The editorials in this newsletter comment on two global events, two months apart. The first is the 18th International AIDS Conference held in Vienna in July, and the second the UN Summit on the Millennium Development Goals being held in New York in September. Both conferences have triggered a wealth of ideas, debates and publication, some of which we include in the newsletter. Both deal with heads of state commitments, made in prior conferences: The first to universal access to treatment for AIDS, the second to the eight MDGs. In the first editorial Sharonann Lynch reminds that after the “talk and spectacle”, many conference participants go back to work in impoverished realities. She suggests concrete people-centred strategies for delivering on treatment commitments in these conditions. In the second, Ranga Machemedze asserts that many living in the most impoverished realities have not yet benefited from the MDGs, even when progress has been made at national level, and asks what the UN Summit will do to close the gap. For both, the test of the global talk is the concrete local improvement it produces for the most disadvantaged communities.
1. Editorial
After the 18th International AIDS Conference (IAC) has wound down in Vienna, the word in the hallways is that the science is in: earlier initiation of treatment and improved antiretroviral (ARV) drug regimens are better for individual patients and communities, and may even ultimately reduce transmission of HIV. Some of the new data presented at the conference come from MSF's project in Lesotho, where I worked from 2006 to 2009. In a two-year study of 1,128 patients from rural Lesotho, where the government has adopted new World Health Organization (WHO) guidelines, patients starting treatment earlier (at CD4 count <350) were 70% less likely to die, 40% more likely to remain in care, and >60% less likely to be hospitalized compared with those started when their disease was already advanced (CD4 <200).
After all the talk and spectacle, many of us—people with HIV/AIDS, clinicians, researchers, and activists—will have to go back to reality: to townships and rural villages still ravaged by the virus; to congested clinics with waiting lists for treatment; and to rich country capitals where donors are ignoring the science and retreating from their commitment to fully fund universal access to treatment, telling us to get used to this new reality—we are in the midst of global economic recession, after all.
At the conference there was a lot of talk about cost-effectiveness and efficiency as a means to mitigate funding shortfalls. Sure, we need to avoid waste and the obscene number of consultants and reports that sit on shelves in Washington, Geneva, and London. But how do the actual people fit in to these crude calculations? What is the cost-benefit to their lives, families, and communities?
We are advocating for a different vision: for patient-centered efficiencies that will increase access to treatment and reduce the burden on patients in taking toxic drugs, reporting excessively to health facilities, and traveling great distances to seek care. We also want efficiencies to reduce the requirements on the health system, for example through task-shifting and community-based, out-of-facility approaches to drug dispending and social support. And economists are telling us these sorts of efficiencies will even be cost-saving in the long run.
So how do we build on Lesotho's example and get more patients on treatment? Here are some forward-looking ideas that could change the game:
* Invest in rigorous research and pilot projects to explore the feasibility and impact of "treatment as prevention." Treatment is increasingly understood to have major prevention benefits, in addition to reducing HIV- and TB-related illness and death.
Support research to radically simplify and optimize the package of ARV treatment, including:
* Dose optimization: If shown to be effective, reducing the dose of some ARVs could potentially treat up to one-third more patients without a cost difference.
* New drug development: Develop new ARV drug delivery platforms and slower-releasing drugs, which could help to decrease the burden on patients as well as the cost per patient per year.
* Accelerate commercialization of point-of-care diagnostics: new instrument-free, point-of-care CD4 cell count blood tests, once available, could be rapidly deployed to the field for use in identifying more patients at the lowest levels of care, while we redouble efforts to develop a point-of-care viral load test.
And additionally;
* Create and implement a financial transaction tax (FTT): billed by some as the "Robin Hood tax" (including activists at IAC dressed up in feathered green hats and bows and arrows), a tiny tax of 0.005% on foreign currency transactions could generate an estimated $33 billion per year for global health needs and other issues affecting the developing world. Such a "tax and treat" strategy could deliver the sufficient, regular, and predictable funding to pay for scale-up, provided donors make good on their existing commitments to the Global Fund and other financing mechanisms.
* Ensure an enabling policy environment to usher in these new innovations, including aggressive use of Trade-Related Aspects of Intellectual Property (TRIPS) flexibilities and an effective patent pool.
If we want to bend the curves of the HIV epidemic, we should seriously consider and put into action radical game-changers such as these.
Please send feedback or queries on the issues raised in this briefing to the EQUINET secretariat: admin@equinetafrica.org. This article is Open Access and was reprinted freely under a Creative Commons license. http://speakingofmedicine.plos.org/2010/07/23/msf-beyond-vienna-possible-game-changers-for-scaling-up-optimal-aids-treatment. For more information on the issues raised in this op-ed please visit the EQUINET website at www.equinetafrica.org or see MSF's website at http://aids2010.msf.org.
According to UN reports, sub-Saharan Africa has the world’s highest rate of child mortality, with one in seven children dying before their fifth birthday. The region has witnessed a 22% decline in the under-5 mortality rate since 1990, although significant variation exists between countries. Although rates of infant mortality have declined since 1990, 17 of the 20 countries with the highest infant mortality rates are African. Maternal mortality is the health indicator that shows the widest gaps between rich and poor, both between and within countries. While data is scarce, WHO estimates that 900 women die per 100 000 live births in Africa. The continent, with the exception of Namibia, is identified by the UN as experiencing high or very high maternal mortality. Sub-Saharan Africa is also the region most affected by the HIV/AIDS epidemic, with over two thirds of all people living with HIV worldwide, and nearly three-quarters of AIDS-related deaths. There are some positive signs: the rate of new HIV infections has slowly declined, and 44% of adults and children in need of antiretroviral therapy had access to treatment, up from 2 % five years earlier. Efforts to combat malaria have progressed: the use of insecticide treated nets by children in 26 African countries rose from 2% in 2000 to 22% in 2008.
African countries have developed numerous strategies to reach the goals. In 2006, the African Union endorsed the Maputo Plan of Action on Sexual and Reproductive Health and Rights, and 22 countries have since set Maternal and Newborn Health Road Maps to improve sexual and reproductive health through laws, policies and health systems. The AU’s African Health Strategy 2007-2015 proposes to strengthen equitable health systems; the AU’s 2005 Gaborone Declaration commits to universal access to HIV prevention, treatment and care; the 2001 Abuja Declaration commits African states to allocate 15% of their national budgets to health and the 2008 Ouagadougou Declaration commits to advancing Primary Health Care and Health Systems in Africa. The 2010 African Union summit held in July in Kampala, passed a number of resolutions, including a renewed commitment to the 15% budgetary allocation to health; and CARMMA- the Campaign for the Accelerated Reduction of Maternal Mortality in Africa.
The African Union and its member states must, however, go beyond rhetoric to implement the promises set out in their declarations and produce tangible results. For example, the Global Fund has reported that as of 2007, out of 52 African countries (no data was available for Somalia), only three (Botswana, Djibouti, and Rwanda) had met the 15% target for health budgets, while three more (Liberia, Malawi and Burkina Faso) surpassed this target.
The UN report, Keeping the Promise – United to Achieve the Millennium Development Goals for the 2010 MDG summit being held in late September in New York has a paragraph on Africa stating that the continent is lagging behind on many of the MDGs, that progress has been made in some African countries but that the poorest ones remain “a grave concern, especially in the wake of the hard hitting financial and economic crisis”. The UN note in the report that while aid to Africa has increased in recent years, it still lags far behind commitments made. Will the Summit produce the resources called for by the UN through delivery of these commitments? Will the UN MDG Summit in September go beyond rhetoric to action? Will it unleash the resources to move from the many strategies to practice?
After all is said and done in September, one sign of that must be the extent to which whatever is said is translated into local level interventions and reaches vulnerable groups. This needs to be tracked, but the UN only collects MDG data aggregated at the national level, making it difficult to track how far this is being achieved. There is no provision in country reports for disaggregation of country-level data to assess sub-national progress on the MDGs. The reports do not therefore capture the stark inequalities among different regions, socio-economic, ethnic, racial and cultural groups within countries on accessing the resources for health or achieving the MDGs.
And should we be measuring targets or rates of progress? The World Bank noted in 2010 that uniform goals like reducing infant mortality by two-thirds, maternal mortality by three-quarters can underestimate progress in poor countries and communities. Why? Because the greater the distance to the goals from low starting points in poor countries, the greater the improvement needed to reach the targets. Is it the rate of progress, or the likelihood of achieving the targets that should be evaluated? While the target is the outcome we are aiming for, Fukuda and Greenstein argued in 2010 that the rate of progress tells more about the likelihood of achieving it along the way, and would place more pressure on governments to do more.
Please send feedback or queries on the issues raised in this briefing to the EQUINET secretariat: admin@equinetafrica.org. This editorial has been edited from the original that appeared in the Health Diplomacy Monitor Special Issue on the UN Summit on the Millennium Development Goals, Vol 1 Issue 3. For more information on the issues raised in this op-ed please visit the EQUINET website at www.equinetafrica.org or see the Global Health Diplomacy website at www.ghd-net.org.
