For the health sector, finding new ways of thinking about strategies to address health inequities is critical if achievement of the Millennium Development Goals is to be remotely possible. Over the past few years, the notion that a Framework Convention on Global Health could help to address some of the most fundamental inequities in health at global level, has been gaining ground. First proposed by Larry Gostin, a leading scholar in the field of health and human rights in 2007, the idea that a new model of global health governance could succeed where ethical exhortations and/or appeals to international legal norms have failed, is very attractive. Indeed, it is not only in health that increasing attention is being turned to these 'Framework Conventions'. The Internet Governance Project (IGP), an alliance of academics that focuses on Internet policy and how information and communication technology affects the interests of civil society, also proposed in 2004 the idea of a Framework Convention as an institutional option for internet governance globally.
Is a Framework Convention on Global Health the missing spark in our efforts to address the yawning and seemingly growing health inequalities around the world? Is it possible that such a Framework Convention will provide answers hitherto lacking in the debates and strategies to strengthen equitable people-oriented health systems? To do so, it is first necessary to understand what is meant by a Framework Convention.
To date, there are approximately four existing framework conventions, two better known conventions under the UN machinery, namely, the UN Framework Convention on Climate Change and the WHO Framework Convention on Tobacco Control, and a convention on the Protection of the Ozone Layer, as well as a Council of Europe Framework Convention for the Protection of National Minorities. A framework convention provides a mechanism for international consensus that avoids focus on details that may be contentious and contested and which may bog down negotiations. It rather establishes principles and norms for international action, setting up a procedure for later negotiation of more detailed arrangements. This was evident in the early agreements needed to set up the Global Convention on Climate Change, which is now overseen by the Conference of States Parties to the convention, with subsequent rounds to establish targets globally.
Gostin argued in 2008 that a Framework Convention on Global Health could significantly improve global health governance and would, amongst other goals, “...commit States to a set of targets, both economic and logistic, ...set achievable goals for global health spending as a proportion of Gross National Product,...build sustainable health systems; and create incentives for scientific innovation for affordable vaccines and essential medicines.” However, central to the purported benefits of the Framework Convention is the notion that “governments should care about serious health threats outside their borders” in that such threats pose direct health, economic and security risks.
Is this likely to offer us more leverage than other forms of policy engagement, particularly those using existing international human rights mechanisms related to the right to health, such as, for example, holding governments accountable for core obligations regarding the right to health? The experience in relation to other Framework Agreements is perhaps salutary. Firstly, negotiations to provide teeth to the Framework Convention on Climate Change through the Kyoto protocol remain locked in dispute, despite the agreement on the basic principles in the Framework Convention. Indeed, the huge quantum of effort invested in lobbying, advocacy, research and policy work since adoption of the Convention to support stricter controls of greenhouse gas emissions has remarkably little to show for the years of investment. Secondly, the ability to strike a deal within the UN system relies on careful diplomacy usually guided by the lowest common denominator acceptable to a wide range of national players and networks, usually dominated by rich and powerful nations. The likelihood of the outcome of such a set of circumstances generating a Framework Convention that fundamentally challenges global power relations therefore seems low. Thirdly, whereas the Climate Change and Tobacco Control Framework Conventions challenged interests that were fundamentally corporate-driven, a Framework Convention on Global Health would be essentially directed at nation states. Such states may either be those actors who need to be convinced that their own interests lie in improving the health of populations outside their border, or states whose weak economies and subservient trade relationships undermine the extent of their sovereignty and ability to regulate independently to realise the right to health of their own peoples. In the latter case, the value of such a Framework Convention, which is likely to be replete with general provisions and non-binding targets, appears singularly weak.
However, the most important consideration is really the extent to which a Framework Convention on Global Health is able to strengthen opportunities for civil society engagement and building agency on the part of those most adversely affected by global health inequalities. Inasmuch as Gostin suggests that a Framework Convention on Global Health “would stimulate creative public/private partnerships and actively engage civil society stakeholders,” it is the extent to which such engagement offers meaningful mechanisms for preferentially strengthening the collective agency of the most marginalised groups, within and between countries that will be the test of whether the Framework Convention on Global Health really promotes equity and the right to health, or whether, like much other international policy-making, it proves a nice-sounding but ineffectual sump into which health equity activists invest endless amounts of energy, with not much to show for it.
Please send feedback or queries on the issues raised in this briefing to the EQUINET secretariat admin@equinetafrica.org. For further information on this issue please visit the EQUINET website- www.equinetafrica.org.
1. Editorial
2. Latest Equinet Updates
The fifteen minute pre-recorded show, ‘Health Worker Retention and Migration’, was produced by WWMP, in conjunction with labour journalists in east and southern Africa. It provided an in-depth analysis of the situation for health workers in Africa, and discussed incentives for retaining health workers. In the pre-recorded show, a Khayelitsha nurse who used to work at Groote Schuur hospital in Cape Town and migrated to Saudi Arabia Mavis Mpangele, Bongani Lose from Democratic Nurses of South Africa (DENOSA), Kwabena Otoo from the Ghana Trade union Congress, Joel Odijie from Nigeria Trade Union Congress, Professor Yoswa Dambisya of the University of Limpopo Department of Pharmacy and EQUINET Steering Committee, Nyasha Muchichwa from the Labour and Economic Research Institute of Zimbabwe and Percy Mahlathi, the South African Director General of the Department of Health were interviewed. The feature covers the push factors and experiences from different African countries. The feature also explores government responses to the problem as well as African trade unions response. It rounds off with examples of success stories in Zambia and Tanzania.
Registration for the EQUINET conference is nearly closing. We look forward to welcoming people from government, non state organisations, academic and research institutions, civil society, parliaments, regional and international organisations and other institutions promoting and working on equity in health in east and southern Africa!
Registration information is at register for the conference and the pre and post conference workshops. Visit the conference website for further information and to see the programme outline.
