The demand for people living with HIV and AIDS in Africa to access treatment cannot be ignored. At the same time the challenges to meeting this demand are many. They include the shortfalls in health services and lack of knowledge about treatment, making decisions about newer regimens, and the risk of resistance to antiretrovirals highlighted in the paper by Stevens et al (p 280). (1 2) The challenges also include ensuring uninterrupted drug supplies, laboratory capacities for CD4 monitoring, accessible voluntary counselling and testing, trained healthcare workers, and effective monitoring of resistance to antiretroviral drugs.(3) A series of papers produced in 2003 through the southern African regional network on equity in health raised further concerns about measures to ensure fairness in the rationing of scarce treatment resources and the diversion of scarce resources from strained public health services into vertical treatment programmes.(4-8)
The reasons for these challenges are not a mystery. They stem from the chronic under-resourcing of health systems, the underdevelopment of strategic public health leadership, the attrition of health personnel, and the high prevalence of poverty, factors that already limit the delivery of many less complex primary healthcare services.(5-7) Given this context, how should resources best be allocated to ensure access to treatment for HIV/AIDS in Africa?
Existing initiatives provide some indications of what to do and what not to do. Making treatment accessible through private and non-government sectors or through redeployment of personnel without addressing the staffing, pay levels, and working conditions of health personnel in public health services can further increase attrition from essential services and aggravate uncoordinated health planning. (7)
Providing treatment on a "first come, first served" system favours urban, higher educated people who are not poor. It also unfairly delegates frontline healthcare workers to decide who does and does not access treatment, resulting in inconsistencies and even corruption. (8)
Providing treatment at central hospitals without strong links to community outreach or primary healthcare services weakens the link between prevention and care. It also limits the benefits that treatment brings in reducing stigma to the higher income users of these hospital services. (5 7) Vertical programmes established to achieve rapid delivery against unrealistic targets can divert scarce resources from strained public health services and bring undesirable opportunity costs and inefficiencies through the creation of parallel management and administrative systems.
In contrast, approaches to expand access to treatment can simultaneously strengthen health systems; build synergies between treatment, prevention, and primary healthcare services; and reach vulnerable groups. For example, when treatment is linked to prevention of parent to child transmission of HIV, provided through maternal health services, the likelihood of women having enhanced access to treatment, reduced social stigma around AIDS in women, and strengthening general maternal health services for all women is greater.
Criteria for selecting patients that explicitly target low income groups or particular subgroups of the population such as health workers and teachers (because their job promotes services for poor people), or that involve communities in decisions about selecting patients, can enhance equity and prevent the development of patronage or corrupt practices around treatment. Community health workers have had an important role in Africa in nutrition, immunisation, maternal health, child spacing, and many interventions that enhance health and treatment related literacy. Developing their role in access to treatment could strengthen primary health care and should be further explored. (7)
Such approaches to treatment access on a national scale will be possible only if the health system is properly organised, coordinated, and managed, and if it is adequately resourced. Organisationally, the principles of a district health system should remain paramount as a remedy to the destructive effects of uncoordinated, disease focused, vertical interventions. For such systems to be functional, we need to address the growing shortfalls and maldistribution of personnel and resources in African countries. (8 9)
If effective, equitable, and sustainable approaches to treatment access are to be replicated, considerable new resources will need to be channelled to Africa's health systems, particularly for district level services. Such resources should come from national public budgets, overseas development aid, global funds, and from the cancellation of debt. The International Monetary Fund and World Bank medium term expenditure framework constraints currently limiting the uptake of increased resources in the public health sector also need to be revisited.
The global recognition of rights to treatment reflects a significant shift in mindset. Another shift is now needed to deliver on those aspirations. Health systems cannot be built from a patchwork of non-government, vertical, ad hoc services around a crumbling public sector core. For treatment access to become a reality for more than a minority, a further step needs to be taken towards an explicit global and national commitment to refinance Africa's public health sector and district health systems.
