African countries face a dilemma that if not reasonably resolved could threaten access to essential medicines. On the one hand countries need to protect their populations against potentially harmful counterfeit medicines, and to protect producers against unfair competition. On the other hand, the laws and measures that do this should not act as a barrier to cheaper, generic medicines. The current proposals for laws to protect against counterfeits in east Africa seem to be excessively weighted towards protecting intellectual property at the cost of access to legitimate generic versions of medicines.
There seems to be no universally accepted definition of ‘counterfeits’. This has caused confusion and created a loophole in determining what a counterfeit product is. The World Health Organization (WHO) has defined a counterfeit medicine as: ’one which is deliberately and fraudulently mislabelled with respect to identity and/or source. Counterfeiting can apply to both branded and generic products and counterfeit products may include products with the correct ingredients or with the wrong ingredients, without active ingredients, with insufficient active ingredients or with fake packaging.’
This definition makes the element of fraud essential in defining a counterfeit medicine, either in relation to the identity or the source of the product. WHO points to the public health risk of using products that have the wrong ingredients or which lack active ingredients.
From an intellectual property perspective, counterfeits are defined in Article 51, Footnote 14 (a) of the Trade Related Aspects of Intellectual Property Rights (TRIPS) Agreement which limits the definition of counterfeits to trademark and copy right infringements. Under this provision, counterfeit trademark goods mean ’any goods, including packaging, bearing without authorization a trademark which is identical to the trademark validly registered in respect of such goods, or which cannot be distinguished in its essential aspects from such a trademark, and which thereby infringes the rights of the owner of the trademark in question under the law of the country of importation’. This definition refers to only one aspect of intellectual property, that is trademarks, and associates counterfeiting with the issue of trademark infringement.
In their efforts to address counterfeits, East African countries are enacting anti counterfeit legislation. Kenya has a law in place, Tanzania has regulations while Uganda has a draft Bill. These laws have adopted a broad definition of counterfeits. For example section 2 of the Anti Counterfeit Act in Kenya provides that: ’counterfeiting includes manufacture, production, packaging, re-packaging, labelling or making, whether in Kenya or elsewhere, of any goods identical or substantially similar to protected goods without the authority of the owner of any intellectual property right (IPR) subsisting in Kenya or elsewhere in respect of those protected goods….. In relation to medicine, this includes the deliberate and fraudulent mislabelling of medicine with respect to identify or source, whether or not such products have correct ingredients, wrong ingredients, have sufficient active ingredients or have fake packaging’.
Such a definition goes beyond the provisions of the TRIPS Agreement Article 51 above.
It implies that legitimate generic versions of medicines fall within the scope of counterfeits. The provisions have thus raised deep concerns among manufacturers and consumers of generic drugs in low income countries as they effectively withdraw the flexibilities provided in the TRIPS agreement to produce and procure generic medicines for public health reasons, and may thus deny patients access to safe and effective, high quality generic drugs.
Generic drugs are produced and distributed without patent protection. They should contain the same active ingredients as the original formulation and be tested to ensure that they are safe and effective. They are usually available once the patent protections afforded to the original developer have expired. However generic drugs can be available during the life time of a patent if national laws provide for the TRIPS flexibilities, under which governments may issue compulsory licences to purchase generic drugs if they are needed for public health reasons. The provisions for compulsory licensing allow for exact copies of the brand to be produced without the consent of the patent owner. Generic drugs made available on under compulsory licensing are not counterfeits, as they are neither fraudulent nor do they infringe trademarks. The proposed legislation on counterfeiting in many east African countries does not recognise this.
For instance the law already enacted in Kenya (Kenya Anti-Counterfeit Act 13 of 2008) and that being proposed in Uganda (Uganda Counterfeit Goods Bill 2009) require the consent of the intellectual property owner to produce a generic version of the drug. This implies that should the manufacture of the generic drug take place without this consent, then what is manufactured is a counterfeit. This requirement undermines the States’ ability to use the TRIPS flexibilities and wrongly applies controls for fraudulent medicines to producers of generic medicines.
The TRIPS flexibilities have been contested in the past as they bias trade law towards social equity and away from corporate interests. The new counterfeit laws open a new possibility for multinationals to limit the flexibilities. The East African Community (EAC) is currently working on a policy and law on Anti-Counterfeiting, Anti-Piracy and Other Intellectual Property Rights Violations, as a “robust legal framework for the protection and enforcement of Intellectual Property Rights” in the region. The technical inputs to this need to be adjudicated for the interests they are advancing. For example, the East African Business Council has reported receiving support for its inputs on anti counterfeiting laws from the Investment Climate Facility. Based in Dar es Salaam, Tanzania ICF describes itself as a unique partnership between private companies, development partners and governments. As viewed from their website, ICF aims to work with receptive African governments to make the continent a better place to do business (http://www.icfafrica.org/). While there are legitimate business interests in protecting against fraud or infringement of trademark, it seems unlikely that an organization like ICF would thus draw attention to provisions that limit business, like the TRIPS flexibilities, when these open branded drugs to price competition from generics. An imbalance in the focus on intellectual property to the cost of access to medicines is precisely what motivated the TRIPS flexibilities, and the same imbalance appears to be creeping back.
Governments should ensure that their counterfeit laws continue to protect gains won through the TRIPS flexibilities and use these fully. For this, counterfeit laws should be clear in their definitions and exclude any possibility of generic medicines being covered by these definitions. Producers of generic medicines should not have to apply for permission from the intellectual property when they are covered by government compulsory licenses and provisions for parallel importation. Drug regulatory authorities should have a role in administration of proposed anti-counterfeit laws where this relates to determinations on counterfeit medicines. It is important for countries in East Africa, and the region as a whole, to ensure that in solving one problem they do not create another. The harm caused by communities in African countries not accessing essential medicines would be enormous.
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 editorial please visit the EQUINET website at www.equinetafrica.org.
1. Editorial
2. Latest Equinet Updates
This report presents a detailed desk review providing the constitutional provisions of the right to health in 15 countries in east and southern Africa (ESA): Angola, Botswana, Congo-Brazzaville, Kenya, Lesotho, Madagascar, Malawi, Mozambique, Namibia, South Africa, Swaziland, Tanzania, Uganda, Zimbabwe and Zambia. The review was carried out within the Regional Network for Equity in Health in East and Southern Africa (EQUINET) by the Center for Health, Human Right and Development. This paper used the six core obligations as spelt out in General Comment 14 to assess the inclusion of the right to health in the constitutional provisions of the ESA countries: to ensure the right of access to health facilities, goods and services on a non-discriminatory basis, especially for vulnerable or marginalised groups; to ensure access to the minimum essential food which is nutritionally adequate and safe, to ensure freedom from hunger to everyone; to ensure access to basic shelter, housing and sanitation, and an adequate supply of safe and potable water; to provide essential drugs, as from time to time defined under the WHO Action Programme on Essential Drugs; to ensure equitable distribution of all health facilities, goods and services; and to adopt and implement a national public health strategy and plan of action.
The countries in eastern and southern Africa and the East African Community are at various stages of enacting laws to address counterfeiting. Counterfeiting is a problem for public health if counterfeit medicines lack the active ingredients that make them effective, or if they are harmful. Yet laws that define counterfeiting so widely as to include generic medicines have even greater potential public harm, as they may make these essential medicines available as branded versions, at significantly higher cost. This policy brief draws policy makers’ attention to the need to ensure that counterfeit laws do not inadvertently include generic medicines. It discusses the key issues in these laws and draft laws and how they are likely to affect public health and access to essential medicines in the region.
