IMF policies are blocking the scale of public spending and hiring of doctors, nurses and teachers African countries need to meet health and development goals. Three recent reports respectively by the IMF’s Independent Evaluation Office (IEO), the Center for Global Development (CGD) and ActionAid International’s Education Team suggest that IMF policies place unreasonable limits to spending of available aid and to scaling-up public spending through overly austere policies that lack empirical justification.
The IMF's mission is to keep inflation under control and promote “macroeconomic stability”. Country access to World Bank aid and other bilateral foreign assistance is contingent upon “thumbs-up” approval from the IMF on macroeconomic policies. The multiplier benefits of major investments in public health and education can take 15 to 20 years to appear in the form of higher GDP growth and productivity rates. Each macroeconomic policy option has its own short-term and long-terms costs and benefits, but because the IMF is always demanding short-term fiscal solvency at any given time, many reasonable alternative macroeconomic policy options for hiring more doctors, nurses and teachers or making long-term investments in the health or education systems are not even being allowed for consideration or debate. So are IMF demands blocking the scale-up of public spending needed to fight AIDS and achieve the Millennium Development Goals (MDGs)? The three reports examine these issues.
The IEO report “The IMF and Aid to Sub-Saharan Africa,” available at http://www.ieo-imf.org/eval/complete/pdf/03122007/report.pdf, examined IMF loan programs to 29 Sub-Saharan African countries from 1999-2005 and found significant percentages of foreign aid were not programmed to be spent because:
* about 37 percent of all annual aid increases were diverted into building international currency reserve levels. Even in countries with sufficient currency reserves, only about $3 of every $10 in annual aid increases was programmed to be spent; the IMF redirected or diverted the remaining $7 out of every $10 into paying domestic debt, building international currency reserves, or both. Having so much new aid not being spent was certainly not the intention of the donors, or citizens in donor countries.
* aid spending was curtailed due to the IMF’s insistence on very low inflation levels. Countries that failed to achieve to 5-7 percent inflation a year were only allowed to spend 15 percent, or just $1.50 of every $10 of their annual aid increases. At a seminar in London in April 2007, Joanne Salop, lead author of the report, said the IEO report team recommended that as the 5-7 percent threshold was the operative IMF policy, it should be publicly stated and clarified - but the IMF Executive Board and management rejected the recommendation.
The IEO report found the IMF Executive Board and senior management were not enthusiastic about donors' emphasis on “poverty reduction” or new efforts to scale-up aid and spending for the MDGs. Without strong leadership directing real policy changes in this regard, the report found, staff simply reverted to prioritising macroeconomic stability over other goals. Yet IMF leadership is overly cautious about deficit spending “crowding out” available credit for the private sector, despite mounting evidence for the reverse, as noted by IMF’s Sanjeev Gupta in a 2006 IMF report (“Macroeconomic challenges of scaling up aid to Africa: a checklist for practitioners,” IMF, 2006. p.26).
The CGD report “Does the IMF Constrain Health Spending in Poor Countries? Evidence and an Agenda for Action,” available at http://www.cgdev.org/doc/IMF/IMF_Report.pdf further explores the implications of this IMF austerity. Produced by fifteen experts from policy-making positions in developing countries, academia, civil society, and multilateral organisations, it reviews experience from Mozambique, Rwanda and Zambia. The report found that: “IMF-supported fiscal programs have often been too conservative or risk-averse”, and have led to underspending of development aid, as they have “not done enough to explore more expansionary, but still feasible, options for higher public spending.” The report calls on the IMF to “explore a broader range of feasible options,” with “less emphasis on negotiating short-term program conditionality.”
The ActionAid International Education Team report “Confronting the Contradictions: The IMF, wage bill caps and the case for teachers,” (http://www.actionaidusa.org/imf_africa.php), found that IMF policies - by varying degrees of influence in setting the level of funds available public sector employees' wages or “wage bill ceilings" - require many poor countries to freeze or curtail teacher recruitment. This leads to persisting chronic and severe teacher shortages. In all three countries studied, inflation-reduction and deficit reduction targets and the wage bill ceiling is too low to allow governments to hire enough teachers to achieve the 40:1 pupil-teacher recommended by the Education for All-Fast-Track Initiative, thereby compromising the quality of education in these countries.
