EQUINET NEWSLETTER 36 : 01 March 2004

1. Editorial

Free trade agreements, Southern Africa and access to health services


* Treatment Action Campaign (TAC)/AIDS Law Project (ALP) Memorandum on the United States/Southern African Customs Union Free Trade Agreement Negotiations. Prepared by: Jonathan Berger (Law and Treatment Access Unit, AIDS Law Project) and Njogu Morgan (International Desk, Treatment Action Campaign.

Introduction

On 4 November 2002, United States Trade Representative (USTR) Robert Zoellick formally notified US Congressional leaders of President Bush's intention to initiate negotiations for a free trade agreement (FTA) with the Southern African Customs Union (SACU), which includes Botswana, Lesotho, Namibia, South Africa and Swaziland. These negotiations are now underway, with the next round scheduled for 23 February 2004 in Namibia. As far as we are able to ascertain, the negotiators plan to conclude their discussions in or around October 2004, with a US-SACU FTA being signed before the end of the year.

The Treatment Action Campaign (TAC) and the AIDS Law Project (ALP) believe that trade between nations, when conducted within the framework of a reasonable and fair set of rules that adheres to the triple-bottom line of environmental, social and commercial sustainability has the potential to act as a tool for attaining developmental priorities. Our support for the ongoing negotiations would therefore be predicated on the agreement strictly adhering to these principles. Yet the US position, as clarified in Mr Zoellick's correspondence with Congress, raises cause for concern.

In his letters to the Speaker of the House of Representatives and the President of the Senate, Mr Zoellick set out reasons for entering into such negotiations, as well as the USTR's “specific objectives for negotiations with the SACU countries”. In particular, Mr Zoellick raises the following US objectives:

“We plan to use our negotiations with the SACU countries to address barriers in these countries to U.S. exports - including high tariffs on certain goods, overly restrictive licensing measures, inadequate protection of intellectual property rights, and restrictions the SACU governments impose that make it difficult for our services firms to do business in these markets. We also see the negotiations as an opportunity to advance U.S. objectives for the multilateral negotiations currently underway in the World Trade Organisation (WTO)." In our view, a number of the specific objectives identified have the potential to undermine the financing and provision of health care services in SACU countries, both in the public and private health sectors, as well as the rights of people living with HIV/AIDS. In particular, if translated in binding commitments, many of these objectives have the potential to limit the ability of the South African government in discharging its constitutional obligations, primarily in respect of the right of access to health care services. In our view, such undertakings would be an unconstitutional exercise of power.

This memorandum highlights our concerns in respect of two key areas: intellectual property (IP) and trade in services.

Intellectual property

With respect to intellectual property rights, the US government's specific objectives are as follows:

" - Seek to establish standards that reflect a standard of protection similar to that found in U.S. law and that build on the foundations established in the WTO Agreement on Trade-Related Aspects of Intellectual Property (TRIPs Agreement) and other international intellectual property agreements, such as the World Intellectual Property Organisation Copyright Treaty and Performances and Phonograms Treaty, and the Patent Cooperation Treaty.

“ - Establish commitments for SACU countries to strengthen significantly their domestic enforcement procedures, such as by ensuring that government agencies may initiate criminal proceedings on their own initiative and seize suspected pirated and counterfeit goods, equipment used to make or transmit these goods, and documentary evidence. Seek to strengthen measures in SACU countries that provide for compensation of right holders for infringements of intellectual property rights and to provide for criminal penalties under the laws of SACU countries that are sufficient to have a deterrent effect on piracy and counterfeiting.”

Quite clearly, the US sees the SACU negotiations as an opportunity to extract standards of intellectual property protection in excess of what the Agreement on Trade-Related Aspects of Intellectual Property (or TRIPS) currently requires. This is consistent with its approach to other regional and bilateral trade negotiations. A review of a range of such trade negotiations initiated by the US indicates that it has sought to extract greater concessions than those provided under existing international trade rules, largely to the detriment of developing countries.

To meet "standards of protection similar to that found in U.S. law", SACU nations would be required to adopt a range of TRIPS-plus provisions, including limiting compulsory licenses to national emergencies or to governmental, non-commercial use only. This is clearly in conflict with the Declaration on the TRIPS Agreement and Public Health adopted at the WTO Ministerial Conference at Doha in November 2001, which unambiguously states that "[e]ach Member has the right to grant compulsory licences and the freedom to determine the grounds upon which such licences are granted". Further, SACU members would be required to bar parallel trade, to extend patent monopolies for administrative delays, to link drug registration rights to patent status, to enhance protections for clinical trial testing data and to adopt criminal enforcement for patent violations, including improvidently granted compulsory licenses.

