Current Issue

EQUINET NEWSLETTER 232 : 01 June 2022

1. Editorial

Be part of the exchanges at #EQUINETConf22 on Catalysing Change for Health and Social Justice!
EQUINET steering committee

The EQUINET Conference 2022 “Catalysing change for health and social justice” welcomes community members, workers, state personnel at all levels, civil society, parliamentarians, academics, trade unions, diverse professionals, innovators, producers and others to present ideas and hear experience from the east and southern Africa region. We will also learn how other regions are confronting equity challenges and discuss and propose key areas of action and policy to promote health equity and social justice. We need your input so please don't get left behind! Find out more in the EQUINET update section of the newsletter, follow @EQUINETConf22 on twitter or visit the conference website at https://www.equinetafrica.org/conference/home.html.

Confronting inequities in the ‘donor’-‘recipient’ relationship in health in Uganda
Danny Gotto, Innovations for Development, Uganda

Like many other countries in East and Southern Africa, Uganda’s health sector is highly dependent on overseas development aid (ODA). The country receives considerable sums from external funders through grants, loans, and other forms. As initially conceived of, ODA intended to reduce poverty, and to support socio-economic development. Although initially conceived to be a form of temporary assistance, Uganda, like many other countries in the east and southern Africa, has continued to face financing gaps for these development aspirations. ‘Short-term’ foreign funding has become ‘long-term’ and Uganda, like others, has become increasingly dependent on aid to meet key health service obligations.

The COVID-19 pandemic threatens to turn this dependency into debt. In a 2021 analysis of aid flows to Uganda before and during COVID-19, Owori (https://devinit.org/resources/aid-uganda-covid-19/) reported bilateral grants to be the largest source of ODA to Uganda in 2020. The United States was noted to be the largest external funder, followed by the European Commission. However, Owori also found that the profile of official development assistance had switched in 2020 from grants to increased proportions of concessional loans from international financial institutions. At a time when the country faces significant liabilities from the pandemic, and a rise in the debt to GDP ratio from 48% before COVID-19 to 52% in 2022, the shift from grants to loans adds further pressures to the public purse. The ‘East African’ reported in February 2021 that the National Budget Framework Paper 2021/2022, approved by parliament, projected that Uganda will spend 97% of its total domestic revenue on debt servicing, with the US$231 million for this six times the health sector budget. Efforts to re-negotiate or restructure loans have not yet yielded meaningful progress. Uganda is yet to benefit from G20 Debt Service Suspension Initiative (DSSI) and China, the largest creditors is not part of the DSSI. This means that Uganda has to borrow to pay.

The level of global inequality between countries and between elites and many in society clearly calls for redistributive financing within and between countries. Foreign funding to the health sector has led to impressive areas of progress in Uganda, such as in relation to reducing HIV and responding to treatment and care needs for AIDS.

However, concerns have been raised in the past over the way ODA from high to low and middle income countries can encourage corruption, distort priorities, mask inefficiencies and shift attention away from domestic budget commitments, and from deeper international economic and investment issues. Despite long-standing and significant levels of external aid, Uganda’s health sector still suffers from inadequate funding and infrastructure, wider health system deficits and weaknesses in governance. The provision of foreign assistance appears to have generated a culture of dependency from recipients and paternalism from funders. A ‘donor’ - ‘recipient’ relationship risks local expertise, knowledge and capacities being ignored, and can encourage neo-colonial and racist assumptions and attitudes. A northern aid industry has often placed itself in the position of managers, intermediaries, implementers, and monitors of ODA. On the other side, it also leads to an unhealthy reliance on foreign funding to meet state and sector obligations in health, such as immunizing children that should be funded by the Uganda government.

Whatever the well-meaning intentions, a mix of dependency and paternalism carries the risk of infantilizing leaders, and of absolving states of their responsibilities to their populations through domestic resources. It would be naïve to ignore that ODA carries with it interests of both funder and recipient. This calls for transparency in and negotiation of these interests. Commitments have been stated to increase transparency in this relationship, but these commitments are not always delivered on, and still far too little information is shared with local actors. ODA financing of a large share of health expenditure comes with conditions for close monitoring and reporting by states to external funders, sometimes with stronger state accountability to high income country funders and tax payers that to the citizens and parliaments of recipient countries, marginalizing mechanisms for domestic accountability. While such accountability needs to be demanded within our countries and there have been improvements in aid accountability, Wild and Domingo have observed in the past that what is written on paper is often different from what is practiced (https://tinyurl.com/57jap9jn). A preference for vertical funding of health sector programmes, not all through state systems, and off-budget funding with parallel reporting mechanisms means that evidence is not always shared with domestic actors. It is not easy to access information on external funding when off budget, such as in various forms of private- public partnerships or parallel institutions. Demands for domestic accountability also face power imbalances between funders and communities, and between high and low income countries.

