Latest Equinet Updates

Responding to inequalities in health in urban areas in east and southern Africa: Brief 2: What does the data tell us?
Loewenson R; Masotya M: TARSC, EQUINET, Harare, May 2018

Cities concentrate opportunities, jobs and services, but they also concentrate risks and hazards for health. How fairly are these risks and opportunities distributed across different population groups but also across generations? How well are African cities promoting current and future wellbeing? How far are health systems responding to and planning for these changes? TARSC as cluster lead of the “Equity Watch” work in EQUINET explored these questions in 2016-7, for east and southern African (ESA) countries. This brief reports what we found from analysis of data on indicators of wellbeing. Detail on the methods, findings and analyses of data can be found in full in Loewenson R, Masotya M (2018) Inequalities in health and wellbeing in urban areas in east and southern Africa: what does the data tell us? EQUINET Discussion paper 114, TARSC, EQUINET, Harare. Available at ht tps://tinyurl.com/y9nwy9oh. A number of holistic frameworks were found in the literature. They challenge the equation of progress in development with economic growth, when this is at the cost of intense exploitation of nature and significant social inequality. They thus focus on basic needs, wellbeing and quality of life (material, social and spiritual) of the individual and community, and of current and future generations, as a common good. While context dependent and with different terms in different regions, the buen vivir paradigm, (‘living well’ or ‘wellbeing’) best captures their key features. The brief presents evidence from data in several online databases with comparable data across ESA countries to see how far they measured these dimensions of wellbeing. ESA countries face a challenge in tracking progress in wellbeing, with data missing for many of its dimensions, limited disaggregation by social group or area, and more common measurement of negative than positive outcomes.

Responding to inequalities in health in urban areas: How well do current data measure urban wellbeing in East and Southern Africa?
Loewenson R, Masotya M: EQUINET Discussion paper 114: EQUINET Harare, 2018

By 2050, urban populations in Africa will increase to 62%. The World Health Organisation (WHO) and UN Habitat in their 2010 report ‘Hidden Cities’ note that this growth constitutes one of the most important global health issues of the 21st century. TARSC as cluster lead of the ‘Equity Watch’ work in EQUINET implemented a multi-methods approach to gather and analyse diverse forms of evidence and experience of inequalities in health and its determinants within urban areas, and on current and possible responses to these urban conditions, from the health sector and the health-promoting interventions of other sectors and communities. We aimed to build a holistic understanding of the social distribution of health in urban areas and the responses and actions that promote urban health equity. The different stages and forms of evidence are presented in a set of reports and briefs and a final synthesis document. This report presents the findings of the separate search on holistic paradigms relevant to urban wellbeing, and an analysis of statistical evidence on health and wellbeing in east and southern Africa (ESA) countries using indicators drawn from these approaches. The findings indicated that ESA countries face a challenge if they seek to track progress in the multiple dimensions of wellbeing or to build an understanding from the quantitative data gathered. First, there are no data measured across the 16 ESA countries for many dimensions of a more holistic approach to wellbeing. Second, in ESA countries, the indicators that are measured are more commonly those of negative rather than positive wellbeing outcomes. This turns the focus away from the assets in society. It points out where the problems are, but not the progress in achievement of positive or affirmative goals. Third, where data do exist, they are poorly disaggregated to show urban areas separately or to show intro-urban inequalities or levels in specific social groups. Finally and importantly, the subjective views of people on their life satisfaction do not always match measured data, and needs to be elicited and taken into account more directly in planning for urban wellbeing, including for interpreting, validating, adding to or even challenging quantitative data.

Mining and Public Health in Zambia Meeting report, 10 April 2018, Lusaka, Zambia
Ministry of Health Zambia; EQUINET

The Southern African Development Community (SADC) framework for harmonising mining policies, standards and laws, approved by the SADC Mining Ministers in 2006, specifies that member states develop, adopt and enforce appropriate and uniform health, safety and environmental guidelines for the sector and seeks to harmonized standardization in health as an immediate milestone area. The Ministry of Health in Zambia is in the process of improving public health in the mining sector in the country as part of its Universal Health Coverage policy, as well as to address the social determinants of health. A meeting was thus held to dialogue with key national level representatives of health and related sectors on evidence and actions related to public health in mining. The meeting aimed to 1. Share and dialogue with key national level representatives of health and related sectors on: evidence from Zambia on mining and health with a focus on population/public health issues and the current responses to health promotion, prevention and management, and on evidence from regional level on public health issues and health standards in mining, and their implications for regional responses. 2. To discuss follow up actions in relation to key areas of health and cross sectoral collaboration on mining and public health in Zambia and for regional co-operation and exchange on setting and implementing harmonised standards on mining and health.

