One question being asked in relation to the recently adopted Sustainable Development Goals (SDGs) is how they relate to human rights based approaches. In the health sector for instance, SDG 3 aims to ensure healthy lives and the promotion of well-being for all ages. This includes a target of reducing the global ratio of women dying in childbirth to less than 70 in every 100 000 live births. While maternal mortality has fallen by almost 50 per cent since 1990, fourteen times more mothers do not survive childbirth in developing countries than in developed countries.
By 2014, Uganda’s maternal mortality rate was amongst the highest, with 360 mothers dying in every 100 000 live births, according to Uganda’s 2014/5 Annual Health Sector Performance Report. The country has failed by a large margin to realise the target set for maternal mortality in the Millennium Development Goals (MDGS), and what should be a healthy reproductive event continues to claim women’s lives in the country. The 2014 figures indicate that 6 000 Ugandan mothers die in childbirth annually, which is an average of sixteen daily, or one death every 90 minutes.
There have been a number of promising policy statements and interventions suggested by government to address this unacceptable level of mortality. Bottlenecks in the financing, delivery and uptake of maternal health services have however led to a shortfall in the delivery of these interventions. We view this situation as a complete failure by the state to deliver its constitutionally mandated obligations under Article 33 of the Constitution to provide the facilities and opportunities needed for women to realise their full potential; and to protect women and their rights, including their reproductive rights and functions in society.
The shortfall in maternal health services has been a focus of civil society advocacy in Uganda for some time. Civil society has consistently argued for the state to resolve the poor conditions in which mothers have to give birth in Uganda. It has used a human rights based approach in this, framing the demands in the language of legal rights and constitutional obligations. There is evidence of some success in this. A group of civil society organisations, led by the Center for Health, Human Rights and Development (CEHURD), acting together with two aggrieved families brought before the courts the deaths of two mothers. This was led as a constitutional challenge, arguing that the deaths occurred as a result of failures in the health system to provide basic commodities for safe deliveries. In this case, the Supreme Court directed the Constitutional Court to hear the case, on the basis that the failure by the government of Uganda to provide women with basic essential care was being challenged as a contravention of Uganda’s Constitution and the women’s rights.
The legal battle did not go without challenges. There were constant delays, with frequent adjournments due to non-appearances by the state or the failure to assemble a full panel of judges to hear the case. The state objected to the case, claiming that the judiciary had no authority to question the political decisions of the state. Initially the Constitutional court agreed with the state and dismissed the case. This was, however, reversed on appeal to the Supreme Court. In his judgment at the Supreme Court, Chief Justice Bart Katureebe stated that “….if a citizen alleges that a health policy or actions and omissions made under that policy are inconsistent with the constitution…., then the constitutional court has a duty to come in…”. The case is thus now before the Constitutional Court, as directed by the Supreme Court. The process to date raises an important point of law for the SDGs, and particularly Goal 16. This goal focuses on promoting peaceful and inclusive societies for sustainable development. It emphasizes access to justice for all and building effective, accountable and inclusive institutions at all levels. For the health sector, traditionally a reserve of public health and medical actors, the SDGs and human rights approaches indicate that other actors will now have a significant role to play.
The experience in Uganda already raises learning on this: The court process motivated civil society to advocate for health issues with one voice. It created awareness that social and economic rights are justiciable in Uganda, and that citizens can seek justice in the courts if other arms of government do not deliver on their obligations. The Ministry of Health has since pushed for increased funding for maternal health and parliament has made resolutions to support increased health financing and asked government to recruit more health workers to strengthen health services. The Ministry of Health has also now developed guidance on the mainstreaming of human rights in the provision of health care in Uganda.
The judiciary has also increased its understanding of health rights. Subsequent court judgments have, for instance, pronounced that access to emergency obstetric care is a human right, which was not the case previously. The courts have also held a local government authority accountable for a mother’s death where it failed to properly supervise the health professionals falling within its mandate.
While there is still a lot to be done, and while the constitutional case is still pending, the experience indicates that framing health demands in the language of legal rights and constitutional obligations, including through litigation and other legal processes, can assist to place health rights as a more central issue for the court of judges and the court of public opinion. Our experience indicates that such human rights based approaches have a role to play in taking action to implement global goals to ensure healthy lives and the promotion of well-being for all ages.
Please send feedback or queries on the issues raised in this briefing to the EQUINET secretariat: admin@equinetafrica.org.
