The third EQUINET regional conference was held in September 2009 and brought together parliamentarians, professionals, civil society members, policy makers, state officials, health workers and international agency personnel. It provided an opportunity to exchange across areas of work on different dimensions of health equity in east and southern Africa. The conference theme, ‘Reclaiming the Resources for Health: Building Universal People Centred Health Systems in East and Southern Africa’ was chosen to share experience and evidence on alternatives through which: poor people claim a fairer share of national resources to improve their health; a larger share of global and national resources are invested in redistributive health systems, to overcome the impoverishing effects of ill health; and countries in east and southern Africa (ESA) claim and obtain a more just return from the global economy, to increase the resources for health. The report follows the abstract book, also available on the EQUINET website, and provides the proceedings of the conference.
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The Regional Meeting of Parliamentary Committees on Health in Eastern and Southern Africa, held in Munyonyo, Kampala, Uganda, 21 September 2009, gathered members of Parliamentary Committees responsible for health from 12 countries and regional bodies in Eastern and Southern Africa, with technical government and civil society and regional partners to promote information exchange, facilitate policy dialogue and identify key areas of follow up action to advance health equity and sexual and reproductive health in the region. The meeting was held as a follow up to review progress on actions proposed at the September 2008 Regional Meeting of Parliamentary Committees on Health in Eastern and Southern Africa hosted by the same organisations.
The fifteen-minute pre-recorded show, ‘Public healthcare financing’, was produced by WWMP, in conjunction with labour journalists in east and southern Africa. The show examined the lack of public health care financing in Africa in the context of health worker shortages, poor working conditions for health workers, provision of medicine for tuberculosis and AIDS, and poor access to care for patients (long queues, poor facilities, lack of equipment etc), as well as the impact of the current global economic crisis and neo-liberal government policies. The show discussed the purpose of the Abuja 15% target agreed by African heads of state, and financing mechanisms (tax funding and health insurance) appropriate to funding public health care.
The EQUINET steering committee has proposed to take forward the production of an Equity Watch at country and regional level to gather evidence on, analyse and promote dialogue on equity in the context of country and regional opportunities and challenges. It held a regional methods workshop in September to gather potential lead institutions of country teams and resource personnel to build on existing work done on the equity watch to date to develop the design and plan implementation of the equity watch work at country level in participating countries and at regional level. The workshop aimed to: review and agree on the purpose, intended targets, process and outcomes of an equity watch at country and regional level; discuss the questions about equity to be addressed, and the dimensions of equity to be included; review and agree on the parameters, indicators, targets/progress markers/stratifiers for the analysis and organisation of the analysis to address these questions/ dimensions; review types, quality and sources of evidence for the analysis; and discuss and set the next steps and roles for the work at country and regional level, including mentoring and regional review.
The Regional Meeting of Parliamentary Committees on Health in Eastern and Southern Africa, Munyonyo, Kampala, Uganda, 21 September 2009, gathered members of parliamentary committees responsible for health from twelve countries and from regional bodies in Eastern and Southern Africa, together with technical, government, civil society and regional partners, to promote information exchange, facilitate policy dialogue and identify key areas of follow up action to advance health equity and sexual and reproductive health in the region. The meeting was held as a follow up to review progress on actions proposed at the September 2008 Regional Meeting of Parliamentary Committees on Health in Eastern and Southern Africa hosted by the same organisations. This document outlines the commitments to follow up action made at the meeting.
The promotion of universal coverage means that health systems should seek to ensure that all citizens have access to adequate health care (adequately staffed with skilled and motivated health workers) at an affordable cost and which improve both income cross-subsidies (from the rich to the poor) and risk cross-subsidies (from the healthy to the ill) in the overall health system. This stems from our understanding of equity, which requires that people should contribute to the funding of health services according to their ability to pay and benefit from health services according to their need for care. Prior work in the fair financing theme in the network indicates that there is still a heavy dependence on donor funding in some east and southern African (ESA) countries and heavy burdens on poor people through high levels of out of pocket financing. There have been efforts to increase domestic funding of health services, and a number of countries are increasing government funding of health services. The Health Economics Unit, University of Cape Town and HealthNet Consult Uganda used evidence from work done in the past 5 years on tax and mandatory health insurance sources of domestic resource mobilisation as inputs to a regional research and policy review meeting in September 2009. The meeting presented and reviewed research, implemented in and beyond the network, on domestic public resource mobilisation; examined policy options, and country experiences in and barriers to improving domestic public resource mobilisation, with a focus on ‘success stories’ where countries have been successful in motivating for greater allocation of public resources towards the health sector. The meeting was held in Uganda just prior to the EQUINET Regional conference to connect delegates to the conference and to input into the wider network of equity actors and debates at the conference. The meeting identified knowledge gaps for follow up research, including on gender dimensions.
