EQUINET NEWSLETTER 142 : 01 December 2012

1. Editorial

Performance based funding for African health systems: Who is setting the agenda?
Garrett Wallace Brown, Department of Politics, University of Sheffield

Over the last eight years there has been an increased interest in the use of performance based funding to ‘strengthen’ African health systems. Performance based funding has been used in different ways in the past within countries. With its growing popularity at global level, we need to be clearer about how these funding models work in practice and how far the performance based agenda being advanced at global level integrates meaningful participation and partnership in building health systems in Africa. How much are African actors setting and shaping this emerging global agenda?

Performance based funding refers to the idea of transferring resources (money, material goods) for health on condition that measurable action will be taken to achieve predefined health system performance targets. These performance targets may relate to particular health outcomes, to indicators of delivery of effective interventions (such as immunization coverage), to the utilization of certain services (like HIV counseling and testing), or to meeting targets in relation to quality of care. Because performance based financing offers incentives for positive action, many global institutions promote it as a way to efficiently and effectively reform the way that health systems are planned, financed, coordinated and steered. This is particularly true of external funding in many low and middle-income African countries, where there is growing evidence to suggest that performance based funding is being championed by global and bilateral funders as a key innovation in health financing. Funding agencies such as the Global Fund to Fight AIDS, Tuberculosis and Malaria and the World Bank claim that performance based funding promotes reform in a way that can also be locally owned and accountable. This argument is based on a claim that performance targets and indicators will be developed through the active participation of local actors from within various African states, rather than being set by global agencies from the top-down.

Despite increasing use of these arguments for performance based funding within global health policy, there is still a lack of consensus about what performance based funding actually means, and little evidence to support the assumed causal pathways through which diverse African health systems theoretically achieve the governance outcomes claimed. There is also limited evidence about the extent of local participation in the design of performance based initiatives, and particularly in how far African actors – governments, civil society, health services, individuals and the private sector – have participated in the design, implementation and delivery of performance based funding initiatives. It is thus not clear who is participating in shaping, deciding and adopting performance based funding agendas and goals and how these decision-making processes work. There are questions about how targets are set, who sets these targets, as well as about how ‘performance’ is measured, and what exactly constitutes ‘good’ performance.

These ambiguities raise concern about how performance based funding complements other key processes that aim to broaden participation within ‘global health partnerships.’ Partnership has, for example, become a key concept within the Global Fund, World Bank and WHO processes. Millennium Development Goal 8 refers to developing a partnership for development, and the Paris Declaration aims to increase the ability of national and local governments and stakeholders to engage with and shape health policy at national, regional and global levels. However, if we don’t know how far African actors do actually participate in the formulation, implementation and evaluation of initiatives such as performance base funding, it is unclear how far they meet these commitments towards more cooperative processes, where all stakeholders engage with and shape health policy. Given that participation is a key normative aim in debates about furthering more equitable health diplomacy, it is important to know whether and how far performance based funding, as it is currently being practiced, fulfills these normative aims and is (or is not) an effective strategy for reforming health system governance in a participatory and equitable manner.

These questions are being explored in collaborative research currently underway in EQUINET, through the University of Sheffield, Queen Mary University, the University of Zambia, the University of Dar es Salaam, the Ministry of Health Zambia and the University of Kwazulu-Natal, as one input to regional dialogue on global health partnership and equitable health system strengthening.

Performance based financing initiatives have potentially powerful effects on health systems. Their agendas and preferred performance targets become embedded in, and potentially shape, local and national forms of state governance, participation and authority. The current context of global actors devising and advancing such models makes it is critical for African actors to proactively and effectively access and engage in the processes that shape these emerging global health policies: from design (agenda setting) through to implementation and delivery. It is equally critical to know the possibilities and limits of the spaces and places for such participation, especially those provided for by global actors such as the WHO, World Bank and Global Fund .

Please send feedback or queries on the issues raised in this briefing to the EQUINET secretariat: admin@equinetafrica.org. For more information on the issues raised in this op-ed please visit www.equinetafrica.org

2. Latest Equinet Updates

Policy brief 31: Implementing the International Health Regulations in Africa
SEATINI and TARSC: November 2012

The notification and prevention of the spread of diseases and other public health risks across borders is a longstanding area of health diplomacy. The International Health Regulations (IHR) (2005) were adopted by the 58th World Health Assembly in May 2005 to control the spread of diseases and public health risks across borders. The IHR (2005) are global standards that become legally binding in countries once they have been incorporated into domestic public health law (unless country constitutions specifically state that such international standards automatically apply). Member states of WHO, who are “States Parties” to the IHR, were given up to 2007 to assess their capacity and develop national action plans on the regulations. Countries were given up to 2012 to meet the requirements of the IHR regarding their national surveillance, reporting and response systems to public health risks and emergencies and to provide the measures set for disease control at designated airports, ports and ground crossings. Progress toward attainment of these goals depends on eight core capacities, to be in place by the year 2012. This policy brief outlines the context and content of the IHR and how far the provisions have been implemented in east and southern Africa.

The growth of the private for profit health sector in East and Southern Africa
EQUINET And The University Of Cape Town Health Economics Unit: September 2012

There has been recent growth in the private for-profit health sector in East and Southern African countries. African governments are being encouraged to facilitate private sector growth through changing their policies and laws and providing funding for the private sector. This poster / leaflet explores what parts of the private sector are growing, the consequences of a growing private health sector and what civil society organisations and Ministries of Health should be doing to protect the integrity of their health systems. Civil society should contribute to monitoring funded of the private sector. Governments should not use tax funds to support the development of the private for-profit sector and should assess the impact of any proposed for-profit activities on the overall health sector before allowing it to proceed, make this impact assessment report publicly available and put in place adequate regulations and collect accurate information on private sector health services.

3. Equity in Health

Atlas of African Health Statistics: Health Situation Analysis in the African Region, 2012
World Health Organisation: 2012

In this latest edition of the Atlas of African Health Statistics, the World Health Organisation (WHO) provides the latest available data on Health status and trends for various countries, including Life expectancy, Adult mortality, Child mortality, Maternal mortality, and Age standardised death rates. It also contains data on Africa’s burden of disease and various aspects of the health system, such as health financing, the health workforce, medical products and equipment, health information and health technology. Specific programmes and services run on the continent are also included, such as HIV and AIDS, tuberculosis, malaria, immunisation and vaccines development, child and adolescent health, maternal and newborn health, gender and women's health, neglected tropical diseases, and non-communicable diseases and conditions. The Atlas also considers the key determinants of health, including risk factors for health, food safety and nutrition, demography, resources and infrastructure, poverty and income inequality, environment, science and technology and emergencies and disasters. Progress so far on the Millennium Development Goals is included. All data is presented in visual format, such as graphs and maps, for easier reading.

High-Level Taskforce for women, girls and HIV calls for accelerated efforts to protect the rights and wellbeing of young women and girls in South Africa
UNAIDS: 31 October 2012

The High-Level Taskforce for Women, Girls, Gender Equality and HIV for Eastern and Southern Africa concluded a week-long political advocacy mission to South Africa by calling for renewed commitment and leadership to protect the health and rights of young women and girls in the country. South Africa’s Department of Women, Children and People with Disabilities invited the Taskforce to advocate with the country’s leadership around the critical issues facing women and girls today including teenage pregnancy, gender based-violence, transmission of HIV from mother-to-child, and sex work. In order to address the high rates of maternal mortality in South Africa - 310/100,000 live births - earlier this year, the National Department of Health, spearheaded by the Minister of Health, launched the Campaign for Accelerated Reduction of Maternal Mortality in Africa (CARMMA) in South Africa. Some of the key elements of CARMMA is to strengthen women’s access to comprehensive sexual and reproductive health services, especially family planning to prevent new HIV infections and unintended pregnancies, strengthen the health system to provide human resources for maternal and child health and to intensify the management of HIV-positive mothers.