* For a list of references, please click on the link below. This article was an editorial in the 31 January issue of the British Medical Journal. http://bmj.bmjjournals.com
1. Editorial
2. Equity in Health
In mid-December, the World Health Organisation (WHO) released its annual World Health Report, the first under the leadership of Director-General Jong-wook Lee. Building on its earlier announcement of a plan to bring AIDS treatment to 3 million people by the end of 2005 (http://www.africafocus.org/docs03/who0312.php), the WHO called for a return to the goal of "Health for All" adopted twenty-five years ago. The report calls for strengthening health systems across the board to address the widening gap between rich and poor countries, and it stresses that AIDS treatment will not be sustainable unless it is linked to the strengthening of primary health systems. The report thus presents a sharp contrast to the U.S. model of commercialized health care and the bilateral approach stressed by President Bush's new AIDS initiative. U.S. officials have used the weaknesses of national health care systems in African and other developing countries as an argument for a slower pace in funding for AIDS programs. The WHO reverses that argument, stressing the need for immediate steps to build additional health care capacity. This posting from the AfricaFocus Bulletin contains excerpts from the WHO's World Health Report, as well as links to additional recent reports from late 2003.
HIV/AIDS awareness campaigners from developing nations are mobilising themselves to form a strong bloc to confront the World Trade Organisation (WTO), which they claim has made it difficult for people living with the disease to access treatment. They claim that the trade body articulates interests of western nations, which have suppressed developing states, giving way to unfair trade. This, the campaigners say, has made it impossible for poor nations to obtain cheap drugs, especially antiretrovirals (ARVs).
“At least tens of thousands of children die every year” because the World Health Organisation and the Global Fund for AIDS, Tuberculosis, and Malaria (GFATM) continue to fund (or support the funding) the purchase of old drugs by African countries rather than the newer, more effective and dramatically more expensive artemisinin-class combination therapies (ACT), according to an editorial “viewpoint” published in the January 17th issue of The Lancet. The editorial, written by academic malaria specialists and some researchers in the developing world accuses both organisations of “medical malpractice” and blames them for caving into pressure from donor governments such as the USA, whose aid officials say that ACT is too expensive.
Senior WHO and World Bank officials have warned donor countries and developing countries that many poor nations are behind in meeting the millennium development goals (MDGs) by the target date of 2015, and stressed that more resources and good policies and programmes are needed. The health-related goals include: halving maternal and child mortality rates by 2015; halving the proportion of people who suffer hunger; combating HIV/AIDS and other infectious diseases; and enhancing access to safe drinking water and essential drugs. A recent study by the World Bank concluded that so far no sub-Saharan African country is on target to reach the MDGs.
The South African AIDS advocacy group Treatment Action Campaign, which has been nominated for the 2004 Nobel Peace Prize, announced plans in January for a new campaign in its battle for universal AIDS treatment that would target inequities between the country's public and private health care systems, Reuters reports. South Africa's health care system has retained its apartheid-era structure of "elite" private hospitals, which primarily care for wealthy whites, and public hospitals, which are overburdened in their attempts to care for the majority of blacks, Mark Heywood of TAC said. In its campaign, TAC plans to target private hospitals, which it says are "too expensive," and push for a "people's health service for a people's antiretroviral program," Heywood said.
War is devastating health standards around the world as resources are deflected from fighting disease, health activists said ahead of the World Social Forum. The People's Health Movement, an international pressure group, said that more than 30,000 children over the world died of preventable diseases every day. Nine billion dollars is needed to provide water and sanitation for poor nations, while the global military expenditure was 900 billion dollars a year, said K. Unnikrishnan, spokesman for the movement.
Zambian President Levy Mwanawasa announced his government will provide free anti-retroviral drugs to about 100,000 patients by next year through the public health system. In a state-of-the-nation address to parliament, Mwanawasa said 10,000 HIV-infected people have so far been put on anti-retroviral therapy provided by the government.