For health and education advocates who are trying desperately to maximize budgets, wages and get every last doctor, nurse and teacher hired, such empirically unfounded economic policy-making is totally unacceptable. An array of reasonable alternative policy options for increasing public spending is being unnecessarily omitted from consideration.
The ActionAid report calls for IMF advice to provide a range of policy options so that governments and other stakeholders – including parliaments and civil society –can make informed choices about macroeconomic policies, wage bills and the level of social spending.
The report also highlights the growing policy contradiction in the foreign aid system: as the richest donor countries try to scale-up spending and foreign aid, they also block the ability of many poor countries to spend that aid because of the IMF loan programs they have approved. A July 4, 2005 New York Times editorial appropriately summarized this current contradiction in donor policies: “There is a desperate need for greater policy coherence in a period when many national governments, including Washington, are sensibly exhorting African governments to spend more on primary health care and education, while international financial institutions largely controlled by those same Western governments have been pressing African countries to shrink their government payrolls, including teachers and health care workers.”
Please send feedback or queries on the issues raised in this briefing to the EQUINET secretariat admin@equinetafrica.org. For further information on this issue please visit www.actionaidusa.org.
1. Editorial
2. Latest Equinet Updates
The purpose of this paper is to explore the interface between HIV and AIDS and food and nutrition security, and the policy and programme implications for a comprehensive strategy to address these issues synergistically. Specifically, this paper examines and compares the policies and programmes related to HIV and AIDS and food and nutrition security that are currently in place in three Eastern Africa countries (Kenya, Tanzania and Uganda) and three Southern Africa countries (Mozambique, South Africa and Zimbabwe) and concludes with elements of a comprehensive approach. This paper is based on a desk review of exisiting policies and programs in each of the six study countries. In addition, key informat interviews were conducted with persons from various government departments, United Nations (UN) agencies and non-governmental organisations (NGOs).
An Economic Partnership Agreement (EPA) is being negotiated between east and southern African countries (ESA) and the European Union (EU). The final agreement is due to be signed in December 2007. The EPA is likely to impact on health, on public revenues for health and health care, including access to medicines, and to affect other inputs to health such as food security. Without a proper health impact assessment these impacts are not easily quantified and ESA countries are urged to take a precautionary approach and safeguard health in the EPA. This policy brief outlines the ways in which the EPA may affect health and the measures that ESA can take to protect health within the EPA. While it is focused on the EU-ESA EPA, these impacts and measures have wider general relevance to trade.
3. Equity in Health
This short paper outlines the perspectives and motivations for the work of the Regional Network for Equity in Health in Eastern and Southern Africa (EQUINET). It presents key areas of work on health equity being implemented to strengthen the state and public sector in health; organised around the active participation and involvement of communities. This includes work on strengthening people's power for health, on increased fair financing, on retaining health workers and challenging trade policies that encroach on health. Such work faces challenges that can be met through increased regional networking to exchange experience, information and expertise, particularly given the demand for learning by doing.
The lack of attention to equity in health, health care and determinants of health is a burden to the attainment of good health in many countries. With this underlying problem as a basis, a series of meetings took place between 1999 and 2000, culminating in the creation of the Global Equity Gauge Alliance (GEGA). GEGA is an international network of groups in developing countries, mainly Asia, AFrica, and Latin America, which develop projects designed to confront and mitigate inequities in health, known as Equity Gauges. Equity Gauges aim to contribute towards the sustained decline in inequities in both the broad sociopolitical determinants of health, as well as inequities in health system. Their approach is based on three broad spheres of action, known as "pillars". Through a series of examples from local or national level gauges, this paper showcases their work promoting the interaction between research and evidence-based policy formulation and implementation, and the interaction between the community and policy makers.
Kofi Annan focused on the progress of Africa in the 5th Nelson Mandela Annual Lecture in Johannesburg, saying it needed to be balanced on three pillars: security, development and human rights. The past secretary-general of the United Nations, said significant progress had been made in Africa in relation to all three of these pillars, yet much still needed to be done. He noted, that more than 300-million people in sub-Saharan Africa live on less than $1 a day, and are “starved not only for food, but for opportunity and hope”. Mr Annan was critical of the imbalances of globalisation, and said the world’s rich needed to help the poor, because “If some of us are poor, we are all poorer.” He further pointed out: “We live in an era of inter dependence … [which] in some ways is more obvious in Africa than anywhere else,” he said.
