Current Issue

EQUINET NEWSLETTER 193 : 01 April 2017

1. Editorial

From resource curse to fair benefit? Protecting health in the extractive sector
Rene Loewenson, Training and Research Support Centre


The African Union (AU) African Mining Vision envisages a mining sector on the continent that contributes to the continent’s development, not only in terms of its economic growth, but also through mining processes that are “safe, healthy, gender and ethnically inclusive, environmentally friendly, socially responsible and appreciated by surrounding communities.” An increasing number of multinational companies from all regions globally are extracting mineral resources in east and southern Africa (ESA), but how far are these extractive industries (EIs) delivering on this vision of flourishing, healthy communities in their vicinity?

Notwithstanding the price fluctuations in the sector, EI exports have yielded significant returns, with oil, gas and mineral exports from the continent estimated in 2009 to be worth roughly five times the value of international aid inflows. They have, however, been associated with rapid but unsustainable growth and high levels of inequality, especially where they have limited forward or backward linkages into the national economy, and where they do not adequately invest in or protect the social and economic development of local communities.

A demand for socially responsible EI practice has already led to over 25 international standards, codes, performance standards and guidance documents from United Nations (UN) institutions, international agencies, including the International Finance Corporation, civil society and from business itself. The standards relate to business and human rights, to labour, health, environmental and social obligations, to socially responsible investment and practice and to transparency in governance of the sector. The international standards relating to health in EIs are detailed in a recent EQUINET report (Discussion paper 108) and policy brief available on the EQUINET website. As a condition for granting mining or prospecting rights, they cover duties to assess and prevent health, social and environmental risks and to ensure fair process and health, social and livelihood protections for communities that are relocated due to mining. During the mining processes, they include prevention of harm to the health of workers and surrounding communities, making fair fiscal contributions to health care and ensuring fair benefit and transparency in their operations. They also include post closure obligations in relation to any longer term health and social harm.

Recognising regional need and benefits, African states have resolved to harmonise standards and laws for the sector at sub-regional level, in west Africa, through ECOWAS, and southern Africa, through SADC. A number of ESA countries, such as South Africa, Mozambique, Zambia and Kenya, have also set in place initiatives to bring local standards and practice for EIs in line with global best practices.

The rapid expansion of the sector into new areas, the legislative gaps in countries with newer sectors, the differences in power between multinational actors and under-resourced states and communities, amongst other factors, have led to various areas of harm and conflict that call for such rights and duties to be made clear. Notwithstanding the employment, income and fiscal contributions they bring, EIs have been reported to bring health risks for workers and surrounding communities. These risks arise from hazardous working conditions and degraded or polluted environments, from the displacement of local people, several thousand in some cases, without adequate replacement of living conditions, resources, services and livelihoods, and from generous tax exemptions that limit EI contributions to social services. The EQUINET discussion paper summarises some of this published evidence. It also reports evidence of discontent or protest from local communities, who feel excluded from decisions and frustrated by grievance handling mechanisms. Indeed, the African Commission on Human and People’s Rights has established a Working Group on Extractive Industries, Environment and Human Rights Violations in Africa to examine and propose measures to prevent and provide reparation for such negative impacts, while civil society campaigns, like ‘Publish what you pay’ have sought greater transparency in EI operations. These conditions suggest that it would be timely to give more attention to realising the intentions to harmonise regional standards on EIs and to ensure that health is included within this.

An analysis of the laws on EIs and health in the ESA region in Discussion paper 108 indicates some general findings across the region: There is generally protection in current ESA laws of occupational health for workers employed by EIs, of duties to the environment, and of fiscal and post mine closure duties. There is, however, weaker protection in current ESA laws of the health and social wellbeing of communities displaced by mines, of families living around mines and of health duties post-closure, such as in relation to chronic diseases. In the laws analysed, fewer countries included duties on forward and backward links with local sectors, communities and services.

It was however a positive finding that where there are gaps in the law, there are also clauses in the law of one or more individual ESA countries that are aligned to international standards that may guide what may be included in the laws of others.

Such ‘good practice’ clauses could inform the content of harmonised regional standards. Their origin from ESA countries of different size and income also suggests that it would be feasible to apply them more widely across the region. The EQUINET discussion paper and policy brief at http://tinyurl.com/gr6yyza present suggested clauses for regional guidance on health in EIs (and the laws they derive from), in line with international and continental standards.

Implementing the vision of a socially responsible, healthy and inclusive mining sector clearly calls for more than law. In relation to health, there is evidence of the need for strengthened enforcement and practice, such as to revisit over-generous fiscal exemptions, to integrate health more centrally in tools for and approvals from impact assessment, to strengthen public sector co-ordination and capacities to monitor and prevent health risks, and to provide public information and meaningful mechanisms for community voice and agency in measures to protect their health. However, having harmonised regional standards may help to raise awareness and understanding amongst the different public sectors, private actors and communities of their roles, rights and duties in relation to health in EIs, and give support to the social and institutional processes and measures needed to promote healthy practice.

Please send feedback or queries on the issues raised in this oped to the EQUINET secretariat: admin@equinetafrica.org. You can read further evidence in EQUINET Discussion paper 108 Corporate responsibility for health in the extractive sector in East and Southern Africa at http://tinyurl.com/zm7afbk and Policy brief 42 at http://tinyurl.com/gr6yyza

2. Latest Equinet Updates

10th ECSA Best Practices Forum and 26th Directors Joint Consultative Committee Meeting
ECSA HC: 10 to 12 April 2017, Arusha, Tanzania

The East, Central and Southern Africa Health Community (ECSA-HC) will host the
10th Best Practices Forum and 26th Directors Joint Consultative Committee from 10 to 12 April 2017 in Arusha, Tanzania. The theme is Promoting Multi-Sectoral Collaboration for Health through Sustainable Development Goals. The Conference will address its Theme through the following sub-themes:
1. Good Governance and Leadership Practices in the Health sector
2. Mitigating the Impact of emerging and re-emerging diseases.
3. Multi-Sectoral responses to Non-communicable Diseases.
4. Accountability for Women’s, Children’s and Adolescent Health post-2015
The scientific papers and best practices will form the basis for the recommendations that will be presented to the Health Ministers for further deliberation and adoption as resolutions. Further information is available on the website. EQUINET has a formal association with ECSA HC and will be represented at the meeting. EQUINET will host a joint session at the Best Practices Forum on Global Health Diplomacy including inputs on health standards in the extractive industries and on the forthcoming World Health Assembly agenda.

EQUINET Policy brief 42: Harmonising regional standards for extractive industry responsibilities for health in east and southern Africa
Loewenson R; Hinricher J; Papamichail A: TARSC, EQUINET, Harare

This brief aims to inform policy dialogue on the protection of health in extractive industries (EIs) in the mining sector in east and southern Africa (ESA). It outlines on pages 5-7 a proposal for a ‘Regional guidance on minimum standards for the duties and responsibilities of parties in the extractive sector for health and social protection’. EIs play a key economic role, but also bring health, environmental and social risks. International codes and guidance exist on the duties of corporate actors to control these risks and contribute to health. ESA country laws provide for some health protection in EIs, but all have gaps in legal provisions. In line with the intentions of the Southern African Development Community (SADC) and other regional economic communities, standards and laws for the sector should be harmonised and brought in line with international standards. The proposal for regional guidance draws clauses from current laws in ESA countries, suggesting the feasibility of their wider application across the region.