In the DR Congo, where the national HIV prevalence is around 5%, testing and treatment services are more available in urban than rural areas, despite the latter being more affected by the epidemic. In Bunia and Aru, North eastern DRC, people living with HIV and AIDS (PLWHA) cannot access testing or treatment services unless they travel to Bunia town, some distance away. Discrimination from community members towards PLWHA is further identified as a reason for people not coming for HIV testing, and for discouraging other prevention activities. The Pan African Institute of Community Health (IPASC) used a participatory reflection and action (PRA) approach with the concerned rural communities to examine and act on negative perceptions within the community around HIV testing and treatment, to support improved demand for and uptake of these services, to make more effective use of available resources and services. The process targeted male and female PLWHA aged 20-49 years, male and female adolescents 15-19 years, community and church leaders and community health workers because of their vulnerability and influence on attitudes towards HIV and AIDS. Community level barriers (largely stigma) interfaced with service level constraints to diminish testing and treatment coverage. Both users and providers faced barriers. These related to resources (drugs, transport), while the lack of accessible services was a fundamental deterrent. Leaving treatment to late stages when people are ill made this worse, as people found it difficult to make the long journey at that stage. While service factors were not been dealt with in the short time of the intervention, there were improvements in social dialogue on treatment and mechanisms introduced to deal with the community level barriers to testing and treatment. Communities are able to make significant changes in barriers to testing and treatment if organised to do so using participatory processes. Community based sensitisers are an important resource in the community and can produce a measurable change in the attitudes that discourage early testing and treatment.
This report presents the experiences and learning from participatory action research implemented by Country Minders for Peoples Development (CMPD), (a Malawi non government organization) on the co-ordination of support from service providers and community organisations for protection of sexual and reproductive health of orphans and vulnerable children in Monkey Bay, Malawi. The work was implemented within a Regional Network for Equity in Health in east and southern Africa (EQUINET) programme that aimed to explore, through participatory reflection and action (PRA) methods, dimensions of (and impediments to delivery of) Primary Health Care responses to HIV and AIDS. Through baseline and follow up surveys, key informant interviews, focus groups and participatory reflection and action (PRA) meetings the study team led by CMPD identified the health needs and coping strategies of orphans and vulnerable children and their consequent risk of health and SRH problems; mapped the services and resources available for orphans and vulnerable children, and their coverage of and gaps in meeting the identified needs; implemented and assessed the outcomes from actions by local services, community organisations and communities responding to problems prioritised by the community, and drew learning from this work on the factors affecting community level support for vulnerable children that would need to be included in comprehensive primary health care responses to AIDS. The findings suggest that a Primary Health Care approach to AIDS should be embedded within and reinforce a wider social protection strategy that addresses life course needs, such as those of vulnerable children. Significant attention and resource commitment has to be given to promoting outreach and uptake of services and to the intersectoral actions and community organisations that support this, if resources are to be accessed and used by vulnerable groups.
Facing multiple global crises, governments and corporations are arguing that new technologies are the solution to fixing everything from climate chaos to hunger and health problems. What do these new technologies mean for African countries? In which contexts are they being developed? Who controls and who will benefit from them? Are they bringing new impacts to our health, environment and economies? The workshop will feature presentations from ETC group, an international civil society organization based in Canada, and African partners which will explain and introduce the issues, followed by questions and discussions with participants.
Visit the conference website for more details and to register
3. Equity in Health
The current economic downturn will diminish wealth and health, but the impact will be greatest in the developing world. The world can be grateful that health officials are recommitting themselves to primary health care, the surest route to greater equity in access to health care. Much of the blame for the essentially unfair way our world works rests at the policy level. Time and time again, health is a peripheral issue when the policies that shape this world are set. When health policies clash with prospects for economic gain, economic interests trump health concerns. Time and time again, health bears the brunt of short-sighted, narrowly focused policies made in other sectors. Equity in health matters. It matters in life-and-death ways. The HIV/AIDS epidemic taught us this, in a most visible and measurable way. We see just how much equity matters when crises arise.
Deaths of children aged under five years have dropped by 27% globally since 1990, according to the latest WHO estimates. But in WHO’s first progress report on the health-related Millennium Development Goals (MDGs) released today in the World Health Statistics 2009, other results are mixed. An estimated nine million children aged under five years died in 2007, significantly fewer than the 12.5 million estimated to have died in 1990. However, in many African countries and in low-income countries generally, progress has been insufficient to reach the MDG target, which aims for a two-thirds reduction in child mortality by the year 2015. ‘The decline in the death toll of children under five illustrates what can be achieved by strengthening health systems and scaling up interventions,’ said Dr Ties Boerma, Director of WHO’s Department of Health Statistics and Informatics.
The 62nd session of the World Health Assembly took place in Geneva during 18-22 May 2009. At this session, the Health Assembly discussed a number of public health issues, including: pandemic influenza preparedness: sharing of influenza viruses and access to vaccines and other benefits;
implementation of the International Health Regulations; primary health care, including health system strengthening; social determinants of health; and monitoring the achievement of the health-related Millennium Development Goals. The Health Assembly also discussed the programme budget, administration and management matters of WHO. The proceeedings and resolutions can be found at the website provided.
The 62nd session of the World Health Assembly took place in Geneva during 18-22 May 2009. At this session, the Health Assembly discussed a number of public health issues, including pandemic influenza preparedness: sharing of influenza viruses and access to vaccines and other benefits, implementation of the International Health Regulations, primary health care (including health system strengthening), the social determinants of health and monitoring the achievement of the health-related Millennium Development Goals. The Health Assembly also discussed the programme budget, administration and management matters of the World Health Organization.
This paper examines the health status of residents in a major urban centre in Kenya and reviews the effects of selected social determinants on local health. Through field surveys, focus group discussions and a literature review, this study canvasses past and current initiatives and recommends priority actions. Areas identified that unevenly affect the health of the most vulnerable segments of the population were: water supply, sanitation, solid waste management, food environments, housing, the organisation of health care services and transportation. The use of a participatory method proved to be a useful approach that could benefit other urban centres in their analysis of social determinants of health.
The 62nd World Health Assembly in May 2009 adopted a resolution strongly reaffirming the values and principles of primary health care, including equity, solidarity, social justice, universal access to services, multisectoral action and community participation as the basis for strengthening health systems. It calls on WHO to reflect the values and principles of the Declaration of Alma-Ata in its work and that the overall organizational efforts across all levels contribute to the renewal of primary health care and to strengthen the Secretariat’s capacities to support this. Full text is found at the website provided.
The People’s Health Movement has warned that the current global economic recession is a threat to the world’s health. It demands immediate measures by the international community and individual governments to ensure adequate resources to revitalise public health systems, pay urgent attention to the needs of the poor rather than reviving failed big commercial banks, allocate funds for the restoration of jobs and livelihood opportunities in low-income communities and strengthen social welfare programmes in developing countries. It urges those in power not to use the economic crisis downturn as an excuse to cut funds for welfare-related programmes and calls upon the World Health Assembly to adopt the final recommendations of the Commission on Social Determinants of Health immediately.
