The global attention to equity and to Africa has grown. The 2006 United Nations Human Development Report, the 2005 UN Report on the World Social Situation and the 2006 World Bank World Development Review focused on inequalities and equity, while a WHO Commission on the Social Determinants of Health will report in 2008 on a global inquiry into options to improve health equity through action on the social determinants of health. Africa has been the focus of Commissions and special programmes. In 2007, the World Health Organisation Director General stated that improved health in Africa was one of the organisations’ top priorities.
Within Africa, millions of people experience deprivation of the most basic rights to water, shelter and food, millions of children have lost parents due to early adult death, a majority do not have secure incomes and many live in situations of conflict and social disruption. Also within the continent, health workers, teachers and others provide valuable services, state officials and university staff take on intense workloads with limited resources, and civil society and community organisations implement innovative local ways of improving life.
An enormous gap continues to exist between global attention and local reality.
On October 23 2007, EQUINET is launching a new publication- an analysis of equity in health in east and southern Africa. The book, “Reclaiming the resources for health: A Regional analysis of equity in health in east and southern Africa” explores the challenges and options for overcoming persistent inequalities in health in east and southern Africa (ESA). It is written by the EQUINET steering committee and jointly published by EQUINET with three African publishers, Weaver Press Zimbabwe, Fountain Publishers Uganda and Jacana publishers, South Africa.
The book presents a synthesis of the evidence gathered from a range of sources, including eight years of work in EQUINET, published literature on and from the region, data drawn primarily from government, intergovernmental, particularly Africa Union and UN sources and the less commonly documented and heard experience within the region, found in grey literature, in interviews and testimonials and gathered through participatory processes. In the analysis, we do not seek to simply describe our situation, but to understand it in ways that generate and inform affirmative action from within the region.
The evidence in the analysis points to three ways in which “reclaiming” the resources for health can improve health equity:
• for poor people to claim a fairer share of national resources to improve their health;
• for a more just return for ESA countries from the global economy to increase the resources for health; and
• for a larger share of global and national resources to be invested in redistributive health systems to overcome the impoverishing effects of ill health.
The region has the economic and social potential to address its major health needs. Yet improved growth has often occurred with falling human development indicators and increased poverty. In many ESA countries, widening national inequalities in wealth block poor households from the benefits of growth, while substantial resources flow outwards from Africa, leaving most of its people in poverty, and depleting the resources for health. The analysis adds evidence to the growing call for a more fair form of globalisation, and a more just return to Africa from the global economy. The report maps the trade, investment and production policies and measures that have strong public health impact, the options to address outflows, and to promote access to food, health care and medicines within economic and trade policies. National measures that redistribute these resources for wider economic and social gain provide clear pathways for equitable use of funds released from debt cancellation, improved terms of trade, increased external funding and other global measures.
While many of these actions lie outside the health sector, the analysis argues that health systems can make a difference, by providing leadership, shaping wider social norms and values, demonstrating health impacts and promoting work across sectors.
Drawing on a diversity of evidence and experience from the region, the analysis describes the comprehensive, primary health care oriented, people-centred and publicly led health systems that have been found to improve health, particularly for the most disadvantaged people with greatest health needs. While resource scarcities and selective approaches weakened these universal systems in recent decades, the lessons presented from the roll out of prevention and treatment for HIV and AIDS continue to demonstrate their relevance, particularly at district level.
The persistence of disadvantage in access to health care in those with highest health needs is thus of concern. The analysis explores the reasons for this, within the way health systems are funded and organised, and the barriers that disadvantaged people face in using health services.
Addressing these problems demands a strengthened public sector in health. Current average spending on health systems in the region is below the basic costs for a functional health system, or even for the most basic interventions for major public health burdens. Therefore one priority is for governments to meet the as yet largely unmet commitment made in Abuja to 15% of government spending on health, excluding external financing. We argue, however, for “Abuja PLUS” - for international delivery on debt cancellation and for a significantly greater share of this government spending to be allocated to district health systems.