These shortfalls and concerns are being voiced in many countries in the region, and by some stakeholders in high income countries, including those seeking to ‘decolonise’ ODA while still meeting obligations to global public goods and solidarity. This raises questions about how ODA is directed, given and used now and in the longer term, especially if the ‘giving’ creates repayment liabilities that the public will be paying for well into the future.

These issues need to be debated. In writing this oped with the intention to contribute to this dialogue, including on the actions to address the issues raised. For example, I suggest some areas of action.

Transparency and access to information should be at the heart of the negotiation of and accountability on interests in ODA relationships, not only between states, but also to the public on both sides. The lack of transparency and blockages in information flow noted earlier, including between states and citizens need to be addressed. This includes bringing ODA ‘on-budget’ in the health sector to capture and align the resources towards national health priorities and systems, and to enable and improve the mechanisms for and practice of public domain reporting and oversight.

The priorities brought by ODA need to be aligned to national health system priorities. The upward accountability to funders and high income source countries and power imbalances between low- and high-income countries can be argued to generate a reliance on solidarity and inadequate incentives for ODA funders to make good on their commitments under the Paris Declaration and other global commitments. ODA funders need to understand, engage with and align to the contexts, priorities and cultures of countries they engage with, and to invest time and resources upfront to engage to a greater degree in designing their investments and projects with local actors. This is important to avoid overlooking and under-investing in local health problems and priorities, and in the institutional and system needs to implement them. It can be argued that the shift noted earlier in Uganda from grant to loan funding, for example, reflects more the interests of high income country funders than the post-pandemic realities faced by the country and its communities.

This places a demand on states to build strategic capacities and alliances to negotiate domestic interests, to look beyond immediate sums to their implications and future burdens. However, there is also an obligation on ODA funders to not exploit or exacerbate weaknesses in recipient capacities and accountability mechanisms, but reinforce or support their strengths. For both sides this is a business of ‘relationships’ and diplomacy, and one in which power inequities and the institutional barriers on both sides of the relationship need to be more explicitly addressed, to achieve outcomes that matter for sustained population health equity.

We welcome your feedback or queries on the issues raised in this editorial. Please send them to the EQUINET secretariat. You can read more from I4DEV at http://www.i4dev.or.ug/

2. Latest Equinet Updates

Diss 125: Protecting equity in the face of privatisation of health services in east and southern Africa
Loewenson R: EQUINET Discussion paper 125, TARSC, EQUINET, Harare

Funding for public health services paid from general taxation, provided universally and free at the point of access, is considered the most effective way of redistributing resources from high to low income groups while contributing to improvements in health. Nonetheless, in recent decades the privatisation of health services has expanded, through the in privatisation of services and expansion of private sector services in parallel with the public system, or in various forms of commercialised market reforms within public sectors, and the growth of public-private partnerships. This paper outlines equity-related evidence on privatisation in the ESA region in terms of differential entitlements, assets, endowments, and capabilities; differentials in vulnerability; health outcomes; and in life course, long-term and wider system consequences. Drawing on this evidence, the paper suggests elements of the pathways for responding to the equity dimensions of privatisation of health services and reflections on which elements may have a broad impact on multiple dimensions of inequity. The presentation of areas for action on pathways for change is not intended to be prescriptive. It rather intends to stimulate and inform dialogue and advocacy, understanding that what may be relevant and feasible depends on the country context. Motivating actions to address the inequities inherent in privatisation implies countering a common narrative that limiting privatisation of services undermines development. In contrast it implies promoting the right to health care, as embedded in many constitutions of ESA countries, and the understanding that public sector health systems are central for universal health coverage.

