EQUINET NEWSLETTER 224 : 01 June 2020

1. Editorial

A crisis to learn and change from
Editor, EQUINET newsletter

In the past two months, drawing on a diversity of inputs, EQUINET has produced a series of information sheets on different aspects of COVID-19 in ESA countries. For 1st June we take a pause on these information briefs to send out our regular quarterly newsletter, with thanks to the newsletter team for meeting the challenges of co-production from various corners of a lockdown. Given the context, there are many articles and resources in the newsletter relating to COVID-19, but there are also those relating to other health challenges and health system developments that continue to be present, to offer learning and to demand attention in our region.

Yet we are in a crisis, not understood as an event to recover from, but in the way the Chinese word for crisis brings together two characters – “wei ji”, with wei standing for danger and ji standing for opportunity. A crisis to learn and change from.

Different dangers and risks in the COVID-19 pandemic are emerging and are the subject of an explosion of information and exchanges across countries, institutions and disciplines. The information exchanges range from stories of lived experience, responses and ideas to evidence from trials, information systems, global case tracking, reviews and analyses. Constrained by size, the newsletter only points to some of these in the region and many many more are reported daily in different platforms.
The pandemic tells us a lot about the status of our societies. COVID-19 has shown us how globalisation has opened up multiple digital channels for information to flow, how scientific collaboration can rapidly advance and share knowledge and how communities show solidarity, initiative and empathy.

It also shows where there are gaps. We talk about the poorest but the voices of the poorest communities and poorest countries are often overshadowed or absent, sometimes even silenced by the very responses to COVID-19. We see the limits in global solidarity as many African countries struggle with the diversion of critical resources to debt repayment and fail to access key diagnostics and medicines. We talk about causes, but treat each outbreak, including COVID-19, as disconnected emergencies, delinked from their deeper, sustained and common drivers in the nature of production and commercial systems, in the destruction of habitats and biodiversity and in the lack of investment in basic standards of water, sanitation, housing, clean energy and other public health inputs, drivers that converge to expose significant concentrations of people to new and old pathogens and to repeated pandemics. The 2008 Commission on the Social Determinants of Health used to say of the health sector “we cannot keep treating people to send them back to the same conditions that made them ill”. It seems we need to expand this to “we cannot keep responding to public health and climate emergencies and sending ourselves as a global community back to the same conditions that led to them.”

There are also signs of opportunities for recalibrating this pathway that is externalising and distributing pollution, climate change, precarious employment, different forms of malnutrition, pandemics, violence and other harms that threaten us as a society and as a species. The online conversations often flag responses to COVID-19 that work with and support communities and local health workers as more successful, especially when built on prior investments in distributed primary health care and socio-economic well-being. There are items in the newsletter that raise similar themes around responses to HIV, health workforce management or gender based violence.

But recalibration also needs to take place at global level. The recent World Health Assembly (WHA) resolution on COVID-19 (included in the newsletter) refers to vaccines as a global public good (implying free from intellectual property protection). There is also a link to a call from leaderships from across all regions that COVID-19 vaccines, diagnostics, tests and treatments be provided free of charge to everyone, everywhere. At the opening of the WHA, the UN Secretary General Antonio Guterres stated that “the recovery from the COVID-19 crisis must lead to more equal, inclusive and sustainable economies and societies” , as “an opportunity to address the climate crisis and inequality of all kinds”… and “to rebuild differently and better”.

The pandemic has provoked a sense that it cannot be ‘business as usual’ . For example, the Africa Group, Zambia and other country inputs to the WHA, and an ECSA HC and EQUINET brief included in this issue, raise some immediate, practical issues, including debt relief or cancellation for African countries to invest in the response and rebuild, and the removal of barriers to innovation and technology transfer for local manufacturing of diagnostics, medicines, vaccines for COVID-19 in Africa. How such issues are now treated in global forums, such as the forthcoming World Trade Organisation Ministerial and beyond, and how far our international, national and local responses reflect ‘more equal, inclusive and sustainable economies and societies’ will signal how far and for whom this crisis has been an opportunity for change, or a continuity of danger.

