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EQUINET NEWSLETTER 39: 01 MAY 2004
Http://www.equinetafrica.org
CONTENTS:
1. Editorial, 2. Equity in Health, 3. Values, Policies and Rights, 4. Health equity in economic and trade policies, 5. Poverty and health, 6. Human Resources, 7. Public-Private Mix, 8. Resource allocation and health financing, 9. Equity and HIV/AIDS, 10. Governance and participation in health, 11. Monitoring equity and research policy, 12. Useful Resources, 13. Jobs and Announcements

1. Editorial

RECLAIMING THE STATE: ADVANCING PEOPLES HEALTH, CHALLENGING INJUSTICE
EQUINET Steering Committee
In just over a month delegates from all over southern African will be converging at the third EQUINET Southern African Regional Conference on Equity in Health being held in Durban, South Africa on the theme ‘Reclaiming the state: Advancing peoples Health, Challenging Injustice’. This conference theme has been chosen to reflect the commitment by EQUINET to go beyond mapping the problems in and challenges to health equity and social justice in southern Africa and to proactively build the alternative vision, analysis, perspective and practice needed to meet those challenges.

The conference will debate the actions and systems needed to advance people’s health equitably, fairly and within the broader context of social justice. EQUINET proposes that such systems must integrate principles and practice:
- of public health, viz the protection and promotion of population health and prevention of ill health
- of providing relevant, quality health services and care for all according to need and financed according to ability to pay
- of building the human resources and knowledge to shape and deliver public health and health services, and
- of protecting and ensuring the social values, ethics and rights that underlie health systems, including to participation and involvement.

The conference will also review through various areas of work the proposal that health must be supported by redistribution of the resources for health in an equity oriented policy agenda supported by the state. The conference will explore options for policies and systems that are explicitly centred on rising investment in health through the state and public sector. What does it mean conceptually and practically at national and global level to reclaim the central role of the state for equitable health systems?

Efforts by states and citizens in the region to equitably meet the health needs of their people confront the challenge posed by a globalization process based on unfair global trade relations, dominance of transnational corporation interests, reduced role and authority of the state and political and economic marginalization of southern and low income populations. Such conditions contribute to a huge ‘brain drain’ of health personnel, growing household food insecurity, massive constraints in meeting the drug and other inputs to health care and privatization of essential services, all with damaging implications for equity in health.

The conference will present and discuss the perspectives, shared values and options for challenging the injustices undermining people’s health. We will draw from the experiences of work with government, parliaments and civil society. We will examine the rights and governance approaches that are needed to support such action for health.

We invite all those with ideas, issues and options to contribute to this process, whether or not you are coming to the conference! Send us your feedback, resolutions, and contributions with your name and institution to admin@equinetafrica.org and we will integrate it into the inputs to the conference resolutions and keep you informed on the outcome. What do you see as the major challenges and contributions to advancing people’s health in southern Africa? What policies and actions are needed to strengthen the role and performance of the state and public sector in health? How can southern Africans more effectively challenge the injustices that undermine health? What should EQUINET do, as a network based on shared vision and values of equity and social justice, to strengthen our analysis, actions and institutions to better deliver on our collective aspirations for health equity and social justice? What role would you like to play in this?


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2. Equity in Health

ACCELERATING RESPONSE TO AIDS IN SWAZILAND
http://www.plusnews.org/AIDSreport.asp?ReportID=3309
Accelerating its response to the AIDS challenge, the Swazi government has announced preferred suppliers of antiretroviral drugs, while the national AIDS funding agency says it has applied for a US $48.5 million grant from the Global Fund. "The nearly $50 million we have requested is for a five-year period, with $7 million going toward our first-year projects, and the funds will enable us to significantly step up interventions, particularly our programmes directed toward youth, which are currently under-funded," National Emergency Response Committee on HIV/AIDS (NERCHA) director Dr Derek Von Wissell told PlusNews.

CHALLENGES REMAIN FOR MSF'S SOUTH AFRICA ART PROGRAMME
http://www.plusnews.org/AIDSreport.asp?ReportID=3325
Three years after its inception, the first project to provide free AIDS drugs to South Africans put the 1,000th patient on antiretroviral treatment (ART). In May 2001 the Medicins Sans Frontieres (MSF) and Western Cape Health Department project started providing people at an advanced stage of AIDS with ART at three HIV/AIDS clinics in Khayelitsha township, outside Cape Town. Today the clinics offer about 2,000 consultations every month in the sprawling township. "We estimate that 5,000 people need treatment in Khayelitsha today," MSF campaign coordinator Marta Darder told PlusNews.

