In November 2010, the first Global Symposium on Health Systems Research (HSR) on ‘Science to Accelerate Universal Health Coverage’ shared evidence and identified priorities for strengthening HSR to achieve universal health coverage (UHC). The focus and alliance that emerged from the conference and the high-level support from many global and national agencies suggest the potential for greater visibility and inclusion of evidence on health systems in future global health policy debates. While the many global forums advocating UHC indicate that there is a consistent focus on policy on universality, different perspectives on UHC indicate that the term ‘universal’ cannot simply be assumed to include the same interests, meanings, and values for all who use it. The author argues that UHC as a goal – and the health systems strengthening it – should inform policy dialogue on specific global agendas, and that stakeholders should make clear and discuss their different positions on UHC, their policy options and consequences, and the political views and values that lie behind them. (EQUINET through TARSC and SEATINI regularly contributes to the Global Health Monitor.)
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A Ministers’ and Senior Leadership Scoping Workshop was held to provide an opportunity for Ministers of Health and senior leadership teams in ECSA member states to be briefed on and review the Global Health Diplomacy (GHD) Initiative in the ECSA region, to identify synergies and opportunities for collaboration with on-going and planned country and partner activities and to agree on modalities for implementation. The meeting reviewed the experiences in GHD to date, the international initiatives on GHD and the proposed programme activities. The Ministers and senior officials made recommendations for the implementation of the programme.
In this paper, the author considers elements of the design of health systems and how these relate to moving towards UC 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, she argues. 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 ESA 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.
Participatory Reflection and Action work in EQUINET has shown that health workers suffer problems of poor work environments, poor remuneration, lack of growth opportunities and motivational incentives. This may pose a barrier to their interaction with communities, despite the role that communication plays in patient-centred care. Communities on their side may not possess the skills and capacities to negotiate or communicate with service providers, leading to misunderstanding, lack of knowledge and even anger. In 2011, building on work done on health literacy in Zimbabwe, Malawi and Botswana, and in the EQUINET PRA equity network to strengthen communication between health workers and communities, TARSC implemented a one year programme with HEPS Uganda and, with Cordaid support, to extend health literacy in Uganda and use the skills built to promote dialogue and accountability between health workers and communities. In 2012-2014 TARSC and HEPS-Uganda are building on this work to widen and deepen the capacity of civil society organisations (CSOs) for Health Literacy (HL) in Uganda. This report outlines a meeting that was a first step in this two-year programme. It brought together five CSOs working within districts on health. The workshop trained facilitators, education and lead personnel from five CSOs in Uganda to plan, implement and monitor HL programmes at district level, including a specific focus on women’s health.
This review assesses the resource mobilisation and allocation performance and challenges faced by the MoHCW in meeting the target set out in its Investment Case. As the Investment Case was meant to complement the annual government budget and resource mobilisation efforts by other players, the review took these resources into account in assessing the level and direction of funding. The review specifically looked at the response from funders of the health sector to the Investment Case, in terms of what resources were raised and the successes and challenges associated with raising the intended resources. It assesses the resources raised and some of the health outputs from these resources. The study included interviews with key informants in the Ministry, review of policy documents and analysis of financial data from government and external funders.
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.
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.