Socioeconomic inequalities in risk factors for noncommunicable diseases in low-income and middle-income countries
Hosseinpoor AR, Bergen N, Kunst A, Harper S, Guthold R, Rekve D et al: BMC Public Health 12(912), 28 October 2012

In this study, researchers quantified prevalence of current daily smoking, low fruit and vegetable consumption, physical inactivity, and heavy episodic alcohol drinking and compared them across wealth and education levels in low- and middle-income countries. The study included self-reported data from 232,056 adult participants in 48 countries, derived from the 2002-2004 World Health Survey. Smoking and low fruit and vegetable consumption were found to be significantly higher among lower socioeconomic groups. The highest wealth-related inequality was seen in smoking among men in low- income countries. Physical inactivity was less prevalent in populations of low socioeconomic status, especially in low-income countries. Mixed patterns were found for heavy drinking.

4. Values, Policies and Rights

A summary of South Africa’s National Strategic Plan on HIV, STIs and TB: 2012–2016
Health Systems Trust: November 2012

Health Systems Trust has summarised South Africa’s National Strategic Plan (NSP) for easy reading. The NSP is a strategic guide for South Africa’s national response to HIV, STIs and TB from 2012 to 2016. It is coordinated by the South African National AIDS Council (SANAC). It aims to inform national, provincial, district and community-level stakeholders with strategic directions when developing implementation plans. The Plan contains baseline data on the various diseases and identifies key populations for HIV and TB response. Its goals are to reduce the number of HIV infections by 50%; ensure at least 80% of patients eligible for antiretroviral treatment are receiving it, with 70% alive and being treated after five years; reduce the number of new infections of TB and deaths by 50%; ensure the rights of individuals living with HIV, TB and STIs are protected; and reduce self-reported stigma associated with HIV and TB by 50%. The Plan also outlines how the goals will be reached, who will oversee implementation of goals and how progress of the NSP will be assessed. Implementing the NSP is estimated to cost R130.7 billion over five years.

Domestic violence rises as incomes fall in Madagascar
IRIN News: 6 November 2012

Incomes have slipped to their lowest level in a decade since Madagascar’s 2009 coup d’etat, and, in parallel, domestic violence has sharply risen, according to IRIN News. The World Bank’s October 2012 economic update estimates that, since 2008, another four million people have fallen below the poverty level. The rising poverty has exacerbated women’s vulnerability in this deeply traditional society. Locals report more domestic conflict over family resources, as well as increased alcohol and drug abuse. Impoverished women also have fewer options to escape violence and are less able to advocate for the safety of themselves and their children. A spokesperson for a legal aid clinic near Antananarivo said that women often feel they have neither the ability nor the right to end abuse. A community spokesperson also reported that most domestic fights were about money and abusive men were often drunk when assaulting their partners.

Gender relations, sexual violence and the effects of conflict on men and women in North Kivu, Eastern Democratic Republic of Congo: preliminary results from the International Men and Gender Equality Survey (IMAGES)
Sonke Gender Justice Network and Promundo: October 2012

More than one in three men surveyed in the Democratic Republic of the Congo's war-torn east admits committing sexual assault, and three in four believe that a woman who "does not dress decently is asking to be raped", according to this study. Some 61.4% of men interviewed said women sometimes deserve to be beaten; 42.7% think that if a woman doesn't show physical resistance when forced to have sex, it's not rape; and 27.9% believe that sometimes women want to be raped. Well over 40% of the men polled asserted that a man should reject his wife when she has been raped. The study was carried out in Congo's North Kivu province. A total of 708 men and 754 women aged between 18 and 59 took part in individual interviews and focus group discussions. The self-reporting of men revealed that 34% admit having carried out some form of sexual violence in conflict, homes or other settings. The study, part of the International Men and Gender Equality Survey, also suggests that many men are themselves victims of violence, including sexual violence, and shows a clear association between exposure to violence and increased likelihood of subsequent perpetration. The authors make recommendations including far greater promotion of gender equality in schools and public policy and a massive campaign of psycho-social care for boys and girls exposed to multiple forms of violence at a young age.

Integrating interventions on maternal mortality and morbidity and HIV: A human rights-based framework and approach
Fried S, Harrison B, Starcevich K, Whitaker C and O'Konek T: Health and Human Rights (pre-print online version), 2012

Maternal mortality and morbidity (MMM) and HIV represent interlinked challenges arising from common causes, magnifying their respective impacts and producing related consequences. Accordingly, an integrated response will lead to the most effective approach for both, argue the authors of this paper. HIV and MMM are connected in both outcomes and solutions in sub-Saharan Africa, where HIV is the leading cause of maternal death and prevention of unintended pregnancy and access to contraception have been identified as two of the most important HIV-related prevention efforts. In turn, both are central to reducing unsafe abortion, a major cause of maternal death in Africa. The authors propose that a human rights-based framework will help to identify the shared determinants of MMM and HIV. It should also help to establish the health-related human rights standards to which all women are entitled, as well to outline the indivisible and intersecting human rights principles that inform and guide efforts related to HIV and MMM. The authors point to the Millennium Development Goals (MDGs) as a good example of an agreement with quantifiable goals for achieving human rights while emphasising that no single goal can be achieved without progress on all development goals.

Making it work: Lessons learnt from three regional workshops to integrate human rights into national HIV strategic plans
UNAIDS: 2012

To strengthen the rights-based national response to HIV, the Joint United Nations Programme on HIV/AIDS (UNAIDS), with the technical support of the International HIV/AIDS Alliance (the Alliance), initiated a project in 2011 to help national stakeholders integrate human rights programmes into National Strategic Plans (NSPs). This brief report outlines some short-term outcomes and lessons learnt from this initiative. The three regional workshops, held in South Africa, Thailand and Saudi Arabia, have led to concrete outcomes, namely the integration of HIV-related human rights into NSPs in a number of countries. Participants have also initiated (or are planning) innovative human rights projects as a direct result of the workshops. The workshops have given governments, civil society representatives, affected communities and UNAIDS an opportunity to share good practice, exchange views and learn from each other. The challenge remains to continue to apply this learning to the protection and promotion of a rights-based approach in the national response to HIV, and to make the commitments of the 2011 Political Declaration a reality.

The State of World Population 2012: By choice, not by chance: Family planning, human rights and development
United Nations Population Fund (UNFPA): 14 November 2012

Making voluntary family planning available to everyone in developing countries would reduce costs for maternal and newborn health care by $11.3 billion annually, according to this report by the United Nations Population Fund (UNFPA). UNFPA argues that increased access to family planning has proven to be more than just a sound economic investment, with knock-on gains in reducing poverty, exclusion, poor health and gender inequality. Nevertheless, the report finds that financial resources for family planning have declined and contraceptive use has remained mostly steady. The report also calls on governments and leaders to: take or reinforce a rights-based approach to family planning; secure an emphasis on family planning in the global sustainable development agenda that will follow the Millennium Development Goals in 2015; ensure equality by focusing on specific excluded groups; and raise the funds to invest fully in family planning.

Uganda’s anti-gay bill could be passed before Christmas
Plus News: 13 November 2012

Uganda's parliament will, before Christmas, pass a highly controversial bill which seeks more stringent punishments for people engaging in homosexual acts and those perceived to be "promoting" homosexuality, says the speaker of the house. Rebecca Kadaga told hundreds of petitioners in Kampala on 9 November that she would ensure the Anti-Homosexuality Bill, which has been before parliament since 2009, would be passed before the end of 2012. The punishment for “aggravated homosexuality” is life imprisonment. Activists have decried the bill, saying it is a violation of human rights that would make men who have sex with men (MSM) even less willing to access health services. Gay people in Uganda say they face discrimination and are stigmatised by health workers when they seek care in the public and private health system. MSM are considered by the Uganda AIDS Commission to be a "most at-risk population", but because homosexual acts are illegal, there are no policies or services targeting HIV interventions towards them. Legal experts in Uganda have challenged the constitutionality of the bill, arguing it infringes on the right to privacy and freedom of expression and choice.

