The barriers researchers face in having qualitative research published in many mainstream health and medical journals is limiting our understanding of important dimensions of health care. At a time when health systems are increasingly involving a range of disciplines in health teams and using more holistic models to respond to the mix of physical, psycho-social and environmental factors that lead to ill health, excluding qualitative work deprives decision makers of a significant body of knowledge that could inform decision making on health systems. “Furthermore, this effectively silences the voices of community members, particularly those who are marginalised across all countries”.
So argued 170 co-signatories from all regionals globally of a letter from the Social science approaches for research and engagement in health policy & systems (SHaPeS) thematic working group of Health Systems Global, the Regional Network for Equity in Health in East and Southern Africa (EQUINET), and the Emerging Voices for Global Health. The full letter was published in June in the International Journal for Equity in Health and can be read at http://equityhealthj.biomedcentral.com/articles/10.1186/s12939-016-0368-y
The signatories raised that many issues that affect both the effectiveness and equity of health systems cannot simply be ‘measured’ by numbers alone. Issues such as the subjective relationships and communication between health workers, clients and communities, the perceptions of and trust in services, the role of social literacy, or the values and preferences that managers, health workers and communities bring to systems affect health outcomes and therapeutic relationships. One young researcher argues in the letter that qualitative work “facilitates my understanding beyond what the numbers show”.
Researchers in east and southern Africa have in past EQUINET forums voiced similar views. They have raised the difficulties they face in publishing generally, not only in meeting the format, style and other demands of a journal paper, but also in finding the time for the process, given competing time pressures. Those working with qualitative research appear to face even higher barriers. The signatories to the letter stated “We are particularly disenchanted by our general experience of the limited and often inadequate publication of qualitative research in the major health and medical journals, and the resultant loss of important insights for those working in, or concerned with, health services and systems, including around clinical decision-making”.
For those working with participatory approaches the barriers can seem even more insurmountable. At a 2014 regional workshop on participatory action research, researchers raised that most traditional journals - and many funders - do not understand or appreciate these approaches. One researcher, from Malawi, described that despite his research leading to real changes, publishing it was an uphill task, calling for constant efforts to make to justify the approach, the role of community members as partners in the research and the use of subjective or qualitative evidence. Indeed in another article in this issue of the newsletter the authors comment: "research and publishing is the oxygen of academic life. But the regimes of control that surround contemporary approaches to publishing are choking creativity..."
The letter published by the health system researchers argues for methodological diversity in mainstream publication on health systems research, to build a more holistic and richer understanding of complex systems. Given the multiple factors, including subjective, dynamic and social factors, that influence health and the way services are delivered and experienced, it would indeed seem to oversimplify reality to give singular dominance to the old maxim that “what is measured counts” at the cost of the wider range of methods and lenses that we have to explore, analyse, and understand what counts.
The full letter referred to in this editorial was published as SHaPES, EQUINET, Emerging voices for global Health, Daniels, Loewenson et al., 2016, International Journal for Equity in Health 15:98 DOI: 10.1186/s12939-016-0368-y. Please send feedback or queries on the issues raised in this briefing to the EQUINET secretariat: email@example.com or to the SHaPES working group in Health Systems Global http://www.healthsystemsglobal.org/
The barriers researchers face in having qualitative research published in many mainstream health and medical journals is limiting our understanding of important dimensions of health care. At a time when health systems are increasingly involving a range of disciplines in health teams and using more holistic models to respond to the mix of physical, psycho-social and environmental factors that lead to ill health, excluding qualitative work deprives decision makers of a significant body of knowledge that could inform decision making on health systems. “Furthermore, this effectively silences the voices of community members, particularly those who are marginalised across all countries”.
2. Latest Equinet Updates
The 2005 International Health Regulations (IHR) adopted by member states in the World Health Organization (WHO) require that all countries have the ability to detect, assess, report and respond to potential public health emergencies of international concern at all levels of government, and to report such events rapidly to the WHO to determine whether a coordinated, global response is required. Recent epidemics have strengthened the demand to improve the capacities to implement the IHR and the effectiveness of health system prevention and detection of and responses to epidemics. Evidence from ESA countries suggests that this demands effective communication between local levels of health systems and national responses, and capacities for prevention, detection and response at community, primary care and district level. In 2016 two new global financing mechanisms were introduced to support emergency responses, the WHO Contingency Fund for Emergencies (CFE), that aims to fill the gap from the beginning of a declared emergency and a World Bank Pandemic Emergency Facility (PEF), to support follow up measures after initial CFE funding. This report provides information on the new CFE and PEF financing mechanisms, to explore any stated or implied links with the IHR goals and health system strengthening in the response to emergencies. It is based on a desk review of available literature by the University of Sheffield and the Training and Research Support Centre, under the umbrella of EQUINET. The report aims to inform African policy-makers and stakeholders about the CFE and PEF financial mechanisms and their relationship to the IHR to locate areas where links could be more explicitly made between the new financial mechanisms, the IHR and the health system strengthening needed for longer-term preparedness for and prevention of emergencies.
