“Land is more than a resource in east and southern Africa. For millions of people it is their home, their culture, and their livelihood. So when we talk of the droughts, floods and unpredictable growing seasons caused by climate change it is not just an ‘inconvenient truth’ – it is a catastrophe for all those who live and depend on the land. When these communities are also losing land to multinational corporations annexing land for industrial mono-cropping, they deprive people of livelihoods, wellbeing and generations of wisdom, making people more vulnerable to challenges like climate change”.
This discussion at the sixth EQUINET webinar on climate and health equity in east and southern Africa pointed out how deep the action needs to be to uproot climate- related inequities that undermine health.
This, and the previous five webinars heard from community, national and regional/international speakers how the roots of climate change intertwine with other drivers of inequities in health, and what that means for action at all these levels. High levels of economic and social inequality in the east and southern Africa region – and globally- undermine the right to health for many, including for the many young people who make up the majority of the region’s population.
Looking across rights, laws, health systems, extractive sectors, agroecology, urban food, trade and tax systems, the webinars presented evidence of how climate change and emergencies are clearly having wide-ranging health impacts, with extreme weather disrupting environments, food and water access, expanding disease vectors and increasing injury, mental distress, communicable disease and mortality. The direct health impacts are profound in a region where a large share of the population is reliant on climate-sensitive sectors like agriculture and natural resource-dependent livelihoods and are particularly affected by water scarcity. Climate impacts have raised demand for health care, but have also damaged health infrastructures, adding to existing barriers to access. While acute disasters attract the most attention, many of these direct health impacts emerge from longstanding deficits, especially for already vulnerable communities.
Across all the webinars, climate impacts were reported to not only intersect with existing inequalities in the region, but to also widen them. Whether discussing female reproductive rights, household food security, employment and incomes and other factors affecting health, webinar speakers and participants gave examples of how climate change is exacerbating existing health disparities, widening gender inequalities and depriving already disadvantaged people of the resources for health. The numbers affected are huge: there was constant reference to poor households, women, children, young people, rural and coastal and flood-prone communities and urban informal settlement residents or workers, and others already disadvantaged in the current political economy.
While there was concern that we often lose sight in climate change and policy forums on the lived experience of these local realities, speakers and participants also raised their global drivers. Commercialised agribusiness and food systems clear forests and land and degrade environments. Transnational corporations (TNCs) are extracting and exporting non-renewable minerals, in activities that are leading to water and air pollution, land subsidence, degraded environments and increasing water scarcity. A skewed global trade system compounds these impacts, as trade protectionism and patents held by high-income countries and TNCs limit the technology and resource transfers needed to manage climate change and its impacts. A global tax and financing system and weak public sector tax capacities enables significant transnational financial outflows, including to tax havens, diminishing the public resources for more inclusive, climate adapted economies, social protection or health systems. In the face of these global drivers, poorly met climate financing promises of only 12% of Africa’s estimated annual financing need of US$300 billion to prevent and mitigate climate impacts, largely provided as unpredictable aid or debt inducing loans, made it clear that global diplomacy processes are neither adequate nor equitable to address these drivers nor mitigate their consequences.
Our final webinar on March 20th on climate-related migration and health equity in the region closes the first round of our discussions and moves our focus more directly to responses to improve health equity, whether at local, national, or regional level, or in engaging globally. We welcome further evidence, views and collaboration in this next phase!
The previous webinars have pointed to options for action. Many build on existing actions to promote health equity, such as: ensuring health literacy and an informed public able to claim their rights, use laws and demand that states meet duties to implement laws and hold those harming health accountable; integrating local voice in planning integrated economies and public services that meet food, energy, waste management and water needs of the whole population; promoting health and environment impact assessments, and inclusive inter-sectoral processes to ensure longer-term planning and public control over TNCs extracting mineral and biodiversity resources to internalise health costs; investing in and ensuring equity in primary health care oriented health systems; and strengthening unified African voice and positions in global engagement.
At the same time, the way climate exacerbates existing drivers of health inequity was seen to demand additional responses, embedded within these measures for health equity, including: integrating climate literacy and specific rights and legal protections related to climate impacts across all sectors;. improving monitoring, collection and use of disaggregated evidence on climate impacts and responses; promoting exchange of promising practice; integrating health and climate considerations in democratic planning, using circular economy models that benefit local incomes and wellbeing; improving TNC tax contributions to generate climate-proofed activities, jobs, services and infrastructures; developing early warning systems and promoting climate-resilient health care practices and infrastructures; and demanding predictable and equitably distributed global tax-based climate financing in place of loans that worsen already high debt burdens.
As high income countries intensify their fossil fuel explorations and global conflicts absorb resources in military activities rather than the transformations needed to protect the planet, the global context appears to be intensifying risk. Consistently across the webinar discussions participants have observed that inclusion of the voices of affected, vulnerable communities and young people into climate planning and negotiations is essential to ground a more robust, people-driven and locally responsive approach within the region. This is seen as essential to strengthen the just demand from the region for changes in the global political economy that are critical in the face of climate change, not only for health equity, but for human survival.
We welcome your feedback or queries on the issues raised in this oped – please send them to the EQUINET secretariat. You can watch the different climate webinars and read the breaks and reports on the EQUINET website.