EXPERTS MEET TO DISCUSS MALARIA DRUGS
http://www.unwire.org/UNWire/20040429/449_23307.asp
Public health experts met in New York recently to discuss expanding access in developing nations to artemisinin-combination therapy (ACT), which offers one of the fastest and most effective cures for malaria, USA Today reports. Malaria parasites have become resistant to older drugs, but funding for the newer ACT remains a problem. ACT costs about $1.50 for a three-day course, compared with 10 cents for older drugs such as chloroquine and Fansidar. Many African governments can devote just $5 per person annually to public health.

FUNDS HAMPER THOSE WHO NEED MALARIA DRUGS
http://www.newsday.com/news/health/wire/sns-ap-malaria-drugs,0,1280044.story?coll=sns-ap-health-headlines
Medicines to fight the rising malaria epidemic don't reach millions who need them because the money and the international commitment to supply the drugs are lacking, experts said at a conference. Although malaria kills more than a million people a year - most of them African children - national and international policy makers show a "lack of urgency and political will" to use new treatments in the face of drug resistance, conference organizers said in a statement.

LANDMARK AGREEMENT REACHED IN AIDS FIGHT
A historic agreement to adopt a unified global response to tackling HIV/AIDS was reached by the international community last month. Despite stepped up resources and the best intentions, the AIDS epidemic continues to be one of the greatest crises of the century, with 40 million people currently infected and over 25 million deaths to date. A major step was taken at a meeting in Washington D.C., co-chaired by UNAIDS, the UK and the US, where donors and developing countries agreed to three core principles to better coordinate the scale-up of national AIDS responses.
Further details: /newsletter/index.php?id=1959

MORE AID IS NEEDED TO HALVE WORLD POVERTY, SAYS REPORT
http://www.thelancet.com/journal/vol363/iss9419 /full/llan.363.9419.news.29501.1
Poor people in developing countries have little hope of overcoming poverty and deprivation unless urgent action is taken, according to the 2004 Global Monitoring report. The report, whose purpose is to assess progress towards internationally agreed objectives for reducing poverty, was the focus of discussions by the World Bank and the International Monetary Fund (IMF) during a meeting in Washington, April 24-25. The report claims that most developing countries will not meet the Millennium Development Goals (MDGs), which include halving the proportion of the population in extreme poverty, ensuring primary education for all children, and decreasing child and maternal deaths by 2015. (This article requires registration.)

NUTRITION FOR IMPROVED DEVELOPMENT OUTCOMES
United Nations System - Standing Committee On Nutrition (SCN) Report
http://www.unsystem.org/scn/Publications/AnnualMeeting /SCN31/SCN5Report.pdf
The 5th Report on the World Nutrition Situation outlines how reducing malnutrition is central to the achievement of the Millennium Development Goals (MDG), citing evidence that links nutrition to a range of other development outcomes. It highlights how a nutrition perspective can strengthen key development mechanisms and instruments such as poverty reduction strategies, health sector reform, improving governance and human rights, and trade liberalization. The Report makes specific suggestions about how nutrition can be engaged in a practical programme and policy context. This contribution is timely, as progress towards the 2015 MDG targets has been slower than anticipated.

RESURGENCE OF TB IN ZIMBABWE CAUSES CONCERN
http://www.plusnews.org/AIDSReport.ASP?ReportID=3250
Malnutrition due to the ongoing food crisis, the HIV/AIDS epidemic, and overcrowded urban areas are all contributing to a rise in tuberculosis (TB) infections in Zimbabwe. Nicholas Siziba, the national coordinator of the Ministry of Health's special TB programme, sounded the alarm while visiting Matabeleland South province - one of the worst-affected in terms of TB rates.

