Fair financing of health services requires that countries reduce their reliance on out-of-pocket (OOP) funding for health services and improve their pre-payment financing through general tax revenue and health insurance (particularly mandatory health insurance). While many countries in east and southern Africa (ESA) receive high levels of external funding, it is critical to increase domestic government funding for the health system to support this move away from out-of-pocket funding to provide effective financial protection from the costs of health care. This policy brief reviews progress in reducing out-of-pocket payments in ESA countries and in increasing government funding for health, particularly in terms of meeting the Abuja target of 15% of the government budget being devoted to the health sector and a target of government spending of US$60 per capita. While there has been some progress in some countries, most ESA countries are still far from achieving these fair financing targets. The brief highlights areas that merit action to meet policy commitments on fair financing.
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The Consultation on Improving Access to Health Workers at the Frontline for Better Maternal and Child Survival was held at the InterContinental Hotel in Nairobi, Kenya from 25 to 27 June 2012. The objective of the consultation was ‘to speed up and scale up country responses to the human resource needs of both the UN Global Strategy for Women’s and Children’s Health (Every Woman Every Child), and the Global Plan towards the Elimination of New HIV Infections Among Children by 2015 and Keeping their Mothers Alive (Global Plan) as a key aspect of both plans’. The communique presents the key proceedings and opportunities, experiences and challenges to guide further action. The Consultation underscored the need for ministries of health, continental mechanisms such as the AUC, regional organisations such as ECSA HC, SADC, WAHO and OCEAC, development partners, FBOs, funding agencies, academic and research institutions, and civic society organisations to give priority to efforts towards increasing access to health workers at the frontline for better maternal and child survival. Recommendations were made to achieve this.
Fair financing of health services requires that countries reduce their reliance on out-of-pocket (OOP) funding for health services and improve their pre-payment financing through general tax revenue and health insurance (particularly mandatory health insurance). While many countries in east and southern Africa (ESA) receive high levels of external funding, it is critical to increase domestic government funding for the health system to support this move away from out-of-pocket funding to provide effective financial protection from the costs of health care. This policy brief reviews progress in reducing out-of-pocket payments in ESA countries and in increasing government funding for health, particularly in terms of meeting the Abuja target of 15% of the government budget being devoted to the health sector and a target of government spending of US$60 per capita. While there has been some progress in some countries, most ESA countries are still far from achieving these fair financing targets. The brief highlights areas that merit action to meet policy commitments on fair financing.
This paper synthesises reports on community participation (CP) concept and its practicability in countries’ health service systems, much focus being on developing countries. The authors were supported through EQUINET to narratively review the published and grey literature traced from electronic sources and hard copies as much as they could be accessed.
CP is a concept widely promoted, but few projects/programmes have demonstrated its practicability in different countries. In many countries, communities are partially involved in one or several stages of project cycles - priority setting, resource allocation, service management, project implementation and evaluation. There is tendency of informing communities to implement the decisions that have already been passed by elites or politicians. In most of the project/programmes, professionals dominate the decision making processes by downgrading the non-professionals or non-technical people’s knowledge and skills. CP concept is greatly misinterpreted and sometimes confused with community involvement. In some cases, the community participates in passive manner. There is no common approach to translate CP into practice and this perpetuates debates on how and to what extent to which the community members should participate. The authors argue that persistent misconceptions about CP perpetuate inequalities in many countries’ health systems, suggesting that more concerted measures are needed.
The meeting held June 4-5 in South Africa was organised by Training and Research Support Centre and Centre for Trade Policy and Law for EQUINET in dialogue with the Strategic Initiative of Global Health Diplomacy co-ordinated by the East Central and Southern Africa (ECSA) Health Community. It was supported by IDRC (Canada). The workshop was held to gather the lead institutions of the research teams for the three case study areas, together with resource people from policy, technical, international agency and research communities to discuss and further develop the three case studies and their links to policy processes on global health diplomacy. The case studies are on implementation of the WHO Code on international Recruitment of health personnel: access to essential drugs through south- south relationships with China, Brazil and India; and involvement of African actors in global health governance on universal access to prevention and treatment for HIV and AIDS. Publications in these areas have been included in the searchable annotated bibliography database on the EQUINET website and materials arising from the work will be posted to this website.
In 1948, the World Health Organisation (WHO) was established as the agency for directing and coordinating authority on international health work, particularly in setting norms and standards and policies in public health , establishing and maintaining effective collaboration with the United Nations, specialised agencies, governmental health administrations, professional groups and such organisations as may be deemed appropriate, furnishing appropriate technical assistance in emergencies, necessary upon request or acceptance of governments (WHO Constitution Chapter II Art 2) By 2011 many new institutions exist in global health, with different governance mechanisms and funding, powers and mandates. This brief explores the range and influence of global health actors and the implications for health diplomacy within east and southern Africa.
This report was commissioned by the Regional Network for Equity in Health in East and Southern Africa (EQUINET). It highlights areas of concern for gender equity in health in East and Southern Africa (ESA), based on a review of published literature. The report provides examples of key areas of gender equity in health drawn from the literature. It raises dimensions of gender equity in health in relation to the contexts for and social determinants of health; in health outcomes; in health systems and options for acting on gender equity in health. The report does not provide a systematic analysis using household data and is not a comprehensive assessment of all dimensions of gender equity. Rather by presenting key dimensions of gender inequity in health in the region, it raises the argument for more systematic audit and mainstreaming of gender within health systems in ESA countries.
Two recent global initiatives – the United Nations Secretary General’s Global Strategy on Women’s and Children’s Health (Every Woman Every Child, EWEC) and the Global Plan for Elimination of new HIV Infections among Children by 2015 and Keeping Mothers Alive (Global Plan) – recognise the importance of strong health workforces and call for additional commitments on human resources to be made. This consultation cohosted by EQUINET seeks to gather stakeholders from within and beyond the region to action-oriented movements to strengthen health workforces and improve access to good practice in addressing barriers to improving the numbers, distribution and quality of the health workers needed for maternal and child health. The meeting will share experiences and best practices in how the health worker needs of the EWEC and the Global Plan fits with the overall human resource planning, the promising practices underway and unresolved issues that need to be addressed. Please email the address below for further information.
Convened by EQUINET, in association with the ECSA Health Community and IDRC Canada, this session presented evidence and experience from work carried out in 2010-2012 in five countries and at regional level in East and Southern Africa to assess progress in key areas of equity in health outcomes, in social determinants of health and in redistributive health systems. The session reviewed the learning from the work, particularly in relation to monitoring policy commitments to equity in health, and discuss the opportunities and the challenges for institutionalising and using equity analysis within health policy and planning. This report summarises the presentations and issues raised at the session.
In 2012 EQUINET is initiating a three-year policy research programme to implement case study research on global health diplomacy in east and southern Africa (ESA). Working with government officials in health and diplomacy, with technical institutions, civil society and other stakeholders in ESA countries, we will examine the role of health diplomacy in addressing selected challenges to health and equitable health systems and use the learning and evidence to inform African policy actors and stakeholders. We will feed into regional processes, including the Strategic Initiative of Global Health Diplomacy co-ordinated by the East Central and Southern Africa Health Community. A review meeting on the case study design is being held in Johannesburg, South Africa on June 4-5 2012.