The EQUINET website and bibliography and newsletter databases will be undergoing a significant software upgrade in February 2016 so we will not be producing a March issue of the newsletter on 1 March 2016. We hope we have given you alot of interesting material ranging from papers, reports, bibliographies, online books and graphics in this issue the meantime and the newsletter will resume on 1 April 2016. We aim to ensure that any periods in which the bibliography databases will be unavailable during the upgrade are as brief as possible. Please email us on admin@equinetafrica.org if you have any queries or feedback, and we also look forward to receiving submissions, reports and articles from you!
EQUINET NEWSLETTER 180 : 01 February 2016
CONTENTS: 1. Editorial, 2. Latest Equinet Updates, 3. Equity in Health, 4. Values, Policies and Rights, 5. Health equity in economic and trade policies, 6. Poverty and health, 7. Equitable health services, 8. Human Resources, 9. Public-Private Mix, 10. Resource allocation and health financing, 11. Equity and HIV/AIDS, 12. Governance and participation in health, 13. Monitoring equity and research policy, 14. Useful Resources, 15. Jobs and Announcements
1. Editorial
Announcement on the newsletter and website
Editor
Will the Sustainable Development Goals deliver on African solutions to African problems?
Garrett Brown, Rene Loewenson, Rangarirai Machemedze, Nancy Malema, EQUINET
The theme for the November 2015 62nd East, Central and Southern African Health Community (ECSA-HC) Health Ministers Conference on transitioning from Millennium Development Goals (MDGs) to the Sustainable Development Goals (SDGs) provided a timely opportunity for countries in the region to frame priorities for health for the next 15 years. In his opening remarks to the Health Ministers Conference, the Minister of Health for Mauritius, the Honorable Anil Kumarsingh Gayan pointed to the SDGs as an ambitious framework that looked at health holistically in terms of healthy lives, including and beyond health care. As detailed also by the World Health Organisation representative Dr Rufaro Chatora at the conference, the transition is from a disease and poverty focused agenda to one that is more focused on the policy goals that apply to all countries. Hon Minister Gayan cautioned that the goals must not remain ‘in a state of aspiration’, and called for them to be addressed through ‘African solutions to African problems’.
While many of the SDGs contribute to health, SDG 3 raises the need to ‘ensure healthy lives and promote well-being for all at all ages’ and lists a daunting array of ambiguous targets (such as universal health coverage). Many of these are open to interpretation and strategic thinking in regards to their implementation, including in terms of how they are integrated into national, regional and continental development plans, such as the African Union’s Agenda 2063: ‘The Africa we want’. With global discussion underway on indicators, funding and other ways of operationalizing the SDGs, the region has a window of opportunity to shape these agendas, rather than react to those set outside the region.
Minister Gayan highlighted the importance of inspiring regional leadership and collective action across countries to steer the SDG agenda to advance health and address mutual concerns across countries in the region through an agenda set within the region. This, he indicated, called for regional organisations to be ‘innovative, responsive, imaginative and effective’.
The ECSA HC Best Practices Forum (BPF), Directors Joint Consultative Conference and Health Ministers Conference, this year involving about 150 delegates from ministries of health, health experts and researchers, heads of health research and training institutions from ECSA countries and diverse collaborating partners in and beyond the region, provided a unique opportunity to blend experience, evidence, exchange, policy review and networking to contribute to such features. It included inputs from diverse actors in the region on universal health coverage (UHC), on health financing, on regional collaboration in the surveillance and control of communicable diseases, on the situation and responses to non- communicable diseases (NCDs), on global health diplomacy and on innovations in health professional training.
The BPF conference raised a number of key recommendations aimed at supporting the transition from the MDGs to the SDGs, including; strengthening mandatory pre–payment for health, and monitoring, evaluation and shared learning across the ESCA-HC members on measures for this and on progress towards UHC; strengthening and sharing capacities and knowledge for tracking and reporting communicable diseases and for responding to outbreaks; increasing ECSA initiatives for health professional training and recognition of qualifications across countries in the region; strengthening regional capacity and evidence in global health negotiations; strengthening investment in research and the use of evidence in health policy, and facilitating ‘south-south knowledge exchange’ in various areas, including on multi-sectoral measures and capacities to detect and control NCDs and traumas; and in global health diplomacy.
Such regional exchange, co-ordination and voice was found in EQUINET’s research as one factor - amongst others- in effective engagement in global health negotiations. In the ECSA HC conference, regional co-operation was raised in various discussions as an important platform for solving a number of problems, including for countries with excess to deploy skilled professionals to countries with scarcities, or for more rapid deployment of capacities for response to emergencies. At the same time, EQUINET’s research also found that regional organisations are often bypassed or lack formal voice in global processes. It was thus interesting that the ECSA HC Director General Professor Yoswa Dambisya launched one of the few examples of a successfully secured regionally based Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria (GF) grant, which will align programs and provide increased capacity for tuberculosis monitoring and response in the region. This capacity will not only increase the ability of states in the region to detect new cases of tuberculosis, but also provides the possibility for new capacity scale-up to detect other neglected communicable diseases (NCDs) as laboratory resources and expertise increase.
There were, however, a number of signals on the challenges to further strengthen such regional roles. Minister Gayan in his opening speech pointed to how shortfalls in payment of membership fees to the regional body weakens the financial forecasting and planning needed to take forward a proactive agenda. The recent experience of weak implementation of the WHO Code of Practice on the International Recruitment of Health Personnel signaled deficits in technical follow through on policies. At the same time the conference also raised the role of domestic investment in country driven research and ministerial leadership to effectively support and coordinate such follow through.
With the long-term nature of the issues being tackled, these annual regional conferences need a consistency of focus on issues that are key for the region and strategic use of time to share and review the learning from implementation of regional recommendations as ‘African solution to African problems’. The involvement of many of the countries in several regional economic communities also necessitates co-ordination of efforts across these regional bodies.
Notwithstanding the challenges, the conference highlighted the potential of ECSA-HC and other regional processes in facilitating the exchange and sharing of policy relevant evidence and ‘south-south’ learning. The contribution of such institutional resources and processes should not be overlooked in asserting African health priorities in the global health agenda. While this is more a ‘marathon’ than a ‘sprint’, for the window of opportunity of current discussions on the SDG indicators and financing, the time to voice African health priorities in this global SDG process is now.
