Current Issue

EQUINET NEWSLETTER 231 : 01 March 2022

1. Editorial

Meet commitments to public sector financing of public health to walk the talk of’ ‘pandemic preparedness’
Bona Chitah, University of Zambia


After a long period of domestic underfunding of public health services, particularly prevention and promotion services, the COVID-19 pandemic generated massive immediate demand to fund these same services. It arrived at a time when many public health systems in east and southern Africa (ESA) were fragmented, with challenges in service quality and provision and unmet need in the population. An analysis of health financing in ESA countries included in this newsletter showed that the pandemic called for a massive scale up of investment in testing; surveillance; infection prevention; waste management and health promotion. These were all areas that had seen declining investment in most ESA countries in the decade before the pandemic.

The regional analysis reviewed selected indicators available from the WHO Global Health Expenditure database for 2000–2019 of the extent to which governments prioritise health in domestic budget spending; provide financial protection; and spend on primary health care. A country case study then gave a deeper look at the health financing demand for the response to the pandemic, using national ministry of health data for 2020–2021 and projections for 2023.

Between 2000 and 2019, less than half of ESA countries included progressively increased their share of health spending in the budget and by 2019, only two met the Abuja Declaration commitment of 15% of government budget spending on the health sector. By 2019, seven ESA countries had out-of-pocket spending (OOPS) above the upper limit of 20% suggested by WHO to avoid catastrophic expenditures and impoverishment, four of them considerably so. For nine of the 16 ESA countries (including Zambia) in 2019, less than 50% of spending on primary health care (PHC) came from government spending, suggesting a high degree of reliance on external funders for this key area of pro-poor spending.

It can be argued that those countries that gave less priority to public sector health in government spending and that provided less financial protection against impoverishment for users through OOPS could have been in a weaker position at the onset of the COVID-19 pandemic in relation to provide public health sector leadership, protect wider services and protect households during the pandemic. Adequate domestic spending on PHC is necessary to resource the public and community health and primary care levels of health systems that are key in pandemic responses.

While Zambia had low OOPS, its share of government spending on health had also been falling prior to 2020, and, with a low share of government spending in total PHC expenditures, was dependent on external funds for these services. As overall health spending fell in real terms in the years immediately before the pandemic, the budget increasingly focused on curative care, with a falling share of spending on health promotion and prevention.

Hence, while Zambia implemented features of a robust preventive, health promotion and care response, the prior financing trends and a wide reported gap between needs versus resources mobilised suggests funding constraints to achieving the full scope of what intended in policy. The financial plans for the health sector response to the pandemic showed that, contrary to prior spending patterns, the greater share of resources were needed for prevention-related activities including testing, infection prevention and control, including for the health workforce, for health products and waste management systems. These are also areas where the funding gap was noted to be highest. It appeared (excluding vaccination donations) that external funder committed support was more focused on treatment and care, rather than for the wider range of prevention services. This funding gap thus placed high demand for domestic resource mobilisation, at a time when the pandemic also led to economic disruption, recession and increased debt, intensifying resource scarcity, for both households and for health sector spending.

The Zambian health ministry COVID-19 budget showed a sudden, urgent and costly increase imposed by the need to mitigate COVID, with some reports of reversals in gains made in areas such as maternal and child health programmes as resources were redirected to address emergent pandemic needs and health workers were over-stretched.

Estimates of the funding needed for the pandemic response indicate budget needs that are nearly 60 times higher than the last recorded government health spending in the 2016 national health accounts. While the response to an emergency inevitably demands new resources, there is a question of how far a sustained period of under-financing of critical prevention infrastructure, supplies and services over many years contributed to this gap. Conversely, the benefit of areas of previous investment is apparent in Zambia’s ability to make use of existing HIV, malaria and TB related laboratory services to rapidly decentralise laboratory capacity for COVID-19.

