In 2008, Members of Parliament from twelve countries in East and Southern Africa pledged to advance health equity and sexual and reproductive health in the region. How much progress had been made a year later? This was the question that was in focus in a follow up regional meeting in September 2009.
At a meeting in September 2008 hosted by Partners in Population and Development Africa Regional Office (PPD ARO), Regional Network for Equity in Health in East and Southern Africa (EQUINET), African Population Health Research Centre (APHRC) and Southern and East African Parliamentary Alliance of Committees of Health (SEAPACOH) with international partners, the members of parliamentary committees on health made commitments to promote primary health care, health equity and reproductive health.
These reflected the fact that parliaments can and do play a key role in promoting health and health equity through their representative, legislative and oversight roles, including budget oversight. EQUINET reports have documented examples of how these roles have been exercised in East and Southern Africa (ESA) to prioritise health in budgets, to monitor the performance of the executive, to strengthen laws protecting health and to keep the need to redress inequity in health and to promote sexual and reproductive health high on the public agenda.
As a unique measure to consolidate this, members of the health committees came together in the Southern and East African Parliamentary Alliance of Committees of Health (SEAPACOH) in 2005, to build a more consistent collaboration of the committees towards achieving individual and regional goals of health equity and effective responses to HIV and AIDS. The committee members carried out field visits to local governments at districts and lower levels to appraise themselves with the prevailing health needs, and mobilised and sensitised leaders at local government levels, in civil society and in communities on health and reproductive health issues. The parliamentary committees on health have met to review this work on health with EQUINET and various partners in 2003, 2005, 2008, and most recently in September 2009. In April 2009 with PPD support SEAPACOH developed and adopted a Strategic Plan for 2009 – 2013. The three main areas of focus identified include: ensuring needs-based resourcing of the health sector; ensuring effective domestication, implementation and compliance with agreed upon commitments in the health sector by governments; and ensuring sustainability of the alliance.
The follow up meeting in September 2009, hosted by the same organizations provided an opportunity to review progress, share experiences and lessons learnt over the past one year on the implementation of the resolutions of the September 2008 meeting.
Parliamentarians shared information on their progress, challenges, and on how to move commitments further forward. Progress had indeed been made since September 2008. For example:
• The East Africa Legislative Assembly have developed model laws on HIV, AIDS and female genital mutilation and is working to develop pooled procurement of drug, medical supplies and medical equipment; to review health insurance schemes, and to explore options for contracting health workers.
• In Kenya, the Parliament is scrutinizing the government budget through interrogating line ministries’ budgets. They have promoted an economic stimulus package, which provides for model health centers to be set up across the country and for twenty nurses to be hired in each constituency. In Kenya, a parliamentary taskforce has been set up to monitor and oversee action on socio-economic inequalities, including inequality in health and access to health care. The health committee have sensitized fellow MPs and the Ministers of Health and Finance on health issues, leading to legal provisions for Health Committees to be include in the budget process.
• In Malawi, Parliamentarians have moved a motion to persuade government to draft legislation on research activities to prevent abuse of citizens in clinical research trials.
• Namibia’s Committee on Human Resources, Social and Community Development were trained in gender based violence, reproductive health and HIV and AIDS in 2009. They undertook field visits to assess the implementation of government policies and programmes with regard to health and education issues; and revised and costed the national roadmap that outlines strategies and guidelines for improving maternal and child health, as a contribution to reducing illness and mortality in 2009.
• The Parliament of Swaziland reported implementing capacity building work on sexual and reproductive health for members. Members have also moved several motions, including on access to health services, and to promote investigation into the increase in abortions among young people and into the increase in maternal mortality.
• In Uganda, Parliamentarians have engaged Ministries of Health and Finance and the media on the need to fund sexual and reproductive health issues and recommended policy changes in the management and administration of the budget for drugs, including for reproductive health commodities. The committee has with the executive allocated additional government resources for reproductive health and HIV and AIDS. The committee has successfully advocated for a budget line of 200 million Uganda shillings (US$105 000) for activities to address female genital mutilation and prepared and presented a private member’s bill entitled “The Prohibition of Female Genital Mutilation Bill, 2009.
• In Zimbabwe, the Parliament has improved the allocation of resources to health in the budget. The committee on health has tabled a motion on the need to link sexual and reproductive health and HIV in programmes and policies that address vulnerabilities of women and children, has lobbied for the provision of appropriate, affordable, accessible and friendly adolescent and reproductive health services and are currently crafting a policy on male circumcision as one of the added strategies to reduce HIV infection. This was supported by a number of research studies in areas of sexual and reproductive health.
With these areas of progress taking place, the need to network regionally to share progress and experience was evident. In agreeing on a way forward over the next year, the committees agreed to operationalize the SEAPACOH Strategic Plan, including strengthening their own networking and communication across the region. This will enable those making progress in key areas of health to share information on achievements, to exchange experiences in their oversight of regional commitments and international agreements and to support new and innovative programmes to enhance health, including reproductive health. The adoption of common platforms and a regional agenda can only make the work of the individual committees stronger.
Please send feedback or queries on the issues raised in this briefing to the EQUINET secretariat: admin@equinetafrica.org. For more information on the issues raised in this op-ed and the regional parliamentary meeting please visit the websites of PPD ARO: www.ppdafrica.org; EQUINET: www.equinetafrica.org; and APHRC: www.aphrc.org. The SEAPACOH strategic plan is at http://www.equinetafrica.org/bibl/docs/SEAPACOHstrategicplan09.pdf. The 2009 commitments are included in this newsletter and are also at http://www.equinetafrica.org/bibl/docs/RegParl%20mtg09%20res.pdf. The resolutions and report of the 2008 meeting are at http://www.equinetafrica.org/bibl/docs/REPMET0908parl.pdf and http://www.equinetafrica.org/bibl/docs/RESsep2008parl.pdf.
1. Editorial
2. Latest Equinet Updates
This paper presents a summary of the regional programme on incentives for health worker retention in the Regional Network for Equity in Health in East and Southern Africa (EQUINET) in co-operation with the East, Central and Southern Africa Health Community (ECSA-HC). The studies sought to investigate the causes of migration of health professionals, the strategies used to retain health professionals, how they are being implemented, monitored and evaluated, as well as their impact, to make recommendations to enhance the monitoring, evaluation and management of non-financial incentives for health worker retention. They aimed to have some comparability in design to share learning. The findings revealed that all four countries studied (Swaziland, Zimbabwe, Tanzania, Kenya) have put in place strategies to improve morale and retain staff in the public health sector. They were designed after some assessment of the drivers of attrition, often through prior surveys of push/pull factors. All the countries studied were applying a mix of non-financial incentives according to their strategies and plans, although implementation was not always uniform at all levels or for all cadres, or reached all those cadres intended. All implement non-financial incentives, together with some form of financial incentives. All studies indicated the presence of policies providing for non-financial incentives. The country studies observed that incentives were not uniformly applied to all health workers, and did not always reach all in the target category. The studies indicated a need to intensify focus on issues of operationalising and implementing non-financial incentives: moving from inserting incentives in policies and strategies to ensuring their application across all providers; moving from focused application for specific cadres of health workers to sector wide application of incentives for all health workers; and moving from experiments within the health sector to more sustained multi-sectoral policies that involve other sectors, including public service, finance, public works, education and housing. The results of the work were reviewed at a regional meeting to review the findings from this body of work and to explore the implications for policies and measures aimed at valuing and retaining health workers in ESA, develop proposals and guidelines for policy and action relevant to health worker deployment and retention, and identify knowledge gaps for follow up work. The recommendations from this meeting are presented.
This review of the capital flows in the health sector in Zimbabwe was carried out in 2008 and draws from secondary evidence. It presents evidence on the current composition of the health sector, particularly showing the public-private mix; trends over time post-1995 in private capital flows to the health sector showing key entry points for capital and the impact on the health care sector of these flows. The paper explores arguments used to support private flows, the role of trade agreements, and the policy, regulatory, institutional and public responses to the capital flows. It comments on issues arising in relation to methods used to analyse capital flows and their impacts, including data availability and bias. The rapid liberalisation of the health sector in Zimbabwe in the late 1990s created opportunities for private capital. While this was a policy objective of the time, it coincided with cuts in public expenditure during the 1990s and an economic crisis post-2000 that meant that private sector growth was not matched with public sector growth. The marked decline in public health investment reversed the major gains made during the 1980s, and private for-profit health care investments were concentrated in a few urban areas serving a minority of the wealthier population. The absence of a national health insurance system resulted in the 90% uninsured population having difficulties in accessing health services. Private health services were concentrated in a few vertically linked operations, sparking fears of anti-competitive behaviour, especially in the retail pharmaceutical sectors. Incentives given to private-for-profit health care providers did not lever public health gains, and the cost of both public and private health care soared, undermining access. The paper highlights areas for increased policy attention: for government to significantly increase public investment in health and control out of pocket expenditure; for the establishment of social health insurance; for the Ministry of Health to use its powers to monitor and regulate the expansion of private capital so that it serves policy objectives of universal coverage and equity. With powerful national interests gaining from profits in the health sector, including in the medical profession, monitoring and advocacy by communities is essential to engage on policy measures that protect equity and access. The paper further notes the regulatory role of the Competition and Tariff Commission.
