A recent conference hosted by the Municipal Services Project in Johannesburg highlighted a growing tide of defiance from people around South Africa over privatisation and its impact on access to basic services. People travelled from all parts of South Africa to testify in the workshop on their experiences of hardship as a result of privatisation and unaffordable service costs, noting stories of evictions, and water and electricity cut offs. Most of these testimonies articulated the view that basic needs, such as water and electricity, are basic rights. Many highlighted the negative impact of reduced access to basic services such as water supplies on health and quality of life.
Among the delegates were representatives of non government organisations (NGO’s), academics, community based organisations (CBOs), and unionists. They consistently raised the constraints to service delivery under globalisation, privatisation and cost recovery measures, and their negative health impacts. Eddie Cottle of the Rural Services Development Network reported, for example, on the link between the cholera outbreak in South Africa and the introduction of user fees for water.
During the workshops, delegates discussed strategies to address the issue. Would a rights based approach or one centred on claiming legal redress for deprivation of basic rights be successful? Glen Farred from the Community Legal Centre noted that while the establishment of a constitution and a bill of rights provided certain opportunities, They were difficult to apply in the case of access to safe water. The meeting identified the need for a new wave of social mobilisation as being more important than legal battles in achieving constitutional rights around basic services.
The impact of foreign intervention in basic services was also explored. It was noted that the world’s water management continues to be taken up by foreign companies. Large dam projects funded by international finance institutions were also reported to undermine service access in poor communities. Medha Patkar from the Narmada valley India reported at the meeting on the struggle of people in the catchment area of one such large dam to stop the dam from being built. This dam was reported to be threatening 40 000 families, with thousands more homes reported to have been submerged since construction began. She described passionately the irreversible loss of a way of life, livelihood and wellbeing for indigent people and said globalisation, privatisation, and centralised management of the world’s natural resources made humanity itself one of the greatest threats to itself.
Patkar and others noted that the response to such challenges called for a social movement, able to strategise, resisting co-option by international agencies and able to resist neoliberal policies. Some role models were presented of health systems arising out of social movements, such as Daniel Chavez’s description of Porto Allegro, where strong mechanisms exist for citizen participation in municipal affairs.
The conference explored how such social forces for health are organised – and growing. Community struggles around access to basic services were seen to be snowballing, particularly when they have support from social movements around the world. More well established movements, like the youth activists and organised labour all noted their roles internationally in targeting access to serves and in building alliances with other community based organisations.
A growing social movement to pressure for basic services was thus seen as the greatest predictor of service cover. This was particularly the case as neoliberal forces have grown. As Yash Tandon noted:
“At Doha first world countries recaptured the gains won in Seattle through pressure and manipulation and aggressive tactics. The outcome was the pursuit of neoliberalism such that the markets must be opened to international competitors even for public goods. “
Market policies and inequitable development were viewed as primary threats to increasing cover of basic services. This drew attention to the potential impact of the proposed new African recovery plan - NEPAD - on access to basic services. Delegates observed features within NEPAD, including its commitment to deepen neoliberal market policies, that are likely to have negative effects for basic service access and generate increased social conflict over access to water, electricity and other basic rights. Whether poor communities obtain or lose access to safe water and electricity will certainly be one litmus test of whether NEPAD brings real recovery for African households.
1. Editorial
2. Equity in Health
Journal Of Health Economics Vol. 21 (Issue3 - May 2002) pp. 497-513. Copyright (c) 2002 Elsevier Science B.V. Antoine Bommier, Guy Stecklov. Institut National d'etudes Démographiques (INED), INRA-Jourdan, Paris, France; and Department of Population Studies, Department of Sociology and Anthropology, Mount Scopus Campus, Hebrew University of Jerusalem, Israel. While there has been an important increase in methodological and empirical studies on health inequality, not much has been written on the theoretical foundation of health inequality measurement the authors discuss several reasons why the classic welfare approach, which is the foundation of income inequality analysis, fails to provide a satisfactory foundation for health inequality analysis. They propose an alternative approach which is more closely linked to the WHO concept of equity in health and is also consistent with the ethical principles espoused by Rawls [A Theory of Justice. Harvard University Press, Cambridge, MA, 1971]. This approach in its simplest form, is shown to be closely related to the concentration curve when health and income are positively related. Thus, the criteria presented in the paper provide an important theoretical foundation for empirical analysis using the concentration curve. They explore the properties of these approaches by developing policy scenarios and examining how various ethical criteria affect government strategies for targeting health interventions.
William Easterly, Center for Global Development - Institute for International Economics, Working Paper No.1, January 2002.
