How can we attract health workers to stay within our public health services?
How many countries in our region meet the Abuja target of 15% of government spending on health?
What does an African debt burden of $8.6 billion a year mean for health services?
How many countries in our region include the right health in the constitution?
How can the cost of health for the poorest communities be reduced?
What does it mean to have a ‘people centred’ health system?
The EQUINET newsletter is over five years old and has in its lifetime covered a spectrum of issues affecting health equity in our region, and raised some of the questions above. In 2005 our editorials ranged from access to treatment to the outflow of resources from Africa. The spectrum of challenges to health equity are clearly wide, and involve many different people, communities, disciplines and actors. We hope that the newsletter has been informative and useful and will continue to be so. We’d greatly welcome your ideas and information on how to improve it.
In 2006 we are also asking for you to play a more active role! EQUINET will, with your support, be carrying out a regional equity analysis in 2006, to profile the issues, evidence, experiences and options for action to strengthen health equity, through a regional equity analysis. The adoption in 2005 of the SADC Health protocol gives us a policy framework for this. Within this context, we will over the course of 2006 draw together YOUR perspectives, evidence, experiences, and views on how to advance health equity at local, national and regional level.
From the work we have done in EQUINET, including the values and perspectives communicated through the last five years of this newsletter, we have identified some priority areas that we will focus on. People in the region have major health concerns relating to access to incomes, food, employment, healthy living conditions and community environments. These require action from all sectors, and not just the health sector. There is a common concern that to advance health across all sectors and all social groups, we also need to revitalize and build comprehensive, universal and integrated national health systems that address these concerns and that provide access to health care for all. While many features of health systems have been raised, there are some that have been most commonly identified as a priority for health equity that we will give more focus to in 2006.
These are
i. building people-centred health systems that organise, empower, value and entitle communities;
ii. promoting increased fair, sustainable and equitable financing for health at national, regional and global level;
iii. ensuring adequate, well-trained, equitably distributed and motivated health workers; and
iv. backing national policies with fair global policy, including just trade, reversing unfair flows of resources and having the national and regional policy flexibility to exercise policies that improve health.
What policies, programmes and obstacles exist in these areas in our region?
Which have been more successful in overcoming differences in health across social groups and ensuring access to health care for all?
What opportunities and challenges do we face in implementing these policies and programmes?
We invite you to contribute to the dialogue, learning and analysis that we will build in these areas, through your expertise and experience, positive examples and case studies, evidence and data, and photographs. Email us on admin@equinetafrica.org with any information, published papers or pictures of the work you or others are doing in these priority areas. Through the newsletter we will share this information more widely. We will also feed it into the regional equity analysis.
We also invite you to be involved in the research, student grants, training, dialogue forums, exchange visits and other areas of work that we will be carrying out with you in 2006 to inform and strengthen learning and action on health equity. Our website (www.equinetafrica.org) provides up to date information on these activities.
We look forward to working with you in 2006!
1. Editorial
2. Latest Equinet Updates
The workshop on Protecting health in Trade agreements held in Johannesburg in October 2005 was held within an EQUINET programme with Centre for Health Policy South Africa and SEATINI Zimbabwe that aims to build capacities in state, legislative and civil society institutions to know, understand, analyse and promote public sector equity oriented health systems within trade and investment policies and agreements. The workshop reviewed the work and research papers of the capacity building programme implemented in Tanzania and Zimbabwe to date.
Training and Research Support Centre (TARSC), the Ifakara Health Research and Development Centre (IHRDC) with The Southern African Regional Network on Equity in Health (EQUINET) and CHESSORE Zambia invites applicants to participate and share experiences in a Workshop on Participatory Methods for research and training for a people centred health system being held in Bagamoyo, Tanzania, March 1-4, 2006.
3. Equity in Health
Heavy rains have exacerbated a cholera outbreak in Zambia, where at least six people have died and more than a thousand cases have been recorded. Zambia's ministry of health confirmed that 1,144 cases of cholera have been reported since the outbreak began in August.
The government of President Bingu wa Mutharika has made strides in improving Malawi's health care system. IRIN spoke to World Health Organisation (WHO) representative Matshidiso Moeti about the remaining challenges.
QUESTION: What is your general impression of the health system in Malawi?
ANSWER: The health system in Malawi is in a very dynamic process of improvement right now. But I know there are a number of challenges: these ... include shortage of staff, and there is need to recruit more to meet these challenges; the other challenge facing the health system is the supply and management of drugs.
* Click on the link for the full interview.
