We are living during a time of unprecedented threat and opportunity for the right to health. We are seeing cutbacks in the funding for prevention and treatment of HIV, retreats from commitments to ‘universal access’ to HIV and TB treatment, attacks on human rights and new threats to national and global health, including through climate change and food insecurity. At the same time there are new and better technologies available for health, new medicines and diagnostics for common diseases like tuberculosis, and an array of interventions that could improve health and reduce malnutrition. Some states, particularly South Africa and Brazil, are seriously seeking to improve health on the principle that health is a human right. But it is questionable whether they have the resources to do it. There are examples of growing global co-operation and legal agreement around social challenges, such as climate change, although not yet around the most immediate social challenges that face the poor. Activist movements exist around AIDS, health and around social justice.
The Commission on the Social Determinants of Health pointed to the demand for a response to this moment of contradiction between threat and opportunity from a leadership and governance that is driven by social justice. It stated: “In order to address health inequities, and inequitable conditions of daily living, it is necessary to address inequities – such as those between men and women – in the way society is organized. This requires a strong public sector that is committed, capable, and adequately financed. To achieve that requires more than strengthened government – it requires strengthened governance: legitimacy, space, and support for civil society, for an accountable private sector, and for people across society to agree public interests and reinvest in the value of collective action. In a globalized world, the need for governance dedicated to equity applies equally from the community level to global institutions.”
This is not a new call. It resonates with the recognition of the right to health as a human right found in the 1946 World Health Organisation Constitution, the 1966 International Covenant on Economic Social and Cultural Rights (ICESCR), the 1978 Alma Ata Declaration and the 2000 UN Committee on Economic, Social and Cultural Rights ‘General Comment 14’ on Article 12 of ICESCR. Increasingly it is also reflected in the incorporation of the right to health into the national constitutions of over seventy countries in the last decade.
Nevertheless good health and access to adequate health care services remains out of reach to billions of people. Nearly two billion people (a third of the world’s population) lack access to essential medicines and about 150 million people suffer financial catastrophe annually due to ill health, while the costs of care pushes 100 million below the poverty line.
The world is well aware of these facts. They are published by the WHO and others. When these facts are raised in international forums, it has led states to make bold promises….that they later do not keep. In Africa, 19 of the African countries who signed the 2001 Abuja Declaration to spend 15% of their government budget on health al¬locate less now than they did in 2001. Yet the WHO indicate that low-income countries could raise an additional US$ 15 billion a year for health from domestic sources by increasing health’s share of total government spending to 15%. Neither are high income countries meeting their promises. According to the ‘Africa Progress Report 2010’, published by a unique panel chaired by Kofi Annan, when the $25 billion Gleneagles commitment comes due at the end of 2011, the resources allocated by G8 countries will have fallen short by at least $9.8 billion. The panel calls this a “staggering shortfall.”
Does this mean that the right to health has no value? No. Has the right to health been sufficiently popularised or used? No. Are the state and United Nations institutions who have a duty to protect and realise the right to health fulfilling their obligations? No.
In the last decade AIDS activists have established in practice the principle that states must fund treatment as a right, with the organisation of resources globally to meet this obligation. Currently we are seeing a reversal of this basic entitlement, as the right to these resources are being challenged by arguments over cost effectiveness, a retreat from funding treatment in middle income countries, despite the fact that three quarters of the poorest people in the world live in middle income countries; and a claim that too much money is going to AIDS treatment, despite the fact that an estimated ten million people still need treatment globally. Some states in low income countries claim to have inadequate resources for health even while their political and economic elites grow visibly wealthier, and even states who have met the Abuja commitment try to fairly distribute unfairly inadequate amounts of money for health.
The Commission on the Social Determinants of Health called for conditions that would enable civil society to organize and act in a way that promotes and realises the political and social rights affecting health equity. It seems that we should go further than this, given the reversals in progress and growing inequalities in health. We need to see the level of activism by civil society as a key social determinant of health. The fight for health should be a central pillar of all movements for social justice and equality, not in the abstract, but for the specific goods, institutions, demands and resources that will realise the right to health.
Please send feedback or queries on the issues raised in this briefing to the EQUINET secretariat: admin@equinetafrica.org.This is an edited extract of a speech given at the Southern African Regional Dialogue on Realising the Right to Health in March 2011. For more information on the issues raised in this op-ed and for this and other presentations made at the conference see: www.section27.org.za.
1. Editorial
2. Latest Equinet Updates
On 25-26 March 2011, Section27 convened a meeting of 70 activists and experts from 16 countries, including from EQUINET, mostly from Southern Africa but also from India, Brazil, the United States and Europe. The meeting’s aim was to build a common vision, and if possible programme, for realising the right to health and to discuss how to mobilise and support new campaigns for health at local, national, regional and global levels. A further objective of the consultation was to explore and debate whether, in future, a Framework Convention on Global Health (FCGH) could be an effective international legal instrument for coordination of currently fragmented activities, sustainable and sufficient resource mobilisation and standard-setting to realise the right to health. The conference reinforced the view that there is a need to mobilise people from the grass-roots level to fight for their own rights to health by educating people on and popularising the right to health, and linking community and national movements into a truly global movement of for the right to health. Finally, it confirmed the importance of exploring the idea of a future FCGH as one component of this struggle.
Commissioned by the World Health Organization (Department of Ethics, Equity, Trade and Human Rights - Social Determinants of Health) and the Regional Network for Equity in Health in East and Southern Africa (EQUINET) through REACH Trust and Training and Research Support Centre (TARSC) – 2010. “….Barriers that prevent access to antiretroviral treatment services (ART) are often socially determined. Using the Tanahashi model of health service coverage and by identifying areas of health systems and programs where action needs to be strengthened to improve equity, this publication proposes a set of potential indicators to monitor equity in access to ART. Monitoring equity in access helps decision-makers to reach people frequently excluded from treatment and facilitates efforts to overcome barriers by addressing their social determinants, within and beyond the health system. This jointly prepared publication follows up previous WHO work that explores the barriers and social determinants that impact on specific health conditions presented in the book "Equity, social determinants and public health programmes" (2010). It also builds on over 8 years of policy dialogue and research in east and southern Africa in EQUINET on equity in health, with a particular focus on HIV and AIDS. The rationale, concepts and indicators included in this publication can be further refined and adapted in the future to measure equity in access to health services or to other public health programs (e.g. TB, non-communicable diseases).
A report released by HEPS Uganda and partner organisations in the Uganda Health Equity Network (UHEN) entitled ‘Right to Health: A Civil Society Perspective on the 12th Annual Report of the Uganda Human Rights Commission’, has criticised Uganda Human Rights Commission (UHRC) for taking a narrow approach in reporting on the status of the Right to Health in Uganda. Noting that the report is a key tool and an opportunity to inform Parliament on the state of the Right to Health in Uganda, the civil society organisations are concerned that the Uganda Human Rights Commission’s silence on the key determinants of health and the country’s emerging public health challenges suggests that it is not doing enough to fulfil its mandate of promoting and monitoring human rights in the country. The HEPS/UHEN report, analysing the Commission’s most recent report to Parliament, points out that UHRC’s report inexplicably does not report the impact on health of trade, the proposed health insurance scheme, climate change, urbanisation, environmental degradation and similar socioeconomic determinants of health.
3. Equity in Health
The Commission on Social Determinants of Health (CSDH) framework shows how social, economic and political mechanisms give rise to a set of socioeconomic positions, whereby populations are stratified according to income, education, occupation, gender, race/ethnicity and other factors. These socioeconomic positions in turn shape specific determinants of health status (intermediary determinants) reflective of people’s place within social hierarchies; based on their respective social status, individuals experience differences in exposure and vulnerability to health-compromising conditions. The CSDH framework departs from many previous models by conceptualising the health system itself as a social determinant of health (SDH). The role of the health system becomes particularly relevant through the issue of access, which incorporates differences in exposure and vulnerability, and through intersectoral action led from within the health sector. Arguably the single most significant lesson of the CSDH conceptual framework is that interventions and policies to reduce health inequities must not limit themselves to intermediary determinants, but must include policies specifically crafted to tackle the social mechanisms that systematically produce an inequitable distribution of the determinants of health among population groups. To tackle structural, as well as intermediary, determinants requires intersectoral policy approaches.
