This report presents different experiences of using PAR in health systems from India, East and Southern Africa, Guatemala and Canada. These experiences are used to explore and discuss the learning on methods, on the knowledge generated and the implications for health systems, and what this means for the profile and practice of PAR. The report outlines the presentations and discussions from two sessions on participatory action research convened by the authors at the first Global Symposium on Health Systems Research in Montreux Switzerland, November 16-19 2010.
Latest Equinet Updates
Experiences of participatory action research in building people centred health systems and approaches to universal coverage: Report of the Sessions at the Global Symposium on Health Systems Research, Montreux, Switzerland
Loewenson R; Flores W; Shukla A; Kagis M; Baba A; Ryklief A; Mbwili-Muleya C; Kakde D, March 2011
Strengthening Health Worker-Community Interactions through Health Literacy and Participatory approaches , Zambia Training workshop report
Training and Research Support Centre; Lusaka District Health Management Team, May 2011
The training held in Lusaka district Zambia was aimed at building capacities of Health workers and communities jointly to work together to strengthen their interactions through health literacy and participatory approaches. It is anticipated that the training will go a long way in strengthening communication between health workers (employed in the health system in the community or the primary care level services) and community members at primary care level towards specific, measurable improvements of the health system for both with local coordination by Health Literacy facilitators. Specifically the training aimed to: •Introduce the health literacy programme and Participatory Reflection and Action (PRA) approaches to community members and Health Workers in Lusaka District •Provide core skills and information to health literacy facilitators to implement joint action to improve and strengthen Community-Health worker interactions •Reflect on the current facilitators and blocks to communication between health workers and communities, and how to improve this. •Provide training materials and orient facilitators to jointly identify and prioritize health needs and ill health problems, identify actions on shared priorities, identify gaps or barriers to uptake of primary health care (PHC) responses to prioritized problems, and set a shared (HW-Community) action plan. •Orient Facilitators in Lusaka District on administering the baseline and the programme post survey instruments.
Health and justice activists gather to debate strategies to achieve the right to health
Section27: 27 March 2011
On 25-26 March 2011, Section27 convened a meeting of 70 activists and experts from 16 countries, including from EQUINET, mostly from Southern Africa but also from India, Brazil, the United States and Europe. The meeting’s aim was to build a common vision, and if possible programme, for realising the right to health and to discuss how to mobilise and support new campaigns for health at local, national, regional and global levels. A further objective of the consultation was to explore and debate whether, in future, a Framework Convention on Global Health (FCGH) could be an effective international legal instrument for coordination of currently fragmented activities, sustainable and sufficient resource mobilisation and standard-setting to realise the right to health. The conference reinforced the view that there is a need to mobilise people from the grass-roots level to fight for their own rights to health by educating people on and popularising the right to health, and linking community and national movements into a truly global movement of for the right to health. Finally, it confirmed the importance of exploring the idea of a future FCGH as one component of this struggle.
Further details: /newsletter/id/35968
Monitoring Equity in Access to AIDS treatment programmes
WHO; EQUINET; REACH Trust; TARSC
Commissioned by the World Health Organization (Department of Ethics, Equity, Trade and Human Rights - Social Determinants of Health) and the Regional Network for Equity in Health in East and Southern Africa (EQUINET) through REACH Trust and Training and Research Support Centre (TARSC) – 2010. “….Barriers that prevent access to antiretroviral treatment services (ART) are often socially determined. Using the Tanahashi model of health service coverage and by identifying areas of health systems and programs where action needs to be strengthened to improve equity, this publication proposes a set of potential indicators to monitor equity in access to ART. Monitoring equity in access helps decision-makers to reach people frequently excluded from treatment and facilitates efforts to overcome barriers by addressing their social determinants, within and beyond the health system. This jointly prepared publication follows up previous WHO work that explores the barriers and social determinants that impact on specific health conditions presented in the book "Equity, social determinants and public health programmes" (2010). It also builds on over 8 years of policy dialogue and research in east and southern Africa in EQUINET on equity in health, with a particular focus on HIV and AIDS. The rationale, concepts and indicators included in this publication can be further refined and adapted in the future to measure equity in access to health services or to other public health programs (e.g. TB, non-communicable diseases).
Uganda Human Rights Commission report disappoints civil society
HEPS Uganda: 15 April 2011
A report released by HEPS Uganda and partner organisations in the Uganda Health Equity Network (UHEN) entitled ‘Right to Health: A Civil Society Perspective on the 12th Annual Report of the Uganda Human Rights Commission’, has criticised Uganda Human Rights Commission (UHRC) for taking a narrow approach in reporting on the status of the Right to Health in Uganda. Noting that the report is a key tool and an opportunity to inform Parliament on the state of the Right to Health in Uganda, the civil society organisations are concerned that the Uganda Human Rights Commission’s silence on the key determinants of health and the country’s emerging public health challenges suggests that it is not doing enough to fulfil its mandate of promoting and monitoring human rights in the country. The HEPS/UHEN report, analysing the Commission’s most recent report to Parliament, points out that UHRC’s report inexplicably does not report the impact on health of trade, the proposed health insurance scheme, climate change, urbanisation, environmental degradation and similar socioeconomic determinants of health.