Fair publication of qualitative research in health systems: a call by health policy and systems researchers
SHaPeS thematic working group of Health Systems Global, EQUINET, and Emerging Voices for Global Health, Daniels K; Loewenson R et al.: International Journal for Equity in Health 2016 15:98 doi:10.1186/s12939-016-0368-y

An open letter from Trisha Greenhalgh et al. to the editors of the British Medical Journal (BMJ) triggered wide debate by health policy and systems researchers globally on the inadequate recognition of the value of qualitative research and the resulting deficit in publishing papers reporting on qualitative research. One key dimension of equity in health is that researchers are able to disseminate their findings and that they are taken into account in a fair and just manner, so that they can inform health policy and programmes. While the 170 researcher cosignatories to this paper work on different aspects of health systems, all feel that more serious recognition of the value of qualitative research is required, including to disseminate evidence and contribute voice to advance equity in health. The researchers are particularly disenchanted by a general experience of the limited and often inadequate publication of qualitative research in the major health and medical journals, and the resultant loss of important insights for those working in, or concerned with, health services and systems, including around clinical decision-making. The article reports on the value of qualitative research to health systems and the ways it should be given greater profile in research publications.

3. Equity in Health

Socioeconomic status and non-communicable disease behavioural risk factors in low-income and lower-middle-income countries: a systematic review
Allen L; Williams J; Townsend N; Mikkelsen B; Roberts N; Foster C; Wickramasinghe K: The Lancet Global Health, 5(3), 2017

This study aimed to review evidence on the association between socioeconomic status and harmful use of alcohol, tobacco use, unhealthy diets, and physical inactivity within low-income and lower-middle-income countries (LLMICs). The authors searched 13 electronic databases, grey literature, and reference lists for primary research published between Jan 1, 1990, and June 30, 2015. They used a piloted version of the Cochrane Effective Practice and Organisation of Care Group data collection checklist to extract relevant data at the household and individual level from the included full text studies including study type, methods, outcomes, and results. Low socioeconomic groups were found to have a significantly higher prevalence of tobacco and alcohol use than high socioeconomic groups. These groups also consumed less fruit, vegetables, fish, and fibre than those of higher socioeconomic status. Groups at higher socioeconomic status were found to be less physically active and to consume more fats, salt, and processed food than individuals of low socioeconomic status. Despite significant heterogeneity in exposure and outcome measures, the evidence shows that behavioural risk factors are affected by socioeconomic position within LLMICs.

The Second National Burden of Disease Study for South Africa: Cause of death profile Report, 1997 – 2012
Msemburi W; Pillay-van Wyk V; Dorrington RE et al: South African Medical Research Council: Cape town, 2016

This report estimates consistent and coherent cause-specific death rates for the period 1997–2012 and identifies the leading causes of death and premature mortality for South Africa, taking into consideration and adjusting for the data deficiencies. The report used the methodology of the Global Burden of Disease Study 2005 in secondary analysis of data obtained from Statistics South Africa (Stats SA), the Injury Mortality Survey 2009 (IMS) and National Injury Surveillance System 2000 (NIMSS). For the non-communicable diseases, there was an increasing trend in numbers over the whole period while the trends for communicable disease combined with maternal causes, perinatal conditions and nutritional deficiencies, remained fairly stable between 1997 and 2009, decreasing slightly thereafter. HIV/AIDS and TB increased between 1997 and 2006, where it peaked at 687 deaths per 100,000 population and then decreased steadily each subsequent year. The report points to a considerable burden from non-communicable diseases and concerning signs of an increase in diabetes mortality. The authors say that efforts targeting prevention and management of non-communicable diseases and their risk factors need to be scaled up.

World Malaria Report 2016
World Health Organization: WHO Geneva, 2016

The World Malaria Report, published annually by WHO, provides an in-depth analysis of progress and trends in the malaria response at global, regional and country levels. It is the result of a collaborative effort with ministries of health in affected countries and many partners around the world. The 2016 report spotlights a number of positive trends, particularly in sub-Saharan Africa, the region that carries the heaviest malaria burden. It shows that, in many countries, access to disease-reducing measures is expanding at a rapid rate for those most in need. The proportion of the population at risk in sub-Saharan Africa sleeping under an insecticide-treated mosquito net (ITN) or protected by indoor residual spraying (IRS) is estimated to have risen from 37% in 2010 to 57% in 2015. The proportion of the population at risk in sub-Saharan Africa who are infected with malaria parasites is estimated to have declined from 17% in 2010 to 13% in 2015. Further data on malaria prevention, treatment and outcomes are presented.

4. Values, Policies and Rights

Advancing the right to health: the vital role of law
Magnusson R: World Health Organization, Geneva, 2017

This report aims to raise awareness about the role that the reform of public health laws can play in advancing the right to health and in creating the conditions for people to live healthy lives. By encouraging a better understanding of how public health law can be used to improve the health of the population, the report aims to encourage and assist governments to reform their public health laws in order to advance the right to health. The report highlights important issues that may arise during the process of public health law reform. It provides guidance about issues and requirements to be addressed during the process of developing public health laws. It also includes case studies and examples of legislation from a variety of countries to illustrate effective law reform practices and some features of effective public health legislation.

Young people building a new vision for Port Elizabeth : Young Urbanists meet in Nelson Mandela Bay
Coetzee L: Future Cape Town, 2016

In 2016, a hundred-strong group of young Port Elizabethans gathered at the Athenaeum in Central, for the city’s first YOUNGURBANISTS meeting. A historic building and national monument situated on the corner of Castle Hill and Belmont Terrace, the Athenaeum is not a typical art gallery. It has reinvented itself as a community hub for emerging creatives in Nelson Mandela Bay and surrounds. Set in the heart of the ‘old city,’ the Athenaeum sets out to be a tangible example of a reimagined, multi-use urban space – a fitting location for a Young Urbanists event. Speakers included Oyama Vanto, project leader in Development and Infrastructure for the Mandela Bay Development Agency (MBDA), who introduced the audience to the MBDA’s goals of reversing urban decay and attracting people and businesses back into the inner city, and to its current projects: the resurrection of Zola Nqiri Square, the development of Vuyisile Mini Square and the extension of Route 67. Oyama’s passion for the democratization for city spaces resonated clearly in his talk, and he called out for a safer city for women and children as the starting point in enabling a more inclusive city. The audience were invited to share their vision for the future of our city, and to record it on a piece of paper and placed into a box. Young urbanists in attendance voiced their ideas and their concerns, calling for clear objectives through which they could move Nelson Mandela Bay forward as a model for future cities. One issue in particular was to identify the many pockets of multidisciplinary communities in our cities, with the hope of promoting synergy and fostering a participatory environment. Grand visions in place, the attendees are reported to now be reflecting on the ways that they can begin to take steps towards making such visions a reality, and dwell on the question of how, as young urbanists of PE, they can collectively propel a momentum shift and foster a culture of pride in their city.

5. Health equity in economic and trade policies

Gold Mining in Uganda
Berry I: Magnum Pro, March 2017

The author argues that fair trade isn’t only about coffee and bananas. The Fairtrade Foundation points out that it doesn’t matter what the commodity is, people should get a fair price for the work they do. African gold miners are often exploited, but the author argues that workers do not have a choice; it’s dig or starve and it’s accept a pittance for their labors or work harder the following day. The Fairtrade Foundation is reported to have intervened and to be gradually improving conditions on mines. In this photo - essay Ian Berry reflects on the Ugandan gold trade as efforts are made to encourage fairer trading practices. He follows the gold from Ugandan mines to the London workshops of jewellers.

The health impact of sexual violence among women in a platinum mining belt
Zhang M; Steele S; Shroud A; Van Cutsem G; Khan J; Barnwell G; Hill J; Duncan K: Medecins Sans Frontières, 2017

New analysis of data detailing the extent of sexual violence in the Rustenburg area indicates that one in five HIV infections (approximately 6,765 of all female cases) and one in three cases of depression among women (5,022 cases) are attributable to rape and intimate-partner violence (IPV), while one in three women inducing abortion (1,296 cases) was pregnant as a result of sexual violence. These results have emerged from an in-depth 2015 survey conducted by Medecins Sans Frontiers (MSF) among more than 800 women living in communities along the mining belt where the health consequences of sexual violence remain largely unaddressed and demand urgent action. Much additional suffering could have been prevented if survivors had been able to access a basic package of healthcare services, but opportunities are missed each day to prevent HIV infection, psychological trauma, and unwanted pregnancy for victims of sexual violence in on the platinum mining belt, because there are too few health facilities with the capacity to provide essential care. As South Africa finalises its next five-year National Strategic Plan (NSP) on HIV, TB and STIs (2017-2022), MSF is calling for the inclusion of ambitious targets for increasing sexual violence survivors’ access to medical and psychosocial services at all health facilities. Key interventions include providing post-exposure prophylaxis (PEP) to prevent HIV and other sexually transmitted infections, psychosocial support including trauma counselling, emergency contraception, other basic medical services (e.g. first aid), and the option of forensic examination..