The 2000s have seen health stand higher than ever on the international development agenda, and stakeholders increasingly acknowledge the inadequacy of health strategies that fail to address the social roots of illness and well-being. Momentum for action on the social dimensions of health is building. Based on the historical survey, four key issue areas are highlighted here, relevant to work on social determinants of health. The first concerns the scope of change and appropriate policy entry points, and the choice between comprehensive and selective primary health care that confronted public health leaders in the 1980s. The work needs evaluation criteria for identifying appropriate policy entry points for different countries/jurisdictions. Potential resistance to social determinants messages can be anticipated from several constituencies, but there are also exceptional political opportunities, including in the global and national processes connected to the MDGs.
According to this article, Africa faces numerous health challenges on the ground, such as lack of skilled health workers and poor social determinants of health, as well as several challenges originating from the global health arena. In global health, idealists who believe that money and technical assistance must be available in sufficient quantities to meet demand are pitted against policy makers who are working with finite resources and competing priorities. The author identifies lack of co-ordination of policies and programmes in Africa as another major obstacle to achieving universal health coverage. In addition, he argues that global health continues to operate on a financing mechanism that strengthens the hand of donor organisations at the expense of host nations and their priorities. Measuring the impact of global health programmes is technically difficult and a massive data gap exists. The author notes lack of participation by target populations in global health initiatives with regard to conceptualisation and design of projects, and their knowledge, attitudes and perceptions of target populations are also seldom included, especially the voices of poor and underserved communities. In Africa and other parts of the developing world, the author argues that global health is evolving from traditional concerns about the spread of infectious diseases to concerns about human security and dignity.
Africa is confronted by a heavy burden of communicable and non-communicable diseases. Cost-effective interventions that can prevent the disease burden exist but coverage is too low due to health systems weaknesses. This editorial reviews the challenges related to leadership and governance; health workforce; medical products, vaccines and technologies; information; financing; and services delivery. It also provides an overview of the orientations provided by the WHO Regional Committee for Africa for overcoming those challenges. It cautions that it might not be possible to adequately implement those orientations without a concerted fight against corruption, sustained domestic and external investment in social sectors, and enabling macroeconomic and political (i.e. internally secure) environment.
Using South Africa's annual mortality and population estimates data, the authors of this study calculated lung cancer age-standardised mortality rates for the period 1995 to 2006. Lung cancer caused 52,217 deaths during the study period. There were 4,525 deaths for the most recent year (2006), with men accounting for 67% of deaths. For the entire South African population, the age-standardised mortality rate of 24.3 per 100,000 persons in 1995 was similar to the rate of 23.8 per 100,000 persons in 2006. Overall, there was no significant decline in lung cancer mortality in South Africa from 1995 to 2006. In men, there was a statistically non-significant annual decline of 0.21 deaths per 100,000 persons. Despite this promising trend, the authors caution that the increasing rate in women is a public health concern that warrants intervention. Smoking intervention policies and programmes need to be strengthened to further reduce lung cancer mortality in men and to address the increasing rates in women.
In this study, the author reviews a range of health inequalities, across social class, gender, wealth and within and between countries. He tentatively identifies pathways of causality in each case, and makes judgments about whether or not each inequality is unjust. Health inequalities that come from medical innovation are among the most benign, he argues. The author emphasises the importance of early life inequalities, and of trying to moderate the link between parental and child circumstances. He argues that racial inequalities in health are unjust and add to injustices in other domains. The vast inequalities in health between rich and poor countries are neither just nor unjust, nor are they easily addressable. The author concludes that there are grounds to be concerned about the rapid expansion in inequality at the very top of the income distribution: this is not only an injustice in itself, but it poses a risk of spawning other injustices, in education, in health, and in governance.
4. Values, Policies and Rights
While health has always been a part of international relations, the author of this paper argues that it is only in recent years that it has attracted much attention and started the move from an issue of ‘low-politics’ to one of ‘high-politics.’ While the strategies of most governments point to the increasing central role health plays in national strategy, health is still not yet an issue at the heart of government policy. However, research and thinking by groups such as the Chatham House Centre on Global Health and Foreign Policy and the FIOCRUZ Centre for Global Health and International Co-operation can help it became an increasingly important part of it, the author argues. Given increased globalisation and ‘convergence of interest’, there will likely be much more interaction in the future between ministries of health and other ministries, as well as increased priority given to health in foreign policy strategies. The author notes that a call was made in 2009 to the United States (US) President to highlight health as a pillar of US foreign policy, and he predicts that the United States will put more resources into developing a formal foreign relations-based health strategy.
Global health financing has increased dramatically in recent years, indicative of a rise in health as a foreign policy Issue, in the form of global health diplomacy, which informs foreign policy decision-making in the advancement of international co-operation in health. In this paper, the authors review the arguments for health in foreign policy that inform global health diplomacy. These are organised into six policy frames: security, development, global public goods, trade, human rights and ethical/moral reasoning. Each of these frames has implications for how global health as a foreign policy issue is conceptualised. Differing arguments within and between these policy frames, while overlapping, can also be contradictory. This raises an important question about which arguments prevail in actual state decision-making. This question is addressed through an analysis of policy or policy-related documents and academic literature pertinent to each policy framing with some assessment of policy practice. The reference point for this analysis is the explicit goal of improving global health equity. This goal has increasing national traction within national public health discourse and decision-making and, through the Millennium Development Goals and other multilateral reports and declarations, is entering global health policy discussion. Initial findings support conventional international relations theory that most states, even when committed to health as a foreign policy goal, still make decisions primarily on the basis of the ‘high politics’ of national security and economic material interests. Development, human rights and ethical/moral arguments for global health assistance, the traditional ‘low politics’ of foreign policy, are present in discourse but do not appear to dominate practice. While political momentum for health as a foreign policy goal persists, the framing of this goal remains a contested issue. The analysis offered in this article may prove helpful to those engaged in global health diplomacy or in efforts to have global governance across a range of sectoral interests pay more attention to health equity impacts.
In this study, the impact of a government policy change, comprising the provision of rapid diagnostic tests (RDTs) and advice to restrict anti-malarial treatment to RDT-positive individuals, was assessed by describing diagnostic behaviour and treatment decision-making in febrile outpatients <10 years of age in three hospitals in the Kagera and Mwanza Region in northern Tanzania. The researchers found that, prior to policy change, there was no evident association between the actual level of transmission intensity and drug-prescribing behaviour. After policy change, there was a substantial decrease in anti-malarial prescription and an increase in prescription of antibiotics. The proportion of parasite-negative individuals who received anti-malarials decreased from 89.1% to 38.7% in Biharamulo and from 76.9% to 10% in Rubya after policy change. This study shows that an official policy change, where RDTs were provided and healthcare providers were advised to adhere to RDT results in prescribing drugs can be followed by more rational drug-prescribing behaviour. The current findings are promising for improving treatment policy in Tanzanian hospitals.
