EQUINET NEWSLETTER 233 : 01 September 2022

1. Editorial

Share your stories of change in promoting health and social justice in the region
Editor, EQUINET newsletter

In exchanges and work in the region and in the 2022 EQUINET conference 'Catalysing change for health and social justice' we have heard and shared creative, committed and often sustained experiences that promote health equity and social justice at local, national and regional level, and in engaging in global processes. In future newsletters we thus plan to share these stories of change together with our usual editorials. Please contribute and share your work! We invite submissions of about 1000 words that tell the story with links where available to further information that we can feature in future issues. If you need edit support to write it we can assist. Please email your submission to the EQUINET secretariat (email address on the website) with 'Story of Change' in the subject line. If you haven't yet joined the online EQUINET conference you are still in time to register for and join the remaining days. Details are on the EQUINET website.

STORIES OF CHANGE: Opening doors for young people through affordable e-learning in South Africa
Nadine Nanji, Public Health Researcher, University of Cape Town, South Africa

South Africa has high levels of socio-economic inequality and youth unemployment. The COVID-19 pandemic has created many economic challenges, especially for those who are already insecure or who live and work in precarious conditions, many of whom are young people. Poverty and lack of opportunity in a country where there is a visible display of wealth has led to frustration and social unrest. Unemployed youth and those in precarious employment and in lowest income communities are vulnerable to many risks, including mental stress, gender-based violence, sexual abuse, teenage pregnancies, and use of harmful substances.

Digital courses are available, but are often unaffordable for the lowest income youth, as are university courses and other formal training programmes. Digital skills have high value, but how do unemployed, underserved or economically disadvantaged South African youth access these skills? This generates new forms of digital inequity that add to the country’s other dimensions of inequality. While young people have many interests, they want to follow learning tracks that improve their incomes, working lives and wellbeing. They also don’t want to have to high jump over huge demands for formal educational qualifications to have the chance to learn new skills.

In 2021, an initiative was launched to tackle these issues facing the disadvantaged young people, triggered also by the increased demand for online interaction during the COVID-19 pandemic. Afrika Tikkun, a South African non-profit organisation, aims to improve the lives of young people, leveraging solidarity partnerships with other organisations. Afrika Tikkun saw an opportunity to tackle inequities in youth unemployment through education, skills development and placement programmes. They found a partner in Nedbank, who, having done an assessment in 2020 on social issues that could be rectified through financial investment, identified a huge gap in the digital job market in South Africa, with an unmet demand due to a shortfall in skills. Any programme aimed the lowest income young people tapping this opportunity would need to address the multiple barriers they face in access to and the costs of online platforms, to avoid entry barriers from a demand for high formal education levels, and to encourage and guide learning through mentoring and peer support. Afrika Tikkun and Nedbank partnered with Microsoft to draw on their experience in digital skills building, in a collaboration that brought different capacities and roles towards a shared goal.

These partners established an e-learning platform called DigiSkills, with an explicit goal of supporting digital equity for young people. No formal education was needed to join the programme, the program provides in a low bandwidth five free online short courses on professional digital skills with constant support through facilitators, mentors and peer groups to encourage and support participation. The app provides free access to online learning, although data charges to get online still need to be met. The equity test and sustainability of the initiative lies, however, not so much in the resources of the launching partners, but in the reach to and social and economic value it has for the participating young people, particularly those normally excluded from such skills programmes.

By the end of 2021, 1000 students had completed the online digital skills training, with prior screening ensuring that there were drawn from disadvantaged, unemployed or displaced youth. Over 400 of these young people found job opportunities. In 2022, a further 4000 young South Africans are undergoing the training. The DigiSKills program is supporting students to link learning pathways to job creation and entrepreneurial opportunities, and to solidarity with other young people. 26-year-old David, previously unemployed, who took the course and now works as a developer at MLab, commented that the opportunity has given him a power he did not have before to sustain himself and his family. 31-year old Thabani, also a graduate courses, is now assisting other young people to sign up and intends to start his own IT training company to help more youth in South Africa.

There are no magic bullets however. These programmes don’t intend to substitute pathways to higher levels of skills, research and development and on their own don’t stop the brain drain from South Africa. They don’t replace more significant levels of investment in self-determined research and innovation in the country. They don’t yet address the wider cost barriers to internet and data and to capital for young people to create new enterprises. All these areas need state and political attention and a wider level of change on the multiple institutions involved in the systems for skills development, research, innovation and entrepreneurship, including from early child development and in schools.

However, there are some lessons from the story of change on how partnerships can bring together actors with different background and capabilities, based on evidence and embedding clear values, towards a shared vision and implementation. The initiative is perhaps not perfect, not adequate for the significant inequities faced and still to be tested in the longer term. It suggests, however, that individually the young people and each of the institutions involved are not drivers of transformation. It is perhaps in their convergence, and their mindfulness and consistency in addressing an equity goal, that there is a possibility for producing change or shifting power in this key area of inequity for young people in South Africa.