Current Issue
EQUINET NEWSLETTER 241 : 01 March 2025
CONTENTS: 1. Editorial, 2. Latest Equinet Updates, 3. Equity in Health, 4. Values, Policies and Rights, 5. Health equity in economic and trade policies, 6. Poverty and health, 7. Equitable health services, 8. Human Resources, 9. Public-Private Mix, 10. Resource allocation and health financing, 11. Equity and HIV/AIDS, 12. Governance and participation in health, 13. Monitoring equity and research policy, 14. Useful Resources, 15. Jobs and Announcements
1. Editorial
Uprooting climate-related health inequities in East and Southern Africa
EQUINET Steering committee
We invite submissions on Artificial Intelligence and health equity in east and southern Africa
Editor, EQUINET News
The expansion and embedding of Artificial Intelligence (AI) in many processes that positively and negatively affect wellbeing will clearly impact on health equity. There are interesting papers on this in this issue that flag some of the issues for this. In this time of challenging political economy changes and influential digital entrepreneurs, actors and platforms we invite and welcome published papers and reports and editorial submissions to the newsletter (email: admin@equinetafrica.org) that help to strengthen informed analysis and debate on AI and health equity from a regional lens. We look forward to hearing from you!
2. Latest Equinet Updates
Brief on climate, land rights and agroecological links to pandemics in East and Southern Africa
EQUINET, SEATINI, TARSC, December 2024
This brief from the webinar on Climate, land rights and agroecological links to pandemics summarises key issues raised related to: climate links to land and agro-ecology in the region and the impacts on health equity and pandemics; actions proposed to address these issues at local, national, regional and in global level processes; and issues for further research and discussion. The session noted that current agricultural practices in East and Southern Africa are creating significant environmental and health challenges. Industrial agriculture relies heavily on chemical pesticides, which contribute to biodiversity loss, soil and water pollution, and increased zoonotic disease risks, exacerbating climate change impacts and creating conditions that make communities more vulnerable to pandemics. To address these challenges webinar speakers and participants noted that policies need to be re-oriented to support smallholder farmers and provide land security. Trade agreements that undermine seed sovereignty must be rejected and a One Health approach must be implemented to manage zoonotic disease risks. The brief emphasizes the importance of integrating climate adaptation and food security into local and national plans, and ensuring that farmer-led solutions are central to trade, investment, and climate policy discussions.
Call for case studies: Scaling up promising practice to promote healthy urban people and ecosystems in east and southern Africa
Call closes 5pm April 30th 2025
In 2024 the regional community of practice on urban health in EQUINET proposed 10 recommendations on areas of practice and policy to build, enable and amplify climate-responsive integrated healthy urban food, waste and ecosystems in ESA. A brief (on the EQUINET website) indicates that we already have many examples of practices in these areas. This call is seeking case study examples of promising sustained practice, policy or measures within urban and peri-urban areas in ESA countries or if relevant at regional level relevant to water, energy, green spaces, climate and local economies that show innovation in one or more of the five areas The selected case studies should be drafted in May 2025 and provide evidence showing the learning in a 5-6 page brief with photographs written in an accessible style on the specific practice(s) underway that demonstrate one or more of the five areas. These five areas are explained in the call with the details requested to be sent by those responding. EQUINET will provide review, copy edit and layout and publishing of the case study in July 2025 for wider dissemination on the EQUINET website and in an updated recommendations brief. The authors will be integrated into activities and partnerships of the regional community of practice on urban health.
EQUINET Webinar on Climate-Related Migration and Health Equity in East and Southern Africa
Thursday 20th March, 2025 12:00-14:00 Southern African time; 13.00-15:00 East African time
This webinar discusses the most critical drivers of climate-related migration in the region and how they affect differentials in both opportunities for and threats to improved wellbeing. We hear from key panellists from community, national and international/global lens and discuss how far current policies and actions address the health risks and benefits of climate-related mobility, and what strategies and integrated approaches can prevent or mitigate the risks and maximise benefits. Register now in advance to receive a confirmation email with further information on the meeting and your link to join.
3. Equity in Health
A scoping review and expert consensus on digital determinants of health
van Kessel R; Seghers L; Anderson M; et al: Bulletin of the World Health Organisation 103(2), 110-125H, doi: 10.2471/BLT.24.292057, 2024
This systematic review mapped how social, commercial, political, and digital determinants of health have evolved during society's digital transformation. Analyzing 204 studies from 13,804 records (MEDLINE, Embase, Web of Science) published since 2018, supplemented by expert recommendations and recent literature searches, researchers identified 127 related health determinants across four domains: digital (37), social (33), commercial/economic (33), and political (24). Through thematic analysis and a two-round consensus process, 30 determinants (23.6%) were identified as requiring urgent policy attention. The findings provide a comprehensive framework for understanding how digitalization influences health outcomes through policy decisions, individual behaviours, and broader societal factors, offering insights for addressing these complex, interconnected determinants within the modern digital ecosystem. The study highlights the need for targeted policy interventions to address emerging health challenges in an increasingly digitalized society.
Additive interaction of conjoint tobacco smoking and heavy drinking on hypertension prevalence in rural Uganda: a community-based cross-sectional study
Masengere P; Halbesma N; Ndejjo R; et al. BMC Public Health 25:201, 1-9, doi: https://doi.org/10.1186/s12889-025-21429-9, 2025
This cross-sectional study examined the combined effects of smoking and alcohol consumption on hypertension among 4,372 adults in rural Uganda's Mukono and Buikwe districts. Among participants, 23% had high blood pressure. Results showed smokers had 1.36 times higher risk of hypertension than non-smokers, while moderate drinkers had 1.45 times and heavy drinkers 2.53 times higher risk than non-drinkers. Notably, the combination of smoking and heavy drinking produced an additive effect, with combined users showing 45% higher odds of hypertension than the sum of individual risks. These findings suggest the need for integrated interventions targeting both smoking and heavy drinking to reduce hypertension in rural Uganda.