This paper argues that the conflicting results in the voluminous recent literature on inequality and growth are missing the big picture on inequality and long-run economic development. Consistent with the provocative hypothesis of Engerman and Sokoloff 1997 and Sokoloff and Engerman 2000, this paper confirms with cross-country data that commodity endowments predict the middle class share of income and the middle class share predicts development. The use of commodity endowments as instruments for middle class share addresses problems of measurement and endogeneity of inequality. The paper tests the mechanisms - institutions, redistributive policies, and schooling - by which the literature has argued that a higher middle class share raises per capita income. It tests the inequality hypothesis for institutional quality, redistributive policies, and schooling against other recent hypotheses in the literature. The results were subjet to testing for over-identifying restrictions, reverse causality, and other checks for robustness. While finding some evidence consistent with other development fundamentals, the paper finds high inequality to independently be a large and statistically significant barrier to developing the mechanisms by which prosperity is achieved.
Paula Braveman, Department of Family & Community Medicine, University of California, USA; Eleuther Tarimo, Consultant, Ministry of Health and Child Welfare, Harare, Zimbabwe. Available online at the Social Science & Medicine website. While interest in social disparities in health within affluent nations has been growing, discussion of equity in health with regard to low- and middle-income countries has generally focused on north-south and between-country differences, rather than on gaps between social groups within the countries where most of the world's population lives. This paper aims to articulate a rationale for focusing on within- as well as between-country health disparities in nations of all per capita income levels, and to suggest relevant reference material, particularly for developing country researchers. explicit concerns about equity in health and its determinants need to be placed higher on the policy and research agendas of both international and national organizations in low-, middle-, and high-income countries. International agencies can strengthen or undermine national efforts to achieve greater equity. The Primary Health Care strategy is at least as relevant today as it was two decades ago; but equity needs to move from being largely implicit to becoming an explicit component of the strategy, and progress toward greater equity must be carefully monitored in countries of all per capita income levels. Particularly in the context of an increasingly globalized world, improvements in health for privileged groups should suggest what could, with political will, be possible for all.
Zimbabwe's government has declared a state of emergency over HIV/AIDS and will allow the importation and manufacture of generic drugs, a local state-controlled newspaper reported. However, Lindy Francis, director of The Centre, an NGO working with people living with AIDS (PWAs) in Harare said that if true, the declaration was "five years too late".
3. Human Resources
More than 95% of medical aid scheme members have access to HIV/AIDS cover exceeding the state's proposed package of minimum benefits, but less than 1% of them are coming forward to take advantage of the available care. This is one of the key findings of a study released by the Centre for Actuarial Research at the University of Cape Town in association with the Treatment Action Campaign (TAC).
When Mercy Makhalemele's husband died of HIV/AIDS seven years ago her home was taken away after the insurance company refused to pay out his life cover. "At the time, I decided not to fight it because I had too many things to deal with," she told IRIN. As the executive director of a local community organisation, Makhalemele has been working with members to create a burial scheme for people with HIV/AIDS. Through her work, Makhalemele said she has encountered people who have been treated with injustice and a lack of respect, because of their status.
Phyllida Travis, Dominique Egger, Philip Davies, Abdelhay Mechbal. Evidence and Information for Policy, World Health Organization, 2002.
The paper proposes that stewards should have access to reliable, up-to-date information on: Current and future trends in health and health system performance? For example, on levels, trends and inequalities in key areas such as national health expenditures; human resources; health system outcomes; health risk factors; vulnerable groups; coverage; provider performance; organisational / institutional challenges in provision, financing, resource generation, stewardship Important contextual factors and actors the political, economic and institutional context; the roles and motivation of different actors; user / consumer preferences; opportunities and constraints for change. Events / reforms in other sectors with implications for the health sector Possible policy options, based on national and international evidence and experience? For example, intelligence on different policy tools and instruments for similar problems; on their effects in different settings, and on managing change. It includes information on relatively specific things such as cost-effective interventions; and on possible institutional arrangements for different functions.
THE government, workers and employers have entered into negotiations that could result in the launch of a medical aid scheme to provide health cover for Zimbabwean workers, according to National Social Security Authority (NSSA) general manager Amod Takawira. He said NSSA, the government's main investment arm, was involved in the negotiations but would not indicate how long the consultations had been going on. "The national health insurance scheme is being finalised by the relevant stakeholders and will benefit all employees who meet the required conditions," Takawira told the Financial Gazette.