4. Values, Policies and Rights
Proposed food labelling regulations which aim to help consumers make healthier choices, are set to revolutionise the eating habits of South Africans. The new draft Regulations Relating to the Labelling and Advertising of Foodstuffs, have been published in the Government Gazette by the Department of Health in terms of the Foodstuffs, Cosmetics and Disinfectants Act. They focus on a number of strategies to improve public health, through promoting healthy food choices and improved nutrition by having products which are sold nationally, being labelled with more specifics.
5. Health equity in economic and trade policies
The World Trade Organisation (WTO) has proposed a new plan to unlock global trade talks that have stalled over farm subsidies in rich countries and reluctance by poor nations to further open their markets for Western goods and services without reciprocation from industrialised nations. But analysts who studied the new text warned that it still leaves rich countries' trade protections largely intact, while giving poor nations little in return.
This video debate asks: 'Does the TRIPS agreement strike the right balance between the rights of governments and the rights of patent holders?'
The European Union's only directly elected institution is at loggerheads with the bloc's 27 governments over a measure officially designed to ensure that poor countries have access to affordable medicines. In 2003, the EU helped broker a temporary waiver to the World Trade Organisation's (WTO) agreement on intellectual property rights, which is known by the acronym TRIPS. Meeting on July 17, however, the European Parliament's committee on international trade decided to delay giving its assent to ratification because it is not satisfied that the EU is doing enough to boost the supply of vital drugs to the needy.
Globalisation 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. This first article of a three-part series, describes the origins of the series in work conducted for the Globalization Knowledge Network of the World Health Organization's Commission on Social Determinants of Health and in the Commission's specific concern with health equity. This paper explains the rationale for defining globalisation with reference to the emergence of a global marketplace, and the economic and political choices that have facilitated that emergence. It identifies a number of conceptual milestones in studying the relation between globalisation and SDH over the period 1987–2005, and shows that because globalisation comprises multiple, interacting policy dynamics, reliance on evidence from multiple disciplines (transdisciplinarity) and research methodologies is required. So, too, is explicit recognition of the uncertainties associated with linking globalisation – the quintessential "upstream" variable – with changes in SDH and in health outcomes.
This article is the third in a three-part review of research on globalisation and the social determinants of health (SDH). The third article of the series discusses how interventions to reduce health inequities by way of SDH are inextricably linked with social protection, economic management and development strategy.
This second article of the series identifies and describes several, often interacting clusters of pathways leading from globalisation to changes in SDH that are relevant to health equity. These involve: trade liberalization; the global reorganization of production and labour markets; debt crises and economic restructuring; financial liberalization; urban settings; influences that operate by way of the physical environment; and health systems changed by the global marketplace.
Rwanda plans to import a generic HIV/AIDS medicine made in Canada, making it the first country to test a WTO waiver on drug patents. In a submission to the WTO, the country said it expects over the next two years to buy 260,000 packs of TriAvir, a fixed-dose combination of widely used anti-AIDS drugs lamivudine, zidovudine and nevirapine. The generic product is manufactured in Canada by Apotex Inc. This essentially means Rwanda has invoked a never-before-used August 2003 waiver to WTO's intellectual property rules, meant to allow poor countries with public health problems to import generics when they cannot manufacture the drugs themselves.
The World Trade Organisation's Declaration on the TRIPS Agreement and Public Health (known as the Doha Declaration) of 2001, and subsequent Decision on the Interpretation of Paragraph 6 reached in 2003, affirmed the flexibilities available under the Agreement on Trade Related Property Rights (TRIPS) to member states seeking to protect public health. Despite these important clarifications, the actual implementation of these measures to improve access to medicines remains uncertain. There are also concerns that so-called TRIPS-plus measures within many regional and bilateral trade agreements are further undermining the capacity of the poor to access affordable medicines.
6. Poverty and health
The five-year Millennium Challenge Compact with Lesotho aims to increase water supplies for industrial and domestic use, to mitigate the devastating affects of poor maternal health, HIV/AIDS, tuberculosis and other diseases, and to remove barriers to foreign and local private sector investment. By 2013, the Compact will benefit the majority of the population of 1.8 million due to its broad geographic scope and focus on sectors that impact most Basotho such as health and the provision of potable water.
