Population health deals with health beyond the individual. It addresses the combined impact of social determinants such as environment and social structure and includes health care. With the role of pharmacists traditionally centering on the supply and distribution of medicines, pharmacists, particularly in low and middle income countries, have been viewed as having little to do with population health. Yet ironically, the community pharmacy is often the first port of call for most people with minor ailments. Pharmacists are thus strategically positioned to provide essential services that promote, maintain and improve the health of the population in the broadest sense.
Pharmacy is an age old profession that deals with the science of making and administering medicines. Over the years, the profession has evolved to encompass a wide range of service areas. In high income countries these areas and roles are well defined and structured. In low and middle income countries, this is not the case. Often pharmacists in these counties have to carve their own individual career pathways that may not bear any relationship to their professional training. In most cases however, pharmacists in low and middle income countries work in dispensing roles, mainly in community pharmacies.
In high income countries, pharmacists routinely engage in public health programs such as disease screening, pregnancy testing and counseling, immunization and counseling for at-risk populations among others roles. In lower income countries, where ironically the need is greater, pharmacists’ involvement in population health is at best minimal.
Economic growth in low and middle income country economies is taking place at a rate faster than ever, but key health and demographic indicators remain stunted. The time is ripe for the profession of pharmacy to stand up and be counted, and for pharmacists to play a more central role in population health.
The community pharmacy holds a number of benefits as a setting for public health interventions. With extended opening hours and no appointment needed for advice, community pharmacies are more accessible than other settings. In some high income countries it has been reported that on average at least nine in every ten residents visit a community pharmacist at least once a year. In lower income countries, even though this frequency may be smaller, the services that local pharmacies provide to the community could have much greater impact. For instance, community pharmacies could be a source of information related to health and well-being that could have far-reaching impact in communities that lack access to such information. Clients who visit a pharmacy to seek information may also obtain other products they need, giving a return to both the pharmacist and the client.
For pharmacists to assume population based roles both they as a profession and the community they work in need to believe that they are capable and suitably trained for it. This calls for a change in the way pharmacists are viewed and ere behave. Pharmacists must be comfortable with roles in population health and view them as opportunities. Studies have reported that while pharmacists valued population health functions, they were more comfortable with achieving health improvements through medicines. There is thus need for interventions to improve the confidence of pharmacists in using their skills for population health. From the community side, the public need to shift their view of pharmacists to see them as professionals that are also involved in population health services.
There are many ways that pharmacists could be involved in health promotion. They could carry out or be involved in education programmes on safe and effective medication as well as on other community health-related topics, such as exercise, health and nutrition. In major cities in Africa where pharmacies are readily accessible, this is a ready-made opportunity to provide valuable information on HIV and AIDS, on teen pregnancy and on other health risks. The increased use of the emergency contraceptive pill in some Africa countries may make people less concerned about pregnancy, but raise the risk of HIV transmission, undermining prevention programmes. On issues such as these, pharmacists should be in the frontline of providing information and protecting the public from such unintended consequences. Pharmacists can be involved in educational programmes that start at an early age, such as through school health programmes, to help children develop good health practices that can continue into adulthood. Their education programmes could also reach out to community leaders, legislators, regulators, public officeholders, school officials, religious leaders among others.
We also suggest that pharmacists participate in population health policy development. By linking social factors, lifestyles and the environment, in a holistic manner, to utilization of medicines, pharmacists can broaden the scope of prevention and population health. They can ensure that policies are formulated with a better understanding of the relationship between drug therapy and the many other factors that affect health outcomes.
These are some examples, and we propose that there be wider dialogue on how pharmacists can play a vital role in maintaining and promoting population health, especially in low and middle income countries. This should include participating in global, national, state, and institutional efforts to promote population health and integrating these efforts into their practices. There should be a role for pharmacists in improving community health through population-based care; in developing disease prevention and control programs; in providing health education; and in collaborating with local authorities to address local need.
To achieve this, the onus is on the profession to view such roles as opportunities and not as unnecessary burdens, and to take the next steps.
Please send feedback or queries on the issues raised in this briefing to the EQUINET secretariat: firstname.lastname@example.org. For more information on the issues raised in this op-ed please visit www.equinetafrica.org, http://www.muchs.ac.tz/ and www.pharmasystafrica.com
2. Latest Equinet Updates
The meeting held June 4-5 in South Africa was organised by Training and Research Support Centre and Centre for Trade Policy and Law for EQUINET in dialogue with the Strategic Initiative of Global Health Diplomacy co-ordinated by the East Central and Southern Africa (ECSA) Health Community. It was supported by IDRC (Canada). The workshop was held to gather the lead institutions of the research teams for the three case study areas, together with resource people from policy, technical, international agency and research communities to discuss and further develop the three case studies and their links to policy processes on global health diplomacy. The case studies are on implementation of the WHO Code on international Recruitment of health personnel: access to essential drugs through south- south relationships with China, Brazil and India; and involvement of African actors in global health governance on universal access to prevention and treatment for HIV and AIDS. Publications in these areas have been included in the searchable annotated bibliography database on the EQUINET website and materials arising from the work will be posted to this website.
In 1948, the World Health Organisation (WHO) was established as the agency for directing and coordinating authority on international health work, particularly in setting norms and standards and policies in public health , establishing and maintaining effective collaboration with the United Nations, specialised agencies, governmental health administrations, professional groups and such organisations as may be deemed appropriate, furnishing appropriate technical assistance in emergencies, necessary upon request or acceptance of governments (WHO Constitution Chapter II Art 2) By 2011 many new institutions exist in global health, with different governance mechanisms and funding, powers and mandates. This brief explores the range and influence of global health actors and the implications for health diplomacy within east and southern Africa.
3. Equity in Health
Human-induced climate change will have the greatest, and generally earliest, impact on the poorest and most disadvantaged populations, according to this paper. Climate change adaptation is receiving much attention given the inevitability of climate change and its effects, particularly in developing contexts, where the effects of climate change will be experienced most strongly and the response mechanisms are weakest. Financial support towards adaptation activities from various actors including the World Bank, the European Union and the United Nations is increasing substantially. With this new global impetus and funding for adaptation action come challenges such as the importance of developing adaptation activities on a sound understanding of baseline community needs and vulnerabilities, and how these may alter with changes in climate. The global health community is paying heed to the strengthening focus on adaptation, albeit in a slow and unstructured manner. The aim of this paper is to provide an overview of adaptation and its relevance to global health, and highlight the opportunities to improve health and reduce health inequities via the new and additional funding that is available for climate-change adaptation activities.
Considerable declines in malaria have accompanied increased funding for control since the year 2000, but historical failures to maintain gains against the disease underscore the fragility of these successes. In this study, researchers conducted a systematic review of the literature to identify historical malaria resurgence events. They identified 75 resurgence events in 61 countries, occurring from the 1930s through the 2000s. Almost all resurgence events (91%) were attributed at least in part to the weakening of malaria control programmes for a variety of reasons, of which resource constraints were the most common (57%). Over half of the events (59%) were attributed in part to increases in the intrinsic potential for malaria transmission, while only 32% were attributed to vector or drug resistance. Given that most malaria resurgences have been linked to weakening of control programmes, this study highlights the need to develop practical solutions to the financial and operational threats to effectively sustaining today's successful malaria control programmes.
According to the World Health Organisation (WHO), measuring health can tell us how well development is advancing the three pillars of sustainability, namely social, environmental and economic sustainability. It therefore stands to reason that indicators of healthy development can help identify success stories, barriers and the extent to which benefits of greener economies are equitably distributed. Examples of health-relevant indicators for six Rio+20 themes are presented here: sustainable cities, food, jobs, water, energy and disaster management. WHO has identified three key ways in which health can both contribute to, and benefit from, greener and cleaner development. First, achieving universal health coverage will result in healthier people who can contribute economically and socially. Reducing gender, employment and housing inequities will also improve health. Second, strategies need to be designed specifically to enhance health gains from sustainable development investments and decisions – health gains from development are not automatic. Third, governments and other role players should adopt health indicators to measure progress/achievements in sustainable development.
