Up to two-thirds of all Africans in east and southern Africa (ESA) live in rural areas, three-quarters of them living below the poverty line. Agriculture contributes 35% to the southern African regional GDP and 13% of total export earnings. In addition, about 70% of the population of the region depends on agriculture for food, income and employment. The recent widespread food crisis in the region that pushed more than sixteen million people into severe food shortage is further evidence that agriculture and food security still play a fundamental role in determining the development and health of the poorest in the region.
The Regional Network for Equity in Health in Southern Africa (EQUINET) recognising the importance of food security in health equity, commissioned a paper that explores equity concerns around food security and nutrition within the SADC and East Africa region, drawing information from available secondary data. The paper aims to analyse the current food security and nutrition situation in the region and the health and equity issues and policy concerns arising. EQUINET has commissioned this analysis of the determinants of the current situation, and the policy influences that enhance or undermine equity in food security and nutrition, to propose areas for policy and programme engagement and for research and debate by EQUINET.
This paper argues that there are at least five good reasons why food security and nutrition should be given high priority in actions to improve health equity and socio-economic development across the region:
1. Poverty, hunger and under-nutrition are getting worse in ESA, even though they are improving in almost every other region. This undermines the achievement of UN Millenium Development Goals in this region.
2. Instead of the potential virtuous cycle that could be created between improved nutrition and improved economic wellbeing, ESA is currently caught in a vicious cycle of worsening poverty, hunger and under-nutrition accentuating income and health inequalities and increasing vulnerability.
3. Proven effective interventions indicate that public policy can make a difference, that nutritional improvements can be effected, even under conditions of poverty, and that these can have positive impacts on economic wellbeing.
4. Implementing public policies that address food security provides an opportunity to deal with the demands of AIDS, the challenges of the competing signals from global trade to health and development and the challenges to equitable public policy in the current governance of the food supply system.
5. Confronting hunger and nutrition provides one further area where alternatives can be built that promote policy objectives of justice and equity. This calls for interventions that build a multi-disciplinary and integrated response to food security and nutrition, especially focused upon gender inequalities, community control over productive resources and fair trade - ie one that is shaped on food sovereignty.
This analysis suggests that equity in health will be difficult to achieve in this region unless there more explicit attention is paid to the underlying nutrition and food security determinants. These in turn are being shaped by larger forces such as trade rules, corporatisation of the food supply chain, HIV/AIDS, gender inequalities etc. However we can start to identify areas of common action that would strengthen equity in food security, nutrition and health outcomes.
At a minimum an equity programme should focus on:
- Building civil - state alliances around a programme of action that links a food sovereignty perspective with the equitable public policy that supports this.
- Promoting further assessment of the links between trade and health in the region to feed into advocacy for trade policies and agreements that strengthen public health.
- Supporting, informing and evaluating policies and initiatives that provide safety nets to those most affected by negative effects of trade and agricultural policies and of HIV and AIDS.
- Continuing to identify how gender inequalities exacerbate the impact of globalisation and HIV and AIDS on the poorest families and decrease the efficiency of policy responses and propose programme and policy responses for these problems.
* The full article is available at http://www.equinetafrica.org/bibl/equinetpub.php
* Please send comments to admin@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.
EQUINET will award a number of small grants to post graduate students and undergraduate students in East and Southern Africa for research proposals in the areas of:
- Equity in Human Resources for Health
- Equity issues in food security and nutrition
- Equity in health sector responses to HIV/AIDS and treatment access
- Using health rights as a tool for equity in health
- Health equity in economic and trade policies
- Fair financing in health
- Governance and community participation in health
- Understanding and analyzing policy processes.
3. Equity in Health
Wealthy countries "deliberately" enlist doctors and nurses from poor nations, costing developing states US $500 million a year in lost training, Ndioro Ndiaye, deputy director-general of the International Organisation for Migration, said. According to Ndiaye, the UK drafted more than 8,000 nurses and midwives from outside of Europe in the year 2000. This was in addition to the 30,000 hired over previous years. Some 21,000 Nigerian doctors were working in the US the same year, while there were more doctors from Benin working in France than in their own country, she said.