The UNAIDS Reference Group on HIV and Human Rights has called on UN Member States to reaffirm the focus on human rights that has driven thirty years of progress in the global HIV response. This statement sets out five non-negotiables for Member States as they negotiate the outcome document for the High-Level Meeting between now and June 8. It states that the outcome document should reaffirm the emphasis on a human rights approach that mutually obliges rich and poor nations to fulfil the human right to health and that respects, protects and fulfils the human rights of people living with, affected by and vulnerable to HIV and AIDS, as well as reaffirm Member States’ shared responsibility to realise the human right to health by setting clear targets for funding the HIV response. Governments should also commit to utilising, to the fullest extent possible, flexibilities under the TRIPS agreement to lower the price of essential medicines, as well as remove laws, policies, practices, stigma and discrimination that block effective responses to AIDS. They should reaffirm the centrality of people living with HIV to the response as well as their human rights to non-discrimination, treatment as prevention, and meaningful participation.
A controversial United States-based project that pays drug users and alcoholics to undergo sterilisation or long-term contraception, is alleged in this article to be setting its sights on women living with HIV in South Africa. The Founder of Project Prevention is reported to have confirmed that they were making plans to offer similar services to women living with HIV in South Africa as well as drug users, in co-operation with local non-governmental organisations. However a government official in the Maternal, Child and Women’s Health in the Department of Health is reported to have said they would approach the Human Rights Commission if the project started operating in South Africa, and that doctors found involved in such medical interventions could be reported to the Health Professions Council of South Africa.
5. Health equity in economic and trade policies
In this report, the author found that proprietary rights on “influenza genetic sequences and the proteins they encode, used in vaccines,” get in the way of developing countries’ access to medicines. The study shows a sharp rise in patent applications in this area since 2006, shortly after the outbreak of H5N1 in late 2005. The study lists a series of examples of patent applications, such as Baxter International, for the production of influenza vaccines, published in July 2010. This patent application includes animal and human H5N1 types from China, Vietnam, Indonesia, Thailand, Cambodia, Turkey, and Singapore. According to the author, developing countries “collect and share influenza viruses with WHO’s Global Influenza Surveillance Network with the understanding that those viruses are to be used for public health.” However, proprietary claims can prevent access to technology and products produced with a given technology, he said.
The report notes that poor-quality, or "substandard", medicines threaten patients and public health in developing countries. Prioritisation of medicines regulation by developing-country governments, with the technical and financial support of rich countries, is badly needed. Yet under the guise of helping to address dangerous and ineffective medicines, rich countries are pushing for new intellectual-property rules and reliance on police - rather than health regulatory - action. This approach will not ensure that medicines consistently meet quality standards. Worse, new intellectual property rules can undermine access to affordable generic medicines and damage public health. Developing countries must improve medicines regulation - not expand intellectual-property enforcement - in order to ensure medicine quality.
The United Nations has been enjoined in a court case in Kenya case challenging a potential threat to supply of generic drugs for HIV and AIDS. It claimed enforcement of the Anti-Counterfeit Act 2008 would endanger the lives of people infected. The High Court in Nairobi heard those affected would not access affordable and essential drugs. The UN Special Rapporteur indicated his wish to intervene as an interested party to support the constitutional principles of access to essential medicines, according to advocate Ombati Omwanza. Justice Daniel Musinga allowed Anand Grover to represent the UN in the suit. The court allowed importation of generic anti-retrovirals, pending the hearing and determination of this case. The interim order issued in April 2010 was aimed at saving the lives of those living with the virus. The judge’s interim order stopped the implementation of three sections of the new Anti-Counterfeit Act.
This review by the Chinese ambassador to Botswana marks the 35th anniversary of the establishment of diplomatic relations between the China and Botswana. According to the ambassador, trade and technical co-operation serve as the driving force behind bilateral relations between the two countries, as China considers mutually beneficial co-operation as more important and useful than unilateral assistance. The Chinese government has also undertaken technical exchanges and transfers with Botswana, notably in agriculture and health. From the 1970s to 1980s, China helped train a group of agriculture technical personnel from Botswana and sent experts to conduct local land survey and planning projects. Three Chinese senior agricultural experts are now helping Botswana in agricultural policy making and improving farming technology. In health and medicine, China has sent medical teams to Botswana since 1980, like the Twelfth Team, comprising 40 medical staff and six support staff, who provide medical services in public hospitals in Gaborone and Francistown. In the review, the ambassador acknowledges that his country aims to further scale up human resources development as an important component of bilateral relations. Since 1999 almost 300 Botswana officials and technicians have attended seminars, workshops and short-term training programmes in China – covering areas of administrative management, commerce, information etc – and the number is set to increase.
The Graduate Institute’s Global Health Programme, in cooperation with the University of Ottawa, held a public seminar at the Institute in April 2011 to discuss the threat that fake and substandard medicines pose to public health and the potential role of the World Health Organisation (WHO) in resolving this daunting health challenge. A major theme running throughout the seminar was the need to redress the critical imbalance in the provision of international legal tools to tackle the illicit trade and criminal production of fake medicines. A complete legal system would address both the positive challenge, to promote greater access to safe, WHO-qualified treatments, as well as the negative challenge, to stop criminal activity and bogus treatments that are intentionally fraudulent, illicitly traded and sold. Currently, the global system lacks balance, with most legal tools addressing the issue of counterfeit medicines. In other words, the international system is currently more prepared to tackle this issue as a violation of intellectual property rights rather than as a significant danger to public health.
One of the action plans emerging from the Forum on China-Africa Co-operation – the main platform for Chinese-African relations – is the Sharm El Sheikh Action Plan, in which the Chinese government committed itself over the period 2010-2012 to, among other things, send 50 agricultural technology teams to Africa and help train 2,000 African agricultural technicians, build and implement 20 agricultural technology demonstration centres in Africa, and implement 100 joint research and demonstration projects to aid science and technology transfer. The government has also committed to contribute medical equipment and malaria-fighting materials worth 500 million yuan (US$76.35 million) to 30 hospitals and 30 malaria prevention and treatment centres built by China for Africa in the three-year period. China will invite African professionals working in the field of malaria to attend training programmes in China in an effort to ensure sustainable development of the project. The country will also help relevant African countries train a total of 3,000 doctors, nurses and administrative personnel. Africa and China pledged to scale up joint efforts to prevent and treat major communicable diseases like HIV, malaria, tuberculosis, avian influenza and influenza A (H1N1). The two sides will continue to enhance co-operation in setting up mechanisms to handle public health emergencies.
In this essay, the author considers the impact of the India-Brazil-SouthAfrica (IBSA) and the Brazil-Russia-India-China (BRIC) summits on South-South co-operation and development. In terms of the health sector, the author argues that IBSA and BRIC offer synergies among the countries in the alliances. As regards HIV/AIDS, for instance, the interests of the three countries are quite convergent. India has the second largest number of HIV-positive people (2.4 million) and also the largest generic drugs industry. Brazil has developed role-model public policies in fighting AIDS and exports its know-how to several African, Asian and Latin American countries. South Africa has a high demand in this regard, since it has the largest number of HIV-positive people (5.7 million) and faces severe constraints in democratising public health services regarding the epidemic. In recent years the IBSA countries have been prominent in the G-21 lobby that succeeded in lessening the negative effects of the Trade-Related Aspects Of Intellectual Property Rights agreement (TRIPS). Flexibilities in TRIPS permit governments to issue licenses for generic drug production for the domestic market in the interests of public health, without the consent of the patent owner, to help bring down the high costs for patented drugs in developing countries. India is one of the world’s leading producers of generic medicines. While a trilateral trade agreement has been alluded to on numerous occasions, the author alleges it is unlikely to materialise between India, Brazil and South Africa, which are technically bound to regional trade blocs.