Malawi is one of two low-income sub-Saharan African countries on track to meet the Millennium Development Goal (MDG 4) for child survival despite high fertility and HIV rates and low health worker density. In this study, researchers examined changes in newborn survival in the decade 2000-2010, and assessed national and external funding, as well as policy and programme changes. Compared with the 1990s, they found that progress towards MDGs 4 and 5 accelerated considerably from 2000 to 2010. They argue that a significant increase in facility births and other health system changes, including increased human resources, likely contributed to the 3.5% annual decline in neonatal mortality rate. The initial entry point for newborn care in Malawi was mainly through facility initiatives, such as Kangaroo Mother Care. This transitioned to an integrated and comprehensive approach at community and facility level through the Community-Based Maternal and Newborn Care package, now being implemented in 17 of 28 districts. Addressing quality gaps, especially for care at birth in facilities, and including newborn interventions in child health programmes, will be critical to the future agenda of newborn survival in Malawi, the paper concludes.
As part of a multi-country analysis, the authors of this paper examined changes for newborn survival in Uganda over the past decade through mortality and health system coverage indicators as well as national and external funding for health, and changes in policies and programmes. Between 2000 and 2010 Uganda’s neonatal mortality rate reduced by 2.2% per year, which is greater than the regional average rate of decline but lower than national reductions in maternal mortality and under-five mortality. Attention and policy change for newborn health is comparatively recent, the authors note. In 2006, a national Newborn Steering Committee was launched, which was given a mandate from the Ministry of Health to advise on newborn survival issues. This multi-disciplinary and inter-agency network of stakeholders has been able to preside over a number of important policy changes at various levels of facility care, education and training, in addition to community-based service delivery through village health teams and changes to essential drugs and commodities. The committee’s comprehensive reach has enabled rapid policy change and increased attention to newborn survival in a relatively short space of time. Translating this favourable policy environment into district-level implementation and high quality services is now the priority.
The growing global burden of non-communicable diseases (NCDs) is now killing 36 million people each year and needs urgent and comprehensive action, according to this article. The authors provide an overview of key critical issues that need to be resolved to ensure that recent political commitments are translated into practical action. These include categorising and prioritising NCDs in order to inform external funding commitments and priorities for intervention, and finding the right balance between the relative importance of treatment and prevention to ensure that responses cover those at risk in addition to those who are already sick. Governments should also define the appropriate health systems response to address the needs of patients with diseases characterised by long duration and often slow progression, and address research needs, in particular translational research in the delivery of care, as well as ensure sustained funding to support the global NCD response.
This paper assesses the patterns and levels of physical intimate partner violence (PIPV) against women and its association with problem drinking of their sexual partners in a nationwide survey in Uganda. The data came from the women's dataset in the Uganda Demographic and Health Survey of 2006. Results show that 48% of the women had experienced PIPV while 49.5% reported that their partners got drunk at least sometimes. The prevalence of both PIPV and problem drinking significantly varied by age group, education level, wealth status, and region and to a less extent by occupation, type of residence, education level and occupation of the partner. Women with a higher wealth status or education level were less likely to experience violence. Women whose partners got drunk often were six times more likely to report violence compared to those whose partners never drank alcohol. The authors conclude that problem drinking among male partners is a strong determinant of PIPV among women in Uganda. PIPV prevention measures should address reduction of problem drinking among men. Long-term prevention measures should address empowerment of women including ensuring higher education, employment and increased income.
More than 3,000 delegates from approximately 120 countries assembled at the 13th World Congress on Public Health in Addis Ababa from the 23rd to 27th of April 2012. In this statement, delegates re-affirm their commitment to international agreements enshrining health as a human right. They also pledge to promote innovative research to generate evidence on the social determinants of health and health equity, as well as advocate for: evidence-based policy; making health equity an integral part of policy and development; equitable access to high quality health services; and fair trade in all commodities that affect human health. The Federation further intends to strengthen partnerships and networks to take common action on global public health priorities, share experiences and help build capacity.
4. Values, Policies and Rights
Health inequalities represent perhaps the most consequential global health challenge and yet they persist despite increased funding and innovative programmes. The United Nations is revising the Millennium Development Goals (MDGs) that will shape the world for many years to come. What would a transformative post-MDG framework for global health justice look like? A global coalition of civil society and academics - the Joint Action and Learning Initiative on National and Global Responsibilities for Health (JALI) - has formed an international campaign to advocate for a Framework Convention on Global Health (FCGH). Recently endorsed by the UN Secretary-General, the FCGH would reimagine global governance for health, offering a new post-MDG vision. This Special Communication describes the key modalities of an FCGH to illustrate how it would improve health and reduce inequalities. The modalities would include defining national responsibilities for the population’s health; defining international responsibilities for reliable, sustainable funding; setting global health priorities; coordinating fragmented activities; reshaping global governance for health; and providing strong global health leadership through the World Health Organisation.
An survey reported by the Zimbabwean on the Constitution found that 40% of those interviewed were in favour of the Constitution preserving full rights for women to have an abortion, while fewer(39%) believed it should be preserved only in certain instances which must be clearly stated by law. Only 19% were completely opposed to the Constitution preserving any rights for a woman to have an abortion. More men than women were in favour of full rights for women to seek an abortion. The government, which says it is aware of the practice of illegal abortions, promotes safe sex as a solution, but a spokesman for the Ministry of Health and Child Welfare admitted this was a huge challenge due to the unavailability of – and cultural resistance to – contraceptives. A largely Christian society, abortion in Zimbabwe is condemned by both the church and the state. Women who do choose the abortion route say that although a safe, legal abortion is exorbitant – around US$350 – it’s still a lot cheaper than the cost of giving birth to a child in a city hospital. Pregnant women who cannot afford the legal option are reported to resort to taking herbal remedies from traditional healers.
This article poses questions about what will be achieved at Rio+20. The author argues that all global environmental problems—from climate change to hazardous waste—have separate agreements. International rules of engagement and cooperation are being discussed in parallel processes and institutions. Rio+20 has raised the green economy rather than 1992’s concept of sustainable development, but without clarifying what this is. Does it mean the world will invest in technologies to green the current economy? Or will it seriously reinvent growth so that it is not driven by cheap consumption that is costing us the earth?
In this press statement, human rights organisation Release Political Prisoners (RPP) Trust registers its support for the position taken by the Kenya National Commission on Human Rights to promote the rights of lesbians, gays, bi-sexual and transgender people as well as commercial sex workers. RPP notes that the constitution protects all Kenyans against any form of discrimination and that the bill of rights guarantees all persons, non-heterosexuals included, all rights and entitlements under that Chapter, including the right to health and education. Statistics indicate that up to 15% of new HIV infections in Kenya are attributable to gay men and 6 out every 10 gay men are in heterosexual relationships. Yet discrimination hampers access to health services for these marginalised groups. Even when they get infected, they rarely have access to treatment and are reportedly often discriminated against by health workers. RPP notes several incidences in the recent past where gay men and women have been threatened and attacked at health facilities while seeking treatment for HIV. It argues that these attacks can be directly attributed to the preaching of hatred against gays and lesbians by religious leaders, and calls on the National Cohesion and Integration Commission (NCIC) to consider investigating these religious groups for hate speech and for promoting discrimination against non-heterosexuals and commercial sex workers.
The Ugandan government has launched an HIV and AIDS workplace policy in a bid to promote freedom from stigma and non-discrimination for all employees, according to this article. The policy, spearheaded by the Ministry of East African Affairs, will address discrimination against employees living with HIV or AIDS, ensure that they are provided with antiretrovirals, promote gender equity and equality, help with management of HIV-positive employees to enable them achieve their potential, as well as guaranteeing them total confidentiality. The policy acknowledges that HIV and AIDS have continued to impact negatively on the country’s economy, through the loss of skilled labour, absenteeism from work due to stigma and increased healthcare expenditure. The policy covers all employees except the police and army, which do not recruit people living with HIV, even if they meet all other requirements.
President Joyce Banda has announced her intention to repeal Malawi's laws gainst homosexual acts, going against a trend in Africa in which gays, lesbians and transgendered people are being increasingly singled out for prosecution. President Banda, who assumed the presidency in April 2012 when her predecessor died, made the announcement in her first state of the nation address, vowing to repeal indecency and unnatural acts laws. Repealing the law requires a parliamentary vote. The authors caution that it is unclear how much political support Banda would have for these changes. In South Africa, the only African country with laws protecting gay rights, HIV and AIDS activist Mark Heywood said Banda would have international support.
