EQUINET NEWSLETTER 73: 01 MARCH 2007
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
CLAIMING OUR SPACE: USING TRIPS FLEXIBILITIES TO PROTECT ACCESS TO MEDICINES
Aulline H. Mabika, Percy F. Makombe, SEATINI
In February this year the WHO Director General, Margaret Chan caused a storm when she was quoted in Thailand saying that the country should negotiate with pharmaceutical companies before issuing a compulsory license. She encouraged the nation’s public health ministry to improve its relationship with drug companies to strike the right balance in accessing drugs. Chan’s statement created the impression that there was something wrong with compulsory licensing that needed to be corrected through negotiating with pharmaceutical companies.
If the comments were meant to shock and awe, they achieved exactly that! Shocked treatment access advocates sought clarification from the DG herself on the alleged statements. Five days after the comments appeared in the Bangkok Post of February 2, civil society received information that a letter was dispatched to Thai’s Minister of Health, Mongkol Na Songkhla. There had been a misunderstanding, the Director General said. She regretted that her comments “were misrepresented in the media, and may have caused embarrassment to the government of Thailand. They should not be taken as criticism of the decision of the Royal Thai government to issue compulsory licences which is entirely the prerogative of the government, fully in line with the TRIPS agreement.”
For the avoidance of doubt, the Director General went on to say the following:
"WHO unequivocally supports the use by developing countries of the flexibilities within the TRIPS agreement that ensure access to affordable, high quality drugs. This includes the use of compulsory licensing, as described in paragraph 6 of the Doha Declaration on the TRIPS Agreement and Public Health. The decision whether to issue a compulsory license for a pharmaceutical product is a national one. There is no requirement for countries to negotiate with patent holders before issuing a compulsory licence."
This statement helped to clarify an impression that pharmaceutical companies have higher priority than people’s lives. For Africa this is particularly important, with Southern Africa the epicentre of the global HIV epidemic with 34 % of global AIDS deaths occurring in the region. While AIDS places a heavy burden on households and health systems generally, the cost of treatment for AIDS continues to be disproportionate to the incomes of affected families and of governments.
According to Oxfam reports, prices of some treatment regimens for AIDS are on the rise. This is saddening evidence coming six years after the historic signing of the Doha Declaration on TRIPS and Public Health in 2001. Fierce generic competition has helped prices for first-line AIDS drug regimen to fall by 99% from $10,000 to roughly $130 per patient per year since 2000. However prices for second-line drugs remain high due to increased patent barriers in key generics producing countries like India. Patients who develop resistance to first line regimens need these second line drugs, and the number is likely to grow over time, as will the unaffordable cost to health systems.
As outlined in the EQUINET / SEATINI leaflet on using TRIPS flexibilities (at www.equinetafrica.org) countries have full authority under TRIPS to use compulsory licensing or parallel importation of drugs if their laws provide for this and they need them for public health., Most (but not all) countries in the region have now passed the relevant laws for this. But the political and diplomatic pressure to dissuade governments from using these TRIPS flexibilities keeps mounting. A case in point is the legal action against the Indian government by a pharmaceutical company, Novartis. Novartis is challenging a section of India's Patents Act that aims to restrict certain kinds of patents. Novartis brought a civil lawsuit against the Indian government after the country rejected in January 2006 the company's attempt to patent a new version of its leukaemia drug, Gleevec, on the basis that the drug is a new formulation of an existing drug. If Novartis wins the case it could potentially set a precedent for other pharmaceutical companies seeking patent protection for formulations of drugs made before 1995, including antiretrovirals.
As institutions involved in health in Africa, we expect no ambiguity on this from WHO. Governments should be encouraged to use the flexibilities provided to them in the WTO TRIPS Agreement, including issuing compulsory licenses, to access generic drugs. With the Global Fund for AIDS, TB and Malaria and UNAIDS, still more needs to be done to bring down the cost of these drugs, particularly of the second line regimens, and to make them affordable on a long term basis.
For our part, we expect our governments and parliaments to ensure that our national laws incorporate TRIPs flexibilities, that our authorities are organised to implement them and that our populations are organised to protect their use. We expect our governments to reject clauses in bilateral trade agreements that attempt to remove authority to use these flexibilities. We have regional intergovernmental organisations such as COMESA and SADC to share information, resources and expertise and to harmonise legislation.
We can also stimulate the production and marketing of generic drugs, increasing returns to producers and access for people who need them. We can work through these same regional organisations to collectively issue compulsory licenses for common public health problems. In Latin America, for example, ten countries joined efforts to get agreements from generic manufacturers and originators on generic drug production. If ESA countries use regional frameworks to collectively issue compulsory licenses for the same drug, this builds a large enough market to encourage producers to invest in producing cheaper, generic versions of these drugs.
Please send feedback or queries on the issues raised in this briefing to the EQUINET secretariat at TARSC, email email@example.com and please visit the SEATINI website at www.seatini.org. EQUINET work on health equity in economic and trade policy and further information on TRIPS flexibilities is available at the EQUINET website at www.equinetafrica.org.
