The fifteen minute pre-recorded show, ‘Health Worker Retention and Migration’, was produced by WWMP, in conjunction with labour journalists in east and southern Africa. It provided an in-depth analysis of the situation for health workers in Africa, and discussed incentives for retaining health workers. In the pre-recorded show, a Khayelitsha nurse who used to work at Groote Schuur hospital in Cape Town and migrated to Saudi Arabia Mavis Mpangele, Bongani Lose from Democratic Nurses of South Africa (DENOSA), Kwabena Otoo from the Ghana Trade union Congress, Joel Odijie from Nigeria Trade Union Congress, Professor Yoswa Dambisya of the University of Limpopo Department of Pharmacy and EQUINET Steering Committee, Nyasha Muchichwa from the Labour and Economic Research Institute of Zimbabwe and Percy Mahlathi, the South African Director General of the Department of Health were interviewed. The feature covers the push factors and experiences from different African countries. The feature also explores government responses to the problem as well as African trade unions response. It rounds off with examples of success stories in Zambia and Tanzania.
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Registration for the EQUINET conference is nearly closing. 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!
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In the DR Congo, where the national HIV prevalence is around 5%, testing and treatment services are more available in urban than rural areas, despite the latter being more affected by the epidemic. In Bunia and Aru, North eastern DRC, people living with HIV and AIDS (PLWHA) cannot access testing or treatment services unless they travel to Bunia town, some distance away. Discrimination from community members towards PLWHA is further identified as a reason for people not coming for HIV testing, and for discouraging other prevention activities. The Pan African Institute of Community Health (IPASC) used a participatory reflection and action (PRA) approach with the concerned rural communities to examine and act on negative perceptions within the community around HIV testing and treatment, to support improved demand for and uptake of these services, to make more effective use of available resources and services. The process targeted male and female PLWHA aged 20-49 years, male and female adolescents 15-19 years, community and church leaders and community health workers because of their vulnerability and influence on attitudes towards HIV and AIDS. Community level barriers (largely stigma) interfaced with service level constraints to diminish testing and treatment coverage. Both users and providers faced barriers. These related to resources (drugs, transport), while the lack of accessible services was a fundamental deterrent. Leaving treatment to late stages when people are ill made this worse, as people found it difficult to make the long journey at that stage. While service factors were not been dealt with in the short time of the intervention, there were improvements in social dialogue on treatment and mechanisms introduced to deal with the community level barriers to testing and treatment. Communities are able to make significant changes in barriers to testing and treatment if organised to do so using participatory processes. Community based sensitisers are an important resource in the community and can produce a measurable change in the attitudes that discourage early testing and treatment.
This report presents the experiences and learning from participatory action research implemented by Country Minders for Peoples Development (CMPD), (a Malawi non government organization) on the co-ordination of support from service providers and community organisations for protection of sexual and reproductive health of orphans and vulnerable children in Monkey Bay, Malawi. The work was implemented within a Regional Network for Equity in Health in east and southern Africa (EQUINET) programme that aimed to explore, through participatory reflection and action (PRA) methods, dimensions of (and impediments to delivery of) Primary Health Care responses to HIV and AIDS. Through baseline and follow up surveys, key informant interviews, focus groups and participatory reflection and action (PRA) meetings the study team led by CMPD identified the health needs and coping strategies of orphans and vulnerable children and their consequent risk of health and SRH problems; mapped the services and resources available for orphans and vulnerable children, and their coverage of and gaps in meeting the identified needs; implemented and assessed the outcomes from actions by local services, community organisations and communities responding to problems prioritised by the community, and drew learning from this work on the factors affecting community level support for vulnerable children that would need to be included in comprehensive primary health care responses to AIDS. The findings suggest that a Primary Health Care approach to AIDS should be embedded within and reinforce a wider social protection strategy that addresses life course needs, such as those of vulnerable children. Significant attention and resource commitment has to be given to promoting outreach and uptake of services and to the intersectoral actions and community organisations that support this, if resources are to be accessed and used by vulnerable groups.
Facing multiple global crises, governments and corporations are arguing that new technologies are the solution to fixing everything from climate chaos to hunger and health problems. What do these new technologies mean for African countries? In which contexts are they being developed? Who controls and who will benefit from them? Are they bringing new impacts to our health, environment and economies? The workshop will feature presentations from ETC group, an international civil society organization based in Canada, and African partners which will explain and introduce the issues, followed by questions and discussions with participants.
