The Third EQUINET Regional Conference on Equity in Health in East and Southern Africa, held 23 –25 September 2009 in Munyonyo, Kampala, Uganda brought together over 200 government officials, parliamentarians, civil society members, health workers, researchers, academics and policy makers, as well as personnel from United Nations, international and non-governmental organisations from East and Southern Africa and internationally.
Conference delegates recognised the significant, growing, avoidable and unjust inequalities in health and in the resources for health in our countries, our region and our world. The conference reiterated the findings of the World Health Organisation Commission on the Social Determinants of Health that this social injustice is killing people on a grand scale.
We note that we have the resources for health within our region; that many resources important for health, including health workers, flow out of Africa; that the remaining resources do not reach those with greatest health needs, and that inequality blocks economic opportunities from reaching those who need them most.
We affirm that we stand for equity and social justice in health. We recognise that unless we address inequalities in health and in the resources for health, we will not achieve the policy goals set in the 1999 Southern African Development Community Protocol on Health, the resolutions of the Ministers of the East Central and Southern African Health Community, nor the United Nations Millennium Development Goals;
We affirm that it is imperative that we act to improve heath equity, and to reclaim the resources for health.
Our deliberations indicated that health equity is advanced when:
• health is integrated within national policies and goals,
• equity in health is a political and social goal, advocated, planned for and monitored,
• our health systems have strong public sectors, and redistribute resources towards those with highest health need, and
• the role of people – communities and health workers- is valued, resourced and supported;
Towards this, we call on all in the region, our international partners, and propose ourselves, to intensify efforts to:
Advance equity in health as a political and social goal and in all policies:
• Monitor and ensure that the right to health is included in our constitutions, provided for in our laws and universally applied, especially for vulnerable groups;
• Strengthen community awareness and capacity to claim these entitlements;
• Advocate for the promotion and protection of health in all policies, particularly those that provide for the social determinants of health, including education, safe water and sanitation; food sovereignty, energy and technology;
• Organise evidence and raise awareness on health implications of trade and intellectual property regimes and of new technologies and strengthen negotiating power to ensure that they protect health, particularly given the corporate control of resources;
Build universal, redistributive and people centred health systems:
• Identify and advocate for clear, comprehensive and integrated health care entitlements that secure universal coverage of health systems;
• Identify and implement options to strengthen, resource and organise primary health care and inter-sectoral action for health as a priority in health systems;
• Generate and share evidence on and implement options to close gaps in access to key services for priority health conditions, including for maternal, family and child health, for mental health and for improved nutrition;
• Organise the evidence, advocacy and political support to meet and go beyond the 2001 Abuja commitment of 15% government spending on health - excluding external funding; and to promote increased per capita spending on health, supported by debt cancellation;
• Meet the “people’s Abuja” of at least 25% of government spending in health allocated to the primary care and community level of the health system;.
• Support plans and strategies for harmonising the various health financing schemes into one framework for universal coverage, reducing out of pocket payments, providing for cross subsidies and pooling resources from progressive tax funding and prepayment schemes;
• Support the removal of user fees through a sustainable, planned strategy that strengthens the health system;
• Support the development and implementation of plans to deploy and retain health workers in decent working conditions and to ensure consistent availability of vital and essential drugs and supplies at primary and district levels of health systems;
• Draw on the growing body of evidence on the causes of health worker migration and measures for health worker retention, promote constructive engagement across health workers, trade unions and governments to ensure that country driven strategies for retention are negotiated, resourced, implemented and monitored;
• Strengthen public sector systems and capacities, including for financial management, to improve equity in the allocation of resources, and to absorb and effectively use the resources for health;
• Through civil society and parliaments, monitor how funds are used and how services are provided;
• Ensure effective regulation of the private-for-profit sector so that it complements public sector provision and to prevent negative impacts on health equity;
• Identify, make visible and overcome the barriers that disadvantaged and vulnerable communities face in accessing and using health and essential services;
• Noting that AIDS is one of a number of disease burdens and that approaches to HIV and AIDS should integrate with programmes for all major health problems, resource and strengthen rights based, holistic, integrated primary health care oriented approaches to prevention, treatment and care for HIV and AIDS, that recognize and act on the social barriers to access and uptake of services; that build links between communities and services; that recognize and train traditional healers, community health workers, peer support networks and non-medical health providers; that provide prevention and treatment to health care workers; that strengthen local safety nets and that address disparities in access to services across gender, area and income and for children, commercial sex workers and other vulnerable groups.
Recognise and support the central role of people – communities and health workers –leadership and alliances in advancing health equity:
• Recognise and formally provide in laws, budgets, mechanisms and programmes for the central role of people in health systems; to build informed empowered communities and health workers and participatory processes for community involvement in health;
• Demand and strengthen capable strategic leadership, stewardship and management in health systems; who consult, engage with and harness the range of constituencies and resources needed to advance health equity;
• Develop the communication, engagement, capacities and networking to strengthen government, civil society, health worker, parliament and researcher alliances to shape, advocate, implement and monitor the policies that promote health equity;
Monitor and make visible progress and gaps in advancing health equity:
• Monitor and make visible the progress and gaps in advancing health equity through implementing an Equity Watch at country and regional level, in a manner that builds alliances across actors; that analyses health disparities, including gender differentials; that makes visible progress against benchmarks and drivers of health equity; that complements a core framework of parameters with deeper district and household level assessment and that combines different forms of evidence, including from community level photography, to stimulate action on equity.
• Develop and promote investment in and capacities for a research agenda on health equity, including on new challenges, such as how climate change and globalisation are affecting health; on operational issues, such as how health systems are functioning after the removal of user fees; and to inform policy development, such as on the effects of the private-for-profit sector and of commercialisation in health systems on health equity;
• Build capacities amongst researchers to involve stakeholders from the earliest stages of research and to effectively communicate evidence.
We call for these efforts to be supported by wider levels of social justice globally and for a more just return for east and southern African countries from the global economy. The net outflow of resources from Africa must be reversed and the strategic resources of Africa used for the development and security of its populations.
We call on our international partners to advocate and engage with us to achieve:
• The global commitment to and resourcing of the universal rights to health in the International Convention on Economic and Social Rights, the Convention on the Rights of Children and the Convention on the Elimination of Discrimination against Women,
• G8 targets of universal access to prevention, treatment and care for HIV and AIDS and the UN Millennium Development Goals;
• Debt cancellation, with the resources released channelled to human development;
• Economic justice, fair trade, and democracy in the governance of global financial institutions;
• Bilateral and multilateral agreements that recognise and redress the resource outflows that affect African health and health systems, particularly from health worker migration.
• Genuine partnerships and external funding aligned to national priorities, that are developed through participatory and informed consultation with the people.
We will all take these commitments forward into our various organisations and forums. The conference has set a programme of work and action for all of us. EQUINET, as a consortium of institutions from the region, is committed to take and support these actions to advance health equity, to produce and share evidence and good practice and to advocate and monitor equity and social justice, especially through the equity watch. EQUINET is committed to building the intergovernmental, parliamentary, civil society, health worker and academic forums in East and Southern Africa to strengthen our values based leadership, democratic states and regional integration and co-operation in Africa, to reclaim the resources for health and advance health equity.
In the face of injustice it is imperative that we act.
A note from the editor: This oped presents the resolutions made and adopted by delegates at the EQUINET Regional Conference September 2009. In future issues of the newsleter we will give profile to specific areas of and reflections from the conference, whose ideas, community and exchanges re-energised and informed our work, actions and interactions towards advancing health equity. The abstract book for the conference is available at http://www.equinetafrica.org/bibl/docs/EQ%20Conf%20Sep09%20abstract%20bk.pdf and the conference report will be available on the EQUINET website in November. Please contact the EQUINET secretariat admin@equinetafrica.org for any queries or feedback on issues relating to the conference or resolutions. For further information on the conference, the papers presented or EQUINET work please visit the EQUINET website at www.equinetafrica.org.
1. Editorial
2. Latest Equinet Updates
This work sought to identify the barriers to delivery, coverage and uptake of Prevention of Mother to Child Transmission of HIV (PMTCT) services at primary health care and community level and to generate improved demand for and utilization of PMTCT within Kamwenge sub-county in Kamwenge district and Mulagi subcounty in Kiboga district in Uganda. The work was implemented by HEPs Uganda within an EQUINET participatory action research programme and was mentored by Training and Research Support Centre (TARSC) in co-operation with Ifakara Health Institute Tanzania. Participatory methods were used to explore the barriers to using services to prevent vertical transmission and to identify actions to improve uptake. The findings suggested a need to emphasise couple counselling and testing; encourage local leaders to mobilise communities for antenatal care, PMTCT and other primary health care services and to address cultural barriers like male dominance. The baseline survey indicated that even where services are provided, while health workers may be effective in referring those who attend services for testing, PMTCT and ANC, there is a gap in people actually getting to services which breaks this link. Weak links are also made with some other maternal health services. Communities need to be involved in designing interventions that encourage male participation in demand and utilisation of testing and PMTCT services. This would appear to be a core element of any PHC oriented AIDS programme to prevent vertical transmission, as essential as other more biomedical elements.