2. Latest Equinet Updates

Securing COVID-19 related diagnostics, health technology, medicines and vaccines for African public health

The ability of African countries to mount effective and equitable responses to COVID-19 reflects in part the access that countries have to reliable, sustained, distributed supplies of diagnostics (antigen and antibody test kits and equipment for decentralised laboratories) and health technologies (personal protective equipment (PPEs), oxygen and constant positive airway pressure equipment). As medicines and vaccines are developed and approved for COVID-19 they too need to be available at mass scale and locally distributed. Currently, African countries, like many others, face shortfalls in all of these essential commodities relative to need. Various global, multilateral and bilateral arrangements have been proposed to address innovation in and access to these technologies. This brief shares information on initiatives related to diagnostics, health technologies, medicines and vaccines, the issues for African countries and options for addressing them in the dialogue and negotiations at global fora. It covers African interests and options in relation to (i) securing solidarity-based bilateral and multilateral resource streams for supply needs; (ii) using existing TRIPS flexibilities (iii) enabling open innovation and sharing of intellectual property and (iv) enabling open manufacturing and distributed and local production of these technologies. The pressure is thus growing for all COVID-19 related drugs, diagnostics, vaccines and health products, existing or future, to be considered global public goods, as expressed by the UN Secretary General on 24 April. At the same time, the brief argues that the way to make these products available to everyone, everywhere, must be by structurally linking open innovation and open manufacture to distributed production and access. Current experience suggests that any other approach may fall short on delivering timely and equitably distributed access for African countries.

EQUINET Diss 121: Public health and mining in East and Southern Africa: A desk review of the evidence
Chanda-Kapata P: EQUINET Discussion paper 121, EQUINET, Harare, 2020

This desk review, commissioned by EQUINET through TARSC as part of the ongoing work on the extractive sector in the region aims to inform public sector professionals, policy-makers, civil society and parliamentarians on the population health impacts of large- and small-scale mining activities in East and Southern Africa. The paper specifies the known health risks for the different types of small- and large-scale mines in the ESA region. Poor communities are likely to be more affected as they have limited choices for employment, sub-optimal housing and limited access to safe drinking water. People living close to mining sites or near mine dumps and those whose livelihoods are tied to rivers for domestic and agriculture water are exposed to polluted environments due to mining wastes and contaminated air and drinking water. Discrepancies exist between what is documented and known about the health risks of mining globally and documented levels of these health outcomes in the ESA region. The author presents various reasons for this. Health impacts assessments are not always done before mines are licensed. After mines are licensed, these health outcomes may be poorly monitored. Information on the numbers and health status many living and working in mining and of ex-miners remains limited.

EQUINET Information sheet 1 on COVID-19
TARSC: March 2020

This information sheet aims to assist by bringing together information and links to resources from various sources on a range of issues related to COVID-19 covering: 1: Basic information on the virus and its health impact 2: The level and growth of the pandemic 3: What individuals and communities can do to prevent and respond to COVID-19 4: What workplaces and organisations can do to prevent and respond to COVID-19 5: Protection and support of health and other frontline workers 6: What countries are doing to prevent and respond to COVID-19. While the specific focus intends to be on east and southern Africa, this first information sheet provides information drawn from other regions and more mature epidemics that may be useful for those in the ESA region or that may raise issues to discuss and plan for in the region.

EQUINET Information sheet 2 on COVID-19
TARSC: EQUINET, April, 2020

This is the second information brief from EQUINET to summarise and provides links to official, scientific and other resources as of April 1st 2020 to support an understanding of and individual to regional level responses to COVID-19. This brief complements and does not substitute information from your public health authorities. This brief covers: 1: Developments in the COVID-19 epidemic 2: The health system response 3: Policy, politics and rights 4: Support for and in different communities 5: The macro-economic challenges 6: What does this all mean for equity?

EQUINET Information sheet 3 on COVID-19
TARSC: EQUINET, April 2020

This is the third information brief from EQUINET to summarise and provides links to official, scientific and other resources as of April 14 2020 to support an understanding of and individual to regional level responses to COVID-19. This brief complements and does not substitute information from your public health authorities. This brief covers: developments in the COVID-19 epidemic; a discussion on population evidence and models; initiatives on health technologies; an update on the African engagement on releasing resources from debt and various resources.

EQUINET Information sheet 4 on COVID-19

This is the fourth information sheet on COVID-19 from EQUINET. It summarises information from and provides links to official, scientific and other resources as of end April 2020 on 1: Developments in the COVID-19 epidemic 2: Rolling back lockdowns- when and what next? 3: What COVID-19 has meant for the risks and returns from migration 4: An update on access to medicines and vaccines, and 5: Resources, COVID-19 and the creative economy.

