When Indonesia announced in late 2006 that it had stopped sharing H5N1 virus samples with the World Health Organisation (WHO) Global Influenza Surveillance Network (GISN) - the global alert mechanism for the emergence of influenza viruses with pandemic potential - it shone a torch on an area of global inequity. Developing countries had been freely providing samples to the GISN, but were then not able to afford the vaccines that pharmaceutical companies developed and patented using the same samples.
The sharing by countries of influenza virus samples is important for vaccine development, and for understanding how viruses are mutating. Developing countries have thus freely provided samples to the WHO. But when private pharmaceutical companies use the samples to develop and patent vaccines which the same developing countries cannot afford, this is unjust and undermines public health.
Dealing with epidemics like influenza is not simply a concern at national level. The increased movement of people across nations and continents has been accompanied by an increased risk of spread of diseases across borders, such as bird flu, swine flu, SARS and others. Dealing with these pandemics is a matter of global health security that calls for the sharing of technology, information and resources to detect and respond to epidemics, including through vaccines effective for the current virus strain. African countries, often lack the infrastructure, skilled personnel and laboratory facilities needed for detecting and managing epidemics. Africa only has 12 National Influenza Centres sampling people with influenza like illnesses. These NICs submit the virus samples to the global network, and they are used to produce to vaccines that contain the major virus strains predicted for that year. The global network provides the means for countries to share in the benefit of these viruses used for vaccines. But, as the 2006 Indonesia action exposed, the benefit is not shared.
In 2007, the World Health Assembly (WHA) requested the WHO Director-General (DG) to convene an intergovernmental meeting to review how to ensure timely sharing of influenza viruses with pandemic potential and equitable access to the benefits from this. By April 2011 the intergovernmental process had drafted a Framework for this, termed the “Standard Material Transfer Agreement” (SMTA), that has been tabled and agreed to at the just concluded WHA in May 2011. The Framework contains provisions governing the sharing of influenza viruses and the resulting benefits, and obliges the pharmaceutical industry and other entities that benefit from the WHO virus sharing scheme to share benefits. In the SMTA for entities outside the WHO network, the recipient of the virus has to commit to at least two options of benefit sharing, such as donating at least 10% percent of vaccine production to WHO, or reserving treatment courses of needed antiviral medicine for the pandemic at affordable price, or granting royalty-free licences to manufacturers in developing countries.
However the Framework does not make mandatory the commitments to share knowledge and technology with developing countries on vaccine production, and is silent on patent issues and availability of affordable vaccines in countries where there is no manufacturing capacity, as is the case in many African countries. So while the SMTA establishes the principle of equity, it doesn’t fully operationalise it.
There is some guidance in existing international instruments on this issue. The World Trade Organisation (WTO) Trade Related Aspects of Intellectual Property Rights (TRIPs) agreement makes clear, for example, that intellectual property (IP) should not compromise countries’ obligation to protect public health. IP should thus not be used to deny countries affordable and timely access to vaccines. The Convention on Biological Diversity (CBD) and its associated Nagoya protocol affirm that states have sovereign rights over their own biological resources and to the fair and equitable sharing of benefits arising from the use of their genetic resources. The Nagoya protocol goes further to provide more specific information on how this should be achieved through monetary and non monetary benefits. These are not yet provided for in the SMTA and there was some debate on mentioning the protocol in the SMTA. Although there is debate over whether the CBD, which deals with genetic resources that have functional units of heredity, applies to viruses, their intent sends a message on the principle that should guide countries in finalising the SMTA. Whether the Nagoya protocol is named or not, if WHO is a custodian of global health security, it should provide no less protection of benefit sharing than is evident in the CBD, and should further provide for the sort of innovative approaches that facilitate technology and capacity transfer between high and low income countries to operationalise benefits sharing.
When the May 2011 WHA considered the SMTA, it presented an important opportunity to redress an area of global inequity in health. The debate at the World Health Assembly (WHA) had many interventions, some of which wanted substantial changes. For example Australia and several other countries wanted to delete mention of the Nagoya protocol from the resolution, which the committee recommended. Jamaica wanted to add an obligation for WHO to facilitate access to vaccines and antivirals through stockpiling and affordable pricing. Bolivia proposed that patenting of influenza biological material is against public health interests. In general however countries did not change the text to allow the process to move forward, and Bolivia reserved its rights to seek a prohibition of the patenting of influenza biological materials outside WHO GISRS. The major preoccupation was with implementation. Many low and middle income countries (LMIC) were keen to see how the SMTA would be applied, and Kenya and Algeria urged other countries to support capacities and technology transfer for monitoring and dealing with pandemic disease.
The gathering of people from all corners of the world would seem to be a good reminder of ease with which pandemics could spread, although the environment at the WHA may be very different to that of the low income communities who may have least access to the resources to prevent or manage them. An effective response to the potential severity of a global pandemic calls for strong, and where needed, mandatory commitments, plans and actions to share knowledge, technology and know-how, to prevent IP barriers and to operationalise principles of equity in benefits sharing and access, so that the timely delivery of viral samples translates into the timely access to vaccines for those who need them.
Please send feedback or queries on the issues raised in this briefing to the EQUINET secretariat admin@equinetafrica.org. For further information on this issue or the full please visit SEATINI (www.seatini.org) or EQUINET (www.equinetafrica.org).
1. Editorial
2. Latest Equinet Updates
EQUINET is commissioning and calling for applicants to prepare, through desk review of existing data and literature on the east and southern African region, a situation report on gender related dimensions of equity in health, and the policy measures and options for addressing gender inequalities. Specifically the report will provide evidence, data and analysis on priority dimensions of gender equity in health in east and southern Africa within the context of the overall framework of progress markers for equity in health defined by EQUINET. The gender equity analysis will be expected to broadly provide
1. Evidence on and an analysis of trends over the past decade (2001-2011) (drawing on available secondary data) in terms of gender-related inequalities in health (including in access to social determinants of health and health systems) in East and southern Africa, and identify gaps in addressing these inequalities.
2. An overview of key priorities, policy options and specific measures for improving gender equity in health, drawing on evidence from policy analysis and evaluation, analysis of trends related to gender inequalities and case studies
3. A discussion of the implications of (1) and (2) above for the organisation and financing of health systems and the allocation of resources to and within health systems.
Applications should be emailed by 5:00pm June 30 2011 to admin@equinetafrica.org with GENDER EQUITY in the subject line and must include information as in the longer version on the website.
This report presents different experiences of using PAR in health systems from India, East and Southern Africa, Guatemala and Canada. These experiences are used to explore and discuss the learning on methods, on the knowledge generated and the implications for health systems, and what this means for the profile and practice of PAR. The report outlines the presentations and discussions from two sessions on participatory action research convened by the authors at the first Global Symposium on Health Systems Research in Montreux Switzerland, November 16-19 2010.