This study aimed to explore the understanding of and factors in adherence to ARV treatment in people living with HIV and AIDS (PLWHA) who are engaged in harmful alcohol use and to intervene on prioritised factors to improve adherence, using participatory research and action (PRA) methods. We sought to determine the perceptions of and understanding of alcohol abuse and ARV treatment among PLWHA, their peers, family members and health workers. We aimed to increase collaboration between the mental health workers from clinic and hospital level and the community to respond to identified barriers to improve adherence to ARV treatment in PLWHA who use alcohol in a socio-economically deprived urban area in Nairobi (Kariobangi). The work was implemented within an EQUINET programme that aimed to build capacities in participatory action research to explore dimensions of (and impediments to delivery of) Primary Health Care responses to HIV and AIDS. The majority of the PLWHA included in the study were socially disadvantaged, unemployed, and with low education. Social support was equally poor since a large number were widowed, separated or divorced. Most of the PLWHA who participated were single or divorced women, some of whom admitted that they sometimes engaged in commercial sex to cater for their basic needs. These factors, together with poor health, limited their economic opportunities and security. In this context, alcohol use, noted by PLWHA, community members and health workers to be prevalent in the community, is not only encouraged by poor living and social conditions, but also by cost (it is relatively cheap) and by the social pressure to use alcohol to escape the mental stress caused by poverty. This is exacerbated by social attitudes that do not discourage alcohol use, and misconceptions that in fact encourage alcohol use, such as that alcohol can kill the HIV virus. This study suggests that the problem of alcohol abuse is poorly recognised for both communities and health workers: It was generally under reported to services, with low numbers of people on ARVs reported to have alcohol related problems, so that health workers see only a small share of the problem. A survey of the local health centres providing ARVs showed that screening for alcohol use was not routinely done and protocols for managing alcohol related disorders were not available. For PLWHA on ARVs, there are already challenges in dealing with the timing, frequency of medication and appointments and the availability and cost of food to support treatment. For PLWHA who use alcohol these difficulties are compounded. There are a range of services in the community that could potentially address these barriers that are involved in nutrition, psychosocial, medical care, PHC, HIV prevention and treatment services, counselling, social, legal, information and referral support for PLWHA. However these do not explicitly deal with the treatment of alcohol and drug related problems in the community or the needs of PLWHA on ARVs who use alcohol, and their adherence to treatment. Reflecting on these problems, the participants implemented a programme of counselling and education. The health workers were taught how to use the AUDIT in identifying problem drinkers and how to recognise and manage alcohol related disorders such as withdrawal fits. The PLWHA and their family members were encouraged to support one another and to identify symptoms of harmful alcohol use among themselves. The process was perceived by those involved to have reduced the harmful use of alcohol in those involved; to have made some improvements in community and health service support; in management of mental health and communication with families and in reducing stigma around alcohol use and HIV. The scores of the PLWHA on the repeat AUDIT questionnaire were however significantly lower than the baseline level.
3. Equity in Health
Concepts of fair distribution of health, such as equity of access to medical care, may not be sufficient to equalise health outcomes but, nevertheless, they may be more practical and effective in advancing health equity in developing countries. This study used a framework for relating health equity goals to development strategies allowing progressive redistribution of primary health care resources towards the more deprived communities is formulated. The framework is applied to the development of primary health care in post-independence Namibia. In Namibia health equity has been advanced through the progressive application of health equity goals of equal distribution of primary care resources per head, equality of access for equal met need and equality of utilisation for equal need. For practical and efficiency reasons it is unlikely that health equity would have been advanced further or more effectively by attempting to implement the goal of equality of health status. The goal of equality of health status may not be appropriate in many developing country situations; instead, a stepwise approach based on progressive redistribution of medical services and resources may be better.
This report presents a picture that is slightly at variance with many other reports on Africa’s progress towards the targets of the Millennium Development Goals (MDGs). It shows that progress is being made in a number of areas such as primary enrolment, gender parity in primary education, malaria deaths and representation of women in parliaments. There has also been a reinforcement of state capacity to deliver growth in many countries. If this rate of progress continues, the continent will be on course to meet a significant number of the MDGs by the target date (2015), but not all. A critical area for progress is the health-related MDGs, where progress is slowest. Interventions to accelerate progress on the health MDGs will yield significant dividend. In sum, the preconditions for accelerating progress to meet the targets of the MDGs are now largely in place, albeit constrained by inadequate resource flows and capacity in some critical areas like health capacity.
Entrenched poor health and health inequity are important public health problems. Conventionally, solutions to such problems originate from the health care sector, a conception reinforced by the dominant biomedical imagination of health. By contrast, attention to the social determinants of health has recently been given new force in the fight against health inequity. The health care sector is a vital determinant of health in itself and a key resource in improving health in an equitable manner. Actors in the health care sector must recognise and reverse the sector's propensity to generate health inequity. The sector must also strengthen its role in working with other sectors of government to act collectively on the deep-rooted causes of poor and inequitable health.
At least 100 people have died of cholera in parts of eastern Democratic Republic of Congo (DRC) since January. South Kivu Province is the worst affected, with at least 75 people dead and 6,392 infected. The South Kivu governor, Louis Leonce Muderwa, said the 10 worst-affected health zones in the province included Fizi in the region of Baraka, Nundu, Uvira, Kadutu, Ibanda, Bunyakiri, Katana, Minova, Nyantende and Kabare zones. Two deaths have been reported in Kadutu and one each in Ibanda and Katana. Muderwa declared a cholera epidemic there on 14 September. In neighbouring North Kivu Province, 48 deaths had been recorded and 4,609 people infected by 13 September. Other eastern regions have also recorded cases, with Katanga listing 199 new cases and two deaths. The North Kivu provincial medical inspector, Dominique Bahago, blamed the cholera outbreaks on poor hygiene. ‘The majority of the population's supply of cooking and drinking water is from Lake Kivu where all kinds of waste is dumped; cholera is endemic in that zone,’ said Bahago.
This study investigated the association between precipitation patterns and cholera outbreaks and the preventative roles of drainage networks against outbreaks in Lusaka, Zambia. Data was collected on 6,542 registered cholera patients in the 2003–2004 outbreak season and on 6,045 cholera patients in the 2005–2006 season. Correlations between monthly cholera incidences and amount of precipitation were examined. The distribution pattern of the disease was analysed by a kriging spatial analysis method. The association between drainage networks and cholera cases was analyzed with regression analysis. The study found that increased precipitation was associated with the occurrence of cholera outbreaks, and insufficient drainage networks were statistically associated with cholera incidences. Insufficient coverage of drainage networks elevated the risk of cholera outbreaks. Integrated development is required to upgrade high-risk areas with sufficient infrastructure for a long-term cholera prevention strategy.
Increasingly it is evident that women are affected by blindness and visual impairment to a much greater degree than men. In 1980 a systematic review of global population-based blindness surveys carried out showed that blindness is about 40% more common in women compared to men. This short article explores the gender dimensions of vision loss. The document considers the different risk factors faced by men and women including social and cultural differences and biological. Issues concerning the limited access women have to services are examined and the implications of women usually having a longer life expectancy. Cataract and trachoma are considered in addition to childhood blindness and briefly glaucoma and diabetic retinopathy. The authors emphasis the importance of understanding these problems at community, country, and global level. Reports should be provided which are disaggregated by sex.
This report gives an overview and analysis of the prevalence and impact of Alzheimer's disease, based on a systematic review identifying studies in 21 global burden of disease (GBD) world regions. The authors estimate 35.6 million people with dementia in 2010, with the numbers nearly doubling every 20 years, to 65.7 million in 2030 and 115.4 million in 2050. In low- and middle-income countries, especially, there is a general lack of awareness of Alzheimer’s and other dementias as medical conditions. They are perceived as a normal part of ageing. This general lack of awareness has important consequences, such as a lack of training on dementia recognition and management at any level of the health service. The authors recommend that the World Health Organization (WHO) should declare dementia a world health priority. Low- and medium-income countries should create dementia strategies based first on enhancing primary healthcare and other community services. Collaborations should be created between governments, people with dementia, their carers and their Alzheimer associations, and other relevant non-governmental organisations and professional healthcare bodies.
4. Values, Policies and Rights
Debate has emerged that pits health-systems support against targeted health campaigns. In classical terms, the debate may be framed as the Bismarck model versus the Beveridge model, but this dichotomy is increasingly viewed as being as false as that which seeks to pit vertical schemes of health against horizontal. In truth, development of systems capable of delivering health, generally, or specifically targeted campaigns and health initiatives, all rely on the existence of health financing mechanisms that offer universal access to health. The specific nature of such financing schemes and service delivery models will vary between nations. To assume that universal health coverage necessarily requires a single-payer government mechanism would be a mistake, and adherents to that position doom the people of the poorest nations to generations of medical deficiency. Whether a nation chooses a mixed economy model of coverage, single-payer mode, donor-issued voucher mechanism, or other innovative models of universal financing is not the issue. Provision of universal health coverage is the issue facing the entire global health construct. Sadly, for most of the world's populations universal health coverage remains a mirage, blurred further out of focus by the present world financial crisis.
This book brings together leading researchers from a variety of disciplines to examine three areas: health disparities and inequity due to gender, the specific problems women face in meeting the highest attainable standards of health, and the policies and actions that can address them. It also brings together experts from a variety of disciplines, such as medicine, biology, sociology, epidemiology, anthropology, economics and political science, who focus on three areas: health disparities and inequity due to gender; the specific problems women face in meeting the highest attainable standards of health; and the policies and actions that can address them. Highlighting the importance of intersecting social hierarchies (such as gender, class and ethnicity) for understanding health inequities and their implications for health policy, contributors detail and recommend policy approaches and agendas that incorporate, but go beyond commonly acknowledged issues relating to women’s health and gender equity in health.
Aggravated homosexuality will be punished by death, according to a new bill tabled in Parliament of Uganda on 13 October 2009. The private member’s bill was tabled by Ndorwa West MP, David Bahati (NRM). A person commits aggravated homosexuality when the victim is a person with disability or below the age of 18, or when the offender is HIV-positive. The bill thus equates aggravated homosexuality to aggravated defilement among people of different sexes, which also carries the death sentence. The Bill, entitled the Anti-Homosexuality Bill 2009, also states that anyone who commits the offence of homosexuality will be liable to life imprisonment. A person charged with the offence will have to undergo a mandatory medical examination to ascertain his or her HIV status. The bill further states that anybody who attempts to commit the offence is liable to imprisonment for seven years. The same applies to anybody who aids, abets, counsels or procures another to engage in acts of homosexuality or anybody who keeps a house or room for the purpose of homosexuality. The bill also proposes stiff sentences for people promoting homosexuality – a fine of 100 million Ugandan shillings or prison sentences of five to seven years.