5. Health equity in economic and trade policies

Agriculture, trade, food sovereignty and agroecology: Proposals on alternatives to current EU trade policies
Saragih H and Malig ML: Comhlámh 2012

The European Union (EU), as part of the G-20, has backed the Global Partnership for Agriculture and Food Security (GAFSP) and has given the World Bank a lead role in operationalising the programme. However, the authors of this article argue that this programme will make small farmers dependant on genetically modified seed technology, and criticises the programme as being a way of legitimising land acquisition by agribusiness in the name of increased land investment and higher agricultural productivity. The GAFSP is supposed to promote agricultural productivity but analysts agree that the kind of productivity this describes is one of intensification of agribusiness. The authors call on the EU and the rest of the G-20 to scrap solutions that increase neoliberal free trade. The authors propose options for trade in the region based on solidarity and complementarity with food sovereignty as a core principle.

Asian countries set the trend for affordable generics
Khor M: Third World Network, 22 October 2012

Recent government actions by Indonesia and India to issue compulsory licenses will enable access to cheaper medicines in Asia to treat serious ailments, especially HIV and AIDS, cancer and hepatitis B. The supply of generic medicines, either through import or local production, has been the major method of reducing prices and making medicines affordable. In 2003, Malaysia became the first developing country to issue a compulsory license to a local firm to import medicines from India to treat HIV and AIDS, with Indonesia, Thailand and India following suit. In September 2012, Indonesia issued compulsory licenses to enable local manufacturers to make, import and sell generic versions of seven patented drugs used for treating HIV, AIDS and hepatitis B. The author suggests that countries in Africa follow this precedent.

Developing countries firm up common Doha climate talks position
Africa Review: 30 October 2012

Negotiators from 46 Least Developed Countries met in Nairobi on 29 October 2012 to develop a common position to be presented at the November climate talks in Doha. The technical experts said that developing nations will agree on shared goals, which include establishment of a new climate treaty, financing and technologies required to accelerate green transition. Kenya's Permanent Secretary in the Ministry of Environment and Mineral Resources, Ali Mohammed, said that the global South has borne the brunt of negative impacts of climate change despite minimal contribution to green house gases responsible for warming the planet. He endorsed the multilateral process of the climate talks, which provides vulnerable developing countries with a forum for participating in global discussions and agreements. At the same time, developing countries should strengthen their negotiation capacity to influence a positive outcome of the Doha climate talks and overcome roadblocks in their efforts to table their concerns. Developing countries are in agreement that financing for climate adaptation, operationalisation of a green climate fund and the future of Kyoto protocol are key issues that should be prioritised at the Doha meeting.

Earth Grab: Geopiracy, the New Biomassters and Capturing Climate Genes
Bronson D: Fahamu Books and Pambazuka Press, October 2012

Earth Grab analyses how Northern governments and corporations are cynically using growing concerns about the ecological and climate crisis to propose geoengineering 'quick fixes'. These threaten to wreak havoc on ecosystems, with disastrous impacts on the people of the global South. As calls for a 'greener' economy mount and oil prices escalate, corporations are seeking to switch from oil-based to plant-based energy. The book exposes how a biomass economy based on using gene technologies to reprogramme living organisms to behave as microbial factories will facilitate the liquidation of ecosystems. This constitutes a devastating assault of the peoples and cultures of the South, accelerating the wave of land grabs that are becoming common in Africa, Asia and Latin America. It also shows how the world’s largest agribusiness companies including Monsanto, BASF, Dupont and Syngenta are pouring billions of dollars into, and claiming patents on, what are claimed to be 'climate-ready crops'. Far from helping farmers adjust to a warming world – something peasant farmers already know how to manage – these crops will allow industrial agriculture to expand plantation monocultures into lands currently cultivated by poor peasant farmers. These crops are not a solution to growing hunger, they will feed only the gluttony of corporate shareholders for profits.

How to rob Africa: Why does the Western world feed Africa with one hand while taking from it with the other?
Kwenda S: Al Jazeera, November 2012

The world's wealthy countries often criticise African nations for corruption but shares culpability in not tackling money laundering or the anonymous off-shore companies and investment entities that enable it. In this investigative piece shown on Al Jazeera, Zimbabwean journalist Stanley Kwenda takes a journey through the world of offshore banking.

IMF calls for land reform, wage reductions in Swaziland
International Monetary Fund: 7 November 2012

Following a visit to Swaziland, a delegation from the International Monetary Fund (IMF) issued a press release noting that a budget surplus of 1% of GDP targeted for the 2012 fiscal year is unlikely to be met without additional expenditure cuts. The mission recommended a reduction in the wage bill of 300 million emalangeni (US$3.4 million), cuts in 'non-priority' recurrent expenditures and implementation of an Enhanced Voluntary Early Retirement Scheme. The IMF acknowledged that these cuts will imply sacrifices from Swazi society, and proposed that the basic needs of the most vulnerable be protected. The delegation further recommended that subsistence farmers have access to title deeds to give them collateral to raise funds for basic improvements such as irrigation systems to increase their yields.

Smallholders’ use of pesticides in Ugandan agriculture
Duus J, Streibig JC, Sekimpi D, Maziina J and Jørs Erik: African Newsletter on Occupational Health and Safety 22(1): 16-18, May 2012

This article reports the results from a research project on farmers’ and pesticide dealers’ knowledge and practice when handling pesticides in two districts of Uganda. In Uganda the number of farmers using pesticides is growing because of the evolution of the farming from mainly organic subsistence farming to a mix of cash crop and subsistence farming involving the use of increasing amounts of pesticide. This research project took place in the districts of Wakiso and Pallisa, Uganda, in January and February 2011. In all, 24 small-scale farmers and 20 pesticide dealers were observed and interviewed. Researchers observed many health and environmental problems in the use of pesticides in Wakiso and Pallisa, with faulty equipment, exposure of children to drift spray and environmental pollution. However, no pesticides classified as WHO class Ia or Ib were found apart from dichlorvos. The main problems were found to be a lack of use of personal protective equipment and the farmers’ failure to follow the instructions for the correct handling of pesticides. Training for both farmers and pesticide dealers could be a way to solve the problems. Moreover, the instruction for use should be adapted to the reality of the small-scale farmers.

South Africa’s “easy patents” cost patients
PlusNews: 5 November 2012

South Africa grants almost every patent application it receives, making its patent regime one of the world’s most lenient, according to this article. While pharmaceutical companies cash in, patients face staggering healthcare costs, and medicines like cancer treatments, third-line antiretrovirals (ARVs) and treatments for drug-resistant tuberculosis (DR-TB) are often priced out of reach. According to activists from Médecins Sans Frontières’s (MSF) Campaign for Access to Essential Medicines and the South Africa AIDS lobby group the Treatment Action Campaign (TAC), easy patents mean companies can extend their exclusive right to manufacture and sell certain drugs through a process known as evergreening, where minor changes are made to a drug and it is re-issued with a new patent, the process being repeated indefinitely.. The most recent review of South African patents, conducted in 2008, found that about half of all South African patents that year were granted to US companies, followed by companies from the UK, Germany and France. The Department of Trade and Industry’s draft of the new intellectual property policy is set to be submitted to the cabinet on 5 December 2012. A three-month period of public comment on the policy will then be opened before the policy becomes a bill. MSF and TAC are calling on interested parties to get involved and ensure the policy protects public health by including provisions to prevent evergreening and to allow for compulsory licences, which allow generics to be manufactured for use in developing countries without the patent owner’s permission.