EQUINET, through its Equity Watch Cluster invites your stories of change on any areas that reflect change in health equity and social justice, locally, within countries and regionally in east and southern Africa. In about 1000 words they tell the story of how a change came about, and who made it happen. To send feedback on the issues raised in this oped or to send a story please email the EQUINET secretariat: admin@equinetafrica.org. Further information on Digiskills can be found at the Africa Tikkun website (https://afrikatikkun.org/ ) and at https://www.digiskills.careers/.

2. Latest Equinet Updates

Call for applicants: Desk review of health-related food standards in east and southern Africa
Deadline for applications: September 15, 2022, 5pm Southern Africa time

EQUINET is calling for applicants for a desk review of domestic legal and statutory provisions in 16 ESA countries (Angola, Botswana, DRC, Kenya, Lesotho, Madagascar, Malawi, Mozambique, Mauritius, Namibia, South Africa, Swaziland, Tanzania, Uganda, Zimbabwe, Zambia) taking note of key international and regional standards, and guidance. The review will use online information from international agency websites and African and ESA regional organisations, and online legal databases for the above 16 countries to identify the most recent laws and specific standards in force for: International and regional standards and guidance relevant to food risks, safety and standards relating to the principles, rights, duties and authorities included, the key areas of food safety, risk, standards covered; and provisions/guidance on functions, governance and financing. Domestic law in relation to food and health in relation to scope, objectives and mission; principles, rights and duties; key areas of food safety, risks and standards; key functions; mechanisms and administration; governance and financing. Applicants for the call are asked to outline their key experience, capacities and availability for the task, institutional and individual country location and contact information for follow up; their CV and the pdfs of at least two publications related to this field that they have authored. Applicants will be informed of the outcome of their application before or by September 21 2022. For further information on the grant and application see the website.

EQUINET Information sheet 8 on COVID-19: Experience of the pandemic from a youth lens
Training and Research Support Centre for EQUINET, July 2022

What does looking at the pandemic from a youth lens tell us about what we need to address now in our region? This brief focuses on this. EQUINET information sheets on COVID-19 summarise information from and provide links to official, scientific and other resources on east and southern Africa (ESA) covering selected themes related to equity in the pandemic. This brief covers: recent data on COVID-19 in ESA countries and in youth; youth health and wellbeing during the pandemic; services and responses to youth needs during the pandemic; youth led responses and initiatives and equity issues and actions exposed by the pandemic for young people.

Join the EQUINET conference on Reclaiming the State, Online, Next session 15 September
Register before 5 September

The 2022 EQUINET regional conference 'Catalysing change for health and social justice' is sharing and discussing experiences, evidence, analysis, successes and struggles from local to regional level and engagement globally to advance health and wellbeing in East and Southern Africa. Through the exchanges we are framing propositions to advance health equity and social justice in our region that will inform policy engagement and future work. The conference includes statements from key institutional representatives in the region and internationally, research papers, photojournalism, art and music and group discussions. The first day has been held, but you can still register for the second and third days on the conference website. The programme for the second day "Reclaiming the State 2" on September 15th is now available online covering issues relating to urban health, youth health, equitable health financing, promoting primary health care in pandemics and more.

Tax justice for universal public sector health systems in East and Southern Africa
Loewenson R; Mukumba C: Training and Research Support Centre, Tax Justice Network Africa, EQUINET Discussion paper 126, EQUINET, Harare, 2022

This paper outlines performance on key dimensions of public sector health financing: the size of the funding ‘gap’ in relation to basic health service needs; population entitlements; and state duties to health care; with brief discussion on the negative implications for equity of meeting this gap through out of pocket spending and privatisation of health services. With tax revenues the most progressive source of health financing for universal health coverage, it examines the level, sources and drivers of lost tax revenue in ESA countries, and relates the public sector health system funding gap to the sources of lost tax revenue. The paper points to how the current global tax framework and its unfair allocation of taxing rights benefits high income countries to the significant detriment of low- and middle-income countries. Despite promises of reforms by some larger high income countries, those that have been proposed fail to address this tax injustice. This evidence indicates that it is possible to meet the health financing gap for public sector health systems in the region through adequate funding from progressive taxation. With the public health and economic implications of COVID-19 having drawn socio-political attention to the need for investment in public sector health systems, the authors argue that there is an opportunity for a more ambitious alliance between the health and finance sectors to demonstrate the public health value of addressing these critical tax losses to increase public revenues for health.

