EQUINET NEWSLETTER 40 : 01 June 2004

1. Editorial

Reclaiming the state: Advancing people's health, challenging injustice
Facts, figures and quotes from the Equinet Conference, Durban, South Africa 8-9 June 2004

* “Equity in health implies addressing differences in health status that are unnecessary, avoidable and unfair. Equity in health implies directing more resources for health to those with greater health need. Equity in health means having the power to influence decisions over how resources for health are shared and allocated.” - From a presentation 'Reclaiming the state: Advancing people's health, challenging injustice'.

* “In the highly unequal societies of southern Africa, our health challenges demand health systems that assertively redistribute the resources for health and policies that reflect values of equity, solidarity and universality. This can be achieved through rising investment through the state and public sector.” - From a presentation 'Reclaiming the state: Advancing people's health, challenging injustice'.

* “The gains of neoliberal globalisation?
- 4% GDP lost in unfair terms of trade 1970-1990
- Africa's FDI share from MNC investment 25% in 1970's, 5% in 1990s.
- Income gap richest to poorest 53x in 1960 and 121x in 2000
- 185 million people out of work
- 55 million people live on <$1 a day
- Southern outflows increased.” - From a presentation 'Reclaiming the state: Advancing people's health, challenging injustice'.

* “Despite a hostile global environment, which has the potential to subjugate us to political and economic imperatives not of our choosing, we can and must mobilize collective action to chart and implement our positive vision and policies on the equitable health systems that we want.” - From a presentation 'Reclaiming the state: Advancing people's health, challenging injustice'.

* “ Impact of malnutrition on development:
- [A study of the long term impacts of the 1982-84 Zimbabwe drought on 665 children]…resulted in a loss of stature of 2.3 centimeters, 0.4 grades of schooling, and a delay in starting school of 3.7 months.
- [It is estimated] that this loss of stature, schooling and potential work experience results in a loss of lifetime earnings of at least 7 - 12%.” - From a presentation on 'Household Food Security, Nutrition and Equity.'

* “Only 3 out of 10 African countries show a decrease in severe maternal nutritional status in the last decade.” - From a presentation on 'Household Food Security, Nutrition and Equity.'

* “31 countries in Africa do not meet the 'Health for All' standard of a minimum of one doctor per 5000 people.” - From a presentation 'Health Personnel in Southern Africa Confronting Maldistribution and the Brain Drain'.

“External debt of the USA is $2.2 trillion - almost the same as the $2.5 trillion owed by the entire developing world…Every American citizen owes the rest of the world $7,333 while every citizen of all the developing countries only owes the rest of the world $500.” - From a presentation 'Health Personnel in Southern Africa Confronting Maldistribution and the Brain Drain'.

* “Estimating the cost of training a GP in the SADC Region to be $US60 000, then it can be assumed that there is a reverse subsidy from the developing world of $500m per annum for health personnel alone.” - From a presentation 'Health Personnel in Southern Africa Confronting Maldistribution and the Brain Drain'.

* “UNCTAD estimates that US$184,000 is saved in training costs per professional and that US saved US$3.86 billion as a result of importing 21 000 Nigerian doctors.” - From a presentation 'Health Personnel in Southern Africa Confronting Maldistribution and the Brain Drain'.

* “Things are pretty bad here you know. South Africa is not the Tropicana Hotel [in Durban, where the conference took place]. Since independence the rich have been getting richer and the poor poorer.” - Trevor Ngwane, Anti-Privatisation Forum, commenting in a parallel workshop session.

* “The green rooms [negotiating forums at the World Trade Organisation criticised for their lack of transparency] are basically where the bully countries call in the smaller countries, beat them up and then send them home with a message to their mothers.” - Riaz Tayob, SEATINI, replying to a question on a presentation on global trade and health.

Reclaiming the State: Advancing Peoples Health, challenging Injustice
Resolutions of the Third Southern African Conference on Equity in Health, Durban, South Africa, June 8 and 9, 2004

Noting:

* The 1997 Kasane meeting on Equity in Health that confirmed the commitment to equity in health at all levels in southern Africa; the 1999 Southern African Development Community (SADC) Protocol on Health, the 2003 Maseru Declaration on HIV and AIDS and the resolutions of the SADC Heads of States Summit on food security held in Tanzania, 2004;
* The formation of EQUINET and our work since 1998 in support of these commitments, to strengthen the understanding of, the evidence for, advocacy of and implementation of this policy commitment to equity and social justice;
* Our conception of equity and social justice in health, which aims to address unfair differences in health and in access to health care through the redistribution of the societal resources for health, including the power to claim and the capabilities to use these resources;
* The widening constituency we are building for equity and social justice in health amongst governments, parliamentarians, health professionals, trade unions and other organs of civil society, researchers and communities at national and regional level;
* The challenges posed by neoliberal globalisation to our values of equity and social justice, to government ability and flexibility to implement the public policies that we choose and to the public sector health and essential services and that are critical for our health;