3. Equity in Health
This study used the Millennium Development Goals’ (MDG) database from 2000 to 2006 to investigate the association between globalisation and women’s health in sub-Saharan Africa based on various determinants of heath. Results suggest that developing countries are becoming more integrated with world markets through some lowering of trade barriers. At the same time, women’s occupational roles are changing, which could affect their health status. However, it is difficult to measure the impact of globalisation on women’s health from the MDG database. First, data on trade liberalisation is aggregated at the regional level and does not hold any information on individual countries. Second, too few indicators in the MDG database are disaggregated by sex, making it difficult to separate the effects on women from those on men. The paper concludes that the MDG database is not adequate to assess the effects of globalisation on women’s health in Sub-Saharan Africa. It recommends that researchers aim to address this research question to find other data sources or turn to case studies. Further research on globalisation and health, using reliable sources, is urgently needed.
The child survival and development strategy in Kenya is guided by the National Health Sector Strategic Plan II: 2005–2010 (NHSSP II), the targets anticipated in achieving the Millennium Development Goals (MDGs) and Vision 2030 goals. The health sector has laid down policy and plans to facilitate the implementation of accelerated child survival and development within this strategy. The health sector currently faces several challenges and needs to focus on improving access to health services, as utilisation remains low, with more than 47% of the population travelling more than five kilometres to reach a health facility. Yet several notable achievements have been made in efforts to reduce the causes of childhood morbidity and mortality, especially with regards to malaria, vaccine preventable diseases, diarrhoea and in improving water and sanitation. There still needs to be a significant scaling up of activities related to specific targets both in terms of programme delivery and financing. Despite recent improvements, Kenya still needs to reduce infant mortality from 77 to 26 deaths per 1,000 live births and under five mortality from 115 to 33 deaths per 1,000 live births to achieve MDGs on child survival and development by 2015.
The objective of this study was to determine the leading causes of fatal injury for urban South African children aged 0–14 years, the distribution of those causes and the current potential for safety improvements. Injury surveillance data was obtained from the National Injury Mortality Surveillance System 2001–2003 for six major South African cities varying in size, development and sociodemographic composition. The study identified the leading causes of fatal injury in childhood as road traffic injuries – among vehicle passengers and especially among pedestrians – drowning, burns and, in some cities, firearm injuries. Disparities between cities and between population groups were largest for deaths from pedestrian injuries, while differences between boys and girls were greatest for drowning deaths. The study concluded that, in the face of the high variability observed between cities and population groups in the rates of the most common types of fatal injuries, a safety agenda should combine safety-for-all countermeasures and targeted countermeasures that help reduce the burden for those at greatest risk.
For the first time in decades, researchers are reporting a significant drop worldwide in the number of women dying each year from pregnancy and childbirth, to about 342,900 in 2008 from 526,300 in 1980. The findings, published in the medical journal The Lancet, challenge the prevailing view of maternal mortality as an intractable problem that has defied every effort to solve it. 'The overall message, for the first time in a generation, is one of persistent and welcome progress,' the journal’s editor, Dr Richard Horton, wrote. The study cited a number of reasons for the improvement: lower pregnancy rates in some countries; higher income, which improves nutrition and access to health care; more education for women; and the increasing availability of 'skilled attendants' – people with some medical training – to help women give birth. Improvements in large countries like India and China helped to drive down the overall death rates.
In this speech, delivered as the Eighth Annual Jeffrey P Koplan Global Leadership in Public Health Lecture in Atlanta, in the United States, Margaret Chan, Director-General of the World Health Organization, has admitted that global governance has failed to embrace equity as an explicit policy objective in the international systems that govern financial markets, economic relations, trade, commerce and foreign affairs. And health has suffered as a result. She criticises the way in which development models have assumed that living conditions and health status would somehow automatically improve as countries modernised, liberalised their trade and experienced rapid economic growth – yet this has not happened. She also points out that international trade agreements will not, by themselves, guarantee food, job or health security, nor access to affordable medicines. Instead, all of these outcomes require deliberate policy decisions. She calls for world leaders to recognise that health concerns can, in some instances, be more important than economic interests and that the net result of all our international policies should be to improve the quality of life for as many of the world’s people as possible. Greater equity in health status should be adopted as an indicator of human progress, she recommends.
There is a strong consensus that Africa faces significant challenges in chronic disease research, practice and policy. This editorial reviews eight original papers submitted to a Globalization and Health special issue themed: 'Africa's chronic disease burden: Local and global perspectives'. The papers offer new empirical evidence and comprehensive reviews on, among others, diabetes in Tanzania, and HIV and AIDS care-giving among children in Kenya. Regional and international reviews are offered on cardiovascular risk in Africa, comorbidity between infectious and chronic diseases and cardiovascular disease, diabetes and established risk factors among populations of sub-Saharan African descent in Europe. The editorial discusses insights from these papers within the contexts of medical, psychological, community and policy dimensions of chronic disease. It argues that there is an urgent need for primary and secondary interventions and for African health policymakers and governments to prioritise the development and implementation of chronic disease policies. Two gaps need critical attention. The first gap concerns the need for multidisciplinary models of research to properly inform the design of interventions. The second gap concerns understanding the processes and political economies of policy making in sub-Saharan Africa. The editorial concludes that the economic impact of chronic diseases for families, health systems and governments and the relationships between national policy making and international economic and political pressures have a huge impact on the risk of chronic diseases and the ability of countries to respond to them.
A new report by Zimbabwe's National AIDS Council (NAC), showing a dramatic rise in sexually transmitted infections (STIs) among people aged 15 to 24 in the capital, Harare, has health experts worried that the country's success so far in reducing HIV could be reversed. STIs heighten vulnerability to HIV infection, and this age group is one of the most affected. According to the NAC report, more than 24,000 people were treated for STIs in 2009, compared to 8,500 cases recorded in 2008. During this time almost 900,000 male condoms and over 155,000 female condoms were distributed in Harare. Itai Rusike, executive director of the Community Working Group on Health (CWGH), a network of civic groups that promote health awareness, blamed the rise in STIs on a too-narrow focus on HIV and AIDS treatment, at the cost of prevention interventions, especially for young people.
4. Values, Policies and Rights
These clinical guidelines are designed to address the current goals of the South African government's programme for managing HIV and AIDS, including: integrating services for HIV, tuberculosis (TB), maternal and child health, sexual and reproductive health, and wellness; earlier HIV diagnosis; preventing HIV disease progression; averting AIDS-related deaths; retaining patients on lifelong therapy; reducing infection; and mitigating the impact of HIV and AIDS. They contain relevant information on the government's national eligibility criteria for starting anti-retroviral therapy (ART) regimens, national ART regimens, national monitoring for adults and adolescents with HIV, national ART and anti-retroviral regimens for HIV positive pregnant women and their infants, and recommended ART regimens for treatment-naive adults and adolescents. They also indicate what to expect in the first four months of ART and when it is necessary to switch ART. Concomitant TB and its relationship with HIV is also addressed. Most of the document is dedicated to the relevant criteria and correct procedures for patient management.
These guidelines contain essential information on prevention of mother-to-child transmission, as well as counselling, support and testing, and preventing paediatric HIV infection. Clinical features of HIV-positive children are provided. Care guidelines are given on HIV-positive children on anti-retroviral therapy (ART). Nutritional support is also covered, providing indicators for assessing the nutritional status of children and requirements for nutritional support, including nutrition interventions in situations where children have not been adequately nourished. Treatment guidelines for concomitant tuberculosis are also given, along with responses to adverse advents, like side-effects from ART, and guidelines for treatment of a range of typical secondary infections, like respiratory infections, thrush and gastro-enteritis.
Rwanda's national condom awareness campaign has failed to include messages designed for people with disabilities, despite their risk of HIV being the same as the rest of the population. Many disabled people are sexually active and may take part in unprotected sex, according to Jacques Sindayigaya, coordinator of the HIV programme for the non-governmental organisation, Handicap International. A three-month government campaign, which mainly used radio and television spots as well as billboards and more than 200,000 posters to spread information on condoms, ended in February 2010. According to government sources, it was successful in raising awareness. However, this article points to the need for such campaigns to also target the specific needs and situations of those with disability.
