EQUINET NEWSLETTER 156 : 01 February 2014

1. Editorial

Universal Health Coverage: Uncovering the neoliberal agenda
Amit Sengupta, National Co-convenor, Jan Swasthya Abhiyan, India

It is time to raise critical questions around the wide and growing enthusiasm for Universal Health Coverage (UHC), which is increasingly seen as a silver-bullet solution to health care needs in low- and middle-income countries. Although confusion still exists as to what UHC actually means, international development agencies typically define it as a health financing system based on pooling of funds to provide health coverage for a country’s entire population, often in the form of a ‘basic package’ of services made available through health insurance and provided by a growing private sector.

Global health agencies such as the World Health Organization, and international financial institutions such as the World Bank, are promoting this approach in response to the rise in catastrophic out-of-pocket expenditure for health services, and in the face of crumbling public health systems in the global South (both of which were precipitated by the fiscal austerity imposed by organizations such as the World Bank and the International Monetary Fund in the 1980s and early 1990s). In this new model, UHC prescribes a clear split between health financing and health provision, allowing for the entry of private insurance companies, private health providers and private health management organizations. The logic is that health care challenges require an immediate remedy, and since the public system is too weak to respond, it is strategic to turn to the private sector.

In short, the UHC model is built on, and lends itself to, standard neoliberal policies, steering policy makers away from universal health options based on public systems. Building and improving the public healthcare system is not part of this mainstream narrative, with the state generally confined to managing the system.

Although these programs are now zealously promoted by global health agencies, the evidence to support their implementation remains extremely thin. Giedion, Alfonso and Díaz in a review of existing evidence for the World Bank published in 2013 observed that reliable data upon which to evaluate their performance are hard to come by and methodologies designed to collect good evidence are singularly lacking, illustrated by the highly contested data of some early health reforms based on universal insurance in the South (e.g. Chile, Colombia and Mexico), which have nonetheless been used to legitimize the current UHC agenda.

In a paper recently published by the Municipal Services Project, we argue that secure finances for health care are a necessary but insufficient condition for systems that are equitable and provide good quality care. We analyze the reasons why finances need to be channeled through well-designed public systems if they are to be spent efficiently. We further argue that, in glossing over the importance of public provisioning of services, many proponents of UHC are actually interested in the creation of health markets that can be exploited by capital.

In Europe, 20th-century reforms have intensified health being delivered as a market commodity. The more recent experiences of Brazil’s SUS, India’s Arogyasri and Thailand’s Universal Health Care Coverage scheme all show features of this neoliberal model, within very diverse settings and reforms. They all show a persistence or expansion of private sector participation in provision of care, despite the fact that all are tax-funded health systems. In all cases, public funding does not match needs and this opens space for the progressive creep of the private sector into the larger health system. In Brazil, while the SUS has expanded public primary care services, hospital care remained largely publicly paid and privately provided. Despite a strong policy commitment to universal public sector health systems in Brazil and Thailand, the neoliberal ethos and its promotion of private provisioning appears too strong to shake off. Consequently all three countries have a powerful private for profit sector in health. This influences the functioning of the system as a whole, ratcheting up costs, jeopardizing the integrity of the public sector and drawing away resources, both financial and human, from resource-starved public facilities.

The three countries typify the challenges that LMICs face while attempting to construct universal systems that borrow from the internal logic of a UHC that is not based on public systems, where ideological pressures prevent the adoption of an entirely public system of care provision. The challenges of providing high quality and equitable health care are most acute in low and middle-income countries because of faster growing populations, higher prevalence of infectious diseases, and growing burdens of non-communicable illnesses. We would argue that re-imagining public health care – rather than the private sellout of health systems via a neoliberal agenda in UHC – is the only way forward in building truly universal health outcomes.

Please send feedback or queries on the issues raised in this briefing to the EQUINET secretariat: admin@equinetafrica.org. For more information on the issues raised in this op-ed please see the Municipal Services Project website at www.municipalservicesproject.org and the MSP Occasional Paper, ‘Universal Health Coverage: Beyond Rhetoric’ at: http://www.municipalservicesproject.org/publication/universal-health-coverage-beyond-rhetoric.

