From the 1-3 July 2007, African leaders will meet in Accra, Ghana at the 9th Ordinary Session of the Assembly of the African Union. The major agenda item is the proposal and plans for the United States of Africa. Africa’s Under-development as manifested in its public health catastrophe is not on the AU summit agenda. This raises the crucial question of the kind of unity African leaders wish to achieve. Significantly the debate about the proposed union has revolved mainly around political issues without commensurate attention to the development issues which were no less important to the founders of the Pan African movement.
It is now six years since Heads of State of African Union member states pledged in Abuja in 2001 to commit at least 15% of national budgets to health. To say it is tragic that in 2007 only two out of fifty three AU member countries (Botswana and Seychelles) have clearly met that pledge does not even begin to describe the situation. It is beyond tragedy.
In these past few weeks, all roads led to the G8 Summit in Germany. In what has become an annual ritual since the turn of the century, international campaigners Bono, Bob Geldof and an impressive assortment of Development and AIDS related organisations led the calls for more aid to Africa, and for Africa not to be forgotten in the clamour over climate change. As usual, selected African leaders turned up with begging bowls and for photo calls. Leading international campaigners have since described the aid pledged by the G8 this month as 'a farce' and 'grossly inadequate'.
We know that many of the more developed countries have played historical roles in under developing Africa. 400 years of industrial scale slavery, in addition to colonialism, ruthless exploitation of Africa’s resources, cynical ‘interventions’ and the debt burden have cost Africa dearly. The ‘foreign’ aid to Africa is a percentage of what has been taken out in human and natural resources, and is but a small step towards repairing the damage done to Africa.
But we also know that African leaders cannot seriously expect other countries to commit to, or meet pledges to ‘save’ Africa when they themselves appear indifferent to Africa’s future. To be going forward with plans for African unity without simultaneously meeting the most fundamental commitment to African development – that of health - is misguided to say the least.
It is comical for us to be calling on the G8 countries to meet the recent Gleneagles pledges when the vast majority of AU member states have not met their own Abuja 2001 pledge. This is not a pledge we can afford to pass unfulfilled. The Africa Public Health Rights Alliance (APHRA) and its '15% Now!' Campaign revealed on Human Rights Day (December 10) 2006 that by crossing continental, sub regional, country, health, disease specific and development information from a wide range of agencies and institutions we computed that an estimated 8,000,000 Africans are dying annually from preventable, treatable and manageable diseases and health conditions – mainly Malaria, TB, HIV, child and maternal mortality. This figure does not include organ related disease (heart, liver, kidney and lung diseases), an assortment of cancers, vaccine preventable diseases and so forth which could very easily add another million – or more. The consistency of these figures over the past six years alone means that Africa has suffered an estimated 48,000,000 preventable deaths since 2001.
By coincidence, the dream of the United States of Africa is planned to be actualised by 2015, the same year the Millennium Development Goals are to be met. If Africa’s health catastrophe continues unabated we could loose another 72,000,000 lives by then. This is the equivalent of whole nations dying out within a year or a decade. Many African countries (such as Botswana, Burundi, Eritrea, Gambia, Lesotho, Liberia, Libya, Namibia and
Swaziland) have populations of between 1-8,00,000. Most of the island countries have populations of less than a million. Even Africa’s most populous countries (DRC, Ethiopia, Kenya, South Africa, Sudan - with the exception of Nigeria at 130,000,000) all have populations of between 30-80,000,000.
It would therefore not be an exaggeration to describe over 120 million preventable deaths between 2001 and 2015 as genocide – by inaction. In this case and for every life lost, government indifference to Public Health is the equivalent of an Interehamwe machete or Nazi gas chamber. If we were set up memorials to the preventable deaths from one year alone, we would need 100 stadiums in Africa with the capacity to each host 80,000 skulls – each a stadium of shameful silence, and a monument to government without responsibility.
Africa Must Unite! But for it to be a meaningful unity it must not be a unity of the dead. It must not be unity as a continental graveyard.
Meeting the 15% pledge will be a significant indication that African leaders care for their countries and are prepared to live up to their primary responsibility of keeping their citizens alive and healthy. No meaningful and sustainable development of Africa can happen without sustainable financing for health care. Indeed the status of public health is the most significant indicator of social and economic development. This is why the Right to Health is the most crucial Right of all – we all have to be alive and well to exercise any other Rights. The dead have no Rights – except perhaps the ‘Right to a decent burial’.
To postpone the meeting of the 15% pledge to the future is to accelerate the death of Africa. We call on the African Union to place the 2001 15% pledge on the July 2007 summit agenda and at the very least to introduce it as urgent business [under item vii, AOB]. We further call on them to make it a major agenda item of the next summit or to call a special summit dedicated to meeting the 15% pledge. This should be preceded by a special summit of Finance and Economic Development Ministers
To further illustrate the full scale of Africa’s health disaster, it is not enough to demonstrate only the unprecedented scale of preventable death. It is also crucial to demonstrate the scale of Africa’s impotence and one example will suffice.