Please send feedback or queries on the issues raised in this editorial to the EQUINET secretariat: admin@equinetafrica.org. For further information on the ECSA HC Regional Conferences please visit the ECSA HC website at http://www.ecsahc.org/
2. Latest Equinet Updates
Discussion paper 106: Responding to inequalities in health in urban areas: A review and annotated bibliography
Loewenson R; Masotya M: TARSC, EQUINET, Harare
Training and Research Support Centre (TARSC) as cluster lead of the “Equity Watch” work in EQUINET is following up on the findings of the 2012 Regional Equity Watch and the country Equity Watch reports with a deeper systematic analysis of available evidence on inequalities in health and its determinants within urban areas and the responses to urban inequalities from the health sector and through health promoting interventions of other sectors and communities acting on public health and the social determinants of health. This document presents evidence from 105 published papers in English post 2000 on patterns of and responses to urban inequalities in health in east and southern African countries. The evidence is presented in an annotated bibliography and analysis. It is being used to identify key areas of focus and parameters for deeper review and analysis. The picture presented in the literature is not a coherent one- it is rather a series of fragments of different and often disconnected facets of risk, health and care within urban areas. There is also limited direct voice of those experiencing the changes and limited report of the features of urbanisation that promote wellbeing. The literature found was significantly more focused on the challenges than on the solutions. The papers sourced confirmed the relevance of primary care and community-based approaches, with CHWs, to carry out participatory assessments, promote new PHC approaches, use social media and support service uptake to address urban determinants. However the documented interventions made weak links between PHC services, urban public health and the work of other sectors. The rapid, diverse and multifactorial changes taking place in urban areas, some of which are poorly documented, also call for participatory approaches that include the direct voice of those experiencing urban life.
3. Equity in Health
Equity in Maternal Health in South Africa: Analysis of Health Service Access and Health Status in a National Household Survey
Wabiri N; Chersich M; Zuma K; Blaauw D; Goudge J; Dwane N: PLoS One 8(9), 2013
South Africa is increasingly focused on reducing maternal mortality. Documenting variation in access to maternal health services across one of the most inequitable nations could assist in re-direction of resources. This analysis draws on a population-based household survey that used multistage-stratified sampling. Women, who in the past two years were pregnant (1113) or had a child (1304), completed questionnaires and HIV testing. Poorest women had near universal antenatal care coverage (ANC), but only 39.6% attended before 20 weeks gestation; this figure was 2.7-fold higher in the wealthiest quartile. Women in rural-formal areas had lowest ANC coverage (89.7%), percentage completing four ANC visits (79.7%) and only 84.0% were offered HIV testing. Testing levels were highest among the poorest quartile (90.1% in past two years), but 10% of women above 40 or with low education had never tested. Skilled birth attendant coverage (overall 95.3%) was lowest in the poorest quartile (91.4%) and rural formal areas (85.6%). Around two thirds of the wealthiest quartile, of white and of formally-employed women had a doctor at childbirth, 11-fold higher than the poorest quartile. Overall, only 44.4% of pregnancies were planned, 31.7% of HIV-infected women and 68.1% of the wealthiest quartile. Self-reported health status also declined considerably with each drop in quartile, education level or age group. Aside from early ANC attendance and deficiencies in care in rural-formal areas, inequalities in utilisation of services were mostly small, with some measures even highest among the poorest. Considerably larger differences were noted in maternal health status across population groups. This may reflect differences between these groups in quality of care received, HIV infection and in social determinants of health.
Health Equity: The Key for Transformational Change
Garay J; Kelley N; Chiriboga D: Editorial Nacional de Salud y Seguridad Social (EDNASSS), Costa Rica, 2015
The authors of this paper, drawing also on experience in primary health care in Zimbabwe, developed a "healthy, feasible and sustainable (HFS)" model utilising trends in readily available data from 1960s onwards in detailed tables, figures and maps and identifying specific countries which fit the criteria of the model. They also identify countries and population subgroups affected by inequity, with practical insights to eliminate global health inequities. They quantify the cost of bridging the global health equity gap, and outline mechanisms to finance the necessary interventions through a binding global redistribution system. This is compared with what is considered to be an outdated, arbitrary and inefficient international cooperation model. The approach considers global levels of poverty and excessive global accumulation, which abuses natural resources in such a way as to deprive current and future generations from the access they deserve, making reference to the concept of inter-generational equity. The online book discusses the difference between equity and equality, the global burden of health equity, the minimum income threshold for dignity, the maximum threshold of income above which excessive accumulation or hoarding occurs, and how resource hoarding is directly linked to the burden of health equity; while also proposing a holistic health index, including healthy life expectancy by gender, the happiness index, and life-years lost of others due to the hoarding effect and to exhausting effect. The methodology provides tools to defend the right to health for all by supporting the development of binding instruments linked to concrete health standards attainable through a financially sustainable mechanism.
4. Values, Policies and Rights
Anchoring universal health coverage in the right to health: What difference would it make?
World Health Organisation Policy Brief: November 2015
Universal Health Coverage UHC is a critical component of the new Sustainable Development Goals (SDGs) which include a specific health goal: “Ensure healthy lives and promote wellbeing for all at all ages”. Within this health goal, a specific target for UHC has been proposed: “Achieve UHC, including financial risk protection, access to quality essential health care services and access to safe, effective, quality and affordable essential medicines and vaccines for all”. In this context, the opportunity exists to unite global health and the fight against poverty through action that is focussed on clear goals. For WHO, “UHC is, by definition, a practical expression of the concern for health equity and the right to health”; thus promoting UHC advances the overall objective of WHO, namely the attainment by all peoples of the highest possible standard of health as a fundamental right, and signal a return to the ideals of the Declaration of Alma Ata and the WHO Global Strategy for Health for All by the Year 2000. Yet some argue that the “current discourse on UHC is in sharp contrast with the vision of Primary Health Care envisaged in the Alma Ata declaration of 1978”. The underlying assumption of this paper is that efforts towards achieving UHC do promote some, but not necessarily all, of the efforts required from governments for the realisation of the right to health. While this publication explores how efforts to advance towards UHC overlap with efforts to realise the right to health, its main focus is the gaps that exist between UHC efforts and right to health efforts.