2. Latest Equinet Updates

EQUINET work on Global Engagement in Health
EQUINET Cluster on Engaging globally on regional priorities for health equity

In 2014 EQUINET and partners are finalising and reporting work in case study areas of global engagement in health that were defined as priorities in global health diplomacy (GHD) by senior officials and Ministers in 2011 for the region. The three case study areas are:
1. Implementation of the WHO Code on international Recruitment of health personnel:
2. Collaborating on access to essential drugs through south- south relationships with China, Brazil and India:
3. The involvement of African actors in global health governance on universal access to prevention and treatment for HIV and AIDS
The research work is being finalised and the evidence will be shared through policy dialogue forums, drawing strategic advice on and peer review of the work, and through regional review meetings and peer reviewed publication. If you are working on or interested in these areas please visit the website for publications produced to date or contact the EQUINET secretariat.

3. Equity in Health

Community Level Risk Factors for Maternal Mortality in Madagascar
Hernandez JC, Moser CM: Afr J Reprod Health 17[4]: 118-129, December 2013

This paper explores the effect of risk and socioeconomic factors on maternal mortality at the community level in Madagascar using a unique, nationwide panel of communes (i.e., counties). Previous work in this area uses individual or cross-country data to study maternal mortality, however, studying maternal mortality at the community level is imperative because this is the level at which most policy is implemented. The results show that longer travel time from the community to the hospital leads to a high level of maternal mortality. The findings suggest that improvement to transportation systems and access to hospitals with surgery rooms are needed to deal with obstetric complications and reduce maternal mortality.

4. Values, Policies and Rights

Reproductive Health and the Question of Abortion in Botswana: A Review
Smith SS: Afr J Reprod Health 17[4]: 26-34, December 2013

The complications of unsafe, illegal abortions are a significant cause of maternal mortality in Botswana. The stigma attached to abortion leads some women to seek clandestine procedures, or alternatively, to carry the fetus to term and abandon the infant at birth. The author reports in this paper on research into perceptions of abortion in urban Botswana in order to understand the social and cultural obstacles to women’s reproductive autonomy, focusing particularly on attitudes to terminating a pregnancy. She carried out 21 interviews with female and male urban adult Batswana. The article presents a review of the abortion issue in Botswana based on the research. She notes that restrictive laws must eventually be abolished to allow women access to safe, timely abortions. The findings however, suggest that socio-cultural factors, not punitive laws, present the greatest barriers to women seeking to terminate an unwanted pregnancy. These factors must be addressed so that effective local solutions to unsafe abortion can be generated.

The Justiciability and Enforcement of the Right to Health under the African Human Rights System
Bahar J: Haramaya Law Review, 1(2): 29-50, 2013

The right to health is a fundamental human right which is recognized in international and regional human rights systems. The African Human Rights System is also duly recognized the right to health. Although recognizing the right in the human rights instrument is important, the meaningful protection of the right needs appropriate and consistent interpretation and adequate implementation mechanisms. This article scrutinizes the Justiciability and Enforcement of the right to health in the African Human Rights System. Based on analysis of relevant African Human Rights Instruments, literatures and cases of African Commission, the author argues that the justiciability of the right to health in African Human Rights System is upheld. Regarding its enforcement, the article argued that there are relevant institutional frameworks in African human rights systems and African political architecture. Hence, the enforcement of the right to health falls squarely in most of these institutions’ mandate.

The need for an ethical and political de-colonization of human rights
Baraka A: Pambazuka News 659, 18 December 2013

There is growing dissatisfaction and even mistrust of human rights as an instrument for radical social change. The author argues that what is needed is a revolutionary approach to human rights informed by an analysis of the oppressive, anti-human social/historical context of national and global social relationships. For many social justice activists, moral contradictions in thye use of rights frameworks by both Western and non-Western states has created dissatisfaction and even mistrust of human rights as an instrument for radical social change. A “people-centered human rights” concept and approach has been developing, based on the communitarian principles of social solidarity, cooperation, non-discrimination in all social relationships, collective public ownership of the earth’s resources, respect for difference, self-determination of all peoples’ and the recognition and respect for the inherent dignity of all individuals and people’s.

5. Health equity in economic and trade policies

A decade of tobacco control: The South African case of politics, health policy, health promotion and behaviour change
Reddy PD, James S, Sewpaul R, Yach D, Resnicow K, Sifunda S, Mthembu Z, Mbewu A: South African Medical Journal, 103 (11):835-840, November 2013

The South African (SA) government has implemented comprehensive tobacco control measures in line with the requirements of the Framework Convention on Tobacco Control. The effect of these measures on smoking prevalence and smoking-related attitudes, particularly among young people, is largely unknown. This paper describes the impact of a comprehensive health promotion approach to tobacco control amongst SA school learners with evidence from four successive cross-sectional Global Youth Tobacco Surveys (GYTSs) in 1999, 2002, 2008 and 2011 among nationally representative samples of SA grades 8 - 10 school learners. Smoking-related attitudes and behaviours showed favourable changes over the survey period. The surveys demonstrated that the comprehensive and inter-sectorial tobacco control health promotion strategies implemented in SA have led to a gradual reduction in cigarette use amongst school learners. Of concern, however, are the smaller reductions in smoking prevalence amongst girls and black learners and an increase in smoking prevalence from 2008 to 2011. Additional efforts, especially for girls, are needed to ensure continued reduction in smoking prevalence amongst SA youth.