BUILDING EQUITABLE, PEOPLE-CENTRED NATIONAL HEALTH SYSTEMS: THE ROLE OF PARLIAMENT AND PARLIAMENTARY COMMITTEES ON HEALTH IN EAST AND SOUTHERN AFRICA
Musuka G, Chingombe I
The Health Systems Knowledge Network of the WHO Commission on the Social Determinants of Health in co-operation with the Regional Network for Equity in Health in east and southern Africa (EQUINET) commissioned a desk review of the role of parliaments and parliamentary portfolio committees on health in building equitable and people centered national health systems. This review presents evidence from published literature, and other secondary evidence in the east and southern African regions.
THE DISPOSSESSION OF AFRICAN WEALTH AT THE COST OF AFRICAN HEALTH
This article synthesises data reported in EQUINET discussion paper 30 about the outflow of Africa’s wealth, to reveal structural factors behind the continent’s ongoing underdevelopment. The flow of wealth out of sub-Saharan Africa to the North occurs primarily through exploitative debt and finance, phantom aid, capital flight, unfair trade, and distorted investment. Although the resource drain from Africa dates back many centuries—beginning with unfair terms of trade, amplified through slavery, colonialism, and neocolonialism—today, neoliberal (free market) policies are the most direct causes of inequality and poverty. They tend to amplify preexisting class, race, gender, and regional disparities and to exacerbate ecological degradation. Reversing this outflow is just one challenge in the struggle for policy measures to establish a stronger funding base for the health sector.
A LENS ON THE WORLD SOCIAL FORUM
Editor, EQUINET Newsletter
In the February newsletter we carried stories of the World Social Forum held in January 2007 and called for comment and report from those who attended. In this issue we carry three of the responses, that give a different set of lenses on and expectations of the WSF. They signal aspirations and contradictions that seemed to resonate across the WSF. The WSF offered all the potential of an agenda of social justice, international solidarity, gender equality, peace and defence of the of the environment. This made reports of big business sales of food, corporate signs and overshadowing of local people by international organisations harsh and visible contradictions. But the WSF also gave visibility and support to struggles for health and an opportunity to amplify the call on African Union member states to meet their commitments in health, like the pledge to spend 15% of government spending on health. If the “battle for ideas” is central to the building of alternatives, the WSF taught that it is not only the content of the ideas that count, but who owns and voices them.
DIALOGUE BETWEEN AFRICANS AND ASIANS AT THE WORLD SOCIAL FORUM: “STRUGGLES IN THE SOUTH ARE CHANGING THE WORLD!”
Mwajuma Masaiganah, Tanzania
Prior to the World Social Forum in Nairobi, as people from African and Asian countries in “the South” we met and discussed over two days our conditions, our experience and how we can work to construct an Africa and an Asia where we can control our resources and make decisions in the interests of ordinary people.
THE ROLE OF ACADEMICS AT THE WSF
Fred Mugisha, Kenya
I'm apprehensive- what can I, an academic, write about the World Social Forum (WSF) January 2007? This WSF in Nairobi was the first I had attended. I was invited by the Eastern Africa Coalition on Economic social and cultural rights under the Human rights caucus to discuss how evidence from research supports civil society efforts. I met several groups of people from all walks of life, and from all over the world – farmers, people living in slums, refugees, gay people, those fighting for the rights of the poor, and others. After my talk, a Civil Society Organization (CSO) leader came to me and said: “Mugisha, thank for your talk. We in civil society have the guns, but we lack bullets”. For a moment, I did not understand. Was he talking about a guerilla war? Later I understood him to mean that civil society have the platform, but lack the evidence to inform and sharpen their messages for maximum impact.
WORLD SOCIAL FORUM: DEMAND POLITICAL LIBERATION OF COMMUNITIES TO TAKE CONTROL OF RIGHT TO HEALTH
Thomas Deve, Zimbabwe
Kasarani, an otherwise sleepy stadium in Nairobi, Kenya was a beehive of activity in January. Thousands of activists from all corners of the world thronged the stadium for the World Social Forum in search of a path to sustainable development, social and economic justice, continuing a tradition that started with the first the WSF, organized in Porto Alegre, Brazil in 2001. For all of us present, we realise that building another world is possible, but through alternative models for people-centred and self-reliant progress, and not the current neo-liberal globalization. Those who work on health had a clear message on what that means for health. “Health is a fundamental right. The time has come work for the right to health, to put in place universal, comprehensive and equitable health systems and social security.”
WORLD SOCIAL FORUM: TRADE FAIR TO LEFT POLITICS?
Bond P: Pambazuka News 289, February 2007
In this article Patrick Bond assesses the aftermath of the World Social Forum (WSF), held from January 20-25 in Nairobi. It documents that there were some triumphs for social justice, but also some worrying trends that emerged from the forum. Bond examines what it means for the future of the WSF concept. It describes how a mixed message - combining celebration and autocritique - is in order, in the wake of the Nairobi World Social Forum. From January 20-25, the 60,000 registered participants heard the triumph of radical rhetoric and yet, too, witnessed persistent defeats for social justice causes - especially within the WSF's own processes.
WSF007? LOVED IT!!!
Kachingwe N: AGP Global Action News, February 2007
This author introduces themselves as an overtly vocal critic. She reports being most disheartened about the avalanche of negative writing that has thundered from on high on the WSF and discusses ways in which the 2007 World Social Forum (WSF-Africa)produced failures and achievements. She ends on a high note "From the bottom of my heart to all those people who came to WSF, who organised their workshops, seminars, tribunals and marches, who set up their tents and sat through hours of discussion, who travelled for 3 days on the bus, who got grey hairs being in the organising committees or dealing with the organising committees, whose possessions were stolen or burnt, who lost luggage, who were denied visas, who monopolised communication services, who catered, who invaded the caterers, who brought partners, ex-presidents and Nobel prize winners, who played drums and rapped and sang and danced, who spoke for an hour rather than 10 minutes, who shared their personal experiences, who wrote all manner of nasty articles, who ripped us off in taxis, who cleaned the portable toilets for little thanks, who printed not so practical programmes .... everyone, everyone, everyone, everyone ... till we meet again ... ASANTE SANA! VIVA!"
