Dr LEE Jong-wook, Director-General of the World Health Organization, died on 22 May 2006 following a short illness. EQUINET joins the many who have paid tribute to Dr Lee for his contribution to global public health, and send deep condolences to his family and colleagues.
Dr Lee was a national of the Republic of Korea and a world leader in public health. His contribution to global health has been commended from a wide spectrum of the global community: Treatment and health activists have recognized his decisive and bold leadership in declaring AIDS a global emergency in 2003 and in mobilising WHO organizational resources to deliver on the global commitment to provide 3 million people with Ante-retroviral treatment by 2005. While many challenges remain in this, the over 700% increase in the number of people in Sub-Saharan Africa on treatment between 2003 and 2005 is testimony to this leadership.
According to the WHO website (http://www.who.int/dg/lee/tribute/en/), Dr Lee, in explaining his vision of "universal access" to staff a few days before his death, indicated that there could be no 'comfort level' in the fight against HIV, and that the commitment to universal access to treatment by 2010 would be measured by an outcome in 2010 that no-one dies because they can't get drugs. In another editorial in this issue we explore some of the issues this poses globally, and for the region.
The United Nations Secretary-General Kofi Annan declared " The world has lost a great man today. LEE Jong-wook was a man of conviction and passion. He was a strong voice for the right of every man, woman and child to health prevention and care, and advocated on behalf of the very poorest people."
In his very first speech to WHO staff as Director-General, Dr Lee vowed that WHO would do the right things, in the right places. The WHO tribute makes clear that to him, the right places were the countries that most needed WHO's support. He considered WHO's job as one of huge responsibility to its 192 Member States, and the health needs of their people. This country focus sharply raised a glaring issue: that of equity and the inequalities within and across countries in health and health care. In his address to the Fifty Seventh World Health Assembly in 2004 Dr Lee noted “We have yet to get to grips with the links between health, equity and development. The underlying theme of my first year as Director-General is equity and social justice”.
To support work in this area, WHO set up a Commission on the Social Determinants of Health to gather evidence on the social and environmental causes of health inequities, and how to overcome them. EQUINET values the focus that Dr Lee gave to these inequities in health and health care, and the wider responsibility he articulated for action on the conditions and policies causing them within the whole global community. As he noted in 2004: “Hopes of peace and security in the world fade where these inequities prevail”. We pay tribute to Dr Lee for his championing, at the helm of the WHO, these values and goals of equity and social justice. They are deeply shared by EQUINET.
Under the Rules of Procedure of the World Health Assembly, and in accordance with the decision of the Director-General, WHO has indicated that Dr Anders Nordström - currently Assistant Director-General for General Management - will serve as Acting Director-General.
For information on the institutions in the EQUINET Steering Committee see www.equinetafrica.org or contact EQUINET through admin@equinetafrica.org
1. Editorial
When the United Nations General Assembly meets in June to review progress in tackling the AIDS epidemic it will be reminded by civil society globally of the commitment made to ensure universal access to treatment for AIDS by 2010. This commitment has greatest resonance in sub-Saharan Africa where AIDS related mortality is highest. Two years ago, in June 2004 the regional EQUINET conference of civil society, state, academic and parliamentary delegates resolved that the health challenges in east and southern Africa demanded health systems that are universal, comprehensive, equitable, participatory and publicly funded. This also has urgency in a region where poverty is undermining progress in meeting the most basic Millennium Development Goals.
How do these two sets of imperatives relate to each other? Do they reinforce each other or are they competing for policy attention and resources? Does giving urgency to addressing the right to treatment for AIDS boost or weaken efforts to rebuild fragile health systems? This was the focus of debate at a meeting in Cape Town in early May this year that gathered international AIDS activists, people living with HIV and AIDS (PLWHA) and health activists. The meeting was organised by Gay Men’s Health Crisis with support from the Rockefeller Foundation, and focused on “Identifying public policies for scaling up antiretroviral therapy (ART) and strengthening health systems in developing countries”
The gathering of AIDS and health systems activists itself signals a widening social debate on health and health systems, raising the social, economic and political profile of health after decades of market reforms that have undermined equity and solidarity in health and that have weakened public health systems. It builds on new and increased resources that AIDS brings to health systems, and a growth in social movements for health that can strengthen relationships between health services and communities.
