EQUINET NEWSLETTER 161: 01 JULY 2014
CONTENTS: 1. Editorial, 2. Latest Equinet Updates, 3. Equity in Health, 4. Values, Policies and Rights, 5. Health equity in economic and trade policies, 6. Poverty and health, 7. Equitable health services, 8. Human Resources, 9. Public-Private Mix, 10. Resource allocation and health financing, 11. Equity and HIV/AIDS, 12. Governance and participation in health, 13. Monitoring equity and research policy, 14. Useful Resources, 15. Jobs and Announcements
FROM TALK TO IMPLEMENTATION - NURSES ROLE IN THE POST 2015 AGENDA
Philemon Ngomu, Southern African Network Of Nurses And Midwives (SANNAM)
Nurses play an essential role in the post 2015 global agenda of ensuring universal health care. They make up majority of the health workforce. Health systems cannot successfully function without nurses. They influence how systems function, change or are delivered, through the values, knowledge and experience they bring. Their lives and work are affected by the policy decisions and health system roles that are expected to achieve the post 2015 global agenda. So the Southern African Network of Nurses and Midwives (SANNAM) have argued that nurses must be included in the political and policy discussions and health system transformation efforts currently underway.
The Southern African Network of Nurses and Midwives (SANNAM), a network of National Nurses Associations (NNAs) in the 15th Southern African Development Community (SADC) countries met in Pretoria, South Africa in February 2014 to examine the post 2015 proposals for Universal Health Coverage (UHC). The meeting reviewed the proposals from the ongoing global consultations on the focus post- 2015 for ensuring UHC and sustainable development globally.
The report of High Level Panel of eminent persons on the post- 2015 global development agenda and an evaluation of progress on MDGs 2000–2013 have identified a need to secure the planet for all in a sustainable way and to ensure that the global agenda puts people first and at the centre of future development efforts. These reports identify a universal agenda with transformative shifts in five thematic areas:
i. leaving no one behind as a principle of universality in access, sharing resources and assets in all sectors;
ii. putting sustainable development at the centre, including as a means for improving people’s health;
iii. transforming economies and jobs for inclusive growth, with what is drawn from earth’s resources distributed equitably;
iv. building peace and effective, open and accountable institutions that protect human rights; and
v. forging new global partnerships, given that action in one sector, country, and community influences the others.
These proposals obtained broad support from nurses in the SANNAM meeting.
The performance of health systems is necessary to achieve this post 2015 vision. As the 2011 World Health Organisation (WHO) global conference in Brazil on social determinants of health reported, good health requires a universal, comprehensive, equitable, effective, responsive and accessible quality health system. It also depends on the involvement of and dialogue with other sectors and actors, and on effective collaboration in coordinated and inter-sectoral policy actions. The health sector contributes to sustainable development and human rights, and plays a role in ensuring that economic activities do not harm and do benefit social wellbeing. For example South Africa’s extensive ARV programme has contributed widening the benefit from medical technology and raising life expectancy, and the implementation of the National Health Insurance scheme is mobilizing economic resources for universal access to services.
However, SANNAM delegates noted that health systems in many countries fall short of their potential, resulting in a large numbers of preventable deaths and disability, especially for poor people. While UHC means that all people should be able to use the quality health services that they need and do not suffer financial hardship in paying for them, many countries are not achieving this.
So while the goals are noble, a lot more attention needs to be given to how they will be achieved. In the SANNAM meeting, nurse leaders from all countries in the region discussed this further. There are a number of challenges to implementation in our region. There are resource constraints, health professional shortages, migration and distribution of health professionals, household poverty and poor performance of services. Services face challenges in the adequacy of nursing education, with shortages and inadequate skills mix in health workers, loss of a caring ethos and inadequate social participation in services. Shortfalls in leadership, professional competencies and service resources and weak application of governance styles that involve people have led to falling morale. Negative conditions encourage individual practices that further worsen the system, such as moonlighting practices. Unless these and other constraints are addressed, UHC goals may remain aspirations rather than reality.
At the heart of the changes needed, SANNAM members identified the need for a paradigm shift from hospital-centered to community-centered health care. This calls for a rights-based approach to healthcare, where the individual and community are central to the processes for promoting health, preventing and treating disease and care for chronic illness or disability.
Nurses identified that they play a key role in implementing these transformations in health systems. Their competencies, communication and approaches to care can facilitate (or if absent block) peoples uptake of services. They can support (or impede) patient and family-centred care, cultural congruence and team based approaches with other health workers and sectors. They can deliver services in a way that supports people’s role and rights, and that reviews and improves service performance.
Taking goals and policies to implementation thus demands more attention to the people and practice environments of key personnel responsible for delivering on these goals, such as nurses. For example, there is need to promote a positive working environment for nurses and professional associations, to develop creative ways to involve frontline nurses individually and through their associations and networks in policy and practice changes and in evaluation and review, to integrate their proposals and improve responsiveness and feedback. The systems to support this need to be put in place, from Chief Nursing Officers within national ministries of health, and cascading down to provinces and districts to primary care level. The models identified should be backed by adequate resources, management practices and information, and by academic preparation of nurses for their role. Incentives should be oriented to rewarding and supporting implementation of key roles and outcomes, including the communication with and involvement of communities, patients and other sectors.