This study considered whether female youths from communities with higher sexual violence were at greater risk of negative reproductive health outcomes. It used data from a 2003 nationally representative household survey of youths aged 15–24 years in South Africa. The key independent variable was whether a woman had ever been threatened or forced to have sex. The variable was aggregated to the community level to determine, with control for individual-level experience with violence, whether the community-level prevalence of violence was associated with HIV status and adolescent pregnancy among female, sexually experienced, never-married youths. The study found that youths from communities with greater sexual violence were significantly more likely to have experienced an adolescent pregnancy or to be HIV-positive than were youths from communities experiencing lower sexual violence. Youths from communities with greater community-level violence were also less likely to have used a condom at their last sexual encounter. Individual-level violence was only associated with condom non-use. Programmes to reduce adolescent pregnancies and HIV risk in South Africa and elsewhere in sub-Saharan Africa must address sexual violence as part of effective prevention strategies.
Strict observance of state sovereignty, once a mainstay of international relations, has given way to a global concern to protect human rights wherever they are threatened. On paper, at least, Africa shares this international commitment in its establishment of monitoring bodies like the African Commission on Human and Peoples’ Rights and the African Union’s Peace and Security Council. But how central are human rights to the actual conduct of international relations by the continent? Are they merely a ‘variable concern’? There are no simplistic answers to this question. Africa has long been committed to supporting the rule of law, safeguarding refugees, protecting women and children, encouraging youth participation, and promoting democracy. But, as ever, national interest still plays an important role when it comes to defining how the continent relates to the world. The author argues that China’s policy of non-interference in the internal affairs of its trading partners has the potential to foster corruption, fuel armed conflicts and encourage human rights violations. African governments, it is proposed, should ensure that their emerging foreign policy solutions, whatever they are, do not compromise the commitment they have already made to foster human rights and good governance.
5. Health equity in economic and trade policies
Anti-counterfeiting initiatives might have a negative impact on access to medicines while not addressing the problem of fake medicines, particularly in developing countries, says a panel, which met on 25 September at the World Intellectual Property Organization General Assemblies. Confusion between legitimate generic medicines, poor quality medicines and those illegally copying the trademark of a brand-name product could have a devastating impact, and a precise definition and scope of counterfeiting is needed, they said. IP enforcement measures should only be used against drugs with trademark violations. Counterfeit medicines are products that are packaged to intentionally look like a legitimate product but are not. This is a trademark infringement. On the other hand, substandard medicine is a legitimately produced medicine that does not meet the standards set by the relevant drug regulatory authority. This is an issue of quality control. ‘When we speak about anti-counterfeiting initiatives, we are basically referring to the global IP enforcement agenda,’ Sangeeta Shashikant, senior legal advisor at the Third World Network, said at the meeting.
From the 1960s to the present, many African integration groupings have emerged and faded away. Within the various integration groupings, the development of trade has been a major objective pursued through programmes aimed at achieving a free trade area, a customs union and a common market. But outcomes of decades of experimentation with integration in Africa have on balance remained modest. For instance, African trade statistics continue to paint a generally modest picture of trade between regional economic communities (RECs), as well as intra- African trade. The countries generally lack a strong industrial capacity to produce diversified manufactured goods for trade within regional markets. Many of the multiple national currencies in Africa lack convertibility and efforts towards monetary, financial and physical integration have not been very promising. The cost of doing business in the continent is generally high, due in part to infrastructure gaps, duplicative border procedures and cumbersome paper requirements. Paperless trade still remains a distant objective. The free movement of people and the right of establishment have progressed in some RECs, but remain a paper objective in many other African subregions.
At the end of the World Intellectual Property Organization (WIPO) General Assemblies, held from 25–30 September 2009, frustration at the lack of consensus was palpable, especially among developing countries calling for a legally-binding international instrument. ‘We believe our countries are being treated unfairly,’ said a delegate from Burundi during the plenary session, in reference to the fact that there is as yet no international instrument to protect traditional knowledge and genetic resources. ‘The [WIPO] Secretariat is an arbiter and should intervene,’ he added. But others questioned the legally binding instrument as an outcome. Korea suggested in plenary that ‘perhaps we can prevent misappropriation without proprietisation,” and suggested looking at options to protect traditional knowledge and genetic resources within the existing system, and several developed countries said a renewed mandate should not commit to a specific outcome. Botswana and Zimbabwe mentioned efforts through the African Regional Intellectual Property Office (ARIPO) to create a regional instrument, while Ecuador spoke of creating a national biodiversity and traditional knowledge database that would include sui generis protection measures.
It has been frequently claimed that cholera epidemics, both in the 19th century and today, were and can be the key stimulus for procurement of safe water and sanitation, an idea that the author calls ‘cholera forcing’. ‘Technology forcing’ refers to imposition of exogenous factors that suddenly make possible achievements that had not seemed so; cholera has been seen in this light. He argues that this view oversimplifies and under-represents the importance of industrialisation in securing water supplies. Careful study of the financial, political, and administrative foundations of such changes will be more fruitful.
Today there is a real attempt by certain actors to confuse the debate about substandard, counterfeit and generic drugs. Articles in the media often discuss counterfeit, substandard and generic medicines as if they are all one problem and the same solution can be used for all of them. This confusion can have a negative impact – because if the public believes that generic medicines are the same as counterfeit medicines, they will lose confidence in generic medicine. Another negative consequence of confusing counterfeit and generic drugs, is that this often leads to calls for stronger intellectual property enforcemement, which then creates access to medicines problems. Even at the level of policy makers, these confused messages can have a very negative effect. The World Health Organization (WHO) has a role to play in supporting national regulators to take measures against both counterfeit and substandard medicines. But, perhaps most importantly, WHO should shift its attention to substandard medicines, a much bigger problem.
After a year of stalled deliberations on the issue of protecting traditional knowledge, genetic resources and traditional cultural expressions, delegates at the World Intellectual Property Organization General Assemblies on 1 October found a compromise text that gives the committee its strongest mandate yet. The new Intergovernmental Committee on Intellectual Property and Genetic Resources, Traditional Knowledge and Folklore (IGC) agreement is to undertake text-based negotiations that will eventually become an ‘international legal instrument (or instruments)’ to ‘ensure the effective protection of’ traditional knowledge, genetic resources and traditional cultural expressions (folklore). It also lists three texts – containing language in the format of a possible draft instrument – that will form the basis of those negotiations, though it does not limit negotiations to just those texts. It also says there will be three inter-sessional working groups during the next biennium to accelerate the work.
It caught observers and analysts by surprise. The Pittsburgh G20 summit witnessed the death-knell of the G8 as the sole arbiter of global economic policy and the transference of power to the G20 grouping. Officially this will take place at the G20 summit at the end of 2010 in South Korea, as Canada – in perhaps an unwelcome reminder of parochial G8 decision-making –is keen to keep ‘its’ G8 event as relevant as possible. The author argues that the G8, after much debate over its futility as a global decision-making body, is consigned as a forum to consider security matters. But the G20 counts just one African nation as a member. Although developing countries such as India, Brazil and South Africa have more authority to speak on behalf of poorer nations, the voices of low-income countries themselves were not included or seemingly solicited. ‘One of the most important successes of Pittsburgh is that that the G20 is the most qualified forum to deal with global issues,’ African Development Bank president Donald Kaberuka said, speaking on the periphery of a conference. ‘(However) (t)he way it is now structured...the low-income countries' priorities are still an appendix, a footnote.’
Kenya is facing a nationwide shortage of anti-retroviral (ARV) drugs after a court case held up the purchase of the life-prolonging medication. The High Court in the capital, Nairobi, barred the Ministry of Health from procuring ARVs after a consortium of drug suppliers challenged the tender process earlier this month. According to James Ole Kiyapi, permanent secretary in the Ministry of Public Health, unless the court allows the government to purchase ARVs, there is a real risk that people who depend on government hospitals for their medication could go without. ‘We have very little medicine left and there is nothing we can do to get the drugs because we have to abide by the court order; we can do very little at the moment unless the court reverses the order,’ he said. Earlier this year, the Public Procurement Review Board (PPRB) – responsible for monitoring the government's purchases – issued an order forcing the Kenya Medical Supply Agency (KEMSA) to accept tender documents by an Indian company, Hetero Drugs Limited, and start the tender process afresh. KEMSA had rejected the company's tender documents because they allegedly did not comply with procurement rules. The consortium that originally won the controversial tenders has now gone to court to reverse the order of the PPRB.
Many countries have been able to use the TRIPS flexibilities to access lower-priced generic drugs. However, as pharmaceutical product patents start to be granted in producing countries, this situation will change. To resolve the problem of high drug prices caused by patent monopolies, this book recommends that developing countries should make full use of the provisions in the Doha Declaration. It introduces a re-conceptualised definition of innovation as encompassing discovery, development and delivery, thereby including access as an integral part of innovation. Equally important, the international community should consider supporting patent pools as a tool for improving the management of intellectual property for access and innovation. In this sense, the book suggests a new agreement on sharing the costs and benefits of medical research and development (R&D) for the sake of humankind. In like manner, the book underlines a proposition to change the way R&D is financed. At the core of this proposal is the elimination of the linkage between drug prices and drug discovery. It also highlights the importance of establishing a trade framework for R&D that focuses on equitable contribution to the cost of R&D through multiple means – not exclusively through the granting of patent monopoly rights.
In April 2009, the G20 countries committed US$750 billion to the International Monetary Fund (IMF), which has assumed a central role in global economic management. The IMF loans to financially ailing countries come with loan conditions that have been extremely controversial. In principle, they are designed to help countries balance their books. In practice, they often translate into reductions in social spending, including spending on public health and health care delivery. This article introduces a series in which contributors review the evidence on the relationship between the IMF and public health and discuss potential ways to improve the Fund’s effects on health. While more evidence is needed for some regions, there is sufficient evidence to indicate that IMF programmes have been significantly associated with weakened health care systems, reduced effectiveness of health-focused development aid, and impeded efforts to control tobacco, infectious diseases, and child and maternal mortality. Reforms are urgently needed to ensure progress towards meeting the health Millennium Development Goals.