South Africa’s Intellectual Property Laws Amendment Bill, which is hoped to pave the way for the protection of the country’s traditional medicinal knowledge, has finally been passed by Parliament and is awaiting the approval of President Jacob Zuma. The bill aims to: improve the livelihoods of indigenous knowledge holders and communities, benefit the national economy, prevent bio-piracy, provide a legal framework for protection and empower local communities and prevent exploitation of indigenous knowledge. Indigenous peoples in South Africa and the rest of the world have put forward the argument that knowledge of the use of certain plants, for example, has been developed over several generations, and ask why only the present generation should benefit. They also question why some governments or corporates are reaping the rewards of indigenous knowledge through patented products when the knowledge was born from the communities of indigenous peoples. The difficulty in answering these questions, according to law experts, is that indigenous knowledge systems do not have a clearly devised timeline to the origin or source of the knowledge. It still proves very difficult for proponents of indigenous intellectual property to trump corporates wanting to capitalise on indigenous knowledge systems, more especially within a western legal framework. Meanwhile, the main critique of the new Bill is that it incorporates traditional knowledge into existing law, rather than being governed by its own separate act, which was the main objection raised during public hearings on the bill.
The Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health considers in this report occupational health as an integral component of the right to health. The report outlines international human rights and other instruments related to occupational health, and it addresses occupational health in the informal economy, focusing on the needs of vulnerable and marginalized groups. It also addresses the obligation of States to formulate, implement, monitor and evaluate occupational health laws and policies, as well as the requirement for the participation of workers at all stages of those activities. The discussion of State obligations is followed by the analysis of such occupational health issues as environmental and industrial hygiene; prevention and reduction of the working population's exposure to harmful substances; challenges posed by emerging technologies; minimization of hazards in the workplace; and availability and accessibility of occupational health services. The Special Rapporteur then elaborates on the prospective and retrospective components of accountability, as well as remedies for violations related to occupational health. The Special Rapporteur concludes his report with a number of recommendations aimed at strengthening occupational health, as a component of the right to health.
To commemorate World No Tobacco Day on 31 May 2012, the Cancer Association of South Africa (CANSA) announced plans to increase public awareness of the tobacco industry’s aggressive marketing tactics in South Africa. Over 44,000 people are estimated to die each year from tobacco-related diseases in the country, despite advertising restriction requirements in legislation. CANSA notes that tobacco companies are targeting women and young people to become smokers, as they represent a relatively untapped market for these companies. In the past, cigarettes were made freely available and promoted at exclusive parties and evidence has come to light of specific brands promoting cigarettes in a supermarket, as well as at a restaurant, as recently as November 2011, with beautiful women used to promote and distribute free cigarettes. CANSA notes that the Tobacco Control Act restricts tobacco advertising, including ‘viral’ marketing via social media like Facebook and Twitter, which is a favoured approach to target young people. The organisation highlights the need for this law to be leveraged to stop tobacco companies from marketing their harmful products to the public.
5. Health equity in economic and trade policies
In this open letter from 13 African civil society organisations, they argue that sub-Saharan Africa is caught between the desire to regain control of its own development and excessive reliance on external sources of funding. In the past decade, African states have committed to dedicate more public resources to agriculture and to promote regional agricultural policy and trade through regional trade blocs like ECOWAS and NEPAD. These commitments testified to a real commitment to agriculture on the part of the African authorities, as well as to a new desire to assume control of African development in dialogue with local populations, and they were a sign to social movements and networks of peasants and producers that agriculture had regained its position at the heart of the political agenda. Unfortunately the methodology adopted for the formulation of the Comprehensive Africa Agriculture Development Programme, NEPAD’s initiative to boost agricultural productivity in Africa, rapidly degenerated, and the National Agricultural Development Programmes, promoted from above with insufficient dialogue with the concerned actors, appeared to be merely occasions for negotiating new aid. The letter argues that success in agricultural policies in Europe, the United States and in emerging countries like Brazil and India, have always been the product of sovereign will and of a partnership between the states and the economic actors, that is the producers, the processors, the traders. Therefore external funders and foreign investors are not the appropriate role players to drive agricultural policy in Africa.
This new book explores the development policies of Brazil, China, India, Mexico and South Africa. Using a case study approach, the author charts the evolution of South-South cooperation and elaborates on the lessons learnt from traditional forms of external funding. Against the background of the changes in the international system of development cooperation, she also discusses the possibility for convergence or conflict in this transitional phase of the architecture of development cooperation. The emergence of new development partners should be seen as the starting point for the gradual emergence of more comprehensive and balanced international development cooperation, bringing greater gains to aid-dependent economies, including key international development issues such as international tax cooperation, sovereign debt workouts and international economic governance. Emerging economies want to be rule makers, not just rule takers, and increasingly are making their voices heard in international forums. In so doing they are eroding the West's 'monopoly' on developmental issues.
On 18 May 2012, a few days before the 2012 World Health Assembly, the permanent mission of Brazil organised an informal meeting on sanitary regulation and how to improve global cooperation among drug regulatory agencies. Margaret Chan, Secretary-General of the World Health Organisation (WHO), discussed the WHO drug prequalification programme, which she said was intended to give the opportunity for manufacturers from low- and middle-income countries to enter the market with straight quality and safety standards, and to enter into fair competition with other manufacturers. Many countries lacked capacity to pre-qualify their medical products, such as vaccines, as they did not have a functional national drug regulatory authority. These authorities often lacked resources and support from government and other stakeholders. Medicins sans Frontiers voiced its support for regional cooperation between regulatory agencies, adding that WHO should continue the development of norms and standards for phamacovigilence and support their implementation at country level. The Indian delegation identified lack of harmonisation of regulatory systems as a challenge and argued for the exchange and sharing of information among drug regulatory agencies.
This report contends that Africa should not follow the same ‘grow now, clean up later’ approach that was adopted by currently industrialised countries. The continent should instead pursue a different path that reconciles economic growth with environmental sustainability. The report urges African governments to shift from traditional to modern, less-polluting energy sources, wherever these energy sources are economically and environmentally viable, and to promote a shift to organic agriculture to ensure environmentally sustainable increases in harvests, to bring higher prices to farmers and to keep rural populations engaged in farming rather than migrating to the cities. The report calls for developed countries to increase financial assistance to Africa, but emphasises that equally important will be greater technology transfer from developed and emerging countries to Africa, increased South-South cooperation in green technology use and adaptation, and more flexibilities in the design of the global intellectual property rights regime. More "policy space" will be needed for African governments so that they have the ability to use incoming funds and technology in the most efficient way for their specific circumstances. Each African country will have to design strategies and policies based on its own sectoral and resource priorities, environmental challenges, initial conditions and domestic capabilities. Countries that are already embarked on that path in Africa include Kenya, Mauritius and South Africa.
Developed countries have traditionally been the source of most biopharmaceutical innovations as well as the destination for the resulting economic and health benefits. As a result, most prior research on this sector has focused on developed countries. This paper seeks to fill the gap in research on emerging markets by analysing factors that influence innovative activity in the indigenous biopharmaceutical sectors of China, India, Brazil and South Africa. Using qualitative research methodologies, the authors show how biopharmaceutical innovation is taking place within the entrepreneurial sectors of these emerging markets, identify common challenges that indigenous entrepreneurs face and highlight the key role played by the state. Their findings reveal that the transition to innovation by companies in the emerging markets is characterised by increased global integration. Further findings suggest that biopharmaceutical innovators in emerging markets are capitalising on opportunities to participate in the drug development value chain. In this way, they are developing capabilities and relationships for competing globally both with and against established companies headquartered in developed countries.
The culture of secrecy that surrounds agricultural land deals raises concerns about government misconduct in relation to issues of public interest, according to this article. There is a growing global consensus in favour of contract transparency and a few governments have started publishing contracts or improving legislation on transparency, with Liberia leading the way. After a review and renegotiation of all extractive industry concessions and contracts, President Sirleaf introduced the Liberia Extractive Industry Transparency Initiative Act (the LEITI Act), which requires all payments by individual companies and operating contracts and licenses to be published and reviewed on the LEITI website. This bold step has not deterred investors, as initially feared. Other countries are following suit. Ghana has also started publishing contracts in the oil sector, and Ethiopia has started making certain contracts public, the article notes. Some countries, including Sierra Leone, Ghana and Liberia, require large investment projects to be ratified in parliament, ensuring a layer of public scrutiny.