As the evidence focused on broad trends in the region and a focus on only one country on pandemic budgets, it would be useful to explore further the experience across other ESA countries. However, for health financing in the region, the evidence suggests that pandemic preparedness is not an acute event, but rather a sustained process of investment in public health services and personnel that may be more likely to enable rapid repurposing and switching to address new pandemic needs. This implies governments meeting the Abuja commitment, not letting the public sector share of financing fall to levels that undermine domestic public sector leadership of the multiple actors in preparing for and responding to public health priorities, and more consistently prioritising prevention and promotion and PHC services in domestic health financing.

Please send feedback or queries on the issues raised in this oped to the EQUINET secretariat: admin@equinetafrica.org. More information can be found in EQUINET Discussion paper 124 on the EQUINET website.

2. Latest Equinet Updates

Bring your experiences and ideas to the EQUINET conference in 2022!
Watch out for the announcement and call for submissions in April 2022

EQUINET is holding a regional conference in 2022. We are living in a time of widening inequity, globally and in our region, but also of intensifying levers of change. The conference is for you! The EQUINET steering committee is inviting voices from all levels, disciplines, sectors and institutions that contribute to health equity in the region to share, discuss, network and reflect on experiences, ideas and actions, and to consolidate proposals for advancing equity in health and wellbeing in our region. The conference will be online, with thematic conference days held intermittently between July and November 2022. We will include a range of forms of evidence, including studies, stories, artistic and visual evidence, on our challenges and actions to reclaim the resources for health, our states, and our public services, and collective agency and solidarity in health. Leading up to the final day, we will explore how we organise as a network of equity actors from in the region. The full announcement with information on the conference, the registration and the call for submissions will be shared in April. To receive further information by email please subscribe at https://www.equinetafrica.org/content/subscribe.html

EQ Diss 124: Health sector financing and COVID-19: East and Southern Africa trends and a Zambia case study
Chitah B: UNZA, EQUINET Discussion paper 124, EQUINET, Harare, 2022

EQUINET commissioned this study from the author at University of Zambia to explore trends in equity-related healthcare expenditures in East and southern Africa (ESA) countries prior to the pandemic (2000–2019), and, through a deeper case study of expenditures in Zambia, how financing changed during the COVID-19 pandemic in 2020/21. The regional analysis reviewed selected indicators available from the WHO Global Health Expenditure database for 2000–2019 of the: extent to which governments prioritise health in domestic budget spending; level of financial protection; level of government pro-poor spending on primary health care; and the share of public versus private financing in total health expenditure. The financing trends for 2000–2019 in ESA countries raise issues around health system preparedness for the pandemic, while the Zambia case study demonstrates the consequent impact of the responses to COVID-19 on health system financing.

EQUINET Information sheet 7 on COVID-19: Turning vaccines to vaccination in the region
TARSC, EQUINET: Harare, 2022

EQUINET information sheets on COVID-19 summarise information from and provide links to official, scientific and other resources on east and southern Africa (ESA) covering selected themes related to equity in the pandemic. They complement and do not substitute information from public health authorities. Brief 7 summarises pandemic developments in the region to December 2021, with a focus on equity in vaccination coverage. It covers: 1: Recent trends in COVID-19 in ESA countries; 2: Vaccine supply to the ESA region; 3: Storage and distribution of vaccines in the region; 4: Vaccine uptake and vaccination coverage; and 5: Addressing equity - from vaccines to vaccinated populations.

Report of the East and Southern Africa Regional People’s Health University
EQUINET, PHM: 2021

The first East and Southern Africa Regional People’s Health University (ESA RPHU) jointly convened by the People’s Health Movement (PHM) and Regional Network for Equity in Health in East and Southern Africa (EQUINET) was held virtually between 29 July and 12 November 2021 with the theme ‘Past, present and future struggles for Health equity’. The course aimed to build and share evidence, experience, analysis, and knowledge on the drivers of health equity to support efforts and activism within countries, and regional co-operation and joint engagement, from local to global level, on shared priorities. The course further aimed to share evidence, practical experiences, insights and learning from action, including on the implications of the COVID-19 pandemic in the region. To widen uptake in the region, background readings and presentations from sessions are available on the ESA RPHU Resources page.