1. Editorial
2. Latest Equinet Updates
In 2012 EQUINET initiated a three year policy research programme working with government officials, researchers, diplomats and others in the ESA region on the role of health diplomacy and international co-operation in health, including south –south diplomacy, in addressing selected key challenges to health and strengthening health systems. We aimed to use the evidence and learning to inform African policy actors and stakeholders within processes of health diplomacy. The work was done in association with the Strategic Initiative of Global Health Diplomacy co-ordinated by the East Central and Southern Africa Health Community (ECSA-HC). The research reports and policy briefs have been produced and are included in the EQUINET publications on this website. A March 2015 workshop included senior officials from national and regional organisations, health diplomats, researchers from the EQUINET work and others working on health diplomacy and on south-south co-operation in the region and internationally. The workshop discussed the evidence from the EQUINET research and from research on GHD from other institutions with a particular focus on east and southern Africa and proposed areas for follow up policy, action and research, within ESA and through south-south collaboration. The meeting report is on this website. EQUINET is now taking forward the proposals from this meeting in association with a consortium of institutions in the region, and is working with the ECSA Health Community in its Strategic initiative on global health diplomacy to share evidence and analysis for key global processes, including in the forthcoming regional workshop on GHD hosted by the ECSA HC with EQUINET.
3. Equity in Health
This document provides a preliminary assessment of the Zambian health system relative to the goal of universal health coverage, with a particular focus on the financing system and related aspects of provision. Zambia is making continuous progress in all the key areas of its health system. However, there are gaps which need to be resolved for the country to be able to realise the goal of universal coverage, including universal financial protection and access to care. First, a more equitable distribution of resources between urban and rural areas is required. Second, resources need to be allocated to promote access to, and utilisation of, health care by the poorer socio-economic groups. The higher consumption of public inpatient health care services by wealthier groups is a striking example of inequitable utilisation, as is the relatively greater levels of government subsidy received by wealthier groups, even for primary health care. Third, the impoverishing effect of out-of-pocket payments exposes poorer households to financial risk, driving households into poverty or further into poverty. This requires reconsideration of public hospital user fees, both in terms of the level of fees and the application of bypass fees (which are charged when patients bypass primary
health care facilities, including because of the severity of their conditions and their proximity to higher-level health facilities). Finally, Zambia’s ambition to introduce social health insurance as a mechanism for improving the pooling and purchasing of services needs to be scrutinised for its possible impacts on equity. The proposed social health insurance scheme would require co-payments and perhaps other contributions, which would increase the financial burden on households. This means that the proposed scheme could effectively run counter to the ambition of attaining universal health coverage. There should be a critical evaluation of the alternative option of simply continuing – and strengthening - the current tax-based financing system.
4. Values, Policies and Rights
Female Genital Mutilation (FGM) is outlawed in Kenya. In this interview, Kenyan activist John Wafula holds the view that: “FGM is not a culturally enriching choice but rather a tool to isolate women and girls for disempowerment, domination and stagnation. If FGM negates girls’ right to education and healthy bodies then it ceases to be tenable as a cultural identity”. Prior to interventions to address FGM, he reports undertaking a baseline study to establish the prevalence of FGM in refugee camps, survivors, practitioners. The reasons why FGM was practiced, mostly among refugees of Somali descent, included perceptions that uncircumcised women would otherwise be unfaithful and ineligible for marriage. Their efforts to prevent FGM entailed creating awareness about its health, social and psychological consequences at the community level. They also invited religious scholars to engage the community on religion-based myths that were peddled to justify FGM. They sensitized school children on human rights, which also encompassed protection against any form of violence, FGM included. They targeted refugee community leaders for sensitization because of their visible position as community gatekeepers. The 2014 Kenya Demographic Health Survey indicated a nation-wide prevalence of 23%, down from 27% in 2008-09 and 32% in 2003. After enactment of the Prohibition of Female Genital Mutilation Act in 2011, an Anti-FGM Board was established that is reviewing a FGM policy with vigorous media campaigns to sensitize the public on the Act, supported by insights from research.
Expanded mobility and cross-border trading across the road transport sector in Southern Africa have contributed to increased HIV prevalence rates among key populations and communities living in the region. To support a strengthened and co-ordinated response to the unique public health challenges this presents, the Southern African Development Community (SADC) approved the Regional Minimum Standards and Brand for HIV and other Health Services Along Road Transport Corridors in the SADC Region (RMSB) in November 2015. It includes guiding principles on the right to health; health-promoting workplaces; gender mainstreaming; empowerment of commercial sex workers and effective partnership. It sets minimum standards on service delivery and a minimum package of services for those involved in road transport corridors.
5. Health equity in economic and trade policies
The author argues that the outcome of the last WTO Ministerial, the 'Nairobi Package', was in fact a slap in the face for the peoples of the South. He observes it to be especially egregious that the US used the 10th Ministerial, with the help of the Kenyan leadership, to undermine the future of Pan-African trading relations and to drive a wedge between the BRICS societies and those that the US wants to manipulate in the poor countries. He further argues that the 10th Ministerial has hastened the demise of the WTO in an article which charts the various trade agreements and roles played by state actors in the North and South in achieving unfair and unequal global agreements.