Eliminating stigma and discrimination in health-care systems
UNAIDS: Geneva, November 2015
Widespread HIV-related stigma and discrimination in the health-care sector impedes access to services and impairs the quality of health-care delivery for people living with HIV and other key populations. It also undermines efforts to achieve the highest attainable standard of health for everybody. At a two-day meeting held in Geneva, Switzerland, on 10 and 11 November 2015, key stakeholders came together to discuss ways to eliminate all forms of discrimination in health-care settings, using the lessons learned from the AIDS response as an entry point. The event, organised by UNAIDS and the Global Health Workforce Alliance, also focused on the UNAIDS 2016–2021 Strategy and the upcoming Global Strategy on Human Resources for Health: Workforce 2030. Stigma and discrimination in health takes many forms—the denial of health care and unjust barriers to service provision, inferior quality of care and a lack of respect. Abuse and other forms of mistreatment, violation of physical autonomy, mandatory testing or treatment and compulsory detention are other forms of stigma and discrimination encountered by people living with HIV. The meeting concluded with a clear call for more coordinated action. UNAIDS and the Global Health Workforce Alliance were asked to develop a plan before next year’s Zero Discrimination Day, on 1 March 2016, to work towards ending discrimination in health-care settings. Priorities include political advocacy, strengthening accountability mechanisms, sharing existing evidence and best practices and building evidence-informed policy for implementation and scale-up of programmes to reduce stigma and discrimination at all levels.
The International Health Regulations 10 years on: the governing framework for global health security
Gostin L: DeBartolo M; Friedman E: The Lancet 386(10009), 2222–2226, 2015
Fundamental revisions to the International Health Regulations in 2005 were meant to herald a new era of global health security and cooperation. Yet, 10 years later, the International Health Regulations face criticism, particularly after the west African Ebola epidemic. Several high-level panels are reviewing the International Health Regulations' functions and urging reforms. The Global Health Security Agenda, a multilateral partnership focused on preventing, detecting, and responding to natural, accidental, or intentional disease outbreaks, has similar capacity building aims, but operates largely outside the International Health Regulations.
Universal health coverage: The strange romance of The Lancet, MEDICC, and Cuba
Waitzkin H: Social Medicine 9(2) 93 -97, 2015
As a key supporter of universal health coverage (UHC), The Lancet recently partnered with Medical Education Cooperation with Cuba (MEDICC), a non-governmental organisation based in the United States, to produce a Spanish-language translation of The Lancet’s series on UHC in Latin America. This translation was launched as part of Cuba Salud 2015, an international health conference held during April 2015 in Havana, Cuba. Despite its often ambiguous definition, UHC is often used to refer to a financial reform extending insurance coverage in varying degrees to a larger part of a country’s population. This is different to “healthcare for all” (HCA) – a healthcare delivery system that provides equal services for the entire population regardless of an individual’s or family’s financial resources. UHC as a more limited insurance concept has received wide criticism because it does not necessarily create a unified, accessible system; because it usually encourages a role for private, for- profit insurance corporations; and because it involves tiered benefits packages with differing benefits for the poor and non-poor. Although the UHC orientation has become “hegemonic” in global health policy circles, its ideological assumptions have not been confirmed empirically. The authors urge that the Lancet and MEDICC Review provide “equal time” for critiques of UHC and presentations of endeavours to achieve HCA.
5. Health equity in economic and trade policies
Making Medicines in Africa: The Political Economy of Industrializing for Local Health
Mackintosh M; Banda G; Tibandebage P; Wamae W: Palgrave Connect Open Access International Political Economy Series, 2015
The importance of the pharmaceutical industry in Sub-Saharan Africa, its claim to policy priority, is rooted in the vast unmet health needs of the sub-continent. Making Medicines in Africa, an open access book under a CC-BY license, is a collective endeavour by a group of contributors with a strong African and more broadly Southern presence, to find ways to link technological development, investment and industrial growth in pharmaceuticals to improve access to essential good quality medicines, as part of moving towards universal access to competent health care in Africa. The authors aim to shift the emphasis in the international debate and initiatives towards sustained Africa-based and African-led initiatives to tackle this huge challenge. The authors argue that without the technological, industrial, intellectual, organisational and research-related capabilities associated with competent pharmaceutical production, and without policies that pull the industrial sectors towards serving local health needs, the African sub-continent cannot generate the resources to tackle its populations' needs and demands.
More than cooking stoves: need for an ambitious plan on air pollution
People’s Health Movement; Medicus Mundi International: 27 January 2016
In a statement People's Health Movement (PHM) and Medicus Mundi International (MMI) pointed out the weaknesses of the draft roadmap established by the WHO for an enhanced global response to the adverse health effects of air pollution. In it, they argue that this draft misses an analysis of the current economic and trade-related rules that would prevent the establishment of a robust plan of action. PHM and MMI see serious barriers for the transfer to clean technologies due to the continuing pressure for higher levels of intellectual property protection and investor state dispute settlements in trade agreements. PHM and MMI urge member states to insist on a more strategic and focused approach to the social and economic determinants of air pollution and to address these fundamental issues.
The environmental profile of a community’s health: a cross-sectional study on tobacco marketing in 16 countries
Savell E; Gilmore AB; Sims M; Mony PK; Koon T; et al: Bulletin of the World Health Organisation 93(12), 93:851-861G., December 2015
The objective of the study was to examine and compare tobacco marketing in 16 countries while the Framework Convention on Tobacco Control requires parties to implement a comprehensive ban on such marketing. Between 2009 and 2012, a kilometre-long walk was completed by trained investigators in 462 communities across 16 countries to collect data on tobacco marketing. The authors interviewed community members about their exposure to traditional and non-traditional marketing in the previous six months. To examine differences in marketing between urban and rural communities and between high-, middle- and low-income countries, the authors used multilevel regression models controlling for potential confounders. Compared with high-income countries, the number of tobacco advertisements observed was 81 times higher in low-income countries and the number of tobacco outlets was 2.5 times higher in both low- and lower-middle-income countries. Of the 11 842 interviewees, 1184 (10%) reported seeing at least five types of tobacco marketing. Self-reported exposure to at least one type of traditional marketing was 10 times higher in low-income countries than in high-income countries. For almost all measures, marketing exposure was significantly lower in the rural communities than in the urban communities. Despite global legislation to limit tobacco marketing, it appears ubiquitous. The frequency and type of tobacco marketing varies on the national level by income group and by community type, appearing to be greatest in low-income countries and urban communities.
