1 CODESRIA INSTITUTE ON HEALTH, POLITICS AND SOCIETY IN AFRICA Theme: Governing the African Health System Call for Applications for the 2004 Inaugural Session The Council for the Development of Social Science Research in Africa (CODESRIA) was established in 1973 as an initiative of African scholars for the promotion of multidisciplinary research that extends the frontiers of knowledge production in and about Africa, and also responds to the challenges of African development. Within the broad framework of the mandate defined for the Council in its Charter, various research and training programmes have been developed over the years for the purpose both of mobilising the African research community and responding to its needs. The Council also has a robust publications programme which has earned it a reputation as one of the leading scholarly publishers in Africa. Its training programmes are particularly targeted at younger, mid-career scholars whose need for support in advancing their reflections on conceptual and methodological questions was at the origin of the initiation by the Council of a number of annual thematic institutes. At present, CODESRIA runs annual Governance, Gender, Humanities, and Child and Youth Studies institutes. As part of on-going programme innovation and expansion, the Council has decided to launch an experimental institute on Health, Politics and Society in Africa in a bid to promote an enhanced interest in multidisciplinary health research among African scholars. The initiative flows from the current CODESRIA strategic plan which has placed a considerable emphasis on the promotion of a social science approach to health studies in Africa and a structured dialogue between the Social Sciences and the Health/Biomedical Sciences. The initiative has also become imperative at a time when the African continent is faced with one of the most severe health crises in its history. Most symbolic of this crisis is the HIV/AIDS pandemic which has been ravaging the continent for sometime now even as such diseases as malaria continue to take a heavy toll while tuberculosis and polio, once under control, are enjoying a resurgence. The HIV/AIDS pandemic itself came to the fore in the context of a generalised weakening of the health structures and processes of African countries, as well as the decline in the average health and nutritional status of Africans, the latter speaking directly to the increased levels of personal and household impoverishment on the continent. At the root of the decline in the health status of Africans are such factors as the prolonged economic crises which African countries have faced in the period since the early 1980s, the inappropriate adjustment measures prescribed by the International Financial Institutions (IFIs) for containing the crises but which exacerbated the problems that were already being experienced in the health sector, and the massive brain drain from the sector. Objectives: The main objectives of the Institute on Health, Politics and Society are to: �� Encourage the emergence and sustenance of a networked community of younger African scholars in the field of health research; �� Promote methodological and conceptual innovations in research on African health questions through the application of an enhanced social science approach; �� Encourage a structured dialogue between the Social Sciences and the Health/Biomedical Sciences as part of the quest for a holistic approach to understanding health, politics and society in Africa; and �� Promote the sharing of experiences among researchers, activists and policy makers drawn from different disciplines, methodological/conceptual orientations, and geographical experiences on a common theme over an extended period of time. 2 Organisation: The activities of all CODESRIA institutes centre on presentations made by resident researchers, visiting resource persons, and the participants whose applications for admission as laureates are successful. The sessions are led by a scientific director who, with the help of invited resource persons, ensures that the laureates are exposed to the range of research and policy issues generated by or arising from the theme of the Institute for which they are responsible. Open discussions drawing on books and articles relevant to the theme of a particular institute or a specific topic within the theme are also encouraged. Each of the participants selected to participate in any of the Council’s institutes as a laureate is required to prepare a research paper to be presented during the course of the particular institute they attend. Laureates are expected to draw on the insights which they gain from the Institute in which they participate to produce a revised version of their research papers for consideration for publication by CODESRIA. For each institute, the CODESRIA Documentation and Information Centre (CODICE) prepares a comprehensive bibliography on the theme of the year. Access is also facilitated to a number of documentation centres in and around Dakar. The 2004 Inaugural Session: Governing the African Health System: In the face of the severe health problems which have confronted the African continent in recent years, a considerable amount of work has been generated designed to promote a general understanding on the origins, nature, dimensions and impact/consequences of the contemporary African health crises. However, these studies, while offering some useful insights, have also been marked by certain critical weaknesses, among them a lack of historical depth and context, a dearth of comparative insights, a general absence of multidisciplinarity of approach, and an excessive, illinformed cultural determinism underpinned by narrow socio-anthropological perspectives. These are weaknesses which require to