework distinguishes between pre-existing factors influencing uptake and the ways in which researchers can actively influence the policy landscape and promote research uptake through their policy engagement actions and strategies. The authors conclude by highlighting the need for continued multi-sectoral work on understanding and measuring research uptake and for prospective approaches to receive greater attention from policy analysts.
Country
Publisher
Health Research Policy And Systems
Theme area
Monitoring equity and research to policy
Title of publication The Impact of HIV and AIDS Research: A Case Study from Swaziland
Date of publication
2011 June
Publication type
Journal Article
Publication details
Health Research Policy And Systems 9 Suppl 1
Publication status
Published
Language
English
Keywords
HIV and AIDS, research impact, Swaziland
Abstract
In this study, researchers analysed the impact of the report ‘Reviewing ‘Emergencies’ for Swaziland: Shifting the Paradigm in a New Era’, which was published in 2007 and built a picture of the HIV and AIDS epidemic as a humanitarian emergency, requiring urgent action from international organisations, external funders and governments. Following a targeted communications effort, the report was believed to have raised the profile of the issue and Swaziland - a success story for HIV and AIDS research. The authors conducted a literature search on the significance of understanding the research-to-policy interface, using the report as a case study. They explored key findings from the assessment, suggesting lessons for future research projects. They demonstrate that, although complex, and not without methodological issues, impact assessment of research can be of real value to researchers in understanding the research-to-policy interface. Only by gaining insight into this process can researchers move forward in delivering effective research, they argue.
Country
Swaziland
Publisher
Health Research Policy And Systems
Theme area
Monitoring equity and research to policy
Title of publication Strategies and Tensions in Communicating Research on Sexual and Reproductive Health, HIV and AIDS: A Qualitative Study of the Experiences of Researchers and Communications Staff
Date of publication
2011 June
Publication type
Journal Article
Publication details
Health Research Policy And Systems 9 Suppl 1
Publication status
Published
Language
English
Keywords
communicating research, sexual and reproductive health, HIV and AIDS
Abstract
This qualitative study focuses on the research communication and policy-influencing objectives, strategies and experiences of four research consortia working in sexual and reproductive health, HIV and AIDS in nine countries in sub-Saharan Africa and Asia. The authors carried out 22 in-depth interviews with researchers and communications specialists to identify factors that affect the interaction of research evidence with policy and practice, using an adapted version of the Overseas Development Institute’s RAPID analytical framework. Results indicated that the characteristics of researchers and their institutions, policy context, the multiplicity of actors, and the nature of the research evidence all play a role in policy influencing processes. Research actors perceived a trend towards increasingly intensive and varied communication approaches. Effective influencing strategies include making strategic alliances and coalitions and framing research evidence in ways that are most attractive to particular policy audiences. Tensions include the need to identify and avoid unnecessary communication or unintended impacts, challenges in assessing and attributing impact and the need for adequate resources and skills for communications work. The authors conclude that the adapted RAPID framework can serve as a useful tool for research actors to use in resolving tensions.
Country
Publisher
Health Research Policy And Systems
Theme area
Governance and participation in health
Title of publication The Architecture and Effect of Participation: A Systematic Review of Community Participation for Communicable Disease Control and Elimination. Implications for Malaria Elimination
Date of publication
2011 August
Publication type
Journal Article
Publication details
Malaria Journal 10 225
Publication status
Published
Language
English
Keywords
community participation, communicable disease, malaria
Abstract
This paper reports the findings of an atypical systematic review of 60 years of literature in order to arrive at a more comprehensive awareness of the constructs of participation for communicable disease control and elimination and provide guidance for the current malaria elimination campaign. Of the 60 papers meeting the selection criteria, only four studies attempted to determine the effect of community participation on disease transmission. The studies showed statistically significant reductions in disease incidence or prevalence using various forms of community participation. The use of locally selected volunteers provided with adequate training, supervision and resources is crucial to the success of the interventions in these studies, the authors argue. After a qualitative synthesis of all 60 papers, they elucidate the complex architecture of community participation for communicable disease control and elimination. The authors stress the importance of ensuring that current global malaria elimination efforts do not derail renewed momentum towards the comprehensive primary health care approach. They recommend that the application of the results of this systematic review be considered for other diseases of poverty in order to harmonise efforts at building 'competent communities' for communicable disease control and optimising health system effectiveness.
Country
Publisher
Malaria Journal
Theme area
Governance and participation in health
Title of publication Engaging Media in Communicating Research on Sexual and Reproductive Health and Rights in Sub-Saharan Africa: Experiences and Lessons Learned
Date of publication
2011 June
Publication type
Journal Article
Publication details
Health Research Policy And Systems 9 Suppl 1
Publication status
Published
Language
English
Keywords
media, sexual and reproductive health and rights, sub-Saharan Africa
Abstract
In sub-Saharan Africa media coverage of reproductive health issues is poor due to the weak capacity and motivation for reporting these issues by media practitioners, the authors of this paper argue. They describe the experiences of the African Population and Health Research Centre and its partners in cultivating the interest and building the capacity of the media in evidence-based reporting of reproductive health issues in sub-Saharan Africa. The authors note that the Research Centre’s media strategy evolved over the years, including: enhancing journalists’ interest in and motivation for reporting on reproductive health issues through training and competitive grants for outstanding reporting; building the capacity of journalists to report reproductive health research and the capacity of reproductive health researchers to communicate their research to media through training for both parties and providing technical assistance to journalists in obtaining and interpreting evidence; and establishing and maintaining trust and mutual relationships between journalists and researchers through regular informal meetings between journalists and researchers, organising field visits for journalists, and building formal partnerships with professional media associations and individual journalists. The authors conclude that a sustained mix of strategies that motivate, strengthen capacity of, and build relationships between journalists and researchers can be effective in enhancing quality and quantity of media coverage of research.
Country
Publisher
Health Research Policy And Systems
Theme area
Governance and participation in health
Title of publication Civil Society, Public Action and Accountability in Africa
Date of publication
2011 July
Publication type
Document
Publication details
World Bank, Development Research Group Policy Research Working Paper Working Paper 5733
Publication status
Published
Language
English
Keywords
civil society, public action, accountability
Abstract
In this paper, the authors examine the potential role of civil society action in increasing state accountability for development in Sub-Saharan Africa. They build on the analytical framework of the World Development Report 2004 on accountability relationships, to emphasise the underlying political economy drivers of accountability and implications for how civil society is constituted and functions. The main argument is that the most important domain for improving accountability is through the political relations between citizens, civil society and state leadership. The evidence broadly suggests that when higher-level political leadership provides sufficient or appropriate powers for citizen participation in holding within-state agencies or frontline providers accountable, there is frequently positive impact on outcomes. However, the big question remaining for such types of interventions is how to improve the incentives of higher-level leadership to pursue appropriate policy design and implementation. The paper concludes that there is substantial scope for greater efforts in this domain, including through the support of external aid agencies. Such efforts and support should, however, build on existing political and civil society structures (rather than transplanting ‘best practice’ initiatives from elsewhere), and be structured for careful monitoring and assessment of impact.
Country
Publisher
World Bank Development Research Group
Theme area
Resource allocation and health financing
Title of publication A Financial Transaction Tax for Global Health
Date of publication
2011 August
Publication type
Document
Publication details
Harm Reduction International
Publication status
Published
Language
English
Keywords
financial transaction tax, global health, Millennium Development Goals, Harm Reduction International
Abstract
The financial sector is traditionally under-taxed relative to the rest of the economy, so it is ideally suited as a source of taxes that can be used for global health, according to this brief. Taxes on the sector are also predominantly progressive, falling on the richest institutions and individuals. Harm Reduction International (HRI) proposes a financial transaction tax (FTT) that collects a tiny percentage (between 0.5% and 0.005%) of the value of each financial product that is traded. An average tax of just 0.05% on transactions (such as bond and share sales) could raise as much as US$409 billion a year, HRI notes, significant funding for disease responses and health system strengthening in poorer countries. HRI cautions that the FTT would be in addition to - not instead of - government commitments to overseas development assistance, so it could help bridge the resource gap that currently exists to achieve the Millennium Development Goals.
Country
Publisher
Harm Reduction International
Theme area
Public-private mix
Title of publication Exploring New Health Markets: Experiences From Informal Providers of Transport for Maternal Health Services in Eastern Uganda
Date of publication
2011 August
Publication type
Journal Article
Publication details
BMC International Health And Human Rights 11 Suppl 1
Publication status
Published
Language
English
Keywords
maternal health, Uganda
Abstract
The author of this paper examined the functioning of the informal transport markets in facilitating access to maternal health care in Eastern Uganda, to demonstrate the role that higher institutions of learning can play in designing projects that can increase the utilisation of maternal health services. Data were collected through qualitative and quantitative methods that included focus group interviews and a review of project documents and facility-level data. There was a marked increase in attendance of antenatal, and delivery care services, with the contracted transporters playing a leading role in mobilising mothers to attend services, the authors found. The project also had economic spill-over effects to the transport providers, their families and community generally. However, some challenges were faced including difficulty in setting prices for paying transporters, and poor enforcement of existing traffic regulations. The findings indicate that locally existing resources such as motorcycle riders can be used innovatively to reduce challenges caused by geographical inaccessibility and a poor transport network with resultant increases in the utilisation of maternal health services. However, care must be taken to mobilise the resources needed and to ensure that there is enforcement of laws that will ensure the safety of clients and the transport providers themselves.
Country
Uganda
Publisher
BMC International Health And Human Rights
Theme area
Human resources for health
Title of publication The Organisation and Implementation of Community-Based Education Programmes for Health Worker Training Institutions in Uganda
Date of publication
2011 March
Publication type
Journal Article
Publication details
BMC International Health And Human Rights 11 Suppl 1
Publication status
Published
Language
English
Keywords
community-based education, health worker training institutions, Uganda
Abstract
This study was undertaken to assess the scope and nature of community-based education (CBE) for various health worker cadres in Uganda. Curricula and other materials on CBE programmes in Uganda were reviewed to assess nature, purpose, intended outcomes and evaluation methods used by CBE programmes. In-depth and key informant interviews were conducted with people involved in managing CBE in twenty-two selected training institutions, as well as stakeholders from the community, Ministry of Health, Ministry of Education, civil society organisations and local government. The researchers found that CBE curriculum is implemented in most health training institutions in Uganda and is a core course in most health disciplines at various levels. The CBE curriculum is systematically planned and implemented with major similarities among institutions. Organisation, delivery, managerial strategies, and evaluation methods are also largely similar. Strengths recognised included providing hands-on experience, knowledge and skills generation and the linking learners to the communities. Almost all CBE implementing institutions cited human resource, financial, and material constraints. It is still uncertain whether this approach is increasing the number graduates seeking careers in rural health service, one of the stated programme goals.
Country
Publisher
BMC International Health And Human Rights
Theme area
Human resources for health
Title of publication Perception and Valuations of Community-Based Education and Service By Alumni at Makerere University College of Health Sciences
Date of publication
2011 March
Publication type
Journal Article
Publication details
BMC International Health And Human Rights 11 Suppl 1
Publication status
Published
Language
English
Keywords
community-based education, Makere University College
Abstract
In this study, researchers surveyed the alumni of Community-Based Education and Service (COBE) programmes at Makerere University, Uganda, to obtain their perceptions of the management and administration of COBE and whether COBE had helped develop their confidence as health workers, competence in primary health care and willingness and ability to work in rural communities. A total of 150 alumni were contacted, of which 24 (13 females and 11 males) were selected for focus group discussions. The alumni almost unanimously agree that the initial three years of COBES were very successful in terms of administration and coordination. COBES was credited for contributing to development of confidence as health workers, team work, communication skills, competence in primary health care and willingness to work in rural areas. The alumni also identified various challenges associated with administration and coordination of COBES at Makerere. The authors conclude that health planners should take advantage of the long-term positive impact of COBES and provide the programmes with more support.
Country
Publisher
BMC International Health And Human Rights
Theme area
Human resources for health
Title of publication Analysing the Implementation of the Rural Allowance in Hospitals in North West Province, South Africa
Date of publication
2011 July
Publication type
Journal Article
Publication details
Journal Of Public Health Policy 32 S80-S93
Publication status
Published
Language
English
Keywords
rural allowance, health workers, South Africa
Abstract
Using a policy analysis framework, the authors of this study analysed the implementation and perceived effectiveness of a rural allowance policy and its influence on the motivation and retention of health professionals in rural hospitals in the North West province of South Africa. They conducted 40 in-depth interviews with policy-makers, hospital managers, nurses, and doctors at five rural hospitals and found weaknesses in policy design and implementation. These weaknesses included: lack of evidence to guide policy formulation; restricting eligibility for the allowance to doctors and professional nurses; lack of clarity on the definition of rural areas; weak communication; and the absence of a monitoring and evaluation framework. Although the rural allowance was partially effective in the recruitment of health professionals, it has had unintended negative consequences of perceived divisiveness and staff dissatisfaction. The authors recommend that government should take more account of contextual and process factors in policy formulation and implementation so that policies have the intended impact.
Country
South Africa
Publisher
Journal Of Public Health Policy
Theme area
Equitable health services
Title of publication Makerere University College of Health Sciences' Role in Addressing Challenges in Health Service Provision at Mulago National Referral Hospital
Date of publication
2011 March
Publication type
Journal Article
Publication details
BMC International Health And Human Rights 11 Suppl 1
Publication status
Published
Language
English
Keywords
health service provision, Makerere University College
Abstract
In 2009, as part of a strategic planning process, Makerere University College undertook a qualitative study to examine care and service provision at Mulago National Referral Hospital (MNRH), identify challenges, gaps, and solutions, and explore how the University could contribute to improving care and service delivery at MNRH. Twenty-three key informant interviews and seven focus group discussions were conducted with nurses, doctors, administrators, clinical officers and other key stakeholders. Participants identified a number of challenges to care and service delivery at MNRH, including resource constraints, staff inadequacies, overcrowding, a poorly functioning referral system, limited quality assurance, and a cumbersome procurement system. They also pointed to insufficiencies in the teaching of professionalism and communication skills to students, and patient care challenges that included lack of access to specialised services, risk of infections, and inappropriate medications. The authors recommend addressing these barriers by strengthening the relationship between the hospital and Makerere. Strategic partnerships and creative use of existing resources, both human and financial, could improve quality of care and service delivery.
Country
Publisher
BMC International Health And Human Rights
Theme area
Poverty and health
Title of publication Equity Implications of Coverage and Use of Insecticide Treated Nets Distributed For Free or With Co-Payment in Two Districts in Tanzania: A Cross-Sectional Comparative Household Survey
Date of publication
2011 July
Publication type
Journal Article
Publication details
International Journal For Equity In Health 10 29
Publication status
Published
Language
English
Keywords
insecticide-treated nets, co-payment, social marketing
Abstract
Arguments about the most effective and equitable approach to distributing insecticide-treated nets (ITNs) centre around whether to provide ITNs free of charge or continue with existing social marketing strategies. In this study, researchers in Tanzania examined the equity implications of ownership and use of ITNs in households from different socioeconomic quintiles in a district with free ITNs (Mpanda) and a district without free ITN distribution (Kisarawe). They found that ownership of ITNs increased from 29% in the 2007/08 national survey to 90% after the roll out of free ITNs in Mpanda, and use increased from 13% to 77%. Inequality was considerably lower in Mpanda. In Kisarawe, ownership of ITNs increased from 48% in the 2007/08 national survey to 53%, with marked inequality. The results suggest that inequality in ownership and use of ITNs may be addressed through the provision of free ITNs to all.
Country
Publisher
International Journal For Equity In Health
Theme area
Monitoring equity and research to policy
Title of publication The Wider Determinants of Inequalities in Health: A Decomposition Analysis
Date of publication
2011 July
Publication type
Journal Article
Publication details
International Journal For Equity In Health 10 30
Publication status
Published
Language
English
Keywords
determinants of health inequalities
Abstract
The common starting point of many studies scrutinising the factors underlying health inequalities is that material, cultural-behavioural, and psycho-social factors affect the distribution of health systematically through income, education, occupation, wealth or similar indicators of socioeconomic structure. However, little is known regarding if and to what extent these factors can assert systematic influence on the distribution of health of a population independent of the effects channelled through income, education, or wealth. In their analysis, the authors of this paper suggest that three main factors persistently contribute to variance in health: the capability score, cultural-behavioural variables and to a lower extent, the materialist approach. Of the three, the capability score illustrates the explanatory power of interaction and compound effects as it captures the individual's socioeconomic, social, and psychological resources in relation to his/her exposure to life challenges. Models that take a reductionist perspective and do not allow for the possibility that health inequalities are generated by factors over and above their effect on the variation in health channelled through one of the socioeconomic measures are underspecified and may fail to capture the determinants of health inequalities, the authors conclude.
Country
Publisher
International Journal For Equity In Health
Theme area
Governance and participation in health, Monitoring equity and research to policy
Title of publication Raising The Profile Of Participatory Action Research At The 2010 Global Symposium On Health Systems Research; MEDICC Review 13(3): 35-38
Date of publication
2011 July
Publication type
Journal Article
Publication details
MEDICC Review 13(3): 35-38, July 2011
Publication status
Published
Language
Keywords
participatory action research; health systems research
Abstract
By involving citizens and health workers in producing evidence and learning, participatory action research has potential to organise community evidence, stimulate action, and challenge the marginalisation that undermines achievement of universal health coverage. In this paper, the authors summarise and analyse results of two sessions on this research model convened by the authors at the First Global Symposium on Health Systems Research in Montreux Switzerland, 16–19 November 2010. In so doing, it reviews case studies and experiences discussed, particularly their contribution to universal health coverage in different settings. The authors reflects on challenges faced by participatory action research, and outline recommendations from the two sessions, including the creation of a learning network for participatory action research.
Country
East and southern Africa region
Publisher
Equinet Publication Type
Academic papers
Theme area
Equity and HIV/AIDS
Title of publication Prevention of mother-to-child transmission of HIV and the health-related Millennium Development Goals: time for a public health approach
Date of publication
2011 July
Publication type
Journal Article
Publication details
The Lancet 378 9787
Publication status
Published
Language
English
Keywords
mother to child transmission, AIDs, Millennium Development Goals, Malawi
Abstract
Like many other countries in Africa, Malawi is preparing to revise its policies for prevention of mother-to-child transmission (PMTCT) of HIV and for antiretroviral therapy (ART) in response to WHO's 2010 guidelines.This guidance is timely in view of the limited efficacy of single-dose nevirapine used in many PMTCT programmes and the challenges facing the effective expansion of health service delivery.4 The drive from the Global Fund to Fight AIDS, Tuberculosis and Malaria to increase coverage of PMTCT services is increasing, particularly in countries with high burdens of HIV infection; high coverage is essential to reduce transmission to infants, to provide treatment for HIV-infected women, and to meet the relevant 2015 Millennium Development Goals of reducing child mortality, improving maternal health, and combating HIV infection and AIDS, malaria, and other diseases.
Country
Publisher
Theme area
Values, policies and rights
Title of publication South Africa's health: departing for a better future?
Date of publication
2009 August
Publication type
Journal Article
Publication details
The Lancet 374 9692
Publication status
Published
Language
English
Keywords
health system, social determinants of health, AIDS, South Africa
Abstract
South Africa is at an important crossroads. The government under President Zuma inherited a massive task to improve health and health care for about 49 million South Africans, and to provide a lead and example for other countries in sub-Saharan Africa. The challenges are great- low morale of doctors, health outcomes widely disproportionate to spending, and a diverse population with a history of colonisation and apartheid that has had important effects on social determinants of health. Since 1994, there have been achievements: poverty reduction, new housing, sanitation and electricity, and the emergence of an affluent black middle-class. There have also been failures, including the failure to address AIDS early and decisively with far-reaching consequences for prevention and availability of treatment for HIV, for maternal, newborn, and child health, for the South African workforce, including health workers, and for overall economic productivity. In his book The Mbeki Legacy, Brian Pottinger, a former editor and publisher of the South African Sunday Times, describes Mbeki's term as President of South Africa as a story “fraught with contradictions” Nowhere is this more apparent than in the health sector argue the authors.
Country
South Africa
Publisher
Theme area
Values, policies and rights
Title of publication Achieving the health Millennium Development Goals for South Africa: challenges and priorities
Date of publication
2010 September
Publication type
Journal Article
Publication details
The Lancet 374 9694
Publication status
Published
Language
English
Keywords
Millennium Development Goals, South Africa; AIDs
Abstract
15 years after liberation from apartheid, South Africans are facing new challenges for which the highest calibre of leadership, vision, and commitment is needed. The effect of the unprecedented HIV/AIDS epidemic has been immense. Substantial increases in mortality and morbidity are threatening to overwhelm the health system and undermine the potential of South Africa to attain the Millennium Development Goals (MDGs). However The Lancet's Series on South Africa has identified several examples of leadership and innovation that point towards a different future scenario. The authors discuss the type of vision, leadership, and priority actions needed to achieve such a change. The study asserts that there is still have time to change the health trajectory of the country, and even meet the MDGs. The South African Government, installed in April, 2009, has the mandate and potential to address the public health emergencies facing the country—will they do so or will another opportunity and many more lives be lost?
Country
Publisher
Theme area
Resource allocation and health financing
Title of publication What has tax got to do with development, A critical look at Mozambique's tax system
Date of publication
2011 July
Publication type
Document
Publication details
AFRODAD 2011
Publication status
Published
Language
English
Keywords
tax revenue, tax reform, transparency, Mozambique
Abstract
The Mozambican tax system has undergone major reforms to conform to international and regional standards in order to attract foreign investment. The main existing taxes for the mobilisation of domestic resources are Value Added Tax (VAT), Corporate Tax (IRPC), Individual Tax (IRPS), Excise Taxes (ICE), Import Duties (DA), Simplified Income Tax for Small Contributors (ISPC) and Fuel Tax (FT) to name a few. There is a general understanding on the need to pay taxes but the authors argue that the government has to improve its communication with the public to build trust so that people will know what to expect from the money they pay. The extractive industry has a potential to contribute to taxation and poverty reduction but it is still in an initial stage and is also a major beneficiary of fiscal benefits that reduce the extent to which it contributes to domestic resources. The country has decided to adhere to the Extractive Industries Transparency Initiative (EITI), a step that will increase public understanding about its contribution to economic development and government use of tax collected. Civil Society Organisations have been engaged in undertaking research, disseminating information and contributing to the present debate on taxation. The establishment of partnerships with government and the private sector for tax justice can bring tangible benefits to the country.
Country
Mozambique
Publisher
Theme area
Resource allocation and health financing
Title of publication What has tax got to do with development, A critical look at Zimbabwe's tax system
Date of publication
2011 July
Publication type
Document
Publication details
AFRODAD 2011
Publication status
Not published
Language
English
Keywords
tax system, tax reform, social services, Zimbabwe
Abstract
The research looked at the Zimbabwe tax system and tax reforms in relation to revenue collection and made a comparison with tax systems in the region. The study looked at weaknesses in the policy and in tax collection in relation to tax evasion and avoidance. This was linked to the informal sector activities, including informal cross border trade. The research also analysed government expenditure to determine the support to social services. The study found that revenue collection in Zimbabwe is poor. This was attributed to weaknesses in policies and to the Zimbabwe Revenue Authority (ZIMRA)’s failure to effectively monitor business transactions. It was also noted that the Government lacks the expertise to monitor mining operations. The government is aware of the short-comings and has proposed some reforms in the legislation to increase revenue collection. Similarly, the Government introduced new legislation in 2010 to improve the management of public funds - the new Acts on Public Fund Management (PFM) and Audit. While the Government has a reasonably strong regulatory framework in the form of statutes on PFM, enforcement has often lagged behind. The study found that overall, the interaction between the Government and the business sector and other sectors through budget consultations is considered very effective. The appointment of the Tax Steering Committee, on which the Ministry of Finance, ZIMRA and the private sector are represented, was a big step in the right direction. But dialogue with the informal sector has lagged behind and there has been calls to give more attention to this sector, which accounts for 60% of all business.
Country
Zimbabwe
Publisher
Theme area
Equity in health
Title of publication Globalisation and health inequalities: Can a human rights paradigm create space for civil society action?
Date of publication
2011 April
Publication type
Journal Article
Publication details
Social Science & Medicine
Publication status
Published
Language
English
Keywords
Human rights; parliament; globalisation; Civil society; State; Accountability; Health inequalities; east and southern Africa;
Abstract
While neoliberal globalisation is associated with increasing inequalities, global integration has simultaneously strengthened the dissemination of human rights discourse across the world. This paper explores the seeming contradiction that globalisation is conceived as disempowering nations states’ ability to act in their population’s interests, yet implementation of human rights obligations requires effective states to deliver socio-economic entitlements, such as health. Central to the actions required of the state to build a health system based on a human rights approach is the notion of accountability. Two case studies are used to explore the constraints on states meeting their human rights obligations regarding health, the first drawing on data from interviews with parliamentarians responsible for health in East and Southern Africa, and the second reflecting on the response to the HIV/AIDS epidemic in South Africa. The authors argue that human rights, as both a normative framework for legal challenges and as a means to create room for active civil society engagement provide a means to contest both the real and the purported constraints imposed by globalisation. A neglected aspect of health systems analysis is the role of human rights approaches in strengthening pro-poor protections. Human rights paradigms can strengthen parliamentary oversight over the executive to advance health equity. Human rights paradigms can enable civil society agency critical to hold states accountable for the right to health. ‘Cunning states’ selectively disown accountability for socio-economic rights under diffused systems of global governance. By increasing state accountability, human rights can counter the negative consequences of globalization for health equity.
Country
Publisher
Theme area
Equity in health
Title of publication Social Determinants of Smoking in Low- and Middle-Income Countries: Results from the World Health Survey
Date of publication
2011 May
Publication type
Journal Article
Publication details
PLoS ONE 5 6
Publication status
Published
Language
English
Keywords
tobacco smoking, social determinants of health, global health , low and middle income countries
Abstract
Tobacco smoking is a leading cause of premature death and disability, and over 80% of the world's smokers live in low- or middle-income countries. The objective of this study is to assess demographic and socioeconomic determinants of current smoking in low- and middle-income countries. We used data, from the World Health Survey in 48 low-income and middle-income countries, to explore the impact of demographic and socioeconomic factors on the current smoking status of respondents. The data from these surveys provided information on 213,807 respondents aged 18 years or above that were divided into 4 pooled datasets according to their sex and country income group. The overall proportion of current smokers, as well as the proportion by each relevant demographic and socioeconomic determinant, was calculated within each of the pooled datasets, and multivariable logistic regression was used to assess the association between current smoking and these determinants. The odds of smoking were not equal in all demographic or socioeconomic groups. Some factors were fairly stable across the four datasets studied: for example, individuals were more likely to smoke if they had little or no education, regardless of if they were male or female, or lived in a low or a middle income country. Nevertheless, other factors, notably age and wealth, showed a differential effect on smoking by sex or country income level. While women in the low-income country group were twice as likely to smoke if they were in the lowest wealth quintile compared with the highest, the association was absent in the middle-income country group. Information on how smoking is distributed among low- or middle-income countries will allow policy makers to tailor future policies, and target the most vulnerable populations.
Country
Publisher
Theme area
Values, policies and rights
Title of publication Global Justice and the Social Determinants of Health
Date of publication
2010 June
Publication type
Journal Article
Publication details
Ethics & International Affairs 2 24
Publication status
Published
Language
English
Keywords
global justice, social determinants of health, social epidemiology
Abstract
Public scrutiny and deliberation are central to both the sciences and ethical reasoning. In the sciences, research findings and analyses are put forward in the public arena not simply to announce new evidence but also for public examination, to be either corroborated or disputed. In ethics there is a similar process, whereby reasoned arguments are put forward about what is the good or right thing to do. In either domain, knowledge is expanded through the coherence and acceptance of the analyses and arguments, which depends on their being able to withstand public scrutiny. Therefore, when scientific and ethical arguments are brought together, the task of public deliberation is twofold, as it must encompass the empirical and the normative; and when the arguments concern an issue of such enormous scope as global health inequalities, public deliberation has to include national and global domains.
Country
Publisher
Theme area
Resource allocation and health financing
Title of publication More Money, Less Cure: Why Global Health Assistance Needs Restructuring
Date of publication
2009 September
Publication type
Journal Article
Publication details
Ethics & International Affairs 3 23
Publication status
Not published
Language
English
Keywords
global health; health financing human development
Abstract
Is more money for global health always good news? In this brief essay Esser argues that the answer is "No." He suggests that many of the problems that plague decision-making in global health assistance lie not in the global South but in the North, where the monetary flows originate and where most policies are conceived. In sketching several constitutive elements of the political economy of global health finance, Esser develops a series of arguments that show why the contemporary practice of throwing good money into a dysfunctional global health system makes neither economic nor ethical sense. What emerges is an image of global health as a deeply political arena shaped by local and global interests and incentives. Esser concludes with three proposals to strengthen global health assistance through the more equitable involvement of critical partners. Only thus can financial investment in global health reasonably be expected to make effective and efficient contributions to human development and global equity.
Country
Publisher
Theme area
Equity and HIV/AIDS
Title of publication Africa: Study reveals concerns over ART resistance
Date of publication
2011 July
Publication type
Journal Article
Publication details
The Lancet 08 61345-8
Publication status
Not published
Language
English
Keywords
ART resistance, sub saharan Africa, Antiretroviral therapy
Abstract
There are few data on the epidemiology of primary HIV-1 drug resistance after the roll-out of antiretroviral treatment (ART) in sub-Saharan Africa. The study aimed to assess the prevalence of primary resistance in six African countries after ART roll-out and if wider use of ART in sub-Saharan Africa is associated with rising prevalence of drug resistance. The research includes a cross-sectional study in antiretroviral-naive adults infected with HIV-1 who had not started first-line ART, recruited between 2007 and 2009 from 11 regions in Kenya, Nigeria, South Africa, Uganda, Zambia, and Zimbabwe. Research of population-based sequencing of the pol gene on plasma specimens with greater than 1000 copies per mL of HIV RNA. The study identified drug-resistance mutations with the WHO list for transmitted resistance. The prevalence of sequences containing at least one drug-resistance mutation was calculated accounting for the sampling weights of the sites. It assesses the risk factors of resistance with multilevel logistic regression with random coefficients. The odds ratio for drug resistance associated with each additional year since the start of the ART roll-out in a region was 1.38 (95% CI 1.13—1.68; p=0.001). The study concludes that the higher prevalence of primary drug resistance in Uganda than in other African countries is probably related to the earlier start of ART roll-out in Uganda. It states that resistance surveillance and prevention should be prioritised in settings where ART programmes are scaled up.
Country
Publisher
Theme area
Equity in health, Monitoring equity and research to policy
Title of publication Equity Watch: Assessing Progress towards Equity in Health in Zambia
Date of publication
2011 August
Publication type
Report
Publication details
Equity Watch: Assessing Progress towards Equity in Health in Zambia, EQUINET,
Publication status
Published
Language
Keywords
Equity watch; health equity analysis; social determinants of health; Zambia
Abstract
An Equity Watch is a means of monitoring progress on health equity by gathering, organizing, analysing,
reporting and reviewing evidence on equity in health. Equity Watch work is being implemented in countries
in eastern and southern Africa in line with national and regional policy commitments. In February 2010
the Regional Health Ministers' Conference of the ECSA Health Community resolved that countries should 'report on evidence on health equity and progress in addressing inequalities in health'. This report provides an array of evidence on the responsiveness of Zambia’s health system in
promoting and attaining equity in health and health care, using the Equity Watch framework. T he report
introduces the context and the evidence within four major areas: equity in health, household access to the
resources for health, equitable health systems and global justice. It shows past levels (1980–2005), current levels (most current data publicly available) and comments on the level of progress towards health equity.
Country
Zambia
Publisher
EQUINET
Equinet Publication Type
Reports, Discussion paper, Equity indicators
Theme area
Resource allocation and health financing
Title of publication EQUINET Discussion Paper 87: Expansion of the private health sector in east and southern Africa
Date of publication
2011 August
Publication type
Report
Publication details
Expansion of the private health sector in east and southern Africa’, EQUINET Discussion Paper 87. EQUINET: Harare.
Publication status
Published
Language
English
Keywords
private for profit sector; health financing; east and southern Africa
Abstract
This review was commission by EQUINET to explore the implications of expansion of the private for profit health sector for equitable health systems in East and Southern Africa. It summarises the rationale behind the IFC’s recommendations. It then explores whether there are signs of increasing for-profit private sector activity in the region, along the lines suggested by the IFC. The report then identifies issues of concern on private for profit activity in the health sector. It is an initial scoping exercise based on a desk review of predominantly grey literature. It suggests from the evidence presented that Ministries of Health need to highlight both benefits and pitfalls of encouraging for-profit private sector provisioning in economic growth policies and assess the opportunity costs of supporting the for-profit private health sector as opposed to developing the public health system. Comprehensive policies on the private sector need to be developed, together with a robust regulations and state capacities to monitor private sector activity and enforce regulations and sanctions.
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Discussion paper
Theme area
Health equity in economic and trade policies
Title of publication Policy Brief 25: Pandemic Influenza Preparedness: sharing of influenza viruses and access to vaccines and other benefits
Date of publication
2011 August
Publication type
Document
Publication details
Policy brief, EQUINET, ECSA HC Harare
Publication status
Published
Language
Keywords
virus sharing; trade and health; east and southern Africa; pandemic influenza
Abstract
The sharing by countries of influenza virus samples is important for vaccine development, and for understanding how viruses are mutating. Developing countries have thus freely provided samples to the World Health Organisation (WHO). But when private pharmaceutical companies use the samples to develop and patent vaccines which the same developing countries cannot afford, this is unjust and exposes thousands of people in developing countries to preventable deaths. This policy brief outlines the opportunities that African countries have to negotiate for equitable benefit sharing in the use of viral resources, through international treaties. The United Nations Convention on Biological Diversity (CBD) and the Nagoya Protocol on Access to Genetic Resources provide for fair and equitable sharing of benefits
from the use of biological resources. The brief provides information on their enabling clauses and outlines the options that African countries may
consider in their negotiations for an equitable system.
Country
East and southern Africa region
Publisher
EQUINET, ECSA HC
URL:
Equinet Publication Type
Policy brief
Theme area
Health equity in economic and trade policies
Title of publication Policy Brief 24: Preventing substandard, falsified medicines and protecting access to generic medicines in Africa
Date of publication
2011 August
Publication type
Document
Publication details
EQUINET Policy Brief with ECSA HC
Publication status
Published
Language
Keywords
counterfeit; access to medicines; trade and health
Abstract
Anti-counterfeiting laws and actions have raised concern about such laws and actions not undermining the flexibilities in the World Trade
Organisation TRIPS agreement to protect access to affordable and generic medicines. At the same time, importing countries need measures to protect
against substandard imported drugs. The 2011 World Health Assembly resolved that a working group review World Health Organisation (WHO)
policy on counterfeit, falsified and substandard medicines, and WHOs relationship with IMPACT. This policy brief defines counterfeit, substandard
and falsified medicines. It points to the separate measures and mandates needed to combat each: for dealing with fraudulent trade mark and
intellectual property (IP) infringement in counterfeit medicines by IP authorities, for ensuring that any anti-counterfeit measures protect TRIPS
flexibilities, including for access to generic medicines; and for national drug regulatory authorities to ensure that substandard and falsified medicines do not compromise health.
Country
East and southern Africa region
Publisher
EQUINET, ECSA HC
Equinet Publication Type
Policy brief
Theme area
Equity and HIV/AIDS
Title of publication When masculinity interferes with women's treatment of HIV infection: a qualitative study about adherence to antiretroviral therapy in Zimbabwe
Date of publication
2011 June
Publication type
Journal Article
Publication details
Journal of the International AIDS society 14 29
Publication status
Published
Language
English
Keywords
masculinity, women's treatment, HIV infections, antiretroviral therapy, Zimbabwe
Abstract
Social constructions of masculinity have been shown to serve as an obstacle to men's access and adherence to antiretroviral therapies (ART). In the light of women's relative lack of power in many aspects of interpersonal relationships with men in many African settings, the authors explored how male denial of HIV/AIDS impacts on their female partners' ability to access and adhere to ART. The paper reports a qualitative case study involving thematic analysis of 37 individual interviews and five focus groups with a total of 53 male and female antiretroviral drug users and 25 healthcare providers in rural eastern Zimbabwe. Men saw HIV/AIDS as a threat to their manhood and dignity and exhibited a profound fear of the disease. In the process of denying and avoiding their association with AIDS, many men undermined their wives' efforts to access and adhere to ART. Many women felt unable to disclose their HIV status to their husbands, forcing them to take their medication in secret, and act without a supportive treatment partner, which is widely accepted to be vitally important for adherence success. Some husbands, when discovering that their wives have enrolled themselves in an ART programme, denied them permission to take the drugs, or occasionally stole the drugs for their own treatment. Men's avoidance of HIV also leave many HIV-positive women feeling vulnerable to re-infection as their husbands, in an attempt to demonstrate their manhood, are thought to continue engaging in HIV-risky behaviours. These notions of masculinity can interfere with women's adherence to ART and services need to explore ways to work with both women and men to identify couples-based strategies to increase adherence to ART.
Country
Zimbabwe
Publisher
Journal of the International AIDS society
Theme area
Equitable health services
Title of publication Viewing the Kenyan health system through an equity lens: Implications for universal coverage
Date of publication
2011 May
Publication type
Journal Article
Publication details
International Journal for Equity in Health 10 22
Publication status
Published
Language
English
Keywords
equitable health systems, universal coverage, Kenya
Abstract
This paper assessed the extent to which the Kenyan health financing system meets the key requirements for universal coverage, including income and risk cross-subsidisation. Recommendations on how to address existing equity challenges and progress towards universal coverage are made. An extensive review of published and gray literature was conducted to identify the sources of health care funds in Kenya. In cases where data were not available at the country level, they were sought from the World Health Organisation website. Each financing mechanism was analysed in respect to key functions namely, revenue generation, pooling and purchasing. The Kenyan health sector relies heavily on out-of-pocket payments. Government funds are mainly allocated through historical incremental approach. The sector is largely underfunded and health care contributions are regressive (i.e. the poor contribute a larger proportion of their income to health care than the rich). Health financing in Kenya is fragmented and there is very limited risk and income cross-subsidisation. The country has made little progress towards achieving international benchmarks including the Abuja target of allocating 15% of government's budget to the health sector. The Kenyan health system is highly inequitable and policies aimed at promoting equity and addressing the needs of the poor and vulnerable have not been successful. Some progress has been made towards addressing equity challenges, but universal coverage will not be achieved unless the country adopts a systemic approach to health financing reforms. Such an approach should be informed by the wider health system goals of equity and efficiency.
Country
Kenya
Publisher
International Journal for Equity in Health
Theme area
Equitable health services
Title of publication Poverty and patient abandonment at Muhimbili National hospital, Tanzania
Date of publication
2009
Publication type
Journal Article
Publication details
Tanzania Medical Journal 24 2
Publication status
Published
Language
English
Keywords
Poverty, patient abandonment, health care services, level of education
Abstract
Poverty is the state of having little or no money and few or no material possessions. Poverty can be caused by unemployment, low education, deprivation and homelessness. This study assessed the relationship between poverty and patient abandonment (PA) in hospitals, and the attitude of health care professionals (HCPs) towards the patient. The study targeted all patients who were abandoned at MNH and who voluntarily accepted to participate in this study under informed consent and strict confidentiality. This is the first study to be conducted in Dar es Salaam with respect to PA in hospital. Results revealed unnecessary overcrowding in wards and overwhelmingly heavy burden of patient care on the HCPs. The study also observed a correlation between poverty and PA, which was to a great extent related to the patient's level of education. The respondents strongly condemned PA immoral. The authors propose that government re-introduce subsidies on services to alleviate the burden of medical expenses incurred by the low income citizens, particularly the unemployed and farmers. The study also recommends that the government should improve services in regional hospitals to reduce travel and patients care expenses.
Country
Tanzania
Publisher
Tanzania Medical Journal
Theme area
Equitable health services
Title of publication MaiMwana women's groups: a community mobilisation intervention to improve mother and child health and reduce mortality in rural Malawi
Date of publication
2010
Publication type
Journal Article
Publication details
Malawi Medical Journal 22 4
Publication status
Published
Language
English
Keywords
community mobilisation, mother and child health, Malawi
Abstract
This article presents a detailed description of a community mobilization intervention involving women's groups in Mchinji District, Malawi. The intervention was implemented between 2005 and 2010. The intervention aimed to build the capacities of communities to take control of the mother and child health issues that affect them. To achieve this it trained local female facilitators to establish groups and using a manual, participatory rural appraisal tools and picture cards guided them through a community action cycle to identify and implement solutions to mother and child health problems. The groups then catalysed community collective action to address mother and child health issues to improve te health and reduce the mortality of mothers and children. Their impact, implementation and cost-effectiveness have been rigorously evaluated through a randomized controlled trial design and the results of these evaluations will be reported in 2011.
Country
Malawi
Publisher
Malawi Medical Journal
Theme area
Poverty and health
Title of publication Are there particular social determinants of health for the world's poorest countries?
Date of publication
2011
Publication type
Journal Article
Publication details
African Health Sciences 11 1
Publication status
Published
Language
English
Keywords
social determinants, health policy, southern Africa
Abstract
The task of improving Social and Economic Determinants of Health (SEDH) imposes a significant challenge to health policy makers in both rich and poor countries. In recent years, while there has been increasing research interest and evidence on the workings of SEDHs, the vast majority of studies on this issue are from developed countries and emphasizes specific concerns of the developed nations of the world. Importantly, they may not fully explain the underlying causal factors and pathways of health inequality in the world's poorest countries. The paper aimed to explore whether there are specific social determinants of health in the world's poorest countries, and if so, how they could be better identified and researched in Africa in order to promote and support the effort that is currently being made for realizing a better health for all. Extensive literature review of existing papers on the social and economic determinants of health. Most of the existing studies on the social and economic determinants of health studies may not well provide adequate explanation on the historical and contemporary realties of SEDHs in the world's poorest countries. As these factors vary from one country to another, it becomes necessary to understand country-specific conditions and design appropriate policies that take due cognisance of these country-specific circumstances. Therefore, to support the global effort to close gaps in health disparities, further research is needed in the world's poorest countries, especially on African social determinants of health.
Country
East and southern Africa region
Publisher
African Health Sciences
Theme area
Equity and HIV/AIDS
Title of publication The history of AIDS exceptionalism
Date of publication
2010 December
Publication type
Journal Article
Publication details
Journal of the International AIDS Society 13 47
Publication status
Published
Language
English
Keywords
ethnography, public health, sexually transmitted disease, southern Africa
Abstract
In the history of public health, HIV/AIDS is unique; it has widespread and long-lasting demographic, social, economic and political impacts. The global response has been unprecedented. AIDS exceptionalism - the idea that the disease requires a response above and beyond "normal" health interventions - began as a Western response to the originally terrifying and lethal nature of the virus. More recently, AIDS exceptionalism came to refer to the disease-specific global response and the resources dedicated to addressing the epidemic. There has been a backlash against this exceptionalism, with critics claiming that HIV/AIDS receives a disproportionate amount of international aid and health funding. This paper situations this debate in historical perspective. By reviewing histories of the disease, policy developments and funding patterns, it charts how the meaning of AIDS exceptionalism has shifted over three decades. It argues that while the connotation of the term has changed, the epidemic has maintained its course, and therefore some of the justifications for exceptionalism remain.
Country
South Africa
Publisher
Journal of the International AIDS Society
Theme area
Governance and participation in health
Title of publication Knowledge Attitudes and Practices of grade three primary schoolchildren in relation to schistosomiasis, soil transmitted helminthiasis and malaria in Zimbabwe
Date of publication
2011 June
Publication type
Journal Article
Publication details
BMC Proceedings 11 169
Publication status
Published
Language
English
Keywords
Knowledge, practices, schoolchildren, schistosomiasis, soil transmitted helminthiasis, malaria, Zimbabwe
Abstract
Helminth infection rates in grade three children are used as proxy indicators of community infection status and to guide treatment strategies in endemic areas. However knowledge, attitudes and practices (KAP) of this target age group (8-10 years) in relation to schistosomiasis, soil transmitted helminthiasis (STHs) and malaria is not known at a time when integrated plasmodium - helminth control strategies are being advocated. This study sought to assess KAP of grade 3 children in relation to schistosomiasis, STHs and malaria in order to establish an effective school based health education for disease transmission control. Grade 3 children (n = 172) attending four randomly selected primary schools (one in rural and 3 in the commercial farming areas) in Zimbabwe were interviewed using a pre-tested interviewer administered questionnaire. It was observed that 32.0%, 19.2% and 4.1% of the respondents had correct knowledge about the causes of schistosomiasis, malaria and STHs, respectively, whilst 22.1%, 19.2% and 5.8% knew correct measures to control schistosomiasis, malaria and STHs. Sixty-two percent and 44.8% did not use soap to wash hands after toilet and before eating food respectively, whilst 33.1% never wore shoes. There were no functional water points and soap for hand washing after toilet at all schools. There was a high prevalence distribution of all parasites investigated in this study at Msapa primary school - S. haematobium (77.8%), S. mansoni (33.3%) hookworms (29.6%) and P. falciparum (48.1%). There is a critical need for targeting health messages through schools in order to reach the most susceptible schoolchildren. This will empower the schoolchildren with the basic knowledge and skills ultimately protecting them from acquiring schistosomiasis, STHs and malaria.
Country
Zimbabwe
Publisher
BMC Proceedings
Theme area
Equitable health services
Title of publication Perceptions and viewpoints on proceedings of the Fifteenth Assembly of Heads of State and Government of the African Union Debate on Maternal, Newborn and Child Health and Development, 25 - 27 July 2010, Kampala, Uganda
Date of publication
2011 June
Publication type
Journal Article
Publication details
BMC Proceedings 5 Supp 5
Publication status
Published
Language
English
Keywords
Maternal mortality; maternal health services, policy makers, Africa
Abstract
This article reflects on the discussions held during the Fifteenth Assembly of the Heads of State and Government of the African Union on the reasons why the maternal mortality ratio is so high in Africa and what can be done to reduce it. The high maternal mortality ratios in countries were attributed to weak national health information systems; leadership and governance challenges related to poverty, health illiteracy, poor transport networks and communications infrastructure, risky cultural practices, armed conflicts and domestic violence, dearth of women empowerment; inadequate levels of skilled birth attendants; inadequate domestic and external funding; stock-outs of consumable inputs; and limited coverage of maternal and child health interventions. In order to accelerate progress towards MDGs 4 and 5, the Heads of State and Government recommended that countries should make maternal deaths notifiable and institutionalize maternal death audits; develop, fund and implement policies and strategies geared at improving maternal, newborn and child health; accelerate inter-sectoral action to address the broad health determinants; increase the number of skilled birth attendants; fulfil commitment to allocate at least 15% of the national budget to the health sector and allocate adequate resources to prevent stock-outs of essential medicines and reproductive health commodities; leverage health promotion approaches to raise national awareness; and ensure that there is a health centre within a radius of four kilometres equipped to provide good quality integrated maternal, newborn and child health services. There was consensus among the discussants that there was urgent need to speed up actions for strengthening health systems to improve coverage of maternal, newborn and child health services.
Country
East and southern Africa region
Publisher
BMC Proceedings
Theme area
Equitable health services
Title of publication Malaria control in the African Region: perceptions and viewpoints on proceedings of the Africa Leaders Malaria Alliance (ALMA)
Date of publication
2011 June
Publication type
Journal Article
Publication details
BMC Proceedings 5 Supp 5
Publication status
Published
Language
English
Keywords
Malaria control; health services, policy makers, Africa
Abstract
In 2009 a total of 153,408 malaria deaths were reported in Africa. Eleven countries showed a reduction of more than 50% in either confirmed malaria cases or malaria admissions and deaths in recent years. However, many African countries are not on track to achieve the malaria component of the Millennium Development Goal (MDG) 6. The African Leaders Malaria Alliance (ALMA) working session at the 15th African Union Summit discussed the bottlenecks to achieving MDG 6 (specifically halting and beginning to reverse the incidence of malaria by 2015), success factors, and what countries needed to do to accelerate achievement of the MDG. This article reflected on the proceedings of the ALMA working session. The main bottlenecks identified related to the capacity of the health systems to deliver quality care and accessibility issues; need for strong, decentralized malaria-control programmes with linkages with other health and development sectors, the civil society and private sector entities; benefits of co-implementation of malaria control programmes with child survival or other public health interventions; systematic application of integrated promotive, preventive, diagnostic and case management interventions with full community participation; adapting approaches to local political, socio-cultural and administrative environments. The following prerequisites for success were identified: a clear vision and effective leadership of national malaria control programmes; high level political commitment to ensure adequate capacity in expertise, skill mix and number of managers, technicians and service providers; national ownership, intersectoral collaboration and accountability, as well as strong civil society and private sector involvement; functional epidemiological surveillance systems; and levering of African Union and regional economic communities to address the cross-border dimension of malaria control. It was agreed that countries needed to secure adequate domestic and external funding for sustained commitment to malaria elimination; strengthen national malaria control programmes in the context of broader health system strengthening; ensure free access to long-lasting insecticide treated nets and malaria diagnosis and treatment for vulnerable groups; strengthen human resource capacity at central, district and community levels; and establish strong logistics, information and surveillance systems. It is critically important for countries to have a clear vision and strategy for malaria elimination; effective leadership of national malaria control programmes; draw lessons from other African countries that have succeeded to dramatically reduce the burden of malaria; and sustain funding and ongoing interventions.
Country
East and southern Africa region
Publisher
BMC Proceedings
Theme area
Human resources for health
Title of publication Keeping health staff healthy: evaluation of a workplace initiative to reduce morbidity and mortality from HIV/AIDS in Malawi
Date of publication
2011 January
Publication type
Journal Article
Publication details
Journal of the International AIDS Society 14 1
Publication status
Published
Language
English
Keywords
occupational health, sexually transmitted disease, Malawi
Abstract
In Malawi, the dramatic shortage of human resources for health is negatively impacted by HIV-related morbidity and mortality among health workers and their relatives. Many staff find it difficult to access HIV care through regular channels due to fear of stigma and discrimination. In 2006, two workplace initiatives were implemented in Thyolo District: a clinic at the district hospital dedicated to all district health staff and their first-degree relatives, providing medical services, including HIV care; and a support group for HIV-positive staff. Using routine programme data, the paper evaluated the following outcomes up to the end of 2009: uptake and outcome of HIV testing and counselling among health staff and their dependents; uptake and outcomes of antiretroviral therapy (ART) among health staff; and membership and activities of the support group. In addition, we included information from staff interviews and a job satisfaction survey to describe health workers' opinions of the initiatives. Almost two-thirds (91 of 144, 63%) of health workers and their dependents undergoing HIV testing and counselling at the staff clinic tested HIV positive. Sixty-four health workers had accessed ART through the staff clinic, approximately the number of health workers estimated to be in need of ART. Of these, 60 had joined the support group. Cumulative ART outcomes were satisfactory, with more than 90% alive on treatment as of June 2009 (the end of the study observation period). The availability, confidentiality and quality of care in the staff clinic were considered adequate by beneficiaries. Staff clinic and support group services successfully provided care and support to HIV-positive health workers. Similar initiatives should be considered in other settings with a high HIV prevalence.
Country
Malawi
Publisher
Journal of the International AIDS Society
Theme area
Equity and HIV/AIDS
Title of publication The feasibility of preventing mother-to-child transmission of HIV using peer counselors in Zimbabwe
Date of publication
2008
Publication type
Journal Article
Publication details
AIDS Research and Therapy 5 17
Publication status
Published
Language
English
Keywords
sexually transmitted disease, counseling, Zimbabwe
Abstract
Prevention of mother-to-child transmission of HIV (PMTCT) is a major public health challenge in Zimbabwe. Using trained peer counselors, a nevirapine (NVP)-based PMTCT program was implemented as part of routine care in urban antenatal clinics. Between October 2002 and December 2004, a total of 19,279 women presented for antenatal care. Of these, 18,817 (98%) underwent pre-test counseling; 10,513 (56%) accepted HIV testing, of whom 1986 (19%) were HIV-infected. Overall, 9696 (92%) of women collected results and received individual post-test counseling. Only 288 men opted for HIV testing. Of the 1807 HIV-infected women who received posttest counseling, 1387 (77%) collected NVP tablet and 727 (40%) delivered at the clinics. Of the 1986 HIV-infected women, 691 (35%) received NVPsd at onset of labor, and 615 (31%) infants received NVPsd. Of the 727 HIV-infected women who delivered in the clinics, only 396 women returned to the clinic with their infants for the 6-week follow-up visit; of these mothers, 258 (59%) joined support groups and 234 (53%) opted for contraception. By the end of the study period, 209 (53%) of mother-infant pairs (n = 396) came to the clinic for at least 3 follow-up visits. Despite considerable challenges and limited resources, it was feasible to implement a PMTCT program using peer counselors in urban clinics in Zimbabwe.
Country
Zimbabwe
Publisher
AIDS Research and Therapy
Theme area
Equitable health services
Title of publication Health system weaknesses constrain access to PMTCT and maternal HIV services in South Africa: a qualitative enquiry
Date of publication
2011 March
Publication type
Journal Article
Publication details
AIDS Research and Therapy 8 10
Publication status
Published
Language
English
Keywords
health systems, antiretroviral therapy, South Africa
Abstract
HIV remains responsible for an estimated 40% of mortality in South African pregnant women and their children. To address these avoidable deaths, eligibility criteria for antiretroviral therapy (ART) in pregnant women were revised in 2010 to enhance ART coverage. With greater availability of HIV services in public health settings and increasing government attention to poor maternal-child health outcomes, this study used the patient's journey through the continuum of maternal and child care as a framework to track and document women's experiences of accessing ART and prevention of mother-to-child HIV transmission (PMTCT) programmes in the Eastern Cape (three peri-urban facilities) and Gauteng provinces (one academic hospital). In-depth interviews identified considerable weaknesses within operational HIV service delivery. These manifested as missed opportunities for HIV testing in antenatal care due to shortages of test kits; insufficient staff assigned to HIV services; late payment of lay counsellors, with consequent absenteeism; and delayed transcription of CD4 cell count results into patient files (required for ART initiation). By contrast, individual factors undermining access encompassed psychosocial concerns, such as fear of a positive test result or a partner's reaction; and stigma. Data and information systems for monitoring in the three peri-urban facilities were markedly inadequate. A single system- or individual-level delay reduced the likelihood of women accessing ART or PMTCT interventions. These delays, when concurrent, often signalled wholesale denial of prevention and treatment. There is great scope for health systems' reforms to address constraints and weaknesses within PMTCT and ART services in South Africa. Recommendations from this study include: ensuring autonomy over resources at lower levels; linking performance management to facility-wide human resources interventions; developing accountability systems; improving HIV services in labour wards; ensuring quality HIV and infant feeding counselling; and improved monitoring for performance management using robust systems for data collection and utilisation.
Country
South Africa
Publisher
AIDS Research and Therapy
Theme area
Equity and HIV/AIDS
Title of publication Estimating the impact of expanded access to antiretroviral therapy on maternal, paternal and double orphans in sub- Saharan Africa, 2009 - 2020
Date of publication
2011 March
Publication type
Journal Article
Publication details
AIDS Research and Therapy 8 13
Publication status
Published
Language
English
Keywords
antiretroviral therapy, health policy, southern Africa
Abstract
HIV/AIDS has orphaned 11.6 million children in sub-Saharan Africa. Expanded antiretroviral therapy (ART) use may reduce AIDS orphanhood by decreasing adult mortality and population-level HIV transmission. The study modelled two scenarios to measure the impact of adult ART use on the incidence of orphanhood in 10 sub-Saharan African countries, from 2009 to 2020. Demographic model data inputs were obtained from cohort studies, UNAIDS, UN Population Division, WHO and the US Census Bureau. Compared to current rates of ART uptake, universal ART access averted 4.37 million more AIDS orphans by year 2020, including 3.15 million maternal, 1.89 million paternal and 0.75 million double orphans. The number of AIDS orphans averted was highest in South Africa (901.71 thousand) and Nigeria (839.01 thousand), and lowest in Zimbabwe (86.96 thousand) and Cote d'Ivoire (109.12 thousand). Universal ART use may significantly reduce orphanhood in sub-Saharan Africa.
Country
East and southern Africa region
Publisher
AIDS Research and Therapy
Theme area
Values, policies and rights
Title of publication Imprisoned and imperiled: access to HIV and TB prevention and treatment, and denial of human rights, in Zambian prisons
Date of publication
2011 February
Publication type
Journal Article
Publication details
Journal of the International AIDS Society
Publication status
Published
Language
English
Keywords
human rights, sexually transmitted disease, tuberculosis, criminal justice, Zambia
Abstract
Although HIV and tuberculosis (TB) prevalence are high in prisons throughout sub-Saharan Africa, little research has been conducted on factors related to prevention, testing and treatment services. To better understand the relationship between prison conditions, the criminal justice system, and HIV and TB in Zambian prisons, the study conducted a mixed-method study, including: facility assessments and in-depth interviews with 246 prisoners and 30 prison officers at six Zambian prisons; a review of Zambian legislation and policy governing prisons and the criminal justice system; and 46 key informant interviews with government and non-governmental organization officials and representatives of international agencies and donors. The facility assessments, in-depth interviews and key informant interviews found serious barriers to HIV and TB prevention and treatment, and extended pre-trial detention that contributed to overcrowded conditions. Disparities both between prisons and among different categories of prisoners within prisons were noted, with juveniles, women, pre-trial detainees and immigration detainees significantly less likely to access health services. Current conditions and the lack of available medical care in Zambia's prisons violate human rights protections and threaten prisoners' health. In order to protect the health of prisoners, prison-based health services, linkages to community-based health care, general prison conditions and failures of the criminal justice system that exacerbate overcrowding must be immediately improved. International donors should work with the Zambian government to support prison and justice system reform and ensure that their provision of funding in such areas as health services respect human rights standards, including non-discrimination. Human rights protections against torture and cruel, inhuman or degrading treatment, and criminal justice system rights, are essential to curbing the spread of HIV and TB in Zambian prisons, and to achieving broader goals to reduce HIV and TB in Zambia.
Country
Zambia
Publisher
Journal of the International AIDS Society
Theme area
Human resources for health
Title of publication "More money for health - more health for the money": a human resources for health perspective
Date of publication
2011 July
Publication type
Journal Article
Publication details
Human Resources for Health 9 18
Publication status
Published
Language
English
Keywords
health policy, health financing, maternal health, global
Abstract
At the MDG Summit in September 2010, the UN Secretary-General launched the Global Strategy for Women's and Children's Health. Central within the Global Strategy are the ambitions of "more money for health" and "more health for the money". These aim to leverage more resources for health financing whilst simultaneously generating more results from existing resources - core tenets of public expenditure management and governance. This paper considers these ambitions from a human resources for health (HRH) perspective. Using data from the UK Department for International Development (DFID) we set out to quantify and qualify the British government's contributions on HRH in developing countries and to establish a baseline. To determine whether activities and financing could be included in the categorisation of 'HRH strengthening' we adopted the Agenda for Global Action on HRH and a WHO approach to the 'working lifespan' of health workers as our guiding frameworks. To establish a baseline the paper reviews available data on Official Development Assistance (ODA) and country reports, undertook a new survey of HRH programming and sought information from multilateral partners. In financial year 2008/9 DFID spent GBP901 million on direct 'aid to health'. Due to the nature of the Creditor Reporting System (CRS) of the Organisation for Economic Co-operation and Development (OECD) it is not feasible to directly report on HRH spending. The paper therefore employed a process of imputed percentages supported by detailed assessment in twelve countries. This followed the model adopted by the G8 to estimate ODA on maternal, newborn and child health. Using the G8's model, and cognisant of its limitations, the authors concluded that UK 'aid to health' on HRH strengthening is approximately 25%. In quantifying DFID's disbursements on HRH the paper encountered the constraints of the current CRS framework. This limits standardised measurement of ODA on HRH. This is a governance issue that will benefit from further analysis within more comprehensive programmes of workforce science, surveillance and strategic intelligence. The Commission on Information and Accountability for Women's and Children's Health may present an opportunity to partially address the limitations in reporting on ODA for HRH and present solutions to establish a global baseline.
Country
United Kingdom
Publisher
Human Resources for Health
Theme area
Equitable health services
Title of publication Equity implications of coverage and use of insecticide treated nets distributed for free or with co-payment in two districts in Tanzania: A cross sectional comparative household survey
Date of publication
2011 July
Publication type
Journal Article
Publication details
International Journal for Equity in Health 10 29
Publication status
Published
Language
English
Keywords
social marketing, insecticide treated bednets, malaria, user fees, Tanzania
Abstract
In Tanzania, the distribution and coverage of insecticide-treated nets (ITNs) is inequitable. Arguments about the most effective and equitable approach to distributing ITNs are centered on whether to provide ITNs free of charge or continue with existing social marketing strategies. The Government has decided to provide free ITNs to all children under five in the country. It is still uncertain whether this strategy will achieve equitable coverage and use. This study examined the equity implications of ownership and use of ITNs in households from different socioeconomic quintiles in a district with free ITNs and a district without free ITN distribution. A cross-sectional comparative household survey was conducted in two districts: Mpanda in Rukwa Region (with free ITN roll out) and Kisarawe in Coast region (without free ITNs). Heads of 314 households were interviewed in Mpanda and Kisarawe. The concentration index was estimated and regression analysis was performed to compare socioeconomic inequalities in ownership and use of ITNs. Ownership of ITNs increased from 29% in the 2007/08 national survey to 90% after the roll out of free ITNs in Mpanda, and use increased from 13% to 77%. Inequality was considerably lower in Mpanda, with nearly perfect equality in use (concentration index 0.009) and ownership (concentration index 0.010). In Kisarawe, ownership of ITNs increased from 48% to 53% in the 2007/08 national survey, with a marked inequality concentration index 0.132. ITN use in Kisarawe district was 42 % with a pro rich concentration index of 0.027. The results shed some light on the possibility of reducing inequality in ownership and use of ITNs and attaining Roll Back Malaria and Millennium Development Goals through the provision of free ITNs to all. This has the potential to decrease the burden of disease and reduce disparity in disease outcome.
Country
Tanzania
Publisher
International Journal for Equity in Health
Theme area
Poverty and health
Title of publication Do enhancements to the urban built environment improve physical activity levels among socially disadvantaged populations?
Date of publication
2011 July
Publication type
Journal Article
Publication details
International Journal for Equity in Health 10 28
Publication status
Published
Language
English
Keywords
health policy, urban environment, physical activity
Abstract
There is growing recognition that the urban built environment influences physical activity at the population level, although the effects on disadvantaged groups are less well understood. Using the examples of open / green space and street connectivity, this paper explores whether enhancements to the built environment have potential for addressing physical activity-related health inequalities among Maori, Pacific and low income communities in New Zealand. A high-level review of the international literature relating open space and street connectivity to physical activity and/or related health outcomes at a population level was completed. Consideration was given to whether these features of the built environment have a disproportionate effect on disadvantaged populations. Findings from international studies suggest that open space and street connectivity have a beneficial effect on physical activity. Enhancing the built environment may be particularly advantageous for improving physical activity levels among disadvantaged populations. It is likely that open space and street connectivity have a positive effect on physical activity behaviour; however due to the cross-sectional nature of existing research and the paucity of research among disadvantaged populations definitive conclusions about the effect in these populations cannot be made. Further research is required (e.g. natural experiments or quasi experimental research designs) to determine the effect of changing the environment on physical activity and obesity.
Country
New Zealand
Publisher
International Journal for Equity in Health
Theme area
Resource allocation and health financing
Title of publication Who pays for health care in Ghana?
Date of publication
2011 June
Publication type
Journal Article
Publication details
International Journal for Equity in Health 10 26
Publication status
Published
Language
English
Keywords
health policy, health financing, Ghana
Abstract
Financial protection against the cost of unforeseen ill health has become a global concern as expressed in the 2005 World Health Assembly resolution (WHA58.33), which urges its member states to "plan the transition to universal coverage of their citizens". An important element of financial risk protection is to distribute health care financing fairly in relation to ability to pay. The distribution of health care financing burden across socio-economic groups has been estimated for European countries, the USA and Asia. Until recently there was no such analysis in Africa and this paper seeks to contribute to filling this gap. It presents the first comprehensive analysis of the distribution of health care financing in relation to ability to pay in Ghana.
Country
Ghana
Publisher
International Journal for Equity in Health
Theme area
Resource allocation and health financing
Title of publication Health financing in Africa: overview of a dialogue among high level policy makers
Date of publication
2011 July
Publication type
Journal Article
Publication details
BMC Proceedings 5 5
Publication status
Published
Language
English
Keywords
health financing; policy makers; Africa;
Abstract
Even though Africa has the highest disease burden compared with other regions, it has the lowest per capita spending on health. In 2007, 27 (51%) out the 53 countries spent less than US$50 per person on health. Almost 30% of the total health expenditure came from governments, 50% from private sources (of which 71% was from out-of-pocket payments by households) and 20% from donors. This article reflects the proceedings of the African Union Side Event on Health Financing in the African continent, drawing from the presentations, panel discussion and open public discussion with ministers of health and finance from the African continent. The current unsatisfactory state of health financing was attributed to lack of clear vision and plan for health financing; lack of national health accounts and other evidence to guide development and implementation of national health financing policies and strategies; low investments in sectors that address social determinants of health; predominance of out-of-pocket spending; underdeveloped prepaid health financing mechanisms; large informal sectors vis-a-vis small formal sectors; and unpredictability and non-alignment of majority of donor funds with national health priorities. Countries need to develop and adopt a comprehensive national health policy and a costed strategic plan; a comprehensive evidence-based health financing strategy; allocate at least 15% of the national budget to health development; use GFATM and PEPFAR funds for health systems strengthening; strengthen intersectoral collaboration to address health determinants; advocate among donors to implement the Paris Declaration on Aid Effectiveness and its Accra Agenda for Action; ensure universal access to health services for pregnant women, lactating mothers and children aged under five years; strengthen financial management capacities; and develop prepaid health financing systems, especially health insurance to complement tax funding. In addition, countries need to institutionalize national health accounts; undertake feasibility studies of various health financing mechanisms; and document and share best practices in health financing. There was consensus that every country ought to have an evidence-based comprehensive health financing strategy with a road map for attaining universal health service coverage vision; and increase physical and financial access by pregnant women, lactating mothers and by children under five years to quality health services.
Country
East and southern Africa region
Publisher
BMC Proceedings
Theme area
Health equity in economic and trade policies
Title of publication Globalization and Women’s Health in East and Southern Africa Research workshop report, Nairobi Kenya
Date of publication
2011 May
Publication type
Report
Publication details
Publication status
Published
Language
Keywords
Globalisation; womens health; womens occupational roles; east and southern Africa
Abstract
The research project on globalization and women’s health in east and southern Africa has been co-ordinated by Karolinska Institute and Training and Research Support Centre with support from SAREC Sweden. It has in 2008-2010 implemented field studies, data gathering, analysis and desk studies. The project aimed to analyse the impact of globalisation on women’s occupational roles and health in Sub-Saharan Africa, and the consequences for household food security, health and nutrition. The case studies were performed in urban Dar es Salaam, Tanzania, urban Nakuru in Kenya and rural Ntungamo in Uganda. The country co-ordination was done by the Training and Research Support Centre (TARSC) Tanzania, the University of Makerere in Uganda and African Institute for Health and Development, Kenya. Analysis of indicators from the Millennium Development Goals (MDGs) database to investigate the association between globalisation and women’s health in Sub-Saharan Africa found that developing countries are becoming more integrated with world markets through some lowering of trade barriers, that women’s occupational roles are changing, but that the impact of these changes on women’s health is difficult to assess from the MDG database due to lack of adequate disaggregation. The literature review suggested that globalisation related economic and trade policies have on balance been associated with shifts in women’s occupational roles and resources that contribute to documented poor nutritional outcomes in Africa. These results have been presented in published scientific research papers in peer reviewed journals. Follow up field case study findings were presented orally at the Regional Network on Equity in Health in Southern Africa (EQUINET) conference held in September 2009 and two have been submitted to peer reviewed journals. The research workshop was thus held by Training and Research Support Centre (TARSC)/ EQUINET, Karolinska Institute, Sweden, African Institute for Health & Development (AIHD) and locally hosted by African Institute for Health & Development (AIHD) to report back on the findings of the project and share evidence among stakeholders involved in research globalization and women’s health issues; to discuss a research agenda for future work; to identify methods issues and options for work on globalization and health; and to explore and build partnerships in future research, policy engagement and information dissemination.
Country
East and southern Africa region
Publisher
AIHD, TARSC, Karolinska
Theme area
Equity and HIV/AIDS
Title of publication Sexuality among the elderly in Dzivaresekwa district of Harare: the challenge of information, education and communication campaigns in support of an HIV/AIDS response
Date of publication
2011 January
Publication type
Journal Article
Publication details
African Journal of AIDS Research 10 1 pp 95-100
Publication status
Published
Language
English
Keywords
ageing, ethnography, health education, sexual health, sexually transmitted infections, southern Africa
Abstract
This ethnographic study in Dzivaresekwa district, Harare, Zimbabwe, examines the issue of sexuality among the elderly and their challenges in accessing information, education, and communication (IEC) campaigns in the face of HIV and AIDS. The research depended heavily on collecting life histories through key informant interviews. The theory of structuration as proposed by Anthony Giddens was adopted as a framework to analyse the findings. The findings reveal that although the sample of elderly people in Dzivaresekwa district were sexually active, HIV/AIDS-related interventions in the form of IEC campaigns mainly focus on the age group of 14–49-year-olds, and otherwise consider the elderly only as a group indirectly affected by the epidemic and less at risk of HIV infection. This is mainly a result of society’s presumption that people withdraw from sexual life with advanced age. Thus, the elderly are incorrectly regarded as sexually inactive and not susceptible to contracting sexually transmitted infections. A fuller understanding of the sexuality of the elderly is important to increase the usefulness HIV/AIDS efforts, while IEC campaigns that target them are still needed.
Country
Zimbabwe
Publisher
African Journal of AIDS Research
Theme area
Resource allocation and health financing
Title of publication The impact of social cash transfers on children
Date of publication
2007
Publication type
Academic paper
Publication details
Publication status
Published
Language
English
Keywords
Malawi, child health, social cash transfers, poverty
Abstract
The authors of this paper discuss the degree to which social cash transfer schemes that do not explicitly target HIV and AIDS affected persons or households reach HIV and AIDS affected households. By comparing different schemes in Zambia, Malawi and South Africa, the study identifies the main factors that determine both the share of HIV and AIDS affected households reached, and the impact achieved. The authors find that in terms of the share of HIV and AIDS affected households benefiting from the scheme, the Zambia and Malawi schemes seem to have the highest share of HIV and AIDS affected households as a percentage of all beneficiary households. About 70 per cent of the beneficiary households seem to be HIV and AIDS affected, even though they do not use HIV and AIDS as a targeting criterion. With regard to focusing on the ultra poor and neediest of the HIV and AIDS affected households the Zambia and Malawi schemes score high whereas the South African schemes score low. In the impact on children in HIV and AIDS affected households reached by the different schemes, the South African ones score highest. The generous amounts transferred by these schemes go some way to ensuring that the basic needs of children are met.
Country
Malawi
Publisher
Malawi Social Cash Transfer Pilot Scheme
Theme area
Resource allocation and health financing
Title of publication The 'diagonal' approach to global fund financing: A cure for the broader malaise of health systems?
Date of publication
2008 March
Publication type
Journal Article
Publication details
Globalization And Health 4 6
Publication status
Published
Language
English
Keywords
Global health diplomacy, Africa, Global Fund, HIV/AIDS, tuberculosis, malaria, health financing
Abstract
The potentially destructive polarisation between 'vertical' financing (aiming for disease-specific results) and 'horizontal' financing (aiming for improved health systems) of health services in developing countries has found its way to the pages of Foreign Affairs and the Financial Times. The opportunity offered by 'diagonal' financing (aiming for disease-specific results through improved health systems) seems to be obscured in this polarisation. In April 2007, the board of the Global Fund to fight AIDS, Tuberculosis and Malaria agreed to consider comprehensive country health programmes for financing. The new International Health Partnership Plus, launched in September 2007, will help low-income countries to develop such programmes. The combination could lead the Global Fund to fight AIDS, Tuberculosis and Malaria to a much broader financing scope. This evolution might be critical for the future of AIDS treatment in low-income countries, yet it is proposed at a time when the Global Fund to fight AIDS, Tuberculosis and Malaria is starved for resources. It might be unable to meet the needs of much broader and more expensive proposals. Furthermore, it might lose some of its exceptional features in the process: its aim for international sustainability, rather than in-country sustainability, and its capacity to circumvent spending restrictions imposed by the International Monetary Fund. The authors believe that a transformation of the Global Fund to fight AIDS, Tuberculosis and Malaria into a Global Health Fund is feasible, but only if accompanied by a substantial increase of donor commitments to the Global Fund. The transformation of the Global Fund into a 'diagonal' and ultimately perhaps 'horizontal' financing approach should happen gradually and carefully, and be accompanied by measures to safeguard its exceptional features.
Country
East and southern Africa region
Publisher
BioMed
Theme area
Resource allocation and health financing
Title of publication Maintaining quality of health services after abolition of user fees: A Uganda case study
Date of publication
2008 May
Publication type
Journal Article
Publication details
BMC Health Services Research 8 102
Publication status
Published
Language
English
Keywords
Uganda, user fees, poverty
Abstract
It has been argued that quality improvements that result from user charges reduce their negative impact on utilisation especially of the poor. In Uganda, because there was no concrete evidence for improvements in quality of care following the introduction of user charges, the government abolished user fees in all public health units on 1 March 2001. Different quality variables assessed showed that interventions that were put in place were able to maintain, or improve the technical quality of services. There were significant increases in utilisation of services, average drug quantities and stock out days improved, and communities reported health workers to be hardworking, good and dedicated to their work. The levels of technical quality of care attained in a system with user fees can be maintained, or even improved without the fees through adoption of basic, sustainable system modifications that are within the reach of developing countries. However, a trade-off between residual perceptions of reduced service quality, and the welfare gains from removal of user fees should guide such a policy change.
Country
Uganda
Publisher
BioMed
Theme area
Human resources for health
Title of publication Guidelines: Incentives for health professionals
Date of publication
2008 May
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
Global health diplomacy, Africa, recruitment, retention, incentives
Abstract
The world's leading health and hospital professional associations worked together to produce the first joint guidelines on incentives for the retention and recruitment of health professionals. Underlining both financial and non-financial incentives as critical to ensuring effective recruitment, retention and performance of health workers across the world, the Guidelines on Incentives describe different approaches taken by a number of countries. Examples of financial incentives cited include tax waivers, allowances (e.g. - housing, clothing, child care, remote location weighting etc.), insurance, and performance payments. Examples of non financial incentives include ensuring positive work environments, flexibility in employment arrangements and support for career development. The report underlines how incentives are important levers that organisations can use to attract, retain, motivate and improve the performance of their staff in all professions and walks of life. This is especially and urgently needed in the health care sector, where the growing gap between the supply of health care professionals and the demand for their services is reaching crisis levels in many countries.
Country
East and southern Africa region
Publisher
Global Health Workforce Alliance
Theme area
Human resources for health
Title of publication Intent to migrate among nursing students in Uganda: Measures of the brain drain in the next generation of health professionals
Date of publication
2008 February
Publication type
Journal Article
Publication details
Human Resources For Health 6 5
Publication status
Published
Language
English
Keywords
Global health diplomacy, Uganda, brain drain, migration
Abstract
There is significant concern about the worldwide migration of nursing professionals from low-income countries to rich ones, as nurses are lured to fill the large number of vacancies in upper-income countries. This study explores the views of nursing students in Uganda to assess their views on practice options and their intentions to migrate. Most (70%) of the participants would like to work outside Uganda, and said it was likely that within five years they would be working in the US(59%) or the UK(49%). About a fourth (27%) said they could be working in another African country. Only eight percent of all students reported an unlikelihood to migrate within five years of training completion. Survey respondents were more dissatisfied with financial remuneration than with any other factor pushing them towards emigration. Those wanting to work in the settings of urban, private, or UK/US practices were less likely to express a sense of professional obligation and/or loyalty to the country. Those who have lived in rural areas were less likely to report wanting to emigrate. Students with a desire to work in urban areas or private practice were more likely to report an intention to emigrate for financial reasons or in pursuit of country stability, while students wanting to work in rural areas or public practice were less likely to want to emigrate overall.
Country
Uganda
Publisher
Theme area
Health equity in economic and trade policies
Title of publication A critical review of Uganda’s Draft Industrial Property Bill
Date of publication
2008 March
Publication type
Journal Article
Publication details
Medicine Access Digest 4 1 pp 4-5
Publication status
Published
Language
English
Keywords
Global health diplomacy, Uganda, TRIPS, essential medicines
Abstract
Most Ugandans are likely to go without essential medicines if the government does not take advantage of the flexibility provisions of the WTO’s Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) in the process of enacting the national intellectual property (IP) law. HEPS-Uganda’s review of the draft Industrial Property Bill 2007 established that while the draft bill attempts to incorporate the TRIPS flexibilities, some of them were drafted in a restrictive style such that Uganda may not derive maximum flexibility as envisaged by TRIPS Agreement, the Doha Declaration and other non-legally binding instruments.
Country
Uganda
Publisher
Theme area
Monitoring equity and research to policy
Title of publication How can southern research influence aid policy?
Date of publication
2008
Publication type
Academic paper
Publication details
Publication status
Published
Language
English
Keywords
Global health diplomacy, Africa, aid policy, health research
Abstract
In light of increased access to policy dialogue about the reform of the international aid architecture, this paper explores ways in which southern researchers can maximise their input in to the debate. The authors argue that the current aid system is changing significantly, not only in terms of the increasing amounts of money which are likely to flow through the system, but also because of the range of new donors and funding vehicles which are joining it. This change is making the system more complex, and could potentially reduce the effectiveness of the aid that flows through it, but it also offers significant opportunities for reform. Specifically a number of decision-making fora have recently opened up which offer the chance for greater participation by southern organisations, particularly research institutes and think-tanks. To aid southern researchers’ affect on the debate the authors propose that they: target the content of the research; ensure it is in an appropriate medium and tailor it to the policy-makers; identify which international aid policy fora are most likely to take up their research; and increase focus on effective communication – researchers need to prepare a communications strategy to help to target their limited resources and capacity more effectively.
Country
East and southern Africa region
Publisher
Forum On The Future Of Aid
Theme area
Equity and HIV/AIDS
Title of publication International politics of HIV/AIDS: Global disease-local pain
Date of publication
2007
Publication type
Book
Publication details
Publication status
Published
Language
English
Keywords
Global health diplomacy, sub-Saharan Africa, HIV/AIDS, global governance
Abstract
This book examines the global governance of the AIDS epidemic, interrogating the role of this international system and global discourse on interventions. The geographical focus is Sub-Saharan Africa since the region has been at the forefront of these interventions. There is a need to understand the relationship between the international political environment and the impact of resulting policies on HIV and AIDS in the context of people's lives. There is a certain disjuncture between this governance structures and the way people experience the disease in their everyday lives. Although the structure allows people to emerge as policy relevant target groups and beneficiaries, the articulation of needs and design of policy interventions tends to reflect international priorities rather than people's thinking on the problem and the nature of the system does not allow interventions to be far reaching and sustainable.
Country
Southern Africa Regional
Publisher
Routledge UK
Theme area
Equity in health, Equitable health services
Title of publication HIV-TB co-infection: Meeting the challenge
Date of publication
2007
Publication type
Academic paper
Publication details
Publication status
Published
Language
English
Keywords
Sub-Saharan Africa, Africa, tuberculosis, HIV/AIDS, HIV-TB co-infection
Abstract
Ten per cent of individuals infected with TB develop the active disease but this is greatly increased in those whose immune systems have been weakened by HIV. This report from the Forum for Collaborative HIV Research highlights the difficulty in managing the co-epidemic of HIV and TB that is rapidly spreading in Sub-Saharan Africa. The report concludes that strategies for dealing with TB and HIV currently exist in isolation, often reinforced by vertical programme financing. Efforts must be made to integrate these disease treatment programmes that will involve stakeholders working together within an evidence-based collaborative framework.
Country
Southern Africa Regional
Publisher
The Forum For Collaborative HIV Research
Theme area
Resource allocation and health financing
Title of publication Mozambique: An independent analysis of ownership and accountability in the development aid system
Date of publication
2008 March
Publication type
Academic paper
Publication details
Publication status
Published
Language
English
Keywords
Global health diplomacy, Mozambique, external funders, Paris Declaration, aid effectiveness
Abstract
Mozambique is referred to as being a success story after seventeen years of civil war and economic and social decline. The country is highly dependent on external aid. Long before the Paris Declaration on Aid Effectiveness, the Government of Mozambique (GoM) and a group of donors made efforts to coordinate and harmonise external aid. Therefore, it is interesting to study the evolution of external aid mechanisms to the country. The general objective of the research is to contribute to the agenda, discussion and results of the Ghana High Level Forum on aid effectiveness, reporting on progress and concerns regarding the implementation of the Paris Declaration. In the specific case of Mozambique, the research aims to examine critically the aid system and the implications of the Paris Declaration, especially concerning ownership and accountability in the external aid system.
Country
Mozambique
Publisher
Better Aid
Theme area
Resource allocation and health financing
Title of publication Mobilising external development support for the MDGs in SADC: Promises, progress and challenges
Date of publication
2008
Publication type
Academic paper
Publication details
Publication status
Published
Language
English
Keywords
Global health diplomacy, Southern African Development Community, Millennium Development Goals, aid
Abstract
This paper focuses on the efforts to increase development aid. What were the decisions and promises made following the adoption of the Millennium Development Goals? What pledges and commitments did the traditional donor agencies and the developed countries make? What are the achievements? Did they deliver? The paper finds that the traditional donor countries – the G8 and the OECD countries - have delivered far less than promised and expected. The target of doubling aid flows to Africa in 2010 compared to 2004 is unlikely to be achieved. There have been significant increases in aid to Africa but most of the additional aid is provided for debt relief operations with only modest increases in aid for development programmes. In Southern Africa all increase is tied to debt relief operations (mainly for the DR Congo) with no additional aid provided for development programmes. Although not much additional development aid is forthcoming through these channels; it may have helped to shift priorities to accelerate achievement of some MDGs, such as child health. The emergence of China and other emerging powers in the south as development actors in Africa is of major significance. It creates both new opportunities and new challenges for development and poverty reduction. These countries are not primarily providers of development aid, but they are important in assisting development as investors, traders and providers of support for infrastructure development – and in potentially increasing the bargaining power of African states.
Country
Southern Africa Regional
Publisher
SADC
Theme area
Health equity in economic and trade policies
Title of publication The ability of select sub-Saharan African countries to utilise TRIPs Flexibilities and Competition Law to ensure a sustainable supply of essential medicines: A study of producing and importing countries
Date of publication
2006
Publication type
Academic paper
Publication details
Publication status
Published
Language
English
Keywords
Global health diplomacy, Africa, Southern African Development Community, TRIPS, essential medicines
Abstract
Despite the successes in using competition law to reduce drug prices in South Africa, the prospects of other countries in the SADC region for being able to utilise competition law and policy to attain similar objectives are not high due to a lack of institutional capacity (in some cases) and a lack of expertise, the authors of this paper argue. By an initial focus on domestic legislation, SADC countries may ultimately pave the way for a form of regional harmonisation for competition policy. As developments in South Africa have shown, national competition policy can ensure that national markets function efficiently, assure consumers of competitive prices and product choices, and promote other such efficiency-plus objectives. However, it is true that market developments tend to outstrip policy and regulatory developments. This region demonstrates perhaps one of the most confusing and complex arrays of overlapping membership of regional trade organisations with various countries being members either of SACU, SADC or COMESA. Given the spaghetti bowl of multiple memberships of regional trading organisations in the region, it is suggested that the two most viable (but by no means exclusive) options to explore for a regional competition policy are COMESA and SACU.
Country
Southern Africa Regional
Publisher
ICTSD, UNCTAD and tralac
Theme area
Human resources for health
Title of publication University partnership to address the shortage of healthcare professionals in Africa
Date of publication
2008 April
Publication type
Journal Article
Publication details
Global Public Health 3 2 pp 137-148
Publication status
Published
Language
English
Keywords
Global health diplomacy, Africa, health worker shortage, medical education
Abstract
The shortage of qualified health professionals is a major obstacle to achieving better health outcomes in many parts of the world, particularly in Africa. The role of health science universities in addressing this shortage is to provide quality education and continuing professional development opportunities for the healthcare workforce. Academic institutions in Africa, however, are also short of faculty and especially under-resourced. The authors describe the initial phase of an institutional partnership between the Muhimbili University of Health and Allied Sciences (MUHAS) and the University of California San Francisco (UCSF) centred on promoting medical education at MUHAS. The challenges facing the development of the partnership include the need: (1) for new funding mechanisms to provide long-term support for institutional partnerships, and (2) for institutional change at UCSF and MUHAS to recognize and support faculty activities that are important to the partnership. The growing interest in global health worldwide offers opportunities to explore new academic partnerships. It is important that their development and implementation be documented and evaluated as well as for lessons to be shared.
Country
East and southern Africa region
Publisher
Theme area
Human resources for health
Title of publication A global dialogue on a global crisis
Date of publication
2008 April
Publication type
Journal Article
Publication details
The Lancet 371 9619
Publication status
Published
Language
English
Keywords
Africa, global health diplomacy, health worker migration, recruitment
Abstract
At the first Global Forum on Human Resources for Health in Kampala, Uganda, delegates endorsed a Global Agenda for Action on the alarming imbalances in the availability and distribution of health workers worldwide. One component of the Agenda was a pledge to "accelerate negotiations for a code of practice on the international recruitment of health workers". The first step was taken on March 31 with the launch of a 3-week online global dialogue convened by the Health Worker Migration Policy Initiative. The global dialogue provided a unique opportunity for anyone affected by the vast complexities of health-worker migration, in whatever capacity, to share experiences and knowledge on the realities of migration, on effective strategies to retain health workers where they are needed most, and on what the key principles of a global code of practice should be. The paper questions whether another code of practice really required.
Country
East and southern Africa region
Publisher
Theme area
Equity in health, Values, policies and rights
Title of publication Health transition in Africa: practical policy proposals for primary care
Date of publication
2010 December
Publication type
Journal Article
Publication details
Bulletin Of The World Health Organization 88 12 pp 943-948
Publication status
Published
Language
English
Keywords
Global health diplomacy, sub-Saharan Africa, primary health care, communicable diseases, non-communicable diseases
Abstract
Sub-Saharan Africa is undergoing health transition as increased globalization and accompanying urbanization are causing a double burden of communicable and noncommunicable diseases. Rates of communicable diseases such as HIV/AIDS, tuberculosis and malaria in Africa are the highest in the world. The impact of noncommunicable diseases is also increasing. As the entry point into the health service for most people, primary care plays a key role in delivering communicable disease prevention and care interventions. This role could be extended to focus on noncommunicable diseases as well, within the context of efforts to strengthen health systems by improving primary-care delivery. The authors put forward practical policy proposals to improve the primary-care response to the problems posed by health transition: improving data on communicable and noncommunicable diseases; implementing a structured approach to the improved delivery of primary care; putting the spotlight on quality of clinical care; aligning the response to health transition with health system strengthening; and capitalizing on a favourable global policy environment. Implementing these proposals requires action by national and international alliances in mobilizing the necessary investments for improved health of people in developing countries in Africa undergoing health transition.
Country
East and southern Africa region
Publisher
World Health Organisation
Theme area
Health equity in economic and trade policies, Poverty and health, Governance and participation in health
Title of publication Ten reasons why the Rockefeller and the Bill and Melinda Gates Foundations’ Alliance for Another Green Revolution will not solve the problems of poverty and hunger in sub-Saharan Africa
Date of publication
2008
Publication type
Academic paper
Publication details
Publication status
Published
Language
English
Keywords
Global health diplomacy, Africa, poverty, agriculture, Alliance for a Green Revolution in Africa, Gates Foundation, Rockefeller Foundation
Abstract
This article analyses the effectiveness of the joint ‘Alliance for a Green Revolution in Africa’ (AGRA), a project of the Rockefeller Foundation and the Bill & Melinda Gates Foundation aimed at reducing poverty, hunger and malnutrition. The authors argue that, based on the first Green Revolution experience, this initiative will not succeed because: 1. The Green Revolution actually deepens the divide between rich and poor farmers; 2. Over time, Green Revolution technologies degrade tropical agro-ecosystems and increase environmental risk; 3. The Green Revolution leads to the loss of agro-biodiversity; 4. Hunger is not primarily due to a lack of food, but rather because the hungry are too poor to buy the food that is available; 5. Without addressing structural inequities in the market and political systems, approaches relying on high input technologies fail; 6. The private sector alone will not solve the problems; 7. Genetic engineering (GE) will make Sub-Saharan smallholder systems more environmentally vulnerable; 8. GE crops into smallholder agriculture will likely lead to farmer indebtedness; 9. The assertion that “There Is No Alternative” (TINA) ignores the many successful agro-ecological and non-corporate approaches to agricultural development; 10. AGRA’s “alliance” does not allow peasant farmers to be the principal actors in agricultural improvement. The authors conclude that if the Gates and Rockefeller Foundations want to end hunger, poverty and malnutrition in rural Africa, then they should invest in the service of the struggle by peasant and farmer organisations and their allies to truly achieve food sovereignty.
Country
East and southern Africa region
Publisher
Institute For Food And Development Policy
Theme area
Resource allocation and health financing
Title of publication Microfinance and poverty reduction in the SADC region
Date of publication
2008
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
Southern Africa, Southern African Development Community, poverty, development
Abstract
This report by the SADC secretariat summarises microfinance outcomes of the SADC International Conference on Poverty and Development, held from 18–20 April 2008 in Mauritius. Microfinance has been recognised, globally, as a viable and sustainable tool for poverty reduction and economic development through improving income generating activities and employment creation. Despite well documented evidence of the positive impact of promoting access to finance to under-served segments of the community, many poor people in the Africa, particularly in Southern African Development Community (SADC), still remain excluded from the mainstream financial system. Microfinance programmes are reported to stimulate the growth of the micro-enterprises and the SME sectors, assist in the formalization of the informal sector and integrate that sector into the mainstream economy, thus contributing to socio-economic development and to poverty reduction.
Country
Southern Africa Regional
Publisher
SADC
Theme area
Equity in health, Poverty and health
Title of publication Economic impact of the three communicable diseases: HIV and AIDS, TB and malaria on the SADC region
Date of publication
2008
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
Southern Africa, Southern African Development Community, communicable diseases, HIV/AIDS, tuberculosis, malaria
Abstract
This report by the SADC secretariat summarises some of the outcomes of the SADC International Conference on Poverty and Development, held from 18–20 April 2008 in Mauritius. The region as a whole is not on track to meet the MDG targets owing to, among others, increased prevalence of communicable diseases. In this report, the secretariat discusses the Economic impact of the three communicable diseases: HIV and AIDS, TB and malaria and demonstrate that these diseases negatively affect economic growth. The paper is based on literature review of studies done within and outside the SADC region on the impact of the three communicable diseases.
Country
Southern Africa Regional
Publisher
SADC
Theme area
Health equity in economic and trade policies, Poverty and health, Governance and participation in health
Title of publication Agriculture and the WTO in Africa: Understand to act
Date of publication
2007
Publication type
Book
Publication details
Publication status
Published
Language
English
Keywords
Global health diplomacy, Africa, World Trade Organisation, agriculture
Abstract
African countries have always struggled to participate fully in the World Trade Organisation (WTO) and to influence its decisions. In addition to under-representation at WTO headquarters, the complexity of WTO bodies, rules and procedures weakens inputs. This book provides guidance in understanding how international trade institutions and agreements operate. Its aim is to provide those in charge of civil society organisations in sub-Saharan Africa with tools and references to better understand the stakes behind, and means for, their participation in world trade. Organised around descriptive and factual texts, this work contains many definitions and is illustrated by concrete experiences that facilitate reading.
Country
East and southern Africa region
Publisher
Groupe De Recherche Et D'echanges Technologiques
Theme area
Governance and participation in health
Title of publication Our money, our responsibility: A citizens' guide to monitoring government expenditures
Date of publication
2008
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
Africa, government expenditure, national budget, civil society
Abstract
This Guide documents pioneering methodologies used by civil society organizations around the developing world to hold their governments to account for the use of public resources. Specific methodologies examined by the Guide include social audits, citizen report cards, public expenditure tracking surveys, procurement monitoring tools, and participatory auditing tools. These methodologies are considered in detailed case studies presenting the work of 17 organizations from 12 countries in Asia, Africa, and Latin America. The Guide will enable readers to gain familiarity with the typical processes followed by national-level governments during the execution of budgets, management of procurements, measurement of impact achieved by expenditures, and oversight of budget expenditures through audits and legislative supervision. For each of these processes, the Guide provides practical tools and techniques that readers can use to monitor the results achieved by government expenditures.
Country
East and southern Africa region
Publisher
International Budget Project
Theme area
Resource allocation and health financing
Title of publication Health insurance in sub-Saharan Africa: A call for subsidies
Date of publication
2008 March
Publication type
Journal Article
Publication details
Bulletin Of The World Health Organization 86 3 pp A-F
Publication status
Published
Language
English
Keywords
Sub-Saharan Africa, national health insurance, poverty, health financing
Abstract
If health insurance is to cover broader population strata in sub-Saharan Africa and to assure satisfactory health services, schemes will require continuous and long-term subsidies to bridge the gap between household capacity to contribute financially and the real costs of health care. The development of approaches addressing this dilemma should be considered as a research priority. They might include initiatives of north–south risk pooling. This necessity is underpinned by the capacity of health insurance to formalise social protection and create a market between health service providers and their “customers”, simultaneously alleviating poverty and empowering communities. Yet, available evidence points out that to play these roles, health insurance needs subsidies.
Country
East and southern Africa region
Publisher
Theme area
Governance and participation in health
Title of publication Harmonisation for health in Africa: An action framework
Date of publication
2007
Publication type
Academic paper
Publication details
Publication status
Published
Language
English
Keywords
Global health diplomacy, Africa, Harmonisation for Health in Africa, Millennium Development Goals
Abstract
This paper sets out an initiative by African Development Bank, UNAIDS, UNFPA, UNICEF, WHO and the World Bank that aims to tackle barriers to scaling up health in Africa. The ‘Harmonisation for Health in Africa’ initiative HHA is a regional mechanism through which collaborating partners agree to focus on providing support to the countries in the African region for reaching health MDGs. The HHA initiative aims to: support countries to identify, plan and address health systems constraints to improve health related outcomes; develop national capacity through training, planning, costing and budgeting, harmonisation and stimulating peer exchange; promote the generation and dissemination of knowledge, guidance and tools for specific technical areas including strengthening health service delivery and monitoring health systems performance; support countries to leverage predictable and sustained resources for the health sector; ensure accountability and assist in monitoring performance, of national health systems, aid effectiveness and the performance of the International Health Partnership; and enhance coordination to support nationally owned plans and implementation process, helping countries to address the country level bottlenecks arising from constraints within international agencies.
Country
East and southern Africa region
Publisher
World Health Organisation
Theme area
Values, policies and rights, Health equity in economic and trade policies
Title of publication Human rights guidelines for pharmaceutical companies in relation to access to medicines: The sexual and reproductive health context
Date of publication
2009 March
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
Global health diplomacy, Africa, human rights, pharmaceutical sector, sexual health, reproductive health
Abstract
In this briefing, the authors consider the responsibilities of pharmaceutical companies for enhancing access to medicines in the context of sexual and reproductive health. They first examine the issue of access to medicine in the context of both HIV/AIDS and the human papilloma virus (HPV), highlighting the intersection with the fundamental rights to sexual and reproductive health. Having provided this context, the authors outline the responsibilities of States to ensure that medicines are available, accessible, culturally acceptable, and of good quality. However, they stress that the pharmaceutical sector has an indispensable role to play in relation to the right to health and access to medicines. The responsibility should be shared between the pharmaceutical industry and global and national governing bodies.
Country
East and southern Africa region
Publisher
University Of Essex
Theme area
Equity and HIV/AIDS
Title of publication SADC, put your money where your mouth is
Date of publication
2008 December
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
Global health diplomacy, Southern African Development Community, HIV/AIDS, Abuja Declaration
Abstract
In this survey on access to AIDS treatment within Southern African Development Community (SADC) countries, SATAMo calls on regional leaders to keep the promises they made towards the provision of HIV treatment by committing much-needed resources. This is the first regional treatment monitoring research to be carried out by community-based treatment activists. They noted that more than 80% of SADC governments have not honoured the Abuja Declaration more than seven years after the commitment, barriers to treatment still exist, reports of stigma and discrimination by health care workers remain high and stock-outs of drugs are common in more than 80% of the countries surveyed. Most countries are struggling to provide first-line treatment to those who need it, with eight countries in SADC below 35% coverage and only two exceeding 75% coverage.
Country
Southern Africa Regional
Publisher
Theme area
Equity in health
Title of publication Health challenges in Africa and the way forward
Date of publication
2008 December
Publication type
Journal Article
Publication details
International Archives Of Medicine 1 27
Publication status
Published
Language
English
Keywords
Africa, communicable diseases, non-communicable diseases, health financing
Abstract
Africa is confronted by a heavy burden of communicable and non-communicable diseases. Cost-effective interventions that can prevent the disease burden exist but coverage is too low due to health systems weaknesses. This editorial reviews the challenges related to leadership and governance; health workforce; medical products, vaccines and technologies; information; financing; and services delivery. It also provides an overview of the orientations provided by the WHO Regional Committee for Africa for overcoming those challenges. It cautions that it might not be possible to adequately implement those orientations without a concerted fight against corruption, sustained domestic and external investment in social sectors, and enabling macroeconomic and political (i.e. internally secure) environment.
Country
East and southern Africa region
Publisher
Theme area
Values, policies and rights, Health equity in economic and trade policies, Equity and HIV/AIDS
Title of publication US trade policy and HIV treatment: The struggle for treatment access
Date of publication
2008 November
Publication type
Document
Publication details
Id21 Insights 75
Publication status
Published
Language
English
Keywords
Global health diplomacy, United States, Africa, HIV/AIDS, trade policy, human rights
Abstract
The United States government’s trade policy has violated the human rights of African people living with HIV and AIDS through its ‘moral’ restrictions prioritising abstinence-only sex education, restricting condom distribution and stigmatising sex workers, according to this article. The author argues that, furthermore, government’s close ties with pharmaceutical companies and manipulation of trade in medicines have also infringed on the human right to health by undermining international efforts to enshrine access to essential medicines as a human right. By sanitising and de-sexualising the politics of HIV and AIDS, and focusing on technocratic approaches such as biomedical quick fixes, like the recent emphasis on male circumcision, it ignores the deeply gendered, racial and sexual dimensions of the disease or its social, economic and cultural pathology.
Country
East and southern Africa region
Publisher
Theme area
Governance and participation in health
Title of publication Foreign policy and global health: Country strategies
Date of publication
2008
Publication type
Academic paper
Publication details
Publication status
Published
Language
English
Keywords
Global health diplomacy, Africa, foreign policy, World Health Organisation
Abstract
While there has been much interest in global health and foreign policy, there has been little data available in this area examining how countries are attempting to address the foreign policy-global health nexus. To address this gap, the World Health Organization (WHO) has brought together six country case studies of Norway, the UK, Switzerland, France, Brazil and Thailand on foreign policy and global health. This paper aims to serve as an introduction to these studies, as well as outline the key issues raised by them. It firsts examines the key reasons why these countries have moved towards linking foreign policy and global health. It then describes the ways in which these governments are engaging both internally and externally and concludes by putting forth four key issues for discussion and for future research. First, the increasing involvement of Ministries of Foreign Affairs raises questions regarding the ability of the WHO to adequately handle this transition to global health diplomacy. Second, ‘second world’ countries are engaging differently on the global stage by relying on clubs for agenda-setting, prioritising key issues and reaching a common position before negotiations in the WHO. Third, further research is required into the current global health-foreign policy nexus. Fourth, while health advocates might use the language of foreign policy as instrumental in gaining attention for causes like malaria and HIV and AIDS, this attention may not move into less ‘glamorous’ areas such as health systems, malnutrition and water and sanitation.
Country
East and southern Africa region
Publisher
Oxford University
Theme area
Governance and participation in health
Title of publication Framing health and foreign policy: Lessons for global health diplomacy
Date of publication
2010 August
Publication type
Journal Article
Publication details
Globalization and Health 6 14
Publication status
Published
Language
English
Keywords
Global health diplomacy, Africa, foreign policy, health finance
Abstract
Global health financing has increased dramatically in recent years, indicative of a rise in health as a foreign policy Issue, in the form of global health diplomacy, which informs foreign policy decision-making in the advancement of international co-operation in health. In this paper, the authors review the arguments for health in foreign policy that inform global health diplomacy. These are organised into six policy frames: security, development, global public goods, trade, human rights and ethical/moral reasoning. Each of these frames has implications for how global health as a foreign policy issue is conceptualised. Differing arguments within and between these policy frames, while overlapping, can also be contradictory. This raises an important question about which arguments prevail in actual state decision-making. This question is addressed through an analysis of policy or policy-related documents and academic literature pertinent to each policy framing with some assessment of policy practice. The reference point for this analysis is the explicit goal of improving global health equity. This goal has increasing national traction within national public health discourse and decision-making and, through the Millennium Development Goals and other multilateral reports and declarations, is entering global health policy discussion. Initial findings support conventional international relations theory that most states, even when committed to health as a foreign policy goal, still make decisions primarily on the basis of the ‘high politics’ of national security and economic material interests. Development, human rights and ethical/moral arguments for global health assistance, the traditional ‘low politics’ of foreign policy, are present in discourse but do not appear to dominate practice. While political momentum for health as a foreign policy goal persists, the framing of this goal remains a contested issue. The analysis offered in this article may prove helpful to those engaged in global health diplomacy or in efforts to have global governance across a range of sectoral interests pay more attention to health equity impacts.
Country
East and southern Africa region
Publisher
Theme area
Health equity in economic and trade policies
Title of publication International trade in health services: Assessing the trade and the trade-offs
Date of publication
2008
Publication type
Academic paper
Publication details
Danish Institute for International Studies Working Paper no 2008/11 pp 1-37
Publication status
Published
Language
English
Keywords
Global health diplomacy, Africa, health services, trade
Abstract
Based on recent but scattered literature, the aim is to provide an overview of the commercial opportunities from trade in health services for developing countries and the trade-offs these are argued to be associated with. Based on recently published data, the author of the paper estimates the global value of international trade in health services at US$ 33 billion in 2005. He concludes that the literature often falls into one of two ‘traps’. It either regards trade as a threat to public health that must be combated or it makes buoyant claims regarding the current and potential commercial opportunities from trade. Neither ‘trap’ is supported by empirical evidence. Achieving data of a quality and depth on trade in health services that is comparable to that available for trade in goods would be a helpful tool for policy makers, researcher and others trying to access the trade and ‘trade offs’ in cross-border health services delivery.
Country
East and southern Africa region
Publisher
Danish Institute for International Studies
Theme area
Governance and participation in health
Title of publication From G8 to G20, is health next in line?
Date of publication
2010 June
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
Global health diplomacy, Africa, G8, G20
Abstract
In this article, the G8 and G20 are compared in terms of their impact on furthering the global health agenda. The G20’s reach extends beyond the political networks accessible to the G8 and it also avoids some of the limiting bureaucracy of formal structures, allowing it to improvise and to act rapidly as a risk manager during perceived health crises. These factors might mean that the G20 responds more favourably to health issues that have an emerging consensus, for example donor co-ordination. The G20 can also arrange ad hoc working groups to catalyse debate on health issues that are sometimes framed in security or economic terms, such as intellectual property. However, as we move out of recession, the author cautions that there is little indication that the G20 wishes to champion the interests of low-income countries. In the short term, the controversies of climate change negotiations could mean that discussing global health directly in the G20 is viewed as an agenda too far. It is possible that the core G8 membership that drove higher ambitions on development and global health in the past decade – most notably the United States and the United Kingdom – might carry that energy into a G20 context. The World Bank could similarly emerge as a galvaniser of the G20 on these issues. However, a disease-based approach to global health might remain comfortably within the remit of the G8, the authors conclude.
Country
East and southern Africa region
Publisher
Centre on Global Health Security
Theme area
Resource allocation and health financing
Title of publication Illicit financial flows from Africa: Hidden resource for development
Date of publication
2009
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
Global health diplomacy, Africa, health finance, fraud
Abstract
According to this report, in the 39-year period from 1970 through 2008, illicit financial outflows from Africa totalled US$854 billion. This estimate is regarded as conservative, since it addresses only one form of trade mispricing, does not include the mispricing of services, and does not encompass the proceeds of smuggling – the adjusted figure is closer to $1.8 trillion. This massive flow of illicit money out of Africa is facilitated by a global shadow financial system comprising tax havens, secrecy jurisdictions, disguised corporations, anonymous trust accounts, fake foundations, trade mispricing, and money laundering techniques. The cost to African development is great, as the outflow drains hard currency reserves, heightens inflation, reduces tax collection, cancels investment and undermines free trade. It has its greatest impact on those at the bottom of income scales in their countries, removing resources that could otherwise be used for poverty alleviation and economic growth. Addressing this problem requires concerted effort by both African nations and by Western countries, Global Financial Integrity argues. The outflow from Africa and the absorption into western economies deserve equal attention. Through greater transparency in the global financial system, illicit outflows can be substantially curtailed, thereby enhancing growth in developing countries and at the same time stabilising the economies of richer countries.
Country
East and southern Africa region
Publisher
Global Financial Integrity
Theme area
Health equity in economic and trade policies
Title of publication Registering new drugs: The African context
Date of publication
2010 January
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
Global health diplomacy, Africa, generics, drug manufacturing
Abstract
According to the George Institute, African national medicine regulatory authorities (MRAs) may have some experience in managing generics, but many have only limited experience in assessing, approving and registering innovator products, the vast majority of which are for shared ‘global’ diseases, such as diabetes, hypertension and cancer. The fundamental problem is that, while well-resourced Western MRAs have extensive experience in assessing novel products for chronic diseases such as hypertension and diabetes, they are largely unfamiliar with products for malaria or sleeping sickness, or with the circumstances in which they will be used in developing countries. A reduction in Western regulatory checks on medicines commonly used in Africa, combined with the advent of new products developed for tropical diseases, means that standard approaches to registration of novel drugs need to be rethought or augmented for the African context. Indeed, there are currently no regulatory approaches that satisfy all components of optimal drug registration for Africa. WHO vaccine pre-qualification is strongly supported by African governments, and is often seen as being preferred over Federal Drug Agency (FDA) and European Medicines Agency (EMEA) vaccine approvals. However, there were also perceived downsides. Vaccine pre-qualification has significant costs and the process is also relatively slow.
Country
East and southern Africa region
Publisher
University of Sydney
Theme area
Health equity in economic and trade policies
Title of publication Tide turns for drug manufacturing in Africa
Date of publication
2010 May
Publication type
Journal Article
Publication details
The Lancet 375 9726 pp 1597-1598
Publication status
Published
Language
English
Keywords
Global health diplomacy, Africa, drug manufacturing, pharmaceutical sector
Abstract
The author of this article examines the growth in global activity aimed at increasing local production of pharmaceutical drugs in developing countries. The African Union (AU) is currently devising a fully costed business plan for the production of drugs for HIV and AIDS, tuberculosis, and malaria on the continent. Pharmaceutical companies from various countries in Africa are being assisted by foreign pharmaceutical companies to reach international standards, specifically to meet WHO’s prequalification standards for production. The author criticises government subsidies that allow Indian manufacturers to sell drugs at artificially low prices, unfairly competing with Africa manufacturers, who do not benefit from any subsidies. Additionally, attaining pre-qualification in a poor African country is a costly business, in terms of exorbitant salaries paid for foreign experts engaged in technology transfer, and laboratory studies that require major financial resources. The AU wants to promote regional rather than local production, which will allow neighbouring countries to work together to supply one another’s drug needs. Alternatively, several African countries might choose instead to club together and buy drugs from abroad at a cheaper price or use flexibilities in world trade rules to access more imports. The author calls for stronger regulation to identify substandard drugs and manufacturers, as well as improved drug distribution systems to prevent drug stock outs and hefty price mark-ups levied by the supply chain. In conclusion, governments must be prepared to co-ordinate and harmonise legislation of drugs within regions but, if manufacturing policy does not make sense from a public health viewpoint, they should withdraw support.
Country
East and southern Africa region
Publisher
Theme area
Health equity in economic and trade policies
Title of publication Registering new drugs for low-income countries: The African challenge
Date of publication
2011 February
Publication type
Journal Article
Publication details
PLoS Medicine 8 2
Publication status
Published
Language
English
Keywords
Global health diplomacy, Africa, neglected diseases, drug manufacturing
Abstract
A recent shift in the drug product environment for Africa has seen a score of new products being developed specifically for diseases of the developing world, creating new challenges for regulators in Africa and elsewhere. However, it is not at all certain that African regulatory authorities currently have the capacity to meet these new demands, according to this article. The growing demand to assess novel neglected disease (ND) products for African use has generated a range of responses from policymakers and product developers, but there is limited guidance for product developers in choosing between approaches, and little or no integration between approval mechanisms. In this article, the authors discuss the various mechanisms in which novel ND drugs are assessed and approved for developing country use. They make six recommendations to achieve an optimal drug registration approach for Africa that can reliably evaluate safety, efficacy, and quality of drugs for African use. These recommendations are: instituting formal twinned regulatory review; automatic World Health Organisation (WHO) prequalification of all novel ND products approved by using standard regulatory pathways; integrating Article 58 with other approval mechanisms by allowing automatic WHO drug prequalification for products given a positive opinion under Article 58; selecting experienced Western stakeholders to conduct prequalifications on behalf of, and in addition to, the WHO; conducting a strategic review of WHO drug prequalification disease and product priorities, along the lines of WHO Strategic Advisory Group of Experts (SAGE) reviews for vaccines; and funding Centres of Regulatory Excellence in each of Africa’s main regions.
Country
East and southern Africa region
Publisher
Theme area
Equitable health services
Title of publication Chapter 72: Ensuring supplies of appropriate drugs and vaccines
Date of publication
2006
Publication type
Book Section
Publication details
Disease Control Priorities in Developing Countries pp 1323-1337
Publication status
Published
Language
English
Keywords
Africa, essential medicines, vaccines
Abstract
Ensuring that needed essential medicines and vaccines are available is critical for the success of any disease control programme, according to this article. A great deal is known about what works and what does not work. Careful selection, procurement from prequalified suppliers, proper storage and distribution using secure reliable channels, and assurance of rational use and correct dispensing are all critical components of any drug and vaccine supply system. Ensuring that adequate funds are available to pay for the procurement, distribution, and quality assurance of all medicines and vaccines is equally critical. Depending on the circumstances, the authors argue that either the public or the private sector or a combination of both can efficiently deliver quality-assured medicines and vaccines. The experience of a number of countries and programmes has demonstrated that essential medicines and vaccines can be reliably delivered to poor people using the approaches described in this chapter.
Country
East and southern Africa region
Publisher
World Bank
Theme area
Governance and participation in health
Title of publication The other world wide web: Global public policy networks
Date of publication
2000
Publication type
Journal Article
Publication details
Foreign Policy 117 pp 44-57
Publication status
Published
Language
English
Keywords
Global health diplomacy, Africa, global public policy networks
Abstract
In this article, the author examines global public policy networks, such as Roll Back Malaria, which consist of government agencies, international organisations like the United Nations, transnational corporations and elements of civil society, such as non-governmental organisations (NGOs) and professional associations. He argues that these networks thrive in a ‘borderless’ environment and capitalise on technological innovation – the very conditions that hamper policy makers in traditional institutions. The networks, however, are helping policy makers to some extent by connecting groups that might otherwise have never connected, as well as consolidating and disseminating knowledge, and helping correct market and intergovernmental failures by stepping in and providing services, like health services. The author identifies a major disadvantage of global public policy networks as the tendency for Western governments, prominent NGOs and large multinational companies to dominate these networks, and he calls for greater inclusiveness, with the continuous inclusion of new voices in the debate on global public policy.
Country
East and southern Africa region
Publisher
Theme area
Governance and participation in health
Title of publication A turning point for global health governance
Date of publication
2011 February
Publication type
Academic paper
Publication details
Publication status
Published
Language
English
Keywords
Global health diplomacy, Africa, World Health Organisation
Abstract
This article is a review of the January 2011 Executive Board meeting of the World Health Organisation (WHO). The author identifies a new sense of purpose and willingness of member states to address politically complex issues head on and work towards acceptable compromises in the interest of global health. This was exemplified by the negotiation of a proposal from the African group of countries to institute a policy of rotation between geographic regions for the election of future WHO Director-Generals. The issue could have led to political deadlock on the board, the author argues, but it was artfully avoided through a deft show of statesmanship and above all a collective desire to see the board succeed in its work. The African group of countries also called for a greater involvement of developing nations and emerging economies in global health governance. Concrete proposals for how to move forward with a sense of urgency were raised, and Director General Margaret Chan received a clear mandate to develop reform proposals for discussions at the World Health Assembly in May 2011.
Country
East and southern Africa region
Publisher
Global Health Europe Task Force
Theme area
Governance and participation in health
Title of publication Health security or health diplomacy? Moving beyond semantic analysis to strengthen health systems and global cooperation
Date of publication
2008 August
Publication type
Journal Article
Publication details
Health Policy and Planning 23 6 pp 376-378
Publication status
Published
Language
English
Keywords
Global health diplomacy, Africa, health security, foreign policy
Abstract
The author of this article argues that the emerging global health diplomacy movement points to the need for core capacities in the public health and diplomatic arenas. Among these are an understanding of international relations among public health professionals and greater recognition by diplomats of the population health outcomes of foreign policy. More specifically, the author notes that their training should include perspectives on globalisation, social determinants of health and cultural competence, macro-economics and political negotiation. Communities and citizens are often not considered in the formal policy arena but play an important role in meeting foreign policy goals and in cultivating trust and friendship across national borders, particularly in times of crisis and emergency. Future foreign policy and global health efforts need to ensure dialogue with affected communities and be more intentional in engaging and citizens groups in defining needs and goals. While it is likely that health security will remain a prominent rationale for developed countries to invest in global health initiatives, a the author concludes that more coherent approach to foreign policy and health diplomacy could result in better alignment between the health security goals of developed countries and health equity and development goals of developing countries, while at the same time recognising and channelling the growing financial and technical contributions of private citizens, companies and organisations.
Country
East and southern Africa region
Publisher
Theme area
Governance and participation in health
Title of publication Brazil’s conception of South-South ‘structural co-operation in health’
Date of publication
2009
Publication type
Book Section
Publication details
Innovating for the Health of All Chapter 18 pp 100-107
Publication status
Published
Language
English
Keywords
Global health diplomacy, Africa, Brazil, foreign policy, south-south co-operation
Abstract
In the 21st century, technical co-operation has gained a strategic place in Brazilian foreign policy, while at the same time as health is being recognised as a predominant theme on the national agenda for South-South co-operation, according to this paper, requiring unprecedented collaboration between the Foreign Ministry and the Ministry of Health. In this way, Brazil has become a world leader in forging closer relations between health and foreign policy. The author argues here that the shift to region-wide co-ordination in Brazil’s co-operation in health – both in Africa and in South America – stems from the desire to ensure a foreign policy of ‘diversified autonomy’ and more effective international co-operation. The strong involvement of health ministers in building strategic and political consensuses has been secured by frequent meetings among the countries at a variety of locations and levels, in partnership with other international organisations and prominent actors committed to promoting South-South co-operation in health. These meetings have enabled provisional consensuses to be built, thus permitting these endeavours to advance. The close partnership between Brazil’s Ministry of Health and Foreign Ministry signals a national effort to associate expertise in health with the strength of the foreign affairs sector, especially as regards South-South co-operation.
Country
East and southern Africa region
Publisher
Global Forum for Health Research
Theme area
Governance and participation in health
Title of publication Foreign policy and global health: Country strategies
Date of publication
2009
Publication type
Academic paper
Publication details
Publication status
Published
Language
English
Keywords
Global health diplomacy, Africa, United States, foreign policy
Abstract
While health has always been a part of international relations, the author of this paper argues that it is only in recent years that it has attracted much attention and started the move from an issue of ‘low-politics’ to one of ‘high-politics.’ While the strategies of most governments point to the increasing central role health plays in national strategy, health is still not yet an issue at the heart of government policy. However, research and thinking by groups such as the Chatham House Centre on Global Health and Foreign Policy and the FIOCRUZ Centre for Global Health and International Co-operation can help it became an increasingly important part of it, the author argues. Given increased globalisation and ‘convergence of interest’, there will likely be much more interaction in the future between ministries of health and other ministries, as well as increased priority given to health in foreign policy strategies. The author notes that a call was made in 2009 to the United States (US) President to highlight health as a pillar of US foreign policy, and he predicts that it is only a matter of time until the United States develops a formal foreign relations-based health strategy.
Country
East and southern Africa region
Publisher
University of Oxford
Theme area
Governance and participation in health
Title of publication South-South co-operation or trilateral diplomacy?
Date of publication
2010 April
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
Global health diplomacy, South Africa, India, Brazil, China, Russia, trade, TRIPS, generics
Abstract
InDepth NewsAnalysis, United Nations Development Programme
In this essay, the author considers the impact of the India-Brazil-South Africa (IBSA) and the Brazil-Russia-India-China (BRIC) summits on South-South co-operation and development. In terms of the health sector, the author argues that IBSA and BRIC offer synergies among the countries in the alliances. As regards HIV/AIDS, for instance, the interests of the three countries are quite convergent. India has the second largest number of HIV-positive people (2.4 million) and also the largest generic drugs industry. Brazil has developed role-model public policies in fighting AIDS and exports its know-how to several African, Asian and Latin American countries. South Africa has a high demand in this regard, since it has the largest number of HIV-positive people (5.7 million) and faces severe constraints in democratising public health services regarding the epidemic. In recent years the IBSA countries have been prominent in the G-21 lobby that succeeded in lessening the negative effects of the Trade-Related Aspects Of Intellectual Property Rights agreement (TRIPS). Flexibilities in TRIPS permit governments to issue licenses for generic drug production for the domestic market in the interests of public health, without the consent of the patent owner, to help bring down the high costs for patented drugs in developing countries. India is one of the world’s leading producers of generic medicines. While a trilateral trade agreement has been alluded to on numerous occasions, the author alleges it is unlikely to materialise between India, Brazil and South Africa, which are technically bound to regional trade blocs.
Country
South Africa
Publisher
Theme area
Governance and participation in health
Title of publication Brazil’s Ascendance: The soft power role of global health diplomacy
Date of publication
2011 February
Publication type
Journal Article
Publication details
European Business Review Jan-Feb 2011 pp 61-64
Publication status
Published
Language
English
Keywords
Global health diplomacy, Brazil, soft power
Abstract
Already the world’s tenth largest economy, and eighth highest ranking military power, Brazil looks set to assume its long expected role as a regional and global leader. Hard power, however, provides only a partial explanation of the country’s meteoric rise over the past two decades. Recognising the complementarity of both hard and soft power in a globalizing world, the Lula Administration has actively enhanced the country’s leadership status through values, ideas and knowledge based on domestic experience and global aspiration. The realm of global health diplomacy has been a key component of this strategy. Through its principled stance on ARVs, commitment to strong and effective tobacco control, and the provision of bilateral and multilateral aid, Brazil has earned widespread credibility among other emerging economies, as well as a broad spectrum of non-state actors. Even critics now recognise the country’s importance at the top tables of decision making in international relations for achieving collective action on shared challenges. As the world’s political and economic centre of gravity continues to shift, Brazil’s future ability to walk softly and carry a big stick should continue to pay dividends.
Country
Brazil
Publisher
Theme area
Resource allocation and health financing
Title of publication How China delivers development assistance to Africa
Date of publication
2008 February
Publication type
Academic paper
Publication details
Publication status
Published
Language
English
Keywords
Global health diplomacy, China, Africa, foreign policy, aid
Abstract
According to this article, the Forum on China-Africa Co-operation is the main mechanism whereby China’s Ministry of Foreign Affairs and its Ministry of Commerce are starting to align their respective responsibilities toward more effective co-ordination and implementation of a Chinese foreign policy and aid policy toward Africa. Figures on China’s aid disbursements to Africa remain vague, the authors note, in absence of a central Chinese aid agency to monitor funding flows to the continent. Part of China’s strategic industrial plan for Africa is to establish five preferential trade and industrial zones for Chinese business entry in Africa: Zambia, Mauritius, Egypt, Nigeria and possibly Tanzania. In 2007, The Chinese Development Bank was designated to manage the US$5 billion China-Africa Development Fund, but the authors cautions that, even though it is termed a ‘development fund’, it has been actually put in place to finance the market entry of Chinese firms into the African economy. In conclusion, the authors provide recommendations to relevant stakeholders that are engaged in the aid process. Recommendations for African countries include developing a better understanding of the Chinese approach to aid; facilitating regional co-ordination; avoiding poor co-ordination which may lead to Chinese aid fatigue; avoiding the division between traditional and emerging donors; strengthening the African voice; improving the reporting mechanisms within recipient countries; and improving debt reporting.
Country
East and southern Africa region
Publisher
Centre for Chinese Studies, University of Stellenbosch
Theme area
Resource allocation and health financing
Title of publication Aid within the wider China-Africa partnership: A view from the Beijing Summit
Date of publication
2006
Publication type
Academic paper
Publication details
Publication status
Published
Language
English
Keywords
Global health diplomacy, China, Africa, Beijing Summit, trade
Abstract
This paper is a review of the China-Africa Beijing Summit held in Beijing on 4 and 5 November 2006. According to the author, the approach taken at the Summit combined intensive bilateral co-operation in a wide and inclusive, collective framework, and agreements were not prescriptive in tone or spirit. Two-way trade and business opportunities were very visibly associated with the Summit and new business instruments were set up to maintain the momentum build so far by trade and diplomatic relations between Africa and China. A series of new development assistance initiatives were promised in education, health, preferential loans, market access and debt cancellation. The author highlights the positive engagement with Africa at the Summit in the form of positive and wide coverage of the event in the Chinese media, representing Africa in a positive light and avoiding Afro-pessimism with stereotyped images of poverty. Attendance figures were high and a wide range of participants included presidents, premiers, students, researchers, business people and traders, ambassadors and school children. The author concludes that the Summit did not deliver a ‘Beijing Model’ or ‘Beijing Consensus’, but rather it has confirmed a strategic partnership that does not depend on a donor to deliver but on African countries’ efforts independently to resolve African problems.
Country
East and southern Africa region
Publisher
University of Hong Kong
Theme area
Health equity in economic and trade policies
Title of publication China and Africa: Policy and challenges
Date of publication
2007
Publication type
Journal Article
Publication details
China Security 3 3 pp 69-93
Publication status
Published
Language
English
Keywords
Global health diplomacy, China, Africa, foreign policy
Abstract
In this article, the author provides an historical overview of diplomatic and trade relations between China and Africa, taking the establishment of the People’s Republic of China in 1949 as his starting point. Initially ultra-left and dogmatic, Chinese policy towards Africa resulted in a lot of foreign aid flowing into the continent between 1956 and 1978, but the 1980s saw a change in approach, whereby China focused on improving Africa’s self-reliance, reducing reliance on external funding. The author argues that China’s approach takes into account notions of sovereignty and equality among nations, thereby espousing principles of equal treatment, a respect for sovereignty, noninterference, mutual benefit and co-development. He contrasts the interests of Chinese corporations operating in Africa, which lie in maximising short-term economic gains, with Chinese national interests, which are more long term and focus on the overall relationship between China and Africa. As the Chinese presence in Africa grows, the author predicts emerging conflicts between Chinese and Western interests, as Western countries still include Africa in their ‘spheres of influence’, regarding China as an external player in the continent. However, Africa and China have historical diplomatic ties that are historically and politically separate from Africa’s links with the West, and the author recommends building on these in the form of enhanced bilateral and multilateral tools of co-operation with Africa. To manage the growing tensions resulting from the closer economic relationship between China and Africa, China must increase the frequency and depth of consultations both with African nations and other nations with interests in Africa. It should also continue to use international mechanisms, such as United Nations peacekeeping operations.
Country
East and southern Africa region
Publisher
Theme area
Health equity in economic and trade policies
Title of publication Sharm El Sheikh Action Plan (2010-2012)
Date of publication
2009 November
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
Global health diplomacy, China, Africa, Sharm El Sheikh Action Plan
Abstract
One of the action plans emerging from the Forum on China-Africa Co-operation – the main platform for Chinese-African relations – is the Sharm El Sheikh Action Plan, in which the Chinese government committed itself over the period 2010-2012 to, among other things, send 50 agricultural technology teams to Africa and help train 2,000 African agricultural technicians, build and implement 20 agricultural technology demonstration centres in Africa, and implement 100 joint research and demonstration projects to aid science and technology transfer. The government has also committed to contribute medical equipment and malaria-fighting materials worth 500 million yuan (US$76.35 million) to 30 hospitals and 30 malaria prevention and treatment centres built by China for Africa in the three-year period. China will invite African professionals working in the field of malaria to attend training programmes in China in an effort to ensure sustainable development of the project. The country will also help relevant African countries train a total of 3,000 doctors, nurses and administrative personnel. Africa and China pledged to scale up joint efforts to prevent and treat major communicable diseases like HIV, malaria, tuberculosis, avian influenza and influenza A (H1N1). The two sides will continue to enhance co-operation in setting up mechanisms to handle public health emergencies.
Country
East and southern Africa region
Publisher
Theme area
Health equity in economic and trade policies
Title of publication South-South relations: Sino-African engagement and co-operation
Date of publication
2010 July
Publication type
Electronic Source
Publication details
Emerging Powers in Africa Programme, Fahamu
Publication status
Published
Language
English
Keywords
Global health diplomacy, China, Africa, bilateral trade
Abstract
According to this article, China has become one of Africa's leading trading partners, with trade totaling US$106.8 billion in 2008, up 45 per cent from the previous year. China's increasing demand for raw materials to fuel its domestic growth has resulted in agreements on access to and extraction of minerals and oil from resource-rich African countries. China has also become an emerging player in providing financial assistance for infrastructure development in Africa, helping African countries address their infrastructure needs such as railways, hydropower and roads. China has sought to provide concessional financing for infrastructure and construction projects through its Export-Import Bank, often using Chinese companies to carry out the projects. Since 200, China's foreign policy in the region has been directed through the Forum on China-Africa Co-operation (FOCAC), which is the main vehicle for China's activities in Africa, providing a multilateral platform for dialogue with a view to reaching mutually agreeable goals. A number of action plans have emerged from FOCAC, which outline commitments to Africa by the Chinese government, such as the 2009 Sharm El Sheikh Action Plan, in which the Chinese government commits itself to finance the training of African nurses, as well as contribute to malaria health services by supplying equipment and anti-malaria drugs.
Country
East and southern Africa region
Publisher
Emerging Powers in Africa Programme, Fahamu
Theme area
Governance and participation in health
Title of publication Memories and blessings of China-Botswana relations: A review on 35 years of diplomatic relations between China and Botswana
Date of publication
2007 January
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
Global health diplomacy, China, Botswana, bilateral trade
Abstract
This review by the Chinese ambassador to Botswana marks the 35th anniversary of the establishment of diplomatic relations between the China and Botswana. According to the ambassador, trade and technical co-operation serve as the driving force behind bilateral relations between the two countries, as China considers mutually beneficial co-operation as more important and useful than unilateral assistance. The Chinese government has also undertaken technical exchanges and transfers with Botswana, notably in agriculture and health. From the 1970s to 1980s, China helped train a group of agriculture technical personnel from Botswana and sent experts to conduct local land survey and planning projects. Three Chinese senior agricultural experts are now helping Botswana in agricultural policy making and improving farming technology. In health and medicine, China has sent medical teams to Botswana since 1980, like the Twelfth Team, comprising 40 medical staff and six support staff, who provide medical services in public hospitals in Gaborone and Francistown. In the review, the ambassador acknowledges that his country aims to further scale up human resources development as an important component of bilateral relations. Since 1999 almost 300 Botswana officials and technicians have attended seminars, workshops and short-term training programmes in China – covering areas of administrative management, commerce, information etc – and the number is set to increase.
Country
Botswana
Publisher
Ministry of Foreign Affairs of the People’s Republic of China
Theme area
Health equity in economic and trade policies
Title of publication China's African policy
Date of publication
2006 January
Publication type
Academic paper
Publication details
Publication status
Published
Language
English
Keywords
Global health diplomacy, China, Africa, foreign policy
Abstract
In this African policy paper, the Chinese Government presents its policy objectives towards Africa and the measures to achieve them, as well as its proposals for co-operation in various fields in the coming years, with a view to promoting the steady growth of China-Africa relations in the long term and bringing their mutually beneficial co-operation to a new stage. The paper covers a number of areas, including the health field where the Chinese government aims to expand medical and health co-operation. China commits to continue sending medical teams and providing medicines and medical materials to African countries, and to help them establish and improve medical facilities and train medical personnel. It will also increase its exchanges and co-operation with African countries in the prevention and treatment of infectious diseases – including HIV/AIDS and malaria and other diseases – research and application of traditional medicine and experience concerning mechanism for public health emergencies. China acknowledges the role of the African Union (AU) in safeguarding peace and stability in the region and promoting African solidarity and development and it intends to foster relations with the AU, as well as support Africa's sub-regional organisations in promoting political stability, economic development and integration in their own regions.
Country
East and southern Africa region
Publisher
Theme area
Governance and participation in health
Title of publication Global health diplomacy: An emerging field
Date of publication
2010 June
Publication type
Journal Article
Publication details
The African Executive 270
Publication status
Published
Language
Keywords
Global health diplomacy, Africa, economic development
Abstract
In this article, the author briefly examines various definitions of ‘global health diplomacy’ (GHD), reviews possible fundamental principles and discusses unresolved challenges. He argues that fundamental principles of GHD should include: ethical participation and decision making; human rights concerns and enforcements; rule of law and clear process for settling disputes; social determinants of health and how to mitigate their impact; shared bilateral and international interests and priorities; centrality of target populations and sensitivities to local customs, religions and social mores; research as part of efforts to expand the frontiers of the field; training and field experience for all practitioners; an understanding of political, policy making, advocacy and implementation issues in global health; globalisation and international trade issues; integration and mainstreaming of policies and programmes in the relationship between global health, bilateral diplomacy and multilateral development; and public/private/civil society partnerships and alliances. He identifies five challenges for GHD. The first challenge is to further develop the field of GHD as a discipline. The second challenge is how to harmonise the divergent orientation of public health experts, trained diplomats and development experts. Thirdly, stakeholders must ensure that global health diplomacy retains a significant focus on the needs of target populations around the world. They should also ensure that global health diplomacy does not create additional tensions between donor and host nations. Finally, stakeholders must find strategies to maintain the current non-partisan support of policy makers on global health issues over the long term.
Country
East and southern Africa region
Publisher
Theme area
Resource allocation and health financing
Title of publication The challenge of global health
Date of publication
2007 February
Publication type
Journal Article
Publication details
Foreign Affairs 86 1 pp 14-38
Publication status
Published
Language
English
Keywords
Global health diplomacy, Africa, vertical funding, disease control
Abstract
In this article, the author argues that, despite increased global funding for health, this money is paying for largely unco-ordinated health programmes and directed mostly at specific high-profile diseases, rather than at public health in general, which not only means that current efforts could fall short of expectations but could actually make things worse on the ground. Some stakeholders see stopping the spread of HIV, tuberculosis, malaria, avian influenza and other major killers as a moral duty, while some see it as a form of public diplomacy and others see it as an investment in self-protection, given that microbes know no borders. There is currently no systemic approach that is designed to match essential health needs with the resources that are actually available. The author calls for a strategic framework that could guide both financial contributions and actions, with external funders focusing on how to build up the capabilities in poor countries in order to eventually transfer operations to local control: in other words, to develop exit strategies so as to avoid either abrupt abandonment of worthwhile programmes or perpetual hemorrhaging of foreign aid. They must help build effective local health infrastructures, as well as local industries, franchises and other profit centres, that can be sustained and thrive from increased health-related spending.
Country
East and southern Africa region
Publisher
Theme area
Health equity in economic and trade policies
Title of publication Harnessing genomics and biotechnology to improve global health equity
Date of publication
2001 October
Publication type
Journal Article
Publication details
Science Magazine 294 5540 pp 87-89
Publication status
Language
English
Keywords
Global health diplomacy, Africa, biotechnology, genomics
Abstract
The authors of this article argue that advancements in genome-related biotechnology in the area of health has resulted in designer pharmacogenomics in rich countries and lost opportunities for advancing the health of those in developing countries. How can genomics be systematically harnessed to benefit health in developing countries? The authors identify several future actions. Research is needed to identify the most promising technologies and the barriers to their application – lessons learned can be applied to build successful genomics and biotechnology industries in developing countries. Developing countries also need to generate their own expertise in addressing the scientific, ethical, legal, social and policy aspects of genomics and biotechnology, as well as establishing leadership development programmes and centers of excellence. The authors also argue that building consensus among all stakeholders – including the public – will be essential to address different value orientations and develop wise public policy. They call for innovative financing mechanisms to channel large investments into promising scientific ideas targeted on health problems of developing countries.
Country
East and southern Africa region
Publisher
Theme area
Governance and participation in health
Title of publication The new diplomacy of the South: South Africa, Brazil, India and trilateralism
Date of publication
2005
Publication type
Journal Article
Publication details
Third World Quarterly 26 7 pp 1077-1095
Publication status
Published
Language
English
Keywords
Global health diplomacy, South Africa, Brazil, India, trilateralism, South-south co-operation
Abstract
In this article, the authors examine the rise of the co-operative strategy known as 'trilateralism' by regional leaders within the South. Specifically, they look at the relationship between three emerging regional powers – South Africa, Brazil and India – in the context of multilateralism, as well as at the formulation and implementation of trilateralism. As with previous co-operative efforts in the developing world, the authors argue that prospects of success are rooted in overlapping domestic, regional and international influences on South African, Brazilian and Indian foreign policies. Long-term prospects for the trilateral initiative hinge more on the economic underpinnings of the relationship than on ideological ones. The authors identify a number of obstacles to the trilateral relationship, such as difficulties in negotiating reductions in tariffs to protected industries in India, the failure of the Indian Ocean Rim initiative, and statements from the Brazilian business community expressing strong reservations about any serious shift in economic priorities away from their traditional markets. In the absence of the kind of directive investment promoted by governments' use of parastatals and politically connected businesses, the authors conclude that it is difficult to envisage how the trilateral partnership will grow and develop.
Country
South Africa
Publisher
Theme area
Health equity in economic and trade policies
Title of publication Local pharmaceutical production in developing countries: How economic protectionism undermines access to quality medicines
Date of publication
2008 January
Publication type
Academic paper
Publication details
Campaign for Fighting Diseases discussion paper no. 1 pp 1-15
Publication status
Published
Language
English
Keywords
Global health diplomacy, Africa, India, generics, public-private partnerships
Abstract
The author of this paper argues for public-private partnerships to help deliver locally produced generics in Africa, and against protectionism in favour of open market access. He points to promising developments, such as experienced Indian and Western pharmaceutical firms undertaking original research and development and partnering with firms in African countries. He believes this investment by reputable companies should help ensure quality drugs are produced by furnishing the technical expertise that overcomes capacity constraints. Local production enterprises in Africa will allow international companies to diversify their supply sources, the author argues, guarding against potentially disastrous shocks such as a natural disaster that would destroy an Artemisia crop and send the price of artemisinin-based malaria drugs skyrocketing. Local production partnerships could encourage trade, especially because the bulk active ingredients needed to produce them still come most efficiently from abroad. Partnerships between foreign pharmaceutical firms and African companies may also help train a pool of skilled workers, improving a country’s long-term development prospects.
Country
East and southern Africa region
Publisher
Campaign for Fighting Diseases
Theme area
Resource allocation and health financing
Title of publication Can social inclusion policies reduce health inequalities in sub-Saharan Africa? A rapid policy appraisal
Date of publication
2009 August
Publication type
Journal Article
Publication details
Journal of Health, Population and Nutrition 27 4 pp 492-504
Publication status
Published
Language
English
Keywords
Sub-Saharan Africa, Botswana, Mozambique, South Africa, Zimbabwe, social inclusion policies
Abstract
In this paper, three categories of social inclusion policies are reviewed – cash-transfers, free social services and specific institutional arrangements for programme integration – in six selected countries, including Botswana, Mozambique, South Africa and Zimbabwe. The authors highlight the impact of these policies on health inequities. They identify crosscutting benefits, such as poverty alleviation, notably among vulnerable children and youths, improved economic opportunities for disadvantaged households, reduction in access barriers to social services, and improved nutrition intake. However, they caution that the impact of these benefits, and hence the policies, on health status can only be inferred. A major weakness of most policies was the lack of a monitoring and evaluation system. The authors call on governments of sub-Saharan African countries to conduct research to measure health inequities and design social policies that address the constraints identified in the research. They also call for support for a strong movement by civil society to address health inequities and to hold governments accountable for improving health and reducing inequities.
Country
East and southern Africa region
Publisher
Theme area
Health equity in economic and trade policies
Title of publication Tobacco companies' use of developing countries' economic reliance on tobacco to lobby against global tobacco control: The case of Malawi
Date of publication
2009 August
Publication type
Journal Article
Publication details
American Journal of Public Health 99 10 pp 1759-1771
Publication status
Published
Language
English
Keywords
Global health diplomacy, Malawi, tobacco control
Abstract
According to this article, transnational tobacco manufacturing and tobacco leaf companies engage in numerous efforts to oppose global tobacco control. One of their strategies is to stress the economic importance of tobacco to the developing countries that grow it. The authors analysed tobacco industry documents and ethnographic data to show how tobacco companies used this argument in the case of Malawi, producing and disseminating reports promoting claims of losses of jobs and foreign earnings that would result from the impending passage of the Framework Convention on Tobacco Control (FCTC). In addition, they influenced the government of Malawi to introduce resolutions or make amendments to tobacco-related resolutions in meetings of United Nations organisations, succeeding in temporarily displacing health as the focus in tobacco control policymaking. However, these efforts did not substantially weaken the FCTC, the authors conclude.
Country
Malawi
Publisher
Theme area
Equity and HIV/AIDS
Title of publication A grave and gathering threat: Business and security implications of the AIDS epidemic and a critical evaluation of the Bush Administration's response
Date of publication
2004 January
Publication type
Journal Article
Publication details
Georgetown Journal of International Law 433 2003-2004
Publication status
Published
Language
English
Keywords
Global health diplomacy, United States, Africa, HIV/AIDS, Global Fund
Abstract
In 2003, United States (US) President George W Bush pledged substantial US financial support over the next five years to help fight AIDS in Africa and the Caribbean, surprising his political allies and enemies alike by committing significant funds to an issue that had so far received limited attention in his Administration. According to this article, the reason why US interest in Africa increased is because of the growing importance of Africa’s oil resources since the 11 September 2001 attack on New York and the US occupation of Iraq shortly thereafter, especially as tensions between the US and oil-rich Arab nations have increased. However, the author argues that the security of the oil supply is threatened by the devastating effects of AIDS on the labour force and by its tendency to destabilise governments. Loss of productivity and increased political instability are identified as the main HIV-related threats to economic stability in the continent. Also, multinational oil companies and other international enterprises doing business in Africa have recognised the harm that the HIV and AIDS epidemic causes to their interests and have begun to implement AIDS programmes in the workplace. While the author lauds moves like these and the US President's commitment to humanitarian aid in Africa, he argues that the AIDS crisis would be more effectively and efficiently addressed through co-ordinated international efforts administered by the Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria.
Country
East and southern Africa region
Publisher
Theme area
Health equity in economic and trade policies
Title of publication Trade, empires, and subjects: China-Africa trade: A new fair trade arrangement or the third scramble for Africa?
Date of publication
2008 March
Publication type
Journal Article
Publication details
Vanderbilt Journal of Transnational Law
Publication status
Published
Language
English
Keywords
Global health diplomacy, China, Africa, trade
Abstract
Since 2000, the interest of China in Africa has grown steadily as trade between the country and Africa has grown exponentially. China-Africa trade volume increased from US$10 billion to $18 billion between 2000 and 2003. In 2005, total trade between Africa and China surged to $40 billion, and in 2006 China-Africa trade was valued at $55.5 billion. A third of China's crude oil imports come from Africa. In the West, reaction to China's involvement in Africa has been negative, with policy makers and analysts concerned that China could gain control over Africa's vast and untapped natural resources while, for African economists, the current struggle over Africa's resources may evoke memories of earlier European conquests. In this article, the author examines the opportunities and pitfalls that Sino-African trade relations present for Africa. Instead of paranoia, the author calls for guarded optimism regarding the deepening relationship. While there is much that Africa could gain, African leaders and Africans must guard against imperialism of any sort and shy away from arrangements that threaten sustainable development or undermine respect for human rights. The author calls on African leaders to push past Beijing's rhetoric of anti-hegemonism and develop clear policies to guide the continent's engagement with China. Drawing on lessons from the European ‘scramble for Africa’ in the nineteenth century, African leaders must avoid the economic, political, and legal pitfalls of the past and position the continent to benefit from strategic relations with countries that could become future partners.
Country
East and southern Africa region
Publisher
Theme area
Health equity in economic and trade policies, Governance and participation in health
Title of publication China's health diplomacy in Africa
Date of publication
2010 March
Publication type
Journal Article
Publication details
China: An International Journal
Publication status
Published
Language
English
Keywords
Global health diplomacy, China, Africa
Abstract
In this article, health diplomacy is examined within the context of increased trade between China and Africa. China's support for African healthcare systems has ebbed and flowed over the past 50 years, the author indicates, but it has come to assume a prominent place just as the government has sought to increase its political influence, economic footprint and access to natural resources throughout the continent. Providing healthcare resources not only helps China gain favourable trading terms and access to necessary resources, but also supports the government's attempts to portray itself as a good international citizen. The author argues that this combination of hard and soft power, with economic and ideological benefits, marks a significant change in China's health diplomacy strategies. Chinese health diplomacy appears to further the country's soft power and its diplomatic ambitions, but the author indentifies two important limitations, one coming from China, the other from Africa. First, pressures on the Chinese medical system may prevent it from continuing to deploy medical teams throughout the continent. Second, some evidence suggests a growing backlash in various parts of Africa against the increasingly pervasive Chinese presence. Pro-democracy and human rights activists in Africa (and the West) have charged the Chinese government with propping up authoritarian regimes and undermining efforts to increase freedom throughout the continent. The author concludes that China's embracing of health diplomacy in Africa are an integral part of efforts to promote itself as a vanguard trade alternative to leading Western states.
Country
East and southern Africa region
Publisher
Theme area
Health equity in economic and trade policies, Governance and participation in health
Title of publication China's engagement with global health diplomacy: Was SARS a watershed?
Date of publication
2010 April
Publication type
Journal Article
Publication details
PLoS Medicine 7 4
Publication status
Published
Language
English
Keywords
Global health diplomacy, China, Africa
Abstract
The authors of this article argue that, since the global SARS outbreak of 2002-2003, China has put public health high on their foreign policy agenda by providing development assistance and global public goods for health. It is now using public health as a means to strengthen its diplomatic relations with the developing world, including African countries. After the SARS outbreak, the Chinese government reiterated its commitment to improving Africa's public health service in the form of its China's African Policy, published in early 2006. Despite criticisms that its energy and resource extraction in Africa grab the scarce resources there and that it shields disreputable regimes in such countries as Sudan and Zimbabwe from international opprobrium, China has stressed ‘win-win’ relations in its deepening engagement with African countries, for example its no-strings-attached policy in offering financial aid and technical support. In contrast, donor countries in the West and international financial institutions often attach conditionalities to their foreign aid programmes, which are linked to market and political liberalisation and good governance. China’s growing presence in Africa may be seen in the form of contracts with government to build infrastructure, such as hospitals, and training facilities for health practitioners. The Chinese government has also made public commitments to promote sustainable development and help African countries tackle their social problems, of which public health was one of the top priorities.
Country
East and southern Africa region
Publisher
Theme area
Health equity in economic and trade policies, Governance and participation in health
Title of publication Civil society influence on global health policy
Date of publication
2003 April
Publication type
Academic paper
Publication details
Publication status
Published
Language
English
Keywords
Global health diplomacy, Africa, civil society organisations, global health policy
Abstract
In this review of policy processes, the author notes that globalisation has prompted civil society organisations (CSOs) to engage in global health policy clusters in areas related to regulation of corporate health risks (tobacco, breast milk substitutes), promotion of public health systems and promotion of the health rights and needs of vulnerable groups. CSOs have strengthened public interest lobbies in these areas, reinforcing states and making a valuable and sometimes essential contribution to successful policy outcomes. However, critics point out that ‘corporatist’ inclusion of CSOs in policy processes produces bias towards well-organised northern hemisphere-based CSOs, marginalizing southern CSOs, and the more critical analysis and challenge that they bring to the health and social policy. This bias within CSOs and their networks is reinforced by characteristics of the policy processes, with barriers arising from formal procedures as well as from non transparent informal processes, and from the attitudes towards CSOs held by state and UN personnel. The author identified a lack of research into CSO engagement in global health policy and the relationship between civic contributions and global health policy outcomes, as well as the role of the internet in influencing CSO involvement. In particular, further research is needed into differential access to global health policy processes between CSOs (largely northern) that enjoy greater access to processes, power and resources compared to those without such access (largely southern).
Country
East and southern Africa region
Publisher
Training and Research Support Centre
Theme area
Equity in health
Title of publication The refugee crisis in Africa and implications for health and disease: A political ecology approach
Date of publication
1998 July
Publication type
Journal Article
Publication details
Social Science & Medicine 46 12
Publication status
Published
Language
English
Keywords
Global health diplomacy, Africa, refugees, poverty
Abstract
Political violence in civil war and ethnic conflicts has generated millions of refugees across the African continent and caused untold suffering and death. Using a political ecology framework, this paper examines the geographies of exile and refugee movements and the associated implications for re-emerging and newly emerging infectious diseases in great detail. It examines how the political ecologic circumstances underlying the refugee crisis influences health services delivery and the problems of disease and health in refugee camps. It has four main themes, namely, an examination of the geography of the refugee crisis; the disruption of health services due to political ecologic forces that produce refugees; the breeding of disease in refugee camps due to the prevailing desperation and destitution; and the creation of an optimal environment for emergence and spread of disease due to the chaotic nature of war and violence that produces refugees. The author argues in this paper that there is great potential of something more virulent than cholera and Ebola emerging and taking a big toll before being identified and controlled. The author concludes by noting that once such a disease is out in the public rapid diffusion despite political boundaries is likely, a fact that has a direct bearing on global health. The extensive evidence presented in this paper of the overriding role of political factors in the refugee health problem calls for political reform and peace accords, engagement and empowerment of Pan-African organisations, foreign policy changes by Western governments and greater vigilance of non-governmental organisations in the allocation and distribution of relief aid.
Country
East and southern Africa region
Publisher
Theme area
Governance and participation in health, Monitoring equity and research to policy
Title of publication Experiences of participatory action research in building people centred health systems and approaches to universal coverage: Report of the Sessions at the Global Symposium on Health Systems Research, Montreux, Switzerland
Date of publication
2011 March
Publication type
Report
Publication details
Publication status
Published
Language
Keywords
Participatory action research; learning network
Abstract
This report presents different experiences of using PAR in health systems from India, East and Southern Africa, Guatemala and Canada. These experiences are used to . explore and discuss the learning on methods, on the knowledge generated and the implications for health systems, and what this means for the profile and practice of PAR. The report outlines the presentations and discussions from two sessions on participatory action research convened by the authors at the first Global Symposium on Health Systems Research in Montreux Switzerland, November 16-19 2010.
Country
Publisher
TARSC, EQUINET, CEGSS, SATHI-CEHAT,
Equinet Publication Type
Reports
Theme area
Equitable health services
Title of publication Review of primary health care in the African region
Date of publication
2008
Publication type
Report
Publication details
Publication status
Language
Keywords
Abstract
This World Health Organisation review examines the implementation of primary health care (PHC) in Africa and identifies strategic interventions required to cope with the new challenges facing the health systems in the 21st century. The review addresses PHC policy formation and implementation, the resources that are available for PHC implementation, monitoring and review. The review finds that PHC policy formation had been well articulated in the national health policies by most countries, however, the extent to which PHC policies encompassed equity, community participation, inter-sectoral collaboration and affordability is still questionable. Factors delaying PHC implementation include weak structures, inadequate attention to PHC principles, inadequate resource allocation and inadequate political will.
Country
Publisher
URL:
Theme area
Equitable health services, Human resources for health, Governance and participation in health
Title of publication Strengthening Health Worker-Community Interactions through Health Literacy and Participatory approaches , Zambia Training workshop report,
Date of publication
2011 May
Publication type
Report
Publication details
Publication status
Published
Language
Keywords
health literacy; health workers; community participation; Zambia
Abstract
The training held in Lusaka district Zambia was aimed at building capacities of Health workers and communities jointly to work together to strengthen their interactions through health literacy and participatory approaches. It is anticipated that the training will go a long way in strengthening communication between health workers (employed in the health system in the community or the primary care level services) and community members at primary care level towards specific, measurable improvements of the health system for both with local coordination by Health Literacy facilitators. Specifically the training aimed to:
•Introduce the health literacy programme and Participatory Reflection and Action (PRA) approaches to community members and Health Workers in Lusaka District
•Provide core skills and information to health literacy facilitators to implement joint action to improve and strengthen Community-Health worker interactions
•Reflect on the current facilitators and blocks to communication between health workers and communities, and how to improve this.
•Provide training materials and orient facilitators to jointly identify and prioritize health needs and ill health problems, identify actions on shared priorities, identify gaps or barriers to uptake of primary health care (PHC) responses to prioritized problems, and set a shared (HW-Community) action plan.
•Orient Facilitators in Lusaka District on administering the baseline and the programme post survey instruments
Country
Zambia
Publisher
EQUINET
Equinet Publication Type
Reports
Theme area
Equitable health services, Human resources for health, Governance and participation in health
Title of publication Strengthening Health Worker-Community Interactions through Health Literacy and Participatory approaches , Uganda Training workshop report
Date of publication
2011 May
Publication type
Report
Publication details
Strengthening Health Worker-Community Interactions through Health Literacy and Participatory approaches , Uganda Training workshop report, EQUINET, Harare
Publication status
Published
Language
Keywords
health worker; communication; participatory methods; halth literacy; Uganda
Abstract
The training held in Kiboga district Uganda was aimed at building capacities of Health workers and communities jointly to work together to strengthen their interactions through health literacy and participatory approaches. It is anticipated that the training will go a long way in strengthening communication between health workers (employed in the health system in the community or the primary care level services) and community members at primary care level towards specific, measurable improvements of the health system for both with local coordination by Health Literacy facilitators. Specifically the training aimed to:
•Introduce the health literacy programme and Participatory Reflection and Action (PRA) approaches to community members and Health Workers in Kybwanzi District (Former Kiboga District)
•Provide core skills and information to HEPS Uganda health literacy facilitators to implement joint action to improve and strengthen Community-Health worker interactions
•Reflect on the current facilitators and blocks to communication between health workers and communities, and how to improve this.
•Provide training materials and orient HEPS Uganda facilitators to jointly identify and prioritize health needs and ill health problems, identify actions on shared priorities, identify gaps or barriers to uptake of primary health care (PHC) responses to prioritized problems, and set a shared (HW-Community) action plan.
•Orient HEPS Facilitators in Kybwanzi District on administering the baseline and the programme post survey instruments
Country
Uganda
Publisher
EQUINET
Equinet Publication Type
Reports
Theme area
Equity and HIV/AIDS
Title of publication Monitoring Equity in Access to AIDS treatment programmes:
Date of publication
2011 April
Publication type
Book
Publication details
Publication status
Published
Language
English
Keywords
HIV and AIDS; monitoring, equity; health systems; social determinants
Abstract
Commissioned by the World Health Organization (Department of Ethics, Equity, Trade and Human Rights - Social Determinants of Health) and
the Regional Network for Equity in Health in East and Southern Africa (EQUINET) through
REACH Trust and Training and Research Support Centre (TARSC) – 2010. “….Barriers that prevent access to antiretroviral treatment services (ART) are often socially determined. Using the Tanahashi model of health service coverage and by identifying areas of health systems and programs where action needs to be strengthened to improve equity, this publication proposes a set of potential indicators to monitor equity in access to ART. Monitoring equity in access helps decision-makers to reach people frequently excluded from treatment and facilitates efforts to overcome barriers by addressing their social determinants, within and beyond the health system. This jointly prepared publication follows up previous WHO work that explores the barriers and social determinants that impact on specific health conditions presented in the book "Equity, social determinants and public health programmes" (2010). It also builds on over 8 years of policy dialogue and research in east and southern Africa in EQUINET on equity in health, with a particular focus on HIV and AIDS. The rationale, concepts and indicators included in this publication can be further refined and adapted in the future to measure equity in access to health services or to other public health programs (e.g. TB, non-communicable diseases).
Country
Publisher
Equinet Publication Type
Toolkits and training materials, Equity indicators
Theme area
Monitoring equity and research to policy
Title of publication Diss Paper 86: Regional resources and interactions for evidence based health policy in east and southern Africa
Date of publication
2011 February
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
research to policy; east and southern Africa
Abstract
The 52nd Health Ministers Conference of the East, Central and Southern African Health Community that took place from 25th to 29th October 2010 in Harare, Zimbabwe, under the theme: Moving from Knowledge to Action: Harnessing Evidence to Transform Healthcare, recognised the limited production and use of locally generated evidence to influence policy within the region, and resolved to promote use of evidence in decision making and policy formulation within the region and make more effective links with existing resources and institutions within the region for this.
This report provides information to support the connections particularly between regional institutions and regional policy forums. It provides summary information from desk review, internet sites and email follow up on the 25 institutions and networks in East and Southern Africa (ESA) identified that are local to the region and that undertake health policy, strategy, and health systems work at regional level. The report further presents the perceptions from key informant interview of six regional policy institution personnel of the current links with technical institutions in the region, and how they can be improved. The evidence gathered is used to suggest implications for strengthening links between regional technical institutions and regional policy forums. The recommendations identify actions that can be taken with current resources, and those that call for additional investment or re-orientation of resources. The authors welcome feedback and comment on the issues raised, as well as information on other institutions from within the region working at regional level on health policy issues to add to the database compiled.
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Discussion paper
Theme area
Governance and participation in health
Title of publication Civil society organisations: Perspectives and priorities
Date of publication
Publication type
Publication details
Publication status
Language
Keywords
Abstract
Note year of publ is 2011
This report documents perspectives from civil society organisations (CSOs) on the performance of the health sector in Uganda, against the background of the government’s Health Sector Strategic and Investment Plan III (HSSIP).
Researchers found that most priority areas are in the integrated health systems, including health workforce development, increasing production and equitable deployment of health workers, increasing financial resources, strengthening the role of civil society in monitoring and accountability, and ensuring reliable access to medicines and health supplies. They call for the Ministry of Health to demonstrate its leadership, stewardship, and political will to push forward the recommendations not only elucidated in this report, but also in the HSSIP. Specific critical areas of intervention are also highlighted, including mental health and non-communicable diseases (including cancer and sickle cell disease), malaria, HIV and AIDS, health promotion and human rights. The authors recommend critical interventions in health financing, human resources for health, essential medicines and health supplies, and delivery of the Uganda Minimum Health Care Package (UMHCP).
Country
Publisher
URL:
Theme area
Human resources for health
Title of publication Resolutions of the SANNAM 2010 Network Meeting and Policy Conference
Date of publication
2010 December
Publication type
Publication details
Publication status
Language
Keywords
Abstract
The Southern African Network of Nurses and Midwives (SANNAM) 2010 Network Meeting and Policy Conference was held in Johannesburg, South Africa, from 2–4 December 2010, where a number of resolutions were made for 2011. SANNAM called on WHO and SADC to recognise the network as a partner in
monitoring the implementation of the Global Code of Practice for recruiting health workers, and resolved to maintain a database on information on health worker migration in the southern African region. To help countries in the region to reach their child and maternal health Millennium Development Goal targets, SANNAM will lobby for midwifery to be declared a specialisation after midwives have completed their basic training, as well as lobby for nursing regulatory bodies in countries that don’t have them and help to implement these bodies. SANNAM will also develop a position statement that seeks to remove bureaucratic obstacles to free movement of nurses wishing to work in different countries in the region.
Country
Publisher
URL:
Theme area
Resource allocation and health financing
Title of publication EQUINET Discussion paper 85: Experiences of implementation of a deprivation-based resource allocation formula in Zambia: 2004–2009
Date of publication
2010 December
Publication type
Report
Publication details
EQUINET Discussion Paper 85. EQUINET: Harare.
Publication status
Published
Language
Keywords
resource allocation; Zambia
Abstract
This study was undertaken by University of Zambia within the Health Financing theme work of the Regional Network for Equity in Health in East and Southern Africa (EQUINET) within a regional programme, co-ordinated by Training and Research Support Centre (TARSC) and the University of Cape Town’s Health Economics Unit, that is exploring progress in integrating equity into resource allocation. It is part of the monitoring and evaluation work in which EQUINET continues to take an active interest and supports health systems strengthening and health care financing work. The study was undertaken to:
• update the experiences and progress on the design, review and implementation of an equity-based resource allocation formula in the Zambian health sector;
• provide a critical assessment of the formula in terms of weaknesses and strengths, constraints and success factors;
• assess its contribution towards relative redistribution of financial resources on a geographic basis (or/and demographic basis); and
• identify evidence of the formula associated with health systems strengthening.
We found that the formula has only been implemented in partial form. From the current body of evidence, the only criterion to have been implemented in its full context was the first-generation formula that used district population as a weighting factor. Second- and third-generation formulae have not been adjusted in the implementation process. For instance, due to the issues surrounding re-distribution of resources, the urban areas have experienced the largest share of likely reduction in the resources in comparison to previous levels – a result that has brought about key resistance from the districts concerned and from policy makers. A related issue concerns the static levels of funding – the already constrained budgets have received little additional increases. This has constrained the capacity to phase the implementation in a way that would have held the revenue loss constant while adjusting the additional revenue upwards for the districts that were expected to receive higher revenues. Although the formula was revised for the third time, this was made without an attempt to undertake an evaluation of the effects of the partial use of the formula.
This study makes a number of recommendations. It is necessary to have an evaluation of the changes in health outcomes, outputs or processes as a consequence of the revised formula in the country to determine the causality or association of the formula with any changes. The evaluation should assess the intended achievement objectives and the variance as well as, accordingly, the revised objectives. The public health system has a pooled financing mechanism in place. However, policy implementation has weakened since the 1990s. As a result, parallel financing structures have evolved particularly in the disease or programme areas of HIV and AIDS, malaria, tuberculosis, child health and maternal health. These programmes have marginalised the health system and compromised the extent of the efficacy of total health system resources to the extent that resources for the three diseases are greater than the total contribution to the entire health system. This has contributed to the situation in which the formula addresses only limited resources and has run the risk of limited impact with respect to the objective of addressing inequalities in the health system. Evidently there is a need for a strengthened health system in which the integration of financing is a key factor, in order to begin to generate the anticipated gains.
The expansion of the pooled resource envelope to the health sector is necessary for a realistic implementation of the formula. In accordance with public financing principles, the richer districts should not have to risk a revenue reduction as opposed to limited revenue growth relative to accelerated revenue growth for the poorer districts. A clear time line should be established with regard to the transformation of the resource allocation and this should be updated based on emerging evidence. A monitoring and evaluation process that tracks performance of both resource allocation and health performance should be developed as opposed to the current situation in which nothing exists. Lastly, it has been observed that the institutional framework such as the Resource Allocation Working Group (RAWG), and its sub-group the Resource Allocation Technical Committee no longer exist. In addition, following the abolition of the decentralisation of health boards, the performance-based funding arrangement was extensively diluted. Implementation and achievement of performance-based targets may have been adversely affected by this measure. Ministry of Health needs to evaluate the effect of structural changes with regard to resource management and performance so as to ensure that best implementation modalities.
Country
Zambia
Publisher
EQUINET
Equinet Publication Type
Discussion paper
Theme area
Health equity in economic and trade policies, Governance and participation in health
Title of publication Supporting Strategic Leadership in Global Health Diplomacy in East, Central and Southern Africa : Report Of The Ministerial And Senior Leadership Scoping Workshop, Harare, Zimbabwe
Date of publication
2010 October
Publication type
Report
Publication details
Publication status
Published
Language
Keywords
Global health diplomacy; policy; east and southern Africa
Abstract
A Ministers’ and Senior Leadership Scoping Workshop was held to provide an opportunity for Ministers of Health and senior leadership teams in ECSA member states to be briefed on and review the Global Health Diplomacy (GHD) Initiative in the ECSA region, to identify synergies and opportunities for collaboration with on-going and planned country and partner activities and to agree on modalities for implementation. The meeting reviewed the experiences in GHD to date, the international initiatives on GHD and the proposed programme activities. The Ministers and senior officials made recommendations for the implementation of the programme.
Country
Tanzania
Publisher
ECSA HC
Equinet Publication Type
Reports
Theme area
Governance and participation in health
Title of publication Monkey Bay, Malawi Participatory Communication Project with Orphans and Vulnerable Children
Date of publication
2010 October
Publication type
Electronic Source
Publication details
Publication status
Published
Language
Keywords
vulnerable children; Malawi; participation
Abstract
This radio series was developed from a participatory communications process undertaken in Monkey Bay, Malawi. The participatory communication process was a follow up to previous PRA research, and sought to identify a key message, the audience participants wanted the message to reach and the medium appropriate for doing so. In the participatory process, it was decided to communicate a positive message about how girl orphans and vulnerable children could avoid sex work to local stakeholders such as community-based organisations, families and local government officials. The participants chose to create a radio drama, for broadcast in Chichewa on Dzimwe Community Radio station. The script was developed by participants in the workshop, including orphans and vulnerable children and reformed sex workers; the children then acted in the show, and the show was later broadcast in several parts. The radio drama focuses on the ordeals of one character, Irene, who is an orphan staying with an abusive aunt. Despite the ordeals she goes through she finally succeeds, while the promiscuous children around her who turn to sex work, loose. The show encourages listeners to love and understand the needs of orphans and encourages orphans to seek positive ways out of their difficulties, not sex work. The file size for the programme is too large to upload but can be sent by direct email on request to admin@equinetafrica.org
Country
Malawi
Publisher
Equinet Publication Type
Reports
Theme area
Values, policies and rights, Governance and participation in health
Title of publication Regional meeting on health and human rights: Report of Proceedings, Kampala Uganda
Date of publication
2010 October
Publication type
Report
Publication details
Publication status
Published
Language
Keywords
health rights; governance; community participation mechanisms
Abstract
The Learning Network for Health & Human Rights (South Africa) through University of Cape Town and HEPS-Uganda co-convened this regional meeting in Kampala Uganda on 8th October 2010 within the Regional Network for Equity in Heath in East and Southern Africa (EQUINET). The primary intention of the meeting was to enable the regional sharing of best practice around the right to health and community participation, as well as to explore the development of a toolkit / training manual on the Right to Health for Civil Society groups in the region. Discussions for the way forward included plans for future action on the toolkit, a human rights curriculum for health workers, and for community governance structures for health.
Country
Uganda
Publisher
EQUINET, HEPS
Equinet Publication Type
Reports
Theme area
Resource allocation and health financing
Title of publication Health Financing for Universal Coverage in South Africa
Date of publication
2010 April
Publication type
Electronic Source
Publication details
Publication status
Published
Language
Keywords
health financing; universal coverage; South Africa
Abstract
Labour Voices of the Airwaves is broadcast in five languages on 39 community radio stations in South Africa. This 7-minute long show broadcast earlier this year looks at the South African government's progress towards the World Health Assembly resolution on universal coverage, defined as adequate access for all at an affordable price. The spokesperson from the Ministerial Advisory Committee on the National Health Insurance (NHI), Fidel Radebe explained that the NHI is intended to be a financing system to provide universal coverage to all South Africans. Prof Di McIntyre from EQUINET -Health Economics Unit at the University of Cape Town, argued that universal coverage can only be achieved through fair financing mechanisms, and these would either be tax funding or a national health insurance scheme that integrates all funds into one pool for the benefit of all. Nehawu spokesperson Sizwe Mpamla explained why the union is in favour of NHI, saying that an universal health system would mean increased funding for the public health sector, which would lead to improved facilities and this would positively impact on health workers working conditions. Asanda Fonqa of Denosa was similarly positive about the move towards NHI. Prof David Sanders of the School of Public Health at the University of the Western Cape said that NHI would only contribute to achieving universal coverage if it chose a viable model for delivery; he said that if the bulk of NHI funds were used to cover private health services, universal coverage would not be achieved. Activists like Sipho Magodella of the Anti-Privatisation Forum remained skeptical that the government was really committed to delivering an equitable, universal health system and therefore skeptical of the planned NHI. Only when the full NHI proposal is made public will South Africans be able to assess to what extent it is likely to bring about universal coverage. This file is too large to load to the website so those interested are asked to contact admin@equinetafrica.org
Country
South Africa
Publisher
Equinet Publication Type
Policy brief
Theme area
Values, policies and rights
Title of publication Statement from the People's Health Movement on the Global Symposium on Health Systems Research
Date of publication
2010 November
Publication type
Publication details
Publication status
Language
Keywords
Abstract
This statement was released by the People’s Health Movement (PHM) in response to the Global Symposium on Health Systems Research, held from 16-29 November 2010 in Montreux, Switzerland. It raises a number of issues and suggestions for the future. It identifies some areas of relative neglect that may be rectified in the next Symposium, such as: the role of the health system in promoting primary health care, including the involvement of communities and intersectoral action; the place of people and participatory research in the field of health systems research; the challenge of balancing equity with universal coverage; and the roles of and interrelationship between public financing and insurance. PHM detects a tacit approval for the expansion of private financing and insurance models, which they consider problematic. While the importance of political and ideological factors were mentioned several times, PHM believes that more discussion could be had to discuss and determine the political, normative and ideological views of the community of health systems researchers. Health systems policy should be informed by research, but it needs to be shaped by normative principles and values first. At the Symposium, PHM notes that there was inadequate discussion about the way the HSR is shaped by university/academic context and the publishing industry and no discussion about the political economy of HSR and the biases in the research agenda that exist. Finally, PHM urges leaders and civil society not to tolerate the ‘myth of scarce resources’, and instead insist on equal focus and emphasis on the structural and macro-economic context of health systems.
Country
Publisher
URL:
Theme area
Governance and participation in health
Title of publication East, Central and Southern African Health Community: Resolutions of the 52nd Health Ministers Conference
Date of publication
2010
Publication type
Publication details
Publication status
Published
Language
Keywords
Abstract
This Conference was held in Zimbabwe from 25-29 October 2010, and the theme was ‘Moving from Knowledge to Action: Harnessing Evidence to Transform Healthcare’. A number of resolutions were passed, calling for East, Central and Southern African (ECSA) governments to promote evidence-based policy making, engage with the international community/global movement towards achieving universal health coverage, develop training programmes and monitoring mechanisms for improved maternal child health and reproductive health/family planning, establish and/or strengthen a national gender commission for dealing with gender-based violence and child sexual abuse, develop and monitor strategies for retaining health workers in the region and support strategic leadership in global health diplomacy. Further resolutions call for ECSA countries to prioritise nutrition interventions, strengthen monitoring and evaluation systems, strengthen the response to multi-drug resistant and extremely drug resistant tuberculosis, and strengthen partnerships for health by ensure that partner involvement in health programmes is aligned and harmonised with national health policies, plans and priorities. The countries should develop mechanisms for tracking health care investment and evaluating the outcomes of partnerships.
Country
Publisher
URL:
Theme area
Equity in health, Health equity in economic and trade policies, Equitable health services, Human resources for health, Resource allocation and health financing, Equity and HIV/AIDS, Governance and participation in health, Monitoring equity and research to policy
Title of publication Launch of the Mozambique Equity Watch, Report, Maputo, September 27
Date of publication
2010 November
Publication type
Report
Publication details
Publication status
Published
Language
Keywords
Equity Watch; Mozambique; equity analysis; policy
Abstract
On September 27 2010, the Ministry of Health of Mozambique, in co-operation with partners, launched the Mozambique Equity Watch report. The launch was held during a one week World Health Organisation AFRO training course building capacities in health equity and the social determinants of health. The launch was held in co-operation with EQUINET, represented through Training and Research Support Centre (TARSC). The report was launched by the Minister of Health Hon Dr Paulo Ivo Garrido and attended by officials of the Ministry and other sectors of government, the National Institute of Health, various technical institutions, and partners of the Mozambique Sector Wide Programme (SWAP) in health, including the focal point for the donor community, WHO and UNICEF. The Minister noted in the launch the need to now make effective use of the evidence in various forums and that the Ministry would want to repeat the Equity Watch in 2012 to see what progress has been made, and to include the inputs from other sectors of government and from civil society. After the presentations and comments participants were organized in three groups to discuss and propose measures for the follow up action on the Equity Watch:
1. On the actions to be taken by the Ministry of Health
2. On taking forward the dialogue with other stakeholders and partners on the report
3. On areas of follow up investigation and research
Country
Mozambique
Publisher
MoH Mozambique, EQUINET
Equinet Publication Type
Reports, Equity indicators
Theme area
Equity in health, Monitoring equity and research to policy
Title of publication Equity Watch: Assessing Progress towards Equity in Health in Mozambique
Date of publication
2010 September
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
Health equity; Mozambique; Equity Watch
Abstract
An Equity Watch is a means of monitoring progress on health equity by gathering, organizing, analysing, reporting and reviewing evidence on equity in health. Equity Watch work is being implemented in countries in East and Southern Africa in line with national and regional policy commitments. This report explores the dimensions of inequality that need to be addressed for the improvements in economic performance to translate into the eradication of poverty and sustained and widest improvements in human development. It focuses on the social determinants of health and the features of the health system that have been shown to make a difference in reducing social inequalities, including in health, and asks the question: what progress are we making? The report examines the positive results achieved so far, the current levels and the prevailing constraints, in the context of the overall national response to equity. It presents recommendations based on an analysis of information available.
Country
Mozambique
Publisher
EQUINET
Equinet Publication Type
Equity indicators
Theme area
Equity in health, Monitoring equity and research to policy
Title of publication Observatório da Equidade: Avaliação do progresso da equidade na saùde
Date of publication
2010 September
Publication type
Report
Publication details
Publication status
Published
Language
Portuguese
Keywords
Equity Watch; health equity; Mozambique
Abstract
‘Observatório de Equidade’ é um meio de monitoria do progresso da equidade na saúde através da recolha, organização, análise de dados e elaboração de relatórios sobre a equidade na saúde. Este relatório explora as dimensões da inequidade que precisam de ser resolvidas para garantir melhorias no desempenho económico para conduzir à erradicação da pobreza e ao alcance de melhorias sustentáveis no desenvolvimento humano. Dá enfoque às determinantes sociais da saúde e às características do sistema de saúde que provaram fazer a diferença na redução das inequidades sociais, incluindo na saúde, e faz a seguinte pergunta: Que progresso estamos a fazer? O relatório analiza os resultados positivos alcançados até agora, os níveis actuais e os constrangimentos prevalecentes, no contexto da resposta nacional em relação à inequidade. Apresenta recomendações baseadas numa análise da informação disponível.
Country
Mozambique
Publisher
EQUINET
Equinet Publication Type
Policy paper, Equity indicators
Theme area
Equity in health, Monitoring equity and research to policy
Title of publication Observatório da Equidade,
Date of publication
Publication type
Publication details
Publication status
Language
Keywords
Abstract
Country
Publisher
Theme area
Public-private mix, Resource allocation and health financing
Title of publication Meeting report: The role and functioning of Medical Aid Societies in Zimbabwe
Date of publication
2010 August
Publication type
Report
Publication details
Investing in the health sector: The role and functioning of Medical Aid Societies in Zimbabwe National Review Meeting Report, EQUINET: Harare.
Publication status
Published
Language
Keywords
health financing, medical aid societies, capital flows, Zimbabwe
Abstract
The national review meeting on the role of the medical aid societies in Zimbabwe was convened by TARSC, SEATINI with collaboration from the Ministry of Health and Child Welfare, and support from the Southern African Health Trust through ISER, Rhodes University, in EQUINET. The activity was one of a series in a regional programme on capital flows in the health sector in southern Africa co-ordinated by ISER. The workshop brought together researchers, policy makers, health sector regulators and the medical aid societies to discuss issues around the flow and impact of capital flows through medical aid societies in the health sector in Zimbabwe. The review workshop guided by the research work that was implemented in Zimbabwe by TARSC and SEATINI on capital flows in the health sector, separately reported in EQUINET discussion paper 82. The meeting raised issues in relation to the functioning of medical aid societies and made recommendations to address them.
Country
Zimbabwe
Publisher
EQUINET
Equinet Publication Type
Reports
Theme area
Monitoring equity and research to policy
Title of publication Report of the 1st Regional Monitoring and Evaluation Expert Core Group Meeting Report 12-16 July 2010, Harare, Zimbabwe
Date of publication
2010 August
Publication type
Report
Publication details
Publication status
Published
Language
Keywords
monitoring and evaluation; ECSA health community; equity analysis; equity watch
Abstract
The ECSA Secretariat organized the 1st Regional Monitoring and Evaluation Expert Core Group meeting in Harare Zimbabwe from 12th to 16th July 2010. The participants
came from Member States of Tanzania, Kenya, Lesotho, Zimbabwe, Zambia, Uganda, Malawi, Mozambique and Mauritius and International partners namely EQUINET, UNICEF- ESARO, WHOIST/ ESA and USAID-EA. The meeting deliberated and agreed on the Terms of Reference for the regional M&E Expert Group. The
meeting also updated the HMC Monitoring tool, adopted with amendments the Regional Core set of indicators that will be used to monitor progress towards the MDGs, finalized the M& E Framework, developed indicators to monitor the implementation of the HMC resolutions and included indicators to monitor health equity in order to address inequalities in health in the region. In addition, the meeting
resolved that it was necessary to monitor other codes, protocols and conventions such as the WHO Global Code of Practice on the International recruitment of health personnel. The indicators and the monitoring tools agreed upon by the expert core group will not only make it easier to compare member states in progress towards achieving the MDGs, addressing equity issues in health and implementation of the HMC resolutions, but also will be valuable in evaluation of in country changes from the baseline. The meeting also discussed, reviewed and adopted the Equity watch work in east and southern African countries.
Country
East and southern Africa region
Publisher
ECSA HC
Equinet Publication Type
Equity indicators
Theme area
Public-private mix
Title of publication EQUINET Discussion paper 83: The drugs industry and access to essential medicines in Tanzania
Date of publication
2010 July
Publication type
Document
Publication details
EQUINET Discussion Paper Series 83 Training and Research Support Centre, SEATINI, Rhodes University, EQUINET: Harare
Publication status
Published
Language
Keywords
pharmaceutical industry; private for profit health sector; Tanzania
Abstract
This paper outlines the flows of private capital that lie behind the growth of the for-profit pharmaceutical sector in Tanzania, and analyses the policy, access and equity challenges posed by the shift to increasing private sector participation in medicine provision. The study was implemented within EQUINET by the Institute of Development Studies, University of Dar es Salaam, in a regional programme co-ordinated by the Institute for Social and Economic Research, South Africa. Strengthening the pharmaceutical sector to produce an adequate supply of medicines in Tanzania, for Tanzanians, is hindered by numerous constraints, including: non inclusion of TRIPS flexibilities in Tanzanian law; lack of skilled staff; financial constraints; poor industrial infrastructure and services; weak local and international pharmaceutical industry links; and counterfeit medicines entering the market. The report recommends that the health ministry step up its own monitoring systems to ensure effective distribution of medicines to health facilities. New legislation is also needed to improve quality standards, implement TRIPS flexibilities in Tanzanian law, and tackle substandard medicines entering the market.
Country
Tanzania
Publisher
EQUINET
Equinet Publication Type
Discussion paper
Theme area
Public-private mix
Title of publication EQUINET Discussion paper 84: Private sector involvement in funding and providing health services in South Africa: Implications for equity and access to health care
Date of publication
2010 July
Publication type
Document
Publication details
EQUINET Discussion Paper Series 84 Health Economics Unit (UCT), ISER Rhodes University, EQUINET: Harare
Publication status
Published
Language
Keywords
private for profit health sector; health financing; South Africa
Abstract
The private health sector in South Africa is substantial. This paper explores the private sector involvement in funding and providing health services in South Africa and the implications for equity and access to health care. Serious challenges face the private health care sector in South Africa, not least of all the very rapid increases in expenditure and, hence, contribution rates in medical schemes. A range of factors underlie these trends; but in recent years, schemes’ spending increases have been driven largely by private for-profit hospitals and specialists, with the number of private hospital beds increasing rapidly and considerable consolidation of beds within three large private hospital groups. The 2007 policy conference of the ruling African National Congress (ANC) resolved to introduce a National Health Insurance (NHI). If successfully implemented, the substantial reforms envisaged will promote health system equity, affordability and sustainability within South Africa. However, there are growing concerns that the introduction of these reforms will contribute to increased activities by South African private for-profit health care companies in other African countries. Private health care firms in South Africa not only have an interest in expanding into other African countries, they will also have access to substantial investment resources. In particular, the World Bank’s International Finance Corporation (IFC) is actively seeking to invest in the private health sector in African countries. The experience of the private health sector in South Africa should be taken into account by policy-makers in other African countries when considering what role they envisage for the private health sector within their country context.
Country
South Africa
Publisher
EQUINET
Equinet Publication Type
Discussion paper
Theme area
Resource allocation and health financing
Title of publication EQUINET Policy Brief 23: Strategies to improve equitable domestic financing to reach universal coverage in East and Southern Africa
Date of publication
2010 July
Publication type
Document
Publication details
EQUINET Policy brief 23, EQUINET, Harare
Publication status
Published
Language
Keywords
health financing; universal coverage; domestic financing
Abstract
In most East and Southern African (ESA) countries, total health expenditure from all sources, including external resources, is still less than the US$ 45 per capita per year needed to provide basic health services. This limits their ability to achieve universal coverage of basic health services. This policy brief draws policy makers’ attention to the demands and challenges in health financing in meeting universal coverage, the demand for improved domestic public financing for health, and suggests options for doing this.
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Policy brief
Theme area
Monitoring equity and research to policy
Title of publication Challenges facing national health research systems in the WHO African region
Date of publication
2007
Publication type
Journal Article
Publication details
African Journal Of Health Sciences 14 3-4 pp 100-103
Publication status
Published
Language
English
Keywords
East and southern Africa, national health research systems
Abstract
Many countries in the African region do not have functional national health research systems (NHRS) that generate, disseminate, uses, and archives health-related knowledge/ideas in published form (hard, electronic or audio forms). In such countries, death of each modern or traditional health practitioner constitutes a permanent loss of a library of knowledge, ideas, innovations and inventions. The WHO African Advisory Committee on Health Research and Development (AACHRD) has attributed the fragility of NHRS in the Region to poor environment for research, inadequate manpower, inadequate infrastructures and facilities, inaccessibility to modern technology, and lack of funds. The weak and uncoordinated NHRS partly explain the poor overall performance of majority of national health systems in the Region. Continued fragility of NHRS can be attributed to lack of implementation of the WHO Regional Committee for Africa and the World Health Assembly resolutions on health research. This paper urges African countries, to fully implement the contents of those resolutions for substantive health research outputs to share with the rest of the world.
Country
East and southern Africa region
Publisher
African Journals Online
Theme area
Equity and HIV/AIDS
Title of publication Supporting HIV-positive teachers in East and Southern Africa: Technical consultation report: 30 November-1 December 2006
Date of publication
2007 September
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
east and southern Africa, HIV, HIV-positive teachers
Abstract
East and southern Africa are the two regions in the world that are the most highly affected by HIV and AIDS. A significant number of people with HIV are educators, ranging from primary school teachers to head teachers and university lecturers. In response, UNESCO together with the three partners convened a consultation with HIV-positive teachers and other key stakeholders from Ministries of Education and teachers’ unions from Kenya, Namibia, United Republic of Tanzania, Uganda, Zambia and Zimbabwe. This report presents a summary of the key points, outcomes and recommendations emerging from the consultation that aimed to share experiences and articulate common, key elements of comprehensive responses for HIV-positive teachers. In order to provide a comprehensive response for HIV-positive teachers, the report argues that there needs to be support for HIV-positive teachers to continue teaching in a supportive environment free of stigma and discrimination. For this to be in place, a number of actions are recommended as necessary, including to: identify and address the varying needs of HIV-positive teachers; tackle stigma and discrimination; ensure access to prevention programmes, treatment, care and support; and build links between teacher’s unions and networks of HIV-positive teachers.
Country
East and southern Africa region
Publisher
United Nations Educational, Scientific and Cultural Organization (UNESCO)
Theme area
Equity and HIV/AIDS
Title of publication Impact of HIV/AIDS mortality on South Africa's life expectancy and implications for the elderly population
Date of publication
2007
Publication type
Journal Article
Publication details
African Journal Of Health Sciences 14 3-4 pp 201-211
Publication status
Published
Language
English
Keywords
South Africa, HIV, AIDS, elderly population, AIDS mortality
Abstract
The study seeks to raise awareness and expand knowledge about the deleterious effect of HIV and AIDS mortality on South Africa's life expectancy, a country with a relatively high HIV and AIDS prevalence rate (19%). Using the multiple and associated single decrement life table techniques, the study estimates the total number of South Africans who would die from HIV/AIDS by the time they reach age 75 from a hypothetical cohort of 100,000 live births, assuming that the mortality conditions of 1996 for South Africa prevailed. The findings indicate that 5.7% of babies will eventually die of AIDS. Furthermore, 7.7% and 11.5% of those aged 60 years, and 75 years and above respectively will die of AIDS. Overwhelming majority of deaths will come from persons within the reproductive and productive age groups. A tremendous gain in life expectancy to the tune of about 26 years would result in the absence of HIV. The elderly persons, who are the grandmothers and grandfathers, are likely to manage family affairs following the death of their adult children. This condition is likely to impoverish the elderly population. Everything should be done to reduce AIDS mortality in order to increase life expectancy in the country.
Country
South Africa
Publisher
African Journals Online
Theme area
Resource allocation and health financing
Title of publication Vouchers for scaling up insecticide-treated nets in Tanzania: Methods for monitoring and evaluation of a national health system intervention
Date of publication
2008 June
Publication type
Journal Article
Publication details
BMC Public Health 8 205
Publication status
Published
Language
English
Keywords
Tanzania, insecticide-treated nets, Tanzania National Voucher Scheme, malaria
Abstract
The Tanzania National Voucher Scheme (TNVS) uses the public health system and the commercial sector to deliver subsidised insecticide-treated nets (ITNs) to pregnant women. The system began operation in October 2004 and by May 2006 was operating in all districts in the country. Evaluating complex public health interventions which operate at national level requires a multidisciplinary approach, novel methods, and collaboration with implementers to support the timely translation of findings into programme changes. This paper describes this novel approach to delivering ITNs and the design of the monitoring and evaluation (M&E). A comprehensive and multidisciplinary M&E design was developed collaboratively between researchers and the National Malaria Control Programme. Five main domains of investigation were identified: (1) ITN coverage among target groups, (2) provision and use of reproductive and child health services, (3) "leakage" of vouchers, (4) the commercial ITN market, and (5) cost and cost-effectiveness of the scheme. The evaluation plan combined quantitative (household and facility surveys, voucher tracking, retail census and cost analysis) and qualitative (focus groups and in-depth interviews) methods. This plan was defined in collaboration with implementing partners but undertaken independently. Findings were reported regularly to the national malaria control programme and partners, and used to modify the implementation strategy over time. The M&E of the TNVS is a potential model for generating information to guide national and international programmers about options for delivering priority interventions. It is independent, comprehensive, provides timely results, includes information on intermediate processes to allow implementation to be modified, measures leakage as well as coverage, and measures progress over time.
Country
Tanzania
Publisher
BioMed Central
Theme area
Human resources for health
Title of publication Shortage of health workers in the Malawian public health services system: How do Parliamentarians perceive the problem?
Date of publication
2008
Publication type
Journal Article
Publication details
African Journal Of Health Sciences 13 1-2 pp 124-130
Publication status
Published
Language
English
Keywords
Malawi, health worker shortages, Parliamentarians
Abstract
The quality and quantity of health care services delivered by the Malawi public health system is severely limited, due to, among other things the shortage of adequate numbers of trained health care workers. In order to suggest policy changes and implement corrective measures, there may be need to describe the perceptions of the legislature on how they perceive as the cause of the problem. Training more health workers, training new but lower cadres of health workers not marketable to the outside world, improving the working conditions and remuneration of health workers are suggested as some of the solutions. Even without the brain drain of health workers to other countries, Malawi's health sector personnel numbers are not adequate to serve the needs of the country. Relying on training more health workers in the numbers normally produced from the prevailing training institutions is unlikely to remove the shortages.
Country
Malawi
Publisher
African Journals Online
Theme area
Human resources for health
Title of publication Improving retention and performance in civil society in Uganda
Date of publication
2008 June
Publication type
Journal Article
Publication details
Human Resources For Health 6 11
Publication status
Published
Language
English
Keywords
Uganda, Family Life Education Programme, community-based health services, worker retention
Abstract
This article describes the experience of the Family Life Education Programme (FLEP), a reproductive health programme that provides community-based health services through 40 clinics in five districts of Uganda, in improving retention and performance by using the Management Sciences for Health (MSH) Human Resource Management Rapid Assessment Tool. A few years ago, the FLEP of Busoga Diocese began to see an increase in staff turnover and a decrease in overall organisational performance. An action plan to improve their human resource management (HRM) system was developed and implemented. By implementing the various recommended changes, FLEP established an improved, responsive HRM system. Increased employee satisfaction led to less staff turnover, better performance, and increased utilisation of health services. These benefits were achieved by cost-effective measures focused on professionalising the organisation's approach to HRM.
Country
Uganda
Publisher
BioMed Central
Theme area
Equitable health services
Title of publication What does access to maternal care mean among the urban poor? Factors associated with use of appropriate maternal health services in the slum settlements of Nairobi, Kenya
Date of publication
2008 February
Publication type
Journal Article
Publication details
Maternal And Child Health Journal 13 pp 130-137
Publication status
Language
English
Keywords
Kenya, maternal health, urban poverty
Abstract
The study seeks to improve understanding of maternity health seeking behaviours in resource-deprived urban settings. The objective of this paper is to identify the factors which influence the choice of place of delivery among the urban poor, with a distinction between sub-standard and “appropriate” health facilities. The data are from a maternal health project carried out in two slums of Nairobi, Kenya. A total of 1,927 women were interviewed, and 25 health facilities where they delivered, were assessed. Facilities were classified as either “inappropriate” or “appropriate”. Place of delivery is the dependent variable. Ordered logit models were used to quantify the effects of covariates on the choice of place of delivery, defined as a three-category ordinal variable. Although 70% of women reported that they delivered in a health facility, only 48% delivered in a facility with skilled attendant. Besides education and wealth, the main predictors of place of delivery included being advised during antenatal care to deliver at a health facility, pregnancy “wantedness”, and parity. The influence of health promotion (i.e., being advised during antenatal care visits) was significantly higher among the poorest women. Interventions to improve the health of urban poor women should include improvements in the provision of, and access to, quality obstetric health services. Women should be encouraged to attend antenatal care where they can be given advice on delivery care and other pregnancy-related issues. Target groups should include poorest, less educated and higher parity women.
Country
Kenya
Publisher
Springer Publications
Theme area
Equitable health services
Title of publication Risk factors for incomplete vaccination and missed opportunity for immunisation in rural Mozambique
Date of publication
2008 May
Publication type
Journal Article
Publication details
BMC Public Health 8 161
Publication status
Published
Language
English
Keywords
Mozambique, rural health, vaccination, immunisation
Abstract
Inadequate levels of immunisation against childhood diseases remain a significant public health problem in resource-poor areas of the globe. Nonetheless, the reasons for incomplete vaccination and non-uptake of immunisation services are poorly understood. This study aimed at finding out the reasons for non-vaccination and the magnitude of missed opportunities for vaccination in children less than two years of age in a rural area in southern Mozambique. Mothers of children under two years of age (N = 668) were interviewed in a cross-sectional study. The Road-to-Health card was utilised to check for completeness and correctness of vaccination schedule as well as for identifying the appropriate use of all available opportunities for vaccination. The chi-square test and the logistic regression were used for statistical analysis. The researchers found that 28.2% of the children had not completed the vaccination program by two years of age, 25.7% had experienced a missed opportunity for vaccination and 14.9% were incorrectly vaccinated. Reasons for incomplete vaccination were associated with accessibility to the vaccination sites, no schooling of mothers and children born at home or outside Mozambique. Efforts to increase vaccination coverage should take into account factors that contribute to the incomplete vaccination status of children. Missed opportunities for vaccination and incorrect vaccination need to be avoided in order to increase the vaccine coverage for those clients that reach the health facility, specially in those countries where health services do not have 100% of coverage.
Country
Mozambique
Publisher
BioMed Central
Theme area
Equitable health services
Title of publication Health and survival of young children in southern Tanzania
Date of publication
2008 June
Publication type
Journal Article
Publication details
BMC Public Health 8 194
Publication status
Published
Language
English
Keywords
Tanzania, children, rural health
Abstract
With a view to developing health systems strategies to improve reach to high-risk groups, this research has been conducted on health and survival from household and health facility perspectives in five districts of southern Tanzania. The researchers documented availability of health workers, vaccines, drugs, supplies and services essential for child health through a survey of all health facilities in the area. The researchers conclude that relatively short distances to health facilities, high antenatal and vaccine coverage show that peripheral health facilities have huge potential to make a difference to health and survival at household level in rural Tanzania, even with current human resources.
Country
Tanzania
Publisher
BioMed Central
Theme area
Equitable health services
Title of publication Delayed care-seeking for fatal pneumonia in children aged under five years in Uganda: A case-series study
Date of publication
2008 May
Publication type
Journal Article
Publication details
World Health Bulletin 86 5 pp 332-338
Publication status
Published
Language
English
Keywords
Uganda, pneumonia, child health, malaria
Abstract
This research paper reviews individual case histories of children who have died of pneumonia in rural Uganda and investigates why these children did not survive. The research was conducted in the Lganga/Mayuge region in Uganda, where 67,000 people were visited once every three months for population-based data. Children aged 1-59 months from November 2005 to August 2007 were included in the study. The paper finds that of the pneumonia deaths that were registered, half occurred in hospital and one-third at home. Median duration of pneumonia illness was seven days, and median time taken to seek care outside the home was two days. Most children first received drugs at home: 52% antimalarials and 27% antibiotics. The paper concludes that many children with fatal pneumonia experienced mistreatment with antimalarials, delays in seeking care and low quality of care. To improve access to and quality of care, the feasibility and effectiveness of training community health workers and drug vendors in pneumonia and malaria management with prepacked drugs should be tested.
Country
Uganda
Publisher
World Health Organization
Theme area
Equitable health services
Title of publication Capacity of healthcare facilities in the implementation of direct observed treatment strategy for tuberculosis in Arumeru and Karatu districts, Tanzania
Date of publication
2008
Publication type
Journal Article
Publication details
Tanzania Journal Of Health Research 10 2 pp 95-98
Publication status
Published
Language
English
Keywords
Tanzania, Arumeru, Karatu, tuberculosis
Abstract
Directly Observed Treatment Short course strategy (DOTS) has proved to have potential improvement in tuberculosis (TB) control in Tanzania. The objective of this cross sectional study was to assess the capacity of health facilities in implementing DOTS, in Arumeru and Karatu districts, Tanzania. Information sought included the capacity to offer TB service and availability of qualified staff and equipment for TB diagnosis. Information on availability and utilization of TB registers and treatment outcome for the year 2004 were also collected. A total of 111 health facilities were surveyed, 86 (77.5%) in Arumeru and 25 (22.5%) in Karatu. Only 23.4% (26/111) facilities were offering TB treatment services in the two districts. Majority 17/26 (65.38%) of them were government owned. Thirty eight (44.7%) facilities were offering TB laboratory services. All facilities with TB services (TB laboratory investigation and treatment) had TB registers. Seventy two (85.0%) of health facilities which do not provide any TB services had qualified clinical officers and at least a microscopy. Of the 339 cases notified in Arumeru in 2004, 187 (60.7%) had treatment outcome available, 124 (66.3%) were cured and 55 (29.4%) completed treatment. In Karatu 638 cases were notified in 2004, 305 (47.8%) had treatment outcome available, 68 (22.3%) cured and 165 (54.1%) completed treatment. In conclusion, the overall capacity for implementing DOTS among the facilities surveyed is found only in about 20% and 30% for clinical and laboratory components of DOTS, respectively. The capacity to provide TB diagnosis and treatment in Karatu district was relatively lower than Arumeru. It is important that capacity of the facilities is strengthened concurrently with the planned introduction of community- based DOTS in Tanzania.
Country
Tanzania
Publisher
African Journals Online
Theme area
Equitable health services
Title of publication Acceptability of evidence-based neonatal care practices in rural Uganda: Implications for programming
Date of publication
2008 June
Publication type
Journal Article
Publication details
BMC Pregnancy And Childbirth 8 21
Publication status
Published
Language
English
Keywords
Uganda, rural health, neonatal care, women
Abstract
Although evidence-based interventions to reach the Millennium Development Goals for Maternal and Neonatal mortality reduction exist, they have not yet been operationalised and scaled up in Sub-Saharan African cultural and health systems. A key concern is whether these internationally recommended practices are acceptable and will be demanded by the target community. The researchers explored the acceptability of these interventions in two rural districts of Uganda; conducted ten focus group discussions consisting of mothers, fathers, grand parents and child minders (older children who take care of other children); and ten key informant interviews with health workers and traditional birth attendants. Most maternal and newborn recommended practices are acceptable to both the community and to health service providers. However, health system and community barriers were prevalent and will need to be overcome for better neonatal outcomes. Pregnant women did not comprehend the importance of attending antenatal care early or more than once unless they felt ill. Women prefer to deliver in health facilities but most do not do so because they cannot afford the cost of drugs and supplies which are demanded in a situation of poverty and limited male support. Postnatal care is non-existent. For the newborn, delayed bathing and putting nothing on the umbilical cord were neither acceptable to parents nor to health providers, requiring negotiation of alternative practices. Communities associate the need for antenatal care attendance with feeling ill, and postnatal care is non-existent in this region. Health promotion programs to improve newborn care must prioritise postnatal care, and take into account the local socio-cultural situation and health systems barriers including the financial burden. Male involvement and promotion of waiting shelters at selected health units should be considered in order to increase access to supervised deliveries. Scale-up of the evidence based practices for maternal-neonatal health in Sub-Saharan Africa should follow rapid appraisal and adaptation of intervention packages to address the local health system and socio-cultural situation.
Country
Uganda
Publisher
BioMed Central
Theme area
Poverty and health
Title of publication The material and political bases of lived poverty in Africa: Insights from the Afrobarometer
Date of publication
2008 May
Publication type
Academic paper
Publication details
Afrobarometer Working Paper 98 pp 1-34
Publication status
Published
Language
English
Keywords
East and southern Africa, Afrobarometer, poverty
Abstract
The Afrobarometer has developed an experiential measure of lived poverty called the Lived Poverty Index (LPI). It measures how frequently people go without basic necessities during the course of a year. This is a portion of the central core of the concept of poverty not captured by existing objective or subjective measures. As an individual measure, the LPI is found to be valid and reliable. However, it exhibits only moderate external validity when compared with absolute measures of national wealth. Contrary to what appears to be the consensus among economists, GDP growth is accompanied by increases in lived poverty, and there is only a weak relationship between LPI and measures of human development or income poverty. At the same time, lived poverty is strongly related to country level measures of political freedom. This supports Sen's (1999) arguments about development as freedom and Halperin et al’s (2005) arguments about the “democracy advantage” in development. This paper concludes that this measure does well at measuring the experiential core of poverty, and capturing it in a way that other widely used international development indicators do not.
Country
East and southern Africa region
Publisher
IDASA
Theme area
Poverty and health
Title of publication Malnutrition among women in sub-Saharan Africa: Rural-urban disparity
Date of publication
2008
Publication type
Journal Article
Publication details
Rural And Remote Health 8 931
Publication status
Published
Language
English
Keywords
East and southern Africa, malnutrition, women, rural-urban
Abstract
Malnutrition is a serious public health problem, particularly in developing countries, linked to a substantial increase in the risk of mortality and morbidity. Women and young children are most often affected. Rural disadvantage is a known factor, but little attention has been paid to rural-urban disparity among women. To provide a reliable source of information for policy-makers, the current study used nationally representative data from 26 countries in sub-Saharan Africa to update knowledge about the prevalence malnutrition and its rural-urban disparities among women. The data sources were the demographic and health surveys of 26 countries conducted between 1995 and 2006. Overall, rural women were 68% more likely to be malnourished compared with their urban counterparts.
Country
East and southern Africa region
Publisher
Rural and Remote Health
Theme area
Health equity in economic and trade policies
Title of publication Strengthening international health co-operation in Africa through the regional economic communities
Date of publication
2007
Publication type
Journal Article
Publication details
African Journal Of Health Sciences 14 3-4 pp 104-113
Publication status
Published
Language
English
Keywords
Regional economic communities, international health co-operation, east and southern Africa
Abstract
The Regional Economic Communities (RECs) are the pillars of the African Union (AU), and have been recognised by the AU as the key vehicles for economic integration and cooperation in Africa. The 2003 Session of the AU Conference of African Ministers of Health (CAMH) considered and adopted, inter alia, recommendations on a proposal to establish Health and Social Affairs Desks within the RECs. The 2003 Maputo Session of the Assembly of AU Heads of State and Government duly endorsed the Report of the Ministers and their recommendations. This paper represents an attempt to assess the extent to which the 2003 decision of CAMH has been implemented. The researchers also argue that regional integration and cooperation should not be geared solely towards economic, trade or political purposes but to the social sector as well, and proposes a set of criteria as useful starting points for determining which social (i.e. health) activities can be undertaken at the regional and sub-regional levels.
Country
East and southern Africa region
Publisher
African Journals Online
Theme area
Values, policies and rights, Equity and HIV/AIDS
Title of publication Compendium of key documents relating to human rights and HIV in Eastern and Southern Africa
Date of publication
2008
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
Human rights, HIV, AIDS, east and southern Africa
Abstract
The Compendium of key documents relating to human rights and HIV in Eastern and Southern Africa is a collection, in five parts, of global, regional, sub-regional and national human rights instruments, policies, legislation and case law that are relevant to HIV and AIDS. In most instances, only excerpts pertinent to HIV and AIDS are provided. When applicable, reference is made to a source where the full text may be accessed.
Country
East and southern Africa region
Publisher
Pretoria University Law Press
Theme area
Equitable health services
Title of publication Health service delivery in early recovery fragile states: Lessons from Afghanistan, Cambodia, Mozambique, and Timor Leste
Date of publication
2006 June
Publication type
Academic paper
Publication details
Publication status
Published
Language
English
Keywords
Essential health services, aid, Millennium Development Goals, fragile states, Mozambique
Abstract
This case study explores some key themes in the emerging literature on service delivery in fragile states in light of the health sector experience in four early recovery countries, including Mozambique. The analysis considers the various impacts of foreign assistance on state stewardship of the health sector and the programming implications. The investigation starts with state effectiveness and legitimacy. Findings point to the importance of and structural impediments to donor harmonisation in re-establishing health services in a post-conflict context. The document shows that United Nations (UN) coordination in all four countries was constrained by state avoidance strategies, a spike in aid flows that were out of sync with emerging government capacity, and, in Mozambique, an emphasis on highly visible but largely unsustainable infrastructure projects that were limited by the absence of a planning framework. Harmonisation and alignment of aid systems and accountability requirements were enabled through joint frameworks, common approaches, and trust funds that offered direct budget support that strengthened government systems, accountability, and a common policy framework. The authors show how capacity-building efforts have been limited by a restricted focus on skills building rather than power sharing and particularly a lack of control over resources. The document highlights that promising approaches to support state stewardship include: contracting with NGOs, establishing equity funds and civil service performance-based reform. There should be sectoral plans under discussion in all countries and significant budget support.
Country
Mozambique
Publisher
Pp 51 BASICS
Theme area
Equity and HIV/AIDS
Title of publication Surgeons and HIV: South African attitudes
Date of publication
2009 February
Publication type
Journal Article
Publication details
South African Medical Journal 99 2 pp 110-113
Publication status
Published
Language
English
Keywords
HIV, AIDS, human resources, surgeons, discrimination, South Africa
Abstract
The HIV status of surgeons, in the context of the informed consent obtained from their patients, is a contentious matter. This study surveyed the views of practising surgeons in South Africa regarding aspects of HIV and its impact on surgeons. A cross-sectional survey was conducted with surgeons who were members of the Association of Surgeons of South Africa to find out their attitudes to the preceding issues. The salient findings included the view that a patient-centred approach requiring HIV status disclosure to patients would be discriminatory to surgeons and provide no clear benefit to patients, and that HIV-positive surgeons should determine their own scope of practice. Patient-centred approaches and restrictive policies do not accord with clinicians’ sentiments. In the absence of comparable local or international data, this study provides clinicians' views with implications for the development of locally relevant policies and guidelines.
Country
South Africa
Publisher
African Journals Online
Theme area
Equity and HIV/AIDS
Title of publication HIV/AIDS, conflict and security in Africa: Rethinking relationships
Date of publication
2008
Publication type
Journal Article
Publication details
World Hospital Health Services 44 4 pp 36-41
Publication status
Published
Language
English
Keywords
HIV, AIDS, conflict, security, east and southern Africa
Abstract
Conflict has long been assumed to contribute significantly to the spread of HIV infection. However, new research is casting doubt on this assumption. Studies from Africa suggest that conflict does not necessarily predispose to HIV transmission and indeed, there is evidence to suggest that recovery in the ‘post-conflict’ state is potentially dangerous from the standpoint of HIV transmission. There has also been concern that high rates of HIV infection among many of the militaries of sub-Saharan Africa poses a threat to regional security. However, data is lacking on this. These issues are of vital importance for HIV programming and health sector development in conflict and ‘post-conflict’ societies and will constitute formidable challenges to the international community. Further research is required to better inform the discussion of HIV, conflict and security in sub-Saharan Africa.
Country
East and southern Africa region
Publisher
BioMed
Theme area
Values, policies and rights
Title of publication Genes from Africa: The colonisation of human DNA
Date of publication
2009
Publication type
Academic paper
Publication details
African Centre for Biosafety Briefing Paper 5 pp 1-16
Publication status
Published
Language
English
Keywords
Intellectual property, patents, DNA, human genome, genetic resources, east and southern Africa
Abstract
This report discusses the University of Pennsylvania’s African Human Genetic Diversity Project, and the filing of patent claims in October 2007 over genetic material collected from communities in Africa. It questions the staking of legal claims over the natural genetic resources of Africans. Such patents not only allow exclusive rights to such resources, but also enable profit from future medical applications. the report notes that the patent is possible, because US patent law extends patent protection to life forms. This new trend has enabled research institutions and corporations to secure patents for almost 5% of the entire human genome. The report seeks to contribute to stopping the exploitation of African genetic resources.
Country
East and southern Africa region
Publisher
African Centre for Biosafety
Theme area
Equity in health, Values, policies and rights
Title of publication Millennium Development Goals: Progress and prospects for meeting child survival targets in South Africa
Date of publication
2008
Publication type
Journal Article
Publication details
Critical Health Perspectives 1 pp 1-3
Publication status
Published
Language
English
Keywords
Millennium Development Goals, child survival, primary health care, poverty, South Africa
Abstract
This paper takes a critical look at South Africa's prospects for meeting the Millennium Development targets for child survival. It asks the question that much peer research has been asking: is a return to comprehensive primary health care (PHC) what is needed? The time is long overdue for energetically translating the rhetorically rich promises of the PHC approach to reality, turning dormant policies into action. The main actions should centre around the development of comprehensive, well-managed programmes involving the health sector, other sectors and communities. The process needs to be structured into functioning district systems. In most countries these need to be considerably strengthened, particularly at the household, community and primary care levels.
Country
South Africa
Publisher
People’s Health Movement
Theme area
Public-private mix, Resource allocation and health financing
Title of publication EQUINET Discussion Paper 82: Capital flows through Medical Aid Societies in Zimbabwe’s health sector
Date of publication
2010 May
Publication type
Report
Publication details
EQUINET Discussion Paper Series 82. Training and Research Support Centre, SEATINI, Rhodes University, EQUINET: Harare.
Publication status
Published
Language
Keywords
Zimbabwe; medical aid; capital flows;
Abstract
Medical aid societies (MAS) in Zimbabwe cover a tenth of the population, and about 80% of income to private health care providers in Zimbabwe comes from MAS. They contribute more than 20% of the country’s total health expenditure. This paper outlines the flows of private capital that lie behind the growth of the profit medical aid and insurance health care sector in Zimbabwe. It was implemented within the Regional Network for Equity in Health in East and Southern Africa (EQUINET) by Training and Research Support Centre and SEATINI, in a regional programme co-ordinated by the Institute for Social and Economic Research, South Africa. The report proposes measures for improving the functioning of and equity in the sector and to address the current exposure of beneficiaries, including:
i. Strengthening the regulatory environment to address legal ambiguities on investment of the industry’s ‘surplus’ funds, to ensure the multiple relevant laws from finance and health are known and applied by MAS/ insurance providers, and to fairly and firmly enforce the law.
ii. Ensuring timely scheme reporting as required by law and maintenance of a database with basic information on schemes.
iii. Ensuring registration of all schemes, avoiding increasing segmentation of the sector into small fragmented risk pools from individual schemes and encouraging (for example through enforcement of regulation on registration and liquidity requirements), mergers into larger and more viable risk pools.
iv. Introducing regulatory and scheme policy measures to require and implement cross- subsidies necessary for equity and ensuring benefits packages cover personal care and personal prevention services.
v. Taking up the shortfalls in coverage of medicines on existing plans.
vi. Checking the degree of vertical integration in each scheme and unbundling any monopolies across the sector that are limiting patient choice (e.g. paying only for selected linked services).
vii. Improving the outreach of consumer information on schemes, benefits packages and consumer rights to members and organisations servicing members (e.g. the labour movement and employer organisations).
Country
Zimbabwe
Publisher
EQUINET
URL:
Equinet Publication Type
Discussion paper
Theme area
Title of publication
Date of publication
Publication type
Publication details
Publication status
Language
Keywords
Abstract
Shamu S, Loewenson R, Machemedze R and Mabika A (2010) ‘Capital flows through Medical Aid Societies in Zimbabwe’s health sector,’ EQUINET Discussion Paper Series 82. Training and Research Support Centre, SEATINI, Rhodes University, EQUINET: Harare.
Country
Publisher
Theme area
Health equity in economic and trade policies
Title of publication Serie de Politicas 18: Comércio e Saúde na África Oriental e Austral
Date of publication
2010 June
Publication type
Document
Publication details
Publication status
Published
Language
Portuguese
Keywords
Abstract
O crescimento do comércio internacional tem conseqüências significativas para a saúde pública. A relação entre o comércio e a saúde não é simples, e não é unidirecional. Neste informe levantamos questões sobre porquê é que questões sobre o comércio têm que ser compreendidas e geridas com o intuito de promover a saúde e realçamos as principais preocupações em saúde pública decorrentes dos acordos sobre o comércio livre. Chamamos a atenção para as medidas que os governos e a sociedade civil na região podem tomar com vista a alcançar maior coerência entre o comércio e as políticas de saúde, de maneira a que o comércio internacional e as regras do comércio maximizem os benefícios para a saúde e minimizem os riscos em saúde, especialmente para populações pobres e vulneráveis.
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Policy brief
Theme area
Public-private mix
Title of publication Rethinking privatisation: Towards a critical theoretical perspective
Date of publication
2007
Publication type
Document
Publication details
Public Services Yearbook 2005/2006 pp 1-12
Publication status
Published
Language
English
Keywords
South Africa, privatisation, neoliberalism
Abstract
The question of why privatisation and commercialisation of public services is taking place is a hotly contested one. Neoliberal analysts have argued that privatisation occurs because states fail: state officials are rent-seeking, inefficient, unaccountable, inflexible and unimaginative. Privatisation is seen as a rational and pro-poor policy choice, obvious to anyone willing to look at the track record of public versus private sector delivery: The authors here argue, by contrast, that the privatisation of public services has not happened because it has been inspired by some renewed sense of cultural enthusiasm for the market, but rather that it has become a necessity imposed on the state by economic circumstances: reduced public borrowing; cuts in state spending; liberalisation; and the opening up of new economic fields for intensified capital accumulation. Not surprisingly, some of the biggest boosters of privatisation are the private companies themselves, which have spent considerable time and effort trying to secure new market opportunities. They have actively sought contracts around the world, and consultancy firms, such as PriceWaterhouseCoopers and KPMG, have been actively promoting privatisation efforts and lobbying for the expansion and acceleration of the General Agreement on Trade and Services (GATS).
Country
South Africa
Publisher
Municipal Services Project
Theme area
Equitable health services
Title of publication Cataract surgery: Ensuring equal access for boys and girls
Date of publication
2009
Publication type
Journal Article
Publication details
Community Eye Health Journal 22 70 pp 28-29
Publication status
Published
Language
English
Keywords
Tanzania, cataracts, child health
Abstract
Surgical intervention is necessary if children with cataract are to regain their sight. In many low- and middle-income countries, cataract is the leading cause of avoidable blindness among children. This article in considers the gender dimensions of surgery and the background to the situation in Tanzania where many children are not brought for surgery in a timely fashion and follow up is often poor. Girls have a significantly lower rate of surgery with only half as many girls receiving treatment as boys and tended to be bought for surgery much later than boys. In poor or struggling communities, sons are often seen as a source of income and financial security for parents when they get older, whereas girls are seen as a financial burden. Analysis showed that women’s level of education, their socioeconomic status, and the decision-making power they had within their household and their community all played a major role in determining whether and when their children would receive cataract surgery and whether they would be taken for follow-up visits. A number of ways forward are discussed including mass media efforts which may provide the first opportunity for rural villagers to learn about the need for early referral of young children with vision loss.
Country
United Kingdom
Publisher
International Centre for Eye Health
Theme area
Poverty and health
Title of publication Diarrhoea: Why children are still dying and what can be done
Date of publication
2008
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
Africa, diarrhoea, child mortality
Abstract
This report, focusing on South-east Asia and Africa, lays out a seven-point plan that includes a treatment package to reduce childhood diarrhoea deaths and a prevention strategy to ensure long-term results: fluid replacement to prevent dehydration; zinc treatment; rotavirus and measles vaccinations; promotion of early and exclusive breastfeeding and vitamin A supplementation; promotion of hand washing with soap; improved water supply quantity and quality, including treatment and safe storage of household water; and community-wide sanitation promotion. Dr Margaret Chan, Director-General of the World Health Organization, said: ‘We know where children are dying of diarrhoea. We know what must be done to prevent those deaths. We must work with governments and partners to put this seven-point plan into action.’ Yet, despite the known benefits of improving water supply and sanitation, some 88% of diarrhoeal diseases worldwide are attributable to unsafe water, inadequate sanitation and poor hygiene. As of 2006, an estimated 2.5 billion people were not using improved sanitation facilities, and nearly one in every four people in developing countries was practicing open defecation.
Country
Switzerland
Publisher
World Health Organization
Theme area
Monitoring equity and research to policy
Title of publication Assessing progress in Africa towards the Millennium Development Goals
Date of publication
2008
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
Africa, Millennium Development Goals
Abstract
This report presents a picture that is slightly at variance with many other reports on Africa’s progress towards the targets of the Millennium Development Goals (MDGs). It shows that progress is being made in a number of areas such as primary enrolment, gender parity in primary education, malaria deaths and representation of women in parliaments. There has also been a reinforcement of state capacity to deliver growth in many countries. If this rate of progress continues, the continent will be on course to meet a significant number of the MDGs by the target date (2015), but not all. A critical area for progress is the health-related MDGs, where progress is slowest. Interventions to accelerate progress on the health MDGs will yield significant dividend. In sum, the preconditions for accelerating progress to meet the targets of the MDGs are now largely in place, albeit constrained by inadequate resource flows and capacity in some critical areas like health capacity.
Country
Ethiopia
Publisher
Economic Commission For Africa
Theme area
Equity in health
Title of publication A step too far? Making health equity interventions in Namibia more sufficient
Date of publication
2003 April
Publication type
Journal Article
Publication details
International Journal For Equity In Health 2 5
Publication status
Published
Language
English
Keywords
Namibia, primary health care, health equity
Abstract
Concepts of fair distribution of health, such as equity of access to medical care, may not be sufficient to equalise health outcomes but, nevertheless, they may be more practical and effective in advancing health equity in developing countries. This study used a framework for relating health equity goals to development strategies allowing progressive redistribution of primary health care resources towards the more deprived communities is formulated. The framework is applied to the development of primary health care in post-independence Namibia. In Namibia health equity has been advanced through the progressive application of health equity goals of equal distribution of primary care resources per head, equality of access for equal met need and equality of utilisation for equal need. For practical and efficiency reasons it is unlikely that health equity would have been advanced further or more effectively by attempting to implement the goal of equality of health status. The goal of equality of health status may not be appropriate in many developing country situations; instead, a stepwise approach based on progressive redistribution of medical services and resources may be better.
Country
United Kingdom
Publisher
BioMed Central
Theme area
Monitoring equity and research to policy
Title of publication Monitoring the South African National Antiretroviral Treatment Programme, 2003–2007: The IEDEA Southern Africa Collaboration
Date of publication
2009 September
Publication type
Journal Article
Publication details
South African Medical Journal 99 pp 653-660
Publication status
Published
Language
English
Keywords
South Africa, antiretroviral therapy, South African National Antiretroviral Treatment Programme
Abstract
This multi-cohort study of eleven anti-retroviral therapy (ART) programmes monitored the South African National Antiretroviral Treatment Programme, 2003–2007, in Gauteng, the Western Cape, Free State and KwaZulu-Natal. Subjects were all adults and children (<16 years old) who initiated ART with ≥3 antiretroviral drugs before 2008. Most sites were offering free treatment to adults and children in the public sector, ranging from 264 to 17,835 patients per site. Among 45,383 adults and 6,198 children combined, median age (interquartile range) was 35 years and 42.5 months respectively. Of adults, 68% were female. Between 2003 and 2007, enrolment increased eleven-fold in adults and three-fold in children. The study describes dramatically increased enrolment over time. Late diagnosis and ART initiation, especially of men and children, need attention. Investment in sentinel sites will ensure good individual-level data while freeing most sites to continue with simplified reporting.
Country
South Africa
Publisher
Health and Medical Publishing Group
Theme area
Equity and HIV/AIDS
Title of publication Injection drug use, unsafe medical injections, and HIV in Africa: A systematic review
Date of publication
2009 August
Publication type
Journal Article
Publication details
Harm Reduction Journal 6 24
Publication status
Published
Language
English
Keywords
Africa, drug abuse, medical injections, needle sharing, HIV
Abstract
The re-use of injecting equipment in clinical settings is well documented in Africa and appears to play a substantial role in generalised HIV epidemics. Several African governments have taken steps to control injecting equipment, including banning syringes that can be reused. However, injection drug use (IDU), of heroin and stimulants, is a growing risk factor for acquiring HIV in the region, having become increasingly common among young adults in sub-Saharan Africa and also associated with high-risk sex. Demand-reduction programmes based on effective substance use education and drug treatment services are very limited, and imprisonment is more common than access to drug treatment services. Drug policies are still very punitive and there is widespread misunderstanding of and hostility to harm-reduction programmes. These new injection risks will take on increased epidemiological significance over the coming decade and will require much more attention by African nations to the range of effective harm reduction tools now available in Europe, Asia and North America.
Country
United Kingdom
Publisher
BioMed Central
Theme area
Resource allocation and health financing
Title of publication Financing South Africa's national health system through national health insurance: Possibilities and challenges
Date of publication
2008
Publication type
Academic paper
Publication details
Human Sciences Research Council Policy Analysis Unit Paper pp 1-64
Publication status
Published
Language
English
Keywords
South Africa, national health insurance, health sector reform, policy development
Abstract
Although much progress has been made towards the creation of a national health system which makes 'access to health for all' a reality, much remains to be done. These colloquium proceedings are an effort to initiate policy dialogue and critical discussion on how health services are accessed, provided and funded – and to formulate ideas, views and recommendations that could be presented to those involved in health policy development. The book is divided into three sections. Section A discusses the context for policy debates on health within a comprehensive system of social security. Section B synthesises the colloquium proceedings, beginning with a brief summary of inputs and discussions under the four key themes: the reform path since 1994; critical options for health within the context of a comprehensive system of social security; local and international evidence on health system models; and health systems reform and stakeholder engagement. Section C provides recommendations for improving implementation and taking the process of policy development forward.
Country
South Africa
Publisher
Human Sciences Research Council
URL:
Theme area
Title of publication HIV-related public-private partnerships and health systems strengthening
Date of publication
2009 July
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
ECSA countries, public-private partnerships, HIV, health systems strengthening
Abstract
This report focuses on the contribution of AIDS-related public-private partnerships to the six building blocks of health systems: service delivery; human resources; information; medicines and technologies; financing; and leadership. A desk review and interviews were conducted with representatives of private and public organisation stakeholders, as well as development partners. Interviewees identified mutual understanding as an important precondition for the implementation of efficient and successful partnerships. The private sector at times lacks profound knowledge of the complex stakeholder landscape in the HIV response and health care provision. To develop flourishing partnerships, honest and wide-ranging dialogue to inform and secure agreement in joint planning is essential from the very earliest stages. Such planning will of course consider issue such as sustainability, follow-up, and monitoring, essential to flourishing partnerships. Health financing mechanisms, HIV and tuberculosis treatment and mobile health technology are areas which are of interest to the private sector and which require further technical expertise and promotion.
Country
Switzerland
Publisher
Joint United Nations Programme On HIV/AIDS (UNAIDS)
Theme area
Resource allocation and health financing
Title of publication A call for a massive paradigm shift from just health financing to integrated health, population and social development investment in Africa: The case for progressing from only 15% to 15%+
Date of publication
2010 April
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
Africa, Millenium Development Goals, Abuja Declaration
Abstract
This paper was presented at the African Union's (AU) Continental Conference on Maternal, Infant and Child Health in Africa from 19 to 21 April 2010. It seeks to outline, in broad terms, the basis for a required massive paradigm shift in ‘health financing’ in Africa. It argues that the key basis for the shift is that all available evidence over the past nine to ten years indicates that, after an initial burst of progress, isolated health financing on its own has achieved mixed or limited success, and Africa’s overall health burden and mortality is now greater in 2010 than it was in 2000. In April 2001, African Heads of State met in Abuja, Nigeria to make the continent's main financial commitment towards meeting the health Millennium Goals by pledging to allocate at least 15% of domestic national budgets to health. Yet nine years later, the pledge remains largely unmet. However, this paper notes that the problem is not only that the Abuja 15% Commitment has not been met by the majority of AU member states. Instead, more broad based social development investment is required in addition to the 15% pledge. In addition to this, the Abuja 15% commitment as it presently stands contains an inbuilt flaw that needs to be corrected – both in content, and in the process through which the commitment was reached. The paper concludes that we should no longer refer to 'health financing' in Africa, but rather aim for investment in integrated and needs-based health, population and social development. In other words, we need to go from just 15% to 15%+.
Country
United Kingdom
Publisher
: Africa Public Health Alliance, 15%+ Campaign and Africa Public Health Parliamentary Network
URL:
Theme area
Human resources for health
Title of publication Training needs assessment for clinicians at antiretroviral therapy clinics: Evidence from a national survey in Uganda
Date of publication
2009 August
Publication type
Journal Article
Publication details
Human Resources For Health 7 76
Publication status
Published
Language
English
Keywords
Uganda, antiretroviral therapy, task shifting, staff training
Abstract
This study sought to identify task shifting that has already occurred and assess the antiretroviral therapy (ART) training needs among clinicians to whom tasks have shifted. It surveyed health professionals and heads of ART clinics at a stratified random sample of 44 health facilities accredited to provide this therapy. A sample of 265 doctors, clinical officers, nurses and midwives reported on tasks they performed. Thirty of 33 doctors (91%), 24 of 40 clinical officers (60%), 16 of 114 nurses (14%) and 13 of 54 midwives (24%) reported that they prescribed ART. Yet, 64% of the people who prescribed antiretroviral therapy were not doctors. Seven percent of doctors, 42% of clinical officers, 35% of nurses and 77% of midwives assessed that their overall knowledge of antiretroviral therapy was lower than good. The study concluded that training initiatives should be an integral part of the support for task shifting, while making sure that ART is used correctly and toxicity or drug resistance do not reverse accomplishments to date.
Country
United Kingdom
Publisher
BioMed Central
Theme area
Human resources for health
Title of publication The role of nurses and midwives in polio eradication and measles control activities: A survey in Sudan and Zambia
Date of publication
2009 September
Publication type
Journal Article
Publication details
Human Resources For Health 7 78
Publication status
Published
Language
English
Keywords
Zambia, polio, measles, nurses, midwives
Abstract
The authors of this study conducted a survey among nurses and midwives working at district level in Sudan and Zambia to determine their roles and functions in polio eradication and measles elimination programmes. Nurses and midwives practising in four selected districts in Sudan and in Zambia completed a self-administered questionnaire on their roles and responsibilities, their routine activities and their functions during supplementary immunisation campaigns for polio and measles. This study shows that nurses and midwives play an important role in implementing immunisation activities at the district level and that their roles can be maximised by creating opportunities that lead to their having more responsibilities in their work and in particular, their involvement in early phases of planning of priority health activities. This should be accompanied by written job descriptions, tasks and clear lines of authority as well as good supportive supervision. The lessons from supplementary immunisation activities, where the roles of nurses and midwives are maximised, can be easily adopted to benefit the rest of the health services provided at district level.
Country
United Kingdom
Publisher
Biomed Central
Theme area
Equitable health services
Title of publication Trends in tuberculosis incidence and their determinants in 134 countries
Date of publication
2009 September
Publication type
Journal Article
Publication details
Bulletin Of The World Health Organization 87 9 pp 683-691
Publication status
Published
Language
English
Keywords
Sub-Saharan Africa, tuberculosis, directly observed therapy
Abstract
To investigate the effect of case management programmes on TB incidence, this paper carried out a comparative analysis of factors that could be key direct or indirect determinants of national TB incidence trends over 1997–2006. Cases of TB (in all its forms) reported annually to WHO were used to calculate trends in incidence rate, the latter expressed as the number of cases notified annually in a given country per 100,000 population. The striking observation in this study was that, more than a decade after directly observed therapy was first implemented, none of the seven direct measures of TB programme performance was associated with TB trends globally. National TB control programmes play a vital role in curing TB patients and preventing deaths, as the diagnosis and treatment of active TB have significantly reduced disease transmission and incidence in some countries. However, treatment programmes have not had a major, detectable effect on incidence on a large scale. The possible reasons are that: patients are not diagnosed and treated soon enough to significantly reduce transmission; case detection, cure and TB incidence trends cannot be measured accurately; there has been insufficient time to see the effects of reduced transmission; and any effects on transmission are offset by a growing risk of developing TB following infection.
Country
Switzerland
Publisher
World Health Organization
Theme area
Equitable health services
Title of publication Health care providers' attitudes towards termination of pregnancy: A qualitative study in South Africa
Date of publication
2009 August
Publication type
Journal Article
Publication details
BMC Public Health 9 296
Publication status
Published
Language
English
Keywords
South Africa, Western Cape, pregnant women, abortion
Abstract
This is the first known qualitative study undertaken in South Africa exploring providers' attitudes towards abortion. It used qualitative research methods to collect data. Thirty four in-depth interviews and one focus group discussion were conducted during 2006 and 2007 with health care providers who were involved in a range of abortion provision in the Western Cape Province, South Africa. Data were analysed using a thematic analysis approach. Complex patterns of service delivery were prevalent throughout many of the health care facilities and fragmented levels of service provision operated in order to accommodate health care providers' willingness to be involved in different aspects of abortion provision. Almost all providers were concerned about the numerous difficulties women faced in seeking an abortion and their general quality of care. An overriding concern was poor pre- and post-abortion counselling, including contraceptive counselling and provision. To sustain a pool of abortion providers, programmes that both attract prospective abortion providers and retain existing providers, need to be developed and financial compensation for abortion care providers needs to be considered.
Country
United Kingdom
Publisher
BioMed Central
Theme area
Poverty and health
Title of publication Low malnutrition but high mortality: Explaining the paradox of the Lake Victoria region
Date of publication
2009
Publication type
Academic paper
Publication details
Publication status
Published
Language
English
Keywords
Kenya, Lake Victoria, malnutrition, child mortality
Abstract
The combination of low levels of malnutrition together with dramatically high rates of mortality encountered in Kenya's Lake Victoria territory is unique for Sub-Saharan Africa. This paper points to a unique interplay of cultural, geographical and political factors in the region that are responsible for causing the described paradox. Moreover, it demonstrates that a salient disease environment is one of the key drivers of the massive under-5 mortality rates in the lake region. This environment is characterised by extremely high malaria prevalence, polluted water sources and high rates of infectious diseases like HIV. It also found that an ethnic specific effect remains even after controlling for mother's age at birth, birth spacing, birth order and HIV-status. Political discrimination seems also to be an important factor. The paper reveals that the HIV status of the mother and children's diarrhoea status explain the largest part in the variation of stunting outcomes between families. Educational attainment of the mother turns out to be the single most important source in explaining mortality differentials between families.
Country
Norway
Publisher
Norwegian University of Life Sciences
Theme area
Poverty and health
Title of publication HIV/AIDS, growth and poverty in KwaZulu-Natal and South Africa: An integrated survey, demographic and economy-wide analysis
Date of publication
2009 September
Publication type
Journal Article
Publication details
Journal Of The International AIDS Society 12 18
Publication status
Published
Language
English
Keywords
South Africa, KwaZulu-Natal, HIV, AIDS, economic development
Abstract
This paper estimates the economic impact of HIV and AIDS on the KwaZulu-Natal province and the rest of South Africa. It extended previous studies by employing: an integrated analytical framework that combined firm surveys of workers' HIV prevalence by sector and occupation; a demographic model that produced both population and workforce projections; and a regionalised economy-wide model linked to a survey-based micro-simulation module. Results indicate that HIV and AIDS greatly reduces annual economic growth, mainly by lowering the long-run rate of technical change. However, impacts on income poverty are small, and inequality is reduced by HIV and AIDS because high unemployment among low-income households minimises the economic costs of increased mortality. By contrast, slower economic growth hurts higher income households despite lower HIV prevalence. The increase in economic growth that results from addressing HIV and AIDS is sufficient to offset the population pressure placed on income poverty. Moreover, incentives to mitigate HIV and AIDS lie not only with poorer infected households, but also with uninfected higher income households. The findings confirm the need for policies to curb the economic costs of the pandemic.
Country
United Kingdom
Publisher
Biomed Central
Theme area
Equity in health
Title of publication World Economic and Social Survey 2009: Promoting development, saving the planet
Date of publication
2009
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
Sub-Saharan Africa, climate change, development
Abstract
According to this report, food production, access to clean water and health in Africa may be affected by climate change. In eastern Africa, rainfall is expected to increase in some parts of the region. In southern Africa, rains will be disrupted, bringing a notable drop in maize production. In contrast, growing seasons may lengthen in parts of Southern Africa, for example Mozambique, owing to a combination of increased temperature and higher rainfall. Yet net revenues from crops could shrink by up to 90% by 2100. There is likely to be a greater number of people living with water stress by 2055 as rainfall becomes more erratic or declines. The previously malaria-free highland areas of Ethiopia, Kenya, Rwanda and Burundi could experience modest incursions of malaria by the 2050s, with conditions for transmission becoming highly suitable by 2080s. Rift Valley fever epidemics could become more frequent and widespread as El Niño events increase. In southern Africa, more areas are likely to become more suitable for malaria, with a southward expansion of the transmission zone into Zimbabwe and South Africa.
Country
Switzerland
Publisher
United Nations: Development Policy and Analysis Division
Theme area
Monitoring equity and research to policy
Title of publication Improving data to reduce the burden of disease: Lessons from the Western Cape
Date of publication
2009 September
Publication type
Journal Article
Publication details
South African Medical Journal 99 9 pp 641-642
Publication status
Published
Language
English
Keywords
South Africa, Western Cape, burden of disease, data management, health priorities
Abstract
The Western Cape provincial government initiated the collaborative Burden of Disease (BOD) Reduction Project to reduce its burden of disease and promote equity in health. This shift in thinking from facilities to a population-based approach to health demonstrates increased awareness about the crucial role of upstream factors on population health. Several lessons may be learnt from the Western Cape experience with mortality surveillance. Identifying health priorities is important, like leading causes of premature mortality such as HIV and AIDS, tuberculosis, homicides and road traffic injuries. Identifying inequities must be done in line with the recommendations of the World Health Organization Commission on Social Determinants of Health to monitor health inequities. Government also needs to start evaluating priority health programmes. Providing accessible information for policy makers is also crucial, as well as advocating for an intersectoral response, such as improving living conditions with the involvement from other sectors such as housing, water and sanitation.
Country
South Africa
Publisher
Health and Medical Publishing Group
Theme area
Monitoring equity and research to policy
Title of publication District Health Barometer 2007/2008
Date of publication
2009
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
South Africa, maternal mortality, prevention of mother-to-child HIV transmission, HIV, AIDS
Abstract
The quality of health care, including access to HIV prevention and testing services, depends to a large extent on which of South Africa's 52 districts you happen to live in. Major inequities were noted between urban and rural areas, as rural areas were usually underserved. Some of the inequities highlighted by the District Health Barometer (DHB) can be traced to differences in health spending, with different districts spending different amounts. The uneven distribution of HIV infection in South Africa also influenced ratings: higher rates of Caesareans were linked to higher HIV rates in pregnant women. Writing in the DHB, Dr Tanya Doherty attributed a lack of improvement in child and maternal mortality rates to the HIV epidemic – under-five mortality barely shifted from 60 per 1,000 births in 1990, to 59 in 2007, while maternal mortality actually increased. Prevention of mother-to-child HIV transmission (PMTCT) is vital to reducing maternal and child mortality and combating HIV, but health authorities have failed to properly monitor PMTCT interventions. ‘This is indicative of management neglect of the programme from national to facility level,’ she wrote.
Country
South Africa
Publisher
Health Systems Trust
Theme area
Monitoring equity and research to policy
Title of publication Challenges for routine health system data management in a large public programme to prevent mother-to-child HIV transmission in South Africa
Date of publication
2009 May
Publication type
Journal Article
Publication details
Public Library of Science ONE 4 5
Publication status
Published
Language
English
Keywords
South Africa, prevention of mother-to-child HIV transmission, pregnant women, HIV, AIDS, data management
Abstract
This study assessed the completeness and accuracy of routine prevention of mother-to-child transmission of HIV (PMTCT) data submitted to the district health information system (DHIS) in three districts of Kwazulu-Natal province, South Africa, covering 316 clinics and hospitals. Data elements were reported only 50.3% of the time and were ‘accurate’ (within 10% of reconstructed values) 12.8% of the time. The data element ‘Antenatal Clients Tested for HIV’ was the most accurate element (consistent with the reconstructed value) 19.8% of the time, while ‘HIV PCR testing of baby born to HIV positive mother’ was the least accurate, with only 5.3% of clinics meeting the definition of accuracy. Data collected and reported in the public health system across three large, high HIV-prevalence districts was neither complete nor accurate enough to track process performance or outcomes for PMTCT care. Systematic data evaluation can determine the magnitude of the data reporting failure and guide site-specific improvements in data management. Solutions are currently being developed and tested to improve data quality.
Country
United States
Publisher
Public Library of Science
Theme area
Equity and HIV/AIDS
Title of publication Male partner HIV-1 testing and antenatal clinic attendance associated with reduced infant HIV-1 acquisition and mortality
Date of publication
2009
Publication type
Slide presentation
Publication details
Publication status
Published
Language
English
Keywords
Kenya, prevention of mother-to-child HIV transmission, pregnant women. HIV, AIDS
Abstract
This study in the Kenyan capital, Nairobi, noted reduced HIV risk when the male partner of a pregnant woman attended antenatal clinic visits and was also tested for HIV. The study enrolled 532 HIV-positive pregnant women, 140 of whom were accompanied by their male partners on antenatal visits. Results showed that the one-year-old children of women whose partners had attended the clinics had an HIV-free survival rate 59% higher than those whose partners did not attend. These findings indicate that promotion of programmes aimed at increasing male attendance in antenatal care could function to reduce the risk of vertical transmission and infant mortality. About 80% of antenatal clinics in Kenya offer prevention of mother-to-child HIV transmission (PMTCT) services, but the uptake of counselling and testing is below 50%. The government is considering various incentives, such as waiving maternity fees for couples who attend PMTCT sessions together, to boost male participation.
Country
Switzerland
Publisher
International AIDS Society
Theme area
Equity and HIV/AIDS
Title of publication Determinants of knowledge of HIV status in South Africa: Results from a population-based HIV survey
Date of publication
2009 June
Publication type
Journal Article
Publication details
BMC Public Health 9 174
Publication status
Published
Language
English
Keywords
South Africa, HIV status, determinants of knowledge
Abstract
This paper seeks to describe the associations between socio-demographic, behavioural and social characteristics and knowledge of HIV status among a nationally representative population in South Africa. A multistage, representative probability sample involving 16,395 male and female respondents, aged 15 years or older was selected. From the total sample 27.6% ever and 7.8% knew their HIV status in the past 12 months. In multivariate analyses, being female, the age group 25 to 34 years old, other than African Black population group (White, Coloured and Asian), higher educational level, being employed, urban residence, awareness of a place nearby where one could be tested for HIV, impact of HIV on the household and having had two of more sexual partners in the past year were associated with knowledge of HIV status. Education about HIV and AIDS and access to HIV counselling and testing in rural areas, in particular among the Black African population group needs to be improved, in order to enhance the uptake of HIV counselling and testing services, an essential step for the initiation of treatment.
Country
United Kingdom
Publisher
BioMed Central
Theme area
Equity and HIV/AIDS
Title of publication Clinical and financial burdens of secondary level care in a public sector antiretroviral roll-out setting
Date of publication
2009 May
Publication type
Journal Article
Publication details
South African Medical Journal 99 5 pp 320-325
Publication status
Published
Language
English
Keywords
South Africa, antiretrovirals, antiretroviral therapy
Abstract
While efforts have been made to assess the costs of providing antiretroviral therapy (ART) via accredited service points, little information is available on its downstream costs, particularly in public secondary level hospitals. This paper aims to determine the cost of care for inpatients and outpatients at a dedicated antiretroviral referral unit, the GF Jooste Hospital, during March 2005. This prospective costing study on 48 outpatients and 25 inpatients was conducted from a health system perspective. Incremental cost per outpatient was found to be R1,280 and R5,802 per inpatient. Costs were dominated by medical staff costs (62% inpatient and 58% outpatient, respectively). As the costs of providing secondary level care for patients on or immediately preceding ART initiation can be significant, the study recommends that they should be included in the government’s strategic planning so that the service can be expanded to meet current and future needs and to avoid crowding out other secondary level health services.
Country
South Africa
Publisher
Health and Medical Publishing Group
Theme area
Public-private mix
Title of publication HIV-related public-private partnerships and health systems strengthening
Date of publication
2009 July
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
ECSA countries, HIV, AIDS, public-private partnerships
Abstract
This report focuses on the contribution of AIDS-related public-private partnerships to the six building blocks of health systems: service delivery; human resources; information; medicines and technologies; financing; and leadership. A desk review and interviews were conducted with representatives of private and public organisation stakeholders, as well as development partners. Interviewees identified mutual understanding as an important precondition for the implementation of efficient and successful partnerships. The private sector at times lacks profound knowledge of the complex stakeholder landscape in the HIV response and health care provision. To develop flourishing partnerships, honest and wide-ranging dialogue to inform and secure agreement in joint planning is essential from the very earliest stages. Such planning will of course consider issue such as sustainability, follow-up, and monitoring, essential to flourishing partnerships. Health financing mechanisms, HIV and tuberculosis treatment and mobile health technology are areas which are of interest to the private sector and which require further technical expertise and promotion.
Country
Switzerland
Publisher
Joint United Nations Programme On HIV/AIDS (UNAIDS)
Theme area
Human resources for health
Title of publication Designing financial-incentive programmes for return of medical service in underserved areas: Seven management functions
Date of publication
2009 June
Publication type
Journal Article
Publication details
Human Resources For Health 7 52
Publication status
Published
Language
Keywords
Sub-Saharan Africa, underserved areas, financial incentives, health worker management
Abstract
This paper draws on studies of financial incentive programmes and other initiatives with similar objectives to discuss seven management functions that are essential for the long-term success of financial incentive programmes aimed at retaining staff in underserved areas: using innovative financing; promoting health as a career; introducing specific selection criteria to ensure programme success and achieve goals; ensuring correct placement of new employees; offering support by staying in close contact with participants throughout enrolment and assigning them mentors; enforcement (programmes may use community-based monitoring or outsource enforcement to existing institutions); and routine performance evaluation of programmes. To improve the strength of the evidence on the effectiveness of financial incentives, controlled experiments should be conducted where feasible.
Country
United Kingdom
Publisher
BioMed Central
Theme area
Equitable health services
Title of publication The whole is greater than the sum of the parts: Recognising missed opportunities for an optimal response to the rapidly maturing TB-HIV co-epidemic in South Africa
Date of publication
2009 July
Publication type
Journal Article
Publication details
BMC Public Health 9 243
Publication status
Published
Language
English
Keywords
South Africa, TB-HIV co-epidemic, tuberculosis, HIV
Abstract
Despite widely acknowledged WHO guidelines for the integration of tuberculosis (TB) and HIV services, heavily burdened countries have been slow to implement these and thus significant missed opportunities have arisen. The individual-centred, rights-based paradigm of the national AIDS policy remains dissonant with the compelling public-health approach of TB control. The existence of independent and disconnected TB and HIV services wastes scarce health resources, increases burden on patients' time and finances, and ignores evidence of patients' preference for an integrated service, resulting in ongoing missed opportunities, such as failure to maximise collaborative disease surveillance, voluntary counselling and testing, adherence support, infection control, and positive prevention. The full potential of an integrated TB-HIV service has not been fully harvested. Missed opportunities discount existing efforts in both programmes, will perpetuate the burden of disease, and prevent major gains in future interventions. This paper outlines simple, readily implementable strategies to narrow the gap and reclaim existing missed opportunities.
Country
United Kingdom
Publisher
BioMed Central
Theme area
Equitable health services
Title of publication Saving mothers 2005-2007: Fourth report on confidential enquiries into maternal deaths in South Africa
Date of publication
2009 July
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
South Africa, maternal health, maternal mortality
Abstract
South Africa witnessed a 20% increase in maternal deaths between 2005 and 2007, when compared to the previous three-year period, with HIV and AIDS accounting for 43.7% of all deaths. Almost four (38.4%) out of every 10 deaths were ‘clearly avoidable within the health care system’, according to researchers, which means they could have been prevented with proper care. The report recommends that the department of health addresses maternal deaths by: improving health care provider knowledge and skills in providing emergency care and ensuring adequate screening and treatment of the major causes of maternal death; improving the quality and coverage of reproductive health services, namely contraceptive and termination of pregnancy services; better management of staffing and equipment norms, transport and availability of blood for transfusion; and community involvement and empowerment regarding maternal, neonatal and reproductive health in general.
Country
South Africa
Publisher
South African Department of Health
Theme area
Equitable health services
Title of publication Patient experiences and health system responsiveness in South Africa
Date of publication
2009 July
Publication type
Journal Article
Publication details
BMC Health Services Research 9 117
Publication status
Published
Language
English
Keywords
South Africa, health services, public health sector, private health sector
Abstract
Using the data from the South African World Health Survey (WHS), this study aimed to evaluate the degree of health care service responsiveness (both out-patient and in-patient) and comparing experiences of individuals who used public and private services in South Africa. Data was used from a population-based survey of 2,352 male and female participants, which was conducted in South Africa in 2003. Major components identified for out-patient care responsiveness in this survey were highly correlated with health care access, communication and autonomy, secondarily to dignity, confidentiality and quality of basic amenities, and thirdly to health problem solution. The degree of responsiveness with publicly provided care was in this study significantly lower than in private health care –16.8% versus 3.2%. Health care access, communication, autonomy, and discriminatory experiences were identified as priority areas for actions to improve responsiveness of health care services in South Africa.
Country
United Kingdom
Publisher
BioMed Central
Theme area
Equitable health services
Title of publication Iron supplementation in early childhood: Health benefits and risks
Date of publication
2009
Publication type
Journal Article
Publication details
American Journal Of Clinical Nutrition 84 6 pp 1261-1276
Publication status
Published
Language
English
Keywords
Tanzania, supplements, child health
Abstract
This study reviewed 26 randomised controlled trials of preventive, oral iron supplementation in young children (aged 0–59 months) living in developing countries to ascertain the associated health benefits and risks. It found that among iron-deficient or anaemic children, haemoglobin concentrations were improved with iron supplementation. Reductions in cognitive and motor development deficits were observed in iron-deficient or anaemic children, particularly with longer-duration, lower-dose regimens. With iron supplementation, weight gains were adversely affected in iron deficient children; the effects on height were inconclusive. Most studies found no effect on morbidity, although few had sample sizes or study designs that were adequate for drawing conclusions. More research is needed in populations affected by HIV and tuberculosis. Iron supplementation in preventive programmes may need to be targeted through identification of iron-deficient children.
Country
United States
Publisher
American Journal of Clinical Nutrition
Theme area
Poverty and health
Title of publication Nutrition in ART programmes
Date of publication
2009 July
Publication type
Journal Article
Publication details
HIV & AIDS Treatment In Practice 141 pp 2-11
Publication status
Published
Language
English
Keywords
ECSA countries, nutrition, antiretroviral therapy
Abstract
The consequences of malnutrition for the efficacy of anti-retroviral therapy (ART) are poorly understood, and evidence regarding the impact of food supplementation on ART outcomes is still limited. The World Health Organization and World Food Programme have issued guidance on food support in ART programmes: every newly enrolled patient should have a nutritional assessment that includes measurement of weight and body mass index, along with nutritional counselling and monitoring. Promotion of activity that increases ability to maintain and expand food supplies, either through growing crops or trading (`livelihoods`) may be a more appropriate response to malnutrition in people with less-advanced HIV disease, with cash transfers also being used as a means of addressing food insecurity. Households affected by HIV often experience multiple threats to their livelihoods. All nutritional support programmes need realistic strategies to avoid dependency and promote long-term food security.
Country
United Kingdom
Publisher
NAM
Theme area
Health equity in economic and trade policies
Title of publication Construction health and safety in South Africa: Status and recommendations
Date of publication
2009 June
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
occupational health and safety, South Africa
Abstract
Construction health and safety has long been the focus of attention of many industry stakeholders and role-players in South Africa, and while it is acknowledged that many industry associations and professional societies, contracting organisations and others have made significant efforts to improve health and safety within the construction industry, overall, construction health and safety is not improving significantly. Notably, construction continues to contribute a disproportionate number of fatalities and injuries, and there continues to be a high level of non-compliance with the health and safety regulations in South Africa. Against this context, the Construction Industry Development Board (cidb) has undertaken this report on the status of construction health and safety in South Africa, so as to provide a context for the efforts and actions of industry stakeholders and role-players in improving construction health and safety – including those of the CIDB.