Health care financing in South Africa is inadequate, and in recent years we have been moving away from achieving the Abuja target of 15% government funding for health care. This has resulted in numerous crises in the public health sector, and most South Africans (about 41 million) are unable to access decent, adequate health care, as enshrined in our constitution. South Africans that do access decent, adequate health care primarily do so through private funding (typically private health insurance schemes), but even in this sector, costs are spiralling and the package of benefits on offer is declining. To increase public health funding in South Africa, the government has proposed the introduction of a National Health Insurance (NHI) scheme. A recent national household survey found that 71% of medical scheme members were willing to join a publicly supported health insurance scheme if their monthly contribution was less than for current medical schemes. The NHI has been proposed to create a mechanism to level the playing field and create equitable distribution of resources resulting in high quality of health services for all the people. Universal access to a basic package of services for both the rich and poor will be achieved by the NHI and the costs of health care for poor and middle class South Africans will decrease. In-studio guests on a radio show discussing these issues were: Proffessor Di Mc Intyre, Health Economics Unit, UCT and EQUINET Fair Financing Theme Co-ordinator; Sheila Barsel, Policy Unit for the National Health and Allied Workers Union (NEHAWU); and Dr Siva Pillay, Member of the Parliamentary Portfolio Committee of Health in South Africa.
3. Equity in Health
A new species of mosquito has been discovered by South African researchers that might be a malaria vector. The authors of the report note that ‘understanding the vectors is absolutely key; if we don't do anything about mosquitoes, we will never do anything about malaria.’ The previously unknown species was discovered during field studies in and around rural villages in northern Malawi near the town of Karonga, on the western shore of Lake Malawi. The new species is related to the major African malarial vector, Anopheles funestus, but the ‘jury is still out on ... whether it carries [the] malaria [parasite]," Coetzee, one of the authors, said. The Anopheles funestus Giles group of mosquitoes has nine known African species, and ‘although the members of the Anopheles funestus group may be similar in morphology [its form and structure], their efficiencies as malaria vectors vary greatly,’ the report said. Coetzee said it was important to ascertain whether Anopheles funestus Giles was a malaria vector or not, but this could only be determined after further research.
Fifteen years after liberation from apartheid, South Africans are facing new challenges for which the highest calibre of leadership, vision, and commitment is needed. The effect of the unprecedented HIV and AIDS epidemic has been immense. Substantial increases in mortality and morbidity are threatening to overwhelm the health system and undermine the potential of South Africa to attain the Millennium Development Goals (MDGs). This paper has identified several examples of leadership and innovation that point towards a different future scenario. It discusses the type of vision, leadership and priority actions needed to achieve such a change. There is still time to change the health trajectory of the country, and even meet the MDGs. The new South African Government, installed in April 2009, has the mandate and potential to address the public health emergencies facing the country – will they do so or will another opportunity and many more lives be lost?
This paper highlights gender as a very important factor in determining vulnerability in Disaster Risk Reduction (DRR). The degree of vulnerability to disaster is determined by social variables like gender, age, health status, ethnicity, religion and socio-economic status and understanding these is necessary to identify the underlying causes of disasters and thus try to prevent them. In most countries, women are particularly at risk from disasters. Subsequently, understanding why women are often vulnerable and taking appropriate steps can make a huge difference on impact. The paper looks at DRR in relation to livelihoods. People, especially in developing countries are particularly vulnerable to disasters as they often live in high-risk areas, have lower coping capacities, and have no form of insurance or other safety nets. Furthermore, they are heavily dependent on climate-sensitive primary industries like agriculture and fishing. A disaster can eradicate livelihoods or years of local development efforts in a very short time.
In 1987, the World Health Organization (WHO) estimated that vitamin A deficiency was endemic in 39 countries based on the ocular manifestations of xerophthalmia or deficient serum (plasma) retinol concentrations. In 1995, WHO updated these estimates and reported that vitamin A deficiency was of public health significance in 60 countries, and was likely to be a problem in an additional 13 countries. The current estimates reflect the time period between 1995 and 2005, and indicate that 45 and 122 countries have vitamin A deficiency of public health significance based on the prevalence of night blindness and biochemical vitamin A deficiency, respectively, in preschool-age children.
The Western Cape provincial government initiated the collaborative Burden of Disease (BOD) Reduction Project to reduce its burden of disease and promote equity in health. This shift in thinking from facilities to a population-based approach to health demonstrates increased awareness about the crucial role of upstream factors on population health. Several lessons may be learnt from the Western Cape experience with mortality surveillance. Identifying health priorities is important, like leading causes of premature mortality such as HIV and AIDS, tuberculosis, homicides and road traffic injuries. Identifying inequities must be done in line with the recommendations of the World Health Organization Commission on Social Determinants of Health to monitor health inequities. Government also needs to start evaluating priority health programmes. Providing accessible information for policy makers is also crucial, as well as advocating for an intersectoral response, such as improving living conditions with the involvement from other sectors such as housing, water and sanitation.
The combination of low levels of malnutrition together with dramatically high rates of mortality encountered in Kenya's Lake Victoria territory is unique for Sub-Saharan Africa. This paper points to a unique interplay of cultural, geographical and political factors in the region that are responsible for causing the described paradox. Moreover, it demonstrates that a salient disease environment is one of the key drivers of the massive under-5 mortality rates in the lake region. This environment is characterised by extremely high malaria prevalence, polluted water sources and high rates of infectious diseases like HIV. It also found that an ethnic specific effect remains even after controlling for mother's age at birth, birth spacing, birth order and HIV-status. Political discrimination seems also to be an important factor. The paper reveals that the HIV status of the mother and children's diarrhoea status explain the largest part in the variation of stunting outcomes between families. Educational attainment of the mother turns out to be the single most important source in explaining mortality differentials between families.
Weather and climate affect the key determinants of human health: air, food and water. They also influence the frequency of heatwaves, floods and storms as well as the transmission of infectious diseases. In addition, policies to mitigate climate change (for example in the energy, transport or urban planning sectors) have a direct and important influence on health, for example through effects on local air pollution, physical activity, or road traffic injuries. In order to guide research in this field, the World Health Organization (WHO) carried out a global consultation. Experts on climate change, health and related disciplines produced background reports covering each of the themes identified by the World Health Assembly Resolution, as well as an additional report on how to support research in this field. This was followed by an online consultation, and a three-day workshop attended by over 70 leading researchers, health practitioners, and representatives of funding bodies and other United Nations (UN) agencies. This report presents the conclusions and recommendations from this process, with the aim of improving the evidence base for policies to protect health from climate change.
According to this book, food production, access to clean water and health in Africa may be affected by climate change. In eastern Africa, rainfall is expected to increase in some parts of the region. In southern Africa, rains will be disrupted, bringing a notable drop in maize production. In contrast, growing seasons may lengthen in parts of Southern Africa, for example Mozambique, owing to a combination of increased temperature and higher rainfall. Yet net revenues from crops could shrink by up to 90% by 2100. There is likely to be a greater number of people living with water stress by 2055 as rainfall becomes more erratic or declines. The previously malaria-free highland areas of Ethiopia, Kenya, Rwanda and Burundi could experience modest incursions of malaria by the 2050s, with conditions for transmission becoming highly suitable by 2080s. Rift Valley fever epidemics could become more frequent and widespread as El Niño events increase. In southern Africa, more areas are likely to become more suitable for malaria, with a southward expansion of the transmission zone into Zimbabwe and South Africa.
4. Values, Policies and Rights
The Universal Periodic Review mechanism of the UN Human Rights Council, which came into effect in 2008, has established itself as a mechanism with huge potential and which promotes dialogue and a level playing field for all countries undergoing the review of their human rights record. Building on the Commonwealth Secretariat’s observations and analysis of the process, and the seminars it has conducted with member states, Universal Periodic Review of Human Rights consolidates the lessons learned so far, speaking equally to the three major stakeholders in the process – to states, to national human rights institutions, and to civil society organisations. An effective UPR mechanism will enhance the promotion of human rights across the world. It is therefore essential for the key players to understand and advance the UPR process including at the implementation phase. This publication describes UPR, shares experiences and provides analysis of the Commonwealth countries that reported in the first year of the UPR process.
The second volume of Health and Human Rights brings one more piece to the set of educational materials available from multiple sources, mostly, although not exclusively, in the English language. Intended primarily for health practitioners, the book incorporates a succinct introduction laying out essential concepts, principles and mechanisms relevant to the congruence between public health and human rights. Ten case studies follow, each constructed around clearly set learning objectives, including questions to be addressed, highlights of the public health issue and references to specific human rights relevant to the case study, sources of pertinent information and bibliography. The case studies focus on major public health issues such as maternal mortality, female genital mutilation, access to medicine and prison health. They constitute a useful tool for classroom education as well as self-learning. As Internet access expands in low- and medium-income countries, the material presented could serve to structure a distance-learning facility (a field in which one of the co-authors specialises) with interactivity between learners and their mentors.
Several health-related budget decisions taken in the past financial year in South Africa are reported to have violated the Constitution, the National Health Act, the Public Finance Management Act and the Promotion of Administrative Justice Act, according to a group of activists, researchers, unionists, health workers and academics, called the Budget and Expenditure Monitoring Forum (BEMF). The Forum has written to the ministers of health and finance, expressing concern over the effect of budgeting practices within the public health system on HIV and AIDS programmes, including on antiretroviral (ARV) treatment and prevention of mother-to-child transmission programmes, citing the moratorium on starting new patients on ARVs in the Free State as one example of such a decision.
The United Nations Educational, Scientific and Cultural Organization (UNESCO) has drafted the 98-page International Guidelines on Sexuality Education. The guidelines are still being finalised but a draft version suggests key areas that a sex education curriculum should cover at four different age levels between five and 18. The topics include relationships, reproduction, gender inequality and various aspects of sexuality, but conservative groups in the United States have focused on a handful of suggested learning areas that they view as overly explicit and inappropriate for young children. Various critics have taken issue with suggestions that teachers discuss homosexuality, contraception, and gender-based violence. However, defenders of the guide assert that ‘it's better they have the right information than the wrong information.’ A report in the New York Times asserted that the controversy had caused the UN Population Fund (UNFPA), a key partner, to pull out of the project, but a UNFPA spokesperson refused to confirm this, saying only that the organisation was still in discussion with UNESCO about making the publication ‘more context specific’.
