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.
Health equity in economic and trade policies
This Oxfam report timed for the World Economic Forum (WEF) in Davos raised that unless bold political solutions are instituted to curb the influence of wealth on politics, governments will work for the interests of the rich, while economic and political inequalities continue to rise. In the report Oxfam called for those in the WEF to not dodge taxes in their own countries or in countries where they invest and operate, by using tax havens; not use their economic wealth to seek political favours that undermine the democratic will of their fellow citizens; to make public all the investments in companies and trusts for which they are the ultimate beneficial owners; to support progressive taxation on wealth and income; to challenge governments to use their tax revenue to provide universal healthcare, education and social protection for citizens; and to apply a living wage in all the companies they own or control.
The South African (SA) government has implemented comprehensive tobacco control measures in line with the requirements of the Framework Convention on Tobacco Control. The effect of these measures on smoking prevalence and smoking-related attitudes, particularly among young people, is largely unknown. This paper describes the impact of a comprehensive health promotion approach to tobacco control amongst SA school learners with evidence from four successive cross-sectional Global Youth Tobacco Surveys (GYTSs) in 1999, 2002, 2008 and 2011 among nationally representative samples of SA grades 8 - 10 school learners. Smoking-related attitudes and behaviours showed favourable changes over the survey period. The surveys demonstrated that the comprehensive and inter-sectorial tobacco control health promotion strategies implemented in SA have led to a gradual reduction in cigarette use amongst school learners. Of concern, however, are the smaller reductions in smoking prevalence amongst girls and black learners and an increase in smoking prevalence from 2008 to 2011. Additional efforts, especially for girls, are needed to ensure continued reduction in smoking prevalence amongst SA youth.
Alcohol was the cause of nearly five million deaths globally in 2010, an increase of over one million deaths recorded ten years earlier. It was the leading risk factor for disease in southern sub-Saharan Africa (SSA). Several factors account for the increasing harm associated with alcohol in Africa among which are the availability of a wide variety of alcoholic beverages, rising urban populations, more disposable income to purchase alcohol, and unrestrained marketing and promotion of alcohol. Using a variety of strategies, producers of alcohol target young people and women with aspirational messages and other exhortations in an onslaught of marketing and promotion. The author argues that missing in the discussion on alcohol in most African countries is the understanding that alcohol marketing is not an ordinary economic activity and that the business of alcohol (an addictive substance with high potential for harm) can subvert individual rights and democratic principles. This paper discusses these issues with particular attention to the harms caused by alcohol (to drinkers and non-drinkers alike), the potential for far-reaching harms to individuals and the society at large if the present scenario continues, and how these harms can be averted or minimized with the implementation of evidence-based policies.
The idea that Africans have never had it so good is rapidly becoming economic orthodoxy. This article comments that foreign investors, media and politicians from William Hague to Jacob Zuma have championed a narrative usually summed up in two words: "Africa rising". However the author asserts that the majority of Africans themselves feel that the picture is far less rosy, complaining that the continent's much vaunted economic growth is failing to trickle down to their daily lives, according to the biggest survey of its kind. "After a decade of growth in Africa, little change in poverty at the grassroots," is the title of a report by the Afrobarometer research project, covered in the article which questioned 51,605 respondents in 34 countries from October 2011 to June this year. He reports critics who have warned that the boom is benefiting only a narrow elite while leaving the poor and jobless behind, exacerbating inequality and potentially sowing seeds of unrest. The wave of "Afro-optimism" should be qualified, they argue.
The East African Community (EAC) modeled on the EU has enormous potential and resources. Resolving political differences and harmonizing with other regional blocks remains the foremost challenges. The East African Community (EAC) heads of state are due to sign a monetary union paving a way for a single currency for Uganda, Kenya, Tanzania, Rwanda, Burundi and those other countries that will join the community later on. The benefits of monetary union include a single currency; low transaction costs for business people; tuition and visa fees of the same value in all the countries; amongst others. The author explores the geopolitical, demographic and resource potentials for the east African community. The paper also argues that there is no single formula for regional integration. Rather than being competitors, the various regional blocks provide avenues for more complex and beneficial collaboration in the continent.
According to 2012 estimates, internet penetration in Africa has reached 15.6%. Though the actual number of people on whom the internet has an impact is undoubtedly much higher, this statistic does demonstrate a significant infrastructural disparity between Africa and other continents. Currently, this connectivity gap is being filled by other media, such as in the astonishing growth rate in the African mobile market. Radio remains one of the cheapest, most versatile and most widespread forms of mass communication there is and a powerful tool for African educators, despite its lack of interactivity. In this paper the author explores the opportunities of combining the pervasiveness of radio with the enhanced connective power of the internet. The paper describes trials to test the viability of white space broadband technologies to extend information access in several African countries in schools, healthcare centres and libraries.
Global spending on prescription medicines will accelerate next year to exceed $1tn for the first time, fuelled by the launch of more innovative drugs and rising health expenditure in emerging markets led by China. The rise was projected by the IMS Institute for Healthcare Informatics. The rise is attributed in part to emerging markets, where rising demand for healthcare paid out of pocket by the growing middle class is being matched by an expansion in universal health coverage programmes to extend provision, with targeted public health policies such as rising vaccination rates. The jump comes at a time of growing use of cheaper off-patent generic medicines, predicted to grow from 27 per cent to 36 per cent of the global market by 2017 and as high as 63 per cent in the fast-growing emerging economies. The report projects that two-thirds of the total medicines market in 2017 will be accounted for by the eight markets of the US, France, Germany, the UK, Italy and Spain, as well as China and Japan, which will also be responsible for nearly 60 per cent of the total growth in spending.
Emerging regional powers in the South have produced powerful finance capitalists. In this paper an example is given of an Egyptian firm buying land, rights to water and precious metals in other African countries. Consolidation of the formal economies of Southern countries has meant not only expansion into existing markets but ‘diversification’ into new markets, domestically and regionally. Allied with global governance institutions, the author argues that such finance capitalists represent greater control over vital resources and distribution routes for private wealth accumulation.
External challenges to health systems, such as those caused by global economic, social and environmental changes, have received little attention in recent debates on health systems’ performance in low-and middle-income countries (LMICs). One such challenge in coming years will be increasing prices for petroleum-based products as production from conventional petroleum reserves peaks and demand steadily increases in rapidly-growing LMICs. Health systems are significant consumers of fossil fuels in the form of petroleum-based medical supplies; transportation of goods, personnel and patients; and fuel for lighting, heating, cooling and medical equipment. Long-term increases in petroleum prices in the global market will have potentially devastating effects on health sectors in LMICs who already struggle to deliver services to remote parts of their catchment areas. The authors propose the concept of “localization,” originating in the environmental sustainability literature, as one element of response to these challenges. Localization assigns people at the local level a greater role in the production of goods and services, thereby decreasing reliance on fossil fuels and other external inputs. Effective localization will require changes to governance structures within the health sector in LMICs, empowering local communities to participate in their own health in ways that have remained elusive since this goal was first put forth in the Alma-Ata Declaration on Primary Health Care in 1978. Experiences with decentralization policies in the decades following Alma-Ata offer lessons on defining roles and responsibilities, building capacity at the local level, and designing appropriate policies to target inequities, all of which can guide health systems to adapt to a changing environmental and energy landscape.