On December 10 the Africa Public Health Rights Alliance launched an important “15% now!” campaign. We carry information on the campaign in this newsletter, and its call for African heads of state to allocate 15% on government spending to health, as promised at the African Union (AU) summit in Abuja, in 2001.
There is clear evidence of the pressing demand for significantly improved resources for health in east and southern Africa (ESA): We see it in high levels of poverty and deprivation, persistently high HIV, AIDS and other preventable diseases, high rates of child and early adult mortality, inadequately staffed and resourced public health services and massive inequalities in health outcomes between sub-Saharan Africa and other regions. The EQUINET newsletters in 2006 have presented different facets of this evidence. Health is determined by the conditions in which people live, work and interact, and depends on policies and spending beyond the health sector. The investments in the health sector are, however, critical, especially in the context of high levels of inequality and poverty. These investments can prevent avoidable illness and mortality, redistribute social resources to deprived households, protect against the impoverishing effects of ill health and demonstrate our values and commitment as a society to human security. As our May newsletter editorial suggests, health sector investments have greatest impact on low income communities when they are made in public sector primary health care and district health systems.
The World Health Organisation estimated in 2000 that an expenditure of US$60 per capita is the minimum level of health expenditure needed for a health system to function well. The Macroeconomic Commission on Health estimated in 2003 that a minimally adequate set of interventions to meet the basic health needs of poor communities is between US$34 and US$38 per person per year, not including some of the wider systems demands for a functional health system. However African health systems and communities face challenges that call for additional resources: The World Bank estimated in 2002 that Africa would need an additional US$4.2 billion to meet the costs of HIV prevention and AIDS Care, given the scale of the epidemic. Meeting the Millennium Development Goals (MDGs) adds to this cost. This makes an expenditure of US$60 per person per year a not unreasonable estimate, and one that would need to be made largely in the public sector if the benefits are to reach poor households.
Yet many public health sectors in ESA are trying to deliver health systems, pay health workers and respond to health challenges on less than $15 per person per year, and some on less than US$10 per year. Overall per capita expenditures on health in the region, public and private combined, average less than US$30 per person per year, while government spending on health is less than 10% total government spending for the majority of countries in the region.
Increasing to 15% of Government spending on health is an important and necessary sign of government commitment to health, even while it would not on its own for most countries in ESA provide adequate per capita resources for health. The call for “15% now!” justifiably calls for implementation of this commitment. If the 15% target is met through increased donor resources and not through increased application of domestic revenue, it is not a clear test of that commitment and is vulnerable to donor withdrawal. The “15% now” should thus be understood to exclude donor resources.
However, many countries in the region need more than the 15% government spending. Additional resources must be applied.
One of the sources for this must be debt cancellation. With over US$ 100 billion external debt in ESA in 2003 and even more paid out over three decades to service the debt, current debt relief measures are inadequate to overcome “debt domination”. Applied over many decades, with relatively small reductions in annual debt, they still leave African countries with significant debt burdens and deplete domestic resources for heath. As in last year’s call by civil society organisations and governments in the South-North consultation on alternatives to debt domination, the a call for “15% now!” must go together with a call for “Debt cancellation now!”.
Debt servicing is only one of the many ways resources are flowing out of our region. As demonstrated in the April EQUINET newsletter editorial, unfair and unequal terms of trade, outflows of private finance, shifts to speculative foreign investment, phantom aid, a massive outflows of health workers and global exploitation of non renewable African resources represent some of the vast and ongoing outflows of the continent’s existing and potential wealth. A recently released UN WIDER report included in this newsletter observes that inequalities in wealth have widened, with the richest 2% of adults in the world owning more than half of global household wealth, while the bottom half of the world adult population –a large share in Africa - own barely 1% of global wealth. Net outflows of African wealth represent a perverse flow of resources for health from those with greatest health needs in the poorest regions, to those with least health needs in the wealthiest regions.
This calls for a global response. An increase in predictable long term overseas development aid would provide one means of addressing this situation, and could be applied to increase the per capita spending on health to more meaningful levels, over and above the “15% now”. Efforts by some G8 countries to explore new sources of tax funding for global transfers are important steps towards this. So while African governments must be accountable for their 15% to health, so too wealthy countries must honour their commitment to “0.7% GDP to ODA now!”