10 000 ABORTIONS DONE IN SOUTH AFRICA PER WEEK
The Argus, 3 February 2007
For South Africa's anti-abortion campaigners, 1 February 2007 is a day of sadness and mourning. But for the government and women's rights groups, it was a day for victory and celebration. Ten years ago, on 1 February 1997, the Choice on Termination of Pregnancy Act came into effect, becoming one of the most liberal abortion laws in the world. Records show a steady access to services nationally and progress towards greater service provision. A 1998-2001 mortality study by the Medical Research Council (MRC) found there was a reduction of up to 91 percent in deaths from unsafe abortions. But detractors such as Doctors for Life and the Christian Action Network continue to decry its existence and have mounted one legal challenge after the next to have it scrapped.
HEALTH AND DEMOCRACY: A GUIDE TO HUMAN RIGHTS, HEALTH LAW AND POLICY IN POST APARTHEID SOUTH AFRICA
Hassim A, Heywood M, Berger J: Siber Ink Publishers
This book highlights the key issues that constitute and affect health law in post apartheid South Africa. It is a constructive, precise and detailed book that has innovative ideas on how the law can be used to protect and serve its people more effectively. It examines the South African health system from a rights perspective and makes recommendations for future policy and legislative development. It draws attention to many complex issues linked to health care and goes on to challenge health personnel, policy makers and users of the health system to defend the human right to health.
INTERNATIONAL WOMEN'S DAY 2007
IWD, February 2007
Organisations, companies, governments and media all around the world are busy planning exciting and meaningful International Women's Day activities for 8 March 2007. The UN theme for International Women's Day is "Ending Impunity for Violence against Women and Girls".
THE STATE OF THE WORLD'S CHILDREN
The State of the World’s Children 2007 examines the discrimination and disempowerment women face throughout their lives – and outlines what must be done to eliminate gender discrimination and empower women and girls. It looks at the status of women today, discusses how gender equality will move all the Millennium Development Goals forward, and shows how investment in women’s rights will ultimately produce a double dividend: advancing the rights of both women and children.
ARE TRIPS PROTECTIONISM AT THEIR WORST?
Editorial: The Lancet 9555(369): 2, 2007
The article describes international campaigns that are trying to defend the access of poor people in the world to pharmaceuticals. Both campaigns are calling for the rules of a World Trade Organization agreement called Trade Related Aspects of Intellectual Property to be upheld. The pharmaceutical company Novartis is bringing the government of India to court for not granting a patent to the company for the cancer drug imatinib mesylate. India only grants patents for medicines that are new and innovative. The Government Pharmaceutical Organization of Thailand wishes to make a generic version of the drug efavirenz. The US government and the pharmaceutical company Merck believe that the Thai government should have asked Merck's permission first before developing the drug.
COMPULSORY LICENCES STATEMENT SLATED BY NGOS
A controversy has emerged in the last few days on statements made by the new World Health Organisation (WHO) Director General Dr Margaret Chan on the compulsory licenses issued by the Thai government for the production of three patented drugs. Dr Chan was in Bangok to attend the Prince Mahidol Award Conference 2007 held on 1-2 February 2007. Witnesses noted quite a shocking series of events linked to the event.
GENERIC DRUGS STAND BY WHO CHIEF SLAMMED
Macan-Markar M: Inter Press Service News, 2 February 2007
Civil society and humanitarian groups slammed the new head of the World Health Organisation (WHO), on the sidelines of a meeting here, after she appeared to favour the interests of pharmaceutical giants over the plight of the sick and the poor in the developing world.
GENERIC MEDICINES DEFENDED BY MALAYSIAN ATTORNEY-GENERAL
3D Information Note 6, 5 February 2007
Malaysia's Attorney-General Tan Sri Abdul Gani has publicly stated his country's stand "that generic drugs should not be restricted in any manner," as generics are cheaper than patented medicines. He made this statement before the UN Committee on the Rights of the Child (CRC), whose session concluded in Geneva last week. He was speaking in response to pointed questions from the Committee?s Chair, Jacob E. Doek, who asked Malaysian governmental representatives how they can ensure that trade agreements do not affect provision of generic medicines, particularly for the treatment of HIV/AIDS.
GENERICS LICENSE STATEMENT REGRETABLE SAYS WHO DIRECTOR GENERAL
Khor M: Third World Network, 15 February 2007
The WHO Director General Dr. Margaret Chan, has sent a letter to Thailand's Health Minister expressing regret for the embarrassment caused to his government by remarks she was reported to have made in Bangkok that were critical of the compulsory licenses granted by the government for three medicines. The letter follows the deep offence that Dr. Chan's comments had caused the government and particularly the Minister of Public Health. Dr. Chan's reported comments had also caused outrage among international health NGOs and grassroots health movements worldwide, especially groups representing people living with HIV-AIDS. More than 400 groups and individuals have sent her a protest letter asking her to change her views.
