Primary Health Care (PHC) has inspired and galvanized action on health. PHC affirms that health is a state of complete physical, mental and social wellbeing and not merely the absence of disease and that health is a fundamental human right. In the past decade, global institutions have promoted and channeled external funds through performance-based financing (PBF), as a strategy to improve service delivery and access. While there have been studies on whether these particular services targeted under PBF have improved, there has been little systematic evaluation of its system-wide effects, nor of its impacts on comprehensive PHC. In EQUINET, we thus saw it to be important to ask: How is the use of targets in PBF affecting health workers’ professional roles, work and interaction with communities and their ability to deliver comprehensive PHC? In 2018-2019 the PAR involved 21 online participants from seven sites in five ESA countries, including health workers from primary health cent res, community members in HCCs and country site facilitators from seven national health civil society organisations in the region, referred to in this brief collectively as the ‘online participants’. We also included offline local discussions with an average of 19 community members and 15 health workers per site. Four major areas of action and ten proposals were made within them for PBF to enable and not detract from PHC. These are 4 briefs each of which present the general findings and proposals from the work with separate final points in the first brief for local level; in the second for district and national level; in the third brief for regional level agencies and in the fourth brief for international agencies. The link is to one of the briefs but all four are on the website.
Latest Equinet Updates
Most countries in east and southern Africa have rich deposits of a range of mineral reserves that are highly sought after in global trade. Extractive industries (EIs), largely multinationals from all regions of the world, extract these minerals, oil and gas from the earth through mining, dredging and quarrying. Countries in east and southern Africa thus face a challenge to make and implement policy choices that link these natural resources to improved social and economic development, and to ensure that extraction processes do not harm health or environments. EQUINET is working with trade union partners in the Southern Africa Coordination Council (SATUCC), Ex mineworkers in the Southern Africa Miners Association (SAMA) and civil society through Benchmarks SA on health in the mining sector in east and southern African (ESA) countries. EQUINET are holding a regional meeting on February 1 and 2 2020 in Cape Town South before the Alternative Mining Indaba to share health literacy information on mining and health, distribute the health literacy module on mining and health, and share other materials and experiences in EQUINET’s ongoing programmes and advocacy on mining and health in the region. The workshop is aimed at trade union, ex mineworker and civil society health organisers. There are very limited sponsored places and self-sponsored places left so those interested, and those attending the AMI who wish to join the meeting, are asked to apply soonest by email.
This discussion paper is produced by the Centre for Human Rights and Development (CEHURD) as part of the theme work on health rights and law of the Regional Network for Equity in Health in East and Southern Africa (EQUINET). The paper examines the implementation of constitutional provisions on the right to healthcare in Kenya and Uganda, two countries in East Africa. It aims to identify factors and mechanisms that have facilitated implementation of constitutional provisions on the right to healthcare, including how the constitutions were developed and framed. It compares implementation in Kenya, where the right to healthcare is explicit in their 2010 Constitution, and in Uganda, where the right to healthcare is implicit in the National Objectives and Directive Principles of State Policy. The paper draws on two EQUINET case studies on implementation of constitutional provisions on the right to health, one each in Kenya and Uganda, published in 2018, a 2017 regional workshop that discussed the implementation of constitutional provisions on the right to health, and additional review of published literature. It presents a thematic analysis of the findings from the two case studies in terms of the judicial, political and popular implementation mechanisms, exploring further the factors and mechanisms that have facilitated or blocked their implementation. As the two constitutions address the right to healthcare differently, this analysis of their application provides insights into the factors and mechanisms for practice that may be useful in other settings.
EQUINET commissioned this desk review paper. It aims to contribute to a regional understanding of the positive and negative implications of the different domestic health financing options being explored, advocated and implemented in the East and Southern African (ESA) region. It presents issues to be addressed in the implementation of these financing options from the perspective of equitable progression towards universal health coverage (UHC), to inform policy dialogue and decisions on domestic health financing in ESA countries. The paper considers only one aspect of health financing reform, namely, revenue collection. It distinguishes between policy instruments, i.e., the sources of finance, and policy strategies, i.e., how these instruments are deployed to achieve various objectives or to address contextual features. Non-contributory sources (essentially tax-financed) and contributory (employment-based) options are explored. The paper presents: a. A typology of domestic revenue instruments and strategies; b. Domestic financing trends and options in place, or under consideration, in ESA countries; c. A review of low- and middle-income country experiences of domestic financing options; and d. Conclusions on the findings and lessons for ESA countries.
This brief aims to present the positive and negative implications of the different domestic revenue sources being explored, advocated and implemented in the East and Southern African (ESA) region. It presents issues to be considered in choosing between, and implementing, the different non-contributory and contributory options for revenue collection, given the policy commitments in the region to equity and universal health coverage (UHC). The brief draws information from experiences of other low and middle income countries globally, including on the fiscal, revenue, progressiveness and acceptability implications of different options. The brief highlights that revenue collection measures need to be accompanied by measures to strengthen strategic purchasing and access to equitable, effective, quality care. The full report the brief is drawn from is also being made available on the EQUINET website.