The June 2004 EQUINET conference in Durban South Africa affirmed that we stand for:

* Equity and social justice in health;
* Public interests over commercial interests in health;
* International and global relations that promote equity, social justice, people's health and public interests;
* Increased unconditional resource flows from the North and fairer terms of trade;
* Reduction and where possible restitution of flows of resources from South to North;
* A conception of human rights that affirms the agency of communities in claiming social and economic entitlements, the primacy of vulnerable groups and that captures African traditions of communitarianism;
* Equitable health systems that provide healthcare for all and redistribute and direct resources towards those with greatest needs;
* Rising investments in the state and public sector in health;
* Health (care) systems which promote collective, population oriented strategies for health and comprehensive primary health care;
* Trade and agricultural policies that ensure food sovereignty and household food security through land redistribution and investment in small holder farming in ways that promote gender equity and sustainable food production;
* At least 15% of government budgets invested in the public health sector, as committed in Abuja, together with debt cancellation;
* Progressive tax-based funding of health systems;
* Fair financing for health, in which the rich contribute a greater share of their income to health than the poor, with strengthened cross subsidies for solidarity and risk pooling;
* Equitable and affordable access to generic drugs, with application of essential drug policies across all health providers;
* Ethical and equitable human resource policies at national, regional and international level, backed by compensation for regressive south-north subsidies incurred through health personnel migration;
* Equitable public health and multisectoral responses to HIV and AIDS for prevention and health promotion, treatment and care and to mitigate the impact of the epidemic, particularly within and for young people and vulnerable groups;
*The expansion of access to anti-retroviral therapy for people living with AIDS in Southern Africa as an urgent priority, through funding and approaches that strengthen, and do not compromise, our public health services and systems;
* Democratic and accountable states, with full authority to exercise policy measures necessary to protect the health of people;
* Powerful and effective participatory and representative mechanisms at all levels of our health and social sectors and in the state more generally;
* Effective and accountable mechanisms for public and stakeholder contribution to decision making in health;
* Regional integration and co-operation within Africa to strengthen democratic states, advance the health of people and challenge injustices to health;
* Values based leadership across organisations working to promote equity in health.

The conference set out a programme of work and action for EQUINET and its partners to implement these goals.

* * Visit the Values, Policies and Rights, Health equity in economic and trade policies, Poverty and health, Human Resources, Resource allocation and health financing, Equity and HIV/AIDS and Governance and participation in health sections of the newsletter for more details about papers presented at the conference. The full abstract book and other conference documents will be available on the EQUINET website (www.equinetafrica.org) by the end of this month. Please send all comments to admin@equinetafrica.org

Restoring a socially-conscious state
Abstract of Equinet conference keynote address, Adebayo Olukoshi, Director, CODESRIA, Dakar Senegal

Historically, the state has played an important role as a social actor. Indeed, the social function of the state was as critical to the constitution of the social contract as the quest for a secured territorial framework within which individuals and groups could exercise their livelihoods. The high point of the development of the social state came in the period after the Second World War with the growth and spread of different variants of social democracy and welfare states.

Not surprisingly, African states at independence were invested with broad-ranging social responsibilities which they pursued with varying degrees of success. However; the onset of the African economic crises in the period from the early 1980s onwards and the rise on a global scale of the forces of neo-liberalism encapsulated the confluence of factors that culminated in the retrenchment of the social state - including from an institutional and expenditure point of view - and the enthronement of a narrow, market-based logic in the provision of social services - including, among other things, the pursuit of cost recovery, the imposing of user fees, the promotion of privatisation, and the employment of new public sector management strategies in the social sectors.

At the same time, the social sectors, including especially the health system, were to suffer a serious erosion of capacity that was connected to the drain of talents, the degradation of the infrastructure of service, and the collapse of professionalism. Perhaps much more serious is the decoupling of social policy from macro-economic policy-making and its treatment as a residual category to which targeting strategies such as safety nets, various programmes for the alleviation of the social effects of economic structural adjustment and a plethora of poverty reduction strategies would be applied. It is suggested that this decoupling of social and macro-economic policy making is at the root of the expansion of the boundaries of exclusion that defines the structural roots of injustice in the social sectors generally and the health sector in particular.