Delegates recognised that access to treatment for AIDS is a right, and so too is access to essential health care. An advocacy and public policy agenda that recognises both of these rights of necessity calls for health-systems friendly, people (especially PLWHA) driven approaches to the establishment, scale-up and long-term sustainability of AIDS treatment programs. There has been past debate on whether the speed of responding to treatment rights compromises this goal of building sustainable systems. The AIDS epidemic is an emergency, and the level of avoidable infection and death calls for measures to bring HIV prevention and AIDS treatment services rapidly to community levels. At the same time it is a chronic long term issue that calls for sustainable systems and measures beyond emergency responses.
How can this be achieved? The meeting reinforced the more general call within the region for people centred health systems. The role people play in decision making in the health sector is important, and often weakly recognised. Specific measures were called for to remedy this.
For example it was proposed that decision making structures and processes include the active participation of PLWHAs, their communities, health care workers and other stakeholders from civil society. However, the governance of the health sector is weak in many countries and the acceptance of the role of civil society is contentious for many governments, thus making real participation a challenge in most settings. In order to pave the way for greater involvement, this participation needs to be backed by regulatory frameworks, guidelines, clear policy messages from governments and effective mechanisms and processes to manage this engagement, including for transparently managing conflicts in the interests and priorities of different groups.
Delegates agreed that involvement in decision making and delivery raises a corresponding obligation of PLWHAs and communities to be literate on both HIV prevention and AIDS treatment and on how health systems work. Building on community-based AIDS treatment literacy, health systems literacy is needed to build community knowledge on public health, and the health systems through which prevention and treatment are delivered. Just as AIDS treatment literacy has become a vehicle for mobilising communities around rights of access to ART, so health systems literacy should be a tool to mobilise communities around their collective rights to health and health care.
The desire to move at ‘AIDS speed’ has led to vertical programming to meet short term demands and delegates at the meeting agreed that some verticality is needed in the short term in response to the epidemic. However vertical programmes can only sustain the long term, lifetime delivery of ART if they are integrated within the wider health system. The issue of vertical programming and the integration in health systems is not unique to AIDS, and affects many other disease based programmes. The resources flowing to AIDS programmes gives it specific prominence, however, as the positive and negative systems effects can be pronounced. This issue naturally arose in the dialogue: delegates at the meeting recommended that plans for AIDS treatment programs need to assess which components can be immediately integrated into general health systems and which require vertical implementation in the short- to medium-term. Delegates also raised the need for plans to be set up front for how all vertical components will be integrated into the health system in the medium- and long-term. Whether initial decisions are made to vertically implement certain components of AIDS treatment programmes or to immediately integrate these components into general health systems, delegates raised the need to recognise, monitor and address problems that might arise from whatever approach is adopted. As the meeting noted, this calls for national information systems and research that is able to identify these effects. It also calls for policy processes that are responsive to this information and flexible enough to rapidly correct problems.
EQUINET has raised that fair financing and valuing of health workers is central to rebuilding national health systems in the region. These issues were also central in the dialogue at the meeting.
The absolute shortage of trained health care workers, at crisis levels in some African countries, is now a major impediment to treatment access, and needs short-term action linked to long-term measures. Health systems and AIDS activists agreed on this. Efforts by some governments in east and southern Africa to tackle this issue were noted, and need to be supported, spread, and backed by consultation with health workers. This calls for targets for training and employing health workers, new resources to employ and pay incentives to retain health workers and removal of any international finance institution conditions or fiscal restraints that undermine the application of these measures. The meeting delegates expressed frustration at the slow pace of global discussions and measures to cancel debt, mobilise aid and lift fiscal restraints to support these health system measures, relative to the speed with which these resources are needed.