GROUPS URGE NOVARTIS TO DROP PATENT CASE AGAINST INDIA
Raja K: Third World Network, 30 January 2007
Nearly a quarter of a million persons from more than 150 countries have voiced concerns over the negative impact that a legal challenge brought by the multinational pharmaceutical company Novartis against India's patent law could have on access to medicines in developing countries. The legal challenge brought by the Swiss-based Novartis against the government of India began to be heard in the Chennai High Court on Monday - despite an international petition launched by the international medical humanitarian organization Medicins Sans Frontieres (MSF) last December to put pressure on the company to drop its patent case against India.
HIV/AIDS CIVIC SOCIETY ORGANISATIONS AND MOVEMENTS WORKING ON ACCESS ADDRESS WHO DG
5 February 2007
This letter represents people living with HIV/AIDS and their advocates around the world who are fighting for access to affordable treatment for HIV, writing to request that the Director General of the World Health Organisation (WHO) reconsider her comments regarding the Thai government’s decision to issue a compulsory license for the production or importation of three drugs, two for treating HIV/AIDS. They state that she has been entrusted, in your position as director general of WHO, to work for “the attainment by all peoples of the highest possible level of health”, and their belief that her comments last week do not reflect this mission, and in fact work against it.
LINKING MIGRATION, HIV/AIDS AND URBAN FOOD SECURITY IN SOUTHERN AND EASTERN AFRICA
Southern African Mobility Project (SAMP)
Mobility is the means by which many individuals and households seek security of income and livelihood: traders move between sources and markets, migrant workers go to mines, factories, towns and farms. Looking specifically at the experiences of women, both as street traders and domestic workers, the authors find that mobility is that is essential to securing these women's individual and household livelihoods increases their vulnerability to HIV. Research found that lack of information on HIV was one of the main factors in making them more vulnerable highlighting the need for HIV education initiatives targeted at specific migrant communities.
PROMINENT FIGURES CALL ON NOVARTIS CALLED TO DROP ITS CASE IN INDIA
Raja K: Third World Network, 17 February 2007
More prominent figures have joined the chorus of over 300,000 people worldwide voicing concerns about Novartis’ legal challenge against the Indian government and its impact on access to essential medicines across the globe. They include the former Swiss President, Archbishop Desmond Tutu, Stephen Lewis former UN Special Envoy for HIV/AIDS in Africa, and Dr. Michel Kazatchkine, the head of the Global Fund to Fight AIDS, Tuberculosis and Malaria.
WHO EXECUTIVE BOARD UNABLE TO MOVE IP GROUP PROCESS
Hong E: Third World Network, 2 February 2007
Several developing-country members of the Executive Board of the World Health Organisation have expressed concern and frustration at the lack of progress and direction of a WHO group tasked with charting the organisation's future action on intellectual property, innovation and health. These concerns were voiced at the WHO's Executive Board meeting being held on 22-30 January. At the end of the discussion on the item, the frustration was even more palpable because the Board itself could not seem to make any progress on the issue.
DOES LIVING IN AN URBAN ENVIRONMENT CONFER ADVANTAGES FOR CHILDHOOD NUTRITIONAL STATUS? ANALYSIS OF DISPARITIES IN NUTRITIONAL STATUS BY WEALTH AND RESIDENCE IN ANGOLA, CENTRAL AFRICAN REPUBLIC AND SENEGAL
Kennedy G, Nantel G, Brouwer ID, Kok FJ: Public Health And Nutrition 9(2):187-93, April 2006
The purpose of this paper is to examine the relationship between childhood undernutrition and poverty in urban and rural areas.
TOWARD FOOD AND NUTRITION SECURITY IN AFRICA
International Food Policy Research Institute, January 2007
Several major initiatives in the past few years have brought renewed attention and commitment to economic development and food and nutrition security in Africa. The recent economic recovery and the new commitment to change among African leaders and development partners indicate for the first time after decades that Africa is poised to achieve real progress toward food and nutrition security. Sustaining and accelerating growth to reach the poverty reduction and nutrition Millennium Development Goals will require clear strategies to guide future policy and investment decisions. Furthermore, these goals seek to only halve the number of poor and malnourished in the next 10 years, something a number of African countries will fail to do. Progress toward food and nutrition security in Africa, therefore, calls for more than growth and requires a greater focus on human welfare improvement supported by adequate investments in health and nutrition safety nets to protect vulnerable segments of the population.
CALL TO ACTION: HEALTH SYSTEM STRENGTHENING THROUGH THE GLOBAL FUND
The Global Fund
Round 7 of the Global Fund to Fight AIDS, Tuberculosis and Malaria, which launches March 1, 2007, offers an important opportunity to fund health system strengthening, including the health workforce. To prepare for Round 7, health workers, ministry of health officials, and other individuals and institutions that have an interest in their countries' health systems are strongly encouraged to consider utilizing this opportunity for strengthening health systems. If interested, you should immediately contact members of your country's Country Coordinating Mechanism to discuss this potential, as well as the national process and timeline for developing these proposals. The proposals are expected to be due to the Global Fund in early July 2007.