Cross-cultural insights into internet addiction and mental health: a network analysis from China and Malawi
Li M; Wang Y; Liu B; et al. BMC Public Health 25:320, 1-10, doi: https://doi.org/10.1186/s12889-025-21496-y, 2025
This paper compared, using network analysis, the network structures of Internet addiction and mental health symptoms among university students in China and Malawi, to provide insights into culturally sensitive prevention and intervention strategies. The prevalence of internet addiction and mental health was significantly higher in China than Malawi. In Malawi, the strongest edges were school work, job performance and a sense of worthlessness. The central nodes were daily work, suffering, fantasizing and loss of interest. In China, the strongest edges were neglected household, neglected partner and difficulties with daily work suffering. The central nodes were trouble thinking, unhappiness, and inability to 'play a useful part'. Bridge symptoms varied between the countries, with functional impairments being more prominent in Malawi and emotional disturbances in China. The study highlights significant differences in the network structures of internet addiction and mental health between China and Malawi. This underscores the importance of culturally sensitive mental health interventions. In Malawi, addressing functional impairments related to academic and work performance is crucial, while in China, interventions should focus on emotional and relational aspects.
Exploring the inherent resilience of health districts in a context of chronic armed conflict: a case study in Eastern Democratic Republic of the Congo
Makali S L; St Louis P; Karemere H; et al:Health Research Policy and Systems 22(175), 1-15, doi: https://doi.org/10.1186/s12961-024-01252-1, 2024
This mixed-methods study compared health districts with and without armed conflict exposure in South Kivu, DRC, using the Kruk index framework. Through document review, stakeholder interviews, and Likert scale questionnaires, researchers identified essential resilience components including prior knowledge of strengths/weaknesses and crisis risks, plus community and non-health actor involvement. The conflict-affected district implemented additional mechanisms including armed forces involvement, mobile clinics, warning systems, and displaced persons monitoring. Findings emphasize that health districts need better resourcing during stable periods to build capacity for crisis resilience, enabling improved care quality and disturbance management.
Socioeconomic disparities in child malnutrition: trends, determinants, and policy implications from the Kenya demographic and health survey (2014 - 2022)
Okutse A O; Athiany H: BMC Public Health 25:295, 1-17, doi: https://doi.org/10.1186/s12889-024-21037-z, 2025
This study analyzed child malnutrition trends and determinants using Kenya Demographic Health Survey data (2014-2022), examining stunting, underweight, and wasting in children under five. Analysis showed increased socioeconomic inequality in malnutrition between 2014-2022, particularly affecting the poorest households. Key risk factors for stunting included child's age, household poverty, and sex, while underweight and wasting were associated with mother's age, child's sex, and socioeconomic status. Residence specifically influenced wasting risk. Socioeconomic status proved the strongest predictor of health inequality, though its effectiveness as a screening tool for stunting was moderate (sensitivity 67.4%, specificity 50.6%). Findings highlight the need for interventions that address both immediate health risks and underlying socioeconomic factors to improve child nutrition outcomes equitably.
4. Values, Policies and Rights
Africa’s leaders must address weaponisation of rape in Sudan’s conflict
Noor F: Al Jazeera, February 2025
This article highlights the devastating impact of sexual violence on women and girls in Sudan's ongoing conflict, focusing on the humanitarian crisis that has displaced over 11 million people. The author, drawing from a personal visit to a refugee camp in Renk, South Sudan, shares the harrowing story of Afrah, a 15-year-old who was raped by soldiers while protecting her younger siblings, exemplifying the widespread weaponization of sexual violence in the conflict. The narrative underscores the urgent need for African leaders to take concrete action, emphasizing that the systematic rape of women and girls has become a common war tactic with virtually no accountability. By centering the experiences of survivors like Afrah, the article calls for immediate international intervention, humanitarian access, and comprehensive support for victims, arguing that addressing the plight of women and girls is crucial to Sudan's potential path to healing and peace.
Exploring the hurdles of implementing National School Health Policy in Namibian Schools: insights from stakeholders
Katangolo-Nakashwa N; Honest Mfidi F H: BMC Health Services Research (2025) 25(131), 1-7, doi: https://doi.org/10.1186/s12913-024-12197-0, 2025
This paper explored stakeholders’ perspectives on the challenges of implementing Namibia's National School Health Policy (NSHP) in schools using a specifically designed interview guide. A total of 20 stakeholders participated, including educators, nurses, principals, and health program administrators from three regions in Namibia. The study identified significant barriers to effectively implementing the school health policy, including staffing shortages, inadequate resources, limited learner awareness of health rights, and insufficient teacher well-being. Additional challenges involve resource constraints, a lack of monitoring and evaluation, and limited coordination between the education and health sectors. The analysis emphasizes the need for increased resource allocation, comprehensive training, collaborative policy development, and initiatives to improve teacher well-being, and highlights the importance of strong leadership, stakeholder involvement, and adequate funding to support the policy goals.
Solidarity and its decoloniality in global health ethics
Fayemi AK; Kirchhoffer DG; Pratt B: International Journal for Equity in Health 24(13), 1-16, doi:https://doi.org/10.1186/s12939-025-02380-y, 2025
Solidarity is one of the emerging values in global health ethics, with some bioethics papers linking it to decoloniality. However, conceptions of solidarity in global health ethics are influenced primarily by Western perspectives, suggesting any inclusion of decolonial ideas need to include non-Western perspectives. This article explores a decolonial interpretation of solidarity. It employs a palaver approach, typical of African (Yorùbá) relational culture, developing a conception of solidarity grounded in a beehive metaphor. Through this approach, the authors posit that a beehive metaphor allegorically symbolises solidarity, embedding it in relational virtues and duties that foster harmony, particularly for people with whom one shares similar circumstances for harmonious well-being through concerted efforts. The authors address five potential objections to this account of solidarity in global health ethics and explores what an African account of solidarity means for global health research funding, including for expanding conceptual perspectives on solidarity in global health ethics.