Without health workers, no amount of free medicines can be delivered to citizens, and all ‘foreign’ AID is meaningless. Yet many African governments have no clue how close to death their countries are due to shortage of health workers of all categories.
The DRC with a population of 57 million, roughly equivalent to the populations of UK, France and Italy has only 5,827 doctors compared to the
France’s 203,000, Italy’s 241,000 and the UK’s 160,000. But it is not just a case of the most developed countries being able to train more health workers, or to poach from Africa to make up their shortfalls. Cuba with a population of about 11 million has roughly the same population as Malawi, Zambia or Zimbabwe. But Cuba has 66,567 Doctors compared with Malawi’s 266, Zambia’s 1,264 and Zimbabwe’s 2,086. Not surprisingly, Cuba has roughly the same life expectancy (77 years) as the G8 Countries, the Scandinavian and other developed countries while the average life expectancy for African countries compared to it here is 37 to 40 years. The success of Cuba in the areas of health care and education demonstrates it can be done. Despite issues with the Castro government, western countries have visited Cuba to study how they have achieved their health success. To come anywhere near meeting the World Health Organisation recommended health worker’s to patient ratio or meeting the health based MDG’s these African countries compared to Cuba will need to train and retain roughly 59,000 Doctors each in 8 years. The DRC will need to train and retain at least 150,000. The numbers for nurses, pharmacists and most categories of health workers are comparable across board. This should be Africa’s priority.
In other words, there is no alternative to long term in country sustainable financing to rebuild Africa’s Public Health systems including health workers and improved working conditions and remuneration for them, adequately equipped clinics and hospitals, improved sanitation and environmental health, clean drinking water and so forth. Without these Africa may achieve its dream of continental unity, but it will be a fools paradise.
We are for a United Africa. But it must be a unity of the living, and of a healthy African people – able to enjoy full civil, social, economic and political Rights - not a unity of the diseased, dead and dying.
Successfully unity can only be based on successful development of which health is the corner stone.
The Africa Public Health Rights Alliance and its 15% Now campaign call on you to join the undersigned below in signing the petition calling
on AU member countries to fulfil their 15% Abuja pledge as the first genuine step towards a healthy United States of Africa.
You can sign by sending your name, position, organisation and country to
africa_15percentnowcampaign@yahoo.com - Also stating if signing in a personal or organisational capacity.
*Signatories to the petition do not necessarily endorse the views expressed in this article.
Article originally published by Pambazuka News, 21 June 2007: http://www.pambazuka.org/en/category/comment/42108
EQUINET calls for Abuja PLUS! EQUINET advocates for governments to meet their Abuja commitment to 15% government spending on health, excluding external funding, PLUS debt cancellation and international support to meet at least US$60 per capita on health systems. Information and publication on EQUINET work on health financing is available at the EQUINET website at www.equinetafrica.org.
1. Editorial
2. Latest Equinet Updates
SEATINI with TARSC under the EQUINET umbrella are carrying out work on the health and trade theme. This work involves skills building, research and information exchange on the effects of trade agreements on health. Within this programme SEATINI / TARSC in EQUINET will host a training workshop on policy engagement and advocacy to promote health in trade agreements in Bagamayo, Tanzania, 31 August 31 and 1 September 2007. The workshop will cover general issues of trade and health, and a deeper review of TRIPS and use of TRIPS flexibilities, the EU-ESA EPA, and health services liberalisation. It will include 2 people from each of the following countries: Zimbabwe, Tanzania, Kenya and Uganda, one each from health and trade backgrounds. Interested applicants from Zimbabwe, Tanzania, Kenya and Uganda are asked to send in by July 3 2007 to the EQUINET secretariat admin@equinetafrica.org and copy to percy@seatini.org.
The International Organization for Migration (IOM) and the Regional Network on Equity in Health in east and southern Africa (EQUINET), in co-operation with the East, Central and Southern African Health Community (ECSA-HC) are calling for expressions of interest from researchers in Kenya to undertake a baseline study entitled Managing the Migration of Human Resources for Health in Kenya: the Impact on Health Service Delivery. This will be a detailed review and critical analysis on the impact of the migration of health workers on health service delivery. Further details are available on the EQUINET website.