The meeting agreed that a point of synthesis of all these points is that of support for bottom-up district level planning as this brings communities and health service providers together around priority health needs, including AIDS treatment. A number of key features were raised, for example:
• bottom-up level district planning that involves communities in a substantive way;
• respect for district planning by governments, international agencies, non government organisations and donors;
• ensuring free access to AIDS treatment (and primary health care services) at point of service and addressing other barriers to accessing care, such as transport to health services;
• resource allocation systems that are responsive to district planning.
To this we may add ensuring that health workers at district and primary health care levels are adequate, valued and retained, including ensuring their own access to AIDS treatment, strengthening district level health information and planning systems and revitalising and resourcing the community health worker and primary health care approaches that strengthened the interface between communities and health services.
Finally, the stewardship of global public health, AIDS programs and health systems, needs independent and rigorous external monitoring. The promises made at the 2001 UNGASS were largely promises broken and the new promises made at the 2006 UNGASS in New York need to be held open to greater scrutiny in the years ahead. Stronger mechanisms for monitoring of good practices and stewardship in health at global, regional and country level must be established and led by institutions from developing countries.
The dialogue at the meeting in Cape Town in May provided a useful opportunity to identify shared goals and paths to strengthening health systems and ensuring universal access to AIDS treatment. It now provides a useful ‘watching brief’ for health systems activists and AIDS activists to see how far the dialogue at UNGASS addresses our shared expectations.
Please send feedback or queries on the issues raised in this briefing to the EQUINET secretariat, email admin@equinetafrica.org . EQUINET work on equity and health systems strengthening in health sector responses to AIDS is available at the EQUINET website at www.equinetafrica.org . Information on Gay Men’s Health Crisis can be found at http://www.gmhc.org/
2. Latest Equinet Updates
EQUINET is part of a consortium that was appointed in September 2005 to co-ordinate the Health Systems Knowledge Network of the WHO Commission on the Social Determinants of Health. The Centre for Health Policy in South Africa has been appointed as the hub of the Knowledge Network on Health systems. The Commission is a global strategic mechanism to improve equity in health through action on the social determinants of health at global, regional and country level. This outline briefly describes the function and key areas of work of the Health Systems Knowledge Network, exploring the important role that health systems can play in reducing social differentials in health.
Malawi, like many southern African countries, is facing a critical human resources for health (HRH) crisis, preventing it from delivering acceptable quality health care services to its population. The reasons underlying the shortage of health professionals are multiple and include limited output from training institutions, high attrition rates resulting from migration and disease, and increased workloads because of HIV and AIDS. Despite the increasing levels of migration of health professionals from Malawi which have caught international attention, many continue to serve their country. The challenges encountered by these health workers (which may eventually become push factors), and the coping or survival strategies that they utilise deserve attention if any meaningful solutions to retain health professionals in Malawi are to be developed.
The study was part of a cluster of countries studies on distribution and retention of human resources for health in the EQUINET/ Health Systemns Trust theme work on Human Resourdces for Health. The paper explored factors in the retention of pharmacists in South Africa. The key findings are:
• Most pharmacists trained at the University of the North are within South Africa.
• Of 121 respondents, 46% work in rural areas, and 63% in the public sector. Pharmacists of rural origin are more likely to work in rural areas and in the public sector than their counterparts coming from urban areas.
• In the reasons given for choosing the current job, opportunities for further professional development and the desire to serve the community were more commonly cited factors than pay. However, many said they would change jobs for better pay.
• Respondents perceived that the profession was not adequately recognised or valued within the health sector nor by clients.
These and other study findings reported suggest that a mix of financial and non-financial incentives are needed to address the scarcity of pharmacists in the public sector and in rural areas.
3. Equity in Health
The World Health Assembly is the supreme decision-making body for WHO. It generally meets in Geneva in May each year, and is attended by delegations from all 192 member states. The main function of the World Health Assembly is to determine the policies of the Organization. This year, issues discussed included: strengthening pandemic-influenza preparedness and response; infant/child nutrition; HIV/AIDS; polio eradication; sickle-cell anaemia; smallpox eradication and the destruction of variola virus stocks; prevention of avoidable blindness; international trade and health; tobacco control; and intellectual property rights.