The Mozambican debt crisis: How a sovereign state was sold
Serumaga M: Pambazuka news 808, February 2017

The author reports on 2013 loans taken without parliament approval in Mozambique totaling $2 billion. External funders suspended credit to Mozambique because of the loans, and the national currency fell by 70% in 2016. Restructuring the loans means imposed austerity on a population already living in extreme austerity and eventually repaying the creditors from revenues derived from Mozambique’s natural gas deposits that come on the market in 2023. The author presents information on the case, the funders and the implications for other African countries.

What Does the End of Africa's Boom Mean for Universal Health Coverage?
Russo, G; Bloom, G: IDS Rapid Response Briefing 16, 2017

According to the authors, achieving universal health coverage by 2030, as stated in UN Global Goal 3, will require substantial increases in health spending and the proportion funded through taxation or social insurance to make health care affordable for all. Not only will institutions need to be established to ensure sustainable arrangements for social finance, it will also be vital to ensure that health financing is resilient to economic and other shocks if Global Goal 3 is to be realised. This is argued to present a major challenge in Africa, where an economic downturn is projected in a number of resource-dependent countries, such as Mozambique and Guinea Bissau and where countries such as Sierra Leone have weakened health systems. The response to these challenges by governments and development partners, will have important effects on how well people, and the health services on which they rely, cope in the short term and longer-term evolution of health coverage.

6. Poverty and health

Impoverishing effects of catastrophic health expenditures in Malawi
Mchenga M; Chirwa G; Chiwaula L: International Journal for Health in Equity 16(25), 2017

Out-of-pocket (OOP) health spending can potentially expose households to risk of incurring large medical bills, and this may impact on their welfare. This work investigates the effect of catastrophic OOP on the incidence and depth of poverty in Malawi. The paper is based on data that was collected from 12,271 households that were interviewed during the third Malawi integrated household survey (IHS-3). The paper considered a household to have incurred a catastrophic health expenditure if the share of health expenditure in the household's non-food expenditure was greater than a given threshold ranging between 10 and 40%. As the authors increase the threshold from 10 to 40%, they found that OOP drives between 0.73%-9.37% of households into catastrophic health expenditure. The extent by which households exceed a given threshold (mean overshoot) drops from 1.01% of expenditure to 0.08%, as the threshold increased. When OOP is accounted for in poverty estimation, an additional 0.93% of the population is considered poor and the poverty gap rises by 2.54%. The authors’ analysis suggests that people in rural areas and middle income households are at higher risk of facing catastrophic health expenditure. The authors conclude that catastrophic health expenditure increases the incidence and depth of poverty in Malawi. They call for financing measures to minimise the incidence of catastrophic health expenditure especially to the rural and middle income population.

New Open Access Book: Sustainable Food Systems: The Role of the City
Biel R: UCL Press, UK, December 2016

Faced with a global threat to food security, it is perfectly possible that society will respond by reasserting co-operative traditions. This open access book, by a leading expert in urban agriculture, proposes a solution to today’s global food crisis. By contributing more to feeding themselves, it argues that cities can allow breathing space for the rural sector to convert to more organic sustainable approaches. Biel’s approach connects with current debates about agroecology and food sovereignty. It asks key questions, and proposes lines of future research. He suggests that today’s food insecurity – manifested in a regime of wildly fluctuating prices – reflects not just temporary stresses in the existing mode of production, but more profoundly the troubled process of generating a new one. He argues that the solution cannot be implemented at a merely technical or political level: the force of change can only be driven by the kind of social movements which are now daring to challenge the existing unsustainable order.

Safe and inclusive cities survey
Institute of Environmental Studies, University of Zimbabwe, 2015

The proportion of people worldwide living in urban areas has been increasing over the past century. Southern Africa is one of the least urbanised but fastest urbanising region. The pace of urbanisation in sub-Saharan Africa is twice the global average, making it the highest in the world. The urban population annual growth rate for the region is pegged at 3.75%. South Africa and Botswana have urban populations of more than 60% and Zimbabwe 33%. The survey was conducted in 4 purposively sampled urban high density suburbs. A multi-stage random sampling was then used to select households in the 4 suburbs. The sampling frame for selecting households was obtained from ZIMSTAT, the country’s statistical office. Data was collected over a period of a week in each of the sampled suburbs. During the week the enumerators would conduct household interviews in the Enumeration Areas (EAs). Household questionnaire were used to collected data from the sampled households. The questionnaire covered: characteristics of household members; availability of and access to shelter, water and sanitation; energy sources; income sources; assets. Results shows that where the council provided the houses, the critical services were provided and water, electricity and sanitation were not an issue. The urban councils developed the properties, but their role was not clear in the new urban landscape. Issues of restitution in the event of evictions in these areas were grey areas and people did not know where to go to get assistance when evicted, to where to access legal advice. Residents wanted advice on issues to do with access to land for vending, law enforcement and women empowerment, on land tenure and how to get title deeds. Most lease agreements and title deeds were in the name of the husband, giving men more access to land for housing than women.

7. Equitable health services

A realist review of mobile phone-based health interventions for non-communicable disease management in sub-Saharan Africa
Opoku D; Stephani V; Quentin W: BMC Medicine 15 (24), doi: 10.1186/s12916-017-0782-z, 2017

The prevalence of non-communicable diseases (NCDs) is increasing in sub-Saharan Africa. At the same time, the use of mobile phones is rising, expanding the opportunities for the implementation of mobile phone-based health (mHealth) interventions. This review aims to understand how, why, for whom, and in what circumstances mHealth interventions against NCDs improve treatment and care in sub-Saharan Africa. Four main databases (PubMed, Cochrane Library, Web of Science, and Google Scholar) and references of included articles were searched for studies reporting effects of mHealth interventions on patients with NCDs in sub-Saharan Africa. All studies published up until May 2015 were included in the review. Following a realist review approach, middle-range theories were identified and integrated into a Framework for Understanding the Contribution of mHealth Interventions to Improved Access to Care for patients with NCDs in sub-Saharan Africa. The main indicators of the framework consist of predisposing characteristics, needs, enabling resources, perceived usefulness, and perceived ease of use. Studies were analyzed in depth to populate the framework. The search identified 6137 titles for screening, of which 20 were retained for the realist synthesis. The contribution of mHealth interventions to improved treatment and care is that they facilitate (remote) access to previously unavailable (specialized) services. Three contextual factors (predisposing characteristics, needs, and enabling resources) influence if patients and providers believe that mHealth interventions are useful and easy to use. Only if they believe mHealth to be useful and easy to use, will mHealth ultimately contribute to improved access to care. The analysis of included studies showed that the most important predisposing characteristics are a positive attitude and a common language of communication. The most relevant needs are a high burden of disease and a lack of capacity of first-contact providers. Essential enabling resources are the availability of a stable communications network, accessible maintenance services, and regulatory policies. The authors propose that policy makers and program managers consider predisposing characteristics and needs of patients and providers as well as the necessary enabling resources prior to the introduction of an mHealth intervention. They argue that researchers would benefit from placing greater attention on the context in which mHealth interventions are being implemented instead of focusing (too strongly) on the technical aspects of these interventions.