3. Equity in Health
At the midway point between their adoption in 2000 and the 2015 target date for achieving the Millennium Development Goals, sub-Saharan Africa is not on track to achieve any of the Goals. Although there have been major gains in several areas and the Goals remain achievable in most African nations, even the best governed countries on the continent have not been able to make sufficient progress in reducing extreme poverty in its many forms. This UN report outlines the current indicators and gives some success stories. It observes that existing commitments made and reaffirmed by world leaders at the G8 Summit in Gleneagles and the 2005 World Summit are sufficient to meet the Goals. At the midway point of 2007, these commitments must be urgently translated into practical plans with systematic follow-through.
WHO presents country data on the burden of disease preventable through healthier environments. These estimates provide the stepping stone for informed policy making in disease prevention. The country profiles provide an overview of summary information on selected parameters that describe the environmental health situation of a country, as well as a preliminary estimate of health impacts caused by environmental risks.
The report includes a Mothers’ Index, which identifies the best and worst countries to be a mother and child-based on a comprehensive look at child and maternal well-being in 140 countries. To succeed in saving the lives of children under 5, Save the Children recommends that countries: ensure the well-being of mothers; invest in basic, low-cost solutions to save children’s lives; make health care available to the poorest and most vulnerable mothers and children; increase funding and improve strategies to provide basic, effective, lifesaving services to those who most need it.
4. Values, Policies and Rights
The issue of women continuing to be at higher risk of HIV infection than men has received considerable attention at a gathering of women's affairs ministers from Commonwealth countries underway in Uganda's capital, Kampala. Of the 53 Commonwealth member states, 38 are represented at the '8th Triennial Commonwealth Women's Affairs Ministers Meeting' (8WAMM), being held under the theme 'Financing Gender Equality for Development and Democracy'. United Nations statistics indicate that women and girls in Commonwealth countries make up a third of all HIV infections. In addition, women between the ages of 15 and 24 in sub-Saharan Africa - the region most prominently represented in the Commonwealth - are two and a half times more likely to be infected than men of the same age.
This paper is a report on the development of a conceptual model delineating contexts and processes of HIV/AIDS stigma as reported by persons living with HIV/AIDS and nurses from African countries. It is part of a larger study to increase understanding of HIV/AIDS stigma.
It has been estimated that more than 80% of people in Africa use traditional medicine (TM). With the HIV/AIDS epidemic claiming many lives in Africa, the majority of people affected rely on TM mainly because it is relatively affordable and available to the poor populations who cannot afford orthodox medicine. Whereas orthodox medicine is practiced under stringent regulations and ethical guidelines emanating from The Nuremburg Code,1 African TM seems to be exempt from such scrutiny. Although recently there have been calls for TM to be incorporated into the health care system, less emphasis has been placed on ethical and regulatory issues. In this paper, an overview of the use of African TM in general, and for HIV/AIDS in particular, is given.
Governments in southern Africa are moving with zeal to address social challenges faced by women. The SADC member states view education for women and girls as a sticking point for achieving this cause. For this reason, an ambitious leap to put together the SADC gender protocol is on course.
The South African Human Rights Commission's public inquiry into health care services concluded the open hearings phase on 1 June 2007. The Commission put together a programme that created space for all who needed to be heard, on the right of everyone to access health care services as provided for in the Bill of Rights. Several organisations made submissions
The SAHRC embarked upon provincial assessments in all nine provinces in preparation for a national enquiry into the right to have access to health care. This report provides a synthesis of the findings and main themes emerging from those assessments.
An international order responsible for widespread inequalities and poverty prevents the realisation of the right to health. The affirmation of health as a human right and the definition of its relation to other human rights are essential to clarify the obligations of those involved in its realisation. This brochure discusses: the right to health and its implementation.
This article is an interview with Eveline Herfkens, executive coordinator of the Millennium Campaign, about the plight of Africa and the role of African governments in recreating poverty.She argues that too few governments in Africa have taken responsibility for themselves, for their future, and that donors have operated in a way that undermined accountability and responsibility, making African countries look more at what their donors want than what their own people want.
5. Health equity in economic and trade policies
This issue of Globalization and Health presents a paper by Kerry and Lee that considers the TRIPS agreement and the recent policy debate regarding the protection of public health interest, particularly as they pertain to the Doha Declaration. This editorial considers the debate, examines issues of enacting, implementing and monitoring TRIPS provisions and identifies questions that should be considered by key stakeholders in ongoing discussions.
Globalization is a key context for the study of social determinants of health (SDH): broadly stated, SDH are the conditions in which people live and work, and that affect their opportunities to lead healthy lives. In the first article in this three part series, we described the origins of the series in work conducted for the Globalization Knowledge Network of the World Health Organizations Commission on Social Determinants of Health and in the Commissions specific concern with health equity.
Uganda is currently preoccupied with reforms for its commercial laws. The
patent law is one of the laws under reform. A draft bill known as the Industrial Property bill is pending submission to cabinet at the time of writing. This report explains the process of reform of the patent law and traces the genesis of the process, stakeholders involvement, as well as the driving force for the reforms.