RISKING HIV TO ACCESS GRANT IN SOUTH AFRICA
http://www.plusnews.org/AIDSReport.ASP?ReportID=3296
The South African government expressed concern last month after a news report highlighted the story of a young woman who admitted she was thinking of contracting the HI virus to access a disability grant. The young woman, Thato, said she had ten 'boyfriends' with whom she slept for money. She was supporting two nieces, her own child and a grandmother suffering from diabetes on the money she made, by being what she described as a "prostitute in disguise".

TAC EXTENDS OLIVE BRANCH TO HEALTH MINISTER
South Africa's the Treatment Action Campaign (TAC) has welcomed the re-appointment of Health Minister Manto Tshabalala-Msimang, with whom the organisation has had a fraught relationship over the last four years. “The re-appointment of Health Minister, Dr Manto Tshabalala-Msimang will be a disappointment for many of us, especially the range of actors in the health sector. However, we urge Minister Tshabalala-Msimang to re-establish a working relationship in the interest of fulfilling the mandate of our people,” said the TAC.
Further details: /newsletter/index.php?id=1957

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3. Values, Policies and Rights

GENDER BASED VIOLENCE AND THE RISK OF HIV INFECTION
http://www.thelancet.com/journal/vol363/iss9419 /full/llan.363.9419.original_research.29458.1
Gender-based violence and gender inequality are increasingly cited as important determinants of women's HIV risk; yet empirical research on possible connections remains limited. No study on women has yet assessed gender-based violence as a risk factor for HIV after adjustment for women's own high-risk behaviours, although these are known to be associated with experience of violence. Women with violent or controlling male partners are at increased risk of HIV infection. Research suggests that abusive men are more likely to have HIV and impose risky sexual practices on partners. Research on connections between social constructions of masculinity, intimate partner violence, male dominance in relationships, and HIV risk behaviours in men, as well as effective interventions, are urgently needed. (Access to this article requires registration.)

GLOBALIZATION, HEALTH, WHO AND IMF/WB
http://lists.essential.org/pipermail/stop-imf /2004q2/000889.html
The World Health Organisation should be faithful to its Constitution, making health care and access to health care a human right, confronting powerful governments including the US government, which is in clear violation of the WHO Charter's instruction that member countries should ensure their citizens' access to health care in time of need. WHO should regain its credibility and moral standing, and could include growing movements of protest such as the anti-globalisation movement that are providing pointers to another possible world. Membership of WHO should be conditional on governments' acceptance of a whole set of principles and practices, including the promotion of health as a human right and the obligations deriving from this right. This is according to an article "The world situation and WHO", published in the Lancet.

HEALTH RESEARCH AND HUMAN RIGHTS IN SOUTH AFRICA
http://www.thelancet.com/journal/vol363/iss9418 /full/llan.363.9418.health_and_human_rights.29399.1
The death of apartheid - symbolised by the multiracial elections in South Africa on April 27, 1994 - was a defining moment of the 20th century. The tenth anniversary of this event is a time to consider how well the post-apartheid government is fostering health and human rights through reforms in health research policy. The realisation of health care depends, to an extent, on the formulation of a rational and responsive national research agenda; this has proven a challenge in post-apartheid South Africa. Notwithstanding its laudable attempts to redress the country's skewed national health research agenda, only when the South African government commits itself to transparent, competent research leadership free of ideological bias will the country truly graduate from erstwhile pariah nation to celebrated champion of health and human rights. (This article requires registration.)

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4. Health equity in economic and trade policies

DEBT FOR AIDS SWAPS
http://www.unaids.org/html/pub/publications/irc-pub06 /jc1020-debt4aids_en_pdf.pdf
Debt swaps exchange debt for some other asset or obligation. In the context of development, they normally involve countries negotiating cancellation of external debts in return for commitments on internal resource mobilization or some other government action. There has been considerable international interest in debt swaps and their potential to create a new and additional financing mechanism to help overcome long-standing barriers to development. The impact of AIDS on many developing countries, including many of the most indebted, has been severe. In the worst cases, AIDS has caused development progress to be set back by decades. There is therefore emerg­ing interest in examining whether debt swaps are potentially useful new instruments to apply to the problem of AIDS and development. This is according to a UNAIDS policy brief on the issue.

