Current Issue

EQUINET NEWSLETTER 216 : 01 March 2019

1. Editorial

The Price of Life – WHO’s efforts to justify health protection
Leslie London, University of Cape Town, Sofia Gruskin, University of Southern California, Sharon Fonn, Witwatersrand University, South Africa


In the same month that it reaffirmed the 1978 Alma Ata Declaration’s commitment to “the fundamental right of every human being to the enjoyment of the highest attainable standard of health” in its October 2018 Declaration of Astana, the World Health Organisation (WHO) launched, with much fanfare and hubris, its “first investment case” for 2019-2023, as a proposal that could “save up to 30 million lives”.

Despite the rhetoric of the Astana Declaration, the WHO appears to be in a political moment where it is under pressure to justify, in economic terms, its existence as a global governance structure for health. To convince the doubting reader, the investment case promised “economic gains of US$ 240 billion” as the return to be made on increasing annual country contributions by US$10 billion to enable the WHO to meet its annual budget of US$14 billion.

Two things are striking. Firstly, the investment case purports to lay the basis for “a stronger, more efficient, and results-oriented WHO …and … highlights new mechanisms to measure success, ensuring a strict model of accountability and sets ambitious targets for savings and efficiencies.” This is the language of the private sector.

There is nothing wrong with working more efficiently, but the WHO should be placing health equity and human rights at the centre of its work and should guard against efficiency and managerialism coming at the expense of equity and social justice. The bureaucracy and inefficiency of the WHO needs addressing, but the idea that the solution lies in the application of New Public Management is a political choice, rather than a necessary outcome of clear analysis.

Secondly, the parlous state of WHO funding is not a coincidence. It is the result of a systematic decline in assessed contributions by member states, particularly the United States, over past decades. Whereas assessed contributions were 75% of WHO’s budget in 1971, the Peoples Health Movement and others showed in 2017 that this is now about 25% of the institution’s budget and that countries that do pay, choose to put most funding into voluntary contributions. Voluntary contributions can be tied to particular programmes, meaning countries can determine the work of WHO through funding dependence. WHO’s budget has also been stagnant for the past eight years, which is why the organisation now has to go cap-in-hand, clutching a seemingly miraculous investment case argument, to beg for the budgets it has been starved of for the past decade.

It is astonishing, but deeply revealing, that the WHO has to justify human life in monetary or investment’ terms. Who would have thought the Constitution of the World Health Organization which 70 years ago heralded the enjoyment of the highest attainable standard of health as one of the fundamental rights of every human being would end up in such abysmal decline?

Please send feedback or queries on the issues raised in this oped to the EQUINET secretariat: admin@equinetafrica.org. The WHO Investment case referred to in the editorial can be found at https://tinyurl.com/yavqzjvk

2. Latest Equinet Updates

EQUINET Diss 117: Pathways to urban health equity: Report of multi-method research in east and southern Africa
Loewenson R; Masotya M: TARSC, Working with Harare and Lusaka youth, Civic Forum on Human Development and Lusaka District Health Office, EQUINET, Harare

By 2050, urban populations in Africa will increase to 62%. The World Health Organization (WHO) and UN-Habitat in their 2010 report ‘Hidden Cities’ note that this growth in the urban population constitutes one of the most important global health issues of the 21st century. In 2016-2018, Training and Research Support Centre (TARSC) in the Regional Network for Equity in Health in East and Southern Africa (EQUINET) explored the social distribution of health in urban areas and the opportunities for and practices promoting urban health and well-being. It focused on youth 15-24 years of age as an important group for both current and future well-being. The paper synthesises and reports evidence from a programme of work that unfolded iteratively over two years. The work involved desk reviews of published literature and analysis of data from international databases for east and southern African countries, and international evidence on practices supporting urban well-being in areas prioritised by urban youth. The findings were subject to cycles of participatory review and validation by young people from diverse urban settings and socio-economic groups in Harare and Lusaka. These methods were applied with an intention to draw on different disciplines, concepts and variables from different sectors and on the lived experience and perceptions of the youth directly affected by different urban conditions. Separate publications produced in the project give more detail on particular methods, and findings and are cited in this paper. A series of dissemination and dialogue activities have been carried out with youth, local authority and policy actors, supported by shorter briefs and technical reports.