The analysis presents progressive options for mobilising these additional domestic resources for health systems without burdening poor households, and for increasing spending on district and primary health care systems. One of the areas of increased spending is on health workers. Without health workers there is no health system. In the face of massive shortfalls and significant outflows of health workers, the analysis explores incentives countries in the region are using to train, retain and ensure effective and motivated work of health workers, and the strategic capacities and role of health workers in designing and implementing these plans.
These approaches are not without challenge, whether from local elites, competing approaches or global trade pressures. Yet health is a universal human right, and international and regional conventions call for a ‘bottom line’ of rights and obligations to protect people’s health. One basis for the positive potential for achieving equity in health in the region is in the significant social pressure for these goals, and the social resources, networks and capabilities that exist to achieve them. The analysis points to the many ways health systems can act to empower people, stimulate social action and create powerful constituencies to advance public interests in health. Tapping these potentials calls for a robust, systematic form of participatory democracy and a more collectively organised and informed society.
To champion these values, policies and measures, to monitor progress and enhance accountability, the analysis proposes a set of targets and indicators that signal progress in key dimensions of health equity, and towards meeting regional and global commitments. EQUINET, as a network of institutions in the region, is committed to implementing and supporting the building of knowledge, skills and learning to meet these goals.
The analysis is presented as resource for the people, institutions and alliances working in and beyond the region towards goals of improved health and social justice. EQUINET, as a network of institutions within the region, itself remains committed to generating knowledge, facilitating dialogue and analysis, and supporting practice to deliver on these goals within the region.
The book” Reclaiming the Resources for Health” will be available after its launch on 23rd October from EQUINET (admin@equinetafrica.org)or from the publishers in the region (Weaver Press, Fountain Publishers and Jacana). See EQUINET Updates below for contact information. For feedback on this brief please contact the EQUINET secretariat at admin@equinetafrica.org. For further information on the issues raised in this brief please also visit the EQUINET website at www.equinetafrica.org.
1. Editorial
2. Latest Equinet Updates
This report commissioned by EQUINET / HST in co-operation with the ECSA-HC presents a review of literature on the methods for analysis costs and benefits of the migration of health workers from East and Southern African (ESA) countries.
In October 2007 EQUINET has produced a regional equity analysis that offers a comprehensive, yet accessible, resource presented through text, tables, figures, case studies, quotes and images. The evidence in this analysis points to three ways in which ‘reclaiming’ the resources for health can improve health equity:
• for poor people to claim a fairer share of national resources to improve their health;
• for a more just return for east and southernAfrican countries from the global economy to increase the resources for health; and
• for a larger share of global and national resources to be invested in redistributive health systems to overcome the impoverishing effects of ill health.
The book can be obtained from EQUINET by contacting admin@equinetafrica.org or through the publishers in the region, that is Weaver Press weaver@mweb.co.zw; Fountain Publishers (for East African region) sales@fountainpublishers.co.ug and Jacana (for South Africa, Botswana, Lesotho and Swaziland) sales@jacana.co.za.
This report is of the proceedings of a training workshop on policy engagement and advocacy to promote health in trade agreements held in Bagamayo, Tanzania, August 31 and Sep 1 2007. The workshop covered 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.
3. Equity in Health
This article in BMC public health assesses trends in inequities in health and health service utilisation in Malawi using data from the Demographic and Health Surveys (DHS) of 1992, 2000, and 2004. The paper finds that there has been an increase in the levels of pro-rich inequity in infant and under-five mortality rates. This implies that the burden of infant and under-five mortality is getting disproportionately higher among children from the poor than the non-poor households. Inequalities are also observed in the use of interventions including treatment of diarrhoea. In addition, the paper finds that the publicly provided services for some of the selected interventions including child delivery, benefit the non-poor more than the poor.
The Interim Statement sets out the Commission’s vision and goals, the problems it seeks to ameliorate, and the intellectual foundation for a social determinants approach. In doing so, the Interim Statement is a resource for stakeholders concerned with social determinants of health and health equity, as they build towards a global movement. Recommendations for action, based on the evidence gathered across all the Commission’s work streams, will be made in the Final Report in May 2008.