The authors report that the world’s poorest countries are losing billions of potential tax revenue each year as a result of illicit financial flows and the tax dodging schemes associated with them. These complex and shadowy tax dealings are robbing developing countries of revenue they need to spend on essential public services. Making a Killing analyses one part of the web of illicit financial flows, the ‘misinvoicing’ of international trade – a way of hiding the true value of imports and exports, shifting profits and evading taxes. The figures are staggering. The sums being lost are comparable to the amounts currently missing from the health budgets of very poor countries – lost money that could boost total budgets and pay for desperately needed doctors, nurses, clinics, hospitals and medicines, and provide the basic minimum of decent healthcare to mothers and children. If the world is to meet its ambitious targets on health and child survival, let alone the broader objectives of the Sustainable Development Goals, illicit financial flows must be urgently addressed. This reports sets out recommendations for action by the international community.
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 is an open access online book that 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 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.
In a response to critiques of the 2016 Alternative Mining Indaba, the Bench Marks Foundation asserts their commitment to a popular movement of workers and poor people in contesting corporate power and elite control over mining processes. The authors define their approach as evidence or research-based activism, accompanied by community organising and monitoring of corporate conduct with the view of challenging corporate power and continuing to agitate wherever power lies. To date, they have followed an advocacy strategy built on research, community organising, building alliances with organised workers and other communities. The organisers of the Alternative Mining Indaba argue that it is a time for governments to rededicate themselves with concrete deeds to protect and prevent harm for poor people.
6. Poverty and health
Much of the benchmarking that takes place in the water sector today focuses on financial and technical performance, making it difficult for water operators to pursue broader social, political and environmental objectives. As an alternative this paper introduces the concept of social efficiency; to widen the scope of performance evaluation by adding new indicators that emphasize equity and promote publicness, informed by extensive field research in Africa and Latin America. We argue that advancing social efficiency could be the most important contribution the Global Water Operators Partnerships Alliance (GWOPA) makes to knowledge transfer in the water sector, given the relatively small budgets it can leverage. WOPs may be the proverbial drop in the bucket when it comes to improving water and sanitation services around the world, but they could be a significant drop in that bucket.The paper examines two WOPs. The first is between Morocco Office National de Électricité et de l'Eau Potable (ONEE) and Burkina Faso Office National de Eau et de Assainissement (ONEA). The second is between Uruguay Obras Sanitarias del Estado (OSE) and Porto Alegre Departamento Municipal de Água e Esgotos (DMAE) in Brazil. The research shows that both of these partnerships reflect the general trend of prioritizing technical and financial efficiency. Despite having innovative social programs at home, neither WOP has formal pro-poor objectives or evaluation mechanisms to assess pro-poor outcomes, highlighting the untapped potential for knowledge sharing on this type of expertise. Platforms such as GWOPA could provide the necessary guidance and incentives to match water operators interested in pro-poor initiatives and prioritize social efficiency in partnership activities.
7. Equitable health services
The first-ever ministerial conference on immunization in Africa was held in February in Addis Ababa. According to the author it presents the perfect opportunity to acknowledge the benefits of vaccine programs, celebrate the successes on the continent, look seriously at what needs to be done to make sure all children get the vaccines they need, and then commit to making that happen. A new study from the Johns Hopkins Bloomberg School of Public Health estimates that between 2011 and 2020, the majority of countries in Africa will collectively see a net economic benefit of $224 billion by investing in immunization programs. The study also found that, in 94 low- and middle-income countries around the world, for every dollar invested in vaccines during the decade, there will be an estimated return of 16 times the costs, taking into account treatment costs and productivity losses. Unfortunately, at the current rate of progress, we are not on track to meet the ultimate goal of reaching all children with vaccines. Right now, one in five African children still do not receive the vaccinations they need. Of the 10 countries around the world with the most unvaccinated children, five are African: the Democratic Republic of the Congo, Ethiopia, Nigeria, South Africa and Uganda.
As the Ebola outbreak in West Africa wanes, the author argues that it is time for the international scientific community to reflect on how to improve the detection of and coordinated response to future epidemics. The interdisciplinary author team identified key lessons learned from the Ebola outbreak that can be clustered into three areas: environmental conditions related to early warning systems, host characteristics related to public health, and agent issues that can be addressed through the laboratory sciences. In particular, they argue there is a need to increase zoonotic surveillance activities, implement more effective ecological health interventions, expand prediction modeling, support medical and public health systems in order to improve local and international responses to epidemics, improve risk communication, better understand the role of social media in outbreak awareness and response, produce better diagnostic tools, create better therapeutic medications, and design better vaccines. This list highlights research priorities and policy actions the global community can take now to be better prepared for future emerging infectious disease outbreaks that threaten global public health and security.