The prospects for the restoration of a socially-conscious state will depend on the capacity of governments to adopt an approach in which social policy is treated as an integral part of macro-economic strategies for growth and development.

* Adebayo Olukoshi, Professor of International Economic Relations and currently the Executive Secretary of the pan-African Council for the Development of Social Science Research in Africa (CODESRIA) which is headquartered in Dakar, Senegal. He has previously served as Director of Research at the Nigerian Institute of International Affairs, Lagos, Nigeria and as a Senior Fellow/Research Programme Coordinator at the Nordic Africa Institute, Uppsala, Sweden. His current research interests centre around the politics of reform and transition in African politics, economy and society.

2. Latest Equinet Updates

** Reclaiming the state: Advancing peoples Health, Challenging Injustice
Abstract of EQUINET Steering committee paper presented at the Equinet conference, Durban, 8-9 June 2004

This paper is the third overview produced by the Southern African Regional Network for Equity in Health (EQUINET) steering committee since EQUINET’s launch after the Kasane meeting in 1997. The first paper in 1998 identified a concept of health equity that would guide EQUINET work, outlined the areas of policy commitment to this vision of equity in southern Africa, and the gaps in delivery on these commitments. The second paper in 2000 described the profile of poverty, inequality and ill health in southern Africa despite these commitments, and proposed policy measures that would better direct resources towards health needs, and the forms of health care most appropriate and accessible to those with greatest health needs, particularly through primary health care strategies. This paper highlighted the important role played by the social forces that drive policy choices, and proposed specific measures for organising and investing in opportunities for informed, authoritative participation of all social groups and particularly the poorest in their health systems, and for building health system responsiveness and accountability to social groups.

Further details: /newsletter/id/30451
Meeting on Equity in Human Resources for Health in Southern Africa
April 15-17, 2004

The Regional Network for Equity in Health in Southern Africa (EQUINET) and Health Systems Trust South Africa (HST) successfully held a review meeting on Equity in the Distribution of Personnel in Southern Africa. This meeting is part of the two-year research and advocacy programme of work in this area that aims to promote the equitable distribution of health personnel in southern Africa. Watch the site www.equinetafrica.org for a report of the meeting.

3. Equity in Health

10/90 health research gap may be closing

Spending on research on diseases of the poor, such as malaria, tuberculosis and dengue fever, has increased substantially over recent years, according to the annual report of the Global Forum for Health Research. Major donations from governments and charities pushed global health research funding to more than US$100 billion in 2001, up from US$30 billion in 1987.

Clinics in three Zimbabwe provinces lack water access

Only half of the health clinics in three Zimbabwean provinces have access to safe water and the majority of districts face shortages of essential drugs, according to an NGO monitoring group, the Food Security Network (FOSENET). Based on information drawn from 52 districts, FOSENET noted that clinics spread across central Zimbabwe - in Mashonaland West, the Midlands and Masvingo - had the poorest access to safe water out of the country's eight provinces.

Local production of AIDS drugs begins in Zimbabwe

Access to anti-AIDS drugs is improving in Zimbabwe, due to recent initiatives to roll-out antiretroviral (ARV) therapy and to manufacture the medicines locally. A Zimbabwean pharmaceutical company has started manufacturing generic antiretroviral (ARV) drugs in a bid to significantly reduce the cost of the medication for people living with HIV/AIDS.

Networking of SA municipalities critical for tackling HIV/AIDS

A new study commissioned by the South African Cities Network (SACN) urges local municipalities to develop a multi-sectoral strategy to tackle the effects of HIV/AIDS on their communities. The report, titled 'South African Cities and HIV/AIDS: Challenges and Responses', noted that while there had been a number of initiatives to support local government in developing an HIV/AIDS response, there was little attempt to assess the challenges facing the cities.

New WHO roadmap for primary health care incomplete, says PHM

Twenty-five years ago WHO promised 'Health for All' through the Alma Ata declaration. However, the UN body abandoned the primary health care agenda in the later years. ‘Health systems, including primary health care’, a new WHO document, endorses the primary health care agenda. It is a welcome return to the basics. Grassroots movements like the People’s Health Movement (PHM) offer a cautious welcome, but say this is not enough. The UN health body’s new ‘road map’ that is being presented during the ongoing World Health Assembly endorses the importance of primary health care - something that grass roots movements like the PHM has been demanding for years.