3. Values, Policies and Rights
In order to understand how and why social movements are fighting for women's health and rights you need to have a 21st century notion of these rights. This is a central message of the book Global Prescriptions: Gendering Health and Human Rights. The rights that Rosalind Pollack Petchesky discusses are not those determined by grey-suited lawyers and bureaucrats, and enshrined as fixed, universal, and unalienable principles. They are rights that exist in an era of global capitalism; rights that are influenced by sex, race, class, geography, and ethnicity; rights that are dynamic and malleable; and rights that, above all, are a necessary and irrepressible element of movements for social change. Petchesky views individual and social rights as "two sides of the same coin". She ascribes equal importance to social and economic rights as to those related to reproduction, sexuality, and health; noting that together they form "a single fabric of rights".
Gaps in child mortality between rich and poor are unacceptably wide and growing. Poorer children face disadvantages at every step from exposure and resistance to infectious disease, through care-seeking, and to effective treatment. How can policy-makers close these gaps? An international team of researchers explore the options of targeting and universal coverage.
This new publication draws attention to important human rights issues that migration poses for health policy-makers internationally, such as the health implications of forced migration as well as detaining and screening migrants at the borders. The book will serve as a guide to emphasise important human rights principles by which governments, policy-makers and other actors can design and implement health policies and programmes in the context of migration. It sets out to demonstrate the need for further attention, research and elaboration of policy approaches in this area.
4. Health equity in economic and trade policies
The movement of private capital into developing economies has stalled. Moreover, the flow of private capital is often concentrated, fickle and reversible. Recent research has looked at the potential changes that could be made to the international financial system to influence private investors and lenders and increase the size, regularity and geographical spread of the flow of capital to poor countries. The expansion of private capital flows to developing countries which took place in the early 1990s has not continued. Crises in emerging markets and an increased aversion to risk on the part of investors and bankers have led to developing countries having limited access to sufficient – and sufficiently long-term – flows of private capital. The volatility of these flows to emerging markets has had a grave impact on economic development. This is according to research from the Institute of Development Studies and the University of Oxford’s Queen Elizabeth House.
Debt relief should be financed as it is more efficient than new aid, and because it reduces the burden of managing aid, argues this paper from the UN Economic Commission for Africa. The paper says that debt relief is an important source of finance for African countries but on its own will be woefully insufficient to allow African countries to finance the Millennium Development Goals (MDGs) and achieve long-term debt sustainability. The paper also examines the rationale for further debt relief and the ways in which debt relief can be financed.
"We denounce the unsustainable situation of debt in poor countries of the world, and the coercive use by governments, multinational corporations and international financial institutions. We strongly demand the total and unconditional cancellation and rejection of the illegitimate debts of the Third World. As a preliminary condition for the satisfaction of the fundamental economic, social, cultural and political rights, we also demand the restitution of the longstanding plunder of the Third World. We especially support the struggle of the African peoples and their social movements. Once again we raise our voices against the G8 Summit and the meetings of the IMF and World Bank, who bear the greatest responsibility for the plunder of entire communities. We reject the imposition of regional and bilateral free-trade agreements such as FTAA, NAFTA, CAFTA, AGOA, NEPAD, Euro-Med, AFTA and ASEAN."
5. Poverty and health
Poverty reduction efforts in Malawi pivot on the twin strategies of the Poverty Reduction Strategy Paper (PRSP) and decentralisation. Yet researchers argue that the Malawi PRSP represents a mixture of policies and generalities that could equally well have appeared in any strategic document of the past 30 years. A paper from the University of East Anglia’s Overseas Development Group takes a sceptical view of the PRSP and decentralisation processes in Malawi. The authors argue that PRSP-generated poverty indicators cannot reveal causes and effects regarding the opportunities and constraints experienced by citizens. The report shows that creating an enabling environment for people to construct their own routes out of poverty may be prevalent in many PRSPs, but the nature of public sector roles and modes of conduct required to build such an enabling environment are poorly articulated by both donors and governments.