2. Equity in Health
Save the Children’s research compares mortality rates of poor children and rich children in 32 countries. In many countries that are successfully reducing child mortality, progress is concentrated among the poorest and most disadvantaged children. Conversely, in countries making slow or no progress, disparities in life chances between children from the poorest and richest backgrounds tend to be extreme. Since 1990, the global child mortality rate has declined by 28%, which falls short of the target set by Millennium Development Goal (MDG) 4 (a two-thirds reduction by 2015). Still, many high-mortality countries have substantially reduced child deaths, and 19 of 68 high-priority countries are now expected to meet MDG 4. The findings underscore a great gap in reaching the poorest with essential health care, including pre-and post-natal care, skilled attendance at birth, and low-cost prevention and treatment for the major child killers – pneumonia, diarrhoea, and malaria. Save the Children found inequity in child survival to be a persistent and sometimes growing problem in many of the world’s developing countries, where 99% of all child deaths occur.
This report was prepared to advise the United Nations Development Group Millennium Development Goal (MDG) Task Force at the United Nations Summit on the MDGs, held from 20–24 September 2010, in the United States. It discusses six priorities to help countries to accelerate progress towards meeting the MDGs. 1. Country-led MDG strategies should integrate MDGs in their national development strategies, grounded in annual resource budgets that are planned through a medium-term expenditure framework. 2. A local accountability plan should be used to implement and evaluate results with mechanisms that are transparent and accountable to citizens. Policy, legal and institutional frameworks must make accountability real. 3. Governments should prioritise community participation and partnerships, taking full advantage of the efficiency and effectiveness gains from community involvement and through the use of the private sector and south-south partnerships. 4. Gender equality and women’s empowerment should be high on the agenda, and world leaders must recognise that progress on gender equality and women’s empowerment is critical to progress on the MDGs overall. 5. A policy of inclusion should be followed that addresses issues of inequality, exclusion and discrimination. Governments must assess and strengthen the targeting of public services and programmes to address inequality and all those that suffer from discrimination and social exclusion. 6. Resilience, for example in adapting to climate change, should help to protect the most vulnerable. Governments should adopt an effective and inclusive approach to social protection and prioritise sustainable development.
This decade report collects and analyses data from the 68 countries that account for at least 95% of maternal and child deaths. It reviews progress made from 2000-2010 and provides a mix of good and bad news. Good news is that the under-5 child mortality rate has declined by 28% from 1990 2008, accounting for a reduction of nearly four million child deaths per year. Nineteen of the 68 Countdown countries are now on track to meet Millennium Development Goal (MDG) 4, which calls for reducing child deaths by two-thirds between the 1990 base line and 2015. However, many Countdown countries are still off track for achieving MDGs 4 and 5 and are not increasing coverage of key health interventions quickly enough, especially in sub-Saharan Africa. The report further found that most of the 68 Countdown countries were experiencing poorly functioning health infrastructure, inadequate numbers of health workers, slow adoption of evidence-based health policies and insufficient focus on quality of care. The report argues that only a dramatic acceleration of political commitment and financial investment can make achieving MDGs 4 and 5 possible by 2015.
According to the September editorial of The Lancet, overall, progress on achieving the Millennium Development Goals(MDGs) is uneven, with some regions, especially in the poorer countries, lagging far behind. The editors argue that business cannot continue as usual in the next five years if the promises made a decade ago are to be met. On the positive side, the MDGs have achieved much. They have mobilised unprecedented political support, advocacy efforts, financial resources, and have encouraged improved monitoring and evaluation of programmes. However, the editors argue that the targets were narrow and fragmented. Potential links and synergies between goals have not been fully realised. Over the past 40 years improvements in women's education (MDG 2) has reduced child mortality (MDG 4) substantially, averting 4.2 million deaths globally. Furthermore, the results point to the importance of a reduction of the gender gap in educational achievement, thereby promoting gender equity and empowering women (MDG 3). The addition of new targets over time has also been unsuccessful, as seen with universal access to reproductive health. Newer priorities facing the world, such as non-communicable diseases (NCDs) and climate change, have been slow to be accepted in the current framework, although the focus on NCDs at the UN General Assembly in September, 2011 may be an important step forward. Given these problems and challenges, the editorial proposes that the next MDG framework be built on a shared vision of development across the life course rather than on separate goals and targets. It argues that the issue of equity should be central to any measures, focusing on those who are marginalised.
According to this report, progress towards achieving sustained and sustainable development in Africa have had mixed results so far. Some positive results have been achieved. Africa has achieved strong and sustained economic growth, outpacing global per capita growth since 2001 after lagging behind for two decades, and helping to reduce the proportion of its population living on less than US$1 a day. Multi-party democracy has taken a stronger hold, and the number of state-based armed conflicts has been reduced. There has been significant progress towards the Millennium Development Goal (MDG) goal of universal primary education. However progress on other MDGs, particularly maternal mortality, has been poor and, according to present trends, no country in Africa will meet all the MDGs by 2015. The report underlines the need to scale up efforts to improve governance including by consolidating the trend to multiparty democracy. Stronger action needs to be taken to resolve long-running conflicts that continue to cause immense human suffering in the continent. Capacity shortages remain a key constraint in all areas.
On 13 May 2010, the United Nations (UN) General Assembly passed resolution 265, ‘Prevention and control of non-communicable diseases’, which called for Heads of State to address NCDs in a high-level plenary meeting scheduled for September 2011. Out of this meeting, and its associated outcome document, will come a series of programmatic steps by all UN members. This editorial analyses the UN resolution and describes the kinds of outcomes that are possible and needed to make chronic non-communicable diseases (NCDs) a global priority among international leaders and to generate global interest and a social movement to ensure commitment by Heads of State. The authors argue that the attention of Heads of State and Government must be secured to promote their participation in the meeting in September 2011. Second, while Member States will decide on the final outcomes of the meeting, international development agencies, the World Bank, UN Agencies, civil society, and the private sector must provide support through a consultative process towards the outcome document. Third, stakeholders must be rallied around a common vision and road map to operationalise a global response to NCDs during the decades to come.
This report on progress towards achieving the Millennium Development Goals is mixed. It acknowledges some success but also points to shortcomings. Successes include progress on poverty reduction – with the developing world as a whole remaining on track to achieve the poverty reduction target by 2015 – and improvements in key disease interventions, which have cut child deaths from 12.5 million in 1990 to 8.8 million in 2008. Between 2003 and 2008, the number of people receiving antiretroviral therapy increased tenfold - from 400,000 to 4 million - corresponding to 42% of the 8.8 million people who needed treatment for HIV. However, some challenges remain. The most severe impact of climate change is being felt by vulnerable populations who have contributed least to the problem, gender equality has shown little progress, armed conflict continues to add to the growing number of refugees worldwide and the number of people who are undernourished has continued to grow, as the slow progress in reducing the prevalence of hunger has stalled in some regions. About one in four children under the age of five are underweight, mainly due to lack of adequate and quality food, inadequate water, sanitation and health services, and poor care and feeding practices. An estimated 1.4 billion people were still living in extreme poverty in 2005. Moreover, the effects of the global financial crisis are likely to persist: poverty rates will be slightly higher in 2015 and even beyond, to 2020, than they would have been had the world economy grown steadily at its pre-crisis pace.
This paper aims to identify cross-cutting challenges that have emerged from Millennium development Goal (MDG) implementation so far. The MDGs have had notable success in encouraging global political consensus, providing a focus for advocacy, improving the targeting and flow of aid, and improving the monitoring of development projects. However, they have also encountered a range of common challenges with regard to conceptualisation and execution: gaps that exist in goals, targets with too narrow a focus, a lack of ownership and poor equity outcomes. The paper concludes that future goals should be built on a shared vision of development, and not on the bundling together of a set of independent development targets. Development should be conceptualised as a dynamic process involving sustainable and equitable access to improved wellbeing, which is achieved by expansion of access to services that deliver the different elements of wellbeing.
The number of women dying due to complications during pregnancy and childbirth has decreased by 34% from an estimated 546,000 in 1990 to 358,000 in 2008, according to this report. Despite the progress, the report notes that the annual rate of decline is less than half of what is needed to achieve the Millennium Development Goal (MDG) target of reducing the maternal mortality ratio by 75 between 1990 and 2015. This will require an annual decline of 5.5%. The 34% decline since 1990 translates into an average annual decline of just 2.3%. In the period from 1990 to 2008, ten out of 87 countries with maternal mortality ratios equal to or over 100 per 100,000 live births in 1990 are on track with an annual decline of 5.5% between 1990 and 2008. At the other extreme, 30 made insufficient or no progress since 1990. The study shows progress in sub-Saharan Africa, where maternal mortality decreased by 26%. Ninety-nine per cent of all maternal deaths in 2008 occurred in developing regions, with sub-Saharan Africa and South Asia accounting for 57% and 30% of all deaths, respectively.
This article predicts that the Millennium Development Goals (MDGs) will not be achieved by 2015. Progress is especially slow in fragile contexts, where institutions are weak and there is a risk of violent conflict. But a closer examination shows that the MDGs are inadequate measures of development progress, and as such they represent an international development paradigm that is tired and confused. The article proposes a more ‘useful’ way to consider human progress: consider a ‘developed society’ as one with a defined set of characteristics and create from these a vision for change. Building on work by others, the authors propose a generic vision consisting of six key characteristics: equal access to political voice, and the legitimate and accountable use of power; equal participation in a vibrant and sustainable economy; equal access to justice, and equality before the law; freedom from insecurity; the ability of people to maintain their mental and physical well-being, to have aspirations and make progress towards them; and the self-reinforcing presence of institutions and values that support and enable equitable progress and peace. While these characteristics provide a vision of human progress, they do not provide guidance on how to get there, the authors caution. The ‘how’ of implementation has to be defined at a local, rather than a global level, and should be informed by lessons from history.
