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.
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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.
African countries are highly dependent on imported medicines and related products despite a stated policy intention in the African Union and regional bodies to develop local pharmaceutical production, which is expected to facilitate responsiveness to local health needs and has stated advantages for employment, skills retention, and foreign currency savings. Noting these policy intentions, this paper explores how the stated policy of local production in African Union (AU), Southern African Development Community (SADC) and East African Community (EAC) policies is being implemented and the bottlenecks to implementation. The paper examines the efforts made in selected countries to overcome these obstacles and the role of international and south-south co-operation. Drawing upon document reviews and key informant interviews, it presents case studies of Uganda, Kenya and Zimbabwe and their co-operation agreements with China and India. The study found limited evidence of operational co-operation, especially that which is based on south-south collaborations, despite the potential contribution of such collaborations to overcoming bottlenecks to local medicines production. Although the evidence from the case studies had limitations, the research suggests that a convergence of interests between countries in east and southern Africa and emerging economies on trade and investment cannot be assumed and that national and regional economic and social interests need to be actively negotiated to overcome identified bottlenecks. The authors thus recommend measures to strengthen the enabling policy, legal, trade and investment environments, to strengthen oversight and regulation of medicines, and to enhance technical and strategic capacities in the east and southern African region needed to support local production of medicines.
There has been increased interest in whether “South-South” co-operation by Brazil, Russia, India, China and South Africa (BRICS) advances more equitable initiatives for global health. This article examines the extent to which resolutions, commitments, agreements and strategies from BRICS and Brazil, India and China (BIC) address regionally articulated policy concerns for health systems in East and Southern Africa (ESA) within areas of resource mobilisation, research and development and local production of medicines, and training and retention of health workers. The study reviewed published literature and implemented a content analysis on these areas in official BRICS and ESA regional policy documents between 2007 and 2014. The study found encouraging signals of shared policy values and mutuality of interest, especially on medicines access, although with less evidence of operational commitments and potential divergence of interest on how to achieve shared goals. The findings indicate that African interests on health systems are being integrated into south-south BRICS and BIC platforms. It also signals, however, that ESA countries need to proactively ensure that these partnerships are true to normative aims of mutual benefit, operationalise investments and programs to translate policy commitments into practice and strengthen accountability around their implementation.
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.
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.