But achieving global commitments to health in ESA calls for more than increased aid. Global commitments to universal access to antiretroviral treatment discussed in our June newsletter editorial, or the social development goals set at the 1995 World Summit for Social Development (WSSD), discussed in our November editorial, call for enabling, accessible, responsive and accountable states committed to mobilize the resources for health (15% now!), unencumbered by excessive debt servicing (Debt cancellation now!) and supported by ODA (0.7% GDP to ODA now!) Yet this can leave governments and people in ESA heavily reliant on external aid for their health, while wealthy groups in high income countries and corporates continue to benefit from trade, finance and resource outflows from the region. Levering increased investments in heath must be backed by challenge to these resource outflows and to the trade and macroeconomic policies that intensify inequities in control over the resources for health. “Reclaim African wealth for African health...now!”.
Please send feedback or queries on the issues raised in this editorial to the EQUINET secretariat at TARSC, email admin@equinetafrica.org
1. Editorial
2. Latest Equinet Updates
The Regional network for equity in health in east and southern Africa (EQUINET) is calling for expressions of interest from researchers based in countries within East and Southern Africa (ESA) to undertake country level research into distribution of the costs and benefits of health worker migration. The country research will be implemented between April 2007 and April 2008 and aims to inform policy negotiation, design and evaluation on managing health worker migration within ESA. Applications should be sent by February 1st 2007
This review was prepared as an outline for the WHO Commission on the Social Determinants of Health for a knowledge network exploring the role of health systems in health equity and the social determinants of health. It presents data showing that health services tend to be used proportionately more by richer than poorer social groups. It analyses the social factors affecting access to, and uptake of, health services and shows how these interact with inequitable features of the health care system. Overall, the review argues that the interaction between household health-seeking behaviour and experience of the health system generates differential health and economic consequences across social groups. The long-term costs of seeking care often impoverish poorer households, reinforcing pre-existing social stratification. These are costs that can be addressed by deliberate aspects of health system design.
The World Health Organization’s 2006 World Health Report “Working Together for Health” highlights the urgent need to improve human resources (HR) in the health sector in developing countries (HRH). the report does not address the shortfall specifically in the persdonnel for health research, nor the skills and human resources needed by developing countries to improve health research. A conference on Human Resources for Health Research (HR-HR) was held on July 2-5, 2006 on this issue. The conference opened discussion on the health research environment; the role of research networks and of communities in health research and skills to improve health research communication. This is the final report and record of the HR-HR expert meeting in Nairobi. Two further products
are under preparation: A short synthesis report of key messages from the conference; and a publication featuring reviewed papers produced by each HR-HR theme.
In 2001 the Doha Declaration on TRIPS and Public Health provided a landmark political commitment reaffirming the option for World Trade Organisation (WTO) member states to use all flexibilities provided in the TRIPS Agreement to ensure access to affordable medicines, and to prevent patent monopolies stopping access to medicines where they are needed for public health. By 2006, many of these flexibilities are not yet exploited in Africa, despite the massive demand for cheap medicines. This brief outlines the opportunities that African countries have to use these flexibilities and the legal and other changes needed for this. It also outlines the challenges that we may face and the measures to respond to them.
In 2007 EQUINET with Centre for Health Policy University of the Witwatersrand is implementing a programme that aims to build capacity in health policy analysis in east and southern Africa. The participants will meet for the first time in February 2007 in Johannesburg to attend a policy analysis course, after which they will spend a further week developing their study protocols. The research will be conducted between March and September 2007, with all the participants meeting again in October 2007 for a workshop that will support data analysis and report writing.
3. Equity in Health
This report is on male participation in sexual and reproductive health (SRH) examined within a wider context of gender relations and the family. It is the result of two collaborative surveys, one quantitative and one qualitative, which were conducted in rural and urban areas of the Copperbelt Province in Zambia. During the quantitative survey data was collected from men and their partners. The qualitative survey collected data through focus group discussions, in-depth interviews and two small community workshops.
This report examines the discrimination and disempowerment women face throughout their lives – and outlines what must be done to eliminate gender discrimination and empower women and girls. It looks at the status of women today, discusses how gender equality will move all the Millennium Development Goals forward, and shows how investment in women’s rights will ultimately produce a double dividend: advancing the rights of both women and children.