Further details: /newsletter/id/30466
The wealth gap in health

Despite improvements in public health in the last half-century, large disparities in health exist between and within countries. Differences among socioeconomic groups can be pronounced, but are easily masked by national data that are used for monitoring and reporting progress. A recent analysis of data from the Demographic and Health Surveys (DHS) program provides clear evidence of the gap between the rich and poor in a range of health and population indicators— fertility, infant and child mortality, nutrition, and the use of family planning and other health services.

US rejects global strategy on reproductive health

While the United States “dissociated” itself from the consensus, the World Health Organisation's first strategy on reproductive health was adopted by the 57th World Health Assembly (WHA). Reproductive and sexual ill-health accounts for 20% of the global burden of ill-health for women and 14% for men. "Once again, the Bush Administration has shown their true colours by calling for a reproductive health policy that is more about ideology than reality,” said Congresswoman Barbara Lee (D-CA). “We have a moral responsibility to ensure the health and well-being of women and men around the world."

4. Values, Policies and Rights

** Health rights as a tool for health equity
Abstract of paper presented at the Equinet conference, Durban, 8-9 June 2004, by Leslie London, University of Cape Town, EQUINET theme co-ordinator

Most public health practitioners acknowledge the value of human rights in promoting human well-being. However, there is potential for tension between human rights approaches and public health objectives such as equity, access and efficiency, particularly in developing countries where resource constraints exacerbate balancing of competing priorities. This potential tension may stem from inappropriate conceptualizations of human rights and how they should be operationalised in a public health context. For example, where human rights are conceived as individual entitlements, public health officials could erroneously equate this to favouring individuals over the welfare of the community to the detriment of equity. Health and health care are recognized as human rights, which span the full range of civil, political and socio-economic rights, many of which are essential requirements for health.

Further details: /newsletter/id/30452
Reproductive Health and Human Rights: Integrating Medicine, Ethics, and Law
Rebecca J. Cook, Bernard M. Dickens and Mahmoud F. Fathalla

The concept of reproductive health promises to play a crucial role in improving health care provision and legal protection for women around the world. Here now is an authoritative and much-needed introduction to and defence of the concept that, though internationally endorsed, is still contested by conservative agencies. The authors of this book are leading authorities on reproductive medicine, women's health, human rights, medical law, and bioethics: they integrate their disciplines to provide an accessible but comprehensive picture.

5. Health equity in economic and trade policies

** Globalisation, Trade and Health
Abstract of paper presented at the Equinet conference, Durban, 8-9 June 2004, by R Tayob SEATINI, EQUINET theme co-ordinator

This paper posits that the International Trading System (ITS) is biased in favour of richer northern states. It argues that greater circumspection is required by developing countries within the ITS if they want to maintain their sovereign right to meet the needs of their people. The inequitable system of “globalisation” is imposed through the ideology of neo-liberalism, which the developed countries present as a “natural” form of globalisation. It is a very particular type of globalisation that is being imposed on the world by the major economic powers, i.e. neo- liberal globalisation. This form of globalisation has worsened material conditions in developing countries.

Further details: /newsletter/id/30457
How Do Patents And Economic Policies Affect Access To Essential Medicines

This paper studies the relationship between patents and access to essential medicines. It finds that in sixty-five low- and middle-income countries, where four billion people live, patenting is rare for 319 products on the World Health Organisation’s Model List of Essential Medicines. Only seventeen essential medicines are patentable, although usually not actually patented, so that overall patent incidence is low (1.4 percent) and concentrated in larger markets. This and other results shed light on the policy dialogue among public health activists, the pharmaceutical industry, and governments that is often based on mistaken premises about how patents affect corporate revenues or the health of the world’s poorest.

The General Agreement On Trade In Services: Implications For Health Policymakers

The General Agreement on Trade in Services (GATS), created under the auspices of the World Trade Organisation, aims to regulate measures affecting international trade in services - including health services such as health insurance, hospital services, telemedicine, and acquisition of medical treatment abroad. The agreement has been the subject of great controversy, for it may affect the freedom with which countries can change the shape of their domestic health care systems. This article explains the rationale behind the agreement and discusses its scope. It also addresses the major controversies surrounding the GATS and their implications for the U.S. health care system.