3. Equity in Health

Under-five mortality in the Democratic Republic of the Congo: secondary analyses of survey and conflict data by province
Schedwin M; Furaha A B; Kapend R; Akilimali P; et al: Bulletin of the World Health Organisation 100(7), 422–435, 2022

This study compared coverage of key child health policy indicators across provinces and to explore their association with under-five mortality and level of conflict in the Democratic Republic of the Congo. A secondary analysis of nationally representative data was implemented from 1380 health facilities and 20 792 households in 2017–2018 was done. All grouped coverage scores demonstrated large ranges across the 26 provinces: newborn health: 20% to 61%; pneumonia: 26% to 86%; diarrhoea: 25% to 63%; malaria: 22% to 53%; and safe environment: 4% to 53%. The diarrhoea score demonstrated the strongest association with under-five mortality. Child mortality and the odds of coverage were higher in conflict-affected provinces for 13 out of 23 indicators. However, the authors also noted that children in unaffected provinces should not be neglected while addressing the needs of the most vulnerable in conflict settings. They notes that prevent, protect and treat strategies for diarrhoeal disease could help improve equity in child survival.

4. Values, Policies and Rights

COVID- 19 and human right to food: lived experiences of the urban poor in Kenya with the impacts of government’s response measures, a participatory qualitative study
Kimani-Murage E W; Osogo D; Nyamasege C K; et al: BMC Public Health 22(1399), 1-15, 2022

This paper explored the lived experiences of the urban poor people in Kenya in the context of government’s COVID-19 response measures and its impact on the right to food, using focus group discussions, interviews, photovoice and digital storytelling in two informal settlements in Nairobi between January and March 2021. The human right to food was affected in various ways. Many people lost their livelihoods, affecting affordability of food, due to response measures such as social distancing, curfew, and lockdown. The food supply chain was disrupted causing limited availability and access to affordable, safe, adequate, and nutritious food. Consequently, hunger and an increased consumption of low-quality food was reported. Social protection measures were instituted. However, these were inadequate and marred by irregularities. Some households resorted to scavenging food from dumpsites, skipping meals, sex-work, urban-rural migration and depending on food donations to survive. On the positive side, some households resorted to progressive measures such as urban farming and food sharing in the community. Generally, the response measures could have been more sensitive to the human rights of urban poor people. The authors conclude that COVID-19 restrictive measures exacerbated the already existing urban vulnerability to food insecurity and violated food rights and that future response measures be executed in ways that respect the right to food and protect marginalized people from resultant vulnerabilities.

Motion to setup Parliamentary Caucus on the Rights of Persons with Disabilities adopted
Mwale I: Deaf Zimbabwe Trust, Harare, 2022

Since 2020, Deaf Zimbabwe Trust has been advocating with the Parliament of Zimbabwe for the establishment of a Parliamentary Disability Caucus. In April this year Parliament approved a motion to establish a Parliamentary Disability Caucus that will ensure that Persons with Disabilities have a voice during the formulation of laws and policies. Currently, disability issues fall under the Parliamentary Portfolio Committee on Public Service and Social Welfare. The caucus will enhance the visibility of persons with disabilities and their access to socio-economic rights. Deaf Zimbabwe Trust working with the Victim friendly Unit and the Judiciary Service Commission is working on the development of Disability Identity Stickers on dockets to foster readiness of the Justice System in dealing with persons with disabilities and better accommodate persons with disabilities in court proceedings.

Why enforcing more strict tobacco control measures will go a long way in protecting the future of Uganda
Dhafa E: CEHURD newsletter, August 2022

Tobacco use has remained a significant public health challenge in Uganda and a leading cause of non-communicable diseases including heart diseases and premature deaths. The author argues that tobacco is also the only legally available consumer product that kills people when it is used entirely as intended. Even when the law is in place, tobacco is still used in various forms including smoked and smokeless tobacco. The author proposes that government strengthen existing schemes to make tobacco producers more responsible for the environmental and economic costs of dealing with tobacco waste products.

5. Health equity in economic and trade policies

Asserting public health interest in acting on commercial determinants of health in sub-Saharan Africa: insights from a discourse analysis
Loewenson R; Godt S; Chanda-Kapata P: BMJ Global Health 7:e009271, doi: http://dx.doi.org/10.1136/bmjgh-2022-009271, 2022

While not always labelled commercial determinants of health (CDOH), some policy attention has been given in sub-Saharan Africa (SSA) to both harms and benefits of commercial impacts on health, particularly from harmful products and processes, and noting rising non-communicable diseases. This discourse analysis highlights differing interests and lenses among the multiple policy actors involved; the forms of narrative, agential and structural power used to advance and contest commercial policy interests in the health sector; and how this has been intensified by COVID-19. The evidence is used to propose actions to advance public health interests. Public health actors and ‘one health’ actions need to build on current efforts to strengthen own discursive power, challenging narratives with evidence; to strengthen their agential power through institutionalising health impact assessment, regulation and control measures; and to deepen initiatives to engage with structural power through support for local producers, harmonised regional standards and engagement on global rules that constrain health promoting activity, as was done in the Trade Related Aspect of Intellectual Property Rights (TRIPS) Waiver. Subregional and continental level organisations play a key role in enabling such actions, as does investment in SSA leadership in locally relevant innovation and production, and in links between state, academic and civil society actors to support evidence and to ensure public interests, transparency and accountability in policy decisions on CDOH.