A new study on The World Distribution of Household Wealth by the World Institute for Development Economics Research of the United Nations University (UNU-WIDER) launched on Tuesday 5 December 2006. The most comprehensive study of personal wealth ever undertaken also reports that the richest 1% of adults alone owned 40% of global assets in the year 2000, and that the richest 10% of adults accounted for 85% of the world total. In contrast, the bottom half of the world adult population owned barely 1% of global wealth.
A significant number of displaced women in South Darfur, western Sudan, suffer from depression and experience suicidal thoughts because of largely unaddressed mental-health problems, according to a study by the International Medical Corps (IMC).
4. Values, Policies and Rights
On the occasion of Human Rights Day 2006, the African Public Health Rights Alliance launches the "15% Now!" Campaign and opens for signature the global petition calling on African leaders to without further delay implement their 2001 Abuja AU Summit pledge to commit fifteen percent of annual national budgets to health in order to end the tragic loss of an estimated 8 million lives annually to preventable, treatable and manageable diseases, illnesses and maladies.
Have development interventions promoted only negative messages in relation to sexuality, ignoring poor people's rights to pleasure, affirmation and joy through sex and sexuality? This Cutting Edge Pack hopes to inspire thinking on this question - with an Overview Report outlining key issues on gender, sexuality and sexual rights in the current climate, a Supporting Resources Collection providing summaries of key texts, tools, case studies and contacts of organisations in this field, and a Gender and Development In Brief newsletter with three short articles on the theme.
The World Health Organization (WHO), like many other organisations around the world, has recognised the need to use more rigorous processes to ensure that health care recommendations are informed by the best available research evidence. This is the 10th of a series of 16 reviews that have been prepared as background for advice from the WHO Advisory Committee on Health Research to WHO on how to achieve this.It explores options for integrating values and consumer involvement in research.
The Lancet's current Sexual and Reproductive Health Series encompasses the annual 16 days of campaigning against gender violence that began on November 25, International Day Against Violence Against Women. The emphasis is on the connection between violence to women and HIV.
This Convention is a remarkable and forward-looking document. While it focuses on the rights and development of people with disabilities, it also speaks about our societies as a whole -- and about the need to enable every person to contribute to the best of their abilities and potential.
5. Health equity in economic and trade policies
Some of the world's biggest pharmaceutical companies, including FTSE 100 giant GlaxoSmithKline, are reported to have failed to sign a formal agreement that would ensure HIV and AIDS patients in poor nations receive vital drugs. The agreement was drawn up during three years of talks between companies and the International Federation of Chemical, Energy, Mine and General Workers' Unions (ICEM), which has 20 million members and 400 affiliated unions worldwide.
Thousands of people living with AIDS in the Democratic Republic of Congo (DRC) are going without treatment while the production line at a modern antiretroviral (ARV) factory in the east of the country lies largely idle. Pharmakina has produced generic ARVs since April 2005 in the eastern province of Bukavu, the first pharmaceutical firm to do so in central Africa, but it is now forced to await approval from the World Health Organization (WHO).
The World Health Organisation (WHO) needs to get serious about high cost of new AIDS drugs. AIDS treatment will not be sustainable unless international institutions get serious about the high cost of newer medicines. This warning comes from Medecins Sans Frontiers (MSF) the medical humanitarian organisation. MSF says that the WHO has failed to outline a strategy to help countries access these drugs which remain largely inaccessible in developing countries. Thailand uses compulsory licence for cheaper AIDS drug. Thailand, however, has for the first time announced it will issue a compulsory licence for the domestic manufacture of a key AIDS drug. The following articles report on both these issues.
6. Poverty and health
Several households falling into poverty as a result of HIV/AIDS desperately need support systems. African communities have modified existing safety net mechanisms and pioneered new responses such as home based care programmes, support groups and orphans and vulnerable children initiatives. Safety nets protect people from the worst effects of poverty. They prevent poor households from making hasty decisions to sell productive assets and increase their chances of escaping destitution. But how long can self-resourced initiatives continue to function?