The training held in Lusaka district Zambia was aimed at building capacities of Health workers and communities jointly to work together to strengthen their interactions through health literacy and participatory approaches. It is anticipated that the training will go a long way in strengthening communication between health workers (employed in the health system in the community or the primary care level services) and community members at primary care level towards specific, measurable improvements of the health system for both with local coordination by Health Literacy facilitators. Specifically the training aimed to: •Introduce the health literacy programme and Participatory Reflection and Action (PRA) approaches to community members and Health Workers in Lusaka District •Provide core skills and information to health literacy facilitators to implement joint action to improve and strengthen Community-Health worker interactions •Reflect on the current facilitators and blocks to communication between health workers and communities, and how to improve this. •Provide training materials and orient facilitators to jointly identify and prioritize health needs and ill health problems, identify actions on shared priorities, identify gaps or barriers to uptake of primary health care (PHC) responses to prioritized problems, and set a shared (HW-Community) action plan. •Orient Facilitators in Lusaka District on administering the baseline and the programme post survey instruments.
3. Equity in Health
Non-communicable diseases (NCD) occur more commonly among people in lower socioeconomic groups. NCDs and poverty are in a vicious cycle, where poverty exposes people to behavioural risk factors for NCDs and, in turn, the resulting NCDs may become an important driver of poverty. Since in poorer countries most health-care costs must be paid by patients out-of-pocket, the cost of health care for NCDs create significant strain on household budgets, particularly for lower-income families. Treatment for diabetes, cancer, cardiovascular diseases and chronic respiratory diseases can be protracted and therefore extremely expensive. Such costs can force families into catastrophic spending and impoverishment. Household spending on NCDs, and on the behavioural risk factors that cause them, translates into less money for necessities such as food and shelter, and for the basic requirement for escaping poverty – education. Each year, an estimated 100 million people are pushed into poverty because they have to pay directly for health services.
Increased control has produced remarkable reductions of malaria in some parts of sub-Saharan Africa, including Rwanda. In the southern highlands, near the district capital of Butare, a combined community- and facility-based survey on Plasmodium infection was conducted early in 2010. In this study, a total of 749 children below five years of age were examined including 545 randomly selected from 24 villages, 103 attending the health centre in charge, and 101 at the referral district hospital. The researchers found that one out of six children under five years of age is infected with malaria. The many asymptomatic infections in the community form a reservoir for transmission of malaria. Risk factors for malaria include low socio-economic status and ineffective self-reported bed net use.
The authors explain how health-care systems are currently facing an increasing burden of chronic disease aggravated by ageing populations, by the continuing risk of infectious diseases and by global pandemics. While the authors welcome the timely present focus on health systems, there are gaps in responding to the burden of chronic disease in developing countries. Discussions to date largely centre on delivering the model of acute-centric care, with some concentration on tackling the weaknesses in the six key components of health systems: service delivery, finance, governance, technologies, workforce, and information; and within the context of universal coverage and equity. Although this approach might be appropriate for acute conditions, and arguably for higher-income countries, the paper argues that it is unaffordable and unsustainable given the increasing burden of chronic disease in low income and middle-income countries. The authors concludes that primary health care approaches might have a better chance of success.
This paper presents a combined historical and contemporary review of the clinical burden of malaria within one of Africa's largest urban settlements, Nairobi, Kenya. The authors conducted a review of historical reported malaria case burdens since 1911 within Nairobi using archived government and city council reports. An audit of 22 randomly selected health facilities within Nairobi was undertaken, including interviews with health workers, and a checklist of commodities and guidelines necessary to diagnose, treat and record malaria. The researchers found that, from the 1930s through to the mid-1960s, malaria incidence declined coincidental with rapid population growth. During this period malaria notification and prevention were a priority for the city council. From 2001-2008 reporting systems for malaria were inadequate to define the extent or distribution of malaria risk within Nairobi. The facilities and health workers included in this study were not universally prepared to treat malaria according to national guidelines or identify foci of risks due to shortages of national first-line drugs, inadequate record keeping and a view among some health workers (17%) that slide negative patients could still have malaria. Combined with historical evidence, there is a strong suggestion that very low risks of locally acquired malaria exist today within Nairobi's city limits and this requires further investigation.
A draft technical background paper for the World Conference on the Social Determinants of Health October 2011 is being circulated for peer review. It covers the five themes of the Conference, selected to highlight key ways of successfully implementing policies on social determinants. These themes are closely inter-related, reflecting the need for action on social determinants to be undertaken across society: governance to tackle the root causes of health inequities by implementing action on social determinants of health; the role of the health sector, including public health programmes, in reducing health inequities; promoting participation by providing community leadership for action on social determinants; global action on social determinants, especially regarding aligning priorities and stakeholders; and monitoring progress in terms of measurement and analysis to inform policies on social determinants.
4. Values, Policies and Rights
This report focuses on the specific needs and challenges of girls and women at risk of, or living with non-communicable diseases (NCDs). The authors contend that NCDs impact on women’s health and development across the lifecycle, causing morbidity and mortality, and compromising their socio-cultural status in communities. In light of this, the authors argue that failure to act now on NCDs will undermine development gains made to date, including progress made on women’s empowerment. They argue that recognition of the importance of women’s contribution to society in their productive and reproductive roles as well as consumers and providers of healthcare will enable real progress in turning back the global epidemic of NCDs. In conclusion, the authors note that there is lack of awareness around this critical issue for women's health and thus call for attention to NCDs as a priority for women’s health and development, policy dialogue on the particular issues related to girls and women and evidence-informed actions by all partners to improve the health and lives of girls and women worldwide.
Ministers of Health and Heads of Delegation of the WHO African Region, having convened at a Regional Consultation on the Prevention and Control of Noncommunicable Diseases (NCDs) in Brazzaville, Congo, from 4-6 April 2011 in preparation for the 28-29 April 2011 Moscow Ministerial Meeting on Healthy Lifestyles and NCDs; and the United Nations High-Level Summit on NCDs, to be held in New York, USA, in September 2011; made this statement on Noncommunicable Diseases prevention and control in Africa.
A coalition of civil society organisations and academics is initiating a Joint Action and Learning Initiative on National and Global Responsibilities for Health (JALI) to research key questions involving health rights and responsibilities, with the goal of securing a global health agreement and supporting social mobilisation around the right to health. A Framework Convention on Global Health would inform post-Millennium Development Goal global health commitments, be grounded in the right to health, help resolve unconscionable global health inequities, and ensure universal health coverage. JALI seeks to clarify the health services to which everyone is entitled under the right to health, the national and global responsibilities for securing this right, and global governance structures that can realise these responsibilities and close major health inequities.
Uganda's Anti-Homosexuality Bill and HIV Prevention and Control Bill are likely to be carried over to the new session of parliament, despite international and local pressure. David Bahati, the Member of Parliament who introduced the Anti-Homosexuality Bill in 2009, said he fully intended to re-introduce the bill into the next session. The new parliament was sworn in on 16 May 2011. Men who have sex with men (MSM) are considered by the Uganda AIDS Commission to be a "most at-risk population", but because homosexual acts are illegal, there are no policies or services targeting HIV interventions towards them. AIDS activists say the bill would only drive an already stigmatised population further underground, leaving them even more vulnerable to HIV. Amid international condemnation in 2010, President Yoweri Museveni said he would not back a bill with either death penalty or "aggravated homosexuality" provisions. Nevertheless, activists say a weaker version of the bill would retain the illegal nature of homosexuality and keep homosexual people in the closet while encouraging dangerous stigma against them in society.
