We are daily confronted by images of vulnerable people, including children, starving and dying in situations of preventable conflict. We are weekly confronted with stories of hospitals being attacked and health workers killed in military attacks. We are constantly hearing of floods and extreme weather destroying lives and homes of already precarious communities. We keep hearing about toxic pollution of rivers, harmful emissions and extreme hazards in work that are causing injury and disability. There are international human rights norms and standards that were set to prevent and respond to these realities and new, important standards being set, but they appear to be ignored and inadequate for new challenges, including from transnational corporate control of artificial intelligence. International and national institutions that were supposed to ensure their implementation appear to be disregarded and ineffective, and solidarity resources cut and redirected to military budgets. Powerful actors who are generating these conditions and their consequences appear to be able to act without penalty. If such a global situation is taking hold, the consequences can and are impacting on our national and local realities. What is a just response? There are interesting developments, and podcasts in this newsletter and the editorial from the Global Health Watch share some proposals. Please send us your contributions and experience on this as we explore these realities and their consequences and discuss the responses further in our next issue.
Current Issue
EQUINET NEWSLETTER 242 : 01 August 2025
CONTENTS: 1. Editorial, 2. Latest Equinet Updates, 3. Equity in Health, 4. Values, Policies and Rights, 5. Health equity in economic and trade policies, 6. Poverty and health, 7. Equitable health services, 8. Human Resources, 9. Public-Private Mix, 10. Resource allocation and health financing, 11. Equity and HIV/AIDS, 12. Governance and participation in health, 13. Monitoring equity and research policy, 14. Useful Resources, 15. Jobs and Announcements
1. Editorial
Can equity survive in an age of impunity?
EQUINET Steering committee
Global Health Watch 7: Mobilizing for Health Justice
Ronald Labonté, Chiara Bodini, People’s Health Movement, co-editors of Global Health Watch 7
From the “shadow of the COVID-19 pandemic” that set a context for Global Health Watch 6, the Global Health Watch 7 (GHW7) is being released under a different and more ominous shadow, that of Donald Trump’s return to the US presidency. We are in the midst of a massively disruptive transition in which the former US-dominated (neo)liberal world order is being transformed into a form not yet clear. The new Trump administration is driving this change, leaving global health churning in its chaotic wake, affecting all regions including east and southern Africa. Hence the heightened imperative to continue our activist mobilizing for health justice.
GHW7 begins with the ‘big picture’ issues in the global political economy, including chapters on ecofeminisms and ancestral health knowledge systems. Together these three chapters outline a new scenario for a global economy based on planetary health and human wellbeing. A second section delves into the state of play across health systems, opening with an update on the privatization, financialization and corporatization challenges affecting health systems, and provides public health alternatives. It raises the pros and cons of the increased use of artificial intelligence (AI) in health systems, makes proposals for equitable health systems from an intersectional gender perspective, and presents an analysis of ‘abolition medicine’ which draws important connections between the social organization of prisons and health care systems. It includes a commentary on ‘decolonizing’ global health.
However, the GHW7 is not only focused on the health system, It goes ‘beyond health care’ to discuss issues that are critically important for health, beginning with the rise in conflicts globally. It includes a focus on the genocide in Gaza, but the discussion of conflicts is equally important for east and southern Africa given conflicts in Sudan and DRC. It points to the role of capitalism’s ‘military-industrial complex’ in sustaining conflict for purposes of profit and geopolitical power, and provides an analysis of the drivers of migration and displacement, which are the highest ever recorded. There is a focus on some of the core dynamics linking work, employment, and health in the context of neoliberal capitalism. This raises attention to the importance of tax justice and progressive tax reforms at national and global scales, as also advocated from Africa. In discussing the commercial or corporate determinants of health, or those commercial influences in health, it covers the capitalist consumptogenic marketing of unhealthy commodities (tobacco, ultra-processed foods, alcohol) and provides a critique of the consultancy/accountancy transnationals (the ‘Big Four’ firms) that increasingly dominate global health policy making, including for east and southern Africa.
There is a fourth ‘watching’ section in the GHW7 that looks at what is new in global governance for health. It begins with an analysis of the health of the World Health Organization (WHO), noting its declining leadership worsened by the US withdrawal of funding, albeit with the potential uptick of having reached agreement on a new Pandemic Treaty. There is an assessment of the strengths and weaknesses of the Pandemic Treaty (referred to as a Pandemic Accord), particularly in terms of the still-to-be-negotiated annexes that will deal with improved access to pandemic tools for the Global South and global financing for pandemic prevention, preparedness, and response. Some of these funding issues are explored in greater detail in a subsequent chapter that focuses on future pandemic financing models.
With the current situation demanding the activist mobilisation for health justice noted earlier.
The final chapters in GHW7 document health activism at different scales, celebrating acts of resistance (some successful, others not) and describing new activist modalities for healthful change. Its closing chapter draws from the 5th People’s Health Assembly held in Mar del Plata, Argentina, in April 2024, and its declaration calling on activists worldwide to continue advancing the struggle for liberation and against capitalism.
The GHW7 is affirmative for its content and focus, However, it is also innovative for its content coming from writing groups and contributions representing the geographic breadth of People’s Health Movement (PHM).It is a co-production of PHM, ALAMES, EQUINET, Health Poverty Action, Medact, Medico International, Sama, Third World Network, and Viva Salud.In striving to have this edition be an exercise in ‘movement building’ and not simply an analytical synopsis of global health issues, writing groups were encouraged to use their chapters as opportunities to discuss and engage across these geographies, allowing activists to learn with each other. As with previous editions, scores of activists worldwide contributed to its production.
