We are African organisations deeply committed to improving the health of the people of our continent. Yet we are deeply concerned about the lack of progress, and in some countries reversal of progress, resulting in millions of preventable deaths that continue to burden our countries each year. It is clear that as long as our health systems remain weak in many dimensions and our countries face a health workforce crisis, the current unacceptable trends will persist.
In spite of this slow progress, we remain optimistic. We have observed progress in some regions and countries, and identify with the deepening commitment to the health of many of our Government and institutions. Our Regional Economic Communities have assumed an important leadership role within the continent in catalyzing actions required to strengthen health systems and achieve health MDGs. We are convinced that the engagement of our partners locally and globally can translate into the political will, resources, and efficiency required to transform health on our continent. With so many lives at stake, our neighbors, our children, and ourselves, we must succeed.
Cognizant of the continuing intolerable burden of disease, African Union ministers of health have developed an Africa Health Strategy 2007-2015 that seeks to “provides a strategic direction to Africa’s efforts in creating better health for all.” At the core of the Africa Health Strategy is the strengthening of health systems based on carefully costed National Health Plans that incorporate the commitments made by African governments, including achieving the Millennium Development Goals and universal access to HIV/AIDS treatment, care, prevention, and support by 2010.
The chief responsibility for the success of these plans lies with our own governments. We will hold our governments accountable. We will insist – and are demanding – that they take the necessary steps to achieve the promises of good health, a foundation of healthy societies. Collectively, we will hold our governments accountable to increasing health sector investments to at least 15% of the national budget, improving the efficiency in allocation and application of these resources, and the implementation of health workforce and systems strengthening strategies capable of providing quality health care to all people. We further commit to work with our governments to identify sustainable financing strategies that can replace point-of-service payments (i.e., user fees) for essential health services and to meet their other commitments and responsibilities including as part of the human right to health.
However, the successful implementation of the National Health Plans requires support from Africa’s development partners, especially from the nations that comprise the G8. Even if African governments significantly increase their own funding for National Health Plans, these plans will have significant financing gaps. Many of the actions required for these plans to succeed will require solutions and expertise that crosses national and even continental boundaries.Building health systems must include building partnerships between health care providers and the communities that use those services. It requires donors to listen to African communities to find out what their needs and concerns are, so that services are tailored to those needs, as opposed to imposing systems that may be effective elsewhere but not in Africa. It is about using the opportunities that exist within communities to advance health care, by harnessing the knowledge, resources, and energy in the community and applying it to work together with the formal health system.
We call upon the upcoming G8 summit in Germany to recognize the Africa Health Strategy developed by our health ministers and to engage in substantive dialogue with communities, civil society, governments, regional economic communities, and the African Union.
This dialogue should be backed by firm commitments about steps that we know will be required of wealthy countries if African National Health Plans are to succeed. We call upon the G8 countries to fulfill existing pledges, including the commitment of 0.7 per cent of their own Gross National Income (GNI) to Official Development Assistance (ODA), the doubling of aid to Africa by 2010, and to adhere to the commitments of the Paris Declaration on Aid Effectiveness, including those that relate to alignment and harmonization of aid investments with country plans and leadership.
We ask that this G8 summit also make the following commitments, which are required for African National Health Plans to succeed:
Fiscal Space
1. Provide long-term, predictable funding to cover financing gaps identified in National Health Plans and plans for universal access to HIV/AIDS treatment, care, prevention, and support, and harmonize health assistance with country-driven National Health Plans.
2. Work with International Financial Institutions and developing country governments and civil society to ensure that fiscal and monetary policies are aligned with the best estimates of the fiscal space required to achieve the MDGs and other human development goals and commitments.
3. Accelerate debt cancellation and ensure that debt cancellation supplements rather than displaces aid.
4. Provide the needed financial and technical support to developing countries to design and implement sustainable financing schemes that can support the elimination of point-of-service payments (user fees) for essential health services and that are designed to enable all people, including the poor, access to quality health services.
Health Systems and Workforce
5. Work with the AU and other continental partners to identify a basic package of health systems interventions, implemented at the community and district levels, that can provide the backbone for the delivery of health service packages required to achieve the MDGs and universal access to the best attainable health care.
6. Support the development and implementation of inter-sectoral and comprehensive health workforce strategies that are integrated with a broader health sector response and public service reforms to address numbers of health workers as well as other variables such as internal distribution, skills mix, work environments, productivity, and management capacity.
7. Engage developing countries to formulate a comprehensive strategy to address health worker migration that emphasizes co-development, including by adopting policies to develop self-sustainable workforces within OECD countries and to follow ethical recruitment practices.
8. Increase support to developing countries to fully utilize TRIPS flexibilities to improve access to medicine, including by helping build capacity to utilize these flexibilities and by avoiding any restrictions to such flexibilities – or any other provisions that may be detrimental to health – in trade agreements.
Mutual Accountability
9. Support initiatives and programs that promote peer and independent mechanisms to track the progress of our governments and their partners to the commitments and declarations made at global, continental, and regional fora.