Technology And Innovation Report 2012: Innovation, Technology and South-South Collaboration
United Nations Conference On Trade And Development (UNCTAD): 31 October 2012

UNCTAD’s 2012 technology and innovation report looks at how South-South cooperation could help developing countries breach the technological divide and promote inclusive growth through industrialisation. The report focuses on how technological learning and innovation capacity can be promoted across developing countries. The South is argued to be an important partner to promote technology and innovation capacity in the developing world. Policy experiences of other developing countries in fostering innovation capacities may be more relevant to other developing countries. Further, the technology employed in countries in the South may be more suitable for developing countries’ local needs and conditions. The report proposes a set of five principles around which a framework of South-South collaboration for technology and innovation can be structured: integrate the technological needs of developing countries into South-South exchanges; share and better integrate lessons learned from ongoing catch-up experiences of other developing countries in building innovation capabilities through proactive policies; promote technological learning in particular through alliances and technology transfer initiatives; make South-South foreign direct investment more technology oriented; and pool resources of developing countries to address common technological challenges.

6. Poverty and health

Africa’s Agricultural Cooperatives Crucial for Food Security
Nigeria Daily News: 31 October 2012

As the International Year of Cooperatives is being observed in 2012, the Food and Agriculture Organisation (FAO) has said that one of the only chances small-scale food producers have to gain competitive access to local and global markets is by banding together in cooperatives. According to FAO chief, Graziano da Silva, cooperatives follow core values and principles that are critical to doing business in an equitable manner, that empower and benefit members and the local community. This is especially relevant in poor rural communities and in promoting sustainable local development. He said that the cooperative business model helps small- and medium-scale farmers add value to their production and access markets. Small scale food producers are also able to take part in policy discussions through co-operatives. Co-operatives help to generate employment, boost national economies, reduce poverty and improve food security. The FAO has pledged to foster the growth of agricultural cooperatives, including through their promotion by special ambassadors for cooperatives and by developing approaches, guidelines, methodologies and training tools for supporting policy on and organisational development of co-operatives.

Foreign Farmers Undermine Food Security in Zambia
Mulenga N: Inter Press Service, 1 November 2012

Increased agricultural development in Zambia will compromise the country’s food security if peasant farmers continue to be driven off customary land to pave the way for large-scale local and foreign agribusiness, according to the University of Zambia’s Dean of the School of agriculture, Mickey Mwala. He argued that smallholder farmers are responsible for food security in Zambia. Land grabs and forced evictions of local farmers by both foreign and local investors are common, according to the Zambia Land Alliance, a land rights advocacy organisation. The Alliance blames the eviction of farmers on the cumbersome procedures involved in obtaining title deeds and “archaic” laws, which do not recognise customary rights as a form of land ownership. Under Zambian law, title deeds are the only legal proof of ownership of land. To get a title deed takes between two months and 10 years and is discouragingly complicated for illiterate applicants who cannot afford legal assistance.

Land justice, land reform and access: Proposals for land justice for poor families with particular emphasis on Zambia
Mbinji J: Comhlámh 2012

In this paper the author proposes policy options to ensure that poor Zambian families do not lose their land rights in the face of trade policies. The proposals focus on addressing the obstacles that poor families face in accessing and obtaining legal title to land. Strengthening national land policy, the legal framework and investment guidelines would help to protect the land rights of poor families. A comprehensive pro-poor land policy needs to be developed to guide the review of legislation for land administration. For these proposals to work, local communities need to register as legal entities or trusts to legally own land.

7. Equitable health services

Do health workers' preferences influence their practices? Assessment of providers' attitude and personal use of new treatment recommendations for management of uncomplicated malaria, Tanzania
Masanja IM, Lutambi AM and Khatib RA: BMC Public Health 12(956), 8 November 2012

Due to growing antimalarial drug resistance, Tanzania changed malaria treatment policies twice within a decade – in 2001 and again in 2006. The authors of this study assessed health workers‟ attitudes and personal practices following the first treatment policy change, at six months post-change and two years later. Two cross-sectional surveys were conducted in 2002 and 2004 among healthcare workers in three districts in South-East Tanzania using semi-structured questionnaires. Attitudes were assessed by enquiring which antimalarial was considered most suitable for the management of uncomplicated malaria for the three patient categories: children below 5; older children and adults; and pregnant women. A total of 400 health workers were interviewed; 254 and 146 in the first and second surveys, respectively. Results showed that following changes in malaria treatment recommendations, most health workers did not prefer the new antimalarial drug, and their preferences worsened over time. However, many of them still used the newly recommended drug for management of their own or family members’ malaria episode. This indicates that factors other than providers’ attitude may have more influence in their personal treatment practices.

Low long-lasting insecticide nets (LLINs) use among household members for protection against mosquito bite in Eastern Ethiopia
Gobena T, Berhane Y and Worku A: BMC Public Health 12(914), 29 October 2012

The authors of this study assessed barriers related with long-lasting insecticide treated net (LLIN) use at the household level in Ethiopia from October to November 2010. A total of 2,867 households were selected and data were collected by interviewing women, direct observation of LLINs conditions and use, and in-depth interviewing of key informants. Results indicated that only about one third of LLIN owned households are actually using at least one LLIN for protection against mosquito bite. Thus, most of the residents are at higher risk of mosquito bite and acquiring of malaria infection. Households living in fringe zone are not benefiting from the LLIN protection. Further progress in malaria prevention can be achieved by specifically targeting populations in fringe zones and conducting focused public education to increase LLIN use, the authors recommend.

Will our public healthcare sector fail the NHI?
Bateman C: South African Medical Journal November 102(11): 817-818, November 2012

Feasible universal health coverage in South Africa seems ever more remote, according to this article, as a dysfunctional Department of Public Works continues to stymie vital public hospital revitalisation projects, and five provinces have proved grossly incapable of spending their health budgets. Meanwhile, hospitals fall into disrepair and programmes are not expanded. Health Minister, Aaron Motsoaledi told parliament that the national ‘failure to spend’ was due to delays in the awarding of tenders, rolling over of budgets, poor performance of contractors (and the consequent termination of contracts and ensuing court challenges). Against this background, Dr Olive Shisana, Chairperson of the NHI ministerial advisory task team, argued that quality-based health facility accreditation is pivotal to the South African national health insurance (NHI) model. Dr Ravindra Rannan-Eliya, Director for Health Policy in Colombo, Sri Lanka, added that for an NHI to succeed in South Africa, public sector service quality and availability would need to ‘at least’ reach current medical scheme levels.

8. Human Resources

A descriptive study on health workforce performance after decentralisation of health services in Uganda
Lutwama G, Roos J and Dolamo B: Human Resources for Health 10(41), 7 November 2012

In this cross-sectional descriptive survey the authors investigated the performance of health workers after decentralisation of the health services in Uganda to identify and suggest areas for improvement. A structured self-administered questionnaire was used to collect quantitative data from 276 health workers in the districts of Kumi, Mbale, Sironko and Tororo in Eastern Uganda. Results revealed that even though the health workers are generally responsive to the needs of their clients, the services they provide are often not timely. The health workers take initiative to ensure that they are available for work, but low staffing levels undermine these efforts. While the study shows that the health workers are productive, over half (50.4%) of them reported that their organisations do not have indicators to measure their individual performance. The findings indicated that health workers are competent, adaptive, proactive and client oriented.

