Thirty years after the 1978 Declaration of Alma Ata, it seems the world is still at odds on how best to implement the principles of primary health care. The slow progress in improving health outcomes for all raises questions about the effectiveness of current ways of doing business. A concerted global alliance of global and country actors need to set positive and realistic paths to implement the intentions of Alma Ata.
Sixty years ago, the World Health Organisation (WHO) stated in its constitution that health is a “a state of physical, mental and social wellbeing, not only the absence of disease or infirmity’. Thirty years later, the Alma Ata declaration on Primary Health Care (PHC) among other things declared that “health is a fundamental right” and set a thirteen point understanding to ensure this right. This understanding captured concepts of essential care, universally accessible and affordable to individuals and families in the community through their full participation, in a spirit of self determination. It located PHC as an integral part both of the country’s health system, but involving all related sectors and aspects of national and community development.
The WHO constitution’s definition of health and the Alma Ata declaration together prompt a diametrical but complementary state that need to be concurrently addressed if health is to be attained: The first deals with the clinical determinants of health, pushing for the absence of disease in individuals. The second addresses the determinants of health that predispose or prevent individuals from attaining a state of mental, physical and social wellbeing as a fundamental right. These include appropriate governance, the absence of war, economic and infrastructure development, adequate infrastructure and aid policies. A unique moment occurred in 1978 to bring these complementary understandings together.
Before the ink could dry on the Alma Ata declarations it had, however, already generated polarised antagonism. It was considered too socialist with an excessive preference of government providing state managed intervention. From a capitalist standpoint, it was a ridiculous proposition, too costly and defying economic reasoning. The conservative duo of JA Walsh and KS Warren launched the Selective PHC debate, arguing that it is probably more efficient to save children and limit population growth. The two main PHC proponents, WHO and UNICEF soon drifted apart, as UNICEF promoted a selective package of low cost interventions. With resource flows following selective PHC, Primary Health Care was translated in most countries to mean a basic package of services to be delivered at district and community levels based on a selected number of interventions with some outreach services, with a watered down district health strengthening based on this.
Why nobody asked at the time whether there was any moral significance to be attached to a person’s life or pointed out that choices based on state preferences for total health gain can be justified over financial resource allocation efficiency is difficult to comprehend. Aside from efficiency based arguments being ridiculous propositions founded on utility based preference or embodying unattractive equity assumptions; the economic bargain in a healthy population should at least have also appealed to responsible international choice.
Alot has since been achieved from the advance in technology in dealing with specific clinical determinants of specific diseases. It could be argued that a saturation point has been reached, where increases in financial and human investments in existing technologies are yielding less than proportional gains. Despite this the selective interventions approach continues to define health and health services delivery. It was given a new lease on life by the World Bank through its World Development Report 1993, ‘Investing in Health’. This report, which hardly acknowledged PHC, commoditised and delinked health from development and moved the world closer to the interventionist approach to health – intervening at a selective point in the epidemiology of a disease or health system.
This approach has since had wide global appeal. Currently there are over thirty WHO resolutions on AIDS, TB or Malaria alone, more than all other subjects. The health Millennium Development Goals (MDGs) have further entrenched this disease specific approach to resource mobilisation. There are over eighty major global health initiatives linked to the health MDGs, providing over US$ 100 million annually. The Italian Global Health Watch reported in 2008 that the Global Fund has allocated approximately US$ 3.5 billion to countries for interventions on AIDS, TB and Malaria, mainly in Africa. Together, these initiatives have thrown billions of dollars at addressing diseases and improving clinical health conditions and made up a significant part of health sector budgets.
PHC is hardly mentioned in these initiatives. Member States went to sleep on PHC except for anniversaries, and the occasional mention linked to district health system strengthening. For various reasons the world assumed an emergency mode to address what are considered new and urgent public health issues. Single disease interventions that lend themselves to easily recognisable financial accountability, quantitative monitoring and evaluation held greater appeal for funders, especially when twinned with arguments of weak domestic governance and public policy failures and capacity limitations.
While these initiatives on clinical determinants hummed with measurable outcomes on specific diseases, the nexus of poverty and ill health was exacerbated. As a result, inequalities in health have deepened to a significantly greater level than thirty years ago. There is a growing trend in urban slum development, a decline in state services, market failures in privatised economies, growing food insecurity and massive deprivation of rights to health care.
Hence while a lot has been done in the past thirty years to deal with disease in individuals, the unique opportunity provided by the Alma Ata Declaration to also address the determinants of health have largely been lost. Thirty years later we see the costs of this omission in a burden of poverty and disparity related ill health that ill matches the level of knowledge or technological advance achieved globally.
As we approach another anniversary for PHC expectations are high. People expect that their physical and mental health will be promoted in a safe social, economic and political environment. They expect to have quality health systems that provide preventive services, diagnose, treat and manage disease injury, and reduce the severity and repeated occurrence of disease. They do not expect to see wide social and economic disparities in these basic entitlements. In Africa, furthest from delivery on these expectations globally, the Ouagadougou declaration on Primary Health Care issued on April 30th 2008 called for a renewal of the Principles of Primary Health Care and its implementation in developing countries and by the international community.
Such declarations are encouraging. However their implementation calls for resolution of the longstanding debate of the past thirty years. These debates are not academic. They present in choices made over the policy measures, relative allocation of institutional, social and financial resources and complementary systems for dealing with the social determinants of health (mostly dealt with by actions outside the health sector) and those reducing the health, social and economic inequalities that arise due to the burden of disease (mostly dealt with within the health sector). There are no clear answers for how a conceptual framework of Primary Health Care in 2008 will address this.
And while there is a massive coalition of global initiatives dealing with diseases, there is no clear coalition of global institutions supporting or funding the determinants of health, the second factor in the PHC equation. At global level, Bretton Wood institutions and OECD initiatives for debt relief and poverty reduction have led in some African countries to short lived increases in spending on health and education, no global initiatives so far adequately address the determinants of health.
This leaves PHC as an orphan with no global home. WHO’s attempt to foster parent PHC is inadequate given the pluralistic global environment. The state of poverty and the winds of change in international health resource priorities will make rational choices among the various dimensions impossible and predispose countries to the dictate of new interventions and their implementation. While the debates over the conceptual understanding of PHC will not end in 2008, at least 2008 could mark the turning point for a new institutional response, that builds a Global Alliance to generate the momentum and support for countries to implement PHC and that generates policy learning based on practice from the bottom up, reminiscent of another basis for the Alma Ata declaration.
A WHO or UN resolution creating such a global alliance would be a befitting PHC birthday gift for the millions of people seeking more than another conference. It will squarely put implementation right at the door step of a recognisable entity that can mobilise the needed funds and support countries with implementation.