An open letter from Trisha Greenhalgh et al. to the editors of the British Medical Journal (BMJ) triggered wide debate by health policy and systems researchers (HPSRs) globally on the inadequate recognition of the value of qualitative research and the resulting deficit in publishing papers reporting on qualitative research. One key dimension of equity in health is that researchers are able to disseminate their findings and that they are taken into account in a fair and just manner, so that they can inform health policy and programmes. The Greenhalgh et al. letter and editorial responses were actively discussed within “SHAPES”, a thematic group within Health Systems Global, focused on Social Science approaches for research and engagement in health policy & systems (http://healthsystemsglobal.org/twg-group/6/Social-science-approaches-for-research-and-engagement-in-health-policy-amp-systems/) and within EQUINET (www.equinetafrica.org). The discussion precipitated this follow up open letter/commentary, which has 170 co-signatories. Collectively, the signatories feel that barriers to publication of qualitative research limit publication of many exemplary studies, and their contribution to understanding important dimensions of health care, services, policies and systems.
This 2016 regional meeting was convened by ECSA HC with EQUINET in line with HMC Resolution – ECSAHMC50/R2 to prepare and discuss issues on the 69th World Health Assembly (WHA) Agenda and Regional GHD work. The objectives of the meeting were to 1. Update participants from ECSA-HC member states on Global Health Diplomacy (GHD) and its health impact. 2. Share information and discuss, from a GHD perspective, selected WHA agenda items and related issues from other key global health platforms. 3. Present and discuss research findings, recommendations on effective engagement on GHD and proposals for future work. 4. Discuss proposals for strengthened regional co-ordination and communication on GHD and a framework for monitoring progress. The meeting included senior officials delegated or responsible for health diplomacy from ECSA HC member states and South Africa, diplomats from the Africa group from ECSA HC member states, technical personnel from EQUINET and other institutions, including regional organisations and partners.
3. Equity in Health
Physical, emotional and sexual abuse of children is a major problem in South Africa, with severe negative outcomes for survivors. This study investigated the prevalence and incidence, perpetrators, and locations of child abuse in South Africa using a multicommunity sample. 3515 children aged 10–17 years (56.6% female) were interviewed from all households in randomly selected census enumeration areas in two South African provinces. Child self-report questionnaires were completed at baseline and at 1-year follow-up (97% retention). Prevalence was 56% for lifetime physical abuse (18% past-year incidence), 36% for lifetime emotional abuse (12% incidence) and 9% for lifetime sexual abuse (5% incidence). 69% of children reported any type of lifetime victimisation and 27% reported lifetime multiple abuse victimisation. Main perpetrators of abuse were reported: for physical abuse, primary caregivers and teachers; for emotional abuse, primary caregivers and relatives; and for sexual abuse, girlfriend/boyfriends or other peers. This is the first study assessing current self-reported child abuse through a large, community-based sample in South Africa. Findings of high rates of physical, emotional and sexual abuse demonstrate the need for targeted and effective interventions to prevent incidence and re-abuse.
Road traffic injuries are among the leading causes of death and life-long disability globally. The World Health Organization (WHO) reports road traffic injuries as the leading cause of death among young people aged 15–29 years globally and are among the top three causes of mortality among people aged 15–44 years. In Africa, the number of road traffic injuries and deaths have been increasing over the last three decades. According to the 2015 Global status report on road safety, the WHO African Region had the highest rate of fatalities from road traffic injuries worldwide at 26.6 per 100 000 population for the year 2013. In 2013, over 85% of all deaths and 90% of disability adjusted life years (DALYs) lost from road traffic injuries occurred in low- and middle-income countries, which have only 47% of the world’s registered vehicles. The increased burden from road traffic injuries and deaths is partly due to economic development, which has led to an increased number of vehicles on the road. Given that air and rail transport are either expensive or unavailable in many African countries, the only widely available and affordable means of mobility in the region is road transport. However, the road infrastructure has not improved to the same level to accommodate the increased number of commuters and ensure their safety and as such many people are exposed daily to an unsafe road environment. The 2009 Global status report on road safety presented the first regional estimate of a road traffic death rate, which was used to statistically address the under-reporting of road traffic deaths by countries with an unreliable death registration system. In the 2009 report, Africa had the highest estimated fatality rate at 32.2 per 100 000 population, in contrast to the reported fatality rate of 7.2 per 100 000 population. The low reported death rate is said to reflect missing data due to non-availability of road traffic data systems. This has a direct impact on health planning including emergency care and other responses by government agencies.