The five-year $362.6 million grant to Lesotho seeks to increase water supplies for industrial and domestic use, to mitigate the devastating affects of poor maternal health, HIV/AIDS, tuberculosis and other diseases by substantially strengthening the country’s health care infrastructure and human resources for health capacity, and to remove barriers to foreign and local private sector investment. Mozambique’s five-year $506.9 million Millennium Challenge Compact aims to reduce poverty levels through increased incomes and employment by improving water, sanitation, roads, land tenure, and agriculture. This program is expected to benefit about five million Mozambicans by 2015.
Medicins Sans Frontiers comment on limitations in the Millenium Challenge Corporation funding of poverty reduction programmes. They note that the allocation of funding almost entirely to capital costs with no resources for recurrent costs, such as salaries, will constrain implementation in low income countries.
Mortality rates for older persons in Botswana have been unavailable and little is known of predictors of mortality in old age. This study may serve as a precursor for more detailed assessments. The objective was to assess diminished function and lack of social support as indicators of short term risk of death. Older community dwelling persons with diminished cognitive or physical function, solitary daily meals and living in a small household have a significantly increased risk of rapid deterioration and death. Health policy should include measures to strengthen informal support and expand formal service provisions to older persons with poor function and limited social networks in order to prevent premature deaths.
The UN Children's Fund says the children of Zimbabwe have entered a new phase of hardship. UNICEF says millions of children are missing out on their most basic needs because of a severe drought and the dramatic deterioration of Zimbabwe's economy. The unprecedented hardship facing Zimbabwe is biting particularly hard among children and quality health care in the country's schools has all but collapsed.
7. Equitable health services
Implementation of known effective interventions could reduce the malaria burden by half by the year 2010. Identifying geographical disparities of coverage of these interventions at small area level is useful to inform where greatest scale-up efforts should be concentrated. They also provide baseline data against which to compare future scale-up of interventions. However, population data are not always available at local level. This study applied spatial smoothing methods to generate maps at subdistrict level in Malawi to serve such purposes.
This eleventh annual WHO report on Tuberculosis (TB) assesses whether national TB control programmes (NTP) around the world met the 2005 targets of 70 per cent case detection and 85 per cent cure, and examines the effectiveness of the Stop TB strategy. The paper finds that TB is still a major cause of death worldwide, but the global epidemic is on the threshold of decline – in 2005 the TB incidence rate was stable or in decline in all six WHO regions, and had reached a peak worldwide. Most government health services now recognise that TB control must go beyond DOTS (the recommended strategy for controlling TB), however, the broader Stop TB Strategy is not yet fully operational in most countries.
This paper reports on a meeting co-organised by the World Health Organization, UNAIDS and international organisations, to accelerate an effective and joint response to the epidemic of HIV-related tuberculosis (TB). The paper highlights the achievements of the global TB/HIV working group from the Stop TB Partnership, and discusses the concept of universal access to HIV services and its importance and contribution to TB prevention, diagnosis and treatment services. It also highlights some critical issues that have been neglected in the global response to HIV-related TB, including the optimal treatment regimens to use when treating TB and HIV at the same time.
This article reviews the progress made on a three-year tuberculosis (TB)/HIV plan implemented in Malawi between 2003 and 2005. The objectives of the plan were to scale up HIV testing among TB patients and, for HIV-positive TB patients, to provide cotrimoxazole preventive therapy (which provides protection against bacterial infections including pneumonia) and facilitate access to antiretroviral (ARV) treatment. The paper finds that the proportion of TB patients tested for HIV increased from 15 per cent in 2003 to 47 per cent in 2005. During this time, most HIV-positive TB patients started cotrimoxazole preventative therapy.
The level and longevity of protective antibodies elicited by a measles vaccine is significantly shortened by HIV infection in Zambian children. Measles still remains a significant cause of childhood mortality in sub-Saharan Africa despite the availability of a vaccine. Barriers to successful measles control by vaccination include poor logistics and insufficient resources, lack of political will, and HIV/AIDS. Successful measles control in southern Africa with a high HIV prevalence suggests that the HIV epidemic is not a bottleneck to control. The determinants of this success must be identified so that it is replicated in other regions. Specifically, how can a high population immunity be achieved in regions with high HIV prevalence so that measles can be eliminated?
This article reviews how commitments to antiretroviral (ARV) treatment affect tuberculosis (TB) control and sets out the changes needed to address HIV and TB in a coordinated manner. The article examines the burden of HIV and TB in Africa and how the HIV epidemic has challenged the Directly Observed Treatment Strategy (DOTS) as a way of controlling tuberculosis. The authors argue that collaboration between TB and HIV/AIDS treatment programmes is needed, along with a unified public-health vision towards the prevention and treatment of these interacting diseases.