Establishing the Africa Centres for Disease Control and Prevention: responding to Africa's health threat
Nkengasong J; Maiyegun O; Moeti M: The Lancet Global Health 5(3), e246-247, 2017

On Jan 31, 2017, heads of states and governments of the African Union and the leadership of the African Union Commission officially launched the Africa Centres for Disease Control and Prevention (Africa CDC) in Addis Ababa, Ethiopia. As detailed in the African Union's Africa Agenda 2063—a roadmap for the development of the continent—some of the concerns that justified the establishment and initiation of an Africa-wide public health agency include rapid population growth; increasing and intensive population movement across Africa, with increased potential for new or re-emerging pathogens to turn into pandemics; existing endemic and emerging infectious diseases, including Ebola; antimicrobial resistance; increasing incidence of non-communicable diseases and injuries; high maternal mortality rates; and threats posed by environmental toxins.

Sexual and reproductive health services utilization by female sex workers is context-specific: results from a cross-sectional survey in India, Kenya, Mozambique and South Africa
Lafort Y; Greener R: Roy A: et al.: Reproductive Health 14 (13) DOI: 10.1186/s12978-017-0277-6, 2017

Female sex workers (FSWs) are extremely vulnerable to adverse sexual and reproductive health (SRH) outcomes. To mitigate these risks, they require access to services covering not only HIV prevention but also contraception, cervical cancer screening and sexual violence. To develop context-specific intervention packages to improve uptake, this paper identified gaps in service utilization in four different. A cross-sectional survey was conducted, as part of the baseline assessment of an implementation research project. FWSs were recruited in Durban, South Africa (n = 400), Mombasa, Kenya (n = 400), Mysore, India (n = 458) and Tete, Mozambique (n = 308), using respondent-driven sampling (RDS) and starting with 8-16 ‘seeds’ identified by the peer educators. FSWs responded to a standardised interviewer-administered questionnaire about the use of contraceptive methods and services for cervical cancer screening, sexual violence and unwanted pregnancies. Current use of any modern contraception ranged from 86.2% in Tete to 98.4% in Mombasa (p = 0.001), while non-barrier contraception (hormonal, IUD or sterilisation) varied from 33.4% in Durban to 85.1% in Mysore (p < 0.001). Ever having used emergency contraception ranged from 2.4% in Mysore to 38.1% in Mombasa (p < 0.001), ever having been screened for cervical cancer from 0.0% in Tete to 29.0% in Durban (p < 0.001), and having gone to a health facility for a termination of an unwanted pregnancy from 15.0% in Durban to 93.7% in Mysore (p < 0.001). Having sought medical care after forced sex varied from 34.4% in Mombasa to 51.9% in Mysore (p = 0.860). Many of the differences between cities remained statistically significant after adjusting for variations in FSWs’ sociodemographic characteristics. The use of SRH commodities and services by FSWs is often low and is highly context-specific. Reasons for variation across cities need to be further explored. The differences are unlikely caused by differences in socio-demographic characteristics and more probably stem from differences in the availability and accessibility of SRH services. The authors advise that intervention packages to improve use of contraceptives and SRH services be tailored to gaps in each city.

Using mHealth for HIV/TB Treatment Support in Lesotho: Enhancing Patient–Provider Communication in the START Study
Hirsch-overman Y; Daftary A; Yuengling K; Saito S; Ntoane M; Frederix K; Maama B; Howard A: Journal of Acquired Immune Deficiency Syndromes 74, S37–S43, 2017

mHealth is a promising means of supporting adherence to treatment. The Start TB patients on ART and Retain on Treatment (START) study included real-time adherence support using short-text messaging service (SMS) text messaging and trained village health workers (VHWs). The authors describe the use and acceptability of mHealth by patients with HIV/tuberculosis and health care providers. Patients and treatment supporters received automated, coded medication and appointment reminders at their preferred time and frequency, using their own phones, and $3.70 in monthly airtime. Facility-based VHWs were trained to log patient information and text message preferences into a mobile application and were given a password-protected mobile phone and airtime to communicate with community-based VHWs. The use of mHealth tools was analysed from process data over the study course. Acceptability was evaluated during monthly follow-up interviews with all participants and during qualitative interviews with a subset of 30 patients and 30 health care providers at intervention sites. Use and acceptability were contextualised by monthly adherence data. From April 2013 to August 2015, the automated SMS system successfully delivered 39,528 messages to 835 individuals, including 633 patients and 202 treatment supporters. Uptake of the SMS intervention was high, with 92.1% of 713 eligible patients choosing to receive SMS messages. Patient and provider interviews yielded insight into barriers and facilitators to mHealth utilisation. The intervention improved the quality of health communication between patients, treatment supporters, and providers. HIV-related stigma and technical challenges were identified as potential barriers. The mHealth intervention for HIV/tuberculosis treatment support in Lesotho was found to be a low-tech, user-friendly intervention, which was acceptable to patients and health care providers.

‘You must carry your wheelchair’ – barriers to accessing healthcare in a South African rural area
Vergunst R; Swartz L; Mji G; MacLachlan M; Mannan H: Global Health Action 8(1); http://dx.doi.org/10.3402/gha.v8.29003, 2017

There is international evidence that people with disabilities face barriers when accessing primary healthcare services and that there is inadequate information about effective interventions that work to improve the lives of people with disabilities, especially in low-income and middle-income countries. Poor rural residents generally experience barriers to accessing primary healthcare, and these problems are further exacerbated for people with disabilities. This study explored the challenges faced by people with disabilities in accessing healthcare in Madwaleni, a poor rural Xhosa community in South Africa. Purposive sampling was done with 26 participants, using semi-structured interviews and content analysis to identify major themes. The study showed a number of barriers to healthcare for people with disabilities. These included practical barriers, including geographical and staffing issues, and attitudinal barriers.

8. Human Resources

3rd Board Meeting of the African Platform on Human Resources for Health (APHRH)
APHRH: Kampala, Uganda, 2016

The Board of the APHRH met on the 30th Nov 2016 in Kampala to discuss key issues that concerning the Health Workforce in Africa. A resolution was made to convene a regional consultation meeting of key stakeholders and networks to develop a consensus on ways to accelerate advocacy for a strengthened health workforce in Africa. The Board made a number of decisions to initiate acceleration of the work of the platform at all levels and enhance lobby and advocate for the prioritization of the Health Workforce agenda in Africa, outlined in this document, including: to request the WHO Regional Director for Africa to urgently consider an enhanced technical support program to African countries to strengthen country level health workforce development and management departments, especially at the ministries of health headquarters of member states; to support African Member states in translating for action key regional and global policies including the African Health Strategy, the Global Health Workforce Strategy and Sustainable Development Goals (SDGs) and to fast track the strengthening of Health Workforce information systems of countries to manage workforce inflows, stock and outflow by implementation of the WHO code on International Recruitment and track progress of strengthening through improved reporting on the code at the 3rd round due in 2018.

Community health worker perspectives on a new primary health care initiative in the Eastern Cape of South Africa
Austin-Evelyn K; Rabkin M; Machete T; Mutiti A; Mwansa-Kambafwile J; Dlamini T; El-Sadr W: PLoS ONE 12(3) 2017, doi:10.1371/journal.pone.0173983

In 2010, South Africa’s National Department of Health launched a national primary health care (PHC) initiative to strengthen health promotion, disease prevention, and early disease detection. The strategy, called Re-engineering Primary Health Care (rPHC), aims to provide a preventive and health-promoting community-based PHC model. A key component of rPHC is the use of community-based outreach teams staffed by generalist community health workers (CHWs). The authors conducted focus group discussions and surveys on the knowledge and attitudes of 91 CHWs working on community-based rPHC teams in the King Sabata Dalindyebo (KSD) sub-district of Eastern Cape Province. The CHWs studied enjoyed their work and found it meaningful, as they saw themselves as agents of change. They also perceived weaknesses in the implementation of outreach team oversight, and desired field-based training and more supervision in the community. The authors find that there is a need to provide CHWs with basic resources like equipment, supplies and transport to improve their acceptability and credibility to the communities they serve.