4. Values, Policies and Rights
The authors note a proposal for the World Health Organization (WHO) to provide capacity-building for drafting health laws in Member States. They highlight that WHO has the authority and credibility to work with countries to make their national laws easier to access and understand, and to monitor and evaluate their implementation. WHO’s new technical support work related to universal health coverage (UHC) laws is observed as one example of its support for Member States in this important area. Strengthening countries’ legal and regulatory frameworks and engaging in universal health coverage-compliant law reforms has been missing from the universal health coverage agenda. WHO calls on Member States to align their health system policies with universal health coverage goals such as equity, efficiency, health service quality and financial risk protection. Strengthening health systems using health laws and legal frameworks is a pivotal means for attaining these goals and achieving sustainable results in health security and resilience.
A constitutional guarantee of access to essential medicines has been identified as an important indicator of government commitment to the progressive realisation of the right to the highest attainable standard of health. The objective of this study was to evaluate provisions on access to essential medicines in national constitutions, to identify comprehensive examples of constitutional text on medicines that can be used as a model for other countries, and to evaluate the evolution of constitutional medicines-related rights since 2008. Relevant articles were selected from an inventory of constitutional texts from WHO member states. References to states’ legal obligations under international human rights law were evaluated. Twenty-two constitutions worldwide now oblige governments to protect and/or to fulfil accessibility of, availability of, and/or quality of medicines. Since 2008, state responsibilities to fulfil access to essential medicines have expanded in five constitutions, been maintained in four constitutions, and have regressed in one constitution. Government commitments to essential medicines are an important foundation of health system equity and are included increasingly in state constitutions.
World Population Day in July 2016 was held with the theme “Investing in teenage girls”. “The teenage years are for some girls a time of exploration‚ learning and increasing autonomy. But for many others‚ it is a time of increasing vulnerability and exclusion from rights and opportunities‚ or just plain discrimination‚'” said Babatunde Osotimehin‚ UN under-secretary-general and executive director of the UN Population Fund (UNFPA). “When a teenage girl has the power‚ the means and the information to make her own decisions in life‚ she is more likely to overcome obstacles that stand between her and a healthy‚ productive future. This will benefit her‚ her family and her community.” According to the UN‚ 20 000 girls under the age of 18 give birth every day in developing countries. Siyabulela Mamkeli‚ Cape Town mayoral committee member for health‚ said good health and access to services were “crucial to help young women on the road to success”. In conjunction with other organisations‚ the city has been involved in pilot projects to provide girls who have started with their menstrual cycle with reusable sanitary towels. Meanwhile‚ the UNFPA's initiative - to end child marriages‚ curb adolescent pregnancy and encourage girls to make informed decisions about their futures - helped more than 11-million girls between the ages of 10 and 19 gain access to sexual and reproductive health services and information in 2015.
Governments in low- and middle-income countries are legitimising the implementation of universal health coverage (UHC), following a United Nation’s resolution on UHC in 2012 and its reinforcement in the sustainable development goals set in 2015. UHC will differ in each country depending on country contexts and needs, as well as demand and supply in health care. Therefore, fundamental issues such as objectives, users and cost–effectiveness of UHC have been raised by policy-makers and stakeholders. While priority-setting is done on a daily basis by health authorities – implicitly or explicitly – it has not been made clear how priority-setting for UHC should be conducted. The authors provide justification for explicit health priority-setting and guidance to countries on how to set priorities for UHC.
5. Health equity in economic and trade policies
How Africa urbanises will be critical to the continent’s future growth and development, according to the African Economic Outlook 2016. Africa’s economic performance held firm in 2015 amid global headwinds and regional shocks. The continent remained the second fastest growing economic region after East Asia. In 2015, net financial flows to Africa were estimated at USD 208 billion, 1.8% lower than in 2014 due to a contraction in investment, while official development assistance increased by 4%; and remittances remain the most stable and important single source of external finance at USD 64 billion in 2015. According to the authors, if harnessed by adequate policies, urbanisation can help advance economic development through higher agricultural productivity, industrialisation, services stimulated by the growth of the middle class, and foreign direct investment in urban corridors. It also can promote social development through safer and inclusive urban housing and robust social safety nets. Finally, it can further sound environmental management by addressing the effects of climate change as well as the scarcity of water and other natural resources, controlling air pollution, developing clean cost-efficient public transportation systems, improving waste collection, and increasing access to energy. Seizing this urbanisation dividend requires bold policy reforms and planning efforts, however, such as by strengthening local governance, tailoring national urban strategies to specific contexts and diverse urban realities and harnessing innovative financing instruments.