Deconstructing the TRIPS Waiver Discussions: The Susan Sell Interview
Patnaik P: Geneva Health Files, Newsletter Edition #150, August 2022

In June 2022, the World Trade Organization adopted a decision at its 12th Ministerial Conference, as the outcome of a 20-month long discussion on the TRIPS Waiver. Ultimately what resulted was a rather narrow legal mechanism, essentially clarifying existing rules in the WTO TRIPS Agreement. In this interview, Susan K Sell from the Australian National University explains why words matter and how the Waiver discussions, though disappointing, have broadened and shifted the conversation on intellectual property and public health forever. .

Kenyan tea pickers on Scottish-run farm to pursue health issues in UK court
Bricks L: The Guardian, August 24, 2022

More than a 1,000 Kenyan tea pickers who say that harsh and exploitative working conditions on a Scottish-run tea farm have caused them crippling health complaints can now pursue their class action in an Edinburgh court. Prolonged bending to gather tea for James Finlay Kenya is argued to accelerate ageing of pickers’ backs by up to 20 years. Lawyers acting for the tea pickers have won an order from the court of session, Scotland’s highest civil court, telling James Finlay Kenya Ltd (JFK) to abandon attempts to block the suit through the Kenyan courts. Finlays, an Aberdeen-registered multinational whose estates in Kericho, Kenya, stretch across 10,117 hectares (25,000 acres), is one of the largest suppliers of tea and coffee in the world. The company has defended its health and safety record, and carries the Fairtrade mark on its products, as well as certifications from the Soil Association and the Rainforest Alliance. But in previous testimony, the article reports that workers claimed that oppressive working conditions caused them significant and permanent musculoskeletal damage. They said they had to work up to 12 hours a day in a six-day week, carry up to 26lb of the tea leaf pickings on their back over rough slopes, and in some cases meet a weight target of 66lb of tea a day or not get paid. The article reports that the lawyers hope that the case will impact more broadly on practices in the industry.

Test to protect: equal access to diagnostics for all
Aslanyan G; Rodriguez B; Moyo S: Global Health Matters Podcast, Episode 14, 2022

The COVID-19 pandemic has brought a new global awareness of the accessibility of diagnostics and the need to test to protect with equal access for all. This episode of Global Health Matters, answers key questions including the availability of essential diagnostics in low- and middle-income countries (LMICs). Host Garry Aslanyan interviews guests who have a deep understanding of diagnostics and their application worldwide: Bill Rodriguez is CEO of FIND, the global alliance for diagnostics, and is also founder of his own diagnostics company, Daktari Diagnostics; and Sikhulile Moyo who led the team that helped discover the Omicron variant in Botswana through careful cross-examination of COVID-19 tests. Join Global Health Matters in this podcast episode to understand the state of diagnostic testing in LMICs and how to achieve equity in access to testing in all countries.

TRIPS Waiver proponents back at the table to push for therapeutics and diagnostics
Patnaik P: Geneva Health Files, Newsletter Edition #148, July 2022

While the supporters of the original TRIPS waiver are still coming to terms with the remains of the 20 month saga that yielded a ministerial decision clarifying the rules of compulsory licensing for the production of vaccines, they are back at the WTO to stomach another fight, this time, to discuss the way forward to boost the production of therapeutics and diagnostics by seeking to extend the applicability of the June decision to these medical products. This puts the co-sponsors, again, directly in opposition to industry interests where companies alone are projected to make billions off a single drug to treat COVID-19. The co-sponsors point out that there are four times as many patent filings related to therapeutics compared to vaccines. Already, more than 5,200 patent applications related to COVID-19 were published across 49 patent offices between 2020-21, according to the World Intellectual Property Organization Patent Landscape Report, the co-sponsors cite. They argue that granting of patents could delay the entry of generic drugs, and in turn lead to price increases affecting access. They seek an extension of the policy tools provided in the June ministerial decision to therapeutics and diagnostics. This, they say, “will help developing countries to address IP barriers to the expansion and diversification of production”.

WTO finally agrees on a TRIPS deal. But not everyone is happy
Green A: Devex, June 2022

After its four-day ministerial conference spilled over into a sixth day in June, the World Trade Organization finally arrived at an agreement on the controversial TRIPS waiver. After heavily contested negotiations, member states agreed on a deal that temporarily removes intellectual property barriers around patents for COVID-19 vaccines, and postpone the discussions on extending the waiver to treatments and tests by six months. The five-year agreement was struck after a marathon negotiating session at the WTO’s highest meeting. It allows low- and middle-income countries to temporarily waive protections on those patents to produce the shots, either to use domestically or to send abroad. It pushes a decision on treatments and tests off by six months, though it is noted that WTO is notoriously bad at sticking to its deadlines. It also wiped away the original proposal’s calls to temporarily waive protections on trade secrets, copyrights, and industrial designs. The biggest change — and one of the most contentious points of discussion at the ministerial conference — according to observers, was the limit the new deal imposed on eligibility. Any country was able to take advantage of existing WTO flexibilities. But under the deal, export eligibility is limited to LMICs.