Country
South Africa
Publisher
Construction Industry Development Board (cidb)
Theme area
Values, policies and rights
Title of publication Guidelines for occupational safety and health, including HIV in the health services sector
Date of publication
2008 February
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
Uganda, occupational health, HIV, AIDS
Abstract
These guidelines recognise that all types of work are hazardous and persons at work are exposed to situations that may result into injury, disease or even death. In Uganda, the authors argue that the health sector is loaded with a wide variety of situations where health and safety issues are crucial. Additionally, while the economic cost of occupational risks is high, public awareness of safety and health tends to be quite low. The Ugandan health sector requires a standardised framework for workplace safety and health, including responding specifically to HIV as a workplace hazard. The first chapter gives background information on occupational health and safety (OHS). The second addresses the basic OHS principles and interventions. The third deals with management of HIV and AIDS as a specific workplace hazard, while the fourth covers management of the other common hazards that exist at the health workplace. The final chapter deals with implementation of a workplace safety and health programme, including aspects of monitoring.
Country
Uganda
Publisher
Uganda Ministry Of Health
Theme area
Equitable health services
Title of publication The hidden epidemic amongst former miners: Silicosis, tuberculosis and the Occupational Diseases in Mines and Works Act in the Eastern Cape, South Africa
Date of publication
2009 June
Publication type
Academic paper
Publication details
Publication status
Published
Language
English
Keywords
South Africa, Eastern Cape, occupational disease, miners, lung disease
Abstract
The aim of the research was to assess current and historical surveillance of the pneumoconioses in former miners, in particular silicosis, silico-tuberculosis and tuberculosis, and to assess the functioning of the Occupational Diseases in Mines and Works Act (ODMWA) surveillance and compensation system, which is a responsibility of the Department of Health. The research also aimed to assess the impact of the burden of lung disease and disability on the public health system and on the labour-sending communities from which the miners come and to which they return. The main objective was thus to investigate health systems surveillance of the pneumoconioses in former underground gold miners, and to assess diagnostic and compensation systems under the legal framework of the Occupational Diseases in Mines and Works Act 78 of 1973 as Amended (ODMWA). The main finding was that this is a historically neglected subject, under-researched and undocumented.
Country
South Africa
Publisher
Health Systems Trust
Theme area
Equity and HIV/AIDS
Title of publication Nutrition and HIV/AIDS: A training manual for nurses and midwives
Date of publication
2008
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
ECSA countries, nutrition, HIV, AIDS
Abstract
This training manual, funded by the Food and Nutrition Technical Assistance II (FANTA-2) Project, recognises that nutrition interventions are an important component of comprehensive care and support for people living with HIV. They help to manage symptoms, promote response to treatment and improving functioning and quality of life. The authors argue that equipping nurses, who in many settings play a critical role in HIV care, with nutrition and HIV knowledge and skills enables them to provide effective nutrition care and support. The manual is organised into three parts: Part I includes introductory sessions with basic information about HIV, Part II aims to build technical knowledge and Part III provides guidance on nutrition care for different clients living with HIV. This training manual is designed to be used for pre-service training, but it can also be used or adapted for in-service training – an advantage considering the fact that nursing school curricula in the East, Central and Southern Africa region often includes little or no information on the subject.
Country
Tanzania
Publisher
East, Central And Southern African Health Community (ECSA)
Theme area
Equity and HIV/AIDS
Title of publication Making prevention work: Lessons from Zambia on reshaping the US response to the global HIV/AIDS epidemic
Date of publication
2009 June
Publication type
Academic paper
Publication details
Publication status
Published
Language
English
Keywords
Zambia, sex education, HIV prevention, condoms
Abstract
This study’s main aim was to determine what US$577 million in funding from the US President’s Fund for AIDS Relief (PEPFAR) between 2004 and 2008 has achieved in Zambia. Its findings are based on interviews with HIV and AIDS organisations, activists, medical professionals, community leaders, policymakers and programme participants. PEPFAR followed the ABC (abstain, be faithful and use a condom) approach to HIV prevention in Zambia but, according to this report, in 2008, US$20.5 million was channelled to programmes focused on abstinence and being faithful, compared to only US$12.4 million allocated to programmes promoting other approaches, including the use of condoms. Only four organisations received funding to promote condom use. ‘The disproportionate emphasis on abstinence-until-marriage [...] has created a distinctly anti-condom atmosphere,’ the authors noted. They recommended more extensive sex education programmes.
Country
United States
Publisher
Sexuality Information And Education Council Of The United States
Theme area
Resource allocation and health financing
Title of publication Taskforce Working Group 2 technical report: Raising and channeling funds
Date of publication
2009 June
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
Sub-Saharan Africa, aid, healthcare funding
Abstract
Depending on decisions taken by politicians and parliamentarians, a large part of the additional US$36–45 billion needed in 2015 could be available in an entirely predictable and sustained manner. Most of the gap will need to be filled by domestic resources contributed by national governments and citizens. But even if governments in low-income countries give more priority to health, they will still be unable to meet the required costs of scaling up health systems and providing free essential health services. If low-income countries are to reach the health millennium development goals, international funding will have to complement domestic health resources. Development partners are strongly urged to fulfil the commitments they have already made. Innovative development finance is the way forward, with non-traditional applications of official development assistance (ODA), joint public-private (or private) mechanisms and flows that support fund-raising, engage partners as stakeholders and deliver financial solutions to development problems on the ground.
Country
Switzerland
Publisher
Taskforce On Innovative International Financing For Health Systems
Theme area
Resource allocation and health financing
Title of publication Taskforce Working Group 1 technical report: Constraints to scaling up and costs
Date of publication
2009 June
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
Sub-Saharan Africa, aid, healthcare funding
Abstract
This report calculates that, if financial commitments are met, there will be, on average and across all countries, no financing gap in 2015. However, donors and recipient governments are currently far from delivering on agreed targets, and the economic recession is making this more difficult. If current relationships of health spending to GDP remain unchanged, the financing gap is will be US$28–37 billion in 2015. If commitments are met, for sub-Saharan Africa (SSA), there will be a funding gap of US$3–5 billion. In the no-change scenario, the funding gap for SSA is predicted by 2015 is US$26–24 billion. Financing arrangements must ensure sustainable and equitable domestic financing structures, predictable external finance, improved risk pooling over time, and effective purchasing of priority services. Service delivery arrangements should reflect the most cost-effective ways of providing services that are accessible, responsive to users, and equitable, taking advantage of both public and private providers where appropriate.
Country
Switzerland
Publisher
Taskforce On Innovative International Financing For Health Systems
Theme area
Human resources for health
Title of publication Understanding informal payments in health care: Motivation of health workers in Tanzania
Date of publication
2009 June
Publication type
Journal Article
Publication details
Human Resources For Health 7 53
Publication status
Published
Language
English
Keywords
Tanzania, informal payments, health worker motivation, health worker retention
Abstract
This study attempts to assess if and how informal payments occur in Kibaha, Tanzania. Moreover, it aims to assess how informal earnings might help boost health worker motivation and retention. Nine focus groups were conducted in three health facilities of different levels in the health system. In total, 64 health workers participated in the focus group discussions (81% female, 19% male) and, where possible, focus groups were divided by cadre. Participants mentioned that they felt enslaved by patients as a result of being bribed and this resulted in loss of self-esteem, with fear of detection as a main demotivating factor. Informal payments were not found to be related to retention of health workers in the public health system. The findings suggest that the practice of informal payments contributes to the general demotivation of health workers and negatively affects access to health care services and quality of the health system. Policy action is needed.
Country
United Kingdom
Publisher
Biomed Central
Theme area
Human resources for health
Title of publication Health workforce attrition in the public sector in Kenya: A look at the reasons
Date of publication
2009 June
Publication type
Journal Article
Publication details
Human Resources For Health 7 58
Publication status
Published
Language
English
Keywords
Kenya, health worker attrition, health worker retention
Abstract
This study analysed data from a human resources health facility survey conducted in 2005 in 52 health centres and 22 public hospitals (including all provincial hospitals) across all eight provinces in Kenya. The study looked into the status of attrition rates and the proportion of attrition due to retirement, resignation or death among doctors, clinical officers, nurses and laboratory and pharmacy specialists in surveyed facilities. Results showed that overall health workers attrition rates from 2004 to 2005 were similar across type of health facility: provincial hospitals lost on average 4% of their health workers, compared to 3% for district hospitals and 5% for health centres. The main reason for health worker attrition (all cadres combined) at each level of facility was retirement, followed by resignation and death. Appropriate policies to retain staff in the public health sector may need to be tailored for different cadres and level of health facility. Further studies, perhaps employing qualitative research, need to investigate the importance of different factors in the decision of health workers to resign.
Country
United Kingdom
Publisher
Biomed Central
Theme area
Human resources for health
Title of publication Nurses in the workplace: Expectations and needs: A global survey
Date of publication
2009 May
Publication type
Slide presentation
Publication details
Publication status
Published
Language
English
Keywords
South Africa, Kenya, Uganda, nurses
Abstract
According to this survey, more than half of nurses (53%) in South Africa said their workload was worse today when compared to five years ago. Nurses in South Africa indicated that the least favourable aspects of their profession were overwhelming workloads (32%), insufficient pay and benefits (22%), lack of recognition (11%), budget cuts and inadequate health care systems (11%). In contrast, the most favourable aspect was patient contact (39%). In South Africa, as in other countries surveyed, most nurses (85%) said they faced time constraints that prevented them from spending as much time with individual patients as they thought necessary. Some 87% of the nurses surveyed in South Africa said spending more time with individual patients would have a significant impact on patient health. On the plus side, they saw their professional associations as effective in advancing their interests (86%) and supportive of their needs (87%), and 63% perceived the nation's health care system as better than it was five years ago.
Country
Switzerland
Publisher
International Council Of Nurses
Theme area
Human resources for health
Title of publication Conflicting priorities: Evaluation of an intervention to improve nurse-parent relationships on a Tanzanian paediatric ward
Date of publication
2009 June
Publication type
Journal Article
Publication details
Human Resources For Health 7 50
Publication status
Published
Language
English
Keywords
Tanzania, Health Workers for Change, nurses
Abstract
Participatory research approaches such as the Health Workers for Change (HWC) initiative have been successful in improving provider-client relationships in various developing country settings, but have not yet been reported in the complex environment of hospital wards. This study evaluated the HWC approach for improving the relationship between nurses and parents on a paediatric ward in a busy regional hospital in Tanzania. Six workshops were held, attended by 29 of 31 trained nurses and nurse attendants working on the paediatric ward. Two focus-group discussions were held with the workshop participants six months after the intervention. Some improvement was reported in the responsiveness of nurses to client needs (41.2% of parents were satisfied, up from 38.9%). But nurses felt hindered by persisting problems in their working environment, including poor relationships with other staff and a lack of response from hospital administration to their needs.
Country
United Kingdom
Publisher
Biomed Central
Theme area
Human resources for health
Title of publication Burnout and use of HIV services among health care workers in Lusaka district, Zambia: A cross-sectional study
Date of publication
2009 July
Publication type
Journal Article
Publication details
Human Resources For Health 7 55
Publication status
Published
Language
English
Keywords
Lusaka, Zambia, occupational burnout, HIV
Abstract
The successful continuation of existing HIV care and treatment programmes is threatened by health care worker burnout and HIV-related illness. This study, conducted between March to June 2007, looks at occupational burnout and utilisation of HIV services among health providers in the Lusaka public health sector. Providers from thirteen public clinics were given a 36-item, self-administered questionnaire and invited for focus group discussions and key informant interviews. Focus group participants described burnout as feeling overworked, stressed and tired. In the survey, 51% reported occupational burnout. Risk factors were having another job and knowing a co-worker who left in the last year. Both discussion groups and survey respondents identified confidentiality as the prime reason for not undergoing HIV testing. In Lusaka primary care clinics, overwork, illness and death were common reasons for attrition. Programmes to improve access, acceptability and confidentiality of health care services for clinical providers and to reduce workplace stress could substantially benefit workforce stability.
Country
United Kingdom
Publisher
BioMed Central
Theme area
Equity and HIV/AIDS
Title of publication Nurse-driven, community-supported HIV/AIDS treatment at the primary health care level in rural Lesotho: 2006-2008 programme report
Date of publication
2009
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
Lesotho, primary health care, rural health, HIV, AIDS, tuberculosis
Abstract
In an effort to tackle the challenges related to a severe shortage of human resources, and geographic and financial barriers, that prohibit patients from accessing care and treatment, a decision was taken to decentralise HIV and AIDS services in Lesotho to the primary health care level. This report outlines the community-based approach to the decentralisation of HIV and AIDS services. The Wellspring of Hope was the first programme in Lesotho to provide HIV and AIDS treatment and care through an entire health service area as a result of this initiative. The report discusses a range of topics: the delivery of HIV and AIDS services, specifically testing and counselling, prevention of mother-to-child transmission and antiretroviral therapy, a nurse-driven approach to the provision of antiretroviral therapy at the community level, and gives activities aimed at health systems strengthening challenges associated with the implementation of this model. This innovative approach has proven to be successful in delivering quality HIV and AIDS and TB services integrated into existing primary health care structures for a population living in remote, rural areas.
Country
South Africa
Publisher
Médecins Sans Frontières
Theme area
Equitable health services
Title of publication Malaria misdiagnosis in Uganda: Implications for policy change
Date of publication
2009 June
Publication type
Journal Article
Publication details
Malaria Journal 8 66
Publication status
Published
Language
English
Keywords
Uganda, malaria, malaria misdiagnosis
Abstract
This study examines the effectiveness of the current methods for the diagnosis of malaria in Uganda. Diagnosis has mainly been through presumptive management, namely diagnosis on the basis of episodes of fever. However, this paper argues that presumptive management has significantly contributed to the misdiagnosis of malaria. Interviews were conducted with patients at 188 facilities and laboratory samples were taken to assess the accuracy of existing diagnoses. Overall prevalence of malaria was around 24.2%, with a rate of 13.9% in adults and 50.5% for children under five, with 96.2 percent of patients with a positive diagnosis receiving treatment, as well as 47.6% of patients with a negative result. The study authors therefore argue for changes in existing public health policy to include the use of laboratory methods such as microscopy and the introduction of malaria rapid diagnostic tests.
Country
United Kingdom
Publisher
BioMed Central
Theme area
Equitable health services
Title of publication Delivering post-rape care services: Kenya’s experience in developing integrated services
Date of publication
2009 June
Publication type
Journal Article
Publication details
Bulletin Of The World Health Organization 87 7 pp 555-559
Publication status
Published
Language
English
Keywords
Kenya, post-rape services, reproductive health
Abstract
This paper, covering the period 2002–2008, describes how multisectoral teams at district level in Kenya have provided post-exposure prophylaxis, physical examination, sexually transmitted infection and pregnancy prevention services. These services were provided at casualty departments as well as through voluntary HIV counselling and testing sites. In 2003 there was a lack of policy, coordination and service delivery mechanisms for post-rape care services in Kenya. Post-exposure prophylaxis against HIV infection was not offered. The paper also found that, between early 2004 and the end of 2007, a total of 784 survivors were seen in the three centres at an average cost of US$27, with numbers increasing each year. Almost half (43%) of these were children younger than 15. The paper outlines how the lessons learned were translated into national policy and the scale-up of post-rape care services through the key involvement of the Division of Reproductive Health.
Country
Switzerland
Publisher
World Health Organization
Theme area
Values, policies and rights
Title of publication Moving beyond gender as usual
Date of publication
2009 June
Publication type
Academic paper
Publication details
Publication status
Published
Language
English
Keywords
Sub-Saharan Africa, HIV, AIDS, external funders, gender
Abstract
This study looks at how sub-Saharan Africa’s three main HIV and AIDS donors have incorporated gender issues into their policies, and to what extent they have been put into practice and monitored. Although PEPFAR, the Global Fund and MAP have all made high-level commitments to address gender issues in their programming, these commitments have ‘not yet produced concrete and systematic action on the ground’. The study found 61% of people living with HIV in sub-Saharan Africa are women, up from about 33% in the 1980s, and argues that gender inequality seriously undermines efforts to curb the epidemic and has actually fuelled the spread of HIV in the region, making women vulnerable to sexual violence, hindering their ability to have safe sex, and limiting their access to health, education and employment. It urges the three donors to collaborate on gender issues to make the most of their individual strengths and avoid duplication by helping countries establish gender-related goals in their HIV and AIDS responses, and sharing research and knowledge.
Country
United States
Publisher
Center for Global Development
URL:
Theme area
Values, policies and rights
Title of publication Gender Review: Mainstreaming Gender and Aids in the Development Portfolio of the Norwegian Embassy in Zambia
Date of publication
2009 May
Publication type
Report
Publication details
Norad Report 6/2009 pp 1-58
Publication status
Published
Language
English
Keywords
Zambia, gender, AIDS
Abstract
The aim of this report is to see how gender and AIDS concerns could be better mainstreamed in Zambia’s Norwegian Embassy portfolio. It indicates that gender inequalities exist at all levels in Zambia, and challenges remain critical and fundamental to the country’s achievement of its vision and goal on gender. Four programmes were reviewed, and the researchers noted that good opportunities existed for better synergies and learning. They give four key recommendations. First, internal organisation is required at the Embassy – responsibility should be placed at management level, and gender and AIDS competence should be secured. Second, at programme level, selection and focus should be on only one or two gender and AIDS mainstreaming topics. Third, at programme level, the main focus should be on only one programme or sector (in addition to improved quality work on the others). And fourth, at policy level, further work is needed to integrate the gender and AIDS aspects in the political dialogue with the government of Zambia and key development partners.
Country
Norway
Publisher
Norwegian Agency for Development Cooperation
Theme area
Equity and HIV/AIDS
Title of publication The impact of the AIDS pandemic on health services in Africa: Evidence from demographic and health surveys
Date of publication
2009
Publication type
Academic paper
Publication details
Publication status
Language
English
Keywords
Sub-Saharan Africa, AIDS, pregnant women, children
Abstract
This paper documents the impact of the AIDS crisis on non-AIDS related health services in 14 sub-Saharan African countries. The authors, using multiple waves of Demographic and Health Surveys (DHS) for each country, examined antenatal care, birth deliveries, and rates of immunisation for children born between 1988 and 2005. They found deterioration in nearly all of the above dimensions of health care over this period. Using data collected on HIV prevalence in the most recent DHS survey for each country, they noted that erosion of health services is highly correlated with increases in AIDS prevalence. Consequently, regions of countries that have light AIDS burdens have witnessed small or no declines in health care, using the measures noted above, while those regions currently shouldering the heaviest burdens have seen the largest erosion in treatment for pregnant women and children. Finally, the authors estimate that the beginning of the divergence in health services between high- and low-HIV regions took place in the mid-1990s.
Country
United States
Publisher
National Bureau of Economic Research
Theme area
Resource allocation and health financing
Title of publication Participatory budgeting in Africa: A training companion with cases from Eastern and Southern Africa: Volume II: Facilitation methods
Date of publication
2008
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
ESA countries, participatory budgeting, governance, accountability
Abstract
Participatory budgeting in Africa is part of an effort to build the capacity of local government officials and their partners for greater accountability and good governance. This toolkit is aimed at helping local governments and other stakeholders to prepare for, design, initiate and manage a participatory budgeting process, by training key actors who initiate the budgeting processes. This is the second of two volumes that provide users with information, tools, methodologies, case studies and tips on how participatory budgeting can be introduced and sustained. These resources have been collected from local governments where participatory budgeting is already being practised.
Country
Kenya
Publisher
United Nations Human Settlements Programme (UN-HABITAT)
Theme area
Monitoring equity and research to policy
Title of publication The changing conceptions and focus of health research in East Africa
Date of publication
2008
Publication type
Journal Article
Publication details
African Journal Of Health Sciences 13 1-2 pp 1-6
Publication status
Published
Language
English
Keywords
East Africa, health research
Abstract
Perceptions in health research are a product of the circumstances within the society, where the research activities are situated. In East Africa there has been a change in conceptualisation over a period of time from an elitist de-linked status to the present, which has evolved to embrace the local community. In this paper, researchers trace the changes and highlight some occurrences that exerted the greatest influence in shaping the notions that currently dominate in research. They conclude that the paradigm shift is a positive development and that the present conception is suitable for heath research at this point in time.
Country
South Africa
Publisher
African Journals Online
Theme area
Equity in health
Title of publication RESOLUÇÕES PARA ACÇÃO: Recuperar os Recursos para Saúde:
Date of publication
2009 September
Publication type
Document
Publication details
Publication status
Published
Language
Portuguese
Keywords
EQUINET, Conference resolutions; east and southern Africa
Abstract
EQUINET September 2009 Conference Resolutions: Mais de 200 oficiais de governo, membros de parlamento, membros de sociedade civil, trabalhadores de saúde, pesquisadores, acadêmicos, e executores de política assim como pessoal das Nações Unidas, e organizações internacionais bem como não governamentais de Africa Oriental e Austral, encontraram na terceira conferência regional da EQUINET sobre Equidade em Saúde em África, realizado entre 23-25 setembro 2009, em Munyonyo, Kampala.
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Resolutions
Theme area
Equity in health
Title of publication EQUINET: Rede Regional para a Equidade em Saúde na África Oriental e Austral
Date of publication
2010 May
Publication type
Document
Publication details
Publication status
Published
Language
Portuguese
Keywords
EQUINET, briefing
Abstract
Leaflet on EQUINET: A Rede Regional para a Equidade em saúde na África oriental e austral (EQUINET) é
uma rede de profi ssionais, membros da sociedade civil, formuladores de diretrizes
políticos, ofi ciais do estado e outros dentro desta região que se juntaram como catalisadores de equidade, para poder promover e realizar os valores compartilhadas da equidade e justice social na saúde.
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Briefs
Theme area
Equity in health
Title of publication EQUINET: Réseau Régionale pour l’Équité en Santé en Afrique Orientale et Australe
Date of publication
2010 May
Publication type
Document
Publication details
Publication status
Published
Language
French
Keywords
EQUINET; briefing
Abstract
Briefing leaflet on EQUINET. Le Réseau Régional sur l’Equité en matière de santé en Afrique orientale et australe (EQUINET) est un réseau de professionnels, membres de la société civile, décideurs, employés gouvernementaux et autres personnalités de la région qui se sont réunis pour
mettre en oeuvre une politique en matière d’équité, ce afi n de promouvoir et défi nir des
valeurs communes en matière d’équité et de justice sociale au niveau de la santé.
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Briefs
Theme area
Equity in health
Title of publication Les Resolutions pour l'action, Troisième Conférence Régionale de EQUINET sur l’Équité en Matière de Santé en Afrique Orientale et Australe
Date of publication
2009 September
Publication type
Document
Publication details
Resolutions, Troisième Conférence Régionale de EQUINET sur l’Équité en Matière de Santé en Afrique Orientale et Australe, Kampala, 23–25 septembre
Publication status
Published
Language
French
Keywords
Les Resolutions, l’Équité en Matière de Santé, Afrique Orientale et Australe
Abstract
Plus de 200 employés gouvernementaux, parlementaires, membres de la société civile, professionnels de santé, chercheurs, universitaires et décideurs, mais aussi les membres des Nations Unies, d’organisations internationales et non-gouvernementales d’Afrique orientale et Australe se sont rassemblés à la troisième Conférence Régionale de EQUINET sur l’Équité en Matière de Santé en Afrique Orientale et Australe, qui s’est tenue du 23 au 25 septembre 2009 au complexe hôtelier de Munyonyo à Kampala. Les délégués ont reconnu des inégalités significatives, grandissantes, évitables et injustes en matière de santé et de ressources de santé dans nos pays, notre région et notre monde. Comme la Commission de l’Organisation Mondiale de la Santé sur les Déterminants Sociaux de la Santé, nous sommes conscients que cette injustice sociale est en train de décimer certaines populations à une grande échelle.
Bien que nous ayons dans notre région les ressources de santé nécessaires, nous notons que beaucoup d’entre elles, dont les professionnels de santé, quittent l’Afrique. Nos ressources restantes atteignent par conséquent rarement les personnes les plus démunies. Ceux qui en ont le plus besoin n’y accèdent pas suite aux contraintes économiques, causée par cette inégalité.
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Resolutions
Theme area
Governance and participation in health
Title of publication Participatory Communications for orphans and vulnerable children in Malawi
Date of publication
2010 February
Publication type
Report
Publication details
EQUINET Workshop Report, 3 February 2010, Monkey Bay, Malawi. EQUINET:
Publication status
Published
Language
Keywords
vulnerable children; participatory communications
Abstract
This is a report of a workshop for a project that TARSC and Country Minders for People’s Development (CMPD), under the auspices of EQUINET, undertook as a pilot to explore options for participatory communications with the community based organisations and some of the orphans and vulnerable children in Monkey Bay.
Country
Malawi
Publisher
EQUINET
Equinet Publication Type
Reports
Theme area
Values, policies and rights
Title of publication EQUINET Discussion paper 81: Provisions for the right to health in the Constitutions of east and southern Africa
Date of publication
2010 March
Publication type
Academic paper
Publication details
EQUINET Discussion Paper 81. Centre for Health, Human Rights and Development in the Regional Network for Equity in Health in East and Southern Africa (EQUINET): Harare. EQUINET Discussion P
Publication status
Published
Language
Keywords
health rights; constitution; east and southern Africa
Abstract
This report presents a detailed desk review providing the constitutional provisions of the right to health in 15 countries in east and southern Africa (ESA): Angola, Botswana, Congo-Brazzaville, Kenya, Lesotho, Madagascar, Malawi, Mozambique, Namibia, South Africa, Swaziland, Tanzania, Uganda, Zimbabwe and Zambia. The review was carried out within the Regional Network for Equity in Health in East and Southern Africa (EQUINET) by the Center for Health, Human Right and Development.
This paper used the six core obligations as spelt out in General Comment 14 to assess the inclusion of the right to health in the constitutional provisions of the ESA countries:
· to ensure the right of access to health facilities, goods and services on a non-discriminatory basis, especially for vulnerable or marginalised groups;
· to ensure access to the minimum essential food which is nutritionally adequate and safe, to ensure freedom from hunger to everyone;
· to ensure access to basic shelter, housing and sanitation, and an adequate supply of safe and potable water;
· to provide essential drugs, as from time to time defined under the WHO Action Programme on Essential Drugs;
· to ensure equitable distribution of all health facilities, goods and services; and
· to adopt and implement a national public health strategy and plan of action
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Discussion paper
Theme area
Health equity in economic and trade policies
Title of publication EQUINET Policy Brief 22: Anti-counterfeiting laws and access to essential medicines in East and Southern Africa
Date of publication
2010 March
Publication type
Document
Publication details
EQUINET Policy Brief 22 EQUINET, CEHURD, TAR
Publication status
Published
Language
Keywords
counterfeit medicines; access to medicines; east africa; law
Abstract
The countries in eastern and southern Africa and the East African Community are at various stages of enacting laws to address counterfeiting. Substandard and fasified medicines are a problem for public health if they lack the active ingredients that make them effective, or if they are harmful. Yet making quality, safety and efficacy an intellectuual property issue, and defining counterfeiting so widely as to include generic medicines have even greater potential public harm, as they may make these essential medicines available as branded versions, at significantly higher cost. This policy brief draws policy makers attention to the need to ensure that counterfeit laws do not include generic medicines and that falsified medicines are dealt with under public health and not ntellectual propoperty law. It discusses the key issues in these laws and draft laws and how they are likely to affect public health and access to essential medicines in the region.
Country
East Africa regional
Publisher
EQUINET
Equinet Publication Type
Policy brief
Theme area
Equity in health, Governance and participation in health
Title of publication Keeping an eye on Equity: Community visions of equity in health
Date of publication
2010 March
Publication type
Book
Publication details
EQUINET, Harare
Publication status
Published
Language
Keywords
community photography; participation; primary health care
Abstract
Photographs speak louder than words. This book presents photographs taken by community photographers in seven east and southern African countries, namely: the Democratic Republic of Congo, Tanzania, Zimbabwe, Kenya, Uganda, South Africa and Zambia. We called our photographers the ‘Eye on equity’ team because
the work was part of EQUINET’s participatory action research work. Implemented through institutions in east and southern Africa, this work investigated, documented and implemented actions to understand and promote equity in health. We added
photography as another tool to build and strengthen people centred health systems and people’s empowerment in health. The book presents images of equity in health and of actions to improve health. These are the stories of insiders: of members,
health workers and health activists in the communities that are shown in the photographs. The photographs are being used to stimulate discussion of health issues and actions. The book thus introduces both the realities and the work underway. It opens discussion on community photography as a means of keeping an
eye on equity and as a tool for change. The web version is for onscreen viewing. For a hard copy of the book please contact admin@equinetafrica.org.
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Book
Theme area
Equity in health
Title of publication EQUINET: Regional network for Equity in Health in east and southern Africa
Date of publication
2010 March
Publication type
Document
Publication details
Publication status
Published
Language
Keywords
Brief; EQUINET
Abstract
The Regional Network on Equity in Health in east and southern Africa (EQUINET) is a network of professionals, civil society members, policy makers, state officials and others within the region who have come together as an equity catalyst, to promote and realise shared values of equity and social justice in health. This brief outlines EQUINETs mission, organisation, areas of work and resources.
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Briefs
Theme area
Title of publication Resolutions of the 50th East, Central and Southern African Health Ministers Conference, February 2010
Date of publication
2010 February
Publication type
Conference Proceedings
Publication details
Resolutions of the 50th East, Central and Southern African Health Ministers Conference, February 2010, Mimeo Kampala
Publication status
Published
Language
Keywords
Regional conference; health ministers; governance; resolutions
Abstract
The 50th ECSA Heath Ministers’ Conference took place at Serena Hotel, Kampala, in the Republic of Uganda from 15 – 19 February 2010. This document provides the resolutions adopted in the following areas: ECSA/HMC50/R1: Health Insurance and Financing ECSA/HMC50/R2: Leadership, Stewardship and Governance ECSA/HMC50/R3: Leadership and Management ECSA/HMC50/R4: Improving the Capacity of HRH Departments ECSA/HMC50/R5: Improving Maternal and Child Health/Family Planning ECSA/HMC50/R6: Challenges in Funding and Implementing HIV/AIDS, TB and Malaria Programmes ECSA/HMC50/R7: Maternal and Child Nutrition ECSA/HMC50/R8: Prevention of Non- Communicable Diseases ECSA/HMC50/R9: Tracking Progress towards the MDGs ECSA/HMC50/R10: Management of HIV/AIDS and Tuberculosis (TB) in ECSA Region ECSA/HMC50/R11: Expression of Gratitude to Partners of the ECSA Health Community ECSA/HMC50/R12: Expression of Gratitude to His Excellency the President of the Republic of Uganda and the people of Uganda
Country
East and southern Africa region
Publisher
ECSA HC
Theme area
Governance and participation in health
Title of publication Strong Ministries for strong health systems
Date of publication
2010 January
Publication type
Report
Publication details
Publication status
Published
Language
Keywords
Ministers of Health; leadership; capacities
Abstract
The study and report were commissioned by the Rockefeller Foundation to explore the feasibility of establishing a support mechanism for ministers and ministries of health especially in the poorest countries, as part of the Foundation’s Transforming Health Systems initiative, The study was initially designed to assess the potential value of three proposed programs to strengthen the leadership capabilities of ministers of health: a global executive leadership program for new ministers; an ongoing, regional, in-person and virtual leadership support program for sitting ministers; and a virtual global resource center for ministers and high level ministerial officials providing real-time access to information. During the course of the study, it became clear that it was essential to expand the inquiry to better understand the challenges and needs of ministries as a whole, as they and their ministers provide the stewardship function for country health systems.
The content of the report was derived from six major activities: a comprehensive literature review of the theory and practice of effective leadership development and organizational capacity building, and an environmental scan to identify any existing or planned leadership development programs for ministers of health or any that have occurred in the recent past globally; a survey of the turnover of ministers of health; targeted interviews with ministers, former ministers, and key stakeholders who interact with them, conducted between October 2008 and September 2009, to better understand the roles of ministers and ministries, the challenges they face, resources at their disposal, and their thoughts on what additional resources might enhance their personal effectiveness and that of their ministries; a consultative meeting of experts and stakeholders held in Bellagio, Italy part way through the project; participation of the project leaders (Omaswa and Boufford) in relevant global and regional meetings, as well as individual meetings about the project with critical leaders in international and donor organizations and potential champions of this effort; and a consultation with African regional health leaders to discuss the final report, held in Kampala, Uganda.
Country
Uganda
Publisher
ACHEST, NY Academy of Medicine, Rockefeller Foundation
Theme area
Health equity in economic and trade policies
Title of publication Discussion paper 80: Implementation of the TRIPS flexibilities by east and southern African countries: Status of patent law reforms by 2010
Date of publication
2010 January
Publication type
Report
Publication details
EQUINET Discussion Paper 80. EQUINET: Harare.
Publication status
Published
Language
Keywords
Abstract
Least Developed countries have until 2016 to reform their IP regimes and enact new patent laws in line with Trade-related Aspects of Intellectual Property Rights (TRIPS) Agreement of the World Trade Organisation (WTO). A number of amendments to the TRIPS agreement were made–TRIPS 'flexibilities' – to take care of the health-related concerns of developing countries. Member states have the authority to use these flexibilities when this is necessary to protect public health and to promote access to medicines. The Southern and Eastern African Trade, Information and Negotiations Institute (SEATINI), under the umbrella of the Regional Network for Equity in Health in East and Southern Africa (EQUINET), carried out an assessment of LDCs in East and Southern Africa with regard to their progress towards the new IP regimes. The study reviewed the situation in sixteen east and southern African countries through a desk review of published and grey literature. The study found that most of the IP regimes currently in ESA countries were in existence before the TRIPS agreement was adopted. These included laws that provide some flexibilities, which were in most cases not being implemented. Only Mauritius and Zambia have formally adopted the protocol amending the TRIPS agreement at the WTO. The December 2009 deadline has been further extended to the end of December 2011 and it is important for all ESA countries to formally adopt the proposal by then to avoid unnecessary renegotiations of the TRIPS amendments. This paper presents a number of recommendations on how ESA countries should apply and implement the TRIPS flexibilities.
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Discussion paper
Theme area
Equity and HIV/AIDS
Title of publication EQUINET PRA Report: Unlocking the potential of the child: Improving Social Support and Health Care of Orphans and Vulnerable Children Through Increased Child Participation in Victoria Falls, Zimbabwe
Date of publication
2010 February
Publication type
Report
Publication details
EQUINET PRA Report, HOCSI, TARSC, EQUINET, Harare.
Publication status
Published
Language
English
Keywords
vulnerable children; Zimbabwe; participatory methods
Abstract
The AIDS epidemic has resulted in over 1 million orphans and many other vulnerable children in Zimbabwe. Most of these children remain in their communities, either in child-headed households or looked after by their extended family or members of the community. Due to early school dropout, child labour, economic insecurity and poor adult support, many of these children are susceptible to early onset of sexual activity and thereby to HIV infection. While there has been a massive response from local community groups, government, civic and international organisations to the plight of these children, many of these policies and programmes have been designed in a top-down manner, without taking into consideration the views of the children themselves. This lack of child participation in the planning, implementation and evaluation of programmes weakens their potential impact and undermines the inherent capacity, experience and skills of the children themselves. The study used a mix of quantitative assessment and participatory action research methods (PRA) to explore and strengthen the participation of orphans and vulnerable children in primary health care (PHC) in Victoria Falls, a town in the north-western part of Zimbabwe. Children, community representatives and health workers identified three priority health problems faced by these children, ie:
• poor access to ART;
• child abuse; and
• poor housing.
Structural constraints, such as poverty and weakened health and community services, were seen as the primary underlying causes, resulting in difficulties obtaining anti-retrovirals, inadequate counselling at the clinics, delays in reporting and taking action on cases of abuse, poor living conditions at home and poor waste management. Also, according to participants, social and personal issues contributed to inadequate participation of children in finding solutions to their problems. Low levels of participation by other social groups (such as men) in the prevention of mother-to-child transmission (PMTCT) programme was also associated with superstition and denial. As a result of the work, community organisations involved mainstreamed psychosocial support activities into their actions, undertook a number of awareness campaigns, initiated and participated in child protection committees and started to meet monthly to strengthen coordination. This action research suggests that child involvement is an important component in a PHC approach to meeting the health needs of children. There are various strategies for doing this. At a minimum, these include creation of an enabling social environment that encourages child involvement in decision-making processes, the support of vulnerable children through structured platforms for the exchange of information and experiences, provision of child friendly services, and promotion of effective communication between health workers, community members and children to support effective coverage of services.
Country
Zimbabwe
Publisher
EQUINET
URL:
Equinet Publication Type
Discussion paper
Theme area
Equity in health
Title of publication Healthy students for a prosperous nation
Date of publication
Publication type
Publication details
Publication status
Language
Keywords
Abstract
Country
Publisher
URL:
Theme area
Equity and HIV/AIDS
Title of publication Quarterly report antiretroviral treatment programme in Malawi with results up to 30 September 2009
Date of publication
2009
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
anti-retroviral treatment, Malawi
Abstract
By the end of September 2009, there were 236 static ART clinics in Malawi in the public and private health sector; 22 of these static clinics provided ART at a total of 103 outreach or mobile sites, bringing the total to 339 ART service delivery points in Malawi in Q3 2009. In the third quarter of 2009 (July to September) a total of 18,292 new patients initiated ART and 3,030 ART patients transferred between clinics, resulting in a total of 21,322 ART clinic registrations (39% male, 61% female; 91% adults and 9% children). Improved integration of the supervision system for the public and private sector has led to a revision of previous M&E data in the private sector and patient outcomes in the private sector are similar to those in the public sector. The National programme has been affected by serious ARV drug supply shortage during Q3 due to the delayed release of funding and the ensuing logistical complications resulting in widespread drug re-allocations between sites. However a targeted survey revealed that patients were affected only in isolated cases, requiring regimen changes or short term treatment interruption.
Country
Malawi
Publisher
Malawi Government
URL:
Theme area
Equitable health services, Equity and HIV/AIDS, Governance and participation in health, Monitoring equity and research to policy
Title of publication Participatory methods for people centred Health Systems, Regional Review Workshop Report September 2009
Date of publication
2009 December
Publication type
Report
Publication details
Regional Review Workshop Report; TARSC with IHI in EQUINET: EQUINET, Harare
Publication status
Published
Language
Keywords
participation, health equity, power, east and southern Africa
Abstract
The workshop on Participatory approaches to people centred health systems was held on the 22nd of September 2009 in Munyonyo Uganda before the EQUINET regional Conference held at the same venue on 23rd -25th of September 2009. This gave participants from the workshop an opportunity to engage with the wider regional community working on health equity, but also to feed input from the participatory work into the conference process and resolutions. The regional review workshop gathered researchers from the PRA research programme since 2005. The studies implemented that were used as the basis for the discussions are separately reported and are shown in Appendix 8.3 of the report. The workshop reviewed the learning from, policy issues and knowledge gaps from the research studies, to inform planning of future work on empowerment and health and on people centred health systems in the ESA region and to explore the role of PRA approaches and community photography in advancing health equity. The workshop gathered those who had led the studies, community photographers and others involved with work on empowerment and health. This report documents the proceedings of the meeting.
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Reports
Theme area
Equity in health, Values, policies and rights, Health equity in economic and trade policies, Human resources for health, Public-private mix, Resource allocation and health financing, Governance and participation in health, Monitoring equity and research to policy
Title of publication Taking forward the Equity Watch in east and southern Africa: Report of a regional Methods Workshop
Date of publication
2009 December
Publication type
Report
Publication details
Report of a regional Methods Workshop, 30 November – 2 December 2009, Cape Town South Africa EQUINET: Harare.
Publication status
Published
Language
Keywords
equity analysis; monitoring; MDGs; health equity
Abstract
The EQUINET steering committee has proposed to take forward the production of an Equity Watch at country and regional level to gather evidence on, analyse and promote dialogue on equity in the context of country and regional opportunities and challenges. The country analysis follows a standard regional framework, adding further information as relevant to that country. The country analysis is implemented by national institutions with support from TARSC and the EQUINET steering committee, and the regional analysis is compiled by TARSC. The Regional methods workshop was held to gather potential lead institutions of country teams and resource personnel to build on existing work done on the equity watch to date to develop the design and plan implementation of the equity watch work at country level in participating countries and at regional level. The workshop aimed to
1. review and agree on the purpose, intended targets, process and outcomes of an equity watch at country and regional level
2. discuss the questions about equity to be addressed, and the dimensions of equity to be included
3. review and agree on the parameters, indicators, targets / progress markers; stratifiers for the analysis and organization of the analysis to address these questions/ dimensions
4. review types, quality and sources of evidence for the analysis
5. discuss and set the next steps and roles for the work at country and regional level, including mentoring and regional review.
The meeting was organised by Training and Research Support Centre (TARSC) WHO (AFRO), EQUINET, ECSA-HC and SADC with financial support by SIDA Sweden, IDRC Canada and WHO, and hosted at the Health Economics Unit, University of Cape Town.
Country
Publisher
EQUINET
URL:
Equinet Publication Type
Reports
Theme area
Human resources for health
Title of publication Management of expatriate medical assistance in Mozambique
Date of publication
2006 January
Publication type
Journal Article
Publication details
Human Resources for Health 4 26
Publication status
Published
Language
English
Keywords
resources for health; health system; contracting; Mozambique
Abstract
This paper discusses how Mozambique coped with the health system needs in terms of specialised doctors since independence, in a troubled context of war, lack of financial resources and modifying settings of foreign aid. The Ministry of Health (MOH) managed to make up for its severe scarcity of specialist MDs especially through contracting expatriate technical assistance. Different scenarios, partnerships and contract schemes that have evolved since independence are briefly described, as well as self-reliance option possibility and implications. Lessons learned about donor initiatives aimed at contracting specialists from other developing countries are singled out. The issue of obtaining expertise and knowledge in the global market as cheap as possible is stressed, and realistic figures of cost planning are highlighted, as determined by the overall health system necessities and budget limitations.
Country
Mozambique
Publisher
BioMed Central
Theme area
Public-private mix
Title of publication Public hospitals: Options for reform through public-private partnerships
Date of publication
2002 January
Publication type
Document
Publication details
Public Policy for the Private Sector Note 241 pp 1-4
Publication status
Published
Language
English
Keywords
public-private partnerships, PPPs; regulations; consolodation; public funding; policy issues
Abstract
The authors argue that as governments struggle with rising health care costs, public-private partnerships in constructing and managing public hospitals can provide innovative ways to control costs and improve service. They say experience shows that such partnerships offer significant benefits as long as policymakers structure the transactions carefully and create sound regulatory arrangements to ensure universal access, quality care, and improvements in efficiency. But getting
them right requires careful attention to the critical policy issues, including: ensuring that all public patients, particularly the poor and uninsured, have access to adequate hospital care; linking public funding (whether from the budget or from public insurance) to performance while
also rewarding quality care and patient satisfaction; consolodating services; allowing or creating a competitive environment between private hospitals; and introducing an independent regulator.
Country
Publisher
World Bank
Theme area
Public-private mix
Title of publication Franchising reproductive health Services
Date of publication
2004
Publication type
Publication details
Health Services Research 39 6 Part II pp 2053-2080
Publication status
Published
Language
English
Keywords
franchising; reproductivehealth services; client volumes; client outcomes; family planning
Abstract
Networks of franchised health establishments, providing a standardised set of services, are being implemented in developing countries. This article examines associations between franchise membership and family planning and reproductive health outcomes for both the member provider and the client. Regression models are fitted examining associations between franchise membership and family planning and reproductive health outcomes at the service provider and client levels in three settings. The researchers found that franchising has a positive association with both general and family planning client volumes, and the number of family planning brands available. Similar associations with franchise membership are not found for reproductive health service outcomes. In some settings, client satisfaction is higher at franchised than other types of health establishments, although the association between franchise membership and client outcomes varies across the settings. Franchise membership has apparent benefits for both the provider and the client, providing an opportunity to expand access to reproductive health services, although greater attention is needed to shift the focus from family planning to a broader reproductive health context.
Country
Publisher
Theme area
Health equity in economic and trade policies
Title of publication Africa-bound AIDS drugs resold illegally
Date of publication
2002 November
Publication type
Journal Article
Publication details
Canadian Medical Association Journal 167 11 pp 1281
Publication status
Published
Language
English
Keywords
illegal drug trade; anti-retrovirals; ARV; parmaceutical industr; Africa
Abstract
Reduced-price antiretroviral drugs intended for Africans are turning up in European pharmacies and in private clinics in Africa, undermining a 2-year-old UN program to provide medicine to people with AIDS/HIV living in the world's poorest nations. The European Federation of Pharmaceutical Industries and Associations, which called for urgent action, warned that the unscrupulous practices were jeopardizing drug companies' participation in the program. Meanwhile, Ugandan health authorities said part of a 290 000-pill shipment of fluconazole (Diflucan) donated by Pfizer was being sold illegally on the open market. Health Minister Jim Muhwezi said Uganda has asked the World Health Organization to audit distribution of the drug in the country. He warned that the illegal trade might hurt 'the commitment and goodwill of Pfizer and other donors to support the poor in Africa'.
Country
Publisher
Theme area
Human resources for health
Title of publication The training and expectations of medical students in Mozambique
Date of publication
2007 August
Publication type
Journal Article
Publication details
Human Resources for Health 5 11
Publication status
Published
Language
English
Keywords
medical students; migration; rural employment; financial support; public sector; Mozambique
Abstract
This paper describes the socio-economic profile of medical students in the 1998/99 academic year at the Universidade Eduardo Mondlane (UEM) Medical Faculty in Maputo. It aims to identify their social and geographical origins in addition to their expectations and difficulties regarding their education and professional future. The data were collected through a questionnaire administered to all medical students at the faculty. Although most medical students were from outside Maputo City and Maputo Province, expectations of getting into medical school were already associated with a migration from the periphery to the capital city, even before entering medical education. This lays the basis for the concentration of physicians in the capital city once their term of compulsory rural employment as junior doctors is completed. The decision to become a doctor was taken at an early age. Close relatives, or family friends seem to have been an especially important variable in encouraging, reinforcing and promoting the desire to be a doctor. The academic performance of medical students was dismal. This seems to be related to several difficulties such as lack of library facilities, inadequate financial support, as well as poor high school preparation. Only one fifth of the students reported receiving financial support from the Mozambican government to subsidise their medical studies. Medical students seem to know that they will be needed in the public sector, and that this represents an opportunity to contribute to the public's welfare. Nevertheless, their expectations are, already as medical students, to combine their public sector practice with private medical work in order to improve their earnings.
Country
Mozambique
Publisher
BioMed Central
Theme area
Health equity in economic and trade policies
Title of publication Foreign direct investment and trade in health services: A review of the literature
Date of publication
2004 December
Publication type
Journal Article
Publication details
Social Science and Medicine 59 11 pp 2313-2323
Publication status
Published
Language
English
Keywords
foreign direct investment; FDI; trade in health services; national regulatory environments; commercialisation; liberalisation
Abstract
As a result of the rise of transnational corporations, challenges in health care financing, porous borders and improved technology, there is increasing scope for increased ‘foreign direct investment’ (FDI) in health care. Given the rapid development of this area, there are little empirical data. This paper provides a review of evidence concerning FDI and health services, and found that perhaps due to the rapid developments in this area, most of the literature is speculative, polarised between those arguing for the benefits of liberalisation and those arguing against. However, three issues emerge as important: (i) the extent to which a national health system is commercialised per se is of more significance than whether investment in it is foreign or domestic; (ii) the national regulatory environment and its ‘strength’ will significantly determine the economic and health impact of FDI, the effectiveness of safeguard measures, and the stability of GATS commitments; and (iii) any negotiations will depend upon parties having a common understanding of what is being negotiated, and the interpretation of key definitions is thus critical. Countries should take a step back and first think through the risks and benefits of commercialisation of their health sector, rather than being sidetracked in to considering the level of foreign investment.
Country
Publisher
Theme area
Resource allocation and health financing
Title of publication Building on the user-fee experience: The African case
Date of publication
2003
Publication type
Document
Publication details
Health System Financing, Expenditure and Resource Allocation Discussion Series 3 pp 2-23
Publication status
Published
Language
English
Keywords
user fees; Bamako Initiative; resource mobilisation; institutional setting; institutional capacity
Abstract
Since its wide-spread introduction under the Bamako Initiative (BI) in the 1980s, the user fee experience in Africa has been reviewed extensively with respect to actual versus theoretical/planned outcomes. This paper starts with a brief contextual background of user charges in Africa. Given the specific goals of the BI, these focused on the demand response to charges, revenues from which were earmarked for improving drug availability as an instrument to promote utilisation of primary health centres (PHCs). Using a basic economic model for household demand for health care, the study then examines the determinants of utilisation response to fees. Under the BI, user fees were levied at the point of service delivery and borne entirely by the consumer, under various institutional setting. Previous reviews indicated that predicted levels of resource mobilisation were not realised and that, in fact, revenues raised from implementing user fees fell well short of estimates, being on average about 7% of non-salary costs rather than the anticipated 15%. This has limited both the envisaged increase in utilisation, through an improvement in the availability of drugs, as well as reallocation of resources, through exemptions schemes to protect the poor. The reviews emphasise the importance of establishing an 'enabling environment', especially institutional capacity, as a key first step to ensuring the feasibility of a system of fees: policy directives for fee structures, revenue collection, retention and expenditures; exemption guidelines; and motivated staff with the capacity to enforce these rules with community participation.
Country
Publisher
World Health Organization
Theme area
Public-private mix
Title of publication Private health insurance: Implications for developing countries
Date of publication
2005 February
Publication type
Journal Article
Publication details
Bulletin of the World Health Organization 83 2 pp 127-134
Publication status
Published
Language
English
Keywords
private health insurance; public health insurance; regulations; publich sector
Abstract
Private health insurance is playing an increasing role in both high- and low-income countries, yet is poorly understood by researchers and policy-makers. This paper shows that the distinction between private and public health insurance is often exaggerated since well regulated private insurance markets share many features with public insurance systems. It notes that private health insurance preceded many modern social insurance systems in western Europe, allowing these countries to develop the mechanisms, institutions and capacities that subsequently made it possible to provide universal access to health care. The authors also review international experiences with private insurance, demonstrating that its role is not restricted to any particular region or level of national income. The seven countries that finance more than 20% of their health care via private health insurance are Brazil, Chile, Namibia, South Africa, the United States, Uruguay and Zimbabwe. In each case, private health insurance provides primary financial protection for workers and their families while public health-care funds are targeted to programmes covering poor and vulnerable populations.
They argue that private health insurance cannot be ignored, but should be harnessed to serve the public interest if governments implement effective regulations and focus public funds on programmes for those who are poor and vulnerable. It can also be used as a transitional form of health insurance to develop experience with insurance institutions while the public sector increases its own capacity to manage and finance health-care coverage.
Country
Publisher
World Health Organization
Theme area
Equitable health services
Title of publication From funding to action: Strengthening healthcare systems in sub-Saharan Africa
Date of publication
2005
Publication type
Publication details
World Economic Forum White Paper pp 1-49
Publication status
Published
Language
English
Keywords
skills management; centres of excellence; out-of-pocket expenditures; mandatory health insurance; accreditation; health care facitlities; technology; least developed countries; LDC
Abstract
This paper argues that there are four strategic opportunities for collaboration among multiple players to leverage their unique skills, competencies, roles and resources to improve health systems in Africa. The authors argue that it is important to develop regional and local centres of excellence in training on essential management and professional skills, based in various institutions throughout Sub-Saharan Africa, focussing on building capacity and establishing centres of
excellence in least developed countries (LDC). They suggest that it is important to support development and operations of mandatory health coverage in those countries with high out-of-pocket expenditures, and establish minimum evidence-based quality standards specifically for LDCs focused on resource-poor and rural setting by providing a mechanism for quality accreditation of health care facilities, laboratories and outreach centres. They argue that developing countries must take advantage of new, inexpensive technologies to build communities of practice amongst healthcare providers who are sparsely located and address the challenge of providing quality care in remote settings.
Country
Publisher
Centre for Public-Private Partnership, Global Health Initiative
Theme area
Public-private mix
Title of publication Franchising in health
Date of publication
2003 June
Publication type
Document
Publication details
Public Policy for the Private Sector Note 263 pp 1-4
Publication status
Published
Language
English
Keywords
franchising; health services; coverage; service providers; public policy goals
Abstract
A growing number of health franchising schemes have emerged in developing countries in recent years. Often reaching tens of thousands of poor households, these private schemes currently provide logistical, managerial, and sometimes financial support to small-scale providers (franchisees) of preventive care, such as family planning and maternal and child health services. While franchising has attracted growing interest among governments and donors as a possible way to achieve health objectives, there is some debate about the ability of the model to reach the poorest people and the ability of franchisers to sustain themselves financially. Early results from health franchising schemes
suggest that the model can rapidly expand the coverage of basic health services to poor people, capture economies of scale, and reduce the
information asymmetries that often adversely affect the quality of care. While franchisees may reach financial sustainability relatively quickly, as has happened in the Well-Family Midwife Clinic Network, franchisers that pursue public policy goals may need to continue to rely on public subsidies.
Country
Publisher
World Bank
Theme area
Health equity in economic and trade policies, Public-private mix
Title of publication The changing role of the World Bank in global health
Date of publication
2005 January
Publication type
Journal Article
Publication details
American Journal of Public Health 95 1 pp 60-70
Publication status
Published
Language
English
Keywords
Abstract
Country
Publisher
Theme area
Public-private mix
Title of publication Working for God? Evaluating service delivery of religious not-for-profit health care providers in Uganda
Date of publication
2003 April
Publication type
Document
Publication details
Policy Research Working Paper Series 3058 pp 1-50
Publication status
Published
Language
English
Keywords
private not-for-profit providers; PNFP; medical staff; pro-poor services; quality of care; financial aid; Uganda
Abstract
The authors explore a micro-level data-set on primary health care facilities in Uganda to address the question: What motivates religious not-for-profit (RNP) health care providers? The authors use two approaches to identify whether an altruistic (religious) effect exists in the data. First, examining cross-section variation, they show that RNP facilities hire qualified medical staff below the market wage, are more likely to provide pro-poor services and services with a public good element, and charge lower prices for services than for-profit facilities, although they provide a similar (observable) quality of care. RNP and for-profit facilities both provide better quality care than their government counterparts, although government facilities have better equipment. These findings are consistent with the view that RNP facilities are driven in part by altruistic concerns and that these preferences matter quantitatively. Second, the authors explore a government-initiated program of financial aid for the RNP sector and show that financial aid leads to more laboratory testing of suspected malaria and intestinal worm cases, and hence higher quality of service and lower prices, but only in RNP facilities.
Country
Uganda
Publisher
World Bank
Theme area
Public-private mix
Title of publication The economics of public and private roles in health care: Insights from institutional economics and organizational theory
Date of publication
2000 June
Publication type
Document
Publication details
Health, Nutrition and Population Discussion Paper 21875 1 pp 1-23
Publication status
Published
Language
English
Keywords
stewardship; financing; health sector; government; privatisation; private sector
Abstract
This report presents an argument for a continued and even an enhanced role for the state in providing strong sectoral stewardship and securing equitable and sustainable financing for the health sector. But it challenges the principles and nature of public intervention pursued by many governments, especially in the area of the public production of health services. It argues that a three-step process can be used to move gradually from one balance to another in the public-private mix in service delivery. First, when there is already a large private sector, the public sector can begin by recognising its existence and slowly increase use of these resources through better coordination, contracts, and a positive regulatory environment. Once some learning has taken place in coordinating and contracting with existing providers, the positive lessons from this experience can be transferred to other priority areas where nongovernmental providers may not yet be active. Finally in some cases where the public sector is clearly engaged in inefficient activities such as public production of many inputs, these can be converted through outright privatisation and subsequently brought from the private sector. A more integrated approach and greater public sector involvement in health care financing, sectoral coordination, regulation, monitoring, and evaluation is suggested.
Country
Publisher
World Bank
Theme area
Public-private mix
Title of publication Private sector, human resources, and health franchising in Africa
Date of publication
2005 April
Publication type
Journal Article
Publication details
Bulletin of the World Health Organization 83 4 pp 274-279
Publication status
Published
Language
English
Keywords
franchising; health services; delivery point availability; medicine; service providers; quality; Africa
Abstract
In much of the developing world, private health care providers and pharmacies are the most important sources of medicine and medical care and yet these providers are frequently not considered in planning for public health. This paper presents the available evidence, by socioeconomic status, on which strata of society benefit from publicly provided care and which strata use private health care. Using data from The World Bank's Health Nutrition and Population Poverty Thematic Reports on 22 countries in Africa, an assessment was made of the use of public and private health services, by asset quintile groups, for treatment of diarrhoea and acute respiratory infections, proxies for publicly subsidized services. The evidence and theory on using franchise networks to supplement government programmes in the delivery of public health services was assessed. Examples from health franchises in Africa and Asia are provided to illustrate the potential for franchise systems to leverage private providers and so increase delivery-point availability for public-benefit services. We argue that based on the established demand for private medical services in Africa, these providers should be included in future planning on human resources for public health. Having explored the range of systems that have been tested for working with private providers, from contracting to vouchers to behavioural change and provider education, we conclude that franchising has the greatest potential for integration into large-scale programmes in Africa to address critical illnesses of public health importance.
Country
Publisher
World Health Organization
Theme area
Public-private mix
Title of publication Humanitarian programmes of the pharmaceutical industry in developing nations
Date of publication
2003 March
Publication type
Book
Publication details
Global partnerships pp 1-22
Publication status
Published
Language
English
Keywords
Pharmaceutical Research and Manufacturers of America (PhRMA)
Abstract
In recent years, the humanitarian activities of the pharmaceutical
industry have grown to such size and scope that they have become part of the global efforts to fight disease and improve public health in the developing world. The industry’s health spending in developing countries rivals that of the World Health Organization. The authors argue that what contributes most to the effectiveness of humanitarian programs are the collaborative efforts to build local infrastructure and capacity so that products reach those who need them. Moreover, such collaborative efforts at local level provide an impetus for improvements in the primary health care systems. Success depends on governments and the international aid community doing their part through sustainable financing; investments in infrastructure, including education; and the exercise of political will to direct the pace of change.
Country
Publisher
Pharmaceutical Research and Manufacturers of America (PhRMA)
Theme area
Public-private mix
Title of publication The role of contracting in improving health systems performance
Date of publication
2004
Publication type
Publication details
Health System Financing, Expenditure and Resource Allocation Discussion Series 1 pp 1-65
Publication status
Published
Language
English
Keywords
contracting; health services; corruption; competition
Abstract
This paper argues that the transition from a system in which actors' roles are kept separate to one in which there are interrelations between more and more actors brings about a far-reaching change in the actors' behaviour. While it is possible to consider that contracting is a tool for building better relations between the actors concerned, it may also have a downside that may cancel out its benefits. In this respect, the paper emphasises how the excessive competition that encourages opportunistic behaviour may fruitlessly overburden the transaction costs. In addition, there is always the possibility that corruption may at any time sneak into the contractual process. Finally, it is also possible to view contracting as but another rule of the game over access to health resources, in place of the traditional administrative channels.
Country
Publisher
World Health Organization
Theme area
Public-private mix
Title of publication Can working with the private for-profit sector improve utilization of quality health services by the poor? A systematic review of the literature
Date of publication
2007 November
Publication type
Journal Article
Publication details
International Journal for Equity in Health 6 17
Publication status
Published
Language
English
Keywords
private sector; poverty; quality; health services; equity
Abstract
The private sector represents an important source of care for all socioeconomic groups, including the poorest and substantial concerns have been raised about the quality of care it provides. Interventions have been developed to address these technical failures and simultaneously take advantage of the potential for involving private providers to achieve public health goals. Limited information is available on the extent to which these interventions have successfully expanded access to quality health services for poor and disadvantaged populations. This paper addresses this knowledge gap by presenting the results of a systematic literature review on the effectiveness of working with private for-profit providers to reach the poor. A literature review was undertaken, focussing on studies which evaluated the impact of interventions on utilisation and/or quality of services and which provided information on the socioeconomic status of the beneficiary populations. The authors argue that many interventions have worked successfully in poor communities and positive equity impacts can be inferred from interventions that work with types of providers predominantly used by poor people. Better evidence of the equity impact of interventions working with the private sector is needed for more robust conclusions to be drawn.
Country
Publisher
BioMed Central
Theme area
Human resources for health
Title of publication A model for analysis, systemic planning and strategic synthesis for health science teaching in the Democratic Republic of the Congo: A vision for action
Date of publication
2004 December
Publication type
Journal Article
Publication details
Human Resources for Health 2 16
Publication status
Published
Language
English
Keywords
training; human resources for health; competences; integrated strategies; Democratic Republic of Congo; DRC
Abstract
The problem of training human resources in health is a real concern in public health in Central Africa. What can be changed in order to train more competent health professionals? Taking into account the level of training of secondary-level nurses in the Democratic Republic of the Congo (DRC), a systemic approach, based on the PRECEDE PROCEED model of analysis, led to a better understanding of the educational determinants and of the factors favourable to a better match between training in health sciences and the expected competences of the health professionals. The results show that it is important to start this training with a global and integrated approach shared by all the actors. The strategies of action entail the need for an approach taking into account all the aspects, i.e. sociological, educational, medical and public health. The analysis of the results shows that one cannot bring any change without integrated strategies of action and a multidisciplinary approach that includes all the complex determinants of health behaviour, and to do it within the organisation of local structures and institutions in the ministry of health in the DRC.
Country
Zaire
Publisher
BioMed Central
Theme area
Public-private mix
Title of publication A new face for private providers in developing countries: What implications for public health?
Date of publication
2003
Publication type
Publication details
Bulletin of the World Health Organization 81 4 pp 292-297
Publication status
Published
Language
English
Keywords
Delivery of health care; Primary health care; Private sector; Public sector; Quality of health care; Comparative study; South Africa
Abstract
The use of private health care providers in low- and middle-income countries (LMICs) is widespread and is the subject of considerable debate. This paper reviews a new model of private primary care provision emerging in South Africa, in which commercial companies provide standardised primary care services at relatively low cost. The structure and operation of one such company is described, and features of service delivery are compared with the most probable alternatives: a private general practitioner or a public sector clinic. In a case study of cost and quality of services, the clinics were popular with service users and run at a cost per visit comparable to public sector primary care clinics. However, their current role in tackling important public health problems was limited. The implications for public health policy of the emergence of this new model of private provider are discussed. It is argued that encouraging the use of such clinics by those who can afford to pay for them might not help to improve care available for the poorest population groups, which are an important priority for the government. Encouraging such providers to compete for government funding could, however, be desirable if the range of services presently offered, and those able to access them, could be broadened. However, the constraints to implementing such a system successfully are notable, and these are acknowledged. Even without such contractual arrangements, these companies provide an important lesson to the public sector that acceptability of services to users and low-cost service delivery are not incompatible objectives.
Country
South Africa
Publisher
World Health Organization
Theme area
Public-private mix
Title of publication Strengthening the role of the private sector in expanding health coverage in Africa
Date of publication
2006 November
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
private health care; role of government; financing; regulation; Africa
Abstract
This paper argues that over the next twenty years, there is likely to be a transition from a Ministry of Health charged with managing hospitals and health centers, and staffed primarily by clinicians, nurses, pharmacists to one charged with overseeing the broader health system. In this new role, the ministries of health will be tasked with ensuring equitable and sustainable financing, regulation, and, staffing, both in the public and private sector. It argues that ministries of health are gradually starting to separate service provision from their responsibilities for policy making, planning, financing, monitoring, regulating and informing the public on health matters.
Country
East and southern Africa region
Publisher
The Woodrow Wilson International Center for Scholars
Theme area
Public-private mix
Title of publication Learning from failed health reform in Uganda
Date of publication
2004 November
Publication type
Journal Article
Publication details
British Medical Journal 329 7475 pp 1173-1175
Publication status
Published
Language
English
Keywords
markets; health objectives; heath reforms; universal health; Uganda
Abstract
Uganda embarked on market based health reforms in 1994. This paper argues that these reforms have not only failed to improve health services and the health of the population but have arguably been the key factor behind their deterioration. Market economic principles are good for generating wealth but poor at improving health and social welfare. To carry out genuine health sector reforms based on agreed health objectives, the health reforms must be disentangled from market based economic reforms. In particular, governments must guarantee social security and essential health services to all. This means macroeconomic variables should be manipulated to facilitate the attainment of social welfare targets without jeopardising economic growth. Market philosophy, which is based on greed and the accumulation of profit, cannot be the proper basis for maximising welfare. Instead, the principles of solidarity and compassion should provide the basis for social welfare. The study of how to achieve
maximum health within a given economy should be developed as a separate discipline from market based health economics, which is primarily concerned with minimisation of spending. Aid and technical
assistance to poor countries must be given and managed in a way that ensures a positive effect on health and social welfare. In the long run, poor countries such as Uganda should adopt a universal health and welfare framework, which they must increasingly finance from internal sources. Health and welfare must be assessed by using genuine indicators that comprehensively measure the reality of people’s lives.
Country
Uganda
Publisher
Theme area
Resource allocation and health financing
Title of publication Resource mobilization for the health sector in Zimbabwe
Date of publication
1996 December
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
private health insurace; user fees; resources; tax revenues; health services; Zimbabwe
Abstract
This paper argues that rising demands from service users, and tight constraints on public funds for health care in Zimbabwe have led to a search for additional mechanisms to mobilise resources. However, groups of self-employed people can be accepted for membership. In general it seems that MAS are well run and efficient (the likely range for administration costs is 8-12% of turnover), and there is little evidence of systematic selection of low risk cases. On retirement members can continue in membership. Around 6% of the population is currently covered by MAS schemes. In principle the MAS are funders of care and do not provide services directly, although there are some cases of investments by them in health care facilities (in principle on a commercial basis). It is likely that the dependence on tax revenues for financing health services in Zimbabwe will decline, and other sources will be needed. It is clear that the combination of some higher fees, more careful management of exemptions and more enthusiastic collection of fees could increase fee income to ver 20% of total health service costs.
Country
Zimbabwe
Publisher
Data for Decision Making Project, Harvard University
Theme area
Health equity in economic and trade policies
Title of publication Trading health services across borders: GATS, markets, and caveats
Date of publication
2005 January
Publication type
Journal Article
Publication details
Health Affairs pp 42-51
Publication status
Published
Language
English
Keywords
globalisation; trade in health services; developing countries; private providers; commercial health care
Abstract
This paper argues that the globalisation of health services requires the resources of the academic and corporate sectors of the developed world for equitable and sustainable growth. Health services trade should be seen as a tool for achieving these goals, rather than as an end in itself. There is a tacitly held belief that involvement in global health issues in developing countries is equivalent to charity work. This belief is false. Although groups such as Doctors without Borders will not fail for lack of work any time soon, the international market for health services offers increasingly robust opportunities. The shrinking impact of time and space made possible by advances in travel and information technology has made international trade in services generally, and in health services specifically, a growing commercial concern. Liberalisation of markets in developing countries will increasingly lure private providers of health care services with the promise of large, underserved, and increasingly affluent populations. Of greater significance, however, these markets are opening and will do so with or without the knowledge, experience, and perspective of the academic and commercial health care community of the developed world. With this in mind, it is important to note that it is not globalisation per se that will be good or bad for the developing world, but how we manage this globalisation. The shortcomings of developed-world health systems aside, these countries have much to offer in terms of financial and intellectual capital to these developing markets.
Country
Publisher
Theme area
Public-private mix
Title of publication Kenya: Reaching the poor through the private sector - A network model for expanding access to reproductive health services
Date of publication
2005
Publication type
Document
Publication details
Reaching the poor with health, nutrition and populations services: What works and what doesn't? 5 pp 81-96
Publication status
Published
Language
English
Keywords
reproductive health services; service providers; private for profit; private non-profit; training; Kenya
Abstract
This study measured the effectiveness of a Kenyan program dedicated to increasing the availability of reproductive health services to the poor through training and networking of private medical providers. The Kisumu Medical and Educational Trust (KMET) program focuses on family planning services and encourages providers to add these services to the normal range of consultations, commodity sales, and clinical care they already provide. The study looked at the pool of potential clients of KMET members to evaluate which wealth group benefits from the subsidy given to private providers through the KMET. Analysis of actual KMET clients was used to better understand the program’s success in providing quality reproductive health care. By grouping private, for-profit health providers into a network with NGOs and the public sector, the KMET furnishes responsive training and support to many service delivery points that are theoretically accessible to the poor. Enrolled medical providers, limited to one per site, become part of the
KMET network. Participating providers are required to meet specified facility standards. In rural areas the average clients of both KMET providers and non-member providers are somewhat poorer than the households in the nearby community. Both groups of providers serve a similar proportion of clients in the lowest socioeconomic stratum. Because the KMET clients reflect an undifferentiated cross-section of socioeconomic status from the catchment area in which the clinics are located, defined here by the households surveyed, the success or failure of the KMET network to continue reaching the poor is likely to be determined primarily by the network’s ability to identify and enroll more providers in rural settings. The findings indicate that the KMET has succeeded so far in reaching rural clients, but researchers could not draw a conclusion about whether this is attributable to provider differentiation or to program emphasis on rural placement.
Country
Publisher
World Bank
Theme area
Public-private mix
Title of publication Franchising of health services in low-income countries
Date of publication
2002 June
Publication type
Journal Article
Publication details
Health Policy and Planning 17 2 pp 121-130
Publication status
Published
Language
English
Keywords
franchising; health services; service providers; quality; low-income countries
Abstract
This paper argues that grouping existing providers under a franchised brand, supported by training, advertising and supplies, is a potentially important way of improving access to and assuring quality of some types of clinical medical services. While franchising has great potential to increase service delivery points and method acceptability, a number of challenges are inherent to the delivery model: controlling the quality of services provided by independent practitioners is difficult, positioning branded services to compete on either price or quality requires trade-offs between social goals and provider satisfaction, and understanding the motivations of clients may lead to organisational choices which do not maximise quality or minimise costs. This paper describes the structure and operation of existing franchises and presents a model of social franchise activities that will afford a context for analysfing choices in the design and implementation of health-related social franchises in developing countries.
Country
Publisher
Oxford University Press
Theme area
Public-private mix
Title of publication What can be done about the private health sector in low-income countries?
Date of publication
2002
Publication type
Journal Article
Publication details
Bulletin of the World Health Organization 80 4 pp 325-330
Publication status
Published
Language
English
Keywords
Health services/supply and distribution; Private sector; Marketing of health services; Quality of health care; Legislation, Health; Consumer advocacy; Developing countries
Abstract
This paper argues that a very large private health sector exists in low-income countries. It consists of a great variety of providers and is used by a wide cross-section of the population. There are substantial concerns about the quality of care given, especially at the more informal end of the range of providers. This is particularly true for diseases of public health importance such as tuberculosis, malaria, and sexually transmitted infections. Although the evidence base is not good, there is a fair amount of information on the types of intervention that are most successful in directly influencing the behaviour of providers and on what might be the necessary conditions for success. There is little evidence effective approaches to interventions on the demand side and policies that involve strengthening the purchasing and regulatory roles of governments. Although this study identified some successful efforts to influence private providers, they can be problematic. These efforts may imply sanctioning treatment practices that are contrary to current policy and there may be strong opposition from powerful professional groups. The monitoring function is vital but difficult to sustain in the long term. Successful projects are hugely resource intensive, especially when they involve working with unorganized individual providers. Consequently, careful judgements have to be made concerning the relative return on investment in improving private sector activities as opposed to investment in a strengthened public sector. Working with the more organized formal private sector, i.e. doctors, nurses and pharmacists, is a more feasible starting point for governments. In this connection, however, there is a dilemma in that the poor more frequently use informal, illegally practising private providers. How to bring the informal sector into an overall public policy net remains an unsolved problem. Training and investment in a stronger formal sector, both private and public, and restructuring the market so as to strengthen the purchasing and regulation functions of government, may displace the informal sector, but this is likely to be a very long-term process.
Country
Publisher
World Health Organization
Theme area
Human resources for health, Public-private mix
Title of publication Improving malaria home treatment by training drug retailers in rural Kenya
Date of publication
2004 April
Publication type
Journal Article
Publication details
Tropical Medicine and International Health 9 4 pp 451-460
Publication status
Published
Language
English
Keywords
drug retailers; training; private providers; impact; Kenya
Abstract
Recent global malaria control initiatives highlight the potential role of drug retailers to improve access to early effective malaria treatment. This report discusses the implications of an educational programme for rural drug retailers and communities in Kenya between 1998 and 2001 in a study population of 70,000. Impact was evaluated through annual household surveys of over-the-counter (OTC) drug use and simulated retail client surveys in an early (1999) and a late (2000) implementation area. The programme achieved major improvements in drug selling practices. The proportion of OTC anti-malarial drug users receiving an adequate dose rose from 8% to 33% between 1998 and 1999 in the early implementation area. By 2001, and with the introduction of sulphadoxine pyrimethamine group drugs in accordance with national policy, this proportion rose to 64%. Overall, the proportion of shop-treated childhood fevers receiving an adequate dose of a recommended anti-malarial drug within 24 hours rose from 1% to 28% by 2001. The authors argue that these findings strongly support the inclusion of private drug retailers in control strategies aiming to improve prompt effective treatment of malaria.
Country
Publisher
Theme area
Public-private mix
Title of publication Trends and opportunities in public-private partnerships to improve health service delivery in Africa
Date of publication
2005
Publication type
Document
Publication details
Africa Region Human Development Working Paper Series pp 1-100
Publication status
Published
Language
English
Keywords
public-private mix, health services, poverty, planning, regulations, financing, PPP, service providers, Africa
Abstract
The report, discusses how to engage the private sector in Africa effectively and provides examples of successful public-private partnerships in health, highlighting some of the trends in these types of partnerships. It argues that poorer segments of the population do use the private sector extensively, and the public sector does substantially subsidise richer people who use its services. Planning, financing,
regulating, and formal PPPs all need to be set up based on the packages of public health functions that a government wants to deliver to different
population groups, which must involve all service providers in the country.
Country
East and southern Africa region
Publisher
World Bank
Theme area
Resource allocation and health financing
Title of publication Malawi national health accounts: A broader perspective of the Malawian health sector
Date of publication
2001
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
health financing; geographic allocation; out-of-pocket spending; debt burden; health budget; redistribution; Malawi
Abstract
This study has shown that financial flows and uses in Malawi’s health system have departed considerably from previous understanding and knowledge. Economic, demographic and health indicators for Malawi are
generally poor even in a regional comparison. Analysing government expenditure by function, shows allocation to health at unduly low levels of total expenditure, largely due to the extent public debt service (nearly 40% in 1998/9 FY) crowding out expenditure on social or economic sectors. In terms of provision, government facilities 42 are still the largest handler of financial flows, 42% of all expenditure is a result of the patient initially seeking care at government facilities (including non-MoHP). However, some of this 42% represents patient’s out-of-pocket expenditure on transport and food, and eventually on drugs from vendors and shops due to stock-outs at the relevant facility. Secondary government hospitals now handle a similar proportion of the sector’s expenditure as NGOs (18.4%) or private firms (18.2%), and this proportion is likely to be upwardly biased. Private-forprofit providers have grown to handle a not insignificant 10.1%. Most of the government’s health budget is spent on personal emoluments and drugs and medical supplies. Public health resources have not historically been allocated on a geographical basis in any systematic way. Household out-of-pocket expenditure is very substantial. The greatest redistributive scope from government finances is from district hospitals to primary health centers and the community level. Tertiary care already has minimum funding levels, and administration is not excessively expensive by international standards (although efficiency in these areas could be increased by allocation mechanisms between central hospitals and/or central government departments). Donors possibly could re-allocate from urban and curative services to preventative and primary services in rural areas. Re-programming donor expenditure is most feasible within a SWAp focused around delivering an essential health package.
Country
Malawi
Publisher
Malawi Ministry of Health and Population
Theme area
Health equity in economic and trade policies, Public-private mix
Title of publication Health care commercialisation and the embedding of inequality
Date of publication
2003 September
Publication type
Document
Publication details
RUIG / UNRISD Health Project Sythesis Paper pp 1-40
Publication status
Published
Language
English
Keywords
commercialisation; health care; inequality; social cohesion; globalisation
Abstract
This paper examines the pressures for commercialisation in health care; proposes analytical categories of analysis of commercialisation that can be used for empirical work; explores some available data on the extent of commercialisation and examines its interaction with other aspects of inequality. It argues that health care is a key site on which the social challenge of globalisation is played out: an area where commercialisation has to be at least partially blocked if socially inclusive development is to be possible, and also a policy arena within which - because of the ethical importance of health care to society - that blocking is possible. Commercialisation in health care is particularly destructive of social cohesion, as well as a key site for the social and political framing of more egalitarian development processes.
Country
Publisher
United Nations Research Institute for Social Development (UNRISD)
Theme area
Public-private mix
Title of publication Planning and market regulation: Strengths, weaknesses and interactions in the provision of less inequitable and better quality health care
Date of publication
2007 November
Publication type
Document
Publication details
Open Discussion Papers in Economics 64 1 pp 54
Publication status
Published
Language
English
Keywords
health care provision; redistributive; market regulation; government planning; health system management; integration
Abstract
This paper argues that planned health care provision and market regulation play distinct roles in relation to the effective provision of equitable health care. Governmental planned provision has as a core objective ensuring that the health system is redistributive and that the poor have access to competent care. Market regulation has as its central objective the shaping of the role and behaviour of the private sector within the health system. Management of the health system as a whole, which is a governmental responsibility, therefore requires the integration of planning and regulation in a manner appropriate to each particular context.
Country
Publisher
Open University and World Health Organisation’s Commission on the Social Determinants of Health, Health Systems Knowledge Network
Theme area
Values, policies and rights
Title of publication Issues of equity are also issues of rights: Lessons from experiences in Southern Africa
Date of publication
2007
Publication type
Journal Article
Publication details
BMC Public Health 7 14
Publication status
Published
Language
English
Keywords
human rights; equity; collective agency; community engagement; public-private divide; southern Africa
Abstract
Human rights approaches to health have been criticised 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 Network on Equity in Health in Southern Africa undertook an exploration of three regional case studies – antiretroviral access, patient rights charters and civic organisation for health. A combination of archival reviews and stakeholder interviews were complemented with a literature review to provide a theoretical framework for the empirical evidence. Critical success factors for equity are the importance of rights approaches addressing the full spectrum from civil and political, through to socio-economic rights, as well as the need to locate rights in a group context. Human rights approaches succeed in achieving health equity when coupled with community engagement in ways that reinforce community capacity, particularly when strengthening the collective agency of its most vulnerable groups. Additionally, human rights approaches provide opportunities for mobilising resources outside the health sector, and must aim to address the public-private divide at local, national and international levels. 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.
Country
Southern Africa Regional
Publisher
BioMed Central
Theme area
Public-private mix
Title of publication Buying results? Contracting for health service delivery in developing countries
Date of publication
2005 August
Publication type
Journal Article
Publication details
The Lancet 366 9486 pp 613-615
Publication status
Published
Language
English
Keywords
contracting; package of basic services; health services; non-governmental organisations; low-income countries
Abstract
To achieve the health-related Millennium Development Goals, the delivery of health services will need to improve. Contracting with non-state entities, including non-governmental organisations (NGOs), has been proposed as a means for improving health care delivery, and the global experience with such contracts is reviewed here. According to this study, the ten investigated examples indicate that contracting for the delivery of primary care can be very effective and that improvements can be rapid. These results were achieved in various settings and services. Many of the anticipated difficulties with contracting were either not observed in practice or did not compromise contracting's effectiveness. Seven of the nine cases with sufficient experience (greater than three years' elapsed experience) have been sustained and expanded. Provision of a package of basic services by contractors costs between roughly US$3 dollars and US$6 dollars per head per year in low-income countries.
Country
Publisher
Theme area
Public-private mix
Title of publication Health care on the frontlines: Survey evidence on public and private providers in Uganda
Date of publication
2003
Publication type
Document
Publication details
Africa Region Human Development Working Paper Series pp 1-64
Publication status
Published
Language
English
Keywords
public-private mix, health services, human resources, financing, prescriptions, Uganda
Abstract
This report presents findings from a baseline survey of 155 primary health care facilities (dispensaries, with and without maternity units) that was carried out in Uganda in the latter part of 2000. The analysis compares service delivery performance in three ownership categories: government, private for-profit, and private non-profit. A facility level it explores staffing, availability of drugs and other inputs, remuneration, outputs, and financing. The study found that government facilities are the most important providers of immunisations, modern deliveries, and reproductive health care, while the private sector provides the bulk of curative care. The importance of the private sector is in part a consequence of the almost total collapse of the government system during the 1970s. But private sector provision has also been increasingly encouraged, and in a recent sector strategy
the government proposed that new forms of collaboration with the private sector be explored. The survey finds that government facilities tend to have larger staffs, with higher qualifications. Even so, over 60 percent of staff are nursing aides or “other staff.” This is consistent with administrative data for 2000 showing that only 33 percent of established health positions were filled by qualified staff, with the remainder either vacant or filled by unqualified nursing aides or other staff Although staff in government dispensaries
earn more than staff in the private sector, they are much more likely to experience delays in salary payments, particularly in comparison with for-profit facilities. Inequalities in remuneration
among and within government facilities are also striking. There is a regional pattern, with noticeably higher compensation in
the central region, for all categories of staff. But differences are also driven by the source of financing. For example, staff financed by the subcounty or the facility receive considerably
less than staff in the same category who are financed by the district. evidence from the exit poll indicates that drugs (in particular, antibiotics) are overprescribed in both government and private facilities. The survey did not include consultation
observations or “gold-standard” examinations to assess “true” client need for drugs. Still, the number and nature of the drugs actually received by patients suggest excessive and inappropriate drug prescription.
Country
Uganda
Publisher
World Bank
Theme area
Health equity in economic and trade policies
Title of publication A survey of policy and practice on the use of access to medicines-related TRIPs flexibilities in Malawi
Date of publication
2004 September
Publication type
Document
Publication details
Issues paper: Access to Medicine pp 3-54
Publication status
Published
Language
English
Keywords
TRIPs; Trade Related Aspects of Intellectual Property; pharmaceutical manufacturing; drug access; anti-retroviral; patents; intellectual property; Malawi
Abstract
This pape looks at Malawi's a limited pharmaceutical manufacturing base and it's significant dependence on the importation of products from foreign-based manufacturers. In the case of relatively newer medicines, some of which are covered by intellectual property rights, Malawi must import from brand name manufacturers. Where a patent bar does not exist, Malawi relies on manufacturers in India and, to some extent, in China and South Africa. With respect to anti-retrovirals, Malawi’s HIV/AIDS treatment programme, funded by the Global Fund, relies almost exclusively on fixed-dose combinations generics imported from India. This reliance is potentially problematic because some of the component medicines are still patent protected in Malawi. Malawi’s current efforts to regularise its intellectual property rights affecting access to medicines are ad hoc, problematic and reflect a limited technical capacity. Nonetheless, the apparent political will to revise the Malawian Patents Act and make best efforts to ensure maximum access to medicines should be capitalised upon and key ministries and institutions, particularly the Ministries of Health and Commerce and the Patents Office, should be supported in their access to medicines-related and broader TRIPs-related initiatives. However, this intellectual property reform will not be possible without the assistance of development partners in increasing the availability of specialist skills on issues such as intellectual property law and international drug procurement and further assistance in facilitating the thorough review of legislation and associated policies.
Country
Malawi
Publisher
DFID Health Systems Resource Centre
Theme area
Monitoring equity and research to policy
Title of publication Translating statistical findings into plain English
Date of publication
2009 June
Publication type
Journal Article
Publication details
The Lancet 373 9679 pp 1926-1928
Publication status
Published
Language
English
Keywords
Knowledge translation, statistics, research, plain English, end users, researchers, authors
Abstract
Clinical trial reports usually give estimates of treatment effects, their confidence intervals and p values. But what do these terms mean? The statistical methods and their technical meaning are well established. However, there is less clarity about the concise interpretative wording that authors should use, especially in the abstract and conclusions and by others in commentaries. This article offers guidance and assumes that one short sentence needs to capture the essence of a trial's findings for the primary endpoint. It explains technical terms simply and aims to help researchers to achieve this objective in their writing.
Country
United Kingdom
Publisher
The Lancet
Theme area
Equitable health services
Title of publication The primary health care package for South Africa: A set of norms and standards
Date of publication
2000
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
South Africa, primary health care, PHC, essential health package, basic health package, minimum health package, health services
Abstract
Primary health care is at the heart of the plans to transform the health services in South Africa. This document provides an integrated package of essential primary health care services available to the entire population will provide the solid foundations of a single, unified health system. It as the driving force in promoting equity in health care. The document sets out the norms and standards that are to be made available in the essential package of primary care services, for individuals to see what quality of primary care services they can expect to receive. It also acts as guidance for provincial and district health authorities to provide these services. The document contains norms and standards for clinic and community services. A noorm is defined as a statistical normative rate of provision or measurable target outcome over a specified period of time. A standard is defined as a statement about a desired and acceptable level of health care. Standard setting takes place within specific dimensions of quality -- acceptability, accessibility, appropriateness, continuity, effectiveness, efficiency, equity, interpersonal relations, technical competence and safety. The most important dimensions have been chosen for each service.
Country
South Africa
Publisher
Department Of Health, South Africa
Theme area
Values, policies and rights
Title of publication A user-friendly guide/toolkit for applying the human rights-based framework
Date of publication
2009 June
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
Rights, right to health, activism, lobbying, participation, civil society, civil society organisations, CSOs
Abstract
This assessment guide leads you through a five-step process to document aspects of the denial of the right to health care in your country. It suggests how to lobby and set up activist strategies for addressing the violations you identify. The steps, in brief, aim to answer the following questions. Step 1: What are your government’s commitments? Step 2: Are your government’s policies appropriate to fulfill these obligations? Step 3: Is the health system of your country adequately implementing interventions to realise the right to health and health care for all? Step 4: Does the health status of different social groups and the population as a whole reflect a progression in their right to health and health care? Step 5: What does the denial or fulfillment of the right to health in your country mean in practice? In this final step, you should systematically contrast the obligations outlined in Step 1 with the realities documented in Steps 2, 3 and 4, and briefly highlight the main areas of denial of health rights in your country.
Country
Publisher
People’s Health Movement
Theme area
Monitoring equity and research to policy
Title of publication Cross-community comparability of attitude questions: An application of item response theory
Date of publication
2009 June
Publication type
Journal Article
Publication details
International Journal Of Social Research Methodology 1464 5300
Publication status
Published
Language
English
Keywords
Research, research methodology, surveys, comparative surveys, attitude questions, item response theory
Abstract
The use of attitude questions is very common in comparative surveys as it allows researchers to gauge the perspectives of respondents toward social issues and explain cross-country differentials in attitudes. Comparative studies implicitly assume that equivalently worded items are measuring the same construct in different settings. However, the results of these studies might be questionable if the measurement invariant assumption is violated and different groups of respondents do not have a shared understanding of the attitude items. This paper uses item response theory to compare the measurement of items and to test whether equivalently worded attitude questions about family dissolution are understood in the same way across various communities in India, Malaysia, Pakistan and the Philippines. The paper also examines the interaction between the respondent's gender, the sex of the spouse leaving the marriage and the responses to the attitude questions about acceptability of family dissolution.
Country
United Kingdom
Publisher
Informaworld
Theme area
Monitoring equity and research to policy
Title of publication An assessment of interactions between global health initiatives and country health systems
Date of publication
2008 June
Publication type
Journal Article
Publication details
The Lancet 373 9681 pp 2137-2169
Publication status
Published
Language
English
Keywords
Monitoring, fragile states, global health initiatives, GHIs, health systems, global health
Abstract
Have disease-specific global health initiatives (GHIs) burdened health systems that are already fragile in poor countries or have they been undermined by weak health systems? This study reviews and analyses existing data and 15 new studies that were submitted to the World Health Organization for the purpose of writing this report. It makes some general recommendations and identifies a series of action points for international partners, governments, and other stakeholders that will help ensure that investments in GHIs and country health systems can fulfil their potential to produce comprehensive and lasting results in disease-specific work, and advance the general public health agenda. If adjustments to the interactions between GHIs and country health systems will improve efficiency, equity, value for money and outcomes in global public health, then these opportunities should not be missed.
Country
United Kingdom
Publisher
The Lancet
Theme area
Governance and participation in health
Title of publication Who runs global health?
Date of publication
2009 June
Publication type
Journal Article
Publication details
The Lancet 373 9681 pp 2083-2083
Publication status
Published
Language
English
Keywords
Governance, accountability, responsibility, global health, poverty
Abstract
The past two decades have seen dramatic shifts in power among those who share responsibility for leading global health. In 1990, development assistance for health – a crude, but still valid, measure of influence – was dominated by the United Nations (UN) system (the World Health Organization, the United Nations Children’s Fund and the United Nations Population Fund) and bilateral development agencies in donor countries. Today, while donor nations have maintained their relative importance, the UN system has been severely diluted. This marginalisation, combined with serious anxieties about the unanticipated adverse effects of new entrants into global health, should signal concern about the current and future stewardship of health policies and services for the least advantaged peoples of the world.
Country
United Kingdom
Publisher
The Lancet
Theme area
Governance and participation in health
Title of publication The missing link: Applied budget work as a tool to hold governments accountable for maternal mortality reduction commitments
Date of publication
2009 June
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
Participation, civil society, civil society organisation, CSOs, maternal mortality, pregnancy, childbirth, right to health, rights
Abstract
This brief explores the relevance of civil society budget analysis and advocacy and its potential as a tool to hold governments accountable for their maternal mortality reduction commitments. It discusses three recent examples of civil society groups engaged with budget analysis and advocacy, including Women’s Dignity in Tanzania. Lack of real progress in reducing maternal mortality is unquestionably linked to the failure of governments to make maternal health a budgetary priority. Even though resources to address this issue exist, they are not necessarily being allocated correctly or spent effectively. Governments need to prioritise funding for family planning and prenatal care, skilled care during pregnancy and childbirth, and essential lifesaving interventions. In addition, citizens must actively monitor government spending on maternal health.
Country
Publisher
International Initiative on Maternal Mortality and Human Rights
Theme area
Governance and participation in health
Title of publication EU systematically neglects non-state actors in its development aid programmes
Date of publication
2009 May
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
Participation, European Union, EU, non-state actors, NSAs, European Community, EC, development assistance, overseas development assistance, ODA
Abstract
Non-state actors (NSAs) are systematically neglected in European Union (EU) development assistance programmes, according to this report. It identifies EU practices that are violating its European Consensus on Development policy statement. It found that, despite the European Community’s (EC’s) attempts, NSAs' involvement has been limited and falls short of the sustained and structured dialogue envisaged by the EU legislation and the Commission’s own guidelines. The EC often does not commit enough time and resources to ensure that its delegations involve relevant NSAs throughout the whole process. EC's development aid programmes are reported to often engage NSAs solely as service providers or short-term consultants, without the follow-up and impact needed for sustainability and effectiveness.
Country
Belgium
Publisher
Europe External Policy Advisors (EEPA)
Theme area
Equity and HIV/AIDS
Title of publication What makes a structural intervention? Reducing vulnerability to HIV in community settings, with particular reference to sex work
Date of publication
2009 June
Publication type
Journal Article
Publication details
Global Public Health 1744 1706 pp 715-724
Publication status
Published
Language
English
Keywords
HIV/AIDS, HIV, AIDS, structural intervention, HIV prevention, sex work, sex workers
Abstract
Increasing emphasis is being placed on the need for 'structural interventions' (SIs) in HIV prevention internationally. There is great variation in how the concept of an SI is defined and operationalised, however, and this has potentially problematic implications for their likely success. This paper clarifies and elucidates what constitutes an SI, with particular reference to the structured distribution of power and to the role of communities. It summarises the background to the growing emphasis being placed on the concept of SIs in HIV prevention policy and illustrates the nature of HIV vulnerability and its implications for the design and targeting of successful SIs. The paper draws attention to the dual importance of: attending to local complexities in the micro and macro-level structures that produce vulnerability; and clarifying the meaning and role of communities within SIs.
Country
United Kingdom
Publisher
Informaworld
Theme area
Equity and HIV/AIDS
Title of publication Partners at risk: Motivations, strategies and challenges to HIV transmission risk reduction among HIV-infected men and women in Uganda
Date of publication
2008 June
Publication type
Journal Article
Publication details
AIDS Care 21 6 pp 715-724
Publication status
Published
Language
English
Keywords
HIV/AIDS, HIV, AIDS, Uganda, safe sex, condoms, HIV transmission
Abstract
Despite the estimated 22.4 million HIV-infected adults in Africa, culturally appropriate ‘prevention with positives’ guidelines have not been developed for this region. In order to inform these guidelines, the authors of this study conducted 37 interviews with purposefully selected HIV-infected individuals in care in Uganda. Participants reported increased condom use and reduced intercourse frequency and numbers of partners after testing HIV-positive. Motivations for behaviour change included concerns for personal health and the health of others, and decreased libido. Interventions addressing domestic violence, partner negotiation, use of lubricants and alternative sexual activities could increase condom use and/or decrease sexual activity and/or numbers of partners, thereby reducing HIV transmission risk.
Country
United Kingdom
Publisher
Informaworld
Theme area
Equity and HIV/AIDS
Title of publication HIV and AIDS prevention efforts and infection patterns in Africa mismatched
Date of publication
2009 May
Publication type
Academic paper
Publication details
Publication status
Published
Language
English
Keywords
HIV/AIDS, HIV, AIDS, Kenya, Lesotho, Swaziland, Uganda, Mozambique
Abstract
Between 2007 and 2008, UNAIDS and the World Bank partnered with the national AIDS authorities of Kenya, Lesotho, Swaziland, Uganda and Mozambique to find out how and where most HIV infections were occurring in each country, and whether existing prevention efforts and expenditure matched these findings. The recently released reports reveal that few prevention programmes are based on existing evidence of what drives HIV and AIDS epidemics in the five countries surveyed. For example, in Mozambique, 19% of new HIV infections resulted from sex work, 3% from injecting drug use, and 5% from men who have sex with men (MSM), yet there are very few programmes targeting sex workers, and none aimed at drug users and MSM. The research also found that spending on HIV prevention was often simply too low: Lesotho spent just 13% of its national AIDS budget on prevention, whereas Uganda spent 34%, despite having an HIV infection rate of only 5.4%.
Country
United States
Publisher
Joint United Nations Programme on HIV/AIDS (UNAIDS)
Theme area
Equity and HIV/AIDS
Title of publication Failing women, failing children: HIV, vertical transmission and women’s health: On-the-ground research in Argentina, Cambodia, Moldova, Morocco, Uganda and Zimbabwe
Date of publication
2009 May
Publication type
Academic paper
Publication details
Publication status
Published
Language
English
Keywords
HIV/AIDS, HIV, AIDS, women, children, vertical transmission, prevention of mother-to-child transmission, PMTCT, pregnancy, stigma, Zimbabwe, Uganda
Abstract
Research conducted by civil society activists in various countries, including Uganda and Zimbabwe, shows that efforts to prevent vertical transmission are failing to reach the very group they were designed for – HIV-positive pregnant women. One of the key reasons for this is that the national programmes have been narrowly focused on providing antiretroviral prophylaxis and not on the other essentials – prevention, counselling, care and treatment for women and children. ‘On paper, the existing global programme is a model of sound design, human rights principles and a comprehensive approach’, the researchers noted. ‘In practice, it is a shameful demonstration of double standards and another instance of women's programming for which everyone and no one at the United Nations is in charge.’ In every country, the researchers found rampant fear of stigma among women and discrimination by health care workers.
Country
United States
Publisher
International Treatment Preparedness Coalition
Theme area
Resource allocation and health financing
Title of publication ‘Beyond aid’ for sustainable development
Date of publication
2009
Publication type
Document
Publication details
Overseas Development Institute Project Briefing 22 pp 1-4
Publication status
Published
Language
English
Keywords
Resources, resource allocation, financing, aid, Beyond Aid
Abstract
This briefing proposes that while prospects for developing countries are often shaped by domestic and regional politics and aid, it is necessary to looks at beyond aid at issues like trade, migration, investment, environmental issues, security and technology. The authors explore the progress made towards policy coherence and conceptualise a three-phase cycle: phase 1 includes setting and prioritising objectives, which requires political commitment and policy statements; phase 2 looks at policy coordination and the implementation mechanisms by establishing formal mechanisms at inter-ministerial level for coordination and policy arbitration; and phase 3 is about effective systems of monitoring, analysis and reporting. The paper concludes by recommending that the Beyond Aid agenda could help drive faster progress towards partnerships for community development and policies that are more ‘development friendly’, in practice as well as on paper.
Country
United Kingdom
Publisher
Overseas Development Institute
Theme area
Resource allocation and health financing
Title of publication More money for health and more health for the money Taskforce on Innovative International Financing for Health Systems
Date of publication
2009 May
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
Resources, resource allocation, financing, innovative financing, fair financing, pro-poor, accountability
Abstract
Participants at the Abuja Consultation recommend that the High Level Task Force recognise the right of all people to essential health care, pursue policies that will reduce inequity and social disparities, promote democratic and pro-poor reforms to the governance of the global economy as a means of creating a long-term and sustainable foundation for health financing, and add (not substitute) ‘innovative financing’ to existing commitments of governments, which must be fulfilled. The Task Force should also improve the efficiency, impact and accountability of current development assistance for health and place transparency and accountability at the heart of all proposed solutions. The health financing agenda must be moved forward according to principles of progressive finance, optimal pooling of finance, equitable and needs-based budgeting and expenditure, accountable planning and financial management, and the full engagement of civil society.
Country
Switzerland
Publisher
World Health Organization
Theme area
Resource allocation and health financing
Title of publication Lasting benefits: The role of cash transfers in tackling child mortality
Date of publication
2009 June
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
Resources, resource allocation, financing, cash transfers, children, child mortality, poverty, nutrition
Abstract
Over the past decade, an increasing number of developing country governments, working with donors and NGOs, have been implementing cash transfer programmes — regular transfers of cash to individuals or households. These programmes are united by common assumptions: that income poverty has a highly damaging impact on people’s health and nutrition, and that cash empowers poor individuals and households to make their own decisions on how to improve their lives. This report examines three key questions: What contribution can cash transfers make to reducing child mortality? What are the broader economic benefits of investing in cash transfers? How can child-focused cash transfers be affordable in developing countries? The report argues that cash transfers have a critical role to play in accelerating reductions in child mortality, as well as broader economic benefits. It estimates current costs and finds that child and maternity benefits are possible on a large scale, even in developing countries.
Country
United Kingdom
Publisher
Save The Children Fund
Theme area
Resource allocation and health financing
Title of publication Financing of global health: Tracking development assistance for health from 1990 to 2007
Date of publication
2009 June
Publication type
Journal Article
Publication details
The Lancet 373 9681 pp 2113-2124
Publication status
Published
Language
English
Keywords
Resources, resource allocation, financing, development assistance, overseas development assistance, ODA, donors, funders, funding, global health initiatives, GHIs, aid
Abstract
This study aimed to provide a comprehensive assessment of development assistance for health (DAH) from 1990 to 2007. It used several data sources to measure the yearly volume of DAH in 2007 United States dollars, and created an integrated project database to examine the composition of this assistance by recipient country. It found that DAH grew from $5.6 billion in 1990 to $21.8 billion in 2007. DAH has risen sharply since 2002 because of increases in public funding, especially from the USA, and on the private side, from increased philanthropic donations and in-kind contributions from corporate donors. Although the rise in DAH has resulted in increased funds for HIV/AIDS, other areas of global health have also expanded. The influx of funds has been accompanied by major changes in the institutional landscape of global health, with global health initiatives such as the Global Fund and the Global Alliance for Vaccines and Immunization having a central role in mobilising and channelling global health funds.
Country
United Kingdom
Publisher
The Lancet
Theme area
Resource allocation and health financing
Title of publication Embezzlement of donor funding in health projects
Date of publication
2008 May
Publication type
Document
Publication details
Chr. Michelsen Institute U4 Brief 11 pp 1-4
Publication status
Language
English
Keywords
Donors, funders, corruption, aid, embezzlement, east Africa
Abstract
Donor funding has fuelled a vast increase in service delivery, medical research and clinical trials throughout the developing world, yet, with pressures to spend funds quickly and achieve results, projects may not pay sufficient attention to internal monitoring and security systems to protect against embezzlement. This U4 Brief analyses how this type of corruption occurred in a donor-funded project, and what can be done to minimise the risk. While not widely publicised, many organisations have dealt with the frustrations of financial mismanagement, embezzlement and theft. Recommendations include tighter financial controls, better management policies and channels for disclosure. For projects that are just beginning, establishing a sound financial system should be a priority. Changes in policies, procedures and reporting can help promote a culture of compliance and avoid corruption.
Country
East Africa regional
Publisher
Chr. Michelsen Institute
Theme area
Public-private mix
Title of publication Bill and Melinda Gates Foundation's grant-making programme for global health
Date of publication
2009 May
Publication type
Journal Article
Publication details
The Lancet 373 9675 pp 1645-1653
Publication status
Published
Language
English
Keywords
Private sector, privatisation, Gates Foundation, global health grants, grants
Abstract
Although the Bill and Melinda Gates Foundation’s contribution to global health generally receives acclaim, fairly little is known about its grant-making programme. This paper is an analysis of 1,094 global health grants awarded between January 1998 and December 2007, totalling US$895 billion, of which $582 billion (65%) was shared by only 20 organisations. In total, $362 billion (40% of all funding) was given to supranational organisations such as the World Health Organization, the GAVI Alliance, the World Bank, the Global Fund to Fight AIDS, Tuberculosis and Malaria. Of the remaining amount, 82% went to recipients based in the United States. Just over a third ($327 billion) of funding was allocated to research and development (mainly for vaccines and microbicides) or to basic science research. The findings of this report raise several questions about the foundation's global health grant-making programme, which needs further research and assessment.
Country
United Kingdom
Publisher
The Lancet
Theme area
Human resources for health
Title of publication Task-shifting HIV counselling and testing services in Zambia: The role of lay counsellors
Date of publication
2009 March
Publication type
Journal Article
Publication details
Human Resources for Health 7 44
Publication status
Published
Language
English
Keywords
Human resources, task shifting, task-shifting, lay counsellors, HIV, Zambia
Abstract
This study was conducted to review the effectiveness of lay counsellors in addressing staff shortages and the provision of HIV counselling and testing services. Quantitative and qualitative data were collected by means of semistructured interviews from all active lay counsellors in each of the facilities, including a facility manager or counselling supervisor, and through focus group discussions with health care workers at each facility. The study found that lay counsellors provide counselling and testing services of quality and relieve the workload of overstretched health care workers, providing up to 70% of counselling and testing services at health facilities. The data review revealed lower error rates for lay counsellors, compared to health care workers, in completing the counselling and testing registers.
Country
Zimbabwe
Publisher
BioMed Central
Theme area
Human resources for health
Title of publication Compensation for the brain drain from developing countries
Date of publication
2009 May
Publication type
Journal Article
Publication details
The Lancet 373 9676 pp 1665-1666
Publication status
Published
Language
English
Keywords
Human resources, brain drain, recruitment, migration, east and southern Africa
Abstract
In January, 2009, the World Health Organization’s (WHO) Executive Board considered the adoption of a global code of practice to address the movement of health workers from developing countries, the ‘WHO Draft Code of Practice for the International Recruitment of Health Workers’. This attention to brain drain is welcome, but the initiative does not begin to adequately address the consequences or roots of health-worker migration from sub-Saharan Africa to the rich developed world, especially to the United Kingdom, United States and Canada. The movement of skilled health workers constitutes a major transfer of riches from poor societies to the affluent, and the only appropriate redress is a bilaterally managed scheme of direct reimbursement of the value lost, along the lines proposed by Mensah and colleagues in 2005.
Country
East and southern Africa region
Publisher
The Lancet
Theme area
Human resources for health
Title of publication A critical review of interventions to redress the inequitable distribution of healthcare professionals to rural and remote areas
Date of publication
2009 June
Publication type
Journal Article
Publication details
Rural And Remote Health 9 1060
Publication status
Published
Language
English
Keywords
Human resources, rural areas, remote areas, recruitment, retention, health worker retention, attrition
Abstract
This review provides a comprehensive overview of the most important studies addressing the recruitment and retention of doctors in rural and remote areas. A comprehensive search identified 1,261 references and, of these, 110 articles were included. Available evidence was classified into five intervention categories: selection, education, coercion, incentives and support. The review argues for the formulation of universal definitions for the above categories to assist study comparison and future collaborative research. Although coercive strategies address short-term recruitment needs, little evidence supports their long-term positive impact. Current evidence only supports the implementation of well-defined selection and education policies, although incentive and support schemes may have value. There remains an urgent need to evaluate the impact of untested interventions in a scientifically rigorous fashion in order to identify winning strategies for guiding future practice and policy.
Country
Australia
Publisher
Journal of Rural and Remote Health
Theme area
Governance and participation in health
Title of publication Meeting Report: Regional Meeting of Parliamentary Committees on Health in Eastern and Southern Africa: Munyonyo, Kampala, Uganda, September 21 2009
Date of publication
2009 September
Publication type
Conference Proceedings
Publication details
Munyonyo, Kampala, Uganda, September 21 2009
Publication status
Published
Language
Keywords
parliament, east and southern Africa, health financing, reproductive health
Abstract
The Regional Meeting of Parliamentary Committees on Health in Eastern and Southern Africa, held in Munyonyo, Kampala, Uganda, 21 September 2009, gathered members of Parliamentary Committees responsible for health from 12 countries and regional bodies in Eastern and Southern Africa, with technical government and civil society and regional partners to promote information exchange, facilitate policy dialogue and identify key areas of follow up action to advance health equity and sexual and reproductive health in the region. The meeting was held as a follow up to review progress on actions proposed at the September 2008 Regional Meeting of Parliamentary Committees on Health in Eastern and Southern Africa hosted by the same organisations.
Country
Uganda
Publisher
PPD, EQUINET
Equinet Publication Type
Reports
Theme area
Health equity in economic and trade policies
Title of publication Willingness and ability to use TRIPs flexibilities: Kenya case study’
Date of publication
2004 September
Publication type
Document
Publication details
DFID Issue Paper - Access to Medicine pp 3-54
Publication status
Published
Language
English
Keywords
medicine; pharmaceutical manufacture; World Trade Organization; WTO; Trade-Related Aspects of Intellectual Property Rights; TRIPS; African Regional Intellectual Property Office; ARIPO; Kenya
Abstract
Kenya possesses a moderate pharmaceutical manufacturing capacity but relies on imports to supplement local sources of essential medicines. The imports are mainly from other developing countries, such as India, which have developed generic manufacturing industries in part because of case-specific extended grace periods under the World Trade Organization’s (WTO) Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPs). However, once these grace periods expire in 2005 it is expected that these importation options will be restricted. Key challenges in the delivery of essential medicines arise from the international intellectual property rights regime. This international regime provided the framework for the reform of Kenya’s intellectual property rights legislation from 1999 to 2002 and access to medicines became a dominant theme in the reform process. Among related legislative and policy measures, the process for the registration of medicines is a potential barrier to access, particularly due to its largely unenforceable requirement for local clinical trials. Regional frameworks, such as the African Regional Intellectual Property Office (ARIPO), and trade agreements also have some potential to influence access to medicines in Kenya, although the possible directions of this
influence are yet to fully emerge. Kenya’s ability to maximise the benefits of its relatively advanced legislation to promote
access to medicines is limited and technical assistance to strengthen implementation efforts in various administrative authorities could encourage progress in this area. This limited capacity can be seen in the fact that Kenya has no strategy to adapt to coming changes in the international intellectual property framework and not even any detailed understanding of what these changes, and their impact, might be. The situation in Kenya suggests a number of specific future needs: support local manufacturers to develop capacity and meet international standards; capacity building in implementation of intellectual property and competition legislation; review of competition legislation should harmonise with intellectual property legislation; asymmetries in the treatment of importers and local manufacturers should be addressed; voluntary licence legislation and practice should be reviewed; medicines registration legislation and practice should be reviewed; and an assessment of the likely impacts of forthcoming changes in the international intellectual property rights framework should be considered.
Country
Kenya
Publisher
DFID Health Systems Resource Centre
Theme area
Values, policies and rights, Equitable health services, Public-private mix
Title of publication Health systems and commercialisation: In search of good sense
Date of publication
2004
Publication type
Conference Proceedings
Publication details
Paper prepared for the UNRISD international conference on Commercialization of Health Care: Global and Local Dynamics and Policy Responses pp 1-67
Publication status
Published
Language
English
Keywords
health policy; values; commercialisation; health system approach; economic analysis; market economy
Abstract
The authors argue that health policies reflect, and have always reflected, values, culture and policy priorities in different countries. The analysis of health policies therefore necessarily brings together sociological and political understanding and more technical evidence with insights from epidemiology, clinical medicine and economics. However, in the world at present, health policy analysis has come to take a particular predominant form: the analysis of health care as an economic sector of health service provision plus a set of managerial evaluation techniques for analysing health care inputs and outcomes. This dominant “common sense” of health policy then perpetuates fragmentation through a policy framework that allocates public health measures to a limited policy sphere of “public goods” while framing health services as a sector of market trading. The authors draw on both new research and existing evidence to argue that this dominant common sense in health policy is in certain ways both incoherent and damaging: It is well understood that a properly functioning health system is essential to an effective market economy; to make a health system work in a market economy, however, does not imply simply the commercialisation of the health care sector itself. It requires a health systems approach and recognises the importance of values. It also acknowledges the existence of market failures in health systems. It draws on economic analysis of health care financing and economic assessment of health care systems as a whole. But it draws also on public health and medical knowledge concerning the needs and problems that health systems have to deal with.
Country
Publisher
UNRISD
Theme area
Resource allocation and health financing
Title of publication An overview of health financing patterns and the way forward in the WHO African Region
Date of publication
2006 September
Publication type
Journal Article
Publication details
East African Medical Journal 83 9 Supplement pp S1-S28
Publication status
Published
Language
English
Keywords
health financing mechanisms; prepayment; private health expenditure; universal coverage; Africa
Abstract
The way a health system is financed affects the performance of its other functions of stewardship, input (or resource) creation and services provision, and ultimately, the achievement of health system goals of health improvement (or maintenance), responsiveness to people’s nonmedical expectations and fair financial contributions. This study analysed the changes between 1998 and 2002, in health financing from various sources, and proposed ways of improving the performance of health financing function in the WHO African Region. A retrospective analysis of data obtained from the World Health Report, 2005. The analysis reported in this paper is based on the National Health Accounts (NHA)
data for the 46 WHO Member States in the African Region. The analysis revealed that: fifteen countries spent less than 4.5% of their GDP on health; forty four countries spent less than 15% of their national annual budget on health; 63% of the governments in the Region spent less than US$10 per person per year; 50% of the total expenditure on health in 24 countries came from government sources; prepaid health financing mechanisms cover only a small proportion of populations in the Region; private spending constituted over 40% of the total expenditure on health in 31; direct out-of-pocket expenditures constituted over 50% of the private health expenditure in 38 countries. Every country needs to develop clear pro-poor health financing policy and a
comprehensive health financing strategic plan with a clear roadmap of how it plans to transit from the current health financing state dominated by inequitable, catastrophic and impoverishing direct out-of-pocket payments to a visionary scenario of universal coverage. The strategic plan should
also contain policy interventions aimed at strengthening health financing function, e.g. strengthening of health sector advocacy and health financing capacities, health economics evidence generation and utilisation in decision-making, making better use of available and expected resources, monitoring of equity in financing, strengthening of the exemption mechanisms, managed removal of direct out-of-pocket payments (for countries that choose to), and improving country-led sectoral coordination mechanisms (e.g. Sector Wide Approaches).
Country
East and southern Africa region
Publisher
Theme area
Monitoring equity and research to policy
Title of publication How effective are health systems strengthening programs in reaching the poor? A rapid assessments approach
Date of publication
2006 March
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
rapid assessment tool; evaluation; health programmes
Abstract
Over the past two decades, a number of countries have adopted health reform policies to improve the performance and effectiveness of the health sector including ensuring access to care for the poor. To identify the types of interventions that work, it is important to evaluate the interventions quickly by using relatively simple methodological approaches. The purpose of this paper is to provide an overview of the rapid assessment methods used in the evaluation of poverty alleviation activities and health and development programs. Based on a literature review, the study proposes a simple methodology that can be used to identify methods that can be used to rapidly assess the effect of health policy changes on the health service utilization and health status of the poor. By using the methods proposed, evaluators should be able to evaluate health programs and their impact on the
health of the poor within a short period of time.
Country
East and southern Africa region
Publisher
The Partners for Health Reformplus Project, Abt Associates Inc.
Theme area
Equitable health services
Title of publication Medicine Price Monitor, January 2007
Date of publication
2007 January
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
medicine; essential medicines list; availability; public facilities; private facilities; Kenya
Abstract
Price continues to be a major barrier to reliable access to medicines in Kenya. To help address this issue, the MOH conducts surveys on a quarterly basis to monitor medicine prices. Information is collected and widely disseminated on availability, affordability, and price variation of a basket of medicines in the public, private and mission sectors. A total of 63 urban and rural facilities, in four provinces (Central, Coast, Eastern and Nairobi) were surveyed, including 22 facilities in the public sector, 23 facilities in the private sector, and 18 facilities in the mission sector. Thirty-two commonly prescribed and dispensed medicines were monitored, 28 of which are on Kenya’s Essential Medicines List (KEML 20032). The prices are recorded for the lowest-priced product available on the day of data collection. The findings for January 2007 show a marginal decrease in availability of the surveyed medicines in the public sector, and an overall decrease in the patient price for most medicines in all three sectors. In general, prices were lowest in the public sector. The pricing practices in the mission and public sector are not uniform; some facilities charge for medicines and some provide medicines free of charge to the patient. Eight common medicines (i.e. recommended in national standard treatment guidelines (STGs)) were available in more than 75% of the public sector facilities. The two ARVs surveyed, AZT/3TC and 3TC/d4T/NVP, were available in 64% and 55%, respectively, of the public health facilities surveyed. Sulphadoxine/ Pyrimethamine was available in more than 80% of the facilities in all the three sectors. The first line antimalarial, Artemether/Lumefantrine, had higher availability in the public health facilities (91%), as compared private facilities. In the public sector, significant improvement in availability of certain key essential medicines was noted over the duration of these surveys, particularly medicines for malaria and HIV. However, other key medicines had low availability in this sector, There is need to further strengthen procurement and supply mechanisms in the public sector, for improved availability.
Country
Kenya
Publisher
Government of Kenya
Theme area
Equity and HIV/AIDS
Title of publication Experience of initiating collaboration of traditional healers in managing HIV and AIDS in Tanzania’
Date of publication
2007 January
Publication type
Journal Article
Publication details
Journal of Ethnobiology and Ethnomedicine 3 6
Publication status
Published
Language
English
Keywords
traditional healers; HIV; AIDS; provision of care
Abstract
Collaboration between traditional healers and biomedical practitioners is now being accepted by many African countries south of the Sahara because of the increasing problem of HIV/AIDS. The key problem, however, is how to initiate collaboration between two health systems which differ in theory of disease causation and management. This paper presents findings on experience learned by initiation of collaboration between traditional healers and the Institute of Traditional Medicine in Arusha and Dar-es-Salaam Municipalities, Tanzania where 132 and 60 traditional healers respectively were interviewed. Of these 110 traditional healers claimed to be treating HIV/AIDS. The objective of the study was to initiate sustainable collaboration with traditional healers in managing HIV/AIDS. Consultative meetings with leaders of traditional healers' associations and government officials were held, followed by surveys at respective traditional healers' "vilinge" (traditional clinics). The findings showed that influential people and leaders of traditional healers' association appeared to be gatekeepers to access potential good healers in the two study areas. After consultative meetings these leaders showed to be willing to collaborate; and opened doors to other traditional healers, who too were willing to collaborate with the Institute of Traditional Medicine in managing HIV/AIDS patients. Seventy five percent of traditional healers who claimed to be treating HIV/AIDS knew some HIV/AIDS symptoms; and some traditional healers attempted to manage these symptoms. Even though, they were willing to collaborate with the Institute of Traditional Medicine there were nevertheless some reservations based on questions surrounding sharing from collaboration. The reality of past experiences of mistreatment of traditional healers in the colonial period informed these reservations. General findings suggest that initiating collaboration is not as easy as it appears to be from the literature, if it is to be meaningful; and thus we are calling for appropriate strategies to access potential healers targeted for any study designed with sustainability in mind.
Country
Tanzania
Publisher
BioMed Central
Theme area
Human resources for health
Title of publication The health workforce in Africa: Challenges and prospects
Date of publication
2006 September
Publication type
Document
Publication details
Human Resources for Health and Development pp i-120
Publication status
Language
English
Keywords
health workers, shortages, training, donors, HR planning, information systems, Africa
Abstract
The availability of health workers is severely limited in terms of numbers, skills and distribution as a consequence of the constraints of the economic environment. Poor HR planning and information systems contribute significantly to the health crisis. The performance of health workers is hampered by curricula that produces well-qualified cadres but creates skills and competencies that may not always reflect Africa’s priority health problems. The coyness of donors to invest in retention and motivation of workers has almost conditioned governments’ proposals for funding to routinely avoid human resources issues except those for programme specific in-service training. Sustained development of the health sector in Africa requires coordinated government and donor action to improve the supply and retention of human resources through investments into incentives and welfare. A range of policy options is available to respond to the challenges facing the continent. These policy options should be taken up and supported by the main regional and international partners as well
as by stakeholders within countries. Capacity limitations in Africa will mean a lot of support will be required from regional organisations and inter-country resources and expertise.
Country
East and southern Africa region
Publisher
Joint Learning Initiative
Theme area
Equitable health services, Equity and HIV/AIDS
Title of publication Routine offering of HIV testing to hospitalized pediatric patients at University Teaching Hospital, Lusaka, Zambia: Acceptability and feasibility
Date of publication
2009 June
Publication type
Journal Article
Publication details
Journal of Acquired Immune Deficiency Syndrome 51 2 pp 202-208
Publication status
Published
Language
English
Keywords
HIV, AIDS, child health, HIV testing, Zambia
Abstract
The difficulties diagnosing infants and children with HIV infection have been cited as barriers to increasing the number of children receiving antiretroviral therapy worldwide. Design: We implemented routine HIV antibody counselling and testing for paediatric patients hospitalised at the University Teaching Hospital, a national reference centre, in Lusaka, Zambia. We also introduced HIV DNA polymerase chain reaction (PCR) testing for early infant diagnosis. Caregivers/parents of children admitted to the hospital wards were routinely offered HIV counselling and testing for their children. HIV antibody positive (HIV+) children <18 months of age were tested with PCR for HIV DNA. From January 1, 2006, to June 30, 2007, among 15,670 children with unknown HIV status, 13,239 (84.5%) received counselling and 11,571 (87.4%) of those counselled were tested. Overall, 3373 (29.2%) of those tested were seropositive. Seropositivity was associated with younger age: 69.6% of those testing HIV antibody positive were <18 months of age. The proportion of counselled children who were tested increased each quarter from 76.0% in January to March 2006 to 88.2% in April to June 2007. From April 2006 to June 2007, 1276 PCR tests were done; 806 (63.2%) were positive. The rate of PCR positivity increased with age from 22% in children <6 weeks of age to 61% at 3-6 months and to 85% at 12-18 months. Routine counselling and antibody testing of paediatric inpatients can identify large numbers of HIV-seropositive children in high prevalence settings. The high rate of HIV infection in hospitalised infants and young children also underscores the urgent need for early infant diagnostic capacity in high prevalence settings.
Country
Zambia
Publisher
MedScape
Theme area
Equitable health services, Equity and HIV/AIDS
Title of publication Reducing vertical HIV transmission in Kinshasa, Democratic Republic of Congo: Trends in HIV prevalence and service delivery
Date of publication
2009
Publication type
Journal Article
Publication details
Journal of AIDS Care 21 5 pp 583-590
Publication status
Published
Language
English
Keywords
HIV, AIDS, vertical transmission, ante-natal care, Democratic Republic of Congo
Abstract
Scale-up of vertical HIV transmission prevention has been too slow in sub-Saharan Africa. This paper describes approaches, challenges, and results obtained in Kinshasa. Staff members of 21 clinics managed by public servants or non-governmental organizations were trained in improved basic antenatal care (ANC) including nevirapine (NVP)-based HIV transmission prevention. Programme initiation was supported on-site logistically and technically. Aggregate implementation data were collected and used for programme monitoring. Contextual information was obtained through a survey. Among 45,262 women seeking ANC from June 2003 through July 2005, 90% accepted testing; 792 (1.9%) had HIV of whom 599 (76%) returned for their result. Among 414 HIV+ women who delivered in participating maternities, NVP coverage was 79%; 92% of newborns received NVP. Differences were noted by clinic management in programme implementation and HIV prevalence (1.2 to 3.0%). Initiating vertical HIV transmission prevention embedded in improved antenatal services in a fragile, fragmented, severely resource-deprived health care system was possible and improved over time. Scope and quality of service coverage should further increase, and strategies to decrease loss to follow-up of HIV+ women should be identified to improve programme effectiveness. The observed differences in HIV prevalence highlight the importance of selecting representative sentinel surveillance centres.
Country
Congo Democratic Republic
Publisher
Informaworld
Theme area
Equitable health services
Title of publication Apocalypse or redemption? Responding to extensively drug-resistant tuberculosis
Date of publication
2008 June
Publication type
Journal Article
Publication details
World Health Organization Bulletin 87 pp 481-483
Publication status
Published
Language
English
Keywords
Extensively drug-resistant tuberculosis, XDR-TB, drug resistance, tuberculosis, TB, research, HIV/AIDS, HIV, AIDS
Abstract
The World Health Organization (WHO) has launched an eight-point plan to respond to extensively drug-resistant tuberculosis (XDR-TB): strengthen the quality of basic TB and HIV/AIDS control; scale up programmatic management of multi-drug-resistant TB (MDR-TB) and XDR-TB; strengthen laboratory services; expand MDR-TB and XDR-TB surveillance; develop and implement infection control measures; strengthen advocacy, communication and social mobilisation; pursue resource mobilisation at all levels; and promote research and development of new tools. Additional considerations included: conducting adherence research; building the evidence-base for infection control practices; supporting communities affected by TB; enhancing public health response, while addressing the social determinants of health; embracing palliative care; and advocacy for research.
Country
Switzerland
Publisher
World Health Organization
Theme area
Health equity in economic and trade policies
Title of publication Negotiation of a free trade agreement: European Union-India: Will India accept TRIPS-Plus protection?
Date of publication
2009 June
Publication type
Academic paper
Publication details
Publication status
Published
Language
English
Keywords
Trade, European Union, EU, World Trade Organization, WTO, TRIPS, India, generics, generic medicines, patents
Abstract
India’s status as a top world supplier of generic medicines could be threatened by a free trade agreement its government is negotiating with the European Union (EU), according to this study. A draft of the proposed agreement put forward by EU officials recommends that it should incorporate a wide range of intellectual property issues. But at least two of the provisions in the draft could hamper access to affordable medicines for developing countries. One provision could require India to forbid the manufacture of generic versions of patented drugs for up to five years after the patents in question expire. Another provision would offer protection to test data submitted for the approval of branded medicines for a certain length of time (the precise duration has not yet been specified by EU officials). In effect, this would bar makers of generic drugs from using that data. The study notes that the EU recommendations go beyond the scope of the World Trade Organisation’s Trade-Related Aspects of Intellectual Property Rights (TRIPS) agreement.
Country
Germany
Publisher
Oxfam Germany
Theme area
Values, policies and rights
Title of publication The impact of conflict on women’s education, employment and health care
Date of publication
2009
Publication type
Academic paper
Publication details
Publication status
Published
Language
English
Keywords
Conflict, rights, women’s rights, women’s health, values, discrimination, disability, pregnancy
Abstract
This paper suggests that the extent to which conflict restricts women’s freedom of movement depends on a number of factors, including the stage of conflict, whether the women are displaced, whether they are directly or indirectly affected by the conflict and the cultural norms of the conflict-affected area. In times of political, economic and social uncertainty, there is a strong tendency to revert to traditional values, which appear to offer protection for women and girls, but which restrict their mobility. Some of the negative impacts of conflict on women‘s health and education include: lowered access to reproductive health care facilities; lack of access to education because of conflict, household and domestic tasks or cultural norms and higher teenage pregnancy rates. Girls who are disabled, disfigured or severely mentally affected by the crisis are also likely to be kept at home.
Country
United Kingdom
Publisher
Governance and Social Development Resource Centre
Theme area
Values, policies and rights
Title of publication Sexual violence and its health consequences for female children in Swaziland: A cluster survey study
Date of publication
2009 June
Publication type
Journal Article
Publication details
The Lancet 373 9679 pp 1966-1972
Publication status
Published
Language
English
Keywords
Sexual violence, children, Swaziland, girls, rape, sexual health, pregnancy, reproductive health, sexually transmitted infections, STIs, rights
Abstract
This study reports on the prevalence and circumstances of sexual violence in girls in Swaziland, and assesses the negative health consequences. It obtained data from a nationally representative sample of 1,244 girls and women aged 13–24 years from selected households in Swaziland between, with a two-stage cluster design. It found that 33.2% of respondents reported an incident of sexual violence before they reached 18 years of age, mostly by men or boys from the neighbourhood and boyfriends or husbands. Sexual violence was associated with reported lifetime experience of sexually transmitted diseases, pregnancy complications or miscarriages, unwanted pregnancy and depression. Knowledge of the high prevalence of sexual violence against girls in Swaziland and its associated serious health-related conditions and behaviours should be used to develop effective HIV and sexually transmitted diseases prevention strategies.
Country
United Kingdom
Publisher
The Lancet
Theme area
Values, policies and rights
Title of publication Does ratification of human-rights treaties have effects on population health?
Date of publication
2009 June
Publication type
Journal Article
Publication details
The Lancet 373 9679 pp 1987-1992
Publication status
Published
Language
English
Keywords
Human rights, treaties, rights, right to health, accountability, social indicators
Abstract
This paper assesses whether ratification of human-rights treaties is associated with improved health and social indicators. Data for health (including HIV prevalence, and maternal, infant, and child [<5 years] mortalities) and social indicators (child labour, human development index, sex gap, and corruption index), gathered from 170 countries, showed no consistent associations between ratification of human-rights treaties and health or social outcomes. Established market economy states had consistently improved health compared with less-wealthy settings, but this was not associated with treaty ratification. The paper suggests more stringent requirements for ratification of treaties, improved accountability mechanisms to monitor compliance of states and financial assistance to support the realisation of the right to health.
Country
United Kingdom
Publisher
The Lancet
Theme area
Equity in health
Title of publication World Health Statistics 2009
Date of publication
2009 May
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
Millennium Development Goals, MDGs, maternal health, health systems, pandemics, child mortality
Abstract
Deaths of children aged under five years old have dropped by 27% globally since 1990, according to the latest World Health Organization (WHO) estimates. But, in WHO’s first progress report on the health-related Millennium Development Goals, released in the World Health Statistics 2009, other results are mixed. Areas where there has been little or no movement are notably maternal and newborn health. In many African countries – and in low-income countries generally – progress has been insufficient to reach the Millennium Development Goal target that aims for a two-thirds reduction in child mortality by the year 2015. ‘While data is patchy and incomplete, it appears that the regions with the least progress are those where levels of maternal mortality are the highest. The challenges ahead are those presented by weak health systems, those associated with noncommunicable chronic conditions and emerging health threats such as pandemics and climate change,’ said WHO.
Country
Switzerland
Publisher
World Health Organization
Theme area
Equity in health
Title of publication Managing the health effects of climate change
Date of publication
2009 May
Publication type
Journal Article
Publication details
The Lancet 373 9676 pp 1693-1733
Publication status
Published
Language
English
Keywords
Climate change, global warming, global health, disease
Abstract
Effects of climate change on health will affect most populations in the next decades and put the lives and wellbeing of billions of people at increased risk. During this century, earth's average surface temperature rises are likely to exceed the safe threshold of 2°C above preindustrial average temperature. Rises will be greater at higher latitudes, with medium-risk scenarios predicting 2–3°C rises by 2090 and 4–5°C rises in northern Canada, Greenland, and Siberia. This report outlines the major threats – both direct and indirect – to global health from climate change through changing patterns of disease, water and food insecurity, vulnerable shelter and human settlements, extreme climatic events, and population growth and migration.
Country
United Kingdom
Publisher
The Lancet
Theme area
Equity in health
Title of publication Making sense of the Millennium Development Goals: Addressing inequality to achieving the Millennium Development Goals
Date of publication
2008
Publication type
Journal Article
Publication details
Development 51 pp 220-227
Publication status
Published
Language
English
Keywords
Millennium Development Goals, MDGs, development, economics
Abstract
Several misunderstandings have arisen about the Millennium Development Goals (MDGs). The biggest is that every country must achieve the same numerical targets (for example, halve poverty by 2015), which is incorrect because global performance is an average of all countries’ performance, so some countries will perform above and below average in order to achieve them. A one-size-fits-all approach will not work, as different countries have followed different approaches and strategies for achieving social and economic progress, with varying costs. Unless disparities within countries are addressed, the MDGs will not be met by 2015. To formulate a homegrown MDG-based national development strategy to address inequality and to achieve the MDGs, the author proposes four practical steps: tailor the global targets to make them context-sensitive, set intermediate targets for political accountability, translate targets into specific programmes and policies, and cost programmatic and policy interventions.
Country
Kenya
Publisher
Society For International Development
Theme area
Equity in health, Values, policies and rights, Health equity in economic and trade policies, Equitable health services, Human resources for health, Resource allocation and health financing, Equity and HIV/AIDS, Governance and participation in health, Monitoring equity and research to policy
Title of publication Conference report: Third EQUINET Regional Conference on Equity in Health in East and Southern Africa Conference Report: 'Reclaiming the Resources for Health Building Universal People Centred Health Systems in East and Southern Africa
Date of publication
2009 December
Publication type
Conference Proceedings
Publication details
Third EQUINET Regional Conference on Equity in Health in East and Southern Africa Conference Report: 'Reclaiming the Resources for Health Building Universal People Centred Health Systems in East and Southern Africa' Munyonyo, Uganda September 23-25, 2009 Conference Report Mu
Publication status
Published
Language
Keywords
Abstract
The third EQUINET regional conference was held in September 2009 and brought together parliamentarians,
professionals, civil society members, policy makers, state officials, health workers and international agency personnel. It provided an opportunity to exchange across areas of work on different dimensions of health equity in east and southern
Africa. The conference was held at Speke Conference Centre, Munyonyo, Kampala, Uganda September 23rd–25th 2009. The EQUINET steering committee was the conference Scientific Committee, and it was organised by Training and
Research Support Centre (TARSC), working in cooperation with a local organising committee involving HEPS Uganda, Makerere University and Ministry of Health Uganda. It was
supported by institutional participants from the region and by SIDA (Sweden), IDRC (Canada), Cordaid, Kellogg, and APHRC. The conference theme, ‘Reclaiming the Resources for Health: Building Universal People Centred Health Systems in East and Southern Africa’ was chosen to share experience
and evidence on alternatives through which:
• poor people claim a fairer share of national
resources to improve their health;
• a larger share of global and national resources
are invested in redistributive health systems,
to overcome the impoverishing effects of ill
health; and
• countries in east and southern Africa (ESA)
claim and obtain a more just return from the
global economy, to increase the resources for
health.
The report follows the abstract book, also available on the EQUINET website, and provides the proceedings of the conference.
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Reports
Theme area
Governance and participation in health
Title of publication Using maps for advocacy: A manual
Date of publication
2009
Publication type
Publication details
Publication status
Published
Language
English
Keywords
Advocacy, maps, communication, non-governmental organisations, NGOs, internet, online advocacy
Abstract
This booklet is an effective guide to using maps in advocacy. The mapping process for advocacy is explained vividly through case studies, descriptions of procedures and methods, a review of data sources and a glossary of mapping terminology. Scattered through the booklet are links to websites that afford a glance at a few prolific mapping efforts. Hosting a map on your website can now become a reality as the guide takes you through the specifics of the process. Examples of valuable data sources, like youtube, facebook, flickr and socialight, have been cited, along with a brief outline of their mapping features. The fold-out offers an illustrative sketch of the inside story, while the fold-in explains a swift and easy method to create a map. The purpose of the booklet is to enable advocacy groups explore the potential of maps to effectively send out their message.
Country
Publisher
Tactical Technology Collective
Theme area
Governance and participation in health
Title of publication Quick ‘n easy guide to online advocacy
Date of publication
2009
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
Advocacy, communications, communication, non-governmental organisations, NGOs, information design, business communication, internet, online advocacy
Abstract
This guide presents advocates with a collection of popular online services that can be used for advocacy quickly with little to no technical support. There are services for publishing photographs and video, for setting up a campaign blog or for using mobiles to communicate in a group. An amazing amount of functionality and tools are available simply by connecting to the internet and opening up a web browser. You don't need to have a lot of technical expertise to try some of these. You also don't need much money, as these services are offered at low or no cost. They require a broadband connection and are not recommended for dial-up connections. Advocates can easily and quickly connect, gather information and distribute powerful messages by utilising these services, while the majority of technology is out of sight. This guide presents use of these services from a Northern perspective, though it has tried to present alternative services popular in different regions and languages.
Country
Publisher
Tactical Technology Collective
Theme area
Governance and participation in health
Title of publication Message-in-a-box: Media toolkit for non-governmental organisations
Date of publication
2009
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
Multimedia, media, journalism, non-governmental organisations, NGOs
Abstract
Do you want to use multimedia, online or offline tools to advance your cause creatively and effectively? Would you like to reach the broadest possible audience? Do you want to create and distribute audio programmes, comic books, posters and newsletters? What about setting up a website or a blog to champion your issue? Message-in-a-Box can be used as a resource for any citizen-based journalism work. Combining tools and the tactics to use them is a great way to put technology in context. Tools are only effective if they are matched with effective planning and good strategies and when they are matched with skills and resources. Message-in-a-Box delivers information on doing all this.
Country
Publisher
Tactical Technology Collective
Theme area
Governance and participation in health
Title of publication Visualizing information for advocacy: An introduction to information design
Date of publication
2009
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
Advocacy, communications, communication, non-governmental organisations, NGOs, information design, business communication
Abstract
This manual is aimed at helping non-governmental organisations (NGOs) and advocates strengthen their campaigns and projects through communicating vital information with greater impact. This project aims to raise awareness, introduce concepts, and promote good practice in information design – a powerful tool for advocacy, outreach, research, organisation and education. Effective communcation is essential for any organisation to operate properly, and the guide covers all aspects of business communication. It is part of a programme of work by Tactical Technology Collective to promote research, development and design in the public interest.
Country
Publisher
Tactical Technology Collective
Theme area
Monitoring equity and research to policy
Title of publication The feasibility of determining the impact of primary health care research projects using the Payback Framework
Date of publication
2009 May
Publication type
Journal Article
Publication details
Health Research Policy and Systems 7 11
Publication status
Published
Language
English
Keywords
Monitoring equity, primary health care, PHC, Payback Framework, Buxton and Hanney Payback Framework
Abstract
This project explored the feasibility of using the Buxton and Hanney Payback Framework to determine the impact of a stratified random sample of competitively funded, primary health care research projects. The project conducted telephone interviews based on the Payback Framework with leaders of the research teams and nominated users of their research, used bibliometric methods for assessing impact through publication outputs and obtained documentary evidence of impact where possible. The framework provided rich information about the pathways to impact, better understanding of which may enhance impact. It is feasible to use the Buxton and Hanney Payback framework and logic model to determine the proximal impacts of primary health care research.
Country
United Kingdom
Publisher
BioMed Central
Theme area
Monitoring equity and research to policy
Title of publication Knowledge to policy: Making the most of development research
Date of publication
2009
Publication type
Book
Publication details
Publication status
Published
Language
English
Keywords
Research, research policy, policy, International Development Research Centre, IDRC, monitoring equity
Abstract
Does research influence public policy and decision-making and, if so, how? This book is the most recent to address this question, investigating the effects of research in the field of international development. It starts from a sophisticated understanding about how research influences public policy and decision-making. It shows how research can contribute to better governance in at least three ways: by encouraging open inquiry and debate, by empowering people with the knowledge to hold governments accountable, and by enlarging the array of policy options and solutions available to the policy process. Knowledge to Policy examines the consequences of 23 research projects funded by Canada’s International Development Research Centre. Key findings and case studies from Asia, Africa, and Latin America are presented in a reader-friendly, journalistic style, giving the reader a deeper grasp and understanding of approaches, contexts, relationships and events.
Country
Canada
Publisher
International Development Research Centre (IDRC)
Theme area
Governance and participation in health
Title of publication Grand challenges in global health governance
Date of publication
2009 April
Publication type
Journal Article
Publication details
British Medical Bulletin 90 1 pp 7-18
Publication status
Published
Language
English
Keywords
Governance, participation, research, development, policy
Abstract
This review identifies an agenda for global health by highlighting the current 'grand challenges' related to governance. Sources included literature from the disciplines of health policy and medicine, conference presentations and documents, and materials from international agencies (such as the World Health Organization). The present approach to global health governance has proven to be inadequate and major changes are necessary. There are a number of areas of controversy. The source of problems behind the current global health governance challenges have not always been agreed upon, but this paper attempts to highlight the recurrent themes and topics of consensus that have emerged in recent years. Growing points and areas timely for developing research are identified. A solution to the 'grand challenges' in global health governance is urgently needed to serve as an area for developing research.
Country
United Kingdom
Publisher
Oxford Journals
Theme area
Governance and participation in health
Title of publication Bridging the divide: Global governance of trade and health
Date of publication
2009 January
Publication type
Journal Article
Publication details
The Lancet 373 9661 pp 416-422
Publication status
Published
Language
English
Keywords
Governance, participation, trade, World Health Organization, WHO, World Trade Organization, WTO, capacity
Abstract
The main institutions responsible for governing international trade and health – the World Trade Organization (WTO), which replaced the General Agreement on Tariffs and Trade (GATT) in 1995, and the World Health Organization (WHO) – were established after World War 2. For many decades the two institutions operated in isolation, with little cooperation between them. The growth and expansion of world trade over the past half century amid economic globalisation and the increased importance of health issues to the functioning of a more interconnected world, brings the two domains closer together on a broad range of issues. Foremost is the capacity of each to govern their respective domains, and their ability to cooperate in tackling issues that lie at the intersection of trade and health. This paper discusses how the governance of these two areas relate to one another, and how well existing institutions work together.
Country
United Kingdom
Publisher
The Lancet
Theme area
Human resources for health, Equity and HIV/AIDS
Title of publication Surgeons and HIV: South African attitudes
Date of publication
2009 February
Publication type
Journal Article
Publication details
South African Medical Journal 99 2 pp 110-113
Publication status
Published
Language
English
Keywords
HIV/AIDS, HIV, AIDS, human resources, surgeons, doctors, discrimination, policy
Abstract
The HIV status of surgeons, in the context of the informed consent obtained from their patients, is a contentious matter. This study surveyed the views of practising surgeons in South Africa regarding aspects of HIV and its impact on surgeons. A cross-sectional survey was conducted with surgeons who were members of the Association of Surgeons of South Africa to find out their attitudes to the preceding issues. The salient findings included the view that a patient-centred approach requiring HIV status disclosure to patients would be discriminatory to surgeons and provide no clear benefit to patients, and that HIV-positive surgeons should determine their own scope of practice. Patient-centred approaches and restrictive policies do not accord with clinicians’ sentiments. In the absence of comparable local or international data, this study provides clinicians' views with implications for the development of locally relevant policies and guidelines.
Country
South Africa
Publisher
African Journals Online
Theme area
Resource allocation and health financing
Title of publication Public healthcare financing
Date of publication
2009 October
Publication type
Report
Publication details
African Labour Radio Project
Publication status
Published
Language
English
Keywords
Abuja; health financing; tax funding; health insurance; public health care; Malawi; Zimbabwe; Nigeria; Ghana; South Africa
Abstract
The fifteen minute pre-recorded show, ‘Public healthcare financing’, was produced by WWMP, in conjunction with labour journalists in east and southern Africa. The show examined the lack of public health care financing in Africa in the context of health worker shortages, poor working conditions for health workers, provision of medicine for tuberculosis and AIDS, and poor access to care for patients (long queues, poor facilities, lack of equipment etc), as well as the impact of the current global economic crisis and neo-liberal government policies. The show discussed the purpose of the Abuja 15% target agreed by African heads of state, and discussed financing mechanisms (tax funding and health insurance) appropriate to funding public health care. Content for the show was provided by EQUINET in terms of questions to be asked and suitable candidates for interview, as well as by drawing on WWMP’s labour networks in Africa to secure additional interviews. The pre-recorded 15 minute slot had voices from South Africa, Malawi, Zimbabwe, Nigeria and Ghana. Guests included:
• Di McIntyre for EQUINET/ Health Economics Unit, University of Cape Town
• Barbara Ruiters, a South African health worker
• Lydia Cairncross, surgeon at Groote Schuur Hospital
• Harriet Kapyepye, National Organisation of Nurses and Midwives in Malawi
• Mark Haywood, South African National AIDS Council
• Bongani Lose, Democratic Nursing Organisation of South Africa (DENOSA)
• Nyasha Muchichwa, Labour and Economic Development Research Institute of Zimbabwe
• Mavis Mpangele, a South African health worker
• Role Ordija, the Nigerian Labour Congress
• Kwabena Otoo, Ghana Trade Union Congress
• Percy Moleke, Office of the Presidency, South Africa.
Country
East and southern Africa region
Publisher
SABC
URL:
Equinet Publication Type
Briefs
Theme area
Equity and HIV/AIDS
Title of publication HIV/AIDS, conflict and security in Africa: Rethinking relationships
Date of publication
2008
Publication type
Journal Article
Publication details
World Hospital Health Services 44 4 pp 36-41
Publication status
Published
Language
English
Keywords
HIV/AIDS, HIV, AIDS, conflict, security, military
Abstract
Conflict has long been assumed to contribute significantly to the spread of HIV infection. However, new research is casting doubt on this assumption. Studies from Africa suggest that conflict does not necessarily predispose to HIV transmission and indeed, there is evidence to suggest that recovery in the ‘post-conflict’ state is potentially dangerous from the standpoint of HIV transmission. There has also been concern that high rates of HIV infection among many of the militaries of sub-Saharan Africa poses a threat to regional security. However, data is lacking on this. These issues are of vital importance for HIV programming and health sector development in conflict and ‘post-conflict’ societies and will constitute formidable challenges to the international community. Further research is required to better inform the discussion of HIV, conflict and security in sub-Saharan Africa.
Country
United Kingdom
Publisher
BioMed Central
Theme area
Equity and HIV/AIDS
Title of publication HIV/AIDS knowledge, attitudes, beliefs and behaviours among rural South African youth: Implications for health education
Date of publication
2008
Publication type
Journal Article
Publication details
African Journal of AIDS Research 8 1 pp 28-32
Publication status
Published
Language
English
Keywords
HIV, AIDS, condoms, safe sex, sexual health, South Africa
Abstract
The aim of the study was to evaluate data on behavioural indicators in relation to HIV prevention and occurrence in a rural youth population in South Africa. A representative community sample of youth using a three-stage cluster sampling method was chosen for a household survey, and qualitative data were obtained from the youths using ten focus group discussions. Results indicated a moderately adequate knowledge of HIV. HIV and AIDS knowledge was associated with more consistent condom use, and with a more supportive attitude towards persons with HIV or AIDS. Among female youth, 15.2% reported to have become victims of forceful sex during the last 12 months. For youth the major reasons for not using a condom with a non-commercial partner were 'not available', followed by 'did not like them', 'did not think of it', 'other' (mainly trust in partner), and 'partner objected'.
Country
South Africa
Publisher
African Journals Online
Theme area
Equity and HIV/AIDS
Title of publication Disclosure of HIV status: Experiences of patients enrolled in an integrated TB and HAART pilot programme in South Africa
Date of publication
2009
Publication type
Journal Article
Publication details
African Journal of AIDS Research 8 1 pp 1-6
Publication status
Published
Language
English
Keywords
HIV, AIDS, tuberculosis, highly active antiretroviral therapy, South Africa
Abstract
This study presents the experiences of a cohort of 17 patients enrolled in the first integrated TB and HIV treatment pilot programme, in Durban, South Africa, as a precursor to a pivotal trial to answer the question of when to start antiretroviral treatment (ART) in patients co-infected with HIV and TB. Individual interviews, focus group discussions, and observations were used to understand patients’ experiences with integrated TB and HIV treatment. The patients described incorporating highly active antiretroviral therapy (HAART) into their daily routine as ‘easy’; however, they experienced difficulties with disclosing their HIV status. Being on TB treatment created a safe space for all patients to conceal their HIV status from those to whom they did not wish to disclose. Directly observed therapy for TB may have the added benefit of creating a safe space for introducing ART to patients who are not ready to disclose their HIV+ status.
Country
South Africa
Publisher
African Journals Online
Theme area
Equity and HIV/AIDS
Title of publication Conceptions of mental health among Ugandan youth orphaned by AIDS
Date of publication
2009
Publication type
Journal Article
Publication details
African Journal of AIDS Research 8 1 pp 7-16
Publication status
Published
Language
English
Keywords
AIDS orphans, mental health, AIDS, Uganda
Abstract
A qualitative study was conducted to comprehensively describe the experience of orphanhood and its impact on mental health from the culturally specific perspective of Ugandan youths. The researchers conducted interviews with a purposeful sample of 13 youths (ages 12 to 18) who had lost one or both parents to AIDS illness and who were supported by a non-governmental organisation. The orphaned youths experienced significant ongoing emotional difficulties following the death of their parent(s). The youths in this study were unfamiliar with the term ‘mental health’; however, they easily identified factors associated with good or poor mental health. The findings of this study suggest that Western terminologies and symptom constellations in the Diagnostic and Statistical Manual IV may not be applicable in an African cultural context.
Country
Uganda
Publisher
African Journals Online
Theme area
Resource allocation and health financing
Title of publication The household costs of health care in rural South Africa with free public primary care and hospital exemptions for the poor
Date of publication
2009 April
Publication type
Journal Article
Publication details
Tropical Medicine and International Health 14 4 pp 458-467
Publication status
Published
Language
English
Keywords
Rural health, poverty, primary health care, free health services, South Africa
Abstract
The objective of this study was to measure the direct cost burdens (health care expenditure as a percentage of total household expenditure) for households in rural South Africa, and examine the expenditure and use patterns driving those burdens in a setting with free public primary health care and hospital exemptions for the poor. Data was drawn from a cross-sectional survey of 280 households. The low overall mean cost burden of 4.5% suggests that free primary care and hospital exemptions provided financial protection. However, transport costs, the difficulty of obtaining hospital exemptions, use of private providers, and complex treatment patterns undermined this. The significant non-use of care shows the need for other measures such as more outreach services and more exemptions in rural areas. Fee removal anywhere must be accompanied by wider measures to ensure improved access.
Country
South Africa
Publisher
Wiley Publishing
Theme area
Resource allocation and health financing
Title of publication Reducing user fees for primary health care in Kenya: Policy on paper or policy in practice?
Date of publication
2009 May
Publication type
Journal Article
Publication details
International Journal for Equity in Health 8 15
Publication status
Published
Language
English
Keywords
User fees, primary health care, policy, poverty, Kenya
Abstract
Whether or not the positive impacts of user fees removal policies are sustained has hardly been explored. This study documents the extent to which primary health care facilities in Kenya continue to adhere to a 'new' charging policy three years after its implementation. Data was collected in two districts, Kwale and Makueni, and focus group discussions and patient exit interviews were conducted. Adherence to the policy was poor in both districts, and drug shortages, declining revenue, poor policy design and implementation processes were the main reasons given for poor adherence to the policy. In conclusion, reducing user fees in primary health care in Kenya is a policy on paper that is yet to be implemented fully. Caution must be taken when deciding on how to reduce or abolish user fees and all potential consequences should be carefully considered.
Country
Kenya
Publisher
BioMed Central
Theme area
Public-private mix
Title of publication Improving effectiveness and outcomes for the poor in health, nutrition and population
Date of publication
2009
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
Private sector, privatisation, World Bank, nutrition, poverty, health systems
Abstract
The World Bank Group’s support for health, nutrition, and population (HNP) has been sustained since 1997, totalling US$17 billion in country-level support by the World Bank and US$873 million in private health and pharmaceutical investments by the International Finance Corporation (IFC) through mid-2008. This report evaluates the efficacy of the Bank Group’s direct support for HNP to developing countries since 1997 and draws lessons to help improve the effectiveness of this support. It presents findings that the Bank Group now funds a smaller share of global support for health, nutrition, and population than it did a decade ago, but its support remains significant. About two-thirds of the Bank’s HNP projects show satisfactory outcomes, but a third do not. The accountability of Bank Group investments for demonstrating results for the poor has been weak. Although the Bank Group has an important role in helping countries to improve the efficiency of health systems and the potential for improving HNP outcomes through actions by non-health sectors is great, incentives to deliver them are weak. Adding HNP objectives to Bank projects in other sectors, such as water supply and sanitation, raises the incentive to deliver health benefits. For the Bank Group to achieve its objectives of improving health sector performance and HNP outcomes among the poor, the report indicates that it needs to act in five areas: intensify efforts to improve the performance of the World Bank portfolio; renew the commitment to delivering results for the poor, including greater attention to reducing high fertility and malnutrition; build its own capacity to help countries to make health systems more efficient; enhance the contribution of other sectors to HNP outcomes; and boost evaluation to implement the results agenda and improve governance.
Country
United States
Publisher
World Bank
Theme area
Human resources for health, Equity and HIV/AIDS
Title of publication ‘Conditional scholarships’ for HIV/AIDS health workers: Educating and retaining the workforce to provide antiretroviral treatment in sub-Saharan Africa
Date of publication
2009 February
Publication type
Journal Article
Publication details
Social Sciences Medicine 68 3 pp 544-551
Publication status
Published
Language
English
Keywords
Human resources, anti-retroviral therapy, scholarships, medical students, east and southern Africa
Abstract
Researchers conducted a cost-benefit analysis of a health care education scholarship that is conditional on the recipient committing to work for several years after graduation delivering ART in sub-Saharan Africa. Such a scholarship could address two of the main reasons for the low numbers of health workers in sub-Saharan Africa: low education rates and high emigration rates. Conditional scholarships for a HAHW team sufficient to provide ART for 500 patients have an expected net present value (eNPV) of US$1.24 million per year. The eNPV of the education effect of the scholarships is larger than eNPV of the migration effect. Policy makers should consider implementing ‘conditional scholarships’ for HAHW, especially in countries where health worker education capacity is currently underutilised or needs to be rapidly expanded.
Country
East and southern Africa region
Publisher
Elsevier
Theme area
Human resources for health, Equity and HIV/AIDS
Title of publication Use of task-shifting to rapidly scale-up HIV treatment services: Experiences from Lusaka, Zambia
Date of publication
2009 January
Publication type
Journal Article
Publication details
BMC Health Services Research 9 5
Publication status
Published
Language
English
Keywords
Human resources, Zambia, anti-retroviral therapy, task shifting, task-shifting
Abstract
As part of ART services expansion in Lusaka, Zambia, this study implemented a comprehensive task-shifting programme among existing health providers and community-based workers. It provides on-going quality assessment using key indicators of clinical care quality at each site. Programme performance is reviewed with clinic-based staff quarterly. When problems are identified, clinic staff members design and implement specific interventions to address targeted areas. Ongoing quality assessment demonstrated improvement across clinical care quality indicators, despite rapidly growing patient volumes. The task-shifting strategy was designed to address current health care worker needs and to sustain ART scale-up activities. While this approach has been successful so far, long-term solutions to the human resource crisis are urgently needed.
Country
Zambia
Publisher
BioMed Central
Theme area
Human resources for health
Title of publication The health worker shortage in Africa: Are enough physicians and nurses being trained?
Date of publication
2009 March
Publication type
Journal Article
Publication details
Bulletin Of The World Health Organization 87 3 pp 225-230
Publication status
Published
Language
English
Keywords
Human resources, health worker shortage, pre-service training, attrition, migration, east and southern Africa
Abstract
This paper set out to estimate systematically the inflow and outflow of health workers in Africa and examine whether current levels of pre-service training in the region suffice to address this serious problem. Most data came from the 2005 World Health Organization (WHO) health workforce and training institutions' surveys. The study was restricted to 12 countries in sub-Saharan Africa. It found that the health workforce shortage in Africa is even more critical than previously estimated. In 10 of the 12 countries studied, current pre-service training is insufficient to maintain the existing density of health workers once all causes of attrition are taken into account - it would take 36 years for physicians and 29 years for nurses and midwives to reach WHO's recent target of 2.28 professionals per 1,000 population for the countries taken as a whole - and some countries would never reach it.
Country
East and southern Africa region
Publisher
World Health Organization
Theme area
Human resources for health
Title of publication Perceptions towards private medical practitioners' attachments for undergraduate medical students in Malawi
Date of publication
2009
Publication type
Journal Article
Publication details
Malawi Medical Journal 21 1 pp 6-11
Publication status
Published
Language
English
Keywords
Human resources, Malawi, medical students, private sector
Abstract
This study aimed to describe perceptions of medical students, recent medical graduates, faculty of the College of Medicine, University of Malawi and private medical practitioners (PMPs) towards an attachment of undergraduate medical students in private medical doctors' offices. A qualitative cross-sectional study was conducted in Blantyre, Malawi in 2004 using in-depth key informant interviews and content analysis. In general, private medical practitioners were favourable to the idea of having medical students within their consulting offices while the majority of students, recent graduates and faculty opposed, fearing compromising teaching standards. Private medical practitioners (PMPs) were seen as outdated in skills and knowledge. Faculty, medical students and recent graduates of the Malawi College of Medicine do not perceive PMPs as a resource to be tapped for the training of medical students.
Country
Malawi
Publisher
African Journals Online
Theme area
Human resources for health
Title of publication Ritual and the organisation of care in primary care clinics in Cape Town, South Africa
Date of publication
2009 April
Publication type
Journal Article
Publication details
Social Science and Medicine 68 8 pp 1464-1471
Publication status
Published
Language
English
Keywords
primary health care, tuberculosis, power relations, South Africa
Abstract
This paper explores the organisation of health care work in primary care clinics in Cape Town by analysing two elements of clinic organisation as rituals: a formal, policy-driven element of care – directly observed therapy for tuberculosis patients – and an informal ritual – morning prayers in the clinic. Seven clinics providing care to people with tuberculosis were sampled. Findings suggest that, rather than seeing the ritualised aspects of clinic activities as merely traditional elements of care that potentially interfere with the application of good practice, it is essential to understand their symbolic value if their contribution to health care organisation is to be recognised. These rituals embody the conflicting values of patients and staff in these clinics and reinforce asymmetrical relations of power between different constituencies, strengthening conventional modes of provider-patient interaction.
Country
South Africa
Publisher
Elsevier
Theme area
Equitable health services
Title of publication Planning for district mental health services in South Africa: A situational analysis of a rural district site
Date of publication
2009 March
Publication type
Journal Article
Publication details
Health Policy Planning 24 2 pp 140-150
Publication status
Published
Language
English
Keywords
Mental health, health services, rural health, primary health care, South Africa
Abstract
This study sought to assess progress in South Africa with respect to deinstitutionalisation and the integration of mental health into primary health care, with a view to understanding the resource implications of these processes at district level. A situational analysis in one district site, typical of rural areas in South Africa, was conducted, based on qualitative interviews with key stakeholders and the World Health Organization's Assessment Instrument for Mental Health Systems (WHO-AIMS). The decentralisation process remains largely limited to emergency management of psychiatric patients and ongoing psychopharmacological care of patients with stabilised chronic conditions. Similar to other low- to middle-income countries, deinstitutionalisation and comprehensive integrated mental health care in South Africa is hampered by a lack of resources for mental health care within the primary health care resource package, as well as the inefficient use of existing mental health resources.
Country
South Africa
Publisher
Oxford University Press
Theme area
Equitable health services
Title of publication Lessons learned from health sector reform: A four-country comparison
Date of publication
2008
Publication type
Journal Article
Publication details
International Community Health Education 28 2 pp 153-164
Publication status
Published
Language
English
Keywords
Decentralisation, community participation, reform, efficiency, sustainability, Tanzania
Abstract
This article discusses health sector reform experiences of four developing countries, including Tanzania, and identifies the lessons learned. Findings suggest that decentralisation works effectively while implementing primary and secondary health programmes. Decentralisation of power and authority to local authorities requires strengthening and supporting these units. Community participation facilitates recruitment and development of field workers, facility improvement and service delivery. For providing financial protection to the poor, there is a need to review user fees and develop affordable health insurance with an exemption mechanism. There is no uniform health sector reform approach for all countries – policy makers must examine the context and determine the reform measures that constitute the best means in terms of equity, efficiency and sustainability.
Country
Tanzania
Publisher
National Center for Biotechnology Information
Theme area
Equitable health services
Title of publication Impact of the Kenya post-election crisis on clinic attendance and medication adherence for HIV-infected children in Western Kenya
Date of publication
2009 April
Publication type
Journal Article
Publication details
Conflict and Health 3 5
Publication status
Published
Language
English
Keywords
HIV, AIDS, child health, child mortality, Kenya
Abstract
This paper describes the immediate impact of conflict following Kenya’s presidential elections on 27 December 2007 with regard to clinic attendance and medication adherence for HIV-infected children cared for within the USAID-Academic Model Providing Access to Healthcare (AMPATH) in western Kenya. The researchers conducted a mixed methods analysis that included a retrospective cohort analysis, as well as key informant interviews with paediatric healthcare providers. They found that, during this period of humanitarian crisis, the vulnerable, HIV-infected paediatric population had disruptions in clinical care and in medication adherence, putting children at risk for viral resistance and increased morbidity. However, unique programme strengths may have minimised these disruptions.
Country
Kenya
Publisher
National Center for Biotechnology Information
Theme area
Equitable health services
Title of publication How equitable is bed net ownership and utilisation in Tanzania? A practical application of the principles of horizontal and vertical equity
Date of publication
2009 May
Publication type
Journal Article
Publication details
Malaria Journal 8 109
Publication status
Published
Language
English
Keywords
Insecticide-treated nets, malaria, long-lasting insecticidal nets, Tanzania
Abstract
The objective of this paper was to measure the extent and causes of inequalities in the ownership and utilisation of bed nets (ITNs) across socioeconomic groups (SEGs) and age groups in Tanga District, north-eastern Tanzania. A questionnaire was administered to heads of 1,603 households from rural and urban areas and focus group discussions were used to explore community perspectives on the causes of inequalities. Use of ITNs remained appallingly low compared to the RBM target of 80% coverage. The results highlight the need for mass distribution of free ITNs, a community-wide programme to treat all untreated nets and to promote the use of long-lasting insecticidal nets (LLINs) or longer-lasting treatment of nets, targeting the rural population and under-fives.
Country
Tanzania
Publisher
BioMed Central
Theme area
Equitable health services
Title of publication Health care practices influencing health promotion in urban black women in Tshwane, South Africa
Date of publication
2008 September
Publication type
Journal Article
Publication details
Curationis 31 3 pp 36-43
Publication status
Published
Language
English
Keywords
Women's health, health promotion, primary health care, South Africa
Abstract
Understanding urban black women's health care practices will enable health promoters to develop interventions that are successful. The problem investigated here was to gain an understanding of the health care practices of urban black women that could influence health promotion activities. The design was qualitative and exploratory. The sampling method was convenient and purposive, and the sample size was determined by saturation of the data. Data was gathered through semi-structured interviews using six specific themes and the analysed using open coding. The results indicated that the social environment created by the registered nurses in the primary health influenced the health care practices of the women negatively. Practices regarding the seriousness of a health problem suggest a possible reason may exist for late admission of a person with a serious health problem.
Country
South Africa
Publisher
National Center for Biotechnology Information
Theme area
Equitable health services
Title of publication Global health partnerships in practice: Taking stock of the GAVI Alliance's new investment in health systems strengthening
Date of publication
2009
Publication type
Journal Article
Publication details
International Journal of Health Planning Management 24 1 pp 3-25
Publication status
Published
Language
English
Keywords
Global Alliance for Vaccines and Immunisation, GAVI, health systems, health services, global health partnerships, global health, partnerships, governance, maternal health, alliances
Abstract
This paper describes and analyses the Global Alliance for Vaccines and Immunisation’s (GAVI’s) early experience with health systems strengthening (HSS) to improve immunisation coverage and other maternal-child health outcomes. The challenges have been forging a common vision and approach, governance, balancing pressure to move money with incremental learning, managing partner roles and relationships, managing the ‘value for money’ risk, and capacity building. This mid-point stock-taking makes recommendations for moving GAVI forward in a thoughtful manner. The findings should be of interest to other global health partnerships because of their larger significance. This is a story about how a successful alliance that decided to broaden its mandate has responded to the technical, organisational, and political complexities that challenge its traditional business model.
Country
United States
Publisher
Wiley Publishing
Theme area
Equitable health services
Title of publication A basic package of health services for post-conflict countries: Implications for sexual and reproductive health services
Date of publication
2008 May
Publication type
Journal Article
Publication details
Reproductive Health Matters 16 31 pp 57-64
Publication status
Published
Language
English
Keywords
Reproductive health, conflict, post-conflict, health services, essential health services, sexual health
Abstract
Health systems in countries emerging from conflict are often characterised by damaged infrastructure, limited human resources, weak stewardship and a proliferation of non-governmental organisations, which all undermine health services. One response is to improve health service delivery in post-conflict countries by jointly contract non-governmental organisations to provide a Basic Package of Health Services for all the country's population. The approach is novel because it is intended as the only primary care service delivery mechanism throughout the country, with the available financial health resources primarily allocated to it. The aim is to scale up health services rapidly. This paper describes the Basic Package of Health Services contracting approach and discusses some of the potential challenges this approach may have for sexual and reproductive health services, particularly the challenges of availability and quality of services, and advocacy for these services.
Country
Netherlands
Publisher
Elsevier
Theme area
Poverty and health
Title of publication Social determinants of health in very poor ruralities
Date of publication
2009
Publication type
Journal Article
Publication details
Global Health Promotion 16 1 pp 53-56
Publication status
Published
Language
English
Keywords
Poverty, social determinants, socioeconomic status, socio-economic status, East and southern Africa
Abstract
Globally, research on social determinants of health has built a considerable knowledge base over the last decade. Still, not much of this research has been carried out in the extremely poor areas of the world, like for instance Africa south of the Sahara. In very poor ruralities, classic indicators of socioeconomic status are not well suited. Few people have any education, monetary income is not a good measure of material standing and people cannot be classified by occupation as they make their livelihood from a variety of activities. For efforts towards health equity to benefit the poorest of the poor, more suitable indicators of social health determinants must be identified. Health research might benefit from knowledge developed in neighbouring fields like development research, anthropology and sociology.
Country
East and southern Africa region
Publisher
Sage Journals Online
Theme area
Poverty and health
Title of publication Determinants of infant growth in eastern Uganda: A community-based cross-sectional study
Date of publication
2008 December
Publication type
Journal Article
Publication details
BMC Public Health 8
Publication status
Published
Language
English
Keywords
Uganda, poverty, child health
Abstract
The aim of this study was to describe current infant growth patterns using World Health Organization Child Growth Standards and to determine the extent to which these patterns are associated with infant feeding practices, equity dimensions, morbidity and use of primary health care for the infants. A cross-sectional survey of infant feeding practices, socio-economic characteristics and anthropometric measurements was conducted in Mbale District, Eastern Uganda in 2003 with 723 mother-infant pairs. The prevalences of wasting and stunting were 4.2% and 16.7%, respectively. The adjusted analysis for stunting showed associations with age and gender – it was more prevalent among boys than girls (58.7% versus 41.3%). Sub-optimal infant feeding practices after birth, poor household wealth, age, gender and family size were associated with growth among Ugandan infants.
Country
Uganda
Publisher
BioMed Central
Theme area
Poverty and health
Title of publication Characteristics of households experiencing under-five deaths: A case of Tropical Institute of Community Health And Development (TICH) partnership districts
Date of publication
2009 May
Publication type
Journal Article
Publication details
African Journal of Food, Agriculture, Nutrition and Development 9 3 pp 873-884
Publication status
Published
Language
English
Keywords
Child mortality, insecticide-treated nets, malaria, poverty, Kenya
Abstract
In this paper, child mortality and its relationship to specific variables relating to background and proximate factors were considered. Between 2006 and 2007, proportions of households with child deaths declined in all the districts and the proportions of health facility deliveries decreased in households that experienced under-five deaths. Measles vaccination coverage was lower among households with child deaths and so was use of insecticide-treated nets (ITNs). Households living in poor conditions experienced the highest proportions of child mortality. Education of mothers remains a significant determinant of child mortality along with health facility delivery. No difference in child mortality was realised between mothers having primary education and those that had none. Better health-seeking behaviour should be encouraged to help stem the high child mortality rates.
Country
Kenya
Publisher
Rural Outreach Programme
Theme area
Health equity in economic and trade policies
Title of publication A new debt crisis? Assessing the impact of the financial crisis on developing countries
Date of publication
2009
Publication type
Academic paper
Publication details
Publication status
Published
Language
English
Keywords
Debt, developing countries, developing nations, debt cancellation Jubilee Debt Campaign
Abstract
This paper details the extent of what it sees as a burgeoning ‘debt crisis’. With traditional sources of finance drying up, export markets collapsing and a range of other economic impacts, the threat of a renewed debt crisis is very real. Out of the 43 most vulnerable countries, 38 needed at least some debt cancellation to meet their people’s basic needs. Governments with large debt burdens, which are usually denominated in foreign currencies such as the dollar, may struggle to meet the repayment requirements and even default on their debts. Private capital flows to developing countries could fall to around US$165 billion in 2009. The paper recommends canceling more debts, responsible finance and a debt tribunal. Current debt relief initiatives are inflexible, entirely creditor-controlled and wholly inadequate to meet the challenge of the continuing debt crisis.
Country
United Kingdom
Publisher
Jubilee Debt Campaign
Theme area
Values, policies and rights
Title of publication Polygyny and women's health in sub-Saharan Africa
Date of publication
2009 January
Publication type
Journal Article
Publication details
Social Science And Medicine 68 1 pp 21-29
Publication status
Published
Language
English
Keywords
Polygyny, reproductive health, sexually transmitted infections, mental health, east and southern Africa
Abstract
This paper reviews the literature on the association between polygyny and women's health in sub-Saharan Africa. It argues that polygyny is an example of ‘co-operative conflict’ within households, with likely implications for the vulnerability of polygynous women to illness, and for their access to treatment. Polygyny is associated with an accelerated transmission of sexually transmitted infections, because it permits a multiplication of sexual partners and correlates with low rates of condom use, poor communication between spouses, and age and power imbalances, among other factors. The paper also examines areas that have so far received only cursory attention: mental health and a premature ‘social’ menopause. Although data is scarce, polygyny seems to be associated with higher levels of anxiety and depression. The examples reviewed here should help build a framework for mixed method quality research to inform policy makers better.
Country
East and southern Africa region
Publisher
National Center for Biotechnology Information
Theme area
Equity in health
Title of publication WHA resolution on primary health care, including health systems strengthening
Date of publication
2009 January
Publication type
Conference Proceedings
Publication details
Publication status
Published
Language
English
Keywords
World Health Assembly, WHA, universal access, universal coverage, social justice, participation, primary health care, PHC
Abstract
The 62nd World Health Assembly in May 2009 adopted a resolution strongly reaffirming the values and principles of primary health care, including equity, solidarity, social justice, universal access to services, multisectoral action and community participation as the basis for strengthening health systems. It calls on WHO to reflect the values and principles of the Declaration of Alma-Ata in its work and that the overall organisational efforts across all levels contribute to the renewal of primary health care and to strengthen the Secretariat’s capacities to support this. Full text is found at the website provided.
Country
Switzerland
Publisher
World Health Organization
Theme area
Equity in health
Title of publication Social determinants of health and health inequities in Nakuru, Kenya
Date of publication
2009 May
Publication type
Journal Article
Publication details
International Journal for Equity in Health 8 16
Publication status
Published
Language
English
Keywords
social determinants, health inequities, Kenya
Abstract
This paper examines the health status of residents in a major urban centre in Kenya and reviews the effects of selected social determinants on local health. Through field surveys, focus group discussions and a literature review, this study canvasses past and current initiatives and recommends priority actions. Areas identified that unevenly affect the health of the most vulnerable segments of the population were: water supply, sanitation, solid waste management, food environments, housing, the organisation of health care services and transportation. The use of a participatory method proved to be a useful approach that could benefit other urban centres in their analysis of social determinants of health.
Country
Kenya
Publisher
BioMed Central
Theme area
Monitoring equity and research to policy
Title of publication Evidence in the learning organization
Date of publication
2009 March
Publication type
Journal Article
Publication details
Health Research Policy and Systems 7 4
Publication status
Published
Language
English
Keywords
Research, research policy, evidence-based medicine, learning organisation, Evidence in the Learning Organization, ELO, innovation
Abstract
Three years ago, the Society of General Internal Medicine's Evidence-based Medicine Task Force began an inquiry to integrate evidence-based medicine (EBM) and the learning organization (LO), an approach to training from a systems-based perspective, into one model to address the knowing-doing gap problem. The authors of this study searched several databases for relevant LO frameworks and their related concepts by using a broad search strategy. They found seven LO frameworks particularly relevant to evidence-based practice innovations in organisations. These were integrated to form the new Evidence in the Learning Organization (ELO) model, which can be used by health organisations to identify their capacities to learn and share knowledge about evidence-based practice innovations.
Country
United Kingdom
Publisher
BioMed Central
Theme area
Governance and participation in health
Title of publication African ethics, health care research and community and individual participation
Date of publication
2009
Publication type
Publication details
Journal of Asian and African Studies 44 2 pp 239-253
Publication status
Published
Language
English
Keywords
Governance, participation, HIV/AIDS, HIV, AIDS, ethics, bioethics, informed consent
Abstract
This article discusses the appropriateness of western bioethics in the African setting. It focuses on the decision-making process regarding participation in health research as a contested boundary in international bioethics discourse. An ethnomethodological approach is used to explain African ethics, and African ethic is applied to the decision-making process in the African community. An HIV and AIDS surveillance project is used as a case study to explore the concept of communitarianism. The article argues that what exists in Africa is communal or social autonomy, as opposed to individual autonomy in the West. As a result, applying the western concept of autonomy to research involving human subjects in the African context without adequate consideration for the important role of the community is inappropriate. It concludes that lack of adequate consideration for community participation in health research involving human subjects in Africa will prevent proper management and lack truly informed consent.
Country
Publisher
Sage Journal Online
Theme area
Equity and HIV/AIDS
Title of publication HIV/AIDS education in Tanzania: The experience of at-risk children in poorer communities
Date of publication
2009 March
Publication type
Journal Article
Publication details
Publication status
Published
Language
English
Keywords
HIV/AIDS, HIV, AIDS, condoms, safe sex, young people, youths, teenagers, poverty, Tanzania
Abstract
This study investigated human immunodeficiency virus (HIV) knowledge, attitudes and sexual at-risk behaviours of youths from disadvantaged communities of Dar es Salaam, Tanzania. Participants were 800 youths, aged 12–15 years and from poorer communities. Participants showed low levels of HIV knowledge, little experience with condom use and low intention to use condoms. Contrary to expectations, there were no significant differences between those in school and those out of school. Gender differences were apparent, in that girls scored consistently lower than boys on all variables. HIV and AIDS education within the schools of Tanzania needs to be re-evaluated and better educational strategies developed.
Country
United Kingdom
Publisher
Informaworld
Theme area
Equity and HIV/AIDS
Title of publication Caring for AIDS-orphaned children: A systematic review of studies on caregivers
Date of publication
2009 March
Publication type
Journal Article
Publication details
Vulnerable Children and Youth Studies 4 1 pp 1-12
Publication status
Published
Language
English
Keywords
HIV/AIDS, HIV, AIDS, children, child health, AIDS orphans, orphans, caregivers
Abstract
This article presents the first known systematic review of the research literature on carers of AIDS-orphaned children. Twenty-nine studies of caregivers of AIDS-orphaned children were identified and assessed, mostly in the developing world. Most studies included identifying the individuals who were providing care, assessing the capacity of the extended family to care for AIDS orphans and exploring the process of care placement. Few examined the caregiving experience in any depth, including the challenges of caring for orphans or the effects of caring for these children on the caregivers' health and wellbeing. The article concludes with suggestions for future research to guide policy and programming efforts.
Country
United Kingdom
Publisher
Informaworld
Theme area
Resource allocation and health financing
Title of publication The Fund’s facilities and financing framework for low-income countries
Date of publication
2009
Publication type
Academic paper
Publication details
Publication status
Published
Language
English
Keywords
Health financing, low-income countries, International Monetary Fund, east and southern Africa
Abstract
This paper assesses the adequacy of the International Monetary Fund’s toolkit for low-income countries (LICs), with a view to ensuring that it keeps pace with a changing world, particularly as global economic conditions deteriorate and put pressure on countries. It seeks to answer the following key questions: What are the needs of LICs in relation to Fund financing and how have they changed? How have existing instruments met LIC needs, and are there gaps or overlaps? Could changes to access rules, financing terms, or conditionality help the Fund better support LICs? What is the available concessional resource envelope and how will the changing external environment affect possible financing needs through the medium term? What scope is there to make the concessional financing framework more flexible?
Country
East and southern Africa region
Publisher
International Monetary Fund
Theme area
Human resources for health
Title of publication Migration as a form of workforce attrition: A nine-country study of pharmacists
Date of publication
2009 April
Publication type
Journal Article
Publication details
Human Resources for Health 7 32
Publication status
Published
Language
English
Keywords
Health worker migration, pharmacists, Zimbabwe, retention
Abstract
This paper reports on the first international attempt to investigate the migration intentions of pharmacy students and identify migration factors and their relationships. Nine countries were surveyed, including Zimbabwe. Results showed a significant difference in attitudes towards the professional and sociopolitical environment of the home country and perceptions of opportunities abroad between those who have no intention of migrating and those who intend to migrate on a long-term basis. Given the influence of the country context and environment on migration intentions, research and policy should frame the issue of migration in the context of the wider human resource agenda, thus viewing migration as one form of attrition and a symptom of other root causes. Policy development must take into account both remuneration and professional development to encourage retention.
Country
Zimbabwe
Publisher
BioMed Central
Theme area
Human resources for health
Title of publication Does a code make a difference? Assessing the English Code of Practice on International Recruitment
Date of publication
2009 April
Publication type
Journal Article
Publication details
Human Resources for Health 7 33
Publication status
Published
Language
English
Keywords
Code of Practice, international recruitment, Kenya, health workers
Abstract
The paper examines trends in inflow of health professionals to the United Kingdom from other countries, using professional registration data and data on applications for work permits. Available data show a considerable reduction in inflow of health professionals, from the peak years up to 2002 (for nurses) and 2004 (for doctors). There are multiple causes for this decline, including declining demand in the United Kingdom. Regulatory and education changes in the United Kingdom in recent years have also made international entry more difficult. Two lessons were learnt: comprehensive data is needed for proper monitoring of the impact of a code, and countries with many independent, private-sector health care employers struggle to implement a code. The authors note therefore the significant challenges in implementing and monitoring a global code on the recruitment of health professionals.
Country
Kenya
Publisher
BioMed Central
Theme area
Human resources for health
Title of publication Community health workers for ART in Sub-Saharan Africa: Learning from experience and capitalizing on new opportunities
Date of publication
2009 April
Publication type
Journal Article
Publication details
Publication status
Published
Language
English
Keywords
Community health workers, primary health care, anti-retroviral treatment, east and southern Africa
Abstract
This paper investigates whether present community health worker programmes for antiretroviral treatment are taking into account the lessons learnt from past experiences with community health worker programmes in primary health care and to what extent they are seizing the new antiretroviral treatment-specific opportunities. It is based on a desk review of multi-purpose community health worker programmes for primary health care and of recent experiences with antiretroviral treatment-related community health workers. The renewed attention to community health workers is very welcome, but the scale-up of community health worker programmes runs a high risk of neglecting the necessary quality criteria if it is not aligned with broader health systems strengthening. To achieve universal access to antiretroviral treatment, this is of paramount importance and should receive urgent attention.
Country
East and southern Africa region
Publisher
BioMed Central
Theme area
Human resources for health
Title of publication Are doctors and nurses associated with coverage of essential health services in developing countries? A cross-sectional study
Date of publication
2009 March
Publication type
Journal Article
Publication details
Human Resources for Health 7 27
Publication status
Published
Language
English
Keywords
Human resources, essential health services, immunisation, tuberculosis, antenatal care, east and southern Africa
Abstract
This study examined the relationship between doctor and nurse concentrations and utilisation rates of six essential health services in developing countries: antenatal care, attended delivery, caesarean section, measles immunisation, tuberculosis case diagnosis and care for acute respiratory infection. It found that nurses were associated with high levels of utilisation of skilled birth attendants and doctors were associated with high measles immunisation rates, but neither were associated with the remaining four services. It is plausible that other health workers, such as clinical officers and community health workers, may be providing a substantial proportion of these health services, which means that the human resources for health research agenda must be expanded to include these other workers.
Country
East and southern Africa region
Publisher
BioMed Central
Theme area
Values, policies and rights, Equitable health services
Title of publication Policy characteristics facilitating primary health care in Thailand: A pilot study in a transitional country
Date of publication
2009 March
Publication type
Journal Article
Publication details
International Journal for Equity in Health 8 8
Publication status
Published
Language
English
Keywords
Resources, resource allocation, human resources, primary health care, PHC, policy, co-payment, health financing, poverty
Abstract
This pilot study in Thailand assessed policies about primary health care (PHC), focusing on how equitably resources are distributed, the adequacy of resources, comprehensiveness of services and co-payment. A questionnaire survey was administered to five policymakers, five academicians and 77 primary care practitioners at a PHC workshop. Responses were consistent: financial resources should be allocated based on different health needs and special efforts must be made to assure PHC to underserved populations. The supply of essential drugs should be adequate, as well, with equitable distribution of services and low out-of-pocket payments. The questionnaire was robust across key stakeholders and feasible for use in transitional or less-developed countries, like those in Africa.
Country
United Kingdom
Publisher
BioMed Central
Theme area
Poverty and health, Equitable health services
Title of publication Health facility-based active management of the third stage of labor: Findings from a national survey in Tanzania
Date of publication
2009 April
Publication type
Journal Article
Publication details
Health Research Policy and Systems 7 6
Publication status
Published
Language
English
Keywords
Haemorrhage, pregnancy, childbirth, maternal health, child health, sexual health, AMTSL, health services, women, mothers, poverty
Abstract
Haemorrhage is the leading causes of obstetric mortality. Studies show that active management of third stage of labour (AMTSL) reduces post partum haemorrhage. This study describes the practice of AMTSL and barriers to its effective use in Tanzania. Correct practice of AMTSL was observed in only 7% of 251 deliveries. Knowledge and practice of AMTSL is very low and STGs are not updated on correct AMTSL practice. The drugs for AMTSL are available and stored at the right conditions in nearly all facilities. All providers used ergometrine for AMTSL instead of oxytocin as recommended by ICM/FIGO. The study also observed harmful practices during delivery. These findings indicate that there is need for updating the STGs, curricula and training of health providers on AMTSL and monitoring its practice.
Country
United Kingdom
Publisher
BioMed Central
Theme area
Health equity in economic and trade policies
Title of publication Rebuilding global trade: Proposals for a fairer, more sustainable future
Date of publication
2009
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
Trade, fair trade, economics, World Trade Organization, WTO, governance, developing countries, Doha
Abstract
This compilation consists of short essays from a broad range of experts to provide proposals on immediate trade priorities in the context of the economic crisis and provide a forward-looking agenda for global trade governance. The essays focus special attention on the needs of developing countries and sustainable development considerations. Some conclusions drawn from the compilation include the recommendation to establish a working group of experts to propose World Trade Organization (WTO) reforms. Immediate action should be taken to implement those areas of the Doha Development Agenda where agreement exists. The WTO’s capacity needs to be expanded and a trade-and-development ombudsman should be appointed at the WTO to whom third-party complaints about trade impacts can be brought.
Country
United Kingdom
Publisher
Global Economic Governance Programme (GEG)
Theme area
Governance and participation in health
Title of publication Put people first: Policy platform and recommendations to the United Kingdom's government
Date of publication
2009
Publication type
Academic paper
Publication details
Publication status
Published
Language
English
Keywords
Financing, economics, globalisation, civil society organisations, CSOs, participation, poverty
Abstract
This paper is an unprecedented collaboration between a wide spectrum of civil society organisations in the United Kingdom (UK). These civil society organisations in the UK called on the UK government to initiate an economic system that that seeks to work for people and for the planet. The civil society statement makes recommendations to world leaders to chart a path out of recession in a way that builds an equitable global economy. It prioritises tax reforms to end poverty, accountable and transparent processes for the international finance system and calls for reforms to be implemented through the United Nations in consultation with governments, trade unions and civil society organisations.
Country
United Kingdom
Publisher
Put People First
Theme area
Resource allocation and health financing
Title of publication How will the financial crisis affect health?
Date of publication
2009 April
Publication type
Journal Article
Publication details
British Medical Journal
Publication status
Published
Language
English
Keywords
Financing, recession, determinants, social determinants, social determinants of health, Commission on Social Determinants of Health
Abstract
Is there a link between the financial crisis dominating the front pages of newspapers and the health stories on the inside? The Commission on Social Determinants of Health certainly believed so. Its starting point was that the economic and social features of society are closely linked to the distribution of health within and between countries. The social determinants of health are the conditions of daily life and its structural drivers will be influenced by the financial crisis. As social determinants are affected by the financial crunch, so will health outcomes be affected as well.
Country
United Kingdom
Publisher
British Medical Journal
Theme area
Values, policies and rights
Title of publication The UN Special Rapporteur on the Right to Health: A guide for civil society
Date of publication
2009 April
Publication type
Electronic Source
Publication details
Publication status
Published
Language
English
Keywords
Civil society organisations, CSOs, participation, poverty, rights, human rights, Special Rapporteur
Abstract
This guide is intended to aid civil society actors in becoming more involved in the work of the United Nations (UN) Special Rapporteur on the Right to Health, with a specific focus on the valuable role that health workers can play. The appointment of the first Special Rapporteur in 2002 and the resulting body of work on the right to health has proven to be a valuable catalyst for further action within the health and human rights movement. At the same time there remains much unawareness and misconception concerning the work of the Special Rapporteur and the ways in which civil society actors can be involved. The guide provides general information on the Special Rapporteur, and presents possibilities for contribution and follow-up to the three main areas of his work. It offers concrete assistance on how the annual reports, country missions and the individual complaints mechanism of the Special Rapporteur can be used by civil society.
Country
Netherlands
Publisher
International Federation Of Health And Human Rights Organisations
Theme area
Health equity in economic and trade policies
Title of publication Genes from Africa: The colonisation of human DNA
Date of publication
2009
Publication type
Academic paper
Publication details
African Centre for Biosafety Briefing Paper 5 pp 1-16
Publication status
Published
Language
English
Keywords
Intellectual property rights, intellectual property, IP, patents, DNA, genes, genetics, trade
Abstract
This paper discusses the University of Pennsylvania’s African Human Genetic Diversity Project, and the filing of patent claims in October 2007 over genetic material collected from communities in Africa. It questions the staking of legal claims over the natural genetic resources of Africans. Such patents not only allow exclusive rights to such resources, but also enable profit from future medical applications. the report notes that the patent is possible, because US patent law extends patent protection to life forms. This new trend has enabled research institutions and corporations to secure patents for almost 5% of the entire human genome. The paper seeks to contribute to stopping the exploitation of African genetic resources.
Country
South Africa
Publisher
African Centre for Biosafety
Theme area
Values, policies and rights, Poverty and health
Title of publication Situational analysis of children in South Africa, 2007–2008
Date of publication
2009 April
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
Millennium Development Goals, child mortality, child health, South Africa
Abstract
A bleak picture has been painted in the Situational Analysis of Children in South Africa 2007–2008, a report compiled by the United Nations Children’s Fund (UNICEF) that looks at the standard of living of children in South Africa. It shows that poverty and crime continue to wreak havoc in the lives of this country’s children. It confirmed the view that South Africa will most likely not reach its Global Millennium Goal of reducing child mortality by two-thirds by 2015. Of every 1,000 children born in KwaZulu-Natal, 99 die before they reach the age of five. Gauteng’s mortality rate is still at about 63 deaths per 1,000 births; in Western Cape the ratio is 40 per 1,000.
Country
South Africa
Publisher
The Presidency (Office of the Rights of the Child)
Theme area
Values, policies and rights, Governance and participation in health
Title of publication Global governance: Feminist perspectives
Date of publication
2008 February
Publication type
Book
Publication details
Publication status
Published
Language
English
Keywords
Gender, governance, decision-making, human rights, discrimination, women, participation, democracy, policy
Abstract
To understand the potential for governance to empower women and lead to greater gender equality, it is crucial to pay greater attention to governance institutions and processes beyond the state. Taking this argument as its starting point, this book focuses on global governance – the frameworks, rules and processes of management through which international social and economic policy is coordinated and regulated. Its chapters on institutions – including the United Nations (UN), the European Union (EU), the International Labour Organization (ILO) and the International Criminal Court (ICC) – demonstrate how international processes and frameworks are extremely influential for national policies and laws. But they often fail to involve women as equal partners in decision-making or to identify how decisions will affect women and men differently. The book’s central point is that a gendered analysis can enhance our very understanding of global governance – its processes, institutions and relationships – and assist in developing strategies to bring about social transformation. Theoretical issues associated with initiating a gendered analysis of global governance are tackled in the first three chapters. The following four chapters look at strategies for opening spaces within state institutions to reflect upon their effectiveness. For example, the hierarchical and non-transparent decision-making forums of the EU have meant that advocates have struggled to get gender mainstreaming taken seriously. While the fact that the ICC is a relatively new institution has provided an opportunity to contest the gendered assumptions on which international law is based. Outside the state, broader movements for justice have failed to adequately involve and listen to feminist perspectives, and international feminist advocates have not adequately considered and supported the important role of local actors. The book concludes that transforming global governance is a multi-faceted task that requires a sophisticated understanding of different institutions and the opportunities they offer.
Country
United Kingdom
Publisher
Palgrave Macmillan
Theme area
Equitable health services, Monitoring equity and research to policy
Title of publication A User's guide to measuring gender-sensitive basic service delivery
Date of publication
2009
Publication type
Electronic Source
Publication details
Publication status
Published
Language
English
Keywords
Gender, governance, decision-making, human rights, discrimination, women, participation, democracy, services, service delivery, basic services
Abstract
Gender, governance and basic services are inextricably linked. A functioning democratic system of governance enables people to express their needs through the political system, and ensures that the system responds appropriately to their needs. This guide reviews the role of basic services in development and in relation to the Millennium Development Goals (MDGs). It is harder to achieve service-related MDGs where women and girls are missing out on vital services. Indicators and related data are important tools for promoting human development, including gender equality, and for the delivery of services. The guide aims to contribute to the development and better use of gender-sensitive indicators so that services are delivered more effectively and efficiently to women and girls. It argues that the MDGs will not be achieved unless women are able to contribute to and benefit from development equally with men. It provides an overview and framework for analysing the role of governance indicators in the gender sensitive delivery of basic services. Practitioner experiences of the collection and use of indicators are included, as are examples of good practice. It offers suggestions and tools on how to develop appropriate gender sensitive governance indicators for various service delivery contexts. A fictional case study illustrates perspectives of various actors in different administrative positions, from national to local levels. The guide includes a valuable analytical map of existing databases, assessments and indicators, showing a general lack of indicators that directly measure the delivery of services, especially to women. It is primarily targeted at national stakeholders, donors and international actors involved in service delivery measurements and programmes.
Country
Norway
Publisher
United Nations Development Programme (UNDP); United Nations Development Fund for Women (UNIFEM)
Theme area
Governance and participation in health, Monitoring equity and research to policy
Title of publication Measuring democratic governance: A framework for selecting pro-poor and gender sensitive indicators
Date of publication
2006 May
Publication type
Academic paper
Publication details
Publication status
Published
Language
English
Keywords
Gender, governance, decision-making, human rights, discrimination, women, participation, democracy, poverty, pro-poor policy
Abstract
This paper presents a framework for generating pro-poor and gender-sensitive indicators to assist policymakers in monitoring and evaluating democratic governance at the country level. The framework is applied to seven areas of democratic governance: parliamentary development; electoral systems and processes; human rights; justice; access to information and the media; decentralisation and local governance; and public administration reform and anti-corruption efforts. After defining the scope of each area of governance, a set of key questions is presented, followed by a pair of indicator matrices. The first matrix provides examples of pro-poor indicators, while the second matrix suggests gender-sensitive indicators. For example, the following two questions are designed to reveal some of the challenges which prohibit women and poor people from exercising their right to vote: What proportion of men and women in poor households who are eligible to vote have registered as voters? What are the costs of voting faced by men and women in poor households – for example, the time it takes to get to voting booths, transport costs, intimidation, and lack of security – and how may these be reduced? Potential gender-sensitive indicators are also outlined, including: voter turnout among registered females in poor districts; expenditure on special programmes in civic and voter education targeted at women; prevalence of women in poor districts indicating that it was common for women to vote as instructed by their father, husband or other male figure; and the percentage of seats in national Parliament reserved for women.
Country
United States
Publisher
United Nations Development Programme (UNDP)
Theme area
Values, policies and rights
Title of publication The Politics of Rights: Dilemmas for Feminist Praxis
Date of publication
2007
Publication type
Book
Publication details
Publication status
Published
Language
English
Keywords
Gender, governance, decision-making, human rights, discrimination, women, participation, democracy
Abstract
Since the late 1990s, development institutions have increasingly used the language of rights in their policy and practice. But what has the adoption of ‘rights-based development’ meant for the promotion of women’s rights in development? Has all this new talk about rights translated into any meaningful changes in policy and practice that can advance the struggle for social and gender justice? As human rights have become increasingly associated with development agendas, implicating states and external agencies, advancing rights agendas appears less straightforwardly ‘progressive’ than once it seemed. And this is perhaps even more the case with regard to women’s rights, which have increasingly become the site of intense political struggles. This book explores the strategies, tensions and challenges associated with ‘rights work’ from a feminist perspective. Articles from the Middle East, Latin America, and East and South Asia examine the dilemmas that arise from feminist praxis (the process of putting theoretical knowledge into practice) in these diverse locations, and address the question of what rights can contribute to struggles for gender justice. They explore the intersection of formal rights – whether international human rights conventions, constitutional rights or national legislation – with the everyday realities of women in settings characterised by gender inequalities and poverty, plural legal systems and cultural norms that can create major obstacles to realising rights. While the contributions to the book demonstrate how entrenched the challenges of realising women’s rights remain, they also point to signs of hope – particularly to the growing visibility of women in their efforts to make their demands heard.
Country
United Kingdom
Publisher
Routledge
Theme area
Values, policies and rights, Governance and participation in health
Title of publication The Politics of Democratic Governance: Organising for Social Inclusion and Gender Equity
Date of publication
2007
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
Gender, governance, decision-making, human rights, discrimination, women, participation, democracy
Abstract
Democratic governance involves developing institutions and processes that are more responsive to the needs of ordinary citizens. Specifically, it seeks to promote greater participation of marginalised groups within political processes, through addressing gender, class, race, ethnicity, caste, disability and sexuality inequalities, and greater accountability of governments towards those who have traditionally been excluded from political action. Political processes include both formal, organised politics and non-formal political activism by civil society organisations (CSOs) or social movements engaging with local and national governments. Most democratic states employ a system of representative democracy in which elected representatives are tasked with acting in the interest of constituents. In this context, calls for the development of more participatory forms of democracy have been voiced. This report is based on a two-day seminar organised by One World Action in London in March 2007. The event brought together activists at the forefront of democracy building in various countries, including Malawi and Zambia, with policymakers in the United Kingdom and Europe to focus on how poor and marginalised people can have a voice in the decisions that affect their lives. Participants examined the challenges marginalised groups face in organising, engaging with and transforming political processes. Looking at examples from a range of international contexts, the presentations and discussions considered the potential of new strategies and forms of political engagement that aim to build equitable, gender-sensitive, democratic and accountable governance. The two central seminar objectives were: to create a learning environment in which information, skills and experience could be shared through South–South, South–North, North–South and North–North circuits; and to provide opportunities for Southern civil society leaders to engage directly with and influence policymakers and opinion-formers from the North.
Country
United Kingdom
Publisher
One World Action
Theme area
Values, policies and rights, Governance and participation in health
Title of publication Governing Women: Women’s Political Effectiveness in Contexts of Democratization and Governance Reform
Date of publication
2008
Publication type
Book
Publication details
Publication status
Published
Language
English
Keywords
Gender, governance, decision-making, human rights, discrimination, women, participation, democracy
Abstract
Though the proportion of women in national assemblies still barely scrapes 16% on average, there are some striking examples: 49% of Rwanda’s assembly is female, Argentina’s stands at 35%, and Liberia and Chile’s new women presidents have raised expectations of an upward trend in women’s representation, from which we may expect big changes in the quality of governance. But getting into public office is just the first step in the challenge of creating governance and accountability systems that respond to women’s needs and protect their rights. Using case studies from around the world – including from Latin America, the Middle East, South Asia and Southern Africa – the essays in this book consider: the conditions for effective connections between women in civil society and women in politics; the evolution of political party platforms responsive to women’s interests; local government arrangements that enable women to engage effectively; and accountability mechanisms that answer to women. It tackles issues from public administration reform and women in decision-making in China to overarching issues around governing women or enabling women to govern and the relationships between these issues and the ‘Good Governance Agenda’. The book argues that good governance from a gender perspective requires more than women in politics. It requires fundamental changes to incentives to orient public action and policy to support gender equality.
Country
United Kingdom
Publisher
Routledge
Theme area
Resource allocation and health financing
Title of publication Regional Workshop Report: Fair financing for health: mobilising domestic resources and managing commercialisation of health systems
Date of publication
2009 September
Publication type
Report
Publication details
EQUINET Workshop Report, 22 September 2009, Munyonyo, Uganda. UCT HEU, HNC, EQUINET: Harare
Publication status
Published
Language
Keywords
domestic resources; fair financing; east and southern Africa
Abstract
The promotion of universal coverage means that health systems should seek to ensure that all citizens have access to adequate health care (adequately staffed with skilled and
motivated health workers) at an affordable cost and which improve both income cross-subsidies (from the rich to the poor) and risk cross-subsidies (from the healthy to the ill) in
the overall health system. This stems from our understanding of equity, which requires that people should contribute to the funding of health services according to their ability to pay and benefit from health services according to their need for care. Prior work in the fair
financing theme in the network indicates that there is still a heavy dependence on donor funding in some east and southern African (ESA) countries and heavy burdens on poor
people through high levels of out of pocket financing. There have been efforts to increase domestic funding of health services, and a number of countries are increasing government funding of health services.
The Health Economics Unit, University of Cape Town and HealthNet Consult Uganda used evidence from work done in the past 5 years on tax and mandatory health insurance sources of domestic resource mobilisation as inputs to a regional research and policy review meeting in September
2009. The meeting presented and reviewed research, implemented in and beyond the network, on domestic public resource mobilisation; examined policy options, and country experiences in and barriers to improving domestic public resource mobilisation, with a focus on ‘success stories’ where countries have been successful in motivating for greater allocation of public resources towards the health sector. The meeting was held in Uganda just prior to the EQUINET Regional conference to connect
delegates to the conference and to input into the wider network of equity actors and debates at the conference. The meeting identified knowledge gaps for follow up
research, including on gender dimensions.
Country
East and southern Africa region
Publisher
EQUINET
URL:
Equinet Publication Type
Reports
Theme area
Resource allocation and health financing
Title of publication African health development and financing parliamentary policy and budget action plan
Date of publication
2009 October
Publication type
Report
Publication details
Network of African Parliamentarians for Health Development and Financing pp 1-6
Publication status
Not published
Language
English
Keywords
Health financing, Millennium Development Goals, MDGs, African Union, Parliament, resources, development financing
Abstract
This report details a meeting by the Network of African Parliamentarians for Health Development and Financing held in Addis Ababa, Ethiopia, 7–9 September 2009, which met to deliberate on: accelerating African domestic health financing; implementing health priorities in an integrated manner; strengthening collaboration; preparations for the July 2010 African Union Summit; and coordinating global and African resource mobilisation. They determined that, without delay, further meetings should take place at three levels in the 53 African Union member states: at pan-African Parliament level; at each Regional Economic Community Parliament; and at country level. These joint working meetings should consist of chairs and secretaries/rapporteurs of the Parliamentary Committees of: health; finance/budget; women/gender; social development and Millennium Development Goals (MDGs) and others, including children and youth; water resources; environment and sanitation; education; food and agriculture; labour and human resources; planning and economic development. They will assess the state of health-based and related MDGs at each level. These committees should form health and social development financing clusters in parliaments to facilitate coordination and accelerated action on health and development financing.
Country
East and southern Africa region
Publisher
Network of African Parliamentarians for Health Development and Financing
URL:
Theme area
Poverty and health
Title of publication Child health now: Together we can end preventable deaths
Date of publication
2009 October
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
Child health, primary health care, PHC, poverty, financing, health financing, hygiene, Millennium Development Goals, MDGs, Millennium Development Goal 4, MDG 4
Abstract
The epicentre of the child health emergency is sub-Saharan Africa and South Asia but, without a concerted and sustained effort in their countries, there’s little prospect of Millennium Development Goal 4 being met at a global level. The causes of this emergency vary according to the local context, and will require tailored responses by governments, donors and international institutions. Examples of good leadership exist in countries like Liberia, where President Ellen Johnson Sirleaf has used the peace dividend to triple health spending, withdraw user charges and focus on the prevention of malaria. The first tier of healthcare for children is the household level, and beyond that the immediate community. Yet relatively little attention is paid by most governments to low-cost and easy-to-deliver measures that can be taken at this level, which can have a decisive impact on child health, from hand washing and breastfeeding to early identification of pneumonia. World Vision estimates that a comprehensive package of family and community care alone could prevent 2.5 million child deaths each year. What’s needed is a redefinition of health systems to incorporate family- and community-level care, in tandem with a fundamental rebalancing of public spending placing much greater emphasis on prevention. Safe water and sanitation and basic hygiene are necessary to achieve this aim – the World Health Organization estimates that they could together save US$7 billion in health care costs each year.
Country
United States
Publisher
World Vision
URL:
Theme area
Values, policies and rights, Governance and participation in health
Title of publication Just politics: Women transforming political spaces
Date of publication
2008
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
Gender, governance, decision-making, human rights, discrimination, women, participation
Abstract
This report focuses on two main themes: ways to increase women’s political participation and strategies for transforming political spaces. To increase women’s political participation it is necessary to address social and structural barriers to women’s participation in politics including poverty, policies of exclusion, women’s disproportionate responsibility for domestic labour, traditional gender roles and values, heightened security regimes and curtailed civil liberties, and the persistence of gender violence. And supporting initiatives to create safe spaces to enable women’s political participation is key to addressing such barriers. But while increasing the numbers of women in politics is crucial, it is not enough. Once in power, women need to become effective political actors so that they can transform political spaces and be held accountable alongside men for gender equity and social justice. Various support mechanisms can help elected women become effective political actors: training and mentoring programmes; creating safe political spaces; networking and political alliances; information-sharing initiatives; and meaningful engagement with the media. And accountability for addressing gender inequities cannot be demanded only from women representatives. Integrated and concerted action from governments, political parties, international institutions, civil society, social movements, and women’s and feminist groups is essential if political systems and processes are to become more transparent, participatory and accountable to women’s needs. For example, greater accountability can and has been achieved through effective lobbying of and engagement with policy makers and practitioners.
Country
United Kingdom
Publisher
One World Action
Theme area
Values, policies and rights, Governance and participation in health
Title of publication Who answers to women? Gender and accountability: Progress of the world’s women, 2008/2009
Date of publication
2008
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
Gender, governance, human rights, women, participation, Millennium Development Goals, MDGs, accountability
Abstract
The evidence reflected throughout this report suggests that, despite formal guarantees of equality, progress for many women, particularly the poorest and most marginal, has been far too slow. Who answers to women? Accountability failures that reinforce gender-based inequality can be seen: every time legal systems turn a blind eye to injustices experienced by women; every time public service systems respond to women’s needs only in relation to narrowly defined traditional roles; and every time structures of opportunity in markets favour men’s enterprises or limit women to vulnerable or low-return employment. The achievement of gender equality depends upon building the accountability of power holders to women so that power holders are answerable for meeting commitments to women’s rights and gender equality. A framework for gender-responsive accountability – containing two essential elements – is proposed: women are participants in all oversight processes; and accountability systems must make the advancement of gender equality and women’s rights one of the standards against which the performance of officials is assessed. This is both a political and a technical project. Improving accountability to women requires stronger mandates, clearer performance indicators, better incentives and sustained advocacy efforts – in short, good governance. This report makes recommendations on five areas where strengthening accountability to women is urgent: politics, access to public services, economic opportunities, justice, and the distribution of international assistance for development and security. Finally, this report reviews the gender equality dimensions of all the eight Millennium Development Goals (MDGs) – concluding that gender inequality is a major factor in holding back achievement of the MDGs.
Country
United States
Publisher
United Nations Development Fund for Women (UNIFEM)
Theme area
Values, policies and rights, Governance and participation in health
Title of publication Political cleaners: Women as the new anti-corruption force?
Date of publication
2007 January
Publication type
Journal Article
Publication details
Development and Change 38 1 pp 87-105
Publication status
Published
Language
English
Keywords
Corruption, aid, gender, governance, women, participation
Abstract
There is a myth that women are less corrupt than men. Some aid donors have cited statistical evidence that countries with larger numbers of women in politics and in the workforce have lower levels of corruption. That this finding can be explained by the fact that there are more women in politics and the workforce in liberal democracies that are anyway less corrupt than poorer less liberal regimes does not detract from the eagerness with which some development actors are seizing upon the potential role women might play in fighting corruption. The myth of women’s incorruptibility is not, of course, new. It is grounded in ideas that women naturally have a higher moral nature and an assumed propensity to bring this to bear on public life, and particularly on the conduct of politics. After demonstrating that some of the recent studies about gender and corruption record six perceptions about inclinations to engage in corrupt behaviour, this article suggests rather that the gendered nature of access to politics and public life shapes opportunities for corruption. In addition, corruption can be experienced differently by women and men, which has implications for anti-corruption strategies. A gendered analysis of corruption is, in fact, a useful entry point to the examination of the gendered nature of accountability failures, and of gender-specific gaps in current attempts to promote good governance.
Country
United Kingdom
Publisher
Wiley Publishing
Theme area
Values, policies and rights, Governance and participation in health
Title of publication Gendering governance
Date of publication
2008 December
Publication type
Book Section
Publication details
Politics, Gender and Concepts: Theory and Methodology pp 114-135
Publication status
Published
Language
English
Keywords
Gender, governance, decision-making, human rights, discrimination, women, participation
Abstract
Governance has become a central concept used by policymakers and politicians at the local, national, regional and global levels – as well as by political and other social scientists. Given this broad range of actors and the multiple institutions and disciplines in which it is used, governance is a notoriously ‘slippery’ and contested concept – with each ‘field’ tending to place greater emphasis on some characteristics associated with governance than others. However, most agree that the move towards the use of governance is the result of changes in the structures and processes of government and the emergence of new ways of thinking about governing. Yet gendered perspectives have been mostly absent from the growing literature on governance – ‘mainstream’ work has rarely gone beyond mentioning women’s organisations as new policy actors. And to date, feminist critiques of this mainstream literature remain sparse. This chapter argues that, despite the lack of ‘gender’, the move from a focus on government to one on governance provides feminist political scientists with new opportunities. This broader understanding moves beyond government to interrogate a range of changing relationships – relationships between market and state, policy communities of state and non-state actors, and the arenas of the ‘public’ and the ‘private’. This chapter – along with recommendations for further work – prioritises producing gendered analyses of institutions; of the actors and the relationships between them; and, particularly, of the changing relationship between the market and state, and the role of citizens. So the aim should not be to throw out the concept of governance but to change the substance, to reflect gendered understandings. In fact, feminist and mainstream political sciences alike have much to gain from each other.
Country
United Kingdom
Publisher
Cambridge University Press
Theme area
Values, policies and rights, Governance and participation in health
Title of publication Gender and governance: Overview report
Date of publication
2009 April
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
Gender, governance, decision-making, human rights, discrimination, women, participation
Abstract
With their focus on democracy, transparency, accountability, inclusive citizenship and participatory processes there is huge potential in the ideas and practices of governance to catalyse real change in terms of gender equality. However, this potential remains largely untapped. This overview report points to the failure to challenge the entrenched unequal, gendered power relations and other forms of exclusion that have been built into governing processes and institutions for centuries. It argues that gender equality in these decision-making fora is vital, both for enabling far-reaching social change and for empowering people excluded from decision-making on the grounds of their gender. There has been some progress in redressing the gender imbalance in national and local governance processes and institutions – most notably, electoral reform has meant the inclusion of more women in government institutions, particularly at a local level. But these mechanisms do not guarantee quality and equality of participation in governance institutions and processes. This report considers how we can ensure that the principles of inclusive, accountable governance go beyond rhetoric. Through an examination of innovative work on gender and governance, the report highlights where opportunities lie for achieving gender-sensitive governance processes and institutions.
Country
United Kingdom
Publisher
BRIDGE, Institute of Development Studies
Theme area
Monitoring equity and research to policy
Title of publication Health policy analysis: Regional skills workshop report
Date of publication
2009 September
Publication type
Report
Publication details
EQUINET Workshop Report, 22 September 2009, Munyonyo, Kampala, Uganda. EQUINET: Harare.
Publication status
Published
Language
Keywords
health policy, capacity building, policy analysis
Abstract
Over the last five years the Regional Network For Equity In Health In East and Southern Africa (EQUINET) has generated a range of analyses of specific policy experiences in Southern and Eastern Africa and has developed the understanding and skills necessary to conduct this sort of work. Other work conducted by EQUINET, such as around governance and participation, is also relevant to understanding how to strengthen health system decision-making in ways that support health equity goals. It is time, now, to take stock of the range of health policy analysis work in Africa - and to draw out lessons from past experience, as well as identify new challenges for the years ahead.
This workshop took place as part of the pre-conference activities of the EQUINET conference September 2009 on Reclaiming the Resources for Health. It was convened by Lucy Gilson, School of Public Health and Family Medicine, University of Cape Town and Ermin Erasmus, Centre for Health Policy, The University of the Witwatersrand. The workshop aimed to
 Reflect on health policy analysis and its role in health system development
 Share experience in the use of health policy analysis to support policy development and implementation
 Share experience in teaching health policy analysis (in short course, post-graduate programmes etc)
 Develop shared ideas of how to strengthen this field of work in Africa.
It provided an opportunity to reflect on health policy analysis and its role in health system development. Participants shared experience in the use of health policy analysis to support policy development and implementation and on teaching health policy analysis. In the workshop participants shared ideas of how to strengthen this field of work in Africa. The workshop was held as a pre conference workshop to the EQUINET Regional Conference and involved delegates drawn from the confrebce and thus the wider regional work on equity in health.
Country
East and southern Africa region
Publisher
EQUINET
URL:
Equinet Publication Type
Reports
Theme area
Monitoring equity and research to policy
Title of publication Writing skills for peer reviewed journals: Regional skills workshop report
Date of publication
2009 September
Publication type
Report
Publication details
EQUINET Workshop Report, 26 September 2009, Munyonyo, Uganda. TARSC, EQUINET: Harare.
Publication status
Published
Language
Keywords
Abstract
As part of its ongoing skills development programme, the Regional Network fort Equity in Health in East and Southern Africa (EQUINET) has committed to developing the writing skills of health equity researchers in the region, particularly with regards to writing for peer reviewed journals, as well as for improving writing skills on EQUINET Discussion Papers. This workshop took place as part of the post-conference activities of the EQUINET conference September 2009 on Reclaiming the Resources for Health. It was convened by Rebecca Pointer under the auspices of Training and Research Support Centre. The workshop used the EQUINET writing skills raining manual found as its core resource material (at http://www.equinetafrica.org/bibl/docs/EQ%20Writskill%20man.pdf) . The workshop sought to equip researchers with a basic step-by-step approach to writing for peer reviewed journals, and to approach scientific writing as a routine process. The participants were those working on publications in areas related to health equity from countries in east and southern Africa.
Country
East and southern Africa region
Publisher
EQUINET
URL:
Equinet Publication Type
Reports
Theme area
Equity in health, Values, policies and rights, Equitable health services, Resource allocation and health financing, Equity and HIV/AIDS, Governance and participation in health
Title of publication Commitments from the 2009 Regional Meeting of Parliamentary Committees on Health in Eastern and Southern Africa
Date of publication
2009 September
Publication type
Document
Publication details
Munyonyo, Kampala, Uganda, 21 September 2009
Publication status
Published
Language
Keywords
parliament; health equity; reproductive health
Abstract
The Regional Meeting of Parliamentary Committees on Health in Eastern and Southern Africa, Munyonyo, Kampala, Uganda, 21 September 2009, gathered members of parliamentary committees responsible for health from twelve countries and from regional bodies in Eastern and Southern Africa, together with technical, government, civil society and regional partners, to promote information exchange, facilitate policy dialogue and identify key areas of follow up action to advance health equity and sexual and reproductive health in the region. The meeting was held as a follow up to review progress on actions proposed at the September 2008 Regional Meeting of Parliamentary Committees on Health in Eastern and Southern Africa hosted by the same organisations. This document outlines the commitments to follow up action made at the meeting.
Country
East and southern Africa region
Publisher
EQUINET, PPD ARO
Equinet Publication Type
Resolutions
Theme area
Equity in health, Values, policies and rights, Health equity in economic and trade policies, Equitable health services, Human resources for health, Public-private mix, Resource allocation and health financing, Equity and HIV/AIDS, Governance and participation in health, Monitoring equity and research to policy
Title of publication Resolutions for Action: The Third EQUINET Regional Conference on Equity in Health in East and Southern Africa
Date of publication
2009 September
Publication type
Conference Proceedings
Publication details
Publication status
Language
English
Keywords
Health equity; resolutions
Abstract
Over 200 government officials, parliamentarians, civil society members, health workers, researchers, academics and policy makers, as well as personnel from United Nations, international and non-governmental organisations from East and Southern Africa and internationally met at the Third EQUINET Regional Conference on Equity in Health in East and Southern Africa, held 23–25 September 2009 in Munyonyo, Kampala. This document presents the resolutions of the conference for action on equity in health.
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Resolutions
Theme area
Human resources for health
Title of publication Discussion paper 78: Policies and incentives for health worker retention in east and southern Africa: Learning from country research
Date of publication
2009 October
Publication type
Academic paper
Publication details
Policies and incentives for health worker retention in east and southern Africa: Learning from country research. University of Namibia, Training and Research Support Centre, University of Limpopo, EQUINET, ECSA-HC, EQUINET Discussion Paper 78 EQUINET:
Publication status
Published
Language
Keywords
health worker retention; non financial incentives
Abstract
This paper presents a summary of the regional programme on incentives for health worker retention in the Regional Network for Equity in Health in East and Southern Africa (EQUINET) in co-operation with the East, Central and Southern Africa Health Community (ECSA-HC). The studies sought to investigate the causes of migration of health professionals, the strategies used to retain health professionals, how they are being implemented, monitored and evaluated, as well as their impact, to make recommendations to enhance the monitoring, evaluation and management of non-financial incentives for health worker retention. They aimed to have some comparability in design to share learning. The findings revealed that all four countries studied (Swaziland, Zimbabwe, Tanzania, Kenya) have put in place strategies to improve morale and retain staff in the public health sector. These have been designed after some assessment of the drivers of attrition, often through prior surveys of push/pull factors. All the countries studied were applying a mix of non-financial incentives according to their strategies and plans, although implementation was not always uniform at all levels or for all cadres, or reached all those cadres intended. All implement non-financial incentives, together with some form of financial incentives. All studies indicated the presence of policies providing for non-financial incentives. What is of concern is implementation: how they are introduced, the reasons for and measures to address gaps in implementation, how they are managed, monitored and evaluated, and the systems and information needed to support implementation. This area needs more attention, from ensuring the effective performance of institutions and roles set up to manage HRH, to generating the information and processes needed to introduce them, assess their impact and to build trust and credibility around their application. The country studies observed that incentives were not uniformly applied to all health workers, and did not always reach all in the target category. The studies indicated a need to intensify focus on issues of operationalising and implementing non-financial incentives: moving from inserting incentives in policies and strategies to ensuring their application across all providers; moving from focused application for specific cadres of health workers to sector wide application of incentives for all health workers and moving from experiments within the health sector to more sustained multi-sectoral policies that involve other sectors, including public service, finance, public works, education and housing. The results of the work were reviewed at a regional meeting that was convened on 25-27 February in Windhoek by EQUINET and ECSA-HC, hosted by the University of Namibia in co-operation with TARSC and University of Limpopo, to review the findings from this body of work and to explore the implications for policies and measures aimed at valuing and retaining health workers in ESA, develop proposals and guidelines for policy and action relevant to health worker deployment and retention, and identify knowledge gaps for follow up work. The recommendations from this meeting are presented.
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Discussion paper
Theme area
Health equity in economic and trade policies, Equitable health services, Public-private mix
Title of publication Discussion paper 79: Capital flows in the health care sector in Zimbabwe: Trends and implications for the health system
Date of publication
2009 August
Publication type
Report
Publication details
EQUINET Discussion Paper Series 79. Rhodes University, Training and Research Support Centre, SEATINI, York University, EQUINET: Harare.
Publication status
Published
Language
Keywords
privare sector; medical aid; capital flows
Abstract
This review of the capital flows in the health sector in Zimbabwe was carried out in 2008 and draws from secondary evidence. It presents evidence on the current composition of the health sector, particularly showing the public-private mix; trends over time post-1995 in private capital flows to the health sector showing key entry points for capital and the impact on the health care sector of these flows. The paper explores arguments used to support private flows, the role of trade agreements, and the policy, regulatory, institutional and public responses to the capital flows. It comments on issues arising in relation to methods used to analyse capital flows and their impacts, including data availability and bias. The rapid liberalisation of the health sector in Zimbabwe in the late 1990s created opportunities for private capital. While this was a policy objective of the time, it coincided with cuts in public expenditure during the 1990s and an economic crisis post-2000 that meant that private sector growth was not matched with public sector growth. The marked decline in public health investment reversed the major gains made during the 1980s, and private for-profit health care investments were concentrated in a few urban areas serving a minority of the wealthier population. The absence of a national health insurance system resulted in the 90% uninsured population having difficulties in accessing health services. Private health services were concentrated in a few vertically linked operations, sparking fears of anti-competitive behaviour, especially in the retail pharmaceutical sectors. Incentives given to private-for-profit health care providers did not lever public health gains, and the cost of both public and private health care soared, undermining access. The paper highlights areas for increased policy attention: for government to significantly increase public investment in health and control out of pocket expenditure; for the establishment of social health insurance; for the Ministry of Health to use its powers to monitor and regulate the expansion of private capital so that it serves policy objectives of universal coverage and equity. With powerful national interests gaining from profits in the health sector, including in the medical profession, monitoring and advocacy by communities is essential to engage on policy measures that protect equity and access. The paper further notes the regulatory role of the Competition and Tariff Commission.
Country
Zimbabwe
Publisher
EQUINET
URL:
Equinet Publication Type
Discussion paper
Theme area
Equity and HIV/AIDS, Governance and participation in health
Title of publication EQUINET PRA paper: Improving adherence to ante-retroviral treatment for people with harmful alcohol use in Kariobangi, Kenya
Date of publication
2009 October
Publication type
Report
Publication details
EQUINET PRA paper, University of Nairobi, TARSC: EQUINET, Harare
Publication status
Published
Language
Keywords
Abstract
This study aimed to explore the understanding of and factors in adherence to ARV treatment in people living with HIV and AIDS (PLWHA) who are engaged in harmful alcohol use and to intervene on prioritised factors to improve adherence, using participatory research and action (PRA) methods. We sought to determine the perceptions of and understanding of alcohol abuse and ARV treatment among PLWHA, their peers, family members and health workers. We aimed to increase collaboration between the mental health workers from clinic and hospital level and the community to respond to identified barriers to improve adherence to ARV treatment in PLWHA who use alcohol in a socio-economically deprived urban area in Nairobi (Kariobangi). The work was implemented within an EQUINET programme that aimed to build capacities in participatory action research to explore dimensions of (and impediments to delivery of) Primary Health Care responses to HIV and AIDS. The majority of the PLWHA included in the study were socially disadvantaged, unemployed, and with low education. Social support was equally poor since a large number were widowed, separated or divorced. Most of the PLWHA who participated were single or divorced women, some of them admitted that they sometimes engaged in commercial sex to cater for their basic needs. These factors, together with poor health, limited their economic opportunities and security. In this context, alcohol use, noted by PLWHA, community members and health workers to be prevalent in the community, is not only encouraged by poor living and social conditions, but also by cost (it is relatively cheap) and by the social pressure to use alcohol to escape the mental stress caused by poverty. This is exacerbated by social attitudes that do not discourage alcohol use, and misconceptions that in fact encourage alcohol use, such as that alcohol can kill the HIV virus. This study suggests that the problem of alcohol abuse is poorly recognised for both communities and health workers: It was generally under reported to services, with low numbers of people on ARVs reported to have alcohol related problems, so that health workers see only a small share of the problem. A survey of the local health centres providing ARVs showed that screening for alcohol use was not routinely done and protocols for managing alcohol related disorders were not available. For PLWHA on ARVs, there are already challenges in dealing with the timing, frequency of medication and appointments and the availability and cost of food to support treatment. For PLWHA who use alcohol these difficulties are compounded. There are a range of services in the community that could potentially address these barriers that are involved in nutrition, psychosocial, medical care, PHC, HIV prevention and treatment services, counselling, social, legal, information and referral support for PLWHA. However these do not explicitly deal with the treatment of alcohol and drug related problems in the community or the needs of PLWHA on ARVs who use alcohol, and their adherence to treatment. Reflecting on these problems, the participants implemented a programme of counselling and education. The health workers were taught how to use the AUDIT in identifying problem drinkers and how to recognise and manage alcohol related disorders such as withdrawal fits. The PLWHA and their family members were encouraged to support one another and to identify symptoms of harmful alcohol use among themselves. The process was perceived by those involved to have reduced the harmful use of alcohol in those involved; to have made some improvements in community and health service support; in management of mental health and communication with families and in reducing stigma around alcohol use and HIV. The scores of the PLWHA on the repeat AUDIT questionnaire were however significantly lower than the baseline level.
Country
Kenya
Publisher
EQUINET
Equinet Publication Type
Discussion paper
Theme area
Equity in health
Title of publication Abstract Book: EQUINET Regional Conference on Equity in Health in East and Southern Africa
Date of publication
2009 September
Publication type
Report
Publication details
Abstract Book: Third EQUINET Regional Conference on Equity in Health in East and Southern Africa Speke Conference Center, Munyonyo, Uganda September 23-25 2009, EQUINET Harare
Publication status
Published
Language
Keywords
Abstract
The EQUINET Steering Committee welcomed delegates to the Third EQUINET Regional Conference on Equity in Health in east and southern Africa at Munyonyo, Uganda September 23rd -25th 2009. This abstract book presents the abstracts of the papers included in the conference.
The Regional Network for Equity in Health in East and Southern Africa (EQUINET) is a network of institutions within east and southern Africa- involving university, state, civil society, parliament and other institutions- that have sought to support the regional community in its commitment to secure equity in health. We are happy to come together with colleagues from state, civil society and non-state organisations, parliaments, regional and international organisations from within and beyond the region to share our collective experiences, knowledge, work and views, to explore the challenges we face in addressing inequalities in health and access to health care, and to support the development and implementation of policy choices that will strengthen health equity.
We have chosen the conference theme ‘Reclaiming the Resources for Health: Building Universal People Centred Health Systems in east and southern Africa to raise, debate and give visibility to the alternatives we have for advancing people’s health based on values of fairness and justice, particularly through policies and actions through which
• poor people claim a fairer share of national resources to improve their health;
• ESA countries claim a more just return from the global economy, to increase the resources for health; and
• a larger share of global and national resources are invested in redistributive health systems, to overcome the impoverishing effects of ill health.
The conference provided an opportunity to review evidence; to share information on policy, programme and health systems options; and to strengthen networking and interactions towards goals of improved health and social justice. The conference energised and informed work, and identified key areas to be followed through by EQUINET and others in future research, policy and programme design to advance health equity.
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Reports
Theme area
Resource allocation and health financing
Title of publication Workers on Wednesday: Healthcare financing: The state of healthcare and the working class
Date of publication
2009 September
Publication type
Electronic Source
Publication details
Workers on Wednesday
Publication status
Published
Language
English
Keywords
national health insurance; private health insurance; South Africa
Abstract
Health care financing in South Africa is inadequate, and in recent years we have been moving away from achieving the Abuja target of 15% government funding for health care. This has resulted in numerous crises in the public health sector, and most South Africans (about 41 million) are unable to access decent, adequate health care, as enshrined in our constitution. South Africans that do access decent, adequate health care primarily do so through private funding (typically private health insurance schemes), but even in this sector, costs are spiralling and the package of benefits on offer is declining. To increase public health funding in South Africa, the government has proposed the introduction of a National Health Insurance (NHI) scheme. A recent national household survey found that 71% of medical scheme members were willing to join a publicly supported health insurance scheme if their monthly contribution was less than for current medical schemes. The NHI has been proposed to create a mechanism to level the playing field and create equitable distribution of resources resulting in high quality of health services for all the people. Universal access to a basic package of services for both the rich and poor will be achieved by the NHI and the costs of health care for poor and middle class South Africans will decrease.
In-studio guests on the show were: Prof Di Mc Intyre – SA Research Chair in 'HEALTH & WEALTH', Health Economics Unit, UCT and EQUINET Fair Financing Theme Co-ordinator; Sheila Barsel – NEHAWU Policy Unit; and Dr Siva Pillay - Member of Parliamentary Portfolio Committee of Health (SA).
Country
Publisher
SABC
Equinet Publication Type
Briefs
Theme area
Equity and HIV/AIDS, Governance and participation in health
Title of publication EQUINET PRA paper: Prevention of vertical HIV transmission in Kamwenge and Kiboga districts, Uganda
Date of publication
2009 September
Publication type
Academic paper
Publication details
EQUINET PRA paper, HEPS Uganda, TARSC: EQUINET, Harare
Publication status
Published
Language
Keywords
Uganda; Participation; vertical transmision; HIV / AIDS
Abstract
This project sought to identify the barriers to delivery, coverage and uptake of PMTCT services at primary health care and community level and to generate improved demand for and utilization of PMTCT within Kamwenge sub-county in Kamwenge district and Mulagi subcounty in Kiboga district in Uganda. The work was implemented by HEPs Uganda within an EQUINET participatory action research programme and was mentored by Training and Research Support Centre (TARSC) in co-operation with Ifakara Health Institute Tanzania. Participatory methods were used to explore the barriers to using services to prevent vertical transmission and to identify actions to improve uptake. The findings suggested a need to emphasise couple counselling and testing; encourage local leaders to mobilise communities for antenatal care, PMTCT and other primary health care services and to address cultural barriers like male dominance. The baseline survey indicated that even where services are provided, while health workers may be effective in referring those who attend services for testing, PMTCT and ANC, there is a gap in people actually getting to services which breaks this link. Weak links are also made with some other maternal health services. Communities need to be involved in designing interventions that encourage male participation in demand and utilisation of testing and PMTCT services. This would appear to be a core element of any PHC oriented AIDS programme to prevent vertical transmission, as essential as other more biomedical elements.
Country
Uganda
Publisher
EQUINET
URL:
Equinet Publication Type
Discussion paper
Theme area
Equitable health services
Title of publication The Hidden Epidemic amongst Former Miners: Silicosis, Tuberculosis and the Occupational Diseases in Mines and Works Act in the Eastern Cape, South Africa
Date of publication
2009 June
Publication type
Book
Publication details
Publication status
Published
Language
English
Keywords
mineworkers; occupational health; health system surveillance; Occupational Diseases in Mines and Works Act 78 of 1973; South Africa
Abstract
The main objective of this research was thus to investigate health systems surveillance of the pneumoconioses in former underground gold miners, and to assess diagnostic and compensation systems under the legal framework of the South African Occupational Diseases in Mines and Works Act 78 of 1973 as Amended (ODMWA). This is a historically neglected subject which is a vastly under-researched and undocumented area of occupational disease and ill-health in South Africa. The findings from the 100% sample (n=205) of former miners over ten village settlements in the region of Ntabankulu, Eastern Cape is generalisable to all the other high recruitment and labour-sending rural areas of the Eastern Cape, as well as to other provinces in South Africa. Although the majority of the former miners (77.5%) reported that they had been informed of the dangers of respirable dust while in service, it is of great concern that 22.4% reported that they had not been informed. Additionally, the quality of information conveyed to those who reported that they had been informed is suspect as a large proportion of those men who did confirm knowledge of the dangers of dust subsequently revealed that this knowledge, that they initially had indicated was on the dangers of dust, was actually only on safety issues and matters relevant to potential accidents. Knowledge of the ODMWA is non-existent. Extremely high levels of respiratory illness were found amongst the former miners.Although just over thirty-one percent (31.2%) reported that they did not have lung disease on their own assessment, when clinical signs and symptoms were recorded 95.6% were coughing, 71.2% experienced dyspnoea, 82.4% fever, 80.9% pain and 83.4% had experienced weight loss. A very high number had dug deep into their pockets to consult private sector physicians; close to fifty-two percent (51.7%) had paid private sector rates for a consultation with a doctor, and many of these men had consulted privately more than once. It is also notable that these private sector physicians did not inform the former miners of the ODMWA; most likely a consequence of their own lack of knowledge of the Act. It seems that the ODMWA is a system designed to systematically displace the responsibility for former miners onto the state so that the deprivation and destitution experienced by them is then addressed through a variety of state social security grants and DoH services. Any improvement in medical surveillance, and compensation for occupational disease, would be substantial in the light of the dire historical and current situation. The mining companies need to demonstrate that they are discharging people following the proper procedures. This requires full examination on exit with any pathology shown being immediately addressed through the proper legal channels. There is a legal liability to do this. The medical records of those who have left mine service need to be checked by Mine Inspectors. Government has the right to monitor and check for full compliance and for information on the results of Exit Medical Examinations.
Country
South Africa
Publisher
Health Systems Trust
URL:
Theme area
Monitoring equity and research to policy
Title of publication Papers and Presentations: Directions and Themes in International Indigenous Health Research 2008
Date of publication
2008 July
Publication type
Publication details
Global Indigenous Health Research Symposium Report pp 1-85
Publication status
Published
Language
English
Keywords
indigenous communities; public health; indigenous health; research; partnerships; policy
Abstract
The health issues of Indigenous communities are difficult to solve as they are often embedded in a colonial history of dominance and oppression. Expanding political economies of settler societies often excluded and displaced Indigenous communities in seeking opportunities for economic development. The collision of cultural differences often neglected to understand or respect Indigenous ways of knowing in health and the diversity of factors that held promise for improvements. Efforts to advance our knowledge in Indigenous population and public health now seek to engage communities as full partners. Such alliances will likely lead to improvements in individual and community health if researchers and their community partners use knowledge gained for strategic action. In other words, translating knowledge into action through policy, strategy and new funding for programs is critical to realising the health dividends accrued from investments in the health research enterprise.
Country
Publisher
Centre for Aboriginal Health Research, University of Victoria
URL:
Theme area
Equitable health services, Equity and HIV/AIDS, Governance and participation in health
Title of publication EQUINET PRA Report: Access to HIV treatment and care amongst commercial sex workers in Malawi
Date of publication
2009 August
Publication type
Report
Publication details
EQUINET PRA paper, REACH Trust, TARSC: EQUINET, Harare
Publication status
Published
Language
Keywords
HIV/AIDS; Malawi; commercial sex workers
Abstract
Policies in Malawi explicitly mention the need for focus on services for commercial sex workers (CSWs) because of their susceptibility to HIV infection and the potential risk they have of spreading the virus. This study aimed to explore and address barriers to coverage and uptake of HIV prevention and treatment services among CSWs in Area 25 Lilongwe district, Malawi, using Participatory Reflection and Action (PRA) methods. The work was implemented within a programme of the Regional Network for Equity in Health in east and southern Africa (EQUINET co-ordinated by Training and Research Support Centre (TARSC) in co-operation with Ifakara Health Institute Tanzania, REACH Trust Malawi and the Global Network of People Living with HIV and AIDS (GNPP+). An initial baseline survey in 20 health workers and 45 CSWs showed high knowledge but poor rating of access and uptake of HIV prevention, testing and treatment services, due to both barriers in the community and in the services themselves. A PRA process drew out further detail and experiences of the barriers faced, with priorities identified as:
• Lack of early treatment seeking practices amongst CSWs
• Ill treatment of CSWs at health facilities by Health practitioners
• Lack of adherence to treatment by most of CSWs.
The PRA process itself raised issues of gender violence and abuse that CSWs face (including through attitudes and practices in health care services) that dehumanise them, and perpetuate their own harmful behaviours. The group of CSWs and health workers as a whole identified interventions that were immediate and feasible to address the three barriers they prioritized. An intensive intervention, involving door to door counseljng, engagement at places of work, formation of joint committees between CSWs and health workers and sensitization of health workers was implemented, steered and reviewed by the team with the CSWs and health workers themselves. Health workers and CSWs reported in a follow up survey improvements across all areas in the assessed baseline, except for quality of health services. Health workers reported improvements in the same areas noted by the CSWs, although their rating of improvements were generally a little more modest than the CSWs. We suggest that a public health PHC oriented approach to services for CSWs recognize, listen to, involve and build capacity in CSWs and ex-CSWs, and the civil society organisations that work with them, as a primary group for reaching and mobilizing uptake of services in CSWs.
Country
Malawi
Publisher
EQUINET
Equinet Publication Type
Discussion paper
Theme area
Resource allocation and health financing
Title of publication Kenya national health accounts: 2001-2002
Date of publication
2002
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
gross domestic product; health care financing; inability to pay; Kenya
Abstract
The government of Kenya faces the dilemma of combating a growing burden of disease, regulating quality, and improving equity in health care distribution within the context of declining public financing that is forcing rationalisation of health service delivery. To help resolve the dilemma, Kenyan policymakers need
a comprehensive understanding of the organisation and financing of the country’s health care system, including the expenditures on health care made by donors, public sector
entities, and the private sector, particularly households. In terms of the overall health resource envelope, Kenya spends 5.1% of its
gross domestic product (GDP) on health; this is comparable to other countries in sub-Saharan Africa, which average 5.7%, but well below the high-income OECD countries’ average of 9.8%. The other major financiers of health care in Kenya were the donor community, which contribute 16% of total health expenditures, and employers, which contribute 3%. Households in the poorer income quintiles use less health care than do households in the richest quintile – more than a third of the poor who were ill did not seek care compared to only 15% of the rich. This suggests that inability to pay is contributing to lower utilisation rates by the poor. NHA findings reveal a need to address the issue of equity in health care resource allocation. To this end, the government is using NHA findings to inform its resource allocation formulas for the development of the social health insurance plan and community-based health insurance schemes, and the distribution of Ministry of Health funds among public facilities. The ministry also plans to use the findings to carry out further analysis into the efficiency of hospital-based service delivery by more closely monitoring the consumption of resources against production of outputs.
Country
Kenya
Publisher
Government of Kenya
Theme area
Public-private mix
Title of publication Local production of pharmaceuticals: Industrial policy and access to medicines: An Overview of Key Concepts, Issues and Opportunities for Future Research
Date of publication
2005 January
Publication type
Report
Publication details
Health, Nutrition and Population Discussion Paper pp 1-40
Publication status
Published
Language
English
Keywords
pharmaceutical, local production, health policy, industrial policy, developing countries
Abstract
Local production of pharmaceuticals in developing countries may be seen as helping to stimulate industrial policy and/or as stimulating pharmaceutical 'access' to needed medicines.
However, if a developing country with manufacturing facilities is able to finish off bulk active ingredients sourced from developed or other countries at high costs, such manufacture may have
no impact whatever on patient access to needed medicines. There has been some critical thinking in the past regarding whether or not small developing countries should make their own pharmaceuticals, but no recent comprehensive summary of the issues and policy options. This paper summarises the issues surrounding 'local production' from a policy and public health
viewpoint. It provides four brief country-level case studies, and reviews the evidence supporting the industrial policy assumptions underlying the goal of local production. In many parts of the world, producing medicines domestically makes little economic sense. If many countries begin local production, the result may be less access to medicines, since economies of scale may be lost if there are production facilities in many countries. The document concludes by providing a research agenda specifically designed to test assumptions about local production of pharmaceuticals.
Country
Publisher
World Bank, Human Development Network
Theme area
Public-private mix
Title of publication Evaluating the private sector potential for franchising TB and HIV/AIDS diagnosis and care in Sub-Saharan Africa
Date of publication
2004 April
Publication type
Report
Publication details
Overview Report pp 1-100
Publication status
Published
Language
English
Keywords
tubercolosis, HIV and AIDS, health sector, private sector, franchises, health workers, prescriptions, developing countries
Abstract
The aim of the study was to gather information from the nine countries on the following: a) The existence, number, and geographic distribution of those with a Bachelor of Medicine and Bachelor of Surgery (MBBS) qualification (basic medical doctor) and mid-level providers (Nurses, Clinical Officers, Assistant Nurse Midwives (ANMs) or equivalent) operating privately and independently (distinguishing full-time private from after-hours government workers). b) The legal status and ability to prescribe drugs by private mid-level providers, include restricted prescription lists, if any, for particular provider types. c) Government attitude toward current private providers, and likely willingness to consider organized franchise as a model for expanding access, particularly to TB and HIV programmes. d) Estimate of incomes for mid-level providers: to answer the question of whether proposed franchise income estimates would be sufficient to attract them? (True income to be estimated using multiple methods where data is available, so as to assure best-possible result). On the basis of this initial review of the situation regarding private practice in the nine Sub-Saharan African countries reviewed, Tanzania, Nigeria, Uganda and Cameroon seem to offer the best potential for operating a franchising scheme for TB and HIV/AIDS diagnosis and care for
hard to reach populations. However, due to time restrictions and data availability, this report only reflects an initial assessment about which countries might be worth investigating further. In order to develop a costed proposal for introducing such a franchising scheme, it is highly recommended that further detailed work and review of the situation in the selected countries is undertaken.
Country
Publisher
Institute for Health Sector Development
Theme area
Resource allocation and health financing, Governance and participation in health
Title of publication Community involvement in health care financing: A survey of the literature on the impacts, strengths, and weaknesses
Date of publication
2001 September
Publication type
Book
Publication details
Health, Nutrition and Population Discussion Paper pp 1-74
Publication status
Published
Language
English
Keywords
health financing, community financing, access, financial protection, social inclusion, developing countries
Abstract
The paper reviews 45 published and unpublished reports on community financing completed between 1990 and 2001. The study focused on reporting measures on three indicators in particular: resource mobilization capacity; social inclusion; and financial protection. The main objective of the study was to explore performance measures reported in the literature regarding community financing. The study concluded that the reviewed literature is rich in describing scheme design and implementation. At the same time, evidence on the performance of community financing schemes is limited. Community health insurance (CHI) schemes are growing in importance in low-income settings, where health systems based on user fees have resulted in significant barriers to care for the poorest members of communities. They increase revenue, access and financial protection, but concerns have been expressed about the equity of such schemes and their ability to reach the poorest. Few programmes routinely evaluate equity impacts, even though this is usually a key objective. This lack of evidence is related to the difficulties in collecting reliable data on utilisation and socio-economic status.
Country
Publisher
World Bank, Human Development Network
Theme area
Public-private mix
Title of publication Partnerships to build healthier societies in the developing world
Date of publication
2009 May
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
pharmaceutical production, research and development, medicine, developing countries, Millenium Development Goals
Abstract
This report outlines how pharmaceutical companies help to improve health in developing countries. The programmes in this report show what companies are doing to help achieve the Millenium Development Goals. This report looks at the work some of the world's largest pharmaceutical multi-national organisations are doing to address maternal and child health, HIV and AIDS, tubercolosis, Malaria and other tropical diseases.
Country
Publisher
International Federation of Pharmaceutical Manufacturers and Associations
Theme area
Public-private mix
Title of publication The business of health in Africa: Partnering with the private sector to improve people’s lives
Date of publication
2007
Publication type
Book
Publication details
Publication status
Published
Language
English
Keywords
private sector; health care provision, policies and regulations, investment climate, sub-Saharan Africa
Abstract
This report highlights the critical role the private sector can play in meeting the need for more and higher-quality health care in Sub-Saharan Africa. It also identifies policy changes that governments and international donors can make to enable the private sector to take on an ever more meaningful role in closing Africa’s health care gap. Many in the public health community oppose in principle a role for the private sector in health care. Indeed, there are legitimate concerns about the role of private providers. The private sector in Sub-Saharan Africa is diverse and fragmented, and as a result, quality can be inconsistent. Moreover, the lack of regulatory and accreditation frameworks combined with a largely uninformed patient population can sometimes allow an unscrupulous minority to prevail over responsible providers — to the detriment of the reputation of all. However, for-profit companies, non-profit organisations, and social enterprises, along with insurers, providers, and manufacturers, already play an important role in providing health care to the region. They account for as much as 50% of health care provision, and their role is growing. Five main imperatives emerged that together create an agenda that can mobilise the responsible development of private sector health care in the region: develop and enforce quality standards; foster risk pooling programs; mobilise public and donor money to the private sector; modify local policies and regulations to foster
the role of the private sector; and improve access to capital. The weak investment climate in Sub-Saharan Africa has long posed a daunting challenge to entrepreneurs and their potential backers alike, but signs of positive change abound. Political stability has improved, reflecting a steep decline in the incidence armed conflict. Economic growth in most of the continent has been strong for the past half decade, and inflation is down. The expected improvement in Africa’s macroeconomic climate over the next decade will expand
the health care gap, as higher incomes will create new demand. A broad range of investment opportunities exist
across all components of the health care industry in the region (as described in detail in this report). These opportunities can
deliver compelling financial returns and have an enormous potential development impact.
Country
East and southern Africa region
Publisher
International Finance Corporation
Theme area
Public-private mix
Title of publication Do they work? Regulating for-profit providers in Zimbabwe
Date of publication
2004
Publication type
Journal Article
Publication details
Health Policy and Planning 15 4 pp 368-377
Publication status
Published
Language
English
Keywords
private sector, legislation, health sector, Zimbabwe
Abstract
The experience of low- and middle-income countries (LMC) with respect to regulation and legislation in the health sector is in marked contrast to that of Canada and Europe. It is suggested that the degree to which regulatory mechanisms can influence private sector activity in LMC is quite low. However, there has been little work done on exploring just how, and to what extent, these regulations fail. Through the use of stakeholder interviews, this study explored the effectiveness of regulations directed at the private-for-profit sector (general practitioners, private clinics and hospitals) in Zimbabwe. The study found that there was limited and asymmetric knowledge of basic regulations among government bodies and private providers. However, there was a clear feeling that regulations are not being implemented and enforced effectively. A variety of opportunistic practices have been observed among private providers, including: practices of self-referral, where patients are sent to other services the provider has a financial interest in; over-servicing; doctor-patient collusion to collect health insurance payments; and the use of unlicensed staff in private facilities. Key factors limiting effectiveness of regulation in the health sector include the over-centralization and lack of independence of the regulatory body, the absence of legal mechanisms to control the price of care, and the lack of knowledge by patients of their rights. The study also identified a number of potential strategies for improving the current regulatory environment. For example, in order to improve monitoring, ‘informal’ arrangements between the centralized regulatory body and local authorities developed. There is a need to develop ways to formalize the role of these authorities. In addition, professional associations of private providers are also identified as key players through which to improve the impact of regulation among private providers. Increasing consumer access to information and knowledge is another potential way to improve information within the regulatory process as well as implementation.
Country
Zimbabwe
Publisher
Oxford University Press
Theme area
Public-private mix
Title of publication Private health care provision in developing countries: A preliminary analysis of levels and composition
Date of publication
1998
Publication type
Report
Publication details
Data for Decision Making Project 76 pp 1-36
Publication status
Published
Language
English
Keywords
public-private mix, regulatory environment, levels of provision, resource mix index, developing countries
Abstract
The analysis presented in this paper constitutes an early attempt to study the determinants of the size of the private provision sector. While there are existing models of total health expenditure, and, by tautology, the aggregate supply of
health services, these models do not explain the differential growth of public and private providers, and thus the structure of the provision sector. Institutional features such as the regulatory environment, financing arrangements, and national cultural and political attitudes towards private practice may be the most important predictors of the number of private health care providers and the public-private composition of care. Lacking data on many of these qualitative health system descriptors, and in the absence of a structural model, this analysis should be considered descriptive and preliminary rather than causal. Nonetheless, the analysis has revealed a number of interesting preliminary findings: there is considerable variation in the levels of private provision and
composition of the physician and hospital bed components of the private sector; Latin American countries have the most private doctors, while African countries have the fewest; there is little variability across the four regions in the average proportion of physicians in the private sector; private physicians supply is highly income elastic, with a rate of increase significantly exceeding that of income. The income elasticity of public physician supply is around unity. Private beds also have unit elasticity with respect to income but public beds appear to be an 'inferior' good with their share diminishing as income increases. Other factors which appear to be associated with the size of the private sector include the degree of urbanization, secondary school enrolment, and health expenditure levels. Higher life expectancy and lower infant mortality seem to be associated with a larger private sector. There is only weak evidence of a relationship between income and the public-private mix of physicians. The share of for-profit beds is positively associated with income while other measures seem to be uncorrelated with income levels. Other factors related to composition are education and population
density, as well as levels of expenditure, although marginal dollar has about same effect regardless whether is public or private source. The public-private mix in financing is unrelated to the mix in provision: this suggests that the health system is not as clearly segmented as the simple model would suggest. There are a number of official and unofficial structures that lead to breaks between financing and provision, for example, user fees for public services and unofficial private practice
by civil servants. There is some evidence that public and private physicians are substitutes; no conclusive result can be reached for hospital beds. The resource mix index confirms accumulating case study evidence that in many countries the ambulatory sector is relatively dominated by private providers, and the hospital sector by the public sector. Evidence from different countries suggests very different levels of productivity for public and private providers. Future analysis should also include an assessment of the role of other providers, such as nurses, pharmacies, traditional healers, etc.
Country
Publisher
Department of Population and International Health, Harvard University
Theme area
Resource allocation and health financing
Title of publication Are free government health services the best way to reach the poor?
Date of publication
2004 September
Publication type
Academic paper
Publication details
Health, Nutrition and Population Discussion Paper pp 1-11
Publication status
Published
Language
English
Keywords
resource allocation and purchasing, health care financing, free government health services, universal coverage, targeting, social security
Abstract
The paper asks whether the pursuit of universal coverage by a wide range of free government services constitutes the most promising approach to meeting the needs of disadvantaged population groups. The response given to that question is 'probably not'. The record to date points clearly to the danger that the benefits of subsidized government health services will flow primarily to the better-off, rather than to the poor for whom the services are intended. While there is no perfect approach to dealing with this issue, the record also points to several approaches that can significantly ameliorate the situation. Two of them, discussed in the paper, are the adoption of targeting measures to increase the proportion of benefits from government expenditures that flow to the poor; and the development of alternative, selfsustaining service financing and delivery mechanisms to serve the better-off. Successful implementation of approaches like these would allow governments to focus their efforts to achieve universal free coverage on a limited number of interventions that are particularly important for poor groups.