Four United Nations agencies and offices will be amalgamated to create a new single entity within the organisation to promote the rights and well-being of women worldwide and to work towards gender equality. The UN Development Fund for Women (UNIFEM), the Division for the Advancement of Women, the Office of the Special Adviser on Gender Issues and the UN International Research and Training Institute for the Advancement of Women (UN-INSTRAW) will be merged. Secretary-General, Ban Ki-moon, said he was ‘particularly gratified’ that the Assembly had accepted his proposal for ‘a more robust promotion’ of women’s rights under the new entity. Mr Ban said that he had appointed more women to senior posts than at any other time in the history of the UN, including nine women to the rank of under-secretary-general. The number of women in senior posts has increased by 40% under his tenure.
5. Health equity in economic and trade policies
On 25 September 2009, hundreds of farmers, traders, students, women groups and civil society from across Kenya congregated at Uhuru Park to proclaim their concerns about the economic partnership agreements (EPAs) currently under negotiation between the European Union (EU) and African countries. The protesters delivered a petition to the Ministry of Trade as well as Trade committee of the Kenyan parliament. Through a collective mass fax and e-mail action, more than 80 organisations in 30 countries across Europe, Africa and the Pacific have called on decision-makers to fundamentally change the course of the ongoing negotiations. The multiple messages are aimed at stressing the importance of bold committed African leadership displayed by only supporting trade and economic policies that lead to the development of their people.
On 14 September, the governing Trade and Development Board (TDB) of the United Nations Conference on Trade and Development (UNCTAD) began its fifty-sixth session with UNCTAD Secretary-General Dr Supachai Panitchpakdi stressing that the global financial and economic crisis presents an opportunity to find long-term, multilateral solutions to the cycle of financial crisis and unsustainable global imbalances. Amongst others, this year's TDB session will also be holding a high-level discussion on the global economic crisis and the necessary policy response. The mega-stimulus packages introduced by many governments appear to have had a decisive impact in slowing the global economy's descent, but Dr Panitchpakdi nevertheless ‘believes we must still continue to be cautious about the evidence for recovery, and in particular what this means for developing countries.’ He also referred to the so-called 'shadow banking system', which at its peak, held assets in the US of approximately $16 trillion, the collapse of which kick-started the global economic crisis.
Following the signing of the Southern African Development Community (SADC) countries to negotiate an economic partnership agreement (EPA) with the European Union, the Botswana government has been warned to exercise its rights in making sure that threats facing the private sector are taken into consideration. Dr Howard Sigwele, executive director of Delta Diaries, Botswana's first jointly owned citizen milk producing company, indicated that although there were benefits in the agreement in trying to enhance private sector participation in foreign markets, there were possible threats such as unregulated entry of goods and subsidised European Union imports into Botswana, undermining the performance of local business and lead to company closure. He warned about the possible entry of goods of inferior standard and possible importation of diseases and pests unless measures are taken to prevent this.
Authorities in India, the leading producer of generics in the world, have rejected applications for patents on two AIDS drugs, opening the way for cheaper generic versions to be developed and marketed. In the Gleevec case, the Swiss drug company filed a special petition, seeking leave to appeal to the Supreme Court. The petition was to be heard on 31 August but the matter was adjourned after the presiding judge recused himself. India’s patent office has rejected the patents for tenofovir and darunavir, which are expensive but needed for AIDS patients failing on their existing treatments. Brand-name producer Gilead also previously failed to win a patent for tenofovir in Brazil, according to Medicin Sans Frontieres (MSF). The rejection of the patents has yet to be confirmed by official sources. MSF credited Indian Law Section 3(d) with preventing the evergreening of drug patents and opening the way for generics competitors to enter the market.
The legitimacy of the intellectual property (IP) system depends on the correct balance between the public interest and the private privilege given to the IP holders. This balance has been disrupted by a one-size-fits-all global regime in the TRIPS agreement. Yet TRIPS has some flexibilities that can be used. Recently, developed countries have been promoting a TRIPS-Plus agenda that reduces or removes TRIPS flexibilities. Their IP enforcement programme has resulted in legitimate generic drugs of developing countries being seized in European ports while in transit to other developing countries. At the World Intellectual Property Organization (WIPO), developing countries have not accepted the TRIPS-Plus proposals and are protesting against the actions on generic medicines. Issues covered here include the row over generic drug seizures, the recent controversies at the WIPO meeting on Patent Cooperation Treaty, the TRIPS-Plus enforcement agenda, and the move towards a ‘global IP infrastructure’.
The two-day Mini-Ministerial meeting of 36 trade ministers hosted by India on 3–4 September appears to have concluded with a few proposals on a process to ‘re-energise’ the World Trade Organization Doha Round of multilateral trade negotiations, but with no movement on substance. Virtually all developing country groupings endorsed the multilateral approach of negotiations and cautioned against the attempt to subvert the process through bilateral or plurilateral negotiations. They also endorsed the December texts as the basis of negotiations rather than unravelling the texts. This is presumably because the US is demanding even more concessions than what is outlined in the December text. In the corridors on the last day of the meeting on 4 September, one negotiator from an invited country said: ‘Not much has happened here but a discussion on process and reiteration of positions.’ A delegate from a G20 country stated: ‘The US came here, but is in no position to offer anything. They are demanding that we open the text and give more market access, but are not willing to offer anything in return.'
The statement covers the cooperation in the Southern African Development Community-European Community (SADC-EC) economic partnership agreement, and the implications for regional integration in Southern Africa. The statement proposes support for regional integration and development in Southern Africa, based on the 1999 Trade, Development and Cooperation Agreement (TDCA). The first Revision Agreement, which together with the Joint Action Plan for the SA-EU Strategic Partnership is argued to lay the ground for an enhanced and deepened relationship in existing and new areas of cooperation, including migration, health, space, energy, information and communication technologies (ICT) and maritime transport.
The major objectives of this paper are to analyse the inter-relationship among economic growth, inequality and poverty and to propose a typology of countries within sub-Saharan Africa based on the different initial conditions they face and that can be used to derive appropriate development strategies. In particular, an attempt is made at deriving distinct strategies that embrace growth patterns that are likely to reduce poverty in each separate group of countries. The choice of the most appropriate development strategy is clearly context-specific and, ultimately, has to be shaped at the individual country level. Yet, the advantage of a typology is to highlight and emphasises the importance of those key and distinct conditions and features that influence the development paths of different categories of countries sharing relatively similar conditions. In order to understand better the anatomy of the development process, the changing structure of growth throughout this process has to be explored. In a continent where most countries are still at an early development stage and where the majority of the people reside in rural areas and are employed in agriculture, understanding the structural transformation process and the role of agriculture as a potential engine of growth is of fundamental importance.
To date, claims about the likely development effects of economic partnership agreements (EPAs) have been speculative because the final details of the agreements were unknown. The conclusion of a full EPA with the CARIFORUM region and interim EPAs (IEPAs) with some African and Pacific states makes it possible to analyse what has actually been agreed and to assess the potential development effects. This book provides a comprehensive analysis of the African IEPAs as they stand in early 2009. It also establishes the negotiations that remain to be completed and the challenges facing Africa in implementation, some of which require support from Europe. It provides both a summary of the principle features of very complex documents and also the foundations for the many follow-up studies that will be needed to look in more detail at specific country, sectoral and other specific features of the IEPAs.
This report presents the latest trends in patents, trademarks and copyrights. Patents, which are of direct relevance to drug prices and procurement, showed a slowdown in growth rate, with fewer patent filings and grants. In 2007, patent filings increased 3.7%, compared to a 5.2% increase in the previous year. Despite this slowdown, around 1.85 million applications were filed across the world in 2007. The figures show the early effects of the global economic downturn on patent filings and the available data for 2008 point toward a further slowdown in patent filings. Patent filings and grants have also become more concentrated. In other words, the majority of patent filings are from residents of industrialised countries and there is a strong relationship between the volume of patent filings and the level of GDP and investment in research and development. Residents of Japan and the United States own approximately 47% of the 6.3 million patents in force across the world. Since the late 1990s, patent filings have grown at a faster rate than patent grants (or rejections) in most offices, most notably at the patent office of the US. As a result, the number of unexamined (pending) patent applications has increased.
6. Poverty and health
The drought that has ravaged parts of northeastern Kenya, killing a large number of livestock, has affected the availability of milk, in turn undermining child nutrition, say officials. Most of the rural population in the areas where Save the Children is working is heavily dependent on relief food and many children are eating only one meal a day, of corn porridge. ‘This poor diet means they are missing out on vital nutrients, which can mean they grow up stunted and their brains and bodies can suffer permanent damage,’ the organisation said. Since July, the number of severely malnourished children seeking treatment at its northeastern emergency feeding centres has increased by 25%. ‘The government and donors need to be aware of the changing climate now and in future, and shape their policies accordingly,’ Philippa Crosland-Taylor, head of Oxfam in Kenya, said in August. ‘Emergency aid is urgently needed now, but in the long term we need to rethink policies to focus on mitigating the risks of droughts before they occur, rather than rushing in food aid when it is too late.’