Responding to inequalities in health in urban areas in east and southern Africa: Brief 5: What does the evidence indicate for advancing urban health and wellbeing?
Loewenson R; Masotya M: TARSC, EQUINET, Harare

Training and Research Support Centre (TARSC) as cluster lead of the “Equity Watch” work in EQUINET implemented a multi-methods approach to gather and analyse diverse forms of evidence and experience on inequalities in health and its determinants within urban areas. We explored current and possible responses to these urban conditions, from the health sector and the health promoting interventions of other sectors and of communities. We aimed to build a holistic understanding of the social distribution of health in urban areas and the distribution of opportunities for and practices promoting health and wellbeing from different perspectives and disciplines. We worked with Harare and Lusaka youth, the Civic Forum on Human Development and Lusaka District Health Office for the participatory validation This brief, the fifth in the series on urban health, reports on the combined findings and their implications for improving equity in urban health and wellbeing.

3. Equity in Health

Initiating a participatory action research process in the Agincourt health and socio–demographic surveillance site
Wariri O; D’Ambruoso L; Twine R: Journal of Global Health 7(1), doi: 10.7189/jogh.07.010413, 2017

Despite progressive health policy, disease burdens in South Africa remain patterned by deeply entrenched social inequalities. The authors suggest that accounting for the relationships between context, health and risk can provide important information for equitable service delivery. This research used a participatory research process with communities in a low income setting in the Agincourt health and socio–demographic surveillance site (HDSS) in rural north–east South Africa. Three village–based discussion groups were convened and consulted about conditions to examine, one of which was under–5 mortality. A series of discussions followed in which routine HDSS data were presented and participants’ subjective perspectives were elicited and systematized into collective forms of knowledge using ranking, diagramming and participatory photography. The process concluded with a priority setting exercise. Visual and narrative data were thematically analysed to complement the participants’ analysis. Participants identified a range of social and structural root causes of under–5 mortality: poverty, unemployment, inadequate housing, unsafe environments and shortages of clean water. Despite these constraints, single mothers were often viewed as negligent. A series of mid–level contributory factors in clinics were also identified: overcrowding, poor staffing, delays in treatment and shortages of medications. However, blame and negativity were directed toward clinic nurses in spite of the systems constraints identified. Actions to address these issues were prioritized as: expanding clinics, improving accountability and responsiveness of health workers, improving employment, providing clean water, and expanding community engagement for health promotion.

4. Values, Policies and Rights

Kenya’s Health in All Policies strategy: a policy analysis using Kingdon’s multiple streams
Mauti J; Gautier L; De Neve J et al: Health Research Policy and Systems 17(15) 1-12, 2019

This paper assesses the extent to which Health in All Policies (HiAP) is being translated into the process of governmental policy-making and is supported by international development partners and non-state actors. A qualitative case study was performed, including a review of relevant policy documents and 40 key informants with diverse backgrounds. Kenya is facing major health challenges that are influenced by various social determinants, but the implementation of intersectoral action focusing on health promotion is still arbitrary. On the policy level, little is known about HiAP in other government ministries. Many health-related collaborations exist under the concept of intersectoral collaboration, which is prominent in the country’s development framework of Vision 2030, but with no specific reference to HiAP. The paper highlights that political commitment from the highest office would facilitate mainstreaming the HiAP strategy, for example by setting up a department under the President’s Office. The budgeting process and planning for the Sustainable Development Goals were found to be potential windows of opportunity. While HiAP is being adopted as policy in Kenya, it is still perceived by many stakeholders as the business of the health sector, rather than a policy for the whole government and beyond. The authors propose that Kenya’s Vision 2030 use HiAP to foster progress in all sectors with health promotion as an explicit goal.

