In 2014, the EAC regional Technical Working Group for Communicable and Non-Communicable Diseases conceived the idea of developing a regional plan for preparedness and response to public health emergencies. ECSA-HC, through the World Bank-funded East Africa Public Health Laboratory Networking Project, supported the drafting and development of the initial version of the plan. This is a multi-hazard preparedness and response plan whose scope includes epidemic prone diseases, and other known and unknown hazards that may have overwhelmed individual countries or are spreading across international border(s) in the EAC region. The Incident Command System describes teams of stakeholders involved in triggering and managing the preparedness, response and recovery phases of public health emergencies, all implemented in a One Health context. The command system is triggered by the national disease surveillance system at a point they determine to be in need of regional assistance. The plan was launched on June 11th 2019 at a ceremony in Namanga at the inauguration of the field simulation exercise for a fictitious Rift Valley fever outbreak spreading across the border between Kenya and Tanzania. ECSA-HC provided technical support in the planning and execution of the World Health Organization-led exercise.
Values, Policies and Rights
The authors propose that applying a robust human rights framework would change thinking and decision-making in efforts to achieve Universal Health Coverage (UHC), and advance efforts to promote women’s, children’s, and adolescents’ health in East Africa, a priority under the Sustainable Development Agenda. Nevertheless, they point to a gap between global rhetoric of human rights and ongoing health reform efforts. This article seeks to fill part of that gap by setting out principles of human rights-based approaches and then applying those principles to questions that countries face in undertaking efforts toward UHC and promoting women’s, children’s and adolescents’ health, particularly to ensure enabling legal and policy frameworks, establish fair financing and priority-setting and provide meaningful oversight and accountability mechanisms. In a region where democratic institutions are weak, the authors argue that the explicit application of a human rights framework could enhance equity, participation and accountability, and in turn the democratic legitimacy of UHC reforms being undertaken in the region.
This proposed strategy provides a vision and way forward on how the world and its health community need to respond to environmental health risks and challenges until 2030, and to ensure safe, enabling and equitable environments for health by transforming ways of living, working, producing, consuming and governing. The Health Assembly noted the report, and requested the Director-General to report back on progress at the 74th World Health Assembly in 2022. The WHO draft global strategy envisions a world in which sustainable development has eliminated the almost one quarter of the disease burden caused by unhealthy environments, through health protection and promotion, good public health standards, preventive action in relevant sectors and healthy life choices, and which manages environmental risks to health. The strategy sets six strategic objectives. Strategic objective 1 aims towards primary prevention: to scale up action on health determinants for health protection and improvement in the 2030 Agenda for Sustainable Development. Strategic objective 2 calls for cross-sectoral action to act on determinants of health in all policies and in all sectors. Strategic objective 3 concerns a strengthening health sector leadership, governance and coordination roles. Strategic objective 4 aims towards building mechanisms for governance, and political and social support. Strategic objective 5 calls for generating the evidence base on risks and solutions, and to efficiently communicate that information to guide choices and investments. Lastly, strategic objective 6 aims to guide actions by monitoring progress towards the Sustainable Development Goals.
In his address to the 72nd session of the World Health Assembly, Dr Tedros Adhanom Ghebreyesus, the Director-General of the World Health Organisation (WHO) said that strong primary health care is the front-line in defending the right to health, including sexual and reproductive rights. According to WHO, the “triple billion” targets that are at the heart of its strategic plan for the next five years are: one billion more people benefiting from universal health coverage (UHC); one billion more people better protected from health emergencies; and one billion more people enjoying better health and well-being. Dr Tedros cited various initiatives in countries that demonstrate progress and new normative products developed by WHO that are being used globally to protect and promote health. He highlighted three priorities that must guide discussions to make advances in primary health care: health is about political leadership; health is about partnership; and health is about people.
Community participation, the central principle of the primary health care approach, is widely accepted in the governance of health systems. Health Committees (HCs) are community-based structures that can enable communities to participate in the governance of primary health care. Previous research done in the Cape Town Metropole, South Africa, reports that HCs' potential can, however, be limited by a lack of local health providers' (HPs) understanding of HC roles and functions as well as lack of engagement with HCs. This study was the first to evaluate HPs' responsiveness towards HCs following participation in an interactive rights-based training. Thirty-four HPs, from all Cape Metropole health sub-districts, participated in this qualitative training evaluation. Two training groups were observed and participants completed pre- and post-training questionnaires. Semi-structured interviews were held with 10 participants 3–4 months after training. Following training, HPs understood HCs to play an important role in the communication between the local community and HPs. HPs also perceived HCs as able to assist with and improve the quality and accessibility of PHC, as well as the answerability of services to local community needs. HPs expressed intentions to actively engage with the facility's HC and stressed the importance of setting clear roles and responsibilities for all HC members. This training evaluation reveals HPs' willingness to engage with HCs and their desire for skills to achieve this. Moreover, it confirms that HPs are crucial players for the effective functioning of HCs. This evaluation indicates that HPs' increased responsiveness to HCs following training can contribute to tackling the disconnect between service delivery and community needs. Therefore, the training of HPs on HCs potentially promotes the development of needs-responsive PHC and a people-centred health system.