Proper nutrition is a powerful good: people who are well-fed are generally healthy. Healthy women can lead more fulfilling lives; healthy children learn more in school and out. Good nutrition benefits families, their communities and the world as a whole. Malnutrition is, by the same logic, devastating. It plays a part in more than half of all child deaths worldwide. It perpetuates poverty. Malnutrition blunts the intellect and saps the productivity of everyone it touches, said a new report released by Unicef for the World Economic Forum.
Long-term and vigorously pursued redistributive strategies and policy frameworks are key to eradicating poverty and inequality in South Africa. In addition, sustainable poverty eradication programmes ought to be elaborated within a broader redistributive framework within which development activities would be located. This would also create space for winning back the support of civil society, according to a paper from the Southern African Regional Poverty Network that reviews the status of poverty and inequality in South Africa before exploring the contestation over how to lessen both.
What effect does the degree of a family's poverty have on the health of young children? Are girls the losers when it comes to healthcare in Tanzania? The Ifakara Health Research and Development Centre, together with colleagues from research groups in six countries, studied health care for children under five in poor rural areas of southern Tanzania.
6. Equitable health services
Researchers examined how well Lusakan health services met the safe motherhood and reproductive health care needs of women with disabilities, using in-depth tape-recorded interviews with 24 women with disabilities and 25 safe motherhood service providers. Social, attitudinal, and physical barriers to accessing safe motherhood and reproductive health services in this particular setting were experienced by the women, such as assumption among reproductive health service providers that women with disabilities will not be sexually active and will not require reproductive health services. Beliefs about transmission of disabilities were also experienced, and nurse-midwives' feared delivery complications in women with physical impairments.
7. Human Resources
A study by South Africa's Human Sciences Research Council (HSRC) has confirmed earlier findings regarding the under reporting of emigration by highly skilled South Africans to major consuming countries such as the United States, Canada, the United Kingdom, Australia and New Zealand, with the flow up to four times higher than the official figures of Statistics South Africa. Releasing the study, entitled "Flight of the Flamingos, the Study on Mobility of Research and Development (R&D) workers" in Cape Town, the HSRC said a key finding was that, although emigration figures of highly skilled researchers remain high, the greatest mobility of high-level skills is now within the country.
In the health sector, HIV/AIDS increases the demand for care, the level and complexity of work and the risk of infection, whilst also placing a strain on resources. These burdens exacerbate problems of sickness, absenteeism and workload, increasing losses of health workers. The stress and fear lowers health worker morale and adds to factors pushing them out of low-income countries and into the international labour market. This paper, produced by EQUINET, discusses the implications for health personnel of the HIV epidemic, and health sector responses to it, in southern Africa, using Malawi as a case study. The paper first covers the context of health sector organisations in southern Africa, and then in Malawi.
The devastating impact of HIV/AIDS on the general population in Africa is now well recognised but the extent to which it affects the health workforce is less understood and appreciated. Recently two researchers from the Support for Analysis and Research in Africa (SARA) project, under the oversight of the Academy for Educational Development (AED), looked at the dual impact of HIV/AIDS on the health workforce and on health care systems. The result is a streaming video, produced by the World Bank, which records a discussion of the findings of this research with the SARA researchers, Dr. Stephen Kinoti, a former professor of paediatrics at the University of Nairobi, and Oscar Picazo, a senior health economist on leave from the World Bank's Africa region. The video includes a discussion of the real and perceived risks health care workers face with the pandemic and human resource factors that influence the supply of services, costs and data.
The problem of geographical imbalance among human resources for health (HRH) across countries in the developing world holds important implications at the local, national and international levels, in terms of constraints for the effective deployment, management and retention of HRH, and ultimately for the equitable delivery of health services. This is according to a study that investigated the uses of demographic census data for monitoring geographical imbalance in the health workforce for three developing countries, as a basis for formulation of evidence-based health policy options.
