The workshop is the third in a series run by TARSC and Ifakara on participatory reflection and action (PRA) methods in health, using a toolkit developed by TARSC and Ifakara in EQUINET, with support from IDRC and SIDA and peer review by CHESSORE Zambia. The PRA training focus in 2008 was on strengthening equitable primary health care responses to HIV and AIDS. The 2008 training aimed to build understanding of PRA approaches and their use in strengthening people centred health systems, particularly community focused and PHC oriented HIV and AIDS interventions. The workshop aimed to draw on experiences in the east and southern African region for strengthening community focused and PHC oriented HIV and AIDS interventions; work through practical examples of PRA approaches and their application in areas of work that participants are practically involved with at community level; provide initial mentoring and support to development of research and training proposals for EQUINET support on equitable, community driven responses.
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The Kamwenge Community Empowerment and Participation in Maternal Health Project aimed to contribute to the improvement of the health of expectant mothers in Kamwenge Sub-county, Kamwenge District. We aimed, through the use of PRA approaches, to increase demand for, access to and utilisation of maternal health services by expectant mothers. Using various PRA tools the project team worked with the community to prioritise, act and follow up on the most critical barriers to maternal health at the three levels – health service, community and household. While a comparison of questionnaires before and after the intervention suggested that maternal health problems remained high and many barriers to access services persisted, positive change was perceived in ease of access to and affordability of services, in communication between community and health workers and the respect shown by health workers, in the support given by health workers and families, and in awareness and action on maternal health in the community. The strongest positive changes were noted in the communication between health workers and pregnant women, and this seemed to be the area of greatest impact of the intervention.
This participatory action research project aimed to explore and strengthen the community’s capacity to recognise and advocate for their mental health needs, to increase the awareness of mental health problems among the community and to increase collaboration between the mental health workers from clinic and hospital level and the community in the management of mental health problems in the community. Both health workers and community identified exclusion, isolation and poor control over life, associated with risks and a poor physical state, as features of mental ill health. The Kariobangi community was felt to experience high levels of mental ill health, with poverty a major contributing factor. The major mental disorders identified were depression, stress, poverty, lack of awareness, drugs/substance abuse, lack of essential services (mental health services), mental retardation and epilepsy. The intervention is still at an early stage, but the evidence suggests that the PRA approach has strengthened community roles and interaction with health workers in improving mental health care in an underserved community.
Participatory approaches were used to facilitate a programme of work aimed at: improving communication and understanding between HIV positive clients and the HIV clinic personnel in HIV clinics; raising HIV positive clients’ voices and participation in improving the HIV clinic services in the division; and promoting networking to overcome isolation, increasing exchange and co-operation through conducting. Participatory approaches, while challenging and time intensive, were perceived by health workers, clients and the facilitators to be a powerful means to enhancing communication, overcoming power imbalances that are barriers to good health or effective use of services and to encouraging the sustainable, “bottom up” community involvement on health visioned in Kenya health policy documents. Real changes were made to make the services more client-friendly, including installed suggestion box, re-streamlined queuing and filling system, taking of vital signs, interpreter involvement, and ordering of bulk drug supply, while clients formed a network that would sustain the communication and reduce social isolation of PLWHIV.
Reviewing experience in selected countries in the region, this policy brief suggests that countries can strengthen equitable allocation of resources for health by increasing the overall share of government funding allocated to the health sector, bringing external aid and government funding into one pooled fund and allocating it through a single mechanism. Equitable resource allocation calls for governments to establish annual targets for equitable allocation of these public funds, and to collect information to monitor and report on progress in meeting these targets, including to parliaments and civil society. Resource allocation is a politicised process and requires careful management, including to plan, organise and provide incentives for redistributing health care staff to areas where health need is higher.
Over the last two decades there has been growing interest in the potential of social health insurance (SHI) as a health financing mechanism in low and middle-income countries. However, few countries in Africa have implemented SHI. Uganda is currently designing its own SHI scheme, in preparation for its imminent implementation. It is hoped that SHI will bring additional resources for the Ugandan health sector and that its introduction will improve equity in access. Very little was known about the Insurance market in Uganda before this study was undertaken, so one of our main objectives was to provide quantitative and qualitative data that could be used by the Ugandan Ministry of Health as a basis for designing this scheme and for future SHI policy-making.
Drawing on the analytic framework of the regional analysis, an analysis of equity in health at district level was implemented in Tanzania, through secondary review and field work. We found a clear policy commitment to equity, the administrative means to implement it and a political stability that enables this. A number of features of Tanzania’s context and health system make reducing differentials in health and access to health care possible, including the investment of debt relief resources in health and education, increased public spending in health, methods for managing external funds that pool resources for wider reallocation to areas of need and a resource allocation formula that considers access, poverty and disease burden in the allocation of resources and provides guidelines for spending to protect areas of equity oriented spending.
The growth of international trade has significant consequences for public health. The relationship between trade and health is not simple, nor is it unidirectional. In this brief we raise why trade issues need to be understood and managed to promote health and we highlight the main concerns arising from free trade agreements for public health. We draw attention to measures that governments and civil society in the region can take to achieve greater coherence between trade and health policies, so that international trade and trade rules maximize health benefits and minimize health risks, especially for poor and vulnerable populations.
Call for registration for and abstracts of research and practice by January 29 2008.
The first National meeting on Equity in Health in Uganda will be hosted by the HEPS Uganda – Coalition for Health Promotion and Social Development and Makerere University in co-operation with Regional Network on Equity in Health in East and Southern Africa (EQUINET). The meeting will bring together researchers, policy-makers, practitioners and others concerned with equity in health to exchange information and develop an agenda of follow up work to support health equity in Uganda. People interested in attending the Conference are invited to notify the organizing Committee and submit an abstract by January 29th preferably by email to heps@utlonline.co.ug and copy to admin@equinetafrica.org or to HEPS-Uganda P.o Box 2426, Kampala.
This study reviews the Zambian deprivation-based health resource allocation formula and assesses how such a formula has been implemented in terms of achieving the initial desired goals of resource – re-distribution. It further considers the extent of converge or divergence in the equity goals relating to resource re-distribution through the allocation of funding to the districts.