It is published by a solidarity publisher (Daraja Press) rather than a conventional academic or trade book publisher. Each chapter could thus be downloaded and distributed free of charge as soon as it was completed. With all chapters now completed, we will soon produce all as a single book, downloadable for free as a PDF or available for purchase as a printed book. It is available in both English and Spanish, partly with contribution from Latin American PHM activists in convening the 2024 5th People’s Health Assembly in Argentina. It is thus a resource for the many areas and forms of health equity activism in east and southern Africa.
Please send any feedback on and contribution to editorials to admin@equinetafrica.org. You can read more about PHM and freely access the Global Health Watch 7 chapters on the PHM website https://phmovement.org/global-health-watch, where all previous editions can also be found, and on the publisher’s website https://darajapress.com/publication/mobilizing-for-health-justice-en.
2. Latest Equinet Updates
A Biodigester for clean energy at ENSOA, Antsirabe, Vakinakaratra,Madagascar
E-TAntsoroka ho an'ny Fampandrosoana ny maha Olona: EQUINET, Harare, July 2025
EQUINET’s recommendations on integrated urban health in 2024 in Eastern and Southern Africa include measures to BUILD health promoting integrated improvements for urban health, including supporting the locally produced technologies for this. This case study exemplifies the ‘BUILD’ agenda in its domestic investment in technology R&D, and in a supportive technology ecosystem for locally appropriate, climate-sensitive technologies and infrastructures that build links between food, waste and energy systems. This case study illustrates a promising practice in the construction of a biodigester at the Ecole Nationale des Sous-Officiers d’Active (ENSOA) in Antsirabe Madagascar.It is based on key informant interviews after consent and review of published documents collected in May 2025. Despite the initial challenges, the biodigester at ENSOA has yielded notable results. The use of firewood has decreased by 30%, reducing pressure on forest resources and lowering greenhouse gas emissions. Organic waste now has effective value, strengthening the environmental sustainability of ENSOA. The biogas produced enables the school to partially meet its energy needs, providing around eight hours of cooking time per day for approximately 700 people.
Brief on climate-related migration and health equity in East and Southern Africa
Training and Research Support Centre, EQUINET: Online, March 2025
The final thematic webinar in EQUINET's climate and health equity webinar series was held in March 2025, It brought together 52 participants from east and southern Africa and internationally, focusing on the interplay for health equity between climate and migration in and beyond the region. Organised and moderated by TARSC, three panellists gave presentations: Mr Francis Pawandiwa, Coordinator, Nyahunure Community Trust, Mutoko district, Zimbabwe, from a community lens; Dr Moeketsi Modisenyane, School of Health Systems and Public Health, Faculty of Health, University of Pretoria, from a national and regional lens and Hannah Marcus, Environmental Health Working Group, World Federation of Public Health Associations, covering the international lens. People migrate to exploit new resources and opportunities, or are forced to migrate due to conflict, land expropriations, economic, food and water insecurity, emergencies and loss of livelihoods. When climate changes intensify these drivers, it also increases migration. The webinar interrogated the relationships between climate, migration and health equity at the local, national and global levels, and suggested actions to be taken to mitigate the impacts. This brief summarises the key issues raised on the role of climate change as a risk multiplier of drivers in sending communities leading to migration, for affected migrants along the route, and in the receiving communities. It highlights their health equity impacts in these three groups, the responses to these impacts and areas for further research.
Online meeting: Strategies for engaging with the public health impacts of climate change and fossil fuels
EQUINET, Global Climate and Health Alliance, Federal University of Rio Grande do Sul: 30th September 12noon -1330pm Southern Africa time
EQUINET through TARSC in association with colleagues from the Global Climate and Health Alliance and Federal University of Rio Grande do Sul will hold an online meeting on Tuesday 30th September 12noon -1330pm Southern Africa time on 'Strategies for engaging with the public health impacts of climate change and fossil fuels". The meeting will hear from two international presenters: Shweta Narayan, Global Climate and Health Alliance on a Public health strategy to challenge health and climate impacts of the fossil fuel industry, and Carlos Dora, Federal University of Rio Grande do Sul, Brazil, on Health impact assessment to respond to commercial determinants of climate change. The presentations will be followed by discussion. This will be a unique oppportunity to be part of a dialogue that also aims to inform research, policy engagement and online training in the region. Register at https://us06web.zoom.us/meeting/register/8YweFlRzTNq8xhS_DceNiw for further information and to be included in the session.
Turning waste into value: Plastics recycling in a circular economy in Kasangati Town Council, Uganda
Innovations for Development: EQUINET, Harare, July 2025
EQUINET’s recommendations on integrated urban health in 2024 in Eastern and Southern Africa include measures to BUILD and ENABLE health promoting integrated improvements for urban health, including those that link improved environments to health (EQUINET, 2024). This case study exemplifies the ‘BUILD’ and ‘ENABLE’ agenda through a town council and social enterprise support of local income generating plastic waste reduction and recycling. The initiative has built women and young people’s skills in recycling and supported incomes, while also visibly reducing plastic pollution and protecting the environment. The initiative was enabled by strong community engagement and local leadership. Involving community members in its design and implementation built trust and relevance and fostered a sense of ownership that supports sustainability. The collaboration with schools, religious institutions and informal sector workers fostered a community centred circular economy that promotes equity, environmental conservation, and youth empowerment. The use of accessible, low-tech methods minimised the need for expensive infrastructure or specialised skills. Ideas could be adopted and replicated using locally available materials and knowledge. A revenue-generating model producing marketable goods, the contribution of the founder and fees obtained for the training has sustained operations and created income streams that reduce dependency on external funding.