Country
Publisher
World Bank, Human Development Network
Theme area
Public-private mix
Title of publication Processes and issues for improving access to medicines: The evidence base for domestic production and greater access to medicines
Date of publication
2004 September
Publication type
Academic paper
Publication details
Issues paper: Access to Medicine: A briefing paper for DFID on technology transfer in the pharmaceuticals sector pp 1-99
Publication status
Published
Language
English
Keywords
access to medicine, pharmaceutical production, procurement guidelines, public health, domestic production, sub-Saharan Africa
Abstract
This study seeks to contribute to the discussion of domestic production by analysing, from a business context, whether or not such production of drugs in sub-Saharan Africa is sufficiently profitable to enable an enterprise that produces drugs to be a going concern while at the same time enabling increased access to drugs by providing them at prices lower than those available from international sources. When the factors that affect the operations of a going concern in sub-Saharan Africa are examined, including those related to the country environment, government strategy and policy, and potential market size, a few countries appear to offer a moderately favourable climate for pharmaceutical production in terms of political risk and human resource availability, but throughout the region drug manufacturers face obstacles in terms of access to financial capital, technical know-how, purchasing and maintaining equipment, and obtaining spare parts. Furthermore, domestic producers face several challenges in the market place: institutions and governments will be major buyers of the currently recommended drugs to treat HIV/AIDS, TB, and malaria and will be obliged to respect the procurement guidelines of major donors; and most national markets in sub-Saharnan Africa are too small alone to absorb the production of drugs to treat these three diseases. Under certain conditions (i.e. at prices that are competitive
with those of imported drugs, with significant market share, a stable political context, and the production of drugs to treat both priority diseases and conditions of lesser public health importance etc.) domestic production in sub-Saharan Africa has the potential to be financially viable as well as to offer the possibility of a modest reduction in the ex-works prices of
quality drugs. However, there is no guarantee that all of the drugs produced will necessarily meet widely accepted international quality standards, because the WHO pre-qualification only covers a limited set of drugs. The financial viability of the enterprise appears fragile because it depends on the price of active pharmaceutical ingredients and market share. The inability to obtain favourable prices for active pharmaceutical ingredients from suppliers, or failure to obtain needed market share would threaten the ability of the enterprise to continue as a going concern.
Country
East and southern Africa region
Publisher
DFID Health Systems Resource Centre
Theme area
Public-private mix
Title of publication Leveraging the private sector for public health objectives
Date of publication
2004 September
Publication type
Academic paper
Publication details
Issues paper: Access to Medicine: A briefing paper for DFID on technology transfer in the pharmaceuticals sector Issues paper: Access pp 1-41
Publication status
Published
Language
English
Keywords
technology transfer, public-private partnerships, PPPs, TRIPS, intellectual property
Abstract
Recognising that technology transfer is potentially a very important activity for the international community to encourage,
particularly when such transfers further public health objectives, this briefing paper documents a variety of TT experiences and analyses the motivations behind the enabling agreements. These experiences range from those that occur spontaneously, sometimes between relatively equal partners engaging in more of a technology exchange, to those taking place in countries with industries in more nascent stages of development, as well as those where public bodies sometimes impose obligations or offer incentives, including through public-private partnerships (PPPs), to bring parties together. The TRIPS agreement is weak on imposing technology transfer obligations in developed countries as a legal requirement, although the statements referring to TT as an objective may be used as an interpretative device, either to inform the application of other parts of the TRIPS Agreement, or as the basis for political objection to the manner in which the Agreement is being interpreted and applied by developed members. Developed country examples where governments have offered incentives to industry to engage in TT are limited. However, non-governmental and international organisations have been active in this field, and their engagement well noted in the examples. Regardless of where the TT experience fits within the ‘spontaneous/purely commercial’ versus PPP continuum, sustainable arrangements have required a solid business rationale for engaging in any such technology transfers. Many of the TT experiences have involved an element of public funding or technical support that serve to ‘sweeten’ the deal, making it a sound business investment for the technology donor and/or recipient. As for how changing intellectual property (IP) can be expected to impact TT, as long as the institutional and governance structures are aligned with increasing protection of IP, then we might expect to see more willingness of firms to license and contract out increasingly important/ proprietary technologies to developing country firms. However, the opposite argument has also been made – that strong intellectual property protection is liable to stifle technology transfer as technology owners exploit their market power. The technology/patent-holder will no doubt need to consider all types of costs and benefits when choosing the most appropriate contractual/ownership mode and the degree of technology that can be successfully transferred.
Country
Publisher
DFID Health Systems Resource Centre
Theme area
Resource allocation and health financing
Title of publication Following the Money: Toward Better Tracking of Global Health Resources
Date of publication
2007 May
Publication type
Report
Publication details
Report of the Global Health Resource Tracking Working Group pp 1-76
Publication status
Published
Language
English
Keywords
health expenditure, tracking, policy relevance, health sector, developing countries
Abstract
The lack of timely, accurate information about spending on health services and public health programs represents a key constraint for good policymaking and effective use of limited resources in developing countries. Although important advances have been made in improving the quality of data and policy-relevance of data on national spending and external flows from public and private donors, the need to further improve data systems is clear. None of the existing tracking systems or efforts provide up-to-date, comprehensive information in a form that addresses central policy questions. Without information about what resources are expected - from whom, and for what purpose - and without better tracking of how those funds have been spent, policy leaders, advocates and analysts are unlikely to be able to effectively raise additional resources and allocate them toward the populations and types of services that are vital to the achievement of the Millennium Development Goals. This report calls for a move: from tracking expenditures on specific health programs in an unco-ordinated way to coherent and long-term support to improve government budgetary and financial systems in the developing world; to institutionalising standard approaches to documenting and analysing health sector expenditures; and to providing more timely, predictable and forward‑looking data on external assistance to the health sector.
Country
Publisher
Centre for Global Development
Theme area
Values, policies and rights
Title of publication Failure to Deliver: Violations of Women’s Human Rights in Kenyan Health Facilities
Date of publication
2007
Publication type
Book
Publication details
Publication status
Published
Language
English
Keywords
reproductive rights, human rights violations, health system, patient's rights, Kenya
Abstract
For decades, women seeking reproductive health services in Kenya have been suffering serious human rights violations, including physical and verbal abuse and detention in health facilities for inability to pay. Shortages of funding, medical staff,
and equipment plague the health care system, particularly the public sector, dramatically interfering with the ability of health care staff to provide adequate care. These systemic problems have persisted, in part, because of a dismal lack of accountability within the health care system, which in turn stems from a lack of basic awareness about patients’ rights and the absence of transparent and effective oversight mechanisms. The lack of funding for public health facilities contributes to the emergence of a two-tiered health care system in Kenya, which discriminates against poor women and prevents or delays access to much-needed care. The government of Kenya controls slightly over half of all health facilities in the country while the rest—including the majority of maternity homes—are controlled by non-governmental, private, and mission organisations. While government facilities cost less money, they tend to have long lines, suffer from congestion, lack supplies, and treat patients unequally. Women expressed a firm belief that money usually buys better treatment, and when they could afford it, they opted for private facilities. The Minister of Health recently declared the Ministry’s intention to remove maternity fees in public health facilities as of July 1, 2007. Should this plan be implemented, it would increase access to delivery services and eliminate the detention of women and their babies in public facilities for inability to pay delivery costs. However, the success of such a plan hinges on it being supported by necessary funding and the provision of enough health care professionals to provide sufficient care. Adequate funding would go a long way toward fixing the broken exemption and waiver system, and remove the incentive in public health facilities to detain patients
in order to recoup costs. The government must also promote and implement laws and policies that protect the rights of health care users. This process should include establishing
formalized internal complaint mechanisms in both public and private health facilities, as well as external mechanisms that enforce ethical and professional standards of care.
Country
Kenya
Publisher
Federation of Women Lawyers Kenya
Theme area
Values, policies and rights
Title of publication Pathologies of Power: Health, Human Rights, and the New War on the Poor
Date of publication
2003 April
Publication type
Book
Publication details
Series in Public Anthropology 4 pp 1-419
Publication status
Published
Language
English
Keywords
human rights, global health, racism, sexism, economic injustice
Abstract
Pathologies of Power uses harrowing stories of life—and death—in extreme situations to interrogate our understanding of human rights. The book exposes the relationships between political and economic injustice, on one hand, and the suffering and illness of the powerless, on the other. The same social forces that give rise to epidemic diseases such as HIV and tuberculosis also sculpt risk for human rights violations. Racism and gender inequality in the United States are embodied as disease and death. The book presents an urgent plea to think about human rights in the context of global public health and to consider critical issues of quality and access for the world's poor should be of fundamental concern to a world characterised by the bizarre proximity of surfeit and suffering.
Country
Publisher
University of California Press
Theme area
Health equity in economic and trade policies
Title of publication Kenya’s Pharmaceutical Industry 2005
Date of publication
2005
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
pharmaceutical manufacture; access to drugs; drug quality; protectionism; Kenya
Abstract
Kenya's pharmaceutical industry consists of three segments - the manufacturers, distributors and retailers - which play a major role in supporting the country’s health sector. The market for pharmaceutical products in Kenya is estimated at KShs 8 billion per annum. Kenya is currently the largest producer of pharmaceutical products in the Common
Market for Eastern and Southern Africa (COMESA) region, supplying about 50% of the regions’ market. Of the region’s estimated 50 recognised pharmaceutical manufacturers; about 30 are based in Kenya, and about 9,000 pharmaceutical products have been registered for sale in Kenya, categorised according to particular levels of outlet as freesales/ OTC (Over The Counter), pharmacy technologist dispensable, or pharmacist dispensable/ prescription only. The number of companies engaged in manufacturing and distribution of pharmaceutical products in Kenya continue to expand, driven by the Government’s efforts to promote local and foreign investment in the sector. The Kenya Medical Suppliers Agency (KEMSA), a division of the Ministry of Health, largely carries out the distribution of pharmaceutical products in Kenya. It distributes drugs to government public health facilities and private health facilities. KEMSA has been an autonomous body since 1st July 2003. Its policy is to make available essential drugs and equipment primarily but not exclusively, to public facilities. KEMSA competes with other suppliers, e.g. the mission based medical supply facility (MEDS) and private wholesalers. Pharmaceutical products in Kenya are channelled through pharmacies, chemists, health facilities and shops. There are about 700 registered wholesale and 1,300 retail dealers in Kenya, manned by registered pharmacists and pharmaceutical technologists. The drugs on sale in Kenya are sold according to the outlet categorization, which can be described as free-sales/OTC, pharmacy technologist dispensable, or pharmacist dispensable/prescription only.
Country
Kenya
Publisher
Government of Kenya
Theme area
Public-private mix
Title of publication OTC Healthcare in South Africa
Date of publication
2008
Publication type
Electronic Source
Publication details
Euromonitor International
Publication status
Published
Language
English
Keywords
over-the-counter, OTC, retail value, pharmaceuticals, drugs, price controls, South Africa
Abstract
This growth over 2008 within OTC was impressive as many other industries within South Africa are experiencing declines in growth due to the tough economic conditions, attributed to increasing costs of raw materials, inflation, distribution and exchange rate fluctuations. A handful of companies dominated OTC healthcare sales within South Africa at the end of the review period. South African company Adcock Ingram was the leading player. Adcock leads OTC pharmacy sales with its range of well established brands, such as Panado, Corenza C, Syndol, Betapyn, Pynstop) and Adco-generic products within analgesics and cold and cough medicines. Other active companies include Aspen Pharmacare, Johnson & Johnson, Reckitt Benckiser Pharmaceuticals and GlaxoSmithKline. Price regulations in 2006 resulted in lower price increases compared with other fast-moving consumer goods within the current economic climate. Price regulations established by the department of health initiated the “single exit price” (SEP) in April 2004. SEP entails that the manufacturer or importer must set a price at which a particular medicine shall be sold to any person other than the State. The government also set a limit on future price increases and confirms the allowed percentage increase annually. No price increases was allowed over 2003-6. In May 2008 the annual price increase was capped at 6.5%, and the government allowed a 6.5% increase on medicine prices during 2008. Increasing raw materials’ prices and distribution costs and changing exchange rates resulted in tighter profit margins for manufacturers. A declining growth rate expected over the forecast period will be due to the consumer trend from self-medication to prevention. Increasing focus on health and wellness and costs related to illness will result in the increasing adoption of the “prevention is better than cure” ethos. Consumers are more educated and an increasing number realise the benefits of living a healthy lifestyle. Immune system-boosting supplements are expected to dominate in terms of future performance.
Country
South Africa
Publisher
Euromonitor International
Theme area
Public-private mix
Title of publication OTC Healthcare in Kenya: Market insight
Date of publication
2008
Publication type
Electronic Source
Publication details
Euromonitor International
Publication status
Published
Language
English
Keywords
over-the-counter, OTC, retail value, pharmaceuticals, drugs, cost of production, Kenya
Abstract
In 2008 OTC Healthcare in Kenya maintained steady retail value growth despite a poor start early in the year due to post election violence when many businesses temporarily ceased trading, many business premises were looted and transportation was halted, which thus led to a slow down in retail value sales over the first quarter of the year. However, the situation changed once a governmental coalition was formed, resulting in peace and thus enabling retailers to commence trading. By the end of 2008 the majority of companies affected had recovered their losses. In addition to the high cost of raw materials, rising inflation and the high cost of fuel led to increases in production costs for manufacturers in OTC Healthcare in 2008. Most companies considered importing medicinal products from other countries in order to reduce their operational costs. In some cases, for example Reckitt Benckiser East Africa Ltd, the high cost of production prompted companies to cease their manufacturing operations in Kenya. OTC Healthcare is expected to experience a slow down over the forecast period, which is expected to be attributable to further increases in inflation and also production costs, which in turn will hamper volume demand. The cost of raw materials increased over the review period and is expected to increase further over the forecast period as a result of which more companies are expected to potentially cease production activities in Kenya.
Country
Kenya
Publisher
Euromonitor International
Theme area
Public-private mix
Title of publication Public-private partnership units: What are they, and what do they do?
Date of publication
2006
Publication type
Document
Publication details
Public Policy for the Private Sector 311 pp 1-4
Publication status
Published
Language
English
Keywords
public-private partnerships, PPPs, policy, performance, service delivery
Abstract
As governments turn to the private sector to provide services once delivered by the public sector, they must learn new skills. This Note reviews the experience. These public-private partnerships (PPPs) are often long-term arrangements in which the government purchases services under a contract, either directly or by subsidising supply to consumers. In other PPPs the government bears substantial risks—for example, by guaranteeing revenue or returns— on projects that sell directly to consumers. This shift from traditional public sector
methods places new demands on government agencies. They need the capacity to design projects with a package of risks and incentives that makes them attractive to the private sector. They need to be able to assess the cost to taxpayers, often harder than for traditional projects because of the long-term and often uncertain nature of government commitments. They need contract management skills to oversee these arrangements over the life of the contract. And they need advocacy and outreach
skills to build consensus on the role of PPPs and to develop a broad program across different sectors and levels of government.
An increasingly common way to provide these capacities is to establish PPP units, as new agencies or as special cells within a cross-sectoral ministry such as finance or planning. Making the right choices on what functions these units should perform and how they should interact with line agencies responsible for service delivery will be critical to ensuring that they both add value and fit into existing governmental processes.
Country
East and southern Africa region
Publisher
International Finance Corporation
Theme area
Public-private mix
Title of publication Impact of public-private partnerships addressing access to pharmaceuticals in selected low and middle income countries: A synthesis report from studies in Botswana, Sri Lanka, Uganda and Zambia
Date of publication
2004 September
Publication type
Document
Publication details
Operational Issues of Health Pubic-Private Partnerships pp 1-57
Publication status
Published
Language
English
Keywords
access, Botswana, collaboration, drugs, impact, low- and middle-income countries, pharmaceuticals, Sri Lanka, Uganda, Zambia
Abstract
The country studies, undertaken in Botswana, Sri Lanka, Uganda and Zambia, examined PPPs supplying donated or discounted drugs for leprosy, lymphatic filariasis (LF), malaria, onchocerciasis, sleeping sickness, and HIV/AIDS (the Drug Access Initiative, Accelerating Access Initiative, the Diflucan® Partnership Programme and the Viramune® Donation Programme. The specific remit was to examine issues of ownership, integration, coordination, implementation and impact. A key question concerned the degree to which the involvement of multinational research and development-based pharmaceutical companies, as partners in supplying free or discounted drugs, facilitated better drug availability and access by the poor. The involvement of multi-national pharmaceutical companies in tropical disease drug access PPPs has facilitated better drug availability very substantially in the three countries, with negligible – if any – negative side-effects. The major, widely-appreciated benefit of drug donation PPPs lies in the assurance of a sustained, consistent and high quality supply of effective drugs which governments would mostly struggle to afford. The drug donation PPPs for leprosy, LF, onchocerciasis and sleeping sickness were appreciated unreservedly at country level. Other benefits include partner pharmaceutical companies’ willingness to invest in packaging and formulations more appropriate to local health system needs, and the recognition that a driving interested party such as a drug access PPP or the drug donation itself can be a stimulus to wider partnerships and programme initiation/ revitalisation at global and country levels. Considerable health impact has already been achieved in the study countries by the mature tropical disease programmes for control of onchocerciasis and elimination of leprosy, where the target now in all relevant countries is to secure progress in eliminating small pockets of leprosy at sub-national level. For the more recent tropical disease drug donation PPP/programmes for LF and malaria, real health impact will undoubtedly be secured because of the
numbers of people receiving new or better treatment through the PPPs. A commitment to continued pharmaceutical company
contribution through drug donations and discounts is important to sustainability, as is the preparedness of donors to sustain support for some element of operations during maintenance as well as intensive phases of elimination/control, if resurgence of disease is to be avoided. Partners of all kinds should be prepared to follow the model of those companies which have pledged to contribute for as long as is needed to achieve elimination or control goals.
Country
Publisher
Global Forum for Health Research
Theme area
Public-private mix
Title of publication Impact of public-private partnerships addressing access to pharmaceuticals in low and middle income countries: Botswana
Date of publication
2004 September
Publication type
Document
Publication details
Operational Issues of Health Pubic-Private Partnerships pp 1-54
Publication status
Published
Language
English
Keywords
access, Botswana, collaboration, drugs, impact, low- and middle-income countries, operational issues, pharmaceuticals, poverty
Abstract
The study looked at PPPs to improve access to drugs for HIV/AIDS and related conditions, in contrast to the other countries, where PPPs also address to tropical diseases not prevalent in Botswana. The study’s remit was to assess the health and health systems impact of the PPPs, looking in particular at issues of ownership, integration, co-ordination, implementation and impact, with a focus on the benefits, challenges, risks and lessons learned in these PPPs, as distinct from other programmes where drugs are competitively procured. A range of government and other stakeholders took part in over 50 interviews carried out in May 2004. The study included visits to eight district level public health facilities providing HIV/AIDS related services, including government supported hospitals managed by the corporate mining sector and a faith (mission) based organisation. There are three current PPPs operating in Botswana. Products supplied through the HIV/AIDS related donation partnerships and discount arrangements are greatly valued by the Government of Botswana and are in line with national priorities and policies. An important feature of the implementation of the drug access partnerships in Botswana is their full integration into the national drug supply and management system. The partnerships have certainly contributed to increased access to HIV/AIDS drugs, in terms of coverage and take-up rates of treatment programmes for anti-retroviral therapy, opportunistic infections and prevention of mother-to-child transmission of HIV. The lack of a centralized overview function in government for the drug access partnerships may mean that opportunities are missed in terms of developing a consistent approach over time to price and timeline negotiations or conditionalities. A key policy question is the willingness of pharmaceutical companies to extend donation and discount offers to the private sector, as part of national public-private partnerships with providers, as a contribution to scaling up treatment strategies. Since the first agreement with the Government of Botswana in 2000, companies are developing their involvement – to greater and lesser extent – as new and valued development partners in Botswana. Ongoing efforts are needed to monitor and negotiate appropriate medical education and patient information material, sometimes offered in the context of donation and discount arrangements.
Country
Botswana
Publisher
Global Forum for Health Research
Theme area
Public-private mix, Resource allocation and health financing
Title of publication New actors in health financing: Implications for a donor darling
Date of publication
2006
Publication type
Document
Publication details
Policy brief 33 pp 1-34
Publication status
Published
Language
English
Keywords
health financing, official development assistance, ODA, funders, budgets, Ghana
Abstract
This Policy Brief examines trends in development finance, drawing on the experience of Ghana’s health sector. It finds that, even for 'donor darlings', where aid accounts for a large percentage of GDP, new sources of finance have become a credible alternative to Official Development Assistance (ODA). This has important policy implications. Though new sources of finance may have increased the overall financial envelope, they have also brought monitoring and co-ordination challenges. Findings from Ghana suggest that developing countries need stronger information systems to predict the various flows and to plan with them. For more effective finance, they also need co-ordination mechanisms that include the new funders. Finally, in order to take ownership of their own development process, developing countries must find ways to improve inter-ministerial co-operation and to address mismatches between budgets and spending.
Country
Ghana
Publisher
OECD Development Centre
Theme area
Public-private mix, Resource allocation and health financing
Title of publication Private health insurance in low and middle-income countries: Scope, limitations, and policy responses
Date of publication
2005 March
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
private health insurance, PHI, low- and middle income countries, prepayment, health systems, universal coveraage, inequality
Abstract
This paper aims at analysing characteristics of private health insurance (PHI) in low- and middle income countries and evaluating its significance for national health systems. It yields three major results: First, PHI involving pre-payment and risk sharing currently only plays a marginal role in the developing world. Coverage rates are generally below 10 % of the population while private risk sharing programs only have wider significance in a small number of countries (e.g., South Africa,
Uruguay, and Lebanon). Secondly, in many countries the importance of PHI to finance health care is on a rise. Various factors contribute to this development: growing dissatisfaction with public health care, liberalisation of markets and increased international trade in the insurance industry, and overall economic growth allowing higher and more diversified consumer demand. This last aspect in particular is expected to put pressure on the supply side of the system to increase choices and improve the quality of health care coverage. Third, the development of PHI presents both opportunities and threats to the health care system of developing countries. If PHI is carefully managed and adapted to local needs and preferences, it can be a valuable tool to complement existing health care financing options. In particular non-profit droup-based insurance schemes could become an important pillar of the health care financing system, especially for individuals who would otherwise be left outside of a country’s health insurance system. However, PHI could also undermine the objective of universal coverage. Opening up markets for private health insurance without an appropriate regulatory framework might lead to rising inequalities in the access to health care: it may lead to cost escalation, a deterioration of public services, a reduction of the provision of preventive health care and a widening of the rich-poor divide in a country’s medical system. Given these risks, the crucial challenge for policy makers is to develop a regulatory framework that is adapted to a country’s institutional capacities and that, at the same time, sets the rules and standards in which PHI can efficiently operate and develop.
Country
East and southern Africa region
Publisher
OECD Development Centre
Theme area
Public-private mix
Title of publication Impact of public-private partnerships addressing access to pharmaceuticals in low and middle income countries: Zambia
Date of publication
2004 September
Publication type
Document
Publication details
Operational Issues of Health Pubic-Private Partnerships pp 1-60
Publication status
Published
Language
English
Keywords
access, collaboration, drugs, impact, low- and middle-income countries, operational issues, pharmaceuticals, poverty, Zambia
Abstract
This study in Zambia was to assess the health and health systems impact of public-private partnerships (PPPs) for improving access to pharmaceuticals in relation to tropical diseases and HIV / AIDS and prevention and treatment of opportunistic infections. The specific remit of this study was to examine issues of ownership, integration, coordination, implementation and impact, with a particular focus on the unique strengths and problems of these access PPPs as distinct from other comparable programmes where drugs are competitively procured.
Country
Zambia
Publisher
Global Forum for Health Research
Theme area
Equitable health services
Title of publication Editorial: The future of health care in Africa: Depends on making commitments work in and outside Africa
Date of publication
2005
Publication type
Journal Article
Publication details
British Medical Journal 331 7507 pp 1-2
Publication status
Published
Language
English
Keywords
health system, financing, health policy, sub-Saharan Africa
Abstract
Chronic underinvestment, interventions by global partnerships that focus only on single diseases, and sporadic financing by both national governments and their partners have left African health systems prostrate. They are unable to deliver drugs, tools, and other interventions of proved effectiveness against the leading causes of early death and illness throughout the continent. The apparently unabating national and household poverty in Africa is widely debated, and yet, despite the substantial growth in the global economy over the past half century, most of Africa remains poor. The living conditions are not conducive to good health, and people are without access to the inexpensive drugs and medicines that have proved efficacious and beneficial. The world can no longer ignore Africa and its people, and commitments to reverse this unacceptable trend are now at centre stage. Interventions in health policy will be just as important as efforts to move forward Africa's social and economic development agenda.
Country
East and southern Africa region
Publisher
British Medical Journal
Theme area
Human resources for health
Title of publication Addressing Africa’s health workforce crisis
Date of publication
2007
Publication type
Publication details
McKinsey Quarterly
Publication status
Published
Language
English
Keywords
health workers, shortages, training, sub-Saharan Africa
Abstract
Africa bears one-quarter of the burden of disease around the world yet has barely 3 percent of all health workers. Millions of people across the continent thus suffer needlessly because they cannot obtain medical care from trained personnel. In sub-Saharan Africa, where the crisis is most acute, fully 820,000 additional doctors, nurses, and midwives are needed to provide even the most basic health services. To meet this shortfall, most of the region’s countries would have to increase the size of their health workforce by 140 percent. Unfortunately, the money to hire, train, and sustain new recruits on this scale isn’t available and likely won’t be in the foreseeable future.
Country
East and southern Africa region
Publisher
McKinsey & Company
Theme area
Equitable health services
Title of publication Angola health system assessment
Date of publication
2005 September
Publication type
Publication details
The Partners for Health Reformplus Project pp 1-146
Publication status
Language
English
Keywords
health services administration, health personnel, health services, Angola
Abstract
This study assessed the Angolan health system from August 6-19, 2005. The purpose of the assessment was to inform the Mission’s development of a new health program for 2006-2011. Angola currently presents some windows of opportunity because it is in a post-war transition period; Angolans are open to change and anxious for improvement; the young population (60% of Angolans are under the age of 18) has a shorter memory of the war; elections promised for 2006; Angola's long-term economic outlook is very positive; and other donor investments in health system strengthening are in progress or planned (European Union, UN Development Programme/Global Fund, World Bank) with convergence of goals and strategies. On the other hand, Angola faces certain threats, including the risk that elections in 2006 could generate a flurry of facility construction that is not part of a rational plan or part of the health budget for recurrent costs. The country's cost structure is exceptionally high. The team's recommendations for health system strengthening activities are consistent with the Mission's proposed strategy statement, Africa Bureau's new Strategic Framework (in which Angola is classified as a fragile state), and other donor initiatives. The team's findings and recommendations were presented at a stakeholder workshop where participants worked in small groups to review and provide feedback.
Country
Angola
Publisher
Abt Associates Inc
Theme area
Health equity in economic and trade policies, Public-private mix
Title of publication Hazardous to health: The World Bank and IMF in Africa
Date of publication
2002 April
Publication type
Document
Publication details
Position Paper pp 1-14
Publication status
Published
Language
English
Keywords
Abstract
This position paper provides a brief background overview of World Bank and IMF policies. It focuses particularly on their impact on health. Over the past two decades, the World Bank and International Monetary Fund (IMF) have undermined Africa's health through the policies they have imposed. The dependence of poor and highly indebted African countries on World Bank and IMF loans has given these institutions leverage to control economic policy-making in these countries. The policies mandated by the World Bank and IMF have forced African governments to orient their economies towards greater integration in international markets at the expense of social services and long-term development priorities. They have reduced the role of the state and cut back government expenditure. While many African countries succeeded in improving their health care systems in the first decades after independence, the intervention of the World Bank and IMF reversed this progress. Investments in health care by African governments in the 1970s achieved improvements in key health indicators.
Country
East and southern Africa region
Publisher
Africa Action
Theme area
Health equity in economic and trade policies
Title of publication Mapping Health Services Trade in South Africa
Date of publication
2003 July
Publication type
Document
Publication details
Working Paper 8 pp 1-40
Publication status
Published
Language
English
Keywords
private health sector, trade, General Agreement on Trade in Services, GATS, impact
Abstract
In South Africa, there is an increasing trend towards trading health services, both in the public and in the private health sectors, despite minimal formal liberalisation offered by South Africa under the General Agreement on Trade in Services (GATS). Health services trade has been occurring in at least three of the four modes of supply: foreign commercial presence, consumption abroad and movement of natural persons. This paper concentrates on defining regulations in the health sector and determining whether these form barriers to trade or are trade enabling. The paper also provides data on the sector under the categories of human resources, health care providers and health care purchasers. It is concluded that policymakers would be wise to exercise due caution when considering health services trade liberalisation as the impact on the public sector may not be positive.
Country
South Africa
Publisher
Trade and Industrial Policy Strategies
Theme area
Public-private mix
Title of publication Private provider networks: The role of viability in expanding the supply of reproductive health and family planning services.
Date of publication
2006 April
Publication type
Document
Publication details
PSP-One Technical Report Series 3 pp 1-57
Publication status
Published
Language
English
Keywords
maternal-child health services, private healthcare delivery, monitoring, user fees
Abstract
As the private sector plays an increasingly critical role in the delivery of reproductive health/family planning (RH/FP) services, donors and public health ministries are turning their attention to business arrangements that offer the potential to increase access to high-quality priority health services. Private provider networks hold the promise of cost effectively expanding the scale of private practice, and are increasingly being considered as a way to achieve national public health objectives. Networks are an affiliation of health service providers grouped together under an umbrella structure or organisation. They are an attractive mechanism for delivering uniform health services to a broad market, with a structure that lends itself to replication. Networks are able to realise efficiencies in training, capacity building, product distribution, procurement, and the advertising of health services. This paper distinguishes among three types of networks: not-for-profit networks, social franchises, and purely commercial networks. The paper first assesses whether and how networks achieve viability and, second, distills lessons that have contributed to network viability. The review also examines the extent to which viability goals conflict with or support the delivery of RH/FP services. By drawing from the business practices of both commercial and donor-supported networks and assessing their relative strengths and weaknesses, the paper cross-fertilizes lessons from each and suggests the need for synergies and partnerships across sectors.The methodology consisted of a literature review of publications and resources on over 50 networks, the development of a framework to assess network viability, followed by in-depth interviews with representatives of 23 networks. All selected networks met the following criteria: they operate through several service delivery points, serve low to middle-income populations, and provide RH/FP services.
Country
Publisher
Abt Associates, Private Sector Partnerships-One
Theme area
Health equity in economic and trade policies, Human resources for health
Title of publication Trade in health services
Date of publication
2002
Publication type
Journal Article
Publication details
Bulletin of the World Health Organisation 80 2 pp 158-163
Publication status
Published
Language
English
Keywords
health services utilisation; delivery of health care/methods; health services accessibility; health manpower; emigration and immigration; international cooperation; health priorities
Abstract
In light of the increasing globalisation of the health sector, this article examines ways in which health services can be traded, using the mode-wise characterization of trade defined in the General Agreement on Trade in Services. The trade modes include crossborder delivery of health services via physical and electronic means, and cross-border movement of consumers, professionals, and capital. An examination of the positive and negative implications of trade in health services for equity, efficiency, quality, and access to health care indicates that health services trade has brought mixed benefits and that there is a clear role for policy measures to mitigate the adverse consequences and facilitate the gains. Some policy measures and priority areas for action are outlined, including steps to
address the ‘‘brain drain’’; increasing investment in the health sector and prioritizing this investment better; and promoting links between private and public health care services to ensure equity. Data collection, measures, and studies on health services trade all need to be improved, to assess better the magnitude and potential implications of this trade. In this context, the potential costs and benefits of trade in health services are shaped by the underlying structural conditions and existing regulatory, policy, and infrastructure in the health sector. Thus, appropriate policies and safeguard measures are required to take advantage of globalization in health services.
Country
Publisher
World Health Organization
Theme area
Equitable health services
Title of publication Health seeking behaviour in northern KwaZulu-Natal
Date of publication
2005 April
Publication type
Report
Publication details
Working Paper 116
Publication status
Published
Language
English
Keywords
health seeking behavior; demographic surveillance; South Africa
Abstract
This study examines patterns of health seeking behavior prior to death among 1282 individuals who lived in the Umkhanyakude District of Northern KwaZulu-Natal. Information on the health care choices of these individuals, who died between January 2003 and July 2004, was gathered after their deaths from their primary care-givers. We examine choices made concerning public and private medicine, western and traditional medicine, and non-prescribed self-medication. We find that virtually all adults who were ill prior to death sought treatment from a Western medical provider, visiting either a public clinic or a private doctor. In this district, which is predominantly poor, 90% of adults who sought treatment from a public clinic also visited a private doctor. Half also sought treatment from a traditional healer, suggesting that traditional medicine is seen as a complement to, rather than a substitute for, Western care. Better educated people who were ill for less than a month before dying were significantly more likely to visit a private doctor, while those least well educated were more likely to visit a traditional healer. Controlling for length of illness, better educated and wealthier people sought care from a greater range of providers, and spent significantly more on their treatment.
Country
South Africa
Publisher
Centre for Social Science Research, Princeton University
Theme area
Public-private mix, Resource allocation and health financing
Title of publication Community-based health insurance in developing countries: A study of its contribution to the performance of health financing systems
Date of publication
2005 July
Publication type
Journal Article
Publication details
Tropical Medicine and International Health 10 8 pp 799-811
Publication status
Published
Language
English
Keywords
performance of financing health systems, health financing, community health insurance, developing countries
Abstract
We studied the potential of community-based health insurance (CHI) to contribute to the performance of health financing systems. The international empirical evidence is analysed on the basis of the three health financing subfunctions as outlined in the World Health Report 2000: revenue collection, pooling of resources and purchasing of services. The evidence indicates that achievements of CHI in each of these subfunctions so far have been modest, although many CHI schemes still are relatively young and would need more time to develop. We present an overview of the main factors influencing the performance of CHI on these financing subfunctions and discuss a set of proposals to increase CHI performance. The proposals pertain to the demand for and the supply of health care in the community; to the technical, managerial and institutional set-up of CHI; and to the rational use of subsidies.
Country
Publisher
Wiley InterScience
Theme area
Equitable health services
Title of publication Case study 6: Review of health service delivery in Uganda: General country experience and northern Uganda
Date of publication
2004
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
health care provision, project aid, health worker capacity, Northern Uganda
Abstract
Uganda is considered one of Africa’s economic success stories with an average 7% annual economic growth, political stability for almost 20 years and robust macro-economic and pro-poor policies. As a result donors have moved towards putting their financial development aid into direct budget support and sector budget support, rather than working through projects. However, Uganda persists as a difficult environment or country under stress due to ongoing conflict in the North and East of the country where large areas of the regions remain outside government control. Uganda is not on track to meet MDG health targets, with the government citing insecurity in northern districts as being the primary reason. The government has committed up to 22% of the national budget for local government services to northern districts. A 2004 parliamentary report found that large amounts of these allocations go unspent due to the districts’ inability to carry out most routine work in the north. In the health sector for example, on average on 60% of posts are filled, though this masks much higher levels of unfilled posts in some areas of the northern region. Each district has a functioning District Health Management Team, as well as a District Disasters Management Committee. The capacity of members of these teams is viewed to be relatively weak, and various donors have started initiatives to try and strengthen these groups. Much of the gap in health care provision is provided by non-state actors (especially NGOs), though this also remains limited due to insecurity in the region. Government policy frameworks and co-ordination are important for guiding assistance through both public and private sectors. However, the Ugandan government needs more encouragement to treat the north and east as a special case. Long time frames are vital in supporting conflict resolution and postconflict reconstruction efforts, while donors tend to work in much shorter time frames and move too rapidly to adapt appropriate aid instruments, rather than taking the longer term view. Project aid can complement and support government systems and give space for innovation. Without NGO project assistance in Northern Uganda little health or food assistance would be reaching IDPs and areas affected by the conflict. Limited government capacity in the northern districts and limited willingness to invest more human and financial resources towards improving service delivery capacity necessitates the intervention of non-state actors.
Country
Uganda
Publisher
DFID Health Systems Resource Centre
Theme area
Public-private mix
Title of publication Applying managed care concepts and tools to middle and lower income countries: The case of medical aid societies in Zimbabwe
Date of publication
2000
Publication type
Academic paper
Publication details
Data for Decision Making Project pp 1-8
Publication status
Published
Language
English
Keywords
medical aid societies, managed care, regulatory environment, provision of care, Zimbabwe
Abstract
This paper presents information from an investigation of managed care in Zimbabwe by a large medical aid society. The authors contend that it is more important for health managers in middle and lower income countries to become familiar with the many concepts and tools of managed care than the ever-changing organisational forms found in the United States. The question should not be whether HMOs or PPOs as developed in the US are adaptable to other countries, but what specific tools to improve the financing and provision of care are appropriate in other, i.e. non-US health care systems. Focusing on specific managed care mechanisms rather than organisational forms, however, does not eliminate or even necessarily reduce management or policy concerns. Managers, policy-makers and regulators in every environment should be conscious of potentially serious issues relating to quality and access.
Country
Zimbabwe
Publisher
Harvard School of Public Health
Theme area
Public-private mix
Title of publication Can developing countries achieve adequate improvements in child health outcomes without engaging the private sector?
Date of publication
2003 March
Publication type
Journal Article
Publication details
Bulletin of the World Health Organization 81 12 pp 886-894
Publication status
Published
Language
English
Keywords
private sector utilisation; child outcomes; child health programmes
Abstract
The private sector exerts a significant and critical influence on child health outcomes in developing countries, including the health of poor children. This article reviews the available evidence on private sector utilisation and quality of care. It provides a framework for analysing the private sector's influence on child health outcomes. This influence goes beyond service provision by private providers and nongovernmental organisations (NGOs). Pharmacies, drug sellers, private suppliers, and food producers also have an impact on the health of children. Many governments are experimenting with strategies to engage the private sector to improve child health. The article analyses some of the most promising strategies, and suggests that a number of constraints make it hard for policy-makers to emulate these approaches. Few experiences are clearly described, monitored, and evaluated. The article suggests that improving the impact of child health programmes in developing countries requires a more systematic analysis of how to engage the private sector most effectively. The starting point should include the evaluation of the presence and potential of the private sector, including actors such as professional associations, producer organisations, community groups, and patients' organisations.
Country
Publisher
World Health Organization
Theme area
Public-private mix
Title of publication Improving the quality of private sector delivery of public health services: Challenges and strategies
Date of publication
1998 June
Publication type
Journal Article
Publication details
Health Policy and Planning 13 2 pp 107-120
Publication status
Published
Language
English
Keywords
private health care, public-private mix, service provision, sustainability
Abstract
Despite significant successes in controlling a number of communicable diseases in low and middle income countries, important challenges remain, one being that a large proportion of patients with conditions of public health significance, such as tuberculosis, malaria, or sexually transmitted diseases, seek care in the largely unregulated 'for profit' private sector. Private providers (PPs) often offer services which are perceived by users to be more attractive. However, the available evidence suggests that serious deficiencies in technical quality are often present. Evaluations of interventions to promote evidence-based care in high income countries have shown that multi-faceted strategies which increase provider knowledge have had some success in improving service quality. A wider range of factors needs to be considered in low and middle income countries (LMICs), especially factors which contribute to discrepancies between provider knowledge and practice. Studies have shown that PPs, especially, perceive or experience patient and community pressures to provide inappropriate treatments. LMIC governments also lack the capacity to enforce regulatory controls. Context-specific multi-faceted strategies are needed, including the local adaptation and dissemination to providers of relevant evidence, the education of patients and communities to adopt effective treatment-seeking and treatment-taking behaviour, and feasible mechanisms for ensuring and monitoring service quality, which may include a role for self-regulation by provider organizations or provider accreditation. Developing, implementing and evaluating strategies to improve the quality of service provision will depend on the involvement of the key stakeholders, including policy makers and PPs. Focusing on studies from Asia, Africa and Latin America, this paper develops a model for identifying the influences on PPs, mainly private medical practitioners, in their management of conditions of public health significance. Based on this, multi-faceted strategies for improving the quality of treatment provision are suggested. Interventions need to be inexpensive, practical, efficient, effective and sustainable over the medium to long term. Achieving this is a significant challenge.
Country
Publisher
Oxford University Press
Theme area
Public-private mix
Title of publication Key performance indicators from the 2006 survey of medical schemes in Southern Africa
Date of publication
2006
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
private health insurance, performance indicators, medical schemes, South Africa
Abstract
This reports gives a snapshot of both open and restricted medical schemes. This report includes 31 schemes, and while this is not a complete sample of the medical schemes industry, it represents 24% of the schemes and accounts for 79% of the medical scheme enrolment. However, for the purposes of this report the analysis is at the level of the scheme and not at the level of scheme membership per se. The schemes selected are a combination of the 15 largest open schemes and 16 restricted schemes. The overview therefore compares data for all the schemes for 2005. Although this analysis cannot be generalised to the industry as a whole, it seeks to shed light on the complex range of issues affecting the industry. The analysis is based primarily on the annual statutory returns of the medical schemes for the 2005 calendar year. Some of the notable developments in the private healthcare sector during 2005/6 include: the National Health Reference Price List (NHRPL); Social Health Insurance (SHI); consultative investigation into low income medical schemes (LIMS); a tax reform that seeks to limit the tax loss associated with
more expensive medical scheme options, whilst increasing the benefit to lower-income taxpayers, in an attempt to increase affordability and to introduce a progressive tax system; introduction of Government Employee Medical Schemes (GEMS); single exit price (SEP) opn medication legislation has caused some decrease in cost to medical schemes. However, there are expectations in the industry that costs will drop even further once the international benchmarking exercise has been
completed by the Department of Health; the Health Charter is reaching finalisation with all parties agreeing on the majority of the contents; Health Quality Assessment (HQA) report aimed at achieving fair and accurate measurement of health outcomes which allows schemes to evaluate the quality of their benefit options.
Country
South Africa
Publisher
Board of Healthcare Funders
Theme area
Health equity in economic and trade policies
Title of publication International Trade in Health Services and the GATS: Current Issues and Debates
Date of publication
2006 September
Publication type
Book
Publication details
Publication status
Published
Language
English
Keywords
trade, health services, General Agreement on Trade in Services, GATS, World Trade Organisation
Abstract
Health ministries around the world face a new challenge: to assess the risks and respond to the opportunities of the increasing openness in health services under the World Trade Organization's (WTO) General Agreement on Trade in Services (GATS). International Trade in Health Services and the GATS addresses this challenge head-on by providing analytical tools to policymakers in health and trade ministries alike who are involved in the liberalisation agenda and, specifically, in the GATS negotiations. This book informs and assists policymakers in formulating trade policy and negotiating internationally. There is ongoing and animated international debate about the impact of GATS on public services in general and health in particular.
The book offers: detailed legal analysis of the impact of the agreement on health policy; an overview of trade commitments in health-related services; new empirical evidence from nine country studies; and a simple 10-step explanation on how to deal with GATS negotiations.
Country
Publisher
World Bank
Theme area
Public-private mix
Title of publication The policy on the public-private mix in the Ugandan health sector: Catching up with reality
Date of publication
2001
Publication type
Journal Article
Publication details
Health Policy and Planning 16 supplement 2 pp 80-87
Publication status
Published
Language
English
Keywords
public-private mix, policy, Uganda
Abstract
An informal public–private mix in the health sector has always existed in Uganda, and policymakers, planners and the public in general have taken this for granted. There is now renewed effort to develop a comprehensive policy on the mix, but the policy process has proved to be tortuous and the mix has been interpreted differently by different stakeholders. While significant differences in opinion on the mix still remain, it is becoming clear that the new policy should enable health institutions, whether in the public or the private sector, to play roles in which they have clear comparative advantage over others.
Country
Uganda
Publisher
Oxford University Press
Theme area
Public-private mix
Title of publication Kenya: Non-governmental health care provision
Date of publication
1995 April
Publication type
Academic paper
Publication details
Data for Decision Making Project pp 1-151
Publication status
Published
Language
English
Keywords
private health, non-governmental organisations, Kenya
Abstract
Kenya has long followed a strategy of pluralism in the health sector, allowing a large and diverse non-government health sector to develop. This report documents the contributions of this non-government sector to some of Kenya’s health goals. The potential exists for much higher levels of contribution from the non-governmental sector. This requires collaboration between the public and private sectors in identifying national public health priorities and in putting in place a framework for achieving those goals. There is some confusion over the classification of private providers. Non-government providers account for 50% of all hospitals and 36 % of Kenya’s hospital beds. They also account for approximately 21% of health centers and 51% of all other outpatient treatment facilities, although these include a wide variety of different levels of quality and capacity. The private sector has grown from a few providers when Kenya became independent of British rule in 1963, to nearly 1500 in 1993. The provider survey, showed a rise in the numbers of providers beginning work since 1990, implying recent rapid growth.
The geographic distribution of private health facilities in the country shows strong patterns of rural-urban differentiation and concentration of certain types of providers in certain areas.
The non-governmental health sector makes a substantial contribution to Kenya’s health services provision. on-government services are used by all socioeconomic classes, although the type of facility used may differ across these groups.
Country
Kenya
Publisher
Harvard School of Public Health
Theme area
Public-private mix
Title of publication Zambia: Non-governmental health care provision
Date of publication
1995 January
Publication type
Academic paper
Publication details
Data for Decision Making Project pp 1-125
Publication status
Published
Language
English
Keywords
private health, preventative care, public health
Abstract
There a numerous different types of private health care provider in Zambia. A simple typology would include the following major types: the missions, employer-owned clinics, private for-profit clinics and hospitals, pharmacies, shops and traditional providers. The mine facilities are another source of health care, which are run by the government-owned ZCCM, but which in practice are operated independently of the Ministry of Health (MOH). Each of these types distinctively differs in their commercial orientation, structure, activity and distribution in different parts of the country. Policy-makers must take this into account when assessing the potential role of private providers, and when implementing policies towards the sector. In the long-term, expansion of private for-profit provision is likely to be associated with reinforcement of existing inequalities between regions and households in access to modern care. Private provision will tend to expand only in urban areas, and MOH personnel will be more reluctant to work in peripheral areas as the opportunities for supplementing incomes through private practice improve in urban areas. Options to deal with these problems include increased and enforced rural service requirements for newly graduated health personnel, increased compensation for rural MOH employees, and a differential relaxation in private practice rules for MOH employees. Private providers tend to under-provide preventative care and services of public health importance. Regulation is one option, but this is not recommended because
of weak administrative capacity. The better alternatives in Zambia’s case are provision of information to educate consumers, and better training of private providers. Judicious selection of policies should allow policy makers to both increase the level of private provision, and increase the availability of and equity in public provision.
Country
Publisher
Health and Human Resources Analysis for Africa (HHRAA) Project, Harvard University
Theme area
Equitable health services
Title of publication Government capacity to contract: health sector experience and lessons
Date of publication
1998
Publication type
Journal Article
Publication details
Public Administration and Development 18 4 pp 307-326
Publication status
Published
Language
English
Keywords
contracting, capacity, risks, developing countries, government programs
Abstract
Using case-study material of contracting for clinical and ancillary services in the health care sector of developing countries, this article examines the capacities required for successful contracting and the main constraints which developing country governments face in developing and implementing contractual arrangements. Required capacities differ according to the type of service being contracted and the nature of the contractor. Contracting for clinical as opposed to ancillary services poses considerably greater challenges in terms of the information required for monitoring and contract design. Yet, in some of the case-studies examined, problems arose owing to government's limited capacity to perform even very basic functions such as paying contractors in a timely manner and keeping records of contracts negotiated. The external environment within which contracting takes place is also critical; in particular, the case-studies indicate that contracts embedded in slow-moving, rule-ridden bureaucracies will face substantial constraints to successful implementation. The article suggests that governments need to assess required capacities on a service-by-service basis. For any successful contracting, basic administrative systems must be functioning. In addition, there should be development of guidelines for contracting, clear lines of communication between all agents involved in the contracting process, and regular evaluations of contractual arrangements. Finally, in cases where government has weak capacity, direct service provision may be a lower-risk delivery strategy.
Country
Publisher
Public Administration and Development
Theme area
Equitable health services
Title of publication Making health systems work: Working with the non-state sector to achieve public health goals
Date of publication
2005
Publication type
Academic paper
Publication details
Working Paper 2 pp 1-17
Publication status
Published
Language
English
Keywords
non-state actors, public health, non-govermental organisations, social marketing, voucher schemes, franchising
Abstract
The purpose of this paper is to begin to develop consensus about key challenges and effective strategies in working with the non-state sector to achieve public health goals. Non-state actors can help improve coverage of products and services and promote quality care. This paper focuses primarily on the provision of clinical services and commodities, and analyses various interventions such as social marketing, voucher schemes and franchising. The study found that there is a need to:
* define and establish a clear role for government with reference to the non-state sector;
* strengthen basic regulatory functions;
* build institutional capacity in the currently disorganised non-state sector;
* build public sector ability to work with non-state sector;
* build capacity at district level, to support NGO strengthening;
* build capacity of civil society to play an advocacy role and hold state and non-state actors to account; and
* strengthen empirical knowledge base on effective programmes.
Country
Publisher
World Health Organization
Theme area
Resource allocation and health financing
Title of publication Paging Dr Ricardo: A dose of economics for healthier pharmaceutical production
Date of publication
2008 February
Publication type
Academic paper
Publication details
Health Policy Outlook 1 pp 1-10
Publication status
Published
Language
English
Keywords
pharmaceutical manufacture; access to drugs; drug quality; protectionism
Abstract
Efforts to increase the poor’s access to medicines are nothing new. Buying products from quality manufacturers and urging these manufacturers to lower prices for the poorest markets have worked best; other policies have largely failed or are still on the drawing board. But the latest strategy — to encourage local
pharmaceutical production — could also be entirely counterproductive. It could lower drug quality and increase incentives for protectionism, ultimately reducing access. Production of drugs in poorer countries can make sense, but it must be driven by entrepreneurs responsive to market incentives. Unsuccessful local businesses must be allowed to fail, not be propped up by aid groups that support local production
without considering its long-term economic consequences. This would encourage better, more profitable businesses, which will be the engines of growth for poor nations. Coming years will test whether the international community encourages quality production or indirect protectionism.
Country
Publisher
American Enterprise Institute
Theme area
Health equity in economic and trade policies
Title of publication Low enrolment in Ugandan community health insurance schemes: Underlying causes and policy implications
Date of publication
2007 July
Publication type
Journal Article
Publication details
BioMed Health Services Research 7 105
Publication status
Published
Language
English
Keywords
Community Health Insurance, CBHI, community involvement, premiums, policy framework
Abstract
Despite the promotion of Community Health Insurance (CHI) in Uganda in the second half of the 90s, mainly under the impetus of external aid organisations, overall membership has remained low. Today, some 30,000 persons are enrolled in about a dozen different schemes located in Central and Southern Uganda. Moreover, most of these schemes were created some 10 years ago but since then, only one or two new schemes have been launched. The dynamic of CHI has apparently come to a halt. A case study evaluation was carried out on two selected CHI schemes: the Ishaka and the Save for Health Uganda (SHU) schemes. The objective of this evaluation was to explore the reasons for the limited success of CHI. The evaluation involved review of the schemes' records, key informant interviews and exit polls with both insured and non-insured patients. On the demand side, underachievement is because of: lack of basic information on the scheme's design and operation, limited understanding of the principles underlying CHI, limited community involvement and lack of trust in the management of the schemes, and, last but not least, problems in people's ability to pay the insurance premiums. On the supply-side, underachievement is because of: limited interest and knowledge of health care providers and managers of CHI, and the absence of a coherent policy framework for the development of CHI. The policy implications of this study refer to the need for the government to provide the necessary legislative, technical and regulative support to CHI development. The main policy challenge however is the need to reconcile the government of Uganda's interest in promoting CHI with the current policy of abolition of user fees in public facilities.
Country
Uganda
Publisher
BioMed Central
Theme area
Resource allocation and health financing
Title of publication Health insurance for the informal sector in Africa: Design features, risk protection, and resource mobilization
Date of publication
2001
Publication type
Academic paper
Publication details
HNP discussion paper pp 1-58
Publication status
Published
Language
English
Keywords
community based health insurance, CBHI, risk protection, resource mobilisation, design features
Abstract
Studies and literature reviews of health insurance schemes targeting rural or informal sector populations in developing countries (often termed as community insurance schemes) frequently conclude that schemes have design weaknesses, yet do not explore in detail the effect of design features on performance. The paper presents a conceptualisation of how performance in the area of risk protection and resource mobilisation is determined by the interaction of design features with institutional and technical factors.
Country
Publisher
World Bank
Theme area
Resource allocation and health financing
Title of publication Are the poor too poor to demand health insurance?
Date of publication
2004
Publication type
Journal Article
Publication details
Journal of Microfinance 6 1 pp 1-20
Publication status
Published
Language
English
Keywords
community based health insurance, CBHI, poor household
Abstract
Community based microinsurance has aroused much interest and hope in meeting health care challenges that face the poor. This paper explores how institutional rigidities, such as credit constraint, affect the demand for health insurance and how insurance could potentially prevent poor households from falling into the poverty trap. In this setting, we argue that the appropriate public intervention to generate demand for insurance is not to subsidise premium, but to remove these rigidities (i.e., ease credit constraint). Thus from an insurance perspective as well, our analysis highlights the importance of the poor having the appropriate saving and borrowing instruments.
Country
Publisher
Journal of Microfinance
Theme area
Health equity in economic and trade policies
Title of publication The World Bank and world health: Changing Sides
Date of publication
1999 March
Publication type
Journal Article
Publication details
British Medical Journal 318 7187 pp 865-869
Publication status
Published
Language
English
Keywords
World Bank, debt relief, debt burden, health policy, poverty
Abstract
The World Bank’s aim is to reduce poverty by investing in people. The past decade has seen it change image from uncaring bully to compassionate stakeholder, focusing on health. It has displaced the World Health Organisation as the major influence behind health policy in poor countries because of its greater funding power. Critics argue that the World Bank and International Monetary Fund increase the debt burden of those countries least able to pay, and that debt relief would be the best way to eradicate poverty
Country
Publisher
British Medical Journal
Theme area
Governance and participation in health
Title of publication SEAPACOH Strategic Plan 2009-2013
Date of publication
2009 May
Publication type
Report
Publication details
SEAPACOH Strategic Plan 2009-2013
Publication status
Published
Language
Keywords
parliaments, strategic plans, east and southern Africa
Abstract
The Strategic Framework also represents a growing sense of cooperation
between SEAPACOH and its Civil Society partners for health and HIV and AIDS. It also signifies the growing democratization of the parliamentary processes brought about by the Reformation of Parliamentary processes that were undertaken by most parliaments in the regions. Through a participatory process, SEAPACOH has formulated its strategic direction and articulated the Alliance’s priority areas of business focus and strategic interventions during the period 2009-2013. The three main areas of focus identified include:
 Ensuring needs-based resourcing of the health sector
 Ensuring effective domestication, implementation and compliance with agreed upon commitments in the health sector by governments, and
 Ensuring sustainability of the Alliance
level.
Country
East and southern Africa region
Publisher
SEAPACOH
Theme area
Public-private mix
Title of publication Discussion paper 77: Commercialisation of health and capital flows in east and southern Africa: Issues and implications
Date of publication
2009 August
Publication type
Report
Publication details
Discussion Paper Series 77. Rhodes University Institute of Social and Economic Research, York University, Training and Research Support Centre, SEATINI, EQUINET: Harare.
Publication status
Published
Language
Keywords
Capital flows; east and southern Africa; private health sector
Abstract
While there is much promotion of private capital flows into the health sector in Southern Africa in reality these flows have been minimal. Private health is the fifth most promoted sector in African after tourism, hotels and restaurants, energy, and computer services.
To understand flows of private capital behind the growth of the for-profit health care sector in SADC, EQUINET working through Rhodes University Institute of Social and Economic Research (ISER) and other institutions in the region are examining health sector capital flows in ESA. Despite the minor movements of capital in the ESA health sector, Mauritius, South Africa, Botswana and Namibia appear as the growth points for big capital, with the rest of the region relegated to the margins in terms of large investments. Investment potential exists in the pharmaceutical, hospital and hospital services sectors, but most of new FDI in health is in the pharmaceutical sector often for the production of ARVs to absorb large donor funds. The pharmaceutical sector has also had the most significant amounts of overt privatisation of all health-related sectors, either through selling fixed assets or transfer of equity. The report argues that South Africa is likely to be the biggest destination for investment in health care, and the major regional source of private FDI flows to the health sector in ESA countries.
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Discussion paper
Theme area
Public-private mix
Title of publication Discussion Paper 76: Capital flows in the health sector in South Africa: Implications for equity and access to health care
Date of publication
2009 July
Publication type
Report
Publication details
EQUINET Discussion Paper Series 76. Rhodes University. York
Publication status
Published
Language
Keywords
private health sector; capital flows, south Africa; health financing
Abstract
This paper was commissioned under the umbrella of the Regional Network for Equity in
Health in east and southern Africa (EQUINET), led by the Institute of Social and Economic
Research, Rhodes University (ISER) to map and review documented (secondary) evidence on capital flows in the health sector and their implications for equitable access to health care services between 1995 and 2007 in South Africa.
The paper finds that private intermediaries channel more funds than the public ones, yet a significant proportion of the population meets health service costs through out-of-pocket payments, and for many this is catastrophic expenditure. There have been successful pro-equity measures to increase access to both public and private health care services e.g. through removal of barriers, such as user fees at primary health care (PHC) facilities, increased coverage of medical aid and through regulation of the private sector. However, inequities in access persist, as do geographical barriers to access. The period reviewed is one where expansion of both public and private sectors has taken place. The challenge remains to translate this into equitable use of available
resources, or increased access to health services, especially for those with higher health
need. Improved monitoring of health systems impacts of trends described in this paper is urged, given the significant share of private sector services in the public-private mix in health in South Africa.
Country
South Africa
Publisher
EQUINET
URL:
Equinet Publication Type
Discussion paper
Theme area
Title of publication Impacts of health worker migration on health systems in east and southern Africa Report of a regional research methods meeting, 14-16 July 2009, Harare, Zimbabwe.
Date of publication
2009 July
Publication type
Report
Publication details
Impacts of health worker migration on health systems in east and southern Africa Report of a regional research methods meeting, 14-16 July 2009, Harare, Zimbabwe. WHO AFRO, EQUINET: Harare.
Publication status
Published
Language
Keywords
East and southern Africa; health worker migration; research methods
Abstract
A regional meeting was held to bring together the cross section of stakeholders from WHO/AFRO, SADC, ECSA-HC, EQUINET, government officials and researchers from the region to develop a harmonized approach for follow up research on health worker migration. The workshop report outlines the discussions and protocol developed to:
• highlight the key policy issues arising nationally, regionally and globally on the impacts of health worker migration on health systems; and identify key evidence gaps in negotiation of policy and agreements relating to protecting negative health systems impacts of health worker migration.
• Review existing conceptual frameworks, parameters and indicators used for assessing health worker migration flows; and for assessing dimensions of health systems; and propose a conceptual framework and parameters for measuring impacts of health worker migration on health systems;
• Review existing research initiatives on health worker migration in the region, the methodologies (design, tools) used; their limitations; and discuss and develop a shared standardised method for capturing evidence and analysing the impacts of health worker migration on health systems (in source countries) in line with the conceptual framework in (1) above;
• Identify research capacities (research teams, funding, and political will) for the follow up work on health worker migration in the region, and a coordinated and harmonised approach to follow up research on health worker migration in the region.
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Reports
Theme area
Equity and HIV/AIDS, Governance and participation in health
Title of publication EQUINET PRA paper: Intersectoral responses to nutritional needs of among people living with HIV in Kasipul
Date of publication
2009 July
Publication type
Report
Publication details
EQUINET PRA paper, RHE , KDHSG, TARSC: EQUINET, Harare
Publication status
Published
Language
Keywords
Kenya, Participatory methods, HIVand AIDS, nutrition
Abstract
This work was implemented in Kasipul Division, Rachuonyo District, Kenya, where high poverty levels lead to food insecurity exacerbated by rising food prices, by the consequences of two devastating tropical storms and soaring transportation costs. Few PLWHIV own farms, or produce a marketable surplus, and illness and malnutrition interact in a vicious cycle. KDHSG and RHE implemented a participatory action research programme, within EQUINET, to explore dimensions of (and impediments to delivery of) Primary Health Care responses to HIV and AIDS. It used a mix of PRA and quantitative approaches to;
• Identify the nutritional needs, issues and responses for PLWHIV on treatment
• Increase voice and participation of PLWHIV and communication with health workers on their nutritional needs in relation to treatment and on responses to these needs in the clinics and community
• Increase the capacity of health workers and community to identify specific areas for engagement of partners outside the health sector on intersectoral responses to support nutritional inputs for PLWHIV on treatment. This work indicates that expanding access to treatment services needs to be embedded within a wider framework of wider health support, including the intersectoral action to address food needs, if availability is to translate into effective coverage. Nutrition support is a vital element of the chronic care and health management strategies needed for PHC responses to AIDS. This includes shifting perception of PLWHIV from that of disabled dependents of emergency support to people able to know and address their nutritional needs through local food resources.
Country
Kenya
Publisher
EQUINET
Equinet Publication Type
Discussion paper
Theme area
Health equity in economic and trade policies, Resource allocation and health financing
Title of publication Discussion paper 75: Financing for HIV, AIDS, TB and malaria in Uganda: An equity analysis
Date of publication
2009 April
Publication type
Document
Publication details
EQUINET Discussion Paper 75 pp 1-49
Publication status
Published
Language
English
Keywords
global health initiatives; donor funding; PEPFAR; GFATM; World Bank’s Multi-country HIV/AIDS Programme; MAP; President’s Malaria Initiative; PMI; Uganda
Abstract
This paper explores and presents the current patterns of AIDS, TB and Malaria (ATM) financing within the health sector, and investigates the extent to which GHI financing for ATM has influenced heath care financing reforms. We obtained information for this paper through key informant interviews and extensive literature review. There is fragmentation between government and donor project funding, and also within donor project funds, which negatively impacts on creation of larger pools. Donor funding channelled through projects and global health initiatives targeting specific diseases may undermine equity between geographic areas. The lack of effective coordination of donor project funds is a breeding ground for inefficiencies and inequity. We recommend that the Ministry of Health should double its efforts to improve co-ordination and harmonisation of all development aid, including support from global health initiatives (GHIs). Long term institutional arrangements are a starting point for this process, but more buy-in is required in order for it to be accepted by all stakeholders. Government should design mechanisms that will help integrate GHIs resources to allow for greater cross-subsidisation and to reduce overlaps and inefficiencies. The Ministry of Health should negotiate with development partners to channel GHI resources through one common structure within the MoH.
Country
Uganda
Publisher
EQUINET
Equinet Publication Type
Discussion paper
Theme area
Resource allocation and health financing
Title of publication Report of a methods workshop: Integrating equity into resource allocation, 26–27 November 2008, Cape Town
Date of publication
2008 November
Publication type
Conference Proceedings
Publication details
EQUINET Workshop Report pp 1-19
Publication status
Published
Language
English
Keywords
resource allocation, needs-based forumula, distribution of resources, public health care resources, Mozambique
Abstract
This workshop was designed to provide the Ministry of Health in Mozambique with support on practical approaches to achieving a more equitable distribution of public health sector resource allocation outlays. Based on communication with officials of the Mozambican Ministry of Health, there have been concerns around the inequitable distribution of public health care resources, with areas of higher socio-economic status and relatively lower levels of disease burden receiving higher health care allocations. The key problems for the Ministry of Health were: how to empirically show that the current resource allocation outlays are inequitable and how to design a formula that allows for the shift of resources to ensure a more equitable distribution. In addition, the Ministry of Health also needed to understand the critical process issues that need to be considered in adopting a needs-based resource allocation formula.
Country
South Africa
Publisher
EQUINET
URL:
Equinet Publication Type
Reports
Theme area
Values, policies and rights, Governance and participation in health
Title of publication Discussion paper 74: Parliamentary committee experiences on promoting the right to health in east and southern Africa
Date of publication
2009 July
Publication type
Report
Publication details
EQUINET Discussion Paper 74
Publication status
Published
Language
English
Keywords
parliaments; health rights; east and southern Africa
Abstract
Parliaments can play a key role in promoting the right to health in east and southern Africa, particularly in helping to oversee and realise state commitment to health rights. To better understand and support the practical implementation of this role, this report presents the findings of a questionnaire administered to parliamentary committees from 12 countries in the region. Interviews were also conducted with 20 ministers of parliament from 10 of those countries. Knowledge of international human rights and related laws pertaining to the right to health was found to be limited. Parliamentarians were more likely to be familiar with Trade-related Aspects of Intellectual Property Rights (TRIPS) applications and with the provisions of the Abuja Declaration than with rights agreements such as the International Covenant on Economic, Social and Cultural Rights (ICESCR), its General Comment 14 or the African Charter on Peoples and Human Rights. Important gains could be made if parliamentarians were able to analyse, interpret and integrate these agreements into their parliamentary work.
Rights arguments entered mainly through public engagement with parliamentary committees, often invoking rights arguments related to resourcing decisions and, in general, public participation was regarding as very valuable for parliamentary processes. The survey highlighted the importance of building capacity amongst parliamentarians in the region to interpret and use rights-based analyses in their parliamentary roles and to achieve the progressive realisation of health rights. Foreign criticism of a rights-based approach to governance, which claims that it will preference individuals over groups, did not carry weight here, as respondents noted that both individuals and groups stood to gain from this approach. The main challenges facing parliamentarians appear to be: how to deal with policy choices under conditions of severe resource constraints and, particularly, the application of the concept of progressive realisation of the right to health; how to balance individualist concepts of rights with rights claims that benefit groups so that it is not simply a question of those who shout the loudest getting access to decision making processes; and how to structure engagement with civil society to preference groups who are most marginalised – a pro-poor application in human rights practice.
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Discussion paper
Theme area
Equity and HIV/AIDS, Governance and participation in health
Title of publication EQUINET PRA report: Acceptibility and accessibility of HIV testing and treatment services in Bembeyi, Bunia, North eastern DR Congo
Date of publication
2009 May
Publication type
Report
Publication details
EQUINET PRA paper, IPASC, TARSC, IHI: EQUINET, Harare
Publication status
Published
Language
Keywords
participation and health, DR Congo, HIV and AIDS, stigma
Abstract
In the DR Congo, where the national HIV prevalence is around 5%, testing and treatment services are more available in urban than rural areas, despite the latter being more affected by the epidemic. In Bunia and Aru, North eastern DRC, people living with HIV and AIDS (PLWHA) cannot access testing or treatment services unless they travel to Bunia town, some distance away. Discrimination from community members towards PLWHA is further identified as a reason for people not coming for HIV testing, and for discouraging other prevention activities. The Pan African Institute of Community Health (IPASC) used a participatory reflection and action (PRA) approach with the concerned rural communities to examine and act on negative perceptions within the community around HIV testing and treatment, to support improved demand for and uptake of these services, to make more effective use of available resources and services. The specific groups targeted were male and female PLWHA aged 20-49 years, male and female adolescents 15-19 years, community and church leaders and community health workers. All above groups were targeted because of their vulnerability and influence on attitudes towards HIV and AIDS.
The work was implemented within a Regional Network for Equity in Health in east and southern Africa (EQUINET) programme that aimed to build capacities in participatory action research to explore dimensions of (and impediments to delivery of) Primary Health Care responses to HIV and AIDS. The programme was co-ordinated by Training and Research Support Centre (TARSC) in co-operation with Ifakara Health Institute Tanzania, REACH Trust Malawi and the Global Network of People Living with HIV and AIDS (GNPP+). The PRA work showed that a major lesson learned for Primary Health Care responses to AIDS is that communities are able to make significant changes in barriers to testing and treatment if organised to do so, particularly using participatory processes. Community based sensitisers are an important resource in the community and can produce a measurable change in attitudes that discourage early testing and treatment. Information is indeed power and an important entry point to addressing disabling conditions within the community and to building cohesion around addressing wider service problems. PHC interventions for AIDS that do not invest in these dimensions in an empowering way undermine the effective use of other resources and the necessary synergy between communities and health services needed to manage a chronic condition such as AIDS.
Country
Congo Democratic Republic
Publisher
EQUINET
Equinet Publication Type
Discussion paper
Theme area
Equity and HIV/AIDS, Governance and participation in health
Title of publication EQUINET PRA Report: Promoting and protecting health of orphans and vulnerable children in Monkey Bay, Malawi
Date of publication
2009 April
Publication type
Report
Publication details
EQUINET PRA paper, CMPD, TARSC, REACH: EQUINET, Harare
Publication status
Published
Language
English
Keywords
Primary Health Care; participation; HIV; AIDS; vulnerable children
Abstract
This report presents the experiences and learning from participatory action research implemented by Country Minders for Peoples Development (CMPD), (a Malawi non government organization) on the co-ordination of support from service providers and community organisations for protection of sexual and reproductive health of orphans and vulnerable children in Monkey Bay, Malawi. The work was implemented within a Regional Network for Equity in Health in east and southern Africa (EQUINET) programme that aimed to explore, through participatory reflection and action (PRA) methods, dimensions of (and impediments to delivery of) Primary Health Care responses to HIV and AIDS, co-ordinated by Training and Research Support Centre (TARSC) in co-operation with Ifakara Tanzania, REACH Trust Malawi and the Global Network of People Living with HIV and AIDS (GNPP+). Through baseline and follow up surveys, key informant interviews, focus groups and participatory reflection and action (PRA) meetings the study team led by CMPD: * Identified the health needs and coping strategies of orphans and vulnerable children and their consequent risk of health and SRH problems; *Mapped the services and resources available for orphans and vulnerable children, and their coverage of and gaps in meeting the identified needs; * Implemented and assessed the outcomes from actions by local services, CBOs and communities responding to problems prioritized by the community; and *drew learning from this work on the factors affecting community level support for vulnerable children that would need to be included in comprehensive primary health care responses to AIDS.
The findings from the action research suggest that a Primary Health Care approach to AIDS should be embedded within and reinforce a wider social protection strategy that addresses life course needs, such as those of vulnerable children. Strengthening uptake of services and linking services and community resources to prioritized needs suggests that PHC responses need to be decentralized to primary care level, but cannot end at that level. Significant attention and resource commitment has to be given to promoting outreach and uptake of services and to the intersectoral actions and CBOs that support this, if resources are to be accessed and used by vulnerable groups like orphans and vulnerable children. This may generate a positive cycle, as increased health action and demand from previously marginalised groups puts pressure on government and funders to increase their support and on health workers to improve their services. Programme attention, skills orientation and investment is also needed in the communication and participatory processes that bring services, CBOs, communities and children into shared and more empowering frameworks for action.
Country
Malawi
Publisher
EQUINET
Equinet Publication Type
Discussion paper
Theme area
Human resources for health
Title of publication African Labour Radio Project: Health Worker Retention and Migration
Date of publication
2009 April
Publication type
Electronic Source
Publication details
EQUINET radio show
Publication status
Published
Language
English
Keywords
push factors; non-financial incentives; trade unions; health worker retention; east, southern and west Africa
Abstract
The fifteen minute pre-recorded show, ‘Health Worker Retention and Migration’, was produced by WWMP, in conjunction with labour journalists in east and southern Africa. It provided an in-depth analysis of the situation for health workers in Africa, and discussed incentives for retaining health workers. In the pre-recorded show, a Khayelitsha nurse who used to work at Groote Schuur hospital in Cape Town and migrated to Saudi Arabia Mavis Mpangele, Bongani Lose from Democratic Nurses of South Africa (DENOSA), Kwabena Otoo from the Ghana Trade union Congress, Joel Odijie from Nigeria Trade Union Congress, Professor Yoswa Dambisya of the University of Limpopo Department of Pharmacy and EQUINET Steering Committee, Nyasha Muchichwa from the Labour and Economic Research Institute of Zimbabwe and Percy Mahlathi, the South African Director General of the Department of Health were interviewed. The feature covers the push factors and experiences from different African countries. The feature also explores government responses to the problem as well as African trade unions response. It rounds off with examples of success stories in Zambia and Tanzania.
Country
East and southern Africa region
Publisher
Channel Africa
Equinet Publication Type
Briefs
Theme area
Equitable health services
Title of publication The intersections of gender and class in health status and health care
Date of publication
2008
Publication type
Academic paper
Publication details
Global Public Health 3 S1 pp 13-24
Publication status
Published
Language
Keywords
Gender, gender inequalities, power, poverty, class
Abstract
It is increasingly recognised that different axes of social power relations, such as gender and class, are interrelated, not as additive but as intersecting processes. This paper has reviewed existing research on the intersections between gender and class, and their impacts on health status and access to health care. The review suggests that intersecting stratification processes can significantly alter the impacts of any one dimension of inequality taken by itself. Studies confirm that socio-economic status measures cannot fully account for gender inequalities in health. A number of studies show that both gender and class affect the way in which risk factors are translated into health outcomes, but their intersections can be complex. Other studies indicate that responses to unaffordable health care often vary by the gender and class location of sick individuals and their households. They strongly suggest that economic class should not be analysed by itself, and that apparent class differences can be misinterpreted without gender analysis. Insufficient attention to intersectionality in much of the health literature has significant human costs, because those affected most negatively tend to be those who are poorest and most oppressed by gender and other forms of social inequality. The programme and policy costs are also likely to be high in terms of poorly functioning programmes, and ineffective poverty alleviation and social and health policies.
Country
United Kingdom
Publisher
Informa
Theme area
Values, policies and rights, Resource allocation and health financing, Governance and participation in health, Monitoring equity and research to policy
Title of publication Discussion paper 73: Experiences of Parliamentary Committees on Health in promoting health equity in East and Southern Africa
Date of publication
2009 March
Publication type
Report
Publication details
EQUINET Discussion Paper Series 73. TARSC, UCT, SEAPACOH
Publication status
Published
Language
English
Keywords
parliaments, oversight, health budgets, health laws, governance
Abstract
Parliaments can play a key role in promoting health and health equity through their representative, legislative and oversight roles, including budget oversight. To better understand and support the practical implementation of these roles, EQUINET (through University of Cape Town (UCT) and its secretariat at Training and Research Support Centre (TARSC) with SEAPACOH implemented a questionnaire survey in September 2008 to explore and document the work and experiences of parliamentary committees on health. This report presents the findings on the general progress on parliament work on health. The survey highlighted a number of areas of current focus of parliament work in health, the potential and experience of positive outcomes, and the limits and constraints to address to support further work.
Country
Zimbabwe
Publisher
EQUINET
URL:
Equinet Publication Type
Discussion paper
Theme area
Resource allocation and health financing, Governance and participation in health
Title of publication Our money, our responsibility: A citizens' guide to monitoring government expenditures
Date of publication
2008
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
Civil society organisations, financing, expenditure, social audits, procurement, budget, legislation, accountability
Abstract
This guide documents pioneering methodologies used by civil society organisations around the developing world to hold their governments to account for the use of public resources. Specific methodologies examined by the guide include social audits, citizen report cards, public expenditure tracking surveys, procurement monitoring tools, and participatory auditing tools. These methodologies are considered in detailed case studies presenting the work of 17 organisations from 12 countries in Asia, Africa, and Latin America. The guide will enable readers to gain familiarity with the typical processes followed by national-level governments during the execution of budgets, management of procurements, measurement of impact achieved by expenditures, and oversight of budget expenditures through audits and legislative supervision. For each of these processes, the guide provides practical tools and techniques that readers can use to monitor the results achieved by government expenditures.
Country
South Africa
Publisher
Affiliated Network for Social Accountability: Africa
Theme area
Equity in health
Title of publication Analyzing health equity using household survey data
Date of publication
2007 April
Publication type
Book
Publication details
Publication status
Published
Language
English
Keywords
World Bank, household surveys, equity, health equity, financing, expenditure
Abstract
Progress in quantifying and understanding health equities would not have been possible without appropriate analytic techniques. These techniques are the subject of this book, which includes chapters dealing with data issues and the measurement of the key variables in health equity analysis, quantitative techniques for interpreting and presenting health equity data, and the application of these techniques in the analysis of equity in health care utilisation and health care spending. The aim of the book is to provide researchers and analysts with a step-by-step practical guide to the measurement of a variety of aspects of health equity, with worked examples and computer code, mostly for the computer programme, Stata. It is hoped that these step-by-step guides, and the easy-to-implement computer routines contained in them, will help stimulate yet more research in the field, especially policy-oriented health equity research that enables researchers to help policymakers develop and evaluate programs to reduce health inequities.
Country
United States
Publisher
World Bank
Theme area
Values, policies and rights, Governance and participation in health
Title of publication Systematic synthesis of community-based rehabilitation (CBR) project evaluation reports for evidence-based policy: A proof-of-concept study
Date of publication
2008 March
Publication type
Journal Article
Publication details
BMC International Health And Human Rights 8 3
Publication status
Published
Language
English
Keywords
community-based rehabilitation, CBR, evidence-based policy, development, community participation, participation
Abstract
This paper presents the methodology and findings from a proof-of-concept study undertaken to explore the viability of conducting a systematic, largely qualitative synthesis of evaluation reports emanating from Community Based Rehabilitation (CBR) projects in developing countries. Computer assisted thematic qualitative analysis was conducted on recommendation sections from 37 evaluation reports, arising from 36 disability and development projects in 22 countries. Quantitative overviews and qualitative summaries of the data were developed. The application of the synthesis methodology utilised in this proof-of-concept study was found to be potentially very beneficial for future research in CBR, and indeed in any area within health services or international development in which evaluation reports rather than formal research evidence is the primary source material. The proof-of-concept study identified a number of limitations which are outlined. Based on the conclusions of 37 evaluation reports, future policy frameworks and implementation strategies in CBR should include a stronger emphasis on technical, organisational, administrative and personnel aspects of management and strategic leadership.
Country
United States
Publisher
BioMed Central
Theme area
Resource allocation and health financing
Title of publication The role of community-based organisations in household ability to pay for health care in Kilifi district, Kenya
Date of publication
2008
Publication type
Journal Article
Publication details
Health Policy And Planning 22 pp 381-392
Publication status
Published
Language
English
Keywords
Community-based organisations, CBOs, community participation, financing, primary health care, PHC, user fees, insurance
Abstract
There is growing concern that health policies and programmes may be contributing to disparities in health and wealth between and within households in low-income settings. However, there is disagreement concerning which combination of health and non-health sector interventions might best protect the poor. Potentially promising interventions include those that build on the social resources that have been found to be particularly critical for the poor in preventing and coping with illness costs. This paper presents data on the role of one form of social resource— community-based organisations (CBOs)—in household ability to pay for health care on the Kenyan coast. Data was gathered from a rural and an urban setting using individual interviews (n = 24), focus group discussions (n = 18 in each setting) and cross-sectional surveys (n = 294 rural and n = 576 urban households). The study describes the complex hierarchy of CBOs operating at the strategic, intermediate and local level in both settings, and comments on the potential of working through these organisations to reach and protect the poor. It highlights the challenges around several interventions that are of particular international interest at present: community-based health insurance schemes; micro-finance initiatives; and the removal of primary care user fees. It argues the importance of identifying and building upon organisations with a strong trust base in efforts to assist households to meet treatment costs, and emphasise the necessity of reducing the costs of services themselves for the poorest households.
Country
United Kingdom
Publisher
Oxford Journals
Theme area
Governance and participation in health
Title of publication Review of corruption in the health sector: Theory, methods and interventions
Date of publication
2007 November
Publication type
Journal Article
Publication details
Health Policy And Planning 23 2 pp 83-94
Publication status
Published
Language
English
Keywords
Corruption, mismanagement, power, management, financing, governance
Abstract
There is increasing interest among health policymakers, planners and donors in how corruption affects health care access and outcomes, and what can be done to combat corruption in the health sector. Efforts to explain the risk of abuse of entrusted power for private gain have examined the links between corruption and various aspects of management, financing and governance. Behavioural scientists and anthropologists also point to individual and social characteristics which influence the behaviour of government agents and clients. This article presents a comprehensive framework and a set of methodologies for describing and measuring how opportunities, pressures and rationalisations influence corruption in the health sector. The article discusses implications for intervention, and presents examples of how theory has been applied in research and practice. Challenges of tailoring anti-corruption strategies to particular contexts, and future directions for research, are addressed.
Country
United Kingdom
Publisher
Oxford Journals
Theme area
Equity and HIV/AIDS
Title of publication ‘What if they ask how I got it?’ Dilemmas of disclosing parental HIV status and testing children for HIV in Uganda
Date of publication
2008 March
Publication type
Journal Article
Publication details
Health Policy And Planning 23 pp 36-42
Publication status
Published
Language
English
Keywords
HIV/AIDS, HIV, AIDS, stigma, discrimination, disclosure, counselling, testing, VCT, children
Abstract
Limited research has been conducted outside Western settings on how HIV-positive parents decide to test and disclose their own HIV status to children. This qualitative study was conducted in 2001 and 2005 to assess parent attitudes and current counselling policy and practice regarding child testing and parental disclosure in Uganda prior to the roll-out of antiretroviral therapy. Concerns over disclosure to children of parent's HIV status and testing children for HIV represent a major psychological burden for HIV-positive parents. Further research is reported to be needed, but current counselling practice could be improved now by adapting lessons learned from existing research.
Country
United Kingdom
Publisher
Oxford Journals
Theme area
Equity and HIV/AIDS
Title of publication Rural women the losers in HIV response
Date of publication
2008 March
Publication type
Electronic Source
Publication details
Publication status
Published
Language
English
Keywords
HIV/AIDS, HIV, AIDS, women, rural communities, South Africa, poverty, discrimination, gender, marginalisation
Abstract
Rural women living with HIV in circumstances of poverty in South Africa face discrimination in relationships and in communities because of their gender, HIV status and economic marginalisation. A new Amnesty International report based on interviews with rural women, the majority of them living with HIV, exposes the overwhelming challenges they face in the midst of the severe HIV epidemic affecting the country. Despite gradual improvements in the government's response to the HIV epidemic and the adoption of a widely-welcomed five-year plan, five and a half million South Africans are HIV-infected – one of the highest numbers in any country in the world. Fifty-five percent of them are women. South African women under 25 are between three and four times more likely to be HIV-infected than men in the same age group.
Country
United Kingdom
Publisher
Amnesty International
Theme area
Equity and HIV/AIDS
Title of publication Research dossier: HIV prevention for girls and young women: Kenya
Date of publication
2008
Publication type
Academic paper
Publication details
Publication status
Published
Language
English
Keywords
Kenya, HIV/AIDS, HIV, AIDS, women, girls, marriage, gender, gender inequality, condoms, sex education, poverty
Abstract
This research dossier supports the 'Report card on HIV prevention for girls and young women in Kenya, 2008', produced by the United Nations Global Coalition on Women and AIDS (GCWA). It documents the detailed research coordinated for the GCWA by the International Planned Parenthood Federation (IPPF), with the support of the United Nations Population Fund (UNFPA), United Nations Program on AIDS (UNAIDS) and Young Positives. The dossier is divided into two sections: Part 1: Desk Research documents the extensive desk research carried out for the report card by IPPF staff and consultants based in the United Kingdom. Part 2: In-country Research documents the participatory in-country research carried out for the Report Card by a local consultant in Kenya. This involved two focus group discussions with a total of 19 girls and young women aged 15-24 years. The participants included girls and young women who are: living with HIV; in/out-of/school; involved in sex work; living in urban and suburban areas; and working as peer activists. Five one-to-one interviews with representatives of organisations providing services, advocacy and/or funding for HIV prevention for girls and young women. The stakeholders were: a country representative of an international NGO; a nurse at a national NGO focusing on sexual and reproductive health; a counsellor at an NGO/government voluntary counselling and testing centre; a programme officer of a United Nations agency; and a technical adviser of an international donor agency. Additional fact-finding was done to address gaps in the desk research.
Country
Kenya
Publisher
International Planned Parenthood Federation
Theme area
Equity and HIV/AIDS
Title of publication Report card on HIV prevention for girls and young women in Kenya, 2008
Date of publication
2008
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
Kenya, HIV/AIDS, HIV, AIDS, women, girls, marriage, gender, gender inequality, condoms, sex education, poverty
Abstract
The card builds on global policy commitments, particularly those outlined in the Political Declaration on HIV/AIDS from the 2 June 2006 High-Level Meeting, to follow up on the United Nations General Assembly Special Session on AIDS (UNGASS). In Kenya, as a result of the increased scale up of HIV-related services, the overall HIV prevalence rate has decreased in recent years. However, young women and girls in Kenya remain particularly vulnerable to HIV, due to persistent gender inequality and a lack of economic opportunities for young women and girls. Please note that this report card is a companion document to 'Research dossier: HIV prevention for girls and young women: Kenya'.
Country
Kenya
Publisher
International Planned Parenthood Federation
Theme area
Equity and HIV/AIDS
Title of publication Research dossier: HIV prevention for girls and young women: Malawi
Date of publication
2008
Publication type
Academic paper
Publication details
Publication status
Published
Language
English
Keywords
Malawi, HIV/AIDS, HIV, AIDS, women, girls, marriage, rape, intergenerational sex, condoms, sex education
Abstract
This research dossier supports the 'Report card on HIV prevention for girls and young women in Malawi, 2008', produced by the United Nations Global Coalition on Women and AIDS (GCWA). It documents the detailed research coordinated for the GCWA by the International Planned Parenthood Federation (IPPF), with the support of the United Nations Population Fund (UNFPA), United Nations Program on AIDS (UNAIDS) and Young Positives. The dossier is divided into two sections: Part 1: Desk Research documents the extensive desk research carried out for the report card by IPPF staff and consultants based in the United Kingdom. Part 2: In-country Research documents the participatory in-country research carried out for the Report Card by a local consultant in Malawi. This involved three focus group discussions with six young women (ages 25-35) in an urban area of Zomba district; nine young women (ages 21–32) in a rural area of Lilongwe district; and nine girls and young women (aged 14-22) in an urban area of Zomba district. The participants included some girls and young women who are: married/unmarried; in/out of school; living with HIV; widowed; home-based care and orphan care volunteers; and peer educators. One-to-one interviews were held with 21 representatives of organisations providing services, advocacy and/or funding for HIV prevention for girls and young women. The stakeholders included: a peer educator and youth supervisor at a youth drop-in centre; a technical advisor with a Malawian NGO; and a nurse and VCT counsellor at a national counselling organisation. Additional fact-finding was done to address gaps in the desk research.
Country
Kenya
Publisher
International Planned Parenthood Federation
Theme area
Equity and HIV/AIDS
Title of publication Report card on HIV prevention for girls and young women in Malawi, 2008
Date of publication
2008
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
Malawi, HIV/AIDS, HIV, AIDS, women, girls, marriage, rape, intergenerational sex, condoms, sex education
Abstract
The report card builds on global policy commitments, particularly those outlined in the Political Declaration on HIV/AIDS from the 2 June 2006 High-Level Meeting, to follow up on the United Nations General Assembly Special Session on AIDS (UNGASS). Nearly half of Malawi's population is under 15 years old. In 2005, prevalence among females aged 15-24 was four times that of males. The many factors that increase girls' and young women's vulnerability include a lack of knowledge about prevention methods (with only 57.3% stating that condoms can help prevent HIV). Please note that this report card is a companion document to 'Research dossier: HIV prevention for girls and young women: Malawi'.
Country
Kenya
Publisher
International Planned Parenthood Federation
Theme area
Equity and HIV/AIDS
Title of publication Research dossier: HIV prevention for girls and young women: Uganda
Date of publication
2008
Publication type
Academic paper
Publication details
Publication status
Published
Language
English
Keywords
Uganda, HIV/AIDS, HIV, AIDS, women, girls, marriage, rape, intergenerational sex, condoms
Abstract
This research dossier supports the 'Report card on HIV prevention for girls and young women in Uganda, 2008', produced by the United Nations Global Coalition on Women and AIDS (GCWA). It documents the detailed research coordinated for the GCWA by the International Planned Parenthood Federation (IPPF), with the support of the United Nations Population Fund (UNFPA), United Nations Program on AIDS (UNAIDS) and Young Positives. The dossier is divided into two sections: Part 1: Desk Research documents the extensive desk research carried out for the report card by IPPF staff and consultants based in the United Kingdom. Part 2: In-country Research documents the participatory in-country research carried out for the Report Card by a local consultant in Uganda. This required two focus group discussions with a total of 19 girls and young women aged 15-24 years. The participants included girls and young women who are: living with HIV; in/outof/ school; involved in sex work; living in urban and suburban areas; and working as peer activists. Six one-to-one interviews were held with representatives of organisations providing services, advocacy and/or funding for HIV prevention for girls and young women. The stakeholders were: a country representative of an international non-governmental organisation (NGO); a nurse at a national NGO focusing on sexual and reproductive health; a counsellor at an NGO/government voluntary counselling and testing centre; a programme officer of a United Nations agency; and a technical adviser of an international donor agency. Additional fact-finding was done to address gaps in the desk research.
Country
Kenya
Publisher
International Planned Parenthood Federation
Theme area
Equity and HIV/AIDS
Title of publication Report card on HIV prevention for girls and young women in Uganda, 2008
Date of publication
2008
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
Uganda, HIV/AIDS, HIV, AIDS, women, girls, marriage, rape, intergenerational sex, condoms
Abstract
Uganda is one of the few countries where HIV prevalence has arguably declined over the last ten years. However, the rates are still high and young women (15-24 years) – 14% of whom have begun their sex lives by age 15 – are more than four times as likely to be infected with HIV than young men. Among 15-19 year olds, this ratio is as high as six times. This is partially caused by issues around early marriage and negotiation of condom use. In addition, 1 in 10 young women (15-24 years) report force at first sex, or higher risk sexual relations with a man 10 years older or more. Please note that this report card is a companion document to 'Research dossier: HIV prevention for girls and young women: Uganda'.
Country
Kenya
Publisher
International Planned Parenthood Federation
Theme area
Equity and HIV/AIDS
Title of publication Research dossier: HIV prevention for girls and young women: Swaziland
Date of publication
2008
Publication type
Academic paper
Publication details
Publication status
Published
Language
English
Keywords
Swaziland, HIV/AIDS, HIV, AIDS, women, girls, polygamy, rape, intergenerational sex, condoms
Abstract
This research dossier supports the 'Report card on HIV prevention for girls and young women in Swaziland, 2008', produced by the United Nations Global Coalition on Women and AIDS (GCWA). It documents the detailed research coordinated for the GCWA by the International Planned Parenthood Federation (IPPF), with the support of the United Nations Population Fund (UNFPA), United Nations Program on AIDS (UNAIDS) and Young Positives. The dossier is divided into two sections: Part 1: Desk Research documents the extensive desk research carried out for the report card by IPPF staff and consultants based in the United Kingdom. Part 2: In-country Research documents the participatory in-country research carried out for the report card by a local consultant in Swaziland. This involved two focus group discussions with a total of 29 girls and young women and boys and young men aged 14 – 25 years. The participants included girls and young women who are: living with HIV; in/out-of/school; involved in sex work; living in urban and suburban areas; and working as peer activists. Five one-to-one interviews were held with representatives of organisations providing services, advocacy and/or funding for HIV prevention for girls and young women. The stakeholders were: a country representative of an international NGO; a nurse at a national NGO focusing on sexual and reproductive health; a counsellor at an NGO/government voluntary counselling and testing centre; a programme officer of a United Nations agency; and a Technical Adviser of an international donor agency. Additional fact-finding was done to address gaps in the desk research.
Country
Swaziland
Publisher
International Planned Parenthood Federation
Theme area
Equity and HIV/AIDS
Title of publication Report card on HIV prevention for girls and young women in Swaziland, 2008
Date of publication
2008
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
Swaziland, HIV/AIDS, HIV, AIDS, women, girls, polygamy, rape, intergenerational sex, condoms
Abstract
Swaziland has the highest rate of adult (15-49) HIV infection in the world, with a recent figure at 25.8%.23. Heterosexual sex is the main transmission route of HIV and the status of women has only recently been amended from that of minors in the national constitution (2006). As a result of this, young women and girls are highly vulnerable to HIV infection. The preliminary results of the Swaziland Demographic Health Survey undertaken in 2006/7 show that many more young women than young men are living with HIV. Additional factors which contribute to the challenges facing young women and girls are the legalisation of early marriage in the constitution as ‘marriage through customary rites’, strong traditionalist leadership which maintains that polygamy does not contribute to the transmission of HIV and widespread intergenerational sex. Please note that this report card is a companion document to 'Research dossier: HIV prevention for girls and young women: Swaziland'.
Country
Swaziland
Publisher
International Planned Parenthood Federation
Theme area
Equity and HIV/AIDS
Title of publication Reducing prevalence of HIV: the African and Asian scenarios
Date of publication
2008 January
Publication type
Journal Article
Publication details
RITES Journal 10 1
Publication status
Published
Language
English
Keywords
Planned parenthood, family planning, HIV/AIDS, HIV, AIDS, community participation, leadership
Abstract
There are the four pillars that will ensure that Africa and Asia are both able to respond to the challenges of HIV and also apply the painful lessons learned from this epidemic in cultures and societies that may – at first glance – seem so different. These are: visionary leadership; people-centred policies; innovative evidence-informed programmes and passionate participation.
Country
Kenya
Publisher
International Planned Parenthood Federation
Theme area
Equity and HIV/AIDS
Title of publication Predictors of mortality in patients initiating antiretroviral therapy in Durban, South Africa
Date of publication
2008 March
Publication type
Journal Article
Publication details
South African Medical Journal 98 3 pp 204-208
Publication status
Published
Language
English
Keywords
HIV/AIDS, HIV, AIDS, antiretroviral therapy, ART, mortality, predictors
Abstract
Researchers conducted a retrospective cohort study analysing data on patients who presented to McCord Hospital, Durban, and started antiretroviral therapy (ART) between 1 January 1999 and 29 February 2004. Univariate and multivariate analysis were performed and Kaplan-Meier curves were created to assess predictors. Simple clinical and laboratory data independently predict mortality and allow for risk stratification in patients initiating ART in South Africa. Interventions enabling patients to be identified before they develop these clinical markers and earlier initiation of ART will help to ensure maximum benefits of therapy.
Country
South Africa
Publisher
African Journals Online
Theme area
Equitable health services
Title of publication Basis for treatment of tuberculosis among HIV-infected patients in Tanzania: The role of chest x-ray and sputum culture
Date of publication
2008 March
Publication type
Journal Article
Publication details
BMC Infectious Diseases 8 32
Publication status
Published
Language
English
Keywords
Tuberculosis, TB, Tanzania, x-rays, poverty
Abstract
Active tuberculosis (TB) is common among HIV-infected persons living in tuberculosis endemic countries, and screening for tuberculosis (TB) is recommended routinely. The study sought to determine the role of chest x-ray and sputum culture in the decision to treat for presumptive TB using active case finding in a large cohort of HIV-infected patients. Many ambulatory HIV-infected patients with CD4 counts >200/mm3 are treated for presumptive TB. Data suggests that optimal detection requires comprehensive evaluation, including CXR and sputum culture on both symptomatic and asymptomatic subjects.
Country
United States
Publisher
BioMed Central
Theme area
Equity and HIV/AIDS, Governance and participation in health
Title of publication AIDS and home-based health care
Date of publication
2008 March
Publication type
Journal Article
Publication details
International Journal For Equity In Health 7 8 pp 1-4
Publication status
Published
Language
English
Keywords
Western Kenya, HIV/AIDS, HIV, AIDS, gender, women, home-based care, community health workers
Abstract
This paper highlights the socio-economic impacts of HIV on women. It argues that the socio-cultural beliefs that value the male and female lives differently lead to differential access to health care services. The position of women is exacerbated by their low financial base especially in the rural community where their main source of livelihood, agricultural production does not pay much. But even their active involvement in agricultural production or any other income ventures is hindered when they have to give care to the sick and bedridden friends and relatives. This in itself is a threat to household food security. The paper proposes that gender-sensitive policies and programming of intervention at community level would lessen the burden on women who bear the brunt of AIDS as caregivers and livelihood generators at household level. Improvement of medical facilities and quality of services at local dispensaries is seen as feasible since they are in the rural areas. Other interventions should target freeing women's and girls' time for education and involvement in income generating ventures. Two separate data sets from Western Kenya, one being quantitative and another qualitative, have been used.
Country
United States
Publisher
International Journal For Equity In Health
Theme area
Values, policies and rights, Equity and HIV/AIDS
Title of publication Human rights and HIV/AIDS: Now more than ever: Ten reasons why human rights should occupy the center of the global AIDS struggle
Date of publication
2007 November
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
HIV/AIDS, HIV, AIDS, human rights
Abstract
At the 2006 United Nations High Level Meeting on HIV/AIDS, world leaders reaffirmed that 'the full realization of all human rights and fundamental freedoms for all is an essential element in the global response to the HIV/AIDS pandemic.' Yet, 25 years into the AIDS epidemic, this 'essential element' remains the missing piece in the fight against AIDS. Now more than ever, law and human rights should occupy the centre of the global HIV/AIDS struggle. This booklet, published by OSI's Law and Health Initiative, presents ten reasons why.
Country
Netherlands
Publisher
Global Network of People Living with HIV/AIDS
Theme area
Equitable health services
Title of publication Saving newborn lives in Asia and Africa: Cost and impact of phased scale-up of interventions within the continuum of care
Date of publication
2008
Publication type
Journal Article
Publication details
Health Policy and Planning 23 pp 101-117
Publication status
Published
Language
English
Keywords
Neonatal survival, neonatal mortality, scaling up, MDG-4, evidence-based interventions, developing countries, health systems, service delivery
Abstract
Policy makers and programme managers require more detailed information on the cost and impact of packages of evidenced-based interventions to save newborn lives, particularly in South Asia and sub-Saharan Africa, where most of the world's four million newborn deaths occur. This study estimated the newborn deaths that could be averted by scaling up 16 interventions in 60 countries. We bundled the interventions in a variety of existing maternal and child health packages according to time period of delivery and service delivery mode, and calculated the additional running costs of implementing these interventions at scale (90% coverage) in sub-Saharan Africa and South Asia. The phased introduction and expansion of interventions was modelled to represent incremental strategies for scaling up neonatal care in developing country health systems. Low-cost, effective newborn health interventions can save millions of lives, primarily in South Asia and sub-Saharan Africa. Modelling costs and impact of intervention packages scaled up incrementally as health systems capacity increases can assist programme planning and help policy makers and donors identify stepwise targets for investments in newborn health.
Country
United Kingdom
Publisher
Oxford Journals
Theme area
Poverty and health, Equity and HIV/AIDS
Title of publication Has donor prioritisation of HIV displaced aid for other health issues?
Date of publication
2008
Publication type
Journal Article
Publication details
Health Policy and Planning 23 pp 95-100
Publication status
Published
Language
English
Keywords
HIV/AIDS, HIV, AIDS, aid, donors, health systems strengthening, funding
Abstract
Advocates for many developing-world health and population issues have expressed concern that the high level of donor attention to HIV and AIDS is displacing funding for their own concerns. Even organisations dedicated to HIV and AIDS prevention and treatment have raised this issue. However, the issue of donor displacement has not been evaluated empirically. This paper attempts to do so by considering donor funding for four historically prominent health agendas - HIV and AIDS, population, health sector development and infectious disease control - over the years 1992 to 2005. The paper employs funding data from the Organization for Economic Cooperation and Development's (OECD) Development Assistance Committee, supplemented by data from other sources. Several trends indicate possible displacement effects, including HIV and AIDS’ rapidly growing share of total health aid, a concurrent global stagnation in population aid, the priority HIV and AIDS control receives in US funding, and HIV and AIDS aid levels in several sub-Saharan African states that approximate or exceed the entirety of their national health budgets. On the other hand, aggregate donor funding for health and population quadrupled between 1992 and 2005, allowing for funding growth for some health issues even as HIV and AIDS acquired an increasingly prominent place in donor health agendas. Overall, the evidence indicates that displacement is likely occurring, but that aggregate increases in global health aid may have mitigated some of the crowding-out effects.
Country
United Kingdom
Publisher
Oxford Journals
Theme area
Equitable health services, Public-private mix
Title of publication The effectiveness of contracting out primary health care services in developing countries: A review of the evidence
Date of publication
2008
Publication type
Journal Article
Publication details
Health Policy Plan 23 pp 1-13
Publication status
Published
Language
English
Keywords
Privatisation, primary health care services, private sector, accountability
Abstract
The purpose of this study is to review the research literature on the effectiveness of contracting out of primary health care services and its impact on both programme and health systems performance in low- and middle-income countries. Due to the heightened interest in improving accountability relationships in the health sector and in rapidly scaling up priority interventions, there is an increasing amount of interest in and experimentation with contracting-out. Overall, while the review of the selected studies suggests that contracting-out has in many cases improved access to services, the effects on other performance dimensions such as equity, quality and efficiency are often unknown. Moreover, little is known about the system-wide effects of contracting out, which could be either positive or negative. Although the study results leave open the question of how contracting out can be used as a policy tool to improve overall health system performance, the results indicate that the context in which contracting-out is implemented and the design features of the interventions are likely to greatly influence the chances for success.
Country
United Kingdom
Publisher
Oxford Journals
Theme area
Public-private mix
Title of publication South African Health Review 2007: The role of the private sector within the South African health system
Date of publication
2008 March
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
South African Health Review, health indicators, monitoring, evaluation, policy, South Africa
Abstract
The South African Health Review (SAHR) is an annual publication of the Health Systems Trust (HST), which has been published since 1995. The SAHR seeks to provide a South African perspective on prevailing international public health issues, to stimulate debate and critical dialogue and to provide a platform for assessing progress in the health sector. Areas for investigation included principles and policy, pooling of resources and purchasing of health care, monitoring health care delivery, and health and related indicators.
Country
South Africa
Publisher
Health Systems Trust
Theme area
Human resources for health
Title of publication Uganda health workforce study: Satisfaction and intent to stay among health workers in public and PNFP facilities
Date of publication
2008 April
Publication type
Slide presentation
Publication details
Publication status
Published
Language
English
Keywords
Health worker retention, human resources, job satisfaction, health worker migration
Abstract
This presentation was given at the First Forum on Human Resources for Health in Kampala. It describes a study to identify the level of satisfaction and intent to stay among health workers, to inform strategies to improve retention. The study concluded that levels of satisfaction varied among cadres, with doctors most dissatisfied. Overall, there is relative stability, but the level of internal migration (from rural to urban facilities) may be of concern. Retention more problematic for higher-level skills and younger workers, with doctors most likely to leave. Management practices are important in retention.
Country
Switzerland
Publisher
Global Health Workforce Alliance
Theme area
Human resources for health
Title of publication The crisis in human resources for health care and the potential of a ‘retired’ workforce: Case study of the independent midwifery sector in Tanzania
Date of publication
2008
Publication type
Journal Article
Publication details
Health Policy and Planning 23 2 pp 137-149
Publication status
Published
Language
English
Keywords
Human resources, health policy, skilled attendant, retirement, Tanzania, private sector, qualitative, multiple case study
Abstract
The human resource crisis in health care is an important obstacle to attainment of the health-related targets for the Millennium Development Goals. One suggested strategy to alleviate the strain upon government services is to encourage new forms of non-government provision. Detail on implementation and consequences is often lacking, however. This article examines one new element of non-government provision in Tanzania: small-scale independent midwifery practices. A multiple case study analysis over nine districts explored their characteristics, and the drivers and inhibitors acting upon their development since permitted by legislative change. Because of their location and emphasis on personalized care, small-scale independent practices run by retired midwives could potentially increase rates of skilled attendance at delivery at peripheral level. The model also extends the working life of members of a professional group at a time of shortage. However, the potential remains unrealised. Successful multiplication of this model in resource-poor communities requires more than just deregulation of private ownership. Prohibitive start-up expenses need to be reduced by less emphasis on facility-based provision. On-going financing arrangements such as micro-credit, contracting, vouchers and franchising models require consideration.
Country
United Kingdom
Publisher
Oxford Journals
Theme area
Human resources for health
Title of publication Strengthening health leadership and management: the WHO framework
Date of publication
2008 April
Publication type
Slide presentation
Publication details
Publication status
Published
Language
English
Keywords
Leadership, management, human resources, accountability
Abstract
This presentation was given at the First Forum on Human Resources for Health in Kampala. It defines health leadership and management, why strengthening it is important, the lessons learned so far, and the main components and uses of the WHO framework. The framework poses three questions for evaluation: 1) Has a good balance between the four conditions (policies, legislation, norms and standards that support delegation of authority; adequate support for managers; incentives to encourage staff to become managers and for good management; and accountability for performance) been achieved? 2) Have all aspects of management strengthening been taken into account? (Or have management strengthening activities concentrated on particular aspects?) 3) Has management strengthening been effective?
Country
Switzerland
Publisher
Global Health Workforce Alliance
Theme area
Human resources for health
Title of publication Recruitment and placement of foreign health care professionals to work in the public sector health care in South Africa
Date of publication
2008 April
Publication type
Slide presentation
Publication details
Publication status
Published
Language
English
Keywords
Diaspora, health worker retention, brain drain, recruitment, retention
Abstract
This presentation was given at the First Forum on Human Resources for Health in Kampala. Its objective was to assess the feasibility and interest among stakeholders in the Netherlands, UK and US in facilitating recruitment and placement of foreign health care professionals to work in the public sector health care in South Africa. The researcher mapped relevant institutions and associations through desk review, field visits and key informant interviews. It recommends efforts to attract diaspora and foreign health care workers to the South African public health sector.
Country
Switzerland
Publisher
Global Health Workforce Alliance
Theme area
Human resources for health
Title of publication Financing human resources for health: Five questions for the international community
Date of publication
2008 April
Publication type
Slide presentation
Publication details
Publication status
Published
Language
English
Keywords
Human resources, scaling up, finance, health workers, health worker retention, retention
Abstract
This presentation was given at the First Forum on Human Resources for Health in Kampala. It presents five questions on the financial concerns of scaling up the number of health workers to provide adequate health care. First, the presenter discusses push and pull factors affecting health worker migration, then she moves on to the question of how expensive scaling up services will be. Can we pay for it? What can donors do? And what role should the International Monetary Fund play in this process?
Country
Publisher
Global Health Workforce Alliance
Theme area
Equitable health services, Equity and HIV/AIDS
Title of publication Reproductive health issues in rural western Kenya
Date of publication
2008 March
Publication type
Journal Article
Publication details
Reproductive Health 5 1
Publication status
Published
Language
English
Keywords
Reproductive health, Kenya, child mortality, maternal health, HIV
Abstract
In this community-based cross-sectional survey among rural pregnant women in western Kenya, a medical, obstetric and reproductive history was obtained. Blood was obtained for a malaria smear and haemoglobin level, and stool was examined for geohelminths. Height and weight were measured. In this rural area with a high HIV prevalence, the reported use of condoms before pregnancy was extremely low. Pregnancy health was not optimal with a high prevalence of malaria, geohelminth infections, anaemia and underweight. Chances of losing a child after birth were high. Multiple interventions are needed to improve reproductive health in this area.
Country
Publisher
Reproductive Health
Theme area
Poverty and health
Title of publication AID effectiveness: Overview of the results 2006 survey on monitoring the Paris declaration: How can donor countries fulfil the Paris Declaration commitments?
Date of publication
2007
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
Aid, donors, accountability, Paris Declaration, development
Abstract
This document presents the first volume of results from a survey on the Paris Declaration. It provides an overview of the key findings across the 34 countries involved, as well as assessing the survey process and setting out key conclusions and recommendations. Key implications of the survey that are highlighted include higher expectation levels for reform, deeper ownership and more accountable institutions, and increasing aid efficiency together with donor harmonisation. The authors suggest that aid effectiveness issues and results need to be discussed more explicitly at country level, and credible monitoring mechanisms need to be developed. If countries and donors are to accelerate progress towards achieving the Paris Declaration commitments, it is recommended that: partner countries must deepen their ownership of the development process; donors need to support these efforts by making better use of partners' capacity; to further harmonisation, donors must work aggressively to reduce the transaction costs of delivering and managing aid; and to begin addressing mutual accountability commitments, countries and donors should clearly define a mutual action agenda.
Country
France
Publisher
Organisation for Economic Cooperation and Development
Theme area
Values, policies and rights
Title of publication Women and the right to food: International law and state practice
Date of publication
2008
Publication type
Academic paper
Publication details
Publication status
Published
Language
English
Keywords
Gender, poverty, nutrition, women, Millennium Development Goals, MDGs
Abstract
In the light of Millennium Development Goals 1 – to eradicate extreme poverty and hunger – and 3 – to promote gender equality and empower women – the present study provides a cross-cutting analysis of the right to food from a gender perspective, examining relevant international instruments as well as State practice. The analysis of these documents will give an idea of what is today’s level of awareness of women’s right to food and related issues, how much is covered by law and how much is missing.
Country
United States
Publisher
Food And Agriculture Organization Of The United Nations
Theme area
Equity and HIV/AIDS
Title of publication UNAIDS task team on HIV-related travel restrictions
Date of publication
2008 March
Publication type
Electronic Source
Publication details
Publication status
Published
Language
English
Keywords
HIV, AIDS, HIV/AIDS, travel restrictions, immigration, refugees
Abstract
Since the beginning of the HIV epidemic, governments and the private sector have implemented travel restrictions with regard to HIV positive people wishing to enter or remain in a country for a short stay (e.g. business, personal visits, tourism) or for longer periods (e.g. asylum, employment, immigration, refugee resettlement, or study). UNAIDS has set up an international task team to heighten attention to the issue of HIV-related travel restrictions (both short-term and long-term) on international and national agendas and move towards their elimination.
Country
Netherlands
Publisher
Global Network Of People Living With HIV/AIDS
Theme area
Equity in health, Equitable health services, Human resources for health
Title of publication Harmonisation for Health in Africa: An action framework
Date of publication
2007
Publication type
Academic paper
Publication details
Publication status
Published
Language
English
Keywords
Health outcomes, human resources, scaling up, health systems, MDGs, Millennium Development Goals, Harmonisation for Health in Africa, HHA
Abstract
This paper sets out an initiative by African Development Bank, UNAIDS, UNFPA, UNICEF, WHO and the World Bank that aims to tackle barriers to scaling up health in Africa. The ‘Harmonisation for Health in Africa’ initiative HHA is a regional mechanism through which collaborating partners agree to focus on providing support to the countries in the African region for reaching health MDGs. The HHA initiative aims to: support countries to identify, plan and address health systems constraints to improve health related outcomes; develop national capacity through training, planning, costing and budgeting, harmonisation and stimulating peer exchange; promote the generation and dissemination of knowledge, guidance and tools for specific technical areas including strengthening health service delivery and monitoring health systems performance; support countries to leverage predictable and sustained resources for the health sector; ensure accountability and assist in monitoring performance, of national health systems, aid effectiveness and the performance of the International Health Partnership; and enhance coordination to support nationally owned plans and implementation process, helping countries to address the country level bottlenecks arising from constraints within international agencies.
Country
Switzerland
Publisher
World Health Organization
Theme area
Equitable health services
Title of publication Utilisation survey on the District Health Barometer
Date of publication
2008 February
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
District Health Barometer, DHB, South Africa, health indicators, monitoring, evaluation, managers
Abstract
This report and summary deals with the findings of the survey that deal with the District Health Barometer (DHB) publication. The DHB aims at improving the quality of and access to primary health care through monitoring important aspects of the health system at a district level by analysing and comparing a carefully selected range of health indicators. The survey was approved and supported by the National District Health System Committee (NDHSC) and conducted by Health Systems Trust among district health managers, selected provincial sector managers, district (level 1) hospital chief executive officers (CEOs), managers linked to health information systems, strategic planning and monitoring and evaluation (M&E), and local government health managers. A further survey on the next, 2006/07 publication would be useful to confirm that the DHB is still on the right track. The findings will be used to provide feedback to the respective advisory committees towards enhancing the usefulness of the publication, to provide feedback to the funder and to support future funding applications.
Country
South Africa
Publisher
Health Systems Trust
Theme area
Equity in health
Title of publication Research to action to address inequities: The experience of the Cape Town Equity Gauge
Date of publication
2008 February
Publication type
Publication details
International Journal for Equity in Health 7 6
Publication status
Published
Language
English
Keywords
Equity, sanitation, Global Equity Gauge Alliance, GEGA, community participation, resource allocation
Abstract
While the importance of promoting equity to achieve health is now recognised, the health gap continues to increase globally between and within countries. This study looked at how the Cape Town Equity Gauge initiative, part of the Global Equity Gauge Alliance (GEGA) is endeavouring to tackle this problem. It gives an overview of the first phase of research in which an initial assessment was conducted of health status and the socio-economic determinants of health across the sub-district health structures of Cape Town. Two projects from the second phase of the research are described, in which the researchers move from research to action. The first project, the Equity Tools for Managers Project, engages with health managers to develop two tools to address inequity: an Equity Measurement Tool which quantifies inequity in health service provision in financial terms, and a Equity Resource Allocation Tool which advocates for and guides action to rectify inequity in health service provision. The second project, the Water and Sanitation Project, engages with community structures and other sectors to address the problem of diarrhoea in one of the poorest areas in Cape Town through the establishment of a community forum and a pilot study into the acceptability of dry sanitation toilets.
Country
United Kingdom
Publisher
International Journal for Equity in Health
Theme area
Equitable health services
Title of publication District Health Barometer
Date of publication
2008 February
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
Primary health care, South Africa, TB, tuberculosis, deprivation, expenditure, financing, resource allocation
Abstract
Primary health care (PHC) in South Africa forms an integral part of both the country's health policies and health system and has been prioritised as a major strategy in achieving health for all. On the eve of the 30th anniversary of the Alma Ata Declaration, PHC is once again in the spotlight. How far have we come in the last 30 years? How far in the last three? The third edition of the District Health Barometer, the 2006/07 report sheds some light by monitoring the trend of key health and financial indicators in PHC over the last three years by district and province.
Country
South Africa
Publisher
Health System Trust
Theme area
Poverty and health, Equity and HIV/AIDS, Governance and participation in health
Title of publication Stronger together: Supporting the vital role played by older people in the fight against the HIV and AIDS pandemic
Date of publication
2008
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
Poverty, HIV/AIDS, HIV, AIDS, carers, caregivers, home-based care
Abstract
In the HIV and AIDS pandemic, it is older people, particularly grandmothers, who are shouldering most of the emotional and financial burden as carers. Yet their vital role is going unrecognised. This report calls for a major shift in the response to HIV and AIDS. Some of the recommendations include: public recognition of the value, contribution and rights of older women carers to reduce stigma and discrimination against them more sophisticated analysis and understanding of the role of older women and men in caring for adults and children living with HIV, so that urgent; support can be targeted at these older carers; better support to access existing services home-based care policies and programmes that address the specific economic, health and psychosocial needs of older women carers and support them in their care giving roles.
Country
United Kingdom
Publisher
HelpAge International
Theme area
Equitable health services
Title of publication Depoliticizing development and democratizing politics in Tanzania: Parallel structures as obstacles to delivering services to the poor
Date of publication
2008 July
Publication type
Report
Publication details
Norad Report 22 b pp 1-59
Publication status
Published
Language
English
Keywords
Decentralisation, Tanzania, community participation, local government, democracy
Abstract
Local democracy and the involvement of local communities in the provision of social services are central issues in the local government reforms that are presently being implemented in many developing countries. At the same time, institutions that run parallel to local authorities, such as social funds and various user-committees, are established to improve accountability and participation. By focusing on actual political processes rather than administrative, legal, and fiscal aspects of decentralisation, this report traces the breakdown of two development projects in Tanzania to the existence of parallel structures, and suggests that user-committees and social funds should be integrated in local authority structures to avoid fragmentation of participation and to enhance local democracy.
Country
Norway
Publisher
Norwegian Agency for Development Cooperation
Theme area
Equity and HIV/AIDS, Governance and participation in health
Title of publication PRA Report 11: HIV testing and disclosure in women attending prevention, treatment and care clinics at Katutura hospital, Windhoek, Namibia
Date of publication
2009 March
Publication type
Report
Publication details
Hofnie-//Hoëbes K, Kakororo O.M, Jankowsky V, Shilongo N, Callard B, Paulus D, Kaim B, Loewenson R (2009) ‘HIV testing and disclosure in women attending prevention, treatment and care clinics at Katutura hospital, Windhoek, Namibia UNAM, TARSC, An EQUINET PRA proje
Publication status
Published
Language
English
Keywords
participatory research, HIV, AIDS, testing and counseling, disclosure, Namibia
Abstract
This study explored the challenges experienced by HIV infected pregnant women and the coping strategies used by those who disclose or do not disclose, to inform community and health workers roles in supporting pregnant women around disclosure. It was implemented by University of Namibia (UNAM) within an EQUINET programme that aimed to explore dimensions of (and impediments to delivery of) Primary Health Care responses to HIV and AIDS. The programme, was co-ordinated by Training and Research Support Centre (TARSC). The report highlights the barriers to disclosure of HIV status in pregnant women, mainly negative reactions. An intervention planned by the women and health workers involved highlighted the importance of communication, particularly through approaches that recognise women’s perceptions. During the course of the communication intervention in this PRA process, disclosure rose from 60% to 90%. An issue identified but not yet addressed in this study is that of male partners who know their status telling their partners. Acting on the social impediments to testing and disclosure can enhance uptake of services and a PHC oriented response to VCT calls for communication capacities be strengthened in health services. While health workers were able to strengthen their communication in this exercise, the desired shift in communication was limited by language and time barriers. This reinforces the call for expert patient roles, for women in communities to provide more regular support.
Country
Namibia
Publisher
EQUINET
URL:
Equinet Publication Type
Discussion paper
Theme area
Health equity in economic and trade policies
Title of publication Discussion paper 72: Protecting public health and equitable health services in the services negotiations of the EU-ESA Economic Partnership Agreements
Date of publication
2009 March
Publication type
Academic paper
Publication details
EQUINET Discussion Paper 72 pp 1-28
Publication status
Published
Language
English
Keywords
health services, Economic Partnership agreements, liberalisation
Abstract
This paper aims to provide a detailed analysis of the options for protecting universal comprehensive and equitable health services within the framework of the EU-ESA EPA and other EPAs in the region through the services negotiations. The paper notes a number of commitments that the ESA-EU countries have already made in relation to public health. It proposes issues for negotiators in the services negotiations in the EPA to take into account to protect health in these agreements.
Country
Zimbabwe
Publisher
EQUINET; SEATINI; TARSC
URL:
Equinet Publication Type
Discussion paper
Theme area
Human resources for health
Title of publication Health care worker retention in east and southern Africa: Report of a Regional Meeting
Date of publication
2009 February
Publication type
Conference Proceedings
Publication details
EQUINET, ECSA-HC, UNAM, TARSC, U Limpopo (2009) ‘Health worker retention in east and southern Africa,’ Report of a regional meeting, 25-27 February 2009, Windhoek Namibia.
Publication status
Published
Language
English
Keywords
health worker retention; human resources for health
Abstract
A regional meeting was convened on 25-27 February 2009 in Windhoek Namibia by EQUINET and ECSA HC, hosted by the University of Namibia in co-operation with TARSC and University of Limpopo to: review the findings from this body of work and to explore the implications for policies and measures aimed at valuing and retaining health workers in ESA; develop proposals and guidelines for policy and action relevant to health worker deployment and retention; and identify knowledge gaps for follow up work.
The meeting also reviewed work implemented within other EQUINET themes to explore the impact of migration on health systems in Kenya (carried out in co-operation with IOM and ECSA-HC), to explore the impact of AIDS financing on health worker retention (carried out in co-operation with WHO and ECSA-HC), and to examine the relationship between health workers and communities at primary care level (in a programme of work co-ordinated by TARSC and Ifakara Health Institute). The meeting, held at the Safari Hotel in Windhoek, brought together country partners, researchers, regional and co-ordinating institutions involved in the work.
Country
Namibia
Publisher
EQUINET
URL:
Equinet Publication Type
Reports
Theme area
Equity in health
Title of publication Report of a training workshop: Writing for peer reviewed journals on health equity in Uganda
Date of publication
2009 February
Publication type
Report
Publication details
EQUINET Workshop report pp 1-19
Publication status
Published
Language
English
Keywords
peer review, scientific writing, writing structure, planning to write, grammar, computer skills, EQUINET papers, east and southern Africa
Abstract
The writing skills workshop aimed to improve the writing skills of Ugandan health equity researchers to enable them to seek publication of the materials produced on health equity, as presented at the March Conference or implemented as work in EQUINET in peer-reviewed journals, specifically African Health Sciences. The specific aims of the workshop were to: give researchers an overview of scientific writing, peer-reviewed journals and the purpose of peer-review, and how this is pursued at the African Health Sciences; develop a sound understanding of the structure of scientific papers among participants, particularly as pertains to articles in the African Health Sciences; assist researchers in planning their writing in order to ensure publication in the African Health Sciences; practice writing skills and write a draft article for the African Health Sciences; develop experience of receiving criticism and support from other writers and from the facilitators, including the editor of the African Health Sciences; and develop a way forward for mentoring researchers in their writing as well as steps to publication in the African Health Sciences.
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Reports
Theme area
Equity in health
Title of publication Workshop Report: “Keeping an eye on Equity: Community visions of equity in health” Training workshop on photography skills
Date of publication
2009 February
Publication type
Report
Publication details
EQUINET Workshop report pp 1-25
Publication status
Published
Language
English
Keywords
participatory reflection and action; health equity, justice for health, strengthen communication, communities, health workers, east and southern Africa
Abstract
The process under the theme “Keeping an eye on equity: Community visions of equity in health” , is being implemented in sites where participatory reflection and action (PRA) work is taking place through facilitators of the PRA work on people centred health systems. It will be connected to the dialogue around these processes and integrated within the field work visits. We aim through the programme to produce photographs that present peoples visions of “justice” or “equity” in health focusing on the PRA work on people centred health systems in EQUINET, i.e. empowering people to identify and address health issues they prioritise, strengthening communication between
communities and health workers; giving people more control over the resources they need to be healthy and showing what we mean by people centred health systems in dealing with particular health issues of importance to communities. We hope that the
photos will enlarge the lives of the people involved. We hope to enable show diversity of views, allow for both painful and hopeful images to surface, to pose questions, probe, give visions of solutions.
Country
East and southern Africa region
Publisher
EQUINET
URL:
Equinet Publication Type
Reports
Theme area
Human resources for health
Title of publication Recommendations from the regional meeting on health worker retention in East and Southern Africa, 27 February 2009
Date of publication
2009 February
Publication type
Conference Proceedings
Publication details
EQUINET Resolutions pp 1-5
Publication status
Published
Language
English
Keywords
human resource retention strategies, financing retention, capacity, systems support, primary health care, PHC, task shifting, migration, east and southern Africa
Abstract
The EQUINET–ECSA HC regional meeting on health worker retention in east and southern Africa (ESA) was held in Windhoek, Namibia from 25-27 February 2009 and involved 32 delegates from government, academic and research institutions, health worker organisations, parliament and civil society from ten ESA countries and from regional organisations including SADC and WHO. In line with the ECSA Regional Health Ministers Conference resolutions 2006-2008, the SADC Resolutions on Health workers, and the ECSA and SADC strategies on health workers, the meeting reviewed evidence from two regional review papers, five country field studies, a multi-country participatory research programme and delegate experience to propose areas for policy, guidelines and research on health worker retention, especially in priority health services. The evidence presented reinforced the existing policy understanding of the crisis in human resources for health (HRH) , reflected in inadequate numbers of critical health personnel, high levels of external and internal migration, poor distribution of staff in areas of high health need, low staff morale and some report of health worker abuse within the region.
Country
East and southern Africa region
Publisher
EQUINET
URL:
Equinet Publication Type
Resolutions
Theme area
Resource allocation and health financing
Title of publication Integrating equity into Resource allocation: Report of a methods workshop, with Ministry of Health Mozambique Meeting Report, 26-27 November 2008, Cape Town
Date of publication
2008 November
Publication type
Report
Publication details
Meeting Report, 26-27 November 2008, Cape Town pp 1-19
Publication status
Published
Language
English
Keywords
resource allocation, formula, public health sector, socioeconomic status, burden of disease, Mozambique
Abstract
This workshop was designed to provide the Ministry of Health in Mozambique with support on practical approaches to achieving a more equitable distribution of public health sector resource allocation outlays. Based on communication with officials of the Mozambican Ministry of Health, there have been concerns around the inequitable distribution of public health care resources, with areas of higher socio-economic status and relatively lower levels of disease burden receiving higher health care allocations. The key problems for the Ministry of Health were: how to empirically show that the current resource allocation outlays are inequitable and how to design a formula that allows for the shift of resources to ensure a more equitable distribution. In addition, the Ministry of Health also needed to understand the critical process issues that need to be considered in adopting a needs-based resource allocation formula.
Country
Mozambique
Publisher
EQUINET, UCT HEU
URL:
Equinet Publication Type
Reports
Theme area
Poverty and health
Title of publication Living with AIDS in Uganda: Impacts on banana-farming households in two districts
Date of publication
2008
Publication type
Book
Publication details
Publication status
Published
Language
English
Keywords
Uganda, agriculture, HIV, AIDS, HIV/AIDS, marginalisation, poverty, rural poverty, vulnerability
Abstract
The research in this book was carried out among banana-farming households in the districts of Masaka and Kabarole in Uganda. A gendered livelihood approach was used. The research focused on the identification of critical factors that need to be taken into consideration in the development of relevant policies for HIV/AIDS-affected agriculture-based households or those that are at risk. The book shows that HIV/AIDS causes significant negative effects on the lives of those affected. Their resources are affected due to HIV/AIDS-related labour loss and asset-eroding effects and disinvestment in production and child education. While in the overwhelming majority of the affected cases the effects of AIDS are negative and lead to increased impoverishment and vulnerability, for some households HIV/AIDS-related effects are manageable. It is concluded that a household's socio-economic status and demographic characteristics influence the magnitude of HIV/AIDS-related impacts experienced and capacity to cope. The book also highlights some historically specific social practices, policies, and ideologies that continue to maintain or reproduce distinct forms of inequality, with certain social groups being marginalized and others being privileged. Unless these are redressed, they will continue to aggravate people's vulnerability regardless of the type of shock that they are exposed to.
Country
Uganda
Publisher
Wageningen Academic Publishers
Theme area
Resource allocation and health financing, Equity and HIV/AIDS
Title of publication Integrating tuberculosis and HIV services for people living with HIV: Costs of the Zambian protest initiative
Date of publication
2008 January
Publication type
Journal Article
Publication details
Cost Effectiveness And Resource Allocation 6 2 pp 1-13
Publication status
Published
Language
English
Keywords
TB, tuberculosis, HIV, AIDS, HIV/AIDS, Zambia, urban poverty, antiretroviral therapy, ART, home-based care, home caregivers
Abstract
In the face of the dual TB/HIV epidemic, the ProTEST Initiative was one of the first to demonstrate the feasibility of providing collaborative TB/HIV care for people living with HIV (PLWH) in poor settings. The ProTEST Initiative facilitated collaboration between service providers. Voluntary counselling and testing (VCT) acted as the entry point for services including TB screening and preventive therapy, clinical treatment for HIV-related disease, and home-based care (HBC), and a hospice. This paper estimates the costs of the ProTEST Initiative in two sites in urban Zambia, prior to the introduction of anti-retroviral therapy. This study shows that coordinating an integrated and comprehensive package of services for PLWH is relatively inexpensive. The lessons learnt in this study are still applicable today in the era of ART, as these services must still be provided as part of the continuum of care for people living with HIV.
Country
Publisher
Cost Effectiveness And Resource Allocation
Theme area
Equitable health services, Resource allocation and health financing
Title of publication Informal payments and the quality of health care in Tanzania: Results from qualitative research
Date of publication
2007
Publication type
Academic paper
Publication details
CMI Working Paper 5
Publication status
Published
Language
English
Keywords
Tanzania, health workers, informal payments, financing, brain drain, health worker shortages
Abstract
Informal payments for health services are common in many countries, especially in transitional and developing countries. As part of a larger study focusing on health worker performance in Tanzania, one objective was to investigate the nature of informal payments in the health sector, and to identify mechanisms through which informal payments are affecting the quality of health services. A more profound understanding of these mechanisms is of interest because it may improve knowledge of how quality may be enhanced within a system where informal payments are common practice. The findings reveal a variety of positive and negative mechanisms through which informal payments may impact on the quality of health care. Furthermore, they show that informal payments add to health workers' incomes, thus contributing to the retention of workers in the health sector and to avoiding a further escalation of the current health worker shortage.
Country
Switzerland
Publisher
Chr. Michelsen Institute
Theme area
Equitable health services, Equity and HIV/AIDS
Title of publication What if we decided to take care of everyone who needed treatment? Workforce planning in Mozambique using simulation of demand for HIV/AIDS care
Date of publication
2008 February
Publication type
Journal Article
Publication details
Human Resources for Health 6 3 pp 1-40
Publication status
Published
Language
English
Keywords
Workforce planning, universal coverage, HIV, AIDS, HIV/AIDS, Mozambique, demand
Abstract
The growing AIDS epidemic in southern Africa is placing an increased strain on health systems, which are experiencing steadily rising patient loads. One of the most significant challenges in this effort is securing the health care workforce to deliver care in settings where staff are already in short supply. This paper has produced a demand-driven staffing model using simple spreadsheet technology, based on treatment protocols for HIV-positive patients that adhere to Mozambican guidelines. It projects the need for health workers using three different kinds of goals: the number of patients to be placed on anti-retroviral therapy (ART), the number of HIV-positive patients to be enrolled for treatment and the number of patients to be enrolled in a treatment facility per month. Three scenarios are proposed, depending on numbers of patients enrolled. In the first scenario, one starts with 8,000 patients on ART and increases that number to 58,000 at the end of three years (those were the goals for the country of Mozambique). This would require thirteen clinicians and just over ten nurses by the end of the first year, and 67 clinicians and 47 nurses at the end of the third year. In a second scenario, one starts with 34,000 patients enrolled for care (not all of them on ART), and increases to 94,000 by the end of the third year, requiring a growth in clinician staff from 18 to 28. In a third scenario, one starts a new clinic and enrols 200 new patients per month for three years, requiring 1.2 clinicians in year 1 and 2.2 by the end of year 3. Other clinician types in the model include nurses, social workers, pharmacists, phlebotomists and peer counsellors. This planning tool could lead to more realistic and appropriate estimates of workforce levels required to provide high-quality HIV care in a low-resource settings.
Country
Publisher
Human Resources for Health
Theme area
Human resources for health
Title of publication Strengthening management in low-income countries: Lessons from Uganda
Date of publication
2007
Publication type
Academic paper
Publication details
WHO Working Paper 11 pp 1-51
Publication status
Published
Language
English
Keywords
Management, Uganda, local government, skills, training
Abstract
This paper reviews and summarises service delivery management at the district level in Uganda. Specifically, it looks at health sector management development approaches that have been recently implemented, changes in the management capacity and performance and links between management development and health service delivery outputs. The study involved a desk review of country documentation followed by a country visit for an in-depth exploration using key informant interviews and direct observations of management practices at national and sub-national levels. The paper finds that significant effort has gone into developing managers using long and short courses and placing 'technical advisers' with District Health Management Teams. Uganda has made tremendous efforts at improving service delivery coverage and quality through improved management and filling of most critical management positions (e.g. DDHS posts). Opportunities exist for managers to develop appropriate skills but courses need to be better designed to produce the essential competencies needed. Uganda's detailed prescriptive planning formats could result in local priorities and decision making getting lost in the process. The allegiance that district managers hold to both the local government and the national health system appears to be evolving and the role conflicts and dichotomy are likely to improve with time. A health sector competency framework for managers will provide common performance objectives and standards in the sector.
Country
Publisher
World Health Organisation
Theme area
Human resources for health
Title of publication Should active recruitment of health workers from sub-Saharan Africa be viewed as a crime?
Date of publication
February
Publication type
Journal Article
Publication details
The Lancet 371 9613 pp 685-688
Publication status
Published
Language
English
Keywords
Recruitment, international recruitment, sub-Saharan Africa, brain drain
Abstract
Rich countries are poaching so many African health workers that the practice should be viewed as a crime, a team of international disease experts said. If one of these countries that is being systematically poached were to pursue it as a crime, contributing to unrest, they could expect some legal success.
Country
United Kingdom
Publisher
The Lancet
Theme area
Human resources for health
Title of publication Managerial competencies of hospital managers in South Africa: A survey of managers in the public and private sectors
Date of publication
2008 February
Publication type
Journal Article
Publication details
Human Resources for Health 6 4
Publication status
Published
Language
English
Keywords
Management, managers, private sector, public sector, efficiency, sustainability, training, capacity building, management capacity
Abstract
South Africa has large public and private sectors and there is a common perception that public sector hospitals are inefficient and ineffective while the privately owned and managed hospitals provide superior care and are more sustainable. The underlying assumption is that there is a potential gap in management capacity between the two sectors. This study aims to ascertain the skills and competency levels of hospital managers in South Africa and to determine whether there are any significant differences in competency levels between managers in the different sectors. A survey using a self administered questionnaire was conducted among hospital managers in South Africa. Respondents were asked to rate their proficiency with seven key functions that they perform. These included delivery of health care, planning, organising, leading, controlling, legal and ethical, and self-management. Ratings were based on a five point Likert scale ranging from very low skill level to very high skill level. The results show that managers in the private sector perceived themselves to be significantly more competent than their public sector colleagues in most of the management facets. Public sector managers were also more likely than their private sector colleagues to report that they required further development and training. The findings confirm that there is a lack of management capacity within the public sector in South Africa and a significant gap between private and public sectors. Further development of managers, especially those in the public sector, is urgently needed.
Country
Publisher
Human Resources for Health
Theme area
Equity and HIV/AIDS
Title of publication Poor tracking means patients lose out
Date of publication
2008 February
Publication type
Report
Publication details
Publication status
Published
Language
Keywords
Tshepong, South Africa, antiretrovirals, ARVs, drug adherence, antiretroviral therapy, ART
Abstract
Inadequate patient tracking at one of South Africa's largest antiretroviral (ARV) distribution sites, has led to many patients disappearing from the clinic before treatment starts, a new report has found. The report by the Reproductive Health & HIV Research Unit (RHRU) of the University of the Witwatersrand, based on a 2006 review of patient files at the Tshepong Wellness Clinic, about 120km southwest of Johannesburg, shows that a standard percentage - about 14% - stop taking treatment, but more than 20% of patients never get to the treatment stage. Since the file review, the clinic has successfully implemented a defaulter tracing mechanism to promptly identify and follow up on defaulters, improved their longitudinal data systems, filing system, and quality of care especially for patients not yet initiated on ART. RHRU has also revised the data collection tool and the data process. The process, which is being used at other ART clinics in South Africa, now has specific quality assurance mechanisms in place to identify and remedy errors immediately.
Country
South Africa
Publisher
Reproductive Health and HIV Research Unit, University of Witwatersrand
Theme area
Equitable health services
Title of publication Is the Western Cape at risk for an outbreak of preventable childhood diseases? Lessons from an evaluation of routine immunization coverage
Date of publication
Publication type
Journal Article
Publication details
South African Medical Journal 98 1 pp 41-45
Publication status
Published
Language
English
Keywords
Western Cape, South Africa, poverty, measles, polio, childhood diseases, immunisation, rubella, EPI
Abstract
This study in Western Cape South Africa shows that while immunisation coverage indicates that a lot of good work is being done, the coverage is insufficient to prevent outbreaks of measles and other common childhood conditions including polio. The coverage is too low to consider not running periodic mass campaigns for measles and polio. The coverage will need to be sustainably improved before introducing rubella vaccine as part of the EPI schedule. The reasons given by caregivers for their children not being immunised are valuable pointers as to where interventions should be focussed.
Country
Publisher
African Journals Online
Theme area
Values, policies and rights, Equitable health services, Monitoring equity and research to policy
Title of publication Implementation of the Mental Health Care Act (2002) at district hospitals in South Africa: Translating principles into practice
Date of publication
Publication type
Publication details
South African Medical Journal 98 1 pp 46-49
Publication status
Published
Language
English
Keywords
Mental Health Care Act, South Africa, mental health, legislation, monitoring, observation
Abstract
In line with international developments in mental health legislation, the Mental Health Care Act (2002) was promulgated in South Africa. Its core principles – human rights for users; decentralisation and integration of mental health care at primary, secondary and tertiary levels of care; and a focus on care, treatment and rehabilitation – are progressive and laudable. However, the task of implementing the requirements of the Act at community and district hospital levels is fraught with problems. Lack of infrastructure, inadequate skills and poor support and training undermine its successful implementation. Health workers already burdened with enormous workloads and inadequate resources struggle to manage mentally ill patients at district hospitals. The 72-hour observation is a particular area of difficulty throughout the country. This paper outlines the rationale and sense behind this legislation, discusses the problems encountered at the ‘rock face', and offers solutions to the problem of translating principles into practice.
Country
Publisher
African Journals Online
Theme area
Equitable health services
Title of publication Health care waste management in public clinics in the iLembe District: A situational analysis and intervention strategy
Date of publication
2007 November
Publication type
Academic paper
Publication details
Publication status
Published
Language
Keywords
iLembe District, South Africa, health care waste management, health care waste, waste management, pollution
Abstract
The purpose of this study was to investigate health care waste (HCW) management practices used in public health clinics in the iLembe Health District, with a view to developing a HCW management intervention strategy. The study design was observational, descriptive and cross-sectional. Data was collected using a structured questionnaire, which was administered to key informants from 31 rural and urban public sector fixed clinics in the iLembe District Municipality. Thirty public clinics in iLembe district participated in the study. A total of 210 kg/day (0.06 kg/patient/day) of HCW was estimated to be generated in public clinics, 69% was health care general waste (HCGW) and 31% was health care risk waste (HCRW). The district’s waste generation rate was 0.04 kg/patient/day and 0.018 kg/patient/day, for HCGW and HCRW, respectively. The study showed that HCW was not adequately managed in the district. The amount of HCW generated in iLembe differs from World Health Organization norms and this is attributed to improper segregation of waste categories. Sharp waste, however, is given special treatment and properly segregated and managed. It is evident that public health sector clinics have not implemented a proper HCW management plan. The management of health care waste is of great concern. There is need to develop a health care waste management intervention strategy to be implemented consistently and universally in the district. This strategy must incorporate training programmes and a waste management plan.
Country
South Africa
Publisher
Health Systems Trust
Theme area
Poverty and health, Monitoring equity and research to policy
Title of publication Monitoring and evaluating poverty reduction policies in Mozambique: Study 2
Date of publication
2008 January
Publication type
Academic paper
Publication details
CMI Brief 7(3) pp 1-4
Publication status
Published
Language
English
Keywords
Poverty reduction, poverty, policy, agriculture, social exclusion, marginalisation, Mozambique
Abstract
Issues of urban poverty have received little attention in Mozambique, even though the urban poverty rate is high and urban inequality is on the rise. In the bairros of Maputo, unemployment, crime and the high costs of food, housing and land inhibit the poor from converting progress in education and health into increased income and consumption. In a context where money is an integral part of most social relationships, the most destitute become marginalised with no one to turn to. Rising poverty and inequality in Maputo also have an adverse impact on vital urban-rural relationships, and may jeopardise political stability.
Country
Switzerland
Publisher
Chr. Michelson Institute
Theme area
Poverty and health, Monitoring equity and research to policy
Title of publication Monitoring and evaluating poverty reduction policies in Mozambique: Study 1
Date of publication
2008 January
Publication type
Academic paper
Publication details
CMI Brief 7(2) pp 1-4
Publication status
Published
Language
English
Keywords
Poverty reduction, poverty, policy, agriculture, social exclusion, marginalisation, Mozambique
Abstract
From the vantage point of a rural district in northern Mozambique, the development efforts by government and donors are visible through the enhanced capacity of the local administration and investments in education and health, but not where it really matters for poor people: employment creation and reasonable returns from their agricultural production, which currently are adversely affected by an absent or exploitative private sector. The very poorest are marginalised or excluded from social relationships with the extended family, traditional institutions as well as the state, underlining the need to give special attention to the chronically poor and destitute in rural areas.
Country
Switzerland
Publisher
Chr. Michelson Institute
Theme area
Equity in health
Title of publication Inequality and poverty in Africa in an era of globalization: Looking beyond income to health and education
Date of publication
2007 November
Publication type
Academic paper
Publication details
UNU-WIDER Research Paper No. 2007/74 pp 1-23
Publication status
Published
Language
English
Keywords
Education, globalisation, globalisation indexes, poverty, children, Africa
Abstract
This paper describes changes over the past 15-20 years in non-income measures of wellbeing - education and health - in Africa, a period during which it has undergone intense globalisation. Results indicate that in the area of health, little progress is being made in terms of reducing pre-school age stunting, a clear manifestation of poor overall health. Likewise, our health inequality measure showed that while there were a few instances of reduced inequality along this dimension, there was, on balance, little evidence of success in improving equality of outcomes. Similar results were found in our examination of underweight women as an indicator of general current health status of adults. The overall picture gives little cause for complacency or optimism that Africa has reaped, or will soon reap the potential benefits of the process of globalisation. The researchers conclude that there is little to suggest that globalisation is correlated (positively or negatively) with health and education outcomes. While these results may be viewed as somewhat disappointing, they likely reflect the complexity and context specific nature of the dynamic processes that both contribute to changes in the globalisation indexes employed, and how they transmit through very different economic and social structures to affect non-income poverty.
Country
Switzerland
Publisher
Theme area
Values, policies and rights, Equity and HIV/AIDS
Title of publication UNGASS draft report: Sexual and reproductive health and rights indicators: A case study from South Africa
Date of publication
2008 February
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
Reproductive health, reproductive health rights, essential health services, HIV, AIDS, HIV/AIDS, gender, South Africa
Abstract
A workshop was held in July 2007 hosted by MOSAIC at which the participating South African organisations reviewed goals set by UNGASS on reproductive health rights, discussed identified indicators, refined these and shared research and findings. In South Africa, in 2007, government, in collaboration with many stakeholders (civil society, the private sector), launched the HIV and AIDS and STI National Strategic Plan 2007–2011. While there is substantive discussion noting key areas of gender and gender-based violence, cultural attitudes and practices, sexual concurrency and sex workers, there is no overall conceptual lens unpacking sexual and reproductive health and rights. Currently reproductive health is not on the essential health priority list. This leaves gaps in terms of the continuum of care and there is a lack of integration, for example, HIV positive women’s sexual and reproductive intentions are not provided for, abortion services are not regulated within HIV care and sexual violence is not part of the sexually transmitted infection (STI) syndromic approach.
Country
Switzerland
Publisher
United Nations
Theme area
Values, policies and rights
Title of publication Right to health through litigation?
Date of publication
2008
Publication type
Academic paper
Publication details
Publication status
Published
Language
English
Keywords
Health rights, right to health, human rights, legislation, financial resources, justice, policymakers, policy, policy implementation
Abstract
Can court-enforced health rights improve health policy and priority setting in poor countries? This multidisciplinary project aims to systematically investigate whether litigation can make health policies and health systems in poor countries more equitable by forcing policymakers and administrators to take seriously their human rights obligations. Most of the world's governments are obliged through international treaties or national constitutions, or both, to respect, protect, promote and fulfill the human right to health. In most cases, this has not been an enforceable legal right. However, cases regarding the right to health care are increasingly brought before the courts. In a number of low- and middle-income countries - first in Latin America, later in Africa and Asia - court decisions have granted access to certain forms of medical treatment. These are decisions with potentially great implications for how health sector resources are prioritised and allocated, but so far there is little systematic knowledge of the actual effect of such cases on health policy formation, implementation and spending. Do they have a significant effect in practice? And, if so, do they contribute to more - or less - justice in health service delivery?
Country
Norway
Publisher
Chr. Michelsen Institute
Theme area
Equity in health
Title of publication Our cities, our health, our future: Acting on social determinants for health equity in urban settings: Report to the Commission on Social Determinants of Health
Date of publication
2008
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
Knowledge Network on Urban Settings, KNUS, social determinants of health, urban poverty, urbanisation, nutrition, housing, essential health services, community participation, health financing, policy development
Abstract
This report summarises the findings concerning the structural and intermediate social determinants of health in the urban setting, with a focus on slums and informal settlements. It has assembled a wealth of evidence; however, quantitative evidence of health inequalities within cities is seldom available and more research on this topic is needed to underpin policy development. There is evidence that investments in urban health can create major returns for the economy. Social systems based on democracy and strong equity policies have been successful in creating more equitable urban areas in a number of countries. Yet violence and crime affect the urban poor at all development levels and the stresses of poverty are a factor in poor mental health. Poor nutrition and lack of sufficient food is another challenge. Poor people often end up living in unsafe locations affected by flooding or industrial pollution. It is clear that, for people in slums and informal settlements, improving their living environment is essential. In order to ensure access to essential health care services, the health system needs to be designed on an equitable basis. Serious and sustained efforts must be made to give more decision-making powers to urban dwellers themselves rather than government officials or external support agencies. Healthy urban governance and integrated approaches to interventions are key pathways to reducing health inequity. Securing more resources for health investments in urban settings, coupled with fairer distribution of those resources, is vital. The report concludes with the sad fact that, if rich countries had met financial pledges they made over the last twenty years to tackle poverty, urban poverty would have already been eradicated!
Country
Switzerland
Publisher
World Health Organisation
Theme area
Equity in health
Title of publication Constructing the evidence base on the social determinants of health: A guide
Date of publication
2007 November
Publication type
Document
Publication details
Publication status
Published
Language
Keywords
Social determinants of health, health equity, health inequity, evidence into policy, evidence into practice, health inequality
Abstract
This comprehensive guide offers a framework that policy makers, researchers and practitioners can use to develop a systematic and transparent approach to taking action on the social determinants of health. The framework is a cycle that consists of four stages: generating evidence for policy and practice, synthesising evidence and taking action, effective implementation and evaluation, and learning from practice. Central to the framework is the need to get social determinants on the policy agenda before any other action can be taken. All stages are subject to ongoing monitoring. The guide will be useful to those who are unfamiliar with basic concepts such as policy analysis and policy-making, as it describes these concepts in some detail. It provides case studies and reviews existing literature on the latest theories and models on policy, the research process, implementation, and monitoring and evaluation. In due course, precise causal pathways describing the links between social factors and human biology (such as human development) may be able to be identified. This will allow policy to be targeted with a precision we lack today. It will also help to create ways to bring the macro social and economic determinants of health into the policy foreground.
Country
Switzerland
Publisher
World Health Organisation
Theme area
Equity and HIV/AIDS
Title of publication Zimbabwe HIV and AIDS subaccounts 2005
Date of publication
2005
Publication type
Electronic Source
Publication details
Publication status
Published
Language
English
Keywords
expenditure, funding, HIV, AIDS, HIV/AIDS
Abstract
Total HIV and AIDS expenditure in 2005 was around Z$20.9 trillion, an equivalent of US$209.4 million, which represents about US$150.5 per capital per adult population living with HIV and AIDS. The largest contributors to this expenditure are donors at 49% of the total HIV and AIDS expenditures. This is similar to that found in other countries prior to the surge of external targeted funds for HIV and AIDS, which have undertaken similar studies such as Kenya, Malawi, Rwanda and Zambia. From this analysis, it can be concluded that majority of the funds from Ministry of Health and Child Welfare, local NGOs, UN agencies and international NGOs were mainly used for the provision of prevention and public health programmes for HIV and AIDS whereas spending by people living with HIV and AIDS went directly to health facilities for treatment and care of OIs. The Ministry of Health and Child Welfare (about 54% of the total HIV and AIDS funds) and PLWHA through direct out-of-pocket payments (99% of the total of the total HIV and AIDS funds) were principally responsible for paying for treatment and care of OIs. Donors, international NGOs and local NGOs, on the other hand, were mainly responsible for the payment of provision and administration of prevention and public health programmes for HIV and AIDS and ART in 2005.
Country
Switzerland
Publisher
UNAIDS
URL:
Theme area
Governance and participation in health
Title of publication Three case studies on civil society influence on national governance
Date of publication
2007 August
Publication type
Conference Proceedings
Publication details
Publication status
Published
Language
English
Keywords
civil society organisations, CSOs, participatory governance, Malawi, monitoring,
Abstract
Three country-level case studies were presented at CIVICUS’s global conference ‘How can we build political will for participatory governance?’ This conference aimed to explore the lack of political will shown by most governments in meeting the human rights of their people and, more importantly, to share and learn about strategies and tools that have proved successful in building political will for participatory governance. Malawi was the only sub-Saharan African country examined. The Malawian presenter recommended follow-up programmes for monitoring political party manifestos vs their actual delivery in government, with independent budget analyses. Independent civil society budget research for evidence-based advocacy and continued strong advocacy around political and socio-economic developments in the country are also required. In conclusion, the greatest danger facing democracy in our time is the exclusion of the people from real power. Citizens cannot wait passively for the government to educate them. They need to be active and critical: at a local level, organised community groups, with the help of civil society organisations, should engage in controlling local government decision making.
Country
South Africa
Publisher
Idasa
URL:
Theme area
Equitable health services
Title of publication Maximising positive synergies between health systems and global health initiatives
Date of publication
2008 June
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
global health intiatives, GHI, health systems, collaboration, Malawi, human resources, funding
Abstract
Growing awareness of the need for health systems and GHIs to operate in ways that are mutually supportive has prompted those who are responsible for health systems to actively adopt measures that can help integrate and maximise the impact of GHIs. This report looks at a number of country-specific interventions. In sub-Saharan Africa, political commitment and creativity have helped Malawi to negotiate a successful collaboration with GHIs to strengthen and expand human resources for health – a key element of the health system. Faced with a severe HIV epidemic and crippling health workforce shortages, Malawi has collaborated with GHIs and other donors to overcome fiscal constraints and to implement an Emergency Human Resource Plan. Through task shifting, training and salary top-ups Malawi has been able to expand the health workforce to deliver HIV services and has also been able to meet 6 new demand for a range of health services at the community level. There are widespread concerns around the effects of the proliferation of actors in global public health and the complexity of the channels and systems through which funds and commodities are now provided. The need for coordination, harmonisation and alignment is strongly felt. In particular, countries face the challenges of excessive reporting requirements, conflicting time frames in planning and funding cycles and parallel bureaucracies.
Country
Switzerland
Publisher
World Health Organization
URL:
Theme area
Equity and HIV/AIDS
Title of publication Final report: Malawi HIV and AIDS prevalence study
Date of publication
2008 June
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
HIV, AIDS, HIV/AIDS, Malawi, Blantyre, Lilongwe, marriage, extra-marital sex
Abstract
This report compared prevalence rates in Blantyre and Lilongwe, Malawi’s two major cities. It found that the rates in Blantyre were higher than those in Lilongwe, but these differences could not easily be explained, even though other sources of data, namely 2004 DHS data and 2005 and 2006 screening data from ante-natal clinics, confirmed the findings. Although incidence studies among the general population have not been conducted, there is some evidence from available data that the difference is caused by a real difference in HIV incidence. In-migration may have diluted prevalence, but data is inadequate to assess this issue. Lack of male circumcision was ruled out as a contributing factor. Possible contributing factors include a younger age of sexual debut and a longer gap between first sex and first marriage, as well as sex with a non-cohabitating partner, which was more common in Blantyre. Marital stability was found to be protective for women.
Country
United States
Publisher
University of North Carolina
URL:
Theme area
Values, policies and rights, Equitable health services
Title of publication Cholera in a time of health system collapse: Violations of health rights and the cholera outbreak
Date of publication
2009 February
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
Zimbabwe, human rights, cholera, sanitation, health system, water
Abstract
Although Zimbabwe has experienced cholera outbreaks since 1992, the outbreak which began in August 2008 is the worst ever in this country and is set to become the worst outbreak on the African continent. Violations of the rights to safe and potable water, adequate sanitation and a collapsed health system were the cause of the outbreak. The course of the outbreak has been difficult to predict and to control. To date, the Government of Zimbabwe has fallen far short of its responsibility to ensure the availability of appropriate health services. Despite the epidemic continuing for more than six months, sanitation remains poor and lack of access to safe drinking water persists against the backdrop of a collapsed health system with degraded infrastructure and very few health workers. Health is a fundamental human right indispensable for the exercise of other human rights. Despite this, the right to health is becoming an increasingly remote privilege, out of the reach of most Zimbabweans. Health in Zimbabwe is presently largely unavailable, unacceptable, inaccessible and of poor quality. This report concludes that Zimbabwe will require long term commitment of the humanitarian and donor agencies working in the country with large scale, multi-faceted assistance to address the situation. The Government of Zimbabwe must also take responsibility for the restoration of the basic social services that fulfil basic human rights.
ZADHR makes several recommendations. On the public health system: An emergency health response plan to restore function to the public health system must be produced and implemented. This plan should begin by focusing on making primary and secondary care services (clinics and district hospitals) affordable and accessible to all. The Government must also ensure that health workers concerns are addressed to ensure that conditions in which these workers return to work and their skills can be retained are put in place (including adequate remuneration and safe working conditions). On access to safe water: If the outbreak is to be brought under control, and ultimately to an end, there is an urgent need to restore safe potable water to communities. Where infrastructure for piping water exists this needs to be rehabilitated. On adequate sanitation: Ensuring that communities make use of sanitary facilities for defecation is vital. Everyone should have access to a toilet connected to a septic tank or working public sewer system or a ventilated improved pit latrine.
Country
Zimbabwe
Publisher
Zimbabwean Association of Doctors for Human Rights (ZADHR)
URL:
Theme area
Health equity in economic and trade policies
Title of publication Policy Brief 21: Protecting health and health services in the services of the ESA-EU EPA
Date of publication
2009 February
Publication type
Document
Publication details
EQUINET, SEATINI, TARSC
Publication status
Published
Language
Keywords
Abstract
Country
Publisher
EQUINET
Equinet Publication Type
Policy brief
Theme area
Human resources for health
Title of publication Discussion paper 71: A review on the impact of HIV and AIDS programmes on health worker retention
Date of publication
2009 February
Publication type
Report
Publication details
Health Systems Research Group, Department of Pharmacy, University of Limpopo, South Africa in co-operation with WHO, ECSA-HC, TARSC, UNAM
Publication status
Published
Language
Keywords
Abstract
This paper reviews and analyses the literature and secondary evidence on the impact of HIV and AIDS programmes on health care worker (HCW) retention.Countries are using different HIV and AIDS service delivery approaches, and many resource-limited countries with high HIV prevalence rely heavily on external funding, which poses challenges of coordination and sustainability. There is a trend towards coordinated country responses in line with the WHO ‘Three Ones’, and most high-burden countries have high level statutory councils or commissions, national HIV and AIDS policies and strategic plans to guide the responses to the epidemic; and there is stated commitment to delivery of HIV and AIDS services through a public health approach. In practice, however, HIV and AIDS services remain fragmented in most countries. New cadreship has been brought in to support HIV and AIDS services, including expert patients. Innovations such as task shifting and the integrated management of adult and adolescent illness (IMAI) have been applied to more efficiently use available HCWs. Many vertical programmes recruit their own HCWs, especially counsellors and home-based caregivers. This can increase the pool of HCWs. By relying on the health system for the more skilled health professionals, however, HIV and AIDS programmes may also undermine other health programmes. HIV and AIDS programmes have the potential to benefit the health system by attracting and retaining HCWs within the health system.
Country
Publisher
EQUINET
Equinet Publication Type
Discussion paper
Theme area
Human resources for health
Title of publication Employment conditions and health inequalities: Final report to the WHO Commission on Social Determinants of Health
Date of publication
2007 September
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
Commission on Social Determinants of Health, CSDH, Employment Conditions Knowledge Network, EMCONET, social determinants of health, employment conditions, unemployment, child labour, employment relations, employment policies, mortality, community particip
Abstract
The aim of this report is to provide a rigorous analysis on how employment relations affect different population groups, and how this knowledge may help identify and promote worldwide effective policies and institutional changes to reduce health inequalities derived from these employment relations. Systematic reviews were conducted of the scientific and grey literature available on the topic, but there were major limitations in the reviews The report found that high levels of unemployment correlated with poor health and increased mortality and that precariously employed employees suffer adverse health effects through the action of material or social deprivation and hazardous work environments. A growing number of studies have also shown that health problems are one of the main negative effects of child labour. Politics are a fundamental cause of health inequalities but also their only remedy, so the report has devoted considerable effort to a political analysis of the situation. Its recommendations place considerable emphasis on social welfare (poverty alleviation, universal education and public health facilities, government inspectorates) and regulation of labour markets (international standards/agreements, laws and enforcement). The combination of union and community pressure will play a vital role in ensuring government action to improve employment conditions for all workers.
Country
Switzerland
Publisher
World Health Organisation
Theme area
Poverty and health
Title of publication Early child development: A powerful equalizer: Final report to the WHO Commission on Social Determinants of Health
Date of publication
2007 June
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
Commission on Social Determinants of Health, CSDH, early child development, ECD, equity, social determinants of health, lifespan, child rights, human rights, gender, globalisation, health systems, civil society
Abstract
This document synthesises knowledge about opportunities to improve the state of early child development (ECD) on a global scale. In keeping with international policy standards, we define early childhood as the period from prenatal development to eight years of age. What children experience during the early years sets a critical foundation for their entire lifespan. This is because all domains - including the physical, social/emotional and language/ cognitive domains - strongly influences basic learning, school success, economic participation, social citizenry and health. Within the work of the Commission, ECD has strong links to other social determinants of health, particularly urban settings, gender, globalisation and health systems. Areas of common concern with these determinants are discussed throughout this document. Research confirms a strong association between child survival and child development, such that the child survival and health agendas are indivisible from ECD. The study’s developmental approach to the early years includes the factors that affect child health and survival, but goes beyond these to consider how the early years can be used to create thriving global citizens. It provides a framework for understanding the environments (and their characteristics) that play a significant role in influencing early development. The evidence and its interpretation is derived primarily from three sources: peer-reviewed scientific literature, reports from governments, international agencies, and civil society groups, and a knowledge network of experts in ECD that is representative in both international and inter-sectoral terms. The principal strategic insight of this document is that the nurturing qualities of the environments where children grow up, live and learn will have the most significant impact on their development. In most situations, parents and caregivers cannot provide strong nurturing environments without help from local, regional, national and international agencies.
Country
Switzerland
Publisher
World Health Organisation
Theme area
Equity in health, Values, policies and rights
Title of publication Towards health-equitable globalisation: Rights, regulation and redistribution: Final report to the WHO Commission on Social Determinants of Health
Date of publication
2007 June
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
Commission on Social Determinants of Health, CSDH, Globalization Knowledge Network, GKN, globalisation, neoliberalism, disease-specific interventions, primary health care, health systems, private sector, poverty reduction, aid, debt, market liberalisation
Abstract
This report addresses a range of topics, such as the foreign debt crisis for developing nations, the effectiveness of poverty reduction strategies, the need for further aid, the pernicious effects of market liberalisation and trade agreements that impact on health. Key international institutions have contrib¬uted to health care resource scarcities, in particular as they affect the poorest and most vulnerable, by promoting a market-oriented concept of health sector reform that strongly favours private provision and financing. From the mid-1980s until quite recently, the World Bank in particular actively promoted a paradigm of health sector reform that viewed private provision of health care and the pur¬chase of health care or health insurance on the open market as the normative baseline. Such a focus on a narrow conception of technical and economic efficiency has also privileged nar¬rowly-defined cost effective medical interven¬tions. This focus, combined with new sources of funding through global public-private partnerships directed at vertical, disease-specific interventions, has mostly resulted in increased inequity of health care access and increasingly fragmented and ineffective health systems. On the principle of ‘first, do no harm’, no further reforms based on neoliberal health sector reform should be implemented, at least until and unless evidence of their appropriateness, effectiveness and affordability in low- and middle-income countries has been established. On the other hand, there is evidence that publicly funded and universal systems which integrate strong primary health care with public health interventions are associated with better health outcomes and fewer inequities.
Country
Switzerland
Publisher
World Health Organisation
Theme area
Values, policies and rights, Poverty and health
Title of publication Understanding and tackling social exclusion: Final report to the WHO Commission on Social Determinants of Health
Date of publication
2008 February
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
Commission on Social Determinants of Health, CSDH, Social Exclusion Knowledge Network, SEKN, social exclusion, social policies, discrimination,policy, civil society organisations, CSOs, universal rights, collaboration, cooperation, monitoring, evaluation
Abstract
The policies and actions designed to tackle social exclusion that have been appraised in this report by the Social Exclusion Knowledge Network (SEKN) are diverse, including those from countries in South America, Asia and Africa. Very few have been subject to a robust evaluation, so the SEKN appraisals have, of necessity, had to be pragmatic, making use of whatever data on process and/or impact was available. At one level, all seek to reduce or eradicate poverty and/or its many adverse consequences, including extending access to essential services, particularly healthcare and education. But underlying this commonality are profound differences in the ultimate aim of these policies and actions, with some seeking to establish public-funded universal provision to reduce inequalities across societies, while others have the narrower aim of improving the conditions of the poor. In this context, rather than detailed Recommendations on specific policies or actions the SEKN has identified higher-level lessons for policy and action aimed at reversing exclusionary processes, such as the need for policy/action co-ordination, ongoing measurement, monitoring and evaluation, and future research into the drivers of exclusion. The state, civil society organisations, communities and even the private sector all have a role to play by advocating the primacy of universal rights and full and equal inclusion.
Country
Switzerland
Publisher
World Health Organisation
Theme area
Equity in health, Values, policies and rights
Title of publication Unequal, unfair, ineffective and inefficient gender inequity in health: Why it exists and how we can change it: Final report to the WHO Commission on Social Determinants of Health
Date of publication
2007 September
Publication type
Report
Publication details
Publication status
Published
Language
Keywords
Commission on Social Determinants of Health, CSDH, gender equity, gender inequity, gender, discrimination,human resources, health services, accountability, prejudice, bias, Women and Gender Equity Knowledge Network, WGEKN, social determinants of health, a
Abstract
This report shows that gender relations of power exist both within and outside the health sector, and exercise a pernicious influence on the health of people. The report has drawn together the rapidly growing body of evidence that identifies and explains what gender inequality and inequity mean in terms of differential exposures and vulnerabilities for women versus men, and also how health care systems and health research reproduce these inequalities and inequities instead of resolving them. The consequences for people’s health are not only unequal and unjust, but also ineffective and inefficient. It has also documented the growing numbers of actions by non-governmental and governmental actors and agencies to challenge these injustices and to transform beliefs and practices within and outside the health sector in order to generate sustained changes that can improve people’s health and lives. In particular, it calls for support for women’s organisations that are critical to ensuring that women have voice and agency, that are often at the forefront of identifying problems and experimenting with innovative solutions, that prioritise demands for accountability from all actors, both public and private, and whose access to resources has been declining in recent years.
Country
Switzerland
Publisher
World Health Organisation
Theme area
Poverty and health
Title of publication The state of the world's children 2008: Child survival
Date of publication
2008
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
Child survival, child mortality, child heath, access barriers, human rights, financial resources, essential health services, primary health care, PHC, nutrition, water, HIV, AIDS, HIV/AIDS
Abstract
This report by UNICEF provides a wide-ranging assessment of the current state of child survival and primary health care for mothers, newborns and children. It argues that these issues serve as sensitive barometers of a country's development and wellbeing and as evidence of its priorities and values, and states that investing in the health of children and their mothers is a human rights imperative and one of the surest ways for a country to set its course towards a better future. These life-saving measures include applying proven, cost- effective health, nutrition, water, sanitation and hygiene, and HIV and AIDS interventions across a wider range of settings in order to deliver quality health care to women and children. They also include reducing barriers to access and mobilising additional financial and human resources. A focus on results requires strategies that build on the collective knowledge on maternal, newborn and child survival and health. An examination of different approaches to the delivery of essential services from the beginning of the 20th century to the present demonstrates a range of effective solutions that work best for each country and community. The report identifies six pivotal actions at the macro level that urgently require unified engagement to intensify efforts for maternal, newborn and child survival and fulfil the right of women and children to health and well-being.
Country
Switzerland
Publisher
UNICEF
Theme area
Human resources for health
Title of publication Human Resources Retention Scheme: Qualitative and quantitative experience from Zambia
Date of publication
2008
Publication type
Slide presentation
Publication details
Publication status
Published
Language
English
Keywords
Zambia Health Workers Retention Scheme, ZHWRS, health worker retention, retention incentives, health worker attrition, rural health workers, critical service providers, incentives, brain drain, medical brain drain
Abstract
This presentation was given at the First Forum on Human Resources for Health in Kampala. It discusses the Zambia Health Workers Retention Scheme (ZHWRS), an incentive programme targeting key health worker cadres primarily in rural district to decrease attrition rates of critical service providers. It recommends that key stakeholders must be involved in the design and development of a sustainable retention scheme programme, which should include comprehensive support systems at all levels (central, provincial, district and facility levels) and effective and efficient remuneration systems. The retention scheme must aim to strike a balance between financial and non-financial incentive factors, and an effective performance appraisal system should be implemented to monitor the productivity of retention scheme participants.
Country
Switzerland
Publisher
WHO
Theme area
Equitable health services, Human resources for health
Title of publication Effectiveness of training supervisors to improve reproductive health quality of care: A cluster-randomised trial in Kenya
Date of publication
2008
Publication type
Journal Article
Publication details
Health Policy and Planning 23 pp 56-66
Publication status
Published
Language
English
Keywords
Organisation, administration, training, quality of health care, Kenya, reproductive health services, programme evaluation
Abstract
Health facility supervisors are in a position to increase motivation, manage resources, facilitate communication, increase accountability and conduct outreach. This study evaluated the effectiveness of a training intervention for on-site, in-charge reproductive health supervisors in Kenya using an experimental design with pre- and post-test measures in 60 health facilities. Cost information and data from supervisors, providers, clients and facilities were collected. Regression models with the generalised estimating equation approach were used to test differences between study groups and over time, accounting for clustering and matching. Total accounting costs per person trained were calculated. The intervention resulted in significant improvements in quality of care at the supervisor, provider and client–provider interaction levels. Indicators of improvements in the facility environment and client satisfaction were not apparent. The costs of delivering the supervision training intervention totalled US$2113 per supervisor trained. In making decisions about whether to expand the intervention, the costs of this intervention should be compared with other interventions designed to improve quality.
Country
United Kingdom
Publisher
Oxford Journals
Theme area
Human resources for health
Title of publication Global Health Workforce Alliance: Agenda for Global Action 2008
Date of publication
2008 March
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
health worker shortages, brain drain, medical brain drain, health worker retention, health systems, universal access, GHWA
Abstract
This Agenda for Global Action will guide the initial steps in a coordinated global, regional and national response to the worldwide shortage and maldistribution of health workers, moving towards universal access to quality health care and improved health outcomes. It is meant to unite and intensify the political will and commitments necessary for significant and effective actions to resolve this crisis, and to align efforts of all stakeholders at all levels around solutions. It builds on commitments already made by high-level policy makers in efforts designed to marshal the world’s collective knowledge and resources to reverse this crisis. Everyone committed to this agenda shares the vision that ‘all people, everywhere, shall have access to a skilled, motivated and facilitated health worker within a robust health system’.
Country
United States
Publisher
Global Health Workforce Alliance
Theme area
Equitable health services, Human resources for health
Title of publication The NGO Code of Conduct for Health Systems Strengthening
Date of publication
2008 November
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
building health systems, non-governmental organisations, NGOs, code of conduct, ethics, aid
Abstract
The Code of Conduct for Health Systems Strengthening is a response to the recent growth in the number of international non-governmental organisations (INGOs) associated with increase in aid flows to the health sector. It is intended as a tool for service organisations – and eventually, funders and host governments. The Code serves as a guide to encourage NGO practices which contribute to building public health systems and discourage those which are harmful. The working document was drafted by a coalition of activist or service delivery organisations, including Health Alliance International, Partners in Health, Health GAP, and Action Aid International. EQUINET also contributed to the consultations on the Code. It underwent some revisions in a series of consultations during 2008.
Country
United States
Publisher
Health Alliance International (HAI)
Theme area
Public-private mix
Title of publication Social marketing for malaria prevention: Increasing insecticide-treated net coverage
Date of publication
2008
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
Malaria, malaria prevention, insecticide-treated nets, ITNs, children, pregnant women, marketing, social marketing, subsidies, poverty
Abstract
The principal challenge to achieving the Abuja Declaration goal was to develop an efficient, equitable and sustainable mechanism to deliver insecticide-treated nets (ITNs) to the poor and most vulnerable segments of the population. One method – social marketing – employs the principles and practices of commercial marketing techniques to deliver socially beneficial goods at affordable, and often subsidised, prices to particular groups. Social marketing of insecticide treated nets, through a public-private partnership and meaningful community participation in Tanzania, has successfully and quickly increased the distribution of mosquito nets among the poorest populations, particularly children and pregnant women. This programme has resulted in improved health outcomes with respect to the morbidity and mortality impact of malaria on the population of children.
Country
United States
Publisher
World Bank
Theme area
Health equity in economic and trade policies, Equitable health services
Title of publication Meeting report: Access to and rational use of medicine
Date of publication
2007 November
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
civil society organisations, CSOs, faith-based organisations (FBOs)
Abstract
The Pan African meeting on access to essential medicines (AEM) and rational use of medicines (RUM) was convened by Health Action International (HAI) Africa and the Ecumenical Pharmaceutical Network (EPN) on 14–15 November 2007 in Nairobi, Kenya. The meeting brought together African experts and stakeholders from the pharmaceutical sector, including civil society organisations (CSOs) and faith-based organisations (FBOs) to discuss issues around AEM and RUM. Topics included lessons learnt from developed countries about the ethical promotion of new medicines, how to improve patient adherence/compliance with drug regimens, the impact of free trade agreements on access to medicines and promoting access to medicines as a human right.
Country
Kenya
Publisher
Health Action International and Ecumenical Pharmaceutical Network
Theme area
Equitable health services, Human resources for health
Title of publication A systematic review of delay in the diagnosis and treatment of tuberculosis
Date of publication
2008 January
Publication type
Journal Article
Publication details
Public Health pp 1-9
Publication status
Published
Language
English
Keywords
Tuberculosis, treatment delay, diagnostic delay, human resources, training, poverty, HIV, access barriers
Abstract
This paper reviews 58 studies that assess the delay in the diagnosis and treatment of tuberculosis (TB). Delay in diagnosis can affect disease prognosis at the individual level and enhance transmission of TB within the community. The paper identifies the main factors associated with diagnostic delay. These include HIV; coexistence of chronic cough and/or other lung diseases; geographical barriers; rural residence; poverty; old age; gender; alcoholism and substance abuse; low educational level; low awareness of TB; and stigma. The paper concludes that the core problem in delay of diagnosis and treatment appears to be a vicious cycle of repeated visits at the same healthcare level, resulting in non-specific antibiotic treatment, incorrect diagnosis and failure to access specialised TB services. Three groups of healthcare providers were identified as sources of this vicious cycle: primary-level government health posts, which have limited diagnostic facilities and poorly trained personnel, private practitioners with low awareness of TB and unqualified vendors and traditional practitioners.
Country
Publisher
BioMed Central
Theme area
Poverty and health
Title of publication The burden of disease profile of residents of Nairobi's slums: Results from a demographic surveillance system
Date of publication
2007 March
Publication type
Journal Article
Publication details
Population Health Metrics 6 1
Publication status
Published
Language
English
Keywords
urbanisation, urban poverty, slums, Nairobi, burden of disease, preventable diseases, treatable diseases, health outcomes, health indicators, mortality, vulnerable groups
Abstract
With increasing urbanisation in sub-Saharan Africa and poor economic performance, the growth of slums is unavoidable. About 71% of urban residents in Kenya live in slums. Recent research shows that the urban poor fare worse than their rural counterparts on most health indicators, yet much about the health of the urban poor remains unknown. This study aims to quantify the burden of mortality of the residents in two Nairobi slums, using a burden of disease approach and data generated from a demographic surveillance system. It found that slum residents in Nairobi have a high mortality burden from preventable and treatable conditions. It is necessary to focus on these vulnerable populations since their health outcomes are comparable to or even worse than the health outcomes of rural dwellers, who are often the focus of most interventions.
Country
Publisher
Population Health Metrics
Theme area
Resource allocation and health financing
Title of publication From Paris 2005 to Accra 2008: Will aid become more accountable and effective? A critical approach to the aid effectiveness agenda
Date of publication
2007
Publication type
Academic paper
Publication details
Publication status
Published
Language
English
Keywords
Aid, poverty, Accra High Level Forum on Aid Effectiveness, Accra, civil society, civil society organisations, CSOs, community participation
Abstract
This paper argues that politics is central to aid effectiveness and the measures should be taken to ensure democratic ownership of citizens in recipient countries. It argues that aid must ensure mutual accountability between donors, government and citizens. Furthermore, donors need to ensure high standards of aid quality by fairly allocating aid toward poverty reduction, untying aid and limiting technical assistance, as well as ensuring predictability for recipient countries. The paper makes a number of recommendations ahead of the Accra High Level Forum on Aid Effectiveness, which include: donors should recognise the centrality of poverty reduction, equality and human rights; all donor-imposed policy conditionality should be ended; donors and Southern governments must adhere to the highest standards of openness and transparency; donors should recognise CSOs as development actors in their own right and acknowledge the conditions that enable them to play effective roles in development; an effective and relevant independent monitoring and evaluation system for the Paris Declaration and its impact on development outcomes should be developed; mutually agreed, transparent and binding contracts to govern aid relationships should be introduced; and new multi-stakeholder mechanisms for holding governments and donors to account should be created.
Country
United Kingdom
Publisher
Better Aid
Theme area
Health equity in economic and trade policies, Resource allocation and health financing
Title of publication Examining the effects of debt on the provision of healthcare
Date of publication
2007
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
Debt cancellation, jubilee, debt, SAPs, essential services, Highly Indebted Poor Country Initiative, HIPC, universal coverage
Abstract
Developing country governments will struggle to invest in decent public health facilities when valuable resources are needed to service debt. However, the evidence is that debt relief works to alleviate healthcare shortages - spending on health in countries that have received debt cancellation has risen by 70%. The report calls for urgent action to ensure developing countries’ can provide adequate healthcare: rich countries, institutions and commercial creditors must cancel all illegitimate (i.e. due to ‘unfair or irresponsible’ lending) and unpayable debts being claimed from all poor countries, not just those eligible for the Highly Indebted Poor Country (HIPC) Initiative; creditors should recognise debtor governments’ accountability to their own citizens, and not impose economic policies through conditions on debt relief or loans. This includes conditions limiting public spending or specifying how healthcare should be delivered; and Southern governments must abide by the demands of their citizens that funds from debt cancellation be used to improve essential public services – and the governments must be open and accountable to their people over the use and monitoring of these funds.
Country
United Kingdom
Publisher
Jubilee Debt Campaign
Theme area
Equity in health, Equitable health services, Resource allocation and health financing, Monitoring equity and research to policy
Title of publication Equity Watch: Assessing progress towards equity in health in Zimbabwe, 2008
Date of publication
2008 November
Publication type
Document
Publication details
EQUINET Equity Watch pp 1-33
Publication status
Published
Language
English
Keywords
water and sanitation, ART, food security, cost of health services, drug supply, PHC staff, spending gaps, Zimbabwe
Abstract
This report assesses progress towards achieving equity in health in Zimbabwe, drawing on available indicators and peer review from stakeholders. Available evidence suggests a range of gaps to be addressed, including need and coverage in access to anti-retroviral treatment; to safe water and sanitation; and in food security; the gap between “free care” policies and the real formal charges and informal costs for health services that undermine use in poor households; between need and supply in drugs and skilled staff at the primary care level of the health system; between commitments and spending by the international community and government in the health budget, with rising demand on households to meet the gap; between the expectations and real working conditions and incomes of health workers; and between the social capacities for promoting health within communities, and the legal and institutional recognition and support of these capacities. Many inputs to health, including primary education, now need to be revitalised as a means to building the universal, comprehensive systems that address these gaps. The report outlines priorities based on the findings.
Country
Zimbabwe
Publisher
EQUINET, TARSC
Equinet Publication Type
Discussion paper
Theme area
Human resources for health
Title of publication National workshop report: Managing the migration of human resources for health in Kenya, 11-13 November 2007, Lukenya Getaway, Athi River, Kenya
Date of publication
2007 November
Publication type
Conference Proceedings
Publication details
EQUINET Meeting report pp 1-43
Publication status
Published
Language
English
Keywords
migration trends, health workers, implementation, recruitment, incentives, retention, Kenya
Abstract
The meeting was held to discuss issues relating to the effective management of the mobility of health care workers and to shift the agenda from awareness to action. Preliminary findings from three national studies focusing on migration trends of health professionals were presented, providing an evidence base for discussion and a direction for further recommendations. As the realities of migration trends amongst skilled health professionals continue to impact the standards and accessibility of health services on the continent, Kenya has taken a lead in studying these developments at a national and regional level. It was strongly recommended that the National Steering Committee take up immediate action on: briefing of all stakeholders on progress made in implementation of the programme as to encourage wider government ownership; broaden the NSC membership to include key government agencies not presently included, mainly the Ministry of Planning and Ministry of Finance; take immediate steps for establishment of an integrated data management system for managing human resources for health, including a minimum data set on health worker mobility; take immediate steps to active implementation of existing policies and laws relevant to managing internal and external migration of human resources for health; and review and strengthen policies and incentives for recruitment and retention of health workers.
Country
Kenya
Publisher
International Organization for Migration, World Health Organization, International Labour Office, EQUINET
Equinet Publication Type
Reports
Theme area
Equity and HIV/AIDS, Monitoring equity and research to policy
Title of publication Discussion Paper 67: Evaluating the implementation of the Tanzanian National Voucher Scheme: A case study from the Ruvuma region, Tanzania
Date of publication
2008 December
Publication type
Document
Publication details
EQUINET Discussion paper series 67 pp 1-27
Publication status
Published
Language
English
Keywords
malaria, bed nets, pregnant women, mothers, voucher scheme, policy implementation, power, Tanzania
Abstract
In 2004, the Tanzanian government launched its Tanzania National Voucher Scheme (TNVS). The scheme aimed to subsidise the cost of anti-malaria nets for pregnant women and children across the country. But has the implementation of the scheme so far been equitable? This study used a case study approach to analyse the power relations between key implementers of the scheme and the mothers served in four rural district health facilities in Namtumbo and Mbinga districts. The study found that despite the scheme’s impact in reducing severe malaria cases, inadequate national prioritisation of malaria is affecting implementation, leading to inadequate funding, felt most severely at facility level. No resources were allocated specifically for voucher distribution, resulting in periodic shortages, while health workers involved in the scheme had other competing demands on their time. A top-down managerial approach to implementation allowed health workers to exercise unfair power over mothers and pregnant women seeking nets and treatment and women were asked to pay for vouchers in some areas, when they are actually entitled to get them free. The study, building on previous studies in Tanzania and elsewhere, demonstrated that a top-down approach to policy intervention is contributing to implementation gaps. The voucher scheme is not just a tool for ensuring access and equity in health care delivery – it must be carefully considered in the context of those entrusted with the task of overseeing its implementation.
Country
Tanzania
Publisher
EQUINET, Centre for Health Policy (Wits), Health Economics Unit (UCT)
URL:
Equinet Publication Type
Discussion paper
Theme area
Human resources for health
Title of publication Discussion Paper 68: Retention strategies for Swaziland's health sector workforce: Assessing the impact of non-financial incentives
Date of publication
2008 December
Publication type
Document
Publication details
EQUINET Discussion paper series 68 pp 1-30
Publication status
Published
Language
English
Keywords
health worker retention, non-financial incentives, salary, Swaziland
Abstract
Have non-financial incentives been successful in retaining health workers in Swaziland? It seems the answer to this question is a resounding 'No'. This study reviewed nineteen relevant health documents and found only one that mentioned non-financial incentives, suggesting that the value of these incentives in under-rated by government. In contrast, the field study revealed that most workers in Swaziland consider non-financial incentives to be more important than salary in determining whether or not they will remain in their jobs or join the 'medical brain drain' overseas.
Country
Swaziland
Publisher
EQUINET, ECSA-HC
URL:
Equinet Publication Type
Discussion paper
Theme area
Governance and participation in health
Title of publication PRA Report 10: Consolidating processes for community health centre partnership and accountability in Zambia
Date of publication
2008 September
Publication type
Document
Publication details
EQUINET PRA project report 10 pp 1-27
Publication status
Published
Language
English
Keywords
district health system; communities; health workers; communication; Zambia
Abstract
This report has been produced within the capacity building programme on participatory research and action (PRA) for people centred health systems in EQUINET. It is part of a growing mentored network of PRA work and experience in east and southern Africa, aimed at strengthening people centred health systems and people’s empowerment in health. The report presents the work and outcomes from the follow up action research building on a pilot in 2006 that aimed to strengthen community-health centre partnership and accountability in two districts in Zambia. The action research presented consolidated the participatory approaches initiated in 2006 to further enhance the community voice in planning, budgeting and implementation activities at HC and community level; extended the process to two new health centres in Lusaka, and built the capacity of the 2006 group to facilitate scale up of the work to other centres. It explored through this the possibilities for scaling up such processes at wider level. The project demonstrated that using participatory approaches can de-mystify and remove suspicions surrounding the district and health centre planning process, strengthen dialogue between communities and health workers, increase community involvement in planning and budget processes and resolve issues in the interface between health workers and communities. If the processes are to be institutionalized the lessons from the action research are that participatory processes take time to have impact, need continuous mentoring and resource support in the early stages, need to be integrated within routine work and supported by authorities, with orientation of new health workers. Not investing in scale up of the process, however, leads to persistence of disharmony between health workers and communities caused by lack of communication and information flow, undermining the functioning of health systems as envisaged in policy.
Country
Zambia
Publisher
Lusaka District Health Team; Equity Gauge Zambia; EQUINET
Equinet Publication Type
Discussion paper
Theme area
Equity and HIV/AIDS, Monitoring equity and research to policy
Title of publication Discussion Paper 69: How power relations affect the implementation of policy on equity in access to anti-retroviral therapy: The case of rural health centres in Malawi
Date of publication
2008 September
Publication type
Document
Publication details
EQUINET Discussion paper series 69 pp 1-21
Publication status
Published
Language
English
Keywords
HIV and AIDS policy; policy implementation; power relations; health workers; HIV+ patients; Malawi
Abstract
The national ART scale-up plan contains several measures to promote equity, considering also that there are insufficient resources to cover everyone who is eligible. Thus study focused on four of these covering ART enrolment on an open ‘first-come, first-served’ basis; targeted gender-sensitive health promotion of ART, measures to overcome specific geographical barriers to access for remote populations and prioritisation of people already on ART, pregnant women and young children. Using a case study approach the study analysed the power relations that influenced outcomes on these policy measures on four health facilities in Malawi. The findings indicate that health workers commonly exercise power in relation to patients, and that patient acquiesce with health worker behaviours. In poorly performing facilities, implementation of policy measures is negatively affected by managerial practices that discourage teamwork and de-motivate health workers, while in the two better performing facilities, management practices had a more positive role in supporting positive health worker practices. The study findings highlight that implementing equity policies needs to include measures to orient and involve staff, and address power and resource imbalances that can undermine access.
Country
Malawi
Publisher
EQUINET, Centre for Health Policy (Wits), Health Economics Unit (UCT)
URL:
Equinet Publication Type
Discussion paper
Theme area
Human resources for health
Title of publication Capacity Building Paper: The financial losses from the migration of nurses from Malawi
Date of publication
2006 June
Publication type
Document
Publication details
EQUINET Capacity Building Paper pp 1-13
Publication status
Not published
Language
English
Keywords
health worker migration, cost, health systems, financial loss, Malawi
Abstract
The migration of health professionals trained in Africa to developed nations has compromised health systems in the African region. The financial losses from the investment in training due to the migration from the developing nations are hardly known. The cost of training a health professional was estimated by including fees for primary, secondary and tertiary education. Accepted derivation of formula as used in economic analysis was used to estimate the lost investment. The total cost of training an enrolled nurse-midwife from primary school through nursemidwifery training in Malawi was estimated as US$ 9,329.53. For a degree nurse-midwife, the total cost was US$ 31,726.26. For each enrolled nurse-midwife that migrates out of Malawi, the country loses between US$ 71,081.76 and US$ 7.5 million at bank interest rates of 7% and 25% per annum for 30 years respectively. For a degree nurse-midwife, the lost investment ranges from US$ 241,508 to US$ 25.6 million at 7% and 25% interest rate per annum for 30 years respectively. Developing countries are losing significant amounts of money through lost investment of health care professionals who emigrate. There is need to quantify the amount of remittances that developing nations get in return from those who migrate.
Country
Malawi
Publisher
URL:
Equinet Publication Type
Capacity building papers
Theme area
Equity in health
Title of publication A report of the discussion on the Zimbabwe equity analysis and the Zimbabwe launch of the Regional analysis of equity in health in east and southern Africa: Promoting health equity in Zimbabwe
Date of publication
2008 October
Publication type
Document
Publication details
EQUINET Meeting report pp 1-12
Publication status
Published
Language
English
Keywords
equity watch; communities; primary health care; Zimbabwe
Abstract
This meeting provided an opportunity for discussion of evidence in the draft Zimbabwe equity watch from the perspective of people from community and primary health care levels of the health system. Evidence in the Zimbabwe equity analysis provided input to civil society plans within the CWGH and to the resolutions from the CWGH meeting. The discussion on the Zimbabwe equity analysis was a build up to the launch of the book ‘Reclaiming resources for health: A regional analysis for equity in Health in East and Southern Africa’. The event was attended by more than hundred people from Parliament (MPs), Ministry of Health, Ministry of education, academics, representatives from the Health Service Board, private sector, civil society, health worker unions, labour movement, and delegates from the region (Uganda. Malawi, South Africa).
Country
Zimbabwe
Publisher
EQUINET; CWGH; TARSC
Equinet Publication Type
Reports
Theme area
Equitable health services, Governance and participation in health
Title of publication Resolutions by the Community Working Group on Health (CWGH) from the 15th National Conference in Harare
Date of publication
2008 October
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
Community Working Group on Health, strategic partnerships, community participation, health worker retention
Abstract
The CWGH made a number of resolutions after the 15th National Conference in Harare, including a demand that the right to health be included in the National Constitution. It committed itself to strengthening primary health care and district systems by lobbying for incentives and resources for community health workers from government, getting health institutions to remove high charge barriers and lobbying government for policies to retain health workers. It will also lobby the government to provide free access to safe water as a human right, as well as lobby the Parliamentary Portfolio Committee on health for increased health funding and government for the fair allocation of resources at national level. Community participation should also be promoted. That CWGH will develop a proactive agenda on health issues and forge and strengthen strategic partnership locally and regionally to take this forward, capacitate its districts to enable them to advance and monitor the implementation of these resolutions and ensure that the health delivery system is not used for partisan politics.
Country
Zimbabwe
Publisher
URL:
Theme area
Equity in health
Title of publication Open letter to British Prime Minister, Gordon Brown
Date of publication
2008 November
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
democracy, transparency, accountability, Bretton Woods, Gordon Brown, UK, United Kingdom, Conference on the Social Determinants of Health
Abstract
In this open letter, participants of the Conference on the Social Determinants of Health have called on the British Prime Minister to ensure that consideration is not limited to the immediate problems of the banking and financial system, but extends to the key global challenges of ill-health, poverty and climate change, and the anachronistic and undemocratic structure of global governance which underlies the failure of the global community to deal with these issues effectively and to ensure that the ‘Bretton Woods 2’ process itself is fully inclusive of all countries, on an equal basis, and reflects contemporary standards of democracy, transparency and accountability. It is only through such a system of global governance, placing fairness in health at the heart of the development agenda and genuine equality of influence at the heart of its decision-making, that coherent attention to global health equity is possible.
Country
Publisher
Participants of the Conference on the Social Determinants of Health
URL:
Theme area
Human resources for health
Title of publication Recommendations on the World Health Organisation Draft Code of Practice on the International Recruitment of Health Personnel
Date of publication
2008
Publication type
Document
Publication details
Publication status
Language
English
Keywords
health worker migration, brain drain, recruitment, World Health Organisation Draft Code of Practice
Abstract
Global Policy Advisory Council members have reviewed and responded to the WHO Draft Code of Practice and had a number of recommendations to make. They believe the Code needs to reflect further on World Health Assembly Resolutions 57.19 and 58.17 and to focus more strongly on mitigating the adverse effects of health personnel migration and its negative impact on health systems in developing countries. A strong preamble is needed to appropriately inform the rationale, context and vision underlying the accompanying articles. The current Code pays much attention to the role of member states generally, but the specific roles of source and destination countries, health workers, recruiters/ employers and other relevant stakeholders require further elaboration. There was wide, though not unanimous, agreement that the principle of shared responsibility is paramount: states that are global employers must help support their source countries’ local health workforce. Clear implementation guidelines are lacking, specifically about how and what information must be collected. Developing countries will need technical and capacity-related assistance, otherwise they will not be able to pay the costs of implementing the Code.
Country
United States
Publisher
Health Worker Migration Initiative
URL:
Theme area
Public-private mix, Equity and HIV/AIDS
Title of publication ART in the public and private sectors in Malawi: Results up to 30 June 2008
Date of publication
2008 October
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
cumulative treatment outcomes; eligible patients; stock level assessment; monitoring and evaluation
Abstract
This report presents data on the number of patients accessing ART in both the public and private sectors in Malawi. By the end of June 2008, there were 207 health facilities in Malawi in the public and private health sector delivering ART to HIV-positive eligible patients. In the second quarter of 2008 (April to June), there were 19,849 new patients registered on ART (37% male, 63% female; 91% adults and 9% children). By the end of June 2008, there were 184,405 patients who had ever started on ART (39% male, 61% female; 91% adult, 9% children). Cumulative treatment outcomes by end of June were: 66% alive and on ART at the site of registration, 11% dead, 11% lost to follow-up, 12% transferred out to another facility (and were presumably alive) and <1% stopped treatment. Of the 121,707 patients alive and on ART, 96% were on the first-line regimen, 4% were on an alternative first-line regimen and a small proportion (less than 1%) were on a second-line regimen. By the end of June 2008 there were 32 sites with over 1,000 patients alive and on treatment and 10 sites with over 2,000 patients alive and on treatment. Of the 10 sites with more than 2,000 patients, four did not have an electronic data system in place.
Country
Malawi
Publisher
HIV Unit, Malawi Ministry of Health
URL:
Theme area
Equity in health
Title of publication Reclamando os recursos para Saude uma Analise regional da Equidade na Saude na Africa Oriental e Austral: Introducao & Sumario Executivo
Date of publication
2009 November
Publication type
Book Section
Publication details
Reclamando os recursos para Saude uma Analise regional da Equidade na Saude na Africa Oriental e Austral pp 1-5
Publication status
Published
Language
Portuguese
Keywords
regional analysis, health equity, health systems
Abstract
Temos o conhecimento, habilidade, e experiência de superar desigualidades persistentes na saúde na Africa Oriental e Austral. Esta análise providencia uma mensagem inspiradora e emposada, explorando vários aspectos da saúde e sistemas da saúde e fornecendo muitos exemplos de boa prática na região.
A evidência dentro desta análise aponta para três formas em quais reclamando os recursos para a saúde pode melhorar a equidade da saúde. Estas são: para as pessoas pobres reclamar uma divisão mais justa dos recursos nacionais a fim de melhorar a sua saúde; para um regresso mais justo para Africa Oriental e Austral da economia global a fim de aumentar os recursos para a saúde; e para uma divisão mais ampla dos recursos nacionais e globais para serem investidos nos sistemas redistribuitivos da saúde a fim de superar os efeitos empobrecidos da má-saúde.
Embora a imagem de saúde da Africa Oriental e Austral está actualmente triste, com taxas altas de mortalidade, baixa esperança da vida e cargas altas de subalimentação, HIV e SIDA, tuberculose (TB) e malaria, a mensagem que emerge deste livro é uma de esperança e reconhecimento das nossas forças e possibilidades para acções.
Country
East and southern Africa region
Publisher
EQUINET
URL:
Equinet Publication Type
Book section
Theme area
Governance and participation in health
Title of publication Regional Meeting of Parliamentary Committees on Health in East and Southern Africa: Health Equity and Primary Health Care: Responding to the Challenges and Opportunities
Date of publication
2008 September
Publication type
Conference Proceedings
Publication details
EQUINET Meeting report: pp 1-36
Publication status
Published
Language
English
Keywords
health equity situation; health financing; treaties; east Africa; southern Africa
Abstract
The meeting, held at Munyonyo Uganda September 16-18 2008, gathered members of parliamentary committees responsible for health from twelve countries in East and Southern Africa, with sixteen technical, government and civil society and regional partners. The objectives of the meeting were to: review the health equity situation assessment in the region in relation to regional goals (e.g. Maputo Plan of Action, Abuja Declaration) as well as international frameworks (e.g. ICPD PoA, and the MDGs); review and discuss sexual and reproductive health, RH commodity security, HIV and AIDS, integration of RH and HIV/AIDS; as well as population policies, legislation and budgets; hear evidence on and discuss options for fair and adequate health care financing and for promoting equitable resource allocation, particularly in relation to budget processes; explore the application of international and regional treaties and conventions on the right to health; update on current health and trade issues, including patenting laws and the EPA negotiations and more generally legal frameworks for ensuring protection of public health in trade agreements; discuss developments in primary health care and essential health care entitlements; and review and make proposals to strengthen SEAPACOH regional networking and organisation.
Country
East and southern Africa region
Publisher
EQUINET, UNFPA, APHRC, DSW, Venture Strategies for Health and Development, PPD ARO, SEAPACOH
URL:
Equinet Publication Type
Reports
Theme area
Resource allocation and health financing
Title of publication Séries Politicas 20: Alcançando a a promess: O progresso sobre o compromisso da Abuja de 15% dos fundos do governo para a saúde
Date of publication
2008 November
Publication type
Document
Publication details
EQUINET Séries Politicas 20 pp 1-4
Publication status
Published
Language
Portuguese
Keywords
Abstract
No ano 2001, em Abuja na Nigeria, os Chefes dos estados membros da União Africana comprometeram para alocar ao menos 15% de orçamentos dos governos para seus sectores da saúde. Ao mesmo tempo chamaram os países doadores para complementar seus esforços a fim de mobilizar domesticamente os recursos através de cumprirem o seu compromisso de dedicar 0.7% do seu PBN como AOD para os países em via de desenvolvimento e cancelar a dívida externa da Afica em favor Do aumento de investimento no sector social.
O alvo de Abuja, assim, consiste de três componentes; os países Africanos deveriam: mobilizar os recursos domésticos para a saúde (15% agora); estar não sobre-carregado pela prestação de contas do débito (Cancelamento de Débito agora); e ser apoiada pela AOD (0.7% PBN agora).
Country
Southern Africa Regional
Publisher
EQUINET, HEU, TARSC
Equinet Publication Type
Policy brief
Theme area
Resource allocation and health financing
Title of publication Séries Politicas 19: Será que estamos a fazer progressso em a equita frica Os diferentes distritos, regiões e províncias num país têm diferentes necessidades de saúde e os s r a gestão orque importa alocação equitativa dos recursos de assistência da os, o
Date of publication
2008 November
Publication type
Document
Publication details
EQUINET Séries Politicas 19 pp 1-4
Publication status
Published
Language
Portuguese
Keywords
Abstract
Os diferentes distritos, regiões e províncias num país têm diferentes necessidades de saúde e recursos disponíveis dos cuidados da saúde. Os fundos do governo justamentamente distribuídos para a saúde assim chamam para uma formula que calcula a divisão dos recursos totais para seremalocados para áreas baseadas sobre indicadores da necessidade relativa para cuidados da saúde naquela área. Muitos países na região usam tais formulários. Eles usam diferentes indicadores da necessidade de saúde, incluindo a capacidade populacional e a sua composição, os níveis da pobreza, doenças específicas e mortalidade. Revelando experiência em certos países selecionadodentro da região, esta breve política sugere que os países podem fortalecer uma alocação equitativa dos recursos para a saúde através de aumentar a cota global do financiamento do governo alocada ao sector da saúde, trazendo ajuda externa e o financiamento do governo num só conjunto de fundose aloca-los atraves dum mecanismo simples. Alocação de recursos equitativos chama para os governos estabelecer alvos anuais para alocação equitativa destes fundos públicos, e colecionainformação para monitorar e reportar sobre progresso em alcançar estes alvos, incluindo parliamentos e sociedade civil. Alocação de recursos é um processo politizado e requer umcuidadosa, incluindo, planificar, oraganizar e providencia de incentivos para a re-distribuição do pessoal de cuidados da saúde para áreas onde a necessidade da saúde é alta.
Country
Southern Africa Regional
Publisher
EQUINET, HEU, TARSC
Equinet Publication Type
Policy brief
Theme area
Health equity in economic and trade policies
Title of publication Workshop report: Protecting health and equitable health services in the Economic Partnership Agreements in east and southern Africa, 18 and 18 September 2008, Munyonyo, Uganda
Date of publication
2008 September
Publication type
Conference Proceedings
Publication details
EQUINET Workshop report pp 1-17
Publication status
Published
Language
English
Keywords
Economic Partnership Agreements, EPAs, European Commission, European Union, EU, negotiating positions; east Africa; southern Africa
Abstract
This workshop brought together civil society, parliamentarians, human rights commissions, trade and health ministries officials to review and deliberate on protection of health and access to health care services in the ongoing EPA negotiations, and particularly in the services negotiations. The meeting aimed to:
• Update on current health and trade issues, including patenting laws and the EPA negotiations and more generally legal frameworks for ensuring protection of public health in trade agreements.
• Review the technical analysis report developed looking on the services negotiations in the Economic Partnership Agreements.
• Review and develop key positions to be advanced for the protection of public health in trade agreements and strategies for advancing them.
• Develop and adopt strategies for the advancement of the negotiating positions.
Country
East and southern Africa region
Publisher
EQUINET, SEATINI
URL:
Equinet Publication Type
Reports
Theme area
Resource allocation and health financing
Title of publication Discussion Paper 66: Key issues in equitable health care financing in East and Southern Africa
Date of publication
2008 May
Publication type
Document
Publication details
EQUINET Discussion paper series 66 pp 1-33
Publication status
Language
English
Keywords
resource mobilisation; dependency on donor funding; tax system; household burden; out-of-pocket payment; cross-subsidies; pre-payment; debt servicing; east Africa; southern Africa
Abstract
This report provides an overview of the status of health care financing in seven East and Southern African (ESA) countries (Malawi, Namibia, South Africa, Tanzania, Uganda, Zambia, Zimbabwe), illustrates recent developments and proposes changes to health care financing in the region. It draws on country case-studies and a collaborative cross-country analysis undertaken at an EQUINET workshop. These health care financing issues are considered through an equity lens, using a framework that focuses on the key functions or components of health care financing systems - revenue collection, pooling of funds and purchasing. There remains a heavy dependency on donor funding in several countries, and while debt relief initiatives are translating into increased government funding for health care in some countries, in other countries, the health sector has not benefited much from reduced debt servicing. Due to high levels of out-of-pocket payments in many ESA countries and a heavy emphasis in the tax system on VAT, individual households carry a heavy burden. Health insurance is growing in popularity, particularly community-based health insurance which has placed the financing burden on relatively poor rural communities and those living in informal urban areas. All the countries under review have poor fund pooling with little in the way of risk equalisation mechanisms, which severely limits the potential for income and risk cross-subsidies. To achieve equitable health care financing it is necessary to: eliminate, or at least reduce out-of-pocket payments; increase the funding of health services from tax revenue; and introduce mechanisms to integrate all forms of pre-payment (i.e. tax funding and health insurance).
Country
East and southern Africa region
Publisher
EQUINET, Health Economics Unit (UCT)
URL:
Equinet Publication Type
Discussion paper
Theme area
Equity in health
Title of publication Reclaiming the Resources for Health: A Regional Analysis of Equity in Health in East and Southern Africa
Date of publication
2007 October
Publication type
Book
Publication details
A Regional Analysis of Equity in Health in East and Southern Africa
Publication status
Published
Language
English
Keywords
health equity; regional analysis; east and southern africa
Abstract
The Regional analysis of Equity in Health in East and Southern Africa presents a synthesis of the evidence gathered from a range of sources: published literature on and from the region, reviews of current evidence, where available, data drawn primarily from government, intergovernmental, particularly Africa Union and UN sources and the less commonly documented and heard experience within the region, found in grey literature, in interviews and testimonials and gathered through participatory processes. The report is written for many audiences. For the diverse community involved in health equity within east and southern Africa, it provides a source book of evidence and analysis to support and advance work.
The Sections of the book are
• Section 1: Progress in health traces the sources of inequalities in health in the region. It shows that we need to address inequality if economic growth is to lead to poverty reduction.
• Section 2: Reclaiming the economic resources for health maps the outflow of resources from Africa, and examines options to reclaim control over resources for health in areas such as food security and access to medicines.
• Section 3: Building universal, comprehensive people centred health systems shows the ways in which health systems can make a difference, particularly for those with greatest health needs, and presents lessons learned from primary health care and from the roll-out of prevention and treatment for HIV and AIDS.
• Section 4: Fair financing of health systems explores ways in which we can fairly mobilize and allocate domestic resources for health systems, what that implies for the management of international resources, and how we can avoid financial barriers to services for poor people with the greatest need.
• Section 5: Valuing and reclaiming investments in health workers describes the outflow of health workers from vital health services and discusses the policies and measures to involve, value and retain health workers in the region.
• Section 6: Organising people-centred health systems points to the many ways health systems can act to empower people, stimulate social action and build alliances to promote equity-oriented health systems.
• Section 7: Taking action to reclaim the resources for health summarises the policy messages presented and proposes that we monitor targets and indicators of key dimensions of health equity, to review progress, inform health planning and make health equity issues more visible in national planning.
Country
Zimbabwe
Publisher
EQUINET with Weaver Press, Fountain Publishers, Jacana Media
Equinet Publication Type
Book
Theme area
Equity and HIV/AIDS
Title of publication ‘Antwerp in Geneva’ workshop on the AIDS response and health systems strengthening in sub-Saharan Africa, 28 May 2008
Date of publication
2008
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
Institute of Tropical Medicine, funding, anti-retroviral therapy, health systems, human rights, budget, finance
Abstract
On 28 May 2008 the Institute of Tropical Medicine (Antwerp, Belgium) hosted a meeting at the World Health Organization (Geneva, Switzerland) to review the evidence on the effects of AIDS programmes on Health Systems, particularly in high HIV prevalence settings, and discuss the way forward. Over 30 participants attended from a range of backgrounds (implementers, activists, academics and funders) and HIV-affected countries (Ethiopia, Ivory Coast, Malawi, Mozambique, South Africa, and Uganda). Participants noted that HIV is substantially better resourced than many other health priorities, and this has created tensions. However, it cannot be said that HIV is ‘over-funded’, as some have claimed recently: the majority of patients needing ART are still not receiving it and there is still a considerable funding gap between what is needed and what is provided. Rather, insufficient health care funding overall creates competition for these scarce funds.
Significant debate has been generated on whether AIDS programmes have in their design or implementation strengthened of weakened health systems. From the experience and evidence presented at the meeting, both benefit and harm were observed. A priority needs to be given to human resources development. Perhaps the most important lesson from the AIDS response is the need to promote a rights-based approach to health, a perspective that refuses to accept the existing status quo of human and financial resource constraints. There needs to be greater advocacy for a dramatic increase of health sector resources, both from national budgets and from international support; the latter should be considered not as an act of charity but as part of the obligation to fulfil universal human rights. This can be encouraged by involving civil society at all levels of health system strengthening.
Country
Publisher
URL:
Theme area
Equitable health services
Title of publication From Mexico to Mali: Taking stock of achievements in health policy and systems research
Date of publication
2008
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
Health policy, systems research, health financing, worker relations, non-state sector
Abstract
This is the final statement of a meeting held in Nyon, Switzerland, 25–27 May 2008 between the Alliance for Health Policy and Systems Research, WHO and the International Development Research Centre, Canada. Considerable progress has been made in established health policy and systems research (HPSR) areas such as health financing, worker relations and the role of the non-state sector, though achievements in these areas vary substantially. In some, such as health financing, a large number of studies and recent reviews have began to synthesise findings; in others, such as HRH, relatively limited empirical work has been conducted and there is a need to intensify research efforts.
There is an urgent need to move from research that is descriptive and identifies problems, to research that is action oriented and helps develop and evaluate potential solutions. Stronger links among researchers, policy makers and research and development funders are required to facilitate this. Despite interesting work in the field, HPSR continues to perceived as the poor relation to more basic health sciences research. More must be done to highlight the positive contributions that HPSR can make to the big health issues of our time.
Country
Publisher
URL:
Theme area
Equity and HIV/AIDS, Monitoring equity and research to policy
Title of publication ART in the public and private sectors in Malawi: Results up to 31 March 2008
Date of publication
2008 May
Publication type
Electronic Source
Publication details
Publication status
Published
Language
English
Keywords
ART, Malawi, monitoring, pharmaceutical, anti-retrovirals
Abstract
ART scale up in Malawi continues to progress well. Sites are doing well, despite theincreasing burden of work. The majority are taking the initiative of doing quarterlyand cumulative cohort analysis, although nearly one third of sites are still not comingup with correct outcomes. This will require continued and regular vigilance andsupervision. The treatment outcomes for ART are reasonable. Early death rates arestill a problem, and defaults still constitute a significant proportion of the outcomes.ARV drug stocks were again assessed, and nationally drugs stocks are adequate.However, some sites are over-performing to a large extent and causing problems withdrug stocks (both for starter packs and continuation packs). The quarterly drug stocktaking assists in the activity of re-distributing drugs from under- to over-performingsites. Some drugs for HIV-related diseases, particularly morphine and vincristine, are out ofstock in most facilities.
Country
Publisher
URL:
Theme area
Human resources for health
Title of publication Workers on Wednesday: Healthworker retention in South Africa
Date of publication
2008 September
Publication type
Publication details
EQUINET radio show
Publication status
Published
Language
English
Keywords
health workers, working condtions, remuneration, consultation and participation, ratios, South Africa
Abstract
SAFM is the largest English language current affairs radio station in South Africa. In its 'Workers on Wednesday' slot the host, live studio guests and call-in audience discussed the reasons for migration of health workers - from rural to urban areas, from the public to the private sector, and from South Africa to other countries - and the effectiveness of incentives to retain health workers in the South African public sector.
Country
South Africa
Publisher
SAFM; Workers World Media Productions; EQUINET
Equinet Publication Type
Briefs
Theme area
Governance and participation in health
Title of publication Resolutions: Regional Meeting of Parliamentary Committees on Health in East and Southern Africa: Health Equity and Primary Health Care: Responding to the Challenges and Opportunities: Munyonyo, Uganda, 16-18 September 2008
Date of publication
2008 September
Publication type
Document
Publication details
Resolutions: Regional Meeting of Parliamentary Committees on Health in East and Southern Africa: Health Equity and Primary Health Care: Responding to the Challenges and Opportunities: Munyonyo, Uganda, 16-18 September 2008 pp 1-2
Publication status
Published
Language
English
Keywords
equity in health, primary health care, sexual and reproductive heath rights, socio-economic and health inequality, Millennium Development Goals (MDGs), economic and social empowerment and development, treaties, implementation of agreements, enactment of l
Abstract
The Regional Meeting of Parliamentary Committees on Health in East and Southern Africa, Munyonyo Uganda September 16-18 2008, gathered members of parliamentary committees responsible for health from twelve countries in East and Southern Africa, with sixteen technical, government and civil society and regional partners to promote information exchange, facilitate policy dialogue and identify key areas of follow up action to advance health equity and sexual and reproductive health in the region.
Country
Southern Africa Regional
Publisher
Southern and East African Parliamentary Alliance of Committees On Health (SEAPACOH); Partners in Population and Development, Africa Regional Office; R
URL:
Equinet Publication Type
Resolutions
Theme area
Monitoring equity and research to policy
Title of publication Policy Brief 21: Tackling implementation gaps through health policy analysis
Date of publication
2008 September
Publication type
Document
Publication details
EQUINET Policy Brief 21 pp 1-4
Publication status
Published
Language
English
Keywords
Health system development; policy analysis; policy implementation; power; rules, norms and customs; global environment; health policy actors; east and southern Africa
Abstract
Implementing any policy or intervention faces a range of challenges, especially for those seeking to benefit the poorest social groups. Much public health analysis focuses on the technical aspects of good policy design. However, experience shows that it can be more difficult to deal with the political and institutional barriers to implementation than to design new policies and programmes. Predicting and managing these political and institutional factors is essential to make the changes necessary to strengthen equitable health systems. Health policy analysis provides frameworks and tools for investigating these issues, and for tackling them. There are a range of resources in Africa and elsewhere to support this key area of work in health.
Country
East and southern Africa region
Publisher
EQUINET; Centre for Health Policy, University of Witwatersrand; Health Economics Unit, University of Cape Town
Equinet Publication Type
Policy brief
Theme area
Resource allocation and health financing
Title of publication Policy brief 20: Meeting the promise: Progress on the Abuja commitment of 15% government funds to health
Date of publication
2008 May
Publication type
Document
Publication details
EQUINET Policy Brief 20 pp 1-4
Publication status
Published
Language
English
Keywords
Abuja commitment; public funds; debt cancellation; health financing; government budgets; east and southern Africa
Abstract
Devoting 15% of domestic public funds to the health sector is necessary - both to address the health and health care needs within east and southern Africa (ESA) and to ensure progress towards building a universal and comprehensive health system. The target of 15% is not unrealistic – it is very much in line with levels of public spending in other countries around the world. Achieving the 15% target demands that public funds not be consumed by debt servicing, so rapid implementation of debt cancellation is critical. The 15% is understood to mean domestic public spending on health, excluding external funding. It should be regularly monitored and publicly reported by governments. Even if countries achieve the 15% target, for many there will still be a substantial gap in funding for health services. More resources flow out of Africa than into the continent, so sustainable health financing demands global solidarity. OECD countries should meet their commitment to contribute 0.7% of their GNP as official development assistance (ODA). Increased spending on health services should not be at the expense of spending on other social services.
Country
East and southern Africa region
Publisher
EQUINET; Health Economics Unit, University of Cape Town; Training and Research Support Centre
URL:
Equinet Publication Type
Policy brief
Theme area
Human resources for health
Title of publication Discussion Paper 65: Retention incentives for health workers in Zimbabwe
Date of publication
2008 May
Publication type
Document
Publication details
EQUINET Discussion paper series 65 pp 1-35
Publication status
Published
Language
English
Keywords
Health worker retention; incentives; retention packages; monitoring and evaluation; Zimbabwe Health Service Board; Zimbabwe
Abstract
This paper investigates the impact of the framework and strategies to retain critical health professionals (CHPs) that the Zimbabwean government has put in place, particularly regarding non-financial incentives, in the face of continuing high out-migration. The study investigated the causes of migration of health professionals; the strategies used to retain health professionals, how they are being implemented, monitored and evaluated and their impact, in order to make recommendations to enhance the monitoring, evaluation and management of non-financial incentives for health worker retention. The field survey results showed that Zimbabwe is losing the most experienced CHPs, but even newly qualified staff aspire to migrate to gain experience. The major factor driving out-migration was economic hardship that CHPs face due to the deterioration of the country’s economy. Other factors identified include poor remuneration, unattractive financial incentives and poor working conditions. The retention package offered by the Zimbabwe Health Service Board (ZHSB) appears not to have much impact on the ground. Many interviewees indicated that the package was not attractive and some said they were not aware of it. We suggest that managing health worker incentives calls for the ZHSB to have greater decision making latitude.
Country
Zimbabwe
Publisher
EQUINET, University of Namibia, University of Limpopo in co-operation with the East, Central and Southern African Health Community (ECSA-HC)
URL:
Equinet Publication Type
Discussion paper
Theme area
Equity and HIV/AIDS
Title of publication ART in the public and private sectors in Malawi: Results up to 31st March 2008
Date of publication
2008 July
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
cumulative treatment outcomes; eligible patients; stock level assessment; monitoring and evaluation
Abstract
This report presents data on the number of patients accessing ART in both the public and private sectors in Malawi. By the end of March 2008, there were 157 free-standing facilities in Malawi in the public health sector delivering ART free of charge to HIV-positive eligible patients. In the first quarter of 2008 (January to March), there were 17,642 new patients started on ART (39% male, 61% female; 91% adults and 9% children. By the end of March 2008, there were 159,111 patients who had ever started on ART (39% male, 61% female; 92% adults and 8 % children). By the end of March 2008, there were 45 facilities in Malawi in the private health sector delivering ART at a subsidised rate to HIV-positive eligible patients. In the first quarter of 2008 (January to March), there were 669 new patients started on ART (44% male, 56% female, 95% adult, 5% children). By the end of March 2008, there were 6,076 patients who had ever started on ART (51% male, 49% female, 95% adults, 5% children).
Country
Malawi
Publisher
Ministry of Health, Malawi
URL:
Theme area
Values, policies and rights, Governance and participation in health
Title of publication Parliament briefing 4: Using health rights to promote equity oriented health budgets
Date of publication
2008 July
Publication type
Document
Publication details
EQUINET Parliament briefing 4 pp 1-4
Publication status
Published
Language
English
Keywords
public policy; primary health care; district health services; budget allocations; oversight on public spending; east and southern Africa
Abstract
Public policy can make a difference to people’s health. Health improves with increased wealth. But countries with low per capita national incomes have been able to achieve very high health outcomes when they have directed resources towards primary health care and district health services. This indicates that it is not only how much, but how resources are spent that influence health outcomes. Parliaments can contribute to these health outcomes in their debate on, review and approval of government budget allocations and oversight of public spending by the executive. This function is often seen as separate to the legislative role of parliament. But this leaflet argues that in fact, rights and their expression in law can be a powerful tool for parliamentarians when they are arguing the case for increased budget allocations, especially for health, and for these resources to be directed at the areas of health that matter most for equity.
Country
East and southern Africa region
Publisher
EQUINET; University of Cape Town; TARSC
Equinet Publication Type
Briefs
Theme area
Values, policies and rights
Title of publication Parliament briefing 3: Parliament roles in protecting rights to health in east and southern Africa
Date of publication
2008 July
Publication type
Document
Publication details
EQUINET Parliament briefing 3 pp 1-4
Publication status
Published
Language
English
Keywords
international human rights commitments, right to health, legal framework, parliament, east and southern Africa
Abstract
Parliaments have a significant role to play in ensuring that people are able to access the right to health, that health rights are enshrined in national laws, and that national governments make proper provisions for implementing health rights. This brief sets out the international legal framework for the right to health and the responsibilities of national legislatures in making that right to health real. Parliaments and their committee structures play a key role in the process of ratifying international human rights commitments, passing and reviewing laws to implement these commitments, overseeing the executive and monitoring implementation of these laws, and in including civil society in such processes. Parliament thus plays a critical role in protecting the right to health.
Country
East and southern Africa region
Publisher
EQUINET, University of Cape Town; TARSC
Equinet Publication Type
Briefs
Theme area
Governance and participation in health
Title of publication Civil society influence on national governance
Date of publication
2008 August
Publication type
Conference Proceedings
Publication details
Civicus Participatory Governance Programme: How can we build political for participatory governance, 17-18 June 2008 pp 1-10
Publication status
Published
Language
English
Keywords
participation, benefits, budget, political will
Abstract
Although participatory governance offers important concrete benefits for citizens and state actors alike, there is often initial resistance from political actors and government offiicals who are unfamiliar with such approaches. This small working group session involved three case studies which describe and analyse Civil Society Organisation approaches to building political will for participatory governance.
Country
South Africa
Publisher
Idasa
URL:
Theme area
Human resources for health
Title of publication Discussion Paper 61: Non-financial incentives and retention of health workers in Tanzania: Combined evidence from literature review and a focussed cross-sectional study
Date of publication
2008 July
Publication type
Report
Publication details
EQUINET Discussion Paper 61 pp 1-39
Publication status
Published
Language
English
Keywords
health worker migration, retention, non-financial incentives, policy, implementation, resource barriers, Tanzania
Abstract
The Tanzanian public health sector is losing workers to internal and external migration. This paper examines the implementation of policies to govern non-financial incentives to retain health workers. It examines a range of non-financial incentives, including training; leave; promotion; housing; and a safe and supportive working environment. It also examines the systems for managing personnel and the implementation of incentives as a factor in retention, including the participatory personnel appraisal system; worker participation in discussing their job requirements and welfare; supervision; recognition and respect. Drawing on a review of policy, published and grey literature and on a field stidy of seven districts, including five underserved districts, the paper finds that while a number of incentives exist in policy, their sustainability is eroded by the absence of special earmarked funding for their implementation. Decentralised districts also lack adequate powers and authority to manage health workers weakening their ability to implement non-financial incentives. There was general consensus from health workers and managers that interventions such as training and education, promotion and the provision of safe working and living environments, can be strong motivators if implemented in an effective and sustainable manner. In contrast, health workers interviewed pointed to the demotivating effect of poor implementation of available non-financial incentives. The management and resource barriers to implementing non financial retention incentives are further explored in the paper and recommendations made to strengthen the implementation of incentives. The authors conclude that analysis of issues driving retention needs to take into account both individual and structural factors that shape individual health workers' preference structures and the complex nature of the health care labour market. A trivialised pull and push factors framework in analysing complex problems like retention, will not guide sustainable solutions, which need to be based on an understanding of factors that not only guide the design of incentive regimes, but also the resources, management systems and other factors that enable their implementation in practice.
Country
Tanzania
Publisher
EQUINET, ECSA-HC, University of Namibia, NIMRI
URL:
Equinet Publication Type
Discussion paper
Theme area
Equity in health
Title of publication Registration form, EQUINET Conference September 23-25 2009
Date of publication
2008 July
Publication type
Document
Publication details
Registration form, EQUINET Conference September 23-25 2009
Publication status
Language
Keywords
Abstract
Country
Publisher
Equinet Publication Type
Briefs
Theme area
Equity in health
Title of publication Abstract submission form, EQUINET Conference, September 23-25 2009
Date of publication
2008 July
Publication type
Document
Publication details
Publication status
Published
Language
Keywords
Abstract
Country
Publisher
Equinet Publication Type
Briefs
Theme area
Equity in health
Title of publication First announcement: EQUINET Regional Conference, Uganda, September 23-25 2009
Date of publication
2008 July
Publication type
Document
Publication details
First Announcement: EQUINET Regional Conference September 23-25 2009
Publication status
Published
Language
Keywords
Abstract
Country
Publisher
Equinet Publication Type
Briefs
Theme area
Values, policies and rights
Title of publication Women and the right to food: International law and state practice
Date of publication
2007
Publication type
Academic paper
Publication details
Publication status
Published
Language
English
Keywords
Millennium Development Goals, poverty, hunger, gender
Abstract
In the light of Millennium Development Goals No. 1 – to eradicate extreme poverty and hunger – and No. 3 – to promote gender equality and empower women – the present study provides a cross-cutting analysis of the right to food from a gender perspective, examining relevant international instruments as well as State practice. The analysis of these documents will give an idea of what is today’s level of awareness of women’s right to food and related issues, how much is covered by law and how much is missing.
Country
Switzerland
Publisher
Food and Agriculture Organization of the United Nations
Theme area
Equity in health, Equitable health services
Title of publication Is the declaration of the Alma Ata still relevant to primary health care?
Date of publication
2008 March
Publication type
Journal Article
Publication details
British Medical Journal 336 pp 536-538
Publication status
Published
Language
English
Keywords
primary health care, strategic partnerships, universal access, Alma Ata
Abstract
After years of relative neglect, the World Health Organization has recently given strategic prominence to the development of primary health care. This year sees the 30th anniversary of the declaration of Alma Ata. Primary health care 'based on practical, scientifically sound and socially acceptable methods and technology made universally accessible through people’s full participation and at a cost that the community and country can afford' was to be the key to delivering health for all by the year 2000. Primary health care in this context includes both primary medical care and activities tackling determinants of ill health.
Country
United Kingdom
Publisher
Theme area
Equitable health services, Governance and participation in health
Title of publication Harmonisation for health in Africa: An action framework
Date of publication
2007
Publication type
Academic paper
Publication details
Publication status
Published
Language
English
Keywords
monitoring, evaluation, performance, health system, scaling up
Abstract
This paper sets out an initiative by African Development Bank, UNAIDS, UNFPA, UNICEF, WHO and the World Bank that aims to tackle barriers to scaling up health in Africa. The ‘Harmonisation for Health in Africa’ initiative HHA is a regional mechanism through which collaborating partners agree to focus on providing support to the countries in the African region for reaching health MDGs. The HHA initiative aims to: support countries to identify, plan and address health systems constraints to improve health-related outcomes; develop national capacity through training, planning, costing and budgeting, harmonisation and stimulating peer exchange; promote the generation and dissemination of knowledge, guidance and tools for specific technical areas including strengthening health service delivery and monitoring health systems performance; support countries to leverage predictable and sustained resources for the health sector; ensure accountability and assist in monitoring performance, of national health systems, aid effectiveness and the performance of the International Health Partnership; and enhance coordination to support nationally owned plans and implementation process, helping countries to address the country level bottlenecks arising from constraints within international agencies.
Country
Switzerland
Publisher
WHO
Theme area
Equitable health services, Resource allocation and health financing
Title of publication Global tuberculosis control: Surveillance, planning, financing
Date of publication
2008
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
tuberculosis, Millennium Development Goal 6, Stop TB Partnership, MGD
Abstract
Tuberculosis (TB) is a major cause of illness and death worldwide, especially in Asia and Africa. Globally, 9.2 million new cases and 1.7 million deaths from TB occurred in 2006, of which 0.7 million cases and 0.2 million deaths were HIV-positive people. Population growth has boosted these numbers compared with those reported by the World Health Organization (WHO) for previous years. More positively, and reinforcing a finding first reported in 2007, the number of new cases per capita appears to have been falling globally since 2003, and in all six WHO regions except the European Region where rates are approximately stable. If this trend is sustained, Millennium Development Goal 6, to have halted and begun to reverse the incidence of TB, will be achieved well before the target date of 2015. Four regions are also on track to halve prevalence and death rates by 2015, compared with 1990 levels, in line with targets set by the Stop TB Partnership. Africa and Europe are not on track to reach these targets, following large increases in the incidence of TB during the 1990s. At current rates of progress these regions will prevent the targets being achieved globally.
Country
Switzerland
Publisher
WHO
Theme area
Human resources for health
Title of publication Discussion Paper 62: Incentives for health worker retention in Kenya: An assessment of current practice
Date of publication
2008 July
Publication type
Academic paper
Publication details
EQUINET Discussion Paper 62 pp 1-28
Publication status
Published
Language
English
Keywords
health worker retention incentives, recruitment, management, urban and rural areas, Kenya
Abstract
In Kenya, internal migration of workers, from rural/poor areas to
urban/rich areas, is just as serious a problem as international
migration. Shortages in the health workforce are aggravated by the unequal distribution of health workers as a result of economic, social, professional and security factors. This report is of a literature review and field research on strategies for the retention of health workers in Kenya. It examines trends in health worker recruitment and retention; existing policies, strategies and interventions to retain health workers; and assesses their implementation and the factors affecting this. The study data suggests that better organised facilities, often in higher-income areas, are more successful in providing incentives. Yet it is at the lower levels of the health system (in rural and poorer areas) where incentives are more urgently needed to counteract the strong push factors that force workers out of these areas. Recommendations are proposed for measures to retain health workers in rural areas, in lower-income districts and at lower levels of the health system to ensure that all areas reach minimum standards with regard to numbers of personnel per population. Such incentives are not only financial. A number of non-financial incentives are highly valued: improved working conditions; training and supervision; and good living conditions, communications, health care and educational opportunities for themselves and their families.
Country
Kenya
Publisher
EQUINET, African Mental Health Foundation, Training and Research Support Centre, University of Limpopo and East, Central and Southern African Health C
URL:
Equinet Publication Type
Discussion paper
Theme area
Equity in health
Title of publication Editoriais do Boletim da“EQUINET Newsletter”, Janeiro 2007 – Maio 2008
Date of publication
2008 July
Publication type
Document
Publication details
EQUINET newsletter editorials, Portuguese 1 pp 1-50
Publication status
Published
Language
Portuguese
Keywords
equity, east and southern Africa
Abstract
This document compiles twenty one editorials of the newsletter of the Regional Network for Equity in Health in East and southern Africa from January 2007 to April 2008 translated into Portuguese. The issues covered range from debates and policy positions on financing for health to the public health impacts of criminalising HIV transmission. The editorial content reflects a range of authors from academic, professional and civil society groups and not the views of the EQUINET steering committee.
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Policy brief
Theme area
Monitoring equity and research to policy
Title of publication Utilisation survey on the District Health Barometer
Date of publication
2008 February
Publication type
Academic paper
Publication details
Publication status
Published
Language
English
Keywords
primary health care, District Health Baromenter, access, health indicators, monitoring, South Africa
Abstract
This report and summary deals with the findings of the survey that deal with the District Health Barometer (DHB) publication. The DHB aims at improving the quality of and access to primary health care through monitoring important aspects of the health system at a district level by analysing and comparing a carefully selected range of health indicators.
Country
South Africa
Publisher
Health Systems Trust
URL:
Theme area
Equity and HIV/AIDS, Governance and participation in health
Title of publication Stronger together: Supporting the vital role played by older people in the fight against the HIV and AIDS pandemic
Date of publication
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
caregivers, carers, home carers, women, HIV, AIDS
Abstract
In the HIV and AIDS pandemic, it is older people, particularly grandmothers, who are shouldering most of the emotional and financial burden as carers. Yet their vital role is going unrecognised. This report calls for a major shift in the response to HIV and AIDS. Some of the recommendations include: public recognition of the value, contribution and rights of older women carers to reduce stigma and discrimination against them; a more sophisticated analysis and understanding of the role of older women and men in caring for adults and children living with HIV, so that urgent; support can be targeted at these older carers; and better support to access existing services home-based care policies and programmes that address the specific economic, health and psychosocial needs of older women carers and support them in their care-giving roles.
Country
Publisher
HelpAge International
URL:
Theme area
Poverty and health, Equitable health services, Resource allocation and health financing
Title of publication Depoliticising development and democratising politics in Tanzania: Parallel structures as obstacles to delivering services to the poor
Date of publication
2008
Publication type
Publication details
Journal of Development Studies 2008
Publication status
Published
Language
English
Keywords
local democracy, authority structures, local authorities, social services, decentralisation, Tanzania
Abstract
Local democracy and the involvement of local communities in the provision of social services are central issues in the local government reforms that are presently being implemented in many developing countries. At the same time, institutions that run parallel to local authorities, such as social funds and various user-committees, are established to improve accountability and participation. By focusing on actual political processes rather than administrative, legal, and fiscal aspects of decentralisation, this article traces the breakdown of two development projects in Tanzania to the existence of parallel structures, and suggests that user-committees and social funds should be integrated in local authority structures to avoid fragmentation of participation and to enhance local democracy.
Country
United Kingdom
Publisher
Journal of Development Studies
Theme area
Values, policies and rights, Governance and participation in health
Title of publication Decentralisation and gender: A study on coordination and cooperation in local government for maternal health
Date of publication
2007
Publication type
Academic paper
Publication details
Publication status
Published
Language
English
Keywords
maternal mortality, child mortality, Tanzania, decentralisation
Abstract
Tanzania initiated the Local Government Reform Programme in 1996. The objective of the reform is decentralisation by devolution, and to strengthen local authorities' ability to deliver quality and accessible services in cooperation with local communities, civil society organisations, the private sector and other development actors. This report describes various forms of coordination and cooperation in four districts, using maternal health as an entry point and example. Four districts with relatively low maternal mortality rates were selected: Ileje, Misungwi, Serengeti, and the Moshi rural area. The objective of the study was to identify if, and in what ways, these districts perform better than others when it comes to cooperation on maternal health, and to identify best practices and disseminate these practices to other districts.
Country
Canada
Publisher
Chr. Michelson Institute (CMI)
Theme area
Human resources for health, Equity and HIV/AIDS
Title of publication Workforce analysis using data mining and linear regression to understand HIV/AIDS prevalence patterns
Date of publication
2008 January
Publication type
Journal Article
Publication details
Human Resources for Health 6 2
Publication status
Published
Language
English
Keywords
health workers, literacy, brain drain, nurses, doctors, MDGs, millennium development goals
Abstract
The achievement of the Millennium Development Goals (MDGs) depends on sufficient supply of health workforce in each country. Although country-level data support this contention, it has been difficult to evaluate health workforce supply and MDG outcomes at the country level. The purpose of the study was to examine the association between the health workforce, particularly the nursing workforce, and the achievement of the MDGs, taking into account other factors known to influence health status, such as socioeconomic indicators. The main factors in understanding HIV prevalence rates are physician density followed by female literacy rates and nursing density in the country. Using general linear model approaches, increased physician and nurse density (number of physicians or nurses per population) was associated with lower adult HIV prevalence rate, even when controlling for socioeconomic indicators. Increased nurse and physician density are associated with improved health outcomes, suggesting that countries aiming to attain the MDGs related to HIV would do well to invest in their health workforce. Implications for international and country level policy are discussed.
Country
Publisher
Human Resources for Health
Theme area
Human resources for health, Equity and HIV/AIDS, Monitoring equity and research to policy
Title of publication Knowledge about HIV/AIDS and policy in a South African state hospital
Date of publication
2007
Publication type
Publication details
Publication status
Published
Language
English
Keywords
nurses, counselling, VCT, training, state hospitals, South Africa
Abstract
This research was undertaken to investigate what level of HIV knowledge medical staff have in a state hospital in South Africa. In particular, it looks at their knowledge about and practical use of current HIV policy and counselling programmes within their hospital. The conclusions are applicable to other hospitals in South Africa. The report highlights several areas of poor knowledge. Education of medical staff may be insufficient due to several factors including lack of access to information, lack of training and counselling, and lack of knowledge about HIV policy. The authors recommend the effectiveness of current counselling services is evaluated and that hospital HIV policy and counselling programmes are developed in co-operation with community-based organisations and all cadres in the hospital, especially nurses.
Country
South Africa
Publisher
Social Aspects of HIV/AIDS Research Alliance
Theme area
Equity and HIV/AIDS, Governance and participation in health
Title of publication Family caregivers' perspectives on providing care
Date of publication
2007
Publication type
Academic paper
Publication details
Publication status
Published
Language
English
Keywords
KwaZulu-Natal Income Dynamics Study, home care providers, HIV, KwaZulu-Natal, South Africa
Abstract
This paper is based on findings from the KwaZulu-Natal Income Dynamics Study (KIDS) and describes caregivers’ perspectives on providing care for HIV positive family members. The paper focuses on understanding what care provision means to family caregivers and, in turn, why they provide care. It highlights various aspects of the experience of providing care and the effects of care on caregivers’ lives. Caregivers reported that caring is stressful and physically, emotionally and socially taxing. Moreover, in households in which care takes place, there is in most cases a lack of resources to provide appropriate care. Almost all caregivers indicate that they do not always know what to do to provide care. The report recommends increased support for caregivers, namely training in how to provide the highest quality care possible such as delivering palliative care. This should be provided by home-based care organisations and health workers such as community health workers and nurses through home visits.
Country
South Africa
Publisher
University of KwaZulu-Natal, School of Development Studies
URL:
Theme area
Equity and HIV/AIDS
Title of publication Barriers to condom access: Setting an advocacy agenda
Date of publication
2007
Publication type
Academic paper
Publication details
Publication status
Published
Language
English
Keywords
condoms, safe sex, HIV prevention, monitoring
Abstract
The failure to remove barriers that determine whether a person can access and use a condom is one of the biggest impediments to preventing millions more HIV infections. This advocacy briefing from International Council of AIDS Service Organisations (ICASO) examines some of these barriers and addresses what can be done to overcome them. Information was sourced from a community-led monitoring project in 14 countries undertaken in 2005 and 2006, which collected and analysed data and information on the broad response to HIV and AIDS. The report states that to overcome prominent barriers, governments and donors around the world need to commit new resources and enact and reform legislation, policy and programming that will ensure condom access and availability. It argues that a mobilised community sector that can forcefully advocate for condom access is needed now more than ever.
Country
Canada
Publisher
International Council Of AIDS Services Organisations
URL:
Theme area
Human resources for health, Resource allocation and health financing
Title of publication Informal payments and the quality of health care in Tanzania: Results from qualitative research
Date of publication
2007
Publication type
Academic paper
Publication details
Working Paper 5 pp 1-26
Publication status
Published
Language
English
Keywords
brain drain, human resources, emigration, health professional, retention, informal payments, Tanzania
Abstract
Informal payments for health services are common in many countries, especially in transitional and developing countries. As part of a larger study focusing on health worker performance in Tanzania, one objective was to investigate the nature of informal payments in the health sector, and to identify mechanisms through which informal payments are affecting the quality of health services. A more profound understanding of these mechanisms is of interest because it may improve knowledge of how quality may be enhanced in a system where informal payments are common practice. The findings reveal a variety of positive and negative mechanisms through which informal payments may impact on the quality of health care. Furthermore, they show that informal payments add to health workers' incomes, thus contributing to the retention of workers in the health sector and avoiding a further escalation of the current health worker shortage.
Country
Publisher
CMI
URL:
Theme area
Public-private mix
Title of publication African Union Technical Committee meeting on local production of pharmaceuticals
Date of publication
2008 February
Publication type
Conference Proceedings
Publication details
Publication status
Published
Language
English
Keywords
primary health care, manufacturing, essential medicines, private-public partnerships, PPPs
Abstract
As the World celebrates 30 years of the Alma Ata Declaration that launched the Primary Health as the pillar of quality services, there is greater need for all of us to improve access to affordable medicines. Even in rich countries, access to affordable medicines cannot be guaranteed. Of course, the problems are much greater in many developing countries, with insufficient or no manufacturing capacities in the pharmaceutical sector. Africa is also reliant on other countries to provide its essential medicines. This is not strategic and correct, as Africans cannot guarantee availability of appropriate technologies that truly respond to their current and emerging needs.
Country
South Africa
Publisher
Department of Health
Theme area
Human resources for health
Title of publication Strengthening management in low-income countries: Lessons from Uganda
Date of publication
2007
Publication type
Academic paper
Publication details
Publication status
Published
Language
English
Keywords
management, competency, skills development, District Health Management Teams, Uganda
Abstract
This World Health Organization background paper reviews and summarises service delivery management at the district level in Uganda. Specifically, it looks at health sector management development approaches that have been recently implemented, changes in the management capacity and performance and links between management development and health service delivery outputs. The paper finds that significant effort has gone into developing managers using long and short courses and placing "technical advisers" with District Health Management Teams. The paper concludes that, while opportunities exist for managers to develop skills, courses need to be better designed to produce the essential competencies needed. A health sector competency framework for managers will provide common performance objectives and standards in the sector.
Country
Switzerland
Publisher
WHO
URL:
Theme area
Values, policies and rights, Human resources for health
Title of publication Should active recruitment of health workers from sub-Saharan Africa be viewed as a crime?
Date of publication
2008 February
Publication type
Journal Article
Publication details
The Lancet 371 9613 pp 685-688
Publication status
Published
Language
English
Keywords
brain drain, human resources, emigration, health professional, recruitment
Abstract
Rich countries are poaching so many African health workers that the practice should be viewed as a crime, a team of international disease experts has said. If one of these countries that is being systematically poached were to pursue it as a crime, contributing to unrest, they would have a leg to stand on. This article takes a legal approach to the problem.
Country
United Kingdom
Publisher
The Lancet
Theme area
Human resources for health
Title of publication Managerial competencies of hospital managers in South Africa: A survey of managers in the public and private sectors
Date of publication
2008 February
Publication type
Journal Article
Publication details
Human Resources for Health 6 4
Publication status
Published
Language
English
Keywords
private hospitals, public sector, managerial compentencies, South Africa
Abstract
South Africa has large public and private sectors and there is a common perception that public sector hospitals are inefficient and ineffective while privately owned and managed hospitals provide superior care and are more sustainable. The underlying assumption is that there is a potential gap in management capacity between the two sectors. This study aims to ascertain the skills and competency levels of hospital managers in South Africa and to determine if there are any significant differences in competency levels between managers in the different sectors. The findings confirm the lack of management capacity in the public sector in South Africa and the significant gap between private and public sectors. They provide evidence that there is a great need for further development of managers, especially those in the public sector. The onus is therefore on administrators and those responsible for management education and training to identify managers in need of development and to make available training that is contextually relevant in terms of design and delivery.
Country
Publisher
Human Resources for Health
Theme area
Human resources for health
Title of publication Intent to migrate among nursing students in Uganda: Measures of the brain drain in the next generation of health professionals
Date of publication
2008 February
Publication type
Journal Article
Publication details
Human Resources for Health 6 5
Publication status
Published
Language
English
Keywords
nursing, Uganda, brain drain
Abstract
There is significant concern about the worldwide migration of nursing professionals from low-income countries to rich ones, as nurses are lured to fill the large number of vacancies in rich countries. This study explores the views of nursing students in Uganda to assess their views on practice options and their intentions to migrate. Improving remuneration for nurses is the top priority policy change sought by nursing students in this study. Nursing schools may want to recruit students desiring work in rural areas or public practice to lead to a more stable workforce in Uganda.
Country
Publisher
Human Resources for Health
Theme area
Equitable health services, Equity and HIV/AIDS
Title of publication Poor tracking means patients lose out
Date of publication
2008 February
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
anti-retrovirals, ARVs, distribution, equity, access to drugs, South Africa
Abstract
Inadequate patient tracking at one of South Africa's largest antiretroviral (ARV) distribution sites has led to many patients disappearing from the clinic before treatment starts, a new report has found. The report by the Reproductive Health & HIV Research Unit (RHRU) of the University of the Witwatersrand, based on a 2006 review of patient files at the Tshepong Wellness Clinic, about 120km southwest of Johannesburg, shows that a standard percentage – about 14% – stop taking treatment, but more than 20% of patients never get to the treatment stage.
Country
Switzerland
Publisher
IRIN
URL:
Theme area
Equitable health services
Title of publication Is the Western Cape at risk for an outbreak of preventable childhood diseases? Lessons from an evaluation of routine immunisation coverage
Date of publication
2008
Publication type
Journal Article
Publication details
South African Medical Journal 98 1 pp 41-45
Publication status
Published
Language
English
Keywords
immunisation, vaccination, children, polio, measles
Abstract
This study in Western Cape South Africa shows that while immunisation coverage indicates that a lot of good work is being done, the coverage is insufficient to prevent outbreaks of measles and other common childhood conditions, including polio. The coverage is too low to consider not running periodic mass campaigns for measles and polio. The coverage will need to be sustainably improved before introducing rubella vaccine as part of the EPI schedule. The reasons given by caregivers for their children not being immunised are valuable pointers as to where interventions should be focused.
Country
Publisher
African Journals Online
Theme area
Equitable health services
Title of publication Implementation of the Mental Health Care Act (2002) at district hospitals in South Africa: Translating principles into practice
Date of publication
2008
Publication type
Journal Article
Publication details
South African Medical Journal 98 1 pp 46-49
Publication status
Published
Language
English
Keywords
Abstract
In line with international developments in mental health legislation, the Mental Health Care Act (2002) was promulgated in South Africa. Its core principles – human rights for users; decentralisation and integration of mental health care at primary, secondary and tertiary levels of care; and a focus on care, treatment and rehabilitation – are progressive and laudable. However, the task of implementing the requirements of the Act at community and district hospital levels is fraught with problems. Lack of infrastructure, inadequate skills and poor support and training undermine its successful implementation. Health workers already burdened with enormous workloads and inadequate resources struggle to manage mentally ill patients at district hospitals. The 72-hour observation requirement is a particular area of difficulty throughout the country. This paper outlines the rationale and sense behind this legislation, discusses the problems encountered at the ‘rock face', and offers solutions to the problem of translating principles into practice.
Country
Publisher
African Journals Online
Theme area
Equitable health services
Title of publication Health care waste management in public clinics in the Ilembe District: A situational analysis and intervention strategy
Date of publication
2008
Publication type
Publication details
Publication status
Language
English
Keywords
health care waste management
Abstract
All waste generated at health care facilities in the past was regarded as hazardous and was incinerated before disposal. Today, however, waste generated at health facilities is separated out and disposed of according to the risks it poses. The purpose of this study was to investigate health care waste (HCW) management practices used in public health clinics in the iLembe Health District, with a view to developing a HCW management intervention strategy. The management of health care waste is of great concern. There is need to develop a health care waste management intervention strategy to be implemented consistently and universally in the district.
Country
South Africa
Publisher
Health Systems Trust
URL:
Theme area
Poverty and health, Monitoring equity and research to policy
Title of publication Monitoring and evaluating poverty reduction policies in Mozambique: Study 2
Date of publication
2008
Publication type
Academic paper
Publication details
CMI Brief 7 (3)
Publication status
Published
Language
English
Keywords
agriculture, development, employment, poverty, finance, trade, Mozambique
Abstract
Issues of urban poverty have received little attention in Mozambique, even though the urban poverty rate is high and urban inequality is on the rise. In the bairros of Maputo, unemployment, crime and the high costs of food, housing and land inhibit the poor from converting progress in education and health into increased income and consumption. In a context where money is an integral part of most social relationships, the most destitute become marginalised with no one to turn to. Rising poverty and inequality in Maputo also have an adverse impact on vital urban-rural relationships, and may jeopardise political stability.
Country
Sweden
Publisher
CMI
Theme area
Health equity in economic and trade policies
Title of publication Study 1: Monitoring and evaluating poverty reduction policies in Mozambique
Date of publication
2008
Publication type
Electronic Source
Publication details
Chr. Michelsen Institute Brief 7 (2) pp 1-64
Publication status
Published
Language
English
Keywords
urban poverty, inequality, Maputo, Mozambique
Abstract
From the vantage point of a rural district in northern Mozambique, the development efforts by government and donors are visible through the enhanced capacity of the local administration and investments in education and health, but not where it really matters for poor people: employment creation and reasonable returns from their agricultural production, which currently are adversely affected by an absent or exploitative private sector. The very poorest are marginalised or excluded from social relationships with the extended family, traditional institutions and the state, underlining the need to give special attention to the chronically poor and destitute in rural areas.
Country
Sweden
Publisher
Chr. Michelsen Institute (CMI)
Theme area
Poverty and health
Title of publication Inequality and poverty in Africa in an era of globalisation: Looking beyond income to health and education
Date of publication
2007 November
Publication type
Academic paper
Publication details
Publication status
Published
Language
English
Keywords
globalisation, health, education, Africa
Abstract
This paper describes changes over the past 15–20 years in non-income measures of wellbeing - education and health - in Africa. Results indicate that in the area of health, little progress is being made in terms of reducing pre-school age stunting, a clear manifestation of poor overall health. Likewise, health inequality measures showed that while there were a few instances of reduced inequality along this dimension, there was, on balance, little evidence of success in improving equality of outcomes. Similar results were found in the examination of underweight women as an indicator of general current health status of adults. The overall picture gives little cause for complacency or optimism that Africa has reaped, or will soon reap, the potential benefits of the process of globalisation.
Country
Publisher
UNU-WIDER
Theme area
Health equity in economic and trade policies
Title of publication European development policy: Aid effectiveness and key priorities
Date of publication
2008
Publication type
Conference Proceedings
Publication details
Publication status
Published
Language
English
Keywords
policymakers, policy-makers, Wilton Park
Abstract
Policymakers from the EU and developing countries, together with NGOs and academics, met from 21–24 January at Wilton Park for a strategic and creative dialogue on the effectiveness of European development policy. With input from the Department for International Development and the European Centre for Development Policy Management, the group discussed Europe's development agenda and potential reforms. The group considered ways to improve aid effectiveness in preparation for the Paris commitment review meeting in Accra in September: the closing session was led by the Ghanaian Finance Minister.
Country
United Kingdom
Publisher
European Centre For Development Policy Management; Department For International Development
Theme area
Health equity in economic and trade policies
Title of publication EPA negotiations: Where do we stand?
Date of publication
2008 January
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
Economic Partnership Agreements, EPAs, European Commission, European Union, EU, preferential trade
Abstract
This document gives a detailed picture of the state of EPA negotiations in 2007/2008. While all parties remain committed to concluding comprehensive EPAs, as confirmed in the joint review endorsed in May 2007, progress in the negotiations has been slower than expected. By October, it became apparent that EPAs would not be concluded by the target date of 31 December, set by the expiry of the WTO waiver covering the current preferential trade regime of Cotonou. In reaction to this, the European Commission issued a communication on 23 October, which outlined a pragmatic approach to safeguard preferential market access for non-LDC countries from January 2008. The communication aims at concluding WTO-compatible goods market access arrangements to be in order to extend the negotiation time towards complete EPAs while avoiding adisruption in trade. In line with this approach, a number of interim agreements were concluded over the last weeks of 2007 between the EU and ACP regions, subregions and individual countries.
