The WHO and Government of Brazil sponsored Conference on the Social Determinants of Health held in late October turned out to be a case study of how expectations materialized in a war of brackets added to the text of the original Rio Political Declaration on Social Determinants of Health (www.who.org ). The rich countries’ brackets and ‘toning-down-relativisation-adjectives’ won, despite fierce debate. This begs the question: Are United Nations declarations predictable?
The frustration in the halls ran so high that no less than three alternative declarations made it to the floor of the final day. One from the Peoples Health Movement (www.phmovement.org ), one from the Latinamerican Association of Social Medicine (www.alames.org ) and one from the International Federation of Medical Students’ Associations (www.ifmsa.org).
Dr Michael Marmot, chair of the Commission on Social Determinants of Health that produced the 2008 report said: …”Closing the gap in a generation is a rousing call. Did the World Health Organization’s Commission on Social Determinants of Health really believe it to be possible? Technically, certainly. …the evidence suggests that we can make great progress towards closing the health gap by improving the conditions in which people are born, grow, live, work and age. …..In the three years since ‘Closing the Gap in a Generation’ was published, there is no question that there is much to make us gloomy: the global financial crisis and the steps put in place to deal with it have worse impacts on the poor and relatively disadvantaged; the persistence of bad governance nationally and globally; climate change and inequitable measures for mitigation and adaptation and, in many countries, an increase in health inequalities….”
The weaknesses were clear. WHO Member States were reluctant to discuss or redress the power relations that year-in-year-out reproduce health inequalities. The social determinants of health cannot be addressed by just fixing policy coherence and inter-sectoral action in health as is being called for. Obscuring these realities of power under platitudes about inter-sectoral action and policy coherence across sectors only helps to perpetuate the continuing violation of the right to health. In fact there is significant policy coherence across sectors, including the health sector, influenced by currently dominant conservative economic policies which have also promoted a market approach in health care financing. Irrational global trade liberalization, capital flight and a continued unfair regime of patents, especially of medicines are clearly maintaining health inequalities. Comprehensive primary health care, with proactive community involvement, is the fundamental guide for an equitable health system. The progressive privatization of health care provision over the last three decades has seriously weakened capacities to organise comprehensive primary health care.
It is thus the stubborn combination of poor social policies and programmes, unfair economic arrangements, and bad politics that are depriving large numbers of people of opportunities to lead healthy lives. Reducing health and nutrition inequalities is critically dependent upon changes in the functioning of the global economy. Differences among countries; between social classes; between men and women; between corporations and communities result from the interaction of the different axes of power which end up critically determining which actions will be taken and which will not on the social determinants of health and nutrition. A willingness to transfer real power to communities is thus key to deal with the existing unequal power relations and with the measures taken to tip them in favour of dire community needs.
Despite the committed role all representatives of the Brazilian government and civil society in bringing out the deficiencies above, in the final Declaration, no mention was made of redressing the unequal power relations that lie at the base of the determinants. The Declaration thus proposes an apolitical agenda. In this respect it is a step back from the recommendations of the WHO Report on the Social Determinants of Health.
Peoples Health Movement and Alames in their declarations insist that the institutions, corporations and governments which promote the current state of affairs need to be confronted if there are to be any shifts in the way the social determinants of health are addressed. These declarations make specific proposals for how to do this. For example, WHO has led the way in developing a global regulatory regime for tobacco control and should do the same for the food industry. The financial sector needs to be held accountable for the economic crisis and contribute to addressing the vast resource gap in health by paying a small tax on financial transactions.
The Conference at best served for leaders to acknowledge social determinants of health as an ‘issue’. But it leaves us with the lingering question: Can the health and nutrition sector take upon its shoulders the tackling of the social determinants of health? We are the sector that picks up the pieces of a sick society. Putting our own house in order will not be enough.
The declarations referred to in this editorial are included in the newsletter. Please send feedback or queries on the issues raised in this briefing to the EQUINET secretariat: admin@equinetafrica.org. The views expressed in this editorial are the authors. For more information on the issues raised in this op-ed please visit the website of the World Conference on Social Determinants of Health http://www.who.int/sdhconference/en/ and of Peoples Health Movement at www.phmovement.org
1. Editorial
2. Latest Equinet Updates
By involving citizens and health workers in producing evidence and learning, participatory action research has potential to organise community evidence, stimulate action and challenge the marginalisation that undermines achievement of universal health coverage, the authors of this paper argue. They begin by summarising and analysing the results of two sessions on this research model convened by the authors at the First Global Symposium on Health Systems Research in Montreux Switzerland, 16–19 November 2010. They then review case studies and experiences discussed, particularly their contribution to universal health coverage in different settings. The authors reflect on challenges faced by participatory action research, and outline recommendations from the two sessions, including the creation of a learning network for participatory action research.
In August 2011, the South African Minister of Health released a Green Paper on introducing a National Health Insurance (NHI). While there has been a relatively muted response to the release of the paper, there has been sufficient public commentary to identify positive and negative key areas. On the positive side, the proposals have been praised for: being based on universal coverage principles; adopting a carefully phased approach; focusing firmly on addressing the problems in the public health sector first; and building a strong foundation of improved primary care services. However, while there appears to be a commitment to a single public pooling and purchasing entity, the Green Paper mentions also considering a multi-payer option whereby private insurance schemes would act on behalf of the NHI, raising concerns about high administration costs, which would limit income and risk cross-subsidies, and reduce the cost-containment benefits that would accrue if government was a single purchaser. The proposal to purchase services from the private sector may also mean a two-tier system will be retained as wealthier groups live closer to private providers than the less well-off and, given the rapid increase in fee levels among private for-profit providers, may threaten the sustainability of the NHI. Although it is proposed that there will be no fees at the point of service, the Green Paper also mentions having to consider co-payments, which would limit the financial protection afforded to beneficiaries. There are clearly some contradictions within this policy document that need to be resolved, the author concludes.
Work on health equity in east and southern Africa was given profile at the World Conference on the Social Determinants of Health. Work on equity monitoring, including the Equity Watch in Zimbabwe and the ECSA Region was included in the background paper and reported on by the Hon Minister of Health Zimbabwe, also current chair of the ECSA Health Community. EQUINET as an equity catalyst bringing social forces across state, civil society, academic and parliament institutions was included in a panel on social participation. Community Working Group on Health, the cluster lead for social empowerment made input to the media cover and to the wider civil society platforms, especially of the People's Health Movement, and EQUINET publications were included in the material displayed by WHO Afro. TAC South Africa, the Ministers of Health of South Africa and of Kenya made inputs to panels on institutionalising participation in policy making and on changing the role of public health and Professor Sanders UWC in the final plenary on SDH and the life course. Case studies on work on social determinants of health for the conference from Namibia, Rwanda, Kenya, Uganda and Zimbabwe can also be found at www.who.int/sdhconference/resources/case_studies/en/index.html.
3. Equity in Health
The United Nations (UN) High-Level Meeting on Non-communicable Diseases (NCDs) has helped raise awareness about the burden of NCDs, but the authors of this article caution that the real work of preventing and controlling NCDs must begin. They put forward several important steps that must be taken immediately. Governments need to implement the commitments in the Political Declaration that call for acceleration of the Framework Convention on Tobacco Control (FCTC), a global public health treaty focused on reducing the five million deaths per year caused by tobacco use. In addition, national plans to address NCDs need to be developed and NCDs need to be incorporated into the United Nations’ Millennium Development Goals. Clear, effective, and achievable targets to reduce NCDs - developed with input from health experts and civil society - need to be established and monitored by the World Health Organisation. And, importantly, global and national funding needs to be mobilised by governments, the private sector and civil society so that these plans can be effectively implemented, particularly in low- and middle-income countries. Moreover, the global health and development community must commit to greater collaboration across sectors and disease groups. Vertical interventions that target one disease at a time must be folded into comprehensive horizontal health programmes that promote overall health and wellness across the individual’s lifespan.
The World Health Organisation estimates that global warming and trends in rainfall due to human-induced climate change already claim over 150,000 lives annually. Diseases associated with climate change include heart and lung disease due to heat waves, increased spread of infectious diseases, and malnutrition due to crop failures. Sub-Saharan Africa is one of the most vulnerable regions, especially its sprawling cities where the effects of urbanisation aggravate extreme climatic events. More people die from the effects of climate change in Africa than anywhere else. Given the devastating and growing impact of climate change on health, it is ironic that health systems themselves contribute substantially to climate change through their enormous greenhouse gas (GHG) emissions, the authors of this article note. While no data exist for South Africa, estimates from the United Kingdom indicate that the country’s National Health Service contributed 25% of public sector emissions in 2004. The authors emphasise that the parallel policy initiatives of South Africa’s proposed National Health Insurance and ‘Re-engineering Primary Health Care’ initiative could, if thoughtfully implemented, address three crises simultaneously: the health crisis, the employment crisis and the carbon emissions crisis.
In this background paper to the World Conference on the Social Determinants of Health, held in October 2011, the World Health Organisation (WHO) argues that poor progress in the implementation of a social determinants approach reflects in part the inadequacy of governance at the local, national and global levels to address the key problems of the 21st century. WHO proposes a number of priority strategies for action. In terms of governance, WHO argues that governments should build good governance for action on the social determinants of health by implementing collaborative action between sectors (intersectoral action). WHO further recommends that governments should promote participation by: creating the conditions for participation; playing a role as brokers in participation and ensuring representativeness; and facilitating participation by civil society. WHO also considers the role of the health sector in reducing health inequities, arguing that the sector should: execute its role in governance for social determinants; re-orient health care services and public health programmes to reduce inequities; and institutionalise equity into health systems governance. With regard to global action on social determinants, international organisations, non-governmental agencies, bilateral co-operation partners and governments need to align their efforts and priorities for addressing the social determinants of health. Progress also needs to be monitored, as governments should: use measurement and analysis to inform policies and build accountability on social determinants; identify sources, select indicators, collect data, and set targets; move forward despite unavailability of systematic data; and disseminate data on health inequities and social determinants and integrate these data into policy processes.