6. Poverty and health

A qualitative assessment of gender roles in child nutrition in Central Malawi
Mkandawire E; Bisai C; Dyke E; Dressel A; et al: BMC Public Health 22(1392), 1-13, doi: https://doi.org/10.1186/s12889-022-13749-x, 2022

This study was implemented in central Malawi in 2017 to understand the different roles that Malawian men and women play in child nutrition. It involved interviews (76), focus group discussions and in-depth interviews. The authors found that women carried a disproportionate workload in supporting child nutrition compared to men, and that their heavier workloads in other areas often prevented them from being able to meet children’s food needs. There were some shifts in gender roles with men taking up responsibilities typically associated with women, but this did not necessarily increase women’s power within the household. Women continued to be primarily responsible for the food, care, and health of the household. The authors suggest that improving gender equality and child nutrition will require efforts to redistribute gendered work and encourage men to move towards shared power with women over household decision-making and control over income.

7. Equitable health services

Childhood immunization services accessibility and utilization during the COVID-19 pandemic in Africa
Dzinamarira T; Moyo E; Moyo P; et al: Journal of Infection, doi: https://doi.org/10.1016/j.jinf.2022.07.020, 2022

The authors present findings of a synthesis of available evidence on the accessibility and utilization of child immunization services (CIS) in Africa during the COVID-19 pandemic period. Data were independently extracted from eligible studies from online journals. The review revealed that CIS was disrupted in some countries and that uptake fell in most sub-Saharan African countries during the pandemic. In some CIS completely ceased during the lockdowns, yet in others, there were no significant changes. The authors propose strengthened monitoring of childhood immunization during pandemics to plan early catch-up vaccination activities.

Determinants of COVID-19 vaccine behaviour intentions among the youth in Kenya: a cross-sectional study
Osur J O; Chengo R; Muinga E; et al: Archives of Public Health 80(159), 1-13, 2022

This study assessed COVID-19 vaccine youth behaviour intentions and their determinants in Kenya using a cross-sectional survey and focus group discussions across 47 urban, peri-urban ad rural counties. The findings indicated that only 42% of the youth were ready to be vaccinated, with 52% adopting a wait and see approach to what happens to those who had received the vaccine and 6% totally unwilling to be vaccinated. Hesitancy was higher among females, some religious groups and those with post-secondary education. Lack of information and concerns around vaccine safety and effectiveness were main cause of vaccine hesitancy. Social media was the major information source in hesitancy. Other contributors to hesitancy included low trust in the health ministry, and belief that mass vaccination is not helpful. The authors raise that these causes of vaccine hesitancy are modifiable and suggest that health systems engage with young people to reduce vaccine hesitancy.

There is nowhere to take the child: a qualitative study of community members’ views on managing early childhood substance use in Mbale, Uganda
Skylstad V; Engebretsen I M S; Nalugya S J; et al: BMC Public Health 22(1192), 1-13, 2022

This study explores the experiences and perceptions of community members regarding how childhood substance use (before age 10) is managed in in Mbale District, Uganda. this area. Three main themes were identified: ‘We don’t talk about it’: Despite concern, childhood substance use was not addressed in the community. Participants attributed this to a lack of leadership in addressing it, changing acceptability for peer parental interference, and uncertainty about repercussions related to children’s rights. ‘There is nowhere to take the child’: Since substance use was not considered a medical problem, help from the health sector was only sought for adverse consequences, such as injury. This left the participants with the experience that there was in effect nowhere to take the child. ‘The government has not done so much’: The participants called for government action and clear laws that would regulate the availability of alcohol and other substances to children, but they had limited trust in the capacity and commitment of the government to act. Despite concern about childhood alcohol and substance use, the complexity and magnitude of the problem left community members feeling incapacitated in responding. The authors propose measures that address leadership, service, and legal deficits and that support collective agency to act on the issue in communities.

Transforming Africa's health system in wake of COVID-19 pandemic
World Health Organization (AFRO): WHO, Lome 24 August 2022

As Africa strives to recover from the impact of the COVID-19 pandemic, health authorities and experts gathered in end August for the Seventy-second session of the World Health Organization (WHO) Regional Committee for Africa launched a new drive to find ways of revamping the region's health systems. At a special event on Rethinking and rebuilding resilient health systems in Africa during the 22 – 26 August Regional Committee meeting in Lomé, Togo, delegates examined the measures that have worked in achieving universal access to health care as well as the shortfalls. They also explored ways to maintain essential services during outbreaks and the investments and actions needed to ensure equitable access to quality medical products and health technologies. The special event launched at the Regional Committee kicks off a collective process to support African countries as they ramp up efforts to recover from the pandemic-triggered disruptions and work to rebuild better their health systems. A series of consultations and actions will follow to support countries in achieving universal health coverage and health security.