The author argues that Africa has not benefited substantially from its mineral wealth and that it is essential for resource-rich African countries to tailor their economic policies to harness and utilise mineral revenues to improve the productivity of non-mineral sectors to break out of the extractive enclave. The article observes that the remarkable extractives-driven economic growth of the last decade across Africa failed to trickle down. It was jobless, benefited foreign corporates and the local elite, and it widened the gap between the rich and the poor. If Africa is to avoid the failures of the previous decades and successfully transition from its present state to that foreseen by Agenda 2030 then the author proposes that it must better harness the potential benefits of its vast mineral wealth. African countries must institute fiscal reforms that will ensure that they are better positioned to derive maximum benefit from the next commodity price super cycle; they must plug loopholes that continue to facilitate the bleeding of much needed development revenues via illicit flows; countries must align all relevant local frameworks to the African Mining Vision, thereby putting the needs of citizens at the centre of their natural resource management agenda; and Africa must unite in a broad and strong push for long overdue global tax reforms.
The Comprehensive Africa Agricultural Development Programme (CAADP) Results Framework is an essential component in facilitating CAADP implementation. The AU Malabo Declaration in June 2014 sent the goals for African countries, including a 10% public spending target for agriculture, a commitment to zero hunger by 2025, reducing stunting to 10%, halving poverty, by 2025, and providing preferential and participation for women and youth in gainful and attractive agribusiness This document presents the critical actions required to achieve agricultural development agenda targets. The indicators are accompanied by baseline data and targets that can be achieved within the next 10 years. The framework provides standardised tools which can be used by CAADP stakeholders at country, REC (Regional Economic Community) and continental level to measure agricultural performance and progress. It intends to be used in improving planning processes and strengthening existing monitoring and evaluation systems to achieve CAADP targets within the next 10 years.
6. Poverty and health
Southern Africa’s unprecedented El Niño-related drought and weather-related stress has triggered a second shock-year of hunger and hardship for poor and vulnerable people with serious consequences that World Food Programme (WFP) say will persist until at least to the next harvest in 2017, with the 2015-16 maize harvest insufficient to cover full cereal needs for the region without significant importation. El Niño conditions have caused the lowest recorded rainfall between October 2015 and January 2016 across many regions of Southern Africa in at least 35-years. The period also recorded the hottest temperatures in the past 10 years. Short-term forecasts, based on more recent data, (February to May) indicate the high probability of continuing below-normal rainfall across the region, signalling this may become one of the worst droughts in recent history. El Niño’s impact on rain-fed agriculture is severe. Poor-rainfall, combined with excessive temperatures, has created conditions that are unfavourable for crop growth in many areas. In Lesotho, South Africa, Swaziland, Zambia and Zimbabwe, planting was delayed by up to two months or more and is expected to severely impact maize yields. Already by early 2016 an estimated 15.9 million people in southern Africa were highly food insecure, not including a growing number in South Africa. Zimbabwe, Malawi, Lesotho, Madagascar were the hardest hit from the 2015 poor harvest and early impacts from El Niño, with Swaziland, Angola and Mozambique show increasing signs of concern. WFP note that El Niño is usually accompanied by economic slowdown in Southern Africa, associated with reduced agricultural output and contraction in industrial activities. Current macro-economic conditions, including falling international commodity prices and currency depreciations, may inhibit countries’ capacity to secure sufficient food supply. Crop failure and economic contraction threaten both rural and urban livelihoods as it undermines people’s capacity to meet their basic social and economic needs, coupled with increasing levels of livelihood stress and unemployment, El Niño incurs social, economic and political consequences. The WFP note that regional coordination and government leadership of critical contingency, preparedness and response planning is crucial to guarantee sufficient food supply and access for the most vulnerable people.
