Labour Voices of the Airwaves is broadcast in five languages on 39 community radio stations in South Africa. This 7-minute long show broadcast earlier this year looks at the South African government's progress towards the World Health Assembly resolution on universal coverage, defined as adequate access for all at an affordable price. The spokesperson from the Ministerial Advisory Committee on the National Health Insurance (NHI), Fidel Radebe explained that the NHI is intended to be a financing system to provide universal coverage to all South Africans. Prof Di McIntyre from EQUINET -Health Economics Unit at the University of Cape Town, argued that universal coverage can only be achieved through fair financing mechanisms, and these would either be tax funding or a national health insurance scheme that integrates all funds into one pool for the benefit of all. Nehawu spokesperson Sizwe Mpamla explained why the union is in favour of NHI, saying that an universal health system would mean increased funding for the public health sector, which would lead to improved facilities and this would positively impact on health workers working conditions. Asanda Fonqa of Denosa was similarly positive about the move towards NHI. Prof David Sanders of the School of Public Health at the University of the Western Cape said that NHI would only contribute to achieving universal coverage if it chose a viable model for delivery; he said that if the bulk of NHI funds were used to cover private health services, universal coverage would not be achieved. Activists like Sipho Magodella of the Anti-Privatisation Forum remained skeptical that the government was really committed to delivering an equitable, universal health system and therefore skeptical of the planned NHI. Only when the full NHI proposal is made public will South Africans be able to assess to what extent it is likely to bring about universal coverage. This file is too large to load to the website so those interested are asked to contact admin@equinetafrica.org
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On September 27 2010, the Ministry of Health of Mozambique, in co-operation with partners, launched the Mozambique Equity Watch report. The launch was held during a one-week World Health Organisation AFRO training course building capacities in health equity and the social determinants of health. The launch was held in co-operation with EQUINET, represented through Training and Research Support Centre (TARSC). The report was launched by the Minister of Health and attended by officials of the Ministry and other sectors of government, the National Institute of Health, various technical institutions, and partners of the Mozambique Sector Wide Programme (SWAP) in health, including the focal point for the donor community, WHO and UNICEF. The Minister noted in the launch the need to now make effective use of the evidence in various forums and that the Ministry would want to repeat the Equity Watch in 2012 to see what progress has been made, and to include the inputs from other sectors of government and from civil society. After the presentations and comments participants were organized in three groups to discuss and propose measures for the follow up action on the Equity Watch: 1. On the actions to be taken by the Ministry of Health 2. On taking forward the dialogue with other stakeholders and partners on the report 3. On areas of follow up investigation and research.
Members of the EQUINET steering committee will be presenting work at the First Global Symposium on Health Systems Research, November 16-19 2010. EQUINET (through TARSC), with CGESS Guatemala and SATHI India is holding a session reviewing experiences with participatory action research (PAR) on health systems in Latin America, Africa, Asia and North America. In a roundtable, the case studies from the four regions will be presented and discussed to examine and reflect on the shared learning on health systems derived from PAR, the methods used and their application in health systems research and policy change. EQUINET will also have a marketplace stand at the Symposium and welcome visitors to the stand to see publications and hear more about the work of the network.
An Equity Watch is a means of monitoring progress on health equity by gathering, organizing, analysing, reporting and reviewing evidence on equity in health. Equity Watch work is being implemented in countries in East and Southern Africa in line with national and regional policy commitments. This report presents the Equity Watch in Mozambique. It explores the dimensions of inequality that need to be addressed for the improvements in economic performance to translate into the eradication of poverty and sustained and widest improvements in human development. It focuses on the social determinants of health and the features of the health system that have been shown to make a difference in reducing social inequalities, including in health, and asks the question: what progress are we making? The report examines the positive results achieved so far in health equity in Mozambique, the current levels and the prevailing constraints, in the context of the overall national response to equity. It presents recommendations based on an analysis of information available.
This document is published in Portuguese. ‘Observatório de Equidade’ é um meio de monitoria do progresso da equidade na saúde através da recolha, organização, análise de dados e elaboração de relatórios sobre a equidade na saúde. Este relatório explora as dimensões da inequidade que precisam de ser resolvidas para garantir melhorias no desempenho económico para conduzir à erradicação da pobreza e ao alcance de melhorias sustentáveis no desenvolvimento humano. Dá enfoque às determinantes sociais da saúde e às características do sistema de saúde que provaram fazer a diferença na redução das inequidades sociais, incluindo na saúde, e faz a seguinte pergunta: Que progresso estamos a fazer? O relatório analiza os resultados positivos alcançados até agora, os níveis actuais e os constrangimentos prevalecentes, no contexto da resposta nacional em relação à inequidade. Apresenta recomendações baseadas numa análise da informação disponível.