This latest edition of Roll Back Malaria’s (RBM) global progress report indicates that all but four of the 46 African region countries still have ongoing malaria transmission. Four countries in southern Africa (Botswana, Namibia, South Africa and Swaziland) share a common goal of eliminating malaria by 2015. They were joined by their four northern neighbours (Angola, Mozambique, Zambia and Zimbabwe) in 2009, to form the sub-regional malaria elimination initiative known as the Elimination Eight (E8). Another four countries in Africa (Gambia, Rwanda, São Tomé and Principe, and Madagascar) have secured Global Fund grants to prepare for elimination. The long-term cost benefit of elimination still needs to be sufficiently documented, RMB notes, in order to facilitate the required policy and financing commitments. Success is accumulating, however, and the evidence base guiding local, national, regional and global action is growing quickly. Future investment in new malaria control tools and in socio-economic development that will support malaria control and communities broadly will be essential, RBM argues. With strong human capacity, continued investment, evidence-based programming and continued partnership, achieving the ambitious Roll Back Malaria 2015 targets, including elimination in at least eight to ten countries is still possible, the report concludes.
In the three years since ‘Closing the Gap in a Generation: Health Equity Through Action on the Social Determinants of Health’ was published by the World Health Organisation (WHO), the global financial crisis has deepened and the steps put in place to deal with the crisis have had worse impacts on the poor and relatively disadvantaged, while bad governance nationally and globally persists, and measures to mitigate climate change have served to increase health inequity. Despite the dissenters who claim that social determinants are not the concern of WHO, specialists across WHO used evidence-based research to show that action on social determinants of health was fundamental to disease control programmes. The author of this article suggests that the global community can still make great progress towards closing the health gap by improving the social determinants of health and by ensuring equity for every child from the start, as well as ensuring healthier environments, fair employment and decent work, social protection across the life course and universal health care. But to make progress, the global community must also deal with inequity in power, money and resources – the social injustice that is killing on a grand scale.
4. Values, Policies and Rights
The number of abortions among women older than 18 has increased steadily over the past two years in the Western Cape Province, according to South African Health MEC Theuns Botha. Responding recently in the legislature on the impact that illegal abortions have on public health care facilities, Botha said such abortions continued to take place, despite the legal service that was offered at more than 30 health care centres in the province. While health care facilities had treated a number of women with complications arising from illegal abortions, Botha said it was difficult to say how many cases there had been as those known to the department were only of women who volunteered the information during treatment. According to the latest figures from the National Health Department, between 1997 – when legal termination of pregnancy was introduced – and last year, about 702,354 abortions were performed at public health care facilities nationwide. About 528,000 of these involved teenagers. Health Minister Aaron Motsoaledi expressed concern about the number of teenagers who were having abortions, arguing this was proof that young people were engaging in unprotected sex and risking HIV infection. A spokesperson from Marie Stopes – a non-profit organisation offering reproductive health services – called on parents and teachers to talk openly about contraception, saying that research showed that most pregnant teenagers are in poor communities where educational and financial opportunities are limited. Women need to be made aware that abortion is not a form of contraception, she said.
The Rio Declaration is the outcome document of the World Conference on Social Determinants of Health, held from 19-21 October 2011 in Rio de Janeiro, Brazil. In the Rio Declaration, heads of government, ministers and government representatives reaffirm their commitment to take action on social determinants of health to create vibrant, inclusive, equitable, economically productive and healthy societies, and to overcome national, regional and global challenges to sustainable development. They recognise that the current global economic and financial crisis urgently requires the adoption of actions to reduce increasing health inequities and prevent worsening of living conditions and the deterioration of universal health care and social protection systems. They offer specific actions under the following common objectives: to adopt better governance for health and development; to promote participation in policy-making and implementation; to further reorient the health sector towards reducing health inequities; to strengthen global governance and collaboration; and to monitor progress and increase accountability. In the declaration, signatories call upon the World Health Organisation, United Nations agencies and other international organisations to advocate for, co-ordinate and collaborate in the implementation of these objectives.
According to this statement by Latin American social medicine and civil society organisations at the World Conference on Social Determinants of Health, the fundamental cause of the inequalities within and between nations is the neoliberal economy, infused with an exclusively speculative desire for unlimited profit. Capitalism grabs profits and socialises losses, they argue, resorting to new and crueler neoliberal measures that further reduce the fundamental social rights of people. There are abundant resources for all of us on the earth, but the ‘logic’ of the market prevents people from obtaining what they need. In the area of public health, neoliberalism translates into the commercialisation of life, legal protections for intellectual property for the benefit of the medical industrial complex, control of the media in order to create ‘need’ through shock, damage to public health systems, manipulation of civil society, multiple forms of violence and other strategies to colonise the ‘collective thought’. The current dominant societal model, using the lifestyle of affluent Americans as a basis, they argue is not sustainable. The statement concludes with a call for the establishment of global alliances between progressive governments and social movements, and meaningful social participation, as well as support for the creation and consolidation of health systems and social security systems that are universal, free, integral, and public, with coverage for all people for all services.
This study explores and describes the views of drivers and conductors on the causes of workplace violence (WPV) and ways of preventing it in the road passenger transport sector in Maputo, Mozambique. The design was qualitative. Participants were purposefully selected from among transport workers identified as victims of WPV in an earlier quantitative study, and 32 transport professionals were interviewed. The triggers and causes of violence included fare evasion, disputes over revenue owing to owners, alcohol abuse, overcrowded vehicles, and unfair competition for passengers. Failures to meet passenger expectations, e.g. by-passing parts of a bus route or missing stops, were also important. There was disrespect on the part of transport workers, e.g. being rude to passengers and jumping of queues at taxi ranks, and there were also robberies. Proposals for prevention included: training for workers on conflict resolution, and for employers on passenger-transport administration; and promoting learning among passengers and workers on how to behave when travelling collectively. Regarding control and supervision, participants expressed the need for the recording of mileage and for the sanctioning of workers who transgress queuing rules at taxi ranks. They also requested that police or supervisors should prevent drunken passengers from getting into vehicles, and said drivers should refuse to go to dangerous, secluded neighbourhoods. Finally, participants called for an institution to judge alleged cases of employees not handing over demanded revenues to their employer.
In response to the Rio Political Declaration at the World Conference on Social Determinants of Health held from 19-21 October in Rio de Janeiro, Brazil the International Federation of Medical Students’ Associations (IFMSA) delegation raised issues that the Declaration failed to address. In their statement, they recognise the Rio Declaration as a major step in the quest for global health equity, but point to its failure to explicitly indicate how the unfair distribution of power, resources and wealth will be addressed, especially by United Nations (UN) Member States, arguing that leaders have missed an opportunity to make a strong statement on this. IFMSA believes that democracy is the key instrument in fixing the existing imbalances in power and in ultimately reducing health inequities, but the Declaration does not emphasise the value of democracy in all processes – from decision-making to evaluation – and at all levels – from community to global level. IFMSA also notes that the Declaration fails to specifically define the role of the private sector in reducing health inequities and does not clearly draw the lines governing engagement between government and the private sector, nor does it demand that global economic governance institutions, such as the International Monetary Fund, the World Trade Organisation and the World Bank, adhere to the same standards of transparency, accountability and democracy as those urged of UN Member States. In addition, the Declaration is silent about how tackling health inequities will be financed, making no mention of innovative financing schemes such as progressive taxation on capital gains or extremely-high earners, a financial transactions tax or the prevention of tax evasion. Although the Declaration recognises the importance of engaging with civil society, it does not advocate for the creation of spaces for dynamic dialogue that will enable civil society to be heard, reflecting the fact that civil society was excluded from the official process of developing the Declaration. Finally, IMFSA notes that the Declaration does not explicitly mention the inclusion of young people and youth organisations in the movement for action on social determinants of health.
Botswana should decriminalise homosexuality and prostitution to prevent the spread of HIV, says ex-President Festus Mogae. Mogae, who heads the Botswana government-backed Aids Council, said it was difficult to promote safe sex when the two practices were illegal. He also called for condoms to be distributed in prisons. His views are controversial as many conservative Batswana frown upon homosexuality and prostitution. Yet Botswana has one of the highest HIV rates in the world - 17% of the population is HIV positive. Mogae asserted that homosexuals were Botswana citizens and entitled to the same rights as heterosexual citizens. He said the government's failure to give prisoners' condoms was worsening the HIV and AIDS pandemic. However, a government spokesman on HIV and AIDS said that homosexuality and prostitution would remain illlegal until the government concluded wide-ranging consultations to see whether there was a need to change the law.
In this declaration by health civil society organisations from around the world, Peoples Health Movement insist that real power be trabsferred to communities to deal with the social determinants of health. A call is made for United Nations Member States and the World Health Organisation to take action around ten key areas affecting the social determinants of health. 1. Implement equity-based social protection systems and maintain and develop effective publicly provided and publicly financed health systems that address the social, economic, environmental and behavioural determinants of health with a particular focus on reducing health inequities. 2. Use progressive taxation, wealth taxes and the elimination of tax evasion to finance action on the social determinants of health. 3. Recognise explicitly the clout of finance capital, its dominance of the global economy, and the origins and consequences of its periodic collapses. 4. Implement appropriate international tax mechanisms to control global speculation and eliminate tax havens. 5. Use health impact assessments to document the ways in which unregulated and unaccountable transnational corporations and financial institutions constitute barriers to Health for All. 6. Recognise explicitly the ways in which the current structures of global trade regulation shape health inequalities and deny the right to health. 7. Reconceptualise aid for health from high-income countries as an international obligation and reparation legitimately owed to developing countries under basic human rights principles. 8. Enhance democratic and transparent decision-making and accountability at all levels of governance. 9. Develop and adopt a code of conduct in relation to the management of institutional conflicts of interest in global health decision making. 10. Establish, promote and resource participatory- and action-oriented monitoring systems that provide disaggregated data on a range of social stratifiers as they relate to health outcomes.