SOUTH AFRICAN HEALTH REVIEW 2006 - MATERNAL, WOMENS AND CHILD HEALTH - THE UNFINISHED AGENDA
Health Systems Trust, 22 February 2007
Great strides have been made in improving maternal care in South Africa over the last decade. A record high of ninety percent of pregnant women attend antenatal care and 92% of deliveries of babies are conducted by skilled health workers. Despite such achievements in access to care, maternal deaths are on the increase, mostly fuelled the HIV and TB epidemics.
THE COST OF UNCOMPLICATED CHILDHOOD FEVERS TO KENYAN HOUSEHOLDS: IMPLICATIONS FOR REACHING INTERNATIONAL ACCESS TARGETS
Larson BA, Amin AA, Noor AM, Zurovac D, Snow RW: BMC Public Health 6:314, 29 December 2006
We assemble data developed between 2001 and 2002 in Kenya to describe treatment choices made by rural households to treat a child's fever and the related costs to households. Using a cost-of-illness approach, we estimate the expected cost of a childhood fever to Kenyan households in 2002. We develop two scenarios to explore how expected costs to households would change if more children were treated at a health care facility with an effective antimalarial within 48 hours of fever onset.
NEW DATA ON AFRICAN HEALTH PROFESSIONALS ABROAD
Center For Global Development Working Paper 95, 8 November 2006
The migration of doctors and nurses from Africa to developed countries has raised fears of an African medical brain drain. But empirical research on the causes and effects of the phenomenon has been hampered by a lack of systematic data on the extent of African health workers’ international movements. We use destination-country census data to estimate the number of African-born doctors and professional nurses working abroad in a developed country circa 2000, and compare this to the stocks of these workers in each country of origin. Approximately 65,000 African-born physicians and 70,000 African-born professional nurses were working overseas in a developed country in the year 2000. This represents about one fifth of African-born physicians in the world, and about one tenth of African-born professional nurses. The fraction of health professionals abroad varies enormously across African countries, from 1% to over 70% according to the occupation and country. These numbers are the first standardized, systematic, occupation-specific measure of skilled professionals working in developed countries and born in a large number of developing countries.
AFRICA'S NURSES: UNWITTING TUBERCULOSIS CARRIERS
Du L, Scott C, Harvey E: Medicine Online, 2007
More than half of all healthcare workers in the developing world, including Africa, are unknowingly infected with latent tuberculosis, according to a report available on the open-access Science and Development Network website. The study, published in the online journal Medicine by the open-source Public Library of Science, highlights the risk of tuberculosis transmission from patients to healthcare workers - and onward into the general community.
BETTER PAY IN STORE FOR HEALTH WORKERS
Mail & Guardian (South Africa), 21 February 2007
Eextra money budgeted for the Health Department means better salaries for health workers -- particularly nurses, it said on Wednesday after Finance Minister Trevor Manuel's Budget speech. The additional R5,3-billion allocated for human resources was in response to the department's proposals, said spokesperson Sibani Mngadi.
EXPERIENCE OF INITIATING COLLABORATION OF TRADITIONAL HEALERS IN MANAGING HIV AND AIDS IN TANZANIA
Kayombo EJ, Uiso FC, Mbwambo ZH, Mahunnah RL, Moshi MJ, Mgonda YH: Journal Of Ethnobiology And Ethnomedicine 3:6, 26 January 2007
Collaboration between traditional healers and biomedical practitioners is now being accepted by many African countries south of the Sahara because of the increasing problem of HIV/AIDS. The key problem, however, is how to initiate collaboration between two health systems which differ in theory of disease causation and management. This paper presents findings on experience learned by initiation of collaboration between traditional healers and the Institute of Traditional Medicine in Arusha and Dar-es-Salaam Municipalities, Tanzania where 132 and 60 traditional healers respectively were interviewed. Of these 110 traditional healers claimed to be treating HIV/AIDS. The objective of the study was to initiate sustainable collaboration with traditional healers in managing HIV/AIDS. Consultative meetings with leaders of traditional healers' associations and government officials were held, followed by surveys at respective traditional healers' "vilinge" (traditional clinics). The findings were analysed using both qualitative and quantitative methods.
HEALTH SECTOR REFORMS AND HUMAN RESOURCES FOR HEALTH IN UGANDA AND BANGLADESH: MECHANISMS OF EFFECT
Ssengooba F, Rahman SA, Hongoro C, Rutebemberwa E, Mustafa A, Kielmann T, McPake, B: Human Resources For Health 5:3, 1 February 2007
Despite the expanding literature on how reforms may affect health workers and which reactions they may provoke, little research has been conducted on the mechanisms of effect through which health sector reforms either promote or discourage health worker performance. This paper seeks to trace these mechanisms and examines the contextual framework of reform objectives in Uganda and Bangladesh, and health workers' responses to the changes in their working environments by taking a 'realistic evaluation' approach.
TACKLING MALAWI'S HUMAN RESOURCES CRISIS
Palmer D: Reproductive Health Matters: 14 (27): 27-39, 2006
In sub-Saharan Africa, health systems are fragile and staffing is grossly inadequate to meet rising health needs. Despite growing international attention, donors have been reluctant to undertake the significant investments required to address the human resources problem comprehensively, given social and political sensitivities, and concerns regarding sustainability of interventions and risks of rising donor dependency. In Malawi in 2004 the government launched a new health initiative to deliver an Essential Health Package, including a major scale-up of HIV and AIDS related services. Improving staffing levels is the single biggest challenge to implementing this approach. Registration (free of charge) with medscape is required to view the article.