3. Equity in Health

Assessing the impact of Covid-19 on older people in the African Region
WHO Regional Office for Africa: WHO, Brazzaville, 2021

The COVID-19 pandemic has had a significant impact on older persons globally and in the African region. Although overall the region’s population is younger relative to many other world regions, the WHO AFRO region has a population just over 62 million older people and is ageing rapidly, with the number of older people expected to triple in the next three decades. This desktop review, complemented with regional and national stakeholder interviews for six country case studies assessed the impact of COVID-19 on older people. The six case study countries were South Africa, Ghana, Rwanda, Mozambique, Senegal and Mauritius. The findings indicated impacts on falling incomes, rising poverty and food insecurity in older people, particularly in the face of weak social protection systems. Older people faced increasing isolation and challenges in accessing resources and services, and barriers to online systems. Long-term care services for older people were heavily impacted by COVID-19 and the authors point to 'ageism' in ignoring older people's needs and roles in recovery policies and plans. The authors recommend member states in the region expedite policy implementation in the context of the Decade of Healthy Ageing 2021-2030 to address these challenges through strengthened health care systems, community-based associations and networks of older people, age friendly environments and social protection mechanisms.

Inequality kills: The unparalleled action needed to combat unprecedented inequality in the wake of COVID-19
OXFAM International:: Policy Papers, Oxfam, 2022

This report observes that the wealth of the world’s 10 richest men has doubled since the pandemic began, while the incomes of the majority of the global population has fallen due to COVID-19, with widening economic, gender, and racial inequalities within countries and inequality between countries. The report explores the structural causes in policy choices that are made for the richest and most powerful people. Inequality is reported to contribute to the death of at least one person every four seconds. The authors recommend a radical redesign of economies to be centered on equality, clawing back extreme wealth through progressive taxation; investments in powerful, proven inequality-busting public measures; and bold shifts in power in economies and society.

SARS-CoV-2 infection in Africa: A systematic review and meta-analysis of standardised seroprevalence studies, from January 2020 to December 2021
Lewis HC; Ware H; Whelan M; et al.medRxiv 02.14.22270934; doi: https://doi.org/10.1101/2022.02.14.22270934, 2022

This preprint article presents a meta-analysis of population-based seroprevalence studies conducted in Africa published 01-01-2020 to 30-12-2021 to estimate SARS-CoV-2 seroprevalence in Africa. The authors aim to inform evidence-based decision making on Public Health and Social Measures (PHSM) and vaccine strategy. From 54 full texts or early results, reporting 151 distinct seroprevalence studies in Africa, 63% had a low/moderate risk of bias. SARS-CoV-2 seroprevalence rose from 3% in Q2 2020 to 65% in Q3 2021. The ratios of seroprevalence from infection to cumulative incidence of confirmed cases was large (overall: 97:1, ranging from 10:1 to 958:1) and steady over time. Seroprevalence was highly heterogeneous both within countries - urban vs. rural (lower seroprevalence for rural geographic areas), children vs. adults (children aged 0-9 years had the lowest seroprevalence) - and between countries and African sub-regions (Middle, Western and Eastern Africa associated with higher seroprevalence).The high seroprevalence in Africa suggests greater population exposure to SARS-CoV-2 and protection against COVID-19 disease than indicated by surveillance data.

4. Values, Policies and Rights

A comparative human rights analysis of laws and policies for adolescent contraception in Uganda and Kenya
Perehudoff K; Kibira D; Wuyts E; et al: Reproductive Health 19(37), 1-14, 2022

This report outlines how far national laws and policies for adolescent contraception in Uganda and Kenya are consistent with WHO standards and human rights law. Of the 93 laws and policies screened, 26 documents were included. Ugandan policies have 6 out of 9 WHO recommendations and miss WHO’s recommendations for adolescent contraception availability, quality, and accountability. Kenyan policies consistently address multiple WHO recommendations, most frequently for contraception availability and accessibility for adolescents and address 8 out of 9 WHO recommendations, except for that on accountability. The current policy landscapes for adolescent contraception in Uganda and Kenya include important references to human rights and evidence-based practice. However the authors suggest that there is still room for improvement, and that aligning national laws and policies with WHO’s recommendations on contraceptive information and services for adolescents may support interventions to improve health outcomes, provided these frameworks are effectively implemented.

