EQUINET NEWSLETTER 157 : 01 March 2014

1. Editorial

Engaging in global health: who sets the agenda?
Bente Molenaar Neufeld, The Centre for Trade Policy and Law, Canada

The World Health Organization (WHO) states in its constitution that it aims to achieve "the attainment by all people of the highest possible level of health.” The World Health Assemblies (WHAs) provide a key opportunity to engage on the achievement of this aim. Yet in an interesting study by Kitamura et al. in May 2013 in Health Policy reviewing the agendas of the WHAs between 1970 and 2012, the authors concluded that “agenda items of the WHA do not always reflect international health issues in terms of burdens of mortality and illness.”

So how are countries and stakeholders shaping the WHA agenda?

One way is through the WHO Executive Board (EB), particularly as it plays a role in setting the provisional agenda for the WHA. EB members are individuals nominated by countries with technical expertise in health. Of the 34 members of the Executive Board, seven are from the African region. Currently these are from Cameroon (2011-2014), Chad (2012-2015), Namibia (2013-2016), Nigeria (2011-2014), Senegal (2011-2014), Sierra Leone (2011-2014) and South Africa (2013-2016). As EB members, they are well-positioned to be heard and to bring concerns from their regions to the table. They can also block issues being discussed. The WHO secretariat also plays a role in agenda setting. Procedurally, the provisional EB agenda is proposed by the WHO Director-General. Getting issues on the agenda for the WHA is, however, not difficult. According to the rules of procedure, every proposal brought by a member state and any proposals submitted by the DG should be included in the provisional WHA agenda. So how are these policy levers being used?

Take the 2014 EB agenda for example. Many agenda items were not controversial as they are carried over from previous years, after broad agreement around their importance. This included non-communicable diseases (NCDs), neglected tropical diseases and reform of the WHO. Other agenda items may be more controversial. For example, when in 2012 the United States of America and Thailand successfully petitioned to include lesbian, gay, bisexual and transgender (LGBT) access to health in the WHO EB agenda for consideration it provoked debate, with Egypt and Nigeria, on behalf of their regions, asking for the item to be deleted.

This issue exemplified how health concerns can reflect and raise political division. Bringing health into diplomacy platforms, including that of the WHO, poses a challenge for how to avoid foreign policy concerns overshadowing health issues. The US delegate, Nils Daulaire, speaking about the demands for deletion of the LGBT item in 2012 said that it was “unprecedented for WHO member states to come together to attempt to remove an item legitimately placed on the Executive Board agenda by another member state. We believe it is important to afford each other the courtesy to discuss these important health items, even those with which not everyone agrees. Changing this deeply-established precedent risks politicizing all EB agenda items moving forward.” At the same time, countries are sensitive about health platforms being used to advance wider foreign policy agendas.

On the specific agenda item, a compromise position was reached to delete it and to ask the DG to consult with members on how to address the public health issues for future discussion. African diplomats in Geneva noted that the issue could continue to cause a stalemate unless the DG brings compromise solutions from her consultations within the regions. In the 2014 EB the item thus appeared as ‘[deleted]’ on the final agenda, and there was no discussion of it, as Member States had not agreed on a title or content of accompanying documentation for it. Until they do, the item will not be discussed.

Agenda setting can and does thus fall victim to politics and requires diplomacy to reach solutions that are acceptable to the membership. However African countries have successfully brought items to the WHA agenda, such as that of ethical recruitment of health workers. What may restrict both the inclusion and action on agenda item may be the limits set by the General Program of Work (GPW). The GPW is set for the organization every 5 years. Unless a suggested item falls within the GPW and has funding allocated to it, it is unlikely to make it onto the formal agenda. The Organization is currently working on its 2014-2019 GPW and bases its’ plans on a set of distinct categories in the GPW that have been agreed to by Member States - that is communicable diseases, non-communicable diseases, promoting health through the life course, health systems, and preparedness, surveillance and response. One reform of the WHO underway, according to the WHO website, is to “allow greater flexibility in allocating resources to priorities within these categories”, which may then give flexibility for new agenda items not yet covered in the GPW.

Even when issues make it to the WHA agenda, will they receive adequate attention?

The agenda of both the EB and the WHA have become longer and longer over the years. In May 2013, for example, the WHA agenda included numerous weighty issues, including health post 2015, NCDs, communicable diseases (including malaria and neglected tropical diseases), WHO reform, substandard/spurious/falsely-labelled/falsified/counterfeit medical products and a range of other issues. With such packed agendas, smaller delegations to the WHA face challenges in participating when equally important issues are being discussed at the same time. Dr. Emmanuel Makasa, health attache at the Zambia high commission in Geneva noted in one 2013 meeting in the region that African delegations have responded to this by working as a group: “We work together as the African Group of Health Experts in Geneva to tackle issues and engage as a group, which helps with our individual member state staff shortages and different professionals present at the meetings.”