This article reports that Somali women and girls living in Ethiopian and Kenyan refugee camps are facing major health problems as camps lack security and basic services like latrines, accompanied by a fourfold increase in reports of sexual violence since May 2011. The real numbers are likely much higher, the Women’s Refugee Commission (WRC) notes, because many women and girls fail to report attacks for fear of their safety, because they don't want to be ostracised or because they don't trust that their rapists will ever be caught or prosecuted. Some of those living in the camps also face violence from their partners, and some are being forced into early marriage or survival sex, because they have no other way to support themselves. WRC argues that immediate action will more effectively protect women and girls than trying to fix problems after they have become entrenched. WRC recommendations include not only ensuring that women and girls have safe access to basic necessities, such as food, cooking fuel, potable water, sanitation and shelter, but that they are protected from sexual violence and that health care, particularly reproductive health care, is provided, using the updated Minimum Initial Service Package for reproductive health as a basis. WRC calls on the international community to rapidly scale up efforts initiated by humanitarian agencies in the region.
5. Health equity in economic and trade policies
At the United Nations’ meeting on non-communicable diseases (NCDs) in September 2011, heads of state were told that cancers, heart disease and mental health issues were critical to the future of the global economy: NCDs are forecast to cost $47 trillion, or 4% of global gross domestic product (GDP), over the next 20 years. This, the author of this article points out, was the only figure put forward to contextualise NCDs, as the meeting failed to produce any concrete targets, funds and action plan. Although the UN General Assembly called on the World Health Organisation (WHO) to develop a global monitoring framework over the next twelve months, the framework will contain only voluntary targets and there is little in the declaration that is specific on international co-operation or coordination. Most action is for sovereign interpretation and subject to domestic interests. Health system development, the regulation of industry and key interventions across sectors such as education, environment, agriculture, and transport remain areas for intervention at the national level only. While trade issues concerning access to medicines, food regulation and tobacco control are affected by global policy, governments remained divided in their interpretation of such policies. On the one hand, health ministries now recognise the human and economic cost of overt protection of industries but on the other hand, commerce officials continue to promote consumption of goods domestically and internationally with simplistic assumptions about individual and social impacts.
In this paper, the author argues that, in order to ensure food security for everyone, all aspects of the food security supply chain, global governance, investment and trade will need to be addressed simultaneously. For improving global governance, full support should be given to the work of the reformed Committee on World Food Security (CFS). This may involve merging the United Nations (UN) High Level Task Force with the Committee. At the same time, the Committee may need to work more independently of the Rome-based agencies and report to the UN Economic and Social Council with more coordination than has existed so far. To ensure a functional global food supply system, World Trade Organisation members should consider alternative mechanisms for adjusting trade rules and expanding the mandate of the Committee on Agriculture according to the changing global requirements, the article notes. Thanks to many positive developments such as having a reformed CFS, the Global Partnership on Food Security, substantial new funding and a much more coordinated approach, the global community is in a much better position to reduce global hunger. Unfortunately trade rules are not keeping up with other developments the author concludes.
The Medicines Patent Pool, which negotiates voluntary licences for lower pharmaceutical prices, has announced the signing of an agreement with Indian generics producer Aurobindo Pharma Limited to manufacture antiretroviral (ARV) medicines. The Patent Pool has recently come under criticism from AIDS activists concerned about its July 2011 licence agreement with drug company Gilead, and it remains to be seen if this action will address their concerns. The Medicines Patent Pool said that the agreement will enable Aurobindo to manufacture ARVs licensed to the Pool by Gilead Sciences in July. The uptake of the listed ARVs by generic manufacturers will help close the gap between the arrival of new medical technology in developed country markets and its often delayed arrival in developing countries, according to the Pool. In particular, Aurobindo took advantage of a key provision negotiated by the Pool so it can sell the ARV, tenofovir, to a larger number of countries without paying royalties. The arrangement is expected to make it possible for Aurobindo to sell tenofovir to a larger number of countries than before.
In response to the Medicine Patent Pool Foundation’s (MPPF) first voluntary license agreement with pharmaceutical giant, Gilead, the International Treatment Preparedness Coalition (ITPC) and the Initiative for Medicines, Access and Knowledge – both aiming to secure universal access to medicines – called for a meeting with the MPPF, arguing that the agreement represented a setback for universal access. On 2 October 2011, both organisations and members from civil society from the global south met with MPPF and UNITAID in Geneva, and made three demands. First, the agreement with Gilead should be substantially revised or terminated, given Gilead’s bad faith and the controversial terms of the agreement. Second, MPPF should institute an immediate moratorium on negotiations of any new licence agreements with multinational drug companies until such time as standard terms and conditions or a model agreement is agreed to. Third, the current structure of the MPPF needs to be revised, including its governance and administration, goals and mission, and comprehensive reforms must be implemented that are designed to enhance its transparency, accountability and adherence to core principles of health equity.
From 19-21 September 2011, the World Trade Organisation (WTO) hosted Public Forum 2011, where non-profit organisations Knowledge Ecology International (KEI) and IQsensato held a joint panel session on a proposal to the WTO entitled ‘An Agreement on the Supply of Knowledge as a Global Public Good’. The session provided a space to debate the feasibility of adding the supply of public goods involving knowledge as a new category in negotiated binding commitments in international trade. Proposal advocates argue that in the wake of current high levels of knowledge protection in the form of patents, the global community faces an under-supply of public goods, including knowledge. Opening up knowledge as a public good would include developing nations that have hitherto been increasingly excluded from accessing knowledge which has been patented by multinationals and developed nations. Options include collaborative funding of inducement prizes to reward open source innovation in areas of climate change, sustainable agriculture and medicine, and agreements to fund biomedical research in areas such as new antibiotics, avian influenza and the development of an AIDS vaccine.
Aid for trade (AfT) has proved to be largely ineffective in Malawi because it has had limited success in developing the local human and institutional capacity required to enable trade, according to this article. A key contributor to this has been a failure by trade promoters and external funders to identify where Malawi stands on its development curve. AfT solutions have tended to assume that Malawi is on the same point on its development curve as Cambodia, Vietnam, Ghana or Rwanda. Yet Malawi simply does not have the scale of human capacity that is required to ensure a pro-poor business environment. It lacks the capacity to ensure businesses have affordable access to finance, business development services, inputs, information, markets, labour and technology. The core problem is that civil society, government and the development community have not adequately recognised the roles that development and trade play in their poverty reduction objectives, the author concludes.
6. Poverty and health
In response to declining soil fertility in southern Africa and the negative effects that this leads to, such as food insecurity, fertiliser tree systems (FTS) were developed as technological innovation to help smallholder farmers to build soil organic matter and fertility in a sustainable manner. In this paper, the authors trace the historical background of FTS and highlight the developmental phases and outcomes of the technology. The synthesis shows that FTS are inexpensive technologies that significantly raise crop yields, reduce food insecurity and enhance environmental services and resilience of agro-ecologies. Many of the achievements recorded with FTS can be traced to some key factors: the availability of a suite of technological options that are appropriate in a range of different household and ecological circumstances, partnership between multiple institutions and disciplines in the development of the technology, active encouragement of farmer innovations in the adaptation process, and proactive engagement of several consortia of partner institutions to scale up the technology in farming communities. It is recommended that smallholder farmers would benefit if rural development planners emphasise the merits of different fertility replenishment approaches and take advantage of the synergy between FTS and mineral fertilisers rather than focusing on `organic vs. inorganic' debates.
In this interview with the World Health Organisation, Brazilian Minister of Health Alexandre Padilha calls on other countries around the world to develop a pact to eradicate poverty and hunger. Padhila calls for the launch of a proactive and rational agenda that encompasses the food, pharmaceutical, arms, tobacco and alcohol industries, as well as action to develop and increase the wealth of peoples, setting goals for environmental sustainability and the end of extreme poverty. The last two United Nations meetings on health – on polio and HIV and AIDS – point to the same direction in solving both challenges: equity in the access to prevention measures and treatment, he notes. The Brazilian Ministry of Health has carried out a broad public consultation to prepare a plan to address non-communicable diseases. The prevention and control of these diseases will be the subject of a set of political and governmental policies.
Despite guarantees to the right to adequate food in its current Constitution and ratification of several international covenants that expressly recognise this right, the Kenyan government has failed its people in this regard, writes the author of this article. The current food crisis is marred by reports of surplus crops rotting in granaries due to lack of markets or means of transportation to ready markets, while there have been allegations of theft of relief food by government officials. The government has admitted that it does not have sufficient infrastructure to distribute relief food and is relying on local and international relief agencies to do the job. Poor distribution of relief food has been exacerbated by government’s failure to map the drought zones properly, the author argues. Controversy has also raged regarding the safety of genetically modified maize being imported into the country, with the public bio-safety regulatory authority admitting incapacity to conduct the required tests. It is on record that the government ignored the adverse weather forecast from the Kenya Meteorological Department and the local chapter of the International Committee for the Red Cross, failing to plan ahead. Poor government policies that fail to incentivise maize production - the country’s staple food - have also been blamed for declining maize yields, year on year. The author calls on government for effective measures to end the cycle of famines.
The new wave of land deals in agriculture has had a negative impact on the poor in developing countries, according to this paper by Oxfam. Oxfam’s research has revealed that residents regularly lose out to local elites and domestic or foreign investors because they lack the power to claim their rights effectively and to defend and advance their interests. Oxfam makes a number of key recommendations. First, the rights of the communities affected by these deals must be respected and their grievances addressed, and those who are profiting from the international deals must help to ensure this happens. Second, the balance of power must be shifted in favour of local rights-holders and communities. Governments should adopt strong, internationally applicable standards on good governance relating to land tenure and management of natural resources. Third, host governments should respect and protect all existing land use rights, and ensure that the principle of free, prior and informed consent is followed and that women have equal rights to access and control over land. Fourth, investors should respect all existing land use rights. Fifth, financiers and buyers should accept full supply-chain responsibility. Sixth, home country governments should require companies investing overseas to fully disclose their activities, and ensure that standards and safeguards are implemented to protect small-scale food producers and local populations.
