A two-day consultation on health committees as vehicles for community participation was held in Cape Town on September 27th and 28th 2014 prior to the 3rd Global Health Systems Research Conference. The meeting, funded by the International Development Research Council (IDRC Canada), had 38 participants from 12 countries of which nine were African countries. The meeting build on previous regional networking to share experiences of health committees as vehicles for community participation from countries across the globe. The discussion focused particularly on health committees in the African region, but benefited from considerations of experiences from other countries of the South (Guatemala and India). The discussions also reaffirmed the importance of health committees for Health System responsiveness and highlighted the importance of health committees as autonomous structures able to enhance democratic governance of health systems through monitoring and evaluation of health service performance and holding the state accountable. This applies irrespective of how services are delivered. To achieve this, it is critically important for health committees to be capacitated to fulfil this role through appropriate training, health systems design and sustainable support. Government should recognize the importance of health committees for their health systems, and invest appropriate human and financial resources to ensure functional health committees. Such investments are part of state obligations with respect to realising the Right to Health. Further, strategies must be developed to obtain buy-in of health workers, managers and policy-makers in supporting meaningful participation by health committees.
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Immediately following the 2014 Global Symposium on Health Systems Research, a one day workshop was held, convened by Training and Research Support Centre (TARSC) (www.tarsc.org) and the pra4equity network in the Regional Network for Equity in Health in east and southern Africa (EQUINET) with Asociación Latinoamericana de Medicina Social (ALAMES). The workshop was held to deepen the discussion on the use of participatory action research (PAR) in health policy and people centred health systems, including in acting on the social determinants of health. While there are many forms of participatory research, the workshop specifically focused on PAR, that is on research that transforms the role of those usually participating as the subjects of research, to involve them instead as active researchers and agents of change, where those affected by the problem are the primary source of information and the primary actors in generating, validating and using the knowledge for action, and that involves the development, implementation of, and reflection on actions as part of the research and knowledge generation process. PAR seeks to understand and improve the world by changing it, but does so in a manner that those affected by problems collectively act and produce change as a means to new knowledge. The one day workshop was open to delegates from all regions globally to foster cross regional exchange and to include people from the pra4equity network in east and southern Africa. This report presents the proceedings of the workshop.
This brief outlines the factors that affect medicines production in East and Southern Africa, drawing on the African Union, Southern Africa Development Community (SADC) and East African Community (EAC) pharmaceutical plans. It identifies the barriers to local production as: lack of supportive policies, capital and skills constraints, gaps in regulatory framework, small market size and weak research and development capacities. It highlights, from case study work in selected countries in East and Southern Africa the potential opportunities for strengthening local medicine production. In the brief we propose that African countries strengthen domestic capacities, co-operation between domestic private and public sectors within ESA countries, and regional co-operation across ESA countries to address bottlenecks. Some areas such as infrastructure development and training may be important groundwork for others, such as technology transfer and research and development. South-south cooperation in medicines production can play a role in this but it cannot be assumed. Negotiations on south-south arrangements should look not only at the immediate production investment, but at strengthening capacities for research and development, for regulation, medicines price and quality monitoring, prequalification, infrastructure and human resource development.
Participants at the Regional Meeting on Health Committees co-hosted by the Learning Network for Health and Human Rights, the Centre for Health, Human Right and Development (CEHURD) and the Network on Equity in Health in East and Southern Africa (EQUINET), 27-28 September 2014, Cape Town developed the statement from the meeting committing themselves to strengthen regional learning networks between countries of the south for advancing health committees as vehicles for community participation and calling on governments to recognise and incorporate health committees into their health systems in ways that maintain their roles as autonomous agents for democratic governance; WHO to provide guidance on inclusion of Health Committees in Health Systems Governance; and for discussions on updating the WHO Building Blocks approach to recognise the role of collective community action through Health Committees when inserting notions of public and patient engagement.
EQUINET, COPASAH and Rotterdam Global Health Initiative Erasmus University, for the participatory cluster in the SHaPeS TWG for Health Systems Global is hosting a satellite workshop at the GSHSR on ”New resources and opportunities for participatory research in health systems: areas of focus for Health systems Global” on Tuesday, 30 September from 12.00 – 14.00. We welcome all interested in this work! The satellite session will be convened by the three organisations in the participatory cluster of the SHaPeS Technical working Group in HSR global. It will present and discuss with delegates interested in the cluster the issues, resources and capacities for the field and how these could be developed through the TWG, and will make available work we have done to date, particularly through EQUINET and COPASAH. It will review the experience of using participatory action research, (PAR), community monitoring and innovations in social media in transforming local health systems, the challenges faced and the areas for future participatory work in HSR. It will launch the EQUINET, AHPSR and IDRC methods reader on participatory action research and web tools from COPASAH. The session will identify field building inputs in terms of the resources, capacity building, methods and opportunities that need to be taken forward by the participatory cluster of the SHaPeS Technical Working Group and the people who are interested in playing a role in the different areas of work. Contact admin@equinetafrica.org with GSHSR SATELLITE in the subject line for further detail or to let us know of your participation.