Two developments have led to this report. The first is the growing international awareness that many MDGs will not be reached unless malnutrition is tackled, and that this continued failure of the development community to tackle malnutrition may derail other international efforts in health and in poverty reduction. The second development is the now unequivocal evidence that there are workable solutions to the malnutrition problem and that they are excellent economic investments. The May 2004 Copenhagen Consensus of eminent economists (including several Nobel laureates) concluded that the returns of investing in micronutrient programs are second only to the returns of fighting HIV/AIDS among a lengthy list of ways to meet the world’s development challenges.
7. Equitable health services
This study looks specifically at prescribing habits in South Africa and examines the following questions: what impact the national drug policy (NDP) has on pharmaceutical use in the public sector; whether the NDP achieved rational prescribing and dispensing of drugs by medical, paramedical and pharmaceutical personnel; whether the essential drugs list is used effectively; and what the level of generic prescribing is.
Promotion of family planning in countries with high birth rates has the potential to reduce poverty and hunger and avert 32% of all maternal deaths and nearly 10% of childhood deaths. It would also contribute substantially to women's empowerment, achievement of universal primary schooling, and long-term environmental sustainability. However, in half the 75 larger low-income and lower-middle income countries (mainly in Africa), contraceptive practice remains low and fertility, population growth, and unmet need for family planning are high. The author discusses in detail how a revitalisation of the agenda is urgently needed.
Complications from unsafe abortion are believed to account for the largest proportion of hospital admissions for gynaecological services in developing countries. The WHO estimates that one in eight pregnancy related deaths result from unsafe abortions. The social stigma and legal restrictions associated with abortion in many countries means that data on the magnitude of this problem are scarce; this article estimates the rate and numbers of hospital admissions resulting from unsafe abortions in developing countries to help quantify the problem.
This report provides an overview of the continuum of care for maternal, newborn and child health (MNCH) in Africa. The report investigates the prevalence and causes of neonatal deaths and highlights the gaps in coverage of care through the pre-pregnancy, pregnancy, childbirth and postnatal period. It also discusses how to integrate care with key programmes aimed at preventing mother to child transmission of HIV, controlling malaria, and immunisation. The report presents case studies of six African countries which have progressively reduced newborn death rates despite low gross national income. The authors find that two thirds of the 1.6 million newborn deaths in sub-Saharan Africa could be avoided if essential interventions already in policy reached 90 per cent of African mothers and newborns.
A recent United Nations Conference on Trade and Development (UNCTAD) expert meeting discussed how developing countries face challenges and problems in providing universal access to services to their people. The meeting comprised panels looking at general issues as well as various sectors, including water, health, education and telecommunication services. It also had a session on the WTO's General Agreement on Trade in Services (GATS). Among the problems highlighted were the adverse effects of user fees, with the imposition of charges and fees to citizens in exchange for public services, introduced in many countries as part of World Bank-IMF programmes, the effects of privatisation of services, and the negative effects of patents and bilateral free trade agreements on access to medicines and health services.
Among all reproductive health indicators, the least progress has been made in reducing maternal mortality. This means that the fifth Millennium Development Goal to reduce by three quarters the maternal mortality ratio, given that over half a million women die every year during pregnancy or childbirth – will not be reached in many countries. Lack of funds and the slow progress to implement laws that protect maternal healthcare and reproductive health rights are undermining this goal.
A participatory assessment has revealed the strengths and gaps of health services in Tanzania – from the perspectives of Burundian and Rwandan refugees. Refugees benefit from employment in hospitals, feeding programmes, drugs, HIV and AIDS education and so on. But lack of food, fear of rape and ‘voluntary repatriation’, and preferential treatment by health staff are a problem.
This document contains several different articles by various authors on adressing the global challenges to more equitable health systems. health systems. This article briefly reviews the types of constraints faced by health systems in developing countries, and points to the types of information and research needed by decisionmakers to address these constraints. Future health systems in developing countries will need to understand the increasingly complex and unpredictable interactions of local, national and international actors and trends.
The importance of media reporting on health issues in sub-Saharan Africa has gained significant attention over the past several years from media outlets, health development organisations and donors. Although reporting on health issues has increased and improved in recent years, stories with little informational content or based on faulty information still surface far too frequently. Using a combination of interviews, document analysis and Internet research, this report describes some of the challenges in increasing the use of high quality scientific information in health coverage, some of the current efforts to make improvements and where the gaps to success lay.