According to IRIN News, new cases of leprosy have been reported from clinics in Antalaha, a remote area of Madagascar. The driving force behind the outbreak of the disease is increased malnutrition, the article reports, caused by dramatic increases in the price of rice. And while people are becoming poorer and more susceptible to illness, the public healthcare system is receiving less money from the government. According to the United Nations Children's Fund (UNICEF), government spending for health dropped to US$2 a person in 2010, compared to $5 in 2009 and $8 in 2008. Clinics in remote places like Antalaha are the most likely to suffer from shortages of drugs and medical supplies. Six to 12 months of treatment with multidrug therapy - a combination of two antibiotics and an anti-inflammatory (medicines that the World Health Organisation distributes for free) - stops the disease from spreading, but there are other obstacles to overcome. The main one, according to medical workers, is that the Malagasy authorities declared that leprosy had been eradicated from the country in 2010. Medical workers are reported to be afraid to report new cases to the authorities as this will contradict the official position on the disease. Diagnosing the illness can also be tricky in a tropical climate that causes many dermatological problems, and basic items like bandages – which are needed to dress the wounds – are usually lacking in health centres.
Swaziland's parliamentarians recently debated the social safety net covering children, the elderly and the disabled. Recipients often depend on these small grants and pensions for survival. The debate on the future of social services was prompted by submissions from the Deputy Prime Minister, Themba Masuku, on the suspension of grants to the elderly. A number of Members of Parliament (MPs) supported the call for a constitutional amendment to abolish these government grants when government had no money to pay for them. The article reports that many pensions were suspended in the first quarter of 2011. In June 2011 only 6,480 pensions were reported to be paid, while at least 40,000 pensioners without bank accounts were reported to have received no benefits, so that OVC grants could be paid instead. The Deputy Prime Minister did not respond to parliamentary questions as to when regular pension payments would resume. The non-payment of social grants is expected to have a knock-on effect on health of the country’s population, particularly those living in extreme poverty.
According to the United Nations Food and Agriculture Organisation’s (FAO) Food Price Index, overall food costs rose by 39% in 2011, while grain prices went up by 71%. The authors of this article point to investor speculation in commodity futures as the main culprit for price increases, as the more the price of food commodities increases, the more money pours into the sector and the higher prices rise. Although the volume of index fund speculation increased by 2,300% between 2003 and 2008 alone, the FAO estimates that today only 2% of commodity futures contracts result in the delivery of real goods. The problem is particularly glaring in Ethiopia, the authors note, where 5.7 million Ethiopians are dependent on international food aid, while the government sells or leases large tracts of fertile land to foreign investors. They, in turn, export most of the food they produce to other countries. Since 2007, the Ethiopian government is reported to have approved 815 foreign-funded agricultural projects. Given the threat posed by climate change, the authors call for a radical departure from agricultural mass production, as well as an end to large-scale monocultures and the massive use of pesticides. They argue that this type of agriculture contaminates water and dries up the soil, and that the export-oriented agricultural industry destroys markets in developing countries. What is needed is a re-orientation toward a system of agriculture driven by small farmers who grow their crops at the local level, using both sustainable and environmentally compatible methods. However, governments and economists continue to push for large-scale agriculture as the solution to poverty and hunger, even though it is actually a contributing factor to the problem, the authors argue.
Is job creation really the best way to seek wellbeing for all in countries with chronic, high unemployment? No, according to the author of this article, especially not in a wealthy middle-income country like South Africa, where very high unemployment combines with high poverty rates. A universal income grant, he argues, makes much more sense. He points out that earning a decent secure wage is not a prospect for millions of South Africans, especially with the global economic crisis having hit the country and unemployment standing at 35%. Having a job does not automatically prevent poverty, as most workers earn very low wages and have minimal labour protection, a situation exacerbated by the shift towards the use of casual and outsourced labour and the related decline in real wages for low-skilled workers. Although the current social grant system separates millions from destitution, he notes that it is ill-suited to today’s realities, as it hinges on the fiction that every worker, sooner or later, will find a decent job. In addition, targeted and means-tested social protection is burdensome, costly and humiliating. The author argues that a universal income is developmental and would boost wellbeing and health, referring to studies that show reduced stunting in children, better nutrition levels and greater school enrolment. He notes that a universal grant as small as US$12 per month could close South Africa’s poverty gap by 74% and lift about six million people above a poverty line of US$50 per month.
7. Equitable health services
The Global Immunisation Vision and Strategy (GIVS 2006-2015) aims to reach and sustain high levels of vaccine coverage, provide immunisation services to age groups beyond infancy and to those currently not reached, and to ensure that immunisation activities are linked with other health interventions and contribute to the overall development of the health sector. The objective of this study was to examine mid-term progress (through 2010) of the immunisation coverage goal of the GIVS for 194 countries or territories with special attention to data from 68 countries which account for more than 95% of all maternal and child deaths. The study presents national immunisation coverage estimates for the third dose of diphtheria and tetanus toxoid with pertussis (DTP3) vaccine and the first dose of measles-containing vaccine (MCV) during 2000, 2005 and 2010. Results show that globally DTP3 coverage increased from 74% during 2000 to 85% during 2010, and MCV coverage increased from 72% during 2000 to 85% during 2010. A total of 149 countries attained or were on track to achieve the 90% coverage goal for DTP3 (147 countries for MCV coverage). The researchers conclude that progress towards GIVS goals highlights improvements in routine immunisation coverage, yet they voice concern that some priority countries showed little or no progress during the past five years. These results highlight that further efforts are needed to achieve and maintain the global immunisation coverage goals.
This statement was delivered at the World Conference on Social Determinants of Health, held from 19-21 October 2011 in Rio de Janeiro, Brazil. According to Kenya’s Minister for Public Health and Sanitation, there are a number of steps that the Kenyan government has taken to reduce inequities in health. In 201 out of the country’s 210 constituencies, a model health facility is being constructed, with an additional 50 health workers employed per constituency, totaling 12,000 additional health workers. The Community-led Total Sanitation (CLTS) project for urban areas is also being rolled out, with government aiming at attaining full coverage by 2013. The Health Sector Service Fund has also been established, through which funds are being disbursed directly to health facilities that are run by local committees, and intersectoral co-ordinating mechanisms for thematic areas like child health, sanitation and malaria have been created. However, the Minister identified challenges in providing universal access to health services, including inadequate funding to the health sector, the influx of refugees from neighbouring countries with weak health systems, high levels of rural-urban migration, the emerging threat of non-communicable diseases, and hard-to-reach terrains which hinder access to health facilities. With regards to the medical brain drain, the Minister urged the developed countries that are the major beneficiaries of health worker migration to support training of health workers in developing countries.
An ongoing Phase 3 study of the efficacy, safety and immunogenicity of candidate malaria vaccine RTS,S/AS01 is being conducted in seven African countries, including Ghana, Kenya, Malawi, Mozambique and Tanzania. From March 2009 through January 2011, 15,460 children were enrolled in two age categories - 6 to 12 weeks and 5 to 17 months old - for vaccination with either RTS,S/AS01 or a non-malaria comparator vaccine. After 250 children had an episode of severe malaria, researchers evaluated vaccine efficacy in both age categories. Vaccine efficacy in the combined age categories was 34.8% during an average follow-up of 11 months. Serious adverse events occurred with a similar frequency in the two study groups. Among children in the older age category, the rate of generalised convulsive seizures after vaccination was 1.04 per 1,000 doses. The researchers conclude that the RTS,S/AS01 vaccine provided protection against both clinical and severe malaria in African children.
The authors of this paper argue that the importance of strong health care systems to fragile nations and the damage done to these systems during conflict receive less attention than they should. They note that the impact of the cycle of violence and poverty on health and health care in fragile states is enormous, to the extent that no low-income fragile or conflict-affected country has yet achieved a single Millennium Development Goal. Although the international community spends billions of dollars each year in aid to these nations, gains have generally been small – without infrastructure and stability, much of this aid is wasted. In conclusion, the authors argue that adequate and equitable provision of quality health care will be met only if health systems and structures are preserved and developed, and if health care personnel have the freedom and safety to provide necessary care to those who need it.
The purpose of this paper was to assess the epidemiology of endemic health care-associated infection (HAI) in Africa. Three databases (PubMed, the Cochrane Library, and the WHO regional medical database for Africa) were searched, of which 19 articles were included in this study, and four abstracts of leading international infection control conferences were also included. The hospital-wide prevalence of HAI varied between 2.5% and 14.8%; in surgical wards, and the cumulative incidence ranged from 5.7% to 45.8%. The largest number of studies focused on surgical site infection, whose cumulative incidence ranged from 2.5% to 30.9%. Data on causative pathogens were available from a few studies only and highlighted the importance of Gram-negative rods, particularly in surgical site infection and ventilator-associated pneumonia. The authors note that limited information is available on the endemic burden of HAI in Africa, even though its frequency is much higher than in developed countries. There is an urgent need to identify and implement feasible and sustainable approaches to strengthen HAI prevention, surveillance and control in Africa.
To demonstrate how reforms at Makerere University College of Health Sciences (MakCHS) can lead to making systemic changes that can improve maternal health services, the university has developed a demand and supply side strategy by working with local communities and national stakeholders. This quasi-experimental trial was conducted in two districts in Eastern Uganda. The supply side component included health worker refresher training and additions of minimal drugs and supplies, whereas the demand side component involved vouchers given to pregnant women for motorcycle transport and the payment to service providers for antenatal, delivery and postnatal care. Analysis from routine health information systems showed that motorcyclists in the community organised themselves to accept vouchers in exchange for transport for maternal care and have become actively involved in ensuring that women obtain care. Maternal care improved, with the number of safe deliveries in the intervention area immediately jumping from less than 200 deliveries/month to over 500 deliveries/month in the intervention arm. Voucher revenues were used to obtain needed supplies and to pay health workers, ensuring their availability at a time when workloads are increasing. The researchers conclude that transport and service vouchers appear to be a viable strategy for rapidly increasing maternal care.