The integration of maternal mental health into primary health care has been advocated to reduce the mental health treatment gap in low- and middle-income countries (LMICs). This study reports findings of a cross-country situation analysis on maternal mental health and services available in five LMICs, to inform the development of integrated maternal mental health services integrated into primary health care. The situation analysis was conducted in five districts in Ethiopia, India, Nepal, South Africa and Uganda, as part of the Programme for Improving Mental Health Care (PRIME). The analysis reports secondary data on the prevalence and impact of priority maternal mental disorders (perinatal depression, alcohol use disorders during pregnancy and puerperal psychosis), existing policies, plans and services for maternal mental health, and other relevant contextual factors, such as explanatory models for mental illness. Limited data were available at the district level, although generalizable data from other sites was identified in most cases. Community and facility-based prevalences ranged widely across PRIME countries for perinatal depression (3–50 %) and alcohol consumption during pregnancy (5–51 %). Maternal mental health was included in mental health policies in South Africa, India and Ethiopia, and a mental health care plan was in the process of being implemented in South Africa. No district reported dedicated maternal mental health services, but referrals to specialised care in psychiatric units or general hospitals were possible. No information was available on coverage for maternal mental health care. Challenges to the provision of maternal mental health care included; limited evidence on feasible detection and treatment strategies for maternal mental disorders, lack of mental health specialists in the public health sector, lack of prescribing guidelines for pregnant and breastfeeding women, and stigmatising attitudes among primary health care staff and the community. It is difficult to anticipate demand for mental health care at district level in the five countries, given the lack of evidence on the prevalence and treatment coverage of women with maternal mental disorders. Limited evidence on effective psychosocial interventions was also noted, and must be addressed for mental health programmes, such as PRIME, to implement feasible and effective services.
South African health authorities say the visitor diagnosed with the mosquito-spread Zika virus has recovered and there is minimal likelihood of a local outbreak. The visiting Colombian businessperson who was diagnosed with the Zika virus in South Africa last week is “completely well” and “poses no risk to anybody”, says Lucille Blumberg, the deputy director of the National Institute for Communicable Diseases. Blumberg says the man presented with a mild illness four days after his arrival in the country. After he underwent a number of tests, “Zika was confirmed as the cause of his illness”. Blumberg further confirmed, “We’re not going to have local transmissions because of one incoming traveller with Zika. You’ll need multiple people with the virus in their blood and many mosquitoes around with the competent vectors to set off a local outbreak.”
Medicine availability is improving in sub-Saharan Africa for palliative care services. There is a need to develop strong and sustainable pharmaceutical systems to enhance the proper management of palliative care medicines, some of which are controlled. One approach to addressing these needs is the use of mobile technology to support data capture, storage and retrieval. Utilizing mobile technology in healthcare (mHealth) has recently been highlighted as an approach to enhancing palliative care services but development is at an early stage. An electronic application was implemented as part of palliative care services at two settings in Uganda; a rural hospital and an urban hospice. Measures of the completeness of data capture, time efficiency of activities and medicines stock and waste management were taken pre- and post-implementation to identify changes to practice arising from the introduction of the application. Improvements in all measures were identified at both sites. The application supported the registration and management of 455 patients and a total of 565 consultations. Improvements in both time efficiency and medicines management were noted. Time taken to collect and report pharmaceuticals data was reduced from 7 days to 30 min and 10 days to 1 h at the urban hospice and rural hospital respectively. Stock expiration reduced from 3 to 0.5 % at the urban hospice and from 58 to 0 % at the rural hospital. Additional observations relating to the use of the application across the two sites are reported. A mHealth approach adopted in this study was shown to improve existing processes for patient record management, pharmacy forecasting and supply planning, procurement, and distribution of essential health commodities for palliative care services. An important next step will be to identify where and how such mHealth approaches can be implemented more widely to improve pharmaceutical systems for palliative care services in resource limited settings.
African Ministers of Health, Finance, Education, Social Affairs, Local Governments attended the Ministerial Conference on Immunization in Africa in February 2016 in Addis Ababa, Ethiopia, convened by the World Health Organization in collaboration with the African Union Commission. The ministers collectively and individually commited themselves to keeping universal access to immunisation at the forefront of efforts to reduce child mortality, morbidity and disability; to increasing and sustaining domestic investments and funding, including innovative financing, to meet the cost of traditional vaccines and fulfil new vaccine financing requirements, and to support EPI programs. They sought to address persistent barriers in vaccine and healthcare delivery systems, especially in the poorest, vulnerable and most marginalized communities, including through strengthening data collection, reporting and use and building effective and efficient supply chains and integrated procurement systems as part of strong and sustainable primary health care systems. The agreed to develop a capacitated African research sector and to work with communities, civil society organizations, traditional and religious leaders, health professional associations and parliamentarians to promote universal access to vaccines, and to invest in regional capacities for the development and production of vaccines in line with the African Union Pharmaceutical Manufacturing Plan. They called on African development banks and regional economic communities to support the implementation of the Declaration, and on member states and partners to negotiate with vaccine manufacturers to facilitate access to vaccines at affordable prices and to increase price transparency in line with resolution WHA68.6. They called on GAVI to consider refugees and internally displaced populations as eligible recipients of support for vaccines and operational costs.