4. Values, Policies and Rights
This paper reviews the literature on the association between polygyny and women's health in sub-Saharan Africa. It argues that polygyny is an example of ‘co-operative conflict’ within households, with likely implications for the vulnerability of polygynous women to illness, and for their access to treatment. Polygyny is associated with an accelerated transmission of sexually transmitted infections, because it permits a multiplication of sexual partners and correlates with low rates of condom use, poor communication between spouses, and age and power imbalances, among other factors. The paper also examines areas that have so far received only cursory attention: mental health and a premature ‘social’ menopause. Although data is scarce, polygyny seems to be associated with higher levels of anxiety and depression. The examples reviewed here should help build a framework for mixed method quality research to inform policy makers better.
The United States has announced that it will seek a seat this year on the United Nations Human Rights Council. The decision to run reflects the US commitment to helping the Human Rights Council play its intended role as a balanced, credible, and effective forum for the advancement of human rights. Elections to the Human Rights Council are scheduled for 12 May in the UN General Assembly in New York. UN Secretary General Ban Ki-moon welcomed the US decision to join the UN Human Rights Council saying, ‘Full US engagement on human rights issues is an important step toward realising the goal of an inclusive and vibrant intergovernmental process to protect rights around the globe.’
5. Health equity in economic and trade policies
This paper details the extent of what it sees as a burgeoning ‘debt crisis’. With traditional sources of finance drying up, export markets collapsing and a range of other economic impacts, the threat of a renewed debt crisis is very real. Out of the 43 most vulnerable countries, 38 needed at least some debt cancellation to meet their people’s basic needs. Governments with large debt burdens, which are usually denominated in foreign currencies such as the dollar, may struggle to meet the repayment requirements and even default on their debts. Private capital flows to developing countries could fall to around US$165 billion in 2009. The paper recommends canceling more debts, responsible finance and a debt tribunal. Current debt relief initiatives are inflexible, entirely creditor-controlled and wholly inadequate to meet the challenge of the continuing debt crisis.
Applause broke out at the conclusion of the annual World Health Assembly as agreement was reached at the end of a five-year process to devise a plan for boosting research and development on and access to drugs needed by developing countries. Now with the full assembly’s approval, the focus turns to five-year implementation and as-yet unclear ways to pay for it. ‘This is a critical resolution, and we have come a long way to the place we are today,’ committee meeting Chair Stephen McKernan said. The approved global strategy and plan of action on public health, innovation and intellectual property aims by 2015 to train over 500,000 research and development workers, improve research infrastructure, national capacity and technology transfer, and lead to numerous other outcomes such as creating 10 public access compound libraries and 35 new health products (vaccines, diagnostics and medicines).
As poor countries face a possible swine flu pandemic with only enough Tamiflu to treat a tiny fraction of their populations, some experts are calling for a simple but contentious solution: massive production of generics. Indian pharmaceuticals giant Cipla said it would charge about $12 per course of a generic Tamiflu. One course of Roche Tamiflu can sell for up to $100. That has led critics to question why the World Health Organization (WHO) hasn't ordered up batches of generic Tamiflu or encouraged poor countries to do so Some suspect WHO is reluctant to anger drug companies, which supply the agency with stockpiles of drugs, by encouraging the use of generics. Despite WTO rules, Western pharmaceuticals have long fought to keep generics out of the market in all circumstances. There needs to be a better system in place so that WHO does not have to rely on the goodwill and charity of drugmakers to get medicines for poor countries.
The United Nations is the only existing legitimate forum through which the financial crisis can be resolved. The Stiglitz Commission provides a good basis on which new models can be built. In the current financial context, any decrease in aid will push more people into poverty, in particular in the most vulnerable least-developed countries. The cutbacks of aid by some EU member states are already signs that this is happening. It is imperative, therefore, that the fundamental reform of the international financial system must take place in reference to the needs of developing countries. The world’s richest Nations agreed a financial stimulus package amounting worth 832 billion Euros (1.1 trillion US dollars) yet barely one quarter will be given to developing countries. And the money destined for developing countries will be channelled through the IMF, whose loan conditionalities have been central in spreading misery around the developing world. Recent changes in IMFs policies have not resolved this problem.
The Indian government's efforts to bring in affordable patented medicines for chronic and lifestyle ailments, may hit a roadblock with multinational companies trying to stall the move. The mechanism would have increased affordability of drugs like Tarceva, Herceptin, Pegasys and Januvia used for treatment of chronic ailments, which at present are exorbitantly priced. Government put forth a model to multinational pharmaceutical companies, which has not met with much enthusiasm from the industry. It asked them to ensure that patented drugs introduced in the country are priced cheapest here than anywhere in the world. Significantly, the recommendations say that patented block-buster drugs that have no substitute in the market and offer substantial therapeutic benefit should be offered at prices 40% to 70% cheaper than the maximum retail price through the public health system.
After their workshop, participants made a number of recommendations. They wanted governments to meet their obligations in the Abuja Declaration to spend at least 15% of its budget on the health sector, in addition to any donor aid the country may receive for the same purpose. A process should be initiated to review and amend all patent legislation, especially to ensure maximum use of TRIPS flexibilities that promote access to medicines. The implications of ratifying the 30 August 2003 decision on licenses for exports to countries with insufficient manufacturing capacity need to be considered. An improvement is required in the monitoring, transparency and participation of all interested stakeholders in the negotiation of free trade agreements and economic partnership agreements to ensure no eroding of flexibilities and no further enforcement processes to patents.
The World Trade Organization’s 2009 Global Monitoring Report notes that the deepening global recession, rising unemployment, and volatile commodity prices in 2008 and 2009 are seriously affecting progress toward poverty reduction. The recent food crisis has thrown millions into extreme poverty. Deteriorating growth prospects in developing countries will further slow the pace of poverty reduction. Recovery prospects depend on effective policies that restore confidence in the financial system and counter falling global demand. While the responsibility for restoring global growth lies largely with rich countries, emerging and developing countries have a key role to play in improving the growth outlook, maintaining macroeconomic stability, and strengthening the international financial system. Financing the health sector may be negatively impacted by the recession.
6. Poverty and health
In this paper, child mortality and its relationship to specific variables relating to background and proximate factors were considered. Between 2006 and 2007, proportions of households with child deaths declined in all the districts and the proportions of health facility deliveries decreased in households that experienced under-five deaths. Measles vaccination coverage was lower among households with child deaths and so was use of insecticide-treated nets (ITNs). Households living in poor conditions experienced the highest proportions of child mortality. Education of mothers remains a significant determinant of child mortality along with health facility delivery. No difference in child mortality was realized between mothers having primary education and those that had none. Better health-seeking behaviour should be encouraged to help stem the high child mortality rates.
