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.
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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.
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.
This critical assessment of different health financing options in east and southern African countries is being commissioned by the Regional Network for Equity in Health in East and Southern Africa (EQUINET) through and in collaboration with key regional partners. It aims to inform policy makers on the positive and negative implications and issues to consider in applying the different domestic public health financing options current being explored, advocated and implemented in east and southern Africa - including mandatory national health insurance; social health insurance, community based health insurance, voluntary insurance, earmarked taxes, wealth taxes, other direct/ indirect taxes and other sources. Read more at the link shown.
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.
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.
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.
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.
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.
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.