Following the 1994 elections in South Africa, the new ANC government committed itself to the development of a District Health System that would meet the health needs of local communities and allow for grassroots input into the management of primary health care. Ten years later, there is still indecision and confusion surrounding the governance and financing of primary health care delivery and it is not clear which authorities will take leading responsibility for administering the district health services.
Municipal health workers together with their provincial counterparts and community health workers stand in the front line of delivering primary health care to the majority of South Africans. The SAMWU/MSP/IHRG National Survey into the State of Occupational Health and Safety in the Municipal Health Clinics asks “Who cares for health care workers?” While the health care profession embraces important ethics of service and sacrifice in meeting the health needs of the public, our research points to neglect of the health and well-being of health care workers themselves.
We found little taking place to identify hazards, evaluate risks, prevent workplace injury and illness and ensure that the conditions in which health workers care for others allows them to care also for themselves. Even where measures are provided, there is little employee involvement in shaping these health and safety practices.
We found that probably the biggest health and safety hazard facing health care workers in the public health sector in South Africa is the shortage of staff. Growing queues of patients lead to stress, burnout and increase the risk of accidental injury. Lack of facilities, equipment, and medicines further frustrate clinic staff and add to tensions between staff and the communities.
This situation is not simply a management problem- it is also reinforced and reproduced by health workers themselves. The inclination of the majority of health workers to accept appalling working conditions, to isolate themselves, and to individualise their workplace traumas, stress and exhaustion, presents an enormous challenge to SAMWU and other unions organising in the public health sector.
We intend to shape an alternative to that neglect. As activist investigators, we are challenging the silence and neglect that characterises work in the health sector. This starts with our research activity - asking questions; identifying workplace hazards; documenting case studies of workplace injury and illness; interviewing management and workers in the clinics; sharing stories of needle-prick incidents; interrogating policy and protocols; challenging employers’ non-compliance; discovering rights and responsibilities; and examining the extent of effective representation and functioning of health and safety committees.
* This briefing is edited by the EQUINET secretariat at TARSC. Please send feedback or queries on the issues raised in this briefing to Nick Henwood, IHRG at ihnick@ihrg.uct.ac.za or to the EQUINET secretariat email admin@equinetafrica.org .
* The research report cited will be available in late January as a downloadable pdf file from the Municipal Services Project website (http://www.queensu.ca/msp/) or from the EQUINET website at www.equinetafrica.org
1. Editorial
2. Latest Equinet Updates
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
The EQUINET regional meeting on 'Community Voice and Agency in Health' is 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 2005.
The meeting will involve researchers and practitioners working on community participation and involvement in health. The regional meeting will
* 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.
3. Equity in Health
This article, published in Social Science and Medicine, reports on progress towards the goal of health for all, with specific reference to international development commitments made by the G7/G8 nations at the 1999, 2000 and 2001 summits. It argues that the limited progress toward achieving health for all derives largely from the failure of G8 nations to fulfil their development commitments. In particular, efforts to reduce poverty and economic security have been insufficient; and national governments have not been enabled to make basic investments in health systems, education and nutrition.
As anti-AIDS drugs become available to more South Africans, a growing number of HIV-positive women are choosing to become pregnant in spite of their status. Although it is generally accepted that all women have the right to bear children, society finds it harder to accept when women living with the virus exercise that choice.
Mozambique's National Council for the Fight Against AIDS (CNCS) has spent less than 40 percent of the funds allocated to HIV/AIDS activities in the country in 2004. According to the local news agency, AIM, the CNCS had planned programmes costing US $17.7 million, but only $6.5 million was disbursed and used, leaving projects planned by civil society and the public sector in the lurch.
This volume examines the foundations of health equity. With contributions from philosophers, anthropologists, economists, and public-health specialists, it centers on five major themes: what is health equity?; health equity and its relation to social justice; health inequalities and responsibilities for health; ethical issues in health evaluation and prioritization; and anthropological perspectives on health equity.
The initial response by the world's richest countries to the earthquake and tidal wave disaster in Southern Asia has been pathetic. While many of these countries have poured billions into invading and bringing misery to the people of Iraq, they cannot seem to find anywhere near enough money to seriously help the mainly poor people who have been made destitute by this natural disaster, according to this article on the website of the Socialist Alliance.
Related Link:
* Earthquakes, Tsunamis and Nuclear Testing
http://www.counterpunch.org/rajiva12302004.html
When Dr Keith Bolton treated children in the 1990s, the death of a patient was still relatively infrequent. As head of child health at South Africa's Coronation Hospital in Johannesburg, Bolton saw an average of one child die each week. Now, Bolton and his colleagues see one child die every day. "In the past, death was an uncommon event in children, especially after the newborn period," said Bolton. "Now we've seen a complete reversal of the gains we made in the 1960s, '70s and '80s."