How are global health policies transferred to sub-Saharan Africa countries? A systematic critical review of literature.
Odoch, W.D., Senkubuge, F., Masese, A.B. et al:. Global Health 18, (25), 2022.

This review sought to contribute to literature in this area by exploring how health policy agendas have been transferred from global to national level in sub-Saharan Africa. Nine articles satisfied the eligibility criteria. The predominant policy transfer mechanism in the health sector in sub-Saharan Africa is voluntarism, but there are cases of coercion, albeit usually with some level of negotiation. Agency, context and nature of the issue are key influencers in policy transfers. The transfer is likely to be smooth if it is mainly technical and changes are within the confines of a given disease programmatic area. Policies with potential implications on bureaucratic and political status quo are more challenging to transfer. The authors propose that policy transfer, irrespective of the mechanism, requires local alignment and appreciation of context by the principal agents, availability of financial resources, a coordination platform and good working relations amongst stakeholders. Potential effects of the policy on the bureaucratic structure and political status are also important during the policy transfer process.

Two years of COVID-19 in Africa: lessons for the world
Happi CT; Nkengasong JN; Nature, Online, January 2022

In the early months of the COVID-19 pandemic, Africa’s rapid and coordinated response, informed by emerging data, was remarkable. Now, in 2022, as vast vaccination campaigns have enabled the global north to gain some control over the pandemic, Africa lags behind. In principle, Africa could build on the astonishing gains it has made in surveillance and public-health responsiveness to outbreaks in recent years. It could sufficiently invest in commodities to ensure its health security, and position itself as a world leader in fighting infectious diseases. The authors argue that there is no alternative to this. If the continent does not work towards guaranteeing self-sufficiency, it will fail to address the infectious-disease threats of the twenty-first century and to achieve its development goals. In tracing the history of pandemic responses, the authors suggest that historically, efforts to assist Africa have tended to be siloed. They take a top-down approach, with decision-making coming from a central body outside the continent, not from African institutions and experts. Efforts have generally focused on short-term crisis management, not on the kinds of sustainable systems, such as manufacturing capability for diagnostics, that could help Africa to take charge of its health security. To reconfigure to greater self-determination, the authors propose that the continent honour their commitments to allocate at least 15% of their annual budgets to the health sector, strengthen national public-health institutions, and accelerate translational research and development.

5. Health equity in economic and trade policies

Assessing the effects of mining projects on child health in sub-Saharan Africa: a multi-country analysis
Cossa H; Dietler D; Macete E; Munguambe K: Globalization and Health 18(7), 1-16, 2022

To assess the impact of mines on child health, this study analyses socio-demographic, health, and mining data before and after several mining projects were commissioned in sub-Saharan Africa. Data of 90,951 children living around 81 mining sites in 23 countries in sub-Saharan Africa were analysed for child mortality indicators, and 79,962 children from 59 mining areas in 18 sub-Saharan Africa countries were analysed for diarrhoea, cough, and anthropometric indicators. The results presented suggest that the impacts of mining on child health vary throughout the mine’s life cycle. Mining development was found to contribute positively to the income and livelihoods of the impacted communities in the initial years of mining operations, but that these benefits are likely to be at least partially offset by food insecurity and environmental pollution during early and later mining stages, respectively.

Inside Facebook's African Sweatshop
Perrigo B: Time, February 2022

This investigative journalism examines the workplace conditions of outsourced Facebook content moderators in Nairobi, Kenya. They perform the task of viewing and removing illegal or banned content from Facebook before it is seen by the average user. While demanding, including of multiple language skills, the workers were reported to be amongst the lowest-paid for the platform anywhere in the world, and to experience a workplace culture characterized by mental trauma, intimidation, and alleged suppression of the right to unionize. The authors question whether the corporate is protecting the wellbeing of the very people upon whom it relies to ensure its platform is safe in the continent.