Three articles published by the Associated Press in mid-December criticising the conduct of a trial of the antiretroviral drug nevirapine in Uganda are threatening to undermine its use in newborn babies in developing countries, according to South African experts. A single dose of the drug given to mothers while in labour and to their babies at the time of birth is known to greatly reduce transmission of HIV from mother to child. The articles, which appeared in newspapers and were broadcast on radio stations in the United States, Britain, South Africa, and many other countries, made allegations about a trial that was conducted from 1997 to 1999 in Uganda by researchers from Johns Hopkins University and Makerere University in Kampala, Uganda, and subsequently published.
This paper, from the Health Systems Trust, is an analysis of the clinical, health systems and underlying reasons for the drastic deterioration in maternal health in Malawi. It finds that the high maternal mortality rates are a result of poor health care, health systems deficiencies, limited access to care and harmful ‘patient-related behaviour.’ The paper argues that there are three ways of improving maternal health: through an integrated health systems approach, through improvements within maternal health programmes, and by equitably addressing poverty and social inequalities.
In the crowded wards of African hospitals, coughs and bony bodies tell the story of a deadly return. Tuberculosis (TB), supposedly defeated 40 years ago, is back, riding on the AIDS epidemic, and the world is ill-prepared, says the relief agency Medecins Sans Frontieres (MSF). In its study 'Running out of Breath? TB Care in the 21st Century', MSF's Campaign for Access to Essential Medicines urges a radical rethink of the global approach to the disease. TB kills two million people every year, nearly all in developing countries. Yet TB, if detected early and treated, is curable.
Although 2.2 million children are living with AIDS, at least two-thirds of them in Africa, anti-retroviral formulations for children are not available and the youngsters are just being left to die, a United Nations special envoy battling HIV/AIDS on the continent said. "In the instance of anti-retroviral (ARV) therapy, the scenario for children is quite simply, doomsday," Stephen Lewis, Secretary-General Kofi Annan's Special Envoy for HIV/AIDS in Africa, told a news conference. "Incredibly enough, we don't even have paediatric formulations. When treatment takes place - a rarity among rarities - doctors and nurses fumble over breaking capsules into several pieces to estimate the dosage for a child, or scramble around to find a syrup solution. It's bizarre."
The World Health Organization (WHO) has underlined the need to urgently tackle the health issues highlighted in the Millennium Project's "Investing in Development" report. The report provides detailed recommendations on how the world must immediately and massively increase the investment in health programmes to achieve the Millennium Development Goals (MDGs). This includes programmes to deliver AIDS treatment, to improve maternal and child health, to control and treat tuberculosis and malaria, and to make more medicines affordable.
4. Values, Policies and Rights
HIV/AIDS is a preventable disease, yet approximately 5 million people were newly infected with HIV in 2003, the majority of them through sex. Many of these cases could have been avoided, but for state-imposed restrictions on proven and effective HIV prevention strategies, such as latex condoms. Condoms provide an essentially impermeable barrier to HIV pathogens. According to the Joint United Nations Programme on HIV/AIDS (UNAIDS), scientific data "overwhelmingly confirm that male latex condoms are highly effective in preventing sexual HIV transmission." However, many governments around the world either fail to guarantee access to condoms or impose needless restrictions on access to condoms and related HIV/AIDS information. Such restrictions interfere with public health as well as set back internationally recognized human rights - the right to the highest attainable standard of health, the right to information, and the right to life.
Enthusiasm for “rights-based approaches” to development has grown during the past decade. Rights now have diverse meanings within the policies and actions of development agencies, governments and civil society organisations. This “rise of rights” has sparked critical reflection about the origins of rights-based approaches to development and what they mean in policy and practice. One of the key concerns, as with all development fashions, is “what is really different this time?” Can this emerging focus on rights help to bring about real changes in favour of poor and marginalised people? How do we know that “rights-based development” is not just putting new labels on old wine? This is the issue explored by the 'IDS Bulletin' from the Institute of Development Studies.
5. Health equity in economic and trade policies
The emergence of an increasingly global economy suggests that the ability of individual countries to shape their own destinies is becoming more difficult. International trends and pressures now influence national, and even local, health care policy making. Researchers from the University of the Witwatersrand, South Africa, together with Oxford University, looked at the effect of globalisation on health issues in South Africa and assessed its influence compared to national and local forces. Political and economic developments in the international arena will inevitably influence health issues in South Africa. Institutions such as the WHO and the World Bank, together with international events such as the spread of AIDS, affect health care in the country. However local forces also play a large part in shaping the future of the South African health service.
