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.
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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.
From 26-28 April 2012, EQUINET held a regional methods workshop in Cape Town, South Africa. It gathered the lead institutions of country teams in the Equity Watch work, the EQUINET steering committee, regional and international agencies and networks involved in work on health equity. The workshop aimed to: provide training on equity analysis and discuss future approaches to capacity building on equity analysis; review Equity Watch work at country level and the learning and implications from the work for future monitoring of health equity within countries; and review and discuss the draft regional Equity Watch and the follow up and dissemination. Equity Watch presentations were delivered at the meeting for five of the countries in east, central and southern Africa included in the EQUINET network, namely Kenya, Uganda, Zambia, Zimbabwe and Mozambique. Results were mixed from the various countries, indicating success in improved aggregate health in most countries, some closing of rural-urban disparities in health, but widening social and economic inequalities in health and the social determinants of health. Delegates argued that aggregated data obscured inequities in health in the region. They identified decreases in public health spending as a major problem in giving ministries the leverage over other sources of spending on health. They also called for ‘mainstreaming’ health equity into the national and regional health agendas, as well as for the dissemination of the Equity Watch results at country and regional level to all stakeholders, identifying champions who will take Equity Watch forward, putting effective monitoring and evaluation in place to measure progress in health equity in the region, and conducting district-level analysis (so far Equity Watch analysis has been on regional and national levels only). Presentations were also given on various aspects of equity analysis, such as disaggregating health expenditure, analysing the social determinants of health equity and universal health coverage and linking equity analysis to the Millennium Development Goals.
Convened by EQUINET, in association with the ECSA Health Community and IDRC Canada, a session was held at Forum 2012 in Cape Town on April 25th to present evidence and experience from work carried out in 2010-2012 in five countries - Mozambique, Zambia, Zimbabwe, Uganda, Kenya - 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. The session explored why equity analysis is important for strategic planning and what has been learned from the Equity Watch; what challenges countries face in implementing equity analysis and what opportunities exist for linking equity analysis to processes within the health system; and recommendations from the work for institutionalizing equity analysis across different sectors of government and with other actors. A concluding PechaKucha (20 images in 20 seconds each) flagged the key messages and continuing debates in taking equity monitoring and analysis from research to institutional practice in health and health systems. A regional meeting to have deeper dialogue on the national and regional Equity Watch work was held after the forum and the report will be made available through the June newsletter and EQUINET website.
The Ministry of Health and Child Welfare and Training and Research Support Centre with EQUINET hosted a one day meeting in February in Harare to report on and review the findings of the 2011 Zimbabwe Equity Watch; to involve health and non health sector actors in identifying priorities and actions to strengthen equity in universal health coverage and action on the social determinants of health; and to propose how to institutionalise health equity monitoring. The meeting involved 52 delegates from different sectors of government, parliament, civil society, private sector, technical institutions and international organisations. The meeting identified a number of recommendations and areas of follow up action flowing from the discussions on the Equity Watch report and the presentations in the plenary and parallel sessions that are presented in the report. Stakeholders endorsed equity as a guiding principle for universal health coverage, as well as health in all policies and made proposals for short and medium term steps to work towards equity in universal health coverage. They called for strengthened consistent co-ordination of the institutions and agencies that influence the determinants of health and delivery on universal health coverage. It was proposed that the Equity Watch be institutionalised and repeated in future with the involvement of other sectors, with indicators also identified for annual monitoring in the routine information system. Specific additional areas for equity analysis were identified.