WTO: Dangers of “take-it-or-leave-it” compromise outcome on TRIPS waiver
Third World Network: SUNS #9521, February 2022

In the face of growing “vaccine inequity” amidst the ongoing COVID-19 pandemic across countries, the authors observe that the chances of finalizing a credible outcome on the temporary TRIPS waiver at the WTO seem to be getting slimmer, with the likelihood of a “take-it-or-leave-it” compromise solution being foisted on the members apparently gaining ground, according to people familiar with the development. In her brief statement at a TRIPS Council meeting on 22 February, the Deputy Director-General (DDG) Ms Anabel Gonzalez from Costa Rica is reported to have said that the progress has been difficult during the ongoing quadrilateral consultations between the four members on the temporary TRIPS waiver and the EU’s proposal on compulsory licensing which mostly restates Article 31 of the TRIPS Agreement. South Africa reminded members that while it welcomes the support from the global community in establishing an mRNA hub in South Africa, as well as manufacturing facilities in Kenya, Tunisia, Nigeria, Senegal and Egypt, it noted that the full operationalization of the mRNA hub faces hurdles due to the intellectual property barriers. At the TRIPS Council meeting, members adopted the draft statement proposed by the TRIPS Council chair to continue discussions on either the waiver or the EU’s proposal on compulsory licensing, due to lack of convergence among the members.

6. Poverty and health

Application of community dialogue approach to prevent adolescent pregnancy, early marriage and school dropout in Zambia: a case study
Zulu I; Zulu J; Svanemyr J; Michelo C; et al: Reproductive Health 19(30), 1-9, 2022

This paper presents parents’ perspectives on the application of the community dialogue approach in addressing adolescents’ early pregnancy and school dropout in a 2018 cluster randomized controlled trial in rural Zambia. The guardians/parents perceived the community dialogue to be a relevant approach for addressing social and cultural norms regarding early pregnancy, marriage and school dropout. It was embraced for its value in initiating individual and collective change. The facilitators’ interactive approach and dialogue in the community meetings coupled with the use of films and role plays with the parents, lead to active participation and open discussions about sexual and reproductive health topics during the community dialogue meetings. Group interactions and sharing of experiences helped parents clarify their sexual and reproductive health values and subsequently made them feel able to communicate about sexual and reproductive health issues with their children. However, cultural and religious beliefs among the parents regarding some topics, like the use of condoms and contraceptives, complicated the delivery of reproductive health messages from the parents to their children.

Does disability increase households’ health financial risk: evidence from the Uganda demographic and health survey
Guets W and Behera D K: Global Health Research and Policy 7(2), 1-8, 2022

The authors examined the influence of disability and socio-demographic factors on households’ health financial risks in Uganda, using nationally representative cross-sectional data for 19305 households from the 2016 Uganda Demographic and Health Survey. Financial risk was measured by money paid for health care services. Almost 32% of households paid money for health care services access, among which 32% paid through out-of-pocket. Almost 41% of household heads were affected by disability. The majority of families went to the public sector for health care services. The mean age was 45 years. The findings indicated that disability is significantly associated with the household financial risk, as is a choice to use private sector health care services. The authors recommend identifying families with disability and those experiencing difficult living conditions for health authorities to enhance health coverage progress.

7. Equitable health services

Incentives for mothers, health workers and “boda–boda” riders to improve community-based referral process and deliveries in the rural community: a case of Busoga Region in Uganda
Muluya K M; Mugisha J F; Kithuka P; et al: Reproductive Health 19(24), 1-9, 2022

Th authors report how financial and non-monetary incentives provided for 6 months to mothers, health workers and boda–boda (motorbike) riders improved the community-based referral process and deliveries in the rural community of Busoga region in Uganda. The incentives included training, training allowances, refreshments during the training, transport fares payable by mothers to boda–boda riders, free telephone calls through establishment of a pre-paid Closed Caller User Group, provision of bonus airtime to all registered Closed Caller User Group participants and rewards to best performers. The study used a mixed methods design. The proportion of mothers who delivered from health centres and used boda–boda transport were 71% in the intervention arm compared to 51% in the control arm. Of the mothers who delivered from the health centres, majority (69%) were transported by trained boda–boda riders while only 31% were transported by untrained boda–boda riders. Of the mothers transported by the boda boda riders, 21% in the intervention arm reported that the riders responded to their calls within 20 min, an improvement from 4% before the intervention, while in the control arm there was limited change. The authors suggest that such incentives and partnerships for different stakeholders along the maternal health chain are key for effective referral processes.