Since the 1980s, neoliberal policies have prescribed reducing the role of governments, relying on market forces to organize and provide health care and other vital human services. In this context, international trade agreements increasingly serve as mechanisms to enforce the privatization, deregulation, and decentralization of health care and other services, with important implications for democracy as well as for health. Critics contend that social austerity and "free" trade agreements contribute to the rise in global poverty and economic inequality and instability, and therefore to increased preventable illness and death.
International AIDS activists working for access to affordable AIDS treatment called on the Indian Government to repeal the law that introduced product patent protection on medicines through an Ordinance, promulgated December 26, 2004. "India should be proud to be producing and exporting cheap, generic AIDS drugs for people in need. The changes to the patent law will increase the price of new drugs, as well as some AIDS medicines that are already produced and exported in generic form," said Rolake Nwagwu of Positive Action for Treatment (PATA), Nigeria. "Rising treatment costs will spell disaster for people with HIV in India and around the world." 8,500 people with HIV die daily worldwide due to lack of access to treatment.
Has health benefited from the Poverty Reduction Strategy Paper (PRSP) process launched in 1999 by the international community? The first part of the paper examines the macro-economic constraints on health care financing and considers whether enhanced debt reduction, flexibility on fiscal deficits and the potential for increased aid would alleviate these constraints. The authors conclude that the PRSP process has not lived up to the expectations it has generated.
6. Poverty and health
Malnutrition and related diseases are expected to rise in Zimbabwe, peaking in the January to March 2005 period, according to a new report by the Famine Early Warning Systems Network (FEWS NET). While staple cereals are increasingly unavailable in rural areas, maize prices on the parallel market continue to climb, limiting the ability of households to buy enough food to satisfy their needs, said both FEWS NET and the World Food Programme (WFP) in separate surveys.
This survey by the Development Policy Research Unit (DPRU) at the University of Cape Town of poverty in post-apartheid South Africa defines and examines poverty in the South African context. The aim of the report is to provide a picture of asset and services deprivation, economic activity, and health and safety. The report also examines the changes in these indicators from 1996 to 2001.
7. Human Resources
This report presents the findings and recommendations of the Joint Learning Initiative (JLI). The report highlights major global challenges in human resources for health. These include: global shortages of skilled workers; skill imbalances in existing workers; poor distribution of services worsened by increased migration; poor work environments; and a weak knowledge base. The findings show that effective workforce strategies, including community action and country leadership, enhance the performance of health systems even under difficult circumstances. The authors call for immediate action to harness the power of health workers, which must be country based and led.
8. Public-Private Mix
The quality of primary health care (PHC) delivered to people in developing countries is often poor and coverage is not yet universal. This is despite a focus on the public delivery of comprehensive PHC over the past 20 years. People frequently consult private providers including qualified medical professionals and unqualified health practitioners. A better use of private care providers, therefore, might be a potential solution, including contracting them to provide services on behalf of the public sector. Research from the London School of Hygiene and Tropical Medicine, the University of Witwatersrand and the University of Cape Town examines the performance of various models of PHC provision in South Africa.
This paper, produced by Health Research Policy and Systems, outlines key challenges in public-private arrangements in health care and makes a Global Call to Action to address these challenges. The author establishes several ethical challenges in public-private partnerships. These include: a lack of global norms and principals, threatened impartiality of health care due to poorly designed partnerships, the risk of abandoning social safety nets for vulnerable groups, and conflict of interest due to ‘for-profit’ demands of the private sector. Other ethical issues consist of redirecting national health policies, fragmentation of the health system, contribution to common goals and objectives, and lack of contributions to improvements in quality and efficiency.
This Initiative on Public-Private Partnerships for Health report provides an overview from a series of studies of drug access programmes in Uganda, Botswana, Sri Lanka and Zambia. The report draws out three broad conclusions from the studies. Firstly, it highlights a fragmentation of initiatives, funding and conditionalities. Secondly, it points to a lack of understanding of the range of options regarding access to medicines, as well as a lack of capacity to compare and contrast alternatives best suited to national needs. Finally, the authors find that the decision to exclude the private sector from most initiatives lacked grounding in the reality of health service delivery in sub-Saharan Africa.