Zimbabwe's deteriorating health services have made room for a thriving parallel market for drugs, many of them counterfeit, warn concerned health professionals. The sale of genuine as well as fake medicines on the streets was "big, booming business," said Dr Paul Chimedza, the president of the Zimbabwe Medical Association (ZIMA). "The health system has been adversely affected by the poorly performing economy. There is a general shortage of drugs within the country and unscrupulous dealers are capitalising on the situation by selling medical drugs on the streets."
8. Human Resources
Some 400 newly qualified doctors in public hospitals are reported to be facing dismissal in December. This media report outlines the proposed measure which ends the automatic employment of interns due to budgetary retraints, to make way for incoming interns. While a share of these doctors may be rehired in the annual advertisement of positions this is reported to no longer be automatic.
Endorsing the Millennium Development Goals (MDG), the international community committed itself to significant improvements in the health of the poor and set ambitious targets. Achieving the MDG will depend on improving access to priority health interventions, which requires significant supply and demand side constraints to be overcome. The study investigated the human resource implications of expanding the coverage of priority health interventions in Tanzania and Chad. The authors conclude that the health workforce in Tanzania and Chad, and probably in many other SSA countries, is grossly insufficient for the expansion of priority interventions envisaged in current international dialogue. An immediate response at the national and international level is required to ensure progress towards the MDG.
This paper discusses how Mozambique coped with the health system needs in terms of specialised doctors since independence, in a troubled context of war, lack of financial resources and modifying settings of foreign aid. Different scenarios, partnerships and contract schemes that have evolved since independence are briefly described, as well as self-reliance option possibility and implications. Lessons learned about donor initiatives aimed at contracting specialists from other developing countries are singled out. The issue of obtaining expertise and knowledge in the global market as cheap as possible is stressed, and realistic figures of cost planning are highlighted, as determined by the overall health system necessities and budget limitations.
This report presents a comprehensive analysis of the human resources for health (HRH) currently available and required to reach the targets set by the President’s Emergency Plan for AIDS Relief and the Millennium Development Goals (MDGs) in both the public sector and the faith-based organisations (FBOs) in Kenya. A stratified convenience sample of health facilities at all levels of care in each of the eight provinces was selected for the assessment. A sample of Ministry of Health and FBO health facilities at all levels of service in each of the eight provinces was selected for the assessment. Conclusions include that the geographical distribution of skilled HRH in Kenya is heavily skewed towards urban areas; and substantial annual growth rates (across all staff categories) are needed to meet the future requirements.
"Swaziland is dying. Will the last nurse on duty please turn off the lights?" reads a handwritten note at a clinic in Manzini, the country's AIDS-hit commercial centre, 35km southeast of the capital, Mbabane. The wry note disguises the pain of Swaziland's diminishing number of nurses and hints at the reason why their colleagues have fled the country to offer their services elsewhere.
On World AIDS Day, Physicians for Human Rights sent a letter to President Bush urging the US government to address the massive health worker shortage in Africa. An estimated one million additional health workers are needed in sub-Saharan Africa alone to fight AIDS and other diseases. The letter was signed by over 100 prominent US health professionals, including 33 deans of medical, nursing, and public health schools, representing some of the country's most influential health leaders. Many of these health experts have seen first-hand the devastation caused by the lack of health workers, medicines, and supplies in many African countries struggling with the AIDS pandemic.
9. Public-Private Mix
In 1999, the U.S. Agency for International Development launched the NetMark, in partnership with the Academy for Educational Development, to reduce the human cost caused by malaria. Since its launch, NetMark has developed partnerships with 37 African and 9 international commercial partners. NetMark's mission is to reduce malaria cases and deaths in Africa by increasing the availability, affordability and use of insecticide-treated bednets (ITN) through partnerships with commercial net and insecticide manufacturers, their African distributors, ministries of health, and NGOs. To accomplish this goal, NetMark works through public-private partnership to achieve both short and long-term public health impact. NetMark's model, based on efficient and effective delivery of ITNs, could easily be applied to other areas of malaria prevention.
Adequate and appropriate vehicles are essential for health service delivery. These are required for transport and transfer of patients from community to health facilities and between levels of health care delivery of essential equipment, medicines and other supplies to point of service delivery transport of health workers for supervisory visits, to attend meetings and training sessions and for administrative purposes. A transport management system that is efficiently and cost effectively run is essential to ensure availability of vehicles for health service delivery when required.