Sub-Saharan Africa continues to record strong economic growth, despite the weaker global economic environment. Regional output rose by 5% in 2011, with growth set to increase slightly in 2012, helped by still-strong commodity prices, new resource exploitation, and the improved domestic conditions that have underpinned several years of solid trend growth in the region’s low-income countries. But there is variation in performance across the region, with output in middle-income countries tracking more closely the global slowdown and with some sub-regions adversely affected, at least temporarily, by drought. Threats to the outlook include the risk of intensified financial stresses in the euro area spilling over into a further slowing of the global economy and the possibility of an oil price surge triggered by rising geopolitical tensions.
This report investigates the external debts of both governments and the private sector in the global South. Analysing recently compiled data from international financial institutions, it finds that private sector debt payments out of impoverished countries are now double those of the public sector, a complete turnaround since the year 2000. What is of concern is the fact that similar high levels of private sector debt have been the main cause of the financial crisis in Europe. Across the 32 low- and lower middle-income countries where data is available, private sector external debt payments were found to have increased from 4% of export earnings in 2000 to 10% in 2010. In contrast, government external debt payments for these countries have fallen from 20% of export revenues in 1998 to 5% in 2010. The negative impacts of the financial crisis – including falling trade revenues, loss of money sent home from migrants and multinational companies sending more money back to the rich world – have seen lending to the 35 most impoverished country governments almost double from $5 billion in 2007 to $9 billion in 2009. As a result, government debt payments by impoverished countries are predicted to rise by a third by 2014. Although debt cancellation has released some countries from one debt trap, the Jubilee Debt Campaign argues that the developed country debt crisis has led to an increase in unregulated and opaque private lending, which could increase social inequality and the risk of further economic crisis. A new system for monitoring and regulating the way money moves across the world is needed, so that finance works for the benefit of everyone.
6. Poverty and health
Angola has made vast progress since the end of the civil war in 2002 according to this report. Despite being one of Africa’s wealthiest nations in terms of natural resources, particularly oil, and recording impressive gross domestic product growth rates of 7% per year, poverty among the country’s citizens is rampant. Angola has ranked near the bottom of the bottom of the United Nations’ Human Development Index and Angola has high inequality and urban poverty. Government is reported to have made various commitments to address these issues, including investment in jobs and houses, decentralisation of government services and development of the agricultural sector.
This paper argues that many of the world’s extreme poor live in countries where the total cost of ending extreme poverty is not prohibitively high as a percentage of gross domestic product. In the not-too-distant future, the author argues that most of the world’s poor people will live in countries that have the domestic financial scope to end extreme poverty and, in time, moderate poverty. This calls in the authors opinion for a (re)framing of poverty as a matter of national distribution and national social and political contracts between elites, middle classes and poor people.
In this open letter to the United States President, the Oakland Institute and the Solidarity Movement for a New Ethiopia announce their submission of a petition signed by over 8,000 supporters of the indigenous and local communities of Gambella, Ethiopia - 70,000 people in all - who are being forcibly relocated to make land available for large-scale agriculture. There are plans to relocate an additional 150,000 people, most of whom are subsistence farmers who have been able, until now, to feed their families without receiving government or foreign aid over the last twenty years. The Oakland Institute's field research in Ethiopia has reported allegations of violence, coercion in and unrealised benefits for relocated communities, confirmed by a Human Rights Watch study earlier in 2012. The Ethiopian government's plans for economic growth are reported to include this large scale land acquisition in Gambella and the Lower Omo Valley, where half a million people are projected to lose their lands. Ethiopia is one of the largest recipients of US development aid (more than $1 billion a year since 2007), and the letter points to the food insecurity that will result from these trends.
The East African Community (EAC) has made substantial progress on its regional integration agenda. Within a short period of time, it has been able to attain a common market status and is currently working towards establishing a monetary union by 2012, according to this article. Given that the region is prone to food shortages and drought, promoting regional integration and cooperation around agriculture has the potential to help the EAC address its and food security challenges. The author argues that NEPAD’s Comprehensive Africa Agriculture Development Plan (CAADP) should be used as a regional integration and food security tool. The EAC Secretariat is working towards developing a regional CAADP compact in 2012, adopting a bottom-up approach, building on the existing national compacts and addressing challenges shared among partner states. Most stakeholders within the region agree that a regional CAADP process is the appropriate framework to stimulate improved coordination of regional agricultural initiatives addressing food security. Stakeholders have called for stronger commitment and action from the regional level that allows farmers, especially smallholders, to move beyond subsistence.
A new film from the African Biodiversity Network (ABN) and the Gaia Foundation, narrated by actor Jeremy Irons, addresses pervasive myths about agriculture, development and Africa’s ability to feed herself. Africa is under growing pressure to turn to hybrid seeds, fertilisers, pesticides and genetically modified organisms in an effort to scale up agricultural production. In April 2012, President Obama of the United States launched the New Alliance for Food Security and Nutrition, which will see the combined forces of agribusiness giants Monsanto, Syngenta, Cargill, DuPont and Yara investing US$3 billion into creating new markets in Africa, amidst claims that this will solve hunger and malnutrition. In the process, the enormous wealth and diversity of locally adapted seeds and farmer knowledge is ignored, undermined and eroded by policy makers. ‘Seeds of Freedom’ shows how powerful corporate interests are destroying the biological diversity of the world’s crops. As the global food supply becomes dependent on just a few seed varieties, owned by a handful of corporations, global food insecurity is set to deepen.
The tensions over huge land purchases and leases by foreign companies and governments in south western Ethiopia illustrate the central importance of access to water in the global land rush, according to this article. Hidden behind the current scramble for land is a world-wide struggle for control over water. Those who have been buying up vast stretches of farmland in recent years understand that the access to water they gain, often included for free and without restriction, may well be worth more over the long-term, than the land deals themselves. In recent years, Saudi Arabian companies have been acquiring millions of hectares of lands in developing countries to produce food to ship back home, as their country lacks water needed for agricultural production. Indian companies are doing the same, as their country’s aquifers have become depleted by decades of unsustainable irrigation. All of the land deals in Africa involve large-scale, industrial agriculture operations that will consume massive amounts of water. These water resources are lifelines for local farmers, pastoralists and other rural communities. These mega-irrigation schemes will not only put the livelihoods of millions of rural communities at risk, they will threaten the freshwater sources of entire regions, says GRAIN.
7. Equitable health services
Since 2002, an estimated 4.7 million long-lasting insecticide-treated nets (LLINs) have been distributed in the Southern Nations, Nationalities and Peoples Region (SNNPR) of Ethiopia among a population of approximately 10 million people at risk for contracting malaria. This study sought to determine the status of current net ownership, utilisation and rate of long-lasting insecticide-treated nets (LLIN) loss in the previous three years. A total of 750 household respondents were interviewed in SNNPR. Approximately 67.5% of households currently owned at least one net. An estimated 31% of all nets owned in the previous three years had been discarded by owners, most of whom considered the nets too torn, old or dirty. Households reported that one-third of nets (33.7%) were less than one year old when they were discarded. These results suggest that the life span of nets may be shorter than previously thought, with little maintenance by their owners. With the global move towards malaria elimination it makes sense to aim for sustained high coverage of LLINs, the authors argue. However, in the current economic climate, it also makes sense to use simple tools and messages on the importance of careful net maintenance, which could increase their lifespans.
The purpose of this study was to describe the results of eight human papillovirus (HPV) vaccination programmes conducted in seven lowest-income countries, including Lesotho, through the Gardasil Access Programme (GAP), which provides free HPV vaccines to organisations and institutions working in those countries. The eight programmes initially targeted a total of 87,580 girls, of which 76,983 received the full three-dose vaccine course, with mean programme vaccination coverage of 87.8%, while the mean adherence between the first and third doses of vaccine was 90.9%. Mixed models consisting of school-based and health facility-based vaccinations were found to record better overall performance compared with models using just one of the methods. Increased rates of programme coverage and adherence were positively correlated with the number of vaccination sites. Qualitative key insights from the school models showed a high level of coordination and logistics to facilitate vaccination administration, a lower risk of girls being lost to follow-up and vaccinations conducted within the academic year to limit the number of girls lost to follow-up. This study is intended to provide lessons for development of public health programmes and policies as countries go forward in national decision-making for HPV vaccination.