Towards an inclusive digital health ecosystem
Xie Y; Fadahunsi K; Kelleher C; et al: Bulletin of the World Health Organisation 103(2), 170-173, doi: 10.2471/BLT.24.292020, 2024
Digital inclusion in health technologies remains a critical global challenge, with significant barriers preventing equitable access across diverse populations. The authors argue that achieving meaningful digital health inclusion requires more than technological advancements, demanding a comprehensive, multisectoral approach that addresses complex social and technical interconnections. The authors propose a novel concept of "universal design for decision-making" as a strategic framework to overcome existing limitations. This approach emphasizes multilevel collaboration, involving stakeholders from individual users to governments, and focuses on creating an ecosystem where inclusivity is naturally embedded in technological design, policy development, and health interventions. By integrating sociotechnical methods with universal design principles, the approach aims to develop digital health solutions that accommodate the diverse needs of all populations. The research highlights seven critical dimensions for optimizing inclusive digital health, ranging from policy development and technology design to addressing the needs of underserved groups and ensuring secure, trustworthy systems. The authors underscore that achieving true digital health equity is a continuous, transformative process requiring collective efforts, adaptive governance, and a deep understanding of human diversity across technological, social, and policy landscapes.
5. Health equity in economic and trade policies
Artificial intelligence, recessionary pressures and population health
Occhipinti J; Prodan A; Hynes W; et al: Bulletin of the World Health Organisation 103(2), 155-163H, doi: 10.2471/BLT.24.292057, 2024
Economic and labour policies significantly impact health and well-being through financial and environmental mechanisms. The rapid rise of generative artificial intelligence (AI) presents challenges to economic stability, with the potential to perform non-routine cognitive tasks and create new efficiencies. While offering opportunities for innovation, AI's labour-displacing potential raises serious concerns about economic equity and social health. The authors propose an AI-capital-to-labour ratio threshold that could trigger a self-reinforcing cycle of recessionary pressures beyond market correction. They call for a proactive global response that reorients economic systems towards collective well-being, as outlined in the World Health Assembly resolution Economics of health for all and the United Nations' Global Digital Compact. Integrated strategies combining fiscal policy, regulation, and social policies are critical to ensuring generative AI advances societal health while mitigating potential harm from excessive job displacement.
Challenging the myth of women's empowerment: Mining development and commercial sex in a Zambian town
Johnston L, Mulenga M, Davison C. et al: Wellbeing, Space and Society, 6,100186,doi.org/10.1016/j.wss.2024.100186, 2024
Commercial sex and mining have long been interwoven. With the spread of neoliberal capitalism, social relations around the mine site have become increasingly commodified. This ethnographic study examines the experiences of female sex workers in the mining town of Solwezi, Zambia. Women's stories offer insight into the lives of those excluded from the conventional women's economic empowerment narrative that has been widely adopted by the mining industry and what this means for their wellbeing and health. Despite the rhetoric, economic empowerment is not easily attained and women often remain heavily reliant on mine workers given limited and unequal opportunities within the labour market. In Solwezi, women who have been abandoned by a mine-working husband may find that sex work is the one opportunity available to them. Alternatively, women have migrated from across the country to participate in commercial sex work in Solwezi. Men, especially mine workers with twice-monthly pay cheques, have become a sought-after commodity, by both sex workers and wives. This has increased their power in their relationships, entrenches inequality, and increases the potential for abuse in these relationships. Despite these dynamics, sex working women continue to be neglected in Solwezi and by the broader development community. When they are considered, generally attention is directed towards HIV prevention. The authors note that these interventions fail to consider the complex social, political, and economic context that can affect women's living and working conditions.
6. Poverty and health
A comparative study of menstrual poverty among urban and rural female learners in government schools of Zambia
Bwalya B B; Mwansa A; Amanzi P; et al. BMC Women's Health 25:17, 1-15, doi: https://doi.org/10.1186/s12905-024-03542-w, 2025
This mixed-methods study examined menstrual poverty among 447 female learners in Zambian urban and rural schools. Urban students showed better understanding of menstruation than rural peers, though both groups reported similar emotional responses including fear and discomfort. Support-seeking behaviors and cultural practices varied by location, with rural learners often using herbal remedies. Over 50% of all students reported inadequate sanitary facilities, citing problems with cleanliness, privacy, and handwashing. The authoprs indicate that the significant urban-rural disparities in menstrual knowledge and practices highlight the need for comprehensive menstrual health education in public schools and collaboration with the Ministry of Health to ensure access to essential resources and gender-sensitive facilities.
Cross-sectional analysis of risk factors associated with the coexistence of three undernutrition indicators among children aged 0–23 months in Tanzania
Pallangyo E E; Kimaro O J; Mwalupani N R; et al: BMC Nutrition 11(4), 1-11, doi: https://doi.org/10.1186/s40795-024-00980-5, 2025
This paper investigates demographic, maternal, and child-related factors associated with the coexistence of stunting, wasting, and underweight. Secondary data from 2,158 children aged 0–23 months in the 2022 Tanzania Demographic and Health Survey were analyzed. Risk factors assessed included child age, birth weight, size at birth, birth order, and maternal education. Multinomial regression analysis was conducted to determine associations. The risk of coexisting undernutrition was significantly higher among children aged 12–17 months and 18–23 months. Protective factors included birth weight < 2,501 g, average size at birth, and higher birth order. The authors propose that interventions target the 12–23-month age group and address maternal education to address child malnutrition in Tanzania.
Socio-economic and demographic determinants of undernutrition among 6–59 months old children living in Malawian stunting hotspots: a cross-sectional community study
Ndovie P; Nkhata S G; Geresomo N; et al: BMC Nutrition 11(4), 1-8, doi: https://doi.org/10.1186/s40795-025-01001-9, 2025
This paper examined socio-economic and demographic determinants of undernutrition among children aged 6–59 months, offering insights to guide interventions in these areas. This cross-sectional study of 1,275 caregiver-child pairs from Mzimba, Mchinji, and Mangochi Malawi used multi-stage sampling. Wasting was linked to occupation, marital status, household size, religious affiliation, and vaccination, with protective factors including farming, business, being single, and full vaccination. Underweight was associated with occupation and household type, with higher risks in business and single-parent households, and protection in smaller households. Stunting was related to unemployment and full vaccination. Education and income showed no significant association with stunting.