Using health impact assessment to lever improvements in urban health in Lilongwe
Country Minders for Peoples Development: EQUINET, Harare, July 2025
EQUINET’s recommendations on integrated urban health in 2024 in Eastern and Southern Africa include measures to ENABLE health promoting integrated improvements for urban health (EQUINET, 2024). This case study provides an example of this ‘ENABLE’ agenda by institutionalizing health impact assessment (HIA), linking where relevant with environment impact assessment, for policies that have high health impact in urban areas. The case study illustrates implementation of a health impact assessment (HIA) of the 2019 Malawi National Urban Policy was implemented in February to June 2024 in informal settlements in Lilongwe Malawi to show the situation and health impacts relating to the waste management, hygiene, safe water and clean energy services and to recommend improvements in line with the policy. The assessment recommendations, such as on budget resources and services and integration of community representatives in urban planning were tabled with the local authorities and have led to improvements in and commitments to increase funding for these areas. The authorities indicated as feedback that the HIA assists them to interrogate existing problems, their causes and what needs to be done in line with existing policy and legal frameworks. The team saw that the HIA process creates an evidence-backed platform for engagement between residents and authorities to improve service delivery and improve health outcomes in these areas.
3. Equity in Health
Transition in care interventions for Refugee, Immigrant and other Migrant (RIM) populations: a health equity-oriented scoping review
Liu A; Yazdani Y; Elias M; et al: Globalization and Health 21:25, doi: https://doi.org/10.1186/s12992-025-01114-7, 2025
This health equity-oriented scoping review examines transition in care interventions for refugee, immigrant, and migrant (RIM) populations, analyzing 42 studies evaluating 38 unique interventions from databases including MEDLINE, Embase, and Scopus for studies published from 2000 onward. The systematic search identified interventions delivered across various healthcare sectors and professionals, with some programs enlisting non-medical personnel to provide health-related education and support, with the most promising programs involving health navigation or providing public health education for RIM populations. Results showed that language, education, and cultural background were the most common equity-relevant characteristics targeted. Three types of continuity of care: informational, management, and relational were found, with interventions addressing challenges including linguistic and cultural barriers, unfamiliarity with healthcare systems, and complex health needs such as untreated chronic conditions or trauma-related mental health issues. The authors conclude that future research should target transitions to digital health technologies, public health, hospital-to-home, and paediatric to adult care gaps to ensure smoother transitions for equity-deserving populations navigating new healthcare systems, while emphasizing the need for culturally appropriate and contextually responsive interventions for diverse subgroups within the broader migrant population.
4. Values, Policies and Rights
It's me who supports. How are you going to refuse to have a child?: The social norms and gender dynamics of men’s engagement in family planning practices in the Democratic Republic of the Congo
Ekambi S; Sugg K; Mpata F; et al: Reproductive Health 22 (120), 1-14, doi: https://doi.org/10.1186/s12978-025-02029-7, 2025
This paper explored the social norms shaping perceptions, attitudes, and decision-making around family planning among men in three provinces of Kasai Central, Lualaba, and Sankuruthe of the Democratic Republic of the Congo through semi-structured interviews and focus group discussions. The authors found that while social norms oppose the use of modern contraceptive methods and advocate for larger family size, there is notable social support for birth spacing. Some men reported they would support their wives in learning about contraceptive methods if they were able to make the final decision. However, other men felt that allowing their wives to seek a method would undermine their authority, or their virility. To increase modern contraceptive uptake, the authors recommend that interventions address the underlying issues that contribute to non-adherence, addressing the three categories and their associated norms individually and engaging reference groups important to each, including healthcare providers, religious leaders, and male peer groups, in family planning programming.
Regulation of artificial intelligence in Uganda’s healthcare: exploring an appropriate regulatory approach and framework to deliver universal health coverage
Mugalula K: International Journal for Equity in Health 24 (158), 1-24, doi: https://doi.org/10.1186/s12939-025-02513-3, 2025
This paper analysed the two prominent regulatory approaches to Artificial Intelligence (AI) in Europe that have adopted risk-based and principles-based approaches. It investigates whether these approaches are suitable for regulating AI in Uganda’s healthcare and in achieving Universal Health Coverage (UHC). The strengths and weaknesses of each approach are examined. The paper advocates for considering a human rights-based approach that can be integrated with the principles-based approach. Regulation is argued to have a potential to emancipate ordinary people’s lives so Uganda should leverage the positive aspects of both principles-based and human rights-based approaches to regulation to ensure that AI’s potential to achieve UHC is effective. The hybrid approach to AI regulation is best suited to serve Uganda’s healthcare needs. However, such a hybrid approach while contributing will not be a silver bullet and the author recommends that Uganda supplement efforts to achieve UHC with other non-regulatory strategies.
TWN's Statement on the Pandemic Agreement Adoption
Shashikant S: Third World Network, May 2025
This Third World Network (TWN) statement on the adoption of the Pandemic Agreement at the 78th World Health Assembly states that "The adoption of the Pandemic Accord marks the beginning, not the end, of the equity debate." The organization views the agreement as a milestone following three years of intense negotiations, deep divides, and difficult compromises, representing an initial multilateral effort to address global inequities and promote international cooperation for pandemic prevention, preparedness and response in a world marked by growing health inequities and geopolitical fragmentation. However, TWN stresses that the real test lies ahead, particularly in the next phases of negotiations beginning with the Pathogen Access and Benefit-Sharing System (PABS). The upcoming PABS discussions offer WHO Members a rare opportunity to build a transparent and accountable system, anchored in legally binding rules for sharing biological materials and sequence data of pathogens with pandemic potential, coupled with enforceable benefit-sharing obligations. The statement warns that if these next steps fail, the world may once again face a pandemic armed only with empty promises, risking a repeat of the devastating failures seen during COVID-19, emphasizing that the agreement's success will be measured by whether it becomes a meaningful tool for equity or remains merely symbolic in ensuring developing countries can access affordable vaccines, treatments, and diagnostics swiftly and fairly during health emergencies.