SANNAM delegates observed that it is therefore critical that nurses, amongst others, understand the health policy issues and the policy-making processes underway and are actively involved in them. The experience nurses bring will help to align the policies and strategies to real conditions and expectations in the system, and contribute to building the post 2015 agenda from the bottom up.
Please send feedback or queries on the issues raised in this briefing to the EQUINET secretariat: firstname.lastname@example.org. For more information on the issues raised in this op-ed please visit www.equinetafrica.org
CALL FOR PAPERS: JOURNAL OF HEALTH DIPLOMACY CO-OPERATION WITH EQUINET: THIRD ISSUE ON AFRICA, HEALTH AND DIPLOMACY
Call Closes: 3 November 2014
The Journal of Health Diplomacy (JHD) is now receiving manuscripts for its third issue, titled: Africa, health and diplomacy. This issue is broadly concerned with the theory and practice of health diplomacy of African states, as a co-operation with the Regional Network for Equity in Health in East and Southern Africa (EQUINET). The issue will include invited and submitted manuscripts. To be considered for the latter, please submit your proposed manuscript to the Managing Editor at the email below by 3 November 2014. Manuscripts submitted to JHD will undergo a peer-review process, with referees selected for their particular knowledge/experience on the topic of the manuscript. Authors are asked to ensure that their identity is not revealed directly or indirectly on any page. Manuscripts that are being considered for publication elsewhere, or that have been previously published must not be submitted to the journal. A complete set of author guidelines is available at the website shown. JHD welcomes contributions from all academic disciplines, including international relations, political science, anthropology, sociology, history and geography. We are also interested in interdisciplinary perspectives that cross the boundaries between different theoretical fields and represent novel understandings of health diplomacy.
EQUINET DISCUSSION PAPER 103: THE ENGAGEMENT OF EAST AND SOUTHERN AFRICAN COUNTRIES ON THE WHO CODE OF PRACTICE ON THE INTERNATIONAL RECRUITMENT OF HEALTH PERSONNEL AND ITS IMPLEMENTATION
Dambisya YM; N Malema; Dulo C; Matinhure S; Kadama P: June 2014
The World Health Organisation (WHO) ‘Global Code of Practice on the International Recruitment of Health Personnel’ (hereinafter called the “Code”) adopted by the World Health Assembly (WHA) in May 2010 was the culmination of efforts by many different actors to address the maldistribution and shortages of health workers globally. African stakeholders influenced the development of the Code, but two years after its adoption only four African countries had designated national authorities, and only one had submitted a report to the WHO secretariat. This synthesis report is part of the Regional Network for Equity in Health (EQUINET) programme of work on Contributions of global health diplomacy to health systems in sub-Saharan Africa: Evidence and information to support capabilities for health diplomacy in east and southern Africa. The programme aims to identify factors that support the effectiveness of global health diplomacy (GHD) in addressing selected key challenges to health strengthening systems in eastern and southern Africa (ESA). The report compiles evidence from various research strategies undertaken to examine the above issues surrounding the WHO Code that involved an extensive review of literature; a ‘fast-talk’ session at the 66th World Health Assembly in May 2013 involving stakeholders from African countries to gauge views and concerns relating to the Code; a region-wide questionnaire survey implemented in 2013 to obtain views of government informants on issues affecting and measures for managing health workers, including migration of health workers in ESA countries; and three country case studies undertaken in Kenya, Malawi and South Africa concluded in 2014 to provide an in-depth exposition of perspectives on the Code and its implementation.
GENDER EQUITY AND SEXUAL AND REPRODUCTIVE HEALTH IN EASTERN AND SOUTHERN AFRICA: A CRITICAL OVERVIEW OF THE LITERATURE
Eleanor MacPherson E, Richards E, Namakhoma I, Theobald S: Glob Health Action, 7: 23717, June 2014
Gender inequalities are important social determinants of health. We set out to critically review the literature relating to gender equity and sexual and reproductive health (SRH) in Eastern and Southern Africa with the aim of identifying priorities for action. During November 2011, the authors identified studies relating to SRH and gender equity through a comprehensive literature search. Gender inequalities were found to be common across a range of health issues relating to SRH with women being particularly disadvantaged. Social and biological determinants combined to increase women’s vulnerability to maternal mortality, HIV, and gender-based violence. Health systems significantly disadvantaged women in terms of access to care. Men fared worse in relation to HIV testing and care with social norms leading to men presenting later for treatment. Gender inequity in SRH requires multiple complementary approaches to address the structural drivers of unequal health outcomes. These could include interventions that alter the structural environment in which ill-health is created. Interventions are required both within and beyond the health system.
SATELLITE SESSION AT THE GSHSR: NEW RESOURCES AND OPPORTUNITIES FOR PARTICIPATORY RESEARCH IN HEALTH SYSTEMS: AREAS OF FOCUS FOR HEALTH SYSTEMS GLOBAL, SEPTEMBER 30 12 NOON -2PM
EQUINET, COPASAH And Rotterdam Global Health Initiative Erasmus University,for The Participatory Cluster In The SHaPeS TWG For Health Systems Global
The satellite session will be convened by the three organisations leading the participatory cluster of the SHaPeS Technical working Group in HSR global. It will present and discuss with delegates interested in the cluster the issues, resources and capacities for the field and how these could be developed through the TWG, and will make available work we have done to date, particularly through EQUINET and COPASAH. It will review the experience of using participatory action research, (PAR), community monitoring and innovations in social media in transforming local health systems, the challenges faced and the areas for future participatory work in HSR. It will launch the EQUINET, AHPSR and IDRC methods reader on participatory action research and web tools from COPASAH. The session will identify field building inputs in terms of the resources, capacity building, methods and opportunities that need to be taken forward by the participatory cluster of the SHaPeS Technical Working Group and the people who are interested in playing a role in the different areas of work. All those interested in this area of work and in being involved in the work of the the participatory cluster of the SHaPeS Technical Working Group are welcomed to join.