In short, the specific objectives in respect of IP would significantly undermine the ability of SACU member states' to make use of the regulatory flexibilities and public health safeguards identified in the Doha Declaration. If implemented, the negotiating objectives would severely limit access to essential medicines used in the prevention and treatment of a range of health conditions, including but not limited to HIV/AIDS. In addition, by seeking to impose TRIPS-plus provisions on SACU members, the USTR would be violating the principal negotiating objectives in the US Trade Act of 2002, which require "respect [for] the Declaration on the TRIPS Agreement and Public Health, adopted by the World Trade Organisation at the Fourth Ministerial Conference at Doha, Qatar on November 14, 2001", as well as Executive Order 13155, which deals specifically with access to "HIV/AIDS pharmaceuticals or medical technologies".

Trade in Services

With respect to trade in services, the US government's specific objectives include pursuing "disciplines to address discriminatory and other barriers to trade in the SACU countries' services markets." As mentioned above, the US plans to use the negotiations to address "overly restrictive licensing measures" and "restrictions the SACU governments impose that make it difficult for our services firms to do business in these markets."

If implemented, these negotiating objectives would render a range of legislative provisions in the South African Medical Schemes Act, for example, as unlawful. Such provisions increase access to health care services, by ensuring that unfair discrimination on the basis of health status is prohibited and by ensuring that medical scheme beneficiaries are guaranteed a minimum package of care, regardless of financial contribution.

It is not only trade in health care services that is of concern to TAC and the ALP. Similar arguments apply with equal effect, for example, to any regulatory steps taken by the state to ensure access to financial services for people living with HIV/AIDS. In our view, the state has a constitutional obligation to regulate the insurance services industry in such a manner, to ensure that people with HIV/AIDS have access to life cover and funeral benefits, as well as access to insurance services necessary for accessing financing for housing.

Conclusion

The ALP and TAC are concerned that the US/SACU FTA negotiations have the potential to result in binding commitments on SACU member states that undermine access to health care services, the rights of people living with HIV/AIDS and the ability of such states to comply with their domestic, regional and international human rights obligations. In our view, such an agreement would not only unlawfully conflict with certain national constitutions and human rights instruments, but would also serve to advance the interests of the US at the expense of the health and welfare of the people of Botswana, Lesotho, Namibia, South Africa and Swaziland.

* Please send comments for publications in the Letters section of Equinet News to editor@equinetafrica.org

2. Equity in Health

Bush's Aids plan slammed by activists

The Bush Administration's Global AIDS strategy is based on selective and misleading use of science, evidence and rhetoric in support of an ideological approach to AIDS prevention and treatment that fails to address the needs of women and girls, who now represent the majority of those infected with HIV worldwide, asserts the Centre for Health and Gender Equity (CHANGE), a U.S.-based organisation focused on the effects of U.S. international policies on women's rights and health worldwide. "This plan is all smoke and mirrors when it comes to responding to the spread of HIV among women and girls," asserted Jodi Jacobson, Executive Director of CHANGE. "On one hand, the strategy correctly cites critical factors, such as violence and sexual coercion, that put women and girls at high risk of infection," notes Jacobson. "Yet the plan fails to offer any concrete strategies for addressing these concerns." This posting also includes information from the latest issue of the Africa Focus Bulletin on the Aids plan, which was released in late February.

Further details: /newsletter/id/30266
Healthcare for SA poor comes first, says HST

Improvements in secondary and tertiary hospital capacity should not come at the expense of basic care for the poor, the Health Systems Trust (HST) says. The Durban based NGO was responding to a speech by Minister of Health Manto Tshabalala-Msimang, in which she said R2 billion would be spent on upgrading and revitalising hospital facilities next year, including the building of 18 new facilities. The minister also said inequities in the funding allocated to primary healthcare in different provinces would have to be addressed, with some provinces allocating R50 per person each year, and others R300. But Antoinette Ntuli, HST information dissemination and equity director, urged her to ensure resources and initiatives are "fast-tracked in poor, rural areas".