From 2016, co-ordinated by Training and Research Support Centre (TARSC), EQUINET has implemented research and policy engagement on extractive industries / mining and health in east and southern Africa (ESA), working with regional partners in East Central and Southern Africa Health Community, the Southern African Trade Union Co-ordinating Council, SADC Council of NGOs, the Alternative Mining Indaba ad others. The work and knowledge shared contributed to the development of a Mining and Health Literacy Module, to provide information and support discussion on advancing public health and implementing the right to health in the mining sector in the ESA region. In March 2019, against this background, TARSC in EQUINET organised a regional meeting on health literacy in the mining sector in Harare, Zimbabwe from 28-29 March 2019 for organisations that had been actively involved in planning and leading work on health in mining to date. The meeting involved delegates from Botswana Federation of Trade Unions, Benchmarks Foundation, Swaziland Migrant Mineworkers Association, Southern African Trade Union co-ordinating conference, Botswana Labour Migrants Association, Zimbabwe Congress of Trade Unions, National Mineworkers Union of Zimbabwe, Southern and East African Trade Information and negotiations Institute and TARSC. The meeting discussed health literacy outreach for workers, communities and ex mineworkers in the mining sector; shared information on the scope of and groups covered in current mining and health capacity building programmes and reviewed the methods for and use of the EQUINET health literacy module on Mining and health. Delegates planned collectively subsequent follow up training activities on mining and health, and discussed co-operation on upcoming regional processes on health in mining. The group agreed to continue to work together as a ‘Mining and Health’ Working group to take follow up work forward, with each contributing inputs related to their work. A health literacy training of trainers workshop on mining and health will be held in follow and those interested should please contact EQUINET using the feedback form at the website shown.
By 2050, urban populations in Africa will increase to 62%. The World Health Organization (WHO) and UN-Habitat in their 2010 report ‘Hidden Cities’ note that this growth in the urban population constitutes one of the most important global health issues of the 21st century. In 2016-2018, Training and Research Support Centre (TARSC) in the Regional Network for Equity in Health in East and Southern Africa (EQUINET) explored the social distribution of health in urban areas and the opportunities for and practices promoting urban health and well-being. It focused on youth 15-24 years of age as an important group for both current and future well-being. The paper synthesises and reports evidence from a programme of work that unfolded iteratively over two years. The work involved desk reviews of published literature and analysis of data from international databases for east and southern African countries, and international evidence on practices supporting urban well-being in areas prioritised by urban youth. The findings were subject to cycles of participatory review and validation by young people from diverse urban settings and socio-economic groups in Harare and Lusaka. These methods were applied with an intention to draw on different disciplines, concepts and variables from different sectors and on the lived experience and perceptions of the youth directly affected by different urban conditions. Separate publications produced in the project give more detail on particular methods, and findings and are cited in this paper. A series of dissemination and dialogue activities have been carried out with youth, local authority and policy actors, supported by shorter briefs and technical reports.
This discussion paper is produced by the Centre for Human Rights and Development (CEHURD) as part of the theme work on health rights and law of the Regional Network for Equity in Health in East and Southern Africa (EQUINET). The paper examines the implementation of constitutional provisions on the right to healthcare in Kenya and Uganda, two countries in East Africa. It aims to identify factors and mechanisms that have facilitated implementation of constitutional provisions on the right to healthcare, including how the constitutions were developed and framed. It compares implementation in Kenya, where the right to healthcare is explicit in their 2010 Constitution, and in Uganda, where the right to healthcare is implicit in the National Objectives and Directive Principles of State Policy. The paper draws on two EQUINET case studies on implementation of constitutional provisions on the right to health, one each in Kenya and Uganda, published in 2018, a 2017 regional workshop that discussed the implementation of constitutional provisions on the right to health, and additional review of published literature. It presents a thematic analysis of the findings from the two case studies in terms of the judicial, political and popular implementation mechanisms, exploring further the factors and mechanisms that have facilitated or blocked their implementation. As the two constitutions address the right to healthcare differently, this analysis of their application provides insights into the factors and mechanisms for practice that may be useful in other settings.
The Regional EQUINET meeting on health literacy in the mining sector is being held on March 28 and 29 2019 in Harare to discuss health literacy outreach for workers, communities and ex mineworkers in the mining sector. We will be sharing information on the scope of and groups covered in current mining and health capacity building programmes; the methods for and use of the EQUINET health literacy module on Mining and health and co-operation on key upcoming regional processes on health in mining. The meeting involves EQUINET (TARSC, SEATINI); Botswana Federation of Trade Unions; Zimbabwe Congress of Trade Unions, Southern African Trade Union Co-ordinating Council, Benchmarks Foundation South Africa, Swaziland Migrant Mineworkers Association, Eswatini and BoLAMA Botswana. For those interested in further follow up health literacy training in the Mining sector being held later in 2019 please contact the EQUINET secretariat.
By 2050, urban populations in Africa will increase to 62%. The World Health Organization (WHO) and UN-Habitat in their 2010 report ‘Hidden Cities’ note that this growth in the urban population constitutes one of the most important global health issues of the 21st century. In 2016-2018, Training and Research Support Centre (TARSC) in the Regional Network for Equity in Health in East and Southern Africa (EQUINET) explored the social distribution of health in urban areas and the opportunities for and practices promoting urban health and well-being. It focused on youth 15-24 years of age as an important group for both current and future well-being. The paper synthesises and reports evidence from a programme of work that unfolded iteratively over two years. The work involved desk reviews of published literature and analysis of data from international databases for east and southern African countries, and international evidence on practices supporting urban well-being in areas prioritised by urban youth. The findings were subject to cycles of participatory review and validation by young people from diverse urban settings and socio-economic groups in Harare and Lusaka. These methods were applied with an intention to draw on different disciplines, concepts and variables from different sectors and on the lived experience and perceptions of the youth directly affected by different urban conditions. Separate publications produced in the project give more detail on particular methods, and findings and are cited in this paper. A series of dissemination and dialogue activities have been carried out with youth, local authority and policy actors, supported by shorter briefs and technical reports.