Over the last five years the Regional Network For Equity In Health In East and Southern Africa (EQUINET) has generated a range of analyses of specific policy experiences in Southern and Eastern Africa and has developed the understanding and skills necessary to conduct this sort of work. Other work conducted by EQUINET, such as around governance and participation, is also relevant to understanding how to strengthen health system decision-making in ways that support health equity goals. It is time, now, to take stock of the range of health policy analysis work in Africa – and to draw out lessons from past experience, as well as identify new challenges for the years ahead. This workshop took place as part of the pre-conference activities of the EQUINET conference September 2009 on Reclaiming the Resources for Health. It was convened by Lucy Gilson, School of Public Health and Family Medicine, University of Cape Town and Ermin Erasmus, Centre for Health Policy, The University of the Witwatersrand. The workshop aimed to: reflect on health policy analysis and its role in health system development; share experience in the use of health policy analysis to support policy development and implementation; share experience in teaching health policy analysis (in short course, post-graduate programmes etc); and develop shared ideas of how to strengthen this field of work in Africa. It provided an opportunity to reflect on health policy analysis and its role in health system development. Participants shared experience in the use of health policy analysis to support policy development and implementation and on teaching health policy analysis. In the workshop participants shared ideas of how to strengthen this field of work in Africa. The workshop was held as a pre-conference workshop to the EQUINET Regional Conference and involved delegates drawn from the conference and thus the wider regional work on equity in health.
Over 200 government officials, parliamentarians, civil society members, health workers, researchers, academics and policy makers, as well as personnel from United Nations, international and non-governmental organisations from East and Southern Africa and internationally met at the Third EQUINET Regional Conference on Equity in Health in East and Southern Africa, held 23–25 September 2009 in Munyonyo, Kampala. This document presents the resolutions of the conference for action on equity in health.
As part of its ongoing skills development programme, the Regional Network fort Equity in Health in East and Southern Africa (EQUINET) has committed to developing the writing skills of health equity researchers in the region, particularly with regards to writing for peer-reviewed journals, as well as for improving writing skills on EQUINET discussion papers. This workshop took place as part of the post-conference activities of the EQUINET conference September 2009 on Reclaiming the Resources for Health. It was convened by Rebecca Pointer under the auspices of the Training and Research Support Centre. The workshop used the EQUINET writing skills raining manual found as its core resource material. It sought to equip researchers with a basic step-by-step approach to writing for peer-reviewed journals, and to approach scientific writing as a routine process. The participants were those working on publications in areas related to health equity from countries in east and southern Africa.
This paper presents a summary of the regional programme on incentives for health worker retention in the Regional Network for Equity in Health in East and Southern Africa (EQUINET) in co-operation with the East, Central and Southern Africa Health Community (ECSA-HC). The studies sought to investigate the causes of migration of health professionals, the strategies used to retain health professionals, how they are being implemented, monitored and evaluated, as well as their impact, to make recommendations to enhance the monitoring, evaluation and management of non-financial incentives for health worker retention. They aimed to have some comparability in design to share learning. The findings revealed that all four countries studied (Swaziland, Zimbabwe, Tanzania, Kenya) have put in place strategies to improve morale and retain staff in the public health sector. They were designed after some assessment of the drivers of attrition, often through prior surveys of push/pull factors. All the countries studied were applying a mix of non-financial incentives according to their strategies and plans, although implementation was not always uniform at all levels or for all cadres, or reached all those cadres intended. All implement non-financial incentives, together with some form of financial incentives. All studies indicated the presence of policies providing for non-financial incentives. The country studies observed that incentives were not uniformly applied to all health workers, and did not always reach all in the target category. The studies indicated a need to intensify focus on issues of operationalising and implementing non-financial incentives: moving from inserting incentives in policies and strategies to ensuring their application across all providers; moving from focused application for specific cadres of health workers to sector wide application of incentives for all health workers; and moving from experiments within the health sector to more sustained multi-sectoral policies that involve other sectors, including public service, finance, public works, education and housing. The results of the work were reviewed at a regional meeting to review the findings from this body of work and to explore the implications for policies and measures aimed at valuing and retaining health workers in ESA, develop proposals and guidelines for policy and action relevant to health worker deployment and retention, and identify knowledge gaps for follow up work. The recommendations from this meeting are presented.