AFRICA PROGRESS REPORT 2014- GRAIN, FISH MONEY, FINANCING AFRICA’S GREEN AND BLUE REVOLUTIONS
Africa Progress Panel, May 2014
Africa is a rich continent. Some of those riches – especially oil, gas and minerals – have driven rapid economic growth over the past decade. The ultimate measure of progress, however, is the wellbeing of people – and Africa’s recent growth has not done nearly as much as it should to reduce poverty and hunger, or improve health and education. To sustain growth that improves the lives of all Africans, the continent needs an economic transformation that taps into Africa’s other riches: its fertile land, its extensive fisheries and forests, and the energy and ingenuity of its people. The Africa Progress Report 2014 describes what such a transformation would look like, and how Africa can get there. Agriculture must be at the heart that transformation. Most Africans, including the vast majority of Africa’s poor, continue to live and work in rural areas, principally as smallholder farmers. In the absence of a flourishing agricultural sector, the majority of Africans will be cut adrift from the rising tide of prosperity. To achieve such a transformation, Africa will need to overcome three major obstacles: a lack of access to formal financial services, the weakness of the continent’s infrastructure and the lack of funds for public investment. The Africa Progress Report 2014 describes how African governments and their international partners can cooperate to remove those obstacles – and enable all Africans to benefit from their continent’s extraordinary wealth.
SOCIOECONOMIC INEQUALITIES AND MORTALITY TRENDS IN BRICS, 1990–2010
Mújica OM, Vázquez E, Duarte EC, Cortez-Escalante JJ, Molina J, Da Silva JB: Bulletin Of The World Health Organization. Volume 92, Number 6, June 2014.
This paper explores the presence and magnitude of – and change in – socioeconomic and health inequalities between and within Brazil, the Russian Federation, India, China and South Africa – the countries known as BRICS – between 1990 and 2010. Comparable data on socioeconomic and health indicators, at both country and primary subnational levels, were obtained from publicly available sources. Health inequalities between and within countries were identified and summarized by using standard gap and gradient metrics. Four of the BRICS countries showed increases in both income level and income inequality between 1990 and 2010. The exception was Brazil, where income inequality decreased over the same period. The paper finds that despite the economic prosperity and general improvements in health seen since 1990, profound inequalities in health persist both within and between BRICS. However, the substantial reductions observed – within Brazil and China – in the inequalities in income-related levels of infant mortality are encouraging.
LABOUR AND COMMUNITY IN TRANSITION: ALLIANCES FOR PUBLIC SERVICES IN SOUTH AFRICA
McKinley DT: MSP Occasional Paper June 2014
While South Africa in the 1980s was rich in broad, politically independent labour-community alliances against the oppressive apartheid system and the ravages of neoliberal capitalism, following the 1994 democratic transition unions largely embraced the ANC-run state’s neoliberal corporatism, which increased social distance between employed workers and poor communities. Consistent attempts to repress community-led dissent in response to the failures of the ‘new’ democracy, and to delegitimize community struggles around public services, undermined further the bases for unity. This paper critically analyzes the national context and practical experience of contemporary labour-community alliances to oppose privatization and promote public services. It presents case briefs of existing labour-community alliances – the South Durban Environmental Community Alliance; the Cape Town Housing Assembly and South African Municipal Workers Union; and the Eastern Cape Health Crisis Action Coalition – as a means to raise their nature, challenges and successes.
LITIGATION AS A TOOL FOR THE REALIZATION OF ECONOMIC, SOCIAL AND CULTURAL RIGHTS
Mugisha M: CEHURD News, June 2014
This paper explores litigation as a mechanism for the realization of the economic, social and cultural. Though it is often the last resort after all advocacy methods have been rendered futile, it is argued to draw government to the drawing board remembering the obligations in the international human rights instrument that it bonds itself for proper economic and social development. By its self, litigation may not yield the desired result but if backed up by strong advocacy the results are far more reaching.
SUCCESSFUL SODIUM REGULATION IN SOUTH AFRICA
Hofman K, Lee R: WHO AFRO 2013
Hypertension is neither unique nor novel to South Africa (SA), but the legislative actions undertaken by the South African government reflect a new approach to addressing this growing burden. Current levels of hypertension in SA affect a significant proportion of the population, in which some districts show a prevalence rate of over 40% in both men and women. Hypertension also adds a tremendous strain to the national health budget, as over South Africa Rand (ZAR) eight billion is spent on treating hypertension and other noncommunicable diseases on an annual basis. Research has shown that a significant portion of hypertension is linked to sodium consumption, and a major proportion of sodium consumption in SA comes from bread--part of the staple diet. Aware of the burden of hypertension and the high levels of sodium in processed foods, Minister of Health Aaron Motsoaledi and the National Department of Health (NDOH) spearheaded legislative action to regulate sodium in food products at the manufacturing level. Based on the mixed results of voluntary regulation in other countries, the NDOH decided to initiate mandatory regulation to effectively curb sodium consumption.