The national review meeting on the role of the medical aid societies in Zimbabwe was convened by TARSC, SEATINI with collaboration from the Ministry of Health and Child Welfare, and support from the Southern African Health Trust through ISER, Rhodes University, in EQUINET. The activity was one of a series in a regional programme on capital flows in the health sector in southern Africa co-ordinated by ISER. The workshop brought together researchers, policy makers, health sector regulators and the medical aid societies to discuss issues around the flow and impact of capital flows through medical aid societies in the health sector in Zimbabwe. The review workshop guided by the research work that was implemented in Zimbabwe by TARSC and SEATINI on capital flows in the health sector, separately reported in EQUINET discussion paper 82. The meeting raised issues in relation to the functioning of medical aid societies and made recommendations to address them.
The ECSA Secretariat organised the first Regional Monitoring and Evaluation Expert Core Group meeting in Harare Zimbabwe from 12th to 16th July 2010. The participants came from Member States of Tanzania, Kenya, Lesotho, Zimbabwe, Zambia, Uganda, Malawi, Mozambique and Mauritius and international partners, namely EQUINET, UNICEF, ESARO, WHOIST/ESA and USAID-EA. The meeting deliberated and agreed on the Terms of Reference for the regional M&E Expert Group. The meeting also updated the HMC Monitoring tool, adopted with amendments the Regional Core set of indicators that will be used to monitor progress towards the Millennium Development Goals (MDGs), finalised the M & E Framework, developed indicators to monitor the implementation of the HMC resolutions and included indicators to monitor health equity in order to address inequalities in health in the region. In addition, the meeting resolved that it was necessary to monitor other codes, protocols and conventions such as the WHO Global Code of Practice on the International recruitment of health personnel. The indicators and the monitoring tools agreed upon by the expert core group will not only make it easier to compare member states in progress towards achieving the MDGs, addressing equity issues in health and implementation of the HMC resolutions, but also will be valuable in evaluation of in country changes from the baseline. The meeting also discussed, reviewed and adopted the Equity watch work in east and southern African countries.
This paper outlines the flows of private capital that lie behind the growth of the for-profit pharmaceutical sector in Tanzania. It reports an analysis of the policy, access and equity challenges posed by the shift to increasing private sector participation in the sector. The study was implemented within EQUINET by the Institute of Development Studies, University of Dar es Salaam, in a regional programme co-ordinated by the Institute for Social and Economic Research, South Africa. Strengthening the pharmaceutical sector to produce an adequate supply of medicines in Tanzania, for Tanzanians, is hindered by numerous constraints, including: non inclusion of TRIPS flexibilities in Tanzanian law; lack of skilled staff; financial constraints; poor industrial infrastructure and services; weak local and international pharmaceutical industry links; and counterfeit medicines entering the market. The report recommends that the health ministry step up its own monitoring systems to ensure effective distribution of medicines to health facilities. New legislation is also needed to improve quality standards, implement TRIPS flexibilities in Tanzanian law, and tackle substandard medicines entering the market.
The private health sector in South Africa is substantial. This paper explores the private sector involvement in funding and providing health services in South Africa and the implications for equity and access to health care. Serious challenges face the private health care sector in South Africa, not least of all the very rapid increases in expenditure and, hence, contribution rates in medical schemes. A range of factors underlie these trends; but in recent years, schemes’ spending increases have been driven largely by private for-profit hospitals and specialists, with the number of private hospital beds increasing rapidly and considerable consolidation of beds within three large private hospital groups. The 2007 policy conference of the ruling African National Congress (ANC) resolved to introduce a National Health Insurance (NHI). If successfully implemented, the substantial reforms envisaged will promote health system equity, affordability and sustainability within South Africa. However, there are growing concerns that the introduction of these reforms will contribute to increased activities by South African private for-profit health care companies in other African countries. Private health care firms in South Africa not only have an interest in expanding into other African countries, they will also have access to substantial investment resources. In particular, the World Bank’s International Finance Corporation (IFC) is actively seeking to invest in the private health sector in African countries. The experience of the private health sector in South Africa should be taken into account by policy-makers in other African countries when considering what role they envisage for the private health sector within their country context.
In most East and Southern African (ESA) countries, total health expenditure from all sources, including external resources, is still less than the US$ 45 per capita per year needed to provide basic health services. This limits their ability to achieve universal coverage of basic health services. This policy brief draws policy makers’ attention to the demands and challenges in health financing in meeting universal coverage, the demand for improved domestic public financing for health, and suggests options for doing this.