The Regional Network for Equity in Health in East and Southern Africa (EQUINET) is implementing a three year policy research programme to address selected challenges to health and strengthening health systems within processes of global health diplomacy (GHD). In the June 2012 inception workshop for the programme, delegates called for a paper that explains the concepts and emergence of global health diplomacy, the different approaches being taken in GHD, including African approaches. Given the de facto rise in health diplomacy, this paper explores questions on GHD, to inform debate and dialogue in Africa on raising health within global diplomacy. The authors briefly present the roots and emergence of GHD, and the debates on raising public health within global diplomacy. They outline how the concepts of and approaches to GHD differ across countries and regions. They explore the perspectives that have informed diplomacy in Africa, and ask what this means for African engagement in GHD, and for public health in Africa. At various points in this paper they raise questions on what implications the developments described have for health diplomacy in Africa. Given the limitations of documented evidence on African approaches or analysis of health diplomacy from an African lens, it is difficult to draw conclusions. The authors thus raise questions that they hope will provoke dialogue, debate and response.
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An Equity Watch is a means of monitoring progress on health equity by gathering, organising, analysing, reporting and reviewing evidence on equity in health. Equity Watch work is being implemented in countries in eastern and southern Africa in line with national and regional policy commitments. In February 2010 the Regional Health Ministers' Conference of the ECSA Health Community resolved that countries should 'report on evidence on health equity and progress in addressing inequalities in health'. This report provides an array of evidence on the responsiveness of Tanzania’s health system in promoting and attaining equity in health and health care, using the Equity Watch framework. The report introduces the context and the evidence within four major areas: equity in health, household access to the resources for health, equitable health systems and global justice. It shows past levels (1980–2005), current levels (most current data publicly available) and comments on the level of progress towards health equity.
This study was undertaken by University of Zambia within the Health Financing theme work of the Regional Network for Equity in Health in East and Southern Africa (EQUINET) within a regional programme that is exploring progress in integrating equity into resource allocation. The study was undertaken to update the experiences and progress on the design, review and implementation of an equity-based resource allocation formula in the Zambian health sector. The author found that the formula has only been implemented in partial form, and that second and third generation formulae have not been adjusted in the implementation process. A severe lack of funding for the public health system, whose funding is smaller than the financing for specific health programmes like HIV and AIDS, remains a significant concern. The study makes a number of recommendations. The author calls for more research evaluating the changes in health outcomes, outputs or processes as a consequence of implementing resource allocation formulae. He calls for integration of financing and expansion of the pooled funding for the health sector to raise possibilities for a realistic implementation of the resource allocation formula. Richer districts should not have to risk a revenue reduction. The way to achieve the formula should rather use limited revenue growth in these districts relative to accelerated revenue growth for the poorer districts. A clear time line should be established with regard to the transformation of resource allocation and this should be updated based on emerging evidence. A monitoring and evaluation process should track performance of both resource allocation and health and health care outcomes. Finally, the Ministry of Health should evaluate the effect of structural changes with regard to resource management and performance so as to ensure optimum implementation.
In November 2010, the first Global Symposium on Health Systems Research (HSR) on ‘Science to Accelerate Universal Health Coverage’ shared evidence and identified priorities for strengthening HSR to achieve universal health coverage (UHC). The focus and alliance that emerged from the conference and the high-level support from many global and national agencies suggest the potential for greater visibility and inclusion of evidence on health systems in future global health policy debates. While the many global forums advocating UHC indicate that there is a consistent focus on policy on universality, different perspectives on UHC indicate that the term ‘universal’ cannot simply be assumed to include the same interests, meanings, and values for all who use it. The author argues that UHC as a goal – and the health systems strengthening it – should inform policy dialogue on specific global agendas, and that stakeholders should make clear and discuss their different positions on UHC, their policy options and consequences, and the political views and values that lie behind them. (EQUINET through TARSC and SEATINI regularly contributes to the Global Health Monitor.)
A Ministers’ and Senior Leadership Scoping Workshop was held to provide an opportunity for Ministers of Health and senior leadership teams in ECSA member states to be briefed on and review the Global Health Diplomacy (GHD) Initiative in the ECSA region, to identify synergies and opportunities for collaboration with on-going and planned country and partner activities and to agree on modalities for implementation. The meeting reviewed the experiences in GHD to date, the international initiatives on GHD and the proposed programme activities. The Ministers and senior officials made recommendations for the implementation of the programme.