Manto Tshabalala-Msimang, the South African health minister, and Paulo Ivo Garrido, the Mozambican health minister, have signed an agreement ensuring co-operation in tackling health issues affecting the two countries. South African citizens and their Mozambican counterparts will from now on have easier access to health care at both countries' public hospitals. The agreement was signed at Tonga Hospital in Mpumalanga, an area plagued by malaria. To prevent the spread of the disease, local households were sprayed with insecticides. South Africa has also donated ten tons of DDT, an anti malaria insecticide, to Mozambique.
4. Values, Policies and Rights
The World Health Organization (WHO) dedicated International Human Rights Day, 10 December, to people with mental disorders and the all-too-prevalent violations of their basic human rights. People with mental disorders face an alarming range of human rights abuses in countries throughout the world, yet there are proven ways to dramatically improve the situation. Misunderstanding and stigma surrounding mental ill health are widespread. Despite the existence of effective treatments for mental disorders, there is a belief that they are untreatable or that people with mental disorders are difficult, not intelligent, or incapable of making decisions.
One of the most fundamental human rights is the assumption that each person matters, and everyone deserves to be treated with dignity—this is the tenet from which all other human rights flow. Another is that those who are most vulnerable deserve special protection. However, in many developing countries, vast numbers of children are born but never counted, and their health and welfare throughout their lives remains unknown. And because single-mean measures of population health mask inequalities among the best-off and worst-off, the health of vulnerable populations is not effectively documented and acknowledged. Health information systems can play an important role in supporting these rights by documenting and tracking health and health inequities, and by creating a platform for action and accountability.
5. Health equity in economic and trade policies
International health and AIDS activists are up in arms over the World Trade Organisation’s (WTO) pre-Hong Kong approval of a controversial amendment to its intellectual property agreement, saying it will limit access to affordable medicines for the neediest countries - those that have little or no pharmaceutical production base. Activists say the amendment, approved on 6 December, is proof that the WTO has ignored those with expertise on public health and intellectual property, and buckled under the pressure of big pharmaceutical companies, who supported the amendment.
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.
"Rather than being an important milestone towards the achievement of the much touted development round, Hong Kong has ended as a platform for anti-development outcomes. The declaration from the Hong Kong WTO Ministerial is a loss for African countries. They have been forced to concede on most of the positions with which they came to Hong Kong. And whatever comfort exists in the other areas is ambiguous at best, illusory at worst."
Health ministries around the world face a new challenge: to assess the risks and respond to the opportunities of the increasing openness in health services under the World Trade Organization's (WTO) General Agreement on Trade in Services (GATS). International Trade in Health Services and the GATS addresses this challenge head-on by providing analytical tools to policymakers in health and trade ministries alike who are involved in the liberalization agenda and, specifically, in the GATS negotiations.
6. Poverty and health
The Millennium Declaration of the United Nations committed the global community to halving, by 2015, the proportion of the world's population who live in poverty and suffer from hunger. Attaining the United Nations' goal requires good governance, a genuine political commitment by both developed and developing countries, and increased resources. Yet, reducing global poverty also requires a clear understanding of the factors that predict whether an individual or household will become less poor or more poor over time. Intervention programs often are evaluated on a short time frame, even though such interventions may have long-term effects.
7. Human Resources
The debate on the 'brain drain', or the emigration of skilled workers, is not new but it has taken on greater urgency in the context of a globalizing economy and ageing societies. Today, the developed world is perceived as poaching the best and the brightest from the developing world, thus prejudicing those countries of their chance of development. This paper starts with two guarded caveats: first, that any brain drain is as much internal within any country as it is among countries and, second, that the skilled migration system should not be seen in isolation from other types of migration. The paper reviews the data available for the analysis of skilled migration and identifies the main global trends. It goes on to examine the globalization of education and of health as reflected in the movement of students and health personnel.
African public health care systems suffer from significant "brain drain" of its health care professionals and knowledge as health workers migrate to wealthier countries such as Australia, Canada, USA, and the United Kingdom. Knowledge generated on the continent is not readily accessible to potential users on the continent. In this paper, the brain drain is defined as both a loss of health workers (hard brain drain) and unavailability of research results to users in Africa (soft brain drain). The "pull" factors of "hard brain drain" include better remuneration and working conditions, possible job satisfaction, and prospects for further education, whereas the "push" factors include a lack of better working conditions including promotion opportunities and career advancement.