Global Health Workforce Labor Market Projections for 2030
Liu J; Goryakin Y; Maeda A; Bruckner T; Scheffler R: Human Resources for Health 15(11) 3, 2017

In low- and middle-income countries, scaling essential health interventions to achieve health development targets is constrained by the lack of skilled health professionals to deliver services. The authors project the future health workforce demand based on projected economic growth, demographics and health coverage. They used health workforce data for 1990–2013 for 165 countries from the WHO Global Health Observatory. The demand projections are compared with the projected growth in health worker supply and the health worker “needs” as estimated by WHO to achieve essential health coverage. The model predicts that, by 2030, global demand for health workers will rise to 80 million workers, double the current (2013) stock of health workers, while the supply of health workers is expected to reach 65 million over the same period, resulting in a worldwide net shortage of 15 million health workers. Growth in the demand for health workers will be highest among upper middle-income countries, driven by economic and population growth and ageing. This results in the largest predicted shortages which may fuel global competition for skilled health workers. Middle-income countries will face workforce shortages because their demand will exceed supply. By contrast, low-income countries will face low growth in both demand and supply, both of which are estimated to be far below what will be needed to achieve adequate coverage of essential health services. This may lead to the paradoxical phenomenon of unemployed (“surplus”) health workers in those countries facing acute “needs-based” shortages.

Kenyan doctors’ strike: Why the centre can no longer hold
Oyoo S: Pambuzuka News, February 2017

The doctors’ strike now in its third month in Kenya has caused great suffering to the majority poor people who cannot afford medical care in private hospitals. The author writes that the strike is not merely about the welfare of the healthcare workers, but about a public health system crumbling under deliberate state neglect and corruption. By mid-February Kenyan doctors had been on strike for over two months. They have made several demands including: better remuneration, availability of more doctors in public hospitals, better equipment and availability of drugs in these facilities, and more allocation of funds to health research. They are, according to the author, demanding better healthcare for all Kenyan citizens. The author comments that the doctors’ demands have been spurned by government, and the media to some extent, in what is part of a wider effort to portray the doctors as greedy individuals. The negotiation process has been long and tortuous, with the government side not keen on implementing a Collective Bargaining Agreement (CBA) it signed with the doctors in 2013. Private healthcare providers on the other hand are argued to stealthily lie like vultures – waiting for the public healthcare system to implode so they can expand their ‘investments’ in Kenya, a country that’s been described as ‘a lucrative market for private healthcare service provision’. One can almost imagine that this is part of a wider scheme to privatise the Kenyan healthcare system, a move which would drive the cost of treatment beyond reach of the majority. Kenya was ranked 145 out of 176 in Transparency International’s corruption perception index in 2016. The author writes that it is no longer possible to stand by and watch as up to a third of the Kenyan budget is lost to corruption, and disappears into the pockets of a select few. Kenyans can no longer stand by and watch the state audaciously claim it cannot pay their doctors. Kenyans just cannot afford to be spectators in such a matter of life and death.

9. Public-Private Mix

Free Zimbabwean contraceptives smuggled for sale in South Africa
K Mutandiro: Groundup, Times Live, March 2017

This article tells a story of Nancy (not her real name), who every month travels to Zimbabwe to stock up on Marvelon family planning pills distributed at hospitals‚ clinics and pharmacies through the Family Planning Council of Zimbabwe. She smuggles them back into South Africa‚ where she sells them at a healthy profit to other Zimbabweans who for various reasons don’t want the contraceptive pills dispensed in South African clinics. Nancy’s suppliers are hospital staff in Zimbabwean hospitals who sell the pills to her for R5 a blister pack. If she runs short of stock‚ she buys packets for R10 from a “wholesale” supplier in Johannesburg who also illegally imports the pills from Zimbabwe. Nancy says she has a 100 customers a month in Springs alone‚ and she sells the packets for R20 to bulk buyers or R30 to individuals. By contrast‚ Marvelon tablets were reported to be sold for about R130 per 28 tablets in Johannesburg pharmacies

10. Resource allocation and health financing

Adapting global health aid in the face of climate change
Gupta V, Mason-Sharma A, Caty S, KerryV: Lancet Global health Volume 5, No. 2, e133–e134, 2017

WHO estimates an additional 250 000 mortalities between 2030 and 2050 will be attributable to climate-associated increases in malnutrition, malaria, diarrhoea, respiratory disease, water inaccessibility, and heat stress. Spillover effects on state and regional security are argued to be inevitable. The World Economic Forum has identified climate change as the single greatest threat to global stability because of its considerable consequences on the health and stability of developing nations. The complex interaction between climate change, health system burdens, and poor health outcomes, and their subsequent impact on politics, security, and society can be captured within the concept of a so-called climate-health-security nexus. Many of the world's poorest and most politically fragile nations lie at the centre of this nexus. Within this nexus, poverty, state fragility, poor pre-existing health outcomes, and high susceptibility to climate change converge to amplify the effects of future famines, droughts, and neglected tropical diseases. This amplification subsequently leads to worsened economies, social instability, and reliance on external support. The nations most at risk for climate-triggered health crises are primarily scattered throughout sub-Saharan Africa and south Asia and are already afflicted by the highest rates of disease burden globally (table, appendix). Notably, most of these countries are low-income nations without the resources to adequately contend with climate-related challenges.

Incentives to change: effects of performance-based financing on health workers in Zambia
Shen G; Nguyen H; Das A; Sachingongu N; Chansa C; Qamruddin J; Friedman J: Human Resources for Health 15(20), 2017, doi: 10.1186/s12960-017-0179-2

Performance-based financing (PBF) has been implemented in a number of countries with the aim of transforming health systems and improving maternal and child health. This paper examines the effect of PBF on health workers’ job satisfaction, motivation, and attrition in Zambia. It uses a randomised intervention/control design to evaluate before–after changes for three groups: intervention (PBF) group, control 1 (C1; enhanced financing) group, and control 2 (C2; pure control) group. Mixed methods were employed. The quantitative portion comprises of a baseline and an endline survey. The survey and sampling scheme were designed to allow for a rigorous impact evaluation of PBF or C1 on several key performance indicators. The qualitative portion sought to explain the pathways underlying the observed differences through interviews conducted at the beginning and at the three-year mark of the PBF program. Econometric analysis shows that PBF led to increased job satisfaction and decreased attrition on a subset of measures, with little effect on motivation. The C1 group also experienced some positive effects on job satisfaction. The null results of the quantitative assessment of motivation cohere with those of the qualitative assessment, which revealed that workers remain motivated by their dedication to the profession and to provide health care to the community rather than by financial incentives. The qualitative evidence also provides two explanations for higher overall job satisfaction in the C1 than in the PBF group: better working conditions and more effective supervision from the District Medical Office. The PBF group had higher satisfaction with compensation than both control groups because they have higher compensation and financial autonomy, which was intended to be part of the PBF intervention. While PBF could not address all the reasons for attrition, it did lower turnover because those health centres were staffed with qualified personnel and the personnel had role clarity. In Zambia, the implementation of PBF schemes brought about a significant increase in job satisfaction and a decrease in attrition, but had no significant effect on motivation. Enhanced health financing also increased stated job satisfaction.