7. Equitable health services
Building evidences in Public Health Emergency Preparedness ("BePHEP" Project)—a systematic review
Mercogliano M; Spatari G; Noviello C; et al: International Journal for Equity in Health 24(41), 1-17, doi: https://doi.org/10.1186/s12939-025-02382-w, 2025
This systematic review evaluated strategies and interventions implemented in low- and middle-income countries (LMICs) to prevent and manage infectious disease outbreaks during humanitarian crises from 2018 to 2023. Utilizing a comprehensive literature search across Scopus, PubMed, and Web of Science, the authors identified eleven studies from 1,415 unique articles. The research examined diverse interventions including vaccination campaigns, epidemiologic surveillance, and integrated health services across multiple countries. Case studies from Haiti, Mozambique, Thailand, India, the Philippines, Yemen, Uganda, South Sudan, and Nigeria demonstrated the effectiveness of multimodal, targeted, and collaborative responses to complex health emergencies. The findings highlighted the critical importance of adaptable healthcare systems and international collaboration in addressing infectious disease risks during humanitarian crises. Despite successful interventions, the study noted persistent challenges such as infrastructure limitations, insecurity, and logistic constraints that impede comprehensive public health emergency preparedness.
COVID-19 vaccine uptake in Zimbabwe and Sierra Leone: an application of Health Belief Model constructs
Ssentongo S; Muhereza A; Mustapha M; et al: BMC Public Health 25:451, 1-8, doi: https://doi.org/10.1186/s12889-025-21610-0, 2025
This cross-sectional study examined vaccine acceptance factors among 2,312 participants in Zimbabwe and Sierra Leone using the Health Belief Model and Theory of Planned Behaviour frameworks. Using adjusted logistic regression models accounting for gender, age, education, and location, researchers found high vaccine uptake correlated with heightened perceived COVID-19 threat, recognized vaccination benefits, stronger perceived behaviour control, and fewer barriers to vaccination. Conversely, low uptake was linked to diminished perceived threats, fewer perceived benefits, weaker perceived behaviour control, and heightened perceptions of barriers. Results underscore the importance of theoretical constructs in understanding vaccine uptake variations and suggest public health campaigns should focus on reshaping risk perceptions, addressing obstacles, emphasizing vaccination benefits, and fostering a sense of self-efficacy within target communities.
Stigma relating to tuberculosis infection prevention and control implementation in rural health facilities in South Africa — a qualitative study outlining opportunities for mitigation
van der Westhuizen H-M; Ehrlich R; Somdyala N; et al: BMC Global and Public Health 2:66, 1-13, doi: https://doi.org/10.1186/s44263-024-00097-8, 2024
This qualitative study explored tuberculosis stigma in rural South Africa through interviews with 18 health workers and 15 patients. Using Link and Phelan's theoretical model, researchers found that TB infection prevention and control measures sometimes exacerbated stigma through physical isolation and mask-wearing requirements. Patients and health workers had contrasting perspectives: patients focused on communal benefit while health workers emphasized negative impacts on patient relationships. Recommendations included improving TB education, promoting respectful communication, emphasizing communal safety, and implementing universal precautions rather than targeted measures. The study suggests using ubuntu (an African humanist framework) to guide stigma mitigation interventions and policy changes.
8. Human Resources
A workplace-based HIV self-testing intervention as a determinant for self-testing knowledge, beliefs, and use among unskilled workers in Wakiso Uganda
Nsereko G M; Musanje K; Ayesiga E R; et al. BMC Public Health 25(187), 1-12, doi: https://doi.org/10.1186/s12889-025-21471-7, 2025
This paper examined the effect of a workplace-based HIV self-testing intervention (HIVST) on the use of HIV self-testing among unskilled workers in Wakiso Uganda. A quasi-experimental one-group pretest-posttest design was conducted among 46 participants systematically and randomly selected. A comparison of the mean differences between the pre-post-test scores for the intervention group showed a statistically significant difference for HIVST knowledge, perceived susceptibility, perceived benefits, perceived barriers, and HIVST use. However, perceived barriers increased exponentially than earlier hypothesized amidst the knowledge acquired. Multiple regression showed that HIVST knowledge and individual beliefs predict 37.2% of the variance in HIVST use and that the overall biggest predictor of HIVST use was perceived susceptibility. The authors propose advocacy for frequent knowledge sharing about self-testing among unskilled working populations in Uganda. Organizations, alongside HIV testing implementing partners, should awaken people operating in risky environments and those engaging in risky sexual acts on the threat of succumbing to HIV as this greatly increases HIVST and repeat testing.
Assessing feasibility and acceptability of increasing access to sexual and reproductive health and rights through pharmacy outlets and community health volunteers: lessons from pilot study in Kenya
Liambila W; Obare F; RamaRao S; et al: BMC Health Services Research 24(1663), 1-16, doi: https://doi.org/10.1186/s12913-024-12176-5, 2024
This paper assessed in 2022 the feasibility and acceptability of using pharmacy outlets and community health volunteers to increase women’s and girls’ access to information, medication abortion and other sexual and reproductive health services and rights. The study utilized a single arm pre-test and post-test design that involved implementing a set of interventions and comparing the baseline and endline indicators using simple frequencies considering the number of respondents involved in the study. Data collected from 10 pharmacy staff and 20 community health volunteers, along with pharmacy sales records, showed steady increase in service uptake. Medication abortion clients increased from 15 to 112 monthly, with 527 total clients, of whom 523 also obtained family planning methods. All pharmacy staff and health volunteers reported satisfaction and positive attitudes toward service provision. The intervention demonstrated the feasibility and acceptability of providing medication abortion and reproductive health services through private pharmacies, with community health volunteers effectively increasing awareness and strengthening referral systems. Results suggest potential for addressing unsafe abortion, a leading cause of maternal mortality in Kenya.
