Public policy can make a difference to people’s health. Health improves with increased wealth. But countries with low per capita national incomes have been able to achieve very high health outcomes when they have directed resources towards primary health care and district health services. Parliaments can contribute to these health outcomes in their debate on, review and approval of government budget allocations and oversight of public spending by the executive. This function is often seen as separate to the legislative role of parliament. But this leaflet argues that in fact, rights and their expression in law can be a powerful tool for parliamentarians when they are arguing the case for increased budget allocations, especially for health, and for these resources to be directed at the areas of health that matter most for equity.
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The Third EQUINET Regional Conference on Equity in Health in East and Southern Africa will take place at the Speke Conference Centre, Munyonyo, Kampala, Uganda, 23-25 September 2009. This is a unique opportunity to hear original work and debate on the determinants and forces that are driving or impeding equity in health in east and southern Africa, including those at global level. Visit the conference website at http://www.equinetafrica.org/conference2009/index.php. The conference will have plenary and workshop/ parallel sessions on: * Health equity in east and southern Africa; * Protecting health in economic and trade policy; * Building universal, primary health care oriented health systems; * Equitable, health systems strengthening responses to HIV and AIDS Fair Financing of health systems, and reclaiming financial resources for public sector health services; * Valuing and retaining health workers; * Organising participatory, people centred health systems; Social empowerment and action for health; Understanding and managing equity oriented policy development and implementation; * Country experiences of advocacy and promotion of equity in health; and Monitoring progress through country and regional equity watches. A call is made for proposals for pre- and post-conference skills and theme workshops to be sent to the Conference Scientific Committee before 25 September 2008. Workshops are anticipated to be one day or half-day sessions and to include about 30 people. Accepted workshops will be listed in October 2008.
The Tanzanian public health sector is losing workers to internal and external migration. This paper examines the implementation of policies to govern non-financial incentives to retain health workers. It outlines a range of non-financial incentives set in policy in Tanzania, including training; leave; promotion; housing; and a safe and supportive working environment. It also examines the systems for managing personnel and the implementation of incentives as a factor in retention, including the participatory personnel appraisal system; worker participation in discussing their job requirements and welfare; supervision; recognition and respect. Drawing on a review of policy, published and grey literature and on a field study of seven districts, including five underserved districts, the paper finds that while a number of incentives exist in policy, their sustainability is eroded by the absence of special earmarked funding for their implementation.
Partners in Population and Development, Africa Regional Office (PPD ARO) the Regional network for Equity in Health in East and Southern Africa (EQUINET), African Population Health Research Centre (APHRC) and Alliance of parliamentary committees on Health in east and southern Africa (SEAPACOH) are jointly organizing a meeting in Kampala, Uganda on September 16-18 2008. The meeting will invite MPs drawn from Parliamentary Committees responsible for health as well as technical, civil society and regional partners. The meeting will review the health equity situation assessment in the region, including in relation to regional and international goals; review and discuss sexual and reproductive health, HIV and AIDS, population policies, laws and budgets; discuss options for fair and adequate health care financing and for promoting equitable resource allocation, particularly in relation to budget processes; explore the application of international and regional treaties and conventions on the right to health; update on current health and trade issues and legal frameworks for ensuring protection of public health; discuss developments in primary health care and essential health care and review and make proposals to strengthen SEAPACOH and parliamentary committee regional networking. For more information on the meeting please contact us at admin@equinetafrica.org
SEATINI / EQUINET are holding a workshop bringing together civil society, parliamentarians, human rights commissions, trade and health ministries officials to review and deliberate on protection of health and access to health care services in the ongoing EPA negotiations, and particularly in the services negotiations. The meeting will be held in Kampala Uganda September 18-19 2008. The meeting aims to:
* Update on current health and trade issues, including patenting laws and the EPA negotiations and more generally legal frameworks for ensuring protection of public health in trade agreements.
* Review the technical analysis report developed looking on the services negotiations in the Economic Partnership Agreements.
* Review and develop key positions to be advanced for the protection of public health in trade agreements and strategies for advancing them.
* Develop progress markers with regards to the EPA negotiations and protection of public health.