5. Health equity in economic and trade policies
The author of this article asserts that East African countries risk not attaining the Millennium Development Goal (MDG) on universal treatment of people living with HIV and AIDS, malaria and other diseases if the region’s parliament adopts the draft anti-counterfeit laws currently under consideration. Civil society representatives, government officials and intellectual property experts have warned that the region would not meet this MDG if it adopted the proposed policy and bill, as they would block the production and importation of generic medicines used by health care services to treat diseases. The countries affected are Uganda, Tanzania, Rwanda, Burundi and Kenya. The draft laws could erode recent gains in scaling up treatment of people living with HIV and AIDS, according to Tenu Avafia, policy specialist on intellectual property, trade and HIV and AIDS at the United Nations Development Programme (UNDP).
The European Union (EU) is reported to be funding the drafting of Uganda's controversial Counterfeit Goods Bill, a proposed law that has caused an outcry as it threatens access to life-saving generic medicines in this low income East African country. According to the article, about 90% of medicines used in Uganda's health-care system are imported, of which about 93% are generics. According to this article, part of the five million euros that Uganda's ministry on tourism, trade and industry received from the EU in a financing agreement signed in July 2009 was to finance the drafting of this contentious bill that has consistently been criticised as a threat to treatment. The financing agreement is aimed at supporting Uganda's implementation of the economic partnership agreement (EPA) between the EU and East African countries. Health activists have criticised the draft law for defining counterfeiting so broadly as to criminalise the production and importation of generic medicines, including those for HIV and AIDS and malaria. They note that the draft law does not take advantage of the flexibility that Uganda, as a least developed country, has until 2016 before it is obliged to provide patent protection for pharmaceutical products as per the Trade-Related Aspects of Intellectual Property Rights (TRIPS) regime of the World Trade Organisation.
The head of the European Union (EU) delegation to Tanzania, Ambassador Timothy Clark, says a realistic timetable for signing the East African Community’s (EAC) interim economic partnership agreements (EPAs) must be established. Clark said: 'The situation, as it stands now, is untenable. EAC countries, despite not signing the EPA, have been enjoying free access to EU markets in the same way with other African, Carribean and Pacific (ACP) countries that took legally binding commitments by signing EPAs. This is inconsistent and contrary to both EU law and World Trade Organization rules.' However, Tanzanian Trade Minister, Mary Nagu, said the EAC wanted firm commitments from the EU on development assistance before it would sign a full agreement, including assistance for infrastructure, such as properly working railways and ports to enable Tanzania to trade. She called for a level playing field for Tanzanian trade, with Tanzania enjoying an equal footing with the EU. She did not see aid as a long-term solution to the country's financial woes. Despite the current situation, withdrawing trade preferences provided to the EAC under the EU’s EPA market access regulation is reported to require a unanimous vote by EU Member States, which may prove politically difficult at present.
Worldwide sales of counterfeit medicines could top US$75 billion this year, a 90% rise in five years, according to this article. The World Health Organization (WHO) is currently working with Interpol to dislodge the criminal networks making billions of dollars from the trade in counterfeit medicines and posing a growing threat to public health. In 2006, the International Medical Products Anti-Counterfeiting Task Force (IMPACT) was launched, drawing members from international organisations, enforcement agencies, industry and nongovernmental organisations. Sabine Kopp, IMPACT’s interim executive secretary and manager of WHO’s anti-counterfeiting programme, says that WHO is currently conducting a survey to compare legislation and terminology used to combat counterfeiting of medical products in different countries. It is difficult to measure the extent of the problem when there are so many sources of information and different definitions of 'counterfeit'.
6. Poverty and health
This communication lays out a new policy framework for European Union humanitarian action to strengthen efforts to tackle food insecurity in humanitarian crises. In it, the he European Commission reports its intention to strengthen four pillars of food security in general and emergency settings by increasing availability of food, improving access to food, improving quality and ensuring people eat nutritious food, and boosting the effectiveness of crisis prevention and management. Key points include the benefits of involving beneficiaries in operations and incorporating gender, livelihood and protection considerations in assessing needs and designing and delivering responses. The Commission draws attention to the needs of nutritionally vulnerable groups, including children under-two and pregnant women, while urging for integration of programmes so that needs are addressed holistically, and underlining the importance of linking relief with rehabilitation and development. The framework on food security spells out the need to support agriculture in poor countries to help them reach the UN Millennium Development Goal of halving hunger and poverty by 2015.
This report examines the daily challenges urban refugees face, including police harassment, discrimination and limited livelihood opportunities. The report presents the challenges that affect refugees and explores the policies and current assistance government is giving to them, to identify ways of attending to their long-term and immediate needs. The authors suggest a gap in clear policy on the issue. They point to issues for policy attention: Many refugees have not registered with authorities and lack required identification documents. In addition, they experience difficulties in accessing formal employment and face problems of poor access to adequate health and education services and precarious living conditions.
Nutrition surveys carried out by the government of Democratic Republic of Congo (DRC), with the support of the United Nations (UN) Children’s Fund and the UN World Food Programme, have found unusually high levels of malnutrition in children living in five provinces of the Democratic Republic of Congo (DRC). Experts believe the basic structural causes of malnutrition have been aggravated by conflict, high food prices and the global financial crisis, which has shaken the mining industry in the west and south-east of the country. Some 530,000 children under five and more than one million pregnant women need urgent nutrition interventions, according to the DRC Ministry of Health. In several areas surveyed, global acute malnutrition rates are above the 10% threshold for intervention and also in some cases above the emergency threshold of 15%. The causes behind such high malnutrition rates vary from one territory to another and are identified in the survey as lack of access to healthcare and to safe drinking water, poor access to good quality food, non-optimal feeding practices of infants, young children and women, and lack of tools and seeds for agriculture.
According to this book, the abuse of alcohol has drastic consequences on the safety and health outcomes of nations. Road accidents, family and sexual violence and homicide and foetal alcohol syndrome, are some of the occurrences where alcohol tends to have a direct role. Working Together to Reduce Harmful Drinking contains nine chapters written by experts in the alcohol industry, government and academia. It seeks to contribute to a global strategy to reduce irresponsible and harmful alcohol consumption and its attendant risks.
7. Equitable health services
This study sought to describe the magnitude and variation of the epilepsy treatment gap worldwide. A systematic review of the peer-reviewed literature published from 1 January 1987 to 1 September 2007 in all languages was conducted, using PubMed and EMBASE. The purpose was to identify population-based studies of epilepsy prevalence that reported the epilepsy treatment gap, defined as the proportion of people with epilepsy who require but do not receive treatment. The study found that the treatment gap was over 75% in low-income countries and over 50% in most lower middle- and upper middle-income countries, while many high-income countries had gaps of less than 10%. However, treatment gaps varied widely both between and within countries. The dramatic global disparity in the care for epilepsy between high- and low- income countries, and between rural and urban settings, calls for immediate attention, according to the study. It urged for a broadening of current understanding of the factors affecting the treatment gap and recommended that future investigations should explore other potential explanations of this gap.
A Kenyan initiative to use mobile phones to improve health systems indicates that the use of mobile phones to track patients may help relieve the burden of overworked health workers. 'Eighty percent of those [health workers] we talked to in Nairobi and Kajiado said they feel relieved - health workers need that kind of relief,' said Sarah Karanja, study coordinator of the Weltel Project. 'Patients, on the other hand, feel they are cared for which is good for their health and wellbeing.' Weltel uses a weekly text message to study mobile-phone effectiveness for health. The message to the patient reads 'Mambo', Swahili for 'How are you?' to which the patients can respond 'Sawa' ('OK') to show they are fine, or 'Shida', which means 'problem', to show they need attention. Patients who respond Shida and non-responders are followed up with a call from the clinic nurse to identify and handle any problems. Initial study findings reveal that 80% of patients are comfortable with the use of mobile phones to manage their HIV care and treatment. Mobile phone use in Kenya has risen rapidly from 200,000 users in 2000 to an estimated 17.5 million today, offering great potential for expanding the use of mobile phones for health services.