Please send feedback or queries on the issues raised in this briefing to the EQUINET secretariat admin@equinetafrica.org.
1. Editorial
Stifled by perennial under-funding, inadequate health care workers and a critical shortage of infrastructure, Uganda’s modest primary health care system has a more significant challenge to contend with – building effective demand among poor and vulnerable people. The Alma Ata declaration on Primary Health Care (PHC) declared health to be a fundamental right, but also observed that this called for full participation of communities in their health services.
Official statistics show, however, that only a third of the population uses the government-supported health system in Uganda – both public and private-not-for-profit. This means that a large share of poor and vulnerable people, including disabled people, families led by single mothers, orphans and internally displaced people, are not reached by public investments in health. They may seek services in private clinics, or buy medication from pharmacies or herbalists, but many poor people are likely to self-medicate at home, or hope for a natural healing process.
This still limited uptake of public sector health services obviously has many roots. The Coalition for Health Promotion and Social Development (HEPS-Uganda), a local health rights civil society organisation, advocates for access to affordable health care and essential medicines, especially for disadvantaged people. The evidence HEPS-Uganda has gathered from the eight of the eighty five districts of the country where it operates suggests that both service providers and users lack awareness of their rights and responsibilities in health. The Uganda Human Rights Commission confirmed this picture in 2007, observing that health rights of many Ugandans are being violated, especially the right to information, dignity and access to essential medicines. This is surely one contributor to the poor use of services, and a barrier to effective organisation of the health system around PHC.
Through its Community Outreach and Health Complaints and Counselling (C&C) programmes, HEPS-Uganda has worked with communities and health providers in eight districts of Uganda to implement initiatives aimed at increasing public and community participation in planning and implementing primary health care, including in the rational use of medicines.
The results have been telling. When expectant mothers in Kamwenge District in western Uganda, in Kawempe Division of the capital Kampala, in the districts of Pallisa and Budaka in eastern Uganda, and in the Lira District in the North of the country have increased their understanding of their health rights and the services that meet them, their uptake of antenatal services and their delivery at health centres under professional supervision has in some cases doubled over a year to eighteen months.
Through the C&C programme, HEPS-Uganda has established an independent feedback mechanism that receives complaints of health rights violations from health consumers, which it then tries to resolve through mediation with health providers and counselling. The process creates awareness of health rights and responsibilities in both sides, and has proved an effective way to identify and improve the whole system, within the community and within the local level health services.
The Uganda Human Rights Commission has observed that the violation of health rights has not been given adequate attention in Uganda. But programmes like HEPS-Uganda’s C&C programme create confidence and hope: Community members can approach health providers in an informed manner and demand the services they are entitled to. On the other side, health providers also recognize their duties and play their roles more effectively. The benefits are tangible for poor communities. In Pallisa and Budaka districts, community representation on health centre management committees is now more effective in the programme areas, and decisions are more responsive to community needs and preferences. Health centres have scrapped illegal charges that consumers have continued to incur across the country, despite government abolishing cost-sharing as far back as 2001. The end result is a more people centred, friendlier health care environment for communities as well as health workers, and the initiative is successfully demonstrating the people’s power in improving their health.
It is not that the country’s policy makers do not appreciate the value of community empowerment in the effort to achieve “Health for All”. Uganda is among the countries that adopted the Alma-Ata Declaration 30 years ago, committing itself among other things to a human rights approach to health in which “the people have the right and duty to participate individually and collectively in the planning and implementation of their health care.”
At the country level, the national health policy commits the Government “to ensure that communities are empowered to take responsibility for their own health and well being, and to participate actively in the management of their local health services.”
With ill-health identified in official surveys as the leading cause of high levels of poverty, national development plans, including the Health Sector Strategic Plan and the Poverty Eradication Action Plan, contain planned activities aimed at empowering communities for health.
There are numerous examples of how communities are playing a role in efforts to create a community-based primary health care system. Community drug distributors dispense anti-malarial medicines door-to-door; village health teams mobilise communities for sanitation and HIV prevention and treatment and community members are involved in implementing the “directly-observed treatment” strategy to manage tuberculosis (TB). There have also been policies to entrust management of lower level health units to local governments and to management committees with community representatives.
However, with the exception of the TB management strategy, the performance of the rest of the initiatives still leaves alot to be desired. Other planned activities that would have empowered communities and consolidated the success of those already underway remain at the planning level, nearly a decade since the policy and other development plans were published. For example, there has not been any national programme of community capacity building “for effective participation of health problems, planning of health services, in resource mobilization and in the monitoring of health activities”.
Uganda has made the important step of guaranteeing a minimum health care package, but with minimal resources. It is trying to attain universal access to primary health care, but with US$8 per person, instead of the estimate of $34 made by the Macroeconomic Commission on Health. Without effective and collective demand from community level people will carry on ‘making do’ with poorly resourced health systems, and under-using the resources that are applied.
Effective and collective demand calls, however, for a system that involves the intended beneficiaries in planning and implementation, and for an informed and empowered community, able to demand and use the services it needs. In a resource poor setting like Uganda, the case for community empowerment for health is even stronger. It is needed in setting priorities, deciding on resource allocation, monitoring the performance of service providers and in building health care seeking behaviours. Government will have to live to its commitment to empower communities health if it is to guarantee their right to quality health care.
Please send feedback or queries on the issues raised in this briefing to the EQUINET secretariat admin@equinetafrica.org.
2. Latest Equinet Updates
The Tanzanian public health sector is losing workers to internal and external migration. This paper examines the implementation of policies to govern non-financial incentives to retain health workers. It examines a range of non-financial incentives, including training; leave; promotion; housing; and a safe and supportive working environment. It also examines the systems for managing personnel and the implementation of incentives as a factor in retention, including the participatory personnel appraisal system; worker participation in discussing their job requirements and welfare; supervision; recognition and respect. Drawing on a review of policy, published and grey literature and on a field stidy of seven districts, including five underserved districts, the paper finds that while a number of incentives exist in policy, their sustainability is eroded by the absence of special earmarked funding for their implementation. Decentralised districts also lack adequate powers and authority to manage health workers weakening their ability to implement non-financial incentives. There was general consensus from health workers and managers that interventions such as training and education, promotion and the provision of safe working and living environments, can be strong motivators if implemented in an effective and sustainable manner. In contrast, health workers interviewed pointed to the demotivating effect of poor implementation of available non-financial incentives. The management and resource barriers to implementing non financial retention incentives are further explored in the paper and recommendations made to strengthen the implementation of incentives. The authors conclude that analysis of issues driving retention needs to take into account both individual and structural factors that shape individual health workers' preference structures and the complex nature of the health care labour market. A trivialised pull and push factors framework in analysing complex problems like retention, will not guide sustainable solutions, which need to be based on an understanding of factors that not only guide the design of incentive regimes, but also the resources, management systems and other factors that enable their implementation in practice.