SA doctors certificates will stay, says health minister

The proposed Certificate of Need (CoN) for doctors, which they claim intrudes on their right to freedom of movement, will remain. This was the word from Health Minister Manto Tshabalala-Msimang in a February media briefing. "The government will move on the CoN framework to achieve our goals in terms of the constitution," the minister said. "The CoN will remain. It is intended to transform the healthcare sector in South Africa."

TAC and Aids Law Project hold health transformation seminar

On the 10th of February, the Treatment Action Campaign (TAC) and the AIDS Law project held a joint seminar on transformation of the South African Health System, including both the public and private sectors. This is part of preparations for a conference to be held in May with the aim of developing detailed policy positions for TAC's Campaign for a People's Health Service. Presentations made at the workshop can be found on the TAC website.

To march or not to march: Protest sparks debate over health legislation

The South African Medical Association (SAMA) organised a protest march by doctors to the opening of parliament on 6 February. Amongst other grievances, the march was over controversial new legislation that includes a proposed Certificate of Need (CON) that would impact on where doctors are able to practice. SAMA said in the build up to the march that the CON would intrude "on doctors’ right to human dignity; freedom of movement and residence; freedom of trade, occupation and profession; and property rights". This sparked a debate when the Peoples' Health Movement came out in support of the CON, saying it represented an attempt to address the greatest inequity in S.A.'s health system, namely the widening gap between the public and private health sectors. Read the PHM press statement and a report from the SAMA website about the march by clicking on the link below.

Further details: /newsletter/id/30308
UN criticises developed countries for reneging on promises on sexual health

The developed world is breaking its pledges to fund sexual and reproductive health care in the developing world, says a new report published by the Alan Guttmacher Institute and the United Nations Population Fund. "It is time for developed countries to live up to the pledges they made at the 1994 International Conference on Population and Development (ICPD). In 2000, these countries provided $2.6 billion (£1.4; €2.1bn) for sexual and reproductive health services in developing countries - less than half of what they had pledged at ICPD for that year," the report states.

3. Values, Policies and Rights

Basic services, democracy and human rights
Seminar report

The challenge for human rights academics, activists, and advocates is to make human rights relevant to the issue of privatisation of basic services. The human rights framework must be used to ensure that privatising basic services does not result in the denial of rights. This was identified as one of the challenges at a seminar hosted by the Socio-Economic Rights Project and the Local Government Project of the Community Law Centre on 2–3 October 2003, at the University of the Western Cape. The seminar looked at the privatisation of basic services, democracy and human rights. The need for collaborative efforts with social movements and community organisations for effective use of legal strategies in challenging ill-planned privatisation policies was emphasised.

Health and Human Rights Publication
An International Journal Announcement

The FXB Centre has published Health and Human Rights since 1994. The journal explores the reciprocal influences of health and human rights, including the impact public health programs and policies have on human rights, the consequences human rights violations have on health, the importance of health in realizing human rights, and the ways in which human rights can be integrated into public health strategies. Health and Human Rights may provide free or reduced-price, two-year subscriptions for individuals in developing countries upon request. Some institutions in developing countries - NGOs, universities, and libraries with restricted budgets - may also be eligible for a free or reduced-price subscription.

Not a minute more: Ending violence against women

Violence against women has become as much a pandemic as HIV/AIDS or malaria. But it is still generally downplayed by the public at large and by policymakers who fail to create and fund programmes to eradicate it. However, the achievements over the last few decades of women and men around the world who have worked to combat violence against women and promote women's empowerment are monumental. This report from Unifem also includes a focus on the problem of violence against women as a violation of human rights as well as a public health issue. "In the last decade, gender-based violence moved from the shadows to the foreground. It is increasingly recognized as a violation of human rights, as a public health problem and as a crime against women and society," says the report.

The domains of health responsiveness: a human rights analysis

Human rights and the domains of health system responsiveness share a common goal: furthering the rights of individuals and communities in the context of the health system. If a health system is responsive, it is possible that the interactions which people have within the health system will improve their well-being, irrespective of improvements to their health. This brief report from the World Health Organisation’s Evidence and Information for Policy cluster discusses the human rights context to the provision of health services to the public.