3. Values, Policies and Rights
Kenyan human rights activists have filed an appeal for the release of two men imprisoned for defaulting on their tuberculosis (TB) treatment, and are warning that the arrests could discourage other patients from seeking treatment. The appeal has been filed at Kapsabet court in Rift Valley Province. Arrested in August 2010, the two men have been held in police remand in Kapsabet for ‘posing a risk to the health of the wider community’. Under the Public Health Act, they can be held until the district medical officer who ordered their arrest decides they are no longer a public health threat. According to Nelson Otwoma, national coordinator of the Network of People Living with HIV/AIDS in Kenya, the two men have not been isolated, posing a health risk to other inmates. He warned that the arrests could act as a deterrent to patients needing treatment. ‘This is a negative consequence of the government's action’, he added, denouncing criminalisation of the disease. ‘Counselling of those on treatment will have better outcomes,’ he noted.
The Botswana government has passed an amendment to its Employment Act that will bring an end to dismissal based on an individual's sexual orientation or HIV status, but rights groups believe the legislation needs to go further. Civil society organizations in Botswana welcomed the move but said legislation to protect the rights of people living with HIV in the workplace was necessary. The Botswana Network on Ethics, Law and HIV/AIDS (BONELA) noted that ‘tolerance and acceptance of sexual minorities will ensure universal access to prevention, treatment, care and support - crucial for Botswana to achieve its ... goal of zero new HIV infections by 2016’. Gadzani Mhotsha, Secretary General of the Botswana Federation of Trade Unions (BFTU) warned that the legislation was not comprehensive enough in dealing with the serious issues of HIV at the workplace and called for comprehensive legislation, not piecemeal amendments. BONELA also added that a specific HIV Employment Act should be passed that attends to matters of reasonable accommodation for those who are HIV-positive, ensuring they have a safe and supportive environment to access treatment, care and support. Civil society has also called on the government to enact laws prohibiting private sector employers from testing potential employees for HIV and subsequently disqualifying them on the basis of an HIV-positive status.
The criminal use of firearms in South Africa is widespread and a major factor in the country having the third-highest homicide rate in the world. Violence is a common feature of South African society. A firearm in the home is a risk factor in intimate partner violence, but this has not been readily demonstrated in South Africa because of a lack of data, according to this paper. The paper drew on several South African studies including national homicide studies, intimate partner studies, studies with male participants and studies from the justice sector, to discuss the role of gun ownership on gender-based violence. It concludes that guns play a significant role in violence against women in South Africa, most notably in the killing of intimate partners. Although the overall homicide data suggest that death by shooting is decreasing, data for intimate partner violence are not readily available. It was unclear if the overall decrease in gunshot homicides applies to women in relationships. In view of the general role guns play in violence against women, the paper urges the government to keep gun control high on the legislative agenda.
Christiana Figueres, newly appointed executive secretary of the United Nations (UN) Framework Convention on Climate Change (UNFCCC), has voiced the UN’s position on the state of climate change negotiations and said that there is a constructive atmosphere and a growing sense of urgency among governments about climate change mitigation. At Cancun, Mexico, where the sixteenth Conference of the Parties will be held from 29 November–10 December 2010, governments need to go from the politically possible to the politically irreversible, she said. During the last meeting in Bonn, Germany, in June 2010, Figueres said that countries decided that the ‘text before them is now a negotiation text,’ and a ‘party text,’ which shows serious commitment, she said. In addition, comments were heard from ‘very important countries’ that their confidence and trust in the negotiation process was restored, which was not the case at the end of the 2009 conference at Copenhagen. Figueres said that she was expecting governments attending the Cancun meeting to make decisions on the relevant financing mechanism and technology for fighting global climate change, on how to push forward reduction of emissions from deforestation, on adaptation, and on monitoring, she said. At Cancun, four or five decisions could be taken to establish the operational entities that would be the basis for the next chapter of the climate regime.
According to this study, there have been few studies on domestic violence and women in developing countries, including South Africa, which has one of the highest rates of intimate partner violence in the world. The study examined the association between physical intimate partner violence and physical health outcomes and behaviours among South African women. Using data from the cross-sectional, nationally representative South Africa Stress and Health Study, the study assessed exposure to intimate partner violence, health-risk behaviours, health-seeking behaviours and chronic physical illness among a sample of 1,229 married and cohabiting women. It found the prevalence of reported violence was 31%. This correlated with several health-risk behaviours (smoking, alcohol consumption, and use of non-medical sedatives, analgesics and cannabis) and health-seeking behaviours (recent visits to a medical doctor or healer). Intimate partner violence was not significantly associated with chronic physical illness, although rates of headache, heart attack and high blood pressure reached near-significance. The study recommends that public health programmes in South Africa should incorporate interventions to mitigate the impact of violence on victims and reduce the risk of negative behavioural outcomes. Further investigation of the pathways between violence exposure and health behaviours is needed to inform the design of such programming.
Opt-out testing for the human immunodeficiency virus (HIV) incorporates testing as a routine part of health care for all patients unless they refuse. The ethics of this approach to testing in sub-Saharan Africa is a source of controversy. Opt-out HIV testing is expected to improve survival by increasing case detection and thus linking more HIV-infected people to earlier treatment, provided there is effective patient follow-up and programme sustainability. At the population level, these benefits will likely outweigh the potential negative consequences of individuals experiencing HIV-related stigma, according to this article. These justifications appeal to consequentialist moral theories that the acceptability of an action depends upon its outcomes. On the other hand, liberal moral theories state that the autonomy of individuals should always be protected unless restricting autonomy is necessary to protect the welfare of others. Opt-out consent may restrict autonomy and it is unclear whether it would benefit people other than those being tested. Yet, the doctrine of libertarian paternalism proposes that it is justifiable and desirable to use unobtrusive mechanisms to help individuals make choices to maximise their own welfare. Central to this idea are the premises featured by supporters of opt-out consent that individuals will not always make the best choices for their own welfare but they may be influenced to do so in ways that will not compromise their freedom of choice. Also important is the premise that all policies inevitably exert some such influence: opt-in consent encourages test refusal just as opt-out consent encourages acceptance. Based on these premises, the article argues that opt-out testing may be an effective and ethically acceptable policy response to Africa’s HIV epidemic.
In preparation for the Millennium Development Goal (MDG) Summit, held from 20-22 September 2010, in New York, Women in Development Europe (WIDE) launched the new campaign ‘Mobilising for Gender Justice Beyond the MDGs’ to advance gender and social justice for all. WIDE’s view on the MDGs framework is that it offers too narrow and minimalist a focus for measuring development or the advancement of gender equality and women´s rights. WIDE considers that the MDGs’ shortcoming is that the indicators exclude the structural nature of poverty as well as the structural nature of gender inequality. WIDE is inviting participation in the ‘Gender Justice Beyond the MDG Campaign’ to share analysis, opinions, activities and proposals, news, processes, expectations and outcomes of the summit.
4. Health equity in economic and trade policies
This study set out to produce quantitative estimates of the Indian role in generic global anti-retroviral (ARV) supply to help understand potential impacts of such measures on HIV and AIDS treatment in developing countries. It utilised transactional data containing 17,646 donor-funded purchases of ARV tablets made by 115 low- and middle-income countries from 2003 to 2008 to measure market share, purchase trends and prices of Indian-produced generic ARVs compared with those of non-Indian generic and brand ARVs. The study found that Indian generic manufacturers dominate the ARV market, accounting for more than 80% of annual purchase volumes. From 2003 to 2008, the number of Indian generic manufactures supplying ARVs increased from four to 10 while the number of Indian-manufactured generic products increased from 14 to 53. Indian-produced generic ARVs used in first-line regimens were consistently and considerably less expensive than non-Indian generic and innovator ARVs. The study warns that future scale up using newly recommended ARVs will likely be hampered until Indian generic producers can provide the dramatic price reductions and improved formulations observed in the past. Rather than agreeing to inappropriate intellectual property obligations through free trade agreements, India and its trade partners - plus international organisations, donors, civil society and pharmaceutical manufacturers - should ensure that there is sufficient policy space for Indian pharmaceutical manufacturers to continue their central role in supplying developing countries with low-priced, quality-assured generic medicines.
At the African Regional Intellectual Property Organization (ARIPO) diplomatic conference on 9-10 August in Swakopmund, Namibia, the protocol on the Protection of Traditional Knowledge and Expressions of Folklore was signed by African nine states. ARIPO currently has 17 member states. Nine states signed the protocol and the remaining eight states will have to accede to the protocol. Some states have already initiated the process for the ratification and accession, according to a spokesperson for ARIPO, Emmanuel Sackey. The protocol will enter into force after six contracting states have ratified or acceded to it, Sackey said. The organisation is expected to take initiatives on traditional knowledge and link its initiatives with those undertaken by the World Intellectual Property Organization (WIPO) through its active involvement in the WIPO activities in this field. The protocol is meant to ‘protect creations derived from the exploitation of traditional knowledge in ARIPO member states against misappropriation and illicit use through bio-piracy,’ according to ARIPO. The protocol should also prevent the ‘grant of patents in respect of inventions based on pirated traditional knowledge (…) and to promote wider commercial use and recognition of that knowledge by the holders, while ensuring that collective custodianship and ownership are not undermined by the introduction of new regimes of private intellectual property rights.’ The United Nations has warned against the application of western legal and economic principles to collectively owned knowledge in traditional communities.