Parliaments have a significant role to play in ensuring that people are able to access the right to health, that health rights are enshrined in national laws, and that national governments make proper provisions for implementing health rights. This brief sets out the international legal framework for the right to health and the responsibilities of national legislatures in making that right to health real. Parliaments and their committee structures play a key role in the oversight of international human rights commitments, passing and reviewing laws to implement these commitments, overseeing the executive and monitoring implementation of these laws, and in including civil society in such processes.
Public policy can make a difference to people’s health. Health improves with increased wealth. But countries with low per capita national incomes have been able to achieve very high health outcomes when they have directed resources towards primary health care and district health services. Parliaments can contribute to these health outcomes in their debate on, review and approval of government budget allocations and oversight of public spending by the executive. This function is often seen as separate to the legislative role of parliament. But this leaflet argues that in fact, rights and their expression in law can be a powerful tool for parliamentarians when they are arguing the case for increased budget allocations, especially for health, and for these resources to be directed at the areas of health that matter most for equity.
3. Equity in Health
In its report, the Commission calls for increased public finance for programmes and policies to support the social determinants of health, including child development, education, improved living and working conditions and health care, recognising the failure of markets to supply vital goods and services equitably. It also calls for progressive taxation at the national level, a major increase in aid, improved aid quality and greater debt cancellation. It sees an urgent need for a global economic system that supports renewed government leadership to balance public and private sector interests, and identifies quantifying the impact of supra-national political, economic, and social systems on health and health inequities within and between countries as an important research need. Stronger global management of integrated economic activity and social development is needed as a more coherent way to ensure fairer distribution of globalisation's costs and benefits. The entrenched interests of some social groups and countries are seen as ‘barriers to common global flourishing’, and transnational companies should become accountable to the public good, not just to private profit.
This World Health Organisation report takes a broad look at inequality and health. The report issues a call to arms, stressing the need to tackle the inequitable distribution of power, money and resources through better governance, transparency, support for civil society and more equitable economic policies. Some claim the report offers a way out of the ‘sterile debate’ about whether poor health causes poverty, or vice versa. Critics point out that it downplays the link between income (as opposed to inequality) and health. One example of the correlation between money and health is from South Africa, where the health of older people improved after receiving pensions at the age of 65. But whether people are well or sick also depends on factors and policies that lie far beyond the remit of any health minister. For example, the Health Ministry may try to encourage handwashing, but it is unlikely to happen unless there is running water - which is beyond the Ministry’s control.
Publish What You Fund is the Global Campaign for Aid Transparency, which brings together leading NGOs and NGO coalitions to draft a first set of consultation materials – the Publish What You Fund principles, which were released in July 2008. These five principles are designed to be signed by all public and private bodies engaged in funding and delivering aid: 1. Information on aid should be published proactively. 2. Everyone can request and receive information on aid processes. 3. Information on aid should be timely and accessible. 4. Information on aid should be comparable. 5. The right of access to information about aid should be promoted. The principles will be reviewed in the run-up to the Accra High Level Forum, following an initial consultation period.
4. Values, Policies and Rights
Essential medicines must be physically accessible (available), economically accessible (affordable) and must be administered without discrimination. To help ensure this, the HIV Clinical Group at Pretoria University, in conjunction with PIJIP and WCL clinic students, is working to gather widespread NGO support for a submission before the African Commission during its meeting in Abuja, Nigeria from the 10th to the 24th of November. This submission will call upon the African Commission to adopt an interpretation of the right to health under the African Charter, which mirrors the one provided by General Comment 14 to the ICESCR, specifically recognising that access to medicines is a crucial component to the right to health. Furthermore, upon recognising that the right to health includes the components of accessibility, availability, acceptability, and good quality of medicines, the submission will call upon the African Commission, in the future, to use these standards as a means to uniformly monitor the state’s compliance with the right to health.
Adopted in 2005, the Paris Declaration on Aid Effectiveness is the most recent framework on management of development aid assistance agreed by the donor community in the OECD, in partnership with some Southern governments. It aims to contribute to achieving the Millennium Development Goals by 2015. There have been some improvements in recognising the importance of gender equality and women’s rights, such as the Accra Agenda for Action (AAA), which emphasises their central place of poverty reduction and human rights in development policy. The AAA also recognises the need to improve access to sex-disaggregated data but fails to explicitly recognise the need for coherence with international agreements on human rights, gender equality, environmental sustainability and decent work as frameworks for aid relationships. Ultimately, there has been no significant change in direction since 2005.
This paper questions the right of corporations in developed countries to own biological samples of traditional medical knowledge in developing nations. This phenomenon has been referred to as biopiracy or as bioprospecting. Biopiracy is tackled in two international treaties - the Trade-related Aspects of Intellectual Property Rights (TRIPS) agreement and the Convention on Biological Diversity (CBD). But these treaties have different goals: the CBD focuses on protecting biological diversity, while TRIPS promotes private ownership. This paper addresses friction about how to interpret international contracts with embedded biopiracy. It recommends collecting traditional knowledge on publicly accessible databases so that patent offices can determine the real source of knowledge. Patent applicants could also be required to disclose the source of biological material to prevent misappropriation of genetic material. Countries should also strike deals with corporations to obtain fair compensation for use of resources.
In the clinical situation it is difficult to know whether gender differences in management reflect physicians' gender bias or male and female patients' different needs or different ways of expressing their needs. To shed some light on these possibilities this study investigated to what extent it was possible to identify patients' sex when reading their blinded illness narratives, i.e., do male and female patients express themselves differently enough to be recognised as men and women without being categorised beforehand? Eighty-one authentic letters about being diseased by cancer were blinded regarding sex and read by 130 students of medicine and psychology. For each letter the participants were asked to give the author's sex and to explain their choice. The students' explanations for their choice of sex agreed with common gender stereotypes implying that such stereotypes correspond, at least on a group level, to differences in male and female patients' illness descriptions. However, it was also obvious that preconceptions about gender obstructed and biased the interpretations, a finding with implications for the understanding of gender bias in clinical practice.
In September 2008 world leaders convened in Accra, Ghana for Third High-Level Forum on Aid Effectiveness to sign what is now popularly called the Triple A (the Accra Agenda for Action). It is actually a prepackaged condensation of evaluations of implementation of the Paris Declaration and consultations about them conducted between 2006 and 2008 in all the regions of the world. It charts the broad actions that will occupy many development actors between now and December 2011 when the Fourth High Level Forum on Aid Effectiveness takes place. This paper attempts to show how and why the text of the Triple A had to be different from the Paris Declaration and notes that gender is absent from the agenda. The custodians of the Paris declaration say the Triple A does not overtake, override nor overwrite the Paris Declaration. The former only reasserts the latter, which does not help gender issues.