5. Health equity in economic and trade policies

Reflections of an Engaged Economist: An Interview with Thandika Mkandawire
Meagher K: Development and Change 0(0), doi: https://doi.org/10.1111/dech.12481, 2019

This article reports an interview with Professor Thandika Mkandawire, a leading development economist of Malawian origin specializing in the comparative study of Africa. The interview explores how growing up under colonialism in Zimbabwe meant that huge decisions were being made that had profound effect on one's life, that he saw in the experience of his father as a unionised worker on a mine and a tailor at home. He recounts the conversations on politics and working conditions on the mines that took place while people waited for their garments, as people tried to make sense of policies they had no contribution to. As a school student in Malawi doing is 'O levels' at a time of anti-colonial struggles, he was involved in demonstrations that exposed the brutality of the police. After school and working on a weekly paper his experience of being arrested exposed the facade of rule of law in a trial that he called a farce. His study of economics was initially to be a better journalist. Studying in Latin America he saw the hostility of Latin Americans to the USA as a 'more naked' form of the 'new imperialist order'. The interview traces him to his life in exile from Malawi, living in Sweden, where the thinking of Amartya Sen and others exposed the deeply social and political nature of economics, while the writing of African nationalists exposed the tension between class and nation as the overriding concern, a debate he posits as continuing until today. Living in Sweden at that time provided an experience of a democratic state that could "tame the structural power of capital", reinforcing but also moderating his "leftist inclinations". The interview continues to track how his life experiences and work at institutions such as CODESRIA and UNRISD influenced his thinking on developmental states, his views on strategic responses to the structural adjustment programmes in Africa, of the role of intelligent, capable and democratic states as the only viable instrument for development, and of social investment as a developmental tool. The interview explores his views on the implications for the current African political economy and for African scholarship.

The Global Commission on the Future of Work calls for fundamental changes in health at work
Osseiran N: World Health Organisation, Geneva, Switzerland, 2019

The ILO Global Commission on the Future of Work called for fundamental changes in the way people work in the wave of globalisation, rapid technological development, demographic transition and climate change, according to its report Work for a Brighter Future published in January 2019. The report examines how to achieve a better future of work for all at a time of un­precedented change and exceptional challenges in the world of work. These changes require placing health higher on the agenda of the world of work. Everybody has the right to health, which is defined by WHO as a state of complete physical and mental wellbeing and not only the absence of disease and infirmity. Working people have the right to health and to health care as close as possible to where they live and work. In 2018, WHO and ILO established a global coalition on occupational safety and health as multi-partner initiative of international and national agencies to create common solutions for the challenges for health and safety at work and to stimulate joint actions by health and labour sectors in countries. WHO welcomed the attention given by the Global Commission on the care economy and healthcare is a major part of it. WHO is also working with ILO and OECD to implement a five-year ‘Working for Health’ global action plan to create new and decent job opportunities in health care, to ensure the necessary workforce for universal health coverage and at the same time for stimulating economic growth.

6. Poverty and health

Can social network analysis help to include marginalised young women in structural support programmes in Botswana? A mixed methods study
Loutfi D; Andersson N; Law S; Salsberg J; et al: International Journal for Equity in Health 18(12) 1-11, 2019

This paper investigated social networks of young women in Botswana to see if an approach based on an understanding of these networks could help with recruitment into support programmes. A national HIV trial was testing an intervention to assist young women to access government programs for returning to education and improving livelihoods. Structural factors such as poverty, poor education, strong gender inequalities and gender violence render many young women unable to act on choices to protect themselves from HIV. Social network analysis was used to identify key young women in four communities and to describe the types of people that marginalised young women turn to for support. In discussion groups, the same young women helped explain results from the network analysis. Most marginalised young women went to other women, usually in the same community and with children, especially if they had children themselves. Rural women were better connected with each other than women in urban areas, though there were isolated young women in all communities. Peer recruitment contributed most in rural areas; door-to-door recruitment contributed most in urban areas. The authors argue that since marginalised young women seek support from others like themselves, outreach programs could use networks of women to identify and engage those who most need help from government structural support programs. while this alone may be insufficient, a combination of approaches, including, for instance, peers, door-to-door recruitment and key community informants could be explored as a strategy for reaching marginalised young women for supportive interventions.