Commissioned by the SADC (Southern African Development Community) AIDS Network of Nurses and Midwives (SANNAM) in collaboration with UNAIDS, this report summarises the results of a month of field research in five countries in Southern Africa – Botswana, Lesotho, Namibia, South Africa and Zambia. It highlights the fact that, among health professionals, nurses and midwives shoulder most of the care, treatment and support responsibilities for people living with HIV/AIDS (PLWHA) in Southern Africa. It also stresses the limited resources and constraints under which they deliver care.
The papers presented in the book cover the main dimensions of HRD in health: planning and managing the workforce, education and training, incentives and working conditions, managing the performance of personnel and policies needed to ensure that investments in human resources produce the benefits to which the investing populations are entitled. Authors write from diverse professional, regional and cultural perspectives, and yet there is a high degree of consistency in their diagnosis of problems and proposals for strategies to address them. They all agree on the multidimensionality of problems and on the need for solutions that take into account all dimensions. They also agree that if problems tend to be similar in nature, they take forms that are time and context-determined.
8. Public-Private Mix
The UK Department for International Development (DFID) funded the Initiative on Public Private Partnerships for Health (IPPPH) to conduct a pilot study in Uganda to assess the health and health systems impact of public private partnerships (PPPs) for improving access to pharmaceuticals in relation to leprosy, lymphatic filariasis, onchocerciasis, sleeping sickness, and HIV/AIDS. The specific remit was to examine issues of ownership, integration, coordination, implementation and impact, with a particular focus on the unique strengths and problems of these access PPPs as distinct from other comparable programmes where drugs are competitively procured.
What chance do poor countries have of reducing child mortality by two thirds between 1990 and 2015? What contribution can public spending make to meeting this Millennium Development Goal (MDG)? Research by the Overseas Development Institute suggests the need for a greater pro-poor focus in public health expenditure. The author argues that the state’s role is to provide public goods, to regulate healthcare and health insurance, and to offer a safety net for the poor. Good health itself and many preventative and curative interventions have broader benefits for society. This justifies state funding of health.
9. Resource allocation and health financing
The gravity of the HIV/AIDS situation in Botswana, Lesotho, Mozambique, South Africa, Swaziland and Zimbabwe calls for prioritisation, protection and targeting of HIV/AIDS spending, says a comparative study by the Human Sciences Research Council (HSRC), South Africa that assesses the readiness and ability of six African countries to respond to the HIV/AIDS epidemic. The study says revenue neutral efforts have not been very successful and that it will be important for all these countries to share lessons and experiences before and after they embark on the Global Fund process. Furthermore, the ability to absorb the vastly increased resources will be a critical determinant of whether these resources are translated into increased outputs and ultimately increased outcomes.
Cost-effectiveness analysis (CEA) is potentially an important aid to public health decision-making but, with some notable exceptions, its use and impact at the level of individual countries is limited. A number of potential reasons may account for this, among them technical shortcomings associated with the generation of current economic evidence, political expediency, social preferences and systemic barriers to implementation. However, health policy-makers and programme managers can use results as a valuable input into the planning and prioritization of services at national level, as well as a starting point for additional analyses of the trade-off between the efficiency of interventions in producing health and their impact on other key outcomes such as reducing inequalities and improving the health of the poor.
10. Equity and HIV/AIDS
The demand for people living with HIV and AIDS in Africa to access treatment cannot be ignored. At the same time the challenges to meeting this demand are many. They include the shortfalls in health services and lack of knowledge about treatment, making decisions about newer regimens, and the risk of resistance to antiretrovirals. The challenges also include ensuring uninterrupted drug supplies, laboratory capacities for CD4 monitoring, accessible voluntary counselling and testing, trained healthcare workers, and effective monitoring of resistance to antiretroviral drugs. A series of papers produced in 2003 through the southern African regional network on equity in health raised further concerns about measures to ensure fairness in the rationing of scarce treatment resources and the diversion of scarce resources from strained public health services into vertical treatment programmes.