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6. Poverty and health
This report lays out a seven-point plan that includes a treatment package to reduce childhood diarrhoea deaths and a prevention strategy to ensure long-term results: fluid replacement to prevent dehydration; zinc treatment; rotavirus and measles vaccinations; promotion of early and exclusive breastfeeding and vitamin A supplementation; promotion of hand washing with soap; improved water supply quantity and quality, including treatment and safe storage of household water; and community-wide sanitation promotion. Dr Margaret Chan, Director-General of the World Health Organization, said: ‘We know where children are dying of diarrhoea. We know what must be done to prevent those deaths. We must work with governments and partners to put this seven-point plan into action.’ Yet, despite the known benefits of improving water supply and sanitation, some 88% of diarrhoeal diseases worldwide are attributable to unsafe water, inadequate sanitation and poor hygiene. As of 2006, an estimated 2.5 billion people were not using improved sanitation facilities, and nearly one in every four people in developing countries was practicing open defecation.
Five years ago, pregnant women in the village of Sauri, in western Kenya's Nyanza Province, had access to just one rundown and poorly staffed sub-district hospital. Few chose to use it, instead giving birth at home, risking complications during delivery and, for those living with HIV, passing it on to their child. Sauri is now part of the Millennium Villages Project, which, since December 2004, has established maternity wards in nine health facilities across Yala division. The village project, part of the United Nations (UN) Millennium Project, aims to lift communities out of extreme poverty through community-led initiatives to improve health, agriculture, education, gender equality and environmental sustainability. ‘With the improvement of these health facilities through the provision of free maternal services, 64% of expectant women in Sauri now come to deliver in health centres,’ said Patrick Mutuo, science coordinator and team leader of the Sauri cluster. ‘Right now those mothers still delivering at home are doing so not because of cost or distance. It could be due to cultural beliefs or other reasons. We have also initiated door-to-door voluntary testing and counselling services and health education,’ he added.
Treating household water with low-cost, widely available commercial bleach is recommended by some organisations to improve water quality and reduce disease in developing countries. This study analysed the chlorine concentration of 32 bleaches from twelve developing countries. The average error between advertised and measured concentration was 35% (range = -45%–100%; standard deviation = 40%). Because of disparities between advertised and actual concentration, the use of commercial bleach for water treatment in developing countries is not recommended without ongoing quality control testing.
7. Equitable health services
This special report on health care and technology describes how developing countries are using mobile phones to provides personalised medicine. Drawing from experiences of various countries, the authors demonstrate how new technologies help to tackle the health problems of the world’s poorest. The authors argue that given their ubiquity, personal convenience and interactivity, mobile phones offer an innovative way to reach reticent HIV sufferers. With demonstrated success in the use of mobiles for health (mHealth) in the likes of Uganda, Kenya, Rwanda and Mexico, the authors recommend that the visible face of any mHealth or e-health scheme, regardless of where it operates, needs to be as simple and user-friendly as possible, whereas the hidden back end should use sophisticated software and hardware. The authors conclude that the poor clearly benefit from technical improvements that cut the cost of manufacturing medical devices, make drugs more effective, or eliminate the need for refrigerating vaccines, as well as through big technical breakthroughs that save many millions of lives. Mobile phones, as demonstrated from the examples in this report, can aid early detection, effective early responses, and remote medicine.
In sub-Saharan Africa, more than 90% of children with sickle-cell anaemia die before the diagnosis can be made. The causes of death are poorly documented, but bacterial sepsis is probably important. This study examined the risk of invasive bacterial diseases in children with sickle-cell anaemia. It was undertaken in a rural area on the coast of Kenya, with a case-control approach. Blood cultures were undertaken on all children younger than 14 years who were admitted from within a defined study area to Kilifi District Hospital between 1 August 1998 and 31 March 2008 – those with bacteraemia were defined as cases. The study detected 2,157 episodes of bacteraemia in 38,441 admissions (6%). 1,749 of these children with bacteraemia (81%) were typed for sickle-cell anaemia, of whom 108 (6%) were positive as were 89 of 13,492 controls (1%). The study concludes that the organisms causing bacteraemia in African children with sickle-cell anaemia are the same as those in developed countries. Introduction of conjugate vaccines against S pneumoniae and H influenzae into the childhood immunisation schedules of African countries could substantially affect survival of children with sickle-cell anaemia.
Surgical intervention is necessary if children with cataract are to regain their sight. In many low- and middle-income countries, cataract is the leading cause of avoidable blindness among children. This article in considers the gender dimensions of surgery and the background to the situation in Tanzania where many children are not brought for surgery in a timely fashion and follow up is often poor. Girls have a significantly lower rate of surgery with only half as many girls receiving treatment as boys and tended to be bought for surgery much later than boys. In poor or struggling communities, sons are often seen as a source of income and financial security for parents when they get older, whereas girls are seen as a financial burden. Analysis showed that women’s level of education, their socioeconomic status, and the decision-making power they had within their household and their community all played a major role in determining whether and when their children would receive cataract surgery and whether they would be taken for follow-up visits. A number of ways forward are discussed including mass media efforts which may provide the first opportunity for rural villagers to learn about the need for early referral of young children with vision loss.
Three years ago, the Church of Scotland Hospital in the rural Umsinga area of South Africa's KwaZulu-Natal Province was the epicentre of a deadly outbreak of extremely drug-resistant tuberculosis (XDR-TB). It was reported that 52 of the 53 patients initially diagnosed died within a month of contracting this strain of TB, which is resistant to both of the first-line antibiotics used to treat the disease, as well as two classes of second-line drugs. At the peak of the epidemic in 2006, Umsinga was contributing more than two-thirds of the XDR-TB and multi-drug resistant TB (MDR-TB) cases in the province, but Dr Tony Moll, Principal Medical Officer at the Church of Scotland Hospital, is credited with leading efforts to turn the tide against the deadly new TB strains. Since then, 488 cases of XDR-TB and 356 cases of MDR-TB have been diagnosed. ‘The TB prevalence rate is still very high in the area,’ Moll said. ‘We get about 150 new TB cases every month.’ In 2008, the hospital achieved a TB cure rate of 83%, compared to the national cure rate of about 60%.
Traditionally, standards of care have been developed by a panel of experts and then implemented by a multidisciplinary team. This paper considered the feasibility of involving health professionals of all grades and policymakers in the establishment of standards for postpartum hemorrhage (PPH) in Malawi. The team established these standards using evidence from Malawi national guidelines and World Health Organization (WHO) manuals. They agreed on ten objectives and developed the structure, process, and outcome for each objective. The standards addressed different aspects of prevention, diagnosis and treatment. The involvement of both health professionals and policymakers might promote ownership, sustainability and allocation of resources for implementation.
At least 50 people have been quarantined in Tanzania's northern district of Mbulu to curb the spread of influenza H1N1, a highly contagious viral disease that killed one person last week, say health officials. The death is the first in East Africa. ‘We are struggling to control [the] further spread of the disease,’ said Anael Pallangyo, Mbulu District Medical Officer. All 18 dispensaries in the district were now on alert and about 50 patients placed in isolation wards. Tanzanian health authorities have stepped up surveillance at all the country's entry points, where people with flu-related symptoms such as coughing, fever and sneezing are taken to hospital for screening and treatment. The ministry of health recently announced 172 confirmed cases of H1N1 at the end of September.
There has been an increase in the number of pandemic HIN1 influenza cases being reported in the East African region, say medical officials. Some of the new cases have been recorded in schools. ‘Some 350 H1N1 influenza cases have been confirmed in Kenya,’ said Shahnaaz Sharif, the Director of Public Health, adding that the cases had been mild. ‘There may be more cases out there.’ So far, no deaths have been reported. Children, young adults and pregnant women, as well as those with pre-existing medical conditions, such as asthma, AIDS, diabetes, heart and blood diseases, are at increased risk of severe and sometimes fatal illness. Sharif said the affected schools in the Nairobi and Central regions had been provided with guidelines and other assistance on disease control. In Uganda, at least 33 H1N1 cases have been confirmed, mainly in the western district of Bushenyi. Health ministry spokesman, Paul Kagwa, said that nine seminarians at the Kitabi Catholic Seminary in Bushenyi had tested positive, while another 300 people were undergoing treatment for flu-related symptoms.
In 2007, a randomised controlled study was performed among a cohort of French soldiers returning from Cote d'Ivoire to assess the feasibility and acceptability of sending a daily short message service (SMS) reminder message via mobile device to remind soldiers to take their malaria chemoprophylaxis, and to assess the impact of the daily reminder SMS on chemoprophylaxis compliance. Among 424 volunteers randomised to the study, 47.6 % were assigned to the SMS group and 52.3 % to the control group. Approximately 90% of subjects assigned to the SMS group received a daily SMS at midday during the study. Persons of the SMS group agreed more frequently that SMS reminders were very useful and that the device was not annoying. Compliance did not vary significantly between groups across the compliance indicators. In conclusion, SMSes did not increase malaria chemoprophylaxis compliance above baseline, likely because the persons did not benefit from holidays after the return and stayed together. Another study should be done to confirm these results on soldiers or other types of individual travellers.
8. Human Resources
A ten-point plan to improve the nursing profession through education and training was recently agreed upon by the national Health Ministry in South Africa. Health minister, Aaron Motsoaledi, said discussions were underway between the department of Higher Education and Training, his department, the Council on Higher Education and Umalusi on the role of new quality councils in quality assurance of the diversity of health science offerings. From this discussion, an agreement emerged between the Department of Health and the Department of Higher Education and Training on the need for a diversified nursing education and training system. The next step was to revitalise the nursing colleges sector. This followed a recognition that strengthening colleges would contribute to a vibrant nursing education and training system. ‘What we need to do is work out how we can retain nurse educators, encourage nurse education as a critical career path and more generally attract young people into the profession,’ Motsoaledi said.