7. Equitable health services

Integrating noncommunicable disease services into primary health care, Botswana
Tapela N; Tshisimogo G; Shatera B; et al: Bulletin of the World Health Organisation 97(2), 142-153, 2018

Despite the rising burden of noncommunicable diseases, access to quality decentralized noncommunicable disease services remain limited in many low- and middle-income countries. The authors describe strategies that were employed to drive the process from adaptation to national endorsement and implementation of the 2016 Botswana primary healthcare guidelines for adults. The strategies included detailed multilevel assessment with broad stakeholder inputs and in-depth analysis of local data; leveraging academic partnerships; facilitating development of policy instruments and embedding noncommunicable disease guidelines within broader primary health-care guidelines in keeping with the health ministry strategic direction. At facility level, strategies included developing a multi-method training programme for health-care providers, leveraging on the experience of provision of human immunodeficiency virus care and engaging health-care implementers early in the process. Through the strategies employed, the country’s first national primary health-care guidelines were endorsed in 2016 and a phased three-year implementation started in August 2017. Provision of primary health-care delivery of noncommunicable disease services was included in the country’s 11th national development plan (2017–2023). During the guideline development process, the authors learnt that strong interdisciplinary skills in communication, organisation, coalition building and systems thinking, and technical grasp of best-practices in low- and middle-income countries were important. They found that delays and poor communication emerged from the misaligned agendas of stakeholders, exaggerated by a siloed approach to guideline development, underestimation of the importance of having policy instruments in place and weak initial coordination of the processes outside the health ministry. The authors share this experience for its relevance to other countries interested in developing and implementing guidelines for evidence-based services for noncommunicable diseases.

8. Human Resources

Strategic leadership capacity building for Sub-Saharan African health systems and public health governance: a multi-country assessment of essential competencies and optimal design for a Pan African DrPH
Agyepong I; Lehmann U; Rutembemberwa E: Health Policy and Planning 33 (1) (suppl 2), ii35-ii49, 2018

Leadership capacity needs development and nurturing at all levels for strong health systems governance and improved outcomes. The Doctor of Public Health (DrPH) is a professional, interdisciplinary degree focused on strategic leadership capacity building. The concept is not new and there are several programmes globally, but none within Africa, despite its urgent need for strong strategic leadership in health. To address this gap, a consortium of institutions in Sub-Saharan Africa, UK and North America have embarked on a collaboration to develop and implement a pan-African DrPH. This paper presents findings of research to verify relevance, identify competencies and support programme design and customisation. A mixed methods cross sectional multi-country study was conducted in Ghana, South Africa and Uganda. Data collection involved a non-exhaustive desk review, 34 key informant (KI) interviews with past and present health sector leaders and a questionnaire with closed and open ended items administered to 271 potential DrPH trainees. Most study participants saw the concept of a pan-African DrPH as relevant and timely. Strategic leadership competencies identified by KI included providing vision and inspiration for the organisation, core personal values and character qualities such as integrity and trustworthiness, skills in adapting to situations and context and creating and maintaining effective change and systems. There was consensus that programme design should emphasise learning by doing and application of theory to professional practice. Short residential periods for peer-to-peer and peer-to-facilitator engagement and learning, interspaced with facilitated workplace based learning, including coaching and mentoring, was the preferred model for programme implementation.

9. Public-Private Mix

Perceptions of and support for national health insurance in South Africa's public and private healthcare sectors
Booysen F; Hongoro C: The Pan African Medical Journal 30(277), doi: doi:10.11604/pamj.2018.30.277.14147, 2018

For the purpose of effective implementation of a National Health Insurance (NHI) policy the authors argue that it is necessary to have an understanding of the awareness and perceptions of and support for such policy among clients using the healthcare system. The South African National Health and Nutrition Examination Survey asked household heads a series of questions on healthcare utilisation and access and collected information on knowledge and perceptions of and support for national health insurance. Comparisons are drawn between private sector healthcare users with medical aid and public sector healthcare users without medical aid, using descriptive and regression analysis. Inequalities in access to quality healthcare remain stark. Only 8.5% of private users had postponed seeking healthcare compared to 23.9% of public users. Only 11.9% of public users were very satisfied with the quality of healthcare services compared to 50.2% of private users. More than eighty percent of healthcare users however were of the opinion that NHI is a top priority. The findings suggest that this requires a national health insurance that provides better quality healthcare, increasing the probability of support for an NHI with lower cost and full coverage by 10.1%. The authors suggest that it is imperative to provide better quality healthcare services in the public sector for private sector users to be supportive of national health insurance. Concerted efforts are also required to develop a proper communication strategy to disseminate information on and garner support for national health insurance, both in the public and private healthcare sectors.