New Special Supplement: Reimagining Health Systems for Better Health and Social Justice
Health Systems Global: HSG, 2021

Health Systems Global (HSG) and Health Policy and Planning (HPP), with the support of the International Development Research Centre (IDRC), announce the publication of a Special Supplement – Reimagining health systems for better health and social justice. This Supplement distills and spotlights some of the debates and discussions that took place during the Sixth Global Symposium on Health Systems Research (HSR2020) – Re-imagining health systems for better health and social justice. Articles in the supplement include the editorial Reimagining Health Systems: Reflections from the 6th Global Symposium on Health Systems Research and original manuscripts on equity in public health spending in Ethiopia, universal health coverage in Ghana, organizational structure and human agency within the South African health system and social accountability in Malawi.

What Is COVID-19 Teaching Us About Community Health Systems? A Reflection From a Rapid Community-Led Mutual Aid Response in Cape Town, South Africa
van Ryneveld M; Whyle E; Brady L: International Journal of Health Policy and Management, 11, 5-8, 2022

The COVID-19 pandemic exposed the wide gaps in South Africa's formal social safety net, with the country's high levels of inequality, unemployment and poor public infrastructure combining to produce devastating consequences for a vast majority in the country living through lockdown. In Cape Town, a movement of self-organising, neighbourhood-level community action networks (CANs) has contributed significantly to the community-based response to COVID-19 and its ensuing epidemiological and social challenges. This article describes and explains the organising principles that inform this community response, and reflects on the possibilities and limits of such movements as they interface with the state and its top-down ways of working, often producing contradictions and complexities. This presents an opportunity for recognising and understanding the power of informal networks and collective action in community health systems in times of unprecedented crisis, and brings into focus the importance of finding ways to engage with the state and its formal health system response that do not jeopardise this potential.

8. Human Resources

Qualitative assessment of community health workers’ perspective on their motivation in community-based primary health care in rural Malawi
Ndambo M K; Munyaneza F; Aron M B; et al: BMC Health Services Research 22(179), 1-13, 2022

Few studies have described the Community Health Worker (CHW) perspective on their intrinsic and extrinsic motivation in relation to their activities. Data was collected in 8 focus group discussions with 90 CHWs in October 2018 and March–April 2019 in seven purposively selected catchment areas. The results indicate that enabling factors are primarily intrinsic, such as positive patient outcomes, community respect, and recognition by the formal health care system, but that this can lead to the challenge of increased scope and workload. Extrinsic factors such as the increased scope and workload from original expectations, lack of resources for their work, and rugged geography present challenges, but with a positive work environment and supportive relationships between CHWs and supervisors enabling the CHWs. The authors suggest that challenges can be mitigated through focused efforts to limit geographical distance, manage workload, and strengthen CHW support to reinforce their recognition and trust, and by giving focus to enhancing motivational factors in primary health care systems.

9. Public-Private Mix

Regulation of medicines advertisement in Zimbabwe: an assessment of the impact of pharmaceutical promotion on the prescribing behaviour of healthcare professionals
Semu T C; Ngara B and Mudzviti T: BMC Health Services Research 21(1337), 1-7, 2021

The authors present results of a cross sectional study the levels of knowledge, attitude and perception towards regulation of pharmaceutical promotion among 330 healthcare practitioners in Zimbabwe, using face-to-face interviews and a web-based online survey. The study found that healthcare practitioners in Zimbabwe have a favourable relative importance index score of knowledge (95%), attitudes (67%), and perceptions (90%). This outcome and a positive perception of the regulation of pharmaceuticals related to health care workers’ profession, gender, education level, the nature of the working institution and the number of prescriptions involved per week.