The Doha Declaration on the TRIPs Agreement and Public Health (2001), aimed at improving access to medicines, especially for HIV/AIDS, malaria and tuberculosis in developing and least developed countries, has not yet been used for compulsory licences to import generic medicines or for expanding production for export to poor countries. By analysing HIV/AIDS treatment in Uganda, this article discusses the variety of TRIPs-related channels for ensuring drugs for domestic treatment, and argues that emphasising the restrictive nature of TRIPs provisions fails to grasp the scale of the obstacles involved. Lack of domestic resources leaves African countries dependent on donor financing, which in turn constrains their ability to exploit international trade provisions.
6. Poverty and health
While Botswana has succeeded in decreasing its poverty rate, it is unlikely that the country will achieve the United Nations' fourth Millennium Development Goal of decreasing child mortality rates by two thirds by 2015. Figures have shown an increase in child mortality between the 1990s and the 2000s. A 2001 report by the government's Central Statistics Office (CSO) on population and housing indicates that in 1991, infant mortality in Botswana stood at 48 deaths per 1,000 live births. This figure increased to 56 deaths per 1,000 live births by 2001. Over the same period, under-five mortality increased from 63 to 74 deaths per 1,000 live births. The United Nations Children's Fund's figures for the under-five mortality rate in Botswana are worse than the Botswana government's official figures, rising from 58 deaths per 1,000 live births in 1990 to 116 in 2004. The high prevalence of HIV/AIDS is one of the factors behind this phenomenon.
The fourth of the United Nations' Millennium Development Goals (MDGs) seeks a two-third reduction in the deaths of children under five by 2015. But the issues related to the first MDG, the eradication of extreme poverty and hunger, will push the reduction of child mortality in Zimbabwe beyond the target date of 2015.
The WHO based Special Programme for Research and Training in Tropical Diseases (TDR) has adopted a new strategy for strengthening and expanding research to prevent and control 'infectious diseases of poverty'. The strategy builds on the programme’s 30-year record of developing new drugs, delivery strategies and enhancing research capacity in countries where parasitic tropical diseases are endemic. The new plan addresses some of the emerging disease challenges facing developing countries, such as TB-HIV co-infection.
This paper describes patterns of association between different groups of young orphans and vulnerable children (OVC) and their nutritional and health outcomes; and develops a theoretical framework to analyse the determinants of child malnutrition and ill-health, and identify the different mechanisms which contribute to these outcomes in such children.
It is based on statistical analysis of data on 31 672 children aged 0–17 years (6753 aged under 5 years) selected from the Zimbabwe OVC Baseline Survey 2004. Differences in exposure to extreme poverty among young children by OVC status were relatively small and did not explain the greater malnutrition and ill-health seen in OVC.
7. Equitable health services
In Malawi essential drugs are provided free of charge to patients at all public health facilities in order to ensure equitable access to health care. The country thereby spends about 30% of the national health budget on drugs. In order to investigate the level of drug shortages and eventually find the reasons for the drugs shortages in Malawi, we studied the management of the drug supplies for common and life threatening diseases such as pneumonia and malaria in a random selection of health centres.
In early 2007, the Indonesian government decided to withhold its bird flu virus samples from WHO’s collaborating centers pending a new global mechanism for virus sharing that had better terms for developing countries. The 60th World Health Assembly subsequently resolved to establish an international stockpile of avian flu vaccines, and mandated WHO to formulate mechanisms and guidelines for equitable access to these vaccines. Are there analogous opportunities for study volunteers or donors of biological materials in clinical trials or other research settings to exercise corresponding leverage to advance health equity? This paper will appear in Development in Practice 18(1), February 2008 and also shortly as a UN-DESA working paper.
Malaria microscopy, while the gold standard for malaria diagnosis, has limitations. Efficacy estimates in drug and vaccine malaria trials are very sensitive to small errors in microscopy endpoints. This fact led to the establishment of a Malaria Diagnostics Centre of Excellence in Kisumu, Kenya. The primary objective was to ensure valid clinical trial and diagnostic test evaluations. Key secondary objectives were technology transfer to host countries, establishment of partnerships, and training of clinical microscopists.
Malaria rapid diagnostic tests (RDTs) are relatively simple to perform and provide results quickly for making treatment decisions. However, the accuracy and application of RDT results depends on several factors such as quality of the RDT, storage, transport and end user performance. A cross sectional survey to explore factors that affect the performance and use of RDTs was conducted in the primary care facilities in South Africa.