The Least Developed Countries Report 2015: Transforming Rural Economies
United Nations Conference on Trade and Development(UNCTAD): New York, November 2015
The United Nations Conference on Trade and Development Least Developed Countries (LDC’s) Report 2015 focuses on the transformation of rural economies. Assessing LDCs’ progress in agricultural productivity, the extent and nature of their rural economic diversification, and gender issues in rural transformation, it shows that agricultural productivity began to increase in LDCs in 2000, following decades of stagnation or decline, but has risen strongly only in Asian LDCs. The report also shows that rural economic diversification varies widely between LDCs, but only a few have passed beyond the stage in which non-farm activities are centred on agriculture, and that urban linkages are limited. Further, the report highlights that women comprise half the rural workforce in LDCs, but face serious constraints on realising their productive potential, slowing rural transformation. The 2030 Agenda both highlights the need and provides the opportunity for a new approach to rural development centred on poverty-oriented structural transformation (POST), to generate higher incomes backed by higher productivity. In rural areas, this means upgrading agriculture, developing viable non-farm activities, and fully exploiting the synergies between the two, through appropriately designed and sequenced efforts to achieve the SDGs. The Report argues that differentiation is needed between peri-urban, intermediate, remote and isolated rural areas and a key priority is to overcome the contradiction between need and opportunity, by which more remote areas and poorer households have the greatest need but also the most limited opportunities for income diversification. Gender-specific measures are needed to overcome disadvantages arising directly from gender norms, and more inclusive gender-sensitive approaches to address their poverty-related consequences. Access to appropriate technologies, inputs, skills and affordable finance needs to be fostered. Effective policy coordination is required nationally, while producers’ associations, cooperatives and women’s networks can play a key role locally. Innovative approaches to trade and cross-border investment could make a substantial contribution. Finally, the report highlights the importance of adequate support from the international community to achieve structural transformation and fulfil the SDGs, based on the principle that “to will the end is to will the means”.
6. Poverty and health
Right to sanitation, a distinct human right
Heller L; Sadi W: United Nations Human Rights Office of the Commissioner, New York, December 2015
The United Nations Special Rapporteur on the human right to water and sanitation, Léo Heller, and the Chair of the UN Committee on Economic, Social and Cultural Rights, Waleed Sadi, welcomed the explicit recognition of the ‘human right to sanitation’ as a distinct right, together with the ‘human right to safe drinking water’ by the UN General Assembly in December. Over 2.5 billion people still lack access to improved sanitation - the sanitation target under Goal 7 has been missed by one of the widest margins of all the 18 targets under the Millennium Development Goals. One billion people practise open defecation, nine out of ten in rural areas across the world. The experts explained that while sanitation does not necessarily have to be water-borne, governments tend to focus on this type, rather than on-site sanitation such as pit latrines and septic tanks, which are still widely used. As a result, individual households which rely on on-site sanitation often have to operate the entire system themselves, including collection and disposal, without government support. “The right to sanitation also requires privacy and dignity,” the experts stressed. In the UN General Assembly resolution, adopted by consensus on 17 December 2015, Member States recognized that ‘the human right to sanitation entitles everyone, without discrimination, to have physical and affordable access to sanitation, in all spheres of life, that is safe, hygienic, secure, socially and culturally acceptable and that provides privacy and ensures dignity.’ “We urge all Member States, in both their national budgeting and international development cooperation, to target the allocation of resources to sanitation in particular to the most marginalised and disadvantaged groups and individuals, as those living in urban informal settlements and in rural areas,” the experts said.
7. Equitable health services
Assessing Coverage, Equity and Quality Gaps in Maternal and Neonatal Care in Sub-Saharan Africa: An Integrated Approach
Wilunda C; Putoto G; Dalla Riva D; Manenti F; Atzori A; Calia F; Assefa T; Turri B; Emmanuel O; Straneo M; Kisika F; Tamburlini G; Tarmbulini G: PloS one 10(6), May 2015
The authors present the base-line data of a project aimed at simultaneously addressing coverage, equity and quality issues in maternal and neonatal health care in five districts belonging to three African countries. Data were collected in cross-sectional studies with three types of tools. Coverage was assessed in three hospitals and 19 health centres (HCs) utilising emergency obstetric and newborn care needs assessment tools developed by the Averting Maternal Death and Disability program. Emergency obstetrics care (EmOC) indicators were calculated. Equity was assessed in three hospitals and 13 HCs by means of proxy wealth indices and women delivering in health facilities were compared with those in the general population to identify inequities. All the three hospitals qualified as comprehensive EmOC facilities but none of the HCs qualified for basic EmOC. None of the districts met the minimum requisites for EmOC indicators. In two out of three hospitals, there were major quality gaps which were generally greater in neonatal care, management of emergency and complicated cases and monitoring. Higher access to care was coupled by low quality and good quality by very low access. Stark inequities in utilisation of institutional delivery care were present in all districts and across all health facilities, especially at hospital level. The authors findings confirm the existence of serious issues regarding coverage, equity and quality of health care for mothers and newborns in all study districts. Gaps in one dimension hinder the potential gains in health outcomes deriving from good performances in other dimensions, thus confirm the need for a three-dimensional profiling of health care provision as a basis for data-driven planning.
People's Commission of Inquiry: Free State in Chains
Report back from the People's Commission of Inquiry into the Free State Healthcare System - 7-8 July 2015: Treatment Action Campaign, November 2015
A two-day long People’s Commission of Inquiry into the Free State Health System was held in Bloemfontein, Free State on July 7th and 8th 2015. The inquiry was organised and hosted by the Treatment Action Campaign (TAC) but was set up as a public forum to enable people in the province to give testimony in front of an independent commission of inquiry through verbal and written testimony from more than 60 people representing 15 communities in the province. Civil society, activists and healthcare professionals also spoke or made submissions to the commissioners and the Free State Department of Health was also invited to testify and to make submissions. The key findings that emerged from the testimonies were that: The South African government, in particular the provincial Free State government, are failing to assume their responsibility to protect access to healthcare services, especially for the poor in the province. It reports shortages and stock outs of medication and medical supplies; broken or unavailable equipment; inadequate health workers; long waiting times for provincial emergency medical services and patient transport systems and unreliability and indignity experienced in these services. Many of the oral testimonies spoke of people having to pay out-of-pocket payments for transport to health facilities. Whistle-blowing and engagement is reported to be discouraged and at times met with intimidation. The report offers recommendations to improve access to quality services. The report indicates that the commission is committed to working together with communities, healthcare professionals, the provincial government and all other interested parties to improve conditions.