REGULATING PRIVATE HEALTH INSURANCE TO SERVE THE PUBLIC INTEREST: POLICY ISSUES FOR DEVELOPING COUNTRIES
Sekhri N, Savedoff W: The International Journal Of Health Planning And Management 21(4): 357-392
Private health insurance plays a large and increasing role around the world. This paper reviews international experiences and shows that private health insurance is significant in countries with widely different income levels and health system structures. It contrasts trends in private health insurance expansion across regions and highlights countries with particularly important experiences of private coverage. It then discusses the regulatory approaches and policies that can structure private health insurance markets in ways that mobilize resources for health care, promote financial risk protection, protect consumers and reduce inequities. The paper argues that policy makers need to confront the role that private health insurance will play in their health systems and regulate the sector appropriately so that it serves public goals of universal coverage and equity.
SHARING THE BURDEN OF TB/HIV? COSTS AND FINANCING OF PUBLIC–PRIVATE PARTNERSHIPS FOR TUBERCULOSIS TREATMENT IN SOUTH AFRICA
Sinanovic E, Kumaranayake L: Tropical Medicine & International Health 11(9): 1466-1474
The objective of this study was to explore the economic costs and sources of financing for different public–private partnership (PPP) arrangements to tuberculosis (TB) provision involving both workplace and non-profit private providers in South Africa. The financing required for the different models from the perspective of the provincial TB programme, provider, and the patient are considered.
DARK CLOUD OVER GOOD WORKS OF GATES FOUNDATION
Piller C, Sanders E, Dixon R: L A Times, 7 January 2007
In a contradiction between its grants and its endowment holdings, Corporate Watch reports that Gates Foundation provides 5% of its worth annually as grants for health initiatives, public education and social welfare and invests the other 95% of its worth. The investigation found investments in companies that have failed tests of social responsibility because of environmental lapses, employment discrimination, disregard for worker rights, or unethical practices. Corporate Watch outlines those investments that appear to contradict the foundations grant support goals and the feedback obtained from the Gates Foundation on the findings.
DISTRICT HEALTH BAROMETER
Health Systems Trust, 22 February 2007
The highest per capita primary health care expenditure in the public sector by a district in South Africa during 2005/06 was R416 per person in Bophirima district in the North West province. This is in stark contrast to the lowest rate of R115 per person spent in Greater Sekhukhune, a relatively deprived district in Limpopo province.
HEALTH INSURANCE FOR THE INFORMAL SECTOR IN TANZANIA: SOCIAL SECURITY FOR THE EXCLUDED MAJORITY
Kiwara, A: International Labour Organisation (ILO)
For the past two decades the informal sector has grown very rapidly in Tanzania. In the early 1990s it was estimated to be contributing about 60% of the country's GDP. Some authorities even believe that this figure is an underestimate. This sector provides a "safety net" to many women and youth in the country. Its role in providing for livelihood is becoming more important as the formal sector shrinks due to retrenchment. This feasibility study aimed at assessing how and under what conditions the outputs produced and the activities deployed by the ILO project on social security for the informal sector will contribute to the establishment of a social security system in the two areas. The main emphasis for this study was the establishment of health insurance schemes in the identified areas, i.e., Mbeya and Arusha.
REPORT HITS GLOBAL FUND EXPENSES: DONATIONS USED FOR MEALS, LIMOS
Donnely J: The Boston Globe, 5 February 2007
The executive director of a $7 billion fund to fight deadly diseases in the world's poorest countries has made extensive use of a little-known private bank account, spending hundreds of thousands of dollars on limousines, expensive meals, boat cruises, and other expenses, according to an internal investigation. While not disputing 37 specific limousine charges in cities across Europe and the United States, dozens of entertainment and meals expenses, among other expenditures the inspector general deemed excessive, the Global Fund spokesman disputed the context, tone, and several facts in the inspector general's report. A separate investigation, overseen by the World Health Organization, also raised concerns about the use of the private bank account.
AIDS TREATMENT AND INTRAHOUSEHOLD RESOURCE ALLOCATIONS: CHILDREN'S NUTRITION AND SCHOOLING IN KENYA
Thirumurthy H, Zivin JG, Goldstein M: Center For Global Development Working Paper 105, 22 January 2007
The provision of life-saving antiretroviral (ARV) treatment has emerged as a key component of the global response to HIV/AIDS, yet little is known about the impact of this intervention on the welfare of children whose parents receive treatment. In this working paper CGD post-doctoral fellow Harsha Thirumurthy and his co-authors use longitudinal household survey data collected in collaboration with a treatment program in western Kenya to provide the first estimate of the impact of ARV treatment on children’s schooling and nutrition. They find that children's weekly hours of school attendance increase by over 20 percent within six months after treatment is initiated for the adult household member. Young children's short-term nutritional status also improves dramatically. Since the improvements in children’s schooling and nutrition at these critical early ages will affect their socio-economic outcomes in adulthood, the authors argue that the widespread provision of ARV treatment is also likely to generate significant long-run macroeconomic benefits.