When leaders of governments, international organisations, corporations, nongovernmental organisations and faith-based groups came together on 14 December 14 in Washington, they jump started an ambitious public-private effort to save lives from the preventable and treatable mosquito-borne disease of malaria.
According to the UN Under-Secretary General, the private sector in Africa, although still in its infancy and not as organised as in other parts of the world, is expanding at a very fast rate, is contributing to growth and poverty reduction and that the state, by expanding economic space, has been central to this development. However, there is much that remains to be done both by the state and the private sector to realise the full possibilities of the sector’s contribution to African development.
10. Resource allocation and health financing
The World Health Organization (WHO), like many other organisations around the world, has recognised the need to use more rigorous processes to ensure that health care recommendations are informed by the best available research evidence. This is the 11th of a series of 16 reviews that have been prepared as background for advice from the WHO Advisory Committee on Health Research to WHO on how to achieve this. Objectives We reviewed the literature on incorporating considerations of cost-effectiveness, affordability and resource implications in guidelines and recommendations.
Given the size of the HIV epidemic in South Africa and other developing countries, scaling up antiretroviral treatment (ART) represents one of the key public health challenges of the next decade. Appropriate priority setting and budgeting can be assisted by economic data on the costs and cost-effectiveness of ART. The objectives of this research were therefore to estimate HIV healthcare utilisation, the unit costs of HIV services and the cost per life year (LY) and quality adjusted life year (QALY) gained of HIV treatment interventions from a provider's perspective. This article presents baseline cost-effectiveness data from one of the longest running public healthcare antiretroviral treatment programmes in Africa that could assist in enhancing efficient resource allocation and equitable access to HIV treatment.
This study exploits the opportunities created by a pilot study of micro health insurance with capitation in Rwanda to address this issue. Using cross-sectional data collected in 52 health centres, the paper employs an econometric cost function with payer-specific outputs to assess the cost impact of two provider payment mechanisms: (1) user fees for care paid by the uninsured, and (2) capitation payment paid by informal insurance schemes for the insured. Findings point to significant differences in cost between the two payment forms. For both payment types there are important short-run economies of scale, which could be exploited through more intensive use of idle resources in health centres.
11. Equity and HIV/AIDS
Fear of stigmatisation in Angola is keeping people living with HIV/AIDS in hiding. Caregivers are more than willing to help but are having a hard time finding patients to take care of. "People prefer to keep silent and to die in silence," Ambrósio Cabral, coordinator of Angola's Red Cross HIV/AIDS programme, told IRIN/PlusNews.
This draft meeting report is the result of a resolution taken by the AIDS and Rights Alliance for Southern Africa (ARASA). ARASA was tasked with drawing up a code that is similar to the SADC code on HIV and Employment, but focussed specifically on gender related issues within the Aids epidemic.
This article refers to that by John Cleland and Mohamed Ali in the same issue of the Lancet. The authors offer interesting results on behaviours about HIV sexual transmission in women from different African countries. Cleland and Ali use information from all countries in sub-Saharan Africa that have had two or more Demographic and Health Surveys since 1990 to estimate behaviour trends.Their study is valuable for epidemiologists and public-health practitioners, and has important strengths.
Twenty-five years of knowingly living with HIV, the global community is still falling behind the virus in its alarming, complex and often hidden progress. Despite many diverse and creative successes in committed peoples' responses and many lessons drawn along the way, few have been widely adopted. Civil society groups have often led the way. A passionate - sometimes desperate - drive to respond to HIV and AIDS, and their own diversity unites them. This issue of id21 insights features examples of such real-life responses and asks: how can we move forward to catch up with the virus?
A research article highlights how the combination of a microfinance initiative and an educational programme can empower women and reduce the incidence of intimate partner violence in rural South African communities. The study showed no effect, however, in reducing HIV.
This article, published in the Bulletin of the World Health Organization, explores how the HIV epidemic has affected the infant feeding experiences of HIV-positive mothers in South Africa. The paper finds that the HIV epidemic has changed the context in which infant-feeding choices are made and implemented. HIV positive mothers are struggling to protect their decision-making autonomy; uncertainty about the safety of breastfeeding has increased the power and influence of health workers who act as gatekeepers to knowledge and resources such as formula milk. Women who chose to exclusively formula feed experience difficulties accessing formula milk because of inflexible policies and a lack of supplies at clinics. Limited support for mothers with newborn babies can result in social isolation and mothers doubting their ability to care for their children.