Strategies for achieving global collective action on antimicrobial resistance
Hoffman S; Caleo G; Daulaire N; Elbe S; Matsoso P; Mossialos E; Rizvi Z; Røttingen JA: Bulletin of the World Health Organisation 93(12), 867-876, 2015
Global governance and market failures mean that it is not possible to ensure access to antimicrobial medicines of sustainable effectiveness. Many people work to overcome these failures, but their institutions and initiatives are insufficiently coordinated, led and financed. Options for promoting global collective action on antimicrobial access and effectiveness include building institutions, crafting incentives and mobilising interests. No single option is sufficient to tackle all the challenges associated with antimicrobial resistance. Promising institutional options include monitored milestones and an inter-agency task force. A global pooled fund could be used to craft incentives and a special representative nominated as an interest mobiliser. There are three policy components to the problem of antimicrobials – ensuring access, conservation and innovation. To address all three components, the right mix of options needs to be matched with an effective forum and may need to be supported by an international legal framework.
8. Human Resources
Global health leadership training in resource-limited settings: a collaborative approach by academic institutions and local health care programs in Uganda
Nakanjako D; Namagala E; Semeere A; et al: Afya Bora Consortium members: Human Resources for Health 13(87), November 2015
Due to a limited health workforce, many health care providers in Africa must take on health leadership roles with minimal formal training in leadership. Hence, the need to equip health care providers with practical skills required to lead high-impact health care programs. In Uganda, the Afya Bora Global Health Leadership Fellowship is implemented through the Makerere University College of Health Sciences (MakCHS) and her partner institutions. Lessons learned from the program, presented in this paper, may guide development of in-service training opportunities to enhance leadership skills of health workers in resource-limited settings. The Afya Bora Consortium, a consortium of four African and four U.S. academic institutions, offers 1-year global health leadership-training opportunities for nurses and doctors. Applications are received and vetted internationally by members of the consortium institutions in Botswana, Kenya, Tanzania, Uganda, and the USA. Fellows have 3 months of didactic modules and 9 months of mentored field attachment with 80% time dedicated to fellowship activities. Fellows’ projects and experiences, documented during weekly mentor-fellow meetings and monthly mentoring team meetings, were compiled and analysed manually using pre-determined themes to assess the effect of the program on fellows’ daily leadership opportunities. Between January 2011 and January 2015, 15 Ugandan fellows (nine doctors and six nurses) participated in the program. Each fellow received 8 weeks of didactic modules held at one of the African partner institutions and three online modules to enhance fellows’ foundation in leadership, communication, monitoring and evaluation, health informatics, research methodology, grant writing, implementation science, and responsible conduct of research. In addition, fellows embarked on innovative projects that covered a wide spectrum of global health challenges including critical analysis of policy formulation and review processes, bottlenecks in implementation of national HIV early infant diagnosis and prevention of mother-to-child HIV-transmission programs, and use of routine laboratory data about antibiotic resistance to guide updates of essential drug lists. In-service leadership training was feasible, with ensured protected time for fellows to generate evidence-based solutions to challenges within their work environment. With structured mentorship, collaborative activities at academic institutions and local health care programs equipped health care providers with leadership skills.
Training needs for research in health inequities among health and demographic researchers from eight African and Asian countries
Haafkens J; Blomstedt Y; Eriksson M; Becher H; Ramroth H; Kinsman J: BMC Public Health 14(1254), 2014
To support equity focussed public health policy in low and middle income countries, more evidence and analysis of the social determinants of health inequalities is needed. This requires specific know how among researchers. The INDEPTH Training and Research Centres of Excellence (INTREC) collaboration identified learning needs among INDEPTH researchers from Ghana, Tanzania, South Africa, Kenya, Indonesia, India, Vietnam, and Bangladesh to conduct research on the causes of health inequalities in their country. Using an inductive method, online concept-mapping, participants were asked to generate statements in response to the question what background knowledge they would need to conduct research on the causes of health inequalities in their country. Of the 150 invited researchers, 82 participated in the study: 54 from Africa; 28 from Asia. African participants assigned the highest importance to further training on methods for assessing health inequalities. Asian participants assigned the highest importance to training on research and policy.
9. Public-Private Mix
A Trojan horse of the private sectors interests at the World Health Organisation
People’s Health Movement; Medicus Mundi International: 26 January 2016
A January 2016 statement of the People's Health Movement (PHM) and Medicus Mundi International (MMI) identified that the Framework of Engagement with Non-State Actors (FENSA) currently under discussion at the World Health Organisation (WHO) fails to provide a robust framework against undue influence of the corporate sector and its philanthropies. In the statement the PHM and MMI argue that FENSA is symbolic of a more fundamental issue of the compromise to WHO’s independence due to its under-funding and tightly earmarked voluntary contributions making it vulnerable to such influence. They argue for an end to the dual freeze on the WHO Programme Budget and on assessed contributions which severely limits WHO’s functioning. "Until and unless this is addressed, WHO stands at risk of private sector capture and further loss of its integrity, independence, and credibility", the statement warned.
Common Declaration for Responsible Partnerships
International Forum on Public-Private Partnerships for Sustainable Development, December 2015
In the context of the 2015 Paris Climate Conference, COP 21, an International Forum on Public-Private Partnerships (PPPs) for Sustainable Development has been held in Annemasse. Within this framework and in view of the Sustainable Development Goals defined by the UN, the Cité de la Solidarité Internationale organised on October 30 2015 a collective intelligence workshop gathering representatives from the civil society as well as public and private stakeholders. The assembly called for PPPs that guarantee access for all to common goods and the respect of Human Rights to foster an economy of human dimension. They recommended to: Include the civil society in the entire process of public-private partnerships, upstream to downstream, by identifying the genuine needs, promoting the general interest as the final goal and avoiding conflict of interest and controlling the services of which they are the main beneficiaries. They argued that it is necessary to create a legal framework and appropriate tools to strengthen civil society legitimacy, to guarantee co-construction of equal win partnerships with general interest as a common objective to avoid an unbalanced or competitive approach and to consider alternative approaches and initiatives of collaboration (such as social and solidarity-based economy) as an evolution towards more balanced and inclusive partnerships favouring a participatory democracy.
Do financial contributions from ‘pharma’ violate WHO Guidelines?