The findings in this report by the United Nations Development Programme (UNDP) cast new light on some common misconceptions about migration. Most migrants do not cross national borders, but instead move within their own country: 740 million people are internal migrants, almost four times the number of international migrants. Among international migrants, less than 30% move from developing to developed countries. For example, only 3% of Africans live outside their country of birth. Contrary to commonly held beliefs, migrants typically boost economic output and give more than they take. Detailed investigations show that immigration generally increases employment in host communities, does not crowd out locals from the job market and improves rates of investment in new businesses and initiatives. Overall, the impact of migrants on public finances is relatively small, while there is ample evidence of gains in other areas such as social diversity and the capacity for innovation. The gains to people who move can be enormous. Research found that migrants from the poorest countries, on average, experienced a 15-fold increase in income, a doubling of school enrolment rates and a 16-fold reduction in child mortality after moving to a developed country.
African countries, much poorer and less resourced than South Africa, are using trained mid-level health workers to perform tasks traditionally reserved for doctors, including surgery, and, in the process, are saving the lives. Presenters from Mozambique, Tanzania and Malawi at the 14th FIGO (International Federation of Gynecology & Obstetrics) World Congress of Gynecology and Obstetrics on 4 October shared details of how mid-level health workers are performing caesareans and other emergency surgical procedures in hospitals where there are simply no doctors and often no professional nurses. In Mozambique, 92% of all Caesarean sections at the district hospital level are carried out my mid-level providers – tecnicos de cirugia. In Tanzania the percentage is 84%. Studies in all three countries have shown that with the right training these mid-level providers – some trained straight after school while other have some experience of working in the health sector – have similar outcomes to doctors when providing life-saving emergency obstetric surgical care. Compared to doctors, their retention rates, especially in rural and district areas where the need is desperate, are excellent.
This survey was conducted 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. The survey 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.
9. Public-Private Mix
In June 2009, a new Health in Africa Fund was launched by the International Finance Corporation (IFC), the branch of the World Bank group mandated with supporting and expanding the private for-profit sector. This Fund will be managed by Aureos Capital, a private equity fund manager focusing on emerging markets. Through investment in small- and medium-sized private providers, the Fund will attempt to’[help] low-income Africans gain access to affordable, high-quality health services.’ The Fund targets initial commitments of US$ 100–120 million and intends harnessing private capital and private sector providers to improve quality and coverage of health services. But it is unlikely to improve access or quality of care unless it is complemented by initiatives to strengthen the public sector capacity to regulate, train, oversee and sub-contract (where appropriate) private providers. In addition, the Fund would also require the development of risk-pooling and subsidy mechanisms, so that privately-provided services can be offered free at the point of delivery. If it fails to do so, there is a concrete risk that, contrary to its objectives, it will contribute to the entrenchment of two-tier health-care systems and to a further concentration of human and financial resources in services catering to affluent urban dwellers.
The question of why privatisation and commercialisation of public services is taking place is a hotly contested one. Neoliberal analysts have argued that privatisation occurs because states fail: state officials are rent-seeking, inefficient, unaccountable, inflexible and unimaginative. Privatisation is seen as a rational and pro-poor policy choice, obvious to anyone willing to look at the track record of public versus private sector delivery: The authors here argue, by contrast, that the privatisation of public services has not happened because it has been inspired by some renewed sense of cultural enthusiasm for the market, but rather that it has become a necessity imposed on the state by economic circumstances: reduced public borrowing; cuts in state spending; liberalisation; and the opening up of new economic fields for intensified capital accumulation. Not surprisingly, some of the biggest boosters of privatisation are the private companies themselves, which have spent considerable time and effort trying to secure new market opportunities. They have actively sought contracts around the world, and consultancy firms, such as PriceWaterhouseCoopers and KPMG, have been actively promoting privatisation efforts and lobbying for the expansion and acceleration of the General Agreement on Trade and Services (GATS).
10. Resource allocation and health financing
The world is not on track to achieve the health-related targets of the Millennium Development Goals (MDGs) by 2015. As a solution, this article proposes a global fund for health Millenium Develelopment Goals, which will focus on measurable improvements in health outcomes, with a performance evaluation framework that looks at coverage with services relating to reproductive, maternal, newborn, and child health, HIV, malaria and tuberculosis, other infectious and non-communicable chronic diseases, quality of care, and fairness of financial contribution to the health system. Clear mandate and funding criteria that address key bottlenecks in health systems (including long-term predictable support for recurrent costs) are needed. A rights-based approach to health is the ideal, supported by new model of globally shared financial sustainability. The fund should have the capacity to disburse resources beyond the public system and beyond health sector when this represents appropriate and cost-effective approach to improve health outcomes. Its governance and accountability structure will be open to civil society at global and country levels and will be flexible enough to provide support to public sector on-budget or off-budget, in form of grants and not loans, unconstrained by financial ceilings.
Recognising the limitations of disease-specific approaches and the shortcomings of a fragmented international architecture for health, Save the Children UK welcomes the process of harmonisation among the World Bank, the Global Fund and the GAVI Alliance of their support to health systems strengthening programmes and activities. Save the Children supports the establishment of a joint funding and programming platform for health system strengthening by the three financiers of international health in line with the principles of the International Health Partnership and related initiatives (IHP+). To make the new joint mechanism completely aligned to the IHP+ principles, Save the Children recommends that the new entity operates in full transparency and openness, with a governance structure open to civil society at both global and country level, and that, in addition to striving for harmonisation among funding agencies, the new platform explicitly adopts the objective of better alignment to national needs.
The cost of artemisinin-based combination treatments (ACTs), the only truly effective antimalarials, is far beyond the reach of the average family in Africa, let alone poorer populations. The Affordable Medicines Facility for malaria (AMFm), an initiative of the Global Fund to Fight AIDS, Tuberculosis and Malaria, offers a radical solution: the possibility for countries to procure heavily subsidised ACTs that will reduce the price for patients so it is similar to that of chloroquine. One of the main reasons for mortality from malaria in Uganda is the exorbitant price of non-effective antimalarials and of ACTs in the private sector, which is the first port of call for more than 60% of Ugandans. A pilot study in Uganda, led by the Ministry of Health and Medicines for Malaria Venture, showed that availability of subsidised ACTs led to rapid growth of stocks of these drugs. Drug shops seemed to charge reasonable markups. Supportive interventions, such as communication and training, were essential to ensure accessibility and uptake of ACTs. Affordability of drugs rose in the private sector with a concomitant increase in uptake by children younger than five years. Augmented ACT uptake also eroded the market share of ineffective antimalarials such as chloroquine.
This budget analysis report focused on expenditure allocated to the health and HIV/AIDS sectors. While a promising increase in funding was achieved overall, questions remain about the allocation of funds. There is little regard of last year’s budget analysis findings and the Malawi Health Equity Network (MHEN) urges government to more actively engage with civil society now, and in the future, to ensure that the people’s voice is represented within the budget. In last year’s analysis, the key issues raised were health service financing; drug availability; health worker incentives; human resource development and management; and the health service impact of HIV and AIDS. Unfortunately many of these issues have not received the desired attention within this budget. MHEN recommends keeping the Abuja Commitment, ensuring efficient and transparent implementation and reporting, building capacity and pro-poor funding to district assemblies, increasing drug allocation and mainstreaming gender and youth issues.
This paper attempts to measure herding behaviour in the allocation of foreign aid, proposing different indexes that try to capture the specific features of aid allocation. The authors chose to use two measures initially developed in finance and adapted them to the specifics of foreign aid. However, the different estimates all reject the hypothesis of no herding. They describe pure herding behaviour, which create pendulum swing effects comparable to those in financial markets, and identify different indexes for detecting donor herding - its exact size depending on the measure adopted. The preferred index, relying on three year disbursements which indicates a significant level of herding, is similar to that which is found on financial markets. There is no, or very limited, herding among multilateral donors, in contrast to bilateral donors, who are frequently subject to herding behaviour. Yet, observable determinants actually explain little of the herding levels, leaving a large part of herding unexplained. The paper concludes that more research is needed and that the preferred measure finds a herding level around 11%. In other words, in a world where 50% of all allocation changes are increases, the average recipient experiences 61% of its donors changing their allocation in the same direction.
This paper analyses the interaction between aid donors and recipients from various angles. It considers the fact that the effort associated with ensuring aid effectiveness concerns both principal and agent, which requires cooperative behaviour – something that is difficult to design and predict. The analysis comes up a number of conclusions. There is a possibility of intrinsic motivation on the part of the agent through deriving utility from poverty alleviation. The interaction between donor and recipient may be better described through simple non-cooperative games. In this context, if effort by both sides is important to achieving aid effectiveness, there could be a double moral hazard. Designing a mechanism aimed at ensuring commitment to optimal policies is problematic, although the paper suggests that there should be a single global agency to manage poverty reduction and the coordination of donor behaviour. Aid effectiveness requires a stronger commitment to rewarding credible (hence costly) signals of the recipient's commitment to change.
The objectives of this paper were to explore public perceptions on what changes in the public health system are necessary to ensure acceptability and sustainability of national health insurance (NHI), and whether or not South Africans are ready for a change in the health system. A cross-sectional nationally representative survey of 4,800 households was undertaken, using a structured questionnaire. It found dissatisfaction with both public and private sectors, suggesting South Africans are ready for health system change. Concerns about the quality of public sector services relate primarily to patient-provider engagements (empathic staff attitudes, communication and confidentiality issues), cleanliness of facilities and drug availability. There are concerns about the affordability of medical schemes and how the profit motive affects private providers’ behaviour. South Africans do not appear to be well acquainted nor generally supportive of the notion of risk cross-subsidies. However, there is strong support for income cross-subsidies. Public engagement is essential to improve understanding of the core principles of universal pre-payment mechanisms and the rationale for the development of NHI. Importantly, public support for pre-payment is unlikely to be forthcoming unless there is confidence in the availability of quality health services.