AMPLIFYING THE AFRICAN VOICE IN TREATMENT ADVOCACY
Pan African Treatement Access Movement (PATAM) Strategic Planning Workshop Report, 15-18 December 2006
The Pan African Treatment Access Movement (PATAM) is a social movement comprised of individuals and organizations dedicated to mobilising communities, political leaders, and all sectors of society to ensure access to antiretroviral (ARV) treatment, as a fundamental part of comprehensive care for all people with HIV/AIDS in Africa. However, the year 2005 saw some changes that affected the movement’s effectiveness and threatened its survival. These made it necessary for the PATAM leadership to convene a strategic planning workshop and make decisions concerning the movement’s future. The workshop, which was hosted by the ALCS and funded by ActionAid, was divided into two parts. This document provides a detailed report of the workshop highlights.
STEEP HIV PREVALENCE DECLINES AMONG YOUNG PEOPLE IN SELECTED ZAMBIAN COMMUNITIES: POPULATION-BASED OBSERVATIONS (1995–2003)
Michelo C, Sandøy IF, Dzekedzeke K, Siziya S, Fylkesnes K: BMC Public Health 6:279, 10 November 2006
Understanding the epidemiological HIV context is critical in building effective setting-specific preventive strategies. We examined HIV prevalence patterns in selected communities of men and women aged 15–59 years in Zambia.
STREAMLINING ARV PROVISION FOR REFUGEES
Science In Africa, February 2007
The United Nations refugee agency, UNHCR, has launched a new policy to ensure that HIV-positive refugees and other displaced people around the world have access to life-prolonging antiretroviral (ARV) medication. The policy, designed to offer guidance to UNHCR and its partners as well as host governments, aims to integrate ARV provision as part of a comprehensive HIV/AIDS programme for refugees that includes prevention, care and support.
THE COST-EFFECTIVENESS OF ANTIRETROVIRAL TREATMENT IN KHAYELITSHA, SOUTH AFRICA – A PRIMARY DATA ANALYSIS
Cleary SM, McIntyre D, Boulle AM: Cost Effectiveness And Resource Allocation 4:20, 6 December 2006
Given the size of the HIV epidemic in South Africa and other developing countries, scaling up antiretroviral treatment (ART) represents one of the key public health challenges of the next decade. Appropriate priority setting and budgeting can be assisted by economic data on the costs and cost-effectiveness of ART. The objectives of this research were therefore to estimate HIV healthcare utilisation, the unit costs of HIV services and the cost per life year (LY) and quality adjusted life year (QALY) gained of HIV treatment interventions from a provider's perspective.
ZAMBIA: HIV/AIDS SERVICE PROVISION ASSESSMENT SURVEY 2005
Ministry Of Health (Zambia), Central Statistical Office (Zambia), ORC Macro: 2006
This report summarises the findings of the 2005 Zambia HIV/AIDS Service Provision Assessment (Zambia HIV/AIDS SPA) Survey carried out by the Zambia Ministry of Health and the Zambia Central Statistical Office. ORC Macro provided technical assistance and the U.S. Agency for International Development (USAID) provided funding.
AIDS, TB AND MALARIA: AFRICA DECLARES COMMITMENT
Ogbonnaya R: This Day (Lagos), 18 February 2007
Friends of the Global Fund Africa popularly referred to as Friends Africa, a new pan-African advocacy organisation, chose Kigali as the venue for the inauguration of its board and first board meeting to chart the way forward in the fight against HIV/Aids, tuberculosis and malaria, the three diseases it claimed have been dealing a great blow to African continent. In Kigali , Friends Africa brought together some of the most committed, credible and influential voices of Africa as an indication of African leaderships' determination to lead the fight against the three diseases.
HOME-BASED MANAGEMENT OF FEVER IN RURAL UGANDA: COMMUNITY PERCEPTIONS AND PROVIDER OPINIONS
Nsabagasani X, Sabiiti JN, Källander K, Peterson S, Pariyo G, Tomson G: Malaria Journal 6:11, 26 January 2007
Uganda was the first country to scale up Home Based Management of Fever/ Malaria (HBM) in 2002. Under HBM pre-packaged unit doses with a combination Sulphadoxine/Pyrimethamin (SP) and Chloroquine (CQ) called "HOMAPAK" are administered to all febrile children by community selected voluntary drug distributors (DDs). In this study, community perceptions, health worker and drug provider opinions about the community based distribution of HOMAPAK and its effect on the use of other antimalarials were assessed.
DEVELOPMENT OF AMSTAR: A MEASUREMENT TOOL TO ASSESS THE METHODOLOGICAL QUALITY OF SYSTEMATIC REVIEWS
Shea BJ, Grimshaw JM, Wells GA, Boers M, Andersson N, Hamel C, Porter AC, Tugwell P, Moher D, Bouter LM: BMC Medical Research Methodology 7:10, 15 February 2007
A measurement tool for the assessment of multiple systematic reviews (AMSTAR) was developed. The tool consists of 11 items and has good face and content validity for measuring the methodological quality of systematic reviews. Additional studies are needed with a focus on the reproducibility and construct validity of AMSTAR, before strong recommendations on its use can be made.
PROJECTIONS OF GLOBAL MORTALITY AND BURDEN OF DISEASE FROM 2002 TO 2030.
Mathers CD, Loncar,D: Plos Medicine 3(11): E442-e442
Global and regional projections of mortality and burden of disease by cause for the years 2000, 2010, and 2030 were published by Murray and Lopez in 1996 as part of the Global Burden of Disease project. To address the widespread demand for information on likely future trends in global health, and thereby to support international health policy and priority setting, the authors have prepared new projections of mortality and burden of disease to 2030 starting from World Health Organization estimates of mortality and burden of disease for 2002. This paper describes the methods, assumptions, input data and results.