The N$90 million for drought relief set aside by the government from April 2016 to feed the 595 000 needy people in Namibia will last only until the end of July said Prime Minister Saara Kuugongelwa- Amadhila. In the light of this, she said that the government needs to raise N$659 million for the drought relief programme from 1 August 2016 until March 2017. President Hage Geingob declared a state of emergency in 2016 due to the ongoing drought in the country. This is the second time in three years that the Namibian government has declared a state of emergency. The 2016/17 Rural Food Security and Livelihood Vulnerability Forecast report presented yesterday by Obert Mutabani from the Prime Minister's Office shows that the price of maize meal increased from N$8 per kilogramme in 2012 to N$18 now. Millet now costs about N$14 from N$7 in 2012, while sorghum is at N$29, up from N$7. The report also revealed that about 595 839 people have been affected by the drought, and will need assistance. It gave recommendations that government should set up programmes to help communities become self-reliant.
Started 10 years ago, South Africa’s shack dwellers movement Abahlali baseMjondolo has mounted a remarkable struggle – often at a terrible cost - to protect and promote the rights of impoverished people in the towns. This inspirational story shows what poor people can achieve when they organise themselves. The Abahlali baseMjondolo movement was formed in the Kennedy Road shack settlement in Clare Estate in Durban in 2005. It was formed to fight for, protect, promote and advance the interests and dignity of shack dwellers and other impoverished people in South Africa. At the time of the movement’s formation Kennedy Road was facing eviction. The conditions were very bad in the settlement due to the lack of infrastructure. At the time the government had a policy of ‘eradicating slums’ and promised that there would be no more ‘slums’ by 2014. However the process left some people homeless and others would be taken to tiny and badly made ‘houses’ far outside of the cities. So the Abahlali baseMjondolo movement successfully organised to stop the evictions and the ‘slum eradication’ program. They organised clean ups and brought ’Operation Khanyisa” (self-connection to electricity) which started in Soweto to Durban. Abahlali aims to build the power of the impoverished from below. However they write that they have faced serious repression in their struggle and that basic rights, like the right to protest, have been denied to them. They reject that others should speak for them and that municipalities should work with people in shack settlements to plan participatory upgrades so that the impoverished can live a dignified life.
In response to the advent of the El Nino phenomena which has resulted in the country experiencing long dry spells, the ZimVAC undertook a rapid assessment focussing on updating the ZimVAC May 2015 results. The process followed a 3 pronged approach which were, a review of existing food and nutrition secondary data, qualitative district Focus Group Discussions (FGDs) and for other variables a quantitative household survey which in most cases are representative at provincial and national level. This report provides a summation of the results for the 3 processes undertaken. The report concludes that there is an urgent need to strengthen and expand current livestock support programmes to prevent further deterioration of livestock condition and deaths; to implement a Drought Relief Policy and Food Deficit Mitigation Strategy through multi-sectoral participation of all relevant Government structures, and to adopt registration, distribution and monitoring strategies that are inclusive. Gender based violence cases were found to be on the increase in most districts, while noting that this may be attributable to an increase in awareness and reporting and not necessarily to an increase in incidents.
7. Equitable health services
Despite the progress in the Millennium Development Goals (MDGs) 4 and 5, inequity in the utilization of maternal, newborn and child health (MNCH) care services still remain high in sub-Saharan Africa (SSA). In this study, the authors explored the distributions in the utilisation MNCH services in 12 SSA countries and further investigated the associations in the continuum of care for MNCH as key for health equity, using Demographic and Health Surveys data of 12 countries in SSA. Some countries have a consistently low (Mali, Nigeria, DR Congo and Rwanda) or high (Namibia, Senegal, Gambia and Liberia) utilisation in at least two levels of MNCH care. The path relationships in the continuum of care for MNCH from ‘adequate antenatal care’ to ‘adequate delivery care’ (0.32) and to ‘adequate child’s immunisation’ (0.36); from ‘adequate delivery care’ to ‘adequate postnatal care’ (0.78) and to ‘adequate child’s immunisation’ (0.15) were positively associated and statistically significant. Only the path relationship from ‘adequate postnatal care’ to ‘adequate child’s immunisation’ (−0.02) was negatively associated and significant. In conclusion, utilisation of each level of MNCH care is related to the next level of care, that is – antenatal care is associated with delivery care which is then associated with postnatal and subsequently with child’s immunisation. At the national level, identification of communities which are greatly contributing to overall disparity in health and a well laid out follow-up mechanism from pregnancy through to child’s immunisation program could serve towards improving maternal and infant health outcomes and equity.