In Malawi, HIV/AIDS has created an increasing demand for healthcare, exacerbated by population pressure, chronic poverty and food insecurity. This demand is set against a reduced capacity to supply healthcare. With funding from the Global Fund for HIV/AIDS, Tuberculosis and Malaria (GFATM), Malawi is now in a position to commence a programme of provision of anti-retroviral therapy (ART) using a public health approach, within an integrated programme of prevention, care and support. This technical paper, produced by Equinet in cooperation with Oxfam GB, analyses the equity issues in HIV/AIDS health sector responses in Malawi, including access to ART.
AIDS activists from the advocacy group, AIDS Therapeutic Treatment Now, South Africa (ATTN SA) expressed outrage and frustration over the move by the South African government to cut by two-thirds its AIDS budget. According to the Financial Times (UK) newspaper (2/2/04), "The initial budget of R296m (pounds Sterling 22m, $42m, euro 34m) for the first phase of the roll-out of treatment, up to the end of next month, has been cut to R90m by the Treasury, without explanation."
Problems with drug supply of antiretrovirals have come to the surface in both Nigeria and South Africa in the past few weeks as the realities of implementing large-scale treatment access begin to hit home. In South Africa the Treatment Action Campaign (TAC) has issued a warning that supplies of the paediatric formulation of efavirenz (Stocrin) are running out, with no stock guaranteed to be brought into the country by the drug’s manufacturer, Merck Sharp and Dohme (MSD), before January 28. TAC claims that one patient has already had to interrupt treatment as a result of the drug `stock out`, and highlights the risk of resistance that may arise if efavirenz treatment is interrupted without planning.
A paper developed by the Health Systems Resource Centre on behalf of the Department for International Development (DFID) and in collaboration with the World Health Organisation (WHO) aims to increase understanding of the requirements for introducing and scaling up provision of antiretroviral therapy (ART) as part of comprehensive HIV/AIDS programmes in resource-poor countries. The paper provides an overview of experience and lessons learned with regard to: The feasibility of ART in resource-poor settings; The different approaches being taken to delivery of ART; and The issues to be considered in scaling up ART provision. The review is based on published and unpublished literature, interviews with key informants, web searches and country information.
11. Governance and participation in health
Broad public services most important to the poor - health and education - are also the services most vulnerable to three distortions of the political marketplace: Lack of information among voters about politician performance; Social fragmentation among voters manifested as identity-based voting; and Lack of credibility of political promises to citizens. This is according to a World Bank Policy Research Working Paper. For decentralization to have a positive impact on social services, says the Paper, voters must be more likely to use information about the quality of local public goods in making their voting decisions for local elections, and political promises to voters at large must be more credible than when decision-making over local public goods was in the hands of regional or national governments. Support for better education and health outcomes, and support for political party development and the development of political institutions are important elements to enhance credibility in the political system.
Community participation is widely advocated as a mechanism to allow health service users to be involved in the design, implementation and evaluation of activities, with the aim of increasing the responsiveness, sustainability and efficiency of health programmes. This exploratory study conducted by the National Institute For Medical Research (NIMR), Tanzania reviews nearly 100 studies, mainly from the developing world. Topics covered include the link between community participation, governance and equity in health; and the factors explaining poor community involvement, despite increasing emphasis on decentralisation.
12. Monitoring equity and research policy
The purpose of this report was to assess the application of clinical predictors for the diagnosis of the HIV infections, including AIDS, among TB-positive subjects enrolled within an urban heterosexual sero-discordant couple (one partner HIV-positive and the other HIV-negative) cohort study at an HIV prevention and research centre in Lusaka, Zambia. The report documents the relative effectiveness of the World Health Organisation clinical case definition for HIV/AIDS (WHOCCDA) in predicting HIV/AIDS cases and discusses the health and policy implications.