This report presents for the first time the treatment outcomes from all sites providing complete data for new and previously treated multi-drug-resistant TB (MDR-TB) patients. Ten of the 27 high MDR-TB burden countries reported treatment outcomes. A total of 71 countries and territories provided complete data for treatment outcomes for 4,500 MDR-TB patients. In 48 sites documenting outcomes, patient management and drug quality were found to conform to international standards. Treatment success was documented in 60% of patients overall. The report found that treatment success in MDR-TB patients remains low, even in well-resourced settings because of a high frequency of death, treatment failure and default, as well as many cases reported without definitive outcomes. New findings presented in this report give reason to be cautiously optimistic that MDR-TB can be controlled. While information available is growing and more and more countries are taking measures to combat MDR-TB, urgent investments in infrastructure, diagnostics, and provision of care are essential if the target established for 2015 – the diagnosis and treatment of 80% of the estimated M/XDR-TB cases – is to be reached.
Attention-deficit/hyperactivity disorder (AD/HD) is a multidimensional disorder that, although commonest in childhood and adolescence, can be diagnosed across the age span. Worldwide prevalence is about 5%. This study recommends an appropriate package of treatment for AD/HD in low- and middle-income countries (LMICs), which should include screening of high-risk groups, psychoeducational interventions with caregivers, methylphenidate, and behavioural interventions. Strategies to facilitate the delivery of effective interventions in LMICs should increase demand for services, access to AD/HD interventions, and the capacity of health care teams, as well as improve recognition of AD/HD, develop community-based and practice-based programs, and address the impact of AD/HD on other health and social outcomes. Interventions to address AD/HD should be part of a more comprehensive package of services for mental disorders.
Epilepsy is the most common chronic neurological disorder, affecting over 65 million people worldwide, of whom 80% are estimated to live in low- or middle-income countries (LMICs). Anti-epileptic drugs are very effective in controlling seizures, but most people with epilepsy in LMICs do not receive appropriate treatment. According to this review, this 'treatment gap' is influenced by factors such as limited knowledge, poverty, cultural beliefs, stigma, poor health delivery infrastructure, and shortage of trained health care workers. Several studies implementing interventions at the community level (for example, training programmes for primary health care workers) have successfully improved the identification of people with epilepsy and reduced the treatment gap. The sustainability of these interventions needs to be addressed, however, and efforts must be made to ensure a continuous supply of anti-epileptic drugs.
This study had three aims: to measure agreement between nine structured approaches for diagnosing childhood tuberculosis; to quantify differences in the number of tuberculosis cases diagnosed with the different approaches, and to determine the distribution of cases in different categories of diagnostic certainty. It investigated 1,445 children aged less than two during a vaccine trial held in a rural South African community from 2001 to 2006. Clinical, radiological and microbiological data were collected prospectively. Tuberculosis case status was determined using each of the nine diagnostic approaches. Tuberculosis case frequency ranged from 6.9% to 89.2%. Significant differences in case frequency occurred in 34 of the 36 pair-wise comparisons between structured diagnostic approaches. There was only slight agreement between structured approaches for the screening and diagnosis of childhood tuberculosis and high variability between them in terms of case yield. Diagnostic systems that yield similarly low case frequencies may be identifying different subpopulations of children. The study findings do not support the routine clinical use of structured approaches for the definitive diagnosis of childhood tuberculosis, although high-yielding systems may be useful screening tools.
According to this information sheet, within the public sector, the poor benefit relatively more than the rich from outpatient services at lower levels of care (i.e., district hospitals, clinics and community health centres). The rich benefit considerably more than the poor from regional and central hospital services (both outpatient and inpatient services) and also benefit more from public sector inpatient services overall. The rich benefit far more from private sector services than the poor; the richest 40% of the population receive about 70% of the benefits of private outpatient services (from general practitioners, specialists, dentists and retail pharmacies) and nearly 80% of the benefits of inpatient care in private hospitals. Overall, health care benefits in South Africa are very ‘pro-rich’, with the richest 20% of the population receiving more than a third of total benefits while the poorest 20% receive less than 13% of the benefits, despite the poor bearing a much greater share of the burden of ill-health than the rich.
8. Human Resources
This study conducted a systematic literature review of task shifting and found 2,960 articles, of which 84 were included in the core review. Fifty-one articles reported outcomes, including research from ten countries in sub-Saharan Africa. The most common type of task shifting studied was the delegation of tasks from doctors to nurses and other non-physician clinicians, especially initiating and monitoring highly active anti-retroviral therapy (HAART). Five studies showed increased access to HAART through expanded clinical capacity; four concluded task shifting is cost effective; nine showed staff could deliver equal or better quality of care; and studies on whether non-physicians and physicians were in agreement with their clinical decisions offered mixed results, with most showing good agreement. The study argues that task shifting is an effective strategy for addressing shortages of health workers in HIV treatment and care and believes it offers high-quality, cost-effective care to more patients than a physician-centered model could. The main challenges to implementation include adequate and sustainable training, support and pay for staff in new roles, the integration of new members into healthcare teams, and the compliance of regulatory bodies. The study recommends that task shifting should be considered for careful implementation where health worker shortages threaten rollout programmes.
This qualitative paper reports on the experience of three community health worker (CHW) supervisors who were responsible for supporting infant feeding peer counsellors. The intervention took place in three diverse settings in South Africa. Each setting employed one CHW supervisor, each of whom was individually interviewed for this study. The study forms part of the process evaluation of a large-scale randomised controlled trial of infant feeding peer counselling support. The findings highlight the complexities of supervising and supporting CHWs. In order to facilitate effective infant feeding peer counselling, supervisors in this study had to move beyond mere technical management of the intervention to broader people management. While their capacity to achieve this was based on their own prior experience, it was enhanced through being supported themselves. In turn, resource limitations and concerns over safety and being in a rural setting were raised as some of the challenges to supervision. Adding to the complexity was the issue of HIV. Supervisors not only had to support CHWs in their attempts to offer peer counselling to mothers who were potentially HIV positive, but they also had to deal with supporting HIV-positive peer counsellors. This study highlights the need to pay attention to the experiences of supervisors so as to better understand the components of supervision in the field.
9. Public-Private Mix
This article outlines the measures that European Union (EU) and African countries are planning through the economic partnership agreements to address public and private corruption, including non-compliance with promised off-sets in public contracts, in both African and EU governments and companies. Corruption is argued to distort fair competition, as companies gain competitive advantages and increase profitability and share value through illegal and unethical behaviour, while those companies that choose to be responsible find themselves at a disadvantage. Africa is argued to be no more corrupt than any other region, with alleged costs to African economies of US$148 bn per year, according to estimates by the Commission of the African Union. Corruption is argued to be responsible for losses of up to 50% of countries’ tax revenue, in many cases more than foreign debt.
Health equity remains a major challenge to policymakers despite the resurgence of interest to promote it. In developing countries, especially, the sheer inadequacy of financial and human resources for health and the progressive undermining of state capacity in many under-resourced settings have made it extremely difficult to promote and achieve significant improvements in equity in health and access to healthcare. In the last decade, public-private partnerships have been explored as a mechanism to mobilise additional resources and support for health activities, notably in resource-poor countries. While public-private partnerships are conceptually appealing, many concerns have been raised regarding their impact on global health equity. This paper examines the viability of public-private partnerships for improving global health equity and highlights some key prospects and challenges. The focus is on global health partnerships and excludes domestic public-private mechanisms such as the state contracting out publicly-financed health delivery or management responsibilities to private partners. The paper is intended to stimulate further debate on the implications of public-private partnerships for global health equity.