6. Poverty and health

** Food security and nutrition
Abstract of paper presented at the Equinet conference, Durban, 8-9 June 2004, by Mickey Chopra, David Sanders, School of Public Health University of Western Cape

The lack of household food security, and the subsequent poor nutrition, continues to blight the lives of millions of people in Southern Africa. Adequate food and nutrition is a basic right. The deprivation of this right has immense consequences for addressing inequities across the region. Poor nutritional status stunts educational development as well as increasing the risk of acquiring, and the severity of, infectious diseases (including HIV/AIDS). The lack of household food security has led to increased vulnerability, especially of women, to diseases such as HIV.

Further details: /newsletter/id/30453
Food systems and security: helping the poor to cope

Food security can be defined as ‘having enough physical, social and economic access to sufficient, safe and nutritious food’. Threats include the ability of people to deal with declining farm productivity or the loss of assets before or after harvest. Increasingly, the traditional rural focus of food security is shifting due to rapid urbanisation and growing urban slums. Approximately 800 million people in the developing world are undernourished and suffering from chronic hunger.

Growth, Inequality and Poverty

This paper raises some critical issues in the economic analysis of growth, inequality and poverty. It explores the relationship between growth and inequality, and looks into policies and institutions that are causally related to equitable growth. The author argues that in as much as progress has been made by economic literature, relatively little is known about how a society comes to acquire good policies and institutions, and exactly what is being offered when accepting the Millennium Development Goal of halving the incidence of income poverty by the year 2015.

The Chronic Poverty Report 2004-2005

Between 300 and 420 million people are trapped in chronic poverty. They experience deprivation over many years, often over their entire lives, and commonly pass poverty on to their children. Many chronically poor people die prematurely from health problems that are easily preventable. For them poverty is not simply about having a low income: it is about multidimensional deprivation – hunger, undernutrition, dirty drinking water, illiteracy, having no access to health services, social isolation and exploitation. Such deprivation and suffering exists in a world that has the knowledge and resources to eradicate it.

7. Human Resources

** Confronting challenges in health personnel
Abstract of paper presented at the Equinet conference, Durban, 8-9 June 2004, by Antoinette Ntuli, Health Systems Trust, EQUINET theme co-ordinator

The biggest and most important component of any health system is its human resources (HR). The effective, equitable and appropriate production, training and deployment of health workers has been associated with periods of high health gain in southern Africa. Despite this, many health systems in southern Africa now face a variety of HR problems and personnel scarcities have become a critical limiting factor in health interventions. Health worker migration is further compounding inequities and stresses. Responding to economic and social triggers, personnel flow from rural to urban areas, from public to private sectors, from lower to higher income countries within southern Africa and from African countries to industrialized countries, exacerbating inequities and providing a reverse (poor to rich) subsidy. However a new policy momentum exists in relation to human resources for health.

Further details: /newsletter/id/30455
African Nations To Be Compensated For Health Care Brain Drain

Members of the African Union struck a deal with wealthy members of the World Health Organisation to be compensated for the loss of their health care workers to richer countries, the Nairobi Daily Nation reports. The negotiations were held during the 57th World Health Assembly in Geneva May 17-22. "The African Union pushed the agenda of compensation as one voice and we will jointly negotiate the terms like the European Union does," said Gideon Konchella, Kenya's assistant minister for health.

Community involvement in medical practitioner recruitment and retention

The provision of health services to rural and remote communities has been the source of much concern and debate in recent times. One aspect of this is the universal problem of insufficient medical practitioners in rural areas and the associated issues of recruitment and retention. Rural communities can play an important role in the recruitment and retention of health professionals, particularly in terms of aiding the integration of health professionals and their families into the community.

Health Personnel in Southern Africa: Confronting Maldistribution and Brain Drain
Equinet, Health Systems Trust and Medact 2003

This report describes the exodus of healthcare workers from areas of poverty and low socio-economic development, to more highly developed areas. The flows follow a hierarchy of ‘wealth’ and result in a global conveyor belt of health personnel moving from the bottom to the top, increasing inequity. The report describes personnel flows and migration from rural to urban areas, from public to private sectors, from lower to higher income countries within southern Africa and from African countries to industrialized countries. The report describes a variety of push and pull factors that impact on the movement of healthcare professionals.

Trends In International Nurse Migration

Predicted shortages and recruitment targets for nurses in developed countries threaten to deplete nurse supply and undermine global health initiatives in developing countries. A twofold approach is required, involving greater diligence by developing countries in creating a largely sustainable domestic nurse workforce and their greater investment through international aid in building nursing education capacity in the less developed countries that supply them with nurses.