Donor support for the HIV response has increased dramatically in recent years. In parallel, the debate continues between those who argue that the money is still too little, and those who say there is too much emphasis on HIV. Often there is little relation between a country’s total funding for HIV and the actual HIV burden. This is not necessarily a problem, and in fact the same is true for other diseases. Burden of disease is not the only basis for allocating resources; other criteria used to justify donor support include cost-effectiveness, aligning funding with stated country priorities, or equity. However, there is little to suggest that current donor practices on HIV funding can be justified on any of these grounds. The HLSP Institute’s analysis also suggests that donor spending on HIV has, to some extent, crowded out other expenditure on health and population. Put simply, funding for health would have increased more rapidly had it not been for the large increase in support for HIV. If such programmes were to continue to expand (as they probably will) sustainability challenges would be even greater, and the potential for further misalignment of health sector funding would be likely to increase.
11. Equity and HIV/AIDS
This paper sought to determine whether individuals’ risk perceptions and efficacy beliefs could be used to meaningfully segment audiences to assist interventions that seek to change HIV-related behaviours. A household-level survey of 968 individuals was conducted in four districts in Malawi. Cluster analysis was used to create four groups within the risk perception attitude framework: responsive, avoidant, proactive, and indifferent. The researchers ran analysis of covariance models (controlling for known predictors) to determine how membership in the risk perception attitude framework groups would affect three variables: knowledge about HIV, HIV-testing uptake and condom use. A significant association was found between membership in one or more of the four Risk Perception Attitude Framework groups and the three variables. In conclusion, the Risk Perception Attitude Framework can serve as a theoretically sound audience segmentation technique to determine whether messages should augment perceptions of risk, beliefs about personal efficacy or both.
This paper explored the extent to which public sector roll-out has met the estimated need for paediatric treatment in a rural South African setting. Local facility and population-based data were used to compare the number of HIV infected children accessing HAART before 2008, with estimates of those in need of treatment from a deterministic modeling approach. The impact of programmatic improvements on estimated numbers of children in need of treatment was assessed in sensitivity analyses. It found that, if PMTCT uptake were extended to reach 100% coverage, the annual number of infected infants could be reduced by 49.2%. Despite progress in delivering decentralised HIV services to a rural sub-district in South Africa, substantial unmet need for treatment remains. In a local setting, very few children were initiated on treatment under one year of age and steps have now been taken to successfully improve early diagnosis and referral of infected infants.
This study set out to assess paediatric antiretroviral treatment (ART) outcomes and their associations from a collaborative cohort representing 20% of the South African national treatment programme. It took the form of a multi-cohort study of 7 public sector paediatric ART programmes in Gauteng, Western Cape and KwaZulu-Natal provinces. The subjects were ART-naïve children (≤16 years) who commenced treatment with ≥3 antiretroviral drugs before March 2008. The study found that the median (IQR) age of 6,078 children with 9,368 child-years of follow-up was 43 months, with 29% being <18 months. Most were severely ill at ART initiation. More than 75% of children were appropriately monitored at 6-monthly intervals with viral load suppression (<400 copies/ml) being 80% or above throughout 36 months of treatment. Mortality and retention in care at 3 years were 7.7% (95% confidence interval 7.0 - 8.6%) and 81.4% (80.1 - 82.6%), respectively. Dramatic clinical benefit for children accessing the national ART programme is demonstrated. Higher mortality in infants and those with advanced disease highlights the need for early diagnosis of HIV infection and commencement of ART.
HIV and AIDS will slow Africa’s economic growth, but most important it will deplete human capital. Investment is declining as households, businesses and governments increase their recurrent expenditure to compensate for losses and disruptions because of sick or dead individuals. The health system – usually at the forefront in absorbing the impact of HIV and AIDS-related illnesses – is being eroded through the loss of many skilled personnel. Health staff are retiring, leaving for the private sector or other countries and succumbing to AIDS. In high-prevalence countries the epidemic is adversely affecting popular participation through attrition among the politically active age groups. The attrition among government officials and civil service personnel is compromising the state’s ability to implement decisions and policies. The epidemic is also likely to affect popular political opinion and levels of activism by reshaping political priorities and loyalties. But these challenges can be met if governance continues to improve across Africa.
This article summarises the challenges, opportunities and lessons learned from presentations, discussions and debates addressing major policy and programmatic responses to HIV in six geographical regions, including sub-Saharan Africa. It draws from AIDS 2008 Leadership and Community Programmes, particularly the six regional sessions, and Global Village activities. While the epidemiological, cultural and socio-economic contexts in these regions vary considerably, several common, overarching principles and themes emerged: advancing basic human rights, particularly for vulnerable and most at risk populations; ensuring the sustainability of the HIV response through long-term, predictable financing; strengthening health systems; investing in strategic health information; and improving accountability and the involvement of civil society in the response to AIDS. Equally important is the need to address political barriers to implementing evidence-based interventions such as opioid substitution therapy (OST), needle and syringe programmes (NSPs), comprehensive sexuality education for youth, and sexual and reproductive rights.
In this study, 202 isiXhosa speaking older caregivers from Motherwell in the Eastern Cape Province of South Africa were trained to provide care for grandchildren and adult children living with HIV or AIDS. Based on a community needs assessment, a health education intervention comprising four modules was designed to improve skills and knowledge which would be used to assist older people in their care-giving tasks. Some topics were HIV and AIDS knowledge, effective intergenerational communication, providing home-based basic nursing care, accessing social services and grants, and relaxation techniques. Structured one-on-one interviews measured differences between pre-intervention and post-intervention scores among those who attended all four modules vs. those that missed one or more of the sessions. The results demonstrated that older people who participated in all four workshops perceived themselves more able and in control to provide nursing care. The participants also showed a more positive attitude towards people living with HIV or AIDS and reported an increased level of HIV and AIDS knowledge.
More than four million people in low- and middle-income countries were receiving antiretroviral therapy (ART) at the close of 2008, representing a 36% increase in one year and a ten-fold increase over five years, according to this report. It highlights other gains, including expanded HIV testing and counselling and improved access to services to prevent HIV transmission from mother to child. Access to antiretroviral therapy continues to expand at a rapid rate. Of the estimated 9.5 million people in need of treatment in 2008 in low- and middle-income countries, 42% had access, up from 33% in 2007. The greatest progress was seen in sub-Saharan Africa, where two-thirds of all HIV infections occur. Prices of the most commonly used antiretroviral drugs have declined significantly in recent years, contributing to wider availability of treatment. The cost of most first-line regimens decreased by 10–40% between 2006 and 2008. However, second-line regimens continue to be expensive. Despite recent progress, access to treatment services is falling far short of need and the global economic crisis has raised concerns about their sustainability. Many patients are being diagnosed at a late stage of disease progression resulting in delayed initiation of ART and high rates of mortality in the first year of treatment.
The Ugandan parliament's house Committee on HIV/AIDS and related matters has appealed to the government to increase its funding for HIV, especially as infection rates remain high and the country continues to experience frequent shortages of anti-retroviral medicines. ‘As a committee we are advocating for the government to increase its funding on HIV/AIDS activities in the country to at least 15% [of the national budget],’ said Beatrice Rwakimari, chair of the committee. Uganda's most recent budget allocated about US$30 million to the purchase of anti-retrovirals and anti-malaria medication, and gave the Uganda AIDS Commission about US$3 million to fight HIV, while US$500,000 was earmarked for prevention programmes. The total allocation to HIV programmes – which makes up 6% of the national budget –marks an increase on previous years, but members of Parliament say it is still not nearly enough to roll back the effects of the pandemic. ‘This funding is too little, as we continue to get new infections every year,’ Rwakimari said. Uganda's HIV prevalence has risen marginally from a low of 6% in 2000 to 6.4%, according to the government.
Zimbabwe's adult HIV prevalence rate is continuing its downward trend, showing a drop from 14.1% in 2008 to 13.7% in 2009, according to new estimates released by the Ministry of Health and Child Welfare. The 2009 Antenatal Clinic (ANC) Surveillance Survey, based on blood specimens collected from 7,363 pregnant women anonymously screened at 19 clinic sites throughout the country, estimated that 1.1 million Zimbabweans in a probable population of around 11 million were living with HIV. The prevalence rate is expected to continue decreasing; investigations have shown that the decline ‘most likely resulted from a combination of an increase in adult mortality and a decline in HIV incidence, resulting from adoption of safer sexual behaviours’, said Douglas Mombeshora, Deputy Minister of Health and Child Welfare. ‘When prevention programmes achieve heightened awareness, significant changes in behaviour will occur, and one of the main outcomes is the significant reduction in the need for PMTCT [prevention of mother-to-child transmission] services, as well as a reduced number of new HIV infections,’ he noted.
As part of a broader initiative to monitor the implementation of the national antiretroviral therapy (ART) programme, this qualitative study investigated the impact of ART availability on perceptions of HIV in a rural ward of north Tanzania and its implications for prevention. A mix of qualitative methods was used including semi-structured interviews with 53 ART clinic clients and service providers. Four group activities were conducted with persons living with HIV. People on ART often reported feeling increasingly comfortable with their status reflecting a certain ‘normalisation’ of the disease. Overcoming internalised feelings of shame facilitated disclosure of HIV status, helped to sustain treatment, and stimulated VCT uptake. However ‘blaming’ stigma – where people living with HIV were considered responsible for acquiring a ‘moral disease’ – persisted in the community and anticipating it was a key barrier to disclosure and VCT uptake. As long as an HIV diagnosis continues to have moral connotations, a de-stigmatisation of HIV paralleling that occurring with diseases like cancer is unlikely to occur.
