An open letter from Trisha Greenhalgh et al. to the editors of the British Medical Journal (BMJ) triggered wide debate by health policy and systems researchers (HPSRs) globally on the inadequate recognition of the value of qualitative research and the resulting deficit in publishing papers reporting on qualitative research. One key dimension of equity in health is that researchers are able to disseminate their findings and that they are taken into account in a fair and just manner, so that they can inform health policy and programmes. The Greenhalgh et al. letter and editorial responses were actively discussed within “SHAPES”, a thematic group within Health Systems Global, focused on Social Science approaches for research and engagement in health policy & systems (http://healthsystemsglobal.org/twg-group/6/Social-science-approaches-for-research-and-engagement-in-health-policy-amp-systems/) and within EQUINET (www.equinetafrica.org). The discussion precipitated this follow up open letter/commentary, which has 170 co-signatories. Collectively, the signatories feel that barriers to publication of qualitative research limit publication of many exemplary studies, and their contribution to understanding important dimensions of health care, services, policies and systems.
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This 2016 regional meeting was convened by ECSA HC with EQUINET in line with HMC Resolution – ECSAHMC50/R2 to prepare and discuss issues on the 69th World Health Assembly (WHA) Agenda and Regional GHD work. The objectives of the meeting were to 1. Update participants from ECSA-HC member states on Global Health Diplomacy (GHD) and its health impact. 2. Share information and discuss, from a GHD perspective, selected WHA agenda items and related issues from other key global health platforms. 3. Present and discuss research findings, recommendations on effective engagement on GHD and proposals for future work. 4. Discuss proposals for strengthened regional co-ordination and communication on GHD and a framework for monitoring progress. The meeting included senior officials delegated or responsible for health diplomacy from ECSA HC member states and South Africa, diplomats from the Africa group from ECSA HC member states, technical personnel from EQUINET and other institutions, including regional organisations and partners.
This brief introduces EQUINET, our organisation, work and the lessons we have learned in the struggle for equity and social justice in health. EQUINET is a consortium network of institutions registered in different countries in the region, with its secretariat at TARSC, a non-profit organization registered in Zimbabwe. The network constitution sets out its vision, principles, composition, structures, governance and procedures. The network is governed by a steering committee of institutions leading key areas of work from within and beyond east and southern Africa. The steering committee includes academic, government, civil society, parliament and non-profit institutions that co-ordinate different theme, process and country activities in the network and the secretariat. The five clusters of EQUINET work are: 1. Cross cutting equity analysis, integrating work in other clusters and the pra4equity network on PAR and the newsletter, together with theme work on the equity watch and district health systems. 2. Health rights and the law, integrating work of the learning network on heath rights, theme work on law and constitutional rights in health, and work in national networks. 3. Fairly resourcing health systems, integrating theme work on health financing and health workers. 4. Social empowerment for health, integrating theme work on health centre committees, and with parliamentarians and civil society. 5. Global engagement, including work on trade and health and health diplomacy.
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.
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.
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.
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.
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.
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
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.