The issue of appropriate health care financing mechanisms is once again high on the policy agenda of African governments. Not only have a number of governments (including South Africa, Uganda and Zambia) abolished some or all fees at public health facilities, which looks set to have ripple effects around the continent, but international organisations are placing considerable importance on health care financing in their engagements with African governments.
This is occurring in a context where:
• funding of health services from government tax revenue is very low, with about 60% of African countries devoting less than 10% of government expenditure to health care, despite the commitment by African Heads of State in Abuja in 2001 to commit 15% of their funds to the health sector;
• there is a heavy reliance on donor funding, with donors accounting for over a quarter of total health care financing in about 35% of African countries;
• there is very limited health insurance coverage; and
• the single largest source of health care finance is in most cases out-of-pocket payments – more than half of all health care expenditure is financed in this way in 40% of African countries.
It is critical that African governments are empowered to make their own decisions on appropriate ways of financing health services in their specific context. This is necessary to avoid the devastating consequences of financing policies imposed on Africa by international organisations over the past two decades. The most striking example is the World Bank and IMF requirement that governments reduce their funding of health services and increasingly rely on user fees as part of their Structural Adjustment Programs. This has not only contributed to the systematic devastation of public health systems but has impoverished households through the costs of illness. International organisations are already fighting for the hearts and minds of African policy makers. Some like Save the Children and the British agency DfID are pushing for rapid removal of user fees but with insufficient consideration of the need for wider action to develop the locally sustainable financing systems necessary to reconstruct national health systems. Others, specifically the World Bank, are pushing for private insurance for those working in the formal sector, with no acknowledgement of the equity problems of such financing mechanisms. The 2005 World Health Assembly adopted a resolution encouraging member states to pursue social and other forms of health insurance. WHO-AFRO is currently preparing a resolution on health care financing for review by African Ministers of Health. There is thus an urgent need for greater awareness of health care financing issues to promote locally relevant and equitable financing options.
It is particularly important that a set of equity principles are adopted at an early stage, against which alternative financing mechanisms can be evaluated within individual country contexts and which can be used to counter the arguments of international organisations and others attempting to impose inappropriate mechanisms. These include:
• The mechanism(s) should provide financial protection. No one who needs health services should be denied access due to inability to pay and payment for health care should happen before rather than at the time of use of services, such as through tax and/or health insurance.
• Contributions to health care should be based on ability-to-pay. Those with greater ability-to-pay should contribute a higher proportion of their income than those with lower incomes.
• Cross-subsidies (from the healthy to the ill and from the wealthy to the poor) in the overall health system should be promoted. This implies that there should be cross-subsidies across different financing mechanisms.
• Financial resources should translate into universal access to health services. All individuals should be entitled to benefit from health services via one of the funding mechanisms in place, and the package of benefits to which they are entitled should be clear, known and accessible. There should not be substantial differences in the range and quality of health services that different groups have access to.
On the basis of these principles, and an extensive review of health care financing options (outlined in EQUINET discussion paper 27) we recommend that in Africa:
• Governments make explicit commitments to move away from out-of-pocket funding of public sector health services and pursue alternative financing approaches.
• We increase tax revenue for health through improved tax collection and more appropriate corporate and wealth taxation strategies.
• We increase the health sector’s share of government resources in line with the existing commitment of African Heads of States, made in Abuja in 2001, to a 15% share for health.
• There be unconditional cancellation of African governments’ external debt, so that debt servicing can be redirected to health care.
• We introduce or expand health insurance schemes as part of an overall financing system that allows for cross-subsidy and closely monitor their equity impacts.
• We exercise caution in relation to private insurance for formal sector workers, which has undermined system-wide cross-subsidies in countries such as South Africa and Zimbabwe.
• Ministries of Health lead and control decisions on the use of donor funds to ensure that they contribute to achieving national health priorities.
• We implement effective mechanisms for identifying and protecting the poor and other vulnerable groups, such as by ensuring that they are subsidised as members of health insurance and do access decent health services.
• We equitably allocate the funds for health to ensure universal access to services
• We carefully plan any new financing policy developments, to take into account the views of beneficiaries, gain support from the health staff responsible for their implementation and identify any other strategic action required to generate adequate political and popular support to sustain policy change. It is particularly important to recognise that health workers are often caught in the middle of these policy changes, managing patients without the resources to meet their needs and expectations.