This report from the African Palliative Care Association (APCA) identifies a number of problems with the delivery of pain-relief drugs to people with HIV and AIDS. The survey found that the key problems were inadequate and unreliable supplies of drugs, restrictive legislation, poor levels of education and training about prescribing such drugs among clinical staff, and practical problems such as high costs and inadequate storage facilities. The key challenges to overcoming these problems were identified as a lack of political will, the need for education and cultural change among medical practitioners and a lack of resources.
This chapter provides an overview of developments in South Africas health system over the past 12 years, using the WHOs assessment framework. While this framework has good health is an obvious goal, broader social objectives such as responsiveness to the needs of citizens and promotion of equity are also measured. Despite the largely successful efforts to shrug off the legacy of a racially divided health system and to generate numerous transformation initiatives, the reality is that the current system is as problematic as it was 12 years ago.
This study investigated socio-economic inequities in self-reported illnesses, treatment-seeking behaviour, cost burdens and coping strategies in a rural and urban setting along the Kenyan coast. Key findings were significantly higher levels of reported chronic and acute conditions in the rural setting, differences in treatment-seeking patterns by socio-economic status (SES) and by setting, and regressive cost burdens in both areas. These data suggest the need for greater governmental and non-governmental efforts towards protecting the poor from catastrophic illness cost burdens.
Hundreds of thousands of cases of drug-resistant tuberculosis (TB) can be prevented and as many as 134 000 lives saved through the implementation of a two-year response plan, published/launched by WHO and Stop TB Partnership. The Global MDR-TB and XDR-TB Response Plan 2007-2008 sets out measures needed now to prevent, treat and control extensively drug-resistant TB (XDR-TB) and multidrug-resistant TB (MDR-TB). The plan also sets in motion actions to reach a 2015 goal of providing access to drugs and diagnostic tests to all MDR-TB and XDR-TB patients, saving the lives of up to 1.2 million patients.
The Zimbabwe government and the United Nations Children’s Fund (UNICEF) conducted a countrywide immunisation programme aimed at eliminating polio and other diseases to prevent children from having the same experience as Chirewa and others. It is a continuation of similar efforts over the past few years. The programme has seen many mothers across the country taking their children to centres around the country for immunisation. About two million children were vaccinated during the week-long programme, not only immunised against polio but also against diseases such as tuberculosis, measles, diphtheria, tetanus, whooping cough and hepatitis B. They also received vitamin A supplements.
8. Human Resources
Creating a national electronic nursing workforce database provides more reliable information on nurse demographics, migration patterns, and workforce capacity. Data analyses are most useful for human resources for health (HRH) planning when workforce capacity data can be linked to worksite staffing requirements. As a result of establishing this database, the Kenya Ministry of Health has improved capability to assess its nursing workforce and document important workforce trends, such as out-migration. Current data identify the United States as the leading recipient country of Kenyan nurses. The overwhelming majority of Kenyan nurses who elect to out-migrate are among Kenya's most qualified.
Despite the expanding literature on how reforms may affect health workers and which reactions they may provoke, little research has been conducted on the mechanisms of effect through which health sector reforms either promote or discourage health worker performance. This paper seeks to trace these mechanisms and examines the contextual framework of reform objectives in Uganda and Bangladesh, and health workers' responses to the changes in their working environments by taking a 'realistic evaluation' approach.
A shortage of health care workers is paralysing the health system in Lesotho, Malawi, Mozambique and South Africa, and threatens the lives of millions, particularly in rural areas, warns Medecins Sans Frontieres. A new report by the organisation, launched in Johannesburg, shows that only South Africa has met the World Health Organisation (WHO) target for an adequate supply of health care workers: 74.3 doctors, 393 nurses and 468 health providers per 100,000 people.
This report investigated community health workers’ (CHW) adherence over time to guidelines for treating ill children and to assess the effect of refresher training on adherence. The average adherence score was 79.4%. Multivariable analyses indicate that immediately after the first refresher training, the mean adherence level improved for patients with a severe illness, but worsened for patients without severe illness. Adherence scores declined rapidly during the 6 months after the second refresher training.
The Global Fund to Fight AIDS, Tuberculosis and Malaria was created to fight three of the world’s most devastating diseases. Recent internal comments from the Global Fund suggest an intention to focus more on these diseases, and to leave the strengthening of health systems and support for the health workforce to others. This article, in PLoS Med, examines the implications of this strategy, and suggests that it could create a ‘Medicines without Doctors’ situation in which the medicines to fight AIDS, tuberculosis, and malaria are available, but not the doctors or the nurses to prescribe those medicines adequately.
The state of nursing practice in SSA appears to have been impacted negatively by migration. Available (though inadequate) quantitative data on stocks and flows, qualitative information on migration issues and trends, and on the main strategies being employed in both source and recipient countries indicate that the problem is likely to grow over the next 5–10 years. the paper reports that multiple actions are needed at various policy levels in both source and receiving countries to moderate negative effects of nurse emigration in developing countries in Africa; however, critically, source countries must establish more effective policies and strategies.