12. Governance and participation in health
This study sought to determine the best approach of integrating community interventions for TB control. It evaluated the records of 3,110 new TB patients registered in three Local Service Areas (LSAs), from quarter 1 2004 to quarter 4 2005. It found that bacteriological coverage, smear conversion and treatment success rates dropped in the interventional LSA, while the control LSAs remained consistent. The defaulter rates dropped in all LSAs, while the proportion of unevaluated cases increased in the interventional LSA. However, patients registered in the clinics had better chance of successful treatment outcome compared to their hospital counterparts. The study concluded that community participation by itself is not adequate to improve the performance of a TB control programme. Enhancement of the program’s technical and organisational capacity is crucial, prior to engaging purely community interventions. Failure to observe this logical relationship would ultimately result in suboptimal performance. Therefore, the process of entrusting communities with more responsibility in TB control should be gradual and take cognisance of the various health system factors.
In the last several years, a democratic boom has given way to a democratic recession. Between 1985 and 1995, scores of countries made the transition to democracy, bringing widespread euphoria about democracy's future, but more recently, democracy has retreated in some. These developments, along with the growing power of China and Russia, have led many observers to argue that democracy has reached its high-water mark and is no longer on the rise. The authors argue that that conclusion is mistaken and that the underlying conditions of societies around the world point to a more complicated reality. They note that it is unrealistic to assume that democratic institutions can be set up easily, almost anywhere, at any time. The conditions conducive to democracy, it is argued, can and do emerge – and the process of ‘modernisation’ advances them. Once set in motion, it tends to penetrate all aspects of life, creating a self-reinforcing process that transforms social life and political institutions, bringing rising mass participation in politics and – in the long run – making the establishment of democratic political institutions increasingly likely.
The People’s Health Movement (PHM), a world-wide civil society network, has a series of concerns about the World Health Summit (WHS), which is being planned as an annual event. Although the summit speaks of participation of nongovernmental organisations (NGOs), the costs ranging between 290–490 Euro for NGOs will exclude those that could legitimately reflect the voices and needs of grassroots and marginalised communities. The summit is also by invitation only, which suggests that NGO participation will be hand-picked and limited. PHM believes that, rather than creating a parallel policy forum, efforts and resources should be spent strengthening the World Health Organization (WHO) as the international coordinating body for issues related to people's health. WHO is one of the United Nation organisations in which each country has a voice. WHO thus provides a reasonably democratic decision making process, despite mechanisms used by powerful member states to direct the decisions. We are concerned that the declaration of the World Health Summit is likely to preferentially represent the interests of the Global North, corporations and those who financially sponsor the Summit.
Although the South African state has shifted away from uncritical promotion of neo-liberal public management, the government continues to mesh limited welfarism with market-driven reforms. It has tried to use service delivery to win political loyalty, but this strategy has largely backfired. There is growing public awareness that the current failures and inequities in access to public services can no longer be blamed on the legacy of apartheid. According to the free basic water policy applied since 2001, poor South Africans are entitled to 6,000 litres of free water per month. Yet, according to the Department of Finance’s own numbers, most poor households use 25,000 of water per month. Consequently, most such households then fall into arrears. Free basic water, often seen as a big improvement, also has unintended effects. It is a way to increase state surveillance of citizens by requiring registration and its restrictive availability is used as a disincentive for poor people to use water. If poor people use more than their basic allocation, they are heavily penalised by higher tariffs.
The Strengthening the AIDS Response Zambia (STARZ) programme marked a cutting edge multisectoral approach to HIV in the region. Non-governmental sectors (including civil society and the private sector) tend to be poorly organised, and authority tends to rest with government ministries. Not all sectors have incentives or welcome being coordinated, particularly by relatively young commissions claiming the mandate to do so. Coordination can also mean different things to different groups – for some it signifies regulation and control, while for others the emphasis is on participation and information exchange and even access to resources. The main aim of this project was to support the national AIDS commission, known locally as the National AIDS Council (NAC), in coordinating a multisectoral response to the epidemic. The report notes that coordination is improved when the roles and rules of engagement for key stakeholders are understood, and where accessible coordination structures are in place to enable public, civil society and private sector representatives to work effectively with the NAC. The STARZ programme has supported important processes that have focused on improved relationships between the NAC and the civil society and private sectors – including internal coordination.
13. Monitoring equity and research policy
This prevalence survey – based on blood samples from 34,000 pregnant women who attended antenatal clinics in 52 health districts in South Africa – measured HIV prevalence at 29.3%, compared to 29.4% in 2007 and 29% in 2006. Prevalence among women aged 15 to 40 declined slightly from 22.1% in 2007 to 21.7% in 2008, but the infection rate among women in the 30 to 34 age group rose from 39.6% in 2007 to 40.4% in 2008. Age was found to be the most important risk factor, with women of 22 years or older significantly more likely to be HIV-infected. In this age group, race was the next most important factor, with 37.6% of African women infected, compared to 6.8% of white, Asian and coloured (mixed race) women. The figures revealed wide variations between the country's nine provinces: as in previous years, KwaZulu-Natal Province recorded the highest prevalence (38.7%) and Western Cape the lowest (16.1%); at district level the disparities were even greater - in some the infection rate was as high as 45%, in others as low as 5%. The survey authors strongly recommended that the health department conduct more in-depth epidemiological surveys to investigate the causes of these wide disparities.
Since 1986, Uganda has made substantial progress in promoting good governance at the political and economic fronts. It recorded sustained economic growth averaging 6% over the last two decades, moving from recovery and reconstruction toward sustainable growth and poverty reduction. Macroeconomic stability remains a cornerstone of the country’s reform efforts. According to Uganda Official Statistics, the proportion of people living in absolute poverty, declined from 56% to 35% between 1992 and 2005/06, although per capita income gains have been modest because of the country’s high population. Nonetheless, significant challenges persist, and these include the fight against poverty and corruption, the resolution of the conflict in the North and other forces that hamper Uganda’s democratisation and economic development process. They call for a concerted effort from all interested parties across the country. The major challenge ahead consists in sustaining the momentum of the peer review process through the successful implementation of the National Programme of Action (NPOA) emanating from the exercise. The Forum will receive Annual Progress Reports in this regard and maintain sustained interest in the implementation process.
Several South African organisations have recently joined together to form the Budget and Expenditure Monitoring Forum (BEMF). The forum advocates for reasonable and sufficient funds to be allocated to health care based on the best evidence available, particularly for HIV programmes, and for those funds to be spent in a reasonable and constitutionally valid manner. It will work to ensure that there are no further treatment interruptions and moratoriums, that there is proper monitoring and evaluation of the highly active antiretroviral treatment (HAART) and prevention of mother-to-child transmission (PMTCT) programmes, and that the national departments of health and finance intervene in provinces not delivering these programmes adequately. In the last financial year several budgeting decisions were made which the member organisations of the BEMF believe violated the legal rights of individuals. The most visible was the moratorium on the initiation of patients onto HAART in the Free State from November 2008 through March 2009. The Southern African HIV Clinicians Society estimated that at least 30 lives a day were lost as a result this decision.
The overarching aim of this study is to develop a GIS-based planning approach that contributes to equitable and efficient provision of urban health services in cities in sub-Saharan Africa. The broader context of the study is the 'urban health crisis', namely the disparity between the increasing need for medical care in urban areas and declining carrying capacity of existing public health systems. The analysis proposes a 'what if' type of planning approach designed to evaluate and improve the spatial performance of the Dar es Salaam governmental health care system. It illustrates how more sophisticated GIS-based analytical techniques can be usefully applied to strategic spatial planning of urban health services delivery. Its evaluation framework appraises the performance of the existing Dar es Salaam governmental health delivery system on the basis of generic quantitative accessibility indicators, while its intervention framework explores how existing health needs can better be served by proposing alternative spatial arrangements of provision using scarce health resources. Health planners will be able to detect spatial deficiencies of a given delivery system, propose priority spatial planning interventions and estimate the expected impact of potential interventions on spatial performance.
Recent attempts to integrate geographic information systems (GIS) and participatory techniques have given rise to terminologies such as participatory GIS and community-integrated GIS. Although GIS was initially developed for physical geographic application, it can be used for the management and analysis of health and health care data. Geographic information systems, combined with participatory methodology, have facilitated the analysis of access to health facilities and disease risk in different populations. Little has been published about the usefulness of combining participatory methodologies and GIS technology in an effort to understand and inform community-based intervention studies, especially in the context of HIV. This paper attempts to address this perceived gap in the literature. The authors describe the application of participatory research methods with GIS in the formative phase of a multisite community-based social mobilisation trial, using voluntary counselling and testing and post-test support as the intervention.
World Health Statistics 2009 contains the World Health Organization’s (WHO's) annual compilation of data from its 193 member states, and includes a summary of progress towards the health-related millennium development goals and targets. This edition also contains a new section on reported cases of selected infectious diseases. It provides a comprehensive summary of the current status of national health and health systems including; mortality and burden of disease, causes of death, reported infectious diseases, health service coverage, risk factors, health systems resources, health expenditures, inequities and demographic and socioeconomic statistics. The section on inequities presents statistics on the distribution of selected health outcomes and interventions within countries, disaggregated by sex, age, urban and rural settings, wealth and educational level. It is an integral part of WHO’s ongoing effort to inform better measures of population health and national health systems.
14. Useful Resources
The World Health Organization (WHO) Collaborating Centre for Knowledge Translation and Health Technology Assessment in Health Equity is currently in the process of updating and expanding its Equity-Oriented Toolkit for Health Technology Assessment (HTA). The toolkit is based on a needs-based model of health technology assessment. It provides tools that explicitly consider health equity at each of the four steps of health technology assessment: burden of illness, community effectiveness, economic evaluation, and knowledge translation and implementation. The Centre has recently received seed funding from the Canadian Institutes of Health Research to update the toolkit via a series of workshops targeting both academics and policy makers. This will allow a debate on the tools to be included – or not – at each step. The Centre is exploring the plausibility of incorporating health impact assessment within the toolkit.