3. Equity in Health

Seventy Third World Health Assembly and Resolution 73.1 on the COVID-19 response
World Health Assembly: WHA 73.1 Geneva, 19 May 2020

The May 2020 session of the World Health Assembly was held as a virtual 'de minimis' meeting by video conferencing, with consideration of most items deferred to written procedure or a resumed meeting later in the year. In opening the Assembly the WHO Director General Dr Tedros Ghebreyesus stated "COVID-19 is not just a global health emergency; it is a vivid demonstration of the fact that there is no health security without resilient health systems, or without addressing the social, economic, commercial and environmental determinants of health". The full speech is available at https://apps.who.int/gb/ebwha/pdf_files/WHA73/A73_3-en.pdf. The virtual WHA discussed and endorsed a key resolution sponsored by multiple countries, including Zambia in the east and southern Africa region and the Africa group and its member states. The resolution is shown at the website provided. The chair of the Africa group noted in the deliberations the importance of making full use of the flexibilities contained in the TRIPS Agreement and the Doha Declaration on the TRIPS Agreement and Public Health and called for the transfer of technology and know-how for medicines for vaccines, diagnostics and other commodities to meet demand and ensure equity. He also called for debt relief to enable countries to meet the demands of responses and the economic impact of the pandemic. The statements by countries to the WHA73 are reported at https://apps.who.int/gb/statements/WHA73/

4. Values, Policies and Rights

A Preliminary Human Rights Assessment of Legislative and Regulatory Responses to the COVID-19 Pandemic across 11 Jurisdictions
Bonavero Institute of Human Rights: Bonavero Report No 3/2020, May 2020

The current context indicates that exceptional measures designed to combat the spread of COVID-19 need to be continually evaluated, taking into account the positive obligations that States bear to protect life, access to health and health security, and the extent to which these obligations should be shaped by countervailing negative rights. The authors indicate that striking an appropriate balance between these positive obligations and countervailing negative rights, in this rapidly evolving environment, can only be successfully achieved in an environment of democratic, judicial and scientific contestation. Moreover, in the context of positive obligations, it is imperative to emphasise the least coercive means through which public health can be achieved. This report provides a human rights analysis using this lens of a cross section of jurisdictions from different countries globally, including South Africa and Zimbabwe.

Assessing the relationship between gender based violence and COVID-19 pandemic in Uganda
Kabonesa C; Kindi F: Konrad Adenauer Stiftung, April 2020

The authors interrogate the relationship between gender based violence (GBV) and COVID-19 in Uganda through documentary reviews and in-depth interviews from selected key informants. The authors find an increase in cases of GBV that calls for government ministries and agencies to prioritize measures to address the issue. They recommend gender sensitization of communities on GBV and its effects especially in situations of health related emergencies. The authors find that the majority of the fights are heightened by men having limited funds to fulfil their provisioning roles, and recommend that vulnerable households should be identified and provided with food. They also argue that is important to provide women with a platform where they can air their views and concerns about COVID-19 and GBV.

Constitutional implications of COVID-19: Arrests and the use of force to enforce lockdown
Brickhill J: JUTA Talking Points, Issue 11, South Africa

This brief is one of a weekly analysis of constitutional issues arising from COVID-19 and the responses to it. In this instalment, the author outlines the role of the courts and the arrest and the use of force by the police and the military in enforcing the lockdown, following the judgment in Khosa v Minister of Defence and Military Veterans [2020] ZAGPPHC 147 in South Africa. The author finds that arrest in the context of COVID-19 runs the risk of subverting the very purpose of the lockdown regulations, by exposing enforcement officers and arrested civilians to a greater risk of contracting the virus. The South African Police Service has released guidelines on the use of force by security services, in a circular dated 19 May 2020 that set out principles on the use of force, the prohibition of torture and provide information on where to make complaints about police misconduct. The author proposes that thorough investigation and action on those implicated in any injury related to lockdown enforcement and ensuring an effective complaints mechanism are the crucial.