The aim of this study was to describe current infant growth patterns using World Health Organization Child Growth Standards and to determine the extent to which these patterns are associated with infant feeding practices, equity dimensions, morbidity and use of primary health care for the infants. A cross-sectional survey of infant feeding practices, socio-economic characteristics and anthropometric measurements was conducted in Mbale District, Eastern Uganda in 2003 with 723 mother-infant pairs. The prevalences of wasting and stunting were 4.2% and 16.7%, respectively. The adjusted analysis for stunting showed associations with age and gender – it was more prevalent among boys than girls (58.7% versus 41.3%). Sub-optimal infant feeding practices after birth, poor household wealth, age, gender and family size were associated with growth among Ugandan infants.
Globally, research on social determinants of health has built a considerable knowledge base over the last decade. Still, not much of this research has been carried out in the extremely poor areas of the world, like for instance Africa south of the Sahara. In very poor ruralities, classic indicators of socioeconomic status are not well suited. Few people have any education, monetary income is not a good measure of material standing and people cannot be classified by occupation as they make their livelihood from a variety of activities. For efforts towards health equity to benefit the poorest of the poor, more suitable indicators of social health determinants must be identified. Health research might benefit from knowledge developed in neighbouring fields like development research, anthropology and sociology.
7. Equitable health services
Health systems in countries emerging from conflict are often characterised by damaged infrastructure, limited human resources, weak stewardship and a proliferation of non-governmental organisations, which all undermine health services. One response is to improve health service delivery in post-conflict countries by jointly contract non-governmental organisations to provide a Basic Package of Health Services for all the country's population. The approach is novel because it is intended as the only primary care service delivery mechanism throughout the country, with the available financial health resources primarily allocated to it. The aim is to scale up health services rapidly. This paper describes the Basic Package of Health Services contracting approach and discusses some of the potential challenges this approach may have for sexual and reproductive health services, particularly the challenges of availability and quality of services, and advocacy for these services.
This paper describes and analyses the GAVI Alliance's early experience with health systems strengthening (HSS) to improve immunisation coverage and other maternal-child health outcomes. The challenges have been forging a common vision and approach, governance, balancing pressure to move money with incremental learning, managing partner roles and relationships, managing the ‘value for money’ risk, and capacity building. This mid-point stock-taking makes recommendations for moving GAVI forward in a thoughtful manner. The findings should be of interest to other global health partnerships because of their larger significance. This is a story about how a successful alliance that decided to broaden its mandate has responded to the technical, organisational, and political complexities that challenge its traditional business model.
Understanding urban black women's health care practices will enable health promoters to develop interventions that are successful. The problem investigated here was to gain an understanding of the health care practices of urban black women that could influence health promotion activities. The design was qualitative and exploratory. The sampling method was convenient and purposive, and the sample size was determined by saturation of the data. Data was gathered through semi-structured interviews using six specific themes and the analysed using open coding. The results indicated that the social environment created by the registered nurses in the primary health influenced the health care practices of the women negatively. Practices regarding the seriousness of a health problem suggest a possible reason may exist for late admission of a person with a serious health problem.
The objective of this paper was to measure the extent and causes of inequalities in the ownership and utilisation of bed nets (ITNs) across socioeconomic groups (SEGs) and age groups in Tanga District, north-eastern Tanzania. A questionnaire was administered to heads of 1,603 households from rural and urban areas and focus group discussions were used to explore community perspectives on the causes of inequalities. Use of ITNs remained appallingly low compared to the RBM target of 80% coverage. The results highlight the need for mass distribution of free ITNs, a community-wide programme to treat all untreated nets and to promote the use of long-lasting insecticidal nets (LLINs) or longer-lasting treatment of nets, targeting the rural population and under-fives.
This paper describes the immediate impact of conflict following Kenya’s presidential elections on 27 December 2007 with regard to clinic attendance and medication adherence for HIV-infected children cared for within the USAID-Academic Model Providing Access to Healthcare (AMPATH) in western Kenya. The researchers conducted a mixed methods analysis that included a retrospective cohort analysis, as well as key informant interviews with pediatric healthcare providers. They found that, during this period of humanitarian crisis, the vulnerable, HIV-infected paediatric population had disruptions in clinical care and in medication adherence, putting children at risk for viral resistance and increased morbidity. However, unique programme strengths may have minimised these disruptions.
This article discusses health sector reform experiences of four developing countries, including Tanzania, and identifies the lessons learned. Findings suggest that decentralisation works effectively while implementing primary and secondary health programmes. Decentralisation of power and authority to local authorities requires strengthening and supporting these units. Community participation facilitates recruitment and development of field workers, facility improvement and service delivery. For providing financial protection to the poor, there is a need to review user fees and develop affordable health insurance with an exemption mechanism. There is no uniform health sector reform approach for all countries – policy makers must examine the context and determine the reform measures that constitute the best means in terms of equity, efficiency and sustainability.
New Health Minister, Dr Aaron Motsoaledi has announced five key priorities for action, one of which is to strengthen the quality of care in the health service. To succeed in boosting service delivery, the new Health Minister identified four key areas he will be giving his immediate attention in the next few weeks: the official launch the prevention of mother-to-child HIV transmission acceleration plan, a new team that will deal with norms and standards between national, provincial and district health systems, a future meeting of provincial health MECs to come up with cost-containment measures or austerity measures to curb over-spending, and a consultation with his counterparts within the Inter-Ministerial Committee to speedily resolve the issues around the occupational-specific dispensation. But Motsoaledi was thin on detail about how he plans to address the issues.
This study sought to assess progress in South Africa with respect to deinstitutionalisation and the integration of mental health into primary health care, with a view to understanding the resource implications of these processes at district level. A situational analysis in one district site, typical of rural areas in South Africa, was conducted, based on qualitative interviews with key stakeholders and the World Health Organization's Assessment Instrument for Mental Health Systems (WHO-AIMS). The decentralisation process remains largely limited to emergency management of psychiatric patients and ongoing psychopharmacological care of patients with stabilised chronic conditions. Similar to other low- to middle-income countries, deinstitutionalisation and comprehensive integrated mental health care in South Africa is hampered by a lack of resources for mental health care within the primary health care resource package, as well as the inefficient use of existing mental health resources.
