Call Closes On January 7 2005
This call invites applicants to participate in the EQUINET programme on trade and health being held in co-operation with the Southern and East African Trade Information and Negotiations Institute (SEATINI) and with the EQUINET Secretariat (Training and Research Support Centre)
The call:
EQUINET invites middle to senior policymakers, academics and civil society members working in areas of trade and / or health from countries in East and Southern Africa to participate in a capacity building and research programme on trade and health, i.e. to
- Participate in country-level training on trade and health to be held between January and March 2005
- In country level teams, to undertake and report on national assessments of trade and health, supported by technical and financial resources, between March and June 2005
- Review the country level assessments at a regional meeting in mid 2005
- Make recommendations on follow up of the programme
Initial countries will be selected on the basis of a critical mass of interested people from across both trade and health disciplines and from state, academia and civil society.
The programme
Southern African countries developing equity-oriented policies face significant external pressures. Globalisation has deepened the liberalisation trends initiated by the structural adjustment programmes, while WTO agreements have extended trade liberalisation to significant new areas, including trade in services, trade related investments and intellectual property rights. As a result of these intrusions, governments enjoy less policy flexibility to pursue pro-equity goals and to regulate in the public interest. Commercialisation of health systems, exacerbated under the WTO TRIPS and GATS agreements undermines: access to care; access to essential drugs and medical technology; cross-subsidy from the wealthy to the poor; cost-containment measures in both the public sector and to users; retention of skilled health workers in public facilities and; the regulation of the private sector to promote equity. Instead of the health system becoming a vehicle for social cohesion, solidarity and equity, it runs the risk of reinforcing existing social, economic and health inequalities.
New agreements such as the Trade Related Aspects of Intellectual Property Rights (TRIPS) do provide limited space for countries to act in interests such as public health. They demand significant institutional resources and capabilities to identify and take advantage of those spaces. These resources are not always available to individual countries in the south. Regional co-operation, such as at the Southern African Development Community (SADC) level, is important for responding to these global pressures. It offers a strategic platform for countries to reinforce their bargaining power, co-ordinate their efforts and provide regional solutions to challenges faced.
To support regional responses, EQUINET aims to build proactive capacity in the region to understand, assess the health consequences of and respond to these agreements. EQUINET has with its partners in the region proposed options for using TRIPS flexibilities, for protecting national authorities and public health systems under and from the GATS and for resisting the commercialisation of health services. EQUINET advocates for government authority to regulate trade in areas where this is needed to deliver on obligations to protect the right to health and for the protection of public over commercial interests in health.
With support from IDRC and SIDA and through the Centre for Health Policy (Wits University) and SEATINI, EQUINET is implementing a programme of work and capacity development in the field of trade and health that seeks to:
- Pilot a training programme and materials on trade and health systems for countries in Southern and East Africa
- Provide technical and resource support for country level teams to carry out national assessments, identify options for promoting health systems and equity goals within current trade and investment policies and agreements and identify areas for follow up work, policy review and negotiation.
The programme will
- Carry out country-level training workshops on trade and health between February and March 2005
- Support country level teams to undertake and report on national assessments of trade and health with mentoring from SEATINI and CHP between March and June 2005
- Review the country level assessments at a regional meeting of the country teams to be held in mid 2005 to identify options for promoting health systems and equity goals within current trade and investment policies and agreements and identify areas for follow up work, policy review and negotiation, together with relevant stakeholders and expertise.
- Make recommendations on follow up training, on widening the programme and on specific areas for research and follow up work.
Call for participation and applications:
Interested applicants should submit a 1-2 page ‘expression of interest’ that provides
- a personal CV,
- brief information on the institution that they work in, and their position in the institution.
Please send applications to the EQUINET secretariat (admin@equinetafrica.org)/ Fax 263-4-737 220) and the programme co-ordinators (riazt@iafrica.com and haroon.wadee@nhls.ac.za) by January 7th 2005.
Applicants will be informed by mid-January 2005 on the outcome of their submission, including sponsorship and of the logistic follow up. Participants of existing EQUINET programmes are welcome to apply.