From public rallies in various locations in New York to a meeting of women leaders at the United Nations, Governments and organisations are uniting to launch a new global and unprecedented drive today to slash maternal and child deaths. The "Deliver Now for Women + Children" initiative is a direct response to warnings by the UN that the world is lagging behind in achieving the Millennium Development Goals to cut maternal and child deaths by 2015.
The authors describe how gender inequality damages the physical and mental health of millions of girls and women across the globe, and also of boys and men despite the many tangible benefits it gives men through resources, power, authority and control. Because of the numbers of people involved and the magnitude of the problems, taking action to improve gender equity in health and to address women’s rights to health is one of the most direct and potent ways to reduce health inequities and ensure effective use of health resources. The authors emphasise that deepening and consistently implementing human rights instruments can be a powerful mechanism to motivate and mobilize governments, people and especially women themselves.
4. Values, Policies and Rights
The UN Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health, Paul Hunt, today launched for public consultation a draft 'Human Rights Guidelines for Pharmaceutical Companies in relation to Access to Medicines'. Access to medicines is a central feature of the right to the highest attainable standard of health. States have primary responsibility for enhancing access to medicines, as set out in the expert's report to the UN General Assembly last year (13 September 2006, A/61/338). The Special Rapporteur routinely questions Governments about their national medicines policies and implementation plans.
The Southern African Gender Protocol Alliance[2] has expressed disappointment that SADC leaders failed to sign the Protocol on Gender and Development at the August 2007 summit in Lusaka. Representatives of sixteen regional and national NGOs working to promote the rights of women in the region said they were at a loss as to why heads of state failed to seize the moment of the 2007 summit after the draft had successfully passed through all the preparatory stages. This included endorsement by ministers of gender; justice ministers and the Council of Ministers that generally comprises finance ministers from the region. From their perspective the targets in the Protocol for the achievement of equality between women and men are non-negotiable. The failure this year will only increase their pressure for implementation when the Protocol is finally signed.
Mental disorders affect one person in four in their lifetime, and can be found in 10 per cent of the adult population. It has been estimated that mental disorders and problems will increase by 50 per cent by the year 2020. Yet, according to the WHO: "All countries have to work with limited resources. Too often, prejudice and stigma hamper the development of mental health policies, and are reflected in poor services, low status for care providers and a lack of human rights for mentally ill people." This essay examines the elements of international human rights law directly linked to persons with mental disabilities that are crucial in National mental health legislations. It critically considers the Uganda Mental Health Treatment Act as an example subjecting it to the test of human rights standards as spelled out in the United Nations Human Rights Instruments. The further examines the provisions of this Act from a public health perspective and concludes with recommendations on how the Act can be made better in light of human rights.
5. Health equity in economic and trade policies
This Analytical Note is part of a series of Fact Sheets designed to overview and assess the development implications of the Economic Partnership Agreements (EPAs), which the EU is currently negotiating with 76 countries in Africa, the Caribbean and Pacific (ACP). The purpose of these Fact Sheets is to examine the existing material on EPAs and to provide an analysis of their potential impact on ACP countries. The Fact Sheets seek to increase the understanding of the substantive issues at stake in the negotiations, thereby enabling policy-makers, lobbyists and campaigners to make informed decisions about how to engage with EPAs.
The paper delivers an analytical framework for the assessments of this new sector of international trade which takes into account both the ‘general welfare aspects’ and the effects for the achievement of general ‘health system goals’. Trade in Health Services is split up according to the four modes of service supply introduced by the General Agreement of Trade in Services (GATS). For each mode examples are enclosed and the current level of trade is analysed. It is also examined what are the major obstacles for trade in these modes and what liberalization perspectives are given. The subsequent discussion and plausibility considerations of how each mode may contribute to improve efficiency as well as equity in national health systems is a systematic starting point for further research. It provides a first insight in how trade in Health Services could help to overcome resource constraints in national health systems as well as allude to the potential risks of which sight shouldn’t be lost.