This report highlights the systemic problems that prevent women, men and young people from accessing reproductive health supplies, and provide recommendations on moving forward. The authors call for increased funding for reproductive health and argue that reproductive health must be incorporated into national health plans and budgeted for accordingly. Additionally, governments should create an enabling environment for sexual and reproductive health and rights. The authors make several recommendations for health service provision. Governments should ensure that a wide range of reproductive health supplies are included in the national essential drug list, while health system-strengthening initiatives and national health plans must include provisions for monitoring the distribution of reproductive health supplies. Capacity for quality of care should be built among all health professionals that deliver supplies, including health care providers, pharmacists and nurses, and there should be more investment in adequate storage facilities at national and municipal levels, and implementation of logistics management systems.
This qualitative study explored in detail the ability of output-based aid (OBA) voucher programmes to increase access to gender-based violence recovery (GBVR) services. It was conducted in 2010 and data was gathered through in-depth interviews (IDIs) with health managers, service providers, voucher management agency (VMA) managers and focus group discussions (FGDs) with voucher users, voucher non-users, voucher distributors and opinion leaders drawn from five programme sites in Kenya. The findings showed promising prospects for the uptake of OBA GBVR services among target population. However, a number of factors affect the uptake of the services, such as lack of general awareness of the GBVR services vouchers, lack of understanding of the benefit package, immediate financial needs of survivors, as well as stigma and cultural beliefs that undermine reporting of cases or seeking essential medical services. The researchers also found that accreditation of only hospitals to offer GBVR services undermined access to the services in rural areas, and low provider knowledge on GBVR services and lack of supplies undermined effective provision and management of GBVR services. They argue that there is a need to build the capacity of health care providers and police officers, strengthen the community strategy component of the OBA programme to promote the GBVR services voucher, and conduct widespread community education programmes aimed at prevention, ensuring survivors know how and where to access services and addressing stigma and cultural barriers.
Intermittent screening and treatment (IST) of school children for malaria is one possible intervention strategy that could help reduce the burden of malaria among school children. This study was conducted alongside a cluster-randomised trial to investigate local perceptions of school-based IST among parents and other stakeholders on the Kenyan south coast. Six out of the 51 schools receiving the IST intervention were purposively sampled, and 22 focus group discussions and 17 in-depth interviews were conducted with parents and other key stakeholders involved in the implementation of school health programmes in the district. Results showed that the use of alternative anti-malarial drugs with simpler regimens was generally preferred. General consensus was that health workers were best placed to undertake the screening and provide treatment, and although teachers' involvement in the programme is critical, most participants were opposed to teachers taking finger-prick blood samples from children. There was also a strong demand for the distribution of mosquito nets to augment IST. Future research should carefully consider the various roles of teachers, community health workers, and health workers, and the use of anti-malarial drugs with simpler regimens.
Poor-quality antimalarial drugs lead to drug resistance and inadequate treatment, posing a threat to vulnerable populations and jeopardising progress in combating malaria. In this study, the authors reviewed published and unpublished studies reporting chemical analyses and assessments of packaging of antimalarial drugs. Of 1,437 samples of drugs in five classes from seven countries in southeast Asia, 497 (35%) failed chemical analysis, 423 (46%) of 919 failed packaging analysis, and 450 (36%) of 1,260 were classified as falsified. In 21 surveys of drugs from six classes from 21 countries in sub-Saharan Africa, 796 (35%) of 2,297 failed chemical analysis, 28 (36%) of 77 failed packaging analysis, and 79 (20%) of 389 were classified as falsified. Data were insufficient to identify the frequency of substandard (products resulting from poor manufacturing) antimalarial drugs, and packaging analysis data were scarce. Concurrent interventions and a multifaceted approach are needed to define and eliminate criminal production, distribution, and poor manufacturing of antimalarial drugs. Empowering national medicine regulatory authorities to protect the global drug supply is more important than ever, the authors conclude.
This study investigated the extent and predictors of condom use and condom refusal in the Free State province in South Africa. Through a household survey, 5,837 adults were interviewed. Eighty-three per cent of the respondents had used condoms before, of which 38% always used them, 61% used them during the last sexual intercourse and 9% had refused in the past to use them. The analysis indicated that the strongest predictor of condom use was its perceived need, followed by 'knowledge of correct use of condom' and condom availability, as well as being young in age, single and having a higher education. The strongest predictor of condom refusal was shame associated with condoms, as well as lacking knowledge about the use of condoms. The authors conclude that further improvement in correct and consistent use of condoms will require targeted interventions. In addition to existing social marketing campaigns, tailored approaches should focus on establishing the perceived need for condom-use and improving skills for correct use. They should also incorporate interventions to reduce the shame associated with condoms and individual counselling of those likely to refuse condoms.
The World Health Organisation’s (WHO) Department of HIV/AIDS has developed public health guidelines, called GRADE, for delivering an evidence-based, essential package of interventions for the prevention and treatment of HIV and other sexually transmitted infections (STIs) among men who have sex with men (MSM) and transgender people in the health sector in low- and middle-income countries. The objective of this paper is to review the methodological challenges faced and solutions applied during the development of the guidelines. The development of the guidelines followed the WHO guideline development process, which utilises the GRADE approach. The authors identified, categorised and labelled the challenges identified in the guidelines development process and described the solutions through an interactive process of in-person and electronic communication. The paper describes how the researchers dealt with the following challenges: heterogeneous and complex interventions; paucity of trial data; selecting outcomes of interest; using indirect evidence; integrating values and preferences; considering resource use; addressing social and legal barriers; wording of recommendations; and developing global guidelines. In conclusion, the researchers were able to successfully apply the GRADE approach for developing recommendations for public health interventions. Applying the general principles of the approach while carefully considering specific challenges can enhance both the process and the outcome of guideline development, they recommend.
8. Human Resources
In this study, researchers in Zambia examined the relationship between health worker incomes and their satisfaction and motivation. Cross-sectional data collection was undertaken using both quantitative and qualitative methods. Data was collected in three regions that represent extremes in overall remuneration and benefits. Lusaka represented the favourable area while Monze and Nyimba represented less favourable areas for study in Zambia. The researchers found that there are hefty disparities between different health workers. There are also enormous salary differentials for the same workers between the public and private sectors. These salary differentials explain the experience of public-to-private migration of health workers as well as casual private sector work by public sector health workers, they argue. In addition, there are negligible efforts by government to reduce the benefits gaps among key public health cadres. The low incomes received by public health workers in Zambia have many negative implications: it begets absenteeism, results in low output, poor quality health care, and the departure of health workers to the private sector and overseas.
Globally, there is a lack of data tracking the movements of health workers within health systems. In this study, researchers aimed to collate what research exists in the form of a review of the available literature on implementation processes for human resources information systems (HRIS). They retrieved 11,923 articles in four languages published in peer-reviewed and grey literature, of which 95 articles with relevant HRIS information were reviewed, mostly from the grey literature, which comprised 84 % of all documents. Whereas a high percentage of countries reported the capability to generate workforce supply and deployment data, few systems were documented as being used for HRH planning and decision-making. Of the systems examined, only 23% explicitly stated they collect data on workforce attrition. Most countries experiencing crisis levels of HRH shortages (56%) did not report data on health worker qualifications or professional credentialing as part of their HRIS. This study is intended to serve as a baseline for scaling up HRIS at national, regional and global levels.
In this study, researchers developed and piloted a methodology to establish tuberculosis-related work load at primary care level for clinical and laboratory staff. They found that workload was determined by the nature of the activities that staff had to implement, the amount of time they had to perform them and their frequency, as well as patient load. Of particular importance, the researchers note, is the patient pathway for diagnosis and treatment and the frequency of clinic visits. They recommend using observation with checklists, clocking, interviews and review of registers to assess the contribution of different factors on the workload.