8. Public-Private Mix

Health care commercialisation and inequality

Health care systems can embed and reinforce inequality within societies or, conversely, can be a platform for the public combatting of poverty and inequality. The objective of the paper is to argue that the process of health care commercialisation - a marked trend across the world since the 1970s for reasons that are explored - and the associated process of globalisation of both health care and health policy, changes the terms of these interactions. Commercialisation, sometimes discreditably sold as a policy for increasing equity, has generally acted to embed inequality in new forms.

Public-Private partnerships: Monitoring the effects on healthcare

Aids, malaria, tuberculosis and other infectious diseases have reached enormous proportions in many developing countries. Efforts to control and eradicate these diseases are extremely complex. Increasingly, global public-private initiatives are set up to address these issues. The question is whether global public-private initiatives are the most appropriate approach, and whether such partnerships can really serve the direct interests of the people. Public-private cooperation is a relatively new phenomenon, but it has already gained considerable ground.

9. Resource allocation and health financing

** Fair financing in health systems
Abstract Of Paper Presented At The Equinet Conference, Durban, 8-9 June 2004, by Lucy Gilson, Centre for Health Policy, University of the Witwatersrand

The starting point of this paper is to briefly discuss alternative definitions of ‘fair financing’. The term ‘fair financing’ was popularised by the WHO in their 2000 World Health Report, which set about evaluating and ranking health systems around the world. The WHO has defined this concept as individuals paying for health services in proportion to their income. Others suggest that a more ‘progressive’ definition of fair financing would be appropriate. The focus of the paper is to review the key findings of work relating to health care financing that has been supported by Equinet over the past few years. In addition, other striking health care financing trends in the SADC region will be referred to.

Further details: /newsletter/id/30458
Community-Based health financing: An overview

In the context of inadequate public expenditure in the health sector, many countries have installed cost recovery systems, such as user fees, as a supplementary financing approach for health care services. This practice has raised concerns over equity and access to health care for the poor, and the search for complementary financing solutions continues. A 1997 review identified 81 documented CBHF schemes from throughout the world, with the majority in sub-Saharan Africa and Asia. This document aims to answer basic questions on CBHF that might be posed by policymakers and technical assistance providers interested in this topic.

10. Equity and HIV/AIDS

** Ensuring universal treatment access through sustainable public health systems
Abstract of paper presented at the Equinet conference, Durban, 8-9 June 2004, by David McCoy and Rene Loewenson, Equinet

There is no question that an effective and urgent response is needed to extend access to antiretroviral therapy (ART) in southern Africa. The efforts of treatment activists, national governments, the World Health Organisation and the Global Fund to highlight this unmet health need are commendable. However, after decades of under-investment, harmful structural adjustment programmes and de-skilling, many health systems face significant obstacles in rising to the challenge of meeting the treatment needs. Treatment activism now needs to join with broader public health activism to ensure that treatment can be extended in ways that are sustainable, effective and equitable. This paper draws on work carried out by EQUINET and others to discuss the threats and opportunities entailed with the expansion of ART access in Southern Africa- threats that must be managed and opportunities tapped to realise aspirations of treatment access for more than a minority.

Further details: /newsletter/id/30454
ARV's and the prevention of MTCT in resource-constrained settings

Interventions focusing on HIV-infected pregnant women need to be complemented by interventions that address primary prevention of HIV infection, particularly in women of child-bearing age and their partners, and prevention of unintended pregnancies among HIV-infected women. This is one of the findings of a paper that analyses the different alternatives that are available for the prevention of mother-to-child transmission (MTCT) of HIV in resource-constrained settings, and makes recommendations about the best course of action in a number of situations.

Health systems approaches to treatment access in Tanzania
Equinet meeting report

The meeting was focused on ensuring universal treatment access through sustainable public health systems. The goal of the meeting was to develop resolutions on the principles for strengthening health systems for treatment access, and to develop potential areas for work for EQUINET related to EQUINET’s programme of work areas. In the introductory remarks, it was indicated that while there were various prevention activities, focused on for example, workplace education, condom promotion, sexually transmitted infection treatment and control, youth, women, commercial sex workers, men who have sex with men, etc, there was 2.2 million Tanzanians living with HIV out of which 800 000 have full-blown AIDS.

South Africa Civil society network ready to help ARV rollout

About 90 non-governmental organisations (NGOs) in South Africa's KwaZulu-Natal province have teamed up to work with the government in rolling out antiretroviral (ARV) drugs, in the first structured civil society response of its kind in South Africa, and possibly even on the continent. When the government announced a national rollout plan for free ARVs in September 2003, Cati Vawda, director of the Durban-based Children's Rights Centre, and a number of her NGO colleagues, quickly realised that "government alone cannot do it".