Context matters with regard to foreign aid. The implications are only slowly coming to the fore: external funders are realising that they will not find a magic wand or global prescription or best practice by which they can unleash the change that will reduce poverty on a significant and sustainable scale. Context – the institutional, social, political, cultural and economic fabric of society – matters, and its significance is much greater than that of aid from external partners. So, the problem for funders in dealing with context seems to be first and foremost dealing with their own context that forces them to try to do more than they objectively can. The challenge is to find ways to change the political and systemic factors that constrain the capacity and willingness of funders to act with modesty, realism and humility. This requires an environment in which their stakeholders are genuinely happy to be small contributors to processes that mainly depend on everything but funders and aid.
This paper estimates the economic impact of HIV and AIDS on the KwaZulu-Natal province and the rest of South Africa. It extended previous studies by employing: an integrated analytical framework that combined firm surveys of workers' HIV prevalence by sector and occupation; a demographic model that produced both population and workforce projections; and a regionalised economy-wide model linked to a survey-based micro-simulation module. Results indicate that HIV and AIDS greatly reduces annual economic growth, mainly by lowering the long-run rate of technical change. However, impacts on income poverty are small, and inequality is reduced by HIV and AIDS because high unemployment among low-income households minimises the economic costs of increased mortality. By contrast, slower economic growth hurts higher income households despite lower HIV prevalence. The increase in economic growth that results from addressing HIV and AIDS is sufficient to offset the population pressure placed on income poverty. Moreover, incentives to mitigate HIV and AIDS lie not only with poorer infected households, but also with uninfected higher income households. The findings confirm the need for policies to curb the economic costs of the pandemic.
Violence and injuries are the second leading cause of death and lost disability-adjusted life years in South Africa. With a focus on homicide, and violence against women and children, this paper reviews the magnitude, contexts of occurrence, and patterns of violence, and refer to traffic-related and other unintentional injuries. The social dynamics that support violence are widespread poverty, unemployment, and income inequality; patriarchal notions of masculinity that valourise toughness, risk-taking and defence of honour; exposure to abuse in childhood and weak parenting; access to firearms; widespread alcohol misuse; and weaknesses in the mechanisms of law enforcement. So far, there has been a conspicuous absence of government stewardship and leadership. Successful prevention of violence and injury is contingent on identification by the government of violence as a strategic priority and development of an intersectoral plan based on empirically driven programmes and policies.
7. Equitable health services
This interview was conducted with Dr John Seffrin, CEO of the American Cancer Society (ACS), who spoke about the cancer challenges facing Africa. By next year cancer is set to become the biggest killer in the world, killing more people than HIV/AIDS, TB and malaria combined. In Africa, people are dying of cancers that are curable in the developed world. Cancer is a growing problem in Africa but is given little attention as the continent is overwhelmed by many other problems. There are relatively low cancer prevalence rates in Africa, but a high growth of the cancer burden. This is argued to call for health promotion for people who don’t have cancer and palliative care for people who have late-stage disease.
This is the first known qualitative study undertaken in South Africa exploring providers' attitudes towards abortion. It used qualitative research methods to collect data. Thirty four in-depth interviews and one focus group discussion were conducted during 2006 and 2007 with health care providers who were involved in a range of abortion provision in the Western Cape Province, South Africa. Data were analysed using a thematic analysis approach. Complex patterns of service delivery were prevalent throughout many of the health care facilities and fragmented levels of service provision operated in order to accommodate health care providers' willingness to be involved in different aspects of abortion provision. Almost all providers were concerned about the numerous difficulties women faced in seeking an abortion and their general quality of care. An overriding concern was poor pre- and post-abortion counselling, including contraceptive counselling and provision. To sustain a pool of abortion providers, programmes that both attract prospective abortion providers and retain existing providers, need to be developed and financial compensation for abortion care providers needs to be considered.
Health officials in Tanzania are confident they are on track to eradicate malaria deaths by 2015, even if significant challenges stand in the way of the target. The National Malaria Control Programme (NMCP) says malaria is a leading killer in the East African country, infecting about 18 million people annually, and 30–40% of attendance at health centres and hospitals are related to malaria cases, burdening overstretched facilities. Malaria, according to the National Planning Commission (NPC) costs the country an estimated loss that is equivalent to 3.4% of gross domestic product. Alex Mwita, a senior NMCP official, said initiatives being implemented under the Roll Back Malaria programme, such as insecticide-treated bed nets and indoor residual spraying (IRS), had helped reduce malaria cases, along with deaths of children under five and infants (younger than one). ‘Under-five deaths have dropped to 91 per 1,000 live births in 2008, down from 147 in 1999,’ he said. Although the decline could not be attributed to a fall in malaria cases alone, research showed a decline in prevalence of the disease had a big impact on childhood and maternal mortality.
Between a quarter and half of maternal, neonatal, and child deaths in South Africa’s national audits have an avoidable health-system factor contributing to the death. Using the LiST model, the researchers estimate that 11,500 infants' lives could be saved by effective implementation of basic neonatal care at 95% coverage. Similar coverage of dual-therapy prevention of mother-to-child transmission with appropriate feeding choices could save 37,200 children's lives in South Africa per year in 2015 compared with 2008. These interventions would also avert many maternal deaths and stillbirths. The total cost of such a target package is US$1.5 billion per year, 24% of the public-sector health expenditure; the incremental cost is US$220 million per year. Such progress would put South Africa squarely on track to meet Millennium Development Goal (MDG) 4 and probably also MDG 5. The costs are affordable and the key gap is leadership and effective implementation at every level of the health system, including national and local accountability for service provision.
South Africa’s burden of non-communicable diseases will probably increase as the roll-out of antiretroviral therapy takes effect and reduces mortality from AIDS. The scale of the challenge posed by the combined and growing burden of HIV and AIDS and non-communicable diseases demands an extraordinary response that South Africa is well able to provide. Concerted action is needed to strengthen the district-based primary health-care system, to integrate the care of chronic diseases and management of risk factors, to develop a national surveillance system, and to apply interventions of proven cost-effectiveness in the primary and secondary prevention of such diseases within populations and health services. The researchers urge the launching of a national initiative to establish sites of service excellence in urban and rural settings throughout South Africa to trial, assess and implement integrated care interventions for chronic infectious and non-communicable diseases.
In 1994, when apartheid ended, the health system faced massive challenges, many of which still persist. Macroeconomic policies, fostering growth rather than redistribution, contributed to the persistence of economic disparities between races despite a large expansion in social grants. The public health system has been transformed into an integrated, comprehensive national service, but failures in leadership and stewardship and weak management have led to inadequate implementation of what are often good policies. Pivotal facets of primary health care are not in place and there is a substantial human resources crisis facing the health sector. The HIV epidemic has contributed to and accelerated these challenges. All of these factors need to be addressed by the new government if health is to be improved and the Millennium Development Goals achieved in South Africa.
To investigate the effect of case management programmes on TB incidence, this paper carried out a comparative analysis of factors that could be key direct or indirect determinants of national TB incidence trends over 1997–2006. Cases of TB (in all its forms) reported annually to WHO were used to calculate trends in incidence rate, the latter expressed as the number of cases notified annually in a given country per 100 000 population. The striking observation in this study was that, more than a decade after directly observed therapy was first implemented, none of the seven direct measures of TB programme performance was associated with TB trends globally. National TB control programmes play a vital role in curing TB patients and preventing deaths, as the diagnosis and treatment of active TB have significantly reduced disease transmission and incidence in some countries. However, treatment programmes have not had a major, detectable effect on incidence on a large scale. The possible reasons are that: patients are not diagnosed and treated soon enough to significantly reduce transmission; case detection, cure and TB incidence trends cannot be measured accurately; there has been insufficient time to see the effects of reduced transmission; and any effects on transmission are offset by a growing risk of developing TB following infection.
A new laboratory in the College of Health Sciences at Uganda's Makerere University will conduct tuberculosis diagnosis and research to the highest international standards. ‘The lab is built with world-class TB diagnostic capacity,’ Moses Joloba, head of the department of microbiology at Makerere University's medical school, said at the opening ceremony on 28 August. ‘Normally difficult-to-treat TB infection will be diagnosed here.’ The new lab will be sued for clinical trials of a potential TB vaccine. The currently available TB vaccine, Bacille Calmette-Guerin (BCG), was developed nearly 90 years ago and provides some protection against serious forms of TB in children. However, it is not reliable against pulmonary TB, which accounts for much of the global disease burden. Uganda ranks 16th out of the 22 countries in the world with the highest TB burden. Insufficient resources, non-adherence to TB treatment, poor access to healthcare services and a limited number of skilled staff and diagnostic facilities all contribute to the country's TB epidemic.
Some manufacturers announced in July that the H1N1 vaccine is available, but that doesn’t mean it’s ready for use, as it needs regulatory approval. Regulatory authorities are considering the best way to register these vaccines as quickly as possible. The consensus is that the first doses will be available to governments for use in September. The World Health Organization (WHO) has a cross-organisational operation that is in place to secure vaccines for developing countries, spearheaded by the Director-General’s Office and the legal and vaccine departments. WHO is engaged in three types of activities. The first is to negotiate donations with manufacturers. Second, it is working with other manufacturers to reserve a portion of their vaccine production for WHO at a reduced price. Third, it is working with governments to raise funds to purchase vaccines, as well as with 11 vaccine manufacturers based in developing countries, providing them with seed financing and technical expertise to help them produce influenza vaccine domestically.
