While there is much promotion of private capital flows into the health sector in Southern Africa in reality these flows have been minimal. Private health is the fifth most promoted sector in African after tourism, hotels and restaurants, energy, and computer services. To understand flows of private capital behind the growth of the for-profit health care sector in SADC, EQUINET working through Rhodes University Institute of Social and Economic Research (ISER) and other institutions in the region are examining health sector capital flows in ESA. Despite the minor movements of capital in the ESA health sector, Mauritius, South Africa, Botswana and Namibia appear as the growth points for big capital, with the rest of the region relegated to the margins in terms of large investments. Investment potential exists in the pharmaceutical, hospital and hospital services sectors, but most of new FDI in health is in the pharmaceutical sector often for the production of ARVs to absorb large donor funds. The pharmaceutical sector has also had the most significant amounts of overt privatisation of all health-related sectors, either through selling fixed assets or transfer of equity. The report argues that South Africa is likely to be the biggest destination for investment in health care, and the major regional source of private FDI flows to the health sector in ESA countries.
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Policies in Malawi explicitly mention the need for focus on services for commercial sex workers (CSWs) because of their susceptibility to HIV infection and the potential risk they have of spreading the virus. This study aimed to explore and address barriers to coverage and uptake of HIV prevention and treatment services among CSWs in Area 25 Lilongwe district, Malawi, using Participatory Reflection and Action (PRA) methods. The work was implemented within a programme of the Regional Network for Equity in Health in east and southern Africa (EQUINET co-ordinated by Training and Research Support Centre (TARSC) in co-operation with Ifakara Health Institute Tanzania, REACH Trust Malawi and the Global Network of People Living with HIV and AIDS (GNPP+). An initial baseline survey in 20 health workers and 45 CSWs showed high knowledge but poor rating of access and uptake of HIV prevention, testing and treatment services, due to both barriers in the community and in the services themselves. A PRA process drew out further detail and experiences of the barriers faced, with priorities identified as: lack of early treatment seeking practices amongst CSWs; ill treatment of CSWs at health facilities by health practitioners; and lack of adherence to treatment by most of CSWs. The PRA process raised issues of the gender violence and abuse that CSWs face (including through attitudes and practices in health care services) that dehumanise them and perpetuate their own harmful behaviours. The group of CSWs and health workers as a whole identified interventions that were immediate and feasible to address the three barriers they prioritized. An intensive intervention, involving door to door counseling, engagement at places of work, formation of joint committees between CSWs and health workers and sensitization of health workers was implemented, steered and reviewed by the team with the CSWs and health workers themselves. Health workers and CSWs reported in a follow up survey improvements across all areas in the assessed baseline, except for quality of health services. Health workers reported improvements in the same areas noted by the CSWs, although their rating of improvements were generally a little more modest than the CSWs. We suggest that a public health PHC oriented approach to services for CSWs recognize, listen to, involve and build capacity in CSWs and ex-CSWs, and the civil society organisations that work with them, as a primary group for reaching and mobilizing uptake of services in CSWs.
A regional meeting was held to bring together the cross section of stakeholders from WHO/AFRO, SADC, ECSA-HC, EQUINET, government officials and researchers from the region to develop a harmonized approach for follow up research on health worker migration. The workshop report outlines the discussions and protocol developed to: highlight the key policy issues arising nationally, regionally and globally on the impacts of health worker migration on health systems; and identify key evidence gaps in negotiation of policy and agreements relating to protecting negative health systems impacts of health worker migration; review existing conceptual frameworks, parameters and indicators used for assessing health worker migration flows and for assessing dimensions of health systems; propose a conceptual framework and parameters for measuring impacts of health worker migration on health systems; review existing research initiatives on health worker migration in the region, the methodologies (design, tools) used, their limitations, and discuss and develop a shared standardised method for capturing evidence and analysing the impacts of health worker migration on health systems; and identify research capacities (research teams, funding, and political will) for the follow up work on health worker migration in the region, and a coordinated and harmonised approach to follow up research on health worker migration in the region.
A reminder to all who have registered that the third EQUINET Regional Conference on Equity in Health in East and Southern Africa is coming up next month! It provides a unique opportunity to hear original work and debate on the determinants of, challenges to and opportunities for equity in health in this region. The programme is broad and covers a range of topics including claiming rights to health, equitable health services, women’s health and social empowerment in health systems. Other main topics include retaining health workers, primary health care, developing and using participatory approaches, resourcing health systems fairly, building parliamentary alliances and people's power in health, policy engagement for health equity, trade and health, access to health care and monitoring equity. We will also show how to build country alliances and conduct regional networking. A post-conference workshop will be held on BANG (bits, atoms, neurons and genes), billed the Next Technological Challenge to Africa’s Health and Well-being. Further activities associated with the conference include photographic displays and skills meetings. Registration has closed, but the abstract book for the conference will be posted to the EQUINET website after the conference and a report will be produced from the conference that will also be on the site. Registered conference delegates should have received information on their delegate status, an information sheet on the conference arrangements and delegates sponsored for travel should have received their e tickets. Letters have been sent to those who need visas. For any queries around visa's or local arrangements please contact gloevents@infocom.co.ug. Speakers have been briefed by their session convenors. If you have not received relevant information above please contact admin@equinetafrica.org. To see the conference programme visit www.equinetafrica.org/conference2009/programme.php.