Advancing public health rights, claims and standards in mining, Report of a Side Session at the Alternative Mining Indaba, 6 February 2018, Cape Town South Africa
EQUINET; TARSC; SATUCC; Benchmarks Foundation; SADC CNGO, EQUINET, Harare, 2018

The Alternative Mining Indaba has been held annually since 2010 at the same time as the Mining Indaba to provide a platform for communities affected by mining to voice their concerns and be capacitated to fight for their rights. The theme for the 2018 AMI was: “Making Natural Resources Work for the People: Towards Just Legal, Policy and Institutional Reform”. This report presents information on a side session at the Indaba that aimed to raise and discuss the key public health challenges facing workers and communities in the extractive sector / mining in east and southern Africa, the strategies for responding to them, including proposals for harmonised regional health standards, and the proposals made by civil society to advance them.

EQUINET discussion paper 113: The role of an essential health benefit in health systems in east and southern Africa: Learning from regional research
Loewenson R; Mamdani M; Todd G; Kadowa I; Nswilla A; Kisanga O; Luwabelwa M; Banda P; Palale M; Magagula S: TARSC and IHI, EQUINET, Harare, 2018

An Essential Health Benefit (EHB) is a policy intervention defining the service benefits (or benefit package) in order to direct resources to priority areas of health service delivery to reduce disease burdens and ensure health equity. Many east and southern African (ESA) countries have introduced or updated EHBs in the 2000s. Recognising this in 2015-2017, the Regional Network for Equity in Health in East and Southern Africa (EQUINET), through Ifakara Health Institute (IHI) and Training and Research Support Centre (TARSC), with ministries of health in Swaziland, Tanzania, Uganda and Zambia, implemented desk reviews and country case studies, and held a regional meeting to gather and share evidence and learning on the role of EHBs in resourcing, organising and in accountability on integrated, equitable universal health systems. This report synthesises the learning across the full programme of work. It presents the methods used, the context and policy motivations for developing EHBs; how they are being defined, costed, disseminated and used in health systems, including for service provision and quality, resourcing and purchasing services and monitoring and accountability on service delivery and performance, and for learning, useful practice and challenges faced. This research pointed to the evidence within the region for policy dialogue on universal health systems. It raised the usefulness of designing, costing, implementing and monitoring an EHB as a key entry point and operational strategy for realising universal health coverage and systems and for making clear the deficits to be met.

Resource curse or fair benefit?
Loewenson R, EQUINET: Alternative Mining Indaba, Cape Town, February 2018

This plenary presentation at the Alternative Mining Indaba presented work taking place in EQUINET to raise health rights and duties in the extractive sector. Mining was noted to be a key vehicle linking African countries to neoliberal globalisation, with by 2008, developing countries reported to be transferring about a trillion dollars more a year to wealthy countries than they received in FDI. There is evidence of poor return for local wellbeing, with examples of districts with large EI projects having higher poverty and food insecurity and poorest improvements in these areas than those without, despite the wealth generated. The presentation raised the potential to better use the power of public health rights and laws in mining. Various international standards commit to protecting health in mining for workers and communities and the SADC UNECA harmonisation of policies and standards indicated that Member States should develop, adopt and enforce appropriate and uniform health, safety and environmental guidelines for the sector as an immediate milestone area. However, while there has been progress on doing this for TB and HIV and some attention is now being paid to chronic occupational diseases for ex mineworkers, there is as yet no comprehensive focus on public health in the mines. From an analysis of laws in the region no single country provides adequate legal protection, but different countries have good practice clauses that could be used for regional guidance on minimum standards. At regional level she observed that there is both a need and potential to harmonise rights and duties for health in SADC, to ensure health impacts are assessed and prevented before licenses are granted, mines provide living standards, incomes, health infrastructures and health services before people are resettled, the public health and health care of communities living in and around mines is invested in, including to address longer term impacts from mining that may persist even after mines close.

