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.
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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.
This call invites applicants from all regions globally to participate and share experiences in an International Workshop on ‘Participatory action research in people centred health systems’ being held on 4th October in Cape Town South Africa, following the Global Symposium on Health Systems Research (30th Sept–3rd October). It is hosted by TARSC and pra4equity network in the Regional Network for Equity in Health in east and southern Africa (EQUINET) and Asociación Latinoamericana de Medicina Social (ALAMES).
This call invites applicants from east and southern African countries to participate and share experiences in a three day skills workshop of the EQUINET pra4equity learning network on an ‘Participatory action research in people centred health systems’ being held on 4-6 October in Cape Town South Africa, following the Global Symposium on Health Systems Research (30th Sept–3rd October). It includes at the same venue on the first day (4 October) the one day post GSHSR workshop on PAR hosted by EQUINET and ALAMES (for which there is a separate call open to all regions), and the following two days (5-6 October) the skills training for the east and southern African delegates, hosted by EQUINET.
Health Centre Committees (HCCs) have provided one vehicle for social participation and accountability in health systems in east and southern Africa (ESA). Recognising this contribution and building on prior work on HCCs, EQUINET held a regional meeting involving those working with HCCs in ESA countries to exchange experiences and information on the laws, roles, capacities, training and monitoring systems that are being applied to HCCs in the ESA region. The meeting gathered 20 delegates representing seven countries from the region, all involved in training and strengthening HCCs. An interim desk review of existing published literature on HCCs was prepared for the meeting. The desk review covered all 16 ESA countries covered by EQUINET, that is Angola, Botswana, Democratic Republic of Congo (DRC), Kenya, Lesotho, Madagascar, Malawi, Mauritius, Mozambique, Namibia, South Africa, Swaziland, Tanzania, Uganda, Zambia and Zimbabwe. Delegates validated and added to the evidence presented. This discussion paper combines the evidence from the desk review and the further evidence that was presented at the regional meeting. It covers the legal frameworks, roles, composition, capacities and monitoring of HCCs in ESA countries.
EQUINET will hold a Workshop on ‘Participatory action research in people centred health systems’ immediately after the Global Symposium on Health Systems Research ending 3rd October as a one day post symposium workshop (4th October) and a two day skills training (5-6 October) in Cape Town South Africa. We invite you to send us expressions of interest in participating in the workshop and will post more information on the workshops on the EQUINET website in May.
EQUINET convened this Regional meeting on Health Centre Committees in East and Southern Africa to: i. Provide a forum for exchange of experience and learning between partners doing work on training and strengthening HCCs in countries in the ESA region; ii. Exchange and review information on the legal frameworks, capacities, training materials, and monitoring systems used in capacity building of HCCs, identify and discuss ways of advancing and documenting good practice in these aspects of HCCs; and iii. Develop a shared monitoring framework for assessment of the capacity, functioning and impact of HCCs, to apply to settings where HCCs are operating, and to discuss options for on-going exchange and documentation on the learning across settings. The meeting gathered 20 delegates representing seven countries from east and southern Africa, all of whom are involved in training and strengthening HCCs. The report provides the proceedings of the workshop.
This update reports on one of the presentations at the EQUINET Regional meeting on Health Centre Committees (HCCs) in East and Southern Africa held in January-February that exchanged experience and learning between partners doing work on training and strengthening HCCs in the region. HCCs are mechanisms for public participation and joint planning at primary care level of health systems. The next newsletter will include the full report, more experiences on HCCs and the resolutions of the meeting. For example, we found that HCCs are often not provided for in law: Does that weaken their recognition, power or effectiveness? From Zambia, we heard experience around neighbourhood health committees (NHCs) that dated back to 1991, when the new government committed to building a health system that guaranteed “equity of access to cost effective quality health care as close to the family as possible.” The 1995 National Health Services Act set in law District Health Boards and NHCs, as well as the Central Board of Health at national level. NHCs became the vital link between the community and the health institutions. Over the next 10 years the number of NHCs in the country grew. While formally recognised, they also faced a series of challenges related to the voluntary nature of the work of NHC members, their lack of planning skills, and political interference. In 2006 the National Health Services Act was repealed, and the structures under it were dissolved, except for the NHCs. Despite the change in their legal status, the MoH continued to recognise their role in PHC and maintained it through policy guidelines. In Lusaka, an NHC Working Group was set up to provide support, operational guidelines and a constitution was developed for NHCs to clarify their role, they worked actively in budgeting, planning and community health, and annual meetings were held to review NHC experiences and activities. The case study led to interesting discussion on the legal status of to HCCs. On the one hand fornalising their status was seen to be important for their recognition and for HCCs to receive and account for public funds. On the other, even if there is a legal framework, there is no guarantee that communities will know about or understand it and the Lusaka experience showed the many ways HCCs can be formally supported, even in the absence of laws. Also it was noted that laws may be important, but they need to arise from and be upheld by the actions of communities.
In 2014 EQUINET and partners are finalising and reporting work in case study areas of global engagement in health that were defined as priorities in global health diplomacy (GHD) by senior officials and Ministers in 2011 for the region. The three case study areas are:
1. Implementation of the WHO Code on international Recruitment of health personnel:
2. Collaborating on access to essential drugs through south- south relationships with China, Brazil and India:
3. The involvement of African actors in global health governance on universal access to prevention and treatment for HIV and AIDS
The research work is being finalised and the evidence will be shared through policy dialogue forums, drawing strategic advice on and peer review of the work, and through regional review meetings and peer reviewed publication. If you are working on or interested in these areas please visit the website for publications produced to date or contact the EQUINET secretariat.
Health Centre committees (HCCs) (known by a range of names) are mechanisms that exist at community and primary care level for co-determination by communities and health workers on their health systems and on PHC. In January 2014 EQUINET through TARSC and with CWGH is holding a regional meeting on the role of health centre committees in primary health care. The regional workshop includes organisations doing work on training and strengthening HCCs in east and southern African countries. It aims to exchange and document information on the laws, capacities, training materials used, and monitoring systems used in HCCs, and to develop a shared monitoring framework for assessing how HCCs are functioning.