Exchange experience! Submit an Abstract to the EQUINET 2002 CONFERENCE before June 15th 2022
EQUINET Steering committee: Abstract submission is open and closes 15 June 2022

The EQUINET Conference 2022 “Catalysing change for health and social justice” invites submissions from different voices and in different forms for presentation at the conference within the three strategic areas of the conference. For Day1 July 28th: Reclaiming the Resources for Health, for Day 2 September 15th: Reclaiming the State, for Day 3 October 13th: Reclaiming Collective Agency and Solidarity. The abstract submission page at https://www.equinetafrica.org/conference/abstract-submission.html provides further information on content areas and the online submission form. We are inviting presentations of research, interventions, policy engagement with a focus on actions for equity oriented change. Your presentation may be an oral presentation but we are also inviting short videos, podcasts, zoom recordings of discussions, poems, photojournalism and other forms. We expect presentations to be short (less than 15 minutes) so please indicate in the abstract how much time you envisage your input will need. We may provide some support for preparation of presentations for those with limited resources. Please complete the information in the online Abstract submission form below and ensure you submit before 15 June. Accepted abstracts will be notified by 30 June.

Join the discussion! Register for the EQUINET 2002 CONFERENCE before July 15th 2022
EQUINET Steering committee: Registration is open and closes 15 July 2022

The EQUINET Conference 2022 “Catalysing change for health and social justice” invites participation from community members, workers, state personnel at all levels, civil society, parliamentarians, academics, trade unions, diverse professionals, innovators, producers and others. The online conference will be 9am to 5pm Southern African time for the three full days: Day1 July 28th: Reclaiming the Resources for Health, Day 2 September 15th: Reclaiming the State, and Day 3 October 13th: Reclaiming Collective Agency and Solidarity. Participants can register online for one, two or all three days of the conference at the registration page at https://www.equinetafrica.org/conference/registration.html. Please register separately for each of the three days, using all three links for all three days if you want to attend all. All those attending a day of the conference will be automatically registered for the fourth half day 9am to 1pm on November 17th. Registration is free. The inputs to the conference will inform the future work of the network. Please join and be part of it!

3. Equity in Health

Tackling health inequities in indigenous communities
World Health Organisation: WHO, Geneva, 2022

There are currently 476 million indigenous people globally who experience structural racial and ethnicity-based discrimination, higher rates of health risks and poorer health outcomes. Their leadership and participation in public health is argued to be central to understand and address their health issues. In May 2022, WHO hosted a side event at the 21st session of the UN Permanent Forum under the theme “indigenous peoples, business, autonomy and the human rights principles of due diligence including free, prior and informed consent." The session explored the ‘causes of the causes’ of these health inequities and considered measures to tackle them, with members of indigenous communities speaking out on health systems strengthening, restorative justice, racism and discrimination, traditional medicine and health practices, access to water and social determinants of health like housing and education.

4. Values, Policies and Rights

Africa’s reaction to the AU’s ‘African common position to the UN Food Systems Summit’: A blueprint for corporate capture and industrial agriculture
Africa Common Position by Civil Society (ACPCS): At the UN Food Systems Summit.July, 2021

Sixty civil society organisations in Africa under the banner of an Africa Common Position by Civil Society (ACPCS) presented a statement in reaction to the AU’s ‘African common position to the UN Food Systems Summit.’ In a well-attended and inclusive social movement process in July 2021, small-scale African producers of all kinds – fisherfolk, pastoralists, women, young people, agricultural workers, indigenous peoples and the urban food insecure – articulated their concerns that the United Nations Food Systems Summit (UNFSS) had been captured by multinational corporations, and called for Africa’s food sovereignty and transformation of the industrial food system. The statement condemns the corporate hegemony of food systems, with food systems being depicted as being in need of saviour western technology, productivity and competitive enhancement and the gross power imbalances that corporations hold over food systems. The statement calls for the UN system to address the legitimate concerns raised by civil society and open spaces and meet responsibilities for this in the public sphere at both national and global level.

Launching ‘Lessons to Africa from Africa: Reclaiming Early Post-independence Progressive Policies’
CODESRIA: Post-Colonialisms Today, Online, 2022

This recording covers Day 1 of the launch of’ Lessons to Africa from Africa: Reclaiming Early Post-independence Progressive Policies’—a special issue of CODESRIA’s Africa Development journal from Post-Colonialisms Today. The authors share rich archival research on early post-independence Africa policies around industrialization, international solidarity, delinking from colonial currency, and more; and their relevance for today’s development challenges. A Special Issue journal: https://journals.codesria.org/index.php/ad/issue/view/245 provides more detailed information on these policies, and why they hold lessons for today's efforts to disengage from neocolonial realities.