9. Public-Private Mix
Despite the positive health effects of breast feeding, and adverse health effects of breastmilk substitutes, particularly in conditions of poverty, Nestlé is reported by Baby Milk Action to be continuing promotion of the use of formula. The authors report that Nestlé has backtracked on a past commitment not to advertise formula brands in ‘high risk’ developing countries. The authors report that the World Health Organisation's Guidelines for the safe preparation, storage and handling of powdered infant formula are not adequately included on labels of its products, that health workers in India are being included in sponsored events, and that it is pushing in Philippines, as part of an industry alliance, for a weakening of current law in this area. The World Health Assembly (WHA) has called for companies to bring their activities at every level into line with the International Code on Marketing of Breastmilk Substitutes and subsequent WHA Resolutions.
10. Resource allocation and health financing
This report indicates that family planning and maternal and newborn services fall well short of needs in developing countries, particularly in the world’s two poorest regions, South Asia and Sub-Saharan Africa. The authors argue that helping women and couples have healthy, wanted pregnancies in these regions will help achieve social and economic gains beyond the health sector. Several barriers to services were identified, such as weaknesses in health systems that need to be addressed, including insufficient capacity, weak contraceptive supply systems and poor financial management systems, as well as prejudice among providers toward unmarried, sexually active young people, or toward women who have had unsafe abortions. The authors suggest that the additional funds needed for improving services could come from a combination of domestic and international resources. Furthermore, decision makers need to recognise that changes outside the service environment (e.g. social changes) may improve demand for sexual and reproductive health care.
The central argument of this working paper is that, given the magnitude of the investment in infrastructure that is required, especially in Africa, the role of external funding (foreign aid) in the future should be distinctly different to what it is now. While external funding will be required to continue to fill the ‘savings gap’ in some small countries and land-locked countries, in most other countries it can play a very different role in facilitating the creation of institutional mechanisms that help mobilise more funding from other sources. These include domestic revenues (which already fund a large proportion of infrastructure), investments by China and the other BRIC countries, sovereign wealth funds and infrastructure funds. There are already examples of external funding playing such a leveraging role. What is needed is to take this to a new and higher level, the authors argue. The study provides an overview of evidence on infrastructure needs and also possible magnitudes of flows from different sources for investment in infrastructure.
This article considers the new players in development financing, namely Brazil, Russia, India and China (BRIC). Unlike external funding (aid) from traditional Western funders, BRIC financing (excluding Russia) focuses on mutual benefits without attachment of policy conditionality. Despite the clear advantage for low-income countries (LICs) that are receiving this funding, the authors caution that governments of these LICs will still need to ensure they get high returns for BRIC-financed projects through sound public investment management. While the scaling up of public investment associated with most BRIC financing is likely to have large positive growth effects, it is critical that LICs align BRIC-financed projects with national development priorities. To help ensure transparency and governance, improvements in data are needed regarding the size and terms of financing flows, the structure and conditions of packaged deals, as well as the rights of concessions for natural resources. Safeguarding debt sustainability will also be key, the authors argue. The final challenge will be to deepen project links to the local economy. LICs and BRICs could work together to build incentives, as part of a total package for development financing, to encourage local employment, foster skills development and improve technology transfer.
According to this article, Africa needs to innovatively diversify the way in which it raises finances for development, arguing that diaspora bonds are one way of doing this. World Bank and International Monetary Fund figures have put remittances from Africans abroad to the continent at between US$25 billion and US$34 billion a year. Unrecorded informal flows of remittances were most probably at least a third of this amount. The authors recommend that Africa should leverage this African diaspora money more aggressively and innovatively for development. The idea of issuing diaspora bonds should be considered as a viable alternative to raise finance for Africa’s development. Some of these remittances from Africans abroad could be channeled into buying such diaspora bonds, which can be specifically used to finance Africa’s development in terms of infrastructure or health. Diaspora bonds are long-term sources of finance and therefore less volatile and they may also allow Africa to circumvent the conditionalities that accompany development and investment finance from both old industrial and new emerging powers. However, poor governance and lack of democracy in some African governments could mean potential African diaspora investors may be wary. The article considers India and Israel, two countries where diaspora bonds have been used successfully as model examples of how Africa could proceed.
11. Equity and HIV/AIDS
This book is a collection of essays that critique leadership on HIV and AIDS in Africa from the 1980s to the present. They examine the rhetoric on HIV and AIDS, which has influenced culture and behaviour, service delivery, policy, the design of national interventions and the varied success of different countries in containing the pandemic. African scholars contextualise a host of public and scholarly disputes, ranging from AIDS exceptionalism, racialised data manipulation and ‘denialism’ to the racist debates on ‘African promiscuity’ and the recent revival of assertions that homosexuality is not ‘African’ behaviour. The book refers to the record of governments in a wide range of African countries with case studies drawing on the rhetoric of governments and the nature of leadership in Ethiopia, the Gambia, Morocco, South Africa and Zambia. What emerges is that the rhetoric is diverse, occasionally logical and effective in terms of informing systemic HIV and AIDS interventions that improve the welfare of people, and sometimes it is contradictory to the point of absurdity.
The World Health Organisation recommends HIV-infected mothers exclusively breastfeed their infants, unless replacement feeding is Acceptable, Feasible, Affordable, Sustainable and Safe (AFASS). The aim of this study was to develop and content validate an AFASS assessment tool that could be used for infant feeding counselling in sub-Saharan Africa (SSA). An AFASS assessment tool consisting of 15 questions was developed based on the evidence and tools available regarding why replacement feeding is not AFASS in the region. Fifty-seven experts involved in prevention of mother-to-child HIV transmission (PMTCT) programmes in five SSA countries were approached to participate as members of the Delphi expert panel, reduced to a final panel of 15 experts. Thirteen of the 15 questions in the tool achieved consensus agreement among panel members and they also reached consensus regarding the applicability and appropriateness of the tool within the regional context. Suggestions made by the expert panel were incorporated into the revised tool. Ideally the revised tool should be tested by providers of infant feeding advice with the aim of adoption into routine PMTCT programmes in SSA, but within the context of the 2010 WHO guidelines which advocate a public health rather than an individualised approach, it may inform the WHO process of improving counselling tools for health care workers involved in PMTCT programmes.
Although Madagascar and its neighbouring islands states of Comoros, Mauritius and Seychelles have extremely low HIV prevalence rates at around 0.37% (or 24,000 confirmed cases), they are reporting problems with supplying health services to HIV-positive people. Recent stock-outs have sometimes left patients without treatment for months, exposing them to the risk of developing drug-resistance. The Malagasy Ministry of Health and its private sector distributor, Salama, have reported experiencing problems placing orders because suppliers are not interested in providing small quantities, making it difficult to keep adequate supplies of antiretrovirals in stock. One possibility being explored is putting in place a central purchasing mechanism for the four Indian Ocean countries. This facility would fall under the oversight of the High Level Partnership Forum, which is expected to be set up after discussions with the Indian Ocean Commission, an inter-governmental cooperation group. The forum would include Ministers of Foreign Affairs, Ministers of Health, networks of people living with HIV, support groups and various financial partners.
This integrated biological and behavioural surveillance survey of migrant sex workers in Nairobi, Kenya's capital, reveals that HIV prevalence among migrant and Kenyan female sex workers stands at 23.1%, more than three times the national average of 6.3%. However, Kenyan sex workers were found to have better knowledge of HIV and health-seeking behaviour than their migrant counterparts, and nearly all Kenyan female sex workers (98%) had heard of sexual transmitted infections, compared to 70% of migrant female sex workers. The study was conducted in 2010, when just over half of the 628 participants said they had ever tested before for HIV, and 25.8% did not know that condoms protected against HIV. Only 72% of migrant female sex workers knew where to go for an HIV test, compared to 92% of women in the general population. Services for migrant sex workers need to be integrated into programmes for general sex workers, the authors argue. However, special care must be given to the language and cultural needs of the migrants. The authors also propose that role players lobby the Kenyan government to provide a legal framework for the regulation of sex work, which would increase access to services and provide protection for sex workers.