Alcohol marketing in Africa: not an ordinary business
Obot IS: African Journal of Drug and Alcohol Studies, 12(1), 2013

Alcohol was the cause of nearly five million deaths globally in 2010, an increase of over one million deaths recorded ten years earlier. It was the leading risk factor for disease in southern sub-Saharan Africa (SSA). Several factors account for the increasing harm associated with alcohol in Africa among which are the availability of a wide variety of alcoholic beverages, rising urban populations, more disposable income to purchase alcohol, and unrestrained marketing and promotion of alcohol. Using a variety of strategies, producers of alcohol target young people and women with aspirational messages and other exhortations in an onslaught of marketing and promotion. The author argues that missing in the discussion on alcohol in most African countries is the understanding that alcohol marketing is not an ordinary economic activity and that the business of alcohol (an addictive substance with high potential for harm) can subvert individual rights and democratic principles. This paper discusses these issues with particular attention to the harms caused by alcohol (to drinkers and non-drinkers alike), the potential for far-reaching harms to individuals and the society at large if the present scenario continues, and how these harms can be averted or minimized with the implementation of evidence-based policies.

6. Poverty and health

The economic costs of malaria in children in three sub-Saharan countries: Ghana, Tanzania and Kenya
Sicuri E, Vieta A, Lindner L, Constenla D and Sauboin C: Malaria Journal 12(307): 3 September 2013

Malaria causes significant mortality and morbidity in sub-Saharan Africa (SSA), especially among children less than five years of age (U5 children). Although the economic burden of malaria in this region has been assessed previously, the extent and variation of this burden remains unclear. This study aimed to estimate the economic costs of malaria in U5 children in three countries (Ghana, Tanzania and Kenya). Health system and household costs previously estimated were integrated with costs associated with co-morbidities, complications and productivity losses due to death. Several models were developed to estimate the expected treatment cost per episode per child, across different age groups, by level of severity and with or without controlling for treatment-seeking behaviour. Total annual costs (2009) were calculated by multiplying the treatment cost per episode according to severity by the number of episodes. Annual health system prevention costs were added to this estimate. Household and health system costs per malaria episode ranged from approximately US$ 5 for non-complicated malaria in Tanzania to US$ 288 for cerebral malaria with neurological sequelae in Kenya. On average, up to 55% of these costs in Ghana and Tanzania and 70% in Kenya were assumed by the household, and of these costs 46% in Ghana and 85% in Tanzania and Kenya were indirect costs. Expected values of potential future earnings (in thousands) lost due to premature death of children aged 0–1 and 1–4 years were US$ 11.8 and US$ 13.8 in Ghana, US$ 6.9 and US$ 8.1 in Tanzania, and US$ 7.6 and US$ 8.9 in Kenya, respectively. The expected treatment costs per episode per child ranged from a minimum of US$ 1.29 for children aged 2–11 months in Tanzania to a maximum of US$ 22.9 for children aged 0–24 months in Kenya. The total annual costs (in millions) were estimated at US$ 37.8, US$ 131.9 and US$ 109.0 nationwide in Ghana, Tanzania and Kenya and included average treatment costs per case of US$ 11.99, US$ 6.79 and US$ 20.54, respectively. This study provides important insight into the economic burden of malaria in SSA that may assist policy makers when designing future malaria control interventions.

7. Equitable health services

"I just answer 'yes' to everything they say": Access to health care for deaf people in Worcester, South Africa and the politics of exclusion
Kritzinger J, Schneider M, Swartz L and Braathen SH: Patient Educ Couns. 14. pii: S0738-3991(13)00520-X. December 2013

This paper explored whether there are other factors besides communication difficulties that hamper access to health care services for deaf patients. Qualitative methodology applied semi-structured interviews with 16 deaf participants from the National Institute for the Deaf in Worcester and 3 Key informants from the Worcester area, South Africa. Communication difficulties were found to be a prominent barrier in accessing health care services. In addition to this interpersonal factors including lack of independent thought, over-protectedness, non-questioning attitude, and lack of familial communication interact with communication difficulties in a way that further hampers access to health care services. These interpersonal factors play a unique role in how open and accepting health services feel to deaf patients. Health care services need to take cognizance of the fact that providing sign language interpreters in the health care setting will not necessarily make access more equitable for deaf patients, as they have additional barriers besides communication to overcome before successfully accessing health care services.