Policy response to COVID-19 in Senegal: power, politics, and the choice of policy instruments
Riddea V; Fayeb A: Policy Design and Practice, 1-20, https://doi.org/10.1080/25741292.2022.2068400, 2022

The authors explored and drew learning from how Senegal formulated its policy response to the COVID-19 pandemic. The response was rapid, comprising conventional policy instruments used previously for containing Ebola. The policy-making process involved several agencies, which resulted in significant leadership and coordination problems. Community participation and engagement with relevant scientific communities were limited, despite their recognized importance in the response. Instead, international funders had a significant influence on the choice of policy tools. The paper contributes to thinking on the autonomy of policy instruments and calls for a review of how academics, civil society, and decision-makers collaborate to design public policies and policy tools based on evidence and context, and not only politics.

5. Health equity in economic and trade policies

How the marketing of formula milk influences our decisions on infant feeding.
World Health Organization, UNICEF,: WHO Geneva, 2022

Formula milk companies are reported by World Health Organization (WHO) to be paying social media platforms and influencers to gain direct access to pregnant women and mothers at some of the most vulnerable moments in their lives. The global formula milk industry, valued at some US$ 55 billion, is said to be targeting new mothers with personalized social media content that is often not recognizable as advertising. This new WHO report titled Scope and impact of digital marketing strategies for promoting breast-milk substitutes has outlined the digital marketing techniques designed to influence the decisions new families make on how to feed their babies. Through tools like apps, virtual support groups or ‘baby-clubs’, paid social media influencers, promotions and competitions and advice forums or services, formula milk companies can buy or collect personal information and send personalized promotions to new pregnant women and mothers.

6. Poverty and health

COVID-19 Crisis and the Informal Economy
WIEGO: Study Report, 2022

Women in Informal Employment: Globalizing and Organizing (WIEGO) is a global network focused on empowering the working poor, especially women, in the informal economy to secure their livelihoods. WIEGO implemented this study in two rounds to capture changes across the different stages of the crisis during the second and third quarters of 2020, and how workers adapted by the first quarter of 2021. The study was implemented in 12 cities, including Dar es Salaam in Tanzania and Durban in South Africa. The work provides a platform to give visibility to the experience and voices of informal workers in policy. The organizations of informal workers involved in the study called for continuing relief, inclusive recovery and longer-term reforms for informal workers going forward. These demands, with concrete examples, were categorized into a common framework. a “Summary of Demands” to support these and other organizations of informal workers in their on-going advocacy and negotiations for a full and just recovery and for a “better deal” in the future for informal workers.

7. Equitable health services

Challenging the Illusion: Health Equity Amidst New Variants
Essar MY; Lal A; Ahmad S; et al: International Journal of Public Health 67:1604896, doi: 10.3389/ijph.2022.1604896, 2022

Low- and middle-income countries (LMICs) with limited capacities and infrastructures have experienced striking and disproportionate public health and economic losses during the COVID-19 pandemic—particularly due to imposed lockdowns and restrictions. The pandemic’s emerging variants are identified in this paper as a manifestation of unequal and unjust distribution of COVID-19 vaccination—unmasking “health equity” as an illusion. The authors state that firm actions have been taken by High income countries and powerful actors, who could be playing a leading role in offering solutions rather than privileging self-defeating interests. They urge that the ongoing COVID-19 response and future efforts for pandemic preparedness should ensure health equity is made an urgent, core priority—rather than an afterthought.

Improving vaccination equity in rural Uganda
Clinton Health Access Initiative: Uganda, March 2022

From November 2020, Clinton Health Access Initiative (CHAI) Uganda’s vaccines team and Uganda government addressed challenges with routine immunisation service delivery to improve equity across 14 districts representing around 11 percent of the country’s children under five. An assessment in December 2018 found that in the 14 focus districts there was limited interaction between health facilities and the communities they serve. In addition, health facilities were unable to systematically identify underserved communities within their catchment to use their limited resources in an optimal way, leading to a significant number of children un or under-immunised. To address this, health workers were trained on how to identify underserved villages proactively and systematically within their catchment areas and potential barriers to vaccination in these communities. The team piloted an intervention that monitors geographic variations in care-seeking trends in high-volume health facilities, detecting villages with the highest number of unimmunized (zero-dose) children within their catchment areas. Once these underserved villages are identified, health facilities hold meetings with community leaders and influencers to understand the barriers to immunisation and develop targeted mitigation strategies. This work is reported to have led to increased vaccination rates in underserved villages and to have improved the effectiveness of outreach sessions by targeting the underserved communities with high numbers of un- or under-vaccinated children.