World Court says countries are legally obligated to curb emissions, protect climate
UN: United Nations News, Online, July 2025
The UN’s principal judicial body, the International Court of Justice, ruled that States have an obligation to protect the environment from greenhouse gas (GHG) emissions and act with due diligence and cooperation to fulfil this obligation. This includes the obligation under the Paris Agreement on climate change to limit global warming to 1.5°C above pre-industrial levels. The Court further ruled that if States breach these obligations, they incur legal responsibility and may be required to cease the wrongful conduct, offer guarantees of non-repetition and make full reparation depending on the circumstances. The Court used Member States’ commitments to both environmental and human rights treaties to justify this decision. Firstly, Member States are parties to a variety of environmental treaties, including ozone layer treaties, the Biodiversity Convention, the Kyoto Protocol, the Paris Agreement and many more, which oblige them to protect the environment for people worldwide and in future generations. But, also because “a clean, healthy and sustainable environment is a precondition for the enjoyment of many human rights,” since Member States are parties to numerous human rights treaties, including the Universal Declaration of Human Rights, they are required to guarantee the enjoyment of such rights by addressing climate change.
5. Health equity in economic and trade policies
Safeguarding global health security amidst a scramble for Africa's minerals for the clean energy transition
Ajumobi O: Globalization and Health 21:24, doi: https://doi.org/10.1186/s12992-025-01102-x, 2025
This commentary addresses the global health security threats posed by increased critical minerals mining in Africa driven by the clean energy transition and 2050 net-zero emissions targets. The Democratic Republic of Congo houses over 55% of global cobalt reserves and produces 75% of global cobalt, while Guinea contains the world's largest bauxite reserves, South Africa holds over 70% of platinum, and Zimbabwe has the largest untapped lithium deposits. The author argues that without appropriate safeguards, expansion of mining operations increases risks of mining-associated infectious disease outbreaks with epidemic and pandemic potential. Several studies report linkages between habitat encroachment from mining activities and outbreaks of emerging/re-emerging infectious diseases, with examples from DRC and Uganda. The recent emergence of a more severe strain of the 2023 Mpox outbreak in DRC has for example been traced to the Kamituga mining area. The author recommends expanding Environmental, Social, and Governance standards to include biosecurity risk analysis under Environmental Impact Assessments; increased stakeholder representation in the Mineral Security Partnership; integration of spill-over/emergence/spread (SES) risk analysis into the draft Pandemic Accord, and leveraging earth observation technologies and pathogen surveillance for early detection and prevention of mining-associated health security threats.
Untangling Antimicrobial Resistance (AMR): The Legacy of an Unhealthy Development Model
Society for International Development (SID): Online Blog, July 2025
This blog post discusses how conflicts in Gaza, Sudan, and Ukraine, affecting 2.4 billion people worldwide, create conditions where bacteria develop immunity to existing drugs through the destruction of infrastructure, forced population movements, and environmental contamination. Heavy metals used in weapons (zinc, lead, mercury, chromium, antimony, and barium) released during bombings are easy inducers of antimicrobial resistance. Examples from Iraq, Afghanistan, Libya, Syria, and Gaza show recurrent outbreaks of multi-resistant bacteria among military personnel and civilians. AMR is said to have already resulted in 5 million deaths in 2019, with projections suggesting humanity could return to a "pre-penicillin era" if current trends continue. The author argues that the systemic scope of AMR is underestimated, with hyper-reductionist interpretations dominated by financial interests in food, pharmaceutical, and bio-surveillance industries reluctant to change course. Microorganisms are observed to know no geopolitical borders and to strengthen their ability to spread silently during uncontrolled chaos of war, with spill-over effects in neighbouring countries and regions affected by ongoing conflicts.
6. Poverty and health
Prevalence and factors associated with intimate partner violence among women in Tanzania: evidence from Tanzanian demographic and health survey 2022
Luoga P; Abihudi S A; Adam J; et al: BMC Women's Health 25 (235), 1-12, doi:https://doi.org/10.1186/s12905-025-03760-w, 2025
This study used a nationally representative secondary data from the 2022 Tanzania Demographic and Health Survey for women aged 15–49 years in a cross-sectional design to identify factors associated with intimate partner violence (IPV) among women in Tanzania. The results revealed that women who are working and those whose husband/partner drinks alcohol had higher odds of experiencing IPV compared to their counterparts. Conversely, protective factors include women’s secondary and higher education level and residing in the Southern zones. The prevalence of IPV among women in Tanzania at 38.9% remains high compared to the global average of 30%. The authors recommend that the government implement community-based educational programs to raise awareness about IPV and dedicate more efforts like raising the tax on all alcoholic beverages to controlling alcohol consumption among men as a strategy to combat IPV in society.
7. Equitable health services
Inequalities in full immunization coverage among one-year-olds in the Democratic Republic of the Congo, 2007–2017
Bwira E M; Bukele T K; Mutombo P B; et al: BMC Public Health 25 (2354), 1-14, doi: https://doi.org/10.1186/s12889-025-23297-9, 2025
This paper assessed the extent and trends of inequalities in full immunization coverage among one-year-olds from the 2007 and 2013 rounds of the DRC Demographic and Health Surveys, and the 2010 and 2017 rounds of the DRC Multiple Indicator Cluster Surveys. The national coverage of full immunization among one-year-olds significantly decreased from 30.7% in 2007 to 21.7% in 2017. Significant disparities in full immunization coverage across the four dimensions of inequality were observed in all study periods. In 2017, for example, the authors recorded substantial economic, maternal education-based, place of residence-based and regional inequalities in full immunization coverage. Economic, urban‒rural, and regional relative inequalities followed a U-shaped trend, while absolute inequalities remained constant or decreased. However, inequality based on maternal education remained constant across all summary measures over time. The decreasing trend of the national full immunization coverage among one-year-olds over the ten-year study period masked substantial and persistent socioeconomic and geographic inequalities. To reduce inequalities in full immunization coverage in the DRC, the authors call for urgent equity-driven interventions to address poverty, illiteracy, and inadequate infrastructure, particularly in rural and underserved regions. Strengthening the health workforce and improving the vaccine supply chain are also seen to be crucial to ensuring equitable access to immunization services.