This work was implemented in Kasipul Division, Rachuonyo District, Kenya, where high poverty levels lead to food insecurity exacerbated by rising food prices, by the consequences of two devastating tropical storms and soaring transportation costs. Few PLWHIV own farms, or produce a marketable surplus, and illness and malnutrition interact in a vicious cycle. KDHSG and RHE implemented a participatory action research programme, within EQUINET, to explore dimensions of (and impediments to delivery of) Primary Health Care responses to HIV and AIDS. It used a mix of PRA and quantitative approaches to; • Identify the nutritional needs, issues and responses for PLWHIV on treatment • Increase voice and participation of PLWHIV and communication with health workers on their nutritional needs in relation to treatment and on responses to these needs in the clinics and community • Increase the capacity of health workers and community to identify specific areas for engagement of partners outside the health sector on intersectoral responses to support nutritional inputs for PLWHIV on treatment. This work indicates that expanding access to treatment services needs to be embedded within a wider framework of wider health support, including the intersectoral action to address food needs, if availability is to translate into effective coverage. Nutrition support is a vital element of the chronic care and health management strategies needed for PHC responses to AIDS. This includes shifting perception of PLWHIV from that of disabled dependents of emergency support to people able to know and address their nutritional needs through local food resources.
This paper explores and presents the current patterns of AIDS, TB and Malaria (ATM) financing within the health sector, and investigates the extent to which GHI financing for ATM has influenced heath care financing reforms. We obtained information for this paper through key informant interviews and extensive literature review. There is fragmentation between government and donor project funding, and also within donor project funds, which negatively impacts on creation of larger pools. Donor funding channelled through projects and global health initiatives targeting specific diseases may undermine equity between geographic areas. The lack of effective coordination of donor project funds is a breeding ground for inefficiencies and inequity. We recommend that the Ministry of Health should double its efforts to improve co-ordination and harmonisation of all development aid, including support from global health initiatives (GHIs). Long term institutional arrangements are a starting point for this process, but more buy-in is required in order for it to be accepted by all stakeholders. Government should design mechanisms that will help integrate GHIs resources to allow for greater cross-subsidisation and to reduce overlaps and inefficiencies.
A reminder to all who have registered that the third EQUINET Regional Conference on Equity in Health in East and Southern Africa is coming up next month! It provides a unique opportunity to hear original work and debate on the determinants of, challenges to and opportunities for equity in health in this region. The programme is broad and covers a range of topics including claiming rights to health, equitable health services, women’s health and social empowerment in health systems. Other main topics include retaining health workers, primary health care, developing and using participatory approaches, resourcing health systems fairly, building parliamentary alliances and people's power in health, policy engagement for health equity, trade and health, access to health care and monitoring equity. We will also show how to build country alliances and conduct regional networking. A post-conference workshop will be held on BANG (bits, atoms, neurons and genes), billed the Next Technological Challenge to Africa’s Health and Well-being. Further activities associated with the conference include photographic displays and skills meetings.
Parliaments can play a key role in promoting the right to health in east and southern Africa. To better understand and support the practical implementation of this role, this report presents the findings of a questionnaire administered to parliamentary committees on health from 12 countries in the region. Knowledge of international human rights and related laws pertaining to the right to health was found to be limited. Parliamentarians were more likely to be familiar with Trade-related Aspects of Intellectual Property Rights (TRIPS) applications and with the provisions of the Abuja Declaration than with rights agreements such as the International Covenant on Economic, Social and Cultural Rights (ICESCR), its General Comment 14 or the African Charter on Peoples and Human Rights. Important gains could be made if parliamentarians were able to analyse, interpret and integrate these agreements into their work.
The main challenges facing parliamentarians appear to be: how to deal with policy choices under conditions of severe resource constraints and, particularly, the application of the concept of progressive realisation of the right to health; how to balance individualist concepts of rights with rights claims that benefit groups so that it is not simply a question of those who shout the loudest getting access to decision making processes; and how to structure engagement with civil society to preference groups who are most marginalised – a pro-poor application in human rights practice.
In the DR Congo, where the national HIV prevalence is around 5%, testing and treatment services are more available in urban than rural areas, despite the latter being more affected by the epidemic. In Bunia and Aru, North eastern DRC, people living with HIV and AIDS (PLWHA) cannot access testing or treatment services unless they travel to Bunia town, some distance away. Discrimination from community members towards PLWHA is further identified as a reason for people not coming for HIV testing, and for discouraging other prevention activities. The Pan African Institute of Community Health (IPASC) used a participatory reflection and action (PRA) approach with the concerned rural communities to examine and act on negative perceptions within the community around HIV testing and treatment, to support improved demand for and uptake of these services, to make more effective use of available resources and services. The PRA work showed that a major lesson learned for Primary Health Care responses to AIDS is that communities are able to make significant changes in barriers to testing and treatment if organised to do so, particularly using participatory processes. Community based sensitisers are an important resource in the community to produce change in those attitudes that discourage early testing and treatment, supported by actions that address disabling conditions within the community and that build cohesion around addressing wider service problems. PHC interventions for AIDS that do not invest in these dimensions in an empowering way undermine the effective use of other resources and the necessary synergy between communities and health services needed to manage a chronic condition such as AIDS.
This workshop was designed to provide the Ministry of Health in Mozambique with support on practical approaches to achieving a more equitable distribution of public health sector resource allocation outlays. Based on communication with officials of the Mozambican Ministry of Health, there have been concerns around the inequitable distribution of public health care resources, with areas of higher socio-economic status and relatively lower levels of disease burden receiving higher health care allocations. The key problems for the Ministry of Health were: how to empirically show that the current resource allocation outlays are inequitable and how to design a formula that allows for the shift of resources to ensure a more equitable distribution.