The overriding message of this guide is that human rights are not merely add-ons or luxuries that only a few countries may be able to afford – they must be integral to developing health workforce strategies in all countries. Plans should be accountable to human rights obligations and other health goals and commitments. Broad participation in developing the plan will help ensure that it is accountable to those it serves. Planners may need to provide incentives for health workers to stay and should make sure their response to the health workforce crisis is comprehensive, covering aspects of the workforce such as numbers, distribution, quality of training, productivity, management, and information systems. Finally, health workforce strategies must be sustainable, so that countries provide their populations with ever-improving levels of health services, and maintain and enhance commitments to equality. This requires setting priorities that will ensure that essential health services, including those in underserved areas, can continue even if there are funding shortfalls beyond the country’s control.
5. Health equity in economic and trade policies
The Brazilian Patent Office has rejected a patent application by Gilead on the drug tenofovir disoproxil fumarate (TDF), in a move that could increase access to a key HIV/AIDS medicine across the developing world. The decision means that the medicine can now be produced by Brazilian generic companies or imported from other generic sources from abroad. This is the first time that a patent related to an antiretroviral (ARV) medicine has been rejected as a result of a pre-grant opposition in Brazil. The patent office in Brazil rejected it on the grounds that it lacks inventiveness – one of the key requirements for a patent in Brazilian and international patent law. The consequences extend far beyond Brazil’s borders and may set a precedent for other developing nations.
The behaviour of China and India as development partners is changing the global aid picture, most importantly in Africa. Welcomed by African governments as alternative sources of development finance to the West, they have modelled their development finance on a framework of concessional loans and aid for resource security and infrastructure reconstruction. But their development assistance remains negligible, compared to the DAC and multilateral donors, who remain Africa’s main development partners. Until fairly recently, both countries have received large Overseas Development Assistance (ODA) disbursements. Conflicting definitions of aid as co-operation or ODA, offered by the Chinese government and well positioned academic sources, reflect a lack of clarity in Chinese foreign aid policy. Trying to pigeon hole or compartmentalise aid policies in each country into neatly defined boxes proves difficult, particularly as China and India’s donor activities in Africa are often inextricably viewed together with commercial interests and investment projects.
Africa’s share of world trade declined from 5.5% in 1980 to 2% in 2003, with an overwhelming dependency on trade with the EU (European Union). Trade policies have a critical role to play in supporting economic development across Africa. These policies are increasingly set through agreements in international arenas. Whilst the World Trade Organisation has set trade rules that have implications for African countries, it is a new generation of bilateral/regional trade and investment agreements that will critically determine the types of trade and wider economic policies that governments can use to support development. There are widespread and justified fears that the configuration of the EPA negotiating blocs will undermine rather than promote aid effectiveness.
This policy brief assesses the current status of health and trade policies and analyses opposition to liberalizing trade in health care. It conceptualises and contrasts two international policy dialogues. One, typified by UN bodies such as the World Health Organisation, is skeptical - if not hostile - to increased trade in health care, particularly North-South integration. Its policy errs on the side of protectionism and favours an industrial policy approach. The other, operating under World Trade Organisation (WTO) discourse, has more of a free trade bent. And yet, in policy practice, few countries in the WTO trade in health care and trade agreements typically contain little to promote liberalisation. Examples in this study from those few (mainly developing) countries that have shown initiative towards trade in health care contradict this negative and apathetic approach. Countries as diverse as Brazil, China, Cuba, India and South Africa are already significant exporters of health care. Trade does hold some very tangible benefits for this sector, for North and South alike, and does not necessarily entail undermining government regulatory power. Further analysis of different health care systems’ trade-compatibility is needed.
This article discusses African countries and the second generation of ‘emerging market’ countries. Eight countries in sub-Saharan Africa have been deemed to meet the ‘emerging market’ criteria by the International Finance Corporation: Botswana, Ghana, Kenya, Mozambique, Nigeria, Tanzania, Uganda and Zambia. The rise of some African countries to emerging market status gives them great economic opportunity. The article looks at ways to determine a countries growth prospects, depending on whether a country is resource-rich or resource-scarce.
6. Poverty and health
The UN Secretary-General has warned in a new report that the gains made in reducing extreme poverty are under threat from the rise in global food and fuel prices and global economic slowdown. According to World Bank data, the number of extreme poor has fallen – from 1.8 billion to 1.4 billion – between 1990 and 2005, with the biggest gains made in eastern Asia, in particular, China. In sub-Saharan Africa and the Commonwealth of Independent States, however, the number of poor has increased in the same period. While these figures confirm that the global poverty rate is likely to be halved by 2015 – achieving the first MDG - the UN report indicates that the worldwide increases in food prices will push another 100 million people into absolute poverty.
This paper argues that it is necessary to reverse the trends in aid, and provide a much larger share of aid for productive sector development, including development of rural and urban areas, and the development of agricultural and non-agricultural sectors. Although urban centres mostly host non-agricultural industries, sustainable urbanisation also strongly depends on what happens in the agricultural sectors. Productive employment opportunities in rural areas are important to combat an unsustainable migration from rural areas to urban centres, and productive employment opportunities in urban centres are essential to absorb the rapidly increasing labour force in the non-agricultural sector. Successful urban development cannot be separated from successful rural development.
Should social protection be universal (provided to everyone) or targeted (restricted to certain groups, like the poor)? Universal programmes reduce the likelihood of excluding those who need them. But programmes such as food subsidies are expensive, and a considerable share of their benefits tends to flow to people who do not need them. Evidence suggests that in terms of reaching the poor, targeted cash transfer programs tend to perform better than untargeted subsidies. But choosing to target requires deciding who should be targeted and how. Ways of doing this include 1) means testing, which has worked reasonably well in South Africa's cash transfer programs; 2) selection by community-based committees, which has worked well on a pilot basis in Zambia and Malawi; 3) targeting categorically by characteristics such as region or age - such as old-age pensions in South Africa that have been shown to improve children's education (increasing attendance by 20-25%) and nutrition (increasing child height-for-age by approximately 1-5 centimeters); and 4) self targeting, where anyone can participate but the poorest tend to self-select, which has worked well in public works programs in many countries. The optimal method depends on the programme objectives, administrative capacity, and social characteristics of communities.