The focal points for queries on this programme are Riaz Tayob, SEATINI (riazt@iafrica.com) and Haroon Wadee, Centre for Health Policy, Wits University (haroon.wadee@nhls.ac.za or haroonwadee@hotmail.com).
1. Editorial
2. Latest Equinet Updates
Equinet Regional Meeting On Participation And Governance In Health, Zambia, January 26-28 2004: Call Closes On December 5 2004
This call invites applicants to participate in and present work at the EQUINET regional meeting on participation and Governance in Health being held in co-operation with Centre for Health and Social Science Research (CHESSORE) Zambia and Training and Research Support Centre (TARSC) Zimbabwe in Lusaka, Zambia, January 26-28 2004.
The call:
EQUINET invites researchers and practitioners working on community participation and governance in health to participate in a regional meeting to
- Discuss and exchange evidence and experience on the impacts of community participation and joint community- health service structures on the performance of health systems
- Identify areas for follow up research, training and policy review to strengthen mechanisms for effective community involvement in health systems and for increased responsiveness of health services to community priorities and needs.
We invite interested organisations and individuals to submit an application to participate with information on their work and role in this area (see below). Applicants can also apply for EQUINET sponsorship to the meeting (see below). Applications need to be sent to the EQUINET secretariat by December 5 2004.
The programme:
The Regional Network on Equity and Health in Southern Africa (EQUINET) (www.equinetafrica.org) has noted 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. To do this requires a clearer analysis of the social dimensions of health and their role in health equity, i.e. the role of social networking and exclusion, of the forms and levels of participation and of how governance systems distribute power and authority over the resources needed for health. To understand these factors, EQUINET has been carrying out research work to evaluate the current and desired forms of participation within health systems in Zambia, Zimbabwe and Tanzania amongst other Southern African countries. This work has been co-ordinated by CHESSORE Zambia and TARSC Zimbabwe.
The multicountry programme explored the functioning of district and clinic level structures (neighbourhood and health centre committees and district health boards) for community participation in terms of whether they i. represent the interests of communities ii. have any role in health system performance and resource allocation iii. include community preferences in health planning and resource allocation iv. improve equity in resource allocation v. improve health system performance, especially in relation to equity The field studies and literature review in this programme explored outcomes in these areas, and how these outcomes were influenced by the functioning of these joint community- health service structures and deeper underlying determinants, including their legal status, authority and mandate.
The regional meeting:
The EQUINET/ CHESSORE/ TARSC regional meeting will be held in Lusaka, Zambia 26-28 January 2005 and will review the results of the multicountry programme and of other experiences in the region of joint health service and community structures for community participation in health, particularly in terms of their effectiveness representing community interests, and in improving the equity, relevance and quality of health systems. The meeting aims to share experience over a 3 day period from individuals and organisations working in east and southern Africa, and to use this to identify a follow-up programme of training, research and policy review in the region. EQUINET also propose to produce a book on participation, governance, equity and health in 2005 and will invite submissions from presentations to the regional meeting.
Call for participation and applications:
Interested applicants should submit a 1-2 page ‘expression of interest’ that outlines
- a title that summarises their work in this area
- an abstract of the research question, methods and key findings in this area OR a summary of the work they are doing in this area, that they would want to present at the meeting
- a personal CV,
- brief information on the institution that they work in, and
- a sample document written by the applicant on any relevant theme.
- An indication of whether they are self sponsored or whether they need sponsorship for travel, or accommodation,. or both
Applicants should submit this information by 5th December 2004 to the EQUINET secretariat admin@equinetafrica.org / Fax 263-4-737 220 and copy it to rene@tarsc.org and chessore@zamnet.zm
Applicants will be informed by 17th December 2004 on the outcome of their submission, including sponsorship and of the logistic details for the meeting. Participants of existing EQUINET programmes are welcome to apply.
Focal points for queries on this programme are Dr TJ Ngulube at the Centre for Health and Social Science Research Zambia and Dr R Loewenson (TARSC). Please send queries through admin@equinetafrica.org)
In October 2004, EQUINET and the Equi-TB programme Malawi hosted a regional meeting in Lilongwe Malawi to review options for monitoring equity and health systems issues in the current programmes to expand treatment access in the region. The meeting gathered government, academic, civil society, international and UN agencies and regional organisations from the SADC region. It aimed to propose a framework and follow up work to strengthen the monitoring of equity and health system issues in ART rollout at national and regional level.