4. Health equity in economic and trade policies

Health, Wealth and Welfare
Finance & Development - Quarterly magazine of the IMF

The authors explore the economics of health and development, arguing that new evidence coupled with a wider perspective suggest sizable economic returns to better health. Drawing on studies of human welfare, they say that past estimates of economic progress have been understated and that recent economic losses caused by HIV/AIDS are likewise being understated if economists rely on GDP per capita as a yardstick. A better indicator is "full income"- an assessment of economic welfare that captures both the value of changes in life expectancy and income as measured in national accounts. For Africa, they say, this new yardstick "signals catastrophe ahead".

Medicines, Patents and Trips

The agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) introduced intellectual property rules into the multilateral trading system for the first time, with profound consequences for developing countries. But the high cost of AIDS treatments has injected an ethical element into the TRIPS debate, posing new problems for the pharmaceuticals industry.

Robbing the poor to pay the rich?: how the United States keeps medicines from the world’s poorest

This paper argues that the government of the United States is contravening its commitment under the "Doha Declaration" of 2001by using technical assistance, bilateral and regional trade agreements, and the threat of trade sanctions to ratchet up patent protection in developing countries. The paper states that the U.S. is pressuring developing countries to implement patent laws which go beyond TRIPS obligations and do not take advantage of its public-health safeguards in order to benefit the influential U.S. pharmaceutical industry.

SADC on track for free trade area by 2008

The SADC region is on track towards meeting the major objective of its trade protocol which is to “achieve a Free Trade Area by 2008, when substantially all trade would be dutyfree.” Implementation of the SADC Trade Protocol and other instruments affecting the economic development of the region has shown remarkable progress in 2003, the SADC Executive Secretary, Dr Prega Ramsamy said in his year-end briefing. The Trade Protocol is the most important legal instrument in the region’s quest for economic integration, and is in its third year of implementation since ratification in January 2000.

5. Poverty and health

Policy options and access to healthcare by poor households

A package of policies is required to deal with the multi-faceted nature of barriers to health care in developing countries, according to a paper from the Centre for Health Policy's School of Public Health, at the University of the Witwaterstrand, South Africa. This package would have higher levels of taxation of higher income groups, insurance in proportion to income and would allow greater cross-subsidisation across groups, with exemption schemes and low or no user fees. Increasing health expenditure is another important means of increasing provision for the poor, but the impact of any increase will depend on how resources are allocated. The paper says most developing countries aim for universal access to health but in reality, health systems are often ineffective at reaching the poor, as the poor face greater cost-related barriers to accessing health care.
This paper reviews a set of key health policies and examines the factors that influence their effectiveness.

The Poor-Rich Health Divide

Sweeping changes in public health have transformed life over the past century. On average, people live longer, healthier lives than ever before. Even so, this past century's revolution in human health and well-being is incomplete. For people living on less than US$1 per day - and according to the World Bank there are more than 1 billion of them - health services and modern medicines are still out of reach. Moreover, many initiatives to improve the health of people in extreme poverty have been unsuccessful. A forthcoming Population Reference Bureau publication, "Improving the Health of the World's Poorest People," delves into the poor-rich health divide and what can be done to shrink it.

6. Human Resources

110 Cuban doctors expected in Zimbabwe

At least 110 Cuban doctors are expected to arrive in the country at the end of this month under the Zimbabwe-Cuba Joint Commission. Head of the Cuban Medical Brigade in Zimbabwe Dr Felipe Delgado Bustillo said the doctors would serve in the country for two years. "The doctors will be working under the comprehensive health programme launched by President Fidel Castro in 1998, which is aimed at providing something like a donation to other people specially those in Africa in solving various health related problems," said Dr Bustillo.

New wave of mass global migration expected

Immigration is an issue that elicits heated views from all sides of the political and economic spectrum. In the 21st century, how might we expect our lives and societies to be affected by changes in immigration? In Part One of a two-part series, economist Lant Pritchett argues that there are five irresistible forces setting the world up for a new wave of mass migration. Topping the list are the huge cross-national inequalities in wages and standards of living. Differences in labour demand across countries comprise another pressure promoting migration. Population growth imbalances also contribute to the trend, with aging populations of wealthy countries needing younger workers to help support national pension plans.

Nurses strike impacts on healthcare in Swaziland

A nurses' strike has shut down most of Swaziland's health care system, drawing attention to financial and technical shortcomings, and the problems besetting the nursing profession. "While we continue our strike action, doctors and orderlies will have to take care of patients," said the president of the Swaziland Nurses Association, Masitsela Mhlanga, at a press conference. Nurses are striking over the government's inability to pay salaries on time, back pay and salary increases.