be remedied if African health studies are to advance in a problem-solving direction that also contributes to the deepening of knowledge and promotes analytic innovation. It is proposed to take a first step in that direction through the organisation of a focused reflection on the governance of the African health system as a whole. It is now generally established in the literature that health is, at all levels, a public good. If, indeed, that is so, then it is equally important that serious attention should be paid to the governance of the health system. As an arena and a vector of power relations in society, the health system both embodies and conveys questions of access, equity, justice and sustainability that require to be followed through for a proper understanding of the functioning and functionality of the system. In the specific African context, the questions of access, equity, justice and sustainability in the health system are made more pressing today by the various cases of systemic failure which have added up to produce a situation in which the health status of Africans is in greater peril today than at any other time since independence in the 1960s. Indeed, as has been widely observed, including by agencies such as UNICEF, even some of the historic gains in health status recorded after independence in such areas as infant mortality have been rolled back. Amidst the crises that has gripped the health sector, the decline in the overall health status of many Africans, the cut-back in the public health expenditure of the state, the various health emergencies facing the continent, and the challenges of reform that are posed, questions of access, equity and sustainability clearly arise both as important issues in their own right and as elements integral to the exercise of citizenship, democratic rights and the social contract. Furthermore, the changes in health-seeking behaviour occurring across the continent, side by side with the emergence and/or revival of new private and popular forms of health provisioning come 3 with new governance challenges that deserve to be more closely studied beyond the anecdotal. For instance, the growth of private health insurance markets and private clinics are pointers to a growing stratification of the health market in line with the intensified income and social differentiation that has occurred over the last two decades; it is, however, also a development which poses new policy-making, managerial and regulatory challenges to which governments and professional associations have to respond. Similarly, the growth of the popular market for alternative medicines and the rediscovery and popularisation of the institution of the “traditional”/faith healer offer pointers to the crises in the formal health sector and popular coping strategies that are being adopted; they also open new terrains of power, rights and standards which elicit regulatory responses of their own. The increase in the illegal production and distribution of fake and sub-standard drugs points to an opportunistic entrepreneurial logic seeking to profit from the African health crises and the problems of the health system; the opportunism may only be the flip side of the operations of international pharmaceutical cartels whose pricing strategies eat disproportionately into developing country health budgets, take the prospects of treatment beyond the reach of the working poor and expose many to the ruthless dealers in fake and illicit substitutes. Additionally, changes in the structure of care brought about by the explosion of the HIV/AIDS pandemic, the persistence of malaria as a major killer and the resurgence of diseases like tuberculosis which were previously under control have implications for the governance of health systems in so far as they are correlated with the diminished/diminishing capacity of the public health facilities to cope with a complex range of expanded needs. This diminished capacity proliferates all spheres of the health system, ranging from the drain of talents to the collapse of training and personnel management structures designed to produce and reproduce critical human resources. Government health budgets, already diminished by years of economic crises and structural adjustment, are under continuing strain and public health managers are confronted with the difficult, even grim task of prioritising expenditure among a range of equally important diseases and policy measures. Governments are also called upon to strive to meet various targets set out in a range of global/social development health agreements, manage the activities of donors and nongovernmental organisations active in the health sector, and overcome the difficulties associated with the quest for the production/importation of generic drugs for which the major multinational pharmaceutical companies hold patents. Inescapably, therefore, the role of the state as provider, facilitator and regulator in the health sector is one with which we are constantly required to grapple. This fact makes it equally important to address questions about the nature and composition of the state - capacity, legitimacy, etc. – and the ways in which these are refracted into the functioning of the health system. The growth, over the last few decades, of an international health coalition, both inter-governmental and nongovernmental as well as the interface between this coalition and local civil society actors, present additional dimensions of the governance of the health system to which attention needs to be paid at a time of weakened state capacity across the African continent. The range and variety of issues associated with health sector reforms and the governance of the health system is endless and various multidisciplinary entry points are required for the achievement of a balanced and holistic understanding. Prospective participants in the Institute on Health, Politics and Society in Africa are invited to address themselves to these different entry points and other aspects of research on health system governance in Africa. 