Insitute on Health, Politics And Society in Africa - A ccess and Equity in African Health Systems, Call for Application, 2005 CODESRIA INSTITUTE ON HEALTH, POLITICS AND SOCIETY IN AFRICA Theme: Access and Equity in African Health Systems   Call for Applications for the 2005 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 in 2004 launched an 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 social science approaches 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:   q       Encourage the emergence and sustenance of a networked community of younger African scholars in the field of health research; q       Promote methodological and conceptual innovations in research on African health questions through the application of an enhanced social science approach; q        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 q       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.   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 2005  Session: Access and Equity in African Health Systems African countries attained independence in the 1960s on the basis of a broad social contract between the nationalists who inherited state power from the colonial authorities and the general populace whose support was instrumental to the success of the independence struggle. At the centre of the contract was a commitment by the nationalists to an across-the-board  improvement in the lives and well-being of the populace, with a promise to do so in ways which overcame the discriminatory restrictions that underpinned colonial social policy and opened new opportunities for social advancement. The health and educational sectors occupied a pride of place in the early investments which post-colonial governments made in the social sectors and overall, these sectors witnessed an all-round expansion in the period up to the end of the 1970s. To be sure, even in the periods of expansion, there were numerous questions of equity and access which were posed. Apart from income-based differentials which conditioned and, in some cases, limited equitable access to health services, there were also pent-up demands which were not always met on account of various capacity limitations. Furthermore, there were sharp differences between the levels and quality of urban and rural health services, with the former being generally better resourced than the latter. Furthermore, public investments in the development of "traditional" medicine patronised by a large proportion of the populace was almost non-existent as all attention went to the development of a "modern" medical sector structured along the dominant institutional approach introduced during the colonial period. The difficulties encountered in sustaining equitable access were exacerbated by policy inconsistencies and incoherencies, including the long-term neglect of primary health care, preventive health education, and the creative interfacing of "modern" and "traditional" health services. These policy deficiencies spoke to the shortfalls and shortcomings in the allocation of resources for healthcare; they also touched upon the priorities set for the treatment of different diseases. Finally, the issue of equitable access to healthcare is linked to the broader strategies of social policy which are pursued, including especially measures designed to eradicate poverty and promote welfare. To the extent that poverty and inequality grew in significance, it could be argued that this was an area in which early post-independence policy recorded some shortcomings.   Still, the 1960s and 1970s were a period of generalised expansion in the modern African health sector, including major investments in the training of health personnel. Furthermore, in spite of the weaknesses that inhered in post-colonial African social policy in general and health policies in particular, it was not until the 1980s that the question of inequality in the health systems was brought to the fore of public debate. The immediate context for this was the economic crisis which gripped African countries at the beginning of the 1980s and the structural adjustment programmes which were introduced to manage the crisis. Both the austerity measures introduced by African governments and the thrust of the adjustment programmes that were adopted contained commitments to cost recovery and the introduction of user charges; structural adjustment went a step further to incarnate marketisation as the directive principle of policy and practice. The introduction of user charges, cost recovery and other marketisation policies occurred at the same time as real incomes for the working poor collapsed in the face of deep and repeated currency devaluations; major losses of employment took place as the public sector was first "downsized" and then "rightsized"; a heavy inflationary spiral occurred which fuelled prices and ate into incomes; the competitiveness of public sector wages and salaries collapsed and a flight of talent from the health sector in general and the public health system in particular was experienced; there was a deterioration of the physical infrastructure and equipment of public health facilities in the face of a shortage of funds associated with the deflationary public expenditure policies adopted by most governments and which particularly targeted the social expenditures of the state; and a proper public policy was lacking in relation to the traditional medical system to which an increasing number turned as part of their strategies for popular provisioning.   As the economic crises and structural adjustment policies took their toll on the public health system, the differences between public and private health provisioning widened, with the new investments taking place in the health sector mostly going into fee-paying private heath institutions run on a purely commercial logic. What was left of the public health system was itself increasingly exposed to an internal commercial logic which, for the average patient, meant payment for virtually every service rendered. And yet, in most African countries, public health insurance systems are non-existent and the culture of private health insurance remains highly underdeveloped. Also, the "social safety net" programmes put in place by most governments to alleviate the social consequences of the various reform policies introduced failed to make a positive impact as they were generally under-resourced, came with very stiff qualification criteria that were meant to dissuade as many people as possible from benefiting, produced unacceptable social stigmas, and were generally after-thoughts that were residual to the macro-economic strategy. In the meantime, traditional health insurance institutions, such as the burial societies of Southern Africa, were faced with serious difficulties of survival arising from a variety of factors, including increased levels of mortality. The new privately-owned or commercially-oriented local health service providers that emerged did not, as a consequence, serve a large proportion of the populace but only the richest individuals who also had access to private air ambulances for evacuation to the best-equipped hospitals abroad. Arguably, the growth in the international provision of health services offered on highly commercial terms and serving a clientele that is drawn from the South is reflective of the sharp social inequalities that have emerged over the last two decades in the developing countries. The practice of self-medication and treatment at home has become a prevalent feature of health-seeking behaviour of those who have been excluded from access to quality local health services at affordable prices and the "globalised" services that are on offer to the wealthy. The circulation of fake medicines and medical quackery have also been on the rise. All of these developments pose varying degrees of challenges to the well-being of the working poor. Furthermore, home-base care, always a feature of the health-seeking behaviour of the populace, has increased in significance in the face of the increasing inability of individuals and households to afford quality health services and as public health institutions became reduced to shadows of themselves and governments sought to displace the burden of care to families.   The deterioration of the public health system across Africa has had a host of consequences which have already attracted scholarly and policy attention, among them the reversal of many of the historic gains that had been made in the post-independence period especially with regard to the health and nutritional status of the populace, and the diminished capacity of the public health system to prevent and manage diseases. Most of these difficulties have been both symptom and cause of the deepening inequalities in access to health services in Africa, inequalities which have grown in tandem with the widening gulf between the rich and the poor, the expansion of the ranks of the working poor, the thinning out of the middle class, and the increased segmentation of the category of the working poor. At the same time as numerous questions of equity and access have been posed domestically, the North-South divide in health and well-being has also deepened, with Africa being the continent with the worst indicators. The drain of talent from the African health sector to the countries of the North has exacerbated this North-South divide. 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. Participants in the 2005 session of the CODESRIA Institute on Health, Politics and Society will be encouraged to explore the various dimensions of historic and contemporary inequity in the African health system, the intellectual challenges of responding to them and policy alternatives that could be pursued in the bid reform the health system and at the same time make it inclusive and effective. The range and variety of issues associated with the quest for equitable access to health services is endless and various multidisciplinary entry points are required for the achievement of a balanced and holistic understanding. Prospective participants in the Institute are invited to address themselves to these different entry points and other related aspects of research on health system governance in Africa.             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.   Applications Applicants for the position of Director should submit :   q       an application letter; q       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; q       a detailed and up-to-date curriculum vitae; and q       three writing samples.   Applications for the position of resource persons should include: q       an application letter ; q       two writing samples ; q       a curriculum vitae ; and q       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 : q       an application letter; q       a letter indicating institutional or organisational affiliation; q       a curriculum vitae ; q       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 2005 Institute; and q       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 10 June, 2005. The Institute will be held in Dakar, Senegal in July 2005.    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, CP 18524, Dakar, Senegal Tel.: (221) 825 98 21/22/23 Fax: (221) 824 12 89 E-Mail: Health.Institute@codesria.sn Website: www.codesria.org