10. Through diplomatic levers, technical assistance, and other strategies, support African civil society efforts to hold our own governments accountable to their commitments and responsibilities.
Signed by 82 organisations and individuals.
The views expressed in this newsletter, including the signed editorials, do not necessarily represent those of EQUINET. Please send feedback or queries on the issues raised to the EQUINET secretariat admin@equinetafrica.org.
1. Editorial
"Universal access to antiretroviral treatment in SADC remains elusive... Of the 13 SADC states for which information is available, only two countries, Botswana and Namibia, had achieved antiretroviral treatment coverage of more than 70% of those who needed it by December 2005."
Evidence of commitment and action, but also lack of progress on universal access to AIDS treatment, care and prevention, and thus on realising the right to health for people living with AIDS and vulnerable communities. These were key findings of an ARASA report released in April 2007 entitled: 'HIV/AIDS and Human Rights in SADC: An evaluation of the steps taken by countries within the Southern African Development Community (SADC) to implement the International Guidelines on HIV/AIDS and Human Rights'.
This ground breaking report is the first in the region to attempt to measure the successes and failures of SADC countries in responding to HIV in a human rights based framework. Given that sub-Saharan Africa has just over 10% of the world’s population but is home to more than 60% of all people living with HIV, HIV and AIDS is a key human rights issue with tremendous civil, political and socio-economic implications.
Many countries in the region have risen to the challenge of responding to the HIV epidemic but are confronted with financial, structural and political barriers to the implementation of law and policy reforms and the establishment and scale-up of programmes to effectively address the epidemic.
Although respondents interviewed in thirteen of the fourteen SADC countries felt that there was political commitment to addressing HIV and AIDS (evidenced by the declaration of HIV and AIDS as a national emergency or by politicians being open about their status) only six countries passed muster in terms of translating commitment into action, particularly in the area of human rights, civil and political rights, and social and economic rights.
One overarching problem identified was lack of commitment to implementation. Although Swaziland, Tanzania, Zimbabwe and Zambia declared HIV and AIDS a national disaster, they were reported to have made little significant progress in the review or reform of laws to ensure the protection of basic human rights so critical to the success of national responses to HIV and AIDS. But even if laws and policies exist, alone they do not solve the problem: 50% of SADC countries have less than 15% antiretroviral treatment coverage and similarly dismal figures for coverage of mother-to-child-transmission treatment and other key HIV and AIDS interventions.
Therefore, resources are needed to implement existing laws and policies if people are to be enabled to enjoy their right to the highest attainable standard of health. Access to resources at individual, community and national levels poses a barrier to access to prevention, treatment and care programmes and requires urgent attention at government, regional and international levels.
Although eleven SADC countries have laws or policies prohibiting unfair discrimination on the basis of HIV status, human rights abuses hamper the implementation and utilisation of existing prevention, treatment and care programmes for people living with HIV and AIDS. The prevalence of gender-based violence and inferior treatment of women and children continues to fuel the epidemic. Much of this can be ascribed to individual attitudes and beliefs, which laws and policies alone cannot change. Changing these social norms is made even more difficult when political commitment is superficial.
If we are to make progress on HIV and human rights, on HIV treatment and prevention, tokenistic commitment must be replaced with true leadership - leadership not only within governments but at every level of civil society as well. This requires the engagement of our leaders, from the village chiefs up to the offices of presidents and prime ministers. Political rhetoric is no substitute for leadership that translates into action.
The views expressed in this newsletter, including the signed editorials, do not necessarily represent those of EQUINET. Please send feedback or queries on the issues raised in this editorial to the EQUINET secretariat admin@equinetafrica.org. For further information on the issues raised or to access the full report referred to, please visit ARASA www.arasa.info or EQUINET www.equinetafrica.org.
2. Latest Equinet Updates
The paper reviewed evidence from published and grey (English language) literature on the use of non-financial incentives for health worker retention in sixteen countries in east and southern Africa (ESA): Angola, Botswana, DRC, Kenya, Lesotho, Madagascar, Malawi, Mauritius, Mozambique, Namibia, South Africa, Swaziland, Tanzania, Uganda, Zambia and Zimbabwe. There is a growing body of evidence on health worker issues in ESA countries, but few studies on the use of incentives for retention, especially in under-served areas.
This report examines two case studies of school feeding schemes in South Africa and Malawi, viz the Primary School Nutrition Programme (PSNP) established in South Africa in 1994 and the World Feeding Program (WFP) feeding schemes in Malawi, in the context of policy outlined by the New Partnership for Africa’s Development (NEPAD). The report notes that school feeding programmes largely take the form of a vertical intervention programme, rather than a comprehensive nutritional programme, weakening their likely sustained impact on children's nutritional status.
