This paper presents a qualitative study of perceptions and opinions regarding Chinese-supported health related activities in Africa through in-depth interviews among local African and Chinese participants in Malawi and Tanzania. The findings revealed shared experiences and views related to challenges in communication; cultural perspectives and historical context; divergence between political and business agendas; organization of aid implementation; management and leadership; and sustainability. Participants were broadly supportive and highly valued Chinese investment in health. However, they also shared common insights on challenges in communication between health teams; and limited understanding of priorities and expectations, and the need to improve needs assessments, rigorous reporting, and monitoring and evaluation systems.
Resource allocation and health financing
To respond to the outbreak of the COVID-19 pandemic, the International Monetary Fund (IMF) has committed $1 trillion and so far provided $89 billion worth of financial assistance to countries around the world. Oxfam has tracked this COVID-19 financing and fiscal measures referenced in each of the 91 packages approved so far using official IMF reports for the respective countries. The tracker covers the amounts of funding IMF committed and disbursed to borrowing countries by region, types of financing instruments the Fund has employed, the borrowing countries’ current debt situation, fiscal policy measures, particularly social spending aimed at addressing the crisis, anti-corruption and transparency measures which countries have committed to undertake, and proposed fiscal measures for the recovery period. The text provided in this tracker is a compilation of select and relevant quotes/excerpts from official IMF reports while the debt data was drawn from the World Bank’s Debtor Reporting System. The tracker has been compiled for the benefit of persons and institutions wanting a snapshot view of what governments are borrowing, what they intend to do with these funds, what the IMF is encouraging countries to take during the pandemic and in the recovery period, and to give citizens and civil society a tool to hold their governments and the IMF accountable.
Price, availability and stock-out data was collected in July 2019 for over fifty lowest-priced sexual and reproductive health (SRH) commodities from public, private and private not-for-profit health facilities in Kenya, Tanzania, Uganda and Zambia. Affordability was calculated using the wage of a lowest-paid government worker. Accessibility was illustrated by combining the availability and affordability measures. Overall availability of SRHC was low at less than 50% in all sectors, areas and countries, with highest mean availability found in Kenyan public facilities. Stock-outs were common; the average number of stock-out days per month ranged from 3 days in Kenya’s private and private not-for-profit sectors, to 12 days in Zambia’s public sector. In the public sectors of Kenya, Uganda and Zambia, as well as in Zambia’s private not-for-profit sector, all were free for the patient. In the other sectors unaffordability ranged from 2 to 9 SRH commodities being unaffordable. Accessibility was low across the countries, with Kenya’s and Zambia’s public sectors having six SRH commodities that met the accessibility threshold, while the private sector of Uganda had only one meeting the threshold. Accessibility of SRH commodities remains a challenge. Low availability in the public sector is compounded by regular stock-outs, forcing patients to seek care in other sectors where there are availability and affordability challenges. The authors propose that the findings be used by national governments to identify the gaps and shortcomings in their supply chains.
Perceptions regarding Chinese-supported health related activities in Africa were gathered through in-depth interviews among local African and Chinese participants in Malawi and Tanzania. The findings revealed shared experiences and views related to challenges in communication; cultural perspectives and historical context; divergence between political and business agendas; organization of aid implementation; management and leadership; and sustainability. Participants were broadly supportive and highly valued Chinese health aid. However, they also shared common insights that relate to challenging coordination between China and recipient countries; impediments to communication between health teams; and limited understanding of priorities and expectations. Further, they share perspectives about the need for shaping the assistance based on needs assessments as well as the importance of rigorous reporting, and monitoring and evaluation systems. The authors’ findings suggested that China faces similar challenges to those experienced by other longstanding development aid and global health funders.
“In Chiawelo, we are united as a community; people are kind, loving and supportive but most of all it's a place full of diversity- it allows us to learn different cultures, languages and teaches us to respect different people”. These are the words of eighteen-year-old Sanele Nkosi, the youngest member of the Chiawelo Budgeting for Change (CBC) Group, based in Soweto, Johannesburg. The group is a reflection of Sanele’s words, including many different people from many different walks of life: traditional Healers, local community members, clinic workers, community health workers, ward based outreach teams, clinic committee members and local government officials amongst others. In this Community Statement, the group highlight with evidence the health realities and resource gaps faced around the COVID-19 pandemic, including lack of access to social protection, food security, sanitation and adequate health care, gender-based violence, unsafe transport and reopening of educational institutions, youth unemployment, lack of support to the small business sector, for those in chronic unemployment and for community-led COVID-19 responses and safety initiatives and poor working conditions for Community Health Workers. They call for resources for a people- centred response to the COVID-19 pandemic and access to the rights people are entitled to.