9. Resource allocation and health financing
This book from the International Development and Research Centre presents the Tanzania Essential Health Interventions Project (TEHIP). The premise of this project is that health reforms should be based not just on increased funding but on more strategic investments in health. The first section outlines the TEHIP idea, while the second section details the implementation of TEHIP in two districts in Tanzania. The remaining sections outline the results of the project, current efforts to extend the impact of TEHIP innovations, and the critical lessons learned from the TEHIP experience.
10. Equity and HIV/AIDS
By the end of 2004, 700 000 people living with AIDS in developing countries were receiving antiretroviral (ART) treatment thanks to the efforts of national governments, donors and other partners. This is an increase of approximately 75% in the total number receiving treatment from a year ago, and is up from 440 000 in July 2004. At a joint press conference at the World Economic Forum’s Annual Meeting, Switzerland, the World Health Organization (WHO), the Joint United Nations Programme on HIV/AIDS (UNAIDS), the United States Government and the Global Fund to fight AIDS, Tuberculosis and Malaria revealed the results of their joint efforts to increase the availability of ART in poor countries. However all the organizations warned that major, continued efforts are needed in countries and internationally to continue working towards the goal of access to treatment for all who need it.
Signed by the African Network for the Campaign on Education for All (ANCEFA), African Womens Development and Communications Network (FEMNET), African Centre for Democracy and Human Rights (ACDHR), Center for Democracy and Development (CDD), Pan African Movement (PAM), Pan African Development Education and Advocacy Programme(PADEAP), West African Students Union (WASU), Womens Rights Advancement and Protection Alternatives (WRAPA), Development Network of Indigenous Voluntary Agencies (DENIVA), Fahamu, ActionAid International, Oxfam GB
Summary
The fourth Ordinary African Union Summit of the Heads of States takes place at a time when the consequences of poorly financed and collapsing public health services across the continent can only be described as a public health emergency. Returning to Abuja where four years ago they committed themselves to accelerate the fight against HIV/AIDS, Tuberculosis and other related infectious diseases, it is clear that key obstacles continue to prevent hundreds of millions of Africans from realising the right to health. African Governments and the African Union must reinvigorate the fight against the violation of HIV/AIDS and health related rights.
Recommendations
- African Governments must commit to increasing GDP allocation for health by three per cent each year in order to reach the 2001 Abuja Summit commitments of 15%. - African government should ensure that treatment of AIDS and infectious diseases is provided free, reaches vulnerable groups and in an accountable manner. - African Governments, who have to yet ratify the AU Protocol on the Rights of Women, must do so. It is a major instrument in securing the right to health for Africa's women and girls. - The African Union Commission must lead on lobbying the G8 in 2005 for debt cancellation and measures from industrialised countries to compensate for the brain drain of African health workers. - The African Union Commission must lead on lobbying the G8 in 2005 for debt cancellation and securing measures from industrialised countries to compensate for the brain drain of African health workers. - African Governments must mandate the African Union Commission to champion for enabling laws and policies in member states and a coordinated global advocacy approach towards the WTO Hong Kong Inter-ministerial in December 2005.
South African generic AIDS drug manufacturer, Aspen Pharmacare, has become the first African firm to win approval from the US Food and Drug Administration (FDA) for its production plant. The FDA conducted a pre-operational review and close inspection to ascertain good manufacturing practice at Aspen's Port Elizabeth facility in September last year. As a result of this approval, funds from the US President's Emergency Plans for AIDS Relief (PEPFAR) can be used to purchase Aspen-manufactured drugs for use in countries where the local drug regulatory agency has approved them.
Malawi aims to more than triple the number of HIV-positive people in the country who are receiving antiretroviral drugs at no cost by July with the help of a $14 million grant from the Global Fund to Fight AIDS, Tuberculosis and Malaria, a Malawian health official said on Monday, AFP/Independent Online reports. Malawi in May 2004 began a five-year, $196 million nationwide program to provide antiretroviral drugs to HIV-positive people at no cost.