Ethics of instantaneous contact tracing using mobile phone apps in the control of the COVID-19 pandemic
Parker M; Fraser C; Abeler-Dörner L: Journal of Medical Ethics, doi:10.1136/medethics-2020-106314, May 2020

In this paper the authors discuss ethical implications of the use of mobile phone apps in the control of COVID-19. Contact tracing is a well-established feature of public health practice during infectious disease outbreaks but the high proportion of pre-symptomatic transmission in COVID-19 means that standard contact tracing methods are too slow to stop the progression of infection through the population. To address this many countries globally have deployed or are developing mobile phone apps capable of supporting instantaneous contact tracing. Informed by the on-going mapping of ‘proximity events’ these apps are intended both to inform public health policy and to provide alerts to individuals who have been in contact with a person with the infection. The proposed use of mobile phone data for ‘intelligent physical distancing’ in such contexts raises a number of important ethical questions that need to be understood and analysed against the public health benefits. The authors explore the relative benefit and harms; the impact on identified individuals; the implications for privacy and liberty; the responsibilities of institutions and professionals; and the longer term equity, ethical and public trust issues of how the data is deleted or used, issues that are not only relevant for COVID-19 but also for future outbreaks.

5. Health equity in economic and trade policies

An assessment of workers’ rights in the mining sector during the COVID-19 Lockdown
Mlevu S: Centre for Natural Resource Governance, Zimbabwe, May 2020

This situation update from the Centre for Natural Resource Governance Zimbabwe looks at how the mining companies have been handling labour concerns as they have been operating during the lockdown. The authors report from various mines that companies have been making piecemeal commitments to health and safety of the employees, with some ignoring stipulated health measures. It also identifies only one company in Mutoko that invested time and money towards the health and safety of their employees during the lockdown. During the lockdown, the authors report that some workers have failed to get their salaries, while some workers have gone for 3 months without pay. The authors recommend that government convene a Tripartite Negotiating Forum to discuss the conduct of employers and their employees during the lockdown, that the Labour Act be revised to provide for the conduct of employers and employees during emergencies; that companies provide decent accommodation to their employees to minimise staff movements and contact with community members and protective equipment for all workers despite rank or grade who are working during the pandemic.

The Impact of COVID-19 on SADC Economy
SADC Macroeconomic Subcommittee, SADC Secretariat: SADC, Gaborone, May, 2020

This report presents the impact of the COVID-19 Pandemic and implications for SADC Region as monitored by the SADC Macroeconomic Subcommittee, supported by the SADC Secretariat. It provides policy recommendations to Member States. The report recommends policy interventions in the face of the significant global economic downturn from COVID-19, including adding to the focus on health and humanitarian responses, strengthening early warning systems, response and mitigation of pandemics and disasters that have proved to be major threats to education, tourism, informal sector and other sectors; and developing Roadmaps and Action Plans that prioritize investments and channel scarce resources to identified economic sectors to resuscitate their economies, strengthen resilience and improve competitiveness, based on the SADC macroeconomic convergence programme.

6. Poverty and health

COVID-19 soars women’s water burden
Gender desk team: Daily Nation, Kenya, April 2020

Coronavirus has increased demand for and consumption of water in households. At the same time this presents Water scarcity presents a challenge for women in rural areas and informal settlements. Rural women walk up to 30 kilometres to fetch water from rivers, dams and boreholes. This may mean that some rural family members minimise use of the water; exposing them to health risks. Urban slum women now spend up to an extra Kenya Sh120 daily on water, and those that can't afford to buy are reported to resort to the polluted city river. This article highlights the experiences of women in rural and urban Kenya in gathering water needed for their work and families in light of COVID-19. It illustrates the lived experience of additional burdens that the pandemic now places on them, affecting their livelihoods and their physical and mental wellbeing.

Evidence for Transformative Change: UNRISD Survey on Responses to Covid-19 and Vulnerable Communities
United Nations Research Institute for Social Development: UNRISD, Geneva, 2020

The Covid-19 pandemic is hitting vulnerable people the hardest in both high- and low-income countries. At the same time, in areas where infection rates are currently lower and policies still taking shape, there is a window of opportunity for informed analysis to provide added value. With the help of its global network of experts, UNRISD is gathering and quickly analysing how well current government policies on Covid-19 in all countries and regions are responding to the needs of vulnerable people. The result will be evidence-based recommendations on how governments can make sure their Covid-19 response policies leave no one behind. There can be no one-size-fits all answers and national and local government policy making in different regions must also respond to different social, economic, political and cultural contexts.