8. Human Resources

Burnout among primary health-care professionals in low- and middle-income countries: systematic review and meta-analysis
Wright T; Mughal F; Babatunde O; et al: Bulletin of the World Health Organisation 100(6), 385–401A, 2022

This study estimated the prevalence of burnout among primary health-care professionals in low- and middle-income countries and factors associated with burnout. The authors systematically searched nine databases up to February 2022 to identify studies investigating burnout in primary health-care professionals in low- and middle-income countries. Three studies collected data during the coronavirus disease 2019 pandemic but provided limited evidence on the impact of the disease on burnout. The overall single-point prevalence of burnout ranged from 2.5% to 87.9%, the pooled prevalence of a high level of emotional exhaustion was 28.1%, and a high level of reduced personal accomplishment was 31.9%. The authors note that a high prevalence of burnout among primary health-care professionals in low- and middle-income countries, particularly in Africa, has implications for patient safety, care quality and workforce planning and call for further evidence-based assessment to inform solutions..

Conceptualization, detection, and management of psychological distress and mental health conditions among people with tuberculosis in Zambia: a qualitative study with stakeholders’ and TB health workers
Mainga T; Gondwe M; Stewart R C; et al: International Journal of Mental Health Systems 16(34), 1-12, 2022

In this qualitative study, the authors aimed to understand how tuberculosis (TB) health workers and other stakeholders viewed mental health conditions linked to TB and how they screened and treated these in their patients. It was conducted in eight urban communities in Zambia through focus group discussions with local health committee members and TB stakeholders and in-depth interviews with key TB health workers. TB stakeholders and health workers were reported to have an inadequate understanding of mental health and commonly described mental health conditions among TB patients by using stigmatizing terminology and overtones, using for example “madness” to imply a character flaw rather than illness, or describing psychological distress as “overthinking", and not a condition that would benefit from mental health intervention. There were no standard screening and treatment options for mental health conditions in TB patients and most TB health workers had no mental health training, but TB Stakeholders and health workers understood the negative implications of mental health conditions on TB treatment adherence and overall wellbeing for TB patients. The authors propose integrating mental health training in TB services and screening TB patients for mental health conditions followed by care and treatment for those identified with mental health disorders.

9. Public-Private Mix

Private sector engagement in the COVID-19 response: experiences and lessons from the Democratic Republic of Congo, Nigeria, Senegal and Uganda
Kabwama S N; Kiwanuka S N; Mapatano M A; et al: Globalization and Health 18(60), 1-10, 2022

This paper documented public and private sector partnerships in the Democratic Republic of Congo, Nigeria, Senegal and Uganda between November 2020 and March 2021 in responses to the COVID-19 pandemic, using literature review and key informant interviews. Across the 4 countries, private sector strengthened laboratory systems, COVID-19 case management, risk communication and health service continuity. Across the 4 countries, the private sector supported expansion of access to COVID-19 testing services through establishing partnerships with the public health sector albeit at unregulated fees. In Senegal and Uganda, governments established partnerships with private sector to manufacture COVID-19 rapid diagnostic tests. In addition, private entities provided personal protective equipment, conducted risk communication to promote adherence to safety procedures and health promotion for health service continuity. However, there were concerns related to reporting, quality and cost of services, calling for quality and price regulation in service provision. The authors indicate that regulatory frameworks are needed in public–private engagements in pandemics, including of pricing, quality assurance and alignment with national plans and priorities.

10. Resource allocation and health financing

The economic burden of treating uncomplicated hypertension in Sub-Saharan Africa: a systematic literature review
Gnugesser E; Chwila C; Brenner S; et al: BMC Public Health 22(1507), 1-20, 2022

This paper identified costs and major cost drivers across countries in Sub-Saharan Africa, drawing on published literature. The costs are in US$. Medication costs were accountable for most of the expenditures and varied across countries, with a range from $1.70 to $97.06 from a patient perspective and $0.09 to $193.55 from a provider perspective per patient per month. Major cost drivers were multidrug treatment, inpatient or hospital care and having a comorbidity like diabetes. Hypertension is argued from the findings to pose a significant economic burden for patients and governments in SSA, with medication costs one of the biggest cost contributors. The authors suggest that addressing the economic burden of hypertension implies reducing medication costs, including in the form of subsidies for patients.

