Latest Equinet Updates

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.

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.

EQUINET in co-operation with ECSA-HC have, with government and researchers in five countries, carried out review and field studies on the implementation of incentives for health worker retention and of their impact on the adequacy and distribution of health workers. A regional meeting will be held in February 2009 to review this work and other work on health worker migration and distribution in EQUINET in Windhoek Namibia, locally hosted by the University of Namibia. If you are interested in this meeting please contact us at admin@equinetafrica.org, using "HCW Retention meeting" in the subject line.

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). It draws on country case-studies and a collaborative cross-country analysis undertaken at an EQUINET workshop. Health care financing issues are considered through an equity lens, with a focus on revenue collection, pooling of funds and purchasing. There remains a heavy dependency on donor funding in several countries. 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).