4. Values, Policies and Rights
As part of basic building-blocks to develop a solid foundation for WHO's emerging work on health and human rights, a Global Database on Health and Human Rights Actors has just been launched on WHO Health and Human Rights website. This database contains information gathered from a survey of organizations concerning their structures and programs. It is searchable by country (where the organization is located) or by specific health issue.
5. Health equity in economic and trade policies
Efforts to bring antiretroviral treatment to AIDS patients in developing countries are threatened by the looming implementation of new World Trade Organisation patent rules, the charity Médecins Sans Frontières warned in December. The organisation’s TRIPS (trade related aspects of intellectual property rights) agreement comes into force for most signatories on 1 January 2005. It requires the organisation’s members to grant 20-year patents to new pharmaceutical products. Only the least developed countries can postpone implementation until 2016.
WHO estimates that currently one third of the world's population lacks access to essential drugs. Over fifty percent of people in the developing world especially in Africa and Asia do not have access to even the most basic essential drugs. There are many factors which influence and maintain the higher and unaffordable prices of drugs, however, lack of price control measures and the pricing policies of multinational pharmaceutical companies are considered the most important contributing factors. This paper presents an overview on Globalization, Intellectual Property Rights (IPRs) and Patents, which have taken a new turn with the introduction of the Agreement on Trade-Related aspects of Intellectual Property Rights (TRIPs Agreement).
6. Poverty and health
Considering the high levels of chronic poverty in the Southern Africa region, and the ongoing impact of HIV/AIDS, safety net programmes will be required to support the poorest in the community over the long term. Cash-based transfers to supplement income are likely to be the most efficient and appropriate means of doing this, though in-kind safety nets, such as vouchers for education or health costs, or for subsidised agricultural inputs, will also be suitable in some circumstances.
2004 ended on a grim note for many in Southern Africa, where emergency food supplies cannot meet their needs. The United Nations World Food Programme (WFP) announced that it had been cutting rations to more than 2.8 million people over the past six months, as it lacked the funding to purchase additional food supplies. "There will be serious health and nutritional repercussions if people have to accept a further reduction in their meagre rations," said Mike Sackett, WFP Regional Director for Southern Africa, in a press release issued December 22.
Southern Africa should prepare itself for recurring drought, likely to strike at least twice every decade, says a new report. The report, 'Anticipating and Responding to Drought and Emergencies in Southern Africa', was prepared for the New Partnership for Africa's Development (NEPAD) and noted that the region could experience a recurrence of the devastating drought of 2002/03, which resulted in a food deficit of 3.3 million mt. While the general regional situation shows some hopeful signs, the report noted the concerns of some policy experts that many households have become more vulnerable to shocks.
7. Human Resources
Physician migration from poor countries to rich ones contributes to worldwide health workforce imbalances that may be detrimental to the health systems of source countries. The migration of over 5000 doctors from sub-Saharan Africa to the USA has had a significantly negative effect on the doctor-to-population ratio of Africa. The finding that the bulk of migration occurs from only a few countries and medical schools suggests policy interventions in only a few locations could be effective in stemming the brain drain.
This report presents the findings and recommendations of the Joint Learning Initiative (JLI), an enterprise engaging more than 100 global health leaders in landscaping human resources for health and in identifying strategies to strengthen the workforce of health systems. The JLI was launched because the most critical factor driving health system performance, the health worker, was neglected and overlooked. At a time of opportunity to redress outstanding health challenges, there is a growing awareness that human resources rank consistently among the most important system barriers to progress.
Small antiretroviral drug programmes are beginning to take shape in some of the worst affected countries in Africa. But as the drugs flow in, the medical personnel needed to administer them are being lured away by the rich countries that talk loudly about finding a solution to Africa's AIDS crisis and whose companies provided the drugs. WHO estimates that only 750000 health workers are available to care for 682-million people in sub-Saharan Africa, which has more than 25-million people infected with HIV, or 60% of the global total.
8. Public-Private Mix
This paper, produced by Partnerships for Health Sector Reform/plus, discusses the effectiveness of contracting out primary care services as a tool for health reform. The paper provides a short history of contracting out, a discussion of its advantages and disadvantages, and a review of the available literature on the impact of contracting out. The authors note that there is a lack of evaluation research on the success of contracting-out, and a lack of conclusive evidence that contracting out improves overall health sector efficiency.
Wealthy governments trying to help develop drugs for poor counties have been slow to recognise the potential for public-private partnerships, according to the UK-based Pharmaceutical R&D Policy Group (PRPG). Since May 2004, the PRPG has been assessing different ways of funding drug development for 'neglected diseases' - such as malaria and sleeping sickness - that affect many people in poor countries but receive little attention from the global research community.