13. Useful Resources
The African Regional Youth Initiative (ARYI) is a collaboration of youth and community-based projects and organisations in Africa working to fight HIV/AIDS and malaria. The ARYI releases a newsletter every two months full of latest activities and events being implemented by ARYI members around the world. The January edition of the newsletter has just been released.
AMEDEO has been created to serve the needs of healthcare professionals, including physicians, nurses, pharmacists, administrators, other members of the health professions, and patients and their friends. They can easily access timely, relevant information within their respective fields. AMEDEO’s core components include weekly emails with bibliographic lists about new scientific publications, personal Web pages for one-time download of available abstracts (see example), and an overview of the medical literature published in relevant journals over the past 12 to 24 months. All these new information resources are free of charge.
This web site contains comprehensive information on scientific journals impact factor, science citation index, history of science and tips on good publication practice. This information is relevant to health professionals in developing countries particularly those with academic affiliations/aspirations.
14. Jobs and Announcements
The Regional Network for Equity in Health in Southern Africa (EQUINET) and Health Systems Trust South Africa (HST) are inviting expressions of interest from individuals or organisations based within the region to contribute to a programme of work on Equity in the Distribution of Personnel in Southern Africa. Equinet is a network of research and advocacy organizations that have a specific concern for equity in health issues based within the SADC region (see www.equinetafrica.org or email admin@equinetafrica.org).
This South Africa Symposium on Private Sector Roles for the Public's Health is being held in cooperation with the Nelson Mandela School of Medicine, The African Health Forum, The Nuffield Trust of England, and the Cambridge International Health Leadership Programme of the Judge Institute of Management in Cambridge England. The symposium will among other highlights showcase new insights into successful outsourcing of services from public hospitals and health plans to private sector organisations.
Monitoring and Evaluation for Sexual and Reproductive Health examines the underlying principles of monitoring and evaluation for programme managers. Participants explore the steps in establishing effective monitoring and evaluation systems and are guided in how to integrate gender analysis into their monitoring and evaluation plans.
The conference will bring together stakeholders interested in the Social Aspects of HIV/AIDS Research in Africa. The conference is expected to be all embracing of all institutions, networks and alliances and would be widely disseminated through AFRONETS, AFAIDS and other dissemination channels. All interested stakeholders are urged to distribute the announcement of this meeting. The outcome of the African Conference should be of specific interest to researchers and policymakers who would like to promote SAHARA within the New Partnership for African Development (NEPAD).
Are you committed to equity in health and health care? Would you like to work with skilled and committed individuals in developing countries around the world? Are you willing to travel? This is an exciting opportunity for a committed, enthusiastic, and hard working public health professional to work with world-renowned researchers, advocates and policy-makers focused on cutting-edge public health work. GEGA, based out of Health Systems Trust in South Africa, is dedicated to the promotion of equity in health and health care through effective advocacy and community action, based upon reliable health monitoring information. GEGA focuses on fairness in health and access to health care. GEGA's 13 country-based Equity Gauge projects, located in South America, Africa, and Asia, monitor inequalities and injustices in the distribution of health and health care resources, and aim to ensure that countries and communities can use this information to make a difference to those with the poorest health and the greatest need. More information on GEGA can be found at www.gega.org.za.
The Global Fund to Fight AIDS, Tuberculosis and Malaria has issued a call for a new round of proposals for grant funding. The new round of grants will contribute to a substantial increase in the amount of money available in the global fight against the three diseases.
This campaign aims to promote a universal access to healthcare and to reassert the role of the Government as guarantor of the universal right to health. In order to do so we are asking the World Bank to :
· Cease promoting the privatization of health services and to redirect its financing towards public and supportive health system ;
· Stop supporting the utilization of user fees, which limit the access to health for the poorest populations ;
· Deliver its aid through grants instead of loans, so that financing access to health no longer adds to States' indebtness.
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