10. Resource allocation and health financing
This article argues that, as a result of the current financial crisis, there has been a resurgence of commitment to transparency in overseas development aid (ODA) in all areas and greater focus on the effectiveness of spending. It notes that progress on ODA transparency can occur swiftly and the impacts can be significant. Eighteen donors are reported to have signed up to the International Aid Transparency Initiative (IATI), including major multilateral and bilateral donors like the World Bank and the United Kingdom’s Department for International Development (DFID). The process of defining the standards is ongoing, calling for common standards of transparency, including publication of what is funded. One of the consequences of lack of transparency on ODA resources is the issue of donor ‘orphans’ or ‘darlings’ - where aid flows disproportionately to a particular region, sector, issue or ministry. Greater levels of information and transparency is needed on ODA benefits to civil society, including non-governmental organisations, parliamentarians and direct beneficiaries. This is a prerequisite for not only holding donors and service providers accountable over commitments they have made, but also for citizens to hold their governments to account over discrepancies between ODA received and spent on behalf of beneficiaries.
The academic literature on budget institutions in low-income countries is scarce, and originates to a large extent from the field work of donors and development agencies. This study is intended to fill that research gap. It has developed a composite index of the quality of budget institutions for 72 low-income and middle-income countries drawing upon empirical studies, budget survey databases and assessment reports, supplemented by case studies and other reports and data from the International Monetary Fund (IMF), the World Bank and donors engaged in capacity building in low-income countries. It found that, in general, budget institutions in low-income countries are much less developed than in developed and emerging market countries, and display widely different characteristics that reflect country-specific factors, such as colonial heritage, and a variety of cultural and administrative traditions and practices. Evidence suggests that weak capacity, ineffective civil society institutions and political/economic factors act as a severe constraint on the progress of modernising budget institutions. In low-income countries, numerical targets and formal constraints on spending and fiscal deficit that exist on paper may not be binding in practice because mechanisms that make adherence to budget rules and procedures transparent, and hold government ministers and officials accountable for their decisions, are usually not well established. Therefore, this study argues, enhancing the transparency and comprehensiveness of the budget process, and public dissemination of budget documents, even in the absence of formal rules, may be particularly important.
This study's main objective was to estimate the cost to the health system of obstetric complications due to female genital mutilation (FGM) in six African countries. A multistate model was used, which depicted six cohorts of 100,000 15-year-old girls who survived until the age of 45 years. The risk of obstetric complications was estimated based on a 2006 study of 28,393 women. The annual costs of FGM-related obstetric complications in the six African countries studied amounted to I$ 3.7 million and ranged from 0.1 to 1% of government spending on health for women aged 15–45 years. In the current population of 2.8 million 15-year-old women in the six African countries, a loss of 130,000 life years is expected owing to FGM’s association with obstetric haemorrhage. This is equivalent to losing half a month from each lifespan. Beyond the immense psychological trauma it entails, FGM imposes large financial costs and loss of life. The cost of government efforts to prevent FGM will be offset by savings from preventing obstetric complications.
The goal of this paper is twofold. First, the paper extends the analysis evaluating the performance of aid agencies by creating several best and worst practices indices, including an overall aid agency index. It does so by relying on a newly available dataset and draw from the benchmarks established in the previous literature where different measures of aid transparency, specialisation, selectivity, ineffective aid channels and overhead costs are utilised. Secondly, the analysis attempts to explain agency behaviour, addressing why agencies behave the way they do. This section relies on bureaucracy theory to address the capability of agencies to achieve best practices, highlighting both economic and political constraints.
Every year, billions of dollars of environmental overseas development aid (ODA) flow from high income countries in the North to low income countries in the South. This book interrogates this flow of ODA by addressing a number of questions. Why do countries provide this ODA? What do they seek to achieve? How effective is the ODA provided? And does it always go to the places of greatest environmental need? These questions are addressed using a comprehensive dataset of ODA.
This study was based on a systematic analysis of all data sources available for government expenditures on health as agent in developing countries, including government reports and databases from the World Health Organization and the International Monetary Fund. It found that, in all developing countries, public financing of health in constant US$ from domestic sources increased by nearly 100% from 1995 to 2006. Furthermore, development assistance for health (DAH) to government appeared to have a negative and significant effect on domestic government spending on health – for every US$1 of DAH to government, government health expenditures from domestic resources were reduced by $0•43. To address the negative effect of DAH on domestic government health spending, the study recommends strong standardised monitoring of government health expenditures and government spending in other health-related sectors; establishment of collaborative targets to maintain or increase the share of government expenditures going to health; investment in the capacity of developing countries to effectively receive and use DAH; careful assessment of the risks and benefits of expanded DAH to non-governmental sectors; and investigation of the use of global price subsidies or product transfers as mechanisms for DAH.
This information sheet provides basic facts about financing of health care in South Africa. Health care financing is based on tax, which, in South Africa, is relatively progressive. Tax revenue is the only funding in South Africa that is used for health services that benefit all. Out-of-pocket payments or direct payments to health care providers are regressive. Medical scheme contributions are the biggest single share of health care financing in South Africa. Lower income medical scheme members contribute a higher percentage of their income than higher income medical scheme members. The greatest burden of funding health services rests on medical scheme members, particularly the lowest income scheme members, and the largest part of this burden takes the form of medical scheme contributions.
11. Equity and HIV/AIDS
This study is one of Zimbabwe's national efforts to assess specific HIV and AIDS needs of mobile and migrant populations (MMPs) in the country and the barriers to accessing HIV and AIDS prevention, treatment and care services by these groups. The study also sought to identify the gaps that exist in meeting the HIV and AIDS needs for MMPs. The study was conducted in all major corridors in Zimbabwe, targeting a range of groups of MMPs. It found that the rising poverty levels (and in some cases absolute poverty levels) emanating from the rapid socio-economic decline and political uncertainty in the country, have provided a basis upon which vulnerability to HIV infection of MMPs, as well as that of the general population is premised. The study calls for improved coordination and strategic partnerships, modification of art access regulations, inclusive programming, awareness raising and creating regional approaches.
This study looked at HIV prevalence in the higher education sector in South Africa. It reported both quantitative and qualitative data. Out of a total of 29,856 eligible participants available at testing venues, 79,1% participated fully by completing questionnaires and providing specimens. Because of a substantial amount of missing data in 230 questionnaires, the final database consisted of 23,375 individuals made up of 17,062 students, 1,880 academic staff and 4,433 administrative and service staff. The mean HIV prevalence for students was 3,4%. HIV was significantly more common among men (6,5%) and women (12,1%) who reported symptoms of a sexually transmitted infection (STI) in the last year compared to men (2,5%) and women (6%) who did not report an STI. First-year students appeared to lack the required experience to make good, risk-aware decisions, especially regarding sexual liaisons and the use of alcohol. Qualitative data pointed to underlying causes of HIV transmission on campus as including reported transactional sex, intergenerational sex (a young woman with an older wealthier man), poor campus leadership on HIV and AIDS, limited uptake of voluntary testing and counselling services, poor levels of security on campus and stigma surrounding the disease.
The 2007 Kenya AIDS indicator survey is the first of its type in Kenya and provides data on HIV and other sexually transmitted infections (STIs), which may be used for advocacy and planning appropriate interventions for HIV prevention, treatment and care. It found that, of adults aged 15-64 years, an estimated 7.1%, or 1.42 million people, were living with HIV infection in 2007. Prevalence among adults aged 15-49 years was 7.4%, and was not statistically different from an earlier estimate of 6.7%. Women were more likely to be infected (8.4%) than men (5.4%). In particular, young women aged 15-24 years were four times more likely to be infected (5.6%) than young men of the same age group (1.4%). Knowledge of HIV status was low (16.4% of HIV-infected respondents), likewise with knowledge of partner’s HIV status. Co-infection with STIs and HIV was common: 16.9% of persons with syphilis were infected with HIV, as were 16.4% of persons with HSV-2 infection. At the time of the survey, an estimated 344,000 HIV-discordant couples needed targeted HIV testing and prevention. Overall, 57.5% of women and 56.4% of men reported having had unprotected sex with at least one partner of HIV-discordant or unknown HIV status in the twelve months prior to the survey.