Using cellphones to deliver health services to teens: a sub-Saharan Africa review
Somefun OD; Onukwugha FI; Smith L; Magadi M: The Conversation, May 2022

Adolescents in sub-Saharan Africa have the highest rate of unplanned pregnancies, almost half (46%) of which end in abortion. Mobile health interventions using mobile phones or devices are argued to have become popular in addressing health issues and were assessed for their role in improving adolescents’ uptake of sexual and reproductive health services. The results showed that mobile health interventions were effective. They improved adolescents’ uptake of sexual and reproductive health services across a wide range of services, particularly contraceptive use. The findings suggest that mobile health interventions promoting prevention or ante-retroviral treatment adherence are acceptable to adolescents and feasible to deliver in sub-Saharan Africa. The authors conclude that there is a need to develop mobile health interventions by and for young people.

8. Human Resources

Community health workers and health equity in low- and middle-income countries: systematic review and recommendations for policy and practice
Ahmed S; Chase LE; Wagnild J; et al: International Journal for Equity in Health 21, doi: https://doi.org/10.1186/s12939-021-01615-y, 2022

This systematic review aimed to synthesise research findings on the Community Health Worker (CHW) effectiveness at reaching the most disadvantaged groups in low- and middle-income countries (LMIC) contexts, and in reducing health inequities in the populations they serve. One hundred sixty-seven studies met the search criteria, reporting on CHW interventions in 33 LMIC. Quantitative synthesis showed that CHW programmes successfully reach many (although not all) marginalized groups, but that health inequalities often persist in the populations they serve. Qualitative findings suggest that disadvantaged groups experienced barriers to taking up CHW health advice and referrals and point to a range of strategies for improving the reach and impact of CHW programmes in these groups. Ensuring fair working conditions for CHWs and expanding opportunities for advocacy were also revealed as being important for bridging health equity gaps. In order to optimise the equity impacts of CHW programmes, the authors propose moving beyond seeing CHWs as a temporary sticking plaster, and instead building meaningful partnerships between CHWs, communities and policy-makers to confront and address the underlying structures of inequity.

Community Health Workers in Pandemics: Evidence and Investment Implications
Ballard M; Johnson A; Mwanza I; et al: Global Health: Science and Practice 10(2):e2100648; doi: https://doi.org/10.9745/GHSP-D-21-00648, 2022

Community health workers (CHWs) have been a critical part of health care delivery across diverse contexts for over a century. This article argues that a strong and accessible national health system, including at the community level, is critical for pandemic preparedness and response. Community health workers who are equipped, trained, and paid as part of a well-functioning health system can help prevent epidemics from becoming pandemics and maintain health care delivery amid significant disruption. To achieve resilient health systems, bi/multilateral aid and private philanthropies need to review their investment practices to replace those that cause harm (high transaction costs, earmarking, short-termism, appropriation of sovereignty) with practices that ensure timely and effective implementation of priorities set by government stakeholders (pooling, longer commitments, and alignment with evidence-based guidelines).

9. Public-Private Mix

Africa and the corrosive international tax system
Mukumba C; Etter-Phoya R: Tax Justice Network, 2021

Illicit financial flows are argued by the authors to punch holes in the public purse across the African continent. Over the past five decades Africa is reported to have lost in excess of US$ 1 trillion in illicit financial flows, dwarfing the continent's receipts of overseas development assistance during this period and the foreign direct investment into Africa. Based on research of national laws, policies and practice, each of the 70 countries included in the Corporate Tax Haven Index are given a score. African countries are found to contribute less to tax abuse than European Union and OECD member states and their dependencies, but have less robust transparency and anti-avoidance measures. The authors call for policy improvements in African countries to curb and protect against corporate tax abuse, and advocate for a UN Tax Convention.

