Latest Equinet Updates

EQUINET Discussion paper 107: Literature Review: Essential health benefits in east and southern Africa
Todd G; Mamdani M; Loewenson R: IHI, Tanzania, TARSC, EQUINET, Harare, June 2016

An Essential Health Benefit (EHB) is a policy intervention designed to direct resources to priority areas of health service delivery to reduce disease burdens and ensure equity in health. Many east and southern Africa (ESA) countries have introduced or updated EHBs in the 2000s. Recognising this, EQUINET, through Ifakara Health Institute and Training and Research Support Centre is implementing research to understand the role of facilitators and the barriers to nationwide application of the EHB in resourcing, organising and in accountability on integrated health services. This literature review provides background evidence to inform the case study work and regional dialogue. It compiles evidence from published and public domain literature on EHBs in sixteen ESA countries, including information on the motivations for developing the EHBs; the methods used to develop, define and cost them; how they are being disseminated and communicated within countries; how they are being used in budgeting, resourcing and purchasing health services and in monitoring health system performance for accountability; and the facilitators and barriers to their development, uptake or use.

EQUINET Policy brief 40: Implementing the International Health Regulations in east and southern Africa: Progress, opportunities and challenges
SEATINI, TARSC

When the International Health Regulations (IHR) were adopted in 2005 by member states of the World Health Organisation (WHO), State Parties were given up to June 2012 to have developed minimum core public health capacities to implement them. This included having surveillance, reporting and response systems for public health risks and emergencies and measures for disease control at designated airports, ports and ground crossings. In East and Southern Africa (ESA), the IHR are being implemented within an Integrated Disease Surveillance and Response (IDRS), which is a comprehensive, evidence-based strategy for strengthening national public health surveillance and response systems in African countries. This policy brief outlines the progress made and deficits in ESA countries in achieving the core capacities to implement the IHR. It proposes national measures to strengthen public health systems to both meet gaps in the implementation of the IHR and to link responses to health emergencies and outbreaks to health systems strengthening in ESA countries.

EQUINET PRA paper: Reflections on actions and learning from participatory work on health in Cassa Banana, Zimbabwe.
Kaim B: TARSC, ZADHR, Cassa Banana Community Health Committee, EQUINET, Harare, 2016

Over the last two years (2014-2015), the Training and Research Support Centre in cooperation with the Zimbabwe Association of Doctors for Human Rights has been building a programme that aims to foster local and national dialogue to build active citizenship and public and private accountability on water and sanitation, as a key element of primary health care. The work draws on experiences and learning arising from the Health Literacy programme and pra4equity network within EQUINET. This paper explores the Cassa Banana residents’ response to their health situation over the last two years, with a particular focus on the role of the Community Health Committee (CHC) in meeting community health needs and in trying to strengthen relations with the Harare City Council and other key stakeholders. In doing so, the paper reflects on the successes and challenges faced by the CHC, and looks at issues of leadership, social cohesion and power within the community as key components to the successful mobilisation of a diverse and fractured community in trying to get its needs met. It ends by recommending possible actions to deal with the problems identified and comments on the extent to which the challenges faced in Cassa Banana can be generalised to other communities in Zimbabwe.

Discussion paper 106: Responding to inequalities in health in urban areas: A review and annotated bibliography
Loewenson R; Masotya M: TARSC, EQUINET, Harare

Training and Research Support Centre (TARSC) as cluster lead of the “Equity Watch” work in EQUINET is following up on the findings of the 2012 Regional Equity Watch and the country Equity Watch reports with a deeper systematic analysis of available evidence on inequalities in health and its determinants within urban areas and the responses to urban inequalities from the health sector and through health promoting interventions of other sectors and communities acting on public health and the social determinants of health. This document presents evidence from 105 published papers in English post 2000 on patterns of and responses to urban inequalities in health in east and southern African countries. The evidence is presented in an annotated bibliography and analysis. It is being used to identify key areas of focus and parameters for deeper review and analysis. 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 also limited direct voice of those experiencing the changes and limited report of the features of urbanisation that promote wellbeing. The literature found was significantly more focused on the challenges than on the solutions. The papers sourced confirmed the relevance of primary care and community-based approaches, with CHWs, to carry out participatory assessments, promote new PHC approaches, use social media and support service uptake to address urban determinants. However the documented interventions made weak links between PHC services, urban public health and the work of other sectors. The rapid, diverse and multifactorial changes taking place in urban areas, some of which are poorly documented, also call for participatory approaches that include the direct voice of those experiencing urban life.

African responses to the 2014/5 Ebola Virus Disease Epidemic
Loewenson R, Papamichail A, Ayagah I: EQUINET Brief, Harare, 2015

There has been significant documentation on the various international responses to the 2014/5 Ebola epidemic in West Africa. There is also evidence that the epidemic
triggered new developments in epidemic prevention and response from Africa. In April 2015 the AU called for the lessons learned to be identified for future responses. This brief summarises the publicly available documentation on the response of African countries to the epidemic. It is based on 63 documents accessed through key word search in July–August 2015 of online databases, supplemented by documents obtained from snowballing in September 2015. The brief presents evidence on
a. The actions taken by African governments and institutions at national, regional and continental level to support the response to the epidemic.
b. The identified positive features and challenges in the African response.
c. The links between the African emergency response to the EVD epidemic and health system strengthening.