RECORD LINKAGE RESEARCH AND INFORMED CONSENT: WHO CONSENTS?
Huang N, Shih SF , Chang HY, Chou YJ: BMC Health Services Research 7:18, 12 February 2007
Linking computerized health insurance records with routinely collected survey data is becoming increasingly popular in health services research. However, if consent is not universal, the requirement of written informed consent may introduce a number of research biases. The participants of a national health survey in Taiwan were asked to have their questionnaire results linked to their national health insurance records. This study compares those who consented with those who refused.
INCREASING PUBLIC HEALTH SPENDING IN THE SOUTH
ActionAid International USA
ActionAid International USA presents an introductory exploration of alternative macroeconomic policies for beginners from tuesday 13 March 2007 to 15 March 2007. This economic literacy training is designed to introduce US-based international advocacy organisations working on health, education, HIV/AIDS and women's rights to the issues and debates about how to increase public spending in poor countries throughout the Global South. This training is designed to provide a simple and clear introductory overview of the key issues for NGOs and non-economists, and will include several presentations by professional economists to explain the current policies and introduce possible alternatives that would enable countries to hire more doctors, nurses and teachers.
THE BIAS FREE FRAMEWORK: A PRACTICAL TOOL FOR IDENTIFYING AND ELIMINATING SOCIAL BIASES IN HEALTH RESEARCH
Burke MA, Eichler M: Global Forum For Health Research
The BIAS FREE Framework is a new, rights-based tool for identifying and eliminating biases deriving from social hierarchies in research, legislation, policies, programs, service delivery and practices. We know that you will find the BIAS FREE Framework of interest. See www.globalforumhealth.org to order hard copies or to download a pdf version.
4TH INTERNATIONAL GENDER CONFERENCE: SEXUAL AND GENDER-BASED VIOLENCE, A SOCIAL NIGHTMARE PROVOKING ACTION
The theme for this conference has been chosen because Sexual and Gender Based Violence is a major Public Health and Human Rights problem throughout the world. There is the call on Governments and all other Stakeholders to take concerted action and make recommendations for the Health, Education and Criminal Justice sectors of society to take the problem seriously. The organisers believe that no positive and sustainable change can occur unless the problems of Gender Equity are analysed within the framework of Public Health, Human Rights and Human Security. It is only when all aspects of society have equal rights and mutual recognition of these rights, that there can be an all encompassing and equitable development for all.
BURSARY COMPETITION 2007: QUEEN MARGARET UNIVERSITY, EDINBUROUGH
Applications are now invited for the Bursary Competition 2007. These are the only funded studentships QMU offers. Research at Queen Margaret University (QMU) awards two higher degrees by research, Doctor of Philosophy (PhD) and Master of Philosophy (MPhil). Research methods training is offered in the first semester but after that there are no taught elements as such - students are expected to manage their own research project, with guidance from a supervisor. Bursaries cover all tuition fees and provide help with living costs for three years (the prescribed period of study for a PhD). Bursaries are only available for PhD study based at Queen Margaret University, Edinburgh. The closing date for applications is 26 March 2007. No applications will be accepted after that date.
NOMINATIONS FOR THE CORE AND SUPPORT DELEGATION
The Global Fund To Fight AIDS, TB, And Malaria
Communities living with HIV, TB and affected by Malaria Delegation Global Fund to fight HIV, TB and Malaria for the AIDS Alliance are soliciting nominations for CORE delegation members for the Global Fund Board delegation of the Communities Living with HIV, TB and affected by Malaria. They are also soliciting nominations for SUPPORT delegation members for the Global Fund Board delegation of the Communities Living with HIV, TB and affected by Malaria. The closing date for all nominations is Monday 5 March 2007 at 17h00 GMT.
PEOPLE’S HEALTH MOVEMENT SOUTH AFRICA COORDINATION: PART-TIME ONE YEAR CONTRACT POSITION WITH A POSSIBILITY OF RENEWAL
People's Health Movement, 2007
The Peoples Health Movement (PHM) is a large global civil society network of health activists supportive of the WHO policy of Health for All and organised to combat the economic and political causes of deepening inequalities in health worldwide and revitalise the implementation of WHO’s strategy of Primary Health Care. PHM in South Africa (PHM-SA) is currently most active in Cape Town, but we aim to extend our activities throughout South Africa. They are looking for a dynamic and well organized person to co-ordinate the PHM-SA activities in consultation with the Cape Town-based Steering Committee. The closing date is Friday 2 March 2007.
PEPFAR: HELPING OR HINDERING THE WORKFORCE PLANNING OF HEALTH SYSTEMS IN POOR COUNTRIES? A CALL FOR EVIDENCE, CASE STUDIES AND STORIES
Physicians For Human Rights
Physicians for Human Rights and the Global Health Watch are calling for evidence, case studies and anecdotal reports of PEPFAR’s impact on health workforce planning in order to provide members of the US Congress and other officials who are seeking to improve the effectiveness of PEPFAR. Please submit or inform them of any evidence, reports, case studies or stories that can help answer the following questions. There are two deadlines by which we seek this information. • As soon as possible, not later than February 23rd – to inform Congress in time for them to be able to influence PEPFAR’s operational plans for FY 08 and • June 15th – to allow information to be incorporated into the next alternative world health report, as well as to help inform the reauthorization of PEPFAR.
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