According to this paper from the World Bank, an Economic Partnership Agreement (EPA) is unlikely to offer much in terms of improved access to European Union services markets, especially for temporary movement of unskilled workers, a key issue for African countries. The main impacts of a services EPA for African countries would come from locking in openness to trade, providing precedents for regulation in key sectors, cooperation on competition policy and support for regional integration. According to the Bank, many of these goals could be pursued through a more cooperative approach with interested African countries, without necessarily negotiating and signing a broad EPA agreement.
The African, Caribbean and Pacific (ACP) countries face a massive challenge in tackling hunger and under-nutrition, but many critics have argued that the commitments required of ACP countries under Economic Partnership Agreements (EPAs) will make this more difficult. This article investigates the threat to food security posed by these agreements. While some observers blame trade liberalisation for these problems, the article identifies the lack of investment to improve productivity and address supply-side constraints as the major limiting factor. It argues that the debate around the issue of EPAs and food security distracts from the more important question of what domestic initiatives ACP countries need to take to ensure that agriculture can play its role as an engine of economic growth and poverty reduction. Government should invest in agriculture rather than rely on trade restrictions for food security. The potential of EPAs to improve food security can only be realised by a focus on greater agricultural investment and improved institutions. Resources can be made available from the EU budget, the EU’s European Development Fund and bilateral external funders, but the prerequisite is that these requirements are prioritised by ACP countries.
This report by the United Nations assesses global progress towards meeting Millennium Development Goal (MDG) 8: Develop a global partnership for development. According to the report, only five member countries of the Development Assistance Committee have met their pledge, made in 2005, to pay 0.7% of their gross national as official development assistance, representing a major shortfall in funding. Market access (trade) has not improved, for developing countries, with no reductions in tariffs and no agreements having yet been reached at the Doha negotiations. The debt situation of many developing and transition economy countries deteriorated during the financial and economic crisis owing to the slowing down of the global economy and the fall in trade, remittances and commodity prices. In terms of access to affordable essential medicines, the report urges countries without significant pharmaceutical manufacturing capacity to take advantage of flexibilities in the World Trade Organization Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) to import affordably priced essential medicines or, if they have the capacity, to produce generic pharmaceuticals and promote foreign investment to acquire new technologies for producing the medicines. With regard to new technologies, disparities between developed and developing countries remain. Large regional disparities in the use and uptake of information and communication services also persist. For instance, access to the Internet at broadband speeds remains very low in developing countries and is practically negligible in less-developed countries.
This article explains how trade preference programmes can be made more effective for poorer countries. It is based on five principles put forward by the Center for Global Development (CGD) to make trade preferences more effective for less-developed countries: expand coverage to all exports from all least developed countries; relax restrictive rules of origin; make trade preference programmes permanent and predictable; promote co-operation between countries giving and receiving preferences; and encourage advanced developing countries to implement trade preference programmes that adopt the other four principles. It argues that extending full duty-free, quota-free market access to all least developed countries would have far more power if it is a project of the G-20, not just the G-8, and Brazil, China, India and Turkey are already showing the way. The author urges the G-20 to show its leadership on global development issues and to realise the Millennium Development Goal of using trade as a tool for development.
This collection of essays assesses how the world is doing in meeting the Millennium Development Goals (MDGs). The lead essay, 'Regaining Momentum,' notes that, while several of the MDGs are within reach, the global economic crisis has set back progress toward a number of the targets, especially those related to health. Developing countries will need the support of advanced economies in to get back on track. In other essays, economist Jagdish Bhagwati calls into question the premise of the MDGs and economists Arvind Panagariya and Rodney Ramcharan debate on how important it is to fight inequality.
This report, written for Oxfam, examines the impact of the global financial crisis on the budgets of low-income countries, especially their spending to reach the Millennium Development Goals (MDGs). It points out that the current global economic crisis has created a huge budget revenue hole of US$65 billion, of which aid has filled only one-third. As a result, after some fiscal stimulus to combat the crisis in 2009, most low-income countries (LICs) – including those with International Monetary Fund (IMF) programmes – are cutting MDG spending, especially on education and social protection. They have also had to borrow expensive domestic loans, and increase anti-poor sales taxes. The report argues that almost all LICs could absorb much more aid without negative economic consequences (whereas they have much less space to borrow or to raise taxes). It urges the international community to make strong new aid commitments at the Millennium Summit in September 2010, funded by financial transaction taxes or other innovative financing. The IMF should encourage LICs to spend more on MDG goals and on combating climate change and to report regularly on such spending, and LIC governments should increase spending on social protection and education, and bolster efforts to fight tax avoidance.
5. Poverty and health
This paper considers previous systematic assessments of educational attainment, and estimated the contribution of improvements in women's education to reductions in child mortality in the past 40 years. The authors compiled 915 censuses and nationally representative surveys, and estimated mean number of years of education by age and sex. They found that the global mean number of years of education increased from 4.7 years to 8.3 years for men and from 3.5 years to 7.1 years for women. For women of reproductive age (15-44 years) in developing countries, the years of schooling increased from 2.2 years to 7.2 years. By 2009, in 87 countries, women aged 25—34 years had higher educational attainment than had men in the same age bracket. Of 8.2 million fewer deaths in children younger than five years between 1970 and 2009, the paper estimates that 4.2 million (51.2%) could be attributed to increased educational attainment in women of reproductive age. In conclusion, the substantial increase in education, especially of women, and the reversal of the gender gap have important implications not only for health but also for the status and roles of women in society. The continued increase in educational attainment even in some of the poorest countries suggests that rapid progress in terms of Millennium Development Goal 4 might be possible.
According to this report, malnutrition levels in pastoralist districts of northeastern Kenya have remained high, despite recent rains that boosted livestock productivity, the mainstay of the local economy. Improvements in household food security have not translated into a decisive reduction in rates of child malnutrition in the northeastern districts, suggesting that causal factors of the unacceptably high rates go beyond availability of food at the household level. The Ministry of Health and its partners found Global Acute Malnutrition (GAM) levels above the World Health Organization's 15% emergency threshold in Mandera Central Districts, Wajir South and Wajir East. Mandera West recorded GAM rates above 25%. High illiteracy levels may mean that parents do not ensure their children receive a balanced diet, resulting in malnutrition. The report also emphasises the growing problem of urban poverty, with an estimated 3.5‐4.1 million (or up to 20%) out of 13.5 million urban households situated in high-density areas that are suffering various degrees of food insecurity. Further assessment of urban poverty in Kenya is already underway, according to the Ministry.
In the run-up to the United Nations’ (UN) three-day summit on the Millennium Development Goals (MDGs), held in New York from 20–24 September 2010, UN Member States underlined the vital role that democracy plays in reducing poverty. Democracy remains central to any development approach, Joseph Deiss, President of the General Assembly, told a meeting at UN Headquarters. He identified the pursuit of the MDGs – which include reducing poverty, fighting disease, halting environmental degradation and boosting health – along with UN reform and the promotion of environmentally sustainable development as key areas of focus for the Summit. In particular, he argued that stakeholders must bridge the gaps in the fight against hunger, child mortality and maternal health. He called for a sincere commitment from all world leaders taking part in the Summit and a genuine plan of action to ensure that the MDGs are reached. Member States are expected to come prepared to put forward concrete commitments on what they will do over the next five years to reach the MDGs.
In May 2010, the World Health Assembly adopted Resolution EB126.R11, its Global Strategy to Reduce the Harmful Use of Alcohol, based in part on an extensive amount of evidence on both alcohol's contribution to the global burden of disease and the policies capable of ameliorating the harm it causes. Now that the strategy has been adopted, this article calls for public health science to take on two new challenges. The first is to expand the evidence base so that it applies not just to the developed countries where most of the world's alcohol consumption is concentrated, but also to the low- and middle-income countries where alcohol consumption is increasing and where the policy response is still weak. The second challenge is to use scientific research to guide the adoption of effective alcohol policies at the national and international levels. The author of the article urges for a systematic investigation of the alcohol industry itself as a vector for alcohol-related disease and disability. Aggressive marketing of alcoholic beverages in low-consumption developing countries needs to be monitored, as does industry compliance with its own codes for responsible advertising. More stringent measures to protect young people from exposure to irresponsible advertising need to be considered, as self-regulation codes are easily circumvented and not enforceable.
Consumer anxieties over the rising cost of food in rich and poor countries alike are stoking fears of social unrest in impoverished parts of the world once again. On 1 September 2010, at least six people - including two children - were killed during violent demonstrations over soaring prices for basic necessities, including bread and fuel, in and around Maputo, the capital of Mozambique, one of Africa's poorest countries. The government has increased bread prices by 30% and protestors complained that they are struggling to feed themselves and their families. The violence echoes the food price crisis of 2007-2008, which helped push the number of hungry people in the world above a billion, and sparked protests and riots in nearly 40 countries. Surging wheat prices - mainly due to Russian restrictions on sales following a major drought there - drove international food prices up 5% in August, the biggest month-on-month increase since November 2009, according to the Food and Agricultural Organization (FAO). The FAO's Food Price Index - a basket of meat, dairy, cereals, oils, fats and sugar - has reached its highest level since September 2008, but is still 38% below its peak in June 2008. The FAO says the forecast for world cereal production this year has been lowered by 41 million tons to 2,238 million tons since June, but that would still be the third highest annual amount on record and above the five-year average.