A lengthening agenda may also reflect the widening reach of global factors and policies in health, or the widening range of concerns claiming for attention. Either way, countries need proactive strategies to get their health concerns onto the global agenda, to ensure that they obtain attention and are addressed. It implies long term thinking, preparing and collaborating with partners in advance to develop positions and organizing the evidence, expertise and alliances to raise and advance agenda items. As Chigas et al. highlighted in 2007 those who can early on “frame the definition of the problem and the terms of the collective debate, can have enormous influence on the subsequent negotiations and their outcomes.”

Please send feedback or queries on the issues raised in this briefing to the EQUINET secretariat: admin@equinetafrica.org. The Centre for Trade Policy and Law is working with EQUINET on a research programme on GHD in association with the ECSA HC Strategic Initiative on Global Health Diplomacy. For more information on the issues raised please visit www.equinetafrica.org

2. Latest Equinet Updates

The changing legal status of Zambia’s neighbourhood health committees
Lungu M: Lusaka District Health Management Committee (LDHMT), Presentation to the EQUINET Regional Meeting on Health Centre Committees, Harare, January 30-February 2 2014

This update reports on one of the presentations at the EQUINET Regional meeting on Health Centre Committees (HCCs) in East and Southern Africa held in January-February that exchanged experience and learning between partners doing work on training and strengthening HCCs in the region. HCCs are mechanisms for public participation and joint planning at primary care level of health systems. The next newsletter will include the full report, more experiences on HCCs and the resolutions of the meeting. For example, we found that HCCs are often not provided for in law: Does that weaken their recognition, power or effectiveness? From Zambia, we heard experience around neighbourhood health committees (NHCs) that dated back to 1991, when the new government committed to building a health system that guaranteed “equity of access to cost effective quality health care as close to the family as possible.” The 1995 National Health Services Act set in law District Health Boards and NHCs, as well as the Central Board of Health at national level. NHCs became the vital link between the community and the health institutions. Over the next 10 years the number of NHCs in the country grew. While formally recognised, they also faced a series of challenges related to the voluntary nature of the work of NHC members, their lack of planning skills, and political interference. In 2006 the National Health Services Act was repealed, and the structures under it were dissolved, except for the NHCs. Despite the change in their legal status, the MoH continued to recognise their role in PHC and maintained it through policy guidelines. In Lusaka, an NHC Working Group was set up to provide support, operational guidelines and a constitution was developed for NHCs to clarify their role, they worked actively in budgeting, planning and community health, and annual meetings were held to review NHC experiences and activities. The case study led to interesting discussion on the legal status of to HCCs. On the one hand fornalising their status was seen to be important for their recognition and for HCCs to receive and account for public funds. On the other, even if there is a legal framework, there is no guarantee that communities will know about or understand it and the Lusaka experience showed the many ways HCCs can be formally supported, even in the absence of laws. Also it was noted that laws may be important, but they need to arise from and be upheld by the actions of communities.

3. Equity in Health

The political origins of health inequity: prospects for change
The Lancet—University of Oslo Commission on Global Governance for Health: Lancet, Volume 383, Issue 9917, Pages 630 - 667, 15 February 2014

Despite large gains in health over the past few decades, the distribution of health risks worldwide remains extremely and unacceptably uneven. The Lancet—University of Oslo Commission on Global Governance for Health reports that with globalisation, health inequity increasingly results from transnational activities that involve actors with different interests and degrees of power: states, transnational corporations, civil society, and others. The norms, policies, and practices that arise from global political interaction across all sectors that affect health are termed global political determinants of health. The Commission argues that global political determinants that unfavourably affect the health of some groups of people relative to others are unfair, and that at least some harms could be avoided by improving how global governance works. This report examines power disparities and dynamics across a range of policy areas that affect health and that require improved global governance: economic crises and austerity measures, knowledge and intellectual property, foreign investment treaties, food security, transnational corporate activity, irregular migration, and violent conflict. The Commission calls for stronger cross-sectoral global action for health, for strengthened use of human rights instruments for health, and new frameworks for international financing that go beyond traditional development assistance such as for research and social protection.