8. Public-Private Mix
Global Public Goods for Health addresses the growing globalization of health from the unique perspective of the economic concept of public goods. This concept identifies where a ‘good’ or service (such as knowledge of an infectious disease outbreak) which would be of benefit globally will not be produced or disseminated if left to ‘the market’, because of a lack of incentive: no-one can be excluded from accessing the good, no charge can be levied for use and no costs recouped.
Poverty is a major factor in the continuing burden of malaria in sub-Saharan Africa. The gross national product (GNP) per capita is around US$306, or less than $1 per day. On average, these countries spend less than $20 per head of population per year on health care. Patients urgently need new therapies to combat malaria. However, malaria is not an economically viable disease for drug developers and new antimalarials are therefore usually developed within public–private partnerships.
Speaking in December at the 14th International Conference on HIV/AIDS and Sexually Transmitted Infections in Africa (ICASA), in Abuja, Nigeria, Jim Yong Kim, Director of the World Health Organization (WHO) HIV/AIDS Department, emphasized the importance of a public health approach in promoting long-term sustainability and equity of HIV treatment access programmes in resource-limited settings.
9. Resource allocation and health financing
The objectives of this study are to assess the costs and health effects of tuberculosis control interventions in Africa and South East Asia in the context of the millennium development goals. The conclusions are that DOTS treatment of new smear-positive cases is the first priority in tuberculosis control, including in countries with high HIV prevalence. DOTS treatment of smear-negative and extra-pulmonary cases and DOTS-Plus treatment of multidrug resistant cases are also highly cost effective. To achieve the millennium development goal for tuberculosis control, substantial extra investment is needed to increase case finding and implement interventions on a wider scale.
There is a marked variation in deprivation between various districts in Tanzania. Tanzania recently adopted a needs-based formula, which includes a poverty measure, to allocate resources to districts. This paper presents an analysis of the allocation of health care resources in Tanzania. This paper analyses equity in current resource allocation in Tanzania, and compares these allocations to equity target allocations, using an index of deprivation. The results revealed that districts currently receiving relatively high allocations according the current poverty-based formula would receive slightly lower budgets if the deprivation index was used in the resource allocation formula. Those with very low allocations would receive slightly more if the deprivation index was used to guide resource allocation. However, the resource allocation differences between the poverty-based and deprivation-based formulae were small. This suggests that Tanzania has already made good progress in addressing equity in resource allocation between districts.
Debates about the best way to fund South Africa's health system have run for over a decade. Plans for social health insurance have not received enough support to become law. In contrast reform of private health insurance regulations have been passed. Why has the pace of reform between the private and public sectors differed? The University of Cape Town, together with the London School of Hygiene and Tropical Medicine, compared reforms to private and social health insurance to see why their success has varied.
10. Equity and HIV/AIDS
The Global Fund to fight HIV/AIDS, Tuberculosis and Malaria has pulled the plug on financing loveLife, a controversial South African youth-targeted HIV/AIDS campaign. In a statement the Global Fund board said it had found that loveLife "was deemed to not have sufficiently addressed weaknesses in its implementation". Global Fund spokesman Jon Liden said it had become difficult to measure how the prevention campaign was contributing to the reduction of HIV/AIDS among young people.
The lack of newer AIDS drugs in Africa could jeopardise the lives of people already receiving the treatment, medical humanitarian organisation Medecins Sans Frontieres (MSF) has warned. With many countries on the continent embarking on national programmes to provide antiretrovirals (ARVs), the first-line drug regimen has become cheaper and widely available. But as resistance to the basic drugs inevitably builds up, there will be a need for a second generation of drugs within a few years.
An AIDS epidemic as severe as the one plowing through South Africa will change society. But how and along what lines? Buckling: The impact of AIDS in South Africa, a new publication by Hein Marais, tackles the question in distinctive and critical-minded fashion – and arrives at disquieting and surprising conclusions. A detailed, multidisciplinary review of research evidence, this short book adopts a unique perspective which reveals more clearly the contingency and complexity of the epidemic's effects. It shows how conventional conceptions of AIDS impact (and programme responses) tend to reflect dominant ideological fixations – particularly the overriding emphasis on productive processes and economic growth, governance and security – and how the wellbeing of humans typically is refracted through those preoccupations.
When Maria (last name withheld), 35 years old and HIV-positive, reflects on the past year she gives an answer that a growing number of Mozambicans living with HIV/AIDS would probably echo. "The year 2005 has been good for my health. It has got so much better because this year I started taking ARVs (antiretroviral drugs)," she told PlusNews. Maria is one of 17,000 people now accessing ARVs of a national target to treat 20,000 people by the end of 2005.