Prompt access to effective treatment is central in the fight against malaria. However, a variety of interlinked factors at household and health system level influence access to timely and appropriate treatment and care. Furthermore, access may be influenced by global and national health policies. As a consequence, many malaria episodes in highly endemic countries are not treated appropriately. The ACCESS Programme is a combination of multiple complementary interventions with a strong evaluation component. With this approach, ACCESS aims to contribute to the development of a more comprehensive access framework and to inform and support public health professionals and policy-makers in the delivery of improved health services.
8. Human Resources
Infant feeding is a subject of worry in prevention of mother to child transmission (PMTCT) programmes in settings where breastfeeding is normative. Nurse-counsellors, expected to counsel HIV-positive women on safer infant feeding methods as defined in national/international guidelines, are faced with a number of challenges. This study aims to explore the experiences and situated concerns of nurses working as infant feeding counsellors to HIV-positive mothers enrolled in PMTCT programmes in the Kilimanjaro region, northern Tanzania.
This report by the White Ribbon Alliance for Safe Motherhood in Tanzania, summarises the key points discussed at a forum exploring the issues impacting on the maternal health crisis in Tanzania. Specifically, the forum looked at the current role and feasibility of promoting the use of community midwives to provide support and guidance for women through all stages of pregnancy, to coordinate services between the facility and community, and to manage the basic health of a community.
This paper aims to quantify the contribution of international health volunteers (IHVs) to the health workforce in sub-Saharan Africa and to explore the perceptions of health service managers regarding these volunteers. The paper found that international health volunteers contribute relatively small numbers to the health workforce in sub-Saharan Africa, and it seems unlikely that they will do more in the future. In areas where they play a role, their contribution to service delivery can be significant.
9. Public-Private Mix
The Global Fund to fight AIDS, Tuberculosis and Malaria was founded on the principle of public-private partnership. It was created with the belief that without the combined efforts of government, civil society and the private sector, the world could not hope to halt the spread of the world's infectious disease. This speech examines some of the contributions made by the private sector in this regard.
The World Health Organization made a unique proposition: what if big donors pooled resources to take out private insurance to pay for vaccines in the case of a bird flu pandemic? WHO Director-General Dr Margaret Chan said WHO had been given more preparation time than it could have hoped for ahead of an influenza pandemic. WHO is using that time to study various financing options to allow low income countries to access vaccines and prevent a pandemic catastrophe that could kill millions of people.
10. Resource allocation and health financing
This report calls for a move from tracking expenditures on specific health programs in an uncoordinated way to coherent and long-term support to improve government budgetary and financial systems in the developing world; to institutionalizing standard approaches to documenting and analyzing health sector expenditures; and to providing more timely, predictable and forward‑looking data on external assistance to the health sector.
This paper estimates the monetary costs of the 19 million unsafe abortions that take place every year around the world. This includes the direct costs of treatment related morbidity and mortality to health systems, and indirect costs to the national economy and households – the cost to women when they suffer from abortion complications whilst they receive treatment and recuperate from such treatment.
About one-third of foreign aid from developed countries is now channelled through or directly to civil society in developing countries. There is a significant change in the way donors give support to civil society, including pooling donor support through national and regional intermediaries; multiple funding agencies and adoption of a variety of support models. Based on a detailed analysis of seven country case studies (Botswana, Lesotho, Malawi, Namibia, South Africa, Zambia and Zimbabwe), the findings challenge the conventional wisdom and advance the civil society agenda in certain key ways.
Uninsured risk has substantial welfare costs, not just in the short run, but also in terms of perpetuating poverty. This paper discusses the scope for extending insurance to the poor, drawing mainly on examples from Latin American and Caribbean countries. It is argued that insurance provision to the poor could play an important role in a comprehensive system of protection against risk, including other ex-ante measures such as promoting credit and savings as insurance, as well as a credible overall ex-post safety net. Insurance provision is best promoted via a partner-agent model, in which a local finance institution with close links to relatively poor communities teams up with an established insurer to deliver low-cost, tailored products, such as life, health, property and weather insurance.The paper also argues for the involvement of local indigenous risk-sharing and finance institutions as intermediaries to maximise the ability to reach the poor and the overall welfare benefits.