9. Public-Private Mix
Benefits, challenges, and best practices of collaborative partnerships among health supply chain stakeholders in Rwanda: a cross-sectional study
Tuyishime A; Hahirwa I; Njunwa K J; et al: BMC Health Services Research 25(75), 1-9, doi: https://doi.org/10.1186/s12913-025-12239-1, 2025
This cross-sectional study examined health supply chain management in Rwanda through surveys of 103 respondents from 54 institutions, including government bodies, medical suppliers, pharmacies, and hospitals. Health commodity availability ranked highest (98.0%) among benefits, alongside improved infrastructure and cost-effectiveness. Major challenges included insufficient financial resources, skilled staff shortages, and limited information sharing. Participants recommended improving collaborative partnerships through political will, supply performance measurement, better financing policies, and increased transparency. Results emphasize the importance of strengthening stakeholder collaboration, staff capacity, and information sharing to enhance supply chain efficiency and client satisfaction.
Measuring the uptake of clinic-based HIV treatment and prevention services following HIV testing and referral at private pharmacies in Kenya
Omollo V; Roche S D; Zhang S; et al. BMC Health Services Research (2025) 25:23, 1-9, doi: https://doi.org/10.1186/s12913-024-12165-8, 2025
This pilot study evaluated HIV service uptake when private pharmacies offered free testing and referrals in Kisumu County, Kenya. Among 1,500 pharmacy clients tested, 1,178 were followed up after three months. Most participants were women (median age 26), testing HIV-negative and receiving pre-exposure prophylaxis (PrEP), or post-exposure prophylaxis (PEP) referrals. While antiretroviral therapy (ART) initiation and PEP uptake was high among those referred, PrEP uptake remained low at 9%, with prior PrEP use being the only significant predictor of initiation. Findings suggest the need for additional interventions to support PrEP referral follow-through or alternative delivery models like same-day pharmacy initiation.
10. Resource allocation and health financing
A case for increasing taxes on cigarettes, vapes and oral nicotine pouches, Kenya
Mostert C M; Ayo-Yusuf O A; Kumar M; et al: Bulletin of the World Health Organisation 102, 618–620, doi: http://dx.doi.org/10.2471/BLT.23.290985, 2024
This paper explored Kenya’s current cigarette tax regime which fails to control cigarette consumption efficiently, especially among young people. For example, the 2007 Global Youth Tobacco Survey revealed that 1 out of 10 students aged 13 to 15 years were current smokers, and boys were twice more likely to be using tobacco than girls. In 2013, WHO reported that this prevalence estimate remained relatively unchanged despite the adoption of the Tobacco Control Act. To date, no comparable survey has been published in Kenya, but in 2022, preliminary findings of a study conducted by the Kenya Tobacco Board on the use of tobacco and its products in four counties showed that consumption of e-cigarette and nicotine pouches was increasing among young people in Kenya. These developments underscore the need for reforming tax policies to protect young Kenyans from nicotine- and tobacco-related harms.
Global strategies for implementing health financing equity – a state-of-the-art review of political declarations
Nimubona A; Yandemye I; Nigaba C; et al: International Journal of Equity in Health 24(45), 1-16, doi: https://doi.org/10.1186/s12939-025-02404-7, 2025
This study investigated the global strategies for implementing health financing equity that emerged from political declarations made before 2024. The authors identified the political declarations from a search of United Nations databases and snowball searches and extracted the global strategies of health financing equity implementation that emerged from the political declarations, using the WHO Health Financing Progress Matrix framework. In total, 40 political declarations were included. From these declarations emerged strategies of targeted, selective, contributory, universal, claims, proportionate, experimental, united, and aggregated financing to implement health financing equity in countries. Thirty nine of the 40 political declarations that labelled the global health community from 1944 until 2023 placed more efforts on duplicating the prevailing strategies. The declarations, categorised into nine groups (target, unity, universality, selectivity, contribution, aggregation, claims, experience, and proportionality-oriented political declarations), were used to press countries to implement the strategies, although the strategies could not claim effectiveness nor to be optimal for providing efficient and sustainable UHC in all countries. Authors propose careful management and adaptation of global strategies for the diverse needs of the diverse population.
11. Equity and HIV/AIDS
Over a decade of HIV infection prevalence and incidence among Mozambican pregnant women: a secondary analysis of prospectively collected data
Mendes-Muxlhanga A; Nhacolo A; Figueroa-Romero A; et al: BMC Public Health 25(251), 1-11, doi: https://doi.org/10.1186/s1288902521467-3, 2025
This paper describes HIV infection trends over eleven years in women attending selected antenatal care clinics in southern Mozambique. The authors performed a secondary analysis of data registered at the ANC clinic of the Manhiça District Hospital and from the Ministry of Health's HIV National Program Registry between 2010 and 2021. HIV incidence was calculated using prevalence estimates. HIV incidence trends over time were obtained by fitting splines regression model. Data from 21,810 pregnant women were included in the analysis. Overall HIV prevalence was 29.3%, with a reduction from 28.2% in 2010 to 21.7%, except for a peak in prevalence in 2016. Over the study period, by maternal age group, the largest reduction in HIV prevalence was in the 15–20 year-old group, followed by the 20–25 year old group and the 25–30 year old group. Incidence of HIV infection increased from 12.75 per 100 person-years in 2010 to 18.65 per 100 person-years in 2018, and then decreased to 11.48 per 100 person-years in 2021. The prevalence of HIV decreased while the overall incidence stayed similar in Mozambican pregnant women, during 2010 to 2021. However, both estimates remain unacceptably high, which authors suggest indicates the need to revise current preventive policies and implement effective ones to improve HIV control among pregnant women.