A three day skills workshop on PARTICIPATORY ACTION RESEARCH IN PEOPLE CENTRED HEALTH SYSTEMS is being hosted by EQUINET. It will include a one day workshop on 4 October hosted hosted by TARSC and the Regional Network for Equity in Health in east and southern Africa (EQUINET) and Asociación Latinoamericana de Medicina Social (ALAMES), following the Global Symposium on Health Systems Research (30th Sept–3rd October). The workshop will be held to deepen the discussion on the use of participatory action research in health policy and people centred health systems, including in acting on the social determinants of health. The workshops aim to deepen capacities in the use of participatory action research (PAR) particularly on
• Experiences and learning of the pra4equity network in using PAR and future work of the pra4equity network
• Knowledge and research paradigms and how they are reflected in the features and process of PAR
• Applying the theory and process of PAR in practice: Methods and tools for PAR; issues in and experiences of implementation
• Meta-analysis across sites and use of new technologies in PAR
• Ethical issues in PAR, and
• Documenting and reporting PAR
It will draw on and distribute the Reader on Participatory Action Research in Health system developed by EQUINET with the Alliance for Health Policy and Systems Research and IDRC Canada.
In the 21st century there is a growing demand to channel collective energy towards justice and equity in health, and to better understand the social processes that influence health and health systems. Communities,frontline health workers and other grass-roots actors play a key role in responding to this demand, in raising critical questions, building new knowledge and provoking and carrying out action to transform health systems and improve health. There is a widening array of methods, tools and capacities – old and new – to increase social participation and power in generating new knowledge through participatory research. At the same time, we need to be clear about exactly what participatory research is and what it can offer. This reader promotes understanding of the term ‘participatory action research’ (PAR) and provides information on its paradigms, methods, application and use, particularly in health policy and systems. This reader was produced through the Regional Network for Equity in Health in East and Southern Africa (EQUINET), with Alliance for Health Policy and Systems Research (AHPSR) and International Development Research Centre (IDRC) Canada and is being launched at the Third Global Symposium on Health Systems Research in South Africa September 30 2014 after which the full reader will replace this leaflet. The result of team work, the reader draws on experience and published work from all regions globally and explains:
• key features of participatory action research and the history and knowledge paradigms that inform it;
• processes and methods used in participatory action research, including innovations and developments in the field and the ethical and methods issues in implementing it; and
• communication, reporting, institutionalization and use of participatory action research in health systems.
The Learning Network for Health and Human Rights, in conjunction with the Network on Equity in Health in East and Southern Africa (EQUINET) will be holding a 2-day regional consultation on the role of Health Committees in Equitable, People-centred Health Systems in the Southern and East African region as a satellite meeting linked to the 3rd Global Symposium on Health Systems Research. The regional consultation will take place in Cape Town on Sat 27th and Sun 28th of September 2014 at the University of Cape Town and is funded by a grant from the International Development Research Council. The meeting has been called to share experiences from the southern and east Africa region of community participation in health systems governance through health committees. The focus of the consultation is on health committees as a strategy for realising the right to health and strengthening health systems. The consultation will build on previous meetings by the different partners in Kampala, Kiboga and Harare over the past 4 years. The target participants are those who have experience of working with health committees and community participation structures.
Billions of dollars are channelled each year to African governments by external funders, from global institutions such as the World Bank and Global Fund to support health systems. Much of the money is provided in the form of “Performance Based financing” (PBF) schemes. In 2013/4 we reviewed the decision making on and design of these PBF schemes, including through interviews with officials in Africa and at Africa regional and global levels. This brief explains what PBF schemes are and the reasons for their popularity. It presents the positive and negative features of and views expressed on PBF. It presents a set of questions national authorities should take into account when negotiating any PBF type scheme within health systems and makes recommendations for African officials who wish to improve the design and implementation of PBF schemes to support national health system goals.
The adoption of primary health care (PHC) in all east and Southern African(ESA) countries means that public participation is central to the design and implementation of health systems. One mechanism for this is through Health Centre Committees (HCCs) that involve representatives of communities and primary-care level health workers in planning, implementing and monitoring health services and activities. Known by different names in different countries, they are a common mechanism for communities to ensure that health systems access and use resources to address their needs and are responsive and accountable to them. They have been found to have a positive impact on health outcomes. This brief presents information and experiences from document review and from the exchanges of people working with HCCs in ESA countries at a 2014 EQUINET regional meeting on how HCCs are functioning in the region. It presents proposals for improving their functioning and impact.