Parliaments play an important role in health. Generally and through their specialised committees, they can scrutinise and ensure that national budgets meet national policy goals, debate and pass laws that institutionalise social goals and provide leadership, representation and space for public participation in health. Parliaments can also provide oversight of the executive in terms of how this arm of government is implementing national policy. This brief is the second in a series jointly produced be EQUINET and SEAPACOH with institutions in the EQUINET network. It explores how these parliamentary roles can be applied to strengthen the fair financing of health systems. Copies of the leaflet and a feedback form on it can be obtained from the EQUINET secretariat at admin@equinetafrica.org.
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In Zimbabwe, there are four categories of state owned tertiary institutions: universities, teachers colleges, polytechnic colleges and agricultural colleges. All institutions are either in urban or semi-urban areas, except for agricultural colleges, which are mostly located in farming communities due to the nature of their studies and are governed by the Ministry of Lands and Agriculture instead of the traditional Ministry of Tertiary and Higher Education. Such discrepancies have led to the ‘isolation’ of the students attending these institutions especially in matters concerning the students’ health. In particular there has been inadequate effort to address the reproductive health challenges of the students in these institutions despite their sexually active and high risk age group, including for risk of HIV infection. Students and Youths Working on Reproductive Health Action Team (SAYWHAT) a civil society organization in Zimbabwe, used the Participatory Reflective and Action (PRA) methodology as the starting point to involve the agricultural colleges in addressing reproductive health challenges.
The Zambia Participatory Reflection and Action (PRA) project was implemented to strengthen communication between primary care level health workers and communities in one urban and one rural area of Zambia. It was implemented following PRA training in EQUINET as a pilot of the PRA method. The work has has shown that the PRA method is useful to strengthen health worker - community interactions in health planning and is replicable in other health centres of Zambia operating under district health management teams. The PRA method was found through pre- and post intervention assessment to improve communication and interaction between community members and health providers in attaining a people-centred health system in resource limited settings such as Zambia.
EQUINET through Health Systems Trust, University of Namibia and its secretariat at Training and Research Support Centre, in co-operation with the Regional Health Secretariat for east, central and southern Africa, is implementing in east and southern Africa research, capacity building and programme support for the retention of health workers and for management of out- migration of health personnel. The programme will support empirical research on the costs and benefits of health worker migration within and beyond east and southern Africa (ESA); and will support evaluation of the effectiveness of current policies and agreements to manage these costs and benefits. The University of Namibia is now co-ordinating the work on HRH retention and Health Systems Trust the work on HRH migration, in co-operation with EQUINET Secretariat (TARSC) and ECSA Regional Health Secretariat. For further information on the programme please contact EQUINET (admin@equinetafrica.org) and ECSA (regsec@crhcs.or.tz).
This Participatory, Reflection, and Action (PRA) project on occupational health services offered an opportunity for IHRG and a group of unionised health workers to use innovative learning and research methodologies as a means to investigate and intervene in their experiences of workplace injury and illness. Following IHRG’s participation in a regional training workshop hosted by EQUINET with TARSC and Ifakara, IHRG used selected PRA tools in a participatory action research programme. The project consisted of three workshops, workplace-based investigations, and the dissemination of networking resources among the participants. The combination of workplace-based case investigations and the process of critically reflecting on these interventions provided a very powerful action-learning experience. Processes of change were evident even in this short term project. Participants’ workplace investigations uncovered real cases of workplace injury and illness that have been buried under a culture of ignorance, neglect, silence, and denial of workers’ health and safety rights.
This study is a review of the literature and secondary evidence on community participation in central, eastern and southern Africa. It focuses in particular on South Africa, Mozambique, Malawi, Zambia and Kenya, and presents and analyses evidence of the current situation with regard to the role of districts in promoting community participation and articulating community voice. This includes looking at how: • community voice and roles at district level are structured and integrated into planning; • the way districts carry out their functions enables or blocks participation; • districts articulate and represent community interests at national level; and • wider contexts and processes at national and district levels influence and explain these outcomes. The purpose of the review is to identify examples of enabling and blocking mechanisms for community participation at district level and to provide pointers for further research.
The EQUINET and MRC meeting on Food Security and Nutrition in east and southern Africa sought to bring together case study writers and expert facilitators that have been working on nutrition initiatives, policies, and to update them on the prevailing situation, current interventions, equity and policies on food security. The meeting took a focus on how health systems can advance and encourage food sovereignty, including community control and enhanced gender equity in food production. The meeting established the framework for a series of case studies that demonstrate and examine health system approaches to food sovereignty that will be implemented in 2006.
The nursing curriculum of the University of Namibia is based on Primary health care approach. However nursing students do not have the skills for a participatory approach to communities and perceive that communities do not know or need to be consulted on their health needs. Communication breakdown between communities and nurses is not in the interest of either. This study aimed to create awareness among the student nurses to help them view the communities as partners in health, and at the same time to empower the communities to be more responsible for own health.
The research was located in Cape Town, South Africa where the need for equity policies to be implemented is great. However ongoing restructuring and change lead to fatigue in the management and staff of the primary health services. Their resistance could block the implementation of equitable staffing plans. It is necessary to understand the management and workplace factors leading to potential resistance of equitable staffing plans and thus these were explored. A policy analysis approach using a case study analysis was sought to provide understandings, approaches and tools to illuminate the processes involved in health policy.
The workshop on Protecting Health in Trade Agreements held in Malawi in June 2006 aimed to build capacities in state, legislative and civil society institutions to understand, analyse and promote public sector equity-oriented health systems within trade and investment policies and agreements. The course aim to enable participants to carry out assessments nationally of the key trade and investment agreements that impact on health and to identify options for promoting public sector equity-oriented health systems within current trade and investment policies and agreements.