4. Public-Private Mix
Marion Danis, MD, Andrea K. Biddle, PhD, Susan Dorr Goold, MD. Journal of General Internal Medicine
Volume 17 Issue 2 Page 125 - February 2002. A frequently cited obstacle to universal insurance is the lack of consensus about what benefits to offer in an affordable insurance package. This study was conducted to assess the feasibility of providing uninsured patients the opportunity to define their own benefit package within cost constraints.
D. Fidler, CMH Working Paper Series Paper No. WG2: 18, 2002. At the beginning of the 21 st century, the global public good of infectious disease control is increasingly under-produced. The World Health Organization (WHO) warned of a global infectious disease crisis in 1996, and the crisis has deepened in succeeding years. The HIV/AIDS pandemic continues to devastate the developing world; and old scourges such as tuberculosis, malaria, cholera, and pneumonia continue to cause morbidity and mortality around the world.2 The anthrax attacks on the United States in 2001 raise the terrifying reality of bioterrorism and its threat to national and global public health. Attention to improving production of the global public good of infectious disease control has become imperative. The paper is also available online as PDF file.
5. Resource allocation and health financing
An HIV/AIDS vaccine offers the best hope of controlling the pandemic in Africa, leading scientists have said at the opening of a two-day meeting of the African AIDS Vaccine Programme (AAVP) in Cape Town, South Africa. HIV/AIDS was a "nightmare" for Africa but the development of a vaccine for the continent was a "dream worth dreaming", Jose Esparaza, coordinator of the World Health Organisation (WHO)/UNAIDS HIV Vaccine Initiative, told about 200 delegates attending the meeting. Two-thirds of all people living with HIV are in Africa, yet African vaccine research received only 1.6 percent of the US $2.5 billion spent on HIV research annually, he said.
The HIV/AIDS pandemic has spurred significant advances in reproductive health policies across Africa, however, governments do not allocate sufficient legal and financial resources to ensure that the policies are effective, according to a report launched by advocates from seven African countries: Ethiopia, Ghana, Kenya, Nigeria, Tanzania, South Africa, and Zimbabwe, and the U.S.-based Center for Reproductive Law and Policy (CRLP). The report is based on two years of collaborative research and analysis of laws and policies related to women's reproductive lives.
Somnath Chatterji, Bedirhan L Ustün, Ritu Sadana, Joshua A Salomon, Colin D Mathers, Christopher JL Murray, Global Programme on Evidence for Health, Policy Discussion Paper No. 45, World Health Organization, 2002. Health is an attribute of individuals, which is best operationalized as a multidimensional set of domains; To obtain meaningful information on health and health interventions, the boundaries of the notion of health must be determined by identifying a set of core domains of health. The threshold for loss of health in any given domain reflects norms or standards. Health state description and measurement must be distinguished from (1) subjective evaluations of health; (2) consequences of health states; and (3) environmental impacts on health and other proximate or distal determinants of health.
In keeping with the above conclusions, WHO thus recommends that for measurement purposes, health be understood as a multidimensional phenomenon that can be narrowed to a core set of health domains, each characterized by a single cardinal scale of capacity (measured or latent, and including currently available personal aids). The overall level of health associated with the set of abilities (or capacities) on the core health domains may be characterized by a cardinal scale of health state valuations. These valuations quantify level of health, not quality of life, well-being or utility.
6. Governance and participation in health
Swaziland's mayors are adopting a novel method in the fight against HIV/AIDS. They are reversing the usual top-down approach and are being led instead by their constituents, ordinary Swazis. "The voice of the people will determine how we will combat AIDS in the towns," explained chairman of the Ezulwini town board, Nokuthula Mthembu. The first woman to hold the top government post in her municipality, Mthembu is chair of the Executive Council of the Alliance of Mayors' Initiative for Community Action on AIDS at the Local Level (AMICAALL). "There has never been a project like this one," Mthembu told PlusNews. "But we absolutely must have an innovative approach to combat the deadly disease that is attacking our municipalities. We desperately need fresh ideas."
The Global Initiative on AIDS, Inc. and the Global Initiative on AIDS in Africa is calling on African journalists, writers, physicians, scientists, researchers, health care providers, grassroots activists and citizens in general who are involved on every level of the struggle against HIV/AIDS in African and throughout the Diaspora to submit articles, issues, opinions, research findings, and news about HIV/AIDS related matters. GIAA will publish "The Voice of the People," An International Journal Chronicling the Battle Against HIV/AIDS from the Perspective of Africans, African-Americans, African-Carribeans and Africans Around the World. Anyone interested in submitting articles and/or contributing to this effort should contact Angele Kwemo or Patricia Okolo.
