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Latest Equinet Updates
EQUINET Policy brief 28: Implementing the WHO Global code of Practice on the International Recruitment of health Personnel in Africa
SEATINI, ACHEST AND TARSC: 2011
The World Health Organisation (WHO) Global Code of practice on the international recruitment of health personnel was adopted by the 63rd World Health Assembly in May 2010 in response to the intensifying movement of health workers, especially from low to high income countries. This movement of health workers aggravates inequity, particularly with regard to the number of health workers relative to health need. The WHO Code is a voluntary ethical framework. This policy brief looks at the developments in Sub-Saharan Africa since the adoption of this code with regards to its implementation. It presents the activities required to monitor its implementation and what actions have so far been implemented.
EQUINET Discussion Paper 88: Research to support strategic leadership in global health diplomacy in east, central and southern Africa
Loewenson R, Machemedze R and Manyau E: November 2011
This publication reports from stakeholders the information and knowledge gaps and research priorities on global health diplomacy (GHD) in Africa to inform regional discussion on a research agenda for GHD. The findings indicate that research on GHD should identify factors that support the effectiveness of GHD in addressing selected key challenges to health strengthening systems in Eastern and Southern Africa, in a way that strengthens the capacity of key African policy actors and stakeholders within processes of health diplomacy. . The findings indicate a preference from officials and policy makers to do this in three broad areas: i. Firstly, to explore the implementation of existing global commitments in the region, to learn lessons from the current experience, generate evidence for input to monitoring and review of the commitments, and to inform future health negotiations. ii. Secondly, to explore the extent to which African interests are advanced in areas under global health negotiation, to assess the implications, costs and benefits of specific issues for the diverse countries in the region, and the different negotiating positions of countries in and beyond the region. iii. Thirdly to explore how effectively interests in the region are being represented in the current global architecture and governance, including of the global initiatives that fund health, to inform African engagement on global governance reforms.
Equity Watch: Assessing progress towards equity in health, Uganda, 2010
Zikusooka CM, Loewenson R, Tumwine M and Mulumba M: November 2011
The Equity Watch monitors progress in areas of equity in health, household access to the resources for health, equitable health systems and global justice. This report provides evidence on the performance of Uganda’s public policies and systems in promoting and attaining equity in health using the Equity Watch framework. The evidence presented in this report indicates progress in some key areas, such as in closing social and geographical gaps in access to education, safe water, immunisation and other areas of primary health care. It also highlights challenges, including in coverage of maternal health services and in the distribution of health workers.
Clarity and contradiction at the World Conference on the Social Determinants of Health
Loewenson R: Health Diplomacy Monitor 2(5): 8-11, November 2011
At the World Conference on the Social Determinants of Health, held in Rio de Janiero Brazil from 19-21 October 2011, reports from countries indicated a promising range of actions being taken to assess or monitor equity and the social determinants of health (SDH), measures to plan and review action on SDH, as well as actions to strengthen constitutional protection of the right to health and to strengthen intersectoral action and comprehensive primary health care. However, few countries reported on actions on economic determinants, and countries that have regulated commercial interests for public health reasons, such as introducing taxes on foods high in fat or sugars, or in implementing legal controls over tobacco, allege they have faced counter litigation from companies. Despite persuasive evidence, health equity has been a marginal consideration in trade, economic or climate forums. Public health advocates argue that equity should be included at the centre of wider economic, trade and development agendas, including the UN Conference on Sustainable Development in June 2012 (Rio+20) and the UN Millennium Development Goals. While a task force of UN agencies was set at the WCSDH, key economic and trade agencies were not present.