Mobile phones improve antenatal care attendance in Zanzibar: a cluster randomized controlled trial
Lund S, Nielsen BB, Hemed M, Boas IM, Said A, Said K, Makungu MH and Rasch V: BMC Pregnancy Childbirth. 17;14(1):29 January 2014

Applying mobile phones in healthcare is increasingly prioritized to strengthen healthcare systems. Antenatal care has the potential to reduce maternal morbidity and improve newborns' survival but this benefit may not be realized in sub-Saharan Africa where the attendance and quality of care is declining. This study evaluated the association between a mobile phone intervention and antenatal care in a resource-limited setting. It aimed to assess antenatal care in a comprehensive way taking into consideration utilisation of antenatal care as well as content and timing of interventions during pregnancy. The wired mothers' mobile phone intervention significantly increased the proportion of women receiving the recommended four antenatal care visits during pregnancy and there was a trend towards improved quality of care with more women receiving preventive health services, more women attending antenatal care late in pregnancy and more women with antepartum complications identified and referred. Mobile phone applications may contribute towards improved maternal and newborn health and should be considered by policy makers in resource-limited settings.

8. Human Resources

Brain Drain: Advocating to Alleviate the Global Health Worker Migration Crisis.
Chen J, Hampson S, Robertson A: Student Voices 5; McMaster Health Forum, March 2013

In this paper, the authors evaluate various policy options to address the global health worker migration crisis, which include: financial and technical support from destination countries; bilateral and multilateral agreements between states; creation of self-sufficient healthcare systems; and collection of reliable migration data. Implementation requires the support of key stakeholders such as the World Health Organisation, member states, and other international organisations. However, there are many obstacles to policy change, including the power disparities between source and destination countries, ethical sensitivity of policies, financial incentives, lack of data collection, and limited international cooperation.

International codes of medical recruitment: evolution and efficiency
Cehan I and Manea T: Romanian Journal of Bioethics, 10(1): 100-109, March 2012

The international migration of healthcare professionals has increased in the last decade, increasing the medical staff crisis in low income countries. The World Health Organisation adopted in 2010 The Global Code of Practice on the International Recruitment of Health Personnel to use it as a landmark for establishing and improving the necessary legal framework of medical staff international recruitment. This paper highlights analyses the effectiveness of codes on health worker recruitment, and the consequences that might result from disobeying them.

9. Public-Private Mix

Using the Right to Health to Enforce the Corporate Responsibilities of Pharmaceutical Companies with Regard to Access to Medicines
Oke E: Journal of Health Diplomacy (1) 1: July 2013

This paper seeks to determine how the corporate responsibilities of pharmaceutical companies in relation to access to medicines can be clarified and enforced. Two cases, one each from India and South Africa, are examined to determine how the domestic courts in both countries indirectly utilized the right to health to ensure that pharmaceutical companies did not impede access to affordable medicines through exercising their patent rights. There is a need to clarify and enforce the responsibilities pharmaceutical companies have to promote the right to health. The two cases from India and South Africa demonstrate the potentials of domestic courts as forums where these responsibilities can be effectively enforced. In the absence of a global enforcement mechanism for enforcing the right-to-health responsibilities of pharmaceutical companies, domestic courts can effectively fill this gap. In addition, this paper demonstrates that domestic courts can equally serve as forums for health diplomacy.

Wrangle may delay healthcare inquiry
Visser A: Business Day Live. 6 January 2014

On the eve of the landmark inquiry into the private healthcare industry in South Africa, the Netcare group is challenging the Competition Commission's use of professional services firm KPMG as its technical service provider for the investigation. The commission originally suggested the market inquiry into the private healthcare industry after concerns were expressed that certain factors in the sector prevent, distort or restrict competition. Health Minister Aaron Motsoaledi has been particularly vocal in expressing his disquiet about the matter. The market inquiry provision in the Competition Act became effective last year and paved the way for the introduction of an inquiry into private healthcare. The provision will allow the commission to initiate an inquiry if it has reason to believe that any feature of a market distorts or restricts competition. Unlike the 2006 inquiry into banking costs, which required the banks’ voluntary co-operation, the commission now has wide-ranging powers to summon people to testify or to provide documents. It will be able to call for any information it may deem relevant and may initiate a complaint against a firm based on what it gathers during the inquiry. The final terms of reference for the competition authorities’ private healthcare inquiry were published at the end of last year. They included looking at possible cost drivers such as pharmaceutical manufacturers, medical equipment and the inter-relationship between the public and private healthcare systems.

