This case study report compiles evidence on the experience of the Essential Health Benefit (EHB) in Zambia. The paper aims to contribute to national and regional policy dialogue regarding the role the EHB plays in budgeting, resourcing and purchasing of health services as well as monitoring health system performance for accountability. It outlines the motivations for developing the EHBs in Zambia, the barriers encountered in the process, the methods used to develop EHBs, and issues related to dissemination and communication of its content. The paper was done under the auspices of an EQUINET research programme through Ifakara Health Institute (IHI) and Training and Research Support Centre (TARSC), in association with the ECSA Health Community, supported by IDRC (Canada), and with the permission of the Ministry of Health of Zambia.
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The Essential Health Benefit (EHB) is known as Essential Health Care Package (EHCP) in Swaziland. This desk review provides evidence on the experience of EHCPs in Swaziland and includes available policy documents and research reports. It was implemented in an EQUINET research programme through Ifakara Health Institute (IHI) and Training and Research Support Centre (TARSC), in association with the ECSA Health Community, supported by IDRC (Canada). The desk review presents the motivations for and methods used to develop, define and cost EHCP. It includes key informant input from a multi-disciplinary national task team through a workshop of key stakeholders with technical support from the World Health Organisation (WHO). It outlines how the EHCP has been disseminated and used in the budgeting and purchasing of health services and in monitoring health system performance for accountability. The paper also reports on the facilitators and barriers to development, uptake and use of the EHCP. In guiding the provision of services for all, the EHCP was envisaged to contribute towards the alleviation of poverty and as a tool for universal health coverage. Its implementation calls for a health service Infrastructure that is in good condition, competent health personnel, readiness to undergo training in new medical technology, supporting laws and capacity in the health financing unit. The EHCP in Swaziland was intended to guide the provision of health services. However, its costs were beyond the national resources to fund it. The adoption of a more restricted health service package currently being assessed in ten clinics in all four regions of the country suggests that a phased approach to delivery of an EHB may be more affordable financially for the country.
An Essential Health Benefit (EHB) is a policy intervention designed to direct resources to priority areas of health service delivery to reduce disease burdens and ensure equity in health. Mainland Tanzania’s most recent benefit package – the National Essential Health Care Interventions Package-Tanzania (NEHCIP-TZ) – describes the EHB as a minimum or “limited list of public health and clinical interventions.” The package identifies where priorities are set for improved public health. This report shows the challenges of turning a policy ‘wish list’ and package into a reality of services that can be accessed across different facility levels. This report describes the evolution of mainland Tanzania’s EHB; the motivations for developing the EHBs, the methods used to develop, define and cost them; how it is being disseminated, communicated, and used; and the facilitators (and barriers) to its development, uptake or use. Findings presented in this report are from three stages of analysis: literature review, key informant perspectives and a national consultative meeting. The case study on Tanzania was implemented in a research programme of the EQUINET through Ifakara Health Institute and Training and Research Support Centre. The programme is being implemented in association with the East Central and Southern African Health Community, supported by IDRC (Canada).
The Essential Health Benefit (EHB) policy interventions aim to optimize efficiency while extending coverage by increasing equity of access to the defined benefits. Uganda’s EHB is referred to as the Uganda National Minimum Healthcare Package (UNMHCP) introduced in the 1999 Health Policy. The UNMHCP is composed of cost efficient interventions against diseases or conditions most prevalent in the country. This report compiles evidence from published, grey literature and key informants on the UNMHCP since its introduction in Uganda’s health system, and findings were further validated during a one day national stakeholder meeting. It includes information on the motivations for developing the EHBs, the methods used to develop, define and cost them, and how it has been disseminated, used in budgeting, resourcing and purchasing health services and in monitoring health system performance for accountability. It was implemented in an EQUINET research programme through Ifakara Health Institute and Training and Research Support Centre, in association with the ECSA Health Community, supported by IDRC (Canada).
The new “Participatory Action Research Portal” for resources on Participatory Action Research (PAR) is now live on the EQUINET website. The portal has a homepage and a series of ‘subpages’ for Training, resources - which will provide links to online training courses, whole training guides and reports of training activities; Methods, tools and ethics - which will provide links to online specific papers on PAR methods, to specific examples of tools, and to discussions/ guidelines on ethical issues; PAR work – which will provide links to stories, case studies, briefs, videos, text or photojournalism stories of PAR work, including facilitator reflections; Organisations and networks - which will provide the name, snippet of information, country and link to organisations and networks involved PAR; Publications - which will provide published journal papers and reports on PAR through links to the urls or on the EQUINET database; and Other - which will provide ad hoc information that doesn’t fit anywhere else. The portal is a resource for all those working with PAR and includes resources in any language. There is a form for people to send videos, photojournalism, organisations, journal papers, training guides and other resources for the portal. The url link shown here is in English but there is also a Spanish version at http://www.equinetafrica.org/content/portal-de-recursos-para-la-investigaci%C3%B3n-acci%C3%B3n-participativa-iap
The 13th Southern African Civil Society Forum was held from 14-17 August 2017 at Birchwood Hotel and Conference Centre Johannesburg, organised by the Southern African Development Community (SADC) Council of Non government organisations (CNGO), Southern African Trade Union Co-ordinating Council (SATUCC) and Federation of Churches in Southern Africa (FOCISA). It involved about 300 delegates from different constituencies and civil society organisations across the SADC region. A commission session was convened by EQUINET and SATUCC within the 13th Southern African Civil Society Forum to share information on the findings and proposals for harmonised regional standards on health in the extractive sector. The session objectives were to discuss the key issues and formulate concrete strategies for responding to the regional context and priority challenges for protection of health in the extractive sector in the region and to make proposals for harmonised regional standards to protect health in the sector. Delegates recommended that health be included in the SADC harmonised standards for the mining sector, with a comprehensive focus on public health and environment, with details of what this means and actions proposed at national, regional and local level.