In 2006, the Regional Network for Equity in Health in East and Southern Africa (EQUINET) and the Health Systems Research Unit of the Medical Research Council (MRC) of South Africa commissioned a series of country case studies on existing food security and nutrition programmes in East and Southern Africa that promote food sovereignty and equity. This paper gives an overview of the findings from the case studies on three important nutrition responses in ESA:
• food aid in Malawi;
• HIV/AIDS-related nutrition interventions in ESA; and
• School feeding programmes in Malawi and South Africa.
The EQUINET-ECSA-HC programme in 2007-8 is supporting research and dialogue on strategies for managing health worker migration and for use of incentives for health worker retention in east and southern Africa (ESA). This work is being co-ordinated by University of Namibia, Health Systems Trust South Africa with the EQUINET Secretariat at TARSC and the ECSA HC Secretariat and Technical Working Group on Human Resources for Health. This report outlines the proceedings of a regional meeting of the programme held in March 2007 in Arusha Tanzania to review the aims and protocols for the programme of work.
3. Equity in Health
The theme for this conference was: “Strengthening of Health Systems for Equity and Development in Africa”, with emphasis on the Africa Health Strategy 2007-2015. Africa has made significant strides in certain areas of social and economic development but has the potential to achieve even more if it can overcome the large burden of disease which continues to be a barrier to faster development. This has prompted the African Union Ministers of Health to harmonise all existing health strategies by drawing this Africa Health Strategy which Regional Economic Communities (RECs) and other regional entities and Member States can use to enrich their strategies, depending on their peculiar challenges. The Strategy neither competes with nor negates other health strategies but seeks to complement other specific and detailed strategies by adding value from the unique perspective of the African Union. It provides a strategic direction to Africa’s efforts in creating better health for all.
The 8th meeting of the Africa Partnership Forum (APF) took place from 22-23 May 2007 in Berlin, just two weeks before the G8 Heiligendamm summit. Participants included Personal Representatives for the G8-Africa Process coming from G8 and OECD countries and from African member states of the NEPAD steering committee. Participants discussed four key areas affecting Africa: investment, gender, climate change, and peace and security. Through the intensive dialogue between the G8 Africa Personal Representatives and the African partners in preparing the APF, this year’s APF developed substantive recommendations for the G8 summit as well as for the AU summit, thus following up the joint work on the G8 Africa Action Plan adopted in Kananaskis in 2002.
Growing scientific evidence points to the pervasiveness of inequities in health and health care and the persistence of the inverse care law, that is the availability of good quality healthcare seems to be inversely related to the need for it in developing countries. Achievement of the Millennium Development Goals is likely to be compromised if inequities in health/healthcare are not properly addressed.
The World Health Assembly (WHA), the supreme decision-making body of the World Health Organization (WHO), wrapped-up its sixtieth session today, reaching last-minute agreement on two key resolutions on Pandemic influenza preparedness and Public health, innovation and intellectual property. More than 2400 people from WHO's 193 Member States, nongovernmental organizations and other observers attended the meeting which took place from 14-23 May.
4. Values, Policies and Rights
South Africa is likely to be the first country in the world to host an adolescent HIV vaccine trial. Adolescents may be enrolled in late 2007. In the development and review of adolescent HIV vaccine trial protocols there are many complexities to consider, and much work to be done if these important trials are to become a reality.
Citing a high rate of maternal deaths due to illegal, unsafe abortions, Mozambique policymakers are considering legalising the procedure. The country may eventually become one of only a handful in Africa where abortion is available on demand. The push for the new legislation, officially introduced earlier this year, has come from the Mozambican health ministry, arguing that unsafe abortion is the third leading cause of death among pregnant women in the country. Mozambique has one of the highest maternal death rates in the world.
5. Health equity in economic and trade policies
The full call and signatories are found here to this call from African organisations to the G8 presented in the editorial section of the newsletter.
Amid news that the President of Brazil, Luiz Inacio Lula da Silva, today will announce Brazil’s intention to issue a compulsory license for Merck’s HIV/AIDS drug Efavirenz, AIDS Healthcare Foundation (AHF), the largest US provider of HIV/AIDS healthcare, education and prevention and operator of free AIDS treatment clinics in the US, Africa, Latin America/Caribbean and Asia, hailed the move as a victory for global AIDS activism and AIDS patients worldwide.
The negotiations for Economic Partnership Agreements (EPA) between the EU and the African Caribbean and Pacific Countries are likely to result in additional layers of intellectual property right protection, at least in the case of the agreement with Cariforum countries. A review of the ongoing negotiations and various draft texts and papers demonstrates an inadequate focus on the need for technological development, promotion of public health, protection of genetic resources and traditional knowledge as well as for ensuring access to knowledge. Considering the level of economic development in ACP countries, the negotiations should not include IP rights as part of the partnership agreement. Instead they should focus on industrial and technological development and aim to address the longstanding issues on various EU policies that have impeded participation of the ACP countries in the value-chain of products, protection of biodiversity and traditional knowledge and the use of TRIPS flexibilities.