10. Resource allocation and health financing

Incorporating concerns for equity into health resource allocation: A guide for practitioners
Love-Koh J; Griffin S; Kataika E; Revill P: CHE Research Paper 160, 1-25, 2019

This paper summaries the methods for analysing health equity available to policymakers regarding the allocation of health sector resources. The authors provide an overview of the major tools that have been developed to measure, evaluate and promote health equity, along with the data required to operationalise them. These were organised into four key policy questions facing decision-makers: (i) what is the current level of inequity in health; (ii) does government health expenditure benefit the worst-off; (iii) can government health expenditure more effectively promote equity; and (iv) which interventions provide the best value for money in reducing inequity? Benefit incidence analysis is identified as the principal tool for estimating the distribution of current public health sector expenditure, with geographical resource allocation formulae and health system reform being the main government policy levers for improving equity. Techniques from the economic evaluation literature, such as extended and distributional cost-effectiveness analysis can be used to identify ‘best buy’ interventions from a health equity perspective. A range of inequality metrics, from gap measures and slope indices to concentration indices and regression analysis, can be applied to these approaches to evaluate changes in equity. Methods from the economics literature can be used to generate novel evidence on the health equity impacts of resource allocation decisions. They provide policymakers with a toolkit for addressing multiple aspects of health equity, from health outcomes to financial protection, and can be adapted to accommodate data commonly available in either high income or low and middle income settings. However, the quality and reliability of the data are crucial to the validity of all methods.

Sociodemographic patterns of health insurance coverage in Namibia
Allcock S; Young E; Sandhu M: International Journal for Equity in Health 18(16) 1-11, 2019

This paper aimed at assessing the prevalence of health insurance, the relation between health insurance and health service utilisation and to explore the sociodemographic factors associated with health insurance in Namibia. Such findings may help to inform health policy to improve financial access to healthcare in the country. Using data on 14,443 individuals, aged 15 to 64 years, from the 2013 Namibia Demographic and Health Survey, the association between health insurance and health service utilisation was investigated using multivariable mixed effects Poisson regression analyses. Just 17.5% of this population were insured. In fully-adjusted analyses, education was significantly positively associated with health insurance, independent of other sociodemographic factors. Female sex and wealth were also independently associated with insurance. There was a complex interaction between sex, education and wealth in the context of health insurance. With increasing education, women were more likely to be insured and education had a greater impact on the likelihood of health insurance in lower wealth quintiles. In this population, health insurance was associated with health service utilisation but insurance coverage was low, and was independently associated with sex, education and wealth. Education may play a key role in health insurance coverage, especially for women and the less wealthy. The authors suggest that the findings may help to inform the targeting of strategies to improve financial protection from healthcare-associated costs in Namibia.

The Politics of Resource Bargaining, Social Relations and Institutional Development in Zimbabwe Since Independence
Saunders R: United Nations Research Institute for Social Development, Working Paper 1, UNRISD, Geneva, 2019

This paper examines evolving models and experiences of domestic resource mobilisation in Zimbabwe since independence in 1980. Grounded in UNRISD’s Politics of Domestic Resource Mobilization and Social Development project, the study explores key questions around the nature and dynamics of resource bargaining over revenue mobilisation and allocation; the changes in relationships among key actors; and the forms and outcomes of institutional development surrounding resource bargaining processes. It adopts a historical approach to explore the balance of forces among actors and institutional constraints in the formulation of successive resource mobilisation strategies. Three case studies in the paper of divergent resource mobilisation innovations underscore the complexity of challenges faced by governments whose actions are shaped by uneven state capacity and policy autonomy; a weak formal sector in which established business actors wield significant power and influence; and growing contestation over legitimacy and participation by political and social actors. The Zimbabwean experience underscores the critical importance of political undercurrents and contesting interests in resource bargaining. It highlights the uneven nature of social actors’ access to and influence in bargaining processes; and of the state itself in the wake of neoliberal austerity, state capture and intra-elite competition. At the same, the author argues that the evidence from Zimbabwe points to the benefits of more transparent, inclusive and capacitated forms of revenue mobilisation involving a wider array of social actors.