This briefing paper provides an overview of existing literature on the mental health effects of sexual violence and rape, a summary of effective interventions, and outlines a brief research agenda for mental health responses to sexual violence in resource-poor settings. The authors found that, in resource-poor settings, most efforts to strengthen responses to survivors of sexual violence have so far focused on the training of specialised staff based in hospitals or crisis centres who administer limited services – immediate care and a forensic exam – before referring patients to mental health practitioners or social workers for mental health interventions, if the latter are available. Most therapies and treatments for mental health problems have been implemented in the developed world and may require multiple counselling sessions over the long-term with professional staff, but developing countries generally lack capacity to provide psychological interventions. Of the various approaches, evidence consistently points to cognitive behavioural therapies as being more effective in reducing symptoms of post-traumatic stress than counselling. Sexual violence is an under-researched area across the globe but there is a particular lack of research from resource poor countries on the mental health aftermath of sexual violence. The authors call for further research, providing a basic research agenda at the end of the paper.
In this study, researchers examined the factors associated with use of nets owned in Ghana. The data was derived from an August 2008 survey in Ghana of households with a pregnant woman or a guardian of a child under five, conducted during the rainy season. A total of 1,796 households were included, which generated a sample of 1,852 mosquito nets. The final multivariate model consisted of ten variables statistically associated with whether or not the net was used the prior night: rural location, lower socio-economic status, not using coils for mosquito control, fewer nets in the household, newer nets and those in better condition, light blue colour, higher level of education of the guardian of the child under five, knowing that mosquitoes transmit malaria, and paying for the net instead of obtaining it free of charge. The results of this study suggest that net use would increase in Ghana if coloured nets were made available in mass distributions as well as in the commercial market; if programmes emphasise that malaria is caused only by night-biting mosquitoes, and that nets protect against mosquitoes better than coils and need to be used even if coils are burning; if donated nets are replaced more frequently so that households have nets that are in good condition; and if there were support for the commercial market so that those who can afford to purchase a net and want to choose their own nets can do so.
The aim of this paper was to describe the pre-operative surgical case mix among patients undergoing cataract extraction and explore associations between case mix, country level of development (as measured by the Human Development Index, or HDI) and cataract surgery rates (CSRs). Ophthalmologists at 112 eye hospitals (54% of them non-governmental) in 50 countries provided data on 11,048 cataract procedures over nine months in 2008. Patients whose visual acuity (VA) before surgery was < 6/60 in the better eye comprised 47% of the total case mix in poorly developed countries and 1% in developed countries. Overall, 72% of the eyes undergoing surgery had a VA < 6/60. Very low VA before cataract surgery was strongly associated with poor development at the country level and inversely associated with national CSRs. The researchers conclude that the proportion of patients with very poor preoperative VA is a simple indicator that can be easily measured periodically to monitor progress in ophthalmological services. Additionally, the internet can be an effective tool for developing and supporting an ophthalmological research network capable of providing a global snapshot of service activity, particularly in developing countries.
The aim of this paper is to show that current provider-centred models of chronic care are not adequate and to propose 'full self-management' as an alternative for low-income countries. People with chronic life-long conditions need to 'rebalance' their life in order to combine the needs related to their chronic condition with other elements of their life, the authors argue. They have a crucial role in the management of their condition and the opportunity to gain knowledge and expertise in their condition and its management. Therefore, people with chronic life-long conditions should be empowered so that they become the centre of management of their condition. In full self-management, patients take full responsibility for their condition, supported by peers, professionals and information and communication tools. The authors examine two current trends to enhance the capacity for self-management and coping: the emergence of peer support and expert-patient networks, and the development and distribution of smart phone technology.
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8. Human Resources
A stakeholder and sustainability analysis of 25 key informant interviews was conducted among past, current and potential stakeholders of Makerere University College of Health Sciences (MakCHS) to obtain their perspectives and contributions to sustainability of the College in its role to improve health outcomes. Results showed that the College has multiple internal and external stakeholders. Stakeholders from Uganda wanted the College to use its enormous academic capacity to fulfil its vision, take initiative, and be innovative in conducting more research and training relevant to the country’s health needs. External stakeholders felt that MakCHS was insufficiently marketing itself and not directly engaging the private sector or Parliament. Stakeholders also indicated MakCHS could better embrace information technology in research, learning and training, and many also wanted MakCHS to start leadership and management training programmes in health systems. This study points towards the need for MakCHS and other African public universities to build a broad network of partnerships to strengthen their operations, relevance and sustainability.
According to this profile document, health services and functions in Ghana have been decentralised and budget management centres have been created to improve both access to health services and community involvement in planning and delivery of services. There are about 52,258 individuals currently formally working in the health sector in Ghana. The Ministry of Health employs 42,299 staff, which represents about 81.5% of the total health sector workforce. In addition, about 21,791 people countrywide are registered as engaged in traditional medicine, while 367 people are registered as traditional birth attendants. Current human resources policies and plans emphasise the training of more middle-level cadres, which are cheaper to train and maintain. Distribution of health workers is skewed in favour of the more affluent regions, most of which are in the southern half of the country. Highly skilled professionals are concentrated in Greater Accra region, as well as in Korle Bu and Komfo Anokye Teaching Hospitals. Although training of health professionals has been a shared responsibility between the Ministries of Health and Education, there has not been clearly defined roles and collaboration. There is no comprehensive training policy to clarify roles and address issues.
In South Africa’s new human resources for health strategy, eight thematic priorities have been identified to form the strategy’s framework: leadership, governance and accountability; health workforce information and health workforce planning; re-engineering of the workforce to meet service needs; scaling up and revitalising education, training and research; creating the infrastructure for workforce and service development in the form of academic health complexes and nursing colleges; strengthening and professionalising the management of human resources and prioritising health workforce needs; ensuring professional quality care through oversight, regulation and continuing professional development; and improving access to health professionals and health care in rural and remote areas. The strategy aims to ensure necessary and equitable staffing of the health system and to ensure a workforce fit for purpose to meet health needs by: developing health professionals and cadres to meet health and health care needs; ensuring the health workforce has an optimal working environment and rewarding careers; ensuring innovative and efficient recruitment and retention of the health workforce; enabling clinical research which enhances clinical and service development; and providing the organisation and infrastructure for health workforce development. The Strategy also contains forecasts on the numbers of health workers required to fill critical gaps in public health service delivery.
South African health minister Aaron Motsoaledi has announced that R1.24-billion (US$ 155 million) will be spent to ‘revitalise nursing colleges’ and improve infrastructure to train more nurses, as part of the department's new human resource policy. For the current financial year, the department will spend US$27.5 million, and $64 million per year thereafter. A department spokesperson said nursing colleges standing empty would have to be fixed up so that they were fit for use. South African universities currently train 1200 doctors each year. Earlier this year Motsoaledi asked the deans of South Africa's medical schools to each train 40 more students per year. Wits University was the first to do so by taking in an extra 40 at the beginning of the year at the cost of R8-million. The Wits medical faculty dean said the country was short of every type of medical specialist and it would take a long time to fix because it took six to eight years to train specialists after they had qualified as doctors.
In an effort to expand much-needed HIV services in the Ugandan capital of Kampala, the Infectious Disease Institute, an affiliate of Makerere University College of Health Science, has established a community-university partnership with the Ministry of Health to implement an innovative model to build capacity in HIV service delivery. In this paper, the authors evaluate the impact on the nurses from this programme to provide more health care in six nurse-managed Kampala City Council (KCC) Clinics. A mixed method approach was used. The descriptive study collected key informant interviews from the clinics’ six nurse managers, and administered a questionnaire to 20 staff nurses between September and December 2009. Results showed that introducing new HIV services into the KCC clinics was positive for the nurses. They identified the project as successful because of perceived improved work environment, increase in useful in-service training, new competence to manage patients and staff, improved physical infrastructure, provision of more direct patient care, motivation to improve the clinic because the project acted on their suggestions, and involvement in role expansion. All of these helped empower the nurses, improving quality of care and increasing job satisfaction.
9. Public-Private Mix
The Global Business Coalition for Health (GBCHealth), which took part in the United Nations Conference on Non-Communicable Diseases (NCDs) held in New York in September 2011, has argued that companies must have a place at the tables where their future is discussed. GBCHealth, which represents companies that manufacture unhealthy (junk) foods and tobacco products, believes that their expertise is essential to developing public health policy. But activists disagree, arguing instead that industries producing unhealthy products should not be viewed as trusted partners and should not have a seat at the table during public health negotiations. In this open letter, AIDS activist Gregg Gonsalves responds to GBCHealth’s article justifying their right to be part of the negotiations. Though GBCHealth has had a long history of working on HIV and AIDS, he argues that big business cannot be considered representative of civil society, which is largely composed of marginalised groups, civil society organisations and other interested parties whose fight for civil, social and economic rights are not part of big business, whose primary goals are profit oriented. He calls on big business to stop trying to halt generic production of anti-retrovirals and drugs for NCDs (such as Novartis' continuing attempts to alter Indian patent law), to stop selling and promoting cigarettes and to stop advertising and marketing of high-sugar and high-fat foods across the globe.
The United States (US) Department of State, the George W. Bush Institute, the US President’s Emergency Plan for AIDS Relief (PEPFAR), Susan G Komen for the Cure, and the Joint United Nations Programme on HIV/AIDS (UNAIDS) have launched Pink Ribbon Red Ribbon (PRRR), a partnership to leverage public and private investment in global health to combat cervical and breast cancer, the leading causes of cancer death in women in Sub-Saharan Africa and Latin America. The partnership aims to expand the availability of vital cervical cancer screening and treatment and breast care education, notably for women most at risk of getting cervical cancer in developing nations because they are HIV-positive. With initial indications of interest, PRRR expects to have commitments of up to US$75 million across five years, which will grow to include additional participants and services. The goals are to reduce deaths from cervical cancer by an estimated 25% among women screened and treated through the initiative, significantly increase access to breast and cervical cancer prevention, screening and treatment programmes, and create innovative models that can be scaled up and used globally. This public-private initiative includes initial commitments from founding corporate participants Merck, Becton Dickinson, QIAGEN, Caris Foundation, Bristol-Myers Squibb, GlaxoSmithKline and IBM.
