The study reviewed existing literature, and held focus group discussions and interviews with key informants to examine the contribution of the AIDS levy in Zimbabwe to national health financing. Two provinces were randomly sampled for the in-depth assessment of spending on AIDS levy. The study revealed that the contribution of the AIDS levy has so far been relatively low and undermined by inflation, with inequities in the allocation of funds by province in relation to HIV prevalence. The provincial and district levels, where most patient care takes place, are severely under-funded. If inflation is controlled for, the study concludes that the AIDS levy is a noble idea but that improvements are needed in the allocation of resources.
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Discussion paper 56: National Health Financing in Zimbabwe 2005: Contribution of the National AIDS Levy to National Health Care Support
Mpofu A, Nyahoda P. National AIDS Council of Zimbabwe
A PRA project report: Community participation in the management of mental disorders in Kariobangi, Kenya
Othieno CJ, Kitazi N, Mburu J, Obondo A, Mathai MA
This participatory action research project aimed to explore and strengthen the community’s capacity to recognise and advocate for their mental health needs, to increase the awareness of mental health problems among the community and to increase collaboration between the mental health workers from clinic and hospital level and the community in the management of mental health problems in the community. Both health workers and community identified exclusion, isolation and poor control over life, associated with risks and a poor physical state, as features of mental ill health. The Kariobangi community was felt to experience high levels of mental ill health, with poverty a major contributing factor. The major mental disorders identified were depression, stress, poverty, lack of awareness, drugs/substance abuse, lack of essential services (mental health services), mental retardation and epilepsy. The intervention is still at an early stage, but the evidence suggests that the PRA approach has strengthened community roles and interaction with health workers in improving mental health care in an underserved community.
A PRA project report: Strengthening communication between people living with HIV and clinic health workers in Kaisipul Division, Kenya
Ongala J
We used participatory approaches to facilitate a programme of work aimed at: * Improving communication and understanding between HIV positive clients and the HIV clinic personnel in HIV clinics; Raising HIV positive clients’ voices and participation in improving the HIV clinic services in the division; Promoting networking to overcome isolation, increasing exchange and co-operation through conducting; Participatory approaches, while challenging and time intensive, were perceived by health workers, clients and the facilitators to be a powerful means to enhancing communication, overcoming power imbalances that are barriers to good health or effective use of services and to encouraging the sustainable, “bottom up” community involvement on health visioned in Kenya health policy documents. Real changes were made to make the services more client-friendly, including installed suggestion box, re-streamlined queuing and filling system, taking of vital signs, interpreter involvement, and ordering of bulk drug supply, while clients formed a network that would sustain the communication and reduce social isolation of PLWHIV.
An assessment of the Zimbabwe government strategy for retention of health professionals
Chimbari MJ, Madhina D, Nyamangara F, Mtandwa H, Damba V
This poster presentation at the Global Health Worker Alliance Conference, March 2008, is based on a study that aimed to determine and assess the impacts of incentives instituted by the Zimbabwe government and non-government sector to retain Critical Health Professionals. It found that the tendency of health professionals to migrate has increased, even among low levels of staff and the macro-economic environment is the main driver of megration. Sustaining the retention incentives in this environment seems unattainable and bonding is unpopular and further increases migration.
Training workshop on Participatory methods for a people centred health system: Strengthening community focused, primary health care orientated responses to prevention and treatment of HIV and AIDS, Bagamoyo Tanzania, 27 February to 1 March 2008
TARSC, Ifakara, REACH Trust, Global Network of People living with HIV/AIDS
The workshop is the third in a series run by TARSC and Ifakara on participatory reflection and action (PRA) methods in health, using a toolkit developed by TARSC and Ifakara in EQUINET, with support from IDRC and SIDA and peer review by CHESSORE Zambia. The PRA training focus in 2008 was on strengthening equitable primary health care responses to HIV and AIDS. The 2008 training aimed to build understanding of PRA approaches and their use in strengthening people centred health systems, particularly community focused and PHC oriented HIV and AIDS interventions. The workshop aimed to draw on experiences in the east and southern African region for strengthening community focused and PHC oriented HIV and AIDS interventions; work through practical examples of PRA approaches and their application in areas of work that participants are practically involved with at community level; provide initial mentoring and support to development of research and training proposals for EQUINET support on equitable, community driven responses.