10. Resource allocation and health financing

Feasibility of introducing compulsory community health fund in low resource countries: views from the communities in Liwale district of Tanzania
Marwa B, Njau B, Kessy J and Mushi D: BMC Health Services Research 13(298): 8 August 2013

In 1995, Tanzania introduced the voluntary Community Health Fund (CHF) with the aim of ensuring universal health coverage by increasing financial investment in the health sector. The uptake of the CHF is low, with an enrolment of only 6% compared to the national target of 75%. Mandatory models of community health financing have been suggested to increase enrolment and financial capacity. This study explores communities’ views on the introduction of a mandatory model, the Compulsory Community Health Fund (CCHF) in the Liwale district of Tanzania. A cross-sectional study which involved 387 participants in a structured face to face survey and 33 in qualitative interviews (26 in focus group discussions (FGD) and 7 in in-depth interviews (IDI). Structured survey data were analyzed using SPSS version 16 to produce descriptive statistics. Qualitative data were analyzed using content analysis. 387 people completed a survey (58% males), mean age 38 years. Most participants (347, 89.7%) were poor subsistence farmers and 229 (59.2%) had never subscribed to any form of health insurance scheme. The idea of a CCHF was accepted by 221 (57%) survey participants. Reasons for accepting the CCHF included: reduced out of pocket expenditure, improved quality of health care and the removal of stigma for those who receive waivers at health care delivery points. The major reason for not accepting the CCHF was the poor quality of health care services currently offered. Participants suggested that enrolment to the CCHF be done after harvesting when the population were more likely to have disposable income, and that the quality care of care and benefits package be improved.

Tanzania: The budget made easy with new online tool
Twaweza: Tanzania December 2013

The Tanzanian Budget Explorer is an initiative to make information about the way the Treasury allocates taxpayers money more accessible: transparent, easy to understand and exciting to follow. Public access to information about how the government spends money in Tanzania is beginning to improve. When available in reports or budget books, however, this information often is too bulky and complex to grasp. It can be a time consuming job to understand, and many people simply don’t have time to invest in doing it. This is an initiative to make information about the way the Treasury allocates taxpayers money more accessible: transparent, easy to understand and exciting to follow.

The ethics of conditional cash transfers
Ichou C: Pambazuka News Issue 661, 15 January 2014

Around one billion people receive conditional cash transfers today, which have been praised as the magic bullet for poverty eradication. Such programmes are being implemented in Latin America and Africa. But they raise numerous ethical questions Bodies of evidence have shown that Conditional Cash Transfers (CCTs), as a form of social protection, can reduce inequality and poverty. Conditional Cash Transfers are payments made to poor households on the condition that they comply with a set of requirements and invest in their children’s human capital. CCT programmes have led to an uptake in health services, health outcomes and nutritional status of children as well as school enrolment and attendance. This reflexive note discusses development ethics by using Conditional Cash Transfers as a case study. It questions whether CCT prioritise human dignity by giving an overview of the methodology and underlying principles of CCT programmes in alleviating poverty and then analysing them in the light of ethics.

Trends in national and provincial health and HIV/ AIDS budgeting and spending in South Africa
Centre for Economic Governance and AIDS in Africa (CEGAA): CEGAA Occasional Paper December 2013

This paper provides an analysis of trends in health and HIV/AIDS budgeting and spending, as well as trends in some related spending areas that are important for effective HIV and AIDS management in South Africa. The endless fight against HIV and AIDS would not have been possible without financial investment and rigorous research in the HIV and AIDS field. The recent procurement and distribution of the triple combination therapy for AIDS in South Africa depicts the commitment by government to intensify the fight against the pandemic and to enhance good adherence among those taking AIDS treatment.