Attempts by the United States to prolong the retention of variola (smallpox) virus stocks have been thwarted at the World Health Assembly (WHA) that met from 16 to 24 May. The WHA instead decided to put aside the US proposal in favour of resuming the discussion at the 67th WHA in 2014. The decision followed contentious discussions on a draft resolution, proposed by the US and several co-sponsors, that would have allowed continued retention of the existing virus stocks, with a report on progress of research only in five years' time (2017), at the 69th WHA. Despite an informal working group meeting to deliberate the issue, there was no consensus and a decision was then made to defer the discussion on the draft resolution. In the final decision adopted on 24 May, the WHA decided to strongly reaffirm the decisions of previous WHA sessions that the remaining stocks of variola virus should be destroyed. It also reaffirmed the need to reach consensus on a proposed new date for the destruction of variola virus stocks when research outcomes critical to an improved public health response to an outbreak so permit. It further decided to include a substantive item "Smallpox eradication: Destruction of variola virus stocks" on the provisional agenda of the 67th WHA session.
5. Health equity in economic and trade policies
The author of this paper argues for public-private partnerships to help deliver locally produced generics in Africa, and against protectionism in favour of open market access. He points to promising developments, such as experienced Indian and Western pharmaceutical firms undertaking original research and development and partnering with firms in African countries. He believes this investment by reputable companies should help ensure quality drugs are produced by furnishing the technical expertise that overcomes capacity constraints. Local production enterprises in Africa will allow international companies to diversify their supply sources, the author argues, guarding against potentially disastrous shocks such as a natural disaster that would destroy an Artemisia crop and send the price of artemisinin-based malaria drugs skyrocketing. Local production partnerships could encourage trade, especially because the bulk active ingredients needed to produce them still come most efficiently from abroad. Partnerships between foreign pharmaceutical firms and African companies may also help train a pool of skilled workers, improving a country’s long-term development prospects.
In this study, the authors argue that an optimal drug registration approach for Africa should reliably evaluate safety, efficacy, and quality of drugs for African use. It should include African expertise, contribute to building African regulatory capacity, and, ultimately, expedite African access by reducing duplicative and sequential reviews by different regulators. However they present an overview of the current situation that shows the present system of drug approval to be far from achieving these goals, with inefficiencies in the use of regulatory resources and in the uptake of capacity-building opportunities for African regulators. As a result regulatory processes and decisions may not meet current needs. The authors recommend that countries institute formal twinned regulatory reviews, fund Centres of Regulatory Excellence in each of Africa’s main regions and conduct a strategic review of WHO drug pre-qualification disease and product priorities.
Despite the successes in using competition law to reduce drug prices in South Africa, the prospects of other countries in the region being able to utilise competition law and policy to attain similar objectives are not high, due to a lack of institutional capacity (in some cases) and a lack of expertise, the authors of this paper argue. By taking an initial focus on domestic legislation, SADC countries may ultimately pave the way for a form of regional harmonisation for competition policy. As developments in South Africa have shown, national competition policy can ensure that national markets function efficiently, assure consumers of competitive prices and product choices, and promote other such efficiency-plus objectives. However, it is true that market developments tend to outstrip policy and regulatory developments. This region demonstrates perhaps one of the most confusing and complex arrays of overlapping membership of regional trade organisations with various countries being members either of SACU, SADC or COMESA. Given the mix of multiple memberships of regional trading organisations in the region, it is suggested that the two most viable (but by no means exclusive) options to explore for a regional competition policy are COMESA and SACU.
This article looks at the main challenges to European Union-Africa relations in light of the EU-Africa summit held in Tripoli, Libya from 29-30 November 2010. The Tripoli meeting marked the third Africa-EU Summit since 2000. In 2007, both parties to the JAES pledged to work together to implement the Africa Health Strategy, the EU Project on Human Resources for Health, the Abuja commitment to dedicate 15% of government financing for health, and the European Programme for Action to Tackle the Shortage of Health Workers in Developing Countries. President Jacob Zuma of South Africa openly expressed his concern that after ten years of the partnership, there was still too little to show in terms of tangible implementation of the undertakings made in previous summits. He cautioned the summit against committing to another action plan when commitments made in the past have not been implemented. The author noted that for example the ongoing Economic Partnership Agreement (EPA) negotiations, have become a contentious issue in EU-Africa relations, with clauses that may negatively impact on the production of affordable generic medicines for developing countries by rigorously protecting patent holders in developed countries.
6. Poverty and health
The number of people requiring humanitarian assistance in the Horn of Africa could increase sharply in coming months due to below-average rainfall and high food and fuel prices, say aid workers. According to the World Food Programme, the Horn of Africa drought, which began with the failure of the short rains in December 2010, is the first since a two-year regional drought in 2007-2009 that saw the number of people needing humanitarian assistance in the region rise to more than 20 million. Conflict over rising food prices could further increase the number of people requiring help. While governments of the affected countries have already started interventions, short- and long-term international assistance is needed to help address critical needs but also underlying structural causes and chronic vulnerabilities. What is needed, according to this article, is a set of interventions which strengthens people's own resilience capacity and coping mechanisms to survive such severe conditions while at the same time responding to their current humanitarian needs and protecting their livelihoods. It is crucial that people can feed themselves through their own means instead of being dependent on food distributions.
The thirteen case studies contained in this publication – including studies from Tanzania and South Africa - were commissioned by the research node of the Knowledge Network on Priority Public Health Conditions (PPHC-KN), a WHO-based interdepartmental working group associated with the WHO Commission on Social Determinants of Health. The publication is a joint product of the Department of Ethics, Equity, Trade and Human Rights (ETH), Special Programme for Research and Training in Tropical Diseases (TDR), Special Programme of Research, Development and Research Training in Human Reproduction (HRP), and Alliance for Health Policy and Systems Research (AHPSR). The case studies describe a wealth of experiences with implementing public health programmes that intend to address social determinants and to have a great impact on health equity. They also document the real-life challenges in implementing such programmes, including the challenges in scaling up, managing policy changes, managing intersectoral processes, adjusting design and ensuring sustainability.
7. Equitable health services
The authors of this study compared medical abortion practised at home and in clinics in terms of effectiveness, safety and acceptability. A systematic search for randomized controlled trials and prospective cohort studies comparing home-based and clinic-based medical abortion was conducted. Nine studies met the inclusion criteria. Complete abortion was achieved by 86–97% of the women who underwent home-based abortion and by 80–99% of those who underwent clinic-based abortion. Pooled analyses from all studies revealed no difference in complete abortion rates between groups. Serious complications from abortion were rare. Women who chose home-based medical abortion were more likely to be satisfied, to choose the method again and to recommend it to a friend than women who opted for medical abortion in a clinic.
In this paper, using in-depth case studies of Ghanaian and Cameroonian responses, the authors discuss the challenge of developing effective primary and secondary prevention to tackle chronic diseases such as stroke, hypertension, diabetes and cancers. They observe fundamental differences between Ghana and Cameroon in terms of "multi-institutional and multi-faceted responses" to chronic diseases. Whereas Ghana does not have a chronic disease policy, the authors note that it has a national health insurance policy that covers drug treatment of some chronic diseases, a culture of patient advocacy for a broad range of chronic conditions and mass media involvement in chronic disease education. On the other hand, the authors note that Cameroon has a policy on diabetes and hypertension as well as established diabetes clinics across the country and provides training to health workers to improve treatment and education despit lack of community and media engagement. In both countries churches provide public education on major chronic diseases, but neither country has conducted systematic evaluation of the impact of interventions on health outcomes and cost-effectiveness. In conclusion, the authors recommend a comprehensive and integrative approach to chronic disease intervention that combines structural, community and individual strategies. To this end, they outline research and practice gaps and best practice models within and outside Africa that can instruct the development of future interventions.