7. Equitable health services
This paper assesses the progress towards meeting the goals of the African Regional Strategic Plan of the Expanded Programme on Immunisation between 2001 and 2005. These goals include: to interrupt the circulation of wild polio virus in all countries; eliminate maternal and neonatal tetanus in all high-risk districts; 80% of the countries to have reached at least 80% diphtheria-tetanus-pertissus-3 (DTP-3) coverage; and measles to be controlled and eliminated in Southern Africa. The paper finds that although more infants had been immunised by 2005, most of the targets had been missed by at least half of the region’s countries. The authors estimate that DTP-3 coverage increased from 54% in 2000 to 69% in 2004, and as a result the number of non-immunised children declined from 1.4 million in 2002 to 900,000 in 2004. Reported measles cases dropped from 520,000 in 2000 to 316,000 in 2005 and mortality was reduced by approximately 60%. The paper concludes that the rates of immunisation coverage are improving dramatically in the WHO African region. The huge increases in spending on immunisation and the related improvements in programme performance are linked predominantly to increases in donor funding.
Kenyan health activists last week slammed the country’s proposed anti-counterfeiting law, saying that provisions had been slipped into it to prevent the importation of cheap generic medicines. They say the Kenya Anti-Counterfeit Bill 2008 does not distinguish between medicines and ordinary items such items as pens, DVDs and batteries, and also contravenes the provisions of the 2001 Industrial Property Act (IPA), which paved the way for the widespread use of generic ARVs to manage HIV/AIDS. The Bill contains various ambiguities, which, if misinterpreted or abused, would be detrimental to the government’s ongoing efforts to ensure access to essential medicines for all Kenyans. These ambiguities should be addressed in order to ensure that interested parties, including the multinational pharmaceutical industry, do not misuse the Bill as a front to discriminate against more affordable generic competition.
Is scaled-up investment in HIV/AIDS programmes strengthening or weakening fragile health systems of developing countries? Among the positive impacts are the increased awareness of and priority given to public health by governments, some primary health care services have been inmproved, services to people living with HIV/AIDS have rapidly expanded, and in many countries infrastructure and laboratories have been strengthened. The effect of AIDS on the health work force has been lessened by the provision of antiretroviral treatment to HIV-infected health care workers, by training, and task-shifting. However, there are concerns about a temporal association between increased AIDS funding and stagnant reproductive health funding, and accusations that scarce personnel are siphoned off from other health care services by offers of better-paying jobs in HIV/AIDS programmes - with limited hard evidence. Because service delivery for AIDS has not reached a level close to Universal Access, countries and development partners must maintain the momentum of investment in HIV/AIDS programmes. At the same time, global action for health is even more underfunded than the response to the HIV epidemic. The real issue is therefore not whether to fund AIDS or health systems, but how to increase funding for both.
This paper aimed to provide a better understanding of obstacles to accessing malaria treatment so as to develop practical and cost-effective interventions. After intensive health education, the biomedical concept of malaria has largely been adopted by the community. At last 80% of the fever cases in children and adults were treated with one of the recommended antimalarials. But only 22.5% of children and 10.5% of adults received prompt and appropriate antimalarial treatment. A clear preference for modern medicine was reflected in frequent use of antimalarials. Yet, case-management and functioning exemption mechanims were far from satisfactory for the main risk group. Private drug retailers played a central role in complementing existing formal health services. Health system factors like these must be tackled urgently to translate the high efficacy of artemisinin-based combination therapy into equitable community-effectiveness and health-impact.
This WHO review examines the implementation of primary health care (PHC) in Africa and identifies strategic interventions needed to cope with challenges facing the health systems in the 21st century. It finds that PHC policy formation had been well articulated in the national health policies by most countries; however, the extent to which PHC policies encompassed equity, community participation, inter-sectoral collaboration and affordability is still questionable. Factors delaying PHC implementation include weak structures, inadequate attention to PHC principles, inadequate resource allocation and inadequate political will. Key recommendations include harmonising health sector reforms with PHC to ensure initiatives promote equity and quality in health services, improving the fairness of financing policies and strategies and service coverage for the poor, and supporting countries to address particular human resource needs through clear articulation of human resources policies, plans, development and strengthening of national management systems and employment policies, as well as to identify and put in place mechanisms for attracting and retaining health personnel.
8. Human Resources
This desk review notes a lack of sex-disaggregated data, which hides the presence of women in the health workforce or misrepresents their work. Gender also influences the structural location of women and men in health occupations, resulting in significant gender differences in terms of employment security, promotion, remuneration etc. These differences are neither static nor universal, so they need to be analysed and monitored in changing national contexts, specific health system circumstances and by other social determinants. Recommendations include monitoring delegation, implementing strategies to address gender inequalities (such as affirmative action and training), halting the gender bias that questions the personal and professional prestige of women health workers and recognising home-based care efforts, which are mostly shouldered by women. Source and recipient countries must do more to retain local nursing staff, and recognise violence in the health work place. Individual efforts by women and men must be constructively and collectively amplified through policy and programme efforts at higher and broader levels in health systems.
Despite a pool of unemployed health staff available in Kenya, staffing levels at most facilities are only 50% and maldistribution of staff has left many people without access to antiretroviral therapy (ART). It typically takes one to two years to fill vacant positions, even when funding is available, so an emergency approach was needed to fast-track hiring and deployment. A stakeholder group was formed to bring together leaders from several sectors to design and implement a fast-track hiring and deployment model to mobilise 830 more health workers. The recruitment process was shortened to less than three months. By providing job orientation and on-time pay checks, the programme increased employee retention and satisfaction. Most active roadblocks to changes in the health workforce policies and systems are 'human' - not technical - stemming from a lack of leadership, a problem-solving mindset and the alignment of stakeholders from several sectors. Strengthening appointment on merit is a powerful, yet simple way to improve the image and efficiency of the health sector and governments. The quality and integrity of the public health sector can be improved only through professionalising human resources (HR), reformulating and consolidating fragmented HR functions, and bringing all pieces together under the authority and influence of HR departments and units with expanded scopes. HR staff must be specialists with strategic HR functions and not generalists who are confined to playing a restricted and bureaucratic role.
The Voluntary Code of Ethical Conduct for the Recruitment of Foreign-Educated Nurses to the United States reflects the mutual recognition of stakeholder interests relevant to the recruitment of foreign-educated nurses (FENs) to the United States. It is based on an acknowledgement of the rights of individuals to migrate, as well as an understanding that the legitimate interests and responsibilities of nurses, source countries, and employers in the destination country may conflict. It affirms that a careful balancing of those individual and collective interests offers the best course for maximising the benefits and reducing the potential harm to all parties. While it acknowledges the interests of these three primary stakeholder groups, its subscribers are the organisations that recruit and employ foreign educated nurses, namely, third party recruiting firms, staffing agencies, hospitals, long-term care organisations and health systems.