8. Human Resources
Strengthening the role of community health assistants in delivering primary health care: the case of maternal health services in Zambia
Akinola O; Banda N; Silumbwe A; et al: BMC Primary Care 26 (156), 1-12, doi: https://doi.org/10.1186/s12875-025-02829-7, 2025
This paper explored the role of the community health assistants (CHA) in delivering as maternal and child health (MCH) services in Zambia. Key informant interviews and focus group discussions were held in all 10 provinces of the country with the CHAs, and their supervisors, health workers, neighbourhood health committees and community members. The community health systems strengthening interventions (provision of training manuals, streamlined recruitment and deployment policies, capacity building of CHA supervisors, provision of transport and monthly remuneration) contributed to improved delivery and acceptability of MCH services. The CHAs leveraged community networks, linkages and partnerships when delivering these services, including with traditional and religious leaders, contributing to improved coverage and acceptability of MCH services. Health systems barriers such as limited supplies in some health facilities, shortage of health workers, persistent transportation challenges and failure to fully abide by the CHA recruitment and selection criteria affected delivery and acceptability of the services. The authors emphasize the need to integrate provision of training manuals, enhanced recruitment and deployment policies, capacity building of supervisors, provision of transport and remuneration within the CHA program to enhance the provision and acceptability of health services.
9. Public-Private Mix
Global health development aid initiatives and the quality of medical laboratory services in sub-Saharan: a narrative review
Musuka H; Mano O; Iradukunda P; et al: Global Health Journal, doi:https://doi.org/10.1016/j.glohj.2025.06.006, 2025
This study used a narrative review study design to identify five sub-themes from successful global health development aid initiatives with medical laboratory services. The themes were capacity building and training programs, infrastructure development, partnership models, policy advocacy and regulatory support, quality control and standardization of laboratory services. The sub-themes from the challenges and barrier theme were insufficient funding and resource allocation, human resource constraints, inadequate infrastructure and equipment, and political and institutional barriers. The authors observe that achieving long-term sustainability requires strategies that ensure financial self-sufficiency, foster a skilled and stable workforce, and integrate laboratory services into national health frameworks.
10. Resource allocation and health financing
Money can’t buy health, but taxes can improve healthcare
Etter-Phoya R; O'Hare B; Loewenson R; et al: Blog, Tax Justice Network Africa, 2025
Most people who have the greatest health needs don’t have enough money in their pockets to pay for expensive private care. In contrast, enough money in the government’s public purse would make all the difference. Governments can finance better public healthcare systems, train, employ and equitably distribute more staff, and build the necessary infrastructure, so that more people will live longer, healthier lives. This blog examines how tax justice can make all the difference in improving health. It draws from a chapter in the Global Health Watch 7. The authors argue "Taxes may be society’s superpower. Yet deep historic and structural global injustices mean that governments are often unable or unwilling to generate and allocate taxes in ways that dismantle inequalities effectively". The blog presents options to deliver on the five principles of tax justice - revenue, redistribution, repricing, representation, reparations- that would better finance the features of public sector health systems that promote equity and the national and international reforms that are needed to back this.
Out of pocket and catastrophic health expenditure in Tanzania: recent evidence on the incidence, intensity and distribution
Massito J; Hinju G: BMC Health Services Research 25 (677), 1-11, doi: https://doi.org/10.1186/s12913-025-12783-w, 2025
This paper investigates the catastrophic impact of out-of-pocket health expenditure by estimating the levels, intensities and distribution of catastrophic health expenditure among households in Tanzania. The study applied the Wagstaff and va-Doorslaer methodology using panel data 2020/2021. The study found that 21.9% of the respondents reported visiting a healthcare facility within four weeks before the survey. Over 50% reported an incidence of illness or injury within the same period. Among those who used health care, about 7.1% experienced catastrophic health expenditures. Poor households are more likely to experience catastrophic health costs than rich households. The authors conclude that out-of-pocket health expenditures expose poor households to more poverty and forcing them to resort to coping mechanisms that compromise their welfare. They propose that this necessitates the development of new and reinforced existing systems to protect impoverished households against out-of-pocket and catastrophic healthcare costs.
The cost of delivering COVID-19 vaccines in Mozambique: a bottom-up costing study
Namalela T; Moi F; Dipuve A; et al: BMC Health Services Research 25 (521), 1-11, doi: https://doi.org/10.1186/s12913-025-12671-3, 2025
This retrospective, bottom-up costing study in Mozambique estimated the financial and economic costs from a payer perspective of delivering COVID-19 vaccines in 2022 USD, during the first year of introduction. Recurrent costs were collected for the initial rollout period and for a later, higher-volume period. The cost per dose for the first year of implementation was $1.14 for economic costs and $0.50 for financial costs. For the initial rollout period, when the volume delivered was low, the economic cost per dose was $3.56 and decreased considerably to $0.85 when the program delivered at scale and volume delivered increased to 225 doses/vaccination day. Opportunity costs made up a considerable share of the economic cost per dose, 73% and 49% respectively during the initial rollout and when the program delivered at scale. Qualitative interviews found that political prioritization and workers’ commitment made the program possible despite little financial investment. The cost of delivering COVID-19 vaccines in Mozambique was found to be low compared to other countries, due to reliance on existing resources and little additional investment into the program.