Fast food and alcohol advertisements in South Africa could soon be a thing of the past, according to the National Health Department. At a summit held in Johannesburg in September 2011, the Health Minister, Dr Aaron Motsoaledi, highlighted the importance of healthy lifestyles in the fight against non-communicable diseases (NCDs). An Inter-Ministerial Committee on alcohol use and abuse has been set up, aimed at banning alcohol advertising and, despite intense lobbying by the alcohol industry, the Minister has vowed not to change his position. The Minister also aims to target the fast food industry by banning their advertising during children’s television programmes. He says he is working with the relevant industries to make fruit and vegetables cheaper and more accessible, and intends to encourage regular exercise in schools in the form of physical education programmes, citing obesity levels among school children at 23%.
10. Resource allocation and health financing
Tiered pricing - the concept of selling drugs and vaccines in developing countries at prices systematically lower than in industrialised countries - has received widespread global support as a way to improve access to medicines for the poor. Researchers in this study carried out case studies based on a review of international drug price developments for antiretrovirals, artemisinin combination therapies, drug-resistant tuberculosis medicines, liposomal amphotericin B (for visceral leishmaniasis), and pneumococcal vaccines. They found several critical shortcomings to tiered pricing: it is inferior to competition for achieving the lowest sustainable prices; it often involves arbitrary divisions between markets and/or countries, which can lead to very high prices for middle-income markets; and it leaves a disproportionate amount of decision-making power in the hands of sellers rather than consumers. In many developing countries, resources are often stretched so tight that affordability can only be approached by selling medicines at or near the cost of production. Policies that ‘de-link’ the financing of research and development from the price of medicines merit further attention, the authors argue, since they can reward innovation while exploiting robust competition in production to generate the lowest sustainable prices.
The advent of South Africa’s National Health Insurance (NHI) scheme opens up a political space to campaign for a health service that will best address South Africa’s health crisis and reduce the extreme inequities between poor and rich, rural and urban, and public sector and private health service users. The authors argue that such a campaign must counter powerful groups with vested interests who portray public systems as inefficient and second-best, and see the NHI as an opportunity to preserve a private health system (which is innately inequitable because of the need to profit from disease). They further argue that the NHI will not only render health care more accessible and equitable, but also create many more jobs and indirectly improve health by reducing the prevalence and depth of poverty. Rationalisation, standardisation and expansion of the skills of community-based care workers is urgently needed, as is improvement of their insecure employment conditions. The proposed ‘Re-engineering of Primary Health Care’ initiative puts forward a healthcare model that is similar to Brazil’s successful Family Health Programme, and would be substantially cheaper than the current private sector model, and more cost-effective than the current hospital-dominated public sector.
The financial transaction tax (FTT) proposed by France and Germany and due to be discussed in the November G20 Summit, could help save millions of lives if a percentage were allocated to global health, according to an issue brief released today by the international medical humanitarian organisation Medecins Sans Frontieres (MSF). MSF’s issue brief, Five Lives, outlines through five personal stories the transformative impact an FTT allocation to global health could have. The report looks at interventions that can prevent a child from becoming severely malnourished to begin with; protect children from deadly measles outbreaks; prevent a baby from acquiring HIV through childbirth; get people on life-saving tuberculosis treatment sooner; and save lives while dramatically reducing the spread of HIV through treatment. It is estimated the funds raised by an EU FTT could reach 55 billion euros per year. Even a portion of that sum would be a significant boost to tackling global health crises.
The question of how developing countries can improve domestic resource mobilisation (DRM) was one of the main topics under discussion at the latest International Tax Compact (ITC) meeting held from 12 to 14 September 2011 in Bonn, Switzerland. The communiqué identifies five main issues facing developing countries looking to improve DRM: taxation and public financial management; taxation and state-building; taxation for economic growth; extractive resource taxation; and international taxation. Although each of these has been the focus of research, the most interesting questions and issues appear to lie at the intersection of each of these, such as how to align public financial management reforms relating to tax with the objectives of promoting economic growth and state capacity. Many of the issues were touched upon during the ITC meeting, and the discussions highlighted the important research being conducted on both the nature of the challenges developing countries must overcome and the technical and governance aspects of tax reforms. Enhancing tax revenues is not an end in itself, participants emphasised, as taxation is at the centre of resilient state-society relations and must therefore be linked with governance efforts and public service delivery and should be undertaken ‘with an overarching view to make tax systems more pro-poor’.
On 12 September 2011, the European Union (EU) signed a grant for €10 million (US$14 million) with the United nations Children’s Fund (UNICEF), in support of the Essential Medicines Support Programme (EMSP) in Zimbabwe. The money will be used to buy essential drugs and medical supplies which will be distributed to health centres by Natpharm, the supply arm of the Ministry of Health and Child Welfare. Since 2008, availability of essential medicines in Zimbabwe's public health sector has improved largely due to a funding collaboration between the government, UNICEF, the EU, the United Kingdom, Australia, Canada and Ireland. Since 2008, EMSP has received US$52 million in funding, according to UNICEF. The contribution has resulted in 82.5% of the primary health care facilities having 80% of essential medicines available, meaning that there have been virtually no stock outs of essential medicines so far in 2011.
The crowd of health issues jostling for a share of Kenya's inadequate health budget is expanding, with activists calling for an increase in resources for the management of non-communicable diseases (NCDs), which account for more than 50% of hospital deaths and admissions, according to Plus News. At the same time, against a backdrop of two consecutive rejections for funding by the Global Fund to fight AIDS, Tuberculosis and Malaria and flat-lined funding from the United States President's Emergency Plan for AIDS Relief, Kenyan AIDS activists worry that any move to increase funding for NCDs could mean less for HIV and AIDS. Just 440,000 out of 1.5 million HIV-positive Kenyans have access to treatment, and more than 100,000 new HIV infections occur annually. Activists have identified the problem as a combination of scarce resources and a lack of political will by the country’s leadership. They claim that the government pays lip service to the global health issues in vogue – last year it was maternal health, while this year it is NCDs – without any significant improvements in health services. The medical superintendent of Mbagathi District Hospital in Nairobi says government has policies and guidelines in place for the management of NCDs, but there is a lack of strategic focus on operational implementation.
While the Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria has recently come under scrutiny about how well it tracks the money it disburses, the author of this article argues that the Fund represents one of the better examples of global funding initiatives for health. He believes that its high level of transparency sets it apart from other bilateral and multilateral institutions, and it is precisely this transparency and accountability that means that any problems in this regard tend to be widely reported. In early 2011, the Fund commissioned an independent panel to evaluate how it can improve its operations and effectiveness. The panel’s recommendations, which were in line with the Global Fund’s own reform agenda, were met by the Global Fund Board’s commitment in October 2011 to deliver on the recommendations and to continue to adjust practices to use its resources as efficiently as possible. Still, some feel that the Fund isn’t going far enough, saying that even very small amounts of money that cannot be accounted for should be grounds for cutting off that country’s grant monies from the Fund. Yet the author argues here that global funding bodies all face some degree of risk from irregularities and, although the Fund should continue to aspire to the highest degrees of effective stewardship of resources and accountability, a perfect score card is not a practical possibility. He cautions that, in pursuit of such rigorous policies, external funders should be careful of unwittingly stifling innovation and new approaches and ultimately reducing impact on health outcomes.
This document was prepared as a follow-up to the United Nations Summit on Non-communicable Diseases, held in September 2011. It proposes a micro-levy on tobacco products – the Solidarity Tobacco Contribution (STC) – that can be used to generate revenue for Health Ministries. The STC concept builds on and is additional to existing national taxes on tobacco products and broader World Health Organisation (WHO) recommendations for countries to raise their tobacco taxes for public health goals. It does not replace existing national tobacco excise taxes nor does it exclude the need to increase them to WHO‐recommended levels. It is intended to achieve three simultaneous benefits: public health benefits by reducing tobacco consumption and saving lives; a source of revenue to support health; and financial support for international health efforts in developing countries. WHO has conducted an economic feasibility study and has determined that potential revenue from the STC, if applied in 43 countries (G20+), could generate between US$5.5 billion and US$16 billion each year.
11. Equity and HIV/AIDS
Paediatric antiretroviral adherence is difficult to assess, the authors of this paper argue, and subjective measures are affected by reporting bias, which in turn may depend on psychosocial factors such as alcohol use and depression. In this study, they enrolled 56 child caregiver dyads from Cape Town, South Africa, and followed their adherence over one month via various methods. The Alcohol Use Disorder Inventory Tool and Beck Depression Inventory 1 were used to assess participants’ alcohol use and levels of depression and their effect on drug adherence. The median age of the children was four years, and median time on antiretroviral therapy (ART) was 20 months. Increased time on ART was associated with poorer adherence via three-day recall. Alcohol use was inversely associated with adherence. Having a mother as a caregiver and shorter time on highly active antiretroviral therapy (HAART) were significantly associated with better adherence. The authors conclude that paediatric adherence is affected by caregiver alcohol use, but the caregiver’s relationship to the child is most important. This small study suggests that interventions should aim to keep mothers healthy and alive, as well as alcohol-free.
In this study, researchers aimed to assess the prevalence of primary resistance in six African countries after anti-retroviral therapy (ART) roll-out and to determine if wider use of ART in sub-Saharan Africa is associated with rising prevalence of drug resistance. They conducted a cross-sectional study in antiretroviral-naive adults infected with HIV-1 who had not started first-line ART, recruited between 2007 and 2009 from 11 regions in Kenya, Nigeria, South Africa, Uganda, Zambia, and Zimbabwe. Of a total of 2,590 participants, 2,436 (94.1%) had a pretreatment genotypic resistance result. Drug class-specific resistance prevalence was 2.5% for nucleoside reverse-transcriptase inhibitors (NRTIs), 3.3% for non-NRTIs (NNRTIs), 1.3% for protease inhibitors, and 1.2% for dual-class resistance to NRTIs and NNRTIs. The most common drug-resistance mutations were K103N (1.8%), thymidine analogue mutations (1.6%), M184V (1.2%), and Y181C/I (0.7%). The higher prevalence of primary drug resistance in Uganda than in other African countries is probably related to the earlier start of ART roll-out in Uganda, the authors conclude. Resistance surveillance and prevention should be prioritised in settings where ART programmes are scaled up.