Country
Netherlands
Publisher
European Centre For Development Policy Management
Theme area
Values, policies and rights, Equity and HIV/AIDS, Monitoring equity and research to policy
Title of publication Sexual and reproductive health and rights indicators: A case study from South Africa
Date of publication
2008 February
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
indicators, reproductive health rights, sexual health, gender, gender-based violence, South Africa
Abstract
A workshop was held in July 2007, hosted by MOSAIC, at which the participating South African organisations reviewed goals set by UNGASS on reproductive health rights, discussed identified indicators, refined these and shared research and findings. In South Africa, in 2007, government collaborated with many stakeholders (such as civil society and the private sector) and launched the HIV and AIDS and STI National Strategic Plan 2007–2011. While there is substantive discussion noting key areas of gender and gender-based violence, cultural attitudes and practices, sexual concurrency and sex workers, there is no overall conceptual lens unpacking sexual and reproductive health and rights. Currently reproductive health is not on the essential health priority list. This leaves gaps in terms of the continuum of care and there is a lack of integration. For example, HIV positive women’s sexual and reproductive intentions are not provided for, abortion services are not regulated within HIV care and sexual violence is not part of the STI syndromic approach.
Country
Switzerland
Publisher
UNGASS
Theme area
Equitable health services, Monitoring equity and research to policy
Title of publication The State of the World’s Children 2008: Child survival
Date of publication
2008
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
maternal mortality, child mortality, newborns
Abstract
The State of the World's Children 2008 provides a wide-ranging assessment of the current state of child survival and primary health care for mothers, newborns and children. The report argues that these issues serve as sensitive barometers of a country's development and wellbeing and as evidence of its priorities and values, and states that investing in the health of children and their mothers is a human rights imperative and one of the surest ways for a country to set its course towards a better future. The report identifies six pivotal actions at the macro level that urgently require unified engagement to intensify efforts for maternal, newborn and child survival and fulfil the right of women and children to health and well-being.
Country
Switzerland
Publisher
UNICEF
Theme area
Human resources for health, Equity and HIV/AIDS
Title of publication What if we decided to take care of everyone who needed treatment? Workforce planning in Mozambique using simulation of demand for HIV/AIDS care
Date of publication
2008 February
Publication type
Journal Article
Publication details
Human Resources for Health 6 3
Publication status
Published
Language
English
Keywords
ART, resource-limited settings, human resources, Mozambique
Abstract
The growing AIDS epidemic in southern Africa is placing an increased strain on health workers, who are experiencing steadily rising patient loads. The authors of this study propose three scenarios to help, depending on numbers of patients enrolled. In the first scenario, Mozambique will start with 8,000 patients on ART and increase that number to 58,000 at the end of three years. This would require thirteen clinicians and just over ten nurses by the end of the first year, and 67 clinicians and 47 nurses at the end of the third year. In the second scenario, the country will start with 34,000 patients enrolled for care (not all of them on ART), and increase to 94,000 by the end of the third year, requiring a growth in clinical staff from 18 to 28. In the third scenario, the country will start a new clinic and enrol 200 new patients per month for three years, requiring 1.2 clinicians in year 1 and 2.2 by the end of year 3. Other clinician types in the model include nurses, social workers, pharmacists, phlebotomists, and peer counsellors. This planning tool could lead to more realistic and appropriate estimates of workforce levels required to provide high-quality HIV care in a low-resource settings.
Country
Publisher
Human Resources for Health
Theme area
Human resources for health, Equity and HIV/AIDS
Title of publication Using nurses to identify HAART eligible patients in the Republic of Mozambique: Results of a time series analysis
Date of publication
2007
Publication type
Journal Article
Publication details
Human Resources for Health 5 7 pp 1478
Publication status
Published
Language
English
Keywords
HAART, adult infections, HIV, AIDS, universal coverage
Abstract
The most pressing challenge to achieving universal access to highly active anti-retroviral therapy (HAART) in sub-Saharan Africa is the shortage of trained personnel to handle the increased service requirements of rapid roll-out. The authors of this study conducted a time-series intervention trial in two HIV clinics in central Mozambique to discern whether expanding the role of basic-level nurses to stage HIV-positive patients using CD4 counts and WHO-defined criteria would lead to more rapid information on patient status (including identification of HAART eligible patients), increased efficiency in the use of higher-level clinical staff, and increased capacity to start HAART-eligible patients on treatment. They found that the CD4 nurse intervention, when implemented correctly, was associated with a more rational use of higher-level clinical providers, which may improve overall clinic flow and efficient use of the limited supply of human resources. However, this intervention did not lead to an increase in the number of patients starting HAART or a reduction in the time to HAART initiation. The month in which the study took place appears to have played an important role in all outcomes, suggesting that general improvements in clinic efficiency may have overshadowed the effect of the intervention. The lack of observed effect in these outcomes may be due to additional health systems bottlenecks that delay the initiation of treatment in HAART-eligible patients.
Country
Publisher
Theme area
Poverty and health, Equitable health services
Title of publication An autopsy study of maternal mortality in Mozambique: The contribution of infectious diseases
Date of publication
2008 February
Publication type
Journal Article
Publication details
PloS Medicine 5 2
Publication status
Published
Language
English
Keywords
malaria, AIDS, antibiotics, maternal health, maternal mortality, bed nets, Mozambique
Abstract
Maternal mortality is a major health problem concentrated in resource-poor regions. Accurate data on its causes using rigorous methods is lacking, but is essential to guide policy-makers and health professionals to reduce this intolerable burden. The aim of this study was to accurately describe the causes of maternal death in order to contribute to its reduction, in one of the regions of the world with the highest maternal mortality ratios. The researchers conducted a prospective study between October 2002 and December 2004 on the causes of maternal death in a tertiary-level referral hospital in Maputo, Mozambique, using complete autopsies with histological examination. In this tertiary hospital in Mozambique, infectious diseases accounted for at least half of all maternal deaths, even though effective treatment is available for the four leading causes, HIV/AIDS, pyogenic bronchopneumonia, severe malaria, and pyogenic meningitis. These observations highlight the need to implement effective and available prevention tools, such as intermittent preventive treatment and insecticide-treated bed nets for malaria, antiretroviral drugs for AIDS, or vaccines and effective antibiotics for pneumococcal and meningococcal diseases. Deaths due to obstetric causes represent a failure of health-care systems and require urgent improvement.
Country
Publisher
PloS Medicine
Theme area
Poverty and health, Equitable health services
Title of publication Risk factors for incomplete vaccination and missed opportunity for immunisation in rural Mozambique
Date of publication
2008 May
Publication type
Journal Article
Publication details
BMC Public Health 8 161
Publication status
Published
Language
English
Keywords
immunisation, vaccination, children, Mozambique
Abstract
Inadequate levels of immunisation against childhood diseases remain a significant public health problem in resource-poor areas of the globe. Nonetheless, the reasons for incomplete vaccination and non-uptake of immunisation services are poorly understood. This study aimed at finding out the reasons for non-vaccination and the magnitude of missed opportunities for vaccination in children less than two years of age in a rural area in southern Mozambique. Mothers of children under two years of age were interviewed in a cross-sectional study. The researchers found that 28.2% of the children had not completed the vaccination program by two years of age, 25.7% had experienced a missed opportunity for vaccination and 14.9% were incorrectly vaccinated. Reasons for incomplete vaccination were associated with accessibility to the vaccination sites, no schooling of mothers and children born at home or outside Mozambique. Efforts to increase vaccination coverage should take into account factors that contribute to the incomplete vaccination status of children.
Country
Publisher
BMC Public Health
Theme area
Equity and HIV/AIDS
Title of publication The HIV/AIDS Epidemic in Mozambique
Date of publication
2005 October
Publication type
Document
Publication details
HIV/ AIDS Policy Fact Sheet 7361 pp 1-2
Publication status
Published
Language
English
Keywords
Mozambique, HIV prevalence, people living with HIV and AIDS, women, youth, orphans, ART access
Abstract
Mozambique has over one million people estimated to be living with HIV/AIDS (1.3 million as of the end of 2003). Although Mozambique’s prevalence rate (the percent of people living with the disease) is lower than some of the hardest hit countries in the region, it is higher than the sub-Saharan African region overall and recent estimates suggest that the prevalence rate may be on the rise. The epidemic poses significant development challenges to this low-income country. The Government of Mozambique formed a National AIDS Council (NAC) in 2000, and is currently operating its National Strategic Plan to Combat HIV/AIDS for 2005-2009.
Country
Mozambique
Publisher
Kaiser Family Foundation (KFF)
URL:
Theme area
Equitable health services
Title of publication Improving health for the poor in Mozambique: The Fight Continues
Date of publication
2002 February
Publication type
Document
Publication details
Health, Nutrition and Population (HNP) Discussion Paper pp 1-40
Publication status
Published
Language
English
Keywords
Health, Health Services, Poverty Reduction, Mozambique
Abstract
The health sector in Mozambique has made significant progress in terms of increasing coverage of services. However, health remains a major concern in the area of poverty reduction. The study describes the health status of the population, especially of the poor, and how the sector responds to the needs. Huge inequalities continue to exist with regards to resource allocation, deployment of staff and availability of services among various geographic areas, between the urban and rural population, and between the poor and the non-poor. The study builds upon the existing studies on health and consolidates the sector knowledge. Based on the analysis, the study makes various recommendations on how the health sector reforms can be made more pro-poor by focusing on certain interventions, by targeting certain areas and population groups, by designing new delivery models that would bring the services closer to the population, and by improving financial management to serve the poor more effectively.
Country
Mozambique
Publisher
The International Bank for Reconstruction and Development, The World Bank
Theme area
Equitable health services, Resource allocation and health financing
Title of publication Primary health care in Mozambique: Service delivery in a complex hierarcy
Date of publication
2004 April
Publication type
Document
Publication details
World Bank, Africa Region: Human Development Working paper series pp 1-112
Publication status
Published
Language
English
Keywords
record keeping, financial systems, supply systems, management systems, resource allocation, service delivery, use fees, cost recovery
Abstract
This report presents finding of a nationwide Expenditure Tracking and Service Delivery Survey in Mozambique from August to Ocotober 2002. The study focuses on the primary health care system, which is often the only source of health care for most Mozambicans. the data offers a unique perspective on interactions between different levels of the health system, particularly related to financing, allocation, distribution and use of resources. The report covers a broad set of issues including institutional context, budget managemet, cost recovery, drug allocation and distribution, human resources, infrastructure and equipment, and service outputs. The analysis reveals a number of weakness in service delivery.
Country
Mozambique
Publisher
World Bank, Africa Region: Human Development
URL:
Theme area
Equitable health services
Title of publication Medicines without doctors: In Mozambique, salaries are not the biggest problem
Date of publication
2007 July
Publication type
Letter
Publication details
PLoS Medicine 4 7 pp 1280-1281
Publication status
Published
Language
English
Keywords
health workers, salaries, training, doctors, donors
Abstract
In the case of health workers in Mozambique, the brain drain is not the biggest problem, neither are the salaries. There is a pure lack of doctors, with only up to 60 doctors a year being trained at the University for a population of 18 million. In 2004, Mozambique had about 700 medical doctors, expatriates from all nongovernmental organisations and projects included. The Mozambican Ministry of Health received hundred of millions of dollars from international donors for the National AIDS Plan, while the Faculty of Medicine,
dependant on the Ministry of Education, was struggling to survive. Not a single dollar from all the AIDS millions went to support the basic education of doctors. Not out of bad will, but because donors have too many restrictions.
Country
Publisher
PloS Medicine
URL:
Theme area
Equity and HIV/AIDS, Monitoring equity and research to policy
Title of publication Systematic review of effectiveness of school-based sexual health interventions in sub-Saharan Africa
Date of publication
2008 January
Publication type
Journal Article
Publication details
BMC Public Health 8 4
Publication status
Published
Language
English
Keywords
adolescents, HIV/AIDS education, schoolchildren, sexual health
Abstract
The AIDS epidemic remains of global significance and there is a need to target the adolescent age-groups in which most new infections occur and sub-Saharan Africa, where the greatest burden of the epidemic lies. A focused systematic review of school-based sexual health interventions in sub-Saharan Africa to prevent HIV and Sexually Transmitted Infections (STI) in this age group was therefore conducted. Some 1,020 possible titles and abstracts were found, 23 full text articles were critically appraised, and 12 articles (10 studies) reviewed, reflecting the paucity of published studies conducted relative to the magnitude of the HIV epidemic in sub-Saharan Africa. Knowledge and attitude-related outcomes were the most associated with statistically significant change. Behavioural intentions were more difficult to change and actual behaviour change was least likely to occur. Behaviour change in favour of abstinence and condom use appeared to be greatly influenced by pre-intervention sexual history. There is a great need in sub-Saharan Africa for well-evaluated and effective school-based sexual health interventions.
Country
United Kingdom
Publisher
BioMed Central Ltd.
Theme area
Monitoring equity and research to policy
Title of publication National audit of critical care resources in South Africa: Research methodology
Date of publication
2007
Publication type
Journal Article
Publication details
South African Medical Journal 97 12 pp 1308-1310
Publication status
Published
Language
English
Keywords
audit, critical care, quality control
Abstract
This article provides an in-depth description of the methodology that was followed and the quality control measures that were implemented during the audit of national critical care resources in South Africa.
Country
Publisher
African Journals Online
Theme area
Monitoring equity and research to policy
Title of publication DSS and DHS: Longitudinal and cross-sectional viewpoints on child and adolescent mortality in Ethiopia
Date of publication
2007 December
Publication type
Journal Article
Publication details
Population Health Metrics 5 12
Publication status
Published
Language
English
Keywords
demographics, mortality, registration, census
Abstract
In countries where routine vital registration data are scarce, Demographic Surveillance Sites (DSS: locally defined populations under longitudinal surveillance for vital events and other characteristics) and Demographic and Health Surveys (DHS: periodic national cluster samples responding to cross-sectional surveys) have become standard approaches for gathering at least some data. This paper aims to compare DSS and DHS approaches, seeing how they complement each other in the specific instance of child and adolescent mortality in Ethiopia. Data from the Butajira DSS 1987-2004 and the Ethiopia DHS rounds for 2000 and 2005 formed the basis of comparative analyses of mortality rates among those aged under 20 years, using Poisson regression models for adjusted rate ratios. Patterns of mortality over time were broadly comparable using DSS and DHS approaches. DSS data were more susceptible to local epidemic variations, while DHS data tended to smooth out local variation, and be more subject to recall bias. Both DSS and DHS approaches to mortality surveillance gave similar overall results, but both showed method-dependent advantages and disadvantages. In many settings, this kind of joint-source data analysis could offer significant added value to results.
Country
Publisher
Population Health Metrics
Theme area
Monitoring equity and research to policy
Title of publication Databases as policy instruments: About extending networks as evidence-based policy
Date of publication
2007
Publication type
Journal Article
Publication details
BMC Health Services Research 7 200
Publication status
Published
Language
English
Keywords
Data, monitoring, databases, information technology
Abstract
This article seeks to identify the role of databases in health policy. Access to information and communication technologies has changed traditional relationships between the state and professionals, creating new systems of surveillance and control. As a result, databases may have a profound effect on controlling clinical practice. Three case studies were undertaken to reconstruct the development and use of databases as policy instruments. Our results demonstrate that policy makers hardly used the databases, neither for cost control nor for quality assurance. The databases fulfill control functions that were formerly located within the policy realm. They facilitate collaboration between policy makers and physicians, since they enable quality assurance by professionals. Delegating regulatory authority downwards into a network of physicians who control the use of pharmaceuticals seems to be a good alternative for centralised control on the basis of monitoring data.
Country
Publisher
BMC Health Services Research
Theme area
Governance and participation in health
Title of publication Analysing health equity using household survey data: A guide to techniques and their implementation
Date of publication
2007
Publication type
Book
Publication details
Publication status
Published
Language
English
Keywords
Stata, computer code, computerised systems, policy, technology
Abstract
Health equity has become an increasingly popular research topic during the course of the past 25 years. Many factors explain this trend, including a growing demand from policymakers, better and more plentiful household data, and increased computer power. But progress in quantifying and understanding health equities would not have been possible without appropriate analytic techniques. These techniques can provide researchers and analysts with a step-by-step practical guide to the measurement of a variety of aspects of health equity, with worked examples and computer code, mostly for the computer programme, Stata.
Country
Switzerland
Publisher
World Bank
Theme area
Governance and participation in health
Title of publication Theorising inequalities in the experience and management of chronic illness: Bringing social networks and social capital back in (critically)
Date of publication
2007
Publication type
Journal Article
Publication details
Research in the Sociology of Health Care 25 pp 15-42
Publication status
Published
Language
English
Keywords
chronic illness, disability, inequalities, research, social networks
Abstract
Social networks have been a central focus of sociological research on inequalities but less has focused specifically on chronic illness and disability despite a policy emphasis on resources necessary to support self-management. The study sought to unpack overlaps and distinctions between social network approaches and research on the experience and management of chronic illness. The authors outlined four main areas viewed as central in articulating the potential for future work consistent with a critical realist perspective: body/society connections and realist/relativist tensions; the controversy of “variables” and accounting for social and cultural context in studying networks for chronic illness support; conceptualising social support, network ties and the significance of organisations and technology; and translating theory into method.
Country
Publisher
Research in the Sociology of Health Care
Theme area
Governance and participation in health
Title of publication Participation in different fields of practice: Using social theory to understand participation in community health promotion
Date of publication
2007 November
Publication type
Journal Article
Publication details
Journal Of Health Psychology 12 6 pp 949-960
Publication status
Published
Language
English
Keywords
Bourdieu, community participation, identity
Abstract
Participation' by community members in health-related programmes is an appealing concept that has not always been easy to achieve. Such programmes are often directed towards communities defined on the basis of neighbourhood or group identity. This article aims to develop an account of participation and identity by drawing on Bourdieu's theory of practice to understand participation as the practice of social identities structured by habitus, capital and field. Examples from interviews with members of one deprived neighbourhood illustrate the theory by showing that people may identify with their neighbourhood for certain social purposes, but have different identity practices in different fields of practice. Implications for community-based health programmes are briefly outlined.
Country
Publisher
Journal Of Health Psychology
Theme area
Governance and participation in health
Title of publication Grand challenges in global health: Community engagement in research in developing countries
Date of publication
2008
Publication type
Journal Article
Publication details
PloS Medicine 4 9
Publication status
Published
Language
English
Keywords
community, outsiders, traditions, values
Abstract
There is no standard definition of a community. The term “community” has been used to describe interactions among people in primarily geographic terms. But it is now accepted that people who live in close proximity to one another do not necessarily constitute a community, since they may differ with respect to value systems and other cultural characteristics that are more relevant to the social concept of community. Some have argued that the defining feature of a community is the common identity shared by its members. Thus, a single individual may belong simultaneously to different religious, vocational, or ethnic communities, or communities with distinct values and aspirations may inhabit a single geographic area. Even though community is determined largely by shared traditions and values, communities are not static and may accommodate multiple and even conflicting interpretations of their own traditions and values. Outsiders may also define community differently from insiders. The extent to which a community reflects these features is a measure of its cohesiveness. The authors argue that different levels of community cohesiveness or specific features may warrant different research protections.
Country
Publisher
PloS Medicine
Theme area
Governance and participation in health
Title of publication Assessing the promise of user involvement in health service development: An ethnographic study
Date of publication
2008 January
Publication type
Journal Article
Publication details
British Medical Journal 29 January 2008
Publication status
Published
Language
English
Keywords
health resources, user involvement, community participation
Abstract
This study set out to understand how the policy of user involvement is interpreted in health service organisations and to identify factors that influence how user involvement is put into practice. The design was that of an ethnographic study using participant observation, interviews, and collection of documentary evidence. Set in a multiagency modernisation programme to improve stroke services in two London boroughs, participants consisted of service users, National Health Service managers, and clinicians. Author conclusions include that user involvement may not automatically lead to improved service quality. Healthcare professionals and service users understand and practise user involvement in different ways according to individual ideologies, circumstances, and needs. Given the resource implications of undertaking user involvement in service development there is a need for critical debate on the purpose of such involvement as well as better evidence of the benefits claimed for it.
Country
United Kingdom
Publisher
British Medical Journal
Theme area
Equity and HIV/AIDS
Title of publication Using VCT statistics from Kenya in understanding the association between gender and HIV
Date of publication
2007 March
Publication type
Journal Article
Publication details
SAHARA Journal 4 3 pp 707-710
Publication status
Published
Language
English
Keywords
VCT, HIV, AIDS, gender
Abstract
This paper demonstrates the importance of utilising official statistics from the voluntary counselling and testing centres (VCT) to determine the association between gender and HIV infection rates in Kenya. The study design adopted was a record based survey of data collected from VCT sites in Kenya between the second quarter of 2001 and the second quarter of 2004. Of those who were tested, significantly more females tested positive and had twice as high a chance of being infected by HIV than males. The researchers conclude that VCT statistics may lead to better planning of services and gender sensitive interventions if utilised well.
Country
South Africa
Publisher
SAHARA Journal
Theme area
Equity and HIV/AIDS
Title of publication HIV/AIDS prevention through peer education and support in secondary schools in South Africa
Date of publication
2007 March
Publication type
Journal Article
Publication details
SAHARA Journal 4 3 pp 678-694
Publication status
Published
Language
English
Keywords
peer education, HIV, AIDS, teenagers, youth
Abstract
The implementation and evaluation of a peer education and support programme in secondary schools to prevent and reduce high-risk sexual behaviour amongst adolescents is discussed. The aims of the programme were to provide accurate information about HIV, discuss and reconsider peer group norms, and establish support for learners. In the programme that was implemented in 13 secondary schools in Tshwane, South Africa, peer educators were identified, trained and supported to implement the programme in their schools with the assistance of a teacher and postgraduate students as facilitators. The results showed that the percentage of learners in the experimental group who were sexually experienced remained unchanged over the time period of 18 months. In contrast, a significantly increased percentage of learners in the control group were sexually experienced after the same time period. The control group also perceived more of their friends to be sexually experienced. No differences were reported in condom use in either of the groups. The findings of this study suggest that peer education can contribute to a delayed onset of sexual activity, and can therefore contribute to the prevention of HIV amongst adolescents.
Country
South Africa
Publisher
SAHARA Journal
Theme area
Equity and HIV/AIDS
Title of publication A comprehensive programme addressing HIV/AIDS and gender based violence
Date of publication
2008 March
Publication type
Journal Article
Publication details
SAHARA Journal 4 3 pp 695-706
Publication status
Published
Language
English
Keywords
gender-based violence, gender, stigma, HIV risk, HIV, AIDS
Abstract
A survey was administered to 304 respondents participating from three areas near Welkom, South Africa. Face-to-face interviews were conducted with women from randomly selected households to evaluate the impact of a service provision programme targeting women living with HIV/AIDS and gender based violence. Gender based violence (GBV) awareness and knowledge was high. Respondents had high perceived levels of risk. The key findings of this study support the notion of using a holistic approach, targeting more than one issue. There is lower stigma levels associated with combined conditions, which might allow easier access to vulnerable groups. Coordination and collaboration of services are however needed to enable this benefit.
Country
South Africa
Publisher
SAHARA Journal
Theme area
Resource allocation and health financing
Title of publication Distribution matters: Equity considerations among health planners in Tanzania
Date of publication
2008 February
Publication type
Journal Article
Publication details
Health Policy 85 2 pp 218-227
Publication status
Published
Language
English
Keywords
distribution, resource scarcity, resource-poor, health outcomes
Abstract
Maximising health as the guiding principle for resource allocation in health has been challenged by concerns about the distribution of health outcomes. There are few empirical studies that consider these potentially divergent objectives in settings of extreme resource scarcity. The aim of this study is to help fill this knowledge gap by exploring distributional preferences among health planners in Tanzania. Distribution of health outcomes, in terms of life-years, matters. Specifically, the lower the initial life expectancy of the target group, the more important the programme is considered. Such preferences are compatible, within the sphere of health, with what ethicists call “prioritarianism”.
Country
Publisher
Health Policy
Theme area
Public-private mix
Title of publication The business of health in Africa: Partnering with the private sector to improve people's lives
Date of publication
2008 January
Publication type
Report
Publication details
Publication status
Language
English
Keywords
private sector, private health care
Abstract
This report describes opportunities for engaging and supporting a well-managed and effectively regulated private sector to improve the region’s health and complementary to traditional public sector approaches. The private sector should play a supporting role in meeting a country's national health needs. This report investigates the idea of public-private partnerships.
Country
Publisher
Theme area
Public-private mix
Title of publication SACP statement on plans by private hospitals to increase fees
Date of publication
2008 January
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
private health care, price increases, fees
Abstract
The SACP is outraged at the plans by some of the big private hospital groups, including the National Hospital Network and Netcare, to hike fees by as much as up to 33% as from this year. The private health care sector is already consuming a much bigger slice of our health resources and is also making huge profits for itself at the direct expense of the majority of the people of our country, feeding like parasites on workers’ already overstretched medical aid schemes.
Country
South Africa
Publisher
South African Communist Party
Theme area
Equitable health services
Title of publication The three domains of public health: An internationally relevant basis for public health education�
Date of publication
2008 February
Publication type
Journal Article
Publication details
Public Health 122 2 pp 201-210
Publication status
Language
English
Keywords
MSc, Master of Science, public health education, public health practice
Abstract
By focusing on the Masters of Public Health course, this study took a pragmatic approach to exploring the interface between public health education and public health practice. The commonly utilised ‘three domains of practice’ framework could provide a robust and explicit link between educational provision and practice for public health. This model provides the workforce, the university, the students and the potential funders of the course with an easily comprehensible framework for understanding how the modules of an MSc can support the development of competency within the context of practice.
Country
Publisher
Public Health
Theme area
Human resources for health
Title of publication Reducing child deaths: The contribution of community health workers
Date of publication
2007
Publication type
Journal Article
Publication details
ID21 Health News
Publication status
Published
Language
English
Keywords
policy implementation; health workers, participatory democracy
Abstract
Insufficient progress is being made towards the Millennium Development Goals, including those dealing with child and maternal mortality. At the current rate of progress in sub-Saharan Africa, the target of a two-thirds reduction in child mortality by 2015 will only be reached in 2165. Renewed interest in the potential contribution of community health workers may be timely. This study reviews the literature for evidence of whether community health workers are capable of carrying out the tasks required of them as part of a sustainable workforce. The study concluded that several factors influence programme impact and sustainability and determine whether child death reductions can be realised on a national scale: national socio-economic and political factors, community factors, health system factors and international factors. For instance, particularly if the political context is not a participatory democracy, support within the community for community health workers may be undermined by social class and caste divisions. Moreover, the success of a community health worker programme depends to a considerable extent on a successful interaction with the formal health services sector.
Country
Publisher
ID21 Health News
Theme area
Equity and HIV/AIDS
Title of publication Non-physician clinicians in 47 sub-Saharan African countries
Date of publication
2007 December
Publication type
Journal Article
Publication details
The Lancet 370 9605 pp 2158-2163
Publication status
Published
Language
English
Keywords
HIV epidemic, HIV statistics, HIV prevalence, new infections
Abstract
Many countries have health-care providers who are not trained as physicians but who take on many of the diagnostic and clinical functions of medical doctors. We identified non-physician clinicians (NPCs) in 25 of 47 countries in sub-Saharan Africa, although their roles varied widely between countries. In nine countries, numbers of NPCs equalled or exceeded numbers of physicians. In general NPCs were trained with less cost than were physicians, and for only 3–4 years after secondary school. All NPCs did basic diagnosis and medical treatment, but some were trained in specialty activities such as caesarean section, ophthalmology, and anaesthesia. Many NPCs were recruited from rural and poor areas, and worked in these same regions. Low training costs, reduced training duration, and success in rural placements suggest that NPCs could have substantial roles in the scale-up of health workforces in sub-Saharan African countries, including for the planned expansion of HIV/AIDS prevention and treatment programmes.
Country
United Kingdom
Publisher
The Lancet
Theme area
Human resources for health
Title of publication New data on African health professionals abroad
Date of publication
2008
Publication type
Magazine Article
Publication details
Human Resources for Health 6 1
Publication status
Published
Language
English
Keywords
migration, nurses, doctors, medical brain drain
Abstract
The migration of doctors and nurses from Africa to developed countries has raised fears of an African medical brain drain. But empirical research on the causes and effects of the phenomenon has been hampered by a lack of systematic data on the extent of African health workers' international movements. This study uses destination-country census data to estimate the number of African-born doctors and professional nurses working abroad in a developed country circa 2000, and compares this to the stocks of these workers in each country of origin. About 65,000 African-born physicians and 70,000 African-born professional nurses were working overseas in a developed country in the year 2000. This represents about one fifth of African-born physicians in the world, and about one tenth of African-born professional nurses. The authors conclude that these numbers are the first standardised, systematic, occupation-specific measure of skilled professionals working in developed countries and born in a large number of developing countries.
Country
Publisher
Human Resources for Health
Theme area
Human resources for health
Title of publication National audit of critical care resources in South Africa: Nursing profile
Date of publication
2007
Publication type
Journal Article
Publication details
South African Medical Journal 97 12 pp 1315-1318
Publication status
Published
Language
English
Keywords
nurses, health worker shortages, nursing
Abstract
A descriptive, non-interventive, observational study design was used to audit of all public and private sector ICU and HCUs in South Africa to: determine the profile and number of nurses working in South African intensive care units (ICUs) and high care units (HCUs); determine the number of beds in ICU and HCUs in South Africa; and determine the ratio of nurses to ICU/HC beds. This study demonstrates that ICU nursing in South Africa faces the challenge of an acute shortage of trained and experienced nurses. Nurses are tired, often not healthy, and are plagued by discontent and low morale.
Country
Publisher
African Journals Online
Theme area
Human resources for health
Title of publication Major surgery delegation to mid-level health practitioners in Mozambique: Health professionals' perceptions
Date of publication
2007
Publication type
Journal Article
Publication details
Human Resources for Health 5 27
Publication status
Published
Language
English
Keywords
tecnico de cirurgia, community health workers
Abstract
This study examines the opinions of health professionals about the capacity and performance of the “tecnico de cirurgia”, a surgically trained assistant medical officer in the Mozambican health system. Particular attention is paid to the views of medical doctors and maternal and child health nurses. Health workers at all levels voiced satisfaction with the work of the tecnicos de cirurgia. They stressed the life saving skills of these cadres, the advantages resulting from a reduction in the need for patient referrals and the considerable cost reduction for patients and their families. Important problems in the professional status and remuneration of tecnicos de cirurgia were identified. This study, the first one to scrutinise the judgements and attitudes of health workers towards the tecnico de cirurgia, showed that this cadre is highly appreciated and that the health delivery system does not recognise and motivate them enough. The findings of this study can be used to direct efforts to improve motivation of health workers in general and of tecnicos de cirurgia in particular.
Country
Publisher
Human Resources for Health
Theme area
Equity and HIV/AIDS
Title of publication Human resources requirements for highly active antiretroviral therapy scale-up in Malawi
Date of publication
2007 December
Publication type
Academic paper
Publication details
BMC Health Services Research 7 208
Publication status
Published
Language
English
Keywords
HAART, Malawi, adult infections, HIV, AIDS
Abstract
Twelve percent of the adult population in Malawi is estimated to be HIV infected. The country has a public sector-led antiretroviral treatment program both in the private and public health sectors. Estimation of the clinical human resources needs is required to inform the planning and distribution of health professionals. HAART provision is a labour-intensive exercise. Although data in this paper is insufficient to determine whether HAART scale-up has resulted in the weakening or strengthening of the health systems in Malawi, the human resources requirements for HAART scale-up are significant. Malawi is using far less human resources than would be estimated based on the literature from other settings.
Country
United Kingdom
Publisher
BioMed Central Ltd.
Theme area
Human resources for health, Equity and HIV/AIDS
Title of publication 'I believe that the staff have reduced their closeness to patients': An exploratory study on the impact of HIV/AIDS on staff in four rural hospitals in Uganda
Date of publication
2007 December
Publication type
Academic paper
Publication details
BMC Health Services Research 7 205
Publication status
Published
Language
English
Keywords
supervision, management, HIV/AIDS education
Abstract
Staff shortages could harm the provision and quality of health care in Uganda, so staff retention and motivation are crucial. Understanding the impact of HIV/AIDS on staff contributes to designing appropriate retention and motivation strategies. This research aimed 'to identify the influence of HIV/AIDS on staff working in general hospitals at district level in rural areas and to explore support required and offered to deal with HIV/AIDS in the workplace'. Its results were to inform strategies to mitigate the impact of HIV on hospital staff. Organisational responses should be integrated into responses to other problematic working conditions and adapted to the local context. Opportunities already exist, such as better use of supervision, educational sessions and staff meetings. However, exchanges on interventions to improve staff motivation and address HIV in the health sector are urgently required, including information on results and details of the context and implementation process.
Country
United Kingdom
Publisher
BioMed Central Ltd.
Theme area
Equitable health services, Human resources for health
Title of publication Managing the Health Millennium Development Goals: The challenge of management strengthening: Lessons from three countries
Date of publication
2007
Publication type
Academic paper
Publication details
Publication status
Published
Language
English
Keywords
scaling up, health services, management
Abstract
This World Health Organisation study describes various activities aimed towards strengthening the management of health service delivery in three countries: South Africa, Togo and Uganda. The paper considers factors that affect management capacity: the number of managers at all levels; opportunities for building existing managers’ own competences; improving management support systems; and creating a more supportive work environment. It also identifies several ways to help managers do their jobs better, including on-the-job support. In terms of anagement-strengthening activities, the study reveals that a range of approaches have been used in recent years, but countries and external development agencies have concentrated mainly on training and some management systems (planning and monitoring) to the detriment of other key conditions for facilitating good management. Medium- to long-term sector-wide budgets and plans for management strengthening are required if good management is to play its appropriate role in scaling up health services.
Country
Switzerland
Publisher
WHO
Theme area
Equitable health services
Title of publication Strategies to achieve universal coverage: Are there lessons from middle-income countries?
Date of publication
2007
Publication type
Academic paper
Publication details
Publication status
Published
Language
English
Keywords
health care, financing mechanisms, affordable health care
Abstract
This study assesses the evidence regarding strategies used to attain universal coverage and draws out a list of lessons for policy makers, donors and civil society groups. It focuses mainly on middle-income countries that have recently gained, or are close to gaining, universal coverage. It looks at the extent to which various strategies promote equity in terms of financing, access to and use of services. Key financing priorities are to gradually increase risk pooling arrangements over time, and to focus on protecting the poorest and most socially disadvantaged against the costs of health care.
Country
Switzerland
Publisher
WHO Health Systems Knowledge Network
Theme area
Equitable health services
Title of publication South Africa: Effective delivery of public services
Date of publication
2007 November
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
African Union Convention on Preventing and Combating Corruption, Charter for the Public Service in Africa, policy
Abstract
This report uses the examples of the health and education sectors to consider South Africa's compliance with the various standards and best practices laid down in relation to the functioning of the public service, including the African Union Convention on Preventing and Combating Corruption, and the Charter for the Public Service in Africa. While South Africa has many examples of best practice on paper, it is struggling to ensure that these policies are fulfilled in practice: this report offers analysis and suggestions on critical problems for attention.
Country
South Africa
Publisher
AfriMAP
Theme area
Equitable health services, Governance and participation in health
Title of publication Rehabilitating health systems in post-conflict situations
Date of publication
2007
Publication type
Academic paper
Publication details
UNU-WIDER Research Paper No. 2007/06 pp 1-18
Publication status
Published
Language
English
Keywords
donor organisations, war, health systems
Abstract
The researchers analysed the experiences of different countries affected by conflict, including Afghanistan, Cambodia, East Timor, Kosovo, Uganda and Mozambique. They began by looking at the impacts of conflict on public health. They then presented a framework for understanding how programmes for rehabilitating health systems might work in post-conflict countries. The authors suggest three interrelated approaches to health sector rehabilitation: an initial response to immediate health needs (through humanitarian assistance and relief); restoration or establishment of a package of essential health services including immunisation and obstetric care; and restoration of the health system itself. The authors highlight the lack of co-ordination between donor organisations, whose competing needs and projects distract health officials. Non-governmental organisations (NGOs) may also delay progress by continuing to focus on relief when the country has moved on to the next stage.
Country
Switzerland
Publisher
United Nations University World Institute for Development Economics Research
Theme area
Poverty and health, Equitable health services
Title of publication Refugees’ perceptions of their health status and quality of health care services in Durban, South Africa: A community-based survey
Date of publication
2007
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
refugees, translators, xenophobia, discrimination, language barriers
Abstract
There is some evidence from refugees that health care services in South Africa are not responsive to their perceived needs. Using quantitative and qualitative approaches to evaluate the perceptions and opinions of refugees about health care services in South Africa, the authors find that major issues affecting refugees include: discrimination and xenophobic attitudes of health service providers; language barriers leading to inappropriate treatments due to misunderstanding; and exclusion from public hospitals due to lack of valid permits or delay in the delivery of such permits. Based on these findings, the authors suggest that refugees should have at least a baseline health related interview and check-up preferably done in a primary health care (PHC) centre dedicated to refugees. Refugee support systems should be established and health care workers should be informed about issues such as refugee permits and policies regarding referral systems. Also, public hospitals should employ qualified translators to help in cases that are referred from PHC centres for refugees.
Country
South Africa
Publisher
Health Systems Trust
Theme area
Equitable health services
Title of publication National audit of critical care resources in South Africa: Transfer of critically ill patients
Date of publication
2007
Publication type
Journal Article
Publication details
South African Medical Journal 97 12 pp 1323-1326
Publication status
Published
Language
English
Keywords
ICU, HCU, resource constraints, resource distribution public hospitals, budget cuts, South Africa
Abstract
A descriptive, non-interventive, observational study design was used to audit all public and private sector ICUs and HCUs in South Africa to establish the efficacy of the current system of referral of critical care patients from public hospitals with no ICU or HCU facilities to hospitals with appropriate facilities and from public and private sector hospitals with ICU or HCU facilities to hospitals with appropriate facilities. There was considerable variation in time to collect between provinces and between public hospitals that have or do not have ICU/HCU facilities. A combination of current resource constraints, the vast distances in some regions of the country and the historical disparities of health resource distribution represent a unique challenge, which demands a novel approach to equitable health care appropriation.
Country
South Africa
Publisher
South African Medical Journal
Theme area
Equitable health services
Title of publication Malaria risk and access to prevention and treatment in the paddies of the Kilombero Valley, Tanzania
Date of publication
2008 January
Publication type
Journal Article
Publication details
Malaria Journal 7 7
Publication status
Published
Language
English
Keywords
malaria, access to treatment, self-medication, health workers, drugs, Tanzania
Abstract
A longitudinal study followed about 100 randomly selected farming households over six months in Kilombero Valley, Tanzania. Every household was visited monthly and whereabouts of household members, activities in the fields, fever cases and treatment seeking for recent fever episodes were recorded. Fever incidence rates were lower in the shamba compared to the villages and moving to the Shamba did not increase the risk of having a fever episode. Living in the Shamba does not appear to result in a higher fever-risk. Mosquito nets usage and treatment of fever in health facilities reflect awareness of malaria. Inability to obtain drugs in the fields may contribute to less irrational use of drugs but may pose an additional burden on poor farming households. A comprehensive approach is needed to improve access to treatment while at the same time assuring rational use of medicines and protecting fragile livelihoods.
Country
United Kingdom
Publisher
BioMed Central Ltd
Theme area
Equitable health services, Human resources for health
Title of publication Estimated financial and human resources requirements for the treatment of malaria in Malawi
Date of publication
2007 December
Publication type
Journal Article
Publication details
Malaria Journal 6 168
Publication status
Published
Language
English
Keywords
malaria, self-medication, health workers
Abstract
While a qualitative appreciation of the burden of malaria on the health system for malaria is recognised, there is limited quantitative estimation of the burden malaria exacts on the health system, especially with regard to human resources and financial burden on Malawi. The burden of malaria was assessed based on estimated incidence rates for a typically highly endemic country, of which Malawi is one. Data on the available human resources and financial resources committed towards malaria from official Malawi government documents and programme reports were obtained. Malaria exacts a heavy toll on the health system in Malawi. The national recommendation of self-medication with first-line drug for uncomplicated malaria is justified, as there are not enough clinicians to provide clinical care for all cases. The Malawi Ministry of Health’s promotion of malaria drug prescription, including other lower-cadre health workers, may be justified.
Country
Publisher
Theme area
Poverty and health, Monitoring equity and research to policy
Title of publication Nutrition: The forgotten MDG
Date of publication
2008 January
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
nutrition, nutrition surveys, decision making
Abstract
The new Lancet series on nutrition, co-authored and co-financed by the World Bank, depicts the lamentable state of under-nutrition worldwide, and a corresponding negligence on the part of the development community to meet the challenge decisively. Under-nutrition represents the non-income face of poverty. And the world is off track on meeting this goal. Countries with ‘higher overall logistics costs are more likely to miss the opportunities of globalisation,’ according to the study.
Country
United States
Publisher
World Bank
Theme area
Poverty and health
Title of publication Maternal and child undernutrition: Global and regional exposures and health consequences
Date of publication
2008 January
Publication type
Journal Article
Publication details
The Lancet 371 9608 pp 243-260
Publication status
Published
Language
English
Keywords
child mortality, children, early childhood development, nutrition
Abstract
Maternal and child undernutrition is highly prevalent in low-income and middle-income countries, resulting in substantial increases in mortality and overall disease burden. This paper presents new analyses to estimate the effects of the risks related to measures of undernutrition and suboptimum breastfeeding practices on mortality and disease. The high mortality and disease burden resulting from these nutrition-related factors make a compelling case for the urgent implementation of interventions to reduce their occurrence or ameliorate their consequences.
Country
United Kingdom
Publisher
The Lancet
Theme area
Poverty and health
Title of publication Maternal and child undernutrition: Consequences for adult health and human capital
Date of publication
2008 January
Publication type
Journal Article
Publication details
The Lancet 371 9609 pp 340-357
Publication status
Published
Language
English
Keywords
poverty, childhood development, maternal nutrition, child nutrition
Abstract
In this paper, the authors review the associations between maternal and child undernutrition with human capital and risk of adult diseases in low-income and middle-income countries. They analysed data from five long-standing prospective cohort studies from Brazil, Guatemala, India, the Philippines and South Africa. They conclude that damage suffered in early life leads to permanent impairment, and might also affect future generations. Its prevention will probably bring about important health, educational and economic benefits. Chronic diseases are especially common in undernourished children who experience rapid weight gain after infancy.
Country
United Kingdom
Publisher
The Lancet
Theme area
Poverty and health
Title of publication Policy brief 2: Building bridges out of poverty
Date of publication
2008 January
Publication type
Document
Publication details
Southern Africa Trust Policy Brief pp 1-11
Publication status
Published
Language
English
Keywords
poverty, southern Africa, Millenium Development Goals, MDG
Abstract
With less than seven years to go before the attainment of the universal millennium development goals (MDGs), the southern Africa region is still battling with infrastructure issues that might stifle the region’s progression towards the achievement of the goals. This brief examines how transport, energy and water infrastructure in the region can facilitate intra-regional trade and investment, as well as sound management and the development of water resources. The brief discusses how infrastructure development can strengthen regional integration to overcome poverty in southern Africa.
Country
Publisher
Southern Africa Trust
Theme area
Equity and HIV/AIDS
Title of publication Traditional values of virginity and sexual behaviour in rural Ethiopian youth: Results from a cross-sectional study
Date of publication
2008 January
Publication type
Journal Article
Publication details
BMC Public Health 8 9
Publication status
Published
Language
English
Keywords
virginity, traditional values, HIV, sex, youth, young people
Abstract
Delaying sexual initiation has been promoted as one of the methods of decreasing risks of HIV among young people. In traditional countries, such as Ethiopia, retaining virginity until marriage is the norm. This study examined the effect of virginity norm on having sex before marriage and sexual behaviour after marriage among rural Ethiopian youth. Maintaining virginity is still a way of securing marriage for girls, especially in rural areas. As age increased, the likelihood of remaining a virgin decreased. There was no significant difference between married and unmarried young people in terms of number of partners and visiting commercial sex workers. Although virginity norms help delay age at sexual debut among rural Ethiopian youth, and thus reduces vulnerability to sexually transmitted infections and HIV infection, vulnerability among females may increase after marriage due to unprotected multiple risky sexual behaviours by spouses. The use of preventive services, such as VCT before marriage and condom use in marriage should be part of the HIV prevention and control strategies.
Country
United Kingdom
Publisher
BioMed Central Ltd.
Theme area
Values, policies and rights
Title of publication From chloroquine to artemether-lumefantrine: The process of drug policy change in Zambia
Date of publication
2008 January
Publication type
Academic paper
Publication details
Malaria Journal 7 25
Publication status
Published
Language
English
Keywords
morbidity, mortality, health financing, malaria
Abstract
Following the recognition that morbidity and mortality due to malaria had dramatically increased in the last three decades, in 2002 the government of Zambia reviewed its efforts to prevent and treat malaria. Convincing evidence of the failing efficacy of chloroquine resulted in the initiation of a process that eventually led to the development and implementation of a new national drug policy based on artemisinin-based combination therapy (ACT). All published and unpublished documented evidence dealing with the antimalarial drug policy change was reviewed. The data was supplemented by the author’s observations of the policy change process. Study results suggest that drug policy changes are not without difficulties and demand a sustained international financing strategy for them to succeed. The Zambian experience demonstrates the need for a harmonised national consensus among many stakeholders and a political commitment to ensure that new policies are translated into practice quickly.
Country
United Kingdom
Publisher
BioMed Central Ltd.
Theme area
Poverty and health, Equitable health services
Title of publication The Malawi National Tuberculosis Programme: An equity analysis
Date of publication
2007
Publication type
Journal Article
Publication details
ternational Journal for Equity in Health 6 24
Publication status
Published
Language
English
Keywords
TB, HIV, AIDS, poverty, health care costs, Malawi
Abstract
This paper synthesises what is known on equity and TB in Malawi and highlights areas for further action and advocacy. A synthesis of a wide range of published and unpublished reports and studies using a variety of methodological approaches was undertaken and complemented by additional analysis of routine data on access to TB services. TB cases appear to have increased rapidly and this increase has been attributed to HIV/AIDS. The complexity of TB diagnosis requires repeated visits, long queues and delays in sending results, reducing poor women and men's ability to access and adhere to services. The costs are also prohibitive. The major challenge is to increase case detection, especially among the poor.
Country
Publisher
BioMed Central Ltd.
Theme area
Equitable health services
Title of publication Strategies to avoid the loss of developmental potential in more than 200 million children in the developing world
Date of publication
2007 January
Publication type
Journal Article
Publication details
The Lancet 369 January 20, 2007 pp 229-242
Publication status
Published
Language
English
Keywords
child mortality, children, early childhood development
Abstract
This paper is the third in the Child Development Series, focusing on child development in developing countries. In it, the authors assess strategies to promote child development and to prevent or ameliorate the loss of developmental potential. They found that most effective early child development programmes provide direct learning experiences to children and families, are targeted toward younger and disadvantaged children, are of longer duration, high quality and high intensity, and are integrated with family support, health, nutrition or educational systems and services. Despite convincing evidence, programme coverage is low. To achieve the Millennium Development Goals of reducing poverty and ensuring primary school completion for both girls and boys, governments and civil society should consider expanding high quality, cost-effective early child development programmes.
Country
United Kingdom
Publisher
The Lancet
Theme area
Equitable health services
Title of publication Reinstatement of the 90 beds cut at tertiary hospitals in the Western Cape
Date of publication
2008 April
Publication type
Publication details
Publication status
Published
Language
English
Keywords
hospital budgets, health care expenditure, cutbacks, funding
Abstract
During 2006, the two tertiary hospitals in the Western Cape, namely Groote Schuur and Tygerberg Hospitals, were told by the Department of Health that the deficits in budgets required them to cut back on beds in their respective facilities. This was communicated to hospital heads of departments in a meeting with the Department. Two of the doctors from Groote Schuur Hospital came out of the meeting and expressed their outrage to the media about how this decision will impact on service delivery in an already strained system. They were threatened with disciplinary action for publicly communicating confidential information. A meeting was convened and additional funds were provided by government, which will allow them to reinstate the 90 beds across three tertiary hospitals: Groote Schuur Tygerberg and Red Cross Children’s Hospital.
Country
South Africa
Publisher
NEHAWU
Theme area
Governance and participation in health
Title of publication The Kampala Declaration and Agenda for Global Action
Date of publication
2008 March
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
global health, health services, human rights
Abstract
This declaration, made by the participants at the first Global Forum on Human Resources for Health in Kampala, 2-7 March 2008, represents a diverse group from governments, multilateral, bilateral and academic institutions, civil society, the private sector, health workers' professional associations and unions. They acknowledge that the enjoyment of the highest attainable standard of health is one of the fundamental human rights and call upon government to provide leadership, finance and health workers to address the public health crisis in Uganda.
Country
Switzerland
Publisher
Global Health Workforce Alliance
Theme area
Equity and HIV/AIDS
Title of publication Gender, property rights and livelihoods in the era of AIDS
Date of publication
2007 November
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
ART, ARVs, women's rights, children's rights, food security
Abstract
This is a report of the proceedings of the FAO technical consultation regarding gender, property rights and livelihoods. The specific objectives of the consultation were to: review available knowledge on the linkages between gender, property rights, rural livelihoods and HIV and AIDS; explore promising approaches and responses to this issue; and develop a consensus on the way forward for research, programming and advocacy. The main findings of the consultation were:
• There is a close and proven relationship between gender inequality, food insecurity and risky sexual behaviour, which contributes to and exacerbates the spread of HIV.
• Secure land access and property rights are important conditions for food security and
improved livelihoods for women and children.
• Behaviour change is critical in order to achieve real progress at the community level.
• Emergency support is urgently needed (shelter, food, clothes, ARVs and clean water) for
women and children who have been stripped of their property and evicted from their homes.
Country
Switzerland
Publisher
Food and Agriculture Organisation of the United Nations
Theme area
Health equity in economic and trade policies
Title of publication Learning from experience: Health care financing in low- and middle-income countries
Date of publication
2007 June
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
health care, financing mechanisms, affordable health care
Abstract
This report reviews health care financing in low- and middle-income countries as it relates to three main functions: revenue collection, which concerns the sources of funds, their structure, and the means by which they are collected; pooling of funds to mobilise sufficient resources to cover unexpected health care costs and spread health risks over a population; and purchasing, which transfers pooled resources to health service providers so that appropriate and efficient services are available to the population. Two major findings emerged from this review of international experience and current thinking:
• Every effort should be made to achieve universal health care coverage – defined as a system that provides all citizens with adequate health care at an affordable cost – by a prepayment financing mechanism.
• A health care financing mechanism, such as a risk-sharing plan, should provide sufficient financial protection so that no household is impoverished because of a need to use health services.
Country
Switzerland
Publisher
Global Forum for Health Research
Theme area
Monitoring equity and research to policy
Title of publication From Mexico to Mali: Taking stock of achievements in health policy and systems
Date of publication
2008
Publication type
Publication details
Publication status
Published
Language
English
Keywords
research and development, HPSR, funders, funding
Abstract
In preparation for the forthcoming Ministerial Forum on Health Research, to be held in Bamako, Mali in November 2008, more than 40 researchers from 28 countries, both in the South and the North, who have a particular interest in health policy and systems
research (HPSR) and the application of evidence to health policy, gathered in Nyon, Switzerland on 25-27th May to:
• critically assess developments in HPSR in low and middle income countries and its application to policy since the Mexico Summit, 2004;
• highlight current gaps, priorities and challenges in the HPSR field that need to be addressed; and
• discuss and agree how best to move forward the HPSR field.
Meeting participants reviewed evidence about the evolution of the HPSR field and debated emerging needs, with a view to informing discussions at Bamako, and further action by the institutions sponsoring and participating in the meeting, as well as by other
key stakeholders including national governments, researchers, research and development funders.
Country
Publisher
Alliance for Health Policy and Systems Research; WHO; International Development Research Centre, Canada
URL:
Theme area
Resource allocation and health financing
Title of publication Debt relief as if justice mattered
Date of publication
2008
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
jubilee, HIPC, credit, interest rates, MDRI
Abstract
This report is the last in a series from NEF designed to stimulate progress towards a comprehensive and fair treatment of the crisis of sovereign debt. With the end of an unprecedented period of low interest rates in 2008, such a goal is needed more than ever. Debt relief isn’t working. Current approaches (HIPC and MDRI for poor countries and Paris and London Club renegotiations for middle-income countries) are not solving the problems of Third World indebtedness. HIPC and MDRI are indeed reducing debt burdens, but for a small range of countries, and at a high cost in terms of loss of policy space and after long delays, but non-HIPC poor countries also have major debt problems. Middle-income countries’ indebtedness continues to grow. There is a clear need for a new approach to resolving sovereign debt problems that is comprehensive, systematic, fair and transparent and above all, just.
Responses from the creditors so far to criticisms such as those in the previous paragraph have been grossly inadequate. There is as yet no consensus about the way forward. This report aims to stimulate debate and help find a just solution to the debt crisis.
Country
Publisher
NEF
URL:
Theme area
Poverty and health, Equitable health services
Title of publication Civil society principles on the IHP+
Date of publication
2008
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
civil society organisations, civil society networks, health, primary health care
Abstract
Civil society members and advocates for health care from all over the world met to discuss the International Health Partnership and Related Initiatives (IHP+) Scaling Up for Better Health Plan, aimed at strengthening primary health care to achieve the health-related MDGs for developing countries around the world, including Africa. In order to deliver on its stated goals, they believe the IHP+ must commit to a minimum set of guidelines.
These civil society member and advocates stand united on three key principles that they consider non-negotiable: 1) Comprehensive primary health care must be provided for all. 2) Governments must pay their fair share. 3) The people’s voices must be heard.
Country
Publisher
Theme area
Values, policies and rights
Title of publication Ouagadougou Declaration on Primary Health Care and Health Systems in Africa: Achieving better health care for all in the new millennium
Date of publication
2008 May
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
Alma Mater Declaration, health development, national health policy, Burkina Faso, Millenium Development Goals, MDG
Abstract
The International Conference on Primary Health Care and Health Systems in Africa, meeting in Ouagadougou, Burkina Faso, from 28 to 30 April 2008, reaffirms the principles of the Declaration of Alma-Ata of September 1978, particularly in regard to health as a fundamental human right and the responsibility that governments have for the health of their people. Having analysed the experience of Primary Health Care implementation in the countries of Africa in the last 30 years, the Conference expresses the need for accelerated action by African governments, partners and communities to improve health. The Conference also reaffirmed the importance of the involvement, participation and empowerment of communities in health development in order to improve their well-being, as well as the importance of a concerted partnership, in particular, between civil society, private sector and development partners, to translate commitments into action.
Their declaration includes demands such as the need for governments to update their national health policies and plans according to the Primary Health Care approach with a view to strengthening health systems to achieve the Millennium Development Goals, specifically regarding communicable diseases.
Country
Burkina Faso
Publisher
URL:
Theme area
Equity and HIV/AIDS
Title of publication Towards universal access: Scaling up priority HIV/AIDS interventions in the health sector
Date of publication
2008
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
WHO, progress report 2008, scaling up, ART, mother-to-child transmission
Abstract
The combined efforts of countries and international partners have resulted in substantial, ongoing progress towards providing HIV interventions in low- and middle income countries. Access to antiretroviral therapy for advanced HIV infection is increasing at an accelerating pace in low and middle-income countries. About 3 million people were receiving antiretroviral therapy at the end of 2007, nearly 950 000 more compared with the end of 2006 and a 7.5-fold increase during the past four years. Despite progress, antiretroviral therapy coverage remains low: only 31% [27–34%] of people in need were receiving antiretroviral therapy in 2007. The decreases in mortality and morbidity rates among people receiving antiretroviral therapy in low- and middle income countries are comparable to those in high income countries. However, many countries still face significant challenges. These include higher mortality in the six months following the initiation of treatment, and insufficient retention rates. Tuberculosis continues to be the leading cause of death among people living with HIV. Rates of co-infection with hepatitis B and C viruses are high, especially among injecting drug users.
There has been substantial progress in scaling up access to services for the prevention of mother-to-child transmission. In 2007, 33% of pregnant women living with HIV in low- and middle-income countries received antiretroviral drugs to prevent transmission to their children versus 10% in 2004. However, only 12%of pregnant women living with HIV identified during antenatal care were assessed for their eligibility to receive antiretroviral therapy for their own health. Today, more children are accessing care and treatment services than in previous years.
Country
Switzerland
Publisher
WHO
URL:
Theme area
Title of publication Millennium Development Goals: Progress and prospects for meeting child survival targets in South Africa
Date of publication
2008
Publication type
Electronic Source
Publication details
Publication status
Published
Language
English
Keywords
Millenium Development Goals, South Africa, child mortality, child death
Abstract
The under-five mortality (U5MR) rate in South Africa in 1990 was 60. South Africa needs to achieve an U5MR of 20 by 2015 to meet its Millenium Development Goal (MDG) target. Yet, in contrast to most countries, the U5MR in South Africa is rising rather than declining. Based on current trends, unless urgent measures need to be taken to address the main causes of death, South Africa has little hope of reaching the MDG. To develop an effective intervention strategy, this article undertakes a critical examination of under-5 mortality in terms of causes and trends in child mortality, the underlying determinants of child deaths, the effects of global economics and the need for more comprehensive primary health care.
Country
South Africa
Publisher
People’s Health Movement, South Africa
URL:
Theme area
Values, policies and rights, Human resources for health, Monitoring equity and research to policy
Title of publication Discussion paper 64: Exploring the concept of power in the implementation of South Africa's new community health worker policies: A case study from a rural sub-district
Date of publication
2007 April
Publication type
Report
Publication details
EQUINET Discussion Paper 64 pp 1-38
Publication status
Published
Language
English
Keywords
policy implementation, power, stakeholders and actors, community health workers, South Africa
Abstract
The study explores how policies are shaped and transformed in the process of implementation, using as a case study the implementation of two community health workers policies in a rural sub-district in South Africa. Rather than focusing on the gap between policy formation and policy outcome, with implementation being a mere administrative follow-on, we take a 'bottom-up' perspective, which allows one to view implementation as an integral and continuing part of the policy process. Within the policy-action dialectic of the implementation process, we were particularly interested in the use of discretionary power or 'scope of action' exercised by the apparently powerless: how such discretionary power was used by front-line implementers either to develop 'coping mechanisms' in the absence of clear policy rules or to negotiate policy modification in action. Results show that tensions between role players, as well as selective communication and lack of information, led to a 'thinning down' of a complex and comprehensive policy to focus solely on the payment of stipends to community health workers. As frontline implementers at the district and community levels did not have information to understand the content and scope of the policy, their actions were shaped by what they were informed about: the need to pay stipends to selected community health workers (CHWs) and to have them work in specialised fields. While they did not have the power to change the rules that were set and implemented by the provincial actors, they used their knowledge of local conditions, control over local knowledge and distance from the provincial capital to shape implementation at the service level.
Country
South Africa
Publisher
EQUINET; Centre for Health Policy, University of Witwatersrand
URL:
Equinet Publication Type
Discussion paper
Theme area
Equity and HIV/AIDS
Title of publication African Civil Society position paper on HIV and AIDS in Africa: Urgent need to meet the universal access targets
Date of publication
2008 May
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
Africa, health care, Abuja Declaration, scaling up, TB/HIV co-infection, civil society, intellectual property
Abstract
In this position paper, the Coalition raises demands for the improvement of health care in African countries in terms of: improving political commitment and leadership; strengthening civil society to improve absorption of available resources; immediately delivering on the 15% Abuja commitment; scaling up investment in youth empowerment and education to enhance participation of young people in HIV/AIDS; ensuring sustainability of financing and programmes; fast tracking implementation of the global strategy and plan of action on public health, innovation and intellectual property; scaling up HIV prevention, treatment and care; dealing effectively with and invest in programmes for TB/HIV co-infection; addressing the needs of older people and empowering and engaging with PLWHAs.
Country
East and southern Africa region
Publisher
African Civil Society Coalition on HIV and AIDS
URL:
Theme area
Resource allocation and health financing
Title of publication Discussion Paper 60: Progress towards the Abuja target for government spending on health care in East and Southern Africa
Date of publication
2008 April
Publication type
Report
Publication details
EQUINET Discussion Paper 60 pp 1-38
Publication status
Published
Language
English
Keywords
Abuja Declaration, 15% spending, progress on target, east and southern Africa
Abstract
African Heads of State committed themselves at a meeting in Abuja in 2001 to devoting a minimum of 15% of government funds to the health sector in order to address the massive burden of ill-health facing countries in Africa, particularly within the context of a growing burden of HIV, AIDS, TB and malaria, This report considers progress towards this target and is based on information provided by researchers in various Southern and East African countries. Of the countries reviewed, only Zambia and Malawi have made considerable progress towards the Abuja target, with the health sector’s share of total government expenditure increasing consistently from 8% and 5% respectively in 1997 to nearly 11% and 7% in 2000 and almost 18% and 11% in 2003 (thus exceeding the Abuja target in the case of Zambia). Although Namibia has not achieved the Abuja target, it has made good progress from 10% in 1997 to nearly 14% in 2003. Kenya is the furthest from the Abuja target, with only 5% of government resources going to health services in 2006 and with no consistent increase in government spending. This research demonstrates that some seven years after the Declaration, many of the countries are still lagging well behind this target, although there are promising signs of increases in allocations towards the health sector in some countries.
Country
East and southern Africa region
Publisher
Health Economics Unit, University of Cape Town; TARSC; EQUINET
URL:
Equinet Publication Type
Discussion paper
Theme area
Values, policies and rights
Title of publication Discussion Paper 63: A review of Kenyan, Ugandan and Tanzanian public health law relevant to equity in health
Date of publication
2008 May
Publication type
Document
Publication details
EQUINET Discussion Paper 63 pp 1-50
Publication status
Published
Language
English
Keywords
public health laws, legal frameworks, policy commitments, Kenya, Uganda, Tanzania
Abstract
This report presents a review of the public health laws in Kenya, Uganda and Tanzania that impact on equity in health to assess the extent to which the current legal framework addresses public health and health equity, recognising the changing challenges, contexts and policies in all three countries. Public health law has perhaps not had adequate profile in academic and professional practice, but is a critical area of work if countries in east and southern Africa are to protect public health and health equity in an environment increasingly influenced by global challenges and policies. Various areas of law are provided for in all countries, and it is more in their application that there may be deficits. Opportunities for strengthening the institutional interactions and capacities to support implementation are outlined in the paper. Some areas of law are provided for in some laws but not in all relevant laws, or not in all countries. This calls for measures to harmonise the legal frameworks within countries to ensure consistency, and across the three countries to protect health across the region as a whole. In some cases there are policy commitments but omissions or gaps in law to reflect these policy commitments and ensure their application at national level across all sectors. The authors suggest that these areas be reviewed by health authorities, parliamentary committees, health professional associations and health civil society.
Country
East Africa regional
Publisher
EQUINET, TARSC, Faculty of Law, Makerere University
URL:
Equinet Publication Type
Discussion paper
Theme area
Public-private mix, Resource allocation and health financing
Title of publication Discussion Paper 59: Building strategies for sustainability and equity of prepayment schemes in Uganda: Bridging the gaps
Date of publication
2008 April
Publication type
Document
Publication details
EQUINET Discussion Paper 59 pp 1-17
Publication status
Published
Language
English
Keywords
Social Health Insurance, SHI, Community Health Insurance, CHI, private health care, Uganda
Abstract
In Uganda, community-based health insurance started in 1995; however, the number of schemes has remained small with very low coverage levels. This study examines issues of equity and sustainability in these prepayment schemes; if they are to contribute significantly to health sector financing, the schemes must be equitable and sustainable. A descriptive cross-sectional study employing qualitative techniques was carried out. Key informant interviews, focus group discussions and documents review were used. Data was tape-recorded, transcribed, typed, manually analysed thematically using a master sheet. Abolition of user fees did not have a big effect on enrolment into the schemes. People went for higher quality services, which were perceived to be provided in private health facilities rather than government services. Schemes were perceived to directly contribute towards health financing by providing funds for the procurement of drugs and equipment, allowing people to contribute to their own health care. An indirect benefit is that they would ease the pressure on public facilities by diverting patients from the public health sector. Whereas some thought the contribution of CHI schemes was insignificant due to low enrolment, others felt the schemes needed to be strengthened to build confidence in social health insurance.
We recommend that government increase funding to maintain the improvement in quality of health care in public facilities. Future health policy needs to address whether or not CHI has a role to play in the Ugandan context and in institutionalising SHI.
Country
Uganda
Publisher
EQUINET, Health Economic Unit, UCT
Equinet Publication Type
Discussion paper
Theme area
Resource allocation and health financing, Equity and HIV/AIDS
Title of publication Discussion Paper 58: Assessment of equity in the uptake of anti-retrovirals in Malawi
Date of publication
2008 April
Publication type
Document
Publication details
EQUINET Discussion Paper 58 pp 1-21
Publication status
Published
Language
English
Keywords
ARV, retention rates, fee removal, user fees, Malawi
Abstract
This study aimed to assess equity in uptake of antiretroviral therapy in Malawi in 2005, especially according to age (children vs. adults), gender (men vs. women) and income. Particular reference is made to the scaling up of ART and the removal of fees for ART in 2004. Informal interviews were conducted with health sector antiretroviral programme implementers and key policy makers in the Ministry of Health. We also searched both published and grey literature to collect information on the history and operations of the Malawi public sector-led ART programme. Retention rates remain high in Malawi's ART programmes (84%), which compare favourably with those elsewhere on the continent. Retention rates ranging from 44% to 85% after 24 months of treatment have been reported in ART programmes throughout Africa (Rosen et al, 2007). While there were some reports from key informants that the change from fee-paying ART services to free systems may have improved patient adherence to treatment regimes, the research did not provide conclusive evidence of the impact of cost of patients' medications on their adherence to their treatment regimens. Different adherence rates in different areas and programmes suggest that other determinants may be affecting affect this outcome.
Country
Malawi
Publisher
EQUINET; Health Economics Unit, University of Cape Town
URL:
Equinet Publication Type
Discussion paper
Theme area
Governance and participation in health
Title of publication PRA report: Community action for health in ‘Ontevrede’ community
Date of publication
2008 April
Publication type
Academic paper
Publication details
EQUINET PRA report pp 1-27
Publication status
Published
Language
English
Keywords
Nambia, council, community empowerment, toilet facilities, health actions
Abstract
In the second phase, the community working group and UNAM team held meetings with various stakeholders and presented the previously identified health needs and related health risks. This aspect resulted in change of mindsets of the local authorities and they are currently in the process of negotiating with the community to give them possible assistance. Implementing community empowerment for health actions in informal settlement areas faces many challenges, as community members have weak access to decision making on their services. The PRA process needs to respect context and facilitators cannot force the pace of interventions. Actions to implement even the most basic PHC interventions take time to build the co-operation and responses from necessary stakeholders. The PRA team proposes to continue with the process in 2008 and support the ‘Ontevrede’ PRA team until their paper is presented to the City Council and a workable alternative solution found to their problem of lack of toilets.
Country
Zimbabwe
Publisher
EQUINET, University of Namibia
URL:
Equinet Publication Type
Discussion paper
Theme area
Resource allocation and health financing
Title of publication Discussion Paper 57: Removal of user fees at Primary Health Care facilities in Zambia: A study of the effects on utilisation and quality of care
Date of publication
2008 March
Publication type
Academic paper
Publication details
EQUINET Discussion Paper 57 pp 1-20
Publication status
Published
Language
English
Keywords
user fees, impact on utilisation, Zambia
Abstract
This study is a first attempt at gathering evidence on the effects of effects of user fee removal on aspects of utilisation and quality of services. The study was based on data collected from a sample of 23 districts in Zambia. The data included total utilisation, attendance levels at health centre outpatient and inpatient maternal and child health facilities, levels of respiratory infections, skin infections, diarrhoea and supervised deliveries, and the availability of drugs. Utilisation data is categorised by age (under-five years of age and over five years) and according to rural or urban districts. We found a substantial increase in total utilisation of public health services (50% increase in rural populations over 5) and an increase in drug consumption. Districts with a greater proportion of poor people recorded greater increases in utilisation of their facilities. Drug consumption in rural districts was estimated to have increased by about 40%. Staff workloads (calculated as the staff-to-patient ratio per day) in rural districts also showed a slight increase after user fees were removed. Based on patients' perceptions, we report no evidence of deterioration in the quality of care since user fees were removed. However, inadequate numbers of skilled health workers presents a major human resources threat to improving access by all. With sustained budget support from government to the DHMTs, the health system can continue to achieve its desired outcomes without relying on user fees.
Country
Zambia
Publisher
EQUINET, UCT HEU
URL:
Equinet Publication Type
Discussion paper
Theme area
Resource allocation and health financing
Title of publication The challenge of delivering on the budget remains
Date of publication
2008
Publication type
Electronic Source
Publication details
Publication status
Not published
Language
English
Keywords
Millenium Development Goals, Namibia, 2008, budget, resources for health
Abstract
This is a short commentary on Namibia's 2008 Budget by a Namibian health professional with regard to the Millenium Development Goals. A deep look at the budget reveals some problematic areas, namely that the Minister of Health once more missed the opportunity to allocate adequate resources to health. She again missed the Abuja target by 5%, which by international consensus, considers a 15% government budget allocation to health as satisfactory.
Although it was said that the health budget has been increased by 26%, the total health and social services allocation is still standing at 10.08% of the overall Government budget for the 2008-09 financial year. This is a missed opportunity, given that the Minister had enough cash for a fair distribution to national priorities, health included.
Country
Namibia
Publisher
URL:
Theme area
Equity in health
Title of publication Equitable access: Research challenges for health in developing countries
Date of publication
2008
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
research and development, R&D, medicines, research, human resources, financing
Abstract
This report on the Global Forum's annual meeting provides an overview and synthesis of the key issues discussed and conclusions reached about how to achieve equity in health in developing countries, specifically using China for examples of best practice and lessons learnt. These include the need for: additional research; better systems of organising and funding research; ensuring participation in the processes by all the stakeholders; and facilitating research to ensure impact on the health of those in need.
Eight key issues were central to Forum 11 deliberations:
• expanding the use of evidence in policy- and decision-making;
• equity and human rights (access and inclusion);
• encouraging innovation in research;
• priority setting;
• research capacity strengthening;
• power of inter-sectoral collaboration;
• advocacy to underscore the importance of research and resources; and
• communication of research results.
Country
Switzerland
Publisher
Global Forum for Health Research
Theme area
Equitable health services, Public-private mix, Resource allocation and health financing, Equity and HIV/AIDS
Title of publication HIVOS, HEPS-Uganda in Partnership Newsletter
Date of publication
2008 March
Publication type
Journal Article
Publication details
Medicine Access Digest 4 1 pp 1-8
Publication status
Published
Language
English
Keywords
HEPS, Uganda, Newsletter, procurement of medicines for HIV and AIDS, generic medicines, access to medicines,finacing medicines for HIV and AIDS
Abstract
The year 2008's first issue of the quarterly newsletter contains various articles dissecting procurement of medicines for HIV and AIDS, as well as one entitled "Project to monitor medicine and health financing; and fund IP law advocacy".
Country
Uganda
Publisher
HEPS Uganda
URL:
Theme area
Equity in health
Title of publication Writing about equity in health in east and southern Africa: A writing skills manual
Date of publication
2008 May
Publication type
Book
Publication details
EQUINET Toolkit pp 1-128
Publication status
Published
Language
English
Keywords
writing skills, scientific writing, peer review, journals, east and southern Africa
Abstract
The manual is intended for use by researchers in preparing papers, in writer’s training workshops; and will be updated in later editions with additional areas of writing skills. This edition of the manual is a guide to producing scientific reports, peer-reviewed articles, EQUINET policy and discussion papers, briefs and reports. It is intended for those involved in EQUINET programmes to:
• prepare papers for publication in EQUINET papers and in peer-reviewed, scientific journals;
• communicate work on health equity;
• understand and work with peer review processes; and
• improve writing skills generally, including for meeting reports.
Country
Southern Africa Regional
Publisher
EQUINET, TARSC
URL:
Equinet Publication Type
Toolkits and training materials
Theme area
Human resources for health
Title of publication Discussion paper 55: Migration of health workers in Kenya: The impact on health service delivery
Date of publication
2008 April
Publication type
Document
Publication details
EQUINET Discussion Paper 55 pp 1-39
Publication status
Published
Language
English
Keywords
cost of health worker migration; impact on health system; policy responses; Kenya
Abstract
In this study, we aimed to identify determinants, benchmarks and indicators of the costs and benefits and distributional impact of the migration of human resources for health on health services in Kenya and to make policy proposals for intervention. We used the World Health Organization (WHO) 2004 framework on health systems performance, which covers those activities whose primary objective is to maintain or improve population health. The study concentrated on impacts on resource generation, stewardship and service provision and was limited to doctors and nurses. Despite data limitations, the study shows a general trend in migration both locally, from rural to urban areas and internationally, from Kenya to developed countries, with a high emigration rate of 51% for doctors and 71% of respondents indicating an intention to emigrate. From data collected, we made a rough estimate of inward remittances of about US$90 million annually for nurses and doctors which, however, are not available to the health system and may not match outflows from the health system. In training doctors (schooling and university) alone, about US$95 million invested was lost in Kenya due to migration and our estimates suggest these losses may be higher. Even if remittances were to be accounted for, there still appears to be a net outflow of capital from the country and its health system due to migration. This loss has negative impacts on workloads, especially at peripheral facilities and in some rural districts, which may impact on health service provision and on the referral chain. Increased workloads caused by understaffing result in stress, burn out and demotivation. These become push factors that lead remaining health workers to leave. There was some improvement in workloads in 2005/6 despite increases in service uptake, suggesting that there has been some policy response to the staff crisis in those facilities surveyed.
Country
Kenya
Publisher
EQUINET; East, Central and Southern African Health Community
URL:
Equinet Publication Type
Discussion paper
Theme area
Equity in health
Title of publication National meeting report: Knowledge for action on equity in health in Uganda, Hotel Africana, Kampala, Uganda, 27-28 March 2008
Date of publication
2008 March
Publication type
Conference Proceedings
Publication details
EQUINET Meeting report pp 1
Publication status
Published
Language
English
Keywords
equity, access to medicine, fair financing, people-centred health systems, Uganda
Abstract
To promote policies for equity in health EQUINET, with HEPS-Uganda and Makerere University School of Public Health organised a National Meeting to review the body of work taking place in Uganda within government, academic and civil society institutions to explore, understand and propose options for reducing inequalities in health in Uganda. The meeting provided an opportunity to exchange evidence, strengthen networking in Uganda, and feed experience into regional networking. The meeting aimed to assess the progress of equity in health in Uganda. It reviewed gaps and needs in the Ugandan health sector, to feed into and draw from experience in East and Southern Africa. The meeting set up a task force that they proposed include academics, civil society, ministry of health that would take the work forward. HEPS and Makerere were tasked to continue to co-ordinate this, with members also from the co-ordinators of the different theme areas. The following specific follow up activities were identified: prepare conference report and brief with EQUINET; set up a mailing list for the network of institutions in Uganda – institutions start sharing relevant information; include the Uganda institutions in the EQUINET newsletter and mailing list; disseminate the report to workshop participants and other stakeholders; hold a briefing meeting with Ministry of Health; prepare a leaflet on the conference proceedings for wider dissemination; identify a journal for peer reviewed publication; hold a writers workshop for the journal papers and finalise the papers with EQUINET support; produce a journal supplement of conference papers; within key areas of focus hold follow up activities, e.g. systematic reviews, position papers, public forums, media dissemination and original research; regional and community level dissemination of work; organise public dialogues on key issues (target key health days); organise theatre and drama on key issues; and follow up national meeting in a year to review issues and work.
Country
Uganda
Publisher
EQUINET
URL:
Equinet Publication Type
Reports
Theme area
Equity in health
Title of publication Abstract book: Knowledge for action on equity in health in Uganda, Hotel Africana, Kampala, Uganda, 27-28 March 2008
Date of publication
2008 March
Publication type
Conference Proceedings
Publication details
EQUINET Abstract book pp 1-20
Publication status
Published
Language
English
Keywords
Uganda, equity, access to medicine, fair financing, people-centred health systems
Abstract
Over the past fourteen years considerable effort has been made to restore the functional capacity of the health sector, reactivate disease control programmes and re-orient services to Primary Health Care in Uganda. According to the Ministry of Health (2007) there still remain significant challenges in matching need and demands for health services with available resources, making equity or fairness an important issue for advancing national policies for the population as a whole (http://www.health.go.ug/policies.htm) Measures to improve equity in access, like abolition of user fees and investment in primary care and district level services have been a specific and successful response to this challenge. Ensuring that the resources for health fairly reach those with greatest need and that all have fair opportunities for health is not a matter for the Ministry of Health alone, but for all sectors whose activities affect health, and for all sections of society. As a part of this there is a body of work taking place in Uganda in government, academic and civil society institutions to explore, understand and propose options for reducing inequalities in health in Uganda. This meeting aimed to assess the progress of equity in health in Uganda, review gaps and needs in the Ugandan health sector, to feed into and draw from experience in East and Southern Africa. It aimed to develop ways in which networking between people and institutions working in areas relevant to health equity can be strengthened in Uganda to support such work, and widen links with the regional network for equity in health in Uganda. The meeting discussed options for strengthening communication at country level across those working in equity in health and areas for future research and practice.
Country
Uganda
Publisher
EQUINET
Equinet Publication Type
Reports
Theme area
Health equity in economic and trade policies
Title of publication Making full use of TRIPS flexibilities in patent laws: A critical review of Uganda’s draft Industrial Property Bill
Date of publication
2008 April
Publication type
Academic paper
Publication details
Publication status
Published
Language
English
Keywords
TRIPS, patents, intellectual property rights, patent law
Abstract
Since 2000, the Uganda Law Reform Commission has been spearheading the process of reforming Uganda’s patent legislation. The reform is taking place in the context of the Doha Development Agenda, a process for continued negotiations on areas of concern within the WTO agreements raised by developing countries during the Fourth Ministerial Conference in Doha, Qatar in November 2001.
Although the country's draft bill has been improved in a number of aspects, there is still need for improvement on the drafting language to make use of the flexibilities in the widest allowable sense and capture the new thinking regarding these flexibilities. Uganda is a net consumer of technology. It should not feel compelled to offer intellectual property protection of similar strength as those countries that are exporters of technology.
Moreover, its position as one of the world's least developed countries should allow it to have a patent law that is as flexible as possible in order to create conditions for the development of its manufacturing capacity through the use of available technologies for research and production.
Country
Uganda
Publisher
Heps Uganda
URL:
Theme area
Governance and participation in health
Title of publication EPAs: The Way Forward for the ACP
Date of publication
2008 April
Publication type
Conference Proceedings
Publication details
Publication status
Published
Language
English
Keywords
EPA, trade, European Union
Abstract
These are the proceedings of the High Level Technical Meeting in Cape Town, South Africa, 7-8 April, 2008. The objective of the meeting was to undertake a comprehensive stock taking of EPAs that have been concluded in order to provide countries with an objective and accurate assessment of the content, character and implications of the various agreements that will help guide and inform their policy choices. For example, specific studies on particular issues identified useful to assist in the negotiations should be conducted, the ACP Secretariat/Commonwealth Secretariat should assist in organising sensitisation seminars for government officials and Parliamentarians and other stakeholders on EPAs and related issues, and there should be flexibility to engage the EU side at the appropriate political level (Heads of State and Government, EC Presidency and EU Member States) to resolve contentious issues that are inhibiting progress in concluding the EPAs.
Country
United Kingdom
Publisher
Commonwealth and ACP Secretariat
URL:
Theme area
Health equity in economic and trade policies
Title of publication Regulatory issues focus: Registration and the AS/AQ
Date of publication
2008 April
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
malaria, arsunate, FACT, AS, AQ
Abstract
This is a presentation that was given at the second regional meeting of the African Civil Society Coalition on the
Intergovernmental Working Group (IGWG) on Public Health, Innovation and Intellectual Property in Arusha, Tanzania,
3-4 April, 2008. It provides an introduction to the workings of the IGWG and gives international context for its operations. Drug development and application processes are explained and much of the report is devoted to an evaluation of the IGWG's fixed-dose artsunate-based combination therapy (FACT) project for the treatment of malaria.
Country
Publisher
Drugs for Neglected Diseases Initiative
URL:
Theme area
Health equity in economic and trade policies
Title of publication WHO Intergovernmental Working Group (IGWG) on Public Health, Innovation and Intellectual Property
Date of publication
2008 April
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
research and development, developing countries, R&D, medicines, research, financing
Abstract
This is a presentation that was given at the second meeting of the African Civil Society Coalition on the Intergovernmental Working Group in Arusha, Tanzania, 3-4 April. 2008. It provides basic information on the Commission on Intellectual Property Rights,
Innovation and Public Health (CIPIH), regarding its mandate and the implementation of its recommendations. One of these recommendations was to establish an intergovernmental working group (IGWG) to draw up a global strategy and plan of action in order to provide a medium-term framework based on the recommendations of the Commission. The aims of the strategy and plan of action are to secure an enhanced and financially sustainable basis for needs-driven, essential health research and development relevant to diseases that disproportionately affect developing countries.
Country
Kenya
Publisher
URL:
Theme area
Health equity in economic and trade policies
Title of publication Process to date for the World Health Organisation's Intergovenmental Working Group on Public Health, Innovation and Intellectual Property Rights: An African perspective
Date of publication
2008 April
Publication type
Conference Proceedings
Publication details
Publication status
Published
Language
English
Keywords
AFRO, Tanzania, developing countries, IWGPH, negotiations
Abstract
This report was presented at the second regional meeting of the Africal Civil Society Coalition on the Intergovenmental Working Group on Public Health, Innovation and Intellectual Property Rights in Arusha, Tanzania, 3-4 April, 2008. It highlights the process in developing AFRO's approach to the negotiations, the common AFRO position(s), and achievements and challenges so far.
As anticipated, the developing countries 'led' by Kenya and Brazil generally 'ganged up' against the developed countries 'headed' by the USA. AFRO virtually pushed through its position and a number of its concerns were incorporated in the Draft Strategy and Plan of Action progress report. AFRO and developing countries successfully articulated and defended their respective interests during session. However, some interests are not yet realised because either the respective issues have not yet been negotiated or are still bracketed (no consensus on them reached yet).
Country
Kenya
Publisher
Health Action International (HAI) Africa
URL:
Theme area
Poverty and health, Equitable health services, Monitoring equity and research to policy
Title of publication A rights-based approach for advocacy on access to essential medicines
Date of publication
2007 August
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
TRIPS, Kenya, research, development, medicines, patents, intellectual property rights
Abstract
In Kenya, access to essential medicines is ensured legislatively for HIV, TB and malaria specifically, but delivery is patchy. The situation is improving, but not universally, and there is a continued assault on the IP Act and generic procurements by those who want to profit from selling essential drugs for the poor.
Access to medicines is an issue that needs a balance between political will and public involvement/civil society demands. Civil society can demand their rights are realised through campaigns to implement the WTO rules that were designed to protect peoples' access to essential medicines and by stopping the assaults on the procurement of generics, increasing the availability of essential medicines, funding research and development for the medicines we need and abolishing taxes on essential medicines. Providing free essential medicines is the only affordable option for most of the population.
This report was presented at the Africa Regional Civil Society meeting on the IGWG on Public Health, Innovation and Access, in Nairobi, Kenya, 28 –29 August, 2007.
Country
Kenya
Publisher
Health Action International (HAI) Africa
URL:
Theme area
Health equity in economic and trade policies
Title of publication Health research and development in Africa
Date of publication
2007 August
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
research and development, R&D, medicines, research, human resources, financing
Abstract
This report was presented at the African Civil Society meeting on the Intergovernmental Working Group (IGWG) on Intellectual property, Innovation and Health, 28-29 August, 2007, in Nairobi, Kenya.
The environment for health research in Africa presents a host of challenges, such as a chronic lack of funds, so most countries allocate little or no resources for health research. The human resource capacity for research exists but still requires strengthening, due to problems such as a general lack of initiatives/funding for capacity strengthening, the inability to retain senior researchers due to low incentives in health research and poor levels of collaboration and relationships between researchers, health research regulators and health officials. The government’s inability to fund research "leaves the scientists at the mercy of external funding agents whose priorities determine the priority areas of the researchers". Innovation or research and development (R&D) into medicines for the most important diseases of developing countries tends to be ignored.
Public funding for research on health problems in developing countries should be increased. This additional funding should seek to exploit and develop existing capacities in developing countries for R&D.
Country
Publisher
Kenya Medical Research Institute, Centre for Traditional Medicine & Drug Research
URL:
Theme area
Health equity in economic and trade policies
Title of publication Considering Domestic Manufacturing Issues
Date of publication
2007 August
Publication type
Report
Publication details
African Civil Society Meeting: Intergovernmental Working Group on Intellectual Property, Innovation and Health, 28-29 August, 2007 pp 1-22
Publication status
Published
Language
English
Keywords
TRIPS, Kenya, research, development, medicines, patents, intellectual property rights
Abstract
This report was presented at the African Civil Society Meeting of the
Intergovernmental Working Group on Intellectual Property, Innovation and Health in Nairobi, Kenya, 28 -29 August, 2007. It
found that there are over 30 registered local manufacturers in Kenya and at least two others under construction (foreign investments). It also analysed seven PPP projects (six in Kenya & one in Tanzania). The first PPP project passed its first inspection in August 2007 and the others are due for inspection by the end of the project.
The main outcome of the report was that intellectual property rights do not stimulate research and development for medicines for diseases prevalent in developing countries simply because the market in poor countries is considered to be too small or too uncertain.
Country
Kenya
Publisher
Intergovernmental Working Group on Intellectual Property, Innovation and Health
URL:
Theme area
Governance and participation in health
Title of publication EQUINET PRA report 8: Promoting partnership between Communities and Frontline Health Workers: Strengthening Community Health Committees in South Africa
Date of publication
2008 January
Publication type
Report
Publication details
EQUINET PRA report pp 1-28
Publication status
Language
English
Keywords
community participation, health workers, communication, health centre committees, South Africa
Abstract
The workshops provided an opportunity for health workers to discuss the roles and responsibilities of Community Health Committees and to recognise that these structures are sorely under-resourced. They recognised that as health workers they provided limited support for Community Health Committees. The community workshop provided an opportunity for community members to network together and to discuss issues of common interest. Mapping of neighbourhoods surrounding the health facilities provided an important opportunity for exploring the similarities and differences in the challenges and resources available to the local communities. There was an acknowledgement from community members that seldom is an opportunity provided for community members to discuss together in an in-depth way the problems affecting their communities. Community members became more aware of their commonalities, particularly those negatively affecting their communities, such as alcohol abuse, gangsterism and crime, teenage pregnancy. The health workers of sub-district B invested much energy into the process and expressed their eagerness to pursue PRA further and to work more closely to promote the CHCs.
Country
South Africa
Publisher
EQUINET
URL:
Equinet Publication Type
Discussion paper
Theme area
Resource allocation and health financing
Title of publication Discussion paper 56: National Health Financing in Zimbabwe 2005: Contribution of the National AIDS Levy to National Health Care Support
Date of publication
2008 March
Publication type
Document
Publication details
EQUINET Discussion Paper 56 pp 1-26
Publication status
Published
Language
English
Keywords
Zimbabwe, AIDS levy, National AIDS Council
Abstract
The study revealed that the contribution of the AIDS levy in Zimbabwe has so far been insignificant. Furthermore, it is not a stable source of funding due to high levels of inflation in Zimbabwe. Inequities exist in the allocation of funds from the AIDS levy according to province, the most extreme case being Matabeleland South province, which had the highest HIV prevalence but received the second-lowest allocation. Unfortunately, many households already have to pay for health services themselves, so the AIDS levy has simply become an additional tax burden.
Country
Zimbabwe
Publisher
EQUINET
URL:
Equinet Publication Type
Discussion paper
Theme area
Equity in health, Equitable health services
Title of publication Relentless Increase in African Maternal Death Could Be Equated To Genocide By Inaction
Date of publication
2007 October
Publication type
Report
Publication details
Maternal Death Scorecard 2007 pp 1-4
Publication status
Published
Language
English
Keywords
maternal health, genocide, score card
Abstract
The latest global maternal death statistics indicate that of the 536,000 women that died in 2005 of childbirth related complications, about half or 261,000 were African women. The recently released 2005 figures also indicate that Africa is the only region where maternal deaths have increased since 1990 up from 205,000. Maternal deaths dropped in every other continent over the same period. In Europe from 4,800 to 2,900, and in the America’s from 21,000 to 16,000. The prevalent maternal death risk also reflects a much bleaker picture of overall reproductive health in Africa. The Africa Public Health Rights Alliance “15% Now!” Campaign has developed a scorecard based on the 2005 figures and available comparable global health financing and health systems data1. The scorecard shows that in the bottom 10 countries globally - all of which are African except Afghanistan, maternal death risk is between 1 in 7 (Niger) and 1 in 15 (Mali). In the top 10 the risk is between 1 in 47,600 (Ireland) and 1 in 13,800 (Switzerland). Possibly every family in the bottom 10 countries will suffer 1 maternal death. Overall 1 in 23 African women have a lifetime risk of maternal death compared with 1 in 2,300 in Europe.
Country
United Kingdom
Publisher
Africa Public Health Rights Alliance 15% Now Campaign
URL:
Theme area
Human resources for health
Title of publication Factors influencing the distribution of pharmacy graduates of the University of the North, South Africa
Date of publication
2007 October
Publication type
Journal Article
Publication details
East African Medical Journal 84 10 pp 481-486
Publication status
Published
Language
English
Keywords
South Africa, incentives, pharmacists, career choies,
Abstract
Objective: To establish the whereabouts of pharmacists trained at the University of the North (UNIN), and the factors that infl uenced their career choices.
Design: Descriptive, cross-sectional study using quantitative and qualitative approaches.
Setting: Department of Pharmacy, University of Limpopo, South Africa.
Results: Most of the 582 pharmacy graduates from UNIN (1966 - 2003) work in South Africa. The questionnaire was sent to 233 graduates and 129 (55.4%)responses were received, of which 121 were analysed. Eighty five (70.2%) respondents were of rural origin; 46.3% work in rural areas and 62.8% in the public sector. Graduates of rural origin were more likely to work in rural areas and the public sector than those of urban origin. Job satisfaction was not related to income. Professional development and service to the community were more commonly cited motivations for taking up the present job than pay. However, 25% of respondents would change jobs for better pay. The most fulfilling aspects of pharmacy practice were interactions with patients, while the most frustrating ones were doctors, restrictive legislation, lack of recognition for the pharmacy profession and poor pay. The focus group discussions and interviews reinforced the above views, with suggested areas for improvement e.g. conditions of service, rural infrastructure and pharmacist involvement in the health system.
Conclusions: Most UNIN-trained pharmacists are within South Africa. Pharmacists of rural origin were more likely to work in rural areas and the public sector than those of urban origins. Both
financial and non-financial incentives are needed to attract pharmacists to underserved areas.
Country
Kenya
Publisher
East African Medical Journal
Theme area
Governance and participation in health
Title of publication Training workshop on Participatory methods for a people centred health system: Strengthening community focused, primary health care orientated responses to prevention and treatment of HIV and AIDS, Bagamoyo Tanzania, 27 February to 1 March 2008
Date of publication
2008 February
Publication type
Report
Publication details
EQUINET Workshop report pp 1-29
Publication status
Published
Language
English
Keywords
participation, research, methodology, training, AIDS, community, east and southern Africa
Abstract
The workshop is the third in a series run by TARSC and Ifakara on participatory reflection and action (PRA) methods in health, using a toolkit developed by TARSC and Ifakara in EQUINET, with support from IDRC and SIDA and peer review by CHESSORE Zambia. The PRA training focus in 2008 was on strengthening equitable primary health care responses to HIV and AIDS. The 2008 training built understanding of PRA approaches and their use in strengthening people centred health systems, particularly community focused and PHC oriented HIV and AIDS interventions; drew on experiences in the east and southern African region for strengthening community focused and PHC oriented HIV and AIDS interventions; worked through practical examples of PRA approaches and their application in areas of work that participants are practically involved with at community level; provided initial mentoring and support to development of research and training proposals for EQUINET support on equitable, community driven responses.
Country
East and southern Africa region
Publisher
EQUINET
URL:
Equinet Publication Type
Reports
Theme area
Equity and HIV/AIDS, Monitoring equity and research to policy
Title of publication International, clinical, operational health systems research and training award for HIV, TB and OI Research
Date of publication
2008
Publication type
Electronic Source
Publication details
Publication status
Publication status unknown
Language
English
Keywords
training, announcement, Zimbabwe, SADC
Abstract
This announcement is for the 2008 Calendar of Training Courses to be held for the first half of this year. The advert targets mainly universities, research institutions in Zimbabwe and the SADC Region.
Country
Publisher
Biomedical Research and Training Institute (BRTI)
URL:
URL
Theme area
Human resources for health
Title of publication An assessment of the Zimbabwe government strategy for retention of health professionals
Date of publication
2008
Publication type
Publication details
Publication status
Published
Language
English
Keywords
Zimbabwe, push factors, critical health professionals, incentives, impact
Abstract
The study aimed to determine and assess the impacts of incentives instituted by the Zimbabwe government and non-government sector to retain Critical Health Professionals. It found that the tendency of health professionals to migrate has increased, even among low levels of staff and the macro-economic environment is the main driver of megration. Sustaining the retention incentives in this environment seems unattainable and bonding is unpopular and further increases migration.
Country
Zimbabwe
Publisher
National University of Science and Technology, EQUINET
Equinet Publication Type
Discussion brief
Theme area
Governance and participation in health
Title of publication PRA project report 5: Strengthening communication between people living with HIV and clinic health workers in Kaisipul Division, Kenya
Date of publication
2007 December
Publication type
Document
Publication details
EQUINET PRA project report pp 1-27
Publication status
Published
Language
English
Keywords
Kenya, participation, health workers, HIV, communicationantenatal services, Uganda
Abstract
We used participatory approaches to facilitate a programme of work aimed at: Improving communication and understanding between HIV positive clients and the HIV clinic personnel in HIV clinics; raising HIV positive clients’ voices and participation in improving the HIV clinic services in the division; promoting networking to overcome isolation, increasing exchange and co-operation through conducting. Participatory approaches, while challenging and time intensive, were perceived by health workers, clients and the facilitators to be a powerful means to enhancing communication, overcoming power imbalances that are barriers to good health or effective use of services and to encouraging the sustainable, “bottom up” community involvement on health visioned in Kenya health policy documents. Real changes were made to make the services more client-friendly, including installed suggestion box, re-streamlined queuing and filling system, taking of vital signs, interpreter involvement, and ordering of bulk drug supply, while clients formed a network that would sustain the communication and reduce social isolation of PLWHIV.
Country
Kenya
Publisher
EQUINET
URL:
Equinet Publication Type
Discussion paper
Theme area
Resource allocation and health financing, Monitoring equity and research to policy
Title of publication Do international health research programmes do enough to develop research systems and skills in low and middle income countries?
Date of publication
2007
Publication type
Publication details
COHRED Statement pp 2-27
Publication status
Published
Language
English
Keywords
health research, sustainable capacity in research
Abstract
Research plays a crucial role in developing solutions to the health problems suffered by the populations of low and middle income countries. Most health research for and in low and middle income countries is funded from external sources. And most of this externally funded research takes the form of 'vertical' - condition-specific - programmes. This paper begins by highlighting four important problems that result from reliance on this type of funding; including an unduly narrow focus of research on conditions for which international funding is available (mostly HIV and AIDS, tuberculosis, and malaria); lack of interest in leaving behind sustainable capacity in research after the research projects have ended; and loss of interest in the local programme at the time when research findings should be translated into action.
Country
Switzerland
Publisher
Council on Health Research for Development (COHRED)
URL:
Theme area
Equitable health services, Governance and participation in health
Title of publication Mama Health Rights Project kicks off in Pallisa, Budaka
Date of publication
2007 June
Publication type
Journal Article
Publication details
Medicine Access Digest 3 1 pp 1-11
Publication status
Published
Language
English
Keywords
reproductive health services, maternal health, Uganda
Abstract
Expectant mothers in Pallisa and Budaka districts have moved closer to realising their right to adequate reproductive health services, following the launch of HEPS Uganda's Community Empowerment and Participation on Maternal Health Project. The Project, falling within the empowerment, lobbying and advocacy themes of the EU's DSCBP, specifically targets expectant mothers, health care providers, district health officials and other local government leaders as well as community opinion leaders.
Country
Publisher
New Enterprise Publications
URL:
Theme area
Human resources for health
Title of publication Human resources: International context
Date of publication
2005
Publication type
Book Section
Publication details
South African Health Review 2005 Chapter 6 pp 76-87
Publication status
Published
Language
Keywords
Abstract
47. Sanders and Lloyd (2005) “Human Resources: International Context” Chapter 6. Gray A,
Govender M, Gengiah T, Singh J. Health Legislation. In: Ijumba P, Barron P. editors. South
African Health Review 2005. Durban: Health Systems Trust.
Country
Publisher
Health Systems Trust
Theme area
Equitable health services
Title of publication Report of the 5th WONCA World Rural Conference
Date of publication
2002
Publication type
Conference Proceedings
Publication details
Publication status
Published
Language
English
Keywords
Rural health, rural health workers, gender, indigenous, urban, South Africa
Abstract
The fifth in this series of conferences was held in Melbourne from 30th April to 3rd May 2002, with the theme “Working together: Communities, professionals, services”. South Africa was well represented by thirty-one members from government, academic institutions, rural hospitals, and allied health workers such as social workers and physiotherapists. There were four main themes, namely, Recruitment and Retention of the Rural Health Workforce, Gender Issues, Indigenous Issues and the Rural/Urban Interface.
Country
South Africa
Publisher
Rural Doctors Association of Southern Africa
URL:
Theme area
Human resources for health
Title of publication The international mobility of health professionals: An evaluation and analysis
Date of publication
2006
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
brain drain, human resources, nurse, doctor, emigration, health professional,
Abstract
This study assesses the real scale of the international mobility of health professionals in South Africa, and reviews the situation in the healthcare sector. It goes on to describe the causes and consequences of the international mobility of health professionals, and the policies introduced by the South African authorities in response to the emigration of health workers. If the OECD member countries intend to continue to recruit health workers from developing countries, the South African experience shows that it will be essential to strengthen international co-operation in the development and management of health workers, and to seek greater coherence between development and migration policies.
Country
Publisher
OECD
URL:
Theme area
Values, policies and rights
Title of publication The New Partnership for Africa’s Development (NEPAD) Health Strategy
Date of publication
2003
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
NEPAD, health policy, Abuja Declaration, Millenium Development Goals, Africa
Abstract
A number of goals and targets have been set for reducing the disease burden in Africa. Examples are the health-related Millennium Development Goals, the Abuja Declarations and targets set in Health-for-All Policy in the 21st Century in the African Region: Agenda 2020. Although the balance of reasons vary from country-to-country, Africa is not on track to achieve these goals and targets, not because they are unattainable, but because:
• health systems and services are too weak to support targeted reduction in disease burden;
• disease control programmes do not match the scale of the problem;
• safety in pregnancy and childbirth has not been achieved;
• people are not sufficiently empowered to improve their health;
• resources are insufficient;
• widespread poverty, marginalisation and displacement on the continent still exists; and
• the benefits of health services do not equitably reach those with the greatest disease burden.
This health strategy addresses the above issues in detail.
Country
Publisher
URL:
Theme area
Human resources for health, Monitoring equity and research to policy
Title of publication The ethical recruitment of internationally educated health professionals: Lessons from abroad and options for Canada
Date of publication
2007 January
Publication type
Document
Publication details
Canadian Policy Research Networks Research Report H/11 pp 1-44
Publication status
Published
Language
English
Keywords
Canada, sub-Saharan Africa, health workers, health professionals, migration, recruitment, brain drain
Abstract
Canada has always relied on internationally educated health professionals (IEHPs) to play an important role in the health system. Recent waves of IEHPs who have come to Canada are arriving from developing countries, and especially from Africa and Asia. Those source countries in Africa and Asia are concerned
about the loss of highly-trained professionals from their own health care systems and particularly concerned with the possibility that developed countries like Canada are engaging in practices and developing policies specifically designed to encourage this immigration.
While there are no easy answers to this problem, there are paths out of the maze of conflicting rights, interests and responsibilities that can allow Canadian policy-makers to both confront the issue and to develop policy options and instruments
that can serve the interests of both the Canadian health care system and the interests of developing states in preserving and building their own systems. The starting point is a consensus that recruitment of these workers from developing countries is a
serious ethical issue – that it is inappropriate for nations as relatively wealthy as Canada to deal with their own domestic health human resource shortages and maldistribution by relying on the immigration of health professionals from developing countries.
Country
Canada
Publisher
Canadian Policy Research Networks
URL:
Theme area
Values, policies and rights, Human resources for health, Monitoring equity and research to policy
Title of publication The brain drain of health professionals from sub-Saharan Africa to Canada: Some findings and policy options
Date of publication
2006
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
Canada, sub-Saharan Africa, health workers, health professionals, migration, recruitment, brain drain
Abstract
There is a considerable body of literature attesting to the fact that the migration of skilled professionals from developing to developed countries is large and increasing dramatically. While different experts espouse different reasons for the increase, all agree that it is happening. Developing countries are hit hardest by the brain drain as they lose sometimes staggering portions of their college-educated workers to wealthy countries, which can better weather their relatively smaller losses of skilled workers. Highly skilled professionals account for 65 percent of migrants moving to industrialised countries. The International Organization for Migration (IOM) estimates that about 20,000 Africans leave Africa every year to take up employment in industrialised countries. We do not know how many of these are health care professionals (largely because of inadequate systems for gathering such statistics in African countries). The World Health Organisation (WHO), however, found that a quarter to two-thirds of health workers interviewed in a recent study expressed an intention to migrate. Historically, and specific to the sub-Saharan African context, the brain drain has meant not only the exodus of human capital but financial resources as well, as African health care professionals left countries with their savings and reinvested very little of their foreign earnings back into the region. There is only recent evidence suggesting that, while the numbers of professionals leaving continue to increase, émigrés are slowly reinvesting some of their earnings back into their countries. Other research raises doubts about the value of such reinvestments, however, particularly when they are in the form of remittances that are generally private welfare transfers back to family members and are often used for consumption rather than for savings.
Country
Canada
Publisher
Queens University South African Migration Project
URL:
Theme area
Values, policies and rights, Human resources for health
Title of publication Managing health professional migration from sub-Saharan Africa to Canada: A stakeholder inquiry into policy options
Date of publication
2006
Publication type
Journal Article
Publication details
Human Resources for Health 4 22
Publication status
Published
Language
English
Keywords
Canada, sub-Saharan Africa, health workers, health professionals, migration, recruitment, brain drain
Abstract
Canada is a major recipient of foreign-trained health professionals, notably physicians from South Africa and other sub-Saharan African countries. Nurse migration from these countries, while comparatively small, is rising. African countries, meanwhile, have a critical shortage of professionals and a disproportionate burden of disease. What policy options could Canada pursue that balanced the right to health of Africans losing their health workers with the right of these workers to seek migration to countries such as Canada? Flows from sub-Saharan Africa to Canada have increased since the early 1990s, although they may now have peaked for physicians from South Africa. Reasons given for this flow are consistent with other studies of push/pull factors. Reducing pull factors by improving domestic supply and reducing push factors by strengthening source country health systems have the greatest policy traction in Canada. The latter, however, is not perceived as presently high on Canadian stakeholder organisations' policy agendas, although support for it could grow if it is promoted. Canada is not seen as ’actively recruiting’ (‘poaching’) health workers from developing countries. Recent changes in immigration policy, ongoing advertising in southern African journals and promotion of migration by private agencies, however, blurs the distinction between active and passive recruitment.
Country
United Kingdom
Publisher
Human Resources for Health
Theme area
Resource allocation and health financing
Title of publication Quest for equity in resource allocation in the health sector: Budget Analysis of the 2007/8 Health Sector Budget Estimates
Date of publication
2007 July
Publication type
Document
Publication details
MHEN Policy Paper 1 7 pp 1-44
Publication status
Published
Language
English
Keywords
Malawi, health budget, equity, resource allocation, HIV budget estimates
Abstract
The analysis is on public resource allocation on health and HIV and AIDS. It is, however, concentrated on public resource allocation to Ministry of Health, NAC and HIV and AIDS programmes in Government Ministries and Departments dubbed ‘HIV and AIDS in the workplace’. It excludes other public resource allocation to other public health service providers under other public entities like the Malawi Defence Force, Malawi Police Service, City Assemblies and other Government funded public companies and agencies. The analysis also excludes purchases of drug and medical supplies by other Ministries and Departments.
Country
Malawi
Publisher
Malawi Health Equity Network
URL:
Theme area
Governance and participation in health
Title of publication PRA project report 7: Community participation in the management of mental disorders in Kariobangi, Kenya
Date of publication
2008 February
Publication type
Document
Publication details
EQUINET PRA Report pp 1-25
Publication status
Published
Language
English
Keywords
mental health, health workers, poverty, participation, Kenya
Abstract
This participatory action research project aimed to explore and strengthen the community’s capacity to recognise and advocate for their mental health needs, to increase the awareness of mental health problems among the community and to increase collaboration between the mental health workers from clinic and hospital level and the community in the management of mental health problems in the community. Both health workers and community identified exclusion, isolation and poor control over life, associated with risks and a poor physical state, as features of mental ill health. The Kariobangi community was felt to experience high levels of mental ill health, with poverty a major contributing factor. The major mental disorders identified were depression, stress, poverty, lack of awareness, drugs/substance abuse, lack of essential services (mental health services), mental retardation and epilepsy. The intervention is still at an early stage, but the evidence suggests that the PRA approach has strengthened community roles and interaction with health workers in improving mental health care in an underserved community.
Country
Kenya
Publisher
EQUINET
URL:
Equinet Publication Type
Discussion paper
Theme area
Governance and participation in health
Title of publication EQUINET PRA report: Community empowerment and participation in maternal health in Kamwenge District, Uganda
Date of publication
2008 February
Publication type
Document
Publication details
EQUINET PRA Report pp 1-33
Publication status
Published
Language
English
Keywords
Uganda, maternal health, community participation, PRA, access to services, health workers, communication
Abstract
The Kamwenge Community Empowerment and Participation in Maternal Health Project aimed to contribute to the improvement of the health of expectant mothers in Kamwenge Sub-county, Kamwenge District. We aimed, through the use of PRA approaches, to increase demand for, access to and utilisation of maternal health services by expectant mothers. Using various PRA tools the project team worked with the community to prioritise, act and follow up on the most critical barriers to maternal health at the three levels – health service, community and household. While a comparison of questionnaires before and after the intervention suggested that maternal health problems remained high and many barriers to access services persisted, positive change was perceived in ease of access to and affordability of services, in communication between community and health workers and the respect shown by health workers, in the support given by health workers and families, and in awareness and action on maternal health in the community. The strongest positive changes were noted in the communication between health workers and pregnant women, and this seemed to be the area of greatest impact of the intervention.
Country
Zimbabwe
Publisher
EQUINET
URL:
Equinet Publication Type
Discussion paper
Theme area
Resource allocation and health financing
Title of publication Policy Brief 19: Are we making progress in allocating government health resources equitably in east and southern Africa?
Date of publication
2008 January
Publication type
Document
Publication details
EQUINET Policy Brief 19 pp 1-4
Publication status
Published
Language
English
Keywords
resource allocation; formula; foreign aid; annual targets; monitor; progress, east and southern Africa
Abstract
Reviewing experience in selected countries in the region, this policy brief suggests that countries can strengthen equitable allocation of resources for health by increasing the overall share of government funding allocated to the health sector, bringing external aid and government funding into one pooled fund and allocating it through a single mechanism. Equitable resource allocation calls for governments to establish annual targets for equitable allocation of these public funds, and to collect information to monitor and report on progress in meeting these targets, including to parliaments and civil society. Resource allocation is a politicised process and requires careful management, including to plan, organise and provide incentives for redistributing health care staff to areas where health need is higher.
Country
East and southern Africa region
Publisher
EQUINET
URL:
Equinet Publication Type
Policy brief
Theme area
Resource allocation and health financing
Title of publication Discussion Paper 53: Private medical pre-payment and insurance schemes in Uganda: What can the proposed SHI policy learn from them?
Date of publication
2007 December
Publication type
Report
Publication details
EQUINET Discussion Paper 53 pp 1-33
Publication status
Published
Language
English
Keywords
Social Health Insurance, SHI, pre-payment schemes, health maintenance organisations, private health insurance, Uganda
Abstract
Over the last two decades there has been growing interest in the potential of social health insurance (SHI) as a health financing mechanism in low and middle-income countries. However, few countries in Africa have implemented SHI. Uganda is currently designing its own SHI scheme, in preparation for its imminent implementation. It is hoped that SHI will bring additional resources for the Ugandan health sector and that its introduction will improve equity in access. Very little was known about the Insurance market in Uganda before this study was undertaken, so one of our main objectives was to provide quantitative and qualitative data that could be used by the Ugandan Ministry of Health as a basis for designing this scheme and for future SHI policy-making.
Country
Uganda
Publisher
EQUINET; Health Economics Unit, University of Cape Town
Equinet Publication Type
Discussion paper
Theme area
Values, policies and rights, Human resources for health
Title of publication International Council of Nurses: Position statement on ethical nurse recruitment
Date of publication
2007
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
international recruitment, health workers, International Council of Nurses, ICN, nurse
Abstract
The ICN condemns the practice of recruiting nurses to countries where authorities have failed to implement sound human resource planning and to seriously address problems which cause nurses to leave the profession and discourage them from returning to nursing. It denounces unethical recruitment practices that exploit nurses or mislead them into accepting job responsibilities and working conditions that are incompatible with their qualifications, skills and experience. It also recognises the benefits of circular migration and calls for mechanisms to support nurses who wish to return to their home countries.
The ICN and its member national nurses associations call for a regulated recruitment process based on ethical principles that guide informed decision-making and reinforce sound employment policies on the part of governments, employers and nurses, thus supporting fair and cost-effective recruitment and retention practices.
Country
Switzerland
Publisher
International Council of Nurses
Theme area
Values, policies and rights, Governance and participation in health
Title of publication Undemocratic, ineffective and inherently weak: The voluntary approach
Date of publication
2002 August
Publication type
Document
Publication details
Publication status
Language
English
Keywords
Earth Summit, Rio, voluntary approach, sustainable development
Abstract
There is a long history of proponents of the voluntary approach justifying it largely by broad but ultimately superficial arguments against regulation. Justification of this sort tends to be heavy on the pejorative descriptions of regulations (command and control, inflexible, blunt, one size fits all), ignores the growing use of economic instruments in combination with regulation and cites a few restricted examples of leading companies being proactive.
The main arguments for the voluntary approach are that it has less impact on business competitiveness; it is quick and cheap for governments and converts companies to achieving long-term goals. All of these arguments are weak and, in some instances, false.
Country
United Kingdom
Publisher
Friends of the Earth
URL:
Theme area
Values, policies and rights, Human resources for health
Title of publication Recruitment and employment of foreign health professionals in the Republic of South Africa
Date of publication
2006 April
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
international recruitment, health workers, health professionals, South Africa
Abstract
The purpose of this document is to regulate the recruitment, employment, migration and support towards residency status of foreign health professionals in the Republic of South Africa.
The recruitment and employment of foreign health professionals in the South African Health Sector is viewed within the context of recruiting suitably qualified persons with proven skills and experience. Preference is given to recruitment from foreign countries where the training and education meet the minimum requirements of training and education of health professionals in South Africa. The candidature of these applicants may be endorsed for registration with a relevant health professional council in the
so-called ‘non-exam’ (fast-track) route, where it may exist. All other applicants will be subjected to formal testing by a relevant health professions council, which may include an examination, written and/or practical, conducted by the relevant professional board / registration authority. The primary aim of the Department to allow for recruitment from abroad is to deploy health professionals with the relevant skills and competencies to work in under-serviced / remote areas of South Africa.
Country
South Africa
Publisher
Government of South Africa, Department of Health
URL:
Theme area
Values, policies and rights, Human resources for health
Title of publication Code of Practice for the International Recruitment of Healthcare Professionals
Date of publication
2004 December
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
international recruitment, health workers, United Kingdom, UK
Abstract
The aim of the Code of Practice is to promote high standards of practice in the international recruitment and employment of healthcare professionals. This is underpinned by the principle that any international recruitment of healthcare professionals should not prejudice the healthcare systems of developing countries. Therefore a key component of the Code of Practice is to preclude the active recruitment of healthcare professionals from developing countries, unless there exists a government-to-government agreement to support recruitment activities. All employers are strongly commended to adhere to this Code of Practice in all matters concerning the international recruitment of healthcare professionals. This Code of Practice
therefore incorporates best practice benchmarks and guidance to employers in order to promote the effective recruitment and support of each individual healthcare professional. Within the sphere of international recruitment there are also many commercial recruitment agencies that make a valuable contribution to meeting the workforce needs of the NHS and
other healthcare providers. Therefore the Code of Practice offers principles and best practice benchmarks to be met in order to supply international healthcare professionals in an ethical
and managed way. Finally, the Code of Practice also acknowledges the reality that the international movement
of healthcare professionals is a long established practice that will continue. This is a sound and legitimate activity if carried out using an ethical and managed approach. Many international healthcare professionals have developed their own individual career pathways and this Code of Practice gives them the reassurance that employment with the NHS, and other healthcare organisations that comply with the Code of Practice, will offer high standards of induction and support in their new career.
Country
United Kingdom
Publisher
Government of United Kingdom, Department of Health
URL:
Theme area
Values, policies and rights, Human resources for health
Title of publication Companion Document to the Commonwealth Code of Practice for the International Recruitment of Health Workers
Date of publication
2003
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
international recruitment, health workers, Commonwealth
Abstract
The Commonwealth Code of Practice for the International Recruitment of Health Workers has been deliberately kept brief to facilitate easy interpretation and implementation. It is supported by this ‘Companion Document’, which provides information on definition of terms used in the Code, which may have different interpretations, and more detailed explanations of concepts.
2. Where possible, examples of activities undertaken by countries to address various elements of international recruitment have been shared. The Companion Document should therefore be used in conjunction with the Code.
3. The Companion Document is set out along the lines of the Code to facilitate the linking of information. The same participatory approach, using the e-working group, was
taken to develop and finalise the Companion Document.
Country
Switzerland
Publisher
Commonwealth
URL:
Theme area
Values, policies and rights, Human resources for health
Title of publication Commonwealth Code of Practice for the International Recruitment of Health Workers
Date of publication
2003
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
international recruitment, health workers, Commonwealth
Abstract
This Code of Practice for the International Recruitment of Health Workers is intended to provide governments with a framework within which international recruitment should take place. The Code is sensitive to the needs of recipient countries and the migratory rights of individual health professionals. The Code does not propose that governments should limit or hinder the freedom of individuals to choose where they wish to live and work. Commonwealth governments may wish to supplement the Code with additional guidance particular to their own national needs and situations.
Country
Switzerland
Publisher
Commonwealth
URL:
Theme area
Human resources for health
Title of publication International Recruitment of Health Workers to the UK: A Report for DFID
Date of publication
2004 February
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
brain drain, human resources, nurse, doctor, emigration, health professional, health worker, United Kingdom, Ghana, Barbados
Abstract
The main objectives of this report are:
• to examine trends in the inflow of health workers to the UK;
• to examine the methods used in the international recruitment of health workers to the UK;
• to report on the Department of Health Code of Practice;
• to provide case studies in the impact of outflow of health workers from developing countries (Ghana and Barbados); and
• to discuss the international policy context of health workers recruitment and migration and identify current knowledge gaps for future research.
Country
United Kingdom
Publisher
DFID Health Systems Resource Centre
URL:
Theme area
Human resources for health
Title of publication International migration of nurses: Trends and policy implications
Date of publication
2005
Publication type
Document
Publication details
The Global Nursing Review Initiative Issue paper 5 pp 1-40
Publication status
Published
Language
English
Keywords
brain drain, human resources, nurse, emigration, recruitment
Abstract
While the issue of international migration of nurses is sometimes presented as a one-way linear "brain drain", the dynamics of international mobility, migration and recruitment are complex, covering individual rights and choice; motivations and attitudes of nurses to career development; the relative status of nurses (and women) in different systems; the differing approaches of country governments to managing, facilitating or attempting to limit outflow or inflow of nurses; and the role of recruitment agencies as intermediaries in the process. This report provides an overview of this dynamic situation.
Country
Switzerland
Publisher
International Council of Nurses
URL:
Theme area
Human resources for health
Title of publication International migration of health workers: Labour and social issues
Date of publication
2003 July
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
brain drain, human resources, nurse, doctor, emigration, health professional, labour, ILO
Abstract
This study provides an overview of existing information on the migration of health workers, with an emphasis on related social and labour issues. It considers trends in migration, the working conditions of migrants, migration policies and recruitment
practices, the impact of international standards and trade agreements on conditions of migrant health workers. The study also outlines policies and practices associated with more
socially acceptable forms of managed migration. It focuses on nurses and doctors, who have been in the forefront of current debate about health worker migration.
The paper demonstrates that governments and employers have a key role in the migration of health workers. In all countries a higher profile for human resource management in the health sector would not only alleviate some of the “push” factors that
encourage migration, but also reduce the shortage of health professionals that underpins increased international recruitment. It is an indictment of governments and employers that they prefer to rely on the relatively straightforward panacea of international recruitment rather than focusing on underlying problems of pay and working conditions. Improvements
in these areas would ensure increased recruitment and retention amongst the existing health sector workforce.
Governments and employers should do more to safeguard and improve the working conditions of migrant health workers by ensuring the ratification and enforcement of ILO Conventions. When state authorities use policies of international recruitment, the detrimental impact on source countries should be minimized by focusing on regulated, managed migration. Professional associations and trade unions also have an important role
in making migrant workers aware of their legal rights, monitoring and documenting abuses, and ensuring that the welfare of migrant workers is seen as a priority by employers and government agencies.
Country
Switzerland
Publisher
International Labour Office
URL:
Theme area
Human resources for health
Title of publication The health workforce in Africa: Challenges and prospects
Date of publication
2006 September
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
brain drain, human resources, nurse, doctor, emigration, health professional, development goals, GATS
Abstract
The report of the Africa Working Group (Joint Learning Initiative) is in 4 main parts covering a situation analysis, opportunities that arise and the preconditions for effective strategies. Part I
discusses the health crisis in Africa and the human resources in health challenges as it tries to meet health objectives. It discusses the causes and underlying factors behind the shortage
of health workers in Africa, and compares the situation with other parts of the world. The effect of other issues, including HIV/AIDS, on the workforce is also analysed in Part I. Part II examines the opportunities that currently exist and how the international community and countries can respond in making human resources in health systems capable of delivering the development goals. This section examines the role of various stakeholders at global, regional and national levels and discusses positive examples of action taken by some countries to counter the crisis. In Part III, the report looks at how Africa could respond to the human resources crisis and examines the policy environment for strategy development and implementation. Future challenges are also discussed including the macroeconomic and social environments that influence the organization of health services. This includes discussions of the World Trade Organization (WTO) and the General Agreement on Trade in Services (GATS) and its effect on the mobility of the health workforce. In Part IV the report ends with recommendations that evolved during the working group’s
deliberations and are aimed at helping countries, regional organizations and international partners and agencies to construct a framework for tackling the challenges instead of simply offering standardised prescriptions.
Country
Publisher
Africa Working Group of the Joint Learning Initiative on Human Resources for Health and Development
URL:
Theme area
Human resources for health
Title of publication New data on African health professionals abroad
Date of publication
2008 January
Publication type
Document
Publication details
Human Resources for Health 6 1 pp 1-24
Publication status
Published
Language
English
Keywords
brain drain, human resources, nurse, doctor, emigration, health professional,
Abstract
The migration of doctors and nurses from Africa to developed countries has raised fears of an African medical brain drain. But empirical research on the causes and effects of the phenomenon has been hampered by a lack of systematic data on the extent of African health workers’ international movements.
Approximately 65,000 African-born physicians and 70,000 African-born professional nurses were working overseas in a developed country in the year 2000. This represents about one fifth of African-born physicians in the world, and about one tenth of African-born professional nurses. The fraction of health professionals abroad varies enormously across African countries, from 1% to over 70% according to the occupation and country.
These numbers are the first standardized, systematic, occupation-specific measure of skilled professionals working in developed countries and born in a large number of developing countries.
Country
Publisher
Human Resources for Health
URL:
Theme area
Poverty and health, Resource allocation and health financing
Title of publication Medicine Price Monitor
Date of publication
2007 April
Publication type
Electronic Source
Publication details
Medicine Price Monitor 2 pp 1-16
Publication status
Published
Language
English
Keywords
medicine, pricing, HEPS
Abstract
In order to understand how prices affect access to medicines in Uganda, the Ministry of Health (MoH) in collaboration with the World Health Organisation (WHO), Health Action International (HAI-Africa) and the Coalition for Health Promotion and Social Development (HEPS-Uganda), under the banner of Uganda Country Working Group, are carrying out quarterly monitoring of medicine prices and availability in all regions of Uganda. The data generated informs policy interventions aimed at improving affordability and accessibility of medicines. The data is also used in assessing and monitoring the impact of current policy interventions.
KEY FINDINGS: OVERALL
1. Availability of the surveyed medicines was highest in Mission facilities and lowest in Public facilities.
2. In the Public Sector, there was no difference in availability of medicines between rural and urban facilities. However, in the Private and Mission sectors, medicines were more readily available in urban facilities.
3. Prices of medicines in the Private Sector facilities were higher than in Mission facilities.
4. Medicines in Private Sector and Mission facilities were unaffordable for the lowest paid Government worker.
Country
Uganda
Publisher
Uganda Country Working Group
URL:
Theme area
Monitoring equity and research to policy
Title of publication Technical efficiency, efficiency change, technical progress and productivity growth in the national health systems of continental African countries
Date of publication
2007
Publication type
Journal Article
Publication details
East African Social Science Research Review 23 2 pp 19-40
Publication status
Language
English
Keywords
Africa, health systems, efficiency index, monitoring efficiency, technology, technical progress
Abstract
In May 2006, the Ministers of Health of all African countries, at a special session of the African Union, undertook to institutionalise efficiency monitoring within their respective national health information management systems. The specific objectives of this study were: (i) to assess the technical efficiency of National Health Systems (NHSs) of African countries for measuring male and female life expectancies, and (ii) to assess changes in health productivity over time with a view to analysing changes in efficiency and changes in technology. The analysis was based on a five-year panel data (1999-2003) from all 53 countries. Data Envelopment Analysis (DEA) − a non-parametric linear programming approach − was employed to assess the technical efficiency. Malmquist Total Factor Productivity (MTFP) was used to analyse efficiency and productivity change over time among the 53 countries' national health systems. The data consisted of two outputs (male and female life expectancies) and two inputs (per capital total health expenditure and adult literacy). All the 53 countries' national health systems registered improvements in total factor productivity, attributable mainly to technical progress. Over half of the countries' national health systems had a pure efficiency index of less than one, signifying that those countries' NHSs pure efficiency contributed negatively to productivity change.
Country
Kenya
Publisher
East African Social Science Research Review
Theme area
Resource allocation and health financing
Title of publication Interim measures for meeting needs for health sector data: Births, deaths, and causes of death
Date of publication
2007 November
Publication type
Journal Article
Publication details
The Lancet 370 9600 pp 1726-1735
Publication status
Published
Language
English
Keywords
civil registration systems, mortality rates, birth rates, data gathering
Abstract
Most developing countries do not have fully effective civil registration systems to provide necessary information about population health. Interim approaches — both innovative strategies for collection of data, and methods of assessment or estimation of these data—to fill the resulting information gaps have been developed and refined over the past four decades. To respond to the needs for data for births, deaths, and causes of death, data collection systems such as population censuses, sample vital registration systems, demographic surveillance sites, and internationally-coordinated sample survey programmes in combination with enhanced methods of assessment and analysis have been successfully implemented to complement civil registration systems. Methods of assessment and analysis of incomplete information or indirect indicators have also been improved, as have approaches to ascertainment of cause of death by verbal autopsy, disease modelling, and other strategies. Our knowledge of demography and descriptive epidemiology of populations in developing countries has been greatly increased by the widespread use of these interim approaches; although gaps remain, particularly for adult mortality.
Country
United Kingdom
Publisher
The Lancet
Theme area
Resource allocation and health financing
Title of publication Public health decision making: The way forward
Date of publication
2007 November
Publication type
Journal Article
Publication details
The Lancet 370 9601 pp 1719-1799
Publication status
Published
Language
English
Keywords
capacity building, public health systems, morbidity rates, birth rates,civil registration systems
Abstract
Good public-health decision making is dependent on reliable and timely statistics on births and deaths (including the medical causes of death). All high-income countries, without exception, have national civil registration systems that record these events and generate regular, frequent, and timely vital statistics. By contrast, these statistics are not available in many low-income and lower-middle-income countries, even though it is in such settings that premature mortality is most severe and the need for robust evidence to back decision making most critical. Civil registration also has a range of benefits for individuals in terms of legal status, and the protection of economic, social, and human rights.
However, over the past 30 years, the global health and development community has failed to provide the needed technical and financial support to countries to develop civil registration systems. There is no single blueprint for establishing and maintaining such systems and ensuring the availability of sound vital statistics. Each country faces a different set of challenges, and strategies must be tailored accordingly. There are steps that can be taken, however, and we propose an approach that couples the application of methods to generate better vital statistics in the short term with capacity building for comprehensive civil registration systems in the long run.
Country
United Kingdom
Publisher
The Lancet
Theme area
Equity and HIV/AIDS
Title of publication Tanzania national HIV/Aids policy
Date of publication
2001
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
HIV/Aids, Tanzania, government policy, national policy
Abstract
The overall goal of the National Policy on HIV/AIDS is to provide for a framework for leadership and coordination of the National multisectoral response to the HIV/AIDS epidemic. This includes formulation, by all sectors, of appropriate interventions which will be effective in preventing transmission of HIV/AIDS and other sexually transmitted infections, protecting and supporting vulnerable groups, mitigating the social and economic impact of HIV/AIDS. It also provides for the framework for strengthening the capacity of institutions, communities and individuals in all sectors to arrest the spread of the epidemic.
Country
Tanzania
Publisher
Government of Tanzania
Theme area
Equity and HIV/AIDS
Title of publication Reviewing ‘emergencies’ for Swaziland: Shifting the paradigm in a new era
Date of publication
2007
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
HIV/Aids, Swaziland, life expectancy, living standards, holistic
Abstract
The HIV/Aids situation in Swaziland has deteriorated since the beginning of the 1990s. While the disease is not solely to blame for the reduction in living standards and life expectancy, it has compounded the effects of other events such as drought and falling foreign direct investment (FDI). Swazi society is in distress - overwhelming sickness, an increasing dependency ratio and thousands of OVC are placing households and communities under extreme duress. In Swaziland, HIV/Aids is creating a chronic emergency that is permanently altering development. This demonstrates a ‘new’ disaster that exceeds emergency thresholds and requires a new style of holistic response.
While the traditional threshold approach to identifying emergencies remains useful for classifying ‘traditional’ disasters, a new framework of analysis is needed for HIV/Aids. This could take the form of an index system or a series of thresholds. Within this it is crucial that the indicators measured are considered over time, with a sustained fall being the prime indication of an emergency. The element of ‘time’ has been missing from the debate surrounding humanitarian response.
Country
South Africa
Publisher
National Emergency Response Council On HIV/AIDS (NERCHA), Health Economics & HIV/AIDS Research Division (HEARD)
Theme area
Equity and HIV/AIDS
Title of publication Twentieth meeting of the UNAIDS Programme Coordinating Board: Report of the Global Task Team’s independent assessment
Date of publication
2007 May
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
Global Task Team, HIV/Aids, UNAIDS, UN
Abstract
This report from UNAIDS assesses the implementation of the Global Task Team (GTT) recommendations in two key areas: technical support provision to the national AIDS response as brokered by the UN system; and harmonisation and alignment of international partners. In the area of technical support, the report concludes that the UN has made significant progress in establishing joint teams on AIDS and recognises that they are beginning to enable the UN to speak and act as 'one' on HIV/Aids issues. However differences in commitment to joint working and in skills and capacity between agencies combined with high work loads are putting pressures on these teams. The harmonisation and alignment agenda needs strong leadership from headquarters about the importance of joint working.
Country
Switzerland
Publisher
Joint United Nations Programme On HIV/Aids
Theme area
Equity and HIV/AIDS
Title of publication Report and policy brief from the 4th Africa Conference on Social Aspects of HIV/Aids Research: Innovations in access to prevention, treatment and care in HIV/Aids, Kisumu, Kenya, 29 April - 3 May 2007
Date of publication
2007
Publication type
Report
Publication details
SAHARA Journal (Journal of Social Aspects of HIV/AIDS Research Alliance) 4 2 pp 640-651
Publication status
Published
Language
English
Keywords
HIV/Aids policy, HIV prevention, HIV treatment, Aids orphans
Abstract
This report and policy brief summarises the key findings and suggested policy options that emerged from rapporteur reports of conference proceedings including the following themes: (1) Orphans and vulnerable children, (2) Treatment, (3) Prevention, (4) Gender and male involvement, (5) Male circumcision, (6) People living with HIV and AIDS, (7) Food and nutrition, (8) Socioeconomics, and (9) Politics/policy. Policy frameworks which are likely to succeed in combating HIV and AIDS need to be updated to cover issues of access, testing, disclosure and stigma.
Country
South Africa
Publisher
SAHARA Journal
Theme area
Equity and HIV/AIDS
Title of publication Experiences of orphan care in Amach, Uganda: Assessing policy implications
Date of publication
2007
Publication type
Electronic Source
Publication details
SAHARA Journal (Journal of Social Aspects of HIV/AIDS Research Alliance) 4 1 pp 532-543
Publication status
Published
Language
English
Keywords
Aids orphans, Uganda, orphan care, discrimination, Langi, Amach, Lira District
Abstract
This paper presents findings from a study on the experiences of orphan care among Langi people of Amach sub-county in Lira District, northern Uganda, and discusses their policy implications.The findings revealed that the Langi people have an inherently problematic orphan concept, which contribute toward discriminatory attitudes and practices against orphans.The clan-based decision-making to care for orphans, the category of kin a particular orphan ends up living with, the sex and age of the orphan, as well as the cessation of the ‘widow-inheritance' custom emerged as prominent factors that impact on orphan care. Thus there is the need to draw upon such local knowledge in policy-making and intervention planning for orphans.
Country
South Africa
Publisher
SAHARA Journal
Theme area
Equity and HIV/AIDS
Title of publication Examining the actions of faith-based organisations and their influence on HIV/Aids-related stigma: A case study of Uganda
Date of publication
2007
Publication type
Electronic Source
Publication details
African Health Sciences 7 1 pp 55-60
Publication status
Published
Language
English
Keywords
HIV/Aids, faith-based organizations, religion, stigma, discrimination, vulnerability, Uganda
Abstract
This study aimed to explore perceptions of Uganda-based key decision-makers about the past, present and optimal future roles of FBOs in HIV/Aids work, including actions to promote or dissuade stigma and discrimination. Uganda's program continues to face challenges, including perceptions among the general population that HIV/Aids is a cause for secrecy. By virtue of their networks and influence, respondents believe that FBOs are well-positioned to contribute to breaking the silence about HIV/Aids, which undermines prevention, care and treatment efforts.
Country
Uganda
Publisher
African Health Sciences
Theme area
Equity and HIV/AIDS
Title of publication Equity in access to ARV drugs in Malawi
Date of publication
2007
Publication type
Electronic Source
Publication details
SAHARA Journal (Journal of Social Aspects of HIV/AIDS Research Alliance) 4 1 pp 564-574
Publication status
Published
Language
English
Keywords
anti-retrovirals, ARVs, Malawi, equity, access to drugs
Abstract
This paper discusses the issue of equity in the distribution of ARV drugs in the Malawi health system. Malawi is one of the countries most severely affected by HIV/AIDS in southern Africa. It is also one of the poorest countries in the world.ARV drugs are expensive.The Malawi government, with assistance from the Global Fund on Tuberculosis, Malaria and HIV/AIDS, started providing free ARV drugs to eligible HIV-infected people in September 2004.The provision of free drugs brought the hope that everyone who was eligible would access them. Based on data collected through a qualitative research methodology, it was found that achieving equity in provision would face several challenges including policy, operational and socio-economic considerations. Specifically, the existing policy framework, shortage of medical personnel, access to information and inadequacy of effective community support groups are some of the key issues affecting equity.
Country
Publisher
SAHARA Journal
Theme area
Equity and HIV/AIDS
Title of publication Epidemic update: Global HIV prevalence levels off, still leading cause of death globally
Date of publication
2007 November
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
HIV epidemic, HIV statistics, HIV prevalence, new infections
Abstract
The new epidemic update reflects improved and expanded epidemiological data and analyses that present a better understanding of the global epidemic. These new data and advances in methodology have resulted in substantial revisions from previous estimates. While the global prevalence of HIV infection — the percentage of people infected with HIV — has levelled off, the total number of people living with HIV is increasing because of ongoing HIV infections, combined with longer survival times, in a continuously growing general population. Global HIV incidence — the number of new HIV infections per year — is now estimated to have peaked in the late 1990s at over 3 million [2.4 – 5.1 million] new infections per year, and is estimated in 2007 to be 2.5 million [1.8 – 4.1 million] new infections, an average of more than 6,800 new infections each day. This reflects natural trends in the epidemic, as well as the results of HIV prevention efforts.
Country
Switzerland
Publisher
UNAIDS; WHO
Theme area
Equity and HIV/AIDS
Title of publication Barriers to prevention of HIV transmission from mother to child (PMTCT) in a resource-poor setting in the Eastern Cape, South Africa
Date of publication
2007 April
Publication type
Electronic Source
Publication details
African Journal of Reproductive Health 11 1 pp 57-66
Publication status
Published
Language
English
Keywords
prevention of mother to child HIV transmission, PMTCT, HIV counselling, HIV testing, pregnant women, antenatal care, mid-wives
Abstract
The aim of this study was to investigate knowledge of prevention of mother to child HIV transmission (PMTCT) programmes and to describe potential barriers that might affect their acceptability in a resource-poor setting in South Africa. Based on interviews with over 1,500 pregnant women, their families and five communities around the PMTCT clinic areas, the authors found that there are several major potential barriers in implementing PMTCT programmes in a resource poor setting. The authors suggest that increased access to HIV testing and counselling would be one of the most effective ways of reducing perinatal transmission. They state that this can be achieved by ensuring that expectant mothers receive antenatal care from trained staff throughout their pregnancy and have a skilled professional childbirth attendant.
Country
Publisher
African Journal of Reproductive Health
Theme area
Resource allocation and health financing
Title of publication Following the funding for HIV/Aids: A comparative analysis of the funding practices of PEPFAR, the Global Fund and World Bank MAP in Mozambique, Uganda and Zambia
Date of publication
2007 October
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
donors, funding, Aids, aid, Mozambique, Uganda, Zambia, aid programmes, aid policies
Abstract
Donor funding for HIV/Aids has skyrocketed in the last decade from US$300 million in 1996 to US$8.9 billion in 2006; yet, little is understood about how these resources are being spent. This paper analyses the policies and practices of the world’s largest Aids donors as they are applied in Mozambique, Uganda and Zambia. The report offers a number of recommendations for how donors can improve their programmes to increase the effectiveness of aid. Recommendations for all three donors include: jointly coordinate and plan activities to support the National Aids Plan, assist the government in tracking total national Aids funds, focus on building and measuring capacity, and develop strategies with host governments and other donors to ensure financial sustainability.
Country
United States
Publisher
Center for Global Development
Theme area
Public-private mix
Title of publication The viability of local pharmaceutical production in Tanzania
Date of publication
2007
Publication type
Academic paper
Publication details
Publication status
Published
Language
English
Keywords
patents, Tanzania, anti-retroviral therapy, ART, TRIPS, pharmaceutical industry
Abstract
This study analyses the economic potential of pharmaceutical production of anti-retroviral drugs (ARVs) in Tanzania. It includes an analysis of the pharmaceutical sector in the country and the potential to export ARVs to the region. The study shows that production of pharmaceutical products in Tanzania is on the rise and can become viable in the long term. Even though the overall drug market is rather small, public health-related drugs have a significant, largely donor-based, market.
Country
Germany
Publisher
Deutsche Gessellschaft Fur Technische Zusammenarbeit
Theme area
Public-private mix
Title of publication Household storage of pharmaceuticals, sources and dispensing practices in drug stores and ordinary retail shops in rural areas of Kibaha district, Tanzania
Date of publication
2006
Publication type
Journal Article
Publication details
The East and Central African Journal of Pharmaceutical Sciences 9 3 pp 74-80
Publication status
Language
English
Keywords
Tanzania, drug poisoning, drug resistance, anti-malaria drugs, anti-malarial drugs
Abstract
A cross-sectional study was conducted in rural areas of Kibaha district within the Coastal region of Tanzania to assess knowledge on dosage, storage, expiry and dispensing practices of anti-malarial drugs among households, drug stores and ordinary shops. The majority of drug store (53%) and ordinary retail shop (75%) sellers did not dispense correct doses of anti-malarials due to low literacy and lack of dosage guidelines or package inserts. In order to reduce incidences of drug poisoning due to over-dosage or drug resistance due to under-dosage, there is need to educate both consumers and dispensers on correct dosage regimens through mass media such as radio, health education programmes, television, posters, leaflets and newspapers.
Country
Kenya
Publisher
The East and Central African Journal of Pharmaceutical Sciences
Theme area
Public-private mix
Title of publication A survey of prescribing practices of health care workers in Kibaha district in Tanzania
Date of publication
2007
Publication type
Journal Article
Publication details
Tanzania Medical Journal 22 1 pp 31-33
Publication status
Published
Language
English
Keywords
dispensaries, prescriptions, Tanzania, over-prescribing, antibiotics, injections
Abstract
Previous studies in the public sector in Tanzania have demonstrated major prescribing problems due to poly-pharmacy and irrational use of antibiotics and injections. Little is understood about prescribing in the private sector. This paper measures and compares prescribing practices in public and private dispensaries in Kibaha District, Tanzania. Prescribing of antibiotic and injections was significantly higher in private than in public dispensaries (P<0.05). The extent of prescribing in private dispensaries calls for intervention to reduce overuse of antibiotics and injections.
Country
Tanzania
Publisher
Tanzania Medical Journal
Theme area
Human resources for health
Title of publication Teachers' and students' perceptions of the learning environment in clinical departments at the School of Medicine, Muhimbili University College of Health Sciences
Date of publication
2007
Publication type
Journal Article
Publication details
Tanzania Medical Journal 22 1 pp 9-11
Publication status
Published
Language
English
Keywords
health worker training, staff training, learning environment, Tanzania
Abstract
The School of Medicine at Muhimbili is the main doctor-training institution in the country. It runs a five-year MD programme taking 200 students annually. As for many schools in low-income countries, the majority of teachers have no formal training in educational theory. The learning environment at the school has some strengths that should to be amplified, and numerous weaknesses that need to be corrected in order to make the environment more conducive to teaching and learning.
The objective of the paper is to describe the physical and psychosocial learning environment from teachers' and students' perspectives, describe the perceptions of teachers and students of each other, and propose ways of improving the learning environment.
Country
Publisher
Tanzania Medical Journal
Theme area
Values, policies and rights
Title of publication South Africa: The national infection, prevention and control policy for TB, MDRTB and XDRTB
Date of publication
2007
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
South Africa, TB, health workers, workplace safety, prisons
Abstract
The goal of this policy is to help management and staff minimise the risk of TB transmission in health care facilities and other facilities, where the risk of transmission of TB may be high due to high prevalence of both diagnosed and undiagnosed TB, such as prisons.
Country
South Africa
Publisher
Government of South Africa, Department of Health
Theme area
Values, policies and rights
Title of publication South Africa: The national infection prevention and control policy and strategy
Date of publication
2007 April
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
global patient safety, infectious diseases, drug resistance
Abstract
In the quest to improve the safety of health services and align itself with the international challenges set by the World Health Organisation Global Patient Safety drive, the South African government has developed a National Infection Prevention Strategy and Control Policy and accompanying strategy and presented these to all health care personnel in the country.
Many countries across the world are currently grappling with making health care safer for patients through carefully designed systems and methods of care that reduce risks to patients. This need to redesign and strengthen existing systems and implement evidence-based methods has been fanned by the sudden emergence and re-emergence of infectious diseases as well as the gradual development of drug resistance. These threats make it
that more important that health care associated infections acquired in health facilities are prevented or effectively controlled when it does occur. In South Africa these threats have the proven ability to undermine the significant health care advances that the country has made in the past decade.
Country
South Africa
Publisher
Government of South Africa, Department of Health
Theme area
Poverty and health
Title of publication Primary school children's perspectives on common diseases and medicines used: Implications for school healthcare programmes and priority setting in Uganda
Date of publication
2007
Publication type
Document
Publication details
African Health Sciences 7 2 pp 73-79
Publication status
Published
Language
English
Keywords
school health, school health programmes, Uganda, childhood diseases, children's diseases
Abstract
Existing school health programmes in Uganda target children above five years for de-worming, oral hygiene and frequent vaccination of girls of reproductive age. This study assessed primary school children's perspectives on common diseases they experience and medicines used in order to suggest reforms for school healthcare programmes and priority setting. Children named and ranked malaria as the most severe and frequently experienced disease. Other diseases mentioned included diarrhoea, skin fungal infections, flu, and typhoid.The symptoms children recognised in case of illness were high body temperature, vomiting, headache, weakness, appetite loss and diarrhoea. Children were either given medicines by the school nurse or they self-medicated using pharmaceuticals including chloroquine, panadol, flagyl, fansidar, quinine injections, capsules (amoxicillin and ampicillin) obtained from the clinics, drug shops, pharmacies,and other unspecified indigenous medicines from their home and markets.
Country
Uganda
Publisher
African Health Sciences
Theme area
Poverty and health, Governance and participation in health
Title of publication National guidelines for diagnosis, treatment and prevention of malaria for health workers in Kenya
Date of publication
2006 January
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
Kenya, combination therapy, artemesinin, uncomplicated malaria, severe malaria, pregnancy, prevention
Abstract
Based on scientific information and WHO recommendations of changing to combination therapy, the Ministry of Health has adopted the use of Artemesinin based Combination Therapy (ACT) as first-line treatment of uncomplicated malaria. There is therefore need to implement a new anti-malarial treatment policy using ACTs. The Ministry of Health has developed these guidelines for malaria diagnosis, treatment and prevention with an aim of improving malaria case management by health workers and having a harmonized approach in efforts aimed at the reduction of morbidity and mortality due to malaria.
Country
Kenya
Publisher
Government Of Kenya, Ministry Of Health
Theme area
Poverty and health, Governance and participation in health
Title of publication Developing a nutrition and health education program for primary schools in Zambia
Date of publication
2007 November
Publication type
Electronic Source
Publication details
Journal Of Nutrition Education And Behavior 39 6 pp 335-342
Publication status
Published
Language
English
Keywords
school feeding, nutrition intervention, school children, Zambia Nutrition Education in Basic Schools, NEBS
Abstract
School-based health and nutrition interventions in developing countries aim at improving children’s nutrition and learning ability. In addition to the food and health inputs, children need access to education that is relevant to their lives, of good quality, and effective in its approach. Based on evidence from the Zambia Nutrition Education in Basic Schools (NEBS) project, this article examines whether and to what extent school-based health and nutrition education can contribute directly to improving the health and nutrition behaviors of school children. Initial results suggest that gains in awareness, knowledge and behavior can be achieved among children and their families with an actively implemented classroom program backed by teacher training and parent involvement, even in the absence of school-based nutrition and health services.
Country
United States
Publisher
Journal Of Nutrition Education And Behavior
Theme area
Health equity in economic and trade policies, Equity and HIV/AIDS
Title of publication The macroeconomic framework and the fight against HIV and AIDS in Africa
Date of publication
2007
Publication type
Publication details
AFRODAD policy brief 3 pp 1-6
Publication status
Published
Language
English
Keywords
macro-eceonomics, financial assistance, budget ceilings, IMF, trade policy, fiscal policy
Abstract
In recent years, there have been increasing concerns about macroeconomic policy constraints interfering with the ability of many African governments to increase health sector spending and getting access to urgently needed funds for HIV/AIDS human resource development. The International Financial Institutions (IFIs) and, in particular, the IMF have been accused of undermining health care systems in many developing countries through conditionalities that favour budgetary ceilings as a panacea for macroeconomic stability. The economic policies sometimes affect overall spending, resulting in caps on the health sector, salary and recruitment of health workers and the acceptance of large amounts of financial assistance. AFRODAD has conducted a two country study aimed at looking at the links between macroeconomic frameworks provided by the International Financial Institutions (IFIs) and the social spending, and in particular, the fight against HIV/AIDS in Ghana and Malawi. This study reviewed the major channels through which fiscal and monetary policies impact on public expenditure frameworks and how this, in turn, affects the ability of the countries under study to design and implement public programmes concerning those living with and affected by HIV/AIDS and assessing the debt positions of the case studies to see how the HIV/AIDS has impacted on their financial portfolios and planning abilities or vice-versa.
Country
Zimbabwe
Publisher
The African Forum And Network On Debt And Development
Theme area
Values, policies and rights, Resource allocation and health financing, Governance and participation in health
Title of publication Malawi Essential Health Package
Date of publication
2007
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
proposal, primary health care
Abstract
This report presents a draft of the proposed Essential Heath Package (EHP) and its costing for Malawi. It is intended to stimulate comment and debate, and to move the process to a final stage whereby the contents can be incorporated into a broader implementation plan for the Ministry of Health and Population (MOHP) and partners. By MOHP, we mean the various departments at headquarters, the technical programmes, and the districts who will ultimately deliver the EHP services.
Country
Malawi
Publisher
Department of Health, Government of Malawi
Theme area
Equity in health, Values, policies and rights
Title of publication London Declaration on Cancer Control in Africa
Date of publication
2007 May
Publication type
Report
Publication details
Publication status
Published
Language
Keywords
Abstract
The London Declaration on Cancer Control in Africa is a programme of action for cancer therapy in Africa. The purpose of this declaration is to raise awareness of the magnitude of the cancer burden in Africa and to call for immediate action to bring comprehensive care to African countries. The establishment of cancer care programmes in African countries requires the integration of clinical and public health systems. A comprehensive cancer control strategy must bring together prevention, early detection and diagnosis, treatment and palliative care. More investment is needed to deliver these services in terms of trained staff, equipment, relevant drugs and information systems, as well as public education.
Country
Publisher
Theme area
Poverty and health, Governance and participation in health
Title of publication Is Malaria Eradication Possible?
Date of publication
2007 November
Publication type
Journal Article
Publication details
The Lancet 370 9597 pp 1543-1551
Publication status
Published
Language
English
Keywords
Mozambique, RTS,S/AS02D, malaria vaccine
Abstract
Malaria remains a leading global health problem that requires the improved use of existing interventions and the accelerated development of new control methods. In this editorial we reflect on the possibility of eradicating malaria in infants in Africa with the introduction of the malaria vaccine RTS,S/AS02D.
Country
United Kingdom
Publisher
The Lancet
Theme area
Equitable health services, Equity and HIV/AIDS
Title of publication HIV-TB Co-infection: Meeting the Challenge
Date of publication
2007 July
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
HIV strategies, TB strategies, disease treatment programmes, drug-resistant TB
Abstract
Ten per cent of individuals infected with TB develop the active disease but this is greatly increased in those whose immune systems have been weakened by HIV. This report highlights the difficulty in managing the co-epidemic of HIV and TB and identifies priority areas in need of further research: better population-based data on the incidence of drug-resistant TB is required, increased laboratory capacity is needed to make the currently difficult diagnosis of co-infection of HIV-TB accessible to a larger proportion of Africans, more child-specific research is needed especially on paediatric drug formulations. The low uptake of drugs that treat co-infection remains a real problem, with concerns over drug efficacy and the creation of drug resistant strains of TB cited as the main reasons. The report concludes that strategies for dealing with TB and HIV currently exist in isolation, often reinforced by vertical programme financing. Efforts must be made to integrate these disease treatment programmes which will involve stakeholders working together within an evidence based collaborative framework.
Country
United States
Publisher
Forum For Collaborative HIV Research
Theme area
Values, policies and rights
Title of publication Controlling Cancer in Developing Countries: Prevention and Treatment Strategies Merit Further Study
Date of publication
2007 April
Publication type
Electronic Source
Publication details
Publication status
Published
Language
English
Keywords
cancer, developing world, health policy, cancer control, cancer research
Abstract
This paper discusses the burden of cancer in developing countries and examines which types of cancers can be prevented and treated affordably in low-resource settings and which interventions can be used to control them. The paper concludes that to guide policymakers on the most effective cancer control strategies in developing countries, more work is needed in: clinical evaluations of cancer control interventions, health services research, and country specific economic evaluations. It recommends that since current knowledge about cancer control is incomplete, developing countries should start in small areas and gain knowledge from well-documented pilot programmes. Starting small might entail focusing on individuals with certain high-risk characteristics or in a limited geographic area, and scaling up should occur only after pilot programmes have been shown to perform well.
Country
United States
Publisher
Disease Control Priorities Project
Theme area
Equity in health, Poverty and health, Equitable health services
Title of publication Challenges Facing Community Home-based Care Programmes in Botswana
Date of publication
2007
Publication type
Journal Article
Publication details
East African Social Science Research Review 2 23 pp 1-18
Publication status
Published
Language
English
Keywords
CHBC, home-based care, Botswana, HIV, AIDS, terminal illness
Abstract
This study examines the role of Community Home-Based Care in Botswana for people with HIV/AIDS and those with other terminal illnesses. Kerkhoven and Jackson (1995) attribute the popularity of Community Home-Based Care (CHBC) programmes in the developing countries to high rates of HIV/AIDS. Botswana has adult HIV/AIDS prevalence rate of 37 per cent and over 350,000 people living with HIV/AIDS. Rapid rise in incidences of HIV/AIDS has hence resulted in increasing need for CHBC and thus many CHBC services have been established through disorganized and fragmented manners. This paper is an extended literature review. It identifies and discusses challenges facing CHBC programmes in Botswana. The findings indicate that poverty, high cost of community care, inadequate medical facilities, poor infrastructures and socio-cultural issues have threatened the sustainability of CHBC programmes in Botswana. Recommendations and policy options are discussed.
Country
Publisher
East African Social Science Research Review
Theme area
Poverty and health, Governance and participation in health
Title of publication Developing a Nutrition and Health Education Program for Primary Schools in Zambia
Date of publication
2007 November
Publication type
Journal Article
Publication details
Journal Of Nutrition Education And Behavior 6 39 pp 335-342
Publication status
Published
Language
English
Keywords
nutrition and health education; behaviour change; basic schools; Zambia; curriculum development; learner-centred
Abstract
School-based health and nutrition interventions in developing countries aim at improving children’s nutrition and learning ability. In addition to the food and health inputs, children need access to education that is relevant to their lives, of good quality, and effective in its approach. Based on evidence from the Zambia Nutrition Education in Basic Schools (NEBS) project, this article examines whether and to what extent school-based health and nutrition education can contribute directly to improving the health and nutrition behaviors of school children. Initial results suggest that gains in awareness, knowledge and behavior can be achieved among children and their families with an actively implemented classroom program backed by teacher training and parent involvement, even in the absence of school-based nutrition and health services.
Country
United Kingdom
Publisher
Journal Of Nutrition Education And Behavior
Theme area
Health equity in economic and trade policies, Equity and HIV/AIDS
Title of publication Policy Brief 3: The Macro-economic Framework and the Fight Against HIV and AIDS in Africa: The Cases of Ghana and Malawi
Date of publication
2007
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
Ghana, Malawi, HIV, AIDS, health budget, public health finances, monetary policies, fiscal policies
Abstract
In recent years, there have been increasing concerns about macroeconomic policy constraints interfering with the ability of many African governments to increase health sector spending and getting access to urgently needed funds for HIV/AIDS human resource development. The International Financial Institutions (IFIs) and, in particular, the IMF have been accused of undermining health care systems in many developing countries through conditionalities that favour budgetary ceilings as a panacea for macroeconomic stability. The economic policies sometimes affect overall spending, resulting in caps on the health sector, salary and recruitment of health workers and the acceptance of large amounts of financial assistance. AFRODAD has conducted a two country study aimed at looking at the links between macroeconomic frameworks provided by the International Financial Institutions (IFIs) and the social spending, and in particular, the fight against HIV/AIDS in Ghana and Malawi. This study reviewed the major channels through which fiscal and monetary policies impact on public expenditure frameworks and how this, in turn, affects the ability of the countries under study to design and implement public programmes concerning those living with and affected by HIV/AIDS and assessing the debt positions of the case studies to see how the HIV/AIDS has impacted on their financial portfolios and planning abilities or vice-versa.
Country
Zimbabwe
Publisher
The African Forum And Network On Debt And Development
Theme area
Values, policies and rights, Monitoring equity and research to policy
Title of publication Some Intellectual Property Issues Related to H5N1 Influenza Viruses, Research and Vaccines
Date of publication
2007 July
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
flu vaccine, influenza vaccine, patents, intellectual property
Abstract
A dramatic rise in international patent applications related to influenza is underway. This includes patent applications covering the virus itself, vaccines, treatments, and diagnostics. As recently as 1993, years passed with little or no such patent activity. In 2006, however, more than 30 international (Patent Cooperation Treaty) patent applications were filed on influenza vaccines alone, making it the largest year on record - but not for long. World Intellectual Property Organization (WIPO) data indicates that during the first half of 2007 as many influenza vaccine patent claims have been filed as in the entirety of 2006, meaning that this year is on track to at least double the record set in 2006. Together, these developments are resulting in a much more complex and limiting field of intellectual property claims than has ever before existed for influenza vaccine. And it is going to get worse.
Country
Malaysia
Publisher
Third World Network
Theme area
Values, policies and rights
Title of publication South Africa: Health Strategic Plan 2007/08 - 2009/10
Date of publication
2007 March
Publication type
Document
Publication details
Publication status
Language
English
Keywords
South Africa, health strategy, strategic plan, national health report
Abstract
This document describes the priorities for the National Health Department in the periods 2007/08 - 2009/10.
Country
South Africa
Publisher
Department Of Health, Government of South Africa
Theme area
Values, policies and rights, Equitable health services
Title of publication Policy on Quality Health Care for South Africa
Date of publication
2007 April
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
South Africa, quality health care, health strategy, government policy, health policy
Abstract
This abbreviated version of the Policy on Quality in Health Care for South Africa follows on the original that became national policy in 2001. It comes at a time when the public health care system is in dire need of again refocusing its collective efforts towards improving the quality of care provided in public health facilities and communities. Knowing that quality is never an accident, always the result of high intention, sincere effort, intelligent direction and skilful execution, and that it represents the wise choice of many alternatives, this abbreviated version attempts to provide to all public health officials in a nutshell and in a more reader friendly language, the strategic direction health facilities and officials need to follow to assure quality in health care and continuous improvement in the care that is being provided. Health care personnel are encouraged to use this copy of the Policy to focus their intentions and guide their efforts.
Country
South Africa
Publisher
Department Of Health, Government of South Africa
Theme area
Health equity in economic and trade policies
Title of publication EPA Interim Agreement - A Dangerous Trojan Horse!
Date of publication
2007 November
Publication type
Electronic Source
Publication details
Publication status
Published
Language
English
Keywords
EPA, EPA interim agreement, free trade agreement, Cotonou preferences
Abstract
The Southern African civil society organisations campaigning on the Economic Partnership Agreements (EPAs), met in Gaborone, Botswana, from 20-22 November 2007, to review the EPA negotiations. This is a statement compiled by these organisations to re-affirm their opposition to these self-serving Free Trade Agreements that the European Union (EU) seeks to impose on African, Caribbean and Pacific (ACP) countries. The respective civil society organisations condemned the interim arrangement put in place to address market access to the EU at the expiration of the Cotonou preferences on December 31, and describe the treacherous framework as designed for bulldozing Africa into signing a comprehensive EPA/FTA.
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Briefs
Theme area
Health equity in economic and trade policies
Title of publication ACP Ministers Clarify Their EPA Principles and Options
Date of publication
2007 November
Publication type
Electronic Source
Publication details
Publication status
Published
Language
English
Keywords
economic partnership agreements, EPA, ACP, trade, European Community
Abstract
The Ministers of the African, Caribbean and Pacific (ACP) group of countries have issued their most comprehensive policy statement on the Economic Partnership Agreements (EPAs) at the end of a meeting they held in Brussels on 8-9 November. From the "Conclusions of the meeting" that they issued, it is clear that the Ministers recognised that the six ACP regional groupings are at different stages of negotiations with the European Commission on their respective EPAs, and that there are also differences between the regions on the issues that the EPAs would cover and on whether or not the negotiations will end by the official 31 December deadline. The Ministers welcomed the results obtained and stressed the need to do everything possible to ensure that the list submitted by the ACP Group regarding the preference erosion is rationalised to render it more credible.
Country
Publisher
Theme area
Health equity in economic and trade policies
Title of publication Access to Medicines Divides Rich and Poor at WHO
Date of publication
2007 November
Publication type
Electronic Source
Publication details
Publication status
Published
Language
English
Keywords
intellectual property rights, drug patents, patent pool, TRIPS, neglected diseases
Abstract
Two proposals to change the current patent system are causing a new diplomatic battle at the World Health Organisation in November. One concerns the launch of new medicines and the other seeks to make existing drugs available at low prices in developing countries. A coalition of developing countries, amongst them Brazil, and non-governmental organisations are defending a “patent pool” to combine intellectual property rights on existing medicines, and a “prize fund” to reward and stimulate discovery of new medicines for so-called neglected diseases. The two initiatives are receiving strong opposition from some rich countries and the pharmaceutical industry. They have also caused a split between the two major Latin American countries. Mexico is moving away from Brazil’s position and is making an alliance with the US, alleging that it has commitments in the trade agreement with Washington.
Country
Publisher
Theme area
Health equity in economic and trade policies
Title of publication Governments (Still) Pondering How to Make Drugs Accessible
Date of publication
2007 October
Publication type
Electronic Source
Publication details
Publication status
Published
Language
English
Keywords
anti-retrovirals, generic drugs, patents, TRIPS, patent pool system
Abstract
The struggle to make medicines affordable to the world’s poor, especially in Africa, is raging on at the highest levels. Last week the European Commission took a landmark decision on generic drugs and next week a high-level intergovernmental meeting will look at ways to prevent patents from blocking access to drugs.
Country
Publisher
IPS News
Theme area
Equity in health
Title of publication Squaring the Circle: Aids, Poverty and Human Development
Date of publication
2007 October
Publication type
Journal Article
Publication details
PloS Medicine 4 10
Publication status
Published
Language
English
Keywords
AIDS treatment, HIV prevention, poverty, inequality, socio-economic development
Abstract
The relationship between AIDS and poverty has more to do with inequality than poverty per se. The relationship between socioeconomic status and HIV varies considerably from country to country, reflecting differences in culture and traditions. Effective actions to tackle AIDS must directly address these specific factors—the inequalities—that drive HIV transmission in different contexts, and must overcome the obstacles to accessing treatment in different groups. It is crucial to place AIDS squarely at the centre of all socio-economic development, and provide long-term, high-level domestic and international investment in HIV prevention and treatment in the world's poorest countries.
Country
United States
Publisher
Public Library of Science
Theme area
Health equity in economic and trade policies
Title of publication Policy brief 18: Trade and health in east and southern Africa
Date of publication
2007 December
Publication type
Document
Publication details
EQUINET Policy brief 18 pp 1-4
Publication status
Published
Language
English
Keywords
trade liberalisation; privatisation; commercialisation; health equity; GATS commitments; east and southern Africa
Abstract
The growth of international trade has significant consequences for public health. The relationship between trade and health is not simple, nor is it unidirectional. In this brief we raise why trade issues need to be understood and managed to promote health and we highlight the main concerns arising from free trade agreements for public health. We draw attention to measures that governments and civil society in the region can take to achieve greater coherence between trade and health policies, so that international trade and trade rules maximize health benefits and minimize health risks, especially for poor and vulnerable populations.
Country
East and southern Africa region
Publisher
EQUINET
URL:
Equinet Publication Type
Policy brief
Theme area
Governance and participation in health
Title of publication Civil society promotion of equity and the social determinants of health through involvement in the governance of health systems: the case of the Community Working Group on Health in Zimbabwe
Date of publication
2007 March
Publication type
Report
Publication details
Case study commissioned by the Health Systems Knowledge Network of the WHO Commission on the Social Determinants of Health pp 1-14
Publication status
Published
Language
English
Keywords
Zimbabwe, civil society, participation, CWGH
Abstract
Stakeholders who formed the CWGH realised that priority health
programmes varied widely across different areas and decided to take CWGH down to different districts for locals to drive its programmes and set its agenda. The CWGH members also invited the associations of health professionals and representatives of
government, churches, the private sector, Non Governmental
Organisations and traditional health providers in a meeting in order
to identify conflict or consensus over community views and
strategies on health. From there District Committees were set up and tasked to identify their main health-related problems and develop solutions for them. To date, the CWGH has established local CWGH committees at district level in 25 districts in Zimbabwe. The committees coordinate local activities, including education and
health action and link the community with all service providers.
Country
Switzerland
Publisher
WHO Knowledge Network
Theme area
Governance and participation in health
Title of publication Crossing sectors: Experiences in intersectoral action, public policy and health
Date of publication
2007
Publication type
Report
Publication details
Canada's response to the WHO Commission on the Social Determinants of Health pp 1-40
Publication status
Published
Language
English
Keywords
Canada, intersectoral action, health sector
Abstract
This paper represents the first phase of a Canadian initiative on intersectoral action for health and provides an overview of approaches to intersectoral action at the global, sub-regional, national, sub-national, and community levels. Experiences documented by academics, policy-makers and practitioners in more than 15 countries are examined in an attempt to improve understanding of questions relating to:
* the types of problems addressed through intersectoral action (IA);
* the conditions that shape horizontal and interjurisdictional collaboration;
* tools, mechanisms and approaches to support IA; and
* roles played by the health sector and other actors.
Country
Canada
Publisher
WHO Knowledge Network
Theme area
Governance and participation in health
Title of publication Civil society participation in programme implementation for intersectoral action on health equity and intersectoral action for health: A Case Study of the Health Civil Society Network in East and Southern Africa
Date of publication
2007 March
Publication type
Report
Publication details
Case study commissioned by the Health Systems Knowledge Network of the WHO Commission on the Social Determinants of Health pp 1-11
Publication status
Published
Language
English
Keywords
Health Civil Society in East and Southern Africa, networking, impact
Abstract
The Health Civil Society Network (HCSN) is a coalition of seventeen
organizations operating in the southern and east African region that are united around the common objective of advancing an agenda and action for people's health, equity and justice. It is a brain child of the Regional Network for Equity in Health in east and Southern Africa (EQUINET), People’s Health Movement (PHM), International People’s Health Council (IPHC) and the Community Working Group on Health (CWGH). Towards the end of 2002, they identified the need for a closer dialogue and networking between health and related civil society in east and southern Africa in order to achieve common health goals and to link issue based goals under a common and shared umbrella (HCSN, 2003). This paper examines the role and impact of the network.
Country
Switzerland
Publisher
WHO Knowledge Network
Theme area
Equitable health services, Governance and participation in health
Title of publication Building equitable, people-centred national health systems: The role of parliament and parliamentary committees on health in east and southern Africa
Date of publication
2007 February
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
parliamentary portfolio committee, parliamentary groupings, best practices, health systems, policy
Abstract
Many East and Southern countries, beginning with South
Africa in 1994, have set up portfolio committees to track the activities of government sectors such as health, education, mining, agriculture and transport among others. Meetings of such committees offer an opportunity to scrutinize and report on the activities of the State. As ‘watch dogs’ parliamentary portfolio committees, have a role of monitoring national budget performances and ensuring that the national budgets address
key health issues affecting everybody in the country. Many parliaments in the Southern and East African region are also now sharing experiences and information on best practices through interaction with such Parliamentary groupings as the SADC Parliamentary Forum (SADC PF), The East African Assembly (EAA), the East African Legislative Assembly (EALA), the SADC Parliamentary Health Committees Alliance for Equity in Health
(SEAPACOH) and the Common Wealth Parliamentary Association (CPA). Relevant expertise and information is also being availed to parliaments by non-governmental organizations (NGOs) and networks operating in these countries. This paper examines the impact of these new structures on health systems and health policy makers in the region.
Country
Switzerland
Publisher
WHO Knowledge Network
Theme area
Governance and participation in health
Title of publication Leveraging parliamentarians: The case of Nairobi equity Gauge
Date of publication
2007 June
Publication type
Report
Publication details
Case study commissioned by the Health Systems Knowledge Network of the WHO Commission on the Social Determinants of Health pp 1-15
Publication status
Published
Language
English
Keywords
Abstract
There have been pessimism and public criticism regarding the effectiveness of legislators, in particular members of parliament in executing their roles of oversight, representation and legislation on behalf of their constituents. The experience of the Equity Gauge in Kenya regarding relationships with parliament are examined. This piece of work shows the beginning of a wider agenda to mainstream family planning and reproductive health within the health system.
Country
Switzerland
Publisher
WHO Knowledge Network
Theme area
Governance and participation in health
Title of publication The Potentials of involving Communities in Health Research
Date of publication
2007
Publication type
Book Section
Publication details
Global Forum Update on Research for Health 4 pp 176-180
Publication status
Published
Language
English
Keywords
PRA, participatory research, policy-makers, communities
Abstract
The potential of participatory research comes from the researched people as active analysts of the researched subjects. With participatory research, solutions to research questions come from the people supported with data, and not from data supported by trained data analysts. Historically, health policies designed without a community participatory approach, some of which have acquired a global attention, often have failed to solve people’s health problems. The trend will be the same and the vicious cycle maintained unless the participatory research community can succeed to show, demonstrate, convince and prove to local and global health policy-makers that participatory research has the
potential to solve many of our health problems.
Country
United Kingdom
Publisher
Pro Brook Publishing
Theme area
Governance and participation in health
Title of publication Building and maintaining the capacity, representativeness and informed engagement: The case of SIZAKUYENZA Community-Based Organisation in South Africa
Date of publication
2007
Publication type
Document
Publication details
Case study commissioned by the Health Systems Knowledge Network of the WHO Commission on the Social Determinants of Health
Publication status
Published
Language
English
Keywords
Abstract
Country
Switzerland
Publisher
Theme area
Values, policies and rights
Title of publication Making human rights work for the public’s health: Equity and access
Date of publication
2007
Publication type
Book Section
Publication details
The Global Forum Update on Research for Health: Equitable access: Research challenges for health in Developing Countries 4 pp 54-59
Publication status
Published
Language
English
Keywords
public health facilities, human rights, HIV epidemic
Abstract
Human rights occupy a somewhat fraught place in the evolution of public health. Historically, public health approaches have evolved from relatively authoritarian traditions in placing the public interest, however defined, ahead of the rights of individuals or groups. However, the advent of the HIV epidemic, in particular, prompted a
rethinking of the place of respect for human dignity within a population approach to health and spurred the growth of a movement for mainstreaming the place of human rights in health. Nonetheless, such trends have not resolved a residual unease experienced by public health planners and governments with a perceived incompatibility between rights claims by individuals and responsibilities of public health systems towards the health of populations. These have been manifested in, for example, claims that approaches based on social justice and public health utility are better suited than human rights to address the challenges of HIV in Africa, and in the most recent debates preceding WHO endorsement of routine testing for HIV in public health facilities.
Country
Switzerland
Publisher
Pro Brook Publishing
Theme area
Governance and participation in health
Title of publication Manner in which parliamentarians have been able to use the budget process to make visible inequalities in health and to promote equitable distribution in South Africa: A case study commissioned by the Health Systems Knowledge Network of the WHO Commission
Date of publication
2007 March
Publication type
Report
Publication details
Publication status
Publication status unknown
Language
English
Keywords
South Africa, parliamentary capacity, Health Committee, equity issues
Abstract
If Parliaments are to fulfil their function as representatives of the people they need to be well informed and equipped with compelling facts and arguments. The need to build capacity of Parliamentarians and especially of those participating in relatively new structures, as was the case in South Africa, is easily overlooked. In the experience of this project, Parliamentarians needed support to understand and analyse equity issues and to identify possible useful policy trajectories, as well as to interrogate plans and reports from the Executive. This project utilised a range of interventions designed to strengthen the Health Committee. The combination of first hand experience, through site visits, supplemented with ongoing and accessible technical support is a minimum if Health Committees are to be effective role players in moving beyond rhetoric to make a real impact on inequitable health care provision.
Country
Switzerland
Publisher
WHO Knowledge Network
Theme area
Equity and HIV/AIDS
Title of publication Managing HIV/AIDS in the world of work: Experiences from Southern Africa
Date of publication
2007
Publication type
Publication details
Publication status
Published
Language
English
Keywords
Southern Africa, workplace, AIDS policies, impact of HIV and AIDS
Abstract
The aim of this publication is to motivate and encourage organisations and businesses to talk openly about AIDS, acknowledge its existence and treat it like any other chronic disease. The document also encourages employers to develop (or finalise draft) AIDS policies.
Country
Zimbabwe
Publisher
SAfAIDS
URL:
Theme area
Public-private mix
Title of publication Public is as private does: The confused case of Rand Water in South Africa
Date of publication
2007 August
Publication type
Document
Publication details
Municipal Services Project Occasional Paper Series 15 pp 1-86
Publication status
Published
Language
English
Keywords
Abstract
Critique and protests against private sector involvement in public water services have led to calls by groupings on the left for the creation of ‘public-public partnerships’ (PUPs) as a mechanism for improving public services and negating private sector involvement. The assumption is that PUPs will protect the public nature of water services much better than PPPs and will be better at ensuring access to water for the poor and marginalised, particularly in countries in the South. It is in this context of changes in public sector management and in the water sector that we see Rand Water (RW), the biggest public water utility in Africa, entering the market on the continent, as well as engaging in other activities that are beyond its core function of providing bulk potable water to local government in the industrial heartland of South Africa. This report examines the expansion of RW into non-core activities in the period 1994-2006. The report covers RW’s expansion within South Africa and outside of it, considers the rationales offered by RW
for that expansion, and deliberates on this expansion in the context of similar activities by other public sector operations both in South Africa and in other countries.
We investigate factors that explain the expansion of public utilities beyond their original public service responsibility, both within their home country and beyond. We also examine the relationship between commercial activities and public service provision, and the unresolved tensions created by these seemingly contradictory activities as a result of the underlying processes of corporatisation, commercialisation and marketisation.
Country
South Africa
Publisher
Municipal Services Project
Theme area
Equity in health
Title of publication Discussion paper 54: Equity in Health in Tanzania: Translating national goals to district realities
Date of publication
2007 December
Publication type
Document
Publication details
EQUINET Discussion Paper 54 pp 1-51
Publication status
Published
Language
English
Keywords
district health system, equity, resource allocation formula, debt relief, health spending, Tanzania
Abstract
Drawing on the analytic framework of the regional analysis, an analysis of equity in health at district level was implemented in Tanzania, through secondary review and field work. We found a clear policy commitment to equity, the administrative means to implement it and a political stability that enables this. A number of features of Tanzania’s context and health system make reducing differentials in health and access to health care possible, including the investment of debt relief resources in health and education, increased public spending in health, methods for managing external funds that pool resources for wider reallocation to areas of need and a resource allocation formula that considers access, poverty and disease burden in the allocation of resources and provides guidelines for spending to protect areas of equity oriented spending.
Country
Tanzania
Publisher
Ifakara Health Research Development Centre (Tanzania), TARSC, EQUINET
URL:
Equinet Publication Type
Discussion paper
Theme area
Health equity in economic and trade policies
Title of publication Trade is about people, not profit
Date of publication
2007 November
Publication type
Report
Publication details
Publication status
Language
English
Keywords
agriculture, finance, trade, Kenya
Abstract
An interim report from November 2007, containg various articles, both local and international, on agriculture, finance and trade.
Country
Kenya
Publisher
Health and Trade Advocacy Team, Kenya
URL:
Theme area
Resource allocation and health financing
Title of publication A position paper on the SWAp mid-year review of 2007
Date of publication
2007 May
Publication type
Publication details
Publication status
Published
Language
English
Keywords
SWAp, health budget, annual review, evaluation, Malawi
Abstract
This report reviews mid-year performance of the sector against the M and E framework, (Annual Implementation Plan) AIP and budget, as well as propose new undertakings to be achieved by next annual review. It also reviews and ratifies sector priorities for next financial year and presents progress on mid-term evaluation of the SWAp Program of work.
Country
Malawi
Publisher
Malawi Health Equity Network
URL:
Theme area
Equity in health, Resource allocation and health financing
Title of publication Quest for equity in resource allocation in the health sector
Date of publication
2007
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
health budget, health finance, health equity, Malawi
Abstract
MHEN commissioned this analysis to assist it in its mandate of lobbying for health equity in the provision of health services. The purpose of the analysis is to highlight issues from the 2007/8 health budget that need to be looked at during the current June-August 2007) parliamentary seating.
Country
Malawi
Publisher
Malawi Health Equity Network
URL:
Theme area
Values, policies and rights
Title of publication Analysis of the Uganda Mental Treatment Act from a Human Rights and Public Health Perspective
Date of publication
2007
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
mental illness, human rights, legislation, Uganda
Abstract
This essay examines the elements of international human rights law directly linked to persons with mental
disabilities that are crucial in national mental health legislation. It critically compares the Uganda Mental Health Treatment Act with the human rights standards spelled out in the United Nations Human Rights Instruments.
Country
Publisher
URL:
Theme area
Health equity in economic and trade policies
Title of publication The World Bank: Development agency, credit union or institutional dinosaur?
Date of publication
2008
Publication type
Electronic Source
Publication details
International Journal of Political Economy Spring
Publication status
Published
Language
English
Keywords
World Bank, privatization, social services
Abstract
As an agent of global social reproduction, the World Bank itself is also subject to forces pushing for privatization (in this case, divestment of its development lending role to private capital markets), much in the way that welfarist states are urged to
selectively offload their more profitable (or commercially viable) social services to the private sector.
Country
Publisher
International Journal of Political Economy
URL:
Theme area
Equity and HIV/AIDS
Title of publication How far will we need to go to reach HIV-infected people in rural South Africa?
Date of publication
2007 June
Publication type
Electronic Source
Publication details
BioMed Central 5 16
Publication status
Published
Language
English
Keywords
HIV/AIDS, South Africa, antiretrovirals, travel, access to healthcare
Abstract
The South African Government has outlined detailed plans for antiretroviral (ART) rollout in KwaZulu-Natal Province, but has not created a plan to address treatment accessibility in rural areas in KwaZulu-Natal. Here, we calculate the distance that People Living With HIV/AIDS (PLWHA) in rural areas in KwaZulu-Natal would have to travel to receive ART. Specifically, we address the health policy question 'How far will we need to go to reach PLWHA in rural KwaZulu-Natal?'.
Country
Publisher
BioMed Central Ltd.
Theme area
Equity and HIV/AIDS
Title of publication Healthcare utilization of patients accessing an African national treatment program
Date of publication
2007 June
Publication type
Electronic Source
Publication details
BioMed Central 7 80
Publication status
Published
Language
English
Keywords
HIV/AIDS, national treatment programs, HAART, access to medicine
Abstract
The roll-out of antiretroviral therapy (ART) in Africa will have significant resource implications arising from its impact on demand for healthcare services. Existing studies of healthcare utilization on HAART have been conducted in the developed world, where HAART is commenced when HIV illness is less advanced. This study examines the impact of HAART in the African context.
Country
Publisher
BioMed Central Ltd.
Theme area
Equity and HIV/AIDS
Title of publication Community views about routine HIV testing and antiretroviral treatment in Botswana: Signs of progress from a cross-sectional study
Date of publication
2007 June
Publication type
Electronic Source
Publication details
Human Resources for Health 7 5
Publication status
Published
Language
English
Keywords
HIV/AIDS, Botswana, routine testing, health services
Abstract
The Botswana government began providing free antiretroviral therapy (ART) in 2002 and in 2004 introduced routine HIV testing (RHT) in government health facilities, aiming to increase HIV testing and uptake of ART. There have been concerns that the RHT programme might be coercive, lead to increased partner violence, and drive people away from government health services. This paper examines these concerns.
Country
Publisher
Human Resources for Health
Theme area
Human resources for health
Title of publication Postoperative outcome of caesarean sections and other major emergency obstetric surgery by clinical officers and medical officers in Malawi
Date of publication
2007 June
Publication type
Electronic Source
Publication details
Human Resources for Health 5 17
Publication status
Published
Language
English
Keywords
Caesarian sections, Malawi, healthworkers, clinical officers
Abstract
Clinical officers perform much of major emergency surgery in Malawi, in the absence of medical officers. The aim of this study was to validate the advantages and disadvantages of delegation of major obstetric surgery to non-doctors.
Country
Publisher
Human Resources for Health
Theme area
Human resources for health
Title of publication Nurses' experiences of recruitment and migration from developing countries: A phenomenological approach
Date of publication
2007 June
Publication type
Electronic Source
Publication details
Human Resources for Health 5 15
Publication status
Published
Language
English
Keywords
Human resources, recruitment, migration
Abstract
There is growing concern globally at the current flows of nurse migration, particularly from low-income to middle and high-income countries. Recruitment practices of many countries such as Ireland are thought to be fuelling this rate of migration. This paper aims to establish the perceptions and opinions of those involved in the recruitment process on their role in recruitment and the effects recruitment has on both source and destination countries.
Country
Publisher
Human Resources for Health
Theme area
Equitable health services
Title of publication Deficient supplies of drugs for life threatening diseases in an African community
Date of publication
2007 June
Publication type
Electronic Source
Publication details
BioMed Central 7 86
Publication status
Published
Language
English
Keywords
Drug supplies, Malawi, health budget, access to medicine
Abstract
In Malawi essential drugs are provided free of charge to patients at all public health facilities in order to ensure equitable access to health care. The country thereby spends about 30% of the national health budget on drugs. In order to investigate the level of drug shortages and eventually find the reasons for the drugs shortages in Malawi, we studied the management of the drug supplies for common and life threatening diseases such as pneumonia and malaria in a random selection of health centres.
Country
Publisher
BioMed Central Ltd.
Theme area
Equity and HIV/AIDS
Title of publication Knowledge about safe motherhood and HIV/AIDS among school pupils in a rural area in Tanzania
Date of publication
2007 April
Publication type
Electronic Source
Publication details
BioMed Central 7 5
Publication status
Published
Language
English
Keywords
HIV/AIDS, Tanzania, safe motherhood, maternal health
Abstract
Most female adolescents in Africa experience pregnancy, childbirth and enter motherhood without adequate information about maternal health issues. Information about these issues could help them reduce their pregnancy related health risks. Existing studies have concentrated on adolescents' knowledge of other areas of reproductive health, but little is known about their awareness and knowledge of safe motherhood issues. We sought to bridge this gap by assessing the knowledge of school pupils regarding safe motherhood in Mtwara Region, Tanzania.
Country
Publisher
BioMed Central Ltd.
Theme area
Equity and HIV/AIDS
Title of publication Gender distribution of adult patients on highly active antiretroviral therapy (HAART) in Southern Africa: a systematic review
Date of publication
2007 April
Publication type
Electronic Source
Publication details
BioMed Central 7 63
Publication status
Published
Language
English
Keywords
HIV/AIDS, gender, Southern Africa, HAART, access to medicine
Abstract
HIV and AIDS are significant and growing public health concerns in southern Africa. Most countries in the region have national adult HIV prevalence estimates exceeding 10 percent. The increasing availability of highly active antiretroviral therapy (HAART) has potential to mitigate the situation. There is however concern that women may experience more barriers in accessing treatment programs than men. This paper examines the gender distribution of adult patients accessing HAART in southern Africa
Country
Publisher
BioMed Central Ltd.
Theme area
Human resources for health
Title of publication The metrics and correlates of physician migration from Africa
Date of publication
2007 May
Publication type
Electronic Source
Publication details
BioMed Central 7 83
Publication status
Published
Language
English
Keywords
Human resources, migration, Africa
Abstract
Physician migration from poor to rich countries is considered an important contributor to the growing health workforce crisis in the developing world. This is particularly true for Africa. The perceived magnitude of such migration for each source country might, however, depend on the choice of metrics used in the analysis. This study examined the influence of choice of migration metrics on the rankings of African countries that suffered the most physician migration, and investigated the correlates of physician migration.
Country
Publisher
BioMed Central Ltd.
Theme area
Equitable health services
Title of publication Investigating health system performance: An application of data envelopment analysis to Zambian hospitals
Date of publication
2007 April
Publication type
Electronic Source
Publication details
BioMed Central 7 58
Publication status
Published
Language
English
Keywords
data development, Zambia, health systems, technical effieciency
Abstract
Zambia has recently articulated an ambitious national health program designed to meeting health-related MDGs. Public expectations are high and Zambia continues to receive significant resources from global and bilateral donors to support its health agenda. Although the lack of adequate resources presents the most important constraint, the efficiency with which available resources are being utilised is another challenge that cannot be overlooked. Inefficiency in producing health care undermines the service coverage potential of the health system. This paper estimates the technical efficiency of a sample of hospitals in Zambia.
Country
Publisher
BioMed Central Ltd.
Theme area
Values, policies and rights, Equity and HIV/AIDS
Title of publication Enrolling adolescents in HIV vaccine trials: Reflections on legal complexities from South Africa
Date of publication
2007 May
Publication type
Electronic Source
Publication details
BioMed Central 8 5
Publication status
Published
Language
English
Keywords
HIV, AIDS, South Africa, rights, vaccine trials, protocol
Abstract
South Africa is likely to be the first country in the world to host an adolescent HIV vaccine trial. Adolescents may be enrolled in late 2007. In the development and review of adolescent HIV vaccine trial protocols there are many complexities to consider, and much work to be done if these important trials are to become a reality.
Country
Publisher
BioMed Central Ltd.
Theme area
Equity in health
Title of publication Equity in health and healthcare in Malawi: Analysis of trends
Date of publication
2007 May
Publication type
Publication details
BMC Public Health 7 78
Publication status
Published
Language
English
Keywords
Equity, Malawi, healthcare, MDGs
Abstract
Growing scientific evidence points to the pervasiveness of inequities in health and health care and the persistence of the inverse care law, that is the availability of good quality healthcare seems to be inversely related to the need for it in developing countries. Achievement of the Millennium Development Goals is likely to be compromised if inequities in health/healthcare are not properly addressed.
Country
Publisher
BMC Public Health
Theme area
Human resources for health, Public-private mix
Title of publication Public-private partnerships to build human capacity in low income countries: Findings from the Pfizer program
Date of publication
2007 March
Publication type
Electronic Source
Publication details
Human Resources for Health 5 8
Publication status
Language
English
Keywords
Human resources, Public-private mix, capacity building, working environments, technical assistance, staff performance
Abstract
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.
Country
Publisher
Human Resources for Health
Theme area
Human resources for health
Title of publication Health sector reforms and human resources for health in Uganda and Bangladesh: Mechanisms of effect
Date of publication
2007 February
Publication type
Electronic Source
Publication details
Human Resources for Health 3 5
Publication status
Published
Language
English
Keywords
Human resources, Uganda, health sector reforms, working environments
Abstract
Despite the expanding literature on how reforms may affect health workers and which reactions they may provoke, little research has been conducted on the mechanisms of effect through which health sector reforms either promote or discourage health worker performance. This paper seeks to trace these mechanisms and examines the contextual framework of reform objectives in Uganda and Bangladesh, and health workers' responses to the changes in their working environments by taking a 'realistic evaluation' approach.
Country
Publisher
Human Resources for Health
Theme area
Human resources for health
Title of publication Experience of initiating collaboration of traditional healers in managing HIV and AIDS in Tanzania
Date of publication
2007 January
Publication type
Electronic Source
Publication details
Journal of Ethnobiology and Ethnomedicine 3 6
Publication status
Published
Language
English
Keywords
Traditional healers, HIV, AIDS, access to care, Tanzania
Abstract
The objective of the study was to initiate sustainable collaboration with traditional healers in managing HIV/AIDS. Consultative meetings with leaders of traditional healers' associations and government officials were held, followed by surveys at respective traditional healers' "vilinge" (traditional clinics). The findings were analysed using both qualitative and quantitative methods. The findings showed that influential people and leaders of traditional healers' association appeared to be gatekeepers to access potential good healers in the two study areas.
Country
Publisher
Journal of Ethnobiology and Ethnomedicine
Theme area
Resource allocation and health financing
Title of publication The cost of uncomplicated childhood fevers to Kenyan households: implications for reaching international access targets
Date of publication
2006 December
Publication type
Electronic Source
Publication details
BioMed Central 6 314
Publication status
Published
Language
English
Keywords
Financing, malaria, poor households, access to medicine
Abstract
Fever is the clinical hallmark of malaria disease. The Roll Back Malaria (RBM) movement promotes prompt, effective treatment of childhood fevers as a key component to achieving its optimistic mortality reduction goals by 2010. This paper examines how communities will access these new medicines promptly and the costs to poor households when they are located in rural areas distant to health services.
Country
Publisher
BioMed Central Ltd.
Theme area
Values, policies and rights, Equitable health services, Human resources for health
Title of publication Linking migration, HIV/AIDS and urban food security in Southern and Eastern Africa
Date of publication
2006 June
Publication type
Electronic Source
Publication details
Publication status
Published
Language
English
Keywords
migration, HIV, AIDS, food security, policy
Abstract
This paper provides a review of the literature on migration, HIV/AIDS and urban food security, and attempts to draw the links between these three powerful dynamics which are at play in Southern and Eastern Africa. The paper aims to stimulate discussion and provide a platform for developing an action research agenda to inform policy and programming within these three inter-connected sectors.
Country
Publisher
Theme area
Governance and participation in health
Title of publication Local primary health care committees and community-based health workers in Mkuranga district, Tanzania: Does the public recognise and appreciate them?
Date of publication
Publication type
Electronic Source
Publication details
Publication status
Language
English
Keywords
community participation, Tanzania, primary health care committees, district healthcare
Abstract
This study explores the views of villagers on the existence and functioning of local primary health-care (PHC) committees, village health workers (VHWs), skilled staff at government health facilities and their responsiveness to community health needs in Mkuranga district, Tanzania.
Country
Publisher
Ethno-Med
Theme area
Equitable health services
Title of publication Saving newborn lives: Tools for newborn health
Date of publication
2006
Publication type
Electronic Source
Publication details
Publication status
Published
Language
English
Keywords
mobilisation, immunisation, community health
Abstract
This guide describes how to design and carry out a social mobilisation program to create demand and increase participation during immunisation campaigns and routine immunisations, and thereby improve the health of communities in developing countries.
Country
Publisher
UNICEF
Theme area
Poverty and health, Equitable health services
Title of publication The meaning and measurement of acute malnutrition in emergencies: A primer for decision-makers
Date of publication
2006 November
Publication type
Electronic Source
Publication details
Publication status
Published
Language
English
Keywords
nutrition, nutrition surveys, decision making
Abstract
This paper aims to help decision-makers obtain and apply nutritional information and analysis. In non-technical language, it describes some of the basic concepts used in nutrition, sets out the purposes to which nutrition information is typically put, and explains how nutrition surveys are constructed and interpreted.
Country
Publisher
Humanitarian Practice Network
Theme area
Human resources for health
Title of publication Rising to the challenges of human resources for health in Kenya: Developing empirical evidence for policy making
Date of publication
2006 July
Publication type
Electronic Source
Publication details
Publication status
Published
Language
English
Keywords
Human resources, Kenya, targets, health facilities
Abstract
This report presents a comprehensive analysis of the human resources for health (HRH) currently available and required to reach the targets set by the Kenyan President’s Emergency Plan for AIDS Relief and the Millennium Development Goals (MDGs) in both the public sector and the faith-based organizations (FBOs). A stratified convenience sample of health facilities at all levels of care (primary, secondary, tertiary) in each of the eight provinces was selected for the assessment. Detailed information on human resources and provision of services related to HIV/AIDS, tuberculosis (TB), malaria, maternal health, and child health was collected.
Country
Kenya
Publisher
Government of Kenya
Theme area
Title of publication Using mid-level cadres as substitutes for internationally mobile health professionals in Africa. A desk review
Date of publication
2004 June
Publication type
Electronic Source
Publication details
Human Resources for Health 2 7
Publication status
Published
Language
English
Keywords
Human resources, training, staff, impact
Abstract
This paper looks at the role and impact of substitute health workers who take on some of the functions and roles normally reserved for internationally recognised health professionals such as doctors, pharmacists and nurses but who usually receive shorter pre-service training and possess lower qualifications.
Country
Publisher
Human Resources for Health
Theme area
Human resources for health
Title of publication Addressing the human resources crisis: A case study of the Namibian health service
Date of publication
2007 January
Publication type
Electronic Source
Publication details
Human Resources for Health 5 1
Publication status
Published
Language
English
Keywords
Namibia, human resources management, retention
Abstract
This paper addresses an important practical challenge to staff management in Nambia.
Country
Publisher
Human Resources for Health
Theme area
Human resources for health
Title of publication Improving motivation among primary health care workers in Tanzania: a health worker perspective
Date of publication
2006 March
Publication type
Electronic Source
Publication details
Human Resources for Health 4 6
Publication status
Published
Language
Human Resources for Health
Keywords
Human resources, primary health, Tanzania, retention
Abstract
The aim of this study was to explore the experiences of health workers working in the primary health care facilities in Kilimanjaro Region, Tanzania, in terms of their motivation to work, satisfaction and frustration, and to identify areas for sustainable improvement to the services they provide.
Country
Publisher
Human Resources for Health
Theme area
Human resources for health
Title of publication Wastage in the health workforce: Some perspectives from African countries
Date of publication
2005 August
Publication type
Electronic Source
Publication details
Human Resources for Health 3 6
Publication status
Published
Language
English
Keywords
Human resources, HIV/AIDS, disease burden, supply of healthworkers
Abstract
This paper looks at the health sector human resources crisis facing Sub-Saharan Africa. Over the past two decades its population has increased substantially, with a significant rise in the disease burden due to HIV/AIDS and recurrent communicable diseases and an increased incidence of noncommunicable diseases. This increased demand for health services is met with a rather low supply of health workers, but this notwithstanding, sub-Saharan African countries also experience significant wastage of their human resources stock.
Country
Publisher
Human Resources for Health
Theme area
Title of publication The exodus of health professionals from sub-Saharan Africa: Balancing human rights and societal needs in the twenty-first century
Date of publication
2007 June
Publication type
Electronic Source
Publication details
Nursing Inquiry 14 2 pp 114-124
Publication status
Published
Language
English
Keywords
Human resources, migration, sub-Saharan Africa, human rights
Abstract
In this paper we present a comprehensive analysis of the literature on health worker migration and argue that, from a human rights perspective, there are competing rights in the international migration of health professionals: the right to leave one's country to seek a better life; the right to health of populations in the source and destination countries; labour rights; the right to education; and the right to nondiscrimination and equality. Creative policy approaches are required to balance these rights and to ensure that the individual rights of health professionals do not compromise the societal right to health.
Country
Publisher
Nursing Inquiry
Theme area
Equitable health services
Title of publication Country Health System Fact Sheet 2006: Ethiopia
Date of publication
Publication type
Publication details
Publication status
Published
Language
English
Keywords
Fact sheet, Ethiopia
Abstract
Country Health System Fact Sheet for Ethiopia
Country
Publisher
World Health Organization
Theme area
Human resources for health
Title of publication Kenya’s health care crisis: Mobilizing the workforce in a new way
Date of publication
2006 December
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
Human resources, HIV/AIDS, Kenya, attrition, working conditions
Abstract
This paper examines the reasons for the human resource crisis in Kenya, including a long freeze on civil service employment and a high rate of attrition due to the impact of HIV/AIDS, poor working conditions and low salaries.
Country
Publisher
Capacity Project
Theme area
Human resources for health
Title of publication Human resources and the success of health sector reform
Date of publication
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
Human resources, health sector reforms, Zambia, case studies
Abstract
The paper aims to examine and explain the importance of human resources (HR) to the success or failure of health reforms using case studies from Russia, Zambia and the United Kingdom.
Country
Publisher
Theme area
Human resources for health
Title of publication Bold solutions to Africa’s health worker shortage
Date of publication
2006 August
Publication type
Document
Publication details
Publication status
Language
English
Keywords
Human resources, Africa, HIV/AIDS, migration, health workers, working conditions
Abstract
Africa’s current shortage of over 1 million health workers is one of the key impediments to meeting the global commitment to universal access to HIV/AIDS treatment, care and prevention by 2010, as well as to reaching the health-related Millennium Development Goals. This shortage is partly due to international migration of health workers. African doctors and nurses, in large numbers, have sought improved living and working conditions for themselves and their families in developed countries.
Country
Publisher
Physicians for Human Rights
Theme area
Human resources for health
Title of publication Migration by graduates of the University of Ghana Medical School: A preliminary rapid appraisal
Date of publication
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
Human resources, brain drain, migration, retention strategies, staff supply
Abstract
This exploratory descriptive study examined migration of locally trained doctors from Ghana using graduates of the country’s first medical school as a proxy. The objectives of the study were to describe trends in the loss of medical personnel to emigration and the influence this has on human resources planning, including forecasting of staff supply and requirements. It was also to provide some information towards the development of strategies to counteract such losses.
Country
Publisher
Theme area
Human resources for health
Title of publication Do visas kill? Health effects of African health professional emigration
Date of publication
2007 March
Publication type
Publication details
Publication status
Published
Language
English
Keywords
Human resources, immigration, health professionals, public health, health workers
Abstract
This study uses a new database of health worker emigration from Africa to test whether exogenous decreases in emigration raise the number of domestic health professionals, increase the mass availability of basic primary care, or improve a range of public health outcomes. It identifies the effect through two separate natural quasi-experiments arising from the colonial division of the African continent. These produce exogenous changes in emigration comparable to those that would result from different immigration policies in principal receiving countries. The results suggest that Africa's generally low staffing levels and poor public health conditions are the result of factors entirely unrelated to international movements of health professionals. A simple model proposes that such results would be explained by segmentation of health workforce labor markets in the sending countries. The results further suggest that emigration has caused a greater production of health workers in Africa.
Country
Publisher
Centre for Global Development
Theme area
Equity in health, Values, policies and rights
Title of publication Africa health strategy: 2007-2015
Date of publication
2007 April
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
Africa, health strategy, essential health care, equity
Abstract
The Africa Health Strategy aims to contribute to Africa’s socioeconomic development by improving the health of its people and ensuring access to essential health care for all Africans, especially the poorest and most marginalised, by 2015.
Country
Publisher
African Union
Theme area
Equity and HIV/AIDS
Title of publication Zambia HIV/AIDS Service Provision Assessment Survey
Date of publication
2006 July
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
Abstract
Country
Zambia
Publisher
Theme area
Equity in health
Title of publication Report of the 38th regional commonwealth health ministers’ conference
Date of publication
2003 February
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
Health Ministers Conference, health workers, human resource policies
Abstract
The conference noted with concern the growing burden of infectious diseases including HIV and AIDS, Tuberculosis, Malaria and other conditions such as non-communicable diseases as well as reproductive health problems. Unfortunately, the region is also facing a human resources for health (HRH) crisis which makes it difficult to adequately address this disease burden.
The human resources for health situation in the region is characterized by the following:
• Inadequate supply of trained health workers
• High levels of attrition of HRH due to the combined effects of illness and death primarily from HIV/AIDS, migration of skilled HRH from the region to developed countries as well as retrenchment and retirement of health workers.
• Ill motivated health workers who are overworked, poorly paid and insufficiently equipped to provide acceptable quality health care
• Poor deployment causing imbalance in the distribution of health workers resulting in fewer workers in rural areas where the majority of the population.
• Inadequate human resource policies on planning and management of HRH.
Country
Zambia
Publisher
Commonwealth Regional Health Community
Theme area
Resource allocation and health financing
Title of publication Discussion paper 52: Progress towards equitable health care resource allocation in east and Southern Africa
Date of publication
2007 December
Publication type
Document
Publication details
EQUINET Discussion Paper 52 pp 1-14
Publication status
Published
Language
English
Keywords
resource allocation; formula; historical patterns; Namibia, South Africa, Zambia, Zimbabwe
Abstract
There are large disparities in the health care resources available to different districts, regions and provinces within individual countries. Using a resource allocation formula, that is based on indicators of the relative need for health care within each geographic area, has been found to be helpful in overcoming historical allocation patterns. This report, implemented under the fair financing theme in the Regional network for equity in health in east and southern Africa (EQUINET) assesses whether there has been progress towards equitable resource allocation in four Southern African countries which have adopted such formulae (Namibia, South Africa, Zamibia and Zimbabwe). Researchers in Namibia, South Africa, Zambia and Zimbabwe provided information on implementation progress in their countries.
Country
East and southern Africa region
Publisher
EQUINET, Health Economics Unit (UCT)
URL:
Equinet Publication Type
Discussion paper
Theme area
Resource allocation and health financing
Title of publication Discussion paper 51: Deprivation-based resource allocation criteria in the Zambian health service: A review of the implementation process
Date of publication
2007 September
Publication type
Document
Publication details
EQUINET Discussion paper 51 pp 1-37
Publication status
Published
Language
English
Keywords
resource allocation, formula, deprivation, redistribution, Zambia
Abstract
This study reviews the Zambian deprivation-based health resource allocation formula and assesses how the deprivation-based resource allocation formula has been implemented in terms of achieving the initial desired goals of resource redistribution. It further considers the extent of converge or divergence in the equity goals relating to resource re-distribution through the allocation of funding to the districts.
Country
Zambia
Publisher
EQUINET; Health Economics Unit, University of Cape Town
URL:
Equinet Publication Type
Discussion paper
Theme area
Equity in health
Title of publication EQUINET report: Regional training workshop on writing, Lilongwe, Malawi, 20-24 October 2007
Date of publication
2007 October
Publication type
Report
Publication details
EQUINET Workshop report pp 1-29
Publication status
Published
Language
English
Keywords
research writing; east and southern Africa
Abstract
The workshop took participants through the writing process from developing a key message, planning the structure of writing, to writing the specific sections of scientific papers such as the title, abstract, keywords, executive summary, introduction, methodology, results and discussion, conclusions and references. In addition, Prof Malcolm Molyneux from the Malawi Medical Journal gave input on various aspects of peer-reviewed publishing. Issues of authorship, copyright and plagiarism were also discussed.
Country
Southern Africa Regional
Publisher
EQUINET with REACH Trust
Equinet Publication Type
Reports
Theme area
Equity in health
Title of publication Report of the launch: Reclaiming the resources for health: Regional analysis of equity in health in east and southern Africa, 23 October 2007, Lilongwe Hotel, Lilongwe Malawi
Date of publication
2007 October
Publication type
Report
Publication details
Report of the launch of the book, 23 October 2007, Lilongwe Hotel, Lilongwe Malawi pp 1-7
Publication status
Published
Language
English
Keywords
regional equity analysis, public health, policy, trade, investment, human resources, east and southern Africa
Abstract
The book was launched in the region in Lilongwe Malawi on October 23rd 2007 at an event locally hosted by REACH Trust Malawi and Malawi Health Equity Network, two EQUINET steering committee member institutions. The book was officially launched by the Principal Secretary for Health, Mr Chris Kang’ombe, with the Chair of the Parliamentary Committee for Health, Honourable Austin Mtukula and speakers from region, followed by dance and drama presenting health challenges in communities. Hastings Banda from REACH Trust chaired the session, attended by people working in health in Malawi and delegates from seven of the 16 countries in east and southern Africa.
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Reports
Theme area
Human resources for health
Title of publication Discussion Paper 50: A review of codes and protocols for the migration of health workers
Date of publication
2007 September
Publication type
Document
Publication details
EQUINET Discussion Paper 50 pp 1-39
Publication status
Published
Language
English
Keywords
brain drain, health worker migration, recruitment, codes, agreements, east and southern Africa
Abstract
This paper reviews current multi-lateral agreements, codes of practice, bi-lateral agreements, regional agreements, and strategies and position statements that govern the migration of health workers from East and Southern African countries. The findings of the review have proved to be disappointing. Despite renewed international interest in the ethics of recruiting health workers from poor countries, current frameworks and Codes have clearly been unable to stem the tide of workers flowing to the North (with some exceptions, such as the UK).
Country
East and southern Africa region
Publisher
EQUINET; Health Systems Trust; East, Central and Southern African Health Community
Equinet Publication Type
Discussion paper
Theme area
Values, policies and rights, Equitable health services
Title of publication Call for comments: Human Rights Guidelines for pharmaceutical companies in relation to access to medicines
Date of publication
2007 September
Publication type
Publication details
Publication status
Not published
Language
English
Keywords
Pharmaceutical guidelines, open for comment
Abstract
Health Action International (HAI) is an independent, global network working to increase access to essential medicines and improve their rational use through research excellence and evidence-based advocacy. While this analysis has been developed keeping in mind the responsibilities of States, many of its elements are also instructive in relation to the responsibilities of non-State actors, including pharmaceutical companies. The following draft Guidelines are grouped into overlapping categories; at the beginning of each group, there is a brief italicised commentary signalling some of the elements of the right-to health analysis that are especially relevant to that category. Importantly, the present Guidelines remain a draft. Comments on this draft are invited and should be sent as soon as possible - and before 31 December 2007.
Country
United Kingdom
Publisher
Health Action International (HAI)
Theme area
Values, policies and rights, Equity and HIV/AIDS
Title of publication Public Health Crisis in South Africa is more than just TB and HIV
Date of publication
2007
Publication type
Publication details
Critical Health Perspectives 3
Publication status
Published
Language
English
Keywords
HIV and AIDS, anti-retroviral treatment ARV), health priority, South Africa
Abstract
South Africa's public health crisis is deep-rooted in systemic problems. Progress will require far-sighted, sustainable solutions. South Africa has more than 5 000 000 HIVpositive people. An estimated 1 000 000 need ARV treatment but only somewhere in the order of 2 00 000 people are on treatment. The most urgent long-term priority our country faces is to stop new HIV infections.This requires a massive change in national consciousness. Everyone needs to be made aware of the reality of the epidemic, and leaders have critical role to play in this. Positive role models need to occupypeople’s minds at every opportunity. We’re talking media coverage that far exceeds the feeble attempts we’ve seen up to now.
Country
Egypt
Publisher
People's Health Movement
URL:
Theme area
Equity in health, Values, policies and rights, Health equity in economic and trade policies, Poverty and health, Equitable health services, Human resources for health, Resource allocation and health financing, Equity and HIV/AIDS, Governance and participation in health, Monitoring equity and research to policy
Title of publication Reclaiming The Resources For Health: A Regional Analysis Of Equity In Health In East And Southern Africa
Date of publication
2007 October
Publication type
Book
Publication details
Reclaiming The Resources For Health: A Regional Analysis Of Equity In Health In East And Southern Africa
Publication status
Published
Language
English
Keywords
east and southern Africa; equity in health
Abstract
In October 2007 EQUINET has produced a regional equity analysis that offers a comprehensive, yet accessible, resource presented through text, tables, figures, case studies, quotes and images. The evidence in this analysis points to three ways in which ‘reclaiming’ the resources for health can improve health equity:
• for poor people to claim a fairer share of national resources to improve their health;
• for a more just return for east and southernAfrican countries from the global economy to increase the resources for health; and
• for a larger share of global and national resources to be invested in redistributive health systems to overcome the impoverishing effects of ill health.
The book draws on and will feed into the several thousand organisations
and individuals involved in EQUINET training, research, policy dialogue and
information activities over the past seven years. The book can be obtained from
EQUINET by contacting admin@equinetafrica.org or through the publishers in the region, that is Weaver Press weaver@mweb.co.zw; Fountain Publishers (for East African region) sales@fountainpublishers.co.ug and Jacana (for South Africa and Boleswa) sales@jacana.co.za.
Country
Zimbabwe
Publisher
EQUINET: Weaver press, Fountain Publishers and Jacana media
URL:
Equinet Publication Type
Book
Theme area
Human resources for health
Title of publication Discussion paper 49: The costs and benefits of health worker migration from East and Southern Africa (ESA): A literature review
Date of publication
2007 August
Publication type
Document
Publication details
EQUINET Discussion Paper 49 pp 1-55
Publication status
Published
Language
English
Keywords
health worker migration, cost and benefits, brain drain, diaspora, knowledge networks, theoretical frameworks, East and Southern Africa
Abstract
This report is a review of all available literature on the costs and benefits of the migration of health workers from East and Southern African (ESA) countries to developed nations.
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Discussion paper
Theme area
Health equity in economic and trade policies
Title of publication Regional Meeting report: Training for advocacy on Trade and Health in east and southern Africa, Bagamoyo Tanzania, 31 August-1 September 2007
Date of publication
2007 September
Publication type
Conference Proceedings
Publication details
EQUINET Meeting report pp 1-25
Publication status
Published
Language
English
Keywords
TRIPS, Economic Partnership Agreement, East and Southern Africa
Abstract
This report is of the proceedings of a training workshop on policy engagement and advocacy to promote health in trade agreements held in Bagamayo, Tanzania, August 31 and September 1 2007. The workshop covered general issues of trade and health, and a deeper review of TRIPS and use of TRIPS flexibilities, the EU-ESA EPA, and health services liberalisation.
Country
East and southern Africa region
Publisher
EQUINET
URL:
Equinet Publication Type
Reports
Theme area
Equitable health services
Title of publication Challenging inequity through health systems: Final Report, Knowledge Network on Health Systems
Date of publication
2007 June
Publication type
Journal Article
Publication details
Publication status
Published
Language
English
Keywords
health systems; management and design, inequity, middle- and low-income countries
Abstract
The report discusses important health system actions and features that can address health inequity. While it focuses on low- and middle-income countries, many of the recommendations may be appropriate to high-income countries. Health systems promote health equity when their design and management specifically consider the circumstances and needs of the socially disadvantaged and marginalised populations, including women, the poor, and groups who experience stigma and discrimination, enabling social action by these groups and the civil society organisations supporting them.
Country
Switzerland
Publisher
WHO Knowledge Network
Equinet Publication Type
Discussion paper
Theme area
Health equity in economic and trade policies
Title of publication 3 New Reports Suggest IMF Policies Undermine Efforts on HIV/AIDS, Health and Education
Date of publication
2007
Publication type
Electronic Source
Publication details
Publication status
Published
Language
English
Keywords
International Monetary Fund (IMF), Millenium Development Goals (MDGs), poverty, HIV and AIDS, health
Abstract
The International Monetary Fund’s mission is to keep inflation under control and insist that low-income countries maintain “macroeconomic stability” at all costs. Access to World Bank aid and other bilateral foreign assistance is contingent upon a “thumbs-up” approval signal from the IMF on a country’s macroeconomic policies. But is the IMF’s traditional mission still compatible with the imperatives of poor countries today? Are its economic policies attached as conditions on its loan programs so cautious and restrictive that they are blocking the needed scaling-up of public spending that will be required to accept more aid and achieve the Millennium Development Goals (MDGs)? Are the IMF’s policies blocking efforts to scale-up spending to the levels needed for effectively fighting HIV/AIDS and other preventable and treatable diseases? Three recent reports by the IMF’s Independent Evaluation Office, the Center for Global Development and ActionAid International’s Education Team examine these issues and weigh in on the debate, all suggesting that the IMF’s policies are restricting the ability of low-income countries to scale-up public spending to hire the numbers of doctors, nurses and teachers projected to be necessary to meet their development goals.
Country
United States
Publisher
Action Aid USA
Theme area
Poverty and health, Equitable health services, Equity and HIV/AIDS
Title of publication Discussion Paper 48: A review of nutrition and food security approaches in HIV and AIDS programmes in Eastern and Southern Africa
Date of publication
2007 May
Publication type
Document
Publication details
EQUINET Discussion Paper 48 pp 1-42
Publication status
Published
Language
English
Keywords
food security, nutrition, HIV and AIDS, East Africa, Southern Africa, policy, programmes
Abstract
This paper is explores the interface between HIV and AIDS and food and nutrition security, and the policy and programme implications for a comprehensive strategy to address these issues synergistically. Specifically, this paper examines and compares the policies and programmes related to HIV and AIDS and food and nutrition security that are currently in place in three Eastern Africa countries (Kenya, Tanzania and Uganda) and three Southern Africa countries (Mozambique, South Africa and Zimbabwe) and concludes with elements of a comprehensive approach. This paper is based on a desk review of exisiting policies and programs in each of the six study countries. In addition, key informat interviews were conducted with persons from various government departments, United Nations (UN) agencies and non-governmental organisations (NGOs).
Country
East and southern Africa region
Publisher
EQUINET; Medical Research Council (South Africa)
URL:
Equinet Publication Type
Discussion paper
Theme area
Health equity in economic and trade policies
Title of publication Policy brief 17: Protecting health in the proposed Economic Partnership Agreement (EPA) between East and Southern African (ESA) countries and the European Union
Date of publication
2007 July
Publication type
Document
Publication details
EQUINET Policy brief 17 pp 1-4
Publication status
Published
Language
English
Keywords
Economic Partnership Agreement, EPA, impact on health, trade, East and southern Africa
Abstract
An Economic Partnership Agreement (EPA) is being negotiated between east and southern African countries (ESA) and the European Union (EU). The final agreement is due to be signed in December 2007. The EPA is likely to impact on health, on public revenues for health and health care, including access to medicines, and to affect other inputs to health such as food security. Without a proper health impact assessment these impacts are not easily quantified and ESA countries are urged to take a precautionary approach and safeguard health in the EPA. This policy brief outlines the ways in which the EPA may affect health and the measures that ESA can take to protect health within the EPA. While it is focused on the EU-ESA EPA, these impacts and measures have wider general relevance to trade
Country
East and southern Africa region
Publisher
EQUINET
URL:
Equinet Publication Type
Policy brief
Theme area
Values, policies and rights
Title of publication Provincial Findings in Preparation for The South African Human Rights Commission Public Enquiry into The Right to Have Access to Health Care Services: Synthesis Report
Date of publication
2007 June
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
health facilities, under-funded system, budget limitations, service delivery, health workers
Abstract
The SAHRC embarked upon provincial assessments in all nine provinces in preparation for a national enquiry into the right to have access to health care. This report provides a synthesis of the findings and main themes emerging from those assessments.
Country
South Africa
Publisher
South African Human Rights Commission
Theme area
Resource allocation and health financing
Title of publication International experiences in removing user fees for health services; Implications for Mozambique
Date of publication
2006 June
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
user fees, Mozambique, social policy, public health services
Abstract
Whether Governments should charge patients fees to use public health services has become one of the most contentious social policy issues worldwide. Sadly for policy makers, in recent years, the quality of debate in this area has often been poor, with opposing camps usually resorting to unproven theory and emotive rhetoric. Perhaps a new perspective should be brought to this debate. How would the world of business deal with this problem; which in effect, is an issue of what (if any) price one should charge for health services?
Country
United Kingdom
Publisher
DFID Health Resource Centre
Theme area
Health equity in economic and trade policies
Title of publication In defense of National Interest: A report on Uganda's Reform Process for the Industrial Property Legislation
Date of publication
2003
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
Industrial Property Legislation, patent law, Uganda, reforms
Abstract
Uganda is currently preoccupied with reforms for its commercial laws. The patent law is one of the laws under reform. A draft bill known as the Industrial Property bill is pending submission to cabinet at the time of writing. This report explains the process of reform of the patent law and traces the genesis of the process, stakeholders involvement, as well as the driving force for the reforms.
Country
Uganda
Publisher
Coalition for Health Promotion and Social Development (HEPS-Uganda), PANOS Eastern Africa
URL:
Theme area
Resource allocation and health financing, Equity and HIV/AIDS
Title of publication Assessment implementation of the Uganda Global Fund to fight HIV/AIDS, TB and Malaria
Date of publication
2004 December
Publication type
Document
Publication details
Uganda Global Fund for AIDS, TB and Malaria Project pp i-11
Publication status
Published
Language
English
Keywords
HIV/AIDS, Uganda Coalition for Access to Essential Medicines (UCAEM), Civil Society Organisations (CSOs), implementation
Abstract
This report is from a study carried out by the Uganda Coalition for Access to Essential Medicines (UCAEM), to assess the implementation of the Global Fund to fight HIV/AIDS, Malaria and TB in Uganda. The study was specifically designed to offer an analysis of the implementation process and activities of the UGFATMP with the aim of establishing the involvement of key stakeholders particularly Civil Society Organisations (CSOs), identify the challenges, document beneficiary perspectives and make recommendations on key CSOs concerns about the process. Despite successes around the world this report reveals that there are still concerns at the country level in Uganda.
Country
Uganda
Publisher
Uganda Coalition for Access to Essential Medicines
Theme area
Equity in health
Title of publication Geneva forum towards global access to health: Programme and abstract book
Date of publication
2006 September
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
equity
Abstract
Programme and abstract book for the Geneva forum towards global access to health in 2006
Country
Switzerland
Publisher
Geneva University Hospital
Theme area
Equity in health, Monitoring equity and research to policy
Title of publication Pathways of influence on equity in health
Date of publication
2007
Publication type
Journal Article
Publication details
Social Science and Medicine pp 1-8
Publication status
Published
Language
English
Keywords
Social health, equity, health distribution, tackling inequity
Abstract
An increasing number of studies are documenting the existence of inequities, and attention is now turning to exploring pathways through which they are generated and might be attacked. This appears to be an opportune time to consider what has been learned and what future directions might be taken by researchers to fill gaps in knowledge and make research more useful for policy interventions. This commentary briefly reviews some of the main contributions of past research that have possible relevance to pathways, considers what those pathways might include, and concludes with implications for future research. It makes the case for a conceptualization of influences on equity that explicitly includes distribution of health as an outcome as well as characteristics of the society as influences.
Country
Netherlands
Publisher
Elsevier
URL:
Theme area
Title of publication The impact of health sector reform on public sector health worker motivation in Zimbabwe
Date of publication
1998 November
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
Human resources, Zimbabwe, financial reforms, retention, health management, liberalisation, regulation, decentralisation, implementation
Abstract
During the past decade the economic situation in Zimbabwe has deteriorated significantly. Public sector health care workers have gone from being high status and relatively well paid members of the community to workers struggling to get a living wage from their jobs. This paper describes the specific policy measures that the Zimbabwean government has recently implemented to try to improve health sector performance, and promote higher levels of motivation amongst public sector health care workers. The overall reform package is to include financial reforms (user fees and social insurance), strengthening of health management, liberalization and regulation of the private health sector, decentralization, and contracting out. Unfortunately, the process of reform implementation in Zimbabwe and the government’s poor communication with workers, combined with a conflict between local cultures and the measures being implemented, has undermined the potentially positive effect of reforms on health worker motivation. Workers perceived reforms as threatening their job security, salaries, and training/career advancement opportunities, and feared ethnic and political influence on new employment practices under a decentralized system.
Country
Publisher
Partnerships for Health Reform
URL:
Theme area
Equity and HIV/AIDS
Title of publication Zambia national prevention of mother to child transmission (PMTCT) communication strategy: Mobilising people for action
Date of publication
2004 April
Publication type
Document
Publication details
Publication status
Language
English
Keywords
HIV, AIDS, Zambia, PMTCT, implementation, district health, community health
Abstract
The purpose of this document is to guide those involved in PMTCT activities throughout Zambia in addressing key issues, which affect the success of PMTCT interventions. This document is meant to be user-friendly and provide a simple framework for guiding communication activities. It is meant for health workers, DHMTs, implementing partners, CBOH and any other interested partner working in PMTCT. It is not meant to be a verbose document which sits on office shelves, instead, it is meant to be a living document which is put to use in each district and community wishing to undertake PMTCT activities.
Country
Zambia
Publisher
Government of Zambia
URL:
Theme area
Equity and HIV/AIDS
Title of publication Regional response to TB and HIV/AIDS epidemics: Status of TB and HIV/AIDS collaborative activities in ECSA region
Date of publication
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
HIV, AIDS, TB, Swaziland, Kenya, Uganda, Tanzania, Malawi, Zambia; Zimbabwe,
Abstract
Tuberculosis (TB) infects about 10 million people annually of which about 8 million of the infected persons develop active TB. Globally, tuberculosis incidence is rising by about 1% per year (Global TB Report 2005). This report examines the regional response to the TB crisis.
Country
East and southern Africa region
Publisher
Commonwealth Regional Health Comunity
URL:
Theme area
Title of publication Bold solutions to Africa’s health worker shortage
Date of publication
2006 August
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
Human resources, Africa, HIV/AIDS, migration, health workers, working conditions
Abstract
In Africa, a mere 3% of the world’s trained health workers struggle to combat 24% of the global disease burden. The World Health Organization estimates that sub-Saharan Africa is suffering a shortage of more than 800,000 doctors, nurses, and midwives, and an overall shortfall of nearly 1.5 million health workers. But what are the solutions? This report looks at some bold suggestions for changing patterns of health worker migration.
Country
Publisher
Physicians for Human Rights
URL:
Theme area
Resource allocation and health financing
Title of publication Report of study tour mutual health organisations: Senegal
Date of publication
2003 March
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
Community health, Senegal, Abuja Declaration, MDGs, PRSPs
Abstract
Health Systems in Africa still suffer from chronic under financing. This situation is worse among HPIC countries for which Poverty Reduction Strategy Papers to qualify for debt relief are currently implemented. There is strong political will at international level as evidenced by Millennium Development Goals that take into account better health, particularly maternal and child health. In Africa, heads of states meeting in Abuja in 2001 declared a commitment to health services by announcing the Abuja Declaration which states that governments in Africa should commit 15% of public budget to health services.
Country
Publisher
Commonwealth Regional Health Comunity
URL:
Theme area
Equity and HIV/AIDS
Title of publication Strategic framework for the expansion of the prevention of mother to child transmission of HIV/AIDS services in Zambia
Date of publication
2003 October
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
HIV, AIDS, Zambia, policy framework, PMCTC
Abstract
Mother to Child Transmission (MTCT) is by far the largest source of HIV infection in children below the age of 15 years. According to UNAIDS estimates, over 90 percent of children born to HIV-positive mothers acquire the virus before, during birth or through breastfeeding. This framework looks at how to improve service delivery and reach more mothers and children to prevent the spread of HIV.
Country
Zambia
Publisher
Government of Zambia
URL:
Theme area
Title of publication A national human resources plan for health
Date of publication
2006
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
Human resources, South Africa, deliviry plans
Abstract
The Human Resources for Health Plan will assist us in ensuring that we have the right human resource mix in health to fulfill our health care delivery objectives.
Country
South Africa
Publisher
Government of South Africa
URL:
Theme area
Title of publication Investing in Tanzanian human resources for health
Date of publication
2006 July
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
Human resources, Tanzania, retention, incentives
Abstract
This report follows previous work conducted by consultants with McKinsey & Company’s Global Public Health practice, and specifically their previous report, Acting Now to Overcome Tanzania’s Greatest Health Challenge: Addressing the Gap in Human Resources for Health, originally published in May 2003.
Country
Publisher
Touch Foundation
Theme area
Human resources for health, Resource allocation and health financing
Title of publication Managing the community health fund partnership between communities and the government: Operations manual
Date of publication
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
Community health, government partnership, Tanzania
Abstract
The Commonwealth Health Regional Community Secretariat and The Ministry of Health –Tanzania together have undertaken the development of a CHF Operational manual. The CHF Operational manual is a model that may be adoptable for use in ECSA countries notably Rwanda, Kenya, Tanzania and Uganda, by District Health Teams and CHF managers. This document is the facilitators’ guide on how to conduct CHF courses using the content of the Operations Manual.
Country
Tanzania
Publisher
Government of Tanzania
URL:
Theme area
Equitable health services, Equity and HIV/AIDS
Title of publication Achieving and sustaining universal access to antiretrovirals in rural areas: The primary health care approach to HIV services in Lusikisiki, Eastern Cape
Date of publication
2006 October
Publication type
Report
Publication details
Publication status
Language
English
Keywords
Lusikisiki, antiretrovirals, HIV, AIDS, human resources, capacity building, community engagement
Abstract
There are currently 2,200 people receiving antiretroviral therapy in Lusikisiki, which represents universal coverage of the need for the last year. To achieve this rapid scale up in the face of a chronic shortage of health staff, a model of care was developed along three lines: task shifting to mobilize existing human resources; the creation of additional capacity through the establishment of new posts (in particular adherence counsellors) and a strong community engagement to support the health system; and concerted efforts to improve clinic infrastructure. This report examines the impact of adopting a PHC approach adopted in this Lusikisiki project.
Country
South Africa
Publisher
Médecins Sans Frontières
URL:
Theme area
Values, policies and rights, Human resources for health
Title of publication Human resources development & strategic plan: 2005-2025
Date of publication
2004 July
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
Human resources, Lesotho, Development Plan, labour supply, training requirements, budget
Abstract
This document is a combined Human Resources Development Plan and Human Resources Strategic Plan for the health and social welfare sector of Lesotho. The Development Plan is presented in Chapters 2 through 5, and the Strategic Plan is presented in Chapter 6. The essential difference between the two is that the HR Development Plan represents a technical assessment of the total labor supply and training requirements for the sector in the absence of any budget or production constraints. It reflects a technical assessment of what is needed and what should be produced and financed if we faced no constraints. The Strategic Plan by contrast takes cognizance of budget and production constraints and thus represents a prioritized plan that would be technologically feasible from a production standpoint and financially feasible assuming the investment and incremental recurrent budgetary resources are forthcoming as anticipated.
Country
Lesotho
Publisher
Government of Lesotho
URL:
Theme area
Human resources for health
Title of publication AKHS Kenya community health department dolicy brief no 5: Best practices in community-based health initiatives
Date of publication
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
Human resources, Kenya, case study, best practices, implementation, health status
Abstract
Since independence in 1963, the Kenyan government has worked to prevent, eradicate and control disease while providing adequate and effective diagnostic, therapeutic, curative and rehabilitative services. The government’s 1994 Health Policy Framework seeks “to promote and improve the health status of all Kenyans through the deliberate restructuring of the health sector to make all health services more effective, accessible and affordable.” This case study highlights some of the best practices arising from the implementation of the framework in Kenya.
Country
Kenya
Publisher
Community Health Department
URL:
Theme area
Human resources for health
Title of publication Supplementation programme Dutch medical doctors 1978–2003: Lessons learned
Date of publication
2003 December
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
Human resources, Zambia, retention, rural districts
Abstract
For more than 25 years the Netherlands has supported Zambia by sending General Medical Officers to work in district hospitals or District Health Management Teams. This support was part of a general worldwide programme of the Dutch Ministry of Foreign Affairs, the so-called Supplementation Programme. Due to policy changes in the Netherlands, this Supplementation Programme was phased out in 2001, and responsibilities for technical assistance (TA) were shifted to the embassies. Recently, the Royal Netherlands Embassy (RNE) in Lusaka agreed with the Central Board of Health (CBoH) and the Ministry of Health to phase out the TA at district level (but continue with other types of technical assistance) and to initiate a Retention Scheme for Zambia doctors, working in rural and remote districts.
Country
Publisher
URL:
Theme area
Human resources for health
Title of publication Public sector nurses in Swaziland: Can the downturn be reversed
Date of publication
2006 May
Publication type
Journal Article
Publication details
Human Resources for Health 4 13 pp 1-11
Publication status
Published
Language
English
Keywords
Human resources, Swaziland, case study, policy initiatives
Abstract
The lack of human resources for health (HRH) is increasingly being recognized as a major bottleneck to scaling up antiretroviral treatment (ART), particularly in sub-Saharan Africa, whose societies and health systems are hardest hit by HIV/AIDS. In this case study of Swaziland, we describe the current HRH situation in the public sector. We identify major factors that contribute to the crisis, describe policy initiatives to tackle it and base on these a number of projections for the future. Finally, we suggest some areas for further research that may contribute to tackling the HRH crisis in Swaziland.
Country
Swaziland
Publisher
BioMed Central
URL:
Theme area
Human resources for health
Title of publication Payment of lunch allowance: A case study of the Uganda health service
Date of publication
Publication type
Document
Publication details
Publication status
Language
English
Keywords
Human resources, Uganda, case study, non-financial incentives, lunch allowance
Abstract
A case study of an intervention (the lunch allowance scheme) instituted in Uganda to improve retention and motivation of health workers, and draw lessons form it.
Country
Publisher
Joint Learning Initiative
URL:
Theme area
Human resources for health
Title of publication The health workforce in Africa: Challenges and prospects
Date of publication
2004 March
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
Human resources, Africa, health services
Abstract
The health of Africans is probably one of the greatest challenges to the economic development of the continent and its peoples. However the past two decades have led to signs of a decline in health status in the sub-Saharan region. Indeed life expectancy is estimated to have declined for 17 of the 48 countries in the region between 1970 and 1999. Significant increases in population have not been matched with increases in health’s resources and in a number of countries the ratios of health professionals to population have been stagnant or even in decline. Health services have also been challenged with resurgence of some of the older communicable diseases such as Tuberculosis (TB) and Malaria and now the recent onslaught of HIV/AIDS, combined with the paradox that the earlier improvements in health and life expectancy have now challenged health systems with increases in non communicable diseases.
Country
Publisher
Africa Working Group of the Joint Learning Initiative on Human Resources
Theme area
Human resources for health
Title of publication Human resources for health: Overcoming the crisis
Date of publication
2004
Publication type
Book
Publication details
Publication status
Language
English
Keywords
Human resources, strategies, policies
Abstract
This report presents the findings and recommendations of the Joint Learning Initiative (JLI), an enterprise engaging more than 100 global health leaders in landscaping human resources for health and in identifying strategies to strengthen the workforce of health systems.
Country
Publisher
Joint Learning Initiative
Theme area
Human resources for health
Title of publication Working together to tackle the crisis in human resources for health
Date of publication
2005 November
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
Human resources, technical work, health systems harmonisation, migration policies
Abstract
This paper summarizes the rapidly accumulating evidence and growing recognition of the HRH crisis, especially in sub-Saharan Africa. The nature of the crisis is briefly outlined, drawing attention to escalating activities, demand and momentum emerging from Africa and other countries calling for appropriate and effective global and regional support. There are clear needs for quality technical work, stronger regional cooperation, harmonization of health systems and global initiatives, and for sound fiscal and migration policies. Underscored is the growing gap between energetic yet isolated and fragmented country HRH efforts and appropriate and effective external reinforcement.
Country
Publisher
Transitional HRH Working Group
URL:
Theme area
Human resources for health
Title of publication Health worker motivation in Africa: the role of non-financial incentives and human resource management tools
Date of publication
2006 August
Publication type
Journal Article
Publication details
Human Resources for Health 4 24 pp 1-17
Publication status
Published
Language
English
Keywords
human resources, motivation, incentives
Abstract
There is a serious human resource crisis in the health sector in developing countries, particularly in Africa. One of the challenges is the low motivation of health workers. Experience and the evidence suggest that any comprehensive strategy to maximize health worker motivation in a developing country context has to involve a mix of financial and non-financial incentives. This study assesses the role of non-financial incentives for motivation in two cases, in Benin and Kenya.
Country
Germany
Publisher
BioMed Central
URL:
Theme area
Title of publication HRH action workshop: Methodology and Highlights
Date of publication
2006 January
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
human resources
Abstract
As a key contribution toward increasing human capacity in national health systems, the Capacity Project is hosting a series of Human Resources for Health (HRH) Action Workshops. The initial workshop—held in Johannesburg in partnership with the United Nations Development Programme/Southern Africa Capacity Initiative (UNDP/SACI)—facilitated the exchange of knowledge and best practices in planning, developing and supporting the health workforce.
Country
United States
Publisher
UNAID
Theme area
Health equity in economic and trade policies
Title of publication Globalisation, equity and development: Some reflections on the African experience
Date of publication
2003 January
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
Globalization, equity, development
Abstract
This paper reflects on the last decade and half of intense and continuing debate focused mainly on the direction, structures and impact of the on-going process of globalisation. As highlighted in this paper, the debate, touching on all aspects of the process - historical, economic, technological, political, social and cultural - has thrown up a range of questions, many of which remain unanswered or have been answered unsatisfactorily.
Country
Senegal
Publisher
CODESRIA
URL:
Theme area
Health equity in economic and trade policies
Title of publication Globalization and equity in sub-Saharan Africa
Date of publication
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
globalization, equity, Africa, trade, capital flows
Abstract
This paper examines the issues connected with globalization and equity with specific reference to Sub-Saharan Africa. It shows that while globalization has brought quantum leap in trade, capital flows and income to some regions, globalization is nevertheless a very uneven process with unequal distribution of benefits and losses.
Country
Nigeria
Publisher
University of Ibadan
URL:
Theme area
Human resources for health, Governance and participation in health
Title of publication Local primary health care committees and community-based health workers in Mkuranga district, Tanzania: Does the public recognise and appreciate them?
Date of publication
2007
Publication type
Journal Article
Publication details
Ethono-Med 1 1 pp 27-35
Publication status
Published
Language
English
Keywords
Tanzania, human resources, PHC, community participation, health service delivery
Abstract
Abstract This study was conducted to explore the views of villagers on the existence and functioning of local primary health-care (PHC) committees, village health workers (VHWs), skilled staff at government health facilities and their responsiveness to community health needs in Mkuranga district, Tanzania. To ensure a sense of public trust, ownership and use of the existing health service system, community members need regular and timely feedback on health service delivery constraints and the existing community based health organisations for them to effectively participate in health development matters.
Country
Tanzania
Publisher
National Institute for Medical Research
URL:
Theme area
Human resources for health
Title of publication Human resources for health - an appraisal of the status quo in Tanzania mainland
Date of publication
2004 July
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
Tanzania, human resources, workforce determinants, knowledge gaps
Abstract
The main purpose of this report is to present the available information in a structured way to facilitate the dialogue among stakeholders in the national HRH policy arena. To structure the available information, we developed a framework of key workforce related outcomes and their determinants. We reviewed relevant documents, filled in some critical information gaps in interviews with stakeholders, summarised the collected information and structured it according to the framework. We also reviewed key issues described in country-specific literature, which were refined in a dialogue with the HRH Working Group. Based on the review of available information, we identified critical knowledge gaps in relation to the key issues.
Country
Publisher
URL:
Theme area
Human resources for health
Title of publication Human Resources for Health in Tanzania: Challenges, Policy Options and Knowledge Gaps
Date of publication
2001
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
Tanzania, Human resources, policy, implementation, impact
Abstract
This paper discusses the sharp decline in the number of health workers in Tanzania between 1994/95 and 2001/02, the causes of this decline and the impact of the 1996-2001 Strategic Plan on Human Resources for Health.
Country
Norway
Publisher
CMI
URL:
Theme area
Human resources for health
Title of publication Medical leave: the exodus of health professionals from Zimbabwe
Date of publication
2005
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
Zimbabwe, Human resources, migration, health professionals, impact
Abstract
Zimbabwe is faced with a growing problem of the emigration of its skilled labour. Health professionals in particular are migrating in search of greener pastures outside the country’s borders. This has negatively affected the quality of health care offered in most of the country’s health institutions. This policy paper draws on
research work that was conducted in selected health institutions in July 2002. The study aimed to establish the magnitude of migration of health pr ofessionals, its causes and to document the associated impacts on service delivery.
Country
South Africa
Publisher
South African Management Project
URL:
Theme area
Resource allocation and health financing, Governance and participation in health
Title of publication Managing the community health fund: An operations manual (part one)
Date of publication
2001
Publication type
Document
Publication details
Publication status
Language
English
Keywords
Tanzania, Human resounces
Abstract
Community Health Fund in Tanzania started as a pilot scheme in1996 in Igunga district. This scheme was a result of studies conducted in 1990-92 which revealed that the majority of people in rural and urban areas were willing to contribute provided drugs were available, medical services improved and contributions were reasonable and affordable by the majority. After evaluation, the implementation experience from Igunga was then used to roll out the scheme to nine more districts. In 2001, the policy decision was reached to cover all districts and is taken as one of the conditions to extend cost sharing in primary health care facilities.
Country
Tanzania
Publisher
Government of Tanzania
URL:
Theme area
Human resources for health
Title of publication Rising to the challenges of human resources for health in Kenya: Developing empirical evidence for policy making
Date of publication
2006 June
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
Human resources, Kenya, targets, health facilities
Abstract
This report presents a comprehensive analysis of the human resources for health (HRH) currently available and required to reach the targets set by the Kenyan President’s Emergency Plan for AIDS Relief and the Millennium Development Goals (MDGs) in both the public sector and the faith-based organizations (FBOs). A stratified convenience sample of health facilities at all levels of care (primary, secondary, tertiary) in each of the eight provinces was selected for the assessment. Detailed information on human resources and provision of services related to HIV/AIDS, tuberculosis (TB), malaria, maternal health, and child health was collected.
Country
Kenya
Publisher
USAID
URL:
Theme area
Human resources for health
Title of publication Challenges facing the Malawian health workforce in the era of HIV/AIDS
Date of publication
2004
Publication type
Document
Publication details
Publication status
Language
English
Keywords
Malawi, Human resources, HIV,AIDS
Abstract
Malawi has the eighth highest Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) prevalence rate globally (15%). AIDS is the leading cause of death in Malawi; annual deaths due to AIDS are estimated at 81,000. In Malawi, the prevalence rate has decreased over the last few years in Lilongwe. These lower rates should not be thought of as a reason for complacency, however, since it is likely that these rates reflect increased infection rates matched by high levels of mortality.
Country
Tanzania
Publisher
Commonwealth Regional Health Community Secretariat
Theme area
Governance and participation in health
Title of publication Radio address to the nation by the minister of health
Date of publication
2006 April
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
Botswana, human resource, health
Abstract
A radio address by the minister of health of Botswana
Country
Botswana
Publisher
Government of Botswana
Theme area
Resource allocation and health financing
Title of publication Budget speech 2006
Date of publication
2006 February
Publication type
Publication details
Publication status
Published
Language
English
Keywords
budget, Botswana
Abstract
The 2006 Budget speech of Botswana
Country
Botswana
Publisher
Government of Botswana
URL:
Theme area
Human resources for health
Title of publication Factors affecting performance of professional nurses in Namibia
Date of publication
2006 June
Publication type
Document
Publication details
Publication status
Published
Language
e
Keywords
Human resources, performance, Namibia, management framework
Abstract
This study explores the factors that affect performance of nurses in Namibia with the aim of providing a management framework for improving the performance of professional nurses.
Country
South Africa
Publisher
UNISA
Theme area
Human resources for health
Title of publication Human resources for health workforce a promising practices study promising retention practices of the Christian health association of Malawi
Date of publication
2006 May
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
Human resources, Malawi, national perspectives, health professionals, retention factors
Abstract
This paper provides an overview of literature around health worker retention and the three main perspectives typically used to examine the issue: First, is from that of the birds-eye national perspective, which refers to MOH HR plans as well as and ministry statistics. Such studies provide an overview of the HR situation in any given country. In Malawi the “Proposed 6-Year Human Resource Relief Programme for The Malawi Health Sector: Retention, Deployment and Recruitment” has been an often referenced review. Second, are studies which focus on a specific cadre of health providers. A recent Capacity Project study for the USAID Africa Bureau looked at the retention specifically of nursing tutors in Malawi, predominantly at faith-based training facilities. Third, are the studies which focus on elucidating factors which contribute to retention. Martineau and colleagues studied factors affecting retention of rural health workers in Malawi.
Country
United States
Publisher
USAID
URL:
Theme area
Values, policies and rights, Human resources for health
Title of publication The exodus of health professionals from sub-Saharan Africa: balancing human rights and societal needs in the twenty-first century
Date of publication
2007
Publication type
Publication details
Nursing Inquiry 14 2 pp 114-124
Publication status
Published
Language
English
Keywords
Human resources, migration, sub-Saharan Africa, human rights
Abstract
In this paper we present a comprehensive analysis of the literature on health worker migration and argue that, from a human rights perspective, there are competing rights in the international migration of health professionals: the right to leave one's country to seek a better life; the right to health of populations in the source and destination countries; labour rights; the right to education; and the right to nondiscrimination and equality. Creative policy approaches are required to balance these rights and to ensure that the individual rights of health professionals do not compromise the societal right to health.
Country
Canada
Publisher
Blackwell Publishing Inc.
URL:
Theme area
Poverty and health, Resource allocation and health financing
Title of publication A pro-poor critique of prepayment water meters in South Africa: The Phiri story
Date of publication
2007 May
Publication type
Journal Article
Publication details
Critical Health Perspectives 2007 2 pp 1-3
Publication status
Published
Language
English
Keywords
South Africa, Phiri, pre-payment, water meters, health
Abstract
Responding to the multiple violations posed by PPMs in Phiri, in July 2006 an application was launched in the Johannesburg High Court by five applicants, on behalf of themselves, their households and all residents of Phiri who are in a similar position to the applicants, as well as everyone in the public interest. The application, which is supported by the Coalition Against Water Privatisation and is defended by the Centre for Applied Legal Studies (CALS), seeks to have PPMs declared unlawful and it asks the Court to order Johannesburg Water to provide everyone in Phiri with a FBW supply of 50lcd and the option of a conventional meter at the cost of the City of Johannesburg. The respondents – the City of Johannesburg, Johannnesburg Water and the Minister of Water Affairs and Forestry – have filed their answering affidavits and the applicants will file their replying affidavit by the end of May. The case is likely to be heard in the Johannesburg High Court towards the end of 2007. The applicants and their supporting organisations believe that the case will be critical to securing the constitutionally- guaranteed rights of poor people to dignity, healthcare and sufficient water.
Country
South Africa
Publisher
People's Health Movement (PHM), South Africa
URL:
Theme area
Health equity in economic and trade policies
Title of publication ESA CSO Statement to the 11th RNF, Nairobi, 14-16th May 2007
Date of publication
2007 May
Publication type
Conference Proceedings
Publication details
Publication status
Not published
Language
English
Keywords
Economic Partnership Agreement, Cotenou Agreement, food security, market access, trade, services
Abstract
EPAs should be an instrument to foster the development of ESA countries. Their scope and content should be determined by this objective. Given the level of development and developmental needs of ESA countries, ESA should continue to press for Special and Differential treatment as part of the grand bargain in the overall negotiations. S & D should be recognised as a right and not treated as a favour.
Given the asymmetries among member states, it is patently unrealistic to have a one size fits all approach to negotiations. Our countries need space to develop institutions and capacities necessary to take advantage of market access available in the global market place as well as their own domestic and regional markets. NO COUNTRY MUST BE WORSE OFF AFTER SIGNING AN EPA.
Country
Kenya
Publisher
URL:
Theme area
Human resources for health
Title of publication Discussion paper 44: A review of non-financial incentives for health worker retention in east and southern Africa
Date of publication
2007 March
Publication type
Academic paper
Publication details
EQUINET Discussion paper 44 pp 1-53
Publication status
Published
Language
English
Keywords
health care workers, retention, non-financial incentives, East and southern Africa
Abstract
The paper reviewed evidence from published and grey (English language) literature on the use of non-financial incentives for health worker retention in sixteen countries in east and southern Africa (ESA): Angola, Botswana, DRC, Kenya, Lesotho, Madagascar, Malawi, Mauritius, Mozambique, Namibia, South Africa, Swaziland, Tanzania, Uganda, Zambia and Zimbabwe. There is a growing body of evidence on health worker issues in ESA countries, but few studies on the use of incentives for retention, especially in under-served areas.
Country
East and southern Africa region
Publisher
EQUINET, University of Limpopo
URL:
Equinet Publication Type
Discussion paper
Theme area
Poverty and health, Equitable health services
Title of publication Discussion paper 47: Food sovereignty and nutrition in east and southern Africa: A synthesis of case study evidence
Date of publication
2007 February
Publication type
Academic paper
Publication details
EQUINET Discussion paper 47 pp 1-25
Publication status
Published
Language
English
Keywords
food aid, food sovereignty, school feeding, ESA, east and southern Africa
Abstract
This paper investigates the design and implementation of three important nutrition responses in ESA:
• Food aid: In Malawi, food aid may have played an important role so far in food security, but there is no explicit policy framework for food aid and a growing body of evidence that imported food aid impacts negatively on local production, usually resulting in unintended excess stocks of commercial maize. These excess stocks dampen current and future consumer prices, and may put additional pressure on government budgets if they have been financed through domestic borrowing.
• HIV/AIDS-related nutrition interventions: Studies show that the many small-scale HIV/AIDS-related nutrition programmes in ESA are limited in coverage, do not reach eligible people and are not regularly evaluated for their impact or effectiveness. Overall, the approach is not integrated, tending to deal with the short-term problems caused by HIV/AIDS, without addressing the long-term implications.
• School feeding programmes: School feeding programmes in Malawi and South Africa are informed by the policy outlined by the New Partnership for Africa’s Development (NEPAD). School feeding programmes largely take the form of a vertical intervention programme, rather than a comprehensive nutritional programme, making any proposed impact on children's nutritional status unlikely.
Country
East and southern Africa region
Publisher
EQUINET
URL:
Equinet Publication Type
Discussion paper
Theme area
Human resources for health
Title of publication Regional Meeting report: Health worker retention and migration in east and southern Africa, Arusha, Tanzania, 17-19 March 2007
Date of publication
2007 March
Publication type
Report
Publication details
EQUINET Meeting report pp 1-25
Publication status
Published
Language
English
Keywords
health worker retention, migration, costs and benefits, policy development, incentives, migration agreements, brain drain, east and southern Africa
Abstract
The EQUINET-ECSA programme in 2007-8 is supporting empirical research on the costs and benefits of health worker migration within and beyond east and southern Africa (ESA); and supporting evaluation of the effectiveness of current policies and agreements to manage these costs and benefits. This work is co-ordinated by Health Systems Trust South Africa. The programme is further supporting work with country teams to support monitoring and evaluation and operational research to inform policy development and strengthen management and evaluation of incentives for retention of health workers, particularly non financial incentives. This work is co-ordinated by University of Namibia, Namibia. Both programmes are working with the EQUINET steering committee and the ECSA Technical Working Group on Human Resources for Health.
Country
East and southern Africa region
Publisher
EQUINET
URL:
Equinet Publication Type
Reports
Theme area
Health equity in economic and trade policies
Title of publication The Dispossession of African Wealth at the Cost of Africa's Health
Date of publication
2007 January
Publication type
Journal Article
Publication details
International Journal of Health Services 37 1 pp 171-192
Publication status
Published
Language
English
Keywords
Africa, colonialism, neocolonialism, terms of trade, poverty, health, resource outflows
Abstract
This article synthesizes new data about the outflow of Africa's wealth, to reveal structural factors behind the continent's ongoing underdevelopment. The flow of wealth out of sub-Saharan Africa to the North occurs primarily through exploitative debt and finance, phantom aid, capital flight, unfair trade, and distorted investment. Although the resource drain from Africa dates back many centuries—beginning with unfair terms of trade, amplified through slavery, colonialism, and neocolonialism—today, neoliberal (free market) policies are the most direct causes of inequality and poverty. They tend to amplify preexisting class, race, gender, and regional disparities and to exacerbate ecological degradation. Reversing this outflow is just one challenge in the struggle for policy measures to establish a stronger funding base for the health sector.
Country
United States
Publisher
Baywood Publishing Company Inc.
Theme area
Poverty and health, Equitable health services
Title of publication Discussion paper 46: School feeding in east and southern Africa: Improving food sovereignty or photo opportunity
Date of publication
2007 March
Publication type
Academic paper
Publication details
EQUINET Discussion Paper 46 pp 1-29
Publication status
Published
Language
English
Keywords
school, feeding schemes, nutrition, food sovereignty, NEPAD, east and southern Africa
Abstract
This report examines two case studies of school feeding schemes in South Africa and Malawi: The Primary School Nutrition Programme (PSNP) established in South Africa in 1994; and World Feeding Program (WFP) feeding schemes in Malawi.
Country
East and southern Africa region
Publisher
EQUINET
Equinet Publication Type
Discussion paper
Theme area
Equity and HIV/AIDS
Title of publication AIDS epidemic update: December 2005 - Special section on HIV Prevention
Date of publication
2005 December
Publication type
Electronic Source
Publication details
Publication status
Published
Language
English
Keywords
HIV/AIDS, estimates, scope, HIV prevention
Abstract
The annual AIDS epidemic update reports on the latest developments in the global AIDS epidemic. With maps and regional summaries, the 2005 edition provides the most recent estimates of the epidemic’s scope and human toll, explores new trends in the epidemic’s evolution, and features a special section on HIV prevention.