E-Learning can solve human resource gap in Africa
Diallo B: Pambazuka News 606, 14 November 2012

While there is optimism surrounding Africa’s growth potential, the continent appears to be lagging behind in training the necessary people to match its economic growth, according to this article. Although the number of students enrolling for tertiary education has been growing, the numbers are still low. Only 6% of students in sub-Saharan Africa are enrolled in tertiary institutions. Educationists and economists have observed that if Africa is going to compete in the global economy, this needs to increase to 15%. Africa can overcome barriers to student enrollment by using e-Learning and correspondence to extend education to students who face time and space constraints. There are significant challenges to this, such as limited and high cost internet connectivity on the continent, intermittent power disruption, a lack of national and institutional policies, a scarcity of experienced human resources and a perception that distance education may not offer the same quality as face-to-face education.

Human resources needs for universal access to antiretroviral therapy in South Africa: a time and motion study
Hontelez JAC, Newell M, Bland RM, Munnelly K, Lessells RJ and Bärnighausen T: Human Resources for Health 10(39), 30 October 2012

In this study, the authors quantify the number of HIV health workers (HHWs) required to be added to the current HIV workforce to achieve universal access to HIV treatment in South Africa, under different eligibility criteria. They performed a time and motion study in three HIV clinics in a rural, primary care-based HIV treatment program in KwaZulu-Natal, South Africa, to estimate the average time per patient visit for doctors, nurses, and counselors. They estimated that, for universal access to HIV treatment for all patients with a CD4 cell count of less than or equal to 350 cells/muL, an additional 2,200 nurses, 3,800 counselors, and 300 doctors would be required, at additional annual salary cost of R929 million, equivalent to US$ 141 million. For universal treatment ('treatment as prevention'), an additional 6,000 nurses, 11,000 counselors, and 800 doctors would be required, at an additional annual salary cost of R2.6 billion (US$ 400 million). Universal access to HIV treatment for patients with a CD4 cell count of less than or equal to 350 cells/mul in South Africa may be affordable, but the number of HHWs available for HIV will need to be substantially increased. Unfortunately, treatment as prevention strategies will require considerable additional financial and human resource commitments.

NHI and staff shortages: How can clinical associates help?
Doherty J: Health Policy South Africa, 9 November 2012

South Africa has begun producing a new type of health professional - a clinical associate. Clinical associates are people ideally suited to working in hospitals, helping doctors carry out some of their tasks – like dealing with emergencies and doing procedures. They don’t replace doctors or nurses – they work with them, sharing some of their workload, and allowing them to concentrate on the tasks for which only they are qualified. There is no doubt that more doctors and nurses need to be trained and recruited into the South African health system. But will this alone solve the country’s staff shortages? It takes less time to train a clinical associate. They can become very skilled at what they do because they focus on a special set of skills and are supervised by doctors. They are recruited from rural and disadvantaged communities. So, the author argues, clinical associates could do a lot to address staff shortages in the public sector, especially in district hospitals. Clinical associates are noted as a priority in the latest government human resource strategy but the future of clinical associates and the strategy of National Health Insurance need to become much more closely intertwined.

The evolution of global health teaching in undergraduate medical curricula
Rowson M, Smith A, Hughes R, Johnson O, Maini A, Martin S et al: Globalization and Health 8(35), 13 November 2012

Undergraduate global health teaching has seen a marked growth over the past ten years, partly as a response to student demand and partly due to increasing globalisation, cross-border movement of pathogens and international migration of health care workers. In this study, researchers carried out a survey of medical schools across the world in an effort to analyse their teaching of global health. Results indicate that global health teaching is moving away from its previous focus on tropical medicine towards issues of more global relevance. The authors suggest that there are three types of doctor who may wish to work in global health - the 'globalised doctor', 'humanitarian doctor' and 'policy doctor' - and that each of these three types will require different teaching in order to meet the required competencies. This teaching needs to be inserted into medical curricula in different ways, notably into core curricula, a special developing countries track, optional student selected components, elective programmes, optional intercalated degrees and postgraduate study. The authors argue that teaching of global health in undergraduate medical curricula must reflect the social, political and economic causes of ill health.

The Impossible Dream? Codes of Practice and the International Migration of Skilled Health Workers
Connell J and Buchan J: World Medical and Health Policy 3(3): Article 3, 17 August 2012

To stem the loss of skilled health workers from developing countries, there has recently been an increase in the number of regional Codes of Practice and bilateral Memoranda of Understanding to achieve more effective, equitable and ethical international migration of workers, culminating in the finalisation of the World Health Organisation’s Global Code for Health Worker Recruitment in 2010. Despite this, the authors of this paper point out that there is no agreed definition of ethical international recruitment, and no consensus on the significance and location of harmful recruitment practices. Most codes they analysed covered relatively few regions and exhibited a high degree of generality. Migration, they found, occurs in contexts that do not necessarily involve health issues. Limitations were identified: there are no incentives for recipient countries and agencies to be involved in ethical international recruitment and all codes are voluntary, which has restricted their impact. At the same time, the private sector is effectively excluded from codes. Bilateral agreements and memoranda have a greater chance of success, the authors note, enabling managed migration and return migration, but are more geographically limiting. The most effective constraints to the unregulated flow of skilled health workers are the production of adequate numbers in present recipient countries and provision of improved employment conditions in source countries.

9. Public-Private Mix

From privatisation to corporatisation and the need for a counter-strategy
Magdahl JE: Association for International Water and Forest Studies, Norway, 2012

This report explores the shift from privatisation to corporatisation of urban water services in developing countries. The author calls for the water justice movement to adjust its strategy to take this into account. Corporatisation reform implies the implementation of commercial neoliberal management approaches within public sector water utilities. The author argues that the strategy of the water justice movement has largely focused on privatisation and that it needs to direct more attention towards resisting corporatisation.

Public, private healthcare sectors sign 'historic' pact
Business Day: 8 November 2012

South Africa’s Health Minister Aaron Motsoaledi has signed a "social compact" with the private sector, describing it as a "historic" step towards closer collaboration between the government and private enterprise. Such collaboration was vital for the success of the government’s ambitions for introducing National Health Insurance (NHI), the minister said. The minister and the CEOs of 23 companies have agreed to meet at least twice a year to discuss issues that affect them, and have established the Public Health Enhancement Fund to address the skills shortages facing the healthcare sector. The fund pools donations from 23 companies from the pharmaceutical, private hospital and medical scheme administration industries, who have committed to providing financial support for the next three years. The money will be used to train more doctors, improve the skills of healthcare managers, and ensure more doctors get specialised training in HIV and AIDS. Forty million rand (US$4.5 million) has been committed for the first year.

10. Resource allocation and health financing

Economic evaluation of task-shifting approaches to the dispensing of anti-retroviral therapy
Foster N and McIntyre D: Human Resources for Health 10(32), 13 September 2012

In this study, researchers compared two task-shifting approaches to the dispensing of antiretroviral therapy (ART): Indirectly Supervised Pharmacist’s Assistants (ISPA) and Nurse-based pharmaceutical care models against the standard of care which involves a pharmacist dispensing ART. A cross-sectional mixed methods study design was used. Patient exit interviews, time and motion studies, expert interviews and staff costs were used to conduct a costing from the societal perspective. Six facilities were sampled in the Western Cape province of South Africa, and 230 patient interviews conducted. The ISPA model was found to be the least costly task-shifting pharmaceutical model. However, patients preferred receiving medication from the nurse. This related to a fear of stigma and being identified by virtue of receiving ART at the pharmacy. While these models are not mutually exclusive, and a variety of pharmaceutical care models will be necessary for scale up, it is useful to consider the impact of implementing these models on the provider, patient access to treatment and difficulties in implementation.