According to this article, China has become one of Africa's leading trading partners, with trade totaling US$106.8 billion in 2008, up 45 per cent from the previous year. China's increasing demand for raw materials to fuel its domestic growth has resulted in agreements on access to and extraction of minerals and oil from resource-rich African countries. China has also become an emerging player in providing financial assistance for infrastructure development in Africa, helping African countries address their infrastructure needs such as railways, hydropower and roads. China has sought to provide concessional financing for infrastructure and construction projects through its Export-Import Bank, often using Chinese companies to carry out the projects. Since 200, China's foreign policy in the region has been directed through the Forum on China-Africa Co-operation (FOCAC), which is the main vehicle for China's activities in Africa, providing a multilateral platform for dialogue with a view to reaching mutually agreeable goals. A number of action plans have emerged from FOCAC, which outline commitments to Africa by the Chinese government, such as the 2009 Sharm El Sheikh Action Plan, in which the Chinese government commits itself to finance the training of African nurses, as well as contribute to malaria health services by supplying equipment and anti-malaria drugs.
6. Poverty and health
The objectives of this study were to measure inequalities in child mortality, HIV transmission and vaccination coverage within a cohort of infants in South Africa. The researchers observed disparities in the availability of infrastructure between least poor and most poor families, and inequalities in all measured child health outcomes. Overall, 75 (8.5%) infants died between birth and 36 weeks. Infant mortality and HIV transmission was higher among the poorest families within the sample. Immunisation coverage was higher among the least poor. The inequalities were mainly due to the area of residence and socio-economic position. This study provides evidence that socio-economic inequalities are highly prevalent within the relatively poor black population. Poor socio-economic position exposes infants to ill health. In addition, the use of immunisation services was lower in the poor households. These inequalities need to be explicitly addressed in future programme planning to improve child health for all South Africans.
Health aid advocates are gearing up to lobby for more, and better, aid at the Fourth High Level Forum on Aid Effectiveness in Busan, South Korea, in November 2011. And like many others, health aid advocates seem to be missing the bigger picture, according to this paper. While it is vital to improve aid procedures to get more aid flowing for health, this is not the only important issue: continuously overlooked are problems with the whole development model. Part of the problem is an epistemological one involving the discourse about "poverty reduction" that has seemingly supplanted earlier understandings of development. It seems, somehow, short-term "poverty reduction" has become a stand-in for actual long-term development. The author argues that, while aid advocates lobby external funders in one arena, the advocates' own representatives to the IMF executive board push a conservative monetary policy within another arena that exacerbates the ability of the aid recipients to develop. The same goes for the arena of trade policy, where the donor countries give aid with one hand while pushing for rapid and premature trade liberalisation in poor countries with the other.
In this study, researchers examined the use of contraception among women in 13 countries in sub-Saharan Africa with regard to wealth-related inequity. The analysis was conducted with Demographic and Health Survey data from 13 sub-Saharan African countries. The researchers found that the use of contraception has increased substantially between surveys in Ethiopia, Madagascar, Mozambique, Namibia and Zambia but has declined slightly in Kenya, Senegal and Uganda. Wealth-related inequalities in the met need for contraception have decreased in most countries and especially so in Mozambique, but they have increased in Kenya, Uganda and Zambia with regard to spacing births, and in Malawi, Senegal, Uganda, the United Republic of Tanzania and Zambia with regard to limiting childbearing. After adjustment for fertility intention, women in the richest wealth quintile were more likely than those in the poorest quintile to practice long-term contraception.
In a few malaria-endemic countries with high disease prevalence, especially in children, and local cultivation of Artemisia annua, the availability of recommended malaria medicines is scant. New sources of treatment could be used, drawing from traditional medicine, the autrhors of this paper argue. A popular African millet-porridge was prepared by adding dried, sieved leaves ofArtemisia annua. Artemisinin concentrations were detected by high-performance liquid chromatography–mass spectrometry. The artemisinin content of the porridge is stable and the concentration is maintained. The taste of the porridge is palatable. Authors conclude that further research is needed before proposing the millet-porridge artemisinin formulation, but such an affordable therapy could be an option in the near future (also) for children living in poor areas where access to effective antimalarial drugs is precluded.
This study involved 671 children aged 12-59 months living in the Agincourt sub-district, rural South Africa in 2007. Anthropometric measurements were taken and HIV testing with disclosure was done using two rapid tests. Z-scores were generated using WHO 2006 standards as indicators of nutritional status. Prevalence of malnutrition, particularly stunting (18%), was high in the overall sample of children. HIV prevalence in this age group was 4.4%. HIV positive children had significantly poorer nutritional outcomes than their HIV negative counterparts. Besides HIV status, other significant determinants of nutritional outcomes included age of the child, birth weight, maternal age, age of household head, and area of residence. HIV is an independent modifiable risk factor for poor nutritional outcomes and makes a significant contribution to nutritional outcomes at the individual level. Early paediatric HIV testing of exposed or at risk children, followed by appropriate health care for infected children, may improve their nutritional status and survival, the authors conclude.
This study uses updated global poverty estimates to infer that nearly half a billion people escaped extreme poverty in the five years from 2005 to 2010. However the gains have not been equally distributed, globally. Between 2005 and 2015, Asia’s share of global poverty is expected to fall from two-thirds to one-third, while Africa’s share will more than double from 28% to 60%. Although sub-Saharan Africa’s poverty rate had by 2010 fallen to below 50% for the first time and is projected to fall below 40% by 2015, at global level the authors argue that the share of the world’s poor people living in fragile states is rising sharply and will exceed 50% by 2014.
7. Equitable health services
After a national voucher scheme in 2004 provided pregnant women and infants with highly subsidised insecticide-treated nets (ITNs), use among children under five years (U5s) in mainland Tanzania increased from 16% in 2004 to 26.2% in 2007. In 2008, the Ministry of Health and Social Welfare planned a catch-up campaign to rapidly and equitably deliver a free long-lasting insecticidal net (LLIN) to every child under five years in Tanzania. The ITN Cell, a unit within the National Malaria Control Programme (NMCP), coordinated the campaign on behalf of the Ministry of Health and Social Welfare. Nine donors contributed to the national campaign that purchased and distributed 9.0 million LLINs at an average cost of $7.07 per LLIN, including all campaign-associated activities. The campaign covered all eight zones of mainland Tanzania, the first region being covered separately during an integrated measles immunization/malaria LLIN distribution in August 2008, and was implemented one zone at a time from March 2009 until May 2010. ITN ownership at household level increased from Tanzania's 2008 national average of 45.7% to 63.4%, with significant regional variations. ITN use among U5s increased from 28.8% to 64.1%, a 2.2-fold increase, with increases ranging from 22.1-38.3% percentage points in different regions.
The aim of this study was to synthesise knowledge concerning various models for the integrated delivery of TB/HIV services at health facility level in low- and middle-income countries. The authors conducted a systematic review of literature, selecting 63 papers and 70 abstracts for inclusion, which described 136 examples of models of integration. Strengths and weaknesses of different models of integration are identified. Models based on referral only are easiest to implement, requiring as little as additional staff training and supervision, if a functional referral system exists, but optimal communication is necessary. Models with closer integration are more efficient but require more staff training and may also require additional infrastructure, e.g. private space for HIV counselling. The authors conclude that their comparison of different models of integration of tuberculosis and HIV services was undermined by a lack of rigorous studies. More research is needed to investigate potential efficiencies of integrated care from the perspective of both provider and service user.
The objective of this study was to establish the feasibility and reliability of a questionnaire for healthcare service satisfaction and a questionnaire for satisfaction with information received about TB medicines among adult TB patients attending public and private programme clinics in Kampala, Uganda. Researchers recruited 133 patients of known HIV status and confirmed pulmonary TB who were receiving care at public and private hospitals in Kampala, Uganda. A translated and standardised 13-item patient healthcare service satisfaction questionnaire (PS-13) and the Satisfaction with Information about Medicines Scale (SIMS) tool were administered by trained interviewers. Of the 133 participants, 35% were starting, 33% had completed two months, and 32% had completed eight months of TB therapy. The male to female and public to private hospital ratios in the study population were 1:1. The PS-13 and the SIMS tools were highly acceptable and easily administered. Patients that were enrolled at the public hospital had relatively lower PS-13 satisfaction scores for technical quality of care and responsiveness to patient preferences when compared to patients that were enrolled at the private hospital. The authors conclude that their study provides preliminary evidence that the PS-13 service satisfaction and the SIMS tools are reliable measures of patient satisfaction in TB programmes. Satisfaction score findings suggest differences in patient satisfaction levels between public and private hospitals, as well as between patients starting and those completing TB therapy.