AFRICA: REIMAGINING AFRICA IN A WARMING WORLD
Lenferna A: Pambazuka News 29 May 2014
The future of Africa and the world will be defined by our response to the ongoing climate crisis. In order to effectively confront this era-defining challenge, the author argues that we need to rethink our development paradigm and move beyond the narrow industrial focus towards a future where the environment and social benefit are seen as intrinsically inseparable.
HOTSPOTS OF CLIMATE CHANGE IMPACTS IN SUB-SAHARAN AFRICA AND IMPLICATIONS FOR ADAPTATION AND DEVELOPMENT
Müller C, Waha C, Bondeau A, Heinke J: Global Change Biology Online May 2014
A group of scientists in Germany report that, for the first time, they have identified the "hotspots of climate change in Africa," which cover three regions where people should prepare for multiple climatic problems over the next 20 years. According to scientists from the Potsdam Institute for Climate Impact Research (PIK), the three regions most at risk are parts of Sudan and Ethiopia, the countries around Lake Victoria, and the continent's south-eastern corner, especially parts of South Africa, Mozambique and Zimbabwe. "These regions are expected to see more severe dry seasons and reduced plant growth, with flooding in countries around Lake Victoria." The researchers say that globally Africa has already experience above average affects from the changing global climate - the continent's above average share of poor and undernourished people also increases the potential human impact of this situation.
OIL DRILLERS PROMISE TO WITHDRAW FROM AFRICA'S EDEN
Coghlan A: New Scientist, Issue 2973, 11 July 2014
The author asserts "there will be no drilling in paradise". Soco International, a British oil company, has abandoned plans to drill for oil in Virunga National Park in the Democratic Republic of the Congo (DRC). The park is a World Heritage Site, and UNESCO says it is Africa's richest trove of natural beauty and biodiversity. Soco will leave in about a month, after completing a seismic survey of the park's Lake Edward, where drilling was to have commenced. Tens of thousands of local people depend on the lake for fish, and it is also home to thousands of hippopotamuses. Soco has vowed not to drill in the park without permission from UNESCO, and to keep out of all the world's 981 World Heritage Sites. The firm was under pressure after an expert report last month on the status of the park. French company Total pulled out last year. The DRC government has yet to remove overall permission for oil companies to search and drill for oil in the park.
AFRICA: GDP IS MACHO AND KEEPS WOMEN POOR
Kanengoni A: Codesria News, May 2014
For decades, Gross Domestic Product (GDP) has been used the world over as the measure for economic progress and development. Policies and programmes designed to end poverty and inequality have thus been designed and informed through this GDP lens. Yet, the author argues that the GDP tool and model is macho and masks inequalities - especially gendered inequalities. A telling case is the current "Africa rising" narrative which is largely based on a narrow focus on African countries' upward showing in GDP performance, and overlooks the fact that inequalities continue to grow on the continent; with women and girls becoming poorer and more vulnerable. As the world frames a post 2015 agenda, it is argued to be imperative to rethink this model and explore alternatives that are more inclusive and gender responsive enough to effectively end the feminization of poverty, especially in Africa. While it is important that the post 2015 agenda identifies a goal for transformative gender equality and women's economic empowerment, it is even more important that this transformation includes challenging the efficacy of long-held economic models and tools such as use of GDP as the primary measure of economic performance.
AFRICA: WATER AIDS'S INTERACTIVE ONLINE MAP SHOWS AFRICANS WILL ACCESS CLEAN WATER BY 2030
Mutegi L: All Africa, 28 May 2014
A new interactive map, published by the international development charity Water Aid, has been launched online showing that 14 African governments are on course or within touching distance of reaching the historic mark of everyone in their countries having access to clean drinking water by 2030. The Water Aid map has been released on the day that African water ministers and delegates arrive for the start of African Water Week conference in Dakar, Senegal for crucial talks as to whether they should back a proposed new global Sustainable Development Goal for universal access to water, sanitation and hygiene by the year 2030. The African Water Map shows that on average, 28 million people are gaining access to water each year across Africa, but that if this increased by an extra 17 million people, that everyone everywhere across the continent would have access to clean water by 2030. Currently over a third of African's, 325 million, lack access to clean drinking water, while over 70%, 643 million, go without basic sanitation. A lack of access to these services costs sub-Saharan Africa over US $ 50 billion every year in health care costs and lost productivity, more than the continent receives in aid.
LEARNING FROM HOLISTIC THINKING IN MENTAL HEALTH PROGRAMMES IN KENYA
Loewenson R: WHO AFRO, 2013
This case study describes three levels of intervention on mental health in Kenya that reflect a paradigm shift towards more holistic community centred thinking on mental health and associated intersectoral collaboration. The three levels are a (i) multi-faceted and intersectoral process for national policy development and implementation on mental health, (ii) a co-ordinated district programme on mental health and (iii)locally driven social action on mental health. Using a desk review of (limited) available literature, the case study describes the context for, inception, processes used, outcomes and impact of and lessons learned from each level. Each level was informed by collaborative situation appraisal to inform planning. The appraisal at local level was implemented using a participatory reflection and action approach to support communication and shared understanding across diverse actors, including those directly affected.