PATAM SENDS LETTER TO AFRICAN FINANCE MINISTERS
Finance Ministers that attended the World Bank spring meetings in Washington towards the end of April were urged by the Pan-African Treatment Access Movement (PATAM) to ensure that urgent attention be paid to building the internal capacity of African countries to marshal their own resources against HIV/AIDS, reject fiscal conditions that imply a decline in additional donated revenues for HIV/AIDS, demand full debt cancellation and upport efforts to highlight transparency, accountability and representation in the IMF and World Bank. PATAM send a letter to African ministers of finance which can be read by clicking on the link below.
Further details: /newsletter/index.php?id=1964

WORLD BANK CRITICISED FOR HIV/AIDS RESPONSE
http://www.actionaid.org/resources/pdfs/HIVWorldBank2004.pdf
The World Bank failed to protect social spending during its structural adjustment operations in the 1980s and 1990s, and this led to the deterioration of basic services - including those needed for the prevention and control of HIV/AIDS. And instead of focusing on HIV/AIDS, the World Bank sought improvements in the way goods and services were provided and financed through health sector reforms, such as user fees, privatisation, decentralisation and integration of services. These reforms frequently had the unintended effect of reducing access to effective health care, including services aimed at the prevention and control of HIV/AIDS. This is according to a paper Produced by ActionAid that evaluates the response to the HIV crisis by the World Bank.

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5. Poverty and health

IMPROVING THE HEALTH OF THE WORLD'S POOREST PEOPLE
http://www.eldis.org/cf/rdr/rdr.cfm?doc=DOC14527
This bulletin, produced by the Population Reference Bureau (PRB), highlights the poor-rich health divide that leaves more than 1 billion people worldwide excluded from both essential basic care and the benefits of advances in health and medical technology because of their extreme poverty. Key factors that contribute to these persistent health inequalities include lack of responsiveness by health systems to the needs of the poor; low quality of care; and the reality that public spending on health (justified on equity grounds) benefits non-poor groups more than the poor. In addition, few countries have taken measures to track progress in reducing socioeconomic disparities in health.

MALNUTRITION THE CAUSE OF DISEASE BURDEN
http://www.eldis.org/cf/rdr/rdr.cfm?doc=DOC14676
Improving nutrition would have broad and generally non-specific (or multipurpose) benefits in reducing the effects of infectious diseases. Non-specific public health measures tend to be underestimated in their impact, as the benefits are spread among so many conditions. The estimates in this paper try to capture this broad effect, using underweight (itself a non-specific measure) as an indicator of inadequate nutritional status, in part at least caused by inadequate diet. The results reinforce the case that SubSaharan Africa and Asia (especially South Asia) have the greatest needs. The effects of malnutrition, particularly as a risk factor, are very extensive, implying large potential benefits to health from addressing malnutrition. More attention to public nutrition could be the most effective investment in preventing ill-health and premature mortality throughout much of the developing world.

MEASURING GROWTH IN A POOR WORLD
http://www.wws.princeton.edu/%7Erpds/downloads /deaton_measuringpoverty_204.pdf
The extent to which growth reduces global poverty has been disputed for 30 years. It is possible for consumption of the poor to grow less rapidly than national consumption, without any increase in measured inequality. Current statistical procedures in poor countries understate the rate of global poverty reduction, and overstate growth in the world, argues this research paper.

WORLD BANK FINDS POVERTY IS DOWN
http://www.unwire.org/News/328_426_23113.asp
Rapid economic growth in East and South Asia over the last couple of decades has been responsible for a decrease in the number of people living in extreme poverty in developing countries, from 40 percent of global population in 1981 to 21 percent in 2001. However, Africa, Latin America, Eastern Europe and Central Asia are still far from reaching the U.N. Millennium Development Goal of halving poverty levels by 2015, says a new World Bank report. According to World Development Indicators 2004, East and South Asia, particularly China and India, have lifted 500 million people out of extreme poverty - those living on less than $1 a day - in 20 years.

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6. Human Resources

AFRICA NEEDS 100,000 HEALTH WORKERS TO DISTRIBUTE AIDS DRUGS
http://sfgate.com/cgi-bin/article.cgi?file=/news /archive/2004/04/28/international0958EDT0537.DTL
At least 100,000 health workers are needed to distribute anti-AIDS drugs in Africa, where 70 percent of the world's HIV/AIDS sufferers live, the head of the World Health OrganiSation said Wednesday. "It's difficult to grasp the magnitude of the problem," Dr. Lee Jong-Wook said while visiting Singapore. "The 8,000 people dying every day from AIDS is equivalent to 30 jumbo jets crashing every day." The WHO's aim to provide 3 million HIV-infected people in Africa with the latest available drugs by the end of 2005 was achievable if workers are found to deliver the drugs, Lee said.