This study of progress in financial risk protection in Uganda used data from the Uganda National Household Surveys for 2005/06, 2009/10, 2012/13 and 2016/17, measuring financial risk protection in terms of catastrophic health care payments and impoverishment. Although catastrophic health payments at the 10% threshold decreased from 22.4% in 2005/06 to 13.8% in 2012/13, they increased to 14.2% in 2016/17. The percentage of Ugandans pushed below the national poverty line decreased from 5.2% in 2005/06 to 2.7% in 2016/17. The distribution of both catastrophic health payments and impoverishment varied across socio-economic status, location and residence. The authors suggest targeted interventions reduce ‘out-of-pocket’ (OOP) payments among those affected and ensure that public health services are funded adequately, through forms of mandatory prepayment.
Emeritus Professor Diane McIntyre presents her chapter on: 'How best we can achieve a universal health system: a public conversation'. The chapter was published in the recent South African Health Review. She calls for a broadening of the national discourse on universal health coverage and proposes that the term is replaced with the term 'universal health system' which she suggests is less open to misinterpretation.
To achieve Sustainable Development Goal 3.4, countries have been urged to introduce sin taxes, such as those on sugar. Others have argued that such taxes may affect employment, economic growth and increase poverty. There is limited or no reliable evidence on this. Using a conceptual framework of relationships among SDGs as contradictory, reinforcing, or neutral, the authors used the recent introduction in Zambia of an equivalent 3% tax on non-alcoholic beverages, implicitly targeted at sugar-sweetened beverages to test the issue. While the goal of reducing non-communicable diseases is stated, concerns were raised that such a tax would be detrimental to the Zambia sugar value chain which contributes about 6% to GDP. The authors discuss that contradictions depend on a number of contextual factors, and make two conclusions about sugar taxation in Zambia. First, they argue that the current tax rate of 3% is likely neutral to be because it is too low to have any health or employment effects. However, the revenue raised can be reinvested to improve livelihoods. Secondly, they suggest increasing the tax rate but taking care to ensure that the rate is not too high to generate contradictions, carefully assessing important parameters such as elasticities and alternative economic livelihoods.
Thousands of ex-gold mineworkers in South Africa are suffering from silicosis and lack the medical screening, compensation, healthcare and support they need and deserve. Action for Southern Africa (ACTSA) led a campaign calling on gold companies to provide decent health and compensation in a campaign for justice for Southern African gold mineworkers with silicosis and tuberculosis. The campaign included: protesting outside the High Court; attending and speaking at many Anglo American AGMs; organising petitions; and producing campaign briefings. On 26 July 2019, the South Gauteng High Court approved a class action settlement worth at least R5 billion (approximately £268 million). The settlement establishes the Tshiamiso Trust, which will be responsible for paying compensation to eligible gold mineworkers and their dependents in Southern Africa.
The authors contend that the priorities of Northern donors dictate the aid agenda, implemented by the non-state and Southern ‘partners’ they fund. These priorities often clash with the needs and concerns of communities, governments and civil society in many countries around the world. The aid space is dominated by powerful interests, while the voices of those most affected by health inequity are regularly tokenised or excluded from the conversation. The authors argue that many actors within the sector – even among communities and civil society – do not question the underlying premise and structures of health aid. Their own ideas and world views have been shaped by, and for, aid and the industry that supports it. Questioning aid poses challenges to the professions, livelihoods and sources of power for those who work within the sector. Furthermore, whilst health aid is important in some situations, on its own aid can never lead to a world where all people can live healthy lives. Signatories of the declaration believe that collective social action in solidarity as one global community, working together to address the root causes of the struggle for health, can transform aid into an equitable means of ensuring health rights. Through the Kampala Initiative, the signatories commit to expose, explore, challenge and transform health aid through dialogue, advocacy, activism and action. They commit to build cooperation and solidarity for health, within and beyond the practice of aid, to build a future where health justice and equity are realised, and aid is no longer a necessity.