Innovative financing for health: what is truly innovative?
Atun R, Knaul FM, Akachi Y and Frenk J: The Lancet (Early Online Publication) 24 October 2012

The authors of this paper identify three integrated innovative financing mechanisms - GAVI, Global Fund, and UNITAID - that have reached a global scale. However, resources mobilised from international innovative financing sources are relatively modest compared with external assistance from traditional sources. Instead, the real innovation, they argue, has been establishment of new integrated financing mechanisms that link elements of the financing value chain to more effectively and efficiently mobilise, pool, allocate, and disburse funds to low-and middle-income countries and that create incentives for improved implementation and performance of national programmes. These mechanisms provide platforms for future health funding, especially as efforts to grow innovative financing have faltered. The lessons learned from these mechanisms can be used to develop and expand innovative financing from international sources to address health needs in low- and middle-income countries.

Microeconomics of Firms Compliant with Occupational Safety and Health
Habitu H and Semboja H: African Newsletter on Occupational Health and Safety 22(1): 6-9, May 2012

In this paper, the authors discuss the economics of occupational safety and health (OSH) from a microeconomic point of view. While investments in occupational safety and health factors are perhaps most commonly promoted through ethical arguments, they argue instead that a cost-benefit analysis of OHS should rather be the rationale for implementing OHS. Good OHS may be part of profit maximisation and cost minimisation solutions for businesses, as the costs of ensuring safety are outweighed by savings in reducing the number of accidents and damage. Improvements in worker health can lead to an effective reduction in costs and greater productivity as well. This, in turn, can improve efficiency and thereby heighten the sustainable profitability of businesses compliant with OSH. Labour productivity is also improved by reducing the number of people who retire early or who are unable to work due to injury and illness, thereby cutting the healthcare and social costs of injury and illness, increasing the ability of people to work by improving their health, and improving total productivity by stimulating more efficient capital, equipment, machineries, working methods and production technologies.

Who Sets the Global Health Research Agenda? The Challenge of Multi-Bi Financing
Sridhar D: PLoS Medicine 9(9), 25 September 2012

According to this study, a major challenge in the governance of research funding is agenda-setting, given that the priorities of funding bodies largely dictate what health issues and diseases are studied. The challenge of agenda-setting is a consequence of a larger phenomenon in global health, namely “multi-bi financing.” Multi-bi financing refers to the practice of external funders choosing to route non-core funding - earmarked for specific sectors, themes, countries, or regions - through multilateral agencies such as the World Health Organisation (WHO) and the World Bank and to the emergence of new multistakeholder initiatives such as the Global Fund to Fight AIDS, Tuberculosis and Malaria and the GAVI Alliance. These new multistakeholder initiatives have five distinct characteristics: a wider set of stakeholders that include non-state institutions, narrower problem-based mandates, financing based on voluntary contributions, no country presence, and legitimacy based on effectiveness, not process. The author concludes that this shift to multi-bi financing likely reflects a desire by participating governments, and others, to control international agencies more tightly.

11. Equity and HIV/AIDS

Home-based HIV counseling and testing: Client experiences and perceptions in Eastern Uganda
Kyaddondo D, Wanyenze RK, Kinsman J and Hardon A: BMC Public Health 12(966), 12 November 2012

Doubts have been cast about the ability of Home-Based HIV Counseling and Testing (HBHCT) to adhere to ethical practices including consent, confidentiality, and access to HIV care post-test. This study explored client experiences in relation these ethical issues. Researchers conducted 395 individual interviews in Kumi district, Uganda, where teams providing HBHCT had visited 6–12 months prior to the interviews. They found that 95% of respondents had ever tested (average for Uganda was 38%). Among those who were approached by HBHCT providers, 98% were informed of their right to decline HIV testing. Most respondents were counseled individually, but 69% of the married/cohabiting were counseled as couples. Most respondents (94%) were satisfied with the information given to them and the interaction with the HBHCT providers. These findings show a very high uptake of HIV testing and satisfaction with HBHCT, a large proportion of married respondents tested as couples, and high disclosure rates. HBHCT can play a major role in expanding access to testing and overcoming disclosure challenges. However, access to HIV services post-test may require attention.

Referral and access to care of HIV prevalent cases: experience from the early capture HIV cohort study in Kampala
Mutengu LN, Kibuuka H, Millard M, Sekiziyivu A, Wakabi S, Nanyondo J et al: Retrovirology 9(Suppl 2), 13 September 2012

Trial sponsors and implementers are ethically obligated to refer HIV infected Individuals identified in a research study at screening for HIV care and treatment. Makerere University Walter Reed Project is conducting HIV surveillance among high risk uninfected female sex workers. This study describes patterns in participants’ receipt of HIV results and response to referral for HIV care and treatment. Results indicated HIV prevalence was 35% at screening. Out of the 221 prevalent cases, only 96 participants (43%) received HIV confirmatory results and were referred for care, while 9 (4%) declined referral. The majority did not return for either their initial or confirmatory HIV result; while a few declined a blood re-draw. Of the 96 participants referred, 58% are currently in care, 14% did not report for care predominately citing indecisiveness while 28% could not be tracked. Most of the acutely infected participants (6/8) are in care. The authors argue that, although trial implementers may fulfil their obligation in referring study participants for HIV care, participants have a key role to play in facilitating this process. The large number of HIV prevalent female sex workers who did not return for their HIV results and may not be aware of their status could be a potential driver of the epidemic in Uganda, the paper concludes.

Understanding the modes of transmission model of new HIV infection and its use in prevention planning
Case KK, Ghys PD, Gouws E, Eaton JW, Borquez A et al: Bulletin of the World Health Organization 90(11): 831–838A, November 2012

This paper looks at the modes of transmission model, which has been widely used to help decision-makers target measures for preventing HIV infection. The model estimates the number of new HIV infections that will be acquired over the ensuing year by individuals in identified risk groups in a given population using data on the size of the groups, the aggregate risk behaviour in each group, the current prevalence of HIV infection among the sexual or injecting drug partners of individuals in each group, and the probability of HIV transmission associated with different risk behaviours. The strength of the model is its simplicity, which enables data from a variety of sources to be synthesised, resulting in better characterization of HIV epidemics in some settings. However, concerns have been raised about the assumptions underlying the model structure, about limitations in the data available for deriving input parameters and about interpretation and communication of the model results. The aim of this review was to improve the use of the model by reassessing its paradigm, structure and data requirements. The authors identified key questions to be asked when conducting an analysis and when interpreting the model results and make recommendations for strengthening the model’s application in the future.

12. Governance and participation in health

Oil and Water do Mix: Citizen Struggles in Energy and Water
Spronk S: Municipal Services Project, Briefing Note 3, October 2012

Social movements have been successful in beating back the tide of water privatisation that swept the world in the 1990s, forcing the retreat of water multinational companies in the poorest countries of the global South. With global temperatures rising, unions in the energy sector can learn from these struggles – many of which were worker-led – to give rise to a strong counter-movement for energy democracy. While the political economy of the energy and water sectors are different, the author argues that we can build on water justice victories and draw lessons on how to frame demands for local control over the commons. Further lessons learned include the importance of building broad coalitions with unlikely allies; and practising internal democracy in social movements. While there have been significant victories in the water sector, the author argues that community-based struggles on energy have a long way to go. The struggle for energy democracy is argued to require movements to “resist, reclaim and restructure” communities to draw on locally sourced, decentralised, alternative energy resources.

Reflections on the Third People’s Health Assembly, South Africa
Matheson D: Asia Pacific HealthGAEN Newsletter (5), November 2012

This blog reports on the Third People’s Health Assembly (PHA) held in Cape Town, South Africa, in July 2012. Participants reported on the extraordinary gains in human development occurring in Thailand and Brazil, where millions of people are moving out of poverty and for the first time accessing health care and social support, as well as the impotence of global leadership to effectively deal with climate change, and massive land grabs. Key strategies agreed on at the PHA were supporting countries to act on the PHM’s Right to Health Campaign; a global campaign on the adverse health and environmental effects of extractive industries; a food security campaign focusing on the health consequences of the growth of transnational food corporations, and a campaign against the privatisation of health services, which will document the ways in which public ownership and control of health services is being undermined by various forms of public private partnerships and by the outsourcing of previously publicly provided services.