INTERNATIONAL NURSE MOBILITY: TRENDS AND POLICY IMPLICATIONS
http://www.rcn.org.uk/downloads/InternationalNurseMobility-April162003.doc
This report examines the trends and policy issues relating to the international mobility of one key group of knowledge workers: nurses. The increase in 'knowledge worker' migration, partly as a result of developed countries attempting to solve skill shortages by recruiting from developing countries, is a key component of current international migration patterns. The report examines trends in international recruitment and migration of nurses. It uses data from professional registers and censuses to examine the scale of the movement of nurses. Core data from a selection of five 'destination countries' is used to track trends from source countries. The five destination countries are Australia, Ireland, Norway, UK and USA. Information is also assessed from four 'source' areas - the Caribbean, Ghana, South Africa and the Philippines.

THE ROLE OF WAGES IN THE MIGRATION OF HEALTH CARE PROFESSIONALS FROM DEVELOPING COUNTRIES
http://www.human-resources-health.com/content /2/1/3
Several countries are increasingly relying on immigration as a means of coping with domestic shortages of health care professionals. This trend has led to concerns that in many of the source countries - especially within Africa - the outflow of health care professionals is adversely affecting the health care system. This paper examines the role of wages in the migration decision and discusses the likely effect of wage increases in source countries in slowing migration flows.

TRAINING HEALTH SERVICE STAFF IN DEVELOPING COUNTRIES
http://www.id21.org/education/h1ps3g1.html
The quality of health care is hugely dependent on the skills of health professionals. Clinical skills centres are neutral and protected settings in which a variety of skills and techniques can be taught. In developing countries, resource constraints and pressure to direct skilled staff away from teaching to working in health service facilities can limit the opportunities for developing and implementing an effective training curriculum.

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7. Public-Private Mix

FORCED PRIVATISATION THROUGH AID
http://www.waronwant.org/?lid=7540
This report from War on Want looks at how conditionalities and pressures from aid agencies and development banks force developing countries to adopt privatisation policies in public services. It focuses specifically on the sectors of water, electricity, and healthcare, in six countries: Colombia; El Salvador; Indonesia; Mozambique; South Africa; and Sri Lanka. It examines the impact of the requirements and policies of the International Monetary Fund (IMF), World Bank (WB), and other agencies including regional development banks, the European Commission (EC) and donor countries. It includes a specific examination of the various ways in which the UK’s Department for International Development (DFID) supports privatisation in these services.

THE IMPACT OF HIV/AIDS ON THE HEALTH SECTOR
http://www.hsrcpublishers.co.za/index.html?health_sector.html~content
This report emanates from the results of a study that examined the impact of HIV/AIDS on the public and private health facilities in South Africa, and outlines the subsystems that are affected. Both public and private sector health facilities have reported an increase in the number of patients seeking clinical care for people living with HIV/AIDS, leading to increased admissions to medical and paediatric wards and increased workloads. This study addresses these issues and makes recommendations for managing the HIV/AIDS case load.

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8. Resource allocation and health financing

EXTRA SPENDING ON CLEAN WATER PROMISES EIGHT-FOLD ECONOMIC BENEFITS, SAYS WHO
http://www.who.int/mediacentre/releases/2004/pr28 /en/index.html
The economic benefits of better access to clean water outweigh the extra investment necessary eight-fold by creating a healthier workforce, the World Health Organisation said in a report. An additional investment of around 11.3 billion dollars (9.5 billion euros) per year on top of the money already being spent on improving basic sanitation facilities could generate a total economic benefit of 84 billion dollars annually, the report said. Such an investment would reduce the global occurrence of diarrhoea by an average of 10 percent, according to the study by the Swiss Tropical Institute, which was commissioned by the WHO.

