In this paper, the author considers elements of the design of health systems and how these relate to moving towards universal care in the context of Africa. She focuses particularly on health financing issues (revenue collection, pooling and purchasing), but also raises health service delivery and management issues. In relation to revenue collection, the global consensus is that in order to pursue universal coverage, it is critical to reduce reliance on out-of-pocket payments as a means of funding health services. The author notes that the key focus in moving towards universal coverage should be on mandatory prepayment mechanisms and discusses the options for these. The common assumption of limited fiscal space for increased government spending on the health sector should be challenged and the fiscal space envelop pushed. While mandatory health insurance schemes can also contribute to generating additional revenue for health services, these funds should be pooled with funds from government revenue. Although there is limited evidence in relation to purchasing in east and southern African countries, introducing active purchasing of services, as well as addressing service delivery and management challenges, will be essential if universal access to services of appropriate quality is to be achieved.
Latest Equinet Updates
The notification and prevention of the spread of diseases and other public health risks across borders is a longstanding area of health diplomacy. The International Health Regulations (IHR) (2005) were adopted by the 58th World Health Assembly in May 2005 to control the spread of diseases and public health risks across borders. The IHR (2005) are global standards that become legally binding in countries once they have been incorporated into domestic public health law (unless country constitutions specifically state that such international standards automatically apply). Member states of WHO, who are “States Parties” to the IHR, were given up to 2007 to assess their capacity and develop national action plans on the regulations. Countries were given up to 2012 to meet the requirements of the IHR regarding their national surveillance, reporting and response systems to public health risks and emergencies and to provide the measures set for disease control at designated airports, ports and ground crossings. Progress toward attainment of these goals depends on eight core capacities, to be in place by the year 2012. This policy brief outlines the context and content of the IHR and how far the provisions have been implemented in east and southern Africa.
There has been recent growth in the private for-profit health sector in East and Southern African countries. African governments are being encouraged to facilitate private sector growth through changing their policies and laws and providing funding for the private sector. This poster / leaflet explores what parts of the private sector are growing, the consequences of a growing private health sector and what civil society organisations and Ministries of Health should be doing to protect the integrity of their health systems. Civil society should contribute to monitoring funded of the private sector. Governments should not use tax funds to support the development of the private for-profit sector and should assess the impact of any proposed for-profit activities on the overall health sector before allowing it to proceed, make this impact assessment report publicly available and put in place adequate regulations and collect accurate information on private sector health services.
EQUINET has supported the development of needs-based resource allocation formulae in a number of east and southern African countries in the past, and the methods for developing such a formula are summarised in this paper. EQUINET's work in the region has persuaded us that it is necessary to supplement the development of a formula with other initiatives to support the successful implementation of equity in resource allocation. We believe that for real progress to be made the equity target allocations calculated through a formula must be linked explicitly to planning and budgeting processes to facilitate the gradual shifting of resources. EQUINET through UCT HEU has been developing such an approach in collaboration with the Ministry of Health in Mozambique. A broad overview of this approach, which may be of value to other countries, is outlined in this paper. A needs-based formula is used to identify the provinces and districts that are furthest from their equity targets and that should receive priority for the allocation of additional budgetary resources. A detailed ‘gap analysis’ focuses on comparing the current physical and human resources in each of these provinces and districts to national norms (developed by the Mozambique Ministry of Health based on what is regarded as the ideal or good practice).
There has been recent growth in the private for-profit health sector in East and Southern African countries. African governments are being encouraged to facilitate private sector growth through changing their policies and laws and providing funding for the private sector. This poster / leaflet explores what parts of the private sector are growing, the consequences of a growing private health sector and what civil society organisations and Ministries of Health should be doing to protect the integrity of their health systems.Civil society should contribute to monitoring funded of the private sector. Governments should not use tax funds to support the development of the private for-profit sector and should assess the impact of any proposed for-profit activities on the overall health sector before allowing it to proceed, make this impact
assessment report publicly available and put in place adequate regulations
and collect accurate information on private sector health services.