According to this article, the absence of a threshold in the association between maternal education and child survival suggests that the obvious causal pathway - increased understanding of disease causation, prevention, and cure - might only be part of the explanation. This has led to investigations of many possible behavioural links, including better domestic hygiene, more intense mother-child interactions, and greater maternal decision-making power among mothers who are more educated than among those who are less educated. However, the use of child health services offers the strongest empirical support. Exposure to primary schooling increases a mother's propensity to seek modern preventive or curative services for her children. Schooling seems to engender in adults an increased identification with health institutions, and the confidence and skills to access services and comply with advice. It is likely that the symbiotic effect of schooling and health-service use indicates that improvements in the education of women of reproductive age might account for half of the reduction in mortality in children aged under five years. This contribution is far greater than increased income, a finding that is consistent with previous studies. Income and educational increases are only slightly correlated. Analyses of states that achieved high life-expectancies despite low-income levels (eg: China, Costa Rica, Kerala, and Sri Lanka) revealed a common characteristic: sustained political commitment to equitable access to primary schooling and health care for both sexes.
6. Equitable health services
The study’s aim was to estimate rates of completion of CD4+ lymphocyte testing (CD4 testing) within 12 weeks of testing positive for human immunodeficiency virus (HIV) at a large HIV/AIDS clinic in South Africa, and to identify clinical and demographic predictors for completion. In the study, CD4 testing was considered complete once a patient had retrieved the test results. To determine the rate of CD4 testing completion, researchers reviewed the records of all clinic patients who tested positive for HIV between January 2008 and February 2009 to identify predictors for completion through multivariate logistic regression. Of the 416 patients who tested positive for HIV, 84.6% initiated CD4 testing within the study timeframe. Of these patients, 54.3% were immediately eligible for antiretroviral therapy (ART) because of a CD4 cell count ≤ 200/µl, but only 51.3% of the patients in this category completed CD4 testing within 12 weeks of HIV testing. Among those not immediately eligible for ART, only 14.9% completed CD4 testing within 12 weeks. Overall, of HIV+ patients who initiated CD4 testing, 65% did not complete it within 12 weeks of diagnosis. The higher the baseline CD4 cell count, the lower the odds of completing CD4 testing within 12 weeks. The study concluded that patient losses between HIV testing, baseline CD4 cell count and the start of care and ART are high. As a result, many patients receive ART too late. It recommends health information systems that link testing programmes with care and treatment programmes.
This report presents the global 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.
Severe overcrowding in KwaZulu-Natal’s prisons is contributing to the spread of HIV and tuberculosis and driving the high death toll in prisons, according to King Kumalo, provincial deputy director of health services in the Department of Correctional Services (DCS), in his address to the annual meeting of Hospice Palliative Care Association on 1 September 2010. So far this year, 120 prisoners have died of ‘natural causes’ (diseases) and eight of unnatural causes in KwaZulu-Natal, he reported. In the past, there were more unnatural deaths such as murder and suicide than natural deaths, said King. Last year, 168 prisoners died of natural causes while 14 died of natural causes. As a result of the high death toll, the DCS has brought in hospice workers to assist them to treat people with advanced disease who are in need of pain relief. The HPCA, cares for over 70,000 patients at 200 sites countrywide, also has a memorandum of understanding with the SA National Defence Force to provide palliative care (pain relief). However, hospice workers reported that HIV and TB – particularly drug-resistant TB - were challenging their resources. A shortage of beds for patients, long travelling distances to treatment centres were cited as obstacles, while many of the local clinics were reported to not offer monthly tests on people with drug-resistant TB because staff are scared of becoming infected.
This study took the form of a process evaluation of the tenfold scale-up of an evaluated Youth Friendly Service (YFS) intervention in Mwanza Region, Tanzania to identify key facilitating and inhibitory factors from both user and provider perspectives. The intervention was scaled up in two training rounds lasting six and ten months and evaluated through a simulated patient study, focus group discussions and semi-structured interviews with health workers and trainers, training observations and pre- and post-training questionnaires. The study found that, between 2004 and 2007, local government officials trained 429 health workers. The training was well implemented and over time trainers' confidence and ability to lead sessions improved. The scale-up faced challenges in the selection and retention of trained health workers, however, and was limited by various contextual factors and structural constraints. The study concludes that YFS interventions can remain well delivered even after expansion through existing systems. The scaling up process did affect some aspects of intervention quality and the findings emphasise the need to train more staff (both clinical and non-clinical) per facility in order to ensure YFS delivery. Further research is needed to identify effective strategies to address structural constraints and broader social norms that hampered the scale-up.
This paper presents the results of a feasibility study of a fully integrated model of HIV and non-HIV outpatient services in two urban Lusaka clinics. Assessment of feasibility included monitoring rates of HIV case-finding and referral to care, measuring median waiting and consultation times and assessing adherence to clinical care protocols for HIV and non-HIV outpatients. Provider and patient interviews at both of the sites in the study indicated broad acceptability of the model and highlighted a perceived reduction in stigma associated with integrated HIV services. The paper argues that integrating vertical anti-retroviral therapy and outpatient services is feasible in the low-resource and high HIV-prevalence setting of Lusaka, Zambia. Integration enabled shared use of space and staffing that resulted in increased HIV case finding, a reduction in stigma associated with vertical ART services but resulted in an overall increase in patient waiting times. Further research is required to assess long-term clinical outcomes and cost effectiveness in order to evaluate scalability and generalisability.
The objective of this study was to assess the relationship between the prevalence of vitamin A deficiency among pregnant women and the effect of neonatal vitamin A supplementation on infant mortality. The study’s literature review revealed that studies of neonatal supplementation with vitamin A have yielded contradictory findings with regard to its effect on the risk of infant death, possibly owing to heterogeneity between studies. One source of that heterogeneity is the prevalence of vitamin A deficiency among pregnant women, which the study examined using meta-regression techniques on eligible individual and cluster-randomised trials. The meta-regression analysis revealed a statistically significant linear relationship between the prevalence of vitamin A deficiency in pregnant women and the observed effectiveness of vitamin A supplementation at birth. In regions where at least 22% of pregnant women have vitamin A deficiency, the study recommends giving neonates vitamin A supplements to help protect against infant death.
7. Human Resources
This study presents an innovative approach to healthcare worker (HCW) training using mobile phones as a personal learning environment. Twenty physicians used individual Smartphones, each equipped with a portable solar charger. A set of 3D learning scenarios simulating interactive clinical cases was developed and adapted to the Smartphones for a continuing medical education programme lasting three months. A mobile educational platform supporting learning events tracked participant learning progress. Learning outcomes were verified through mobile quizzes using multiple choice questions at the end of each module. Training, supervision and clinical mentoring of health workers are the cornerstone of the scaling up process of HIV and AIDS care in resource-limited settings. Educational modules on mobile phones can give flexibility to HCWs for accessing learning content anywhere. However lack of software interoperability and the high investment cost for the Smartphones' purchase could represent a limitation to the wide spread use of such learning programmes.
This compendium of examples of promising practices for evidence-based planning and decision-making for dealing with the HIV pandemic is based on the premise that building national strategic information (SI) and monitoring and evaluation (M&E) capacity requires supportive policies for health workers, as well as organisational and leadership development and individual technical capacity development. The promising practices cover the core components of SI (M&E; surveys and surveillance; and health management information systems, including geographical information systems) and span six ‘action fields’ (policy, leadership, partnership, finance, human resource management systems and education) to provide a comprehensive lens through which to strategically plan for and implement M&E workforce strengthening initiatives. By examining the experiences in detail, reviewing available results and supporting materials as well as considering the implementation context, users of the compendium may be able to identify approaches worth testing in their own countries. While the list of practices is by no means exhaustive or representative, it does provide an important starting point upon which to build a more comprehensive learning resource for human resources capacity building for effective HIV M&E systems and strategic information.
Retaining health workers in rural facilities remains a major challenge facing South Africa and other developing nations. But an initiative in the Western Cape shows that the challenge of retaining health workers in rural facilities can be overcome. After unsuccessful attempts by Tygerberg Hospital to recruit and retain rural health workers, the hospital decided to open a nursing college in the Boland region, a large farming area nearby. Helise Schumann, who co-ordinates the activities of the college, pointed out that 70% of all nursing staff in the Boland area (about 800 nursing staff) have been trained through the school. The school uses a step-ladder approach by first starting with training the school’s own staff, like cleaners, porters, food services aid and laundry staff, so they could qualify as nursing assistants. Neighbouring facilities, like Worcester and a number of district hospitals, also owe their staffing levels to the nursing college. She says the college follows a strict selection process when recruiting candidates. The nursing college trains up to 100 students per year. It targets unemployed people and school leavers.
8. Public-Private Mix
This study examined peer-reviewed and grey literature on examples of innovation in private sector health care. From 46 studies, 10 case studies were selected spanning different countries and health service delivery models. The cases included social marketing, cross-subsidy, high-volume, low cost models. They tended to have a narrow clinical focus, facilitating standardised care models but allowing experimentation with delivery models. Information on the social impact of these innovations was variable, with more data on availability and affordability and less on quality of care. The study calls for more rigorous evaluations to investigate the impact and quality of private health service innovations and to determine the effectiveness of the strategies used.