10. Resource allocation and health financing

Analysis of aid flows to Uganda before and during Covid-19
Owori M: Development Initiatives, Online, 2021

The overall profile of official development assistance (ODA) in Uganda is reported to be switching from grants to increased proportions of concessional loans, as international financial institution (IFI) lending became a significant source of foreign aid in 2020. Growth in IFI aid flows to Uganda between 2018 and 2020 was mainly driven by the World Bank, which contributed 77% of the total reported IFI contributions in the three years reviewed. The health sector received the largest share (US$205 million) of bilateral grant aid disbursements in 2020, but this allocation represented a 10% decline from 2019 to 2020. The allocation to the humanitarian sector in 2020 also declined, but the allocation to the agriculture and food security sector increased by 34% to US$128 million between 2019 and 2020,

Catastrophic health expenditure in sub-Saharan Africa: systematic review and meta-analysis
Eze P; Lawani LO; Agu UJ; Acharya Y: Bulletin of the World Health Organisation 100(5), 337-351J, doi: 10.2471/BLT.21.287673, 2022

This study estimated the incidence of, and trends in, catastrophic health expenditure in sub-Saharan Africa. A systematic review of scientific and grey literature was conducted to identify population-based studies on catastrophic health expenditure in sub-Saharan Africa published between 2000 and 2021. A meta-analysis was performed using two definitions of catastrophic health expenditure: 10% of total household expenditure and 40% of household non-food expenditure. The results of individual studies were pooled by pairwise meta-analysis using the random-effects model. The authors identified 111 publications covering a total of 1 040 620 households across 31 sub-Saharan African countries. Overall, the pooled annual incidence of catastrophic health expenditure was 16.5% for a threshold of 10% of total household expenditure and 8.7% for a threshold of 40% of household non-food expenditure. Countries in central and southern sub-Saharan Africa had the highest and lowest incidence, respectively. A trend analysis found that, after initially declining in the 2000s, the incidence of catastrophic health expenditure in sub-Saharan Africa increased between 2010 and 2020. The incidence among people affected by specific diseases, such as noncommunicable diseases, HIV/AIDS and tuberculosis, was generally higher. Although data on catastrophic health expenditure for some countries were sparse, the available data suggest that a non-negligible share of households in sub-Saharan Africa experienced catastrophic expenditure when accessing health-care services, and that stronger financial protection measures are needed.

11. Equity and HIV/AIDS

COVID-19 pandemic restrictions did not harm HIV care outcomes in Uganda
Magak E: NAM AIDSMAP, Online 2022

Despite the strict COVID-19 pandemic restrictions in Uganda, viral load testing and viral load suppression rates improved by 68% and 35% during the first lockdown, while mortality reduced by 25% among people living with HIV in Kampala, according to a presentation by Dr Izudi, Makerere University, at the INTEREST 2022 conference. In 2020, modelling studies of the COVID-19 pandemic’s impact on HIV estimated that interruptions in ART would have the largest effect on HIV-related mortality in Africa, with a three-month interruption of ART supply in 13 African countries estimated to translate to a 35 to 131% rise in mortality in 2021. Observational data from six large HIV clinics and 9952 participants in Kampala compared a pre-pandemic cohort from March 2018 to February 2019 of people with HIV who had not experienced the COVID-19 restrictions, and an exposed cohort from June 2020 to June 2021 of people with HIV who experienced the restrictions. Patients exposed to restrictions had a 68% increase in viral load testing and a 35% increase in viral load suppression compared to the comparison group. Their mortality was also 25% lower than the control group,

“After 25 years of democracy we are still stigmatized and discriminated against…”: Health care experiences of HIV positive older black gay men in a township in South Africa
Mange T; Henderson N; Lukelelo N: The Journal of Practice Teaching and Learning 19(1-2). https://doi.org/10.1921/jpts.v19i1-2.1674, 2022

Older gay black men living with HIV and AIDS and their aging and health care concerns are reported to be invisible in research in South Africa, with the focus being on younger LGBTQI+ men. This qualitative study explored the aging and health-care experiences of older gay black men in a selected township in the Cape Metropole, with the purpose of finding strategies to deal with their real life concerns and also interviewed health professionals working at the local clinic. A key finding was that health-care professionals, particularly nurses at a local clinic, stigmatize older black men living with HIV and AIDS and that rejection by their families and the death of their life partners leads to isolation, loneliness and depression. The authors propose training of health-care professionals by social workers and workshops to educate families of older LGBTQI+ people on their aging concerns.