10. Resource allocation and health financing

Everywhere basic income has been tried, in one map
Samuel S: Vox, Online, 2020

The idea of a basic income was, for decades, something of a policy fantasy. But in the last decade many basic income programs have emerged. This site maps there presence with links to information on them. For example in Kenya a big experiment in universal basic income (UBI) is described. The charity GiveDirectly is making payments of roughly 75 cents (US$) per adult per day, delivered monthly for 12 years to more than 20,000 people spread out across 245 rural villages, with some evidence from a related intervention that this stimulated the local economy and benefited not only the recipients themselves but also people in nearby villages. This site lists all the places that are trying or have tried some version of basic income, noting that UBI is unconditional and different to conditional cash transfers, which may require recipients to send their kids to school or go for health checkups.

Will the National Budget Framework Paper for FY 2022/23 Promote Equitable and Transformative Post COVID 19 Economic Recovery?
SEATINI Uganda: Position paper, Uganda, 2022

This position paper aims to analyze Uganda's National Budget Framework Paper (NBFP) for the financial year 2022/23 and its priorities, interventions and policy proposals for an equitable and transformative post-COVID 19 economic recovery. The authors indicate that COVID 19 and the measures to contain its
spread have had an unprecedented negative impact on Uganda’s economy and people’s livelihoods. While commending the measures for restoring business activity, they suggest that these are inaccessible for and have weak outreach to small and medium enterprises, listing the barriers. They recommend deepening resources and measures for financial inclusion and wellbeing of the population, including investment in areas such as infrastructures, local wealth creation, investment in the public health system, education, water and sanitation and in local production of essential pharmaceutical. The report indicates that an equitable and transformative economic recovery post COVID 19 will require a rethink of policies and practices to address the disconnect between aspirations for recovery and budget allocations and programming.

11. Equity and HIV/AIDS

Utility of HIV support groups in advancing implementation research in resource-limited settings: experiences from an urban-setting HIV support group in Zimbabwe
Mazambara F; Chagwena D; Mudzviti T; et al: AIDS Research and Therapy 19(7), 2022

This paper describes how an adult HIV peer-support group in urban Zimbabwe enabled implementation research, and client recruitment and retention, with successes, challenges and lessons documented over eight years. The interventions involved psychosocial support, nutrition care and support, adherence education and income generating projects. More than 900 people participated in peer-support group activities every month and 400 were engaged in income generating activities. The support group provided a platform for identification of research priorities, patient recruitment and retention and for dissemination of research findings.

12. Governance and participation in health

Africa CDC is Elevated to the Status of a Continental Public Health Agency
Adepoju P: Health Policy Watch, February 2022

The African Union (AU) has decided to elevate its African Centres for Disease Control and Prevention (Africa CDC) to the status of an autonomous public health agency for the continent – rather than operating simply as technical arm of the AU. The elevation of the Africa CDC – which will now report directly to Heads of State of AU Member Countries – is reported to signal the growing member state commitment to strengthening the continent’s response to current and future disease outbreaks.

Promoting social dialogue to improve working conditions for Community Health Workers in Malawi
Public Services International: PSI, Malawi, 2021

Community Health Workers (CHWs) occupy a unique position in-between the community and state bureaucracy, which the authors report to be challenging for CHWs to balance as they are accountable to both. This intermediary position poses disadvantages for CHWs when the expectations of the community and the state bureaucracy differ, leading to high workload and demotivation among CHWs. Nevertheless, given the acute shortage in the health workforce in Malawi, CHWs are an essential cadre in driving forward efforts to achieve universal health coverage. This publication aims to support efforts to understand the working conditions of CHWs and to achieve decent work for CHWs.

Promoting social dialogue to improve working conditions for Community Health Workers in South Africa
Public Services International: PSI, South Africa, 2021

This manual looks at Community Health Workers (CHWs) in South Africa and their crucial role in the health system. The official health policy of the National Department of Health, “Restructuring the national health system for universal Primary Health Care (NDOH 1996) mentioned the important role of CHWs but did not incorporate them into the health system. More recent policies acknowledge CHWs as a vital part of the health team, for the success of Primary Health Care (PHC), but implementation has been delayed. The publication draws attention to the present working conditions of CHWs, their demands and how trade unions can assist them.