Information and Communication Technology (ICT) solutions (e.g. e-health, telemedicine, e-education) are often viewed as vehicles to bridge the digital divide between rural and urban healthcare centres and to resolve shortcomings in the rural health sector. This study focused on factors perceived to influence the uptake and use of ICTs as e-health solutions in selected rural Eastern Cape healthcare centres, and on structural variables relating to these facilities and processes. Attention was also given to two psychological variables that may underlie an individual’s acceptance and use of ICTs: usefulness and ease of use. It is evident that more effective use of ICTs as part of e-health initiatives at the rural healthcare centres was seen to be distinctly possible, but only if perceived shortcomings with regard to structural variables were addressed. Especially relevant was better access to more e-facilities, more health-related information made available via ICTs, ongoing ICT skills training programs and policies for improved technology maintenance and support. In conclusion, all structural and psychological factors investigated were seen to impinge to some extent on effective use of ICT applications as e-health solutions in the rural healthcare centres involved in the study. Furthermore, there was a distinct interplay between the various variables, with perceived ICT-related shortcomings having a negative impact on perceived usefulness and ease-of-use variables and thus decreasing the likelihood of effective e-health solutions. This means that to increase effective use of ICTs that form part of e-health initiatives in the healthcare centres, a vital first step is to address reported perceived shortcomings.
This study is a review of public health perspectives of preeclampsia in developing countries and implications for health system strengthening. Literature from Pubmed (MEDLINE), AJOL, Google Scholar, and Cochrane database were reviewed. Results showed that the prevalence of preeclampsia in developing countries ranges from 1.8% to 16.7%. Many challenges exist in the prediction, prevention, and management of preeclampsia. Promising prophylactic measures like low-dose aspirin and calcium supplementation need further evidence before recommendation for use in developing countries. Treatment remains prenatal care, timely diagnosis, proper management, and timely delivery. Overcoming the prevailing challenges in the control of preeclampsia in developing countries hinges on the ability of health care systems to identify and manage women at high risk, the authors conclude.
Coverage for the recommended two intermittent preventive treatment during pregnancy (IPTp) IPTp doses is still far below the 80% target in Tanzania. This paper investigates the combined impact of pregnant women's timing of ANC attendance, health workers' IPTp delivery and different delivery schedules of national IPTp guidelines on IPTp coverage. Data on pregnant women's ANC attendance and health workers' IPTp delivery were collected from ANC card records during structured exit interviews with ANC attendees and through semi-structured interviews with health workers in south-eastern Tanzania. Among all women eligible for IPTp, 79% received a first dose of IPTp and 27% were given a second dose. Although pregnant women initiated ANC attendance late, their timing was in line with the national guidelines recommending IPTp delivery between 20-24 weeks and 28-32 weeks of gestation. Only 15% of the women delayed to the extent of being too late to be eligible for a first dose of IPTp. This study suggests that facility and policy factors are greater barriers to IPTp coverage than women's timing of ANC attendance. Simplified IPTp guidelines for front-line health workers as recommended by the World Health Organisation (WHO) could lead to a 20% increase in IPTp coverage. Pregnant women also need to be educated about the risks of malaria during pregnancy and their right to receive health services.
Malaria vector control by indoor residual spraying was reinitiated in 2006 with DDT in Zambezia province, Mozambique. In 2007, these efforts were strengthened by the President's Malaria Initiative. This paper reports on the monitoring and evaluation of this programme as carried out by the Malaria Decision Support Project. Annual cross sectional household parasite surveys were carried out to monitor the impact of the control programme on prevalence of Plasmodium falciparum in children aged 1 to 15 years. In 2006, the sporozoite rate in Anopheles gambiae s.s. was 4% and this reduced to 1% over 4 rounds of spraying. The sporozoite rate for An. funestus was also reduced from 2% to 0 by 2008. Of the 437 Anopheles arabiensis identified, none were infectious. Overall prevalence of P. falciparum in the sentinel sites fell from 60% to 32% between October 2006 and October 2008. In conclusion, it appears that both An. gambiae s.s. and An. funestus were controlled effectively with the DDT-based IRS programme in Zambezia, reducing disease transmission and burden. However, the discovery of pyrethroid resistance in the province and Mozambique's policy change away from DDT to pyrethroids for IRS may threaten the gains made.
According to this article, inequity is built into western health systems, due to the disease focus that they have. Diseases are only a partial picture of peoples health, and low income populations experience multiple diseases. The author argues that the problems that bother and disable people, such as chronic pain, deserve more attention because many of these problems cannot be related to specific diseases. It is thus more useful for health services to focus on population health, and manage the multiple health challenges that people, especially poor people have, rather than tackle single diseases and leave the wider ill health burden unmanaged. The author calls on primary care physicians to take leadership in moving medical care where it needs to be: to the care of patients and populations and not the care of diseases. Primary health care that integrates disease with other aspects of patient health is seen as the way forward.
Surveys of medicine prices and availability, conducted using a standard methodology, have shown that poor medicine availability, particularly in the public sector, is a key barrier to access to medicines. Public sector availability of generic medicines is less than 60% across WHO regions, ranging from 32% in the Eastern Mediterranean Region to 58% in the European Region. Private sector availability of generic medicines is higher that in the public sector in all regions. However, availability is still less than 60% in the Western Pacific, South-East Asia and Africa Regions. Due to low availability of medicines in the public sector, patients are often forced to purchase medicines in the private sector. When originator brands are prescribed and dispensed for products that are also available in generic form, patients are paying four times more, on average, to purchase the brand. High medicine prices increase the cost of treatment. Low public sector availability can be addressed through improved procurement efficiency, and adequate, equitable and sustainable financing. Medicine prices can be reduced by eliminating duties and taxes on medicines and promoting the use of quality-assured generic medicines. Mark-ups can also be regulated to avoid excessive add-on costs in the supply chain. The most appropriate actions to follow depend on a country’s individual survey results and their underlying determinants, as well as local factors including existing pharmaceutical policies and market situations.
Irrational use of medicines is an extremely serious global problem that is wasteful and harmful, according to the authors of this paper. In developing and transitional countries, in primary care less than 40% of patients in the public sector and 30% of patients in the private sector are treated in accordance with standard treatment guidelines. Antibiotics are misused and over-used in all regions. In developing and transitional countries, while only 70% of pneumonia cases receive an appropriate antibiotic, about half of all acute viral upper respiratory tract infection and viral diarrhoea cases receive antibiotics inappropriately. Patient adherence to treatment regimes is about 50% worldwide and lower in developing and transitional countries. Harmful consequences of irrational use of medicines include unnecessary adverse medicines events, rapidly increasing antimicrobial resistance (due to over-use of antibiotics) and the spread of blood-borne infections such as HIV and hepatitis B/C (due to unsterile injections) all of which cause serious morbidity and mortality and cost billions of dollars per year. Effective interventions to improve use of medicines are generally multi-faceted. They include provider and consumer education with supervision, group process strategies (such as peer review and self-monitoring), community case management (where community members are trained to treat childhood illness in their communities and provided with medicines and supervision to do it) and essential medicines programmes with an essential medicine supply element.