Many countries have health-care providers who are not trained as physicians but who take on many of the diagnostic and clinical functions of medical doctors. These non-physician clinicians (NPCs) were found in 25 of 47 countries in sub-Saharan Africa, although their roles varied widely between countries. In nine countries, numbers of NPCs equalled or exceeded numbers of physicians. In general NPCs were trained with less cost than were physicians, and for only 3–4 years after secondary school. All NPCs did basic diagnosis and medical treatment, but some were trained in specialty activities such as caesarean section, ophthalmology and anaesthesia. Many NPCs were recruited from rural and poor areas, and worked in these same regions. Low training costs, reduced training duration, and success in rural placements suggest that NPCs could have substantial roles in the scale-up of health workforces in sub-Saharan African countries, including for the planned expansion of HIV/AIDS prevention and treatment programmes.
There is growing concern globally at the current flows of nurse migration, particularly from low-income to middle and high-income countries. Recruitment practices of many countries such as Ireland are thought to be fuelling this rate of migration. This paper aims to establish the perceptions and opinions of those involved in the recruitment process on their role in recruitment and the effects recruitment has on both source and destination countries. A purposive sample of 12 directors of nursing, from major academic teaching hospitals in Dublin and hospitals in South Africa and the Philippines were recruited.
Clinical officers perform much of major emergency surgery in Malawi, in the absence of medical officers. The aim of this study was to validate the advantages and disadvantages of delegation of major obstetric surgery to non-doctors.
Increased international migration of health professionals is weakening healthcare systems in low-income countries, particularly those in sub-Saharan Africa. The migration of nurses, physicians and other health professionals from countries in sub-Saharan Africa poses a major threat to the achievement of health equity in this region. As nurses form the backbone of healthcare systems in many of the affected countries, it is the accelerating migration of nurses that will be most critical over the next few years. 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. Creative policy approaches are required to balance these rights and to ensure that the individual rights of health professionals do not compromise the societal right to health.
9. Public-Private Mix
Advocacy on engaging the private sector in tuberculosis (TB) control is mounting. In the newly launched six-point Stop TB Strategy, WHO makes an urgent appeal to engage private care providers. Even more recently, this was supplanted by a guide on how to involve all care providers in TB control through different Public-Private Mix (PPM) approaches. At the same time the body of evidence on the effectiveness of such approaches, although growing, remains rather weak.
This paper by the AIDS Law Project calls for measures to address inequity in access to private health care services and to regulate costs in the private sector. For this reason regular and accurate information about health financing, service prices and business practices in the private sector is essential in determining both health policy as well as a fair and reasonable price for services and products.
10. Resource allocation and health financing
This report is from a study carried out by the Uganda Coalition for Access to Essential Medicines (UCAEM), to assess the implementation of the Global Fund to fight HIV/AIDS, Malaria and TB in Uganda. The study was specifically designed to offer an analysis of the implementation process and activities of the UGFATMP with the aim of establishing the involvement of key stakeholders particularly CSOs, identify the challenges, document beneficiary perspectives and make recommendations on key CSOs concerns about the process. Despite successes around the world this report reveals that there are still concerns at the country level in Uganda.
The Global Fund to Fight AIDS, Tuberculosis and Malaria has welcomed the latest "endorsement by the G8 leaders of US$6 billion to US$8 billion per year for the Global Fund, a three-fold increase from the current level," as "a strong agreement that makes it possible to defeat" the pandemics.
Whether Governments should charge patients fees to use public health services has become one of the most contentious social policy issues worldwide. Sadly for policy makers, in recent years, the quality of debate in this area has often been poor, with opposing camps usually resorting to unproven theory and emotive rhetoric. Perhaps a new perspective should be brought to this debate. How would the world of business deal with this problem; which in effect, is an issue of what (if any) price one should charge for health services?
Hilary Benn of DFId calls for the global community to deliver better health for poorer people around the world.
11. Equity and HIV/AIDS
The Botswana government began providing free antiretroviral therapy (ART) in 2002 and in 2004 introduced routine HIV testing (RHT) in government health facilities, aiming to increase HIV testing and uptake of ART. This paper reports a household survey of 1536 people in Botswana, asking about use and experience of government health services, views about RHT, views about ART, and testing for HIV in the last 12 months. Public awareness and approval of RHT was very high. The high rate of RHT has contributed to the overall high rate of HIV testing. The government's programme to increase HIV testing and uptake of ART is apparently working well. However, turning the tide of the epidemic will also require further concerted efforts to reduce the rate of new HIV infections.