World is facing a health financing emergency, warns WHO
Raja K: Third World Network Health Info Service, Hi250605, 2025
WHO's Director for Health Financing and Economics states that "the world is faced with a health financing emergency" due to the US government's decision to freeze or discontinue aid programmes and European governments' announcements to reduce aid, creating significant disruptions in aid ecosystems and national health systems. Health aid is projected to decline by 35-40% in 2025 compared to 2023 baseline, decreasing by approximately US$10 billion from US$25.2 billion in 2023, with eleven OECD countries announcing aid-related budget reductions for 2025. The impact is reported to be particularly severe in sub-Saharan Africa where US Development Assistance for Health represented up to 30% of current health expenditure in countries like Malawi or 25% in Mozambique or Zimbabwe. The crisis occurs against a backdrop where since 2006, per capita external aid in low-income countries (US$12.8 in 2022) has consistently surpassed domestic public spending on health, with poor countries spending around $8 per person per year on health through public financing. WHO reports that out-of-pocket spending accounted for 35% in Sub-Saharan African countries and government spending for 33% in 2022, creating the most inequitable financing system where poor households must sacrifice food and schooling to access health services. The organization is working with countries to identify financing gaps, protect the poorest populations, mobilize new revenue through better taxation including tobacco and sugary drinks taxes, and through enhanced highly concessional lending for cost-effective treatments.
11. Equity and HIV/AIDS
Structural barriers and facilitators to accessing HIV services for marginalized working populations: insights from farm workers in South Africa
Mlangeni N; Lembani M; Adetokunboh; et al: Health Policy and Planning 40(1), 75-84, doi: https://doi.org/10.1093/heapol/czae098 , 2025
Farm workers are vulnerable working populations face significant inequalities in accessing health services, including those for human immunodeficiency virus (HIV) prevention, treatment and care. This study explored through in-depth interviews and focus group discussions farm workers’ experiences when accessing HIV services in Limpopo province, South Africa. The results reveal that farm workers report multiple interdependent factors that inhibit or enable their access to HIV healthcare services, including transport affordability, health worker attitudes, stigma and discrimination, models of HIV healthcare delivery, geographic location of health facilities and difficult working conditions. Key facilitators for their HIV healthcare access were reported to include the availability of mobile health services, the presence of community health workers and a supportive work environment. The findings suggest disparities in farm workers’ access to HIV services, with work being the main determinant of access. The authors recommend a review of HIV policies and programmes for the agricultural sector and models of HIV healthcare delivery that address the unique needs of farm workers.
Towards a sustainable HIV response: strengthening Zimbabwe's domestic financing for HIV programs amid declining donor support
Musuka G; Makoni T; Dzinamarira T: Frontiers in Health Services (2025) 5:1558992, doi: https://doi.org/10.3389/frhs.2025.1558992, 2025
This paper examines Zimbabwe's transition toward sustainable domestic financing for HIV programs as external funder support declines. With Zimbabwe's economy projected to achieve middle-income status by 2030, driven by mineral exports (gold, platinum, lithium) and diaspora remittances totalling US$1.9 billion in 2024, the country has opportunities to strengthen health system financing. The authors analyse existing domestic revenue mechanisms including the AIDS levy (generating ~US$40 million annually), Health Fund Levy, and sugary drinks tax. Key findings highlight Zimbabwe's achievement of UNAIDS 95-95-95 targets in 2023, but emphasize the critical need to integrate HIV services into mainstream health systems rather than maintaining standalone programs. The paper proposes innovative financing approaches, strengthening local pharmaceutical manufacturing capacity for ARV drugs, improving accountability mechanisms to prevent corruption and mismanagement, engaging informal sector and private sector stakeholders, and addressing regulatory barriers like the Private Voluntary Organisations Amendment Act that restricts NGO participation.
12. Governance and participation in health
Association between nutrition literacy and diet quality among adolescents and young adults in the rural district of Mayuge, Eastern Uganda
Buyinza T; Buzigi E; Bukenya J; et al: BMC Public Health 25 (2335), 1-13, doi: https://doi.org/10.1186/s12889-025-23498-2, 2025
This paper assessed nutrition literacy and its association with diet quality among 1206 adolescents and young adults aged 10–24 years in Mayuge district, Eastern Uganda. Using a structured questionnaire, the Global Diet Quality Score was adapted to estimate diet quality, and the Adolescent Nutrition Literacy Scale was used to assess nutrition literacy status. Among 1206 respondents, 85.9% were still in school, over 62% were from low socioeconomic status households, and only 14% used mobile phones. Low nutrition literacy was prevalent, with many unfamiliar with a balanced diet or ignoring dietary advice, although 62% were willing to promote healthy eating. Overall, 12.6% had poor diet quality marked by frequent refined grain consumption and low fruit/vegetable intake. Having low nutrition literacy was associated with a close to five-fold increase in poor diets, while mobile phone use was associated with better diet quality by 56%. The authors propose that targeted interventions to improve nutrition literacy can enhance diet quality among adolescents and young adults. .
Engaging communities in climate change and health research and practice in Sub-Saharan Africa
Dowou R; Bain L: Journal of Global Health Science 6(2), 1-9, doi: https://doi.org/10.35500/jghs.2024.6.e10, 2024
Climate change is a major threat to sustainable growth and development in Sub-Saharan Africa (SSA). The efforts of SSA to achieve the Sustainable Development Goals by 2030 may be seen as a mirage if the adverse effects of climate change are not addressed. This review discusses the motivations for and importance of engaging communities in climate change and health research, the extent to which communities have been engaged in this in SSA and the barriers and facilitators faced. The findings highlight the demand to engage communities using strategies and processes that are sensitive to the community context in which it occurs, using participatory rural appraisal and community-based participatory approaches for interventions to address the effects and impacts created by climate change that are effective and responsive to community needs and interests. The authors argue that involvement and support by communities is design is essential for this.