12. Governance and participation in health

Cities can care for people and enable them to care for others, making urban health possible
Obando F; Keith M: PEAK Urban Programme, University of Oxford, 2022

By creating the conditions for health in many ways - through healthcare, childcare, public safety, community and economic development, parks and recreation, among others - local governments care for people. In this paper, three significant ways are discussed. A closer look at the role of local governments in providing water, sanitation and hygiene (WASH), urban planning, and transport shows that the local government contribution to healthy urban lives and equity is unparalleled but faces significant challenges. A contestation of public goods and private interests make the role of a local arbitrator essential. With local governments key actors in collective wellbeing and in generating equity, the authors argue that when they fall short, the consequences for health are disastrous. They provide a framework for navigating complexity and present and draw lessons from the participation of local governments in urban governance during the COVID-19 pandemic.

The importance of prioritizing politics in Good Governance for Medicines Initiative in Zimbabwe: a qualitative policy analysis study
Mhazo AT; Maponga CC: Health Policy and Planning 37(5) 634–643, doi: https://doi.org/10.1093/heapol/czac007, 2022

In 2004, the World Health Organization (WHO) launched the Good Governance for Medicines (GGM) initiative, with the aim of fighting corruption in the pharmaceutical sector. In the case of Zimbabwe, implementation of the initiative slowed down after the development phase. Often, lack of funding and technical considerations are cited as major reasons for issue de-prioritization whilst ignoring the influence of politics in mediating policy diffusion. Between June and August 2021, an in-depth document review was conducted and individuals involved with GGM in Zimbabwe interviewed to understand the political determinants of GGM prioritization in Zimbabwe. The Shiffman and Smith framework was used to guide and direct the analysis. The authors found that the inception of GGM was facilitated by capable leaders, effective guiding institutions and resonance of the idea with the political environment. Prioritization from inception to implementation was constrained by limited citizen engagement, restriction of the issue to the pharmaceutical domain and a political transition that re-oriented policy priorities and reconfigured individual actor power. The portrayal of corruption as a priority problem requiring policy action has been hampered by the political sensitivity of the issue, lack of credible indicators on the prevalence and severity of the problem and challenges to measure the effectiveness of interventions such as the GGM. Despite the slowdown, from 2018 GGM actors have taken advantage of momentous policy windows to reconstitute their power by opportunistically framing GGM within the broader framework of access to essential medicines leading to the creation of new policy alliances and establishment of strategic political structures. To sustain the political prioritization, the author argues that actors need to lobby for the institutionalization of GGM within the Ministry of Health strategy, sensitize citizens on the initiative, involve multiple stakeholders and frame the issue as a strategic intervention that underpins pharmaceutical sector performance within the national developmental framework.

13. Monitoring equity and research policy

Developing context relevant and inclusive course outlines and reading lists
Teaching Health Economics Special Interest Group: Webinar online, Online: June 9, 2022

The Teaching Health Economics Special Interest Group (THE SIG) has organized a series of virtual workshops during 2022. This workshop provides an overview of curriculum development and writing powerful learning outcomes for health economics courses and the importance of identifying topics and readings that are most relevant to the local context. The workshop considers how to ensure courses are inclusive and contain diverse perspectives, and information shared on how academics in low- and middle-income countries can directly access a wide range of publications to use in their teaching programs at no (or low) cost.

‘Working relationships’ across difference - a realist review of community engagement with malaria research
Vincent R; Adhikari B; Duddy C, et al: Wellcome Open Research, 7(13), https://doi.org/10.12688/wellcomeopenres.17192.1, 2022

The authors conducted a realist review to understand how and why community engagement with health research contributes to the pattern of outcomes observed, with a focus on malaria research. Community engagement was found to rely on the development of provisional ‘working relationships’ across differences, primarily of wealth, power and culture that bring tangible research related benefits. Contextual factors that affect these working relationships were reported to include the research organisation commitment to and resources for engagement, while a prevailing ‘dominant health research paradigm context’ was reported to undermine working relationships, as did differences of wealth and power between research centres and local populations and health systems; histories of colonialism and vertical health interventions; and external funding and control of health research. Accommodation of such ethically problematic characteristics in the dominant health research paradigm can undermine community engagement and reproduce this paradigm rather than challenge it with a different logic of collaborative partnership.

14. Useful Resources

Gender and Health
World Health Organisation: WHO, Geneva, 2021

Gender norms, roles and relations, and gender inequality and inequity, affect people’s health all around the world. This Q&A examines the links between gender and health, highlighting WHO’s ongoing work to address gender-related barriers to healthcare, advance gender equality and the empowerment of women and girls in all their diversity, and achieve health for all.