MAXIMIZING THE BENEFIT OF HEALTH WORKFORCE SECONDMENT IN BOTSWANA: AN APPROACH FOR STRENGTHENING HEALTH SYSTEMS IN RESOURCE-LIMITED SETTINGS
Grignon JS, Ledikwe JH, Makati D, Nyangah R, Sento BW, Semo B: Risk Management And Healthcare Policy 7:91; 16 May 2014.
To address health systems challenges in limited-resource settings, global health initiatives, particularly the President's Emergency Plan for AIDS Relief, have seconded health workers to the public sector. Implementation considerations for secondment as a health workforce development strategy are not well documented. This article presents outcomes, best practices, and lessons learned from a President's Emergency Plan for AIDS Relief-funded secondment program in Botswana. Outcomes are documented across four World Health Organization health systems' building blocks. Best practices include documentation of joint stakeholder expectations, collaborative recruitment, and early identification of counterparts. Lessons learned include inadequate ownership, a two-tier employment system, and ill-defined position duration. These findings can inform program and policy development to maximize the benefit of health workforce secondment. Secondment requires substantial investment, and emphasis should be placed on high-level technical positions responsible for building systems, developing health workers, and strengthening government to translate policy into programs.
ENDLINE STUDY FOR QUEEN ‘MAMOHATO HOSPITAL PUBLIC PRIVATE PARTNERSHIP
Vian T, McIntosh N, Grabowski A, Brooks B, Jack, Nkabane EL: Boston University Center For Global Health And Development, September 2013
In 2006, the Government of Lesotho (GoL) adopted a major new public private partnership (PPP) approach in the health care sector. The PPP had two purposes: first, to replace the aging plant and equipment from Queen Elizabeth II (QEII), the 100-year old national referral hospital in Maseru and to extend and upgrade the network of urban filter clinics which, together with the hospital, provided publicly-funded health care services in the greater Maseru district, and referral services for the country. The PPP thus included construction of a new, 425-bed national referral hospital (Queen ‘Mamohato Memorial Hospital, or QMMH), a gateway clinic adjacent to the hospital, and the refurbishment and re-equipment of three urban filter clinics: Qoaling, Mabote and Likotsi. The second purpose of the PPP was to engage the private sector in new ways to ensure that these new facilities functioned effectively as an integrated care network to provide more efficient, higher quality care and expanded access to services for the population. Between February and May 2013, Boston University’s Center for Global Health and Development (CGHD) and LeBoHA, conducted a study of Queen ’Mamohato Memorial Hospital, gateway clinic, and the three urban filter clinics included in the PPP. The results are reported in this paper.
WORLD BANK PRIVATE FINANCING SCHEME BLEEDS LESOTHO'S HEALTH SYSTEM DRY
Chefa L, Lesotho Consumers Protection Association: Bretton Woods Project, May 2014
This article is a comment on the Consumers Protection Association joint report with Oxfam published in April on the negative impact of a health public–private partnership (PPP) on the budget of the Lesotho Ministry of Health and primary health care services in rural areas. The author argues that many of the features of the PPP are alarming. While there is no doubt that Lesotho, like any country, needs a national referral hospital that can provide highly specialised services, the author argues that given that most Basotho live in rural areas, the priority should be to develop a comprehensive network of primary and secondary health care services. Improving access to quality health care, especially in remote mountainous areas where people sometimes have to travel for hours on horseback to reach their nearest clinic, is the surest way to accelerate progress towards improving the health of the nation. However the ability to do so is being undermined by one hospital taking up the lion’s share of the health budget. During the World Bank spring meetings the Bank president Jim Yong Kim said that he would be taking a personal interest in the case. The Lesotho prime minister and minister of health also publicly expressed their concerns about the project in reaction to the report. The IFC was noted to have not yet provided a comprehensive response to the critique of the PPP. The author argues that given the experience in Lesotho, he would not recommend relying on the advice of the IFC, and asks the World Bank Group to stop promoting the project as a success and to remove all misleading marketing materials on the Lesotho PPP from their website. His advice to other countries is "don’t copy us" and demand concrete evidence of the effectiveness and efficiency of PPPs before even considering this option. On behalf of the many civil society organisations he works with, the author calls on the World Bank Group to finance a fully independent and transparent expert financial audit and broader review of the Lesotho health PPP, in partnership with the government of Lesotho.
PROGRESS TOWARDS UNIVERSAL HEALTH COVERAGE IN BRICS: TRANSLATING ECONOMIC GROWTH INTO BETTER HEALTH
Krishna D Rao, Petrosyan V, Araujo EC, McIntyre D: Bulletin Of The World Health Organization 92:429-435, 2014
Brazil, the Russian Federation, India, China and South Africa – the countries known as BRICS – represent some of the world’s fastest growing large economies and nearly 40% of the world’s population. Over the last two decades, BRICS have undertaken health-system reforms to make progress towards universal health coverage. This paper discusses three key aspects of these reforms: the role of government in financing health; the underlying motivation behind the reforms; and the value of the lessons learnt for non-BRICS countries. Although national governments have played a prominent role in the reforms, private financing constitutes a major share of health spending in BRICS. There is a reliance on direct expenditures in China and India and a substantial presence of private insurance in Brazil and South Africa. The Brazilian health reforms resulted from a political movement that made health a constitutional right, whereas those in China, India, the Russian Federation and South Africa were an attempt to improve the performance of the public system and reduce inequities in access. The move towards universal health coverage has been slow. In China and India, the reforms have not adequately addressed the issue of out-of-pocket payments. Negotiations between national and subnational entities have often been challenging but Brazil has been able to achieve good coordination between federal and state entities via a constitutional delineation of responsibility. In the Russian Federation, poor coordination has led to the fragmented pooling and inefficient use of resources. In mixed health systems it is essential to harness both public and private sector resources.