Therapeutic citizens and clients: diverging healthcare practices in Malawi's prenatal clinics
Zhou A: Sociology of Health and Illness (Epub ahead of print), doi: https://doi.org/10.1111/1467-9566.12841, January 2019

This article examines how HIV policies and the funding priorities of global institutions affect practices in prenatal clinics and the quality of healthcare women receive. Data consist of observations at health centres in Lilongwe, Malawi and 37 interviews with providers. The author argues that a neoliberal ideology structuring global health produces a fragmented healthcare system on the ground. He found two kinds of healthcare practices within the same clinic: firstly externally funded non government organisations (NGOs) took on HIV services while government providers focused on prenatal care. NGO practices were defined by surveillance, where providers targeted a limited number of pregnant HIV positive women and intensively monitored their adherence to drug treatment. In contrast, state-led practices were defined by inclusion and rationing. Government providers worked with all pregnant women, but with staff and resource shortages, they limited time and services for each patient in order to serve everyone. The author concludes that global health priorities produce different conditions, practices and outcomes between externally funded NGO and state-led care.

11. Equity and HIV/AIDS

How climate change is undermining the war against HIV in Africa
Lazareva I: Business Day, January 2019

In a study looking at the link between climate change and HIV infection since antiretroviral (ARV) treatment drugs became widely available in Sub-Saharan Africa, researchers found that severe drought threatens to drive new HIV infections. In the urban areas of Lesotho researchers looked at, droughts were linked to an almost five-fold increase in the number of girls selling sex and a three-fold increase in those being forced into sexual relations. Such findings mean climate shocks — which can bring displacement, loss of income and other problems — threaten to undermine progress made in HIV treatment, said Andrea Low, an assistant professor of epidemiology at the International Centre for AIDS Care and Treatment Programmes at Columbia University. “I think the real concern is that we have gained a lot in terms of epidemic control ... but there is always a possibility of losing all those gains if a lot of people are displaced due to climate extremes [and] forced migration.” People forced to migrate as a result of drought may no longer have easy access to the support of family and friends or to HIV treatment. The researchers indicate that said ways of reducing HIV risk associated with climate shocks include providing easier access to medical care, distributing HIV self-testing kits and offering cash transfers to pay school fees for drought-hit families forced to migrate.

12. Governance and participation in health

Applying an intersectionality lens to examine health for vulnerable individuals following devolution in Kenya
McCollum R; Taegtmeye M; Otiso L; Tolhurst R; et al: International Journal for Equity in Health18(24) 1-15, 2019

This paper examines health for vulnerable individuals following devolution in Kenya through a qualitative study between March 2015 and April 2016, involving 269 key informant and in-depth interviews from across the health system in ten counties, 14 focus group discussions with community members in two of these counties and photovoice participatory research with nine young people. The authors adopted an intersectionality lens to reveal how power relations intersect to produce vulnerabilities for specific groups in specific contexts, and to identify examples of the tacit knowledge about these vulnerabilities held by priority-setting stakeholders. The authors identified a range of ways in which longstanding social forces and discriminations limit the power and agency individuals can exercise. These are mediated by social determinants of health, their exposure to risk of ill health from their living environments, work, or social context, and by social norms relating to their gender, age, geographical residence or socio-economic status. While a range of policy measures have been introduced to encourage participation by typically ‘unheard voices’, devolution processes have yet to adequately challenge the social norms and power relations which contribute to discrimination and marginalisation. The authors conclude that if key actors in devolved decision-making structures are to ensure progress towards universal health coverage, there is need for intersectoral action to address these social determinants and to identify ways to challenge and shift power imbalances in priority-setting processes.

Sudanese Women at the Heart of the Revolution
Gaafar R; Shawkat O: African Feminism, 2019

Country-wide peaceful demonstrations against the regime in Sudan have involved women as organised activists. Women in marginalized areas of conflict such as Darfur, South Sudan, the Nuba Mountains and the Blue Nile have lost their children, family and livelihood to war and famine. In addition to their experience of socio-economic deprivation, many of those who fled to the capital Khartoum have been abandoned by their husbands who are unable to support their families. The women’s group No To Women’s Oppression provides legal aid, advocacy and awareness campaigns and monitors violations of human rights, a solid and active component of the resistance. Women activist in the Central Committee for Doctors and other organisations has, however, made them particularly prone to arrests and harassment. Women have also played a vital part in documenting the movement from the inside, especially in providing footage and proof of women's experiences of activism and of their conditions and the brutality they face.