Is it all about the money? A qualitative exploration of the effects of performance-based financial incentives on Zimbabwe's voluntary male medical circumcision program
Feldacker C; Bochner A; Herman-Roloff A et al.: PLoS ONE 12(3), 2017, doi:10.1371/journal.pone.0174047

In 2013, Zimbabwe’s voluntary medical male circumcision (VMMC) program adopted performance-based financing (PBF) to speed progress towards ambitious VMMC targets. The PBF intended to encourage low-paid healthcare workers to remain in the public sector and to strengthen the public healthcare system. The majority of the incentive supports healthcare workers who perform VMMC alongside other routine services; a small portion supports province, district, and facility levels. This qualitative study assessed the effect of the PBF on healthcare worker motivation, satisfaction, and professional relationships. The study objectives were to: 1) Gain understanding of the advantages and disadvantages of PBF at the healthcare worker level; 2) Gain understanding of the advantages and disadvantages of PBF at the site level; and 3) Inform scale up, modification, or discontinuation of PBF for the national VMMC program. Sixteen focus groups were conducted: eight with healthcare workers who received PBF for VMMC and eight with healthcare workers in the same clinics who did not work in VMMC and, therefore, did not receive PBF. Fourteen key informant interviews ascertained administrator opinion. Findings suggest that PBF appreciably increased motivation among VMMC teams and helped improve facilities where VMMC services are provided. However, PBF appears to contribute to antagonism at the workplace, creating divisiveness that may reach beyond VMMC. PBF may also cause distortion in the healthcare system: Healthcare workers prioritised incentivised VMMC services over other routine duties. To reduce workplace tension and improve the VMMC program, participants suggested increasing healthcare worker training in VMMC to expand PBF beneficiaries and strengthening integration of VMMC services into routine care. In the low-resource, short-staffed context of Zimbabwe, PBF enabled rapid VMMC scale up and achievement of ambitious targets; however, side effects make PBF less advantageous and sustainable than envisioned. Careful consideration is warranted in choosing whether, and how, to implement PBF to prioritise a public health program.

11. Equity and HIV/AIDS

Assessment of the World Health Organisation’s HIV Drug Resistance Early Warning Indicators in Main and Decentralised Outreach Antiretroviral Therapy Sites in Namibia
Mutenda N; Bukowski A; Nitschke A; et al.: PLoS ONE 11(12): e0166649, 2016, doi:10.1371/journal.pone.0166649

The World Health Organization early warning indicators (EWIs) of HIV drug resistance (HIVDR) assess factors at individual ART sites that are known to create situations favourable to the emergence of HIVDR. In 2014, the Namibia HIV care and treatment program abstracted adult and paediatric EWIs from all public ART sites (50 main sites and 143 outreach sites) related to on-time pill pick-up, retention in care, pharmacy stock-outs, dispensing practices, and viral load suppression. Comparisons were made between main and outreach sites and between 2014 and 2012. The national estimates were: On-time pill pick-up 81.9% for adults and 82.4% for paediatrics, Retention in care 79% retained on ART after 12 months for adults and 82% for paediatrics, Pharmacy stock-outs 94% of months without a stock-out for adults and 88% for paediatrics. Viral load suppression was significantly affected by low rates of viral load completion. Main sites had higher on-time pill pick-up than outreach sites for adults and paediatrics and no difference between main and outreach sites for retention in care for adults or paediatrics. From 2012 to 2014 in adult and paediatric sites, on-time pill pick-up, retention in care and pharmacy stock-outs worsened. Results of EWIs monitoring in Namibia provide evidence about ART programmatic functioning and contextualise results from national surveys of HIVDR. These results are worrisome as they show a decline in program performance over time. The national ART program is taking steps to minimise the emergence of HIVDR by strengthening adherence and retention of patients on ART, reducing stock-outs, and strengthening ART data quality.

12. Governance and participation in health

A realist review of mobile phone-based health interventions for non-communicable disease management in sub-Saharan Africa
Opoku D; Stephani V; Quentin W: BMC Medicine 15(24), 2017, doi: 10.1186/s12916-017-0782-z

The prevalence of non-communicable diseases (NCDs) is increasing in sub-Saharan Africa. At the same time, the use of mobile phones is rising, expanding the opportunities for the implementation of mobile phone-based health (mHealth) interventions. This review aims to understand how, why, for whom, and in what circumstances mHealth interventions against NCDs improve treatment and care in sub-Saharan Africa. Four main databases and references of included articles were searched for studies up to March 2015 reporting effects of mHealth interventions on patients with NCDs in sub-Saharan Africa. All studies published up until May 2015 were included in the review. Following a realist review approach, middle-range theories were identified and integrated into a 'Framework for Understanding the Contribution of mHealth Interventions to Improved Access to Care for patients with NCDs in sub-Saharan Africa'. The main indicators of the framework consist of predisposing characteristics, needs, enabling resources, perceived usefulness, and perceived ease of use. Studies were analysed in depth to populate the framework. The search identified 6137 titles for screening, of which 20 were retained for the realist synthesis. The contribution of mHealth interventions to improved treatment and care is that they facilitate (remote) access to previously unavailable (specialised) services. Three contextual factors (predisposing characteristics, needs, and enabling resources) influence if patients and providers believe that mHealth interventions are useful and easy to use. Only if they believe mHealth to be useful and easy to use, will mHealth ultimately contribute to improved access to care. The analysis of included studies showed that the most important predisposing characteristics are a positive attitude and a common language of communication. The most relevant needs are a high burden of disease and a lack of capacity of first-contact providers. Essential enabling resources are the availability of a stable communications network, accessible maintenance services, and regulatory policies. Policy makers and program managers should consider predisposing characteristics and needs of patients and providers as well as the necessary enabling resources prior to the introduction of an mHealth intervention. The authors argue that researchers would benefit from placing greater attention on the context in which mHealth interventions are being implemented instead of focusing (too strongly) on the technical aspects of these interventions.

As New AU Chair Mahamat Takes Office: The African Union’s Financing Headache, In Two Charts
Mungai C: Africapedia, March 2017

The new chairperson of the African Union (AU) Commission Moussa Faki Mahamat formally took office in Addis Ababa in March, outlining his top priorities for his four-year tenure. Mahamat said he would focus on implementing structural and financial reforms at the AU, place women and youth at the centre of Africa’s development agenda, accelerate intra-African trade and free movement of people, goods and services in the continent, silence the guns by 2020 and strengthen Africa’s voice in the global arena. However, it is the financing plan that is likely to get the most attention in the short term. It was unveiled at the 2015 AU summit in Kigali by Donald Kaberuka, former president of the African Development Bank (AfDB). As of 2015, more than half of the African Union’s budget is funded by outside funders, compromising the independence of the organisation. The Kaberuka plan is intended to change that, and would see member states finance 100% of the AU’s operating budget, three-quarters of the programmes budget and a quarter of the peace and security budget, starting from January 2016 and phased in incrementally over five years.

Does health-related content in a major Ugandan newspaper reflect the changing burden of disease in East Africa?
Cooper M; Aiyer R; Sornalingam S; Lawrence D: International Journal of Communication and Health 10, 2016

The disease burden in urban sub-Saharan Africa is changing rapidly. Mortality and morbidity from chronic physical disease (heart, disease, stroke and cancer) is rising rapidly and believed to equal that from infections. Other increasing disease burdens in sub Saharan Africa include mental illness, substance abuse and accidents, especially road traffic collisions (RTC). Newspaper readership is rising in Uganda. This study used content analysis to examine health-related coverage in one major Ugandan newspaper (New Vision). Twenty-nine consecutive paper copies from September/October 2013 were examined independently by two researchers. Health-related articles were identified, counted and coded according to clinical content. Clinical and healthcare-related coverage was present in every edition and represented approximate proportions of 2.6% and 0.4% respectively of total newspaper content. Of 214 news articles identified, these covered the following clinical themes: general well-being (15.4%), healthcare services (14.5%), HIV (12.1%), violence/accidents (11.2%), chronic physical disease (11.2%), sexual, maternal and reproductive health (SMRH) (10.8%), non-HIV infective diseases (10.8), malnutrition (7.9%), substance misuse (3.3%) and mental health (2.8%). Coverage of RTCs, alcohol, smoking, and cancers other than of the breast and cervix was minimal. Health-related content was dominated by infections, healthcare quality, general wellbeing, SMRH and malnutrition. This does not represent the changing burden of disease in Uganda. There may be scope for targeted interventions with editors to promote coverage of growing challenges, including lifestyle advice to prevent chronic diseases.