9. Resource allocation and health financing
While countries such as the USA, South Africa and China debate health reforms to improve access to care while rationalising costs, Canada’s health care system has emerged as a notable option. According to this article, in the United States (US), meaningful discussion of the advantages and disadvantages of the Canadian system has been thwarted by ideological mudslinging on the part of large insurance companies seeking to preserve their ultra-profitable turf and backed by conservative political forces stirring up old fears of ‘socialised medicine’. These distractions have relegated the possibility of a ‘public option’ to the legislative dustbin, leaving tens of millions of people to face uninsurance, under-insurance, bankruptcy and unnecessary death and suffering, even after passage of the Obama health plan. While South Africa appears to experience similar legislative paralysis, there remains room for reasoned health reform debate to address issues of equity, access, and financing. This article contributes to the debate from a Canadian perspective by setting out the basic principles of Medicare (Canada’s health care system), reviewing its advantages and challenges, clarifying misunderstandings, and exploring its relevance to South Africa. It periodically refers to the US because of the similarities to the South African situation, including its health care system, which mirrors South Africa’s current position if left unchanged. The article concludes that, while Medicare is neither flawless nor a model worthy of wholesale imitation, an open discussion of Canada’s experience should be included in South Africa’s current policy and political efforts.
This paper analysed aid flows for maternal, newborn, and child health for 2007 and 2008 and updated previous estimates for 2003-2006 in the 68 priority countries in the Countdown to 2015 Initiative. The complete aid activities database of the Organisation for Economic Co-operation and Development for 2007 and 2008 was manually coded and analysed with methods that were previously developed to track overseas development assistance (ODA). The researchers analysed the degree to which external funders target their ODA to recipients with the greatest maternal and child health needs and examined trends over the six years. They found that, in 2007 and 2008, US$4.7 billion and $5.4 billion (constant 2008 US$), respectively, were disbursed in support of maternal, newborn, and child health activities in all developing countries, reflecting a 105% increase between 2003 and 2008, but no change relative to overall ODA for health, which also increased by 105%. Targeting of ODA to countries with high rates of maternal and child mortality improved over the 6-year period, although some of these countries persistently received far less ODA per head than did countries with much lower mortality rates and higher income levels. Funding from the GAVI Alliance and the Global Fund to Fight AIDS, Tuberculosis and Malaria exceeded core funding from multilateral institutions, and bilateral funding also increased substantially between 2003 and 2008, especially from the United States and the United Kingdom. The paper welcomes increases in ODA to maternal, newborn, and child health during 2003-2008 and the improved targeting of ODA to countries with greater needs. Nonetheless, these increases do not reflect increased prioritisation relative to other health areas.
Campaigners for increased health financing have welcomed the commitment by African Union member states to direct more resources to health. But the needs of the continent seem to dwarf available budgets. During the 15th Summit of the African Union heads of state in Kampala in July, African leaders committed to mobilise more resources for the health sector in addition to the allocation of 15 percent of national budgets. However, national resources are considered insufficient to meet the demand. Dr Thomas Kibua, director of health policy and systems research at the African Medical and Research Foundation (AMREF), says even if every African states were to increase allocation to the health sector to 15%, none of the three health-related millennium development goals will be achieved. States would have to increase allocation to health care to 45%, he argued, which is untenable for any country.
Despite the strengths of microfinance, this article argues that it has thus far been largely inaccessible to the absolute poorest communities. The poorest communities continue to depend on public spending and external funding, unable to benefit from microcredit or microsavings because of an absolute lack of capital. Microfinance may alleviate some financial burden on the public sector by providing coverage for some of these people, but its ability to provide for extremely poor people remains to be seen. The article calls on international organisations such as the World Health Organization and the World Bank to continue to make microfinance for health a consideration in technical advice given to governments on health-care financing and social protection. They should also fund systematic, evaluative research so that science can back up what seems to be a logical and useful approach to health-care financing for the poor, particularly as it emphasises prevention and health promotion. The large-scale delivery of these tools will depend on repeated local adoption that must grow from communication of demonstrated success and advice on implementation of effective models. The article concludes that we already have enough knowledge to recognise that microfinance is an important tool in protecting health and that what is required now is further action.
Southern African countries have some of the world's worst income distribution, but can often afford social transfers, which have proved an efficient means of reducing the number of poor, according to regional experts. They say that funds can always be found by governments that have the political will to generate and dedicate money to social transfer schemes. Social transfers cover the various forms of social assistance for low-income or no-income individuals and households, and can include child support grants, non-contributory pensions, school feeding schemes, and agricultural or other inputs. In South Africa, social transfers like old-age pensions, and the child support grants introduced in the early 1990s, have managed to improve the lot of at least 47% of people living on less than US$2 a day, according to this article. Six countries in Southern Africa - Botswana, Lesotho, Mauritius, Namibia, South Africa and Swaziland - provide non-contributory social pensions modelled on European social welfare policies. Mozambique, Malawi and Zambia, among others, are experimenting with some cash transfer programmes.
The United States (US) President's Emergency Plan for AIDS Relief (PEPFAR) has boosted its assistance to Uganda's AIDS programme with an emergency supply of antiretroviral (ARV) drugs worth more than US$5.5 million - enough to put an estimated 72,000 HIV-infected people on the treatment over the next two years. But it has also served notice that Uganda must find new sources of funding if its HIV programmes are to be sustainable. The drugs are expected to help bridge the gap in the availability of ARV drugs in Uganda and prevent stock-outs and are included as part of an increase in funding recently announced by PEPFAR, following appeals from Ugandan AIDS activists and health providers struggling to put patients on ARVs. Uganda is the biggest recipient of PEPFAR funds.
10. Equity and HIV/AIDS
The notion that concurrent sexual partnerships are especially common in sub-Saharan Africa and explain the region's high HIV prevalence is accepted by many as conventional wisdom. This paper’s findings contradict that belief. The paper evaluated the quantitative and qualitative evidence offered by the principal proponents of the concurrency hypothesis and analysed the mathematical model they use to establish the plausibility of the hypothesis. It found that research seeking to establish a statistical correlation between concurrency and HIV prevalence either finds no correlation or has important limitations. Furthermore, in order to simulate rapid spread of HIV, mathematical models require unrealistic assumptions about frequency of sexual contact, gender symmetry, levels of concurrency, and per-act transmission rates. The paper considers qualitative evidence offered by proponents of the hypothesis as irrelevant since, among other reasons, there is no comparison of Africa with other regions. It concludes that promoters of the concurrency hypothesis have failed to establish that concurrency is unusually prevalent in Africa or that the kinds of concurrent partnerships found in Africa produce more rapid spread of HIV than other forms of sexual behaviour. Policy makers should turn attention to drivers of African HIV epidemics that are policy sensitive and for which there is substantial epidemiological evidence.
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 sexuallty 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 counseling services, poor levels of security on campus and stigma surrounding the disease.
The objective of this study was to determine the incidence of loss to follow-up in a treatment programme for people living with human immunodeficiency virus (HIV) infection in Kenya and to investigate how loss to follow-up is affected by gender. Between November 2001 and November 2007, 50,275 HIV-positive individuals aged 14 years and older (69% female) were enrolled in the study. An individual was lost to follow-up when absent from the HIV treatment clinic for more than three months if on combination antiretroviral therapy (cART) or for more than six months if not. Overall, 8% of individuals attended no follow-up visits, and 54% of them were lost to follow-up. The overall incidence of loss to follow-up was high, at 25.1 per 100 persons annually. Among the 92% who attended at least one follow-up visit, the incidence of loss to follow-up before and after starting cART was respectively 27.2 and 14.0 per 100 persons annually. Baseline factors associated with loss to follow-up included younger age, a long travel time to the clinic, patient disclosure of positive HIV status, high CD4+ lymphocyte count, advanced-stage HIV disease, and rural clinic location. Men were at an increased risk overall and before and after starting cART. The study concluded that interventions designed separately for men and women could improve retention.
This study examined the utilisation of the prevention of mother to child transmission (PMTCT) services in five reproductive and child health clinics in 2007 and 2008 in Moshi, northern Tanzania, after the implementation of routine counselling and testing and explored the level of knowledge the postnatal mothers had about PMTCT. Researchers interviewed 446 mothers when they brought their four-week-old infants to five reproductive and child health clinics for immunization and conducted thirteen in-depth interviews with mothers and nurses, four focus group discussions with mothers, and four observations of mothers receiving counselling. The study found that nearly all mothers (98%) were offered HIV testing, and all who were offered accepted. However, the counselling was hasty with little time for clarifications. Mothers attending urban antenatal clinics tended to be more knowledgeable about PMTCT than the rural attendees. Compared with previous studies in the area, this study found that PMTCT knowledge had increased and the counsellors had greater confidence in their counselling. The study concludes that when the PMTCT programme has had time to get established, both its acceptance and the understanding of the topics dealt with during the counselling increases.
South Africa is trying to pull off the most extensive global HIV testing campaign but the ambitious initiative is facing some daunting realities. Launched in April 2010, the campaign aims to test 15 million South Africans over 12 months. But five months in, Health Minister Aaron Motsoaledi has admitted the initiative has stalled. The government is preparing to re-launch the campaign and expand its reach to schools and workplaces. With an adult HIV prevalence of about 18%, just over one million South Africans were on antiretroviral (ARV) treatment as of May 2010, according to National Health Council data. If the campaign is successful in diagnosing more people with HIV and referring them to care, an additional 590,000 people could be eligible for treatment by April 2011, according to health department estimates. However, Mark Heywood, vice-chairman of the South African National AIDS Council (SANAC), referred to government statistics that show that between April and July 2010, about 1.7 million people were tested for HIV as part of the campaign, but, of 300,000 people who tested positive, only half were referred to any related health services. A poor referral system may also explain why, despite a surge in the uptake of voluntary counselling and HIV testing, only an additional 3,000 people were put on ARVs in the campaign's first two months.
