Members of the EQUINET steering committee will be presenting work at the First Global Symposium on Health Systems Research, November 16-19 2010. EQUINET (through TARSC), with CGESS Guatemala and SATHI India is holding a session reviewing experiences with participatory action research (PAR) on health systems in Latin America, Africa, Asia and North America. In a roundtable, the case studies from the four regions will be presented and discussed to examine and reflect on the shared learning on health systems derived from PAR, the methods used and their application in health systems research and policy change. EQUINET will also have a marketplace stand at the Symposium and welcome visitors to the stand to see publications and hear more about the work of the network.
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An Equity Watch is a means of monitoring progress on health equity by gathering, organizing, analysing, reporting and reviewing evidence on equity in health. Equity Watch work is being implemented in countries in East and Southern Africa in line with national and regional policy commitments. This report presents the Equity Watch in Mozambique. It explores the dimensions of inequality that need to be addressed for the improvements in economic performance to translate into the eradication of poverty and sustained and widest improvements in human development. It focuses on the social determinants of health and the features of the health system that have been shown to make a difference in reducing social inequalities, including in health, and asks the question: what progress are we making? The report examines the positive results achieved so far in health equity in Mozambique, the current levels and the prevailing constraints, in the context of the overall national response to equity. It presents recommendations based on an analysis of information available.
This document is published in Portuguese. ‘Observatório de Equidade’ é um meio de monitoria do progresso da equidade na saúde através da recolha, organização, análise de dados e elaboração de relatórios sobre a equidade na saúde. Este relatório explora as dimensões da inequidade que precisam de ser resolvidas para garantir melhorias no desempenho económico para conduzir à erradicação da pobreza e ao alcance de melhorias sustentáveis no desenvolvimento humano. Dá enfoque às determinantes sociais da saúde e às características do sistema de saúde que provaram fazer a diferença na redução das inequidades sociais, incluindo na saúde, e faz a seguinte pergunta: Que progresso estamos a fazer? O relatório analiza os resultados positivos alcançados até agora, os níveis actuais e os constrangimentos prevalecentes, no contexto da resposta nacional em relação à inequidade. Apresenta recomendações baseadas numa análise da informação disponível.
The national review meeting on the role of the medical aid societies in Zimbabwe was convened by TARSC, SEATINI with collaboration from the Ministry of Health and Child Welfare, and support from the Southern African Health Trust through ISER, Rhodes University, in EQUINET. The activity was one of a series in a regional programme on capital flows in the health sector in southern Africa co-ordinated by ISER. The workshop brought together researchers, policy makers, health sector regulators and the medical aid societies to discuss issues around the flow and impact of capital flows through medical aid societies in the health sector in Zimbabwe. The review workshop guided by the research work that was implemented in Zimbabwe by TARSC and SEATINI on capital flows in the health sector, separately reported in EQUINET discussion paper 82. The meeting raised issues in relation to the functioning of medical aid societies and made recommendations to address them.
The ECSA Secretariat organised the first Regional Monitoring and Evaluation Expert Core Group meeting in Harare Zimbabwe from 12th to 16th July 2010. The participants came from Member States of Tanzania, Kenya, Lesotho, Zimbabwe, Zambia, Uganda, Malawi, Mozambique and Mauritius and international partners, namely EQUINET, UNICEF, ESARO, WHOIST/ESA and USAID-EA. The meeting deliberated and agreed on the Terms of Reference for the regional M&E Expert Group. The meeting also updated the HMC Monitoring tool, adopted with amendments the Regional Core set of indicators that will be used to monitor progress towards the Millennium Development Goals (MDGs), finalised the M & E Framework, developed indicators to monitor the implementation of the HMC resolutions and included indicators to monitor health equity in order to address inequalities in health in the region. In addition, the meeting resolved that it was necessary to monitor other codes, protocols and conventions such as the WHO Global Code of Practice on the International recruitment of health personnel. The indicators and the monitoring tools agreed upon by the expert core group will not only make it easier to compare member states in progress towards achieving the MDGs, addressing equity issues in health and implementation of the HMC resolutions, but also will be valuable in evaluation of in country changes from the baseline. The meeting also discussed, reviewed and adopted the Equity watch work in east and southern African countries.