This statement was compiled to prepare a position to feed into the 11th Regional Negotiating Forum for EPAs 14-16 May (SEATINI representatives attended this meeting which was the official meeting of ESA governments). The statement that is attached is from the meeting that was attended with other CSOs from Malawi, Zambia, Burundi, Rwanda, Kenya, Uganda, Zimbabwe and Tanzania.
Developing countries should be aware of the implications of the WTO dispute
settlement reports on US – Gambling and Mexico – Telecommunications as they continue participating in the WTO negotiations. The findings in the reports have set precedents on the interpretation of various GATS articles and concepts, including: necessity tests; Article XIV on General Exception; Article IV on Increasing Participation of Developing Countries; and scheduling
guidelines.
In the next 10 years South Africa is expected to experience a ‘demographic dividend’ where the youthful population will peak, bringing a unique opportunity for rapid human capital development and economic growth, according to the World Bank’s 2007 World Development Report. This is a compelling argument for urgent investment in young people in Africa. The Human Sciences Research Council (HSRC) Youth Policy Initiative is working to ensure that the country is prepared to make the most of this ‘youth bulge’. The initiative will bring together experts from the policy, programme and research environments as well as young people in a series of six roundtable meetings to interrogate the key questions of youth development.
A disproportionate burden of infant and under-five childhood mortality occurs during the neonatal period, usually within a few days of birth and against a backdrop of socio-economic deprivation in developing countries. To guide programmes aimed at averting these 4 million annual deaths, recent reviews evaluated the efficacy and cost-effectiveness of individual interventions. However, no systematic review of the empirical data on packages of interventions, including consideration of community based intervention packages, has yet been performed. To address this gap, we reviewed peer-reviewed journals and grey literature to evaluate the content, impact, efficacy (implementation under ideal circumstances), effectiveness (implementation within health systems), type of provider, and cost of packages of interventions reporting neonatal health outcomes.
On International Workers’ Day PSI called for a fair globalisation and the defence of quality public services. Fair globalisation means committed and adequate investment in vital public services such as health, water, sanitation, electricity and education, where the contributions of workers are properly recognised and recompensed. It is through the proper funding and provision of these services that we will achieve more just and inclusive societies. Policies which drive countries, particularly developing countries, to restructure, outsource and privatise their public services only serve to perpetuate poverty and underline inequalities”
The quiet advance of trade and investment agreements between rich and poor countries threatens to deny developing countries a favourable foothold in the global economy. Driven by the USA and the European Union, these agreements impose far-reaching rules that place severe restrictions on the very policies developing countries need in order to fight poverty.
At the World Health Assembly’s discussions on the patenting of viruses by drug companies, WHO admitted patents have been taken on the avian flu virus, and WHO collaborating centres have entered into Material Transfer Agreements with vaccine manufacturers. Various countries responded to the non compliance of the WHO’s 2005 Guidance on sharing viruses.
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6. Poverty and health
Responding to the multiple violations posed by prepaid meters (PPMs) in Phiri, in July 2006 an application was launched in the Johannesburg High Court by five applicants, on behalf of themselves, their households and all residents of Phiri who are in a similar position to the applicants, as well as everyone in the public interest. The application, supported by the Coalition Against Water Privatisation and defended by the Centre for Applied Legal Studies (CALS), seeks to have PPMs declared unlawful and it asks the Court to order Johannesburg Water to provide everyone in Phiri with a FBW supply of 50lcd and the option of a conventional meter at the cost of the City of Johannesburg. The applicants and their supporting organisations believe that the case will be critical to securing the constitutionally- guaranteed rights of poor people to dignity, healthcare and sufficient water.
The stigma of being labelled poor is inhibiting struggling foster families in Botswana, who are looking after already vulnerable children, from accessing welfare, a new study has found. The study, which focused on the plight of orphans and vulnerable children in Palapye, one of the largest villages in Botswana, located 275km north of the capital, Gaborone, found government assistance was "crippled" by the reluctance of families to register children for state aid. It cited an official as saying, "Some parents do not want to show they have orphans".
Many children younger than 5 years in developing countries are exposed to multiple risks, including poverty, malnutrition, poor health, and unstimulating home environments, which detrimentally affect their cognitive, motor, and social-emotional development. There are few national statistics on the development of young children in developing countries. We therefore identified two factors with available worldwide data—the prevalence of early childhood stunting and the number of people living in absolute poverty—to use as indicators of poor development. We show that both indicators are closely associated with poor cognitive and educational performance in children and use them to estimate that over 200 million children under 5 years are not fulfilling their developmental potential. Most of these children live in south
Asia and sub-Saharan Africa. These disadvantaged children are likely to do poorly in school and subsequently have low incomes, high fertility, and provide poor care for their children, thus contributing to the intergenerational transmission of poverty.
7. Equitable health services
Health ministers at the 60th World Health Assembly were urged to focus on reducing maternal, newborn and young child deaths. A Global Business Plan for the partnership for maternal, newborn and child health was outlined, aiming to spearhead political impetus at the highest level to save lives and achieve MDGs 4 &5. The plan is being developed with The Partnership and other partners, including Chancellor Gordon Brown, UK, the Gates Foundation, Tanzania, Indonesia and Mozambique.