8. Human Resources
Health MEC, Sibongiseni Dhlomo, says that South Africa should produce about 8,000 doctors annually to meet the dire shortage at public hospitals. He referred to a programme to study medicine in Cuba, which targets students mainly from underprivileged areas who would otherwise not have had the financial means for the studies. Dhlomo said universities were not producing enough doctors, which was contributing to the discrepancies in the country's health care system. ‘Producing 200 doctors per university per year is not good enough. We will be speaking to deans and pushing universities to produce at least 2,000 doctors annually, starting in the next year or two,’ he said. Dhlomo said the country had a total of about 8,000 doctors employed by the Health Department. However, he said Limpopo would be able to meet its doctor-patient ratio if all 8,000 doctors were deployed in that province.
The authors of this study conducted a survey among nurses and midwives working at district level in Sudan and Zambia to determine their roles and functions in polio eradication and measles elimination programmes. Nurses and midwives practising in four selected districts in Sudan and in Zambia completed a self-administered questionnaire on their roles and responsibilities, their routine activities and their functions during supplementary immunisation campaigns for polio and measles. This study shows that nurses and midwives play an important role in implementing immunisation activities at the district level and that their roles can be maximised by creating opportunities that lead to their having more responsibilities in their work and in particular, their involvement in early phases of planning of priority health activities. This should be accompanied by written job descriptions, tasks and clear lines of authority as well as good supportive supervision. The lessons from supplementary immunisation activities, where the roles of nurses and midwives are maximised, can be easily adopted to benefit the rest of the health services provided at district level.
This study sought to identify task shifting that has already occurred and assess the antiretroviral therapy (ART) training needs among clinicians to whom tasks have shifted. It surveyed health professionals and heads of ART clinics at a stratified random sample of 44 health facilities accredited to provide this therapy. A sample of 265 doctors, clinical officers, nurses and midwives reported on tasks they performed. Thirty of 33 doctors (91%), 24 of 40 clinical officers (60%), 16 of 114 nurses (14%) and 13 of 54 midwives (24%) reported that they prescribed ART. Yet, 64% of the people who prescribed antiretroviral therapy were not doctors. Seven percent of doctors, 42% of clinical officers, 35% of nurses and 77% of midwives assessed that their overall knowledge of antiretroviral therapy was lower than good. The study concluded that training initiatives should be an integral part of the support for task shifting, while making sure that ART is used correctly and toxicity or drug resistance do not reverse accomplishments to date.
Health care in South Africa’s rural areas is set to get a major boost, following the launch of the Centre for Rural Health by Wits University, in Johannesburg, recently. The centre’s inaugural Director, Prof Ian Couper, said the centre’s main focus is to ‘recruit human resources for rural health. We can do everything in terms of providing facilities, we can make sure the drug supplies are there, but unless we have the health workers, all of that will mean nothing. The centre is trying to focus on multiple strategies: selecting students in rural areas and supporting them to study health sciences, developing post graduate programmes, researching issues around how we can improve resources for rural health and advocacy to bring these issues to the attention of policy makers, politicians and other stake-holders.’ Deputy Health Minister, Dr Molefi Sefularo, expressed gratitude to the university for highlighting issues relating to rural health. ‘We would like you to become a leading academic centre in the field of human resources for rural health’, he said.
9. Public-Private Mix
Social franchising is argued to be a way of rapidly scaling up clinical health interventions in developing countries. Building upon existing expertise in poor and isolated communities, social franchising organisations engage private medical practitioners to add new services to the range of services they already offer. Specific examples are provided, such as the Confiance programme in the Democratic Republic of the Congo that provides a toll-free hotline for answering family planning-related questions and making referrals. It is reported to have been effective in addressing family planning concerns raised by men. This paper argues that standardisation, quality monitoring and scalability make social franchising one platform for the expansion and improvement of a wide range of medical services.
This report focuses on the contribution of AIDS-related public-private partnerships to the six building blocks of health systems: service delivery; human resources; information; medicines and technologies; financing; and leadership. A desk review and interviews were conducted with representatives of private and public organisation stakeholders, as well as development partners. Interviewees identified mutual understanding as an important precondition for the implementation of efficient and successful partnerships. The private sector at times lacks profound knowledge of the complex stakeholder landscape in the HIV response and health care provision. To develop flourishing partnerships, honest and wide-ranging dialogue to inform and secure agreement in joint planning is essential from the very earliest stages. Such planning will of course consider issue such as sustainability, follow-up, and monitoring, essential to flourishing partnerships. Health financing mechanisms, HIV and tuberculosis treatment and mobile health technology are areas which are of interest to the private sector and which require further technical expertise and promotion.
This book is about a new form of philanthropy dubbed 'philanthrocapitalism'. Philanthrocapitalists believe that foundations and non-profit civil society organisations should operate like market-oriented businesses. They believe that success in the business model can be emulated to make a similar impact on social change. The author concedes that it should certainly help to extend access to useful goods and services, and it has a positive role to play in strengthening important areas of civil society capacity, but social transformation requires a great deal more. Philantrocapitalism is a sign of a severely disordered and inequitable world. The author asserts that there is need for public debate between philanthrocapitalists and their critics about the complexities involved in social transformation. The book suggests a number of commitments that should be made: commitments to transparency and accountability, to democracy, to modesty and to devolution by investing in civic capacity and voice, and promoting the long-term financial independence of civil society organisations through long-term support.
This paper from the Harvard Health Policy Review examines the ways in which public and private sectors can cooperate to improve the quality and accessibility of primary health care (PHC) to the poor in developing countries. The authors argue that the promise of alternative business models lies in their ability to accomplish several important functions in PHC. Business-style contracts can organise small providers into units that are large enough to yield returns to scale in investments in physical capital, supply chains, and in worker training and supervision. In order to understand the problems that business models can help solve, this paper sets up a simple economic model of public private interests in health care. The model identifies two key social interests in health care markets: quality of service provision and access to care by disenfranchised groups. The authors finish with policy proposals for future consideration which include a recommendation that supporting the coordinating organizations through government revenue is only one option. A more creative approach to supporting the coordinating bodies would be to allow them to exploit their comparative advantage in obtaining capital.
The concept of franchising for health services is similar to franchises in business. A franchiser develops a way to provide health services, and then other franchisees copy the model. Each franchisee has to follow the original model. There is usually specific training, protocols and standards to follow, monitoring, and a brand name or logo that identifies that the provider is part of a franchise. Early work reports that social franchising may improve the spread of health services across low- and middle income countries. The review does not find any rigorous evidence to demonstrate the effect of social franchising on access to and quality of care in low- and middle-income countries. Well designed studies are needed.
The author describes events in Lesotho and South Africa where public-private health partnerships have not produced the desired results and notes that these incidents are not isolated, but part of a wave of new privatisation initiatives that uses donor dollars for public health by shuttling them into private contractors in poor countries. Advocates of private-public partnerships are noted to cite selective data from specific privatisation schemes, ignoring the costs of contracting and the broader impact of their initiatives on communities. The author questions the idea that foreign health policy analysts know better than local providers and patients, and points to the irony of poorer performance in public health relative to resources in the United States, the country with the greatest number of health policy analysts per capita.
This paper, by the Department for International Development DFID Health Resource Centre, looks at the extent of DFID’s engagement with non-state actors (NSAs) in the health sector and what is known about the value for money of working with different types of NSAs in various ways. The paper details how DFID provides most of its support to health to the public sector. However there are cases where DFID provides funding directly to NSAs. In other cases, DFID support goes to the government, which then uses some of those funds to fund service delivery by NSAs. The author argues that, in addition to seeking value for money, it is important to consider equity. The evidence suggests that all income groups use non-state services but, as in most public sectors, there is higher use by the relatively better off. Whether working with the non-state sector provides better value for money will substantially depend on the quality of design and implementation. There is growing experience in contracting, social franchising, vouchers and performance incentives. The paper outlines various aspects which DFID might want to consider for the future including that in developing or reviewing health sector plans, they should consider opportunities to improve NSA efficiency and effectiveness and as a way to enhance access.
10. Resource allocation and health financing
More than 50 countries have engaged in Gender Budget Initiatives (GBI), but few of these initiatives articulate an explicit connection between budgets and the Convention on Elimination of All Forms of Discrimination Against Women (CEDAW). This booklet, produced by the United Nations Development Fund for Women, articulates what it means to take an explicitly rights-based approach to government budgets. It draws on the lessons of gender budgeting experiences from around the world. It poses three questions. How can the four main dimensions of budgets – revenue, expenditure, macro economics of the budgets and budget decision making processes – be linked to governments’ commitments under CEDAW? Using these links, how can gender budget analysis then assist in monitoring a government’s compliance with CEDAW? How can CEDAW be used to set equality-enhancing criteria in budget activities and guide GBIs and other initiatives towards achieving gender equality? The booklet is intended as an advocacy and action tool for key stakeholders in the area of government budgets and women’s human rights including policy and law makers at the country level and gender human rights advocates.
Although much progress has been made towards the creation of a national health system which makes 'access to health for all' a reality, much remains to be done. These colloquium proceedings are an effort to initiate policy dialogue and critical discussion on how health services are accessed, provided and funded – and to formulate ideas, views and recommendations that could be presented to those involved in health policy development. The book is divided into three sections. Section A discusses the context for policy debates on health within a comprehensive system of social security. Section B synthesises the colloquium proceedings, beginning with a brief summary of inputs and discussions under the four key themes: the reform path since 1994; critical options for health within the context of a comprehensive system of social security; local and international evidence on health system models; and health systems reform and stakeholder engagement. Section C provides recommendations for improving implementation and taking the process of policy development forward.