13. Monitoring equity and research policy

Health Equity Tourism: Ravaging the Justice Landscape
Lett E; Adekunle D; McMurray P; et al: Journal of Medical Systems 46 (17), 2022

“Health equity tourism” is described as the process of previously unengaged investigators pivoting into health equity research without developing the necessary expertise for high-quality work. In this essay, the authors define the phenomenon and provide an explanation of the antecedent conditions that facilitated its development. They outline its consequences as recapitulating systems of inequity within the academy and diluting a landscape carefully curated by scholars who have demonstrated sustained commitments to equity research as a primary scientific discipline and praxis. The authors provide a set of principles to guide equity researchers.

14. Useful Resources

Probable futures
Probable futures collective: Video, 2022

Probable Futures is an online site for science, applications, and imagination. It was founded in 2020 by a group of concerned leaders and citizens who started asking climate scientists direct, practical questions about what climate change would be like in different places around the world: What does the world look like at 1.5°C of warming? What will it feel like? At 2°C? 3°C? Do these different levels of warming mean radically different outcomes for society? Could we communicate the consequences of each increment of warming so vividly that everyone—from parents and teachers to poets and CEOs—can better understand, prepare for, and address what is coming? This site provides maps and information so that climate change is no longer an abstraction. In the portrayal the results are stark, the consequences real and personal and the portrayals of the future useful, intuitive, and profound.

What is health policy & systems research and how can it strengthen health systems?
Health Systems Global: Video, 2017

A short film produced by Health Systems Global and the Alliance for Health Policy and Systems Research outlining the field of Health Policy and Systems Research (HPSR) and the role it can play in strengthening health systems around the world.

15. Jobs and Announcements

Health Economics Research Centre (HERC) Virtual Visitor Scheme (Round 1: Africa)
Deadline for applications: 4 March 2022

The Health Economics Research Centre (HERC), University of Oxford has created a “virtual visitors” scheme to allow early career researchers from low and middle income (LMIC) countries to virtually attend via the internet seminars, events and short courses. In addition, the virtual visitor will be assigned mentors from HERC to discuss their research and explore future projects. The virtual visitor will generally be attached to HERC for a period of six months. During this time the visitor can attend relevant HERC short courses, including the Applied Methods of Cost- Effectiveness Analysis, at no cost. The scheme is entirely virtual and does not involve travelling to the UK, or any funding.

HSG Symposium 2022: Call for Abstracts
Deadline for Individual Abstracts: April 15, 2022 (12 pm noon EST)

HSG is pleased to invite abstract submissions for the 7th Global Symposium on Health Systems Research (HSR2022), to be held in Bogota, Colombia October 31 – November 4, 2022. Health systems face significant challenges all around the world. The experience of the COVID-19 pandemic reveals how valuable strong health systems are to society, lays bare multiple weaknesses in low-, middle- and high-income settings alike, and has also shown us that now, more than ever, trust and solidarity, equity and social justice are the central and most important values from which to build back stronger, more resilient health systems. With the theme 'Systems Performance in the Political Agenda: Sharing lessons for current and future global challenges', HSR2022 aims to face the challenge of optimally sharing – and learning from – the experiences of the last two years. See the website for details on abstract submission.

OWSD PhD Fellowships
Call for applications, closing on 15 April 2022.

The Fellowship is offered to women scientists from science- and technology-lagging countries (STLCs) to undertake PhD research in the natural, engineering and information technology sciences at a host institute in another developing country in the Global South. The general purpose of the fellowship programme is to contribute to the emergence of a new generation of women leaders in science and technology, and to promote their effective participation in the scientific and technological development of their countries. The OWSD PhD Fellowship is offered only to women candidates. Candidates must confirm that they intend to return to their home country as soon as possible after completion of the fellowship. See the website for further and application details.

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