This paper sought to study the progress and challenges with regard to universal antiretroviral (ARV) access in Free State Province, South Africa. Data from the first four years of the public sector ARV roll-out and selected health system indicators was used. Data was collected from the public sector ARV database in Free State Province for new patients on ARVs, average waiting times and median CD4 counts at the start of treatment. Information on staff training, vacancy rates and funding allocations for the ARV roll-out was obtained from official government reports. Projections were made of expected new ARV enrolments for 2008 and 2009 and compared with goals set by the National Strategic Plan (NSP) to achieve universal access to ARVs by 2011. The researchers found that new ARV enrolments increased annually to 25% of the estimated need by the end of 2007. Average waiting times to enrolment decreased from 5.82 months to 3.24 months. Median CD4 counts at enrolment increased from 89 to 124 cells/mm3. There is a staff vacancy rate of 38% in the ARV programme and an inadequate increase in budget allocations. The paper concludes that current vertical model of ARV therapy delivery is unlikely to raise the number of new enrolments sufficiently to achieve the goals of universal access by 2011 as envisaged by the NSP. The Free State is implementing a project (STRETCH trial) to broaden the ARV roll-out in an attempt to increase access to ARVs.
11. Governance and participation in health
According to this article by the secretary general and policy manager of CIVICUS, too little partnership and too little space for civil society is marring progress on the UN Millennium Development Goals (MDGs). The writers express their utmost concern that there is insufficient political will among governments to acknowledge the role of other stakeholders, including civil society, in charting a course for accelerated action on the Millennium Development Goals (MDGs) between now and 2015 and to work in partnership with them. They refer to the increasing trend to systemically restrict freedoms of expression, association and assembly — freedoms that are key to the work of civil society. Against this background, they argue that it is increasingly clear that civil society organisations – which include non-governmental organisations, social movements, think tanks, faith-based charities and community-based organisations – must play a key role in supplementing the efforts of governments and the private sector in order to make substantial progress towards achieving the MDGs.
This paper explores whether community participation through health committees can advance the right to health, and what constitutes best practice for community participation through South African health committees. The paper reports on a series of 32 indepth interviews with members of three Community Health Committees and health service providers in the Cape Metropolitan area and provides some valuable insight into these areas. The most prominent barriers to participation mentioned by participants, included underrepresentation of vulnerable and marginalised groups, and the absence of a formal mandate giving Health Committees clear objectives and the authority to achieve them. A number of characteristics of Health Committees were identified that promoted more meaningful participation: a facility manager who helps tip the balance of power from health professionals towards the community by sharing decision-making with the Health Committee and by involving the Committee in facility operations; a form of apprenticeship in which newer Health Committee members learn skills and procedures from more experienced members; intersectoral activity through the regular involvement of ward councillors and environmental health officers in Health Committee meetings and activities; a mechanism for the Health Committee to be involved in the reviewing and resolution of patient-based complaints at health facilities; the use of the media and written sources of information by Committees to increase their visibility in the clinic and in the community, disseminate important health-related information, inform the community of Health Committee activities and broaden participation. Achieving small gains appeared to act as positive reinforcement and strengthen the Health Committees to achieve bigger gains.
Social Watch’s report calls for justice of all kinds, including climate justice, financial, fiscal and economic justice, and social and gender justice. The report addresses various thematic issues, and looks at international and national progress made on the Millennium Development Goals (MDGs). It notes with concern that progress on poverty reduction has slowed down since the MDGs were set and notes that social progress does not automatically follows economic growth. It highlights that better (non-monetary) indicators are needed to more accurately monitor the evolution of poverty in the world. The report further calls for a complete transformation of society along the lines of a new logic that prioritises human needs over corporate profits; in other words, it calls for ‘a new social deal.’ Besides, it underlines the need to rethink macroeconomics and recognise the role of women in an extensive care economy; and addresses civil society concerns regarding the fundamental ambiguity surrounding the status of public banks such as the European Investment Bank (EIB). A new approach in the advocacy work of civil society organisations is recommended, called ‘critical shareholding’, which will allow civil society organisations and networks buy shares in companies that have negative social and environmental impacts, after which they can criticise these firms from the inside.
Almost a decade after its inception, the African Peer Review Mechanism (APRM) continues to be the continent’s major governance monitoring mechanism. According to this article, the APRM has raised awareness of governance issues, energised the African continent and taken small but significant steps to remedy big problems. It has brought benefits to those countries that have taken it seriously. Recognising this, it is clear that more countries need to be encouraged to be part of the APRM process, and that countries that have made commitments to improve governance be held accountable for promises and progress. However, there have been challenges. For example, the rate of reviews is relatively slow, with the first country (Ghana) only peer reviewed in January 2006, almost four years after the APRM was established. It has been seven years since the launch of the APRM, and so far only 13 of the 29 acceding member countries have been reviewed. In addition, recommendations in the reviews are not mandatory or enforceable and have generally gone unheeded by African governments. For example, the review for Kenya predicted post-election ethnic-related violence in 2007, yet the Kenyan government took no measures to prevent the violence.
12. Monitoring equity and research policy
The Commission on Social Determinants for Health has recommended assessment of health equity effects of public policy decisions, and this study provides guidance on assessing equity for users and authors of systematic reviews of interventions. Particular challenges occur in seven components of such reviews: developing a logic model; defining disadvantage and for whom interventions are intended; deciding on appropriate study design(s); identifying outcomes of interest; process evaluation and understanding context; analysing and presenting data; and judging applicability of results. The study concludes that greater focus on health equity in systematic reviews may improve their relevance for both clinical practice and public policy making.
This compilation of case studies in research ethics is designed for use by course instructors and workshop leaders. The editors argue that the use of case studies in workshops and formal courses is an especially valuable teaching tool, as students and workshop participants can grapple with ethical dilemmas and uncertainties in concrete situations. The editors have collected 64 case studies, based on episodes that have occurred in global health research throughout the world. Eight chapters comprise the cases un¬der the following titles: Defining research; Issues in study design; Harm and benefit; Voluntary informed consent; Standard of care; Obligations to participants and communities; Privacy and confidential¬ity; and Professional ethics. Each chapter begins with an introduction that outlines the issues and provides some guidance for the topics addressed in the cases, and ends with a brief annotated list of suggested readings. Questions for discussion follow each case. In each chapter there is cross-referencing to cases in other chapters.
No national South African institution provides a coherent suite of support, available skills and training for clinicians wishing to conduct randomised controlled trials (RCTs) in the public sector. This study assesses the need for establishing a national South African Clinical Trials Support Unit. Key informant interviews were conducted with senior decision-makers at institutions with a stake in the South African public sector clinical trials research environment. The study found that trial conduct in South Africa faces many challenges, including lack of dedicated funding, the burden on clinical load, and lengthy approval processes. Strengths include the high burden of disease and the prevalence of treatment-naïve patients. Participants expressed a significant need for a national initiative to support and enhance the conduct of public sector RCTs. Research methods training and statistical support were viewed as key. There was a broad range of views regarding the structure and focus of such an initiative, but there was agreement that the national government should provide specific funding for this purpose. In conclusion, stakeholders generally support the establishment of a national clinical trials support initiative. Consideration must be given to the sustainability of such an initiative, in terms of funding, staffing, expected research outputs and permanence of location.
According to this article, the latest estimates of under-five mortality from the United Nations Inter-agency Group for Child Mortality Estimation (IGME) show a one-third decline at the global level of under-five mortality rates from 89 deaths per 1000 livebirths in 1990 to 60 in 2009. Over the same period, the total number of under-five deaths has decreased from 12.4 million in 1990 to 8.1 million in 2009. The article argues that this constitutes evidence that progress on child mortality is being made across all regions of the world, with many regions having reduced the under-five mortality rate by 50% or more. With only five years left until the 2015 deadline to achieve the Millennium Development Goals (MDGs), progress needs to be accelerated. These IGME estimates are the latest available information on child mortality to provide a basis for assessing progress and reaching consensus for action.
This paper presents the first comprehensive effort to provide an overview of the research associated with the World Health Organization (WHO) headquarters in 2006/07. Information was obtained by questionnaire and interviews with senior staff operating at WHO headquarters in Geneva. The paper found that 45% of WHO permanent staff are involved with health research and the WHO's approach to research is predominantly focused on policy, advocacy, health systems and population based research. The Organization principally undertakes secondary research using published data and commissions others to conduct this work through contracts or research grants. This approach is broadly in line with the stated strategy of the Organization. The researchers note that the difficulty in undertaking this survey highlights the complexity of obtaining an organisation-wide assessment of WHO’s research activity in the absence of common standards for research classification, methods for priority setting and a mechanism across WHO, or within the governance of global health research more generally, for managing a research portfolio. As the rollout of the WHO strategy on research for health proceeds, the researchers expressed hope that similar exercises will be undertaken at the WHO Regional Offices and in support of capacity building of national health research systems within Member States.
13. Useful Resources
This Human Rights Impact Assessment (HRIA) manual aims to systematically identify, predict and respond to projects' potential impacts on human rights. The goal of this methodology is to assist in the creation of valid, useful and ultimately meaningful human rights impact assessments. The process of creating and using HRIA is still in its early phases, the manual observes and their relevance will depend on a continuing improvement of method, capacity and result which can only be accomplished through the sharing of experience and information between companies and assessors. The methodology looks at HRIA assessment sources, goals, and types. It covers basic concepts and looks provides five steps for implementation: gather project contexts and company information; drawing up a preliminary list of impacted rights; drawing up a preliminary list of impacted right holders; special topics; and inquiry guided by topic catalogue. The manual offers recommendations for policies, procedures, structures and action. It also provides an appendix of other tools and selected best practices.