4. Values, Policies and Rights

African civil society condemns the signing of the Uganda Anti-Homosexuality Bill into law
AIDS and Rights Alliance for Southern Africa (ARASA): Windhoek, 26 February 2014

The Aids and Rights Alliance for Southern Africa (ARASA) has strongly condemned Uganda’s Anti-Homosexuality Act, signed into law by Ugandan President Yoweri Kaguta Museveni in February. According to ARASA the new law is contrary to the provisions of Uganda’s own constitution and goes against its purported aim of protecting the country’s people. The alliance claims that provisions in the law place unacceptable limitations on the rights to freedom of expression and association and will undermine proven prevention, treatment and care efforts targeted at vulnerable populations, such as men who have sex with men, placing them at greater risk both of contracting HIV and of persecution, harassment, violence and even death. According to ARASA the law contradicts the recent recommendations of the Global Commission on HIV and the Law, whose members included prominent African leaders such as Festus Gontebanye Mogae, former president of Botswana. The Global Commission report recommended that in order “to ensure an effective, sustainable response to HIV that is consistent with human rights obligations, countries must prohibit police violence against key populations. Countries must also support programmes that reduce stigma and discrimination against key populations and protect their rights”.

Homosexuality: A pragmatic bridge to address public health, human rights and morality questions
Kuria D: Pambazuka News, Issue 667, 26 February 2014

The issue of homosexuality arouses different but deeply felt emotions in many parts of the world. In Africa, 38 countries criminalize homosexuality with sentences ranging from a small fine to life imprisonment. The author notes that criminalization goes well beyond the human rights discourse; it is also a public health issue. He notes the many well researched papers that provide evidence on the negative public health impact of criminalization, not just on the homosexual persons, but also on the public health system of a country, leading global health organizations such as World Health Organization and UNAIDS to issue guidelines on the issue of criminalization. The author presents the arguments, given the demonstrable negative impact of stigma and criminalisation on public health and human rights, whether the Kenyan society can broker a middle ground between morality aspirations on the one hand and public health & human rights on the other.

Uganda: Scientific statement from the Ministry of Health on homosexuality
Ministry of Health, Republic of Uganda: Pambazuka News, Issue 667, 28 February 2014

This report provides the summary findings of a team of expert scientists constituted by the Director General Health Services Uganda at the request of the Minister of Health to review research data, deliberate and advise him on key questions about homosexuality. The conclusions of the report as presented by Pambazuka were that there is no definitive gene responsible for homosexuality; that homosexuality is not a disease or an abnormality; that in every society, there is a small number of people with homosexual tendencies; that homosexuality can be influenced by environmental factors (e.g. culture, religion, information, peer pressure); that the practise needs regulation like any other human behaviour, especially to protect the vulnerable and that there is need for studies to address sexualities in the African context.

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.

5. Health equity in economic and trade policies

Fighting disparity: The dream of Davos elites
Chowdhury F: Pambazuka News, Issue 666, 19 February 2014

The world’s richest nations have admitted that global inequality is appalling. But, the author asks, are they prepared to radically tackle the capitalist system that harbours 'rich tax thieves and appropriators of labour', who increase their wealth with political favours? A system that safeguards the interests of the minority at the expense of the majority poor? The World Economic Forum (January 2014) said that the growing rich-poor income gap is the biggest risk the world is facing for the next decade. The author raises that inequality, the world system’s ‘gift’ to humanity, is not only a process active in poor countries. It is also a regular and integral part of advanced, matured capitalist economies. He cites the message of Pope Francis on the World Day of Peace pointing to the ‘new tyranny’ of ‘unfettered capitalism’ and calling for action ‘beyond a simple welfare mentality’saying: ‘I beg the Lord to grant us more politicians who are genuinely disturbed by the state of society, the people, the lives of the poor'. The author however calls for the pressure for change to come from the people, cautioning that the class interests of elites make a vow to fight inequality a day dream.

Redistribution, Inequality, and Growth
Ostry JD, Berg A, Tsangarides CG: International Monetary Fund, Research Department, February 2014

This paper by researchers at the International Monetary Fund appears to debunk a tenet of conservative economic ideology — that taxing the rich to give to the poor is bad for the economy. It incorporates recently compiled figures comparing pre- and post-tax data from a large number of countries. The authors say there is convincing evidence that lower net inequality is good economics, boosting growth and leading to longer-lasting periods of expansion. The study concludes that redistributing wealth, largely through taxation, does not significantly impact growth unless the intervention is extreme.

