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 EHB in the 2000s. Recognising this, the Regional Network for Equity in Health in East and Southern Africa (EQUINET), through Ifakara Health Institute (IHI) and Training and Research Support Centre (TARSC), with country partners from Ministries of Health (MoH) in Swaziland, Tanzania, Uganda and Zambia, implemented research to understand the facilitators and the barriers in nationwide application of the EHB in resourcing, organising and in accountability on integrated, equitable universal health services. A regional review of literature on EHBs in the four country case study reports from the research programme are available on the EQUINET website. This report presents the proceedings of a regional consultative meeting convened on November 27-28, 2017 to present and discuss evidence from the research programme. The regional document review covering 16 east and southern African (ESA) countries, the findings from the country case studies in Swaziland, Tanzania, Uganda and Zambia, experiences from South Africa and Zanzibar and a regional synthesis of the evidence from across the programme were presented at the meeting, and background documents made available. The meeting aimed to: a. Identify issues arising in the motivations for developing the EHB; the methods used to develop, define and cost them; their dissemination, communication and use within countries, including in budgeting, resourcing and purchasing health services; and, in monitoring health system performance for accountability; b. Identify policy-relevant and operational national and regional level recommendations on the role, design and use of EHB; and c. Propose areas for follow up policy, action and research.
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Health Centre Committees are potentially critical vehicles for community voice in health systems. They play not only a service and mobilisation role, but can be effective tools to improve the responsiveness and accountability of services – and thus have an important governance role to play. UCT’s Health and Human Rights programme in the School of Public Health and Family Medicine has been working with Zimbabwean and Zambian partners in EQUINET, on a project under the leadership of the Community Working Group on Health (CWGH) to strengthen Health Centre Committees (HCC’s) as vehicles for social participation in health systems in East and Southern Africa (ESA). UCT has led work to review and assemble capacity building materials for Health Committee training. . They found HCC training materials and processes in a number of countries, including Ethiopia, Kenya, South Africa, Tanzania, Uganda, Zimbabwe and Zambia. The training commonly covered introductions to the health system, its governance, planning and budget processes and HCC roles. It included information on HCCs functions such as problem solving, monitoring and accountability and social mobilization. There were gaps in some areas, such as on conflict management, fundraising, inter-sectoral work and deeper analysis of the causes of social inequalities in ill health and how to address them.
The Participatory Action Research Portal for resources on Participatory Action Research (PAR) on the EQUINET website has a growing number of resources on PAR related to training courses, training guides and reports of training activities; methods, tools and ethics; PAR work and journal publications on PAR. The portal is a resource for all those working with PAR and includes resources in any language. There is a form for people to send videos, photojournalism, organisations, journal papers, training guides and other resources for the portal. The url link shown here is in English but there is also a Spanish version at http://www.equinetafrica.org/content/portal-de-recursos-para-la-investigaci%C3%B3n-acci%C3%B3n-participativa-iap
Stakeholders working with Health Centre Committees (HCCs) in East and Southern Africa (ESA) raised proposals in EQUINET policy brief 37 to improve the functioning and impact of HCCs as potential contributors to equitable, people centred health services. These proposals advocated for legal, institutional and social measures to support and clarify HCC roles, composition, powers and duties, to ensure the capacities and resources for them to function. They also proposed that HCCs strengthen their communication with the communities they represent backed up by wider measures for health literate and informed communities. Since then, institutions in EQUINET have followed up to act on the recommendations, building on existing work. This brief shares information on these developments. It reports some progress in legal recognition and setting of clearer constitutions for HCCs, clearer guidelines for the functioning, use of community based processes like photovoice to connect them with communities and their conditions in their dialogue with health services and efforts to share resources for capacity building of HCCs. It highlights that HCCs continue to play a role in improved frontline health systems. However the potential of HCCs still needs to be realised and the work continues.
The extractive (or mining) sector is a major economic actor in east and southern Africa. The mineral resources extracted are sought after globally, and how the sector operates affects the lives of millions of people. This brief aimed mainly civil society discusses the health impacts of the sector, how far these risks are recognised in policy and controlled in practice, and what civil society can do to ensure that health is protected in EI activity. It presents the proposals made at the 13th Southern Africa Civil society Forum in 2017 to advocate for regional health standards for EIs and a bottom up local to regional campaign for civil society to advocate for these harmonised standards for health in the mining (extractive) sector in SADC.