This paper explores the organisation of health care work in primary care clinics in Cape Town by analysing two elements of clinic organisation as rituals: a formal, policy-driven element of care – directly observed therapy for tuberculosis patients – and an informal ritual – morning prayers in the clinic. Seven clinics providing care to people with tuberculosis were sampled. Findings suggest that, rather than seeing the ritualised aspects of clinic activities as merely traditional elements of care that potentially interfere with the application of good practice, it is essential to understand their symbolic value if their contribution to health care organisation is to be recognised. These rituals embody the conflicting values of patients and staff in these clinics and reinforce asymmetrical relations of power between different constituencies, strengthening conventional modes of provider-patient interaction.
Government has revealed its National Influenza Pandemic Preparedness Plan in the event of an outbreak of swine flu in the country. Dr. Frew Benson, the Chief Director of Communicable Diseases in the Department of Health, explained to the media how the team would respond after being alerted of a suspected case. ‘They would go out to that particular case, investigate, take all the epidemiological data around this case, make certain that the case is isolated and trace all the contacts of this case. They will then make sure, if the case meets the criteria for treatment with anti-virals’, he said. The department has assured the public that it has stockpiled more than enough batches of the anti-viral drug, Tamiflu, which has been found to be effective against swine flu. ‘We’ve got 100,000 doses (of Tamiflu) and more available if need be. We have more than 10 times more than was needed in the Mexican outbreak,’ he added.
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8. Human Resources
This study aimed to describe perceptions of medical students, recent medical graduates, faculty of the College of Medicine, University of Malawi and private medical practitioners (PMPs) towards an attachment of undergraduate medical students in private medical doctors' offices. A qualitative cross-sectional study was conducted in Blantyre, Malawi in 2004 using in-depth key informant interviews and content analysis. In general, private medical practitioners were favourable to the idea of having medical students within their consulting offices while the majority of students, recent graduates and faculty opposed, fearing compromising teaching standards. Private medical practitioners (PMPs) were seen as outdated in skills and knowledge. Faculty, medical students and recent graduates of the Malawi College of Medicine do not perceive PMPs as a resource to be tapped for the training of medical students.
This paper set out to estimate systematically the inflow and outflow of health workers in Africa and examine whether current levels of pre-service training in the region suffice to address this serious problem. Most data came from the 2005 WHO health workforce and training institutions' surveys. The study was restricted to 12 countries in sub-Saharan Africa. It found that the health workforce shortage in Africa is even more critical than previously estimated. In 10 of the 12 countries studied, current pre-service training is insufficient to maintain the existing density of health workers once all causes of attrition are taken into account - it would take 36 years for physicians and 29 years for nurses and midwives to reach WHO's recent target of 2.28 professionals per 1,000 population for the countries taken as a whole - and some countries would never reach it.
As part of ART services expansion in Lusaka, Zambia, this study implemented a comprehensive task-shifting programme among existing health providers and community-based workers. It provides on-going quality assessment using key indicators of clinical care quality at each site. Programme performance is reviewed with clinic-based staff quarterly. When problems are identified, clinic staff members design and implement specific interventions to address targeted areas. Ongoing quality assessment demonstrated improvement across clinical care quality indicators, despite rapidly growing patient volumes. The task-shifting strategy was designed to address current health care worker needs and to sustain ART scale-up activities. While this approach has been successful so far, long-term solutions to the human resource crisis are urgently needed.
Researchers conducted a cost-benefit analysis of a health care education scholarship that is conditional on the recipient committing to work for several years after graduation delivering ART in sub-Saharan Africa. Such a scholarship could address two of the main reasons for the low numbers of health workers in sub-Saharan Africa: low education rates and high emigration rates. Conditional scholarships for a HAHW team sufficient to provide ART for 500 patients have an expected net present value (eNPV) of US$1.24 million per year. The eNPV of the education effect of the scholarships is larger than eNPV of the migration effect. Policy makers should consider implementing ‘conditional scholarships’ for HAHW, especially in countries where health worker education capacity is currently underutilised or needs to be rapidly expanded.
9. Public-Private Mix
The point made by Oxfam’s chief executive concerning failed states and the proliferation of private security firms is indicative of the ideological predisposition that impedes an open debate regarding healthcare delivery in developing countries. The view that healthcare is a fundamental responsibility of the State and must be largely provided by agencies of the State is not generally accepted outside of the UK, and is increasingly being challenged within the UK. British organisations tend to be skeptical of the private sector, but elsewhere the important role of the private sector in health systems, in countries both with and without well functioning state health programmes, is widely acknowledged. Public versus private provision is not a binary choice facing governments, donors, patients, and global policy makers – there is enough space for both to co-exist.
A primary objective of Oxfam’s new paper ‘Blind optimism’ is to encourage and advance an evidence-based debate on the appropriate role of the private sector in health care delivery in poor countries. Montagu’s response detracts from this important debate by misrepresenting the paper. Oxfam advises against investing in risky and unproven private -sector approaches to expand health care in poor countries. It is not the same as advocating that all engagement with the private sector should cease. Unchallenged enthusiasm for private sector solutions is neither justified nor helpful. Based on the evidence available, there is an urgent need for more honesty about the significant risks to efficiency and equity associated with private sector growth in health care, and more openness about the paucity of comprehensive evaluations of private sector approaches and the lack of evidence that these approaches can be scaled up properly.
The World Bank Group’s support for health, nutrition, and population (HNP) has been sustained since 1997—totaling $17 billion in country-level support by the World Bank and $873 million in private health and pharmaceutical investments by the International Finance Corporation (IFC) through mid-2008. This report evaluates the efficacy of the Bank Group’s direct support for HNP to developing countries since 1997 and draws lessons to help improve the effectiveness of this support. The report presents findings that The Bank Group now funds a smaller share of global support for health, nutrition, and population than it did a decade ago, but its support remains significant; About two-thirds of the Bank’s HNP projects show satisfactory outcomes, but a third do not; the accountability of Bank Group investments for demonstrating results for the poor has been weak; the Bank Group has an important role in helping countries to improve the efficiency of health systems and the potential for improving HNP outcomes through actions by non-health sectors is great, but incentives to deliver them are weak. Adding HNP objectives to Bank projects in other sectors, such as water supply and sanitation, raises the incentive to deliver health benefits. For the Bank Group to achieve its objectives of improving health sector performance and HNP outcomes among the poor, the report indicates that it needs to act in five areas: Intensify efforts to improve the performance of the World Bank portfolio; Renew the commitment to delivering results for the poor, including greater attention to reducing high fertility and malnutrition;
Build its own capacity to help countries to make health systems more efficient; Enhance the contribution of other sectors to HNP outcomes; Boost evaluation to implement the results agenda and improve governance.