African leaders met in Abuja, Nigeria, in May to discuss the battle against HIV/AIDS, tuberculosis and malaria, the continent’s top three killers, at a summit organised by the African Union (AU). The pan-African body’s gathering would be attended by attended by senior government figures from at least 18 African countries including SA. Health ministers from 24 countries and finance ministers from about 10 countries had confirmed their attendance; the central theme being universal access to care for HIV/AIDS, tuberculosis and malaria across Africa by 2010.
Last week’s annual meeting of Health Ministers at the World Health Assembly of the WHO started with the shocking news of the sudden death of its Director General, and went on to review global health problems, including avian flu, the effects of patents on health care, and the drain of doctors from poorer to rich countries.
The greatest share of health problems is attributable to the social conditions in which people live and work, referred to as the social determinants of health (SDH). Good medical care is vital to the well-being of populations, but improved clinical care is not enough to meet today's major health challenges and overcome health inequities. Without action on social determinants, those countries in greatest need will neither meet the health-related Millennium Development Goals nor achieve global targets for reducing chronic diseases. The article discusses the conceptual and operational challenges thus faced by the commission.
At the 59th World Health Assembly, Dr Serag challenged WHO to return to the principles of the Alma Ata Declaration in "Managing the Politics of Equity and Social Determinants of Health". The briefing drew sharper focus on the necessity of major health stakeholders to step up action on the social causes of ill-health. High-level policy makers, civil society members and WHO staff attended the briefing, proclaimed as a "historical moment" by a floor delegate. Among the attendees was Dr Halfdan Mahler considered to be the father of the Alma Ata Declaration and former WHO Director-General from 1973 to 1988.
4. Values, Policies and Rights
Violence against girls in Southern African schools is steadily rising, but not enough is being done to prevent and censure abuse in educational institutions. The incidence seems high because more girls are reporting cases of abuse in schools, founder and director of the Girl Child Network (GCN), a Zimbabwean rights NGO. But there are other reasons as well, such as the increasing incidence of poverty: girls from poor homes are lured by teachers with promises of cash. Even the high prevalence of HIV/AIDS is another reason - the myth that sex with a virgin can cure the disease is still very prevalent, and desperate men will do anything. One of the sobering realities highlighted at the gathering, organised jointly by the Open Society Initiative for Southern Africa and ActionAid International to focus on the problem, was that girls in African schools are repirted to be three times more likely to be abused than boys.
This report presents the results and analysis of a survey conducted to develop understanding of what NGOs and child rights coalitions would need in order to mainstream children's rights into the UN treaty body system. The survey found that NGO and child rights coalitions that report to the Committee on the Rights of the Child have not, for the most part, made purposeful ventures into the reporting processes of other treaty bodies. The research also illustrates that mainstreaming means different things in different contexts.
PHM would like to invite civil society organizations, interested individuals and groups to participate in discussing the possibility of hosting such a campaign in South Africa. It would also contribute to building civil society for the Third People’s Health Assembly, planned for 2010 at an African venue (to be determined). This edition of Critical Health Perspectives sketches the background to the campaign and some of the thinking behind it.
5. Health equity in economic and trade policies
At Workers University in Cairo, a mid-May gathering of 100 trade union leaders and intellectuals from across Africa adopted surprisingly common radical language, exhibiting a pent-up desire to jointly fight global neoliberalism. The Council for the Development of Social Science Research in Africa (Codesria) has been an extraordinary network for 5000 members who are the continent's core of progressive academics. The article provides a detailed recount and discussion of the various arguments and perspectives presented.