Many developing countries stressed the importance of access to medicines and of addressing the social determinants of health in order to prevent and control non-communicable diseases. Interventions also called for more funding and political commitment, better private sector regulation and policy-making free of conflict of interests. Several Member States also supported the inclusion of mental health in the context of NCDs. This was at the 64th World Health Assembly (WHA) meeting in Geneva on 16-24 May, during a discussion on the prevention and control of non-communicable diseases (NCDs) that considered the WHO Secretariat report on the matter and adopted a resolution sponsored by 61 Member States including EU member countries. The article reports on the debates and the resolution.
8. Human Resources
This paper proposes a framework for carrying out a costing analysis of interventions to increase the availability of health workers in rural and remote areas with the aim to help policy decision makers. The authors review the evidence on costing interventions to improve health workforce recruitment and retention in remote and rural areas, provide guidance to undertake a costing evaluation of such interventions and investigates the role and importance of costing to inform the broader assessment of how to improve health workforce planning and management. They show show that while the debate on the effectiveness of policies and strategies to improve health workforce retention is gaining impetus and attention, there is still a significant lack of knowledge and evidence about the associated costs. To address the concerns stemming from this situation, key elements of a framework to undertake a cost analysis are proposed and discussed, which should help policy makers gain insight into the costs of policy interventions, to clearly identify and understand their financing sources and mechanisms, and to ensure their sustainability.
The purpose of this study was to examine the relationship between men who engage in carework and commitment to gender equity. The context of the study was that gender inequitable masculinities create vulnerability for men and women to HIV and other health concerns. A qualitative approach was used. Twenty men from three South African cities who were identified as engaging in carework were interviewed. They were engaged in different forms of carework and their motivations to be involved differed. Some men did carework out of necessity. Poverty, associated with illness in the family and a lack of resources propelled some men into carework. Other men saw carework as part of a commitment to making a better world. 'Care' interpreted as a functional activity was not enough to either create or signify support for gender equity. Only when care had an emotional resonance did it relate to gender equity commitment. Engagement in carework precipitated a process of identity and value transformation in some men suggesting that support for carework still deserves to be a goal of interventions to 'change men'. Changing the gender of carework contributes to a more equitable gender division of labour and challenges gender stereotypes, the authors argue. Interventions that promote caring also advance gender equity.
While Kenyan health workers treating tuberculosis patients are working without masks, government officials say problems with the supply chain and funding shortages are the main reason for the lack of protective gear. Health personnel cannot stop treating or offering services to patients even without these commodities and during that time, they risk getting infected by the very patients they treat. According to Joseph Sitienei, head of the National Leprosy and TB Control Programme, sometimes health facilities delay in requesting these much-needed materials and only do so when they completely run out. However, he pointed to increased funding to the health sector recently, which held promise that the situation would improve. He noted that the government is streamlining procurement and supply of commodities including protective gear to health facilities. In contrast, local NGOs say corruption within the health system is to blame for the haphazard availability of medical supplies, with drugs often 'disappearing' from government health facilities and sold to private pharmacies by government pharmacists.
The authors of this study estimated the shortage of mental health professionals in low- and middle-income countries (LMICs). They used data from the World Health Organisation’s Assessment Instrument for Mental Health Systems (WHO-AIMS) from 58 LMICs, country-specific information on the burden of various mental disorders and a hypothetical core service delivery package to estimate how many psychiatrists, nurses and psychosocial care providers would be needed to provide mental health care to the total population of the countries studied. All low-income countries and 59% of the middle-income countries in the sample were found to have far fewer professionals than they need to deliver a core set of mental health interventions. The 58 LMICs sampled would need to increase their total mental health workforce by 239 000 full-time equivalent professionals to address the current shortage, the authors conclude. Country-specific policies are needed to overcome the large shortage of mental health-care staff and services throughout LMICs.
The purpose of this paper is to provide an 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 to identify their social and geographical origins, 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. Researchers found that most academic performance of students was poor, and related to difficulties in accessing materials, finances and insufficient high school preparation. Approximately 75% want to train as hospital specialists and to follow a hospital-based career. A significant proportion is unsure about their future area of specialisation, which for many students is equated with migration to study abroad. Medical education is an important national investment, but the returns obtained are not as efficient as expected, the authors conclude. 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
This case study describes how a public-private partnership initiated to develop a new anti-malarial combination has evolved over time to address issues posed by its effective deployment in the field. In 2002, the Drugs for Neglected Diseases Initiative (DNDi) created the FACT project to develop two fixed-dose combinations, artesunate-amodiaquine and artesunate-mefloquine, to meet the WHO anti-malarial treatment recommendations and international regulatory agencies approval standards. In co-operation with private drug manufacturers, the partners developed the product and embarked on additional partnerships to ensure the adoption of this new medicine by malaria-endemic countries. The speed at which the drug was adopted in the field is argued to show the power of partnerships that combine different sets of strengths and skills, and that evolve to include additional actors.
This paper reports on the initial phases of the pharmaceutical development of an artesunate-amodiaquine (ASAQ) bilayer co-formulation tablet, undertaken following pre-formulation studies by a network of scientists and industrials from institutions of both industrialised and low income countries. University researchers, private companies specialised in pharmaceutical development and clinical batch manufacturing, as well as the World Health Organisation and Medecins Sans Frontieres collaborated on the project within a larger public-private partnership (the FACT project). The main pharmaceutical goal was to combine in a solid oral form two incompatible active principles while preventing artesunate degradation under tropical conditions. Collaborations between research and industrial groups greatly accelerated the process of development of the bi-layered ASAQ tablet. No intellectual property right was claimed. Lack of public funding was the main obstacle hampering the development process.
10. Resource allocation and health financing
According to this report, coverage of Ghana's National Health Insurance Scheme (NHIS) has been exaggerated and could be as low as 18% - less than a third of the coverage suggested by Ghana’s National Health Insurance Authority and the World Bank. Every Ghanaian citizen pays for the NHIS through VAT, but as many as 82% remain excluded. Twice as many rich people are signed up to the NHIS as poor people. Those excluded from the NHIS still pay user fees in the cash and carry system. Twenty five years after fees for health were introduced by the World Bank, they are still excluding millions of citizens from the health care they need. An estimated 36% of health spending is wasted due to inefficiencies and poor investment. Moving away from a health insurance administration alone could save US$83 million each year, Oxfam argues, which is enough to pay for 23,000 more nurses. Oxfam calls on the Ghanaian government to move fast to implement free health care for all its citizens.
