ESA countries face many challenges in the absolute shortages, maldistribution, low production and poor utilisation of their health workforces. The World Health Organisation (WHO) Global Code of Practice on the International Recruitment of Health Personnel (the “Code”) was unanimously adopted by the World Health Assembly in May 2010 to address recruitment and migration of health workers. However, its implementation has shown limited progress in east and southern Africa, according to a study in the EQUINET Research programme on global health diplomacy. Health worker migration is not seen to be the scale of problem it was a decade ago in the region. While concerns from the region were mostly included in the Code,the demand for “mutuality of benefit” and “compensation” were not. This was interpreted by some stakeholders to mean that the Code did not fully accommodate African interests. Implementation of the Code is reported to be impeded by lack of champions; of resources for implementation; by weak functional data (systems) on mobility of health personnel, and by limited domestication and dissemination of the Code in ESA countries. This brief presents opportunities to use the Code in negotiating bilateral agreements and suggests ways of strengthening its implementation.
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Participation is a key policy concept in global health, and relates to the ability of stakeholders to engage with and shape health policy at four intersecting levels: local, national, regional and global. Such engagement remains the key normative aim behind debates about furthering more equitable health diplomacy and has, as a result, been increasingly integrated into the agenda of global agencies, including the Global Fund to Fight AIDS, TB and Malaria and the World Bank. This report forms part of a research programme led by EQUINET focusing on the participation of African actors in global health diplomacy. The report focuses on the participation of African actors in global health governance. In an attempt to better understand the spaces and places within which participation can occur, and particularly the ways in which global actors such as the Global Fund and the World Bank provide such opportunities, the research explored the following questions: • How do the Global Fund and World Bank provide spaces for participation in global health governance processes? • To what extent can African actors nationally and regionally extend their agency within these participatory spaces? • What role does the World Health Organisation (WHO) and its own governance play in the interface between African actors and the Global Fund and World Bank?
The Journal of Health Diplomacy (JHD) is now receiving manuscripts for its third issue, titled: Africa, health and diplomacy. This issue is broadly concerned with the theory and practice of health diplomacy of African states, as a co-operation with the Regional Network for Equity in Health in East and Southern Africa (EQUINET). The issue will include invited and submitted manuscripts. To be considered for the latter, please submit your proposed manuscript to the Managing Editor at the email below by 3 November 2014. Manuscripts submitted to JHD will undergo a peer-review process, with referees selected for their particular knowledge/experience on the topic of the manuscript. Authors are asked to ensure that their identity is not revealed directly or indirectly on any page. Manuscripts that are being considered for publication elsewhere, or that have been previously published must not be submitted to the journal. A complete set of author guidelines is available at the website shown. JHD welcomes contributions from all academic disciplines, including international relations, political science, anthropology, sociology, history and geography. We are also interested in interdisciplinary perspectives that cross the boundaries between different theoretical fields and represent novel understandings of health diplomacy.
The World Health Organisation (WHO) ‘Global Code of Practice on the International Recruitment of Health Personnel’ (hereinafter called the “Code”) adopted by the World Health Assembly (WHA) in May 2010 was the culmination of efforts by many different actors to address the maldistribution and shortages of health workers globally. African stakeholders influenced the development of the Code, but two years after its adoption only four African countries had designated national authorities, and only one had submitted a report to the WHO secretariat. This synthesis report is part of the Regional Network for Equity in Health (EQUINET) programme of work on Contributions of global health diplomacy to health systems in sub-Saharan Africa: Evidence and information to support capabilities for health diplomacy in east and southern Africa. The programme aims to identify factors that support the effectiveness of global health diplomacy (GHD) in addressing selected key challenges to health strengthening systems in eastern and southern Africa (ESA). The report compiles evidence from various research strategies undertaken to examine the above issues surrounding the WHO Code that involved an extensive review of literature; a ‘fast-talk’ session at the 66th World Health Assembly in May 2013 involving stakeholders from African countries to gauge views and concerns relating to the Code; a region-wide questionnaire survey implemented in 2013 to obtain views of government informants on issues affecting and measures for managing health workers, including migration of health workers in ESA countries; and three country case studies undertaken in Kenya, Malawi and South Africa concluded in 2014 to provide an in-depth exposition of perspectives on the Code and its implementation.
