This report presents the proceedings and debates at a meeting, held in Munyonyo Uganda September 16-18 2008, of parliamentary committees responsible for health from twelve countries in East and Southern Africa, with technical, government and civil society and regional partners. The meeting reviewed the health equity situation in the region in relation to regional goals (e.g. Maputo Plan of Action, Abuja Declaration) as well as international frameworks (e.g. ICPD PoA, and the MDGs). Various areas of parliamentary work were reviewed in relationto health equity and primary health care: from a budget and policy oversight lens, the meeting reviewed AIDS and sexual and reproductive health policies and commodity security, and the laws and budgets for this. The meeting explored options for fair and adequate health care financing and for promoting equitable resource allocation, particularly in relation to budget processes. The legal rolesof parliament were discussed in relation to the application of international and regional treaties and conventions on the right to health; and the measures to promote health in patenting laws and the EPA negotiations and more generally in trade agreements. the meeting also explored developments in primary health care and social empowerment in health. The report presents the resolutions of the meeting and and the proposals made to strengthen SEAPACOH regional networking and organisation.
Latest Equinet Updates
Os diferentes distritos, regiões e províncias num país têm diferentes necessidades de saúde e recursos disponíveis dos cuidados da saúde. Os fundos do governo justamentamente distribuídos para a saúde assim chamam para uma formula que calcula a divisão dos recursos totais para seremalocados para áreas baseadas sobre indicadores da necessidade relativa para cuidados da saúde naquela área. Muitos países na região usam tais formulários. Eles usam diferentes indicadores da necessidade de saúde, incluindo a capacidade populacional e a sua composição, os níveis da pobreza, doenças específicas e mortalidade. Revelando experiência em certos países selecionadodentro da região, esta breve política sugere que os países podem fortalecer uma alocação equitativa dos recursos para a saúde através de aumentar a cota global do financiamento do governo alocada ao sector da saúde, trazendo ajuda externa e o financiamento do governo num só conjunto de fundose aloca-los atraves dum mecanismo simples. Alocação de recursos equitativos chama para os governos estabelecer alvos anuais para alocação equitativa destes fundos públicos, e colecionainformação para monitorar e reportar sobre progresso em alcançar estes alvos, incluindo parliamentos e sociedade civil. Alocação de recursos é um processo politizado e requer umcuidadosa, incluindo, planificar, oraganizar e providencia de incentivos para a re-distribuição do pessoal de cuidados da saúde para áreas onde a necessidade da saúde é alta.
No ano 2001, em Abuja na Nigeria, os Chefes dos estados membros da União Africana comprometeram para alocar ao menos 15% de orçamentos dos governos para seus sectores da saúde. Ao mesmo tempo chamaram os países doadores para complementar seus esforços a fim de mobilizar domesticamente os recursos através de cumprirem o seu compromisso de dedicar 0.7% do seu PBN como AOD para os países em via de desenvolvimento e cancelar a dívida externa da Afica em favor Do aumento de investimento no sector social. O alvo de Abuja, assim, consiste de três componentes; os países Africanos deveriam: mobilizar os recursos domésticos para a saúde (15% agora); estar não sobre-carregado pela prestação de contas do débito (Cancelamento de Débito agora); e ser apoiada pela AOD (0.7% PBN agora).
This workshop brought together civil society, parliamentarians, human rights commissions, trade and health ministries officials to review and deliberate on protection of health and access to health care services in the ongoing EPA negotiations, and particularly in the services negotiations. The meeting updated on current health and trade issues, including patenting laws and the EPA negotiations and more generally legal frameworks for ensuring protection of public health in trade agreements. Delegates reviewed a technical analysis report on the services negotiations in the Economic Partnership Agreements and developed positions to be advanced for the protection of public health in trade agreements and specifically negotiating positions on the services negotiations.
The last two issues of EQUINET news have given focus to Primary Health Care (PHC), noting the thirty year anniversay of the Alma Ata declaration on PHC in 1978. The PHC philosophy recognises the need to tackle the broader social and political determinants of health, and involves wide-ranging action to promote health equity. It is focused on improving population health and generating health equity; on inter-sectoral action to address other social determinants of health and is based on social empowerment and comprehensive, integrated and appropriate health care, that emphasises health promotion and prevention and assures first contact care. EQUINET thus sees PHC oriented health systems as a basis for improving equity in health and in access to health services. This month we are making available on our website in electronic form our book "Reclaiming the Resources for Health", a resource that gives the argument for people centred, PHC oriented health systems in east and southern Africa. We report on the resolutions of an important meeting of parliaments health in east and southern Africa held in September 2008 on health equity and PHC, and we present new evidence gathered and methods for advancing PHC oriented health systems. We also present two editorials from our joint issue with Pambazuka news on PHC: Thirty years on. We invite comment and input on PHC in east and southern Africa to admin@equinetafrica.org!
This paper investigates the impact of the framework and strategies to retain critical health professionals (CHPs) that the Zimbabwean government has put in place, particularly regarding non-financial incentives, in the face of continuing high out-migration. The study investigated and reports on the causes of migration of health professionals; the strategies used to retain health professionals, how they are being implemented, monitored and evaluated and their impact, in order to make recommendations to enhance the monitoring, evaluation and management of non-financial incentives for health worker retention. The field survey results showed that Zimbabwe is losing experienced CHPs, but that even newly qualified staff aspire to migrate to gain experience. The major factor driving out-migration is the economic hardship that CHPs face due to deterioration in the country’s economy. Other factors identified include poor remuneration, unattractive financial incentives and poor working conditions. The Zimbabwe Health Service Board (ZHSB) has implemented a retention package but constraints in its adequacy and coverage appear to have limited its impact, whilethe ZHSB itself has limited autonomy to decide on health worker incentives.
The Regional analysis of Equity in Health in East and Southern Africa presents a synthesis of the evidence gathered from a range of sources: published literature on and from the region, reviews of current evidence, where available, data drawn primarily from government, intergovernmental, particularly Africa Union and UN sources and the less commonly documented and heard experience within the region, found in grey literature, in interviews and testimonials and gathered through participatory processes. The report is written for many audiences. For the diverse community involved in health equity within east and southern Africa, it provides a source book of evidence and analysis to support and advance work.
New information can be found at the website for the EQUINET Conference September 2009 on pre and post conference workshops. Regional workshops will be held on issues covering health literacy, policy analysis, participatory methods, writing skillsand health financing. Visit the website at ww.equinetafrica.org/conference2009/index.php for further information. Places are limited so we urge youto register early.
Implementing any policy or intervention faces a range of challenges, especially for those seeking to benefit the poorest social groups. Much public health analysis focuses on the technical aspects of good policy design. However, experience shows that it can be more difficult to deal with the political and institutional barriers to implementation than to design new policies and programmes. Predicting and managing these political and institutional factors is essential to make the changes necessary to strengthen equitable health systems. This guidance brief outlines the frameworks and tools usedin health policy analysis for investigating and tackling these issues. It also presents a range of resources in Africa and elsewhere to support this key area of work in health.
Devoting 15% of domestic public funds to the health sector is necessary - both to address the health and health care needs within east and southern Africa (ESA) and to ensure progress towards building a universal and comprehensive health system. The target of 15% is not unrealistic – it is very much in line with levels of public spending in other countries around the world. Achieving the 15% target demands that public funds not be consumed by debt servicing, so rapid implementation of debt cancellation is critical. The 15% is understood to mean domestic public spending on health, excluding external funding. This policy brief provides information on progress towards meeting the Abuja commitment in east and southern Africa, the obstacles and challengesto address,and the arguments for enhanced effort to prioritising health in national budgets.