With increased levels of school enrolment, more adolescents in Ethiopia are in school today than ever before, but few studies have assessed the sexual behaviour of these learners. This study addresses the research gap by assessing pre-marital sex and factors associated with it among school-going adolescents in Eastern Ethiopia. A cross-sectional school-based study was conducted using a facilitator-guided, self-administered questionnaire. Respondents were students attending regular school classes in fourteen high schools. Results showed that about one in four respondents who were unmarried (24.8%) reported pre-marital sex – of these 28.8% were males and 14.7% were females. Pre-marital sexual debut was more common among adolescents who had their parents in urban areas, who received higher pocket money per month, who perceived low self-educational rank and who lived in rented houses. The girls and those who were less influenced by external pressure were more protected against pre-marital sexual debut than their counterparts. The authors argue that public health interventions should consider the broader determinants of premarital sex, including the ecological factors in which the behaviour occurs.
The objective of this study was to use service data to inform HIV-free survival among HIV exposed children that received antiretroviral drugs to prevent mother-to-child transmission (PMTCT) of HIV. The study was conducted in two rural districts in Malawi between June 2005 and June 2009. Out of 438 children whose home addresses were available, 33 (8%) were lost to follow-up, 35 (8%) were alive but not tested for HIV by the time home visit was conducted, and 52 (12%) were confirmed deceased. A total of 318 children were alive at the time of the home visit and had an HIV antibody test done at median age 15 months. The resulting estimated 24-month probability of HIV-free survival over all children was 78%. Among children who did not receive nevirapine, the estimated 24-month probability of HIV-free survival was 61%, and among those who did receive it, the estimate was 82%. When mothers and newborns received nevirapine, the estimated 24-month probability of HIV-free survival among children was high at 82%. However, the authors warn that these promising findings should be interpreted cautiously due to the wide confidence interval and because the confidence interval range includes 55%, which is the natural HIV-free survival rate in the absence of a PMTCT intervention. This analysis highlighted the need of quality data and well-structured home visits to assess PMTCT effectiveness.
12. Governance and participation in health
In Tanzania, the policy of decentralisation and the health sector reform have placed an emphasis on community participation in making decisions in health care. The objective of this study was to explore challenges to fair decision-making processes in health care services with a special focus on the potential influence of gender, wealth, ethnicity and education. study was carried out in the Mbarali District of Tanzania. A qualitative study design was used, with in-depth interviews and focus group discussions conducted among members of the district health team, local government officials, health care providers and community members. Informal discussion on the topics was also of substantial value. The study findings indicate differences in influence on health care decision-making processes in terms of gender, wealth, ethnicity and education, as men, wealthy individuals, members of strong ethnic groups and highly educated individuals had greater influence. Opinions varied among the study informants as to whether such differences should be considered fair. The differences in levels of influence emerged most clearly at the community level, and were largely perceived as legitimate. The authors conclude that these inequalities in decision making in health care need to be addressed if greater participation is desired. There must be an emphasis on the right of all individuals to participate in decision-making processes, and role players should ensure that information, training and education is fairly distributed so individuals can participate fully in informed decision making.
In this statement, issued before the United Nations Conference on Sustainable Development (Rio+20), held in Brazil from 20-22 June 2012, CIVICUS affirms that the Zero Draft outcome document for Rio+20 must advance a rights-based approach to sustainable development that reaffirms past political commitments, and in particular, the need to protect civil society space, ensure maximum public participation and advance democratic freedoms, by establishing legally binding commitments which support the three dimensions of sustainable development: social justice, environmental sustainability and economic development. CIVICUS argues that the reason why global governance is failing so badly is partly because we have multinationals whose operations are now global beyond the national jurisdiction of any one government to regulate, police or manage. States have reneged on the democratic values they committed themselves to uphold, and governments have become less accountable to the people. Universal norms and standards are being ignored or sidestepped by new rules that favour markets. To achieve and maintain sustainable development, CIVICUS urges UN member states to commit to improve continuously the implementation and enforcement of environmental policies and legislation, with no regression on environmental protection. Commitments to the principle of non-regression at all levels should be a major objective of Rio+20.
The author argues that the stalemate that emerged following the contest between Jean Ping of Gabon and Nkosasana Dlamini-Zuma for the position of African Union Commission Chairperson in Addis Ababa had repercussions for South Africa's foreign policy in Africa, paralysed the institution and divuded it at a time of need. He argued that South Africa should rather have sought consensus among African leaders than choosing a public and political way of challenge, which he observes created camps along lines of language and politics. Naidoo warned that South Africa’s desire to be the dominant economic force on the continent should not raise barriers to effective African unity and urged African leaders to resolve the stalemate before the next AU head of state conference in July 2012.
International capital mobility has long been associated with financial and banking crises. The Articles of Agreement of the International Monetary Fund (IMF) contain multi‐lateral rules to govern global capital flows. For some countries, especially those in the developing world, the IMF Articles of Agreement remain the core framework under which they have autonomy to regulate cross‐border capital flows. For others, these rules have been partly superseded by more recent trade and other economic integration agreements. Thus what used to be a regime of ‘cooperative decentralisation’ has become a patchwork of overlapping and inconsistent governance structures that pose significant challenges to nations attempting to regulate global capital flows for stability and growth, according to the author of this paper. He traces the history of governing global capital flows and presents a framework for understanding three distinct eras in the modern governance of global capital. The framework emphasises how power, interests, ideas, and institutions interact to shape each era in different combinations to yield different outcomes.
A petition backed by over 50 non-governmental organisations and charging Uganda's government with failing to prevent the deaths of two expectant mothers, Sylvia Nalubowa and Jennifer Anguko, was thrown out by the constitutional court on 5 June, but the petition's supporters plan to appeal. The Constitutional Court argued that upholding the petition, which urges the government to boost health services, would have forced judges to wade into a political issue that was outside their jurisdiction, saying that it was the work of the parliament to review the efficiency of the health sector. However, the petitioners said the court relied on outdated international law in making its decision and overlooked its constitutional obligation to protect Uganda's mothers. In throwing out the case, the justices suggested the petitioners seek an order from the High Court compelling a public officer, such as a government health worker, to carry out his or her duties, or to request compensation for individual deaths from the government.
Two lawsuits have been filed against the Ugandan government for alleged negligence in the handling of nodding disease. The disease has killed at least 200 children since 2009 and currently affects 3,500 others, according to the Ministry of Health. A local charity, Health Watch Uganda, has filed one lawsuit, and two members of parliament have filed a separate case. Health Watch Uganda has accused the government of violating the rights of affected children by not providing them with adequate health care. In February, the government rolled out a plan to fight the disease, opening three specialised clinics and training 99 health workers, but critics say it is overdue and inadequate. The Health Ministry says lack of funding has made it difficult to implement the plan. The government has vowed to fight the lawsuits, arguing that it has been conducting research into the disease in cooperation with the World Health Organisation.
13. Monitoring equity and research policy
For many sub-Saharan African countries, a National Health Research System (NHRS) exists more in theory than in reality, with the health system itself receiving the majority of investments. However, this lack of attention to NHRS development can, in fact, frustrate health systems in achieving their desired goals. In this case study, the authors discuss the ongoing development of Zambia's NHRS. They reflect on their experience in the ongoing consultative development of Zambia's NHRS and offer this reflection and process documentation to those engaged in similar initiatives in other settings. Their critical argument is that three streams of concurrent activity are central to developing an NHRS in a resource-constrained setting: developing a legislative framework to determine and define the system's boundaries and the roles all actors will play within it; creating or strengthening an institution capable of providing coordination, management and guidance to the system; and focusing on networking among institutions and individuals to harmonise, unify and strengthen the overall capacities of the research community.
Health system resilience and capacity for emergency risk management are critical to effective disaster management supporting sustainability goals. That is one of the key messages emerging from this paper by the World Health Organisation (WHO). WHO also found that monitoring and reporting on the human health aspects of disasters are important for strengthening disaster risk management, and should be included in government measures to improve risk assessment, prevention, preparedness response and recovery from disasters. This will help reduce health impacts, particularly the loss of human lives, WHO argues. Building health system resilience and capacity for emergency risk management, particularly at a community level, is also critical to effective disaster management, which also supports wider sustainability objectives. Indicators of health system resilience to natural disasters include the proportion of health facilities, new and improved, to withstand hazards, including access to reliable clean energy and water supplies, daily and in emergencies.