13. Monitoring equity and research policy

Success of a South-South collaboration on Human Resources Information Systems (HRIS) in health: a case of Kenya and Zambia HRIS collaboration
Were V; Jere E; Lanyo K; et al: Human Resources for Health 17(6), doi: https://doi.org/10.1186/s12960-019-0342-z, 2019

This paper is a road map of using a South-South collaboration to develop a Human Resources Information System (HRIS) to inform scale-up of the health workforce. In the last decade, Kenya implemented one of the most comprehensive HRIS in Africa. It was funded by the US President’s Emergency Plan for AIDS Relief (PEPFAR) through the Centers for Disease Control and Prevention (CDC) and implemented by Emory University. The Kenyan team collaborated with the Zambian team to establish a similar HRIS in Zambia. This case study describes the collaboration activities between Zambia and Kenya which included needs assessment, establishment of project office, stakeholders’ sensitization, technical assistance and knowledge transfer, software reuse, documents and guidelines reuse, project structure and management, and project formative evaluation. Furthermore, it highlights the need for adopting effective communication strategies, collaborative planning, teamwork, willingness to learn and having minimum technical skills from the recipient country as lessons learned from the collaboration. As a result of the collaboration, while Kenya took 5 years, Zambia was able to implement the project within 2 years which is less than half the time it took Kenya. This case presents a unique experience in the use of South-South collaboration in establishing a HRIS. It illustrates the steps and resources needed while identifying the successes and challenges in undertaking such collaboration.

14. Useful Resources

e-Learning Course on Health Financing Policy for universal health coverage (UHC)
Osseiran N: World Health Organisation, Geneva, Switzerland, 2019

The first e-learning course on health financing policy for universal health coverage has now been launched. This e-learning course comprises six modules which cover the core functions of health financing policy. Each module is divided into a number of sub-topics. This is a foundational course which targets participants of various levels of experience and expertise. The course is designed to be used in a variety of ways: as preparation for those who will attend a WHO face-to-face course, for those who are for various reasons unable to attend a face-to-face course, and for those who have already attended courses and wish to refresh their knowledge. Individual modules can also be used as part of a programme of blended capacity building. Module 1 provides an overview. Module 2 addresses revenue raising and policy objectives. Module 3 looks to pooling and policy objectives, while module 4 and 5 address purchasing and benefit package design.

Scholarship updates for African students and researchers
Strohm R, February 2019

This resource provides a list of scholarships for African students, and research funding for African academics. There are three lists of scholarships and grants for African academics: one for MA and PhD study in Anglophone countries, one for Francophone countries, and one for post-doctoral and research funding. In addition, there are resources for research and travel grants for African professors.

15. Jobs and Announcements

Africa Health Agenda International Conference
5-7 March 2019, Kigali, Rwanda

The Africa Health Agenda International Conference 2019 (Africa Health 2019) in Kigali, Rwanda is geared to be one of the largest health convenings in Africa, with over 1,500 participants expected. Africa Health 2019 will serve as a platform to foster new ideas and home-grown solutions to the continent’s most pressing health challenges, with a focus on achieving universal health coverage (UHC) in Africa by 2030. The conference will be a key opportunity to map a pathway from commitment to action on UHC and to build momentum among diverse stakeholders, including policymakers, civil society, technical experts, innovators, the private sector, thought leaders, scientists and youth leaders.

African Health Economics and Policy Association (AfHEA) 5th scientific conference
11-14 March 2019, Accra, Ghana

The African Health Economics and Policy Association (AfHEA) is hosting the fifth Scientific Conference in Accra, Ghana from 11 to 14 March, 2019. The broad theme of the conference is: Securing PHC for all: the foundation for making progress on UHC in Africa. This broad theme acknowledges the important role of PHC in the achievement of UHC. Strengthening PHC improves equity, accessibility and quality of care. Similarly, UHC ensures access to needed good quality health services irrespective of ability to pay. The two are therefore closely related. PHC is the main gateway to healthcare for the majority of the population, especially for those living in rural and underserved communities. A well-functioning PHC system will be able to respond to the health care needs of most of the population, including preventive, promotive and non-specialist clinical care, at a much lower cost than if similar services were provided at higher levels of the health care system. The conference will explore how securing PHC for all is a more cost-effective way to move towards the UHC agenda of any country, particularly for low income and lower middle income countries (LICs/LMICs) where the resource constraints are more severe.