The report sets out a Ten Point Plan for achieving the necessary reform of Overseas development aid. It calls on donors and southern governments to make vital changes to improve aid so it can effectively play its role in helping to make poverty history.
This Gender Action report reviews the Multilateral Development Banks (MDB) - World Bank, African Development Bank (AfDB), Asian Development Bank (ADB) and Inter-American Development Bank (IDB) - commitment to promoting reproductive health, preventing HIV and treating AIDS. It analyses the quantity and quality of funding for these issues during 2003-2006.
On 5 July 2007, the World Bank Board of Executive Directors approved an additional International Development Association (IDA) credit of US$60 million for the Government of Tanzania to support the second phase of the Health Sector Development Project. The additional funds will support Tanzania’s Second Health Sector Strategic Plan (HSSP) for an additional two years: 2007-2009. Through this project there will be increased funds for more efficient delivery of essential health services and staffing at district level.
11. Equity and HIV/AIDS
The 4th International AIDS Society (IAS) Conference on HIV Pathogenesis, Treatment and Prevention concluded on 27 July 2007 with a call for anti retroviral drugs developed specifically for HIV-infected children.
Frequent antiretroviral therapy (ART) switches in HIV-infected Kenyan urban adults might limit the efficacy of ART. The authors sound the alarm that this is a potentially serious threat to the sustainability of HIV treatment programmes in Kenya and other developing countries.
International medical and public health journals contain a growing body of writing on the practical and ethical implications of the rationing of antiretroviral (ARV) treatment around the world. The brief title of one important article neatly encapsulates the dilemma facing health professionals: “Which patients first?” Medics in most developing countries talk about “targeting priority patients” in order to emphasise that universal access to ARVs is their ultimate ambition. Campaign groups also avoid the language of rationing because they believe it undercuts their campaigns for ARVs and allows governments to retreat from universal treatment commitments.The truth, however, is that only a small proportion of those who could benefit from ARVs around the world are receiving them.
Treating HIV-infected infants with antiretroviral therapy (ART) as early as possible, within the first six to 12 weeks of life — rather than waiting until they show signs of immunological or clinical deterioration — dramatically decreases their risk of early death, according to findings from the Children with HIV Early Antiretroviral Therapy (CHER) trial, a South African study presented today at the 4th International AIDS Society Conference on HIV Treatment and Pathogenesis in Sydney.
Delegates at a major international conference on HIV and AIDS urged developed countries to help guarantee the supply of affordable drugs to combat the virus and the syndrome. Over 5,000 delegates from 130 countries were in Sydney to attend the Fourth International AIDS Society (IAS 2007) conference featuring the latest developments in HIV biology, pathogenesis, treatment and prevention science. It explored how the gap between research and practice can be bridged, particularly in developing countries that bear the brunt of the HIV pandemic.
ACORD, an Africa-led international alliance working for social justice and equality, aims to prevent the further spread and mitigate the impact of HIV/AIDS through community-based research and advocacy and working in alliance and partnership with others. This publication is documents and disseminates the lessons from research carried out by ACORD in Angola, Uganda and Tanzania.
The World Bank approved a credit of US$80 million for Kenya to expand the coverage of targeted HIV and AIDS interventions to prevent and mitigate the impact of the disease. The Total War Against HIV and AIDS (TOWA) Project will assist Kenya to further reduce the prevalence of HIV/AIDS, which dropped from over 13 percent in 2001 to about 6 percent in 2005, by further strengthening the governance of the National AIDS Control Council (NACC)— the lead agency for designing strategies and overseeing the implementation of programmes to control the pandemic. The programmes include use of grant funds by non-governmental organisations (NGOs) which will be subjected to rigorous and transparent processes of selection, implementation monitoring and performance. This approach includes greater community oversight and blacklisting of NGOs that do not perform.
Global AIDS treatment efforts will fall far short of the G8 goal to reach five million Africans and provide global universal access to AIDS drugs in the next few years unless the pace of treatment scale up accelerates and the effort expands to address key barriers, according to this report. The report provides a 17-country overview of AIDS treatment successes and setbacks and offers an in-depth review of treatment delivery in six countries not covered in the group’s previous reports – Cambodia, China, Malawi, Uganda, Zambia and Zimbabwe.
The new HIV/AIDS drugs recommended by WHO raises the cost for patients by nearly 500%, according to Medecins Sans Frontieres. This could affect the availability of these drugs in developing countries. This finding by MSF was in the latest edition of its report "Untangling the Web of Price Reductions" released at the fourth International AIDS Society Conference, in Sydney, Australia.