• We monitor progress and build ‘early learning’ mechanisms to review and adapt policies as implementation proceeds.
These principles and recommendations are a signal of our recognition of a bottom line: no matter what our policy aspirations, the way we finance our health systems will fundamentally determine the way our health systems reflect our social goals and meet our social needs.
Please send feedback or queries on the issues raised in this briefing to the EQUINET secretariat at TARSC, email admin@equinetafrica.org. EQUINET work on fair financing is available at the EQUINET website at www.equinetafrica.org. Discussion paper 27 on health care financing in Africa can be found at http://www.equinetafrica.org/bibl/equinetpub.php
1. Editorial
The forthcoming June (volume 16 (1)) issue of the Malawi Medical Journal is a special issue focussing on equity. This special edition of the Malawi Medical Journal attempts to capture, synthesise and present debates and action around ‘how to’ deliver on equitable health service delivery in Malawi. The papers are organised into four sections.
The journal isssue explores the research and advocacy partnerships needed to promote equity in health in Malawi. It presents various equity studies on how the health sector can reach poor women, men, girls and boys. These studies were commissioned by the Equity and Access Sub Group to inform the equity monitoring of the Essential Health Package (EHP). Although each paper deals with a different health issue, cross-comparison of the papers allows system-wide analysis. The studies point to the need to bring essential services much closer to the poor– not only in terms of geographical proximity, but also in terms of affordability, cultural acceptability, and epidemiological relevance. This recommendation is closely in line with Government policy to implement the EHP of basic services. Thus, the recommendation is not to change policy, but rather to ensure its’ more energetic and effective implementation The EHP – free basic services at the point of delivery – lays a strong foundation for equitable health service provision. More energetic delivery then means improving access, strengthening human resources in Malawi at community level (including investing in Health Surveillance Assistants) and addressing stock outs of essential drugs.
The journal captures different viewpoints and perspectives on equity. The
six articles in this section highlight the importance of viewing equity with a holistic lens. The articles clearly illustrate the need for insights on equity drawn through various methods that capture the perspectives of different players - health workers as well as community members for example. They also demonstrate that many disciplines and approaches need to collaborate to understand, document and take action on the different factors that shape equity or inequity in health services.
The journal gives information on staying up to date and presenting information on equity in different ways. This section contains policy briefings, themed abstracts and details of useful websites on equity and health, which readers can use to stay current with equity and health debates and priorities at a regional and global level. The policy briefings and abstracts produced by REACH Trust are included in this journal for dissemination purposes. They cover issues such as linking research policy and practice to improve equity in health care in Malawi and promoting poor women and men’s access to health services through developing partnerships with community groups in Lilongwe. The abstracts provide snapshots of research findings across a number of thematic sub-headings, including equity and gender perspectives on TB and HIV in Malawi, equity monitoring, equity perspectives on TB diagnosis and an equity lens on pathways to care for TB and HIV care and treatment.
For more information on this journal issue contract REACH trust Malawi directly or through admin@equinetafrica.org
2. Latest Equinet Updates
Over the last couple of years EQUINET, through the Health Economics Unit University of Cape Town and the Centre for Health Policy at the University of the Witswaterand, have been running a program of work on Fair Financing in the health sector. Two calls for proposals sent out this year in line with this program of work are in resource allocation and resource mobilisation. The deadline for the proposals is 19 May 2006, with work expected to begin on 1 July 2006 and completed on 28 February 2007.
The meeting briefly:
* reviewed evidence, current programmes and priority areas for future work to support retention and manage migration of HRH from national and regional level;
* planned a regional programme of work to support national HRH planning, monitoring and evaluation; and
* discussed institutional mechanisms for guidance and review of the follow up work programme.
An exploratory discussion was also held to map priority areas of work to gather, analyse and review evidence on costs and benefits of HRH migration out of east and southern Africa, and to assess and support policy measures aimed at managing HRH migration.
Hon Guracha Galgalo, Chairman of the Parliamentary committee on Health, Housing and Social Services in the Kenya National Assembly was tragically killed in an accident that killed fourteen people after a Kenya Airforce plane crashed into a hill in Marsabit on 10 April 2006. Among those on board the plane were Assistant Ministers Mirugi Kariuki and Titus Nguyoni and MPs Bonaya Godana, Abdi Sasura and Guracha Galgalo. Hon Guracha Galgalo as Chairman of the Parliamentary committee on Health, Housing and Social Services worked with the Nairobi Equity Gauge, GEGA and EQUINET in building parliamenary work to promote equity in health in Kenya and in east and southern Africa. EQUINET has expressed deepest sympathy and heartfelt condolences to Hom Galgalos family, to the members of the Committee and the Kenyan National Assembly as a whole.