EQUINET through the Community Working Group on Health (CWGH) as the cluster lead for the work on social empowerment in health, in partnership with Training and Research Support Centre (TARSC), University of Cape Town (UCT) and Lusaka District Health Office (LDHO), with support from Open Society Initiative for Eastern Africa (OSIEA) have embarked on a regional programme, ‘HCCs as a vehicle for social participation in health systems in East and Southern Africa’ to address some of the outcomes mentioned above. This report documents the proceedings during the Regional HCC exchange visit held at Mwanza clinic, Goromonzi district on the 20th of June 2017 and the review meeting held in Harare on the 21st of June 2017. The meeting aimed to: discuss experiences with laws, policies, guidelines and constitutions on HCCs; share experiences in using Photovoice to enhance the role of HCCs; discuss current training materials and programmes for HCCs in the region and discuss strengthening of internal capacities of institutions working with HCCs through information exchange and skills inputs.
The Center for Health, Human Rights and Development (CEHURD), is an EQUINET cluster lead for the theme work on the right to health. CEHURD, Mubangizi Michael and Musimenta Jennifer Vs the Executive Director of Mulago National Referral Hospital and Attorney General of Uganda (Civil Suit No 212 of 2013), “Mulago case” and Justice Lydia Mugambe’s judgement won the Gender Justice Uncovered Awards in May 2017 hosted by Women’s Link Worldwide. In this landmark ruling Justice Lydia Mugambe noted that the disappearance of the couple's baby also resulted to psychological torture for the parents as well as putting the spotlight on the State's failure to fulfil its obligations under the right to health. The Court also pointed to the overburdened hospital staff which led to errors as another example of the failure of the State to comply with its obligations. The judgment won with 3,829 votes beating 17 other rulings that were nominated for the best judicial decision from all around the world in the Gender Justice Uncovered Awards under the People's Choice Gavel 2017 category. This award comes at a time when CEHURD is implementing the judgment through discussions and support to Mulago National Referral Hospital to develop and put in place mechanisms to ensure the safety of babies after delivery.
In the evaluation of the Reader on PAR in Health Systems Research (online on this site) one of the proposals made by many respondents was to have a website to share a range of PAR materials, and information on networks, trainers etc online. People indicated and we also noted that there are many existing resources on PAR but that we need to make it easier for people to find what is out there based on specific needs that they have. In response to this EQUINET is setting up in July/ August a PAR portal page called the “Participatory Action Research Portal”. The new portal will have a homepage and a series of ‘subpages’ for Training, resources - which will provide links to online training courses, whole training guides and reports of training activities; Methods, tools and ethics - which will provide links to online specific papers on PAR methods, to specific examples of tools, and to discussions/ guidelines on ethical issues; PAR work – which will provide links to stories, case studies, briefs, videos, text or photojournalism stories of PAR work, including facilitator reflections; Organisations and networks - which will provide the name, snippet of information, country and link to organisations and networks involved PAR; Publications - which will provide published journal papers and reports on PAR through links to the urls or on the EQUINET database and Other resources - which will provide ad hoc information that doesn’t fit anywhere else. The page is being worked on in July and August and will be launched in September 2017. A call has been made for institutions working with PAR to provide information on resources they would like the portal to make links to.
In 2017 EQUINET (through TARSC working with Maldaba a web design company) is developing a web platform for participatory action research (PAR) that would allow us to connect across countries on areas of local community level work and action on areas of health, health determinants and health systems that have wider regional and global relevance or relate to global policies being applied across our countries. In doing this we are building a new tool that will allow us to share, discuss, analyse and design actions across countries in the same way we have done so using PAR at local level, that we can use in future for many purposes. TARSC has opened a call for people with experience of PAR working in east and southern Africa who may be interested in being involved in this process. We will be taking forward the web platform for PAR between July 2017 and December 2019 working with eight sites and health workers and community members in a primary care facility in the site. We will be exploring how disease programme or funding targets such as for performance based financing are affecting health workers professionals roles and team work; health workers relationships with communities and the ability to deliver comprehensive primary health care. We invite people to apply to join the programme as country PAR facilitators. To participate in this programme we invite people who work in an organisation/ programme in a country in an east and southern African country; have had some exposure to PAR approaches; have access to internet; have ongoing work or interaction with at least one primary care centre and with the health workers and community members in it, such as through health centre committees, health literacy or other programmes; have primary care level services that are implementing some form of target driven funding or service delivery, such as in performance based financing or specific disease programmes, and are available for the activities, in the time frames and for the duration noted in the process above. If you are interested please email EQUINET at email@example.com by July 7th 2017 with your name, organisation, country and email address for communication, and: (1) list of any prior training received on PAR, with the course, institution providing the course and year; (2) A list of any PAR work you have implemented, with a line for each on what it was about and the year; (3) Confirmation that you have direct access to internet and what it costs you for a one hour session (if provided institutionally through your organisation please indicate this). (4) The name, location and urban/ rural location of a primary care centre that you regularly interact with, including with the health workers and community members, and whether the health workers and / or community members at this centre have access to the internet (not essential but useful). (5) The form of target driven funding or service delivery being implemented at the primary care service, (ie. performance based financing or specific disease programmes specify for what) and (6) Confirmation that you are available for the activities, in the time frames and for the duration noted in the process above. We will provide feedback to applicants who provide the full information above by last week of July.