According to the People’s Health Movement (PHM), the World Health Organisation (WHO) is initiating reform process to enable the organisation to more effectively respond to today’s global health challenges and particularly to its financing challenges. The PHM proposes that reforms are needed in five areas to enable the WHO to exert its global health leadership role: Giving real voice to multiple stakeholders; improving its transparency, performance, and accountability; providing closer oversight of regions; exerting its legal authority as a rule-making body; and ensuring predictable, sustained financing. To fulfil its mandate the WHO needs a budget that is adequate, predictable and untied. PHM argues that WHO’s state of financing is untenable; only 18% of WHO’s funding comes from core, assessed contributions. The rest is cobbled together from multiple streams of voluntary donations, grants and in-kind support, much of which is conditional. A high proportion of voluntary contributions by member states undermines the organisation’s independence and results in huge inefficiencies. Increasing dependence on private philanthropies and corporates carries serious risks of further distorting WHO's priorities. PHM calls for the assessed contributions formula for countries to be reviewed and revised to help create fair and adequate system of public financing for the WHO. PHM proposes that member states collectively commit to increasing assessed funding so that it reaches 50% of the overall budget over the next five years and warn against WHO pursuing public-private partnerships without ensuring safeguards against corporate influence over policy making and pernicious conflicts of interest.
Is performance-based financing just a donor fad or a catalyst for wider reform? Looking at the broader evidence, the author offers several arguments against performance-based financing, based on three main issues. First, there is the issue of its effect on worker motivation in the health sector. It is argued that the introduction of financial incentives into a working environment characterised by a high degree of idealism might actually erode workers’ intrinsic motivation. Second, performance-based financing focuses on a certain range of indicators, resulting in the neglect of non-remunerated aspects of work and the focus on remunerated ones. Third, the hidden costs of performance-based financing are not limited to emotional costs (concerning the self-esteem of health workers) and technical costs (due to misdirected focus on indicators). There are considerable costs (both financially and in working hours invested) in establishing a performance-based financing system that continuously monitors the quantity and perceived quality of health-sector performance. The author notes that all these negative side-effects of performance-based financing are consistently depicted in broader reviews as well as in detailed examination of its use in Rwanda.
In their white paper on foreign aid, the Chinese government notes that, currently, the environment for global development is not favourable. With the repercussions of the international financial crisis continuing to linger, global concerns such as climate change, food crisis, energy and resource security, and epidemic of diseases have brought new challenges to developing countries, aggravating the imbalance in the development of the global economy, and widening the gap between North and South, rich and poor. The international community should strengthen co-operation and jointly rise to the challenges facing development, according to the paper. Against this background, China has a long way to go in providing foreign aid. The Chinese government will make efforts to optimise the country's foreign aid structure, improve the quality of foreign aid, further increase recipient countries' capacity in independent development, and improve the pertinence and effectiveness of foreign aid. China further pledges to continue to promote South-South co-operation, gradually increase its foreign aid input on the basis of the continuous development of its economy and promote the realisation of the UN Millennium Development Goals.
11. Equity and HIV/AIDS
Three international organisations have negotiated reductions on key first- and second-line, and paediatric antiretrovirals (ARVs) that will help countries save at least US$600 million over the next three years: the Clinton Health Access Initiative (CHAI), the international drug purchasing facility UNITAID and the UK Department for International Development (DFID). The deal, expected to affect most of the 70 countries comprising CHAI's Procurement Consortium, features notable reductions in the prices of tenofovir (TDF), efavirenz, and the second-line ritonavir-boosted atazanavir (ATV/r) used in HIV patients who have failed initial, or "first-line", regimens. As part of the deal, the three bodies set price ceilings for more than 40 adult and paediatric ARVs with eight pharmaceutical manufacturers and suppliers, which account for most ARVs sold in countries with access to generic drugs. As a result, the cost of ATV/r is down by two-thirds from just three years ago. Meanwhile, a once-a-day fixed-dose combination (FDC) pill containing TDF and efavirenz will now cost countries less than US$159 per patient per year. In 2008, low-income countries paid about $400 per patient per year for the same pill.
The authors of this paper studied how increased access to antiretroviral therapy affects sexual behaviour, using data collected in Mozambique in 2007 and 2008. They surveyed both HIV-positive individuals and households from the general population. The findings support the hypothesis of disinhibition behaviours, where individuals are more likely to engage in risky sexual behaviour when they believe that they will have greater access to better health care, such as antiretroviral therapy. The findings suggest that scaling up access to antiretroviral therapy without prevention programmes may lead to more risky sexual behaviour and ultimately more infections. The authors conclude that with increased antiretroviral availability, prevention programmes need to include educational messages so that individuals know that risky sexual behaviour is dangerous.
According to this paper, a growing number of studies highlight men's social disadvantage in making use of HIV services. Drawing on the perspectives of 53 ARV users and 25 healthcare providers, researchers examined qualitatively how local constructions of masculinity in rural Zimbabwe impact on HIV testing and treatment uptake. They found that informants reported a clear and hegemonic notion of masculinity that required men to be and act in control, to have know-how, be strong, resilient, disease free, highly sexual and economically productive. However, such traits were in direct conflict with the 'good patient' persona who is expected to accept being HIV positive, take instructions from nurses and engage in health-enabling behaviours such as attending regular hospital visits and refraining from alcohol and unprotected extra-marital sex. This conflict between local understandings of manhood and biopolitical representations of 'a good patient' can provide a possible explanation to why so many men do not make use of HIV services in Zimbabwe. The researchers urge HIV service providers to consider the obstacles that prevent many men from accessing their services.
The authors of this study aimed to increase case-finding of infection with human immunodeficiency virus (HIV) in Zambia and their referral to HIV care and treatment by supplementing existing client-initiated voluntary counselling and testing (VCT), the dominant mode of HIV testing in the country. Lay counsellors offered provider-initiated HIV testing and counselling (PITC) to all outpatients who attended primary clinics and did not know their HIV serostatus. After the addition of PITC to VCT, the number tested for HIV infection in the nine clinics was twice the number undergoing VCT alone. Over 30 months, 44,420 patients were counselled under PITC and 31,197 patients, 44% of them men, accepted testing. Of those tested, 21% were HIV+; 38% of these HIV+ patients enrolled in HIV care and treatment. The median time between testing and enrolment was 6 days. The acceptability of testing rose over time. In conclusion, the introduction of routine PITC using lay counsellors into health-care clinics in Lusaka, Zambia, dramatically increased the uptake and acceptability of HIV testing. Moreover, PITC was incorporated rapidly into primary care outpatient departments. Maximizing the number of patients who proceed to HIV care and treatment remains a challenge and warrants further research.
The introduction of the South African government's HIV tests on schoolchildren has been delayed by legal and confidentiality concerns, but officials insist a pilot project will start later in the year. After the national Department of Health announced the planned testing in January 2011, a pilot project to test pupils, voluntarily, was due to start at several schools in February. But it was shelved because crucial ethical and legal questions had not been answered. A team was set up to test the feasibility of the project, but four months later it has still not completed its research and consultations. Most teachers' unions and parents' organisations supported the proposal in principle, saying HIV screening could help curb the spread of HIV and reduce teenage pregnancies. But some expressed misgivings about how it might affect pupils and the learning environment. Parents must consent to tests and counselling must be provided by the schools.
The authors of this study reviewed the cost-effectiveness of interventions to prevent mother-to-child transmission (MTCT) of HIV in low- and middle-income countries (LMICs). They identified 19 articles published in nine journals from 1996 to 2010, 16 concerning sub-Saharan Africa. Collectively, the articles suggest that interventions to prevent paediatric infections are cost-effective in a variety of LMIC settings, as measured against accepted international benchmarks. The authors conclude that interventions to prevent HIV MTCT are compelling on economic grounds in many resource-limited settings and should remain at the forefront of global HIV prevention efforts. Future cost-effectiveness analyses should focus on local assessment of rapidly evolving HIV MTCT options, strategies to improve coverage and reach underserved populations, evaluation of a more comprehensive set of MTCT approaches, and the integration of HIV MTCT and other sexual and reproductive health services.