The roll-out of antiretroviral therapy (ART) in Africa will have significant resource implications arising from its impact on demand for healthcare services. Existing studies of healthcare utilisation on HAART have been conducted in the developed world, where HAART is commenced when HIV illness is less advanced. This paper describes healthcare utilization from program entry by treatment-naïve patients in a peri-urban settlement in South Africa.
The South African Government has outlined detailed plans for antiretroviral (ART) rollout in KwaZulu-Natal Province, but has not created a plan to address treatment accessibility in rural areas in KwaZulu-Natal. This paper calculates the distance that People Living With HIV/AIDS (PLWHA) in rural areas in KwaZulu-Natal would have to travel to receive ART in rural KwaZulu-Natal. The results show that many PLWHA in rural KwaZulu-Natal are unlikely to have access to ART, and that the impact of an additional 37 HCFs on treatment accessibility in rural areas would be less substantial than might be expected. There is a great length to go to reach many PLWHA in rural areas in South Africa, and specifically in KwaZulu-Natal.
This article examines infant feeding intentions of HIV-infected and uninfected women in South Africa, and the appropriateness of their choices according to their home resources. The paper concludes that most HIV infected women did not have the resources for safe replacement feeding, and appropriately chose instead to exclusively breastfeed. Significantly more intending to exclusively breastfeed, rather than replacement feed, adhered to their intention in week one.
A new World Bank report on HIV/AIDS launched in June says the mobilisation of empowered 'grassroots' communities, along with delivering condoms and life-saving treatments, are beginning to slow the pace of the continent's epidemic. According to the new report ultimate success in defeating HIV/AIDS will depend on marshalling effective prevention, care, and treatment, measures to boost 'social immune systems' in African countries - changing beliefs, perceptions, and social and individual behaviors around the disease to reverse the advance of HIV and stop the damage done by AIDS.
This briefing paper provides an overview of the achievements of the 'Unite for Children, Unite against AIDS initiative' in improving prevention of and treatment for HIV and AIDS among children. The report concludes that, while some progress has been made, many children and mothers are not receiving the services and treatments they require. To redress this, significantly more resources are needed, together with policy changes in affected countries. Appendices to the report provide data on all countries’ HIV infection rates and access to services and medicines.
The African Journal of Drug and Alcohol Studies has posted online a issue, providing a compilation of the peer-reviewed literature documenting the existence of injection and non-injection drug use, and the misuse and abuse of alcohol, and their links to HIV transmission in the region. The papers report and review the findings of research from seven countries — Kenya , Mauritius , Nigeria , Rwanda , South Africa , Tanzania , and Zambia — and document the proceedings of two meetings on alcohol and HIV risk behaviors recently held in the region.
12. Governance and participation in health
Are reproductive health and HIV prevention outcomes for young people better when a project makes an explicit effort to involve community members? This briefing paper summarises the findings of a range of studies that have sought to investigate this question. Most evaluations reviewed identify positive effects including empowerment of participants, increased sustainability, greater acceptance of the initiative, and improved knowledge and attitudes. However, while studies that compared programmes that involved communities with standard programmes found these positive effects, some noted little or no differences in young people’s behaviour. The paper also provides references and links to resources on community involvement and youth reproductive health and HIV prevention.
Care of the mentally ill in Botswana is provided at different levels of coverage and sophistication. There is a single mental hospital in the country. Attached to the district hospitals are psychiatric outpatient clinics run by psychiatric nurses and a psychiatrist who visits them on monthly basis. Mental health care in Botswana has gone through a paradigm shift, from the prepenal years, penal years and institutional to community based care, which reflects a philosophy of citizen involvement and collaboration. The purpose of this article is to provide an insight into the developmental trends in community mental health care in Botswana. Different approaches are discussed and the opportunities that have emanated from them.
Severe acute malnutrition remains a major killer of children under five years of age. Until recently, treatment has been restricted to facility based approaches, greatly limiting its coverage and impact. New evidence suggests, however, that large numbers of children with severe acute malnutrition can be treated in their communities without being admitted to a health facility or a therapeutic feeding centre.
This paper in Globalisation and Health assesses progress in the development of a global framework for responding to non-communicable diseases, as reflected in the policies and initiatives of the World Health Organization (WHO), World Bank and the UN. Responding to the global burden of chronic disease requires an assessment of the global processes that are likely to be most effective in generating commitment to policy change at country level. The paper assesses the merits of the Millennium Development Goals and the WHO framework Convention on Tobacco Control (FCTC), and considers that lessons might be learned for enhancing the implementation of the Global Strategy on Diet.