This document presents the AU Implementation Plan on Universal Access to HIV/AIDS, TB and Malaria services in Africa by 2010 from the Abuja, Nigeria Special Summit on HIV/AIDS, Tuberculosis and Malaria, 2-4 May 2006. The theme of the Special Summit was “Universal Access to HIV/AIDS, Tuberculosis and Malaria Services by 2010”. The purpose of the plan is to guide the role of Member States, the African Union Commission (AUC), Regional Economic Communities (RECs), Development Partners (bilateral and multilateral organizations), and Civil Society and the Private Sector in translating the decisions of the Heads of State at the Abuja 2006 Special Summit into action.
Asmera Getachew had completed a teacher training course when she saw an advert inviting applications from those interested in joining the government Health Service Extension Programme (HSEP). The advert posted on a wall, changed her life. After a one-year training course, she was assigned to Tensyie, a rural village of 5,092 people in North Gonder Zone of Amhara Regional State, to work as a health extension worker. One of 2,800 graduates from 14 HSEP training centres in Ethiopia, quickly settled in to implement a three month plan focusing on health education, environmental health, family health and disease prevention.
This report outlines key interventions for maternal and newborn health care programmes to improve maternal and newborn health and survival. These should be delivered by the health services, family, and the community to the mother during pregnancy, childbirth and in the postpartum period, and to the newborn soon after birth. They include important preventive, curative and health promotional activities for the
present as well as the future.
Zambia has recently articulated an ambitious national health program designed to meeting health-related MDGs. Public expectations are high and Zambia continues to receive significant resources from global and bilateral donors to support its health agenda. Although the lack of adequate resources presents the most important constraint, the efficiency with which available resources are being utilised is another challenge that cannot be overlooked. Inefficiency in producing health care undermines the service coverage potential of the health system. This paper estimates the technical efficiency of a sample of hospitals in Zambia. This study demonstrates that inefficiency of resource use in hospitals is significant. Policy attention is drawn to unsuitable hospital scale of operation and low productivity of some inputs as factors that reinforce each other to make Zambian hospitals technically inefficient at producing and delivering services. It is argued that such evidence of substantial inefficiency would undermine Zambia's prospects of achieving its health goals.
In this study commercial shopkeepers and groups of community leaders were trained to promote and sell ITNs in 19 sites in central Mozambique between 2000 and 2004. Pregnant women and children under 5 years of age comprised the target population. Sales records, household survey results and project experiences were examined to derive ‘lessons learned’. The authors conclude that this project failed to achieve adequate or equitable levels of ITN coverage in a timely manner in the programme sites. Its findings helped support a subsequent Mozambican decision to conduct targeted distribution of long-lasting nets to the neediest populations in the provinces where the project was conducted.
Weak infrastructure and limited distribution systems in low-income countries complicate access to health services, especially in rural areas. Government health outlets may be relatively few and widely dispersed, and private-sector sources often favor wealthier urban areas, resulting in uneven service availability within a country. In the absence of a solid heath infrastructure, strengthening primary health care and innovative community-based health service delivery systems help provide more equitable access to health services. Some programs are underway in Ethiopia whose successes do not depend on the availability of a strong infrastructure.
South Africa was asked to review the progress made by Africa on the implementation of the Plan of Action on the African Union (AU) Decade of Traditional Medicine (2001-2010). The challenge was noted of getting as broad a representation and information from all regions, to foster collaboration among countries and regions as well as to promote information sharing on how best to put African Traditional Medicine in its rightful place.
8. Human Resources
Geographical imbalances in the health workforce are a consistent feature of nearly all health systems, especially in developing countries. This paper investigates the willingness to work in a rural area among final year nursing and medical students in Ethiopia. Analysing data obtained from contingent valuation questions for final year students from three medical schools and eight nursing schools, we find that there is substantial heterogeneity in the willingness to serve in rural areas.
As one of the oldest and most respected professions in the world, the work of midwives is celebrated annually on 5 May. To mark the occasion, the International Day of Midwives will be celebrated at WHO Headquarters on Friday 4 May. WHO staff will gather to show their support for the essential role of midwives in saving the lives of pregnant women who might otherwise die from malnourishment or lack of skilled care during pregnancy and childbirth.
In countries with a high AIDS prevalence, the health workforce is affected by AIDS in several ways. In Zambia, which has a 16.5% prevalence rate, a 2004 study aimed to: explore the impact of HIV/AIDS on health workers, describe their coping mechanisms and recommend supportive measures. Interviews revealed that counsellors and nurses were especially at risk for emotional exhaustion. AIDS complicates the already difficult work environment. In addition to health workers, management also needs support in dealing with AIDS at the workplace.