In 2006-2009, as part of the regional learning network, the Lusaka District Health Management Team (LDHMT) used participatory action research (PAR) to strengthen joint planning and communication, co-operation and trust between communities and health workers. In 2010, building on positive changes found, LDHMT, with TARSC and with Cordaid support, piloted a programme to train health literacy facilitators and hold community health literacy sessions in three areas of Lusaka. The positive feedback from that programme led to dialogue with the Ministry of Health and the proposal for national level implementation of the health literacy programme. This national workshop hosted by Ministry of Health Zambia was thus held with lead stakeholders to review the work done to date and discuss the content, approach and steps towards implementing the programme at national level.
PART ONE OF A BOOK IN TWO PARTS. An Equity Watch is a means of monitoring progress on health equity by gathering, organizing, analysing, reporting and reviewing evidence on equity in health. This 2012 Regional Equity Analysis updates the 2007 EQUINET Regional analysis of equity in health, drawing on the Equity Watch framework developed by EQUINET in cooperation with the East, Central and Southern African Health Community and in consultation with WHO and UNICEF, with some modifications given its regional nature. The report provides evidence from 16 countries in East and Southern Africa, including more detailed evidence from the country Equity Watch reports on: policy, political and legal commitments to equity in health; the current situation with respect to equity in health outcomes; economic opportunities and challenges for health equity; household access to the resources for health and the social determinants of health; challenging inequities through redistributive health systems and global (in)justice and the issues for global engagement. The analysis shows past levels and current levels (most current data publicly available) and comments on the level of progress towards health equity. It raises the factors affecting progress and the challenges to be addressed. The analysis intends to be a comprehensive resource. As the report watches and supports progress, and not simply problems, it includes brief outlines of approaches being taken within the region to advance equity that appear to be yielding progress, with references where further information can be found. Finally, the report presents reflection on the experience of implementing equity analysis at country and regional level and on the experience of the Country Equity Watch work in institutionalising planning and monitoring for health equity.
PART TWO OF A BOOK IN TWO PARTS. This is part 2 of the 2012 Regional Equity Analysis. The report provides evidence from 16 countries in East and Southern Africa, including more detailed evidence from the country Equity Watch reports on: policy, political and legal commitments to equity in health; the current situation with respect to equity in health outcomes; economic opportunities and challenges for health equity; household access to the resources for health and the social determinants of health; challenging inequities through redistributive health systems and global (in)justice and the issues for global engagement. The analysis shows past levels and current levels (most current data publicly available) and comments on the level of progress towards health equity. It raises the factors affecting progress and the challenges to be addressed. The analysis intends to be a comprehensive resource. As the report watches and supports progress, and not simply problems, it includes brief outlines of approaches being taken within the region to advance equity that appear to be yielding progress, with references where further information can be found.
The objective of this 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 intended outcomes of this consultation were broadly stated as: identification of concrete opportunities for progress as well as obstacles to such progress; and documentation of experiences on successes and failures. Through a combination of interactive sessions, the Consultation reviewed progress at country level, what technical support exists, and good practices within the countries. Participants at 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, faith-based organisations, funding agencies, academic and research institutions, and civil society organisations to give priority to efforts towards increasing access to health workers at the frontline for better maternal and child survival and provided a communique of recommendations on actions to achieve this.
The EQUINET 2012 Regional Equity Watch has been produced and is being posted to the website in early September. The report updates the 2007 EQUINET Regional analysis of equity in health, drawing on the Equity Watch framework developed by EQUINET in cooperation with the East, Central and Southern African Health Community and in consultation with WHO and UNICEF, with some modifications given its regional nature. The report provides evidence from 16 countries in East and Southern Africa, including more detailed evidence from the country Equity Watch reports, on: Policy, political and legal commitments to equity in health; The current situation with respect to equity in health outcomes; Economic opportunities and challenges for health equity; Household access to the resources for health and the social determinants of health; Challenging inequities through redistributive health systems and Global (in)justice and the issues for global engagement. Visit the EQUINET website in early September to download the report!