Synergizing Roles: Experiences of Civil Society Working Towards Promoting Local Generic Pharmaceutical Manufacturing in the EAC Region
Mulumba M: Equilibri, January 29 2014

Due to a number of bottlenecks, the generic pharmaceutical manufacturers in the East African Community region produce at a cost disadvantage compared to their large-scale Asian counterparts. This article highlights some of the key areas where civil society has engaged and can still engage with local pharmaceutical industries to address these challenges. While the local manufacturing sector can play an important role in increasing access to and promoting the affordability of medicines in the region, a lot of support is needed for them to not only increase their production capacity but also to make a greater contribution to health care in the EAC region. the author argues that health civil society now needs to get into wider campaigns for the development of regulatory guidelines stating requirements for manufacturers of generic medicines to develop local capacity and undertake increased technology transfer into the region while at the same time lobbying EAC partner states to create subsidies and concessions that can boost the local pharmaceutical manufacturers’ capacity to adequately provide the much needed legitimate, affordable and quality medicines.

Working for the few. Political capture and economic inequality
Oxfam: Oxford, 20 January 2014

This Oxfam report timed for the World Economic Forum (WEF) in Davos raised that unless bold political solutions are instituted to curb the influence of wealth on politics, governments will work for the interests of the rich, while economic and political inequalities continue to rise. In the report Oxfam called for those in the WEF to not dodge taxes in their own countries or in countries where they invest and operate, by using tax havens; not use their economic wealth to seek political favours that undermine the democratic will of their fellow citizens; to make public all the investments in companies and trusts for which they are the ultimate beneficial owners; to support progressive taxation on wealth and income; to challenge governments to use their tax revenue to provide universal healthcare, education and social protection for citizens; and to apply a living wage in all the companies they own or control.

6. Poverty and health

Invasive Aesthetics: A call for a regenerative Architecture in Africa
Allam Z, Allam Z: Another Africa, January 24 2014

Architects and urban designers have a responsibility towards the evolution of the infrastructural landscape and identity. By changing the community skyline, they impact on the community’s sense of belonging. The authors propose that globalisation is the creative hand behind an undesirable uniformity in cities around the world and questions whether it is deconstructing the unique identity of African cities and a denial of Africa roots. This is argued to be important for the social context, including equitable access to services and resources by the residents and the impact on their health and well-being since social welfare is strongly entwined with physical well-being. The authors argue for a more thoughtful urban planning as the continuation of the present, haphazard construction puts future generations at risk of inheriting a place that is not only lacking in design but also an embodied cultural identity necessary for social wellbeing.

Malawi's paradox:Filled with both corn and hunger
Wise T: Global Post, February 25, 2014

This report explores the paradox of food insecurity in Malawi, with inpredictable rainfalls and a focus on a maize staple that is vulnerable to uncertain weather patterns. Further between 1998 and 2001, the World Bank and International Monetary Fund recommended that the Malawi government cut spending. The government eliminated a small but effective program of seed and fertilizer distribution, and maize production fell 40 percent by 2002. The World Bank and IMF then persuaded the government to sell off its food reserves. These measures are reported by the author to underlie a famine that prompted the government to resume its food reserves and to re-establish a broad input subsidy program intended to put good seeds and fertilizer into the hands of poor farmers, a programme that international funders refused to support as it was seen as inimical to free market principles. The programme was reported to be a success, and within a few years Malawi had grown enough maize to export some to neighboring countries. The 2002 famine motivated activists to campaign for a Right to Food Bill that enshrines in law every Malawian’s right to “the progressive realization of the right to food,” committing the government to advance such rights. The Right to Food Bill awaits legislative approval. Further government is distributing seeds for beans, pigeon peas, groundnuts, soybeans to diversify diets, offer crops that ripen at different times of the year, and replenish the soil with nitrogen and organic matter. Farmers have rejecting the high-tech agriculture heavily promoted by international funders and are rebuilding the fertility of depleted soils by intercropping nutritious legumes while growing a vitamin-rich, resilient variety of maize. The author suggests that maybe this is what the progressive realization of the right to food will look like in Malawi.

7. Equitable health services

Harnessing Africa’s untapped solar energy potential for health
Humphreys G: Bulletin of the World Health Organization, 92:82-83, February 2014

According to a WHO study published in Global health: science and practice in August last year, about one in four health facilities in 11 countries in sub-Saharan Africa has no access to electricity and most facilities that do have access have an unreliable supply. This paper describes the use of portable solar power kits containing a small photovoltaic (PV) solar panel, battery charger and outlets for energy-efficient LED (light-emitting diode) lights at clinics in African countries, installed 26 units in clinics in Malawi, Uganda and the United Republic of Tanzania, as well as a mini-grid in the Malawian village of Ndaula, where a PV solar system powers the health clinic, school, a water pumping station and a drip irrigation system. It also raises the work to systematically evaluate needs and interventions for “green” health facilities and energy access in health clinics.