The needs of caregivers of children with disability may not be recognized despite evidence to suggest that they experience increased strain because of their care-giving role. This strain may be exacerbated if they live in under-resourced areas. The authors set out to establish the well-being of caregivers of children with Cerebral Palsy (CP) living in high-density areas of Harare, Zimbabwe. In addition, the authors wished to identify factors that might be predictive of caregivers’ well-being. Finally, they examined the psychometric properties of the Caregiver Strain Index (CSI) within the context of the study. Caregivers of 46 children with CP were assessed twice, at baseline, and after three months, for perceived burden of care and health-related quality of life. The psychometric properties of the CSI were assessed post hoc. The caregivers reported considerable caregiver burden with half of the caregivers reporting CSI scores in the ‘clinical distress’ range. Many of the caregivers experienced some form of pain, depression and expressed that they were overwhelmed by the care-giving role. No variable was found to be associated with clinical distress. The authors propose that caregivers be monitored routinely for their level of distress and that there is an urgent need to provide them with support. The CSI is likely to be a valid measure of distress in this population.
Globally challenges regarding healthcare provision are sometimes related to a failure to estimate client numbers in peri-urban areas due to rapid population growth. About one-sixth of the world's population live in informal settlements which are mostly characterised by poor healthcare service provision. Poor access to primary healthcare may expose residents of informal settlement more to the human immunodeficiency virus (HIV) and to acquired immunodeficiency syndrome (AIDS) than their rural and urban counterparts due to a lack of access to information on prevention, early diagnosis and treatment. This study explored and described the experiences of both the reproductive health services' clients and the healthcare providers with regard to the provision of reproductive health services including the prevention of HIV and AIDS in a primary healthcare setting in Tshwane. A qualitative, exploratory and contextual design using a phenomenological approach to enquire about the participants' experiences was implemented. Purposive sampling resulted in the selection of 23 clients who used the reproductive healthcare services and ten healthcare providers who were interviewed during individual and focus group interviews respectively. The findings revealed that females who lived in informal settlements were aware of the inability of the PHC setting to provide adequate reproductive healthcare to meet their needs, as were providers. The authors argue that inputs from people at grass roots level be integrated during policy development to ensure that informal settlement residents are provided with accessible reproductive health services. It was further found that the community members could be taught how to coach teenagers and support each other in order to bridge staff shortages and increase health outcomes including HIV/AIDS prevention.
8. Human Resources
Despite a global recognition from all stakeholders of the gravity and urgency of health worker shortage in Africa, little progress has been achieved to improve health worker coverage in many of the African human resources for health (HRH) crisis countries. The problem consists in how policy is made, how leaders are accountable, how the World Health Organization (WHO) and foreign funders encourage (or distort) health policy, and how development objectives are prioritized in these countries. The paper uses political economy analysis, which stems from a recognition that the solution to the shortage of health workers across Africa involves more than a technical response. A number of institutional arrangements dampen investments in HRH, including a mismatch between officials’ tenure in office and program results, the vertical nature of health programming, the modalities of Overseas Development Assistance in health, the structures of the global health community, and the weak capacity in HRH units within Ministries of Health. A major change in policy-making would only occur with a disruption to the political or institutional order. The case study of Ethiopia, who has increased its health workforce dramatically over the last 20 years, disrupted previous institutional arrangements through the power of ideas—HRH as a key intermediate development objective. The framing of HRH created the rationale for the political commitment to investment in health workers. The authors argue that Ethiopia demonstrates that political will coupled with strong state capacity and adequate resource mobilization can overcome the institutional hurdles above.
Community health workers (CHWs) are uniquely placed to link communities with the health system, playing a role in improving the reach of health systems and bringing health services closer to hard-to-reach and marginalised groups. A systematic review was conducted to determine the extent of equity of CHW programmes and to identify intervention design factors which influence equity of health outcomes. In accordance with published protocol, the authors systematically searched eight databases from 2004 to 2014 for quantitative and qualitative studies which assessed access, utilisation, quality or community empowerment following introduction of a CHW programme according to equity stratifiers (place of residence, gender, socio-economic position and disability). Thirty four papers met inclusion criteria. A thematic framework was applied and data extracted and managed, prior to charting and thematic analysis. The authors believe this to be the first systematic review that describes the extent of equity within CHW programmes and identifies CHW intervention design features which influence equity. CHW programmes were found to promote equity of access and utilisation for community health by reducing inequities relating to place of residence, gender, education and socio-economic position. CHWs can also contribute towards more equitable uptake of referrals at health facility level. There was no clear evidence for equitable quality of services provided by CHWs and limited information regarding the role of the CHW in generating community empowerment to respond to social determinants of health. Factors promoting greater equity of CHW services include recruitment of most poor community members as CHWs, close proximity of services to households, pre-existing social relationship with CHW, provision of home-based services, free service delivery, targeting of poor households, strengthened referral to facility, sensitisation and mobilisation of community. However, if CHW programmes are not well planned some of the barriers faced by clients at health facility level can replicate at community level. CHWs promote equitable access to health promotion, disease prevention and use of curative services at household level. However, care must be taken by policymakers and implementers to take into account factors which can influence the equity of services during planning and implementation of CHW programmes.