13. Monitoring equity and research policy
Monitoring and evaluation of national antiretroviral therapy (ART) programs is vital, but routine, standardized assessment of national ART patient monitoring systems has not been established. Malawi has undertaken an ambitious ART scale-up effort, with over 57 000 patients initiated on ART by June 2006. This paper reports on an assessment of the national ART monitoring and evaluation system in Malawi to ensure that the response to the epidemic was being monitored efficiently and effectively, and that data collected were useful. It propoises that assessment of ART monitoring and evaluation systems can optimize the effectiveness of national ART programs, and should be considered in other resource-constrained countries rapidly scaling up ART.
Survey data are traditionally collected using pen-and-paper, with double data entry, comparison of entries and reconciliation of discrepancies before data cleaning can commence. We used Personal Digital Assistants (PDAs) for data entry at the point of collection, to save time and enhance the quality of data in a survey of over 21,000 scattered rural households in southern Tanzania.
14. Useful Resources
This publication is presented as a valuable tool for all health care professionals and anyone who needs to evaluate health care options either for their own families or on behalf of their staff, clients or patients. The first part of the book deals with the size and shape of private and public healthcare services, unfolding health care regulations and a description of how all the participants in the industry fit together. It also offers readers a guide to checking on the health of different medical schemes, as well as understanding the details of benefits and options.
15. Jobs and Announcements
The 2007 SADC Peoples’ Summit will be held parallel to the SADC Heads of State Summit in Lusaka, Zambia. Following the successful hosting of the SADC Peoples’ Summit in Maseru in August 2006 - the Southern African Peoples’ Solidarity Network in collaboration with network members and other social movements and people based organizations in the SADC region will be holding a 'People’s Summit' on 15 and 16 August under the Banner 'Reclaiming SADC For Peoples’ Development and Solidarity: Let the People Speak!!!'. The Peoples’ Summit will offer CSO’s and Social Movements and opportunity to consolidate the outcomes of the process launched in 2006.
The Centre for African Family Studies (CAFS) presents the "Resource Mobilisation" training course scheduled to take place in Nairobi, Kenya from 3 to 7 December 2007. This one-week course provides skills for designing, implementing and evaluating an efficient resource mobilisation campaign. With the advent of globalisation and the changing HIV & AIDS paradigm, managers find themselves in a far more competitive environment within which they must secure resources for the growth and sustainability of their organisations and programmes.CAFS invites you and members of your staff, grantees or collaborating partners to apply for admission to this course. The tuition fee for this course is US$1,000, which covers tuition, training materials, supplies and certification awards.
TGNP are pleased to announce that the next Gender Festival on 'African Feminist Struggles in the Context of Globalization' will take place at TGNP's Gender Resource Centre, Mabibo Dar es Salaam Tanzania from 11 to 14 September 2007. Discussions will take into account the present context of corporate-led globalisation and 'free market' ideology, and their impact on development and democracy in Africa and the world over, and examine alternative frameworks and strategies. The deadline for abstracts is 30 June, 2007 and for the final papers is 10 August 2007.
CIHR and its partners are pleased to announce that the 4th annual Partnerships for Health System Improvement (PHSI) competition will be launched mid-July. The PHSI initiative supports teams of researchers and decision makers interested in conducting applied health research useful to health system managers and/or policy makers. Successful teams conduct projects of up to three years duration in high priority thematic areas within health services, health systems and policy research (including public health).
The Collaborative Fund for HIV/AIDS Women and Families in Sub-Saharan Africa calls for submissions of proposals from groups of women groups (non governmental and community based organisations) seeking funding support for Treatment Literacy & Preparedness. The overall objective of this grant is to support initiatives of women-led and/or women PLWHA led organisations especially those that represent specific interests of women living with HIV/AIDS.
A study identifying how project activities have responded to long-term livelihood insecurity and short-term acute need will be discussed at a SARPN, CW and OI two-day experience-sharing workshop to be held in Maputo, Mozambique on 1-2 July 2007. The workshop is targeted at policy makers and influencers, practitioners and researchers from national, regional and international government and non-governmental organisations from the region.
The Global Health Watch is an alternative world health report produced every two and a half years. The aim is to critique and assess the state of global health governance and action with a strong equity lens and with an explicit political and economic critique. One of the forthcoming chapters in the next Watch will be on the Gates Foundation and we are looking for informants, particularly from low and middle income countries, who have any considered views and observations on the Gates Foundation.
The Bill & Melinda Gates Foundation is inviting letters of inquiry (LOIs) from qualified applicants to assist 12 GAVI-eligible countries establish external advisory groups and manage related grants. While this RFP will ultimately yield full proposals, the immediate request is for Letters of Inquiry from qualified applicants with the capability of managing an overall effort to strengthen national decision-making processes in up to 12 countries. On the basis of review of the LOIs, up to three organisations will be invited to begin preparation for submission of a full proposal. Submission of a full proposal will be by invitation only. Deadline for submission is 6 July 2007.
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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