Trump orders immediate end to USAID funding for HIV organisations in SA
Malan M: News24, 27 February, 2025
This report outlines how Pepfar-funded HIV organisations in South Africa, who receive their funds through the United States Agency for International Development, USAID, woke up to letters that were sent overnight telling them their grants have been ended - permanently. USAID-funded district health projects, supported outside of Pepfar, but with other US government funds administered by USAID, have also been instructed to close down, including several projects working on fighting HIV within key populations such as LGBTQI+ groups, and also those working with orphans and vulnerable children, to close down their projects immediately. South African organisations say they have also had reports from Pepfar-funded projects in Kenya and Malawi saying they had received similar letters. The article outlines responses from organisations working on HIV. The Treatment Action Campaign chairperson is reported to have said " It is so painful that these terminations mean death to poor people of the world. Key and vulnerable populations are the most affected". Many organisations noted that HIV related deaths and infections will increase and called for a more urgent government and global response. As one public health specialist noted ""The people - the patients, the frontline workers, the programme recipients who relied on these services for survival - are now left stranded, abandoned by a system that once promised progress and partnership. Every contract cancelled is not just a number; it represents a life, a community, a future now in jeopardy. The sheer disregard for the impact on millions of vulnerable people is unfathomable, and the ripple effects of these decisions will be felt for generations to come".
12. Governance and participation in health
Member States differ on response to US withdrawal from WHO
TWN Info Service on Health Issues, February 2025
The 156th Session of the WHO Executive Board, held in Geneva, witnessed intense deliberations over the financial repercussions of the United States' withdrawal from the organization. Member States engaged in complex negotiations that revealed deep divisions about how to respond to the significant budget shortfall, with proposals ranging from reducing the base budget from USD 5.3 billion to USD 4.9 billion to potentially increasing assessed contributions by 20%. High income countries largely advocated for postponing new resolutions and prioritizing activities, while low income countries strongly resisted such approaches, arguing for the preservation of the organization's comprehensive mandate. The discussions highlighted the underlying vulnerabilities of the WHO's funding model, which heavily relies on voluntary earmarked contributions, and underscored the challenges of maintaining critical global health functions amid financial uncertainty. Diplomatic exchanges were marked by nuanced debates about prioritization, with countries like Russia, China, and India questioning the sudden financial adjustments and calling for more measured, transparent approaches to budgeting and resource allocation. The session ultimately reflected the complex task of balancing organizational sustainability with the diverse health priorities of Member States in an evolving global health landscape.
The nature of self-medication in Uganda: a systematic review and meta-analysis
Makeri D; Dilli P P; Pius T; et al: BMC Public Health (2025) 25:197, 1-11, doi: https://doi.org/10.1186/s12889-025-21380-9, 2025
This systematic review and meta-analysis investigated self-medication prevalence in Uganda through 22 eligible studies encompassing 9,113 participants across different demographics and regions. Analysis revealed that at least one in two Ugandans self-medicate, with antibiotics being the most commonly self-medicated drugs. Key contributing factors included ease of access to medications, perceived cost effectiveness, long hospital waiting times, home storage of drugs, and perceptions of minor illnesses. The high prevalence of antibiotic self-medication is particularly concerning in the context of antimicrobial resistance, indicating an urgent need for awareness campaigns about the dangers of self-medication.
Trial of an mHealth intervention to improve HIV prophylaxis for female sex workers, United Republic of Tanzania
Christopher H Mbotwa C H; Method R Kazaura M R; Kåre Moen K; et al: Bulletin of the World Health Organisation 102, 852–860, doi: http://dx.doi.org/10.2471/BLT.24.291516, 2024
This paper evaluated the effect of a mobile health (mHealth) intervention on early retention of female sex workers in human immunodeficiency virus (HIV) pre-exposure prophylaxis services in the United Republic of Tanzania. The study involved 783 female sex workers: 470 from Dar es Salaam who were given the Jichunge mHealth application in addition to standard HIV pre-exposure prophylaxis, and 313 from Tanga who received pre-exposure prophylaxis alone. Participants were recruited using respondent-driven sampling and followed up for 12 months. Early retention was defined as attending a pre-exposure prophylaxis follow-up clinic within 28 days of an appointment scheduled for 1 month after starting treatment. To assess if the Jichunge app led to higher retention, the authors conducted intention-to-treat and per-protocol analyses using a regression model adjusted by inverse probability weighting. Early retention in HIV pre-exposure prophylaxis care was observed in 27.6% of participants in the intervention arm and 20.1% in the control arm. In the adjusted, intention-to-treat analysis, early retention was observed in 29.4% in the intervention arm and 17.7% in the control arm. Early retention in HIV pre-exposure prophylaxis care was significantly greater among female sex workers in the United Republic of Tanzania who used the Jichunge app than in those who did not. Nevertheless, more than two thirds of sex workers using the application did not attend follow-up services after 1 month, suggesting that additional interventions are needed.
13. Monitoring equity and research policy
A novel approach to expedite evidence to impact in pre-eclampsia: co-developed policy labs in Zambia and Sierra Leone
Kuhrt K; Mabula-Bwalya C; Boulding H; et al: BMC Global and Public Health 3(3), 1-10, doi: https://doi.org/10.1186/s44263-024-00116-8, 2025
This study examined pre-eclampsia management in Sierra Leone and Zambia, where the condition contributes significantly to maternal mortality (70% of 30,000 annual deaths occur in Sub-Saharan Africa). The authors implemented policy labs, a user-centric approach bringing together diverse stakeholders to integrate new evidence into care pathways. Working with the Policy Institute and local stakeholders, the labs focused on improving timely detection and early delivery strategies for pre-eclampsia cases. Participants identified lack of awareness as a key barrier and recommended locally co-designed community strategies to increase access to timely management. The policy lab approach proved effective in both settings for translating new knowledge into policy and action.