7. Equitable health services

A scoping review on family medicine in sub-Saharan Africa: practice, positioning and impact in African health care systems
Flinkenflögel M; Sethlare V; Cubaka V; Makasa M; et al: Human Resources for Health 18(27), 1-18, 2020

This review describes, from a systematic review, the current status of family medicine in sub-Saharan Africa and maps existing evidence of its strengths, weaknesses, effectiveness and impact, and identifies knowledge gaps. Family medicine was first established in South Africa and Nigeria, followed by Ghana, several East African countries and more recently additional Southern African countries. Implementation varies between and within countries. The strengths were found to be having “all- round specialists”, providing mentorship and supervision, and there were positive perceptions of the impact of family medicine. Family medicine was found to be a developing discipline in sub-Saharan Africa. The authors indicate that assessing its impact on the health of populations requires a more critical mass of family physicians and clarity on their position in the health system and their role in universal health coverage.

Exploring barriers to seeking health care among Kenyan Somali women with female genital mutilation: a qualitative study
Kimani S; Kabiru C; Muteshi J; Guyo J: BMC International Health and Human Rights 20(3), 1-12, 2020

This paper explored barriers to care seeking in public health facilities in Kenya among Somali women after complications related to female genital mutilation/cutting (FGM/C). The authors used interviews and focus group discussions to collect data from women aged 15–49 years living with FGM/C, their partners, community leaders, and health providers in Nairobi and Garissa Counties. Barriers to care-seeking included the high cost of care, distance from health facilities, lack of a referral system and concerns on quality and privacy of care. Women faced cultural taboos in discussing sexual health with male clinicians, while fear of legal sanctions given the anti-FGM/C laws deterred women with complications from seeking healthcare. The authors suggest that the health system consider integrating FGM/C-related interventions with existing maternal child health services for cost effectiveness, efficiency and quality care, address health-related financial, physical and communication barriers, and ensure culturally-sensitive and confidential care.

Overcoming the ‘tyranny of the urgent’: integrating gender into disease outbreak preparedness and response
Smith K: Gender and Development 27(2) 355-369, 2019

This article provides a multi-level analysis of gender-related gaps in outbreak responses and illustrates the national and local impacts of failures to challenge gender assumptions and incorporate gender as a priority. The implications of neglecting gender dynamics, as well as the potential of equity-based approaches to disease outbreak responses, is illustrated through a case study of the Social Enterprise Network for Development (SEND) Sierra Leone, a non-government organisation (NGO) based in Kailahun, during the Ebola outbreak. Global policy responses can learn from examples such as SEND Sierra Leone. SEND did not include a gendered approach in its response as an afterthought; it was at the heart of the response because SEND had an established gender strategy. The authors argue that all levels of outbreak response need specific policies to ensure sexual and reproductive health.

Uganda’s experience in Ebola virus disease outbreak preparedness, 2018–2019
Aceng J; Ario A; Muruta A; Makumbi I; et al: Globalization and Health 16(24), 1-12, 2020

In August 2018, the Uganda Ministry of Health activated the Public Health Emergency Operations Centre and the National Task Force for public health emergencies to plan, guide, and coordinate Ebola Virus Disease (EVD) preparedness in the country. The National Task Force selected an Incident Management Team, constituting a National Rapid Response Team that supported activation of the District Task Forces and District Rapid Response Teams that jointly assessed levels of preparedness in 30 designated high-risk districts. The Ministry of Health, with technical guidance from the World Health Organisation, led EVD preparedness activities and worked together with other ministries and partner organisations to enhance community-based surveillance systems, develop and disseminate risk communication messages, engage communities, reinforce EVD screening and infection prevention measures at points of entry and in high-risk health facilities, construct and equip EVD isolation and treatment units, and establish coordination and procurement mechanisms. As of 31 May 2019, there was no confirmed case of EVD as Uganda has continued to make significant and verifiable progress in EVD preparedness. The authors observe the need to sustain these efforts as a multi-hazard framework to avail resources for preparedness and management of incidents at the source, effectively cutting costs of using a “fire-fighting” approach during public health emergencies.