GLOBAL FUNDING FOR HIV/AIDS IN RESOURCE POOR SETTINGS
http://www.eldis.org/cf/rdr/rdr.cfm?doc=DOC14593
This fact sheet analyses current trends in the global funding of HIV/AIDS. It argues that funding to address the epidemic (provided by major donor governments, multilateral organisations, affected countries, and the private sector) has only recently increased to significant levels, but it is still less than estimated need. Actual spending is typically less than budgeted funding, and in 2003 both were well below the estimated need of $6.3 billion. Some key findings included the fact that budgeted funding for HIV/AIDS in 2003 totalled $4.2 billion while actual spending in 2003 totalled about $3.6 billion. In addition, donor governments provide 61% of budgeted funding to address HIV/AIDS in resource poor settings utilising bilateral and multilateral channels.

TUBERCULOSIS CONTROL NEEDS STRONG NATIONAL HEALTH SERVICES
http://www.id21.org/health/h4ym1g1.html
The lack of health care resources is the most obvious barrier for developing countries to reach TB control targets. However, there is a strong association between poverty and TB, say researchers from Belgium's Institute of Tropical Medicine. The number of tuberculosis cases continues to rise worldwide and only a minority of people has access to high quality tuberculosis services. Tuberculosis control cannot reach its targets without investing in an adequate network of accessible, effective and comprehensive health services, say the researchers. However, only a small proportion of all TB patients in the world are detected and many are diagnosed and treated late. The researchers identify many problems in the way in which care and support are delivered. These include insufficient and rundown health facilities, lack of trained and motivated staff, shortages of drugs and medical supplies, poor supervision of health personnel and difficult communication and transport. In many regions, the private health sector is growing rapidly while the regulatory system remains poor.

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9. Equity and HIV/AIDS

ANTIRETROVIRAL THERAPY IN AFRICA
http://bmj.bmjjournals.com/cgi/content/full/328 /7434/280
The experience of tuberculosis treatment in Africa shows that the potential short term gains from reducing individual morbidity and mortality may be far outweighed by the potential for the long term spread of drug resistance, says an article in the British Medical Journal. Given the high levels of HIV prevalence and the lack of resources and infrastructures, HIV/AIDS antiretroviral therapy is likely to be introduced to Africa in a random and haphazard way, with inconsistent prescribing practices and poor monitoring of therapy and adherence: this risks the rapid development and transmission of drug resistance.

BUSH ACCUSED OF BLOCKING ACCESS TO CHEAP AIDS DRUGS
http://bmj.bmjjournals.com/cgi/content/full/328 /7443/783
International health charities have accused George Bush's administration of trying to block developing countries' access to cheap AIDS drugs by questioning the quality of "three in one" generic combination drugs. At a meeting last month in Gaborone, Botswana, the US global AIDS coordinator, Randall Tobias, said that the World Health Organisation's drug pre-qualification programme is not a sufficiently stringent approval process to ensure consistency and quality of fixed dose combination drugs. Médecins Sans Frontičres and other non-governmental organisations working with AIDS patients in Africa accused the US government of trying to escape the 2001 Doha agreement on affordable drugs by the side door.

HAART ALONE NOT ENOUGH TO STOP SPREAD OF HIV
http://www.aidsmap.com/news/newsdisplay2.asp?newsId=2667
Less than 10% of HIV-positive individuals in South Africa will be eligible to receive antiretroviral therapy if World Health Organisation guidelines which mandate the use of anti-HIV therapy in patients with a CD4 cell count below 200 cells/mm3 are followed, according to a French-funded study published in the May 1st edition of the Journal of Acquired Immune Deficiency Syndromes. The study also found that this would have only a limited impact on the spread of HIV.

THE GLOBAL RESPONSE TO AIDS: TEN YEARS ON
http://www.aidsalliance.org/_res/alliance/newsletter /December%202003%20(Eng).pdf
Stigma and discrimination are still huge obstacles to progress on AIDS: the association of HIV/AIDS with marginalised populations has consistently been a major factor impeding action. Furthermore, the involvement of HIV positive people in policymaking and programme delivery is essential to success, and such involvement requires partnership and respect, not sympathy and tolerance. This is according to an article by the International HIV/AIDS Alliance (2003) that presents an assessment of the successes and failures of the global response to AIDS from 1993-2003.