Further details: /newsletter/id/30265
Special allowances for SA health sector welcomed

The SA Medical Association (Sama) has joined political parties in extending praise and support for government's introduction of the special allowances for some health professionals in a bid to stem the brain drain. This follows a decision reached between unions and the government to allocate R500-million towards providing incentives to 33,000 full-time rural healthcare workers. Sama chairman Dr Kgosi Letlape said: "This is a step in the right direction in addressing the concerns that Sama has raised regarding the remuneration of doctors in the public sector, on numerous occasions."

Strategy to tax Zambian nurses abroad

Government is considering engaging countries where nurses have migrated to enter into a formal memorandum of understanding for fixed contracts. Health minister Brian Chituwo says government is working out modalities on how to retain and motivate nurses and other medical personnel that have left the country. The countries in question would be required to pay the Zambian government a certain amount of money which will be re - invested in training.

7. Public-Private Mix

Developing countries and the private sector: What chances for improving child health?

The private sector exerts a significant and critical influence on child health outcomes in developing countries. This article in the Bulletin of the World Health Organisation reviews the available evidence on private sector utilisation and quality of care. It provides a framework for analysing the private sector's influence, extending its analysis to include nongovernmental organisations (NGOs), pharmacies, drug sellers, private suppliers, and food producers. The article analyses some of the most promising strategies for improving child health, and suggests a number of possible constraints to emulating these approaches more widely. The article suggests that improving the impact of child health programmes in developing countries requires a more systematic analysis of the presence and potential of the private sector, including actors such as professional associations, producer organisations, community groups, and patients' organisations.

8. Resource allocation and health financing

Predicting the Impact of Antiretrovirals in Resource-Poor Settings

The authors use mathematical models to predict the potential impact that low to moderate usage rates of antiretroviral (ARV) therapy might have in developing countries. They also review the current state of HIV/AIDS treatment programs in resource-poor settings and identify the essential elements of a successful treatment project, noting that one key element is integration with a strong prevention program. They apply program experience from Haiti and Brazil and the insights gleaned from their modelling to address the emerging debate regarding the increased availability of ARVs in developing countries.

Producing national health accounts: A guide for low income countries

National health accounts are designed to answer precise questions about a country's health system. They provide a systematic compilation and display of health expenditure. They can trace how much is being spent, where it is being spent, what it is being spent on and for whom, how that has changed over time, and how that compares to spending in countries facing similar conditions. They are an essential part of assessing the success of a health system and of identifying opportunities for improvement. This Guide to producing national health accounts from the World Health Organisation, with special applications for low-income and middle- income countries, provides practical help in developing this socio-economic information.

9. Equity and HIV/AIDS

Africa-wide action to improve access to HIV/AIDS treatment

Recognising the need for an Africa-wide movement, a Pan- African Treatment Access Movement (PATAM) has been founded. Zackie Achmat of the Treatment Action Campaign (TAC) of South Africa, and Milly Katana, lobbying and advocacy officer of the Health Rights Action Group in Uganda were among the founders. PATAM is a social movement comprised of individuals and organisations dedicated to mobilising communities, political leaders and all sectors of society to ensure access to anti-retroviral therapy, as a fundamental part of comprehensive care for all people living with HIV and AIDS in Africa. Since its inauguration on August 22, 2002, the movement has been growing. On March 4-6, PATAM will be hosting its third regional conference on Access to Treatment in Harare, Zimbabwe.

Further details: /newsletter/id/30293
Aids quick fix won't save Africa

Short-term relief followed by long-term disaster is not sound policy. Nonetheless, that could be a result of the Aids strategy being contemplated by the World Health Organisation, which on December 1 - World Aids Day - announced a plan to treat 3-million people with HIV/Aids by 2005. The WHO is proposing that billions of dollars be spent on increasing access to anti-retroviral drugs. That is a noble intention. However, it may not be the most cost-effective way to stem the tide of HIV/Aids: it may even be counterproductive. Let's be clear. Reducing the cost and increasing the supply of medicines to the poor is a good thing. But on its own it is not enough. Nor should it be today's priority. The roots of Africa's health care crisis run far deeper and broader than a mere shortage of drugs.