8. Human Resources

Coordinating health workforce management in a devolved context: lessons from Kenya
Thuku M; Muriuki J; Adano U; et al: Human Resources for Health 18 (26), 1-7, 2020

This case study describes how Kenya created an inter-county, multi-stakeholder coordination framework that promotes consensus, commitment, and cooperation in devolved human resources management. The coordination framework has been instrumental in expediting development, customization, and dissemination of policies, enabling national human resources for health officers to mentor their county counterparts, and providing collaborative platforms for multiple stakeholders to resolve challenges and harmonize practices nationwide. Successes catalyzed through the inter-county forums include hiring over 20 000 health workers to address shortages; expanding the national human resources information system to all 47 counties; developing guidelines for sharing specialist providers; and establishing professionalized human resources for health units in all 47 counties. The coordination framework supports alignment of county health operations with national goals while enabling national policy responses to health gaps in the counties.

COVID-19 in Africa: care and protection for frontline healthcare workers
Chersich M; Gray G; Fairlie L; Eichbaum Q; et al: Globalization and Health 16(46), 1-6, 2020

This paper provides a survey of the challenges and proposed interventions to protect healthcare workers on the continent, drawing on articles identified on Medline (Pubmed) in a search on 24 March 2020. Global jostling means that supplies of personal protective equipment are limited in Africa. Even low-cost interventions such as facemasks for patients with a cough and water supplies for handwashing may be challenging, as is ‘physical distancing’ in overcrowded primary health care clinics, raising the risk for healthcare workers and their families. The authors argue, however, that the continent has learnt invaluable lessons from Ebola and HIV control. HIV counselors and community healthcare workers are key and could promote social distancing and related interventions, dispel myths, support healthcare workers, perform symptom screening and trace contacts. Staff motivation and retention may be enhanced through carefully managed risk ‘allowances’ or compensation. International support with personnel and protective equipment, especially from China, could turn the pandemic’s trajectory in Africa around. Telemedicine holds promise as it rationalises personnel and reduces patient contact and thus infection risks. The authors argue that healthcare workers, using their authoritative voice, can promote effective COVID-19 policies and prioritization of their safety. Prioritizing healthcare workers for SARS-CoV-2 testing, hospital beds and targeted research, as well as ensuring that public figures and the population acknowledge the commitment of healthcare workers may help to maintain morale, while international support and national commitment could help safeguard healthcare workers in Africa, essential for limiting the pandemic’s impacts on the continent.

The integration of occupational- and household-based chronic stress among South African women employed as public hospital nurses
Cohen J; Venter W: PLOS One 15(5), e0231693, 2020

This study explored the lived experience of public hospital-employed, black women nurses’ to better understand their stressors and what may help to reduce it. Through semi-structured life history interviews with 71 nurses in Johannesburg, nurses described daily lives of chronic distress, with extreme pressures on their incomes, time, and resources. Much of this pressure was said to come from the number and intensity of family dependents, related financial obligations and debt. This revised from social norms which assign women primary responsibility for unpaid household work, which nurses struggle with as unsustainable, anxiety-inducing and with pay and paid work schedules that make meeting that responsibility virtually impossible. The structure of the nursing occupation contributes to stress outside the workplace, while the structure of nurses’ households contributes to stress and emotional exhaustion. This implies that workplace-oriented interventions may assist but alone are unlikely to adequately address the overall level of stress.

9. Public-Private Mix

OPEN LETTER: Uniting Behind A People’s Vaccine Against COVID-19
Heads of state and Oxfam International: May 2020

This open letter signed by presidents, ministers of state, professors and heads of institutions calls for a people’s vaccine against COVID-19, available to all, in all countries, free of charge. The signatories argue that the World Health Assembly must forge a global agreement that ensures rapid universal access to quality-assured vaccines and treatments with need prioritized above the ability to pay. Access to vaccines and treatments as global public goods are in the interests of all humanity. Signatories call for a global agreement on COVID-19 vaccines, diagnostics and treatments — implemented under the leadership of the World Health Organization — that ensures mandatory worldwide sharing of all COVID-19 related knowledge, data and technologies with a pool of COVID-19 licenses freely available to all countries. Further, signatories call for a global and equitable rapid manufacturing and distribution plan — that is fully-funded by rich nations — for the vaccine and all COVID-19 products and technologies that guarantees transparent ‘at true cost-prices’ and supplies according to need. The signatories call for an agreement to guarantee COVID-19 vaccines, diagnostics, tests and treatments are provided free of charge to everyone, everywhere.