Organisations in the International HIV/AIDS Alliance have been awarded up to $83 million in the sixth round of grants from the Global Fund to Fight AIDS, Tuberculosis and Malaria. Proposals have been successful in Alliance countries including India, Morocco, Senegal and Ukraine, with Global Fund grants for these countries totalling $480 million.
The article examines the incidence of HIV infection among women of reproductive age in Malawi and Zimbabwe. Of the 2,016 women who participated in the study, 1,679 were tested for HIV during follow up and 113 seroconverted resulting in an overall HIV incidence rate of 4.7 per 100 women. HIV incidence continues to be high among women in both countries despite counselling and condom promotion.
Do the gains in confidence and economic well being that can come from participation in a microfinance programme reduce clients’ vulnerability to HIV infection? Until now practical experience and an evidence base relating to such activities have been limited. This article reviews the evidence supporting an enhanced role for microfinance in HIV prevention activities. It describes the Intervention with Microfinance for AIDS and Gender Equity (IMAGE) – a South African case study that has been specifically designed to explore these relationships. The paper discusses the operational integration of microfinance and HIV prevention – highlighting challenges, emerging lessons and limitations in the light of international best practice and several years of field experience.
This article preventive measures for reducing the prevalence and incidence of HIV by weighing the potential benefits of promoting self testing for HIV in developing countries and the concerns that need to be raised.
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12. Governance and participation in health
Preventing and treating malaria are now firmly on the international public health and global poverty agendas. However, despite a considerable increase in funds over recent years the malaria burden in much of sub-Saharan Africa shows little sign of decreasing. This report outlines issues on managing malaria in communities, and explores social roles. It notes that research has been largely concerned either with individual perceptions about the causes and symptoms of the disease or with the implementation of specific interventions. It fails to provide essential information on the context in which communities and households cope with their day-to-day problems, including malaria.
South Africa's national anti-retroviral therapy programme and the Treatment Action Campaign (TAC) have been at the forefront in fighting HIV/AIDS. Rolling out anti-retrovirals nationally and ensuring treatment adherence is far from easy, however. HIV positive people can help themselves and others by being responsible citizens.
13. Monitoring equity and research policy
The World Health Organisation (WHO) regularly gathers, evaluates, and cites evidence to support its recommendations. How this is done varies between departments, but highly centralised processes, complex methods and expert consultations are often used. WHO guidelines are distributed to health workers and policy-makers in developing countries, but few of these people have the opportunity to be involved in the process of choosing and weighing the evidence to formulate the guidelines that are ostensibly designed for their use. Such incomplete engagement may impede ownership of WHO recommendations, and thus be an obstacle to full implementation. This editorial describes how WHO gathers, evaluates, and cites evidence to support its recommendations.
The World Health Organization (WHO), like many other organisations around the world, has recognised the need to use more rigorous processes to ensure that health care recommendations are informed by the best available research evidence. This is the 12th of a series of 16 reviews that have been prepared as background for advice from the WHO Advisory Committee on Health Research to WHO on how to achieve this.
The World Health Organization (WHO), like many other organisations around the world, has recognised the need to use more rigorous processes to ensure that health care recommendations are informed by the best available research evidence. This is the 12th of a series of 16 reviews that have been prepared as background for advice from the WHO Advisory Committee on Health Research to WHO on how to achieve this.
The World Health Organization (WHO), like many other organisations around the world, has recognised the need to use more rigorous processes to ensure that health care recommendations are informed by the best available research evidence. This is the 14th of a series of 16 reviews that have been prepared as background for advice from the WHO Advisory Committee on Health Research to WHO on how to achieve this.
The World Health Organization (WHO), like many other organisations around the world, has recognised the need to use more rigorous processes to ensure that health care recommendations are informed by the best available research evidence. This is the 15th of a series of 16 reviews that have been prepared as background for advice from the WHO Advisory Committee on Health Research to WHO on how to achieve this.