Further details: /newsletter/id/37391
Twenty-fifth Anniversary of the Bamako Initative Series: Community Participation in Health in Context
Falisse J: Health Financing in Africa blog, 28 October 2012

In this article, the author evaluates developments in the field of community participation in health, arguing that in many national experiences, the distinction between the different forms of participation remains blurry. In particular, there is little distinction between community participation as a way to devolve services to community members and community participation as the community (co-)management of health centres. This confusion in part reflects two decades of debate on participation as either an end in itself or as a means for other purposes. Although free care and performance-based financing are two of the most popular health policies currently being developed in Africa, they have implications for participation. Performance-based financing strategies raise a need to ensure that the voice of the people continues to be heard when financial incentives drive the system. Free health care on a large scale also poses new challenges because, with the removal of user fees, the financial interest community members have in the health centre management disappears. Research about community participation has evolved in the last 25 years, with new methods for quantitative approaches mixed with qualitative insights, contrasting with the ethnographic and sociological approaches used in the past.

Twenty-fifth Bamako Initiative Anniversary series: Susan Rifkin on community participation
Falisse J: Health Financing in Africa blog, 11 October 2012

In this interview with Susan Rifkin of the London School of Economics and London School of Hygiene & Tropical Medicine, she talks about the past and future of community participation and community participation research. Community participation, she argues, cannot be limited to an intervention; the next big challenge of research will be to understand the processes that tie community participation and health outcomes. She points to a growing recognition by policy makers that community participation is critical and necessary but not sufficient for improvement of the health of the populations. As communities become aware of their rights and their obligations, they become in a much better position to negotiate policy and the provision of services with policy-makers, she argues. At this moment most research views community participation as an intervention and therefore uses a natural scientific paradigm to look at it linearly as a causal effect. This approach is inductive and very narrow; direct causes have effects. Instead, Rifkin calls for a closer investigation of processes and how community monitoring leads to better health outcomes. The other question about the research in this area is how we address issues around power and control, key to community ownership of health programmes.

13. Monitoring equity and research policy

A resolution by the World Health Assembly: Will there finally be a cure for diseases that affect the poor?
Correa C: South Views 42, South Centre, 12 November 2012

In this article, the author argues that, in order to promote development of new products and their access to populations, especially in developing countries, it is necessary to change the current pharmaceutical research and development (R&D) model. The cost of research should be delinked from the prices of the products generated. The challenge is not only about increasing investment in research or improving the rate of innovation. This will not suffice if the new products are not effectively accessible for those who need them. It is a responsibility of States to provide effective solutions to the health problems of the majority of the planet’s population, he argues, calling for the establishment of a binding convention on R&D for new medicines, vaccines and other pharmaceutical products and technologies. A global binding agreement, negotiated in the World Health Organisation, could be an important part of the solution. Naturally, reaching consensus for its adoption will not be a simple task, neither can it be expected to be instantaneous. It would probably require some years of intense negotiation. However, it will be worth the effort if it can avoid the early death or improve the quality of life of millions of people by creating, on a solid foundation, a new paradigm for research and access to health products, the author concludes.

Further details: /newsletter/id/37406
Approaches to developing the capacity of health policy analysis institutes: A comparative case study
Bennett S, Corluka A, Doherty J and Tangcharoensathien V: Health Research Policy and Systems 10(7): 1-9, 5 March 2012

The aim of this study was to review and assess the factors that facilitate the development of sustainable health policy analysis institutes in low and middle income countries and the nature of external support for capacity development provided to such institutes. Comparative case studies of six health policy analysis institutes (three from Asia and three from Africa) were conducted. The findings are organised around four key themes. (i) Financial resources: Three of the institutes had received substantial external grants at start-up, however two of these institutes subsequently collapsed. At all but one institute, reliance upon short term, donor funding, created high administrative costs and unpredictability. (ii) Human resources: The retention of skilled human resources was perceived to be key to institute success but was problematic at all but one institute. (iii) Governance and management: Boards made important contributions to organisational capacity through promoting continuity, independence and fund raising. (iv) Networks: Links to policy makers helped promote policy influences, while external networks with other research organisations helped promote capacity. Overall, health policy analysis institutes remain very fragile. A combination of more strategic planning, active recruitment and retention strategies, and longer term, flexible funding, for example through endowments, needs to be promoted.

Beyond Aid: Research and Innovation as key drivers for Health, Equity and Development
Council on Health Research for Development Group (COHRED): 2012

This report summarises the outcomes of the conference Forum 2012, which was held in April 2012 in Cape Town, South Africa. It identifies that countries need to collect evidence and use it to identify priorities for their people and that external funders should not set agendas. Assessment should be made of where research is needed before embarking on projects, as is constant monitoring and evaluation. Research ethics frameworks need to be improved and integrated into health research systems. Partnerships are seen to be crucial, particularly local partnerships and scientists need mentoring, stable jobs and good salaries, and to know they are valued. People need to be engaged at a young age about research and innovation for development. Investing in research for health requires a long-term view. Promoting equity in health means addressing the social and economic conditions that cause inequality. Research and innovation can help identify and develop solutions to expand the availability of good quality healthcare and people's access to it, thereby reducing disparities in health.

Creating a Knowledge Translation Platform: Nine Lessons from the Zambia Forum for Health Research
Kasonde JM and Campbell S: Health Research Policy and Systems 10(31), 3 October 2012

In this review, the authors discuss nine key lessons documenting the experience of the Zambia Forum for Health Research, primarily to inform and exchange experience with the growing community of African KTPs. This Knowledge Translation Platform (KTP) provided cohesion and leadership for national-level knowledge translation efforts. They found that ZAMFOHR’s success was linked to selecting a multi-stakeholder and multi-sectoral Board of Directors, performing comprehensive situation analyses to understand not only the prevailing research-and-policy dynamics but a precise operational niche, and selecting a leader who bridges the worlds of research and policy. ZAMFOHR also helped build the capacity of both policy-makers and researchers, as well as a database of local evidence and national-level actors, while catalysing work in particular issue areas by identifying leaders from the research community, creating policy-maker demand for research evidence and fostering the next generation by mentoring up-and-coming researchers and policy-makers. Ultimately, ZAMFOHR’s experience shows that an African KTP must pay significant attention to its organisational details and invest in the skill base of the wider community and, more importantly, of its own staff. At the same time, the role of networking cannot be underestimated.

Emerging Voices 2012: Moses’ experiences
Tetui M: Makerere University School of Public Health, Uganda, 30 October 2012

In this blog from the Second Global Symposium on Health Systems Research, held in Beijing in October 2012, the author discusses the Emerging Voices programme for the Conference. The first part involved an introduction to new methods of presenting scientific research findings to a diverse audience in an effective way: Pecha Kucha and the Prezi. The author considered these picture-based alternatives better the traditional text-based PowerPoint presentation. Secondly, participants went on cultural and field visits to local Chinese traditional sites and were introduced to the Chinese health system. The author visited a district health office and two health centres in a rural area and was particularly impressed by the integration of Chinese traditional medicine with the Western medicine within the mainstream health system. This means that the Chinese give both disciplines and approaches adequate resources and attention in terms of developing them further. The conference offered a great opportunity to meet senior health systems researchers who could share their participatory action research methodologies.