Size of Cabinets in Africa, as Ghana’s Akufo-Addo Names ‘Elephant’ Team of 110 Ministers, and Counting
Mungai C: Africapedia, March 2017

Ghana’s president Nana Akufo-Addo came under fire for naming what has been described as an ‘elephant’ cabinet – with 31 cabinet portfolios, several ministries have two or more deputies, bringing the total size of cabinet to 110 ministers and perhaps more. Such a large team may have significant financial implications, in a country where the debt-to-GDP ratio is about 74%, with a $1 billion bailout from the International Monetary Fund (IMF) in 2015. Looking at Africa more broadly, the median size of cabinets is 30 (excluding deputies). The largest such cabinet is in Cameroon with 63 ministers. Uganda’s cabinet has 31 full cabinet ministers and 49 ministers of state, bringing the total number to 80. In Africa, larger cabinets are more common in post-conflict countries that are trying to build a broader national consensus, especially in countries with high political or ethnic fragmentation, as ministerial appointments are an easy way to build loyalty to the regime of the day. The author indicates that they are also common in resource-rich countries, and in those that have had long-serving heads of state, which tend to have heavy patronage networks. In that way, they serve an important political, if not economic or technocratic function – they create compromise and cohesion within the political class.

The conceptualization of family care during critical illness in KwaZulu-Natal, South Africa
de Beer J; Brysiewicz P: Health SA Gesondheid (22), 2017, doi: http://dx.doi.org/10.1016/j.hsag.2016.01.006

In recent years there has been a movement to promote patients as partners in their care. However, in the case of critically ill patients, who are often sedated and mechanically ventilated, family members may be more involved in the care of the patient. To date, this type of care has been represented by three dominant theoretical conceptualisations and frameworks one of which is family centred care. There is, however, a lack of consensus on the definition of family centred care. This study explored the meaning of family care within a South African context. This study adopted a qualitative approach and a grounded theory research design by Strauss and Corbin (1990). Participants from two hospitals: one private and one public were selected to participate in the study. There was a total of 31 participants (family members, intensive care nurses and doctors) who volunteered to participate in the study. Data collection included in-depth individual interviews. The findings of this study revealed that family care is conceptualised as togetherness, partnership, respect and dignity. During a critical illness, patients' families fulfil an additional essential role for patients who may be unconscious or unable to communicate or make decisions. Family members not only provide vital support to their loved one, but also become the "voice" of the patient.

13. Monitoring equity and research policy

Global Observatory on Health R&D
WHO: WHO Geneva online resource, 2017

The Global Observatory on Health R&D (hereafter called ‘the Observatory’) is a global-level initiative that aims to help identify health R&D priorities based on public health needs, by: consolidating, monitoring and analysing relevant information on the health R&D needs of developing countries; building on existing data collection mechanisms; and supporting coordinated actions on health R&D. Investments in health R&D are still insufficiently aligned with global public health demands and needs. As little as 1% of all funding for health R&D is allocated to diseases such as malaria and tuberculosis (diseases that are predominantly incident in developing countries), despite these diseases accounting for more than 12.5% of the global burden of disease. Governments, policy-makers, funders and researchers need an accurate picture of the current situation so as to spot R&D gaps and ensure that funds and resources are used in the best possible way. The primary scope of the Observatory as outlined by Member States in World Health Assembly resolution WHA69.23 is: type II and type III diseases (i.e. diseases incident in both rich and poor countries, especially the latter; the specific R&D needs of developing countries in relation to type I diseases; potential areas where market failures exist and antimicrobial resistance and on emerging infectious diseases likely to cause major epidemics.

Negotiating better contracts in collaborative research partnerships
Council on Health Research for Development (COHRED): Geneva, 2017

Fair Research Contracting equips research partners with key resources on how to build sustainable, equitable global research partnerships. The rise in international research partnerships means that developing countries need to be better positioned to deal with complexities in collaborative research contracting. COHRED argues that better contract negotiation expertise in LMIC institutions will help improve the distribution of benefits of collaborative research, such as overhead costs, data ownership, institutional capacity in research management, technology transfer, and intellectual property rights. With this in mind, COHRED has developed guidance aimed at optimising research institution building through better contracts and contracting in research partnerships. The guidance highlights the key issues for consideration when entering into formalised research partnerships, and provides tools and resources for negotiating fairer research contracts.

Urban Health Research in Africa: Themes and Priority Research Questions
Oni T; Smit W; Matzopoulos R; Adams J et al.: Initiative for Cities and Health (RICHE) members: Journal of Urban Health 93(4) 722-730, 2016

In Africa, urbanisation and urban growth are dramatically restructuring the nature of cities. The growing majority of urban dwellers now live in informal conditions that, without access to basic services or public amenities, expose residents to greater health risk, and health-care systems are unable to provide affordable or comprehensive cover. The differential exposure to these urban conditions is compounded by social and economic vulnerability, resulting in health inequities. Yet despite pressing needs driven by Africa’s considerable and complex burden of disease and high levels of health inequity, urban health and urban health equity have not yet emerged as major research and policy priorities in Africa. This commentary presents a conceptual framework, using a public health approach, for interdisciplinary research aimed at contributing to the understanding and mitigation of urban health issues and challenges in Africa. It identifies downstream and upstream factors, based on published literature, associated with key determinants in each theme. It represents a collective effort by interdisciplinary academics from public health; anthropology; civil engineering; architecture, planning and geomatics; human biology; psychiatry and mental health; medicine; pathology; and paediatrics, from the Research Initiative for Cities and Health (RICHE), University of Cape Town, to generate African perspectives on urban health and urban health equity. The six focus areas identified as important include obesity and food insecurity, the urban context as a tool for health promotion, urban health governance and policy, community strengthening for healthy inclusive cities, health systems in an urbanising context and migration, urbanisation and health. The authors argue that a complex systems approach is required to investigate and improve understanding of health and well-being in a changing urban context with a view to developing sustainable and cost-effective interventions. This acknowledges the different dimensions of determinants that influence health and understands the need to address gaps in data and access to information from across these dimensions, and to engage all relevant stakeholders across sectors prioritise the interventions to improve health.

14. Useful Resources

Global inequality: Bridging the gap - Counting the Cost
Riley G: tutor2u, Video feature, January 2017

A new Oxfam report claims that the scale of wealth inequality has grown and that eight people in the world have as much wealth as the poorest fifty per cent of the global population. This video presents the information from the report in a video overview.

SexRightsAfrica Network
Regional Sexual and Reproductive Health and Rights Fund: South Africa

The SexRightsAfrica Network brings together organisations and individuals working to realise Sexual and Reproductive Health Rights across Eastern and Southern Africa, and beyond. It is intended to complement, promote and strengthen existing networks and knowledge management platforms. It provides a meeting and referral point at the busy intersection of HIV and AIDS, health and well-being, and economic, social and cultural rights. There are many ways to participate in the network. This website is the platform for the network, as a regional networking hub to share evidence and strengthen action to realise sexual and reproductive health rights.

15. Jobs and Announcements

4th Global Forum on Human Resources for Health
Dublin, Ireland, 13-17 November 2017

The 4th Global Forum on Human Resources for Health will be held in Dublin, Ireland from 13-17 November 2017 hosted by the World Health Organization, the Global Health Workforce Network, Trinity College, Dublin, Irish Aid and the Department of Health. The Forum represents a unique opportunity to engage a multisectoral group of actors across the education, finance, health and labour sectors; multilateral and bilateral agencies; academic institutions; health professional associations and civil society, in a coherent advocacy platform. The Forum will be an occasion to address the health workforce agenda with a multisectoral lens. The theme of the 4th Global Forum is achieving the Global Strategy on Human Resources for Health milestones and the Commission’s recommendations. The Forum will: take stock of progress since the 3rd Global Forum; inform on innovations in workforce policy and practice; engage with and capture the views of various stakeholder groups on advancing implementation to reach the agreed GSHRH milestones by 2020 and 2030; promote collective actions across various stakeholder groups to accelerate implementation towards achieving global and national priorities and targets; and promote learning, sharing, networking, and collaboration among HRH stakeholders. The Forum will also facilitate special sessions to debate and discuss issues of global relevance such as, but not limited to, emergency preparedness & response, antimicrobial resistance, 90-90-90 and others.