HIV-positive children are at high risk of drug resistance, which is of particular concern in settings where antiretroviral options are limited. In this review, the authors explore resistance rates and patterns among children in developing countries in whom antiretroviral treatment has failed. They did a systematic search of online databases and conference abstracts and included studies reporting HIV-1 drug resistance after failure of first-line paediatric regimens in children (<18 years) in resource-poor regions (Latin America, Africa and Asia). They retrieved 1,312 citations, of which 30 studies reporting outcomes in 3,241 children were eligible. Viruses with resistance-associated mutations were isolated from 90% of children. The prevalence of mutations associated with nucleoside reverse transcriptase inhibitors was 80%, with non-nucleoside reverse transcriptase inhibitors was 88%, and with protease inhibitors was 54%. Methods to prevent treatment failure, including adequate paediatric formulations and affordable salvage treatment options are urgently needed, the authors conclude.
There is an urgent need for valid, reliable, and simple-to-use screening tools for HIV-associated dementia (HAD) in South Africa, as little is known about its impact on South Africa's 5.5 million people living with HIV (PLWH). Screening for HAD in South Africa involves several challenges, including a lack of culturally appropriate and validated screening tools and a shortage of trained personnel to conduct screening. This study examined rates of positive HAD screens as determined by the cut-off score on the International HIV Dementia Scale (IHDS) administered by non-specialist community health workers (CHWs) in South Africa and examined associations between positive HAD screens and common risk factors for HAD. Sixty-five HIV-positive individuals on antiretroviral therapy (ART) with low CD4 counts and documented ART adherence problems were administered a battery of demographic, psychiatric and neurocognitive screening measures. Positive HAD screens were present in 80% of the sample. Presence of a current alcohol dependence disorder and CD4 counts of 200 or lower were significantly associated with positive HAD screens. HIV-positive South Africans on ART with low CD4 counts and ART adherence problems may be at a very high risk for HAD, the authors stress, highlighting the need for more routine screening and monitoring of neurocognitive functions among South Africa's millions of PLWH on ART. Future research is needed to validate IHDS performance against a gold standard neurocognitive battery for the detection of HAD and to compare performance of CHWs to expert health care personnel in administering the IHDS.
In recent years, the ways in which HIV and AIDS-focused programmes interact with the delivery of other health services is often discussed, but the evidence as to whether HIV and AIDS programmes strengthen or distort overall health services is limited. The aim of this study was to examine the effect of a PEPFAR-funded HIV and AIDS programme on six government-run general clinics in Kampala, Uganda. Longitudinal information on the delivery of health services was collected at each clinic. Monthly changes in the volume of HIV and non-HIV services were analysed, along with a cross-sectional survey utilising patient exit interviews to compare perceptions of the experiences of patients receiving HIV care and those receiving non-HIV care. All HIV service indicators showed a positive change after the HIV programme began. For non-HIV and AIDS health services, TB lab tests and diagnoses increased significantly, and malaria service indicators also improved. Patients’ overall impressions were positive in both the HIV and non-HIV groups, with more than 90% responding favourably about their experiences. This study shows that when a collaboration is established to strengthen existing health systems, in addition to providing HIV and AIDS services in a setting in which other primary health care is being delivered, there are positive effects not only on HIV and AIDS services, but also on other essential services.
According to Peter Salama, head of the United Nations Children’s Fund (UNICEF) in Zimbabwe, between 6, 000 and 7,000 children die per year in Zimbabwe as a result of HIV and in most cases it is because these children have failed to access paediatric anti-retroviral therapy (ART). The lack of technology meant that many children were not being tested for HIV, Salama said at an AIDS conference in Harare in September 2011. ‘It is important to have an early infant diagnosis as 50% of those children not tested will not be able to reach the age of two,’ he added. About one in seven Zimbabweans is infected with HIV, and about 13% of pregnant women are HIV-positive in Zimbabwe. However, the relatively high costs of medical care and the poor economy means many women give birth at home or never return to hospital for post-natal checkups.
Uganda's longstanding campaigners in its 30-year fight against HIV have expressed discontent with the government's treatment and prevention approaches. Milly Katana, a long-term activist and one of the inaugural board members of the Global Fund to fight HIV, Tuberculosis and Malaria, said that while the injection of millions of dollars had saved lives through treatment, it had also commercialised the industry, leaving it open to abuse by those not truly interested in defeating the epidemic. For Rubaramira Ruranga, executive director of the National Guidance and Empowerment Network of People Living with HIV/AIDS in Uganda, the lack of proper co-ordination at the top of the HIV response has led to disorganisation in the rest of the sector. He noted that Uganda has strong policies to fight HIV, that are not fully implemented. Gideon Byamugisha, founder member of the International Network of Religious Leaders Living with and Personally Affected by HIV/AIDS, argued that the focus on prevention through safe sex has meant that the 21% of new infections that occur through mother-to-child transmission are being overlooked.
12. Governance and participation in health
The author of this article argues that, in Africa, some governments have dodged their responsibility to implement famine-prevention measures because they require a socio-political contract between the government and civil society that allows citizens to hold governments accountable for famine. Instead, through their inaction and acceptance of foreign aid, governments have ceded that responsibility to non-government organisations (NGOs) and ‘foreign technical experts’ with a narrower definition of social responsibility and far less vested interest in the well-being of citizens. In the last sixty years, well over a trillion dollars of ‘development aid’ has been transferred from the West to African nations, but the author cautions that this aid comes at a cost: donor dependency, corruption and lack of incentive for governments to govern well and efficiently. In fact, NGOs may well be in competition with African governments as they provide goods and services that the governments do not. As NGOs step in and fill the gaps with their foreign-funded resources and growing presence and capacities, the legitimacy of aid-recipient states is called into question. Arguably, the legitimacy crisis of NGOs is in tandem with the legitimacy crisis of African governments. Because the provision of public goods and resources is part of the socio-political contract between the government and civil society, NGOs do risk undermining the legitimacy of the government. On the flip side, the legitimacy of foreign-funded NGOs comes under question when the interests of their international and surpranational funders conflict with national interests.
This report draws on the results of the 2011 Survey on Monitoring the Paris Declaration, building on similar surveys undertaken in 2006 and 2008. A total of 78 countries and territories volunteered to participate in the final round of surveys, which look at the state of play in 2010. The results indicate that, at the global level, only one out of the 13 targets established for 2010 – co-ordinated technical co-operation (a measure of the extent to which external funders co-ordinate their efforts to support countries’ capacity development objectives) – has been met, albeit by a narrow margin. Nonetheless, it is important to note that considerable progress has been made towards many of the remaining 12 targets. Globally, the survey results show much variation in the direction and pace of progress across external funders and partner countries since 2005. For the indicators where responsibility for change lies primarily with developing country governments, progress has been significant. For example, improvements have been made in the quality of tools and systems for planning and for financial and results management in a number of developing countries, often requiring deep reforms that go beyond aid management to broader aspects of government processes.
Representatives of over seventy national, regional and global civil society organisations met at the CIVICUS World Assembly held in Montreal, Canada, on 11 September 2011. A number of key points arose from the meeting including the need for civil society leadership to frame the discussion and guide the process on the post-2015 global agenda, and the need for a new global vision for the people and the planet that is radical, ambitious and universal. The vision should be strongly rooted in and use International Human Rights instruments as the basis for accountability, and should also be universal in its application across the north and the south and address the redistribution of wealth. It should empower communities on the ground to claim their entitlements and should aim at equity, with explicit commitments towards women and traditionally excluded groups. Furthermore, the vision should be holistic and address the issues of human rights, inequality, gender justice and environmental sustainability. Participants at the Assembly called on the United Nations (as opposed to other global fora such as the G20) to lead the process, with the UN Secretary General providing personal leadership on the post-2015 agenda. Until the end of 2015, civil society will aim to work together to develop a unifying, coherent global agenda and take action to influence the positions of national governments and the UN, participants concluded.
Corruption is eroding the benefits of good health projects in Africa and governments must look inwards for funding, the World Health Organisation (WHO), has said. In a meeting with African Ministers of Health and Ministers of Finance on 30 August 2011 in Yamoussoukro, Cote d’Ivoire, WHO said solving the problem of funding was necessary for the health sector to thrive in the continent. Director-General of WHO, Margaret Chan, said proper harnessing and utilisation of resources would reduce the dependence on external funders for sponsoring health projects. Chan said the inclusion of these funders in health budgets posed challenges as most of them would weigh options and zero in on areas of interest and priority, which did not necessarily align with government objectives. She said most external funders gave little notice before shifting their targets, thereby creating huge gaps for funding in the countries. She added that ‘health care has to be regulated so that the private sector provides good services without ripping the people off,’ emphasising that health care projects must not be built only on the principle of attracting funds from politicians, but on principles of effectiveness and sustainability.
The current financial crisis in Swaziland is so severe that aid agencies are predicting that in the absence of major new loan, a humanitarian crisis could develop within the next few months. Stocks of antiretrovirals have fallen dramatically, reportedly standing at one month's supply, despite Swaziland having the world's highest prevalence of HIV (26.1%), with 70% of the population below the poverty line. However the author reports that loans and other resources are not reaching those with greatest need, and that wide inequalities in wealth exist.
The Students’ Health Advocacy Project (SHAP) is a community outreach programme of HEPS-Uganda, a health consumers' organisation advocating for health rights and responsibilities that is also a member of the EQUINET network. SHAP targets schools in Rubaga Division to make the students aware of their health rights and responsibilities. This has been going on since 2010. So far, SHAP activities have been conducted in a few schools and for some schools a follow up has been made from the previous outreach made to them, specifically Bright Angels College. The new members of the health club in this school showed great interest in the activities carried out by SHAP and HEPS Uganda. The two organisations are currently refining the programme to make it more focused on raising students’ awareness of their basic health rights. The SHAP team is also working on expanding its activities to various schools in Rubaga and this has been effected through delivering letters so that dates can be scheduled for SHAP to take their presentations to the targeted schools.
