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.
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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.
ESA countries face many challenges in the absolute shortages, maldistribution, low production and poor utilisation of their health workforces. The World Health Organisation (WHO) Global Code of Practice on the International Recruitment of Health Personnel (the “Code”) was unanimously adopted by the World Health Assembly in May 2010 to address recruitment and migration of health workers. However, its implementation has shown limited progress in east and southern Africa, according to a study in the EQUINET Research programme on global health diplomacy. Health worker migration is not seen to be the scale of problem it was a decade ago in the region. While concerns from the region were mostly included in the Code,the demand for “mutuality of benefit” and “compensation” were not. This was interpreted by some stakeholders to mean that the Code did not fully accommodate African interests. Implementation of the Code is reported to be impeded by lack of champions; of resources for implementation; by weak functional data (systems) on mobility of health personnel, and by limited domestication and dissemination of the Code in ESA countries. This brief presents opportunities to use the Code in negotiating bilateral agreements and suggests ways of strengthening its implementation.
Participation is a key policy concept in global health, and relates to the ability of stakeholders to engage with and shape health policy at four intersecting levels: local, national, regional and global. Such engagement remains the key normative aim behind debates about furthering more equitable health diplomacy and has, as a result, been increasingly integrated into the agenda of global agencies, including the Global Fund to Fight AIDS, TB and Malaria and the World Bank. This report forms part of a research programme led by EQUINET focusing on the participation of African actors in global health diplomacy. The report focuses on the participation of African actors in global health governance. In an attempt to better understand the spaces and places within which participation can occur, and particularly the ways in which global actors such as the Global Fund and the World Bank provide such opportunities, the research explored the following questions: • How do the Global Fund and World Bank provide spaces for participation in global health governance processes? • To what extent can African actors nationally and regionally extend their agency within these participatory spaces? • What role does the World Health Organisation (WHO) and its own governance play in the interface between African actors and the Global Fund and World Bank?
The Journal of Health Diplomacy (JHD) is now receiving manuscripts for its third issue, titled: Africa, health and diplomacy. This issue is broadly concerned with the theory and practice of health diplomacy of African states, as a co-operation with the Regional Network for Equity in Health in East and Southern Africa (EQUINET). The issue will include invited and submitted manuscripts. To be considered for the latter, please submit your proposed manuscript to the Managing Editor at the email below by 3 November 2014. Manuscripts submitted to JHD will undergo a peer-review process, with referees selected for their particular knowledge/experience on the topic of the manuscript. Authors are asked to ensure that their identity is not revealed directly or indirectly on any page. Manuscripts that are being considered for publication elsewhere, or that have been previously published must not be submitted to the journal. A complete set of author guidelines is available at the website shown. JHD welcomes contributions from all academic disciplines, including international relations, political science, anthropology, sociology, history and geography. We are also interested in interdisciplinary perspectives that cross the boundaries between different theoretical fields and represent novel understandings of health diplomacy.
The World Health Organisation (WHO) ‘Global Code of Practice on the International Recruitment of Health Personnel’ (hereinafter called the “Code”) adopted by the World Health Assembly (WHA) in May 2010 was the culmination of efforts by many different actors to address the maldistribution and shortages of health workers globally. African stakeholders influenced the development of the Code, but two years after its adoption only four African countries had designated national authorities, and only one had submitted a report to the WHO secretariat. This synthesis report is part of the Regional Network for Equity in Health (EQUINET) programme of work on Contributions of global health diplomacy to health systems in sub-Saharan Africa: Evidence and information to support capabilities for health diplomacy in east and southern Africa. The programme aims to identify factors that support the effectiveness of global health diplomacy (GHD) in addressing selected key challenges to health strengthening systems in eastern and southern Africa (ESA). The report compiles evidence from various research strategies undertaken to examine the above issues surrounding the WHO Code that involved an extensive review of literature; a ‘fast-talk’ session at the 66th World Health Assembly in May 2013 involving stakeholders from African countries to gauge views and concerns relating to the Code; a region-wide questionnaire survey implemented in 2013 to obtain views of government informants on issues affecting and measures for managing health workers, including migration of health workers in ESA countries; and three country case studies undertaken in Kenya, Malawi and South Africa concluded in 2014 to provide an in-depth exposition of perspectives on the Code and its implementation.
Gender inequalities are important social determinants of health. We set out to critically review the literature relating to gender equity and sexual and reproductive health (SRH) in Eastern and Southern Africa with the aim of identifying priorities for action. During November 2011, the authors identified studies relating to SRH and gender equity through a comprehensive literature search. Gender inequalities were found to be common across a range of health issues relating to SRH with women being particularly disadvantaged. Social and biological determinants combined to increase women’s vulnerability to maternal mortality, HIV, and gender-based violence. Health systems significantly disadvantaged women in terms of access to care. Men fared worse in relation to HIV testing and care with social norms leading to men presenting later for treatment. Gender inequity in SRH requires multiple complementary approaches to address the structural drivers of unequal health outcomes. These could include interventions that alter the structural environment in which ill-health is created. Interventions are required both within and beyond the health system.