12. Governance and participation in health
On 8 April 2011 over 400 civil society activists gathered in New York for a one-day hearing with United Nations (UN) Member States on progress toward reaching Universal Access to HIV treatment, prevention, care, and support. This Civil Society Hearing took place as Member States began drafting a new Outcome Document on HIV, to be adopted at a UN High-Level Meeting on AIDS on 8 June 2011. Advocates are calling for a renewed and urgent commitment from member States to reach Universal Access goals by 2015. During the Hearing, civil society advocates stressed that in pursuing Universal Access goals the international community must prioritise public health over politics. They urged Member States to make available to their citizens the full complement of evidence-based HIV prevention, care, treatment, and support technologies and tools as a commitment to the human right to health. They called for the Outcome Document that will emerge from the UN High Level Meeting on HIV AND AIDS to acknowledge global failures to reach Universal Access by 2010, recommit to upholding and implementing priorities in the global AIDS response articulated by key existing global frameworks on HIV, including the UNAIDS 2011-2015 Outcome Strategy, and commit to bold, new targets.
Representatives of organisations working on campaigns for health and social justice, as well as academia, governments and multilateral institutions, gathered in New Delhi from 2-4 May 2011 to address the need for an effective and accountable global governance for health. They believe that WHO needs to rediscover its fundamental multilateral identity. Drawing on its strengths, the organization has to take advantage of its reform process to rethink and reassert itself as the leading actor in a broader governance for health that is coherent with the need for solid public policy responses to the neoliberal prescriptions, so that globalization be shaped around the core values of equality and solidarity. Beyond mere institutional approaches, issues related to public policies in health have to be democratically debated and tackled at the local, national and regional level. This entails the continued participation and meaningful contribution of communities, public opinions, and their direct empowerment through education and knowledge sharing. Health democracy, namely participation, transparency and accountability in health, is a pre-condition for countries to make an impact in the decision making processes at the global level, within WHO and in other multilateral fora.
In this report, the African Power and Politics Programme (APPP) argues that economic growth is slower and more inequitable than it could be, and has not necessarily produced the poverty reduction that might have been hoped for. There is a growing consensus around the world that this is due to failures in governance, to which the APPP adds the hypothesis that the immediate problem is in part due to the application of a ‘good governance agenda’ that is ideological rather than evidence-based. APPP presents four recommendations. First, moving from ‘best practice’ to ‘best fit’ in thinking about institutional development is necessary. Second, a more realistic take on elections and citizen empowerment as means of addressing problems of public goods insufficiency requires us to rely less on the congenial assumption that all good things go together. Third, the leadership factor and the politics thereof are perhaps the biggest influence on the extent to which particular regimes are developmental or not. Fourth, these findings have important implications for aid effectiveness ahead of the Fourth High Level Forum on Aid Effectiveness in Korea later in 2011. Specifically, the concept of country ownership is due to be revamped, and it should be tied explicitly to this leadership question rather than to democracy, parliamentary oversight, or civil society participation.
In this article, the authors describe how governance issues have influenced human resources for health (HRH) policy development and to 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. In total 16 case studies were included in the review and most of the selected studies covered several governance dimensions. The dimension 'performance' covered several elements at the core of governance of HRH, decentralisation being particularly prominent. Although improved equity and/or equality was, in a number of interventions, a goal, inclusiveness in policy development and fairness and transparency in policy implementation did often not seem adequate to guarantee the corresponding desirable health workforce scenario. 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.
In this commentary, the authors offer five proposals for re-establishing WHO’s leadership. First, WHO should give real voice to multiple stakeholders, including philanthropies, businesses, public/private partnerships, and civil society. Second, WHO should improve transparency, performance and accountability, as stakeholders demand clarity on how their resources will achieve improved health outcomes. Also, WHO should exercise closer oversight of regions, and exert legal authority as a rule-making body. Finally, WHO should ensure predicable, sustainable financing, reducing extra-budgetary funding, which now represents almost 80% of the agency's budget. The ideal solution would be for the World Health Assembly (WHA) to set higher member state contributions. Failing decisive WHA action, the WHO should consider charging overheads of 20-30% for voluntary contributions to supplement its core budget.
13. Monitoring equity and research policy
In this study, researchers systematically reviewed the evidence on the impact of interventions for seeking, appraising, and applying evidence from systematic reviews in decision-making by health policymakers or managers. A total of 11,297 titles and abstracts were reviewed leading to retrieval of 37 full-text articles for assessment; four of these articles met all inclusion criteria. Three articles described one study where five systematic reviews were mailed to public health officials and followed up with surveys at three months and two years. The studies found that from 23% to 63% of respondents had used the systematic reviews in policymaking decisions. One trial indicated that tailored messages combined with access to a registry of systematic reviews had a significant effect on policies made in the area of healthy body weight promotion by health departments.
Despite increasing attention and investment for maternal, neonatal, and child health, stillbirths remain invisible - not counted in the Millennium Development Goals, nor tracked by the UN, nor in the Global Burden of Disease metrics. At least 2.65 million stillbirths were estimated worldwide in 2008, of which 98% occured in low-income and middle-income countries. Worldwide, 67% of stillbirths occur in rural families, 55% in rural sub-Saharan Africa and south Asia, where skilled birth attendance and caesarean sections are much lower than that for urban births. National estimates of causes of stillbirths are scarce, and multiple classification systems impede international comparison. Immediate data improvements are feasible through household surveys and facility audit, and improvements in vital registration, including specific perinatal certificates and revised International Classification of Disease codes, are needed, according to the authors of this article.
According to this paper, science is increasingly being applied to systems that are complex, non-linear and dynamic, including questions about climate, environment, society, health and human behaviour, with limited results. At the beginning of the 21st century, policy makers and their expert advisors are working in an environment where the values and outputs of science are questioned by an increasingly informed, involved and vociferous society. Science and technology are now focused on complex systems, in part because it is around such complexity that governments must make decisions. Broadly, improvement in the use of science-based evidence is likely to be gradual and incremental and will require ‘buy-in’ from many stakeholders. The author argues that progress will be dependent on attitudes and approaches taken by agency heads. Other areas may need additional work – for example in establishing across-government principles for protecting the integrity of scientific advice.
14. Useful Resources
This tool is designed to support countries as they design and implement national health sector strategies in compliance with obligations and commitments. The tool focuses on practical options and poses critical questions for policy-makers to identify gaps and opportunities in the review or reform of health sector strategies as well as other sectoral initiatives. It is intended to generate a national multi-stakeholder process and a cross-disciplinary dialogue to address human rights and gender equality in health sector activities, and may be used by various actors involved in health planning and policy making, implementation or monitoring of health sector strategies. The tool provides support, as opposed to a set of detailed guidelines, to assess health sector strategies. It is not a manual on human rights or gender equality, but it does provide users with references to other publications and materials of a more conceptual and normative nature. The tool is intended to operationalise a human rights-based approach and gender mainstreaming through their practical application in policy assessments.