3. Equity in Health
The aim of the paper is to critically review the notion of social capital and review empirical literature on the association between social capital and health across countries. Findings of this literature review led to the tentative conclusion that an association between social capital and health at the individual level is robust with respect to the degree of egalitarianism within a country.
4. Values, Policies and Rights
The link between Human Rights and the MDGs is embodied in the Millennium Declaration. Through the Millennium Declaration, governments commit to the core values of freedom, equality, solidarity, peace, security and the rule of law. The MDGs, which serve as outcome indicators for the Declaration, are about realising human rights within a broader development framework. An e-discussion on these issues is now open and contributions are encouraged.
Aimed at policy makers and advocates this briefing examines proposals for the World Intellectual Property Organization (WIPO) Development Agenda from a human rights perspective. Drawing on the Friends of Development and Africa Group's original submissions it makes recommendations in 6 key areas.
5. Health equity in economic and trade policies
Africa needs the capacity and donor aid to react swiftly to deal with a potentially large-scale outbreak of bird flu, a conference of experts from 19 African countries heard yesterday. "Africa needs a rapid response to the disease and must draw up practical measures to control and prevent the disease," Malawi's Agriculture Minister, Uladi Mussa, said on the opening day of the conference in the capital, Lilongwe.
On the 6th of December 2006 the WTO General Counsel agreed to amend the TRIPs Agreement by permanently incorporating an earlier waiver. Paul Kruger, a TRALAC researcher, comments on the decision to "Amendment to the TRIPs Agreement: The issue of universal access".
Big Pharma could land billions of dollars in annual sales that it would have lost to generic competitors thanks to a Food and Drug Administration backlog of applications for generic drugs. The article dissects the potential advantages and disadvantages, including it being bad news for generic drug makers like the industry leader Teva Pharmaceuticals, but great news for Big Pharma companies which can continue to sell their branded drugs after their patents have expired without any generic competition.
In a green room WTO meeting of some Ambassadors convened on Monday 3 April, Pascal Lamy informed the group that he will indeed convene a mini ministerial. He has told a small group of Ambassadors to let their Ministers know that they should be in Geneva by 29/30 April to 3/4 May. (Another Ambassador gave another set of dates - 27 April - 5 May). It will be a invitation only Ministerial of about 20-30 Ministers. Ministers from Africa are likely to include Kenya, Mauritius, Zambia, Benin, Senegal, Egypt, South Africa, possibly Nigeria. Agriculture and NAMA week is taking place starting 17 April. Read more at the link below.
Research and development (R&D) companies dominate both the public- and private-sector markets in developing countries, despite the growing number of manufacturers able to produce low-cost generic and biosimilar products around the world. This paper describes the different types of hormonal contraceptive manufacturers and opportunities for increased competition from generic and biosimilar suppliers in the procurement field and the commercial sector, as well as barriers faced in the industry.
The World Bank, a leader in the global effort to control malaria, has been accused of deception and medical malpractice by a group of public health doctors for failing to carry out its funding promises and wrongly claiming its programmes have been successful at cutting the death toll from the disease. The serious charges are levelled by Amir Attaran, a professor at the Institute of Population Health and faculty of law of Ottawa University, and colleagues from around the world. Writing in an online publication for the Lancet medical journal, they say the World Bank is unfit to lead global efforts to control the disease, which kills around 1 million people a year - most of them small children.
6. Poverty and health
This chapter analyses the alternative approaches to targeting the poor that have been used in healthcare delivery and draws together evidence from a range of countries about their effectiveness. The authors emphasise the importance of programme design and implementation issues and argue that successful programmes will need to identify these issues and devote adequate resources to overcoming them. The authors propose a conceptual framework for understanding the key elements of targeting policies.