Equity Watch: assessing progress towards equity in health in Zimbabwe
Training and Research Support Centre; Ministry of Health and Child Welfare Zimbabwe; EQUINET: November 2011
This report updates the 2008 Zimbabwe Equity Watch report using a framework developed by EQUINET in cooperation with the eastern, central and southern African health community and in consultation with WHO and UNICEF. The report introduces the context and the evidence within four major areas: equity in health, household access to the resources for health, equitable health systems and global justice. It shows past levels (1980–2005), current levels (most current data publicly available) and comments on the level of progress towards health equity. The 2011 Equity Watch indicates that improvements have been made in priority areas identified in the 2008 Equity Watch report, such as in primary education, in supplies of medicines and staff to primary care and district levels, in immunisation coverage, in access to antiretrovirals, and in recognition and support of community capacities for health. Nevertheless, the report shows that poverty and inequality in wealth remain high. Economic inequality affects access to key inputs to health, like improved incomes or safe water and the uptake of health services.
Policy Brief 26: Expansion of the private for-profit health sector in East and Southern Africa
Doherty J, EQUINET: November 2011
In recent years there has been increased private for-profit health sector activity in certain countries in East and Southern Africa. External funders and governments have subsidised some of these activities. Private ‘high-end’ hospitals have begun to service wealthy groups, even in very low income countries. A report published in 2007 by the World Bank’s International Finance Corporation (IFC) encouraged governments to facilitate further private sector growth. This policy brief explores these developments in East and Southern Africa. In contrast to the IFC report, it raises concerns about the adverse consequences of growth in the private for-profit sector, and proposes steps that Ministries of Health should take to protect the integrity and equity of their health systems.
Policy Brief 27: Constitutional provisions for the right to health in east and southern Africa
Mulumba M, Kabanda D, Nassuna V and Loewenson R, EQUINET: November 2011
The extent to which health rights are neglected or promoted is a major factor in the promotion of health equity in Africa. Central to this is the incorporation of the right to health in the national Constitution, as the supreme law of the country. Including the right to health as a constitutional right provides a bench mark for government, private sector and society to respect, protect, fulfil and promote it. In many countries in east and southern Africa (ESA) there is advocacy and debate on inclusion in the constitution of the right to health. This brief presents a review of how the constitutions of 14 countries covered by EQUINET include the right to health. It uses as a framework the six core obligations spelt out in General Comment 14 of the International Covenant on Economic and Social Rights (ICESR).
Raising the profile of participatory action research at the 2010 Global Symposium on Health Systems Research
Loewenson R, Flores W, Shukla A, Kagis M, Baba A, Ashraf R et al: MEDICC Review 13(3): 35-38, July 2011
By involving citizens and health workers in producing evidence and learning, participatory action research has potential to organise community evidence, stimulate action and challenge the marginalisation that undermines achievement of universal health coverage, the authors of this paper argue. They begin by summarising and analysing the results of two sessions on this research model convened by the authors at the First Global Symposium on Health Systems Research in Montreux Switzerland, 16–19 November 2010. They then review case studies and experiences discussed, particularly their contribution to universal health coverage in different settings. The authors reflect on challenges faced by participatory action research, and outline recommendations from the two sessions, including the creation of a learning network for participatory action research.
Will South Africa finally make progress towards a universal health system?
McIntyre D: Health Economics Unit, University of Cape Town, 12 October 2011
In August 2011, the South African Minister of Health released a Green Paper on introducing a National Health Insurance (NHI). While there has been a relatively muted response to the release of the paper, there has been sufficient public commentary to identify positive and negative key areas. On the positive side, the proposals have been praised for: being based on universal coverage principles; adopting a carefully phased approach; focusing firmly on addressing the problems in the public health sector first; and building a strong foundation of improved primary care services. However, while there appears to be a commitment to a single public pooling and purchasing entity, the Green Paper mentions also considering a multi-payer option whereby private insurance schemes would act on behalf of the NHI, raising concerns about high administration costs, which would limit income and risk cross-subsidies, and reduce the cost-containment benefits that would accrue if government was a single purchaser. The proposal to purchase services from the private sector may also mean a two-tier system will be retained as wealthier groups live closer to private providers than the less well-off and, given the rapid increase in fee levels among private for-profit providers, may threaten the sustainability of the NHI. Although it is proposed that there will be no fees at the point of service, the Green Paper also mentions having to consider co-payments, which would limit the financial protection afforded to beneficiaries. There are clearly some contradictions within this policy document that need to be resolved, the author concludes.