Use of evidence to support healthy public policy: a policy effectiveness–feasibility loop
Bowman S, Unwin N, Critchley J, Capewell S, Husseini A, Maziak W et al: Bulletin of the World Health Organization 90(11): 847-853, November 2012

This paper presents a pragmatic framework for developing and prioritising policy interventions tailored to local epidemiological, political and social conditions. The “policy effectiveness–feasibility loop” (PEFL) framework was developed as part of a multinational project aiming to inform policy for the prevention and control of cardiovascular diseases and diabetes in four middle-income territories. Central to the proposed approach is the involvement of policy-makers in the collection of evidence and its appraisal. The PEFL framework resembles a “equity effectiveness loop”, which is intended to estimate the impact of interventions to reduce socioeconomic inequalities. The major difference is that the PEFL approach includes assessing the local context and the feasibility of potential interventions. Furthermore, its focus is on policy-level interventions, and hence the situation analysis involves local policy-makers. The situation analysis and option appraisal stages of the framework are analogous to policy dialogue, as they facilitate discussion between stakeholders and researchers on policies and how to implement them. The outputs resulting from application of the framework can be used to prepare policy briefs for informing stakeholder discussions on policy options.

14. Useful Resources

Community Discussion Guide for Maternal and Newborn Health Care: A Training Manual for Safe Motherhood Action Groups
Mobilising Access to Maternal Health Services in Zambia Programme (MAMaZ), Ministry of Community Development, and Mother and Child Health and District Health Management Teams: 2012

This Guide is being used in six rural districts of Zambia to train Community Health Volunteers, including members of community Safe Motherhood Action Groups (SMAGs), to promote safe pregnancy planning; help reduce maternal delays; and promote appropriate newborn care. The Guide was developed by the Mobilising Access to Maternal Health Services in Zambia (MAMaZ) programme and district health management team partners in six districts It sets out a process for engaging with rural communities to increase awareness of and social approval to act on maternal and newborn health. It contains detailed guidance on how to train SMAG volunteers in two key areas of their portfolio – maternal and newborn health care – and is intended to complement other maternal health and newborn care training resources. The training approach used here aims to build the knowledge and training capacity of the Mama SMAGs in such a way that they do not have to rely on having a paper version of the Community Discussion Guide, mainly because they may have poor literacy. The approach forces trainers to internalise the Guide’s content and techniques and avoids reliance on the production of training manuals in a context where paper and printing capacity may be in short supply and where the dissemination of manuals can be challenging logistically.

New database on United Nations procurement
UNOPS: 2012

The data.unops.org hub has now been officially launched, making publicly available information about procurement from United Nations organisations. Data includes the value of goods and services procured by each organisation, details on amounts procured from developing countries and countries with economies in transition, and profiles of all countries of supply. There are graphs indicating how much UNOPS is delivering on behalf of its partners including the United Nations, governments, multilateral institutions, foundations and the private sector. The data is inter-connected where possible, enabling users to explore information about UNOPS operations from multiple perspectives such as by country, by partner or by sector.

Out of the Dark: Meeting the needs of children with TB
Médecins Sans Frontières: 2012

This guide outlines the current state of paediatric tuberculosis (TB) care, looking at current practices, new developments and research needs in paediatric TB diagnosis, treatment and prevention. It is intended to act as a guide to treatment programmes for implementation of the best standard of care currently available to children with TB, and to raise awareness of the need to continue to push for improvements in the management of childhood TB.

15. Jobs and Announcements

Call for abstracts: Ninth World Congress on Health Economics: "Celebrating Health Economics": Sydney, Australia: 7-10 July 2013
Deadline: 15 January 2013

All interested parties are invited to submit abstracts for the Ninth World Congress on Health Economics: "Celebrating Health Economics". Individual abstracts should not exceed 500 words. All accepted presenters are expected to register and pay by the deadlines listed on the Congress website.

Call For Applicants: Postdoctoral Fellowship In Community-Based Research
Deadline: 5 December 2012

The Centre for Addiction and Mental Health (CAMH) is calling for applicants for its new Postdoctoral Fellowship in Community-Based Research. CAMH trains students and fellows in the field of mental health and addictions and the purpose of the fellowship is to provide a postdoctoral fellow with training in the techniques and principles of community-based research on mental health and addictions. Fellows can propose research in any area related to mental health and addictions, and can be supervised by any CAMH scientist. In addition to the usual academic requirements of CAMH fellows, successful candidates for this fellowship will be required to show that: their proposed research question is seen as a priority for the community under study; community members and/or organisations will be actively and meaningfully engaged in the research; and the research is likely to have a tangible impact for the community.

Call For Papers: Health In The Post-2015 Development Agenda
Closing Date: 15 December 2012

In preparation for the 2013 United Nations (UN) General Assembly, the UN is inviting interested individuals and groups to submit “think pieces” on the positioning and role of health in the post-2015 agenda. The UN aims to garner experiences and lessons learnt from the health-related Millennium Development Goals and consider how these can be harnessed to ensure that health remains intrinsic to the new development agenda. Papers may also address disease-specific policy and programming challenges, health systems issues, measurement, monitoring and evaluation, or cross-sectoral action for health. Lessons learnt from the past should be used to highlight how new global goals, targets and indicators could be used to strengthen country action and tackle emerging challenges, such as enhancing health equity; building intersectoral links; using health action to achieve human rights, justice, peace and security; and involving communities, business and industry in successful, sustainable health action. Papers can be summaries of existing research and development activities or secondary analyses and discussion around key topics.

Global Maternal Health Conference 2013
15-17 January 2013: Dar es Salaam, Tanzania

The Global Maternal Health Conference is a technical conference for scientists, researchers, and policy-makers to network, share knowledge, and build on progress toward eradicating preventable maternal mortality and morbidity by improving quality of care. The conference is co-sponsored by Management and Development for Health, Dar es Salaam, Tanzania, and the Maternal Health Task Force at the Harvard School of Public Health, Boston, US.

Twenty-First IUHPE World Conference On Health Promotion, 25-29 August 2013, Thailand
Abstract Submission Deadline: 20 December 2012

The International Union for Health Promotion and Education (IUHPE) and Thai Health Promotion Foundation (ThaiHealth) are hosting the 21st IUHPE World Conference on Health Promotion, 25–29 August 2013, Pattaya, Thailand. The conference aims to contribute to the development of equity and social justice across the globe by offering a unique platform for dialogue on the best investments for health between participants from various sectors from all over the world.

United Nations Framework Convention on Climate Change
Doha: 26 November – 7 December 2012

The 18th session of the Conference of the Parties to the United Nations Framework Convention on Climate Change (UNFCCC) and the 8th session of the Conference of the Parties serving as the Meeting of the Parties to the Kyoto Protocol will take place from Monday, 26 November to Friday, 7 December 2012 at the Qatar National Convention Centre in Doha, Qatar. Government, business and civil society from around the world will gather to discuss climate change and seek to move forward with the agenda set by the Kyoto Protocol to halt and reverse global warming.

Vacancy for health economist at PRICELESS SA
Closing date: Until filled

An opening exists at PRICELESS SA (Priority Cost Effective lessons for Systems Strengthening) for a health economist or general applied micro economist with interest and experience in health economics in South Africa or Sub Saharan Africa. The focus of the work is on the role and use of cost effectiveness and related evidence- based approaches in setting priorities for health interventions and maximising their impact. The work will build on the already established base of exciting and innovative economic evaluation that is immediately relevant to health priorities in South Africa. This grant funded position is equivalent to senior lecturer/assistant professor level, dependant on education and experience, and is located in Johannesburg at the MRC /Wits Rural Public Health and Health Transitions Research Unit (Agincourt) at the University of the Witwatersrand School of Public Health. Responsibilities will include substantial technical involvement in studies of the costs and cost effectiveness of different priority interventions and how they articulate with health sector in South Africa. Requirements include a Doctoral degree in economics or a related field (e.g. public health, public policy). Masters degree candidates with a medical degree and at least three years’ experience will also be considered. Interested applicants may obtain more detailed information from Karen Hofman on Karen.Hofman@wits.ac.za and +27 11 717 2083/2606.

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