Strengthening health systems for treatment access

This summary document presents: The principles for ensuring universal treatment access through sustainable public health systems; The major findings and issues from the work carried out in southern Africa on equity in health sector responses to HIV and AIDS, particularly in terms of access to antiretroviral treatment; The key challenges for follow up work identified at the southern African regional meeting on 'Strengthening Health systems for treatment access and equitable responses to HIV/AIDS' in Harare, Zimbabwe, February 2004.

11. Governance and participation in health

** Impact Of Participatory Mechanisms And Structures In Equity And Quality Of Health Service Delivery
Abstract of paper presented at the Equinet conference, Durban, 8-9 June 2004, by TJ Ngulube, R Loewenson, I Rusike, M Macwangi, C Njobu, A Ngwengwe, EQUINET GoVERN theme

In 2002/3 EQUINET implemented a multi-country research study to examine the impact of Health Centre Committees (HCCs) and District Health Boards (DHBs) in bringing about equity in the primary health care services in Zambia and Zimbabwe. The research work sought to examine equity from an EQUINET perspective, with emphasis that equity related work needs to define and build a more active role for important stakeholders in health, and to incorporate the power and ability people (and social groups) have to make choices over health inputs and their capacity to use these choices towards health.

Further details: /newsletter/id/30456
Community Assessment of the Socio-economic Situation in Zimbabwe: Health and Education

Civic organisations have through the monitoring Group of the National NGO Food Security Network (FOSENET) been monitoring food security in Zimbabwe since July 2002. In 2004 this monitoring has been widened to cover other social and economic conditions, recognizing the wide range of conditions influencing social and economic wellbeing. The Civic Monitoring Programme is implemented through NGOs based within districts and community based monitors. Monthly reports from all areas of the country are compiled to provide a monthly situation assessment of food security and social welfare to enhance an ethical, effective and community focussed response to the current situation. Quarterly reports such as this one complement the monthly monitoring and provide more detailed information on specific areas of social and economic conditions at community level. Queries and feedback on these reports is welcomed and should be directed to the Civic Monitoring Programme at fsmt2@mweb.co.zw This is the first round of such quarterly monitoring and continuous measures are being implemented to improve data quality and relevance, including training and peer review, so feedback is welcomed. For the full report, please contact fsmt2@mweb.co.zw.

Parliamentary Functions and Reforms and their application in promoting Health Equity
Equinet discussion paper

In response to demands by the public represented by Civil Society Organisations, Parliaments have been called upon to be more effective in carrying out their functions or representation, oversight and legislating. Beginning with the Parliament of South Africa in 1994 there has thus been a wave of Parliamentary reforms in the region with different levels of success. Parliaments have instituted changes in their committee systems and in the legislative process to allow greater participations from the public. In seeking to promote health equity and public health, legislatures, through their committees, have sought ways to engage with relevant stakeholders, and other organisations in order to broaden their knowledge base.

12. Monitoring equity and research policy

Tackling health inequalities: turning policy into practice?

"...As studies have shown, evidence is rarely applied to decision making in accordance with a rational, linear model. In practice, evidence is often generated through doing – in the enactment of policy. Evidence may be only one component of any decision making process, but it can be made an integral part of a culture of inquiry based on continual learning and development. Leaders and managers need to appreciate the complex relationship between research evidence and practice, and to ensure the right conditions are created to allow practitioners to reflect on, and learn from, the practice of what they do and how they do it. In this way, learning becomes a supply of evidence to be drawn on as practitioners continue to implement and reshape policy..."

13. Useful Resources

Human rights related educational materials

The Department of International Law and Human Rights of the University for Peace, with the support of the Government of the Netherlands, has been working since October 2003 on an innovative human rights project, the Human Rights Educational Project (HREP). The aim of the project is to develop and disseminate educational materials related to human rights in response to the need of individuals and organisations, particularly in developing countries, to obtain convenient access to up-to-date human rights instruments and academic materials. Professionals, practitioners, volunteers, educators and human rights defenders can all benefit from the availability of human rights instruments through the use of a manual and a CD-ROM.

Further details: /newsletter/id/30460
Newsletter on poetry and HIV/AIDS launched

A new newsletter of Poetry on HIV/AIDS in Africa has been launched. The name of the newsletter is AIDS out of AFRICA. AIDS out of AFRICA will be a bi-annual newsletter appearing in June and December.