8. Human Resources
Like many sub-Saharan African countries, Malawi is facing a critical shortage of skilled healthcare workers. In response to this crisis, a formal cadre of lay health workers (LHW) has been established and now carries out several basic health care services, including outpatient TB care and adherence support. While ongoing training and supervision are recognised as essential to the effectiveness of LHW programs, information is lacking as to how these needs are best addressed. The objective of this qualitative study was to explore LHWs responses to a tailored knowledge translation intervention they received, designed to address a previously identified training and knowledge gap. Forty-five interviews were conducted with 36 healthcare workers. Fourteen to sixteen interviews were done at each of 3 evenly spaced time blocks over a one year period, with 6 individuals interviewed more than once to assess for change both within and across individuals overtime. Reported benefits of the intervention included: increased TB, HIV, and job-specific knowledge; improved clinical skills; and increased confidence and satisfaction with their work. Suggestions for improvement were less consistent across participants, but included: increasing the duration of the training, changing to an off-site venue, providing stipends or refreshments as incentives, and adding HIV and drug dosing content. Despite the significant departure of the study intervention from the traditional approach to training employed in Malawi, the intervention was well received and highly valued by LHW participants. Given the relative low-cost and flexibility of the methods employed, this appears a promising approach to addressing the training needs of LHW programs, particularly in Low- and Middle-income countries where resources are most constrained.
9. Public-Private Mix
Over the last five years, universal health coverage (UHC) has become an agreed goal of global health policy and planning initiatives. However, scholars and health policy-makers have noted that attaining this goal will require a sufficient number of prepared and motivated health workers. The World Health Organization (WHO) is developing a global strategy on human resources for health. A consultation has concluded that progress towards UHC will require integrated, people-centred health services, a motivated health workforce and adequate financing from domestic and other sources. While the importance of human resources in UHC and the SDG agenda has been recognized, the extent and impact of health workers’ dual practice – that is, concurrent clinical practice in public and private sectors – has not received much attention. However, given the pervasiveness of dual practice and the growing prominence of the private sector in the provision of health services worldwide, its dynamics and impact on the attainment of UHC should not be ignored. Failure to understand why, how and to what extent health workers engage in dual practice may compromise attempts to regulate it and undermine progress. This paper presents dual practice examples, focusing on UHC-associated policy relevance of the available evidence, especially in low- and middle-income countries. It presents regulatory options in a range of contexts and future research needs.
In the wake of recent widespread failures of privatisation efforts, many communities in the global south now seek new, progressive ways to revitalise the public sector. From rural Guatemalan towns holding the state accountable for public health to an alliance of waste pickers in India and decentralised solar electricity initiatives in Africa, people worldwide are rising up with innovative public service solutions to difficult issues. Making Public in a Privatised World explores such cases, with essays that uncover the radically different ways grassroots movements have proved themselves as successful alternatives in providing essential public services where privatised efforts have failed. Using numerous in-depth case studies, this book offers probing insights from a diverse range of contributors from across the world, including academics, activists, unionists, and social movement organisers. Making Public in a Privatised World addresses the growing worldwide interest in exciting alternatives to privatisation in both developed and developing countries.
Governments around the world are increasingly turning to the use of stand-alone, state-owned utilities to deliver core services such as water and electricity. This article reviews the history of such ‘corporatisation’ and argues that its recent resurgence has been heavily influenced by neoliberal theory and practice, raising important questions about whether it should be adopted as a public service model. Not all corporatisations promote commercialisation, however. The article also discusses stand-alone utilities that have managed to stave off market pressures and develop in more equity-oriented directions. The scope for non-commercialised corporatisation is narrow, but given the expansion of this organisational model, the author argues that it is important that we understand both its limitations and potentials, particularly in low-income countries where service gaps are large and equity is a major challenge.
10. Resource allocation and health financing
Social protection and taxation feature prominently as key policy instruments available to governments in the pursuit of development goals in both the Financing for Development (FFD) Addis Ababa Action Agenda and the Sustainable Development Goals (SDGs). This reflects a growing recognition among policy makers in the international development context of the powerful role fiscal policy plays in shaping development outcomes. It also represents an important opportunity for closer consideration of the ways in which taxation and social protection operate jointly in practice. Taxes and transfers commonly continue to be discussed separately, yet in practice they interact to shape the distribution and redistribution of income and wealth both directly – through the distribution of transfers and the tax burden – and by influencing processes of government accountability and legitimacy, the quality of service provision and people’s willingness to pay taxes. If appropriately designed and implemented, taxes and transfers can make a significant dent in poverty and inequality. In high-income OECD countries, direct taxes and transfers alone contribute to an average 30% reduction in income inequality, reducing the average Gini coefficient from 0.41 to 0.29. In comparison, in developing countries, their impact is more muted. There is thus scope to strengthen these systems, particularly as in July 2015, world leaders in Addis Ababa agreed on a commitment to delivering social protection and essential public services for all through a new social compact to ‘end poverty in all its forms everywhere’.
This paper presents an interview with South Africa's Health Minister, Aaron Motsoaledi. in which he answers six big questions about the National Health Insurance White Paper: Are you intending to stop medical schemes providing the same services as NHI? Are you intending to curb, if not entirely limit, private health care? Was a battle with the Treasury over the enormous amounts of public money it’s going to take to fund NHI a main reason behind the delay in releasing the White Paper? What’s the point in the Healthcare Market Inquiry (HMI)? You’re looking at full implementation of the NHI by 2025. Is that fair? It presents the Minister's answers. He notes that the NHI envisages a society based on values, justice, fairness and social solidarity. Health care is a social investment, therefore it should not be subject to the normal market forces and treated as a normal commodity.