9. Resource allocation and health financing
"The Millennium Development Goals depend critically on scaling up public health investments in developing countries. As a matter of urgency, developing-country governments must present detailed investment plans that are sufficiently ambitious to meet the goals, and the plans must be inserted into existing donor processes. Donor countries must keep the promises they have often reiterated of increased assistance, which they can easily afford, to help improve health in the developing countries and ensure stability for the whole world."
10. Equity and HIV/AIDS
This joint UNAIDS/WHO report outlines the most recent trends in the global AIDS epidemic. Women are increasingly affected by HIV and make up nearly half of the 37.2 million living with HIV world wide. In sub-Saharan Africa, almost 60 percent of adults living with HIV are women. The report identifies Southern Africa as the worst-hit region with HIV prevalence rates surpassing 25 percent. Although global AIDS spending has tripled since 2001 and access to services has improved significantly, the epidemic is still spreading.
Some HIV/AIDS treatment groups have expressed "alarm" about a possible backlash against the use of the antiretroviral drug nevirapine among pregnant women to reduce the risk of mother-to-child HIV transmission because of a recent series of Associated Press articles concerning clinical trials of the drug, the New York Times reports. The articles concerned NIH's research on the use of nevirapine in single doses among HIV-positive pregnant women in Uganda to determine the drug's ability to reduce the risk of vertical HIV transmission.
This British Medical Journal article examines the challenges faced in the World Health Organization's (WHO) '3 by 5' initiative, which aims to deliver anti-retrovirals (ARVs) to 3 million people by 2005. It highlights that the focus on delivering ARVs distracts resources and attention from a broader model of health care. They argue that the initiative must develop a chronic disease model of care through a strengthened public health infrastructure. The authors also point out the exclusionary power of stigma and outline the need for training programmes for health care workers on medical ethics and human rights.
"The European Parliament ...Calls on the EU to continue to prioritise sexual and reproductive health issues through funding programmes on family planning, and in particular to influence sexual behaviour through risk-reduction strategies, to educate young people, and especially girls and young women, about STIs and HIV, and to encourage condom usage in combination with other contraceptive methods and combat any misinformation spread on the effectiveness of condoms..."
In a small village in Kaswela in Karonga district in the northern region of Malawi, 35-year-old Lucy Banda has been critically ill for a year, and her neighbours suspect she is HIV-positive. Despite numerous visits to the hospital, Banda shows no signs of improvement and spends most of her time lying on her mat, unable to talk or eat properly. A community based NGO in the district, Chipulikano Orphan Care (COC), is trying to address the problem of caring for orphans and vulnerable children, as well as raising awareness about AIDS within families - traditionally a taboo subject.
A new project by the South African NGO, Health Systems Trust (HST), will enable communities across the country to provide feedback on progress in the rollout of free anti-AIDS medication. HST, based in the east-coast city of Durban, is developing a monitoring and evaluation tool to screen communities' access to free antiretroviral (ARV) drugs, and will also provide technical assistance in lobbying provincial and national government. The national treatment programme has come under fire from activists over the slow pace of delivery and problems with the procurement of ARVs.
This International Food Policy Research Institute (IPFRI) discussion paper examines the scaling-up of the STEPS initiative (Scaling Up HIV/AIDS Interventions Through Expanded Partnerships) in Malawi, and the factors which interfere with this process. Topics explored in this paper include: Malawi's national response to HIV/AIDS; the pilot project and the development of the community mobilisation model (formerly known as COPE); the scaling up and progress of STEPS; and factors that effect the scaling up process, including the catalysts, institutional arrangements, and organisational capacities. The paper also looks at community-level factors and financing, as well as threats to scaling up, including HIV/AIDS and the ongoing food crisis in the context of widespread and deep poverty, and underdevelopment.
11. Monitoring equity and research policy
This statement, published by the Global Forum for Health Research, reports on its eighth annual meeting, held in Mexico City from 16-20 November 2004, which considered how health research could be used to achieve the Millennium Development Goals (MDGs). Key points outlined in the statement include: (1) a call for renewed effort to close the 10/90 gap in health research by focusing on the diseases that affect the world's poor, essential for achieving the MDG poverty target; (2) the need to address more comprehensively the determinants of health, encompassing health policy and systems research, and the cross-cutting issues of poverty and equity; (3) the requirement to give more prominence to sexual and reproductive health and rights as central to the achievement of the MDGs.