Effective and often cheap interventions exist to achieve the MDGs by 2015. In Tanzania, one of the poorest countries of the world, we explored the human resources challenges of expanding the coverage of such priority interventions. Even in an optimistic scenario, human resource availability will limit the extent to which priority interventions can be expanded in Tanzania, and the government will not be able to avoid adjusting the globally set targets for service coverage and health outcomes to local realities and priorities.
Increased international migration of health professionals is weakening healthcare systems in low-income countries, particularly in sub-Saharan Africa. As nurses form the backbone of healthcare systems in many of the affected countries, accelerating migration of nurses is most critical. In this paper we present a comprehensive analysis of the literature and argue that, from a human rights perspective, there are competing rights in the international migration of health professionals: the right to leave one’s country to seek a better life; the right to health of populations in the source and destination countries; labour rights; the right to education; and the right to nondiscrimination and equality.
Physician migration from poor to rich countries is considered an important contributor to the growing health workforce crisis in the developing world. This is particularly true for Africa. The perceived magnitude of such migration for each source country might, however, depend on the choice of metrics used in the analysis. This study examined the influence of choice of migration metrics on the rankings of African countries that suffered the most physician migration, and investigated the correlates of physician migration.
9. Public-Private Mix
In many countries, private health care providers are the gateway to health services for people with symptoms of TB. The types of private providers and their roles in TB management, however, vary greatly across and within countries. The traditional healers in Malawi, unqualified practitioners in India or hospital-based chest physicians in Indonesia are all, for example, private health care providers in their respective settings with current and potential roles in TB control.
The ability of health organizations in developing countries to expand access to quality services depends in large part on organisational and human capacity. Capacity building includes professional development of staff, as well as efforts to create working environments conducive to high levels of performance. The current study evaluated an approach to public-private partnership where corporate volunteers give technical assistance to improve organizational and staff performance. From 2003 to 2005, the Pfizer Global Health Fellows program sent 72 employees to work with organizations in 19 countries. This evaluation was designed to assess program impact.
Global malaria control strategies highlight the need to increase early uptake of effective antimalarials for childhood fevers in endemic settings, based on a presumptive diagnosis of malaria in this age group. Many control programmes identify private medicine sellers as important targets to promote effective early treatment, based on reported widespread inadequate childhood fever treatment practices involving the retail sector. Data on adult use of over-the-counter (OTC) medicines is limited. This study aimed to assess childhood and adult patterns of OTC medicine use to inform national medicine retailer programmes in Kenya and other similar settings.
10. Resource allocation and health financing
A minimum yearly average increase in resources of US$ 3.9 billion is needed to scale up maternal and newborn health services within the context of the Millennium Development Goals, although annual costs increase over the time period of the model. When more rapid rates of scale-up are assumed, this minimum figure may be as high as US$ 5.6 billion per year. The 10-year estimated incremental costs range from US$ 39.3 billion for a moderate scale-up scenario to US$ 55.7 billion for the rapid scale-up scenario. These projections of future financial costs may be used as a starting point for mobilizing global resources. Countries will have to further refine these estimates, but these figures may serve as goals towards which donors can direct their plans. Further research is needed to measure the costs of health system reforms, such as recruiting, training and retaining a sufficient number of personnel.
More than 300 delegates gathered at the first-ever assembly of The Partnership for Maternal, Newborn and Child Health. Hosted by the Government of Tanzania, the Partner's Forum (17-20 April 2007) declared that action is urgently required, if high rates of unjust deaths of mothers, babies and children in poor countries are to be reversed.
Social health insurance is critical for improving equity in our health system, which is characterised by tremendous disparities between public and private care. As much as there have been increases in real terms in the budgets for public health services, more funding is still required, especially in light of additional demands posed by HIV and Aids.
In a statement ahead of the WHA meetings, APHRA coordinator Rotimi Sankore stated: “The World Health Assembly has in the past three years passed several resolutions on health financing and health worker shortages - yet there has been an overall increase in annual African deaths resulting from lack of sustainable health finance and health worker shortages. The worlds Health Ministers must now move from passing resolutions to effecting resolutions and emergency action to end the deaths of over 8 million Africans a year to preventable, treatable and manageable diseases, caused mainly by maternal mortality, child mortality, HIV/AIDS, TB and malaria.”
11. Equity and HIV/AIDS
HIV and AIDS are significant and growing public health concerns in southern Africa. The majority of countries in the region have national adult HIV prevalence estimates exceeding 10 percent. The increasing availability of highly active antiretroviral therapy (HAART) has potential to mitigate the situation. There is however concern that women may experience more barriers in accessing treatment programs than men.
Severe shortages of health staff are compromising the quality and availability of HIV/AIDS care across southern Africa. There is wide acknowledgement of the human resource crisis, but little action on the ground. MSF is urging governments to develop and implement emergency plans to retain and recruit health care workers that include measures to raise pay and improve working conditions.
The majority of adolescents in Africa experience pregnancy, childbirth and enter motherhood without adequate information about maternal health issues. Information about these issues could help them reduce their pregnancy related health risks. Existing studies have concentrated on adolescents' knowledge of other areas of reproductive health, but little is known about their awareness and knowledge of safe motherhood issues. We sought to bridge this gap by assessing the knowledge of school pupils regarding safe motherhood in Mtwara Region, Tanzania.