The authors of this study set out to assess the prevalence of cardiovascular (CV) risk factors in Seychelles, a middle-income African country, and compare the cost-effectiveness of single-risk-factor management with management based on total CV risk. CV risk factor prevalence and a CV risk prediction chart for Africa were used to estimate the 10-year risk of suffering a fatal or non-fatal CV event among individuals aged 40–64 years. These figures were used to compare single-risk-factor management with total risk management in terms of the number of people requiring treatment to avert one CV event and the number of events potentially averted over 10 years. With single-risk-factor management, 60% of adults would need to be treated and 157 cardiovascular events per 100,000 population would be averted per year, as opposed to 5% of adults and 92 events with total CV risk management. Management based on high total CV risk optimizes the balance between the number requiring treatment and the number of CV events averted. In conclusion, total CV risk management is much more cost-effective than single-risk-factor management. These findings are relevant for all countries, but especially for those economically and demographically similar to Seychelles.
8. Human Resources
In this article, the authors describe how governance issues have influenced HRH policy development and identify governance strategies that have been used, successfully or not, to improve HRH policy implementation in low- and middle-income countries (LMIC). They performed a descriptive literature review of HRH case studies which describe or evaluate a governance-related intervention at country or district level in LMIC, including a total of 16 case studies. This review shows that the term 'governance' is neither prominent nor frequent in recent HRH literature. It provides initial lessons regarding the influence of governance on HRH policy development and implementation. The review also shows that the evidence base needs to be improved in this field in order to better understand how governance influences HRH policy development and implementation. Tentative lessons are discussed, based on the case studies.
This paper provides a description and analysis of the professional expectations of medical students during the 2007-2008 academic year at the public medical schools of Angola, Guinea-Bissau and Mozambique, and identifies their professional expectations and difficulties relating to their education and professional future. Data were collected through a standardised questionnaire applied to all medical students registered during the 2007-2008 academic year. The authors found that medical education is an important national investment, but the returns obtained are not as efficient as expected. Investments in high-school preparation, tutoring, and infrastructure are likely to have a significant impact on the success rate of medical schools. Special attention should be given to the socialization of students and the role model status of their teachers. In countries with scarce medical resources, the hospital orientation of students' expectations is understandable, although it should be associated with the development of skills to coordinate hospital work with the network of peripheral facilities. Developing a local postgraduate training capacity for doctors might be an important strategy to help retain medical doctors in the home country.
9. Public-Private Mix
In this briefing, the authors consider the responsibilities of pharmaceutical companies for enhancing access to medicines in the context of sexual and reproductive health. They first examine the issue of access to medicine in the context of both HIV/AIDS and the human papilloma virus (HPV), highlighting the intersection with the fundamental rights to sexual and reproductive health. Having provided this context, the authors outline the responsibilities of States to ensure that medicines are available, accessible, culturally acceptable, and of good quality. However, they stress that the pharmaceutical sector has an indispensable role to play in relation to the right to health and access to medicines. The responsibility should be shared between the pharmaceutical industry and global and national governing bodies.
Product development partnerships, non-profit research institutes and private sector groups have come together over the past years to conduct research and development (R&D) in the areas of the development of drugs, vaccines and diagnostics for neglected diseases, including tropical diseases and other major infectious diseases like HIV and AIDS, tuberculosis and malaria. However, arguments have been put forward that their efforts are disjointed and that funding flows inefficiently to individual research projects resulting in insufficient resources, funding volatility, poor resource allocation, and duplicated and unnecessary efforts. In response, several pooled funding mechanisms have been proposed to address what proponents see as the key problem(s) in the current system: the Industry R&D Facilitation Fund (IRFF) originally proposed by the George Institute; the Fund for Research in Neglected Diseases (FRIND) proposed by Novartis; and the Product Development Partnership Financing Facility (PDP-FF) proposed by the International AIDS Vaccine Initiative (IAVI). The goal of this paper is to provide insight into the extent to which these three proposed mechanisms would have a positive effect on accelerating R&D for neglected diseases. It considers how these proposals are likely to perform against two criteria: their capacity to raise additional money for neglected disease R&D and their capacity to improve the efficient allocation of those funds. The authors of the paper use a literature review, interviews with key stakeholders and illustrative modelling to assess the proposals against these two criteria. Most interviewees expressed doubts that common ground could be found with regard to the metrics on resource allocation if the fund were covering a large and diverse part of the R&D space. However, stakeholders overwhelmingly agreed that a pooled fund focused on late stage work only would be a more feasible and useful proposition.
10. Resource allocation and health financing
The International Health Partnership and Related Initiatives (IHP+) was launched in 2007 with a commitment by developing country governments and Development Partners to ‘work effectively together with renewed urgency to build sustainable health systems and improve health outcomes in low and middle-income countries’. This independent review has found that the participating country governments and Development Partners made some progress in improving how effectively they were delivering and using health aid by 2009. These findings are broadly consistent with those from the OECD 2008 Paris Declaration monitoring survey, which is conducted at the national level (i.e. does not capture sectoral performance), and covers a larger number of countries and Development Partners. Ethiopia, Mali and Mozambique have seen the most improvements in Development Partners actions to meet their IHP+ targets. Burundi, Djibouti, DRC, Niger and Nigeria have benefitted less. However, these results might be expected given the length of time since each country joined the IHP+ (Djibouti only signed up to the IHP+ Global Compact in July 2009, Niger and DRC in May 2009) and the relative strength of these countries systems and processes.
This report offers a comprehensive view of trends in public and private financing of development assistance for health (DAH), with preliminary estimates of how the economic downturn is affecting health financing in 2010. The Institute for Health Metrics and Evaluation (IHME) notes that the global economic recession appears to be contributing to a slowing of the rate of growth in DAH. Estimates show continued growth through 2010 to a total of $26.87 billion by year’s end, but the rate of growth was cut by more than half from an annual average of 13% between 2004 and 2008 to 6% annually between 2008 and 2010. Spending on HIV and AIDS programmes continued to rise at a strong rate, making HIV and AIDS the most funded of all health focus areas. Maternal, newborn and child health received about half as much funding as HIV and AIDS in 2008. Tuberculosis funding grew steadily from 1990 through 2008. Malaria funding rose more dramatically than any other health focus area between 2007 and 2008. Despite much discussion about the need for general health sector support, funding for that area has grown slowly since 2006, according to the report. Non-communicable diseases receive the least amount of funding compared with other health focus areas. Uncertainty about the future of DAH underscores the importance of tracking global health spending to ensure resources are directed as efficiently as possible to the world’s most pressing health needs.
In this study, the authors cross-validated the global cost of scaling up child survival interventions to achieve the fourth Millennium Development Goal (MDG4) as estimated by the World Health Organization (WHO) in 2007 by using the latest country-provided data and new assumptions. Twenty-six countries were included. The authors fund that country-level validation caused a 53% increase in original cost estimates (i.e. 9 billion 2004 United States dollars [US$]) for 26 countries owing to revised system and programme assumptions, especially surrounding community health worker costs. The additional effect of updated population figures was small; updated epidemiologic figures increased costs by US$ 4 billion (+15%). New unit prices in the 26 countries that provided data increased estimates by US$ 4.3 billion (+16%). Extrapolation to 75 countries increased the original price estimate by US$ 33 billion (+80%) for 2010–2015. In conclusion, country-level validation had a significant effect on the cost estimate. Price adaptations and programme-related assumptions contributed substantially. An additional 74 billion US$ 2005 (representing a 12% increase in total health expenditure) would be needed between 2010 and 2015. Given resource constraints, countries will need to prioritise health activities within their national resource envelope.