Call for Expressions of Interest: Universities and Social Inequalities in the Global South
Deadline for Submission of Proposals: 10 March 2019, 23:59 CET

UNRISD invites expressions of interest from researchers to prepare papers that will feed into the development of a research proposal for a project on the relationship between universities and social inequalities in low- and middle-income countries. With the persistent and rising inequalities of present day encompassing not only income and wealth but also inequalities across race, gender, ethnicity and geographic region, it is critical to reinvent, reimagine and strengthen a wide range of policies and institutions that can play a role in overcoming inequalities. This call and the subsequent research project to be developed focuses on universities as one such institution. The project proposal will focus on the role of universities in reinforcing or lessening social inequalities in low- and middle-income countries. It will explore the following questions: What potential does higher education have today to increase social mobility, reduce inequality and contribute to the advancement of society through the production of knowledge and skills? Are institutions of higher education contributing to inequality rather than equality, and if so, through what specific actions and mechanisms? How can the transformative potential of such institutions be fully harnessed for overcoming inequality?

Global Network of Public Health Nursing 5th International Conference
14-16 May 2019, Nairobi, Kenya

This conference aims to provide delegates with an opportunity to present and learn about new evidence-based knowledge concerning health systems/services/practice to enable public health nursing to contribute to the achievement of the targets of Goal 3 of the UN Sustainable Goals. Because of their global significance and relevance to Public Health Nursing, it was agreed to explore the contribution of public health nursing to achieving Goal 3 of the UN Sustainable Development Goals ‘good health and well being’ as a working title for the conference. The sub themes will focus on the role of public health nursing in achieving the targets of Goal 3 at every aspect and every population group including the elderly, maternal and child groups, people with disabilities, health care systems and safe environments. The focus is on; HIV/AIDS testing, disclosure, access and adherence to care; adolescent reproductive health; public health leadership and governance; health systems integration; rural, county and national levels; infectious disease management; community health strategy; public health workforce, labour relations and mental health.

O'Neill Institute for National and Global Health Law guide to Health Equity Programs of Action
Call for collaboration

The O'Neill Institute for National and Global Health Law at Georgetown University Law Center (Washington, DC) has launched a guide to Health Equity Programs of Action. The Institute offers a systematic, systemic, and inclusive approach to reduce unjust health gaps between populations. It aims to empower the people who experience these inequities and help to establish a sustained national focus on health equity. This implementation framework is based on seven principles: Empowering participation and inclusive leadership; maximizing health equity;
health systems and beyond: social determinants of health; every population counts; actions, targets and timelines; comprehensive accountability; and sustained high-level political commitment. The O'Neill Institute is interested to discuss collaborations and opportunities for taking this approach forward.

The International Conference on (Re-) Emerging Infectious Diseases (ICREID)
The African Union Commission Conference Center, Addis Ababa, Ethiopia, 13-15 March 2019

Organized by the Africa Centres for Diseases Control and Prevention (Africa CDC) and Virology Education, ICREID is a global platform that will bring together experts from around the world involved in emerging diseases in an interactive conference setting. Being the first to be held on the continent, the organisers invite healthcare professionals, researchers, public health experts and policy makers involved in treatment, research, discovery and development of drugs and vaccines in the field of re-emerging infectious diseases. Presentations include reflections on 100 years of Pandemic Flu and other Emerging Infections and analyses of the World Bank and Pandemic Preparedness. There are also talks on lassa fever, cholera and Rift Valley fever, on health economics in outbreak management and on the standardisation of research ethics during public health emergencies in Africa.

The Second Africa Health Forum
26-28 March 2019, Praia, Cabo Verde

The Government of Cabo Verde and the World Health Organization Regional Office for Africa will jointly host The Second WHO Africa Health Forum on the theme: Achieving Universal Health Coverage and Health Security in Africa: The Africa people want to see. The WHO Africa Health Forum Organizing team, also take this opportunity to call on partners to report on what they have been doing in delivering on the Call-to-Action from The First WHO Africa Health Forum - Putting People First: The Road to Universal Health Coverage in Africa.

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