As the world intensifies its fight against the global AIDS epidemic, African countries have begun to develop largescale prevention and treatment programmes. A combination of funds from African governments and international donors are paying for drugs, diagnostics, clinic and laboratory infrastructure, and medical personnel. Although these funds, which reach into the billions of dollars, will pay for antiretroviral therapy for many thousands of HIV-positive Africans, there is almost no chance that African countries will have the human, infrastructural, or financial resources to treat everyone who is in need, at least in the early years.
Commentators are beginning to raise other fundamental questions about the Tsunami disaster, reports the latest edition of the Africa Focus Bulletin. "Most significantly, can the response to the tsunami be carried over to even more devastating crises that are less photogenic, such as AIDS, global health, conflict, and poverty? Or will the effect be to reduce resources for implementing programs that have not been scaled up for lack of political will and resources? " Despite significant expansion of programs in the last two years, only four percent of the estimated 3.8 million people in need of such treatment in Africa now have access. Global spending on HIV/AIDS in low and middle-income countries was estimated at $6.1 billion in 2004, with the need projected at $12 billion for 2005.
11. Governance and participation in health
Post-apartheid South Africa has witnessed the growth of social movements using on-the-ground and network-based modes of organisation that operate at the same time in local, national and global political environments. Networks across countries and grassroots mobilisation have allowed HIV/AIDS activists to use tactics confronting the state while supporting it to be more inclusive. Research from the University of Stellenbosch in South Africa explores the organisational practices and strategies of the Treatment Action Campaign (TAC), a Cape Town-based social movement.
12. Monitoring equity and research policy
"While significant strides have been made in health research, the incorporation of research evidence into healthcare decision-making has been marginal. The purpose of this paper is to provide an overview of how the utility of health services research can be improved through the use of theory. Integrating theory into health services research can improve research methodology and encourage stronger collaboration with decision-makers. Recognizing the importance of theory calls for new expectations in the practice of health services research. These include: the formation of interdisciplinary research teams; broadening the training for those who will practice health services research; and supportive organizational conditions that promote collaboration between researchers and decision makers. Further, funding bodies can provide a significant role in guiding and supporting the use of theory in the practice of health services research."
13. Useful Resources
PATAM is a social movement comprised of individuals and organisations dedicated to mobilizing communities, political leaders, and all sectors of society to ensure access to antiretroviral (ARV) treatment, as a fundamental part of comprehensive care for all people with HIV/AIDS in Africa. This movement was inaugurated on August 22nd 2002. The movement's co-founders are two of the world's leading AIDS activists, Zackie Achmat of the Treatment Action Campaign (TAC) in South Africa and Milly Katana, lobbying and advocacy officer of the Health Rights Action Group in Uganda and member of Board of the Global Fund to Fight AIDS, TB, and Malaria. PATAM's December 2004 newsletter is now available from their website.
At the SHARing Point Server you can find people and their activities like projects, journal articles, abstracts, realtime health news and mailing list postings from Asia, Africa, Europe, North and South America.
14. Jobs and Announcements
The AMREF training programme is available for the year 2005. On offer are a series of short courses and the one-year Diploma in Community Health. The short courses are designed for middle and senior management personnel working in public and private sectors including NGOs, CBOs, religious organizations, donor agencies and government ministries.
Five million deaths from violence and injuries are estimated to account for 9% of global mortality, with violence leading the causes of death among people aged 15 to 44 years. Violence affects many more survivors of all ages, who often live with disabling physical conditions and mental health symptoms. Despite the magnitude of this burden, as well as the known consequences of exposure to violence among survivors, research on violence prevention remains underfunded, understudied, and a neglected public health concern.
The Regional Training Programme for Reproductive Health with special emphasis on Family Planning is supported by the Government of Mauritius, the United Nations Population Fund (UNFPA), the World Health Organisation (WHO) and other international agencies. Its objectives are to contribute to the health and socio-economic development in Africa and the region by improving the Reproductive Health (RH) status of the population through the provision of Training of Trainers programmes for Reproductive Health.
The Public Health in Complex Emergencies (PHCE) training program is available. The dates for all of the courses in 2005 are available through the link below.
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