Country
United States
Publisher
Theme area
Equity and HIV/AIDS
Title of publication The 3 by 5 Initiative: Human capacity-building plan for scaling up HIV/AIDS treatment
Date of publication
2003 September
Publication type
Electronic Source
Publication details
Publication status
Published
Language
English
Keywords
health workers, ARVs, capacity building, emergency response
Abstract
This document outlines a strategic plan for WHO to support the development, strengthening and sustaining of the workforce necessary to radically scale up and maintain antiretroviral treatment. The strategic approach is based on the understanding that achieving this goal critically depends on joint efforts between communities, countries and international organizations. It builds on the experience of successful capacity-building efforts and harnesses existing expertise to strengthen training capacity at the regional and country level in the context of an emergency response.
Country
Switzerland
Publisher
WHO
Theme area
Resource allocation and health financing, Monitoring equity and research to policy
Title of publication Medicine Price Monitor
Date of publication
2007 January
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
Kenya, medicine, pricing, access to medicines
Abstract
Price continues to be a major barrier to reliable access to medicines in Kenya. To help address this issue, the MOH conducts surveys on a quarterly basis to monitor medicine prices. Information is collected and widely disseminated on availability, affordability, and price variation of a basket of medicines in the public, private and mission sectors. This report highlights the findings of the survey, based on data collected in January 2007. Comparisons are also highlighted between data for January 2007 and previous months (April, July and October 2006) for some key findings of the survey.
Country
Kenya
Publisher
Ministry of Health, Government of Kenya
URL:
Theme area
Equitable health services
Title of publication The District Health Barometer 2005/6: What does it say about promises and practice of PHC?
Date of publication
2007 April
Publication type
Journal Article
Publication details
Critical Health Perspectives 1 pp 1-2
Publication status
Published
Language
English
Keywords
South Africa, health policy, District Health System, measurable outcomes, indicators
Abstract
South Africa’s post-election health policy rhetoric was littered with statements about Primary Health Care, Equity, Health Promotion and the importance of a District Health System for health care delivery. But the extent to which this ideology of optimism has translated into measurable or experienced outcomes, remained
until now, an open question. The Health Systems Trust recently published the second South African District Health Barometer (DHB II)1. The report compares the performance on key health indicators for all 53 South African health districts. While the study suffers some limitations of data quality, it nevertheless provides a useful snapshot of health care across the country.
Country
South Africa
Publisher
People's Health Movement (PHM)
URL:
Theme area
Governance and participation in health
Title of publication Raising Our Voice, Breaking Our Silence: Health Workers’ Experiences and Needs around Occupational Health Services in Cape Town, South Africa
Date of publication
2006
Publication type
Document
Publication details
A PRA Poster pp 1-1
Publication status
Published
Language
English
Keywords
health workers, health care, participatory learning, occupational health and safety, OH&S, South Africa
Abstract
This poster highlights the main findings from a PRA project report. It explains that Health workers are not recognised as a community that requires health care. The link between the health and well being of health workers and the quality of health care that they are able to provide to the community needs to be recognised and positively developed.
Country
South Africa
Publisher
IHRG, EQUINET
URL:
Equinet Publication Type
Toolkits and training materials
Theme area
Values, policies and rights, Equity and HIV/AIDS, Monitoring equity and research to policy
Title of publication HIV/AIDS and Human Rights in SADC: An evaluation of the steps taken by countries within the South African Development Community (SADC) region to implement the International Guidelines on HIV/AIDS and Human Rights
Date of publication
2006 December
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
rights, HIV/AIDS, international guildelines, evaluation, treatment access, legal service, legal and policy framework
Abstract
2006 marks the tenth anniversary of the development of the International Guidelines on HIV/AIDS and Human Rights. To celebrate this occasion, the AIDS and Rights Alliance for Southern Africa (ARASA) has conducted research to evaluate the extent to which the International Guidelines have been used and implemented in the Southern African Development Community (SADC) region. This report details the findings of that research. It focuses on the guidelines dealing with:
• Structures and partnerships to support a multi-sectoral response;
• A protective legal and policy framework;
• Access to treatment; and
• Access to legal services.
Country
Namibia
Publisher
AIDS Rights Alliance for Southern Africa (ARASA)
URL:
Theme area
Equity in health
Title of publication Resolutions of the conference: 44th Health Ministers' Conference, Arusha, United Republic of Tanzania, 12-16 March 2007
Date of publication
2007 March
Publication type
Conference Proceedings
Publication details
ECSA Conference Resolutions pp 1-26
Publication status
Not published
Language
English
Keywords
cost effective, Millenium Development Goals, MDGs
Abstract
The meeting was attended by Hon Ministers of Health and senior officials from member states, Health experts, and collaborating partners. The theme of the conference was “Scaling up cost effective Interventions to attain the Millennium Development Goals”. The conference approved and adopted resolutions based on the sub themes of the conference.
Country
Tanzania
Publisher
East, Central and Southern African Health Community (ECSA)
URL:
Theme area
Governance and participation in health
Title of publication Meeting report: Participatory methods for a people centred health system: Training workshop, Bagamoyo Tanzania, 14-17 February 2007
Date of publication
2007 February
Publication type
Report
Publication details
EQUINET Meeting report pp 1-26
Publication status
Not published
Language
English
Keywords
participation, research, methodology, training, east and southern Africa
Abstract
The second regional training workshop on participatory methods for a people centred health system was hosted by the regional network for equity in health in east and southern Africa (EQUINET) , TARSC and Ifakara HRDC in Bagamoyo Tanzania from February 14-17 2007. It involved 35 delegates from in east and southern Africa. It aimed to build skills, share experiences and strengthen work on participatory methods for people centred health systems.
Country
East and southern Africa region
Publisher
EQUINET
URL:
Equinet Publication Type
Reports
Theme area
Poverty and health, Equitable health services
Title of publication Discussion Paper 45: The impact of food aid on food markets and food security in Malawi
Date of publication
2007 April
Publication type
Document
Publication details
EQUINET Discussion paper 45 pp 1-25
Publication status
Published
Language
English
Keywords
food aid, nutrition, health, food security, domestic market operations
Abstract
Food aid takes one of several forms: programme food aid, non-project food aid, project food aid and relief food aid. Historically, relief food aid has made up the largest proportion of food aid. Food aid has been mostly imported, with small amounts being procured from domestic markets. In this minor way, it has affected how domestic food markets operate, depending on the type of food aid and the mode of delivery. This paper explores the effect of food aid on Malawi’s food security and its domestic market. Our main concern is to highlight the fact that food aid interventions also impact on domestic food markets. In other words, future interventions must be designed and implemented in a way that takes domestic market operations into account.
Country
Malawi
Publisher
EQUINET; Medical Research Council (South Africa)
URL:
Equinet Publication Type
Discussion paper
Theme area
Equity and HIV/AIDS
Title of publication Discussion paper 38: Equity and Health System Strengthening in ART Roll Out: An analysis from literature review of experiences from east and southern Africa
Date of publication
2006 July
Publication type
Document
Publication details
EQUINET Discussion Paper 38 pp 1-48
Publication status
Published
Language
English
Keywords
health systems, AIDS policy, ART scale up, ART provision, ART access, Malawi
Abstract
The sub-Saharan region has been the worst hit by the HIV/AIDS epidemic. HIV prevalence rates are highest in the Southern Africa region with rates of over 30% in some countries. With action from multiple players ART scale up has begun. It is critical to analyse equity in ART scale up in the context of health systems. This requires not only the assessment of how decisions are made around ART provision and who is able to access and adhere to ART, but also to analyse the impact of the provision of ART on the broader health system.
Country
East and southern Africa region
Publisher
EQUINET
URL:
Equinet Publication Type
Discussion paper
Theme area
Human resources for health
Title of publication Joint WHO/OGAC Technical Consultation on Task Shifting: Key elements of a regulatory framework in support of in-country implementation of “Task Shifting”
Date of publication
2007 February
Publication type
Report
Publication details
Meeting report pp 1-10
Publication status
Not published
Language
English
Keywords
community health workers, task shifting, human resources
Abstract
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”.
Country
Switzerland
Publisher
WHO, OGAC
URL:
Theme area
Equity in health, Public-private mix
Title of publication Angola health system assesment
Date of publication
2005 September
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
Angola, health systems, equity, capacity, service delivery, access to medicines, public-private partnerships
Abstract
The purpose of the health system assessment is to inform the Mission’s development of a new health program for 2006−2011. To conduct the assessment, the team tested a new health systems assessment approach developed as part of the global Mainstreaming Health Systems Strengthening Initiative of USAID’s Office of Health, Infectious Disease and Nutrition. The team found several weaknesses including a lack of human and institutional capacity and supervision; and insufficient public health financing of basic inputs for service delivery (e.g., supplies, drugs, equipment, electricity, potable water) contributing to user fees being charged by some public facilities. Strengths included the quantity of nurses, Ministry of Health and donor plans to increase staff capacity, the dedication of public sector health staff at multiple levels, implementation of some quality guidelines (IMCI and maternal health); and public−private partnerships in health.
Country
United States
Publisher
USAID
URL:
Theme area
Human resources for health
Title of publication Health workforce innovative approaches and promising practices study: Attracting and retaining nurse tutors in Malawi
Date of publication
2006 March
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
Human Resources, Malawi, retention, Tutor Retention Scheme
Abstract
This paper focuses on Malawi’s nurse tutor retention scheme, chronicling the elements of the approach that are successful for purposes of eventual replication, and suggesting how to address some of the challenges.
Country
United States
Publisher
USAID
Theme area
Equity and HIV/AIDS, Monitoring equity and research to policy
Title of publication Projections of Global Mortality and Burden of Disease from 2002 to 2030
Date of publication
2006 November
Publication type
Journal Article
Publication details
PLoS Medicine 3 11 pp 2011-2030
Publication status
Published
Language
English
Keywords
Equity, HIV, Aids, international health policy, data
Abstract
To address the widespread demand for information on likely future trends in global health, and thereby to support international health policy and priority setting, this document provides new projections of mortality and burden of disease to 2030 starting from World Health Organization estimates of mortality and burden of disease for 2002. This paper describes the methods, assumptions, input data, and results.
Country
Publisher
PLoS Medicine
URL:
Theme area
Equity in health
Title of publication Report of the 38th regional commonwealth health ministers’ conference
Date of publication
2003 November
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
Report, health ministers conference
Abstract
The conference noted with concern the growing burden of infectious diseases including HIV and AIDS, Tuberculosis, Malaria and other conditions such as non-communicable diseases as well as reproductive health problems. Unfortunately, the region is also facing a human resources for health (HRH) crisis which makes it difficult to adequately address this disease burden.
The human resources for health situation in the region is characterized by the following:
• Inadequate supply of trained health workers
• High levels of attrition of HRH due to the combined effects of illness and death primarily from HIV/AIDS, migration of skilled HRH from the region to developed countries as well as retrenchment and retirement of health workers.
• Ill motivated health workers who are overworked, poorly paid and insufficiently equipped to provide acceptable quality health care
• Poor deployment causing imbalance in the distribution of health workers resulting in fewer workers in rural areas where the majority of the population.
• Inadequate human resource policies on planning and management of HRH.
Country
Zambia
Publisher
Commonwealth Regional Health Comunity
URL:
Theme area
Health equity in economic and trade policies
Title of publication Discussion paper 41: Health implications of proposed Economic Partnership Agreement (EPA) between east and southern African countries and the European Union
Date of publication
2007 February
Publication type
Academic paper
Publication details
EQUINET Discussion Paper 41 pp 1-29
Publication status
Published
Language
English
Keywords
economic partnership agreement, EPA, health inputs, health services, protecting health, east Africa, southern Africa, European Union
Abstract
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.
Country
East and southern Africa region
Publisher
EQUINET
URL:
Equinet Publication Type
Discussion paper
Theme area
Human resources for health
Title of publication Capacity Building Paper: A comparative study of the knowledge and attitudes of intern doctors at rural and urban hospitals regarding the migration of health workers
Date of publication
2006 November
Publication type
Academic paper
Publication details
EQUINET Capacity Building Paper 15 pp 1-18
Publication status
Not published
Language
English
Keywords
health workers, retention, migration, push factors, pull factors, Uganda
Abstract
The study was 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 migration is not prioritised as a problem by government, and while improved investments for health worker pay and conditions were recognised as needed, the financial resources for this was a limiting factor.
Country
Uganda
Publisher
Makerere University, EQUINET
Equinet Publication Type
Capacity building papers
Theme area
Values, policies and rights, Governance and participation in health, Monitoring equity and research to policy
Title of publication Factors influencing implementation of the Community Health Fund in Tanzania
Date of publication
2007 February
Publication type
Journal Article
Publication details
Health Policy and Plannng 22 pp 95-102
Publication status
Published
Language
English
Keywords
Tanzania, prepayment schemes, enrolment, scheme management, policy implementation
Abstract
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.
Country
Tanzania
Publisher
Health Policy and Planning
Equinet Publication Type
Capacity building papers
Theme area
Values, policies and rights
Title of publication 'Issues of equity are also issues of rights': Lessons from experiences in Southern Africa
Date of publication
2007 January
Publication type
Journal Article
Publication details
BMC Public Health 7 14 pp 1-10
Publication status
Published
Language
English
Keywords
human rights, health equity
Abstract
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.
Country
South Africa
Publisher
BioMed Central Ltd.
Equinet Publication Type
Discussion paper
Theme area
Health equity in economic and trade policies
Title of publication The dispossession of African wealth at the cost of African health
Date of publication
2007
Publication type
Journal Article
Publication details
International Journal of Health Services 37 1 pp 171-192
Publication status
Published
Language
English
Keywords
Africa, underdevelopment, structural factors, debt, phantom aid, capital flight, unfair trade, distorted investment
Abstract
This article synthesizes new data about the outflow of Africa’s wealth, to reveal structural factors behind the continent’s ongoing underdevelopment. The flow of wealth out of sub-Saharan Africa to the North occurs primarily through exploitative debt and finance, phantom aid, capital flight, unfair trade, and distorted investment. Although the resource drain from Africa dates back many centuries—beginning with unfair terms of trade, amplified through slavery, colonialism, and neocolonialism—today, neoliberal (free market) policies are the most direct causes of inequality and poverty. They tend to amplify preexisting class, race, gender, and regional disparities and to exacerbate ecological degradation. Reversing this outflow is just one challenge in the struggle for policy measures to establish a stronger funding base for the health sector.
Country
South Africa
Publisher
Baywood Publishing Co., Inc
URL:
Equinet Publication Type
Discussion paper
Theme area
Governance and participation in health
Title of publication Building equitable, people-centred national health systems: The role of parliament and parliamentary committees on health in east and southern Africa
Date of publication
2007 January
Publication type
Document
Publication details
A literature review commissioned by the Health Systems Knowledge Network pp 1-41
Publication status
Published
Language
English
Keywords
east and southern Africa, health systems, parliament, parliamentary committees
Abstract
The Health Systems Knowledge Network of the WHO Commission on the Social Determinants of Health in co-operation with the Regional Network for Equity in Health in east and southern Africa (EQUINET) commissioned a desk review of the role of parliaments and parliamentary portfolio committees on health in building equitable and people centered national health systems. This review presents evidence from published literature, and other secondary evidence in the east and southern African regions
Country
Zimbabwe
Publisher
WHO, IDRC, EQUINET
Equinet Publication Type
Discussion paper
Theme area
Health equity in economic and trade policies
Title of publication Declaration of the Abuja food security summit
Date of publication
2006 December
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
Food security
Abstract
Declaration of the Abuja food security summit
Country
Nigeria
Publisher
African Union
URL:
Theme area
Equity and HIV/AIDS
Title of publication Amplifying the African voice in treatment advocacy Pan African treatment access movement (PATAM) strategic planning workshop report
Date of publication
2006 December
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
HIV/AIDS, Africa, treatment, Access
Abstract
The Pan African Treatment Access Movement (PATAM) is a social movement comprised of individuals and organizations dedicated to mobilizing communities, political leaders, and all sectors of society to ensure access to antiretroviral (ARV) treatment, as a fundamental part of comprehensive care for all people with HIV/AIDS in Africa.
Country
Morocco
Publisher
PATAM
URL:
Theme area
Health equity in economic and trade policies
Title of publication International trade and health
Date of publication
2006 May
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
trade, health
Abstract
Minutes on the 59th World Health Assembly on 27 May 2006, agenda point 11.10.
Country
Switzerland
Publisher
World Health Assembly
URL:
Theme area
Resource allocation and health financing
Title of publication National resource flows for HIV/AIDS in Kenya, Rwanda, and Zambia: A Comparative analysis
Date of publication
2006 June
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
HIV/AIDS, Kenya, Rwanda, Zambia
Abstract
This paper reports on subaccount findings for 2002 from Kenya, Rwanda, and Zambia, all of which face generalized HIV/AIDS epidemics. Estimates show that their resource envelopes for HIV/AIDS were quite sizeable even prior to the surge in donor funds for treatment. Expenditures for HIV/AIDS health care – in 2002, primarily treatment of opportunistic infections and programs for prevention and public health – represented approximately 1 percent of national gross domestic product (GDP) levels, this in countries where overall health care resources accounted for only 4-5 percent of the GDP. Although donor financing accounted for the largest share of resources (usually more than half), most of these funds were targeted to programmatic activities, leaving households to pay for at least half of all medical care services. Indeed, people living with HIV/AIDS paid 3–6 times more out-of-pocket for health services than did the general population. Perhaps reflective of the direction in which the response to HIV/AIDS is managed, fund flows in Rwanda are increasingly channeled through the nongovernmental sector. This raises questions about government stewardship of the fight against the epidemic.
Country
United States
Publisher
UNAID
URL:
Theme area
Governance and participation in health
Title of publication Accountability in Health Services: Transforming Relationships and Contexts
Date of publication
2003 February
Publication type
Document
Publication details
Working Paper Series 13 1 pp 1-25
Publication status
Published
Language
English
Keywords
Accountability, transformation
Abstract
Accountability mechanisms ideally mediate relationships between two unequal partners with the aim of redressing the imbalances between them. In order to do this accountability measures must contest power relations, legitimise marginalised groups, and transform the actors involved. These elements endear accountability to people at the margins of society and to health issues marked by social inequalities and stigma, thus making it particularly useful to sexual and reproductive health, but also to other areas like mental health and disability. An emphasis on information, dialogue, and negotiation can ground this approach to accountability within efforts to improve health service delivery. I review case studies that highlight these elements and conclude that efforts to improve accountability cannot just rely on instituting asocial mechanisms. They must support iterative processes and constructive relationships that together transform their social contexts. Here in lie their limitations but also their dynamic power.
Country
United States
Publisher
Harvard Center for Population and Development Studies
Theme area
Resource allocation and health financing
Title of publication A descriptive framework for country-level analysis of health care financing arrangements
Date of publication
2000 October
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
Abstract
Country
Netherlands
Publisher
Elsevier
Theme area
Governance and participation in health
Title of publication What is the evidence on effectiveness of empowerment to improve health?
Date of publication
2006 February
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
patient participation, power, psychology, public health, health services accessibililty, socioeconomic factors, outcome assessment, meta-analysis, health disparities
Abstract
This is a Health Evidence Network (HEN) synthesis report on the effectiveness of empowerment strategies to improve health and reduce health disparities. The report shows that empowering initiatives can lead to health outcomes and that empowerment is a viable public health strategy. The key message from this review is that empowerment is a complex strategy that sits within complex environments. Effective empowerment strategies may depend as much on the agency and leadership of the people involved, as the overall context in which they take place. HEN, initiated and coordinated by the WHO Regional Office for Europe, is an information service for public health and health care decision-makers in the WHO European Region. Other interested parties might also benefit from HEN. This HEN evidence report is a commissioned work and the contents are the responsibility of the authors. They do not necessarily reflect the official policies of WHO/Europe. The reports were subjected to international review, managed by the HEN team.
Country
Switzerland
Publisher
World Health Organization
Theme area
Values, policies and rights
Title of publication Integrating equity into health information systems: A human rights approach to health and information
Date of publication
2005 April
Publication type
Electronic Source
Publication details
PLoS Medicine 2 4
Publication status
Published
Language
English
Keywords
Abstract
One of the most fundamental human rights is the assumption that each person matters, and everyone deserves to be treated with dignity—this is the tenet from which all other human rights flow. Another is that those who are most vulnerable deserve special protection. However, in many developing countries, vast numbers of children are born but never counted, and their health and welfare throughout their lives remains unknown. And because single-mean measures of population health mask inequalities among the best-off and worst-off, the health of vulnerable populations is not effectively documented and acknowledged. Health information systems can play an important role in supporting these rights by documenting and tracking health and health inequities, and by creating a platform for action and accountability.
Country
Publisher
PLoS Medicine
Theme area
Human resources for health
Title of publication Africa: Capacity building and health worker training
Date of publication
Publication type
Electronic Source
Publication details
Publication status
Published
Language
English
Keywords
Human resources, capacity building
Abstract
Central to the issue of human resources is capacity building and health worker training. Factors such as the shortage of health workers and the need to scale up ARV treatment critically impact upon African countries' capacity to produce enough, properly trained health care workers to deliver adequate health services. (For more on these issues, see the pages in this section on scaling up ARV treatment and migration of health workers).
Country
Publisher
Eldis
Theme area
Health equity in economic and trade policies, Monitoring equity and research to policy
Title of publication Joint health systems research programme for Eastern and Southern Africa
Date of publication
Publication type
Publication details
Publication status
Published
Language
English
Keywords
Health system research, Southern Africa
Abstract
The Joint HSR Programme on Health Systems Research is a collaborative enterprise of the Ministries of Health in participating countries in the Eastern and Southern African Region, the World Health Organisation / (AFRO) , and International partners. It started in 1987 and is now in its third phase. The third phase started in January 1996 and will end in 2000. It has eighteen participating countries in the Region, namely: Angola, Botswana, Guinea Bissau, Kenya, Lesotho, Madagascar, Malawi, Mauritius, Mozambique, Namibia, Sao Tome & Principe, Seychelles, South Africa, Swaziland, Tanzania, Uganda, Zambia and Zimbabwe . Other countries may come in soon, e.g. Mali and Ethiopia .
Country
Zimbabwe
Publisher
Afro-Nets
Theme area
Equity in health
Title of publication The South African equity gauge
Date of publication
Publication type
Electronic Source
Publication details
Publication status
Published
Language
English
Keywords
Equity, South Africa
Abstract
The Health Systems Trust (HST) established the South African Equity Gauge project in January 1999 in partnership with national and provincial parliamentarians to provide technical support to the government.
Country
South Africa
Publisher
Health Systems Trust
Theme area
Equity in health
Title of publication The challenge of achieving health equity in Africa
Date of publication
2004 June
Publication type
Electronic Source
Publication details
Publication status
Published
Language
English
Keywords
Equity, Africa
Abstract
Global health professionals have struggled with a definition for some time. Dr Rene Loewenson, a Zimbabwean epidemiologist, recently brought to Canada a Southern African view: equity in health implies addressing differences in health status that are unnecessary, avoidable, and unfair, she says. This also means understanding and influencing, not only the way society allocates health resources, but the power relations involved.
Country
Publisher
Science in Africa
Theme area
Equitable health services
Title of publication Conduct disorder in children: Presentation, treatment options and cultural efficacy in an African setting
Date of publication
Publication type
Electronic Source
Publication details
Publication status
Published
Language
English
Keywords
Children, Zimbabwe
Abstract
Conduct disorder (CD) exists in children in all societies and carries a significant risk of developing into criminal behavior. Practices in the diagnosis and treatment that were developed in Western Countries are better researched and more widely known in the international community that those in non-Western countries. A greater understanding of CD as a health condition affecting children globally is likely to result from knowledge of practices in both Western and non-Western countries. This article presents a practitioner's view on the diagnosis and treatment of CD in Zimbabwe and associated theories. Two case examples on practices with children with CD in Zimbabwe are presented and discussed in relational to local and international practices with children with CD. Spiritual intervention within a multisystemic and multidisciplinary framework is a resource for the diagnosis and treatment of CD in some Zimbabwean children.
Country
United States
Publisher
International Disability Research Centre on Social and Economic Innovation
Theme area
Equitable health services
Title of publication The District Health System Competition: What we have done and learnt in the last two years.
Date of publication
2000
Publication type
Electronic Source
Publication details
Publication status
Published
Language
English
Keywords
District health system, South Africa
Abstract
The South African government adopted the district health system (DHS) as the primary vehicle for the delivery of primary health care services. Some progress has been made despite a range of constitutional, institutional and bureaucratic challenges. This paper will briefly outline some of the processes and the challenges that have been experienced in the development of the DHS since 1996, and focus in detail on the implementation of the national district health systems competition.
Country
South Africa
Publisher
Government of South Africa
Theme area
Equitable health services
Title of publication The development of the district health system in South Africa: Lessons learned from the experience of ISDS
Date of publication
1998 March
Publication type
Electronic Source
Publication details
Technical report 5
Publication status
Published
Language
English
Keywords
District health systems, South Africa
Abstract
Will districts become effective vehicles for improving the quality of care, or expensive paper-shuffling machines? Will district management teams walk an interminable treadmill, or slowly, but surely improve the quality of care? These are the niggling and uncomfortable questions that motivate participants in the Initiative for Sub-District Support (ISDS). Over the past year, the ISDS has tried to develop systematic processes of support to management teams in selected districts in South Africa, aimed at strengthening their ability to improve the quality of health care. Through this experience, we hope to be able to share lessons with other districts to create a positive spin-off effect, demonstrate the process of district development, and pinpoint persistent obstacles.
Country
Publisher
Health Systems Trust
Theme area
Human resources for health
Title of publication Analysis of adequacy levels for human resources improvement within primary health care framework in Africa
Date of publication
2005 December
Publication type
Electronic Source
Publication details
Health Research Policy and Systems 3 8
Publication status
Published
Language
English
Keywords
Equity, Human Resource
Abstract
Human resources in health care system in sub-Saharan Africa are generally picturing a lack of adequacy between expected skills from the professionals and health care needs expressed by the populations. It is, however, possible to analyse these various lacks of adequacy related to human resource management and their determinants to enhance the effectiveness of the health care system.
Country
Belgium
Publisher
Health Research Policy and Systems
Theme area
Governance and participation in health
Title of publication Local primary health care committees and community-based health workers in Mkuranga district, Tanzania: Does the public recognise and appreciate them?
Date of publication
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
community participation, Tanzania, primary health care committees, district healthcare
Abstract
This study explores the views of villagers on the existence and functioning of local primary health-care (PHC) committees, village health workers (VHWs), skilled staff at government health facilities and their responsiveness to community health needs in Mkuranga district, Tanzania.
Country
Tanzania
Publisher
National Institute for Medical Research
Theme area
Equity and HIV/AIDS
Title of publication Botswana 2003: Second generation HIV/AIDS surveillance
Date of publication
2003 December
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
Botswana, HIV, AIDS
Abstract
Botswana is often cited as a success economic and good governance story in Africa. Pivotal to this success has been health, in which Botswana had notably reduced its infant and under-five mortality and increased its life expectancy in the 90’s. However there has been a threat to these achievements due to the scourge of HIV/AIDS that has reversed notable achievements made in the nation’s quality of life.
Country
Botswana
Publisher
National AIDS Coordinating Agency
URL:
Theme area
Equitable health services
Title of publication Overview of the essential health services in Malawi
Date of publication
2006 August
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
Malawi, HIV, AIDS
Abstract
Despite commitments to healthcare and positive moves by the government such as the policy to decentralise healthcare management services, the government of Malawi is not spending enough on this vital sector. Under the Abuja Declaration on HIV/AIDS, Tuberculosis and other related diseases, adopted on 27 April 2001 by African heads of states and governments, the Malawi government agreed to spend at least 15% of its national budget on healthcare. In 2006 the government dedicated 8% of its national budget to healthcare and is heavily reliant on donors to cover the much-needed additional expenditure for this sector. Consequently this has led to a dramatic shortfall in the number of healthcare workers needed to address the nation’s health requirements. A health facility survey (JICA and MOH) conducted in 2003 showed that of the 26 districts in Malawi, 15 (60%) had fewer than 1.5 nurses per health centre, while 5 (20%) had less than 1 nurse per health centre. It also showed that out of the 26 districts, 10 had no doctor in the government district hospitals and four had no doctor at all. The concentration of healthcare resources, including health workers, in larger urban centres is proving an obstacle to achieving the MDGs and is increasing the overall vulnerability of Malawians to HIV and AIDS.
Country
Malawi
Publisher
Oxfam Malawi
Theme area
Values, policies and rights
Title of publication Regaining control: Realising women’s rights to control their own sexuality, well-being and reproductive health in Africa
Date of publication
2006 September
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
woman, equity, sexual health, HIV, AIDS, Africa
Abstract
Since 2001, Africa’s leaders have committed the African Union and their Governments to promote and protect the right to health in a series of international and continental legal protocols and declarations. These commitments provide a comprehensive package for addressing the challenges of maternal mortality, HIV/AIDS, violence and disease. However, the urgent action needed to address what African Governments have described as a “continental state of emergency” can only be achieved by ensuring firm policy and programme linkages between Sexual and Reproductive Health, HIV/AIDS and Gender Based Violence.
Country
Mozambique
Publisher
Oxfam Mozambique
Theme area
Governance and participation in health
Title of publication Democracy and health: An overview of issues presented in four papers
Date of publication
1994 January
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
Democracy, health, strategy
Abstract
This overview presents key questions and strategic options in the area of democracy and health, as an introduction to the material examined in more detail in the four background papers.
Country
United States
Publisher
Harvard School of Public Health
URL:
Theme area
Governance and participation in health
Title of publication When both states and markets fail: Asymmetric information and the role of NGOs in African health care.
Date of publication
2002 February
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
equity in health, quality of healthcare, NGO
Abstract
In African health care the “miracle of the market” has not occurred. Patients exhibit willingness to pay for quality health care and yet good private practitioners are unable to sell their services. Simultaneously nongovernmental organizations (NGOs) are running successful health facilities for which patients are willing to pay. We use a model of the demand for health care in the presence of asymmetric information that allows us to view African health care in the framework of the New Institutional Economics literature. We validate this view empirically and show that NGOs have the institutional capacity to deliver high quality health care. We show that at the same time, neither private practitioners nor regular government organizations charging fees will easily succeed.
Country
Netherlands
Publisher
Elsevier Science Inc
Theme area
Equity and HIV/AIDS
Title of publication Children in Africa with experiences of massive trauma
Date of publication
2005 April
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
HIV/AIDS, children, trauma, Africa
Abstract
The impact of wars and AIDS on children in Africa is immense. Eighteen of the fifty-three countries on the continent are currently involved in, or emerging from armed conflicts. In conflicts where terrorizing civilians has become a routine means to political and military ends, women and children are deliberately targeted for torture and death. Apart from being exposed to wars or even participating in wars as soldiers, there are more than 12 million orphans in Africa today due to the AIDS epidemic. This overwhelming number of needy children has meant that kin support structures can no longer cope.
Country
Sweden
Publisher
Sida
URL:
Theme area
Equitable health services
Title of publication Global meeting on future strategic directions for primary health care: Primary health care and human resources development
Date of publication
2003 October
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
equity in health, human resources
Abstract
In 1978, the International Conference on Primary Health Care in Alma-Ata granted international recognition to the concept of primary health care (PHC), as a result of numerous practical experiences in different countries worldwide. The vision laid out in Alma-Ata offered the group of national governments a strategy for attaining a universal goal of health (Health for All by the Year 2000) that was meant to mobilize political will and set in motion national health system reform processes. This year marks the 25th anniversary of that historic event and is a moment for reflecting on and taking stock of the meaning of the experience, as well as the achievements and possible failures of the strategy.
Country
Switzerland
Publisher
World Health Organization
Theme area
Equity and HIV/AIDS
Title of publication Sub-Saharan Africa fact sheet
Date of publication
2005 November
Publication type
Document
Publication details
Publication status
Language
Keywords
Abstract
Country
Publisher
World Health Organization
Theme area
Monitoring equity and research to policy
Title of publication Equity Gauge: A tool for monitoring equity in health and health care in South Africa
Date of publication
2000 November
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
equity in health
Abstract
The Equity Gauge is a national project established to help South Africans measure if their health is improving. It also helps measure if health care is being provided in a way that is fair and equitable. The project is a partnership between South African Legislators and the Health Systems Trust, a Non-Governmental Organisation established in 1992 to support the transformation of the health system. The project is funded by the Henry J. Kaiser Family Foundation (USA) and the Rockefeller Foundation.
Country
Publisher
Equity Guage
Theme area
Equitable health services
Title of publication Dossier 2: Equity in health system development
Date of publication
2004 February
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
health system development
Abstract
The Alma Ata declaration of Health for All in 1978 was underpinned by an explicit commitment to equity in both health and health care. In the years since, equitable access and resource distribution in health systems around the world continue to be a challenge. Yet, equitable health systems are a pre-requisite to achieving the Millennium Development Goals. This document highlights areas significant to developing equitable health systems.
Country
Canada
Publisher
Canadian Coalition for Global Health Research
Theme area
Governance and participation in health
Title of publication Accountability and participation in Africa
Date of publication
2004
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
Community, accountability, participation
Abstract
The brief for this chapter was to review current experience in Africa with health sector reforms (HSR) as they pertain to health service accountability to users. The chapter, in fact, focuses as much on participation as on accountability, on the argument that the way in which community members participate will determine whether or not health services are accountable to them.
Country
South Africa
Publisher
Woman’s Health Project
URL:
Theme area
Equitable health services
Title of publication The district health system: Experiences and prospects in Africa
Date of publication
2004
Publication type
Book
Publication details
Publication status
Published
Language
English
Keywords
District health system, Africa, accessible healthcare, affordable healthcare
Abstract
Over the last two decades, the Deutsche Gesellschaft für Technische Zusammenarbeit (GTZ) has been implementing programmes and projects on health systems development and the strengthening of district health systems.This work is based on the strategic and policy decisions of the German Government, which funded these programmes as part of its commitment to international development assistance to the world’s most needy countries. The strengthening of district health systems is an essential step in making health services accessible and affordable for the population groups who would otherwise be unable to reap the benefits of health promotion, good quality health care, and access to essential drugs. In this book, 16 colleagues who have personally supported these programmes with their knowledge and expertise reflect on their experiences, opportunities and obstacles encountered. Finally, they make recommendations as to the best way forward.
Country
Germany
Publisher
Deutsche Gesellschaft für Technische Zusammenarbeit
Theme area
Equitable health services
Title of publication The district health system in South Africa: Progress made and next steps
Date of publication
2001 July
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
decentralisation, DHS, South Africa
Abstract
This article attempts to describe the various forms of decentralisation and how it is being implemented in the health system. In addition, the paper will explain why the DHS was adopted and what progress has been made to date in its implementation. The paper ends by proposing next steps on the path to the establishment of well functioning health districts.
Country
South Africa
Publisher
Management Sciences for Health
Theme area
Equitable health services
Title of publication Creating partnerships, improving health
Date of publication
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
Community based research
Abstract
Health-related research studies may develop new treatments or find ways to prevent disease. But it can take years before these treatments become available in most clinics, doctors’ offices, or community health centers. This is especially true for disadvantaged communities, even when they are the subject of the research.
Country
United States
Publisher
US Department of health and human services
Theme area
Equity and HIV/AIDS
Title of publication AIDS in Africa: Three scenarios to 2005
Date of publication
2005 January
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
HIV, AIDS, Africa
Abstract
If, by 2025, millions of African people are still becoming infected with HIV each year, these scenarios suggest that it will not be because there was no choice. It will not be because there is no understanding of the consequences of the decisions and actions being taken now, in the early years of the century. It is not inevitable.
Country
Switzerland
Publisher
UNAIDS
URL:
Theme area
Poverty and health, Equity and HIV/AIDS
Title of publication AIDS primary health care and poverty
Date of publication
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
Equity, HIV, AIDS, Poverty
Abstract
This paper analyses the complex interrelation between poverty and AIDS. Poverty, in its many and diverse aspects and with its many and diverse consequences, creates a fertile breeding ground for the expansion of HIV/AIDS. In turn, HIV/AIDS, for its mode of transmission and its epidemiological features, badly affects the livelihood of its victims, their families, their entire communities and countries. Sub Saharan Africa bears the brunt of the epidemic. The fight against HIV/AIDS is the fight against poverty. The resources to win this war are not lacking. What seems to be lacking are vision, political will and genuine interest in all human beings.
Country
Uganda
Publisher
Uganda Martyrs University
URL:
Theme area
Human resources for health, Equity and HIV/AIDS
Title of publication Governance, equity and health
Date of publication
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
Governance, Equity, HIV/AIDS, health systems, attrition
Abstract
South Africa has one of the fastest growing HIV/AIDS epidemics in the world, with over 5 million of its 42 million people HIV-infected. The resulting impact on South Africa's health sector has been profound. HIV/AIDS has directly affected—and infected—the health system's human resources, expected to lose one-fifth of its employees to the disease over the next few years. Absenteeism and high levels of attrition due to HIV-related illnesses and death have contributed to the enormous strain on South Africa's health sector.
Country
South Africa
Publisher
University of Western Cape
Theme area
Equity and HIV/AIDS
Title of publication Bottlenecks and drip-feeds
Date of publication
2005
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
HIV, Aids, children
Abstract
Southern Africa is being devastated by the loss of health and life resulting from HIV/AIDS. Among the most tragic outcomes of the HIV/AIDS pandemic is its impact on children. One of the biggest challenges for all concerned is how to support the huge and growing numbers of orphans and vulnerable children within their own communities. Small groups of committed community members are already caring for children, but are in urgent need of more funds and technical support to ensure that all orphans and vulnerable children receive the support they need. Currently many blockages exist that prevent resources from reaching communities.
Country
United Kingdom
Publisher
Save the Children
URL:
Theme area
Equitable health services, Equity and HIV/AIDS
Title of publication Vaccine preventable diseases bulletin
Date of publication
2005 January
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
Vaccine, Immunization, Preventable diseases
Abstract
The 12th meeting of the Task Force on Immunization (TFI) in Africa and the 11th meeting of the Africa Regional Inter-Agency Coordination Committee (ARICC) took place in Bamako, Mali, from 7th to 9th December 2004. Established by the Regional Director in 1991, the TFI is mandated to provide broad guidance to immunization programs in the African Region. On the other hand, the ARICC serves to bring together the major partners to harmonize approaches and to promote coherence as well as resource mobilization in support to immunization programs in the Region.
Country
Switzerland
Publisher
World Health Organization
Theme area
Governance and participation in health
Title of publication Local Primary Health Care Committees and Community-Based Local Primary Health Care Committees and Community-Based Public Recognise and Appreciate Them?
Date of publication
2006
Publication type
Journal Article
Publication details
Ethno-Med 08 pp 1-9
Publication status
Publication status unknown
Language
English
Keywords
Community participation; health seeking behaviour; priority-setting; Tanzania
Abstract
A study was conducted to explore the views of villagers on the existence and functioning of local primary health-care (PHC) committees, village health workers (VHWs), skilled staff at government health facilities and their responsiveness to community health needs in Mkuranga district, Tanzania. Information was collected through separate group discussions with some members of households, local PHC committees and district health managers and semistructured interviews with individual household members, clinical and nursing staff at peripheral government facilities, and indepth interviews with officers in central and local government departments at district level. Some villagers did not recognise the existence of VHWs and PHC committees at community level. There was a common report from the village respondents that some nurses behaved impolitely to antenatal clients. Dissatisfaction with diagnostic and prescription skills of rural medical-aides and laboratory services was reported by the majority of the residents, albeit some health staff were not happy with villagers complaining while knowing the constrained health staff working conditions.To ensure a sense of public trust, ownership and use of the existing health service system, community members need regular and timely feedback on health service delivery constraints and the existing community health-based health organisations for them to effectively participate in health development matters.
Country
Tanzania
Publisher
URL:
Theme area
Equity in health
Title of publication Country health equity analysis: Malawi
Date of publication
2007 January
Publication type
Document
Publication details
EQUINET Discussion Paper pp 1-35
Publication status
Published
Language
English
Keywords
Malawi, health equity, health care, essential health package, SWAp
Abstract
This report explores the health equity issues in Malawi, as a country equity analysis and contribution to this regional picture. It explores the current equity situation in Malawi, and the way forward to promote equity in health through a strong network of equity actors whose voice would advocate for equitable access to basic quality health care in Malawi.
Country
Zimbabwe
Publisher
EQUINET
URL:
Equinet Publication Type
Discussion paper
Theme area
Equitable health services, Governance and participation in health
Title of publication Discussion paper 40: A review of district health systems in east and southern Africa: Facilitators and barriers to participation in health
Date of publication
2007 January
Publication type
Document
Publication details
EQUINET Discussion Paper 40 pp 1-27
Publication status
Published
Language
English
Keywords
community participation, district health systems, citizens, people-centred, sub-Saharan Africa
Abstract
We reviewed the available published and grey literature, with a focus on primary health care and the district health systems in sub-Saharan Africa, in order to explore the facilitators and barriers to community participation. We selected six African countries for deeper review and analysis: Botswana, Lesotho, Namibia, Rwanda, Swaziland and Tanzania. The work signals a need for more culturally informed interventions that draw from indigenous knowledge bases, with evidence-based data that is culturally relevant, and that contextualises poverty, health risks and systems in sub-Saharan Africa. This requires further deconstruction of current definitions of ‘district health system’, analysing social constructions of health systems, and finding out how they have been affected by global trends, market reforms and policy shifts, like decentralisation. A number of challenges remain, not the least of which is the prevailing perspective of the citizen as an object of health care or object of research, rather than the required perspective of citizen as participant and knower. So, this perspective needs to change. In research and training, this change of perspective can help to promote health literacy, greater intentionality and a better understanding of local–central power relations, which will inform cross-disciplinary designs for future research.
Country
East and southern Africa region
Publisher
EQUINET
URL:
Equinet Publication Type
Discussion paper
Theme area
Values, policies and rights, Health equity in economic and trade policies
Title of publication Capacity Building Paper: Implications of the GATS and TRIPS agreements for the Right to Health in Malawi
Date of publication
2007 January
Publication type
Academic paper
Publication details
EQUINET Capacity Building Paper 13 pp 1-22
Publication status
Published
Language
English
Keywords
GATS, TRIPS, WTO, globalisation, liberalisastion, health services, drugs, pharmaceuticals, patent law, human rights, Malawi
Abstract
This report undertakes an analysis of the relevant provisions of the World Trade Organisation (WTO) Trade Related Aspects of Intellectual Property Rights (TRIPs) and the General Agreement of Trade in Services (GATS) agreements with respect to the provision and accessibility of health services. The globalisation of production and marketing of drugs and health services is impacting heavily on developing countries. Consequently, the patent system works very well in industrialised countries where the burden of health care (on both governments and individuals) is relatively low and ensures the continuing development of new drugs. But in poor countries, where the burden of health care is very high, the patent system has failed to provide an adequate response to many prevalent diseases and has restricted access to cheaper drugs. Coupled with the pressure of liberalising and privatising health services under the GATS agreement, this will lead to the collapse of health delivery systems of most developing countries.
Country
Malawi
Publisher
SEATINI, UCT, EQUINET
URL:
Equinet Publication Type
Capacity building papers
Theme area
Values, policies and rights, Health equity in economic and trade policies
Title of publication Capacity Building Paper: Zambia: The right to health and international trade agreements
Date of publication
2007 January
Publication type
Academic paper
Publication details
EQUINET Capacity Building Paper 14 pp 1-21
Publication status
Published
Language
English
Keywords
GATS, TRIPS, WTO, globalisation, liberlisastion, health services, drugs, pharmaceuticals, patent law, human rights, Zambia
Abstract
This report undertakes an analysis of the relevant provisions of the World Trade Organisation (WTO) Trade Related Aspects of Intellectual Property Rights (TRIPs) and the General Agreement of Trade in Services (GATS) agreements with respect to the provision and accessibility of health services. The globalisation of production and marketing of drugs and health services is impacting heavily on developing countries. Consequently, the patent system works very well in industrialised countries where the burden of health care (on both governments and individuals) is relatively low and ensures the continuing development of new drugs. But in poor countries, where the burden of health care is very high, the patent system has failed to provide an adequate response to many prevalent diseases and has restricted access to cheaper drugs. Coupled with the pressure of liberalising and privatising health services under the GATS agreement, this will lead to the collapse of health delivery systems of most developing countries.
Country
Zambia
Publisher
SEATINI, UCT, EQUINET
URL:
Equinet Publication Type
Capacity building papers
Theme area
Resource allocation and health financing
Title of publication Discussion paper 43: Zimbabwe National Health Sector Budget Analysis and Equity Issues
Date of publication
2006 October
Publication type
Academic paper
Publication details
EQUINET Discussion Paper 43 pp 1-41
Publication status
Published
Language
English
Keywords
budget analysis, health financing, equity, revenue mobilisation, health promoting investments, policy targets, Zimbabwe
Abstract
This study was implemented to identify trends in the health budget 2001-2006, assess the equity oriented nature of these trends and make recommendations to strengthen pro-equity dimensions of the health budget. The review examines the budget in three major respects: how far are the opportunities for equity in revenue mobilisation being tapped; how far are the allocation and expenditure patterns promoting policy targets, particularly equity; and how far are incentives and investments levering health promoting investments (and penalizing those that undermine health)? The study drew evidence from secondary data and national surveys, from reported Ministry of Finance estimates and from the reported budget allocations provided by government, with a focus on the years 2000-2006.
Country
Zimbabwe
Publisher
EQUINET
URL:
Equinet Publication Type
Discussion paper
Theme area
Human resources for health
Title of publication Discussion Paper 34: Distribution of public sector health workers in Zimbabwe: A challenge for equity in health
Date of publication
2006 April
Publication type
Academic paper
Publication details
EQUINET Discussion Paper 34 pp 1-12
Publication status
Published
Language
English
Keywords
human resources for health, distribution of healthworkers; public sector; impact; health care delivery, incentives, Zimbabwe
Abstract
Zimbabwe, like many other countries in the region, is badly affected by a shortage of health workers. Many of the health indicator improvements achieved during the first ten years of independence are on the decline and the main reason for this is shortage of skilled and experienced health workers at a time when demand for services is increasing due to a growing population and the challenges posed by HIV/AIDS. The public sector provides as much as 65% of health care services in the country (MoHCW 2004), and so a shortage of public sector health workers affects a great majority of the population. Against this background of increasing shortages, concern has been expressed about giving prominence to improved management and better distribution of human resource in health care systems within the SADC region, an area that is witnessing deteriorating health indicators due to shortage of health professionals. This study explored the distribution of public sector health workers to show how its pattern impacts on equity objectives in health care delivery.
Country
Zimbabwe
Publisher
EQUINET
URL:
Equinet Publication Type
Discussion paper
Theme area
Health equity in economic and trade policies
Title of publication Policy Brief 16: Claiming our space: Using the flexibilities in the TRIPS agreement to protect access to medicines
Date of publication
2006 November
Publication type
Document
Publication details
EQUINET Policy Brief 16 pp 1-8
Publication status
Published
Language
English
Keywords
TRIPS; WTO; flexibilities; affordable medicine; patent monopolies; access to medicine; southern Africa
Abstract
In 2001 the Doha Declaration on TRIPS and Public Health provided a landmark political commitment reaffirming the option for World Trade Organisation (WTO) member states to use all flexibilities provided in the TRIPS Agreement to ensure access to affordable medicines, and to prevent patent monopolies stopping access to medicines where they are needed for public health. By 2006, many of these flexibilities are not yet exploited in Africa, despite the massive demand for cheap medicines. This brief outlines the opportunities that African countries have to use these flexibilities and the legal and other changes needed for this. It also outlines the challenges that we may face and the measures to respond to them.
Country
Southern Africa Regional
Publisher
EQUINET, SEATINI
URL:
Equinet Publication Type
Briefs, Policy brief
Theme area
Equitable health services
Title of publication Proposed areas of investigation for the Knowledge Network: An initial scoping of the literature
Date of publication
Publication type
Publication details
Health Systems Knowledge Network Discussion Paper 1 pp 1-28
Publication status
Published
Language
English
Keywords
health services; social groups; social factors; household health-seeking behaviour; health consequences; economic consequences; health costs; social stratification
Abstract
The review began by presenting data showing that health services tend to be used proportionately more by richer than poorer social groups. It analysed the social factors affecting access to, and uptake of, health services and showed how these interact with
inequitable features of the health care system. Overall, the review argued that the interaction between household health-seeking behaviour and experience of the health system generates differential health and economic consequences across social groups. The long-term costs of seeking care often impoverish poorer households, reinforcing pre-existing social stratification.
Country
Switzerland
Publisher
World Health Organisation, The Health Systems Knowledge Network Hub
URL:
Equinet Publication Type
Discussion paper
Theme area
Human resources for health
Title of publication Conference: Human resources for health research: An African perspective
Date of publication
2006 July
Publication type
Conference Proceedings
Publication details
Final report and record of expert consultations, Nairobi, July 2006 pp 1-76
Publication status
Published
Language
English
Keywords
brain drain, capacity building, health sector, human resources
Abstract
The HR-HR initiative brings a new perspective to the questions of brain drain, capacity building in the health sector and to the World Health Organization’s 2006 World Health Report “Working Together for Health”, that highlights the urgent need to improve human resources in the health sector in developing countries (HRH). The WHO report highlights key issues that need to be addressed to improve human resources for health, but does not address the critical implications of skills and human resources needed by developing countries to improve the health research sector.
The HR-HR expert meeting held on July 2-5, 2006 did not have the objective to produce conclusions and definitive recommendations. Rather, its purpose was to open discussion on four themes and bring new perspectives to the HRH debate. HR-HR is a work in progress. Its starting point will be a publication composed of the papers on each of the four HR-HR themes, planned for end 2006.
Country
Kenya
Publisher
Global Forum for Health Research; IDRC; COHRED; African Health Research Forum; EQUINET; AMREF; ACOSHED
URL:
Equinet Publication Type
Reports
Theme area
Resource allocation and health financing
Title of publication Notes on international development assistance in health and its effectiveness: The interests of recipient countries
Date of publication
2001 August
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
aid, development, resources, case studies
Abstract
The Commission on Macroeconomics and Health (CMH) was established by key stakeholders interested in improving global health. The objectives of the work of The Commission include establishing health as a major object of development and recommending decisions and actions that will improve the impact of Development Assistance in Health (DAH), particularly on the well-being of the poor. The Commission reviewed amounts of resources available in relation to the potential pool of resources; examined how what is available is used and what results have been achieved; and explored in what ways the world could do better. This document outlines better and more effective ways to achieve health objectives through aid and developmental programs
Country
Unknown Country
Publisher
Commission on Macroeconomics and Health
URL:
Theme area
Equitable health services
Title of publication Transforming health systems to improve the lives of women and children
Date of publication
2005 March
Publication type
Journal Article
Publication details
The Lancet 365 pp 997-1000
Publication status
Published
Language
English
Keywords
transformation, childcare, maternal care, health systems
Abstract
Ambitious quantitative goals for reducing mortality and increasing access to health interventions are nothing new to the areas of child, maternal, and reproductive health. This document looks at how health systems can be transformed to meet the goals of global declarations.
Country
United Kingdom
Publisher
British Medical Association
URL:
Theme area
Equitable health services, Monitoring equity and research to policy
Title of publication Child health inequities in developing countries: Differences across urban and rural areas
Date of publication
2006 July
Publication type
Document
Publication details
International Journal for Equity in Health pp 1-10
Publication status
Published
Language
English
Keywords
health disparities, data collection, monitoring tools, patterns of spatial distribution
Abstract
The urban advantage in health masks enormous disparities between the poor and the non-poor in urban areas of sub-Saharan Africa. Specific policies geared at preferentially improving the health and nutrition of the urban poor should be implemented, so that while targeting the best attainable average level of health, reducing gaps between population groups is also on target. To successfully monitor the gaps between urban poor and non-poor, existing data collection programs should be re-designed to capture the changing patterns of the spatial distribution of population.
Country
Unknown Country
Publisher
BioMed Central Ltd.
URL:
Theme area
Equitable health services, Governance and participation in health, Monitoring equity and research to policy
Title of publication Monitoring and evaluation of decentralization reforms in developing country health sectors
Date of publication
2004 September
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
research tools, decentralisation, monitoring, evaluation, conceptual framework, data collection, research methodologies
Abstract
The decentralisation of responsibilities from the central government to lower levels of government or semi-autonomous institutions has become an increasingly common strategy for improving the performance of health systems in developing countries and ultimately for improving the health status of developing country populations. However, efforts to monitor and evaluate the implementation and functioning of decentralisation programs are often hampered by poor or incompatible data, by the absence of sound research designs, and by the sheer scope of the reform, which can encompass all aspects of health system functioning. This work presents a conceptual framework for identifying key areas for evaluation of decentralisation programs and the pathways – and potential barriers – by which decentralisation can affect health systems. It also identifies ways to evaluate the impact of decentralisation in achieving key objectives – improved efficiency, accessibility, equity, community participation and health status. The work outlines the types of data that can be collected and a detailed set of indicators in several broad areas – political, administrative, and fiscal – that can be useful for monitoring and evaluation purposes. Most of the indicators described can be collected from existing data collection techniques, although to date, many of these data are not part of routine data collection in many countries. Numerous data collection tools are also described, as are the types of analyses – including impact evaluations of decentralisation – that can be undertaken with that data.
Country
United States
Publisher
Partners for Health Reform Plus
URL:
Theme area
Monitoring equity and research to policy
Title of publication Responsive evaluation: Its meaning and special contribution to health promotion
Date of publication
2005
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
health promotion, injury prevention, evaluation
Abstract
This article presents the theory and methodology of responsive evaluation and discusses several controversial issues among them the nature of evidence and the political question: who should determine what counts as evidence? The value and meaning of responsive evaluation are illustrated by a case example of an injury prevention program for students in two performing art schools.
Country
Netherlands
Publisher
University of Maastricht
URL:
Theme area
Equitable health services
Title of publication Primary Health Care: A framework for future strategic directions
Date of publication
2003
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
Health, primary health care, equity
Abstract
This report provides a platform for debate at the Madrid meeting and subsequent reports to the Fifty-seventh World Health Assembly in May 2004.
Country
Switzerland
Publisher
World Health Organization
URL:
Theme area
Governance and participation in health
Title of publication Democracy and health: An overview of issues presented in four papers
Date of publication
1994 January
Publication type
Document
Publication details
Data for Decision Making Project pp 1-23
Publication status
Published
Language
English
Keywords
developing countries, democratisation, health policy
Abstract
The current global trend toward democratisation provides an opportunity for health improvement in developing countries. Many countries are now experiencing an expansion of the competitive political market along with economic liberalisation. These democratic trends alone, however, may not necessarily lead to better health for the population. This documents examines the relationship between democracy and health in developing countries. This analysis holds critical implications for USAID’s role in promoting democratisation, which constitutes one of the agency’s main strategic pillars for assistance. The health sector within USAID, therefore, may benefit from an exploration of the key issues of democratisation and their implications for health assistance policy.
Country
Publisher
URL:
Theme area
Equity in health
Title of publication Primary health care and the Millennium Development Goals: Issues for discussion
Date of publication
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
Health policy, equity, development, global initiatives, MDGs, funding targets, financial inputs
Abstract
Both the Millennium Development Goals (MDGs) and the Report of the Commission on Macroeconomics and Health recommend and assume extensive new financial inputs to health care. If these recommendations and expressed funding targets materialize, development will be greatly facilitated. The influence of these activities and recommendations will be shown in the decisions made by donor countries concerning their development aid. This paper looks at the crucial issues for success such at how developing countries ensure, vis-à-vis these global initiatives, the necessary country leadership, harmonization and alignment with nationally defined priorities and policies.
Country
Switzerland
Publisher
World Health Organization
URL:
Theme area
Monitoring equity and research to policy
Title of publication Pushing the international health research agenda towards equity and effectiveness
Date of publication
2004 November
Publication type
Journal Article
Publication details
The Lancet 364 pp 1630-1631
Publication status
Published
Language
English
Keywords
health research, developing countries, civil society, poor
Abstract
Despite substantial sums of money being developed to health research, most of it does not benefit the health of poor people living in developing countries – a matter of concern to civil society networks, such as the People’s Health Movement. Health research should play a more influential part in improving the health of poor people, not only through the distribution of knowledge, but also by answering questions, such as why health and healthcare inequalities continue to grow despite greatly increased global wealth, enhanced knowledge and more effective technologies. This paper looks at why and suggests a way forward for researchers.
Country
United Kingdom
Publisher
British Medical Association
URL:
Theme area
Equitable health services
Title of publication Making health systems more equitable
Date of publication
2004 October
Publication type
Journal Article
Publication details
The Lancet 264 pp 1-8
Publication status
Published
Language
English
Keywords
equity, health systems, measures, planning
Abstract
Health systems are consistently inequitable, providing more and higher quality services to the well-off, who need them less, than to the poor, who are unable to obtain them. In the absence of a concerted effort to ensure that health systems reach disadvantaged groups more effectively, such inequities are likely to continue. Yet this situation need not be accepted as inevitable, for there are many promising measures that might be pursued: establishment of goals for improved coverage in the poor, rather than in entire populations, and use of those goals to direct planning toward the needs of the disadvantaged; use of one or more of the several techniques that seem to have been effective in at least some of the settings where they have been tried; and empowerment of poor clients to have a more central role in health system design and operation.
Country
United Kingdom
Publisher
British Medical Association
URL:
Theme area
Equitable health services
Title of publication Global health improvement and WHO: Shaping the future
Date of publication
2003 December
Publication type
Journal Article
Publication details
The Lancet 362 pp 2083-2088
Publication status
Published
Language
English
Keywords
MDGs, 3 by 5, health goals
Abstract
WHO is changing its way of working, alongside member states and financial and technical partners, to reach key national health goals and strengthen equity. This document focuses on the most urgent WHO interventions, including: the health-related Millennium Development Goals, the 3 by 5 target in HIV/AIDS treatment (to provide 3 million people in developing regions with access to antiretroviral treatment by the end of 2005), and addressing the growing epidemics of non-communicable diseases.
Country
United Kingdom
Publisher
British Medical Association
URL:
Theme area
Equitable health services
Title of publication Reducing child mortality: Can public health deliver?
Date of publication
2003 July
Publication type
Journal Article
Publication details
The Lancet 362 pp 159-164
Publication status
Published
Language
English
Keywords
child mortality, interventions, delivery strategies, health planning, monitoring, health systems
Abstract
This paper highlights the importance of separating biological or behavioural interventions from the delivery systems required to put them in place, and the need to tailor delivery strategies to the stage of health-system development. We review recent initiatives in child health and discuss essential aspects of delivery systems, including: need for data at the subnational level to support health planning; regular monitoring of provision and use of health services, and of intervention coverage; and the need to achieve high and equitable coverage with selected interventions. Community-based initiatives can extend the delivery of interventions in areas where health services are hard to access, but strengthening national health systems should be the long-term aim. The millennium development goal for child survival can be achieved, but only if strategies for delivery interventions are greatly improved and scaled-up.
Country
United Kingdom
Publisher
British Medical Association
URL:
Theme area
Equity in health, Equitable health services
Title of publication How many child deaths can we prevent this year?
Date of publication
2003 July
Publication type
Journal Article
Publication details
The Lancet 362 pp 65-71
Publication status
Published
Language
English
Keywords
child mortality, interventions
Abstract
This document reviews child survival interventions feasible for delivery at high coverage in low-income settings, and classify these as level 1 (sufficient evidence of effect), level 2 (limited evidence), or level 3 (inadequate evidence). Our results show that at least one level-1 intervention is available for preventing or treating each main cause of death among children younger than 5 years, apart from birth asphyxia, for which a level-2 intervention is available. There is also limited evidence for several other interventions. However, global coverage for most interventions is below 50%. If level 1 or 2 interventions were universally available, 63% of child deaths could be prevented. These findings show that the interventions needed to achieve the millennium development goal of reducing child mortality by two-thirds by 2015 are available, but that they are not being delivered to the mothers and children who need them.
Country
United Kingdom
Publisher
British Medical Association
URL:
Theme area
Equity in health, Equitable health services
Title of publication Where and why are 10 million children dying every year?
Date of publication
2003 June
Publication type
Journal Article
Publication details
The Lancet 163 pp 2226-2234
Publication status
Published
Language
English
Keywords
child mortality, epidemiology, social determinants
Abstract
More than 10 million children die each year, most from preventable causes and almost all in poor countries. Six countries account for 50% of worldwide deaths in children younger than 5 years, and 42 countries for 90%. The causes of death differ substantially from one country to another, highlighting the need to expand understanding of child health epidemiology at a country level rather than in geopolitical regions. Other key issues include the importance of under-nutrition as an underlying cause of child deaths associated with infectious diseases, the effects of multiple concurrent illnesses, and recognition that pneumonia and diarrhoea remain the diseases most often associated with child deaths. A better understanding of child health epidemiology could contribute to more effective approaches to saving children’s lives.
Country
United Kingdom
Publisher
British Medical Association
URL:
Theme area
Equitable health services, Equity and HIV/AIDS
Title of publication The impact of HIV/AIDS on the health system and child health
Date of publication
2002 June
Publication type
Book Section
Publication details
AIDS, Public Policy and Child Well-Being pp 1-49
Publication status
Published
Language
English
Keywords
HIV, AIDS, child mortality, policy, programmes
Abstract
This chapter reviews the impact of HIV/AIDS on the health sector and on the health status of children in 40 developing countries with medium-high HIV prevalence rates. The chapter illustrates the merits and limitations of the policy and programme responses introduced so far to fight the new pandemics. It concludes that the current efforts on prevention ought to be intensified and the severe problems encountered in this area rectified. At the same time, the future of child mortality will depend also on: a renewed strengthening of PHC as the main vehicle for the treatment of all child diseases, both AIDS and non-AIDS related; a rapid expansion of PMTCT programs; and a gradual expansion of the treatment of mothers and other adults with generic antiretroviral drugs according to simplified protocols.
Country
Italy
Publisher
UNICEF
URL:
Theme area
Resource allocation and health financing
Title of publication A force for change: The Global Fund at 30 months
Date of publication
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
HIV, AIDS, malaria, tuberculosis, financing mechanisms, aid
Abstract
In January 2002, the Global Fund to Fight AIDS, Tuberculosis and Malaria was established. Its creation was the culmination of the hopes and hard work of thousands of people around the world from civil society and governments north and south, each motivated by a belief that the three epidemics could be reversed and their devastation stemmed.This document looks at the record of the Global Fund since its inception..
Country
Switzerland
Publisher
Global Fund
Theme area
Equitable health services, Governance and participation in health, Monitoring equity and research to policy
Title of publication Participatory health information systems development in Cuba: The challenge of addressing multiple levels in a centralized setting
Date of publication
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
Cuba, Africa, Asia, participation, information systems
Abstract
This paper addresses issues of user participation in a large centralistic organisation, based on one year experience of developing a computerised health information system within the Cuban health services. Relevant literature suggests that participative methods may be less feasible in centralistic environments. This paper confirms this by describing how participation in Cuba is restricted by political and organisational constraints. However participatory approaches may be very rewording where such constraints are overcome. The research reported is carried out within a framework of a larger network of similar health information projects being carried out in Africa and Asia, and the case of Cuba is being compared with experience from these countries.
Country
Sweden
Publisher
University of Oslo
Theme area
Title of publication 2005/2006 Report
Date of publication
Publication type
Electronic Source
Publication details
Publication status
Published
Language
English
Keywords
Health, equity, health inequalities, public health
Abstract
Global Health Watch 2005-2006 is a collaboration of public health experts, non-governmental organisations, community groups, health workers and academics. It presents a hard-hitting assessment of inequalities in health and health care - and is aimed at challenging the major institutions, such as the World Health Organization, that influence health.
Country
Publisher
Global Health Watch
Theme area
Values, policies and rights
Title of publication Growing up global: The changing transitions to adulthood in developing countries
Date of publication
2005
Publication type
Book
Publication details
Publication status
Published
Language
English
Keywords
globalisation, youth, inequality, social polarisation
Abstract
The challenges for young people making the transition to adulthood
are greater today than ever before. Globalisation, with its power to reach across national boundaries and into the smallest communities, carries with it the transformative power of new markets and new technology. At the same time, globalization brings with it new ideas and lifestyles that can conflict with traditional norms and values. And while the economic benefits are potentially enormous, the actual course of globalisation has not been without its critics who charge that, to date, the gains have been very unevenly distributed, generating a new set of problems associated with rising inequality and social polarisation. This book examines the impact of globalisation on adolescents today.
Country
Publisher
The National Academies Press
Theme area
Poverty and health
Title of publication Health, poverty and vulnerability
Date of publication
Publication type
Electronic Source
Publication details
Publication status
Published
Language
English
Keywords
Health, equity, poverty, vulnerability, access to health services
Abstract
The Millennium Development Goals (MDGs) relating to poverty reduction and health improvement are closely related, reflecting the close relationships between ill-health, vulnerability and poverty. Many aspects of poverty have a negative impact on health and on access to effective health services. In turn, sickness and disability can affect the productivity of individuals, households and communities, making it more likely they will fall into poverty or be unable to escape poverty for long periods. This part of the resource guide presents information on these complex inter-relationships and appropriate policy responses.
Country
Publisher
Eldis
Theme area
Human resources for health, Equity and HIV/AIDS
Title of publication Human capacity-building plan for scaling up HIV/AIDS treatment
Date of publication
Publication type
Electronic Source
Publication details
Publication status
Published
Language
English
Keywords
HIV/ AIDS scale-up, workforce, health workers, ART, integration, capacity building, training
Abstract
This document outlines a strategic plan for WHO to support the development, strengthening and sustaining of the workforce necessary to radically scale up and maintain antiretroviral treatment (ART). The strategic approach is based on the understanding that achieving this goal critically depends on joint efforts between communities, countries and international organisations. It builds on the experience of successful capacity-building efforts and harnesses existing expertise to strengthen training capacity at the regional and country level in the context of an emergency response.
Country
Switzerland
Publisher
World Health Organization
Theme area
Human resources for health
Title of publication Writing a new prescription for Lesotho
Date of publication
2006 April
Publication type
Electronic Source
Publication details
Publication status
Published
Language
English
Keywords
Lesotho, health, equity, doctors, managing human resources, training
Abstract
There are only about 90 doctors for the two million people living in Lesotho, a small, landlocked country in southern Africa, where the World Health Organization estimates that nearly one of every four adults, and more than 30 percent of pregnant women, are HIV-positive. The hospitals and clinics need help managing their scarce resources. Physicians need the skills to handle really sick people in a hospital and skills in front-line medicine and trauma care. And because physicians in district hospitals are also usually in charge of them, they need training in things like contracts and budgets.
Country
Publisher
BU Today
Theme area
Equity and HIV/AIDS
Title of publication Lesotho develops national guidelines and standards for residential care for orphaned and vulnerable children
Date of publication
2006 March
Publication type
Electronic Source
Publication details
Publication status
Published
Language
English
Keywords
Lesotho, vulnerable children, orphans, national guidelines
Abstract
With the scarce resources of communities already stretched beyond limits and safety nets eroded by the impact of HIV/AIDS, poverty and weakened governance, many orphaned and vulnerable children are being abandoned in places of safety. The latter are often make-shift homes independently set up by individuals. Without guidelines regulating the conduct, standards of care and provision of services, these homes, mushrooming all over Lesotho often expose children to further vulnerability, abuse and neglect. To address this emerging phenomenon, and ensure that children\\\'s rights are upheld and protected especially in these volatile and often precarious conditions a the Department of Social Welfare in collaboration with UNICEF and stakeholders from different sectors* developed Lesotho specific guidelines and standards regulating Residential Care for vulnerable children.
Country
Lesotho
Publisher
Medical News Today
Theme area
Equity in health
Title of publication Lesotho country profile
Date of publication
Publication type
Electronic Source
Publication details
Publication status
Published
Language
English
Keywords
Equity, health system, statistics, Lesotho
Abstract
A Lesotho country profile, presenting the context of health concerns, health expenditures, coverage, human resource issues and illnesses of specific concern.
Country
Lesotho
Publisher
World Health Organization
Theme area
Equitable health services
Title of publication International peer learning in the health sector: DSE promotes public health systems in developing countries
Date of publication
1999 June
Publication type
Electronic Source
Publication details
DC Development and Cooperation 3 pp 16-18
Publication status
Published
Language
English
Keywords
primary health care services, health policy
Abstract
The objective of the Public Health Promotion Centre of the DSE is to assist developing countries in the implementation of Primary Health Care services. It does so in a number of innovative approaches which are a far cry from traditional health care projects, as outlined in this article
Country
Publisher
DC Development and Cooperation
Theme area
Values, policies and rights
Title of publication A synopsis of health policies and legislation: 1994 - 2000
Date of publication
Publication type
Electronic Source
Publication details
Publication status
Published
Language
English
Keywords
South Africa, health policies. legislation
Abstract
This publication is intended for use by all health workers and is an attempt to summarise the most important national health policies and legislation. This is in response to the perception that many health workers are not aware of national health policies and legislation that affect their practice. We have also included summaries of other policies and legislation that have a bearing on the delivery of health services, like the White Paper on Transforming Public Service Delivery, the Employment Equity Act, the Public Service Act and the Public Finance Management Act. The rationale for this is that these pieces of legislation impact significantly on health personnel and financial matters.
Country
South Africa
Publisher
Government of South Africa
Theme area
Poverty and health
Title of publication CAFOD Rwanda country profile
Date of publication
Publication type
Electronic Source
Publication details
Publication status
Published
Language
English
Keywords
Rwanda, poverty, conflict resolution, trauma counselling
Abstract
An overview of CAFOD\'s work in Rwanda, including trauma counselling and conflict resolution.
Country
Publisher
Catholic Agency for Overseas Development
Theme area
Equitable health services, Resource allocation and health financing
Title of publication The International Response to Conflict and Genocide: Lessons from the Rwanda Experience
Date of publication
Publication type
Electronic Source
Publication details
Journal of Humanitarian Assistance
Publication status
Published
Language
English
Keywords
Rwanda, impact of aid
Abstract
The primary objective of this report is to examine the effectiveness, impact and relevance of international assistance on repatriation, rehabilitation, reconstruction and long-term development in Rwanda in the aftermath of the violence that destroyed or severely damaged much of Rwanda\\\'s social, cultural and economic institutions. The report is based on interviews with relief and development agencies in the US and Europe, and on field visits to Rwanda and neighboring countries. The report is a synthesis of the sectoral and topical reports prepared during the field visit.
Country
Publisher
Journal of Humanitarian Assistance
Theme area
Resource allocation and health financing
Title of publication Community-based health insurance in Rwanda
Date of publication
Publication type
Electronic Source
Publication details
Publication status
Published
Language
English
Keywords
Rwanda, health insurance, pilot projects
Abstract
Building on the experiences of mutual health organizations which have emerged in the country, the Ministry of Health (MOH) initiated in 1998 pilot experiments in the health districts of Byumba, Kabgayi and Kabutare, which played a key role in the design and organization of CBHI schemes in the country. It provided also a platform for the compilation of information to support the assessment of CBHI schemes, and to familiarize health sector actors and partners with the strategies needed to support their implementation on a large scale. This document provides an overview of CBHI in Rwanda.
Country
United States
Publisher
World Bank
Theme area
Equitable health services, Resource allocation and health financing
Title of publication Strategic plan Mpumalanga department of health and social services
Date of publication
Publication type
Electronic Source
Publication details
Publication status
Published
Language
English
Keywords
South Africa, Mpumalanga, health, strategic plan
Abstract
South Africa
Country
South Africa
Publisher
Government of South Africa
Theme area
Equity in health
Title of publication SDC regional profile: Rwanda, Burundi, the Great Lakes Region
Date of publication
Publication type
Electronic Source
Publication details
Publication status
Published
Language
English
Keywords
Rwanda, Burundi, Great Lakes region, equity, aid, development
Abstract
Regional developmental profile for Rwanda, Burundi and the Great Lakes region, including development priorities, humanitarian aid priorities.
Country
Publisher
Swiss Agency for Development and Cooperation
Theme area
Equity in health, Monitoring equity and research to policy
Title of publication Rwanda Health Indicators
Date of publication
Publication type
Electronic Source
Publication details
Publication status
Published
Language
English
Keywords
Rwanda, health indicators, statistics
Abstract
Rwandan health indicators, including mortality rates, human resources, disease prevalence, nutrition, etc
Country
Rwanda
Publisher
Government of Rwanda
Theme area
Equity in health
Title of publication Swaziland country profile
Date of publication
Publication type
Electronic Source
Publication details
Publication status
Published
Language
English
Keywords
Equity, health, Swaziland, health system, statistics
Abstract
A Swaziland country profile, presenting the context of health concerns, health expenditures, coverage, human resource issues and illnesses of specific concern.
Country
Switzerland
Publisher
World Health Organization
Theme area
Equitable health services
Title of publication In Focus: Fixing health systems
Date of publication
2004
Publication type
Book
Publication details
Publication status
Published
Language
English
Keywords
Equity, health
Abstract
This book presents the TEHIP story. It is a story of hope, and holds important lessons that can be applied widely throughout the countries of the developing world, and beyond.
Country
Canada
Publisher
IDRC Books
Theme area
Governance and participation in health
Title of publication Indigenous Knowledge (IK) Program
Date of publication
Publication type
Electronic Source
Publication details
Publication status
Published
Language
English
Keywords
Indigenous knowledge, participation, locally-driven solutions, communities
Abstract
IK Notes is a monthly publication that documents development issues that can be effectively dealt with through the application of indigenous knowledge and practices. Each IK Note explores in some detail key aspects of the development challenge in a specific local context, and describes locally-driven solutions which have led to substantive results in improving livelihoods of the target communities. The lessons of experience from these cases could serve to inform development practitioners in adapting the successful practices to other contexts with a view to scaling them up.
Country
United States
Publisher
World Bank
Theme area
Equity and HIV/AIDS
Title of publication Evidence for HIV decline in Zimbabwe: A comprehensive review of the epidemiological data
Date of publication
2005 November
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
Zimbabwe, HIV/AIDS epidemic, prevalence rates, rural vs urban
Abstract
Zimbabwe has experienced one of the largest HIV epidemics in the world. The first case of AIDS was identified in 1985 and by 1990 - the first year of national antenatal-clinic based surveillance - HIV prevalence was estimated to already exceed 10%. The country’s first national estimate, produced in 2003, indicated that HIV prevalence amongst adults had reached 24.6% (range 20–28%). In part, the scale of the epidemic at country level reflects it’s widely disseminated nature. HIV prevalence in small towns, farming estates and mines located in rural areas (35%) exceeds that in the major cities (28%), whilst transmission into and within subsistence farming areas is also extensive (21%).
Country
Publisher
UNAIDS
URL:
Theme area
Poverty and health, Governance and participation in health
Title of publication CSO capacity for policy engagement: Lessons learned from the CSPP consultations in Africa, Asia and Latin America
Date of publication
2006 August
Publication type
Document
Publication details
Publication status
Language
English
Keywords
civil society organisations, pro-poor policy
Abstract
This paper was written as part of the Civil Society Partnerships Programme (CSPP). The CSPP aims to improve the capacity of Southern CSOs to influence pro-poor policy. During its first phase, the CSPP undertook a range of consultations across the world, organised in partnership with Southern policy research institutes in each country.
Country
Unknown Country
Publisher
Overseas Development Institute
URL:
Theme area
Equity in health, Equitable health services, Resource allocation and health financing
Title of publication Global health initiatives in HIV/AIDS in Tanzania: Situation analysis and review of key issues
Date of publication
2004 July
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
Tanzania, health, AIDS, global health initiatives, health system integration
Abstract
With the abundance of global health initiatives (GHI) operating these days, an obvious question to ask is “With what effect?” HIV/AIDS is one disease that is particularly loaded with global health initiatives, and Tanzania is no exception. Therefore, the specific question of this study is to examine to what extent the current global health initiatives in HIV/AIDS are integrated into the health sector in Tanzania, and harnessed to meet Poverty Reduction and Health Sector Strategic Plan targets. These GHIs are assessed under different thematic areas, covering: coordination, priority setting and planning, resource allocation, funding channel, resource requirements for implementation, mode of programme delivery, monitoring and evaluation, and poverty alleviation.
Country
Switzerland
Publisher
Swiss Centre for International Health
URL:
Theme area
Equitable health services, Resource allocation and health financing
Title of publication Tanzania’s health SWAp: Achievements, challenges and lessons learnt
Date of publication
2005 December
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
Tanzania, health, equity, SWAps
Abstract
Tanzania’s Health SWAp was launched in 1998, and thus boasts a seven-year experience. The purpose of this paper, based on a two-week mission to Dar-es-Salaam in June-July 2005 as well as a documentary review, is to analyse the processes and achievements of the SWAp, as well as the challenges it faces, so as to draw lessons from experience that, together with the results of missions to other “observation countries”, will be useful to: (a) other countries that are now proceeding with the adoption or early implementation of their own Health SWAp (or SWAps in other sectors); (b) the Belgian bilateral cooperation, in support of their operations; (c) any other party interested in the results of our work.
Country
Belgium
Publisher
University of Liège
URL:
Theme area
Resource allocation and health financing
Title of publication Policy on development co-operation
Date of publication
2003 December
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
Namibia, health, funding, policy
Abstract
This policy clarifies the goal of external assistance as a contribution to the development of the health and social welfare of the people of Namibia. It identifies the policy objectives and principles on which development co-operation should be co-ordinated and utilised, and further elaborates on strategies for achieving these objectives.
Country
Namibia
Publisher
Government of Namibia
URL:
Theme area
Equity and HIV/AIDS
Title of publication National AIDS strategic plan
Date of publication
2000 September
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
Lesotho, health, equity, HIV/ AIDS policy
Abstract
The preparation of this HIV/AIDS Policy and Strategic Plan was done in two phases. In the first phase, Government of Lesotho (GOL) with the technical assistance of the Institute of Development Management (IDM), prepared the initial draft Policy and Strategic Plan for the HIV/AIDS control. Consultations were undertaken with different ministries and other relevant stakeholders including NGOs. These ministries and other stakeholders were then requested to submit their plans in line with the Strategic Plan. The documents were received from a select number of these stakeholders, and reviewed. Further input was made at a Consensus Workshop held on 3-4 July, 2000.
Country
Lesotho
Publisher
Government of Lesotho
URL:
Theme area
Equity in health, Monitoring equity and research to policy
Title of publication Namibia 2004: Millennium development goals
Date of publication
2004 August
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
Namibia, development goals, healthcare
Abstract
This report shows that since our Independence in 1990 Namibia has made many great achievements; for instance, in providing education and healthcare, water and sanitation, and managing our economic and natural resources.
Country
Namibia
Publisher
Government of Namibia
URL:
Theme area
Equitable health services, Governance and participation in health
Title of publication Social learning in health care: Evidence from Tanzania
Date of publication
2005 February
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
social networks, social learning, health care, households, patient choice
Abstract
Learning is an important force for progress in developing countries and may represent a significant under-utilised resource in health care. Using two separate data sets from Tanzania, we show that households know the outcomes of large numbers of health episodes, that they value quality at health facilities, that they demonstrate increased willingness to pay for quality as the tenure of clinicians increases and that household behavior is consistent with local social networks of learning. Households gather information, change their opinions about doctors based on this information and improve their health by choosing the best doctors.
Country
Colombia
Publisher
Columbia University
URL:
Theme area
Equitable health services
Title of publication Bypassing health centers in Tanzania: Revealed preferences for observable and unobservable quality
Date of publication
2001 April
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
Health, Tanzania, patient choice, quality of care, health care facilities
Abstract
When patients bypass one health facility to seek health care at another, strong preferences are revealed. This paper advances the view that the patterns of bypassing observed in Iringa Rural district in Tanzania show evidence of patients’ understanding of various measures of quality at the facilities that they visit and bypass. Patients seek facilities that provide high quality consultations, are staffed by more knowledgeable physicians, observe prescription practices, and are polite. They avoid facilities that use injections too liberally or over–prescribe medication.
Country
Colombia
Publisher
Columbia University
URL:
Theme area
Equitable health services, Resource allocation and health financing
Title of publication Self-help: What future role in health care for low and middle-income countries?
Date of publication
2004 April
Publication type
Journal Article
Publication details
International Journal for Equity in Health 3 1 pp 1-10
Publication status
Published
Language
English
Keywords
population health, equity, self-help, health care expenditure, health outcomes
Abstract
In the debate on \\\'Third options\\\' for health care delivery in low- and middle-income countries, it is proposed that self-help should play a larger role. Self-help is expected to contribute towards improving population health outcomes and reducing government health care expenditure. We review scope and limitations of self-help groups in Europe and South Asia and assess their potential role in health care within the context of health sector reform.
Country
India
Publisher
International Journal for Equity in Health
URL:
Theme area
Monitoring equity and research to policy
Title of publication Measuring commitment to health: Global health indicators working group report
Date of publication
2006 August
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
Health, equity, indicators, public policy
Abstract
Many funders of international development programs use indicators as proxies for good public policies and the ability of countries to use aid well. As an input to these efforts, the Global Health Indicators Working Group examined potential measures of a government\\\'s commitment to health, with the goal of identifying and recommending a set of indicators for consideration by the Millennium Challenge Corporation and other donors as they assess country eligibility for investment.
Country
United States
Publisher
Centre for Global Development
URL:
Theme area
Human resources for health
Title of publication The financial losses from the migration of nurses from Malawi
Date of publication
2006 November
Publication type
Journal Article
Publication details
BioMed Central Nursing 5 9
Publication status
Published
Language
English
Keywords
Malawi, health worker migration, cost, health systems, financial loss
Abstract
The migration of health professionals trained in Africa to developed nations has compromised health systems in the African region. The financial losses from the investment in training due to the migration from the developing nations are hardly known. The cost of training a health professional was estimated by including fees for primary, secondary and tertiary education. Accepted derivation of formula as used in economic analysis was used to estimate the lost investment. The total cost of training an enrolled nurse-midwife from primary school through nursemidwifery training in Malawi was estimated as US$ 9,329.53. For a degree nurse-midwife, the total
cost was US$ 31,726.26. For each enrolled nurse-midwife that migrates out of Malawi, the country loses between US$ 71,081.76 and US$ 7.5 million at bank interest rates of 7% and 25% per annum for 30 years respectively. For a degree nurse-midwife, the lost investment ranges from US$ 241,508 to US$ 25.6 million at 7% and 25% interest rate per annum for 30 years respectively. Developing countries are losing significant amounts of money through lost investment of health care professionals who emigrate. There is need to quantify the amount of remittances that developing nations get in return from those who migrate.
Country
Malawi
Publisher
BioMed Central Ltd.
URL:
Equinet Publication Type
Capacity building papers
Theme area
Equitable health services, Resource allocation and health financing
Title of publication Have pro-poor health policies improved the targeting of spending and the effective delivery of health care in South Africa?
Date of publication
2006 October
Publication type
Report
Publication details
Publication status
Language
English
Keywords
South Africa, health care expenditure, pro-poor health policies
Abstract
South Africa’s apartheid health system was grossly ineffective. Private and public health spending combined was among the highest in the world at 8.4% of GDP, yet inequalities in provision, poor efficiency of spending and other factors impacting on health status meant that the country was not among the top 60 in terms of health status indicators. In an attempt to remove obstacles to access to health services, the government introduced free primary health care in 1996. This paper attempts to gauge the impact of these changes. The focus falls on changes in the incidence of South African public health spending.
Country
Publisher
United Nations Economic Commission for Africa
URL:
URL
Theme area
Values, policies and rights
Title of publication Regaining control: Realising women\\\'s rights to control their own sexuality, well-being and reproductive health in Africa
Date of publication
2006 September
Publication type
Journal Article
Publication details
Oxfam GB Policy Briefing pp 1-7
Publication status
Published
Language
English
Keywords
protecting right to health, South Africa, sexual and reproductive health, HIV/AIDS
Abstract
Since 2001, Africa’s leaders have committed the African Union and their Governments to promote and protect the right to health in a series of international and continental legal protocols and declarations. Thes commitments provide a comprehensive package for addressing the challenges of maternal mortality, HIV/AIDS, violence and disease. However, the urgent action needed to address what African Governments have described as a “continental state of emergency” can only be achieved by ensuring firm policy and programme linkages between Sexual and Reproductive Health, HIV/AIDS and Gender Based Violence.
Country
United Kingdom
Publisher
Oxfam GB
URL:
URL
Theme area
Equitable health services
Title of publication Essential services : HIV, health services and gender in South Africa
Date of publication
2006 September
Publication type
Journal Article
Publication details
Oxfam International pp 1-12
Publication status
Published
Language
English
Keywords
poverty and access to health services, women in poverty, South Africa, health systems
Abstract
Much has been achieved in just over a decade of democracy in South Africa by facilitating access of the poor to health and other services. However much more needs to be done if the constitutional rights of citizens to dignity is to become universal. Under the strain of an HIV onslaught, second to non in the world, the health systems serving the poor are being incredibly strained. Women in poor communities are having to fill the gap through self devised homedbased care as the public health care system that the vast majority of South Africans rely on is unable to cope. One of South Africa’s greatest challenges is to retain and attract skilled and committed workers.
Country
United Kingdom
Publisher
Oxfam International
URL:
URL
Theme area
Equitable health services
Title of publication National workshop on Essential Health Services in South Africa and Launch of the International Essential Services Campaign Report
Date of publication
2005 September
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
essential health services, oxfam workshop
Abstract
This two-day gathering begun with participants noting their concerns and expectations about the state of essential services in general, as well as the workshop itself. Oxfam reiterated that the purpose of the workshop was to welcome participants’ inputs so that it could help shape Oxfam’s thinking on essential services, and though Oxfam chose to focus on health, education and water internationally, it was up to participants to point the report in the right direction.
Country
United Kingdom
Publisher
Oxfam International
URL:
URL
Theme area
Poverty and health
Title of publication The 2007 Global Development Marketplace
Date of publication
2006
Publication type
Generic
Publication details
Global Development Marketplace
Publication status
Published
Language
English
Keywords
2007 Global Development Marketplace (DM2007), World Bank\'s Health, Nutrition and Population (HNP)
Abstract
The 2007 Global Development Marketplace (DM2007) is a joint effort between the Development Marketplace team and the World Bank\'s Health, Nutrition and Population (HNP) team. The World Bank is soliciting proposals on "improving results in health, nutrition and population for the poor". It is designed to support "creative, small-scale development projects that deliver results and have the potential to be expanded or scaled up." The deadline for applications is 17 November 2006.
Country
United States
Publisher
Global Development Marketplace (DM2007)
URL:
URL
Theme area
Human resources for health
Title of publication Update on the programme of work on health worker migration and retention in east and southern Africa
Date of publication
2006 October
Publication type
Generic
Publication details
Publication status
Published
Language
English
Keywords
capacity building programme, health worker migration, current policy migration, East, Central, and Southern Africa
Abstract
EQUINET through Health Systems Trust, University of Namibia and its secretariat at Training and Research Support Centre, in co-operation with the Regional Health Secretariat for east, central and southern Africa, is implementing in east and southern Africa research, capacity building and programme support for the retention of health workers and for management of out- migration of health personnel. The programme will support empirical research on the costs and benefits of health worker migration within and beyond east and southern Africa (ESA); and will support evaluation of the effectiveness of current policies and agreements to manage these costs and benefits. This work will be co-ordinated by Health Systems Trust South Africa and will be implemented in 2007/8.
Country
South Africa
Publisher
Regional Network For Equity In Health In East And Southern Africa (EQUINET)
URL:
URL
Theme area
Equity and HIV/AIDS
Title of publication Achieving and sustaining universal access to antiretrovirals in rural areas: The Primary Health Care Approach to HIV services in Lusikisiki, Eastern Cape
Date of publication
2006 October
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
HIV/AIDS program, Lusikisiki, Eastern Cape, antiretroviral therapy, health care worker shortage, integrated health care
Abstract
The chronic shortage of health care workers is recognised as a major bottleneck to scaling up antiretroviral therapy, and this has the biggest impact in rural areas where the human resource crisis is most acute. There is a need to develop innovative, effective delivery models, particularly for rural areas with weak health systems. This document reports how the HIV/AIDS programme in Lusikisiki, a partnership between Médecins sans Frontières (MSF) and the Department of Health of the Eastern Cape, has managed to achieve universal access to antiretroviral therapy in one of the most under-resourced and disadvantaged areas of South Africa without compromising on quality.
Country
South Africa
Publisher
Medecins Sans Frontiers
URL:
URL
Theme area
Values, policies and rights
Title of publication A health systems development agenda for developing countries: Time to be clear and visionary
Date of publication
2006 August
Publication type
Publication details
Global Health Watch
Publication status
Published
Language
English
Keywords
civil society organisations (CSO), health care systems development agenda
Abstract
This discussion paper argues for the development of an advocacy agenda to promote comprehensive health systems development in developing countries. It aims to promote discussion amongst health policy experts and civil society organisations (CSOs) about the need for and content of a health systems advocacy agenda. This document is intended to stimulate discussion and is accompanied by a pro-forma document to facilitate your comments, opinions and recommendations in shaping the content of a health systems development agenda and the way forward for appropriate health care systems development.
Country
South Africa
Publisher
Global Health Watch
URL:
URL
Theme area
Equity and HIV/AIDS
Title of publication HIV/AIDS treatment and care plan 2003-2007
Date of publication
2003 June
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
Rwanda, health services, HIV/AIDS
Abstract
This document sets out the Rwandan Governments treatment and care plan to increase longlivity and improved quality of live for people living with HIV/AIDS.
Country
Rwanda
Publisher
Government of Rwanda
URL:
Theme area
Monitoring equity and research to policy
Title of publication Report on strengthening national health information systems: Workshop on the use of geographical information system health map
Date of publication
2002 July
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
Health-for-All, monitoring, evaluation, information systems, health systems
Abstract
National health information systems (NHIS) were always considered as the weak link in health systems. Their strengthening poses a challenge, which needs to be addressed by the countries of the African Region within the framework of the evaluation of the performance of health systems. The WHO Regional Committee for Africa, at its fiftieth session, and by its resolution AFR/RC50/R1 adopted the Health-for-All policy with regional targets to be achieved by 2020 in order to address health problems facing the countries of the African Region. To be capable of monitoring and evaluating these targets correctly, countries have inevitably to strengthen their NHIS and, at peripheral levels, provide their health systems with adequate and simple tools allowing them to analyze data collected and take decisions.
Country
Switzerland
Publisher
World Health Organization
URL:
Theme area
Resource allocation and health financing
Title of publication National health accounts report
Date of publication
2003 November
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
Namibia, health financing, resource flows, health system
Abstract
This report covers detailed results of the National Health Account (NHA) study for the financial years 1998/1999, 1999/2000 and 2000/2001. The study was conducted with the aim of shedding some light into issues of health financing in Namibia and to provide a sound evidence-base for health policies that aim at advancing the achievement of the cherished goals and objectives of the health system.
Country
Namibia
Publisher
Government of Namibia
URL:
Theme area
Poverty and health
Title of publication National strategy for growth and reduction of poverty (NSGRP)
Date of publication
2005 April
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
Tanzania, poverty reduction, socio-economic development, MDGs
Abstract
The National Strategy for Growth and Reduction of Poverty (NSGRP) is a second national organizing framework for putting the focus on poverty reduction high on the country’s development agenda. The NSGRP keeps in focus the aspirations of Tanzania’s Development Vision (Vision 2025) for high and shared growth, high quality livelihood, peace, stability and unity, good governance, high quality education and international competitiveness. It is committed to the Millennium Development Goals (MDGs), as internationally agreed targets for reducing poverty, hunger, diseases, illiteracy, environmental degradation and discrimination against women by 2015. It will strive to widen the space for country ownership and effective participation of civil society, private sector development and fruitful local and external partnerships in development and commitment to regional and other international initiatives for social and economic development.
Country
Tanzania
Publisher
Government of Tanzania
URL:
Theme area
Equity and HIV/AIDS
Title of publication Namibia
Date of publication
2005 June
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
Namibia, HIV/ AIDS, demographic data
Abstract
This document is a demographical profile of Namibia in regards to HIV/AIDS and the WHO 3 by 5 Programme.
Country
Switzerland
Publisher
World Health Organization
URL:
Theme area
Resource allocation and health financing
Title of publication Rwanda national health accounts
Date of publication
2005 March
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
Rwanda, HIV/AIDS, funding, financing flows, resource allocation.
Abstract
National Health Accounts (NHA) is designed to give a comprehensive description of resource flows in a health system, showing where resources come from and how they are used. This NHA report aims to document the magnitude, flows, and uses of public, private and donor funds in Rwanda for overall health care and, specifically, for HIV/AIDS and reproductive health services during the years 2002 and 2000.
Country
Rwanda
Publisher
Government of Rwanda
URL:
Theme area
Equity and HIV/AIDS
Title of publication The response to HIV/AIDS in conflict situations: A research study into Rwanda, Burundi and Eastern-DRC
Date of publication
2003 January
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
Rwanda, Burundi, Eastern-DRC, quality
Abstract
HIV/AIDS is on most organisations\' agendas, and all are in the process of doing \'something\', ranging from a policy debate at headquarters level to the actual implementation of projects in the field. This report attempts to asses the quality of a number of these projects, although within the scope of this study it is impossible to assess the quality of each individual project or organisation.
Country
United Kingdom
Publisher
Save the Children
URL:
Theme area
Equitable health services
Title of publication Service Provision Assessment Survey 2001
Date of publication
2003 June
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
Rwanda, health services, data
Abstract
This report summarizes the findings of the 2001 Rwanda Service Provision Assessment (RSPA) Survey carried out by the Ministry of Health in partnership with the National Population Office.
Country
Rwanda
Publisher
Government of Rwanda
URL:
Theme area
Equitable health services
Title of publication Overview of the Essential Health Services in Malawi
Date of publication
2006
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
Malawi, health care package, interventions, civil society, implementation
Abstract
The guiding principles of the health sector in Malawi are based on the Malawi Poverty Reduction and the current Malawi Growth and Development Strategy (MGDS). The Essential Health Care Package (EHP) was therefore developed to limit the scope of health services to a narrow range of interventions that matches with the available resources targeting the poor and the most vulnerable in the society. The role of civil society in civic education, advocacy and as a watch dog of government cannot be over-emphasized if the EHP is to be implemented successfully. However, several challenges need to be overcome, as outlined in this report.
Country
Malawi
Publisher
Oxfam Malawi
URL:
Theme area
Values, policies and rights
Title of publication Regaining Control: Realising women’s rights to control their own sexuality, well-being and reproductive health in Africa
Date of publication
2006 September
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
Africa, HIV/AIDS, reproductive health, woman’s rights
Abstract
Since 2001, Africa’s leaders have committed the African Union and their governments to promote and protect the right to health in a series of international and continental legal protocols and declarations. These commitments provide a comprehensive package for addressing the challenges of maternal mortality, HIV/AIDS, violence and disease.
Country
Mozambique
Publisher
Oxfam Mozambique
URL:
Theme area
Equity in health
Title of publication Global health watch campaign agenda: 2005-2006
Date of publication
2005 July
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
Global health, health care, political economy
Abstract
This alternative world health report is an evidence-based assessment of the political economy of health and health care – and is aimed at challenging the major institutions that influence health.
Country
Publisher
Global Health Watch
URL:
Theme area
Equity and HIV/AIDS
Title of publication Tanzania
Date of publication
2005 June
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
Tanzania, demographic data, HIV/AIDS
Abstract
This document is a demographical profile of Tanzania in regards to HIV/AIDS and the WHO 3 by 5 Programme.
Country
Switzerland
Publisher
World Health Organization
URL:
Theme area
Equitable health services
Title of publication Health sector strategic plan: 2005-2009
Date of publication
2005
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
Rwanda, health status, poverty, strategic plan, health sector reform, health system investmenent
Abstract
The Government of Rwanda is committed to tackling the illnesses related to poverty and ignorance and improving the health status of the population over the long term through a sector strategy process, whereby all resources are channelled over time towards the support of the sector strategic plan. This document provides the impetus for appropriate and necessary health sector reform and encourage a greater investment in Rwanda’s health system.
Country
Rwanda
Publisher
Government of Rwanda
URL:
Theme area
Resource allocation and health financing
Title of publication Rwanda: Focus on the future
Date of publication
2005
Publication type
Book Section
Publication details
A force for change: The Global Fund at 30 months pp 51-57
Publication status
Published
Language
English
Keywords
Rwanda, HIV/AIDS, funding, Global Fund
Abstract
The devastating impact of HIV/AIDS in Rwanda is particularly cruel in a country still reeling from the 1994 genocide. This report examines the impact of the Global Fund funding on the Rwandan health system.
Country
Switzerland
Publisher
Global Fund
URL:
Theme area
Resource allocation and health financing
Title of publication Performance review of the Supplementary Emergency Financing Facility (SEFF)
Date of publication
2004 September
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
Lesotho, health financing, recommendations
Abstract
This report summarizes the findings of the Supplementary Emergency Financing Facility (SEFF) Performance Review conducted between July and September 2004. It presents recommendations and an implementation plan for finalization of the MOU between the Government of Lesotho and the Christian Health Association of Lesotho that have been reviewed by the stakeholders in the partnership process at a SEFF Performance Review workshop.
Country
Lesotho
Publisher
Medical Care Development International
URL:
Theme area
Title of publication Children on the brink 2004: A joint report of New Orphan Estimates and a Framework for Action
Date of publication
2004 July
Publication type
Report
Publication details
Publication status
Language
English
Keywords
HIV, AIDS, children, orphans
Abstract
HIV/AIDS is recognized worldwide as a threat to children and their families. AIDS is the leading cause of death worldwide for people ages 15 to 49. In 2003, 2.9 million people (estimate range, 2.6–3.3 million) died of AIDS and 4.8 million people (4.2–6.3 million) were infected with HIV. While most of the estimated 37.8 million people (34.6–42.3 million) living with HIV/ AIDS in the world are adults, the pandemic’s devastating effects on families and communities reach down to the most vulnerable among us – our children. This report looks at the impact of the disease on children and suggests a framework for action.
Country
United States
Publisher
Population, Health and Nutrition Information Project
URL:
Theme area
Resource allocation and health financing
Title of publication Memorandum of understanding between the partners (Government of Tanzania and donors) participating in the pooled funding (“basket financing”) of the health sector concerning the pooled funding for the Government of Tanzania’s health sector programme based
Date of publication
2003 July
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
Tanzania, health funding, strategic plan, medium term expenditure framework
Abstract
Memorandum of understanding between the partners (Government of Tanzania and donors) participating in the pooled funding (“basket financing”) of the health sector concerning the pooled funding for the Government of Tanzania’s health sector programme based on the second health sector strategic plan and the health sector medium term expenditure framework.
Country
Tanzania
Publisher
Government of Tanzania
URL:
Theme area
Equity and HIV/AIDS
Title of publication Investing in a comprehensive health sector response to HIV/AIDS: Scaling up treatment and accelerating prevention
Date of publication
2004
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
HIV/AIDS, prevention, treatment, public health
Abstract
The HIV/AIDS epidemic is the single most important challenge facing the global public health community. A comprehensive response to HIV/AIDS is needed to expand evidence-based prevention interventions and to ensure that the people in need receive effective care, treatment and support. This document discusses various strategies to scale-up treatment and prevention.
Country
Switzerland
Publisher
World Health Organization
URL:
Theme area
Monitoring equity and research to policy
Title of publication Socio-economic status and health inequalities in rural Tanzania: Evidence from the Rufiji Demographic Surveillance System
Date of publication
2000
Publication type
Book Section
Publication details
Measuring Health Equity in Small Areas pp 39-52
Publication status
Published
Language
English
Keywords
Socio-economic status, poverty, equity, household
Abstract
This study shows a relationship between socio-economic status and health indicators with particular focus on the differentials between the poorest and the least poor.
Country
United States
Publisher
Ashgate Publishers
URL:
Theme area
Equitable health services
Title of publication National norms, guidelines, and standards on cross-cutting issues for health care practice in Tanzania
Date of publication
2003 February
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
Tanzania, health policy, guidelines, standards, health care practice
Abstract
This guide is intended to be a reference document for norms, guidelines and standards for health care practice in Tanzania.
Country
Tanzania
Publisher
Government of Tanzania
URL:
Theme area
Poverty and health, Resource allocation and health financing
Title of publication The cost of coping with illness
Date of publication
2005 November
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
Rwanda, health cost, financing, access, household economic assessment
Abstract
This study was conducted in Gatonde health district, Ruhengeri. All of the information gathered from the interviews focuses on the year from March 2004 to February 2005. A household economic assessment was undertaken in one village in each administrative district (Bugarura, Bukonya and Buhoma) within the Livelihood Zone. One health center was selected for the health survey in each village. It was decided to select three of the health centers that had active Mutuelle agreements in place and one that did not. A total of 20 interviews were held: four key informant and 16 wealth-group interviews.
Country
United Kingdom
Publisher
Save the Children
URL:
Theme area
Equity and HIV/AIDS
Title of publication Epidemiological fact sheets on HIV/AIDS and sexually transmitted diseases: Rwanda
Date of publication
2004
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
Rwanda, HIV, AIDS
Abstract
In 2003 and during the first quarter of 2004, UNAIDS and WHO worked closely with national governments and research institutions to recalculate current estimates on people living with HIV/AIDS. This document presents current estimates for Rwanda, based on the previously published estimates for 1999 and 2001 and recent trends in HIV/AIDS surveillance in various populations. A methodology developed in collaboration with an international group of experts was used to calculate the new estimates on prevalence and incidence of HIV and AIDS deaths, as well as the number of children infected through mother-to-child transmission of HIV.
Country
Switzerland
Publisher
World Health Organization
URL:
Theme area
Equity and HIV/AIDS
Title of publication Report of the 2004 National HIV Sentinel Survey
Date of publication
2005 May
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
Namibia, HIV, AIDS, surveillance, prevention, treatment
Abstract
Namibia is one of the countries in the world most affected by the HIV/AIDS pandemic. The Government of Namibia (GRN) has mounted an aggressive and tireless campaign against the disease including surveillance, prevention, treatment, care and support, and impact mitigation. Surveillance forms a critical element in the expanded national response as it allows identification of the geographic and demographic population groups most affected by the virus so that prevention and treatment programs can be targeted to these groups. In addition, surveillance activities permit the GRN to monitor HIV trends in various groups and thus evaluate the effectiveness of policies and programs.
Country
Namibia
Publisher
Government of Namibia
URL:
Theme area
Values, policies and rights
Title of publication National Health Policy
Date of publication
2003 October
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
Tanzania, health policy, community involvement
Abstract
The Health Policy is a vital guide towards health development of any country. This Policy is a revision of the 1990 Health Policy, which emphasized on the need for increasing community involvement in health development and improved access and equity in health and health services.
Country
Tanzania
Publisher
Government of Tanzania
URL:
Theme area
Resource allocation and health financing
Title of publication Utilization, cost, and financing of District Health Services in Rwanda
Date of publication
2001 March
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
Rwanda, health financing, prepayment scheme, community participation
Abstract
This study examines the impact of health care financing by prepayment schemes on utilization cost, and finances in three Rwandan health districts: Byumba, Kabgayi, and Kabutare. It seeks to describe the effect of the one-year prepayment scheme pilot test on the four objectives of the Ministry of Health (MOH), i.e to improve the financial accessibility to care, enhance the quality of care in health centers, strengthen the community participation in the organization and management of health services, and reinforce human capacity in financial management of health facilities and prepayment scheme funds.
Country
Rwanda
Publisher
Partnerships for Health Reform
URL:
Theme area
Equity and HIV/AIDS
Title of publication The well being of children affected by HIV/AIDS in Lusaka, Zambia and Gitarama Province, Rwanda: Findings from a study
Date of publication
2004
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
Zambia, Rwanda, children, HIV, AIDS
Abstract
The Community REACH program is conducting an effectiveness study in two countries of selected interventions targeting orphans and children with chronically ill caregivers, ages 6–19. Data were collected from intervention group households with orphans or children with a chronically ill caregiver receiving interventions (selected from project registers) and comparison group of households not receiving interventions selected using a “nearest neighbor” approach. This research is being implemented in collaboration with Community REACH grantees, CARE Rwanda, Bwafwano, and Project Concern International (PCI) Zambia.
Country
United States
Publisher
USAID
URL:
Theme area
Equity and HIV/AIDS
Title of publication Swaziland
Date of publication
2005 June
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
Swaziland, demographic profile, HIV/AIDS
Abstract
This document is a demographical profile of Swaziland in regards to HIV/AIDS and the WHO 3 by 5 Programme.
Country
Switzerland
Publisher
World Health Organization
URL:
Theme area
Values, policies and rights
Title of publication Health sector policy
Date of publication
2005 February
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
Rwanda, health
Abstract
The new policy is expected to come as a real deep reform to address the major traditional problems of health, the new challenges set by the pandemic of HIV/AIDS. This reform comes at an opportune moment when the Government has begun the process of decentralization and planning based upon Vision 2020 and the Poverty Reduction Strategy Paper in the context of good governance.
Country
Rwanda
Publisher
Government of Rwanda
URL:
Theme area
Equity and HIV/AIDS
Title of publication Epidemiological fact sheets on HIV/AIDS and sexually transmitted diseases: Swaziland
Date of publication
2004
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
Swaziland, HIV/AIDS, estimated incidence
Abstract
In 2003 and during the first quarter of 2004, UNAIDS and WHO worked closely with national governments and research institutions to recalculate current estimates on people living with HIV/AIDS. This document presents current estimates for Swaziland, based on the previously published estimates for 1999 and 2001 and recent trends in HIV/AIDS surveillance in various populations. A methodology developed in collaboration with an international group of experts was used to calculate the new estimates on prevalence and incidence of HIV and AIDS deaths, as well as the number of children infected through mother-to-child transmission of HIV.
Country
Switzerland
Publisher
World Health Organization
URL:
Theme area
Equitable health services
Title of publication Assessing the quality of healthcare at the district level in Rwanda
Date of publication
1999
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
Rwanda, health care, quality assessment, action plan
Abstract
In March and April 1999, four teams led by Ministry of Health staff conducted a quality of care assessment at 19 health centers in two districts in Rwanda. The assessment was coordinated by the Division of Promotion of Quality of Services of the Ministry of Health, with technical support from the Quality Assurance Project (QAP). Prior to data collection, district and national staff had worked together to reach consensus on appropriate standards of care that would serve as the basis for the assessment. The assessment teams examined the performance of selected clinical and support activities during 160 general health, 174 prenatal, and 182 vaccination consultations and carried out exit interviews with 289 clients. Ten days after the data collection, the assessors presented preliminary results to staff in each district so they could develop a short-term action plan for introducing immediate improvements and identify those problems that would require the formation of problem-solving teams.
Country
Rwanda
Publisher
Government of Rwanda
URL:
Theme area
Monitoring equity and research to policy
Title of publication Innovations in mobile-based public health information systems in the developing world: An example from Rwanda
Date of publication
2004 June
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
Mobile technology, HIV/AIDS, public health, information systems
Abstract
This paper examines new applications of mobile and wireless technologies to the challenges of public health in the developing world, particularly the Least Developed Countries (LDCs). After a brief review of initiatives underway in Africa and India, the bulk of the paper describes a national HIV/AIDS information system currently under development in Rwanda. This system relies on a combination of Internet technology and traditional telephony (both fixed and wireless) to connect even the most remote rural health clinics. Potential merits of this system will be examined in light of Heeks’ (2002) review of information systems projects in developing nations. This analysis suggests that certain fundamental properties of wireless/mobile technologies are likely to increase the efficacy, scalability, and sustainability of public health information systems in low teledensity settings.
Country
Italy
Publisher
The Center for Global Health and Economic Development
URL:
Theme area
Equity and HIV/AIDS
Title of publication Lesotho
Date of publication
2005 June
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
Lesotho, demographic profile, HIV/AIDS
Abstract
This document is a demographical profile of Lesotho in regards to HIV/AIDS and the WHO 3 by 5 Programme.
Country
Switzerland
Publisher
World Health Organization
URL:
Theme area
Equity and HIV/AIDS
Title of publication Epidemiological fact sheets on HIV/AIDS and sexually transmitted diseases: Namibia
Date of publication
2004
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
Namibia, HIV/AIDS, estimated incidence
Abstract
In 2003 and during the first quarter of 2004, UNAIDS and WHO worked closely with national governments and research institutions to recalculate current estimates on people living with HIV/AIDS. This document presents current estimates for Namibia, based on the previously published estimates for 1999 and 2001 and recent trends in HIV/AIDS surveillance in various populations. A methodology developed in collaboration with an international group of experts was used to calculate the new estimates on prevalence and incidence of HIV and AIDS deaths, as well as the number of children infected through mother-to-child transmission of HIV.
Country
Switzerland
Publisher
World Health Organization
URL:
Theme area
Equity and HIV/AIDS
Title of publication Strategic framework for HIV/AIDS control 2002-2006: Summary
Date of publication
2002 May
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
Rwanda, HIV/AIDS, national policy, strategic plan
Abstract
In the process of re-organizing the activities designed to fight the AIDS pandemic in Rwanda, the formulation of a national policy and the designing of a Framework Program were two very important mandates for the National AIDS Controle Commition (NACC) in 2002. It is in connection with this mission that, between February and May 2002, the NACC embarked on a process of Strategic Planning, which made it possible to produce this essential document.
Country
Rwanda
Publisher
Government of Rwanda
URL:
Theme area
Equity and HIV/AIDS
Title of publication Treating 3 million by 2005: Making it happen: The WHO strategy
Date of publication
2003
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
HIV/ AIDS strategy, provision of ART, health services
Abstract
This WHO strategy aims to set out in clear detail how life-long antiretroviral treatment (ART) can be provided to 3 million people living with HIV/AIDS in poor countries by the end of 2005. Core principles include urgency, equity and sustainability. HIV/AIDS has devastated the populations and health services of many developing countries. We must act now. Further, since this magnitude of scaling up HIV/AIDS treatment has never been attempted before, we must learn by doing.
Country
Switzerland
Publisher
World Health Organization
URL:
Theme area
Monitoring equity and research to policy
Title of publication Lesotho demographic and health survey 2004: Preliminary report
Date of publication
2005 October
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
Lesotho, health survey, social welfare
Abstract
This preliminary report presents selected results of the 2004 Lesotho demographic and health survey (LDHS).
Country
Lesotho
Publisher
Government of Lesotho
URL:
Theme area
Equity and HIV/AIDS
Title of publication Guidelines to prevent mother to child transmission of HIV
Date of publication
2004 June
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
Lesotho, HIV/ AIDS, mother-to-child transmission, public health
Abstract
The impact of HIV/AIDS on child survival in Lesotho is devastating. Every year average of 7 000 babies are infected during pregnancy, labor and delivery and breastfeeding. Preventing mother to child transmission (MTCT) of HIV has become a major public health priority in Lesotho. In addressing this, Government has integrated interventions to prevent MTCT into maternity health services. This document provides guidelines on prevention of MTCT and is aimed at everyone within the country but with special focus to health personnel.
Country
Lesotho
Publisher
Government of Lesotho
URL:
Theme area
Equity and HIV/AIDS
Title of publication Epidemiological fact sheets on HIV/AIDS and sexually transmitted diseases: Lesotho
Date of publication
2004
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
Lesotho, HIV/AIDS, estimated incidence, infection rate
Abstract
In 2003 and during the first quarter of 2004, UNAIDS and WHO worked closely with national governments and research institutions to recalculate current estimates on people living with HIV/AIDS. This document presents current estimates for Lesotho, based on the previously published estimates for 1999 and 2001 and recent trends in HIV/AIDS surveillance in various populations. A methodology developed in collaboration with an international group of experts was used to calculate the new estimates on prevalence and incidence of HIV and AIDS deaths, as well as the number of children infected through mother-to-child transmission of HIV.
Country
Switzerland
Publisher
World Health Organization
URL:
Theme area
Equitable health services
Title of publication Integrated Management of Childhood Illness: Global status of implementation
Date of publication
1999 June
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
childhood illness, interventions, health system
Abstract
Integrated Management of Childhood Illness (IMCI) is a broad strategy, encompassing interventions at home and in the health system. It aims to reduce childhood death, illness and disability and to contribute to improved growth and development.
Country
Switzerland
Publisher
World Health Organization
URL:
Theme area
Equitable health services
Title of publication Legal status of traditional medicine and complimentary medicine: A worldwide review
Date of publication
2001
Publication type
Publication details
Publication status
Published
Language
English
Keywords
traditional medicine, policy mechanisms
Abstract
National policies are the basis for defining the role of traditional and complementary/alternative medicine in national health care programs, ensuring that the necessary regulatory and legal mechanisms are created for promoting and maintaining good practice; assuring authenticity, safety and efficacy of traditional and complementary/alternative therapies; and providing equitable access to health care resources and information about those resources. This document reviews the various mechanisms used by national governments in regulating this sector.
Country
Switzerland
Publisher
World Health Organization
URL:
Theme area
Resource allocation and health financing
Title of publication Medium term expenditure framework process
Date of publication
2005
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
Lesotho, health financing, Medium Term Expenditure Framework
Abstract
The total budget for the Medium Term Expenditure Framework (MTEF) is representative of what the sector perceives as the priorities for the next three years. However, given the existing absorptive capacity and insufficient human resources at the operational level the MTEF plan may have to be scaled down to accommodate systematic weaknesses that can only be eradicated over time. This document defines the process of introducing the MTEF.
Country
Lesotho
Publisher
Government of Lesotho
URL:
Theme area
Equitable health services
Title of publication Expanded Program on Immunisation revised policy
Date of publication
2002 September
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
Lesotho, Primary health, Immunisation
Abstract
The roots of the Expanded Program on Immunisation (EPI) in Lesotho go back to the late 1970s and early 1980s when it was introduced as an important Primary Health Care (PHC) Programme component. Since then the Programme has made remarkable progress that includes improvement of immunisation coverage among infants and woman resulting in considerable reduction in morbidity and mortality from vaccine preventable diseases. This policy document seeks to improve on the successes already achieved by the EPI.
Country
Lesotho
Publisher
Government of Lesotho
URL:
Theme area
Values, policies and rights
Title of publication National health and social welfare policy
Date of publication
2005
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
Lesotho, health and social welfare, poverty reduction, development
Abstract
This document outlines all major policies of the Lesotho Government in regards to health and social welfare.
Country
Lesotho
Publisher
Government of Lesotho
URL:
Theme area
Equity and HIV/AIDS
Title of publication Health crisis in Lesotho
Date of publication
2005 October
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
Lesotho, health, poverty, HIV, AIDS
Abstract
With a per capita income of US$520 in 2000, Lesotho is among the 49 Least Developed Countries and is ranked 91st on the UNDP Human Poverty Index Scale. This article examines how the policies of the Lesotho government are impacting on the fight against HIV/AIDS.
Country
Switzerland
Publisher
World Health Organization
URL:
Theme area
Equitable health services
Title of publication Primary health care: A framework for future strategic directions
Date of publication
2003
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
Primary health care
Abstract
This report is intended to provide a platform for debate at the Madrid meeting and subsequent reports to the Fifty-seventh World Health. Assembly in May 2004.
Country
Switzerland
Publisher
World Health Organization
URL:
Theme area
Equity and HIV/AIDS
Title of publication Mobilizing communities to achieve 3 by 5
Date of publication
2003
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
HIV, AIDS
Abstract
The World Health Organization (WHO) and UNAIDS have identified the global HIV treatment gap as a public health emergency. To address this challenge, they have established the 3 by 5 target, whereby 3 million people in developing countries will be on antiretroviral treatment by the end of 2005. Their aim is to mobilize the many stakeholders globally, regionally and locally who need to play a role in rapidly expanding access to antiretroviral therapy (ART) in resource-restrained countries. This report documents the mobilization process.
Country
Switzerland
Publisher
URL:
Theme area
Equity in health
Title of publication Applying an equity lens to child health and mortality: More of the same is not enough
Date of publication
2003 July
Publication type
Journal Article
Publication details
The Lancet 362 pp 233-241
Publication status
Published
Language
English
Keywords
health, poverty, children, intervention
Abstract
Gaps in child mortality between rich and poor countries are unacceptably wide and in some areas are becoming wider, as are the gaps between wealthy and poor children within most countries. Poor children are more likely than their better-off peers to be exposed to health risks, and they have less resistance to disease because of under nutrition and other hazards typical in poor communities. Equity must be a priority in the design of child survival interventions and delivery strategies, and mechanisms to ensure accountability at national and international levels must be developed. This article examines various interventions and the relative success/ failure of these interventions.
Country
Brazil
Publisher
British Medical Association
URL:
Theme area
Equitable health services
Title of publication Knowledge into action for child survival
Date of publication
2003 July
Publication type
Journal Article
Publication details
The Lancet 362 pp 323-327
Publication status
Published
Language
English
Keywords
health, poverty, children, survival
Abstract
The child survival revolution of the 1980s contributed to steady decreases in child mortality in some populations, but much remains to be done. More than 10 million children will die this year, most of whom are poor. Two-thirds of these deaths could have been prevented if effective child survival interventions had reached all children and mothers who needed them. Translation of current knowledge into effective action for child survival will require leadership, strong health systems, targeted financial and human recourses, and modified health systems to ensure that poor children and mothers benefit. In this call to action from a group of concerned scientists and policy-makers, leaders, governments, and citizens are called upon to translate knowledge into action for child survival.
Country
United States
Publisher
British Medical Association
URL:
Theme area
Equity in health
Title of publication Promoting equity in health
Date of publication
2004 December
Publication type
Journal Article
Publication details
Health policy and development 2 3 pp 186-191
Publication status
Published
Language
English
Keywords
health, equity
Abstract
To promote health equity is to address a great deal of inequities in society. It is not easy but it can be done. It requires that an upstream action is taken. This action consists of eight steps: analyse inequity, act on determinants of inequity invest in demand for health services, invest in life cycle improvement, invest in decreases of poverty, invest in the most vulnerable, ensure good quality of health care, and assess progress using well identified equity objectives and indicators. The exact details of the strategies to address inequity in health depend on the economic, administrative, political and epidemiological circumstances of each country, as discussed in this article.
Country
Italy
Publisher
UMU Press
URL:
Theme area
Equitable health services, Equity and HIV/AIDS
Title of publication Parliament briefing 1: Equity in access to AIDS treatment through stronger health systems
Date of publication
2006 October
Publication type
Document
Publication details
EQUINET Parliament briefing 1 pp 1-4
Publication status
Published
Language
English
Keywords
health systems; HIV and AIDS policy; parliament; East and Southern Africa
Abstract
Parliaments play an important role in health. Generally and through their specialised committees they can scrutinise public spending to ensure that it meets national policy goals, debate and pass laws that institutionalise social goals and provide leadership, representation and space for public participation in health. Parliaments can also provide oversight of the executive in terms of how this arm of government is implementing national policy. This brief explores how these parliamentary roles can be applied to strengthen equitable health systems responses to AIDS.
Country
East and southern Africa region
Publisher
EQUINET
URL:
Equinet Publication Type
Briefs
Theme area
Resource allocation and health financing, Governance and participation in health
Title of publication Parliament briefing 2: Fair financing for health
Date of publication
2006
Publication type
Publication details
EQUINET Parliament briefing 2 pp 1-4
Publication status
Published
Language
English
Keywords
fair financing; parliament; national health accounts; east and southern Africa
Abstract
Parliaments play an important role in health. Generally and through their specialised committees, they can scrutinise and ensure that national budgets meet national policy goals, debate and pass laws that institutionalise social goals and provide leadership, representation and space for public participation in health. Parliaments can also provide oversight of the executive in terms of how this arm of government is implementing national policy. This brief explores how these parliamentary roles can be applied to strengthen the fair financing of health systems.
Country
East and southern Africa region
Publisher
EQUINET
URL:
Equinet Publication Type
Briefs
Theme area
Health equity in economic and trade policies
Title of publication Capacity building paper: Protecting access to Anti-Retroviral Therapy (ART) under trade and market policies: The Zimbawean case
Date of publication
2005 August
Publication type
Document
Publication details
EQUINET Capacity Building Paper pp 1-29
Publication status
Published
Language
English
Keywords
trade, medicines control, TRIPS, health systems, health policy, Zimbabwe
Abstract
This audit was done after a regional training workshop on “Protecting Health in Trade Agreements” held in Harare Zimbabwe in August 2005 within an EQUINET programme with Centre for Health Policy, South Africa and SEATINI and TARSC, Zimbabwe. The audit aims to present to government, policy makers, technocrats and other stakeholders in the health sector and civil society specific aspects of how trade agreements such as General Agreement on Trade in Services (GATS) and Trade Related Aspects of Intellectual Property (TRIPS) are impacting on, or are likely to impact on health systems and the exercise of national health policy.
Country
Zimbabwe
Publisher
EQUINET; Centre for Health Policy, University of Witwatersrand; SEATINI
URL:
Equinet Publication Type
Capacity building papers
Theme area
Governance and participation in health
Title of publication EQUINET PRA report 4: Strengthening community–Health Centre partnership and accountability in Zambia
Date of publication
2006 September
Publication type
Document
Publication details
EQUINET PRA project report 1 pp 1-33
Publication status
Published
Language
English
Keywords
health centres; participatory research; health planning; Zambia
Abstract
The Zambia PRA project has shown that the Participatory Reflection and Action methodology is replicable in other health centres of Zambia operating under district health management teams, be it in a rural setting like Chama or an urban district like Lusaka. The Participatory Reflection and Action methodology can also be used to improve communication and interaction between community members and health providers in attaining a people-centred health system in resource limited settings such as Zambia.
Country
Zambia
Publisher
EQUINET
URL:
Equinet Publication Type
Discussion paper
Theme area
Equitable health services, Governance and participation in health
Title of publication PRA project report 2: Reproductive health challenges of students, lecturers, administration and college communities in the agricultural training institutions in Zimbabwe
Date of publication
2006 July
Publication type
Document
Publication details
An EQUINET PRA project report pp 1-22
Publication status
Published
Language
English
Keywords
reproductive health, participatory methodologies, teaching institutions, Zimbabwe
Abstract
In Zimbabwe, there are four categories of state owned tertiary institutions: universities, teachers colleges, polytechnic colleges and agricultural colleges. All institutions are either in urban or semi-urban areas, except for agricultural colleges, which are mostly located in farming communities due to the nature of their studies and are governed by the Ministry of Lands and Agriculture instead of the traditional Ministry of Tertiary and Higher Education. Such discrepancies have led to the ‘isolation’ of the students attending these institutions especially in matters concerning the students’ health. In particular there has been inadequate effort to address the reproductive health challenges of the students in these institutions despite their sexually active and high risk age group, including for risk of HIV infection. Students and Youths Working on Reproductive Health Action Team (SAYWHAT) a civil society organization in Zimbabwe, used the Participatory Reflective and Action (PRA) methodology as the starting point to involve the agricultural colleges in addressing reproductive health challenges.
Country
Zimbabwe
Publisher
EQUINET
URL:
Equinet Publication Type
Discussion paper
Theme area
Human resources for health
Title of publication Personnel desante au Sud: Penurie mortelle
Date of publication
2006
Publication type
Book
Publication details
Publication status
Published
Language
French
Keywords
Abstract
Country
France
Publisher
Agir ici; Aide Medicale International; Medicins Du Monde; Secours Catholique
Theme area
Health equity in economic and trade policies
Title of publication Press statement by the organisers of the International Peoples Forum versus IMF-WB
Date of publication
2006 September
Publication type
Generic
Publication details
Publication status
Publication status unknown
Language
English
Keywords
International People\'s Forum (IPF), International Monetary Fund (IMF), human rights, equity, sustainable development
Abstract
International People\'s Forum organizers celebrate successful forum and share plans for ways forward. On 18 September the IPF conclude the International Peoples Forum (IPF) versus the International Monetary Fund (IMF) and World Bank, which was convened in Batam from September 15th to17th. Over 500 Indonesians participated in the Forum as did around 200 individuals from 25 countries representing at least 100 organisations. Amongst several other urgent requests made was that for stopping the imposition of policy conditions that undermine economic sovereignty and exacerbate crises in health and education. The statement ends with a call on the governments that are members of the World Bank and IMF Boards of Directors to keep these institutions fully accountable for their impacts on human rights, equity, and the sustainability of development.
Country
Publisher
URL:
URL
Theme area
Values, policies and rights
Title of publication Regaining control: Realising women’s rights to control their own sexuality, well-being and reproductive health in Africa
Date of publication
2006 September
Publication type
Conference Proceedings
Publication details
Oxfam GB background policy briefing for the Special Session of the conference of African Ministers of Health pp 1-7
Publication status
Published
Language
English
Keywords
sexual and reproductive health rights in Africa, women\'s health, the Abuja Declaration, gender-based violence, HIV/AIDS, Maputo, Mozambique
Abstract
Since 2001, Africa’s leaders have committed the African Union and their Governments to promote and protect the right to health in a series of international and continental legal protocols and declarations. These commitments provide a comprehensive package for addressing the challenges of maternal mortality, HIV/AIDS, violence and disease. However, the urgent action needed to address what African Governments have described as a “continental state of emergency” can only be achieved by ensuring firm policy and programme linkages between Sexual and Reproductive Health, HIV/AIDS and Gender Based Violence. The article encourages African Health Experts and Ministers of Health meeting in Maputo to ensure that the draft Action Plan contains targets and indicators that enshrine on key components of the Abuja Declaration.
Country
United Kingdom
Publisher
Oxfam GB
URL:
URL
Theme area
Human resources for health, Governance and participation in health
Title of publication PRA project report 3: Raising our voice, breaking our silence: Health workers’ experiences and needs around Occupational Health Services in Cape Town, South Africa
Date of publication
2006 June
Publication type
Document
Publication details
EQUINET PRA project report pp 1-35
Publication status
Not published
Language
English
Keywords
PRA, participatory methods, health workers, Occupational Health and Safety, OH&S, unions, South Africa
Abstract
This Participatory, Reflection, and Action (PRA) project on occupational health services offered an opportunity for IHRG and a small group of unionised health workers to use innovative learning and research methodologies in an attempt to investigate and intervene in real experiences of workplace injury and illness. Following IHRG’s participation in a regional training workshop hosted by EQUINET, IHRG piloted its use of selected PRA tools within a broader methodology of experiential learning and participatory action research. The project consisted of three workshops, workplace-based investigations, and the dissemination of networking resources among the participants.
The combination of workplace-based case investigations and the process of critically reflecting on these interventions provided a very powerful action-learning experience. Through the use of PRA methodology and tools, participants were also able to critically examine their own learning experience.
Country
South Africa
Publisher
EQUINET
URL:
Equinet Publication Type
Discussion paper
Theme area
Equity and HIV/AIDS
Title of publication The consultative workshop as a qualitative method of inquiry: The case of guidance and counseling teachers and community-based counselors in Maun, Botswana
Date of publication
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
Botswana, consultative workshops, bereavement
Abstract
There are relatively few trained professional counselors in Botswana; counselors and other helping professionals have not had much (if any) specialized training in traumatology, let alone training related to the impact of trauma and bereavement on childhood development. The Maun Counseling Center (MCC), located in Maun, Botswana, and funded by a faith-based NGO (non-governmental organization), recently unveiled a child trauma and bereavement program. Consultative workshops have become a popular way in developing contexts to address new and emergent problems and seek professionally informed solutions to them. This paper uses the case of this particular teacher/counselor workshop to illustrate how the consultative workshop can be used as a qualitative research method, with theoretical links to participatory action research and rapid appraisal methods.
Country
United States
Publisher
URL:
URL
Theme area
Governance and participation in health
Title of publication Community information structures in Botswana: A challenge for librarians (68th IFLA Council and General Conference 18-24 August 2002)
Date of publication
2002 August
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
Botswana, community, development plans, information
Abstract
There are structures at community levels (district and village levels) in Botswana, which produce information for development purposes. Mostly this information end up in village development plans and district development plans. This information is however not captured by libraries and stored for future use. The information from these structures is usually by way of word of mouth because not all of our people can read and write. Again not all of these structures record their proceedings, which can later be stored for future use. But at these structures a lot of important information is discussed which feed into the development process of the country. This presents a challenge for librarians working at community level. This paper discusses these information structures and the challenges facing librarians.
Country
Netherlands
Publisher
International Federation of Library Associations (IFLA)
URL:
URL
Theme area
Human resources for health
Title of publication How are health professionals earning their living in Malawi?
Date of publication
2006 August
Publication type
Journal Article
Publication details
BMC Health Services Research 6 97 pp 1-22
Publication status
Published
Language
English
Keywords
Malawi, health professionals, health systems
Abstract
The migration of health professionals from southern Africa to developed nations is negatively affecting the delivery of health care services in the source countries. Oftentimes however, it is the reasons for the out-migration that have been described in the literature. The work and domestic situations of those health professionals continuing to serve in their posts have not been adequately studied. In order to contribute to the literature on the African brain drain, we conducted a qualitative study of Malawi as a case study, with the following specific objectives: a) determine the sources of income for health professionals in both private and public services in Malawi other than formal wages (pay salaries); b) determine working practices of health professionals in Malawi that may influence their retention in the country; c) determine attitudes of health professionals towards various forms of out of formal employment incomes; d)identify possible strategies that could contribute to retention of staff and have a positive impact on the problem of brain drain in Malawi.
Country
Malawi
Publisher
BioMedical Central Limited
URL:
Theme area
Human resources for health
Title of publication Policy brief: Affirmative action, Nigeria
Date of publication
2006 February
Publication type
Journal Article
Publication details
Policy Brief 15 pp 1-4
Publication status
Published
Language
English
Keywords
affirmative action, ethnic, regional and, gender inequalities in public service employment, Nigeria
Abstract
There is a strong ideological commitment in Nigeria to the country’s form of affirmative action, in the form of its Federal Character Principle. Nigeria is inhabited by 470 ethnic groups, which are distinguished by language, customs and religious beliefs and vary in size, power and influence. Groups in the southern region of the country have traditionally had much higher levels of education and employment in the public sector than groups in the northern region. Much of the country’s politics revolves around methods of preventing or resisting fears of domination of one region or ethnic group over the others. To cope with the problems created by its multi-ethnic society, and to encourage a spirit of ‘unity in diversity’, successive constitutions of Nigeria have included specific provisions to promote power sharing, and to protect groups considered to be relatively disadvantaged. This paper explores Nigeria\\\'s policies with regard to affirmative action.
Country
United Kingdom
Publisher
Overseas Development Institute
URL:
URL
Theme area
Human resources for health
Title of publication Policy brief: Affirmative action, India
Date of publication
2006 February
Publication type
Journal Article
Publication details
Policy Brief 14 pp 1-4
Publication status
Published
Language
English
Keywords
affirmative action, employment equity, discrimination, India
Abstract
In India, the Scheduled Castes (SCs) and Scheduled Tribes (STs), which together constitute a quarter of the total population, have long suffered from discrimination and exclusion. This is reflected in a lack of access to income-earning assets, higher-quality employment and public services. They also experience resistance, violence and even atrocities in their attempts to secure human rights and lawful entitlements. The discrimination and exclusion experienced by these groups has resulted in severe deprivation and poverty. The Indian government’s approach towards these groups consists of three main elements, namely: legal and other safeguards against discrimination; affirmative action measures in the state and state-supported sector; and general developmental and empowerment measures in the private sector. This paper focuses mainly on the second of these, namely the affirmative action policies in the state sector, otherwise known as the country’s reservation policy.
Country
United Kingdom
Publisher
Overseas Development Institute
URL:
URL
Theme area
Human resources for health
Title of publication Policy brief: Affirmative action, Malaysia
Date of publication
2006 February
Publication type
Journal Article
Publication details
Policy Brief 13 pp 1-4
Publication status
Published
Language
English
Keywords
affirmative action, employment equity, Malaysia, inequality, poverty and inequality
Abstract
In Malaysia, inequality between the major ethnic groups – the Bumiputera (Malays and other indigenous groups), Chinese and Indians – has long been a central development issue. When the country achieved its independence in 1957, there were already sizeable inequalities between these groups, and these widened further between 1957 and 1970. Mounting tensions between groups broke out into riots during 1969. The centerpiece of the Malaysian approach to reducing inequality and inter-ethnic economic imbalances, and what can be termed loosely as its affirmative action plan, is the New Economic Policy (NEP). The NEP was introduced in 1970, and has two main objectives: first, to eradicate poverty, irrespective of race or ethnicity; second, to restructure society so as to remove the identification of race or ethnicity with economic status and/or function.
Country
United Kingdom
Publisher
Overseas Development Institute
URL:
URL
Theme area
Public-private mix, Resource allocation and health financing
Title of publication Policy brief: Health insurance for the poor, India
Date of publication
2006 February
Publication type
Journal Article
Publication details
Policy Brief 12 pp 1-4
Publication status
Published
Language
English
Keywords
India, health insurance, public health, low income
Abstract
In India, individuals and families on low incomes face significant barriers to accessing quality healthcare. Public health facilities suffer from poor management, low service quality, and weak finances. On the other hand, private health facilities are expensive, so that households typically have to borrow or sell assets to meet hospitalisation costs. At the same time, insurance companies have until recently shown little interest in offering health insurance products to poor groups. A search for alternative mechanisms for meeting the healthcare needs of the poor in India has given rise to a variety of new health insurance initiatives. This paper describes three such initiatives, namely micro-health insurance, the Yeshasvini scheme in Karnataka state, and the national Universal Health Insurance scheme. Each has the overriding objective of increasing the access of poor individuals and families to quality healthcare at an affordable cost.
Country
United Kingdom
Publisher
Overseas Development Institute
URL
Theme area
Values, policies and rights
Title of publication Policy brief: Educational opportunities for the poor, Sri Lanka
Date of publication
2006 February
Publication type
Document
Publication details
Policy Brief 11 pp 1-4
Publication status
Published
Language
English
Keywords
Sri Lanka, education, poverty, inequality
Abstract
Successive governments in Sri Lanka have made investment in education and other social services a priority. The ‘Universal Free Education Policy’ was introduced in 1945 and backed up with significant government expenditure on education (around 4 per cent of GDP) during the 1950s and 1960s. As a result, Sri Lanka has achieved remarkable levels of literacy and school enrolment rates, compared to many other developing countries in the world.
Nevertheless, concerns remain about the quality of education in Sri Lanka, the existence of regional disparities in education, and a slowing down of further increases in literacy and enrolment rates at the national level. To address these concerns, successive governments since the early 1980s have introduced a series of measures designed to enhance the quality of education, increase educational opportunities for the poor, and thereby increasing school enrolment and completion. Three significant measures, which are the subject of this paper, are the Free School Textbook Programme, the Free School Uniform Programme, and the Navodya School Development programme.
Country
United Kingdom
Publisher
Overseas Development Institute
URL:
URL
Theme area
Governance and participation in health
Title of publication Meeting report at the Southern African Social Forum, Harare, Zimbabwe, 13 October 2005
Date of publication
2005 October
Publication type
Conference Proceedings
Publication details
EQUINET Meeting report pp 1-24
Publication status
Not published
Language
English
Keywords
civil society, consolidating a platform, Southern Africa Social Forum, southern Africa
Abstract
The regional meeting of health civil society in east and southern Africa was planned and held by the health civil society planning group in the region. It aimed to consolidate the civil society platform developed by health civil society, link this with the regional equity analysis proposed by the regional network for equity in health in east and southern Africa (EQUINET) and take it forward within the Southern African Social Forum being hosted in Harare in the following days. It gathered delegates from health civil society in Zimbabwe and from the region.
Country
Southern Africa Regional
Publisher
EQUINET
URL:
Equinet Publication Type
Reports
Theme area
Values, policies and rights
Title of publication Policy brief: National Employment Fund, Tunisia
Date of publication
2006 February
Publication type
Journal Article
Publication details
Policy Brief 7 pp 1-4
Publication status
Published
Language
English
Keywords
educational system, Tunisia, unemployment among the low educated, poverty, National Employment Fund (NFE)
Abstract
The National Employment Fund, or ‘Fonds National de l’Emploi’ (FNE), was established in Tunisia in December 1999. Its aim is to help the most vulnerable categories of unemployed people to find productive long-term employment. It follows on from the success of an earlier initiative aimed at combating poverty, social exclusion and vulnerability in isolated regions, the National Solidarity Fund, or ‘Fonds National de Solidarité’ (FNS). The FNE seeks in particular to promote the labour market integration of two categories of the young unemployed, namely:1.those whose level of education does not give them access to official vocational training provided by official establishments, and 2. those with higher education qualifications, who have acquired initial training in certain areas but have very few employment opportunities outside teaching. The FNE can be considered a success in terms of providing a temporary solution to the problem of unemployment among young people with low levels of education and qualifications.
Country
United Kingdom
Publisher
Overseas Development Institute
URL:
URL
Theme area
Values, policies and rights
Title of publication Policy brief: National Functional Literacy Programme (NFLP), Ghana
Date of publication
2006 February
Publication type
Journal Article
Publication details
Policy Brief 9 pp 1-4
Publication status
Published
Language
English
Keywords
right to access education, education policy, National Functional Literacy Programme (NFLP), Ghana
Abstract
According to recent estimates, nearly half of the population in Ghana is illiterate. Moreover, there are marked differences in illiteracy rates, between rural and urban areas, men and women, and across regions and income groups. Prior approaches to illiteracy eradication in the country had been characterised by short national campaigns, interspersed with periods of neglect associated with political and economic instabilities. More often than not, adult literacy activities were left in the hands of a few religious organisations and non-governmental organisations.
In this context, the Government of Ghana launched in 2000, the second phase of the National Functional Literacy Programme (NFLP), after the completion, in 1997, of what had been considered a successful first phase. The Programme aims to address inequalities in access to literacy and life skills, by targeting specific groups: rural communities, the northern regions and women. Its target is educating about one million non-literate adults, especially the rural poor and women, by 2006.
Country
United Kingdom
Publisher
Overseas Development Institute
URL:
URL
Theme area
Values, policies and rights
Title of publication Policy brief: Youth training, Chile and Argentina
Date of publication
2006 February
Publication type
Journal Article
Publication details
Policy Brief 8 pp 1-4
Publication status
Published
Language
English
Keywords
educational system, youth, unemployment, Chile, Argentina,
Abstract
In recent decades, Chile and Argentina both went through programmes of market-oriented economic reforms, associated with a rise in unemployment. Of particular concern were the high rates of unemployment among young people, mainly from poor families, who had left the educational system at an early age. They represented an accumulated stock of people, with inadequate levels of human capital, who were marginalised from modern sectors and exposed to high-risk behaviours such as crime, drugs and violence. To address the problem of youth unemployment, the decision was made to design and implement special training schemes specifically oriented to young people who had deserted the educational system at an early age. Though the schemes had certain limitations, they made important steps in giving young people from poor families, who had left the education system early, a ‘second chance’ at getting inserted into the labour market.
Country
United Kingdom
Publisher
Overseas Development Institute
URL:
URL
Theme area
Poverty and health
Title of publication Policy Brief: The Maharastra Employment Guarantee Scheme (EGS), India
Date of publication
2006 February
Publication type
Journal Article
Publication details
Policy Brief 6 pp 1-4
Publication status
Published
Language
English
Keywords
India, poverty, employment equity, minimum wage
Abstract
In the semi-arid region to which the state of Maharashtra in India belongs, agriculture is a highly seasonal activity. During the lean periods, large numbers of rural households eke out a bare subsistence through short spells of mostly unremunerative employment. The aim of the Maharastra Employment Guarantee Scheme (EGS) is to address this problem by providing guaranteed employment at a wage level sufficient to ensure a minimum level of subsistence. By reducing risks faced by poor households, and by constructing productive assets and infrastructure, the scheme also aims to have a longer-term developmental role. The EGS is financed through a combination of taxes which are levied specifically for the scheme, and a matching contribution from the state government.
Country
United Kingdom
Publisher
Overseas Development Institute
URL:
URL
Theme area
Poverty and health, Governance and participation in health
Title of publication Policy brief: Social safety nets, Indonesia
Date of publication
2006 February
Publication type
Journal Article
Publication details
Policy Brief 5 pp 1-4
Publication status
Published
Language
English
Keywords
Indonesia, poverty, food security, employment, social safety net
Abstract
Between 1970 and 1996, Indonesia was one of the most rapidly growing economies in the world. Absolute poverty fell by around 50 percentage points, and gains in education and health standards were substantial. Nevertheless, systems of social protection remained largely informal, based on families, friends, and communities. When therefore Indonesia sank into economic crisis in 1998, large numbers of people were pushed into poverty. In response, the government introduced a new, more formal, social safety net. Its overall purpose was to help the poor and the newly poor cope with the impact of the economic crisis. The safety net programmes introduced in 1998 covered five major sectors: food security, employment creation, education, health, and community empowerment. The experience of social safety nets in Indonesia offers certain lessons to other countries.
Country
United Kingdom
Publisher
Overseas Development Institute
URL:
URL
Theme area
Resource allocation and health financing
Title of publication Policy brief: The Programme for Advancement through Health and Education (PATH), Jamaica
Date of publication
2006 February
Publication type
Journal Article
Publication details
Policy Brief 4 pp 1-4
Publication status
Published
Language
English
Keywords
poverty, cash transfers, child labour, health grant, Jamaica
Abstract
The Programme of Advancement through Health and Education (PATH) is a conditional cash transfer (CCT) programme. It provides cash transfers to poor families, who are subject to comply with conditions that promote the development of the human capital of their members. PATH is a nation-wide programme providing two types of grants. The first is a health grant, which is contingent on certain members of the household attending public health clinics at regularly scheduled intervals. The second is the education grant, which is contingent on children aged 6-17 attending school for at least 85% of the total number of school-days each month. Results from initial evaluations indicate that the programme has performed well in terms of targeting. The PATH programme is financed by the government of Jamaica and the World Bank.
Country
United Kingdom
Publisher
Overseas Development Institute
URL:
URL
Theme area
Poverty and health
Title of publication Policy brief: Red de Protección Social, Nicaragua
Date of publication
2006 February
Publication type
Journal Article
Publication details
Policy Brief 3 pp 1-4
Publication status
Published
Language
English
Keywords
Nicaragua, Red de Proteccion Social (RPS) anti-poverty strategy, cash transfer
Abstract
Despite reasonable rates of economic growth and poverty reduction during the 1990s and early 2000s, Nicaragua faces clear challenges in reaching the various targets set out in its Poverty Reduction Strategy Paper. Poverty in rural areas remains high, and significant numbers of households have no access to safe or potable water, receive no prenatal care or family planning, and do not send their children to school. The Red de Protección Social (RPS) is one part of the country’s overall anti-poverty strategy. It represents a significant departure from previous anti-poverty programmes, in terms of being targeted explicitly at households in extreme poverty, and being subject to rigorous monitoring and evaluation.
Country
United Kingdom
Publisher
Overseas Development Institute
URL:
URL
Theme area
Poverty and health
Title of publication Policy Brief: Familias en Acción, Colombia
Date of publication
2006 February
Publication type
Journal Article
Publication details
Policy Brief 2 pp 1-4
Publication status
Published
Language
English
Keywords
social policy, poverty, macroeconomic shock, cash transfer programme, Colombia
Abstract
Towards the end of the 1990s, Colombia was affected by a series of macroeconomic shocks which had particularly adverse impacts on poor households. The percentage of individuals falling below the national poverty line was rising, while levels of school attendance and nutritional intake among poorer households were declining. Familias en Acción was launched in 2000, as part of the Government’s policy to mitigate the adverse effects of those shocks on the country’s poor. Familias en Acción is a conditional cash transfer programme. It provides grants of between US$5 and US$17 per month to poor households with children, on the condition that children aged less than 7 attend regular medical check-ups, and that children aged between 7 and 18 attend no less than 80% of school classes during the school year.
Country
United Kingdom
Publisher
Overseas Development Institute
URL:
URL
Theme area
Poverty and health
Title of publication Policy brief 1: Social grants, South Africa
Date of publication
2006 February
Publication type
Document
Publication details
Inter-Regional Inequality Facility 1 pp 1-4
Publication status
Published
Language
English
Keywords
South Africa, poverty, social security
Abstract
This series of Policy Briefs summarises the experiences of recent government initiatives aimed at addressing inequality in Africa, Asia and Latin America. South Africa’s social security system is the government’s chief initiative in tackling some social problems besetting the country. Since 2000, levels of investment and economic growth in South Africa have achieved their fastest increases in decades. Nevertheless, with an official unemployment rate of 26%, a poverty rate estimated at approximately 50%, and one of the most severe measures of inequality in the world, South Africa faces substantial challenges in addressing poverty, inequality and unemployment. While it ranks as an upper-middle income country based on average income, some of the nation’s social indicators are comparable to those of the poorest countries of the world. There are five major social security grants in South Africa: the State Old Age Pension, the Disability Grant, the Child Support Grant, the Foster Child Grant and the Care Dependency Grant. The grants are implemented and administered by a separate national government agency, the South African Social Security Agency.
Country
South Africa
Publisher
Overseas Development Institute
URL:
Theme area
Poverty and health
Title of publication Rural Agriculture and Pastoralism Programme
Date of publication
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
agriculture and food production, rural, pastoralists, development
Abstract
In Eastern Africa, food production is one of a complex set of options that rural communities pursue to secure better livelihoods. At the same time, the Eastern African population has found itself in a cycle of food-related tragedies - low food intakes, hunger and famine. In view of this, the challenge is how institutions can effectively strengthen the livelihood security of small-scale food producing communities and adequately address food-related tragedies under the various political, socio-economic, technical and environmental forces. The Rural Agriculture and Pastoralism Programme (RAPP) is a food production unit of Intermediate Technology Development Group (ITDG) in Eastern Africa. RAPP aims to enhance livelihood security of pastoralists and marginal farmers in Eastern Africa by enabling them to improve their technological capabilities while taking greater control of the decisions that affect their lives.
Country
Kenya
Publisher
Intermediate Technology Development Group-Eastern Africa (ITDGEA)
URL:
Theme area
Governance and participation in health
Title of publication Indigenous democracy: Traditional conflict resolution mechanisms (Pokot, Turkana, Samburu and Marakwet)
Date of publication
2004 January
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
democracy, traditional, East Africa, conflict resolution, community
Abstract
Conflict resolution and cross-border harmonization is an integral component of the aim of the Intermediate Technology Development Group-Eastern Africa (ITDGEA) of reducing vulnerability among poor people especially the pastoral communities in the Greater Horn of Africa. Traditional conflict resolution structures are closely bound with sociopolitical and economic realities of the lifestyles of the African communities. These conflict resolution structures are rooted in the culture and history of African people, and are in one way or another unique to each community. This publication details the indigenous methods of conflict resolution among the Pokot, Tukana, Samburu, and Marakwet communities of North Rift Kenya. The overriding legitimacy of indigenous conflict resolution structures amongst these communities is striking.
Country
Kenya
Publisher
Intermediate Technology Development Group-Eastern Africa (ITDGEA)
URL:
Theme area
Governance and participation in health
Title of publication A CAFOD background Paper: A participatory approach to partnerships for Africa’s development:
Date of publication
2002 May
Publication type
Journal Article
Publication details
CAFOD Background Paper 1 pp 1-8
Publication status
Published
Language
English
Keywords
New Partnerships for Africa’s Development (NEPAD), G8, donors
Abstract
This paper explores how the donor community should commit themselves not only to additional resources and preferential treatment for Africa but also to a process where partnerships include an influential voice for impoverished people effectively for poverty reduction.
Country
United Kingdom
Publisher
Catholic Agency for Overseas Development (CAFOD)
URL:
Theme area
Equity and HIV/AIDS
Title of publication Evidence for HIV decline in Zimbabwe: A comprehensive review of the epidemiological data
Date of publication
2005 November
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
HIV/AIDS, antenatal, decline, epidemiological data, HIV prevalence, Zimbabwe
Abstract
Recent data from a national antenatal clinic surveillance system suggest that HIV prevalence has begun to fall in Zimbabwe in recent years. Zimbabwe has experienced one of the largest HIV epidemics in the world. The first case of AIDS was identified in 1985 and by 1990—the first year of national antenatal-clinic based surveillance—HIV prevalence was estimated to already exceed 10%. The country’s first national estimate, produced in 2003, indicated that HIV prevalence amongst adults had reached 24.6% (range 20–28%). The current decline in HIV prevalence at the national level is intrinsically a positive and an important development in that it represents a reduction in the burden of infection within the population. If maintained, this is likely to translate into lower mortality within a timescale of five to ten years. However, a decline in HIV prevalence is neither a necessary nor a sufficient indication of programme impact.
Country
Switzerland
Publisher
Joint United Nations Programme on HIV/AIDS (UNAIDS)
URL:
Theme area
Resource allocation and health financing
Title of publication SADC and donors – ideals and practices: From Gaborone to Paris and back
Date of publication
2006 April
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
SADC, donor agencies, Paris Declaration, Millennium Development Goals (MDGs).
Abstract
This report sets out to take stock of the current relations between Southern African Development Community (SADC) and its international co-operating partners (ICPs) – the foreign donor agencies providing support and assistance to the institution and its programme of action. It identifies obstacles and opportunities for making progress and discusses the current efforts to establish modalities and
mechanisms for a new partnership between SADC and donors.
Country
Botswana
Publisher
Botswana Institute for Development Policy Analysis (BIDPA)
URL:
Theme area
Equity and HIV/AIDS
Title of publication Zimbabwe HIV and AIDS logistics system assessment
Date of publication
2006 January
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
Zimbabwe, ARV supply chain, public sector, indicators
Abstract
This document is a report of findings from an assessment conducted by the Zimbabwe Ministry of Health and Child Welfare (MOHCW) on the country’s public sector health facilities. The MOHCW estimates that, according to 2003, HIV prevalence among adults aged 15–49 years in Zimbabwe is 24.6 percent.
Country
Zimbabwe
Publisher
John Snow, Inc., Deliver
URL:
Theme area
Health equity in economic and trade policies
Title of publication IMF macroeconomic policies and health sector budgets
Date of publication
2006 June
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
Health, macroeconomic policy, human resources for health, health sector budgets
Abstract
This report draws on four country case studies carried out in Ghana, Kenya, Uganda and Zambia in November and December 2005 and January 2006, which look at the impacts of International Monetary Fund (IMF) policy on health budgets and employment in the health sector, and the implications for the delivery of health services.
Country
Netherlands
Publisher
URL:
Theme area
Equitable health services, Resource allocation and health financing
Title of publication Guide to producing national health accounts: With special applications for low-income and middle-income countries
Date of publication
2003
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
low-income countries, health expenditure
Abstract
National health accounts (NHA) are designed to answer precise questions about a country’s health system. They provide a systematic compilation and display of health expenditure. They can trace how much is being spent, where it is being spent, what it is being spent on and for whom, how that has changed over time, and how that compares to spending in countries facing similar conditions. The World Health Organization, the World Bank, the United States Agency for International Development and other partners joined forces to produce this Guide to assist countries embarking on the measurement of their national health expenditures.
Country
Switzerland
Publisher
World Health Organisation
URL:
Theme area
Values, policies and rights
Title of publication Trade and development in Africa: A statement of principles
Date of publication
Publication type
Conference Proceedings
Publication details
Publication status
Published
Language
English
Keywords
poverty alleviation, G-8, developing countries
Abstract
Following a roundtable of distinguished trade and Africa specialists, there was consensus on the critical importance of the developed world getting behind efforts to address the tragic poverty conditions in Africa. Notwithstanding the fact that development and poverty alleviation is the primary responsibility of each country towards its own people, there is common agreement that in an inter-connected world, there must be greater acknowledgment of shared responsibilities for realizing the fundamental rights of all.
Country
Publisher
Realizing Rights: The Ethical Globalization Initiative
URL:
Theme area
Governance and participation in health
Title of publication Parliamentary oversight, HIV and AIDS: Recommendations and decisions of the regional meeting
Date of publication
2006 February
Publication type
Conference Proceedings
Publication details
Institute for Democracy in South Africa (IDASA) pp 1-4
Publication status
Published
Language
English
Keywords
Parliament, HIV and AIDS, baseline study
Abstract
In 2004/2005, the Institute for Democracy in South Africa (IDASA)’s Governance and AIDS Programme (GAP) and the Canadian Parliamentary Centre conducted a baseline study on parliamentary oversight of HIV and AIDS in Botswana, Ghana, Kenya, Mozambique and South Africa. The findings of this study informed the objectives of a regional meeting convened from 22–24 February 2006 in Johannesburg, South Africa. Some of the objectives were to contribute to effective parliamentary oversight of the HIV and AIDS response in selected African countries, and to identify strengths, weaknesses and opportunities for effective parliamentary oversight of national HIV and AIDS responses. The meeting was attended by members of parliament (MPs) from Ghana, Kenya, Malawi, Mozambique, Namibia, Zambia, Tanzania and Zimbabwe. Deliberations at the meeting centred around three major themes related to parliamentary oversight of HIV and AIDS.
Country
South Africa
Publisher
Institute for Democracy in South Africa (IDASA)
URL:
Theme area
Equitable health services, Resource allocation and health financing
Title of publication Guide to using the Global Fund to fight AIDS, tuberculosis and malaria to support health systems strengthening in Round 6
Date of publication
2006 May
Publication type
Document
Publication details
Physicians for Human Rights pp 1-38
Publication status
Published
Language
English
Keywords
health systems, HIV, tuberculosis, malaria, health financing
Abstract
In many countries, weak health systems are a central obstacle to successfully scaling-up and sustaining HIV, tuberculosis, and malaria programs. The Global Fund, and specifically this sixth round, presents an opportunity to make significant strides in funding the activities required to remove these obstacles, creating enormous benefits for the people infected and affected by the Fund’s three target diseases. Last round, for example, the Global Fund enabled Malawi to strengthen its health workforce in both the near and longer term, Rwanda to significantly improve access of poor people to health services, and Cambodia to strengthen its drug procurement and distribution system and its health sector planning capacity. Here is a guide meant to assist members of Country Coordinating Mechanisms and other individuals and organisations involved in preparing proposals, or providing input into these proposals, for Round 6 of the Global Fund to Fight AIDS, Tuberculosis, and Malaria.
Country
United States
Publisher
Physicians for Human Rights
URL:
Theme area
Human resources for health, Equity and HIV/AIDS
Title of publication Challenges facing the Malawian health workforce in the era of HIV/AIDS
Date of publication
2004 September
Publication type
Document
Publication details
Publication status
Language
English
Keywords
Malawi, HIV/AIDS, health workforce
Abstract
Malawi has the eighth highest Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) prevalence rate globally (15%). AIDS is the leading cause of death in Malawi; annual deaths due to AIDS are estimated at 81,000. In Malawi, the prevalence rate has decreased over the last few years in Lilongwe. These lower rates should not be thought of as a reason for complacency, however, since it is likely that these rates reflect increased infection rates matched by high levels of mortality.
Country
Tanzania
Publisher
Commonwealth Regional Health Secretariat (CRHCS)
URL:
Theme area
Human resources for health
Title of publication Challenges facing the Kenyan health workforce in the era of HIV/AIDS
Date of publication
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
Kenya, HIV/AIDS, health workforce
Abstract
What effect does the increased number of Kenyans living with HIV/AIDS have on the health sector? To address this question, the Commonwealth Regional Health Secretariat (CRHCS) and Kenyan researchers from the Ministry of Health, with support from the USAID/Bureau for Africa, undertook an assessment to explore the effects of HIV/AIDS on the health workforce in Kenya. The assessment found that the increasing number of people with HIV/AIDS has resulted in huge workload for health care workers, high staff attrition rate, absenteeism and inadequate training for personnel, among other challenges. The Kenyan government and partners can take measures at the human resource management level to redress some of the challenges highlighted. The paper presents broad recommendations that stakeholders can consider to remedy some of these challenges, for example improving remuneration and mitigating occupational stress.
Country
Tanzania
Publisher
Commonwealth Regional Health Secretariat (CRHCS)
URL:
Theme area
Human resources for health
Title of publication Expenditure ceilings, human resources and health: The case for Zambia
Date of publication
2005 November
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
human resources for health (HRH), macroeconomics, millenium development goals (MDGs)
Abstract
This paper argues that policy measures that limit expenditures on wages and salaries for macroeconomic stability purposes without considering alternative policy options appear to be extending the period of poor health status that has characterized Zambia over the past decades.
Country
Zambia
Publisher
Churches Health Association of Zambia (CHAZ)
URL:
URL
Theme area
Equitable health services
Title of publication Older population and health system: A profile of Botswana
Date of publication
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
Botswana, non-communicable diseases, health system
Abstract
The speed of population ageing in developing countries is unprecedented, leading to an increase in age-related non-communicable diseases (NCDs). This paper posits that health systems are urgently required to respond to such ensuing epidemiological shifts. The Botswana Ministry of Health put together a task force to undertake a study to examine the role of the country’s health system in caring for its elderly people. The study employed both the qualitative and quantitative approach, and addressed three key areas, namely the organisation of health services with emphasis on addressing ‘active ageing and life course’, utilisation of health services by those who were 50 years and above, and the ability of the health systems in addressing issues/problems of elderly in terms of availability of services. This paper presents findings from the intra study, and outlines emerging challenges for the health care system of Botswana.
Country
Botswana
Publisher
Botswana Ministry of Health
URL:
Theme area
Equity and HIV/AIDS
Title of publication Four years after Abuja: More action required on spending commitments!
Date of publication
2005 October
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
Abuja summit, HIV/AIDS, infectious diseases
Abstract
This paper, written in 2005, examines African countries’ progress towards the Abuja targets from the time the summit was held in April 2001 in Abuja, Nigeria. The Abuja Summit concluded with the adoption of the Abuja Declaration, a declaration outlining Africa\'s response to HIV&AIDS, tuberculosis (TB) and other related infectious diseases. In that declaration, among other commitments, the leaders of Africa committed to spend 15 per cent of their national budgets to health with emphasis on HIV&AIDS programmes. This publication reveals that there has been inadequate action on the spending commitments agreed on the summit, due to lack of accountability among African leaders, huge debt burden and poor tracking systems for expenditures. The authors assert that the Abuja Declaration is still as important today as it was in 2001, citing ten solid reasons why the Abuja targets should still be pursued.
Country
Kenya
Publisher
ActionAid International Africa
URL:
Theme area
Governance and participation in health
Title of publication Discussion paper 39: Community voice and role in district health systems in east and southern Africa: A literature review
Date of publication
2006 June
Publication type
Document
Publication details
EQUINET Discussion paper series 39 pp 1-59
Publication status
Not published
Language
English
Keywords
community participation, community voice, governance, accountability, mechanisms, district level, east and southern Africa
Abstract
This study is a review of the literature and secondary evidence on community participation in central, eastern and southern Africa. It focuses in particular on South Africa, Mozambique, Malawi, Zambia and Kenya, and presents and analyses evidence of the current situation with regard to the role of districts in promoting community participation and articulating community voice. This includes looking at how: community voice and roles at district level are structured and integrated into planning; the way districts carry out their functions enables or blocks participation; districts articulate and represent community interests at national level; and wider contexts and processes at national and district levels influence and explain these outcomes. The review identifies examples of enabling and blocking mechanisms for community participation at district level and to provide pointers for further research.
Country
East and southern Africa region
Publisher
EQUINET
URL:
Equinet Publication Type
Discussion paper
Theme area
Equity and HIV/AIDS
Title of publication Free by 5: Economists’, public health experts’ and policy makers’ declaration on free treatment for HIV / AIDS
Date of publication
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
universal access, economics, HIV/AIDS
Abstract
We, economists, public health experts and policy makers involved in the fight against AIDS are committed to scaling up access to healthcare, including antiretrovirals (ARVs), for HIV positive people with the objective of universal access. We consider
it a rational economic decision and an absolute priority. We argue that WHO, UNAIDS, the governments of resource-poor countries and international donors, among them the Global Fund, the World Bank, PEPFAR and bilateral cooperation agencies, must adopt and actively promote the principle of universal free access to treatment (including ARVs) and contribute to its implementation. We believe that the treatment package should include HIV tests, prophylaxis and treatment of opportunistic infections, all laboratory and associated examinations. Further, for universally free access, we argue that this package would have to be channelled through the public healthcare system.
Country
Belgium
Publisher
URL:
Theme area
Equity and HIV/AIDS
Title of publication The opportunities and challenges of introducing anti-retroviral therapy (ART) in resource-poor settings
Date of publication
2001 November
Publication type
Document
Publication details
Canadian International Development Agency (CIDA) pp 1-17
Publication status
Published
Language
English
Keywords
consensus, antiretroviral therapy (ART), resource-poor settings
Abstract
This document is a consensus statement by organisations delivering AIDS projects for the Canadian International Development Agency (CIDA). The document was developed at a meeting convened by the Canadian Public Health Association (CPHA) in 2001 and attended by clinicians and public health experts working with major CIDA-funded AIDS projects in West, East and Southern Africa, and in India. The purpose of the meeting was to elaborate a technical consensus on major issues related to the introduction of anti-retroviral drugs in resource-poor settings. The document covers various issues like Integrated Management of Childhood Illnesses (IMCI), current status of access to anti-retroviral drugs as well as safety regarding viral resistance and adverse effects of antiretroviral therapy (ART).The participants acknowledge that policy issues related to access to ART require a much wider social consensus. The consensus is based on what is presently known about ART. It will have to be updated periodically.
Country
Canada
Publisher
Canadian International Development Agency (CIDA)
URL:
Theme area
Human resources for health
Title of publication Where have all the doctors gone? Career choices of Wits medical graduates
Date of publication
2005 June
Publication type
Journal Article
Publication details
South African Medical Journal 95 6 pp 414-419
Publication status
Published
Language
English
Keywords
doctors, public sector, private sector, gender
Abstract
The paper discusses findings from a study done to assess the distribution of University of the Witwatersrand (Wits) medical graduates from 1960 to 1994, with regard to private or public sector work, chosen specialist or generalist careers, and work in urban or rural areas, examining secular trends and gender differences. The study was done using a cross-sectional analysis of the register of what was then the South African Medical and Dental Council (SAMDC) and a telephone interview survey of a sample of medical graduates, collecting retrospective career histories. The findings challenge several assumptions about the likelihood of Wits graduates working as generalists, the voluntary contribution of graduates to the public sector, and, in particular, the value of women doctors to public service and primary care.
Country
South Africa
Publisher
South African Medical Journal
URL:
Theme area
Equity and HIV/AIDS
Title of publication The affordability of antiretroviral therapy in developing countries: What policymakers need to know
Date of publication
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
Antiretroviral therapy, health economics, models, projections
Abstract
This paper aims to assist policymakers in developing countries and international donors by providing an outline of economic information needed to make a decision regarding the purchase of antiretroviral (ARV) drugs. The paper: 1) reviews existing experiences of policymakers in developing countries regarding the purchase of ARVs, 2) identifies issues that would need to be addressed and data that would be required in order to make more informed decisions regarding this issue, and 3) develops a cost-benefit model that could be utilised in designing an economic research project evaluating the economic costs and benefits of antiretroviral therapy. A review of experiences with this issue reveals that there are growing political, legal and budgetary pressures for countries to make tenable decisions regarding the purchase of ARVs.
Country
United States
Publisher
Family Health International’s AIDS Control and Prevention (AIDSCAP) Project,
URL:
Theme area
Equitable health services, Equity and HIV/AIDS
Title of publication Rationing antiretroviral therapy for HIV/AIDS in Africa: Efficiency, equity, and reality
Date of publication
2004 February
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
HIV/AIDS, Sub-Saharan Africa, ART, rationing, health economics
Abstract
Rationing of access to antiretroviral therapy already exists in sub-Saharan Africa and will intensify as national treatment programs develop. The number of people who are medically eligible for therapy will far exceed the human, infrastructural, and financial resources available, making rationing of public treatment services inevitable. In this paper we describe 15 identified criteria by which antiretroviral therapy could be rationed in African countries. We analysed the resulting rationing systems across 5 domains: clinical effectiveness, implementation feasibility, cost, economic efficiency, and social equity. For purposes of simplification, we have drawn a distinction between explicit and implicit rationing systems. We note that there is a direct trade off between economic efficiency and social equity.
Country
United States
Publisher
Center for International Health and Development, Boston University School of Public Health
URL:
Theme area
Equity and HIV/AIDS
Title of publication Guidelines for Antiretroviral Therapy in Zimbabwe
Date of publication
2003 December
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
guidelines, ARV, Zimbabwe
Abstract
With the introduction of antiretrovirals (ARVs) in Zimbabwe, guidelines are needed to provide a standardised approach to treatment and management of HIV/AIDS. Such guidelines were developed and published in 2003.The introduction of antiretroviral drugs has revolutionised the care and management of HIV/AIDS, and, with the price of antiretroviral drugs having fallen, it is possible for more people in developing countries like Zimbabwe to access antiretroviral drugs. These guidelines are meant for use in the Zimbabwean private as well public sectors, and will be updated as new information and evidence becomes available.
Country
Zimbabwe
Publisher
Zimbabwe Ministry of Health and Child Welfare
URL:
Theme area
Equity and HIV/AIDS
Title of publication Zimbabwe: Summary country profile for HIV/AIDS treatment scale-up
Date of publication
2005 June
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
Zimbabwe, ART scale-up, demographic data, socioeconomic data
Abstract
The paper is a summary country profile for HIV/AIDS treatment scale-up in Zimbabwe.It presents demographic and socioeconomic data,HIV indicators,resource requirements and funds committed for scaling up antiretroviral therapy,ART coverage, as well as local and international implementation partners.
Country
Switzerland
Publisher
World Health Organization
URL:
Theme area
Equity and HIV/AIDS
Title of publication Exploring current practices in paediatric antiretroviral roll-out and integration with early childhood programmes in South Africa: A rapid situational analysis
Date of publication
2005 May
Publication type
Report
Publication details
Horizons Research Update pp 1-4
Publication status
Published
Language
English
Keywords
antiretroviral therapy (ART), children, situation analysis
Abstract
The paper reports findings of a study on current practices and perceptions relating to the antiretroviral (ARV) treatment of infants and children with HIV/AIDS in South Africa. Data was collected using a range of qualitative and quantitative methods, namely, ARV facility observations; semistructured questionnaires administered to facility managers and health care workers; and structured questionnaires administered to caregivers of children on antiretroviral therapy. Among other findings, the study demonstrates that initial paediatric ARV roll-out has resulted in a significant number of children on treatment. The gaps in referral to paediatric ARV treatment result in missing significant numbers of children in need. Also, community and family issues are identified to be significant barriers to ARV treatment for children.
Country
South Africa
Publisher
The Population Council, Inc
URL:
Theme area
Human resources for health, Equity and HIV/AIDS
Title of publication Estimating health workforce needs for antiretroviral therapy in resource-limited settings
Date of publication
2006 January
Publication type
Journal Article
Publication details
Human Resources for Health 4 1 pp 1-16
Publication status
Published
Language
English
Keywords
antiretroviral therapy (ART), resource-limited settings, human resources
Abstract
Efforts to increase access to life-saving treatment, including antiretroviral therapy(ART), for people living with HIV/AIDS in resource-limited settings has been the growing focus of international efforts. One of the greatest challenges to scaling up will be the limited supply of adequately trained human resources for health, including doctors, nurses, pharmacists and other skilled providers. As national treatment programmes are planned, better estimates of human resource needs and improved approaches to assessing the impact of different staffing models are critically needed. However there have been few systematic assessments of staffing patterns in existing programmes or of the estimates being used in planning larger programmes.
Country
United States
Publisher
BioMed Central Limited
URL:
Theme area
Equity and HIV/AIDS
Title of publication Closing remarks by Stephen Lewis, UN Special Envoy for HIV/AIDS in Africa, at the XVI International AIDS Conference, Toronto, Canada
Date of publication
2006 August
Publication type
Conference Proceedings
Publication details
Publication status
Publication status unknown
Language
English
Keywords
HIV/AIDS, gender inequality, child rights
Abstract
This is the last speech that Stephen Lewis was to make at international conferences as United Nations Envoy for HIV/AIDS. Within the speech he comments on areas that have previously been of political controversy in the approach to the prevention of HIV/AIDS, including abstinence-only programmes, harm reduction programmes, circumcision, microbicides, nutrition, and with particular emphasis on gender and child inequalities in the acquisition and management of HIV/AIDS.
Country
Publisher
URL:
URL
Theme area
Equity and HIV/AIDS
Title of publication Sixteenth International Conference on HIV/AIDS: Message from Dr. Paulo Teixeira
Date of publication
2006 August
Publication type
Conference Proceedings
Publication details
Publication status
Publication status unknown
Language
English
Keywords
HIV/AIDS, indicators of the 3 by 5 initiative, universal access to prevention and treatment
Abstract
Dr. Teixeira could not be at the sixteenth AIDS conference in Toronto in August 2006, and for this reason wrote this letter to friends and fellows in the fight against AIDS. The letter discusses the various indicators of the "3 by 5 initiative", and Dr. Teixeira\'s deep concern with the manner in which the United Nations agencies and many donors are addressing continuity, under the label of universal access to prevention and treatment. Such lack of commitment does not agree with the evaluations of the 3x5 conducted by the WHO and by an international independent committee and included in the above mentioned documents. Many of the criticisms in it are well founded, but they do not annul the urgency of the 3x5 and do not justify the current attitude.
Country
Publisher
URL:
URL
Theme area
Equitable health services, Equity and HIV/AIDS
Title of publication The real challenges for scaling up ART in sub-Saharan Africa
Date of publication
2006
Publication type
Journal Article
Publication details
AIDS 20 5 pp 653-656
Publication status
Published
Language
English
Keywords
antiretroviral therapy, AIDS, treatment, sub-Saharan Africa, health policy, prevention
Abstract
In contrast to short-term emergency responses given to the AIDS pandemic by health care systems, longer-term objectives and approaches are now necessary in view of the ultimate goal of universal access to antiretroviral therapy (ART). This transition is however fraught with challenges. For example, many health systems in sub-Saharan Africa currently lack the capacity to provide even basic health care to the population, let alone deal with the additional burden of scaling-up ART. Transforming a deadly disease into a manageable chronic one turns millions of people into chronic patients, in need of life-long regular follow-up. The increased workload related to maintaining large numbers of patients on ART calls for more effort and resources which poor countries cannot easily afford.
Country
Belgium
Publisher
Lippincott Williams & Wilkins, 351 West Camden St, Baltimore, MD 21201
URL:
Theme area
Equity and HIV/AIDS
Title of publication Expert patients and AIDS care
Date of publication
2006 March
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
ART, low-income countries, HRH constraints
Abstract
This is a literature review on expert patient programmes in high-income countries, and an exploration of their relevance for HIV/AIDS care in low-income countries with severe human resource shortages. Expert patients are those patients that have been involved in self-management of a particular chronic disease affecting them, and therefore are thought to have the most comprehensive expertise in dealing with that condition. Early evaluations show good results and indicate that the expert patient programme has significantly reduced the use of health services, such as general practitioners’ consultations, outpatient visits, accident and emergency attendances and physiotherapy use. Opportunities for expanding this concept to poorer countries with human resources constraints should be explored.
Country
Germany
Publisher
Department of Public Health, Institute of Tropical Medicine
URL:
Theme area
Equity and HIV/AIDS
Title of publication Zambia: Summary country profile for HIV/AIDS treatment scale-up
Date of publication
2005 June
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
Zambia, ART scale-up, demographic data, socioeconomic data
Abstract
The paper is a summary country profile for HIV/AIDS treatment scale-up in Zambia. It presents demographic and socioeconomic data, HIV indicators, resource requirements and funds committed for scaling up antiretroviral therapy, ART coverage, as well as local and international implementation partners.
Country
Switzerland
Publisher
World Health Organization (WHO)
URL:
Theme area
Poverty and health, Equitable health services
Title of publication Report of a research workshop: The role of health systems in food sovereignty and nutrition
Date of publication
2006 May
Publication type
Report
Publication details
EQUINET Workshop report pp 1-16
Publication status
Not published
Language
English
Keywords
nutrition, food sovereignty, initiatives, policies, sub-Saharan Africa
Abstract
The case study writers meeting on the Food Security and Nutrition concerns in east and southern Africa sought to bring together case study writers and expert facilitators that have been working on nutrition initiatives, policies, and to update them on the prevailing situation, current interventions, equity and policies on food security. It also aimed to outline a clear way of working together and complimenting each others efforts in assisting the case studies to achieve the desired goals and to be able to operationalise the processes decided upon by the meeting.
Country
East and southern Africa region
Publisher
EQUINET
URL:
Equinet Publication Type
Reports
Theme area
Monitoring equity and research to policy
Title of publication Discussion paper 28: Applying policy analysis in tackling health-equity related implementation gaps
Date of publication
2006 January
Publication type
Document
Publication details
EQUINET Discussion Paper 28 pp 1-20
Publication status
Published
Language
English
Keywords
policy implementation; power; South Africa, Zambia, Tanzania
Abstract
In international health policy debates the problems experienced in implementing new policies and interventions are generally seen as resulting from the weak use of available evidence and the failure to hold health workers accountable for their actions. Both of these causes are then sometimes linked to the lack of political will to improve implementation. This paper presents an alternative perspective that takes fuller account of the ways in which the exercise of power shapes implementation experiences.
Country
Southern Africa Regional
Publisher
EQUINET
URL:
Equinet Publication Type
Discussion paper
Theme area
Human resources for health, Monitoring equity and research to policy
Title of publication Discussion paper 38: Potential constraints to equitable service delivery in Cape Town in 2003
Date of publication
2005 May
Publication type
Document
Publication details
EQUINET Discussion Paper 38 pp 1-15
Publication status
Not published
Language
English
Keywords
human resources for health, policy analysis, policy implementation, workplace, Cape Town, South Africa
Abstract
The research was located in Cape Town, South Africa where the need for equity policies to be implemented is great. However ongoing restructuring and change lead to fatigue in the management and staff of the primary health services. Their resistance could block the implementation of equitable staffing plans. It is necessary to understand the management and workplace factors leading to potential resistance of equitable staffing plans and thus these were explored. A policy analysis approach using a case study analysis was sought to provide understandings, approaches and tools to illuminate the processes involved in health policy.
Country
South Africa
Publisher
EQUINET; Centre for Health Policy, University of Witwatersrand
URL:
Equinet Publication Type
Discussion paper
Theme area
Health equity in economic and trade policies
Title of publication Report on a training workshop: Promoting health in trade agreements, 12 to 13 June 2006, Lilongwe, Malawi
Date of publication
2006 June
Publication type
Report
Publication details
EQUINET Workshop report pp 1-8
Publication status
Not published
Language
English
Keywords
protecting health, trade agreements, equity, health systems, assessment of trade and investment policies, southern Africa
Abstract
The workshop on Protecting Health in Trade Agreements held in Malawi in June 2006 aimed to build capacities in state, legislative and civil society institutions to understand, analyse and promote public sector equity-oriented health systems within trade and investment policies and agreements. The course aim to enable participants to carry out assessments nationally of the key trade and investment agreements that impact on health and to identify options for promoting public sector equity-oriented health systems within current trade and investment policies and agreements.
Country
Southern Africa Regional
Publisher
EQUINET
URL:
Equinet Publication Type
Reports
Theme area
Governance and participation in health
Title of publication PRA project report 1: Creating nurse student awareness on community knowledge on health in “Ontevrede” (unsatisfied) informal settlement, Namibia
Date of publication
2006 June
Publication type
Document
Publication details
An EQUINET PRA project report pp 1-36
Publication status
Not published
Language
English
Keywords
particpatory research, Ontevrede, student nurses, informal settlements, Namibia
Abstract
The nursing curriculum of the University of Namibia is based on Primary health care approach. However nursing students do not have the skills for a participatory approach to communities and perceive that communities do not know or need to be consulted on their health needs. Communication breakdown between communities and nurses is not in the interest of either. This study aimed to create awareness among the student nurses to help them view the communities as partners in health, and at the same time to empower the communities to be more responsible for own health.
Country
Namibia
Publisher
EQUINET
URL:
Equinet Publication Type
Discussion paper
Theme area
Equity and HIV/AIDS
Title of publication Gender and monitoring the response to HIV/AIDS pandemic
Date of publication
2004 November
Publication type
Journal Article
Publication details
Emerging Infectious Diseases 10 11 pp 1979-1983
Publication status
Published
Language
English
Keywords
monitoring and evaluation, HIV/AIDS prevention, women
Abstract
The mechanisms, techniques, and data sources used to monitor and evaluate global AIDS prevention and treatment services may vary according to gender. The Joint United Nations Programme on HIV/AIDS has been charged with tracking the response to the pandemic by using a set of indicators developed as part of the Declaration of Commitment endorsed at the U.N. General Assembly
Special Session on AIDS in 2001. Statistics on prevalence and incidence indicate that the pandemic has increasingly affected women during the past decade. Women’s biologic, cultural, economic, and social status can increase their likelihood of becoming infected with HIV.
Country
Switzerland
Publisher
Emerging Infectious Diseases
URL:
Theme area
Equity and HIV/AIDS
Title of publication Rationing antiretroviral therapy for HIV/AIDS in Africa: Choices and consequences
Date of publication
2005 November
Publication type
Journal Article
Publication details
PlosMedicine 2 11 pp 1098-1104
Publication status
Published
Language
English
Keywords
antiretroviral therapy, rationing
Abstract
Rationing of access to antiretroviral therapy (ART) already exists in sub-Saharan Africa. This is an inevitable step given that the number of people who are medically eligible for therapy far exceeds available resources. Rationing can be either explicit implicit. The current study identified 15 criteria for rationing in African countries. These criteria fall in 5 domains, namely: clinical effectiveness, implementation feasibility, cost, economic efficiency, and social equity.
Country
United States
Publisher
PlosMedicine
URL:
Theme area
Values, policies and rights
Title of publication Africa in the eyes of the world
Date of publication
2005
Publication type
Journal Article
Publication details
Croatian Medical Journal 46 4 pp 708-711
Publication status
Published
Language
English
Keywords
apartheid, colonisation, debt, disease burden
Abstract
The article describes the various, widely-held , and arguably false, perceptions about the continent of Africa. The author agues that the present day realities of Africa are inextricably linked to its colonisation and political history, for example apartheid in South Africa. The continent is currently heavily burdened by debt, malaria, TB, and HIV/AIDS.The author asserts that Africa should be regarded as a sleeping giant continent whose inhabitants are geared to solve their problems, of course with the support of the global village.
Country
Publisher
Croatian Medical Journal
URL:
Theme area
Equity and HIV/AIDS
Title of publication Who accesses antiretroviral drugs within public sector in Malawi?
Date of publication
2006
Publication type
Journal Article
Publication details
Croatian Medical Journal 47 pp 356-359
Publication status
Published
Language
English
Keywords
Malawi, antiretroviral therapy, cost-sharing, community survey
Abstract
The National AIDS Commission estimates that at least 10% of the adult Malawi population is infected by HIV. As public sector demand for ART far outweighs supply, the crucial questions of who should receive free ART, as well as whether cost-sharing is necessary are posed. A qualitative community survey in Malawi in 2004 identified various priority groups for ART. Opinions on ART cost-sharing also differed.
Country
Malawi
Publisher
Croatian Medical Journal
URL:
Theme area
Equity and HIV/AIDS
Title of publication Forum lecture: Normalising testing - normalising AIDS
Date of publication
2006 May
Publication type
Conference Proceedings
Publication details
Ronald Louw Memorial Campaign: ‘Get Tested, Get Treated’ pp 1-22
Publication status
Published
Language
English
Keywords
Ronald Louw Memorial Campaign, HIV/AIDS, timely HIV testing
Abstract
The speaker at the Forum depicts the importance of early testing for HIV. They begin: \\"Why did Ronald Louw die? I am not speaking of physical cause. In the sense of fleshly fallibility, we know precisely what caused his death on Sunday 26 June 2005. He died of AIDS. . He need not have died. The causes culminating in his death triumphed for a precise reason. He died not because help was unavailable, but because he accessed it too late. He was tested for and diagnosed with HIV on 15 May 2005 – the very day that he was admitted to hospital in Port Elizabeth with severe symptomatic effects of late-stage AIDS, barely seven weeks before he died.\\"
Country
Publisher
University of KwaZulu-Natal, Durban
URL:
URL
Theme area
Human resources for health
Title of publication Discussion paper 35: Perceptions of health workers about conditions of service: A Namibian case study
Date of publication
2006 May
Publication type
Document
Publication details
EQUINET Discussion paper 35 pp 1-21
Publication status
Published
Language
English
Keywords
human resources, push and pull factors, private healthcare, public healthcare, incentives, retention, Namibia
Abstract
Human resources for health have become a topical issue at local, regional and global levels. In Namibia health worker mobility remains a concern for those in human resources planning. Achieving equity in this area needs a concerted effort from all sectors involved. However little is understood about the role that conditions of service play in influencing health professional mobility in Namibia. The study set out to explore and describe the influence of conditions of service on the movement and retention of the health professionals in Namibia. It is a qualitative study targeting mainly professional nurses, doctors, social workers and health inspectors at both operational and managerial levels, in public and private sectors.
Country
Namibia
Publisher
EQUINET
URL:
Equinet Publication Type
Discussion paper
Theme area
Equitable health services
Title of publication Capacity building paper: Patient involvement in treatment decision making among women with breast cancer: Creating person-centred and equitable health service systems
Date of publication
2006 May
Publication type
Document
Publication details
EQUINET Capacity Building Paper pp 1-17
Publication status
Not published
Language
English
Keywords
breast cancer, treatment, patient participation, patient's rights, Uganda
Abstract
The purpose of this study was to assess patients’ involvement in treatment decision making among women with breast cancer in Mulago hospital, Uganda’s national hospital. Patients’ participation in the treatment decision making process is one of the patients’ rights considered under the patient’s autonomy in the health care delivery process. It is of great value therefore for health care providers and other parties involved in the health services provision to create space for patients’ involvement in their treatment.
Country
Uganda
Publisher
URL:
Equinet Publication Type
Capacity building papers
Theme area
Monitoring equity and research to policy
Title of publication Discussion paper 29: Planning and budgeting for Primary Health Care in Zambia: A policy process analysis of experiences and outcomes (1995-2004)
Date of publication
2005 October
Publication type
Document
Publication details
EQUINET Discussion Paper 29 pp 1-31
Publication status
Published
Language
English
Keywords
health policy, health reforms, implementation, Zambia
Abstract
The work presented in this study was prompted by a request from the Zambian parliamentary committee on Health, Community Welfare and Social Development. The parliamentarians had wanted to know why despite all the funding to the health sector, there were no ‘visible’ gains to speak of from the on-going health reforms.
Country
Zambia
Publisher
EQUINET
URL:
Equinet Publication Type
Discussion paper
Theme area
Health equity in economic and trade policies
Title of publication Capacity building paper: Protecting rights of access to essential medicines under trade and market policies: The Tanzania case study
Date of publication
2005 September
Publication type
Document
Publication details
EQUINET Capacity Building Paper pp 1-23
Publication status
Not published
Language
English
Keywords
GATS, TRIPS, national policy options, Tanzania
Abstract
This study examined and analysed how, through the General Agreement on Trade in Services (GATS) and the Trade Related Intellectual Property Rights Agreement (TRIPS), national policy options that support equity in health in Tanzania are threatened. More specifically the study examines how we can we protect rights of access to essential medicines under trade and market policies.
Country
Tanzania
Publisher
URL:
Equinet Publication Type
Capacity building papers
Theme area
Equity in health, Values, policies and rights
Title of publication Will health rights solve Malawi\'s health problems?
Date of publication
2005
Publication type
Journal Article
Publication details
Croatian Medical Journal: Health in Africa 46 5 pp 853-859
Publication status
Published
Language
Englsih
Keywords
socio-economic rights, health rights, Malawi
Abstract
From 1994, Malawi has experienced an increased appreciation of human rights among its citizens. In 2000, the Malawi Health Equity Network (MEHN), a grouping of non governmental agencies, regulatory bodies, individual activists, health professionals, researchers, and academics started a campaign to institutionalize the Patients and Health Workers’ Charter of Rights and Responsibilities. It was thought that one way of improving the quality of care in the Malawi health system was to use health rights as a tool for such a goal. This work has now been adopted by the Department of Community Health at Malawi’s only medical school.
In this essay, the author presents the literature review on health rights as a part of human rights, and health globally and in Malawi, the program’s research findings on the promotion of health rights, and the challenges faced and opportunities for improvement identified. The paper draws on the experience of the Health Rights and Governance Project (HRGP) work within the Malawi College of Medicine. The aim of the HRGP is to promote availability and accessibility of high quality health care for all people in Malawi and to achieve this through education and training, research, and advocacy.
Country
Publisher
Croatian Medical Journal
Theme area
Values, policies and rights, Poverty and health
Title of publication Universal primary education; Uganda
Date of publication
2006 February
Publication type
Journal Article
Publication details
Policy Brief 10 pp 1-4
Publication status
Published
Language
English
Keywords
Universal Primary Education (UPE), poverty and education, Uganda, rights to education, universal access
Abstract
Universal Primary Education (UPE) is one of the Government of Uganda’s main policy tools for achieving poverty reduction and human development. UPE was introduced in January 1997, following a political commitment by President Museveni that the Government would meet the cost of primary education of four children per family. This commitment was soon extended to allow all people that wanted to access primary education to do so. The UPE programme has required a significant increase in public expenditure devoted to primary education.
The UPE programme in Uganda demonstrates that a poor country with a committed government and donor support can fight poverty through ensuring universal access to education for its citizens. The significant increase in primary school enrolment is also an indication that the payment of school fees was a big impediment to accessing education, especially for poor families. Nevertheless, there are still ways in which the programme could be improved. These include tackling institutional constraints to the delivery of quality education services, taking advantage of opportunities offered by the liberalisation of the education sector, and reducing inequity in access to education and the quality of education across districts and between rural and urban areas.
Country
United Kingdom
Publisher
Overseas Development Institute
Theme area
Health equity in economic and trade policies, Poverty and health, Governance and participation in health
Title of publication Social grants: South Africa
Date of publication
2006 February
Publication type
Journal Article
Publication details
Policy Brief 1 pp 1-4
Publication status
Published
Language
English
Keywords
social security systems in South Africa, government initiatives at adressing inequality
Abstract
Since 2000, levels of investment and economic growth in South Africa have achieved their fastest increases in decades. Nevertheless, with an official unemployment rate of 26%, a poverty rate estimated at approximately 50%, and one of the most severe measures of inequality in the world, South Africa faces substantial challenges in addressing poverty, inequality and unemployment. While it ranks as an upper-middle income country based on average income, some of the nation’s social indicators are comparable to those of the poorest countries of the world.
South Africa’s social security system is the government’s chief initiative in tackling these problems. It has two main objectives. The first is to immediately reduce poverty among groups who are not expected to participate fully in the labour market, and therefore vulnerable to low income: the eldelry, those with disabilities, and children. The second objective is to increase investment in health, education and nutrition, so as to increase economic growth and development. These twin objectives are reflected in the Government’s 1997 White Paper on Social Development, which states that “a social security system is essential for healthy economic development, particularly in a rapidly changing economy, and will contribute actively to the development process. It is important for immediate alleviation of poverty and is a mechanism for active redistribution.”
The author describes in detail the nature and the impact of existing social security systems in South Africa, before concluding with the lessons learned from these.
Country
United Kingdom
Publisher
Inter-Regional Inequality Facility
Theme area
Equity in health, Poverty and health
Title of publication Inequality in sub-Saharan Africa: A synthesis of recent research on the levels, trends, effects, and determinants of inequality in its different, dimensions
Date of publication
2006 February
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
income inequality in Africa, poverty, computer general equilibrium (CGE)
Abstract
This paper reviews recent research on income and non income inequalities within countries in sub-Saharan Africa. It concentrates on research conducted by national and regional institutions and by international agencies in the region. Research on income inequality in Africa is a recent phenomenon. Most studies began in the early 1990s, with the increased availability of household budget surveys for countries in the region. The advent of PRSPs and MDGs, which moved the debate towards issues of pro-poor growth, also required discussion on the nature and trends of income inequality. There are a number of important findings emerging from this particular research.
Country
United Kingdom
Publisher
The Inter-Regional Inequality Facility
Theme area
Human resources for health
Title of publication EQUINET Discussion paper 36: Issues facing primary care health workers in delivering HIV and AIDS related treatment and care
Date of publication
2006 April
Publication type
Document
Publication details
EQUINET Discussion Paper 36 pp 1-27
Publication status
Published
Language
English
Keywords
health workers, community activism, health committees, primary care level, participatory approach, South Africa
Abstract
This study explored the possibility of joint health worker and community activism at a primary care level in South Africa, and the human resource requirements needed for the effective treatment and care of HIV/AIDS within the public health service. The study used participatory approaches and involved five SAMWU shop stewards in the design, data collection and analysis of the research. The study was implemented between October and November 2005 in five primary health care (PHC) clinics in the Western Cape, Free State and KwaZulu Natal. Twenty-four health workers (fifteen of which were interviewed in depth) and eighteen health committee members were interviewed across the five different sites using a semi-structured interview guide.
Country
South Africa
Publisher
EQUINET
URL:
Equinet Publication Type
Discussion paper
Theme area
Health equity in economic and trade policies, Poverty and health
Title of publication Will Africa achieve the Millenium Development Goals?
Date of publication
2006
Publication type
Journal Article
Publication details
Croatian Medical Journal: My Africa 47 pp 194-196
Publication status
Published
Language
English
Keywords
Millenium Development Goals (MDGs), poverty, accountability
Abstract
Lately, the global attempts to eliminate or eradicate poverty seem to be gaining momentum, if not in deeds then at least in words. At almost every United Nations General Assembly and G8 meeting, the world is reminded that it is no longer acceptable for some parts of the world to be in the rocket science age while others are left behind in the Iron Age. The global initiative leading the battle against poverty is the Millenium Development Goals. The Goals are not impossible to achieve but require more than financial, political, and democratic accountability as developed countries stipulate. Achieving the goals will require serious determination of the interventions that are likely to bear fruits in the particular settings of the individual developing countries. The author uses examples of malaria and diarrheal diseases in various different settings to illustrate this.
Country
Malawi
Publisher
URL:
Theme area
Governance and participation in health, Monitoring equity and research to policy
Title of publication Resource guide to development organizations and the internet: Lesotho
Date of publication
2006
Publication type
Document
Publication details
Directory of Development Organizations 1/Africa 7th Edition pp 1-11
Publication status
Published
Language
English
Keywords
resource guide for civil society organizations, research institutions, governments, private sector, directory of development organizations
Abstract
The directory of development organizations, listing 47.500 development organizations, has been prepared to facilitate international cooperation and knowledge sharing in development work, both among civil society organizations, research institutions, governments and the private sector.
The directory serves as a guide to international organizations, governments, private sector development agencies, civil society, universities, grantmakers, banks, microfinance institutions and development consulting firms. In particular, the directory is intended to provide a comprehensive source of reference for development practitioners, researchers, donor employees, and policymakers who are committed to good governance, sustainable development and poverty reduction, through: the financial sector and microfinance, trade and business development services, rural development and appropriate technology, private sector development and policy reforms, legislation & rule of law and good governance, community development and social protection, gender equality and participation, environment and health, research, training and education.
This cutting-edge publication -- Seventh Edition -- will give you hundreds (thousands) of useful sites where you can find the statistics, reports, regulations, best practices and other key information you need...when you need it. This time saving tool includes a country finder index and annotates each organization by category, so you\\\'ll know from the start whether an organization is worth visiting. Its Internet resources will point you in the direction of the best development resources available in each country on the World Wide Web today.
Country
Publisher
Directory of Development Organizations
URL:
URL
Theme area
Governance and participation in health, Monitoring equity and research to policy
Title of publication Resource guide to development organizations and the internet: DR Congo
Date of publication
2006
Publication type
Document
Publication details
Directory of Development Organizations 1/Africa 7th Edition pp 1-21
Publication status
Published
Language
English
Keywords
resource guide for civil society organizations, research institutions, governments, private sector, directory of development organizations
Abstract
The directory of development organizations, listing 47.500 development organizations, has been prepared to facilitate international cooperation and knowledge sharing in development work, both among civil society organizations, research institutions, governments and the private sector.
The directory serves as a guide to international organizations, governments, private sector development agencies, civil society, universities, grantmakers, banks, microfinance institutions and development consulting firms. In particular, the directory is intended to provide a comprehensive source of reference for development practitioners, researchers, donor employees, and policymakers who are committed to good governance, sustainable development and poverty reduction, through: the financial sector and microfinance, trade and business development services, rural development and appropriate technology, private sector development and policy reforms, legislation & rule of law and good governance, community development and social protection, gender equality and participation, environment and health, research, training and education.
This cutting-edge publication -- Seventh Edition -- will give you hundreds (thousands) of useful sites where you can find the statistics, reports, regulations, best practices and other key information you need...when you need it. This time saving tool includes a country finder index and annotates each organization by category, so you\'ll know from the start whether an organization is worth visiting. Its Internet resources will point you in the direction of the best development resources available in each country on the World Wide Web today.
Country
Publisher
Directory of Development Organizations
URL:
URL
Theme area
Governance and participation in health, Monitoring equity and research to policy
Title of publication Resource guide to development organizations and the internet: Kenya
Date of publication
2006
Publication type
Document
Publication details
Directory of Development Organizations 1/Africa 7th Edition pp 1-67
Publication status
Published
Language
English
Keywords
resource guide for civil society organizations, research institutions, governments, private sector, directory of development organizations
Abstract
The directory of development organizations, listing 47.500 development organizations, has been prepared to facilitate international cooperation and knowledge sharing in development work, both among civil society organizations, research institutions, governments and the private sector.
The directory serves as a guide to international organizations, governments, private sector development agencies, civil society, universities, grantmakers, banks, microfinance institutions and development consulting firms. In particular, the directory is intended to provide a comprehensive source of reference for development practitioners, researchers, donor employees, and policymakers who are committed to good governance, sustainable development and poverty reduction, through: the financial sector and microfinance, trade and business development services, rural development and appropriate technology, private sector development and policy reforms, legislation & rule of law and good governance, community development and social protection, gender equality and participation, environment and health, research, training and education.
This cutting-edge publication -- Seventh Edition -- will give you hundreds (thousands) of useful sites where you can find the statistics, reports, regulations, best practices and other key information you need...when you need it. This time saving tool includes a country finder index and annotates each organization by category, so you\\\'ll know from the start whether an organization is worth visiting. Its Internet resources will point you in the direction of the best development resources available in each country on the World Wide Web today.
Country
Publisher
Directory of Development Organizations
URL:
URL
Theme area
Governance and participation in health, Monitoring equity and research to policy
Title of publication Resource guide to development organizations and the internet: Uganda
Date of publication
2006
Publication type
Document
Publication details
Directory of Development Organizations 1/Africa 7th Edition pp 1-46
Publication status
Published
Language
English
Keywords
resource guide for civil society organizations, research institutions, governments, private sector, directory of development organizations
Abstract
The directory of development organizations, listing 47.500 development organizations, has been prepared to facilitate international cooperation and knowledge sharing in development work, both among civil society organizations, research institutions, governments and the private sector.
The directory serves as a guide to international organizations, governments, private sector development agencies, civil society, universities, grantmakers, banks, microfinance institutions and development consulting firms. In particular, the directory is intended to provide a comprehensive source of reference for development practitioners, researchers, donor employees, and policymakers who are committed to good governance, sustainable development and poverty reduction, through: the financial sector and microfinance, trade and business development services, rural development and appropriate technology, private sector development and policy reforms, legislation & rule of law and good governance, community development and social protection, gender equality and participation, environment and health, research, training and education.
This cutting-edge publication -- Seventh Edition -- will give you hundreds (thousands) of useful sites where you can find the statistics, reports, regulations, best practices and other key information you need...when you need it. This time saving tool includes a country finder index and annotates each organization by category, so you\\\'ll know from the start whether an organization is worth visiting. Its Internet resources will point you in the direction of the best development resources available in each country on the World Wide Web today.
Country
Publisher
Directory of Development Organizations
URL:
URL
Theme area
Governance and participation in health, Monitoring equity and research to policy
Title of publication Resource guide to development organizations and the internet: Zambia
Date of publication
2006
Publication type
Document
Publication details
Directory of Development Organizations 1/Africa 7th Edition pp 1-26
Publication status
Published
Language
English
Keywords
resource guide for civil society organizations, research institutions, governments, private sector, directory of development organizations
Abstract
The directory of development organizations, listing 47.500 development organizations, has been prepared to facilitate international cooperation and knowledge sharing in development work, both among civil society organizations, research institutions, governments and the private sector.
The directory serves as a guide to international organizations, governments, private sector development agencies, civil society, universities, grantmakers, banks, microfinance institutions and development consulting firms. In particular, the directory is intended to provide a comprehensive source of reference for development practitioners, researchers, donor employees, and policymakers who are committed to good governance, sustainable development and poverty reduction, through: the financial sector and microfinance, trade and business development services, rural development and appropriate technology, private sector development and policy reforms, legislation & rule of law and good governance, community development and social protection, gender equality and participation, environment and health, research, training and education.
This cutting-edge publication -- Seventh Edition -- will give you hundreds (thousands) of useful sites where you can find the statistics, reports, regulations, best practices and other key information you need...when you need it. This time saving tool includes a country finder index and annotates each organization by category, so you\\\'ll know from the start whether an organization is worth visiting. Its Internet resources will point you in the direction of the best development resources available in each country on the World Wide Web today.
Country
Publisher
Directory of Development Organizations
URL:
URL
Theme area
Governance and participation in health, Monitoring equity and research to policy
Title of publication Resource guide to development organizations and the internet: Swaziland
Date of publication
2006
Publication type
Document
Publication details
Directory of Development Organizations 1/Africa 7th Edition pp 1-14
Publication status
Published
Language
English
Keywords
resource guide for civil society organizations, research institutions, governments, private sector, directory of development organizations
Abstract
The directory of development organizations, listing 47.500 development organizations, has been prepared to facilitate international cooperation and knowledge sharing in development work, both among civil society organizations, research institutions, governments and the private sector.
The directory serves as a guide to international organizations, governments, private sector development agencies, civil society, universities, grantmakers, banks, microfinance institutions and development consulting firms. In particular, the directory is intended to provide a comprehensive source of reference for development practitioners, researchers, donor employees, and policymakers who are committed to good governance, sustainable development and poverty reduction, through: the financial sector and microfinance, trade and business development services, rural development and appropriate technology, private sector development and policy reforms, legislation & rule of law and good governance, community development and social protection, gender equality and participation, environment and health, research, training and education.
This cutting-edge publication -- Seventh Edition -- will give you hundreds (thousands) of useful sites where you can find the statistics, reports, regulations, best practices and other key information you need...when you need it. This time saving tool includes a country finder index and annotates each organization by category, so you\\\'ll know from the start whether an organization is worth visiting. Its Internet resources will point you in the direction of the best development resources available in each country on the World Wide Web today.
Country
Publisher
Directory of Development Organizations
URL:
URL
Theme area
Governance and participation in health, Monitoring equity and research to policy
Title of publication Resource guide to development organizations and the internet: Tanzania
Date of publication
2006
Publication type
Document
Publication details
Directory of Development Organizations 1/Africa 7th Edition pp 1-32
Publication status
Published
Language
English
Keywords
resource guide for civil society organizations, research institutions, governments, private sector, directory of development organizations
Abstract
The directory of development organizations, listing 47.500 development organizations, has been prepared to facilitate international cooperation and knowledge sharing in development work, both among civil society organizations, research institutions, governments and the private sector.
The directory serves as a guide to international organizations, governments, private sector development agencies, civil society, universities, grantmakers, banks, microfinance institutions and development consulting firms. In particular, the directory is intended to provide a comprehensive source of reference for development practitioners, researchers, donor employees, and policymakers who are committed to good governance, sustainable development and poverty reduction, through: the financial sector and microfinance, trade and business development services, rural development and appropriate technology, private sector development and policy reforms, legislation & rule of law and good governance, community development and social protection, gender equality and participation, environment and health, research, training and education.
This cutting-edge publication -- Seventh Edition -- will give you hundreds (thousands) of useful sites where you can find the statistics, reports, regulations, best practices and other key information you need...when you need it. This time saving tool includes a country finder index and annotates each organization by category, so you\\\'ll know from the start whether an organization is worth visiting. Its Internet resources will point you in the direction of the best development resources available in each country on the World Wide Web today.
Country
Publisher
Directory of Development Organizations
URL:
URL
Theme area
Governance and participation in health, Monitoring equity and research to policy
Title of publication Resource guide to development organizations and the internet: Malawi
Date of publication
2006
Publication type
Document
Publication details
Directory of Development Organizations 1/Africa 7th Edition pp 1-18
Publication status
Published
Language
English
Keywords
resource guide for civil society organizations, research institutions, governments, private sector, directory of development organizations
Abstract
The directory of development organizations, listing 47.500 development organizations, has been prepared to facilitate international cooperation and knowledge sharing in development work, both among civil society organizations, research institutions, governments and the private sector.
The directory serves as a guide to international organizations, governments, private sector development agencies, civil society, universities, grantmakers, banks, microfinance institutions and development consulting firms. In particular, the directory is intended to provide a comprehensive source of reference for development practitioners, researchers, donor employees, and policymakers who are committed to good governance, sustainable development and poverty reduction, through: the financial sector and microfinance, trade and business development services, rural development and appropriate technology, private sector development and policy reforms, legislation & rule of law and good governance, community development and social protection, gender equality and participation, environment and health, research, training and education.
This cutting-edge publication -- Seventh Edition -- will give you hundreds (thousands) of useful sites where you can find the statistics, reports, regulations, best practices and other key information you need...when you need it. This time saving tool includes a country finder index and annotates each organization by category, so you\\\'ll know from the start whether an organization is worth visiting. Its Internet resources will point you in the direction of the best development resources available in each country on the World Wide Web today.
Country
Publisher
Directory of Development Organizations
URL:
URL
Theme area
Governance and participation in health, Monitoring equity and research to policy
Title of publication Resource guide to development organizations and the internet: Mauritius
Date of publication
2006
Publication type
Document
Publication details
Directory of Development Organizations 1 7th Edition pp 1-12
Publication status
Published
Language
English
Keywords
resource guide for civil society organizations, research institutions, governments, private sector, directory of development organizations
Abstract
The directory of development organizations, listing 47.500 development organizations, has been prepared to facilitate international cooperation and knowledge sharing in development work, both among civil society organizations, research institutions, governments and the private sector.
The directory serves as a guide to international organizations, governments, private sector development agencies, civil society, universities, grantmakers, banks, microfinance institutions and development consulting firms. In particular, the directory is intended to provide a comprehensive source of reference for development practitioners, researchers, donor employees, and policymakers who are committed to good governance, sustainable development and poverty reduction, through: the financial sector and microfinance, trade and business development services, rural development and appropriate technology, private sector development and policy reforms, legislation & rule of law and good governance, community development and social protection, gender equality and participation, environment and health, research, training and education.
This cutting-edge publication -- Seventh Edition -- will give you hundreds (thousands) of useful sites where you can find the statistics, reports, regulations, best practices and other key information you need...when you need it. This time saving tool includes a country finder index and annotates each organization by category, so you\\\\\\\'ll know from the start whether an organization is worth visiting. Its Internet resources will point you in the direction of the best development resources available in each country on the World Wide Web today.
Country
Publisher
Directory of Development Organizations
URL:
URL
Theme area
Governance and participation in health, Monitoring equity and research to policy
Title of publication Resource guide to development organizations and the internet: Namibia
Date of publication
2006
Publication type
Document
Publication details
Directory of Development Organizations 1/Africa 7th Edition pp 1-13
Publication status
Published
Language
English
Keywords
resource guide for civil society organizations, research institutions, governments, private sector, directory of development organizations
Abstract
The directory of development organizations, listing 47.500 development organizations, has been prepared to facilitate international cooperation and knowledge sharing in development work, both among civil society organizations, research institutions, governments and the private sector.
The directory serves as a guide to international organizations, governments, private sector development agencies, civil society, universities, grantmakers, banks, microfinance institutions and development consulting firms. In particular, the directory is intended to provide a comprehensive source of reference for development practitioners, researchers, donor employees, and policymakers who are committed to good governance, sustainable development and poverty reduction, through: the financial sector and microfinance, trade and business development services, rural development and appropriate technology, private sector development and policy reforms, legislation & rule of law and good governance, community development and social protection, gender equality and participation, environment and health, research, training and education.
This cutting-edge publication -- Seventh Edition -- will give you hundreds (thousands) of useful sites where you can find the statistics, reports, regulations, best practices and other key information you need...when you need it. This time saving tool includes a country finder index and annotates each organization by category, so you\\\'ll know from the start whether an organization is worth visiting. Its Internet resources will point you in the direction of the best development resources available in each country on the World Wide Web today.
Country
Publisher
Directory of Development Organizations
URL:
URL
Theme area
Governance and participation in health, Monitoring equity and research to policy
Title of publication Resource guide to development organizations and the internet: Zimbabwe
Date of publication
2006
Publication type
Document
Publication details
Directory of Development Organizations 1/Africa 7th Edition pp 1-29
Publication status
Published
Language
English
Keywords
resource guide for civil society organizations, research institutions, governments, private sector, directory of development organizations
Abstract
The directory of development organizations, listing 47.500 development organizations, has been prepared to facilitate international cooperation and knowledge sharing in development work, both among civil society organizations, research institutions, governments and the private sector.
The directory serves as a guide to international organizations, governments, private sector development agencies, civil society, universities, grantmakers, banks, microfinance institutions and development consulting firms. In particular, the directory is intended to provide a comprehensive source of reference for development practitioners, researchers, donor employees, and policymakers who are committed to good governance, sustainable development and poverty reduction, through: the financial sector and microfinance, trade and business development services, rural development and appropriate technology, private sector development and policy reforms, legislation & rule of law and good governance, community development and social protection, gender equality and participation, environment and health, research, training and education.
This cutting-edge publication -- Seventh Edition -- will give you hundreds (thousands) of useful sites where you can find the statistics, reports, regulations, best practices and other key information you need...when you need it. This time saving tool includes a country finder index and annotates each organization by category, so you\\\'ll know from the start whether an organization is worth visiting. Its Internet resources will point you in the direction of the best development resources available in each country on the World Wide Web today.
Country
Publisher
Directory of Development Organizations
URL:
URL
Theme area
Governance and participation in health, Monitoring equity and research to policy
Title of publication Resource guide to development organizations and the internet: Angola
Date of publication
2006
Publication type
Document
Publication details
Directory of Development Organizations 1/Africa 7th Edition pp 1-24
Publication status
Published
Language
English
Keywords
resource guide for civil society organizations, research institutions, governments, private sector, directory of development organizations
Abstract
The directory of development organizations, listing 47.500 development organizations, has been prepared to facilitate international cooperation and knowledge sharing in development work, both among civil society organizations, research institutions, governments and the private sector. The directory serves as a guide to international organizations, governments, private sector development agencies, civil society, universities, grantmakers, banks, microfinance institutions and development consulting firms. In particular, the directory is intended to provide a comprehensive source of reference for development practitioners, researchers, donor employees, and policymakers who are committed to good governance, sustainable development and poverty reduction, through: the financial sector and microfinance, trade and business development services, rural development and appropriate technology, private sector development and policy reforms, legislation & rule of law and good governance, community development and social protection, gender equality and participation, environment and health, research, training and education.
This cutting-edge publication -- Seventh Edition -- will give you hundreds (thousands) of useful sites where you can find the statistics, reports, regulations, best practices and other key information you need...when you need it. This time saving tool includes a country finder index and annotates each organization by category, so you\\\'ll know from the start whether an organization is worth visiting. Its Internet resources will point you in the direction of the best development resources available in each country on the World Wide Web today.
Country
Publisher
Directory of Development Organizations
URL
Theme area
Governance and participation in health, Monitoring equity and research to policy
Title of publication Resource guide to development organizations and the internet: Mozambique
Date of publication
2006
Publication type
Document
Publication details
Directory of Development Organizations 1/Africa 7th Edition pp 1-23
Publication status
Published
Language
English
Keywords
resource guide for civil society organizations, research institutions, governments, private sector, directory of development organizations
Abstract
The directory of development organizations, listing 47.500 development organizations, has been prepared to facilitate international cooperation and knowledge sharing in development work, both among civil society organizations, research institutions, governments and the private sector.
The directory serves as a guide to international organizations, governments, private sector development agencies, civil society, universities, grantmakers, banks, microfinance institutions and development consulting firms. In particular, the directory is intended to provide a comprehensive source of reference for development practitioners, researchers, donor employees, and policymakers who are committed to good governance, sustainable development and poverty reduction, through: the financial sector and microfinance, trade and business development services, rural development and appropriate technology, private sector development and policy reforms, legislation & rule of law and good governance, community development and social protection, gender equality and participation, environment and health, research, training and education.
This cutting-edge publication -- Seventh Edition -- will give you hundreds (thousands) of useful sites where you can find the statistics, reports, regulations, best practices and other key information you need...when you need it. This time saving tool includes a country finder index and annotates each organization by category, so you\\\'ll know from the start whether an organization is worth visiting. Its Internet resources will point you in the direction of the best development resources available in each country on the World Wide Web today.
Country
Publisher
Directory of Development Organizations
URL:
URL
Theme area
Governance and participation in health, Monitoring equity and research to policy
Title of publication Resource guide to development organizations and the internet: Botswana
Date of publication
2006
Publication type
Document
Publication details
Directory of Development Organizations 1.A/ AFRICA 7th Edition pp 1-15
Publication status
Published
Language
English
Keywords
resource guide for civil society organizations, research institutions, governments, private sector, directory of development organizations
Abstract
The directory of development organizations, listing 47.500 development organizations, has been prepared to facilitate international cooperation and knowledge sharing in development work, both among civil society organizations, research institutions, governments and the private sector.
The directory serves as a guide to international organizations, governments, private sector development agencies, civil society, universities, grantmakers, banks, microfinance institutions and development consulting firms. In particular, the directory is intended to provide a comprehensive source of reference for development practitioners, researchers, donor employees, and policymakers who are committed to good governance, sustainable development and poverty reduction, through: the financial sector and microfinance, trade and business development services, rural development and appropriate technology, private sector development and policy reforms, legislation & rule of law and good governance, community development and social protection, gender equality and participation, environment and health, research, training and education.
This cutting-edge publication -- Seventh Edition -- will give you hundreds (thousands) of useful sites where you can find the statistics, reports, regulations, best practices and other key information you need...when you need it. This time saving tool includes a country finder index and annotates each organization by category, so you\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\'ll know from the start whether an organization is worth visiting. Its Internet resources will point you in the direction of the best development resources available in each country on the World Wide Web today.
Country
Publisher
Directory of Development Organizations
URL:
URL
Theme area
Health equity in economic and trade policies
Title of publication Intellectual property rules suit the wealthy
Date of publication
2006
Publication type
Journal Article
Publication details
Critical Health Perspectives 2
Publication status
Published
Language
English
Keywords
intellectual property rules, human rights, patented humans
Abstract
There is a constant refrain that a watertight regime of intellectual property rules is essential to protect the rights of those who devised, developed and produced innovative goods, be it art or health cures. A whole set of corollaries are posited by this implication. Is piracy or appropriation of intellectual property always bad? Do the same rules apply across the board to such piracy? Is protection of intellectual property a level playing field? Are stringent intellectual property rules essential to nurture growth, welfare and the general public interest? And how do intellectual property rules affect us individually, collectively, nationally, regionally and continentally? Most importantly, perhaps we must consider whether intellectual property rights were ever intended to be or were devised to be tools to provide almost limitless monopoly rights to the originators of any claims.
None of these are easy questions to answer but they are essential questions to ask in order to inform ourselves how we are affected by this debate as well as how it plays out on national and international stages. This paper attempts to tackle these questions by discussing its moral grounding, the global rights hegemony, the question of patented humans, and other aspects of human rights.
Country
South Africa
Publisher
People\'s Health Movement, South Africa (PHM-SA)
URL:
URL
Theme area
Health equity in economic and trade policies
Title of publication Speech by Deputy President Phumzile Mlambo-Ngcuka at the launch workshop of the African Monitor, Cape Town
Date of publication
2006 May
Publication type
Conference Proceedings
Publication details
Publication status
Publication status unknown
Language
English
Keywords
Millenium Development Goals (MDGs), Archbishop Ndungane, United Nations, workshop of the African Monitor
Abstract
This here is the speech by Deputy President Phumzile Mlambo-Ngcuka at the launch workshop of the African Monitor in Cape Town on May 2nd, 2006.
The Deputy begins by acknowledging the global consensus that humanity needs to join hands in search of a better life for all. The world is at one that we can no longer countenance the duality of prosperity in one corner of the globe and poverty in another corner. Led by the UN, the Deputy continues, the world has moved beyond pious words and declarations of intent. In very concrete terms, the Millennium Development Goals define what each one of the nations of the world has to do in order to lay claim to the assertion that it is indeed a humane society.
Necessarily, attached to these Millennium Development Goals have to be key indicators of progress, the better to measure the progress we are making in concrete terms. Attached to the targets that we have set ourselves have to be concrete measures that the developing nations should take in order to meet their obligations to their citizens. Attached to the goals elaborated by the United Nations have to be performance indicators for the developed world, to measure the realisation of the commitments that they have made to assist the developing countries to attain the ideal of a better life for their peoples, the majority of whom are poor.
The Deputy concludes by congratulating Archbishop Ndungane and colleagues for this initiative, to fashion a monitoring system for all these programmes, so word in actual practice turns into deed. Africa in particular faces a long road ahead in trying to deal with the plethora of challenges thrown up by a legacy as much imposed by the history of colonialism as it was aggravated by the many years of neglect that our own weaknesses spawned.
Country
South Africa
Publisher
The Presidency
URL:
URL
Theme area
Equitable health services
Title of publication Fever treatment and household wealth: The challenge posed for rolling out combination therapy for malaria
Date of publication
2006 March
Publication type
Journal Article
Publication details
Tropical Medicine and International Health 11 3 pp 299-313
Publication status
Published
Language
English
Keywords
antimalarials, combination therapy, equity, household, malaria, socio-economic status
Abstract
Objective: To investigate the variation in malaria parasitaemia, reported fever, care seeking, antimalarials obtained and household expenditure by socio-economic status (SES), and to assess the implications for ensuring equitable and appropriate use of antimalarial combination therapy.
Methods: A total of 2500 households were surveyed in three rural districts in southern Tanzania in mid-2001. Blood samples and data on SES were collected from all households. Half the households completed a detailed questionnaire on care seeking and treatment costs. Households were categorised into SES thirds based on an index of household wealth derived using principal components analysis.
Results: Of individuals completing the detailed survey, 16% reported a fever episode in the previous 2 weeks. People from the better-off stratum were significantly less likely to be parasitaemic, and significantly more likely to obtain antimalarials than those in the middle or poor stratum. The better treatment obtained by the better off led them to spend two to three times more than the middle and poor third spent. This reflected greater use of non-governmental organisation (NGO) facilities, which were the most expensive source of care, and higher expenditure at NGO facilities and drug stores.
Conclusion: The coverage of appropriate malaria treatment was low in all SES groups, but the two poorer groups were particularly disadvantaged. As countries switch to antimalarial combination therapy, distribution must be targeted to ensure that the poorest groups fully benefit from these new and highly effective medicines.
Country
Tanzania
Publisher
Blackwell Publishin Ltd
URL:
URL
Theme area
Health equity in economic and trade policies, Governance and participation in health
Title of publication Global governance campaigning and MDGs: From top-down to bottom-up anti-poverty work
Date of publication
2006
Publication type
Publication details
Third World Quarterly 27 2 pp 339-354
Publication status
Published
Language
English
Keywords
Millenium Development Goals (MDGs), action against poverty, Johannesburg
Abstract
What should be the foundational campaigning demands for those attempting to eradicate Third World poverty? The Millennium Development Goals are popular, serving in 2005 to motivate the British Make Poverty History movement, the Live8 consciousness-raising rock concerts and the Johannesburg-based Global Call to Action Against Poverty. Yet, upon closer inspection, the implementation processes associated with the MDGs have serious weaknesses. They were generated non-transparently by the United Nations, itself moving since the early 2000s to embrace the Washington Consensus and co-operate with the World Bank, to ‘bluewash’ the world’s largest corporations with its Global Compact, to endorse ‘Type 2’ public – private partnership privatisation strategies, to condone US militarism, and to reject even elementary democratic reform. The main decisions at the Monterrey and Doha finance and trade summits were biased against poor people, workers, women and the environment. Aspirational targets like the MDGs are, in any case, far less important than the actual social struggles underway across the world for basic needs and democracy. As shown in the 2005 campaigns, work on MDGs distracts us from solidarity with the real agents of progressive social and environmental history, in progressive civil society.
Country
South Africa
Publisher
Third World Quarterly
URL:
URL
Theme area
Equitable health services, Monitoring equity and research to policy
Title of publication The second equity gauge: Monitoring fairness in access to basic services essential for health
Date of publication
2004 March
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
monitoring equity in health, human rights, inequitable access to health care and social services, South Africa
Abstract
Although South Africa is categorised as an upper middle income country, more than half the population lives in poverty. The health status of a person is linked not only to access to health care but also to broader infra-structural and socio-economic issues such as education and literacy, transport, the social security system, and access to water, energy, and housing. Resources allocated to these sectors are in turn, dependent on the economy and the macro economic policies of the government.
This document will show that in South Africa today, 10 years after the official end of apartheid, access to a decent standard of living, to decent housing, sanitation, education, and employment are all strongly associated with race, gender, and the provinces where people live. All of these factors are wellestablished basic and powerful determinants of health. This means that South Africans’ opportunity to be healthy varies with one’s skin colour, gender, and where one is fortunate – or not – enough to reside. Human rights principles require governments to remove obstacles faced by certain groups who have suffered discrimination and marginalisation that get in the way of disadvantaged groups realising their rights, including their right to health. The basic human right of participation in, and enjoyment of, the benefits of progress is not enjoyed uniformly throughout South Africa. Many communities face obstacles of social and economic deprivation, and rights to water, sanitation, shelter and food remain hugely unequal.
Country
South Africa
Publisher
Health Systems Trust
URL:
URL
Theme area
Health equity in economic and trade policies, Equity and HIV/AIDS
Title of publication Potential impact of adjustment policies on vulnerability of women and children to HIV/AIDS in Sub-Saharan Africa
Date of publication
2005 June
Publication type
Journal Article
Publication details
Journal of Health and Population Nutrition 23 2 pp 105-120
Publication status
Published
Language
English
Keywords
Structural Adjustment Policies (SAP), HIV/AIDS, socioeconomic factors, impact studies, women, child; Sub-Saharan Africa
Abstract
This paper evaluates the potential impact of adjustment policies of the International Monetary Fund and the World Bank on the vulnerability of women and children to HIV/AIDS in sub-Saharan Africa. A conceptual framework, composed of five different pathways of causation, is used for the evaluation. These five pathways connect changes at the macro level (e.g. removal of food subsidies) with effects at the meso (e.g. higher food prices) and micro levels (e.g. exposure of women and children to commercial sex) that influence the vulnerability of women and children to HIV/AIDS. Published literature on adjustment policies and socioeconomic determinants of HIV/AIDS among women and children in sub-Saharan Africa was reviewed to explore the cause-effect relationships included in the theoretical framework. Evidence suggests that adjustment policies may inadvertently produce conditions facilitating the exposure of women and children to HIV/AIDS. Complex research designs are needed to further investigate this relationship. A shift in emphasis from an individual approach to a socioeconomic approach in the study of HIV infection among women and children in the developing world is suggested. Given the potential for adjustment policies to exacerbate the AIDS pandemic among women and children, a careful examination of the effects of these policies on maternal and child welfare is urgently needed.
Country
United Kingdom
Publisher
Centre for Health and Population Research (ICDDR)
URL:
URL
Theme area
Values, policies and rights, Health equity in economic and trade policies
Title of publication Trade, gender, and poverty
Date of publication
2001 October
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
gender equity in trade policies, pverty and gender, growth and poverty reduction
Abstract
This paper focuses on the relationship of trade, on the one hand, with gender and poverty, on the other, within the context of the human development paradigm. Specifically, it examines the impact of trade liberalization on gender inequalities (primarily via employment, wages and the care economy); and the impact of gender inequality on trade performance.These interactions are discussed in light of mainstream literature on trade, growth and poverty reduction, which defines poverty in terms of income or consumption and largely ignores gender. The paper also considers the policy implications of a gender-aware approach to international trade analysis and the current world trade regime.
Country
United States
Publisher
United Nations Development Programme (UNDP)
URL:
URL
Theme area
Values, policies and rights, Health equity in economic and trade policies
Title of publication The Millennium Development Goals: A critique from the south
Date of publication
2006 March
Publication type
Electronic Source
Publication details
Monthly Review Press 57 10
Publication status
Published
Language
English
Keywords
Millenium Development Goals (MDGs), rights, global development partnerships
Abstract
In September 2000, at the United Nations Millennium Summit, the 191 member countries in the United Nations agreed to a set of eight Millennium Development Goals for the world’s poor nations. These goals, targeted for fulfillment by 2015, have since become the fulcrum for public policy discussions and actions concerning economic and social development. Meetings and conferences on the goals under the auspices of the United Nations and the governing bodies of member countries have been held regularly since 2001, most recently at the 2005 Millennium+5 Summit. The aim of these meetings and conferences has been to reiterate the goals and to reaffirm the commitment of countries to them, as well as to assess the extent to which progress has been made toward their fulfillment. Most of the Millennium Development Goals may seem at first sight unobjectionable. Nevertheless, they were not the result of an initiative from the South itself, but were pushed primarily by the triad (the United States, Europe, and Japan), and were co-sponsored by the World Bank, the International Monetary Fund, and the Organization for Economic Cooperation and Development. All of this has raised the question of whether they are mainly ideological cover (or worse) for neoliberal initiatives. Samir Amin’s systematic and revealing critique of the Millennium Development Goals is therefore of the utmost significance. The goals themselves are appended to this article.
Country
United States
Publisher
Monthly Review
Theme area
Human resources for health
Title of publication South African Health Review briefing summary 1999: Distribution of human resources
Date of publication
Publication type
Report
Publication details
South African Health Review Briefing Summary pp 1-13
Publication status
Published
Language
English
Keywords
South African Health Review (SAHR), equity in human resources for health,
Abstract
The 20th Century has seen the professionalisation of health occupations, the establishment of regulatory councils and professional associations, the founding of training schools for an increasingly diverse set of health professions, increasing numbers of professionals, the unionisation of workers and the advent of a very enlightened and legislated labour environment.
There is still, however, wasteful utilisation and inequitable composition, development and distribution of human resources in health. There has been a growing emphasis on curative and high-tech health care, accompanied by hospital-based and doctor-centred services, creating a supply of health personnel not appropriately equipped for preventive and promotive care. The report further adresses the roles of racial segregation, gender inequity, public-private mixes, urban/rural divide, and developments in labour relations at the time in equitable human resources for health before continuing to report the respective statistics from the review.
Country
South Africa
Publisher
Health Systems Trust
URL:
URL
Theme area
Health equity in economic and trade policies, Equitable health services, Resource allocation and health financing
Title of publication Equity in public sector health care financing and expenditure in South Africa: An analysis of trends between 1995/96 to 2000/01
Date of publication
Publication type
Publication details
Publication status
Published
Language
English
Keywords
equity in health finacing, South Africa, equity in district health budgets
Abstract
Health sector policies developed since the elections provide a good basis for addressing the challenges faced by this sector. However, with the introduction of the new constitution in early 1997, provinces were allocated global budgets and could themselves determine the allocation between different sectors or functions. Since this occurred, there has been somewhat less progress in addressing inter-provincial inequities in health budgets. Some provinces (notably Gauteng) are moving away from their equity target health budget allocations.
While the available data suggest that there has been progress in addressing the challenges facing the public health sector since the 1994 elections, it is difficult to draw any firm conclusions due to the lack of expenditure data. Currently, there are no mechanisms for the routine monitoring of equity in health financing and expenditure patterns. Of particular note is the evident lack of concern for equity issues displayed in the MTEF Health Sector Task Team report. This Task Team focussed almost exclusively on efficiency issues, despite the fact that the health sector’s White Paper has equity as a key policy objective. If health sector equity in South Africa is to be achieved in the foreseeable future, it is critical that a mechanism for routine monitoring of health care financing and expenditure patterns from an equity perspective be established.
Country
South Africa
Publisher
Health Systems Trust
URL:
URL
Theme area
Values, policies and rights, Equitable health services
Title of publication Act No. 61,2003: National Health Act, 2003
Date of publication
2004 July
Publication type
Newspaper Article
Publication details
Government Gazette 469 Cape Town No. 26595 pp 1-94
Publication status
Published
Language
English
Keywords
National Health Act, South Africa, laws regarding health services
Abstract
The purpose of the Act is to provide a framework for a structured uniform health system within the Republic, taking into account the obligations imposed by the Constitution and other laws on the national, provincial and local governments with regard to health services; and to provide for matters connected therewith. Herewith attached is the full National Health Act of 2003.
Country
South Africa
Publisher
Government of the Republic of South Africa
URL:
URL
Theme area
Resource allocation and health financing
Title of publication Discussion paper 26: Equity in Health Care in Namibia: Towards a needs-based allocation formula
Date of publication
2005 April
Publication type
Document
Publication details
EQUINET Discussion Paper 26 pp 1-44
Publication status
Published
Language
English
Keywords
health care, resource allocation formula, equity, Namibia
Abstract
The study was conducted with the aim of generating evidence needed to enhance the Ministry of Health and Social Services’ (MoHSS) endeavours to redressing inequities in resource allocation in Namibia. It specifically purports to develop a needs-based allocation formula that will assist the MoHSS to shift its resource allocation mechanism away from the historical incrementalist type.
Country
Namibia
Publisher
EQUINET
URL:
Equinet Publication Type
Discussion paper
Theme area
Equitable health services, Resource allocation and health financing
Title of publication Equity in public sector health care financing and expenditure in South Africa
Date of publication
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
budgeting, resource allocation in health, equity in health care finance, South Africa, MTEF
Abstract
This article begins by highlighting the framework of key equity issues that influence provincial health budgets and how the money from the budgets is distributed within provinces (i.e. between districts and the different levels of care). It proceeds to describe developments over the recent past that have impacted on resources available for government spending, and covers other important aspects of the decision-making process in budgeting and resource allocation, with regard to equity.
Country
South Africa
Publisher
Health Systems Trust
URL:
URL
Theme area
Resource allocation and health financing, Equity and HIV/AIDS
Title of publication HIV/AIDS: Global trends, global funds and delivery bottlenecks
Date of publication
2005
Publication type
Journal Article
Publication details
Globalization and Health 1 13
Publication status
Published
Language
English
Keywords
HIV/AIDS, globalisation, global interventions on HIV/AIDS, strengthening health systems
Abstract
Globalisation affects all facets of human life, including health and well being. The HIV/AIDS epidemic has highlighted the global nature of human health and welfare and globalisation has given rise to a trend toward finding common solutions to global health challenges. Numerous international funds have been set up in recent times to address global health challenges such as HIV.
However, despite increasingly large amounts of funding for health initiatives being made available to poorer regions of the world, HIV infection rates and prevalence continue to increase world wide. As a result, the AIDS epidemic is expanding and intensifying globally. Worst affected are undoubtedly the poorer regions of the world as combinations of poverty, disease, famine, political and economic instability and weak health infrastructure exacerbate the severe and far-reaching impacts of the epidemic.
One of the major reasons for the apparent ineffectiveness of global interventions is historical weaknesses in the health systems of underdeveloped countries, which contribute to bottlenecks in the distribution and utilisation of funds. Strengthening these health systems, although a vital component in addressing the global epidemic, must however be accompanied by mitigation of other determinants as well. These are intrinsically complex and include social and environmental factors, sexual behaviour, issues of human rights and biological factors, all of which contribute to HIV transmission, progression and mortality. An equally important factor is ensuring an equitable balance between prevention and treatment programmes in order to holistically address the challenges presented by the epidemic.
Country
United Kingdom
Publisher
BioMed Central Ltd
Theme area
Equity and HIV/AIDS
Title of publication The real challenges for scaling up ART in sub-Saharan Africa
Date of publication
2006
Publication type
Journal Article
Publication details
AIDS 20 5 pp 653-656
Publication status
Published
Language
English
Keywords
HIV/AIDS, burden of HIV/AIDS on health systems, burden of ART scale-up,long-term impact of ART
Abstract
Although the AIDS epidemic in sub-Saharan Africa certainly requires an emergency response with short-term plans and objectives, we argue that the short time horizon risks constricting our insights and that a much longer-term view is now necessary in view of the ultimate goal of universal access to ART. Many health systems in sub-Saharan Africa currently lack the capacity to provide even basic health care to the population, let alone deal with the additional burden of scaling-up ART. AIDS poses a challenge for health systems that is fundamentally different from all of the other health problems ever faced. Transforming a deadly disease into a manageable chronic one turns millions of people into chronic patients, in need of life-long regular follow-up. This implies that the present efforts and commitments will have to be continuously increased for many years to come.
Country
United States
Publisher
Lippincott Williams & Wilkins
URL:
URL
Theme area
Values, policies and rights, Health equity in economic and trade policies
Title of publication Policy Brief on intellectual property, development, and human rights: How human rights can support proposals for a World Intellectual Property Organization (WIPO)
Date of publication
2006
Publication type
Journal Article
Publication details
Policy Brief 2 pp 1-9
Publication status
Published
Language
English
Keywords
human rights, Intellectual Property (IP), WIPO Development, policy
Abstract
In an increasingly technology-driven world, the standard of protection provided by intellectual property (IP) rules is affecting development policies, human rights and other public-interest goals more than ever. Strict IP rules have had an adverse impact on the ability of many governments to fulfil their human rights obligations. The WIPO Development Agenda discussions have stimulated the submission of a number of written proposals and suggestions to the WIPO process.
This Policy Brief focuses primarily on those proposals submitted in writing to WIPO. It divides the issues covered in those proposals into the following four categories: mandate and governance; norm-setting activities; technical assistance; and access to knowledge. The purpose of this Policy Brief is to encourage advocates, policy-makers and WIPO Member States to continue high-level discussions on a WIPO Development Agenda and elaborate an actionable, pro-development agenda that is consistent with the development commitments and human rights obligations of WIPO Member States. Part I will briefly outline how human rights can reinforce a development approach to intellectual property policy. Part II will consider the main proposals submitted on the WIPO Development Agenda and outline how human rights can support a pro-development outcome.
Country
Switzerland
Publisher
3DThree
URL:
URL
Theme area
Poverty and health, Governance and participation in health
Title of publication Civil Society monitoring of PRSPs: Examples from Malawi and Zambia
Date of publication
2003 October
Publication type
Generic
Publication details
Publication status
Publication status unknown
Language
English
Keywords
civil society organisations (CSO\'s), monitoring, transparency in governance, government participation, Malawi, MEJN
Abstract
This slide presentation begins by explaining the importance of Civils Society Organisation (CSO) monitoring, as well as what they should monitor. The presentation proceeds to inform the reader on how to monitor, using practical examples within sus-Saharan Africa to facilitate understanding; before embarking on a more detailed case study of the experience in Malawi.
Country
Publisher
Catholic Relief Services
URL:
URL
Theme area
Resource allocation and health financing, Governance and participation in health
Title of publication Demystifying the budget process in Tanzania; A seminar to promote civil society advocacy
Date of publication
2004 December
Publication type
Conference Proceedings
Publication details
Publication status
Published
Language
English
Keywords
civil society organisations (CSO\'s), budget decision-making, budget process, governance and health policy, Tanzania
Abstract
The main purposes of this seminar were to raise awareness and stimulate advocacy around Tanzania’s budgeting process. The budget is an area of government process that continues to mystify a large majority of civil society and thus remains a hurdle for civil society to effectively hold government accountable on both issues of finance and policy implementation. Budget documents can be difficult to obtain and understand resulting in the majority of Tanzanians remaining very alienated from government spending. This seminar hoped to build on the knowledge of its participants about understanding budgets and their impacts. Of particular importance was creating not only an understanding of how the budget works at either the national or local level, but also of how these macro and micro budget processes fit together, particularly in regards to monitoring national policy and strategy at local level. Budget advocacy is one of the weakest areas of civil society in Tanzania, and represents one of the missing links.
Country
Tanzania
Publisher
Hakikazi Catalyst
URL:
URL
Theme area
Governance and participation in health
Title of publication Civil society - State interactions in national health systems
Date of publication
2003 April
Publication type
Document
Publication details
Annotated Bibliography on Civil Society and Health BI2 pp 1-25
Publication status
Published
Language
English
Keywords
civil society organisations (CSO\'s), resources to health, health policy in developing countries, Civil Society Initiative, TARSC
Abstract
This paper is part an annotated bibliography which is presented in a searchable web format on the WHO site (http://www.who.int/en/) and the TARSC site (http:/www.tarsc.org). There you can view and download the following theme papers highlighting research findings and issues arising from the literature.
1 Overview of issues from the bibliography on civil Society and health
2.Civil society-state interactions in national health systems
3.Civil society contributions to pro-poor health equity policies.
4.Civil society influence on global health policy
The involvement of civil society organisations (CSOs) in health brings new institutional, technical, political and financial resources to health. How best can these resources be marshalled towards local, national and international health goals? Policies and programmes that seek to engage and utilise the resources within civil society for health need to be informed by evidence and experience of good practice. This is the second paper in the series and presents the evidence from studies on civil society - state interactions in national health systems, and includesd detailed discussion of CSO involvement in health systems.
Country
Zimbabwe
Publisher
Civil Society Initiative, World Health Organisation (WHO); Training and Research Support Centre (TARSC)
URL:
URL
Theme area
Poverty and health, Resource allocation and health financing, Governance and participation in health
Title of publication Civil Society contribution to the 2003/2004 Supplementary Appropriation Bill
Date of publication
2004 March
Publication type
Conference Proceedings
Publication details
Publication status
Published
Language
English
Keywords
civil society, budget and governance participation, Supplementary Appropriation Bill, Malawi
Abstract
The Malawi Economic Justice Network [MEJN], a coalition of civil society organisation on economic governance in Malawi, prepared this submission as part of civil society contribution to the 2003/04 Supplementary Appropriation Bill with the objective of enhancing the understanding of the Bill by the Budget and Finance Committee and all the Members of Parliament. The theme of the 2002/03 Budget is called “FACING OUR REALITIES AND LIVING WITHIN OUR MEANS IN THE FIGHT AGAINST POVERTY”. Such an enticing theme was never supported by reality as Government failed to LIVE WITHIN THE AVAILABLE MEANS. The 2003/04 budget is, therefore, built on the principle of spending only what is available. The Supplementary Appropriation Bill is presented to this House in line with the provisions of Section 177 of the Constitution of the Republic of Malawi. The Supplementary Appropriation Bill is requesting this House to approve additional expenditure of MK11.339 billion. K8.0 billion, of which, is to be spent on interest on domestic debt; MK1.796 billion for increased ORT expenditure in Votes that have over spent and MK3.561 billion to be provided by donors for HIV/AIDS interventions.
Country
Malawi
Publisher
Malawi Economic Justice Network (MEJN)
URL:
URL
Theme area
Resource allocation and health financing, Governance and participation in health
Title of publication Can civil society add value to budget decision-making? A description of civil society budget work
Date of publication
Publication type
Document
Publication details
Publication status
Publication status unknown
Language
English
Keywords
civil society, budget decision-making, public finance practice, budget groups
Abstract
Since the 1990s, civil society organizations have begun to play a larger role in the budget process in some developing countries. This growth has been particularly rapid in the past few years and corresponds with the political trend towards democratization. The growth of independent budget groups is recent. . Budgets remain closed processes in developing countries and most do not have independent budget analysis capacity outside of the public sector.
The purpose of this paper is to examine this expanding contribution of civil society organizations to public budgets in developing countries. The material that
follows will provide examples of civil society budget activities in a variety of country contexts in order to measure the value of this work to public budgeting. The growth of independent applied budget work organizations refers to a specific subset of civil society organizations; hereafter called budget groups.
Country
Publisher
URL:
URL
Theme area
Human resources for health
Title of publication Capacity building paper: Career plans of Year IV medical students at the University of Zimbabwe, College of Health Sciences
Date of publication
2005 December
Publication type
Document
Publication details
EQUINET Capacity Building Paper pp 1-8
Publication status
Not published
Language
English
Keywords
human resources; medical students; career plans; Zimbabwe
Abstract
A study of Career Plans of Year IV Medical Students at the University of Zimbabwe, College of Health Sciences was conducted to assist in understanding the career intentions of this group. The main aim of the study is to describe the perceptions of medical students about working in Zimbabwe, Southern African Development Community (SADC) and abroad. The study utilised a semi-structured self-administered questionnaire. All thirty members of the group of year IV medical students attached to the Department of Community Medicine of the University of Zimbabwe Medical School completed and returned the questionnaires.
Country
Zimbabwe
Publisher
URL:
Equinet Publication Type
Capacity building papers
Theme area
Equitable health services
Title of publication Capacity building paper: Patients’ knowledge of medication use as an equity issue in health care: Do health workers pay attention to this?
Date of publication
2006 February
Publication type
Document
Publication details
EQUINET Capacity Building Paper pp 1-14
Publication status
Not published
Language
English
Keywords
drug therapy; cost of medication; patient information; Uganda
Abstract
The major goal of this study was to measure the level of information given to patients as a component of ensuring equity in health. This was a descriptive cross-sectional survey utilizing both qualitative and quantitative methods of data collection, carried out in Uganda’s national referral, teaching and research hospital. With a sample size of 549 patients interviewed, results showed that 57.9% were females, over 70% of having an educational level of up-to O-Level. Most were low-income earners comprising: unemployed (13.4%), peasant farmers (12.6%), and students (18.7%). Most patients (93.1%) were prescribed drug therapy, but 97.5% of these left the medical clinics without knowing the likely cost of medication.
Country
Uganda
Publisher
URL:
Equinet Publication Type
Capacity building papers
Theme area
Human resources for health
Title of publication Capacity building paper: Perceptions of medical students, faculty and private GPs towards the utilisation of private GPs in the teaching of undergraduate medical students in Malawi
Date of publication
2006 February
Publication type
Document
Publication details
EQUINET Capacity Building Paper pp 1-10
Publication status
Not published
Language
English
Keywords
training; private general practitioners; public teaching hospitals; Malawi
Abstract
A qualitative study was conducted in Malawi to describe the perceptions of medical students, recent medical graduates, faculty members of the Malawi College of Medicine and private general practitioners (GPs) towards a proposed utilization of GPs in the teaching of undergraduate medical students. General Practitioners welcomed these proposed changes whilst the majority of students, recent graduates and faculty were opposed to this idea. General practitioners were perceived not to be able to adapt to the culture of public teaching hospitals.
Country
Malawi
Publisher
URL:
Equinet Publication Type
Capacity building papers
Theme area
Equity and HIV/AIDS
Title of publication Capacity building paper: Secondary school students’ voice in HIV/AIDS prevention interventions in Tanzania: A case study of Mbeya region
Date of publication
2006 February
Publication type
Document
Publication details
EQUINET Capacity Building Paper pp 1-15
Publication status
Not published
Language
English
Keywords
HIV/AIDS interventions, youth participation, Tanzania
Abstract
The school is an appropriate place for HIV/AIDS interventions. Students like other general youths are mostly at risk since they are sexually active and premarital sex among them is so high. In the past, two forms of interventions have been introduced to prevent HIV/AIDS transmission in secondary schools that is to say, programmes within and without the schools. Young people’s Participation may lead to issues being identified which might otherwise be overlooked. Tawil et al (1995) argued that, HIV/AIDS programmes that allow youth participation are more effective and tend to address the concerns and needs of young people better. Regular contact and cooperation in activity implementation as well as decision-making diminishes the distance between 'adult professional' and 'young person'. Young people can also make a valuable contribution in the project design phase. They are not stuck in the usual ways of thinking and 'how it's always been done'. Furthermore, youths are a great human resource and potential to add to organization or programme.
Country
Tanzania
Publisher
URL:
Equinet Publication Type
Capacity building papers
Theme area
Equity and HIV/AIDS
Title of publication Capacity building paper: Willingness of women to test for HIV/AIDS: A case study of Zomba rural, Malawi
Date of publication
2006 February
Publication type
Document
Publication details
EQUINET Capacity Building Paper pp 1-15
Publication status
Not published
Language
English
Keywords
women, HIV testing, Malawi
Abstract
The study set out to explore the reasons why women do not go for VCT regardless of numerous campaigns on HIV testing. The main objectives of the study were to find out whether or not the women in the selected sample were willing to test, and to find out factors that influenced their decisions to go for a test or not to go. The study focused on women because they are the ones most affected by HIV/AIDS. Thus by knowing their status, women would take appropriate measures around prevention and treatment. A sample of 200 women was drawn using a systematic random sampling procedure. The study found out that most women from the sampled areas were willing to test for HIV, but that such factors as the views of other people, especially those important to the women in some way, and also ignorance, though to a lesser extent than the former, do play a part in whether the women go for an HIV test or not. It is therefore recommended that these factors be dealt with and cleared before women can be expected to willingly go and test.
Country
Malawi
Publisher
URL:
Equinet Publication Type
Capacity building papers
Theme area
Human resources for health
Title of publication Discussion paper 31: The distribution of pharmacists trained at the University of the North, South Africa
Date of publication
2005 November
Publication type
Document
Publication details
EQUINET Discussion Paper 31 pp 1-32
Publication status
Published
Language
English
Keywords
pharmacists, retention, rural-urban mix, financial incentives, non-financial incentives, retention, South Africa
Abstract
The study sought to inform EQUINET work on distribution and
retention of human resources for health. The key findings of this paper are: Most of the pharmacists from the University of the North are within South Africa; of 121 respondents, 46.2% work in rural areas, and 62.8% in the public sector; pharmacists of rural origin are more likely to work in rural areas and in the public sector than their counterparts coming from urban areas; when respondents were asked why they took up their present jobs, opportunities for further professional development and the desire to serve the community were more commonly cited motivating factors than pay was. However, many said they would change jobs for better pay; a multi-sectoral approach with financial and non-financial incentives will be needed to address the scarcity of pharmacists in the public sector and rural areas.
Country
South Africa
Publisher
EQUINET
URL:
Equinet Publication Type
Discussion paper
Theme area
Human resources for health
Title of publication Discussion paper 32: Survival and retention strategies for Malawian health professionals
Date of publication
2005 November
Publication type
Document
Publication details
EQUINET Discussion Paper 32 pp 1-30
Publication status
Published
Language
English
Keywords
human resources, health worker strategies, retention, migration, incentives, Malawi
Abstract
Malawi, like many southern African countries, is facing a critical human resources for health (HRH) crisis, preventing it from delivering acceptable quality health care services to its population. The reasons underlying the shortage of health professionals are multiple and include limited output from training institutions, high attrition rates resulting from migration and disease, and increased workloads because of HIV and AIDS. Despite the increasing levels of migration of health professionals from Malawi which have caught international attention, many continue to serve their country. The challenges encountered by these health workers (which may eventually become push factors), and the coping or survival strategies that they utilise deserve attention if any meaningful solutions to retain health professionals in Malawi are to be developed.
Country
Malawi
Publisher
EQUINET
URL:
Equinet Publication Type
Discussion paper
Theme area
Health equity in economic and trade policies
Title of publication The liberal virus: Permanent war and the Americanization of the world
Date of publication
2006 March
Publication type
Book Section
Publication details
Monthly Review Press Books 57 10
Publication status
Published
Language
English
Keywords
developing countries, American liberalism, European liberalism, resistance to American policies
Abstract
The Liberal Virus examines the ways in which the American model is being imposed on the world, and outlines its economic and political consequences. It shows how both citizenship and class consciousness are diluted in "low intensity democracy" and argues instead for democratization as an ongoing process—of fundamental importance for human progress—rather than a fixed constitutional formula designed to support the logic of capital accumulation.
In a panoramic overview, Amin examines the objectives and outcomes of American policy in the different regions of the world. He concludes by outlining the challenges faced by those resisting the American project today: redefining European liberalism on the basis of a new compromise between capital and labor, re-establishing solidarity among the people of the South, and reconstructing an internationalism that serves the interests of regions that are currently divided against each other.