9. Public-Private Mix
This paper analyses private for-profit (PFP) providers currently offering services to the poor on a large scale, and assesses the future prospects of bottom of the pyramid models in health. The authors searched published and grey literature and databases to identify PFP companies that provided more than 40,000 outpatient visits per year, or who covered 15% or more of a particular type of service in their country. For each included provider, the authors searched for additional information on location, target market, business model and performance, including quality of care. Only 10 large scale PFP providers were identified. The majority of these were in South Asia and most provided specialised services such as eye care. The characteristics of the business models of these firms were found to be similar to non-profit providers studied by other analysts. They pursued social rather than traditional marketing, partnerships with government, low cost/high volume services and cross-subsidization between different market segments. There was a lack of reliable data concerning these providers. The authors observe that there is very limited evidence to support the notion that large scale bottom of the pyramid PFP models in health offer good prospects for extending services to the poor in the future, while successful PFP providers often require partnerships with government or support from public funding.
The private for-profit sector's prominence in health-care delivery, and concern about its failures to deliver social benefit, has driven a search for interventions to improve the sector's functioning. The authors review evidence for the effectiveness and limitations of such private sector interventions in low-income and middle-income countries. Few robust assessments are available, but some conclusions are argued to be possible. Prohibiting the private sector is said by the authors to be unlikely to succeed, and regulatory approaches face persistent challenges in many low-income and middle-income countries. Attention is therefore turning to interventions that encourage private providers to improve quality and coverage such as social marketing, social franchising, vouchers, and contracting. However, evidence about the effect on clinical quality, coverage, equity, and cost-effectiveness is inadequate. Other challenges concern scalability and scope. This indicates the limitations of such interventions as a basis for universal health coverage, though they can address focused problems on a restricted scale.
This article explores the areas of likely comparative advantage of the private sector in delivery of health care services for public health goals. It finds that there is a considerable body of evidence on the private provision of healthcare in low- and middle-income countries, often focusing on SSA. However, the evidence base is not robust. Evidence is often mixed and sometimes conflicting and policy implications are unclear. The arguments in favour of private healthcare suggest it is more responsive and efficient, while arguments in favour of public services suggest they are more equitable and better equipped than the market to respond to health needs. Some studies find that the private sector is unregulated, has financial incentives for inappropriate healthcare, and is expensive. There is very little evidence on the comparative cost-effectiveness of the private sector. This varies considerably across country contexts and types of services. There is no conclusive evidence that the private sector is more cost-effective or more efficient than the public sector. The literature warns that increased use of private services may crowd out or decrease the funding available to the public sector. The major criticism of private sector services is that their higher user fees create inequality of access, limiting their use by the poor. The author suggests that the literature is quite clear that private for-profit health services create inequality. Private non-profit, or services run by NGOs, appear to mitigate some of the inequality effects. In practice, boundaries can be blurred between public and private; both formal and informal cost recovery schemes operate at public facilities. NGOs providing healthcare are generally seen as private, although they may not charge for their services. It is observed that the difference between free-at-the-point-of-use NGOs and out-of-pocket-expenditure on private doctors can be enormous, and that it is important to differentiate between the types of providers when reviewing the evidence on private health care.
Private health care in low-income and middle-income countries is noted to be extensive and heterogeneous, ranging from medicine sellers, through millions of independent practitioners—both unlicensed and licensed—to corporate hospital chains and large private insurers. Policies for universal health coverage (UHC) must address this complex private sector. However, no agreed measures exist to assess the scale and scope of the private health sector in these countries, and policy makers tasked with managing and regulating mixed health systems struggle to identify the key features of their private sectors. In this paper, the authors propose a set of metrics, drawn from existing data that can form a starting point for policy makers to identify the structure and dynamics of private provision in their particular mixed health systems; that is, to identify the consequences of specific structures, the drivers of change, and levers available to improve efficiency and outcomes. The central message is that private sectors cannot be understood except within their context of mixed health systems since private and public sectors interact. The authors develop an illustrative and partial country typology, using the metrics and other country information, to illustrate how the scale and operation of the public sector can shape the private sector's structure and behaviour, and vice versa.