“Get us partnerships!” - a qualitative study of Angolan and Mozambican health academics’ experiences with North/South partnerships
Craveiro I; Carvalho A; Ferrinho P; et al: Globalization and Health 16(33), 1-10, 2020

This paper examines how Angolan and Mozambican health sciences researchers experience international collaborations, using evidence from semi-structured interviews and focus group discussions. Participants shared a sense of asymmetry between African researchers and European trainers in processes that did not fully acknowledge their local contexts, compromising the prospective development of partnerships in health. They argue that more attention be devoted to understanding how participants experience capacity building processes, integrating the diversity of their aspirations and perceptions.

10. Resource allocation and health financing

How best we can achieve a universal health system: a public conversation
McIntyre D: Health Systems Trust, March 2020

Emeritus Professor Diane McIntyre presents her chapter on: 'How best we can achieve a universal health system: a public conversation'. The chapter was published in the recent South African Health Review. She calls for a broadening of the national discourse on universal health coverage and proposes that the term is replaced with the term 'universal health system' which she suggests is less open to misinterpretation.

11. Equity and HIV/AIDS

Estimates of the Potential Impact of the COVID-19 Pandemic on Sexual and Reproductive Health in Low- and Middle-Income Countries
Riley T; Sully E; Ahmed Z; Biddlecom Z: International Perspectives on Sexual and Reproductive Health 46, 73-76, 2020

The strain that the COVID-19 outbreak imposes on health systems will undoubtedly impact the sexual and reproductive health of individuals living in low- and middle-income countries (LMICs); however, sexual and reproductive health will also be affected by societal responses to the pandemic, such as when local or national lockdowns close services not deemed to be essential, as well as from consequences of travel restrictions and economic slowdowns. Previous public health emergencies have shown that the impact of an epidemic on sexual and reproductive health often goes unrecognized, because the effects relate to indirect consequences of strained health care systems, disruptions in care and redirected resources. The authors argue for the learning from prior epidemics to be used to put in place critical resources and systems, and ensuring the provision of essential sexual and reproductive health services to avoid health system disruptions that would have devastating, lasting effects on individuals and communities.

Patient and nurse perspectives of a nurse-led community-based model of HIV care delivery in Malawi: a qualitative study
Sande O; Burtscher D; Kathumba D; Tweya H; et al: BMC Public Health 20(685), 1-8, 2020

The authors explored how the nurse-led community-based ART programme in Malawi was perceived, through interview of patients and nurses providing the care. Patients reported saving money on transportation and the time it took them to travel to a health facility. Caseloads and waiting times were also reduced, which made patients more comfortable and gave nurses the time to conduct thorough consultations. Closer relationships were built between patients and care providers, creating a space for more open conversations. Patients’ nutritional needs and concerns related to stigma remain a concern, while operational issues affect the quality of the services provided in the community. The patients interviewed in this study preferred the nurse-led community ART programme approach to the facility-based model of care because of the features above. The authors note that community-led healthcare programmes need to plan for the provision of transportation for care providers; the physical structure of community sites; the timely consolidation of data collected in the field to a central database; and the need for care providers to cover multiple facility-based staff roles.

12. Governance and participation in health

Webinar: Africa and the Pandemic: Clampdown, Survival and Resistance
Review of African Political Economy: ROAPE, May 2020

The webinar, chaired by ROAPE’s Yao Graham in Ghana, asked what is happening across Africa since governments ordered the clampdown. The discussants looked at the impact on the continent of the Covid-19 pandemic and the measures taken against it. All the speakers addressed what was happening at grassroots and national level, and how the popular classes were being affected. Reporting from Kenya, Gacheke Gachihi and Lena Anyuolo asked if the state was really fighting Covid-19 or the poor? They argued that since the curfew was enforced across the country the police continue to brutalise and terrorise people living in informal settlements. Femi Aborisade reported a constant struggle for food and survival in Nigeria, and an intensification in the repression of the poor during the country’s lockdown. In South Africa, Heike Becker looked at the reaction of the government, the struggles of poor communities and the urgency of building new activist groups and politics in the country. Tafadwza Choto from Zimbabwe reported that the government was using the virus as a cover for wider repression. Taking on the broader political economy of the crisis, Gyekye Tanoh addressed how economies and politics are likely to be reshaped by the virus and its consequences, with a likely impact of the global recession on the continent, the IMF and IFI responses and the costs for workers, peasants, social movements, activists, and radical projects.