Despite substantial sums of money being devoted to health research, most of it does not benefit the health of poor people living in developing countries, a matter of concern to civil society networks, such as the People's Health Movement. Health research should play a more influential part in improving the health of poor people, not only through the distribution of knowledge, but also by answering questions, such as why health and healthcare inequities continue to grow despite greatly increased global wealth, enhanced knowledge, and more effective technologies.
“….The number of think tanks worldwide has expanded rapidly over the last two decades as government becomes more receptive to evidence-based policy solutions and seeks new solutions in rapidly changing political environments. What they all have in common is a wish to capture the political imagination; they aim to use their insight to have political impact. This handbook addresses various factors that need to be considered in this process, and provides a comprehensive selection of tools that can be used when attempting to turn research into policy influence…"
12. Useful Resources
The Eldis/HRC Health Resource Guide has been re-launched with a new look and expanded subject coverage. There are new sections on maternal and newborn health, child health, sexual and reproductive health, tuberculosis and malaria. Key readings on each topic have been chosen and prepared in collaboration with technical experts. Each section covers statistical trends and indicators, programme approaches, access to services and information, health systems, and rights and advocacy.
Health workers and others involved in relief efforts will find links to treatment guidelines and other medical and public health references for the prevention and treatment of diseases prevalent in the aftermath of floods and other disasters on our website www.healthnet.org.
A special issue of the INASP Newsletter is dedicated to the "Global Review on Access to Health Information in Developing Countries", a major initiative proposed by representatives of 20 leading health organisations worldwide. The Review aims to assess progress over the last 10 years, lessons learned and ways forward to improve access to relevant healthcare information.
The TRIP Database allows users to rapidly and easily identify high quality medical literature from a wide range of sources. The content of the TRIP Database is separated into a number of categories. Content includes systematic reviews, CATs, and journal clubs.
World Health Organization / Pan American Health and Education Foundation
www.paho.org
* Action Aid
www.actionaid.org
* American Friends Service Committee (AFSC Crisis Fund)
www.afsc.org
* Care International
www.care.org
* Medecins Sans Frontieres / Doctors Without Borders
www.msf.org / www.doctorswithoutborders.org
* Red Cross and Red Crescent
www.ifrc.org
* Salvation Army
www.salvationarmy.org
* Save the Children
www.savethechildren.org
* Oxfam
www.oxfam.org
* United Nations Children's Fund, Unicef
www.unicef.org
* United Nations World Food Programme
www.wfp.org
* UN refugee agency, UNHCR
www.unhcr.ch
This toolkit from the World Health Organisation addresses the fact that lack of access to antiretroviral (ARV) treatment has perpetuated HIV/AIDS-related stigma and discrimination in many countries. Increasing the availability and accessibility of ARV treatment will significantly reduce stigma and discrimination against HIV/AIDS patients.
13. Jobs and Announcements
The 2005 AIDS IMPACT conference held in Cape Town, South Africa will be a partnership between AIDS Impact and the South African HSRC with Dr Olive Shisana (HSRC)and Bridgette Prince ( Nelson Mandela Foundation) and their South African team. The conference has been in existence as an international gathering since the early 1990s.
From a public health perspective, globalization appears to be a mixed blessing. This international collection of essays on globalization and health examines the global health issues associated with the economic, technological, political, social, cultural and environmental effects of globalization-the increasing movement of capital, people, technology, goods, information, environmental pollution, and disease around the globe. Contact elich@brill.nl for more information.
A new book from the Center for Global Development documents the success of 17 large-scale efforts to improve health in developing countries, and highlights their lessons for today’s global health challenges. From the eradication of polio in Latin America, to the elimination of measles in southern Africa, to HIV prevention in Thailand, this work provides clear evidence that large-scale success in health is possible.
"We are calling individuals and organisations – activists, communities, health workers and academics – from around the world to submit case studies and testimonies to be part of the process of the second Peoples’ Health Assembly and the Global Health Watch report 2005. See below for more."
In order to contribute to improved global treatment preparedness in countries and communities, WHO has established the Preparing for Treatment Program (PTP), based in the Department of HIV/AIDS at WHO headquarters in Geneva. To the extent possible, resources available through the PTP will be provided to partner organizations that have expertise and are currently engaged in or have capacity to undertake treatment preparedness activities.
Published for the Network for Equity in Health in Southern Africa by Fahamu - learning for change
http://www.fahamu.org/
Contact EQUINET at TARSC c/o admin@equinetafrica.org
EQUINET-Newsletter is hosted on Kabissa - Space for change in Africa
To post, write to: equinet-newsletter@equinetafrica.org
Website: http://www.equinetafrica.org/newsletter
Please forward this to others.
To subscribe, visit http://www.equinetafrica.org
or send an email to info@equinetafrica.org
* Please send materials for inclusion in the EQUINET NEWS to editor@equinetafrica.org