According to this article, the Forum on China-Africa Co-operation is the main mechanism whereby China’s Ministry of Foreign Affairs and its Ministry of Commerce are starting to align their respective responsibilities toward more effective co-ordination and implementation of a Chinese foreign policy and aid policy toward Africa. Figures on China’s aid disbursements to Africa remain vague, the authors note, in absence of a central Chinese aid agency to monitor funding flows to the continent. Part of China’s strategic industrial plan for Africa is to establish five preferential trade and industrial zones for Chinese business entry in Africa: Zambia, Mauritius, Egypt, Nigeria and possibly Tanzania. In 2007, The Chinese Development Bank was designated to manage the US$5 billion China-Africa Development Fund, but the authors cautions that, even though it is termed a ‘development fund’, it has been actually put in place to finance the market entry of Chinese firms into the African economy. In conclusion, the authors provide recommendations to relevant stakeholders that are engaged in the aid process. Recommendations for African countries include developing a better understanding of the Chinese approach to aid; facilitating regional co-ordination; avoiding poor co-ordination which may lead to Chinese aid fatigue; avoiding the division between traditional and emerging donors; strengthening the African voice; improving the reporting mechanisms within recipient countries; and improving debt reporting.
In this article, the author argues that, despite increased global funding for health, this money is paying for largely unco-ordinated health programmes and directed mostly at specific high-profile diseases, rather than at public health in general, which not only means that current efforts could fall short of expectations but could actually make things worse on the ground. Some stakeholders see stopping the spread of HIV, tuberculosis, malaria, avian influenza and other major killers as a moral duty, while some see it as a form of public diplomacy and others see it as an investment in self-protection, given that microbes know no borders. There is currently no systemic approach that is designed to match essential health needs with the resources that are actually available. The author calls for a strategic framework that could guide both financial contributions and actions, with external funders focusing on how to build up the capabilities in poor countries in order to eventually transfer operations to local control: in other words, to develop exit strategies so as to avoid either abrupt abandonment of worthwhile programmes or perpetual hemorrhaging of foreign aid. They must help build effective local health infrastructures, as well as local industries, franchises and other profit centres, that can be sustained and thrive from increased health-related spending.
The Ugandan Health Ministry has cut its budget to refund about Shs2 billion on behalf of individuals who stole Global Fund money for immunisation of children and financing the health facilities in the country. The directive followed failure by the government to recover the billions stolen from the Global Alliance for Vaccine and Immunisation (GAVI) from the suspects. About Shs1.6 billion was misappropriated in 2006. However, the amount rose to about Shs2 billion due to the exchange rate. But Ministry of Health officials told the Auditor General in his latest report that they acted on cabinet instructions. Mr Samuel Ssenyonga, the Permanent Secretary in the ministry, said that paying back the stolen funds from the public kitty was meant to allow for more funding from GAVI to be released to the country and more time for government to run after the suspects. He also stated that efforts were being made to get those implicated to refund the cash.
11. Equity and HIV/AIDS
Since 2000, access to antiretroviral drugs to treat HIV infection has dramatically increased to reach more than five million people in developing countries. Essential to this achievement was the dramatic reduction in antiretroviral prices, the authors of this paper argue, which was a result of global political mobilisation that cleared the way for competitive production of generic versions of widely patented medicines. Despite these promising changes, a "treatment timebomb" awaits, the authors warn. First, increasing numbers of people need access to newer antiretrovirals, but treatment costs are rising since new ARVs are likely to be more widely patented in developing countries. Second, policy space to produce or import generic versions of patented medicines is shrinking in some developing countries. Third, funding for medicines is falling far short of needs. Expanded use of the existing flexibilities in patent law and new models to address the second wave of the access to medicines crisis are required. One promising new mechanism is the UNITAID-supported Medicines Patent Pool, which seeks to facilitate access to patents to enable competitive generic medicines production and the development of improved products. Such innovative approaches are possible today due to the previous decade of AIDS activism. However, the Pool is just one of a broad set of policies needed to ensure access to medicines for all; other key measures include sufficient and reliable financing, research and development of new products targeted for use in resource-poor settings, and use of patent law flexibilities. Governments must live up to their obligations to protect access to medicines as a fundamental component of the human right to health.
The objective of this paper was to quantify the deaths from human immunodeficiency virus (HIV) infection or acquired immunodeficiency syndrome (AIDS) that are misattributed to other causes in South Africa’s death registration data and to adjust for this bias. Differences between global and South African relative death rates were used to identify the causes to which deaths from HIV and AIDS were misattributed in South Africa and quantify the HIV and AIDS deaths misattributed to each. These deaths were then reattributed to AIDS. In South Africa, deaths from HIV and AIDS are often misclassified as being caused by 14 other conditions. Whereas in 1996–2006 deaths attributed to HIV and AIDS accounted for 2.0–2.5% of all registered deaths in South Africa, the analysis shows that the true cause-specific mortality fraction rose from 19% to 48% over that period. More than 90% of HIV and AIDS deaths were found to have been misattributed to other causes during 1996–2006. In conclusion, adjusting for cause of death misclassification, a simple procedure that can be carried out in any country, can improve death registration data and provide empirical estimates of HIV and AIDS deaths that may be useful in assessing estimates from demographic models.
This study found that farm workers in South Africa's Limpopo and Mpumalanga provinces have the highest HIV prevalence among any working population in Southern Africa. Conducted from March to May 2010 on 23 commercial farms, the survey included 2,810 farm workers, who anonymously gave blood specimens for HIV testing. The survey found that an average of 39.5% of farm workers who tested were HIV positive, which is more than twice the UNAIDS estimated national prevalence for South Africa of 18.1%. HIV prevalence was significantly higher among female employees, with almost half of the women (46.7%) testing positive compared to just under a third (30.9%) of the male workforce. The study could not pin-point a single factor causing this high rate of HIV infection on these farms, but cites a combination of factors such as multiple and concurrent partnerships, transactional sex, irregular condom use, presence of sexually transmitted infections (STIs) and tuberculosis, and high levels of sexual violence. The authors of the study note that a major research gap exists with regard to HIV among farm workers in southern Africa and they call for more research. The report makes several recommendations including increasing farm worker access to healthcare and implementing prevention programmes that are goal driven and monitored. The programmes should address gender norms that increase risky behaviour and vulnerability to HIV, such as the belief that a man has to have multiple partners. Both permanent and seasonal farm workers should be included in workplace health and safety policies.
This report evaluates the work that Medicins sans Frontiers (MSF) has done in HIV and AIDS in Mozambique over the past ten years. MSF’s HIV and AIDS programmes offer HIV testing and counseling, treatment and prevention of opportunistic infections, paediatric diagnosis and treatment, prevention of mother-to-child transmission, and the provision of anti-retroviral therapy. At the end of August 2010, more than 33,000 people in Mozambique were being treated for HIV and AIDS through MSF’s projects. However, the report cautions that MSF’s model of care is not a prescriptive cure, and significant challenges remain. More than 350,000 people in Mozambique are in need of ARV treatment but do not have access to it, which equates to two-thirds of all HIV-positive Mozambicans. After years of political willingness and financial commitment to combat HIV and AIDS, external funders are now either flatlining, reducing or withdrawing their funding for HIV, thus abandoning those who are still in dire need of lifesaving treatment. HIV-infected people continue to face major barriers in their access to services, even in a context of free treatment. A shortage of qualified health workers is also considered a major barrier to access in Mozambique, with only 3 doctors and 143 nurses per 100,000 people, one of the lowest workforce per population ratios in the world.