From 29 March 2008, when Zimbabweans voted in the presidential and parliamentary elections, to 27 June when the presidential run-off election was held, Zimbabwe was hit by successive waves of gruesome political violence. The greatest intensity was in the rural provinces of east and central Mashonaland, but, as 27 June approached, violence engulfed urban areas and the numbers of victims of political violence increased. The world’s attention was on the political nature of the violence, and little focus was given to medical professionals, who risked their lives to assist the victims of political violence. The latest political violence occurred when Zimbabwe was already in dire economic difficulties that had adversely affected the health sector.
9. Public-Private Mix
The UN Secretary-General’s report ‘Delivering on the Global Partnerships for Achieving the Millennium Development Goals’ highlights large gaps in the availability of medicines in the public and private sectors, as well as a wide variation in prices which render essential medicines unaffordable to poor people. The report describes progress towards achieving MDG8 (develop a global partnership for development) and its related targets in the areas of essential medicines, official development assistance, trade, external debt and technology. In cooperation with pharmaceutical companies, access to affordable essential medicines in developing countries was measured using nine indicators and data collected by WHO and its partners. The report found that, in the public sector, generic medicines are only available in 34.9% of facilities, at on average cost 250% more than the international reference price. In the private sector, those same medicines are available in 63.2% of facilities, but cost about 650% more than the international reference price. While policies that promote access such as generic substitution are in place in many countries, more national and international effort is needed to improve the availability and affordability of medicines.
10. Resource allocation and health financing
African church leaders have expressed fear that the interests of the poor are not reflected in draft documents produced for Accra High-Level Forum on Aid Effectiveness. Half of all aid comes in the form of expensive consultants responding to directives from donors. Local communities must have a greater role in making decisions that ultimately affect their lives the most. Imposed conditions of international donors continue to undermine democratic ownership of aid. Rich country governments are behaving shamefully in tying aid to promoting their own economic interests. Requiring food aid be supplied by Northern producers in the current food crisis is immoral. Aid should not benefit the rich while the poor go hungry. Churches and faith-based organisations are major providers of health, education and other social services in developing countries; as such they must be recognised as partners in delivering development aid.
Developing countries reliant on aid want to escape from this dependence, and yet they appear unable to do so. This book shows how developing countries can liberate themselves from aid that pretends to be developmental but is not. Exiting aid dependence should be at the top of the political agenda of all countries. The Third High-Level Forum on Aid Effectiveness was promoted as helping ‘developing countries and marginalised people in their fight against poverty by making aid more transparent, accountable and results-oriented'. This book cautions developing countries against endorsing the agenda proposed at this meeting. If adopted, it would subject recipients to a discipline of collective control by the donors right up to the village level. This will especially affect present donor-dependent countries - particularly poorer countries in Africa, Asia and the Caribbean.
The performance of donors and recipient countries for delivery and use of aid undermine its potential to do good. Some conditionalities imposed to aid recipient countries, like Mozambique, reduce the extent to which it can contribute to poverty reduction and achieve the MDGs - by forcing governments to implement policies that lead to unemployment, declining public services and reduced capacity by citizens to access basic services. On the other hand, Mozambique still faces challenges in ensuring good governance, adequate institutional capacity and coordination of activities at different levels. Corruption practices without an appropriate mechanism for imputing responsibilities, lack of coordination across sectors and weak institutions and systems combined with the absence or weak donors’ coordination and harmonisation practices undermine the full potential of aid.
The Accra high-level meeting on aid effectiveness comes at a critical juncture for the international community, with the global economy beset by the food and energy crises, and the financial market slowdown that threaten to set back hard-won gains in poverty alleviation. The 2005 Paris Declaration on Aid Effectiveness is a first step in establishing a framework for development cooperation, but its implementation is far behind expectations. Only a few genuine partnerships between donor and recipient countries have been created. With attention paid to national ownership and preservation of national policy space, multi- and bilateral donors should prioritise implementing national International Labour Organisation-supported decent-work strategies as part of development cooperation, and should maintain adequate and predictable budget levels for this purpose. Consulting trade unions and other actors in donor and recipient countries is also important in governing aid effectiveness.
This paper looks at the potentially destructive polarisation between 'vertical' financing (aiming for disease-specific results) and 'horizontal' financing (aiming for improved health systems) of health services in developing countries. The authors propose 'diagonal' financing, which aims for disease-specific results through improved health systems to prevent certain diseases from receiving disproportionate resources within a chronically under-funded health system. Rather, specific interventions should drive improvements in the health system, tackling the wide-reaching problems of human resource development, financing, facility planning, drug supply, rational prescription and quality assurance. This would involve the transformation of the Global Fund to fight AIDS, Tuberculosis and Malaria into a Global Health Fund, which requires substantial donor increases and should happen gradually and carefully, accompanied by measures to safeguard its exceptional features.
The author of this book argues that, along with its many benefits, government aid to Africa has often meant more poverty, more hungry people, worse basic services and damage to already precarious democratic institutions. The author proposes that calls for more aid are drowning out pressure for action that would really make a difference for Africa’s poor. Rather than doubling aid to Africa, it is suggested in the book that it is time to reduce the continent's aid dependency.
11. Equity and HIV/AIDS
This paper describes province-wide outcomes and temporal trends of the Western Cape Province antiretroviral treatment (ART) programme five years since inception, to demonstrate the utility of the WHO monitoring system for ART. Data on patients starting ART was prospectively captured into facility-based registers, from which monthly cross-sectional activity and quarterly cohort reports were aggregated. Retention in care, mortality, loss to follow-up and laboratory outcomes were calculated at six-monthly durations. By the end of March 2006, 16,234 patients were in care. Adults starting ART with CD4 counts less than 50 cells/μl fell from 51.3% in 2001 to 21.5% in 2005, while mortality at six months fell from 12.7% to 6.6%, offset in part by an increase in loss to follow-up (reaching 4.7% at six months in 2005). Over 85% of adults tested had viral loads below 400 copies/ml at six-monthly durations until four years on ART. The paper concludes that the location of care in primary-care sites was associated with good retention in care, while scaling-up ART provision was associated with reduced early mortality.
This report presents data on the number of patients accessing ART in both the public and private sectors in Malawi. By the end of March 2008, there were 157 free-standing facilities in Malawi in the public health sector delivering ART free of charge to HIV-positive eligible patients. In the first quarter of 2008 (January to March), there were 17,642 new patients started on ART (39% male, 61% female; 91% adults and 9% children. By the end of March 2008, there were 159,111 patients who had ever started on ART (39% male, 61% female; 92% adults and 8 % children). By the end of March 2008, there were 45 facilities in Malawi in the private health sector delivering ART at a subsidised rate to HIV-positive eligible patients. In the first quarter of 2008 (January to March), there were 669 new patients started on ART (44% male, 56% female, 95% adult, 5% children). By the end of March 2008, there were 6,076 patients who had ever started on ART (51% male, 49% female, 95% adults, 5% children).