To determine differences among persons who provided blood specimens for HIV testing compared with those who did not among those interviewed for the population-based Zimbabwe Young Adult Survey (YAS). When comparing persons who provided specimens for HIV testing with those who did not, few significant differences were found. If those who did not provide specimens had prevalence rates twice that of those who did, overall prevalence would not be substantially affected. Refusal to provide blood specimens does not appear to have contributed to an underestimation of HIV prevalence.
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12. Governance and participation in health
While the Consortium on ’Community Health Promotion’ is suggesting a definition of this new concept to qualify health practices, this article questions the relevance of introducing such a concept since no one has yet succeeded in really differentiating the three existing processes: public health, community health, and health promotion. Based on a literature review and an analysis of the range of practices, these three concepts can be distinguished in terms of their processes and their goals. Public health and community health share a common objective, to improve the health of the population. In order to achieve this objective, public health uses a technocratic process whereas community health uses a participatory one. Health promotion, on the other hand, aims to reduce social inequalities in health through an empowerment process, which is argued to be more effective.
During a microbicide trial feasibility study among women at high-risk of HIV and sexually transmitted infections in Mwanza, northern Tanzania the researchers used participatory research tools to facilitate open dialogue and partnership between researchers and study participants. Participatory techniques were instrumental in promoting meaningful dialogue between the research team, study participants and community representatives in Mwanza, allowing researchers and community representatives to gain a shared understanding of project-related priority areas for intervention.
The provision of appropriate reproductive health care remains one of the main health care challenges in developing countries. The delivery of reproductive health services is continually confronted by challenges from the changing environment, as health sector reforms are implemented, and particularly by decentralisation.
13. Monitoring equity and research policy
Governments world wide are increasingly demanding outcome measures to evaluate research investment. Health and medical research outputs can be considered as gains in knowledge, wealth and health. Measurement of the impacts of research on health are difficult, particularly within the time frames of granting bodies. Thus evaluations often measure what can be measured, rather than what should be measured. Traditional academic metrics are insufficient to demonstrate societal benefit from public investment in health research. New approaches that consider all the benefits of research are needed.
The author developed this framework while conducting an in-depth case study of the safe motherhood initiative and supplemented the findings with research done on AIDS, reproductive health, and other health initiatives. At its core, the framework posits eleven factors under four key categories (actor capability, framing, political opportunities, and issue characteristics) driving the success or failure of health initiatives (i.e. polio eradication, the AIDS movement, etc).
14. Useful Resources
There are currently a large number of indicators being collected and used in the health system. Currently there are a number of problems associated with facility-based indicators. In an attempt to demystify the indicators and to make them more accessible to managers of facilities and to those at higher levels of the system who support facility managers, this booklet has taken the top ten key indicators based on routine facility information and has unpacked them. It is hoped that this publication will make these indicators more easily understandable, will promote greater use of these indicators and will therefore ultimately play a role in improving their quality.
15. Jobs and Announcements
Africa Midwives Research Network invites abstracts for presentation at the 6th Biennial Scientific Conference to be held at Safari Park Hotel in Nairobi , Kenya from 5 th to 9th November 2007. The main theme is "Strengthening research capacity among nurses and midwives: Challenges in utilizing evidence based cost effective interventions in promoting maternal and child health". Sub-themes include 'Health workforce intelligence for maternal and child health policy formulation and program implementation', 'Resource mobilization and equitable allocation for quality maternal and child health care', 'Social determinants of maternal and child survival' and lastly 'Malaria, Tuberculosis, HIV and AIDS in reproductive and child health'. The deadline for submission of abstracts will be 1st August 2007.
The Centre for African Family Studies (CAFS) is pleased to announce its course, "Supervising HIV and AIDS Services" to be held from 20 to 31 August 2007 in Nairobi, Kenya. The purpose of this course is to assist the HIV & AIDS supervisor in using a performance and quality improvement approach to guide, assist, train, and encourage staff to improve their performance and provide high quality health services. It is organised around a step-by-step process, useful for all supervisors, particularly the new supervisor. The process can be used to solve specific performance-related gaps in delivery of HIV & AIDS prevention, treatment care and support services and thereby improve health services. It can also be used to plan and initiate new HIV & AIDS services.
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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