Gender inequalities are important social determinants of health. We set out to critically review the literature relating to gender equity and sexual and reproductive health (SRH) in Eastern and Southern Africa with the aim of identifying priorities for action. During November 2011, the authors identified studies relating to SRH and gender equity through a comprehensive literature search. Gender inequalities were found to be common across a range of health issues relating to SRH with women being particularly disadvantaged. Social and biological determinants combined to increase women’s vulnerability to maternal mortality, HIV, and gender-based violence. Health systems significantly disadvantaged women in terms of access to care. Men fared worse in relation to HIV testing and care with social norms leading to men presenting later for treatment. Gender inequity in SRH requires multiple complementary approaches to address the structural drivers of unequal health outcomes. These could include interventions that alter the structural environment in which ill-health is created. Interventions are required both within and beyond the health system.
This call invites applicants from all regions globally to participate and share experiences in an International Workshop on ‘Participatory action research in people centred health systems’ being held on 4th October in Cape Town South Africa, following the Global Symposium on Health Systems Research (30th Sept–3rd October). It is hosted by TARSC and pra4equity network in the Regional Network for Equity in Health in east and southern Africa (EQUINET) and Asociación Latinoamericana de Medicina Social (ALAMES).
This call invites applicants from east and southern African countries to participate and share experiences in a three day skills workshop of the EQUINET pra4equity learning network on an ‘Participatory action research in people centred health systems’ being held on 4-6 October in Cape Town South Africa, following the Global Symposium on Health Systems Research (30th Sept–3rd October). It includes at the same venue on the first day (4 October) the one day post GSHSR workshop on PAR hosted by EQUINET and ALAMES (for which there is a separate call open to all regions), and the following two days (5-6 October) the skills training for the east and southern African delegates, hosted by EQUINET.
Health Centre Committees (HCCs) have provided one vehicle for social participation and accountability in health systems in east and southern Africa (ESA). Recognising this contribution and building on prior work on HCCs, EQUINET held a regional meeting involving those working with HCCs in ESA countries to exchange experiences and information on the laws, roles, capacities, training and monitoring systems that are being applied to HCCs in the ESA region. The meeting gathered 20 delegates representing seven countries from the region, all involved in training and strengthening HCCs. An interim desk review of existing published literature on HCCs was prepared for the meeting. The desk review covered all 16 ESA countries covered by EQUINET, that is Angola, Botswana, Democratic Republic of Congo (DRC), Kenya, Lesotho, Madagascar, Malawi, Mauritius, Mozambique, Namibia, South Africa, Swaziland, Tanzania, Uganda, Zambia and Zimbabwe. Delegates validated and added to the evidence presented. This discussion paper combines the evidence from the desk review and the further evidence that was presented at the regional meeting. It covers the legal frameworks, roles, composition, capacities and monitoring of HCCs in ESA countries.
EQUINET will hold a Workshop on ‘Participatory action research in people centred health systems’ immediately after the Global Symposium on Health Systems Research ending 3rd October as a one day post symposium workshop (4th October) and a two day skills training (5-6 October) in Cape Town South Africa. We invite you to send us expressions of interest in participating in the workshop and will post more information on the workshops on the EQUINET website in May.
EQUINET convened this Regional meeting on Health Centre Committees in East and Southern Africa to: i. Provide a forum for exchange of experience and learning between partners doing work on training and strengthening HCCs in countries in the ESA region; ii. Exchange and review information on the legal frameworks, capacities, training materials, and monitoring systems used in capacity building of HCCs, identify and discuss ways of advancing and documenting good practice in these aspects of HCCs; and iii. Develop a shared monitoring framework for assessment of the capacity, functioning and impact of HCCs, to apply to settings where HCCs are operating, and to discuss options for on-going exchange and documentation on the learning across settings. The meeting gathered 20 delegates representing seven countries from east and southern Africa, all of whom are involved in training and strengthening HCCs. The report provides the proceedings of the workshop.