This review examines the impact of global health initiatives (GHIs) on health equity, focusing on low- and middle-income countries. It is a summary of a literature review commissioned by the WHO Commission on the Social Determinants of Health. GHIs have emerged during the past decade as a mechanism in development assistance for health. The review focuses on three GHIs: the US President’s Emergency Plan For AIDS Relief (PEPFAR), the World Bank’s Multi-country AIDS Programme (MAP) and the Global Fund to Fight AIDS, TB and Malaria.
Equity in Health
How have global health initiatives impacted on health equity?
Hanefeld J:Promotion and Education 15(1): 19-23, 2008
Public health sector slammed
Ngcobo M: Health-E News, 4 August 2008
The public health sector in South Africa has come under criticism over poor services and the failure to implement government policies effectively. The past 14 years have seen a widening gap between the private and the public health care sectors with the latter struggling to provide quality service, thus making it difficult for most South Africans who don’t belong to medical aid schemes to access quality health care. Advocate Khaya Zweni, a lawyer with the Human Rights Commission (HRC), says most are not happy with the service offered by public health care institutions. Following numerous complaints from the public, the Human Rights Commision conducted a survey in more than 90 public health institutions countrywide. Dr Anban Pillay, the Department of Health's cluster manager for health economics, believes that the problems in health delivery could be dealt with if the department is allocated a bigger budget by Treasury. ‘The problem with the public sector relates to a lack of funding. That lack of funding needs to be corrected. We are currently at the 11% of government expenditure on health care. We need to get around 15%. That’s what the government needs to do,’ Pillay said.
UN calls for increased support for breastfeeding mothers
UNICEF, 31 July 2008
The United Nations Children’s Fund (UNICEF) and the World Health Organisation (WHO) is urging increased support for breastfeeding mothers since the practice has been shown to slash deaths by more than 10% in infants in developing countries. Despite advances in the past 15 years, only 38% of infants under six months of age in the poorer nations are exclusively breastfed, a practice which could curb infant mortality. Various studies have shown that the number of months which mothers breastfeed – especially exclusively – can be extended by education and support. The practice can reduce the number of deaths caused by acute respiratory infection and diarrhoea, as well as other infectious diseases. It also improves mothers’ health and strengthens the bond between mother and child. ‘There is a double message here: it is not enough to say that breastfeeding is an ideal source of nourishment for infants and young children; mothers also need support to make optimal breastfeeding practices a reality,’ WHO Director-General Margaret Chan said.
Long-term food security: Investing in people and livelihoods: Five-year strategic framework on food security for Africa 2008-2012
Red Cross and Red Crescent Centre on Climate Change and Disaster Preparedness, 2008
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.
The persistence of child malnutrition in Africa
id21HealthNews 131, July 2008
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.
'Primary health care remains the best tool to achieve health equity'
People's Health Movement, June 2008
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.
Equitable access: good intentions are not enough
Wells R and Whitworth J: Global Forum Update on Research for Health 4: 152-153
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?
Inequalities in selected health-related Millennium Development Goals indicators in all WHO Member States
Kirigia DG and Kirigia JM: African Journal of Health Sciences 14(3-4):171-186, 2007
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.
Millennium Development Goals: Progress and prospects for meeting child survival targets in South Africa
Sanders D, Reynolds L, Westwood T, Eley B, Kroon M, Zar H, Davies M, Nongena P, van Heerden T, Swingler G: Critical Health Perspectives 1, 2008
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.
Ouagadougou Declaration on Primary Health Care and Health Systems in Africa: Achieving better health care for all in the new millennium
International Conference on Primary Health Care and Health Systems in Africa, Ouagadougou, Burkina Faso, 28-30 April 2008
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.