The author argues in this paper that United States government policy has violated the rights of African people living with HIV and AIDS through its ‘moral’ restrictions prioritising abstinence-only sex education, restricting condom distribution and stigmatising sex workers. The author argues that the focus on technocratic approaches such as biomedical quick fixes, like the recent emphasis on male circumcision, ignores the deeply gendered, racial and sexual dimensions of the disease or its social, economic and cultural pathology in Africa.
12. Governance and participation in health
This article is a review of the January 2011 Executive Board meeting of the World Health Organisation (WHO). The author identifies a new sense of purpose and willingness of member states to address politically complex issues head on and work towards acceptable compromises in the interest of global health. This was exemplified by the negotiation of a proposal from the African group of countries to institute a policy of rotation between geographic regions for the election of future WHO Director-Generals. The issue could have led to political deadlock on the board, the author argues, but it was artfully avoided through a deft show of statesmanship and above all a collective desire to see the board succeed in its work. The African group of countries also called for a greater involvement of developing nations and emerging economies in global health governance. Concrete proposals for how to move forward with a sense of urgency were raised, and Director General Margaret Chan received a clear mandate to develop reform proposals for discussions at the World Health Assembly in May 2011.
In this article, the author briefly examines various definitions of ‘global health diplomacy’ (GHD), reviews possible fundamental principles and discusses unresolved challenges. He argues that fundamental principles of GHD should include: ethical participation and decision making; human rights concerns and enforcements; rule of law and clear process for settling disputes; social determinants of health and how to mitigate their impact; shared bilateral and international interests and priorities; centrality of target populations and sensitivities to local customs, religions and social mores; research as part of efforts to expand the frontiers of the field; training and field experience for all practitioners; an understanding of political, policy making, advocacy and implementation issues in global health; globalisation and international trade issues; integration and mainstreaming of policies and programmes in the relationship between global health, bilateral diplomacy and multilateral development; and public/private/civil society partnerships and alliances. He identifies five challenges for GHD. The first challenge is to further develop the field of GHD as a discipline. The second challenge is how to harmonise the divergent orientation of public health experts, trained diplomats and development experts. Thirdly, stakeholders must ensure that global health diplomacy retains a significant focus on the needs of target populations around the world. Finally, stakeholders must find strategies to maintain the current non-partisan support of policy makers on global health issues over the long term.
The author of this article argues that the emerging global health diplomacy movement points to the need for core capacities in the public health and diplomatic arenas. Among these are an understanding of international relations among public health professionals and greater recognition by diplomats of the population health outcomes of foreign policy. More specifically, the author notes that their training should include perspectives on globalisation, social determinants of health and cultural competence, macro-economics and political negotiation. Communities and citizens are often not considered in the formal policy arena but play an important role in meeting foreign policy goals and in cultivating trust and friendship across national borders, particularly in times of crisis and emergency. Future foreign policy and global health efforts need to ensure dialogue with affected communities and be more intentional in engaging and citizens groups in defining needs and goals. While it is likely that health security will remain a prominent rationale for developed countries to invest in global health initiatives, a the author concludes that more coherent approach to foreign policy and health diplomacy could result in better alignment between the health security goals of developed countries and health equity and development goals of developing countries, while at the same time recognising and channelling the growing financial and technical contributions of private citizens, companies and organisations.
13. Monitoring equity and research policy
Despite substantial investment in health capacity building in developing countries, evaluations of capacity building effectiveness are scarce. By analysing projects in Africa that had successfully built sustainable capacity, the authors of this stuy aimed to identify evidence that could indicate that capacity building was likely to be sustainable. Four projects were selected as case studies using pre-determined criteria, including the achievement of sustainable capacity. The authors found that indicators of sustainable capacity building increased in complexity as projects matured and included: early engagement of stakeholders; improved resources; and funding for core activities secured, with management and decision-making led by Southern partners. Projects became sustainable after a median of 66 months. The authors identified the main challenges to achieving sustainability as high turnover of staff and stakeholders, and difficulties in embedding new activities into existing systems, securing funding and influencing policy development.
According to Mozambique’s scorecard, a national IHP+ Compact was signed in 2008. Prior to that, a SWAp and pooled fund mechanism was in place from 2007. A National Health Sector Plan/Strategy is in place with current targets and budgets that have been jointly assessed. There is currently a costed and evidence based HRH plan in place that is integrated with the national health plan. In 2009 Mozambique allocated 6.8% of its approved annual national budget to health. In 2009, 73% of health sector funding was disbursed against the approved annual budget. In 2009 there was a transparent and monitorable performance assessment framework in place to assess progress against the national development strategies relevant to health and against health sector programmes. Mutual assessments are being made of progress implementing commitments in the health sector, including on aid effectiveness.
In the April 2010 issue of the Bulletin, Date et al. expressed concern over the slow scale-up in low-income settings of two therapies for the prevention of opportunistic infections in people living with the human immunodeficiency virus: co-trimoxazole prophylaxis and isoniazid preventive therapy. In this short paper, the authors discuss the important ways in which policy analysis can be of use in understanding and explaining how and why certain evidence makes its way into policy and practice and what local factors influence this process. Key lessons about policy development are drawn from the research evidence on co-trimoxazole prophylaxis, as such lessons may prove helpful to those who seek to influence the development of national policy on isoniazid preventive therapy and other treatments. Researchers are encouraged to disseminate their findings in a manner that is clear, but they must also pay attention to how structural, institutional and political factors shape policy development and implementation. Doing so will help them to understand and address the concerns raised by Date et al. and other experts. Mainstreaming policy analysis approaches that explain how local factors shape the uptake of research evidence can provide an additional tool for researchers who feel frustrated because their research findings have not made their way into policy and practice.
The Consultative Expert Working Group on Research and Development (CEWG) met from 5-7 April 2011. It was the first meeting of the group, set up at the last WHA, to succeed to a previous group, the Expert Working Group(EWG), whose work was criticised by member states and stakeholders as lacking transparency and being tainted with conflict of interest. The mandate given by the WHA to the CEWG was to take the work of the EWG forward, according to the CEWG Chairperson. The group decided that its core mandate was to help deliver on two elements of the Global Strategy and Plan of Action on Public Health, Innovation and Intellectual Property (GSPOA). These are element 2 on “promoting research and development”, and element 7 on “promoting sustainable financing mechanisms.” The EWG’s work was mainly focused on element 7 of the strategy. Beyond those two core elements, the group also sees its work as an integral part of the global strategy and will take into account the interrelation with other elements of the strategy, such as prioritising research and development needs, building and improving innovative capacity, transfer of technology and application and management of intellectual property to contribute to innovation and promote public health.
14. Useful Resources
The World Health Organisation (WHO), with support from PEPFAR, is leading an initiative on the transformative scale up of health professional education in low and middle-income countries. This process of scaling up health workers is proposing a change from "business-as-usual" in order to ensure that there is not only an increase in the numbers of health workers but in their quality and relevance to the communities they serve. Driven by population health needs, transformative scale-up is a process of education and health systems reform that addresses the quantity, quality and relevance of health care providers in order to increase access to health services and to improve population health outcomes. This cannot be done without the involvement of all relevant stakeholders at the country and regional levels. WHO are therefore inviting participation and call for input on‪ how you can advocate with WHO for scaling up transformative education at the country level, and what WHO can contribute to your efforts at the country, regional and global levels.
The Medicines Patent Pool, an initiative aiming at increasing access to HIV drugs through voluntary licences of patented drugs, has launched a new database of patent information on HIV medicines. The Medicines Patent Pool's patent database provides information on the patent status of selected antiretrovirals in a large number of low- and middle-income countries. It enables users to search by country/region and by medicine to obtain information on the key patents relating to each medicine. Wherever a patent has been applied for or granted in a given jurisdiction, the relevant patent number is also provided if available. The data was obtained from and cross-checked between a variety of sources, including many local patent offices that agreed to make this information available via theWorld Intellectual Property Organization (WIPO). The number of countries included in the database will be expanded periodically as the relevant information is collected by the Medicines Patent Pool.