7. Monitoring equity and research policy
A Unique Opportunity For African Stakeholders to discuss emergent social aspects Of HIV/AIDS research at a meeting preceding the World Summit on Sustainable Development (WSSD). 1st ?4th SEPTEMBER 2002; JOHANNESBURG, SOUTH AFRICA. The Human Sciences Research Council of South Africa, is establishing SOCIAL ASPECTS OF HIV/AIDS RESEARCH ALLIANCE (SAHARA), an alliance of partners to conduct, support and use social sciences research to prevent further spread of HIV and mitigate the impact of its devastation on South Africa, SADC and other regions of Africa. The African Conference will be a vehicle to improve the effectiveness of the SAHARA and to integrate its activities more closely with those of other organizations and individuals active in HIV and AIDS control within SADC and the African continent, through sharing information on progress and experience on social aspects of HIV/AIDS research.
The Canadian Institutes of Health Research (CIHR) requests your assistance in identifying African researchers/professionals involved in grassroots/national/international health issues of Africans. CIHR is taking a lead, through a Global Health Research Initiative partnership, on the consultative process leading up to the G8 meeting in June where the approval of the Africa Action Plan will take place. This Plan will define how G8 member countries will meet the objectives of the New Partnership for Africa's Development (NEPAD). CIHR seek to inform the G8 process by providing a recommendation and supporting background paper on how increased investment in health research contributes to improved health and economic development in Africa. The partners and the Coalition are seeking additional input through consultative processes that are designed to coordinate the views of the developing country researcher community, and invite the views of international and national research organizations with shared interest in global health research. Interested participants could provide input through the website of the Coalition for Global Health Research.
The Agency for Healthcare Research and Quality (AHRQ) Report No.47, 2002 AHRQ's Evidence-based Practice Center at Research Triangle Institute/University of North Carolina.
The report identifies and compares systems that rate the quality of evidence in individual research studies and compilations of studies addressing a common scientific issue. The report also provides guidance on the leading approaches currently in use for improving the quality of scientific evidence. Using well-specified criteria, the researchers identified 19 study-quality and 7 strength-of-evidence grading systems that people conducting systematic reviews and technology assessments can use as starting points for future evidence-based research projects.
The World Health Organization (WHO) released on May 16,2002 a global plan to address those issues. The strategy provides a framework for policy to assist countries to regulate traditional or complementary/alternative medicine (TM/CAM) to make its use safer, more accessible to their populations and sustainable. "Traditional Medicine: Growing Needs and Potential" is the core of the WHO Strategy for Traditional Medicine for 2002-2005. It provides brief information on the growing needs and challenges faced by traditional medicine worldwide. It also gives key messages and a checklist for the safety, efficacy and quality to policy-makers. It sets out WHO's role and how the WHO Strategy could meet the challenges to support WHO Member States in the proper use of traditional and complementary/alternative medicine.
8. Useful Resources
Edited by Peter R Lamptey, MD, DrPH and Helene Gayle, MD, MPH. The Handbook is a comprehensive source of information on how to design and manage HIV/AIDS prevention and care programs, especialy in developing countries. For a copy of this handbook or a CD ROM version, please contact Shawna Brown by email or telephone (USA)703.516.9779.
Migrants Against HIV/AIDS (MAHA), is a small, informal network of immigrant rights and AIDS activitists from Arab, African and other third world communities settled in Europe. This site gives access to some back issues of the MAHA Newsletter and information on how to subscribe to the free migrants-weekly mailing list which has articles and information about "AIDS, racism, and Third World community struggles for Health".
Six new tutorials on HIV and Pregnancy, HIV and Breastfeeding, and HIV and Nutrition. In response to the international HIV/AIDS epidemic, the JHPIEGO Corporation has begun working with the Department of Health and Human Services1(DHHS) and USAID to develop training and education programs in limited-resource settings on the Care of Women with HIV. The first product of this collaboration is a series of tutorials designed to provide physicians, faculty and healthcare trainers with the technical knowledge they need to provide high quality healthcare services to women with HIV/AIDS and to train other healthcare providers. To date, eight tutorials have been developed. A CD-ROM with all eight tutorials is also available and may be obtained by contacting JHPIEGO via email.
9. Jobs and Announcements
4th World Congress - San Francisco - 2003
June 15th - June 18th, 2003
Hilton San Francisco and Towers, California, USA
With the expansion of the world economy and increasing migration, parallel flows have occurred in health systems, medical technology and infectious pathogens. Globalism has increased the need for the development and transfer of accurate health economics research and careful policy analysis. Without it, lessons will go unlearned and mistakes will be repeated. Global health economics offers the potential to improve health for both donor and recipient countries. This is a new and important challenge in the application of economics to health and health care.