11. Equity and HIV/AIDS

Combining photo-elicitation and discourse analysis to examine adolescents’ sexuality in rural Zambia
Mulubwa C; Hurtig A; Zulu J M; et al: International Journal for Equity in Health 21(60), 1-13, 2022

This article analysed constructions of adolescents’ sexualities and sexual health and the consequences for adolescent exercise of their sexual reproductive health and rights in rural Zambia, using discourse analysis in interviews and focus group discussions. The authors identified three interpretative repertories that influenced youth sexual health, linked to adolescent 'immaturity'; and what was respectful behaviours for girls and for boys, that shape how adolescents negotiate, adopt and resist sexual reproductive health and rights interventions. Adolescents were conflicted between having and applying sexual reproductive health and rights knowledge. The authors suggest that interventions that target adolescents’ sexual reproductive health and rights must aim to address these perceptions and discourses that erect barriers against positive sexual behaviours, including access to services that promote safer sex.

Your status cannot hinder you”: the importance of resilience among adolescents engaged in HIV care in Kenya
Adams C; Kiruki M; Karuga R; et al: BMC Public Health 22(1272), 1-13, 2022

This paper identified key stigma-related barriers to ART adherence and strategies used by adolescents in overcoming these barriers. Data were collected by LVCT Health, a Kenyan organization with a programmatic focus on HIV testing, prevention, and care, interviewing 122 participants in Nairobi, Kisumu, and Mombasa, and in focus group discussions with adolescents living with HIV (ALHIV), peer leaders, and adolescents receiving HIV services in community settings irrespective of HIV status. Four major themes emerged. Knowledge and future-oriented goals can drive motivation for ALHIV to remain healthy. Disclosure to others strengthens support systems for ALHIV, medication-taking strategies and can overcome adherence challenges. A supportive clinic environment promotes continuous adolescent engagement in HIV care. These concepts were used to develop a model moderating negative effects of stigma among ALHIV. Strengths-based interventions, focused on increasing positive features in ALHIV in Kenya, and more formal involvement of adolescent peers to bolster adolescent support, are argued to have the potential to improve ART adherence among ALHIV.

12. Governance and participation in health

Assessing the scalability of a health management-strengthening intervention at the district level: a qualitative study in Ghana, Malawi and Uganda
Bulthuis S; Kok M; Onvlee O; et al: Health Research Policy and Systems 20(85), 1-14, 2022

The scale-up of successfully tested public health interventions is critical to achieving universal health coverage. This study assessed the scalability of a tested health management-strengthening intervention (MSI) at the district level in Ghana, Malawi and Uganda. The MSI was seen as credible, as regional- and national-level Ministry of Health officials championed it and district- and national-level stakeholders seemed to be convinced of its value, due to observed positive results regarding management competencies, teamwork and specific aspects of health workforce performance and service delivery. While the relative advantages of the intervention were its participatory and sustainable nature, turnover within the district health management teams and limited (initial) management capacity complicated implementation. The authors propose from the findings that improved documentation of results of the intervention can facilitate scale-up, while embedding continuous assessment with all stakeholders involved can help to adapt to changing conditions..

13. Monitoring equity and research policy

An update on Wellcome’s anti-racism programme
Farrar J: Wellcome, August 2022

In this statement the Director of Wellcome Jeremy Farrar reports that two years ago, Wellcome made a commitment to developing anti-racist principles and an anti-racist programme, and to an external evaluation of progress at the institution. An evaluation has now been reported. While it found some progress, such as improvements in the racial diversity of the workforce and some positive behavioural and practice shifts, it reached a clear conclusion that Wellcome continues to fall short of the commitment to anti-racism, both as a funder and as an employer. Farrar accepted and apologised for this and announced two measures to addressing inequity in Wellcome research funding in 2023, including a set of positive action principles applied to funding decision-making processes and the establishment of a dedicated stream of funding available exclusively to researchers who are Black and people of colour, targeted at the career stages where this will have the greatest benefits for diversity.

Using a theory of change in monitoring, evaluating and steering scale-up of a district-level health management strengthening intervention in Ghana, Malawi, and Uganda – lessons from the PERFORM2Scale consortium
Kok M; Bulthuis S; Dieleman M; et al: BMC Health Services Research 22:1001 https://doi.org/10.1186/s12913-022-08354-y, 2022

This consortium did work to understand the benefits and challenges of using a theory of change (ToC) -based approach for monitoring and evaluating the scale-up of health system strengthening interventions. The consortium held annual ToC reflections that entailed multiple participatory methods, including individual scoring exercises, country and consortium-wide group discussions and visualizations, capturing the reflections around an initiative for strengthening district health management teams, to improve health workforce performance and service delivery at scale. The annual ToC reflections proved valuable in gaining a nuanced understanding of how change did happen and strategizing on actions to further steer the scale-up the intervention. It also led to adaptations of the ToC over time. Based on the experience the authors suggest that ToC-based approaches are useful, should include a variety of stakeholders and require their continued commitment to reflection and learning on intervention implementation and scale-up. ToC-based approaches can help in adapting interventions as well as scale-up processes to be in tune with contextual changes and stakeholders involved, to potentially increase chances for successful scale-up.