'Freedom of Information and Women’s Rights in Africa' is a toolkit guide published by the African Women’s Development and Communication Network (FEMNET) with the support of UNESCO. The book provides guidance for women’s organisations in Africa on how to organise around freedom of information. It has compiled five case studies from five African countries, namely, Cameroon, Ghana, Kenya, South Africa and Zambia under different scenarios.
15. Jobs and Announcements
The SANNAM Biennial Conference and Annual General Meeting will take place from 16-18 November 2011 in Gaborone, Botswana. SANNAM is calling for abstracts for the conference, the main theme of which is ‘Engaging Communities for Accelerating the Achievement of the Millennium Development Goals in the SADC Region’. Sub-themes include: health care programmes for addressing the Millennium Development Goals (MDGs); transforming general educational education for MDGs; strengthening educational nursing and midwifery for improvement for MDGs; community participation and MDGs; capacity building, leadership and MDGs; monitoring and evaluation progress for achievement/milestones on MDGs; challenges/factors related to MDGS; enhancing the environment for achieving MDGs; the expansion of nursing services to meet MDGs; collaboration and partnerships for MDGs; and human resources for achieving MDGs.
The theme of the 2011 PHASA conference, which will be held from 28-30 November 2011, in Johannesburg, South Africa, is "Closing the health equity gap: Public health leadership, education and practice”. The theme will enable participants to review the progress that South Africa has made in achieving equity in health status, health care, the social determinants of health and access to resources.
The ACU Titular Fellowships provide opportunities for staff from member universities and employees working in industry, commerce or public service in a Commonwealth country to spend periods of time in other member universities or relevant institutions outside their own country. Preference will be given to workers in the following priority subject areas: agriculture, forestry and food sciences, biotechnology, development strategies, earth and marine sciences, engineering, health and related social sciences, information technology, management for change, professional education and training, social and cultural development and university development and management. Fellowships will be tenable for up to a maximum of six months.
The World Health Organisation (WHO) and Public Library of Science (PloS) are calling for papers for a joint WHO/PLoS collection on the theme of the 2012 World Health Report on Research for Health. This flagship report from WHO will, for the first time in its history, focus on research for better health. The primary target audience of the report will be ministers of health in the WHO member states, and the goal of the report is to provide new ideas, innovative thinking, and pragmatic advice for member states on how to strengthen their own health research systems. In addition to primary research (both quantitative and qualitative) and well-developed case studies, WHO and PLoS also invite the submission of review and policy articles on how national health research systems contribute to the broader international research endeavour, especially in the context of the following areas: global health research governance; inequitable access to the benefits and products of research; global standards for responsible research conduct; and future research trends with implications for the developing world.
The Africa Initiative, a joint partnership between The Centre for International Governance Innovation (CIGI) and Makerere University (MAK), that the research grants competition is now accepting new proposals for funding of up to $15,000 CAD. They would like to invite applicants to submit proposals that are field-based and address substantive-policy relevant challenges facing African policy makers at national, regional, and global levels in one or more of the areas of conflict resolution, energy, food security, health, migration, and the cross-cutting theme of climate change. The Africa Initiative encourages proposals from relevant fields of physical sciences and social sciences. Priority will be given to African-based scholars, and early- to mid-career Canadian-based researchers. Applicants must have a post-graduate degree or be in the advanced stages of a doctoral program.
The Council for the Development of Social Science Research in Africa (CODESRIA) is calling for proposals for its new Multinational Working Group (GMT) on the theme of "Health, Society and Politics: for a equitable health system in Africa”. MWG is an important CODESRIA program that aims at promoting multinational and multidisciplinary reflections on issues affecting the African community of social science researchers. Each MWG will be led by two or three coordinators and will include a maximum of fifteen researchers. Two to three senior researchers will be selected as independent assessors and will also be resource persons during the meetings of each Group. The average length of an MWG is two years during which all phases of the research process should be completed and final results prepared for publication in the CODESRIA Book Series. For more details on the MWGs and on the activities of CODESRIA, visit the Council’s website: www.codesria.org.
This conference will consider the link between and contributions of the social sciences and humanities to HIV research and action. The International Association of HIV Social Scientists, which is organising the event, argues that social science emphasises a critical, reflexive stance and willingness to confront the social, ethical, and political dimensions of scientific investigations of the HIV epidemic, which has made it instrumental in successful HIV prevention efforts such as the normalisation of condom use against sexual transmission and the introduction of safe injecting equipment for injecting drug use. Social scientific research has also provided insights into issues related to the treatment and care of people living with HIV and AIDS, and has addressed the broader social and political barriers to effective responses to HIV. Yet there have been few forums in which scholars from different social science and humanities disciplines can come together to develop connections among the various phenomena we study, and between ourselves and our biomedical, policy and community based colleagues. This conference is a forum for those keen to extend the scope of the social sciences and its capacity to trace connections between all kinds of phenomenon, notably those that contribute to the complexity and changing nature of the epidemic. Themes include: treatment as prevention, HIV and the body, social epidemiology and social networks, global politics, and responsibility and risk governance, as well as new directions for HIV and AIDS treatment.
This symposium will consider infectious diseases in Africa, including bacterial, viral, fungal and parasitic diseases, which comprise a major cause of death, disability, and social and economic disruption for millions of people in Africa’s developing countries. This conference will aim to look at the borderless effect of infection, its impact on children and the importance of intervention. International speakers will talk about how to help prevent the spread of infectious diseases and discuss new diagnostics vaccines and drug treatments.
This first Southern African Network of Nurses and Midwives (SANNAM) biennial conference will present evidence demonstrating how nurses, as key members of the health team, promote and contribute to quality and access to health care. It will also demonstrate the importance of connecting other health workers and the community at large in accelerating the achievement of the Millennium Development Goals (MDGs). The conference will feature plenary sessions, which will set the stage for discussion of critical issues that either facilitate or impede the achievement of the MDGs. Concurrent sessions, symposia, poster presentations, debates and panel discussions will address issues to demonstrate the intricate links between the MDGs SANNAM is calling on all professionals and communities to work collectively at the conference in addressing the links.
Is aid for trade working? This is the question that the Third Global Review of Aid for Trade will seek to address when it convenes in July 2011. The Review will evaluate progress in terms of the Aid-for-Trade Work Programme 2010-2011, which was issued on 27 November 2009. The work Programme’s aim is to keep an on-going focus on aid for trade, which will generate continued impetus to resource mobilisation, mainstreaming, operationalisation and implementation of aid for trade projects. The Work Programme is complemented by Aid-for-Trade meetings, culminating in the Third Global Review of Aid for Trade. The World Trade Organisation is hosting the event.
Pages
Contact EQUINET at admin@equinetafrica.org and visit our website at www.equinetafrica.org
Website: http://www.equinetafrica.org/newsletter
SUBMITTING NEWS: Please send materials for inclusion in the EQUINET NEWS to editor@equinetafrica.org Please forward this to others.
SUBSCRIBE: The Newsletter comes out monthly and is delivered to subscribers by e-mail. Subscription is free. To subscribe, visit http://www.equinetafrica.org or send an email to info@equinetafrica.org
This newsletter is produced under the principles of 'fair use'. We strive to attribute sources by providing direct links to authors and websites. When full text is submitted to us and no website is provided, we make the text available as provided. The views expressed in this newsletter, including the signed editorials, do not necessarily represent those of EQUINET or the institutions in its steering committee. While we make every effort to ensure that all facts and figures quoted by authors are accurate, EQUINET and its steering committee institutions cannot be held responsible for any inaccuracies contained in any articles. Please contact editor@equinetafrica.org immediately regarding any issues arising.