* Develop a workshop declaration.
For any queries please email admin@equinetafrica.org
In Kenya, internal migration of workers, from rural/poor areas to urban/rich areas, is just as serious a problem as international migration. Shortages in the health workforce are aggravated by the unequal distribution of health workers as a result of economic, social, professional and security factors. This report is of a literature review and field research on strategies for the retention of health workers in Kenya. It examines trends in health worker recruitment and retention; existing policies, strategies and interventions to retain health workers; and assesses their implementation and the factors affecting this. The study data suggests that better organised facilities, often in higher-income areas, are more successful in providing incentives. Yet it is at the lower levels of the health system (in rural and poorer areas) where incentives are more urgently needed to counteract the strong push factors that force workers out of these areas. Recommendations are proposed for measures to retain health workers in rural areas, in lower-income districts and at lower levels of the health system to ensure that all areas reach minimum standards with regard to numbers of personnel per population. Such incentives are not only financial. A number of non-financial incentives are highly valued: improved working conditions; training and supervision; and good living conditions, communications, health care and educational opportunities for themselves and their families.
This document compiles twenty one editorials of the newsletter of the Regional Network for Equity in Health in East and southern Africa from January 2007 to April 2008 translated into Portuguese. The issues covered range from debates and policy positions on financing for health to the public health impacts of criminalising HIV transmission. The editorial content reflects a range of authors from academic, professional and civil society groups and not the views of the EQUINET steering committee.
The Third EQUINET Regional Conference on Equity in Health in east and southern Africa will be held at Speke Conference Centre, Munyonyo, Kampala, Uganda September 23-25, 2009. People are welcome from government, non-state organisations, academic and research institutions, civil society, parliaments, regional and international organisations and other institutions promoting and working on equity in health in east and southern Africa! The conference theme is 'Reclaiming the Resources for Health: Building Universal People Centred Health Systems in East and Southern Africa' and it will highlight opportunities for improving health equity in east and southern Africa.
This study aimed to assess equity in uptake of antiretroviral therapy in Malawi in 2005, especially according to age (children vs. adults), gender (men vs. women) and income. Particular reference is made to the scaling up of ART and the removal of fees for ART in 2004. Informal interviews were conducted with health sector antiretroviral programme implementers and key policy makers in the Ministry of Health. The researchers also searched both published and grey literature to collect information on the history and operations of the Malawi public sector-led ART programme. Retention rates remain high in Malawi's ART programmes (84%), which compare favourably with those elsewhere on the continent. Rates ranging from 44% to 85% of people remaining on treatment after 24 months of treatment have been reported in ART programmes throughout Africa (Rosen et al, 2007). While there were some reports from key informants that the change from fee-paying ART services to free systems may have improved patient adherence to treatment regimes, the research did not provide conclusive evidence of the impact of cost of patients' medications on their adherence to their treatment regimens. Different adherence rates in different areas and programmes suggest that other determinants may be affecting affect this outcome.
In Uganda, community-based health insurance started in 1995; however, the number of schemes has remained small with very low coverage levels. This study examines issues of equity and sustainability in these prepayment schemes; if they are to contribute significantly to health sector financing, the schemes must be equitable and sustainable. A descriptive cross-sectional study employing qualitative techniques was carried out. Key informant interviews, focus group discussions and documents review were used. Data was tape-recorded, transcribed, typed, manually analysed thematically using a master sheet. Abolition of user fees did not have a big effect on enrolment into the schemes. People went for higher quality services, which were perceived to be provided in private health facilities rather than government services. Schemes were perceived to directly contribute towards health financing by providing funds for the procurement of drugs and equipment, allowing people to contribute to their own health care. An indirect benefit is that they would ease the pressure on public facilities by diverting patients from the public health sector. Whereas some thought the contribution of CHI schemes was insignificant due to low enrolment, others felt the schemes needed to be strengthened to build confidence in social health insurance. The researchers recommend that government increase funding to maintain the improvement in quality of health care in public facilities. Future health policy needs to address whether or not CHI has a role to play in the Ugandan context and in institutionalising SHI.