Providing free healthcare to millions of women and children in some of the world's poorest countries has come a step closer, with the unveiling on 23 September of a US$5.3 billion financing package by British Prime Minister, Gordon Brown. The funds, to be used to roll back user fees in six countries, including Malawi, would reportedly benefit 10 million people – mainly women and children – and help cut maternal mortality. In announcing the initiative, Brown said that charging the poor even a few cents for health services ‘became a death sentence for millions’. The funding commitment was the result of twelve months' work by a taskforce on International Innovative Finance for Health Systems, co-chaired by Brown and World Bank President Robert Zoellick, and is to include a pledge of US$3 billion from the online travel industry. The goal is to help developing countries meet their health millennium development goals by 2015, and the financing represents commitments rather than cash immediately available.
On 22 August, the Western Cape Interim Steering Committee of the Conference of the Democratic Left hosted a public meeting on South Africa’s proposed national heath insurance (NHI). More than 100 activists from a wide range of communities and organisations attended the meeting. The Conference made several important decisions to further their campaign to mobilise popular (community and worker), progressive and left voices on the NHI by releasing and circulating widely all available documents on the NHI policy discussions, building the campaign from existing community and worker struggles on health issues, and ensuring the campaign is driven by community organisations, trade unions and shop-stewards organised around local health facilities, as well as ordinary people who use the public health system – their experiences, energies, interests and aspirations. As part of the campaign, a People’s Conference on the NHI and the public health crisis is being planned.
This paper set out to assess the long-term needs and consequences of ARV procurement and to identify policies and practices that could assure long-term sustainable access to ARVs. An analysis of ARV price variation between 2005 and 2008 was carried out using Global Price Reporting Mechanism (GPRM) from the World Health Organization (WHO). A selection of 12 ARVs was identified and price reductions were evaluated for both innovator and generic products. There was a large ARV price variation across countries, even for those countries with a similar socioeconomic status. The price reductions between 2005 and 2008 were greatest for those ARVs that had more providers. Three key factors appear to have an influence on a country’s ARV prices: whether the product is generic or not; the socioeconomic status of the country; and whether the country is a member of the Clinton HIV/AIDS Initiative (CHAI). Factors that did not influence procurement below the highest direct manufacturing cost (HDMC) were HIV prevalence, procurement volume, whether the country belongs to the least developed countries or a focus country of the United States President’s Emergency Plan for AIDS Relief (PEPFAR).
In 2005, the Paris Declaration formulated a number of challenges facing development cooperation. While the principles of the Declaration were broadly accepted, there seemed to be a lack of shared understanding of key underlying issues shaping the debate of EU aid effectiveness. This publication archives all the outputs generated through Whither EC Aid (WECA), from the Initial Discussion Note to the reports of the dozen roundtables held and the thematic Briefing Notes. A year after the adoption of the Accra Agenda for Action, it looks back on the perceptions of various group of stakeholders about the aid effectiveness agenda, to see to what extent the different points of view shared during the WECA process find an echo today in the international agenda on aid. The WECA Compendium is the final stage of a joint ECDPM-Action Aid project initiated in mid-2007.
Will leaders act now to save lives and make health care free in poor countries? On 23 September 2009 leaders met at the United Nations General Assembly in New York for a high-level event on health. On the table was a proposal to support at least seven developing countries to fully implement free care for women and children or to expand free health services to all, including Malawi and Mozambique. Oxfam recommends that governments of these countries make high-level commitments to introduce free health care for women and children and/or fully implement and expand free health care for all, as well as increase government spending on health to at least 15% of the national budget. The authors argue that the same commitments are required from rich country donors and multilateral aid agencies to provide additional long-term and predictable funding necessary to successfully implement free health care in all seven countries, and to officially extend the offer of financial and technical support for free health care to all poor countries who wish to remove fees and to make this event a global turning point in the fight to make health care free for all.
11. Equity and HIV/AIDS
A large supply of paediatric antiretroviral medication donated by the Clinton Foundation could expire in Ugandan medical stores because of low demand. ‘There are few children who are receiving the drugs; they are going to expire by March [2010],’ said Zainabu Akol, head of HIV programming in the Ministry of Health. Fewer than a quarter of the 125,000 Ugandan children who need life-prolonging anti-retroviral treatment (ART) have access to it, mainly because of stigma and inadequate education of parents, say specialists. ‘Due to stigma, parents have failed to take their children for ART,’ said Goretti Nakabugo, from a local non-governmental organisation, called Strengthening HIV/AIDS Counsellor Training. ‘They believe if their children start ART, they will be shunned by the community and pupils at school. People don't yet believe that HIV/AIDS is not transmitted through casual contact; a child with rashes is always shunned,’ she added. Many parents cannot face the idea of telling their children they have a potentially life-threatening illness and they live in denial.
South Africa's Free State Province is again experiencing a crisis in the delivery of antiretroviral (ARV) treatment, with understaffed clinics, erratic drug supplies and long waiting lists preventing many dangerously ill patients from accessing the life-prolonging drugs, according to AIDS activists. Runaway overspending by the provincial health department in 2008 led to a moratorium on new patients starting ARV treatment that lasted from November until February 2009. The Southern African HIV Clinicians Society estimated that 30 people a day died during this three-month period because they could not access treatment. Now, several reports from the Free State suggest that many of the factors leading to last year's moratorium have not been addressed, and patients are again suffering the consequences. Trudie Harrison, director of the Anglican Church's Mosamaria AIDS Ministry, said that the crisis was the result of drug shortages and a dearth of health workers. At one ARV site she recently visited, normally staffed by three doctors, about 200 patients were waiting to see just one doctor.
This paper’s aim is to review facility-based maternal deaths at a tertiary-level centre in Johannesburg, South Africa, from 2003 to 2007, and to investigate the proportion of deaths attributable to human immunodeficiency virus (HIV), the etiology of deaths, and the effects of antiretroviral treatment introduced in late 2004. Patient case files, birth registers, death certificates, and mortality summaries were reviewed. Cause of death was assigned through clinical case discussion. Annual maternal mortality ratios were calculated and disaggregated by HIV status. During the period reviewed, 106 maternal deaths occurred out of 36,708 births. In 72% of cases, HIV status was known, with the majority being HIV-infected (78%). Maternal mortality ratios in HIV-infected women were 95%, 6.2-fold higher than in HIV-negative women. Changes in mortality over time were not detected. Although HIV testing increased 1.4-fold each year and estimated coverage of antiretroviral treatment for pregnant women reached 59.2% in 2007, levels remain suboptimal. In Johannesburg, HIV remains the major cause of maternal mortality despite integration of antiretroviral treatment into prenatal services. Maternal health services should target barriers to uptake of HIV treatment and care.
People living with HIV in Kenya do not have adequate access to family planning services, even though most HIV-infected women do not want children in the immediate future. A recent study by the reproductive health NGO, Family Health International (FHI), in the Nakuru district of Rift Valley Province, found that 80% of HIV-positive women had no intention of having a child in the next two years. However, according to the 2007 Kenya AIDS Indicator Survey, only half the HIV-positive people needing family planning services had access to them. ‘Most prevention of mother-to-child transmission [PMTCT] programmes... looked at it only in the context of preventing transmission to an already conceived child, but meeting contraceptive needs of those living with HIV is a sure way of reducing transmission by avoiding unwanted pregnancies in the first place,’ said Maurine Kuyo, a project director at FHI. About 56% of women in the FHI study mentioned a fear of vertical transmission of HIV to their children as one the reasons they would not want another pregnancy, while 50% mentioned the risk of lowered immunity during pregnancy.
A six-year clinical trial in Thailand has yielded the first ever evidence that an AIDS vaccine can provide some protection against HIV infection. The trial team in Bangkok, Thailand's capital announced on 24 September that rates of HIV infection were 31% lower in trial participants who got the vaccine than in those who received a placebo. ‘These new findings represent an important step forward in HIV vaccine research,’ said Dr Anthony Fauci, director of the US National Institute of Allergy and Infectious Diseases (NIAID), the main funder of the trial. The study began enrolling 16,000 HIV-negative men and women between the ages of 18 and 30 in October 2003. Half the volunteers received a placebo; the other half were given shots containing two different vaccines. The trial was designed to evaluate whether the combined vaccines (ALVAC-HIV and AIDSVAX) lowered HIV infection risk, and whether they had any impact on viral load [the amount of HIV circulating in the bloodstream] in the volunteers who became infected. Of 8,197 people given the vaccine regimen, 51 became infected, compared to 74 of the 8,198 volunteers who received the placebo.
Carrying placards that read, ‘Huwezi Die Uki Abstain’, Swahili slang for ‘You won't die if you abstain [from sex]’, more than 3,000 young people recently marched through Nairobi in an effort to re-energise the campaign to keep teens from having sex too early. But beyond the placard-waving and slogan-chanting, march organisers were also trying to give young people the skills to avoid being pushed into sex before they are ready. James Kabucho, programmes director at Life Skills Promoters, one of the non-governmental organisations that organised the march, explained that the campaign was teaching young people negotiation skills. By acting out real-life scenarios, writing essays, and engaging peer educators in question and answer sessions, young people were able to talk about their experiences and learn to say ‘No’ to unwanted sexual advances. Research shows that early sexual initiation is associated with increased risk of HIV infection, while adolescents who engage in sex at an early age are likely to have more sexual partners than those who delay their sexual debut. Girls who engage in sex in their teens may also face the challenges of teenage pregnancy, unsafe abortions and dropping out of high school.