Country
Publisher
Monthly Review Press Books
Theme area
Equitable health services, Monitoring equity and research to policy
Title of publication District health barometer year 1
Date of publication
2005 November
Publication type
Report
Publication details
District Health Barometer pp 1-87
Publication status
Published
Language
English
Keywords
district health indicators, South Africa, district health barometer, district health services
Abstract
The District Health Barometer (DHB) is a collection of health indicators which presents a snapshot of how well the health districts in South Africa provide primary health care to the population. These indicators do not provide any form of complex analysis or in-depth research, yet they point to districts that need improvement and support and likewise to those districts that are doing well. They show how districts are performing relative to one another and relative to their province and the national average. There is no tool available that shows a district compared with a similar district elsewhere in the country. However, using the District Health Barometer (DHB), comparisons can now be made between the six metropolitan districts, between the 13 rural node districts or between any districts that are of a similar socio-economic status and size. The key purpose of the District Health Barometer is to function as a TOOL to monitor progress and support improvement of equitable provision of primary health care. This report documents findings of year 1 in the life of the district health baromemeter.
Country
South Africa
Publisher
Health Systems Trust
URL
Theme area
Human resources for health, Equity and HIV/AIDS, Governance and participation in health
Title of publication The impact of HIV/AIDS on the health sector. National survey of health personnel, ambulatory and hospitalised patients and health facilities, 2002
Date of publication
2003
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
impact of HIV/AIDS, health facilities, health personnel, impact of HIV/AIDS on hospitalised patients
Abstract
South Africa is estimated to have the largest number of people living with HIV/AIDS in the world. The Nelson Mandela/HSRC study of HIV/AIDS (2002) reported an estimated HIV prevalence of 4.5 million persons aged two years and older. The epidemic results in high morbidity and mortality. Given the overall impact of HIV/AIDS on South African society, and the need to make policies on the management of those living with the disease, it is important that studies are undertaken to provide data on the impact on the health system. South Africa needs data to assess the impact of HIV/AIDS on the health system to assist decision makers and programme planners to make policies to ameliorate this impact.
This was attempted by the HSRC and the National School of Public Health (NSPH) at the Medical University of South Africa (MEDUNSA) responding to Tender No GES 38/2000-2001 called for by the Department of Health (DoH)
We found that the HIV/AIDS epidemic has an impact on the health system through loss of staff due to illness, absenteeism, low staff morale, and also through the increased burden of patient load.
Country
South Africa
Publisher
South African Department of Health
URL:
URL
Theme area
Governance and participation in health
Title of publication Notes for participants in whose reality counts? Very short (1-2 day) PRA/PLA-related familiarisation workshops in 2006
Date of publication
2006
Publication type
Electronic Source
Publication details
Publication status
Published
Language
Englsih
Keywords
PRA.PLA training, RRA
Abstract
These notes are an updated foundation which has been revised every six months or so over the past 15 years. Headings later in this note indicate some of the range of the subject, including some of the many methods. These are more an a la carte menu than a syllabus! I hope these notes are of some use, if only as a source of checklists for occasional reference. You won\\\\\\\'t want to read all of this. Some of the more important points are repeated. You are welcome to reproduce, translate or bin anything that follows, but please remember that I have often been wrong in the past and will surely prove to be wrong about some of the things said here.
This sort of workshop is NOT repeat NOT repeat NOT a PRA/PLA training. At best it may be just a taste. There is no substitute for longer training and exposure which includes field experience.
Country
United Kingdom
Publisher
IDS Participation Resource Centre
URL:
URL
Theme area
Title of publication Notes for participants in \'whose reality counts? Very short (1-2 day) PRA/PLA-related familiarisation workshops in 2006
Date of publication
2006
Publication type
Conference Proceedings
Publication details
Publication status
Published
Language
Keywords
Abstract
Country
Publisher
IDS
Theme area
Equity and HIV/AIDS
Title of publication Progress to global access to HIV antiretroviral therapy. A report on 3 by 5 and beyond
Date of publication
2006 March
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
HIV/AIDS, equity in accessing treatment, Antiretroviral therapy (ARV), global report
Abstract
The “3 by 5” strategy was announced by the World Health Organization (WHO) and the Joint United Nations Programme on HIV/AIDS (UNAIDS) in December 2003 and unanimously endorsed in May 2004 by all 192 WHO Member States at the Fifty-seventh World Health Assembly.
There is currently no evidence of systematic gender bias in access to antiretroviral therapy. However, some studies indicate that women experience particular barriers to adhering to antiretroviral therapy, including fear of disclosure and domestic violence.
An estimated 660 000 children younger than 15 years needed treatment in 2005, representing slightly more than 10% of the total number of people in need. The vast majority of the 570 000 children younger than 15 years who die from AIDS-related illnesses every year contract the disease through mother-tochild transmission. Less than 10% of pregnant women living with HIV/AIDS are estimated to be receiving antiretroviral prophylaxis, resulting in 1800 infants becoming infected with HIV every day. In eastern Europe and central Asia, injecting drug users account for more than 70% of HIV cases but represent only about 24% of the people receiving antiretroviral therapy. The average client volume per treatement site is at least twice as high in sub Saharan Africa (399 people per site) than in most other parts of the world.
Although stigma and lack of perceived benefi ts of treatment may slow the uptake of antiretroviral therapy, demand does not appear to have been the limiting factor in scale-up. Rather, the rate of increase is determined primarily by supply side factors such as drug supply, funding, identifying people’s HIV status and human resource capacity. Providing treatment free of charge in low-income settings has been found to be associated with improved adherence and treatment outcomes.
Country
Switzerland
Publisher
WHO
URL:
URL
Theme area
Equitable health services, Resource allocation and health financing
Title of publication User fees and worst off; It\'s time to find a solution
Date of publication
2006 April
Publication type
Journal Article
Publication details
The Jech Gallery pp 398-398
Publication status
Published
Language
English
Keywords
financing health care, user fees, Haiti, vulnerable populations
Abstract
Many developing countries are still relying on user fees. In contrast with the claims of user fees proponents, such financing methods have excluded vulnerable populations from basic health service, with damaging implications for equity. This brief article brings to light the difficulties faced in areas reliant on this means of financing health care.
Country
Canada
Publisher
BMJ Journals
URL:
URL
Theme area
Equity and HIV/AIDS
Title of publication Mainstreaming HIV/AIDS in development of humanitarian programmes
Date of publication
2004
Publication type
Book Section
Publication details
Publication status
Published
Language
English
Keywords
mainstreaming in HIV/AIDS, mainstreaming in development, Action Aid, household strategies in HIV/AIDS
Abstract
AIDS depends for its success on the failures of development. We now know that the spread of HIV and the effects of AIDS are closely linked to development problems such as poverty and gender inequality. Development and humanitarian agencies should be doing more to respond to the challenges posed by HIV/AIDS. This book suggests a way in which they can do so through their existing work without necessarily establishing special programmes of HIV prevention or AIDS care.
This book is a shorter, simplified version of AIDS on the Agenda (Holden 2003). The ideas in the two books are the same; but this version, we hope, is accessible to a wider range of readers: those who actually do development and humanitarian work, in addition to those who manage it and fund it. The book presents general lessons learned – mainly from the experiences of non-government and community based organisations (NGOs and CBOs) working in the parts of Africa that are worst affected by HIV/AIDS. AIDS has changed the world. This book is about the changes that we need to make in order to do effective development and humanitarian work in a world of AIDS.
Country
United Kingdom
Publisher
Oxfam GB, Action Aid, Save the Children
URL:
URL
Theme area
Human resources for health
Title of publication London calling? The international recruitment of health workers to the capital
Date of publication
2004 July
Publication type
Journal Article
Publication details
King\'s Fund Research Summary pp 1-12
Publication status
Published
Language
English
Keywords
international recruitment, health workforce, London, UK, research, policy
Abstract
International recruitment of health professionals has grown rapidly in recent years, as the health service strives to increase its workforce to meet NHS Plan1 staffing targets. London is more reliant than the rest of the NHS in England on international recruits because it has a higher level of vacancies and staff shortages than the rest of the health service. It has traditionally been the entry point for many international workers, who are attracted to the range of career opportunities and educational resources.
Without these workers the health and health care services in the capital would be unable to function effectively. However, London’s reliance on the global labour market also brings with it a number of challenges. First, how can NHS employers in London support and develop an increasingly culturally and ethnically diverse workforce to enable it to work effectively? Second, how can London’s NHS retain hard-won international health care staff in the face of growing international competition? And finally, how ethical is it for the NHS to continue to rely on health workers from developing countries and those experiencing their own shortages?
This research summary profiles, for the first time, the international workforce in London, and provides case studies detailing the experiences of three London NHS trusts and their international recruitment activities. The research is the first publication from a wider programme of work on the international recruitment of health workers to the capital.
Country
United Kingdom
Publisher
King\'s Fund
URL:
URL
Theme area
Values, policies and rights, Human resources for health
Title of publication Internationally recruited nurses in London. Profile and implications for policy
Date of publication
2005 September
Publication type
Manuscript
Publication details
Publication status
Published
Language
English
Keywords
migration of health workers, internationally, London, UK, nurses, policy on human resources in health
Abstract
The issues surrounding international recruitment and the migration of health workers have generated huge media attention. However, relatively little primary research has been done in this area. Based on a survey of international nurses in London, this paper reports on the country of origin, demographic profile, motivations, experiences and career plans of the 380 respondents. The paper also outlines the overall trends in the numbers of nurses coming to the United Kingdom, examines the policy context in which international recruitment activity has been conducted, and looks at the impact of the United Kingdom’s Code of Practice on international recruitment.
Country
United Kingdom
Publisher
Kings\' Fund
URL:
URL
Theme area
Equity and HIV/AIDS
Title of publication The international treatment preparedness coalition; Letter to Dr. Lee
Date of publication
2006 April
Publication type
Generic
Publication details
The International Treatment Preparedness Coalition pp 1-16
Publication status
Publication status unknown
Language
English
Keywords
International Treatment Preparedness Coalition, HIV/AIDS, people living with HIV/AIDS, WHO, equity
Abstract
This letter was written by and to represent the various groups of people living with HIV/AIDS across the world. Adressed to the Director General of the WHO, Dr Lee, the letter begins by thanking Dr Lee for the truly visionary leadership in launching WHO’s 3x5 campaign in 2003. However, the letter proceeds to express concern that the new Universal Access initiative may lack the specificity of WHO\'s 3x5 campaign and is not accompanied by any clear and concrete operational goals.
Country
Publisher
The International Treatment Preparedness Coalition
URL:
URL
Theme area
Equity in health
Title of publication CSDH Newsletter
Date of publication
2006 January
Publication type
Electronic Source
Publication details
CSDH Newsletter 6 pp 1-4
Publication status
Published
Language
English
Keywords
social determinants of health, CSDH, equity in health, fairer health polies
Abstract
This edition of the CSDH newsletter includes 7 short articles discussing equity and policy in health. It also features informative facts on the social determinants of health, as well as an inside view of some of the work in favour of equity that has been done in Iran.
Country
Switzerland
Publisher
Commission on Social Determinants of Health
URL:
URL
Theme area
Equity and HIV/AIDS, Monitoring equity and research to policy
Title of publication Buckling: The impact of AIDS in South Africa
Date of publication
2005
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
impact of HIV/AIDS on society, South Africa, policies, new analysis of HIV/AIDS impact
Abstract
An AIDS epidemic as severe as the one plowing through South Africa will change society. But how and along what lines? Buckling: The impact of AIDS in South Africa, a new publication by South African writer and journalist Hein Marais, tackles the question in distinctive and critical-minded fashion-and arrives at disquieting conclusions. this multidisciplinary study scrutinizes commonplace conceptions of AIDS impact, presents a fresh understanding of the epidemic\\\'s consequences in South Africa, and proposes a minimum package of social adjustments that could reduce the damage.
According to Marais, most projections of how the AIDS epidemic affects society are vastly oversimplified and often are tailored to fit prevailing ideological perspectives. As a result, they fail to capture the ways in the epidemic\\\'s burdens are deflected onto, and are concentrated among the least-privileged sections of society, particularly women-causing even harsher polarization. Policies and programmatic responses based on conventional conceptions of the societal effects of AIDS are likely to fail, or may even aggravate existing inequities. Relevant recommendations accompany his in depth analyses.
Country
South Africa
Publisher
Centre for the Study of AIDS, University of Pretoria
URL:
URL
Theme area
Values, policies and rights
Title of publication Democratising development: The politics of socio-economic rights in South Africa
Date of publication
2005 November
Publication type
Book Section
Publication details
Publication status
Language
English
Keywords
socio-economic rights, development, policies, democracy, South Africa
Abstract
What are the prospects and means of achieving development through a democratic politics of socio-economic rights? Starting from the position that socio-economic rights are as legally and normatively valid as civil and political rights, this anthology explores the politics of acquiring and transforming socio-economic rights in South Africa. The book brings together an interdisciplinary group of leading scholars in an examination of the multifaceted politics of social and economic policy-making, rights-based political struggles and socio-economic rights litigations. The post-apartheid South African experience shows that there is no guarantee that democracy will eliminate poverty or reduce social inequality, but also that democratic institutions and politics may provide important means for asserting interests and rights in regard to development. Thus it is argued that democratic politics of socio-economic rights may democratise development while also developing democracy.
Country
Norway
Publisher
Brill
Theme area
Equity and HIV/AIDS, Monitoring equity and research to policy
Title of publication Report of the regional workshop of national AIDS authorities on the implementation of the SADC HIV and AIDS strategic framework
Date of publication
2005
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
HIV/AIDS in SADC region, operationalising the SADC framework, resource mobilisation, Southern African Development Community
Abstract
The three-day workshop was held from 26-28 July 2004. It was the first of its kind that brought together coordinators and managers of National AIDS Coordinating Authorities from 13 SADC Member States, civil society organisations, UN agencies, research institutes and representatives of different SADC Secretariat Directorates.
This workshop again demonstrated that today we know more about HIV and AIDS in Southern Africa than ever before. Improved surveillance techniques are providing light not only on the HIV and AIDS situation, but also on the behaviours that drive the epidemic. Increasingly Member States are expressing their political commitment to addressing the epidemic through the allocation of more resources to combat HIV/AIDS, including the provision of treatment. The provision of treatment needs to be complemented by the strengthening the entire health system including development and retainment of human resources who are critical for the future health and welfare of the region.
Delegates to the workshop concluded by calling on the SADC Secretariat to coordinate the regional response to the epidemic, guided by the SADC Strategic Framework on HIV and AIDS.
Country
Botswana
Publisher
SADC HIV and AIDS Unit
URL:
URL
Theme area
Human resources for health
Title of publication The brain gain: Skilled immigrants and immigration policy in post-apartheid South Africa
Date of publication
2000
Publication type
Journal Article
Publication details
Migration Policy Series No. 20 pp 1-35
Publication status
Published
Language
English
Keywords
brain drain, policies, South Africa, South African immigration policy
Abstract
South African immigration policy has become extremely restrictive since 1994. Immigration numbers are at an all-time low, even as emigration accelerates. The number of temporary work permits issued has also declined at a time when South Africa has reconnected to the global economy and many companies and investors wish to import high-level skills. Immigration is not viewed as a public policy tool that could benefit South Africa.
Immigrants and migrants (even the most highly skilled) are more often stereotyped as a threat to the economic and social interests of South Africans.
Why has South Africa’s first democratic government taken such a dim view of immigration to date? Why is immigration invariably seen as a problem to control rather than an opportunity to exploit? Why has South Africa shifted from being a net immigrant-receiving to an immigrant-exporting nation? These are the first questions addressed in this paper. We address the Draft White Paper’s rationale for a restrictionist policy and review various other explanations that have been advanced to explain post-apartheid policy.
Country
South Africa
Publisher
The Southern African Migration Project (SAMP)
URL:
URL
Theme area
Human resources for health
Title of publication Losing our minds: Skills migration and the South African brain drain
Date of publication
2000
Publication type
Publication details
Migration Policy Series No. 18 pp 1-63
Publication status
Published
Language
English
Keywords
brain drain, skilled professionals emigration and immigration, policies, South Africa
Abstract
Many countries, South Africa included, are in a panic about skills emigration – the so-called brain drain. One business oriented institute even thinks that South Africa’s skills shortage is so “desperate” that the country should immediately throw open its borders to anyone who wishes to enter. Yet most South Africans are ambiguous about the wisdom of using immigration policy to offset skills loss. Immigration, no matter how selective and tightly controlled, arouses nationalist passions and causes moral panics. This article discusses at length the various different arguments and perceptions that have been vocalised in debating the correct policy; from a historical, current, as well as futuristic point of view.
Country
South Africa
Publisher
The Southern African Migration Project (SAMP)
URL:
URL
Theme area
Human resources for health
Title of publication The new brain drain from Zimbabwe
Date of publication
2003
Publication type
Journal Article
Publication details
Migration Policy Series No. 29 pp 1-37
Publication status
Published
Language
English
Keywords
brain drain, skilled professionals in health and education, policies, perceptions, destination of emigrants, Zimbabwe
Abstract
Although the precise dimensions and impacts of this “brain drain” have yet to be determined, the Zimbabwean government has recently sought to stem the tide with various policy measures. The education and health sectors appear to be the hardest hit although professionals in other sectors have also been leaving in numbers. The Southern African Migration Project (SAMP) has undertaken a multi-country study of the brain drain within and from the Southern African Development Community (SADC).The Zimbabwean survey was conducted in 2001. A representative sample of 900 skilled Zimbabweans was interviewed to obtain information on personal and household economic circumstances; attitudes towards current and future economic, social and political circumstances; likelihood of emigration in the future; and attitudes towards measures designed to keep them in the country.
Amongst other alarming findings, the first significant finding is that 57% of the sampled population have given a “great deal” of thought to emigrating from Zimbabwe (with another 29% having given the matter some thought). The basic conclusion of this study is that coercive measures will not work and that the best way to curb the high rates of skilled labour migration lies in addressing the economic fundamentals of the country which will ultimately improve living standards.
Country
South Africa
Publisher
The Southern African Migration Project (SAMP)
URL:
URL
Theme area
Human resources for health
Title of publication Zimbabweans who move: Perspectives on international migration in Zimbabwe
Date of publication
2002
Publication type
Journal Article
Publication details
Policy Migration Series No. 25 pp 1-73
Publication status
Published
Language
English
Keywords
intertnational migration, policies, Zimbabwe, refugee and migrant rights, attitudes
Abstract
Between 1997 and 2001, SAMP conducted three representative national surveys of Zimbabwean citizens in order to provide insights into the attitudes, perceptions and migration behaviours of ordinary citizens. This publication brings together the results from two of these surveys (the 1997 Public Opinion Survey and the 2001 National Immigration Policy Survey).
This policy paper also contains an overview of the major migration trends in Zimbabwe since independence, written by Professor Lovemore Zinyama, formerly of the University of Zimbabwe.
Country
South Africa
Publisher
The Southern African Migration Project (SAMP)
URL:
URL
Theme area
Human resources for health
Title of publication Medical Leave: The exodus of health professionals from Zimbabwe
Date of publication
2005
Publication type
Journal Article
Publication details
Migration Policy Series No. 34 pp 1-37
Publication status
Published
Language
English
Keywords
human resources for health, policies for retaining skille professionals, Zimbabwe
Abstract
Zimbabwe is faced with a growing problem of the emigration of its skilled labour. Health professionals in particular are migrating in search of greener pastures outside the country’s borders. This has negatively affected the quality of health care offered in most of the country’s health institutions. This policy paper draws on research work that was conducted in selected health institutions in July 2002. The study aimed to establish the magnitude of migration of health pr ofessionals, its causes and to document the associated impacts on service delivery. The study is based on a multi-faceted methodology including a representative
survey of health professionals in Zimbabwe, focus groups and key informant interviews.
Overall, the study shows that existing policy responses are not having a significant impact on the retention and return of health professionals.
Country
South Africa
Publisher
Southern African Migration Project (SAMP)
URL:
URL
Theme area
Values, policies and rights
Title of publication Early departures: The emigration potential of Zimbabwean students
Date of publication
2005
Publication type
Journal Article
Publication details
Migration Policy Series No. 39 pp 1-29
Publication status
Published
Language
English
Keywords
Southern African Migration Project (SAMP), students, Zimbabwe, brain drain, policies, professional dissatisfaction
Abstract
Zimbabwe is experiencing a crippling flight of professional and skilled people that has escalated to levels that have serious implications for economic growth and development. Previous studies have discovered extremely high levels of dissatisfaction amongst professionals with the cost of living, taxation, availability of goods, and salaries. Unhappiness goes deeper than economic circumstances to include housing, medical services, education and a viable future for children. There is an urgent need for policies to curb the massive brain drain and offer incentives to make staying and working in the country attractive for professionals and skilled people. Policy-makers also need to be able to predict the size and direction of future flows of professional and skilled emigrants.
In an effort to try and understand the future course of the brain drain, the Southern African Migration Project (SAMP) carried out a survey of final-year college and university students in Zimbabwe. The survey yielded very interesting results.
Country
South Africa
Publisher
Southern African Migration Project (SAMP)
URL:
URL
Theme area
Human resources for health
Title of publication Human resources for health: A global crisis
Date of publication
2006
Publication type
Electronic Source
Publication details
Eldis - Health Systems
Publication status
Language
English
Keywords
human resources for health, health service delivery, information resource, IDS Health and Development Information Team
Abstract
The IDS Health and Development Information Team has produced a range of resources which explore critical issues in human resources for health: Human resources for health dossier. This dossier is an information resource on the importance of human resources in improving health service delivery for poor people, developed in collaboration with the DFID Health Resource Centre. The dossier offers practical, up to date information with recommended readings, summarised documents and link to other resources.
Country
United Kingdom
Publisher
Eldis
Theme area
Human resources for health
Title of publication Report of regional planning meeting: Retention and migration of health personnel in southern Africa, 3 April 2006, Lusaka Zambia
Date of publication
2006 April
Publication type
Report
Publication details
EQUINET Meeting report pp 1-22
Publication status
Published
Language
English
Keywords
financial incentives; non financial incentives; policy and programme support, southern Africa
Abstract
The Objectives of the meeting were to review available evidence, current programmes and priority areas for future work to support retention and manage migration of HRH from national and regional level; plan a regional programme of work to support national HRH planning, monitoring and evaluation in selected countries in east and southern Africa; and discuss and agree on institutional mechanisms for guidance and review of the follow up work programme. While there are numerous areas of policy relevance on HRH, given the time limitation the meeting focused on financial and non financial incentives for retention of HRH to outline a programme of work to gather, synthesise and review knowledge on incentives for retention of health personnel, particularly non financial incentives; monitor and assess policy and programme support for implementation of such incentives for their impact on HRH and support policy dialogue and programme management on retention of health personnel. An exploratory discussion was also held to map priority areas of work to gather, analyse and review evidence on costs and benefits of HRH migration out of east and southern Africa, and to assess and support policy measures aimed at managing HRH migration.
Country
East and southern Africa region
Publisher
EQUINET
URL:
Equinet Publication Type
Reports
Theme area
Health equity in economic and trade policies
Title of publication Discussion paper 30: The dispossession of African wealth at the cost of African health
Date of publication
2006 March
Publication type
Document
Publication details
EQUINET Discussion Paper 30 pp 1-29
Publication status
Published
Language
English
Keywords
wealth, dispossession, trade, debt, exploitation, east and southern Africa
Abstract
The South-North drain of African wealth reduces the resources available for health and development, increases dependency on the global North. This drain can be reversed by citizen activism and bold national policies. Africa has been drained of resources that – if harnessed and shared fairly – would meet the needs of the peoples of Africa.
Country
Southern Africa Regional
Publisher
EQUINET, Southern African Centre for Economic Justice
URL:
Equinet Publication Type
Discussion paper
Theme area
Governance and participation in health
Title of publication Meeting report: Participatory methods for a people centred health system: Training workshop, Bagamoyo Tanzania, 28 February-4 March 2006
Date of publication
2006 March
Publication type
Report
Publication details
EQUINET Meeting report pp 1-24
Publication status
Published
Language
English
Keywords
participatory methods, people centred, health systems, east and southern Africa
Abstract
The regional training workshop on participatory methods for a people centred health system was hosted by the regional network for equity in health in east and southern Africa (EQUINET) , TARSC, Ifakara and CHESSORE in Bagamoyo Tanzania from February 28- 3 March 2006. It aimed to build skills, share experiences and strengthen work on participatory methods for people centred health systems.
Country
Southern Africa Regional
Publisher
TARSC
URL:
Equinet Publication Type
Toolkits and training materials
Theme area
Equity in health, Equitable health services
Title of publication “Equity gauge” : A tool for monitoring equity in health and health care in South Africa
Date of publication
2000
Publication type
Conference Proceedings
Publication details
Presentations at GEGA Meetings pp 1-5
Publication status
Published
Language
English
Keywords
equity in health care, GEGA project, project history and evaluation, South Africa, measuring improvement in health
Abstract
The Equity Gauge is a national project established to help South Africans measure if their health is improving. It also helps measure if health care is being provided in a way that is fair and equitable. The project is a partnership between South African Legislators and the Health Systems Trust.
The aim of the \\\\\\\\\\\\\\"Equity Gauge\\\\\\\\\\\\\\" is to establish a set of benchmarks by which progress towards equity in health and health care can be monitored over time, and to facilitate its use and application.
This document desribes in detail the components and uses of this tool, including past and current activities of the project.
Country
South Africa
Publisher
GEGA
Theme area
Equity in health, Values, policies and rights, Governance and participation in health
Title of publication The quality of migration services delivery in South Africa
Date of publication
2005
Publication type
Journal Article
Publication details
Policy Migration Series 41 pp 1-64
Publication status
Published
Language
English
Keywords
vital statistics, SAMP, Services Quality Survey (SQS), South Africa, migration
Abstract
The South African Department of Home Affairs (DHA) is
responsible for the implementation and management of
migration policy and legislation, as well as the registration of
births, mar riages and deaths and the issuing of identity documents and passports. It is often criticised in the media and in private conversation for being administratively inefficient, cumbersome and unwieldy. South African and foreign customers reportedly regularly complain about the poor quality of services delivered by the Department. Such evidence and media reporting underpins the widelyheld
belief that the Department is not easily accessible, is unresponsive to the needs of its customers, is riddled with corruption and, to the extent that systems are in place to provide efficient and quality services, is poorly managed.
In recent years, the DHA has also been plagued by a number of incidents of corruption and mismanagement and a protracted and controversial process of drafting new immigration legislation.
The Southern African Migration Project (SAMP) therefore proposed to test current perceptions of the Department through a study of the quality of services delivered: the Services Quality Survey (SQS) project. In SAMP’s view, the value of implementing such a project lies in assessing and comparing the views, preferences and expectations of
service consumers with those of the service providers. By developing an understanding of the constraints that hinder performance and the factors that enhance performance, the results of the SQS are intended to be used as a baseline against which to assess and benchmark current performance and service standards, and to set realistic targets and objectives to improve service delivery in the future.
Country
South Africa
Publisher
Southern African Migration Project (SAMP) ; Southern African Research Centre
Theme area
Values, policies and rights, Equity and HIV/AIDS
Title of publication Migration and domestic workers : Worlds of work, health and mobility in Johannesburg
Date of publication
2005
Publication type
Journal Article
Publication details
Migration Policy Series 40 pp 1-53
Publication status
Published
Language
English
Keywords
cross-border migration, women and health, Johannesbourg, South Africa, domestic workers, HIV/AIDS, sexual behaviour, SAMP
Abstract
South Africa is in the middle of a well-documented HIV/AIDS
epidemic. Infection rates were calculated to be 22% of the adult population in 2003. A number of different r easons have been advanced to explain the HIV/AIDS epidemic in South Africa. They include poverty and economic mar ginalization; differing strains of HIV; and high rates of sexually transmitted diseases. However, migration
patterns in Southern Africa have also been identified as one of the keys to understanding the high rates of infection in the region. Male migrants have been the focus of research on the relationship between HIV and migration. In the same way that the vulnerabilities of migrant women to HIV have thus far largely remained unexplored, the lives of migrant women have also received far less attention than the lives of
their male counterparts.
This study examines the migrant and health experiences of domestic workers in Johannesburg, as well as some of their points of vulnerability to HIV. In 2004, domestic work was the second largest sector of employment for black women in South Africa. And, as this study shows, a defining characteristic of domestic workers in Johannesburg is their status as migrant workers. Given the importance of domestic work for women workers in South Africa, and the potential for their working conditions to affect their access to health care and their vulnerability to HIV infection, the study explored questions around migrancy, working conditions, access to health care and the experiences of, and vulnerability to HIV of domestic workers working in Johannesburg. The study is based on interviews with 1,100 female domestic workers employed in the City of Johannesburg.
Low levels of condom use, given the circumstances of their relationships, and low levels of knowledge around issues related to HIV/AIDS are of concern. The majority of these women look to television and listen to the radio to get information. The majority attend health services at some point during the year. Therefore, it seems that this cohort of
women workers in Johannesburg are not being reached by health promotion campaigns relating to HIV/AIDS education, prevention and treatment.
Country
South Africa
Publisher
Southern African Migration Project (SAMP) ; Southern African Research Centre
Theme area
Human resources for health
Title of publication Early departures : The emigration potential of Zimbabwean students
Date of publication
2005
Publication type
Journal Article
Publication details
Migration Policy Series 39 pp 1-29
Publication status
Published
Language
English
Keywords
cross-country migration, students, Zimbabwe, SAMP
Abstract
Zimbabwe is experiencing a crippling flight of professional and skilled people that has escalated to levels that have serious implications for economic growth and development. Previous studies have discovered extremely high levels of dissatisfaction amongst professionals with the cost of living, taxation, availability of goods, and salaries. Unhappiness goes deeper than economic circumstances to include housing, medical services, education and a viable future for children. There is an urgent need for policies to curb the massive brain drain and offer incentives to make staying and working in the country attractive for professionals and skilled people. Policy-makers also need to be able to predict the size and direction of future flows of professional and skilled emigrants.
In an effort to try and understand the future course of the brain drain, the Southern African Migration Project (SAMP) carried out a survey of final-year college and university students in Zimbabwe. The survey aimed to obtain information on the demographic profile of the student body; their attitudes towards national issues and government
policies; satisfaction and expectations about economic conditions and about the future; likelihood of leaving after graduation; reasons for moving; most likely destinations; perceived conditions in the most likely destination; and length of stay in the most likely destination. Answers
to questions were analysed by gender, age, rural/urban background and other variables.
This article describes details of the findings at length.
Country
South Africa
Publisher
Southern African Migration Project (SAMP) ; Southern African Research Centre
Theme area
Values, policies and rights
Title of publication Northern gateway : Cross-border migration between Namibia and Angola
Date of publication
2005
Publication type
Journal Article
Publication details
Policy Migration Series 38 pp 1-30
Publication status
Published
Language
English
Keywords
border management, SADC countries, Namibia, Angola, cross-country migration
Abstract
Namibia shares its borders with five other SADC countries:
South Africa, Botswana, Zimbabwe, Zambia and Angola.
Communities in southern Angola and norther n Namibia
share deep cultural roots and people along the border have
similar cultural practices, languages and relatives in both countries.
Now that peace has returned to the area, it is necessary to re-examine the role of the bor der as a barrier or conduit to interaction and greater cooperation between Namibia and Angola. Exactly what kinds and volumes of cross-border traffic in people and goods now flow across the border? How is movement across the border managed? Does border
management facilitate or inhibit the movement of people and goods?
What kinds of pressures exist at official border crossing-points and how could these be better managed? How much irregular border-crossing takes place and with what results?
Findings pertaining to these issues are explored in this article.
Country
South Africa
Publisher
Southern African Migration Project (SAMP) ; Southern African Research Centre
Theme area
Values, policies and rights, Monitoring equity and research to policy
Title of publication Understanding press coverage of cross border migration in Southern Africa since 2000
Date of publication
2005
Publication type
Journal Article
Publication details
Migration Policy Series 37 pp 1-40
Publication status
Published
Language
English
Keywords
xenophobia, cross-cultures, migration in Southern Africa, SAMP
Abstract
Xenophobia is a distinctive and widespread phenomenon in
South and Southern Africa. The print media, in particular,
has been accused of exacerbating xenophobic attitudes. This
paper discusses press coverage of cross-border migration in
Southern Africa from 2000-2003, with a focus on xenophobia. The study revisits research conducted in South Africa by the Southern African Migration Project (SAMP) in the 1990s to determine what, if any, changes have occurred in that country’s press coverage of the issue.
It also extends the investigation to three other SADC states
(Zimbabwe, Botswana and Namibia). Empirical variations across the region serve to highlight that there is no single or universal explanation for xenophobic press coverage in Southern Africa. More importantly, the paper poses a series of hypotheses which attempt to explain why xenophobia does (or does not) exist in the region’s press and how the
problem may be addressed. The hope is that these hypotheses will help us better understand the causes of xenophobia in the South African press – and any trends away from xenophobic press coverage – to assist with ways of combating xenophobia in the future.
Country
South Africa
Publisher
Southern African Migration Project (SAMP) ; Southern African Research Centre
Theme area
Values, policies and rights
Title of publication Restless minds : Southern African students and the brain drain
Date of publication
2005
Publication type
Journal Article
Publication details
Migration Policy Series 36 pp 1-31
Publication status
Published
Language
English
Keywords
braIN drain, students, South Africa, policy implications of brain drain, SAMP
Abstract
Since the end of apartheid, young South Africans can look
beyond the country’s borders to find employment. Yet while
greater opportunities and a wider range of choice may be good news for South Africa’s talented tertiar y students, it may also be bad news for the country as a whole in the form of a momentous loss of skills. Skilled emigration has the potential to rob the country of considerable investment in training and education, and also deprive the economy
of needed skills and upper-end consumers. The brain drain is likely to be particularly damaging to the economy when students leave relatively soon after graduating and the country fails to receive any appreciable return on direct investments in training.
This study therefore assesses the emigration potential of South Africa’s potential skills base: that is, young adults in tertiary training institutions. Altogether, final-year students at 74 South African undergraduate university faculties were surveyed, along with 92 post-graduate university faculties, 37 technikon faculties, and 3 nursing college faculties.
The final sample was 4,784 students. Just over one-third were completing a certificate or diploma (36%), and another third a Bachelor’s Degree (38%). One fifth of the students were engaged in post-graduate study pursuing an Honours Degree (10%), Masters Degree (12%) or a Doctorate (less than 1%). Four percent were pursuing some other form
of degree. The country’s potential skills base (as represented by this sample) is more female (54%) than male (46%); more black (48%) than white (40%); and young (median age of 22). This undoubtedly reflects dramatic changes at the country’s tertiary institutions since the
end of apartheid. A 1998 SAMP survey of skilled adults in the workforce found a population that was overwhelmingly male (61%) and white (72%)
Country
South Africa
Publisher
Southern African Migration Project (SAMP) ; Southern African Research Centre
Theme area
Values, policies and rights, Monitoring equity and research to policy
Title of publication Degrees of uncertainity : Students and the brain drain in Southern Africa
Date of publication
2005
Publication type
Journal Article
Publication details
Migration Policy Series 35 pp 1-39
Publication status
Published
Language
English
Keywords
brain drain, Southern Africa, students, SAMP
Abstract
SAMP has conducted extensive research on the magnitude and impact of the brain drain from South Africa and several other SADC countries. One prominent ANC Minister reviewed the SAMP evidence for an accelerating brain drain and hypothesized to us that this was a temporary problem. He argued that today’s students were far more loyal
to their country of birth and that as they came onto the labour market, they would be much less anxious to leave than their parents’ generation.
SAMP agreed to test this assertion with a major, representative study of the attitudes of final-year students in six SADC countries. A large sample of almost 10 000 final-year students was interviewed in training institutions across the region (universities, technikons, teach training colleges, nursing training colleges and so on). The findings of
this survey are presented here. The results should be a cause of great concern to governments and policy-makers.
Country
South Africa
Publisher
Southern African Migration Project (SAMP) ; Southern African Research Centre
Theme area
Values, policies and rights, Governance and participation in health
Title of publication Migration, urbanisation, and sustainable livelihoods in South Africa
Date of publication
2005
Publication type
Journal Article
Publication details
Migration Policy Brief 15 pp 1-20
Publication status
Published
Language
English
Keywords
service delivery, migration, urbanisation, South Africa
Abstract
When facing turmoil in the 1980s, South Africa embraced an aggressive agenda of social, economic, and political transformation. The results are imperfect, but few question the underlying wisdom of this approach. Many of the country’s local and provincial governments now feel they are facing new crises.
In a context of migration and continued social fragmentation, governing for sustainable livelihoods means overcoming divisions by promoting a sense of a shared future and common rules of economic and social engagement.
This paper explores how exclusion based on nationality or community of origin effects, to borrow from the Gauteng’s Growth and Development Strategy (2005: 3), initiatives “to
achieve a shared vision, amongst all sectors of our society, for the achievement of our goal of improving the quality of life for all citizens.”
Country
South Africa
Publisher
Southern African Migration Project (SAMP)
Theme area
Poverty and health, Monitoring equity and research to policy
Title of publication Energy and poverty in Africa
Date of publication
2005 May
Publication type
Journal Article
Publication details
Policy Insights No. 8 pp 1-6
Publication status
Published
Language
English
Keywords
Africa, energy sources, poverty, policies
Abstract
Access to energy is essential for economic, social and political development. Despite its enormous potential in fossil and renewable energy sources, Africasuffers from major energy deficits. The continent’s resources are underexploited or exported in raw form or wasted in the course of extraction or transport. As a result, supplies available for local populations are largely insufficient and energy consumption is essentially reliant on biomass.
Country
France
Publisher
OECD Development Centre
Theme area
Values, policies and rights, Poverty and health
Title of publication Adaptive capacity and inclusive development : Results of the OECD Development Centre 2003-2004 programme of work
Date of publication
2005 June
Publication type
Journal Article
Publication details
Policy Insights No. 9 pp 1-9
Publication status
Published
Language
English
Keywords
capacity building
Abstract
The Centre has highlighted in particular four areas where OECD countries can make a difference: maintaining a stable macroeconomic environment with affordable interest rates; helping to mitigate risks; enhancing trade opportunities through improving the coherence of their own policies ;and increasing financial flows for achieving the MDGs.
Country
France
Publisher
OECD Development Centre
Theme area
Poverty and health, Governance and participation in health
Title of publication The human dynamics of aid
Date of publication
2005 June
Publication type
Journal Article
Publication details
Policy Insights No. 10 pp 1-9
Publication status
Published
Language
English
Keywords
international development assisstance, efficient use of aid in developing countries
Abstract
International development assistance from richer to poorer (“developing”) economies accounts for major flows of capital, human resources and technical assistance. While the net direction of these flows remains a topic of hot debate, there have been several barriers identified to the efficient use of aid within developing countries, many of which revolve around difficulties with achieving “good governance” in recipient countries.
Country
France
Publisher
OECD Development Centre
URL:
URL
Theme area
Poverty and health, Governance and participation in health
Title of publication The human dynamics of aid
Date of publication
2005 June
Publication type
Journal Article
Publication details
Policy Insights No. 10 pp 1-9
Publication status
Published
Language
Keywords
Abstract
Country
Publisher
OECD Development Centre
Theme area
Poverty and health, Governance and participation in health
Title of publication The human dynamics of aid
Date of publication
2005 June
Publication type
Journal Article
Publication details
Policy Insights No. 10 pp 1-9
Publication status
Published
Language
Keywords
Abstract
Country
Publisher
OECD Development Centre
Theme area
Poverty and health
Title of publication MDGs, taxpayers and aid effectiveness
Date of publication
2005 August
Publication type
Journal Article
Publication details
Policy Insights No. 13 pp 1-8
Publication status
Published
Language
English
Keywords
MDGs, aid systems, new aid-effectiveness targets, taxpayers and aid
Abstract
MDGs and new aid-effectiveness targets are an opportunity for donors to explain what they do before growing scepticism erodes taxpayer support for aid.
If political leaders from donor countries attending the
September 2005 UN Summit on Millennium Development
Goals (MDGs) are genuinely committed to poverty reduction
and long-term development, it is in their interest to shift
from dependency on passive, uninformed public support
for aid to a more critically aware constituency at home.
Greater public awareness and concern about development
issues could put MDG-related issues on domestic political
agendas and thereby protect ODA commitments. This article describes how public awareness raising is thus a key growth area in the global debate on the MDGs.
Country
France
Publisher
OECD Development Centre
URL:
URL
Theme area
Poverty and health
Title of publication The international aid system : A question of perspective
Date of publication
2005 August
Publication type
Journal Article
Publication details
Policy Insights No. 12 pp 1-6
Publication status
Published
Language
English
Keywords
G8 meeting, Millenium Development Goals (MDGs), poverty reduction, aid system
Abstract
In a lengthy series of summits throughout 2005, including the Gleneagles G8 meeting in July, world leaders have made encouraging promises to raise aid volumes and make its management more effective for poverty reduction. However, examinations of progress towards the Millennium Development Goals (MDGs) have made it clear that the international community remains far from achieving its self-imposed targets. It would be tempting to call for sweeping changes to the aid system, but such calls would ignore the many incentives of donor countries, aid agencies and
recipient governments to resist change. With the 2015 MDG deadline nigh, the need for creative approaches to cope with their conflicting priorities is more pressing than ever.
Country
France
Publisher
OECD Development Centre
URL:
URL
Theme area
Poverty and health
Title of publication The international aid system : A question of perspective
Date of publication
2005 August
Publication type
Journal Article
Publication details
Policy Insights No. 12 pp 1-6
Publication status
Published
Language
English
Keywords
G8 meeting, Millenium Development Goals (MDGs), poverty reduction, aid system
Abstract
Country
Publisher
OECD Development Centre
Theme area
Poverty and health
Title of publication The international aid system : A question of perspective
Date of publication
2005 August
Publication type
Journal Article
Publication details
Policy Insights No. 12 pp 1-6
Publication status
Published
Language
English
Keywords
G8 meeting, Millenium Development Goals (MDGs), poverty reduction, aid system
Abstract
Country
Publisher
OECD Development Centre
Theme area
Values, policies and rights
Title of publication Changing social institutions to improve the status of women in developing countries
Date of publication
2005
Publication type
Journal Article
Publication details
Policy Brief 27 pp 1-26
Publication status
Published
Language
English
Keywords
developing countries, gender disparity, institutional reform
Abstract
One of the long-standing priorities of the international community is to reduce gender disparity in developing countries. Yet, the overall picture is still gloomy: women continue to be excluded from access to resources and employment and are denied basic human rights. This Policy Brief explains why progress has been so minimal and what should be done about it.
NB. Links to the French version can be found on our website.
Country
France
Publisher
OECD Development Centre
Theme area
Values, policies and rights
Title of publication Privatisation : A challenge for sub-Saharan Africa
Date of publication
2005 November
Publication type
Journal Article
Publication details
Policy Insights 14 pp 1-4
Publication status
Published
Language
English
Keywords
privatisation, sub-Saharan Africa, efficiency and labour market impact
Abstract
Thirty-eight sub-Saharan African countries have implemented privatisations programmes. The privatisation process is still far from complete and has led to mixed results. The lessons learned from past privatisations allow the identification of elements that could contribute to future success.
Country
France
Publisher
OECD Development Centre
Theme area
Values, policies and rights
Title of publication Renforcer le role economique des femmes dans les pays en developpemnet : pour le changement des institutions sociales
Date of publication
2005
Publication type
Journal Article
Publication details
Cahier de Politicque Economique 27 pp 1-30
Publication status
Published
Language
French
Keywords
les pays en developpement, la reforme des institutions sociales, les institutions sociales discriminatoires, la discrimination a l\'encontre des femmes
Abstract
Les Cahiers de politique économique présentent sous une forme concise, facile à lire et à assimiler, les résultats des travaux de recherche du Centre. De par sa diffusion rapide, large et ciblée, cette série est destinée plus particulièrement aux responsables politiques et aux décideurs concernés par les recommandations qui y sont faites.
La réduction des inégalités entre les sexes dans les pays en développement est une priorité de longue date de la communauté internationale. Pourtant, le panorama reste sombre : les femmes demeurent exclues de l’accès
aux ressources et à l’emploi, et on leur dénie toujours les droits humains fondamentaux. Ce Cahier de politique économique explore les causes de cette réalité persistante et les moyens d’y remédier. Il montre que les institutions familiales sont le principal obstacle à l’égalité des sexes.
Remettre en cause des traditions et des privilèges enracinés qui ne profitent qu’aux hommes demandera un dosage d’incitations et de sanctions, adaptés aux environnements socio-économiques et aux cadres ruraux ou urbains.
NB. The link to the English version can be found on this website.
Country
France
Publisher
Centre de Developpement de l\'OCDE (OECD)
Theme area
Resource allocation and health financing, Governance and participation in health, Monitoring equity and research to policy
Title of publication Priorities in global assisstance for health, AIDS, and population (HAP)
Date of publication
2005 June
Publication type
Journal Article
Publication details
Development Centre Working Papers No. 244 pp 1-41
Publication status
Published
Language
English
Keywords
Official Development Assisstance (ODA) for health, AIDS and population (HAP), priorities in international health assisstance
Abstract
In this report, trends in ODA for health, AIDS and population are analysed to gain information about some surprising revealed priorities.
HIV/AIDS is clearly the top priority in international health assisstance. While the share of HAP in total ODA has increased significantly over the last decade, however, if HIV/AIDS is excluded, health assistance is actually losing, not gaining share in total ODA. Even more striking, apart from HIV/AIDS, the health sub-sectors generally considered pro-poor are losing share in health ODA.
An exception to the rule of declining shares is infectious disease control, which has experienced an increase in share. Given the strong cross-border externalities associated with
infectious disease, this increase would be consistent with growing interest in global public good (GPG) aspects of health in poor countries. However, other explanations are possible, as well.
Previous research has shown that in the area of infectious diseases, ODA priorities reflect factors other than the most commonly cited prioritization tool, the burden of disease as
measured by Disability Adjusted Life Years (DALYs). This paper extends and confirms this finding for all major disease categories.
As the GPG perspective has increasingly been cited as a rationale for international support, concern has been expressed that donors may not take account of recipient-country priorities when they determine ODA priorities. In this paper, the composition of ODA at the country level is compared to health priorities as expressed in country Poverty Reduction Strategy Papers (PRSPs). No clear relationship is found. Methodological problems may be to blame; however, our failure to find a discernable relationship between the treatment of health in the PRSP and the composition of ODA is a source for concern. It suggests room for improvement in the PRSP process, in the allocation of ODA, or both.
Country
France
Publisher
OECD Development Centre
Theme area
Poverty and health, Equitable health services, Resource allocation and health financing
Title of publication L\'assurance maladie privee dans les pays en developpement ; Une solution pour les pauvres?
Date of publication
2005 August
Publication type
Journal Article
Publication details
Reperes 11 pp 1-6
Publication status
Published
Language
French
Keywords
pays en developpement, l\'assurance maladie privee, Africque sub-Saharienne, Asie de l\'Est, Amerique Latine
Abstract
Cette édition des Repères évalue le potentiel et les
risques que présentent pour les pauvres les marchés
de l’assurance maladie privée. Après un bilan de la
situation de l’assurance maladie privée dans les
différentes régions, les auteurs discutent des avantages
et des inconvénients, en termes d’efficacité et d’équité,
de cette forme d’accès aux soins de santé. Ils envisagent
ensuite différentes solutions réglementaires susceptibles
d’améliorer les performances de ce marché en pleine
expansion.
Country
France
Publisher
Centre de Developpement de L\'OCDE (OECD)
Theme area
Public-private mix, Resource allocation and health financing
Title of publication Private health insurance for the poor in developing countries?
Date of publication
2005 August
Publication type
Document
Publication details
Policy Insights 11 pp 1-7
Publication status
Published
Language
English
Keywords
developing countries, private health insurance, Latin America, East Asia, Sub-Saharan Africa
Abstract
This Policy Insight assesses the potentials and risks of private
health insurance markets for the poor. It gives an overview
of the penetration of private health insurance in insurance
markets of different regions, discusses its pros and cons in
terms of efficiency and equity in providing access to health
care and elaborates on how regulation of this growing
market can improve outcomes. In many developing countries, PHI is on a rise. Various factors contribute to this development: growing dissatisfaction with public health care, liberalisation of markets and increased international trade in the insurance industry, as well as overall economic growth allowing higher and more diversified consumer demand. This last aspect in particular is expected to put pressure on the supply side of the system to increase choices and improve the quality of health care coverage. If PHI is carefully managed and adapted to local needs and preferences, it can be a valuable tool to complement existing health-financing options. In particular non-profit group-based insurance schemes could become an important pillar of the health-financing system, especially for marginalised individuals who do not have access to formal insurance. PHI is neither the only alternative nor the definitive solution to addressing alarming health care challenges in the developing world, but it is an option that warrants growing consideration by policy makers around the globe. Thus, the question is not if this tool will be used in the future, but whether it is applied to the best of its potential to serve the needs of a country’s health care system. It is the responsibility of policy makers in developing countries as well as the international donor community to assist this process and to support countries in their endeavour to improve health coverage.
Country
France
Publisher
OECD Development Centre
Theme area
Monitoring equity and research to policy
Title of publication Monitoring financial flaws for health research
Date of publication
2004
Publication type
Newspaper Article
Publication details
Publication status
Published
Language
English
Keywords
research in health, financing health research
Abstract
This second assessment report prepared by the Global Forum for Health Research (GFHR) analyses funding levels and priorities ; and could be an additional source of information on the cost, value, coherence, and impact of recent health research internationally.
The Monitoring Financial Flows for Health Research reports (2001 & 2004) aim to provide decision-makers with an overview of currently available information on resource flows into health research.
Country
Publisher
Theme area
Governance and participation in health, Monitoring equity and research to policy
Title of publication World development indicators - 2005 Report
Date of publication
2005 March
Publication type
Report
Publication details
World Development Indicators
Publication status
Published
Language
Englsih
Keywords
health expenditure, use of health services, disease prevention, national and regional development statistics, environment, economy
Abstract
"The World Bank is committed to achieving the Millennium Development Goal of halving global poverty by 2015. As the international community measures its progress toward that goal, it must have solid and credible statistics that show where we are advancing and where we are falling behind. This year’s World Development Indicators gives policymakers that set of statistics—as a tool it can use in the fight against global poverty." (An extract from the full report\'s foreword.)
Country
United States
Publisher
The World Bank
Theme area
Equity in health, Equitable health services, Governance and participation in health
Title of publication Investing in development : A practical plan to achieve the Millenium Development Goals
Date of publication
2005
Publication type
Report
Publication details
UN Millenium Project : Report to the UN Secretary General pp i-329
Publication status
Published
Language
English
Keywords
Millenium Development Goals (MDGs), health systems, governance in health, community empowerment
Abstract
The final report of the UN Millennium Project released January 2005 suggests how we might achieve the
Millennium Development Goals which include reduction of child mortality, improvement of maternal health, and combating HIV/AIDS, malaria and other diseases by 2015. It outlines practical investment strategies and possible approaches to their financing. Specific sections in the published report relevant to public health issues include \'Health systems: ensuring universal access to essential health sciences\' (Chapter 5: Public investments to empower poor people) and the summaries of the Development Goals by area and target (Appendices 1 & 2).
Both the full report and an overview are available on the Millennium Project site.
Country
United Kingdom
Publisher
Earthscan
Theme area
Values, policies and rights
Title of publication The World Health Report 2005 : Make every mother and child count
Date of publication
2005
Publication type
Report
Publication details
World Health Report pp i-219
Publication status
Published
Language
English
Keywords
maternal and child health
Abstract
"This is an annual report, with the 2005 edition focusing on
the need, and possible strategies, for the improvement of
maternal/child health. \'Calls for greater access to life-saving interventions and a \'continuum of care\' approach to start before pregnancy and extend into the baby\'s childhood\'. Detailed statistical annexes are included.
This report was issued to coincide with World Health Day.
Country
Switzerland
Publisher
World Health Organisation
Theme area
Values, policies and rights, Governance and participation in health
Title of publication Global Monitoring Report 2005. Millenium Development Goals : From concensus to momentum (Summary paper)
Date of publication
2005 April
Publication type
Report
Publication details
Global Monitoring Report pp i-14
Publication status
Published
Language
English
Keywords
Millenium Development Goals (MDGs), Moneterrey Consensus, focus on Sub-Saharan Africa
Abstract
The Millennium Development Goals (MDGs) and the Monterrey Consensus have created a powerful global compact for development. But the continued credibility of this compact hinges on fostering momentum in its implementation. With the five-year stocktaking of the implementation of the Millennium Declaration focusing increased global attention on development, 2005 is a crucial year to build momentum. The MDGs set clear targets for eradicating poverty and related human deprivations, and for promoting sustainable development. The Monterrey Consensus created a framework of mutual accountability between developing, and developed countries in the quest for these goals, calling on developing countries to improve their policies and governance, and, developed countries to open their markets and provide more and better aid. With consensus on the goals and responsibilities for action, the focus was on implementation. As reviewed in this report, both groups of countries have made progress on needed policies and actions, including in the past year. But progress has been uneven and slower than envisaged. The pace must pick up if the vision of the Millennium Declaration is to be realized-hence the title of this report. Based on its analysis, the report proposes a five-point agenda to accelerate progress toward the development goals. Within its global coverage, this year \\\\\\\' s Global Monitoring Report, has a special focus on Sub-Saharan Africa-the region that is farthest from the development goals and faces the toughest challenges in accelerating progress. But much of the analysis of Sub-Saharan countries is relevant to similar countries in other regions.
Country
United States
Publisher
World Bank ; International Monetary Fund (IMF)
Theme area
Equity in health, Equitable health services
Title of publication Our Common Interest. Report of the Commission for Africa
Date of publication
2005 March
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
basic health care, Africa, poverty in Africa, combined forces, Commission for Africa, vicious cycle of poverty
Abstract
This report aims to address, respond to, and outline recommendations for, Africa\'s development needs.
The elimination of preventable diseases, and responses to
HIV/AIDS, are integral to the context considered by the report (Chapter 6: Leaving no-one out: investing in people). Recommended practical actions include \'strengthening health systems in Africa so all can obtain basic health care\'.
Country
Publisher
Commission for Africa
Theme area
Equity in health, Poverty and health
Title of publication Equity enhances the power of growth to reduce poverty : World Development Report 2006
Date of publication
2006
Publication type
Electronic Source
Publication details
Publication status
Published
Language
English
Keywords
equity, World Bank, development, MDGs
Abstract
Equity, defined primarily as equality of opportunities among people, should be an integral part of a successful poverty reduction strategy anywhere in the developing world, says the World Bank\'s annual 2006 World Development Report.
"We argue that an approach to development that is deeply informed by equity is consistent with the frameworks in the last two World Development Reports," said Michael Walton, another lead author of the report. "Indeed, equity is a fundamental part of the package needed to achieve empowerment and a better investment climate. It is also essential to achieving the Millennium Development Goals."
This article can also be found in Spanish, French, Portuguese, Chinese, Russian, Japanese, Italian, Vietnamese, German, Arabic, and Hindi.
Country
United States
Publisher
The World Bank
Theme area
Equity in health
Title of publication World Development Report 2006 : Equity and development
Date of publication
2006
Publication type
Report
Publication details
World Development Report 2006 pp i-320
Publication status
Published
Language
English
Keywords
health inequity within and across studies, global inequalities, equity in institutions and development process
Abstract
\'World Development Report 2006 analyzes the relationship between equity and development. The report documents the persistence of inequality traps by highlighting the interaction between different forms of inequality. It presents evidence that the inequality of opportunity that arises is wasteful and inimical to sustainable development and poverty reduction. It also derives policy implications that center on the broad concept of levelling the playing field-both politically and economically and in the domestic and the global arenas.
The report recognizes the intrinsic value of equity but aims primarily to document how a focus on equity matters for long-run development. It has three parts:
Part I considers the evidence on inequality of opportunity, within and across countries.
Part II asks why equity matters, discussing the two channels of impact (the effects of unequal opportunities when markets are imperfect, and the consequences of inequity for the quality of institutions a society develops) as well as intrinsic motives.
Part III asks how public action can level the political and economic playing fields. In the domestic arena, it makes the case for investing in people, expanding access to justice, land, and infrastructure, and promoting fairness in markets. In the international arena, it considers levelling the playing field in the functioning of global markets and the rules that govern them-and the complementary provision of aid to help poor countries and poor people build greater endowments.\'
Country
United States
Publisher
World Bank ; Oxford University Press
URL:
URL
Theme area
Governance and participation in health
Title of publication Primary Health Care (PHC) as an instrument for mobilization and development
Date of publication
2005 July
Publication type
Conference Proceedings
Publication details
Second People\'s Health Assembly pp 1-10
Publication status
Published
Language
English
Keywords
health polcies, access to health care, primary health care (PHC), selective/basic health packages, health innovative
Abstract
This conference presentation describes how PHC was born in communities, to gain a more systematic structure in Alma Ata, and the various contexts in which it exists in communities today.
This bilingual publication includes both English and Spanish text on the same slides.
Country
Ecuador
Publisher
People\'s Health Assembly
Theme area
Values, policies and rights, Equitable health services, Governance and participation in health
Title of publication "Empowering communities and facilitating the state response for primary health care". An experience from India, Asia
Date of publication
2004 July
Publication type
Conference Proceedings
Publication details
Second People\'s Health Assembly pp 1-5
Publication status
Published
Language
English
Keywords
community participation in health, health policy, primary health care, India, Asia
Abstract
The primary health care movement sprang up in an autonomous manner in different parts of the world in the 1960s and 1970s, and they were part of the responses to the huge gaps in health and health care.
From the late 1990s, NGOs and constituents of the people’s health movement in Karnataka and in India (Jan Sasthya Abhiyan) have been building the movement and facilitating and negotiating with the state. Today health is higher on the public and political agenda. However political economy factors that adversely affect the social determinants of health are strong. While the people’s health movement is growing in strength and has made significant gains, there is need for consistent sustained work. We recount some of our experiences and lessons learned.
Country
Ecuador
Publisher
People\'s Health Assembly
Theme area
Values, policies and rights, Monitoring equity and research to policy
Title of publication The effect of male circumcision on HIV infection
Date of publication
2005 November
Publication type
Electronic Source
Publication details
Science in Africa
Publication status
Published
Language
English
Keywords
research in health, circumcision, infections in heterosexual men, South Africa
Abstract
This article reports on a landmark study that found that circumcision reduced the rate of new infections among heterosexual men in South Africa by about 60%.
Country
South Africa
Publisher
Science in Africa
Theme area
Values, policies and rights
Title of publication What\'s good in space is good on the ground - water purification
Date of publication
2005 November
Publication type
Electronic Source
Publication details
Science in Africa
Publication status
Published
Language
English
Keywords
clean water, priorities in policy-making, water purification in space station, water demand in Africa
Abstract
Good in space, good on the ground. Is a water purifier designed for a space station relevant to rural Africa? New technology targeting Africa\'s demand for clean water.
Country
South Africa
Publisher
Science in Africa
Theme area
Monitoring equity and research to policy
Title of publication Design holds promise for heart surgery
Date of publication
2005 November
Publication type
Electronic Source
Publication details
Science in Africa
Publication status
Published
Language
English
Keywords
South Africa, mining industry, heart surgery, research in health
Abstract
UCT researchers have turned to medical technology to study the inner workings of one of the mining industry\\\\\\\\\\\\\\\'s most common mineral processing devices, resulting in an application that could hold major significance in the field of heart surgery.
The resultant paper has been awarded the 2006 Peterson Award for the Best Applications Paper published over a two-year period in the Journal of Experimental Mechanics.
Country
South Africa
Publisher
Science in Africa
Theme area
Monitoring equity and research to policy
Title of publication
Date of publication
2005 November
Publication type
Electronic Source
Publication details
Science in Africa
Publication status
Published
Language
English
Keywords
Abstract
This article describes how South African innovation in pasteurisation of shell eggs reduces risk of infection by Salmonella enteritidis and potentially Avian influenza.
Country
South Africa
Publisher
Science in Africa
Theme area
Values, policies and rights
Title of publication World\'s broken electronics pile up in Lagos, creating toxic dump
Date of publication
2005 November
Publication type
Electronic Source
Publication details
Science in Africa
Publication status
Published
Language
English
Keywords
electronic waste, Lagos, Nigeria, toxic waste dump
Abstract
This article describes an electronic waste dump hazard, whereby Nigeria is becoming a digital dump by being the recipient of vast numbers of broken gadgets from the West that can leak dangerous substances into water.
Country
South Africa
Publisher
Science in Africa
Theme area
Poverty and health
Title of publication Malaria - Africa\'s silent tsunami
Date of publication
2005 June
Publication type
Electronic Source
Publication details
Science in Africa
Publication status
Published
Language
English
Keywords
malaria prevention, Tanzania, World Economic Forum, Ms Sharon Stone
Abstract
The world’s passion to help those in distress was justifiably roused following the Indian Ocean tsunami. Less well known is the continuous “silent tsunami” of malaria in Africa that takes more than 1.5 million lives per year, mostly among young children and pregnant women. This means almost 3 lives per minute lost from an easily preventable and treatable disease. It was gratifying to see the beginnings of similar passion to deal with malaria at the World Economic Forum in Davos in January of this year when actress and activist Sharon Stone triggered a wave of donations for Tanzania’s efforts to combat malaria. In the space of a few minutes she raised over US $1 million while a beaming President Benjamin Mkapa of the United Republic of Tanzania looked on.
Country
South Africa
Publisher
Science in Africa
Theme area
Monitoring equity and research to policy
Title of publication Tik, memory loss and stroke
Date of publication
2005 June
Publication type
Electronic Source
Publication details
Science in Africa
Publication status
Published
Language
English
Keywords
tik, methamphetamine, MRC Drug Abuse Research Group, longitudinal study, mental health and behaviour, research in health, Cape Town, South Africa
Abstract
Tik (methamphetamine) is a potent and readily available drug that boasts the fastest addiction rates in the Cape Flats areas of South Africa and may other areas associated with gangsterism. This article describes the importance of a longitudinal study designed by a senior scientist a the MRC Alcohol and Drug Abuse Research Group and UCT Department of Mental Health and Psychiatry member.
Country
South Africa
Publisher
Science in Africa
Theme area
Monitoring equity and research to policy
Title of publication Simple yet effective ways to combat cancer-causing food toxin
Date of publication
2005 June
Publication type
Electronic Source
Publication details
Science in Africa
Publication status
Published
Language
English
Keywords
developing countries, cancer-causing food contaminants, research in health, aflatoxins, Guinnea
Abstract
This short article discusses the findings of a study in a June issue of the Lancet ; showing how exposure to a cancer-causing toxin that contaminates crops in developing countries can be reduced by a simple, cost-effective intervention on post-harvest storage.
Country
South Africa
Publisher
Science in Africa
Theme area
Monitoring equity and research to policy
Title of publication Lactose intolerance linked to ancestral environment
Date of publication
2005 June
Publication type
Electronic Source
Publication details
Science in Africa
Publication status
Published
Language
English
Keywords
lactose intolerance, evolution, nomadism, research in health
Abstract
Many people have been found to be unable to digest lactose. This article discusses the implications of findings from a new Cornell University study that show it to be primarily people whose ancestors came from places where dairy herds could be raised safely and economically, such as in Europe, who have developed the ability to digest milk.
Country
South Africa
Publisher
Science in Africa
Theme area
Values, policies and rights, Governance and participation in health
Title of publication Once pristine waters now a health hazard - Senegal
Date of publication
2005 June
Publication type
Electronic Source
Publication details
Science in Africa
Publication status
Published
Language
English
Keywords
water pollution, health hazard, Senegal
Abstract
In Senegal, the sea water of Hann Bay was found to contain a concentration of faecal streptococci - a type of bacteria found in human excrement - 17 times higher than the limit recommended by the World Health Organisation (WHO).
This article further describes how tests also showed a high level of other harmful bacteria, including the microbes that cause salmonella poisoning.
Country
South Africa
Publisher
Science in Africa
Theme area
Equity in health, Values, policies and rights
Title of publication Reaproppriating Health for All ; By and for the people after 25 years of neoliberal capture
Date of publication
2005 July
Publication type
Conference Proceedings
Publication details
Second People\'s Health Assembly pp 1-6
Publication status
Published
Language
English
Keywords
health politics, real social justice political parties, Health for All, World Social Forum, people\'s democracy, people\'s movements, economic justice, equity in health, neoliberal and social justice approaches to health
Abstract
Current international order is grotesquely unjust but also wildly irrational.
These slides were presented at the second People\'s Health Assembly in Ecuador, in attempt to emphasise the inability to achieve Health for All without meeting people’s basic needsm, meet people’s basic needs without fair distribution and sustainable use of the earth’s resources, or to achieve fair distribution in order to meet basic needs.
Country
Ecuador
Publisher
People\'s Health Assembly
Theme area
Equity in health, Values, policies and rights
Title of publication The Cuenca Declaration
Date of publication
2005 July
Publication type
Conference Proceedings
Publication details
Second People\'s Health Assembly
Publication status
Published
Language
English
Keywords
People\'s Health Assembly (PHA), Cuenca, Ecuador, People\'s Health Movement, People\'s Charter for Health, economic justice, equity in health
Abstract
Coming from 82 countries around the world, 1492 people met at the Second People’s Health Assembly in Cuenca, Ecuador from 17th to 22nd July 2005, to analyse global health problems and to develop strategies to promote Health for all.
Overwhelmingly we reaffirmed the continuing importance of the People’s Charter for Health (2000) and saw it as a rallying document for the ongoing struggles of the People’s Health Movement globally and within countries.
The vision endorsed at PHA2 is for a socially and economically just world in which peace prevails; a world in which all people, whatever their social and economic condition, gender, cultural identity and ability, are respected, are able to claim their right to health and celebrate life, nature, and diversity.
Country
Ecuador
Publisher
People\'s Health Assembly (PHA)
Theme area
Equity in health, Values, policies and rights, Resource allocation and health financing, Governance and participation in health, Monitoring equity and research to policy
Title of publication Variation de la taille des cohortes et diminuition de la mortalite aux ages avances : Implications pour le finacement par repartition des systemes de sante
Date of publication
2003 May
Publication type
Conference Proceedings
Publication details
4th International Research Conference on Social Security ; \"Social Security in a Long Life Society\" pp 1-20
Publication status
Published
Language
French
Keywords
public policy, financing social security, health sector, pay as you go-PAYG, mortality in the aged, Quebec
Abstract
L’évolution de la structure par âge des pays industrialisés suscite chez ceux qui mettent en oeuvre les politiques publiques de nombreuses préoccupations quant au financement des programmes de sécurité sociale, notamment dans les secteurs de la retraite et de la santé. Dans ce contexte, il est pertinent de s’interroger sur les conséquences de l’évolution de la taille des cohortes et de la baisse de la mortalité sur le financement par répartition (Pay As You Go -PAYG) de la sécurité sociale, instrument privilégié des gouvernements.
En première partie, nous présentons divers facteurs d’augmentation des coûts en matière de santé sous les deux angles incontournables que sont l’évolution des effectifs des cohortes et le déclin de la mortalité se produisant principalement aux grands âges. Dans un deuxième temps, nous examinons les effets amplificateurs sur les systèmes de financement par répartition d’un déclin de la mortalité plus prononcé que celui escompté par les projections officielles. Notre étude s’appuie sur la situation du Québec.
Country
Switzerland
Publisher
Association Internationale de la Securite Sociale (AISS/ISSA)
URL:
URL
Theme area
Equity in health, Values, policies and rights, Health equity in economic and trade policies
Title of publication Travail, retraite et acces aux soins des personnes vieillisantes : Cas de l\'Algerie
Date of publication
2003 May
Publication type
Conference Proceedings
Publication details
4th International Research Conference on Social Security : \"Social Security in a Long Life Society\" pp 1-20
Publication status
Published
Language
French
Keywords
structural adjustment of the economy, destabilisation of traditional family structure, Algeria, solidarity, social security of aged persons, access of elderly to health care
Abstract
L’examen de la question du travail, de la retraite et de l’accès aux soins des personnes vieillissantes en Algérie présente les particularités suivantes : il n’existe pas dans ce pays en développement de politique spécialement conçue et appliquée à la population vieillissante à cause d’autres priorités qui s’imposent aux pouvoirs publics, telles que le chômage des jeunes, la relance de l’économie et qui plus est, dans une conjoncture particulièrement défavorable qui perdure. En outre, pour un certain temps encore, nous semble-t-il, les solidarités familiales constituent une valeur-refuge sûre pour les vieilles personnes. Enfin, la population âgée n’est pas nombreuse, outre que le vieillissement est encore perçu dans une large mesure comme une fatalité. L’étude montre néanmoins que, pour l’heure, la vieillesse n’est pas pour autant oubliée, jouissant de revenus plus ou moins suffisants et de l’accès aux soins.
Country
Switzerland
Publisher
Association Internationale de la Securite Sociale (AISS/ISSA)
URL:
URL
Theme area
Equity in health, Resource allocation and health financing, Equity and HIV/AIDS
Title of publication System wide effects of the Global Fund : Interim findings from three country studies
Date of publication
2005 September
Publication type
Document
Publication details
Partners for Health Reform Plus pp i-54
Publication status
Published
Language
English
Keywords
health system reform, new financing for health care, health information system disease surveillance, quality health services, SWEF, tuberculosis, malaria, aids, GF policy and support to Benin/Ethiopia/Malawi
Abstract
This paper reports interim findings from research conducted under the auspices of the Systemwide Effects of the Fund (SWEF) research network to assess the effects of the Global Fund to Fight AIDS, Tuberculosis and Malaria (GF) on the broader health systems in Benin, Ethiopia, and Malawi. The overarching objective of the SWEF research is to assess how GF support has interacted with the health systems of recipient countries, focusing on four thematic areas, namely the effects upon: (i) the policy environment; (ii) human resources; (iii) the public/private mix; and (iv) pharmaceuticals and commodities. Baseline data were collected through document review, key stakeholder interviews, and facility and provider surveys.
Overall, the findings suggest that GF support has caused a range of different types of effects on health systems. There is some evidence of GF processes contributing to stronger health systems, while in other cases GF-supported processes have revealed long-standing systems weaknesses.
Findings highlight several areas of concern, such as a disconnect between GF-related processes and existing national policies on decentralization and cost recovery; human resource constraints; and the creation of parallel systems for procurement of drugs and commodities. Examples of positive effects include the creation of new public/private partnerships, and training and infrastructure strengthening efforts that may have positive spin-off effects to other areas of the health system. The research’s reported aim is to improve stakeholders’ understanding of the range of possible effects that GF support may have upon health systems so that negative effects can be ameliorated and
positive effects reinforced. Several recommendations are highlighted that stakeholders – including the GF and the broader international development community – should consider, to improve opportunities for beneficial effects upon broader health systems. The Partners for Health Reformplus
will conduct follow-up SWEF surveys in the three study countries in 2005/2006, allowing for more in-depth consideration of systemwide changes related to the influx of resources from the GF.
Country
United States
Publisher
Partners for Health Reform Plus ; Abt. Associates Inc.
URL:
URL
Theme area
Health equity in economic and trade policies
Title of publication Southern African Trade Union Coordination Council (SATUCC)
Date of publication
Publication type
Generic
Publication details
Publication status
Published
Language
English
Keywords
trade in Southern Africa, Southern African Trade Union Coordination Council (SATUCC), trade union rights, coordination of trade union activities, regional development process, workers education and technical/vocational training
Abstract
One of the goals behind the formation of SATUCC was to
establish a regional trade union movement that would influence
SADC policies at both regional and national levels. Since its
formation, SATUCC has assumed a high political profile, reporting on economic, political and labour conditions in the quest to influence the policies of SADC. Initially SATUCC engaged SADC through the Southern African Labour Commission (SALC) until 1995 when the SADC Council of Minister established the SADC Employment and Labour Sector (ELS). The ELS was based on a tripartite structure with representatives from government, business and trade unions in the region. SADC has since undergone further changes particularly with the Republic of South Africa joining in 1994. To SADC’s original aim of investment in the development of infrastructural projects was added the promotion of greater economic integration of the region. The SADC Extraordinary Summit in 2001 approved major restructuring of SADC institutions under which the twentyone
sectors have been grouped into clusters under four Directorates at the SADC Secretariat. Under the new set up
SADC National Committees will coordinate the respective
Member State interests relating to SADC. At regional level, an
Integrated Committee of Ministers (ICM) will coordinate the
work of different clusters under the new four Directorates. The New SADC includes the Troika system and the Organ on Politics, Defence and Security.
Country
Botswana
Publisher
Southern African Trade Union Coordination Council (SATUCC)
URL:
URL
Theme area
Health equity in economic and trade policies
Title of publication Enjoying the new SADC
Date of publication
Publication type
Generic
Publication details
Publication status
Published
Language
English
Keywords
SATUCC, SADC, SALC, trade union activities in Southern African Countries
Abstract
The Southern African Trade Union Coordination Council (SATUCC) was established in March 1983 in Gaborone, Botswana. This followed the formation a regional block - the Southern African Coordination Conference (SADCC) in 1982, which later on transformed into the Southern African Development Community (SADC). The desire to establish trade union cooperation and solidarity among trade union centres is closely linked to the to the struggles for freedom and independence in the region. The peoples of the Southern African region share a number of common values, resources and are interrelated in many ways including
culture and ethnicity. These aspects have enhanced the opportunity for positive integration for the region.
Country
Publisher
Southern African Trade Union Coordination Council
URL
Theme area
Equity in health, Values, policies and rights, Equitable health services, Equity and HIV/AIDS
Title of publication On a never-ending waiting list : Toward equitable access to anti-retroviral treatment? Experiences from Zambia
Date of publication
2005
Publication type
Journal Article
Publication details
Health and Human Rights 8 2 pp 76-102
Publication status
Published
Language
English
Keywords
HIV/AIDS, access to ARV, human rights and health policy, Zambia
Abstract
Universal access to anti-retroviral (ARV) medication for HIV/AIDS is the clarion call of the WHO/UNAIDS 3 by 5 Initiative. Treatment coverage, however, remains highly uneven. This sharpens the question of who exactly is accessing ARVs and whether access is challenging inequality
or reinforcing it. Issues of distributive justice have long been debated in health policy, but the practical challenges of ARV distribution are relatively new. In exploring what a more equitable process of ARV distribution could involve, this article draws on a human rights framework using case study material from Zambia.
El acceso universal a los medicamentos antiretrovirales (ARV) para VIH/SIDA es la consigna que guía los esfuerzos mundiales, incluida la Iniciativa 3 por 5 de la OMS/ONUSIDA. Sin embargo, la cobertura del pago para los tratamientos sigue siendo sumamente irregular, agudizando los interrogantes sobre quién exactamente está obteniendo
acceso a los ARV, y también si el acceso está ayudando a acabar con la desigualdad o aumentándola. Los temas de justicia en la distribución se han debatido desde hace mucho tiempo en la política de salud pública, pero los problemas prácticos de distribución de ARV son relativamente nuevos. Usando un marco de derechos humanos, este artículo aprovecha documentos de estudio de casos en Zambia para explorar lo que un proceso más equitativo de distribución de ARV podría implicar.
L\\\\\\\'accès universel aux médicaments anti-rétroviraux (ARV) pour le VIH/SIDA est l’axe des efforts mondiaux, en particulier l\\\\\\\'initiative WHO/UNAIDS 3 by 5. Toutefois, la couverture du traitement demeure très inégale. Ceci soulève la question non seulement de qui, exactement, a accès aux médicaments ARV, mais aussi de savoir si leur accès s’attaque aux inégalités ou les renforce. Les questions de la justice de la diffusion fait débat depuis longtemps en matière de santé publique, mais les enjeux pratiques de la diffusion des ARV sont relativement récents. Cet article est basé sur des documents d\\\\\\\'étude de cas en Zambie pour explorer,
au travers du prisme santé-droits de l\\\\\\\'homme, ce que pourrait entraîner un processus plus équitable de distribution des ARV.
Country
United States
Publisher
Harvard College
URL:
URL
Theme area
Values, policies and rights
Title of publication The GATS and South Africa\'s National Health Act ; A cautionary tale
Date of publication
2005 November
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
WTO, GATS, health policy, Geneva, South Africa, public health crisis
Abstract
South Africa’s new flagship health legislation, designed to combat a daunting and urgent public health crisis, conflicts with legally binding commitments the former apartheid regime negotiated under the World Trade Organization’s General Agreement on Trade in Services (GATS). This trade treaty conflict threatens to undermine the much-needed legislation and, if left unresolved, would make meeting the health needs of the majority of the population far more difficult. South Africa has several options for resolving this conflict in favour of its health policy imperatives, but each entails risk. South Africa’s dilemma should serve as a world-wide warning that health policy-makers, governments and citizens need to be far more attentive to negotiations that are now underway in Geneva to expand the reach of the GATS.
Country
Canada
Publisher
Canadian Centre for Policy Alternatives (CCPA)
URL:
URL
Theme area
Health equity in economic and trade policies, Poverty and health, Equity and HIV/AIDS
Title of publication Declaracao da consulta da sociedade civil da Africa austral sobre a omc e o HIV/SIDA
Date of publication
2005 December
Publication type
Conference Proceedings
Publication details
Southern African Civil Society Consultation pp 1-3
Publication status
Language
Portugese
Keywords
Southern Africa, poverty, trade and HIV/AIDS, provision of state services, non-agricultural market access, TRIPS, WTO, securing food production
Abstract
On the 28-29 November 2005 the Southern African Regional Poverty Network (SARPN) and the Economic Justice Network (EJN) held a regional civil society consultation to discuss the connection between Trade and HIV/AIDS in light of the upcoming Hong Kong World Trade Organisation (WTO) Ministerial meeting in December 2005. The event sponsored by Oxfam GB and the Ford Foundation brought together civil society participants from around the region who work in the areas of trade and/or HIV/AIDS.
The consultation issued a statement at the end of the deliberations, which identified areas of concern within the various WTO agreements. This is the Portugese version of the statement.
Country
South Africa
Publisher
Southern African Regional Poverty Network (SARPN)
URL:
URL
Theme area
Health equity in economic and trade policies, Poverty and health, Equity and HIV/AIDS
Title of publication Southern African Regional Poverty Network (ASRPN)
Date of publication
2005 December
Publication type
Conference Proceedings
Publication details
Southern African Civil Society Consultation pp 1-4
Publication status
Publication status unknown
Language
English
Keywords
Southern Africa, poverty, trade and HIV/AIDS, provision of state services, non-agricultural market acces, TRIPS, WTO, securing food production
Abstract
On the 28-29 November 2005 the Southern African Regional Poverty Network (SARPN) and the Economic Justice Network (EJN) held a regional civil society consultation to discuss the connection between Trade and HIV/AIDS in light of the upcoming Hong Kong World Trade Organisation (WTO) Ministerial meeting in December 2005. The event sponsored by Oxfam GB and the Ford Foundation brought together civil society participants from around the region who work in the areas of trade and/or HIV/AIDS.
The consultation issued a statement at the end of the deliberations, which identified areas of concern within the various WTO agreements. The statement can be found below this press release, and the Portuguese version can also be found on the Equinet Africa database.
Country
South Africa
Publisher
Southern African Regional Poverty Network (ASRPN)
URL:
URL
Theme area
Values, policies and rights, Health equity in economic and trade policies
Title of publication Who returns to work and why? Evidence and policy implications from a new disability and work reintegration study : A summary
Date of publication
2002
Publication type
Book
Publication details
Publication status
Published
Language
English
Keywords
work incapacity and reintegration project (WIR-Project), ISSA, social expenditures for sickness and disability programs, implications of WIR-Project on policy
Abstract
Work incapacity has become a major social problem in most industrialized countries, resulting in increased social expenditures for sickness and disability programs and
declines in labor force participation rates. This booklet provides a synopsis of a unique comparative study of work incapacity and reintegration (the WIR Project) undertaken in the mid-1990s under the auspices of the International Social Security Association. Drawing on data compiled in six longitudinal studies of day-to-daypractices and experiences in Denmark, Germany, Israel, the Netherlands, Sweden, and
the United States, the Project permitted researchers to measure the effects of such factors as the duration of work absence, medical and vocational interventions, labour market policies and practices, and other social or demographic aspects such as living alone or the availability of social supports. The Project also examined a wide range of interventions directed at work incapacity and reintegration
that are used currently by social security institutions, health care providers, and employers in an effort to address two key questions: do the various interventions (by social security and health care systems) found in different countries make a difference as to work resumption patterns; and if so, what are the most effective interventions?
This booklet focuses on several key results of the WIR Project and discusses the policy implications that follow from those results.
Findings raise important policy implications: in contrast to current practices, early intervention is essential for successful work resumption; although older age and limited education make return to work more difficult, workplace
adaptation and flexible work hours are significant overall determining factors forincreased work reintegration; job protection rules greatly facilitate return to work; and while the effect of health care on work reintegration is very limited, often the best therapy is early work resumption.
This booklet also addresses additional implications of the WIR Project and the need for further research.
Country
Switzerland
Publisher
International Social Security Association (ISSA)
Theme area
Values, policies and rights, Equity and HIV/AIDS
Title of publication HIV/AIDS, social security, and the two-tier structure of African economies
Date of publication
2003 May
Publication type
Conference Proceedings
Publication details
4th International Research Conference on Social Security : \"Social Security in a long life society\" pp 1-23
Publication status
Published
Language
English
Keywords
social security, demographics, development, HIV/AIDS, Africa, African economies
Abstract
This article is on the occurance of HIV in Africa and its implications on both old-age support schemes and the two-tier economic structure in developing countries. The aim is to
clarify some commonly misperceived issues and to draw a basic framework for social security in Africa by emphasizing where the challenge actually lies in how the situation social security is facing in Africa is very different from that in Europe. We model a two-sector economy in a three-period overlapping generations framework where social security exists both formally as well as informally - thus capturing in essence the situation of many African economies. In such setup, we investigate how the occurance of HIV/AIDS will affect migration between the two sector, where both social security systems act as the motivation to migrate. Calibrating
the model on African economies, we investigate how the incidence rate of HIV/AIDS amongst different cohorts leads to different migration equilibria.
Country
Switzerland
Publisher
International Social Security Association (ISSA)
Theme area
Values, policies and rights, Health equity in economic and trade policies
Title of publication Occupational safety and health in small and medium-sized enterprises. Occupational safety and health services for small and medium-sized enterprises - Experiences and solutions.
Date of publication
Publication type
Publication details
Special Commision on Prevention : Prevention of Occupational Risks pp 1-59
Publication status
Published
Language
English
Keywords
occupational safety, health services for small and medium-sized enterprises, prevention and compensation for occupational accidents and diseases, international concepts
Abstract
As part of the activity programme of the Permanent Committee on Prevention of Occupational Risks of the ISSA for the period 1996-1998 a report was planned on occupational safety and health services for small and medium-sized enterprises. The report carries on from the report IX entitled Occupational health services: Concepts, scope, organization, financing and implementation, by Gerhard Mehrtens, put before and accepted by the Permanent Committee on Prevention of Occupational Risks at the 25th General Assembly of the ISSA in November
1995.
This study is to be seen in connection with the areas to which the ISSA has always paid particular attention, namely the prevention of and compensation for occupational accidents and diseases on the one hand, and the development of practical concepts for occupational health on
the other.
Country
Switzerland
Publisher
International Social Security Association (ISSA)
Theme area
Values, policies and rights, Health equity in economic and trade policies
Title of publication Could the prevention of occupational risks be proposed as a kind of model for prevention in public health?
Date of publication
Publication type
Conference Proceedings
Publication details
Special Commision for Prevention pp 1-4
Publication status
Published
Language
English
Keywords
prevention of occupational risks, social and ethical considerations, economic considerations, social policy, social insurance, transforming organisational models for the prevention of occupational risks to public health
Abstract
At both the national and international levels, the prevention of occupational risks, involving mainly occupational health doctors, technicians and multi-disciplinary teams, constitutes one of the cornerstones of social policy. However, concepts of its composition (both in terms of content and methods of implementation) vary in the different branches of social insurance to which it contributes. In order to improve the efficacity of social protection systems further, a legitimate
question is whether the experience acquired in certain sectors could be useful in others.
Country
Switzerland
Publisher
International Social Security Association (ISSA)
Theme area
Values, policies and rights, Health equity in economic and trade policies
Title of publication Respiratory diseases linked to exposure to products such as asbestos : Are preventive measures sufficient?
Date of publication
Publication type
Publication details
Special Commision on Prevention pp 1-8
Publication status
Published
Language
English
Keywords
risk of asbestos exposure, protecting of workers\' health, workers\' rights, policy on protection of workers\' health, substituting asbestos
Abstract
There is a clear scientific consensus that asbestos in all its varieties (amphiboles or chrysotile) is a proven carcinogen in humans, even at low doses.
Asbestos in its various mineral forms is a natural substance existing on all continents, with many remarkable chemical and physical properties. It has been known since ancient times, and was used extensively in the twentieth century for purposes as varied as protecting buildings and ships against fire, strengthening plastics, constructing sheeting and pipes from asbestos-cement, reinforcing road surfaces and making fireproof cord, gaskets, brake linings and heat-protective clothing, to name just a few of its possible applications.
The industrial use of asbestos began about 140 years ago, posing a serious health risk from the inhalation of fibres released into the air. This risk exists at all stages of the process: mining, preparation, transport, processing, installation, normal use, machining, removal, demolition and waste management. Over 200 million tonnes of asbestos are estimated to have been used throughout the world during this period; the quantity of asbestos mined and
processed globally every year is still estimated at between 2 and 3 million tonnes.
Today, the large-scale use of asbestos which accompanied the rapid industrial development of the twentieth century has created a health crisis on an international scale and is directly responsible for tens of thousands of deaths throughout the world, in both asbestosproducing and asbestos-importing countries. The devastating health effects of asbestos appear several decades after exposure. Hundreds of thousands of deaths from cancer will inevitably occur over the coming decades, mostly due to occupational exposure, but also to domestic and environmental exposure to asbestos.
The general realization of the serious risks of working with asbestos led more and more countries to adopt increasingly strict measures to protect workers from the mid-1970s
onwards, and then to restrict and ban its use. Since the 1990s, repeated recommendations from health-related international organizations have aimed at the replacement of asbestos by less dangerous technologies or substances. More and more States have decided to impose a total ban on all forms of asbestos, with some temporary exceptions for the few cases where substitution still presents some technical difficulties.
Country
Switzerland
Publisher
International Social Security Association (ISSA)
Theme area
Values, policies and rights
Title of publication Antwerp conference : Preliminary synthesis report
Date of publication
2003 May
Publication type
Conference Proceedings
Publication details
4th International Research Conference on Social Security : \"Social Security in a long life society\" pp 1-4
Publication status
Published
Language
English
Keywords
ageing population, expenditure on pensions, health care for ageing populations, expectation of life quality and welfare state pension, average ageing costs
Abstract
This presentation at the 4th International Research Conference on Social Security highlights the key issues drawn from the work of ISSA. It covers the burden, opportunities, potential solutions, as well as challenges faced by developing countries in the wake of growing concerns for policies regarding ageing populations.
Country
Switzerland
Publisher
International Social Security Association (ISSA)
Theme area
Values, policies and rights
Title of publication Press conference on asbestos ban
Date of publication
2005 September
Publication type
Conference Proceedings
Publication details
17th World Congress on Safety and Health at Work : \"Prevention in a globalised world - Success through partnerships\" pp 1-2
Publication status
Published
Language
English
Keywords
international social security association (ISSA), asbestos exposure, banning asbestos manufacture, ethics in health and work, employee compensation
Abstract
It is estimated that hundreds of thousands people around the world fall ill or die each year as a result of asbestos exposure in the workplace. The devastating health effects of asbestos appear only several decades after exposure.
Although the movement to ban asbestos has increased over the past 10 years (e.g. European Union, Latin-America) unfortunately, still in many countries, workers are being exposed to asbestos hazards which in the long run will cause social and economic disaster. ISSA therefore urges all countries to ban the manufacture, trade and use of all types of asbestos and asbestos-containing products as soon as possible.
Country
Switzerland
Publisher
International Social Security Association (ISSA)
Theme area
Values, policies and rights
Title of publication Intergenerational fairness in old age provision : Who cures? Who cares?
Date of publication
2003 April
Publication type
Conference Proceedings
Publication details
4th International Research Conference on Social Security : \" Social Security in a long life society\" pp 1-20
Publication status
Published
Language
English
Keywords
social security and pension arrangements, effect of demographic transition, allocation of retirement costs
Abstract
In the first decades of the 21st century, the industrialized countries will experience a demographic transition that is unprecedented in history and which will put to the test the financial sustainability of existing social security and pension arrangements.
This paper argues that although current public pension schemes may shift the major burden to future generations, private and public transfers of wealth across generations offset this development. As a result the financing of existing social security and pension arrangements seems to be less problematic than commonly assumed.
Policy models that assume there is no linkage between generations except through the state bear little resemblance to empirical reality. An accounting system is therefore needed which highlights the allocation of retirement costs among working and retired population as well as future generations, and includes the public as well as the private ledger.
Many of the aforementioned features are included in the well-established practice of “Generational Accounting”. This paper, however, will integrate private as well as public intergenerational transfers of wealth so as to account not only for the burden, which current generations leave, but also for the wealth, which is passed on to future generations. The analysis is based on earlier findings by Sebald (2001), which seem to suggest that enough resources are available in today’s societies to balance the intergenerational disparities in net lifetime tax rates suggested by ‘Generational Accounting’. In this paper new and amended data is used so as to specify the results and their implications.
The analysis helps to put social security and pension arrangements into a broader societal context, which increases the range of possible policy solutions to the impending financial instability of the traditional settings.
Country
Switzerland
Publisher
International Social Security Assocation (ISSA)
Theme area
Health equity in economic and trade policies
Title of publication Sickness absence in Europe - A comparative study
Date of publication
2003 May
Publication type
Conference Proceedings
Publication details
4th International Research Conference on Social Security : \" Social Security in a long life society\" pp 1-14
Publication status
Published
Language
English
Keywords
sickness absence, unemployment rates, defining sickness absence, health insurance in aged populations, Europe
Abstract
Sickness absence of employees since the early 1980´s is compared across eight countries: Denmark, Finland, France, former West Germany, the Netherlands, Norway, Sweden and the UK. Measured as absence during a whole reference week in Labour Force Surveys, sickness absence is considerably higher and fluctuates more in the Nethe rlands, Sweden and Norway than in the other countries.
Women are more prone to be absent than men in all countries except Germany. Sickness absence of elderly employees is generally higher than that of younger ones. High employment rates of persons aged 60-64, in particular those of women, contribute to high rate of sickness absence in Sweden. High unemployment rates tend to decrease absence rates of employees aged 60-64 in the Netherlands and Sweden. Compared with other countries, the rules for Dutch and Swedish health insurance provide a ample opportunities for employees themselves to determine absence.
Country
Switzerland
Publisher
International Social Security Association (ISSA)
Theme area
Values, policies and rights, Resource allocation and health financing
Title of publication Adapting health and long term care schemes to the challenges of a long life society.
Date of publication
2003 May
Publication type
Conference Proceedings
Publication details
4th International Research Conference on Social Security : \"Social Security in a long life society\" pp 1-8
Publication status
Published
Language
Enlgish
Keywords
social security for aged people, health systems expenditure, compulsory health insurance schemes and care schemes, long life society, age rationalisation
Abstract
The rise in life expectancy as seen since 1993 is thought to be due to a fall in the mortality rate in the over 60\'s age group ; parallel to an increase in the proportion of this age group compared to the population as a whole. This paper discusses the challenges this creates for health services and long term care schemes, as expenditures for medical care increases with advancing age.
The results of several studies show that considerable portions of an individual’s health expenditure during his life are determined by his remaining lifetime and not by his chronological age. As a result the per capita health expenditure in the population as a whole will not necessarily increase in pace with demographic ageing. Rather, a rise in the number of older persons will push the bulk of health expenditure up into a higher age group, without however altering the per capita expenditure.
A long life society does however have an unambiguous impact on the financing of social security systems.
Country
Switzerland
Publisher
International Social Security Association (ISSA)
Theme area
Values, policies and rights, Resource allocation and health financing
Title of publication Adapting health and long term care schemes to the challenges of a long life society
Date of publication
2003 May
Publication type
Conference Proceedings
Publication details
4th International Research Conference on Social Security : \"
Publication status
Language
Keywords
Abstract
Country
Publisher
Theme area
Values, policies and rights
Title of publication A dfferent reaction to the problem of ageing
Date of publication
2003 May
Publication type
Conference Proceedings
Publication details
4th International Research Conference on Social Security : \"Social Security in a long life society\" pp 1-17
Publication status
Published
Language
English
Keywords
social security for older people, ageing, contributors/beneficiaries ratio, cost of pensions, benefits of pensions
Abstract
The problem is not aging. It is the deterioration of the contributors/beneficiaries ratio. This deterioration is caused by several factors, not only by aging. The most important other factors are low birth rate, late entry into professional life, early retirement, high incidence of incapacity to work, and high incidence of unemployment.
Not much can or should be done about these developments ; some are desirable ones and should be promoted, not curbed ; some are of a cultural nature, and belong to the area of self-determination, and most or all of them have proven to be very hard to influence.
Is a solution necessary? Not really. In fact, people show a surprising willingness to pay more for their social security in the future, particularly so for their pensions.
What has still to be done? As we see it, three things are necessary. People have to be convinced that pensions have to cost more. It has to be made sure that (other) people do not enjoy a better deal without paying. People must be shown that the system is trustworthy and well managed.
Country
Switzerland
Publisher
International Social Security Association (ISSA)
Theme area
Values, policies and rights
Title of publication The active welfare state. Open co-ordination and social security in a long life society.
Date of publication
2003 May
Publication type
Conference Proceedings
Publication details
4th International Research Conference on Social Security : \"Social security in a long life society\" pp 1-8
Publication status
Published
Language
English
Keywords
social security, pensions, retirement, old aged people
Abstract
This document was prepared for presentation at the 4th International Research Conference on Social Security organised by the International Social Security Association. The author introduces the presentation by distinguishing those challenges which are "international", in the sense that they are common to many welfare states across the world, from those which are especially impacting on the European welfare states as they are the result of European integration itself.
Country
Switzerland
Publisher
International Social Security Association
Theme area
Values, policies and rights
Title of publication Longevity is increasing. What about the retirement age?
Date of publication
2003 May
Publication type
Conference Proceedings
Publication details
4th International Research Conference on Social Security : \"Social Security in a long life society\" pp 1-18
Publication status
Published
Language
English
Keywords
social security for the aged, retirement age, life expectancy, old age pensions, disability pensions
Abstract
Life expectancy has continued to increase for a very long time. When considering long-term pension expenditure a key factor is whether this trend is continuing, slowing down or stopping. The aim of the paper is to sort out technical alternatives of adjusting the retirement age to the changes in life expectancy. The alternatives can be divided into two main groups:
- adjusting the accrued pension when granted according to the latest discovered mortality rates. The aim of the coefficient is to reflect part of the increase in life expectancy in the number of working years
- gradually raising the set retirement age .
In this document, the main attention is paid to old-age pensions but the effect of raising the retirement age on disability pensions is also discussed. A brief review of the situation in selected countries is included.
Country
Switzerland
Publisher
International Social Security Association (ISSA)
Theme area
Equity in health
Title of publication Ageing and social security : Ten key issues
Date of publication
2003 May
Publication type
Conference Proceedings
Publication details
4th International Research Conference on Social Security : \"Social Security in a long life society\" pp 1-27
Publication status
Published
Language
English
Keywords
ageing populations, social security, old age pension reform, health care for ageing populations, efficiency of health services, equitable health services, demographic pressures on social security systems
Abstract
In view of the ageing of populations around the world, there is increasing concern as to whether social security schemes will be sustainable in the context of these challenges. Much of the discussion on old age pension reform and cost containment in health care has revolved around the issue of economic sustainability in the face of ageing populations. The future viability of ageing societies will inevitably depend on whether the provision of social security is economically sustainable. Nevertheless, this is only one side of the coin. On the other side of the coin, and of equal importance, is the social sustainability of an ageing population.
This contribution identifies a set of ten issues relating to ageing and sustainable social security and discusses them in the light of recent policy discussions and trends.1 In view of the complexity of the questions involved, and the diversity of problems and possible solutions around the world, this approach necessarily is selective.
Country
Switzerland
Publisher
International Social Security Association (ISSA)
Theme area
Resource allocation and health financing
Title of publication Discussion Paper 33: Deprivation and the equitable allocation of health care resources to decentralised districts in Tanzania
Date of publication
2005 November
Publication type
Document
Publication details
EQUINET Discussion Paper 33 pp 1-12
Publication status
Published
Language
English
Keywords
resource allocation; equity targets; needs-based formula; Tanzania
Abstract
There is a marked variation in deprivation between various districts in Tanzania. Tanzania recently adopted a needs-based formula, which includes a poverty measure, to allocate resources to districts. This paper analyses equity in current resource allocation in Tanzania, and compares these allocations to equity target allocations, using an index of deprivation. The results revealed that districts currently receiving relatively high allocations according the current poverty-based formula would receive slightly lower budgets if the deprivation index was used in the resource allocation formula. Those with very low allocations would receive slightly more if the deprivation index was used to guide resource allocation. However, the resource allocation differences between the poverty-based and deprivation-based formulae were small. This suggests that Tanzania has already made good progress in addressing equity in resource allocation between districts.
Country
Tanzania
Publisher
EQUINET
URL:
Equinet Publication Type
Discussion paper
Theme area
Health equity in economic and trade policies
Title of publication Report of the regional review meeting: Promoting health in trade agreements, Johannesburg, 29 October 2005
Date of publication
2005 October
Publication type
Report
Publication details
EQUINET Meeting report pp 1-7
Publication status
Published
Language
English
Keywords
trade, policy support, capacity building, Tanzania, Zimbabwe
Abstract
The workshop aimed to review the work and research papers of the capacity building programme implemented in Tanzania and Zimbabwe to date. The purpose of the workshop was thus to review the training, findings and programme in order to identify issues arising for policy support, future capacity building, extension to other countries in the region and to strengthen linkages with other work on trade and health.
Country
East and southern Africa region
Publisher
EQUINET
URL:
Equinet Publication Type
Reports
Theme area
Equity in health
Title of publication The importance of routine inclusion of gender analysis in all stages of the research process : A case study of an analysis of a final report on the development of a standardised exemption mechanism for Kilombero district - Tanzania
Date of publication
2005 August
Publication type
Report
Publication details
Publication status
Publication status unknown
Language
English
Keywords
gender in health, research in health, gender inequality, inequity in health and health care, Kilombero district, Tanzania
Abstract
This document was presented at the Global Health Research Forum (GHRF), and discusses how gender differences and resultant inequalities are a major cause of inequality in health and health care. It highlights how, despite the availability of a range of materials to enhance the consideration of gender issues in development practice, little research refers specifically to those issues most relevant to health.
The author proceeds to illustrate his arguments by reporting on a study aiming to develop a Standardised Exemption Mechanism for cost-sharing in Kilombero district, Tanzania. In testing its applicability for African settings, this equity analysis used a tool designed for bias analysis related to social hierarchies called the Bias Free Framework.
Country
Tanzania
Publisher
Ifakara Health Research and Development Centre
URL:
URL
Theme area
Resource allocation and health financing
Title of publication Targeting social benefits : International perspetives and trends
Date of publication
Publication type
Book
Publication details
International Social Security Series
Publication status
Published
Language
English
Keywords
social security, welfare expenditures, reforms, surveys, methods for targeting benefits, socio-demographic categories, allocation of social welfare benefits
Abstract
Over the last decade, changing family life and increasing fiscal constraints on welfare expenditures have forced industrialized nations to reconsider how they approach social protection. Faced with fiscal and demographic changes, many countries have been struggling to develop innovative policy responses. Some involve targeting benefits in order to shrink existing programme commitments, to focus welfare expenditures on those most in need, and to give social welfare system more flexibility in redirecting available resources to meet emerging demands. Targeting social benefits: International perspectives and trends provides a systematic assessment of the trend toward targeting in seven countries representing a range of industrialized welfare states – New Zealand, the Netherlands, Britain, Israel, the United States, Italy, and Sweden. The contributors to this volume examine the extent to which each country has adopted measures to focus social benefits on specific population groups and particularly social welfare programme areas. A summary chapter surveys and categorizes the choices nations have made in targeting methods, culls the lessons learned from recent reforms, and explores the implications of these developments for the future of the welfare state. Specific methods for targeting benefits in different programme areas are analysed – these include means tests, income testing, diagnostic criteria, behavioural requirements and the use of socio-demographic categories.This illuminating volume provides an in-depth understanding of alternative approaches to and consequences of policies designed to target social benefits. It will help scholars, professionals, and policymakers deepen their understanding of the alternative methods and the consequences of recent policies designed to shift the allocation of social welfare benefits.
Country
United States
Publisher
Transaction Publishers
Theme area
Resource allocation and health financing, Equity and HIV/AIDS
Title of publication Zambia national health accounts 2002 : Main findings
Date of publication
2004 September
Publication type
Report
Publication details
The Partners for Health Reform plus (PHRplus) Project pp i-27
Publication status
Published
Language
English
Keywords
National Health Accounts (NHA), HIV/AIDS related expenditure, PLWHA, health care utilization
Abstract
The National Health Accounts (NHA) methodology is a tool that allows countries to track the flow of health spending from financial sources to end users. NHA includes estimates of household expenditures, spending that governments have not historically considered when looking at national
health expenditures. This paper summarizes how NHA was used to capture general health and HIV/AIDS-specific expenditures in Zambia in 2002. It was that country’s first attempt to assess spending on a disease-specific expenditure. HIV/AIDS-related expenditure estimates show that households and donors are the major financiers of HIV/AIDS care. People living with HIV/AIDS spend 12 times more on health care than non-HIV-infected individuals. The paper also reviews health care utilization and borrowing patterns for people living with HIV/AIDS.
Country
Publisher
PHRplus Resource Centre, Abt Associates Inc.
URL:
URL
Theme area
Equity and HIV/AIDS
Title of publication Planning for health systems to meet the millenium development goals : Opportunity at the second conference of African Ministers of Health
Date of publication
2005 October
Publication type
Conference Proceedings
Publication details
Health Action AIDS pp 1-11
Publication status
Language
English
Keywords
African Ministers of Health, Millenioum Development Goals (MDGs), African Union
Abstract
A Call to Action :
"Physicians for Human Rights and our partners1 respectfully urge you, the African Ministers of Health, to decide at your October 2005 conference that African Union countries will develop: 1) targets for the development of health workforces and other elements of health systems to enable the achievement of the Millennium Development Goals and other national, regional, and international health aims; 2) specific plans on how to reach these targets, and; 3) budgets to accompany the plans.
The plans may need to change as the evidence base grows, and may be less detailed in more distant years. Similarly, complete budgets for the entire ten year period to 2015 may not be possible. But it is a process that we encourage
you to initiate as soon as possible, incorporating this effort into national development planning processes as appropriate. We further encourage the African Union health ministers to prioritize significantly increasing access to health services, especially in rural and other hard-to-reach areas, and especially for the poorest and most vulnerable
members of society."
Country
United States
Publisher
Health Action AIDS
URL:
URL
Theme area
Values, policies and rights
Title of publication An immeasureable crisis? A criticism of the millenium development goals and why they cannot be measured
Date of publication
2005
Publication type
Journal Article
Publication details
Policy Forum, in PLoS Medicine 2 10 pp 1-7
Publication status
Published
Language
English
Keywords
measurement of Millenium Development Goals (MDGs), principles, performance, poverty eradication
Abstract
In September 2000, 147 heads of state met at the United Nations (UN) headquarters—the largest such gathering ever—to resolve action on the most pressing problems
of humanity and nature [1]. To underscore their commitment, they set numerical targets and deadlines to measure performance. These are the Millennium Development Goals (MDGs), and they span a large range
of topics, including poverty, infectious disease, education, and gender equality. This September, the heads of state will gather again for the Millennium +5 Summit to assess the fi ve-year progress of the MDGs.
In this article, I argue that many of the most important MDGs, including those to reduce malaria, maternal mortality, or tuberculosis (TB), suffer from a worrying lack of scientifi cally valid data. In short, fi ve years into the MDG project, in too many cases, one cannot know if true progress towards
these very important goals is occurring.
Country
Publisher
PLoS Medicine
URL:
URL
Theme area
Equity in health, Equitable health services, Resource allocation and health financing
Title of publication User charges in public health facilities in Tanzania : Effect on revenues, quality of services and people\'s health-seeking behaviour for malaria illnesses in Korogwe district
Date of publication
2005 September
Publication type
Journal Article
Publication details
Health Services Management Research (HSMR) September pp 1-13
Publication status
Published
Language
English
Keywords
health care financing, quality of health services, health-seeking behaviour, revenues in health, malaria, Tanzania, Korogwe district, user fees
Abstract
User charges in public health facilities are aimed at improving efficiency and quality of health services. In Africa, evidence about their effect on patient attendance and
community health-seeking behaviour are mixed. This paper reports a study of the effect of user charges on revenue collection, quality of services and people’s health-seeking
behaviour in relation to malaria in Korogwe district, Tanzania.
Data were collected through focus-group discussions with community members, interviewing community leaders and health workers, field observations and review of patient registers.
Generally, there was no distinct difference in the trends of patient attendances before and after user fee introduction. Public awareness about cost-sharing policy was high, but had low appreciation in the administration of exemptions and waivers. Shortage of drugs, laboratory facilities, and inhospitality of nurses lowered their confidence in the user-fee system. Autonomy to collect and prioritize expenditure of user-fee revenue at the healthfacility level was appreciated by community leaders and health workers who, however,
had reservations with funds being held at the district level and delays by the DMO’s office in approving budgets submitted in request for expenditure of such revenues. Thus,
despite the potential of user charges for revenue mobilization, problems with their administration lowers public confidence in the user-fee system improving quality and accessibility of services to the poor.
Country
Publisher
Health Services Management Centre
URL:
URL
Theme area
Resource allocation and health financing, Governance and participation in health
Title of publication 2005 SADC summit communique
Date of publication
2005 August
Publication type
Conference Proceedings
Publication details
Publication status
Publication status unknown
Language
English
Keywords
SADC, summit, governance in Africa, Gaborone, Botswana, NEPAD, COMESA, African leaders, development in Africa
Abstract
This is a brief report of the gathering of heads of state and government of the Southern African development community (SADC) at the 2005 SADC Summit Communique held in Gaborone, Botswana.
Country
Botswana
Publisher
SADC Summit Communique
URL:
URL
Theme area
Values, policies and rights
Title of publication Jubilee South Declaration II Gloabl Assembly ; Havana, Cuba, September 28, 2005
Date of publication
2005 September
Publication type
Conference Proceedings
Publication details
Jubilee South Declaration II Global Assembly ; Havana, Cuba, September 28, 2005 pp 1-3
Publication status
Publication status unknown
Language
English
Keywords
debt cancellation, neoliberal global order, Cuba, United States, G8, IMF, anti globalisation
Abstract
In this report, Jubilee South reaffirms the role and mandate adopted at our founding Assembly ; to demand and work for the repudiation and total and unconditional cancellation of debts claimed from all countries of the South, and the recognition and restitution of the social, financial, ecological, and moral debt that the North owes to the South.
Country
Cuba
Publisher
Jubilee South Declaration Global Assembly
URL:
URL
Theme area
Resource allocation and health financing, Governance and participation in health, Monitoring equity and research to policy
Title of publication The crisis of public health care in the Eastern Cape : The post-apartheid challenges of oversight and accountability
Date of publication
2004
Publication type
Document
Publication details
Public Service Accountability Monitor (PSAM) pp 1-226
Publication status
Published
Language
English
Keywords
public health, service delivery, Eastern Cape
Abstract
Between 1994 and 2003 the Eastern Cape provincial government earned itself a reputation for sustained service delivery failure and the weak management of public resources. This report sets out to address some of the systemic and structural challenges that face the public health system in the Eastern Cape. It also makes a number of important recommendations explaining how these challenges can be overcome. The Public Service Accountability Monitor is an independent research and monitoring institute dedicated to strengthening democracy in South Africa. The PSAM’s strategic objective is to produce information that will enable civil society and the Legislature oversight bodies to hold public officials accountable for the management of public resources.
Country
South Africa
Publisher
Public Service Accountability Monitor (PSAM)
Theme area
Resource allocation and health financing
Title of publication Discussion Paper 27: Promoting equitable health care financing in the African context: Current challenges and future prospects
Date of publication
2005 November
Publication type
Document
Publication details
EQUINET Discussion Paper 27 pp 1-70
Publication status
Published
Language
English
Keywords
financing mechanisms, health care resources, equity, trends, implications, Southern Africa
Abstract
The issue of appropriate mechanisms for mobilising health care financing resources is once again high on the policy agenda of African governments. The objectives of this paper are to critically evaluate how health services are currently funded, explore recent trends in health care financing and identify lessons from the health care financing experience of African countries. It also considers the implications of this review for policy, advocacy and future research needs.
Country
Southern Africa Regional
Publisher
EQUINET, Centre for Health Policy, Health Economics Unit (UCT), Health Economics and Financing Program (London School of Hygiene and Tropical Medicine
URL:
Equinet Publication Type
Discussion paper
Theme area
Equity in health
Title of publication EQUINET regional review meeting: A common agenda for equity in health in east and southern Africa, Harare, 10-12 October 2005
Date of publication
2005 November
Publication type
Report
Publication details
Meeting report pp 1-23
Publication status
Published
Language
English
Keywords
equity, review, analysis, themes
Abstract
The regional review meeting brought together steering committee members; theme, process and country co-ordinators;
colleagues working in key areas of work central to EQUINET’s agenda; and civil society colleagues. The meeting reviewed EQUINET current work to shape and critically debate the form and content for the annual equity analysis at regional (and country) level.
Country
Southern Africa Regional
Publisher
EQUINET
URL:
Equinet Publication Type
Reports
Theme area
Equity and HIV/AIDS
Title of publication Meeting report: Monitoring equity in ART provision in the context of health systems, Lilongwe, Malawi, 29-30 August 2005
Date of publication
2005 August
Publication type
Document
Publication details
EQUINET Meeting report pp 1-19
Publication status
Published
Language
English
Keywords
equity, ART provision, health systems, Malawi
Abstract
A regional meeting (hosted by EQUINET/Oxfam working with SADC in February 2004) identified the need to monitor equity in access and health systems issues as critical to supporting visibility, policy dialogue and programme planning on these issues of equity and health system strengthening. EQUINET, through Training and Research Support Centre, carried out work to assess the existing monitoring taking place in relation to expanding ART coverage and contracted the Equi-TB Knowledge Programme – now REACH Trust - Malawi, to write a paper on the area of monitoring equity and health systems impacts of ART expansion at subnational and national level, with recommendations for regional level monitoring. Malawi was used as an example to illustrate which equity-related data are available or can be collected to measure equity in ART implementation, and their sources. In October 2004 a regional meeting of state, academic, and civil society representatives held in Malawi reviewed the policy commitments/ issues/ questions being monitored and proposed parameters for monitoring equity and health systems issues at national and regional level. The meeting also identified the follow up pilot work, training, and other measures to be taken to implement all or part of the system and roles in taking this forward.
Country
Malawi
Publisher
EQUINET, REACH Trust
URL:
Equinet Publication Type
Reports
Theme area
Governance and participation in health
Title of publication Resolutions of the Health Civil Society in Southern and East Africa meeting, 13 October 2005
Date of publication
2005 October
Publication type
Conference Proceedings
Publication details
Resolutions presented to the Southern African Social Forum on 14 October 2005 pp 1-2
Publication status
Published
Language
English
Keywords
civil society, right to health, fair financing, human resources, trade, southern Africa
Abstract
Health civil society groups in Zimbabwe and east and southern Africa, met on 13 October 2005 to discuss our struggles for health and agreed on the following resolutions to be presented at the Southern African Social Forum on 14 October 2005.
Country
East and southern Africa region
Publisher
EQUINET
URL:
Equinet Publication Type
Resolutions
Theme area
Human resources for health
Title of publication Report of regional meeting: Equity in the distribution of health personnel in southern Africa: 18-20 August 2005, Johannesburg
Date of publication
2005 August
Publication type
Report
Publication details
EQUINET Meeting report pp 1-29
Publication status
Not published
Language
English
Keywords
human resources for health, migration, attrition, working conditions, southern Africa
Abstract
The EQUINET regional meeting on Human Resources for Health August 19-20 2005 in Johannesburg South Africa discussed and debated Human Resources for Health (HRH) research and policy with a view to improving the equitable distribution of HRH within southern Africa. By the end of the deliberations, the delegates from government, non government, health worker, national, regional and international level at the meeting highlighted key areas of shared perspective on HRH.
Country
Southern Africa Regional
Publisher
EQUINET, HST
URL:
Equinet Publication Type
Reports
Theme area
Health equity in economic and trade policies
Title of publication Promoting health in trade agreements: Brief on a research and training workshop, 15-17August 2005
Date of publication
2005 August
Publication type
Report
Publication details
EQUINET Workshop report pp 1-12
Publication status
Not published
Language
English
Keywords
trade agreements, health systems, WTO, TRIPS, GATS, southern Africa
Abstract
The training course aims to enable participants to be able to carry out assessments nationally of the key trade and investment agreements that impact on health and identify options for promoting public sector equity oriented health systems within current trade and investment policies and agreements. The workshop covered: an introduction to trade and health that outlines major issues affecting the region; an outline of health systems, their major components of health systems and the challenges posed by commercialisation; an introduction to outline of the global major trade systems and the World Trade Organisation and how it agreements that impacts on health, and the options for protecting and promoting health within these trade agreements; an outline of two major trade agreements - TRIPS and GATS - that impact on health, and the options for protecting and promoting health within these trade agreements; a guideline for audit of the impact of trade agreements on health systems; and an introduction to analyzing and understanding the health systems context in which policy is developed, designed and implemented.
Country
Malawi
Publisher
EQUINET
URL:
Equinet Publication Type
Briefs, Toolkits and training materials
Theme area
Equity and HIV/AIDS
Title of publication Using research to promote gender and equity in the provision of anti-retroviral therapy in Malawi
Date of publication
2005 September
Publication type
Conference Proceedings
Publication details
Paper Presented to Forum 9, Global Forum for Health Research, Mumbai, September 12-16th, 2005 pp 1-15
Publication status
Not published
Language
English
Keywords
ART, Malawi, gender equity, poverty reduction, economic growth
Abstract
This paper explores the importance of using research to promote gender and equity in the provision of anti-retroviral therapy (ART) in Malawi. The purpose of the paper is to highlight the importance of operational research in advocating for programmes that are gender sensitive and can contribute to overall national economic growth and poverty reduction. The paper uses a synthesis of the findings of research in Malawi on how gender roles and relations affect access and adherence to anti-retroviral therapy and to illustrate how these can be used to advocate for more equitable policy and practice.
Country
Publisher
REACH Trust, EQUINET
URL:
Equinet Publication Type
Discussion paper
Theme area
Governance and participation in health
Title of publication The impact of Health Centre Committees on health outcomes in Zimbabwe
Date of publication
2005 September
Publication type
Conference Proceedings
Publication details
Paper Presented to Forum 9, Global Forum for Health Research, Mumbai, September 12-16th, 2005 pp 1-15
Publication status
Not published
Language
English
Keywords
Health Centre Committees, health equity, health outcomes, community participation, primary health care
Abstract
This study sought to analyse and better understand the relationship between health centre committees in Zimbabwe as a mechanism for participation in health and specific health system outcomes, including representation of community interests in health planning and management at health centre level; provision of and access to primary health care services and community health knowledge and health seeking behaviour. A Case-Control study design was used, with four case sites with health centre committees and control sites selected in the same districts where there are no health center committees with sufficient distance between catchment areas to avoid spillover of results. This paper reports on the findings from the cross sectional community surveys OF 1006 respondents carried out in February 2003 and the health information system analyses.
The study shows that public sector clinics are the primary source of health care for communities in Zimbabwe, but are not well resourced in terms of basic supplies and staffing. Health Centre Committees appear from the study findings to be associated with improved health resources at clinic level and improved performance of the primary health care services.. Communities in areas with HCCs had a better knowledge of the organization of their health services from the indicators assessed, making services more transparent to them. There was also evidence of improved links between communities and health workers in these areas. The study suggests an association between HCCs and improved health outcomes, even in the highly under-resourced situation of poor communities and poorly resourced clinics. This positive contribution of HCCs to health outcomes calls for greater attention to strengthening these structures as an important component of primary health care and of the health system generally.
Country
Publisher
TARSC, CWGH, EQUINET
URL:
Equinet Publication Type
Discussion paper
Theme area
Resource allocation and health financing
Title of publication Equitable health care financing and poverty challenges in the African context
Date of publication
2005 September
Publication type
Conference Proceedings
Publication details
Paper Presented to Forum 9, Global Forum for Health Research, Mumbai, September 12-16th, 2005 pp 1-10
Publication status
Not published
Language
English
Keywords
health financing; Africa; options, trends and challenges
Abstract
This paper is based on a detailed and critical review of the literature relating to health care financing in the African context. The objectives are to:
* Provide an overview of the equity challenges, particularly in relation to poverty concerns, of current health care financing mechanisms in Africa;
* Provide a brief critical review of major recent developments in health care financing in Africa; and
* Identify key issues in promoting equitable and poverty-reducing health care financing options in the African context.
It is important to stress that health care financing mechanisms differ in each African country and that there are no ‘one-size-fits-all’ solutions. This paper attempts to identify some common trends and challenges, illustrate important issues in relation to particular health
care financing options through reference to specific country experience and propose principles and possible actions that require further consideration within each country-specific context.
Country
South Africa
Publisher
Health Economics Unit, University of Cape Town, Centre for Health Policy, School of Public Health, University of Witwatersrand, EQUINET
URL:
Equinet Publication Type
Discussion paper
Theme area
Monitoring equity and research to policy
Title of publication Applying policy analysis in tackling implementation gaps
Date of publication
2005 September
Publication type
Conference Proceedings
Publication details
Paper Presented to Forum 9, Global Forum for Health Research, Mumbai, September 12-16th, 2005 pp 1-16
Publication status
Not published
Language
English
Keywords
policy analysis, implementation, health system gaps, delivery
Abstract
Ultimately any policy or health system change, whether generated from within or outside national environments, has to work through
those responsible for service delivery, and their interactions with the intended beneficiaries of those changes. Yet we continue to know too little about the experiences of these groups, including how their words, actions and beliefs shape the practice of implementation. This paper used policy analysis to understand these implementation gaps.
Country
South Africa
Publisher
(Centre for Health Policy, School of Public Health, University of Witwatersrand, EQUINET
URL:
Equinet Publication Type
Discussion paper
Theme area
Values, policies and rights
Title of publication To boldly go.....
Date of publication
2000 January
Publication type
Journal Article
Publication details
American Journal of Public Health 90 1 pp 25-33
Publication status
Published
Language
English
Keywords
public health perspectives, limitations of approaches to public health
Abstract
The threshold of the new millenium offers an opportunity to celebrate remarkable past achievements and to reflect on promising new directions for the field of public health. Despite historic achievements, much will always remain to be done (this is the intrinsic nature of public health). While every epoch has its own distinct health challenges, those confronting us today are unlike those plaguing public health a century ago. The perspectives and methods developed during the infectious and chronic disease eras have limited utility in the face of newly emerging challenges to public health.
In this paper, we take stock of the state of public health in the United States by (1) describing limitations of conventional US public health, (2) identifying different social philosophies and conceptions of health that produce divergent approaches to public health, (3) discussing institutional resistance to change and the subordination of public health to the authority of medicine, (4) urging to move from risk factorology to multilevel explanations that offer different types of intervention, (5) noting the rise of the new "right state" with its laissez-faire attitude and antipathy toward public interventions, (6) arguing for a more ecumenical approach to research methods, and (7) challenging the myth of a value-free public health.
Country
United States
Publisher
American Journal of Public Health
URL:
URL
Theme area
Values, policies and rights, Monitoring equity and research to policy
Title of publication The politics of AIDS in South Africa : Beyond controversies
Date of publication
2003 March
Publication type
Journal Article
Publication details
British Medical Journal (BMJ) 326 pp 495-497
Publication status
Published
Language
English
Keywords
HIV, AIDS, health policy, South Africa
Abstract
Discussion of AIDS in South Africa needs to move beyond a simplistic “for or against” stance on President Mbeki\\\'s denial of a connection between HIV and AIDS. The authors propose ways to widen the debate and hence to increase understanding of the epidemic
Country
United Kingdom
Publisher
British Medical Journal (BMJ)
URL:
URL
Theme area
Equitable health services
Title of publication The people\'s health assembly
Date of publication
2000 December
Publication type
Journal Article
Publication details
British Medical Journal (BMJ) 321 pp 1361-1362
Publication status
Published
Language
English
Keywords
Alma Ata declaration goals, poverty, case study
Abstract
The strategy to achieve the goals of the Alma Ata Declaration of 1978 was to be the implementation of
primary health care, with its emphasis on community
participation, and tackling the underlying causes of dis
eases, such as poverty, illiteracy, and poor sanitation. This
week, at Gonoshasthya Kendra People\'s Health Centre
(whose pioneering work formed a case study for the
Alma Ata declaration), a People\'s Health Assembly will
convene to discuss the failure to achieve “Health for All,”
and plan what to do next.
Country
United Kingdom
Publisher
British Medical Journal (BMJ)
URL:
URL
Theme area
Health equity in economic and trade policies, Equitable health services
Title of publication The major infectious diseases in the world ; To treat or not to treat?
Date of publication
2001 July
Publication type
Journal Article
Publication details
New England Journal of Medicine 345 3 pp 208-210
Publication status
Published
Language
English
Keywords
tuberculosis, infectious diseases, treatment, multi-drug resistance, side effects, clinical study, HIV/AIDS, editorial
Abstract
In this issue of the Journal, Tahaoglu and coworkers report on their experience in treating a cohort of patients infected with strains of Mycobacterium tuberculosis that are resistant to powerful antituberculosis drugs. Tuberculosis caused by strains that are resistant to at least isoniazid and rifampin is, by convention, termed “multidrug-resistant tuberculosis.”
The authors of this report work in a referral center in Turkey
that has available a full complement of clinical, laboratory,
and surgical services, including multidrug treatment regimens given for 18 to 24 months, resources for the management of side effects, adjuvant surgery when necessary, and full financial and nutritional support. Tahaoglu et al. show that with a high standard of care, the treatment of multidrug-resistant tuberculosis can have excellent results, especially among younger patients without serious coexisting conditions.
Country
United States
Publisher
New England Journal of Medicine
URL:
URL
Theme area
Resource allocation and health financing
Title of publication Staking claim for claims : A case study of resource allocation in Australian Aboriginal health care
Date of publication
2002
Publication type
Journal Article
Publication details
Social Science and Medicine 54 pp 1657-1667
Publication status
Published
Language
English
Keywords
equity, indigenous health, Aboriginal health, Australia, review
Abstract
There have been numerous ways in which the notion of equity has been put forward in the literature. This reflects the fact that equity is essentially driven by values and is therefore subject to individual interpretation and preferences.
Deciding between these various value judgements is however outside the scope of economic analysis, as conventionally defined. This poses a problem for the examination of issues of resource allocation in Aboriginal health services in Australia, where equity, very clearly, has a role to play. One possibility for moving forward on this issue is the adoption of a ‘claims’ approach where the emphasis is on the explicit recognition of the values to be employed in the ‘equitable’ allocation of resources. This involves teasing out the principles by which, under various approaches, resources are allocated differentially across groups (e.g. under resource allocation formulae, the criterion of ‘need’ as measured by SMRs can be viewed to be a basis for a ‘claim’ over resources). The commonly cited ‘basic needs approach’ is then used in the paper as a case in point to illustrate how such underlying principles may be identified and then assessed.
In relation to the issue of equity in Aboriginal health services, there are a number of possible standards for equity
which seem to have a significant degree of community acceptance. The paper discusses ways in which they can be
applied to the problem of deciding how to allocate resources in Aboriginal health.
Country
Publisher
Elsevier Science, Ltd.
URL:
URL
Theme area
Monitoring equity and research to policy
Title of publication Social issues as public health : Promise or peril
Date of publication
2000
Publication type
Journal Article
Publication details
American Journal of Public Health 90 8 pp 1189-1191
Publication status
Published
Language
English
Keywords
public health, social issues, editorial
Abstract
This editorial adresses the increasing momentum towards a more broad direction of public health, which makes use of expansive definitions of both health and its causes that have been vigorously advocated by many public health professionals.
Country
Publisher
American Journal of Public Health
URL:
URL
Theme area
Equity in health
Title of publication Social inequalities in health within countries : Not only an issue for affluent nations.
Date of publication
2002
Publication type
Journal Article
Publication details
Social Science and Medicine 54 pp 1621-1635
Publication status
Published
Language
English
Keywords
equity, social inequalities in health, developing countries, tutorial
Abstract
While interest in social disparities in health within affluent nations has been growing, discussion of equity in health
with regard to low- and middle-income countries has generally focused on north–south and between-country
differences, rather than on gaps between social groups within the countries where most of the world’s population lives.
This paper aims to articulate a rationale for focusing on within- as well as between-country health disparities in nations of all per capita income levels, and to suggest relevant reference material, particularly for developing country researchers. Routine health information can obscure large inter-group disparities within a country. While appropriately disaggregated routine information is lacking, evidence from special studies reveals significant and in many cases widening disparities in health among more and less privileged social groups within low- and middle- as well as highincome countries; avoidable disparities are observed not only across socioeconomic groups but also by gender,
ethnicity, and other markers of underlying social disadvantage. Globally, economic inequalities are widening and, where relevant information is available, generally accompanied by widening or stagnant health inequalities. Related global economic trends, including pressures to cut social spending and compete in global markets, are making it
especially difficult for lower-income countries to implement and sustain equitable policies. For all of these reasons,
explicit concerns about equity in health and its determinants need to be placed higher on the policy and research
agendas of both international and national organizations in low-, middle-, and high-income countries. International
agencies can strengthen or undermine national efforts to achieve greater equity. The Primary Health Care strategy is at least as relevant today as it was two decades ago; but equity needs to move from being largely implicit to becoming an explicit component of the strategy, and progress toward greater equity must be carefully monitored in countries of all
per capita income levels. Particularly in the context of an increasingly globalized world, improvements in health for
privileged groups should suggest what could, with political will, be possible for all.
Country
United Kingdom
Publisher
Elsevier Science, Ltd.
URL:
URL
Theme area
Equity in health
Title of publication Challenging inequities in health : From ethics to action (summary)
Date of publication
2001
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
public health, health inequity, health and social policy, ethics in health
Abstract
This volume (Challenging Inequities in Health), was conceived as a response concerns about widening “health gaps” both between and within countries;as well as to a disproportionate research focus on inequalities in health in the “North” to the relative neglect of the“South”; and to 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.
Country
United States
Publisher
Oxford University Press
URL:
URL
Theme area
Values, policies and rights
Title of publication Social capital and health : Implications for public health and epidemiology
Date of publication
1998
Publication type
Journal Article
Publication details
Social Science and Medicine 47 9 pp 1181-1188
Publication status
Published
Language
English
Keywords
social capital, public health, epidemiology
Abstract
Public health and its "basic science\'\', epidemiology, have become colonised by the individualistic ethic of medicine and economics. Despite a history in public health dating back to John Snow that underlined the importance of social systems for health, an imbalance has developed in the attention given to generating "social capital\'\' compared to such things as modification of individual\'s risk factors. In an illustrative analysis comparing the potential of six progressively less individualised and more community-focused interventions to prevent deaths from heart disease, social support and
measures to increase social cohesion fared well against more individual medical care approaches. In the face of such evidence public health professionals and epidemiologists have an ethical and strategic decision concerning the relative e.ort they give to increasing social cohesion in communities vs expanding access for individuals to traditional public health programs. Practitioners\' relative efforts will be influenced by the kind of research that is being produced by epidemiologists and by the political climate of acceptability for voluntary individual "treatment\'\' approaches vs universal policies to build "social capital\'\'. For epidemiologists to further our emerging understanding of the link between social capital and health they must confront issues in measurement, study design and analysis. For public health advocates to sensitise the political environment to the potential dividend from building social capital, they must confront the values that focus on individual-level causal models rather than models of social
structure (dis)integration. The evolution of explanations for inequalities in health is used to illustrate the nature of the change in values.
Country
United Kingdom
Publisher
Elsevier Science Ltd.
URL:
URL
Theme area
Monitoring equity and research to policy
Title of publication Reflections and recommendations on research in developing countries
Date of publication
2002
Publication type
Generic
Publication details
Social Science and Medicine 54 pp 1131-1141
Publication status
Published
Language
English
Keywords
ethics research, ethics committees, developing countries, global health, informed consent, international collaboration, justice, standard of care
Abstract
The debate on the ethics of international clinical research involving collaboration with developing countries has
achieved a high profile in recent years. Informed consent and universal standards have been most intensively debated.
Exploitation and lack of adequate attention to justice in the distribution of risks harm and benefits to individuals and
communities have to a lesser extent been addressed.The global context in which these debates are taking place, and
some of the less obvious implications for research ethics and for health are discussed here to broaden understanding of
the complexity of the debate. A wider role is proposed for research ethics committees, one that includes an educational
component and some responsibility for audit.It is proposed that new ways of thinking are needed about the role of
research ethics in promoting moral progress in the research endeavour and improving global health.
Country
United Kingdom
Publisher
Elsevier Science, Ltd.
URL:
URL
Theme area
Equity in health
Title of publication Putting equity in health back onto the social policy agenda : Experience from South Africa
Date of publication
2002
Publication type
Journal Article
Publication details
Social Science and Medicine 54 pp 1637-1656
Publication status
Published
Language
English
Keywords
health equity, vertical equity, procedural justice, South Africa, review/tutorial
Abstract
Over the past decade, international health policy debates have been dominated by efficiency considerations. There
has been a recent resurgence of interest in health equity, including consideration of the notions of vertical equity and
procedural justice. This paper explores the possible application of these notions within the context of South Africa, a country in which inequities in income and social service distribution between ‘racial’ groups were systematically promoted and entrenched during four decadesof minority rule, guided by apartheid and related policies. With the transition to a democratic government in 1994, equity gained prominence on the South African social policy agenda.
Health equity has been awarded a particularly high priority, not least of all because the health sector is seen as vehicle
for achieving rapid equity gains. In addition, many of the other equity-promoting social sector policies (such as
improved access to housing and water and sanitation services) have been motivated on the basis of their potential health equity gains. The South African experience since 1994 provides useful insights into factors which may facilitate or constrain health equity progress. In particular, the constitutional entitlement to health and civil society action to maintain health equity’s place on the social policy agenda are seen as important facilitating factors. Certain health sector programmes have also been developed which are intended preferentially to benefit those who have been
historically dis-advantaged, and which thus support vertical equity goals. However, there have been no efforts to
promote cross-subsidisation between the private and public health sectors, and initial efforts to promote coherency in
social policies (through the Reconstruction and Development Programme) appear not to have been sustained. In
addition, macro-economic policies(particularly the highly ambitiousbudget deficit reduction targetsof the government) are likely to undermine some of the equity-promoting social policy initiatives. Most importantly, the potential inter-relationship of vertical equity and procedural justice goals has not been adequately recognised. As a result, and despite policy rhetoric, this paper concludes that health equity goals are critically dependent on the central
involvement of the dis-advantaged in decision-making about who should receive priority, what services should be
delivered and how equity-promoting initiativess hould be implemented.
Country
Publisher
Elsevier Science Ltd.
URL:
URL
Theme area
Equity in health, Poverty and health, Equitable health services
Title of publication Public health in developing countries
Date of publication
2000 September
Publication type
Publication details
The Lancet 356 pp 841-845
Publication status
Published
Language
English
Keywords
public health, poverty, devloping countries, health care systems, inequalities in health
Abstract
Poverty not only excludes people from the benefits of health-care systems but also restricts them from participating in
decisions that affect their health. The resulting health inequalities are well documented, and the search for greater equity attracts many concerned players and initiatives. Fundamental to the success of these efforts, however, is the need for people to be able to negotiate their own inclusion into health systems and demand adequate health care. This calls for a restatement of the centrality of people in public health and its practice. New forms of communication and cooperation are required at all levels of society, nationally, and internationally, to ensure equitable exchange of views and knowledge to formulate appropriate action to redress inequalities and improve people’s health and wellbeing.
Country
United Kingdom
Publisher
The Lancet
URL:
URL
Theme area
Equity in health, Values, policies and rights, Monitoring equity and research to policy
Title of publication Pathologies of power : Rethinking health and human rights
Date of publication
1999
Publication type
Journal Article
Publication details
American Journal of Public Health 89 10 pp 1486-1496
Publication status
Published
Language
English
Keywords
human rights, health research, equity, review
Abstract
The field of health and human rights has grown quickly, but its boundaries have yet to be traced. Fifty-one years after the Universal Declararation of Human Rights, consensus regarding hte most promising directions for the future is lacking ; however, outcome-oriented assessments lead us to question approaches that rely solely on recourse to formal legal and civil rights. Similarly unpromising are approaches that rely on overmuch on appleas to governments : careful study reveals that state power has been responsible for most human rights violations and that most violations are embedded in \\"structural violence\\" - social and economic inequities that determine who will be at risk for assaults and who will be shielded.
This article advances an agenda for research and action grounded inthe struggle for social and economic rights, an agenda suited to public health and medicine, whose central contributions to future progress in human rights will be linked tot he equitable distribution of the fruits of scientific advancement. Such an approach is in keeping with the Universal Declaration but runs counter to several of the reigning ideologies of public health, including those favouring efficacy over equity.
Country
United States
Publisher
American Journal of Public Health
URL:
URL
Theme area
Values, policies and rights
Title of publication Missing in action : the public health voice in policy debates
Date of publication
2001
Publication type
Journal Article
Publication details
Publication status
Published
Language
English
Keywords
public health, policy, tobacco control, youth, violence, anti-smoking, editorial
Abstract
This editorial reviews the potential influence of public health tools on policy in tobacco control and youth violence, despite low levels of adoption of leading public health groups\' agendas in policy-making within these 2 areas.
Country
Publisher
Aspen Publishers ; Inc.
URL:
URL
Theme area
Equitable health services
Title of publication Measuring the move towards equity ; From the site of service delivery. Results from the nine provinces.
Date of publication
1996 November
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
equity, health services delivery, South Africa, survey, primary level care
Abstract
Introduction
It is important that policies and strategies towards equity in service provision are measured in terms of their impact
on health service delivery. This would begin to demonstrate the practical impact of health reform. In an attempt to measure in part the progress (or lack of progress) towards equity one step would be to measure the quality of service provision at the community (primary care) level. This would give an overview of the disparities between as well as in provinces, and between rural, urban and peri-urban parts of the country.
Purpose of the survey
The overall aim of the research was to evaluate the quality of service provision rendered at the primary level in
South Africa, and to describe any major differences between provinces and between rural and urban / peri-urban
parts of the country.
Process
A request to undertake the survey was obtained from the nine provincial health departments. A total of 160 clinics, 3 from every region of each province in South Africa were visited. 71 were rural, 39 peri-urban and 50 urban. A questionnaire was used to collect information which was then collated.
Findings
Findings were collated under the following categories:
Infrastructure:
Unreliable electricity, water and telephone services and functional refrigerators are all issues of concern.
Human Resources:
It was encouraging to note that nurse supervision appeared relatively high in all provinces, however this was not
complemented by adequate doctor visits, especially to rural clinics.
Quality of Care:
In the area of child health services and family planning services there were some encouraging findings, for
example a relatively acceptable level of child health services and about 72% clinics offering family planning services on a daily basis. Areas of concern included two priority health problems, namely sexually transmitted diseases and tuberculosis, being far from attaining standards set for their management.
The article proceeds to include relevant recommendations.
Country
South Africa
Publisher
Health Systems Trust
URL:
URL
Theme area
Values, policies and rights, Health equity in economic and trade policies
Title of publication Is globalisation good for your health?
Date of publication
2001
Publication type
Journal Article
Publication details
Bulletin of the World Health Organisation 79 pp 827-833
Publication status
Published
Language
English
Keywords
commerce, international cooperation, income, economic development, public health, risk factors, health policy, Acquired immunodeficiency syndrome/transmission/prevention and control, pharmaceutical preparations/supply and distribution, patents, developin
Abstract
Four points are made about globalization and health. First, economic integration is a powerful force for raising the incomes of poor countries. In the past 20 years several large developing countries have opened up to trade and investment, and they are growing well—faster than the rich countries. Second, there is no tendency for income inequality to increase in countries that open up. The higher growth that accompanies globalization in developing countries generally benefits poor people. Since there is a large literature linking income of the poor to health status, we can be reasonably confident that globalization has indirect positive effects on nutrition, infant mortality and other health issues related to income. Third, economic integration can obviously have adverse health effects as well: the transmission of AIDS through migration and travel is a dramatic recent example. However, both relatively closed and relatively open developing countries have severe AIDS problems. The practical solution lies in health policies, not in policies on economic integration. Likewise, free trade in tobacco will lead to increased smoking unless health-motivated disincentives are put in place. Global integration requires supporting institutions and policies. Fourth, the international architecture can be improved so that it is more beneficial to poor countries.
For example, with regard to intellectual property rights, it may be practical for pharmaceutical innovators to choose
to have intellectual property rights in either rich country markets or poor country ones, but not both. In this way
incentives could be strong for research on diseases in both rich and poor countries.
Country
Switzerland
Publisher
World Health Organisation (WHO)
URL:
URL
Theme area
Values, policies and rights
Title of publication Introduction : Merging law, human rights, and social epidemiology
Date of publication
2002
Publication type
Journal Article
Publication details
Journal of Law, Medicine, and Ethics 30 pp 498-509
Publication status
Published
Language
English
Keywords
human rights, law, social epidemiology, Johnathan Mann, ethics, public health
Abstract
Research in social or "ecological" epidemiology has demonstrated relationships between social conditions and health, and has shaped plausible hypotheses about the various biological and social mechanisms through which social factors produce health outcomes in a population. Ths review discusses the evolutionary developments of social epidemiology and law from the era of Johnathan Mann, and delineates more clearly what elements of inequality determine health, through what pathways they operate, and what interventions can reduce the causes or block the pathways.
Country
United States
Publisher
American Society of Law, Medicine, and Ethics
URL:
URL
Theme area
Equity in health, Poverty and health, Equitable health services
Title of publication Recent advances : International perspectives on health inequalities and policy
Date of publication
2001 March
Publication type
Journal Article
Publication details
British Medical Journal (BMJ) 322 pp 591-594
Publication status
Published
Language
English
Keywords
health, equity, inequality in health, poverty, policy, review, defining inequity, perspectives of inequity
Abstract
Inequalities and inequities in health have long been cen
tral to the concerns of public health. Governments in
several countries, including the United Kingdom, have
recently shown renewed interest in tackling these issues.1
Concerted attempts have also been made to push them
up the global health policy agenda,2–4 and at the same
time international agencies and donors are giving priority to efforts to reduce poverty. In this article we provide an overview of the current debates around inequity, inequalities, poverty, and health, drawing together current international understandings of the problem.
Country
United Kingdom
Publisher
British Medical Journal (BMJ)
URL:
URL
Theme area
Equity in health, Poverty and health
Title of publication Poverty, equity, human rights, and health
Date of publication
2003
Publication type
Journal Article
Publication details
Bulletin of the World Health Organisation 81 pp 539-545
Publication status
Published
Language
English
Keywords
health status, poverty, social justice, human rights, health services accessibility/ethics, health care sector/organization and administration, public policy, intersectoral cooperation ( source: MeSH, NLM).
Abstract
Those concerned with poverty and health have sometimes viewed equity and human rights as abstract concepts with little practical application, and links between health, equity and human rights have not been examined systematically. Examination of the concepts of poverty, equity, and human rights in relation to health and to each other demonstrates that they are closely linked conceptually and operationally and that each provides valuable, unique guidance for health institutions’ work. Equity and human rights perspectives can contribute concretely to health institutions’ efforts to tackle poverty and health, and focusing on poverty is essential to
operationalizing those commitments. Both equity and human rights principles dictate the necessity to strive for equal opportunity for health for groups of people who have suffered marginalization or discrimination.
Health institutions can deal with poverty and health within a framework encompassing equity and human rights concerns in five general ways: (1) institutionalizing the systematic and
routine application of equity and human rights perspectives to all health sector actions; (2) strengthening and extending the public health functions, other than health care, that create the conditions necessary for health; (3) implementing equitable health care financing, which should help reduce poverty while increasing access for the poor; (4) ensuring that health services respond effectively to the major causes of preventable ill-health among the poor and disadvantaged; and (5) monitoring, advocating and taking action to address the potential health equity and human rights implications of policies in all sectors affecting health, not only the health sector.
Country
Switzerland
Publisher
World Health Organisation (WHO)
URL:
URL
Theme area
Values, policies and rights
Title of publication Human rights and public health : Dichotomies or synergies in developing countries? Examining the case of HIV in South Africa
Date of publication
2002
Publication type
Journal Article
Publication details
Journal of Law. Medicine, and Ethics 30 4 pp 677-691
Publication status
Published
Language
English
Keywords
HIV, AIDS, human rights, public health , South Africa, case study
Abstract
Despite growing advances in medical technologies, health status inequalities continue to increase across the globe. The challenges facing health practitioners in countries in transition are complex and diverse, and require the balancing of many conflicting imperatives.
The struggles of the transitions faced by South Africa are demonstrated in the movement towards equity in rapid expansion, while holding back on expenditure in some other key areas.
Questions arise as to whether public health objectives are best reached through such rights-based approaches, and whether traditional public health approaches can integrate rights-based approaches to promoting health. In attemtpt to answer these questions, this paper uses a case study of various policy responses to the HIV epidemic in South and Southern Africa.
Country
United States
Publisher
American Society of Law, Medicine, and Ethics
URL:
URL
Theme area
Equity in health, Values, policies and rights, Governance and participation in health
Title of publication Health, equity, justice, and globalisation : Some lessons from the People\'s Health Assembly
Date of publication
2001
Publication type
Journal Article
Publication details
Journal of Epidemiology and Community Health 55 pp 613-616
Publication status
Published
Language
English
Keywords
globalisation, health, equity, justice, human rights, governance, public health
Abstract
There are indications that the current forms of globalisation are making the world a safe place for unfettered market liberalism and the consequent growth of inequities. This economic globalisation is posing severe threats to both people’s health and the health of the planet.
While the recent debate about globalisation is new its negative health impact is not.
This commentary will describe some of the deliberations of a recent gathering of public health activists, the People’s Health Assembly, which examined the health impacts of globalisation, particularly the impact of global trade regimes and considered what can be done to change its character and impact.
Country
Publisher
Journal of Epidemiology and Community Health
URL:
URL
Theme area
Values, policies and rights, Governance and participation in health, Monitoring equity and research to policy
Title of publication Globalisation and occupational health : A perspective from Southern Africa
Date of publication
2001
Publication type
Journal Article
Publication details
Bulletin of the World Health Organisation 79 9 pp 863-868
Publication status
Published
Language
English
Keywords
employment, occupational health, occupational diseases/etiology, commerce, public policy, Southern Africa, review
Abstract
Increased world trade has generally benefited industrialized or strong economies and marginalized those that are weak. This paper examines the impact of globalization on employment trends and occupational health, drawing on examples from southern Africa. While the share of world trade to the world’s poorest countries has decreased, workers in these countries increasingly find themselves in insecure, poor-quality jobs, sometimes involving technologies which are obsolete or banned in industrialized countries. The occupational illness which results is generally less visible and not adequately recognized as a problem in low-income countries. Those outside the workplace can also be affected through, for example, work-related environmental pollution and poor living conditions. In order to reduce the adverse effects of global trade reforms on occupational health, stronger social protection measures must be built into production and trade activities, including improved recognition, prevention, and management of work-related ill-health. Furthermore, the success of production and trade systems should be judged on how well they satisfy both economic growth and population health.
Country
Switzerland
Publisher
World Health Organisation (WHO)
URL:
URL
Theme area
Equity in health, Values, policies and rights, Monitoring equity and research to policy
Title of publication Ethics in public health
Date of publication
2001 July
Publication type
Journal Article
Publication details
AmericanJournal of Public Health 92 7 pp 1056-1056
Publication status
Language
English
Keywords
ethics, research, developing countries, review, public health, equity in health, therapies
Abstract
This month the journal opens a forum for discussion on ehtics in public health research and practice. The authors in this month\\\\\\\'s Health Policy and Ethics Forum review the heightened ethical scrutiny of public health research in the United States, pose challenging questions between research collaborations between developed and developing countries, and suggest mechanisms for fostering a culture of ethics that will both engender public trust and reduce health inequities.
Country
Publisher
American Journal of Public Health
URL:
URL
Theme area
Values, policies and rights, Governance and participation in health, Monitoring equity and research to policy
Title of publication Ethical oversight of public health research : Can rules and IRB\'s make a difference in developing countries?
Date of publication
2002
Publication type
Journal Article
Publication details
American Journal of Public Health 92 7 pp 1079-1084
Publication status
Published
Language
English
Keywords
public health, ethical review, research in health, developing countries, vulberability, international research
Abstract
Controversies in the conduct of international research continue to pose challenges for the system of ethical review, particularly for developing countries. Although the concept of vulnerability is key to adressing these challenges, ethical review has typically ignored the agency of vulnerable participants and groups in determining what kinds of review process is needed. Concurrent with developments shaping the new public health that seek to operationalize empowerment of communities by placing them as initiators and organisors of their own health, ethical review of public health research must find ways to recognise the agency of vulnerable participants, groups, and communities in the review process if it is to adress effectively the ethical dilemmas currently evident in collaborative international research.
Country
United States
Publisher
American Journal of Public Health
URL:
URL
Theme area
Equity in health, Values, policies and rights, Equitable health services
Title of publication Defining equity in health
Date of publication
2003
Publication type
Journal Article
Publication details
Journal of Epidemiology and Community Health 57 pp 254-258
Publication status
Published
Language
English
Keywords
equity, health, defining equity, equality, human rights
Abstract
SUMMARY :
Study objective: To propose a definition of health equity to guide operationalisation and measurement, and to discuss the practical importance of clarity in defining this concept.
Design: Conceptual discussion.
Setting, Patients/Participants, and Main results: not applicable.
Conclusions: For the purposes of measurement and operationalisation, equity in health is the absence of systematic disparities in health (or in the major social determinants of health) between groups with different levels of underlying social advantage/disadvantage—that is, wealth, power, or prestige. Inequities in health systematically put groups of people who are already socially disadvantaged (for example, by virtue of being poor, female, and/or members of a disenfranchised racial, ethnic, or religious group) at further disadvantage with respect to their health; health is essential to wellbeing and to overcoming other effects of social disadvantage. Equity is an ethical principle; it also is consonant with and closely related to human rights principles. The proposed definition of equity supports operationalisation of the right to the highest attainable standard of health as indicated by the health status of the most socially advantaged group. Assessing health equity requires comparing health and its social
determinants between more and less advantaged social groups. These comparisons are essential to assess whether national and international policies are leading toward or away from greater social justice in health.
Country
Publisher
Journal of Epidemiology and Community Health
URL:
URL
Theme area
Equity in health, Values, policies and rights
Title of publication Co-opting the health and human rights movement
Date of publication
2002
Publication type
Journal Article
Publication details
Journal of Law, Medicine, and Ethics 30 4 pp 705-715
Publication status
Published
Language
English
Keywords
health, human rights, public health
Abstract
This article uses the individual civil rights perspective of the United States as a rhetoric of human rights functions, or fails to function, when a particular interpretation of human rights is construed and embedded in civil law. In the United States, community rights are often subordinated to individual civil rights. The political tradition of the United States is that of negative rights, ie. preventing governmental intrusion into tan indiviual\\\\\\\'s personal choices.
Our goal is to examine the implications of human rights language and the law in a particular setting to further the goals of public health in an arena dominated by individual rights.
We argue that human rights rhetoric is contestable terrain and that opponents of public health have effectively co-opted human rights language to the detriment of sound public health policies.
Country
United States
Publisher
American Society of Law, Medicine, and Ethics
URL:
URL
Theme area
Equity in health, Values, policies and rights, Equitable health services
Title of publication Reinvigorating public health
Date of publication
2000 September
Publication type
Journal Article
Publication details
The Lancet 356 9232 pp 787-788
Publication status
Published
Language
English
Keywords
public health, governance in health, social deprivation, equity in health
Abstract
The Public Health Quintet in The Lancet that finishes today has pointed out that, although the scope of modern public health is broad and inclusive,[1 and 2] breadth is missing from much of modern public-health practice. [3, 4 and 5] How then can public health be reinvigorated? A reinvigoration will require an increase in commitment from
the public-health workforce to a broader view of public health and to values of equity and ecological sustainability. Public-health practice needs to focus on overall improvement in population health through the reduction of the readily preventable burden of disease— both communicable and non-communicable—especially among disadvantaged groups.
Reducing social and economic deprivation is the main way to achieve this goal. Publichealth scientists and practitioners can contribute to this goal by clarifying the links between social and economic factors and health status, and by identifying cost-effective approaches to overall health improvement.
Country
Publisher
The Lancet
URL
Theme area
Values, policies and rights
Title of publication A vision of social justice as the foundation of public health : Commemorating 150 years of the spirit of 1848
Date of publication
1998 November
Publication type
Journal Article
Publication details
American Journal of Public Health 88 11 pp 1603-1606
Publication status
Published
Language
English
Keywords
Public Health, social justice, commentary
Abstract
Social justice is the foundation of public health. The year 1848 saw many popular uprisings and movements around the world ; in search of social justice, as well as political and economic democracy. This article discusses the historical pathway that has brought us to consider public health from a perspective of social justice.
Country
United States
Publisher
American Journal of Public Health
URL:
URL
Theme area
Human resources for health
Title of publication Discussion Paper 37: Supporting the retention of human resources for health: SADC policy context
Date of publication
2005 September
Publication type
Report
Publication details
EQUINET Discussion Paper 26 pp 1-60
Publication status
Published
Language
English
Keywords
international migration; staff retention, public and rural services, health system performance, southern Africa
Abstract
This work specifically focussed on the actions needed to stem the flow of international migration by encouraging the retention of health staff within countries. A particular concern raised across countries is staff retention in the public and rural services that preferentially serve the poorest populations. Importantly, policy documents and national respondents see the problems of retaining staff in these locations (the push factors underlying migration) as linked to the factors that undermine motivation and productivity. Policies to address retention issues (and so encourage health workers to stick and stay in country settings) are, thus, also likely to address poor motivation and weak productivity. In addition, these three sets of problems often go hand in hand with poor health worker attitudes and behaviours towards patients. So tackling these problems may have double benefits for health system performance – contributing to adequate availability of competent staff, as well as enhanced staff responsiveness to patients.
Country
Southern Africa Regional
Publisher
EQUINET, HST
URL:
Equinet Publication Type
Discussion paper
Theme area
Human resources for health
Title of publication Working together for results
Date of publication
2005 February
Publication type
Conference Proceedings
Publication details
Oslo Consultation : \"Overcoming the Crisis ; Taking forward the Abuja Action Agenda, Feb 24-25, 2005\" pp 1-3
Publication status
Not published
Language
English
Keywords
human resources, health services, crisis
Abstract
This paper recounts the closing statement made by NORAD director Tove Strand at the February 2005 Oslo Consultation on overcoming the crisis in human resources for health. Acknowledging the importance of the gathering together of eminent people from Africa and the international community at large, the author proceeds to highlight gaps in improvement that have persisted despite better knowledge, as well as summarise their progress as regards human resources for health in view of their original aims.
Country
Norway
Publisher
Human Resources for Health (HRH)
URL:
URL
Theme area
Poverty and health, Equitable health services, Human resources for health
Title of publication Mobilising for action : Political and strategic challenges
Date of publication
2004 February
Publication type
Conference Proceedings
Publication details
Human Resources for Health (HRH) Oslo Consultation, February 24-25, 2005 pp 1-7
Publication status
Publication status unknown
Language
English
Keywords
human resources, health services, crisis, health personnel, poverty eradication, health policy
Abstract
The health personnel situation is a public health crisis that threatens not only to undermine our goals on improving health, but to prevent our progress in the fight against poverty as a whole.
This crisis is a recurring theme in developing countries. In Zambia, health officials are struggling to keep hospitals running in spite of the fact that half of the doctors educated in the country since 1960 have left for greener pastures. In Malawi, overworked and underpaid nurses and doctors have seen a majority of their colleagues disappear to better-paying jobs abroad or in local NGOs. In many of our partner countries, aids brings in an increasing number of patients to hospitals and health care centers that struggle to keep its staff healthy enough to keep on working.
The author discusses the dimensions and important factors influencing this grave situation.
Country
Norway
Publisher
Human Resources for Health (HRH)
URL:
URL
Theme area
Human resources for health
Title of publication "Triple c\'s in Oslo" : Consultation, consensus, and call-for-action
Date of publication
2005 February
Publication type
Conference Proceedings
Publication details
HRH Oslo Consultation : \"Overcoming the crisis ; Taking forward the Abuja Action Agenda\" pp 1-7
Publication status
Publication status unknown
Language
English
Keywords
human resouces, health services, action, crisis, international, Oslo, Abuja, conference proceedings
Abstract
About 130 participants – leaders from Africa, bilateral donors, multilateral agencies, international financial institutions, global funds and initiatives, non-governmental organizations, academia, and professional councils – came together for two days in Oslo to consult on how to overcome the crisis in human resources for health (HRH) in sub-Saharan Africa. Following the Abuja High-Level Forum on the Health-Related MDGs in December and the recently released report of the Joint Learning Initiative, the Oslo consultation aimed to bring together key stakeholders for sparking follow-up action.
In global health, we are experiencing an unprecedented human resources crisis -- leading not just to a health crisis, but also a development crisis, a security crisis, and a moral crisis. The causes are not new but have fresh dimensions – the HIV/AIDS epidemic, global labor markets, and chronic under-investment. And the consequences are complex. Yet the expertly-designed agenda of the Oslo consultation succeeded in moving us steadily through “consultation” towards “consensus,” leading to a final “call for action.”
Country
Norway
Publisher
Human Resources for Health (HRH)
URL:
URL
Theme area
Human resources for health
Title of publication Oslo consultation (February 24-25, 2005) : An NGO perspective
Date of publication
2005 February
Publication type
Report
Publication details
Human Resources for Health (HRH) Oslo Consultation pp 1-4
Publication status
Publication status unknown
Language
English
Keywords
health care workers, human resources, health services, empowerment, crisis, conference proceedings
Abstract
NGOs in both the South and the North have integral roles to play in forcefully addressing the severe human resources for health (HRH) crisis in Africa.To enable NGOs to fulfill these roles to their full capacity, they must have the opportunity to fully participate in HRH planning, implementation, monitoring, and evaluation at both the local and international levels, including in the process that was initiated in at the High Level Forum in Abuja and continues now in Oslo.
This paper discusses the broad range of non-governmental actors encompassed within the term NGO, and the comparative roles played by northern and southern NGO\\\'s as regards human resources for health.
Country
United States
Publisher
Physicians for Human Rights
URL:
URL
Theme area
Human resources for health
Title of publication Statement on the call for action
Date of publication
2005 February
Publication type
Conference Proceedings
Publication details
Human Resources for Health Oslo Consultation pp 1-4
Publication status
Publication status unknown
Language
English
Keywords
human resources, health services, equity, crisis, conference proceedings
Abstract
This report covers general propostions made at the African Group meeting at the Oslo HRH Consultation on February 24th-25th, 2005. The group proposed that an endorsement of the Call for Action go beyond endorsement of the detailed proposals in the background documents to rather address them by the theme/work groups for taking action forward. These include country action alliances and teams, finances, and a global action platform.
Country
Norway
Publisher
Human Resourced for Health (HRH)
URL:
URL
Theme area
Values, policies and rights, Equity and HIV/AIDS
Title of publication HIV/AIDS and children\'s migration in Southern Africa
Date of publication
2004
Publication type
Journal Article
Publication details
Migration Policy Series No. 33 pp 1-41
Publication status
Published
Language
English
Keywords
HIV, AIDS, migration, health policy, child labour, prevalence, Southern Africa, vulnerability of children in migration due to HIV/AIDS
Abstract
Southern Africa is the region worst affected by the global AIDS pandemic and also experiences very high levels of migration. The two countries examined in this paper, Lesotho and Malawi, have estimated adult HIV prevalence rates of 31% and 16% respectively.
The co-existence of high levels of both HIV/AIDS and migrancy in Southern Africa is not entirely surprising, as migration has been shown to make people particularly vulnerable to HIV infection ; while at the same time HIV/AIDS has triggered migration.
Children are a key vulnerable group in relation to HIV/AIDS, being af fected by the disease in a number of ways. Significant numbers con-tract HIV themselves, usually at birth or during lactation. Many more are orphaned. Already around 17% of children in Lesotho and Malawi have lost parents, about half of them to HIV/AIDS. Children are affected by HIV/AIDS long before they become orphans, however. Following the death of a parent or guardian, the difficulties children face often increase, with financial hardship exacerbated by problems relating to inheritance and absence of childcare within the household ; in addition to facing AIDS-related stigma.
A children-focused approach was adopted in this study of Lesotho and Malawi in order to examine: (a) the forms of migration that young people affected by HIV/AIDS engage in; (b) the difficulties they face; (c) the coping strategies they employ and forms of support that are available to them ; and (d) the ways in which they might be better supported.
Country
South Africa
Publisher
Southern African Migration Project (SAMP)
URL:
URL
Theme area
Values, policies and rights
Title of publication Swaziland moves : Perceptions and patterns of modern migration
Date of publication
2004
Publication type
Journal Article
Publication details
Migration Policy Series No. 32 pp 1-61
Publication status
Published
Language
English
Keywords
migration, policy, attitudes, perceptions, Swaziland, South Africa
Abstract
The Southern African Migration Project (SAMP) is committed
to supporting basic research on the dimensions, causes and
consequences of cross-border and internal migration within
the SADC region and to making the results accessible to a
range of inter est groups. Swaziland has an unusually rich migration history. In an effort to provide the government and people of Swaziland with basic, up-to-date information on migration trends, volumes, impacts, and attitudes, SAMP entered into a research partnership with the University of Swaziland.This publication represents the first phase of this ongoing collaboration, bringing together the research findings from two national surveys of migration attitudes and behaviours undertaken in Swaziland in 2001 and 2002.
A renewed cooperative, regional, and harmonized approach (based on sound and reliable migration data and analysis) within SADC is essential ; and this publication is designed to provide the people and government of Swaziland with the information to advance towards that goal.
Country
South Africa
Publisher
Southern African Migration Project (SAMP)
URL:
URL
Theme area
Poverty and health, Equity and HIV/AIDS
Title of publication Migration, sexuality and the spread of HIV/AIDS in rural South Africa
Date of publication
2004
Publication type
Journal Article
Publication details
Migration Policy Series No. 31 pp 1-33
Publication status
Published
Language
English
Keywords
HIV/AIDS, sexual behaviour, migration, rural, South Africa
Abstract
South Africa is experiencing one of the fastest growing HIV epi-demics in the world, with the nation-wide prevalence of HIV infection among women attending antenatal clinics having increased from 0.76 per cent in 1990 to 26.5 per cent in 2002. Migration is one of many social factors that have contributed to the AIDS pandemic. Previous studies have shown that people who ar e more mobile, or who have recently changed residence, tend to be at higher risk of HIV infection than people in more stable living arrangements.
The role of migration in the spread of HIV to rural Africa has con -ventionally been seen as a function of men becoming infected while they are away from home, and infecting their wives or regular partners when they return. However, the precise way in which migration con-tributes to the spread of HIV and other STD’s in rural areas is complex and not well understood. Understanding both ends of the migration
spectrum has important implications for the development and imple-mentation of intervention programmes, especially if it is possible to establish the relative risk of infection among different groups of migrant and non-migrant men and women.
METHODS : Male migrants from two adjacent rural districts (Hlabisa and Nongoma) were recruited for the study at two migration destinations: Carletonville and Richards Bay. Participants were administered a detailed questionnaire and offered voluntary counselling and testing for HIV and STDs.
FINDINGS : These include migration being a risk factor not simply because men return home to infect their rural partners, but also because their rural females partners – both those who are partners of migrants and those who are partners of non-migrants – are likely to become infected in the rural areas from outside their primary relationships.
Country
South Africa
Publisher
Southern African Migration Project (SAMP)
URL:
URL
Theme area
Values, policies and rights, Equitable health services
Title of publication Selecting appropriate antimalarial drugs : A model for policy makers
Date of publication
Publication type
Journal Article
Publication details
Policy Brief pp 1-2
Publication status
Published
Language
English
Keywords
malaria, policy-making, health policy, mortality, antimicrobial therapy, decision model
Abstract
Malaria deaths are increasing globally, mainly because the parasites that cause malaria are becoming resistant to the most commonly used drugs. A new model based on data from the field can help to predict the effective lifespan of a drug before widespread resistance develops. The model focuses on drug combinations and can be applied to both current and potential treatments. It can be used to forecast the lifespan of a drug before parasites develop resistance in a range of combination treatments. This can be a valuable tool for policy makers and National Malaria Control programmes facing dilemmas in choosing appropriate treatment regimes of drugs known as antifolates.
Through this paper the authors present key recommendations from the model.
Country
United Kingdom
Publisher
Policy Brief
URL:
URL
Theme area
Values, policies and rights, Monitoring equity and research to policy
Title of publication Enhancing research uptake through communication, networking, and capacity development
Date of publication
Publication type
Journal Article
Publication details
Malaria Knowledge Programme pp 1-4
Publication status
Published
Language
English
Keywords
malaria, health policy, research, capacity-building, communication, networking
Abstract
The work of the Malaria Knowledge Programme (MKP) demonstrates excellent research practice and addresses a number of issues that are relevant to anyone undertaking research on development. In 2003 the UK Department for International Development (DFID) produced a new research strategy that made key recommendations on development
research. One of the strategy’s most important points is that if development research is to have an impact, the way research is done should promote an enabling environment and make information accessible so that it is more likely
to be adopted. This recognises that communication is an essential element of developing local capacity to generate and use good research.
Policy-making processes are complex and research is only one of many competing influences. The political and institutional context and relationships between different actors are central to the uptake of research. There are gaps in information flows between national and international researchers and policy makers. Different forms of communication are essential to making connections in a holistic and systemic way. MKP’s research programme demonstrates its commitment to strengthening information and communication flows, involving Southern researchers and institutions and creating international networks for the improvement of research communication. This work contributes to meeting the Millennium Development Goals of reducing child mortality (MDG 4), improving maternal health (MDG 5), combating HIV/AIDS, malaria and other diseases (MDG 6) and developing global partnerships for development (MDG 8).
The lessons drawn from the programme, as detailed in this paper, reflect many of the recommendations made by DFID and engage with the dynamics of research, policy making and practice.
Country
United Kingdom
Publisher
Policy Brief
URL:
URL
Theme area
Values, policies and rights, Health equity in economic and trade policies, Poverty and health
Title of publication Malaria overdiagnosis in Africa
Date of publication
Publication type
Journal Article
Publication details
Malaria Knowledge Programme pp 1-2
Publication status
Published
Language
English
Keywords
malaria, diagnosis, Africa
Abstract
In Africa, 70 per cent of fever cases in children are diagnosed in the home and treated with traditional remedies or drugs bought from local shops. These fevers are presumed to be due to malaria, but comparison of accurately diagnosed cases of malaria with presumed cases of malaria reveal shockingly high rates of over-diagnosis. It is estimated that in some areas that have intermittent malaria transmission, three quarters of patients with fevers are advised to take antimalarial drugs for non-malarial illness.
Treatment of all childhood fevers as malaria results in malaria over-diagnosis, which means other causes of febrile illness, such as pneumonia and meningitis, are missed. Indirect evidence shows that the over-diagnosis of malaria
contributes to increasing ill health, death, loss of productivity and a vicious cycle of deepening poverty in the most vulnerable sections of society. Treating all childhood fevers as malaria means that poor people are wasting valuable
resources on malaria drugs, and failing to be treated for other potentially life-threatening illnesses.
Country
United Kingdom
Publisher
Policy Brief
URL:
URL
Theme area
Equity in health, Values, policies and rights, Human resources for health, Monitoring equity and research to policy
Title of publication The international migration of health workers : A human rights analysis
Date of publication
2005 February
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
human resources, equity, policy, human rights, health care professionals, health services, migration
Abstract
The international migration of health workers away from underserved areas in low-income countries is increasingly recognised as one of the most profound problems facing health systems, and the safeguarding of health, in these countries. The problem is particularly acute in sub-Saharan Africa where the burdens of poverty and under-resourcing,
infectious disease and, worthy of distinct mention, HIV/AIDS which has infected up to a quarter of the population in some countries, are causing public health systems to break down.This breakdown is well-documented, and the human resource crisis in low-income country health systems is rising up the international policy agenda. In particular, questions are being asked about its impact on the achievement of the health-related Millennium Development Goals, which this paper hopes to discuss.
Country
United Kingdom
Publisher
Medact
URL:
URL
Theme area
Equity in health, Values, policies and rights, Human resources for health, Monitoring equity and research to policy
Title of publication The "skills drain" of health professionals from the developing world : A framework for policy formulation
Date of publication
2005 February
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
brain drain, policy, human resources, developing countries, equity, health services, health care professionals
Abstract
This paper should be read in association with its companion paper on migration and human rights (Bueno de Mesquita and Gordon 2005). Human rights discussed there form part of the ethical and political premises of this paper. This paper in turn examines policy towards health professionals’ migration from economic and governance perspectives. Our aims are conceptual and agenda-setting. In essence, we
argue that current policy responses to migration of health professionals from low income developing countries underestimate the pressures and mis-identify the reasons
for rising migration, overestimate the impact of recruitment policies on migration flows while ignoring unintended side effects, and mis-specify the ethical dilemmas involved.
The paper employs as its central case study the migration of health professionals from Ghana, the home country of the lead author, to the UK.This case is typical neither of migration flows nor impact, and is not presented as such. Rather, Ghana-UK migration provides a good example of many of the worst problems and contradictions in the
current situation and policy debate. We therefore employ it as a test case, a source of insight, and a ‘place to stand’ in constructing arguments that can be tested subsequently
on a wider field.
The paper puts forward several propositions, with evidence where available and with identification of gaps in evidence that research could usefully address the ‘skills drain’ of health professionals from the developing world.
Country
United Kingdom
Publisher
Medact
URL:
URL
Theme area
Equity in health, Equitable health services, Resource allocation and health financing
Title of publication Assessment of equity in geographical allocation of resources relative to need, in public primary healthcare services in the Northern Cape in South Africa
Date of publication
2004 November
Publication type
Manuscript
Publication details
Publication status
Publication status unknown
Language
English
Keywords
geographical inequity, resource allocation, primary health care, health needs assessment, weighting factors, health care financing, human resources, vertical equity, health expenditure per capita
Abstract
South Africa has one of the most unequal societies in the world with regard to income, gender, socio-economic status and the distribution of key social services. Much of these inequalities, which are also reflected in its health sector and the general health status of its different population groups, can be attributed to the discrimination and systematic disadvantaging of certain race groups under the apartheid rule. Many researchers have highlighted and raised concern about these substantial disparities in allocation of resources
between provinces. In spite of efforts by the post apartheid government to reduce such inequities, these geographic disparities still exist not only between provinces, but also within provinces.
Government resource allocation decisions are largely geographically based and the fiscal federalism, currently used in South Africa has been recognised in many ways for its incompatibility of promoting equity across national sectors. Though inter-provincial allocation of health budgets are set through the medium term fiscal framework process and are monitored for equity, most provinces still use historical budgets when making resource allocations at the
district level, resulting in many rural areas and health districts being under-resourced. In a country like South Africa with gross inequities in health, equity in geographical allocation of resources can only be achieved through vertical
equity, by preferential allocation of resources based on increased need. This descriptive study uses routinely available data to compare health expenditure to health needs in measuring the inequities in financial and human
resource allocation, relative to need, between districts in the Northern Cape.
By identifying the dependent population and then areas of increased need through the use of different indicators weighted according to their costs and burden on health services, it estimates a composite measure of need for a
health district. This measure of composite need is then compared with the expenditure per district to measure the distance from equity for each district. The study also estimates the equitable number of professional nurses per
district in proportion to the dependent population and also assesses the inequities in distribution of professional nurses between districts. The study concludes by making recommendations based on the analysis to the provincial
health management for the equitable redistribution of finance and staff to achieve equity between districts.
Country
South Africa
Publisher
University of the Western Cape
URL:
URL
Theme area
Poverty and health, Equitable health services
Title of publication Bucking the trend. How Sri Lanka has achieved good health at low cost : Challenges and policy lessons for the 21st century
Date of publication
2004
Publication type
Book
Publication details
Publication status
Published
Language
English
Keywords
health services, equity, policy, Sri Lanka
Abstract
In general, poor countries have far higher levels of infant mortality than rich ones, but Sri Lanka’s experience, as one of the few countries to have achieved remarkable progress in
health and social development despite its low-income status, demonstrates that factors other than income can significantly affect health outcomes, including child mortality. The state has financed and provided a high level of healthcare for its citizens at a relatively low cost (around two per cent of GDP), which has contributed to low infant and maternal mortality and high life expectancy.
Considerable attention has been paid to the Sri Lankan example and this paper investigates the factors that have contributed to its achievements in order to see what can be learnt for the benefit of children elsewhere and to consider how these achievements can be sustained when threatened by new challenges. In certain key areas it can be seen that the policies adopted and implemented by the Sri Lankan government have been and in some cases still are at variance with those proposed and widely followed in the general pursuit of the Millennium Development Goals (MDGs).
Country
United Kingdom
Publisher
Save the Children
URL:
URL
Theme area
Poverty and health, Equitable health services, Equity and HIV/AIDS
Title of publication Implementing HIV/AIDS services including ART in a rural resource-poor setting : Lusikisiki La Programme - Lusikisiki, Eastern Cape
Date of publication
2005 March
Publication type
Report
Publication details
Activity Report 2003-2004 pp 1-20
Publication status
Published
Language
English
Keywords
HIV/AIDS
Abstract
MSF has worked in South Africa since 1999 providing medical care for people with HIV/AIDS. The first programme was implemented in Khayelitsha near Cape Town, the largest township in the Western Cape. The Khayelitsha programme was the first to provide dedicated HIV/AIDS services, including antiretroviral (ARV) therapy in a peri-urban resource-poor setting with high levels of infection. The Khayelitsha programme is run in partnership with the Provincial Administration of the Western Cape. Inspired by the impressive clinical outcomes and the acceptability of the programme by the community in Khayelitsha, MSF decided to set up a new programme in a rural setting in the country, in order to explore the particular challenges of delivering services in rural settings with even less developed health
care infrastructure. With this aim, in February 2003, MSF - in partnership with the Nelson Mandela Foundation -started
operating in Lusikisiki, in the former Transkei (Eastern Cape Province). Lusikisiki, Flagstaff and Bizana make up the Qaukeni sub-district. Qaukeni is a local service area (LSA)
of the Oliver Tambo district. The first months of the Lusikisiki programme were devoted to the implementation of basic
HIV/AIDS services, co-ordinating with district and provincial authorities and supporting the Treatment Action Campaign (TAC) in building the community response to HIV.
In October 2003 the Department of Health of the Eastern Cape gave the go-ahead to MSF to start providing ARV therapy in Lusikisiki. The first patients were started on ARV therapy in late October 2003. In October 2004, the Lusikisiki programme was accredited as part of the national government ARV roll-out plan. The present report aims to review key outcomes, strategies and future challenges after two years of experience providing HIV/AIDS care – including ARVs - in Lusikisiki.
Country
South Africa
Publisher
Medicins Sans Frontiers
URL:
URL
Theme area
Poverty and health, Equitable health services, Equity and HIV/AIDS
Title of publication Report on the integration of TB and HIV services in site B Khayelitsha
Date of publication
2005 February
Publication type
Report
Publication details
Publication status
Language
English
Keywords
HIV, AIDS, tuberculosis, Cape Town, health services
Abstract
This report presents the findings after one year of integration of TB and HIV services at Site B “Ubuntu” Clinic in Khayelitsha. The rationale for the project is explored, together with the progress that has been made to date.
The rapid increase in patient number for both TB and HIV services in Khayelitsha and Site B is presented with 1 in 4 sexually active adults assumed to be HIV-infected and a passive TB case-finding rate exceeding 1,000/100,000.
The case for integration rests on the potential for improved clinical care including VCT-uptake (and improved care pathways for HIV-infected patients with smear-negative TB), a friendlier service for patients through a “one-stop” serve, improved efficiency through a uniform approach to staff management and patient administration and monitoring, and better coherency in a uniform patient-centred approach to adherence (hopefully leading to a more manageable service and improved patient outcomes). Significant progress has been made in unifying administrative and clinical systems, with the single approach to adherence promotion in its infancy. Baseline information on VCT uptake,
and TB cure rates has been collected.
Important challenges relate to the urgent need for a larger, more streamlined clinic building, and improved management capacity. Most importantly however is the prospect of ever
increasing patient numbers, and the need for district-level plans to cope with the anticipated increases in both HIV and TB patient numbers.
Country
South Africa
Publisher
University of Cape Town
URL:
URL
Theme area
Equity and HIV/AIDS
Title of publication Interim findings on the national PMTCT pilot sites : Lessons and recommendations
Date of publication
2002 February
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
HIV, AIDS, mother to child transmission, anti-retroviral therapy, South Africa
Abstract
The South African national PMTCT pilot programme alone currently comprises 193 health facilities ; covering about 9% of the total number of country-wide bookings. Some provinces have expanded their services, cntributing to the considerably greater figures for nation-wide access to PMTCT ; with as high as 15% of pregnant women in the country having access to HIV counselling, testing, and Nevirapine. Centeral to the differences ibetween provinces in implentating the programme are the large inequities in health care infra-structure within the country. This report primarily describes the process, progress and extent of service implementation in the 18 pilot PMTCT sites, so as to help improve the effectiveness and efficiency of PMTCT services and inform any planned expansion of the programme.
Country
South Africa
Publisher
Health Systems Trust (HST)
URL:
URL
Theme area
Resource allocation and health financing, Equity and HIV/AIDS
Title of publication HIV prevention and control beyond the workplace : the role of the private sector in Zimbabwe
Date of publication
2002 July
Publication type
Document
Publication details
HIV International AIDS Conference pp 123-127
Publication status
Published
Language
English
Keywords
HIV, AIDS, private sector, economic growth, Zimbabwe
Abstract
The private sector in Zimbabwe has a crucial role to play in achieving sufficient economic growth, including taking the issue of HIV/AIDS on board, as part of its business strategy. This it can do, by going beyond the workplace in combating the spread of HIV in the community where the work force comes from. There is need for a coordinated effort through something like a business coalition, hence the establishment of a Zimbabwe Business Council on HIV/AIDS under the auspices of the National AIDS Council.
Country
Spain
Publisher
Monduzzi Editore
URL:
URL
Theme area
Human resources for health, Equity and HIV/AIDS
Title of publication Human resources for health and ART scale-up in sub-Saharan Afric : A background paper for the MSF access to essential drugs
Date of publication
2005 June
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
HIV, AIDS, human resources, health, essential drugs, sub-Saharan Africa, antiretroviral therapy
Abstract
The lack of Human Resources for Health (HRH) is increasingly being recognised as a major bottleneck for scaling-up anti-retroviral treatment (ART), particularly in sub-Saharan Africa.
Still, country averages mask the internal maldistribution of HRH. This paper sets out (1) to describe the present HRH situation in sub-Saharan Africa, (2) to analyse the consequence of this on ART delivery and scale-up, and (3) to map the main actors in the international HRH arena.
Country
Belgium
Publisher
Institute of Tropical Medicine
URL:
URL
Theme area
Equity and HIV/AIDS
Title of publication HIV transmission through breastfeeding : Is there a critical "cut off" of plasma viral load?
Date of publication
2002 July
Publication type
Document
Publication details
HIV International AIDS Conference, Barclona 2002 pp 295-299
Publication status
Published
Language
English
Keywords
HIV, AIDS, breastfeeding, viral load, mother to child transmission
Abstract
HIV-1 infection found in children in Zimbabwe is a reflection of high prevalence of HIV-1 among pregnant mothers who are invariably encouraged to breastfeed their babies after birth. At present policy makers are still struggling to reconcile the contrasting roles for breast-feeding. There is little information on the biologic features of breast milk, including factors that increase the risk for transmission of the virus. To investigae whether there is a critical "cut off" of plasma viral load which breaks the breast-blood barrier, [we]used the NASBA-based amplification of isolated HIV-1 RNA from paired plasma and blood samples collected from 30 HIV positive women. Virus loads 810 and 350 copies/mL were detected in the breast milk of two women whose plasma viral load were 74 000 and 43 000 copies/mL and none from the women whose loads were even higher. HIV RNA quantity ranged from undetectable to 810 copies/mL in breast milk and 65 to 110 000 copies/mL in plasma. There appeared to [be] no positive correlation even with the CD4 counts. RT-PCR done showed that there were no natural mutations associated with resistance to AZT, 3TC and nevirapine, drugs to be used in the planned MTCT programmes. The results, which still need to be substantiated with a much bigger sample, seem to suggest that shedding of the virus in breast milk may depend on many yet unkown factors.
Country
Spain
Publisher
Monduzzi Editore
URL:
URL
Theme area
Equity and HIV/AIDS
Title of publication HIV infections in sub-Saharan Africa not explained by sexual or vertical transmission
Date of publication
2002 October
Publication type
Journal Article
Publication details
International Journal of STD and AIDS 13 pp 657-666
Publication status
Published
Language
English
Keywords
Iatrogenic, nosocomial, HIV, AIDS, transmission, sub-Saharan Africa
Abstract
An expanding body of evidence challenges the conventional hypothesis that sexual transmission is responsible for more than 90% of adult HIV infections in Africa. Differences in epidemic trajectories across Africa do not correspond to
differences in sexual behaviour. Studies among African couples found low rates of heterosexual transmission, as in developed countries. Many studies report HIV infections in African adults with no sexual exposure to HIV and in children with HIV-negative mothers. Unexplained high rates of HIV incidence have been observed in African women during antenatal and postpartum periods. Many studies show 20%±40% of HIV infections in African adults associated with injections (though direction of causation is unknown). These and other findings that challenge the conventional hypothesis point to the possibility that HIV transmission through unsafe medical care may be an important factor in Africa’s HIV epidemic. More research is warranted to clarify risks for HIV transmission through health care.
Country
United Kingdom
Publisher
Royal Society of Medicine Press Ltd
URL:
URL
Theme area
Values, policies and rights, Health equity in economic and trade policies, Equity and HIV/AIDS
Title of publication HIV/AIDS, democracy, and citizenship
Date of publication
Publication type
Electronic Source
Publication details
Publication status
Publication status unknown
Language
English
Keywords
HIV/AIDS, demography, democracy, epidemiology, review
Abstract
This paper gives a detailed description of the epidemiological and demographic statistics on HIV/AIDS across the world. It continues to discuss the various legal, social, and political dimensions of the HIV/AIDS pandemic ; reading into perspectives on HIV and human rights in light of the prevailing paradigms.
Country
Publisher
URL:
Theme area
Values, policies and rights, Equity and HIV/AIDS
Title of publication On a never ending waiting list : Towards equitable access to anti-retroviral treatment? Experiences from Zambia
Date of publication
Publication type
Publication details
Norwegian Centre for Human Rights pp 1-26
Publication status
Published
Language
English
Keywords
HIV/AIDS, equity, access, ARV, treatment, Zambia
Abstract
Universal access to anti-retroviral medication for HIV/AIDS is the clarion call of the WHO/UNAIDS ‘3 by 5’ initiative. Treatment coverage, however, remains highly uneven. This sharpens the question of ‘who’ exactly is accessing ARV and whether access is challenging inequality or reinforcing it. Issues of distributive justice have long been debated in health policy but the practical challenges of ARV distribution are relatively new. In exploring what a more equitable process could involve the article draws on case study material from Zambia. Human rights instruments remain integral to realizing equitable access to medication. But the broader message is that they are more likely to be implemented by way of a development process more explicit about exercising and claiming rights.
Country
Norway
Publisher
Norwegian Centre for Human Rights
URL:
URL
Theme area
Equity and HIV/AIDS
Title of publication Integrating Highly Active Anti-Retroviral Treatment (HAART) in care, support and treatment : A donor perspective
Date of publication
October
Publication type
Report
Publication details
Publication status
Publication status unknown
Language
English
Keywords
HIV/AIDS, treatment, HAART, support, donor agencies, access
Abstract
Following the Barcelona discussions on bettering access to HAART for People Living With HIV/AIDS (PLWHA), an informal gathering of donor agencies in Scheveningen brainstormed on ways to integrate HAART in care, support, and treatment within development cooperation programs. The need for donor agencies to involve themselves in improving access to HAART despite the potential and existing difficulties encountered in technicalities, finances, as well as policy clashes, has become increasingly apparent. The paper reports on the viewpoints of a number of representatives of donor agencies on the matter.
Country
Canada
Publisher
Canadian International for Development
URL:
URL
Theme area
Human resources for health, Resource allocation and health financing
Title of publication Overtime contracts and salaries : A personal view
Date of publication
2005
Publication type
Journal Article
Publication details
People\'s Health Movement South Africa (PHM-SA) 1 pp 1-3
Publication status
Published
Language
English
Keywords
human resources, health services, contract, commentary
Abstract
Commuted overtime has been included within remuneration packages of some health care professionals in a manner that is now routine but perhaps not as fair or efficient as it should be. The author highlights some of the flaws in the current contracts of health professionals in the public sector in the Western Cape, discussing the issue of overtime by considering health care professional, patient, and administrative perspectives.
Country
South Africa
Publisher
People\'s Health Movement South Africa (PHM-SA)
URL
Theme area
Poverty and health, Equitable health services, Governance and participation in health
Title of publication Access of the very poor to health services in Asia : Evidence on the role of health systems from Equitap
Date of publication
2005 February
Publication type
Document
Publication details
Meeting the Health Related Needs of the Very Poor Workshop pp 1-16
Publication status
Published
Language
English
Keywords
poverty, equity, health systems, access, Asia, risk protection
Abstract
Equitap (Equity in Asia- Pacific Health Systems) is a collaborative research project of European and Asian institutions set to examine the equity performance of national health systems in Asia. The paper reports on important findings of the Equitap study, targetting the participants of the DFID Meeting the Health Needs of the Very Poorest Workshop ; and proceeds to discuss the implications of the results for health systems and pro-poor policy development.
Country
United Kingdom
Publisher
DFID Health Systems Resource Centre
URL:
URL
Theme area
Equity and HIV/AIDS
Title of publication The Impact of HIV/AIDS on older people in Africa : Workshop report ; 23-25 January 2002
Date of publication
2002 January
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
HIV/AIDS, age, policy, development
Abstract
We report on a workshop that brought together participants from a variety of organisations that included, amongst others, older people\'s organisations, AIDS service organisations, and regional bodies. It was highlighted how policy makers, development agencies, and donors do not factor older people in their policies and programmes despite existing data on the impact on older people. Recommendations included specific programmes for older people as well as incorporating older people\'s issues into existing HIV/AIDS policies and programmes.
Country
Kenya
Publisher
HelpAge International
URL:
URL
Theme area
Equity and HIV/AIDS
Title of publication Impact of AIDS on older people in Africa : Zimbabwe case study
Date of publication
2002
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
HIV/AIDS, age, Zimbabwe, methodology, Africa
Abstract
The report describes the Zimbabwe pilot of the greater project "Impact of AIDS on older people in Africa" ; designed to explore the role of people in HIV/AIDS-related care and the burden they bear in each of the 4 African countries Zimbabwe, Ghana, South Africa, and Tanzania. The findings indicate that older caregivers are under serious financial, physical, and emotional stress due to care-giving responsibilities and the abuse that they endure with it.
Country
Switzerland
Publisher
World Health Organisation (WHO)
URL:
URL
Theme area
Equity and HIV/AIDS
Title of publication Demographic characteristics and HIV/AIDS impact
Date of publication
2002 September
Publication type
Conference Proceedings
Publication details
Publication status
Published
Language
English
Keywords
HIV/AIDS, demography, prevalence
Abstract
UNAIDS estimates for the global number of HIV infections by the end of 2001 were at about 40 million, with about 70% being of those living with HIV/AIDS being in SubSaharan Africa.
The HIV/AIDS epidemic has tremendous effects on countries\' demographic characteristics, economy, and social progress. This paper discusses the impact of HIV/AIDS on the demographic characteristics of various Southern African and other countries.
Country
Zimbabwe
Publisher
Institute of Development Studies
URL:
URL
Theme area
Equity and HIV/AIDS
Title of publication Gender and HIV in Southern Africa : A conversation with Stephen Lewis, UN Special Envoy on HIV/AIDS
Date of publication
2003 February
Publication type
Report
Publication details
Poverty Brief pp 1-6
Publication status
Published
Language
English
Keywords
HIV/AIDS, gender, Southern Africa, UN, poverty
Abstract
SARPN aims to promote discussion that will contribute to policy and action to reduce poverty and ameliorate its effects in the SADC region. SARPN invited invited Stephen Lewis to exchange views with a range of researchers, government officials, consultants, activists and donor representatives active in the fight against HIV/Aids in Southern Africa. Themes discussed include those on research and funding, policies and programmes, women and children, and stigmatisation.
Country
South Africa
Publisher
Southern African Regional Poverty Network (SARPN)
URL:
URL
Theme area
Equity and HIV/AIDS
Title of publication Gender and HIV/AIDS : An analysis on Zimbabwe\'s national policies and programs on HIV/AIDS/STI\'s
Date of publication
2003
Publication type
Report
Publication details
The National HIV/AIDS Policy, National AIDS Council of Zimbabwe Act (chapter 15:14) pp 1-20
Publication status
Published
Language
English
Keywords
gender, HIV/AIDS, STI\'s, policies, values, equity, Zimbabwe
Abstract
The relationship between gender, HIV/AIDS, and poverty has not always been understood in a way that informs policy and encourages the adoption and implementation of practical strategies that empower communities to respond to the diverse impacts the epidemic has had on females and males within households, communities, and societies. A UNICEF study estimates that out of the 8.6 million young people in Africa infected with HIV, two thirds are female. Despite there being knowledge on the many factors that make females males more vulnerable to infection than males, our policies still lag behind in responding to these gender inequalities. This report explores the extent to which the 3 HIV/AIDS policies adopted by the government of Zimbabwe (The National HIV/AIDS Policy, the National AIDS Council of Zimbabwe Act [Chapter 15:14], and the National AIDS Trust Fund) adress gender equity and equality. The report includes recommendations on gender gaps identified within the policies.
Country
Zimbabwe
Publisher
Zimbabwe Women\'s Resource Centre and Network
URL:
URL
Theme area
Values, policies and rights
Title of publication Discussion Paper 25: Human rights commitments relevant to heath made by states in Southern Africa: Implications for health equity
Date of publication
2005 June
Publication type
Document
Publication details
EQUINET Discussion Paper 25 pp 1-36
Publication status
Published
Language
English
Keywords
SADC, human rights, ratification, Southern Africa
Abstract
The audit reviews the regional and international human rights instruments relevant to health and the national commitments that have been made under these human rights instruments.
Country
Southern Africa Regional
Publisher
EQUINET
URL:
Equinet Publication Type
Discussion paper
Theme area
Values, policies and rights
Title of publication Annotated Bibliography: Human rights and Health Equity
Date of publication
2005 June
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
human rights and health, community agency, equity, poverty
Abstract
This bibliography pulls together recent articles that speak to the relationship between human rights and health, particularly focused on health equity, poverty and community agency. The bibliography was prepared for the EQUINET Health Rights theme and the articles described in the bibliography have informed much of the conceptual approaches developed in EQUINET to harnessing rights approaches to build health equity. The bibliography overlaps to some extent with other bibliographies held by EQUINET on health equity themes. It should prove useful for researchers exploring issues of human
rights in relation to equity. The intention is to keep this bibliography updated in future, to support EQUINET’s activities in this area.
Country
East and southern Africa region
Publisher
EQUINET
URL:
Theme area
Equity and HIV/AIDS
Title of publication Discussion Paper 24: Monitoring equity and health systems in the provision of Anti-retroviral Therapy (ART): Malawi Country report
Date of publication
2005 May
Publication type
Document
Publication details
EQUINET Discussion Paper 24 pp 1-46
Publication status
Published
Language
English
Keywords
equity, policy, ART provision, health systems, integration, Malawi
Abstract
The report uses pre-existing information and indicators from different stakeholders, analysis of sentinel data from Thyolo district, consultations with key informants, participation in meetings and insights from qualitative studies at the Lighthouse (a high burden ART service provision site in the capital Lilongwe) and in Thyolo district.
Country
Malawi
Publisher
EQUINET; REACH Trust
URL:
Equinet Publication Type
Discussion paper
Theme area
Public-private mix
Title of publication Discussion Paper 23: Public-public partnerships in health and essential services
Date of publication
2005 May
Publication type
Report
Publication details
EQUINET Discussion paper 23 pp 1-37
Publication status
Published
Language
English
Keywords
public-public partnerships, health sector, water sector, southern Africa
Abstract
The paper first discusses the concept of Public-Public Partnerships (PuPs) and proposes a two-dimensional typology for categorising the various forms of partnership so described. The range of types of PuPs is then discussed with reference to specific sectors (water and healthcare), international associations, and six case studies. The final section draws general conclusions and makes recommendations for future research into the subject.
Country
Southern Africa Regional
Publisher
EQUINET, Municipal Services Project
URL:
Equinet Publication Type
Discussion paper
Theme area
Governance and participation in health
Title of publication Descriptive study of debates on health equity matters in the Zimbabwean National Legislative Assembly
Date of publication
2005 February
Publication type
Document
Publication details
Publication status
Not published
Language
English
Keywords
Zimbabwean National Assembly, key health issues, health equity matters
Abstract
A descriptive study of debates on health and health equity matters in the Zimbabwean National Assembly was conducted to identify key issues raised, the positions taken within the key areas of parliamentary functions, legislative, budgetary oversight, policy
oversight and representation. The work also tracked how issues were responded to in parliament, and how they were followed through by parliament. The research drew information from recordings of parliament in the Hansards. The Hansard is the official
transcript of the debates in Parliament and produced by the section of the Parliamentary Service responsible for recording, editing and producing the printed record.
Country
Zimbabwe
Publisher
TARSC, EQUINET
URL:
Equinet Publication Type
Discussion paper
Theme area
Human resources for health
Title of publication Access to continued professional education among health workers in Blantyre, Malawi
Date of publication
2004 December
Publication type
Journal Article
Publication details
Extenza 4 3 pp 182-184
Publication status
Published
Language
English
Keywords
Malawi, continued professional development
Abstract
Objective: To describe the current status of continued professional development (CPD) of healthcare personnel within the Ministry of Health (MoH) health centres in Blantyre, Malawi
Design: A cross-sectional descriptive study utilizing an interviewer-administered questionnaire.
Subjects: Healthcare workers in public health centers in Blantyre District, Malawi.
Results: Fifty-seven healthcare workers participated of whom 47 (82.5%) were nurses, 8 (14.0%) were either medical assistants or clinical officers, and one laboratory technician and a dental therapist. At the time of the study, 50(87.7%) were prescribers and 54 (94.7%) had ever issued a prescription for medications. Participation in workshops and seminars within the past 12 months was reported by 54 (94.7%) of the participants and 49 (86.0%) reported that their health facilities had clinical hand-over meetings. All participants indicated desire to receive professional journals for free while only 35 (61.4%) were willing to pay for a journal subscription. Current personal and institutional subscription to a journal was low, at 2 (3.5%) each. About 30% had been trained to conduct research and 23 (40.1%) had ever conducted research with only 3 (5.3%) ever written a journal or newsletter article. 47.4% had access to a working phone at work and only 3 (5.3%) had access to internet facilities at all. Only 21% were satisfied with their own knowledge on health matters.
Conclusions: Healthcare professionals in Blantyre's DHO zone are using mostly clinical hand-over meetings, seminars and workshops for their CPD. There is need to improve access to relevant professional journals. The regulatory or licensing boards for healthcare professional in Malawi should seriously consider mandatory CPD credits for re-registration.
Country
Malawi
Publisher
Extenza
URL:
Equinet Publication Type
Discussion paper
Theme area
Governance and participation in health
Title of publication Report of a Regional Meeting: Health civil society in east and southern Africa: Towards a unified agenda and action for people’s health, equity and justice, Lusaka 17-19 February 2005
Date of publication
2005 March
Publication type
Document
Publication details
Report of a Regional Meeting, February 17-19 2005, February 17-19 2005 pp 1-37
Publication status
Published
Language
English
Keywords
civil society, programme of action, southern Africa
Abstract
This report outlines the proceedings of the meeting and the resolutions and plans for future work made by the health civil society groups at the meeting. The meeting was hosted by
CHESSORE, the theme co-ordinator in EQUINET on participation in health, with support from TARSC.
Country
Southern Africa Regional
Publisher
EQUINET
URL:
Equinet Publication Type
Reports
Theme area
Human resources for health
Title of publication Occasional paper 8: Who cares for the health care workers?: The state of occupational health and safety in municipal health clinics in South Africa
Date of publication
2005 January
Publication type
Book
Publication details
Occasional papers 8 pp 54pp.
Publication status
Published
Language
English
Keywords
Occupational health & safety (OH&S), muncipal health care workers
Abstract
We gathered evidence on:
• The existence and functioning of workplace health and safety
committees;
• The election of health and safety representatives;
• Workplace OH&S activities, such as incident investigations, hazard
inspections and OH&S training; and
• The capacity of clinics to deal with the HIV/AIDS epidemic and to implement programmes to protect health workers from exposure to occupational HIV.
The findings of our research point to a situation of employer abuse and neglect of the health and well-being of health care workers, even though the health care profession publicly embraces the important ethics of service and sacrifice. There is a culture of reactivity and minimal compliance, so that OH&S is all too often reduced to the processing of compensation claims.
We did not find any proactive or preventive procedures in place for identifying hazards, evaluating risks, preventing workplace injury and illness, and maintaining a safe workplace. More significantly, we found that management did not actively engage with workers and ask for their input when developing health and safety practices in clinics.
Further problems include a lack of facilities, equipment and medicines, which frustrate health workers and add to the already existing tension between themselves and the communities they serve. We identified these problems as caused by negligent OH&S management. However, it is
not that simple. The problem is a cultural one, a culture of neglect in the primary health care sector that is reinforced and reproduced by health workers themselves. The need for health workers to recognise this has been done of the most valuable findings of this research programme.
The inclination of the majority of health workers to accept appalling OH&S conditions, to isolate themselves and to individualise their workplace traumas, stress and exhaustion, presents an enormous challenge to the South African Municipal Workers Union (Samwu) and other unions organising in
the public health sector. Our discussions during this research also led us to recognise that there will be no proper care for health care workers unless these workers collectively build a proactive, preventive culture and engage their employers about their responsibilities as employers.
Country
South Africa
Publisher
Municipal Service Project
URL:
Theme area
Equity and HIV/AIDS
Title of publication Hard choices: rationing antiretroviral therapy for HIV/AIDS in Africa
Date of publication
2004 December
Publication type
Journal Article
Publication details
The Lancet Online 31 December 2 pp 3pp.
Publication status
Published
Language
English
Keywords
ART rationing, patient numbers, global funds
Abstract
As the world intensifies its fight against the global AIDS epidemic, African countries have begun to develop largescale prevention and treatment programmes. A combination of funds from African governments and international donors are paying for drugs, diagnostics, clinic and laboratory infrastructure, and medical personnel.
Although these funds, which reach into the billions of dollars, will pay for antiretroviral therapy for many thousands of HIV-positive Africans, there is almost no chance that African countries will have the human, infrastructural, or financial resources to treat everyone who is in need, at least in the early years. The numbers of patients targeted for treatment are ambitious, but they are only a small fraction of those who are eligible for antiretroviral drugs on even the most conservative medical grounds. In Zambia, for example, the first-year target for treatment is 10 000 patients; 100000 Zambians have already reached the clinical threshold of fewer than 200 CD4 cells per L, and thousands more become eligible each year. Ghana is targeting 12 000 patients for therapy in the first 2 years;3 58 000 are believed to be medically eligible now. Kenya’s target is 50% coverage, as is the global target of WHO’s 35 initiative. Economists call any policy or practice that restricts consumption of goods a rationing system.6 As used by economists, rationing is value-neutral, ie, it does not imply intent to deprive people of a good resource, but rather describes the allocation of a scarce resource. In the marketplace, rationing is based on price. Non-market goods, such as free medical care, are rationed in other ways. Ambitious targets for treatment of HIV/AIDS still
represent only a few of those in need; therefore, the
rationing of treatment services is inevitable. Rationing of
antiretroviral therapy for HIV/AIDS will be necessary as
long as demand exceeds supply.
Country
United Kingdom
Publisher
Elsevier Ltd
URL:
Theme area
Equity and HIV/AIDS
Title of publication Scaling up access to antiretroviral treatment in southern Africa: Who will do the job?
Date of publication
2004 July
Publication type
Journal Article
Publication details
The Lancet 364 pp 103-107
Publication status
Published
Language
English
Keywords
southern Africa, HIV/AIDS burdens, ART plans, health systems, policy makers, financial resources
Abstract
Malawi, Mozambique, Swaziland, and South Africa have some of the highest HIV/AIDS burdens in the world. All four countries have ambitious plans for scaling-up antiretroviral treatment for the millions of HIV-positive people in the region. In January 2004, we visited these countries with the intention of directly observing the effect of AIDS, especially on health systems, to talk with policy makers and field workers about their concerns and perspectives regarding the epidemic, and to investigate the main issues related to scaling up antiretroviral treatment. We found that financial resources are not regarded as the main immediate constraint anymore, but that the lack of human resources for health is deplored as the single most serious obstacle for implementing the national treatment plans.
Yet, none of the countries has developed an urgently required comprehensive human resource strategy. This may also need increased donor attention and resources.
Country
United Kingdom
Publisher
The Lancet
URL:
Theme area
Values, policies and rights
Title of publication What can human rights do for health & health equity in South Africa?
Date of publication
2005 January
Publication type
Document
Publication details
Critical Health Perspectives 1 pp 3pp.
Publication status
Published
Language
English
Keywords
South Africa, constitution, human rights, Bill of Rights, health-generating conditions
Abstract
As South Africa enters its second decade of democracy, we find that health gains anticipated in 1994 remain unrealized for the majority of our people, particularly the poorest in society. Why is it that, despite a Constitution hailed as the most progressive in the world, a victorious liberation movement and a set of governmental and non-governmental institutions designed to promote human rights in our society, we have failed to translate the provisions of our Bill of Rights into reality? To understand this contradiction, we need to understand, firstly, what are human rights; secondly, the relationship between health and human rights; and, thirdly, how human rights commitments can be translated into health-generating conditions and material gains in health for those who need it most. There are potential contradictions between a human rights approach and broad strategies for Primary Health Care, but these arise because of an incomplete or selective understanding of human rights, sometimes deliberately so, intended to further neo-liberal or imperialist political agendas.
Country
South Africa
Publisher
People\'s Health Movement
URL:
Theme area
Equity and HIV/AIDS
Title of publication Expanding access to antiretroviral therapy in sub-Saharan Africa: Avoiding the pitfalls and dangers, capitalizing on the opportunities
Date of publication
2005 January
Publication type
Journal Article
Publication details
American Journal of Public Health 95 1 pp 18-22
Publication status
Published
Language
English
Keywords
ART access, health systems development, sub-Saharan Africa, healthworkers, understaffing, brain drain
Abstract
Unless the push to expand access to ART is placed within the context of a response to comprehensive health systems development, it will fail to avoid the pitfalls and undermine the desired aim of reducing AIDS-related mortality.
Underlying our concern is the fact that treatment expansion plans and programs are being implemented without adequate investment in strengthening the weak, and in some cases collapsing, health systems in SSA.2 A large number of health care systems in SSA are currently grossly underresourced. Thirtyone African countries had total annual per capita health expenditures of $20 or less in 2001.3
The available number and skills of doctors, nurses, and other
health workers fall short of what is required to deliver an adequate
health service, a problem that threatens to get worse as a consequence of the international brain drain of health workers to
developed countries, and the effect of HIV/AIDS itself on health workers.
Country
Zimbabwe
Publisher
American Journal of Public Health
URL:
Theme area
Equity and HIV/AIDS
Title of publication ARVs and rural communities: A solution or a dilemma?
Date of publication
2004 December
Publication type
Conference Proceedings
Publication details
Arusha, Tanzania, December 2004 pp 9pp.
Publication status
Published
Language
English
Keywords
AIDS pandemic, priority access to treatment, rural communities
Abstract
It is estimated that in Tanzania the national HIV prevalence rate among adults is 9.6% thus translating to 2.2 million Tanzanians. Twenty per cent of these people living with HIV/AIDS, i.e. 400,000 people are estimated to be in need of treatment with anti-retroviral therapy (ARVs). There are pockets of high cumulative reported AIDS cases (1993 –2003) found across the country e.g. Mbeya, Dar-Es-Salaam Kagera and Kilimanjaro, (HIV/AIDS/STI Surveillance report, No.18, 2004) yet Kagera was for years the topmost area with the highest HIV prevalence! Should equity values be adhered to during provision of ARVs, if so, then those in greatest need should be given priority in accessing the drugs.
Country
Tanzania
Publisher
TANESA
URL:
Theme area
Equity and HIV/AIDS
Title of publication Where are the human resources to rollout ART?
Date of publication
2004 September
Publication type
Journal Article
Publication details
Publication status
Published
Language
English
Keywords
ART rollout, health worker migration, public health sector
Abstract
The issue of human resources that is critical to ensuring and equitable and self-sustaining ART-rollout has so far been neglected. The situation is compounded by an exodus of healthcare workers from impoverished and socio-economically underdeveloped areas to more highly developed areas. International migration has intensified, hence exacerbating inequalities in the provision of health services between the public and private sectors. This has substantially reduced the ability of the public health sector to rollout ART.
Country
Zimbabwe
Publisher
URL:
Equinet Publication Type
Discussion brief
Theme area
Governance and participation in health
Title of publication Review: Civil society organisation positions on health in east and southern Africa, December 2004
Date of publication
2004 December
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
civil society organisations, health rights, primary health care, patients rights, workers health, globalisation, resistance to privatisation
Abstract
Civil society in this region has built strong platforms and made progress in advancing peoples health in a number of areas, including around broad health rights, primary health care, patients
rights, treatment access, corporate responsibilities to protect workers health, resisting damaging health impacts of globalisation, resistance to privatisation of essential services for health and
protecting rights of people living with HIV and AIDS. Civil society has also through broad networks like EQUINET and PHM and through participation in the Social Forum processes, outlined policies
for building equity and social justice in health and health care, particularly through a strong public sector health system. These wider platforms are, however, not strongly linked to the issue
campaigns, while the issue campaigns are not necessarily all informed by the same analysis of the political and economic causes of ill health, of the health systems we are seeking to build or of the
wider changes needed to achieve health goals.
After consultation with other civil society groups it was agreed that we hold a meeting with representatives from major civil society networks working in health in east and southern Africa to explore the goals of health civil society, the common positions and goals and to propose a mechanisms for enhancing the co-ordination and unity of health civil society to build common perspective and achieve common goals.
Country
Zimbabwe
Publisher
TARSC
URL:
Equinet Publication Type
Reports
Theme area
Governance and participation in health
Title of publication Meeting report: Regional initiative of parliamentary committees on health, Zambia, 24-25 January 2004
Date of publication
2004 January
Publication type
Document
Publication details
EQUINET Meeting report: pp 1-21
Publication status
Published
Language
English
Keywords
parliamentary health committees, support work, southern and east Africa, draft constitution
Abstract
The meeting reported on the steps that have been taken so far by an interim Steering committee to co-ordinate and support work of parliamentary committees on health in the region and set up a more consistent form of organization of this cooperation. A draft constitution and a work plan was presented for consideration; the meeting elected an interim Steering Committee to lead the process for the finalising of a constitution and programme of work for the co-ordination of parliamentary committees on health.
Country
Southern Africa Regional
Publisher
EQUINET
URL:
Equinet Publication Type
Reports
Theme area
Governance and participation in health
Title of publication Meeting Report: Strengthening community voice and agency, Zambia, 26-28 January 2005
Date of publication
2005 January
Publication type
Publication details
EQUINET Meeting report pp 1-36
Publication status
Published
Language
English
Keywords
district structures, clinic structures, health centre committees, district health boards, community interests, health system performance, resource allocation, health planning, Zambia
Abstract
An EQUINET multi-country programme co-ordinated by CHESSORE and TARSC explored the functioning of district and clinic level structures (neighbourhood and health centre committees and district health boards) for community participation in terms of
whether they: represent the interests of communities; have any role in health system performance and resource allocation; include community preferences in health planning and resource allocation; improve equity in resource allocation; and improve health system performance, especially in relation to equity. The field studies and literature review in this programme explored outcomes in these areas, and how these outcomes were influenced by the functioning of these joint community- health service structures and the deeper underlying determinants affecting these outcomes, including their legal status, authority and mandate.
Country
Southern Africa Regional
Publisher
EQUINET
URL:
Equinet Publication Type
Reports
Theme area
Governance and participation in health
Title of publication Abstract book: Strengthening community voice and agency, Zambia, 26-28 January 2005
Date of publication
2005 January
Publication type
Book
Publication details
Abstract Book: Regional Meeting pp 1-24
Publication status
Published
Language
English
Keywords
community involvement, social roles, research, training, policy, practice
Abstract
This book outlines the objectives, inputs and process of the meeting.
Country
Southern Africa Regional
Publisher
EQUINET
URL:
Equinet Publication Type
Book
Theme area
Governance and participation in health
Title of publication Southern African regional meeting of civil society organisations in health, 26 November 2003
Date of publication
2003 November
Publication type
Conference Proceedings
Publication details
Meeting report pp 13pp.
Publication status
Published
Language
English
Keywords
civil society organisations, civil society networks, health
Abstract
The initial discussions held between EQUINET, PHM, IPHC and CWGH identified the need for dialogue between civil society to shares evidence and increase knowledge, awareness and analysis within civil society and health professionals on key health challenges and on options for policy responses. This took note of the existing strong civil society responses on issues such as health rights, treatment access, globalisation and health, privatisation, and economic policy and health. In the background discussions a need was identified to:
· prepare, synthesise and present background documentation by and for civil society on these and other challenges to health
· review the major civic responses to the challenges
· better understand individual civic platforms and build combined platforms on common concerns.
· propose a co-ordinating mechanism to enhance ongoing information flow and analysis and strengthen networking and strategic action
It was agreed that a planning meeting be held to review with representatives from the major civil society networks working in health these aims and the approaches to strengthening health civil society in Africa, particularly southern Africa. The planning meeting was held on November 26 2003.
Country
Zimbabwe
Publisher
TARSC
URL:
Equinet Publication Type
Reports
Theme area
Resource allocation and health financing
Title of publication Equity implications of health sector user fees in Tanzania: Do we retain the user fee or do we set the user f(r)ee? Analysis of literature and stakeholder views
Date of publication
2004 May
Publication type
Document
Publication details
Publication status
Publication status unknown
Language
English
Keywords
user fees, Tanzania, health financing
Abstract
Early 2004, Research for Poverty Alleviation (REPOA) commissioned ETC Crystal to examine the equity implications of health sector user fees in Tanzania, with particular reference to proposed and actual charges at dispensary and health centre level. This year, Tanzania will review its PovertyReduction Strategy. With the findings of the user fee study, REPOA aims at making a valuable contribution to the review process and provide country-specific insight into one of the most debated issues in health financing.
Country
Tanzania
Publisher
ETC Crystal
URL:
Theme area
Poverty and health
Title of publication Discussion paper 22: Food security, rural development and health equity in Southern Africa
Date of publication
2004 December
Publication type
Document
Publication details
EQUINET Discussion Paper 22 pp 1-36
Publication status
Published
Language
English
Keywords
food security, nutrition, poverty, health outcomes, southern Africa
Abstract
This analysis suggests that equity in health will be difficult to achieve in this region unless there more explicit attention is paid to the underlying nutrition and food security determinants. These in turn are being shaped by larger forces such as trade rules, corporatisation of the food supply chain, HIV/AIDS, gender inequalities etc. However we can start to identify areas of common action that would strengthen equity in food security, nutrition and health outcomes.
Country
Southern Africa Regional
Publisher
EQUINET
URL:
Equinet Publication Type
Discussion paper
Theme area
Governance and participation in health
Title of publication The Case for a Broad Social Movement for Peoples Health in South Africa
Date of publication
2004
Publication type
Journal Article
Publication details
Critical Health Perspectives 1 pp 2pp.
Publication status
Published
Language
English
Keywords
health workers, health policies, national health service, primary health care, health system, poverty
Abstract
Along with millions of others, health workers celebrated South Africa’s first democratic elections in 1994 as the first step in rolling back the devastating inequity of an apartheid era health system. At last the health needs of the whole population would be addressed with the advent of representative government and the anticipated “peoples” health system.
An impressive array of health policies and plans were designed to reduce inequities and improve the health of all South Africans. Health activists and struggle veterans were in consensus that a single, unified National Health Service based on a comprehensive Primary Health Care approach would be the key to this transformation.
Despite one of the most progressive constitutions on the planet and a strong rhetorical commitment to addressing the health needs of the poor, implementation has been slow. The huge effort put into reshaping the “architecture” of the health system has not translated into real health gain for all South Africans. Many of the poorest still find themselves marginalized and neglected, just as they were in pre-democratic South Africa.
Country
South Africa
Publisher
People\'s Health Movement
URL:
URL
Theme area
Values, policies and rights
Title of publication Health and human rights abuses in Zimbabwe
Date of publication
2004 December
Publication type
Journal Article
Publication details
Critical Health Perspectives 2 pp 2pp.
Publication status
Published
Language
English
Keywords
human rights, Zimbabwe, doctors, patients, treatment access
Abstract
The human rights environment in Zimbabwe has become increasingly complex. For the last few years political violence has dominated any discussion about health and human rights. Since 2000 there have been periods of intense violence across the whole country, especially around national elections. This punctuates a background intimidation that prevents people from engaging in open discussion, especially where it is different from the official version. Doctors are afraid to challenge the violence because they are afraid of being labeled anti-government or belonging to the opposition, or simply afraid of what ‘might’ happen to them if they stick their necks out. There have been situations of doctors refusing to see or avoiding patients who are victims of organised or state violence. In one case a well-known human rights lawyer was denied treatment at a health facility because a health care worker was afraid to implicate himself if the matter went to court. Such is the atmosphere of intimidation. Violence and torture is carried out to make people support the ruling party and government, or at least make them too afraid to oppose it.
Country
Zimbabwe
Publisher
People\'s Health Movement
URL:
Theme area
Equity in health
Title of publication The potential impact of US-SACU FTA negotiations on public health in southern Africa
Date of publication
2004 November
Publication type
Document
Publication details
TRALAC working paper 6 pp 37pp.
Publication status
Published
Language
English
Keywords
Southern African Customs Union, free trade area, TRIPs, WTO, essential medicines, public heatlh
Abstract
This paper examines the impact and potential consequences of the current negotiations between the Southern African Customs Union (SACU) and the United States (US) aimed at establishing a Free Trade Area (FTA). Given the lull in TRIPs Council negotiations at the WTO following the collapse of the Cancún Ministerial, there has been a marked escalation of bilateral activity, with the US displaying its intention to negotiate and sign FTAs on issues that may continue to remain outside the realm of the WTO for an indeterminable period of time (primarily relating to the Singapore issues). It is highly likely that the FTA negotiations will address a number of trade issues which may have a negative impact on the prospects of increasing access to essential medicines for southern Africans in need of such medicines. Bearing in mind the WTO’s General Council Decision of 30 August 2003 as well as the ambitious timetable and deadline set for the US-SACU negotiations (originally set for conclusion by December 2004), this paper examines what the potential impacts of these negotiations may be on public health in southern Africa, more particularly, in the SACU region.
Country
Southern Africa Regional
Publisher
Trade Law Centre for Southern Africa
URL:
Theme area
Health equity in economic and trade policies
Title of publication Developing countries and trade in health services: which way is forward?
Date of publication
2004
Publication type
Journal Article
Publication details
International Journal of Health Services 34 3 pp 453-466
Publication status
Published
Language
English
Keywords
international trade in health services, international trade agreements, liberalization, GATS, public health
Abstract
International trade in health services appears to be increasing It may receive a further boost when liberalized and bound under international trade agreements, such as the General Agreement on Trade in Services (GATS). Liberalization of trade in health services can create opportunities, but may also exacerbate preexisting problems. Moreover, once liberalization is locked in under international trade agreements, reversing policies becomes difficult, especially for developing countries. Making undue commitments to liberalize health services under GATS may therefore result in the loss of policy space. Yet the GATS agreement contains considerable flexibility to fine-tune commitments in accordance with national (health) objectives. But flexibility entails complexity, and for GATS the complexity is compounded by the fact that some of its rules are still being developed. Moreover, flexibility is meaningless unless used, and used well, which calls for a profound analysis of the alternatives and their implications. This article provides an overview of considerations related to (international) trade in health services and key features of GATS that are relevant to public health. It highlights that policymakers have something at stake in GATS negotiations; thus, they should take an interest in liberalization of trade in health services, analyze its implications, and give input and guidance to their country\'s trade negotiators. Moreover, to convey their concerns and aspirations effectively, they must learn the trade language, while staying focused on (public) health objectives.
Country
Indonesia
Publisher
International Journal of Health Services
Theme area
Health equity in economic and trade policies
Title of publication International trade agreements: hazards to health?
Date of publication
2004
Publication type
Journal Article
Publication details
International Journal of Health Services 34 3 pp 467-481
Publication status
Published
Language
English
Keywords
neoliberalism, health services, international trade agreement, health care, universal access
Abstract
Since the 1980s, neoliberal policies have prescribed reducing the role of governments, relying on market forces to organize and provide health care and other vital human services. In this context, international trade agreements increasingly serve as mechanisms to enforce the privatization, deregulation, and decentralization of health care and other services, with important implications for democracy as well as for health. Critics contend that social austerity and \\"free\\" trade agreements contribute to the rise in global poverty and economic inequality and instability, and therefore to increased preventable illness and death. Under new agreements through the World Trade Organization that cover vital human services such as health care, water, education, and energy, unaccountable, secret trade tribunals could overrule decisions by democratically elected officials on public financing for national health care systems, licensing and training standards for health professionals, patient safety and quality regulations, occupational safety and health, control of hazardous substances such as tobacco and alcohol, the environment, and affordable access to safe water and sanitation. International negotiations in 2003 in Cancun and in Miami suggested that countervailing views are developing momentum. A concerned health care community has begun to call for a moratorium on trade negotiations on health care and water, and to reinvigorate an alternative vision of universal access to vital services.
Country
United States
Publisher
International Journal of Health Services
Theme area
Equity and HIV/AIDS
Title of publication Under the Patam tree
Date of publication
2004 December
Publication type
Document
Publication details
Pan African Treatment Access Movement (PATAM) Newsletter 3 pp 18pp.
Publication status
Published
Language
English
Keywords
HIV/AIDS, Africa, treatment access, treatment literacy
Abstract
In this edition you will find a broad range of articles on activities
within the movement against obstacles to HIV/AIDS treatment. The articles all highlight different aspects of the struggle.
Country
South Africa
Publisher
PATAM
URL:
Theme area
Health equity in economic and trade policies
Title of publication Economic development in Africa: Debt sustainability: Oasis or mirage?
Date of publication
2004
Publication type
Conference Proceedings
Publication details
United Nations Conference on Trade and Development pp 98pp.
Publication status
Published
Language
English
Keywords
debt, Africa, HIPC, Paris Club, unsustainable debt situation
Abstract
In the context of the Millennium Development Goals (MDGs), the international community has set itself a target of reducing poverty by half by the year 2015. Many observers have now come to the conclusion that, on present trends, there is very little likelihood that this objective can be achieved at any time close to that date in the poorer countries, including in Africa.
The continent’s debt problems and its resource requirements are inextricably linked to the capacity of African countries to generate capital accumulation and growth. Among the policy measures that UNCTAD has advanced (UNCTAD, 1998) is the need for an independent assessment of debt sustainability in African countries by a high-level panel of experts on finance
and development, selected jointly by debtors and creditors, with an undertaking by creditors to implement fully and swiftly any recommendations that might be made. While this recommendation did not find favour in the donor community, it was contended that the Heavily Indebted Poor Countries
(HIPCs) Initiative, and later its enhanced version, would ensure a permanent exit solution to Africa’s debt problems. There now seems to be an emerging consensus, however, that many African countries continue to suffer from a debt overhang despite the HIPC Initiative and various actions in the context of the Paris Club. The fact that even those countries that have reached (or are about to reach) the so-called completion point will soon find themselves in an unsustainable debt situation gives credence to the arguments advanced by critics with respect to the inappropriateness of the criteria applied in the debt sustainability analysis. And the fact that several more debt-distressed African countries are not eligible for HIPC debt relief reflects the lack of objectivity in the eligibility criteria.
Debt sustainability is basically a relative concept. The questions that beg for a response are: what level of debt is sustainable for countries in which the vast majority of the population lives on under $1 a day per person? Have debt sustainability criteria been based on internationally recognized benchmarks such as those of the MDGs, or on objectively and theoretically verifiable
criteria? What is the relationship between Africa’s total external debt stocks and the actual amount of debt serviced? Is complete debt write-off a moral hazard or a “moral imperative”?
The current study tries to put these and other related issues in perspective and makes a number of recommendations on how to deal with Africa’s debt overhang, either through the adoption of new approaches or a major revision and improvement of present debt relief policies.
Country
Switzerland
Publisher
United Nations Conference
URL:
Theme area
Equity and HIV/AIDS
Title of publication European Parliament resolution on World AIDS Day
Date of publication
2004 November
Publication type
Conference Proceedings
Publication details
Session document B6-0190/2004 pp 4pp.
Publication status
Published
Language
English
Keywords
responses to HIV/AIDS, poverty, underdevelopment, illiteracy, pharmaceutical companies, rate of infection
Abstract
European Union Resolution on World Aids Day, 2004.
Country
Publisher
European Parliament, ALDE Group
URL:
Theme area
Equity in health, Values, policies and rights, Poverty and health
Title of publication 80 million lives: Meeting the Millennium Development Goals in child and maternal survival
Date of publication
2003
Publication type
Book
Publication details
Publication status
Published
Language
English
Keywords
Millenium Development Goals; primary healthcare, rights-based framework
Abstract
This report argues that the failures in healthcare over the last decade have been the result of flawed analysis and lack of political will. If we are to achieve the Millennium Development Goals (MDGs) we must now absorb the lessons we have learned, and refocus our attention on broad-based, sectorally coordinated, primary healthcare (PHC) system development, located within a rights-based framework, to which all governments must give their
commitment.
Country
Scotland
Publisher
Grow Up Free from Poverty Coalition
URL:
Theme area
Governance and participation in health
Title of publication Facets of experience of the civil society in relation to the 3/5 Initiative
Date of publication
2005 January
Publication type
Conference Proceedings
Publication details
NGO Forum for Health annual symposium pp 3pp
Publication status
Published
Language
English
Keywords
3/5 Initiative, primary health care, wars and conflicts, rape
Abstract
This paper looks at three important issues for WHO to take into consideration in the 3/5 Initiative, namely: primary health care, wars and conflicts and rape.
Country
Tanzania
Publisher
People\'s Health Movement
URL:
Theme area
Human resources for health, Equity and HIV/AIDS
Title of publication HIV, disease plague, demoralization and \'burnout\': Resident experience of medical profession in Nairobi, Kenya
Date of publication
2002
Publication type
Journal Article
Publication details
Culture, Medicine and Psychiatry 26 pp 55-86
Publication status
Published
Language
English
Keywords
depression, HIV/AIDS, hopelessness, Kenya, medical education, narrative, physician burnout
Abstract
This paper describes the experiences of physicians-in-training at a public hospital in Nairobi, Kenya, where medical professionals practice in an environment characterized by both significant lack of resources and patients with HIV/AIDS in historically unprecedented numbers. The data reported here are part of a larger study examining ethical dilemmas in medical education and practice among physicians in East Africa. A questionnaire and semi-structured interview were completed by fifty residents in four medical specialties, examining social and emotional supports, personal and professional sources of stress, emotional numbing and disengagement from patients and peers, and symptoms of
post-traumatic stress and depression. The factors affecting resident well-being are found in this study to be more complex than previous interviews suggested. This study highlights the fact that as a result of working in an environment characterized by poor communication
among hospital staff as well as a lack of resources and high numbers of patients with HIV/AIDS, residents’ perceptions of themselves – their technical proficiency, their ability to care and feel for others and themselves, and for some their entire sense of self – are significantly affected. Also affected are the patients they work to treat.
Country
United States
Publisher
Kluwer Academic Publishers
URL:
Theme area
Equitable health services
Title of publication The bitterest pill of all: The collapse of Africa\'s health systems
Date of publication
2004
Publication type
Report
Publication details
Publication status
Publication status unknown
Language
English
Keywords
health systems, health sector reforms, user fees
Abstract
World leaders are currently discussing the establishment of a multi-billion dollar package aimed at tackling major diseases in poor countries, such as HIV/Aids, TB and malaria. This would be a welcome step forward. However it is important that lessons from the last 30 years are learned before such vast resources are committed. This report, informed by consultations with 50 donor representatives and others involved in healthcare provision in Africa, looks at these important lessons.
Country
Publisher
URL:
Theme area
Poverty and health
Title of publication Poverty reduction and human development in Africa
Date of publication
2004 November
Publication type
Journal Article
Publication details
Journal of Human Development 5 3 pp 399-415
Publication status
Published
Language
English
Keywords
Poverty, Africa, Human development, Governance, Economic growth, Income, Education, Health, Debt, Aid, HIV/AIDS, Landlocked country
Abstract
This paper uses cross-national data to investigate the extent to
which the adoption of human development strategies has resulted in a reduction of poverty in Africa. Inter-country variations in income and human poverty reinforce the established patterns of well-being within the continent, as countries in Northern and Southern Africa have the lowest levels of poverty. The empirical analysis reveals that inter-country differences in poverty levels can be accounted for by variables indicative of the different facets of human development. These include public expenditure on education, primary school enrolment, female educational enrolment,
expenditure on health, and good governance. Other significant variables apart from those pertaining to human development are economic growth, high external debt, the prevalence of HIV/AIDS and the geographical disadvantage of being a landlocked country. The paper also shows that foreign aid has had a limited effect on poverty reduction in Africa.
Country
Jamaica
Publisher
Carfax Publishing, Taylor and Patrick Group
URL:
Theme area
Governance and participation in health
Title of publication Discussion paper 21: Governance, participatory mechanisms and structures in Zambia’s health system: An assessment of the impact of Health Centre Committees (HCCs) on equity in health and health care
Date of publication
2004 December
Publication type
Document
Publication details
EQUINET Discussion Paper 21 pp 1-86
Publication status
Published
Language
English
Keywords
health centre committees, HCCs, district level, community participation, Zambia
Abstract
Using a semi-structured questionnaire, along with key in-depth interviews, PRA tools, stakeholder workshops, outcome mapping techniques and the collection of available data at health facilities. The HCCs were still in existence at all sampled health facilities. Those that performed well during the earlier survey had continued to perform well, despite facing challenges such as hostility from the health system. The innovations introduced were still in place and functioning. However, on average HCCs were known to no more than 20% of community residents. HCCs were better known among the less poor socioeconomic groups than among the poorest groups in society. The better performing HCCs were also performed well with respect to participation in decision making, priority setting, monitoring expenditure and quality of services. Some HCCs had acquired authority to make own decisions on certain things. The better performing HCCs kept their user fees lower and provided for other alternatives to cash payments than the poor performing HCCs. All key stakeholders at district level, whether from HCCs, frontline health workers and from the DHMT were unanimous to say that HCCs have made an impact and their value to the health system was acknowledged. However, this impact was limited in terms of the desired equity goals and coverage. There was consensus too that HCCs had little or no impact among vulnerable groups and in important decision making roles at the health centre, especially in relation to clinical care services. Channels of communication have been developed between the health system and HCC in health promotion and provision of preventive services. Even then, there were still problems in the flow of information, which was usually one way from the health system to communities, with feedback being rare infrequent and ineffective.
Country
Zambia
Publisher
EQUINET, Centre for Health, Science & Social Research (CHESSORE)
URL:
Equinet Publication Type
Discussion paper
Theme area
Governance and participation in health
Title of publication Resolucoes da reuniao sobre s alliancas parliamentares para a igualdade na Saude na Africa Austral, 20-22 de Agosto de 2003, Africa do Sul
Date of publication
2003 August
Publication type
Document
Publication details
EQUINET Resolutions pp 1-2
Publication status
Published
Language
Portuguese
Keywords
parliament, health, trade, southern Africa
Abstract
Country
Southern Africa Regional
Publisher
EQUINET
Equinet Publication Type
Resolutions
Theme area
Resource allocation and health financing, Governance and participation in health
Title of publication Discussion paper 18: Assessing the impact of Health Centre Committees on health system performance and health resource allocation
Date of publication
2004 February
Publication type
Document
Publication details
EQUINET Discussion Paper 18 pp 1-68
Publication status
Published
Language
English
Keywords
Health Centre Committees, health planning, management, resource allocation, access, health seeking behaviour, health care, Zimbabwe
Abstract
This study sought to analyse and better understand the relationship between Health Centre Committees (HCCs) in Zimbabwe as a mechanism of participation and specific health system outcomes, including: improved representation of community interests in health planning and management at health centre level; improved allocation of resources to health centre level, to community health activities and to preventive health services; improved community access to and coverage by selected priority promotive and preventive health interventions; enhanced community capabilities for health (through improved health knowledge and health seeking behaviour, appropriate early use of services); and improved quality of health care as perceived both by providers and users of services.
Country
Zimbabwe
Publisher
EQUINET, TARSC, CWGH
URL:
Equinet Publication Type
Discussion paper
Theme area
Equity and HIV/AIDS
Title of publication Discussion paper 20: Expanding treatment access and strengthening HIV and AIDS programmes in ways that strengthen the broader health systems agenda: Issues for the Global Fund to fight HIV/AIDS, TB and Malaria
Date of publication
2004 September
Publication type
Document
Publication details
EQUINET Discussion Paper 20 pp 1-10
Publication status
Not published
Language
English
Keywords
health systems strengthening, HIV/AIDS treatment, ART programmes, southern Africa
Abstract
This paper outlines the need to ensure a ‘health systems-strengthening’ approach to the delivery of AIDS treatment (ART) as a means for ensuring not just the equitable delivery of essential health care more generally, but also for ensuring the long-term and sustained effectiveness of ART programmes. The paper describes three sets of inadvertent health systems effects that may emanate from the rapid expansion of treatment access in the context of under-resourced and weak health care systems. These are: 1) the worsening of existing health and health care inequities; 2) the weakening of the public health system through the adoption of inappropriate and inadequately coordinated vertical programmes and through the injudicious use of non-government delivery agents; and 3) undesirable and unintended opportunity costs associated with the diversion of scare health care resources to treatment programmes.
Country
Southern Africa Regional
Publisher
EQUINET
URL:
Equinet Publication Type
Discussion paper
Theme area
Governance and participation in health
Title of publication SADC Health Protocol
Date of publication
1999 August
Publication type
Document
Publication details
Publication status
Not published
Language
English
Keywords
SADC, health protocol
Abstract
Country
Southern Africa Regional
Publisher
SADC
URL:
Theme area
Values, policies and rights
Title of publication The health sector policy framework document
Date of publication
2000 September
Publication type
Document
Publication details
Publication status
Not published
Language
English
Keywords
health sector, citizens health, \"Health for All\", primary health care strategy
Abstract
The goal of the Health Sector is to attain an acceptable standard of health for all citizens by promoting, coordinating and supporting the individual and collective efforts of Member States. Within this goal are two aims:
a) to reach specific targets within the objective of “Health for All” in the 21st century by 2020 in all Member States based on the primary health care strategy; and
b) to ensure that health care is accessible to all within each Member State’s economic reality.
Country
Southern Africa Regional
Publisher
SADC Health Sector Coordinating Unit
URL:
Theme area
Governance and participation in health, Monitoring equity and research to policy
Title of publication Discussion paper 19: Effectiveness of District Health Boards in interceding for the community
Date of publication
2004 October
Publication type
Document
Publication details
EQUINET Discussion Paper 19 pp 1-38
Publication status
Published
Language
English
Keywords
health reforms, public health sector, community involvement, health care delivery, effective structures, Zambia
Abstract
The overall objective of the study was to assess the effectiveness of health governance structures in enhancing equity of access and community participation in the delivery of health care services in Zambia. The specific objectives were to: (i) describe the status of health governance structures in Zambia; (ii) examine the linkages between the health governance structures and community; (iii) asses how the health governance structures represent and respond to community inters and needs; (iv) determine the extent to which the community is involved in the planning of health care services and resource allocation and (v) propose option for enhancing equity of access and community participation in the delivery of health care services. A cross-sectional study design was used. Both qualitative and quantitative data were collected using various techniques; interviews, focus group discussion and review of records. Four districts (two rural and two urban) were covered in two provinces.
Country
Zambia
Publisher
EQUINET; The Institute of Economic and Social Research (INESOR), University of Zambia
URL:
Equinet Publication Type
Discussion paper
Theme area
Health equity in economic and trade policies
Title of publication A response to ActionAid International and other organizations
Date of publication
2004 September
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
IMF, operational approach, combatting HIV/AIDS, foreign aid policies, public health
Abstract
The effort to combat HIV/AIDS requires an ongoing debate over issues related to economic, public health and foreign aid policies. The IMF is always ready to engage in discussions that have the potential to enhance our understanding of these issues-and to improve our operational approach to them.
Country
United States
Publisher
External Relations Department, IMF
URL:
Theme area
Health equity in economic and trade policies
Title of publication National policies and economic growth: A reappraisal
Date of publication
2004 February
Publication type
Book Section
Publication details
Draft chapter for Handbook of Economic Growth pp 70pp.
Publication status
Not published
Language
English
Keywords
Macro-economic policy and health, IMF, World Bank, world poverty rates, poverty reduction
Abstract
An influential study by World Bank researchers Paul Collier and David Dollar (2001) finds that policy reform in developing countries would accelerate their growth and cut world poverty rates in half. They conclude that Poverty reduction – in the world or in a particular region or country – depends primarily on the quality of economic policy. Where we find in the developing world good environments for households and firms to save and invest, we generally observe poverty reduction.
I find the audacious claim that policy reform can cut world poverty in half a little daunting – even more so since Collier and Dollar base their results on an unpublished growth regression by me! (Like firearms, it is dangerous to leave growth regressions lying around.)
The International Monetary Fund (2000) also claims that “Where {sound macroeconomic} policies have been sustained, they have raised growth and reduced poverty.” These claims are often held out as hope to economically troubled continents
like Africa: “Policy action and foreign assistance … will surely work together to build a continent that shows real gains in both development and income in the near future.”
Unfortunately, this claim was made in World Bank (1981) and the “real gains” in Africa have yet to arrive as of 2003.
Do the ambitious claims for the power of policy reform find support in the data? Are they consistent with theoretical views of how policy would affect growth? The large literature on the determinants of economic growth, beginning with Romer (1986), has intensively studied national economic policies as key factors influencing long run growth. In this chapter, I take a look the state of this literature today, both theoretical and empirical. I do not claim to comprehensively survey the literature. I focus the chapter on the question of how strong is the case that national economic policies (by which I mean mainly macroeconomic and trade policies) have economically
large effects on the growth rate of economies.
I am in the end skeptical that national policies have the large effects that the early growth literature claimed, or that the international agencies claim today. Although extremely bad policy can probably destroy any chance of growth, it does not follow that good macroeconomic or trade policy alone can create the conditions for high steady state growth.
Country
United States
Publisher
Center for Global Development, New York University
URL:
Theme area
Equity in health
Title of publication Steering Committee briefing: International Society for Equity in Health conference, Toronto, June 2002
Date of publication
2002 June
Publication type
Document
Publication details
Steering Committe Briefing pp 1-2
Publication status
Not published
Language
English
Keywords
research, policy, advocacy for health services, southern Africa
Abstract
EQUINET recently participated and held a workshop in the second conference of the International Society for Equity in Health, Toronto Canada in June 2002. The event brought together people from across the globe to share their interest and knowledge of issues of health and equity. The theme for the gathering was Equity: Research in the Service of Policy and Advocacy for Health and Health Services.
Country
Southern Africa Regional
Publisher
EQUINET
Equinet Publication Type
Briefs
Theme area
Equity in health, Governance and participation in health
Title of publication Steering Committee briefing: Will a new leadership unleash new potentials for health?, August 2002
Date of publication
2002 August
Publication type
Document
Publication details
Steering Committee Briefing pp 1-2
Publication status
Not published
Language
English
Keywords
WHO, elections, policy changes, global
Abstract
In August 2002 Gro Harlen Bruntland, Director General (DG) of WHO, announced that she would not seek a second term as DG. This report compiles some of the debates and papers that have been presented around her record at WHO, the candidates for the new DG and the selection process itself. The political moment created by the election of a new DG stimulates debate about WHO’s priorities and role in international and global health, as the leadership qualities sought in a new DG should reflect those roles.
Country
Southern Africa Regional
Publisher
EQUINET
Equinet Publication Type
Briefs
Theme area
Equity in health
Title of publication Steering Committee briefing: Global Forum 6 conference, 12-15 November 2002, Arusha, Tanzania
Date of publication
2002 December
Publication type
Document
Publication details
Steering Committee Briefing pp 1-2
Publication status
Not published
Language
English
Keywords
10/90 gap, health problems, resource allocation, research
Abstract
The GFHR made one of the meeting's primary goals to address the so-called 10/90 gap. Only 10 per cent out US 70 billion dollars spent worldwide on health research by the public and private sectors is devoted to 90 per cent of health problems faced by poor countries. Most research money, according to GFHR, is spent on diseases like cancer or degenerative conditions, which are more common in affluent nations. The meeting in Arusha aimed to discuss recent progress in helping correct the 10/90 gap, disseminate key research findings, and develop longer term action plans for promoting health research for development and fight against poverty. The Global Forum's host partner was the National Institute for Medical Research of Tanzania (NIMR), an institution founded in 1980 to promote, coordinate, monitor, evaluate and undertake health research on behalf of the government of Tanzania.
Country
Zimbabwe
Publisher
EQUINET
Equinet Publication Type
Briefs
Theme area
Resource allocation and health financing
Title of publication Steering Committee briefing: Briefing on EQUINET workshop on resource allocation and deprivation issues, June 2002
Date of publication
2002 June
Publication type
Document
Publication details
EQUINET Steering Committee Briefing pp 1-2
Publication status
Not published
Language
English
Keywords
lessons, resource allocation, Southern Africa
Abstract
A recent workshop hosted by Equinet brought together research teams from Namibia, Tanzania and Zambia. The teams, comprising a mix of Health Department officials and researchers, discussed the appropriateness of lessons drawn from the South African experience for their own countries. The workshop was assisted by the presence of a team from the Western Australian Department of Health and Curtin University who have been using an innovative and participatory approach to resource allocation issues. This provided a useful contrast to the more statistical approach used in the South African study.
Country
Southern Africa Regional
Publisher
EQUINET
Equinet Publication Type
Briefs
Theme area
Governance and participation in health
Title of publication Steering Committee briefing: Can we better support parliaments to turn protocols into practice for equity in health in southern Africa?, September 2004
Date of publication
2004 September
Publication type
Document
Publication details
Steering Committee Briefing pp 1-2
Publication status
Not published
Language
English
Keywords
SADC health protocol, regional co-operation in health, parliaments, public policy, southern Africa
Abstract
The SADC Health Protocol came into force at the 2004 SADC Mauritius Summit and now applies across the region. It outlines the priorities and mechanisms for regional co-operation in health. We look forward to the protocol being raised and discussed within the parliaments of the region to see how far we are making progress in the regional priorities and approaches signed on to by the heads of state in Mauritius. Why should parliaments be important to struggles for equity in health? Parliaments are a watchdog of public policy and consolidate this policy in law. In their legislative role they are able to transform social norms and values into binding legal entitlements. Their oversight role on the budget and on the actions of the executive provides an important opportunity to ensure that these legal entitlements are realized in practice. For example parliaments are an important watchdog of the government Abuja summit commitment that at least 15% of government budgets are invested in the public health sector. They can give voice through various processes of debate, inquiry, public hearings and consultation to public views, including the views of those areas and groups where such voice may be weaker or less articulate.
Country
Southern Africa Regional
Publisher
EQUINET
Equinet Publication Type
Briefs
Theme area
Human resources for health
Title of publication Steering Committee briefing: Investing in our health workers: approaches to the scarcity and loss of health personnel in southern Africa, November 2004
Date of publication
2004 November
Publication type
Document
Publication details
Steering Committee Briefing pp 1-2
Publication status
Not published
Language
English
Keywords
health workers, scarce health personnel, migration of health workers, policies, southern Africa
Abstract
After decades of neglect, Human Resources for Health (HRH) has in the past few years moved to centre stage of both international and regional debates. Within southern Africa health personnel continue to be scarce in services where they are most needed, are a critical bottleneck to the uptake of new resources from global funds and the region is suffering from escalating out migration of health workers. Dealing with this impact of the migration of health personnel raises debates about effective and just strategies. Those that restrict health worker rights of movement often don’t work and punish individuals. ‘Ethical human resource’ policies and codes appear to have made little difference to practice on the ground, especially when movement is driven by pull and push factors in both sending and receiving countries. So what comprehensive measures will secure the human resources that southern Africa needs for its health services?
Country
Southern Africa Regional
Publisher
EQUINET
Equinet Publication Type
Briefs
Theme area
Values, policies and rights, Monitoring equity and research to policy
Title of publication Steering Committee briefing: Policy analysis work currently underway in EQUINET, April 2003
Date of publication
2003 April
Publication type
Document
Publication details
Steering Committee Briefing pp 1-2
Publication status
Not published
Language
English
Keywords
policy analysis and implementation, constraints on decision-making, equity orientated advocacy, southern Africa
Abstract
The core of policy analysis work is a concern for how decisions are made and how to strengthen future decision-making. Policy analysis work can inform our analyses of the political economy of inequity, of the strategies required to promote and support equity-oriented policies and of the practical approaches to enable implementation of such policies. Yet despite its important role in analyses of, and advocacy, for equity, only few people in the SADC region are actively involved in conducting such analyses Equinet’s current programme of work seeks to begin to address this gap through a dual focus on capacity building in policy analysis and the implementation of relevant small-scale projects. Its objectives are to: promote investigation of health equity-related topics using policy analysis frameworks; better understand the forces constraining decision-making on equity issues and shaping the achievement of equity goals in the health sector; identify levers for equity-oriented advocacy and policy change within the health sector at national/regional/international levels; build capacity in conducting health policy analyses; and strengthen the networks between those involved in this area of work.
Country
Southern Africa Regional
Publisher
EQUINET
Equinet Publication Type
Briefs
Theme area
Equity in health, Monitoring equity and research to policy
Title of publication Policy paper 9: Using Demographic and Health Survey (DHS) data to describe intra country inequities in health status: Zimbabwe
Date of publication
2000 September
Publication type
Document
Publication details
Policy paper 9 pp 1-17
Publication status
Published
Language
English
Keywords
monitoring equity, tools for monitoring equity, Demographic and Health Surveys, health status, health care services, Zimbabwe
Abstract
Improving equity in health is a goal for many countries, for wide disparities in health of different social groups based in privilege is considered to be undesirable and socially unjust. The monitoring of equity is an important activity in the furtherance of this goal. There is however, a need for tools that are valid and relatively easy to use and process, to be able to monitor equity, to provide appropriate information for policy makers and practitioners. Existing data sources could provide useful information for monitoring purposes. One such data source are the Demographic and Health Surveys.
Demographic and Health Surveys (DHS) have been carried out in a number of countries, in many instances more than once. DHS surveys have been carried out in Zimbabwe in 1988, 1994 and 1998. Whilst the Demographic and Health Surveys are primarily concerned with gathering data on fertility and contraception, they also collect data on health status and on some indicators of socioeconomic status. For many countries, these surveys are often the definitive sources of information on demographic, contraception, fertility and health status trends and issues. This indicates a recognition that the data generated by these surveys is of good quality and sufficiently valid to inform policy and practice, particularly in the area of family planning and reproductive health. Through a reanalysis of the DHS data, the potential exists to be able to examine indicators of health status and reported health seeking behaviour by gender, and by different socioeconomic and ethnic groups, at national and at provincial/regional level within countries. As there are often DHS data available at different time points, (the surveys are usually carried out at intervals of five to seven years), the possibility exists for the exploration of trends in health status and health care services in relation to indicators of equity. In so doing, tools could be developed to allow for a description of equity issues, and the generation of hypotheses of how policies and practices might affect equity.
Country
Zimbabwe
Publisher
EQUINET; Social Science and Medicine Africa Network (SOMANET), Department of Community Medicine, University of Zimbabwe
URL:
Equinet Publication Type
Policy paper, Equity indicators
Theme area
Health equity in economic and trade policies
Title of publication Steering Committee briefing: World Trade Organisation agreements: Time to make public health a more central concern, June 2001
Date of publication
2001 June
Publication type
Document
Publication details
Steering Committee Briefing pp 1-3
Publication status
Not published
Language
English
Keywords
World Trade Organisations, TRIPS, public health, policy, drug access, southern Africa
Abstract
The demands that global trade rules now place on southern African states to implement policy, legal and institutional measures to sustain essential drug access, meet public health obligations and protect equity in access to health care. This primarily relates to restrictions on options for lower cost access to newly patented pharmaceutical drugs, and reduced regulation of international private health sector providers.
Country
Southern Africa Regional
Publisher
EQUINET
Equinet Publication Type
Briefs
Theme area
Health equity in economic and trade policies
Title of publication ActionAid International USA & co-authors respond to the IMF critique of "Blocking Progress"
Date of publication
2004 October
Publication type
Document
Publication details
Publication status
Language
English
Keywords
IMF, HIV/AIDS, spending, inflation rates
Abstract
Prior to the October 2-3, 2004 annual meetings of the International Monetary Fund and World Bank in Washington DC, ActionAid International USA and its partners at Global AIDS Alliance, Student Global AIDS Campaign and RESULTS Educational Fund collectively released a policy briefing titled, \\\\\\"Blocking Progress: How the Fight Against HIV/AIDS is Being Undermined by the World Bank and International Monetary Fund.\\\\\\" The briefing explains that current public spending on fighting HIV/AIDS in some of the world\\\\\\\'s poorest countries is being constrained by unnecessarily low inflation targets that are a direct or indirect result of IMF loan conditions. The briefing points out that there is an open debate among economists about what level of inflation begins to undermine economic growth rates, and states that the IMF has a position on one end of this open debate without adequate justification. Yet, this IMF position leads directly and indirectly to tight budget ceilings on public health expenditures that may not be necessary or justifiable.
On September 30, 2004 the IMF\\\\\\\'s External Relations Department posted on the front page of the IMF website, \\\\\\"A Response to ActionAid International and Other Organizations,\\\\\\" which described our briefing as \\\\\\"partly correct but fundamentally wrong in how it assesses the role of the Fund in the fight against HIV/AIDS\\\\\\" and \\\\\\"a vehicle largely for recriminations and accusations.\\\\\\"
Though we welcome and are thankful for the IMF\\\\\\\'s willingness to debate our analysis with us, we feel the IMF response mischaracterizes and misstates the findings of and questions raised in our policy briefing. Consequently, we feel obliged to issue a point-by-point rebuttal publicly in order to clarify and correct many of the points made by the IMF in their response. We still look forward to discussing this issue and others with the IMF in the future.
Country
United States
Publisher
Action Aid International USA
URL:
Theme area
Poverty and health
Title of publication Steering Committee briefing: Equity, poverty and health – how do we make a difference at household level?, July 2001
Date of publication
2001 July
Publication type
Document
Publication details
Steering Committee Briefing pp 1-2
Publication status
Not published
Language
English
Keywords
households, access to healthcare, health service charges, social structures and norms, poor communities, health equity outcomes, resource constraints, southern Africa
Abstract
Many studies show that the poor have serious difficulties in obtaining access to health care. The barriers to household access to health care range from health service charges, to costs of seeking care, to the social structures and norms that influence use of services. Households and individuals within poor communities face different levels of these barriers, influencing health equity outcomes. If health interventions are to reach poorer communities in ways that overcome these barriers, we need to better understand how poor households respond to ill health, the resource constraints they face, the coping strategies they use and the trade–offs they make. We also need to better understand the impact of poverty on health decision-making at household level.