TOWARDS ACHIEVING UNIVERSAL HEALTH COVERAGE IN NIGERIA
Business Day, June 20 2014
As high out-of-pocket payment dominates Nigeria’s healthcare spending and with low priority accorded to health by state and local governments, Nigeria’s quest to attain universal health coverage by 2015 is argued in this article to be bleak. The absence of financial protection has led most Nigerians to depend on out-of-pocket payment for healthcare financing with insurance penetration, which is a measure of the relationship between premiums earned and the nation’s Gross Domestic Product, put at less than 6 percent, according to industry experts. Experts explain that achieving universal health coverage would be hard to attain without expanding the fiscal space (through increasing domestic tax revenues, expanding tax base, developing social health insurance, and getting debt relief. Analysts believe that there is need to expand contributions from large profitable companies and tax mobile phone operators to fund healthcare.
Other innovations include tobacco and alcohol exercise tax, excise tax on foods that contribute to an unhealthy diet, and additional levy on top of existing VAT rate as is in the case with countries like Chile.
Some issues to consider in evaluating each innovative method include administrative costs, magnitude of the potential revenue, political acceptability and whether such funds should go into Consolidated Government Revenues or be earmarked.
CONSENSUS REACHED ON NEW HIV TREATMENT AND PREVENTION TARGETS IN EASTERN AND SOUTHERN AFRICA
UNAIDS, 23 May 2014
Participants attending a two-day consultative workshop held on 19 and 20 May in Johannesburg, South Africa, agreed to set new targets for 2020 and 2030 to scale up access to HIV treatment and prevention programmes in eastern and southern Africa. This consultation followed a call from the UNAIDS Programme Coordinating Board in December 2013 for UNAIDS to support countries to develop new targets for the HIV response beyond 2015. The eastern and southern Africa region is on track to reach several of the targets set for 2015. However, with less than 600 days remaining, new bold and visionary targets are needed to guide the HIV response beyond 2015, incorporate new scientific evidence and lay the foundation to end the AIDS epidemic. Sheila Tlou, Director, UNAIDS Regional Support Team for Eastern and Southern Africa said "We have the opportunity to identify bold and innovative solutions to reach ambitious targets and assess the resources needed to translate our commitment into service delivery for people in need, ensuring that no one is left behind."
IMPROVING ANTIRETROVIRAL THERAPY SCALE-UP AND EFFECTIVENESS THROUGH SERVICE INTEGRATION AND DECENTRALIZATION
Suthar, Amitabh B, Rutherford, George W, Horvath, Tara, Doherty, Meg C, Negussie, Eyerusalem K: AIDS 28; S175-S185 2014
Current service delivery systems do not reach all people in need of antiretroviral therapy (ART). In order to inform the operational and service delivery section of the WHO 2013 consolidated antiretroviral guidelines, this paper summarized systematic reviews on integrating ART delivery into maternal, newborn, and child health (MNCH) care settings in countries with generalized epidemics, tuberculosis (TB) treatment settings in which the burden of HIV and TB is high, and settings providing opiate substitution therapy (OST); and decentralizing ART into primary health facilities and communities. Integrating ART into MNCH, TB, and OST services was often associated with improvements in ART coverage, and decentralization of ART into primary health facilities and communities was often associated with improved retention. Neither integration nor decentralization was associated with adverse outcomes. These data contributed to recommendations in the WHO 2013 consolidated antiretroviral guidelines to integrate ART delivery into MNCH, TB, and OST services and to decentralize ART.
LEADERSHIP FROM ‘BELOW’? CLINICAL STAFF AND PUBLIC HOSPITALS IN SOUTH AFRICA
Doherty J: MSP Briefing Note 4, 2014
This paper identifies the possibilities and challenges related to involving clinical staff in the leadership and management of district hospitals in South Africa. It couches findings and recommendations in terms that are applicable to other service sectors. This is because strengthening the leadership capacity of practitioners (as opposed to simply their line managers’), and facilitating participation in their organizations’ decision-making processes, might be one mechanism to restore responsiveness and quality in public services in general. The study also speaks to how to strengthen the public sector along lines that preserve its ‘publicness’ and enable it to meet its social objectives more effectively, as an alternative to more market-based approaches.