Health Care Systems in Low- and Middle-Income Countries
Mills A: N Engl J Med 2014; 370:552-557February 6, 2014

Recent analyses have drawn attention to the weaknesses of health care systems in low- and middle-income countries. In response to such deficiencies in the health care system, a number of countries have been introducing new approaches to financing, organizing, and delivering health care. This article briefly reviews the main weaknesses of health care systems in low- and middle-income countries, lists the most common responses to those weaknesses, and then presents three of the most popular responses for further review. These responses, which have attracted considerable controversy, involve the questions of whether to pay for health care through general taxation or contributory insurance funds to improve financial protection for specific sections of the population, whether to use financial incentives to increase health care utilization and improve health care quality, and whether to make use of private entities to extend the reach of the health care system. This review raises that the specific circumstances of individual countries strongly influence both decisions about which approaches might be relevant and their success, so the author cautions that any generalizations made from health systems research in particular countries must be carefully considered. It is unlikely that there is one single blueprint for an ideal health care system design or a magic bullet that will automatically remedy deficiencies. The strengthening of health care systems in low- and middle-income countries must be seen as a long-term developmental process.

No universal health coverage without strong local health systems
Meessen B, Malanda B: Bulletin of the World Health Organization, 92:78-78A., February 2014

The district strategy is the backbone of nearly every national health system in Africa; countries are covered by health facilities – organized in a tier system – whose activity packages focus on priority services. The Community of Practice “Health Service Delivery” convened a regional conference in Dakar, Senegal, from 21 to 23 October 2013 gathering 20 country delegations and 170 experts who shared their experiences in organizing primary-health-care services at the local level. The meeting identified that market liberalization means that African health authorities need to use new policy instruments enhanced by information and communication technology; implement the district strategy pragmatically; and ensure inclusiveness, openness to dialogue and support of innovation and learning at the organizational level. The meeting also noted that Primary health care remains as relevant today as it was in 1978.

8. Human Resources

Career and practice intentions of health science students at three South African health science faculties
Naidu C, Irlam J, Diab PN: African Journal of Health Professions Education, 5(2):68-71, November 2013

The distribution and accessibility of healthcare professionals as well as the quality of healthcare services are significantly affected by the career choices of medical and other health science graduates. While much has been reported on the career intentions of medical students, little is known about those of their counterparts in the health sciences. This study describes the career plans of non-medical health science students at three South African health science faculties, and identifies some key motivating factors. A self-administered survey of first- and final-year health science students was conducted at the health science faculties of the universities of Cape Town, KwaZulu-Natal and Limpopo. The findings demonstrated that health science students, similar to medical students, are influenced by a multitude of factors in making career choices. This emphasises the relevance to all health science disciplines of national strategies to address the maldistribution of healthcare professionals.

Stemming the impact of health professional brain drain from Africa: a systemic review of policy options
Zimbudzi E: Journal of Public Health in Africa 4:1 June 2013

Africa has been losing professionally trained health workers who are the core of the health system of this continent for many years. Faced with an increased burden of disease and coupled by a massive exodus of the health workforce, the health systems of many African nations are risking complete paralysis. Several studies have suggested policy options to reduce brain drain from Africa. This paper reviewed policies which can stem the impact of health professional brain drain from Africa through a systemic literature review. 23 articles met the inclusion criteria. The review identified nine policy options, which were being implemented in Africa, but the most common was task shifting which had success in several African countries.

9. Public-Private Mix

An assessment of opportunities and challenges for public sector involvement in the maternal health voucher program in Uganda
Okal J, Kanya L, Obare F, Njuki R, Abuya T, Bange T, Warren C, Askew I and Bellows B: Health Research Policy and Systems 11(38): 18 October 2013