11. Equity and HIV/AIDS

Neglected older women and men: Exploring age and gender as structural drivers of HIV among people aged over 60 in Uganda
Richards E, Zalwango F, Seeley F, Scholten F, Theobald S: African Journal of AIDS Research , 12(2): 71–78, 2013

This study explored how women’s and men’s gendered experiences from childhood to old age have shaped their vulnerability in relation to HIV both in terms of their individual risk of HIV and their access to and experiences of HIV services. It was a small scale-scale study conducted in urban and rural sites in Uganda between October 2011 and March 2012. The study used qualitative methods: in-depth interviews (with 31 participants) and focus group discussions (FGDs) with older women (2) and men (2) in urban and rural sites and 7 key informant interviews (KIIs) with stakeholders from government and non-government agencies working on HIV issues. Women’s position, the cultural management of sex and gender and contextual stigma related to HIV and to old age inter-relate to produce particular areas of vulnerability to the HIV epidemic among older women and men. Women report the compounding factor of gender-based violence marking many of their sexual relationships throughout their lives, including in older age. Both women and men report extremely fragile livelihoods in their old age. Older people are exposed to HIV through multiple and intersecting drivers of risk and represent an often neglected population within health systems. The author argues that research and interventions need to go beyond only conceptualising older people as ‘carers’ to better address their gendered vulnerabilities to HIV in relation to all aspects of policy and programming.

Parents' perceptions of HIV counselling and testing in schools: Ethical, legal and social implications
Gwandure R, Ross E, Dhai A and Gardner J: South African Medical Journal;104(1) 40-42 January 2014

In view of the high prevalence of HIV and AIDS in South Africa, particularly among adolescents, the South African Departments of Health and Education proposed a school-based HIV counselling and testing (HCT) campaign to reduce HIV infections and sexual risk behaviour. Through the use of semi-structured interviews, this qualitative study explored perceptions of parents regarding the ethico-legal and social implications of the proposed campaign. Despite some concerns, parents were generally in favour of the HCT campaign. However, they were not aware of their parental limitations in terms of the Children’s Act. Their views suggest that the HCT campaign has the potential to make a positive contribution to the fight against HIV and AIDS, but needs to be well planned. To ensure the campaign’s success, there is a need to enhance awareness of the programme. All stakeholders, including parents, need to engage in the programme as equal partners.

12. Governance and participation in health

Bringing Justice to Health: The Impact of Legal Empowerment Projects on Public Health
Open Society Foundations: October 2013

Bringing Justice to Health profiles 11 legal empowerment projects based in Indonesia, Kenya, Macedonia, Russia, South Africa, and Uganda. These projects were selected because they show the range of approaches to legal empowerment that they support in their broader effort to promote health-related human rights interventions. The report tells the personal stories of people around the world - such as sex workers, people who use drugs, palliative care patients, people affected by HIV, and Roma - for whom human rights violations are part of everyday life. Sexual violence, discrimination in housing, unwarranted dismissal from employment, unfair evictions, denial of child support, and police harassment are only a few such violations. The report shows how the non-governmental organisations (NGOs) that founded projects to address these issues set about resolving problems in a way that is designed to empower those who are often least able to exercise their rights.

Knowledge, attitudes and practices of Ugandan men regarding prostate cancer
Nakandi H, Kirabo M, Semugabo C, Kittengo A, Kitayimbwa P, Kalungi S, Maena J: African Journal of Urology, 19, 165–170: August 2013

The incidence of prostate cancer in Uganda is one of the highest recorded in Africa. Prostate cancer is the most common cancer among men in Uganda. This study assessed the current knowledge, attitudes and practices of adult Ugandan men regarding prostate cancer through a descriptive cross-sectional study using interviewer administered questionnaires and focus group discussions among 545 adult men aged 18–71 years, residing in Kampala, the capital of Uganda. The majority of the respondents had heard about prostate cancer but 46% had not. The commonest source of information about prostate cancer was the mass media. Only 13% of the respondents obtained information about prostate cancer from a health worker. Respondents confused prostate cancer with gonorrhea and had various misconceptions about its causes. Only 10% of the respondents had good knowledge of the symptoms of prostate cancer.