MOBILE HEALTH FOR NON-COMMUNICABLE DISEASES IN SUB-SAHARAN AFRICA: A SYSTEMATIC REVIEW OF THE LITERATURE AND STRATEGIC FRAMEWORK FOR RESEARCH
Bloomfield GS, Vedanthan R, Vasudevan L, Kithei A, Were M, Velazquez EJ: Globalization And Health 10 :49 June 2014
Mobile health (mHealth) approaches for non-communicable disease (NCD) care seem particularly applicable to sub-Saharan Africa given the penetration of mobile phones in the region. The evidence to support its implementation has not been critically reviewed. The authors systematically searched PubMed, Embase, Web of Science, Cochrane Central Register of Clinical Trials, a number of other databases, and grey literature for studies reported between 1992 and 2012 published in English or with an English abstract available. The search yielded 475 citations of which eleven were reviewed in full after applying exclusion criteria. Five of those studies met the inclusion criteria of using a mobile phone for non-communicable disease care in sub-Saharan Africa. Most studies lacked comparator arms, clinical endpoints, or were of short duration. mHealth for NCDs in sub-Saharan Africa appears feasible for follow-up and retention of patients, can support peer support networks, and uses a variety of mHealth modalities. Whether mHealth is associated with any adverse effect has not been systematically studied. Only a small number of mHealth strategies for NCDs have been studied in sub-Saharan Africa. They report that there is insufficient evidence to support the effectiveness of mHealth for NCD care in sub-Saharan Africa and present a framework for cataloging evidence on mHealth strategies that incorporates health system challenges and stages of NCD care to guide approaches to fill evidence gaps in this area.
HEALTH RESEARCH FOR ALL: THE ROLE OF INNOVATION IN GLOBAL HEALTH IN THE POST-2015 DEVELOPMENT FRAMEWORK
COHRED, GHC, DnDi, IAVI, GHTC, May 31 2014
The Council on Health Research for Development (COHRED), along with the Global Health Council (GHC), the Drugs for Neglected Diseases initiative (DNDi), the International AIDS Vaccine Initiative (IAVI), and the Global Health Technologies Coalition (GHTC) hosted an official nongovernmental organization (NGO) side session at the 67th annual World Health Assembly (WHA) to explore the role of R&D in the post-2015 development agenda. The event organizers developed a statement urging member states and delegates to support health research and related policies and capacity building as a core component of a post-2015 agenda for equitable health and sustainable development. WHA Member States approved a resolution on health in the post-2015 development agenda that called for completing the unfinished work of the health Millennium Development Goals (MDGs) and noted the importance of universal health coverage and stronger health systems.
IDENTIFYING AND TARGETING MORTALITY DISPARITIES: A FRAMEWORK FOR SUB-SAHARAN AFRICA USING ADULT MORTALITY DATA FROM SOUTH AFRICA
Sartorius B, Sartorius K: Plos One. 14 August 2013.
Health inequities in developing countries are difficult to eradicate because of limited resources. The neglect of adult mortality in Sub-Saharan Africa (SSA) is a particular concern. Advances in data availability, software and analytic methods have created opportunities to address this challenge and tailor interventions to small areas. This study demonstrates how a generic framework can be applied to guide policy interventions to reduce adult mortality in high risk areas. The framework, therefore, incorporates the spatial clustering of adult mortality, estimates the impact of a range of determinants and quantifies the impact of their removal to ensure optimal returns on scarce resources. Data from a national cross-sectional survey in 2007 were used to illustrate the use of the generic framework for SSA and elsewhere. Adult mortality proportions were analyzed at four administrative levels and spatial analyses were used to identify areas with significant excess mortality. An ecological approach was then used to assess the relationship between mortality “hotspots” and various determinants. Population attributable fractions were calculated to quantify the reduction in mortality as a result of targeted removal of high-impact determinants. Overall adult mortality rate was 145 per 10,000. Spatial disaggregation identified a highly non-random pattern and 67 significant high risk local municipalities were identified. The most prominent determinants of adult mortality included HIV antenatal sero-prevalence, low SES and lack of formal marital union status. The removal of the most attributable factors, based on local area prevalence, suggest that overall adult mortality could be potentially reduced by ~90 deaths per 10,000.
PHM’S REPORT ON THE 67TH WORLD HEALTH ASSEMBLY
Peoples Health Movement: June 2014
PHM’s report on the 67th World Health Assembly (19-24 May, 2014) is now available. The report provides, for each agenda item:
• Links to the official documents prepared for (and during) the Assembly, including the final resolutions;
• PHM background, analysis and commentary on each agenda item;
• Links to statements delivered by various civil society organisations, including PHM with Medicus Mundi International;
• Semi verbatim reports of the debate at the Assembly, prepared by the WHO Watch team.
WHO Watch is a project of PHM, in association with Medicus Mundi International, Third World Network, and a number of other participating organisations.
The objectives of WHO Watch include:
• Linking the global and the local: sharing with community activists what is happening at the global level
• Building links among activists (global and local) who are working on particular issues
• Working to strengthen the leadership role of WHO in global health
• Holding ministers of health accountable: (i) for how they implement WHO decisions; (ii) for how they speak at the WHA; (iii) for how they fulfil their ‘duty of care’ for WHO. Health activists are warmly invited to stoke the local policy dialogue around health issues using the materials.
THE STATE VOL I: VOICINGS/ARTICULATIONS/UTTERANCES
The State Publishing Practice, 2014
Amidst austerity measures today, we find ourselves increasingly precarious and pixelated; atomized, alienated, and irreparably glitched. For the inaugural issue of The State, the theme was kept intentionally vague; fifteen writers from around the world responded in myriad voices and ways. Topics range from sociohistorical looks at sewers and single parenting throughout the ages, to reimagining a weedy field as a portmanteau of globalisation. Others take a more personal approach, interrogating experiences of Afropolitanism, of being a person of colour in post-9/11 America, and of returning to the Gulf with your tail between your legs. They are joined by two ‘website-specific installations’—exploring joblessness and speaking in tongues—which are scannable within these pages. THE STATE is a publishing practice that investigates South-South reorientations, alternative futurisms, transgressive cultural criticism, the transition from analogue to digital, and the sensuous architecture of this “printernet.”