This paper discusses policies that have inhibited the achievement of the Millennium Development Goals in the Southern African Development Community (SADC) regions. Specifically, the paper argues that neo-liberal structural adjustment policies (SAPs) have exacerbated poverty in the region and that there is a need to balance the role of the private and public sector if the MDGs are to be achieved. The paper points to a number of negative experience and outcomes of structural adjustment in the 1980s. It describes that economic growth is stagnant or declining in many countries and poverty is increasing the context of rising inflation and unemployment. In addition, food shortages have increased particularly in Southern Africa, due to the combination of natural and policy related factors, and HIV and AIDS has ravaged the sub-continent. The paper outlines a number of economic alternatives to structural adjustment which have emerged in the region.
Canada’s Access to Medicines Regime is not delivering on the country’s pledge to help developing countries get affordable medicines. The Canadian HIV/AIDS Legal Network recommends a number of changes that will help fix the current, flawed Regime.
Seven ‘first wave’ countries in Africa and Asia will join the new International Health Partnership which is supported by donor governments and agencies. The partnership was launched formally at an event at 10 Downing Street, London. The Prime Minister said: "There is no greater cause than that every man, woman and child in the world should be able to able to benefit from the best medicine and healthcare. And our vision today is that we can triumph over ancient scourges and for the first time in history conquer polio, TB, measles and then with further advances and initiatives, go on to address pneumoccal pneumonia, malaria and eventually HIV/ AIDS.
On Sept 5, the UK Prime Minister Gordon Brown launched the International Health Partnership —a global "compact" for achieving the Health Millennium Development Goals—at a prestigious gathering at number 10 Downing Street. The support for this initiative is impressive. But what does the International Health Partnership (IHP) mean for people living in poorer countries? The IHP is an agreement between donors and developing countries. Global and country level partnerships will set out a process of mutual responsibility and accountability for the development and implementation of the national health plans of developing countries. The overall aim of the IHP is to improve the coverage and use of health services—whether through public or private channels, or through non governmental organisations—in order to deliver improved health outcomes, especially for the health-related MDGs, and other international commitments such as universal access to antiretroviral therapy. The IHP does not provide any new funding.
A group of university students under the group The Journey and Haven Entertainment organised a conscious hip hop festival to oppose the proposed Economic Partnership Agreements (EPAs) between the European Union and Africa. This effort is part of a wider campaign by citizens, farmers' unions, civil society, and religious groups to stop the government from signing the proposed agreement which, according to economists and experts in international trade, are potentially detrimental to the development agenda and may exacerbate poverty in Kenya and other developing countries.
6. Poverty and health
Food security in Africa is likely to be "severely compromised" by climate change, with production expected to halve by 2020, according to climate change experts. The projections in a report by the Intergovernmental Panel on Climate Change (IPCC), said about 25 percent of Africa's population - nearly 200 million people - do not have easy access to water; that figure is expected to jump by another 50 million by 2020 and more than double by the 2050s, according to the report. This year drought-affected parts of southern Africa - Zimbabwe, Swaziland and Lesotho - experienced a 40 percent to 60 percent reduction in maize production, for which global warming was partly to blame, noted the World Meteorological Organisation (WMO). But the IPCC report was more cautious. "The contribution of climate to food insecurity in Africa is still not fully understood, particularly the role of other multiple stresses that enhance impacts of droughts and floods and possible future climate change".
Desperate measures being taken by residents of Bulawayo, Zimbabwe's second city, to cushion the effects of acute water shortages are aggravating the health problems of its 1.5 million residents. Stringent water rationing has been introduced in a bid to make the contents of fast dwindling dams last until the onset of the expected rains in November, but the municipal council acknowledges that the poor inflows of water into the southern city's reservoirs has led to an increase in waterborne diseases.
7. Equitable health services
Rising rates of mental and emotional illness in Zambia are being met with growing levels of stigma and discrimination, with sufferers often isolated by their communities. Nora Mweemba, a health information promotion officer for the World Health Organisation (WHO) in Zambia, told IRIN, "Mental health problems are on the increase among the population in Zambia, mostly because of the socio-economic difficulties that exist in this country - HIV/AIDS, poverty, joblessness - they all precipitate mental problems."