15. Jobs and Announcements

5TH CODESRIA/CASB Summer School in African Studies and Area Studies in Africa
Deadline for Applications: 30th June 2022

The Council for the Development of Social Science Research in Africa (CODESRIA) and The Centre for African Studies in Basel (CASB) call for applications for their 5th Summer School in African Studies and Area Studies in Africa. The Summer School addresses the question “How Political is Knowledge?”. The political economy of knowledge production in Africa is argued to require critical reflection, raising general questions about the relationship between knowledge, power and politics. The overall objective of the Summer School is to stimulate and consolidate interdisciplinary approaches to research on Africa, but also on other regions of the world undertaken from within the African continent. The 5th CODESRIA/ZASB Summer School invites applications from doctoral students interested in exploring these issues as part of a larger framework of engaging with methodological challenges in African Studies. Travel, accommodation and meals during the Summer School will be provided for participants from African Institutions. Application information is available on the website.

Co-building a New Eco-Social World: Leaving No One Behind, The People's Global Summit
IFSW, UNRISD, WFPHA et al: 29th June to 2nd July 2022 – Online

The People’s Global Summit is brings together individuals and communities, people of lived experiences, along with global organisations to co-build a combined global conversation on the creation of globally shared values for a new eco-social world that leaves no one behind. The vision of this people’s global summit emerges from the pandemic, the climate crisis, and the need to co-build a new eco-social world based on values that shape policies and practices to ensure sustainability and good quality life-cycles – not only for each human being but for each part of our eco-systems on which we all depend, leaving no one behind. The people’s global summit provides spaces for individuals as well as for group representatives to advance their ideas and provide a platform for engagement across different cultures, diverse lived experiences, professional groups, and perspectives. All contributions will shape the Global Values Declaration for a new eco-social world that will be delivered to the United Nations High-Level Political Forum in July 2022 and will create a catalyst for further global action.

Postdoctoral Research Fellowships for 2022/ 2023, South Africa
Deadline for Applications: June 5, 2022

The DSI-NRF South African Research Chair in Industrial Development (SARChI-ID) has positions available for postdoctoral research fellowships. The fellowships are attached to a prestigious international project titled ‘Accelerating Vaccine Production in Africa: A Centres of Excellence Initiative’ that seeks to foster interactions between select African universities and reputed university counterparts in the USA and Europe. There are no teaching obligations. In keeping with the focus of the project, postdocs will be expected to conduct research and engage in translational policy advice at the country and regional level in Africa. The fellowships are for an initial one year period, with possibilities of renewal for up to December 2023 attached to this project, and continuation thereafter. Fellows will be paid a monthly stipend and are provided with office space, laptops, and access to funding for research and travel. In addition to the standard postdoctoral stipends, fellows will receive additional remuneration for project activities.

Seventh Global Symposium on Health Systems Research
Registration open, October 31 - November 4, 2022, Bogota, Colombia

The Seventh Global Symposium on Health Systems Research (HSR2022) will take place at the Ágora Bogotá Centro de Convenciones in Bogota, Colombia from October 31 – November 4, 2022, bringing together approximately 2,000 health systems researchers, policymakers and practitioners from around the world. The Symposium face the challenge of optimally sharing – and learning from – the experiences of the last two years, not only on the stress that health systems faced, and successes encountered during the pandemic, but also on interactions between politics, policy, and service provision and the role of vulnerable and already marginalized populations and the role of power in policy development; and of communities and individuals play. Registration for the conference is now open.

The 13th Best Practices Forum and 29th Directors Joint Consultative Committee Meeting
13 to 15 July 2022, Nairobi, Kenya

The East, Central and Southern African Health Community (ECSA-HC) is an inter-governmental organization that fosters and promotes regional cooperation in health. The aim of the Best Practices Forum (BPF) and the Directors Joint Consultative Committee (DJCC) meetings is to share best practices and research evidence, identify relevant health policy issues and making recommendations to the Health Ministers Conference, towards the improvement of health programming and outcomes in the region. The upcoming conference will provide a forum for health scientists, policy makers, development partners and other stakeholders in health to present their best practices and research evidence that inform policies and programming in the ECSA region. The theme for the 13th BPF is Stronger Health Systems Post Covid-19 for the Attainment of Universal Health Coverage in the ECSA Region.

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