Gopakumar K: Third World Network (TWN) Info Service on Health Issues Dec 15(01), December 2015
Millions of dollars given by major pharmaceutical companies to the World Health Organisation (WHO) raise questions of compliance with the organisation’s guidelines on interactions with commercial enterprises. Currently, WHO’s relations with commercial enterprises are guided by the “Guidelines on interaction with commercial enterprises to achieve health outcomes” . The 107th Session of the Executive Board in 2001 “noted” the Guidelines that cover cash donations, contributions in kind, seconded personnel, collaboration for product development, collaboration for meetings etc. Compliance with the Guidelines has essentially been left to the Secretariat. According to paragraph 11 of the Guidelines, “Commercial enterprises working with WHO will be expected to conform to WHO public health policies in the areas of food safety, chemical safety, ethical promotion of medicinal drug products, tobacco control, and others”. It is notable that the draft Framework of Engagement with Non-State Actors (FENSA) currently being finalised by WHO Member States does not contain a provision that requires a commercial enterprise to conform to WHO’s polices, norms and standard. In the absence of such a clear provision FENSA could legitimise engagement with the private sector, which does not follow WHO’s policies in the areas of food safety, chemical safety, ethical promotion of medicinal drug products, tobacco control, and others. WHO Member States at the resumed session of the Open Ended Intergovernmental Meeting (OEIGM) on FENSA is expected to look at the regulation of WHO’s engagement with the private sector. The experience with the implementation of the Guidelines on interaction with commercial enterprises to achieve health outcomes would be useful for the consideration of Member States. In 2014, WHO received USD 6,158,153 from GlaxoSmithKline (GSK). It received USD 5,785,000 and USD 8,266,284 in 2012 and 2013 respectively from GSK. GSK Biologics paid USD 17,000. Novartis AG donated USD 5,300,000 in 2014 and USD 4,500,000 in 2013. Hoffmann-La Roche donated USD 6,158,153 in 2014 and USD 4,806,492 in 2013. The purposes of those donations were not disclosed.
10. Resource allocation and health financing
#FeesMustFall and the campaign for universal health coverage
Doherty J; McInytre D: The South African Medical Journal 105(12), 1014-1015, 2015
This article reflects on how #FeesMustFall highlighted the political and social upheaval that results from extreme income inequity and inequitable access, problems that beset the health sector as well. It presents data showing how per capita health expenditure declined for a decade after 1994, despite the burgeoning HIV/AIDS epidemic, a blow from which the health system is still trying to recover. The underlying reason for this was a macroeconomic policy that placed constraints on taxation and government expenditure on social services. The article shows how South Africa (SA)'s tax-to-GDP ratio is much lower than other middle-income countries, and argues that raising this limit is essential for development. Spending on health and education should be seen as an investment in the SA economy. The authors suggest that the Department of Health needs to argue this case in Cabinet and demonstrate the effectiveness of health spending through efficient service delivery and fighting corruption.
11. Equity and HIV/AIDS
Relationship between power, communication, and violence among couples: results of a cluster-randomised HIV prevention study in a South African township
Minnis A; Doherty I; Kline T; Zule W; Myers B; Carney T; Wechsberg W: International Journal of Women's Health, 7, 517–525, 2015
Inequitable gender-based power in relationships and intimate partner violence contribute to persistently high rates of HIV infection among South African women. The authors examined the effects of two group-based HIV prevention interventions that engaged men and their female partners together in a couples intervention (Couples Health CoOp [CHC]) and a gender-separate intervention (Men’s Health CoOp/Women’s Health CoOp [MHC/WHC]) on women’s reports of power, communication, and conflict in relationships. Of the 290 couples enrolled, 255 women remained in the same partnership over 6 months. Following the intervention, women in the CHC arm compared with those in the WHC arm were more likely to report an increase in relationship control and gender norms supporting female autonomy in relationships. Women in the MHC/WHC arm were more likely to report increases in relationship equity, relative to those in the CHC arm, and had a higher odds of reporting no victimisation during the previous 3 months. Male partner engagement in either the gender-separate or couples-based interventions led to modest improvements in gender power, adoption of more egalitarian gender norms, and reductions in relationship conflict for females. The aspects of relationship power that improved, however, varied between the couples and gender-separate conditions, highlighting the need for further attention to development of both gender-separate and couples interventions.
“You are wasting our drugs”: health service barriers to HIV treatment for sex workers in Zimbabwe
Mtetwa S; Busza J; Chidiya S; Mungofa S; Cowan F: BMC Public Health 13(698), July 2013,
In Zimbabwe, despite the existence of well-attended services targeted to female sex workers (SWs), fewer than half of women diagnosed with HIV took up referrals for assessment and ART initiation; just 14% attended more than one appointment. The authors conducted a qualitative study to explore the reasons for non-attendance and the high rate of attrition, through three focus group discussions (FGD) in Harare with HIV-positive SWs. SWs emphasised supply-side barriers, such as being demeaned and humiliated by health workers, reflecting broader social stigma surrounding their work. Sex workers were particularly sensitive to being identified and belittled within the health care environment. Demand-side barriers also featured, including competing time commitments and costs of transport and some treatment, reflecting SWs’ marginalised socio-economic position. Improving treatment access for SWs is critical for their own health, programme equity, and public health benefit. The authors suggest that programmes working to reduce SW attrition from HIV care need to proactively address the quality and environment of public services. Sensitising health workers through specialised training, refining referral systems from sex-worker friendly clinics into the national system, and providing opportunities for SW to collectively organise for improved treatment and rights might help alleviate the barriers to treatment initiation and attention currently faced by SW.
12. Governance and participation in health
A Resolve to Reform - A look at the Director-General's Opening Address at the 138th Meeting of the Executive Board (EB138)
People’s Health Movement: Geneva, 25 January 2016
The 138th Meeting of the Executive Board (EB138) of the World Health Organisation (WHO) taking place from 25 to 30 January 2016 in Geneva includes a host of issues, including reviews of the WHO’s governance, finance and emergency structure. In the opening remarks of WHO Director-General Margaret Chan, the topics touched on ranged widely from Ebola to Road Safety, with an emphasis on Universal Health Coverage in her final paragraph. A pointed reference to the “explosive spread of Zika virus in new geographical areas”, was a conscious effort to highlight the potential threats of infectious disease beyond Ebola, and the much needed reform of the WHO’s emergency structures. She commented on Universal Healthcare Coverage as “the most efficient way to respond to the rise of non-communicable diseases” , although the PHM note the debates on how the proposal for UHC has shifted the focus from how services should be provided to how services should be financed, with private sector providers and private insurance assumed to be part of the solution, despite evidence that this can lead to ‘health-defeating’ market failures. The Director General noted, however, that some policy recommendations on child obesity “pick a fight with powerful economic interests”. These remarks were welcomed by PHM if followed through with changes in the organisation’s relationship with big business.