13. Monitoring equity and research policy
In this study, researchers investigated the alignment of health research capacity at Makerere College of Health Sciences (MakCHS) with the health needs and priorities of Uganda, as outlined in the country’s Health Sector Strategic Plan (HSSP). They assessed MakCHS’s research grants and publication portfolio, as well as all the university’s publications, between January 2005 and December 2009. A total of 58 active grants were identified, of which 18 had been initiated prior to 2005 and there were an average of about eight new grants per year. Most grants funded basic and applied research, with major focus areas being HIV and AIDS (44%), malaria (19%), maternal and child health (14%) and tuberculosis (11%). A total of 837 publications were identified, with an average of 167 publications per year, 66% of which addressed the country’s priority health areas, and 58% had MakCHS faculty members or students as first authors. Findings indicate that the research grants and publications at MakCHS are generally well-aligned with Ugandan Health Ministry priorities. Greater efforts to establish centralised and efficient grants management procedures are needed, the researchers argue. In addition, efforts are needed to expand capacity for MakCHS faculty leadership of grants, as well as to continue to expand the contribution of MakCHS faculty to lead research publications.
In this study, reproductive-age women were recruited from the Butajira Demographic Surveillance System (DSS) database to analyse the determinants of fertility in rural Ethiopia. A district health survey maternity history questionnaire was administered to 9,996 participants. Results showed that delayed marriage, a higher level of education, a smaller family, absence of child death experience and living in food-secured households were associated with a smaller number of children. Fertility was significantly higher among women with no child-sex preference. However, migration status of women was not statistically significant. The researchers argue that policy makers should focus on increasing women’s secondary school enrollment and age at first marriage. The community should also be made aware on the negative impact of fertility on household economy, the environment and the country's socio-economic development at large.
The World Intellectual Property Organisation (WIPO), in conjunction with the World Health Organisation, private sector and foundation partners, is preparing to launch a new voluntary database for the sharing of intellectual property for research and development (R&D) on medicines, vaccines and diagnostics for neglected diseases. The project will target least-developed countries and is likely to include a database and a space for creating partnerships. But budget, oversight and the role of member states are still unclear. The aim of the initiative is to boost discovery and development of medicines, vaccines and diagnostics for neglected tropical diseases plus malaria and tuberculosis through greater availability of intellectual property to researchers.
The World Intellectual Property Organisation (WIPO) has joined the Research4Life partnership, which enables free or low-cost online access in the developing world to vital scientific research. With a particular focus on applied science and technology, Access to Research for Development and Innovation (ARDI) seeks to reinforce the capacity of developing countries to participate in the global knowledge economy and to support researchers in developing countries in the innovation process to create and develop new solutions to technical challenges faced on local and global levels. ARDI includes a growing network of Technology and Innovation Support Centres (TISCs) based in universities and research centres around the world, whose trained staff support local users in effectively accessing and exploiting technological knowledge.
14. Useful Resources
A laboratory that will research and monitor emerging infectious diseases (EIDs) such as yellow fever and dengue has been set up in East Africa in an attempt to tackle growing vector-borne health threats in the region. The Martin Lüscher Laboratory for Emerging Infectious Diseases was launched with support from the German and Swiss governments at the International Centre of Insect Physiology and Ecology (ICIPE) in Kenya on 16 September 2011, and is expected to add capacity to respond to disease outbreaks. According to a researcher at ICIPE, the laboratory will improve risk detection, response capacity and research capability for key insect-transmitted diseases in Kenya and the region. It will also train MSc and PhD students under the centre's capacity building programmes.
This paper describes a new financial planning tool developed by the World Health Organisation (WHO) to assist low- and middle income-countries in scaling up a core set of interventions to tackle non-communicable diseases (NCDs).The tool can be used to forecast resource needs at national and sub-national levels. It can enhance traditional budgeting mechanisms in countries and provide new information to development agencies about the resources needed to tackle the growing burden of NCDs. The tool has been used to produce a ‘price tag’ for a combined set of population-based and individual level ‘best buy’ NCD interventions that have been identified as priority actions by WHO. The average yearly cost for all low- and middle-income countries is estimated to be US$11.4 billion over the period 2011-2025. The cost per head of population is low, representing an annual investment of under US$1 in low-income countries and US$1.50 in lower middle-income countries. Expressed as a proportion of current health spending, the cost of implementing such a package amounts to 4% in low-income countries and 2% in lower middle-income countries. Population-based ‘best buy’ interventions address tobacco and harmful alcohol use, as well as unhealthy diet and physical inactivity.
15. Jobs and Announcements
In line with its mandate to promote high-level scientific and academic debates on various aspects of socio-economic development in Africa, the Council for the Development of Social Science Research in Africa (CODESRIA) hereby announces the 2011 edition of its Gender Symposium which will be held from 1-3 November, 2011, in Cairo, Egypt. The Gender Symposium is a forum organised annually by CODESRIA to discuss gender issues in Africa, and the theme of this year’s edition is Gender and the Media in Africa.
The University of Oxford is seeking applications from students ordinarily resident in South Africa for the 2012 Oppenheimer Fund Scholarships to pursue graduate studies in a variety of fields at Oxford. The Oppenheimer Fund Scholarships are available for ordinarily resident South African students wishing to start any new degree bearing course, with the exception of Post Graduate Certificate and Post Graduate Diploma courses, at the University of Oxford.
The International Development Research Centre and the Canadian Global Tobacco Control Forum are calling for concept notes concerning the expansion of fiscal policies for global and national tobacco control. The key objective of this call is to generate knowledge designed to accelerate the adoption of effective fiscal policies for tobacco control in low-and middle-income countries (LMICs). Key thematic areas include: research on the impact of various types of tobacco taxes or pricing policies; region-based research to establish actual and model budgets for tobacco control; research on coordinated regional and global taxes, tariffs and/or other levies on tobacco products and the profits from tobacco sales; and research to identify barriers to, and strategies for, accessing Official Development Assistance for tobacco control. The principal applicant must be a citizen or permanent resident of a LMIC and with a primary work affiliation in a LMIC institution.
The International Development Research Centre is calling for concept notes concerning the promotion of healthy diets as a key strategy for the prevention of non-communicable diseases (NCDs) in low- and middle-income countries(LMICs). The key objective of this call is to support Southern-led research designed to influence the adoption and implementation of effective policies and programmes for the promotion of healthy diets in LMICs. Key thematic areas include: research on policies, population-wide programs and community-based interventions that aim to discourage production and consumption unhealthy food products and promote healthy eating; and evidence syntheses or situation analyses to inform policy dialogues and the adoption and implementation of key interventions to address unhealthy diets as a key NCD risk factor. Please note that three major cross-cutting issues are central to the NCD programme: equity, intersectoral action and commercial influence on public health-related policy. The principal applicant must be a citizen or permanent resident of a LMIC and with a primary work affiliation in a LMIC institution.
The Alliance for Health Policy and Systems Research, in collaboration with the Symposium Secretariat, is organizing the technical programme for the Second Global Symposium on Health Systems Research: Inclusion and Innovation Towards Universal Health Coverage Beijing, China - 31 October - 3 November 2012 and is asking for feedback on the draft programme overview.
At the Fourth High-Level Forum on Aid Effectiveness, approximately 2,000 delegates will review global progress in improving the impact and effectiveness of aid, and make commitments that set a new agenda for development. The Forum follows meetings in Rome, Paris and Accra that helped transform aid relationships between donors and partners into true vehicles for development cooperation. Based on 50 years of field experience and research, the five principles that resulted from these fora encourage local ownership, alignment of development programmes around a country’s development strategy, harmonisation of practices to reduce transaction costs, the avoidance of fragmented efforts and the creation of results frameworks.
The Youth Initiative of the Open Society Foundations (OSF) is currently seeking proposals from eligible registered NGO’s for up to US$10,000 in funding to develop and curate thematic pages on a new global youth portal and community being developed at www.youthpolicy.org. Youthpolicy.org aims to consolidate knowledge and information on youth policies across the international sector, ranging from analysis and formulation to implementation and evaluation. Themes include, but are not limited to: participation and citizenship; activism and volunteering; children and youth rights; youth with disabilities; global drug policy; community work; research and knowledge; informal learning; youth, environment and sustainability; multiculturalism and minorities; and youth justice.
Forum 2012 will bring together key actors to make research and innovation work for health, equity and development: governments, industry, social enterprise, non-governmental organisations, researchers, media, funders , international organisations and others. Partipcipants will explore who will explore ways to go ‘beyond aid’ by building on the rapidly expanding research and innovation capacity of low- and middle-income countries as basis for development. The Forum has three main themes: improving and increasing investments in research and innovation; networking and partnerships in research, technological innovations, social innovations and delivery of better health care; and improvement of health, equity and development of low-income countries by creating a supportive environment, including priority setting in research for health, fair research contracting, research cooperation and ethics, nanotechnologies, technological and social innovations, and using the web as a tool for planning research.
SEYCOHAIDS 2012 is the largest international gathering for young people on HIV and AIDS in the Eastern and Southern Africa region, where young researchers, policy makers, activists, educators and people living with HIV will be able to link with people in other countries and meet to share and learn about HIV prevention methods, treatments, care policies and programmes relating to HIV and AIDS in Africa. The broad objectives for the Conference are to: ensure effective and meaningful youth participation in international AIDS response; identify gaps and challenges in government policies in providing youth-friendly HIV and AIDS services; develop regional and country-level strategic programmes for youth and HIV and AIDS; identify and build the capacity of new and emerging youth leaders for the AIDS response to ensure sustainability of youth initiatives at the national, regional and international levels; sustain adult-youth partnerships and dialogue; develop the Southern and Eastern Africa youth network on HIV and AIDS; develop country specific youth networks on HIV and AIDS; establish funding mechanisms for regional and country youth networks; and monitor government and donor commitments to youth and HIV and AIDS. Applicants must be no older than 35 years old at the time of the application.
The 2011 PHASA conference will have as its focus, a scientific debate and discussion on health inequities and the role of public health leadership, education and practice in reducing health equity gaps. The theme of the conference is "Closing the health equity gap: Public health leadership, education and practice". A programme of local and international speakers will include policy-makers, leading local and international academics and representatives of international organisations. There are five conference tracks: the social determinants of health; burden of disease and population health; performance of the health system; public health leadership and education; and community action and best practices.
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