This review of Global Fund projects in 2010 includes some chapters on projects they have funded in the east, central and southern African region. A chapter on HIV prevention in South Africa focuses on peer education in townships, while prevention of mother-to-child transmission of HIV in Namibia is also covered in terms of breaking the stigma surrounding the disease. Malaria prevention in Zambia is presented as a success story, as clinics are reported to be 'empty of patients', and a chapter on malaria prevention in Swaziland outlines the country's ambitious plan to eliminate malaria by 2015.
This paper assesses evidence on the association between educational attainment and risk of HIV infection over time in sub-Saharan Africa through a systematic review of published peer-reviewed articles. Approximately 4,000 abstracts and 1,200 full papers were reviewed, of which 36 were included in the study, containing data on 72 discrete populations from 11 countries between 1987 and 2003, and representing over 200,000 individuals. Studies on data collected prior to 1996 generally found either no association or the highest risk of HIV infection among the most educated. Studies conducted from 1996 onwards were more likely to find a lower risk of HIV infection among the most educated. HIV prevalence appeared to fall more consistently among highly educated groups. In several populations, associations suggesting greater HIV risk in the more educated at earlier time points were replaced by weaker associations later. It seems that HIV infections are shifting towards higher prevalence among the least educated in sub-Saharan Africa, reversing previous patterns. Policy responses that ensure HIV-prevention measures reach all strata of society and increase education levels are urgently needed.
This paper presents data to show how under-financing the global response to AIDS has proven disastrous in the past. The lack of an early, well-financed and effective response to AIDS in the 1980s and 1990s provided an opportunity for this epidemic to grow rapidly when a sustained, global response could have prevented the spread of HIV and the resulting impact on the health, economies and communities of the world’s poorest nations. Recent increases in dedicated AIDS financing, however, particularly over the last five years, have produced impressive gains across a wide range of health, development, economic and social indicators. Increases in the number of people on HIV treatment tracks the increase in donor financing for AIDS. In 2008 alone, funding for HIV-specific programmes from wealthy countries grew to US$7.7 billion – a 56% increase from 2007. The brief urges governments and other stakeholders to adopt progressive financing mechanisms for health. It notes that, if full investments were made in country-level universal access targets by 2010 that: the number of new HIV infections averted in 2009-2010 alone would be 2.6 million; the number of deaths averted over that year would be 1.3 million; and incidence of HIV over that year would be cut by nearly 50%.
According to this article, since the 2005 commitment by G8 leaders – and thereafter all United Nations Member States – to work towards universal access to HIV treatment, prevention and care by 2010, many resource-limited countries have been highly successful in decreasing AIDS-related morbidity and mortality and slowing down the spread of HIV. The efforts to achieve this scale up have been driven by governments and civil society in these countries, with much of the resources provided by external partners, in particular the United States' PEPFAR2 and the Global Fund to Fight AIDS, TB and Malaria. Since its inception in 2002, the investments made through the Global Fund are estimated to have saved five million lives, including through the provision of HIV treatment to 2.5 million people. This article poses a question to donors to the Global Fund: How many more lives they are prepared to save in the next three years? And will they make the bold investments required to make a real change to the future course of the HIV epidemic?
12. Governance and participation in health
Despite the significant success of global health programs, there is a continuing gap between policy analysis and action. This paper is the first in a series, cosponsored by Results for Development Institute and the Global Health Council, which presents examples and opportunities of how evidence-based research can be translated into policies and programmes that will improve the health of poor people in developing countries. The series includes six presentations that draw from Results for Development's expertise in transparency and governance, the role of the private sector in health, health ministry capacity building, health financing and the health workforce. The first of these talks, 'Civil Society: A Missing Link in Development' took place on 29 March 2010 and featured civil society leaders from India, South Africa and Uganda, who are participating in the Institute's Transparency and Accountability Programme. You can watch the presentations on the website given above.
This paper argues that parliaments and parliamentarians have a crucial role to play in ensuring that governments are accountable for the decisions that they make about how resources – including aid – are spent. The scope parliaments actually have to play this role varies widely. Some parliaments benefit from large resources and a legal framework that back them in playing their oversight and legislative role. Many other parliaments, especially in developing countries, lack resources or power to play an effective role in promoting development or the more effective use of aid. Parliamentarians themselves come from all walks of life and do not share the same knowledge on these issues, and there is no consensus among parliamentarians or across countries on the ways and means by which they can enhance oversight of development policies and how development resources are used. This guidance note addresses some of these challenges and seeks to provide parliamentarians and those who work with them with a common understanding and clear guidance on what they can do to promote more effective and accountable use of aid in particular and of development resources in general.
The purpose of this study was to determine the roles of educators in mitigating the impact of the HIV and AIDS pandemic, and to ascertain the skills and knowledge required by them to play such roles effectively. The study gathered data from 3,678 survey respondents to a questionnaire. Qualitative fieldwork showed that levels of concern among educators were polarised with respect to HIV and AIDS pandemic, ranging from lack of concern and denial of its importance to extreme concern and a strong sense of ethical responsibility to mitigate its impact. However, most respondents displayed a very high level of concern regarding the pandemic. They pointed to an urgent need for training and resources for future roles. The study made four recommendations. It urged for a resolution to South Africa's current strategic dilemma, namely whether to prescribe approaches to mitigating the impact of the pandemic or allow individuals and institutions to develop their own responses. It also called for curriculum interventions that meet the challenges of the pandemic, differentiated interventions that enable educators to meet the challenges of the pandemic and more time to develop appropriate resources and support, including training.
This guide explores a number of different themes related to youth participation in development: governance, voice and accountability, post-conflict transition and livelihoods, and sexual and reproductive health. In the sexual and reproductive health section, several examples of youth-focused health initiatives from Uganda are discussed, such as Uganda's National Development Plan and the Youth Empowerment Programme. Another health initiative, Young, Empowered and Healthy (Yeah) is a sexual health campaign for and by young people in Uganda was launched in 2004 under the auspices of the Uganda AIDS Commission and uses radio and other media to reach youth.
13. Monitoring equity and research policy
This article begins by acknowledging that numerous obstacles exist to improving on current development assistance indices, including: attribution across multiple donors, long time lags between aid and results with unknown lag times, the micro-macro paradox (where donor projects are deemed successful but results are not translated to macro indicators) and difficulties in aggregating across different components of 'development' such as poverty reduction, service delivery and economic growth. The article puts forward a model for measuring quality of development assistance and recommends benchmarking against specific quality indicators, based on literature, with a focus on aid processes not outcomes. It states that the index should require that large number of donors are compared to establish the 'best in class'. Quantitative indices and indices that measure change over time should also be developed and linked to changes in management decisions in aid agencies. Four indices are proposed to measure different aspects of aid effectiveness: maximising impact; reducing burden; foster institutions; and transparency.
The Commitment to Development Index (CDI) rates 22 rich countries on how much they help poor countries build prosperity, good government, and security. Each rich country gets scores in seven policy areas, which are averaged for an overall score. The policy areas include foreign aid, commerce, migration, the environment and military affairs. This website provides an interactive resource for determining scores. You can browse the charts by clicking bars, country names and policy components and explore the data maps to see results in another way. In 2009, Sweden, Denmark, the Netherlands, Norway and New Zealand ranked highest, while South Korea, Japan, Switzerland and Greece ranked lowest.