AIDS Healthcare Foundation endorsed President Bush's efforts to support cost-effective and sustainable programs that provide life-saving Anti-retroviral HIV and AIDS treatment and care globally. The Presidential Emergency Plan for AIDS Relief (PEPFAR) is a $15 billion dollar, five-year global AIDS treatment plan the President first proposed in 2003.
Swaziland's truck drivers are twice as likely to be HIV-positive than other citizens and are finally to get the programmes required to provide them with treatment and support, a conference was told this week. At the Federation of Swaziland Employers (FSE) conference held in Manzini, 35km east of the capital, Mbabane, it was announced that a comprehensive set of initiatives were to be put in place to test, counsel and treat HIV-positive transportation workers after studies showed "truckers as a group have an HIV infection rate double that of the general population," Khosi Hlatshwayo, coordinator of the FSE’s Business Council HIV/AIDS initiative, said.
United Nations Secretary-General Ban Ki-moon today appointed Elizabeth Mataka, a national of Botswana and a resident of Zambia, as his Special Envoy for AIDS in Africa. Ms. Mataka, a social worker by training, has been working in the field of HIV/AIDS for the past 16 years. She has been involved in many different aspects of responding to the AIDS epidemic, including programmes on HIV prevention, clinical treatment for opportunistic infections, care and support at community and national levels.
WHO and UNAIDS have issued new guidance on informed, voluntary HIV testing and counselling in the world's health facilities, with a view to significantly increasing access to HIV treatment, care, support and prevention services. The new guidance focuses on provider-initiated HIV testing and counselling (recommended by health care providers in health facilities), essential to promoting earlier diagnosis of HIV infection, which in turn can maximize the potential benefits of life-extending treatment and care, and allow people with HIV to receive information and tools to prevent HIV transmission to others.
Expanding access to HIV testing is critical in the fight against AIDS, but new WHO/UNAIDS guidelines pay only lip service to the conditions that will make testing successful, Human Rights Watch said today. Human Rights Watch was responding to the release of new WHO/UNAIDS guidelines on provider-initiated HIV testing and counseling. The guidelines appropriately rule out mandatory or coercive testing and call for expanded, health facility-based testing in countries with an “enabling environment” in place and with “adequate resources” available for HIV prevention, treatment and care. But Human Rights Watch warned that few of the most affected countries have such resources and environments in place.
12. Governance and participation in health
Capacity strengthening of rural communities, and the actors that support them, is needed to enable them to lead their own malaria control programmes. The existing capacity of a rural community in western Kenya was evaluated in preparation for a larger intervention. The study shows that culturally sensitive but evidence-based education interventions, utilising participatory tools, are urgently required which consider traditional beliefs and enable understanding of causal connections between mosquito ecology, parasite transmission and the diagnosis, treatment and prevention of disease.
This paper presents findings from a survey of a section of Tanzanian NGOs on their perceptions of their relationships with the government and donors, and their views on their roles and impacts on poverty reduction and development. Key findings of the study indicate that the relationship between NGOs and the government of Tanzania is expanding and improving, characterised by increased communication, interaction and trust. NGOs' relations with donors are seen by respondents as cordial and smooth, but with further probing, numerous frustrations were evident. NGOs view donors as more powerful than the government and the government often sees civil society as a competitor for resources. Despite many barriers, most NGOs felt their organisations have a largely positive impact on policy.
13. Monitoring equity and research policy
The AFRO’s Global Health Atlas brings together for analysis and comparison standardised data and statistics for diseases at country, regional, and global levels. The Atlas acknowledges the broad range of determinants that influence patterns of infectious disease transmission. Country fact sheets are available for South Africa.
The AFRO’s Global Health Atlas brings together for analysis and comparison standardised data and statistics for diseases at country, regional, and global levels. The Atlas acknowledges the broad range of determinants that influence patterns of infectious disease transmission. Country fact sheets are available for Swaziland.
The AFRO’s Global Health Atlas brings together for analysis and comparison standardised data and statistics for diseases at country, regional, and global levels. The Atlas acknowledges the broad range of determinants that influence patterns of infectious disease transmission. Country fact sheets are available for Tanzania.
The AFRO’s Global Health Atlas brings together for analysis and comparison standardised data and statistics for diseases at country, regional, and global levels. The Atlas acknowledges the broad range of determinants that influence patterns of infectious disease transmission. Country fact sheets are available for Uganda.
The AFRO’s Global Health Atlas brings together for analysis and comparison standardised data and statistics for diseases at country, regional, and global levels. The Atlas acknowledges the broad range of determinants that influence patterns of infectious disease transmission. Country fact sheets are available for Zambia.
The AFRO’s Global Health Atlas brings together for analysis and comparison standardised data and statistics for diseases at country, regional, and global levels. The Atlas acknowledges the broad range of determinants that influence patterns of infectious disease transmission. Country fact sheets are available for Zimbabwe.