CALL FOR PAPERS ON PARTICIPATORY VISUAL METHODOLOGIES
Deadline For Manuscript Submission: 15 October 2015
Global Public Health invites the submission of full-length articles for a special journal issue on the theme Participatory Visual Methodologies and Global Public Health, co-edited by Claudia Mitchell and Marni Sommer, Send note of intention to submit & working title to email@example.com
CALL FOR PAPERS: THE JOURNAL OF HUMAN DEVELOPMENT AND CAPABILITIES, SPECIAL ISSUE: HEALTH AND DISABILITY
Deadline For Submissions: November 30, 2014
The Journal of Human Development and Capabilities (JHDC) is pleased to announce a call for papers for a special issue on Health and Disability. This call for papers aims to advance the state of knowledge and expertise regarding health, disability and human development, as well as the linkages among them and a range of policies, institutions, and social structures that influence such links and their dynamics. Submissions related to this topic are welcome. In particular, though not exclusively, we welcome submissions in the following themes: i) Social justice and resource allocation; ii) Health system financing and access; iii) Public health and health policy; iv) Disability, poverty and human development; v) Social determinants of health and disability; vi) Disability definition and measurement; vii) HIV/AIDS and antiretroviral therapies; viii) Health care services and provision, and; ix) Maternal, child and reproductive health. Full papers in English, in .doc or .docx formats should be submitted by November 30th, 2014. Strict compliance with this deadline is required. Papers submitted will be evaluated through a standard peer review process. Authors of the selected papers will be notified by e-mail. Submission of a paper implies that the author has the intention of publishing the paper in the JHDC, and it is not currently under evaluation at another journal.
FCGH PLATFORM STATEMENT NOW OPEN FOR ENDORSEMENTS
Joint Action And Learning Initiative On National And Global Responsibilities For Health
In the next step towards a Framework Convention on Global Health (FCGH), the proposed global health treaty grounded in the right to health and aimed at health equity, the proposers seek to secure a place in the UN Sustainable Development Goals resolution in 2015 for the FCGH, in particular, calling for the launch of a UN/WHO process towards the treaty. Towards this goal and beyond, the FCGH platform statement is now open for endorsements. All are welcome to endorse, and endorsements is encouraged on behalf of organizations where that is possible. The statement provides key principles and core content of the FCGH, as well as explanations of the need for the treaty. The FCGH platform statement and information on endorsement is found at the website shown, together with other briefing materials.
IMPACT OF COMMUNITY HEALTH WORKERS: CURRENT EVIDENCE BASE AND ESSENTIAL FOCUS AREAS
Health Systems Global Webinar Series Tue, Jul 1, 2014 2:00 PM - 3:00 PM BST
Community health workers (CHW) are receiving growing attention as programmes led by governments and non-governmental organizations (NGOs) are implemented around the world. This webinar will ask: As countries scale up CHW programmes, where is a stronger evidence base needed to support policy development and programmes? How can existing evidence be better translated into action? Join for a lively panel discussion where you can hear more about: CHW commitment at the 3rd Global HRH Forum, with an emphasis on expanding the evidence base for CHW programmes; the NGO community’s CHW Principles of Practice and its focus on supporting CHW research; challenges faced by national CHW programmes in a range of African and Asian countries, and the alignment of research to these real world problems and a new reference guide on large scale development and strengthening of CHW programmes.
INAUGURAL HIV RESEARCH FOR PREVENTION CONFERENCE (HIVR4P), 28-31 OCTOBER CAPE TOWN, SOUTH AFRICA
Pre-registration Closes 15 October 2014
The first global conference to feature the latest research on all forms of biomedical HIV prevention. HIV R4P will be held at the Cape Town International Convention Centre in Cape Town, South Africa, 28-31 October 2014. HIV R4P is the world's first and only scientific meeting dedicated exclusively to biomedical HIV prevention research. Through both abstract and non-abstract driven sessions, the conference will support cross-fertilization between research on HIV vaccines, microbicides, PrEP, treatment as prevention and other biomedical prevention approaches, while also providing a venue to discuss the research findings, questions and priorities that are specific to advancing each modality.
ONLINE COURSE ON GLOBAL HEALTH DIPLOMACY, 15 SEPTEMBER - 7 NOVEMBER 2014
Apply Before Friday, 1 August 2014
As health moves beyond its purely technical realm to become an ever more critical element in foreign policy, security policy, and trade agreements, new skills are needed to negotiate global regimes, international agreements and treaties, and to maintain relations with a wide range of stakeholders. This course offered by Global Health Programme and DiploFoundation focuses on health diplomacy as it relates to health issues that transcend national boundaries and are global in nature. The course discusses the challenges facing health diplomacy and how they are being addressed by different groups and at different levels of governance. The course will be of interest to health attachés and health and international relations professionals in departments of international health, ministries of health, and foreign affairs and development cooperation. It may also be of interest to staff in international and regional organisations, NGOs, philanthropic organisations, universities and the private sector, and well as to post-graduate level students of international health or international relations. This course is conducted entirely online over a period of eight weeks. It is highly participatory, drawing on the national and international professional experiences of participants through a multi-disciplinary learning process. The course requires seven to ten hours of study time per week. Read more about the course and apply online on DiploFoundation's website.
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