Call for an interested consultant
Submissions by November 24 2015

EQUINET is seeking a consultant with experience in writing media and promotional materials and knowledge of health and health systems for work in early 2016 to produce a document, drawing on existing materials and inputs provided by institutions in EQUINET, on EQUINETs nature, composition, work, and the impact it has had, that can be used to better explain and promote EQUINETs nature and role with partners and funders in and beyond the region. We ask consultants to submit a CV and a sample of similar work they have produced by November 24th 2015 to admin@equinetafrica.org

Guidance on using needs-based formulae and gap analysis in the equitable allocation of health care resources in East and Southern Africa
McIntyre D; Anselmi L: EQUINET Discussion Paper 93 updated. Health Economics Unit (UCT), EQUINET: Harare

The equitable allocation of limited public sector health care resources across population groups is a critical mechanism for promoting health system equity and efficiency. The population groups are often defined by geographic areas that correspond to administrative authorities. The use of a needs-based resource allocation formula to calculate target allocations for each province or region and each district is becoming increasingly popular in countries where health care is publicly funded and provided. Target allocations are defined according to the relative need for health services in each geographic area, quantified using indicators such as population size, demographic composition, levels of ill health and socio-economic status. EQUINET has supported the development of needs-based resource allocation formulae in a number of east and southern African countries in the past. The methods for developing such a formula are summarised in this paper. Our work in the region has persuaded us that it is necessary to supplement the development of a formula with other initiatives to support the successful implementation of the resource allocation processes. To facilitate the gradual shifting of resources, the equity target allocations calculated through the formula must be linked explicitly to national and local planning and budgeting processes.

Addressing bottlenecks to local production of medicines: Issues for international co-operation in East and Southern Africa
Mulumba M; Machemedze R: Journal of Health Diplomacy 1(3), 1-17, 2015

African countries are highly dependent on imported medicines and related products despite a stated policy intention in the African Union and regional bodies to develop local pharmaceutical production, which is expected to facilitate responsiveness to local health needs and has stated advantages for employment, skills retention, and foreign currency savings. Noting these policy intentions, this paper explores how the stated policy of local production in African Union (AU), Southern African Development Community (SADC) and East African Community (EAC) policies is being implemented and the bottlenecks to implementation. The paper examines the efforts made in selected countries to overcome these obstacles and the role of international and south-south co-operation. Drawing upon document reviews and key informant interviews, it presents case studies of Uganda, Kenya and Zimbabwe and their co-operation agreements with China and India. The study found limited evidence of operational co-operation, especially that which is based on south-south collaborations, despite the potential contribution of such collaborations to overcoming bottlenecks to local medicines production. Although the evidence from the case studies had limitations, the research suggests that a convergence of interests between countries in east and southern Africa and emerging economies on trade and investment cannot be assumed and that national and regional economic and social interests need to be actively negotiated to overcome identified bottlenecks. The authors thus recommend measures to strengthen the enabling policy, legal, trade and investment environments, to strengthen oversight and regulation of medicines, and to enhance technical and strategic capacities in the east and southern African region needed to support local production of medicines.

Business as usual? The role of BRICS co- operation in addressing health system priorities in East and Southern Africa
Brown G; Loewenson R; Modisenyani M; Papamichail A; Cinar B: Journal of Health Diplomacy 1(3), 1-23, 2015

There has been increased interest in whether “South-South” co-operation by Brazil, Russia, India, China and South Africa (BRICS) advances more equitable initiatives for global health. This article examines the extent to which resolutions, commitments, agreements and strategies from BRICS and Brazil, India and China (BIC) address regionally articulated policy concerns for health systems in East and Southern Africa (ESA) within areas of resource mobilisation, research and development and local production of medicines, and training and retention of health workers. The study reviewed published literature and implemented a content analysis on these areas in official BRICS and ESA regional policy documents between 2007 and 2014. The study found encouraging signals of shared policy values and mutuality of interest, especially on medicines access, although with less evidence of operational commitments and potential divergence of interest on how to achieve shared goals. The findings indicate that African interests on health systems are being integrated into south-south BRICS and BIC platforms. It also signals, however, that ESA countries need to proactively ensure that these partnerships are true to normative aims of mutual benefit, operationalise investments and programs to translate policy commitments into practice and strengthen accountability around their implementation.

Learning from research on experiences of health diplomacy in Africa
Loewenson R; Molenaar-Neufeld B: Journal of Health Diplomacy 1(3), 1-18, 2015

This paper presents the findings of research conducted under a wider two-year project (2012-14) that examined the role of African agency in global and south-south health diplomacy in addressing selected key challenges to health and health systems in east and southern Africa (ESA). This research synthesis draws from two desk reviews and a content analysis of three case studies on: (i) the involvement of African actors in global health governance on financing for health systems; (ii) overcoming bottlenecks to local medicine production, including through south-south co-operation; and (iii) health worker migration and the implementation of the World Health Organisation (WHO) Global Code of Practice on the International Recruitment of Health Personnel. Based on the content analysis, the paper reviews evidence on African intervention in four key areas of health diplomacy: agenda setting, policy development, policy selection and negotiation and implementation. The evidence highlights the political and complex nature of global health diplomacy. Effective engagement is enabled in ESA by political leadership and champions with clearly articulated policy positions, regional interaction and unified platforms across African countries and good communication between sectors within countries, between national actors and embassies and with allies in the international community. Negotiators’ understanding of issues and access to credible evidence mattered in policy development and selection. Technical actors, the domestic private sector and civil society appeared to play a weak role relative to the influence of development aid. The case studies suggest there is an opportunity cost in framing health diplomacy in the region within a ‘development aid’ paradigm, if the compromises agreed to lead to a dominance of remedial, humanitarian engagement in African international relations on health, with less sustained attention to structural determinants.

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