A technical group at the World Health Assembly in May agreed on a
resolution that will increase the worldwide research and development
focus on diseases that disproportionately affect developing
countries. Brazil and Kenya, which have been driving the issue,
welcomed the resolution,
The following memorandum was handed to His Excellency, Mr Donald Teitelbaum, Chargé d’Affaires, United States of America, on 10 May 2006, by COSATU Gauteng Provincial Secretary, Siphiwe Mgcina, at a picket of the embassy by COSATU members as part of the Jobs and Poverty Campaign. COSATU writes to bring to the reader's attention the potentially detrimental consequences of the memorandum to be faced by the various sectors in South Africa, and the rest of the countries in the South or the developing nations.
Recent media focus on intellectual property rules has led many to believe that the entire debate centers around the issues of piracy of films, videos and DVDs. There is a constant refrain that a watertight regime of intellectual property rules is essential to protect the rights of those who devised, developed and produced innovative goods, be it art or health cures. Under GATT and the WTO, the latter created in 1995, the rules protecting and harmonising intellectual property have been enhanced to principally benefit corporate and neo-colonial interests, under the Trade Related Intellectual Property (TRIPS) regime. TRIPS is extremely controversial in its failure to recognise traditional and communal knowledge systems and rights while at the same time insisting on strong protection, enforcement and regulation of corporate aligned intellectual property rules.
In a verdict that could ripple across the pharmaceutical industry, a U.S. jury in a federal lawsuit has ruled that Eli Lilly infringed a patent covering drugs that work through one of the body's basic biological pathways. The patent, issued in 2002, is claimed to cover any drug that works by influencing the action of an important protein in the body. Some critics have said that patents covering an entire pathway in the body, as opposed to a particular drug, could hinder drug development.
This discussion paper seeks to determine the impact that bilateral free trade agreements (FTAs) have both internationally and domestically on intellectual property regimes. In particular the paper looks at the impact this will have in countries that are net- importers of products related to IPR. It also highlights strategic approaches that different countries have used when tackling this problematic matter.
The Olle Hansson Award recognises the work of individuals from developing countries who have contributed most to promoting the concepts of essential drugs and their rational use and increasing the awareness among consumers of the dangers of irrational and hazardous drugs.
6. Poverty and health
As the Horn of Africa risks facing a famine not seen since the mid-1980s, World Vision Africa Senior Advisor Nigel Marsh says all hope is not lost. The people of Somalia, Kenya, Ethiopia, Tanzania and Burundi are at the mercy of three giants that are difficult to wish away: namely the weather, poverty, and HIV/AIDS.
The death of a child is always tragic, and in South Africa it is not an unusual occurrence. Every hour, 10 children under five years of age die. Almost one in 10 children will not survive to see their fifth birthday. The majority of these deaths are entirely avoidable.
While new drugs and vaccines are needed to treat diseases of poverty, not enough is being invested in developing these products because of the lack of a demand or market for them. Advance price or purchase commitments potentially offer a solution, yet a number of structure and design issues first need to be resolved.
7. Equitable health services
Nearly 18 months ago, South Africa’s Traditional Health Practitioners Bill made a triumphal passage through parliament, raising hopes in the hearts of the 300 000 or so practising traditional healers in South Africa that they might at last begin to ply their trade on an equal footing with their biomedical counterparts. The legislation included allowing traditional healers’ patients to claim through medical aid schemes, giving them access to government hospitals and clinics and demanding the same respect and courtesy accorded to general practitioners, surgeons and other biomedical professionals.
This publication pulls together available information on how health sector reform (HSR) has impacted on sexual and reproductive health services (SRH), and identifies information gaps and advocacy issues. The findings comes from the work of three research teams from Africa, Asia and Latin America who carried out systematic research on six elements on HSR. These elements include: financing, public-private interaction, priority-setting, decentralisation, integration of services and accountability.
8. Human Resources
Medical professionals working in the public sector often supplement their salaries through second jobs in the private sector. Their dual job activities have both positive and negative implications for the public health sector. What policy options exist for regulating dual job holding and what is their likely effect?