This study presents the Corrected Sibling Survival (CSS) method, which addresses both the survival and recall biases that have plagued the use of survey data to estimate adult mortality. It applies the method to generate estimates of and trends in adult mortality for 44 countries with District Health Survey sibling survival data. Findings suggest that levels of adult mortality prevailing in many developing countries are substantially higher than previously suggested by other analyses of sibling history data. Generally, estimates here show the risk of adult death between the ages of 15 and 60 to be about 20–35% for females and 25–45% for males in sub-Saharan African populations largely unaffected by HIV. In southern African countries, where the HIV epidemic has been most pronounced, as many as eight out of ten men alive at the age of fifteen will be dead by age 60, as will six out of ten women. The results of this study represent an expansion of direct knowledge of levels and trends in adult mortality in the developing world. The study recommends that governments use the CSS method for more accurate tracking of adult mortality rates.
Although global under-five mortality is declining, this paper argues that it is unlikely that Millennium Development Goal 4 will be reached by 2015. The researchers used data about all children born and dead children extracted from 169 Demographic and Health Surveys covering 70 countries to develop four new methods to estimate under-five mortality. Their findings suggest that application of the new methods developed by the researchers could significantly improve the accuracy of estimates of under-five mortality based on summary birth history data. The researchers warn that although their methods can provide accurate estimates of recent under-five mortality, they might not capture rapid fluctuations in mortality such as those that occur during wars. However, they suggest, the two questions needed to generate the data required to apply these new methods could easily be included in existing survey programmes and in routine censuses. Consequently, systematic application of the methods proposed in this study should provide policy makers with the information about levels, recent trends, and inequalities in child mortality that they need to accelerate efforts to reduce the global toll of childhood deaths.
This paper reviewed 29 public expenditure tracking surveys (PETS) and related literature produced since the mid-1990s to identify common problems and lessons learned to improve the quality of public spending in the social sectors via civil society oversight and involvement. It examines ten of the most commonly reported problems in public expenditure management in the social sectors, like the limitations imposed by highly earmarked budgets, which do not allow for reallocation towards priorities, and public monies that do not reach the poor or are 'leaked' to unintended uses. Other problems include corruption, incomplete information and inefficient transfer and expenditure operations, health workers who face perverse incentives, and inefficient, low-quality and unresponsive health services that result in wastage. User fees and informal payments are also to blame for a lack demand from the population for health services. The paper argues that civil society organisations may have a critical role to play in improving the quality of social spending in developing countries. It recommends generating and disseminating information on flows of public spending and materials, advocating for and participating in organisational structures that incorporate citizens in oversight, preparing and disseminating citizen report cards, and carrying out PETS.
Researchers are designing a new model for determining the demographic impact of HIV and AIDS in South Africa. Modelers Leigh Johnson of the Centre for Infectious Disease Epidemiology and Research and Rob Dorrington of the Centre for Actuarial Research at the University of Cape Town have launched the ASSA 2008 model, which has replaced the ASSA 2003 model for estimating HIV prevalence, HIV-related deaths, the numbers of those in need ofanti-retrovirals (ARVs) and the impact of HIV interventions. According to Johnson, the reason the model needed to be updated was because the prevalence data projected was no longer correct because of the new data that emerged from South Africa’s antenatal HIV-prevalence survey. The survey increased the number of women who were tested for HIV and was thus more representative, although there was very little difference in the HIV prevalence results across the board from the ASSA 2003 and 2008 models. ASSA 2008 takes into account new epidemiological data to allow for more accurate projections of HIV prevalence and impact of interventions. It includes the ARV rollout data for up to the end of 2008. Because data shows that two-thirds of people starting ARVs are females, the ASSA 2008 model allows for different rates of ARV initiation in males and females, as well as for children and adults.
Scoping is a novel methodology for systematically assessing the breadth of a body of literature in a particular research area. The objectives of this review were to showcase the scoping review methodology in the review of health system quality reporting, and to report on the extent of the literature in this area. A scoping review was performed based on the York methodology. The researchers searched fourteen peer-reviewed and grey literature databases, specific websites, reference lists and key journals for relevant material and also solicited input from key stakeholders. A total of 1,222 articles were included. These were categorised and catalogued according to the inclusion criteria, and further subcategories were identified through the charting process. Topic areas represented by this review included the effectiveness of health system report cards (194 articles), methodological issues in their development (815 articles), stakeholder views on report cards (144 articles), and ethical considerations around their development (69 articles). The review concluded that the scoping review methodology allowed for the convenient characterisation and cataloguing of the extensive body of literature pertaining to health system report cards. The resulting literature repository from this review could prove useful to researchers and health system stakeholders interested in the topic of health system quality measurement and reporting.
This guide provides an overview of peer review and an assessment of the practice to date. It begins by discussing the main concepts related to peer reviewing of research papers before it outlines the peer review process generally, and specifically with relation to grant applications. It assesses the peer review process by addressing some of its shortcomings. For example, instances of malpractice and misconduct continue and, as reviewers themselves are fallible, peer review cannot provide a guarantee against the publication of bad research. So a number of published papers are retracted each year for a variety of reasons, and there is evidence that the number is rising. The core issues of transparency and subjectivity are discussed in the guide under the idea that peer review should foster fairness. However, financing the high costs of peer review mechanisms still proves problematic. On the positive side, major new opportunities in digital technology, such as the internet, have improved connectivity between stakeholders of the process.
This paper systematically evaluates the performance of 234 variants of DDM methods in three different validation environments where the researchers knew or had strong beliefs about the true level of completeness of death registration. Using these datasets, it identified three variants of the DDMs that generally perform the best. It also found that even these improved methods yield uncertainty intervals of roughly one-quarter of the estimate. Finally, it demonstrates the application of the optimal variants in eight countries. In its conclusion, it notes that partial vital registration data in measuring adult mortality levels and trends still has a role, but such results should only be interpreted alongside all other data sources on adult mortality and the uncertainty of the resulting levels, trends, and age-patterns of adult death considered.
14. Useful Resources
This guide is designed to be a 'support tool' to assist institutions in developing and enhancing their HIV and AIDS workplace programmes. It has been aligned to the Framework for HIV and AIDS Workplace Programmes, which was developed for South Africa's higher education sector. The framework has six key performance areas that make up a comprehensive workplace programme and the guide sets out key standards for each of the performance areas. The areas are: strategic leadership, decision-making and co-ordination; research and analysis; workplace HIV and AIDS policy; workplace HIV and AIDS prevention programmes; workplace HIV and AIDS treatment and care strategies; and monitoring and evaluation.
The goal of this handbook is to highlight some of the best practices around the world in HIV and AIDS services, programmes and policies for people with disabilities. It describes how systematic efforts were made to identify case studies from various countries. However, the numbers of case studies obtained were smaller than expected. This could be an indication that there is little documentation of practice in HIV and AIDS and disability. It could also be that organisations primarily working with disabilities have given minimal attention to HIV and AIDS, and similarly little attention is paid to disability by mainstream HIV and AIDS organisations. This handbook is primarily aimed at organisations involved in or intending to be involved in programming and advocacy to influence or to develop policy and programmes in HIV and AIDS service delivery for persons with disabilities. This handbook is divided into four chapters, each addressing a particular broad topic in reference to best practices for disability and HIV and AIDS. The categories of disabilities covered in the handbook are the deaf, the visually impaired, and the physically and intellectually challenged.
Since it was first published in 2002, Facts for Life has sold over 15 million copies in 215 languages. It aims to help save the lives of millions of children by putting lifesaving knowledge about children‘s health into the hands of those who need it most: parents, caregivers, health workers, government officials, journalists and teachers. This new edition has updated information on safe motherhood, early childhood development, nutrition, HIV and AIDS and other major causes of childhood illnesses and death. It aims to use the best current understanding of science, policy and practice. It presents in simple language, practical, effective, low-cost ways of protecting children‘s lives and promoting their development.