In 2007, South Africa, with 0·7% of the world's population, had 17% of the global burden of HIV infection, and one of the world's worst tuberculosis epidemics, compounded by rising drug resistance and HIV co-infection but, until recently, the government's response to these diseases has been marked by denial, lack of political will and poor implementation of policies and programmes. Nonetheless, there have been notable achievements in disease management, including substantial improvements in access to condoms, expansion of tuberculosis control efforts and scale-up of free antiretroviral therapy (ART). Using the framework of the Strategic Plans for South Africa for Tuberculosis and HIV/AIDS, this paper provides a prioritised four-step approaches for tuberculosis control, HIV prevention, and HIV treatment. Strong leadership, political will, social mobilisation, adequate human and financial resources, and sustainable development of health-care services are needed for successful implementation of these approaches.
Male-to-female transgender individuals, or transgender women (TW), are at high risk for HIV infection and face multiple barriers to HIV care. This article examines how a community-based clinic that offers free or low-cost care addresses the health care needs of TW. A total of twenty TW who attended a health care clinic dedicated to community-based health were interviewed regarding best practices for HIV prevention and primary care. In-depth interviews were conducted, transcribed, coded, and analysed. Factors reported to be effective for HIV prevention and primary care included access to health care in settings not dedicated to serving transgender and/or gay communities, a friendly atmosphere and staff sensitivity, and holistic care, including hormone therapy. Community-based health care settings can be ideal locales for HIV prevention and primary care for TW.
The re-use of injecting equipment in clinical settings is well documented in Africa and appears to play a substantial role in generalised HIV epidemics. Several African governments have taken steps to control injecting equipment, including banning syringes that can be reused. However, injection drug use (IDU), of heroin and stimulants, is a growing risk factor for acquiring HIV in the region, having become increasingly common among young adults in sub-Saharan Africa and also associated with high-risk sex. Demand-reduction programmes based on effective substance use education and drug treatment services are very limited, and imprisonment is more common than access to drug treatment services. Drug policies are still very punitive and there is widespread misunderstanding of and hostility to harm-reduction programmes. These new injection risks will take on increased epidemiological significance over the coming decade and will require much more attention by African nations to the range of effective harm reduction tools now available in Europe, Asia and North America.
Multiple partnerships may not be as common in South Africa as previously thought, according to a study presented at the recent AIDS Research Symposium at the University the Witwatersrand, in Johannesburg. Saul Johnson, managing director of Health & Development Africa (HDA), a health consultancy which conducted the research, said findings from four sites across the country showed about 26% of men and 5% of women reported having had more than one partner in the past year. ‘The perception out there is that [having multiple partners] is more common than it really is,’ he said. The reason may be that men tend to inflate their partner counts. Johnson and his team found that when men were asked to write down a figure for the number of partners they had had in the last twelve months they exaggerated, but when asked to plot their sexual encounters in more detail, using a sexual partner calendar, they often revised the number down slightly. Women's responses were more likely to be consistent.
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12. Governance and participation in health
This guide, produced by the EuropeAid Co-operation Office, offers guidance to European Community (EC) sector specialists on how to analyse and address governance in sector operations in a more systemic and comprehensive way, without being a compulsory blueprint. It aims to strengthen understanding of governance issues at sector level. It is divided into four chapters, which provide a broad definition of governance and overall EC policy on governance, experiences in dealing with governance at sector level reasons for strengthening efforts, a focus on an overall approach in addressing sector governance, and a methodology that can guide the process of analysing governance at sector level.
Like many other developing countries with forbidding landscapes and isolated communities, radio is to be the most effective way of communication in Nepal, where the majority of population lives in villages and the half of it cannot read and write. This manual draws from both the grassroots experience of community media and from international broadcast practices. It considers the issues that are the real basis for the success of community media: public accountability, community representation, locally relevant programming, diverse funding and acknowledgement of staff, including volunteers. It covers in details many key success factors, such as participation and ownership, content, management, volunteerism and networking. It can be applied across a wide range of contexts, from policy issues to the assessment of a local station.
This paper focuses on three crucial issues when analysing human rights and health: the importance of social class in community participation, the pivotal role of power and empowerment, and the role of the state, which refers to the concepts of claim holders and duty bearers included in a rights-based approach to health. The concept of ‘health through people's empowerment’ is proposed to identify and describe the core aspects of participation and empowerment from a human rights perspective and to put forward common strategies. If marginalised groups and classes organise, they can influence power relations and pressure the state into action. Such popular pressure through organised communities and people's organizations can play an essential role in ensuring adequate government policies to address health inequities and in asserting the right to health.
The twenty African countries included in the Afrobarometer include many of the most politically liberal countries on the continent, including seven countries ranked by Freedom House in 2008 as ‘free’. However, when one assesses the quality of these regimes based on popular attitudes and perceptions, one does not find any consolidated democracies among them (although Botswana comes close). In fact, some are consolidating as autocracies, but most countries are best understood as unconsolidated, hybrid regimes. They exhibit some key elements of democracy, such as regular elections and protection of core individual freedoms. But either the popular demand for democracy, or the perceived supply of democracy, or, in most cases, both, fall short of the standards of full democracy. But the trajectories of individual countries are extremely diverse, with some exhibiting sharp declines away from democratic consolidation, while others are steadily advancing.
Zambian civil society fears the imminent introduction of legislation designed to regulate non-governmental organisations (NGOs) that may compromise their independence and even result in a clampdown on their operations. The new 2009 NGO Bill calls for ‘the registration and co-ordination of NGOs, to regulate the work, and the area of work, of NGOs operating in Zambia.’ If the bill becomes law, a 16-member board will be established by the community development minister to ‘receive, discuss and approve the code of conduct [of NGOs], and ... provide policy guidelines to NGOs for harmonising their activities to the national development plan of Zambia.’ NGOs will be compelled to re-register every five years and submit annual information on their activities, funders, accounts and the personal wealth of their officials – failure to comply could result in the suspension or cancellation of registration. However, civil society leaders and human rights activists fear the proposed new law could be used by government to silence critics and erode civil society.
This guide examines the basic issues that a country or organisation should consider when developing and producing a governance assessment. It is by no means the ‘last word’, but should serve as a starting point and outline for those interested in conducting a country-led governance assessment. The paper explains the trade-offs of various approaches and methodologies in terms of quality and costs. At the same time, it provides some basic background on the technical aspects of conducting a governance assessment. The guide attempts to answer the rather complex question: how can country-led governance assessments be carried out with broad stakeholder participation at a reasonable cost, and at the same time produce meaningful results that can be used by civil society and governments alike?
13. Monitoring equity and research policy
In a major step forward for the open access movement, universities at Berkeley, Cornell, Dartmouth and Harvard, as well as the Massachusetts Institute of Technology, have announced a joint commitment to provide their researchers with central financial assistance to cover open access publication fees, and encouraged other academic institutions to join them. The aim of the Compact for Open Access Publication Equity (COPE) is to create a level playing field between subscription-based journals (which institutions support centrally via library budgets) and open access journals (which often depend on publication fees). The Compact commits each university ‘the timely establishment of durable mechanisms for underwriting reasonable publication charges for articles written by its faculty and published in fee-based open-access journals and for which other institutions would not be expected to provide funds.’
The goal of this book is to offer a glimpse in to the world of global health research through an indigenous peoples’ population lens. The symposium began with a presentation on Bridging Indigenous and Global Health, and the opening presenter made a plea for research into healthy equity to take a new direction by including distal determinants in the analysis. She noted that ‘it is the causes of the causes that have to be addressed… [ ] A distal determinant does not mean an unimportant determinant. This is where we have to head if we are truly going to address inequities… [ ] … because long-standing structures of disadvantage are at play in creating inequities.’ Thereafter, a number of plenary sessions were held. Two sessions covered work of direct relevance to east, southern and central Africa, namely: Mental Health Research in Africa: Lessons Learned; and Tackling Inequities in Health: Lessons from the Work of the Regional Network on Equity in Health in East and Southern Africa. Climate change and its impact on developing nations was also discussed.
Scenarios where the results of well-intentioned scientific research can be used for both good and harmful purposes give rise to what is now widely known as the ‘dual-use dilemma’. Four recent cases involving of dual-use discoveries have been particularly controversial: the development of a super strain of mouse pox, the synthesis of a polio virus from scratch, a case of genetically engineering a smallpox virus and the use of techniques of synthetic genomics (similar to those used in the polio study) to ‘reconstruct’ the Spanish flu virus, which killed between 20 and 100 million people in 1918–1919. Research may not only produce cures for modern diseases but may also be used to produce biological weapons. Though they understood the dangers, the scientists and editors involved defended their actions. It is questionable, however, whether reliance on voluntary self-governance of the scientific community in matters of censorship is advisable. Because scientists generally lack training in security studies, they may lack the expertise required for assessment of the security risks of publication in any given case.
This multi-cohort study of eleven anti-retroviral therapy (ART) programmes monitored the South African National Antiretroviral Treatment Programme, 2003–2007, in Gauteng, the Western Cape, Free State and KwaZulu-Natal. Subjects were all adults and children (<16 years old) who initiated ART with ≥3 antiretroviral drugs before 2008. Most sites were offering free treatment to adults and children in the public sector, ranging from 264 to 17,835 patients per site. Among 45,383 adults and 6,198 children combined, median age (interquartile range) was 35 years and 42.5 months respectively. Of adults, 68% were female. Between 2003 and 2007, enrolment increased eleven-fold in adults and three-fold in children. The study describes dramatically increased enrolment over time. Late diagnosis and ART initiation, especially of men and children, need attention. Investment in sentinel sites will ensure good individual-level data while freeing most sites to continue with simplified reporting.