Mobilizing communities to improve maternal health: results of an intervention in rural Zambia
Ensor T, Green C, Quigley P, Badru AR, Kaluba D and Kureya T: Bulletin of the World Health Organization 92:51-59, 2014

In Zambia, as in other low-income countries, maternal health indicators have remained stubbornly resistant to improvement. This intervention involved revitalizing Safe Motherhood Action Groups to raise awareness of the need to prepare for pregnancy complications and delivery. The main aim was to improve both understanding of maternal health and access to maternal health-care services. The approach was predicated on the assumption that women require not only knowledge about when they should seek skilled help but also their husbands’ approval for care seeking, which can be encouraged by community leaders. The authors adopted a quasi-experimental approach to evaluating the effect of a complex community-based intervention that was devised to reduce barriers to the use of maternal health-care services and to increase deliveries involving a skilled birth attendant. The intervention was novel because it involved the whole community and emphasized social approval and its ability to bring about changes in behaviour. The intervention was associated with significant improvements in women’s knowledge of when they should receive antenatal care and of obstetric dangers signs, in the use of emergency transport, in deliveries involving a skilled birth attendant and in the use of modern contraception. However, the increase in the proportion of women who received four or more antenatal care visits and in those who received postnatal care within 6 days was not significant.

PHM watches the 134th WHO's EB session
Peoples Health Movement: January 2014

134th session of the WHO's Executive Board 20-25 January 2014. The watching team in association with a number of PHM affiliate networks have published an 'Open Letter' to the delegates of the members of the Executive Board. The commentary includes analysis and comments on each of the items on the meeting's agenda.

13. Monitoring equity and research policy

A Namibian version of the 28 item General Health Questionnaire
Haidula L, Shino E, Plattner I, Feinstein A: S Afr Psychiatry Rev, 6:23-25, 2003

Namibia faces a daunting array of mental health problems. However, there is no Namibian screening instrument for psychological distress. The papers reports on work to develop a Namibian version of the 28 item General Health Questionnaire (GHQ-28) with a consecutive sample of 159 Oshiwambo speaking patients attending rural health clinics in the north of Namibia. The Oshiwambo version of the 28 item GHQ is presented as a valid screening instrument for psychological distress in clinic attendees.

Shared learning in an interconnected world: innovations to advance global health equity
Binagwaho A, et al: Globalization and Health 9(37): 30 August 2013

The notion of “reverse innovation”--that some insights from low-income countries might offer transferable lessons for wealthier contexts--is increasingly common in the global health and business strategy literature. Yet the perspectives of researchers and policymakers in settings where these innovations are developed have been largely absent from the discussion to date. In this Commentary, we present examples of programmatic, technological, and research-based innovations from Rwanda, and offer reflections on how the global health community might leverage innovative partnerships for shared learning and improved health outcomes in all countries.

14. Useful Resources

Construct Africa
Uncube, Uncube Magazine (17):2013

This special issue of Uncube magazine explores the changing trends in the built environment on the African continent. The issue presents case studies at various scales, from the construction of a sustainable orphanage in Guabuliga, Ghana to the results of a course in supporting residents of a suburb in Johannesburg to be experts of their own living situations.

Santé universelle : couverture privée ou soins publics ?
Municipal Services project and People's Health Movement: January 2014

Video in French: L'agenda politique entourant la 'couverture sanitaire universelle' ouvre la voie à la privatisation des systèmes de santé publics dans le Sud global. En Inde, cette approche basée sur l'assurance privée a négligé les priorités de santé publique et affaibli les soins de première ligne. Cette vidéo d'animation encourage les gens du monde entier à se mobiliser pour défendre les alternatives publiques pour réaliser la santé pour tous. Produit par: Municipal Services Project (MSP) et People's Health Movement (PHM).

Vision, Values, and Voice: A Communications Toolkit
The Opportunity Agenda: December 2013

‘Helvetika Bold’ a social justice superhero, takes you through a toolkit that offers social justice advocates tips and ideas to "unleash their communications superpowers", including guidance on forming a communications strategy, framing and messaging, and media outreach. In addition to big-picture thinking about communication strategies, readers will also find examples of a range of tactics, as well as concrete messaging guidance in the form of detachable "Opportunity Flashcards", the first set of an ongoing series of cards that provide what are intended to be short and easy-to-find advice and sample language on a range of social justice issues. "You can download and print each of these flashcards and use them the next time you have a media interview, need to write an opinion piece, or just need some ideas as you think through your messaging strategy." Each card provides a link to more in-depth information on the toolkit website.

15. Jobs and Announcements

Call For Papers: How Public Health Can Meet The Challenges Of The Twenty-First Century
Call Closes March 7 2014

An upcoming Special Issue on "How Public Health Can Meet the Challenges of the Twenty-First Century," will be published in the Public Health subject area of BioMed Research International in July 2014. A call for papers has been made for the Special Issue, which is open to both original research articles as well as review articles. BioMed Research International is an open access journal, which means that all published articles are made freely available online without a subscription, and authors retain the copyright of their work.