A new global partnership that will strive to address the worldwide shortage of nurses, doctors, midwives and other health workers was launched today. The Global Health Workforce Alliance will draw together and mobilize key stakeholders engaged in global health to help countries improve the way they plan for, educate and employ health workers. The Alliance will seek practical approaches to urgent problems, and will also serve as an international information hub and monitoring body.
Access to good-quality health services is crucial for the improvement of many health outcomes, such as those targeted by the Millennium Development Goals (MDGs) adopted by the international community in 2000. The health-related MDGs cannot be achieved if vulnerable populations do not have access to skilled personnel and to other necessary inputs. This paper focuses on the geographical dimension of access and on one of its critical determinants: the availability of qualified personnel.
This policy brief examines the case for a two-tiered health training system. Within this system, doctors and nurses are trained to international standards, while many others are trained to more basic levels of health care, enabling them to meet the basic needs of the people in rural areas.
A recent conference entitled "Immigration Futures", organised by the Monash Institute for the Study of Global Movements. One panel focused on outward migration which looks at the “brain drain” problem facing many predominantly poor countries since some of their most skilled citizens choose to live and work in predominantly rich countries. Manchester in England, UK for example, has more Malawian doctors than the entire Malawian health system!
As the United States runs short of nurses, senators are looking abroad. A little-noticed provision in their immigration bill would throw open the gate to nurses and, some fear, drain them from the world's developing countries.
9. Public-Private Mix
Aspects of the proposed new dispensing-fee structure for pharmacists need more attention, the Pharmaceutical Stakeholders Forum (PSF) said on Tuesday. These included the recent impact analysis of the proposed dispensing fee on community pharmacies, said PSF coordinator Ivan Kotze. The PSF made the comment in a submission on Monday to the Pricing Committee - appointed by Health Minister Manto Tshabalala-Msimang under the Medicines and Related Substances Control Amendment Act to help bring about a more transparent pricing system for medicines in South Africa.
In sub-Saharan Africa, more than 2 million people die each year as a result of malaria; most victims are pregnant women and children under the age of 5. In Mali, malaria is the Number 1 killer of young children.Insecticide-treated mosquito nets are one of the most effective methods for preventing malaria. Studies conducted since the early 1990s show that their use has decreased severe malaria by 45 percent, premature births by 42 percent and all causes of child mortality by 20 percent. The NetMark Alliance represents a time-limited investment by the U.S. Agency for International Development (USAID) to reduce the burden of malaria in sub-Saharan Africa by increasing the commercial supply of insecticide-treated nets.
Health sector reforms usually involve changes in the organisation and management of health care systems, including a re-examination of the roles of the public and private sectors in the delivery of health care. From a gender perspective there is silence about the unpaid provision of health services in which women in the household and community are the main providers. This silence pervades most of the literature on privatisation.
10. Resource allocation and health financing
The Public Servants' Association (PSA) in South Africa has voiced concern over restrictions imposed by the Government Employees Medical Aid Scheme (Gems). It welcomed the restructuring current medical aid assistance to make medical cover more affordable, but questioned the compulsory membership of Gems.
Researchers say they are bracing for a sharp rise in the cost of public health services in South Africa within the next few years, due to HIV/AIDS. And, they warn that the country's health department might not be able to cope with its ever-growing responsibilities if government fails to increase the department's budget substantially.
Rich countries should back their poorer neighbours in setting up free universal healthcare to help save thousands of lives, Hilary Benn, the minister for international development, will told public service workers in the UK in May.
The Bill and Melinda Gates Foundation, has announced that it would give $104m to a non-profit organisation that fights tuberculosis (TB), a scourge in the developing world. The money will be doled out over five years to the Global Alliance for TB Drug Development to develop new drugs to combat a disease that kills nearly two million people a year. The four available drugs currently used to treat the disease are all more than 40 years old and take six months to work, while many patients have tuberculosis strains that are resistant to existing treatments.
This document argues that by enhancing mutual accountability the aid community and recipient governments can begin to address the power imbalances intrinsic in aid relationships focus aid resources on commonly defined objectives allow recipient governments to influence donor behaviour makes aid more responsive to local needs and priorities.