13. Monitoring equity and research policy

Research Ethics and COVID-19
Rings Research in Gender & Ethics, Health Systems Global, Resilient and Responsive Health Systems, REACH, Wellcome: 2020

In the light of the COVID-19 pandemic a collective of organisations have taken urgent action to collate useful guidance and resources related to research ethics. The resources are organized under the following categories: general guidance, social justice, health systems strengthening, preparedness, care and resource rationing, emergency powers, health care worker wellbeing, gender, quarantine and other mandatory measures, clinical trails, guidance for funders and other resource collections.

UN Women Calls for Integration of Violence Against Women Data and Services in COVID-19 Surveys
UN Women East & Southern Africa: Kenya, 2020

To understand better both impact of and responses to COVID-19, UN Women is recommending stand-alone surveys or integration of questions on violence against women in socio-economic and gender surveys to assess the prevalence and responses to gender based violence during COVID-19. This data is argued to be critical to support evidence-based interventions and to make available lifesaving services. UN Women in East and Southern Africa is working closely with the partner agencies and providing technical support to develop model surveys and guidelines to support quality assessments. This briefing also provides case study analyses of gendered effects of COVID-19 in Uganda, Kenya, South Africa, Ethiopia, Burundi, Zimbabwe, Mozambique and Malawi.

14. Useful Resources

Gender, HRH, COVID-19 Resources
Open source Google doc

This open source Google doc is collating resources on gender and COVID-19. The doc comprises short summaries of articles which are organised under themes including ‘data and resources’, ‘gender based violence’, ‘women’s contributions’, ‘women’s leadership’, ‘unpaid care work’, ‘PPE’, ‘gender transformative policy’ and ‘gender pay gap’.

Gender-based violence prevention, risk mitigation and response during COVID-19
United Nations High Commissioner for Refugees: UNHCR, Geneva, March 2020

This briefing gives an overview of risks of gender-based violence (GBV) in the context of COVID-19. Confinement is expected to increase risks of intimate partner violence for displaced women and girls, worsened socio-economic situation exposes refugee women and girls to increased risks of sexual exploitation by community members and humanitarian workers and there will be challenges in access to regular GBV services. The briefing includes recommendations to mitigate risks and ensure access to GBV services. They include considering from the outset, the gendered impacts of COVID-19, considering the different physical, cultural, security and sanitary needs of women, men, boys and girls in quarantines, providing dignity kits to ensure menstrual health and consulting women and girls on preparedness plans and interventions. Programming through women-led organizations should be prioritised whenever feasible.

IHEA webinars on health economics and COVID-19
IHEA: Online, May 2020

iHEA runs a webinar series on a range of health economics topics, with a current emphasis on issues related to COVID-19 . The website provides a list and link to all upcoming webinars, with new webinar details being posted regularly. Several of these webinars will be held on a multilingual webinar platform to enable wider reach.

Managing the pregnant woman during the COVID-19 pandemic in South Africa: A clinical guide for health workers and clinical managers
Department of Health: Republic of South Africa, April 2020

These guidelines provide guidance to healthcare workers and managers for the management and treatment of pregnant women in the context of COVID-19, read in conjunction with current Maternal and Neonatal health Guidelines and Guidelines for Clinical Management of suspected or confirmed COVID-19 disease. The guidelines change as knowledge regarding strategies to address COVID- 19 develop globally and in South Africa and are updated regularly online.

15. Jobs and Announcements

4th CODESRIA/CASB Summer School in African Studies and Area Studies in Africa: The Normative Order in African Studies, Dakar, Senegal, 14-18 September 2020
Deadline for applications: 17 July 2020

The Council for the Development of Social Science Research in Africa and The Centre for African Studies in Basel call for applications for their 4th Summer School in African Studies and Area Studies in Africa. The overall objective of the Summer School is to stimulate and consolidate interdisciplinary approaches to research on Africa, but also on other regions of the world undertaken from within the African continent. The Summer School is open for PhD students and emerging scholars enrolled and working at Higher Education institutions in any country. Applications in the following disciplines are highly encouraged: Social Anthropology, Sociology, History, Religion, Philosophy, Gender studies and Political science.

Call for Papers: International Labour Review
Deadline for abstracts: 30 June 2020

The International Labour Review (ILR) is calling for the submission of papers related to the COVID-19 pandemic and the world of work with a view to the publication of a special multidisciplinary issue in English, French and Spanish. Submissions are encouraged from all fields related to the world of work, such as economics, law, industrial relations, social policy, sociology, psychosocial studies, environmental studies and history.


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