4 The Director For every session of its various institutes, CODESRIA appoints an external scholar with a proven track-record of quality work to provide intellectual leadership. Directors are senior scholars known for their expertise in the topic of the year and for the originality of their thinking on it. They are recruited on the basis of a proposal which they submit and which contains a detailed course outline covering methodological issues and approaches; the key concepts integral to an understanding of the object of a particular Institute and the specific theme that will be focused upon; a thorough review of the state of the literature designed to expose laureates to different theoretical and empirical currents; a presentation on various sub-themes, case-studies and comparative examples relevant to the theme of the particular Institute they are applying to lead; and possible policy questions that are worth keeping in mind during the entire research process. Candidates for the position of Director should also note that if their application is successful, they will be asked to: - participate in the selection of laureates; - identify resource-persons to help lead discussions and debates; - design the course for the session, including the specification of sub-themes; - deliver a set of lectures and provide a critique of the papers presented by the resource persons and the laureates; - Submit a written scientific report on the session. In addition, the Director is expected to (co-)edit the revised versions of the papers presented by the resource persons with a view to submitting them for publication in one of CODESRIA’s collections. The Director also assists CODESRIA in assessing the papers presented by laureates for publication as a special issue of Africa Development or as monographs. Resource Persons Lectures to be delivered at the Institute are intended to offer laureates an opportunity to advance their reflections on the theme of the programme and on their own research topics. Resource Persons are, therefore, senior scholars or scholars in their mid-career who have published extensively on the topic, and who have a significant contribution to make to the debates on it. They will be expected to produce lecture materials which serve as think pieces that stimulate laureates to engage in discussion and debate around the lectures and the general body of literature available on the theme. One selected, resource persons must: - submit a copy of their lectures for reproduction and distribution to participants not later than one week before the lecture begins ; - deliver their lectures, participate in debates and comment on the research proposals of the laureates ; - Review and submit the revised version of their research papers for consideration for publication by CODESRIA not later than two months following their presentation. Laureates Applicants should be African researchers who have completed their university and /or professional training, with a proven capacity to carry out research on the theme of the Institute. Intellectuals active in the policy process and/or in social movements/civic organisations are also encouraged to apply. The number of places offered by CODESRIA at each session of its institutes is limited to fifteen (15) fellowships. Non-African scholars who are able to raise funds for their participation may also apply for a limited number of places. 5 Applications Applicants for the position of Director should submit: �� an application letter; �� a proposal, not more than 15 pages in length, indicating the course outline and showing in what ways the course would be original and responsive to the needs of prospective laureates, specifically focussing on the issues to be covered from the point of view of concepts and methodology, a critical review of the literature, and the range of issues arising from the theme of the Institute; �� a detailed and up-to-date curriculum vitae; and �� Three writing samples. Applications for the position of resource persons should include: �� an application letter ; �� two writing samples ; �� a curriculum vitae ; and �� a proposal, not more than five (5) pages in length, outlining the issues to be covered in their proposed lecture. Applications for Laureates should include: �� an application letter; �� a letter indicating institutional or organisational affiliation; �� a curriculum vitae ; �� a research proposal (two copies and not more than 10 pages), including a descriptive analysis of the work the applicant intends to undertake, an outline of the theoretical interest of the topic chosen by the applicant, and the relationship of the topic to the problematic and concerns of the theme of the 2004 Institute; and �� two reference letters from scholars and/or researchers known for their competence and expertise in the candidate's research area (geographic and disciplinary), including their names, addresses and telephone, e-mail, fax numbers. An independent committee composed of outstanding African social scientists will select the candidates to be admitted to the institute. The deadline for the submission of applications is set for 16 February, 2004. The Institute will be held in Dakar, Senegal from 03 to 28 March, 2004. All applications or requests for further information should be addressed to: CODESRIA Institute on Health, Politics and Society in Africa Avenue Cheikh Anta Diop x Canal IV BP 3304 Dakar, Senegal Tel.: (221) 825 98 21/22/23 Fax: (221) 824 12 89 E-Mail: virginie.niang@codesria.sn Website: www.codesria.sn