International evidence shows that, if left unregulated, the for-profit health sector may lead to distortions in the quantity, distribution and quality of health services, as well as anti-competitive behaviour. As the for-profit private sector appears to be expanding in east and southern African (ESA) countries, governments need to strengthen regulations to ensure that the for-profit sector does not undermine national health system objectives. This report examines how existing regulation provides for objectives such as the quantity, quality, distribution and price of health care services and suggests priorities for strengthening legal frameworks in 16 countries in east and southern Africa. It draws on a desk-based review of legislation accessed through the internet or from in-country researchers and interviews with in-country experts.
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TARSC, through COPASAH and EQUINET, are holding a regional workshop on Participatory Approaches to Strengthening People Centred Health Systems in the east and southern African region. The workshop will explore how to raise community voice in strengthening the resourcing and functioning of primary health care systems through the use of participatory approaches to build community roles in accountability and action. The workshop is targeted at civil society organisations, NGOs, community leaders, health workers, academics, researchers and others involved in work with communities and health workers in the east and southern African region. Applications to be mailed to info@tarsc.org by 3 September.
Performance-based funding (PBF) has become increasingly popular in global health financing. It is defined essentially as the transfer of resources (money, material goods) for health on condition that measurable action will be taken to achieve predefined health system performance targets such as particular health outcomes, the delivery of effective interventions (such as HIV prophylaxis), utilisation of services (like HIV counselling and testing), or quality care. This annotated literature review has been prepared for work on global health diplomacy and the role of African actors in global health governance in relation to PBF. The review highlights the theoretical thinking behind and strengths and weaknesses associated with PBF schemes in their use in Africa. It reviews documented evidence of the role of African actors in diplomacy and decision-making surrounding PBF. The review highlights that while national governments are generally involved in the design, implementation and evaluation of PBF schemes, some national actors and regional actors appear to be marginalised when it comes to the design and global decision-making process for performance-based funding schemes, even if they are heavily involved in their implementation.
For some time now, people working in the field of health at community level have expressed the need for a toolkit specifically focusing on participatory approaches to working on health. This toolkit was produced in response to this need, drawing on the experiences and knowledge of individuals and institutions working in this field. The toolkit shows how participatory methods can be used to raise community voice, both through health research and by training communities to take effective action and become involved in the health sector. Generally, this toolkit aims to strengthen capacities in researchers, health workers and civil society personnel working at community level to use participatory methods for research, training and programme support. At the end of the course, we hope that the users of the toolkit will have learned and be able to use various methods for participatory approaches to research and training within various areas of work aimed at building people-centred health systems. The toolkit uses experiences from different countries in the east and southern African region.
This review is part of EQUINETs work on contributions of global health diplomacy to health systems in east and southern Africa. It reviews documented literature to examine the extent to which the policy interests of African countries were carried (or not carried) into the Code in the negotiations around the code and the perceived factors affecting this; the extent to which countries in east and southern Africa view and use the Code as an instrument for negotiating foreign policy interests concerning health workers; and the motivations, capabilities and preparations for monitoring the code to engage in the diplomatic environment on African policy interests concerning health workers. The information was analysed using the policy analysis triangle to capture the changing context, processes, content and major actors in the development of the WHO Code, and documentation on its progress and implementation since its adoption. The review discusses the factors behind the relative lull in efforts on the issue of health worker migration following adoption of the Code.
This annotated bibliography was prepared as a resource for people working on different dimensions of social power, social participation and social accountability in health. Social power, participation and accountability are central concepts in building people centred health systems. This annotated bibliography was commissioned by the Community of Practitioners on Accountability and Social Action in Health (COPASAH) and prepared by Training and Research Support Centre (TARSC) within the Regional Network for Equity on Health in East and Southern Africa (EQUINET). The annotated bibliography captures English language literature, and includes materials that are open access in full online. It focuses with a few exceptions on materials published post 2000 and is based on materials accessed through the use of social power / accountability/ participation in health as key words in online searches and literature forwarded from COPASAH members. The limitations of the compilation are discussed. The bibliography is presented in four parts: Section 1 presents papers on social power in health, Section 2 presents papers on social participation in health, Section 3 presents papers on social accountability in health, and Section 4 presents papers on the use of these three concepts in knowledge generation.
This review is part of EQUINET's programme of work on Contributions of global health diplomacy in east and southern Africa. Access to essential medicines is one of the key requirements for achieving equitable health systems and better public health in east and southern Africa (ESA). One constraint to this is that the region’s medicine production capacity remains weak. In May 2007, the African Heads of State and Government adopted the Pharmaceutical Manufacturing Plan for Africa (PMPA) to maintain a sustainable supply of quality essential medicines to improve public health and promote industrial and economic development in Africa. The PMPA includes six priority areas: mapping productive capacity; situation analysis; developing a manufacturing agenda; addressing intellectual property issues; political, geographical, economic considerations; and financing. This review compiles from existing literature bottlenecks to local medicine production in the region. It seeks to inform follow-up case study work on the extent to which relationships and agreements with Brazil, India and China are addressing the bottlenecks identified in the African Union (AU), SADC and EAC plans for pharmaceutical manufacturing.
This review is part of EQUINET's programme of work on Contributions of global health diplomacy in east and southern Africa. This includes work on the WHO Global Code on Ethical Recruitment of Health workers. The research seeks to explore the extent to which the policy interests of African countries were carried (or not carried) into the Code in the negotiations around the code and the perceived factors affecting this; the extent to which countries in east and southern Africa view and implement the Code as an instrument for negotiating foreign policy interests concerning health workers; and the motivations, capabilities and preparations for monitoring the Code to engage on African policy interests concerning health workers. The paper presents a review of published and grey literature on relevant codes of practice on health workers and on bilateral and multilateral agreements on the health workforce. The information was analysed using the policy analysis triangle to capture the changing context, processes, content and major actors in the development of the WHO Code, and documentation on its progress and implementation since its adoption. It raises issues that are being followed up through field research.
This report documents the proceedings of a skills workshop on financing incidence analysis (FIA) that was held to review international experience on the social distribution of burdens of various financing sources and the methods used for assessing financing incidence, drawing on work that has been carried out in Africa. Specifically the workshop sought to: explore ways to realise additional funding from different progressive financing sources; draw input from the Health Economics Unit, University of Cape Town, on methodologies for analysing the progressivity and regressivity of different financing sources; draw lessons from international and local experiences on FIA of different financing sources; and answer questions on how to address challenges with data collection and analysis, review of tools, preliminary results and reporting.
Financing universal health coverage (UHC) is not only about how to generate funds for health services. It is also about how these funds are pooled and used to purchase services. This policy brief explores options for financing UHC in East and Southern Africa (ESA). It presents learning from countries that have made progress towards UHC, including the need to increase domestic funding and to use mandatory pre-payment (tax and other government revenue, possibly supplemented by mandatory health insurance contributions) as the main mechanism for funding health services. The brief indicates the problems associated with introducing or expanding health insurance to fund UHC. With tax funding often the most equitable and efficient option, there is scope for increasing government revenue and health expenditure in many ESA countries.