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.
Latest Equinet Updates
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.
The fifteen minute pre-recorded show, ‘Health Worker Retention and Migration’, was produced by WWMP, in conjunction with labour journalists in east and southern Africa. It provided an in-depth analysis of the situation for health workers in Africa, and discussed incentives for retaining health workers. In the pre-recorded show, a Khayelitsha nurse who used to work at Groote Schuur hospital in Cape Town and migrated to Saudi Arabia Mavis Mpangele, Bongani Lose from Democratic Nurses of South Africa (DENOSA), Kwabena Otoo from the Ghana Trade union Congress, Joel Odijie from Nigeria Trade Union Congress, Professor Yoswa Dambisya of the University of Limpopo Department of Pharmacy and EQUINET Steering Committee, Nyasha Muchichwa from the Labour and Economic Research Institute of Zimbabwe and Percy Mahlathi, the South African Director General of the Department of Health were interviewed. The feature covers the push factors and experiences from different African countries. The feature also explores government responses to the problem as well as African trade unions response. It rounds off with examples of success stories in Zambia and Tanzania.
Registration for the EQUINET conference is nearly closing. We look forward to welcoming people from government, non state organisations, academic and research institutions, civil society, parliaments, regional and international organisations and other institutions promoting and working on equity in health in east and southern Africa!
Registration information is at register for the conference and the pre and post conference workshops. Visit the conference website for further information and to see the programme outline.
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 process targeted male and female PLWHA aged 20-49 years, male and female adolescents 15-19 years, community and church leaders and community health workers because of their vulnerability and influence on attitudes towards HIV and AIDS. Community level barriers (largely stigma) interfaced with service level constraints to diminish testing and treatment coverage. Both users and providers faced barriers. These related to resources (drugs, transport), while the lack of accessible services was a fundamental deterrent. Leaving treatment to late stages when people are ill made this worse, as people found it difficult to make the long journey at that stage. While service factors were not been dealt with in the short time of the intervention, there were improvements in social dialogue on treatment and mechanisms introduced to deal with the community level barriers to testing and treatment. Communities are able to make significant changes in barriers to testing and treatment if organised to do so using participatory processes. Community based sensitisers are an important resource in the community and can produce a measurable change in the attitudes that discourage early testing and treatment.
This report presents the experiences and learning from participatory action research implemented by Country Minders for Peoples Development (CMPD), (a Malawi non government organization) on the co-ordination of support from service providers and community organisations for protection of sexual and reproductive health of orphans and vulnerable children in Monkey Bay, Malawi. The work was implemented within a Regional Network for Equity in Health in east and southern Africa (EQUINET) programme that aimed to explore, through participatory reflection and action (PRA) methods, dimensions of (and impediments to delivery of) Primary Health Care responses to HIV and AIDS. Through baseline and follow up surveys, key informant interviews, focus groups and participatory reflection and action (PRA) meetings the study team led by CMPD identified the health needs and coping strategies of orphans and vulnerable children and their consequent risk of health and SRH problems; mapped the services and resources available for orphans and vulnerable children, and their coverage of and gaps in meeting the identified needs; implemented and assessed the outcomes from actions by local services, community organisations and communities responding to problems prioritised by the community, and drew learning from this work on the factors affecting community level support for vulnerable children that would need to be included in comprehensive primary health care responses to AIDS. The findings suggest that a Primary Health Care approach to AIDS should be embedded within and reinforce a wider social protection strategy that addresses life course needs, such as those of vulnerable children. Significant attention and resource commitment has to be given to promoting outreach and uptake of services and to the intersectoral actions and community organisations that support this, if resources are to be accessed and used by vulnerable groups.
Facing multiple global crises, governments and corporations are arguing that new technologies are the solution to fixing everything from climate chaos to hunger and health problems. What do these new technologies mean for African countries? In which contexts are they being developed? Who controls and who will benefit from them? Are they bringing new impacts to our health, environment and economies? The workshop will feature presentations from ETC group, an international civil society organization based in Canada, and African partners which will explain and introduce the issues, followed by questions and discussions with participants.
Visit the conference website for more details and to register