Oxfam’s latest publication characterises as illogical and unethical the view that governments could serve their people by facilitating and regulating a private sector contribution to health care delivery. The author’s research in South Asia shows that, at least for antiretroviral therapy (ART), there is a role for public as well as private provision in developing countries. In countries like India, the private health care sector is industrious, entrepreneurial and accounts for most health care delivery. However, its quality is extremely varied. This variability of quality is less of a problem when health care addresses non-infectious health problems, like broken arms or diabetes. For these problems, lower quality care may be better than no care at all. So even if the government were able to successfully ban all the lower quality health care providers, it may only end up making health care less accessible to the poorest.
10. Resource allocation and health financing
Following a meeting in London on March 5, civil society representatives from across Africa and Asia gathered in Johannesburg on 13 and 14 May. The purpose of the meeting was broadly the same as the earlier session held in London in April: to allow individuals and groups with first-hand experience of the challenges around healthcare provision and funding to feed their views into the Taskforce’s deliberations. Delegates turned their attention to a series of key issues, including ways to bridge gaps in existing resources, provide more of those resources, and link such measures to existing international and national health system frameworks.
They also had the chance to quiz members of the Taskforce secretariat in plenary sessions, which provoked valuable debate on issues such as stakeholder participation in potential solutions and the way in which the Taskforce operates, as well as airing challenges to be overcome in individual countries. Mrs. Graca Machel, Taskforce member and President of the Foundation for Community Development in Mozambique, addressed delegates on both days of the meeting. In her opening remarks, Mrs. Machel seized on the ‘monumental’ nature of the challenge to meet the health-related MDGs by 2015. Existing crises in food and fuel had been compounded in 2008 by a financial crisis; left unaddressed, these combined crises will cause over 200,000 additional deaths. She called on delegates to consider, in their discussions, how solutions could be ‘country-owned’, but also internationally credible, with monitoring systems implemented which focus firmly on results.
Whether or not the positive impacts of user fees removal policies are sustained has hardly been explored. This study documents the extent to which primary health care facilities in Kenya continue to adhere to a 'new' charging policy three years after its implementation. Data was collected in two districts, Kwale and Makueni, and focus group discussions and patient exit interviews were conducted. Adherence to the policy was poor in both districts, and drug shortages, declining revenue, poor policy design and implementation processes were the main reasons given for poor adherence to the policy. In conclusion, reducing user fees in primary health care in Kenya is a policy on paper that is yet to be implemented fully. Caution must be taken when deciding on how to reduce or abolish user fees and all potential consequences should be carefully considered.
The objective of this study was to measure the direct cost burdens (health care expenditure as a percentage of total household expenditure) for households in rural South Africa, and examine the expenditure and use patterns driving those burdens in a setting with free public primary health care and hospital exemptions for the poor. Data was drawn from a cross-sectional survey of 280 households. The low overall mean cost burden of 4.5% suggests that free primary care and hospital exemptions provided financial protection. However, transport costs, the difficulty of obtaining hospital exemptions, use of private providers, and complex treatment patterns undermined this. The significant non-use of care shows the need for other measures such as more outreach services and more exemptions in rural areas. Fee removal anywhere must be accompanied by wider measures to ensure improved access.
Should development aid be withdrawn because it does not work? No. Under present circumstances aid resources are vital for human survival and the development of many people in Africa. Despite receiving US$38 billion in aid flows in 2008, Africa still faces a serious resource gap to bring about economic and social development and the recent near-collapse of the global financial architecture provides vital evidence that well-targeted and properly administered aid resources are vital to poor people. Africa has recently experienced one of the longest consistent economic growth rates and it has started to make a dent in reducing poverty, which needs to be built on. The debate on the demise or ineffectiveness of aid provokes serious questions about who really holds the key to redressing the injustices that exist globally.
11. Equity and HIV/AIDS
A qualitative study was conducted to comprehensively describe the experience of orphanhood and its impact on mental health from the culturally specific perspective of Ugandan youths. The researchers conducted interviews with a purposeful sample of 13 youths (ages 12 to 18) who had lost one or both parents to AIDS illness and who were supported by a non-governmental organisation. The orphaned youths experienced significant ongoing emotional difficulties following the death of their parent(s). The youths in this study were unfamiliar with the term ‘mental health’; however, they easily identified factors associated with good or poor mental health. The findings of this study suggest that Western terminologies and symptom constellations in the Diagnostic and Statistical Manual IV may not be applicable in an African cultural context.
This study presents the experiences of a cohort of 17 patients enrolled in the first integrated TB and HIV treatment pilot programme, in Durban, South Africa, as a precursor to a pivotal trial to answer the question of when to start antiretroviral treatment (ART) in patients co-infected with HIV and TB. Individual interviews, focus group discussions, and observations were used to understand patients’ experiences with integrated TB and HIV treatment. The patients described incorporating highly active antiretroviral therapy (HAART) into their daily routine as ‘easy’; however, they experienced difficulties with disclosing their HIV status. Being on TB treatment created a safe space for all patients to conceal their HIV status from those to whom they did not wish to disclose. Directly observed therapy for TB may have the added benefit of creating a safe space for introducing ART to patients who are not ready to disclose their HIV+ status.
A coalition of health advocates from Sub-Saharan Africa has warned that the lives of millions of people in Sub-Saharan Africa are in jeopardy because of the lack of political will and investment to realise the right of access to life-saving treatment. ‘If the current cost constraints faced by HIV treatment programmes are not addressed, while the demand for expensive second-line treatment increases, we will find ourselves in a situation similar to the ’90s, where millions of lives were lost unnecessarily because people could not afford the treatment they needed to stay alive’, they said. The coalition rejects pitting HIV against other diseases because they believe there is ample evidence that ARV roll-out has strengthened health systems, and the work done by AIDS service organisations has revolutionised healthcare in the developing world.
The aim of the study was to evaluate data on behavioural indicators in relation to HIV prevention and occurrence in a rural youth population in South Africa. A representative community sample of youth using a three-stage cluster sampling method was chosen for a household survey, and qualitative data were obtained from the youths using ten focus group discussions. Results indicated a moderately adequate knowledge of HIV. HIV/AIDS knowledge was associated with more consistent condom use, and with a more supportive attitude towards persons with HIV or AIDS. Among female youth, 15.2% reported to have become victims of forceful sex during the last 12 months. For youth the major reasons for not using a condom with a non-commercial partner were 'not available', followed by 'did not like them', 'did not think of it', 'other' (mainly trust in partner), and 'partner objected'.