This tool attempts to document the most importance evidence regarding sexual and reproductive health and rights (SRHR) in a way that is useful to organisations with limited time and resources, working in the day-to-day practice of SHRH education for young people. It has been tested in workshops in South Africa and Pakistan partner organisations who implement SRHR/HIV interventions for young people. This tool is for project managers who either design new programmes or who evaluate existing programmes. It focuses on the planning of SRHR/ HIV prevention interventions for young people and consists of 28 indicators for successful/ effective education programmes. The indicators are based on existing theories and evidence and are based on the Intervention Mapping framework. The tool looks at different approaches such as a theory and evidenced approach and a rights-based approach and then outlines six tools to support the following planning and implementation processes: involvement; needs assessment/situation analysis; objectives; evidence-based intervention design; adoption and implementation; and monitoring and evaluation.
The Soul City Institute for Health and Development Communication and the Wits School of Public Health have launched a post-graduate degree programme aimed at developing professionals who will promote and implement social and behaviour change communication in health. The study of Social and Behaviour Change Communication will look at a host of health challenges, including tuberculosis, malaria, chronic and lifestyle diseases. Behaviour change in relation to HIV, for which a vast field of study already exists, will also form part of the curriculum. The division will help students develop skills to apply social and behavioural theory to a range of interventions that include social mobilisation, advocacy, social marketing, edutainment and monitoring and evaluation.
Research Matters has launched a new web resource for knowledge brokers and intermediaries. The forum is a shared space for knowledge brokers and intermediaries, people involved in knowledge translation and peers interested in the role. It is designed as a space where you can: access and share resources on the strategic, practical and technical aspects of knowledge brokering and intermediary work; learn from a global community of peers working involved in knowledge brokering and intermediary work; share experiences on knowledge brokering and intermediary work with others; and obtain advice and peer support on issues and challenges they face. In addition to providing a space for discussions, requesting peer advice and posting knowledge-related blogs, the forum will be hosting regular themed discussions. If you are someone who is interested in knowledge translation and how research evidence can influence decision making, you might be interested in joining the Knowledge Brokers’ Forum at the website address provided.
One World Trust, with support from the International Development and Research Centre (IDRC), has created an interactive, online database of tools to help organisations conducting policy-relevant research to become more accountable. The database provides an inventory of over two hundred tools, standards and processes within a broad, overarching accountability framework. With a dynamic interface and several search functions, it allows users to identify aspects of accountability that interest them, and provides ideas to improve their accountability in this context. Each tool is supported by sources and further reading. The site also encourages engagement with and discussion on the database content, through allowing users to comment on individual tools, or to submit their own tools, processes and standards for inclusion.
14. Jobs and Announcements
The African Women's Development Fund (AWDF) funds local, national, sub-regional, and regional organisations in Africa working towards women’s empowerment. The AWDF is an institutional capacity-building and programme development fund, which aims to help build a culture of learning and partnership within the African women's movement. In addition to awarding grants, the AWDF attempts to strengthen the organisational capacities of its grantees. The AWDF funds work in six thematic areas: women's human rights; political participation; peace building; health, reproductive rights; economic empowerment; and HIV and AIDS. Applicants are expected to build relevant and reasonable running/core costs into their project proposals. Grants are made to national and regional organisations for aspects of organisational growth and development such as strategic planning, developing fundraising strategies, communications systems, retreats, governance systems etc. Grants cover capital costs such as purchase of computers, printers, and photocopiers. The AWDF makes grants in three cycles each year. Applications can be sent in at any time. Organisations can apply for grants ranging from US$1,000 - US$40,000. Grants over US$20,000 are only made to organisations which operate on a regional basis.
The Building and Social Housing Foundation is seeking entries for the World Habitat Awards 2010. Now in their 25th year, the World Habitat Awards seek to identify practical, innovative and sustainable solutions to current housing issues faced by countries of the Global South, as well as the North, which are capable of being transferred or adapted for use elsewhere. The competition is open to all individuals and organisations, including central and local governments, non-governmental organisations, community-based groups, research organisations and the private sector. Each year a panel of international judges assesses the projects entered for the competition and selects two winners. An award of £10,000 is presented to the winners at the annual United Nations global celebration of World Habitat Day. This year’s World Habitat Awards were presented to the Local Housing Movement Programme, from Egypt, and Ekostaden Augustenborg, from Sweden. You can find details of these two winning projects and the competition finalists on the World Habitat Awards website.
Biomed Central is calling for contributions to AIDS Research and Therapy, and the rest of the BioMed Central journal portfolio, which are all covered by an open access license agreement, meaning that anyone with internet access can read, download, redistribute and reuse published articles. In other words, if you publish your next article with AIDS Research and Therapy, you will be able to reach a potentially wider audience than you would by publishing in a subscription journal. Your published article can then be posted on your personal or institutional homepage, e-mailed to friends and colleagues, printed, archived in a collection, distributed on CD-ROM, included in coursepacks, quoted in the press, translated and further distributed as often and widely as possible.
The draft version of UNAIDS’s strategic plan for 2011–2015 is now available for input from interested parties around the world. To add your comment, visit the link given here. The main goals of the plan are to help achieve universal access to HIV prevention, treatment, care and support, halt the spread of HIV and contribute to the achievement of the Millennium Development Goals (MDGs). UNAIDS aims to revolutionise HIV prevention efforts by supporting communities to demand effective prevention approaches and supporting countries to deliver the appropriate combination of biomedical, behavioural and structural approaches. It also aims to support the development of more effective, ethical, affordable and sustainable approaches to treatment including its delivery and to scale up HIV counselling, testing and treatment access and coverage. UNAIDS will intensify its support to governments to realise and protect human rights in the HIV response, promote the enactment and enforcement of supportive laws and the removal of punitive laws, support communities to challenge harmful social and gender norms, address gender-based violence and promote the rights of women and girls for gender equality.
In partnership with Computer Aid International, BioMed Central will be hosting a two-day conference on open access publishing at Kenyatta University in Nairobi, Kenya, from 11-12 November 2010. Open access to the results of scientific and medical research has potential to play an important role in international development, and this conference will discuss the benefits of open access publishing in an African context, from the perspective of both readers seeking access to information, and researchers seeking to globally communicate the results of their work. Attendance at the conference is free and is open to researchers, librarians, vice-chancellors and funders for discussions on access to scientific research. However, space is limited so, to reserve your place, please send an email to the address given here.
Community Toolbox, a global resource of free information on essential skills for building healthy communities is inviting applications for its Out of the Box Prize 2010. The Prize has been established to honour innovative approaches to promoting community health and development worldwide. Non-governmental organisations and other groups working in the areas of community health, education, urban or rural development, poverty, the environment, social justice or other related issues of importance to communities in any part of the world can apply for the Prize. The Prize is looking for innovative and promising approaches implemented in these areas. Innovative approaches may include ‘a unique or effective way of planning or implementing a change effort, creative use of existing community resources, original ways of generating participation and collaboration, implementing a best practice within a new context or group, or other innovative and promising approaches. The grand prize consists of a US$5,000 cash award and a customised WorkStation for your organisation to the value of $2,100.
Registration for the First Global Symposium on Health Systems Research, organised by the World Health Organization (WHO) and partners on ‘Science to Accelerate Universal Health Coverage’ closes on 1 October. Registration can be done at http://www.hsr-symposium.org/index.php/registration. The event will be attended by researchers, policy-makers, funders, and other stakeholders representing diverse constituencies who will to share evidence, identify significant knowledge gaps, and set a research agenda that reflects the needs of low- and middle-income countries. The specific objectives of the symposium are to: share state-of-the art research on universal health coverage; develop a global agenda of priority research on accelerating progress towards universal health coverage; facilitate greater research collaboration and learning communities across disciplines, sectors, initiatives and countries; strengthen the scientific rigour of the field of health systems research including concepts, frameworks, measures and methods; and identify mechanisms for strengthening capacities – individual, institutional and infrastructural – for research on health systems particularly in low- and middle-income countries.
The ninth of a series of seminars of the African Nutrition Leadership Programme (ANLP) will be held in South Africa from 15-25 March 2011. The aim of this programme is to assist the development of future leaders in the field of human nutrition in Africa. Emphasis will be on understanding and developing participants’ qualities and skills as leaders, team building, communication and nutrition information in a broader context, and to understanding the role of nutrition science in the world around us. The programme is designed for individuals who have experience in various fields of nutrition. Preference will be given to candidates with a postgraduate qualification, postdoctoral fellows and candidates with comparable working experience in the broader human nutrition sciences, studying or working in Africa. ANLP is also actively seeking applications from participants who are under the age of 40 years. The maximum number of participants is 30 and the course fee is €1,200.
The Third HIV and AIDS in the Workplace Research Conference, taking place in Johannesburg from 9-11 November, will reflect on the intersection of workplace HIV responses, academic research and surveillance, with a particular focus on strengthening prevention interventions in the fight against HIV and AIDS in Africa, linking prevention research to workplace practice. Prevention will be a key priority focus area, as success in preventing new infections is now widely accepted as the key to ultimately curbing the impact of HIV and AIDS on South Africa and its people. The Conference offers an opportunity for business to step back and reflect on HIV and AIDS programmes, using the lens of research and practice to consider what has worked and what lessons can be extracted. The Conference is also a platform to translate research into meaningful and sustainable responses that can be applied in the workplace.
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