3. Equity in Health
This report from Population Action International examines progress made towards achieving the goal of reproductive health and rights for all by 2015, agreed at the 1994 International Conference on Population and Development (ICPD). Key achievements include a significant increase in contraceptive use, and higher secondary school enrolment rates among girls. However, significant challenges remain, notably: high unmet need for effective contraception and protection from HIV/AIDS and other sexually transmitted infections (STIs); continuing high levels of maternal mortality; high rates of unsafe abortion; and an acute and growing resource shortfall, with many clinics experiencing stockouts (zero supplies) of contraceptives, safe motherhood kits and other reproductive health essentials.
A leading development group has welcomed EU proposals to allow export of cheap medicines to poor countries fighting HIV/AIDS and other killer diseases. Under a system to be known as 'compulsory licensing', poor countries facing public health crises will be able to override patents on expensive drugs and order cheaper copies from generic manufacturers in other countries.
Africa is facing a public health disaster in the form of multi-drug resistant malaria. People infected with malaria in eastern, central and southern Africa are rapidly becoming resistant to one of the most affordable and commonly used anti-malaria drugs, sulphadoxine-pyrimethamine (SP). Previously, a number of safe and cheap drugs including SP have kept down the number of deaths and people suffering from severe ill health caused by malaria. But there are ominous predictions that disaster looms – unless governments are willing to reconsider their treatment regime.
Developing countries are falling short of a United Nations goal of reducing child mortality rates by 2015 because of doctor shortages, failure to improve health- care services, and inconsistent funding, the World Bank said. No country in sub-Saharan Africa has made progress in cutting the number of deaths of children under the age of five from preventable illness since the UN issued its 2002 mandate to reduce mortality by two-thirds. More than 11 million young children died that year, with 42 percent in sub-Saharan Africa.
Along with millions of others, health workers celebrated South Africa's first democratic elections in 1994 as the first step in rolling back the devastating inequity of an apartheid era health system. At last the health needs of the whole population would be addressed with the advent of representative government and the anticipated “peoples” health system. An impressive array of health policies and plans were designed to reduce inequities and improve the health of all South Africans. Health activists and struggle veterans were in consensus that a single, unified National Health Service based on a comprehensive Primary Health Care approach would be the key to this transformation. Despite one of the most progressive constitutions on the planet and a strong rhetorical commitment to addressing the health needs of the poor, implementation has been slow. The huge effort put into reshaping the “architecture” of the health system has not translated into real health gain for all South Africans. Many of the poorest still find themselves marginalized and neglected, just as they were in pre-democratic South Africa.
4. Values, Policies and Rights
The HIV/AIDS pandemic presents a stark example of the nexus between human rights and health. This first became evident when government responses to HIV/AIDS subjected people living with the disease to violations of their rights to liberty, privacy, freedom of association, nondiscrimination, and equality before the law. As the pandemic has progressed, it has become apparent that human rights law is relevant not only to the treatment of infected individuals but also to wider policies that influence vulnerability to HIV/AIDS, as populations that are discriminated against, marginalized, and stigmatized are at a greater risk of contracting the disease.
5. Health equity in economic and trade policies
Health reforms based on market principles have been introduced widely in both developed and developing countries over the past 20 years. In developing countries, international donors have insisted on health reform as a precondition of providing external aid. The reform packages that have been introduced have been strikingly similar across countries as wide apart as Uganda, Bolivia, and Russia. Uganda embarked on market based health reforms in 1994. These reforms have not only failed to improve health services and the health of the population but have arguably been the key factor behind their deterioration. What can we learn from Uganda's experience?