People with AIDS all over the world are fortunate to have fellow sufferers in America and Europe, says this New York Times article. "In poor countries as well, it helps that AIDS strikes all social classes. Brazil would never have become the first poor country to guarantee free AIDS treatment to all who need it without the activism of its many homosexual organizations. For every AIDS victim, though, there are many more suffering from diseases that lack this kind of constituency. Today, contracting a serious disease that affects only poor people is the worst luck of all.
7. Equitable health services
Parents and children will continue dying from malaria, until Europe rejects its colonialist past. But every year calls for action turn out to be mere bombast, as healthcare agencies refuse to go beyond bed nets and capacity building, radical greens continue to obstruct proven strategies, and disease and death rates climb. This year, however, things may be different. Archbishop Desmond Tutu, Greenpeace co-founder Patrick Moore, and hundreds of physicians, clergy and human rights advocates have joined in demanding that DDT be put back into the malaria control arsenal.
In mid-2001 a large rural household survey was conducted in Tanzania to investigate the variation in malaria parasitaemia, reported fever, care seeking, antimalarials obtained and household expenditure by socio-economic status (SES), and to assess the implications for ensuring equitable and appropriate use of antimalarial combination therapy. Findings reflected greater use of non-governmental organisation (NGO) facilities, which were the most expensive source of care, and higher expenditure at NGO facilities and drug stores. Also, poorest groups benefited least from these new and highly effective antimalarials. The report was presented at the EQUIWRITE Workshop in Durban, South Africa.
This study set out to investigate the relationship between the syndromic management of STI, specific aetiology diagnosis and its relationship with HIV infection and health seeking behaviour among youth attending a reproductive health clinic in Dar es Salaam, Tanzania. Findings reflected that the burden of STIs in this youth population is large indicating that youth are at increased risk of STIs and will certainly require youth friendly clinics, and the need to refine the current syndromic management guidelines.
8. Human Resources
With a shortage of health care workers and increasing demand to provide ART, existing ART delivery models may not be adequate and many have argued the need to rethink standard delivery models. Researchers and practitioners have argued that we should consider context-specific delivery models that rely much less on medical doctors in situations where they are in short supply. This feature discusess this matter in detail.
The World Health Organization (WHO) warns that failure to address problems confronting health workers may push some health systems to the brink of collapse. It describes the grave implications of neglecting health workers' rights in terms of remuneration and working conditions.
The figures tell it all. In South Africa, 37 percent of the country's doctors and seven percent of its nurses have migrated to Australia, Canada, Finland, France, Germany, Portugal, Britain and the United States. These statistics, compiled by the Organisation for Economic Co-operation and Development (OECD) and the World Health Organisation (WHO), reflect the magnitude of the health worker "brain drain" in Southern Africa.
The promise of higher salaries and better working conditions lures about 20,000 African nurses and other health-care workers annually to richer countries. The brain drain makes it even harder for African countries to treat diseases such as AIDS, tuberculosis and malaria, which kill millions each year, experts say. But with the United States facing its own nursing shortage, some on Capitol Hill want to make it easier for foreign nurses to immigrate to America. The article describes policies that have facilitated this change.
The Zimbabwe Association of Doctors for Human Rights (ZADHR) statement on World Health Day recognized that realization of the highest attainable standard of physical and mental health remains a daily struggle for all health workers in Zimbabwe. The Zimbabwean health delivery sector is presently in a severe state with a massive exodus of qualified health workers, resulting from many factors, amongst them poor remuneration and lack of basic medical equipment necessary for health workers to satisfactorily carry out their work.
Health Minister Manto Tshabalala-Msimang early in April began World Health Day celebrations with the launch of the new Human Resources (HR) Health Plan, which is meant to help combat the rapidly increasing migration of doctors. The section in the HR plan for health dealing with the migration of health personnel showed that 23 407 South African-born health professionals were now working in Australia, Canada, New Zealand, the United Kingdom and the United States alone.
Proposals on increasing the number of health workers in South Africa and new rules on the hiring of foreign workers in this field form part of the National Human Resource Plan for Health launched early in April on World Health Day. According to the plan, on the Department of Health's website, proposed staff increases include increasing the current newly-qualified 1200 medical practitioners per year to 2400 by 2014, staff nurses from 5000 to 8000 by 2008 and pharmacists from 400 to 600.
It is ironic to be talking of working together for health in southern Africa - a region faced with chronic shortages of health workers as a result of massive brain drain, inadequate drugs, inadequate and chronic shortage of infrastructure and equipment. Working together for health was this year’s theme for World Health Day, commemorated on the 7th of April. Yet the authors further discuss the disheartening fact that little was said in southern Africa for World Health Day.