ARV therapy due to be provided in Zimbabwe, say reports

Owen Mugurungi, program coordinator for the Zimbabwean Ministry of Health and Child Welfare Tuberculosis and AIDS Program, has announced that the government will begin providing antiretroviral drugs to some of its HIV-positive citizens as part of the country's implementation of the World Health Organisation's 3 by 5 Initiative, Xinhua News Agency reports. The $5.5 billion WHO plan aims to treat three million people throughout the world with antiretroviral drugs by 2005.

Gender, AIDS, and ARV Therapies: Equitable access for women

Even with increased commitment, funding, and coordination, U.S. AIDS treatment efforts will fall far short of what is needed to provide ARV treatment to those suffering from AIDS today, according to a document from the Centre for Health and Gender Equity. Given limited resources, choices will inevitably be made about who will be treated and when, raising the issues of equity in access to treatment for sub-groups of those infected. In turn, these considerations dramatically underscore the need to ensure that specific efforts be made to ensure that treatment programs reach those groups that already face a disproportionately higher risk of infection.

South Africa’s antiretroviral rollout stalled

Delays in the drug procurement process and lack of training for doctors are postponing the rollout of antiretroviral therapy (ART) in South Africa, the country’s government has admitted. Except for the Western Cape Province (which has set aside its own funds to buy antiretroviral drugs), the celebrated South African HIV care and treatment programme has yet to treat a single patient. Activists are beginning to question the government’s resolve to put the operational plan into action, citing statements made over the last week by Health Minister Manto Tshabalala-Msimang and President Thabo Mbeki.

The forgotten people: care for people dying of AIDS in sub-Saharan Africa

What care do sufferers of AIDS receive in sub-Saharan Africa (SSA)? If their lives cannot be saved, are their last days made as comfortable as possible? As more funding is made available for the care of terminally-ill AIDS patients, it is important to look at the level of care currently available. King’s College London, together with the US Office of National AIDS Policy, conducted a survey across 14 SSA countries to discover the end-of-life care AIDS patients are currently receiving. As hospitals cannot cope with the sheer numbers of patients, care must take place in the community. Nevertheless, while home-based care seems the only possible solution due to the scale of the epidemic, communities can be overwhelmed by the burden placed on them.

Wealthy nations neglecting need, says AIDS envoy

With pointed jabs at the United States, a U.N. special envoy told a gathering of leading AIDS scientists that wealthy nations must make up for a "decade of financial abstinence'' to battle the global epidemic. Stephen Lewis, a Canadian diplomat who has been the United Nations' special representative for AIDS in Africa, made his case on Sunday for a dramatic increase in spending to fight the disease at the opening session of the 11th Conference on Retroviruses and Opportunistic Infections, held in San Francisco.

10. Governance and participation in health

NO War! NO WTO! Fight for people's health
International campaign information

"As health workers and health advocates, we are witness to the fact that unhampered economic globalization causes increasing poverty, while US-led wars of aggression maim and massacre millions of people and destroy social infrastructure and our planet Earth itself. We therefore call on the peoples of the world to junk the World Trade Organisation and regional trade agreements with a similar character. Key WTO agreements such as the Trade-Related Aspects of Intellectual Property Rights (TRIPS) and the General Agreement on Trade in Services (GATS) promote the commercialization of health care and deprive the people of much needed basic health services."

Further details: /newsletter/id/30290
Realizing rights: transforming approaches to sexual and reproductive well-being

Sexual and reproductive rights for all are fundamental to transforming the lives of millions of adults and young people. Changes in legislation, access to information and provision of services provide an essential route to bringing about wider change. But alone, they are not enough for the most vulnerable to see themselves as having rights to safer and more fulfilling sexual and reproductive lives and to be able to claim them. In a collection of experiences of using participatory approaches for work on sexual and reproductive health and rights, researchers from the UK's Institute of Development Studies and the International Community of Women Living with HIV and AIDS (ICW), show how involving vulnerable groups more directly in efforts to improve their well-being can make a real difference.

11. Monitoring equity and research policy

Building evidence-based policies aimed at health systems development

Decision-makers in countries around the world face a series of common problems as they aim to make appropriate choices to improve the performance of their health systems. With eight per cent of the world's economic output invested in health systems, the way these systems are organized to collect resources and transform them into services for people in need can profoundly influence health outcomes for populations. Yet the scientific evidence-base to inform critical health system decisions is much weaker than the evidence-base to inform individual clinical decisions. This volume reports on a large body of work led by the World Health Organisation that is intended to strengthen the foundations for evidence-based policies aimed at health systems development.