The UK Department for International Development (DFID) works with a wide range of partners from long-term arrangements with partner governments and multilateral organisations to short-term humanitarian aid projects funded through non-governmental organisations. DFID's interest is in ensuring that each is devised and delivered in the most efficient and effective way and links to identified objectives set out in a Divisional Performance Framework or Country/Regional Plan. This guide has been written for DFID project workers and DFID partners, and focuses on helping to make the best use of the Logical Framework (logframe) in designing and managing projects. The new designed format aims to address those weaknesses by encouraging the identification of objectives at the right level, more robust specification of indicators, increased coverage of baseline and target information and better quantification of results. The guide applies to any one involved in the design approval or active use of the logframe and all DFID projects of a value of one million pounds and above. Additional guidance in annexes has been provided to help the reader form a broader picture of what is involved in putting together a logframe.
While written with United Nations Development Programme staff, stakeholders and partners in mind, the handbook provides a useful overview of why and how to evaluate for development results which 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. The handbook covers the following areas: the integrated nature of planning, monitoring and evaluation, and describes the critical role they play in managing for development results; the conceptual foundations of planning and specific guidance on planning techniques and the preparation of results frameworks that guide monitoring and evaluation; how to plan for monitoring and evaluation before implementing a plan and issues related to monitoring, reporting and review; and an overview of the UNDP evaluation function and the policy framework, including key elements of evaluation design and tools and describe practical steps in managing the evaluation process.
Health Links partnerships have the capacity to make a significant contribution to health system strengthening but only if they are well planned, managed and aligned to needs. Governments and health managers in many countries, including the United Kingdom (UK), Uganda, Malawi, Zambia and Tanzania, are now beginning to look more actively at how these types of partnerships can contribute to health system development in their countries. This manual provides guidance, shares experiences and offers examples of good practice from those directly involved in Links. It aims to help both UK and developing country Link partners to think more strategically about their work. As a reference document for Link partnerships, this manual is aimed at those seeking to form a Link, or already involved in an established Link, such as health professionals, policy makers, health advisors, NGOs and others from the UK or a developing country interested in finding out more about what Links are and what they can offer.
The Municipal Service Project (MSP) has just updated its website. MSP is an inter-disciplinary project made up of academics, labour unions, non-governmental organisations, social movements and activists from around the globe. The project is guided by a Steering Committee, made up of representatives from project partners and coordinated by the project co-directors, David McDonald (Queen’s University, Canada) and Greg Ruiters (Rhodes University, South Africa). It is a five-year inter-sectoral and inter-regional research project that systematically explores alternatives to the privatisation and commercialisation of service provision in the health, water, sanitation and electricity sectors. Having spent the first two phases of the project (2000-2007) criticising privatisation, this phase of the project (2008-2013) will analyse service delivery models that are successful alternatives to commercialisation and to understand the conditions required for their sustainability and reproducibility.
This manual outlines some of the practical and organisational considerations required to set up support groups for survivors of domestic violence in a way that enhances their safety and self esteem. It also presents three possible models, any of which can be used as basis for running such groups. Two of these models are facilitated support group programmes and the third model is that of an un-facilitated self-help group. It looks at some of the practical and organisational considerations required to set up support groups, the roles and responsibilities of the facilitator and the co-facilitator skills, knowledge training and experience that are needed to run support groups for survivors of domestic violence, how to plan, promote develop and manage a support group, group policies and protocols and how these can contribute to maintaining the proper environment necessary for survivors of domestic violence. It provides ‘how–to’ guides for running sessions for the two different facilitated models that are known to work effectively.
15. Jobs and Announcements
The Aubrey Sheiham Public Health and Primary Care Scholarship is a three-month scholarship offered annually by The Cochrane Collaboration to health workers, consumers and researchers living in developing countries. The aim of the scholarship is to enable the development of skills in preparing systematic reviews of healthcare interventions within the Cochrane Collaboration. It is awarded annually for work on a topic related to public health or primary health care. The Aubrey Sheiham Scholar spends the three-month scholarship period in Oxford. The scholar is based at the United Kingdom Cochrane Centre in Oxford for the duration of the Scholarship, and resides in free accommodation provided by the Cochrane Collaboration. They are expected to prepare a Cochrane review during the tenure of the scholarship and, upon returning home, to maintain the review and undertake to train other prospective review authors in Cochrane methods. Preferred recipients will have a good understanding of both spoken and written English, limited access to relevant training where they live and a review topic that is of significant importance to people living in middle- or low-income countries.
The Geneva Health Forum is a joint initiative launched by the Geneva University Hospitals and the Faculty of Medicine of the University of Geneva in partnership with the several international organisations active in health in Geneva and around the world. The Forum brings together a diverse range of actors involved in global health - from field workers to policy-makers. The GHF forms a developing global network for international and inter-sectoral dialogue, which has the vision of facilitating the strengthening of health systems and basic health services, striving to keep global access to health on the international agenda. The theme of next year’s Forum is 'Globalisation, Crisis and Health Systems: Confronting Regional Perspectives'. It will take place from 19–21 April 2010 in Geneva, Switzerland. The opening date for registration online is 30 October 2009.
The 20th International Union for Health Promotion and Health Education (IUHPE) World Conference on Health Promotion will take place on 11–15 July 2010 in Geneva, Switzerland. The Conference is calling for abstracts. Submissions must cover core health promotion issues, as well as the crucial links between promoting health and the environmental, economic, urban, social and cultural changes that challenge people, societies and the planet. Abstracts for workshops, symposia, other innovative formats and oral presentations/posters can be submitted in English, French or Spanish. For further details and access to online abstract submission forms, please visit the IUHPE World Conference website.
The British Medical Journal (BMJ) would like to invite you to nominate yourself or someone whom you feel has made a significant impact on health care for the annual BMJ Group Awards, 2010. The BMJ Group Awards recognise pioneering individuals and organisations that have demonstrated outstanding and measurable contributions to health care. The range of categories reflects the values of the BMJ Group: Research Paper of the Year; Getting Research into Practice; Primary Care Team of the Year; Secondary Care Team of the Year; Junior Doctor of the Year; Excellence in Healthcare Education; Best Quality Improvement; Clinical Leadership; Corporate Social Responsibility; Health Communicator of the Year; and the BMJ Group Award for Lifetime Achievement. Be sure to visit the BMJ Group Awards website and submit your entry before 15 November 2009.
Are you interested in helping to peer review a Cochrane Review in progress? The Cochrane Public Health Group’s (PHRG) contact database now contains 500 potential contributors from 55 countries across six continents. Since last year, the PHRG has welcomed representatives from Afghanistan, Fiji Islands, Uruguay and Ghana, just to name a few. As part of the Cochrane Collaborations’ systematic review process, each protocol and subsequent review requires a team of peer reviewers. Peer reviewers are responsible for assessing the relevance and usefulness of the review. This results in Cochrane Reviews that better meet the needs of end users. If you are interested in peer reviewing please contact Jodie. Please make sure you let Jodie know your areas of interest.
The programme of the conference analyses the differences between South/South collaborations and traditional North/South alliances, examines successes and obstacles to effective functioning of these partnerships and culls lessons that can be learned and adopted by the North.
The theme of this year’s conference is ‘Millennium Development Goals: Measuring progress in public health in South Africa’. Assessment of progress towards the Millennium Development Goals (MDGs) during 2008 (the midpoint) revealed a mixed picture: many health goals remain off target, and huge inequities remain between and within countries. Existing evidence suggests that very few, if any, of the MDGs will be achieved in sub-Saharan Africa. The 2009 PHASA Conference is therefore aptly focused on the MDGs and measuring their progress from a public health perspective. An exciting programme is being put together of local and international speakers, including policy makers, leading local and international academics and international organisations, such as the World Health Organisation (WHO).
The International Conference on Healthcare and Trade, organised by the Erasmus Observatory on Health Law, will focus on the influence of the law of both the European Union and the World Trade Organization on trade in health services, health insurance services and health goods (pharmaceuticals). The application of the European Community Treaty, GATS and TRIPS to national regulation of health services, health insurance services and pharmaceuticals raises questions of applicability of, compatibility with and possible exceptions to the provisions of these instruments. In these areas, these questions have not yet been answered conclusively and further research and discussion in this area is ongoing. The conference aims to contribute to the discussion, attempting to formulate both legal and economic answers to these questions. Prepaid advanced registration must be electronically submitted, faxed or mailed no later than 1 December 2009. The conference fee is 250 Euros (concessions are available for students).
The Foundation Council of the Global Forum for Health Research today announced the appointment of Anthony Mbewu as its new Executive Director as of January 2010. Professor Mbewu is currently President of the Medical Research Council of South Africa (MRC). He is also Honorary Professor of Cardiology and Internal Medicine at the University of Cape Town and a Foreign Associate of the Institute of Medicine of the USA. Professor Mbewu trained in medicine at Oxford and London universities, qualifying in 1983. He subsequently trained as a specialist in cardiology and in general medicine at the University of Manchester while also conducting a research doctorate in preventive cardiology on lipoprotein in coronary heart disease. On returning to South Africa in 1994, he was appointed Consultant Cardiologist in the Cardiac Clinic of the Department of Medicine, University of Cape Town. In 1996 he became Executive Director for Research at the MRC and its President and Chief Executive Officer in 2005. Internationally, Professor MBewu is known for his work as co-chair of the Inter-Academy Medical Panel (a body that represents 66 of the world’s medical academies).
Are you interested in international health policies? If so, you might like to know about the Institute of Tropical Medicine’s (ITM) short course on health policy and strategic management, which we take place for the fourth time in 2010 in Antwerp. The course lasts eight weeks from 1 March till 23 April 2010. The aim of this course is to empower participants to play an active role in the development of public health policies in developing countries. The target group for this course are professionals involved in policy formulation and implementation at regional, national or international level working in health care, supervising, regulating or advocacy organisations or institutions (government or non-governmental). A limited number of fellowships are still available. You can look at the brochure online by using the link provided here.
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