Research by the World Health Organisation explores the international migration of nurses and the implications for five countries: Australia, Ireland, Norway, the UK and the USA. The flow of nurses to these countries has risen during the 1990s, and, in some cases, recruitment is from developing countries. In this article the researchers propose a number of policy options to manage nurse migration and make a number of recommendations for improving workforce data systems.
While the World Health Organization's focus on human resources for health in its 2006 World Health Report (WHR) is welcome, the lack of detailed data in the report is disappointing, states an editorial in this week's issue of The Lancet. The author explains how ".....[it] shows just how much of a gap exists between current knowledge and what is necessary to inform policymaking."
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9. Public-Private Mix
Water, the most precious global resource, was the subject of World Water Day on March 22. This was preceded by the World Water Forum, held between 16-22 March, where officials from 140 countries met to discuss how to achieve the UN Millennium Development Goal of halving the proportion of people without sustainable access to safe drinking water by 2015. Patrick Bond discusses the “water wars” – the battle by activists against the global trend that seeks to turn the delivery of water into a commercial enterprise.
10. Resource allocation and health financing
A unanimous Board in Geneva met on 23 March 2006 and elected Dr Lieve Fransen Vice Chair of the Board after Prof Michel Kazatchkine, France's Ambassador on HIV/AIDS and Transmissible Diseases announced his resignation in January.
Civil society organisations have asked the Kenyan government to name the non-governmental organisations that have mismanaged funds meant to fight HIV/Aids, tuberculosis and malaria and, consequently, delayed the disbursement of further money from the Global Fund for HIV/Aids. ‘Civil society organisations have their own disciplinary measures against corruption through the various NGO-member consortiums,’ the CSOs said.
This paper from Population Services International (PSI) outlines a method for segmenting populations as part of a Total Market approach to designing, managing and evaluating reproductive and sexual health interventions in developing countries. The approach is demonstrated using data from South Africa. Until now market segmentation analysis has mainly focused on people’s ability to pay. However, this approach applies the Making Market Systems Work Better for the Poor (M4P) concept and identifies five issues which effect people’s take-up of reproductive health services.
This weekend, six million people in urgent need of essential Aids drugs face betrayal by world leaders. The Global Fund to Fight Aids, TB and Malaria starts two days of meetings in Geneva today, and ActionAid can reveal it is not getting the heavyweight political support it needs. So far, the UK government is the only major donor to declare its support. Without commitment from other countries, the Fund is unlikely to announce any new grants to fight HIV/Aids in 2006.
The Global Fund to Fight AIDS, Tuberculosis and Malaria and the UK Department of International Development have agreed to appoint a Health and HIV/AIDS Adviser to step up advice, monitoring and liaison between DFID, the Global Fund and Mozambican health authorities. The collaboration will ensure that the Global Fund, as a major financier of the health sector of Mozambique, is kept informed and can provide policy inputs whilst having no staff of its own present in the country. The article describes the work up to and components of the agreement.
Zambia scrapped health fees on Saturday, one of the first benefits to flow from debt relief granted to African countries last year by the G8 group of wealthy nations. Many poor people across Zambia often die because they cannot afford health care and are forced to resort to ineffectual traditional remedies. This narrative depicts the impact of this abolition of user fees in the eyes of a Zambian man.
11. Equity and HIV/AIDS
HIV-positive East Africans – and other people in the developing world on life-saving antiretrovirals may find themselves without effective medicines unless measures are taken to lower the cost of second-generation drugs, Aids activists have warned. According to the international humanitarian organisation Medecins Sans Frontieres (Doctors Without Borders), a growing number of HIV patients on first-line ARVs will inevitably have to move to second-line drugs, which are more expensive and therefore harder to access.
This compact argues that sexual and reproductive rights are a pivotal but neglected priority in HIV and AIDS policy, programming and resource allocation. It claims that universal access to sexual and reproductive health services and education, and the protection of sexual and reproductive rights, are essential to ending it. The compact draws on issues in equity in health by calling on HIV and AIDS decision makers to redefine 'high risk' by recognising that women and girls are at serious risk and have the right to all services related to the prevention, treatment, care and support as part of comprehensive sexual and reproductive health services.