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10. Governance and participation in health

HEALTH PROMOTION THROUGH SELF-CARE AND COMMUNITY PARTICIPATION
http://www.biomedcentral.com/1471-2458/4/11/abstract
The concepts of health promotion, self-care and community participation emerged during the 1970s, primarily out of concerns about the limitation of professional health systems. Since then there have been rapid growth in these areas in the developed world, and there is evidence of effectiveness of such interventions. These areas are still in their infancy in the developing countries. There is a window of opportunity for promoting self-care and community participation for health promotion. This article proposes elements of a programme for health promotion in the developing countries following key principles of self care and community participation.

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11. Monitoring equity and research policy

ENSURING SUCCESSFUL TRANSFER OF HEALTH POLICY BETWEEN COUNTRIES
http://tinyurl.com/2orzu
How do health policies spread from one country to the next? Transfer without ownership may make implementation difficult. Researchers from the London School of Hygiene and Tropical Medicine look at the development of international policy on tuberculosis (TB) control over the last two decades. Do policy-makers adopt and adapt health policies voluntarily, after learning about experiences in other countries, or do international organisations or donors more often impose policies? The researchers posed these and other questions during interviews with 40 key players in TB policy development.

GETTING RESEARCH INTO PRACTICE IN DEVELOPING COUNTRIES
http://www.inasp.info/health/workshop33.html
Lessons from medical research may take years to get through to the frontline of healthcare. This is exacerbated in developing countries where there are difficulties in dissemination and barriers that prevent healthcare providers acting on new findings. Furthermore, most biomedical research is in high-income countries, and the results are not necessarily applicable in low-income countries. This is a according to a meeting at the Royal College of Physicians in London in January that explored these issues under the topics of ‘Dynamics and barriers; Systematic reviews: do they have a role?’; and ‘Recent changes in healthcare information and emerging challenges’.

TURNING SCIENCE INTO ACTION TO IMPROVE PEOPLE'S HEALTH
http://www.who.int/rpc/reports/WR2004AnnotatedOutline.pdf
The objective of this World Health Organisation report is to describe strategies to reduce global disparities in health through improvements in health research systems at national and international levels and systematic application of evidence-based knowledge. The Report focuses on bridging of the "know do" gap, the gulf between what we know and what we do in practice, between scientific potential and health realization. The bridging of this gap is central to achieving the health-related Millennium Development Goals (MDG’s) by 2015. The gap exists for each of the MDG’s and represents a fundamental and pragmatic knowledge translation challenge that must be addressed to strengthen health systems performance towards achieving the MDG’s.

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12. Useful Resources

2003 INTERNATIONAL DRUG PRICE INDICATOR GUIDE WITH CD-ROM
http://erc.msh.org
The 2003 edition of the International Drug Price Indicator Guide provides a spectrum of prices from 19 sources, including non-profit drug suppliers, commercial procurement agencies, international development organisations, and government agencies. The Guide helps supply officers determine the probable cost of pharmaceutical products for their programs, compare current prices paid to prices available on the international market, assess the potential financial impact of changes to a drug list, and support rational drug use education.

E-DISCUSSION FORUM: GLOBAL REPORTS
Looking at global reports over time gives us a sense of the various issues that have captured sufficient attention from policy makers and civil society to justify the effort to produce and diffuse a global report. One way to interpret the growth in the number and widening range of issues covered by Global Reports is to suggest that this growth in global reporting reflects the fact that an increasing range of global challenges has emerged. The point up for debate is: Has there been a match or a mismatch between the two? To subscribe to this debate, and to share your views with over 350 people who have registered with this e-discussion forum, send a blank email to: subscribe-gpgnet-reports@groups.undp.org. Read the complete background paper at http://www.gpgnet.net/topic06.php

IDRC ONLINE COURSES: DESIGNING AND CONDUCTING HEALTH SYSTEMS RESEARCH PROJECTS
http://web.idrc.ca/en/ev-33010-201-1-DO_TOPIC.html
This two-volume set presents a course outline, in modular format, that deals step-by-step with the development of a Health Systems Research (HSR) proposal and field testing (Part 1) and with data analysis and report writing (Part 2).