Strategic Leadership Course in Global Health Diplomacy in East, Central and Southern Africa
Nairobi, 14th to 18th March 2011
The course brought together senior officers from the health and related sectors in the East, Central and Sothern Africa-Health Community region (ECSA-HC). The need to build capacity and create strategic leadership in global health diplomacy is clearly manifest in the performance of the regional delegations in regional and global fora. The purpose of the course is to introduce, provide an overview and share information on Global Health Diplomacy, discuss key issues and challenges for GHD for the region and hear inputs about other regions on their response to these challenges. The participants discussed an assessment of institutional capacities and needs, information resources and sources at regional and country level support for Global Health Diplomacy; and shared and enhance their negotiation GDH negotiation skills. This course has been developed in close cooperation between the School of Public Health-University of Nairobi, the Ministry of Public Health and Sanitation Kenya, ECSA-Health Community Secretariat, the Regional Network for Equity in Health in East and Southern Africa (EQUINET), with support from Graduate Institute of International and Development Studies Geneva
EQUINET Discussion Paper 85: Experiences of implementation of a deprivation-based resource allocation formula in Zambia: 2004–2009
Chitah BM: Department Of Economics, University Of Zambia, December 2010
This study was undertaken by University of Zambia within the Health Financing theme work of the Regional Network for Equity in Health in East and Southern Africa (EQUINET) within a regional programme that is exploring progress in integrating equity into resource allocation. The study was undertaken to update the experiences and progress on the design, review and implementation of an equity-based resource allocation formula in the Zambian health sector. The author found that the formula has only been implemented in partial form, and that second and third generation formulae have not been adjusted in the implementation process. A severe lack of funding for the public health system, whose funding is smaller than the financing for specific health programmes like HIV and AIDS, remains a significant concern. The study makes a number of recommendations. The author calls for more research evaluating the changes in health outcomes, outputs or processes as a consequence of implementing resource allocation formulae. He calls for integration of financing and expansion of the pooled funding for the health sector to raise possibilities for a realistic implementation of the resource allocation formula. Richer districts should not have to risk a revenue reduction. The way to achieve the formula should rather use limited revenue growth in these districts relative to accelerated revenue growth for the poorer districts. A clear time line should be established with regard to the transformation of resource allocation and this should be updated based on emerging evidence. A monitoring and evaluation process should track performance of both resource allocation and health and health care outcomes. Finally, the Ministry of Health should evaluate the effect of structural changes with regard to resource management and performance so as to ensure optimum implementation.
EQUINET Discussion Paper 86: Regional resources and interactions for evidence based health policy in east and southern Africa
EQUINET, TARSC, ACHEST and ASHGOVNET: February 2011
The 52nd Health Ministers Conference of the East, Central and Southern African Health Community that took place from 25-29 October 2010 in Harare, Zimbabwe, under the theme: Moving from Knowledge to Action: Harnessing Evidence to Transform Healthcare. The meeting recognised the limited production and use of locally generated evidence to influence policy within the region, and resolved to promote use of evidence in decision making and policy formulation within the region and make more effective links with existing resources and institutions within the region for this. This report provides information to support the connections particularly between regional institutions and regional policy forums. It provides summary information from desk review, internet sites and email follow up on the 25 institutions and networks in East and Southern Africa (ESA) identified that are local to the region and that undertake health policy, strategy, and health systems work at regional level. The report further presents the perceptions from key informant interview of six regional policy institution personnel of the current links with technical institutions in the region, and how they can be improved. The evidence gathered is used to suggest implications for strengthening links between regional technical institutions and regional policy forums. The recommendations identify actions that can be taken with current resources, and those that call for additional investment or re-orientation of resources. The authors welcome feedback and comment on the issues raised, as well as information on other institutions from within the region working at regional level on health policy issues to add to the database compiled.
Strategic Leadership Course in Global Health Diplomacy in East, Central and Southern Africa, Nairobi, 14th to 18th March 2011
ECSA Health Community, University of Nairobi, Ministry of Public Health and Sanitation Kenya, EQUINET, Graduate Institute of International and Development Studies
The course will bring together senior officers from the health and related sectors in the East, Central and Sothern Africa-Health Community region (ECSA-HC). The need to build capacity and create strategic leadership in global health diplomacy is clearly manifest in the performance of the regional delegations in regional and global fora. The purpose of the course is to introduce, provide an overview and share information on Global Health Diplomacy, discuss key issues and challenges for GHD for the region and hear inputs about other regions on their response to these challenges. The participant will discuss an assessment of institutional capacities and needs, information resources and sources at regional and country level support for Global Health Diplomacy. The facilitation at the course will also enable the participants to share and enhance their negotiation GDH negotiation skills. This course has been developed in close cooperation between the School of Public Health-University of Nairobi, the Ministry of Public Health and Sanitation Kenya, ECSA-Health Community Secretariat, the Regional Network for Equity in Health in East and Southern Africa (EQUINET), and the Global Health Programme with support from Graduate Institute of International and Development Studies Geneva.
Innovative financing for development takes a step forward at the 2010 UN summit
Loewenson R: Health Diplomacy Monitor 1(4):6-9, November 2010
On 20-22 September 2010, world leaders gathered in New York to examine what needs to be done to meet the Millennium Development Goals (MDGs). The United Nations called for accelerated progress to meet the MDGs, citing unpredictable and insufficient international financing as the main obstacle. New mechanisms proposed for health financing included a currency transaction tax, in addition to overseas development aid. Mechanisms already launched have been projected to raise a further approximately US$$1billion annually. The transaction tax will raise an estimated US$30 billion per year. Multilateral tax funding has been blocked in the past by concerns over democratic oversight and how the revenues will be spent. The Summit recognised in its draft resolution that ‘innovative financing mechanisms can make a positive contribution’ and called for such financing to scale up and supplement, but not substitute, traditional sources. This article argues that it is likely that attention will grow around effective means to levy global economic activity to pay for global public goods, raising new resources for health and new challenges for African health diplomacy and systems to encourage, orient and effectively apply these resources. (Authors from TARSC and SEATINI in EQUINET contribute to the Global Health Diplomacy Monitor).