Country
Southern Africa Regional
Publisher
EQUINET
Equinet Publication Type
Briefs
Theme area
Values, policies and rights
Title of publication Steering Committee briefing: Equity in health in Southern Africa: Turning values into practice, May 2001
Date of publication
2001 May
Publication type
Document
Publication details
Steering Committee Briefing pp 1-3
Publication status
Not published
Language
English
Keywords
resource allocation, macro-economic policies, equity, health gains, essential servies, southern Africa
Abstract
Equity in health implies addressing differences in health status that are unnecessary, avoidable and unfair. In southern Africa, these typically relate to disparities across racial groups, rural/urban status, socio-economic status, gender, age and geographical region. It was noted that equity motivated interventions in the highly unequal situation in southern Africa should ensure different inputs for those whose needs are different (vertical equity). This means that resources should be allocated preferentially to those with the worst health status; and that higher income groups should contribute proportionately more than those with fewer resources.
It was also noted that macro-economic policies shape the redistribution of social and economic resources and thus affect equity oriented interventions. So too does the power and ability people (and social groups) have to make choices over health inputs and their capacity to use these choices towards health. Where policy measures aimed at greater health equity have overlooked these wider factors, they have been less effective and less sustained in their implementation. The paper observed the health gains were made in southern Africa, particularly through primary health care and public health interventions, and the set-backs in more recent years. Many SADC countries now have relatively high levels of deprivation, with poor access to essential services as well as low levels of human development (such as income and educational status) relative to their economic development levels. Significant disparities have emerged across geographic areas, “ethnic” or “race” groups, and between men and women, generally, and within health and access to health care. Macroeconomic policies have also intensified inequalities in household food intake, income and employment levels and access to education, safe water and other non health sector inputs to health. Structural adjustment and market reforms have affected the level and composition of public expenditure, reducing provision of and access to primary health care services, particularly in low income groups. Reduced access to health care and other safety nets have exacerbated the ‘poverty ratchet’ of ill-health.
Country
Southern Africa Regional
Publisher
EQUINET
Equinet Publication Type
Briefs
Theme area
Resource allocation and health financing
Title of publication Ugandan officials negotiate Global Fund grants: Government limits on health-sector spending may jeapordise funding agreement
Date of publication
2004 January
Publication type
Journal Article
Publication details
The Lancet 363 pp 1pp.
Publication status
Published
Language
English
Keywords
Uganda, health finance,
Abstract
Ugandan health and finance officials are in fresh negotiations
over the future of grants from the Global Fund to fight HIV/AIDS,
Tuberculosis, and Malaria. Last month, the Ministry of Finance
declared that, with effect from July this year, all donor project funds, including the Global Fund’s grants, would have to fit within fixed sector ceilings. Such ceilings mean that public-sector spending has a fixed limit. Therefore, if a sector receives any new funds that
were not initially budgeted for, it forfeits a similar amount from the
government coffers.
Country
United Kingdom
Publisher
Elsevier
URL:
Theme area
Equity and HIV/AIDS
Title of publication Blocking progress: How the fight against HIV/AIDS is being undermined by the World Bank and International Monetary Fund
Date of publication
2004 September
Publication type
Book
Publication details
A policy briefing pp 27pp.
Publication status
Published
Language
English
Keywords
developing countries, HIV/AIDS crisis, public health spending, rates of inflation, IMF, World Bank
Abstract
The seven wealthiest governments (G7), who dominate IMF decisions and influence most other foreign aid donors have an unjustifiable preference for low inflation in developing countries. Poor countries with severe HIV/AIDS crises will not be able to significantly increase public health spending without the possibility of inflation also increasing slightly, but the G7 governments forbid higher rates of inflation. Effective treatment and prevention of HIV//AIDS in low-income countries will require that G7 governments change their policy position, allowing for desperately-needed
increases in public health spending, that may however low the risk, result in slightly higher levels of inflation.
Country
United States
Publisher
Action Aid International USA, Global Aids Alliance, Student Global AIDS Campaign, RESULTS Educational Fund
URL:
Theme area
Equity in health
Title of publication Meeting report: Country meeting on equity in health in Malawi, Lilongwe, 6 October 2004
Date of publication
2004 June
Publication type
Document
Publication details
EQUINET Meeting report pp 1-14
Publication status
Published
Language
English
Keywords
health equity, Malawi
Abstract
EQUINET supported the Malawi Health Equity Network to hold a one day meeting to review the work being done in Malawi on equity in health, under its wider programme of support to health civil society and work on health equity in the region. The meeting was carried out with support from the Rockefeller health civil society support, and as a follow up to the country strengthening processes resolved at the EQUINET conference in June 2004. The meeting was held at the Lingadzi Inn in Lilongwe, Malawi. Twenty-eight individuals from civil society, government, academic and research institutions with an interest in health equity in Malawi attended the meeting.
Country
Malawi
Publisher
EQUINET, MHEN
URL:
Equinet Publication Type
Reports
Theme area
Equity in health
Title of publication Resolucoes: Reivindicando o Estado: Melhorando a Saúde do Povo, Desafiando a Injustiça, Durban, África do Sul , 8 e 9 de Junho de 2004
Date of publication
2004 June
Publication type
Document
Publication details
TERCEIRA CONFERÊNCIA DA ÁFRICA AUSTRAL SOBRE A IGUALDADE NA SAÚDE pp 1-2
Publication status
Published
Language
Portuguese
Keywords
public health, justice, southern Africa
Abstract
Country
Southern Africa Regional
Publisher
EQUINET
Equinet Publication Type
Resolutions
Theme area
Equity in health
Title of publication Resolutions: Redonner son rôle à l’etat: Promouvoir la santé des populations, lutter contre les injustices, Durban, Afrique du Sud, 8-9 JUIN 2004
Date of publication
2004 June
Publication type
Document
Publication details
Publication status
Published
Language
French
Keywords
public health, justice, southern Africa
Abstract
Country
Southern Africa Regional
Publisher
EQUINET
Equinet Publication Type
Resolutions
Theme area
Governance and participation in health
Title of publication Resolutions de la rencontre sur les alliances parlementaires pour l'equite en Sante en Afrique Australe
Date of publication
2003 August
Publication type
Document
Publication details
EQUINET Resolutions pp 1-2
Publication status
Published
Language
French
Keywords
Abstract
Country
Southern Africa Regional
Publisher
EQUINET, GEGA, SADC
Equinet Publication Type
Resolutions
Theme area
Governance and participation in health
Title of publication Resolutions of the meeting on parliamentary alliances for equity in health in Southern Africa
Date of publication
2003 September
Publication type
Document
Publication details
EQUINET Resolutions pp 1-2
Publication status
Published
Language
English
Keywords
parliamentary committees on health, civil society, health professionals, health equity policies, southern Africa
Abstract
Country
Southern Africa Regional
Publisher
EQUINET, GEGA, SADC
Equinet Publication Type
Resolutions
Theme area
Equity and HIV/AIDS
Title of publication NGO study examines state budgets for HIV/AIDS in African and Latin American countries
Date of publication
2004 September
Publication type
Document
Publication details
Press release pp 3pp.
Publication status
Published
Language
English
Keywords
national strategic plans; HIV/AIDS; resource allocation, national budgets, inadequate health systems, treatment
Abstract
The study found that while many countries have developed national strategic plans and programmes, these were poorly costed and budgeted. It also found that the tracking of resources allocated towards HIV/AIDS in national budgets was hindered by weak or absent links between allocations and their intended objectives and outputs. Governments have inadequate systems in place to track the allocation of resources for HIV/AIDS.
Yet the research yielded a number of important findings. In Africa most countries, until recently, have focused on prevention more than treatment. This despite the fact that WHO/UNAIDS estimates that 3.8 million Africans are in need of treatment, while only 150 000 people are currently receiving the life-prolonging drugs. The study notes the boost to HIV/AIDS spending following the recent announcement and launch of ARV treatment programmes in South Africa, Mozambique, Kenya and Namibia. However the researchers caution that even though governments may increase their allocations to provide treatment, this programme may be undermined if more money is not made available to strengthen the health system overall.
Country
South Africa
Publisher
IDASA
URL:
Theme area
Governance and participation in health
Title of publication Content analysis of debates on health in the National Assembly: A case study of Malawi
Date of publication
2004 September
Publication type
Document
Publication details
Publication status
Not published
Language
English
Keywords
policy on health, health services, health personnel, National Assembly
Abstract
A qualitative study was conducted to document the content of the discussions in the Malawi National Assembly in order to inform policy on health and programmatic decisions. The theme areas that members of parliament spent most time on included requests for; health services or health personnel, upgrading of health facilities, and more drugs. It was identified that there was lack of follow-up in future sittings on matters discussed at a previous meeting of the House. For instance, it was noted that what was discussed at a previous sitting were not necessarily brought back for updates and a later sitting of the House. There were several cases where a matter that was not up to date was brought for discussion, not for follow-up but rather out of lack of knowledge that the matter had already been concluded. A case in point would be where a member of parliament would be asking for a service in his/her constituency which Ministry of Health would report that such a service is already being provided in the member’s constituency. Parliamentary immunity and privilege may be a dilemma as it may provide the basis for some MPs to say things that are not well researched. Organizations working with parliament need to understand the process and functioning of National Assemblies. Matters debated and agreed upon in the House, may not necessarily mean it will receive government’s attention later.
Country
Malawi
Publisher
Department of Media Studies, University of Malawi, The Polytechnic, Blantyre, MALAWI; Department of Community Health, College of Medicine
URL:
Theme area
Equitable health services
Title of publication Evaluation of the hemoglobin Colour scale in anaemia screening in Schistosomiasis [S.haematobium] infected school children at community level in rural Zimbabwe
Date of publication
2004
Publication type
Document
Publication details
Publication status
Not published
Language
English
Keywords
equity in health, health status, disparities, race, rural/urban, socio-economic status, gender, age, geographical region, low income communities, low cost methods of diagnosis, anaemia
Abstract
‘Equity in health’ implies addressing differences in health status that are unnecessary, avoidable and unfair. In southern Africa, these typically relate to disparities across racial groups, rural/urban status, socio-economic status, gender, age and geographical region. One mechanism of achieving this end is to make health services more equitable or to increase their accessibility for low income communities. One area for this is to make diagnostic tools more accessible through providing low cost methods for the diagnosis of commonly occurring public health problems, such as anemia.
Country
Zimbabwe
Publisher
National University of Science & Technology; Dept of Applied Biology and biochemistry
URL:
Theme area
Monitoring equity and research to policy
Title of publication GHEN News
Date of publication
2004 August
Publication type
Document
Publication details
GHEN News 3 pp 6pp.
Publication status
Published
Language
English
Keywords
action research; policy implementation; gender; health equity; communities
Abstract
GHEN action research case studies are currently being implemented in India, China, and Mozambique. The three case studies share a common set of research objectives. These are:
· To improve policy implementation with respect to gender and health equity in contexts of high or persisting poverty and inequality;
· To enable communities, and particularly poor women and adolescents, to exercise their rights to good health.
In this issue of GHEN News we provide an overview of the three GHEN case studies and a brief progress report of activities over the last 12 months. We also report on one of the key emerging themes arising from GHEN implementation experiences to date: how to scale up and influence policy.
Country
Mozambique
Publisher
GHEN News
URL:
Theme area
Equity and HIV/AIDS
Title of publication Expanding treatment access and strengthening HIV and AIDS programmes in ways that strengthen the broader health systems agenda: Issues for the Global Fund to Fight HIV/AIDS, TB and Malaria
Date of publication
2004 September
Publication type
Report
Publication details
Position paper for the Global Fund for AIDS, TB and Malaria (GFATM) pp 8pp.
Publication status
Published
Language
English
Keywords
health systems, ART expansion
Abstract
This paper is based on work done and consultations held in EQUINET and the IDRC / SDC Research Matters network. It has been drafted as a position paper for the Global Fund for AIDS, TB and Malaria (GFATM). It aims to raise concerns around health systems strengthening for sustainable ART expansion and the manner in which the GFATM can respond to such concerns.
Country
Zimbabwe
Publisher
EQUINET, IDRC Research Matters
URL:
Equinet Publication Type
Discussion brief
Theme area
Governance and participation in health
Title of publication Meeting report: Assessing the impact of health centre committees on health system performance and health resource allocation
Date of publication
2004 February
Publication type
Report
Publication details
Final project report, February 2004 pp 1-69
Publication status
Published
Language
English
Keywords
community interests; resource allocation; health centres, health care services, Zimbabwe
Abstract
This study sought to analyse and better understand the relationship between health centre committees in Zimbabwe as a mechanism of participation and specific health system outcomes, including: Improved representation of community interests in health planning and management at health centre level; improved allocation of resources to health centre level, to community health activities and to preventive health services; improved community access to and coverage by selected priority promotive and preventive health interventions; enhanced community capabilities for health (through improved health knowledge and health seeking behaviour , appropriate early use of services); and improved quality of health care as perceived both by providers and users of services.
Country
Zimbabwe
Publisher
TARSC; CWGH; EQUINET
URL:
Equinet Publication Type
Reports
Theme area
Health equity in economic and trade policies
Title of publication Trade-related intellectual property rights, trade in services and the fulfilment of children’s rights - Botswana, September 2004
Date of publication
2004 September
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
trade, intellectual property, Convention on the Rights of the Child, human rights
Abstract
Botswana has shown strong political commitment to fulfilling the child’s right to health and the child’s right to life, survival and development. In order to sustain this commitment, it is necessary that Botswana refrain from entering into trade agreements that would undermine its obligations under the Convention on the Rights of the Child and other human rights treaties. It is also crucial that Botswana undertake impact assessments of the human rights effect of proposed IP rules and services liberalization before negotiating and implementing trade agreements. Furthermore, it is important that Botswana take measures to consult and ensure access to information to groups representing children and other vulnerable groups, according to its obligations under the Convention on the Rights of the Child.
Country
Botswana
Publisher
3D->Trade - Human Rights - Equitable Economy
URL:
Theme area
Equity and HIV/AIDS
Title of publication Meeting report: Monitoring equity and health systems issues in ART programmes in Southern Africa, Lilongwe Malawi, 7-8 October 2004
Date of publication
2004 October
Publication type
Report
Publication details
Report of a regional meeting, Lilongwe Malawi, 7-8 October 2004 pp 1-34
Publication status
Published
Language
English
Keywords
HIV, AIDS, health policy, health services, treatment access, resources for health care, east and southern Africa
Abstract
About 15 million adults and children in southern Africa are currently infected with HIV and an estimated 700, 000 - 1million currently have AIDS. HIV and AIDS have had and continue to have a deep impact on health and health equity issues in Southern Africa, imposing challenges in mounting a response to an epidemic that cuts across its economic, social and public health dimensions. In 2003-2004 EQUINET carried out a programme jointly with various institutions in southern Africa and Oxfam GB to inform the policy debates that have grown around health sector responses to HIV and AIDS in the region, particularly with respect to care and treatment access. This programme explored the equity dimensions of the policy choices that are being made within health policy around health services, treatment access and resources for health care. The programme commissioned and produced country research papers (from Zimbabwe, Malawi and South Africa) and a SADC regional paper and further papers on health personnel, nutrition and food security.
Country
Southern Africa Regional
Publisher
EQUINET
URL:
Equinet Publication Type
Reports
Theme area
Health equity in economic and trade policies, Equity and HIV/AIDS
Title of publication Access to medicines in under-served markets: What are the implications of changes in intellectual property rights, trade and drug registration policy?
Date of publication
2004 September
Publication type
Document
Publication details
A DFID HSRC overview paper, drawing on seven studies commissioned by DFID UK pp 35pp.
Publication status
Published
Language
English
Keywords
intellectual property, drug registration, access to medicine, poor, policy implications, generic medicine
Abstract
Major changes in international trade, intellectual property (IP) protections and drug registration requirements are substantially affecting pharmaceutical markets, with significant implications for access to medicines by poor people. The UK government has set out its commitment to increase access to medicines, and to contribute to the efforts of other governments, the private sector, investors and wider stakeholders, in a comprehensive strategy, Increasing access to essential medicines in the developing world: UK Government policy and plans.
Within this framework, and drawing on legal, regulatory, economic and pharmaceutical industry expertise, the UK’s Department for International Development (DFID) has commissioned a series of seven studies. The studies, summarised in this paper, examine the policy implications of these trends for emerging producers of generic medicines such as India and China, and for poor people in developing countries. A key question is how strengthened intellectual property protections and heightened registration standards may or may not improve access to medicines in these currently under-served markets.
Country
United Kingdom
Publisher
DFID
URL:
Theme area
Equity in health
Title of publication Policy paper 15: Reclaiming the state: Advancing people’s health, challenging injustice
Date of publication
2004 June
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
SADC development, health assesments, health equity, inequalities, Southern Africa
Abstract
With the common focus on poverty and ill health, we often forget that Southern Africa is one of the richest regions in Africa and in resource terms in the world. The Southern African Development Community is a regional community that is made up of 14 countries. The SADC land mass covers cover 9 066 840 square km (the equivalent of the USA or China), has a population of over 194 million (which is 30% of the total Sub-Saharan African population) and a combined GDP of US$178 billion in 1999 (Chauvin and Gaulier 2002). Its size and resource base provide both economic and social potential for addressing its health challenges (Muroyi et al 2003).
Despite this wealth of potential, the value of these resources have not yet been adequately harnessed for the people of the region. People have been impoverished by colonial, multinational and elite exploitation of African resources, falling terms of trade for African products, huge resource outflows due to debt, migration, war, displacement, persistent inequalities in access to wealth, poor access to public resources and other factors described further in this paper.
Health assessments by SADC thus point to a profile of the common health problems arising from social and economic poverty and inequality: food insecurity; people who cannot access the basic safe water, sanitation, energy, transport and shelter; high levels of HIV/AIDS, TB, Malaria and other communicable and non communicable diseases, and illness and mortality related to reproductive roles (SADC 2002). These problems are unequally distributed across urban and rural areas, across high and low income communities, across gender, race and social class groupings (EQUINET SC 1998, EQUINET SC 2000). The different experiences of ill health reflect inequalities in access to incomes and in ownership of wealth: Ten out of fourteen SADC countries have Gini coefficients in excess of 0.50 (SURF 2000).
Country
Southern Africa Regional
Publisher
EQUINET
URL:
Equinet Publication Type
Policy paper
Theme area
Equity in health
Title of publication Maazimio June 2004: Kurudisha hali ya afya: Kuendeleza afya ya watu, kupambana na uonevu
Date of publication
2004 June
Publication type
Conference Proceedings
Publication details
Mkutano wa tatur wa nchi za kusini mwa Afrika kuhusu usawa katika afya pp 1-2
Publication status
Published
Language
Swahili
Keywords
public health, justice, southern Africa
Abstract
Country
Southern Africa Regional
Publisher
EQUINET
URL:
Equinet Publication Type
Resolutions
Theme area
Equity and HIV/AIDS
Title of publication Proposed framework for monitoring equity in access and health systems issues in antiretroviral therapy (ART) programmes in Southern Africa
Date of publication
2004 September
Publication type
Document
Publication details
EQUINET DISCUSSION PAPER pp 46pp.
Publication status
Not published
Language
English
Keywords
monitoring equity, HIV/AIDS, ART access, policy development, ART programme integration, human resource development
Abstract
This paper, commissioned by EQUINET, proposes a draft framework for monitoring equity in access and health systems issues in ART programmes in Southern Africa, with Malawi as a case study. It proposes that an equity monitoring system would comprise seven theme areas:
i. Fair policy development, monitoring and accountability through fair process
ii. Equitable access to ART with realistic targets
iii. Fair and sustainable financing and accountable financial management
iv. ART programme integration into the delivery of the essential health package
v. Prioritised human resource development to deliver the essential health package
vi. Sustainable & accountable purchase, distribution and monitoring of drugs and commodities for ART and the essential health package
vii. Ensuring private sector provision of ART is complementary to and enhances public health system capacity
These theme areas encompass a national monitoring ‘system’ which extends beyond one agency or single data collection method. It is intended to be holistic, recognising that some monitoring aspects will be conducted separately by partner organisations in order that together, the contributions of different organisations comprise the
national-level monitoring system. It is also important to recognise that not all aspects of the monitoring could be conducted on an annual basis.
Country
Malawi
Publisher
Equi-TB Knowledge Programme, Malawi; EQUINET
URL:
Equinet Publication Type
Discussion paper
Theme area
Equity in health
Title of publication Workshop report: Writing for peer reviewed journals, Durban, 4-7 June 2004
Date of publication
2004 June
Publication type
Report
Publication details
EQUINET Workshop report pp 1-24
Publication status
Not published
Language
English
Keywords
equity in health, capacity building, southern Africa
Abstract
The capacity building: skills workshop writing for peer reviewed journals workshop was hosted by the Southern African Regional Network on Equity in Health (EQUINET) in co-operation with The University of New South Wales, Sydney. The workshop was run from 4-7th June at the Tropicana Hotel, Durban, South Africa. It was timed to take place before the ISeQH and Southern African Conference on Equity on Health to enable participants to also attend these two important scientific events. It was hoped that the skills built in this workshop would be used to prepare papers for scientific publication with international peer reviewed journals on equity in health.
Country
Southern Africa Regional
Publisher
EQUINET
URL:
Equinet Publication Type
Toolkits and training materials
Theme area
Equity and HIV/AIDS
Title of publication Meeting report: Equity issues in HIV/AIDS, health sector responses and treatment access in Southern Africa, Harare, 19 February 2003
Date of publication
2003 February
Publication type
Report
Publication details
EQUINET Meeting report pp 1-17
Publication status
Published
Language
English
Keywords
HIV, AIDS, public policy, trade, employment, poverty, socieal welfare, gender equity, health sector responses, southern Africa
Abstract
The response to HIV/AIDS is clearly inseparable from wider public policy around trade, employment, poverty, social welfare and gender equity. While equity is a central issue across these public policy responses, the changes in demand for health care, and access to resources for prevention and care and the role of treatment in mitigation of future impact have made equity in access to treatment a critical issue for prevention, caring and mitigation of impacts of HIV/AIDS.
The meeting reviewed current knowledge and issues related to equity in health sector responses to HIV/AIDS, (including treatment access); refined further the scope and key areas for focus of the technical paper at regional and country level; and identified the audiences and processes that should be targeted by the papers and the follow up work to be done.
Country
Southern Africa Regional
Publisher
TARSC
URL:
Equinet Publication Type
Reports
Theme area
Governance and participation in health
Title of publication Meeting report: Impacts of participation and governance on equity in health systems, Harare, 29 May 2003
Date of publication
2003 June
Publication type
Report
Publication details
Report of a research review meeting of the GovERN network, 29 May 2003 pp 30pp.
Publication status
Published
Language
English
Keywords
community action, empowerment, governance in health
Abstract
A community action and empowerment programme is necessary as a way to build and strengthen community capacity to participate in governance in health. An action needs to be worked out, based on the strengths and weaknesses highlighted. Similarly, a programme to systematically alter health worker attitudes and (mis)perceptions on community participations and governance in health needs to be considered and implemented. The specifics to these issues will become clear after validating the findings following the holding of the forthcoming stakeholder meeting in the next phase of this project work.
Country
Southern Africa Regional
Publisher
TARSC, CHESSORE
URL:
Equinet Publication Type
Reports
Theme area
Governance and participation in health
Title of publication Equity in health concerns: Adolescent reproductive health and trade and health, Harare, 21 November 2003
Date of publication
2003 November
Publication type
Report
Publication details
Report on the workshop of the Parliamentary Portfolio Committee on Health and Child Welfare, NGOs and Civic Organisations, Harare, 21 November 2003 pp 21pp.
Publication status
Published
Language
English
Keywords
parliament, adolescent health, trade, WTO, impacts on health, policy concerns
Abstract
The objectives of the meeting were thus:
To review health equity concerns identified at SADC regional level and identify those issues that have relevance to the parliamentary Committee on Health
To review current policy, programmes and perspectives on adolescent reproductive health and identify policy concerns and areas for follow up by parliament
To review and discuss World Trade Organization trade agreements that have impact on health, the positions taken at SADC regional level on protecting health in trade agreements and identify areas for follow up by parliament
Country
Zimbabwe
Publisher
TARSC; CWGH
URL:
Theme area
Equity in health
Title of publication Meeting report: Tanzanian network on equity in health, Dar es Salaam, 26 February 2004
Date of publication
2004 February
Publication type
Report
Publication details
Tanzania National Meeting on Equity in Health, Dar es Salaam, 26 February 2004
Publication status
Published
Language
English
Keywords
national health equity network, Tanzania
Abstract
This meeting was carried out by the Tanzania members of EQUINET in terms of is one of the key goals of the strategic plan, strengthening the network. Noting the critical mass of equity actors and EQUINET supported activities in Tanzania and the resolution made in 2000 to form a country network in Tanzania, the Tanzanian organisations active in EQUINET proposed to hold a one day meeting for EQUINET to review the work being done in Tanzania and to discuss plans for launching a national health equity network.
Country
Tanzania
Publisher
EQUINET
URL:
Equinet Publication Type
Reports
Theme area
Human resources for health
Title of publication How to bridge the gap in human resources for health
Date of publication
2004 October
Publication type
Journal Article
Publication details
The Lancet 364 pp 1451-1456
Publication status
Published
Language
English
Keywords
human resorces, health systems, low income countries, skill requirements, training
Abstract
Human resources are the crucial core of a health system, but they have been a neglected component of health-system development. The demands on health systems have escalated in low income countries, in the form of the Millennium Development Goals and new targets for more access to HIV/AIDS treatment. Human resources are in very short supply in health systems in low and middle income countries compared with high income countries or with the skill requirements of a minimum package of health interventions. Equally serious concerns exist about the quality and productivity of the health workforce in low income countries. Among available strategies to address the problems, expansion of the numbers of doctors and nurses through training is highly constrained. This is a difficult issue involving the interplay of multiple factors and forces.
Country
United Kingdom
Publisher
Elsevier Ltd
URL:
Theme area
Monitoring equity and research to policy
Title of publication Consideration of reports submitted by states parties under Article 44 of the convention: Concluding observations of the Committee on the Rights of the Child: Botswana
Date of publication
2004 October
Publication type
Report
Publication details
CRC C/15 Add.242 pp 13pp.
Publication status
Not published
Language
English
Keywords
children, policy, law, Botswana, Child Act
Abstract
The Committee considered the initial report of Botswana (CRC/C/51/Add.9), submitted on 10 January 2003, at its 977th and 978th meetings (see CRC/C/SR.977 and CRC/C/SR.978), held on 16 September 2004, and adopted at the 999th meeting, held on 1 October 2004 , the following concluding observations.
Country
Botswana
Publisher
CRC
URL:
Theme area
Monitoring equity and research to policy
Title of publication Making research matter: A civil society perspective on health research
Date of publication
2004 October
Publication type
Report
Publication details
Bulletin of the World Health Organization 82 10 pp 757-763
Publication status
Published
Language
English
Keywords
health services research, delivery of health care, non-governmental organisations, primary health care, epidemiologic factors, health priorities, policy making, social justice, consumer participation, evidence-based medicines
Abstract
Complex global public health challenges such as the rapidly widening health inequalities and unprecendented emergencies such as the pandemic of human immunodeficiency virus/ acquired immunodeficiency syndrome (HIV/AIDS) demand the reappraisal of existing priorities in health policies, expenditure and research. Research can assist in mountin an effective response, but will require increased emphasis on health determinants at both the national and global levels, as well as health systems research and broad-based and effective public health initiatives. Civil society organizations (CSOs) are already at the forefront of such research. We suggest that there are at least three ways in which the participation of CSOs in research can be increased: namely, influencing commissioning and priority-setting; becoming involved in the review process and conduction research; and through formal partnerships between communities and universities that link CSOs with academic researchers.
Country
Switzerland
Publisher
WHO
URL:
Theme area
Equity and HIV/AIDS
Title of publication Proposed code for the Southern African Development Community (SADC): Urgent measures needed to promote the equality of women and the reduction of women\'s risk of HIV infection
Date of publication
2004 March
Publication type
Book
Publication details
Code developed at SAT/AIDS Consortium/AIDS Law Project Advocacy Training Workshop held in February 2003 pp 20pp.
Publication status
Published
Language
English
Keywords
women, gender, equality, equity treatment access, socio-economic status, laws and customs, sexual and reproductive rights
Abstract
The links between HIV/AIDS and gender, and particularly how HIV/AIDS affects women differently from men, have not received sufficient attention by governments or civil society in Southern Africa. Despite the fact that many people may accept that women are more vulnerable to contracting HIV because of their biological make-up and that this vulnerability is increased because of women’s social status in society, very little has been done to deal effectively with gender inequality, gender-based violence and women’s empowerment.
Most SADC governments have signed or ratified the International Convention on the Elimination of all Forms of Discrimination Against Women (CEDAW). All have signed the UNGASS Declaration. But within our countries and communities measures are still not being implemented to tackle women’s inequality.
The AIDS epidemic has taught us that it is vital to address gender imbalances and power inequalities as part of a comprehensive approach to HIV/AIDS. A ‘Code on the equality of women and the reduction of risk of HIV infection’ can be a useful instrument to highlight the most important and common gender issues in the region, and propose strategies on how to deal with these issues in an urgent and comprehensive manner. Areas that should receive particular attention include:
- Violence against women and girls
- Women’s lower socio-economic status
- Laws and customs that discriminate against women and girls
- Women’s sexual and reproductive rights
- Women as caregivers
- Women’s lack of access to treatment
The proposed Code should be an instrument that can be used by the community, traditional leaders, civil society as well as policy- and law-makers to design and implement gender-sensitive programmes, participate in interventions that will address women’s vulnerability and to contribute to the prevention and treatment of HIV/AIDS in Southern Africa. By working together as a region we will be better able to address gender inequalities and engage with the epidemic in a constructive way.
Country
South Africa
Publisher
AIDS Rights Alliance for Southern Africa (ARASA)
URL:
Theme area
Monitoring equity and research to policy
Title of publication Informed choices for attaining the Millennium Development Goals: Towards an international cooperative agenda for health-systems research
Date of publication
2004 September
Publication type
Journal Article
Publication details
The Lancet 364 pp 997-1003
Publication status
Published
Language
English
Keywords
equitable, effective and efficient health systems, Millenium Development Goals, research, financial resources, human resources, health services, governance, knowledge management, global influences,
Abstract
Health systems constraints are impeding the implementation of major global initiatives for health and the attainment of the Millennium Development Goals (MDGs). Research could contribute to overcoming these barriers. An independent task force has been convened by WHO to suggest areas where international collaborative research could help to generate the knowledge necessary to improve health systems. Suggested topics encompass financial and human resources, organisation and delivery of health services, governance, stewardship, knowledge management, and global influences. These topics should be viewed as tentative suggestions that form a basis for further discussion. This article is part of a wide-ranging consultation and comment is invited. The potential agenda will be presented at the Ministerial Summit on Health Research in November, 2004, and revised in the light of responses. Subsequently, we hope that resources will be committed to generate the evidence needed to build the equitable, effective, and efficient health systems needed to achieve the MDGs.
Country
United Kingdom
Publisher
Elsevier Ltd
URL:
Theme area
Equity and HIV/AIDS
Title of publication Responding to HIV/AIDS in Africa: A comparative analysis of responses to the Abuja Declaration in Kenya, Malawi, Nigeria and Zimbabwe
Date of publication
2004 June
Publication type
Book
Publication details
ActionAid pp 23pp.
Publication status
Published
Language
English
Keywords
Abuja Declaration, HIV/AIDS strategies, Kenya, Malawi, Nigeria, Zimbabwe, ARV delivery, health service infrastructure, resources,legislation, civil society participation, community based organising
Abstract
The challenge of tackling HIV/AIDS was taken up by African Heads of State at their summit in Abuja in 2001. This lead to the Abuja Declaration, the primary goal of which is to reverse the accelerating rate of HIV infection, TB and other related infectious diseases. As part of its international campaign on HIV/AIDS, ActionAid International commissioned a series of
studies in 2003 and 20042 to discover the extent to which the Abuja commitments were being realised in African countries.
Alongside its direct programme activities ActionAid International (AAI) is campaigning for the right and access to HIV/AIDS care for poor and marginalised communities, especially women and children. This report is based on the research carried out in
Kenya, Malawi, Nigeria and Zimbabwe and provides a comparative analysis of the achievements and challenges faced by these four African countries in relation to the Declaration.
Two and a half years after the Abuja Declaration there has been some progress in all four countries in implementing the agreed strategies. But much remains to be done. Political commitment is increasing and some progress has been made in the area of mobilising the formal and informal education sectors. Progress on the protection of human rights has been limited and everywhere stigma and discrimination remain a problem.
All four countries have attempted to address the need for care, support and treatment, but there are major gaps in delivery, particularly with regard to antiretroviral (ARV) treatment programmes. With the advent of the World Health Organisation’s initiative to treat three million people by 2005, care and treatment should improve but this will require a large investment in health service infrastructure, not least the development of human resources. The lack of sufficient and sustainable resources is a critical issue that continues to pose
challenges for all four countries, aggravated by weak infrastructure, poor legislation and policies, and lack of effective coordination of HIV/AIDS-related activities. As countries continue to work towards meeting the commitments made in Abuja, it would be helpful to revise the framework for action and express the commitments in more specific terms. This, combined with greater transparency regarding budgets, increased participation from civil society, especially women, people living with HIV/AIDS (PLWHA) and community based organisations, will allow all sections of society as well as government and the international community to monitor progress more effectively.
Country
South Africa
Publisher
Action Aid International
URL:
Theme area
Equity and HIV/AIDS
Title of publication Blocking progress: How the fight against HIV//AIDS is being underrmined by the World Bank and Interrnational Monetary Fund
Date of publication
2004 September
Publication type
Book
Publication details
Policy Briefing pp 27pp.
Publication status
Published
Language
English
Keywords
G7, IMF, World Bank, HIV/AIDS, health financing, public health spending, rates of inflation, low-income countries
Abstract
The seven wealthiest governments (G7), who dominate IMF
decisions and influence most other foreign aid donors have an unjustifiable preference for low inflation in developing countries. Poor countries with severe HIV/AIDS crises will not be able to significantly increase public health spending without the possibility of inflation also increasing slightly, but the G7 governments
forbid higher rates of inflation. Effective treatment and prevention of HIV//AIDS in low-income countries will require that G7 governments change their policy position, allowing for desperately-needed increases in public health spending.
Country
United States
Publisher
Action Aid International USA, Global AIDS Alliance, Student Global AIDS Campaign, RESULTS Educational Fund
URL:
Theme area
Equity and HIV/AIDS
Title of publication 3 by 5: Ensuring HIV/AIDS care for all
Date of publication
2004 June
Publication type
Report
Publication details
ActionAid pp 11pp.
Publication status
Published
Language
English
Keywords
HIV/ AIDS, prevention, care, equity, health systems, health service personnel, cost of medicines, financing ARV
Abstract
Unveiled in December 2003, the World Health Organisation’s (WHO) ambitious initiative to treat three million people by 20051 (hereafter 3 by 5) seeks to provide rapid access to approximately half the estimated six million people who are in dire need of antiretroviral therapy.
ActionAid International believes that HIV/AIDS-related care should be financially, socially and physically accessible to all people in need. We welcome the 3 by 5 initiative as an ambitious plan that emphasises the need to provide treatment to people living with HIV/AIDS in developing countries.
While ActionAid International recognises the importance of antiretroviral (ARV) therapy in responding to HIV/AIDS, our experience at community level, and our consultations with poor people infected or affected by HIV/AIDS, shows that the care requirements of infected persons and their families are multifaceted. Care must encompass nutrition, palliative care including psychosocial support, attention to poverty issues and freedom from discrimination and stigma.
Our experience in developing countries and our analysis of major donors and institutions leads us to believe that there are many hurdles to be surmounted before a good paper strategy like 3 by 5 can be translated into an effective and sustainable system for delivering care to people infected and affected by HIV/AIDS.
This paper addresses these concerns: prevention, care and support; equity; health system strengthening; funding and support to ensure that large-scale capacity building programmes for health service personnel are instituted without delay; the cost of medicines; and financing for ARV treatment.
Country
South Africa
Publisher
Action Aid International
URL:
Theme area
Equitable health services
Title of publication Guidelines to strengthen community involvement in district hospitals and to make hospitals more district friendly
Date of publication
2001 January
Publication type
Book
Publication details
The Equity Project pp 54pp.
Publication status
Published
Language
English
Keywords
district hospitals, guidelines, community involvement, hospital management
Abstract
These guidelines are intended to guide to Managers, District Health Training Officers and Non-Government Organisations when conducting workshops for hospital boards. They could be useful for District Managers who are concerned that community involvement has not yet influenced the management of hospitals. They are derived from existing published material on hospital boards. Experiences in workshops and hospital board meetings with ten hospitals in Regions A, B and C in the Eastern Cape Province have shown the value of the material collected in these brief guidelines.
Country
South Africa
Publisher
Management Sciences for Health
URL:
Theme area
Equity and HIV/AIDS
Title of publication Governmental relations and HIV service delivery
Date of publication
2004 March
Publication type
Book Section
Publication details
Publication status
Published
Language
English
Keywords
inter-governmental relations, South Africa, HIV/AIDS services
Abstract
This chapter reports on some of the main findings of a research project that examined inter-governmental relations in the health sector in South Africa. The study focused on HIV/AIDS services but the intention was to use HIV/AIDS as a tracer or probe of broader health system functioning. The main objectives of the research were to describe what HIV/AIDS services are provided, how the different functions are allocated between government actors, and how they are then coordinated.
The study was conducted in two parts. Phase 1 was completed in the second half of 2002 and provided a broad National Overview of HIV/AIDS activities in the national, provincial and local spheres of government. Phase 2 was done in early 2003 and consisted of detailed Case Studies from three different tracer municipalities. The research methodology was mainly qualitative and exploratory and included literature review, document analysis and key informant interviews.
Country
South Africa
Publisher
University of Witwatersrand, Centre for Health Policy
URL:
Theme area
Equity and HIV/AIDS
Title of publication Mainstreaming HIV/AIDS: A conceptual framework and implementing principles
Date of publication
2002 June
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
mainstreaming HIV/AIDS
Abstract
While the concept of mainstreaming has been with us for decades, its application to the area of HIV/AIDS is more recent and represents somewhat uncharted waters. Mainstreaming, within this context, is an essential approach for expanding multi-sectoral responses to HIV/AIDS. Mainstreaming of HIV/AIDS is not an intervention per se. It constitutes a range of practical strategies for scaling up responses and addressing the developmental impacts of HIV and AIDS globally and regionally. Through mainstreaming, government sectors, NGOs, private sector entities, church organisations, etc., can both meet the needs of their own workplace environment, as well as apply their comparative advantage to support specific aspects of national HIV/AIDS responses.
As with other approaches to this fast paced epidemic, understanding of mainstreaming is still evolving. This document tentatively explores the current understanding of the concept and examples of relevant experience. It provides a set of basic principles designed to enable those working at the different levels and aspects of HIV/AIDS policy and practice to begin using mainstreaming processes for expansion and acceleration of HIV/AIDS responses.
Country
Ghana
Publisher
JSA Consultants Ltd. & GTZ Regional AIDS Programme
URL:
Theme area
Human resources for health
Title of publication Motivation for community-based health volunteers in Blantyre, Malawi
Date of publication
2004 September
Publication type
Document
Publication details
Publication status
Publication status unknown
Language
English
Keywords
community health workers; motivation, roles and challenges, mobilisation
Abstract
Malawi is among the countries in the world that have been heavily affected by the HIV/AIDS pandemic with the prevalence rate estimated at 14% in 2003.1 The majority of hospitalized adult patients attending both surgical and medical wards at the Queen Elizabeth Central Hospital in Blantyre are HIV infected.2-4 There is a high patient mortality and those patients that are discharged from the hospital to the community eventually rely on community members through home-based care for healthcare, psychosocial and economic support. These community health care workers are meant to fill the gaps for unmet curative, preventative and promotion of health needs of communities as outlined by national community health workers programs which was established according to the 1978 WHO/UNICEF Primary Healthcare Conference.
While it is undeniable that the community-based volunteers serve a useful purpose in the delivery of health care in their communities there is always concern about sustainability especially regarding motivation of these volunteers. This cross section qualitative and quantitative study using in depth key informant interviews with community health volunteers and traditional leaders was done in Ndirande, a peri-urban area of Blantyre, Malawi to determine what motivates these volunteers, their roles, challenges and identify their source of supplies.
Intrinsic motivating factors included feelings of empathy, altruism and religious conviction. Extrinsic motivators were rarely mentioned. The roles of volunteers included; offering psycho-spiritual support, providing clothes, food and money including school fees to the vulnerable people. Volunteers were spending their own personal resources to help the underprivileged, as mobilizing resources from the local community through contributions was not seen as a viable option.
Country
Malawi
Publisher
College of Medicine Students’ Research Fund, Ireland Aid, MHEN
URL:
Theme area
Equity and HIV/AIDS
Title of publication HIV/AIDS and trade unions: A Mozambican perspective (briefing note)
Date of publication
2004 August
Publication type
Electronic Source
Publication details
Soul Beat Africa pp 2pp.
Publication status
Published
Language
English
Keywords
HIV/AIDS education, trade union activists
Abstract
This paper was prepared for distribution at an interdisciplinary research symposium on HIV/AIDS in the workplace, held from June 29-30 2004 at the University of the Witwatersrand, Johannesburg, South Africa. It provides an overview of current union activities focusing on HIV in Mozambique, based on discussion with Mozambican unionists working as HIV activists and on the work of the Linkage Program with a group of six women\\\\\\\'s committees from six different trade unions.
The paper states that although Mozambique suffers from high HIV prevalence and enjoys approved legislation protecting HIV-positive workers, few workplace policies and programmes are in place. Various factors have made it very difficult to mobilise unions or workplaces to educate about HIV/AIDS and protect HIV-positive workers. The paper refers to current initiatives of trade unions, including educating peers and lobbying for employers to support workplace programmes and for union leaders to focus support on these endeavours. However, only in 2003 did the first large-scale, tripartite HIV workplace initiative began, involving the Ministry of Labour, the two central unions, and three key companies.
Country
Mozambique
Publisher
Soul Beat Africa
URL:
Theme area
Human resources for health
Title of publication Impact of skilled migration on receiving countries
Date of publication
2003 May
Publication type
Electronic Source
Publication details
Science & Development pp 4pp.
Publication status
Published
Language
English
Keywords
migration, global gains, impact, globalisation
Abstract
The worldwide movement of highly skilled people is often seen as an exercise in accounting - one country gains \\"brains\\" that are \\"drained\\" out of another. But this is too simplistic. Many of the global gains from this kind of migration - the creation and transfer of knowledge, the emergence of a skilled and educated workforce, and the fostering of commercial ties - are shared to some extent by countries on both sides of the \\"equation\\".
But what of the impacts on the major world economies at the receiving end? For these countries, globalisation and the increasing economic importance of science and technology have made
skilled international migration an important - and contentious – policy issue.
In the field of biotechnology, for instance, the need for rare combinations of skills - such as expert knowledge about a particular protein together with experience of a particular regulatory procedure - has led some firms to recruit in a number of countries abroad. And in the information technology sector, rapid growth in demand and the easy transferability of skills and qualifications make it worthwhile for countries on the receiving end to cast their recruitment net widely.
Country
Publisher
SciDev
URL:
Theme area
Monitoring equity and research to policy
Title of publication Demographic surveillance and health equity in sub-Saharan Africa: Past and present efforts
Date of publication
2001
Publication type
Electronic Source
Publication details
African Journal of Reproductive Health
Publication status
Published
Language
English
Keywords
data, health policy, demographic surveillance, South Africa, Senegal
Abstract
The need for accurate data to inform health policy is a good justification for the blossoming of field research stations in sub-Saharan Africa. This need is even greater when it comes to reducing health inequalities in the region.
Over the past 60 years, demographic surveillance systems have been crucial research tools for the evaluation of health interventions aimed at reducing socio-economic differentials in mortality and morbidity in sub-Saharan Africa. The bulk of such work has been carried out by field research sites, often operating in remote, resource-constrained settings. The present paper reviews what we have learned since the pioneering work carried out in the filed sites of Pholela (South Africa) and Niakhar (Senegal). It then focuses on current efforts to address health equity through INDEPTH, the international network of field sites with continuous demographic evaluation of population and their health in developing countries.
Country
Kenya
Publisher
African Population and Health Research Centre
Theme area
Equity and HIV/AIDS
Title of publication Report of the SADC Pan-African Treatment Access Movement (PATAM) conference on HIV/AIDS and governance
Date of publication
2004 March
Publication type
Conference Proceedings
Publication details
CONFERENCE ON HIV/AIDS AND GOVERNANCE pp 60pp.
Publication status
Published
Language
English
Keywords
HIV/AIDS treatment access, health systems, health equity
Abstract
The Pan African Treatment Access Movement (PATAM) Conference on Scaling up Access to Treatment in Southern Africa was held from 3-5 March 2004. The Conference was co-hosted by SAfAIDS, ZAHA, The Centre, The AIDS Law Unit, Legal Assistance Centre, the AIDS Rights Alliance for Southern Africa and the Treatment Action Campaign (TAC) with material support from the Tides Foundation, HIVOS, WHO Afro, WHO International, Open Society Initiative for Southern Africa (OSISA), Department for International Development (DFID), AIDS Fonds and the UNAIDS. In planning, it was envisaged that the meeting would offer activists and others concerned with the HIV/AIDS epidemic in the region a thorough understanding of the barriers to treatment and associated implementation challenges, and from which a set of action items for implementation. In these regards, one of the most critical discussion points was to be on how to build strong national treatment access movements that would then channel their strengths into a regional and continental campaign.
The HIV/AIDS crisis in Africa was viewed not as a purely humanitarian tragedy; but far reaching having crippled political and social institutions, leaving a trail of devastation in its path. The Conference noted that the HIV/AIDS crisis in the SADC region is, to a very large extent, a leadership crisis. AIDS was viewed as a political issue to the extent that access to treatment was determined by political decisions. It is the failure of those who have the voices and power that hold the lives of many people in their hands to respond, that is killing millions of people in Africa every year. It was resolved that the issue of HIV/AIDS and access to treatment be put on the political agenda.
HIV and AIDS were characterized as a problem that thrives on silence. Silence is at all levels: individual, family, community, national and global levels. Openness exposed the virus and reduced the challenges of dealing with the disease.
Country
Zimbabwe
Publisher
PATAM
URL:
Theme area
Human resources for health
Title of publication Policy implications of the brain drain\'s changing face
Date of publication
2003 May
Publication type
Document
Publication details
Science & Development pp 4pp.
Publication status
Published
Language
English
Keywords
managing \"brain circulation; mobilit of highly skilled manpower
Abstract
An increasing number of specialists, aware that significant changes in migration patterns have occurred over the past three decades, now agree that a paradigm shift has occurred in the way these movements need to be observed, analysed and dealt with by policy makers.
Such a paradigm shift - from \\\\\\"brain drain\\\\\\" to \\\\\\"brain circulation\\\\\\" – has a major consequence for public policy, namely that the mobility of highly skilled manpower should be seen as a normal process that should not be stopped, and that the real challenge is therefore to manage it as well as possible.
Country
Publisher
SciDev
URL:
Theme area
Equity and HIV/AIDS
Title of publication HIV/AIDS charter
Date of publication
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
HIV/AIDS human rights; inequality; exploitation; corporate globalization
Abstract
Health is a social, economic and political issue and, above all, a fundamental human right. Inequality, poverty, exploitation, violence and injustice are at the root of ill-health. Achieving health for all means that powerful interests that work against people’s wellbeing have to be challenged, corporate globalization has to be opposed and political and economic priorities have to be drastically changed.
HIV and AIDS is a development issue that calls for social and political action. It is also a public health issue that requires people-oriented health and medical interventions. Such responses require democracy, pro-people inter-sectoral policies, good governance, people’s participation and effective communication. They should be rooted in internationally accepted human rights and humanitarian norms.
The special needs of women and children as infected persons, their dependents and care givers should be addressed.
In the current context, this Charter recognises the devastating impact of war and conflict on health systems and how it amplifies the vulnerabilities of people to HIV and AIDS.
This Charter draws upon perspectives of communities affected and infected with HIV and AIDS and those vulnerable to the infection. It encourages people to develop their own solutions and to hold accountable local authorities, national governments, international organisations and corporations to their promises and responsibilities.
Country
India
Publisher
People\'s Health Movement
URL:
Theme area
Equity and HIV/AIDS
Title of publication Global health initiatives in HIV/AIDS in Tanzania: Situation analysis and review of key issues
Date of publication
2004 July
Publication type
Document
Publication details
A briefing paper established in the frame of the SDC-STI SWAp Mandate 2003-4 pp 30pp.
Publication status
Published
Language
English
Keywords
global health initiatives, HIV/AIDS, Tanzania, resource allocation, funding, implementation, delivery, monitoring and evaluation, poverty alleviation
Abstract
With the abundance of global health initiatives (GHI) operating these days, an obvious question to ask is “with what effect?” HIV/AIDS is one disease that is particularly loaded with global health initiatives, and Tanzania is no exception. Therefore, the specific question of this study is to examine to what extent the current global health initiatives in HIV/AIDS are integrated into the health sector in Tanzania, and harnessed to meet Poverty Reduction and Health Sector Strategic Plan targets. To answer these questions, the following global health initiatives in HIV/AIDS in Tanzania were assessed: the National Care and Treatment Plan (NCTP), the Global Fund for HIV/AIDS, TB and Malaria (GFATM), the World Bank’s Tanzania Multi-Sectoral HIV/AIDS Project (TMAP), WHO’s “3 by 5” initiative, and the US President’s Emergency Fund for AIDS Response (PEPFAR). These GHIs are assessed under different thematic areas, covering: coordination, priority setting and planning, resource allocation, funding channel, resource requirements for implementation, mode of programme delivery, monitoring and evaluation, and poverty alleviation.
Country
Switzerland
Publisher
Swiss Agency for Development and Cooperation, Swiss Centre for International HealthSwiss Tropical Institute
URL:
Theme area
Equity in health
Title of publication The Equity Gauge: An approach to monitoring equity in health and health care in developing countries
Date of publication
2000 August
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
equity guage, key indicators, advocacy, commnunity participation
Abstract
An Equity Gauge is an approach to promoting equity which includes monitoring of key indicators, coupled with advocacy and community participation to ensure that information is acted upon. In August 2000 about 70 people from twenty countries came together in South Africa for a working meeting. Fourteen “Equity Gauge” projects made presentations, highlighting their main areas of focus, key stakeholder involvement and major activities. The foci of the Gauges represented at the meeting can be broadly grouped as follows: three have a city-wide focus, two an emphasis on community involvement, two an emphasis on resource allocation, and the remaining six are national survey related. A technical advisory team, providing expertise in measurement and data analysis, advocacy, and community participation, offered suggestions as to how the various Gauges could be strengthened. As a result of the discussions which took place during the meeting greater clarity on the essential components of an “Equity Gauge” has been achieved. Planning has now begun on developing a Global Equity Gauge Alliance which will promote equity by, among other things, providing support and technical expertise to current and emerging gauges.
Country
South Africa
Publisher
Health Systems Trust
URL:
Theme area
Human resources for health
Title of publication International scientific and healthworker migration
Date of publication
2004
Publication type
Report
Publication details
Science & Development pp 3pp.
Publication status
Published
Language
English
Keywords
globalisation, brain drain, highly-skilled
Abstract
As globalisation speeds on, goods, services and people are moving across national borders as never before. Recently, one group of migrants – those “highly skilled” in science and technology – has become the focus of worldwide scrutiny.
Scientists, engineers, information technology (IT) experts and talented university students from poorer countries are flocking to the industrialised world, drawn by the promise of better salaries and working conditions. But not everyone is happy with this arrangement; many – including the governments of some developing countries – regard the phenomenon as a “brain drain” that must be curbed. Others view the situation as with greater optimism, pointing out potentially significant benefits for countries of origin.
Country
Publisher
SciDev
URL:
Theme area
Values, policies and rights
Title of publication People\'s charter for health
Date of publication
2000 December
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
people\'s voices, economic priorities, health, human rights
Abstract
Health is a social, economic and political issue and above all a fundamental human right. Inequality, ooverty, exploitation, violence and injustice are at the root of ill-health and the deaths of poor and marginalised people. Health for all means that powerful interests have to be challenged, that globalisation has to be opposed, and that political and economic priorities have to be drastically changed. This Charter builds on perspectives of people whose voices have rarely been heard before, if at all. It encourages people to develop their own solutions and to hold accountable local authorities, national governments, international organisations and corporations.
Country
India
Publisher
People\'s Health Movement
URL:
Theme area
Monitoring equity and research to policy
Title of publication Country profiles for population and reproductive health: Policy developments and indicators 2003: Angola
Date of publication
2003
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
population health, reproductive health, statistics
Abstract
Constant political and military instability has led to the deterioration of the socio-economic and health care infrastructure in Angola, leaving large parts of the population vulnerable to displacement, hunger, violence and forced migration. Less than 35 per cent of the population has access to basic health services, sanitation and potable water. The unstable environment in the country has led donors to contribute more to emergency aid and less to sustainable, long-term programmes in population, development and reproductive health — where there is a significant need.
Angola has one of the highest maternal mortality rates in the world, as well as a relatively high annual population growth rate. High adolescent fertility rates are considered to be a significant problem. National attention, reflected in the UNFPA country programme, is focused on reproductive health, population and development strategies, and advocacy. To this end a policy statement, National Norms and Policies for Reproductive Health, was approved by the Ministry of Health in 2000. A national youth project, JIRO (Youth Informed, Responsible and Organized), promotes awareness-raising activities and education in reproductive health and encourages the use of youth-friendly counselling and reproductive health centres. The number of people infected with HIV/AIDS in Angola continues to rise rapidly. The pandemic is a matter of higher political attention and concern.
Country
United States
Publisher
Population Reference Bureau
URL:
Theme area
Monitoring equity and research to policy
Title of publication Country profiles for population and reproductive health: Policy developments and indicators 2003: Zambia
Date of publication
2003
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
population health, reproductive health, statistics
Abstract
The population of Zambia has tripled since Independence in 1964. The country is currently facing widespread poverty and severe demographic distortions, attributable in part to the prevalence of HIV/AIDS, which affects about one in five persons in the most economically productive age groups.
Zambia’s current population policy, adopted in 1989, is being revised to include a number of issues, such as the impact of HIV/AIDS on population dynamics; the 2000 national gender policy; the health and development of adolescents; the Zambia Poverty Reduction Strategy; and the decentralization of administration and the sector-wide approach to health services (including the district “health basket” fund, which pools resources from donors to supplement government funding).
While there has been a slight increase in the use of modern contraceptive methods, the population growth rate and fertility rate both remain high. Recognizing the links between population and maternal and child health, the Government, with donor assistance, is supporting family planning and related maternal-child health programmes, including ones focused on youth. However, the emphasis on preventing HIV infection, caring for those affected,
and introducing anti-retroviral (ARV) treatments is overshadowing the need for family planning.
Country
United States
Publisher
Population Reference Bureau
URL:
Theme area
Monitoring equity and research to policy
Title of publication Country profiles for population and reproductive health: Policy developments and indicators 2003: Democratic Republic of Congo
Date of publication
2003
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
population health, reproductive health, statistics
Abstract
Following a decade of political turmoil and war, the Democratic Republic of the Congo (DRC) has experienced relative stability and progress since the ceasefire agreement in July 1999. Unfortunately, the war and ensuing tensions have resulted in significant loss of human life, approximately two million internally displaced persons,
and a number of formidable population and reproductive health challenges. The Republic ranks 155th on the 2002 Human Development Index.
The Government considers the high rate of population growth (which outpaces food production) to be an obstacle to human development. It therefore aims to reduce this rate to 2.5 per cent a year by 2020. UNFPA is funding a programme for the 2002-2006 period to assist the DRC in achieving its population and development goals. The Inter-agency Working Group on Refugee
Reproductive Health and the Reproductive Health for Refugees Consortium have implemented programmes to increase refugees’ access to reproductive health services. Additionally, the World Bank, in collaboration with the Government, is currently preparing an interim Poverty Reduction Strategy Paper, and chairs the twice-yearly technical update meetings including multiple stakeholders.
HIV/AIDS, which affects over 5 per cent of the population, is of major concern to the Government. Incidence rates are higher in regions of conflict, displacement and military deployment. Another challenge is in the area of gender equality. Significant inequalities persist in the areas of education and literacy.
Country
United States
Publisher
Population Reference Bureau
URL:
Theme area
Monitoring equity and research to policy
Title of publication Country profiles for population and reproductive health: Policy developments and indicators 2003: Lesotho
Date of publication
2003
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
population health, reproductive health, statistics
Abstract
Lesotho is a small country located within South Africa. Due to the poor economy, 40 per cent of the male population seeks employment in the surrounding country, resulting in a large proportion of female-headed households. Over three quarters of the population has access to basic health services. However, the relatively poor status of women has hindered the implementation of population and reproductive health programmes, especially the distribution of modern contraception. The Lesotho Safe Motherhood Initiative, a collaborative effort between various UN agencies and the World Health Organization, was formed in direct response to this problem. The initiative also aims to curb the high rates
of maternal, child and infant mortality.
HIV/AIDS continues to drive and be driven by poverty and hinders the country’s overall development. The prevalence of HIV/AIDS among adolescents is an area of concern, as is the high level of adolescent fertility. The migration of workers for employment is a contributing factor in the high HIV/AIDS prevalence rate among adults, one quarter of whom are now infected. In an effort to combat the pandemic, the Government has joined in a public-private partnership with Bristol-Meyers Squibb.
Although Lesotho adopted its National Population Policy in 1994, implementation has been difficult due to lack of strong institutional capacity. Improvement in this area, as well as the incorporation of the principles of the International Conference on Population and Development into the national policy, will be integral to its success.
Continued support for programmes, services and policy formulation will be crucial elements of population and reproductive health programmes. Equally important will be strong advocacy efforts for women’s issues on legal, political and social levels. Key to such efforts is continued support for partnerships with national non-governmental organizations, religious and political leaders, women’s groups, the media and private industry.
Country
United States
Publisher
Population Reference Bureau
URL:
Theme area
Monitoring equity and research to policy
Title of publication Country profiles for population and reproductive health: Policy developments and indicators 2003: Malawi
Date of publication
2003
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
population health, reproductive health, statistics
Abstract
Malawi has had a population policy since 1994. The population policy, which is related to the Government’s policies on youth, gender and HIV/AIDS, emphasizes sexual and reproductive health, the balance of population dynamics with resources, and the mainstreaming of these concerns into sectoral plans and programmes. The policy is consistent with the three critical areas in the Common Country Assessment and the Development Assistance
Framework, namely 1) poverty, 2) governance and human rights, and 3) HIV/AIDS.
Malawi views its population and fertility levels as too high and its under-5 and maternal mortality rates as unacceptable. With a view towards addressing these issues, the Government provides direct support to improving access to modern contraceptive methods. With international assistance, it introduced a national contraceptive management system in 1998.
Malawi, with 64 per cent of its households living in poverty and a drop of five years in its life expectancy level since 1985, is among the world’s least-developed countries. It has subscribed to the Heavily Indebted Poor Countries (HIPC) Initiative on debt relief. With a median age of 18 and Malawi women under 20 accounting for 68 per cent of all first pregnancies, the health sector elements
of the new Poverty Reduction Plan will give attention to making sexual and reproductive health services available nationwide as an integral part of the essential health-care package. The plan’s educational sector component places emphasis on a life-skills curriculum that includes components on sexual health and HIV/AIDS prevention.
Country
United States
Publisher
Population Reference Bureau
URL:
Theme area
Monitoring equity and research to policy
Title of publication Country profiles for population and reproductive health: Policy developments and indicators 2003: Mozambique
Date of publication
2003
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
population health, reproductive health, statistics
Abstract
The HIV/AIDS pandemic is considered the most devastating threat to the nation’s future development, with the potential to wipe out all past and current gains. In 2000, the Government prioritized
poverty reduction as an overall objective for its 2001-2005 development programme.
Various elements of the National Population Policy (1999) were integrated into the poverty reduction action plan, consistent with the overarching programme goal: “to contribute to the reduction of poverty and the improvement of the quality of life of each individual,
addressing sexual health and reproductive health and rights, the HIV/AIDS epidemic, gender equality and the harmonization of population trends with prospects for sustainable development”.
A national maternal mortality reduction strategy was approved in 2000 and a National Directorate for Women and Gender Issues established in the newly created Ministry of Women and Coordination of Social Action. With assistance from United Nations organizations, a national multisectoral AIDS Strategic Plan for 2001-2003 was approved by the Council of Ministers.
With a very young population and nearly half of all new HIV infections among the 15-24 age group, the Government, many international development partners, and a number of national non-governmental organizations are focusing increased attention and resources on meeting the needs (including the reproductive health service needs) of adolescents and young adults.
Country
United States
Publisher
Population Reference Bureau
URL:
Theme area
Monitoring equity and research to policy
Title of publication Country profiles for population and reproductive health: Policy developments and indicators 2003: South Africa
Date of publication
2003
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
population health, reproductive health, statistics
Abstract
The Government adopted a National Population Policy in 1998 (reinforced by an extensive population report for 2000). The policy has three major objectives: to systematically integrate population factors into all development policies and plans at all levels and within all sectors; to develop and implement a comprehensive (i.e., coordinated, multisectoral and interdisciplinary) approach for the planning, implementation and management of development programmes; and to generate reliable data on demographic and related socio-economic indicators to guide policy and programme interventions.
South Africa also has a national Strategic Plan (2000-2005) for HIV/AIDS and other sexually transmitted infections. The plan focuses on facilitating and supporting behavioural change. Development efforts are being seriously hampered by the high prevalence of HIV/AIDS (estimated at about 20 per cent among the general population and 22.4 per cent among pregnant women), which is expected to cut average age life expectancy from 56.5 to 40 years by 2010. While the Constitution guarantees equality between the sexes in all aspects of life, many administrative and cultural practices still discriminate against women. Moreover, the incidence of violence against women remains very high. An affirmative action policy to redress past inequities is gradually evolving.
Although the per capita gross national product puts South Africa into an upper-middle-income category (and contraceptive prevalence is high relative to most of sub-Saharan Africa), the majority of people are poor and there are both large rural areas and urban squatter settlements that are not yet adequately covered by social services (including reproductive health services). With assistance from international and bilateral donors and from non-governmental organizations, the Government is working hard to strengthen the provincial population units so that population factors are integrated into sub-national development plans, particularly those targeting youth and adolescents in disadvantaged areas. To address low condom use, community-based reproductive health information and services are focusing more attention on organizations with
predominantly male memberships. Supported by the provincial units, the Chief Directorate of Population and Development is
being further strengthened to enhance its coordination of the
overall population and development programme.
Country
United States
Publisher
Population Reference Bureau
URL:
Theme area
Monitoring equity and research to policy
Title of publication Country profiles for population and reproductive health: Policy developments and indicators 2003: Swaziland
Date of publication
2003
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
Abstract
Swaziland faces a number of population-related challenges. In the past decade, Swaziland has experienced a rapid increase in HIV/AIDS prevalence. Today, it is one of the five most-affected countries in the world. Nearly one half of all young people aged 20 to 24 are HIV-positive.
Teenage fertility is another significant problem, with over one half of female students dropping out of high school due to pregnancy. Girls’ enrolment in school has also been declining as a result of gender inequality in Swazi society. Under the dual form of government (which consists of both modern and traditional institutions), women have low status. This requires them to secure the consent of either a husband or parent in order to access family planning services, including contraception.
The Government, in collaboration with UNFPA, seeks to reduce the incidence of HIV/AIDS and teenage fertility by increasing contraceptive prevalence and the number of youth-friendly reproductive health services. To this end, a UN grant was awarded to Swaziland in 2000 to develop regional capacity in adolescent reproductive health, targeting girls and boys aged 10 to 24. The Family Life Association of Swaziland (FLAS), a member of the International Planned Parenthood Federation, provides information, education and counselling services to youth and adults. FLAS has also conducted valuable sociocultural research on male attitudes toward contraception, the onset of sexual activity in teenagers, and the legal and policy barriers to family planning services.
One of Swaziland’s key achievements has been the development of gender awareness materials and training for staff and policy makers in an effort to increase female enrolment in schools. The Government is also taking important steps towards the integration of population and family life education into school curricula.
Country
United States
Publisher
Population Reference Bureau
URL:
Theme area
Monitoring equity and research to policy
Title of publication Country profiles for population and reproductive health: Policy developments and indicators 2003: Tanzania
Date of publication
2003
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
population health, reproductive health, statistics
Abstract
The United Republic of Tanzania’s Population Policy (adopted in 1992) has been revised to incorporate such emerging issues as adolescent reproductive health, the environment, gender equity and equality, the empowerment of women, and HIV/AIDS. The policy is compatible with the Government’s Development Vision 2025, the Zanzibar Vision 2025, the national poverty eradication strategy and the Tanzania assistance strategy. It has evolved within the framework of a human rights approach. For example,
affirmative action in favour of women has been enshrined in the Constitution and several recent statutes promoting gender equality have been adopted.
A separate Zanzibar Population Policy has been developed, and a national Adolescent Health and Development policy has been drafted. The President’s Office of Planning and Privatization is
charged with coordinating national population and development policies, assisted by a National Population Steering Committee (as provided for in the revised National Population Policy). Civil society institutions — including non-governmental organizations, religious organizations, universities, the media, the private sector, and training and research institutions — are envisioned as full partners in population policy and programme implementation.
The Government views the country’s current fertility level as too high and has a policy to lower it that includes direct support for access to various contraceptive methods. It also views its current under-5 and maternal mortality levels as being unacceptably high.
Country
United States
Publisher
Population Reference Bureau
URL:
Theme area
Monitoring equity and research to policy
Title of publication Country profiles for population and reproductive health: Policy developments and indicators 2003: Zimbabwe
Date of publication
2003
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
population health, reproductive health, statistics
Abstract
Economic difficulties, “fast track” land distribution, and a decline in donor assistance have negatively impacted social and health services. The increasing prevalence of HIV/AIDS, which now affects one quarter of the adult population, has also led to an overall loss in productivity. In response, UNFPA has interwoven HIV/AIDS content into all itsprojects and has helped integrate HIV/AIDS components into training institutions. In addition, the Fund, along with UNICEF, supports school intervention programmes in adolescent reproductive health and life survival skills.
Despite a comprehensive national policy on HIV/AIDS and numerous other interventions, the pandemic continues unabated. In 2001, training was given to health-care providers in the prevention of mother-to-child transmission of HIV/AIDS, and to schoolteachers, religious leaders and journalists in the area of reproductive and sexual health. Churches, the media and non-governmental organizations encouraged community mobilization and advocacy with regards to HIV/AIDS, reproductive health and rights and gender issues. UNFPA also collaborated with the Government to produce training modules and service guidelines in reproductive health and post-abortion care, to carry out assessments on quality of obstetric care at the district level, and to establish a reproductive health database.
In another positive development, an assessment of male attitudes towards reproductive health, HIV/AIDS and gender issues was carried out. An assessment on youth reproductive health needs and obstetric care was also completed. A rapid assessment of reproductive health and youth vulnerability focused on the impact of economic difficulties on vulnerable groups. A UNFPA-supported project promoting the empowerment of rural poor women and their participation in HIV/AIDS campaigns was launched as part of the Consolidated Appeal conducted by the UN country team in support the Government’s efforts.
The policies on youth, population and HIV/AIDS have all enhanced the implementation environment for adolescent reproductive health programmes. The Government’s reproductive health policy, which includes adolescent reproductive health, is pending approval. The 2001 Sexual Offense Act has promoted the reproductive health rights of adolescents, youth and other vulnerable groups such as handicapped persons.
Country
United States
Publisher
Population Reference Bureau
URL:
Theme area
Equity in health, Values, policies and rights
Title of publication The Mumbai Declaration
Date of publication
2004 January
Publication type
Conference Proceedings
Publication details
The III International Forum for the Defence of the People’s Health pp 6pp.
Publication status
Published
Language
English
Keywords
health for all, human rights
Abstract
We, the 700 delegates from 44 countries, gathered at the III International Forum for the Defence of the People’s Health at Mumbai on 14th and 15th of January 2004, reaffirm the validity and relevance of the People’s Charter for Health, the foundational document of the People’s Health Movement, which describes increasing and serious threats to health in the early 21st century.
Since the Charter’s adoption in December 2000 at the first People’s Health Assembly, at GK Savar, Bangladesh, the health of the world’s poor has worsened and more threats to people’s health have emerged.
Social, political, economic and environmental threats to health identified as the basic causes of ill health and the inequitable distribution of health within and between countries have increased.
The III International Forum for the Defense of the People’s Health provided opportunities to hear inspiring testimonies, from the world’s poor and health activists:
œ Denouncing the denial of health to their communities and their efforts to overcome this injustice.
œ Threats to health from the unfair system of global trade and the imperialist policies of developed countries including unjust wars and efforts to counter them
œ The Demands for acknowledgement of health as a universal human right and the implementation of Comprehensive Primary Health Care as a strategy to achieve Health for All.
The Forum recognized the particular discrimination suffered by many groups which makes achieving Health for All even more difficult. These included women, people with disabilities,
sex workers, children living in difficult circumstances (including street children), migrant workers, people with mental disorders, Dalit people, Indigenous peoples in rich and poor countries, and all those affected by wars, disasters and conflicts.
The Forum demanded Health for All, Now! and reiterated that Another World in which health is a reality for All is necessary and possible.
Country
India
Publisher
People\'s Health Movement
URL:
Theme area
Poverty and health
Title of publication Pushing the boundaries: Health and the next round of PRSPs
Date of publication
2004 June
Publication type
Document
Publication details
RAP 04005 02 pp 50pp
Publication status
Published
Language
English
Keywords
poverty reduction; macroeconomic constraints on healthcare, pro-poor health policy
Abstract
This report attempts to assess whether health has benefited from the Poverty Reduction Strategy Paper (PRSP) process launched 5 years ago by the international community. Focusing on two crucial areas in health and development policy – macro-economic constraints on health care financing and the issue of ‘pro-poor’ health policy - we conclude that, in health at least, the PRSP process has not lived up to the expectations it has generated. Progress has been particularly hamstrung by the continuing financial conservatism of the IMF and World Bank, institutions which have failed to make the radical changes needed to make development work for the poor and their health and well-being.
Country
United Kingdom
Publisher
MedAct, Wemos
URL:
Theme area
Human resources for health
Title of publication Country of training and ethnic origin of UK doctors: Database and survey studies
Date of publication
2004 September
Publication type
Journal Article
Publication details
British Medical Journal Online First pp 5pp.
Publication status
Published
Language
English
Keywords
training of medical practitioners; trained abroad; ethnicity; NHS; United Kingdom
Abstract
To report on the country of training and ethnicity of consultants in different specialties in the NHS, on trends in intake to UK medical schools by ethnicity, and on the specialty choices made by UK medical graduates in different ethnic groups.
Design Analysis of official databases of consultants and of students accepted to study medicine; survey data about career choices made by newly qualified doctors.
Setting and subjects England and Wales (consultants), United Kingdom (students and newly qualified doctors).
Results Of consultants appointed before 1992, 15% had trained abroad; of those appointed in 1992-2001, 24% had trained abroad. The percentage of consultants who had trained abroad and were non-white was significantly high, compared with their overall percentage among consultants, in geriatric medicine, genitourinary medicine, paediatrics, old age psychiatry, and learning disability. UK trained non-white doctors had specialty destinations similar to those of UK trained white doctors. The percentage of UK medical graduates who are non-white has increased substantially from about 2% in 1974 and will approach 30% by 2005. White men now comprise little more than a quarter of all UK medical students. White and non-white UK graduates make similar choices of specialty.
Specialist medical practice in the NHS has been heavily dependent on doctors who have trained abroad, particularly in specialties where posts have been hard to fill. By contrast, UK trained doctors from ethnic minorities are not over-represented in the less popular specialties. Ethnic minorities are well represented in UK medical school intakes; and white men, but not white women, are now substantially under-represented.
Country
United Kingdom
Publisher
British Medical Journal
URL:
Theme area
Human resources for health
Title of publication The fate and career destinations of doctors who qualified at Uganda’s Makerere Medical School in 1984: Retrospective cohort study
Date of publication
2004 September
Publication type
Journal Article
Publication details
British Medical Journal 329 pp 600-601
Publication status
Published
Language
English
Keywords
career paths; Uganda; doctors; human resources
Abstract
Little information exists on the career paths and destinations
of graduates of medical schools from developing countries, in contrast with many such reports from the developed world. I present here perhaps the first report on career paths taken by graduates of Makerere Medical School in Uganda.
Twenty seven doctors who graduated from Makerere in 1984 participated in the study. A database was compiled from the graduation list. Information was obtained through a focus group discussion (three doctors), an email questionnaire (17, including the three focus group members), telephone interviews (six), and in-depth interviews (four). Seventy seven doctors (58 men) graduated in 1984. Reliable information was obtained for 96% (74 (56 men), of whom 22 (19 men) are dead). Seven died between 1984 and 1989, six between 1990 and 1994, six between 1995 and 1999, and three since 2000. The presumed causes of death (death certificates were not available) were AIDS (11); suicide (six); road traffic injuries, hepatitis, and alcohol related disease (one each); and unknown (two). Five of the suicides were related to knowledge or fear of being HIV positive.
Country
United Kingdom
Publisher
British Medical Journal
URL:
Theme area
Equity in health
Title of publication Conference report: Reclaiming the state: Advancing people’s health, challenging injustice, Durban, June 2004
Date of publication
2004 August
Publication type
Conference Proceedings
Publication details
Third Southern African conference on equity in health: Regional conference on equity in health in Southern Africa 1 pp 46
Publication status
Published
Language
English
Keywords
equity in health, injustice, state, AIDS/HIV, information technologies, rights, nutrition, community participation, SADC region
Abstract
The EQUINET Southern African Conference on Equity in Health on June 8 and 9 2004 was held in Durban, South Africa under the conference theme 'Reclaiming The State: Advancing People\'s Health, Challenging Injustice'. The conference theme was chosen to raise debate on and give visibility to the determinants and forces driving or impeding equity in health in our region, southern Africa. The conference gave an opportunity for presentation of the work underway and the findings for policy and practice, it also reflected the development within EQUINET of widening networks of analysis and action around health equity issues, within countries and across different constituencies. The conference was thus structured to enable debate and exchange of information across different groups on key areas of work and on broad policy goals for health equity and social justice. It also provided an opportunity to share information on country level work and on EQUINET.
Country
Southern Africa Regional
Publisher
EQUINET
URL:
Equinet Publication Type
Reports
Theme area
Health equity in economic and trade policies
Title of publication Mapping trade policy: Understanding the challenges of civil society participation
Date of publication
2004 May
Publication type
Document
Publication details
IDS Working Paper 225 pp 65pp.
Publication status
Published
Language
English
Keywords
trade policy, civil society participatoin, Uganda, Kenya, trade liberalisation
Abstract
This paper examines the way that a range of development actors view and engage with the arena of trade policy, focusing in particular on the challenges encountered by civil society actors participating in that arena. The dynamics of civil society participation in the trade arena – what might be achieved, and how – are very different from those that shape civil society participation in processes labelled poverty reduction; this paper explores the differences. To achieve this, we provide an overview of the international trade policy landscape, and discuss factors that shape participation at the interfaces of trade and development policy processes. We go on to present the views and perspectives of two sets of civil society actors – UKbased international non-government organisations, and Ugandan and Kenyan civil society organisations – about their experiences and strategies of engagement and participation. Finally we reflect on some of the challenges of civil society participation in the trade arena: structural complexity and inequities, the exclusion of alternatives to trade liberalisation narratives, and the dynamics of representation.
Country
United Kingdom
Publisher
Institute of Development Studies
URL:
Theme area
Equity and HIV/AIDS
Title of publication Community fostering for children orphaned by HIV/AIDS in India: Perspectives from Southern Africa
Date of publication
2001 June
Publication type
Conference Proceedings
Publication details
Publication status
Published
Language
English
Keywords
informal fostering, orphans, HIV/AIDS
Abstract
Fostering of children in the Third World tends to be informal, undocumented and largely unresearched, in contrast to formal foster care in the First World. This lack of documentation and research unfortunately retards understanding of the relative strengths and weaknesses of informal fostering. A new and urgent reason to explore informal fostering in India is the imminent explosion of orphanhood in the wake of an AIDS pandemic that is gradually gaining momentum. This paper applies experiences and observations from ‘community fostering’ projects in southern Africa to the Indian situation. The crisis that has emerged in informal foster care in Africa as a consequence of large-scale orphanhood may be further exacerbated in India because of demographic, social and political factors. At the same time India evinces some comparative strengths. We discuss ways in which responses to orphanhood related to HIV/AIDS may differ from situations after the environmental disasters with which India is unfortunately too familiar. We draw lessons from southern Africa as to how communities can be mobilized to care for orphans, and about the legal, bureaucratic and economic frameworks that need to be put in place. The key argument, however, concerns relationships between civil society, local non-governmental organizations, the state and external funders -- in the context of using the phrase ‘community fostering’ to indicate new forms of foster care that draw on both the social base of informal fostering and the reflexive mechanisms of formal foster care. The paper ends by outlining ways in which to ready ourselves for AIDS-related mass orphanhood in India through informed preparation and improved understanding, despite a context of widespread denial.
Country
Zimbabwe
Publisher
URL:
Theme area
Equity and HIV/AIDS
Title of publication Scaling-up anti-retroviral treatment and human resources for health: What are the challenges in sub-Saharan Africa?
Date of publication
2004 June
Publication type
Report
Publication details
A short paper established in the frame of the SDC Backstopping Mandate 2004 of the Social Development Division\'s Health Desk pp 18pp.
Publication status
Published
Language
English
Keywords
scaling up ARTs, human resource constraints, Tanzania
Abstract
Through making additional resources available for the delivery of Anti-retroviral Treatment (ART) in middle- and low-income countries it is hoped that 3 million people living with HIV/AIDS (PLWA) can have access to ART by the year 2005. One of the biggest challenges for this scaling-up of ART consists in the availability and requirements of skilled and trained health workers for offering the services. The current documents assesses possible human resources for health (HRH) related constraints for scaling-up ART, identifies possible strategies for overcoming health workforce shortages in view of delivering ARV treatment, and, in a case study of Tanzania, reviews the current and future availability of human resources for scaling-up anti-retroviral treatment.
Country
Switzerland
Publisher
Swiss Agency for Development and Co-operation; Swiss Centre for International Health, Swiss Tropical Institute
URL:
Theme area
Resource allocation and health financing
Title of publication Are user fees and narrow targeting gender-neutral?
Date of publication
2001 October
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
User fees, health outcomes, health care services, children, Millenium development goals
Abstract
In 1990, governments promised that all children would be enrolled in primary school by the year 2000; but progress was merely one-tenth of the promise. An estimated 120 million children in developing countries remain out of school — about the same as a decade ago. The majority of them are girls. The maternal mortality ratio was to be halved between 1990 and 2000; but no significant progress was made. Similarly, it was promised that everybody would have access to safe drinking water and adequate sanitation by 2000; but only a fifth of the promise was kept. Not only have promises been broken, progress has slowed down in the 1990s.
Inadequate progress in these areas greatly undermines the well-being of girls and women. Why are these basic promises not being kept? Why are hundreds of millions of women and girls struggling to overcome the daily grind of hunger, disease and ignorance, when the global economy was experiencing unprecedented prosperity during the 1990s?
The answer relates, at least in part, to the fact that most countries under-invest in basic social services. Governments in developing countries spend, on average, between 12-14 per cent of the national budget on basic social services. Industrialised countries spend, on average, about 10-12 per cent of their meagre aid budgets on these services.
Is this enough? No, it falls short by about a third of what is needed. As a concrete example of partnership between developing and industrialised countries, the 20/20 Initiative calls for an indicative allocation of 20 per cent of the national budget and 20 per cent of official development assistance to basic social services. The Initiative is based on the premise that the Millennium Development Goals set for 2015 will not be met unless we invest more and we invest better in basic social services. If the 20/20 shares were to be achieved, enough money would be available to give each and every child a good start in life.
Country
United States
Publisher
UNDP
URL:
Theme area
Resource allocation and health financing
Title of publication Should African governments scrap user fees for health services?
Date of publication
2004
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
Uganda, user fees, pro-poor healthcare systems, public health care
Abstract
We may like to think that providing public health services is a long way from the sordid world of business, but is it? Firstly, if health services are to make any contribution towards the MDGs, we must increase “sales” (consumption) of effective preventive and curative services. It is not good enough supplying services which we believe are good quality, if our target populations do not use them. So what drives demand for health services?
Research has shown that health care users in developing countries are like other consumers and shop around for health services, basing their choice of provider on their perceptions of quality and price. People choose services which, for them, represent the best value for money. If health care providers want to increase their outputs, they have two main strategies open to them: to improve quality as perceived by the user and/or lower their prices. Perhaps we have been concentrating too much on the first option and underestimating the importance of prices to poor people who, by definition, have very little money.
User fees were introduced in Africa at a time of widespread downward pressure on public expenditure and dwindling aid flows during the late 1980s. Realising that health services were woefully underfunded, it suited both donors and Governments to shift some responsibility for health care financing to the population through “cost sharing”. Sadly this policy has not worked. The research literature shows that fees have raised very little additional revenue ; fee levels have been sufficiently high to suppress demand from poor people and exemption schemes have been ineffective. The net result has been that supposedly pro-poor health care systems have effectively excluded a large proportion of their target populations. There is therefore a strong prima facie case for reversing the policy on user fees. Isn’t it risky though to slash prices and therefore income at a time when resources are already very constrained? The evidence from the following, real, case study would suggest not.
Country
Uganda
Publisher
URL:
Theme area
Resource allocation and health financing
Title of publication Public service provision, user fees, and political turmoil
Date of publication
2003 September
Publication type
Publication details
Publication status
Published
Language
English
Keywords
Madagascar, user fees, health services
Abstract
Following an electoral dispute, the central highlands of the island of Madagascar were subjected to an economic blockade during the first half of 2002. After the blockade ended in June 2002, user fees for health services and school fees were progressively eliminated. This paper examines the provision of schooling and health services to rural areas of Madagascar before, during, and after the blockade.
We found that public services were more resilient to the blockade than initially anticipated, but that health services were more affected than schools. The removal of user fees had a large significant effect on public services that is distinct from the end of the blockade and the increase in school book provision.
Country
United States
Publisher
Cornell Food and Nutrition Policy Program, Cornell University; Department of Economics, Oxford University
URL:
Theme area
Human resources for health
Title of publication Meeting report: Equity in the distribution of health personnel, Johannesburg, 15-17 April 2004
Date of publication
2004 April
Publication type
Conference Proceedings
Publication details
Regional research review: Meeting Report, Johannesburg, 15-17 April 2004 pp 1-27
Publication status
Published
Language
English
Keywords
equity, health personnel, southern Africa
Abstract
Since 2003, EQUINET and HST have implemented a longer term programme of work that has carried out a wider review of the literature on the distribution and migration of health personnel in the region and a regional research programme aimed at building analytic capacity, evidence and policy engagement around the issue. EQUINET and HST collaborated with a consortium of institutions in southern Africa and internationally, known as the Human Resources for Health (HRH) Network, in order to link this southern African programme of work with wider international work on the equitable distribution of health personnel in southern Africa. In January 2004 a call for research proposals was made within a framework set out from the literature and policy review. The proposals were reviewed and a number of these selected for participation in a regional meeting. Between 15 and 17 April 2004, the Health Systems Trust and EQUINET organised the regional meeting in Johannesburg, South Africa, bringing together researchers and stakeholders from southern and western African, Canada, the UK, USA and Australia.
Country
Southern Africa Regional
Publisher
Health Systems Trust, EQUINET
URL:
Equinet Publication Type
Reports
Theme area
Governance and participation in health
Title of publication WHO’s African regional office must evolve or die
Date of publication
2004 August
Publication type
Journal Article
Publication details
The Lancet 364 pp 475-476
Publication status
Published
Language
English
Keywords
WHO, elections, regional offices
Abstract
A resounding silence surrounds an event to take place at the end of this month that, in theory at least, has great significance for the health of the people of Africa. Dr Ebrahim Samba is to step down after serving his maximum two terms of office as Director of WHO’s Africa Region (WHO/AFRO). A new leader for WHO’s governing body in the African region must therefore be nominated when the Regional Committee meets in Brazzaville, Republic of Congo,
between Aug 31 and Sept 3.
Country
Publisher
The Lancet
URL:
Theme area
Resource allocation and health financing
Title of publication The impact of public expenditure management under ESAP of basic social services: Health and education
Date of publication
2001 March
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
SAPs, Zimbabwe, user fees, government expenditure, civil service rationalisation, subsidies, cost recovery, health indicators
Abstract
The goal of ESAP as regards fiscal operations was to reduce government expenditure through removal of subsidies, cost recovery, civil service rationalisation and parastatal reform. Since 1991, the government embarked on a process of expenditure control, which encompassed removal of subsidies on basic commodities, health and education sectors, user fees in the provision of basic social services, reduction of the civil service and parastatal reforms. The belief by mainly government and the IMF/World Bank was that public expenditure reforms would lead to price stability and an improvement in the costeffectiveness of the provision of social services.
According to civil society however, the removal of subsidies and cost recovery in education and health sectors, has resulted in swelling numbers of children out of school, people dying of curable diseases in their homes and women giving birth at home or in scotch carts on their way to health centres. Civil society also contends that several health indicators have deteriorated. Participation in prenatal services has declined; maternal death and mortality rates of babies born before arrival (BBAs) have increased. Declining wages of health personnel since 1990 has resulted in a mass exodus of qualified staff, low morale and general discontent.1 Not only are the hospitals facing critical drugs and equipment shortages, they are facing congestion at casualty departments and mortuaries. The quality of health care has deteriorated at most hospitals. Clayton Shambare of Kuwadzana Extension has a vivid expression of his sordid sojourn at Parirenyatwa Hospital. He said, ìItís not as if I have improved, he explained with emotion, ìI have to leave to allow others to come in as well, I will die but somewhere else. (Daily News, 8 November 2000:17).
Country
Zimbabwe
Publisher
Department of Economics, University of Zimbabwe
URL:
Theme area
Equity and HIV/AIDS
Title of publication Operational plan for comprehensive HIV and AIDS care, management and treatment for South Africa
Date of publication
2003 November
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
AIDS, South Africa, plan
Abstract
The beginnings of a coordinated public policy response to HIV and AIDS date back to 1992, with the formation of the National AIDS Coordinating Committee of South Africa (NACOSA). Progress in implementing the NACOSA plan was assessed in 1997 by the South African National STI and HIV and AIDS Review.
This review identified major strengths in the response to date, but also highlighted areas for substantial strengthening and improvement.
Building on this review, and on an extensive consultation process, government launched its five-year Strategic Plan for HIV and AIDS in 2000. This plan provided the framework within which interventions geared towards initiating and executing a comprehensive response to the epidemic are undertaken. The strategic framework identified four key areas of intervention, namely: (1) prevention; (2) treatment, care, and support; (3) research, monitoring and surveillance; and (4) legal and human rights.
In April 2002, after reviewing its approach to HIV and AIDS, Cabinet reiterated its commitment to the Strategic Plan. Noting progress in the implementation of the Plan and the impact beginning to be made with regard to the prevention campaign, Cabinet decided on a number of measures to strengthen and reinforce these efforts, including:
* Strengthening partnerships, especially via the South African National AIDS Council (SANAC).
* Continued use of nevirapine in preventing mother-to-child HIV transmission, and development of a universal rollout plan.
* Providing a protocol for a comprehensive package of care for survivors of sexual assault, including post-exposure prophylaxis with antiretroviral drugs.
* Ensuring that no one should be turned away without appropriate treatment and management of any infection or illness, irrespective of HIV status.
* Noting that antiretroviral treatment can help to improve the conditions and health of people living with AIDS if administered at certain stages in the progression of HIV and in accordance with international standards, government committed to continue its efforts to remove systemic constraints on access to these drugs.
* Alongside poverty alleviation and nutritional interventions, to encourage investigation into alternative treatments, particularly supplements and medication for boosting the immune system.
Country
South Africa
Publisher
South African government
URL:
Theme area
Human resources for health
Title of publication An action plan to prevent the brain drain: Building equitable health systems in Africa
Date of publication
2004 June
Publication type
Book
Publication details
Publication status
Published
Language
English
Keywords
HIV/AIDS, braindrain, sub-Saharan Africa
Abstract
The nations of the world are setting ambitious health and development goals, including the World Health Organization (WHO) target of providing AIDS treatment to 3 million people by 2005 and health-related UN Millennium Development Goals. Unless greater attention by donors and governments is given to developing human resources, these goals almost certainly will not be met. Many of the countries in sub-Saharan Africa, the region that will be the focus of this report, are experiencing severe shortages of skilled health care workers. There are multiple causes, the significance of which varies by country, but one of the most important factors is brain drain. Brain drain is defined in this report as the exodus of health care workers from developing nations to the wealthier countries of the North. Brain drain is largely a symptom of other health system deficits. Many health professionals who have the opportunity to leave are rejecting these substandard, second-class health systems that their countries and the international community
have been too slow to upgrade.
The causes of brain drain are complex and interrelated, involving social, political, and economic factors. The necessary responses will therefore be varied and cover an array of areas. Drawing on growing interest and scholarship, Physicians for Human Rights (PHR) proposes this plan of action for addressing brain drain and the unequal distribution of health personnel within countries, recommending actions by high-income countries, African governments, WHO, international financial institutions, private businesses, and others.
PHR seeks to mobilize governments and pertinent organizations to direct their resources and energies to a
specific series of actions needed to build equitable health systems. PHR highlights and hopes to gain increased recognition for broad principles about what this goal requires. Building equitable health systems requires a massive infusion of resources, far more than donors or low-income countries have been thus far willing or able to spend. Any serious response to brain drain, a response that is intended to be more than a temporary, partial fix, will entail significant new investments in the health sector, directed, in large part, to health systems, not specific disease programs. Much more than money is needed to improve health systems – policies must be reformed and certain priorities newly emphasized. Within the health sector, systemic changes are needed, including in the priority given to equity, management, and human resources. Systemic changes must extend beyond the health sector to economic policies that provide a framework for government spending that recognizes the importance of ensuring the health and human rights of citizens.
Country
United States
Publisher
Physician for Human Rights
URL:
Theme area
Equity and HIV/AIDS
Title of publication The HIV and AIDS epidemic in Zimbabwe: Where are we now?
Date of publication
2004 May
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
AIDS, Zimbabwe, response
Abstract
The HIV and AIDS epidemic is a health and development crisis throughout much of sub-Saharan Africa, including Zimbabwe. The Joint United Nations Programme on AIDS (UNAIDS) estimates the number of infections worldwide at about 40 million by the end of 2003, of which about 26.6 million are found in sub-Saharan Africa. About five million persons became newly infected in 2003, 3.2 million of whom were sub-Saharan Africans. Worldwide, about three million persons died from AIDS in 2003; sub-Saharan Africans accounted for 2.3 million of the total. Human immunodeficiency virus, the virus that causes AIDS, continues to infect large numbers of Zimbabweans. Analysis of the most recent sources of information indicates that 24.6 percent of the entire adult population ages 15–49 is currently infected, making Zimbabwe one of the most seriously affected countries in the entire world. Even now, most Zimbabweans who are infected do not even know their status.
While the HIV and AIDS epidemic is a national tragedy that will affect the country well into the future, no reason exists to be passive in face of the epidemic. We now know more about prevention programmes than ever before in the history of the epidemic. Three out of every four adults in the population remain free of HIV and all of these people can take active measures to protect themselves and their loved ones. It is especially important to develop prevention programmes for young people. We also know
more about care and support programmes than in the past. Of special note, Zimbabwe and other African countries are beginning to have access to antiretroviral drugs to help prolong and increase the quality of life of those already infected.
Country
Zimbabwe
Publisher
Zimbabwe Ministry of Health and Child Welfare
URL:
Theme area
Human resources for health
Title of publication The brain drain of health workers in Ghana
Date of publication
2003 February
Publication type
Conference Proceedings
Publication details
International Conference on Occupational Health 27 pp 20pp.
Publication status
Published
Language
English
Keywords
healthworker migration, brain drain, Ghana
Abstract
There is a problem of professionals in developing countries leaving for greener pastures in Europe and America - a well known phenomenon over the last 3 decades. However, this brain drain has assumed phenomenal dimensions among health care workers in Ghana in the last few years. This paper describes the extent of the problem of brain drain in Ghana, the underlying factors, the possible contribution of occupational health and safety factors to brain drain and suggestions for curbing current trend.
Country
Ghana
Publisher
Occupational and Environmental Health Unit, Ghana Health Service, Ministry Of Health
URL:
Theme area
Health equity in economic and trade policies
Title of publication Brief Analysis of the Cancun ministerial from an African perspective
Date of publication
2003 September
Publication type
Newspaper Article
Publication details
EcoNews Africa pp 6pp.
Publication status
Published
Language
English
Keywords
WTO, African countries, agricultural concessions,TRIPs
Abstract
The Cancun Ministerial ended in the early afternoon on Sunday 14th September. The decision by the Conference Chair Mexican Foreign Minister Derbez to suddenly and abruptly call the meeting off came as a surprise to many. The immediate reason for the breakdown of the talks was the stalled positions on the Singapore issues. The night before, nine countries (EU, US, Mexico, Brazil, South Africa, China, India, Malaysia and Kenya) had been in the Green Room for two hours discussing the Singapore issues. There was no agreement and countries apparently stuck to their positions. Next morning Derbez decided to continue with the Singapore issues in a larger Green Room meeting, now including around 30 countries. The discussions attempted to unbundle the issues and see which ones could be agreed upon for negotiations. Pascal Lamy offered to drop investment and competition from the agenda. Derbez called a one-hour recess to let Ministers consult with their constituencies. African Ministers in the Green Room met with the African and ACP group and got a clear and strong mandate not to accept negotiations on any of the Singapore issues. When the Green Room reconvened, positions had hardened. The African and ACP group kept firm on their no to negotiations on any of the issues, while South Korea and Japan said that they were not ready to drop any of the issues. Derbez then decided to call off the meeting and close the conference.
Country
Kenya
Publisher
EcoNews Africa
URL:
Theme area
Human resources for health
Title of publication An exodus of African nurses puts infants and the ill in peril
Date of publication
2004 July
Publication type
Newspaper Article
Publication details
New York Times pp 7pp.
Publication status
Published
Language
English
Keywords
brain drain, healthworkers migration, maternal mortality, Malawi
Abstract
The nursing staffs of public health systems across the poor countries of Africa — grossly insufficient to begin with — are being battered by numerous factors that include attrition and AIDS. But none are creating greater anxiety in Africa than the growing flight of nurses discouraged by low pay and grueling conditions.
The result of the nursing crisis — the neglect of the sick — is starkly apparent here on the dilapidated wards of Lilongwe Central Hospital, where a single nurse often looks after 50 or more desperately ill people. What is equally visible is the boon to Britain, where Lilongwe Central\\\'s former nurses minister to the elderly in the carpeted lounges of nursing homes and to patients in hushed private hospital rooms.
It is the poor subsidizing the rich, since African governments paid to educate many of the health care workers who are leaving.
In May, African countries banded together at the annual assembly of the World Health Organization to urge developed nations to compensate them for their lost investment. After an intense debate, the assembled countries resolved to search for ways to lessen the damage of what they called increasing rates of emigration.
The brain drain of health professionals from Africa, and, more broadly, the severe staffing shortages, will be an issue at the 15th International AIDS Conference in Bangkok. Physicians for Human Rights, a Boston-based nonprofit group that shared the Nobel Peace Prize in 1997, will be releasing a report on the topic and proposing steps to avert a deepening of the human resources crisis.
Country
United States
Publisher
New York Times
URL:
Theme area
Equity and HIV/AIDS
Title of publication Challenges facing the scaling up of prevention of mother to child transmission of HIV in Blantyre, Malawi
Date of publication
2004 June
Publication type
Document
Publication details
Publication status
Publication status unknown
Language
English
Keywords
HIV/AIDS, Malawi, mother-to-child transmission, control programmes, women
Abstract
This study was carried out to determine the knowledge, attitudes and practices of pregnant women and nurse-midwives towards various aspects of mother-to-child transmission of HIV in Blantyre District Malawi. The study was carried out based on the realization that many of the suggested programs in PMTCT have been designed without the input of the affected women. Information about these aspects would equip policy makers, program planners and implementers in ensuring that HIV/AIDS prevention and control programs are responsive to stake-holders attitudes, knowledge and practices.
This study has identified several important aspects in the prevention of mother to child transmission of HIV/AIDS. While it is assumed that healthcare workers are well conversant with most issues regarding HIV/AIDS, this is not invariably so. We found that some of the nurses-midwives were themselves not sure as to what they would advise antenatal women on breastfeeding, for instance. In general attitudes of health workers towards HIV infected women were favorable. But there still are areas of concern as some nurse-midwives indicated they would be uncomfortable to assist in the delivery of a known HIV-infected woman.
Women attending antenatal clinics mostly desire to breastfeed. Whether they actually do so after delivery is another matter altogether. The lack of adequate guidance as to what is could be the preferred method of feeding infants when the mother is HIV infected is matter of concern. It is also of concern that health facilities in Blantyre do not routinely screen antenatal women for sexually transmitted infections and yet these infections are known to result in adverse neonatal outcomes and could facilitate the transmission of HIV. There is need to strengthen the training and supervision of health workers in this regard.
Most of the women expressed perceptions of vulnerability to HIV infection and potential for abuse within the household by spouses. This is obviously a matter of great concern and efforts should be put in place to stem down such threats to persons. As most of the issues affected men’s perceptions and practices were obtained from interviewing women, there is need for further research to directly involve men themselves.
Country
Malawi
Publisher
Department of Community Health, Department of Obstetrics and Gynecology, University of Malawi, College of Medicine
URL:
Theme area
Resource allocation and health financing, Equity and HIV/AIDS
Title of publication Implementation of the covenant on civil and political rights, Uganda: Trade-related intellectual property rights, access to HIV/AIDS medicines and the fulfilment of civil and political rights
Date of publication
2004 May
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
HIV/AIDS, Uganda, ARVs
Abstract
This submission to members of the Human Rights Committee delineates our human rights-based concerns and recommends that Uganda seek all available technical assistance, particularly from the Office of the High Commissioner for Human Rights (OHCHR) to ensure that its IP laws governing the manufacture, import and distribution of pharmaceuticals are drafted and implemented in a way that enables Uganda to fulfil its obligations under the ICCPR.
Country
Switzerland
Publisher
3D->Trade - Human Rights - Equitable Economy
URL:
Theme area
Equity and HIV/AIDS
Title of publication Statement by the Minister of Health Hon. Brig. Jim K. Muhwezi on the ocassion of the launch of the free ARV treatment program in Uganda
Date of publication
2004 June
Publication type
Document
Publication details
Publication status
Publication status unknown
Language
English
Keywords
HIV/AIDS, Uganda, ARVs
Abstract
Uganda’s struggle against HIV/AIDS has been through three phases. The first phase started with the visionary leadership of H.E. President Yoweri Kaguta Museveni way back in 1986. He saw that this was a deadly disease without a cure and sounded an alarm loud enough to enable the people of Uganda to rise up against this disease. This first phase accordingly consisted largely of public information campaigns which raised awareness levels and resulted in behaviour change and the decline in prevalence of HIV in the population. This was carried out through the Aids Control Program in the Ministry of Health but with the President personally chairing a number of planning meetings. The second phase followed the realization that HIV/AIDS called for multi-sectoral action. It therefore consisted of the building of institutions and centers of excellence for coordinating the national response not just to prevent the spread of new infections, but also to provide care and support to those infected and affected and through research to seek solutions for the future. This was done through legislation that set up the Uganda Aids Commission as a coordinating agency. This has created an enabling national environment for multiple players to participate within clearly defined boundaries. During this phase, centers of excellence such as JCRC, the Blood Transfusion Service, Uganda Virus Research Institute, Mild May, Hospice, etc., Collaborative research with international partners such as Case Western Reserve University, Johns Hopkins, CDC, Medical Research Council of the UK and many others. This has also made it possible for communities to set up thousands of NGOs such as TASO, NACWOLA, ….and many small ones in districts, towns and villages across our land. The whole country was switched on to fight the epidemic and international partners were harnessed in very productive partnerships.
Country
Uganda
Publisher
Ministry of Health
URL:
Theme area
Human resources for health, Equity and HIV/AIDS
Title of publication Networker: A mouthpiece of the SAMWU/MSP municipal health sector occupational health and safety and HIV programme
Date of publication
2004 May
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
healthworkers, HIV/AIDS
Abstract
Country
South Africa
Publisher
South African Municipal Workers Union (SAMWU), Municipal Services Project (MSP)
URL:
Theme area
Equity in health
Title of publication Summit on agriculture and food security 2004
Date of publication
2004 May
Publication type
Conference Proceedings
Publication details
Publication status
Published
Language
English
Keywords
food security, SADC
Abstract
Summit noted with concern that total cereal production in the SADC region has remained stagnant for over a decade remaining at the same level in 2003 as it was in 1990, with an estimated 22,753 000 and 22,062 000 metric tonnes respectively. In the same period the population has grown from 152 million to 212 million.
Summit further noted that agriculture is a major sector in SADC, contributing 35% to the regional GDP and 13% of total export earnings. In addition, about 70% of the population of SADC depends on agriculture for food, income and employment. However, given the huge land mass available in SADC suitable for the production of food crops and livestock farming, agricultural productivity remains at very low levels.
In this regard, the SADC Heads of State and Government adopted and signed the Dar es Salaam Declaration on Agriculture and Food Security in the SADC Region, which reaffirms their commitment to ensuring accelerated agricultural development and sustainable food security, as a matter of urgency through multi-sectoral strategic interventions in accordance with the United Nations Millennium Development Goals, the Declarations of the World Food Summit in 1996 and 2002 and the Regional Indicative Strategic Development Plan (RISDP).
Country
Tanzania
Publisher
URL:
Theme area
Equity in health
Title of publication Abstract book: Reclaiming the state: Advancing people’s health, challenging injustice, Durban, June 2004
Date of publication
2004 June
Publication type
Book
Publication details
Regional Conference on Equity in Health in Southern Africa pp 46pp.
Publication status
Published
Language
English
Keywords
equity in health, SADC, southern Africa
Abstract
On behalf of the EQUINET steering committee we welcome you to the EQUINET Southern African Conference on Equity in Health being held on June 8 and 9 2004 in Durban South Africa. We have chosen the conference theme \\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\'Reclaiming The State: Advancing People\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\'s Health, Challenging Injustice\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\' to raise, debate and give visibility to the determinants and forces that are driving or impeding equity in health in our region, southern Africa, and to identify strategies and policies for advancing people’s health based on values of fairness and justice. This is the third such conference in the region since 1997, following the Kasane meeting in 1997 and the South African meeting in 2000.
The Southern African Regional Network on Equity in Health (EQUINET) aims to promote and realize shared values of equity and social justice in health. We are therefore honoured and happy to welcome delegates from state, civil society and non state organisations, parliaments, regional and international organisations and other institutions promoting and working on equity in health in southern Africa. The conference brings together a wide spectrum of work and views, drawn from the research, policy and advocacy work done by EQUINET and by others in the region on different dimensions and drivers of equity in health in southern Africa. We hope that the conference will provide you with an opportunity to assess progress towards equity in health. We also hope that you will identify key areas to be followed through by EQUINET and others in future research, policy intervention and programme design
at national and regional level.
Country
Southern Africa Regional
Publisher
EQUINET
Equinet Publication Type
Reports
Theme area
Resource allocation and health financing
Title of publication Economic and welfare effects of the abolition of health user fees
Date of publication
2004 April
Publication type
Report
Publication details
World Bank Policy Research Working Paper 3276 pp 29pp.
Publication status
Published
Language
English
Keywords
User fees, health outcomes, health care services, public and private health care centres
Abstract
Household level data for Uganda for 1999/2000 and 2002/03, before and after the abolition of user fees for public health services, are used to explore the impact of this policy on different groups’ ability to access health services and morbidity outcomes. We find that the policy change improved access and reduced the probability of sickness in a way that was particularly beneficial to the poor. Although the challenge of maintaining service quality remains, aggregate benefits are estimated to be significantly larger than the
estimated shortfalls from the abolition of user fees.
Country
United States
Publisher
The World Bank
URL:
Theme area
Resource allocation and health financing, Equity and HIV/AIDS
Title of publication New allocations for ARV treatment: An analysis of 2004/5 national budget from an HIV/AIDS perspective
Date of publication
2004 May
Publication type
Document
Publication details
IDASA - Budget Information Service: Occasional Papers pp 43pp.
Publication status
Published
Language
English
Keywords
HIV/AIDS, South Africa, ARVs, budget, financing
Abstract
From an HIV/AIDS perspective, the 2004/5 national budget shows serious commitment to making financial resources available for the new anti-retroviral (ARV) treatment programmes to be rolled out this year. National Treasury has specifically allocated R1.439 billion in the national budget for HIV/AIDS programmes and services in 2004/5.
To put these increases in context, the amount designated for HIV/AIDS in this year’s budget is nearly 7 times what was set aside to fight HIV/AIDS in the 2000/1 national budget three years ago. However funds earmarked for HIV/AIDS in the national budget still constitute less than 1% of the total consolidated budget, and health expenditure remains a steady 11% of consolidated national and provincial spending.
A total of R373 million is designated for ARV treatment programmes in the national budget for 2004/5, the first year of roll-out. If we assume a R6000 annual average cost per person on treatment, the ARV conditional grant allocations will only pay for 49,614 persons on treatment in the first year of implementation, which is slightly short of the 53,000 target set in the Operational Plan. Given the current conditional grant allocations to provinces for ARV treatment, only 7% of the estimated number of AIDS sick persons nationally will be able to enter treatment in the first year. However indications are that government’s intention was to provide a level of funding in Budget 2004/5 which could be absorbed by the provinces, and then to ratchet up and add additional resources as and where needed partway through the financial year.
Of the total new conditional grant funds for ARV treatment, KZN receives the largest slice (22%), followed by Gauteng (16%) and Eastern Cape (14%). KZN, Gauteng and Mpumalanga’s shares of the total ARV CG funds are disproportionate to their heavy HIV/AIDS burden.
However, provincial shares of the total estimated AIDS sick persons were not the only factor used to allocate the funds. The resource allocation approach used was a reasonable one. Other important factors were included: the varying abilities of provinces to absorb the added funds, the need to cover basic infrastructure costs in low-population provinces, and the need to build the capacity of under-resourced or underspending provinces.
The critical issue is the ability and commitment of national and provincial health departments to speedily get ARV treatment programmes up and running. Funds being transferred by national government to provincial health departments for HIV/AIDS programmes jump by 134% in this budget, which means that provinces will experience sharp spending pressures. Provinces have significantly improved their spending on HIV/AIDS funds but some provinces still remain problematic and may struggle to spend the additional ARV funds — especially Eastern Cape and Mpumalanga. For those provinces with weaker financial and project management skills, absorption capacity could very well be the primary obstacle to roll-out. A new clause inserted in the 2004 Division of Revenue Bill will allow unspent HIV/AIDS health conditional grant funds to be reallocated to better-performing provinces.
The success of the roll-out of the national ARV treatment programme will be dependant upon strong support and guidance from national Department of Health and the demonstrated performance of provinces in absorbing the added funds.
Country
South Africa
Publisher
IDASA: AIDS Budget Unit
URL:
Theme area
Monitoring equity and research to policy
Title of publication Tracking the millennium development goals in sub-Saharan Africa
Date of publication
2004
Publication type
Journal Article
Publication details
International Journal of Social Economics 31 1/2 pp 12-29
Publication status
Published
Language
English
Keywords
sub-Saharan Africa, development, poverty, performance management, health education
Abstract
This paper reviews, assesses and evaluates the performance of sub-Saharan African countries towards achieving the international development goals and targets set by the United Nations, UN Millennium Development Goals and the Agenda for Action of the 2nd Tokyo International Conference on African Development. Africa’s recent economic performance is a reflection of the policies it has pursued since the 1960s. It summarises the progress of sub-Saharan African countries with a view to providing a clearer understanding of the constraints they face in reaching the goals, with a special focus on the economic, poverty, education, and health targets. The paper also outlines the urgency for action at the national, regional, and international levels. It also demonstrates that the economic and social recovery that Africa experienced in the late 1990s cannot be sustained unless there is progress towards the goals. Africa’s efforts alone cannot achieve the goals, it would require global support and understanding of the special needs of the region.
Country
United Kingdom
Publisher
Emerald Group Publishing Limited
URL:
Theme area
Equity and HIV/AIDS
Title of publication AIDS analysis
Date of publication
2004 June
Publication type
Document
Publication details
Africa Online 15 1 pp 9pp.
Publication status
Published
Language
English
Keywords
HIV/AIDS impact
Abstract
This month\\\'s focus in AAAO on the various contexts for interaction on the issue of AIDS, certainly points to the fact that there remains much to learn - and teach - about the epidemic and its impacts on communities, government, business and the workplace. Two important events on the 2004 AIDS calender must surely be an HIV/AIDS Workplace Symposium organised by Wits University at the end of June, and a pre-conference session hosted by the International AIDS Economists Network (IAEN) scheduled to be held in Bangkok just before the International AIDS 2004 Conference in July. Find information on both of these events in this month\\\'s newsletter.
Country
South Africa
Publisher
Metropolitan Life
URL:
Theme area
Equity and HIV/AIDS
Title of publication Estimating resource needs for HIV/AIDS health care services in low-income and middle-income countries
Date of publication
2003 December
Publication type
Journal Article
Publication details
Health Policy 69 pp 189-200
Publication status
Published
Language
English
Keywords
HIV/AIDS; Health care; Financing; Economics
Abstract
As funding mechanisms like the Global Fund for HIV/AIDS, Tuberculosis and Malaria increasingly make funding decisions on the basis of burden of disease estimates and financial need calculations, the importance of reliable and comparable estimating
methods is growing. This paper presents a model for estimating HIV/AIDS health care resource needs in low- and middle-income
countries. The model presented was the basis for the United Nations’ call for US$ 9.2 billion to address HIV/AIDS in developing
countries by 2005 with US$ 4.4 billion to address HIV/AIDS health care and the rest to deal with HIV/AIDS prevention. The model has since been updated and extended to produce estimates for 2007. This paper details the methods and assumptions used to estimate HIV/AIDS health care financial needs and it discusses the limitations and data needs for this model.
Country
Ireland
Publisher
Elsevier
URL:
Theme area
Equity and HIV/AIDS
Title of publication Access to antiretroviral treatment in Africa: New resources and sustainable health systems are needed
Date of publication
2004 January
Publication type
Journal Article
Publication details
British Medical Journal 328 pp 242-242
Publication status
Published
Language
English
Keywords
health planning, HIV/AIDS, treatment access, ARVs, health services
Abstract
The demand for people living with HIV and AIDS in Africa to access treatment cannot be ignored. At the same time the challenges to meeting this demand are many. They include the shortfalls in health services and lack of knowledge about treatment, making decisions about newer regimens, and the risk of resistance to antiretrovirals highlighted in the paper by Stevens et al (p 280).The challenges also include ensuring uninterrupted drug supplies, laboratory capacities for CD4 monitoring, accessible voluntary counselling and testing, trained healthcare workers, and effective monitoring of resistance to antiretroviral drugs. A series of papers produced in 2003 through the southern African
regional network on equity in health raised further concerns about measures to ensure fairness in the rationing of scarce treatment resources and the diversion of scarce resources from strained public health services into vertical treatment programmes. The reasons for these challenges are not a mystery. They stem from the chronic under-resourcing of health systems, the underdevelopment of strategic public health leadership, the attrition of health personnel, and the high prevalence of poverty, factors that already limit the delivery of many less complex primary healthcare services. Given this context, how should resources best be allocated to ensure access to treatment for HIV/AIDS in Africa?
Existing initiatives provide some indications of what to do and what not to do. Making treatment accessible through private and non-government sectors or through redeployment of personnel without addressing the staffing, pay levels, and working conditions of health personnel in public health services can further increase attrition from essential services and aggravate uncoordinated health planning.
Country
United Kingdom
Publisher
British Medical Journal
URL:
Theme area
Equity and HIV/AIDS
Title of publication The social ecology of AIDS in Africa
Date of publication
2002 March
Publication type
Document
Publication details
Draft paper prepared for the UNRISD project HIV/AIDS and Development pp 19pp.
Publication status
Publication status unknown
Language
English
Keywords
HIV/AIDS prevalence, epidemiology
Abstract
The practice of epidemiology, according to Geoffrey Rose, is based on the question “Why did this patient get this disease at this time” (Rose, 1985). Epidemiologists can be quite good at detecting the causes of illness by comparing individuals with different levels of exposure to hypothesised risk factors or infectious agents. This is how we know that HIV causes AIDS, and how we know that certain behaviours are associated with a higher or lower risk of transmission of HIV.
When we look at AIDS epidemics as social phenomena, however, an entirely different etiological question arises: “Why do some populations have much AIDS, while it is rare in others?” This type of question was asked by Rose when comparing the incidence of arterial hypertension between Kenyan nomads and civil servants in London. The answer, he found, “has to do with determinants of the population mean. What distinguishes the two groups has nothing to do with the characteristics of individuals; it is rather a shift of the whole distribution—a mass influence acting on the population as a whole” (Rose, 1985: 33). The determinants of this shift are the main subjects of reflection for “social epidemiology,” a field of study that is still in its infancy and has not yet developed a clear theoretical framework (Krieger, 2001).
Whatever the reason for a particular “shift in distribution,” it may appear rather insignificant and small yet yield spectacular differences in the population incidence of disease. This has been demonstrated for heart disease (Rose, 1985), suicide (Durkheim, 1951), homicide (Marmot, 1998), psychiatric illness (Rose, 1992), diabetes (McKinlay and Marceau, 2000), alcoholism (Marmot, 1998), syphilis (Kilmarx et al., 1997), and many other conditions of ill health. It is at the base of one of the most important discoveries in public health—the prevention paradox: “A preventive measure that brings large benefits to the community offers little to each participating individual” (Rose, 1992: 12).
If we select a few locations in sub-Saharan Africa with reasonably consistent series of epidemiological surveillance data for HIV and plot these data on a graph, the design we are most likely to obtain looks suspiciously like a box full of snakes. There is no recognisable pattern. Figure 1 shows an example of HIV prevalence over a nine year period among women attending ante-natal clinics in Zinguinchor (Sénégal), Abidjan (Côte d’Ivoire), Francistown (Botswana), and Mbarara (Uganda) (UNAIDS/WHO 2000).
This heterogeneity of HIV epidemics is well known. There are, of course, many explanations: The different time of introduction of HIV; the properties of different viral strains; the prevalence of underlying genital tract pathology; the prevalence of male circumcision, population mobility, and variations in behavioural norms. But one-dimensional causal theories are inept in predicting the profile and course of HIV epidemics. There are many examples of local epidemics that seem to defy conventional theories of risk. For instance:
*Early age of sexual initiation among girls is associated with high prevalence of HIV. In Ghana, about 60 percent of girls aged 15 to 19 are sexually active, compared to only about 30 percent in Zimbabwe (Singh et al., 2000). Yet, the HIV prevalence in Zimbabwe is more than five times as high as in Ghana.
*Low prevalence of male circumcision is associated with high prevalence of HIV. In Malawi, male circumcision is almost universal among the Yao and Lomwe people in the South while it is rarely practised in the North. Yet the HIV prevalence is generally higher in both rural and urban areas of the Southern Region than in the North. (UNAIDS/WHO 2000)
*The prevalence of HIV in a society is related to the average number of sexual partners outside marriage and stable relationships. Men and women in Côte d’Ivoire report consistently more “irregular sexual partners” than in Zambia (Caraël, 1995), yet the HIV prevalence in Lusaka is more than twice the rate in Abidjan.
*The prevalence of HIV decreases when people use condoms more frequently. Between 1994 and 1998 only 5.1 percent of Ugandans reported that they used a condom during intercourse with their last non-regular partner, compared to 22.2 percent of Kenyans and Zambians (combined population). Meanwhile, HIV prevalence in Uganda was falling rapidly while it was static in Zambia and climbing in Kenya (Stoneburner, 2000).
Sometimes we can make causal inferences on the basis of average behavioural profiles. For instance, the fact that settlements along major trucking routes in Africa have a higher than average HIV prevalence is most certainly related to the typical sexual behaviour of the men who drive trucks along these roads and the women who live in these settlements. But once we arrive at a behavioural explanation, we still do not know why people at this time in this particular location behave in a way that puts their health in serious peril. Without this knowledge our ability to intervene is restricted to exhortation for behavioural change; an approach of doubtful effectiveness.
The complexity of this situation was stated bluntly by President Thabo Mbeki of South Africa in his opening speech of the XII International Conference on AIDS in Durban: “As I listened and heard the whole story told about our country, it seemed to me that we could not blame everything on a single virus” (Mbeki, 2000). An intelligent remark by a careful observer. Yet, it fuelled a storm of protest that most certainly damaged his political career.
In fact, even the most vociferous critics of President Mbeki have to admit that they have neither the theory nor the data to explain the widely diverging patterns of AIDS epidemics in Africa or anywhere else. What our preoccupation with examining risk factors has provided us so far is, in the words of McMichael, an explanation and quantification for the “bobbing of corks on the surface of waters, while largely disregarding the stronger undercurrents that determine where, on average the cluster of corks ends up along the shoreline of risk” (McMichael, 1995: 633).
There is, of course, the possibility that all epidemiological curves of HIV would look similar were it not for the success of national AIDS prevention efforts. Would the epidemic in Ziguinchor look like the epidemic in Abidjan had it not been for the political commitment of the Government of Sénégal to fight AIDS? Would the epidemic in Mbarara today look like the epidemic in Francistown had it not been for the vigorous response to AIDS by the Museveni Government in Uganda? We will never know and there is certainly no reason to discount or belittle the efforts of national prevention programmes. However, the profile of the HIV epidemic in Mbarara, Uganda looks a lot like the profile of the epidemic in Bukoba, Tanzania. The HIV prevalence in Ziguinchor, Sénégal is no lower than the prevalence in Nouakchott, Mauritania. It is highly unlikely that programming in Uganda and Sénégal spilled across the borders into Tanzania and Mauritania. The more likely explanation is that there are similarities within the two pairs of neighbouring locations that somehow resulted in similar experiences of HIV epidemics.
Country
United States
Publisher
United Nations Research Institute for Social Development
URL:
Theme area
Human resources for health
Title of publication Women and international migration in the health sector
Date of publication
2004 June
Publication type
Document
Publication details
Final Report of Public Services International’s Participatory Action Research 2003 pp 52pp.
Publication status
Published
Language
English
Keywords
healthworker migration, health service employment, migration impacts on health delivery, unions, mobilisation
Abstract
The PSI Campaign was established as a result of growing concern among trade unionists about the impact of international migration on the quality of public health services and health service employment. It is a matter that has been extensively discussed and given high priority by both the PSI Women’s Committee and the PSI Health Services Task Force. Endorsed by the PSI Women’s Committee in Geneva in May 2002, this research was coordinated by Kim Van Eyck,
an international labour consultant working for PSI. This project was commissioned by PSI\\\\\\\'s Equality and Rights Officer, Nora Wintour. The “participatory action research” involved a survey of nurses and other health care workers and in-depth interviews with employers, government officials and NGOs in: Barbados, Canada, Chile, Ecuador, Fiji, Ghana, Kenya, the Netherlands Antilles, the Philippines, Poland, Sri Lanka, and Scotland and Wales in the UK.
(Surveys in the Netherlands are to be conducted in 2004.)
The central goals of the campaign are 1) to document how the migration of public health service workers impacts health service delivery and the terms and conditions of employment (in both
sending and receiving countries), 2) to mobilize public sector trade unions and their members around issues of migration and 3) to lobby for increased spending in public health and improved terms and conditions of employment for health workers worldwide.
During the first phase of the campaign, a significant amount of both quantitative and qualitative data about migration and employment in the health care sector was collected. The data from over 600 surveys and 20 in-depth interviews is presented in this report.
Country
France
Publisher
Public Services International
URL:
Theme area
Health equity in economic and trade policies
Title of publication Essential drugs in Southern Africa need protection from public health safeguards under TRIPs
Date of publication
2001
Publication type
Journal Article
Publication details
Bridges: Comment pp 2-4
Publication status
Published
Language
English
Keywords
SADC, WTO, TRIPs, drug access, public health policies
Abstract
This article investigates the consequences of the WTO TRIPs Agreement on drug access for Southern African Development Community (SADC) countries. It outlines the key content of the essential drug policies needed to manage the public health problems in the region, and explores the impact of the TRIPs Agreement on these policies. It highlights the options that SADC governments have to address these impacts and the current policy measures which SADC governments and other institutions are pursuing to sustain essential drug access and meet public health obligations.
Country
Zimbabwe
Publisher
Bridges
URL:
Theme area
Equity and HIV/AIDS
Title of publication Two pills a day saving lives: Fixed-dose combinations (FDCs) of antiretroviral drugs
Date of publication
2004 February
Publication type
Document
Publication details
MSF Briefing Note pp 4pp.
Publication status
Published
Language
English
Keywords
ARVs, fixed dose combinations, standardised treatment, poorest and most vulnerable
Abstract
If recent initiatives to scale up antiretroviral (ARV) treatment in developing countries are to succeed in reaching the poorest and most vulnerable people at the community level, several key issues must be addressed. Chief among these is the need to simplify and standardize treatment protocols so that people with HIV/AIDS can access treatment, even in areas where there are few hospitals, few doctors, and few laboratories.
Fixed-dose combinations (FDCs) of ARVs – that is, pills containing two or three AIDS drugs in one tablet – are widely recognized as being a key element in efforts to scale up AIDS treatment in developing countries.FDCs are recommended in the World Health Organization (WHO) treatment guidelines and several generic FDCs have been pre-qualified by WHO (see overleaf ). Based on its own experience delivering ARV treatment in resource-poor settings, Médecins Sans Frontières (MSF) has become a strong advocate of triple FDCs. MSF is currently providing ARV treatment to more than
11,000 people living with HIV/AIDS in over 20 countries in Africa, Asia, Latin America, and Eastern Europe, and expects the total number of patients on ARVs to reach 25,000 in 25 countries by the end of 2004.
Country
Switzerland
Publisher
MSF CAMPAIGN FOR ACCESS TO ESSENTIAL MEDICINES
URL:
Theme area
Equity and HIV/AIDS
Title of publication Understanding community responses to the situation of children affected by AIDS: Lessons for external agencies
Date of publication
2001 March
Publication type
Report
Publication details
Draft paper prepared for the UNRISD project HIV/AIDS and Development pp 28pp.
Publication status
Publication status unknown
Language
English
Keywords
community-based programmes, family coping strategies, children, orphans, HIV/AIDS strategies
Abstract
Throughout Africa, the AIDS epidemic is affecting large numbers of children and generating serious psychological, social and economic problems. Many children who are not themselves infected suffer the consequences of prolonged parental illness. Many others have already experienced the loss of their mother, their father, or both. Estimates for 26 African countries suggest that the number of children losing one or both parents will more than double between 1990 and 2010. By the latter year, 15 percent of children in these countries will have lost one or both parents, with the figure rising as high as 37 percent in Botswana, 34 percent in Zimbabwe, 32 percent in Swaziland and Namibia, and 31 percent in South Africa and Central African Republic (Hunter & Williamson, 2001). During the same period, those who have lost both mother and father will increase eight-fold overall in Africa (from 1.5 to 12 million), with a staggering seventeen-fold increase (from 0.2 to 3.4 million) in southern Africa. Even if rates of new HIV infections in adults were to fall in the next few years, the long incubation period would mean parental mortality rates would not plateau until 2020. The proportion of orphaned children (losing either one or both parents) would therefore remain unusually high throughout the first half of the twenty-first century.
Despite massive increases in orphan numbers, surprisingly small numbers of children have, up to now, slipped through the safety net provided by the extended family. In general, fostering is provided by relatives. Nevertheless family coping strategies are under enormous strain. It is thus important to understand the recent proliferation of initiatives supporting vulnerable children at the community level. These responses to the epidemic – growing out of community solidarity, compassion and religious belief – are often hardly known outside their immediate locale. They have been little studied or documented, and few external organizations have sought to foster their development. Yet robust community initiatives will be an essential element in caring for growing numbers of orphans and vulnerable children in coming years. They must form part of an expanded response to the tragedy of HIV/AIDS.
In the following pages, some of these initiatives will be analysed, with a view to encouraging appropriate support from external institutions ranging from local and national NGOs and researchers to international agencies. At the same time, the paper will attempt to discourage inappropriate support and to underscore the point that ill-advised assistance can easily undermine community initiatives. Outsiders can often play a more useful role as facilitators of community-based programmes than as direct service providers. They can build capacity, and increase the scope and scale of existing activities, without imposing externally-designed solutions that often have negative consequences.
Country
United States
Publisher
UNRISD
URL:
Theme area
Health equity in economic and trade policies
Title of publication GATS and trade in health insurance services: Background note for WHO commission on macroeconomics and health
Date of publication
2001 June
Publication type
Report
Publication details
CMH Working Paper Series 7 pp 10pp.
Publication status
Published
Language
English
Keywords
GATs negotiations, national policies and regulations, health insurance, market access
Abstract
This note provides background on the treatment of health insurance services by the General Agreement on Trade in Services (GATS) of the World Trade Organization, and explains the relevance of current GATS negotiations for health insurance trade. It begins with a general description of GATS, indicates how health insurance is classified in GATS-defined service sectors, and outlines options countries have when making insurance-related market access commitments. It then explains why GATS commitments made to date have not yet had any measurable effect on changes in insurance markets. It reviews some of the issues addressed in current GATS negotiations and their potential implications for market access commitments covering health insurance. It concludes by reviewing the opportunities, risks and challenges presented by GATS for national policies and regulations affecting health insurance.
Country
Switzerland
Publisher
WHO Commission on Macroeconomics and Health
URL:
Theme area
Health equity in economic and trade policies, Human resources for health
Title of publication Mapping health services trade in South Africa
Date of publication
2002
Publication type
Conference Proceedings
Publication details
Trade and Industrial Policy Strategies (TIPS): 2002 Annual Forum pp 38pp.
Publication status
Published
Language
English
Keywords
trade liberalisation, healthworker trade/ migration, GATs, regulations
Abstract
This paper takes a first look at the South African health sector and the barriers to health services trade. This type of service is mainly traded through investments in hospitals and clinics, through the presence of foreign service providers or through the movement of consumers to access health services abroad. While minimal formal liberalisation has been offered by South Africa under the General Agreement on Trade in Services (GATS), trade is certainly occurring. This paper concentrates on defining regulations in the health sector and determining whether these form barriers to trade or are trade enabling. The paper also provides data on the sector under the categories of human resources, health care providers and health care purchasers. It is concluded that policymakers would be wise to exercise due caution when considering health services trade liberalisation as the impact on the public sector may not be positive.
Country
South Africa
Publisher
Trade and Industrial Policy Strategies (TIPS)
URL:
Theme area
Equity in health, Poverty and health
Title of publication Equity in health in Southern Africa: Challenges to research
Date of publication
2003 December
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
poor bear cost, health systems, pro-poor, health gains, southern Africa
Abstract
The paper presents evidence that poor households in southern Africa have borne an inequitable share of the cost burdens of major public health problems such as HIV/AIDS, Malaria and TB. This burden shift derives in part from weaknesses in access to the social and economic protection that comes from housing, clean water, literacy, education, employment opportunities, assets, incomes, access to services and social networks.
Research indicates that these are critical determinants of poverty, but also barriers to improved uptake of new resources. These patterns of deprivation are now well described, as are their links to the distribution of health sector inputs and of social and economic opportunity. Responding to this there have been a range of ‘poverty reducing’ nterventions
aimed at improving access to health inputs, through direct targeted interventions, mobilisation of new resources for health and through promotion of more equitable public and
private resource allocations for health. In southern Africa, evidence and historical experience both suggest that health gains have been more sustained when health systems redistribute resources to areas where poverty is high and on pro-poor services. So why do the cost burdens of ill health continue to shift to poor households? This paper explores the factors emerging from EQUINET and other research in southern Africa on the deeper determinants of whether societal and health resources will be directed towards proven interventions,
nationally and globally. It traces these downwards, to the capacities and mechanisms for communities to participate in, claim and benefit from entitlements in national systems. It
also traces these upwards in the values, policies and practices that inform global trade, investment and economic policies. The paper explores the implications for the areas of focus, approaches and alliances to be pursued if a research agenda is to contribute towards a more equitable distribution of resources for health.
Country
Zimbabwe
Publisher
Training and Research Support Centre (TARSC), EQUINET
URL:
Theme area
Governance and participation in health
Title of publication Mobilising health and social justice movements around an alternative World Health Report
Date of publication
2004
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
civil society, participation, global state of poor health, inequity
Abstract
Global civil society does not participate strongly and consistently in international health advocacy. Whilst there have been some high-profile successes due to pressure from civil society, (for example with campaigns to improve access to medicines and to regulate the promotion of infant formula), there is a striking lack of involvement and pressure from civil society on broad health and health systems issues.
With the failure of the global community to achieve “Health for All by the Year 2000”, new targets - such as the Millennium Development Goals – have come to the fore. However, whilst overseas development assistance levels stagnate, and the trade and investment environment become even more unfriendly to poor countries, there is a likelihood that these targets too will not be met, increasing cynicism and discontent in the world. Growing disparities in health care consumption between the rich and the poor add a significant political and moral dimension to the global state of poor health.
Instead, a fragmented, disease- and issue-specific approach to health dominates advocacy as well as research and governance agendas, under-emphasising the underlying causes of ill-health. In addition, the values that underpin the goal of health equity are often undermined by development policies emphasising efficiency at the expense of fairness; market forces at the expense of planning based on population needs; and selective approaches to diseaseeradication at the expense of comprehensive strategies for promoting health. In addition, the diminished capacity and role of national governments and the public sector, particularly in poor countries, has further undermined the notion of social solidarity and democratic governance.
Although there has been a recent and welcome shift by the World Health Organisation to highlight global inequity and reassert the principles of the Primary Health Care Approach, constant pressure from civil society is needed to hold national policy-makers and international organizations accountable to declared values. To be effective, civil society voices must be well informed, evidence-based, and united on fundamental issues.
Country
Publisher
Global Health Watch
URL:
Theme area
Equity and HIV/AIDS
Title of publication Low Credit: A report on the World Bank’s response to HIV/AIDS in developing countries
Date of publication
2004 January
Publication type
Report
Publication details
Fighting Poverty Together pp 30pp.
Publication status
Published
Language
English
Keywords
World Bank, AIDS crisis, social spending, health systems
Abstract
UNAIDS estimated that in Africa in 2003, more than 2.3 million people died from AIDS, 3 million were newly infected and a total of 12 million children were orphaned. Antiretroviral drugs are reaching a mere 50,000 of those with AIDS in developing countries. The HIV/AIDS pandemic is clearly a human and developmental disaster.
This paper looks at the response to the HIV/AIDS crisis by the World Bank as a key member of the international donor/lending community, a leader in the international health community, and as Africa’s principal development partner. In its seminal document, Intensifying Action Afainst HIV/AIDS, the World Bank acknowledges both its special leadership role in fighting HIV/AIDS and the need that it be held accountable for its stewardship.
It states: “those who look back on this era will judge our institution in large measure by whether we recognised this wildfire that is raging across Africa for the development threat that it is, and did our utmost to put it out. They will be right to do so.”
This paper assesses what the Bank did in response to the epidemic, whether it could have done things differently, and given this, what should happen now. The main findings are as follows.
The World Bank failed the poor. It failed to protect social spending during its structural adjustment operations in the 1980s and 1990s, and this led to the deterioration of basic services – including those needed for the prevention and control of HIV/AIDS. It failed to consider the impact of its policies on the poor, who are already vulnerable to HIV, have less access to safe-sex information, are less likely to use condoms and have fewer STI/HIV services. The Bank failed to consider the possibility that its policies would reduce the safety of health systems and become a source of HIV, especially at the periphery of health systems.
Country
United Kingdom
Publisher
Action Aid International
URL:
Theme area
Equity and HIV/AIDS
Title of publication HIV/AIDS: Implications for poverty reduction
Date of publication
2001 June
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
HIV/AIDS impact, poverty, service delivery
Abstract
HIV/AIDS is having a disastrous impact on the social and economic development of countries most affected by the epidemic. In much of Africa and other affected regions, this epidemic will prove to be the biggest single obstacle to reaching national poverty reduction targets and the development goals agreed on at the United Nations Millennium Summit.
The challenge is immense: How do countries reduce the proportion of people living in poverty when up to a quarter of households are decimated by AIDS? How do countries deliver on policies aimed at equity in access to economic opportunities and social services when AIDS widens economic differentials and undermines service delivery?
How do countries deliver on promises to improve quality of life for coming generations when 40 million children will grow up orphaned by AIDS? How does a country like South Africa deliver on its goal of being a regional engine of growth with over 4 million HIV-positive people and the fastest growing infection rate in the world?
The devastation caused by HIV/AIDS is unique because it is depriving families, communities and entire nations of their young and most productive people. The epidemic is deepening poverty, reversing human development achievements, worsening gender inequalities, eroding the ability of governments to maintain essential services, reducing labour productivity and supply, and putting a brake on economic growth. These worsening conditions in turn make people and households even more at risk of, or vulnerable to, the epidemic, and sabotages global and national efforts to improve access to treatment and care. This cycle must be broken to ensure a sustainable solution to the HIV/AIDS crisis.
Country
United States
Publisher
United Nations Development Programme
URL:
Theme area
Human resources for health
Title of publication Human resources for health: Requirements and availability in the context of scaling-up priority Interventions in low-income countries: Case studies from Tanzania and Chad
Date of publication
2003 January
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
human resources, salaries, scaling up health services, low income countries, Tanzania, Chad
Abstract
Endorsing the Millennium Development Goals, the international community has committed itself to significant improvements in the health of the poor by the year 2015. Governments and societies in developing countries face the challenge of translating these predetermined global targets into national, country specific policies and ensuring their implementation. The
key to sustainable reductions in the burden of disease is the increased accessibility and utilization of cost-effective interventions that address the main causes of disease burden.
Increased access to priority interventions requires the strengthening and expansion of health service delivery systems.
Human resources are one of the key components of health systems. Salaries consume up to two-thirds of recurrent health budgets. Adequate human resource availability is therefore central for any large-scale attempt to increase the reach of health systems. Further, human resource availability is likely to determine the capacity to absorb additional financial resources and thus the pace of scaling up. The purpose of this study was to explore the role and importance of human resources for the scaling up of health services in low income countries. In two case studies, we
(i) investigated the size, composition and structure of the current health work force;
(ii) produced estimates of future human resource availability;
(iii) estimated the quantity of human resources required significantly to scale up priority interventions towards 2015; and
(iv) compared human resource availability and human resource requirements.
Case studies were performed for the mainland of the United Republic of Tanzania and for Chad. Tanzania belongs to the group of least developed countries. In the 1970’s and 1980’s, the country adopted a health for all strategy with significant investments in health system infrastructure including staff. This approach proved financially unsustainable and was followed by a public sector employment freeze over the last decade. Approximately 80% of the population have access to health services. Chad is one of the poorest countries. After decades of armed conflict, the country is struggling to revive a crippled health system. Human resource development is given priority within the current health sector reform process.
Approximately 30% of the population have access to health services.
Country
Switzerland
Publisher
Department for International Development (DFID), LSHTM Health Economics and Financing Programme
URL:
Theme area
Governance and participation in health
Title of publication Public participation in health: Making people matter
Date of publication
1998 December
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
community participation, Zimbabwe, inclusive health systems
Abstract
Participation of communities is widely argued to be an important factor in improving health outcomes and the performance of health systems. This paper uses a review of past experience of participation in Zimbabwe’s health system to propose that participation be strengthened along two dimensions: Creating realistic expectations between communities and health services in their contributions towards health, and in the governance of health systems. Various examples are outlined of the relationship between social participation and control and health outcomes. The paper also outlines the features of and factors in building participation in governance of health systems. It argues for a wider inclusion of social groups from civil society, elected leadership and health systems in structures and processes that set and audit health policies and priorities. It discusses issues to be addressed in enhancing participation, including the information, processes, capacities and resources required. Finally, it reviews the proposals for and issues to be addressed in enhancing participation and accountability in Zimbabwe\\\\\\\\\\\\\\\'s health sector at district, referral hospital and national level.
Country
Zimbabwe
Publisher
Training and Research Support Centre (TARSC), Institute of Development Studies (IDS)
URL:
Theme area
Equity and HIV/AIDS
Title of publication Adaptive strategies and coping mechanisms of families and communities affected by HIV/AIDS in Malawi
Date of publication
2002 March
Publication type
Document
Publication details
Draft paper prepared for the UNRISD project HIV/AIDS and Development pp 16pp.
Publication status
Publication status unknown
Language
English
Keywords
Malawi, HIV/AIDS strategies
Abstract
HIV/AIDS in Malawi is overwhelming. With an HIV prevalence rate of 14 per cent in the economically productive age group of 15-49 years, Malawi is one of the countries most affected by HIV/AIDS in the world1. The first case of AIDS was diagnosed in 1985. In the mid-1980s 2 per cent of pregnant women attending antenatal clinics were HIV infected; in less than two decades an estimated 35 per cent of pregnant women were infected (Kalipeni, 2001). According to the National AIDS Control Programme the prevalence of HIV in the economically productive age group is estimated at 26 per cent in the urban areas and 12 per cent in the rural areas. In the same age group, the prevalence of HIV in the northern region is estimated at 9 per cent, 11 per cent in the central region and 18 per cent in the south (Strategic Planning Unit and National AIDS Control Programme, 1999). According to Government of Malawi and World Bank, high rates of urbanisation and labor migration are the most important contributing factors to the high rates of HIV in the Southern Region (Government of Malawi and World Bank, 1998).
Tuberculosis is an opportunistic infection closely associated with HIV infection and in Malawi an estimated 70 per cent of people reported with tuberculosis are also HIV infected (Kumwenda, 2001). Reported tuberculosis cases have risen from 5,000 in 1985 to 24,000 in 2000 (Kumwenda, 2001 and Glynn et al, 1997). These trends in HIV and tuberculosis infections have put a severe strain on the government\\\\\\\'s health budget because close to 80 per cent of people admitted to hospital wards suffer from HIV/AIDS related problems compared to 20 per cent in 1990.
In Malawi in 1987 the dependency ratio was at 1.01; by 1998 when the last census was conducted this had risen to 1.3 (National Economic Council, 2000). The increase has mainly been attributed to the HIV/AIDS pandemic as it is causing the death of productive men and women. In addition to this, HIV/AIDS has led to the decrease in life expectancy. In Malawi, for example, life expectancy in 1985 was estimated at 45.2 years and expected to rise to 57.4 years by the year 2000. Now, however, it is estimated that the life expectancy rate for Malawi is around 36 years of age.
Country
United States
Publisher
United Nations Research Institute for Social Development
URL:
Theme area
Equity and HIV/AIDS
Title of publication Global neoliberalism and AIDS policy: International responses to Sub-Saharan Africa’s pandemic
Date of publication
2003 December
Publication type
Journal Article
Publication details
Studies in Political Economy 71/72 pp 43-61
Publication status
Published
Language
English
Keywords
HIV/AIDS global response
Abstract
This paper aims to explain the way in which Sub- Saharan Africa has been cast in the global institutional response to the AIDS pandemic, with particular attention to the cultural and ideological meanings attached to global restructuring, and the ways that they are reflected in the response. I provide a sketch of the competing knowledge systems of AIDS—the predominant understandings that have informed the international policy response to AIDS in Africa, their social conditions and institutional contexts. I suggest that a number of factors have converged to shape the African policy response; a particular “Western” understanding of AIDS deriving from biomedicine, and its articulation with a neoliberal and androcentric human rights discourse — the political counterpart to the economic dimensions of global restructuring. Also informing AIDS policy in Africa have been the ideas and of a far-reaching economic reform agenda spearheaded by the IMF and the World Bank, rural living standards, life expectancy, and basic social and nutritional indicators were and remain among the lowest in the world.
Country
Publisher
URL:
Theme area
Governance and participation in health
Title of publication Mapping the links: Citizen involvement in policy processes
Date of publication
2002 April
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
civil society, participation, Canada
Abstract
How to involve citizens in policy making is at the core of discussions over modernizing governance and building a stronger civil society. The renewed interest in citizen involvement is not a passing fad, but stems from shifts toward more horizontal models of governance and toward a more organized, diverse and empowered civil society. In addition, advances in communication technologies have created new potential for how citizens might be involved. While there is no shortage of talk about the need to reduce the democratic deficit and involve citizens in policy processes, there is seemingly little in the way of genuine progress at the federal level in Canada. Part of the problem is conceptual. Both citizen involvement and policy processes tend to be conceived of as one dimensional, so it is difficult to pinpoint which institutions are failing in what aspects of citizen involvement, or to consider multiple, complementary paths for involvement. This paper seeks to develop a fuller understanding of the multidimensional nature of citizen involvement and to assess the adequacy of contemporary practices of citizen involvement in
Canada. We do this by mapping the links between eight dimensions of citizen involvement, three key political institutions, and six stages of the policy process. For each stage of policy, we assess the adequacy of existing political institutions in providing for the dimensions of citizen involvement important to that stage. Based on this assessment, the paper explores, in a practical way, how Canada’s institutions might be reformed to enhance citizen involvement. The focus of the paper is on the involvement of individual Canadians in policy processes. Nonetheless, we also demonstrate that the participation of civil society organizations is a vital, complementary process.
Country
Canada
Publisher
Canadian Policy Research Networks
URL:
Theme area
Human resources for health
Title of publication International NGOs and primary health care in Mozambique: The need for a new model of collaboration
Date of publication
Publication type
Journal Article
Publication details
Social Science & Medicine pp 14pp.
Publication status
In press
Language
English
Keywords
NGOs; Mozambique; International aid; Primary health care; Social inequality
Abstract
In keeping with the neo-liberal emphasis on privatization, international aid has been increasingly channeled through non-governmental organizations (NGOs) and their expatriate technical experts to support primary health care (PHC) in the developing world. Relationships between international aid workers and their local counterparts have thus become critical aspects of PHC and its effectiveness. However, these important social dynamics of PHC remain understudied by social scientists. Based on three years of participant-observation in Mozambique, this paper presents an ethnographic case study of these relationships in one central province. The Mozambique experience reveals that the deluge of NGOs and their expatriate workers over the last decade has fragmented the local health system, undermined local control of health programs, and contributed to growing local social inequality. Since national health system salaries plummeted over the same period as a result of structural adjustment, health workers became vulnerable to financial favors offered by NGOs seeking to promote their projects in turf struggles with other agencies. It is argued that new aid management strategies, while necessary, will not be sufficient to remedy the fragmentation of the health sector. A new model for collaboration between expatriate aid workers and their local counterparts in the developing world is urgently needed that centers on the building of long-term equitable professional relationships in a sustainable adequately funded public sector. The case study presented here illustrates howthe NGO model undermines the establishment of these relationships that are so vital to successful development assistance.
Country
Publisher
Pergamon
URL:
Theme area
Health equity in economic and trade policies
Title of publication Globalisation and liberalisation of healthcare services: WTO and General Agreement on Trade in Services (GATS)
Date of publication
Publication type
Report
Publication details
Issue Paper pp 19pp.
Publication status
Published
Language
English
Keywords
globalisation, TRIPs, GATT, WTO, transnational corporations
Abstract
Access to essential drugs and affordable medical services are major consumer concerns. The Health and Pharmaceuticals Programme of Consumers International Regional Office for Asia and the Pacific (CIROAP) has been campaigning, advocating and lobbying for the formulation and implementation of national drug policies and national health policies. The major components of these national policies include:
· Access to essential drugs and affordable healthcare services
One of the major activities undertaken by the Health and Pharmaceuticals Programme soon after it was set up in November 1986 was to study the impact of pharmaceutical patents on the pharmaceutical supply systems in developing countries. This activity gathered momentum when the Uruguay Round (UR) of Negotiations began in 1987.
In order to alert consumers and to inform policy-makers in developing countries on the impact of pharmaceutical
patents and WTO/TRIPs Agreement on access to drugs and healthcare, CI ROAP prepared the six reports and presented them at different forums.
This paper begins with a description of the evolution of the TRIPs Agreement. Initially the developing countries refused to enter the negotiations when the major trading powers attempted to include services, investment and intellectual property, in addition to goods into the Uruguay Round of Negotiations. A compromise was reached to negotiate services and investment outside the jurisdictional framework of GATT. Negotiations on intellectual property rights (IPRs) would follow the approach in the articles of GATT which ensured that Member States had the freedom to pursue their own regime of protection of intellectual property.
However, soon after the negotiations began in 1987, the US used bilateral threats of trade retaliation and forced developing countries to change their national legislation on patents and go back to the negotiating table. Negotiations continued and the paper describes in some detail the asymmetry of the negotiations.
These were dominated by the major powers. The Final Agreement has been described as the most nontransparent,
non-accountable, anti-people, pro-TNC agreement in the history of international negotiations and agreements. The TRIPs Agreement together with Trade Related Investment Measures (TRIMs) have taken away the powers of economic decision making from the national governments and handed them to the dominant actors in the international market place, namely the transnational corporations (TNCs). The international economic order has been radically restructured by the TRIPs Agreement which encompasses virtually the entire economic spectrum.
The GATT/WTO/TRIPs Agreement was ‘negotiated’ as an integral part of the Uruguay Round (UR) of Negotiations. It is one component of a package of commitments. There is the possibility of cross-retaliation in case of non-compliance with any one component. The TRIPs Agreement cannot, therefore, be taken in isolation but has to be examined in the context of the whole GATT/WTO Agreements. WTO Agreements, by liberalising trade in goods and services, promotes the process of globalisation. It is therefore necessary to examine TRIPs not only in the context of other WTO trade agreements but also in the overall context of globalisation.
To understand fully the implications of WTO/TRIPs Agreement on the access of drugs to consumers in the
ASEAN region, it will be necessary to examine the pharmaceutical sector in the ASEAN countries and in the world. Empirical data on pharmaceutical production and consumption in five ASEAN countries – Indonesia, Malaysia, Philippines, Singapore and Thailand are given. Relevant data on the worldwide pharmaceutical industry and the multinational drug industry are also given.
Country
Malaysia
Publisher
People\'s Health Assembly
URL:
Theme area
Equity in health
Title of publication Discussant paper: Achieving equity and social justice in food security and nutrition - Challenges and major areas of policy and action
Date of publication
2004 June
Publication type
Conference Proceedings
Publication details
EQUINET Conference: Reclaiming the State: Advancing People\'s Health, Challenging Injustice pp 5pp.
Publication status
Published
Language
English
Keywords
SADC, food crisis, HIV/AIDS, food security
Abstract
Southern Africa is going through Food crisis and emergency situation. The humanitarian crisis has highlighted that AIDS and hunger has placed the region in a state of severe vulnerability and a reduced threshold for crises turning into major disasters.
The recent food crisis in Southern Africa has been far more widespread and impacted much more severely than predictions based upon rainfall patterns had anticipated - illustrates the destructive effect AIDS is having in the community.
During the SADC HIV & AIDS Summit held on 1-2 July 2003, in Maseru Lesotho; the Heads of State and Governments declared Food Security as one of the areas requiring urgent attention and action; and that a joint Ministerial meeting on food security should be held for effective implementation of food security programmes in the region. This meeting was held in Tanzania April 2004 highlighting important strategies and regional commitments in addressing food shortage in the region.
Country
Botswana
Publisher
SADC Social and Human Development Directorate - Health
URL:
Theme area
Equity in health
Title of publication Food security and nutrition: Discussion
Date of publication
2004 June
Publication type
Conference Proceedings
Publication details
EQUINET Conference: Reclaiming the State: Advancing People\'s Health, Challenging Injustice pp 2pp.
Publication status
Published
Language
English
Keywords
food security, poverty
Abstract
The paper on food security on nutrition raises many very important issues including:
· Food and nutrition as a basic right;
· Impact of malnutrition on development;
· Economic costs of malnutrition;
· Malnutrition and Poverty;
· Food security and HIV/AIDS.
Country
Tanzania
Publisher
The Centre for Counselling, Nutrition and Health Care (COUNSENUTH)
URL:
Theme area
Equity in health
Title of publication Reclaiming the state: Advancing people’s health, challenging injustice
Date of publication
2004 June
Publication type
Conference Proceedings
Publication details
Publication status
Published
Language
English
Keywords
globalisation, socio-economic disparities
Abstract
The accelerated processes of globalisation that have characterised the last decade and half in world history and the forces/interests that have emerged to dominate and propel them have brought to the fore, a broad range of issues and concerns that touch directly on global and local-level equity and justice both generally as they pertain to the developmental experience and more specifically as they are being played out in the social sectors of which health and education occupy a place of prime importance.
Although, at one level, globalisation appears to promise a great deal of opportunity for progress and advancement, the process, in the way in which it has been shaped in the contemporary period has also been accompanied, at another level, by a sharpening of socio-economic disparities and inequalities among nations and within countries.
Furthermore, even within specific social groups, an accelerated process of differentiation is taking place and overall, in most countries of the world, the social pyramid has grown much narrower at the top, thinner in the middle and broader at the base, suggesting that the main winners from globalisation represent a small and diminishing minority even as millions, including many who once formed part of or aspired for the middle class, have been pushed to the bottom of the social ladder into poverty and misery.
At the same time, the promise which the greater international exchanges associated with the process of globalisation offers also contains the grains of vulnerability to the accelerated spread of diseases across frontiers propelled by the increased cross-border mobility of people. And yet, there is no corresponding globally structured capacity to respond to these vulnerabilities and the states on whom the challenge of managing global disease spread falls are of generally uneven capacity.
Country
Senegal
Publisher
CODESRIA
URL:
Theme area
Equity in health
Title of publication Conference resolutions June 2004: Reclaiming the state: Advancing people's health, challenging injustice
Date of publication
2004 June
Publication type
Conference Proceedings
Publication details
EQUINET Resolutions pp 1-2
Publication status
Published
Language
English
Keywords
public health, justice, southern Africa
Abstract
Country
Southern Africa Regional
Publisher
EQUINET
URL:
Equinet Publication Type
Resolutions
Theme area
Equity in health
Title of publication Conference Programme: Reclaiming the state: Advancing people's health, challenging injustice, Durban, June 2004
Date of publication
2004 June
Publication type
Conference Proceedings
Publication details
Publication status
Published
Language
English
Keywords
health equity, political economy of health
Abstract
Country
Southern Africa Regional
Publisher
EQUINET
URL:
Equinet Publication Type
Book
Theme area
Public-private mix, Resource allocation and health financing
Title of publication Reforming infrastructure: Privatization, regulation,and competition
Date of publication
2004
Publication type
Book
Publication details
A World Bank Policy Research Report pp 43pp
Publication status
Published
Language
English
Keywords
privatization, private infrastructure
Abstract
For much of the 20th Century and in most countries, network utilities—electricity, telecommunications, railroads, water supply, natural gas—were vertically and horizontally integrated state monopolies under ministerial control. Infrastructure’s enormous economic importance, a desire to protect the public interest in industries supplying essential services, and concerns about private monopoly power led governments to conclude that control over these services could not be entrusted to the motivations and penalties of free markets. Governments also believed that, given the large investments involved, public resources were required to increase infrastructure coverage. Accordingly, a single public entity usually controlled every aspect of a utility—facilities, operations, and administration—and determined which services to provide to essentially captive customers.
The past decade has seen dramatic change in views about how network utilities should be owned, organized, and regulated. The new model calls for increased reliance on private infrastructure to improve efficiency, promote innovation, and enhance services. But after a series of financial crises, corporate scandals, and stock market collapses, the California electricity crisis, and blackouts around the world, clear guidance is needed on what should be done for infrastructure—as well as reassurance about (or qualifications of ) earlier, more confident messages. What are the promises and perils of the new model? And what principles should guide future efforts to restructure, regulate, and expand infrastructure?
Country
United States
Publisher
World Bank, Oxford University Pres
URL:
Theme area
Equity in health
Title of publication Putting equity in health back onto the social policy agenda: Experience from South Africa
Date of publication
2002
Publication type
Journal Article
Publication details
Social Science & Medicine 57 pp 1637-1656
Publication status
Published
Language
English
Keywords
health equity goals, policy, South Africa
Abstract
Over the past decade, international health policy debates have been dominated by efficiency considerations. There has been a recent resurgence of interest in health equity, including consideration of the notions of vertical equity and procedural justice. This paper explores the possible application of these notions within the context of South Africa, a country in which inequities in income and social service distribution between ‘racial’ groups were systematically promoted and entrenched during four decadesof minority rule, guided by apartheid and related policies. With the transition to a democratic government in 1994, equity gained prominence on the South African social policy agenda. Health equity has been awarded a particularly high priority, not least of all because the health sector is seen as vehicle for achieving rapid equity gains. In addition, many of the other equity-promoting social sector policies (such as
improved access to housing and water and sanitation services) have been motivated on the basis of their potential health
equity gains. The South African experience since 1994 provides useful insights into factors which may facilitate or constrain health equity progress. In particular, the constitutional entitlement to health and civil society action to maintain health equity’s place on the social policy agenda are seen as important facilitating factors. Certain health sector programmes have also been developed which are intended preferentially to benefit those who have been historically dis-advantaged, and which thus support vertical equity goals. However, there have been no efforts to promote cross-subsidisation between the private and public health sectors, and initial efforts to promote coherency in social policies (through the Reconstruction and Development Programme) appear not to have been sustained. In addition, macro-economic policies(particularly the highly ambitiousbudget deficit reduction targets of the government) are likely to undermine some of the equity-promoting social policy initiatives. Most importantly, the potential inter-relationship of vertical equity and procedural justice goals has not been adequately recognised. As a result, and despite policy rhetoric, this paper concludes that health equity goals are critically dependent on the central involvement of the dis-advantaged in decision-making about who should receive priority, what services should be delivered and how equity-promoting initiativess hould be implemented.
Country
South Africa
Publisher
Pergamon
URL:
Theme area
Human resources for health
Title of publication Developing evidence-based ethical policies on the migration of health workers: Conceptual and practical challenges
Date of publication
2003 October
Publication type
Journal Article
Publication details
Human Resources for Health 1 8 pp 29pp.
Publication status
Published
Language
English
Keywords
healthworkers migration, international trends
Abstract
It is estimated that in 2000 almost 175 million people, or 2.9% of the world’s population, were living outside their country of birth, compared to 100 million, or 1.8% of the total population, in 1995. As the global labour market strengthens, it is increasingly highly skilled professionals who are migrating. Medical practitioners and nurses represent a small proportion of highly skilled workers who migrate, but the loss of health human resources for developing countries can mean that the capacity of the health system to deliver health care equitably is compromised. However, data to support claims on both the extent and the impact of migration in developing countries is patchy and often anecdotal, based on limited databases with highly inconsistent categories of education and skills.
The aim of this paper is to examine some key issues related to the international migration of health workers in order to better understand its impact and to find entry points to developing policy options with which migration can be managed.
The paper is divided into six sections. In the first, the different types of migration are reviewed. Some global trends are depicted in the second section. Scarcity of data on health worker migration is one major challenge and this is addressed in section three, which reviews and discusses different data sources. The consequences of health worker migration and the financial flows associated with it are presented in section four and five, respectively. To illustrate the main issues addressed in the previous sections, a case study based mainly on the United Kingdom is presented in section six. This section includes a discussion on policies and ends by addressing the policy options from a broader perspective.
Country
Publisher
BioMed Central
URL:
Theme area
Resource allocation and health financing, Monitoring equity and research to policy
Title of publication The TEHIP “spark” leads to better health: Integrating research and development was key in Tanzania
Date of publication
Publication type
Report
Publication details
Research Influence on Policy: A case study pp 4pp.
Publication status
Published
Language
English
Keywords
research, policy, district resource allocation, health spending
Abstract
The Tanzania Essential Health Interventions Project (TEHIP) is a research and development partnership involving Tanzania’s Ministry of Health and Canada’s International Development Research Centre (IDRC). It was established to test innovations in planning, priority setting, and resource allocation at the district level. The results make a powerful case that using research to make health spending more proportional to the prevailing burden of disease can have a significant, positive impact on health outcomes.
Country
Canada
Publisher
IDRC
URL:
Theme area
Poverty and health
Title of publication Child health: Reaching the poor
Date of publication
2004 May
Publication type
Journal Article
Publication details
American Journal of Public Health 94 5 pp 726-736
Publication status
Published
Language
English
Keywords
rates of mortality, malnutrition, inequality
Abstract
In most countries, rates of mortality and malnutrition among children continue to decline, but large inequalities between poor and better-off children exist, both between and within countries. These inequalities, which appear to be widening, call into question the strategies for child mortality reduction relied upon to date.
We review (1) what is known about the causes of socioeconomic inequalities in child health and where programs aimed at reducing inequalities may be most effectively focused and (2) what is known about the success of actual programs in narrowing these inequalities.
We end with lessons learned: the need for better evidence, but most of all for a new approach to improving the health of all children that is evidence based, broad, and multifaceted.
Country
United States
Publisher
American Journal of Public Health
URL:
Theme area
Equity and HIV/AIDS
Title of publication Round tables: HIV/AIDS: Report by the secretariat
Date of publication
2004 May
Publication type
Report
Publication details
Agenda item 10 A57/DIV/10 pp 4pp.
Publication status
Published
Language
English
Keywords
tackling HIV/AIDS, best practice, action strategies, policy interventions
Abstract
This report summarizes the main issues raised in the four ministerial round-table discussions on HIV/AIDS that were held concurrently on 18 May 2004. Health ministers or their representatives analysed four key issues and indicated how the challenges posed by HIV infection and AIDS could be best tackled. Participants shared information on best practices, identified means of overcoming major constraints and obstacles to success, highlighted essential policy interventions and action strategies, examined the role of the health and other sectors in improving prevention, treatment and care, and made recommendations to WHO to take forward work in this area.
Country
Switzerland
Publisher
World Health Organisation
URL:
Theme area
Equity and HIV/AIDS
Title of publication Round tables: HIV/AIDS
Date of publication
2004 April
Publication type
Conference Proceedings
Publication details
Provisional Agenda Item 10 A57/DIV/9 pp 5pp
Publication status
Published
Language
English
Keywords
HIV/AIDS global health crisis, response to crisis
Abstract
The global response to the HIV/AIDS epidemic and the HIV treatment emergency is a major priority for WHO. The four round-table sessions at the current Health Assembly will focus on the following subjects: (i) the leadership role of the public health sector in expanding access to HIV care and treatment in countries; (ii) strengthening the capacity of health services to expand delivery of HIV treatment in countries; (iii) mobilizing partners and resources to expand access to HIV treatment in countries; and (iv) integrating prevention and treatment programmes in countries. This document
outlines the crisis due to AIDS and the unprecedented response, and provides an overview of the challenges to expanding access to HIV treatment in developing countries in terms of the specific
topics that might be considered in round tables.
Country
Switzerland
Publisher
WHO
URL:
Theme area
Human resources for health
Title of publication International migration of health personnel: A challenge for health systems in developing countries
Date of publication
2004 May
Publication type
Conference Proceedings
Publication details
Publication status
Published
Language
English
Keywords
resolutions, healthworker migration
Abstract
57th World Health Assembly, conference resolutions on Human Resources and migration of healthworkers.
Country
Switzerland
Publisher
World Health Assembly
URL:
Theme area
Equity and HIV/AIDS
Title of publication Scaling up treatment and care within a coordinated and comprehensive response to HIV/AIDS
Date of publication
2004 May
Publication type
Conference Proceedings
Publication details
Publication status
Published
Language
English
Keywords
resolutions
Abstract
Conference resolution on 22 May 2004, eigth plenary meeting of the World Health Assembly.
Country
Switzerland
Publisher
Fifty-seventh World Health Assembly
URL:
Theme area
Resource allocation and health financing
Title of publication Health outcomes after the abolition of cost-sharing in public hospitals in Uganda
Date of publication
2002 November
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
health financing, user fees, inequalities, Uganda GDP
Abstract
With a GDP per capita of about US$250 per annum, Uganda is listed among the poorest countries of the world. However, in the last 15 years, the country has recorded some of the highest GDP growth rates in the region. A number of policy measures, including structural adjustment, tight fiscal and monetary policies are responsible for this trend. The economic
reforms, first implemented in May 1987, cut across various sectors of the economy, including health, education, public service, industry, agriculture, etc. These reforms have had several positive and negative outcomes on the population of Uganda, depending on the sector.
In this paper, I focus on one aspect of the reforms, cost sharing in public hospitals and the implication of the abolition of the measure in February 2001. Aggregate and household level
data from Ugandan from before and after the abolition of user fees for public health services are used to explore the impact of this policy change on the ability to access health services. The
paper explores the impact of the measure on outcomes in terms of workdays lost due to sickness by different groups of households, and in particular groups (orphans) who had earlier been excluded from such services. Administrative and household level data point to a significant improvement in access to services, much of which is by the poor. The improved access to services was, however, not associated with improved outcomes, suggesting that better access was not accompanied by improvements in the quality of services, as is indeed supported by qualitative evidence and the fact that wealthy households seem to have opted out of public services. The fact that health outcomes have significantly worsened for orphans suggests that more than just eliminating fees is needed to improve health services for the poor and vulnerable.
Country
Uganda
Publisher
Johannes Kepler University
URL:
Theme area
Poverty and health
Title of publication Community assessment of food security and the social situation in Zimbabwe
Date of publication
2004 March
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
food security, poverty, welfare
Abstract
This report is the third of a broader monitoring of food security and social welfare at community level by the Civic Monitoring Programme. Monthly monitoring will be complemented by quarterly monitoring of specific areas of social welfare.
Country
Zimbabwe
Publisher
Civic Monitoring Programme
URL:
Theme area
Poverty and health
Title of publication Poverty and well-being in Mozambique: The second national assessment
Date of publication
2004 March
Publication type
Report
Publication details
Economic Research Bureau, Ministry of Planning and Finance pp 79pp.
Publication status
Published
Language
English
Keywords
poverty, economic growth, welfare indicators
Abstract
This report has very focused objectives. It seeks to present the methodology and results of the poverty analysis of the 2002-03 IAF as well as comparisons with the 1996-97 survey results. The results point to a substantially improved poverty picture relative to 1996-97. The national poverty headcount, defined as the share of the population living in poverty, declines to 54 percent, a 15 percentage point decline from the levels registered in 1996-97. Poverty reductions are more rapid in rural than in urban zones, narrowing considerably the differences in poverty between the two zones, though poverty levels remain higher in rural compared with urban zones. Larger than average reductions in poverty are registered in Niassa, Zambézia, Nampula, Tete, Manica, and Sofala. Consistency of these results with information from other data sources was also explored.
At the national level, broad consistencies exist. National accounts indicate rapid economic growth over the period 1996-2002. The levels of poverty reduction estimated from the IAF 2002–03 are consistent with these aggregate growth levels and a pattern of growth that benefits poorer households. Steep reductions in poverty, such as the ones observed, would have to take place in the context of rapid growth of a character favorable to poverty reduction.
The 2000-01 and 2002-03 Core Welfare Indicators Surveys (QUIBB) both indicated gains in indicators correlated with poverty reduction. A detailed analysis of the QUIBB 2000-01 combined with IAF 1996-97 generated predicted poverty measures on the basis of the QUIBB indicators. This analysis pointed to reductions in poverty at the national level of around nine percentage points for the period 1996-97 to 2000-01 (Massingarela, Simler, and Harrower 2003).
Country
Mozambique
Publisher
National Directorate of Planning and Budget, Ministry of Planning and Finance
URL:
Theme area
Equity and HIV/AIDS
Title of publication Interactions between the agricultural sector and the HIV/AIDS pandemic: Implications for agricultural policy
Date of publication
2004 March
Publication type
Report
Publication details
ESA Working Paper 04-06 pp 43pp.
Publication status
Published
Language
English
Keywords
HIV/ AIDS, food security, eastern and southern Africa
Abstract
This paper considers how the design of agricultural policies and programmes might be modified to better achieve policy objectives in the context of severe HIV epidemics and underscores the central role of agricultural policy in mitigating the spread and impacts of the epidemic. Based on projections of future demographic change in the hardest-hit countries of eastern and southern Africa, HIV/AIDS is likely to have the following effects on the agricultural sector: (1) increased rural inequality caused by is proportionately severe effects of AIDS on relatively poor households; (2) a reduction in household assets and wealth, leading to less capital-intensive cropping systems for severely affected communities and households; and (3) problems in transferring knowledge of crop husbandry and marketing to the succeeding generation of African farmers. It is argued that -- even though the absolute number of working age adults in the hardest-hit countries is projected to remain roughly the same over the next two decades -- the cost of labour in agriculture may rise in some areas as increasing scarcity of capital (notably, animal draft power for land preparation and weeding) will increase the demand for labour in agricultural production or shift agricultural systems to less labour- and capital-intensive crops.
Country
United States
Publisher
Agricultural and Development Economics Division: The Food and Agriculture Organization of the United Nations
URL:
Theme area
Poverty and health
Title of publication Famine in Zimbabwe: Implications of 2003/04 cropping season
Date of publication
2004 April
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
famine, food security, poverty
Abstract
Since the Zimbabwe Government embarked on its fast track land resettlement programme, the food situation, particularly in respect of the staple maize, has been getting worse every year. Initially people were talking of food shortage, but “famine” would now seem a more appropriate term to apply to the situation the country now faces. “Famine” has been used to describe situations of
extreme food scarcity and starvation in countries such as Ethiopia and Eritrea. Nobody ever contemplated that Zimbabwe, formerly the bread-basket of southern Africa, would come to be referred to in terms of famine.
Country
Zimbabwe
Publisher
Friedrich Ebert Stiftung
URL:
Theme area
Equity and HIV/AIDS
Title of publication The impact of HIV/AIDS on livelihoods in Lesotho
Date of publication
2003 November
Publication type
Report
Publication details
Livelihoods Recovery through Agriculture Programme (LRAP)
Publication status
Published
Language
English
Keywords
HIV/ AIDS, food security, Lesotho
Abstract
This report describes the impact of HIV and AIDS on livelihoods in two villages found in Mafeteng district namely:
♦ Van Rooyen’s gate (VR) a semi-urban border post west of Mafeteng town, under the principal chieftainship of Tebang.
♦ Ha Makhakhe (HM) a typical Basotho village situated east of Mafeteng town, under the principal chieftainship of Matelile.
The aim of this report is to present the findings, conclusions and recommendations of the research to policy makers and service providers with the intention of improving understanding of how HIV and AIDS affects household livelihoods strategies in Lesotho.
Following pilot interviews with four members of Positive Action in Maseru, in-depth interviews were carried out with 29 people in the two villages (17 in Van Rooyen and 12 in Ha Makhakhe).
These included 9 purposively selected infected and affected people, 11 randomly selected control households (some of whom also turned out to be affected by HIV/AIDS) and 9 key informants.
Country
Lesotho
Publisher
CARE Lesotho - South Africa
URL:
Theme area
Equity and HIV/AIDS
Title of publication Zimbabwe urban areas: Food security and vulnerability assessment
Date of publication
2003 September
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
household surveys, food shortages, urban areas
Abstract
The assessment was carried out in an environment with economic conditions worsening, the country experiencing food shortages due to droughts and other factors and hyperinflation standing at 455.6 percent in September 2003.
A livelihoods based structured questionnaires covering over 5,123 households, 660 focus groups and 256 institutions were administered over two weeks by 124 researchers through funding from UNDP and SADC FANR VAC. The survey was drawn from the CSO sample frame, by stratifying urban areas and considering population distribution and randomly sampling the households.
Country
Zimbabwe
Publisher
Zimbabwe National Vulnerability Assessment Committee
URL:
Theme area
Equity and HIV/AIDS
Title of publication Organizing the UN response to the triple threat of food insecurity, weakened capacity for governance and AIDS, particularly in southern and eastern Africa
Date of publication
2003 September
Publication type
Conference Proceedings
Publication details
Publication status
Published
Language
English
Keywords
HIV/AIDS, food insecurity, governance, poverty
Abstract
The scale and severity of the HIV/AIDS epidemic in southern and eastern Africa, interlinked with poverty, chronic and recurrent food insecurity, drought and weakened institutional capacity, mean that all UN agencies must urgently retool and scale-up their support of national and community capacities to enable a multi-sectoral response.
The purpose of this paper is to present a coherent system-wide policy and programming approach for the UN on HIV/AIDS with specific recommendations to be endorsed by the Chief Executives
Board. After a brief introduction, the paper summarizes the inter-linkages between HIV/AIDS, food insecurity and governance (section II); it then identifies the paradigm shift required in the UN
system in order to meet these new challenges (section III); lastly the paper presents programmatic and institutional actions UN agencies must undertake (sections IV and V).
Country
Italy
Publisher
United Nations
URL:
Theme area
Poverty and health
Title of publication Vulnerability situation analysis report
Date of publication
2004 March
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
humanitarian crisis, food, HIV
Abstract
Swaziland has been affected by drought conditions this agricultural season. Rainfall for 2003/4 has divided the country into two distinct parts. The western third has been wet while the central and eastern two thirds have had erratic rains with very dry conditions between October and December. Total rainfall may be one-third below the long-run average. The Highveld and ‘Wet’ Middleveld are considered to have
reasonable crop prospects. The ‘Dry’ Middleveld and the Lowveld have been seriously affected by drought conditions with large numbers of people failing to cultivate because of the late rains. Veld and livestock condition have deteriorated.
Between 1.4%-1.6% of the cattle population in Lubombo and Shiselweni Regions died of starvation mostly in the period of November and December 2003. Preliminary maize forecasts (as
at mid-February) indicate 10-15% of normal production in the Lowveld. The gap between cereal consumption requirement and domestic cereal production at national level is estimated to
be between 110,000 MT and 140,000 MT which could be curbed through imports and food aid among other options.
In combination with other shocks and hazards there are concerns about a growing and cumulative ‘humanitarian crisis’ in the worst affected areas in the country where many
households are unable to sustain viable livelihoods in the face of cumulative shocks.
Swaziland’s high level of income inequality ensures that a high proportion of the population is poor and constantly vulnerable to shocks. The levels of vulnerability have considerably worsened given three years of depressed food production
and rural incomes. Furthermore, the current impact of the HIV/AIDS pandemic is exacting a very heavy burden on the population and the economy. The prevalence rate of HIV/AIDS was the second highest in the world in 2002 after Botswana – a drop in the prevalence rate is not anticipated in the near future (see figure 1). Increasing rates of morbidity and mortality are exacting a huge toll on the ability of households to produce food and earn income while at the same time increasing household expenditure on health and related costs. Children are particularly affected by HIV/AIDS with an increasing number of orphans and very vulnerable child headed
households resulting from the over extended kinship networks. The cost to average household in Swaziland. The ability of Government services to respond to the problems has been eroded by illness and mortality of Government and private
sector staff.
Country
Swaziland
Publisher
Swaziland Vulnerability Assessment Committee (VAC)
URL:
Theme area
Equity in health
Title of publication Protocol on health
Date of publication
1999 August
Publication type
Generic
Publication details
Publication status
Published
Language
English
Keywords
health systems, regional collaborations, common strategies
Abstract
States Parties shall co-operate in addressing health problems and challenges facing them through effective regional collaboration and mutual support under this Protocol for the purposes of achieving the following objectives:
a) to identify, promote, co-ordinate and support those activities that have the potential to improve the health of the population within the Region;
b) to co-ordinate regional efforts on epidemic preparedness, mapping, prevention, control and where possible the eradication of communicable and non-communicable diseases;
c) to promote and co-ordinate the development, education, training and effective utilisation of health personnel and facilities;
d) to facilitate the establishment of a mechanism for the referral of patients for tertiary care;
e) to foster co-operation and co-ordination in the area of health with international organisations and co-operating partners;
f) to promote and co-ordinate laboratory services in the area of health;
g) to develop common strategies to address the health needs of women, children and other vulnerable groups;
h) to progressively achieve equivalence, harmonisation and standardisation in the provision of health services in the Region; and
i) to collaborate and co-operate with other relevant SADC Sectors.
Country
Southern Africa Regional
Publisher
URL:
Theme area
Equity and HIV/AIDS
Title of publication Discussion Paper 15: Principles, issues and options for strengthening health systems for treatment access in Southern Africa
Date of publication
2004 March
Publication type
Report
Publication details
EQUINET Discussion Paper 15 pp 1-38
Publication status
Published
Language
English
Keywords
HIV/AIDS treatment access, health systems, health equity, southern Africa
Abstract
This summary document presents the principles for ensuring universal treatment access through sustainable public health systems; the major findings and issues from the work carried out in southern Africa on equity in health sector responses to HIV and AIDS, particularly in terms of access to antiretroviral treatment; and the key challenges for follow up work identified at the southern African regional meeting on Strengthening Health systems for treatment access and equitable responses to HIV/AIDS in Harare, Zimbabwe, February 2004.
Country
Southern Africa Regional
Publisher
EQUINET, OXFAM
URL:
Equinet Publication Type
Discussion paper
Theme area
Poverty and health
Title of publication Final communique: 2004 SADC Heads of State and Government summit on agriculture and food security
Date of publication
2004 May
Publication type
Conference Proceedings
Publication details
Enhancing Agriculture and Food Security for Poverty Reduction in the SADC Region pp 5pp.
Publication status
Published
Language
English
Keywords
food security, SADC, economic liberalisation
Abstract
Underlines the need for the SADC region to continue to fight together for economic liberation of Southern Africa, especially in finding a lasting solution to the pressing questions of food security and sustainable poverty reduction. He said the Summit affords SADC Leaders an opportunity to build political will to put the question of agriculture and food security at the heart of national and regional priorities.
Country
Tanzania
Publisher
URL:
Theme area
Poverty and health
Title of publication Poverty and health reexamined: Evidence and policy lessons from Burkina Faso
Date of publication
2003 September
Publication type
Conference Proceedings
Publication details
The contribution of social services to poverty reduction pp 2pp.
Publication status
Published
Language
English
Keywords
healthcare, household ability to pay, patient fees, health systems reform
Abstract
In contrast to Western countries, where funding for health systems comes essentially from insurance and public sources, in the South, it comes mainly from direct payments by individuals. The consumption of healthcare thus depends largely on household ability to pay, and the poor are consequently at risk of being excluded. This situation fosters inequalities in circumstances in which disease, death and access to health inputs are already distributed very unequally.
Country
Canada
Publisher
Presentation at the GTZ Summer Seminar
URL:
Theme area
Equity in health, Monitoring equity and research to policy
Title of publication Challenging inequities in health: From ethics to action
Date of publication
2001
Publication type
Book
Publication details
Publication status
Published
Language
English
Keywords
healthy equity determinants, policy responses, health gaps, health systems
Abstract
THIS VOLUME, Challenging Inequities in Health, was conceived as a response to the following:
* 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.
Insights about health equity from the fields of epidemiology,
demography, economics and other disciplines are brought to life in case studies from Bangladesh, Chile, China, Japan, Kenya, Mexico, Russia, South Africa, Sweden, Tanzania, the United Kingdom, the United States and Vietnam. The subject matter ranges from adolescent livelihoods in Tanzania to the health burden of peoples living in marginalized counties in
Mexico, from the historical antecedents of health equity in Japan to the recent increase in the gender gap in life
expectancy in Russia.
As a group, the studies point unambiguously to the existence and multiple dimensions of inequities in health around the globe—in rich and poor countries alike.
* In (previously) centrally planned economies, macroeconomic
reforms have been accompanied by new evidence of stark and growing disparities in health. In China, economic liberalization has promoted very uneven development characterized by accelerating urban prosperity and deepening rural poverty. This gaping urban-rural rift has been associated with increased differentials in life expectancy—with the health of urban
populations accelerating and rural populations stagnating.
Russia’s rocky economic adjustments have been paralleled by a health crisis reflected by the enormous growth in the gap between male and female life expectancy. Russian men are dying at younger and younger ages—with the least educated the hardest hit.
* In parts of Africa, a different but related kind of transition
is under way. Largely rural cultures are being rapidly urbanized, and people are losing what fragile social safety nets their families and the state once provided. In Tanzania, where education was once free, adolescents who cannot afford to pay newly introduced school fees drop out of school and are put at risk working in dangerous mines, plantations and on the
streets—with dire health consequences. In Kenya, an
unregulated, profit-driven transport system, open to
exploitation of young poor people, has contributed to
soaring death rates on the roads.
* In Latin America, shifts in economic policies have in some cases reduced the numbers of people living in poverty, but the circumstances of those left behind have worsened. In Mexico, persistent poverty is increasingly concentrated among indigenous people living in barren, isolated communities. In Chile, despite impressive gains in economic growth and aggregate health, socioeconomic inequalities are large and widening, with the uneducated suffering the most.
* In the world’s rich countries, health inequities are similarly
endemic. A chronically ill woman in England has less chance of hanging on to her job than her counterpart in Sweden does. In Japan, the nation with the highest life expectancy, mortality rates for certain occupational groups like male agricultural and service workers are worse than their counterparts in managerial and professional jobs. And young black men in the United States not only have far lower life expectancies than
young white men but also lower life expectancies than
men in many poorer countries, like Bangladesh.
Beyond the sampling of diverse dimensions of equity in health from 13 countries, the book also covers a spectrum of cross-cutting conceptual themes in equity analysis. These range from fundamental issues such as ethics and measurement, to etiological or causal analyses related to underlying social determinants like gender and globalization, to policy approaches to inequities in health including the financing of health care. It is argued throughout that explicit values related to fairness in the distribution of health outcomes should be front and center in the articulation of policy objectives.
Furthermore, policymakers and researchers must be able to draw on appropriate measures of health inequality in pursuit both of a better understanding of their root causes and in tracking the effects of interventions. Greater equity in the distribution of health within and between countries is a daunting challenge facing health systems and societies globally. This collection of studies, therefore, is intended as a resource for a wide readership including students, policymakers and researchers. It aims to enhance equity assessment and analysis and to spur more effective policies and interventions.
There are several distinctive features of the contributions
in the book:
* A conscious effort is made to focus analysis on inequities
in health status, rather than access to health care, and on
health inequities within countries rather than the more
often discussed inequities between countries.
* The studies don’t stop short at describing health
inequities; they examine the determinants of those
inequities in their social context, as affected by policies
both within and beyond the health-care sector.
* The process inherent in each of the country case studies
emphasizes local leadership and ownership aiming
to strengthen capacity for analysis and action on findings
* country studies were undertaken by study teams
within each country rather than by Northern “experts”
parachuted in from outside.
The book draws on a rich diversity of disciplines and
research approaches—from demography, epidemiology
and economics to historical, policy and other qualitative
analyses. This approach makes each case study
unique in terms of subject area, but also means that
direct, cross-country comparisons are not possible.
Equal weight is given to work on health equity carried
out in the South and the North recognizing that no
country is immune to health inequalities and that
understanding and policy responses are enhanced by
drawing on diverse contexts and experiences.
Moreover, the analyses undertaken in low-income countries
—the first in many cases—demonstrate that available
data (however imperfect) can shed light on important
insights when viewed through the lens of equity.
Country
Publisher
Rockerfeller Foundation, Swedish International Development Cooperation Agency, Oxford University Press
Theme area
Human resources for health
Title of publication Trends in international nurse migration: The world’s wealthy countries must be aware of how the “pull” of nurses from developing countries affects global health
Date of publication
2004 May
Publication type
Journal Article
Publication details
Health Affairs 23 3 pp 69-77
Publication status
Published
Language
English
Keywords
nurses, migration, recruitment, health personnel
Abstract
Predicted shortages and recruitment targets for nurses in developed countries threaten to deplete nurse supply and undermine global health initiatives in developing countries. A twofold approach is required, involving greater diligence by developing countries in creating a largely sustainable domestic nurse workforce and their greater investment through international aid in building nursing education capacity in the less developed countries that supply them with nurses.
Country
United Kingdom
Publisher
Project HOPE–The People-to-People Health Foundation, Inc.
Theme area
Human resources for health
Title of publication Responding to the global human resources crisis
Date of publication
2004
Publication type
Journal Article
Publication details
The Lancet 363 pp 1469-1472
Publication status
Published
Language
English
Keywords
health crises, developing countries, essential medicines, financial resources
Abstract
The global community is in the midst of a growing response to health crises in developing countries, which is focused on mobilising financial resources and increasing access to essential medicines. However, the response has yet to tackle the most important aspect of health-care systems--the people that make them work. Human resources for health--the personnel that deliver public-health, clinical, and environmental services--are in disarray and decline in much of the developing world, particularly in sub-Saharan Africa. The reasons behind this disorder are complex. For decades, efforts have focused on building training institutions. What is becoming increasingly clear, however, is that issues of supply, demand, and mobility (transnational, regional, and local) are central to the human-resource problem. Without substantial improvements in workforces, newly mobilised funds and commodities will not deliver on their promise. The global community needs to engage in four core strategies: raise the profile of the issue of human resources; improve the conceptual base and statistical evidence available to decision makers; collect, share, and learn from country experiences; and begin to formulate and enact policies at the country level that affect all aspects of the crisis.
Country
Publisher
The Lancet
Theme area
Governance and participation in health
Title of publication Discussion Paper 16: Parliamentary functions and reforms and their application in promoting health equity in Southern Africa
Date of publication
2003 August
Publication type
Report
Publication details
EQUINET Discussion Paper 16 pp 1-28
Publication status
Published
Language
English
Keywords
public participation, legislation, parliaments, stakeholder input, southern Africa
Abstract
A number of opportunities for parliaments to promote health equity have been identified. Firstly, Parliaments are in charge of their rules which they can revise to become more efficient and effective when they commit themselves to reforms. Secondly, in the region there is a vibrant civil society that raises questions and compels Parliaments to address issues. Parliaments now offer space for stakeholder input through the use of public hearings, Parliament constituency centres and on site visits. Parliaments provide an opportunity pro equity legislative analysis by allowing participation by stakeholders in bill analysis during committee scrutiny. Networking, both nationally and internationally, between Parliaments and with NGOs provides useful information and technical advice which Parliaments can use to carry out its functions effectively. Constraints have also been identified. These include the economic situation, lack of information on the part of Parliament, limitation in public participation and the fact that recommendations made by Parliament are not binding on the executive and are not always implemented.
Country
Southern Africa Regional
Publisher
TARSC, EQUINET, GEGA
URL:
Equinet Publication Type
Discussion paper
Theme area
Values, policies and rights, Monitoring equity and research to policy
Title of publication The right to health and the human rights promise: Lessons from South Africa
Date of publication
2003 October
Publication type
Conference Proceedings
Publication details
Presentation for the 10th Canadian Conference on International Health pp 8pp.
Publication status
Published
Language
English
Keywords
health equity, South African Constitution
Abstract
This paper looks at South African examples of how human rights and the right to health have been enforced by the South African Constitutional Court as justiciable rights.
Country
South Africa
Publisher
Canadian Society for International Health at Ottawa, Canada
URL:
Theme area
Equity and HIV/AIDS
Title of publication Access to AIDS treatment in developing countries: A global issue of equity and human rights
Date of publication
1998 March
Publication type
Journal Article
Publication details
AIDS Analysis Asia 4 2 pp 6pp.
Publication status
Published
Language
English
Keywords
HIV/AIDS treatment access
Abstract
A global AIDS related bio-medical technology transfer initiative, perhaps driven by UNAIDS, is the crying need of the next millennium. Such an initiative should foster an enabling partnership between governments, industry and international organisations and be based on:
* a maximalist perspective of the ethics of access to treatment
* global equity considerations,
* a global perspective on the rights of individuals and communities.
The political will of global institutions and agencies to provide strategic leadership in exploring the global dimensions of shared rights and shared responsibilities in facilitating access to optimum treatment for PWAs in developing countries will remain as the great challenge faced by the global AIDS leadership in the next millennium.
Tremendous optimism has been generated by the recent developments in combination antiretroviral therapy for HIV/AIDS. There is renewed hope for people living with HIV/AIDS (PWA) of effective treatment, prolonged survival and improvement in quality of life. However, it is increasingly evident that this optimism is really only shared by a few who live in developing countries. Access to advanced anti-retroviral therapy for HIV/AIDS in resource -scarce settings is a subject that is not even discussed in certain forums where issues related to AIDS prophylactics are discussed at length. Access to optimum AIDS treatment in developing countries presents unique global challenges to AIDS activism, public health advocacy and global leadership in AIDS prevention and care efforts.
It is also a frustrating experience for health care providers and PWAs in developing countries. Many well-meaning people in the AIDS fields are even beginning to regard access for all to
optimum AIDS care as a utopian ideal, not worth pursuing.
The basic premises of this article is that a proactive approach to facilitate access to care for all PWAs, particularly PWAs from developing countries, requires imaginative and radical steps. Most importantly, in my opinion, all the possible avenues to address this crisis have not yet been explored. At root, what is required is the political will, similar to that which resulted in the
setting-up of unique UN organisation (UNAIDS) to address the AIDS pandemic.
Country
China
Publisher
The Chinese University of Hong Kong
URL:
Theme area
Human resources for health
Title of publication International nurse mobility: Trends and policy implications
Date of publication
2003
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
nurses, migration
Abstract
Country
United Kingdom
Publisher
WHO
Theme area
Equity and HIV/AIDS
Title of publication Meeting report: Health systems approaches to treatment access in Tanzania, Dar Es Salaam, 26 March 2004
Date of publication
2004 March
Publication type
Conference Proceedings
Publication details
Tanzania National Meeting on Equity in Health Sector Responses to AIDS pp 1-11
Publication status
Published
Language
English
Keywords
HIV/AIDS treatment access, health systems, Tanzania
Abstract
The meeting was focused on ensuring universal treatment access through sustainable public health systems. The goal of the meeting was to develop resolutions on the principles for strengthening health systems for treatment access, and to develop potential areas for work for EQUINETA related to EQUINET’s programme of work areas. While there were various prevention activities, focused on for example, workplace education, condom promotion, sexually transmitted infection treatment and control, youth, women, commercial sex workers, men who have sex with men, etc, there was 2.2 million Tanzanians living with HIV out of which 800 000 have full-blown AIDS. About 50% of hospitalized patients were sick because of HIV related disease. Given this situation, there were important questions to be asked and issues to be examined, including:
- Who can access ARVs? Only about 1 000–2 000 Tanzanians were currently accessing treatment.
- To what extent are the formal guidelines on access to treatment, such as having a CD4+ count of 200 or less, being followed?, is realistic?
- Who gets treated, what criteria are used; who does not? Inequality of drug access.
- While the price of the anti-retroviral drugs have gone down to $300 per year, are those on treatment, being treated according to the Ministry of Health published guidelines? There was also a need to link treatment to nutrition.
- What was the impact of effective treatment on sexual behaviour?
- What was the adherence to the drugs? Currently, two of the registered ARVs are Combivir and Triomune. Combivir needs to be taken together with a couple of other drugs twice a day, while Triomune was a combination drug, making compliance easier.
- What are the best practices on the implementation of treatment, in relation to equity?
Country
Tanzania
Publisher
EQUINETA
URL:
Equinet Publication Type
Reports
Theme area
Equity and HIV/AIDS
Title of publication Meeting report: Strengthening health systems for treatment access and equitable responses to HIV and AIDS in Southern Africa, Harare, Zimbabwe, 16-17 February 2004
Date of publication
2004 February
Publication type
Conference Proceedings
Publication details
EQUINET Meeting report pp 1-31
Publication status
Published
Language
English
Keywords
HIV and AIDS healthcare systems, treatment guidelines, treatment access, access policies, southern Africa
Abstract
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 meeting reviewed and discussed the work done to date, including: review EQUINET commissioned and other research evidence on health systems issues in treatment access; debate and develop options for addressing health systems issues in treatment access; and identify follow up work to promote treatment access through strengthened health systems.
Country
Southern Africa Regional
Publisher
TARSC
URL:
Equinet Publication Type
Reports
Theme area
Equity and HIV/AIDS
Title of publication Declaration of action
Date of publication
2004 March
Publication type
Conference Proceedings
Publication details
Publication status
Published
Language
English
Keywords
HIV/AIDS treatment access
Abstract
Without treatment, the 28 million people living with HIV/AIDS (PLWAs) on our continent today will die predictable and avoidable deaths over the next decade. More than 2 million have died of HIV/AIDS in Africa just this year. This constitutes a crime against humanity. Governments, multilateral institutions, the private sector, and civil society must intervene without delay to prevent a holocaust against the poor. We must ensure access to antiretroviral (ARV) treatment as part of a comprehensive continuum of care for all people with HIV who need it. In this regard, at a minimum, we call for the immediate implementation of the World Health Organisation goal to ensure antiretroviral (ARV) treatment for at least three million people in the developing world by 2005. Together with our international allies, we will hold governments, international agencies, donors and the private sector accountable to meet this target.
Country
Southern Africa Regional
Publisher
PATAM
URL:
Theme area
Equity and HIV/AIDS
Title of publication The application of the national health accounts framework to HIV/AIDS in Rwanda
Date of publication
2001 February
Publication type
Report
Publication details
Special Initiatives Report 31 pp 67pp.
Publication status
Published
Language
English
Keywords
HIV/ AIDS expenditure, Rwanda, user fees
Abstract
This paper describes how a National Health Accounts exercise on HIV/AIDS in Rwanda was designed and implemented, what data was captured, and how HIV/AIDS-specific expenditures were determined. The findings regarding expenditures on HIV in Rwanda are both critical and informative, and the process by which data was gathered is also significant. This documentation of the process, challenges, shortcomings, and successes of HIV/AIDS funding in Rwanda will be useful for others seeking to replicate the study elsewhere. The comparison of HIV/ AIDS-related costs (prevention, treatment, and mitigation) within overall health expenditures reveals that AIDS prevention is primarily financed by donor funds, whereas treatment costs place the heaviest financial burden on households. This is because no financial support system exists to facilitate patients’ access to care. Thus, the patient’s socioeconomic background and ability to pay user fees define access to treatment of HIV/AIDS-related diseases. Based on this analysis, the report makes recommendations for policies to improve the financial information process, the sustainability and affordability of health care, and the equity of access to health care in the Rwandan health sector in general and in the HIV/AIDS sector in particular.
Country
United States
Publisher
Partnerships for Health Reform (PHR) Project
URL:
Theme area
Equity in health
Title of publication Inequities among the very poor: Health care for children in rural southern Tanzania
Date of publication
2003 February
Publication type
Journal Article
Publication details
The Lancet pp 6pp.
Publication status
Published
Language
English
Keywords
socio-economic inequities, Tanzania, children, household survey
Abstract
Few studies have been done to assess socioeconomic inequities in health in African countries. We sought evidence of inequities in health care by sex and socioeconomic status for young children living in a poor rural area of southern Tanzania. In a baseline household survey in Tanzania early in the implementation phase of integrated management of childhood illness (IMCI), we included cluster samples of 2006 children younger than 5 years in four rural districts. Questions focused on the extent to which carers’ knowledge of illness, care-seeking outside the home, and care in health facilities were consistent with IMCI guidelines and messages. We used principal components analysis to develop a relative index of household socioeconomic status, with weighted scores of information on income sources, education of the household head, and household assets. 1026 (52%) of 1968 children reported having been ill in the 2 weeks before the survey. Carers of 415 (41%) of 1014 of these children had sought care first from an appropriate provider. 71 (26%) carers from families in the wealthiest quintile knew danger signs compared with 48 (20%) of those from the poorest. Wealthier families were more likely to bring their sick children to a health facility. Their children were more likely than poorer children to have received antimalarials, and antibiotics for pneumonia. Care-seeking behaviour is worse in poorer than in relatively rich families, even within a rural society that might easily be assumed to be uniformly poor.
Country
United Kingdom
Publisher
Tanzania IMCI MCE Baseline Household Survey Study Group
URL:
Theme area
Equity and HIV/AIDS
Title of publication Telling it how it is? The UNAIDS 2003 update on the AIDS epidemic in sub-Saharan Africa
Date of publication
2003
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
HIV/AIDS prevalence, advocacy
Abstract
It is critically important to obtain an accurate picture of HIV prevalence in order to establish the actual and likely impacts of the epidemic, particularly in high prevalence countries, and to gauge the effectiveness of government and other prevention programmes. An objective examination of the available evidence again leads to the conclusion that the AIDS epidemic is not only levelling off in most of Africa, but is beginning to decline in a number of the worst affected countries. Of course, with such high prevalence levels, there is absolutely no room for complacency. But, it is equally important to recognise that progress is being made in the fight against this appalling scourge.
It is extremely important that advocacy (and, increasingly, powerful vested interests) do not get in the way of objective analysis. Insisting that the AIDS epidemic is still largely out of control may help to generate the much need resources to fight the epidemic, but it does not lead to sound policy interventions. Equally serious, it fails to recognise that the actions of African governments, NGOs and individuals themselves are beginning to pay off. Positive messages are also key in helping to counter the high levels of fatalism and despondency about HIV/AIDS that is still common throughout Africa.
Country
United States
Publisher
Knowledge and Skills for Development
URL:
Theme area
Equity in health
Title of publication End of year report 2003
Date of publication
2004 February
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
health equity; public health advocacy
Abstract
Malawi Health Equity Network has completed four years since it was established as a full network in 2000. During the past few years the Network has gone through a significant developmental process which has witnessed it claiming an important public health advocacy position. The present report represents activities, progress, challenges, and way forward for MHEN.
The Malawi Health Equity Network (MHEN) has now completed four (4) years of work in Malawi. The first years have been both turbulent and enjoyable as we all set to see the baby grow. Malawi’s infant mortality rate stands at about 104 deaths per 1,000 live births. The MHEN baby could have died were it not for the nourishment that it obtained from both local and international partners. Of particular mention are been the National Democratic Institute for International Affairs of the UK government, the National Democratic Institute for International Affairs, the Ministry of Health and lately Ireland Aid. It is not only the infant mortality that is unacceptably high in Malawi but also the maternal mortality and the under-five mortality. We therefore wish to ensure that our baby, the MHEN at least reaches the age of five. And there are indications that we are going to succeed. Our relationship with our main partner NDI has grown from strength to strength and so has the relationship with the National Assembly and the Ministry of Health. The media has been an ally in our advocacy work.
Health equity is about attending to the unfair, avoidable differences in health status and health care access among people. We, at the MHEN wish to assure all Malawians that we will not rest until these injustices that we see in the health sector are removed completely. If that would not happen, such would give us reason to the MHEN to continue existing.
Country
Malawi
Publisher
Malawi Health Equity Network
URL:
Theme area
Equity in health
Title of publication Policy Paper 1: Annotated bibliography and overview: Equity in health in the Southern African Development Community (SADC) Region
Date of publication
1998 May
Publication type
Document
Publication details
EQUINET Policy Series 1 pp 1-247
Publication status
Published
Language
English
Keywords
equity, health, southern Africa
Abstract
This bibliography is the first edition of a compilation of publications related to equity in health in Southern Africa. It has been compiled by a network of institutions coming together as a result of the resolutions of the March 1997 Southern African meeting on Equity in Health held in Kasane, Botswana. This meeting, hosted by the National Institute of Development Research and Documentation (Botswana) and the Dag Hammarskjold Foundation (Sweden) gathered participants with backgrounds in government and non government organisations, academia and health professionals. All participants confirmed a commitment to equity in health as a policy goal for the Southern African Region. An Agenda for action on Equity in Health, produced at that meeting, called for greater networking of professionals, civil society and policy makers to promote the policy of equity in health in the region. In particular it was advocated that further work be done to enhance understanding of the concept of equity in health, on intersectoral collaboration, decentralisation, public health training and health research, and on HIV/AIDS. In response to that agenda, several institutions in the region formed a core working group to initiate a network for follow up activities. Objectuves of this follow up network would be to:
a. Develop further the conceptual framework and policy issues in relation to equity in health in Southern Africa
b. Gather and analyse information to support scientific debates and decisions on equity in health in Southern Africa
c. Make input to policies affecting health at National and Southern African Development Community (SADC) regional level.
As the first step towards building a wider involvement of individuals and institutions in the region, the core working group has developed an annotated bibliography of current literature on equity in health in Southern Africa, and developed an overview of concepts, debates and issues arising from that literature. Its aim is to inform about the work being done and materials available on equity in health in Southern Africa, to provoke discussion and exchange of information between those working in this area, and to propose areas for follow up research and information activities.
This document represents the first edition of that bibliography. It was compiled at Training and Research Support Centre (TARSC) Zimbabwe from materials available to the members of the core working group. It was reviewed and finalised at meetings involving members of the network. It is intended that this bibliography be circulated widely. Feedback is invited to the network at TARSC on additional materials that can be incorporated into the next edition. At this stage, evidently, many relevent papers may not be included in the bibliography, and there are apparent gaps in particular countries. A guideline sheet provided at the end of the bibliography for information on further materials for inclusion in later editions. The bibliography includes i. an analysis and overview of the concepts, issues and debates arising in Southern Africa around equity in health; ii. proposed areas of future work to be carried out on equity in health in the region; iii. an annotated bibliography of available materials on equity in health in Southern Africa, with materials on conceptualising equity in health, equity in health rights and policies, equity in health and health care, equity in resource allocations for health and monitoring equity in health.
Country
Southern Africa Regional
Publisher
EQUINET
URL:
Equinet Publication Type
Discussion paper
Theme area
Title of publication Advocating for adolescent reproductive health in Sub-Saharian Africa
Date of publication
1998
Publication type
Publication details
UNFPA Advocates for youth programme pp 1-64
Publication status
Published
Language
English
Keywords
adolescents, reproductive health; Sub-Saharan Africa
Abstract
The paper highlights the important role that CSOs play in raising the visibility of the experience of poor people. They do this directly, or through bridging researchers and communities.
Country
Publisher
UNFPA
Theme area
Equity and HIV/AIDS
Title of publication Reducing African women\'s vulnerability to HIV/AIDS
Date of publication
2001
Publication type
Book
Publication details
Voices From Africa
Publication status
Published
Language
English
Keywords
women, poverty, participations, civil society organisations, community issues
Abstract
Through both organising evidence and giving voice to low income community issues, Civil Society Organisations raise the visibility of the health conditions of poor communities. This study documents CSO roles in organising evidence and making input to state planning. This discussion is more specifically developed in relation to the health of poor women. Women’s poverty is described within a complex web of persistent inequalities that are traced back to social, cultural, economic and political structures. These are noted to erode women’s well-being by restricting their capacity to attain positive health and educational outcomes, secure income and employment, and participate in decision-making within the home and in larger social spheres. In relation to gender equity, the paper reports ways in which CSOs strengthen processes by which women act to promote change for themselves and catalyse broader social transformation.
Country
United States
Publisher
UN NGLS
Theme area
Equity in health, Governance and participation in health
Title of publication Strategies for promoting equity experience with community financing in three African countries
Date of publication
2001
Publication type
Journal Article
Publication details
Health Policy 58 pp 37-67
Publication status
Published
Language
English
Keywords
pro-poor, participation
Abstract
Analysis of equity impacts of community financing in Benin, Kenya and Zambia found that schemes in all countries failed to protect the poorest from the burden of payment. This was traced in part to failures in ensuring that the views of poor communities were heard in decisionmaking, attributed to an absence of local decision-making structures with representation from civil society groups able to voice the needs of the poorest. This is highlighted as essential to ensuring qualities of relevance and voice in pro-poor services.
Country
Zimbabwe
Publisher
Theme area
Equitable health services, Resource allocation and health financing
Title of publication Public spending on health care in Africa: Do the poor benefit?
Date of publication
2000
Publication type
Journal Article
Publication details
Bulletin of the World Health Organization 78 1 pp 66-74
Publication status
Published
Language
English
Keywords
Health subsidies, civil society organisations, health services,health expenditures, poverty, social justice, Africa
Abstract
Health care is a basic service essential in any effort to combat poverty, and is often subsidized with public funds to help achieve that aim. This paper examines public spending on curative health care in several African countries and finds that this spending favours mostly the better-off rather than the poor. It concludes that this targeting problem cannot be solved simply by adjusting the subsidy allocations. The constraints that prevent the poor from taking advantage of these services must also be addressed if the public subsidies are to be effective in reaching the poor.
Country
Switzerland
Publisher
WHO
URL:
URL
Theme area
Equitable health services
Title of publication After the war: Prospects for the health of the poor in Luanda, Angola
Date of publication
1992
Publication type
Journal Article
Publication details
GeoJournal 26 1 pp 6pp.
Publication status
Published
Language
English
Keywords
war; health; Angola; equity
Abstract
Country
Southern Africa Regional
Publisher
Theme area
Health equity in economic and trade policies
Title of publication Policy paper 12: The WTO Global Agreement on Trade in Services (GATS) and health equity in Southern Africa
Date of publication
2003 February
Publication type
Document
Publication details
Policy paper 12 pp 1-60
Publication status
Published
Language
English
Keywords
GATS, World Trade Organisation, health Services, trade, TRIPS, public health, policy options, health infrastructures, health financing, health personnel, southern Africa
Abstract
PART I of the paper provides a brief introduction of the link between trade and development as related to health in general. The history of the World Trade Organisation (WTO) is also briefly introduced as it relates to the General Agreement of Trade in Services (GATS). Then a brief outline of the contents of GATS is given focusing on those areas relevant to public health generally, to health services and to their financing. PART II presents opportunities and threats posed by GATS for public health and health equity goals and policies in southern Africa, in terms of both general obligations and specific commitments across all modes of supply. This is the main focus of the paper. The paper then explores the specific areas of concern and their implications for healthcare systems in southern Africa, particularly in terms of key health equity issues, viz: public health and preventive healthcare, health infrastructures, health financing, health personnel distribution and the regulatory framework for the health sector. The paper further explores the impacts given the current level of trade in these areas and reviews the costs and benefits of possible impacts of GATS on these areas of health system. The paper also looks at the effect of GATS in these areas relative to other WTO agreements, e.g. TRIPS. PART III identifies the policy space and options for southern African countries to protect public health and pro-poor health systems. The paper identifies key areas for follow-up work in the southern African region in terms of information and knowledge gaps to be met, policy and legal issues and institutional capacities nationally and regionally to strengthen the protection of public health in relation to GATS. This includes the assessment of the options southern African countries have for taking up protection of public health within and beyond the procedures and dispute settlement mechanisms set within GATS.
Country
Southern Africa Regional
Publisher
EQUINET/ SEATINI
URL:
Equinet Publication Type
Policy paper
Theme area
Equity and HIV/AIDS
Title of publication Discussion paper 10: Health sector responses to HIV/AIDS and treatment access in Southern Africa: Addressing equity
Date of publication
2003 October
Publication type
Report
Publication details
EQUINET Discussion Paper 10 pp 1-40
Publication status
Published
Language
English
Keywords
HIV/AIDS, ART rollout, equity, southern Africa
Abstract
This paper discusses a set of complex, inter-connecting issues related to the moral imperative to increase access to HIV care and treatment in southern Africa, with a particular focus on antiretroviral therapy (ART). However, it does this with an equity lens. An equity lens seeks not just to look at improving access to care and treatment for the millions of people who currently lack it, but rather seeks to reduce the gap in access to health resources between different population groups. Underlying this view is an explicit argument that the current inequities in access to treatment are related to differentials in power and political influence between different population groups over the manner in which resources for accessing care and treatment are distributed.
Country
Southern Africa Regional
Publisher
Health Systems Trust, EQUINET
URL:
Equinet Publication Type
Discussion paper
Theme area
Equity and HIV/AIDS
Title of publication Women and vulnerable groups
Date of publication
2004 March
Publication type
Conference Proceedings
Publication details
Scaling Up Access to Treatment in Southern Africa; A Way Forward
Publication status
In press
Language
English
Keywords
gender; women; vulnerable groups
Abstract
* Ensure that the special concerns of women and other vulnerable groups are incorporated into national treatment plans.
Country
Zimbabwe
Publisher
PATAM
Theme area
Equity and HIV/AIDS
Title of publication International bodies and financing mechanisms
Date of publication
2004 March
Publication type
Conference Proceedings
Publication details
Scaling Up Access to Treatment in Southern Africa: A Way Forward
Publication status
In press
Language
English
Keywords
WTO/IMF/World bank
Abstract
Conference Resolution (s) for Group to Translate into Action:
* International institutions such as the World Trade Organisation (WTO), International Monetary Fund (IMF) and the World Bank Group cease in constraining responses against HIV/AIDS at country level.
* That the World Health Organisation (WHO) and the Global Fund to Fight AIDS, TB and Malaria (GFTAM) develop a ‘model proposal’ to be made publicly available to support development of stronger GFATM proposals
* Greater and respectful representation of people living with HIV/AIDS (PLWHAs) and other vulnerable groups in all decision-making processes
pertaining to access to treatment
* to adhere to PATAM’s mission statement asserting the right of anti-retroviral therapy and other essential medicines for all
Country
Zimbabwe
Publisher
PATAM
Theme area
Equity and HIV/AIDS
Title of publication Trade and health
Date of publication
2004 March
Publication type
Conference Proceedings
Publication details
Scaling Up Access to Treatment in Southern Africa; A Way Forward
Publication status
In press
Language
English
Keywords
monitoring, treatment access
Abstract
Conference Resolution (s) for Group to Translate into Action:
* to monitoring all regional and international trade agreements to ensure they do not undermine access to treatment or destroy our health systems
* to adhere to PATAM’s mission statement asserting the right of anti-retroviral therapy and other essential medicines for all.
Some concrete suggestions from conference participants:
* Develop a simple activist tool kit that explains some of the complex terminology commonly utilised and highlights important trade negotiations to watch
Country
Zimbabwe
Publisher
PATAM
Theme area
Equity and HIV/AIDS
Title of publication Governance, health and human Rights
Date of publication
2004 April
Publication type
Conference Proceedings
Publication details
Scaling Up Access to Treatment in Southern Africa; A Way Forward
Publication status
In press
Language
English
Keywords
human rights, governance
Abstract
Conference Resolution (s) for Group to Translate into Action:
* to mobilising all peoples irrespective of career choice, age, gender, or geographic representation to ensure that PATAM has a powerful presence in each country across the continent,
* monitor national treatment plans for quality and scale
* genuine political leadership from our governments and other people in positions of influence that rollout of anti-retroviral therapy be entwined with rebuilding our health systems
* Greater and respectful representation of people living with HIV/AIDS (PLWHAs) and other vulnerable groups in all decision-making processes pertaining to access to treatment
Some suggestions from participants:
* Ensure HIV/AIDS is a political issue but not a party political issue
Country
Zimbabwe
Publisher
PATAM
Theme area
Equity and HIV/AIDS
Title of publication Media and communication
Date of publication
2004 March
Publication type
Conference Proceedings
Publication details
Scaling Up Access to Treatment in Southern Africa; A Way Forward
Publication status
In press
Language
English
Keywords
Abstract
Conference Resolution (s) for Group to Translate into Action:
* to work with the media to help convey accurate information on access to treatment
* to adhere to PATAM’s mission statement asserting the right of anti-retroviral therapy and other essential medicines for all
Some concrete suggestions from participants:
* Ensure that implementation models and experiences on roll-out are well-documented and that communication flows effectively.
* Workshops on management and treatment of HIV/AIDS for journalists by professionals, doctors and dieticians.
Country
Zimbabwe
Publisher
PATAM
Theme area
Equity and HIV/AIDS
Title of publication Treatment literacy
Date of publication
2004 March
Publication type
Conference Proceedings
Publication details
Scaling Up Access to Treatment in Southern Africa; A Way Forward
Publication status
In press
Language
English
Keywords
treatment literacy
Abstract
Conference Resolution (s) for Group to Translate into Action:
* to ensure that our communities have correct and complete information on the function, usage and importance of Anti-retroviral therapy (ARV’s).
* to adhere to PATAM’s mission statement asserting the right of anti-retroviral therapy and other essential medicines for all
Some concrete suggestions from participants:
* It was suggested that the group produce a position paper defining what we mean by treatment. This paper must tackle head on the tired and distracting debate on nutrition or ARVs.
* Develop a treatment literacy proposal for international agencies such as the WHO, UNAIDS and others to WHO to assist in implementation throughout the region
* Produce a registry of treatment literacy experts for community mobilisation.
* Develop a resource guide on treatment literacy
Country
Zimbabwe
Publisher
PATAM
Theme area
Equity and HIV/AIDS
Title of publication Internal governance
Date of publication
2004 March
Publication type
Conference Proceedings
Publication details
Scaling Up Access to Treatment in Southern Africa; A Way Forward
Publication status
In press
Language
English
Keywords
Abstract
Participants felt the movement’s effectiveness, credibility and sustainability hinged very much on the way in which it governs itself and operationalises its strategies. Therefore, the current PATAM Steering Group whose mandate runs through the end of April 2004 was tasked with producing a set of governance proposals that would be adopted by the movement.
Country
Zimbabwe
Publisher
PATAM
Theme area
Resource allocation and health financing
Title of publication Deprivation and resource allocation: Methods for small area research
Date of publication
2003 September
Publication type
Document
Publication details
Methods Toolkit pp 17pp
Publication status
Published
Language
English
Keywords
research, resource allocation, deprivation indicators, SADC region
Abstract
There is a growing interest internationally in undertaking studies which consider health disparities between small geographic areas, both as a tool to understand better the determinants of health inequalities and to explore appropriate policy responses. One of the potential policy responses is to consider ways in which government resources can be allocated to redress health inequalities. Small area analyses can be used to identify locations with the greatest health need, and then to give preference in the allocation of health care resources to these areas. A study was recently undertaken to consider these issues in the South African context . This study focused on estimating deprivation in small areas and analysed the distribution of deprivation between these areas. The relationship between deprivation and ill health was also explored. Finally, this study considered how deprivation indicators could be taken into consideration when determining the allocation of public sector resources.
The purpose of this document is to provide a guide to the main steps in completing a small area analysis into deprivation and resource allocation using lessons learnt in the South African study. It is hoped that this will facilitate similar research being undertaken in other countries in the SADC region. This document should be read in conjunction with the research report, which provides greater detail on certain conceptual issues as well as insights into the interpretation and analysis of the data.
Country
South Africa
Publisher
University of Cape Town; University of Witwatersrand
URL:
Equinet Publication Type
Toolkits and training materials
Theme area
Equity and HIV/AIDS
Title of publication Attitudes towards premarital testing on human immunodeficiency virus infection among Malawians
Date of publication
2004
Publication type
Journal Article
Publication details
Croation Medical Journal 45 1 pp 84-87
Publication status
Published
Language
English
Keywords
Counseling; health surveys; HIV infection; Malawi; patient acceptance of health care
Abstract
To determine factors influencing voluntary counseling and premarital testing on human immunodeficiency virus (HIV) in Malawi. We analyzed the data collected by the Malawi Demographic and Health Survey (MDHS) 2000 to determine the likelihood of Malawi population to accept HIV testing. The MDHS was a nationwide cross-sectional study where cluster sampling technique and an interviewer-administered questionnaire were used. We applied the Logitmodel of analysis to determine the HIV testing likelihood according to the following parameters: age, place of residence (urban vs. rural), belief that sexual abstinence protects from HIV infection, knowledge of a location of HIV testing, belief that diagnosis of HIV should be kept secret, and knowledge of anyone with AIDS. Out of 3,092 participants, 23.3% lived in urban and 76.7% in rural areas.Willingness to have premarital HIV counseling and testing was positively associated with increased age, urban residence, and wish to keep one\\\\\\\'s own HIV testing result confidential. However, knowledge of a person with HIV/AIDS, HIV testing location, and other sexually transmitted infections/diseases, as well as belief that abstinence protects againstHIV were inversely related to desire to take an HIV test. Not all population groups have an equal likelihood of accepting voluntary HIV counseling and testing. Public health intervention on HIV counseling and testing should be tailored specifically for each population group.
Country
Publisher
Department of Community Health, University of Malawi College of Medicine
URL:
Theme area
Equitable health services
Title of publication A complex problem: Academic hospitals and the national health system
Date of publication
1994
Publication type
Journal Article
Publication details
Nursing RSA 9 1 pp 24-25
Publication status
Published
Language
English
Keywords
health care, hospitals
Abstract
Country
South Africa
Publisher
Nursing RSA
Theme area
Equity in health, Governance and participation in health
Title of publication Improvement of social environment to improve health
Date of publication
1998
Publication type
Journal Article
Publication details
The Lancet 351 pp 57-60
Publication status
Published
Language
English
Keywords
social capital, health
Abstract
During the 19th century, advances in the health of the population mostly came from improvements in nutrition and the environments in which people lived and worked. In the 20th century, the focus shifted from the environment to the behaviour of individuals. According to this view, the great achievement of epidemiology was to nail down smoking and, to a lesser extent, cholesterol. Having done that, the epidemiologists\\\' job was largely complete. In the future, advances in human health will come from the revolution in molecular biology and genetic approaches to combating disease, and the role of epidemiology will, in its evidence-based, clinical form, be to support the assessment of individual risk, diagnosis, and treatment. Concern with individuals and parts of individuals has been the dominant trend in epidemiology. Ecological analysis, the correlation between the characteristics groups, has been seen as a second-rate way to approach individual risks. Although poor sanitation and malnutrition have been solved in developed countries, the circumstances in which people live and work are still crucial determinants of disease rates and, therefore, potentially provide the place for effective interventions to improve the public\\\'s health. As Rose states, `The primary determinants of disease are mainly economic and social, and therefore its remedies must also be economic and social\\". If the environment is important, the appropriate analysis should be at the environmental level. Thus ecological analyses are not second rate but are the most useful way to examine the effect of social environment on health.
Country
Zimbabwe
Publisher
Theme area
Equity in health
Title of publication Policy paper 14: Can human rights serve as a tool for equity?
Date of publication
2003 December
Publication type
Document
Publication details
Policy paper 14 pp 1-40
Publication status
Published
Language
English
Keywords
health inequalities, human rights, restructuring health, equity, access, efficiency, Southern Africa
Abstract
Despite growing advances in medical technologies, global health status inequalities continue to increase. For developing countries, facing conditions of worsening resource scarcity and an increasingly hostile international economic order that undermines the nation-state’s ability to regulate and choose policies independently, equity is thus a key challenge. Under these circumstances, do the concepts and discourse of human rights offer opportunities for public health practitioners to negotiate better conflicting imperatives in restructuring health care in countries in transition? At a generic level, few public health practitioners will dispute the value of human rights in promoting human well being, and the need for health professionals to be respectful of human rights. However, when it comes to public health, there are arguments that concerns for human rights can act as impediments to the achievement of public health objectives such as equity, access and efficiency.
Country
Southern Africa Regional
Publisher
EQUINET
URL:
Equinet Publication Type
Policy paper
Theme area
Monitoring equity and research to policy
Title of publication Monitoring equity in health: An approach for low- and middle-income countries: First draft for review/ comments
Date of publication
1998
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
monitoring health, health indicators
Abstract
This document addresses the challenges faced by decision-makers and researchers seeking information to guide policies to reduce inequities in health in their countries. Inequities affecting health are large and widespread throughout the world, both between countries and within countries of all income levels. While both concerns are crucial and highly inter-related, the primary focus of this document is on ways to assess equity within rather than between countries. This is because until now, differences between countries have often received more attention, yet distinct challenges arise in trying to obtain information on differences within countries. In addition, prior technical work by WHO on equity has focused primarily on Europe, but people in most low and middle income countries who want to assess equity within their own national borders face particular challenges, given the greater constraints they face both with existing information and the resources to obtain new information. Therefore, while it is hoped that this material will be relevant to all countries, the first priority has been to respond to the needs of people in low and middle income countries who want information to help them develop more equitable national and local policies. In focusing on information, however, it should be emphasised that information is necessary but not sufficient for informed action. Without political will, even the best information will not lead to greater equity. This document is about obtaining information to guide policies for greater equity in health. But information, while necessary, is not sufficient for informed action, particularly where the goals is to achieve more equity. Without political will, even the best information will not lead to greater equity.
Country
Zimbabwe
Publisher
WHO/ARA
Theme area
Monitoring equity and research to policy
Title of publication Measuring social inequalities in health
Date of publication
1995
Publication type
Journal Article
Publication details
Public Health Reports 110 3 pp 302-305
Publication status
Published
Language
English
Keywords
health indicators, inequalities in health
Abstract
Although socio-economic inequalities in health were high on the
public health agenda during much of the first half of the 20th century, they faded from view with the assumption that the United States is a classless society. Unlike Great Britain and may European nations where public health data are routinely reported by a socio-economic measure (most often occupation), the United States generally disaggregate health data by age, sex and race. Many public health data sets, whether Federal, state or local do not contain socio-economic variable at all, severely limiting our understanding of how and why differentials in health outcomes occur. In an era when cost-effective and targeted health planning is more important than ever, these deficiencies in the availability and reporting of data are no longer acceptable. The paper reports a meeting of the Public Health Service under National Institutes of Health leadership in September 1994 in Annapolis, MD, to address these data gaps and related issues in the measurement of social inequalities in health and to make recommendations for improvements in the collections and reporting ofsocio-economic data.
Country
United Kingdom
Publisher
Theme area
Monitoring equity and research to policy
Title of publication The use of a geographical information system for hospital catchment area research in Natal/KwaZulu
Date of publication
1991
Publication type
Journal Article
Publication details
South Africa Medical Journal 80 6 pp 497-500
Publication status
Published
Language
English
Keywords
health services, inequalities in health care, health indicators
Abstract
We use a computerised geographical information system (GIS) to study the population per bed ratios and the implications of open access to the private and the formerly white hospital services in Natal. The advantages of the GIS method over the more usual administrative boundary-based beds per capita ratios are discussed. While the latter method would suggest that hospital bed resources in the province are racially unequal but nevertheless adequate (264 people per general and referral bed for the whole population, 195 for whites and 275 for blacks) the GIS analysis reveals widespread inadequacy, worse for blacks. Of the estimated hospital catchment areas half have more than 275 black people per general and referral bed, and half of these have more than 550 black people per bed. One-third of the catchment areas estimated for whites have ratios above 275 people per bed, and one half of these are also above 550 people per bed. The GIS analysis shows that open access to beds previously reserved for whites will make no difference to rural blacks, and almost none to urban blacks, because there were relatively few such beds, and they were concentrated in the cities. For the same reasons, the opening of private hospital beds to all patients would not significantly alleviate the apparent bed shortages in priority areas. By contrast, people in these priority areas would gain significantly improved access to general hospital care if selected chronic disease and industrial hospitals were upgraded to provide general hospital services. We find the technology to be useful for health planners and recommend that it be implemented as a routine in the national planning office of the Department of National Health and Population Development, with communication of maps and reports on a regular basis to the managers of regional and local services and the public.
Country
South Africa
Publisher
South Africa Medical Journal
Theme area
Poverty and health, Resource allocation and health financing
Title of publication Targeting the poor: Experience from Thailand
Date of publication
1998
Publication type
Report
Publication details
Publication status
Published
Language
Unknown
Keywords
User fees, health financing
Abstract
User fees have always been charged at government health facilities in Thailand and doctors would charge a lower fee or grant exemptions to low income groups. A formal nation-wide exemption policy for the poor started in 1975. The community screening procedures and identification card or `Low Income Card\\\' (LIC) was introduced in 1981. There has been gradual changes to improve the effectiveness of the scheme through information campaigns, a more proactive role for the village head, and an easier interview process. The coverage rate for the eligible poor was improved from 33% in 1987 to 61% in 1990. Problems of under-coverage and leakage have been recognised. The factors involved are weak implementation policy, difficulty or applying eligibility criteria, local politics and socio-cultural problems. Health care utilisation of LIC holders was influenced by perceived severity, perceived quality of care, accessibility and cost of services. The low income spend greater percentage of their income on health care than the wealthier. There is a need to improve policy implementation for the existing scheme and to ensure accessibility for the borderline poor.
Country
Zimbabwe
Publisher
Health Systems Research Institute
Theme area
Equitable health services
Title of publication Resource allocation in Australian aboriginal health care: Staking a claim for claims
Date of publication
1998
Publication type
Report
Publication details
Department of Public Health and Community Medicine pp 15pp.
Publication status
Published
Language
English
Keywords
health financing
Abstract
The health of the Australian Aboriginal and Torres Strait Islander population -the indigenous people of Australia - is well below that of the rest of Australians. This disadvantage is also reflected in other social indicators. The aim of this paper is to build a framework for the equitable allocation of health service resources for Aboriginal and Torres Strait Islander people. For reasons elaborated upon in the paper, three important features of such a framework are: 1) defence to procedural rather than distributive justice; 2) an accounting for vertical equity; and 3) the use of the equity criterion of `equal access for equal need\\\'. These are tied together under what we have termed a `claims\\\' approach and illustrated by a comparison with the commonly arguments. From this discussion, certain principles are established for the allocation of resources at three levels: 1) within indigenous communities; 2) across indigenous communities; 3) between Aboriginal and Torres Strait Islander people and other Australians. The paper has relevance beyond Australia to any country in which there are marked differences groups in the society and/or different ethnic or cultural groupings.
Country
Zimbabwe
Publisher
Department of Public Health and Community Medicine
Theme area
Resource allocation and health financing
Title of publication An unruly melange? Coordinating external resources to the health sector: A review
Date of publication
1997
Publication type
Journal Article
Publication details
Social Science and Medicine 45 3 pp 449-463
Publication status
Published
Language
English
Keywords
health policy, international assistance
Abstract
The past two decades have witnessed an upsurge in the number of external agencies involved in the health sectors of developing countries. Concomitantly, there has been an increase in the volume of resources transferred through multilateral, bilateral and non-governmental organisation to these health systems. Notwithstanding the beneficial impact of increased resources, recipients and donors are increasingly concerned about the effects of this trend. This is particularly pertinent where the effort lacks adequate coordination. Recipients despair of an unruly melange of external ideas and initiatives, that too often results in project proliferation and duplication, unrealistic demands, and ultimately a loss of control over the health development process. Donors on the contrary, are concerned about aid efficiency and effectiveness, two areas it is assumed will gain from increased attention to coordination. Both recipients and donors are looking for ways of better managing the aid relationship. Although there has been considerable experience with coordination strategies, most writing has considered external assistance in general, rather than the health sector in particular. The literature is striking in its bias towards the needs and perspectives of the donor community. There has been little analysis of the manner in which recipient ministries of health manage donors and the influx of resources. This review begins to fill this gap. Its focus is country-level, where most direct gains from co-ordination are to be reaped. The paper begins with an enumeration of the many and diverse trends which have raised the salience of aid coordination. A definition of coordination, a term used ambiguously in the existing literature, is then developed and the principles of aid coordination outlined. Finally, attention is directed to the initiatives of recipients and donors to improve the coordination of health sector aid.
Country
Zimbabwe
Publisher
Social Science and Medicine
Theme area
Resource allocation and health financing
Title of publication The political economy of user fees with targeting: Developing equitable health financing policy
Date of publication
1995
Publication type
Publication details
Journal of International Development 7 3 pp 369-401
Publication status
Published
Language
English
Keywords
user fees, health financing, primary health care
Abstract
Since the 1980s user fees for government services have become an accepted financing option for the health and social sectors in developing countries. Even countries which had a tradition of providing health services free of charge have now introduced fees and the focus of debate has shifted from whether or not to introduce them, to when and how they should be introduced. Proponents of user fees stress that equity and efficiency gains can be achieved through the implementation of a cost-recovery policy package. Within this package user fees are complemented by decentralisation and combined with two targeting mechanisms favouring low income groups: exemptions and the use of fee revenue to improve the services offered to them. The extension and improvement of primary health care, for example, will disproportionately benefit low income groups by addressing their health needs in a cost-effective way. However, targeting mechanisms, and exemptions in particular, have received little attention in theoretical debates within the health sector and current practices have rarely been reviewed. Relatively little is known about their effectiveness or about the conditions required to ensure and enhance it. This paper seeks to contribute to health financing policy debates by reviewing targeting options and assessing the available evidence concerning these issues. Success in protecting the poor appears to be limited and there are considerable informational, administrative, resource and socio-political constraints undermining the development of effective targeting mechanisms. The paper, therefore, urges caution in developing health care financing policy and identifies a relevant research agenda.
Country
Zimbabwe
Publisher
Journal of International Development
Theme area
Resource allocation and health financing
Title of publication Planning and politics of resource allocation for primary health care: Promotion of meaningful national policy
Date of publication
1983
Publication type
Journal Article
Publication details
Social Science and Medicine 17 24 pp 1947-1960
Publication status
Published
Language
English
Keywords
Resource allocation, primary health care
Abstract
Securing resources for primary health care (PHC) involves consideration of the entire health sector: the higher levels of the health service as well as the primary level, and the private and/or social security sub-sector as well as the government service. Reshaping resource distribution is less a redistribution of existing resources than the allocation of new resources in accordance with PHC priorities. In this the planning of future current costs is a crucial element and requires a budgetary system that identifies expenditures by geographical area and level of care. Resources should be allocated geographically to reduce health care inequalities through the provision of an appropriate mix of different levels of care. Central resource planning and local health care programming (with `dialogue\\\\\\\\\\\\\\\' between the two) should be the basic planning division of labour, which largely resolves the so-called top-down/bottom-up dichotomy. The private medical sub-sector exerts economic, ideological and political influences on the public health service. Compulsory health insurance schemes can have some similar effects. Success of a PHC policy requires that governments adopt a holistic approach to the health sector. The allocation of health care resources on the basis of need and equity, as opposed to demand, is a political decision. The establishment of a national PHC policy backed up by adequate resources involves a specific politico-technical exercise with four components: research, planning, policy formulation, and government policy decision making. The resource planning method, based on social epidemiology, is contrasted with conventional health planning methods, based on epidemiology. The articulation of these two approaches is discussed in terms of WHO\\\\\\\\\\\\\\\'s Managerial Process for National Health Development.
Country
United Kingdom
Publisher
Social Science and Medicine
Theme area
Equitable health services
Title of publication Re-thinking reform: Towards strategies for primary health care in the 21st Century
Date of publication
1998
Publication type
Book
Publication details
Publication status
Published
Language
English
Keywords
Primary health care, health sector reform
Abstract
Twenty years after Alma Ata, there have been some substantial global gains in health, but at the same time, growing inequities in health status and access to health care for much of the world\\\'s population. Health system reforms have been a major focus over the last decade but their impact on health and on health systems, even using the limited indicators of efficiency and equity, has been poorly monitored and evaluated. This paper describes those reforms, draw together international experience and analyses the empirical evidence to date, the pressures, both external and internal to the sector, which led to the emphasis on reform are outlined, and a descriptive over-view of the nature of the reforms presented. The difficulties both in implementation and evaluation of the reforms are discussed. It is noted that reform is as an inherently normative and political process but that reforms were introduced in a piecemeal fashion, lacking a cohesive overall policy framework, without considering the `side-effects\\\' on equity of access or long-term implications for the structure of the health system. In the midst of reforms, the goal of Health for All and concepts of Primary Health Care were often overlooked, but the evidence to date points to the importance of maintaining a vision and overall direction for health systems development. The cost effectiveness of equitable provision of primary health care, the effectiveness of empowering primary providers both in terms of patient choice and cost containment, and the importance of public participation in decision-making, setting of priorities and sustainability of reforms are some of the lessons learnt from the reform process. There is a need to assess outcomes of health reforms not only by the traditional economist\\\'s indicators of efficiency and equity, but to encompass health status measures, quality of care and sustainability of systems. It is clear also that incremental rather than radical change is not only more feasible, but more desirable in most countries, and that international `recipes\\\' for reform are unlikely to be successful without local ownership, adaptation and contextual `fit\\\'. In developing future strategies for health systems, the knowledge base that the reforms process has given us and the needs of countries as they face the demands of the future must be assessed realistically. Critical issues are likely to be the evolving role and leadership required by Ministries of Health; the impact of globalisation, both on the macroeconomic environment and on the health sector specifically, and the search for more equitable financing of health systems, particularly in the poorest nations, but also within nations. It is time for a reform in thinking, that establishes health as an essential component of human development, reframing the debate about systems and services in this context.
Country
Zimbabwe
Publisher
Theme area
Public-private mix
Title of publication The private health sector in Malawi: Opening Pandora\'s box
Date of publication
1995
Publication type
Journal Article
Publication details
Journal of International Development 7 3 pp 403-421
Publication status
Published
Language
English
Keywords
private health sector, policy analysis
Abstract
In 1988 the Malawi government liberalized its Medical
Practitioners and Dentists Act, allowing doctors in the public sector to undertake part-time private practice, and permitting paramedical and allied health professionals to enter into private practice. Using a policy analysis approach, the authors trace the context within which policy change occurred, the actors involved, and how the process was initiated and implemented. A rapid survey was undertaken of about half the paramedical and one fifth of the doctors practising privately. This showed that growth of private practice has been greatest among paramedical, that a typical private clinic has a single practitioner, is located in a township, trading centre or peri-urban area, and that although charges per patient visit are relatively low, incomes in the private sector are considerably higher than in the public sector. Growth in the private health sector raise a number of policy questions around control and quality of care for the majority of Malawians.
Country
Malawi
Publisher
Journal of International Development
Theme area
Human resources for health, Resource allocation and health financing
Title of publication Health reforms implementation provincial capacity building proposal 1995-1999
Date of publication
1995
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
Health sector reform, human resources
Abstract
This report outlines the outcome of `the consultative workshop for provincial health management teams, Lusaka August 1994\\\\\\\' where the future role, structure, and functions of the Regional Health Office within the Health Reforms was discussed. Current needs identified for the provincial level include:
* Restructuring the Regional Health Office to redefine
authority, responsibilities, and tasks in support of a decentralised health system
* Developing attitudes, skills, and tools for monitoring,
evaluation and the use of health information
* Capabilities to provide technical advisory support to
districts and hospital management boards
* Developing skills and tools for quality assurance on
clinical, preventive, and promotive health care
* Developing knowledge and skills on research methodology
* Developing capacity to coach districts and hospital
management boards on resource management
* Basic material resources to improve efficiency in work.performance (e.g computers, printers, photocopiers etc).
A brief situation analysis is provided of the provinces and the.offices of the Provincial Medical Officers, using the existing information and.results of a questionnaire regarding the available human resources and present tasks, is presented in chapter two. Major weaknesses including the unclear relationship between the Regional Health Office and the General Hospitals are identified. In chapter three the role, structure, and functions of the Regional Health Office is described. The Regional Health Office will have a similar relation to the hospital management boards as with the districts, i.e monitoring and support without a command authority. A tasks analysis of the Regional Health Office within the Health Reforms reviews the following areas of supportwith respect of support with respect to the districts and hospital management board.
Country
Zambia
Publisher
The Provincial Capacity Building Working Group
Theme area
Public-private mix
Title of publication The 1983 distribution of hospitals and hospital beds in the RSA by area, race, ownership and type
Date of publication
1990
Publication type
Journal Article
Publication details
South Africa Medical Journal 77 5 pp 448-452
Publication status
Published
Language
English
Keywords
Health services, health planning
Abstract
This study used published data to analyze the 1983 distribution of hospitals and hospitals and hospital beds in South Africa by `race\\\', geographical area, type of hospital (academic, specialist, general or other) and the nature of ownership (e.g state, for-profit). Hospitals and hospital beds were found to be inequitably distributed. Overall bed ratios were 150 whites per bed compared with 260 blacks/Asians/coloured per bed. The distribution of beds by geographical area was 130 people per bed for urban whites, 260 for rural whites, and 150, 460 and 300 for urban, rural non-`homeland\\\', and `homeland\\\' blacks/Asians/coloured respectively. These differentials are inefficient and unjust, and should be regularly documented to spur their decline. The continued collection of population group information from health service users is required to monitor changes in `race\\\' disparities. The analysis of distribution by ownership and type suggested that only the public sector is able to provide a hospital service with the appropriate balance of all levels of care for the entire population; but within this sector the dominant position of tertiary care needs to be re-examined. The study highlighted the absence of adequate information on health care resource allocation and utilisation. Appropriate studies in these areas are required and consideration should be given to unifying the planning and management of all hospital resources.
Country
South Africa
Publisher
South Africa Medical Journal
Theme area
Values, policies and rights
Title of publication Reforming Health sectors: Fashions, passions and common sense
Date of publication
1998
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
health reforms
Abstract
Within this complex field of action and research, the aim of this paper is to:
- map the terrain of health sector reform
- identify common themes where they exist, and
- separate out rhetoric from reality.
In doing so, it draws on the writings of some of the key theorists and researches in health sector reform. It presents a broad analysis of overall themes in health sector reforms and issues of the similarity and differences in reform themes and strategies across the world. In the attempt to cover reforms across the world, it uses a diversity of different country groupings. Since the level of complexity of the health system and particularly of the formal private sector is strongly affected by income level countries are categorised by the groupings of low, middle and high income and formerly socialist.
Country
Zimbabwe
Publisher
LSHTM
Theme area
Values, policies and rights
Title of publication Towards another development in health
Date of publication
1975
Publication type
Conference Proceedings
Publication details
Publication status
Published
Language
English
Keywords
health policy
Abstract
The 1977 Dag Hammarskjold Seminar on `Another Development in Health\\\' that brought together 17 social scientists, medical doctors and policy-makers, most of them officials of governments and international organisations. The objective of the Seminar was to promote a general and open debate on how the basic health needs can be satisfied and health given political priority and political visibility, particularly in the Third World. But the intention was also to underline the need for a thorough-going reorientation of health thinking and health policies in the industrialised countries, where preventive and promotive measures should be given greater importance than the present, increasingly costly, high technology care, whose benefits are becoming more and more marginal.
Country
Zimbabwe
Publisher
Dag Hammarskjold Foundation
Theme area
Health equity in economic and trade policies
Title of publication Investing in health - World Bank development report
Date of publication
1993
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
health policy, financing health, government spending, health sector, households, investment
Abstract
The report proposes a three-pronged approach to government
policies for improving health.
i. Fostering an environment that enables households to improve health
ii. Improving government spending health
iii. Promoting diversity and competition in the health sector
The report observes that increased scientific knowledge has
accounted for much of the dramatic improvement in health that has occurred in this century - by providing information that forms the basis of household and government action and by under-pinning the development of preventive, curative, and diagnostic technologies. Investment in continued scientific advance will amplify the effectiveness of each element of the three-pronged approaches
proposed.
Country
United States
Publisher
Oxford University Press
Theme area
Values, policies and rights
Title of publication Health sector reform: Key issues in less developed countries
Date of publication
1995
Publication type
Journal Article
Publication details
Journal of International Development 7 3 pp 329-347
Publication status
Published
Language
English
Keywords
Health sector reform, policiy objectives
Abstract
This paper explores the meaning, and some of the practical implications, of health sector reform in less developed countries. It reviews the problems that reforms have to address, and the policy objectives they are designed to achieve. It argues that the process of reform is not concerned only with defining priorities and refining policies, but also with reforming and restructuring the institutions through which health policies are implemented. Even though some organisational principles are likely to be common to all reform programmes, a prescriptive approach to institutional reform is inappropriate. The choice of reform options can be influenced by technical advice and analysis, but the decision to proceed, and the subsequent success of implementation, will be dependent on political support. The latter part of the paper presents examples of institutional reform from several less developed countries and includes a consideration of the role and influence of donor agencies.
Country
Zimbabwe
Publisher
Journal of International Development
Theme area
Health equity in economic and trade policies, Resource allocation and health financing
Title of publication Market commodities and poor relief: The World Bank proposal for health
Date of publication
1996
Publication type
Journal Article
Publication details
International Journal of Health Services 26 1 pp 1-18
Publication status
Published
Language
English
Keywords
Health policy, World Bank, neoliberal policies, privatization, public institutions
Abstract
Investing in health is the World Bank\\\'s blueprint for a new health policy within the context of structural adjustment. While this document includes a broad range of arguments, its implicit premises are neoliberal as can be deduced from its `agenda for action\\\'. Health is defined as a private responsibility and health care as a private good. This leads to a health policy based on two complementary principles: the reduction of state intervention and public responsibility, and the promotion of diversity and competition (i.e privatization). Thus, public institutions should provide only a limited number of public goods and narrowly defined, cost-efficient forms of relief for the poor. All other health-related activities are considered private utilities, to be resolved by the market, NGOs or families. The World Bank policy provides a pragmatic contribution to efforts to achieve fiscal balance. However, it also pushes to recommodify health care and to turn health into a a terrain for capital accumulation through the selective privatization of health-related financial and `discretionary\\\' services. The proposal implies large-scale experimentation and dismantling of public institutions which are the only alternative now accessible to the majority. It rejects health as a human need and a social right, and violates basic values by claiming that life and death decisions can be justly made by the market or through a cost-effectiveness formula.
Country
Mexico
Publisher
International Journal of Health Services
Theme area
Health equity in economic and trade policies
Title of publication Who is kidding who?
Date of publication
1994 December
Publication type
Report
Publication details
SAPEM pp 3pp.
Publication status
Published
Language
English
Keywords
WHO, market processes, poor nations
Abstract
This is the second in a series of articles analyzing the role of the World Health Organisation. It notes that WHO devotes more money and time pleasing its sponsors, mainly governments of the First World, than on the poorest, and unhealthiest nations of the world. The paper reports on a study conducted in the USA to present normative arguments about public goods and external costs that envision government as acting to provide those services that people would be willing to pay for but which they could not secure through ordinary market processes.
Country
Switzerland
Publisher
WHO
Theme area
Values, policies and rights
Title of publication Equity in health policies for survival in Southern Africa: An agenda for action
Date of publication
1997 March
Publication type
Conference Proceedings
Publication details
Publication status
Published
Language
English
Keywords
Health policy
Abstract
The seminar on equity in health - Policies for Survival in Southern Africa was jointly organised by the National Institute of Development Research and Documentation of the University of Botswana and the Dag Hammarskjold Foundation, Uppsala, Sweden form the 13 to 16 March 1997 at Kasane in Northern Botswana. The seminar brought together 34 participants fro eight Southern African countries, drawn from various disciplines and organisations. It included a range of people, such as politicians, policy makers, health and development practitioners, academics and NGO activists. The report outlines the discussion in the seminar on critical issues of Equity in Health in Southern Africa, and the solutions and actions proposed.
Country
Zimbabwe
Publisher
Theme area
Health equity in economic and trade policies
Title of publication Structural Adjustment Programme in Nigeria: Impact on health and equity in the cross river state
Date of publication
1995
Publication type
Report
Publication details
Publication status
Language
English
Keywords
macro-economic policy, SAPs, healthcare behaviour and patterns, fiscal incentives, households
Abstract
The study examines the impact of the Structural Adjustment Programme on the health pattern in selected areas of Cross River State. Using survey data, the results show that the SAP had some adverse effect on the health care behaviour and pattern in the area. Most of the households maintained that the SAP was either partially or wholly responsible for the hard times which invariably reduced their ability to cater for their health requirements. It is suggested that the State should enhance both the quantity and quality of health care; use of fiscal incentives to encourage the importation of essential drugs. Moreover, households should be educated on the dangers of self-medication or patronising quack health practitioners.
Country
Zimbabwe
Publisher
Economic Policy and Health Network
Theme area
Values, policies and rights, Human resources for health
Title of publication Structural adjustment programmes and workers\' health: Case studies in Africa
Date of publication
1992
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
economic policy, unions, workers\' health, structural adjustment
Abstract
This paper outlines a programme of work developed with worker organisations/trade unions in four participating countries on the impact of structural adjustment on workers\' health.
Country
Zimbabwe
Publisher
ZCTU
Theme area
Values, policies and rights
Title of publication Responsibilities and rights in the promotion of health: Differing positions of the individual and the state
Date of publication
1996
Publication type
Journal Article
Publication details
Social Science and Medicine 43 5 pp 775-782
Publication status
Published
Language
English
Keywords
Health promotion, individuals, patient-centred ethos, rights, responsibilities
Abstract
Medicine is the practice of humanitarianism. Many of the demands being voiced for a more responsive and humane system of health care grow out of the public\\\'s concern that individuals, especially those who are weak or vulnerable, are no longer a central focus of health care delivery. Critics of health care fault changing social values the failure of individuals to take responsibility for their own health, the greed of providers and or payers, the technological imperative, and various other factors as causes of medicine\\\'s loss of its patient-centred ethos. Yet bioethicists, care givers, health care providers, and theologians cannot agree on the appropriate role of the individual in health care contexts. This essay develops a framework within which to examine questions involving rights and responsibilities in medical and health care decision making.
Country
United States
Publisher
Social Science and Medicine
Theme area
Values, policies and rights
Title of publication A comparative constitutional study: Health rights
Date of publication
Publication type
Journal Article
Publication details
Scientific Publication 509 pp 10pp.
Publication status
Published
Language
English
Keywords
Health rights
Abstract
This paper explores the meaning of the term right to health, as it relates to the State\\\\\\\'s role in assuring an individual right to health and the health of the nation. It analyzes the modern concept of health, the distinction between public health and individual health care services, and the various elements of a `right to health\\\\\\\'; the constitutional texts purporting to frame a `right to health\\\\\\\' and cursorily the national legislative policies towards public health and the provision of health care. As of the end of the 1980s, forty years after the initiation of the modern international human rights movement, the right to health is still expressed as a programmatic or progressive right, directed primarily towards legislatures, for the highest attainable standard of health with few definable standards. Health has the same standing in these international documents on social and economic rights as to food, education, work, protection of the family etc., although it has been elevated above a mere element indication of an adequate standard of living, its treatment in the Universal Declaration.
Country
Zimbabwe
Publisher
Scientific Publication
Theme area
Values, policies and rights
Title of publication Planning for equity in health
Date of publication
1984
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
health policy
Abstract
This White Paper outlines Zimbabwe\\\\\\\'s post independence health policy consistent with the in `Growth with Equity\\\\\\\', policy seeks to establish a socialist, egalitarian and democratic society in Zimbabwe. It asserts that national development which can be measured by a nation\\\\\\\'s state of health. The liberation struggle rid Zimbabwe of inequalities in political and social status, wealth and income as well as in health status and access to health care. The rich enjoyed better health, were urban based and had privileged access to the most sophisticated health care. On the other hand the poor who were in the majority were rural based with minimal health and other social facilities. This group was plagued by malnutrition, infection and ill health, and yet the minimal health facilities were provided for them. Planning for \\\\\\"Equity in Health\\\\\\" seeks to redress this imbalance and demands that the rural population be cared for first. It advocates the adoption of the Primary Health Care (PHC) approach whose key components are appropriateness, accessibility, affordability and acceptability of the care provided. This approach advocates for a conscious acceptance by a community of the responsibility for its own health. The Government\\\\\\\'s role becomes one of guidance and support with the health care sector adopting the role of lead agent in a multi-sectoral drive to provide health for all. Far from being a strictly medical problem health is correctly identified as a developmental problem. Like under-development, ill-health becomes the concern of all sectors, which demands clear political commitment, a marshalling of adequate resources and a clearly defined strategy with set goals and target.
Country
Zimbabwe
Publisher
Ministry of Health
Theme area
Values, policies and rights
Title of publication Application of health for all concepts in South Africa: Focus on equity
Date of publication
1989
Publication type
Journal Article
Publication details
CME-VMO 7 11 pp 1309-1317
Publication status
Published
Language
English
Keywords
health policy, health care
Abstract
This article describes international strategies to achieve
\\\'Health for All\\\' (HFA), examines South Africa\\\'s response to these strategies and highlights health status and how health care is distributed in South Africa.
Country
South Africa
Publisher
CME-VMO
Theme area
Values, policies and rights
Title of publication Steering Committee briefing: Health equity and human rights: What role for health rights in EQUINET work? Johannesburg, 25 November 2003
Date of publication
2003 November
Publication type
Document
Publication details
Regional review meeting on health equity and human rights, Johannesburg, 25 November 2003 pp 1-14
Publication status
Published
Language
English
Keywords
strategic approach to human rights, public health approaches, southern Africa
Abstract
Although intuitively attractive, there are potential contradictions between public health approaches that prioritise equity, and views of human rights as individual entitlements or values associated with Western libertarian traditions. For these reasons, EQUINET has identified the importance of developing a strategic approach to human rights, that offers a deeper and more nuanced approach to the relationship between equity and human rights than is presently evident in public debates.