This policy brief by the Chronic Poverty Research Centre, examines the link between mental health and chronic poverty in Uganda. It outlines challenges to implementing effective services for people affected by mental disorders and actions that are needed to promote mental health in the country. The paper shows that mental health and chronic poverty are linked in a vicious cycle of exclusion, poor access to services, low productivity, diminished livelihoods and assets depletion. People with mental disorders in Uganda also experience some of the worst forms of stigma and discrimination linked to lack of awareness, misinformation and stereotyping about their condition.
This paper, published in BMC Public Health, highlights the effects of urban population growth and access to health and social services on progress in achieving Millennium Development Goal (MDG) 4 – to reduce child mortality by two thirds by 2015. The paper examines trends in childhood mortality in sub-Saharan Africa (SSA) in relation to urban population growth, vaccination coverage and access to safe drinking water.
What does the reproductive health (RH) situation among the conflict-affected populations of northern Uganda look like? The Women’s Commission for Refugee Women and Children and the United Nations Population Fund assessed this question in February 2007 and visited the districts of Kitgum and Pader and also a youth center and clinic in Gulu.
8. Human Resources
This paper discusses gender issues manifested within health occupations and across them. It examines gender dynamics in medicine, nursing, community health workers and home carers and explores from a gender perspective issues concerning delegation, migration and violence, which cut across these categories of health workers. Gender plays a critical role in determining the structural location of women and men in the health labour force and their subjective experience of that location. The paper shows that woman are overrepresented in caring, informal, part-time, unskilled and unpaid work and within occupations there are significant gender differences in terms of employment security, promotion, remuneration.
The Health Service Extension Programme (HSEP) is an innovative approach to addressing the shortfall in health human resources in Ethiopia. It has developed a new cadre of Health Extension Workers (HEWs), who are charged with providing the health and hygiene promotion and some treatment services, which together constitute the bedrock of Ethiopia's community health system. This study seeks to explore the experience of the HSEP from the perspective of the community who received the service. A random sample of 60 female heads-of-household in a remote area of Tigray participated in a structured interview survey. While the introduction of HEWs has been a positive experience for women living at the study site, the frequency of visits, extent of effectively imparted health knowledge and affects of HEWs on other health providers needs to be further explored.
This key issues page looks at some of these perceived impacts, and provides recommendations for further reading on the subject of migration and remittances.
Nurses in the public health sector would receive increases of between 20 percent and 88 percent on their starting salaries, Health Minister Manto Tshabalala-Msimang said. The increases, which would be retrospectively introduced from July this year, comes as part of the occupational specific dispensation which would see substantial improvements in the salaries of professionals in the health department and the rest of the civil service over the next few years.
9. Public-Private Mix
The Government of Lesotho, with assistance from the World Bank Group and other development partners, is undertaking a long-term health sector reform program. Replacing the collapsing and only national referral hospital is a major challenge facing the country. To maximize the use of the limited available resources, the Government decided to adopt a PPP model to finance and manage a new replacement hospital. The intention is that partners from the private sector will build, equip and subsequently operate the new hospital before it is eventually turned over to the Government. This initiative, the first of its kind in IDA Sub-Saharan Africa in the public health sector, will have a profound impact on Lesotho’s health sector and its reform program.
Private hospitals are currently not participating in any processes which require the disclosure of the cost to themselves of providing health care services. For this reason, BHF and its members believe that it is necessary and appropriate to call for greater transparency in the area of hospital costs and the setting of hospital fees and prices of medical materials used by hospitals.
10. Resource allocation and health financing
A number of different methodologies will be tested as part of the Risk Equalisation Fund (REF) shadow process in South Africa, according to the Registrar of Medical Schemes Patrick Masobe, under whose control the shadow process falls. The REF is being set up to make sure that all medical scheme members, regardless of their age or state of health, pay the same to access certain basic healthcare benefits. Medical schemes that have a large number of younger and healthier members will have to pay into the REF, while schemes with many older and sicker members will receive payments from the fund.