Zimbabwe has failed to meet the World Health Organization (WHO) target of providing anti-AIDS drugs to at least 120,000 HIV-positive people by the end of 2005, local newspaper The Daily Mirror reported on Tuesday. The lack of adequate foreign currency to purchase medicines and the low numbers of people being tested for the virus prevented the country from even reaching its own target of 55,000 people receiving the life-prolonging medication by the end of 2005.
11. Governance and participation in health
The WE ALL HAVE AIDS Campaign is a show of solidarity among, and an acknowledgment of, many of the world's most accomplished, devoted and inspiring AIDS activists and scientists of the last 20 years. Barefoot and determined, each participant has left a meaningful mark in cement, but more importantly in the fight against HIV/AIDS and the destructive STIGMA associated with this devastating disease. Visit the website to find out more.
12. Monitoring equity and research policy
The successful implementation of health policy requires the backing of health care practitioners, managers, and patients. In South Africa, the introduction of free health care, although supported in principal by nurses and health facility managers, faced resistance as workloads increased and staff felt excluded from a centrally prescribed policy. Proponents of a 'street-level bureaucracy' approach to policy implementation acknowledge the day-to-day methods to cope with pressures that are adopted by frontline health care providers in the face of high demand for their services. It is these mechanisms, they argue, that effectively become public policy, rather than the decisions taken by central government.
13. Useful Resources
This guide aims to support people who facilitate participatory workshops with non-governmental organisations (NGOs) and community-based organisations (CBOs) responding to HIV/AIDS in developing countries. It is based on the practical experiences of the International HIV/AIDS Alliance (the Alliance). The Alliance is an international NGO that supports communities in developing countries to prevent the spread of HIV, support and care for those infected and ease the impact of HIV on families and communities.
This guide, published by the Swedish Association for Sexuality Education (RFSU), provides a comprehensive introduction to the political debate surrounding sexual and reproductive health and rights (SRHR). It discusses the changes in the approach to population issues that emerged from the 1994 International Conference on Population and Development, emphasising the conference's explicit recognition of reproductive rights as human rights. Countries pledged to reduce maternal mortality, fight HIV and AIDS, and improve people's sexual and reproductive health and rights. The guide discusses the controversy over the goals that were adopted and the reservations expressed by many countries.
The HINARI program, set up by WHO together with major publishers, enables developing countries to gain access to one of the world's largest collections of biomedical and health literature. Over 3090 journal titles are now available to health institutions in 113 countries, benefiting many thousands of health workers and researchers, and in turn, contributing to improved world health.
14. Jobs and Announcements
The Johns Hopkins Urban Health Institute in conjunction with the WK Kellogg Foundation announce the launch of a national peer- reviewed journal dedicated to community health partnerships. Progress in Community Health Partnerships: Research, Education, and Action addresses topics focusing on the growing field of community-based participatory research (CBPR) while promoting further collaboration and elevating the visibility and stature of CBPR as a means toward eliminating health disparities. The first issue is expected in Spring/Summer 2006. For more information, including how to subscribe and how to submit papers, visit the Journal's web site at: http://www.press.jhu.edu/journals/pchp
The Lown Fellowship in Cardiovascular Disease in the Developing World offers training in non-invasive and preventive cardiology, public health, and research methodology for physicians from developing countries. The program's goal is to train physicians from the developing world as preventive cardiovascular specialists in order to address the mounting epidemic of CVD facing their countries.
The course is designed for a multi-disciplinary team of healthcare workers who play an important role in the comprehensive care of HIV infected person(s). These include doctors, nurses, counsellors, pharmacists, clinical officers, laboratory technicians, community health workers etc.
When: April 1-2, 2006
Where: Yale University, New Haven, Connecticut
Theme: "Empowering Communities to Bridge Health Divides"
Who should attend? Anyone interested in children's health, medicine, health education, health promotion, public health, international health, international service, eye care, nonprofits, or microenterprise
Conference Goal: To empower conference attendees to identify health needs and to develop solutions to improve access to care for the medically underserved.
The African Malaria Network Trust (AMANET) is a pan-African, non-profit, non-governmental organization whose mission is to promote capacity strengthening, performance and impact of African malaria R & D institutions. AMANET wishes to recruit on contract terms a very senior research scientist to occupy the position of Network Director, which is now vacant. S/He will be based at the AMANET Secretariat in Dar-es Salaam, Tanzania.
Published for the Network for Equity in Health in Southern Africa by
Fahamu - Networks for Social Justice
http://www.fahamu.org/
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