More than 75% of emerging infectious diseases are zoonotic in origin and a transdisciplinary, multi-sectoral One Health approach is a key strategy for their effective prevention and control. In 2004, US Centers for Disease Control and Prevention office in Kenya established the Global Disease Detection Division of which one core component was to support, with other partners, the One Health approach to public health science. A Zoonotic Disease Unit has provided Kenya with an institutional framework to highlight the public health importance of endemic and epidemic zoonoses including Rift Valley Fever, rabies, brucellosis, Middle East Respiratory Syndrome Coronavirus, anthrax and other emerging issues such as anti-microbial resistance. The programme is implementing capacity building programs, surveillance, workforce development, research, coordinated investigation and outbreak response. This has led to an improved outbreak response and generated data that has informed disease control programs to reduce the burden of and enhance preparedness for endemic and epidemic zoonotic diseases, enhancing global health security. Since 2014, the Global Health Security Agenda implemented through Centers for Disease Control and Prevention office in Kenya and other partners in the country has provided additional impetus to maintain this effort and Kenya’s achievement now serves as a model for other countries in the region. Significant gaps remain in implementation of the One Health approach at subnational administrative levels. however, with sustainability concerns, competing priorities and funding deficiencies.
Humanitarian crises and migration make girls and women more vulnerable to poor sexual and reproductive health (SRH) outcomes. This mixed-methods study assessed SRH experiences, knowledge and access to services of 260 refugee girls 13-19 years old in the Nakivale settlement, Uganda between March and May 2018. The majority of girls were born in DR Congo and Burundi. the findings showed weak knowledge of SRH and methods for preventing HIV and pregnancy, school days missed due to menstruation and that 30 of the 260 girls were sexually active, of which 11 had experienced forced sexual intercourse. The latter occurred during conflict, in transit or within the camp. The preferred sources for SRH information was parents or guardians, although participants expressed that they were afraid or shy to discuss other sexuality topics apart from menstruation with parents. Only 30% of the female adolescents had ever visited a SRH service centre, mostly to test for HIV and to seek medical aid for menstrual problems. The authors found that adolescent refugee girls lack adequate SRH information, experience poor SRH outcomes including school absence due to menstruation, sexual violence and FGM and recommend comprehensive SRH services including sexuality education, barrier-free access to SRH services and parental involvement for refugee communities.
Health should not be like playing the lottery - but that is what it has become in Africa. If you’re born rich you win, if you are born poor, you lose.’ This statement was made by Dr Githinji Gitahi, Group CEO of Amref Health Africa at the opening ceremony of the Africa Health Agenda International Conference (AHAIC) which took place in Kigali, Rwanda in March 2019. The conference was focused on Multi-Sectoral Action to achieve Universal Health Coverage (UHC) in Africa by 2030. The conference delegates observed that technology and data are needed to achieve UHC but that most of the technology available is focused on secondary and tertiary sectors and on curative care, rather than at community level. There is also need for regulation of new generation actors that are technology-focused. The authors propose that cross-regional dialogue and knowledge sharing is needed where countries can learn from each other, avoiding traditional silos and engaging multi-stakeholder and multi-sectoral partnerships and shifting the paradigm from a view of health as an investment rather than an expenditure.
The Supreme Court in the United Kingdom announced in April a verdict in the landmark case of the Zambian communities consistently polluted by Konkola Copper Mines (KCM), a subsidiary of British miner Vedanta Resources Plc, allowing them to have their case against the parent company and its subsidiary tried in the UK. The ruling sets a strong legal precedent which will allow people with claims against subsidiaries of British multinationals to sue the parent company in the UK. The judgment by Chief Justice Lady Hale, and four further judges, re-affirms the rulings of the Court of Technology and Construction in 2016 and the Court of Appeal in 2017. Lady Hale refused Vedanta’s pleas in appealing the former judgments stating that, contrary to the claims of Vedanta’s lawyers the claimants do have a bona fide claim against Vedanta; the company does owe a duty of care to the claimants, especially in view of the existence of company-wide policies on environment and health and safety. The judgement noted that the size and complexity of the case, and the lack of funding for claimants at ‘at the poorer end of the poverty scale in one of the poorest countries of the world’ means that they do not have substantive access to justice in Zambia. This has wider implications for other communities affected by multinational mining.
This review identified health policies related to the role of CHWs in the management of pre-eclampsia and eclampsia in Mozambique. It used three methods - policy document review, key informant interview and literature review. Three main themes were identified from the qualitative review as establishment of the community health worker programme and early challenges, revitalization of the community health workers programme and the integration of maternal health in the community health tasks. In 1978, following the Alma Alta Declaration, the Mozambique government brought in legislation establishing primary health care and the community health worker programme. Between the late 1980s and early 1990s, this programme was scaled down due to several factors including a prolonged civil war; however, the decision to revitalise the programme was made in 1995. In 2010, a revitalised programme was re-launched and expanded to include the management of common childhood illnesses, detection of warning signs of pregnancy complications, referrals for maternal health and basic health promotion. The study observe that the role of community health workers has evolved over the last 40 years to include care of childhood diseases and basic maternal health counselling, but do not yet include some possible areas, like management of emergency conditions of pregnancy including pre-eclampsia and eclampsia.