In a health budget that has received a R600-million boost, the Western Cape's drastic nursing shortage, HIV and Aids and tuberculosis are top of the list for the financial year, says Western Cape Health MEC Pierre Uys.
11. Equity and HIV/AIDS
The first draft of the political declaration was released on April 26, and is based on the outcomes of the regional consultations on Scaling Up for Universal Access. Amongst other important strengths, the draft declaration has quite a strong focus on women and girls, committing governments to increase women’s and girls’ capacity to protect themselves from the risk of HIV infection, to take measures that will promote women’s empowerment and to protect and promote women’s human rights. The text also calls for stronger policy and program linkages between sexual and reproductive health and HIV and AIDS.
The mainstays of South Africa’s efforts to fend off the impact of the HIV/AIDS epidemic are anti-retroviral (ARV) therapy provision and home based care. While vitally important, each in current form also expresses the kinds of prevailing inequalities that warp society. Today, of the estimated one million South Africans in need of ARVs, only about 200 000 are receiving such therapy -- half of them through the private health sector, which is accessible to a small minority of South Africans. This crisis demands nothing less than a new strategy (and struggle)for realising social rights.
African leaders meeting at a special summit on HIV/AIDS, tuberculosis and malaria, in the Nigerian capital, Abuja, threw down a challenge to their governments by setting bold new targets to be achieved by 2010. At the end of the gathering to review progress in implementing the 2001 Abuja Declaration on AIDS, TB and Malaria, a major resolution was passed, declaring that at least 80 percent of those in need, especially women and children, should have access to HIV/AIDS treatment, including antiretroviral (ARV) drugs, care and support. Civil society organisations welcomed the ambitious continental targets, but it remains to be seen whether these will be met, particularly when considering how little progress has been made in implementing goals set in 2001. Of particular concern is that leaders reiterated their commitment to devote 15 percent of their national budgets to improving the health sector, while the African Union (AU) found that Nigeria, Burundi and Ethiopia scored worst in this respect, having set aside only four, three and two percent of their annual budgets respectively for health. Only a third of African countries spend 10 percent of their budget or more on health. African countries also pledged that at least 80 percent of pregnant women would have access to medication for preventing mother-to-child transmission (PMTCT) by 2010, and at least 80 percent of target populations would have access to voluntary testing and counselling services.
Civil society groups from across African met in Abuja, Nigeria on April 10 to 12 2006 to develop a consolidated position for use during the review processes of the Abuja Declaration and Framework Plan for action, and the United Nations General Assembly Special Session on AIDS (UNGASS) Declaration of Commitment (DoC), and to chart a way forward regarding access for all people requiring information and services related to HIV prevention, care, support and treatment. This statement reflects the outcomes of these deliberations, as well as the sentiments of the undersigned African Civil Society Organisations.
Uganda began to implement the prevention of mother-to-child transmission (PMTCT) of HIV programme in 2000, and by the end of 2003 it had expanded to cover 38 of 56 districts including Mbale District. However, reports from Mbale Hospital showed that less than 10% of pregnant women accepted antenatal HIV testing. We therefore conducted a study to determine the proportion of pregnant women who tested for HIV and the gaps and barriers in PMTCT implementation.
There are 17.5 million women living with HIV in the world, a majority of them in developing countries. Over 13 million women are living with HIV in sub-Saharan Africa, and almost two million in South and South East Asia. This article explains the people's health movement's positions on why action needs to be taken now.
This short article examines the impacts that HIV and AIDS in a community has on children living in that community. The author reviews the different impacts that these situations have on children. The author also discusses Article 26 of the UN Convention on the Rights of the Child (CRC), in the context of children indirectly affected by HIV and AIDS, which states that children have a right to benefit from state-provided social security. Registration required (free).
How can expensive antiretroviral therapy be best prioritised in under-resourced health systems? In Malawi, targeting laboratory-based tests that measure the progress of the disease may offer one solution to help target those most in need.