14. Useful Resources

New WHO eLearning course series on Health Inequality Monitoring
Free online course, World Health Organisation, Geneva

A new WHO eLearning course series, ‘Health Inequality Monitoring Foundations’ delivers a self-directed learning environment, designed to meet the immediate learning needs of users. It is primarily targeted to monitoring and evaluation officers, researchers, analysts, and others with a general interest in health data and inequality monitoring. The Overview course gives a general introduction to the monitoring process and key terminology and concepts. The Data sources course examines the strengths, limitations and opportunities to improve common data sources for health inequality monitoring, as well as the processes of data source mapping and data linking. The Health data disaggregation course explores how disaggregated health data are integral across the steps of monitoring, and builds skills in assessing and reporting disaggregated data. The Summary measures of health inequality course discusses the general characteristics of simple and complex summary measures, and guides learners through the selection, calculation, interpretation and reporting of a range of measures. The Reporting course demonstrates the components of high-quality health inequality reporting, emphasizing purpose-driven, audience-centred, and technically rigorous approaches. These courses are available for free on the Health Inequality Monitoring channel of OpenWHO.

Samir Amin internationaliste organique/organic internationalist
GRILA présente, 2019

“In our era, when we consider the destructive (ecological and military) might at the disposal of the powers-that-be, the risk.. that war will end up destroying all the opposing camps, is real. On the other hand, there is a second path that demands the lucid and organized intervention of the internationalist front of workers and peoples.” Taking as its point of departure this observation by Samir Amin, this film depicts the audacious struggles of, as well as interviews with, addresses by and special moments involving this outstanding intellectual of the South. In the film Samir Amin discusses the political economy of development, capitalism and imperialism, as well as the resistance of workers and peoples. The film includes testimonies from other key thinkers of the region and images from the film The Dispossessed by Mathieu Roy, and also by several other sequences from throughout the world.

The Pandemic Plot: Conjuring a literary epidemic reading list
Bonhomme E: Mobile Fragments Substack, 2022

Bonhomme argues that some seminal writing during and on pandemics are worth revisiting, mostly because they provide room for ingenuity, strangeness and insight into another world. This short reading list explores how novels — past and present — have not only tackled epidemics but also provided acute and thought-provoking insight into humanity's tenacity. Given these texts' range in time, scope, and region, the novels are presented to offer a new crop of texts to flourish and overcome the corrosive effects of pandemic disillusionment and despair.

15. Jobs and Announcements

City’s Scenes Sounds Actions: Call for Submissions
Open Deadline

The City journal editors are looking for short, innovative and accessible submissions from a diversity of authors, campaigns, practitioners, artists, photographers and activists. These pieces will not follow the standard academic article format and process (i.e. no double blind peer review) as they are aimed at encouraging greater creative freedom, including a wider diversity of voices and reaching beyond academic audiences. These submissions will be shorter than the usual journal length, can include or be led by images and be of varied format, such as opinion pieces, campaign reports etc. Submissions received from campaigns, community organisations, artists, activists and precarious workers will receive a payment of £200. In some cases support is available for pieces being published in, or translated from, a non-English language. Images will be reproduced in colour online and black and white in the printed journal.

EQUINET is looking for a creative writer
Call for talent, for response by 15 September

EQUINET is looking for a creative writer to help us prepare the EQUINET Conference 2022 report linking to visuals and online presentations. If you have skills in preparing reports, and particularly multimedia reports that use visuals and links to make them accessible to a wide variety of readers and are available in October- December 2022 to work with us on preparing the conference report please send your indication of interest, CV and daily rate to the EQUINET secretariat.

PHASA (Public Health Association of South Africa) 17th annual public health conference
, 11 – 14 September, Durban, South Africa

The Public Health Association of South (PHASA) is holding their annual conference in Durban (eThekwini), on the east coast of South Africa. PHASA hosts an annual conferences, with the aim of engaging public health practitioners and interested people from around the country and world to share their experiences and research, discuss topical public health issues, and mentor public health students and young researchers. Hosting the national PHASA conference in Durban aims to add stimulus to the local economy, and contribute to enhanced awareness and widespread advocacy, for health, the social determinants of health, and healthcare in the region.

The Good Food Festival, Zimbabwe
24 September, Harare Botanical Gardens, Harare, Zimbabwe

The Good Food Festival, organised by the Zimbabwe Traditional and Organic Food Forum, is celebrating its 10th anniversary in 2022, hosted on Saturday 24 September at the Harare Botanical Gardens. There will be music all day, a wide range of local produce, products and seeds for sale, a delicious selection of dishes at the food court, chefs’ battles and cooking demos. The event includes a special kids’ zone for children.


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