This research report examines how community organisations responding to HIV can be effectively supported. The report uses case studies to illustrate seven different models for supporting community organisations through a combination of funding, capacity building and networking. These models show the importance of tailoring funding and support according to an organisation’s needs, size and stage of development. These case studies also highlight the importance of providing multi-year funding to allow organisations to grow and the usefulness of horizontal learning and networking. Each of the models have the potential to be replicated or scaled-up.
Mandated jointly by the Government of the Republic of Zambia (GRZ) and the Cooperating Partners (CPs) committed to Poverty Reduction Budget Support (PRBS), the learning assessment (LA), integrated into the Joint Annual Review (JAR) 2007 process, pursued the overall objective of developing practical recommendations on strengthening the effectiveness and efficiency of PRBS-supported programme implementation. The recommendations are based on PRBS experience in general and the 2007 JAR process in particular. The quality of dialogue, performance and accountability was to be specifically assessed. Methodologically, the LA made use of good practices developed elsewhere, observations of JAR sessions, interviews, and written feedback.
Employer-financed health insurance systems, like those used in the United States, distort firms labor demand and adversely affect the economy. Since such costs vary with employment rather than hours worked, firms have an incentive to increase output by increasing worker hours rather than employment. This paper constructs a heterogeneous agent general equilibrium model where individuals differ with respect to their productivity and employment opportunities. The authors generate steady state results for several alternative models for financing health insurance: one in which health insurance is financed primarily through employer contributions that vary with employment; a second where insurance is funded through a non distortionary, lump-sum tax; and a third where insurance is funded by a payroll tax. They further measure the effects of each of the alternatives on output, employment, hours worked and inequality. These findings can be compared with East and Southern African communities that employ such employer-financed health insurance systems.
11. Equity and HIV/AIDS
AIDS drugs, some of them contaminated, diluted, or faked, are being sold at flea markets and hairdressing salons in the face of growing shortages in clinics linked to Zimbabwe's economic crisis, the health ministry said. State media quoted Minister of Health David Parirenyatwa on Monday appealing to people living with HIV or AIDS to buy their medicines from registered pharmacies, clinics, and hospitals only. "These fake drugs increase chances of one becoming resistant to treatment, and it becomes even more expensive for that person to remain on treatment," he was quoted as saying by the official Herald newspaper, which said that the "prohibitive" cost of antiretroviral drugs at private pharmacies had fueled the illegal market.
Between 1990 and 2005, HIV prevalence rates in South Africa jumped from less than 1% to around 29%. Combining ethnographic, demographic and historical insights, this article addresses the important question posed recently by prominent South Africanist scholars: Was Aids in South Africa ‘an epidemic waiting to happen?’ To date, important responses to this question have forefronted the legacy of colonialism and apartheid in order to challenge cultural models that reify an ‘African system of sexuality’ supposedly characterised by sexual permissiveness (for instance as contained in Caldwell, Caldwell and Quiggin, 1989, for a direct critique see Heald, 1995). In particular, the work of social historians has brought to attention the ways in which racial segregation and male migration fuelled an earlier epidemic of syphilis only partially quelled by the introduction of penicillin in the 1950s; moreover, they note how the forces of urbanisation, industrialisation, and Christianisation have long been argued to have destabilised African family structures.
Patients who do not return for follow-up at clinics providing comprehensive HIV/AIDS care require special attention. This is particularly true where resources are limited and clinic loads are high. Data on a sample of patients who failed to return for follow-up were analysed to identify the causes and to plan strategies to overcome the problem.
The latest version of the Missing the Target report on AIDS treatment scale up offers a "no spin" assessment on treatment access -- the successes, challenges, and what needs to change at the national and global levels. The report points out that AIDS treatment delivery represents the best hope to build broader health systems -- but that we are in a new phase of treatment scale up where critical issues beyond simple delivery of ARVs require urgent attention. Governments and global institutions must act on the recommendations in our report to accelerate treatment delivery and address critical challenges in scale up. Without improved efforts, the world will fall short of new G8 AIDS commitments to deliver lifesaving HIV treatment and prevention services.