Going paperless: the strengths and limitations of electronic research ethics information management system in a health training institution in Tanzania
Mkumbwa R D; Pancras G; Sirili N S; et al: BMC Health Services Research 25(12), 1-7, doi: https://doi.org/10.1186/s12913-024-12151-0, 2025
This qualitative pre-post evaluation study examined the transition to an electronic Research Ethics Information Management System at Muhimbili University through interviews with 16 faculty members with experience in both paper-based and electronic systems. Using thematic analysis, researchers identified key strengths including system convenience and improved records management. Limitations centered on demands for reliable information and communication technologies and reduced reviewer-researcher interaction. The findings underscore both benefits and challenges of implementing paperless systems in resource-limited settings, recommending system automation, strengthened institutional capacity, and further studies on system adoptability, particularly in resource-constrained environments.
Investigating inconsistencies regarding health equity in select World Health Organization texts: a critical discourse analysis of health promotion, social determinants of health, and urban health texts, 2008–2016
Amri M; Enright T; O’Campo P; et al: BMC Global and Public Health 2(81), 1-14, doi: https://doi.org/10.1186/s44263-024-00106-w, 2024
This paper assessed the World Health Organization’s approaches to health equity in select health promotion, social determinants of health, and urban health texts from 2008 to 2016. The authors found that the World Health Organization usually measures health equity by comparing groups, explicitly specifies three approaches to health equity and considers health equity inconsistently both in terms of socioeconomic status and other social determinants of health. Socioeconomic status was given substantially more attention than other social determinants of health. The authors argue that there is misalignment with the World Health Organization’s stated approaches to tackle health inequity and its discourses around health equity. This incongruence, they argue, increases the likelihood of pursuing short-term solutions and not sustainably addressing the root causes of health inequity. They argue that critical discourse analysis’ focus on power allowed for an understanding of why ‘radical’ approaches are not explicitly expressed so that governments will be agreeable to addressing health inequity.
14. Useful Resources
Urban Health Capacity assessment and response kit
WHO; Geneva, 2025
WHO has developed an Urban health capacities assessment and response resource kit that equips multi-sectoral teams to assess whether a given initiative can meet its goals in a complex urban environment. It helps answer a critical question: Do we have the right capacities in place to achieve our objectives that influence urban health —whether directly or indirectly? The Kit provides a structured framework through its Primer, and a step-by-step process in the Action Guide and Training Videos, helping you evaluate key capacities across four critical areas: Informed decision-making, monitoring, and evaluation; Policies, programmes, innovation, and change; Resource management (human, financial, and infrastructural) and Partnerships, participation, and knowledge sharing. There are also real-world examples in the City-examples section.
Urban Health Council: Community-led health justice programmes and living knowledges rooted in science for those living in oppressive urban environments.
Urban Health Councils: Centric Lab
This site has been designed as a self-learning tool for grassroots activists, advocacy organisations, and policy makers looking to centre health justice in their work. Work is organised into a unique narrative arch used to help people learn specific health injustice topics. This Urban Health Council’s role is to summon together people under an autonomous method of governance and practice whereby peer-led programmes determine the direction of production of works that support health justice movements, led by the People for the People, meeting them where they are with what they need. Each programme is supported through a scientific, technical and financial ecosystem where all works produced are made open-access in a Living Encyclopedia.
15. Jobs and Announcements
10th East African Health and Scientific Conference (EAHSC)
24th - 26th April 2025, Juba South Sudan
The East African Health and Scientific Conference (EAHSC) is an EAC biennial event convened in East Africa by the EAHRC in collaboration with a host EAC Partner State. Hosting of the event is rotational to each of the Partner States and coordinated through the ministries responsible for EAC affairs, ministries responsible for health and others and it is done in close collaboration with regional and international health-related NGO's, civil society, individuals and stakeholders. The EAHSC contributes towards strengthening regional cooperation in health.
Africa Healthtech Summit
African Union, 13-15 October, 2025
The Africa HealthTech Summit brings together Ministers of Health and ICT, National Public Health Institutes, Regulators, leading Tech Innovators, Healthcare Professionals, Development Partners, Investors and Academia, to explore how emerging technologies can be harnessed to build resilience and improve health systems and individual wellbeing across African communities. The Summit focuses on critical questions such as realizing the potential of technology innovations to tackle Africa’s most pressing health challenges. Further information will be available closer to the date
Call for abstracts: South African Health Review 2025
Deadline 31 March 2025
The South African Health Review (SAHR) invites submissions for its 2025 edition 'Learning health systems: bridging knowledge and practice'. This edition seeks to explore successful health systems reform experiences within the country and draw from good practices and exemplary implementation across the provinces. The 2025 edition aims to identify practical ways to enhance specific aspects of the health system in the short term, while aligning with the broader reforms needed to achieve universal health coverage. The South African Health Review is a peer-reviewed publication accredited with the Department of Higher Education and Training, and published by Health Systems Trust. The aims of the SAHR are to advance the sharing of the knowledge, feature critical commentary on policy implementation, and offer empirical studies for improving South Africa's health system.
Tribute to Professor Charles Ngwenya
EQUINET Steering committee
EQUINET extends our collective condolences to the family, friends and colleagues of Charles Ngwena, a tireless and persistent defender of human rights, particularly from an Afrocentric perspective of law. Professor Ngwena, a native of Zimbabwe but a global scholar, did ground-breaking work in the application of Socio-economic rights in a African context, and particularly focused on disability rights and sexual and reproductive health rights, helping EQUINET develop its early thinking about the relationship between Health Equity and Human Rights. He died in South Africa on 1st Feb and will be sorely missed by our community.
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