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.
Latest Equinet Updates
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!
This report provides an overview of resource-allocation decision making in South Africa as it impacts on the distribution of health budgets. It also looks at changes in the allocation of public health care resources since the early 1990s across provinces. Finally, it considers whether resources are allocated equitably between health districts. The report finds that while considerable progress has been made towards the equitable allocation of public sector health care resources among provinces, substantial disparities in spending on primary health care (PHC) services remain among health districts. It is critical that provincial health departments pay more attention to the equitable allocation of resources for PHC services among the districts within their province, the author argues. In the absence of such efforts, many South Africans will continue to be disadvantaged in their access to PHC services simply because of their place of residence.
This annotated literature review was prepared as a resource for the policy research programme led by EQUINET that is examining the role of global health diplomacy (GHD), including south–south diplomacy, in addressing selected key challenges to health and strengthening health systems. This review provides an annotated bibliography and a summary of key features of peer-reviewed articles, books, book chapters and academic reports published between 1998 and 2004 on three case study areas: research on GHD, particularly in the areas of the World Health Organisation's Code on International Recruitment of Health Workers; access to essential drugs through south-south partnerships; and involvement of African actors in global health governance. It focuses on the theoretical and conceptual frameworks used in peer-reviewed literature on global health diplomacy and on the authors’ methodological choices to reach their conclusions. The report highlights theories that guided the research, the types of conceptual frameworks used and the research strategy and research tools employed in the publications reviewed.
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.
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.