11. Equity and HIV/AIDS
Sub-Saharan Africa alone contributes more than 90 % of global Mother-to-Child Transmission (MTCT) burden. As part of efforts to address this, African countries were earmarked in 2009 for rapid Preventing Mother to child HIV Transmissions (PMTCT) interventions scale-up within their primary care system for maternal and child health. In this study, the authors reviewed records in Ghana, on ANC registrants eligible for PMTCT services to describe regional disparities and national trends in key PMTCT indicators. They also assessed distribution of missed opportunities for testing pregnant women and treating those who are HIV positive across the country. Although there was a decline in HIV prevalence among pregnant women, untested ANC registrants increased from 17 % in 2011 to 25 % in 2013. There were varying levels of missed opportunities for testing across the ten regions of Ghana. Overall, HIV positive pregnant women initiated onto ARVs remarkably increased from 57% (2011) to 82 % (2013). Missed opportunities to test pregnant women for HIV and also initiate those who are positive on ARVs across all the regions pose challenges to the quest to eliminate mother-to-child transmission of HIV in Ghana. For some regions these missed opportunities mimic previously observed gaps in continuous use of primary care for maternal and child health in those areas. The authors contend that increased national and regional efforts aimed at improving maternal and child healthcare delivery, as well as HIV-related care, is paramount for ensuring equitable access across the country.
12. Governance and participation in health
This video shows a recording of the statement made by People's Health Movement and Medicus Mundi International at the Executive Board 138 of the World Health Organisation (WHO) in January 2016. In it they highlight their assertion that the FENSA proposal constitutes a Trojan horse, which will legitimise the influence of private sector interests in WHO decision-making. They argue that FENSA is symbolic of a more fundamental issue - that of WHO’s independence - which is compromised by its financial crisis, lack of member contributions and crippling dependency on tightly earmarked voluntary contributions. They call for the WHO to have strong safeguards to protect it from undue influence from funders and conflicts of interests on the part of industry partners and a robust conflict of interest policy should also include appropriate protection of whistleblowers.
13. Monitoring equity and research policy
Almost seven years after the publication of the final report of the World Health Organisation’s Commission on Social Determinants of Health (CSDH), its third recommendation has not been attended to properly. Measuring health inequities (HI) within countries and globally, in order to develop and evaluate evidence-based policies and actions aimed at the social determinants of health (SDH), is still a pending task in most low and middle income countries (LMIC) in the Latin American region. In this paper the authors discuss methodological and conceptual issues to measure HI in LMIC and suggest a three-stage methodology for the creation of observatories on health inequities (OHI) and social determinants of health, based on the experience of the Brazilian Observatory on Health Inequities. The authors describe the three stages and discuss the replicability of this methodology in other Latin American countries. The authors also carried out a search of suitable national information systems to feed an OHI in Mexico, along with an outline of the institutional infrastructure to sustain it. When implementing the methodology for an OHI in LMIC such as Mexico, the authors found that having strong infrastructure of information systems for measuring HI is required, but not sufficient to build an OHI. Adequate funding and intersectoral network collaborations lead by a group of experts is a requirement for the consolidation and sustainability of an OHI in LMIC.
Inadequate regional provisions have been one of the weak links in the global monitoring of, and accountability for, implementation of the Millennium Development Goals (MDGs). As a result, the question now is how does the regional monitoring and review process need to improve as a more demanding post-2015 development agenda is introduced? To address this question, the paper follows three analytical approaches. First, by reviewing various global-level inputs channelled towards articulating the Sustainable Development Goals (SDGs), it teases out the implications of the new agenda for a Regional Monitoring and Review Mechanism (RMRM). Second, by revisiting the experiences of various existing frameworks for a regional mechanism, it highlights the strengths and weaknesses of their varying approaches and instruments. Third, the paper tries to identify the critical attributes of the institutional structure and modalities that have to characterize such a mechanism in the new context. In conclusion, the paper underscores the need to bolster regional statistical capacity, particularly in the field of regional public goods and the proposed regional indicators of the sustainable development goals. It also proposes elements of a possible mechanism, building on the existing practices of the Economic and Social Commission for Asia and the Pacific (ESCAP).
New reporting guidelines have been published for the growing area of implementation and operational research. The field utilises a range of different research designs, so existing reporting guidelines only partially cover the need for guidance. Wide consultation through the World Health Organization (WHO), the Alliance for Health Policy & Systems Research (AHPSR) and TDR resulted in these recommendations. The paper provides a practical reference for funders, researchers, policymakers, implementers, reviewers and editors working with implementation and operational research. Given that this is an evolving field, they plan to monitor the use of these guidelines and develop future versions as required.