Country
Southern Africa Regional
Publisher
EQUINET, School of Public Health and Primary Health Care (UCT)
URL:
Equinet Publication Type
Briefs
Theme area
Health equity in economic and trade policies
Title of publication Trade related aspects of intellectual property rights (TRIPs) agreement and access to drugs
Date of publication
2003 November
Publication type
Conference Proceedings
Publication details
SEATINI Paper for the TARSC/ Parliament of Zimbabwe/ CWGH/ EQUINET/ SEATINI Workshop on Equity in Health issues, 21 November 2003 pp 7pp.
Publication status
Published
Language
English
Keywords
WTO, TRIPs, global governance, pharmaceutical sector
Abstract
The world we are living in today has no global government accountable to the people of every country to oversee the globalisation process. Rather what we have is a system that might be called global governance without global government (Stiglitz, 2002). A few institutions – the World Bank, the International Monetary Fund (IMF), the World Trade Organisation (WTO) and other players like multinational corporations dominate the scene, but in which many of those affected by their decisions are left almost voiceless, powerless and impoverished.
In 1994 the Uruguay Round trade negotiations culminated in the signature of an agreement instituting the World Trade Organisation (WTO). In deciding to become members of the WTO, states undertook to abide by its rules. A certain number of treaties on trade in goods and services were also annexed to the WTO Convention and are therefore binding on all members. Among these multilateral agreements is the Agreement on Trade Related Aspects of Intellectual Property Rights (TRIPs), which has so far proved to have the most impact on the pharmaceutical sector.
Country
Zimbabwe
Publisher
SEATINI, EQUINET, TARSC
URL:
Equinet Publication Type
Discussion paper
Theme area
Health equity in economic and trade policies
Title of publication The General Agreement on Trade in Services (GATS) and public health
Date of publication
2003 November
Publication type
Conference Proceedings
Publication details
Paper for the TARSC/ Parliament of Zimbabwe/ CWGH/ EQUINET/ SEATINI workshop on equity in health issues, Harare, 21 November 2003 pp 7pp.
Publication status
Published
Language
English
Keywords
GATs, basic service, health care, economic reforms, user fees, public health services
Abstract
Basic services could be described as those services that one never thinks of until one is deprived of them. Health care is one such basic service that we always take for granted until we are sick and more when we are sick and we cannot get the service because we can not afford the service or there are other reasons that hinder us from obtaining the service. Traditionally, all basic services have fallen under the provision of governmental authority with the government holding the monopoly of the provision of such services. However, with the arrival of economic reforms, user fees were introduced and the private sector wasted no time in identifying a market and thus commodifying the basic services. The basic services include health care, water supply, energy supply, education, transport, etc. In this presentation, we will limit our scope of discussion to public health services and other health-related services.
Country
Zimbabwe
Publisher
EQUINET/ SEATINI
URL:
Equinet Publication Type
Discussion paper
Theme area
Health equity in economic and trade policies
Title of publication The GATS threat to public health: A joint submission to the World Health Assembly, May 2003
Date of publication
2003 May
Publication type
Report
Publication details
EQUINET Resolutions pp 1-4
Publication status
Published
Language
English
Keywords
GATS, health service, health systems, public sector, liberalisation, WTO, east and southern Africa
Abstract
Within just 10 years of its adoption, the General Agreement on Trade in Services (GATS) has become one of the most controversial elements of the international trading system. More and more countries are becoming aware of the threat posed by the scope of the GATS agreement, and there is a growing call for governments to defend essential services from the GATS liberalisation agenda. This briefing examines the threat which GATS poses to health. It looks first at the challenge to health services themselves, including the potential for increased inequity, fragmentation of health systems and further marginalisation of the public sector as a result of the increased marketisation of health care. The briefing also examines the health risks which come with liberalisation of other service sectors such as water and insurance, and reveals the challenge to national health regulations from current negotiations at the World Trade Organisation (WTO). In conclusion, the briefing recommends that no country should commit its health services to GATS. In addition, each country should actively involve its health ministry and civil society in comprehensive ‘health checks’ of any GATS commitments proposed in other sectors before deciding on them.
Country
Southern Africa Regional
Publisher
EQUINET; International People's Health Council; Medact; People’s Health Movement; Save the Children; Wemos; World Development Movement
URL:
Equinet Publication Type
Resolutions
Theme area
Equity and HIV/AIDS
Title of publication The living situations of orphans in periurban Blantyre, Malawi
Date of publication
2003 June
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
living conditions, orphans, HIV/AIDS, Malawi
Abstract
Malawi is among the countries in the sub-Saharan region heavily affected by the HIV/AIDS pandemic. At least 10% of the 10 million population is estimated to be infected by HIV (Ministry of Health and Population, 1999). HIV-related illnesses are among the major causes of mortality and morbidity in both children and adults. There has been an increased clinical load from tuberculosis (Harries et al, 1997;Lewis et al, 2002), Pneumocystis carinni pneumonia (Graham et al, 2000), Non-Typhoid Salmonellosis (Graham et al, 2000; Gordon et al, 2002) and other infections as a result of HIV/AIDS. HIV prevalence rates in selected groups such as estate workers and ante-natal mothers have exceed 20% in some areas (Sutcliffe, et al 2002). The maternal mortality ratio which had been estimated as about 520 deaths per 100,000 live births in 1992, is now put at 1120 according to the 2000 Demographic and Health Survey (MDHS, 2001). This sad situation has been partly explained by the HIV/AIDS pandemic. There is an estimated 1 million orphans in Malawi as a result of the HIV/AIDS pandemic. The media, both print and electronic, continue to present to the public the difficult situations and relief efforts, mostly by non-governmental agencies and individuals towards the welfare of the orphans. However, there are a few published studies about the conditions in which orphans in Malawi are living. At study by Panpanich et al (1999) reported that the nutritional status of orphans living within the community had similar health and nutritional status to non-orphan children. Crampin et al (2003) also reported similar findings except that death of an HIV positive mother was associated with excess mortality as compared to death of an HIV negative mother or death of a father. These two studies however were conducted in rural settings. At the time of the study, the authors were unaware of any studies documenting the living conditions of orphan in a peri-urban area of Malawi. This study was therefore conducted to document the living situations or orphans living in households (non-institutional) in a peri-urban area of Blantyre, Malawi.
Country
Malawi
Publisher
Department of Community Health, University of Malawi College of Medicine, Malawi
URL:
Equinet Publication Type
Discussion paper
Theme area
Equity in health, Values, policies and rights, Poverty and health
Title of publication Poverty, equity and health in the developing world: An overview
Date of publication
1998
Publication type
Book
Publication details
Publication status
Published
Language
English
Keywords
Health policy
Abstract
After a decade or more of neglect, a concern for the health of the poorest and for equity in health has begun to make a comeback. However, a review of current thinking and recent experience suggests that those concerned with equity and poverty in health are currently in a poor position to design and implement activities that can accomplish their objectives. There are three reasons for this:
* First, lack of consensus about the nature and relative importance of equity and poverty, and thus about objectives. While the differences that exist about this issue have been of limited practical significance in the past, they promise to become increasingly important as development and the demographic-epidemiological transition proceed.
* Second, deficiency of basic information about health
conditions that prevail among the poor, either in absolute terms or relative to other socio-economic groups. Health has thus far lacked a tradition of collecting data by socio-economic status comparable to that which has produced information about income distribution and poverty levels for use by equity and poverty-oriented economic planners.
* Third, absence of an overall strategic vision for
addressing poverty and equity through the health sector. There is at present nothing comparable to the concepts of \\"primary health care\\" and the \\"child survival revolution\\" that, whatever their subsequently-revealed limitations, proved so effective in shaping health policy and mobilising support when poverty and equity were last in favour. Numerous techniques exist that can and should be much more frequently applied in order to make health programs more relevant for those in greatest need. But it is difficult to see how these techniques alone can suffice to accomplish the degree of reorientation necessary in health systems that are much better suited to serve the needs of the rich than of the poor. The international health community will need to move quickly in dealing with these three issues and in finding a way forward if it is to take advantage of the opportunity currently before it.
Country
Zimbabwe
Publisher
WHO
Theme area
Resource allocation and health financing
Title of publication Meeting report: Resource allocation and deprivation issues for health equity, Johannesburg, 14-16 May 2002
Date of publication
2002 May
Publication type
Conference Proceedings
Publication details
EQUINET Meeting report: pp 1-31
Publication status
Published
Language
English
Keywords
measuring deprivation, census, household survey, public sector resource allocation, SADC, southern Africa
Abstract
During the first phase of EQUINET supported research activities, a South African team undertook a project to critically evaluate alternative ways of measuring deprivation using census and household survey data. The implications of the geographic distribution ofdeprivation between small areas in South Africa for public sector resource allocation patterns were also evaluated. There has been considerable interest among SADC countries in undertaking similar researchinto the geographic distribution of deprivation and the implications for resource allocation. Three countries, Namibia, Tanzania and Zambia sent a team including a combination of Ministry of Health officials and researchers based in academic or other institutions to the workshop. Teams reviewed relevant household survey databases at the workshop.
Country
Southern Africa Regional
Publisher
EQUINET, Centre for Health Policy (Wits), Health Policy Unit (UCT)
URL:
Equinet Publication Type
Reports
Theme area
Equity in health
Title of publication What is the future for equity within health policy?
Date of publication
1989
Publication type
Journal Article
Publication details
Health Policy and Planning 4 4 pp 323-327
Publication status
Published
Language
English
Keywords
Health policy
Abstract
In spite of differences in meaning, equity is generally accepted as an important social and economic policy goal. However, recent policy debates suggest that this consensus is under challenge. This paper explores the current debate between the `New Right\\\' and its opponents, and how different approaches affect health policy. It is strongly argued that if equity is not to remain a misunderstood concept, it is essential to clarify the arguments in its favour, as well as the steps required to protect its position within the policy. The paper then goes on to justify the concern with equity, the broad goals equity seeks to achieve, and the practical translation of these goals into health policy. In the final section essentially practical issues are raised, by considering planning strategies and what research is necessary to support and develop pragmatic planning based on equity goals.
Country
South Africa
Publisher
Health Policy and Planning
Theme area
Governance and participation in health
Title of publication Policy paper 6: Public participation in health systems
Date of publication
2000 May
Publication type
Document
Publication details
Policy paper 6 pp 1-19
Publication status
Published
Language
English
Keywords
community partipation, health systems, best practice, Southern Africa
Abstract
Participation of communities is widely argued to be an to improve health outcomes andthe performance of health systems. Despite this participation is often loosely designedand hardly evaluated for its contribution to health outcomes. Participation takes many forms, and reflects varying degrees of community control over decision making in healthsystems. These different levels of community authority depend also on where authority is located within health systems (over planning, resource allocation etc) and how far health workers and managers are willing to widen the inclusion of different socialgroups in decisions that have often been under their control. The TARSC/EQUINET meeting on public participation in health systems (May 17-19) was held to exchange experience and information and identify key issues in relation to participation across various dimensions of health systems. The meeting will seek to: understand better the various experiences of participation currently taking place; identify key and replicable features of 'promising practices' that could be more widely disseminated; and identify areas for follow up investigation/ intervention/ action that can be taken forward, either through continued networking of delegates or other means.
Country
Southern Africa Regional
Publisher
EQUINET, TARSC
URL:
Equinet Publication Type
Policy paper
Theme area
Monitoring equity and research to policy
Title of publication Equity in health care: Methodological contributions to the analysis of hospital utilization within Canada
Date of publication
1995
Publication type
Electronic Source
Publication details
Social Science and Medicine 40 9 pp 1181-1192
Publication status
Published
Language
English
Keywords
Health services
Abstract
Two reports on health reform outcomes in the Southern Cone and the Andean Region; two international seminars and a regional Andean Workshop database on health reform outcomes; strengthened cooperation between research centres in the Southern Cone and Andean Region; and publication of a book, newsletter, abstracts, working papers and at least eight articles in scientific journals. Special attention will be given to the dissemination of the results among policymakers, managers, public officials and professionals. By contributing to the debate on health reform policies, it is expected that the project will improve community access to health care services in the medium and long term.
Country
Canada
Publisher
Department of Geography, McMaster University
Theme area
Equitable health services, Resource allocation and health financing
Title of publication Smokers, virgins, equity and health care costs
Date of publication
1994
Publication type
Journal Article
Publication details
Journal of Medical Ethics 21 4 pp 209-213
Publication status
Published
Language
English
Keywords
Health economics; health policy
Abstract
Country
Scotland
Publisher
Journal of Medical Ethics
Theme area
Equitable health services, Resource allocation and health financing
Title of publication Equity of health care in Australia
Date of publication
1995 August
Publication type
Journal Article
Publication details
Social Science and Medicine 41 4 pp 475-482
Publication status
Published
Language
English
Keywords
health services; health economics
Abstract
This paper examines the equity characteristics of health care financing and delivery in Australia and compares its performance with recent findings on systems in Europe and the United States. Vertical equity of finance is evaluated with income and payment concentration indices derived from published survey data on taxes and expenditure by income decile. Horizontal equity of health care delivery is assessed with standardized expenditure concentration coefficients for three measures of health status and four types of health services, derived from household survey data on health care utilization, health status, income and demographics. Health cover is available to the entire population. Results show the financing system is slightly progressive despite the fact that 30% of payment comes from private sources, which are regressive. The equity index compares favorably to many European countries and is much better than the U.S. which has a regressive financing system. The Australian system fares less well in terms of equity of health care delivery. Several features favor privately insured higher income persons in use of health care and this is reflected, for some health status measures and types of service, in inequity favoring the better off. This contrasts with inequity favoring the less well off in many European countries and the U.S. This analysis provides a benchmark for monitoring the equity of the Australian system and provides information on the equity of a mixed private and public financing system that covers the entire population. This is relevant to the U.S. which is moving in this direction by extending private cover to the uninsured and to European countries that are increasing private sector involvement in health care financing.
Country
United Kingdom
Publisher
Social Science and Medicine
Theme area
Equitable health services, Monitoring equity and research to policy
Title of publication No real progress towards equity: Health of migrants and ethnic minorities on the eve of the year 2000
Date of publication
1995
Publication type
Journal Article
Publication details
Social Science and Medicine 41 6 pp 819-828
Publication status
Published
Language
English
Keywords
health status indicators, health gaps, policies
Abstract
The paper reviews the available evidence on access to health care and two health outcomes, perinatal mortality and accident/ disability, for migrant and ethnic minorities in selected receiving industrialized countries. The health of these communities is analyzed using the entitlement approach, which considers health as the product of both the individual\\\'s private endowments and the social environment he or she faces. Migrants, especially first and second generations, and ethnic minorities often have reduced entitlements in receiving societies. Not only are they exposed to poor working and living conditions, which are per se determinants of poor health, but they also have reduced access to health care for a number of political, administrative and cultural reasons which are not necessarily present for the native population. The paper argues that the higher rates of perinatal mortality and accidents/disability observed in many migrant groups compared to the native population are linked to their lower entitlements in the receiving societies. Policies aimed at reducing such health gaps need to be accompanied by a more general effort to reduce inequalities and to promote full participation of these groups in the mainstream of society.
Country
Switzerland
Publisher
Social Science and Medicine
Theme area
Governance and participation in health
Title of publication Meeting report: Impacts of participation and governance on equity in health systems, Harare, 28 September 2002
Date of publication
2002 September
Publication type
Conference Proceedings
Publication details
EQUINET Meeting report pp 1-13
Publication status
Published
Language
English
Keywords
participation, governance, equity in health, southern Africa
Abstract
This document has five sections:
1. Background and framework: The background to the work that sets out the steps, identified institutions and links, agreed goals, research questions and methods that guide the governance work.
2. Feedback from the pilot: Information arising out of the pilot work carried out in Zambia and Zimbabwe is reported, with key areas of learning from the pilot. A broad framework finalised at the meeting for the multi-country work is reported.
3. Review of the proposals: The section outlines the submitted proposals and research tools and changes agreed at the meeting.
4. Follow up: Logistic, timeline and administrative information about the next stage of GovERN and cross cutting issues for strengthening the multi-country work
5. Links with Municipal Services Project. A summary of the key areas for potential co-operation between Equinet GovERN and MSP.
Country
Southern Africa Regional
Publisher
EQUINET, TARSC, CHESSORE, CWGH, INESOR
URL:
Equinet Publication Type
Reports
Theme area
Equity in health, Values, policies and rights, Equitable health services
Title of publication Equity in health care: Some conceptual and practical issues
Date of publication
1996
Publication type
Journal Article
Publication details
New Zealand Journal of Public Health 20 1 pp 9-11
Publication status
Published
Language
English
Keywords
health services, health rights,; participation in health
Abstract
Country
Australia
Publisher
New Zealand Journal of Public Health
Theme area
Equitable health services
Title of publication The concept of equity in health services research
Date of publication
1996
Publication type
Journal Article
Publication details
Scandinavian Journal of Social Medicine 24 1 pp 2-7
Publication status
Published
Language
English
Keywords
Health services; forecasting health trends
Abstract
A population approach and the general right to health and medical care have been important issues in the development of health policy over many centuries. However, equity is still a crucial issue in the planning and evaluation of health care. Many definitions and criteria related to equity have been formulated on the basis of conflicting theories and models. Three dimensions of fair and just resource allocation are essential when needs-based models are used: equity in access, utilization, and quality of care relative to needs. Health services research should concentrate on such outcome measures regarding equity and the effect of organizational and processual characteristics of health care systems. Prominent examples of such research efforts are presented, but, unfortunately, there are few reliable and systematic data from this kind of study. Health care researchers have a special responsibility towards the population at large to undertake qualified research on equity and to communicate the results to the general public.
Country
Denmark
Publisher
Scandinavian Journal of Social Medicine
Theme area
Governance and participation in health
Title of publication Approaching equity in consumer health information delivery
Date of publication
1997
Publication type
Journal Article
Publication details
Journal of American Medical Information Association 4 1 pp 6-13
Publication status
Published
Language
English
Keywords
Health information
Abstract
The growing public interest in health and wellness information stems from many sources, including social changes related to consumers\\\' rights and women\\\'s health movements, and economic changes brought about by the managed health care revolution. Public, hospital, and medical center libraries have been ill-equipped to meet the increasing need for consumer-oriented materials, even though a few notable programs have been established. The \\"Information Superhighway\\" could be an effective tool for sharing health information if access to telecomputing equipment and training were available to those with an information need. The University of Cincinnati Medical Center, with its libraries in the leading role, is delivering NetWellness, an electronic consumer health library service, to residents of 29 counties in three midwestern states. Users connect directly through the Internet, through regional Free-Nets, and by visiting one of 43 public access sites where networked workstations have been installed. The continued success of the project depends on developing partnerships, providing quality content and maintaining fair access.
Country
United States
Publisher
Theme area
Values, policies and rights
Title of publication Equity, poverty and health for all
Date of publication
1997
Publication type
Journal Article
Publication details
British Medical Journal 314 7088 pp 1187-1191
Publication status
Published
Language
English
Keywords
Health policy, health rights
Abstract
Country
United Kingdom
Publisher
British Medical Journal
Theme area
Equity in health, Equitable health services, Monitoring equity and research to policy
Title of publication Equity in health care utilization: Further tests based on hurdle models and Swedish micro data
Date of publication
1997
Publication type
Journal Article
Publication details
Health Economist 6 3 pp 303-319
Publication status
Published
Language
Keywords
Health status indicators; health services
Abstract
This paper tests the null hypothesis of no horizontal inequity in delivery of health care by use of count data hurdle models and Swedish micro data. It differs from most earlier work in three principal ways: First, the tests are carried out separately for physician and hospital care; second, the tests are carried out separately for the probability of seeking care and the amount of care received (given any use); and third, the tests are based on a model that includes several socioeconomic variables, e.g. income, education and size of community of residence. The paper rejects the hypothesis of no inequity because socioeconomic factors also have significant effects on utilization, e.g. income and size of community of residence. Size of community of residence has a positive significant effect on the frequency of physician visits but not on the probability of visiting a physician.
Country
Sweden
Publisher
Health Economist
Theme area
Human resources for health
Title of publication Physician equity in health care delivery systems: Three alternative models
Date of publication
1998
Publication type
Journal Article
Publication details
Journal of Health Care Finance 24 2 pp 36-47
Publication status
Published
Language
English
Keywords
Health services, health economics
Abstract
The 1990s have seen many health care organizations attempting to merge, acquire, or affiliate with physician groups. Many have failed to provide physicians a stake in the success of the newly formed enterprise, frequently resulting in declining physician productivity, poor morale, and large operating losses. These problems warrant a reexamination of the traditional acquisition model of growth in favor of structures that retain a physician ownership component. This article examines three models of health care organization in which physicians share in the success of the enterprise and compares them in terms of ownership structure, governance, and funds flow.
Country
Canada
Publisher
Theme area
Equity in health, Values, policies and rights
Title of publication In search of human dignity: Gender equity, reproductive health and healthy aging
Date of publication
1997
Publication type
Journal Article
Publication details
International Journal of Gynaecology and Obstetrics 59 3 pp 195-206
Publication status
Published
Language
Keywords
Health rights
Abstract
This paper analyzes the nine pillars of human dignity (sufficient food, potable water, shelter, sanitation, health services, healthy environment, education, employment and personal security), which humankind tries to establish by following nine approaches to reality (scientific, cultural, religious, ethical, economical, ecological, socio-critical, philosophical and political) in a world drastically changed by nine revolutions (demographic, scientific, technological, communication, global identity, environmental, contraceptive, reproductive health and gender equity). The author\\\'s generation participated in these revolutions and contributed to the global intellectual process by which gender equity and reproductive health assumed a central role in world affairs. A rapidly aging world population constitutes another major challenge. Its likely impact on the very fundaments of our future social, economical, health and even political infrastructures is - as yet - incompletely comprehended by the international community. The International Federation of Gynecology and Obstetrics (FIGO) has and will continue to have an indispensable role in assisting humankind to reach its ultimate goal : human dignity.
Country
Sweden
Publisher
International Journal of Gynaecology and Obstetrics
Theme area
Equitable health services, Resource allocation and health financing
Title of publication Equity and health planning: Critical analysis of the SROS and implications for a model of resource allocation
Date of publication
1997
Publication type
Journal Article
Publication details
Cah Sociology Demographic and Medicine 37 3-4 pp 205-235
Publication status
Published
Language
Keywords
Health planning; health services
Abstract
Country
Canada
Publisher
Cah Sociology Demographic and Medicine
Theme area
Equity in health, Resource allocation and health financing
Title of publication Wealth, equity and health care: A critique of a "population health" perspective on the determinants of health
Date of publication
1996
Publication type
Journal Article
Publication details
Social Science and Medicine 46 7 pp 785-798
Publication status
Published
Language
English
Keywords
health services, health policy
Abstract
In this paper we examine the recent ascendancy of a
\\"population health\\" perspective on the \\"determinants of health\\" in health policy circles as conceptualized by health economists and social epidemiologists such as Evans and Stoddart [Evans and Stoddart (1990) Producing health, consuming health care. Social Science & Medicine 31(12), 1347-1363]. Their view, that the financing of health care systems may actually be deleterious for the health status of populations by drawing attention away from the (economic) determinants of health, has arguably become the \\"core\\" of the discourse of \\"population health\\". While applauding the efforts of these and other members of the Canadian Institute for Advanced Research for \\"pushing the envelope\\", we nevertheless have misgivings about their conceptualization of both the \\"problem\\" and its \\"solutions\\", as well as about the implications of their perspective for policy. From our critique, we build an alternative point of view based on a political economy perspective. We point out that Evans and Stoddart\\\'s evidence is open to alternative interpretations--and, in fact, that their conclusions regarding the importance of wealth creation do not directly reflect the evidence presented, and are indicative of an oversimplified link between wealth and health. Their view, that the financing of health care systems may actually be deleterious for the health status of populations by drawing attention away from the (economic) determinants of health, has arguably become the \\"core\\" of the discourse of \\"population health\\". While applauding the efforts of these and other members of the Canadian Institute for Advanced Research for \\"pushing the envelope\\", we nevertheless have misgivings about their conceptualization of both the \\"problem\\" and its \\"solutions\\", as well as about the implications of their perspective for policy. From our critique, we build an alternative point of view based on a political economy perspective. We point out that Evans and Stoddart\\\'s evidence is open to alternative interpretations--and,in fact, that their conclusions regarding the importance of wealth creation do not directly reflect the evidence presented, and are indicative of an oversimplified link between wealth and health. Their view also lacks an explicit substantive theory of society and of social change, and provides convenient cover for those who wish to dismantle the welfare state in the name of deficit reduction. Our alternative to the \\"provider dominance\\" theory of Evans and Stoddart and colleagues stresses that the factors or forces producing health status, which Evans and Stoddart describe, are contained within a larger whole (advanced industrial capitalism) which gives the parts their character and shapes their interrelationships. We contend that this alternative view better explains both how we arrived at a situation in which health care systems are as costly or extensive as they are, and suggests different policy avenues to those enunciated by Evans, Stoddart and their confreres.
Country
Canada
Publisher
Social Science and Medicine
Theme area
Equity in health
Title of publication Promoting equity in health
Date of publication
1998 June
Publication type
Journal Article
Publication details
Promoting Education 5 2 pp 7-13, 43
Publication status
Published
Language
English
Keywords
health promotion, health rights
Abstract
There is evidence that widening income gaps are a global phenomenon; that in many advanced industrialised countries unemployment rates are rising; that globalisation of the world economy has led to several countries becoming marginalised with a concomitant increase in poverty; and that the absolute number of poor has steadily increased over the last decade. All of these phenomena emphasise the need to focus on equity as a global concern.
Country
Switzerland
Publisher
Promoting Education
Theme area
Equity in health
Title of publication Ethics, equity and health for all
Date of publication
1998
Publication type
Journal Article
Publication details
World Health Forum 19 3 pp 298-299
Publication status
Published
Language
English
Keywords
Primary health care, health services
Abstract
Country
Canada
Publisher
World Health Forum
Theme area
Equity in health
Title of publication Towards equity in health in an unequal society
Date of publication
1998
Publication type
Journal Article
Publication details
Soc Sci Med 47 10 pp 1529-1538
Publication status
Published
Language
English
Keywords
Health Care Reform; Health economics, public health expenditure, South Africa
Abstract
South Africa is one of the world\\\'s most unequal societies and its health sector mirrors these inequalities. Since the first democratic elections in 1994 the government has been under enormous pressure to diminish disparities between population groups in access to health services. This paper documents the structural inequalities in the health sector and discusses the strategic options that are being considered for reducing them. The overall level of health expenditure is high, amounting to 8.5% of GDP. However, less than 40% of expenditure is on public health services and three quarters of that is on acute care hospitals. A more detailed analysis of public health expenditure reveals large differences between census districts. The districts where household incomes are low tend to have fewer public health services. Public health expenditure per capita was lower than the estimated cost of providing basic primary health care in a fifth of districts. The most urgent need is to improve the services likely to reduce excess mortality and morbidity. This will involve additional funding of primary health service services, particularly in underserved localities. Government cannot increase public health rapidly and it will have to re-allocate funding from hospitals. The paper discusses options for achieving this, including the introduction of social health insurance. It argues that restructuring the health sector is complex and there is a risk of failure. Governments should base their strategies on a good understanding of the health sector and of the likely impact of different reform options.
Country
United Kingdom
Publisher
Soc Sci Med
Theme area
Values, policies and rights, Health equity in economic and trade policies
Title of publication Equity in health: Between ethics and economy
Date of publication
1997
Publication type
Journal Article
Publication details
Rev Med Suisse Romande 118 12 pp 989-993
Publication status
Published
Language
Unknown
Keywords
Medical ethics, health policy, health economics
Abstract
Country
Italy
Publisher
Rev Med Suisse Romande
Theme area
Monitoring equity and research to policy
Title of publication On the measurement of the nation\'s equity adjusted health
Date of publication
1998
Publication type
Journal Article
Publication details
Sweden Health Econ 7 7 pp 621-628
Publication status
Published
Language
English
Keywords
Health services, Health status indicators
Abstract
The aim of this article is to show a method for measuring the nation\\\'s equity-adjusted health. In order to estimate what the \\\'nation\\\'s health function\\\' looks like, data from a survey sent to a sample of Swedish politicians were used. The results from the survey can be interpreted as a measure of inequity aversion, and this was applied to data on healthy years (HY) for males in different social groups for the period 1975-1990. The mean of healthy years increased during the period 1986-1990 by 1.09% while equity adjusted healthy years (HY(EDE)) dropped by -1.78%. The nation\\\'s health has decreased in spite of the fact that the individual\\\'s health has increased.
Country
Sweden
Publisher
Sweden Health Econ
Theme area
Monitoring equity and research to policy
Title of publication Surveillance for equity in primary health care: policy implications from international experience
Date of publication
1992
Publication type
Journal Article
Publication details
International Journal of Epidemiology 21 pp 6pp
Publication status
Published
Language
English
Keywords
Health surveillance, equity, primary health care
Abstract
This paper presents evidence from international experience showing that equity is not only justified morally, but makes primary health care effective and efficient. The papers provides the major arguments for equity, taking equity to mean the distribution of benefits according to demonstrable need rather than on the basis of political or socioeconomic privilege. The paper outlines a framework for surveillance of equity, to identify high risk groups amongst whom health problems are concentrated and to trigger priority action. The paper outlines practical issues in the implementation of surveillance for equity and international field experiences of such surveillance, and in particular community based surveillance.
Country
Zimbabwe
Publisher
Theme area
Monitoring equity and research to policy
Title of publication On the measurement of inequalities in health
Date of publication
1990
Publication type
Journal Article
Publication details
Social Science and Medicine 33 5 pp 545-557
Publication status
Published
Language
English
Keywords
inequalities in health, health measurement
Abstract
This paper offers critical appraisal of the various methods employed to date to measure inequalities in health. It suggests that only two of these-the slope index of inequality and the concentration index-are likely to present an accurate picture of socio-economic inequalities in health. The paper also presents several empirical examples to illustrate of the dangers of using other measures such as the range, the Lorenz curve and the index of dissimilarity.
Country
United Kingdom
Publisher
Social Science and Medicine
Theme area
Monitoring equity and research to policy
Title of publication Recommendations of the conference “Measuring social inequalities in health”
Date of publication
1996
Publication type
Journal Article
Publication details
International Journal of Health Services 26 pp 6pp.
Publication status
Published
Language
English
Keywords
inequality in health measurement
Abstract
Country
United States
Publisher
International Journal of Health Services
Theme area
Monitoring equity and research to policy
Title of publication Measurement of equity in health
Date of publication
1986
Publication type
Journal Article
Publication details
World Health Statistics Quarterly 39 pp 10pp.
Publication status
Published
Language
English
Keywords
equity, health, measurement
Abstract
Country
Switzerland
Publisher
Theme area
Monitoring equity and research to policy
Title of publication International equity in coverage of primary health care: Examples from developing countries
Date of publication
1986
Publication type
Journal Article
Publication details
World Health Statistics Quarterly 39 pp 8pp.
Publication status
Published
Language
English
Keywords
equity; primary health care; measurement
Abstract
This paper refers specifically to equity in health care coverage using the essential components of primary health care. A review of the experience of the industrialised countries shows that they are still confronted with problems in the assessment of health in equity and that they have less information on inequity in health care than on inequity in health status. It is thus important to measure population proportions with access to services and activity to population ratio. In carrying this out in some countries, inequalities in access are greater for sanitary facilities than for safe water and inequalities in access to safe water are greater than for health care units. Inequalities also seem to be greater for coverage with attendance for deliveries than for antenatal care. Measures of the inequality variable find their best application in the monitoring of trends, but they should not preclude the use of simple profiles. For the purpose of analysing inequalities in coverage, it is most practical to use population sub-divisions based on geographical areas and sub-areas. This is the most frequently available information and possibly the most useful.
Country
Switzerland
Publisher
Theme area
Monitoring equity and research to policy
Title of publication Equity in health - Policies for survival in Southern Africa: Mozambique’s Experience
Date of publication
1997
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
equity; health monitoring, resource alllocation
Abstract
The paper looks at issues of equity in Mozambique and government and the efforts to increase equity. Equity in health care provision is achieved through an improved resource allocation mechanism that provides for measures of distribution and efficiency. The paper outlines several approaches towards monitoring equity being used in Mozambique, particularly in terms of the relationship between need and human and financial resource allocations. These methods also allow for evaluation of efficiency in the relationship between resource allocations and output.
Country
Mozambique
Publisher
Mimeo
Theme area
Monitoring equity and research to policy
Title of publication Methods for evaluating effects of health reforms
Date of publication
1997
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
health policy; equity; health financing monitoring; health sector refomrs
Abstract
This paper aims to identify simple methods to evaluate the effects of health sector reforms and to discuss the relative usefulness of various methods in different situations. It is noted that, where feasible, it is desirable to combine crosssectional with longitudinal approaches (in addition to the descriptive analysis) to strengthen confidence in one’s conclusions about the changes that are due to the reform(s). Both longitudinal and cross-sectional approaches encounter the problem of controlling for the influence of external factors. For longitudinal approaches, looking for discontinuities in trends where a policy change is quite discrete, looking for changes which are sufficiently large to exclude the likelihood of a long term trend; and generating hypothesis about other explanations of a trend which one then attempts to reject, are all approaches for assessing such factors. Cross-sectional approaches, minimising the expected influence of confounding variables should be done in the design stage. A conclusion on the effects of a reform in one circumstance does not automatically apply in other settings or from local to national level.
Country
United Kingdom
Publisher
London School of Hygiene; World Health Organisation
Theme area
Monitoring equity and research to policy
Title of publication Improving and monitoring the equity of health care provision: A discussion of the selection of indicators
Date of publication
1997
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
monitoring equity; health care
Abstract
The promotion equity of demands measures of health care provision that are useful for monitoring indicators to identify and target disadvantaged population groups and areas of the country for preferential attention and to identify appropriate strategies and interventions for preferentially improving health care provision to disadvantaged population groups and areas. It is also important to collect non-quantitative indicators used to guide and promote certain policymaking and health management processes. Indicators need to be selected and used in a way that drives the process of change, rather than to simply monitor change. Indicators that are used to monitor fairness need to be seen as tools that development rather than as tools of measurement.
Country
South Africa
Publisher
Mimeo
Theme area
Monitoring equity and research to policy
Title of publication Measuring the magnitude of socio-economic inequalities in health: An overview of available measures illustrated with two examples from Europe
Date of publication
1997
Publication type
Journal Article
Publication details
Social Science Medicine 44 6 pp 757-771
Publication status
Published
Language
English
Keywords
Inequalities in health; health measurement
Abstract
This paper reviews the available summary measures of socio-economic inequalities in health. Measures differ in a number of important respects, including the measurement of (i) relative or absolute differences; (ii) effects of lower socioeconomic status or of the total impact of socio-economic inequalities in health upon the health status of the population; (iii) simple versus sophisticated measurement techniques. Eight different classes of summary measures are distinguished. It is however, assessed that measuring inequalities does not revolve particularly given data limitations. Rather a blend of different summary measures may contribute to an understanding of these inequalities and their changes over time.
Country
United Kingdom
Publisher
Social Science Medicine
Theme area
Monitoring equity and research to policy
Title of publication Accounting for the public’s health: An introduction to selected papers from a US Conference on “Measuring social inequalities in health”
Date of publication
1996
Publication type
Journal Article
Publication details
International Journal of Health Services 26 3 pp 383-390
Publication status
Published
Language
English
Keywords
Public health, health management, political economy
Abstract
Accounting for, and being accountable to, the public’s health requires carefully documenting and analysing social inequalities in health. Controversies abound over which measures of socio-economic position to use, at which points in time, and at what level-e.g, individual, household, and neighbourhood. Important debates also concern how to analyse these data and relate them to inequalities race/ethnicity and gender. To improve tools for evaluating socio-economic gradients in health, in 1994 the US Public Health Service and National Institutes of Health sponsored a conference on Measuring Social Inequalities in Health. Research on social inequalities in health reveals that the “socio-economic status” (SES) scientific discourse is very limited in its ability to explain increasing inequalities in health globally. The Weberial category of status of individuals and construct of “life chances” that characterises most scholarly US research on social inequalities does not account for the remarkable growth in these inequalities and their relations to the global economic and social change in the United States and the world today. In recognition of these limitations Wright emphasises class rather than SES to understand growing social inequalities, relating them to the social relations of production rather than SES relations. Developing more powerful theories and methods to explain and eliminate social inequalities in health is necessary given the economic and political changes transforming the structure and composition of the global workforce and the degree of economic inequality within as well as between nations.
Country
Zimbabwe
Publisher
Theme area
Monitoring equity and research to policy
Title of publication Measuring the social inequalities in health
Date of publication
1995 May
Publication type
Journal Article
Publication details
Public health reports 110 May-June pp 3pp.
Publication status
Published
Language
English
Keywords
inequalities in health; political economy monitoring
Abstract
Although socio-economic inequalities in health were high on the public health agenda during much of the first half of the 20th Century, they do not have a high profile in the United States. Unlike many European countries where public health data are routinely reported by a socio-economic measure (most often occupation), the United States generally presents health data by age, sex and race. This severely limits understanding of how and why differentials in health outcomes occur. In an era when cost-effective and targeted health planning is more important than ever, these deficiencies in the availability and reporting of data are no longer acceptable. Socio-economic data collected routinely that linked to health include employment status, amount and sources of income, size and composition of household supported by this income, hardship (poverty), assets (including housing tenure and sources of wealth), health insurance coverage, and completed educational level. Three different levels of socio-economic data should be evaluated, individual, household and neighbourhood, to allow for sharper distinctions among contributing causes of social inequalities in health and to target interventions more effectively.
Country
Publisher
Theme area
Monitoring equity and research to policy
Title of publication Developing a primary health care management information system that supports the pursuit of equity, effectiveness and affordability
Date of publication
1993
Publication type
Journal Article
Publication details
Social Science and Medicine 36 5 pp 11pp
Publication status
Published
Language
English
Keywords
primary health care; equity; health information system
Abstract
Country
Southern Africa Regional
Publisher
Social Science and Medicine
Theme area
Monitoring equity and research to policy
Title of publication The essential step: An interim assessment of equity in health in Zimbabwe
Date of publication
1997 August
Publication type
Conference Proceedings
Publication details
A situational and trend analysis in equity in health and health care in Zimbabwe, 2-4 August pp 5pp.
Publication status
Published
Language
English
Keywords
equity in health; health indicators, Zimbabwe
Abstract
An equity in health project was formerly embarked upon in October 1996, in Zimbabwe. The first-phase conducted a situation and trend analysis on equity in health and health care in order to inform multi-sectoral policies. The report noted the need to work out equity standards, prepare strategies for achieving these as well as related training materials for health planners and managers. Such standards should be used for monitoring and surveillance of equity. An important role of the public sector is that of setting standards and regulating the private sector to ensure quality of services. Training is needed for development of a constituency and institutional mechanisms for ensuring equity considerations in health projects and for tracking internal and external resource flows. There is need for a transparent monitoring and evaluation mechanism to assess the extent of equity in health care.
Country
Zimbabwe
Publisher
Theme area
Monitoring equity and research to policy
Title of publication Health situation analysis and inequities in health
Date of publication
1992
Publication type
Publication details
Publication status
Published
Language
English
Keywords
monitoring, equity, health
Abstract
Country
United States
Publisher
American Public Health Association
Theme area
Monitoring equity and research to policy
Title of publication The measurement of inequities in health: Lessons from the British experience
Date of publication
1990
Publication type
Journal Article
Publication details
Social Science and Medicine 31 pp 11pp.
Publication status
Published
Language
English
Keywords
measurement, equity
Abstract
Country
Zimbabwe
Publisher
Social Science and Medicine
Theme area
Resource allocation and health financing
Title of publication Hospital fee retention in Zimbabwe: Management and impact
Date of publication
1996
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
Health care, fees, financial management
Abstract
Prior to 1996/97 all fee revenues collected by Government including health facilities were deposited into the Treasury’s Exchequer Account, and fee income did not affect allocations made. Consequently, total hospital fees collected by the Ministry of Health were only 2% of government annual recurrent allocation to health in 1990/91-1995/96. In September 1996, government decided that hospital fees being paid by patients would be retained by the collecting institution. While the study is not completely finalised, preliminary results showed that of the seven provincial hospitals visited, in five of these there seemed to be a tendency (weak or strong) to increasing fee income after September 1996. Moreover, there was no clear indication that utilisation of health services declined as measured by the out patient attendances per month in the provincial hospitals.
Country
Zimbabwe
Publisher
Ministry of Health and Child Welfare
Theme area
Resource allocation and health financing
Title of publication Strengthening district health systems: An approach towards equity in health: The Zimbabwe experience
Date of publication
1989
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
Health policy, Health services
Abstract
Country
Zimbabwe
Publisher
Ministry of Health and Child Welfare
Theme area
Resource allocation and health financing
Title of publication An evaluation of health financing reforms with special focus on the abolition of user fees at rural health centres and rural hospitals
Date of publication
1996
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
Health financing reforms; abolition of user fees; rural health centres and rural
Abstract
In March 1995 Ministry of Health and Child Welfare decided that no user fees would be charged at rural health centres and rural hospitals. In addition to this, the new policy prescribed that all referred patients were exempted from paying consultation fees at the next referral centre. The main aims of this policy change were to prevent the under utilisation of the rural health centres and to reduce the congestion at out patient departments at secondary, tertiary and quaternary levels of the health care system (strengthen the referral chain) as well as to cushion the rural majority from some of the negative effects of reforms in the health care sector. Being mostly interested in investigating whether the first objective had been successful, the researchers analysed utilisation statistic from all provinces on a number of districts. It was found that the out-patient attendance increased at the rural health centres and rural hospitals from March 1995 peaking in July 1995, after which utilisation declined probably due to lack of drugs and general shortage of essential inputs. Furthermore, there was a general increase of referrals from rural health centres and rural hospitals to district level and the district level out-patient attendance increased. It was noted that other factors than the reform could have impacted on the utilisation pattern.
Country
Zimbabwe
Publisher
Ministry of Health and Child Welfare
Theme area
Resource allocation and health financing
Title of publication A framework and indicative cost analysis for better health in Africa: Technical working paper
Date of publication
1993
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
health, health economics, cost-benefit analysis
Abstract
District based-health care is equitable, effective, efficient, and now, as this paper illustrates, low cost. The concept of decentralised health care is widely accepted and increasingly implemented in many Afrrican countries. The analytical framework presented in the paper provides planners with a tool to conduct cost analysis, to evaluate current services and cost structures and to design health programs that are cost-effective and responsible to the health needs of the community. Using the framework outlined in this paper, it is estimated that a network of health centres, a district hospital, and a district health management team can deliver a package of services that could effectively meets over 90% of the health care needs of the majority of the population for approximately $13.0 per capita per year in low income Africa. There are wide variety of health care systems in Sub-Saharan Africa. Clearly, systems operating with several tiers cannot be expected to immediately convert to district based systems. The criteria for comparison between current systems and district based systems should be: equity in delivery service to all; effectiveness; efficiency in terms of the gap between potential and actual outputs; and cost effectiveness in terms of achieving the greatest benefits for the largest number of people for the lower cost.
Country
Unknown Country
Publisher
Human Resources and Poverty Division: Africa Technical Department
Theme area
Resource allocation and health financing
Title of publication Development and health: The need for integrated approaches in South Africa
Date of publication
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
health; development
Abstract
The impact of development policies on health are outlined within the context of epidemiological and demographic transition. Macro-economic policies have a major impact on the nutritional status of the population; agricultural policy and particularly changing patterns of land use have in the past resulted in forced resettlement with concomitant health effects, while the development of new irrigation schemes has increased the risk of vector-borne disease. Industrial and energy policies increase the risk of the population for a range of environmental and occupational pollutants. Several adverse health impacts associated with urbanisation include poverty related disease (measles, nutritional diseases); all forms of trauma (from motor vehicle accidents to interpersonal violence); behavioral injurious to health (associated with tobacco, alcohol and sugar consumption); and sexually transmitted diseases. AIDS could well become a major impediment to all aspects of future development. The article concludes by recommending greater interaction between epidemiologists and economists so as to ensure that an integrated approach to development will result in enhancement of the health of people.
Country
Zimbabwe
Publisher
Mimeo
Theme area
Equitable health services
Title of publication Equity in the distribution of quality of care
Date of publication
1981
Publication type
Journal Article
Publication details
Medical Care 19 (Supplement) pp 28pp.
Publication status
Published
Language
English
Keywords
Abstract
Country
Publisher
Medical Care
Theme area
Resource allocation and health financing
Title of publication Cost recovery and equity in the health sector: Issues for developing countries
Date of publication
1997
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
equity, health sector, cost recovery
Abstract
Over the past decade the poorest countries have struggled to maintain the provision of basic health services in the face of economic problems, the resurgence of poverty-related infectious disease, and population growth. Various prescriptions have been advanced for redressing the widening gap between need and resources. One such prescription is cost recovery. Rooted in market-oriented approaches to health finance, user-charges have been recommended by international agencies such as the World Bank and aid donors to mobilise new resources and rationalise service delivery. It is also claimed that cost-recovery programmes, supported by targeted exemption system, enhance equity by increasing the quality and quantity of services available to the poor. This paper traces the influence of cost-recovery prescriptions to the decline in political support for the universal provision of health services and the demise of rights-based approaches. The paper reviews cost-recovery programmes. It concludes that, contrary to the claims of their architects, such programmes have excluded vulnerable populations from access to basic health provision with damaging implications for equity. Exemption systems have generally failed to protect the poor. Evidence of a willingness to pay for health on the part of poor people, widely cited in defence of user charges, has been misinterpreted as evidence of an ability to pay, without reference to the costs associated with coping strategies adopted in response to health costs. The paper also questions whether national cost recovery schemes have succeeded in their objective of mobilising significant new resources. Cost-recovery programmes are often introduced in the context of structural adjustment programmes. The design and implementation of health reforms under these programmes are the outcome of a complex interaction between economic pressures, domestic political processes, and dialogue between governments and the World Bank. The paper describes the outcome of this process in Zimbabwe, where cost-recovery has reinforced other pressures now threatening to erode the gains in human welfare achieved since independence.
Country
United Kingdom
Publisher
OXFAM; Ireland Policy Department
Theme area
Resource allocation and health financing
Title of publication Unknown
Date of publication
1977
Publication type
Journal Article
Publication details
Medical Care 15 4 pp 10pp.
Publication status
Published
Language
English
Keywords
Botswana, mobile health units, cost effectiveness
Abstract
Cost effectiveness techniques are used to simplify resource allocation decisions on land and air transport systems in the health services of a developing country. Outcome classifications are produced for patients seen by mobile and fixed primary care units. The mobile services examined were more costly (8-14 times greater per likely effective patient contact) than comparable care from permanently staffed fixed clinics. This was particularly so for the air-delivered service. This disparity in cost effectiveness was due mainly to the small proportion of patients seen by the mobile services who could be treated effectively in contrast to a far larger proportion at fixed clinics. This was a consequence of the periodic availability of care from the mobil services against the continuing provision of care at fixed clinics. The main justification for the use of transport in connection with primary health care is regular supportive (not policing) visits by skilled health workers to rural clinics. Land vehicles are cheaper than aircraft for visiting the more accessible facilities; for those more distant, the cost of journey by land vehicle is similar to those by aircraft.
Country
Botswana
Publisher
Medical Care
Theme area
Resource allocation and health financing
Title of publication Primary health care in Botswana: A case study in cost-effectiveness
Date of publication
1976
Publication type
Journal Article
Publication details
Proceedings of the Royal Society of Medicine 69 12 pp 3pp.
Publication status
Published
Language
English
Keywords
Botswana, cost benefit analysis, evaluation, primary health care, health services
Abstract
This discussion describes how the techniques of cost efficiency and cost effectiveness were used in Botswana to help in choosing between alternative ways of delivering primary health care: by mobile air and land services by static permanently staffed clinics. With regard to cost efficiency, the land mobile and fixed clinics were similar, while the air service was just over twice as expensive per patient contact. In regard to cost effectiveness, the cost of the fixed clinics was about 1/8 that of the land service and about 1/14 that of the air service, due almost totally to the larger proportion of patients seen at the fixed clinics were it was considered, due to continuous availability of care, that effective treatment was likely. The proportion of patients in whom effective care was thought to be likely seen by the periodic mobile services was much smaller. All the patients contacted by the mobile services were seen by the doctor, but only a minority of patients were seen by a doctor at the fixed clinics only. During visits made by the mobile services very little preventive health care was carried out. If greater emphasis had been planned upon such preventive measures as immunisation then the cost effectiveness of the mobile services could have been increased appreciably. The study findings suggest that mobile health services have a limited pace in the delivery of primary care in Botswana. This is particularly true for services using aircraft. Fixed permanently staffed clinics are to be preferred mainly because they offer greater continuity of care.
Country
Botswana
Publisher
Royal Society of Medicine
Theme area
Resource allocation and health financing
Title of publication Cost recovery in the health care sector in sub-Saharan Africa
Date of publication
1991
Publication type
Journal Article
Publication details
International Journal of Health Planning and Management 6 pp 86-191
Publication status
Published
Language
English
Keywords
User charges; efficiency; equity; Africa
Abstract
Cost recovery continues to be a politically delicate subject in sub-Saharan Africa. Nevertheless, ministries of health are now beginning to understand that the selective pricing of health care services can be a powerful tool for achieving the efficiency and equity goals that can be used to improve the quality of care offered. This article provides a blue-print for these nascent cost-recovery efforts. After a consideration of the rational for cost recovery with a theoretical context, a set of pricing principles for the whole public health sector is presented and a prototypical systematic price schedule is derived from the principles. Constraints to effective and equitable cost-recovery are then discussed, and topics for further empirical research suggested.
Country
Unknown Country
Publisher
International Journal of Health Planning and Management
Theme area
Resource allocation and health financing
Title of publication Macroeconomic adjustment policies (MAPs), health sector reforms and impact on access to utilisation and quality of health care in Zimbabwe
Date of publication
1997
Publication type
Document
Publication details
Publication status
Not published
Language
English
Keywords
macroeconomic adjustment; health sector reforms
Abstract
The paper analyses the changes that have taken place in the health delivery system from the pre-independence period to post independence period. It focuses attention particularly on health sector reforms introduced by the new government aimed at addressing inequities in health care in three consecutive periods: 1980 to 1987, 1987 to 1989 the ESAP period 1989 to the present. These periods highlight changes in government policy and thrust which led to structural changes in the health delivery system, access to and provision of health care. Structural adjustment policies led to the introduction of cost recovery measures and cuts in government public spending provision.
Country
Zimbabwe
Publisher
University of Zimbabwe, Department of Economics
Theme area
Resource allocation and health financing
Title of publication Financing health care: Experiences and opinions of some South Africans
Date of publication
1994
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
health financing; health services
Abstract
South Africans have fairly good access to health services but among Blacks provision for medical expenditure is limited in the country, particularly rural ones were also less well provided than others. A questionnaire was carried out to explore the opinions and experience of South African’s on health services and their cost. The issues surveyed included views on the availability, accessibility, affordability and quality of health services preferences regarding the location or setting of services and extent of respondents own provision for health care.
Country
South Africa
Publisher
HSRC
Theme area
Resource allocation and health financing
Title of publication Financing health care in sub-Saharan Africa through user fees and insurance
Date of publication
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
financing health care, user fees, insurance
Abstract
The feature analyses the implications of the principle of cost recovery introduced by the World Bank in 1987. It revisits the debates and policy thrusts on the economic and social implications of such an approach. In the of sub-Saharan Africa, agreement is growing that some kind of cost sharing is needed in view of escalating health costs and the limited capacity of Ministries of Health to finance or deliver subsidised health care to all citizens. The government’s ability to finance and expand health services has been undermined by unstable economic performance, unprecedented rates of population growth, and the immense cost that the AIDS epidemic is imposing on public health budgets. The paper notes that charging user fees clearly affects the use of health services, but the negative impact of prices on the demand for services can be greatly offset, sometimes, by improving the quality of services offered. This offsetting mechanism affects even the poorest households. Several African governments are adopting user fees and promoting self-financing health insurance to help restore efficiency and equity to national health systems. Such initiatives are creating a more rational referral system through price signals; employing cost sharing to supplement funding for essential supplies, particularly drugs; increasing incentives to providers by allowing them to retain fees they collect; and expanding local participation in both sharing the costs and managing the proceeds. The authors assert that as countries gain experience in administering and collecting fees and as users of health services become more familiar with the system and willing to pay for treatment, the gap between the potential and actual roles of cost sharing narrows. Closer scrutiny of countries where self financing was believed to be virtually nonexistent has revealed a surprising amount of small-scale activity. Governments have a critical role in pushing these positive development further, particularly in mandating employer based insurance and creating enabling environments for private sector activities. The paper concludes that policies to implement user fees or to mandate compulsory insurance need to be researched thoroughly and implemented gradually. No system will be perfect and it will take time to win user’s confidence. The important issue is to find ways to structure and implement user fees and health insurance jointly, maximising both the desires and needs of potential users and the efficiency, equity and sustainability of the health care system themselves.
Country
United States
Publisher
The World Bank
Theme area
Resource allocation and health financing
Title of publication User fees at government health services: Is equity being considered?
Date of publication
1996
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
user fees; health services; equity
Abstract
The report talks about the trends in health financing in different countries. The role of the state in the financing and delivery of health services is reconsidered. The report analyses a wide range of options available for governments to promote equity in health provision without exempting the poor from medical care. Relevant information about the potential impact of fees on equity and the feasibility and effectiveness of policy mechanisms which can be designed to protect the poor is given. The report concludes that policy development needs to take place more cautiously and in a more informed environment. The actual or potential impact of fees on different population groups, and the feasibility of implementing policies which are designed to promote equity (such as exemptions for the poor), need to be seriously considered to prevent user fees exacerbating existing inequalities in health care financing and provision.
Country
Zimbabwe
Publisher
London School of Hygiene and Tropical Medicine; Mimeo
Theme area
Resource allocation and health financing
Title of publication Ability to pay for health care: Concepts and evidence
Date of publication
1996
Publication type
Journal Article
Publication details
Health Policy and Planning 11 3 pp 1-9
Publication status
Published
Language
English
Keywords
Health financing; micro-economics
Abstract
In many developing countries, people are expected to contribute to the cost of health care from their own pockets. As a result, people’s ability to pay for health care has become a critical policy issues in developing countries and a particularly urgent issue where households face combined user fees burdens from various essential service sectors such as health, education, and water. Research and policy debates have focused on willingness to pay for essential services and have tended to assume that WTP is synonymous with ATP. This paper questions this assumption and suggests that WTP may not reflect ATP. Households may persist in paying for care, but to mobilise resources that may sacrifice other basic needs such as food and education, with serious consequences for the household and individuals within it. The opportunity costs of payment make the payment unaffordable because other basic needs were sacrificed. An approach to ATP founded on basic needs and the opportunity costs of payment strategies (including non-utilisation) is therefore proposed. From the few studies available, common household responses to payments difficulties are identified, ranging from borrowing to more serious ‘distress; sales of productive assets (e.g land) to delays to treatment and, ultimately, abandonment of treatment. Although these strategies may have a devastating impact on livelihoods and health, few studies have approached ATP from a perspective of household expenditure priorities, responses to payment difficulties, and the consequences of (non) expenditure decisions. Indepth longitudinal household studies are proposed to develop understanding of ATP and to inform policy initiatives which might contribute to more affordable health care.
Country
South Africa
Publisher
Health Policy and Planning
Theme area
Resource allocation and health financing
Title of publication The social consequences of free trade in health care: A public health response to orthodox economics
Date of publication
1982
Publication type
Journal Article
Publication details
International Journal of Health Services 12 1 pp 1pp.
Publication status
Published
Language
English
Keywords
free trade, public health, health outcomes
Abstract
In recent years, difficulties in US health services have been ascribed to excessive government intervention and regulation; high costs and other problems would be solved, it is argued, by ‘return to the free market and competition’. Examination of the past operations of free trade and competition in health care, however, shows that in this market not one of at least five conditions necessary for effective competition exists. Numerous adjustment made by society reflect strikingly the problems caused by these market deficiencies (such as seriously inadequate information or the presence of major social ‘externalities’). Furthermore, even these adjustments - such as medical ethics or health insurance - have generated serious secondary problems. Many types of waste and social inequity also persist, in spite of all the attempts to compensate for market failure. In effect, the so called free market in health care has survived only because of the extensive regulations and other actions taken to patch it up. Abandoning these adjustments would further aggravate current problems. Only replacement of free trade by systematic social planning could hope to achieve a health care system that allocates resources and distributes services both efficiently and equitably.
Country
Zimbabwe
Publisher
International Journal of Health Services
Theme area
Resource allocation and health financing
Title of publication Crisis-proofing the economy: The response of Botswana to economic recession and drought
Date of publication
1988
Publication type
Book Section
Publication details
Adjustment with a human face 2: Country case studies pp 24pp.
Publication status
Published
Language
English
Keywords
Botswana, socio-economic factors, child health
Abstract
Botswana’s response to its economic recession and drought during 1981-186, reduced its domestic food supply and made the poverty of the 80% rural population much worse. Botswana must import about 60% of its staple food supply. During the 1970s and 80s Botswana had the highest growth rate of all nonoil exporting countries, but was dependent on only 1 product, diamonds, and on strong trade links with South Africa. In 1981 the diamond market faced a declining demand forcing the Government to take a series of adjustment policies to side step the potential economic crisis resulting in the successful increase of foreign exchange reserves. However, in spite of a short lived crisis, in 1982, the country began a 5-year drought that has ‘remains the most critical development issue facing Botswana’. The worst effect of the drought has been the lack of food availability forcing the Government to accept increasing amounts of food aid reaching a level 62% of the population by 1985-86. The economic crisis led the government to develop Early Warning Technical Committee (EWTC) as part of the drought relief program to monitor the drought and its effects on people’s lives. The Food Resources Department was organised for the administration of food aid in the country. Botswana’s Drought Relief Program has been effective in protecting the welfare of its most vulnerable groups, children and farmers, through such measures as diverting large amounts of funding to relief activities, the ability to attract donor support in food aid and technical assistance, the participation of the private sector, and the fact that the 1.13 million people are still a small population in a country where infrastructure is very good.
Country
Botswana
Publisher
Clarendon Press
Theme area
Resource allocation and health financing
Title of publication The consequences of health services privatisation for equality and equity in health care in South Africa
Date of publication
1988
Publication type
Journal Article
Publication details
Social Science and Medicine 27 pp 13pp.
Publication status
Published
Language
English
Keywords
South Africa, health services; equity; health economics
Abstract
The trend towards the privatisation of health services in South Africa reflects a growing use of private sources of finance and the growing proportion of privately owned fee-for-service providers and facilities. Fee-for-service methods of reimbursement aggravate the geographical maldistribution of personnel and facilities, and the competition for scarce personnel resources aggravates the difference in the quality of the public and private services. Thus, the growth in demand for these types of providers may be expected to increase inequality of access in these two respects. The potential expansion of medical scheme coverage is shown to be limited to well under 50% of the population, leaving the majority of the population without access to private sector health care. Even for members of the medical schemes, benefits are linked to income, thus clashing with the principle of equal care for equal need. The public funds needed to overcome financial obstacles to access to private providers could be more efficiently deployed by financing publicly owned and controlled health services directly. Taxation also offers the most equitable method of financing health services. Finally, attention is drawn to the dilemma resulting from the strengthening of the private health sector: while in the short term this can offer better care to more people on a racially non-discriminatory basis, in the long term, health care for the population as a whole may become more unequal and for those dependent on the public sector it may even deteriorate.
Country
Zimbabwe
Publisher
Theme area
Resource allocation and health financing
Title of publication Public expenditures and health care in Africa
Date of publication
1992
Publication type
Journal Article
Publication details
Social Science & Medicine 34 6 pp 615-624
Publication status
Published
Language
English
Keywords
Health care, health financing
Abstract
Unfavourable economic conditions in most of Sub-Saharan Africa have meant austerity and deceleration in government health spending. Given the dominant role of government in providing health services in Africa there is a need to investigate the links between public spending and the provision of health care. Analyzing information from five Sub-Saharan African countries, viz Botswana, Burkina Faso, Cameroon, Ethiopia and Senegal, the authors investigate the impacts of shifting expenditure patterns and levels on the provision of health services as well as on delivery of health care. The country analyses indicate that in addition to the level of public spending, the expenditure mix (i.e. salaries, drugs, supplies etc.), the composition of the health infrastructure (hospitals, clinics, health posts etc.), community efforts, and the availability of private health care all influence health care delivery. Consequently, per capita public expenditure alone as a measure of the availability of health care and especially for cross-country comparisons is inadequate. Reductions in government resources for health care often result in less efficient mixing of resources and hence less health care delivery, in quality and quantity terms. Given recent trends in health spending there should be greater effort to increase the efficient use of increasingly scarce resources, yet the trend in resource mix has been in the opposite direction. Given the input to public health care of local communities, as well as the provision of private health care, government spending on health care should be counter-cyclical, i.e. government health spending should accelerate during periods of economic down turns. Such counter-cyclical spending would tend to offset the difficulties facing local communities and the declining ability of individuals to pay for private health care. Recommending counter-cyclical health spending may seem wishful, but it points up the necessity of understanding what is likely to happen to health care in African countries in the face of economic difficulties, and particularly in the face of fiscal austerity.
Country
Unknown Country
Publisher
Social Science & Medicine
Theme area
Resource allocation and health financing
Title of publication Financing health services in Africa: An assessment of alternative approaches
Date of publication
1990
Publication type
Document
Publication details
Publication status
Language
English
Keywords
Financing health services; Equity
Abstract
The paper outlines a strategy for financing health services in Sub-Saharan Africa. The strategy takes into account the fact that the African continent consists of highly heterogeneous economies in terms of their stages of socio-economic development and types of political systems, so that a uniform method of financing health services would not be appropriate for the whole continent. Health care financing strategy in each country should therefore take into consideration both the external and the domestic factors that affect health budgets. Health care financing measures in this region should therefore be sensitive to economic conditions of households. Referral health care systems that need to be restructured to improve their performance. Policies designed to mobilise resources for health sectors should thus also be aimed at improving the effectiveness of referral systems.
Country
United States
Publisher
The World Bank
Theme area
Governance and participation in health
Title of publication Meeting report: Parliamentary alliances for equity in health in Southern Africa, Gauteng, 20-22 August 2003
Date of publication
2003 August
Publication type
Conference Proceedings
Publication details
EQUINET Meeting report: pp 1-23
Publication status
Published
Language
English
Keywords
equity policies, health status, access to health care, SADC, southern Africa
Abstract
A meeting of representatives of parliamentary committees on health, health professionals, civil society and co-operating organisations from Kenya, Malawi, South Africa, Tanzania, Zambia, Zimbabwe and SADC Parliamentary Forum, hosted by EQUINET and GEGA in co-operation with the SADC Parliamentary Forum confirmed the policy commitment in the region to equity in health and acknowledged the ongoing work towards implementing health equity policies. The meeting urged that greater effort be made to deal with differences in health status and access to health care that are unnecessary, avoidable and unfair.
Country
Southern Africa Regional
Publisher
EQUINET, GEGA, SADC
URL:
Equinet Publication Type
Reports
Theme area
Health equity in economic and trade policies, Resource allocation and health financing
Title of publication Current policy issues in health care reform from an international perspective: The battle between bureaucrats and marketeers
Date of publication
1996
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
health care; market reforms
Abstract
The starting point of the paper is the increasing emphasis being placed on the failures of public sector provision of health services, and the need to reduce public involvement in provision and encourage competition as a means to increase efficiency. The paper examines the respective cases for two alternative health policy paradigms, one seeing improved management of public facilities as the means to increase efficiency; the other competitive forces. It reviews the evidence that either has been or is likely to be successful in increasing efficiency, concluding that the evidence is unconvincing either that public sector provision has necessarily failed, or that competitive contracting can do much better. It argues that while competitive efficiency, it may also introduce a new set of problems. Hence reforms to encourage competition must be introduced carefully and selectively; and be accompanied by evaluation.
Country
Zimbabwe
Publisher
London School of Hygiene and Tropical Medicine
Theme area
Resource allocation and health financing
Title of publication The cost of the district hospital: A case study in Malawi
Date of publication
1993
Publication type
Journal Article
Publication details
Bulletin of the World Health Organization 71 3-4 pp 329-339
Publication status
Published
Language
English
Keywords
District health services, health financing, resource allocation
Abstract
The paper analyses the cost to the Ministry of Health of providing district health services in Malawi, with particular emphasis on the district hospital. District resource allocation patterns were assessed by carefully disaggregating district costs by level of care and hospital department. A strikingly low proportion of district recurrent costs was absorbed by salaries and wages (27-39%, depending on the district) and a surprisingly high proportion by medical supplies (24-37%). The most expensive cost centre in the hospital was the pharmacy. A total of 27-39% of total recurrent costs were spent outside the hospital and 61-73% on hospital services. The secondary care services absorbed 40-58% of district recurrent costs. Unit costs by hospital department varied considerably by district, with one hospital being consistently the most expensive and another the cheapest. A total of 3-10 new outpatients could be treated for the average cost of 1 inpatient-day, while 34-55 could be treated for the average cost of 1 inpatient. The efficiency of hospital operations, the scope for redistributing resources district-wide, and the costing methodology are discussed.
Country
Switzerland
Publisher
WHO
Theme area
Resource allocation and health financing
Title of publication Health expenditure and finance in South Africa
Date of publication
1996
Publication type
Report
Publication details
Health Systems Trust , World Bank pp 15pp.
Publication status
Published
Language
English
Keywords
South Africa; Public health services; Health finance
Abstract
This comprehensive survey of public and private expenditure on health care was undertaken to provide the newly elected government with information relevant to managing to the process of change in the post-apartheid South Africa. It reviews the current levels and distribution of health system expenditure as well as health personnel and facilities - both within the public sector (for example, distribution between provinces, and rural and urban areas) and between the public and private sectors. Data are primarily drawn from the 1992/93 financial year. It reveals for the first time the extent of spending on private health care. Although only 17% of the population are members of a medical scheme 23% use private sector services on a regular basis, almost three fifths of health expenditure is on private sector services. Nearly two-thirds of this private sector expenditure was funded through medical schemes in 1992/3 and around 23% was funded by direct payments. Expenditure by medical schemes increased faster than the rate of inflation over the previous decade. Approximately 62% of general doctors, 66% of specialists, 93% of dentists and 89% of pharmacists practice in the private sector. The survey illustrated that public health services were biased towards curative, hospital-based care and were distributed inequitably between provinces. An unusual feature of the review was that it included a micro-geographic area analysis of some aspects of resource allocation. Magisterial districts were sorted by income quintile and then compared. The richest districts employed 4.5 times as many doctors, 2.4 times as many registered nurses and benefitted from 3.6 times as much public expenditure per head of the population as the poorest districts. The survey findings are used to review a number of policy options that the government might consider, including: improving value for money in public hospitals, generating revenue through user fees, the use of donor funding and the critical need for careful planning in ensuring that the process of structural change benefits poorer areas.
Country
South Africa
Publisher
Health Systems Trust, World Bank
Theme area
Public-private mix
Title of publication Trends in the distribution of South African care expenditure
Date of publication
1990
Publication type
Journal Article
Publication details
South African Medical Journal 78 3 pp 125-129
Publication status
Published
Language
English
Keywords
South Africa, health economics
Abstract
The lack of critical distinction between the public and the private health sectors and what they represent has allowed the claim to be made that South African health care expenditure levels compare favourably with international standards. This paper considers the distribution of health expenditure between the public and the private sectors in South Africa, within these sectors and also no the basis of population group. The extent of maldistribution of health care resources among the people of South Africa is highlighted. The data analysed in this paper indicate that an increasing proportion of public sector expenditure has been spent on curative services, that the gap in real; per capita expenditure between the ‘homelands’ and other public sector departments has been widening, and that per capita expenditure has been increasing more rapidly in the private sector, particularly in the 1980s.
Country
South Africa
Publisher
South African Medical Journal
Theme area
Resource allocation and health financing
Title of publication IMF cuts wreck Zimbabwe’s health achievements
Date of publication
1994
Publication type
Journal Article
Publication details
Development and cooperation 5 pp 27-28
Publication status
Published
Language
English
Keywords
health care; structural adjustment, IMF, user fees, Zimbabwe
Abstract
The number of women dying in child-birth has doubled in Harare since Zimbabwe entered the Economic Structural Adjustment Programme. In 1989, the last full year before the programme imposed cuts in health spending, 101 maternal deaths were recorded. Two years later the total rose to 242. Until the introduction of the adjustment programme in October 1990, Zimbabwe’s health achievements were held up as a model for the region. Infant mortality fell from 140 per 1000 live births in 1980 to 50 in 1989 largely as a result of massive government commitment to improving primary health care. Since the introduction of fees in 1991, people are making fewer visits to hospitals and clinics. Other measures taken under ESAP have lowered the living standards of the poor majority of the population already suffering from the impact of HIV infection and the worst drought of the century. The devalued currency, high inflation, removal of price controls and reduced real minimum wages in many sectors of the economy, along with rising unemployment, all render the poor more vulnerable to hunger and illness. For many Zimbabweans the real cost of ‘adjustment’ is illness and mortality.
Country
Zimbabwe
Publisher
Theme area
Resource allocation and health financing
Title of publication Challenges to equity in health and health care: A Zimbabwean case study
Date of publication
1991
Publication type
Journal Article
Publication details
Social Science & Medicine 32 10 pp 1079-1088
Publication status
Published
Language
English
Keywords
economic crisis, health status, primary health care, health care systems, user fees, equity, health care, Zimbabwe
Abstract
The current economic crisis in Africa has posed a serious challenge to policies of comprehensive and equitable health care. This paper examines the extent to which the Zimbabwe government has achieved the policy of “Equity in Health” it adopted at independence in 1980, or provision of health care according to need. The paper identifies groups with the highest level of health needs in terms of both health status and economic factors which increase the risk of ill health. It describes a series of changes within the health sector in support of resource redistribution towards health needs, including a shift in the budget allocation towards preventive care, expansion of rural infrastructures, increased coverage of primary health care, introduction of free health services for those earning below Z$150 a month in 1980, increased manpower deployment in the public sector and the reorientation of medical training towards the health needs of the majority. The implementation of equity policies in health have however been challenged by several trends and features of the health care system, these becoming more pronounced in theeconomic stagnation period after 1984. These include the reduction in allocations to local authorities, increasing the pressure for fees, the static nominal level of the free health care limit despite inflation, the continued concentration of financial, higher cost manpower and other resources within urban, central and private sector health care and the lack of effective functioning of the referral system, with high cost central quaternary facilities being used as primary or secondary level care by nearby urban residents. While primary health care expansion has clearly been one of the success stories of Zimbabwe’s health care post 1980, the paper notes plateauing coverage, with evidence of lack of coverage in more high risk, socio-economically marginal communities. Measures to address these continuing inequalities are discussed. Their implementation is seen to be dependent on increasing the capacity and organisation of the poor to more strongly influence policy and resource distribution in the health sector.
Country
Zimbabwe
Publisher
Social Science & Medicine
Theme area
Resource allocation and health financing
Title of publication User fees plus quality equals improved access to health care: Results of a field experiment in Cameroon
Date of publication
1993
Publication type
Journal Article
Publication details
Social Science and Medicine 37 3 pp 14pp.
Publication status
Published
Language
English
Keywords
user fees; health; Cameroon; Africa; financing; access; quality; teaching; equity; health care
Abstract
Country
Cameroon
Publisher
Social Science and Medicine
Theme area
Values, policies and rights, Health equity in economic and trade policies, Resource allocation and health financing
Title of publication Report of a workshop on national health and social welfare policies for the decade 1993-2003
Date of publication
1993
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
Health policy
Abstract
The workshop on health and social welfare policies identified diseases such as tuberculosis, STDs, AIDS infection as problems in adults and adolescents. Some diseases such as diarrhoea were identified as contributing to the high mortality and morbidity.
Country
Lesotho
Publisher
Ministry of Health and Social Welfare
Theme area
Resource allocation and health financing
Title of publication Health: Building partnership for the Lesotho health sector reform
Date of publication
1995
Publication type
Conference Proceedings
Publication details
Round Table Conference on Health and Population pp 8pp.
Publication status
Published
Language
English
Keywords
Lesotho; Health sector; Health sector goals
Abstract
This document arises directly out of a Round Table Conference for Lesotho aimed at promoting dialogue and consensus between government and its development partners on the policies, priorities and programmes in the above sectors, and to raise the resources required for their implementation. The macro-economic situation in which these planned developments are located is one of contrast and uncertainty. On the one hand, macro-economic reforms involving tight expenditure controls and more effective revenue raising measures have been highly successful in correcting serious deficits in the fiscal and external balances. On the other, growth has been highly uneven and poverty and unemployment have risen. However, the scope for an across the board demand stimulus is limited, and further structural reforms to the economy, including civil service reform and a transformation of the economic role of the state, have been identified as important pre-requisites for sustainable and equitable growth.
Country
Lesotho
Publisher
Theme area
Health equity in economic and trade policies, Resource allocation and health financing
Title of publication The health and wealth of South Africa
Date of publication
1987 December
Publication type
Journal Article
Publication details
South African Medical Journal 72 11 pp 799-801
Publication status
Published
Language
English
Keywords
health, political economy, GNP, life expectancy, infant mortality, health resource allocation
Abstract
The per capita gross national product (GNP) in South Africa is examined as it relates to life expectancy and the infant mortality rate. Despite South Africa’s relative wealth in per capita GNP terms, life expectancy at birth is 63-65 years and the national infant mortality rate according to Unicef, is unlikely to reach the target of 50/1,000 live births by the year 2000. The distribution of expenditure on health is contrasted between the former provincial administrations, the major local authorities, the national states and the homelands. The health resources allocation distribution is unlikely to ensure health for all by the year 2000.
Country
South Africa
Publisher
South African Medical Journal
Theme area
Public-private mix, Resource allocation and health financing
Title of publication Implications of the development of managed health care in the South African private health care sector
Date of publication
1996 April
Publication type
Journal Article
Publication details
South African Medical Journal 86 4 pp 335-338
Publication status
Published
Language
English
Keywords
Managed health care, South Africa
Abstract
The South African private health care sector has been looking to managed health care (MHC) to control the unsustainable cost escalations of the last decade. This paper draws on experience of MHC in other countries, particularly the USA to assess its potential for solving the private sector’s difficulties. In addition, it looks at problems which may be associated with MHC in a South African setting. The conclusion reached is that MHC alone cannot be seen as a panacea for the private sector’s financial problems, although it may produce a degree of saving and be part of a solution. It is argued that MHC per se seems unlikely to compromise equity, quality of care or the public health care sector and that it may potentially promote national health policy objectives. However, if MHCs benefits are to be promoted and potential negative effects controlled ongoing monitoring of MHC, coupled with an appropriate regulatory and incentive environment, will be required.
Country
South Africa
Publisher
South African Medical Journal
Theme area
Resource allocation and health financing
Title of publication Containing costs in public sector hospitals - a strategy for the future: Lessons from a large teaching hospital
Date of publication
1990 August
Publication type
Journal Article
Publication details
South African Medical Journal 78 3 pp 154-157
Publication status
Published
Language
English
Keywords
health care costs, public health care,
Abstract
Escalating costs of providing health care are cause for worldwide concern. In South Africa there is increasing concern about expenditure in the public and the private health care sectors. Although public sector expenditure has increased in per capita terms over the past 2 decades, at the micro-level comparison of expenditure over a 14-year period in one major teaching hospital region indicates that, despite increasing complexity and sophistication, real costs have not escalated at a greater rate than the consumer price index, if extraordinary factors are discounted. The development and utilisation of productivity and performance indicators are reviewed and some mechanisms for containing costs in public hospitals are discussed. These include formalized strategic planning and allocation of resources, rationalisation and reorganisation of services, improved productivity and utilisation of scarce health manpower, improved accounting and management information systems, and the development and use of measures of outcome. Concern is expressed regarding excessive quantification of costs and efficiency to the detriment of health care in general.
Country
South Africa
Publisher
South African Medical Journal
Theme area
Resource allocation and health financing
Title of publication Restructuring South Africa’s health care: Dilemmas for planners
Date of publication
1995 May
Publication type
Journal Article
Publication details
British Medical Journal 310 6991 pp 1397-1399
Publication status
Published
Language
English
Keywords
Health care, health planning
Abstract
Country
United Kingdom
Publisher
British Medical Journal
Theme area
Resource allocation and health financing, Monitoring equity and research to policy
Title of publication Health reforms does not equal user charges: The need for reflection and careful action
Date of publication
1995 April
Publication type
Journal Article
Publication details
Health Reforms News pp 2pp.
Publication status
Published
Language
English
Keywords
Health reforms; Independent fee schedules; Utilisation; Changes in government health system
Abstract
The article examines the effect of the introduction of user fees for health in Zambia. These were introduced into the government health sector in 1989. The article questions the necessity user charges for health criticises the lack of guidelines on the structure or level of charges to the levied, with resulting implementation varying widely across the country, some decisions being taken at district level, others at provincial or even facility level. The paper suggest that since the success of the reforms depends on popular support, districts should regularly monitor health service utilisation and local about charges in order to be clear about the effects of policies and practices.
Country
Zambia
Publisher
Health Reforms News
Theme area
Resource allocation and health financing
Title of publication Economic dependency, health services, and health: The case of Lesotho
Date of publication
1982
Publication type
Journal Article
Publication details
Journal of Health Politics, Policy & Law 6 4 pp 762-779
Publication status
Published
Language
English
Keywords
Economics, health services
Abstract
This paper is concerned with two factors affecting health in Lesotho: (1) the nation’s function as a reserve labour economy (the primary source of income for about half the country’s male labour force is employment in South Africa); and (2) the health care system (its size, composition, accessibility, and efficiency). Although such diverse factors are often analyzed independently, they might be combined to provide a more complete understanding of the determinants of health. The paper concludes that any substantive solutions to the problems of Lesotho will be found primarily in the wider southern Africa setting, and not within the context of small, dependent nation states. At the same time, these small, dependent nation states must make development decisions considering existing geopolitical realities. Foresightful decision making on these issues could both contribute immediately to the health of the people of Lesotho, and also increase in longer-term possibilities for a better life for all the people of southern Africa.
Country
Lesotho
Publisher
Journal of Health Politics, Policy & Law
Theme area
Poverty and health, Resource allocation and health financing
Title of publication Structural Adjustment and the working poor in Zimbabwe: Studies on labour, women informal sector workers and health
Date of publication
1995
Publication type
Report
Publication details
Publication status
Published
Language
Nordiska Afrikainstitutet
Keywords
Structural adjustment, vulnerable groups, lower income social classes, health, Zimbabwe
Abstract
The three studies in this text provide a detailed account of the situation of various vulnerable groups. These studies, dealing with formal labour, women informal sector workers, and the situation of one urban and one rural community, were carried out as a part of a programme on “The Political and Social Context of Structural Adjustment in Sub-Saharan Africa”. The volume deals with the relation between affecting structural adjustment and changes in the social conditions affecting lower income social classes in Zimbabwe.
Country
Sweden
Publisher
Nordiska Afrikainstitutet
Theme area
Resource allocation and health financing
Title of publication How best to utilize limited resources
Date of publication
1995
Publication type
Journal Article
Publication details
Journal of Hospital Infection 30 (suppl) 15 pp 25
Publication status
Published
Language
English
Keywords
Health financing
Abstract
South Africa’s new health policy embraces the primary health care (PHC) approach for all and includes good primary, secondary and tertiary care. The policy aims to provide the highest possible standards of care, yet be of a scale and complexity that the country can sustain into the future. There will almost certainly be rationalization of many of the tertiary teaching hospitals, with inevitable cut-backs in their budgets. This in turn could carry the risk of damage to the fabric of these institutions, which might be impossible to repair. Medicines offer a simple, cost-effective answer to many health problems in Africa, provided they are available, accessible, affordable and properly used. A problem in African drug markets is inefficiency and waste. The use of counterfeit medicines has reached unparalleled heights. It is vital that there should be a competent, honest, accountable and independent national drug regulatory authority, secured in law, to provide the necessary infrastructure for the acquisition of sound drugs. Medicines are central to a sound national health policy, but there is great public concern about their costs. Anti-infective drugs are amongst the most widely used class of drugs in the world. Inappropriate use of these drugs is widespread and guidelines need to be established for their correct use. The control of all medicines in South Africa is governed by the Medicines & Related Substance Act of 1965. The Medicines Control Council is mandated to ensure that all medicines (including antibiotics) available to the public are efficacious, safe and of high quality. An informally-constituted Antibiotic Study Group has been established to monitor aspects of antibiotic therapy that impinge on more general issues of public health, country-wide. The Antibiotic Study Group has instituted an Antibiotic Surveillance Programme to monitor the development of antibiotic resistance nationally. In addition the majority of the tertiary teaching hospitals have comparable in-house antibiotic control policies to help prevent such resistance and to cut costs. These issues need to be debated and resolved. Once in place and working effectively, they will in the long-term supply the most cost-effective means of providing health care for all.
Country
South Africa
Publisher
Journal of Hospital Infection
Theme area
Resource allocation and health financing
Title of publication Comparative costs of mobile and fixed-clinic primary health care services
Date of publication
1996
Publication type
Journal Article
Publication details
South African Medical Journal 86 5 pp 528-530
Publication status
Published
Language
English
Keywords
Health services, cost benefit, mobile clinics
Abstract
With restructuring and rationalisation of health services in South Africa imminent, the development of methods for comparing and evaluating health services is of great importance at both national and local level, including comparisons of cost-efficiency and cost-effectiveness. The costs of different methods of delivering primary health care in a local authority through mobile and fixed-clinic services have been analysed and aspects of their cost-efficiency compared. The information gained from such an analysis can be used for management purposes to optimise both the use of resources and the quality of service provided at local level.
Country
South Africa
Publisher
South African Medical Journal
Theme area
Public-private mix, Resource allocation and health financing
Title of publication Paying for health services in developing countries: An overview
Date of publication
1985
Publication type
Report
Publication details
World Bank staff working papers 721 pp 11pp
Publication status
Published
Language
English
Keywords
Health care; developing countries; health policy
Abstract
This paper presents an overview of the principal issues, problems, and policy options in financing health services in developing countries. The shortcomings of existing policies, which finance health care to a significant extent from public revenue sources, are reviewed. Alternative approaches are identified and examined, with particular attention to: (i) opportunities for greater cost recovery from users, through fees for services and/or fees for health care ‘coverage’; (ii) the potential role of risk sharing arrangements, which can range from large, formal insurance plans to small, informal community - based cooperatives; (iii) the public/private mix in both providing and financing care, and (iv) to the structuring of subsidies and their incentive effects. Issues relating to these options are discussed concerning efficiency, equity, financial viability, ability and willingness to pay, externalities, users lack of complete information or understanding of health problems and service benefits, and ‘merit good’ and ‘pubic good’ arguments along with several other considerations. Present health financing policies in most developing countries need to be substantially reoriented. Strategies favouring public provision of services at little or no fee to users and with little encouragement of risk-sharing have been widely unsuccessful while new initiatives reversing these trends do not always lead to improvements in efficiency or equity Increased cost recovery from users should be pursued through fees for coverage; i.e by encouraging increased application of risk-sharing arrangements. Tendencies to expand the public role in providing care should be restructured to improve incentives.
Country
Zimbabwe
Publisher
The World Bank
Theme area
Health equity in economic and trade policies, Resource allocation and health financing
Title of publication Stabilisation policies and the effects on child health in Zimbabwe
Date of publication
1991
Publication type
Journal Article
Publication details
Review of African Political Economy 38 pp 3-23
Publication status
Published
Language
English
Keywords
child Health, Zimbabwe, economic stablisation
Abstract
Country
Zimbabwe
Publisher
Review of African Political Economy
Theme area
Health equity in economic and trade policies, Human resources for health
Title of publication Macro-economic trends in the health sector
Date of publication
1997
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
macro-economic trends; health financing, Zimbabwe, health worker earnings, resouce allocations
Abstract
This paper describes the overall trends in health financing in Zimbabwe between 1980-1990s. The paper shows that the overall per capita supply of health workers has declined since independence relative to the growth of population, and the contribution of the health sector to GDP has continued to decline from 2% in the early eighties to 1.5% in the nineties. Health worker earnings have risen as a share of output in the sector but fallen relative to the cost of living. This poses an important stress between keeping down costs of health care and providing adequate wages to health workers. The trends in the economics of the health sector shown in this report signal a need to address revenue sources, wage constraints and resource allocations in the health sector in Zimbabwe.
Country
Zimbabwe
Publisher
Department of Economics, University of Zimbabwe and TARSC
Theme area
Resource allocation and health financing
Title of publication Structural adjustment and health in Zimbabwe
Date of publication
1994
Publication type
Conference Proceedings
Publication details
The Societies of Southern Africa Collected Seminar Papers 48 pp 11pp.
Publication status
Published
Language
English
Keywords
Health; structural adjustment; health care; Zimbabwe
Abstract
The paper reviews the evolution of Zimbabwe’s economic problems and policies since 1980, focusing particularly on health-care provision. The author argues that there has been a decline in the factors determining health since 1990 and that the proximate cause of this is the implementation of ESAP. The structural adjustment policy had the following effects, the introduction of user fees in hospitals and clinics with increases in health care charges of up to 88% since 1993, and areas also for drugs; the devaluation of the Zimbabwe dollar resulting in astronomic increases in the cost of drugs. In January 1994, imported drugs cost about 20% more due to devaluation; the removal of food subsidies, retrenchment and decline in real incomes.
Country
Zimbabwe
Publisher
The Societies of Southern Africa
Theme area
Resource allocation and health financing
Title of publication User fees: They don’t reduce costs and they increase inequity (editorial)
Date of publication
1997
Publication type
Journal Article
Publication details
British Medical Journal 315 pp 2pp.
Publication status
Published
Language
English
Keywords
User fees, equity, health
Abstract
If user fees for health care are the solution, what exactly is the problem? Proponents of user fees recommend them in two situations. The first is when health spending in total is low or falling-fees are recommended as a way to mobilise more money for health care than existing sources provide. The second, paradoxically, is when health expenditure is high or rising quickly, when fees are recommended as a way of improving efficiency by moderating demand and containing costs. Opponents of user fees attack them as a political strategy for shifting health-care costs from the better off to the poor and the sick, pointing to the trade off between this method of raising revenue and maintaining access to care based on need rather than ability to pay. The author notes that in Southern Africa user fees have been used to supplement health spending, but with extremely modest gain in revenue. The cost of implementation, problems with exemption mechanisms, increased ill health and changes in access to care have been negative consequences of user fee policies. User fees have outside Africa been used as a way of controlling demand, but also with limited success, and also at the cost of ignoring the powerful role played by providers in health care patterns. The higher the mix of use fees in health financing, the greater the relative share falling on poor people. The author thus recommends that user fees only be considered after other alternatives have been tried.
Country
United Kingdom
Publisher
British Medical Journal
Theme area
Resource allocation and health financing
Title of publication Adjustment with a human face: Country case studies
Date of publication
1988
Publication type
Book
Publication details
Publication status
Published
Language
English
Keywords
economic conditions, health
Abstract
This is UNICEF’s 2nd volume on its analysis of how economic conditions of most developing countries worsened during the 1980s, forcing the World Bank and the IMF to introduce strict structural adjustment policies (SAPs). These SAPs accelerated the deterioration of the most vulnerable groups, including children, through neglect of social welfare interventions, health and nutrition. In light of the widespread poverty, UNICEF’s alternative policies, “Adjustment with a human face” are “designed to protect the conditions of the vulnerable during periods of economic decline and adjustment as well as accelerating economic growth over the medium and long term”. This Volume provides country studies to help the reader understand, in-depth the effects of the economic recession on each country and those of SAPs. The countries are Botswana, Ghana, Zimbabwe, the Phillipines, South Korea, Sri Lanka, Brazil, Chile, Peru and Jamaica. The basic format used for each study is a description of the initial conditions, the effects of the economic deterioration and macro-economic responses, analysis of development policies and the countrys’ compensatory programs in response to its socio-economic problems and the conclusion. Each country chapter also includes a series of tables giving such data as economic indicators, budget deficits, wage increases, income distribution and nutritional status of children.
Country
United Kingdom
Publisher
Clarendon Press
Theme area
Resource allocation and health financing
Title of publication What does primary health care cost and can we afford to find out? Rationale and methodology for a cost analysis of the Diepkloof Community Health Centre, Soweto
Date of publication
1993
Publication type
Journal Article
Publication details
South African Medical Journal 83 4 pp 275-282
Publication status
Published
Language
English
Keywords
primary health care, costs, South Africa, Soweto
Abstract
Accurate information on the costs of providing primary health care (PHC) services is now an urgent priority for health policy makers and planners, if the Government’s stated commitment to an adequate PHC system is to be realised. Cost information is also a critical management tool for both public and private sector providers. In this context, the inability of public sector PHC providers to generate accurate cost accounting information is a serious shortcoming. In an attempt to address this lack of local PHC cost data, a detailed analysis of the costs of PHC services was undertaken at the Diepkloof Community Health Centre (DK) in Soweto during 1990. The study aimed to assess the cost of each service provided at DK and where possible, to identify areas of inefficiency. This paper is the first of two that report the findings of this study. It briefly describes the methodology employed and presents the major results. These raise several important management issues. Most importantly, the study suggests that there is excess capacity in the administrative and in several of the clinical areas of this community health centre; this implies that the average cost per service could be reduced in several areas. Certain services, such as home visits, are particularly expensive and require careful evaluation. The policy implications of this analysis are also examined. The high cost of several services implies that extension of this type of PHC service to all urban and rural areas is likely to be unaffordable.
Country
South Africa
Publisher
South African Medical Journal
Theme area
Public-private mix, Resource allocation and health financing
Title of publication The private health sector in South Africa: Current trends and future developments
Date of publication
1990
Publication type
Journal Article
Publication details
South African Medical Journal 78 3 pp 139-143
Publication status
Published
Language
English
Keywords
Private health care, South Africa
Abstract
The private health sector is experiencing a crisis of spiralling costs, with average annual cost increases of between 13% and 32% over the decade 1978-1988. This trend is partly explained by the high utilisation rates that result from the combination of the ‘fee-for-service’ system and the ‘third-party’ payment structure of the sector. Medical schemes have responded by promoting the idea of ‘flexible packages’, and have won the right to ‘risk-rate’
prospective members. It is argued that these measures will undermine the principle of equity in health care, and will not solve the problems of the private sector. Instead, a more significant restructuring of the sector is likely to emerge. This may take the form of ‘managed care’ structures, along the lines of the health maintenance organisation model from the USA. ‘Managed care’ structures are shown to be potentially more rational and efficient than the current structure of the private sector. Although some resistance to ‘managed care’ structures can be expected, the convergence of interests of large employers and trade unions in
containing health care costs suggests that their emergence is a likely development.
Country
Zimbabwe
Publisher
South African Medical Journal
Theme area
Resource allocation and health financing
Title of publication A methodology for resource allocation in health care for South Africa: Part III: A South African health resource allocation formula
Date of publication
1990 May
Publication type
Journal Article
Publication details
South African Medical Journal 77 9 pp 456-459
Publication status
Published
Language
English
Keywords
Health care, health financing, South Africa
Abstract
A formula to calculate the proportion of the public sector budget that should be allocated to various geographical regions of South Africa is described. The formula is broadly classified into curative and preventive components. Using data that are routinely available, indices of need are calculated for each of these components. It is concluded that resource allocation on a macro level should closely approximate regional population distribution if cross-border flow of
patients and additional teaching-hospital expenditure are ignored.
Country
South Africa
Publisher
South African Medical Journal
Theme area
Resource allocation and health financing
Title of publication The costs and financing of selected PHC activities in Botswana
Date of publication
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
Health financing, PHC
Abstract
The study presents a survey-based assessment of the costs of providing EPI, CDD and ARI services at the clinic and health post levels, with support activities at central and district levels. Although the study focuses on three programmes, many Findings are generalisable to other PHC programmes. In addition, a pilot “private costs survey” was carried out on costs incurred in seeking care, such as transport cost and time spent at the facility. The study found that the unit costs of PHC in Botswana are hight, and there is a significant amount of variation between facilities. The main component of these high costs is personal emoluments, which amount to about 60% of total programme costs. Expenditure on drugs and vaccines is also high. The structure of expenditure between different levels of the health care system is encouraging: 50-70% of the funds go to the facility level. Thus the programmes are not too heavy with high central organisational costs but few funds are reaching the operational level. The GoB has provided an extensive health care network across a large and sparsely populated country. The low catchment and consequently low attendances at many remote facilities partly explain the high unit costs found. The other main factors affecting costs were location of facility (whether in the east or west of the country) and type of facility (clinic or health post). Both of these variables were significantly correlated with output. The private costs were generally low when compared with the costs of
providing the services. Total private costs in urban areas averaged about P3.20, most of which was in the form of opportunity cost of waiting time. Combined with evidence of high expenditure on medical care (Household Income and Expenditure Survey 1985/86), the study suggests that many of the urban population would be prepared to contribute towards health care services, provided that there was some improvement in these services, such as reduction in waiting times. A number ofinefficiencies in programme delivery were identified. The situation in rural areas is less clear cut. It is suggested that any experimentation with cost sharing be closely monitored so that impact on uptake of services can be minimised. It is proposed that a data base on unit costs be expanded to cover a wider range of services, and such unit costs be monitored on a regular basis to identify inefficiencies arising in the system. Such a data base could assist in the development of a more programme-oriented budgeting system, in which budgetary allocations depend on objectives identified by the district.
Country
Botswana
Publisher
Bamako Initiative Management Unit - Botswana, UNICEF
Theme area
Resource allocation and health financing
Title of publication Economics of health in South Africa: Past, present and future
Date of publication
1989
Publication type
Journal Article
Publication details
Medicine & Law 8 2 pp 111-117
Publication status
Published
Language
English
Keywords
Health economics
Abstract
The paper presents some of the background factors to the present structure of medicine in South Africa, economic aspects of the current (inadequate) health care service and tentative suggestions regarding the directions in which health services should be moving to facilitate the legitimization (political) and accumulation (economic) processes required to meet the needs and demands of all the people of an internationally recognized, just and free South Africa.
Country
South Africa
Publisher
Medicine & Law
Theme area
Resource allocation and health financing
Title of publication Structural adjustment programmes and privatisation of health: Prospects and problems for health for all - now
Date of publication
1995
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
Primary health care; Structural adjustment; Health privatisation
Abstract
Based on a critical analysis of data on the health of the people and the economic conditions in several developing countries, this paper calls attention to the urgent need internationally for a new approach to mobilise the interests, commitments and resources of a broader constituency of support for the poor. International agencies set up to provide assistance to improve the health and well-being of the people and to strengthen economic development have failed, and some have dismantled the little gains made by developing countries during 1960-1980. The real per capita income of the poor has decreased during the last 20 years. The vast majority of the world’s rural population, particularly in Africa, lives below the poverty line. Infants and young children continue to die in equal numbers today as 15 years ago of preventable diseases. In 1978, WHO supported the Alma Ata Declaration on Primary Health care (PHC) based on success stories from countries with very limited material resources, significantly improving the health of their people through national health policies based on primary health care. Unfortunately PHC was strangled soon after its birth by the very forces supposed to assist in implementing it, the medical establishment; UNICEF through GOBI-FFF and the World Bank and IMF through their structural adjustment programmes. The paper proposes that people have lost faith in these international agencies, that the World Health Assembly as a forum of health policy makers has not succeeded in changing health care policies that would be directed mainly to the poor and that people need is an alternative world forum - A people’s World Health Assembly. This paper provides ideas on the structure, objectives and functions of a People’s World Health Assembly.
Country
Malaysia
Publisher
Consumers International Regional Office for Asia and the Pacific, Malaysia
Theme area
Resource allocation and health financing
Title of publication Would national health insurance improve quality and efficiency of health care in South Africa? Lessons from Asia and Latin America
Date of publication
1994
Publication type
Journal Article
Publication details
South African Medical Journal 84 pp 153-157
Publication status
Published
Language
English
Keywords
Health insurance, quality, efficiency
Abstract
Arguments for and against national health insurance (NHI) for South Africa are illuminated by the experiences of other middle-income developing countries. In many Latin American and Asian countries the majority of their populations are covered by NHI, coverage having steadily increased over the last decade. Patterns of care under NHI tend to be inefficient - hospital oriented, highly specialised and technical, with excessive investigation, surgery and medication, neglect of primary care and severe cost escalation. In some cases, however, urban primary care has been promoted through polyclinics and health maintenance organisations. Inequalities in funding, access and utilisation exist between the insured and uninsured, between strata of the insured, and between urban and rural areas. These inequalities have at times been ameliorated by expansion of coverage, subsidisation of poorer beneficiaries and initiation of programmes that extend care to rural areas. NHI can improve or impair efficiency and equity in health care, depending on structures and processes of revenue generation, payment and organisation of care. These depend in turn on how those likely to lose or gain from each option exercise their collective power.
Country
South Africa
Publisher
South African Medical Journal
Theme area
Resource allocation and health financing
Title of publication The State, class and the allocation of health resources in Southern Africa
Date of publication
1989
Publication type
Journal Article
Publication details
Social Science and Medicine 28 5 pp 515-530
Publication status
Published
Language
English
Keywords
Southern Africa, state, health, class, race, gender
Abstract
Country
Zimbabwe
Publisher
Social Science and Medicine
Theme area
Equitable health services, Resource allocation and health financing
Title of publication A situational and trend analysis in equity in health and health care in Zimbabwe
Date of publication
1996
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
Health, health care, equity, Zimbabwe
Abstract
This study describes the current situation regarding equity in health and health care in Zimbabwe and describe trends over time in equity in health and health care in relation to major policies and conditions outside as well as within the health sector. Indicators are presented under three different headings: basic determinants of equity in health, social and geographic inequalities in health status, and social and geographic inequities in health care. It was concluded from the data presented that presently in Zimbabwe there was a high degree of disparity in health status and access to health care among social groups. Disparities could be found in many indicators among provinces, male and females, rural and urban areas, and people of various levels of education. Three recommendations were put forward: (a) Government should put in place a monitoring mechanism of its policies to evaluate the impact of policy changes on patterns and trends in equity in health and health care, (b) The Ministry of Health should develop skills to more effectively monitor access to health care in a liberalised health market. (c) A special task force should be set up to capture available expertise on equity patterns and trends and to define equity standards. Additional tasks would be to prepare strategies for achieving these equity standards as well as related training materials for health planners and managers.
Country
Zimbabwe
Publisher
Theme area
Equitable health services, Governance and participation in health
Title of publication Public health initiatives in South Africa in the 1940s and 1950s: Lessons for a postapartheid era
Date of publication
1993 July
Publication type
Journal Article
Publication details
American Journal of Public Health 83 7 pp 1043-1050
Publication status
Published
Language
English
Keywords
public health, health assessment
Abstract
Inspiration drawn from South African public health initiatives in the 1940s played an important role in the development of the network of community and migrant health centres in the United States. The first such centre at Pholela in Natal emphasised the need for a comprehensive (preventive and curative) service that based its practices on empirical data derived from epidemiological and anthropological research. In addition, community consultation preceded the introduction of new service or research initiatives. The Institute of Family and Community Health in Durban pioneered community-based multidisciplinary training and developed Pholela and other sites as centres for service, teaching, and research. Several important lessons for South African health professionals emerge from the Pholela experience. First, public health models of the past need to be reintroduced locally; second, the training of public health professionals needs to be upgraded and reoriented; third, appropriate research programmes need to respond to community needs and address service demands; fourth, community involvements strategies need to be implemented early on; and fifth, funding sources for innovation in health service provision should be sought.
Country
South Africa
Publisher
American Journal of Public Health
Theme area
Equitable health services
Title of publication Inequalities in health: Determinants and status in South Africa
Date of publication
1994
Publication type
Journal Article
Publication details
Publication status
Published
Language
English
Keywords
health inequalities, South Africa
Abstract
The paper outlines the epidemiologic transition in South Africa, in which pre - and post-transitional diseases co-exist in the same population. The paper notes that a protracted transition may lead to epidemiologic polarisation in which quantitative and qualitative inequalities within a population are aggravated, as certain sectors present not only with higher rates of diseases, but also different kinds of diseases. Failure to recognise this phenomenon may result in health services exacerbating social inequality, while diminishing resources allocated to the ‘left over’ problems of common infectious diseases and malnutrition. The paper outlines how in South Africa, apartheid and associated macro-economic policies have determined access to basic needs (housing, clean water, sanitation and safe energy) social development (education, income, occupation) and preventive and curative health services. Basic demographic, epidemiologic and educational indicators vary profoundly by race. Consequently, analysis of inequality in South Africa must continue to be stratified by race for decades to come. The paper goes beyond racial inequalities in health determinants and status and indicates that under a nonracial democracy, social class will emerge as a more potent and determinant on inequality than race. The paper discusses the determinants of inequality in childhood, adolescent and adult mortality in South Africa, as fundamental indicators of differential health status. The implications for policy development are then outlined in terns of the strategies for reducing inequity, the uneven application of known effective interventions and a focus on effect preventive intervention on childhood and adolescents as a means of reducing ill health later in adult life. The paper concludes that strong political commitment is needed for moving beyond individual intervention to addressing the roots and determinants of inequalities in health.
Country
South Africa
Publisher
Kluwer Academic Publshers
Theme area
Equitable health services
Title of publication Final report of a meeting on policy-oriented monitoring of equity in health and health care
Date of publication
1997
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
Monitoring, equity, health policy
Abstract
The challenge of promoting equity in health and health care is the major theme of the Equity Initiative launched by the WHO and Sida in 1995. One of the strategies adopted has been the development of indicators to monitor equity, with an emphasis on using these to influence the policy process. The report summarises the outcome of a WHO Meeting on Policy-Oriented Monitoring of Equity in Health and Health Care in September/October 1997 to develop policy-oriented monitoring, in the context of development, implementation and advocacy. The report notes that a precise definition of equity is not available. However there was agreement that health inequities exist when there are inequalities in health status, risk factors, or health service utilisation between individuals or groups, that are unnecessary, avoidable and unfair. This requires equity in the distribution of the determinants of health including health services. Reducing inequalities in health status to the point where we can judge them unavoidable and fair, requires: special health sector steps to compensate for inequalities in risk factors arising from other inequalities (socio-economic, gender etc) and further efforts to reduce these other inequalities through intersectoral action. The report notes that routine data from the health sector needs to be supplemented with additional routine information from other sectors to identify neglected groups, socio-economic differences and their health consequences. Four key criteria for selecting indicators for monitoring equity were recommended: Relevance to policy on equity in any relevant sector;
accessibility of disaggregated data; simplicity; and meeting standard scientific and ethical criteria. Different ways of formulating an equity target with a given indicator are presented. Formulating an equity target is probably more important than which specific indicator is selected, as the target provides comparisons among the more and less advantaged. The report recommends indicators for monitoring equity in health and health care and the range of obstacles to equity, e.g lack of clarity of the concept, lack of awareness among policy-makers, lack of data, lack of analysis of existing data management of the health sector, general acceptance of inequities and global issues such as the role of private companies. Strategies for overcoming these obstacles and advance equity were recommended.
Country
Switzerland
Publisher
WHO-Geneva, Council for International Organizations of Medical Sciences and the NGO Forum for Health
Theme area
Equitable health services
Title of publication Equity in health and health care: A WHO/SIDA initiative
Date of publication
1996
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
equity, health care
Abstract
Social gaps in health and in health care are unacceptably wide and are widening throughout the world. Developing countries and industrialised countries alike are finding it difficult to implement equitable policies and often feel caught between consideration of equity and short-term efficiency. This document describes an initiative of the World Health Organisation, with seed funds from the Swedish International Development Cooperation Agency, to place equity in health and health care higher on the public policy agenda and to evaluate and promulgate promising practical approaches to achieving equity in health development.
Country
Zimbabwe
Publisher
WHO-Geneva and SIDA-Seden
Theme area
Human resources for health, Resource allocation and health financing
Title of publication Health manpower issues in relation to equity in and access to health services in Zimbabwe
Date of publication
1989
Publication type
Journal Article
Publication details
Journal of Social Development In Africa pp 18pp.
Publication status
Published
Language
English
Keywords
Health services, Equity, manpower
Abstract
Issues of equity and access in health are important areas of concern in post independent Zimbabwe. The country inherited a fragmented health delivery system at independence in 1980, with a strong bias against the black population. Most services were concentrated in cities, and urban hospitals were better equipped with drugs and manned by skilled personnel. Rural health facilities were poorly managed and faced an acute shortage of medical supplies and personnel. Following government interventions after 1980, race has been replaced by class has good area as a more important determinant of health outcomes, with a continuing rural-urban dichotomy in health care. Manpower distribution continues to be biased towards urban areas, conditions of service are poor in rural areas, and conditions differ in the mission, local council and private company services. The referral system does not operate for almost all medical conditions, about half of those coming to central facilities coming from within 10km of the facility, using the referral centre as a frontline service. This implies a need for a close review of utilisation and referral practices of different levels of care, as well as the need for compulsory rural service, improved conditions of services and facilities in rural areas, and the continued inclusion of rural attachments in the training of doctors.
Country
Zimbabwe
Publisher
School of Social Work
Theme area
Equitable health services, Human resources for health
Title of publication Examination of attendance patterns before and after introduction of South Africa’s policy of free health care for children aged under 6 years and pregnant women
Date of publication
1997
Publication type
Journal Article
Publication details
British Medical Journal 314 pp 2pp.
Publication status
Published
Language
English
Keywords
Health care; Maternal child health, health financing
Abstract
The paper reviews the impact of the new policy measure providing free health care for children under 6 years and pregnant and lactating mothers in South Africa. It examines this in particular through the evaluation of the mobile clinic services in Hlabisa, Kwazulu/Natal. In these clinics under 6 services were always free, but pregnant women paid for antenatal care. The survey found no important changes in attendance patterns in children after the free care measure, but a significant increase in the number of new child patients registering for treatment services and a decrease in the proportion referred to hospital. Women’s use of antenatal care did not change significantly. The reduction in referred cases was attributed to the presentation of earlier or milder forms of illness, (a positive change) or to an increase in self limiting illness reporting to services (a negative change). It was also noted that the workload increased for staff and that increased demand for treatment may if not controlled steer attention and resources from preventive and promotive services.
Country
South Africa
Publisher
British Medical Journal
Theme area
Resource allocation and health financing
Title of publication Health sector reform policies on cost recovery: The sub-Saharan Africa experience in the 1990s
Date of publication
1997
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
health reform, cost recovery
Abstract
The paper discusses cost recovery as a means of health financing in Africa, and uses the stated reasons for their introduction as a means to evaluate their effectiveness. The author notes that user fees have negligibly revenue generating capacity except as part of community based initiatives, and in this case success often depends on strong support from outside personnel. User fees are also argued to have negative consequences for equity, with falls in utilisation of health care and inefficient exemption mechanisms that have significant leakages of the deserving out and the non deserving into safety / exemption nets. Fee retention is noted to improve application of user fee revenue for public utility services and to quality of care, however it is noted that this too is more successful when applied and administered at local level. Cost recovery on a sliding scale by level of service has been used to enhance referral systems, but it is observed that this depends on investments in improved quality of care. The paper reviews the problems in implementation systems. The author concludes that the way forward is in community based projects, external injection of funds for quality of care, and other revenue sources such as social and private health insurance should be pursued.
Country
Zimbabwe
Publisher
Mimeo
Theme area
Equitable health services
Title of publication Inequality in the distribution and differential utilisation of health services: A Botswana case study
Date of publication
1977
Publication type
Journal Article
Publication details
Journal of Tropical Medicine and Hygiene 80 11 pp 238-243
Publication status
Published
Language
English
Keywords
Health services, Botswana, Inequality
Abstract
The uneven provision of health care in a developing country, Botswana, is examined. Curative out-patient attendance and in-patient hospitalisation rates were found to vary markedly for groups of the population living at different distances from health facilities. Those people living 10 miles or less from clinics and hospitals had far higher utilisation rates than those living at further distances. If the disparity in service provision described is to be altered then the planning and development of health services should concentrate upon the provision of basic health care and adapt to the manpower and economic constraints within which such systems operate.
Country
Botswana
Publisher
Journal of Tropical Medicine and Hygiene
Theme area
Resource allocation and health financing
Title of publication Cost and Output of Mobile Clinics in a Commercial Farming Area in Zimbabwe
Date of publication
1990
Publication type
Journal Article
Publication details
Social Science Medicine 31 11 pp 1207-1211
Publication status
Published
Language
English
Keywords
Mobile clinics, agriculture, health economics, Zimbabwe
Abstract
Mobile clinics may be useful to improve the geographic accessibility of health services, but their cost may be higher than that of static clinics. In this paper it is determined to what extent mobile clinics in a commercial farming area in Zimbabwe improve geographic accessibility. The opportunity cost of mobile clinics, comprising cost of staff time and transport is estimated. Staff time appears to be more efficiently utilized in mobile clinics than in static clinics. The cost of transport comprises the cost to the health service and that to the population using the service. The consequences of two extreme assumptions are determined. If the first assumption (outreach does not increase coverage) were true, total transport
cost would increase if outreach were discontinued. If the second assumption (outreach increases coverage by the number of attendances at mobile clinics) were true, a substantial increase in coverage would be obtained in particular for growth monitoring, immunizations and child spacing, without increasing the cost per contact. It is concluded that outreach clinics should continue in this commercial farming area. The sites of the mobile clinics are being reconsidered as a result of this study.
Country
Zimbabwe
Publisher
Social Science Medicine
Theme area
Equitable health services
Title of publication Inequalities in South African health care and prospects of equalisation
Date of publication
1992
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
South Africa; Health care; inequalities; Health finance
Abstract
At present, as has been the case for decades now, health care in South Africa is plagued by multitude of problems, constraints and deficiencies. The nature of these problems and deficiencies pertains on the one hand to the health care system as a provider or distributor of health care, and on the other hand they are related to the population as clientele of that system. The paper comments on the possibilities and prospects of greater equality of South African care through exploring the current inequalities in health care in the country.
Country
South Africa
Publisher
Department of Sociology, University of the Orange Free State
Theme area
Equitable health services
Title of publication Inequalities in South African health care: Part I: The African problem - manifestations and origins
Date of publication
1994
Publication type
Journal Article
Publication details
South African Medical Journal 84 2 pp 99-103
Publication status
Published
Language
English
Keywords
Health care; inequalities; socio-economic factors
Abstract
This paper analyses and contextualise the complex problem of structural inequality in South African health care. socio-economic conditions, racial divisions and geographical location are isolated as the main determinants of inequality in the provision, allocation and distribution of health care, the prevailing inequalities are attributed to a wide range of underlying causes, including the prominent role of apartheid and white domination, the free market, the influence of the medical profession, and the unique socio-cultural set-up of the country. The urgent need for deliberate strategies to equalise the prevailing disparities and discrepancies is posed. South African health care was strikingly characterised by absence of a central, binding health policy. Loose and incoherent legislation, problematic authority structures, and a typically pluralistic health care system were established, leading to a highly divided health care structure, fragmented along lines of race and geographical area, and with inequality based on race and colour . The prominent role for the free market in health care gave rise to a laissez-faire deployment of health personnel and facilities, with lack of co-ordination in health care, inequality and deprivation. The dominance of the medical profession
established specific priorities and emphasises and modelled care delivery structures to suit medical, vocational and professional interests, often neglecting and ousting forms of care more appropriate. From these emanated the heavy
emphasis on curative and institutional care, themselves strikingly conducive to disparities. The diversity of ethnic groupings, cultural systems of knowledge, beliefs and symbols, impinge on the health, illness and consumption behaviour of its people. These determine what people conceive as health and illness, what they deem as appropriate health care, and whom they prefer as healer and consult during episodes of illness. Naturally, these factors produce another dimension of inequalities in health care, albeit in the acceptance or rejection of provided health care.
Country
South Africa
Publisher
South African Medical Journal
Theme area
Equitable health services, Human resources for health, Resource allocation and health financing
Title of publication District health care between quality assurance and crisis management: Possibilities within the limits, Mporokoso and Kaputa District, Zambia.
Date of publication
1995
Publication type
Journal Article
Publication details
Tropical & Geographical Medicine 47 1 pp 23-29
Publication status
Published
Language
English
Keywords
district health services, quality, policy, public health system
Abstract
A tension exists between objectives of health policy makers to achieve high quality standards of care on one hand, while battling for survival of the (public) health system is questioned. The collapsing health services as well as the deteriorating living conditions affect the health status of the population and
contribute to an increase in (health) inequalities both nationally and internationally. Constraints and some examples of achievements in district health management in two districts in Northern Province, Zambia, are presented. A strong focus on community-based health care, partnership with communities and accelerated health-system support via strengthening of on-site supervision is advocated.
Decentralization and self-reliance are potential tools in flexible crisis management, but require continuity in human resource development and appropriate ‘care for the carers’. In order to increase operational efficiency, the need is expressed to conceptualize a practical approach of ‘minimum primary health care’.
Country
Zambia
Publisher
Tropical & Geographical Medicine
Theme area
Human resources for health, Resource allocation and health financing
Title of publication District health service costs, resource adequacy and efficieny: A comparison of three districts.
Date of publication
1996
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
District health services; utilisation, efficiency; Zimbabwe
Abstract
This report presents the results and recommendations from three studies on district level health care services in Shurugwi, Gutu, and Binga districts of Zimbabwe between 1993 and 1995. The studies found that although most services were adequate, there were major gaps for maternal care and environmental health services, attributed to a mixture of staff and/or skill shortages, lack of incentives for rural postings, transport and communication problems, and centralised reimbursement systems. Lower unit costs, particularly at mission facilities do not necessarily indicate efficiency but may indicate poorer quality of care due to severe under-staffing and inadequate patient management. Major gaps exist for material resources (e.g drugs, stationery), and for services (e.g maintenance of vehicles and buildings). over-centralisation of responsibilities and financial control is severely hindering service provision. This is particularly so for day to day operational expenses (such as travel and subsistence allowance), and for those items under the control of other ministries (such as minor building repairs and vehicle maintenance and repair).It is proposed that the Ministry of Health review the human resource requirements and support systems necessary to provide maternal and environmental health services on a wider basis, that government allocations to health be maintained at current levels (in real terms) and increased if possible, that allocations to districts be weighted by total district workload, not merely district hospital workload, and preferably be split between the district hospital and peripheral facilities. The MoH should review staff establishments on the basis of workload, not merely the facility level or bed numbers, and develop a more participative approach to planning and management at district level. District health budgets for recurrent costs should be placed in
district bank accounts, and DHGs given authority to effect payment.
Country
Zimbabwe
Publisher
Ministry of Health and Child Welfare
Theme area
Resource allocation and health financing
Title of publication ESAP and health
Date of publication
1992
Publication type
Journal Article
Publication details
Journal of social change and development 29 pp 14-15
Publication status
Published
Language
English
Keywords
Structural adjustment, health services
Abstract
The feature reviews about effects of the economic structural adjustment policy on hospital and clinic attendances in Zimbabwe. It notes a fall in clinic attendance this does not automatically mean that people’s health is worse. If small children are not attending clinics for preventive measures, it cautions that preventable diseases may rise. A fall in hospital attendances also indicates that people may be ill at home paying rather than escalating hospital fees.
Country
Zimbabwe
Publisher
Theme area
Equitable health services, Human resources for health
Title of publication Intra-provincial inequalities in the provision of health care in the Midlands province of Zimbabwe
Date of publication
1991
Publication type
Journal Article
Publication details
Geographical Journal of Zimbabwe 22 pp 12pp.
Publication status
Published
Language
English
Keywords
Health care, inequality, Zimbabwe, population/doctor ratios
Abstract
The paper assesses the magnitude of spatial inequalities in opportunity levels for access to health facilities and personnel in the Midlands province of Zimbabwe. Districts with large urban centres were found to have more favourable population doctor ratios than the rural, more peripheral districts because of the doctors preference for the large urban areas. There is a gradual deterioration in health services with increasing distance from urban areas. Lack of doctors in some districts implies that patients have to travel long distances to urban centres where doctors are available. Although doctors periodically visit the health institutions in communal areas, the irregularity of their visits coupled with the long lists of priority patients for attention make it more difficult for the less serious cases to be seen by doctors. Few hospital beds have led to situations whereby people who under normal circumstances, would need closer medical attention and rest in a hospital bed, have to commute as out-patients or to travel long distances to the nearest hospital for admission. This results in long recovery periods, loss of time and money and congestion. The perpetuation of such inequalities suggests that attempts to achieve an equitable spread of health services have had limited success. Given constraining factors of expenditure and brought, to minimising the rural-urban gap may require a radical social reform package that includes
preferential treatment of some of these remote districts with poor living conditions.
Country
Zimbabwe
Publisher
Geographical Journal of Zimbabwe
Theme area
Monitoring equity and research to policy
Title of publication Surveillance for equity in maternal care in Zimbabwe
Date of publication
1993
Publication type
Journal Article
Publication details
World Heath Statistcs Quarterly - Rapport Trimestriel de Statistiques Sanitaires Mondiales 46 4 pp 242-247
Publication status
Published
Language
English
Keywords
surveillance, equity, maternal care, Zimbabwe, health indicators
Abstract
The hope and promise of post-independence efforts to promote equitable health care in Zimbabwe started with three years of dramatic improvement. The major constraint to equity was the entrenched pattern of sophisticated, high technology health care which continued to monopolise resources. In spite of the excellent beginning, development of services for the poor was thwarted by recession, prolonged drought, cutbacks in funding for health care as a result of economic adjustment policies. Disparities in maternal care are especially severe and can be improved only by building the infrastructure providing antenatal and perinatal services. The paper recommends that a few selected indicators be used in surveillance, relating directly to control measures so that understanding of causal linkages does not get lost in intervening variables. Each indicator should be measurable at minimal cost in money and time. They should be discrete, readily analysed and easily understood by the people. A menu of possible indicators can help district and community decision-makers think through their alternatives and concerns. A spectrum is desirable which should include, input indicators to measures equity in access, process indicators to quantify utilisation and outcome indicators directly measuring the impact of services. If only input and output indicators are used they tend to produce a conceptual conflict between equity and efficiency. Simplicity and speed in analysis and feedback reporting are more important for management purposes than the detail and precision of data needed for research. Only the most necessary items of data should be gathered through routine reporting because it is easy to overload the information system. For the highest priority problems in an area, surveillance can help standardise responses. Deviations from expected trends in indicators or localised high prevalence should trigger action. The number of interventions implemented at one time should be limited and introduced in a phased sequence.
Country
Switzerland
Publisher
World Heath Statistcs Quarterly
Theme area
Equitable health services, Human resources for health, Resource allocation and health financing
Title of publication The political-economy of health in Namibia: Overcoming the past towards an uncertain future
Date of publication
1991 February
Publication type
Conference Proceedings
Publication details
Workshop on economic policy, equity and health pp 13pp.
Publication status
Published
Language
English
Keywords
Health access; facilities; health services; health policy; health economies.
Abstract
Independence in Namibia in 1990 marked the end of more than a century of colonialism under German and subsequently South African rule. The paper outlines the tasks of transforming an ethnically fragmented society, of redressing extreme imbalances in access to resources and of building a more advanced an
equitable economy with the particular issues posed for the health sector.
Country
Namibia
Publisher
Namibian Institute for social and economic research; University of Namibia
Theme area
Human resources for health, Public-private mix, Resource allocation and health financing
Title of publication Community participation and health: Towards the study of human resources in the development of local healthcare
Date of publication
1991
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
community health services, Zimbabwe, Transkei
Abstract
This article observes that community participation in health involves the activation of local material and human resources. It follows this that the study of local resources is essential in planning community health care. With this in mind, the article discusses family care as a key human resource in handling disease. Using a case study from rural Transkei, the article illustrates the role and functions of family
health care as a potentially viable unit for stimulating community participation in local and health care.
Country
South Africa
Publisher
Development Southern Africa
Theme area
Health equity in economic and trade policies, Equitable health services, Resource allocation and health financing
Title of publication The economy, the health sector and child health in Zimbabwe since independence
Date of publication
1988
Publication type
Journal Article
Publication details
Social Science & Medicine 27 7 pp 723-731
Publication status
Published
Language
English
Keywords
economic environment, health sector, economic stabilisation, nutrition levels, socio-economic conditions, health care, child health, Zimbabwe
Abstract
This paper examines the changes in the economic environment which have taken place in Zimbabwe since independence in April 1980, concentrating on those which are relevant to health. It also describes the post-independence restructuring of the health sector itself. Finally, it considers some changes which have taken place in the health status of children. Despite a prolonged drought, economic recession and the imposition of economic stabilisation measures, there is evidence in the 1980s of a improvement in infant and young child mortality. This has resulted almost certainly from an energetic expansion and reorientation of healthcare provision, and particularly from greatly improved access to immunisation and
oral rehydration therapy. The adverse effects of drought and stabilisation measures have been partially offset by aid-supported relief feeding and particular health programmes. However, the economic crisis has resulted in a decline in real incomes for a large number of households since the immediate post-independence boom. This is reflected in high levels of childhood under-nutrition which seem to have remained static despite the health care drive. This emerging divergence between death rates and quality of life as reflected by nutrition levels is reflective on the one hand of rapid expansion in effective health care provision, and on the other of little change in socio-economic conditions for the majority of the population.
Country
Zimbabwe
Publisher
Social Science & Medicine
Theme area
Equitable health services, Resource allocation and health financing
Title of publication Equity in Health: Zimbabwe nine years on
Date of publication
1990
Publication type
Journal Article
Publication details
Journal of Social Development in Africa 5 pp 5-22
Publication status
Published
Language
English
Keywords
health, structural adjustment, development, Zimbabwe, health sector restucturing, PHC
Abstract
This paper summarises Zimbabwe’s legacy in both health (or disease) and health services. It then examines the changes in the economic environment which have taken place in Zimbabwe since independence in April 1980, concentrating on those which are relevant to health. It also describes the post independence restructuring of the health sector itself. Access to health care and some aspects of the functioning of the referral system are also briefly dealt with. The questions of community participation in health and accountability of health workers, both central to the Primary health care (PHC) approach, are addressed by a brief discussion of the Village health worker (VHW) programme. The relevance of this example for the health sector as a whole is briefly examined. Finally, the paper considers some changes which have taken place in health status since independence and attempts to analyse the sources of these.
Country
Zimbabwe
Publisher
Journal of Social Development in Africa
Theme area
Equitable health services
Title of publication When will sub-Saharan African countries have equitable national health systems
Date of publication
1997 March
Publication type
Conference Proceedings
Publication details
Dag Hammerskjold Seminar on equity in Health pp 15pp.
Publication status
Published
Language
English
Keywords
Equity; health financing, health services
Abstract
PHC is the most appropriate, cost effective health care system to ensure an equitable distribution of health resources, and a level of health for all citizens to lead a socially and economically productive life. Sub-Saharan countries identified eight components of primary health care to be delivered through National Health Systems in an integrated and comprehensive service. While primary health care projects have been developed throughout Africa, none have grown to become national systems. Existing health problems how co-exist with AIDS, calling for new strategies to combat them, health improvements have had an uneven pace. Problems in health systems, corruption, inequities, if not resolved, will hamper progress in reducing the burden of premature death and disability, and frustrate efforts to respond to new a major health challenges such as a AIDS, malaria and tuberculosis.
Country
Zimbabwe
Publisher
Mimeo
Theme area
Equitable health services, Monitoring equity and research to policy
Title of publication The search for equity
Date of publication
1995
Publication type
Publication details
Publication status
Published
Language
English
Keywords
Equity; health systems; health promotion
Abstract
The report summarises the steps that have been taken by Pan American Organisation to ensure equity in the provision and access to health care services. It acknowledges the need to identify gaps in equity and access to ensure effective actions that target populations at greatest risk are programmed and implemented. Data gathered and studies and analysis conducted supplies invaluable information to political and strategic planning and management processes and to efforts to evaluate and redirect technical cooperation activities. These data also will inform
technical cooperation activities directed at defining and formulating investment projects or special programs and effective disease prevention strategies. Further, the information will help mobilise financial resources, define research priorities, and provide data for periodic publications on monitoring the health situation and trends in the region. The paper notes that vast differences exist between countries in health expenditure. Poorer countries tend to invest a lower percentage of their GDP, and this trend tends to widen inequities in availability and accessibility to health care. The availability of medical care decreases in the groups of countries where the per capita GNP is lower. Inequities in the risk of becoming ill and dying prematurely correlate with inequities in the distribution of resources, as evidenced by the distribution of infant mortality for countries in the Region. The search for equity accepts the differences that are a fact of human existence, but seeks to put
in place systems that recognise the essential and the needs of that humanity.
Country
Publisher
PAHO
Theme area
Poverty and health
Title of publication Rural/urban differentials in health in Zambia
Date of publication
1992
Publication type
Report
Publication details
SIDA/ Ministry of Health
Publication status
Published
Language
English
Keywords
health status, Zambia
Abstract
Country
Zambia
Publisher
Zambian Ministry of Health
Theme area
Equitable health services
Title of publication Conceptualising health services in terms of level and location of care - a view from the academic health complex
Date of publication
1995 May
Publication type
Journal Article
Publication details
South African Medical Journal 85 5 pp 347-351
Publication status
Published
Language
English
Keywords
primary health care, health systems, service mapping
Abstract
The origin and characteristics of academic health complexes (AHCs) are briefly outlined, along with pressures for restructuring of health services towards primary levels of care within the primary health care (PHC) approach. Weaknesses and strengths of the PHCs together with imbalances in the overall health system of which they are part are discussed. The Cape Town PHC is used to exemplify a suggested framework for analysis and development of other PHCs in South Africa and their transformation in accordance with the PHC approach. A method of service mapping is employed to aid an appreciation of the complexity of PHC services. Planning for potential transformation may be facilitated by conceptualising services in two dimensions, viz: level and location of care. Two important additional dimensions of service component linkage are integration of levels of care along a vertical axis, and integration across different services at primary level along a horizontal axis (comprehensiveness). PHCs, however skewly developed in terms of level and location of care, are complex combinations of services. They encompass all levels of care provided both within and beyond the walls of multiple health care facilities which are located both centrally and peripherally. PHC services are managed by health professionals in specific academic disciplines. They include PHC functions at the interface between primary and specialist care provision, and community health functions which are principally located outside the health care facilities in the community.
Country
South Africa
Publisher
South African Medical Journal
Theme area
Equitable health services
Title of publication Equity in health: The Zimbabwean experience
Date of publication
1997 March
Publication type
Conference Proceedings
Publication details
Paper presented to the Equity in health policies for survival in Southern Africa Conference pp 17pp.
Publication status
Published
Language
English
Keywords
equity; health care; economic status; health systems; private sector; Zimbabwe
Abstract
The role of health as a determinant of the level of productivity that a nation can achieve, is a reason many nations invest in the health of their citizens. Each person has a right to an equal basic share in health resources of a country, quantitatively and qualitatively. Inequity typified the health care delivery system in Zimbabwe, with facilities and personnel concentrated in urban areas where the minority lived. Health services were provided as divided system with access to health care being characterised by inequalities based on race, geographic location and economic status. The right or access to health care was therefore determined by these factors. The
Zimbabwean government built a broad attack on the social inequalities underlying ill health as a essential component of its primary health care approach, and aimed to make health care affordable, accessible and acceptable to the marginalised population of the rural areas. Despite the policy emphasis on equity, a class bias in health and health care persists, with many new private hospitals and clinics in the cities. The private sector threatens the delivery of a nationally integrated health system, reinforced by current patterns of medical aid funding. These private interests remain powerful and unchallenged.
Country
Zimbabwe
Publisher
Theme area
Equitable health services
Title of publication Health infrastructures in Southern Africa
Date of publication
1992
Publication type
Report
Publication details
Special Report pp 4pp.
Publication status
Published
Language
English
Keywords
health financing, economic destablisation, health infrastructures, SADC
Abstract
The paper examines health infrastructures in SADC, the problems associated with lack of health facilities infrastructure and the impact of health financing on programmes and infrastructure. The distance a person has to travel to the nearest clinic of hospital affects a person’s willingness to seek medical care. Where people walk long distances, cross rivers, pay bus fares etc people may prefer to visit traditional practitioners self treat at home. Poor health conditions in hospitals and poorly staffed and equipped clinics also undermine use of health care. Destabilisation, has undermined access to health facilities, worsening the situation in rural health centres and hospitals which also face a serious shortage of drugs and staff. Government health budget reductions have also undermined
infrastructures. Hence, despite efforts in Southern African to address inequalities in health care rural areas still compare unfavourably with urban areas, and wealthy communities still get a dis-approportionate provision of health spending.
Country
Southern Africa Regional
Publisher
Theme area
Poverty and health
Title of publication The forgotten people: The living and health conditions of farm workers and their families
Date of publication
1994
Publication type
Book
Publication details
Publication status
Published
Language
English
Keywords
health, farmworkers, nutrition, economic living conditins, healthcare status, Zimbabwe
Abstract
This booklet aims at making the plight of the farm workers and their families better known to the wider public. The booklet outlines, based on survey findings, the health nutrition, health care status of farmworkers and the economic living conditions underlying ill health. The report confirms earlier picture of poor health status in these communities.
Country
Zimbabwe
Publisher
Mambo Press
Theme area
Equity and HIV/AIDS
Title of publication Politico-socio economic impact of HIV/STD/AIDS on the individual, family and society
Date of publication
Publication type
Book Section
Publication details
Publication status
Published
Language
English
Keywords
economic impact, social problems, hospital ward, resources
Abstract
The book summarises the social, economic and political effect of AIDS on the people of Zimbabwe, and details on how AIDS affects individuals and society. Increased infant mortality due to AIDS has resulted in the erosion of the successes of the child survival programmes in the past decade. AIDS is resulting in a significant loss in the workforce, a massive resurgence of tuberculosis, premature death of both parents and orphans. These situations result in complex social problems, overcrowded hospital wards and straining the inadequate resources of Ministries of Health. AIDS is more than a medical problem. It is a social and economic problem which demands a multi-sectoral response.
Country
Southern Africa Regional
Publisher
Theme area
Human resources for health
Title of publication Report of a study into factors affecting staffing level of health institutions in Matabeleland North
Date of publication
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
Health care, manpower
Abstract
There has been a reasonable expansion in Health Care Services infrastructure in Matabeleland North Province since 1980 with very little increase in the staffing levels. It is observed that there is reluctance amongst health workers to work in rural areas. This study analysed staffing levels and investigated factors affecting staffing levels. Staffing levels were investigated in relation to existing approved establishment. About 77% of the establishment nursing posts and 50% of doctors posts were filled. It has been found also that there is need to expand the current establishment, to meet the projected criteria of 1983 manpower projections. A descriptive study was carried out into aspects of conditions of service and social environment affecting health workers attitude to working in rural areas. It was found that conditions of service were generally poor especially more in rural areas than urban areas. It was found that health services in both urban and rural areas
were unsatisfactory, with drugs and equipment are in short supply.
Country
Zimbabwe
Publisher
Theme area
Human resources for health, Public-private mix
Title of publication Decentralisation and health systems performance: The Botswana case study
Date of publication
Publication type
Publication details
Publication status
Published
Language
English
Keywords
decentralisation, health care
Abstract
This study examined whether the transfer of the RHTs resulted in the expected benefits of decentralisation, and looked at the wider picture of decentralisation in Botswana. Decentralisation aimed to lead to transfer and more appropriate decision making at the local level. While the CEOs and matrons perceive an improvement in local level decision making, the CHIs have not. However, the DMOs noted less support from the MOH while the MOH expressed frustration over increased barriers to appropriate decision making regarding professional matters after the transfer. Lack of appropriate technical access for the
operations, inadequate technical support, and unclear leadership of senior health managers are areas identified as needing attention. The paper explored whether the RHT transfer has led to an improvement in the quality of PHC services, but could not assess whether RHT transfer led to an overall improvement in the quality of PHC services as it as not possible to disentangle the effects of other changes in the system. Accessibility to PHC services has increased since 1986 in that more facilities were built in remote areas. Most service users were unaware of the transfer so we were unable to ask whether they thought services were delivered in a more appropriate manner. One complaint which was generally expressed and recognised by the community, local authority officers, and central government staff was in the area of indifferent or rude treatment of patients by clinic staff. One
benefit was to provide one hierarchy for health personnel at the local level thus solving what were viewed as conflicting lines of supervision and accountability, still lingering instances of resentment and conflict. The transfer however, led a weakened link for the MOH with the local councils in the areas of surveillance. It was hoped that ‘decentralisation’ would help councils set their own priorities. There was little evidence of health sector planning and priority setting (other than for capital investment). Hampered by the lack of good health systems, districts seemed to plan activities around the availability of staff and previous activities. This underlines the need to strengthen management skills of health managers and to orient non-health council officers to the linkages between health and other sectors. While greater decentralisation is expected to lead to increased community participation, it did not, calling for an urgent need to reassess the meaning of community participation, the constraints on it, and ways to enhance it. Council committees were dominated by bureaucrats and professionals and the general public is uninvolved in the running of health services. Concrete and systematic efforts to translate community participation into local influence on matters relating to health would facilitate decentralisation and serve the intent of the PHC strategy but decentralisation of decision making at the local level can fragment national policy goals, such as of equity.
Country
Botswana
Publisher
DiS Centre for Partnership in Development
Theme area
Poverty and health
Title of publication Population and equity in health
Date of publication
1997 March
Publication type
Conference Proceedings
Publication details
Policies for survival in Southern Africa pp 18pp.
Publication status
Published
Language
English
Keywords
population trends, economic development, Southern Africa
Abstract
The paper analyses the relationship between population trends and economic development. High population growth undermines productive investment and consequently economic growth. However, increasing access to secure incomes, rather than high national economic growth per se, is linked to improvements in health and education with consequent fertility declines. The paper describes the populations of the Southern African region and the relationship between growth, fertility, mortality, migration and health. Populations of Southern Africa are still growing at fairly high levels, albeit with some significant fertility declines in Botswana, South Africa and Zimbabwe. The marked fertility declines are mainly as a result of development in education. However, these gains in education are being eroded by economic reforms. Even if population growth is reduced, unless the health and consequently mortality of the individuals are at acceptable levels, economic development and human welfare will not be achieved. High levels of migration, both internal and international, in the region facilitates the spread of diseases. Fertility is at fairly high levels, as women do not have easy access to credit facilities, and have children as security or insurance against life risks.
Country
Zimbabwe
Publisher
Dag Hammerskjold Foundation on Equity in Health
Theme area
Equity and HIV/AIDS
Title of publication AIDS in Southern Africa
Date of publication
1994
Publication type
Magazine Article
Publication details
Health series 4 pp 3pp.
Publication status
Published
Language
English
Keywords
AIDS, health facilities, AIDS education, prevention
Abstract
The feature looks at the impact of AIDS on health facilities in the region. It also looks at attempts at AIDS education, awareness, prevention and the effects of programmes to date. The rising number of people with AIDS in need of health care is putting a strain on the limited health facilities and comprising the quality of care. The epidemic has spread in Southern Africa at a time when many governments have been forced to cut social services as part of economic structural adjustment. Home based care has been used to reduce costs and AIDS patients are dying prematurely because of lack of medicines, expert care and failure to properly take care of oneself. AIDS education campaigns have had some effect e.g more than 90 percent are aware of the disease and its implications in Malawi. However, as in most of the countries in the region, knowledge has not necessarily been transformed into a change in sexual behaviour.
Country
Southern Africa Regional
Publisher
Southern African News Features
Theme area
Equitable health services
Title of publication Primary health care in Southern Africa
Date of publication
1992
Publication type
Journal Article
Publication details
Health Series 2 pp 3pp.
Publication status
Published
Language
English
Keywords
PHC, Southern Africa
Abstract
The paper focuses on the successes and failures made in primary health care (PHC) by SADC member states. While important strides have been made in SADC nations in the post independence era, AIDS, economic structural adjustment programmes and drought proved to be serious setbacks to the achievements of PHC. This was particularly the case with Mozambique where the situation had
been aggravated by the war. Malnutrition persisted as a major problem due to low household earnings and budget into and declining currencies have interrupted the coverage of PHC, led to increased costs and acute shortages of drugs in hospitals.
Water systems in Tanzania have deteriorated both in urban and rural areas and 40-60 percent of rural children suffer from malnutrition and 20-30 percent of urban children. While Zimbabwe’s “framework for economic reform” states that the government will continue to extend basic health and family planning services hospital fee increases, AIDS, low harvest yields shortages of food and water, has contributed to a deterioration health particularly for the low income groups.
Country
Southern Africa Regional
Publisher
Southern Africa News Features
Theme area
Values, policies and rights
Title of publication Nutritional effects of structural adjustment in sub-Saharan Africa
Date of publication
Publication type
Book Section
Publication details
Publication status
Published
Language
English
Keywords
sub-Saharan Africa; nutrition; Structural Adjustment Programs; policy reforms
Abstract
This book presents a discussion of the major policy issues with regard to nutrition which have been evolving during the last decade. Although this is a policy book, it contains considerable original information in its report of major studies from industrialised and developing countries.
Country
United Kingdom
Publisher
Oxford University Press
Theme area
Equity and HIV/AIDS
Title of publication Powerpoint presentations: Equity and the expansion of access to treatment and care in Southern Africa, Nairobi, 23 September 2003
Date of publication
2003 September
Publication type
Conference Proceedings
Publication details
13th ICASA, Nairobi, 23 September 2003
Publication status
Published
Language
English
Keywords
defining equity; resource constraints; poverty; widening disparities
Abstract
Country
Zimbabwe
Publisher
EQUINET, OXFAM
URL:
Equinet Publication Type
Reports
Theme area
Equity and HIV/AIDS
Title of publication Meeting report: ICASA workshop on equity and the expansion of access to treatment and care for HIV/AIDS, Nairobi, 23 September 2003
Date of publication
2003 September
Publication type
Conference Proceedings
Publication details
Report of 13th ICASA Nairobi 2003 pp 1-6
Publication status
Published
Language
English
Keywords
HIV/AIDS impact, health equity, health care systems, health personnel, Global Health Funds, resources, TRIPs, treatment access, Southern Africa
Abstract
HIV/AIDS has had a deep impact on health and health equity issues in Southern Africa. Health care systems have been stressed by increased demand for care, while themselves suffering HIV/AIDS related losses in health personnel. Household and community caring have complemented and sometimes substituted health care inputs. Where these lack adequate support they increase burdens on already poor households. As HIV/AIDS related mortality rates have fallen with new treatments available in high income countries, treatment access has become a central issue, with campaigns on this in South Africa recently widening through the Pan African HIV/AIDS Treatment Access Movement. The Global Health Fund (GHF) has added raised attention about international obligations around resourcing responses to health risks such as HIV/AIDS, and the challenges to the TRIPS agreement has focused attention on the areas of conflict between trade agreements and access to treatment, including to ARVs. Funds available from the GHF and other sources make ARVs potentially more accessible to some people in southern Africa, but there are issues to be addressed of who, on what basis, and how?
Country
Southern Africa Regional
Publisher
EQUINET, OXFAM
URL:
Equinet Publication Type
Toolkits and training materials
Theme area
Equity in health, Values, policies and rights
Title of publication Meeting report: Equity in health - Policies for survival in Southern Africa, Kasane, Botswana, 13–16 March 1997
Date of publication
1997 March
Publication type
Conference Proceedings
Publication details
Report from seminar, Kasane, Botswana 13-16 March 1997 pp 1-36
Publication status
Published
Language
English
Keywords
health indicators, health status, development agenda
Abstract
Southern Africa is facing several serious health challenges.
Many health indicators are among the worst in the world and diseases such as lower respiratory infections, diarrhoeal diseases, malaria, measles and tuberculosis continue to be dominant causes of morbidity and mortality. Recently, the HIV/AIDS epidemic in the region has emerged as one of the most serious in the world and its impact is expected to worsen the health status of the region significantly. In addition to the suffering it causes to individuals and families, the epidemic will have major impacts on society and prospects for development for several generations to come. There is thus an urgent need to put health and health care at the top of the development agenda.
Country
Botswana
Publisher
URL:
Equinet Publication Type
Reports
Theme area
Equity in health
Title of publication 'A call to action' for equity in health in Southern Africa
Date of publication
2000 September
Publication type
Conference Proceedings
Publication details
EQUINET Resolutions pp 1-4
Publication status
Published
Language
English
Keywords
health status, healthcare, equity, southern Africa
Abstract
The Southern African Regional meeting on Equity in Health in Southern Africa, gathering delegates from health sector, civil, organised labour, political and academic institutions in the region, confirmed the policy commitment to equity in health in southern
Africa and urged that greater effort be put into dealing with differences in health status and access to health care that are unnecessary, avoidable and unfair.
Country
Southern Africa Regional
Publisher
EQUINET
URL:
Equinet Publication Type
Resolutions
Theme area
Equity in health
Title of publication Briefing document on equity in health: Kasane and beyond: Presented to the SADC Health Ministers meeting
Date of publication
2001 January
Publication type
Conference Proceedings
Publication details
EQUINET brief pp 1-9
Publication status
Published
Language
English
Keywords
SADC, commitment to equity, policy priorities and goals, gaps between policy and practice, southern Africa
Abstract
The document aims to inform discussions on how far the commitment to equity has been carried forward within the region, to explore the extent to which commitments made at Kasane have been implemented at national and regional level; the current challenges to equity and the policy priorities and goals to address these; and how the gaps between policy and practice have been and can be addressed.
Country
Southern Africa Regional
Publisher
EQUINET, SADC Health Sector Co-ordinating Unit
Equinet Publication Type
Discussion paper
Theme area
Equity in health
Title of publication Meeting report: EQUINET workshop and inputs to the second conference of the International Society for Equity in Health (ISEqH), Toronto, 14-16 June 2002
Date of publication
2002 April
Publication type
Report
Publication details
ISEqH conference, Toronto, 14-16 June 2002 pp 1-14
Publication status
Published
Language
English
Keywords
rights, health-equity approaches, healthcare policy, equity, southern Africa
Abstract
The focus of this workshop was on the equity issues that concern us in the south, covering the disproportionate emphasis on vertical equity, the dimensions of inequity: in health, in health care and the policy responses to these. We will also explore how change in participation, rights and power need to be built into health-equity approaches, implications of a rights based perspective for equity issues. We discussed the role of Equinet, looking at regional responses to issue of equity - specifically activities and program of Equinet in this regard i.e. research and advocacy.
Country
Southern Africa Regional
Publisher
EQUINET
URL:
Equinet Publication Type
Toolkits and training materials
Theme area
Poverty and health, Human resources for health
Title of publication Industrial relations and conditions in the public health sector
Date of publication
1997
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
public health, manpower, industrial relations, human resources in health sector
Abstract
The paper explores the human resource situation in the health sector in Zimbabwe, noting the shortfalls in many categories of personnel, and the uneven distribution of personnel by level of care, between urban and rural areas and between private and public care. The real earnings of health workers have declined and their conditions of service worsened. This situation needs an effective industrial relations system to manage potential conflict, but the paper outlines a collective bargaining and dispute resolution system that exacerbates rather than manages
potential areas of conflict.
Country
Zimbabwe
Publisher
Mimeo
Theme area
Values, policies and rights, Poverty and health
Title of publication Policies for health and development
Date of publication
1997
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
health policy development; poverty; health rights; economicy policy
Abstract
Globally and in Southern Africa, the majority of ill health is due to preventable communicable diseases, adequate knowledge exists to prevent such diseases and the per capita resources exist to implement this technical knowledge. The paper explores why such diseases continue to exact such an enormous toll in the region. Poverty is noted as the most significant cause of ill health and under-development. Over the past 15 years the world has seen spectacular economic advance for some countries, while for others, particularly in Sub-Saharan Africa and Latin America, there has also been unprecedented decline. A relatively constant half or more of
the people in SADC countries live in poverty, even under conditions of GDP growth, signalling a need to examine the distribution of these resources towards the health and development of the poorest. Within this context, the author argues that health and development policies that create a basis for sustainable improvement in the health of the regions population need to consider the constitutional right to health; that health, as part of human development, is an essential objective of economic policy; that investing in health, as part of investment in human capability, is an essential contributor to economic growth and development and the issue of health being a function of participatory democracy. The author observes that participation is as fundamental to health as health is fundamental to development. If the HIV/AIDS epidemic in its ruthless and consistent spread demonstrates the inability of people to act to prevent life threatening risk in their own sexual lives, it also signals the need for a major ‘turn around’ in the relationship between people and public infrastructures. The health sector has in the past and can in the future play an important catalytic role in effecting the sort of multisectoral and community based action needed to restore people’s faith in their own ability to bring about change.
Country
Zimbabwe
Publisher
Dag Hammerskold Foundation
Theme area
Poverty and health, Resource allocation and health financing
Title of publication Transforming social development: The experience of Zimbabwe
Date of publication
1994
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
Social development, health, education, Zimbabwe
Abstract
This document outlines the trends in social development, including health, food security, education, population and women’s status, from before independence into the 1990s. Positive changes after 1980 are noted with respect to infant and child mortality, reduced in child morbidity from malaria, measles in maternal mortality and areas of adult morbidity. One of the most sustained improvements after 1980 described in paper is that of nutrition. From a situation of wide differentials in nutritional status between income groups, urban and rural, and between different economic sectors pre-1980, there was an absolute reduction in acute and general under-nutrition and in the differential between groups. In all the social sectors the 1980’s are noted to have encouraged and developed policies of community participation levered by state resources and organised/supported through state structures. The paper shows that social investments can be made as specific public policy decisions, even under stagnant/low growth. The paper suggest that one of the most negative impacts of the 1990s has been the weakening of the complementarily between the state and households in meeting health needs.
Country
Zimbabwe
Publisher
UNICEF
Theme area
Equitable health services
Title of publication The health status of labour communities in Zimbabwe: An argument for equity
Date of publication
1984
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
health, labour, health care, inequalities in economic and political status, health inequalities, policy implications
Abstract
The organisation production are analysed in Zimbabwe within the commercial farming, mining and urban sectors, with major factors identified as: i. the extent and distribution of local and foreign ownership of productive assets. ii. the orientation of sector production towards external markets. iii. the extent of low wage and insecure employment, and iv.the structure and extent of labour organisation and political representation. The historical analysis shows that by 1980, commercial farm labour was in the worst position politically and economically followed by mine labour and then urban workers. In the absence of any published, coherent assessment of the relative health status of these groups, an epidemiological study was carried out in 1981/2 Mashonaland Central, to test the hypothesis that the inequalities in economic and political status indicated above would be reflected in corresponding inequalities in health status. The results indicated that with respect to the nutritional, dietary, environmental, socioeconomic
and service factors assessed, commercial farm labour had the poorest health status and conditions, with improving status in mine and then urban labour groups. Decreasing levels of labour organisation, political representation and supportive legislation from urban to mine to commercial farm labour are noted, indicating the decreasing potential of the respective labour group to control the material factors affecting their health. The final section explores the policy implications of the findings within the economic and social policy of Zimbabwe since Independence in 1980.
Country
Zimbabwe
Publisher
University of London
Theme area
Public-private mix
Title of publication Public-private partnership in water supply and sanitation in sub-Saharan Africa
Date of publication
1987
Publication type
Journal Article
Publication details
Health Policy Planning 2 1 pp 1pp.
Publication status
Published
Language
English
Keywords
Kenya, water supplies, health providers
Abstract
Concerned about the provision of a public water supply and sanitation services in developing countries, with special reference to Africa, this paper explores the questions of who delivers such services, the extent to which the private sector is involved, the strengths and weaknesses of existing patterns of service delivery, and alternative means of improving service delivery cost, efficiency, and effectiveness, especially through public-private partnerships. Most water systems in the developing world are built and operated by public entities which are plagued with overcentralisation and politicisation as well as poor management. As in most developing nations, central governments in Africa like to be involved in the
operations of water authorities, to set policy for them, and to use them as tools for political ends, with problems of maintaining the system of tariff issues and efficient operations. Some of the managerial problems stem from central government interference in what is best handled by municipalities. Approaches to public-private partnerships in the Ivory Coast, Botswana and Kenya are reviewed.
Country
East Africa regional
Publisher
Health Policy Planning
Theme area
Poverty and health, Equitable health services
Title of publication 1993 National coverage survey on ARI/CDD/EPI/MHC/FP
Date of publication
1993
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
Lesotho, primary health care coverage
Abstract
An external evaluation of Maternal and Child Health programmes in Lesotho found that more than half the children with ARI problems are treated at home using over the counter drugs and traditional herbs. Treatment is initiated too late, after two or more days, for a large number of children, irrespective of the severity of the disease. This delaying practice predisposes children to premature deaths due to pneumonia, the major cause of infant deaths in Lesotho. Only a few health facilities were equipped with oral rehydration for diarrhoeal diseases and some of the health staff do not know the management and treatment of dehydration in children, and the correct recipes for preparing salt, sugar solution (SSS). Most children were managed at home using SSS, ORS or other home made fluids, but most mothers and caretakers could not give the correct recipes for these preparations, due to inadequate health education at clinics. The coverage of full immunisation increased from 67% and 1990 to 71% in 1993 with limits to coverage rates arising in management problems within the health systems. Teenage and above 35 year old, high risk pregnancies are common. Gestational age at first attendance of antenatal care is late and knowledge of advantages of tetanus toxoid vaccinations during pregnancy is low. 45% of the mothers attend post-natal care, with a significant number of home deliveries conducted by untrained people and a misconception among mothers that PNC is not useful.
Country
South Africa
Publisher
Ministry of Health and Social Welfare
Theme area
Poverty and health, Resource allocation and health financing
Title of publication Paying for health: Poverty and structural adjustment in Zimbabwe
Date of publication
1994
Publication type
Book
Publication details
Oxfam Publications pp 35pp.
Publication status
Published
Language
English
Keywords
health; poverty; structural adjustment; life expectancy; per capita expenditure; user fees; Zimbabwe
Abstract
Zimbabwe made impressive progress in health-care in the years following independence in 1980. Life expectancy increased to 60 years, immunisation programmes were extended to cover over 80 per cent of the population, and by 1989 infant mortality rates had fallen to 46 per 1000 live births. These achievements prompted a recent UNICEF report to describe Zimbabwe as a beacon for progress towards child survival and development in Sub-Saharan Africa. By contrast with the rest of sub-Saharan Africa, Zimbabwe’s health status indicators compare favourably with those of countries in other developing regions, including those with higher income levels. Today however, the achievements of Zimbabwe’s post independence health policies are under threat. The resources available for investment in the social sector have been reduced, and the welfare of poor people undermined, by a combination of factors; slow growth during the 1980s, a crippling economic down-turn caused by drought in 1992, and the budgetary constraints imposed by a structural adjustment programme (SAP) administered under the auspices of the World Bank and the International Monetary Fund (IMF). Expenditure per capita on health and education has fallen steeply, eroding the quality of provision in both areas. The introduction of user fees- initially on the recommendation of the World Bank - as a mechanism for meeting targets to reduce the fiscal deficit has excluded poor people from the health system, with increasing inequities within the health system, and high costs of administering user fees. The exemption system ostensibly designed to protect the poor, has failed to do so effectively, because it suffers from poor design and implementation. This suggests that more effective mechanisms for protecting the poor should be built into adjustment programmes.
Country
Publisher
Oxfam
Theme area
Equitable health services
Title of publication The basic needs approach to development: The question of health care for black people in Natal
Date of publication
1990
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
basic needs, health care
Abstract
Health care is an important facet of the basic needs approach. Health care for black people in Natal is fragmented both with regard to the responsible authority (Department of National Health and Population Development, Natal Provincial Administration, Development Services Board, local authorities and welfare clinics) and spatially (since there is an overlap with KwaZulu health services). Access to health facilities (permanent and mobile), although adequate in some areas, is insufficient in others: the deficiency is most marked in rural areas and with regard to permanent health facilities. Crucial statistical data pertaining to health status are inadequate partly because of the aforementioned fragmentation and partly because they are collected for administrative rather monitoring purposes. Questions are posed regarding future access to health care in the light to the new constitutional dispensation, privatisation and the inadequate attention being given to primary health care.
Country
South Africa
Publisher
University of Natal
Theme area
Equity in health
Title of publication From chronic emergency to development: An analysis of the health of the urban poor in Luanda, Angola.
Date of publication
1992
Publication type
Journal Article
Publication details
International Journal of Health Services 22 2 pp 349-363
Publication status
Published
Language
English
Keywords
urban health, war, Angola
Abstract
There is a dearth of published literature on health care systems in Angola. Like many sub-Saharan African countries, Angola is experiencing rapid urbanization. The authors provide an analysis of the health status, environmental health conditions, and health-related behaviour of the urban poor in Luanda, Angola. Although data are patchy and rarely disaggregated to reveal severe conditions in the shanty towns, a grave picture emerges. An average infant mortality rate of 104/1,000, with malaria and intestinal infections the main causes of death in children under 1 year old, reflects the poor environmental conditions, which are worsening as urbanization continues at a rapid rate. Use of health services is limited; for example, 50 percent of women give birth at home, mainly unassisted, and only 28 percent of children are covered by measles immunization (as validated by card). A discussion of existing health strategies, programs, and their constraints is set in the context of the future possibilities of the ending of the 15-year war and the introduction of structural adjustment policies.
Country
Zimbabwe
Publisher
International Journal of Health Services
Theme area
Values, policies and rights, Health equity in economic and trade policies, Equitable health services, Governance and participation in health
Title of publication Discussion paper 6: Towards an equity-oriented policy of decentralisation in health systems under conditions of turbulence: The case of Zambia
Date of publication
1997
Publication type
Report
Publication details
WHO Discussion Paper 6 pp 1-46
Publication status
Published
Language
English
Keywords
equity; health sector reform; health transition; health policy; monitoring and implementation; financing the reforms; Zambia
Abstract
This paper looks at health policy and practice in Zambia. It reviews the influence of international trends and the local environment on the direction of health policy, discusses the design and implementation of Zambia’s 1991 health sector reforms and outlines future developments in Zambia’s health system. The report notes that under conditions of macro-economic instability, social interests play an important role in influencing the pattern of state intervention and health policies. Past attempts at institutional reforms of health systems in countries like Zambia have led to increased bureaucracy and centralisation of health care, associated with a crisis of health policy, and bureaucratic incompetence. Equity has been a desired principle in many reform efforts. However, the organisation of the public sector medical systems have been built on the logic of hierarchical state administration, which is not designed in a way that promotes achievement of equity. The struggle over health care in Zambia is a struggle for democratic empowerment. The current reforms should serve the health needs of the majority through technologies or approaches that reflect their needs, and their own participation.
Country
Zambia
Publisher
WHO
Equinet Publication Type
Discussion paper
Theme area
Equitable health services
Title of publication Political transition, health service reform and COPC in South Africa
Date of publication
1995
Publication type
Journal Article
Publication details
COPACETIC 2 2 pp 7pp.
Publication status
Published
Language
English
Keywords
South Africa; Health service reform; Primary health care
Abstract
The article traces the origin and development of COPC from 1940 to the present period. The formation of COPC which led to the establishment of a health centre in Pholela, an under-developed and poor African community in rural KwaZulu-Natal was a first and important step in the South African government’s efforts to seriously address the great and unresolved rural health problem. The Government of National Unity has opened the door for profound health service reform in line with the approach used to address the anomalies in the health care system left by the apartheid era. The first wave of health reform rightly focuses on equity and access to care. The article further reviews some of the features of the COPC approach in light of the South African situation as it stands at the present.
Country
South Africa
Publisher
Theme area
Poverty and health, Equitable health services
Title of publication Mortality determinants in Zimbabwe: Policy implications
Date of publication
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
mortality; access to healthcare; socio-economic attributes; Zimbabwe
Abstract
This paper presents a view of available data on mortality in Zimbabwe including; infant and child mortality, maternal mortality and general adult mortality. The risks of maternal mortality vary being generally high for very young women, women over age 35 years, women in their first pregnancy or in the fifth or higher pregnancies, women with pre-existing health problems, poor, malnourished, and uneducated women. Women without easy access to adequate health care are also at relatively high risk of maternal mortality. Differences in infant and child mortality reflect differences in the distribution of resources (income, food), the social attributes of the parents (education, beliefs and norms), the availability of amenities such as water supply and sanitation, access to health services and the physical environmental conditions. They also reflect differences in skills and knowledge of the promotion of health and prevention and treatment of diseases. The diversity of determinants of mortality indicate that reducing mortality requires a multi-sectoral development approach, that socio-economic and political inputs at the national, regional, household and individual levels.
Country
Zimbabwe
Publisher
University of Zimbabwe, Sociology Department
Theme area
Title of publication Primary health care in practice: a study in Mozambique
Date of publication
1994
Publication type
Journal Article
Publication details
Social Science & Medicine 19 8 pp 773-782
Publication status
Published
Language
English
Keywords
Primary health care, health workers
Abstract
This study investigates the delivery of all aspects of Primary Health Care (PHC) in a case study of one urban health centre in Maputo, Mozambique. Within the context of overall social and economic change, Mozambique has given priority to primary health care as the driving force in its newly developed National Health Service. The urban and rural health centres are intended to be the principal vehicles for PHC
delivery, and in this study one of Maputo’s recently opened health centres was investigated by observing all clinic sessions, interviewing all health centre workers and collecting data from health centre records. It was found that a dichotomy exists between the tasks ascribed to the health centre in the PHC framework, and the feasibility of their execution given existing personnel and material resources. This derives in part from lack of involvement of PHC practitioners in the organisation and planning of PHC, plus resource allocation which remains in favour of secondary and tertiary rather than primary care. Prevention is accorded priority
in PHC theory, yet investigation showed that the major demand on the health centre is for curative care. The quality of both curative and preventive care was evaluated on the need for training in specialist diagnostic skills, and a more socially-based understanding of the determinants of health status and risk.
Country
Publisher
Theme area
Resource allocation and health financing
Title of publication The basic health care system in Botswana: A case study of the distribution and cost in the period 1973-1979
Date of publication
1984
Publication type
Journal Article
Publication details
Social Science and Medicine 19 8 pp 6pp.
Publication status
Published
Language
English
Keywords
Botswana, adolescence, child, health
Abstract
Since 1973, Botswana has developed its basic health services with an extensive network of clinics and health posts staffed with nurses, health assistants and Family Welfare Educators (11 weeks in preventive medicine). In 1977 it was estimated that 80% of the population lived within 15km of either a health post or a clinic. In the study period the annual number of new registered outpatient diagnosis per inhabitant increased from 0.65% to 1.50, but even the heavy investment in the rural areas the annual number of visits per rural inhabitant, was in 1979, 0.8 compared to 2.8 in the urban areas. In 1979 the per capita health expenditure was US+18.7, of which the basic health service accounted for US+8.8. The relationship between Botswana’s basic health service and a primary health care system as described in the Declaration of Alma Ata is discussed.
Country
Botswana
Publisher
Social Science and Medicine
Theme area
Equitable health services
Title of publication A national household survey of health inequalities in South Africa: Overview report
Date of publication
1995
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
health survey, inequalities in health
Abstract
This report presents a survey of different population groups in South Africa. The findings indicate that the black population are significantly worse compared to other race groups, due to poverty combined with poor public health conditions. At the same time those with greatest risk are also shown to have poorest access to health services, and are treated ‘most shabbily’ when they do. The survey provides a baseline against which to measure process.
Country
South Africa
Publisher
Community Agency for Social Enquiry (CASE)
Theme area
Values, policies and rights
Title of publication South African health review
Date of publication
1997
Publication type
Book
Publication details
Publication status
Published
Language
English
Keywords
health systems, research, health status determinants, legislation, human resources, financing and expenditure
Abstract
Provides an annual review of health in South Africa covering; the broad picture: health status and determinants; health and development; legislation; private sector; provincial restructuring; local government restructuring; hospital restructuring; financing and expenditure; human resources; drug policy; health information systems; research upgrading health facilities; community involvement in health; health and the media; maternal, child and women’s health; mental health; oral health; occupational health; disability HIV/AIDS; tuberculosis; sexually transmitted diseases; nutrition; injury and trauma; tables of health and related indicators.
Country
South Africa
Publisher
Henry J Kaiser Family Foundation
Theme area
Values, policies and rights
Title of publication South African health review
Date of publication
1995
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
health systems reform, South Africa, policy priorities, policy-directed research
Abstract
Provides an annual review of health in South Africa covering; imperatives for health systems reform; health systems reform in South Africa; priorities of the Ministry of Health; an agenda for policy-directed research.
Country
South Africa
Publisher
Henry J Kaiser Family Foundation
Theme area
Values, policies and rights, Equitable health services
Title of publication Survey on public health care in Zimbabwe
Date of publication
1991
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
Health survey, health services, health policy, Zimbabwe
Abstract
This report presents the results of a study commissioned by Cebemo to enable it to formulate its policy on future assistance to the (Catholic) church health services. The report contains a description and analysis of the organisation and functioning of the Zimbabwe Public Health System and the Church Health services that are described as complementary to the public health systems.
Country
Zimbabwe
Publisher
Cemebo
Theme area
Equitable health services, Resource allocation and health financing
Title of publication Quality, cost and utilisation of health services in developing countries: A longitudinal study in Zaire
Date of publication
1995
Publication type
Journal Article
Publication details
Social Science and Medicine 40 6 pp 743-753
Publication status
Published
Language
English
Keywords
Health services, cost, utilisation
Abstract
Many developing countries, particularly in Africa, have recently introduced payment schedules based on the selling of essential drugs. This is one of the main elements of the Bamako Initiative according to which the income generated would ensure a reliable supply of drugs and would improve other aspects of the quality of the services offered. Thus, quality improvements would compensate for the financial barrier and as a result the utilisation of public health services would be increased or at least maintained. These hypotheses have proven to be partially valid, since there have been cases where the utilisation of health services has increased and other where it has decreased, these inconclusive results have fuelled criticisms concerning the inequitable nature of these measures. This longitudinal study in a rural community of Zaire shows that the utilisation of health services had diminished by close to 40% over 5 years (1987-1991) and that 18-32% of this decrease is explained by cost. The regular supply of drugs and the improvement in the technical quality of the services - technical qualification of the staff, allocation of microscopes, and renovation of the infrastructures - was not enough to compensate for the additional financial barriers created by the increased cost of services. However, on a local level, the interpersonal qualities displayed by some of the nurses sometimes helped to compensate for the negative effects of
the costs, and even to increase the level of utilisation of some health centres. The quality of public services has often been neglected in developing countries. While some attention is given to technical qualities, the interpersonal components of the quality of the services are generally ignored or underestimated by planners and they are the very components which are most resistant to change. It will be a major challenge for health systems to address this issue of quality of care in order to minimise the negative impact of the introduction of user payment schemes. Therefore, now is the time to place quality next to coverage in planner’s agendas.
Country
Zaire
Publisher
Social Science and Medicine
Theme area
Title of publication
Date of publication
1996
Publication type
Journal Article
Publication details
AIDS Care 8 3 pp 361-363
Publication status
Published
Language
English
Keywords
HIV/AIDS; Development; Poverty; Equity; Inequality
Abstract
This paper considers the evidence for AIDS as a disease of poverty. It describes the influence of the social and economic context of HIV/AIDS and of those
behaviours associated with HIV transmission, and urges for a shift in emphasis in the conceptualisation of the ‘AIDS problem’. The relationship between poverty and AIDS is explored, particularly in relation to global economic development, urbanisation, homelessness and the disintegration of neighbourhood, migration and systems of labour and production. AIDS is related to urbanisation, particularly homelessness, industrial developments and rural to urban migration; the system of migrant labour and production; the breakdown of social networks within neighbourhoods making individuals particularly to HIV. Examples of socially driven
community-based responses to the prevention and control of HIV epidemic in diverse cultures are discussed and the need for new outcome measures for assessing community initiatives is proposed.
Country
South Africa
Publisher
Theme area
Governance and participation in health
Title of publication Zambia demographic and health survey 1992
Date of publication
1993
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
health status, demography
Abstract
This report summarises the findings of a University of Zambia study of women of reproductive age designed to provide, among other things, information on fertility, family planning, child survival and health of children.
Country
Zambia
Publisher
Government of Zambia
Theme area
Poverty and health, Resource allocation and health financing
Title of publication Economic impact of malaria in Malawian households
Date of publication
1994 March
Publication type
Journal Article
Publication details
Tropical Medicine & Parasitology 45 1 pp 74-79
Publication status
Published
Language
English
Keywords
malaria, Malawi, household income and spending
Abstract
Household heads were questioned about household income and household expenditures on the treatment or prevention of malaria in a nationwide malaria knowledge, attitudes, and practices (KAP) survey conducted in Malawi in 1992. Very low income households with an average annual income of $68 constituted 52% of the sampled households. The primary income source for these households was farm production (92%), with the majority of goods produced consumed by the household and not available as discretionary income. Expenditure on malaria prevention varied with household income level. Only 4% of very low income households spent resources on malaria preventive measures compared to 16% of other households. In contrast, over 40% of all households, independent of income level, reported expenditures on malaria treatment. Almost half of the reported malaria cases sought treatment at a health facility at a cost of $0.21 per child case and $0.63 per adult case. The overall direct expenditure on treatment of malaria illness in household members was $19.13 per year (28% of annual income) among very low income households and $19.84 per year (2% of annual income) among low to high income households. The indirect cost of malaria, calculated on the basis of days of work lost, was $2.13 per year (3.1% of annual income) among very low income households and $20.61 per year (2.2% of annual income) among low to high income households. Very low income households carried a disproportionate share of the economic burden of malaria, with total direct and indirect cost of malaria among these households consuming 32% of annual household income compared to 4.2% among households in the low to high income categories.
Country
Malawi
Publisher
Tropical Medicine & Parasitology
Theme area
Public-private mix, Resource allocation and health financing
Title of publication Value for money in South African health care: Findings of a review of health expenditure and finance
Date of publication
1996 January
Publication type
Journal Article
Publication details
Central African Journal of Medicine 42 1 pp 21-24
Publication status
Published
Language
English
Keywords
health expenditure, South Africa, distribution of resources, public sector, private sector
Abstract
This article highlights the findings of a review of health expenditure and finance in South Africa in 1992/3. The paper discusses the level of national expenditure on health care and the distribution of resources between the public and private sectors, the maladministration of financial, physical and human resources on a geographic basis, racially and between levels of care, and the cost of redressing inequities, at least at the primary care level, given the additional sources of finance. The paper notes that those living in poor areas clearly have much less access to public health services than those living elsewhere; that additional capital and recurrent funds will be needed to build community hospitals and to develop specialist services in undeserved areas, and to integrate and decentralise administrators; that the extension of private sector care to a greater proportion of the population is a potential strategy for improving access to services; and that donor support will be important in financing the high costs of transition, especially for the development of infrastructure. The reprioritisation of health services and the process of structural change need to be comprehensively planned. Piece-meal planning could impede the establishment of effective services in poor areas and damage staff morale. Planning should occur primarily at provincial and district levels, including the formulation of a building plan, a strategy for improving and expanding primary services rapidly, and a strategy for making better use of the available resources, especially in hospitals.
Country
Zimbabwe
Publisher
Department of Community Health Medical School, University of the Witwatersrand
Theme area
Equity and HIV/AIDS
Title of publication The effect of HIV on health care in sub-Saharan Africa
Date of publication
1996
Publication type
Journal Article
Publication details
Development Southern Africa 13 1 pp 89-100
Publication status
Published
Language
English
Keywords
HIV/AIDS, health care, Southern Africa
Abstract
This paper examines the effect of HIV on the delivery of health care in sub-Saharan Africa. The task is hampered by a lack of data. In most countries there have been no sentinel HIV surveys, and thus no clear idea of the magnitude of the epidemic. However, it is certain that HIV will alter the demand for health care, and the supply and quality of services. Demand will grow as infected adults and children seek care. Most HIV-related illness is found in people who would not normally require care, therefore creating additional demand. Demand for care will also be determined by the availability and accessibility of services. Ironically, the middleincome countries may face higher bills and in this sense the economic effect of the HIV epidemic may be worse in the more developed countries. The supply of services will be affected by increased morbidity and mortality among health care workers as is already happening. The generous terms and conditions of service that most governments offer to workers in the public sector will increase costs. HIV has served to improve the quality of health care in most of the developed world. Patients have sought to take control over their own care, and staff have been more rigorous in taking universal precautions. But in developing countries external aid often determines how health care is organised, and money spent on AIDS is diverted from other areas. This may also be true of local funding. The effect of HIV on health care is lamentably under-researched. This is particularly worrying as the effects of HIV will be felt first by the health care sector. The problem must be confronted urgently from the point of view of the suppliers of health care services, the users and the policy-makers.
Country
Zimbabwe
Publisher
Theme area
Poverty and health
Title of publication Teenage pregnancy in Botswana
Date of publication
1988
Publication type
Journal Article
Publication details
People 15 2 pp 3pp.
Publication status
Published
Language
English
Keywords
Botswana, health services, delivery of health care, family planning programs, population policy, social policy, adolescent pregnancy, state of the art.
Abstract
Diamonds and cattle combine to make Botswana’s economy the soundest in Africa. Its foreign reserves are comparable to those of Saudi Arabia and, in a country roughly the size of France, there are just over a million people. But 3/4 of the land is the sand and scrub of the Kalahari. A rapidly rising population, most of it squeezed into the more fertile eastern belt, has alerted the Government to set about preparing a national population policy. Botswana’s government has identified teenage pregnancy as a severe and growing problem. Government alarm over teenage pregnancy was aroused in 1984 when the Botswana Family Health Survey showed that nearly 1/4 of 15-19 year old girls were already mothers.
Basarwa families were very reliant on their health clinics. The health condition of the Basarwa on the farms was described as abject and pathetic. A large-scale rehabilitation project aims at developing and integrating the Basarwa and other remote area dwellers into Botswana society. Leaders of family planning clinics look back regretfully that men were not involved in family planning from the start.
Country
Botswana
Publisher
People
Theme area
Equitable health services
Title of publication District health service costs, resource adequacy and efficiency: A comparison of three districts
Date of publication
1996
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
District health services, health financing
Abstract
Country
Zimbabwe
Publisher
Ministry of Health and Child Welfare
Theme area
Resource allocation and health financing
Title of publication Socio-economic stress, health and child nutritional status at a time of economic Structural Adjustment - A three-year longitudinal study in Zimbabwe
Date of publication
1996
Publication type
Book
Publication details
Uppsala
Publication status
Published
Language
English
Keywords
health, structural adjustment, Zimbabwe
Abstract
Country
Zimbabwe
Publisher
Nordiska Afrikainstitutet
Theme area
Equitable health services
Title of publication Local government and inequalities in health
Date of publication
Publication type
Book Section
Publication details
Publication status
Published
Language
English
Keywords
Inequalities in health
Abstract
This book describes and analyses inequalities in health at a local level and the role local authorities play in health. On the basis of this analysis, it sets out a strategy that local authorities might adopt in order to reduce local inequalities in health, given their influence over the material and social environment at a local level.
Country
Zimbabwe
Publisher
Avery
Theme area
Equitable health services
Title of publication A systematic review of the effectiveness of health service interventions aimed at reducing inequalities in health
Date of publication
1996
Publication type
Journal Article
Publication details
Journal of Health Services Research and Policy 1 2 pp 93-103
Publication status
Published
Language
English
Keywords
Health care, health inequalities, health interventions
Abstract
The paper reviews the literature to identify interventions which health services alone or in collaboration with other agencies to have reduced inequalities in health. The literature was undertaken using a number of databases including Medline (from 1990), Applied Social Science Index and Abstracts (1987-1994), and the System for Information on Grey Literature in Europe (1984-1994). Ninety-four (94) studies were identified which satisfied all the inclusion criteria and 21 reviews were included. Interventions aimed at improving the health of groups disadvantaged by socio-economic class, ethnicity or age can, if properly targeted, reduce health inequalities, depending on the characteristics of the programme. Characteristics of successful interventions specifically aimed at reducing health differentials include: systematic and intensive approaches to delivering effective health care; improvement in access and prompts to encourage the use of services; strategies employing a combination of interventions and involving a multi-disciplinary approach; ensuring interventions address the expressed or identified needs of the target population; and the involvement of peers in the delivery of interventions.
Country
Zimbabwe
Publisher
Journal of Health Services Research and Policy
Theme area
Poverty and health
Title of publication Tuberculosis and social stratification in South Africa
Date of publication
1990
Publication type
Journal Article
Publication details
International Journal of Health Services 20 1 pp 141-165
Publication status
Published
Language
English
Keywords
TB, South Africa, distribution, racial classification, resource cutbacks
Abstract
Tuberculosis (TB) continues to be a barometer of poverty, determined by racial classification, in both town and countryside in the Republic of South Africa. Despite the fact that whites with the disease stand a greater chance of being diagnosed than their black counterparts, because they have very much better access to health care, the risks of TB for people classified by the state as black and coloured are 27 and 16 times, respectively, the risk for whites. Black gold miners also have increased TB rates. The risks of TB have increased over recent years among coloureds and blacks. Rates of tuberculous meningitis have also increased over the past decade, and show the dramatically worse health care available to people
classified as black and coloured. Although about 60,000 new TB cases are reported in the country each year, there have been cutbacks in the resources available for TB control and treatment.
Country
South Africa
Publisher
International Journal of Health Services
Theme area
Equitable health services
Title of publication The spatial distribution of health resources within countries and communities: Examples from India and Zambia in Curacao
Date of publication
1986
Publication type
Journal Article
Publication details
Social Science and Medicine 22 pp 14pp.
Publication status
Published
Language
English
Keywords
health resources, distribution
Abstract
“Between one country and another, one province and another and even one locality and another there will always exist a certain inequality in the conditions of life, which it will be possible to reduce to a minimum but never entirely remove,” said Friedrich Engels in 1875, The paper describes wide disparities in the availability of welfare facilities including health at international, national, regional and inter-regional levels. At the same time such disparities are increasing over time. In terms of spatial distribution, not only the developing world but even developed countries such as the USA and the United Kingdom, face problems resulting from wide imbalances in the provision of welfare facilities. In this paper, an attempt has been made to study inequalities in the distribution of health facilities in India and Zambia.
Country
Zimbabwe
Publisher
Social Science and Medicine
Theme area
Values, policies and rights
Title of publication Health policy in less developed countries: Past trends and future directions
Date of publication
1995
Publication type
Journal Article
Publication details
Journal of International Development 7 3 pp 299-328
Publication status
Published
Language
English
Keywords
Health policy, less developed countries
Abstract
Health policies worldwide have changed dramatically in the last few decades. We reflect upon these changes, highlight current trends and identify key issues and challenges as the year 2000 approaches. The article comprises five sections: (i)comments on concepts of health and of policy; (ii) historical developments which have influenced policy; (iii) discussion of the context within which health policies in low income countries are formulated and implemented, including macro-political and macro-economic developments, health needs and determinants, financing, approaches to health planning and priority setting, and the key international health policy actors; (iv) an overview of the content of current health policy proposals in less developed countries which considers the financing, organisation and management of health systems, and (v) a concluding section which identifies key issues for the coming years. The recent World Bank Development Report, Investing in Health (1993) and other health sector reform efforts, form the backdrop for this discussion.
Country
Zimbabwe
Publisher
Theme area
Public-private mix
Title of publication A study on the regulation within private medical sector in Zimbabwe
Date of publication
1995
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
private medical care, regulation, Zimbabwe
Abstract
This study was to look at the regulatory environment currently in place for the private sector especially in as far as they addressed the variables price, quality and quantity of care and assess the effectiveness of the regulatory environment. The findings of the study showed that although the health sector was administered by the Ministry of Health and Child Welfare, implementation of provisions of the regulations was generally not effective. For instance, the Health Professions Council, as the official guardian of medical standards in the country, did not have an important unit such as the Inspectorate. Therefore, local authorities conducted
inspections on behalf of the Health Professions Council before issuing licences to providers. Until recent moves by the Health Professions Council, there had not been national minimum standards for health institutions in the country and each local authority was using their own by-laws during inspections. With regards to the services done by private practitioners, Medical Aid Societies were thought to be in a better position to evaluate any improper conduct by practitioners since their investigative departments investigated all claims sent by practitioners before
payment.
Country
Zimbabwe
Publisher
Government Printers
Theme area
Values, policies and rights
Title of publication Zimbabwe health for all action plan
Date of publication
1986
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
Health policy, Health planning
Abstract
The document outlines the plan for the Ministry of Health from 1985-1990 to respond to the major public health problems in the country.
Country
Zimbabwe
Publisher
Ministry of Health
Theme area
Values, policies and rights
Title of publication Planning for “Equity in Health”
Date of publication
1982
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
Health; equity; Zimbabwe
Abstract
This white paper outlines the health policy linked to the economic policy of “Growth with Equity”, which sought to establish a socialist, egalitation and
democratic society in Zimbabwe. Political independence is the necessary first step in the long march towards national development which can be measured by a nation’s state of health. The policy notes racial and social class related inequalities
in health and health care. Planning for “Equity in Health” seeks to redress this imbalance and demands that the rural population be cared for first. It advocates the adoption of the primary health care (PHC) approach whose key components are appropriateness, accessibility, affordability and acceptability of the care provided. This approach advocates for a conscious acceptance by a community of the responsibility for its own health.
Country
Zimbabwe
Publisher
Theme area
Health equity in economic and trade policies
Title of publication The globalisation of public health: The convergence of self-interest and altruism
Date of publication
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
globalisation, public health
Abstract
The trans-nationalisation of disease and health risks will require global awareness, analysis, and action, and indicates a need for global cooperation. These transnational actions must be built on firm local and national foundations, but also require new forms of transnational collaboration in order to minimise risks and build on the opportunities. In a world characterised by the globalisation of public health, countries and communities will need to look beyond their narrow selfinterest in defining and confronting the shared problems which are emerging. In fact, a strong case can be made that enlightened self-interest and altruism converge in the increasingly interdependent world being shaped by the process of
globalisation.
Country
Zimbabwe
Publisher
World Health Organisation
Theme area
Health equity in economic and trade policies
Title of publication The globalisation of public health: Threats and opportunities
Date of publication
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
public health; globalisation; health policy
Abstract
The globalisation of public health poses new threats to health but also holds important opportunities in the coming century. This commentary identifies the major threats and opportunities presented by the process of globalisation, and emphasises the need for transnational public health approaches to take advantage of the positive aspects of global change and to minimise the negative ones. Transnational public health issues are areas of mutual concern for the foreign policies of all countries. These trends indicate a need for cross-nationalcomparisons, for example in the areas of health financing and policy development, and for the development of a transnational research agenda in public health.
Country
Zimbabwe
Publisher
World Health Organisation
Theme area
Equitable health services
Title of publication Inequalities in South African health care: Part II: Setting the record straight
Date of publication
1994
Publication type
Journal Article
Publication details
South African Medical Journal 84 2 pp 99-103
Publication status
Published
Language
English
Keywords
Health care; health policy; equity
Abstract
While Part 1 of this article analysed the problems of structural inequalities in South African health care, this follow-up explores a policy strategy to deal with these discrepancies and disparities, weighed against prevailing realities. The conclusion is reached that for the foreseeable future the chances for equality in South African health care appear to be rather slim; a myriad interest groups with vested interests in the status quo are at play, opposing any fundamental reform to ensure greater equality. This should motivate endeavour to minimise these inequalities, through a recognition of health care as a basic human right and a public concern, the universalisation of health care benefits to every citizen; a social contextualisation of health care provision accompanied by community-based, democratised planning and regionalisation of health care; the integration of authority into a central controlling body and the centralisation of the financial process.
Country
South Africa
Publisher
South African Medical Journal
Theme area
Values, policies and rights
Title of publication Equity in health policies for survival in Southern Africa: An agenda for action
Date of publication
1997
Publication type
Conference Proceedings
Publication details
Publication status
Published
Language
English
Keywords
equity in health; policy
Abstract
The seminar on equity in health -polices for survival in Southern in Southern Africa was jointly organised by the National Institute of Development Research and Documentation of the University of Botswana and the Dag Hammerskjold Foundation, Uppsala, Sweden in March 1997, in Botswana. This agenda for action from the seminar calls for research to develop regional indicators of equity in order to facilitate the monitoring of equity in health both within and between countries in Southern Africa, sharing of experiences with coordination at regional level, a wider regional debate and action by stakeholder on equity in health.
Country
Botswana
Publisher
University of Botswana
Theme area
Health equity in economic and trade policies
Title of publication Health and economic policy
Date of publication
1995 July
Publication type
Journal Article
Publication details
British Medical Journal 311 pp 2pp
Publication status
Published
Language
English
Keywords
Health, economic policy
Abstract
The paper advocates for an intersectoral collaboration in the development of policies in different sectors such as health, transport, housing, energy and many others. It calls for health to play a pivotal role in influencing decisions made in other sectors so as to minimise accidents, loss of lives, wastage of resources and pollution of the environment. The paper argues that what happens in one sector will ‘trickle down’ to other sectors and as such it is the challenge for the health sector to advance the agenda of sustainable development and to identify the potential health gains and losses from different policies. One of the most important being macroeconomic policy. Health sector has a potential to make useful contribution to the current development of macro-economic policy in a number of ways. Four possibilities present themselves. Firstly, the health costs of socio-economic inequalities, unemployment, poverty and crime can be brought to policy makers’ attention whenever possible. Secondly, health professionals should join the social and environmental critics of macroeconomic policy to ensure that the health costs and benefits of macroeconomic policies are examined in policy making. Thirdly, more health professionals can contribute locally to healthy city projects and other intersectoral activities. The health sector can also promote wider understanding of the many positive implications for public health of environmentally sustainable development.
Country
Zimbabwe
Publisher
Theme area
Values, policies and rights
Title of publication Equity and vulnerability: A situation of analysis of women, adolescents and children in Uganda, 1994
Date of publication
1994
Publication type
Book Section
Publication details
Publication status
Published
Language
English
Keywords
women, children, health rights, equity
Abstract
This book deals with women and children’s education, health, rights and their culture in Uganda. It notes a need to achieve more equitable distribution of resources and opportunities for the most vulnerable groups; including women, adolescents and children, attention to equity between rural and urban areas as well as for the various districts in different regions. It calls for a balance between the concerns of the intended beneficiaries, the implementers, the planners and the controllers and between needs and resources, present and future. To a much greater extent than presently occurs, the voices of women, adolescents and children need to be heard in the process of identifying needs. This applies to all vulnerable persons, including orphans, the disabled and adolescent mothers. The problems and their determinants are complex, involving multiple sectors, and issues, such as equity, lack adequate attention because no single unit or sector takes responsibility for them. This calls for innovative problem solving and creative resource sharing that cuts across sectorial boundaries.
Country
Uganda
Publisher
The Government of Uganda
Theme area
Values, policies and rights
Title of publication Health care in South Africa: The rights and responsibilities of the community
Date of publication
1989
Publication type
Journal Article
Publication details
Medicine and Law 7 6 pp 649-655
Publication status
Published
Language
English
Keywords
community mobilisation, participation, rights, justice, equity
Abstract
Both community mobilisation and expert intervention are required for health care. All members of the South African community have a right to justice, equity and participation in their health care system. Justice demands equal facilities for all, and in South Africa cannot be achieved without fundamental political change. Equity demands freedom from financial anxiety. Arguments for the further privatisation of health care in South Africa are immoral and unconvincing. Participation demands that a patient be actively involved in deciding the nature of health care rather than merely a ‘consumer’. This requires both demythologising the medical profession and vesting power in the community. Practical steps towards this are suggested.
Country
South Africa
Publisher
Medicine and Law
Theme area
Values, policies and rights
Title of publication The right to health care
Date of publication
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
health; health care; right to health
Abstract
This feature examines the historical evolution of health care as a legal right and the nature and scope of the right to health care. Medical care and the right to health are also discussed. It examines expanding concept of health as a social responsibility and the assurance of quality of social conditions. Health is posed as a natural right for all human beings. If we assume a right to life, then we must grant a right to health protection. The right to health is both an individual and a social right. The individual right to health must include the protection of an individual’s physical integrity and human dignity. It may entail a moral obligation to avoid harm to one’s health. The social right to health care expresses the responsibility of society to protect the health of its citizens and to assure them care in times of illness. While the right to health is an absolute or, at least, a basic right,
enforcement of the right depends on what society may feasibly grant. Thus, while the right may apply at all times and places, its attainment must vary with society’s capability to provide a certain level of care and protection at each specific time and place. In the gradual evolution of health care as a social responsibility and expression of the right to health care in national constitutions is valuable as a principle. Translation of that principle into reality depends on the expectations and actions of the citizenry and on the political will of governments to assign a high priority to health care for the people.
Country
Zimbabwe
Publisher
School of Public Health
Theme area
Values, policies and rights, Resource allocation and health financing
Title of publication Health and social policies in the new South Africa
Date of publication
1995
Publication type
Journal Article
Publication details
International Journal of Health Services 25 4 pp 727-743
Publication status
Published
Language
English
Keywords
health policy, South Africa, health
Abstract
South Africa’s first democratic government is today confronted with the challenge of recasting apartheid social and health policies, transforming a moribund bureaucracy’s mode of governance, and restructuring a variety of public and private institutions, including the national department of health. In the attempt to redress racial, gender, and class inequities, enormous barriers confront health policy analysts and planners, progressive politicians and activists within civil society who work in the field of health. This article sets the broad social policy context for the emerging strategies, documents some of the continuing inequities in the health sector, and recounts some recent experiences in one of the nine provinces (KwaZulu-Natal), to illustrate the difficulties and potentials that change of this magnitude presents under the prevailing conditions of neo-liberal politics and economics.
Country
Zimbabwe
Publisher
International Journal of Health Services
Theme area
Values, policies and rights
Title of publication Apartheid medicine: Health and human rights in South Africa.
Date of publication
1990
Publication type
Journal Article
Publication details
JAMA 264 16 pp 2097-2102
Publication status
Published
Language
English
Keywords
health; human rights
Abstract
Human rights and health care under apartheid in South Africa were studied. Human rights violations, such as detention without charge or trial, assault and torture in police custody, and restriction orders, have had devastating effects on the health of persons experiencing them. These violations have occurred in the context of a deliberate policy of discriminatory health care favouring the white minority over the black majority. South Africa’s medical societies have had mixed responses to the health problems raised by human rights violations and inequities in the health care system. The amelioration of health care for all and prevention of human rights violations depend on ending apartheid and discrimination and greater government attention to these problems.
Country
Publisher
Theme area
Health equity in economic and trade policies
Title of publication Towards equity in health in an unequal society: Health finance and expenditure in South Africa
Date of publication
1997
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
equity, health sector reform, resource allocation, health finance, South Africa
Abstract
South Africa is one of the world’s most unequal societies and its health sector mirrors these inequalities. Since the first democratic elections in 1994 the government has been under enormous pressure to diminish disparities between population groups in access to health services. This paper documents the structural inequalities in the health sector and discusses the strategic options that are being considered for reducing them. The overall level of health expenditure is high, amounting to 8.5% of GDP. However, less than 40% of expenditure is on public health services and three quarters of that is on acute care hospitals. A more detailed analysis of public health expenditure reveals large differences between census districts. The districts where household incomes are low tend to have fewer public health services. Public health expenditure per capita was lower than the estimated cost of providing basic primary health care in a fifth of districts. The most urgent need is to improve the services likely to reduce excess mortality and morbidity. This will involve additional funding of primary health care services,
particularly in under-served localities. Government cannot increase public health budgets rapidly and it will have to re-allocate funding from hospitals. The paper discusses options for achieving this, including the introduction of social health insurance. It argues that restructuring the health sector is complex and there is a risk of failure. Governments should base their strategies on a good understanding of the health sector and of the likely impact of different reform options.
Country
South Africa
Publisher
Unknown
Theme area
Governance and participation in health
Title of publication Community participation and involvement for health in Botswana
Date of publication
1981
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
Botswana, community participation, health services
Abstract
In Botswana, the Ministry of Health support a health care system in which people play a major role, making decisions about their own health. The system allows everyone to participate in prevent and promotive health programs. People participate from the initial planning stage to evaluation. Seminars are run using the problem posing method, intended to raise the people’s awareness of their existing health problems, helping to sensitize them to the fact that they have the power to solve problems and to change conditions. In the effort to involve people in their own health care, focus is on encouraging their ideas rather than placing the whole responsibility for health on the people. The primary objectives of the Community Leaders Health Seminars are to educate the community leaders in the major health problems to improve family community, and ultimately national health; to develop and improve family community, and knowledge, skill, and attitude in organising different health education activities; and to develop health education process in the country. The role of the health educator is both to set up educational programs to change individual’s health related behaviour and to help people challenge health damaging conditions in their communities and work places and work toward health promoting conditions. During the Community Leaders Health Seminars, some villages suggested the establishment of standing committees of modern health workers and traditional healers. This began communication between the 2 groups involved in public health. The existence of such committees has resulted in a continuous exchanged of ideas and cooperation, consensus being reached by both groups over which disease can best be treated by WHO, considerable improvements in the referral system, and the traditional doctors suggesting that research is needed to learn just what is in the herbs they are using.
Country
Botswana
Publisher
Federal Health Education Division
Theme area
Equity and HIV/AIDS
Title of publication AIDS: Discrimination and public health
Date of publication
1988
Publication type
Conference Proceedings
Publication details
Report of the IV International Conference on AIDS pp 3pp.
Publication status
Published
Language
English
Keywords
AIDS, Discrimination, Public health
Abstract
The paper outlines the United Nations position on non discrimination against people with HIV/AIDS and calls for member states to protect the human rights and dignity of people with HIV/AIDS. This policy is said to be critical to the success of HIV/AIDS prevention programmes. Stigma can lead to the problem being hidden, interrupting the necessary information and contact with support services, including those aimed at preventing future transmission. Discrimination is thus a danger to public health - the protection of the uninfected majority depends upon and is inextricably bound with the protection of the rights and dignity of infected persons.
Country
United States
Publisher
United Nations
Theme area
Values, policies and rights, Resource allocation and health financing
Title of publication Sustaining primary health care
Date of publication
1995
Publication type
Book
Publication details
Publication status
Published
Language
English
Keywords
primary health care; planning; health care market
Abstract
The paper discusses the factors that determine the sustainability of any health system. It argues that while laws and policies set the parameters of investment, direct support for the health system depends on the actions and attitudes of local stakeholder who have the financial muscle to influence policy and government. Building a sustainable national health system therefore requires a constituency that treats health as a priority enough to continue supporting investment in health development. In developing countries a supportive community of local stakeholder is essential due to the extreme scarcity of resources, and the competition with other viable sectors for the national funds. However, the trend has often been that those with power have tended to influence the way resources are used and their distribution. Interest groups often distort the distribution of resources in favour of tertiary care which is out of reach of the poor who are the majority. For example, public sector spending in developing countries such as Ghana, Pakistan and Uganda, public spending is systematically biased against primary level services partly because PHC lacks its own power base. In terms of sustainability, constituents affect the health system according to: the range and number of stakeholder groups; specific stakeholder interests; the relative economic capacity of different stakeholder; and the organisation of stakeholder relations within the health system.
Country
Zimbabwe
Publisher
Earthscan Publications Ltd
Theme area
Governance and participation in health
Title of publication The role of NGOs as an agent for change
Date of publication
1997
Publication type
Conference Proceedings
Publication details
Equity in health: policies for survival in Southern Africa pp 22pp.
Publication status
Published
Language
English
Keywords
Non-government organization
Abstract
The view that NGO participation is essential to good policy making and implementation, is widely accepted and has been institutionalized in international agreements. In some cases this view is framed by anti-statist policies which support NGOs as part of an overall strategy towards non-state delivery of development; in others it is framed by those concerned with facilitating access of the poor and powerless. This paper considers the conditions under which NGOs can influence policy in the direction of equity; the skills required by NGOs in order to play this role; the strategies required in order to influence the policy process; and the legitimacy of NGOs as role-players in the policy process. The paper uses case studies for illustration, and draws conclusions about the challenges facing all those concerned with health and equity, regarding the role of NGOs in Southern Africa. The paper bases its arguments on a global context in which economic growth is understood as the means to reduce poverty, yet is associated with increased inequity and in which the promotion of citizenship in its fullest sense encompasses the goal of equity.
Country
South Africa
Publisher
University of the Witwatersrand
Theme area
Values, policies and rights
Title of publication The politics of health care in South Africa: A general overview
Date of publication
1988
Publication type
Publication details
Publication status
Publication status unknown
Language
English
Keywords
political economy, health
Abstract
Country
Unknown Country
Publisher
ASSA
Theme area
Values, policies and rights, Equity and HIV/AIDS
Title of publication Need for adequate AIDS policies in Southern Africa
Date of publication
1996
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
AIDS socio-economic effects
Abstract
This paper calls for development of adequate policies and strategies for an enabling environment to combat the socio-economic effects of HIV/AIDS in terms of the Southern African Trade Union Coordination Council draft regional code on AIDS and Employment. The AIDS crisis has brought out the inadequacies of the extended family in alleviating the situation. A mixture of financial difficulties, and a breakdown in the traditional obligation to care for extended family members has made it necessary to have some interventions which are guided by policies. Despite several countries having adopted some policies, enforcement measures and channels for redress are not so clear cut. In some instances, the bureaucracy discouraged people from seeking help.
Country
Publisher
Mimeo
Theme area
Equity and HIV/AIDS
Title of publication An overview of health reforms in Zambia
Date of publication
1995
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
Zambia; Health policy reforms; Health financing; Equity
Abstract
The document discusses the reforms introduced by the Ministry of Health in order to deal with the health situation which had led to the deterioration of the country’s health delivery system. The government articulated radical policy reforms, characterised by a move from an excessively centralised system to a more effective decentralised system in which the centre provides support and national guidance. Underlying these reforms was the desire to build effective leadership, accountability and partnership in order to provide equity of access to cost-effective quality health care as close to the family as possible.
Country
Zambia
Publisher
Republic of Zambia Ministry of Health
Theme area
Values, policies and rights
Title of publication The right to health in the Americas
Date of publication
Publication type
Report
Publication details
PAHE: A comparative constitutional study scientific publication 509 pp 12pp.
Publication status
Published
Language
English
Keywords
rights; health; constitutional rights
Abstract
The article explores the meaning of the term right to health, as it relates to the state’s role in assuring an individual right to health and the health of the nations. It analyses the modern concept of health, the distinction between public health and individual health care services, and the various elements of a “right to health”, the constitutional texts purporting to frame a “right to health”; and cursorily the national legislative policies towards public health and the provision of health care. Perfect health, particularly if defined as “a complete state of physical and emotional well-being”, is not a realistic goal: due to natural limitations, infinitives imposed by age, and untreatable maladies will prevent the individual entertainment of perfect health. While there is thus no real dispute about the duty of the state to safeguard the health conditions of society, there is certainly no uniformity on minimal standards or means of assuring them. No true agreement on a legal definition of health can be reached. Health may be defined in terms of prevailing standards.
Country
Zimbabwe
Publisher
PAHE
Theme area
Values, policies and rights
Title of publication Ends and means in public health policy in developing countries
Date of publication
1995
Publication type
Journal Article
Publication details
Health Policy 32
Publication status
Published
Language
English
Keywords
developing countries; public health; policy; equity
Abstract
International discussions of public health policy strategies in developing countries have been characterised by strong and conflicting positions. Differences regarding the means of health sector improvement can often be traced to differences about
the ends, that is, the goals of the health sector. Three types of health sector goals are reviewed; health status improvement, equity and poverty alleviation, and individual welfare (utility) improvement. The paper agrees that all three must be considered in developing health sector reform strategies in all countries. Highly normative policy positions often can be attributed a undimensional affiliation with one health sector goal and denial of the relevance of the others. The current global interest in using cost-effectiveness analysis to set national health priorities is assessed in light of this elect approach. Examples are provided of how a health sector strategy based on cost-effectiveness would give sub-optimal solutions. These examples include situations where a private health care sector exists and provides some degree of substitution for publicly provided services; significantly high income elasticities exist for health care such that higher income beneficiaries may differently capture public subsidies; and market failures exist in insurance. It
is argued that these conditions are virtually universal in developing countries. Thus national policy development should explicitly consider multiple goals for the health sector.
Country
Publisher
Health Policy
Theme area
Values, policies and rights
Title of publication Re-addressing equity: The search for the holy grail: The importance of ethical processes
Date of publication
1998
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
Health policy
Abstract
This paper specifically acknowledges the range of socio-political barriers to equityoriented health reforms and builds on an egalitarian perspective to equity. It has four starting points: (1) health inequity results from differences in health outcomes between groups that are unnecessary, avoidable and unfair; (2) Equity-promoting action in the health sector must put the needs and interests of the poorest and most vulnerable at their heart, as the relatively worse health outcomes of this group in comparison with other groups are most often a function of circumstances beyond their control; (3) Ill-health and poverty are inter-linked and so a concern for health demands the development of strategies to combat poverty rooted in analysis of the factors that influence the ability of the poorest individuals and groups to gain access to the range of resources which enable them to lead healthy lives; (4) The intended beneficiaries must be involved in identifying, formulating and implementing all equity-oriented health policy interventions as they always play a role in the implementation of any policy intervention, actively adapting and using it rather than passively receiving it. Overall, the paper is rooted in the
understanding that ethical processes are critical in promoting equity. At the heart of these processes is the pursuit of procedural justice, rather than only distributional justice, a fundamental respect for the innate worth of other people and a recognition of each citizen’s own responsibility to promote equity. The ‘public action’ required to secure this vision is, therefore, not solely the function of some combination of financing and provision reforms but, more importantly, a broader process of social change in which all groups play an active role. Perhaps the most critical factor underlying this public action is the development of an enabling state which protects and promotes the interests of the poor through
‘public interest’ institutions health care financing mechanisms and strategies are critically important to the promotion of equity goals. However, in contrast with recent reform packages, the perspective of this paper stresses the need to consider how such mechanisms can support ethical processes within the health system rather than how they can mobilise resources or promote efficiency. Such a perspective suggests that rather than promoting divisions between population groups in the level, quality or source of care, financing mechanisms should promote social solidarity and cohesive health systems which give special attention to the needs of the poorest through, in particular, cross-subsidisation between
population groups.
Country
Zimbabwe
Publisher
Centre for Health Policy (University of Witwatersrand) and LSHTM
Theme area
Values, policies and rights
Title of publication In defence and pursuit of equity
Date of publication
1997
Publication type
Document
Publication details
Publication status
Published
Language
English
Keywords
equity, efficiency, health care reforms
Abstract
The paper discusses the equity implications of efficient policies in health. The critique identifies weaknesses in efficiency driven approaches in narrowing the domain of health policy to health cared, in excessively orienting debates to new sources of revenue rather than adequately protecting existing public budget allocations, and in ignoring the broader relationships between public health provision, and household health and welfare. Efficiency approaches are further criticised for inadequately taking on board the capacities of systems and behaviours of people, and for being value neutral. The paper proposes that an equity driven approach promotes a broader vision for policy making and discusses how this would be defined and achieved.
Country
Zimbabwe
Publisher
Centre for Health Policy
Theme area
Values, policies and rights, Equitable health services
Title of publication Achieving health service equity: Dilemmas for policy makers
Date of publication
1993
Publication type
Journal Article
Publication details
South Africa Review 7 pp Unknown
Publication status
Published
Language
English
Keywords
South Africa; health services; equity, policy; health; review
Abstract
See 3.1.4
Country
South Africa
Publisher
Anonymous
Theme area
Equitable health services, Governance and participation in health, Monitoring equity and research to policy
Title of publication Comments and recommendations for next phase of equity work in Zimbabwe, Nyanga workshop on equity in health
Date of publication
1997
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
equity, health, Zimbabwe
Abstract
The paper reports on a workshop in August 1997, attended by parliamentarians, central and provincial-level health decision-makers, program managers, experts and representatives of relevant NGOs on equity in health in Zimbabwe. It was noted that Zimbabwean MoHCW needs to carry out a systematic process of field consultations involving appropriate stakeholders among the public and policy makers not only in the health care sector but in all the key sectors affecting health at the provincial/city and district levels. Provinces/cities and districts would develop their own strategic plans of action, within which they would set a limited number of specific, measurable equity targets to be achieved within the next 5-10 years, which they perceive as achievable despite likely resource constraints.
Country
Zimbabwe
Publisher
Mimeo Report
Theme area
Values, policies and rights
Title of publication Equity in health and health care: A WHO/SIDA initiative
Date of publication
1996
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
equity, health care, health
Abstract
Social gaps in health and in health care are unacceptably wide and are widening throughout the world. Developing countries and industrialised countries alike are finding it difficult to implement equitable policies and often feel caught between considerations of equity and short-term efficiency. This document describes an
initiative of the World health Organisation, with seed funds from the Swedish International Development Cooperation Agency, to place equity in health and health care higher on the public policy agenda and to evaluate and promulgate promising practical approaches to achieving equity in health development.
Country
Zimbabwe
Publisher
World Health Organisation
Theme area
Resource allocation and health financing
Title of publication Two models for change in the health services in Zimbabwe
Date of publication
1985
Publication type
Journal Article
Publication details
International Journal of Health Services 15 3 pp 451-468
Publication status
Published
Language
English
Keywords
Health services, Zimbabwe
Abstract
The health situation in pre-Independence Zimbabwe was much as elsewhere in the Third World. While the majority suffered excess mortality and morbidity, the affluent enjoyed a health status similar to that of the populations of developed countries. The health services also showed the familiar pattern, with expenditure concentrated on sophisticated facilities in the towns, leaving the rural majority with practically no services at all. With independence, the previous pattern of controlling access to facilities on the basis of race could not continue. Two broad routes forward were defined. On the one hand, the private doctors, the private insurance companies, and the settler state proposed a model on improving urban facilities, depending on a trickle-down to eventually answer the needs of the rural people. On the other hand, the post-independence Ministry of Health advocated a policy of concentrating on developing services in the rural areas. The pattern of the future health service will depend on the capacity of the senior health planners and on the enthusiasm of front-line workers but, of overriding importance will be the political commitment to answer the needs of the majority and the outcome of the inevitable struggle for access to scarce health sector resources.
Country
Zimbabwe
Publisher
International Journal of Health Services
Theme area
Governance and participation in health
Title of publication Problems and prospects for health sector: Links in the Southern African region: The role of South Africa
Date of publication
1993
Publication type
Journal Article
Publication details
Southern African Perspective pp 21pp.
Publication status
Published
Language
English
Keywords
health inequities; health services; South Africa; political economy
Abstract
Recent political developments in South Africa provide many opportunities for the development and extension of health sector links in the Southern African region and the possibility to move away from past hostilities towards a constructive future. The need to address health issues at an inter-government level is becoming more urgent as poverty, drought and homelessness take their toll on the health of the region’s population. The paper examines the prospects for and problems with regional integration in the health sector. It begins by outlining the historical context of regional sector links and discussing crucial issues that have to be addressed in relation to future regional activities. Proposed areas in the health sector that would benefit from cooperation, it is proposed that many of the crucial health issues affecting the region are inter-sectoral; such as nutrition, disease control and environmental health and require cooperation between sectors of government as well as between governments.
Country
South Africa
Publisher
University of the Western Cape
Theme area
Values, policies and rights, Health equity in economic and trade policies
Title of publication A national health plan for South Africa
Date of publication
1994
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
health planning, South Africa
Abstract
The challenge facing South Africa is to design a comprehensive programme to redress social and economic injustices. In the health sector this will involve the complete transformation of the national health care delivery system and all relevant institutions. The plan outlines the broad approach towards achieving this, as part of the broader Reconstruction and Development Programme.
Country
South Africa
Publisher
ANC
Theme area
Equity in health
Title of publication The concepts and principles of equity and health
Date of publication
1990
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
equity; health; determinants of health; monitoring and evaluation
Abstract
The 32 member states in WHO-European adopted a common health policy in 1980, followed by unanimous agreement on 38 regional targets in 1984. The first of these targets is concerned with equity, and it sets out that by 2000, the differences in health status between countries and between groups within countries should be reduced by at least 25% by improving the level of health of disadvantaged nations and groups. Equity is an underlying concept in many targets. At present, the targets are also being reassessed and revised, in other particular moving away from a focus on physical health status as measured by mortality to encompass, wherever possible, other dimensions of health and wellbeing. While Equity in health has been judged to be as important for the 1990s, it has not always been clear what is meant by equity. The paper sets out to clarify the concepts and principles. Differences in the health profiles of different nations and different groups within the same country are highlighted, as measured from standard health statistics. Not all of these differences can be described as inequities. Equal access to available care for equal need implies equal entitlement to the available services for everyone, a fair distribution throughout the country based on health care needs, ease of access in each geographical area, and the removal of other barriers to access. Differences in utilisation rates of certain services between different social groups, does not automatically imply inequity as there is need to ascertain why the rates are different. Where use of services is restricted by social or economic disadvantage, there is a case for aiming for equal utilisation rates for equal need. Equal quality of care, implies equal opportunity of being selected for attention through a fair procedure based on need rather than social influence. Equity does not therefore mean that everyone should have the same health status or consume the same amount of health service resources irrespective of need. Accepting equity as a goal is a stimulus to recognise and challenge the causes of inequities involving a range of levels and sectors of activity.
Country
Zimbabwe
Publisher
World Health Organisation Regional Office for Europe
Theme area
Equity in health
Title of publication Literature review: Equity in the health sector in developing countries: With lessons learned for sub-Saharan Africa
Date of publication
1995
Publication type
Journal Article
Publication details
BASICS project
Publication status
Published
Language
English
Keywords
Equity, health
Abstract
Country
Zimbabwe
Publisher
BASICS
Theme area
Equity in health, Monitoring equity and research to policy
Title of publication Quality-adjusted life years (QALYs) and the equity trade off
Date of publication
1991
Publication type
Journal Article
Publication details
Journal of Health Economics 10 pp 20pp.
Publication status
Published
Language
English
Keywords
Quality-adjusted life years; equity and efficiency; equality of access; equality of health; equity and choice.
Abstract
As the volume of research on quality-adjusted life years (QALYs) has increased, concern has begun to be expressed about equity aspects of resource allocation decisions based on this indicator. This paper suggests that a common theme running through the criticisms of the QALY approach is a concern about inequality. It also suggests that the method for incorporating distributional concerns which is currently being pursued by advocates of the QALY approach reflects a concern about inequality. It also suggests that the method for incorporating distributional concerns which is currently being pursued by advocates of the QALY approach will
not effectively capture concerns about inequality. The paper discusses whether the definition of equity can provide a basis for determining an equitable allocation of resources, whether there is a conflict between equity and efficiency and whether equity can be captured simply by weighting QALYs appropriately. The paper concludes that the social aversion towards inequalities in health outcomes. can be incorporated into resource allocation decisions.
Country
Unknown Country
Publisher
Journal of Health Economics
Theme area
Equity in health
Title of publication Explaining health inequalities: Beyond Black and Baker
Date of publication
1995
Publication type
Journal Article
Publication details
European Sociological Review 11 3 pp 219-237
Publication status
Published
Language
English
Keywords
Health inequalities; Poverty and health; Britain
Abstract
The paper examines the explanatory framework provided by the Black Report on ‘Inequalities in Health’. It also examines a new medical theory, praised as representing a paradigmatic shift in medicine, developed by the British epidemiologist David Baker. The answers given by Black and Barker to the above question are related and both are riddled with problems. The typology of four explanations introduced by Black reveals a number of unspoken sociological assumptions. The typology is sometimes obscuring, sometimes not helpful. The favoured explanation is also ambiguous, particularly since there is no clear idea about how poverty is translated into disease in modern society. Baker’s theory that disease results from poverty-driven ‘biological programming’ in foetus, or in infancy, moves the focus of explanation back to the social conditions that existed when the generations now living were born. The link between childhood conditions and adult health, however need not be biological in character. The authors suggest an alternative interpretation based on studying health inequalities across the life cycle and in their historical context. Co-evaluation of health and social achievement could provide an explanation beyond those of Black and Baker.
Country
Zimbabwe
Publisher
Oxford University Press
Theme area
Equity in health
Title of publication Equity and efficiency in health reform: A European view
Date of publication
1994
Publication type
Journal Article
Publication details
Social Science Medicine 39 9 pp 1203-1210
Publication status
Published
Language
English
Keywords
health care reform, equity, European health policy, cost containment
Abstract
Health care reform in both eastern and western Europe is on the agenda, and in both parts of Europe the importance of equity targets has been questioned. In the East, the previously strongly held equity goals were largely a facade, covering privilege systems brought equity as a concept into disrepute. Present developments mean that equity will be brought back on the agenda. In the West, equity has been linked to non-market systems of health care. In moving towards market systems, equity is perceived as conflicting with efficiency goals. This contra-positioning of equity and efficiency is based on confusing strategic goals with the implementation of those goals. Equity could be seen as a strategic goal in its own right while one may ask what are the most efficient ways of financing, managing and delivering medical services to achieve that goal. Clearly this has not been the question on the agenda. Cost containment has been imperative, and the consequences for general health, equity in health or the health and care for those suffering most, has been relegated to second place. The reduction of inequalities in health can be seen as an overall strategy for the improvement of a population’s health, and as helpful in the maintaining and improvement of its human capital. If the focus is on reducing inequality in health, however, policies other than those preoccupied with the financing, management and delivery of medical services must be given much more thought and a more strategic role. The concept of health reforms must embrace a wider range of policies and considerations than those of medical care reform.
Country
Zimbabwe
Publisher
Theme area
Equity in health, Resource allocation and health financing
Title of publication Policies for health sector development: Where does equity feature?
Date of publication
1997
Publication type
Conference Proceedings
Publication details
Paper delivered to conference on equity in Health: Policies for survival in Southern Africa, Botswana pp 13pp.
Publication status
Published
Language
English
Keywords
health sector development policies; equity in health
Abstract
The paper highlights similarities and differences between policies for health sector development in the countries of the region. It also explores the meaning of health sector development and the obstacles to such development. This leads a discussion of critical policy measures to overcome these obstacles. The author presents a conceptual framework to analyse health sector financing and looks at the impact that aspects of the public/private mix policy may have on health sector development and equity. The decline in the level of government funding for health services has had widespread impacts on public health services, affecting salary levels, maintenance and infra-structure provision, supervision and anagement, drug supplies and access to, and quality of, care more generally. This applies to almost all the countries of the region. While the policy of equal care for equal need is a noble goal that should be pursued by countries, poor countries facing increasing inequality must pursue a policy of distributive justice which holds as its first goal, that the well-being of the poorest should increase, but only as a secondary goal that the degree of inequality should be reduced. In brief, the principle is inequality can be tolerated only in so far as it increases the well-being of the worst.
Country
Zimbabwe
Publisher
Theme area
Equity in health
Title of publication What does equity in health mean?
Date of publication
1993
Publication type
Journal Article
Publication details
Journal of Social Policy 22 1 pp 19-48
Publication status
Published
Language
English
Keywords
equity, health
Abstract
Up until very recently, the international debate on health inequity tended to disregard the issue of specifying equity objectives precisely. This was unfortunate, given the importance of normative analysis for understanding why people care about social justice in the field of health; how the concept should be measured; and how rational policies may be formulated and monitored. This article critically appraises six well established approaches to defining equity-egality, entitlement, the decent minimum, utilitarianism. Rawlsian maximum, and envy-free allocations - as well as two alternative formulations recently proposed by health economists - equity as choice and health maximisation. All of these are found wanting in some respect when applied to the sector. It is argued that Sen’s capabilities concepts, strangely ignored by health services researchers in the past, could prove an effective framework within which to organise research and policy formulation in the area of health and health care inequality.
Country
Zimbabwe
Publisher
Cambridge University Press
Theme area
Equity in health, Resource allocation and health financing
Title of publication Equity in future South African health care: A tale of minimally decent Samaritans or good South Africans?
Date of publication
1998
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
Equity; health economics; South Africa, health values, health planning, health policy
Abstract
In the context of equity in any health care system, health policy makers will fail to build an equitable system of health care if they deny the importance of the health care system as a social institution. The paper describes a communitarian perspective on health care and its impact in creating a sense of community, to gain a greater recognition of the embeddedness of individuals in a community of citizens with shared values, here citizens of the new South Africa. What constitutes equity and an acceptable conceptualisation of equity, is determined socially. What constitutes minimal decency is dependent on the links and the relationship, between individuals in the group or community within which minimum decency is to be exercised. The paper argues that policy makers can get important new insights into policies for equity if they adopt or at least understand the communitarian perspective. Adopting such a stance means that it is not just that we are interested in social values and aggregation of individuals’ preferences, or whatever qua individuals but in these as part of community or society where the community itself is valued additionally to the individuals. Most important of all, if health policy makers can take up the challenges of communitarianism in health care, there may be hopes that such considerations might then spill over into other aspects of the economy and of social life more generally. The building of new alliances and of new alliances and of new communities in South Africa looks to be crucial for the development of a unified society - one nation - in the future and none more so than at the level of South Africa per se as a community. The paper argues that there can be few places that are better and potentially more fruitful to further this process than the South African health care system. The health services can act as a bridgehead in the building of that better and fairer community that will be the future South Africa.
Country
Zimbabwe
Publisher
University of Cape Town Medical School
Theme area
Equity in health
Title of publication Assessment and implementation of health care priorities in developing countries: Incompatible paradigms and competing social systems
Date of publication
1984
Publication type
Journal Article
Publication details
Social Science and Medicine 19 4 pp 373-384
Publication status
Published
Language
English
Keywords
health care, health, development
Abstract
Health care priorities in developing countries potentially destabilized by foreign development, agencies who interpret the miserable state of health prevailing in developing countries to avoid conflict with economic systems. In fact the pattern of public health in developing countries is specifically in related to their role in the division of labour, the alleviation of disease demands an alteration in the mode of production itself. In the context of under-development, increased productivity is at the necessary cost of public health. Orienting health care priorities in line with belief in the instruments of profit for eradicating the diseases of underdevelopment is counter-productive. This paper points out that developing countries suffer not only from the under-development of capitalism but also from its development.
Country
Zimbabwe
Publisher
Social Science and Medicine
Theme area
Equity in health
Title of publication Increasing global capacity to promote equity in health
Date of publication
1997 March
Publication type
Report
Publication details
Publication status
Published
Language
English
Keywords
health, equity, challenges
Abstract
Equity or fairness in health has and continues to be a driving force in health policy worldwide. National systems of health insurance emerged from a societal belief in the importance of equitable access to medical care. The World Health
Organisation’s mission of health for all by the year 2000 similarly reflects a global commitment to equity. Despite the attractiveness of this noble objective a number of disturbing signs prompt concern for the future status of equity in health. This paper focuses on three specific areas where knowledge generation is a prerequisite for developing a global capacity to promote equity in health: a global health equity initiative; ii. a socio-economic project and; iii. vital research capacity
for equity in health.
Inequities in health are frequently defined by drawing on a standard or basis of comparison such as socio-economic status, age-group, race etc. The choice of these variables reflects society’s general aversion to disparities in health within these domains. The challenge is, to understand the causes of these differentials. To what extent are they related to differences in genetic stock, access to medical car or health behaviour? In developed and developing countries alike, access to health care has not averted the trend towards increasing inequalities in health status, and fiscal constraints societies are forcing the public sector to down-size with few for those in need. Evidence suggests that factors such as employment grade, social hierarchy and social supports are major determinants of disparities in health status, while inequity and disparity are themselves factors shaping social and political integration and cohesion. If equity in health is to be achieved, the poor and less privileged need to be protected from the high costs of medical care through as free treatment and abolition of user fees in rural hospitals.
Governments are also compelled to continue funding the public health care delivery system to ensure that health remains within the means of every citizen.
Country
Zimbabwe
Publisher
Strategic Planning Team, Health Sciences Division, Rockefeller Foundation
Theme area
Equity in health, Monitoring equity and research to policy
Title of publication Promoting equity: A new approach from the health sector
Date of publication
1993
Publication type
Book
Publication details
Pan American Health Organisation; World Health Organisation pp 91pp.
Publication status
Published
Language
English
Keywords
risk; equity; targeting for health; disease; inequity; social patterns in health
Abstract
This book is about equity its promotion, measurement and the policy tools to promote it. The book uses experiences from urban areas of Brazil, in which a new information system was integrated into planning and decision making procedures. The system collected data from official and informal sources, together with simple surveys and observations based on rapid appraisal approaches. The information identified inequities, both objective and subjective. The authors noted that while society has incorporated universal values into their practices, what is regarded as inequitable in one society may not be seen in this way in another. Such universal values nevertheless provide guidance to policy makers and managers.
Country
Switzerland
Publisher
WHO
Theme area
Equity in health
Title of publication Equity and equality in health and health care
Date of publication
1993
Publication type
Journal Article
Publication details
Journal of Health Economics 12 pp 26pp.
Publication status
Published
Language
English
Keywords
Equity, equality, health care
Abstract
Country
South Africa
Publisher
Journal of Health Economics
Theme area
Equity in health, Resource allocation and health financing
Title of publication Efficiency and equity implications of the health care reforms
Date of publication
1994
Publication type
Journal Article
Publication details
Social Science and Medicine 39 9 pp 1189-1201
Publication status
Published
Language
English
Keywords
Health care reforms, accountability and equity, effectiveness, efficiency and
Abstract
The paper reflects on the recent health care reforms in both developed and developing countries, in the light of evidence that has accumulated over the last few years about the efficiency and equity of different fiscal and organisational arrangements. The scene is set by a brief review of the definitions of efficiency and equity and of the confusions that often arise; and of the problems of making assessments in practice with real data. Among OECD countries, there is little evidence that variations in the levels and composition of health service expenditure actually affect levels of health; equity in financing and delivery appears to mirror equity in other sectors in the same countries; about the only transferrable conclusion is that costs can be kept contained through global budgeting. In the OECD countries despite calls for ‘freedom’ to opt out, public finances continues to be preferred and evidence that health care markets can actually function is ‘weak’. Whilst geographical redistribution of finance has proved to be possible, inequalities in health remain in most countries. User charges in the South seem unlikely to raise a significant fraction of overall revenue; exemptions intended for the poor do not always work; and other trends are likely to exacerbate the patchy coverage of health care system. The final section reflects on the pressures for increased accountability. The emphasis on consumerism in the North has led to an increasing number of poorly designed ‘patient satisfaction’ surveys; in the South, there has been an increasing rhetoric on community participation, but little sign of actual devolution of control. Outcome measurement is strongly promoted but with little rigour.
Country
Zimbabwe
Publisher
Social Science and Medicine
Theme area
Equity in health
Title of publication Equity of access to medical care: A conceptual and empirical overview
Date of publication
1981
Publication type
Document
Publication details
Medical Care 19 pp 23pp.
Publication status
Published
Language
English
Keywords
equity, conceptual overview
Abstract
This paper summarizes the major ethical consideration in the conceptualisation and measurement of the equity of access concept, presents national and community data on the most current profile of access in the United States, and discusses the implications of these conceptual and empirical issues. Changes in health care policy and the future of the “equity of access” objective in the US are also discussed.
Country
Zimbabwe
Publisher
Theme area
Equity and HIV/AIDS
Title of publication Steering Committee Briefing: ART treatment access and effective responses to HIV and AIDS - Providing new momentum for accessible, effective and sustainable health systems, December 2003
Date of publication
2003 December
Publication type
Document
Publication details
Steering Committee Briefing pp 1-21
Publication status
Published
Language
English
Keywords
health sector responses to HIV/ AIDS; ART; vulnerable communities; southern Africa
Abstract
This briefing outlines the major findings and issues from work carried out in southern Africa on equity in health sector responses to HIV and AIDS, particularly in terms of access to antiretroviral treatment. It presents options drawn from the evidence and experience in the region of how to strengthen equity and include low income or more vulnerable communities in treatment access programmes.
Country
Southern Africa Regional
Publisher
EQUINET
URL:
Equinet Publication Type
Briefs, Policy brief
Theme area
Governance and participation in health
Title of publication Discussion Paper 13: Understanding mechanisms for integrating community priorities in health planning, resource allocation and service delivery: Results of a literature review
Date of publication
2003 October
Publication type
Document
Publication details
EQUINET Discussion Paper 13 pp 1-55
Publication status
Published
Language
English
Keywords
community participation, literature review, case studies, southern Africa
Abstract
The aim of this study was to review the evidence for community participation in health, in terms of community contribution to health planning, resource allocation, and service delivery. The review was seen more as an ‘exploratory’ than ‘systematic’ review, although in the end close to 100 studies were reviewed, mainly from the developing world. In selecting literature for inclusion in the review, the focus was on articles published in peer reviewed journals or technical research reports that in one way or another could provide information about equity and governance in health both in theory and practice as experienced in different countries and as discussed under the study sub-themes mentioned above. The reference information cited in this report was mainly taken from original research work and/or review papers that have been published in peer reviewed academic journals as well as specific chapters published in academic books, in addition to selected technical research reports. A framework developed by EQUINET was applied to evaluate a selection of successful case studies – evaluating community participation in terms of underlying factors, proximal factors, and outcomes. Topics that received special attention include: what is understood by community participation; the link between community participation, governance and equity in health; and factors explaining poor community participation, despite increasing emphasis on decentralisation and community involvement.
Country
Southern Africa Regional
Publisher
EQUINET, Swiss Tropical Institute, National Institute For Medical Research (NIMR)
URL:
Equinet Publication Type
Discussion paper
Theme area
Equity and HIV/AIDS
Title of publication Discussion paper 12: HIV/AIDS, equity and health sector personnel in Southern Africa
Date of publication
2003 September
Publication type
Document
Publication details
Discussion paper 12 pp 1-41
Publication status
Published
Language
English
Keywords
health personnel, HIV/AIDS, health sector responses, southern Africa
Abstract
This paper discusses the implications for health personnel of the HIV epidemic, and health sector responses to it, in southern Africa, using Malawi as a case study. Published and grey literature has been consulted to assess the situation and its implications for equity. Where data is not available at present, suggestions are made on the information needed and its collection. A more detailed briefing on case study data collection on HR issues has also been produced from this work.
Country
Southern Africa Regional
Publisher
EQUINET, Equi-TB Knowledge Programme
URL:
Equinet Publication Type
Discussion paper
Theme area
Equity and HIV/AIDS
Title of publication Discussion Paper 11: Equity issues in HIV/AIDS, nutrition and food security in Southern Africa
Date of publication
2003 September
Publication type
Report
Publication details
EQUINET Discussion Paper 11 pp 1-29
Publication status
Published
Language
English
Keywords
HIV/AIDS, nutrition, food security, health care services, southern Africa
Abstract
This paper argues that the traditional focus on efficiency has resulted in a narrow medical focus. The provision of free formula milk to some pregnant women who are HIV positive is an example of narrowly conceived policy that is actually increasing inequity. Women who have the resources to safely formula feed are provided with a substantial subsidy in the form of free formula milk. Meanwhile poorer women who cannot choose this mode of feeding are given nothing. A greater awareness of the synergy between nutrition, food security and HIV/AIDS could lead to more comprehensive policies, which encompass both greater efficiency and equity. Such an approach would be one in which prevention, treatment, rehabilitation and mitigation are combined in ways that will reduce vulnerability and susceptibility to the virus.
Country
Southern Africa Regional
Publisher
EQUINET, OXFAM, University of the Western Cape
URL:
Equinet Publication Type
Discussion paper
Theme area
Equity and HIV/AIDS
Title of publication Discussion paper 9: Zimbabwe's challenge: Equity in health sector responses to HIV and AIDS
Date of publication
2003 August
Publication type
Document
Publication details
EQUINET Discussion Paper 9 pp 1-40
Publication status
Published
Language
English
Keywords
public sector, private sector, quality of care, HIV and AIDS, ART programmes, Zimbabwe
Abstract
This paper discusses some of the equity concerns faced by the health sector in its response to access to treatment for HIV and AIDS in Zimbabwe. The review of treatment in Zimbabwe showed that there is more activity related to provision of treatment for AIDS than a year ago. Most of this has been undermined by the rapid decline in the quality of care provided within the public health service, financial instability in the private sector, and poor communication between the different interest groups in the field of HIV and AIDS. Doctors in the private sector are providing treatment for AIDS, but often in an unregulated, chaotic manner. ARVs are available in some pharmacies but the costs fluctuate with precarious foreign exchange rates, leading to inconsistent use. Several organisations are investigating the feasibility of establishing treatment programmes for the public sector. The review concludes that there is considerable momentum to establish ART programmes in Zimbabwe, mainly from the non-governmental sector. These efforts, however, cannot be extensive enough to provide for the majority of the people who need treatment, who would mainly be provided for through the public sector. An equitable national programme for HIV-related services, therefore, needs extensive international and national collaboration to mobilise the financial and technical resources required. Communication continues to be a major problem, with little information dissemination between key institutions and organisations, so that most interested parties struggle to find out what is happening either on the policy front or in practice. The time taken for programmes to be designed and implemented does not reflect the urgency of the HIV crisis in Zimbabwe.
Country
Zimbabwe
Publisher
EQUINET
URL:
Equinet Publication Type
Discussion paper
Theme area
Equity and HIV/AIDS
Title of publication Discussion paper 8: Equity in health sector responses to HIV/AIDS in Tanzania
Date of publication
2003 August
Publication type
Document
Publication details
EQUINET Discussion Paper 8 pp 1-27
Publication status
Published
Language
English
Keywords
inequality, HIV/AIDS prevalence, equity, Tanzania
Abstract
This paper presents an analysis of the manner in which economic and health inequalities in Tanzania influence equity in access to health care and responses to HIV/AIDS. It is estimated that globally there are 42 million people suffering from AIDS of whom 29.4 million are found in Sub- Saharan Africa. HIV/AIDS was first described in 1983 in Tanzania, and has since spread dramatically. The prevalence in Tanzania has been found to vary between 1.6% of the population in rural areas to 28.6% in urban areas.
Country
Tanzania
Publisher
EQUINET
URL:
Equinet Publication Type
Discussion paper
Theme area
Equity and HIV/AIDS
Title of publication Discussion paper 7: HIV/AIDS and health sector responses in South Africa
Date of publication
2003 September
Publication type
Document
Publication details
EQUINET Discussion Paper 7 pp 1-40
Publication status
Published
Language
English
Keywords
HIV/AIDS, inequity, poverty, South Africa
Abstract
South Africa is among the most inequitable countries in the world. Globalisation, the apartheid legacy, and a failure to implement government policies designed to redress past disadvantage, all contribute to inequity in access to basic social services, including healthcare and HIV/AIDS treatment and care. South Africa represents a highly symbolic case because of its ability to reflect the social and economic inequities that exist at the global level. Current estimates indicate that South Africa has the largest number of people living with HIV/AIDS in the world. About 5 million people are infected and HIV/AIDS is the leading cause of death in the country. The epidemic is severely affecting the future of many South African children, and accounts for almost 75% of all new orphans. HIV/AIDS is disproportionately affecting disadvantaged communities, the communities with least access to general treatment and care. There is evidence that many South Africans, particularly in rural areas, are pushed deeper into poverty as households lose their breadwinners and much of the household’s income is spent on healthcare. Women between the ages of 15 and 49 living in informal urban areas are most at risk.
Country
South Africa
Publisher
EQUINET, Health Systems Trust
URL:
Equinet Publication Type
Discussion paper
Theme area
Equity and HIV/AIDS
Title of publication Discussion paper 5: Equity in health sector responses to HIV/AIDS in Malawi
Date of publication
2003 August
Publication type
Document
Publication details
Discussion paper 5 pp 1-39
Publication status
Published
Language
English
Keywords
HIV/AIDS, health sector responses, ART access, Malawi
Abstract
This technical paper analyses the equity issues in HIV/AIDS health sector responses in Malawi, including access to ART. It is based on a review of published and grey literature on HIV/AIDS, health sector programmes and policies in Malawi. In addition informal meetings were held with 24 key informants representing a range of key stakeholders in HIV/AIDS, including: people living with HIV/AIDS (PLWHA); Non Governmental (NGO) and civil society organisations; and representatives from the Ministry of Health and Population, National AIDS Commission, donor organisations and development partners. The initial findings of this analysis were presented to a meeting of key stakeholders in HIV/AIDS on 2 July 2003, when recommendations and ways forward for promoting equitable public policy within the health sector were discussed.
Country
Malawi
Publisher
EQUINET; National AIDS Commission, Malawi
URL:
Equinet Publication Type
Discussion paper
Theme area
Health equity in economic and trade policies
Title of publication Discussion paper 6: Trade protocols and health: Issues for health equity in Southern Africa
Date of publication
2003 August
Publication type
Document
Publication details
EQUINET Discussion Paper 6 pp 1-36
Publication status
Published
Language
English
Keywords
GATS and TRIPS, WTO, Africa, NEPAD, national policy interests, regional integration, southern Africa
Abstract
SADC countries have to face a wide variety of challenges to improve the health of her people. This paper discusses the challenges posed by global trade under the World Trade Organisation, particularly through the agreements that more directly impact on health (including GATS and TRIPS). It highlights the responses to these challenges in Africa and their strengths and weaknesses, both in historical practice and in new policy developments such as NEPAD. The paper demonstrates the significant challenges that global trade and investment policies can and will have on health. It warns that to tap any opportunities from these agreements, countries need to be in a stronger position to protect national policy interests that are fundamental to equitable and sustainable development. This paper supports the thrust towards strengthened regional integration as a means to confronting these global trade and investment challenges, while also calling for more equity within the regional integration process. This is suggested to be necessary to share capacities, information and resources in the region and to build the market size, resource base, production systems and regional trade necessary for the more internally driven development, growth and trade path that will meet longer term development and health goals. At the same time it presents information that indicates that while regional integration is a policy goal, intraregional trade is still highly unequal and skewed towards a minority of stronger economies in the region.
Country
Southern Africa Regional
Publisher
EQUINET, SEATINI
URL:
Equinet Publication Type
Discussion paper
Theme area
Health equity in economic and trade policies
Title of publication Discussion paper 4: Neoliberalism and poverty reduction strategies in Africa
Date of publication
2003 March
Publication type
Document
Publication details
EQUINET Discussion paper 4 pp 1-34
Publication status
Published
Language
English
Keywords
neo-liberalism, poverty reduction, SAPs, Bretton Woods, southern Africa
Abstract
Macroeconomic trends that, in 2002, continue to bedevil Africa have deep roots. Some are two decades old, namely, the Structural Adjustment Programmes imposed on African countries by the World Bank and IMF, often with ‘homegrown’ orientations. But even deeper, it is crucial to recognise the political nature of the transition from colonialism to neo-colonialism in Africa.
Country
Southern Africa Regional
Publisher
EQUINET
URL:
Equinet Publication Type
Discussion paper
Theme area
Human resources for health
Title of publication Discussion paper 3: Health personnel in Southern Africa: Confronting maldistribution and brain drain
Date of publication
2003
Publication type
Document
Publication details
EQUINET Discussion Paper 3 pp 1-41
Publication status
Published
Language
English
Keywords
migration of healthcare workers, increasing inequity, skills loss, southern Africa
Abstract
The report provides evidence of inadequate ratios of personnel to population for key skilled health personnel, and a maldistribution of personnel along three different axes, between:
public and private heath sectors; urban and rural areas; and tertiary and primary levels of the health system. The report describes the exodus of healthcare workers from areas of poverty and low socio-economic development, to more highly developed areas. The flows follow a hierarchy of ‘wealth’ and result in a global conveyor belt of health personnel moving from the bottom to the top, increasing inequity. The report describes personnel flows and migration from rural to urban areas, from public to private sectors, from lower to higher income countries within southern Africa and from African countries to industrialised countries. International migration further increases and exacerbates inequities that exist between the public and private sector and between urban and rural areas. The knowledge and skills loss from the poorer to the richer countries is considered as a form of reverse (poor to rich) subsidy.
Country
Southern Africa Regional
Publisher
EQUINET; Health Systems Trust (South Africa); MEDACT (UK)
URL:
Equinet Publication Type
Discussion paper
Theme area
Health equity in economic and trade policies
Title of publication Discussion paper 2: A critique of uneven health outcomes and neoliberalism in Africa
Date of publication
2003 March
Publication type
Document
Publication details
EQUINET Discussion paper 2 pp 1-18
Publication status
Published
Language
English
Keywords
health systems, state policies, Bretton Woods Institutions, poverty, Highly Indebted Poor Countries, HIPC, southern Africa
Abstract
In the wake of the devastation wrought in Africa by two decades of ‘neoliberalism’--i.e., state policies that are market-oriented, export-led, subject to fiscal austerity and characterized by the commercialization/privatization of public sector functions--this question repeatedly arises: have matters improved now that the Bretton Woods Institutions (the World Bank and International Monetary Fund) and major donor governments are permitting countries to improve their state health systems and increase spending? And what are civil society watchdog groups and debt advocacy movements such as the Jubilee network saying about recent modifications to neoliberalism, especially the Poverty Reduction Strategy Papers and Highly Indebted Poor Countries debt relief initiative?
Country
Southern Africa Regional
Publisher
EQUINET
URL:
Equinet Publication Type
Discussion paper
Theme area
Governance and participation in health
Title of publication Discussion paper 1: Participation and accountability in health systems: The missing factor in equity?
Date of publication
2000
Publication type
Document
Publication details
EQUINET Discussion Paper 1 pp 1-27
Publication status
Published
Language
English
Keywords
governance systems, vertical equity in health, measures and mechanisms, health systems, social dimensions, Southern Africa
Abstract
This paper examines the features of social and governance systems that support vertical equity in health and their current application within health systems. It proposes measures and mechanisms that need to be included or strengthened within health systems if we are to enhance the relationship between citizen and state towards enhancing vertical equity. Finally it suggests further work towards strengthening the social dimensions of equity in health.
Country
Southern Africa Regional
Publisher
TARSC
URL:
Equinet Publication Type
Discussion paper
Theme area
Poverty and health, Resource allocation and health financing
Title of publication Policy paper 10: Geographic patterns of deprivation and health inequities in South Africa: Informing public resource allocation strategies
Date of publication
2000 August
Publication type
Document
Publication details
Policy paper 10 pp 1-56
Publication status
Published
Language
English
Keywords
measurement, equity, deprivation, ill-health, government resources, resource allocation, South Africa
Abstract
South Africa is a country with vast inequities in the distribution of income, in socioeconomic and health status and in access to key social services. Much of this inequity is attributable to the systematic dis-advantaging of certain race groups under apartheid. The post-apartheid government, under the leadership of the African National Congress, has committed itself to redressing these inequities. In a country such as South Africa where inequities are substantial, a vertical equity perspective, which prioritises human development benefits for the most dis-advantaged through the differential allocation of government resources, is arguably the most appropriate approach for effectively and speedily achieving equity gains.
While the primary underlying concern of this research is that of reducing inequitable health status differentials within South Africa, it does not focus simply on the allocation of health care resources. This is partly due to the fact that health is influenced by a range of factors other than health services, and particularly that there is an internationally established relationship between deprivation (or relative social and material dis-advantage) and ill-health. In addition, the allocation of centrally collected government resources in South Africa takes the form of block grants to individual provinces, which themselves determine allocations to the health and other social sectors. It is, thus, necessary to take a broader perspective than purely health resource allocation issues.
Country
South Africa
Publisher
EQUINET, Centre for Health Policy (Wits), Health Policy Unit (UCT), London School of Hygiene and Tropical Medicine, Health Financing and Economics Di
URL:
Equinet Publication Type
Policy paper, Equity indicators
Theme area
Values, policies and rights
Title of publication Policy paper 5: Health and human rights in Southern Africa?
Date of publication
2000 July
Publication type
Document
Publication details
EQUINET Policy Series 5 pp 1-33
Publication status
Published
Language
English
Keywords
health, human rights approach, service delivery, women, gender-based violence, HIV/AIDS, Southern Africa
Abstract
This paper explores the complex linkages between health and human rights, and ways in which a human rights approach may be used to address some health issues. The intersection of health and human rights particularly in service delivery is also explored to demonstrate some of the challenges of applying a human rights approach in the health sector. The paper begins by identifying to what extent women’s devaluation by society is addressed in international human rights agreements regarding violence and HIV prevention. It then moves to an analysis of the extent to which state parties in the Southern African Development Community (SADC) have developed policies that enshrine health-related rights, and specifically the recognition of gender based violence and the spread of HIV as reflecting a violation of sexual rights and requiring remedies in this area. The second part of the paper explores the extent to which a human rights approach to gender based violence and HIV prevention is being implemented through an interrogation of the values underlying health education materials produced by governments and NGOs in some Southern African countries. Finally, the paper considers to what extent mobilisation around human rights might be possible or helpful in achieving health goals.
Country
Southern Africa Regional
Publisher
EQUINET; Women's Health Project, University of Witwatersrand
URL:
Equinet Publication Type
Policy paper
Theme area
Health equity in economic and trade policies
Title of publication Policy paper 4: World Trade Organisation agreements: Implications for equity and health in Southern Africa
Date of publication
2000
Publication type
Document
Publication details
Policy paper 4 pp 1-33
Publication status
Published
Language
English
Keywords
impact of globalisation on health care, access to drugs, WTO,TRIPS, public health, pharmaceutical industry, Southern Africa
Abstract
The aim of this paper is to inform people in the health sector about the impact of globalisation on health care and access to drugs in developing countries. It is especially concerned about the World Trade Organisation’s (WTO) Agreement on Trade Related Aspects of Intellectual Property (TRIPS), which will have repercussions on public health and the pharmaceutical industry.
Country
Southern Africa Regional
Publisher
EQUINET, SADC Health Co-ordinating Unit
URL:
Equinet Publication Type
Policy paper
Theme area
Poverty and health
Title of publication Policy paper 3: A review of experience concerning household ability to cope with the resource demands of ill health and health care utilisation
Date of publication
2000 June
Publication type
Document
Publication details
Policy paper 3 pp 1-23
Publication status
Published
Language
English
Keywords
literature review, consequences of ill health, households, healthcare access, health policy, barriers to the poor, economic survival, South Africa
Abstract
This paper reviews the literature examining the resource consequences of ill health at the household level. It firstly examines the link between poverty and ill health, arguing that ill health is more likely to lead to further impoverishment amongst the poor than among the wealthy. The paper goes on to examine the different areas of research that have grappled with these issues.
Country
South Africa
Publisher
EQUINET, Centre for Health Policy (Wits)
URL:
Equinet Publication Type
Policy paper
Theme area
Equity in health
Title of publication Policy paper 2: Equity in health in Southern Africa: Overview and issues from an annotated bibliography
Date of publication
1998 May
Publication type
Document
Publication details
EQUINET policy paper series 2 pp 1-30
Publication status
Published
Language
English
Keywords
bibliography, health equity, Southern African Development Community, Southern Africa
Abstract
The annotated bibliography on Equity in Health in Southern Africa is the a compilation of publications related to equity in health in Southern Africa. It has been compiled by a network of institutions coming together as a result of the resolutions of the March 1997 Southern African meeting on Equity in Health held in Kasane, Botswana. This meeting, hosted by the National Institute of Development Research and Documentation (Botswana) and the Dag Hammarskjold Foundation (Sweden) gathered participants with backgrounds in government and non government organisations, academia and health professionals. All participants confirmed a commitment to equity in health as a policy goal for the Southern African Region.
Country
Southern Africa Regional
Publisher
Regional Network for Equity in Health in Southern Africa (EQUINET)
URL:
Equinet Publication Type
Policy paper
Theme area
Equity in health, Monitoring equity and research to policy
Title of publication Policy paper 1: Can research fill the equity gap in Southern Africa?
Date of publication
1999 September
Publication type
Document
Publication details
Policy paper 1 pp 1-15
Publication status
Published
Language
English
Keywords
national health care resources, ability to pay, public sector intervention, Southern Africa
Abstract
In March 1997, a range of people involved with the health sector gathered in Kasane, Botswana to discuss equity in health in Southern Africa. From politician to civic group member, from academic to health service provider, there was agreement across the group that equity in health was a desirable goal. In a region of deep structural inequality in wealth and opportunity, it was agreed that national health care resources should generally flow in a manner that would prioritise those with greatest health needs and with least ability to pay. While participants did not believe that everyone should have equal health status, it was perceived that differences in health status that are unnecessary, avoidable and unfair should be a target of policy attention and of public sector intervention. These differences assume significance as they are generally associated with high levels of deprivation and isolation from essential services were they exist. Equity has become one way of focusing public policy on unacceptable levels of poverty. It would seem from the Kasane meeting that equity in health is a shared value across the Southern African region. It is certainly articulated in post independence health policies in almost all countries of the region, and has been for two to four decades. How successful have we been in eliminating unnecessary, avoidable and unfair differences in health and in access to health care in the region? What are the potentials and constraints to more evenly spreading health sector gains across the region?
Country
Southern Africa Regional
Publisher
EQUINET, TARSC
URL:
Equinet Publication Type
Policy paper
Theme area
Values, policies and rights
Title of publication Policy paper 7: Equity in health in Southern Africa: Turning values into practice
Date of publication
2000 September
Publication type
Document
Publication details
Policy paper 7 pp 39pp.
Publication status
Published
Language
English
Keywords
inequality, southern Africa, market led reforms, policy commitment, implementation and planning
Abstract
All southern African governments have a policy commitment to equity in health. Whether under national liberation platforms, socialist and redistributive policies or market based liberalisation reforms, ‘equity’ has been a consistent aspiration of health systems. This signals a deeply rooted desire to better distribute the gains (and losses) of economic growth across the populations of the region, and to widen the social wellbeing of people in the region. Despite this, inequality persists, is exacerbated by HIV/AIDS, and is widening under market led reforms. These trends indicate that the consistent policy commitment to equity is inadequately translated into practice.
Why? Is it one of those policy priorities that is number one, after all the other number one priorities have been addressed? Is the evidence of inequity inadequate to inform planning or implementation of equity oriented policies? Is it a question of how resources and capacities are allocated and used, within and beyond health systems, or is it that the voices that need to remind us about equity goals become a distant hum when decisions on resources are made?
Country
Southern Africa Regional
Publisher
EQUINET
URL:
Equinet Publication Type
Policy paper
Theme area
Resource allocation and health financing
Title of publication Policy paper 8: An examination of public sector subsidies to the private health sector: A Zimbabwe case study
Date of publication
2000 September
Publication type
Document
Publication details
Policy paper 8 pp 1-26
Publication status
Published
Language
English
Keywords
private sector, subsidies, equity, Zimbabwe
Abstract
A baseline qualitative study was undertaken in Zimbabwe to examine and assess the impact of subsidies on equity when provided as private sector support instrument by the government. The study also considered reciprocal subsidies from the private sector.
Country
Zimbabwe
Publisher
EQUINET, University of Zimbabwe Medical School
URL:
Equinet Publication Type
Policy paper
Theme area
Resource allocation and health financing
Title of publication Can the poor afford ‘free’ health services? A case study for Tanzania
Date of publication
1992
Publication type
Journal Article
Publication details
Health Policy and Planning 7 4
Publication status
Published
Language
English
Keywords
user fees; Tanzania; equity; health services
Abstract
This paper reports on research undertaken for the Government of Tanzania to investigate the case for the introduction of user charges in the health services. A parallel report is being completed on the potentiality of compulsory health insurance for those in regular employment. Five studies were undertaken at the national level. The main studies were interviews of nearly 900 outpatients at the main hospitals and interviews with over 1 800 households all over the country with access to both government and mission hospitals. Information was collected on travel time, travel costs, and waiting time, which health facilities were chosen and why the cost of using them, and difficulty in finding the money to pay and willingness to pay user charges. The most important conclusion was that the because of inadequate supplies of drugs and of food at hospitals many patients had to incur substantial sots to use the ‘free’ services in addition to travel costs. It is therefore concluded that modest charges with attempts to exempt the poor would be less inequitable than the existing situation, if the revenue could be used to ensure that supplies were always adequate at government health services. The level of charges suggested was based on what the majority surveyed said they were willing to pay.
Country
Tanzania
Publisher
Equinet Publication Type
Reports, Policy paper
Theme area
Equity in health, Equitable health services
Title of publication Issues of equity in and access to health care in Zimbabwe
Date of publication
1990
Publication type
Journal Article
Publication details
Journal of Social Development in Africa 5 1 pp 31-38
Publication status
Published
Language
English
Keywords
equity, health care, Zimbabwe
Abstract
This paper identifies and analyses, within the health care delivery system in Zimbabwe, certain categories of people or social groups who may or may not have access to health care. The paper gives the reasons for the maldistribution of health resources and the implications this has for the population of Zimbabwe. Solutions are proposed within the socio-economic and political context of the Zimbabwean stage of development and its historic past.
Country
Zimbabwe
Publisher
Journal of Social Development in Africa