Conflict has long been assumed to contribute significantly to the spread of HIV infection. However, new research is casting doubt on this assumption. Studies from Africa suggest that conflict does not necessarily predispose to HIV transmission and indeed, there is evidence to suggest that recovery in the ‘post-conflict’ state is potentially dangerous from the standpoint of HIV transmission. There has also been concern that high rates of HIV infection among many of the militaries of sub-Saharan Africa poses a threat to regional security. However, data is lacking on this. These issues are of vital importance for HIV programming and health sector development in conflict and ‘post-conflict’ societies and will constitute formidable challenges to the international community. Further research is required to better inform the discussion of HIV, conflict and security in sub-Saharan Africa.
The HIV status of surgeons, in the context of the informed consent obtained from their patients, is a contentious matter. We surveyed the views of practising surgeons in South Africa regarding aspects of HIV and its impact on surgeons. A cross-sectional survey was conducted with surgeons who were members of the Association of Surgeons of South Africa to find out their attitudes to the preceding issues. The salient findings included the view that a patient-centred approach requiring HIV status disclosure to patients would be discriminatory to surgeons and provide no clear benefit to patients, and that HIV-positive surgeons should determine their own scope of practice. Patient-centred approaches and restrictive policies do not accord with clinicians’ sentiments. In the absence of comparable local or international data, this study provides clinicians' views with implications for the development of locally relevant policies and guidelines.
Ugandan HIV activists have expressed concern over a recommendation by parliament's budget committee that the allocation for antiretroviral (ARV) drugs be cut. The national budget for 2008/09 allocated 76 billion shillings (US$38 million) to purchasing ARVs, the first such allocation in the country's history, but the house standing committee recommended that the amount be cut to 40 billion shillings in the 2009/2010 budget. ‘We recognise that HIV is a serious disease but it is not the only disease affecting Ugandans,’ said Rose Akol Okullo, chair of the committee. ‘Cancer and diseases afflicting women need equal attention if we are to meet the Millennium Development Goal on health. More than 300,000 HIV-positive people in Uganda need ARVs. AIDS activists argue that the committee's recommendation will allow the government to shirk its responsibility to provide drugs to them.
12. Governance and participation in health
The main institutions responsible for governing international trade and health - the World Trade Organization (WTO), which replaced the General Agreement on Tariffs and Trade (GATT) in 1995, and WHO - were established after World War 2. For many decades the two institutions operated in isolation, with little cooperation between them. The growth and expansion of world trade over the past half century amid economic globalisation and the increased importance of health issues to the functioning of a more interconnected world, brings the two domains closer together on a broad range of issues. Foremost is the capacity of each to govern their respective domains, and their ability to cooperate in tackling issues that lie at the intersection of trade and health. This paper discusses how the governance of these two areas relate to one another, and how well existing institutions work together.
This review identifies an agenda for global health by highlighting the current 'grand challenges' related to governance. Sources included literature from the disciplines of health policy and medicine, conference presentations and documents, and materials from international agencies (such as the World Health Organization). The present approach to global health governance has proven to be inadequate and major changes are necessary. There are a number of areas of controversy. The source of problems behind the current global health governance challenges have not always been agreed upon, but this paper attempts to highlight the recurrent themes and topics of consensus that have emerged in recent years. Growing points and areas timely for developing research are identified. A solution to the 'grand challenges' in global health governance is urgently needed to serve as an area for developing research.
13. Monitoring equity and research policy
Does research influence public policy and decision-making and, if so, how? This book is the most recent to address this question, investigating the effects of research in the field of international development. It starts from a sophisticated understanding about how research influences public policy and decision-making. It shows how research can contribute to better governance in at least three ways: by encouraging open inquiry and debate, by empowering people with the knowledge to hold governments accountable, and by enlarging the array of policy options and solutions available to the policy process. Knowledge to Policy examines the consequences of 23 research projects funded by Canada’s International Development Research Centre. Key findings and case studies from Asia, Africa, and Latin America are presented in a reader-friendly, journalistic style, giving the reader a deeper grasp and understanding of approaches, contexts, relationships and events.
This project explored the feasibility of using the Buxton and Hanney Payback Framework to determine the impact of a stratified random sample of competitively funded, primary health care research projects. The project conducted telephone interviews based on the Payback Framework with leaders of the research teams and nominated users of their research, used bibliometric methods for assessing impact through publication outputs and obtained documentary evidence of impact where possible. The framework provided rich information about the pathways to impact, better understanding of which may enhance impact. It is feasible to use the Buxton and Hanney Payback framework and logic model to determine the proximal impacts of primary health care research.
14. Useful Resources
With some of the worst health indicators and the least adequate health services in the world, providing health services and rebuilding health systems in fragile states is a complex undertaking. This Health and Fragile States dossier highlights the challenges and approaches to delivering health services in fragile states. The dossier covers a number of issues and poses a number of questions. What are fragile states? How can the health-related Millennium Development Goals be met in these states? What are the best approaches for delivering health services in fragile states? How can the World Health Organization’s six building blocks for health systems strengthening be used as a framework for planning and priority-setting in fragile states? What are the implications of the international aid effectiveness agenda for the building of resilient and responsive states to deliver basic services?
Visualizing Information for Advocacy: An Introduction to Information Design is a manual aimed at helping NGOs and advocates strengthen their campaigns and projects through communicating vital information with greater impact. This project aims to raise awareness, introduce concepts, and promote good practice in information design – a powerful tool for advocacy, outreach, research, organisation and education. Effective communcation is essential for any organisation to operate properly, and the guide covers all aspects of business communication. It is part of a programme of work by Tactical Technology Collective to promote research, development and design in the public interest.
Do you want to use multimedia, online or offline tools to advance your cause creatively and effectively? Would you like to reach the broadest possible audience? Do you want to create and distribute audio programmes, comic books, posters and newsletters? What about setting up a website or a blog to champion your issue? Message-in-a-Box can be used as a resource for any citizen-based journalism work. Combining tools and the tactics to use them is a great way to put technology in context. Tools are only effective if they are matched with effective planning and good strategies and when they are matched with skills and resources. Message-in-a-Box delivers information on doing all this.
This guide presents advocates with a collection of popular online services that can be used for advocacy quickly with little to no technical support. There are services for publishing photographs and video, for setting up a campaign blog or for using mobiles to communicate in a group. An amazing amount of functionality and tools are available simply by connecting to the internet and opening up a web browser. You don't need to have a lot of technical expertise to try some of these. You also don't need much money, as these services are offered at low or no cost. They require a broadband connection and are not recommended for dial-up connections. Advocates can easily and quickly connect, gather information and distribute powerful messages by utilising these services, while the majority of technology is out of sight. This guide presents use of these services from a Northern perspective, though it has tried to present alternative services popular in different regions and languages.