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This paper aims to provide a detailed analysis of the options for protecting universal comprehensive and equitable health services within the framework of the EU-ESA EPA and other EPAs in the region through the services negotiations. The paper notes a number of commitments that the ESA-EU countries have already made in relation to public health. It proposes issues for negotiators in the services negotiations in the EPA to take into account to protect health in these agreements.
Parliaments can play a key role in promoting health and health equity through their representative, legislative and oversight roles, including budget oversight. To better understand and support the practical implementation of these roles, EQUINET (through University of Cape Town (UCT) and its secretariat at Training and Research Support Centre (TARSC) with SEAPACOH implemented a questionnaire survey in September 2008 to explore and document the work and experiences of parliamentary committees on health. This report presents the findings on the general progress on parliament work on health. The survey highlighted a number of areas of current focus of parliament work in health, the potential and experience of positive outcomes, and the limits and constraints to address to support further work. In the budget process parliaments have generally played a role in advocating and engaging on the Abuja commitment, with increasing budget shares to health in a majority of countries, although the target has only been met in two of those included in the survey. Legislative activity is less common, and areas that are of public health concern, such as incorporating TRIPS flexibilities or international commitments into national law are still not well known by parliaments or acted on. Oversight and representative roles are the most frequently reported area of committee action, and parliaments have played an important role in raising debate on and profile of health issues. It appears from the evidence that parliaments can support progress in health equity by enhancing funding for prioritised areas in the budget process, by raising awareness of health issues through parliament debates, by raising public attention to prioritised concerns through media liaison, by gathering evidence and views from communities and communicating issues to communities through constituency visits, and by raising very specific questions to the executive to address.
This study explored the challenges experienced by HIV infected pregnant women and the coping strategies used by those who disclose or do not disclose, to inform community and health workers roles in supporting pregnant women around disclosure. It aimed to explore dimensions of (and impediments to delivery of) Primary Health Care responses to HIV and AIDS in Namibia. The work was implemented at Katutura state hospital, an intermediate hospital in Windhoek, at the Centre for Disease Control, antenatal care and PMTCT services within the hospital complex. The work was done with a small sample (20) due to the criteria of voluntary participation and follow through of a more intensive longitudinal participatory process with the women. The use of participatory methods, while demanding, proved effective even over short time periods to build the empowerment and communication needed to for the changes found. Nursing students proposed that future PRA projects run throughout the year for effective learning and include more students. PHC responses to AIDS start and end in the community, involving households, networks of affected groups, educational, religious and social institutions and supported by primary care services. The study indicates features of this for testing and counselling. Namibia needs to provide high levels of knowledge of services for prevention, testing, health promotion in positive people, partner notification and treatment options to people in the community from an early age onwards. It can also create an enabling social environment encouraging support of PLWHA, openness and reinforcing information on the positive implications of testing and disclosure, including to partners and family members. Another factor is ensuring that testing, counselling and information supporting disclosure, including on positive prevention, is provided at every ANC and PMTCT contact. In addition, it's important to support health worker communication on testing and disclosure with inputs from support groups and expert patients at facilities, and build a health sector response that addresses community as well as health service dimensions of intervention.
A regional meeting was convened on 25-27 February 2009 in Windhoek Namibia by EQUINET and ECSA HC, hosted by the University of Namibia in co-operation with TARSC and University of Limpopo 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 meeting also reviewed work implemented within other EQUINET themes to explore the impact of migration on health systems in Kenya (carried out in co-operation with IOM and ECSA-HC), to explore the impact of AIDS financing on health worker retention (carried out in co-operation with WHO and ECSA-HC), and to examine the relationship between health workers and communities at primary care level (in a programme of work co-ordinated by TARSC and Ifakara Health Institute). The meeting, held at the Safari Hotel in Windhoek, brought together country partners, researchers, regional and national institutions involved with health workers. A set of recommendations were produced, particularly focusing on health worker retention.
This workshop will take place after the EQUINET Regional Conferebce September 23-25 2009. It will draw on the experiences of the African Population and Health Research Center (APHRC) to strengthen skills in effective and innovative strategies of communicating health research evidence to effect policy change. It will be an interactive workshop, and will address some major challenges in communicating health research in an accessible and compelling manner. The workshop will use evidence from APHRC's research in the area of sexual and reproductive health in the sub-Saharan Africa region. The workshop will be useful to people charged with communicating research in their organizations, researchers, advocates/activists, and anyone else who finds the issues above interesting. Visit the conference website to register for the workshop and for the conference.