African heads of state meet this week in Abuja, Nigeria, to review progress made in reversing the spread of HIV/Aids, malaria, tuberculosis and other infectious diseases.
An AIDS epidemic as severe as the one plowing through South Africa will change society, with currently predicted scenarios tending to be roughly hewn and formulaic; fixating on the impact on productive and governance capacities. But exactly how and along what lines? Buckling: The impact of AIDS in South Africa, a new publication by South African writer and journalist Hein Marais, tackles the question in distinctive and critical-minded fashion-and arrives at disquieting conclusions.
The US Government Accountability Office (GAO) have released a long-awaited report analyzing the effects of the abstinence-until-marriage earmark in the US Global Leadership on HIV, Tuberculosis, and Malaria Act of 2003, also known as the President's Emergency Plan for AIDS Relief, or PEPFAR. In theory, the law supports a comprehensive approach often described as ABC or Abstain, Be Faithful, Use Condoms, and argues that prevention programs should be designed to meet local needs and realities. In practice, the law requires that, as of FY 2006, at least 33 percent of prevention funding be set aside for so-called "abstinence-until-marriage" programs. Key findings in the GAO report are reported to indicate that PEPFAR prevention programs have responded in design more to the agenda of the Bush Administration and Congress than to local prevention needs, epidemiological needs and cultural realities.
This report looks at the reasons behind the GAO study, the findings of the study, and relevant recommendations that emerged from the study. It describes the challenges posed by spending requirements in allocating prevention funding under the President's Emergency Funding for Aids Relief (PEPFAR).
An initiative by African governments to step up the pace of HIV prevention was launched at four simultaneous events across the continent. African health ministers designated 2006 as the Year for Accelerating Access to HIV Prevention at a meeting in Maputo last August. The purpose of the campaign is to ensure that prevention reassumes its rightful position as the mainstay of the global response to HIV and AIDS.
This letter was written by and to represent the various groups of people living with HIV/AIDS across the world. Adressed to the Director General of the WHO, Dr Lee, the letter begins by thanking Dr Lee for the truly visionary leadership in launching WHO’s 3x5 campaign in 2003. However, the letter proceeds to express concern that the new Universal Access initiative may lack the specificity of WHO's 3x5 campaign and is not accompanied by any clear and concrete operational goals.
Fifty four women from 21 African countries representing 41 national, regional and international women’s organizations in Africa; comprising of HIV and AIDS organizations, feminist associations and human rights institutions, meeting in Johannesburg, South Africa between April 6 and 7, 2006 to formulate advocacy positions on women’s rights in the context of HIV and AIDS expressed outrage at the conduct of the defence lawyers, the media, the courts and the police in the rape trial of the deputy President of the African National Congress, ANC, Jacob Zuma; concern at the twin epidemics of Violence Against Women and HIV and AIDS; and solidarity with Khwezi for bravely reporting her experience; and for showing respect for the mechanisms that exist in South Africa to report and resolve crimes.
12. Governance and participation in health
African Civil Society Organisations (CSOs) have accused heads of governments in the continent of ‘tactfully shutting’ them out of the fight against the HIV and AIDS pandemic. The CSOs made the accusation in Abuja where they attended a three-day consultative meeting to review the 2001 Abuja Declaration and Framework of Action on HIV and AIDS, Tuberculosis and other related infectious diseases. In a statement they said that ‘without a massive and sustained effort to meaningfully involve CSOs, the global difficulties in reaching three million people with treatment will also be encountered in extending Universal Access to treatment.
Residents of Angolan capital city Luanda's compounds hit by cholera voiced dissatisfaction at the local Government's distribution of treated water as a measure to arrest the spread of the disease. Since the epidemics was declared in Luanda on 13 February, some areas most affected by the disease, have been supplied with water by the Luanda Government (GPL). In order to overcome the poor supply of water to the populations at a time cholera is severely hitting the capital, GPL decided to supply twice a week.
On World Health Day, Health Minister Manto Tshabalala-Msimang announced the launch of a government strategy to ensure that the public health sector has essential human capital to deliver quality care. The National Human Resource Plan for Health is one of the health department's strategies to deal with the critical shortage and migration of health workers from the country.