This booklet is an effective guide to using maps in advocacy. The mapping process for advocacy is explained vividly through case studies, descriptions of procedures and methods, a review of data sources and a glossary of mapping terminology. Scattered through the booklet are links to websites that afford a glance at a few prolific mapping efforts. Hosting a map on your website can now become a reality as the guide takes you through the specifics of the process. Examples of valuable data sources, like youtube, facebook, flickr and socialight, have been cited, along with a brief outline of their mapping features. The fold-out offers an illustrative sketch of the inside story, while the fold-in explains a swift and easy method to create a map. The purpose of the booklet is to enable advocacy groups explore the potential of maps to effectively send out their message.
15. Jobs and Announcements
The 2009 International Conference on Urban Health (ICUH) will bring together the leaders of urban health research, practice, side by side with community voices to frame these issues, provide clear insight, and offer direction and best practices toward healthy urbanisation. The Conference has three planned components. First, the Scientific Programme consists of eight broad tracks or themes in the field of health and urbanisation. Second, the Urban Health Champions Forum is intended for leaders of local and national governments and civil society and will review prevailing policies that affect investment in urban areas. Third, a Community Voices Forum will involve meetings in local informal settlements of Nairobi three weeks prior to the conference to obtain perspectives from the community on urban health.
You are invited to submit abstracts of chapters for a book titled Strategic Health Communication in Urban Contexts, which will be featured as part of the 8th International Conference on Urban Health later this year. The forthcoming book is designed to address issues of urbanization, local, national, regional, and global health, and strategic uses of communication in local urban contexts. The focus is on the triangular interplay among the three components of health, behaviour and strategic communication in urban contexts. Contributions can be based on research, theory, practice or experience. Send a 500-word abstract by 1 July 2009. Notifications of acceptance will be announced on July 15. Complete chapters of about 5,000 words, excluding references and tables, will be expected no later than 1 October 2009.
The Alliance HPSR and the Health Systems Financing Department (WHO) are launching a new programme of work that aims to explore and compare country-specific experiences in developing and implementing universal financial risk protection, with a focus on the factors that have helped or hindered the expansion of financial protection mechanisms. We are interested in learning both from positive and negative experiences. It is envisaged that the final product of this programme of country case-study work will be a book encompassing all of the case-studies, and highlighting cross-cutting policy lessons and issues that are applicable beyond the case-study countries. Research teams are encouraged to submit Expressions of Interest (EoI) by June 30th, 2009. These EoI will be technically reviewed. Research teams that submit the most promising EOI will be invited to a proposal development workshop, where applicants will work with technical advisers to develop proposals for 12 to 18 months of work. Researchers in low and middle income countries are eligible to apply to this call for proposals. See the website for more information
Though studies related to pricing, access to medicines and generic medicines do appear in various journals, a special issue covering all these topics is much needed at this time and would be helpful to nurture pharmaceutical policy debate. Southern Medical Review, a journal with a development focus, is calling for contributions across the following areas: access to medicines and the role of different stakeholders, access to medicines models in the developed world and their relevance (if any) to developing countries, research papers and commentaries based on WHO/HAI medicine pricing surveys and Trade-Related Aspects of Intellectual Property Rights (TRIPS) and Access to Medicines, the promotion of generic drugs, the political economy of the pharmaceutical industry and access to medicines. For further information visit the website address.
This Conference, which will be held from 26–29 October 2009 in Hanoi, Vietnam, aims to further the understanding of the complex and powerful relationships between health, development and human rights and to propose practical ways that policies, strategies and research can optimally respond to these challenges. The themes of the Conference include: HIV/AIDS and other current and emerging public health threats; maternal and child health; climate change; and economic globalisation. The four-day International Conference will engage representatives of research institutes, universities, governmental and non-governmental organisations, as well as leading international and regional scholars, human rights practitioners, health professionals and members of civil society.
The East, Central and Southern African Health Community, in collaboration with USAID-EA, are organising a Forum on Private Sector Response for Reproductive Health and Family Planning to be held in Nairobi, Kenya, July 21–24 2009. The broad objective of the forum is to strengthen the contribution of the private sector in reproductive health and family planning services, education and research. More specifically, it aims to explore ways of increasing the private sector contribution to public health agenda for reproductive health and family planning, build consensus on mechanisms and areas of public subsidy to the private sector to enhance reproductive health and family planning service provision, identify and discuss how to manage policy, technical and regulatory constraints to involving private sector in health initiatives, and share best practices in private sector response to reproductive health and family planning issues.
The world’s largest open scientific conference on HIV/AIDS is held every two years, and attracts about 5,000 delegates from all over the world. It is a unique opportunity for the world’s leading scientists, clinicians, public health experts and community leaders to examine the latest developments in HIV-related research, and to explore how scientific advances can – in very practical ways – inform the global response to HIV/AIDS.
The International Young Campaigner Award recognises campaigners who are 24 or younger, who are based outside the UK, in many of the least developed countries of the global South. Eligible campaigners will be working to achieve social, economic or environmental justice in their home countries – and specifically on issues relevant to girls and young women. The young person who wins the award will benefit from mentoring, coaching and guidance from experienced campaigners to help them achieve results with their campaign. This award is sponsored by the Sheila McKechnie Foundation. It’s award is an opportunity for campaigners working outside the UK in some of the world's poorest countries, to become involved in the awards support programme. The successful applicant will be supported both in their home country and in the UK to help them make best use of the resources available to them, build their networks and alliances in the international community, and develop a successful strategy to achieve change.
From 1 June 2009, the PHM Global Secretariat will be hosted by PHM-South Africa in Cape Town, South Africa. Ms Bridget Lloyd has been appointed Global Co-ordinator. For the last three years, from June 2006 to June 2009, PHM’s Global Secretariat has been based in Cairo at the Association of Health and Environment Development (AHED) and led by Dr Hani Serag with the support of the Global Secretariat Committee (Dr Jihad Marshal, Dr Alaa Shukrallah and Dr Ghassan Issa). Cape Town will be the fourth location of the PHM Global Secretariat. From January 2000 to December 2002, the Secretariat was hosted by Gonoshasthaya Kendra in Savar, Bangladesh and led by Dr Qasem Chowdhury) and then from January 2003 – May 2006 in Bangalore, India when it was hosted by the Community Health Cell and led by Dr Ravi Narayan.
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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