This Working Paper was written by Tenu Avafia, a tralac researcher, and examines the potential impact of the proposed Free Trade Agreement (FTA) between SACU and the United States from the perspective of public health. Avafia examines the ongoing negotiations and expresses concerns about the possible impact of the FTA on public health in the SACU region, particularly, the impact that the proposed FTA is likely to have on the ability of SACU countries to source the most affordable essential medicines required to address urgent public health concerns. Avafia goes on to say that it would be imprudent to enter into a bilateral agreement that contains less favourable provisions on essential medicines than those found in the multilateral arena such as the Doha Declaration on TRIPs and Public Health and the WTO General Council Decision of 30 August 2003.
6. Poverty and health
While tuberculosis (TB) is not exclusively a disease of the poor, the association between poverty and TB is well established and widespread. Globally, the highest burden of TB is found in poor countries. Seventeen of the 22 countries that account for 80 per cent of the world’s TB burden are classified as low income and within countries the prevalence of TB is higher among the poor. This paper, produced by the EQUI-TB Knowledge Programme, analyses the existing evidence that TB causes or worsens poverty and that TB control (or elements of TB control) benefits the poor.
This review assesses the various factors that affect vulnerability to malaria, tuberculosis and HIV/AIDS infection and disease at the individual and household levels. Produced by The Lancet, it examines in particular the influence that age, sex, and genetics have on the biological response to the three diseases and looks at what effect the three illnesses have on each other. In addition, it explores the impact of poverty, livelihoods, gender discrepancies and education on all three infections.
7. Human Resources
Unless sub-Saharan African countries initiate workplace anti-AIDS programmes, the pandemic will decimate the region's human resource capacity, experts warned in the Ghanaian capital, Accra, in November. "African companies already find it difficult to compete in global markets," Ghana's presidential advisor on HIV/AIDS, Professor Fred Sai, told the fourth interactive meeting of the UN Commission on HIV/AIDS and Governance in Africa (CHGA).
This study explores the constraints related to human resources in the health (HRH) sector to achieving the Millennium Development Goals (MDGs) in low-income countries. The author finds that, at an individual level, the decision to enter, remain and serve in the health sector workforce is influenced by a series of social, economic, cultural and gender-related determinants.
A new study to be published in the Lancet has, for the first time, quantified the dangerous scarcity of healthcare workers in countries with climbing rates of HIV, tuberculosis and malaria. The report, 'Human Resources for Health: Overcoming the Crisis', says health workers from developing countries are lured by better salaries and safer working conditions in urban areas or richer countries, creating the so-called "brain-drain".
This article from the journal Human Resources for Health considers some of the effects of health sector reform on human resources for health (HRH) in developing countries and countries in transition by examining the effect of fiscal reform and the introduction of decentralisation and market mechanisms to the health sector. The introduction of market mechanisms often involves the formation of an internal market within the health sector and market testing of different functions with the private sector. This has immediate implications for the employment of health workers in the public sector, because the public sector may reduce its workforce if services are purchased from other sectors or may introduce more short-term and temporary employment contracts.
8. Public-Private Mix
This brief examines the policy implications of increased activity between the UN and the corporate sector, specifically focusing on the increased collaboration between the corporate sector and the World Health Organization (WHO), UNICEF and UNFPA. The brief also explores the major global health-related public-private partnerships (GHPPPs) which operate primarily outside the UN, such as the Global Alliance for Vaccination and Immunisation (GAVI). The brief concludes that, although guidelines and procedures to address public-private interactions (PPIs) have been developed within UN agencies, they are inadequate to ensure UN integrity.
9. Resource allocation and health financing
Attempts to quantify the epidemiologic and economic burden of malaria have so far neglected to specifically address the burden of epidemic malaria. Moreover, the data on the effectiveness and cost-effectiveness of interventions in epidemics is extremely limited. Using the limited data available, we estimate that in Africa, there are more than 12 million malaria episodes and 155,000–310,000 malaria deaths per year. The possible economic impact of malaria epidemics is described in this paper and the limited evidence on the effectiveness and cost-effectiveness of interventions in areas of low or seasonal transmission is reviewed.
10. Equity and HIV/AIDS
The annual AIDS epidemic update reports on the latest developments in the global HIV/AIDS epidemic. With maps and regional summaries, the 2004 edition provides the most recent estimates of the epidemic’s scope and human toll, explores new trends in the epidemic’s evolution, and features a special section on women and AIDS.