Where There Are No Pharmacists is about managing medicines. It explains how to order them, store them, prepare them, dispense them and use them safely and effectively. This book provides advice on all these aspects for people working with medicines as well as information to help communities benefit from the use of medicines. It provides guidance for anyone who is doing the work of a pharmacist; anyone who sells, dispenses, prepares, manages, or explains to others how to use medicines. It is especially intended for use in developing countries.
15. Jobs and Announcements
This international conference brings together leading researchers and industry representatives who will review important recent findings in parasite and vector biology, disease pathophysiology and immunology, disease treatment, prevention and control. Attendees will learn about the latest developments in key areas and initiatives that are at the forefront of malaria research. Topics include parasite and vector cell biology, disease pathogenesis, drug discovery, immunology and vaccine development, and disease control. All participants are invited to submit abstracts for oral and poster presentations. A significant number of talks will be selected from registrants. The time allowed for selected oral presentations will be ten minutes with an additional five minutes for discussion.
The International AIDS Conference is the premier gathering for those working in the field of HIV, as well as policy makers, persons living with HIV and other individuals committed to ending the pandemic. It is a chance to assess where we are in terms of the AIDS pandemic, evaluate recent scientific developments and lessons learnt, and collectively chart a course forward. Given the 2010 deadline for universal access set by world leaders, AIDS 2010 will coincide with a major push for expanded access to HIV prevention, treatment, care and support. The programme will present new scientific knowledge and offer many opportunities for structured dialogue on the major issues facing the global response to HIV. A variety of session types – from abstract-driven presentations to symposia, bridging sessions and plenaries – will meet the needs of various participants. Other related activities, including the Global Village, satellite meetings, exhibitions and affiliated events, will offer an opportunity for professional development and networking.
All African health economists and health policy analysts, whether working in Africa or on research of relevance to Africa, are invited to submit abstracts for the Second Conference of the African Health Economics and Policy Association (AfHEA), which will be held in Dakar, Senegal from 15–19 March 2011 (these dates are provisional). The overall theme of this conference is 'Toward universal health coverage in Africa'. Abstracts are encouraged for research related to the sub-themes of the conference: health care financing for universal financial protection in Africa; promoting universal access to needed health services; and strategies and tactics for key steps to move towards universal coverage. Individuals are also encouraged to submit abstracts on any other interesting or topical research, especially on any aspect of the health system that could contribute to universal coverage. Abstracts may be submitted in English or French and must not exceed 400 words in length. It should indicate the aim and objectives of the paper, the methods used and the key findings.
The key aim of the Graça Machel Scholarship Programme is to help provide the female human resources necessary for economic, social and cultural development in the southern African region and to develop an educated and skilled workforce that can benefit the wider community. Scholarships that target women have long been recognised as an effective approach in addressing gender equality and eradicating poverty. By providing opportunities to study at postgraduate level, these scholarships aim to empower women and to equip them to take up leadership positions in order to have a direct impact in the communities, nations and region in which they live. These female scholars must be positive role models for other women. The scholarships are for female students from Angola, Botswana, Lesotho, Malawi, Mozambique, Namibia, Swaziland, South Africa, Zambia and Zimbabwe studying in South Africa. They are valid for two years’ postgraduate study and include payment of a maintenance allowance, travel, health insurance and tuition fees. Applicants must have at least two years’ relevant work experience.
The World Health Organization's Scientific Resource Group on Equity Analysis and Research, together with the Global Forum for Health Research and the People's Health Movement, have announced a call for research proposals from civil society organisations (CSOs) on the theme: ‘Advancing health equity through research and practice: Identifying what works to reduce health inequities’. In their proposals, CSOs may evaluate interventions they have implemented and their impacts both on health outcomes and on health equity. The interventions to be evaluated need to address social, economic and political determinants of health. The evaluation should examine inequities among different social groups, not only between one disadvantaged group and a population average. Interventions could potentially be adapted for implementation in other countries. Teams submitting expressions of interest should demonstrate expertise in research for health or development, ability to design evaluation studies and ability to analyse data to evaluate impacts of interventions on health and health equity. Demonstration of advanced writing skills will be an advantage. A budget and timeline must be included, specifying how the case award will contribute to the overall evaluation of the intervention.
The World Health Organization and partners will convene the inaugural global symposium on health systems research in 2010. Researchers, policy-makers, funders, and other stakeholders representing diverse constituencies will gather to share evidence, identify significant knowledge gaps, and set a research agenda that reflects the needs of lowand middle-income countries. The first symposium will be dedicated to improving the scientific evidence needed by health policy-makers and practitioners to inform their decisions related to accelerating universal health coverage. Young professionals working in or interested in the wide spectrum of health systems research are invited to submit essays covering one or more of the following areas of inquiry: the political economy of universal coverage; health system financing; scale-up of health services; and knowledge translation. Each submitted essay should reflect the young researcher’s unique perspective on a particular aspect(s) of health systems research. It should include structured arguments and critical analysis based on original quantitative and/or qualitative research, with the intent to demonstrate impact on health and health equity. The essay should be less technical and more provocative, idealistic and inspirational. It should demonstrate the 'human face' of health systems research.
Every year, the CIVICUS World Assembly offers about fifty activities grouped around the overall theme, an annual focus theme and sub-themes. The activities comprise plenary sessions, round tables, workshops, networking sessions and formal events. The 2010 World Assembly in Montreal will introduce the concept of interactive group discussions (or Parcours) for the first time. The overall theme of the CIVICUS World Assembly is 'Acting Together for a Just World'. Every year this is explored through a focus theme. In 2010 the focus theme will be 'Seeking Out Solutions'. This theme will address the issues of economy, development and climate. The Assembly has a number of aims. It offers: to provide first hand knowledge on the state of the art of civil society thinking; to establish cross-cutting relationships with civil society, business, media, government and donor organisation professionals from around the globe; in-depth exchange of expertise on how people from all sectors act together to (re)gain the power to enforce decisions; training and capacity building on a wide range of tangible skills e.g. fundraising, networking, mobilisation, volunteering, campaigning etc; and the opportunity to find partners and funding to realise and expand your projects.
This will be the first time MEDINFO is held in Africa. The Congress aims to boost exposure to grassroots healthcare delivery and the underpinning health information systems, as well as to open the door to new academic partnerships into the future and help to nurture a new breed of health informaticians. The theme for the Congress is ‘Partnerships for effective e-health solutions’, with a particular focus on how innovative collaborations can promote sustainable solutions to health challenges. Information and communication technologies may have enormous potential for improving the health and lives of individuals. Innovative and effective change using such technologies is reliant upon people working together in partnerships to create innovative and effective solutions to problems with particular regard to contextual and environmental factors. To this end, the Congress brings together the health informatics community from across the globe who are seeking to work together and share experiences and knowledge to promote sustainable solutions to global health challenges.
Up to three awards are available for outstanding health researchers from sub-Saharan Africa to strengthen their research skills and build partnerships with a United Kingdom (UK) research institution through a new pilot scheme jointly funded by the Medical Research Council (MRC) and Department for International Development (DFID). The African Research Leader scheme is a highly prestigious award which aims to strengthen research leadership and capacity across sub-Saharan Africa by attracting and retaining researchers of high ability. The pilot scheme is open to all research areas within MRC’s remit that specifically address the priority health problems of people in developing countries and which cannot easily be achieved in the UK. The scope of the scheme includes biomedical and health research, including social sciences and public health research, and translational research relevant to African national and regional health needs and priorities. Awards of up to £500K will be offered to two or three research leaders.
The second South African tuberculosis (TB) conference will focus on partnerships and how solidarity among the state, private sector and civil society at all levels and structures can increase access to services and prevent people dying from a curable disease. Forging Strategic Partnerships to Fight TB and HIV is the theme for this Conference, which will build on the awareness and commitment made by 1,657 people who contributed to the success of the first South African TB Conference in 2008.
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