The role of an essential health benefit in the delivery of integrated health services: Learning from practice in East and Southern Africa, Report of a regional research workshop, November 27-28 2017, Zanzibar, United Republic of Tanzania.
EQUINET; Ifakara Health Institute; Training and Research Support Centre

An Essential Health Benefit (EHB) is a policy intervention designed to direct resources to priority areas of health service delivery to reduce disease burdens and ensure equity in health. Many east and southern Africa (ESA) countries have introduced or updated EHB in the 2000s. Recognising this, the Regional Network for Equity in Health in East and Southern Africa (EQUINET), through Ifakara Health Institute (IHI) and Training and Research Support Centre (TARSC), with country partners from Ministries of Health (MoH) in Swaziland, Tanzania, Uganda and Zambia, implemented research to understand the facilitators and the barriers in nationwide application of the EHB in resourcing, organising and in accountability on integrated, equitable universal health services. A regional review of literature on EHBs in the four country case study reports from the research programme are available on the EQUINET website. This report presents the proceedings of a regional consultative meeting convened on November 27-28, 2017 to present and discuss evidence from the research programme. The regional document review covering 16 east and southern African (ESA) countries, the findings from the country case studies in Swaziland, Tanzania, Uganda and Zambia, experiences from South Africa and Zanzibar and a regional synthesis of the evidence from across the programme were presented at the meeting, and background documents made available. The meeting aimed to: a. Identify issues arising in the motivations for developing the EHB; the methods used to develop, define and cost them; their dissemination, communication and use within countries, including in budgeting, resourcing and purchasing health services; and, in monitoring health system performance for accountability; b. Identify policy-relevant and operational national and regional level recommendations on the role, design and use of EHB; and c. Propose areas for follow up policy, action and research.

Training materials for Health centre committees – building community participation in health systems
Health Rights learning network; UCT, Cape Town, 2018

Health Centre Committees are potentially critical vehicles for community voice in health systems. They play not only a service and mobilisation role, but can be effective tools to improve the responsiveness and accountability of services – and thus have an important governance role to play. UCT’s Health and Human Rights programme in the School of Public Health and Family Medicine has been working with Zimbabwean and Zambian partners in EQUINET, on a project under the leadership of the Community Working Group on Health (CWGH) to strengthen Health Centre Committees (HCC’s) as vehicles for social participation in health systems in East and Southern Africa (ESA). UCT has led work to review and assemble capacity building materials for Health Committee training. . They found HCC training materials and processes in a number of countries, including Ethiopia, Kenya, South Africa, Tanzania, Uganda, Zimbabwe and Zambia. The training commonly covered introductions to the health system, its governance, planning and budget processes and HCC roles. It included information on HCCs functions such as problem solving, monitoring and accountability and social mobilization. There were gaps in some areas, such as on conflict management, fundraising, inter-sectoral work and deeper analysis of the causes of social inequalities in ill health and how to address them.

Growing number of resources on the Participatory Action Research Portal
TARSC: EQUINET pra4equity network, 2017

The Participatory Action Research Portal for resources on Participatory Action Research (PAR) on the EQUINET website has a growing number of resources on PAR related to training courses, training guides and reports of training activities; methods, tools and ethics; PAR work and journal publications on PAR. The portal is a resource for all those working with PAR and includes resources in any language. There is a form for people to send videos, photojournalism, organisations, journal papers, training guides and other resources for the portal. The url link shown here is in English but there is also a Spanish version at http://www.equinetafrica.org/content/portal-de-recursos-para-la-investigaci%C3%B3n-acci%C3%B3n-participativa-iap

Brief: Strengthening health centre committees for people-centred health systems
EQUINET; CWGH; TARSC; LDHO; UCT: EQUINET, Harare, 2017

Stakeholders working with Health Centre Committees (HCCs) in East and Southern Africa (ESA) raised proposals in EQUINET policy brief 37 to improve the functioning and impact of HCCs as potential contributors to equitable, people centred health services. These proposals advocated for legal, institutional and social measures to support and clarify HCC roles, composition, powers and duties, to ensure the capacities and resources for them to function. They also proposed that HCCs strengthen their communication with the communities they represent backed up by wider measures for health literate and informed communities. Since then, institutions in EQUINET have followed up to act on the recommendations, building on existing work. This brief shares information on these developments. It reports some progress in legal recognition and setting of clearer constitutions for HCCs, clearer guidelines for the functioning, use of community based processes like photovoice to connect them with communities and their conditions in their dialogue with health services and efforts to share resources for capacity building of HCCs. It highlights that HCCs continue to play a role in improved frontline health systems. However the potential of HCCs still needs to be realised and the work continues.

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