The Institute of Population Health recently established by the University of Ottawa is seeking applications for Senior and Junior Research Chairs and Postdoctoral Research Fellows. The Institute involves investigators from seven faculties within the University of Ottawa: Administration, Engineering, Health Sciences, Law, Medicine, Science, and Social Sciences. The Institute involves investigators from seven faculties within the University of Ottawa: Administration, Engineering, Health Sciences, Law, Medicine, Science, and Social Sciences. The Institute will carry out a transdisciplinary academic program of research and training in Equity studies, and will serve as a resource to the public, consumers, clinicians, government and industry. Enquiries should be addressed to Liz Lacasse Executive Assistant to Peter Tugwell, Institute of Population Health, University of Ottawa, via telephone 613-562-5346 or email.
New York, NY (May 1, 2002) -- Architecture for Humanity, a non-profit organization that promotes architecture and design solutions to global, social
and humanitarian crises, announces its 2002 International Design Competition. For this year's competition, participants are asked to develop designs for a fully equipped, mobile, medical unit and HIV/AIDS treatment center specifically for use in Africa. "Architects and designers have not only an opportunity," said Frank Gehry, Architecture for Humanity advisory board member, "but a professional obligation to help to end this crisis. We need to employ the same caliber of design talent and innovative use of materials we use in commercial projects to create a viable solution to the HIV/AIDS epidemic." The deadline for design submissions is November 1, 2002. There is a $35 entry fee which will be waived for submissions from developing countries. Contact Cameron Sinclair, Executive Director/Founder. Phone: 1 646 654 0906 or via email.
The Pan American Health and Education Foundation is pleased to announce the introduction of a new international award to recognize and stimulate excellence in the field of bioethics. The 2002 Manuel Velasco-Suarez Bioethics Award is intended to stimulate young scholars or researchers in the development of their capacities for bioethical analysis. The award carries a cash prize of US$10,000. More information can be obtained on the web. Nominations must be received by 15 June 2002 at the Foundation's US office: The Manuel Velasco-Suarez Bioethics Award Committee c/o Pan American Health and Education Foundation - 525 23rd Street NW - Washington, DC 20037
WHO is looking for people with experience in descriptive epidemiology and analysis to work on the Global Burden of Disease 2000 project. This project involves systematic reviews of available data and epidemiological studies on specific diseases, development of disease models for ensuring consistency of mortality data with other epidemiological data, and the preparation of reports and publications. Please send curriculum vitae to Dr. Colin Mathers, Acting Coordinator, Epidemiology and Burden of Disease, World Health Organization.
The South African Medical Research Council (MRC) and the South African AIDS Vaccine Initiative (SAAVI) invite applications or one-year travelling research fellowships in health research, with preference given to proposals which address the MRC's research priorities (available on the wed at the URL below) and particularly to those addressing HIV/AIDS research. The fellowship may be held in South Africa for non-South African applicants, or in any other African country for South African applicants. The award will cover the fellow's return travel from home to host country, the fellow's salary (calculated on South African scales, in US$) in the host country, and reasonable research costs in the host country. Five such fellowships may be awarded. Applicants providing proof of a research doctorate or equivalent in a health-related area including, health economics, nursing or public health will be considered. Applicants that do not hold a research doctorate or equivalent must have proven research capabilities. They must be citizens of an African country, currently working in that country, and must be able to provide assurance that there is a position to return to in their home country on completion of the fellowship. To be considered for this fellowship, applicants must submit a preliminary application with the following information: a) full curriculum vitae of the visiting fellow and host researcher,including full publications lists and reliable telephone, cellullar/mobile 'phone, fax and e-mail contact details; b) a letter of support from the host researcher; c) a letter from the home institution assuring a post to return to after completion of the fellowship; d) a 2-page project outline prepared in consultation with the host researcher; e) a preliminary budget in US$ to cover the fellows return airfare and reasonable research costs. Applicants must send a preliminary application to the MRC by Friday 28 June 2002. Applicants will be notified of the outcome of the preliminary application by Friday 19 July 2002. The full application must reach the MRC by Thursday 31 October 2002. Applicants will be notified of the nominating committee's final decision by the end of January 2003. Medical Research Council of South Africa, 2001 - PO Box 19070, 7505 Tygerberg, South Africa - Tel +27 (0)21 9380911 / Fax +27 (0)21 9380200.
The XIV International AIDS Conference has received almost 10 500 abstract submissions from the world's leading scientists, clinicians, community representatives and people living with HIV/AIDS. This is the highest number of submissions ever received in the history of the series of international AIDS conferences.