PDA4HEALTH electronic forum

PDA4HEALTH, a new electronic forum setup by SATELLIFE, aims to share up-to-date information, knowledge, and experiences on the use of handheld computers for data collection and information dissemination in developing country health settings. Organisations and institutions engaged in field projects are encouraged to exchange the lessons they have learned, challenges faced, and successes achieved. Join for free by sending a message to the email address below.

World Health Assembly Documentation

To access a range of World Health Assembly documents, speeches and resolutions, click on the link below.

Youth InfoNet newsletter online

Youth InfoNet No. 6 is now online. This one-stop monthly source for new publications and information on youth reproductive health and HIV prevention is produced by Family Health International's (FHI) YouthNet program.

14. Jobs and Announcements

11TH Canadian Conference on International Health
October 24 - 27, 2004, Ottawa, Canada

The Canadian Conference on International Health, following the path set in the previous two years, further examines the global stage and the conflicting forces that shape the politics of health and impact our own health. The Conference objective is to provide an open and stimulating forum for practitioners, researchers, educators, policy makers, and community advocates.

2004 SADC Heads of State and government summit on agriculture and food security

The Summit of Heads of State and Government of the Southern African Development Community (SADC) on Agriculture and Food Security was held in Dar es Salaam, United Republic of Tanzania on 15 May 2004, and was chaired by His Excellency, Benjamin W. Mkapa, President of the United Republic of Tanzania. The Summit was held under the theme: Enhancing Agriculture and Food Security for Poverty Reduction in the SADC Region.

Further details: /newsletter/id/30439
Fatal Indifference: The G8, Africa, and Global Health
Ronald Labonte, Ted Schrecker, David Sanders, and Wilma Meeus

The G8 (the United States, England, France, Germany, Japan, Italy, Russia, the European Union, and Canada) represents the major political driver of contemporary globalization. It is also the most powerful political force behind the multilateral institutions that are shaping global economic practice and governance. The aid, trade, and investment policies and practices of G8 member nations largely shape the development possibilities of poorer countries around the world. This book provides a “report card” of commitments over the past three G8 summits (1999, 2000, and 2001) with a preliminary assessment of the most recent 2002 summit in Kananaskis, Canada.

Fellowships on Sexuality and Education in Sub-Saharan Africa

The African Population and Health Research Center (APHRC) based in Nairobi, Kenya is an international non-profit, non-governmental organization committed to conducting high quality and policy relevant research on population and health issues facing sub-Saharan Africa. Through funding from the Ford Foundation's Education and Sexuality Program, the Center seeks to facilitate development of scientific research on sexuality in sub-Saharan Africa. The program is aimed at strengthening scholarly capacity to investigate the notions and perceptions of sexuality, the process of learning, and transmission of sexuality knowledge across generations in the region.

Further details: /newsletter/id/30435
Proposed SADC Code on Gender and HIV/AIDS

The AIDS and Rights Alliance for Southern Africa (ARASA) is leading an initiative to establish a Code for the SADC region on Gender and HIV/AIDS. This Code is similar to the 'Code on HIV/AIDS and Employment' that was adopted by SADC 1997, but focuses specifically on the gendered dimensions of the AIDS epidemic. ARASA, in consultation with a number of human rights, gender and AIDS-services, has drawn up a draft Code entitled "Urgent Measures needed to Promote the Equality of Women and the Reduction of Women's Risk of HIV infection". This Code is available in English http://www.alp.org.za/resctr/other/misc/20040405_ARASA4.doc and Portuguese http://www.alp.org.za/resctr/other/misc/20040405_ARASA3.doc. A consultative meeting for experts in the fields of gender, HIV/AIDS and human rights in the region is planned for June 2004 in order to discuss and finalise the Code.

Towards Unity for Health

What is The Network: Towards Unity for Health? The Network: TUFH is a global association of individuals, groups, institutions and organisations committed to improving and maintaining health in the communities they have a mandate to serve. The Network: TUFH is a Non-Governmental Organisation in official relationships with the World Health Organization (WHO).

Further details: /newsletter/id/30438
Workshop on Proposal Development for Scientific Research Funding in Sub-Saharan Africa
16-20 August 2004, Nairobi, Kenya

The African Population and Health Research Center (APHRC) based in Nairobi, Kenya, in collaboration with the University of Southampton are inviting nominations of senior social science or public health researchers to attend a workshop on research proposal development. The main objective of the workshop is to strengthen the capacity of African scholars and institutions in developing good fundable proposals for scientific research.

Further details: /newsletter/id/30436