HIV prevention has been ongoing in Lusaka for many years. Recent reports suggest a possible decline in HIV sero-incidence in Zambia and some neighbouring countries. This study aimed to examine trends in HIV seroprevalence among pregnant and parturient women between 2002 and 2006. It analysed HIV seroprevalence trends from two Lusaka sources: antenatal data from a city-wide programme to prevent mother-to-child HIV transmission and delivery data from two anonymous unlinked cord-blood surveillances performed in 2003 and again in 2005–2006. For the antenatal data, the HIV seroprevalence among antenatal attendees who were tested declined steadily from 24.5% in the third quarter of 2002 to 21.4% in the last quarter of 2006. For the cord-blood surveillances, overall HIV seroprevalence declined from 25.7% in 2003 to 21.8% in 2005–2006. Among women ≤ 17 years of age, seroprevalence declined from 12.1% to 7.7%.
Current anti-retroviral therapy models are doctor-based and labour-intensive, requiring many qualified staff. Yet countries such as Mozambique, Malawi, Zambia, Rwanda and Tanzania lack sufficient skilled health workers to scale up ART according to these models. This paper considers the kind of model needed for effective scale up of ART programmes in countries which lack skilled health workers. They find that ART delivery involves several types of function requiring different approaches. Good organisation of logistics, supplies and distribution calls for a standardised, centrally controlled or bureaucratic approach. However, a more society-based approach is needed when providing community support to patients. The management of patients who do not fit standardised procedures requires a more professional approach. Finally, care of the individual patient requires a combination of the social and professional approaches.
Uganda's rising HIV prevalence is forcing policy makers to look for inventive ways of educating people about the virus. Their latest tool is mobile phone technology, whose rapid growth has provided an avenue that could potentially reach millions with messages. Text to Change (TTC) , an NGO that uses a bulk short message service (SMS) platform for HIV/AIDS education, recently partnered with the AIDS Information Centre in Uganda and Celtel, a local mobile phone network, to pilot a project in western Uganda aimed at communicating knowledge about the disease and encouraging subscribers to volunteer for HIV testing. The Uganda Communications Commission expects the number of mobile phone users to hit the six million mark by the end of 2008 – however, in urban areas, as many as 50% of people have mobile phones, compared to only 10% in rural areas.
12. Governance and participation in health
The Paris Declaration flags civil society organisations as potential participants in identifying priorities and monitoring development programmes. But it does not recognise them as development actors in their own right, with their own priorities, programmes and partnership arrangements and fails to take into account the rich diversity of social interveners in democratic societies. Human rights principles and standards should be upheld and promoted to achieve Paris Declaration targets and indicators, including scaling up aid, reorganisation of partner countries’ institutions, procedures and national priorities, and meaningful and inclusive citizen-based ownership. As nationally determined priorities become the centerpiece of development assistance, it becomes critical to assess which processes are needed to negotiate them and how legitimate and transparent such processes need be. This requires a focus on the quality of relationships between citizens and states, and the associated processes and mechanisms fundamental to achieving meaningful and inclusive national ownership.
Civil society organisations (CSOs) were present in 2005 when the Paris Declaration (PD) on Aid Effectiveness was signed. Since then, diverse national and international CSOs have engaged in tracking this agreement, raised a range of issues and brought in different perspectives, to ensure the framework translates into effective and accountable development processes. In this paper, they argue that the only true measures of aid effectiveness are its contribution to the sustained reduction of poverty and inequality, and its support of human rights, democracy, environmental sustainability and gender equality. Ownership is essential, but must be democratic. They recommend putting an end to all donor-imposed policy conditionality. Donors and Southern governments must adhere to the highest standards of openness and transparency, and support reforms to make procurement systems more accountable, not more liberalised. Finally, the Accra Agenda for Action must recognise CSOs as development actors in their own right and acknowledge the conditions that enable them to play an effective role in development.
This paper explores the implications of the increasing role of informal as well as formal markets in the health systems of many low and middle-income countries. It focuses on institutional arrangements for making the benefits of expert medical knowledge widely available in the face of the information asymmetries that characterise health care. The paper argues that social arrangements can be understood as a social contract between actors, underpinned by shared behavioural norms, and embedded in a broader political economy. This contract is expressed through a variety of actors and institutions, not just through the formal personnel and arrangements of a health sector. Such an understanding implies that new institutional arrangements, such as the spread of reputation-based trust mechanisms can emerge or be adapted from other parts of the society and economy. The paper examines three relational aspects of health systems: the encounter between patient and provider; mechanisms for generating trust in goods and services in the context of highly marketised systems; and the establishment of socially legitimated regulatory regimes. This analysis is used to review experiences of health system innovation and change from a number of low income and transition countries.
The author of this paper argues that corruption in public procurement is the chief cause of poverty in Africa. It is fostered by poor governance and weak legislation and may be costing the continent up to US$148-billion a year. Yet it can be countered if there is the will and skill to do so. Combatting corruption in public procurement is a multi-faceted problem, which requires a comprehensive package of measures to be implemented concurrently. The author presents proposals for this: The first line of defence is to ensure a sound legal framework that incorporates an anti-corruption law with real authority and effective sanctions. An explicit commitment to eradicate corruption in all forms must be made at the highest level of government. To keep clients and officials accountable, a comprehensive legal and regulatory framework governing public procurement must be implemented. There should be transparency and accountability for all in the bidding process, as well as public service reforms.
Drawing on international best practice, this paper argues that a number of conditions are required to ensure that anti-corruption reforms in any context are effective, sustainable and not easily subverted. These conditions include having the necessary data to inform policy and strategy, comprehensive legal and institutional safeguards to prevent corruption and protect public interest, and the necessary political leadership and will to tackle corruption credibly and put in place long-term reforms. It is clear that to be effective, national anti-corruption/integrity systems require more than a single agency approach. Rather, they need to be supported by an institutional matrix of legal and oversight systems to ensure effective prosecution of offenders. Partnerships, including active engagement by civil society and the media, are also important. Above all, reforms need to be implemented by ethical leaders who scrupulously observe the rule of law.