In this paper, the author considers elements of the design of health systems and how these relate to moving towards UC in the context of Africa. She focuses particularly on health financing issues (revenue collection, pooling and purchasing), but also raises health service delivery and management issues. In relation to revenue collection, the global consensus is that in order to pursue universal coverage, it is critical to reduce reliance on out-of-pocket payments as a means of funding health services. The author notes that the key focus in moving towards universal coverage should be on mandatory prepayment mechanisms and discusses the options for these. The common assumption of limited fiscal space for increased government spending on the health sector should be challenged and the fiscal space envelop pushed, she argues. While mandatory health insurance schemes can also contribute to generating additional revenue for health services, these funds should be pooled with funds from government revenue. Although there is limited evidence in relation to purchasing in ESA countries, introducing active purchasing of services, as well as addressing service delivery and management challenges, will be essential if universal access to services of appropriate quality is to be achieved.
Participatory Reflection and Action work in EQUINET has shown that health workers suffer problems of poor work environments, poor remuneration, lack of growth opportunities and motivational incentives. This may pose a barrier to their interaction with communities, despite the role that communication plays in patient-centred care. Communities on their side may not possess the skills and capacities to negotiate or communicate with service providers, leading to misunderstanding, lack of knowledge and even anger. In 2011, building on work done on health literacy in Zimbabwe, Malawi and Botswana, and in the EQUINET PRA equity network to strengthen communication between health workers and communities, TARSC implemented a one year programme with HEPS Uganda and, with Cordaid support, to extend health literacy in Uganda and use the skills built to promote dialogue and accountability between health workers and communities. In 2012-2014 TARSC and HEPS-Uganda are building on this work to widen and deepen the capacity of civil society organisations (CSOs) for Health Literacy (HL) in Uganda. This report outlines a meeting that was a first step in this two-year programme. It brought together five CSOs working within districts on health. The workshop trained facilitators, education and lead personnel from five CSOs in Uganda to plan, implement and monitor HL programmes at district level, including a specific focus on women’s health.
This review assesses the resource mobilisation and allocation performance and challenges faced by the MoHCW in meeting the target set out in its Investment Case. As the Investment Case was meant to complement the annual government budget and resource mobilisation efforts by other players, the review took these resources into account in assessing the level and direction of funding. The review specifically looked at the response from funders of the health sector to the Investment Case, in terms of what resources were raised and the successes and challenges associated with raising the intended resources. It assesses the resources raised and some of the health outputs from these resources. The study included interviews with key informants in the Ministry, review of policy documents and analysis of financial data from government and external funders.
In this paper, the author considers elements of the design of health systems and how these relate to moving towards universal care in the context of Africa. She focuses particularly on health financing issues (revenue collection, pooling and purchasing), but also raises health service delivery and management issues. In relation to revenue collection, the global consensus is that in order to pursue universal coverage, it is critical to reduce reliance on out-of-pocket payments as a means of funding health services. The author notes that the key focus in moving towards universal coverage should be on mandatory prepayment mechanisms and discusses the options for these. The common assumption of limited fiscal space for increased government spending on the health sector should be challenged and the fiscal space envelop pushed. While mandatory health insurance schemes can also contribute to generating additional revenue for health services, these funds should be pooled with funds from government revenue. Although there is limited evidence in relation to purchasing in east and southern African countries, introducing active purchasing of services, as well as addressing service delivery and management challenges, will be essential if universal access to services of appropriate quality is to be achieved.
The notification and prevention of the spread of diseases and other public health risks across borders is a longstanding area of health diplomacy. The International Health Regulations (IHR) (2005) were adopted by the 58th World Health Assembly in May 2005 to control the spread of diseases and public health risks across borders. The IHR (2005) are global standards that become legally binding in countries once they have been incorporated into domestic public health law (unless country constitutions specifically state that such international standards automatically apply). Member states of WHO, who are “States Parties” to the IHR, were given up to 2007 to assess their capacity and develop national action plans on the regulations. Countries were given up to 2012 to meet the requirements of the IHR regarding their national surveillance, reporting and response systems to public health risks and emergencies and to provide the measures set for disease control at designated airports, ports and ground crossings. Progress toward attainment of these goals depends on eight core capacities, to be in place by the year 2012. This policy brief outlines the context and content of the IHR and how far the provisions have been implemented in east and southern Africa.