This paper describes a reproductive health voucher program that contracts private facilities in Uganda and explores the policy and implementation issues associated with expansion of the program to include public sector facilities. Data presented here describes the results of interviews of six district health officers and four health facility managers purposefully selected from seven districts with the voucher program in southwestern Uganda. Interviews were transcribed and organized thematically, barriers to seeking RH care were identified, and how to address the barriers in a context where voucher coverage is incomplete as well as opportunities and challenges for expanding the program by involving public sector facilities were investigated. The findings show that access to sexual and reproductive health services in southwestern Uganda is constrained by both facility and individual level factors which can be addressed by inclusion of the public facilities in the program. This will widen the geographical reach of facilities for potential clients, effectively addressing distance related barriers to access of health care services. Further, intensifying ongoing health education, continuous monitoring and evaluation, and integrating the voucher program with other services is likely to address some of the barriers. The public sector facilities were also seen as being well positioned to provide voucher services because of their countrywide reach, enhanced infrastructure, and referral networks. The voucher program also has the potential to address public sector constraints such as understaffing and supply shortages. Accrediting public facilities has the potential to increase voucher program coverage by reaching a wider pool of poor mothers, shortening distance to service, strengthening linkages between public and private sectors through public-private partnerships and referral systems as well as ensuring the awareness and buy-in of policy makers, which is crucial for mobilization of resources to support the sustainability of the programs. Specifically, identifying policy champions and consulting with key policy sectors is key to the successful inclusion of the public sector into the voucher program.

10. Resource allocation and health financing

Trends in national and provincial health and HIV/ AIDS budgeting and spending in South Africa
Ndlovu N, Vilakazi M, Majozi M, Sithole F, Mbatha K, Guthrie T: Centre for Economic Governance and AIDS in Africa, CEGAA Occasional Paper 2013-1, 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 2013/14 national and provincial budget statements indicated that there is still strong public commitment to fund HIV and AIDS within the health sector demonstrated by increasing health HIV and AIDS allocations within a shrinking health budget in real terms.

11. Equity and HIV/AIDS

Evaluating traditional healers knowledge and practices related to HIV testing and treatment in South Africa.
George G, Chitindingu E and Gow J: BMC International Health and Human Rights 13(45): 23 October 2013

In a context of inadequate human resources for health, this study investigated whether traditional healers have the knowledge and skill base which could be utilised to assist in the scaling up of HIV prevention and treatment services in South Africa. Using a cross-sectional research design a total of 186 traditional healers from the Northern Cape province were interviewed. Responses on the following topics were obtained: socio-demographic characteristics; HIV training, experience and practices; and knowledge of HIV transmission, prevention and symptoms. Descriptive statistics and chi square tests were used to analyse the responses. Traditional healers’ knowledge of HIV and AIDS was not as high as expected. Less than 50% of both trained and untrained traditional healers would treat a person they suspected of being HIV positive. However, a total of 167 (89%) respondents agreed using a condom can prevent HIV and a majority of respondents also agreed that having one sexual partner (127, 68.8%) and abstaining from sex can prevent HIV (145, 78.8%). Knowledge of treatment practices was better with statistically significant results being obtained. The results indicate that traditional healers could be used for prevention as well as referring HIV positive individuals for treatment. Traditional healers were enthusiastic about the possibility of collaborating with bio-medical practitioners in the prevention and care of HIV and AIDS patients. This is significant considering they already service the health needs of a large percentage of the South African population. However, further development of training programmes and materials for them on HIV and AIDS related issues would seem necessary.

12. Governance and participation in health

Male partner involvements in PMTCT: a cross sectional study, Mekelle, Northern Ethiopia
Haile F, Brhan Y: BMC Pregnancy and Childbirth14:65, 2014

Male partner participation is a crucial component to optimize antenatal care/prevention of mother to child transmission of HIV(ANC/PMTCT) service. Involving male partners during HIV screening of pregnant mothers at ANC is key in the fight against mother to child transmission of HIV(MTCT). This study aimed to determine the level of male partner involvement in PMTCT and factors that affecting it. A Cross-sectional study was conducted among 473 pregnant mothers attending ANC/PMTCT in Mekelle town health facilities in January 2011 to identify factors that affect male involvement in ANC/PMTCT. Twenty percent of pregnant mothers have been accompanied by their male partner to the ANC/PMTCT service. Knowledge of HIV sero status, maternal willingness to inform their husband about the availability of voluntary counselling and testing services in ANC/PMTCT and previous history of couple counselling were found to be the independent predictors of male involvement in ANC/PMTCT service. Male partner involvement in ANC/PMTCT was found to be low and the authors argue that comprehensive strategies should be put in place to sensitize and advocate the importance of male partner involvement in ANC/PMTCT and reach out male partners.