How can our research be improved to better ensure that results are translated into action?

This article explores how health research can be improved to ensure that its results are translated into action. It is based on the author's experience of health research on HIV/AIDS in South Africa. The article pays particular attention to dissemination, and it argues that the most common approach to information dissemination adopted by research organisations, passive dissemination of information in the form of research reports and policy recommendations, is largely ineffective.

12. Useful Resources

INASP Health Links

INASP Health Links is an Internet Gateway to more than 600 websites selected for health professionals, medical libraries, and publishers in developing and transitional countries. Several updates have recently been added.

The Social Medicine Portal

This website is devoted to promoting the principles and practice of social medicine. The goal in developing this site is to put readers in touch with some of the diverse international resources available for health activists and those interested in the interactions between health and society.

Treating HIV & AIDS: A training toolkit

NAM, the publisher of http://www.aidsmap.com and the electronic newsletter "HIV & AIDS Treatment in Practice", has launched a major new resource, 'Treating HIV & AIDS: A Training Toolkit'. This project is a response to the scaling-up of antiretroviral therapy in resource-limited settings, and was developed with the support of doctors providing training on ARVs in Botswana, Kenya and South Africa.

13. Jobs and Announcements

Equity in the Distribution of Personnel in Southern Africa
Reminder! Call for Proposals closes on March 12th!

The Regional Network for Equity in Health in Southern Africa (EQUINET) and Health Systems Trust South Africa (HST) have invited 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. This call for proposals is closing on March 12th. Full details about this call for proposals are available from the Equinet website: www.equinetafrica.org and from the HST website:www.hst.org.za

Further details: /newsletter/id/30309
Health Equity Research to Action Short Course
offered June 7-9 and again June 15-17, Durban, South Africa

The Global Equity Gauge Alliance (GEGA) is calling for participants in a short course focused on developing evidence-based responsive action to support pro-equity policy development and community empowerment. This course is designed to support the development of programmes of work to enhance uptake of pro-equity policy, especially at the national level and also at the local level. It is also intended to encourage sharing of information and experiences among participants, and provide opportunities to link with a larger community of researchers and advocates working in health equity around the world.

Further details: /newsletter/id/30264
Hiv/Aids Programme Planning Course
May 17–22, 2004, Cape Town, South Africa

Using a variety of learning modalities, including case studies, this course is designed to build capacity at the country level for the management of expanded resources. It will assist program managers to formulate effective HIV/AIDS and STI intervention strategies, address priorities for rapid scale-up, use research-to-practice approaches to inform programming decisions, and establish systems for Strategic Information including surveillance, program improvement and health monitoring information systems.

The gendered impact of globalisation on health
Call for submissions

The "Globalization, Gender and Health" project partners are currently drafting a discussion paper on behalf of the Canadian Institutes of Health Research-Institute of Gender and Health. The publication discusses the findings from a critical synthesis of a broad range of literature on globalization, gender and health, and also incorporates insights from diverse groups of professionals, scholars, activists and policy-makers worldwide. The purpose of this initiative is to formulate a global research and training agenda for the impact of globalization on gender and health. The report is available at the website below. Colleagues are invited to submit relevant case studies from different countries and regions (particularly developing or low income countries) that highlight the positive and/or negative differential impact the current wave of globalization has had on the health of women/girls and men/boys as outlined in the report.

The Political Economy of Social Inequalities: Consequences for Health and Quality of Life
Edited by Vicente Navarro

The dramatic increase in social inequalities within and among countries in the last twenty years has had a most negative impact on the health and quality of life of large sectors of the world's populations. In The Political Economy of Social Inequalities, scholars from a variety of disciplines and countries analyse the political and economic causes of these inequalities, their consequences for health, and some proposed solutions.

Wits HIV/AIDS in the Workplace Research Symposium
29th and 30th June 2004, Wits University, Johannesburg, South Africa

HIV/AIDS in the workplace constitutes an important research node for a wide range of disciples including business, economics, law, public health and the social sciences. This symposium will provide an opportunity for researchers in these fields to present and cross-fertilise their work. Within the context of the HIV/AIDS epidemic it is important that research is orientated towards sustainable solutions. Papers orientated to understanding underlying problems and how they should be addressed, along with papers from ‘action researchers’ including managers and trade unionists are welcomed.

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