The World Health Organization (WHO), like many other organisations around the world, has recognised the need to use more rigorous processes to ensure that health care recommendations are informed by the best available research evidence. This is the last of a series of 16 reviews that have been prepared as background for advice from the WHO Advisory Committee on Health Research to WHO on how to achieve this. The authors reviewed the literature on evaluating guidelines and recommendations, including their quality, whether they are likely to be up-to-date, and their implementation. They also considered the role of guideline developers in undertaking evaluations that are needed to inform recommendations.
The World Health Organization (WHO), like many other organisations around the world, has recognised the need to use more rigorous processes to ensure that health care recommendations are informed by the best available research evidence. This is the fourth of a series of 16 reviews that have been prepared as background for advice from the WHO Advisory Committee on Health Research to WHO on how to achieve this.
The World Health Organization (WHO), like many other organisations around the world, has recognised the need to use more rigorous processes to ensure that health care recommendations are informed by the best available research evidence. This is the fifth of a series of 16 reviews that have been prepared as background for advice from the WHO Advisory Committee on Health Research to WHO on how to achieve this.
The World Health Organization (WHO), like many other organisations around the world, has recognised the need to use more rigorous processes to ensure that health care recommendations are informed by the best available research evidence. This is the sixth of a series of 16 reviews that have been prepared as background for advice from the WHO Advisory Committee on Health Research to WHO on how to achieve this.
The World Health Organization (WHO), like many other organisations around the world, has recognised the need to use more rigorous processes to ensure that health care recommendations are informed by the best available research evidence. This is the seventh of a series of 16 reviews that have been prepared as background for advice from the WHO Advisory Committee on Health Research to WHO on how to achieve this.
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14. Useful Resources
The main purpose of the Future Health Systems Research ProgrammeConsortium's (RPC) is to generate knowledge that shapes health systems to benefit the world's poor. Through research and partnership we want to inform and influence the health systems of the future in Nigeria, India, Uganda, Bangladesh, China and Afghanistan.
HuriSearch is a very useful resource for human rights researchers and advocates, academic staff and students, journalists, diplomats and staff of international organisations. HuriSearch searches the content of over 3000 human rights websites, with a total of more than 2.6 million pages. HuriSearch makes it possible to focus searches on information published in a particular country, by a particular type of organisation, a specific organisation, or in a specific language. The HuriSearch website is available in seven languages: English, French, Spanish, German, Russian, Arabic, and Chinese. HuriSearch allows searching information in 77 languages.
The purpose of this guide is to describe how to design and carry out a social mobilization program to create demand and increase participation during immunisation campaigns and routine immunisations, and thereby improve the health of communities in developing countries.
15. Jobs and Announcements
The Centre for African Family Studies (CAFS) is pleased to announce its course on 'Managing Reproductive Health Programmes', to be held from 12 to 30 March 2007 in Nairobi, Kenya. This course provides state of the art guidance to Reproductive Health Programme Managers and enhances their capacity to achieve organisational success through modern management techniques. Participants will gain a wide range of management skills and principles including management process and principles, leadership, team building, programme design, proposal writing, participatory facilitative programme supervision, monitoring and evaluation, strategic planning, human resource management, learning organisations, building coalitions and alliances and facilitation skills.
The Alliance for Health Policy and Systems Research, in collaboration with the Oslo Satellite of the Cochrane Effective Practice and Organization of Care (EPOC) Group, the EPPI-Centre, Institute of Education, London, and the Effective Health Care Research Programme Consortium, Liverpool School of Tropical Medicine, Liverpool, wishes to award grants to four institutions in low and middle income countries in order to: develop capacity in low and middle income countries (LMICs) for the conduct and packaging of systematic reviews of health policy and systems research relevant to these countries; conduct reviews within three main thematic areas; further develop methodologies relevant to systematic reviews of health policy and systems research in LMICs. The closing date for applications is 19 January 2007.
The Sheila McKechnie Foundation is a charity that supports campaigners and gives them the skills they need to make a greater impact. The winner will receive a package of free support including: one to one coaching on campaign tactics and other areas that will help that person's campaign; advice from a senior UK-based campaigner with knowledge of their policy area; the opportunity to spend a day with a decision maker; and participation in a skills development weekend in the UK with other campaigners.
Published by the Regional Network for Equity in Health in east and southern Africa (EQUINET) with technical support from Training and Research Support Centre (TARSC).
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