Generating political priority for breastfeeding and the adoption of Kenya’s 2012 BMS act: the importance of women’s leadership
Wamahiu M; Baker P; Dorlach T: Globalisation and Health 32(21), 1-14, doi: https://doi.org/10.1186/s12992-025-01127-2 , 2025
This qualitative case study identified the political enablers of the successful adoption of an important law to support breastfeeding in Kenya. The strict Breast Milk Substitute (BMS) Act adopted in 2012 has since facilitated and protected remarkable improvements in breastfeeding rates. BMS legislation was first politically debated in Kenya in the 1980s following mobilization of women-led civil society organizations, namely the Breastfeeding Information Group and the Maendeleo ya Wanawake Organization. The issue re-emerged on the political agenda in the 2000s but faced opposition from the transnational formula milk industry. Kenya’s BMS Act was ultimately adopted during a policy window opened by a constitutional reform. The Kenyan case illustrates how women’s political leadership can counteract the power of the transnational formula milk industry and help achieve strict BMS legislation. Effective female leadership for BMS legislation can occur in various political offices and positions, including those of ministers, legislators and bureaucrats. Female leaders can leverage their own influence by strategically exploiting policy windows and recruiting male allies.
Litigation to challenge large extractive projects is gaining traction in Africa
Moodley P: Open Global Rights, South Africa, 2020
This article is a part of Open Global Right's Litigating the Climate Emergency series on how human rights and strategic litigation might best be leveraged in the climate action movements. Communities in Africa are increasingly using litigation to challenge large extractive projects that exacerbate the climate emergency and loss of biodiversity. Climate-related litigation is a growing focus within the Africa context. Several communities and legal environmental organisations have gone to court to stop harmful projects or to assert the rights of communities where there have been violations of justice. While these communities are living in very uncertain times, the cases brought before the courts show that they are not passive bystanders, using strategic climate litigation as one avenue to challenge corporations and governments. While it is time- and money-consuming, the author argues that each victory creates a ripple effect in communities in Africa and in the boardrooms of multi-national companies.
Using radio programming to reach young adolescents with gender and sexual health information in a low-income urban setting in Kenya
Maina B W; Nyakangi V; Mbuthia M; et al: Reproductive Health 22(Suppl 1) (73), 1-13, doi: https://doi.org/10.1186/s12978-025-01984-5, 2025
An increasing body of evidence indicates that young individuals need accurate and easily accessible gender and sexual and reproductive health (SRH) information to equip them to make well-informed choices about their SRH. The authors developed an engaging and educative seven-session radio show, which featured skits and guest speakers. A local radio station in Kenya broadcasted the show as a weekly episode over seven consecutive weeks. The authors conducted in-depth interviews with a purposeful sample of 17 parents and 20 adolescents aged 12—14 years living in an informal settlement in Nairobi and who had participated in at least three of the sessions; the radio manager and program presenter. Both parents and adolescents indicated that they felt more connected to each other after listening to the program and this enhanced communication, especially on SRH issues. Both adolescents and parents expressed greater awareness of gender and adolescent SRH issues, which were rarely discussed in detail in open forums in their context prior to the radio program. They recommended that such radio programs run regularly as they provide a platform where sensitive issues about adolescent health can be shared and discussed openly, allowing for both adolescent and community participation. Radio programming was perceived as a good platform for knowledge transfer and discussions about gender norms and SRH among young adolescents, if messages are designed to resonate with a diverse audience.
13. Monitoring equity and research policy
Global priorities in HIA research: a new agenda for the next decade
Haigh F; Green L; Hirono K; et al. Global priorities in HIA research: a new agenda for the next decade. BMC Public Health 25, 791 https://doi.org/10.1186/s12889-025-21983-2, 2025
Health Impact Assessment (HIA) advances Health in All Policies by identifying impacts of proposed actions on health and equity and recommending changes to address these impacts. Since the Gothenburg Consensus Statement in 1999, HIA has been applied to policies, plans, programmes and projects in multiple sectors and settings across the world. Despite demonstrated effectiveness, its use across the world is inconsistent with few nations systematically using HIA. In a global context of increasing health inequities, pandemics, climate change, and economic crises, HIA can help integrate health and equity into decision making. There is a need for research to support the ongoing evolution and development of HIA. This paper presents a research agenda for the field of HIA, drawn a mixed method approach utilising insights of approximately 280 participants through an international online survey and participatory workshops. The authors identified four research priorities: (1) Institutionalisation - Sustaining and institutionalising HIA in varying contexts and levels. (2) Influence - Identifying mechanisms and strategies that can be employed to effectively influence stakeholders and decision making. (3) Equity and Participation - Analysing the role of equity, justice, power and participation in HIA, and (4) Methodology - Improving HIA Methods to understand the complex relationships between proposed actions, health and health equity outcomes and identifying what to do. We developed research questions for each theme. The research agenda advocates for sustained research and practice to strengthen impact and address knowledge gaps in the field. Functioning as a roadmap for both researchers and funders, it aims to contribute to a healthier and more equitable world. Recognising the valuable role of HIA in addressing global health challenges, the agenda encourages researchers to investigate, develop, and advance the field of HIA.
Routemap for health impact assessment implementation: scoping review using the consolidated framework for implementation research
Kenny T; Harris-Roxas B; McHugh S et al. Health Promotion International, 2025, 40, daaf080 https://doi.org/10.1093/heapro/daaf080, 2025
Health Impact Assessment (HIA) provides a practical set of tools to appraise the potential health effects of a policy, programme, or project prior to implementation. HIA has gained significant attention in recent decades due to its utility in facilitating a broader understanding of health and bringing diverse stakeholders and evidence into decision-making processes. Despite this interest in HIA its implementation remains challenging within governance, decision making, and regulatory contexts. The authors used the Consolidated Framework for Implementation Research (CFIR) 2.0 as a methodological framework to identify potential factors influencing implementation of HIA from an implementation science perspective. The findings suggest that building wider HIA support, awareness, and capacity are essential to progressing HIA, and that this is also dependent on wider public health advocacy.