The AFRO’s Global Health Atlas brings together for analysis and comparison standardised data and statistics for diseases at country, regional, and global levels. The Atlas acknowledges the broad range of determinants that influence patterns of infectious disease transmission. Country fact sheets are available for Angola.
The AFRO’s Global Health Atlas brings together for analysis and comparison standardised data and statistics for diseases at country, regional, and global levels. The Atlas acknowledges the broad range of determinants that influence patterns of infectious disease transmission. Country fact sheets are available for Botswana.
The AFRO’s Global Health Atlas brings together for analysis and comparison standardised data and statistics for diseases at country, regional, and global levels. The Atlas acknowledges the broad range of determinants that influence patterns of infectious disease transmission. Country fact sheets are available for Kenya.
The AFRO’s Global Health Atlas brings together for analysis and comparison standardised data and statistics for diseases at country, regional, and global levels. The Atlas acknowledges the broad range of determinants that influence patterns of infectious disease transmission. Country fact sheets are available for Lesotho.
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14. Useful Resources
This course introduces and provides guidance in assessing different kinds of information systems related to food security analysis.
15. Jobs and Announcements
"Building Consensus on prevention, treatment and care", the conference aims to serve as a platform for deliberations on the key contentious issues relating to prevention, treatment and care. In particular, the conference will highlight state-of-the-art developments in prevention technologies; new approaches to prevention; the long-term impact of highly active antiretroviral therapy on incidence, prevalence, morbidity and mortality; the role of nutrition in HIV/AIDS; and the role of research into the use of complimentary and traditional medicines in HIV/AIDS.
The African Women's Development and Communication Network (FEMNET) is offering an internship as part of their capacity building programme. It is open to female students (both local and international) and to those who have just completed their studies and are looking for experience and mentorship in the area of African women's human rights, gender mainstreaming, African feminist movements and communications.
The Economic Policy Research Institute, the Institute for Development Studies (Sussex ), Maastricht University and the University of Cape Town is offering a two-week course on the design and implementation of social transfer programmes. The course will run in Cape Town from July 22 to August 4 and is aimed at government officials, donor agency representatives and others involves in national social protection initiatives.
In an effort to build local capacity surrounding access to medicines issues, OSI's Public Health Program is issuing a request for proposals. Grants for up to $75,000, renewable for up to three years, will be awarded to local NGOs with a mandate and demonstrated capacity to advance policy and civil society engagement related to access to medicines in Brazil, India, Kenya, Malaysia, South Africa, and Thailand. Interested organisations should submit an application no later than Monday 16 July 2007.
The Ministry of Health, Zambia is organizing a “Human Resource for Health (HRH) Research Conference” on 7-8 June 2007. The goal of the conference is to review evidence (current knowledge, experiences and lessons), discuss how evidence can effectively be translated into HRH policy and make specific recommendations to effectively respond to the HRH crisis in Zambia. The Theme of the Conference is “Transforming Research into Action: Providing Evidence for HRH Policy development, Program Design and Implementation”.
The World Young Women's Christian Association (YWCA), in partnership with the International Community of Women Living with HIV and AIDS (ICW), and other international organisations, will host the first ever global conference on women and AIDS. The summit will bring together 1500 women and men to develop strategies, skills and partnerships in response to the impact of AIDS on women. The conference will be from 4-7 July 2007, Nairobi , Kenya.
Research Action and Information Network for Bodily Integrity of Women (RAINBO) started this Small Grants Project in 1995 in order to provide modest funds and technical assistance to African non-governmental organisations (NGOs) that might not otherwise have access to mainstream sources of funding. The main objectives of the project are: to support effective and innovative projects that combat Female Circumcision (FC)/Female Genital Mutilation (FGM); to strengthen the institutional capacity of African NGOs working on the FC/FGM issue as part of advancing the sexual and reproductive health and rights of women and girls; and to expand collaborative relationships among NGOs, activists, academics and researchers in Africa. The deadline is rolling.
The American Journal of Public Health is calling for submissions to this symposium edition. The Symposium edition has no limits on submissions within the area of reproductive and sexual health, and no preferred topics or disciplinary background. The target date for submissions is 17 September 2007.
This workshop, sponsored and organised by Curtin University of Technology, the Danish Institute for Health Services Research, and the University of Cape Town will explore a number of the ideological and political issues surrounding health and health care in the 21st century. In particular, speakers will look at the links between neo liberalism and both health and health care in a global context. Plenty space will be allowed for comments from the floor. The workshop will be held on Sunday 8 July 2007, 9.00am-4.00pm.
WHO and the journals Education for Health and Human Resources for Health are now accepting papers for joint special issues addressing the critical need for a skilled, sustainable health workforce in the developing world. Submitted articles must fall under the broad theme: 'Towards a scaling-up of training and education for health workers'. Proposals for manuscripts are due by 31 July 2007 and final manuscripts are due by 30 October 2007.
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