WHO criticised for not following policy on recognising NGOs
Rema Nagarajan: Times of India, Jan 31 2014

Civil society groups have expressed disappointment with the number of "industry groupings" that have "incorrectly gained NGO status" with the World Health Organization (WHO). There are 187 organizations or networks recognized as NGOs in official relations with the WHO. According to the International Baby Food Action Network (IBFAN), a new entrant into this WHO list of NGOs, industry groups which have been recognized as NGOs by WHO include Croplife International (representing Monsanto, Syngenta, Bayer, CropScience, Dow Agrosciences, DuPont and other companies promoting GMO technologies ) the International Federation of Pharmaceutical Manufactures and Associations, International Life Sciences Institute (representing Nestle, Coca Cola, Kellogg, Pepsi, Monsanto, Ajinomoto, Danone, General Mills and others) and the Industry Council for Development (representing Nestle, Mars, Unilever and Ajinomoto). "All are guided by market profit-making logic (whose primary interest clashes with that of WHO). Their inclusion goes against WHO's current NGO policy," said a statement issued by IBFAN.

Further details: /newsletter/id/38870

13. Monitoring equity and research policy

Adaptation and implementation of local maternity dashboards in a Zimbabwean hospital to drive clinical improvement
Crofts J, Moyo J, Ndebele W, Mhlanga S, Draycotta T, Sibanda T: Bull World Health Organ 2014;92:146–152

The Commission on Information and Accountability for Women’s and Children’s Health of the World Health Organization (WHO) reported that national health outcome data were often of questionable quality and “not timely enough for practical use by health planners and administrators”. Delayed reporting of poor-quality data limits the ability of front-line staff to identify problems rapidly and make improvements. Clinical “dashboards” based on locally available data offer a way of providing accurate and timely information. A dashboard is a simple computerized tool that presents a health facility’s clinical data graphically using a traffic-light coding system to alert front-line staff about changes in the frequency of clinical outcomes. It provides rapid feedback on local outcomes in an accessible form and enables problems to be detected early. Until now, dashboards have been used only in high-resource settings. An overview maternity dashboard and a maternal mortality dashboard were designed for, and introduced at, a public hospital in Zimbabwe. A midwife at the hospital was trained to collect and input data monthly. Implementation of the maternity dashboards was feasible and 28 months of clinical outcome data were summarized using common computer software. Presentation of these data to staff led to the rapid identification of adverse trends in outcomes and to suggestions for actions to improve health-care quality. Implementation of maternity dashboards was feasible in a low-resource setting and resulted in actions that improved health-care quality locally. Active participation of hospital management and midwifery staff was crucial to their success.

The parameters of the current legal framework for health research: Forms of health research which are regulated and obligations imposed on researchers
Strode AE: South African Journal of Bioethics and Law, 6(2):69-71, November, 2013

On 1 March 2012, the South African Minister of Health operationalised section 71 of the National Health Act (NHA), ushering in a new phase of research regulation. When read with sections 1, 11 and 16 of the NHA, section 71 describes the legal norms for undertaking various forms of health research in South Africa. Three key terms used in the NHA now set the parameters of the legal framework for regulating health research: ‘health research’ (section 1), ‘research or experimentation on a living person’ (section 71), and the provision of a ‘health service for research or experimental purposes’ (section 11). Importantly, these three concepts delineate (i) what forms of health research are regulated by the legal framework, and (ii) the nature of the obligations placed on health researchers and others. The author argues that researchers and members of research ethics committees need to be aware that the NHA assigns different legal obligations to different forms of health research. This article describes the parameters of the new legal framework and the obligations that flow from each of the three categories of health research. It shows how the restrictions the framework imposes are not evenly spread across all forms of research, and concludes by identifying some of its strengths, weaknesses and anomalies. It further suggests that more conceptual elaboration is required to ascertain whether the differences are coherent and justified.

14. Useful Resources

African Oral History Archive
Ichikowitz Family Foundation, March 2014

The African Oral History Archive (AOHA) charts Africa’s history, heritage and collective memory as a multi-media content to preserve African heritage. AOHA is a non-profit initiative dedicated to African story-telling, to the safeguarding of the continent’s heritage for future generations. Over 130 interviews have been recorded, including former heads of state and government, foreign ministers and other key figures who have spoken freely of the decisions they were called upon to make, the criteria by which their decisions were taken, and their personal fears and hopes for the liberation of South(ern) Africa. AOHA promotes public access to these multi-media resources as entry points for young and old to understand Africa’s past. AOHA adopts no single point of view but, rather, provides the raw material for open, pluralistic storytelling.

15. Jobs and Announcements

Call for Abstracts: Prince Mahidol Award Conference 2015 “Global Health Post 2015: Accelerating Equity”.
Deadline for abstract submissions: March 28th 2014

In celebration of the 15th anniversary of the Award in 2007, the Royal Thai Government and the Prince Mahidol Award Foundation decided to convene an annual international conference focusing on policy-related public health issues of global significance. The call for abstracts for the 2015 conference is open and abstracts must be submitted electronically through the conference website.

