Sub-Saharan Africa is not on track to achieving a single Millennium Development Goal, and is the only region in the world where malnutrition, an outcome of food insecurity, is not declining. This paper presents the Red Cross Red Crescent five-year strategic framework on long-term food security for Africa. Guided by the 2000 Ouagadougou Declaration and the Algiers Plan of Action 2004, it aims to reduce food insecurity in communities vulnerable to disasters and/or affected by HIV/AIDS. The paper notes that interventions will be evidence-based and will be driven by good practice developed both internally and externally. Programmes will be developed with the full consultation and participation of vulnerable communities in order to ensure that programmes build on the existing assets, capabilities and priorities of the communities and are owned by them.
Equity in Health
Malnutrition affects about 30% of children in Africa, caused by low birth weight and post-natal growth faltering. Child malnutrition is a persistent problem. The long term trend shows only slow improvement, and malnutrition rates worsen during droughts, economic crises, conflicts and displacement, and HIV. Without greater attention to nutrition, increased child mortality, morbidity and impaired intellectual development are inevitable. Policies must tackle intermittent crises through emergency programmes and support sustained community-based programmes. Nutrition should be reinstated as a priority programme area alongside HIV, tuberculosis and malaria.
This is the interim position paper of the People's Health Movement (PHM). The comprehensive Primary Health Care (PHC) approach articulated at Alma Ata remains as relevant today as it was 30 years ago. It was never really implemented to reflect its true spirit, i.e. the basic intent of the Alma Ata Declaration which highlighted the need for a new international economic order to ultimately solve inequities in health. A PHC policy for 2008 and beyond needs renewed commitment, which, while affirming the fundamental positions of thirty years back, also takes into account the new realities of this age. In its renewed commitment to PHC in 2008, PHM vies to address the obstacles that have blocked PHC's implementation so far and is furthermore committed to incorporate into it the new challenges that have emerged since 1978. PHM is committed to promote the still unshaken basic principles of the Alma Ata Declaration - way beyond its original eight technical components. PHM insists that PHC is to be embedded in the social and political processes in each specific context where it is applied.
Most countries do not have universal health insurance and for most people living in countries without universal access, particularly the poor, illness is a substantial financial burden, and indeed often a crippling burden. Paradoxically, a far greater proportion of out-of-pocket spending occurs in those countries least able to afford it. Inevitably, health care, far from being a basic human right, is simply beyond the reach of many. These problems are magnified in lower- and middle-income countries. For example, in Tanzania a 1997 scheme to implement evidence based health plans at an estimated cost of US$2 per capita was limited by inadequacy of infrastructure and capacity. These difficulties are particularly evident where there is increased spending on vertical programmes in areas of limited capacity and infrastructure, limiting resources available to the system as a whole. In light of this, this article highlights some key questions for tackling equity in health, including: 1) What do we mean by equity? Which aspect has primacy -dollars spent or health status or health outcomes? 2) How do we determine what is a reasonable amount to spend (or invest)? How can this best be contextualised and harmonised with other government priorities? 3) Would there be more equitable access to health services if governance and decision-making were more open to input by community stakeholders? 4) Given the resource and other infrastructure constraints, particularly in poorer countries, what are the most appropriate health care delivery models for a country to adopt?
The objective of this study was to quantify inequalities in selected Millennium Development Goal (MDG) indicators in all the 192 WHO Member States using descriptive statistics, the Gini coefficient and the Theil coefficient. The data on all the indicators were obtained from The World Health Report 2004. The main findings were as follows: (i) generally, all the MDG indicators are significantly worse in low-income countries than in the other three income groupings; (ii) for all the MDG indicators, there are inequalities within individual countries, within the four income groups, and across income groups of countries; (iii) the inequalities in the MDG indicators are higher among the low-income countries than in high-income countries; and (iv) the ranking of income groups, by various indicators, is fairly stable whether one employs the Gini coefficient or Theil coefficient. Member States striving to expand the effective coverage of heatlh strategies and interventions need to do this in a manner that redresses the inequalities in various MDG indicators, and to monitor aggregate changes in MDG indicators and inequalities across the various income quintiles. The lessons learnt from the monitoring should inform the design and targeting of MDG-related policies, strategies and interventions to eradicate inequalities.
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 target. Yet, in contrast to most countries, the U5MR in South Africa is rising rather than declining. Based on current trends, unless urgent measures are taken to address the main causes of death, South Africa has little hope of reaching the MDG target. To inform intervention, this article undertakes a critical examination of the determinants of under-5 mortality.
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.
The 61st World Health Assembly, which comprised of a record 2704 participants from 190 nations, set WHO on a course to tackle longstanding, new and looming threats to global public health. Among its achievements, the Health Assembly provided a platform for removing barriers and using innovative methods to encourage research, development and access to medicines for the common diseases of the developing world.
The conditions in which people live and work - the social determinants of health - help enhance or erode their health. At the direction of Health Assembly in 2005, the Commission on Social Determinants of Health has been examining these factors. The chair of the commission, Professor Sir Michael Marmot briefed delegates on the key recommendations of the commission's work. He said the commission's final report will pose recommendations under three action areas: the conditions of daily life; the structural drivers of those conditions; and the monitoring and training needed to measure progress. Concrete examples of implementing a social determinants approach to health were given from Brazil, Finland, India and Sri Lanka, as well as the International Organization of Migration. A common theme throughout the briefing was the need for more participation and representation from all stakeholder groups in these debates.
The delegates to the recently concluded National Meeting to assess the progress of equity in health in Uganda identified six areas for follow up work on equity for health in Uganda. These areas include: resource mobilisation and allocation to the health sector; health needs of the vulnerable groups; trade and health; governance and health rights. The meeting was organised by HEPS-Uganda and Makerere University School of Public Health, in co-operation with Regional Network for Equity in Health in East and Southern Africa (EQUINET), March 27-28, 2008. The meeting was convened to, among other things, review the gaps and needs in the health sector in Uganda; and to develop ways to strengthen networking and communication between people and institutions working in areas relevant to health equity.