The University of Cape Town is offering a pre conference workshop on September 22 2009 at the EQUINET Conference September 2009 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)
* Develop shared ideas of how to strengthen this field of work in Africa.
This workshop is relevant to you if you seek to influence and shape health policy agendas; analyse or support the processes of health policy-making and implementation at any level of the health system; work as a health leader and want to develop your ideas about how to strengthen the implementation of policy, or teach others about health policy analysis.
The workshop will be interactive and based on the experience that those attending it wish to share. To register fill in the registration form available at http://www.equinetafrica.org/conference2009/index.php giving the name of the workshop and email it to admin@equinetafrica.org
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The closing date for abstract submission for EQUINET Regional Conference on Equity in Health in east and southern Africa is approaching. Please visit the conference website to download the abstract form and the registration form for submission. Preference for sponsorship will be given to accepted abstracts. 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! For more information, please visit the conference website at http://www.equinetafrica.org/conference2009/index.php or send queries to admin@equinetafrica.org, with EQUINET CONFERENCE in the subject line
The closing date for abstract submission for EQUINET Regional Conference on Equity in Health in east and southern Africa is on January 30 2009. Please visit the conference website to download the abstract form and the registration form for submission. Preference for sponsorship will be given to accepted abstracts. 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! For more information, please visit the conference website at http://www.equinetafrica.org/conference2009/index.php or send queries to admin@equinetafrica.org, with EQUINET CONFERENCE in the subject line.
In 2004, the Tanzanian government launched its Tanzania National Voucher Scheme (TNVS). The scheme aimed to subsidise the cost of anti-malaria nets for pregnant women and children across the country. But has the implementation of the scheme so far been equitable? This study used a case study approach to analyse the power relations between key implementers of the scheme and the mothers served in four rural district health facilities in Namtumbo and Mbinga districts. The study found that despite the scheme’s impact in reducing severe malaria cases, inadequate national prioritisation of malaria is affecting implementation, leading to inadequate funding, felt most severely at facility level. No resources were allocated specifically for voucher distribution, resulting in periodic shortages, while health workers involved in the scheme had other competing demands on their time. A top-down managerial approach to implementation allowed health workers to exercise unfair power over mothers and pregnant women seeking nets and treatment and women were asked to pay for vouchers in some areas, when they are actually entitled to get them free. The study, building on previous studies in Tanzania and elsewhere, demonstrated that a top-down approach to policy intervention is contributing to implementation gaps. The voucher scheme is not just a tool for ensuring access and equity in health care delivery – it must be carefully considered in the context of those entrusted with the task of overseeing its implementation.
The national ART scale-up plan contains several measures to promote equity, considering also that there are insufficient resources to cover everyone who is eligible. Thus study focused on four of these covering ART enrolment on an open ‘first-come, first-served’ basis; targeted gender-sensitive health promotion of ART, measures to overcome specific geographical barriers to access for remote populations and prioritisation of people already on ART, pregnant women and young children. Using a case study approach the study analysed the power relations that influenced outcomes on these policy measures on four health facilities in Malawi. The findings indicate that health workers commonly exercise power in relation to patients, and that patient acquiesce with health worker behaviours. In poorly performing facilities, implementation of policy measures is negatively affected by managerial practices that discourage teamwork and de-motivate health workers, while in the two better performing facilities, management practices had a more positive role in supporting positive health worker practices. The study findings highlight that implementing equity policies needs to include measures to orient and involve staff, and address power and resource imbalances that can undermine access.
This report has been produced within the capacity building programme on participatory research and action (PRA) for people centred health systems in EQUINET. It is part of a growing mentored network of PRA work and experience in east and southern Africa, aimed at strengthening people centred health systems and people’s empowerment in health. The report presents the work and outcomes from the follow up action research building on a pilot in 2006 that aimed to strengthen community-health centre partnership and accountability in two districts in Zambia. The action research presented consolidated the participatory approaches initiated in 2006 to further enhance the community voice in planning, budgeting and implementation activities at HC and community level; extended the process to two new health centres in Lusaka, and built the capacity of the 2006 group to facilitate scale up of the work to other centres. It explored through this the possibilities for scaling up such processes at wider level. The project demonstrated that using participatory approaches can de-mystify and remove suspicions surrounding the district and health centre planning process, strengthen dialogue between communities and health workers, increase community involvement in planning and budget processes and resolve issues in the interface between health workers and communities. If the processes are to be institutionalized the lessons from the action research are that participatory processes take time to have impact, need continuous mentoring and resource support in the early stages, need to be integrated within routine work and supported by authorities, with orientation of new health workers. Not investing in scale up of the process, however, leads to persistence of disharmony between health workers and communities caused by lack of communication and information flow, undermining the functioning of health systems as envisaged in policy.
This report assesses progress towards achieving equity in health in Zimbabwe, drawing on available indicators and peer review from stakeholders. Available evidence suggests a range of gaps to be addressed, including need and coverage in access to anti-retroviral treatment; to safe water and sanitation; and in food security; the gap between “free care” policies and the real formal charges and informal costs for health services that undermine use in poor households; between need and supply in drugs and skilled staff at the primary care level of the health system; between commitments and spending by the international community and government in the health budget, with rising demand on households to meet the gap; between the expectations and real working conditions and incomes of health workers; and between the social capacities for promoting health within communities, and the legal and institutional recognition and support of these capacities. Many inputs to health, including primary education, now need to be revitalised as a means to building the universal, comprehensive systems that address these gaps. The report outlines priorities based on the findings.
EQUINET is supporting community level health activists in eight countries with skills to use photography to bring out and display images of health equity issues from a community lens under the theme “KEEPING AN EYE ON EQUITY: Community visions of equity in health”. We hope to use this process to strengthen capacities at community level in selected areas to use photo media to raise awareness and communicate voice on health issues. Images of health from a community lens will be displayed at the EQUINET conference in September 2009 and the photogaphers will be present to explain their work and actions to advancing health. If you are interested in this work or have experience to share, we'd love to hear from you! Please contact us at admin@equinetafrica.org with KEEPING AN EYE ON EQUITY in the subject line.
The meeting was held to discuss issues relating to the effective management of the mobility of health care workers and to shift the agenda from awareness to action. Preliminary findings from three national studies focusing on migration trends of health professionals were presented, providing an evidence base for discussion and a direction for further recommendations. As the realities of migration trends amongst skilled health professionals continue to impact the standards and accessibility of health services on the continent, Kenya has taken a lead in studying these developments at a national and regional level. It was strongly recommended that the National Steering Committee take up immediate action on: briefing of all stakeholders on progress made in implementation of the programme as to encourage wider government ownership; broaden the NSC membership to include key government agencies not presently included, mainly the Ministry of Planning and Ministry of Finance; take immediate steps for establishment of an integrated data management system for managing human resources for health, including a minimum data set on health worker mobility; take immediate steps to active implementation of existing policies and laws relevant to managing internal and external migration of human resources for health; and review and strengthen policies and incentives for recruitment and retention of health workers.
The EQUINET book 'Reclaiming the Resources for Health: A regional analysis of equity in health in East and Southern Africa' published in late 2007 is now available as an electronic download on this site at http://www.equinetafrica.org/bibl/docs/EQUINET%20Reclaiming%20the%20Resources%20for%20Health%20in%20ESA.pdf The book is a resource for researchers, policy makers and health activists and highlights challenges and opportunities for improving health equity in east and southern Africa,
* for poor people to claim a fairer share of national resources for their health;
* for a more just return for ESA countries from the global economy to increase the resources for health; and
* for a larger share of global and national resources to be invested in redistributive health systems.