This paper presents the findings of research conducted under a wider two-year project (2012-14) that examined the role of African agency in global and south-south health diplomacy in addressing selected key challenges to health and health systems in east and southern Africa (ESA). This research synthesis draws from two desk reviews and a content analysis of three case studies on: (i) the involvement of African actors in global health governance on financing for health systems; (ii) overcoming bottlenecks to local medicine production, including through south-south co-operation; and (iii) health worker migration and the implementation of the World Health Organisation (WHO) Global Code of Practice on the International Recruitment of Health Personnel. Based on the content analysis, the paper reviews evidence on African intervention in four key areas of health diplomacy: agenda setting, policy development, policy selection and negotiation and implementation. The evidence highlights the political and complex nature of global health diplomacy. Effective engagement is enabled in ESA by political leadership and champions with clearly articulated policy positions, regional interaction and unified platforms across African countries and good communication between sectors within countries, between national actors and embassies and with allies in the international community. Negotiators’ understanding of issues and access to credible evidence mattered in policy development and selection. Technical actors, the domestic private sector and civil society appeared to play a weak role relative to the influence of development aid. The case studies suggest there is an opportunity cost in framing health diplomacy in the region within a ‘development aid’ paradigm, if the compromises agreed to lead to a dominance of remedial, humanitarian engagement in African international relations on health, with less sustained attention to structural determinants.
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The WHO Global Code of Practice on the International Recruitment of Health Personnel (the Code) provides a global architecture that includes ethical norms and institutional and legal arrangements to guide international co-operation on the management of health worker migration and serves as a platform for continuing dialogue. This paper explores how the policy interests of African countries informed the development of the Code and how east and southern African (ESA) countries have used, implemented and monitored the Code. Data were collected using four approaches: literature review, policy dialogue at the 66th World Health Assembly, a regional questionnaire survey and three country studies in Kenya, Malawi and South Africa. Three years after adoption of the Code, the main concerns relating to human resources for health (HRH) in the region were internal migration and absolute shortages of health professionals, rather than external, or out-, migration. The final version of the Code was not perceived to adequately cover African policy interests on compensation and mutuality of benefits. Concern was also expressed about the voluntary nature of the Code. Dissemination and implementation of the Code was lacking in all countries in the region, and only one country had a designated authority. Beyond the shift in policy concerns, barriers to implementation included lack of champions or designated authorities, poor preparedness, weak mobilisation of stakeholders and low involvement of civil society. The authors recommend that negotiations on international instruments should include provisions relating to their implementation, that deliberate efforts should be made to plan for the mechanisms and resources for their implementation after their adoption, and that the involvement of civil society be promoted at all stages.
This article examines how national health actors in South Africa, Tanzania and Zambia perceive the participatory quality of negotiation processes associated with the performance‐based funding mechanisms of the Global Fund to Fight AIDS, Tuberculosis and Malaria and the World Bank. Through analysis of qualitative fieldwork consisting of 101 interviews within the case countries as well as in Geneva and Washington DC, the research results show that African actors within national governments generally set and negotiate performance targets of performance‐based funding schemes. Nevertheless, the results also show that the quality of those negotiations with external funders were inconsistent, suggesting the existence of asymmetrical power and influence in relation to the quality of those negotiations. This raises questions about the level of power and influence being exerted by external funders and how much leverage African political actors have available to them within global health diplomacy. It also provides evidence that certain key aspects of these negotiated processes are closed off from negotiation for African actors, therefore undermining African participation in significant ways.
Do global health platforms provide meaningful opportunities to advance equitable health systems and population health in east and southern Africa? What factors have supported effective negotiation of African policy goals on health systems within international and global health diplomacy? This brief outlines, with hyperlinks to the relevant reports, the findings and proposals for follow up policy review, action and research from a three year EQUINET led policy research programme with government officials, technical institutions, civil society and other stakeholders and in association with the East, Central and Southern Africa Health Community (ECSA –HC). The first two pages provide the broad findings, proposed actions and research agenda. Subsequent text presents the findings and proposals from the specific themes investigated in the programme.
Malawi's 1994 Constitution obliges the state to provide adequate health care within the resources available, and guarantees equality in access to these health services. Community participation is a central pillar for implementing PHC in Malawi’s 2011-2016 Health Sector Strategic Plan, which commits to ensuring that local communities have a voice and an opportunity to participate in issues that affect their health. This brief describes the role ad functioning of health centre advisory committees in supporting services to be responsive to the needs of people living with HIV. The committee members worked with volunteers, visiting villages with messages about prevention of vertical transmission and the services available for it.
Neighbourhood Health Committees (NHCs) have been set up in all ten provinces in Zambia and district community health offices. Their role is being strengthened across the country, and there are many examples of efforts that have been made to promote their participation in planning, budgeting and health actions. This brief outlines these initiatives and the lessons from the work.
This report presents the proceedings of a meeting held on March 13 and 14 a regional meeting was convened with objectives to i. Present and discuss the findings from the EQUINET research programme and from related research in Africa, and the implications for policy, negotiations and programmes in east and southern Africa; ii. Review methods and challenges for implementing research and analysis on global health diplomacy for policy relevance, from review of research and experience of the work; iii. Discuss and propose areas for follow up policy, action and research, within ESA and through south-south collaboration. It included senior officials involved in health from national and regional organisations, health diplomats, researchers from the EQUINET work and others working on health diplomacy and on south-south co-operation in the region and internationally.
This report presents the proceedings of a meeting held on March 13 and 14 a regional meeting was convened with objectives to
i. Present and discuss the findings from the EQUINET research programme and from related research in Africa, and the implications for policy, negotiations and programmes in east and southern Africa;
ii. Review methods and challenges for implementing research and analysis on global health diplomacy for policy relevance, from review of research and experience of the work;
iii. Discuss and propose areas for follow up policy, action and research, within ESA and through south-south collaboration. It included senior officials involved in health from national and regional organisations, health diplomats, researchers from the EQUINET work and others working on health diplomacy and on south-south co-operation in the region and internationally.
Health Centre Committees (HCCs) in Zimbabwe have made a vital contribution to health services and community health. HCCs have supported health activities and played a role in discussing how funds including those from fee collections are used in the clinics. In 2011 training materials were developed jointly by TARSC, CWGH and MoHCC for an approximately three to four day training for HCCs on these roles using participatory tools. This case study brief outlines the training of HCC members and of community members in health literacy.
In 2012 EQUINET initiated a three year policy research programme working with government officials, researchers, diplomats and others in the ESA region on the role of health diplomacy and international co-operation in health, including south –south diplomacy, in addressing selected key challenges to health and strengthening health systems. We aimed to use the evidence and learning to inform African policy actors and stakeholders within processes of health diplomacy. The work was done in association with the Strategic Initiative of Global Health Diplomacy co-ordinated by the East Central and Southern Africa Health Community (ECSA-HC). The research reports and policy briefs have been produced and are included in the EQUINET publications on this website. A March 2015 workshop included senior officials from national and regional organisations, health diplomats, researchers from the EQUINET work and others working on health diplomacy and on south-south co-operation in the region and internationally. The workshop discussed the evidence from the EQUINET research and from research on GHD from other institutions with a particular focus on east and southern Africa and proposed areas for follow up policy, action and research, within ESA and through south-south collaboration. The meeting report is on this website. EQUINET is now taking forward the proposals from this meeting in association with a consortium of institutions in the region, and is working with the ECSA Health Community in its Strategic initiative on global health diplomacy to share evidence and analysis for key global processes, including in the forthcoming regional workshop on GHD hosted by the ECSA HC with EQUINET.