Health governance in Sub-Saharan Africa
Mooketsane K; Phirinyane M: Global Social Policy15(3): 345–348, December 2015
The interdependence of states and increasing movement of people, the spread of contagious diseases and the heightened complexity of global health issues make cooperation among countries indispensable. Unfortunately resourcing remains a critical challenge to effective health governance. The authors argue that financial resources are not really a major challenge for Sub-Saharan Africa as it is usually perceived. According to the International Monetary Fund (IMF), Sub-Saharan Africa’s economic growth has been robust and capital inflows higher than the developing countries’ average. Notwithstanding threats to the region seems poised for better prospects. The authors argue that health governance should be given a higher significance if growth rates are to be sustained and strategies developed for collaboration between governments and non-state actors. Many Sub-Saharan Africa countries still view non-state actors with suspicion, but the authors argue that those that have embraced them as development partners have reaped some positive results in the provision of health services, such as in the role of mission services in health care provision in Botswana and Malawi. They suggest enhancing a multi-pronged cooperation between African state and non state actors and that the porous borders across countries necessitate regional cooperation to effectively combat the spread of diseases.
Migration Governance and Migrant Rights in the Southern African Development Community (SADC) Attempts at Harmonization in a Disharmonious Region
Dodson B; Crush J: United Nations Research Institute for Social Development (UNRISD) Research Paper 2015–3, October 2015
This paper examines prospects for enhanced regional migration governance and protection of migrants’ rights in the Southern African Development Community (SADC). Migration in this region is substantial in scale and diverse in nature, incorporating economic, political and mixed migration flows. In addition to movements between countries within the region, migrants also come from across the African continent and even further afield. At its foundation in 1992, SADC as an institution initially embraced a vision of intra-regional free movement, but this has not become a reality. If anything, there has been a hardening of anti-migrant attitudes, not least in the principal destination country of South Africa. There have also been serious violations of migrants’ rights. Attempts at regional coordination and harmonisation of migration governance have made limited progress and continue to face formidable challenges, although recent developments at national and regional levels show some promise. In conjunction with the 2003 SADC Charter of Fundamental Social Rights and 2008 Code on Social Security, incorporation of migrants into the SADC 2014 Employment and Labour Protocol could signal a shift towards more rights-based migration governance. The paper concludes by arguing that there can be no robust rights regime, either regionally or in individual countries, without extension of labour and certain other rights to non- citizens, nor a robust regional migration regime unless it is rights-based.
One Million Signatures to Have a Clear Law on Abortion
Centre for Health Human Rights and Development (CEHURD): Uganda, September 2015
The Centre for Health Human Rights and Development(CEHURD) through the Coalition to Stop Maternal Mortality due to Unsafe Abortion, marked the Global Day of Action on Safe and Legal Abortion on the 28th of September 2015. The global trending hash tag on social media was #BustTheMyth that all messages on myths and facts on abortion were attached to while sending out to followers on social media. A petition was read in line with the theme; Because every woman and Girl Counts and a campaign to have 1 million signatures was launched. The campaign sought to have one million signatures to be presented to parliament and the Speaker of Uganda Parliament, the Rt. Hon. Rebecca Kadaga and entire legislative council, to consider having a proper and clear law on abortion. Two social media campaigns in line with the theme were launched to boost the main campaign with the hash tags; #BustTheMyth and #LetHerSpeak: Because every woman and girl counts.
World Health Organisation Executive Board meeting 138
World Health Organisation: Geneva, January 2016
The WHO Executive Board is composed of 34 members technically qualified in the field of health. Members are elected for three-year terms. The main Board meeting, at which the agenda for the forthcoming Health Assembly is agreed upon and resolutions for forwarding to the Health Assembly are adopted, is held in January, with a second shorter meeting in May, immediately after the Health Assembly, for more administrative matters. The main functions of the Board are to give effect to the decisions and policies of the Health Assembly, to advise it and generally to facilitate its work. The full set of documents under consideration at the 138th WHO Executive Board meeting are available online at the organisation's website.
13. Monitoring equity and research policy
Framework for monitoring equity in access and health systems issues in antiretroviral therapy Programmes in southern Africa
Kalanda B; Kemp J; Makwiza I: Malawi Medical Journal19(1) 20–24, 2007
Universal provision of antiretroviral therapy (ART), while feasible, is expensive. In light of this limitation, the World Health Organisation (WHO) has launched the 3 × 5 initiative, to provide ART to 3 million people by the end of the year 2005. In Southern Africa, large-scale provision of ART will likely be achieved through fragile public health systems. ART programmes should therefore be developed and expanded in ways that will not aggravate inequities or result in the inappropriate withdrawal of resources from other health interventions or from other parts of the health system. This paper, proposes a framework for monitoring equity in access and health systems issues in ART programmes in Southern Africa. It proposes that an equity monitoring system should comprise seven thematic areas. These thematic areas encompass a national monitoring system which extends beyond one agency or single data collection method. Together with monitoring of targets in terms of numbers treated, there should also be monitoring of health systems impacts and issues in ART expansion, with reporting both nationally and to a regional body.
Measuring Regional Policy Change and pro-Poor Health Policy Success: A PRARI Toolkit of Indicators for the Southern African Development Community
Amaya A; Choge I; De Lombaerde P; et al.,: UNU CRIS, Open University, December 2015
Developed collaboratively with actors in the region, this toolkit is a guide to the implementation of an indicator system to measure regional policy change and pro-poor regional health policy successes targeted at the pilot areas of HIV/AIDS, TB and malaria in the SADC context. The toolkit also aims to capture the limitations the health sectors in many countries may have in addressing structural issues that make the poor more vulnerable or at risk.
14. Useful Resources
Global health as seen by Congo's sapeurs
Muvudi M: Health Financing Africa, 22 December 2015
Health Financing Africa host a cartoon showing a satirical response to the global development agendas. This cartoon draws on the "Sape" movement (The Society of Ambiance-Makers and Elegant People) in Brazzaville and Kinshasa. Universal Health Coverage figures into the new Sustainable Development Goals and, with a wink, Michel Muvudi (Democratic Republic of the Congo) warns us not to be overly optimistic about the impact of such international objectives at the country level.