WEB TIPS: USEFUL WEB SITES
* http://www.psr.keele.ac.uk/const.htm
Search engine for Constitutions, treaties and declarations at Political Science Resources, UK Contains international conventions and treaties and national constitutions listed by country, A to Z.
* http://confinder.richmond.edu
Search database for National constitutions, organized alphabetically. University of Richmond, School of Law, USA
* http://doc-iep.univ-lyon2.fr/Resources/Liens/constitution-etr.html
Search database for national constitutions at University of Lyon. However, it is all in French, no obvious English option!
* http://www.cia.gov/cia/publications/factbook/
The World Fact Book. You select a country and under the government section, you can locate the icon for constitution. However, it only provides general information on when adopted, etc. The actual constitution is not listed.


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13. Jobs and Announcements

COST-EFFECTIVENESS ANALYSIS WORKSHOP
Durban, South Africa, 10:30 Am - 12:30 Pm, June 12
Cost-effectiveness analysis (CEA) has become an increasingly important tool for analyzing health care systems and setting priorities. CEA was strongly endorsed by the World Bank in its 1993 report on Investing in Health as a way of ensuring that health systems provide “value for money,” and is now being promoted by other agencies as well, as in the case of the World Health Organisation’s WHO-CHOICE initiative. But is CEA a reliable way of getting the most out of limited health system resources? Or does it, rather, distract attention from equity concerns, undermine initiatives to provide primary health care, and distract us from directly challenging political choices that limit resources available for health systems?
Further details: /newsletter/index.php?id=1943

GLOBAL HEALTH WATCH DUE FOR LAUNCH IN 2005
The Global Health Watch – a bi-annual production that will represent an alternative World Health Report will be launched at next year’s World Health Assembly in May 2005 and at the People’s Health Assembly in June 2005. The report is aimed to provide an alternative perspective on health that places equity, human and social rights; the politics and economics of development; and the centrality of health systems development at the forefront of international health debates. In addition, the report aims to act as a monitor of the performance of global health institutions such as WHO and Global Fund; development and multi-lateral agencies such as the World Bank and WTO; multi-national corporations; and the nations of the G8/OECD.
Further details: /newsletter/index.php?id=1926

HEALTH INFORMATICS CONFERENCE
6-8 October 2003, Kimberly, South Africa - Abstracts Due By 31 May
http://www.epatientrecords.co.za/hisa2004/main.php
The South Africa Health Informatics Association, in conjunction with the Computer Society of South Africa, is organising the "Health Informatics: Southern Africa" 2004 conference. This will be held from the 6-8 October 2004 in Kimberley in the Northern Cape Province.


MALAWI HEALTH EQUITY NETWORK (MHEN)
The Malawi Health Equity Network (MHEN) was formed in 2000 as a grouping of individuals and organisations working to promote equity in health in Malawi. This is a national network with central offices (secretariat) in Lilongwe. The Network aims to achieve this goal through networking, research, policy dialogue and advocacy. Key areas of interest by the Network include; essential drug availability in public health facilities, availability of health human resources, national budget formulation, linkages with parliamentary committees and HIV/AIDS.
Further details: /newsletter/index.php?id=1930

SOUTH AFRICA: SENIOR RESEARCHER POSTS: PUBLIC HEALTH EPIDEMIOLOGY AND HEALTH INFORMATION SYSTEMS
The School of Public Health is a forerunner in the public health areas of health promotion, health equity, health information systems, nutrition, health programme development and human resource development. Two senior researchers are required for a new project, aimed at assisting development of health programmes such as HIV/AIDS and nutrition, at health district level. The senior researchers are expected to assist programme managers to develop information systems for their programmes.
Further details: /newsletter/index.php?id=1944

SOUTHERN AFRICA: HIV/AIDS PROGRAMME OFFICER
Open Society Initiative For Southern Africa
(OSISA) is a leading regional foundation, established in 1997 by investor and philanthropist George Soros, to create and sustain the institutions, policies and practices of an open society, where good governance, human rights and justice are respected and upheld. Its programmes broadly focus on Education, Media, Human Rights and Democracy as well as Information Communication Technologies. In addition to undertaking advocacy, and working through multi-level partnerships with others, OSISA oversees US$5 million in grants annually across a region made up of Angola, Botswana, Lesotho, Malawi, Mozambique, Namibia, Swaziland, Zambia and Zimbabwe.
Further details: /newsletter/index.php?id=1933

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