This paper outlines the flows of private capital that lie behind the growth of the for-profit pharmaceutical sector in Tanzania. It reports an analysis of the policy, access and equity challenges posed by the shift to increasing private sector participation in the sector. The study was implemented within EQUINET by the Institute of Development Studies, University of Dar es Salaam, in a regional programme co-ordinated by the Institute for Social and Economic Research, South Africa. Strengthening the pharmaceutical sector to produce an adequate supply of medicines in Tanzania, for Tanzanians, is hindered by numerous constraints, including: non inclusion of TRIPS flexibilities in Tanzanian law; lack of skilled staff; financial constraints; poor industrial infrastructure and services; weak local and international pharmaceutical industry links; and counterfeit medicines entering the market. The report recommends that the health ministry step up its own monitoring systems to ensure effective distribution of medicines to health facilities. New legislation is also needed to improve quality standards, implement TRIPS flexibilities in Tanzanian law, and tackle substandard medicines entering the market.
The private health sector in South Africa is substantial. This paper explores the private sector involvement in funding and providing health services in South Africa and the implications for equity and access to health care. Serious challenges face the private health care sector in South Africa, not least of all the very rapid increases in expenditure and, hence, contribution rates in medical schemes. A range of factors underlie these trends; but in recent years, schemes’ spending increases have been driven largely by private for-profit hospitals and specialists, with the number of private hospital beds increasing rapidly and considerable consolidation of beds within three large private hospital groups. The 2007 policy conference of the ruling African National Congress (ANC) resolved to introduce a National Health Insurance (NHI). If successfully implemented, the substantial reforms envisaged will promote health system equity, affordability and sustainability within South Africa. However, there are growing concerns that the introduction of these reforms will contribute to increased activities by South African private for-profit health care companies in other African countries. Private health care firms in South Africa not only have an interest in expanding into other African countries, they will also have access to substantial investment resources. In particular, the World Bank’s International Finance Corporation (IFC) is actively seeking to invest in the private health sector in African countries. The experience of the private health sector in South Africa should be taken into account by policy-makers in other African countries when considering what role they envisage for the private health sector within their country context.
In most East and Southern African (ESA) countries, total health expenditure from all sources, including external resources, is still less than the US$ 45 per capita per year needed to provide basic health services. This limits their ability to achieve universal coverage of basic health services. This policy brief draws policy makers’ attention to the demands and challenges in health financing in meeting universal coverage, the demand for improved domestic public financing for health, and suggests options for doing this.
Medical aid societies (MAS) in Zimbabwe cover a tenth of the population, and about 80% of income to private health care providers in Zimbabwe comes from MAS. They contribute more than 20% of the country’s total health expenditure. This paper outlines the flows of private capital that lie behind the growth of the profit medical aid and insurance health care sector in Zimbabwe. It was implemented within the Regional Network for Equity in Health in East and Southern Africa (EQUINET) by Training and Research Support Centre and SEATINI, in a regional programme co-ordinated by the Institute for Social and Economic Research, South Africa. The report proposes measures for improving the functioning of and equity in the sector and to address the current exposure of beneficiaries. Strengthening the regulatory environment will help to address legal ambiguities on investment of the industry’s ‘surplus’ funds, to ensure the multiple relevant laws from finance and health are known and applied by MAS/ insurance providers, and to fairly and firmly enforce the law. The sector should ensure timely scheme reporting as required by law and maintenance of a database with basic information on schemes, as well as registration of all schemes, avoiding increasing segmentation of the sector into small fragmented risk pools from individual schemes and encouraging (for example through enforcement of regulation on registration and liquidity requirements), mergers into larger and more viable risk pools. Regulatory and scheme policy measures should be introduced that require and implement cross-subsidies necessary for equity and ensuring benefits packages cover personal care and personal prevention services. Other measures include taking up the shortfalls in coverage of medicines on existing plans, checking the degree of vertical integration in each scheme and unbundling any monopolies across the sector that are limiting patient choice (e.g. paying only for selected linked services), and improving the outreach of consumer information on schemes, benefits packages and consumer rights to members and organisations servicing members (e.g. the labour movement and employer organisations).
This leaflet is a translation of EQUINET’s policy brief on trade and health. The summary information is shown here in Portuguese. O crescimento do comércio internacional tem conseqüências significativas para a saúde pública. A relação entre o comércio e a saúde não é simples, e não é unidirecional. Neste informe levantamos questões sobre porquê é que questões sobre o comércio têm que ser compreendidas e geridas com o intuito de promover a saúde e realçamos as principais preocupações em saúde pública decorrentes dos acordos sobre o comércio livre. Chamamos a atenção para as medidas que os governos e a sociedade civil na região podem tomar com vista a alcançar maior coerência entre o comércio e as políticas de saúde, de maneira a que o comércio internacional e as regras do comércio maximizem os benefícios para a saúde e minimizem os riscos em saúde, especialmente para populações pobres e vulneráveis.