13. Monitoring equity and research policy
Several prominent demographers and scientists have vigorously refuted Health Minister Manto Tshabalala-Msimang's claim that South Africa's HIV epidemic is declining and that the country 'may be making some real progress in its response to the HIV epidemic'. Tshabalala-Msimang's statement was based on a national survey of HIV prevalence among pregnant women, which researchers are describing as deeply flawed. The authors detected a problem when they noticed that changes in prevalence by age group did not tally with the change in overall prevalence, and that district figures were inconsistent with provincial estimates. They deduced that, in the 2006 survey, the results from district antenatal clinics were simply totalled to derive prevalence estimates for the country's nine provinces, but, in the 2007 survey, the health department began weighting provincial figures according to age groups, based on general population estimates for age distribution.
This paper provides an overview of recent work on measuring the quality of medical care in four low- and middle-income countries: India, Indonesia, Tanzania, and Paraguay. The authors describe methods of testing and watching doctors that are relatively easy to implement and yield important insights about the nature of medical care in these countries. The paper discusses the properties of these measures and how they may be used to evaluate policy change. Finally, it outlines an agenda for further research and quality measurement tools. Researchers found the competence of doctors in low-income countries to be insufficient, quality of patient care is even worse than suggested by doctors' competence levels and the poor have access to worse quality care than the rich, in both public and private sectors. Standard measures of health care quality in low-income countries, which are based on an assessment of physical infrastructure, are inadequate. Further research with better methods of measuring of these aspects of quality is required.
14. Useful Resources
The demographic divide - the inequality in the population and health profiles of rich and poor countries - is widening. Two sharply different patterns of population growth are evident: little growth (or even decline) in most wealthy countries and continued rapid population growth in the world's poorest countries. The Population Reference Bureau has released its 2008 World Population Data Sheet, which provides up-to-date demographic, health and environment data for all countries and major world regions. New on the Data Sheet this year is data on maternal mortality and the percentage of population who are undernourished.
This toolkit by NPower Seattle is for any non-profit employee or manager given the task of managing donors. Non-profit organisations regularly face the challenge of accomplishing a mission with limited resources and high accountability for expenditures regularly considered overhead expenses. Donation and grant-dependent funding often means that ‘success’ becomes the ability to tap into and grow these donor bases as efficiently and effectively as possible, but this is hard if you have limited in-house technology expertise and are tasked with maintaining and managing unusual and detailed data to support your services or have data that is stored in multiple locations that don’t talk with one another. The donor management software in this kit will help you to manage relationships with active and prospective donors by tracking contact information, keeping records of correspondence and donations, managing grant deadlines and producing detailed reports.
The International Federation of Health and Human Rights Organisations promotes the monitoring of health-related human rights, including the right to health. The Federation focuses on the role of health professionals in this regard. It also provides free training material in human rights issues.
As part of its ‘This is Public Health’ campaign, ASPH has developed the ‘This is Public Health’ toolkit to which will serve as a resource for anyone interested in educating others about public health issues or the field of public health. The materials in the toolkit are suggestions or templates, which can either be used as is, or tailored to suit your specific audiences. The toolkit also includes links for other sources that can increase knowledge of public health inside and outside classroom. The toolkit contains information on the 'This is Public Health' campaign and the field as a whole. Materials will be provided that target a range of individuals, accommodating varying age groups and differing levels of familiarity with the field of public health.
In a single electronic platform, the WHO’s Communicable Disease Global Atlas brings together for analysis and comparison standardised data and statistics for infectious diseases at country, regional and global levels. The analysis and interpretation of data are further supported through information on demography, socioeconomic conditions and environmental factors. In so doing, the Atlas specifically acknowledges the broad range of determinants that influence patterns of infectious disease transmission.
15. Jobs and Announcements
The 2008 AC3 Non-governmental Organisations’ (NGO) Conference will be held on 23-October 2008 in Pretoria, South Africa. It will focus on building the organisational capacity of communities to respond effectively to their unique needs. The conference will assist organisations to: build organisational skills, identify other capacity building opportunities, provide learning opportunities to expand existing or new skills, provide an opportunity for organisations to share best practices and serve as a major annual networking opportunity for community-based organisations, non-governmental organisations and faith-based organisations.
This year’s AIDS Vaccine Conference will be held on 13-16 October 2008 in Cape Town, South Africa. It’s an annual event for the exchange of scientific information relating to HIV vaccine research and development. The annual conference is organised under the aegis of the Global HIV Vaccine Enterprise and contributes to the goals of the Enterprise by providing a venue for an international exchange of information in HIV vaccine research and development, cross-fertilising scientific areas of research, increasing coordination and communication among international groups and monitoring progress in the field.
The Global Secretariat of the People’s Health Movement (PHM), jointly with the Secretariat of the Global Health Watch 2 (GHW2), calls upon all PHM country circles and networks to participate in the launching of the GHW2. Global Health Watch is a collaboration of leading popular movements and non-governmental organisations consisting of civil society activists, community groups, health workers and academics. It has compiled the second edition of its alternative to World Health Organisation’s (WHO) World Health Report – a hard-hitting, evidence-based analysis of the political economy of health and health care – as a challenge to major global bodies that influence health. Its monitoring of institutions including the World Bank, WHO and UNICEF reveals that, while some important initiatives are being taken, much more needs to be done to have any hope of meeting the UN’s health-related Millennium Development Goals.
The revised dates for the Conference have now been fixed for 10 to 12 March 2009 at the La Palm Beach Hotel in Accra. The theme of the conference is 'Priorities of Health Economics in Africa'. The conference will cover: User fees; Health insurance and equitable health care financing in Africa; New international health care financing mechanisms and initiatives; Human resources for health in Africa; Economic evaluation of health services in Africa; Measuring health and factors contributing to health; Microeconomic techniques and issues; Preferences and willingness to pay; Economics and financing of AIDS and malaria in Africa; and Health research priorities.
The Info-Activism Camp is organised by Tactical Tech and will be held in India in February 2009. Tactical Tech is an international NGO helping rights advocates use information, communications and digital technologies to maximise the impact of their advocacy work. They provide advocates with guides, tools, training and consultancy to help them develop the skills and tactics they need to increase the impact of their campaigning. The Info-Activism Camp will bring together 120 rights advocates from the global South with technologists, designers and activists for a week-long hands-on workshop to share skills, tools and tactics in digital advocacy.
The University of Melbourne is offering an exciting opportunity for a developing academic leader in Health Financing and Policy to make a difference in poor countries. The Research Fellow will play a major role in establishing a Knowledge Hub in Health Finance and related health policy for low- and middle-income countries in the Asia-Pacific region. This new academic centre will bring together and develop expertise and knowledge on the financing of health services, identify research priorities and potential partner institutions, and link with other academic centres in Australia. The date for first review of applications was 31 August 2008, but late applications are accepted.
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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