13. Monitoring equity and research policy
The Executive Director of the GFHR says: "One of the important aspects of our work is that we have been tracking global resources for health research. For example, we found that in 2001 the world spent nearly US$106 billion, with 44% of this total coming from the public sector, 48.3% from the private for-profit sector and 7.6% from private not-for-profit organizations like the Gates and Rockefeller foundations." This article sheds further light on the real picture.
Research bringing intimate knowledge of clients and their care in HIV/AIDS clinics, and of the bureacracy, politics and needs of national and international health government – is making Liverpool VCT and Care a scientific force to be reckoned with, Nduku Kilonzo explains. Kilonzo’s speciality is gaining evidence on the role of gender and rape in the AIDS pandemic – and even more powerfully, changing health policy and actions in response to her results. But how do she and Liverpool VCT do it? This interview demonstrates how her various strategies have allowed this public-private partnership to bear fruit.
As part of its contribution to closing the ‘10/90 gap’, the GFHR conducts studies of the flows of financial resources for health research and the extent to which these address the health needs of the poor and marginalized. This new volume of Monitoring Financial Flows for Health Research looks behind the global totals and examines several facets of the overall picture. The report highlights the revolution of a much broader and more holistic definition of health and the need for a wider and more multisectoral approach to understanding the determinants of health.
Despite improved supply of health care services in low-income countries in the recent past, their uptake continues to be lower than anticipated. This has made it difficult to scale-up those interventions which are not only cost-effective from supply perspectives but that might have substantial impacts on improving the health status of these countries. Understanding demand-side barriers is therefore critically important. This commentary argues that more research on demand-side barriers needs to be carried out and that the stated-preference (SP) approach to such research might be helpful.
14. Useful Resources
The IDS Health and Development Information Team has produced a range of resources which explore critical issues in human resources for health: Human resources for health dossier. This dossier is an information resource on the importance of human resources in improving health service delivery for poor people, developed in collaboration with the DFID Health Resource Centre. The dossier offers practical, up to date information with recommended readings, summarised documents and link to other resources.
This child protection toolkit aims to support agencies at international, national and local levels to put child protection standards into practice. The toolkit has a total of five components, three of which are online documents and include the following: standards for child protection, how to implement the standards training for child protection. The full document can be found at the link provided.
In the first half of 2006, in the lead-up to the second Partnership Forum (Durban, South Africa, 3-4 July 2006), the Global Fund is opening up its website to all stakeholders, inviting them to actively participate in its strategic thinking and to help improve the way it supports its national partners in their fight against AIDS, tuberculosis and malaria. This eForum is an online meeting place where everyone can share ideas, suggestions and comments on the Global Fund's performance and future direction.
Transparency International has put together a website of resources on corruption and health. You may well see your own work reflected in the further reading lists. The idea for the website is to draw attention to some of the research contained in the TI Global Corruption Report 2006, but also to provide links to more detailed analyses and country studies. The website also provides information about the work TI National Chapters have been doing on the topic. Transparency International welcomes information about other resources you think we should include, or organisations working on corruption in health with which they could link.
15. Jobs and Announcements
We had a good response to our call for input into Global Health Watch 2007-2008. The steering committee met in March to finalise the broad framework for the next edition. We would like to have more writers from developing countries in this edition of the Watch. Please let us know if you are interested. We aim to get the first drafts of the chapters back by the end of November 2006.
The International Program Development Evaluation Training (IPDET) is offered by Carleton University and the World Bank in Ottawa, Canada, June 12-July 7th, 2006. It will bring together Southern and Northern evaluators, professionals in multilateral and bilateral agencies, governmental officials, and managers from nongovernmental organizations who are responsible for conducting and managing evaluations of development interventions. The Evaluation Unit has made scholarships open to any Southern-based researcher or evaluator currently involved with an IDRC-supported project. Candidates can be recommended by management, PIs, Secretariats, or Corporate Projects.
The Third World Organization for Women in Science (TWOWS), with funds generously provided by the Department for Research Cooperation (SAREC) of the Swedish International Development Cooperation Agency (Sida), has instituted a fellowship programme for female students from Sub-Saharan Africa and Least Developed Countries (LDCs), who wish to pursue postgraduate training leading to a Ph.D., at centres of excellence in the South (developing countries), outside their own country. This fellowship programme is for female students in Sub-Saharan Africa or Least Developed Countries (LDCs) who wish to pursue postgraduate training leading to a doctorate degree at a centre of excellence in the South outside their own country.
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