The extractive (or mining) sector is a major economic actor in east and southern Africa. The mineral resources extracted are sought after globally, and how the sector operates affects the lives of millions of people. This brief aimed mainly civil society discusses the health impacts of the sector, how far these risks are recognised in policy and controlled in practice, and what civil society can do to ensure that health is protected in EI activity. It presents the proposals made at the 13th Southern Africa Civil society Forum in 2017 to advocate for regional health standards for EIs and a bottom up local to regional campaign for civil society to advocate for these harmonised standards for health in the mining (extractive) sector in SADC.
This case study report compiles evidence on the experience of the Essential Health Benefit (EHB) in Zambia. The paper aims to contribute to national and regional policy dialogue regarding the role the EHB plays in budgeting, resourcing and purchasing of health services as well as monitoring health system performance for accountability. It outlines the motivations for developing the EHBs in Zambia, the barriers encountered in the process, the methods used to develop EHBs, and issues related to dissemination and communication of its content. The paper was done under the auspices of an EQUINET research programme through Ifakara Health Institute (IHI) and Training and Research Support Centre (TARSC), in association with the ECSA Health Community, supported by IDRC (Canada), and with the permission of the Ministry of Health of Zambia.
The Essential Health Benefit (EHB) is known as Essential Health Care Package (EHCP) in Swaziland. This desk review provides evidence on the experience of EHCPs in Swaziland and includes available policy documents and research reports. It was implemented in an EQUINET research programme through Ifakara Health Institute (IHI) and Training and Research Support Centre (TARSC), in association with the ECSA Health Community, supported by IDRC (Canada). The desk review presents the motivations for and methods used to develop, define and cost EHCP. It includes key informant input from a multi-disciplinary national task team through a workshop of key stakeholders with technical support from the World Health Organisation (WHO). It outlines how the EHCP has been disseminated and used in the budgeting and purchasing of health services and in monitoring health system performance for accountability. The paper also reports on the facilitators and barriers to development, uptake and use of the EHCP. In guiding the provision of services for all, the EHCP was envisaged to contribute towards the alleviation of poverty and as a tool for universal health coverage. Its implementation calls for a health service Infrastructure that is in good condition, competent health personnel, readiness to undergo training in new medical technology, supporting laws and capacity in the health financing unit. The EHCP in Swaziland was intended to guide the provision of health services. However, its costs were beyond the national resources to fund it. The adoption of a more restricted health service package currently being assessed in ten clinics in all four regions of the country suggests that a phased approach to delivery of an EHB may be more affordable financially for the country.
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. Mainland Tanzania’s most recent benefit package – the National Essential Health Care Interventions Package-Tanzania (NEHCIP-TZ) – describes the EHB as a minimum or “limited list of public health and clinical interventions.” The package identifies where priorities are set for improved public health. This report shows the challenges of turning a policy ‘wish list’ and package into a reality of services that can be accessed across different facility levels. This report describes the evolution of mainland Tanzania’s EHB; the motivations for developing the EHBs, the methods used to develop, define and cost them; how it is being disseminated, communicated, and used; and the facilitators (and barriers) to its development, uptake or use. Findings presented in this report are from three stages of analysis: literature review, key informant perspectives and a national consultative meeting. The case study on Tanzania was implemented in a research programme of the EQUINET through Ifakara Health Institute and Training and Research Support Centre. The programme is being implemented in association with the East Central and Southern African Health Community, supported by IDRC (Canada).
The Essential Health Benefit (EHB) policy interventions aim to optimize efficiency while extending coverage by increasing equity of access to the defined benefits. Uganda’s EHB is referred to as the Uganda National Minimum Healthcare Package (UNMHCP) introduced in the 1999 Health Policy. The UNMHCP is composed of cost efficient interventions against diseases or conditions most prevalent in the country. This report compiles evidence from published, grey literature and key informants on the UNMHCP since its introduction in Uganda’s health system, and findings were further validated during a one day national stakeholder meeting. It includes information on the motivations for developing the EHBs, the methods used to develop, define and cost them, and how it has been disseminated, used in budgeting, resourcing and purchasing health services and in monitoring health system performance for accountability. It was implemented in an EQUINET research programme through Ifakara Health Institute and Training and Research Support Centre, in association with the ECSA Health Community, supported by IDRC (Canada).