Tanzania’s socio-economic development is challenged by sharp inequities between and within urban and rural areas, and among different socio-economic groups. This paper discusses the importance of strengthening SDH research, knowledge, relevant capacities and responsive systems towards addressing health inequities in Tanzania.The conceptualization of SDH varies considerably among stakeholders and their professional background, but with some consensus that it is linked to “inequities” being a consequence of poverty, poor planning, limited attention to basic humanity and citizenship rights, weak governance structures and inefficient use of available resources. Commonly perceived SDH factors include age, income, education, beliefs, cultural norms, gender, occupation, nutritional status, access to health care, access to safe water and sanitation and child bearing practices. SDH research is in its infancy but gaining momentum. In the absence of a specific “SDH portfolio”, SDH research is scattered and hidden within disease specific, poverty-related research and research on universal health coverage. Research is mainly externally funded, which has implications on the focus of context specific SDH research, national priorities and transfer to policy. This create mismatch with population and research capacity needs. Establishing a system to promote collaboration across sectors and strengthen collective capacities for individuals and institutions researching in SDH will augment existing SDH research initiatives and better inform appropriate intersectoral policies towards addressing prevailing health inequities across the country.
14. Useful Resources
While global inequality has become even more intense since this it was made, this short 4 minute video has some quick visuals on global inequalities in wealth.
The School of Public Health and Family Medicine hosted a seminar and panel discussion, "Knowledge, Equity and Health in post-Apartheid South Africa...What's Race got to do with it?" on 1 August 2013. The guest speaker was Professor Lundy Braun from Browns University, USA. As part of its on-going programme on transformation, Professor Mohamed Jeebhay, head of the School of Public Health and Family Medicine the School of Public Health and Family Medicine invited Professor Braun to draw on her own research in reflecting on the topic. The panellists included Professor Raj Ramesar (human genetics), Glenda Wildschut (Transformation Services Office), Dr Sophia Kisting-Cairncross.
This fact sheet provides information on the Zika virus, a mosquito-borne virus that was first identified in Uganda in 1947 in rhesus monkeys, and subsequently identified in humans in 1952 in Uganda and the United Republic of Tanzania. Outbreaks of Zika virus disease have been recorded in Africa, the Americas, Asia and the Pacific. The incubation period (the time from exposure to symptoms) of Zika virus disease is not clear, but is likely to be a few days. The symptoms are similar to other arbovirus infections such as dengue, and include fever, skin rashes, conjunctivitis, muscle and joint pain, malaise, and headache. These symptoms are usually mild and last for 2-7 days. Zika virus disease is caused by a virus transmitted by Aedes mosquitoes. People with Zika virus disease usually have symptoms that can include mild fever, skin rashes, conjunctivitis, muscle and joint pain, malaise or headache lasting for 2-7 days. There is no specific treatment or vaccine currently available. The leaflet provides updated information on the virus given its recent spread in Latin America.
15. Jobs and Announcements
The Council for the Development of Social Science Research in Africa (CODESRIA) has announced the twenty-seventh session of its Small Grants Programme for Thesis Writing. The grants serve as part of the Council’s contribution to the development of the social sciences in Africa, and the continuous renewal and strengthening of research capacities in African universities, through the funding of primary research conducted by postgraduate students. Hence, candidates whose applications are successful are encouraged to use the resources provided under the grants to cover the cost of their fieldwork, the acquisition of books and documents, the processing of data which they have collected and the printing of their dissertations. The CODESRIA Small Grants Programme is opened to students currently registered in PhD in African universities, and preparing their research in all social science fields and other disciplines involving social or economic analysis. The research proposal should be based on an innovative problematic which sets out the originality of the theme in relation to on-going research in the same area. Candidates’ research proposals should each contain a clear statement of the research hypotheses, a critical review of the existing literature, the methodology to be used, the expected results of the work, and a detailed work plan and timetable. Grants are awarded solely on merit. All applicants are required to use the application forms designed by CODESRIA, accessible via their website.
In 2013, it was reported that more than two-thirds of South Africa’s citizens now live in the country’s sprawling urban areas. The Gauteng region alone saw its population swell to some 12 million, an increase of more than 30% in 10 years and more than double the national average. Such statistics, while significant, are not in themselves very instructive. The everyday impact of South Africa’s urbanisation in the years since apartheid, the daily struggles the the poor urban infrastructure imposes, the expanding social and spatial inequalities that fragment the city, and the architecture of anxiety that determines so many ordinary urban habits, are better understood through the narratives crafted by the city’s writers, filmmakers, performers and visual artists, In the imaginative writing of the city, established authors such as Ivan Vladislavic, William Kentridge, and Willie Bester contribute as much to our understanding of the South African city as the emerging voices of photographers and filmmakers such as Mikhael Subotzky, Ramadan Suleman, and Oliver Hermanus. Moreover, like the graffiti commonly daubed on the M1 underpass in Newtown, Johannesburg and the fiction titles that line the shelves of Cape Town’s Book Lounge, the form these stories adopt and the networks through which they find expression are as diverse and uneven as the cityscapes themselves. Now in it’s fourth year, Writing South Africa Now calls for academic papers that contribute to the ongoing writing of the South African city. For academic papers, send an abstract of 300 words and brief biography to the organisers by 4th March. For artistic contributions, send an outline of the proposed contribution of examples of work, along with a brief biography to organisers as soon as possible.