Access to good quality antiretroviral treatment has transformed the prognosis for people with AIDS in the developed world. Although it is feasible and desirable to deliver antiretroviral drugs in resource poor settings, few of the 95% of people with HIV and AIDS who live in developing countries receive them. The World Health Organization has launched a programme to deliver antiretroviral drugs to three million people with AIDS in the developing world by 2005, the "3 by 5" initiative. This article identifies some of the challenges faced by the initiative, focusing on delivery of care.
In an effort to mobilise leaders to fight HIV/AIDS, the parliament of Lesotho and the UN Children's Fund (UNICEF) have launched a publication called "What Parliamentarians can do about HIV/AIDS Action for Children and Young People". The publication provides parliamentarians with guidelines for responding to the challenge of protecting children and young people through laws, policies, advocacy, education and providing these vulnerable groups with tools to empower them.
The South African social services and population development minister, Zola Skweyiya, has said research into the effect of HIV/AIDS on children is critical for the region's future development. Skweyiya told his southern African counterparts at a recent meeting in Cape Town that the virus was devastating communities and families, and aggravating poverty by killing society's most productive members. According to the South African Press association, he urged that the pandemic be tackled "more vigorously, in an integrated manner".
All people with HIV/AIDS should have equal opportunity to access effective and appropriate treatment. However, in the context of existing social and health inequities, widespread poverty, high rates of new HIV infections, famine and budgetary constraints, increasing access to HIV care and treatment must be organised in a manner that balances HIV prevention and treatment efforts; HIV interventions and the broader strengthening of the health system as a whole; and HIV care and treatment with other public health and social needs.
A giant bright yellow condom was the centre of attraction in Namibia's capital, Windhoek, in November. Namibian civil society organisations - united in the fight against HIV/AIDS - had kicked off a series of activities in the run-up to World AIDS Day on 1 December. "By December 2003 over 100,000 HIV/AIDS cases were [officially] reported in Namibia," deputy health minister Dr Richard Kamwi told the crowd assembled around the condom. "Although these figures are extreme, it should be noted that it is only the tip of the iceberg."
With assistance from the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM), Malawi is scaling-up the delivery of antiretroviral (ARV) therapy to HIV-positive eligible patients. The country has developed National ARV Treatment Guidelines, which emphasize a structured and standardized approach for all aspects of ARV delivery, including monitoring and evaluation. This paper describes the standardized ARV treatment regimens and the treatment outcomes to assess the impact of treatment, the registration and monitoring systems and how the cohort analyses are carried out.
AIDS. It killed roughly 3 million people last year, most of them poor, and most of them in Africa. Between 34 and 42 million people are living with HIV. Absent antiretroviral therapies, AIDS will have killed the vast majority of them by 2015. In such a world, time can seem a luxury, and the rigours of critical enquiry an indulgence. We need things done now, yesterday, last year. Indeed, an overdue sense of urgency has taken hold in the past five years - much of it thanks to relentless AIDS advocacy efforts. Along with sets of received wisdoms, a more or less standardized framework for understanding the epidemic and its effects has evolved, and a lexicon for expressing this knowledge has been established. All this has helped put and keep AIDS in the spotlight. It has popularized knowledge of the epidemic, countered the earlier sense of paralysis or denial, helped marshal billions of dollars in funding and goad dozens of foot-dragging countries into action. It has worked wonders. But alongside these achievements are some troubling trends.
11. Governance and participation in health
The overall objective of the study was to assess the effectiveness of health governance structures in enhancing equity of access and community participation in the delivery of health care services in Zambia. The specific objectives were to: (i) describe the status of health governance structures in Zambia; (ii) examine the linkages between the health governance structures and community; (iii) asses how the health governance structures represent and respond to community inters and needs; (iv) determine the extent to which the community is involved in the planning of health care services and resource allocation and (v) propose option for enhancing equity of access and community participation in the delivery of health care services.