Primary Health Care Performance Initiative Toolkits
Primary Health Care Performance Initiative Website
The Primary Health Care Performance Initiative (PHCPI) is a new partnership that brings together country policymakers, health system managers, practitioners, advocates and other development partners to catalyse improvements in primary health care (PHC) in low- and middle-income countries through better measurement and knowledge-sharing. PHCPI aims to help countries to track key performance indicators for their PHC systems, identifying which parts of the system are working well and which ones aren’t. It aims to enhance accountability and provide decision-makers with essential information, to provide a platform for countries to share lessons and best practices an advocacy toolkit, and a compare tool which allows users to simultaneously compare multiple countries across multiple indicators.
15. Jobs and Announcements
Call for case studies: Reducing the risk of exporting unethical practices to low and middle income countries
Deadline: 2 March 2016
TRUST Equitable Research Partnerships invites the submission of case studies identifying the risks of exporting non-ethical research practices to low and middle income countries. The TRUST project addresses the risks of ethics dumping - that is the export of research practices that would be considered unethical in Europe - for both public and privately funded research. With the globalisation of research activities, there is an increasing risk of research involving sensitive ethical issues being conducted by European organisations outside the European Union, without proper compliance structures and follow-up. To contribute to the research, TRUST are launching this bottom-up call. Five full case studies will be funded from successful applicants to this competition. These cases must refer to research undertaken in low or middle income countries by researchers, sponsors or funders from high income countries; in any field of research (e.g. life sciences, social sciences, agriculture, environment, animals, security, etc.). The deadline for submission of abstracts is March 2nd, 2016 with full submission of selected proposals on May 2nd 2016. The five winners will each receive €2,000. The competition is part of the TRUST project, co-funded by the European Commission under grant number 664771.
Call for contributions: UN Secretary-General’s High-Level Panel on Access to Medicines
Closing date for contributions: 18 February 2016
The United Nations Secretary-General’s High-Level Panel on Access to Medicines is calling for contributions by interested stakeholders that address the misalignment between the rights of inventors, international human rights law, trade rules and public health where it impedes the innovation of and access to health technologies. In particular the High-Level Panel will consider contributions that promote research, development, innovation and increase access to medicines, vaccines, diagnostics and related health technologies to improve the health and wellbeing of all, as envisaged by Sustainable Development Goal 3, and the 2030 Agenda for Sustainable Development more broadly. Submitted contributions should be evidence-informed and include references to the principles, literature and models upon which the contribution is based. The contributions should reflect, align and demonstrate how it will support the attainment of the 2030 Agenda for Sustainable Development and in particular, Sustainable Development Goal 3, that aims to improve the health and wellbeing for all, and where applicable, indicate the political, financial or other requirements to the implement of the proposed ideas.
Call for individual abstracts: Fourth Global Symposium on Health Systems Research, 2016
Closing date for submission: 20 Mar 2016
The Symposium invites abstracts for individual presentations, linked to the following sub-themes: Enhancing health system resilience: absorbing shocks and sustaining gains in every setting; Equity, rights, gender and ethics: maintaining responsiveness through values-based health systems; Engaging power and politics in promoting health and public value; Implementing improvement and innovation in health services and systems; New partnerships and collaborations for health system research and development; Future reciprocal learning and evaluation approaches for health system development. Abstracts in a given sub-theme may address any of the Symposium’s traditional ‘field-building dimensions’: Cutting-edge research, Innovative research approaches and measures, Novel strategies for developing capacity, Learning communities and knowledge translation, Innovative practice in health systems development. See website for details.
Council for the Development of Social Science Research in Africa (CODESRIA) Job Vacancy Senior Programme Officer
Closing date for applications: 28 February 2016
The Council for the Development of Social Science Research in Africa (CODESRIA) invites applications from African scholars to fill the vacant position of Senior Programme Officer (Research) in its pan-African Secretariat located in Dakar, Senegal. This position is categorised as belonging to the senior staff of the Council and as such is filled on the basis of an international announcement. The successful candidate will work as a senior member of the Secretariat under the overall supervision of the Executive Secretary of the Council. Candidates wishing to apply for the position are requested to note the following: The Senior Programme Officer (Research) has as his/her primary responsibility the management of the Council’s Research Programme including overseeing National, Multinational and Trans-National Working Groups, Comparative Research Networks, as well as thematic and issue-specific research programmes, special initiatives and projects. In this connection, the Senior Programme Officer will be responsible for managing all aspects of the portfolio of programmes entrusted to him/her, and overseeing the work of Programme Officers managing programme clusters within the Research Programme, each of which may include several of the following programmes: the Gender Programme, the Academic Freedom Programme, the African Humanities Programme, the Governance Programme, the Health, Politics and Society Programme, the Programme on Children and Youth, the Higher Education Leadership Programme, the Environmental Governance Programme, the Economic Policies Programme, the Lusophone Initiative, and the South-South Tri-continental Collaborative Programme. The Research Programme also organises major conferences tied to the Council’s programmes and strategy. In addition to his/her specific responsibilities, the successful candidate will be called upon to perform the following functions: initiate, develop and, where appropriate, manage new projects and programmes; lend support for the realisation of the other scientific activities of the Council; organise academic and policy meetings; promote contacts with researchers, professional associations and regional organisations; prepare research and funding proposals on themes connected to his/her areas of expertise as may be requested by the Executive Secretary; and where appropriate, liaise with funding organisations under the direction of the Executive Secretary.See website for application details.
Fellowships to Support Doctoral Research on Gender-Based Violence (GBV)/ Violence Against Women and Girls (VAWG)
Closing date for applications: 31 March 2016 (11:59pm, Nairobi time)
As part of efforts to increase capacity to conduct research on GBV/VAWG in the continent, the African Population and Health Research Center, in partnership with the London School of Hygiene & Tropical Medicine, International Rescue Committee and the Department for International Development has announced a call for applications to support 3 doctoral students interested in working in and contributing to this field of research. The expectation is that the fellows will contribute to the field through their doctoral research and, in future, will work in this field, applying their knowledge and expertise. The award of these fellowships is contingent on funding availability. See website for details.
Health Systems Trust Conference 2016
4-6 May 2016, Gauteng, South Africa
Health Systems Trust is hosting a conference from 4-6 May 2016 at the Birchwood Conference centre, Gauteng South Africa. Under the banner of Health for all through strengthened health systems: sharing, supporting, synergising, the event is designed to advance the global public health agenda in improving health outcomes. The three-day conference will convene approximately 300 healthcare workers from the public and private sectors as well as policy- and decision-makers, civil society groupings and academics. The conference will provide an opportunity to discuss challenges faced and solutions adopted at various levels in the health system. See website for details.
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