South African medical experts and activists on Monday warned that poor infection controls in public hospitals have caused dozens of babies to become infected with HIV. Treatment Action Campaign spokesperson Mark Heywood said he was aware of more than 40 such infections. 'The overall lack of inspection control policies, procedures, and budget means that the problem is probably more widespread,' he said. Shaheen Mehtar, head of infection prevention and control at Cape Town's Tygerberg Academic Hospital, said she personally knows of 24 infections in newborns. According to a report in the Cape Times daily newspaper, doctors blame the infections on HIV-tainted expressed breast milk being given to hospitalized babies, the re-use of syringes, and poor sterilization.
This progress report from the World Health Organisation (WHO) shows a steady increase in the global levels of access to antiretroviral therapy (ART) for people living with HIV. However, it shows less improvement in other priority areas of HIV treatment. The coverage rate for access to prophylactic ART by pregnant women, to prevent mother to child transmission of the virus, continues to be low. Similarly, the coverage of HIV counselling services and of interventions directed at intravenous drug users (IDUs) also remain at a low level. The report shows some improvement in the effective monitoring of HIV prevalence.
12. Governance and participation in health
Members of Civil Society Organisations, trade unions, faith based organizations, student bodies and economic justice networks from the SADC region met in Lusaka, Zambia on August 15-16, under the auspices of the Southern Africa Peoples' Solidarity Network (SAPSN), to constitute the SADC People's Summit held parallel to the 27th Heads of State Summit. This document serves as the statement given on their regional theme with respect to civil society.
This Drum Beat is one of a series of commentary and analysis pieces. Getting communication included is an integral element in development programmes, for example improving maternal health. Addressing this challenge needs actions at many levels, all of which entail particular types of communication.
Circumstance, rather than planning, has placed the battle against HIV/AIDS firmly in the hands of Swaziland's 355 chiefdoms. The decentralisation strategy has evolved from government's failure to command the fight against the disease, or even deliver healthcare at its urban hospitals, and much less so in rural areas, where four out of five Swazis live. Swaziland, ruled by sub-Saharan Africa's last absolute monarch, King Mswati III, has a well-established traditional hierarchy, and the use of it to coordinate efforts against HIV/AIDS is being seen as a grassroots-driven solution.
13. Monitoring equity and research policy
Measurement of individuals' costs and outcomes in randomised trials allow uncertainty about cost effectiveness to be quantified. Uncertainty is expressed as probabilities that an intervention is cost effective, and confidence intervals of incremental cost effectiveness ratios. Randomising clusters instead of individuals tends to increase uncertainty but such data are often analysed incorrectly in published studies. The authors used data from a cluster randomized trial to demonstrate five appropriate analytic methods: 1) joint modeling of costs and effects with two-stage non-parametric bootstrap sampling of clusters then individuals, 2) joint modeling of costs and effects with Bayesian hierarchical models and 3) linear regression of net benefits at different willingness to pay levels using a) least squares regression with Huber-White robust adjustment of errors, b) a least squares hierarchical model and c) a Bayesian hierarchical model. All five methods produced similar results, with greater uncertainty than if cluster randomisation was not accounted for. Cost effectiveness analyses alongside cluster randomised trials need to account for study design. Several theoretically coherent methods can be implemented with common statistical software.
This issue of the Lancet publishes two papers of critical interest to child survival. Unfortunately, both have stirred concerns about misuse of data by UN agencies. Here, they review the allegations and try to draw lessons about the place of independent scientific inquiry in the arena of global health policymaking. Greg Fegan and colleagues report the success of an expanded insecticide-treated bednet programme in Kenya . The full paper reveals the strengths and limitations of the study, and provides important estimates of uncertainty. No such statistical caution was expressed in the WHO statement about these data, released on Aug 16. Indeed, WHO claimed that this finding "ends the debate about how to deliver long-lasting insecticidal nets". Yet communications between the Kenyan research team and WHO suggest an ill-considered rush by WHO against the advice of wiser scientific minds.