Call for applicants: Monitoring and Evaluation Technical Advisor Africare
Closing Date: 24 March 2014

Africare’s Injongo Yethu Project provides technical support and assistance as a contribution to the South African Government’s response to HIV and AIDS in the Chris Hani, Cacadu and Amathole Districts of the Eastern Cape province of South Africa. Funded by the President's Emergency Plan for AIDS Relief (PEPFAR), the project aims to strengthen and scale up prevention, treatment, care and support for people living with HIV and AIDS, their caregivers, family members, and community including orphans and children made vulnerable due to HIV and AIDS.Africare seeks to appoint a Monitoring and Evaluation Technical Advisor, based in the Eastern Cape.
For further information visit the website.

Call for applications for the African Doctoral Dissertation Research Fellowships
Deadline: March 20, 2014

The African Population and Health Research Center (APHRC), in partnership with the International Development Research Centre (IDRC), is pleased to announce the seventh call for applications for the African Doctoral Dissertation Research Fellowships (ADDRF). The ADDRF Fellowship Program seeks to facilitate more rigorous engagement of doctoral students in research, strengthen their research skills, and provide them an opportunity for timely completion of their doctoral training. The Program targets doctoral students with strong commitment to a career in training and/or research. The ADDRF will award about 20 fellowships in 2014 to doctoral students who are within two years of completing their thesis at an African university. In this phase of funding and in consideration of IDRC’s health programming priorities, candidates whose dissertation topics address health policy or health systems issues will be given special consideration. The Program has also reserved a small number of fellowships specifically for doctoral students conducting research on health inequities in urban areas or the reproductive health of marginalized urban communities.

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.

Carnegie African Diaspora Fellowship (ADF) Programme
Call closes: March 17, 2014

Applications are now being accepted for the first round of fellowships for the Carnegie African Diaspora Fellowship (ADF) Programme. Public and private higher education institutions in Ghana, Nigeria, Kenya, Tanzania, South Africa and Uganda are eligible to apply to host a Fellow, an African-born scholar who lives and works in a college or university in the United States or Canada.

eLearning Africa "Through your Lens" Photo Competition 2014
Closing date: Monday, April 14th 2014

The eLearning Africa “Through your Lens” Photo Competition is back this year in its fifth edition. Under the theme of “Social Africa: building bridges through ICT”, budding photographers are invited to submit snapshots depicting how ICT is enhancing the way individuals and communities in Africa live, learn, cooperate and connect. Contributions from all sectors and walks of life are welcome. The photo should show how communication tools and information technologies can build bridges and foster relationships between people and be accompanied by a brief description outlining the inspiration behind their idea.

First-ever International Day of Zero Discrimination, 1st March 2014

UNAIDS is calling for all to join Zero Discrimination Day as an opportunity to celebrate everyone’s right to live a full and productive life with dignity—no matter what they look like, where they come from or whom they love. "By joining hearts and voices, individuals, communities and societies can transform the world every day and everywhere. Zero Discrimination Day is a moment to highlight how everyone can become informed and promote tolerance, compassion and peace". The day is part of a global campaign.

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.

Global Health Governance: Call for Submissions
Closing date for Abstracts: March 30, 2014

Global Health Governance will be publishing a special issue on a proposed Framework Convention on Global Health (FCGH) in December 2014. The proposal for an FCGH would create a new international framework, grounded in the international human right to health, that would support health at the national and global levels. For this FCGH special issue, Global Health Governance invites submission of theoretical and empirical policy research articles that examine and analyse how the FCGH could improve health through improved governance and realization of the right to health, in particular articles on 1) defining and articulating the underlying normative aspects of the FCGH and the prospects of implementing these norms across global, national, and local levels; 2) global health diplomacy and the process of drafting a Framework Convention; 3) institutional and political implementation concerns; 4) the roles of and relationship between state and non-state actors in the formulation and implementation of the FCGH; 5) the connection between existing norms and institutions and the FCGH; 6) strategies and challenges for integrating the norms of the FCGH into existing global, national, and local institutions; 7) accountability under the FCGH; and 8) strategies and challenges for using the FCGH to reshape or build on existing global, national, and local institutions to advance health equity and realization of the right to health. Abstracts (up to 400 words) for proposed articles are due March 30, 2014. Submissions should be made by email, in Microsoft Word format, to Lance Gable.

Masters in Occupational safety and health (3rd edition), English; Distance course 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.



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