More than a dozen Heads of State and Government, over 100 Ministers, as well as more than a thousand representatives of civil society and the private sector gathered at United Nations Headquarters in New York in early June for a major review of international efforts to fight AIDS in what officials at the world body said would be marked by unprecedented
action.
12. Monitoring equity and research policy
Bridging the "know-do" gap poses the greatest opportunity for
strengthening health systems and ultimately achieving equity in global
health. This report comes from a meeting on "Knowledge Translation for
Global Health" convened by the WHO.
As health ministers meet in Geneva at the World Health Assembly (WHA) next week, the medical humanitarian organisation Medecins Sans Frontieres (MSF) is calling on governments to overhaul the way medical research and development (R&D) is prioritised and financed, and support a resolution proposed by Kenya and Brazil for a "global framework on essential health R&D." Despite gathering increasing support from many governments, this resolution has faced consistent obstruction on the part of the WHO Secretariat.
13. Useful Resources
A pack by Bridge, a division of IDS, aims to support trade specialists in bringing a gender perspective into their work, and to help gender specialists to understand the broad implications of trade policy and practice. Some of the main questions this pack seeks to address are, in what ways can trade advance or impede gender equality? What practical ways can policy-makers and practitioners promote gender equality in work on trade?
This new key issues guide, from the Health Systems Resource Guide, is a tool for donors, governments and implementers to learn about MDAs for reproductive health and begin thinking of options and issues to encourage, design, implement, manage and evaluate MDAs. Content includes MDA tools, examples of MDAs and country case studies.
14. Jobs and Announcements
The Christopher Reeve Foundation is looking for applications for its Quality of Life Grants Program from non-profit organisations working to address the needs of those living with paralysis (particularly spinal-cord injury), their families, and caregivers. Awards are up to $25,000 per grant. The closing date is 1 March and 1 September (annually).
The Social Science Research Council is pleased to announce the 2006-2007 Fellowship for HIV/AIDS and Public Health Policy Research in Africa. The program is open to African researchers, policy analysts, program planners and practitioners to support research on health and social policy in Eastern and Southern Africa relating to (1) political economy of care giving and HIV/AIDS with particular emphasis on gender analysis; or (2) sexual violence and HIV/AIDS. Two senior fellowships of up to $25,000 and six associate fellowships of up to $10,000 will be awarded. The deadline for applications is 12:00 noon on July 15, 2006 (GMT).
The Global Forum for Health Research and The Lancet are sponsoring a joint essay competition on the occasion of Forum 10, the 2006 annual meeting of the Global Forum for Health Research (Cairo, Egypt, October 29 to November 2 2006). Young professionals working in or interested in the broad spectrum of health research on some aspect of the overall theme of Forum 10: 'Combating Disease and Promoting Health,' are invited to submit essays for consideration to the competition. Deadline for submission: June 1 2006.
Forum 10, the 2006 annual meeting of the Global Forum for Health Research, will take place in Cairo, Egypt, from 29 October to 2 November at the invitation of the Minister of Health and Population of Egypt. This year's theme is Combating Disease and Promoting Health. Additional details on the programme and practical information on travel, hotels and visas can be found on our website www.globalforumhealth.org where the Forum 10 section will be updated on a regular basis. Registration for Forum 10 is open online.
Population Health Research Institute is offering a paid studentship for up to two students to undertake a research project in Peace through Health. One of these studentships will be available to Canadian students, and the other to students from other countries, to pursue a project in Peace through Health. The amount available for each studentship is up to CDN $2,500. This amount could be used to support travel or living expenses when the student is away or can be used towards the costs of the project. Deadline: July 1 - annually.
World of Children Awards recognises ordinary people worldwide whose lives are dedicated to doing extraordinary work on behalf of children in three categories: World of Children Health Award; World of Children Humanitarian Award; and the Founder's Award. The first two award winners will receive US$50,000 Awards; the winner of the Founder's Award will receive US$15,000. the closing date is 9 June 2006.
Published for the Regional Network for Equity in Health in east and southern Africa (EQUINET) by
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