World health statistics 2007, published by the World Health Organization (WHO), presents the most recent health statistics for WHO’s 193 Member States. The core set of indicators was selected on the basis of their relevance to global health, the availability and quality of the data, and the accuracy and comparability of estimates. The core indicators do not aim to capture all relevant aspects of health but to provide a comprehensive summary of the current status of a population’s health and the health system at country level. These indicators include: mortality outcomes, morbidity outcomes, risk factors, coverage of selected health interventions, health systems, inequalities in health, and demographic and socioeconomic statistics.
14. Useful Resources
This is to announce: Sustainability, Education and the Management of Change in Africa SEMCA; a Community of Practice linking those involved in capacity development SEMCA is dedicated to the transformation of Higher Education in Africa for a new generation of graduates working closely with rural communities to research and produce innovative, sustainable development options and implement changes. This Community of Practice is supported by UNDP. SEMCA is a new community of practice that has been established to assist in linking higher education networks, universities, faculties, graduates, students as well as research, policy, development and other agencies all with an interest in capacity development - making research and education more relevant to both smallholders and to the modern, gobalised, knowledge economy.
15. Jobs and Announcements
About 2.4 million doctors, nurses, and midwives are needed in fifty-seven countries with critical health care shortages. The challenge is greatest in sub-Saharan Africa which has only three percent of the world’s health workers and twenty-four percent of the global burden of disease. There is an increasing recognition that the private sector can strengthen public health systems by offering resources, knowledge, and skills. Duke University will host a conference on November 29-December 1 2007 in Durham , North Carolina , USA , to identify successful and emerging private sector responses to the health care worker shortage.
The Health Economics and HIV/AIDS Research Division (HEARD) based at the University of KwaZulu-Natal in South Africa and the International Development Research Centre (IDRC) based in Canada, invite letters of intent from teams led or co-led by researchers from low- and middle income countries interested in conducting innovative projects exploring the linkages among economic globalisation, growth and HIV/AIDS along two themes: Exploring how HIV/AIDS interacts with efforts to facilitate inclusive or pro-poor growth strategies; and exploring the impacts of economic globalisation and growth on vulnerability and resilience to HIV/AIDS. The initial funding round will support up to five grants at a maximum of Canadian$100,000 (approximately US$90,000) each for one- to two-year projects. The application process is in two stages: letters of intent and then full proposals. Letters of intent will undergo competitive peer review, and successful applicants will be provided with Canadian$2,000 to support development of the full proposal. Full proposals will undergo competitive peer review. The deadline for application is 1 November 2007.
The School of Public Health at the University of the Western Cape has an international reputation as a leading research and teaching institution. It provides health and welfare personnel from developing countries with the opportunity to enhance their capacity to build and strengthen the health sector in their countries. Its open learning postgraduate programme, offering multiple entry and exit points, is unique in Southern Africa. Its educational and research activities focus on the implementation of district health systems. The posts advertised are for a Senior Lecturer and for a Lecturer. The closing date for applications is 30 September 2007.
Established in 2002, the AIDS and Rights Alliance for Southern Africa (ARASA) is a regional partnership of non-governmental organisations working together to promote a human rights based response to HIV/AIDS and tuberculosis (TB) in Southern Africa through capacity building and advocacy. The Regional Secretariat of ARASA is located in Windhoek, Namibia. ARASA seeks to appoint an experienced networker, trainer, advocate and activist with a track record in capacity building and facilitating the involvement of people with HIV/AIDS and TB in advocacy work to assume the position of HIV/TB Programme Training and Advocacy Officer. This position will report to the Co-ordinator of ARASA's Treatment and Prevention Literacy and Advocacy Programme, who is based in Cape Town. Access to good international communications and a willingness to travel extensively are essential. The deadline for applications is 19 October 2007.
The Leadership and Advocacy for Women in Africa (LAWA) Fellowship Program was founded in 1993 at the Georgetown University Law Center in Washington, D.C., in order to train women's human rights lawyers from Africa committed to returning home to their countries to advance the status of women and girls throughout their careers. The LAWA programme is inviting applications for July 2008- August 2009 LAWA Fellowship Program; the deadline for submissions is November 30, 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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