12. Monitoring equity and research policy
Annual global spending on health research has more than tripled in a period of 10 years rising to just under US$106 billion from US$30 billion. Despite this sharp growth, the "10/90 gap" persists. This study of financial flows for Health Research by the Global Forum for Health Research is presented as a contribution to answering the questions on how the world's health research resources are being used. Important gaps will be exposed and action galvanized to close them - namely, by leveraging global health research in a way that genuinely improves global health, i.e. the health of the many - the 90 per cent - not just the few.
Health systems research has the potential to produce dramatic improvements in health worldwide and to meet some of the major development challenges in the new millennium. Effective research could prevent half of the world's deaths with simple and cost-effective interventions, the World Health Organization (WHO) says in a new World Report on global health research. The WHO World Report on Knowledge for Better Health: Strengthening Health Systems highlights aspects of health research that, if managed more effectively, could produce even more benefits for public health in future. It sets out the strategies that are needed to reduce global disparities in health by strengthening health systems.
The Report focuses on bridging of the "know do" gap, the gulf between what we know and what we do in practice, between scientific potential and health realization. The bridging of this gap is central to achieving the health-related Millennium Development Goals (MDG’s) by 2015. The gap exists for each of the MDG’s and represents a fundamental and pragmatic knowledge translation challenge that must be addressed to strengthen health systems performance towards achieving the MDG’s. The Report will expound the message that we must turn scientific knowledge into actions, which improves people’s health, and that health improvement through knowledge applications is a critical factor in human development and alleviation of ill-health and poverty worldwide.
13. Useful Resources
Globalization and Health is an Open Access, peer-reviewed, online journal soon to be launched by BioMed Central. Globalization and Health will encompass all aspects of globalization and its effects on public health.
Rural and Remote Health, the international, electronic Journal of Rural and Remote Health education, practice and policy is an initiative of the Greater Green Triangle University Department of Rural Health, located in south-eastern Australia. The Journal's aim is to provide an easily accessible, peer-reviewed, international evidence-base to inform improvement in health service delivery and health status in rural communities.
This book promotes the use of strategic communication to fight against the HIV/AIDS epidemic. Focusing on strategic communication for positive and measurable behaviour change, the authors elaborate on a wide range of issues including: the importance of advocacy and community mobilization; comprehensive approaches to prevention and the use of communication in reducing stigma; communication programmes for a wide range of specific groups including intravenous drug users and refugees; the role of communication in support of clinical and social services; the care and support of vulnerable children; and selected communication approaches such as entertainment-education, telephone hotlines and digital communication.
14. Jobs and Announcements
The Department of International Health at Boston University is looking for new faculty with expertise in the following areas:
1. Practical experience with clinical and management issues at the primary care/district level of the health care system in developing countries.
2. Health finance, management and economics.
3 .Screening and treatment of non-communicable diseases in low resource settings.
4. Pharmaceutical management and policy.
5. Health policy, including the identification and analysis of policy options and the development of support for new policies. Health planning (including manpower) could be the focus of the policy person.
6. Experience with health reform especially if the person had a focus in the Former Soviet Union and/or Eastern Europe. A speaking knowledge of Russian would be helpful.
Anyone interested in further information or in applying should contact John Douglas at johnd@bu.edu or
Susan Foster at sfoster@bu.edu
http://www.bumc.bu.edu/ih
The Alliance for Health Policy and Systems Research, an initiative of the Global Forum for Health Research in collaboration with the World Health Organization, has just published its first biennial review of the emerging field of health policy and systems research. The central concern of this book is how knowledge of health systems can be significantly increased and effectively applied to improve the health of the worst-off of the world's population.
"We invite your collaboration in the We the Peoples 2005 Survey. We the Peoples is an annual survey which analyses and reports on civil society activities, achievements and views regarding the Millennium Declaration and the Millennium Development Goals (MDGs). 2005 promises to be a year of opportunity. In September, a summit-session of the United Nations General Assembly will review progress since the Millennium Declaration of 2000. In July, the G-7 will meet in the UK. Around the world national coalitions are seeking to hold their governments to account for promises made. An international "Call to Action" Campaign is mobilizing civil society to press for accountability and significant progress on aid, debt cancellation and trade justice."
Published for the Network for Equity in Health in Southern Africa by Fahamu - learning for change
http://www.fahamu.org/
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