A PRA project report: Community empowerment and participation in maternal health in Kamwenge District, Uganda
Muhinda A, Mutumba A, Mugarura J HEPS Uganda
The Kamwenge Community Empowerment and Participation in Maternal Health Project aimed to contribute to the improvement of the health of expectant mothers in Kamwenge Sub-county, Kamwenge District. We aimed, through the use of PRA approaches, to increase demand for, access to and utilisation of maternal health services by expectant mothers. Using various PRA tools the project team worked with the community to prioritise, act and follow up on the most critical barriers to maternal health at the three levels – health service, community and household. While a comparison of questionnaires before and after the intervention suggested that maternal health problems remained high and many barriers to access services persisted, positive change was perceived in ease of access to and affordability of services, in communication between community and health workers and the respect shown by health workers, in the support given by health workers and families, and in awareness and action on maternal health in the community. The strongest positive changes were noted in the communication between health workers and pregnant women, and this seemed to be the area of greatest impact of the intervention.
A PRA project report: Community participation in the management of mental disorders in Kariobangi, Kenya
Othieno CJ, Kitazi N, Mburu J, Obondo A, Mathai MA
This participatory action research project aimed to explore and strengthen the community’s capacity to recognise and advocate for their mental health needs, to increase the awareness of mental health problems among the community and to increase collaboration between the mental health workers from clinic and hospital level and the community in the management of mental health problems in the community. Both health workers and community identified exclusion, isolation and poor control over life, associated with risks and a poor physical state, as features of mental ill health. The Kariobangi community was felt to experience high levels of mental ill health, with poverty a major contributing factor. The major mental disorders identified were depression, stress, poverty, lack of awareness, drugs/substance abuse, lack of essential services (mental health services), mental retardation and epilepsy. The intervention is still at an early stage, but the evidence suggests that the PRA approach has strengthened community roles and interaction with health workers in improving mental health care in an underserved community.
A PRA project report: Strengthening communication between people living with HIV and clinic health workers in Kaisipul Division, Kenya
Ongala J
Participatory approaches were used to facilitate a programme of work aimed at: improving communication and understanding between HIV positive clients and the HIV clinic personnel in HIV clinics; raising HIV positive clients’ voices and participation in improving the HIV clinic services in the division; and promoting networking to overcome isolation, increasing exchange and co-operation through conducting. Participatory approaches, while challenging and time intensive, were perceived by health workers, clients and the facilitators to be a powerful means to enhancing communication, overcoming power imbalances that are barriers to good health or effective use of services and to encouraging the sustainable, “bottom up” community involvement on health visioned in Kenya health policy documents. Real changes were made to make the services more client-friendly, including installed suggestion box, re-streamlined queuing and filling system, taking of vital signs, interpreter involvement, and ordering of bulk drug supply, while clients formed a network that would sustain the communication and reduce social isolation of PLWHIV.
Policy Brief 19: Are we making progress in allocating government health resources equitably in east and southern Africa?
Health Economics Unit, University of Cape Town; EQUINET
Reviewing experience in selected countries in the region, this policy brief suggests that countries can strengthen equitable allocation of resources for health by increasing the overall share of government funding allocated to the health sector, bringing external aid and government funding into one pooled fund and allocating it through a single mechanism. Equitable resource allocation calls for governments to establish annual targets for equitable allocation of these public funds, and to collect information to monitor and report on progress in meeting these targets, including to parliaments and civil society. Resource allocation is a politicised process and requires careful management, including to plan, organise and provide incentives for redistributing health care staff to areas where health need is higher.
Discussion Paper 53: Private medical pre-payment and insurance schemes in Uganda: What can the proposed SHI policy learn from them?
Zikusooka CM, Kyomuhangi R
Over the last two decades there has been growing interest in the potential of social health insurance (SHI) as a health financing mechanism in low and middle-income countries. However, few countries in Africa have implemented SHI. Uganda is currently designing its own SHI scheme, in preparation for its imminent implementation. It is hoped that SHI will bring additional resources for the Ugandan health sector and that its introduction will improve equity in access. Very little was known about the Insurance market in Uganda before this study was undertaken, so one of our main objectives was to provide quantitative and qualitative data that could be used by the Ugandan Ministry of Health as a basis for designing this scheme and for future SHI policy-making.