5th Forum of the African Platform on Human Resources for Health
Kampala, Uganda, 19-21 April 2017

The African Platform on Human Resources for Health will hold its 5th Forum in Kampala, Uganda, from Wednesday 19th to Friday 21st April 2017. The African Platform is the regional arm of the Global Health Workforce Network (GWN) that was launched in Geneva last December, 2016 as the successor the Global Health Workforce Alliance (GHWA). The Forum will review the status of implementation of the “Road map for scaling up human resources for health for improved health service delivery in the African Region 2012–2025” that was launched in 2012; build understanding of relevant recent developments such as the “Global strategy on human resources for health: (Workforce 2030)”; the African Health Strategy.; the Five-Year Action Plan to implement the recommendations of the High-Level Commission on Health Employment and Economic Growth; and discuss the implications for African countries of the establishment of the Global Health Workforce Network (GHWN), at the WHO secretariat in Geneva. The forum will review the role of the health workforce (HWF) in Africa in advancing the movement towards Universal Health Coverage, as a part of the means to attain the Sustainable Development Goals (SDGs). The Forum will be conducted through Plenary, Break out and Poster sessions under the following five thematic streams: HWF Education and Training; Preparing the African HWF for Universal Health Coverage ; Leadership for Development, Management and Regulation; Nursing; as the Backbone of the Health and HWF Migration. Participation is open to a broad range of stakeholders especially from the African region.

Call for a consultant to facilitate a review and organisation development process with the Community of Practitioners on Accountability and Social Action in Health
Deadline for Applicants: 15 April 2017

The Community of Practitioners on Accountability and Social Action in Health (COPASAH) is a global network of community of practitioners who share a people–centric vision and human rights based approach to health, health care and human dignity. COPASAH’s Steering Committee, represented by the COPASAH Global Secretariat, is seeking a resource person to facilitate a review and Organisation Development (OD) process. The primary task of the consultant will be to determine the value-addition and impact of COPASAH’s activities for the network’s membership base, examine its organisational structure, and advise on the future structure, strategies and activities within the context of the broader field of social action and accountability for health.

Call for proposals for edited volume on: Making visible the invisible: African women in mining
Deadline for submission of abstracts: 20 April 2017

Scholars working on Women in Mining across Africa are invited to contribute to an edited book volume which aims to focus on contributions (through labour and otherwise) and roles (through social reproduction or resistance struggles) played by African women in mining/ extractive industries. African mining historiography has largely erased or silenced women and neglected their contribution in mining. In this literature and popular culture, mineworkers are almost always seen as men, as though mines are, and have always been, inhabited by men. This is despite evidence from as early as the 1500s which shows women as ‘pit people’. Scholarship which acknowledges women’s presence tends to portray women as outsiders who inhabit the ‘peripheries’ of mining and hardly as ‘centres’ or key players in their own right. This book project aims to address this bias by revisiting and interrogating, from a feminist perspective, the contributions of women in mining and the historiography of mining in Africa, as a way of re-claiming “her-story” and re-insert it into ‘hi-story’ of mining, to recover and resurrect women’s voices, centre their role and attest to their presence and make visible their contributions in mining. The gaps the editors seek to address include; different roles played by women who work/worked in mining (underground, open cast, artisanal and alluvial mines) and the invisible social reproduction work done by women in mining communities. The editors are also interested in chapters that revisit and critically re-examine archival material, and insert African women in the dominant mining historiography which currently excludes and or marginalises them. Authors who are interested in submitting a paper should, in the first instance, send a short abstract-length proposal (not more than 500 words) outlining the scope of their paper and its novelty by the 20th of April 2017.

Call for speakers and papers: Radical transformations in Africa today, interventions from the left
Deadlines for abstracts: Accra meeting – June 2017, Dar es Salaam – November 2017, Johannesburg – January 2018

This series of meetings is an opportunity for activists and scholars to contribute to three linked workshops in Africa. Each two-day meeting will debate current challenges and prospects for analysis and action. The organisers are seeking speakers and offers of papers, with a plan to publish a selection in the Review of African Political Economy. The workshops are scheduled in November 2017 in Accra, Ghana; April 2018 in Dar es Salaam, Tanzania; June 2018 in Johannesburg, South Africa; and September 2018 at the African Studies Association in the UK. These workshops will link analysis and activism in contemporary Africa from the perspective of radical political economy, and will be organised around three linked themes: (1) Africa in a ‘post-crisis’ world, (2) Economic strategy, industrialisation and (3) The agrarian question and resistance and social movements in Africa.

Online course on Global Adolescent Health
Enrolment open: Course begins 22 May 2017

The University of Melbourne is offering an online course that will explore the factors affecting the health and wellbeing of young people around the world. The course will be relevant for anyone with an interest in the health and wellbeing of young people. Applicants don't need to be of any particular personal or professional background to benefit from this course, but having some basic undergraduate study experience will be helpful for learning. Financial support is available for learners who cannot afford the fee.

Primer In Systematic Reviews Online Short-Course May 2017
Closing date for Bursary applications 14 April 2017

Cochrane South Africa, in its role as coordinating unit of the Cochrane African Network, has bursaries available to participate in the Primer in Systematic Reviews online short-course, running from 1 May to 14 July or 1 October to 8 December 2017. This course is being offered by the Centre for Evidence-based Health Care in collaboration with Cochrane South Africa, as part of the Effective Health Care Research Consortium. It aims to build capacity of participants to find, appraise, interpret and consider the use of systematic reviews of effects of interventions. If you would like to apply for a bursary please complete the application form and submit to ameer.hohlfeld@mrc.ac.za by 14 April 2017. The Primer in Systematic Reviews online short-course duration is 6 weeks (excluding orientation) and requires up to 4 hours of effort a week. The course is purely online and uses an e-learning platform called SUNLearn. At the end of the course participants should be able to: 1. Outline the rationale for research synthesis and phrasing questions 2. Identity the principles of randomised controlled trials and risk of bias 3. Find, read and appraise systematic reviews (SRs) 4. Interpret findings of reviews of effects, including statistical interpretation of meta-analysis 5. Be able to interpret a GRADE profile and Summary of Findings table 6. Outline key components of a systematic review of effects that need to be considered in applying to health policy and practice. See website for application information.

Social Accountability Dialogue Series 2017
Community of Practitioners on Accountability and Social Action in Health (COPASAH):2017

COPASAH is a global network of accountability practitioners who share a people centric vision and human rights based approach to health, health care and human dignity. COPASAH is holding a series of social accountability online dialogues to further share mutual learning through the use of virtual platforms and communication technologies. The online platform will support different streams of accountability practice - such as budget monitoring, struggle based health rights groups, health movements and technical resource groups on community monitoring – to interact and share experiences. COPASAH is looking for partners to facilitate online Social Accountability Dialogues, to facilitate discussions on a range of health rights themes.

Urban Studies Foundation International Fellowships for Early to Mid-Career Urban Scholars from the Global South
Deadline for applications: 28 April 2017

Applications are invited for an International Fellowship for urban scholars on any theme pertinent to a better understanding of urban realities in the global south funded by the Urban Studies Foundation. The Fellowship covers the costs of a sabbatical period at a university of the candidate’s choice in either the global north or the global south (facilitating south-south exchange) for the purpose of writing up the candidate’s existing research findings in the form of publishable articles or a book under the guidance of a chosen mentor in their field of study. Funding is available for a period ranging between 3-9 months. Applicants must be early career urban scholars with a PhD obtained within the preceding 5 years who currently work in a university or other research institution within the global south. Candidates must also be nationals of a country in the global south. Preference may be given to candidates from least or low-income countries but middle-income developing countries are not excluded if the need for support is justified. The candidate must make suitable arrangements to be mentored by a suitably experienced senior urban scholar at his/her chosen research institution. The application must include: an outline of the planned research, demonstrating its originality, rigour and value to the field of urban studies; with a statement of the intended research outputs; and further information provided on the website.

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