Strengthening National Leadership for Sustainable HIV Programs: A Policy Brief for Government Leaders
Matanje B; Chunda L; Holmes CB, et al: Blantyre Prevention Strategy/Georgetown University Center for Innovation in Global Health Policy Brief, 2025
This policy brief emerges from a Sustainable HIV Prevention Initiative Convening held in Lilongwe, Malawi on February 18-19, 2025, hosted by the Government of Malawi. The brief presents priority recommendations for governments navigating external funding transitions, including strategies for increasing domestic and innovative financing mechanisms, accelerated integration of HIV services into national health systems and primary care, and ensuring continuation of people-centered HIV services including prevention for key and vulnerable populations. Drawing from the successful Blantyre Prevention Strategy model - a district-based approach that strengthens local institutional capacity for HIV prevention through data-driven decision making, quality improvement, and community engagement - the brief advocates for bold government actions to maintain progress toward ending AIDS as a public health threat by 2030 despite declining donor support.
14. Useful Resources
Climate Change Litigation before the African Human Rights System: Prospects and Pitfalls
Suedi Y; Fall M: Journal of Human Rights Practice 16 (1), 146-159, doi: https://doi.org/10.1093/jhuman/huad024, 2023
Africa is a promising regional venue for climate change-related complaints—not least because it is distinctively vulnerable to climate harms. Yet, neither the African Commission on Human and Peoples’ Rights nor the African Court of Human and Peoples’ Rights had been theatres to such disputes at the time of writing (this may have since changed). Understanding that climate litigation will emerge before the African human rights system, this practice note provides information to the non-State actors and their lawyers on the procedural challenges that may arise, demonstrating how such challenges may be circumventable in the African context.
Health Equity in Focus
Thirs World Network, Online, Malaysia
Health Equity in Focus is a series of podcasts that delve into the intricate dynamics of global health, examining how historical legacies continue to shape present-day realities in the Global South. Global health institutions, when failing to address deep-rooted issues, can perpetuate inequalities between North and South. Across various episodes, the podcast explores issues like the implications of intellectual property to access to medicines, the use of policy space through TRIPS flexibilities, international regulatory standards, the intersection of biological diversity with health, and developments regarding these topics in international fora, through an equity perspective. While they involve technical contributions, they advocate for a reimagined global order, where development equips countries with the means to uplift their populations and foster a fairer, more equitable world..
Mobilizing for Health Justice: Global Health Watch 7
People's Health Movement: Daraja Press, 2025
This seventh edition of Global Health Watch, the flagship publication of the People's Health Movement (PHM), features contributions from over one hundred activists worldwide and is published open access in both English and Spanish. It is structured around five main sections examining: The global political and economic architecture, privatization and financialization of health systems, tax justice, artificial intelligence and digital technologies in health, gender-transformative health systems, abolition medicine, and decolonizing global health approaches; key social and environmental determinants of health, and global governance for health. The final "Resistance, struggles and alternatives" section highlights transformative change areas by health activists, including in contexts of increasing repression. The publication concludes by emphasizing that collective action represents the most powerful medicine against ill health and health inequality at human and planetary levels.
15. Jobs and Announcements
2nd biennial Uganda National Conference on Health, Human Rights and Development (UCHD 2025)
3-5 September, 2025, Kampala, Uganda
The 2nd biennial Uganda National Conference on Health, Human Rights and Development (UCHD 2025) will build on the momentum and successes of the UCHD 2023 conference, which emphasized health as a human right and a cornerstone for realizing Sustainable Development Goals. The 2023 conference, through its outcome document, the Kampala Declaration on Health, Human Rights, and Development recognized the right to health as fundamental to achieving Uganda’s Vision 2040.
Hospitals Under Fire: Lawfare and the attack on care
Geneva Graduate Institute, Queen Mary University: Online Tuesday, September 23, 2025 12:30-14:00 CET
Despite the protections of international humanitarian law, the systematic targeting of healthcare facilities in modern warfare remains a tragic and increasingly recurring reality. From Gaza to Syria, Ukraine to Sudan and Myanmar, the destruction of healthcare facilities raises urgent questions about the limits of the law, the elasticity of the Geneva Conventions, and the moral failure of the international community to enforce basic protections. Legal frameworks provide for the safeguarding of healthcare facilities during conflict, yet wide gaps exist in the way such laws can be interpreted, allowing belligerents to justify, obscure, or deny such attacks. Bringing together researchers, humanitarian professionals, and global health experts, this event will interrogate the normative failures and political complicities that allow such attacks to proliferate. Registration opens August 25, 2025 at www.ghplatform.org.
Postdoctoral Research Fellow: Global Postdoc In Implementation Science And Primary Care
Closing Date: open until filled
The University of Botswana is offering a 1-2 year postdoctoral fellowship in the upcoming academic year. The Postdoctoral Research Fellow will be joining ongoing and planned studies using implementation research to improve primary care in Botswana, focusing on non-communicable diseases, aging, and other relevant health challenges. The Postdoctoral Research Fellow should bring strong qualitative analytical skills (and ability to work with a team of biostatisticians and other experts in behavioural science, clinical medicine and primary care) with experience in health-related research and ideally implementation and primary care research. Other preferred skills include knowledge of health systems strengthening and research, mixed methods, and experience in the field of primary care and chronic diseases research. The Fellow will include working in a strong and supportive multidisciplinary, multi-country team, in person and support from virtual mentoring by research leaders. This is a one-year full-time research post-doctoral fellowship opportunity at University of Botswana. There is a potential for a second year, contingent upon performance and funding. Applications are now being accepted and will be reviewed until the position is filled.
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