This course provides an introduction to systems thinking and systems models in public health. It requires 4 weeks of study, 4-5 hours/week, as an online course. Problems in public health and health policy tend to be complex with many actors, institutions and risk factors involved. If an outcome depends on many interacting and adaptive parts and actors the outcome cannot be analyzed or predicted with traditional statistical methods. Systems thinking is a core skill in public health and helps health policymakers build programs and policies that are aware of and prepared for unintended consequences. An important part of systems thinking is the practice to integrate multiple perspectives and synthesize them into a framework or model that can describe and predict the various ways in which a system might react to policy change. Systems thinking and systems models devise strategies to account for real world complexities.
The overall theme of this conference is “The Sustainable Development Goals (SDGs), the Grand Convergence and Health in Africa”. This theme recognizes the new international health economics and policy landscape with the end of the MDGs and the adoption in September 2015 of the successor SDG global initiative. It seeks to provide an African perspective and analysis of this emerging landscape and agenda. AfHEA will publish a policy paper on this new agenda and the perspectives after the conference. Visit the website for more details.
The Council for the Development of Social Science Research in Africa (CODESRIA) invites researchers to submit their applications for participation in the 2016 Gender Institute to be held from 4th to 15th of July, 2016 in Dakar, Senegal. The re-emergence of a more virulent strain of the Ebola Haemorrhagic Fever (EHF) in West Africa in 2014 has brought to light some key issues of public health governance in Africa. One such issue is the gendered nature of epidemic-prone infectious diseases in Africa. Current epidemiological statistics on Ebola indicate that though the initial cases were predominantly male, the disease is slowly becoming a female epidemic in the affected countries in Africa. This gendered pattern of female vulnerability to disease in its progression and as it progresses in the population, mirrors that of HIV/AIDS. Understanding gender and disease has serious implications for governance of public health in Africa. Governance of public health in Africa relates to more than just the role of government. The relationship between gender, disease and governance of public health raises some key questions which this Institute will explore. Applicants should be PhD candidates or scholars in their early career with a proven capacity to conduct research on the theme of the Institute. Intellectuals active in the policy process and/or social movements and civil society organisations are also encouraged to apply. The number of places offered by CODESRIA for this session is limited to ten (10). Non-African scholars who are able to raise funds for their participation may also apply for a limited number of places. Applicants’ proposals must bring together the three components of the topic: gender, diseases and governance of public health In Africa. The proposed work can be based on empirical studies including field work using quantitative or qualitative methodologies; analytical work involving analysis of existing data or case studies. All work must have some theoretical grounding. Papers can be from any social science discipline including gender studies, sociology, anthropology, demography, economics; or health sciences like epidemiology or biostatistics. Scholars are encouraged to show through their work the way in which gender, diseases and public health governance are linked.
Health system global is calling for short films, documentaries, animated films, photo-essays, and other multimedia, that address any of the six symposium themes of the 4th Global Symposium for Health Systems Research in Vancouver this year (14-18 November). Submissions welcomed from health researchers, film-makers, activists and artists engaging with the content outlined in themes. Submissions will be peer reviewed and selected on the basis of the relevance of the content to the symposium and the ability to convey the message of the thematic areas. Please note that the technical quality of the media (cinematography, animation, professional editing) will not be the primary criteria for selection. Full details on submissions found at the website indicated.
Health Systems Trust (HST) is hosting a conference from 4-6 May 2016 at the Birchwood Conference Centre, Boksburg, Gauteng. 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 conference will provide a forum in which those who contribute in various ways to the South African health system can exchange ideas, develop support mechanisms for common challenges, and foster synergies between interested groups. 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 International AIDS Conference is the premier gathering for those working in the field of HIV, as well as policy makers, persons living with HIV and other individuals committed to ending the pandemic. It is a chance to assess where we are, evaluate recent scientific developments and lessons learnt, and collectively chart a course forward. Keynote speakers will cover areas such as Universal Access: Systems for health in the immediate treatment era, medicines and intellectual property, human rights and stigma.
The International AIDS Conference is a gathering for those working in the field of HIV, as well as policy makers, persons living with HIV and other individuals committed to ending the pandemic. It is a chance to assess state of affairs, evaluate recent scientific developments and lessons learnt, and collectively chart a course forward. The AIDS 2016 programme will present new scientific knowledge and offer many opportunities for structured dialogue on the major issues facing the global response to HIV. A variety of session types – from abstract-driven presentations to symposia, bridging and plenary sessions – will meet the needs of various participants. Other related activities, including the Global Village, satellite meetings, exhibitions and affiliated independent events, will contribute to an exceptional opportunity for professional development and networking.
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