Many food-related diseases and conditions – including undernutrition, micronutrient deficiency, and obesity as well as food safety risks and farmworker health – are interlinked, according to this report. Sustainable food policies that place the promotion and protection of health at the core of strategies from the farm field to the dinner plate can help advance the provision of sustainable, quality foods for all, across the supply chain and the human life-cycle, the World Health Organisation (WHO) argues. WHO offers three health indicators that can be used to monitor progress. 1. Health outcomes: prevalence of anaemia in women of reproductive age; prevalence of stunting in children under 5 years; and prevalence of obesity in children under five and in adults. 2. Food access and dietary quality in association with sustainable foods production: adequate access to protein supply; excessive adult saturated fat consumption; household dietary diversity; and prevalence/incidence of foodborne disease outbreaks. 3. Food market/trade policies supporting health and sustainability: foods that comply with international food safety standards, including hormone, pesticides and antibiotic residues; number of countries that have phased out use of antibiotics as growth promoters; and assessment of health and sustainability impacts in agricultural trade negotiations, policies and plans.
Health offers a universal indicator of progress in attaining the United Nations Secretary General's goals for sustainable energy for all, argues the World Health Organisation (WHO) in this report. Citing estimates of close to 1.3 million deaths annually due to urban air pollution and 2 million death to household air pollution, WHO notes that this health burden could be avoided with more efficient, better used and better distributed energy technologies. WHO puts forward some key health-relevant indicators of progress on sustainable energy, including: household access to modern, low-emission heating/cooking technologies; energy access at community health facilities, particularly for reliable electricity; health burden from air pollution-related diseases and injuries; health equity impacts of energy policies including access by poor and vulnerable populations; clean electricity generation across the energy supply chain in terms of reduced pollution; and greater efficiencies and reliance on renewable energy sources.
14. Useful Resources
More than 120 million women worldwide want to prevent pregnancy, but they and their partners are not using contraception. The aim of this World Health Organisation (WHO) handbook is to help these people by enabling health care providers to give better care in this regard. According to WHO, reasons for the unmet need for family planning are many: services and supplies are unavailable; fear of social disapproval or partner’s opposition; worries of side effects and health concerns; and lack of knowledge. The handbook highlights that family planning methods can be effective when properly provided, and when providers allow clients to choose their own contraceptive method and provide them with support and quality information. Many continuing clients need little support, and for them convenient access is key. The handbook contains specific guidance on twenty family planning methods and addresses many of providers’ different needs, from correcting misunderstandings to managing side effects. It also covers related health issues that may arise in the context of family planning.
The new interface for the World Health Organisation’s Global Price Reporting Mechanism (GPRM) is now available online. This improved interface enables users to search for the price and volumes sold of HIV medicines (all, or selected formulations), in countries, regions, by income category, by Human Development Index category, by manufacturer and by type of manufacturer (generic or innovator). New data has been included for trends of price and volumes sold. All data is quality controlled, as duplicates have been removed, suspicious data are quarantined and queried before they are uploaded. Data for 2011 and 2012 are now available from GPRM in the public domain as they are uploaded for the first time.
15. Jobs and Announcements
All are invited to submit abstracts to the ECSA Health Community for the East, Central and Southern Africa Health Community (ECSA-HC) Director’s Joint Consultative Committee (DJCC) and Best Practices Forum for 2012, which will be held from 14-17 August 2012. The DJCC is the highest technical organ of the ECSA Health Community and consists of directors of health/medical services in member states, directors of health research institutions and deans of medicals schools. The meeting will bring together senior officials from Ministries of Health, health experts, health researchers, heads of health training institutions from member states of the ECSA Health Community, as well as diverse collaborating partners in the region and beyond. These role players will identify policy issues and make recommendations to accelerate and scale up best practices in the ECSA region.
BioMed Central, in conjunction with its two journals, Malaria Journal and Parasites and Vectors, is hosting the second malaria conference under the theme “Challenges in Malaria Research: Progress Towards Elimination” in Basel, Switzerland from 10–12 October 2012. This conference will bring together leading malaria researchers to review current progress and to chart future challenges. International speakers will present their insights into malaria elimination, including social science and policies, artemisinin resistance, new drugs, vaccines, diagnostic challenges and vector controls. Abstract submission is now open for the conference. Abstracts should be no more than 500 words and posters should be A0 size. Please note that the corresponding author of an oral or poster presentation has to register and pay for the conference before being permitted to submit an abstract.
The International Development Research Centre is calling for concept notes with a focus on how and when technology can contribute toward strengthened and more equitable health systems in low-and middle-income countries (LMICs). The overarching objective of the SEARCH project is to support LMIC-based researchers in carrying out rigorous and useful research on how and when eHealth can influence the functioning of health systems to improve health outcomes, and ultimately, contribute to reducing health inequities. Key research areas include: theory, methodology, or framework development; participation, accountability and transparency; enterprise architecture and interoperability; modelling and operations research to generate evidence for decision-making; and sub-national, national and global policy processes. The principal applicant must be a citizen or permanent resident of a LMIC with a primary work affiliation at a LMIC-based institution.
To celebrate the African novel and its adaptability and resilience, Kwani Trust announces a one-off new literary prize for African writing. The Kwani Manuscript Project calls for the submission of unpublished fiction manuscripts from African writers across the continent and in the Diaspora. The top three manuscripts will be awarded cash prizes. In addition Kwani will publish manuscripts from across the shortlist and longlist, including the three winning manuscripts, as well as partnering with regional and global agents and publishing houses to create high-profile international publication opportunities. The word count for submissions is 60,000-120,000 words, and submissions should be adult literary or genre fiction and written in English or variants of the language. The manuscript must be unpublished, although Kwani will accept previously published submissions if circulation has been under 500 copies and limited to one national territory. Eligible participants should have at least one parent born in an African country who holds citizenship of that country.
The theme of this year’s conference is ‘Turning the tide together’. Policy makers, persons living with HIV and other individuals committed to ending the HIV/AIDS pandemic will meet to assess global progress, evaluate recent scientific developments and lessons learnt, and collectively chart a course forward. The programme will present new scientific knowledge and offer many opportunities for structured dialogue on the major issues facing the global response to HIV. Sessions will focus on the latest issues in HIV science, policy and practice and will also seek to share key research findings, lessons learned, best practices, as well as identify gaps in knowledge. The conference will feature abstract-driven sessions, a daily plenary session, a variety of symposia sessions, professional development workshops, and independently organised satellite meetings. In addition, the conference programme will include a number of programme activities, such as the Global Village and the Youth Programme, which are an integral aspect of the International AIDS Conference.
The People’s Health Assembly (PHA), organised by the People's Health Movement (PHM), is a global event bringing together health activists from across the world to share experiences, analyse global health situation, develop civil society positions and to develop strategies which promote health for all. It will look at forms of action to address identified challenges and build capacity among health activists to act. It is an opportunity for PHM as a whole to reflect on the global struggle, to review and reassess, to redirect and re-inspire. PHA3 aims to impact directly in the struggle for social change: for health for all, decent living conditions for all, work in dignity for all, equity and environmental justice. The programme is now available at http://www.phmovement.org/en/pha3/programme
The 2012 CIVICUS World Assembly intends to be more than the primary annual gathering of civil society and other stakeholders of society. It will also see the start of a process of defining a new charter of citizen demands. This comes in response to recent changes in civil society organisation, marked by crisis, volatility and rising dissent, in which the relationships between the state, business, citizens and other parts of the social sphere are being redefined and renegotiated. The World Assembly has three themes: 1. Changing nations through citizens: how can the power of citizen action be maximised to achieve social and political change at the national level? 2. Building partnerships for social innovation: what new partnerships are needed for change, how can they be brokered and what principles should underpin them? 3. Redefining global governance: what needs to change in multilateral processes and institutions to enable effective citizen’s participation?
The Symposium will focus on the science to accelerate universal health coverage around the world. It will cover three main themes: knowledge translation; state-of-the-art health systems research; and health systems research methodologies. There will also be three cross-cutting themes: innovations in health systems research; neglected priorities or populations in health systems research; financing and capacity building for health systems research.
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