Photographs speak louder than words. This book presents photographs taken by community photographers in seven east and southern African countries: the Democratic Republic of Congo, Tanzania, Zimbabwe, Kenya, Uganda, South Africa and Zambia. We called our photographers the ‘Eye on equity’ team because the work was part of EQUINET’s participatory action research work. Implemented through institutions in east and southern Africa, this work investigated, documented and implemented actions to understand and promote equity in health. We added photography as another tool to build and strengthen people-centred health systems and people’s empowerment in health. The book presents images of equity in health and of actions to improve health. These are the stories of insiders: of members, health workers and health activists in the communities that are shown in the photographs. The photographs are being used to stimulate discussion of health issues and actions. The book thus introduces both the realities and the work underway. It opens discussion on community photography as a means of keeping an eye on equity and as a tool for change. The web version is for onscreen viewing. For a hard copy of the book please contact us at the email address given.
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In the last five years EQUINET has through Training and Research Support Centre and Ifakara Health Institute supported participatory action research work in nine countries in east and southern Africa exploring different aspects of community interactions with health systems. We did this to better understand these social dimensions of health, and, more importantly to support the empowerment of groups affected by health issues to analyse, act on and change the conditions that undermine their health. In 2008, working with seven institutions, we developed capacities to use photography as a tool for visual literacy, to support reflection and action in sites in seven countries in east and southern Africa. This book presents the work carried out in 2009, embedded within our work on strengthening people’s power in health. It presents through photography the lives of the people involved, the diversity of views on the determinants of health in these communities, the visions of solutions and the actions taken to act on the problems identified. The book is currently available as a hardcopy from the EQUINET secretariat.
The AIDS epidemic has resulted in over 1 million orphans and many other vulnerable children in Zimbabwe. Most of these children remain in their communities, either in child-headed households or looked after by their extended family or members of the community. While there has been a massive response from local organisations to the plight of these children, many programmes have been designed in a top-down manner, without taking into consideration the views of the children themselves. The study used a mix of quantitative assessment and participatory action research methods (PRA) to explore and strengthen the participation of orphans and vulnerable children in primary health care (PHC) in Victoria Falls, a town in the north-western part of Zimbabwe. Children, community representatives and health workers identified three priority health problems faced by these children, ie: poor access to ART; child abuse; and poor housing. Structural constraints, such as poverty and weakened health and community services, were seen as the primary underlying causes of these problems. Those involved identified actions they could take to address these problems, and based on this community organisations strengthened psychosocial support activities, undertook a number of awareness campaigns, initiated and participated in child protection committees and started to meet monthly to strengthen coordination. A participatory review of the interventions suggested that child involvement is an important component in a primary health care approach to designing ways of meeting children's needs, through structured platforms for the exchange of information and experiences, provision of child friendly services, and promotion of effective communication between health workers, community members and children.
The workshop on participatory approaches to people centred health systems was held on the 22nd of September 2009 in Munyonyo Uganda before the EQUINET regional Conference held at the same venue on 23rd -25th of September 2009. This gave participants from the workshop an opportunity to engage with the wider regional community working on health equity, but also to feed input from the participatory work into the conference process and resolutions. The regional review workshop gathered researchers from the PRA research programme since 2005. The workshop reviewed the learning from, policy issues and knowledge gaps from the research studies, to inform planning of future work on empowerment and health and on people centred health systems in the ESA region and to explore the role of PRA approaches and community photography in advancing health equity. The workshop gathered those who had led the studies, community photographers and others involved with work on empowerment and health. This report documents the proceedings of the meeting.
This regional methods workshop was held to gather potential lead institutions of country teams and resource personnel to build on existing work done on the Equity Watch to date and 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 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.
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.