Fourth Ethics, Human Rights and Medical Law Conference
Gallagher Convention Centre, Midrand, Johannesburg, South Africa, 6-8 May 2014

The 4th Ethics, Human Rights and Medical Law Conference is a must attend event for healthcare professionals in South Africa and the surrounding region. A one-day conference that is fully dedicated to the above topics, it was created to demonstrate how important all three subjects are, as well as how they connect to one another.

Health Systems Trust Researcher/ Programme Evaluator
Closing Date: 9 February 2014

Health Systems Trust (HST) wishes to appoint three Researcher/Programme Evaluators to work from the Cape Town, Johannesburg and Durban offices (i.e. three positions are available). The incumbent’s primary responsibility will be to participate in research projects in line with the organisation’s goal of building an equitable, effective and efficient national health system in South Africa and the region, through strengthening the functioning of health districts. This is a one-year, fixed-term contract position, renewable based on funding and performance. See website for more details.

Innovative healthcare initiative launched in Cape Town
Mulligan G: Humanipo. January 2014.

The Inclusive Healthcare Innovation Initiative (IHII) has been launched in South Africa by two University of Cape Town (UCT) faculties, with the aim of creating a collaborative, cross-disciplinary approach to achieving healthcare innovation. The Graduate School of Business and the Faculty of Health Sciences unveiled the collaborative project, which is intended to encourage African citizens to reimagine healthcare across the continent. “The complexity of challenges faced in healthcare is calling for different paradigms of thinking and for the co-creation of new innovative solutions,” said Professor de Villiers, dean of UCT Faculty of Health Sciences. “Now more than ever innovation is required to develop solutions that can improve the delivery of healthcare in Africa in an inclusive, effective and affordable manner. These solutions must transcend current challenges in the system to improve health outcomes for patients but also to change the routines, responsibility and values of our healthworkers responsible for delivering the care.”New iPad app to record data at Groote Schuur.

Masters In Occupational Safety And Health (3rd Edition), English; Distance + Turin, 8 September 2014 – 30 September 2015
Call For Applicants: Closing Date 31 May 2014

The University of Turin, Italy, in partnership with the International Training Centre (ITC) of the International Labour Organization (ILO), is offering a Master course in Occupational Safety and Health. This one-year programme, to be held in English, includes an Internet-based distance learning phase, a face-to-face residential period on the ITC/ILO's campus in Turin followed by another distance phase for the preparation of the dissertation. The proposed programme combines the advantages of the academic experience in OSH of Turin University with the ITC/ILO's international training experience. An international approach has been applied to the contents, the methodology development as well as to the composition of the training team. This programme involves participants from both developing and developed countries, who will thus have an opportunity to share their different experiences. Applicants to visit the website for information on applications. A number of partial fellowships are available only for participants from developing countries on a competitive basis.

Practicum on Monitoring and Evaluation of Health Communication programs, June 2-4, 2014, Accra, Ghana
Deadline for registration is April 30, 2014.

The African Network for Strategic Communication in Health and Development (AfriComNet), a network of health communication practitioners across 50 countries, proposes an interactive three-day practicum focused on health communication monitoring and evaluation. The practicum will address topics such as how health communication strategy design influences monitoring and evaluation plans; the use of behavior change theories/models to guide evaluation planning; using evaluation and monitoring data to inform program strategies; using health communication research to test theories; and effectively disseminating and using evidence and findings to improve the science of health communication. Early registration is encouraged as the practicum is limited to a maximum of 150 participants. To register, please complete the registration form on the website.

Third Global Symposium On Health Systems Research, Cape Town, South Africa, 30 September -3 October 2014
Call For Individual Abstracts: Call Closes 3 March 2014

The Third Global Symposium on Health Systems Research will be held in Cape Town, South Africa, from 30 September to 3 October 2014.The theme of the symposium is the science and practice of people-centred health systems. Researchers, policy-makers, funders, implementers and other stakeholders, from all regions and all socio-economic levels, will work together on the challenge of how to make health systems more responsive to the needs of individuals, families and communities. The symposium invites abstract submissions. Individual abstract submission closes 3 March 2014. More information is available on the symposium website.

Third International Conference of the African Health Economics and Policy Association
Nairobi, Kenya 11 March 2014 - 13 March 2014

The Second Conference of the African Health Economics and Policy Association (AfHEA), will be held in Nairobi, Kenya, from 11 to 13 March 2014. The overall theme of this conference is "The Post-2015 African Health Agenda and UHC: Opportunities and Challenges".


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