14. Useful Resources
This manual is a free online guide that provides very basic guidelines for small non-governmental organisations (NGOs) in the developing world regarding fund-raising, focusing on the importance of adhering to the basic principles of good governance. The first impulse of many such non-governmental organisation (NGO) seeking funding is to request the contact information for possible funders, and once such information is received, these NGOs often write immediately to the potential funder, stressing how desperately funds are needed. Sadly, this approach often harms the NGO, rather than garnering support. Not only does it rarely attract funding, it can turn funding sources against the NGO altogether. This manual intends to discourage that behaviour and, instead, encourage simple activities by small NGOs that help continually cultivate and attract support. It is, instead, a set of guidelines on how to prepare an organisation to be attractive to donors, how to search for potential donors that support organisations in the developing world and how to approach such potential donors.
Planning, monitoring and evaluation in development requires a focus on nationally owned development priorities and results and should reflect the guiding principles of national ownership, capacity development human development. This handbook is aims to enhance the results-based culture within the United Nations Development Programme (UNDP) and improve the quality of planning, monitoring and evaluation. While written with UNDP staff, stakeholders and partners in mind, the handbook provides a useful overview of why and how to evaluate for results that can be used in other contexts. This handbook concentrates on planning, monitoring and evaluating of results in development and is designed to be used as a reference throughout the programme cycle. It deals with the integrated nature of planning, monitoring and evaluation, and describes the critical role they play in managing for development results, as well as the conceptual foundations of planning and specific guidance on planning techniques and the preparation of results frameworks that guide monitoring and evaluation.
The Policy Analysis and Capacity Enhancement Unit (PACE) website at the Human Sciences Research Council (HSRC) has now been launched. A portal to serve the wider policy and development community in South Africa - civil society, government officials and academics - has been strongly endorsed and Phase 1 of the process has been concluded. Collections of policy-related information are being developed in the following thematic areas: the developmental state, gender, health, poverty, social & economic policy, social innovation and social protection. The portal aims to provide a platform for key issues being debated including national health insurance and poverty alleviation. In addition, the site is developing a collection of information on policy methods – the ‘how-to’ of policy – to support the work of different sectors. Sections of the site include -
Information on methodologies for getting research into policy, policy into action, and on monitoring and evaluation; Policy-related events and training; Journals and listings of policy associations, centres and networks. The portal hosts invite feedback and submision of policy-related information.
Real-time evaluations (RTE) is one of the most demanding types of evaluation practice. It requires wide range of skills from evaluators but also a tightly focused professional approach in order to meet the demands of an RTE. This pilot guide is intended to help both evaluation managers and team leaders in commissioning, overseeing and conducting real time evaluations (RTEs) of humanitarian operational responses. Drawing on practices, it is intended as a flexible resource that can be adopted to a variety of contexts. The guide concentrates on RTEs undertaken in first phase of an emergency response, where RTE fieldwork takes places within a few months of the start of the response. This is because these particular RTEs can post particular problems to both evaluation managers and evaluation teams. The guide offers 25 tools and techniques designed to help both evaluation managers and teams working through their respective steps.
15. Jobs and Announcements
The Forum will take place on 27 and 28 February 2010, immediately preceding the 54th session of the United Nations (UN) Commission on the Status of Women, which will also undertake a 15-year review and appraisal of the Beijing Platform for Action. Early registration (by 15 October) is recommended, as it is cheaper than late registration (after 15 January). 2010 marks the 15th anniversary of the Beijing World Conference on Women. In recognition of this anniversary, the Non-governmental Organisation (NGO) Committee on the Status of Women is organising an NGO Global Women’s Forum to consider implementation of the Beijing Declaration and Platform for Action (BPfA). The Forum programme will include two full conference days commencing with an opening ceremony, and continuing with plenary sessions, panel discussions and workshops. The Forum is working closely with NGOs and UN partners to assure full and representative participation from all regions of the world, especially from developing countries.
The Congress will be held in Africa for the first time, from 4–9 August 2010 in Johannesburg, South Africa. Participants who would like to present an oral or poster presentation must submit an abstract for consideration by the Scientific Committee. The abstracts should be submitted in English. The Scientific Committee will determine whether abstracts will be accepted as oral or poster presentations, with consideration to be given to the author’s preference. The presenting author is required to ensure that all co-authors are aware of the content of the abstract before submission to the Secretariat. Only the abstracts of registered presenting authors will be included in the programme and book of abstracts. The Committee will review abstracts. Following this, information regarding acceptance, and scheduling will be sent to the abstract submitter. Instructions for preparation of posters will be sent together with the acceptance notification. Only abstracts of authors who have paid their registration fees by 2 December 2009 will be scheduled and included in the final programme.
Global Social Policy is a fully peer-reviewed journal that advances the understanding of the impact of globalisation processes upon social policy and social development on the one hand, and the impact of social policy upon globalisation processes on the other hand. The journal analyses the contributions of a range of national and international actors, both governmental and non-governmental, to global social policy and social development discourse and practice. It has a clear focus on social
policies that have global and transnational reach and that have significant implications for the development of social policy worldwide. The Journal publishes three issues a year. The journal is seeking new editors with vision, international standing in global social policy, knowledge and understanding of current trends in global social policy
and closely related areas, journal editorial experience, proficiency in the use of information/communications technology and an ability to adhere to agreed work schedules and deadlines. Further information for interested applicants can be obtained from the email address below.
The Ford Foundation seeks two Program Officers to respectively focus on Addressing Social and Cultural Barriers to Sexual and Reproductive Health and Rights in West Africa (targeting Nigeria and sub-regional initiatives); and Protecting the Rights of Women and Girls and Addressing Social and Cultural Barriers to Sexual and Reproductive Health and Rights in East Africa. The Foundation’s Nairobi office seeks a dynamic individual to implement, monitor and coordinate grant making programs on Protecting the Rights of Women and Girls portfolio and the Sexuality and Reproductive Health and Rights (SRHR) portfolio. For further information please contact the email address below before October 14, 2009.
The Geneva Health Forum 2010 ‘Globalization, Crisis, and Health Systems: Confronting Regional Perspectives’ is fast approaching. We would like to inform you that the Final Date for Abstract Submission is now set at 30 October 2009. The 2010 GHF themes are found at www.ghf10.org/reports/143. Abstract submision is at www.ghf10.org/reports/130. Participant registration opens 10 October 2009. Specific information and updates on the 2010 edition of the Forum can be found on the website.
The Royal College of Gynecologists and Obstetricians is holding a meeting on 4 October, shortly before the FIGO World Congress, which offers to be an excellent opportunity to find out about the work that the LSTM/RCOG International Partnership is undertaking to improve women’s healthcare and contributing to the challenges of Millennium Development Goals 4 – reducing child mortality – and 5 – reducing maternal mortality. It is an opportunity to harness information to better support all those concerned and discuss ways to work together using knowledge and experience for the greater good of newborn and maternal health in the future. This programme will be delivered by national and international experts in their fields. The day will highlight successes and look at areas where more work is needed to effect change.
The International Federation of Gynecology and Obstetrics (FIGO) has finalised the dates of the Nineteenth FIGO World Congress of Gynecology and Obstetrics. The event –the largest gathering of obstetricians and gynecologists from around the world – will take place at the Cape Town International Convention Centre. We aim to build on the immense success of the event that took place in Kuala Lumpur, Malaysia in 2006 by offering delegates, their partners, sponsors and exhibitors an educational and cultural experience. The World Congress is the only event on this scale that brings together specialists in obstetrics and gynecology from all parts of the world. The 2006 event attracted over 6,000 delegates from in excess of 120 countries and territories, and numbers are expected to be higher in 2009.
AIDS Research and Therapy is covered by an open access license agreement which means that anyone with internet access can read, download, redistribute and reuse published articles. Submit your manuscript to AIDS Research and Therapy and reach a wide audience of academics, researchers, community activists and other health stakeholders. Your published article can then be posted on your personal or institutional homepage, e-mailed to friends and colleagues, printed, archived in a collection, distributed on CD-ROM, included in coursepacks, quoted in the press, translated and further distributed as often and widely as possible.
The second international meeting on Innovations and Progress in Healthcare for Women is being jointly held by the UCL Elizabeth Garrett Anderson Institute for Women's Health in collaboration with the Royal College of Obstetricians and Gynaecologists (RCOG). The theme of the meeting will be ‘Prevention, Screening and Risk Prediction in Women’s Health’ and each day will be dedicated to one specialty area. The three specialty areas are: obstetrics and neonatal; gynaecology and reproductive health; and gynaecology and cancer. In parallel to the main programme there will also be specialist workshops and seminars taking place. For more information and to access an online interest submission form, please go to the link provided.
The grants manager, who will serve on the Tuberculosis Alliance DOTS Support Alliance senior management team reporting to the Chief Executive Officer, is responsible for the agency’s membership programme, grant development, donor fundraising and serves as the staff adviser to the Board of Directors on development and fundraising issues. The successful applicant will be able to use a strategic planning approach to identify opportunities for fundraising, and initiate, coordinate and evaluate fundraising activities from grant sponsors and donors. They will work closely with the chief executive officer, the fundraising committee and the Board of Directors to create and implement fundraising goals and solicit funds to meet these goals. A Bachelor’s degree required, with Master’s degree preferred. Five or more years’ broad-based fundraising experience in a grant-centred environment is required, as well as experience working with government agencies and international foundations is required. Competitive compensation, commensurate with experience. Email a cover letter and your curriculum vitae if you would like to apply.
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