Proposals have recently become more sophisticated, reflecting the increased competitiveness and larger resources existing in the NGO sector. Enormous opportunities existing in the sector have led to the trend of making proposal writing a profession. Proposal writing poses many challenges, especially for small and unskilled NGOs. In this manual, some basic and necessary information required for developing a proposal is discussed.
This Knowledge Translation Toolkit provides a thorough overview of what knowledge translation (KT) is and how to use it most effectively to bridge the “know–do” gap between research, policy, practice, and people. It presents the theories, tools, and strategies required to encourage and enable evidence-informed decision-making. The toolkit builds upon extensive research into the principles and skills of KT: its theory and literature, its evolution, strategies, and challenges. The book covers an array of crucial KT enablers — from context mapping to evaluative thinking — supported by practical examples, implementation guides, and references. Drawing from the experience of specialists in relevant disciplines around the world, the toolkit aims to enhance the capacity and motivation of researchers to use KT and to use it well.
Tips and Tricks East Africa has been divided into five sections based on geographic coverage. The first section is regional and includes European funding programmes managed by the European Commission as well as bilateral programmes from European countries, available for non-profit organisations working in the population and reproductive health sector in the region. In addition, non-European programmes have been included when they are particularly relevant. The remaining sections have been divided by individual country. Organisations are advised to review the information in their country’s section as well as the Regional Section. Section 2 includes funding programmes in Ethiopia, Section 3 in Kenya, Section 4 in Tanzania and Section 5 in Uganda.
This publication aims at providing current, accurate, practical and user-friendly funding information to governmental and non-governmental institutions in Kenya. It includes information on European Union (EU) donor governments’ bilateral and multilateral ODA, priority sectors, relevant activities and cooperation with NGOs. Tips & Tricks seeks to increase transparency of EU and other donors’ resource allocation for sexual and reproductive health and rights, HIV and AIDS and population assistance in Kenya. It lists funding priorities in Kenya of the European Commission, European funders, governmental agencies, international NGO’s and private foundations, so that each applicant and funding agency can clearly see what efforts other agencies are undertaking and direct their own endeavours accordingly.
15. Jobs and Announcements
Authors wishing to report original research, innovative projects or novel programs related to global health are encouraged to submit abstracts. Abstracts in all areas of global health are welcoming including:
•Global burden of disease
•Innovations and interventions to advance global Health equity
•Globalization, global trade and movement of populations as drivers of health inequity
•Partnerships and capacity building for education and research in global health
•Social, economic and environmental determinants of health
•Human rights, legal issues, ethics and policy
Abstracts may focus on a new finding, the development of a program, project or new global health tool, moving from development to implementation, policy or ethical issues, or related topics.
Abstract submission deadline: August 1, 2011
Thirty years into the AIDS epidemic, and ten years since the landmark United Nations (UN) General Assembly Special Session on HIV/AIDS, stakeholders from around the world will come together to review progress and chart the future course of the global AIDS response at the 2011 UN General Assembly High Level Meeting on AIDS from 8–10 June 2011 in New York. Member States are expected to adopt a new Declaration that will reaffirm current commitments and commit to actions to guide and sustain the global AIDS response.
The Africa Regional Association of Occupational Health (ARAOH) Congress is to be hosted by the South African Society of Occupational Medicine Conference (SASOM) from 25 – 27 August 2011 in Johannesburg, South Africa. To register for the event visit the link provided.
The University of Pretoria (UP) and the American Cancer Society (ACS) invite applications from citizens from Sub-Saharan Africa for three fully funded fellowships. The UP-ACS Fellowships are awarded for a Master of Public Health degree at the university's School of Health Systems and Public Health. Please visit the Scholarships and internships on the website for information on how to apply. For further assistance kindly contact Joyce Jakavula at joyce.jakavula@up.ac.za.
The Nelson Mandela Foundation, in collaboration with the Deutsche Gesellschaft für Internationale Zusammenarbeit, calls on experienced non-governmental organisations capable of implementing community dialogues in all South African provinces to submit Expressions of Interest. Please submit substantive expressions of interest, the company profile and Curriculum Vitae of the individual to be responsible for the assignment to dialogue@nelsonmandela.org. Closing date for applications is 5 June, 2011.
The World Health Organisation (WHO) is calling for papers for all sections of the Bulletin and encourage authors to consider contributions that address any of the following topics: disease burden assessments in low-income countries, since information in this area is scarce; vaccination implementation and policy, particularly on the cost and public health benefit of vaccination programmes; and the evaluation of nonpharmaceutical public health measures since these are widely described as control measures, but there is less published evidence on their effectiveness than for pharmaceutical interventions (vaccines and medicines). In particular, WHO seeks submission of papers that document experiences from low-resource settings.
Authors involved in original research, innovative projects or novel programmes related to global health are encouraged to submit abstracts for the Global Health Conference 2011 to be held in Canada in November 2011. Abstracts in all areas of global health are welcomed including: the global burden of disease; innovations and interventions to advance global health equity; globalisation, global trade and movement of populations as drivers of health inequity; partnerships and capacity building for education and research in global health; social, economic and environmental determinants of health; and human rights, legal issues, ethics and policy. Abstracts may focus on a new finding, the development of a programme, project or new global health tool, moving from development to implementation, policy or ethical issues, or related topics.
The World Health Organisation (WHO) seeks comments and feedback on the current draft of the Conference technical paper, which aims to inform the conference discussions and provide policy-makers with an overview of key strategies to implement action on social determinants of health. In particular, WHO would like comments on whether the draft fully covers the five themes of the Conference, and whether any major strategies for implementation of action on social determinants have been omitted. Please note that comments will not be posted to the public web site.
The WHO/Geneva, the WHO Regional Office for Africa, the Ghana National Drugs Programme of the Ministry of Health Ghana, the Ghana College of Physicians and Surgeons and the Faculty of Pharmacy, Kwame Nkrumah University of Science and Technology will jointly organize a 10-day training course on the use of pharmacoeconomics in medicines selection.
The course aims to build capacities of managers in health insurance programs, procurement agencies and relevant staff in public and private health facilities to make evidenced based decisions on selection of medicines for their essential medicines lists which are used for procurement, re-imbursements under health insurance programs and promote cost effective use of medicines. Preference will be given to participants from the African region, as well as emphasizing preference for people working in the public sector.
The Million Message March 2011 is a collaborative communication campaign to mobilise community support and political commitment for the Right to Health and Universal Access. It aims to reach out globally to collect one million messages (by SMS or tweets) from people in need of treatment and care (for HIV, cancer, TB, diabetes, hepatitis and other life-threatening diseases) and their families, care-givers and allies. These ‘Voices’ will be amplified, disseminated and projected along the ‘March’ starting at the World Health Assembly in May, through two UN High Level Meetings (HIV in June and Non-Communicable Diseases NCDs in September), and other major health events. The Million Message March will ‘arrive’ on Human Rights Day, the 10th of December, at the Office of the United Nations High Commissioner for Human Rights (OHCHR) so that the messages can ‘Speak-Up’ and be heard at the top of the UN and its Member States. The March began at the World Open Health Assembly (WOHA2011), in tandem with the World Health Assembly, 16-18 May 2011, with a global 'chat' live from Asia, Africa, Europe and NYC.
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