10. Resource allocation and health financing
This research project investigates how governments can generate more of their own national resources for health and reduce their dependence on donor funding, which can be both unstable and unsustainable. Case studies in Nigeria, South Africa and Kenya, document country experiences of increasing the effectiveness of their tax collection services and investigate how this has contributed to increased health sector spending. Governments in Kenya, Lagos State (Nigeria) and South Africa have increased domestic tax revenue by expanding the tax base and improving the efficiency of tax collection systems. Specific efforts have been made to reach the informal sector by taxing businesses (in Kenya) and reaching informal trade associations (in Nigeria). Political support to tax policy reforms and the tax collection agencies led to additional funding for their operations and strengthened human resource capacity. Despite achievements in raising tax revenue, the share of government spending allocated to the health sector has not increased. A critical challenge for Ministries of Health is to make a better case for health during budget negotiations, and to demonstrate the social and economic benefits of health investments.
This paper argues that there are useful lessons for South Africa (and other countries in putting into place the legal and institutional frameworks system and systems for implementation of universal health coverage (UHC). Thailand has received widespread international recognition as one of several middle-income countries that have made enormous progress in building a UHC system and in achieving ‘good health at low cost. Thailand has a strong national fund called the Universal Coverage (UC) Fund, which covers 75% of its population, the rest being covered by social health insurance and the Civil Servant Medical Benefit Scheme. Thailand has a well-developed purchaser-provider split, with the independent UC Fund established by legislation, with a multi-stakeholder governing body including private and civil society representatives. Its internal structure, operating systems, procedures and information technology are firmly established, accessible and affordable in the middle-income country context. It uses capitation purchasing, with a focus on primary care systems. The National Health Security Office (NHSO), which manages the UC Fund, concentrates on pooling and strategic purchasing; it has no revenue collection function, as the scheme is financed through an annual budget. The NHSO manages the disease prevention and health promotion budget for all Thai citizens, thus assisting the other schemes and providing a strong focus on prevention and promotion. The article discusses these and other positive features and the challenges as learning for South Africa and other countries financing UHC.
The author observes that insufficient, ineffective and inequitable public spending on child-focused sectors and programmes stands as the biggest barrier to enjoyment of rights by all children. To date, only 7 countries in Africa have at some point in time met the Abuja target for African governments to allocate at least 15% of their budgets to health. Furthermore, no African country has so far met the Dakar Commitment on Education for All to allocate at least 7% of its GDP to education, which should have increased to 9% in 2010. In 2014, with the exception of Malawi, Niger and South Africa, who have come close by spending between 5.5-7%, the rest of African states are spending below 5% of their GDP on education, well below the Dakar Commitment. The author asks: What then are some of the concrete actions that African states should undertake to ensure sufficient, equitable, sustainable and effective public investments in children? Domestic revenue from effective and progressive taxation will continue to be the most significant and sustainable source of revenue for states to finance investments in children. He argues that, in line with the overarching SDG focus on ‘leaving no one behind’, African governments should develop and implement fiscal policies and budgets that promote equity. In line with the spirit of SDGs and of the African Charter on the Rights and Welfare of the Child, African states should create formal platforms and opportunities for children and their representatives to meaningfully participate in planning and public budgeting, including to hold duty bearers to account for their commitments to children.
In June 2016, South African Minister of Health Dr Aaron Motsoaledi addressed the media to respond to criticism over the high cost associated with rolling out universal health care in South Africa. “The National Health Insurance (NHI) scheme is the only way to ensure that everyone is not excluded to quality health because of their socio-economic status, ” said Motsoaledi. The NHI White Paper was released last year and plans to reform both public and private health sectors by combining all South Africans into one purchasing pool. The cost of NHI has been estimated to be R256-billion by 2025, which is higher than the current national budget allocation toward healthcare. But according to Motsoaledi, the figure is a projection and could change with the process. Arguing the benefit of pooling resources, he stated that in 2002, the department of health combined all South Africans into one purchasing pool and were able to lower the costs of antiretroviral treatment.
11. Equity and HIV/AIDS
There has been remarkable progress in the response to AIDS since the global HIV community last convened in Durban in 2000. Curbing the spread of HIV was the first step . Accelerating investment and action on a robust human rights and social justice agenda is the next. Despite significant scientific advancements, the authors argue that we continue to encounter structural barriers that impede real world progress. Realising the promise of scientific achievement requires a greater commitment to removing barriers between discovery and implementation. The 21st International AIDS Conference (AIDS 2016) must bring these pieces together – the key scientific advances needed to end the epidemic and the key structural barriers impeding progress – and secure greater political commitment including financial resources to get the job done. They argue that it is key to focus on five key scientific advances; ensuring access to antiretroviral therapy for all people living with HIV, scaling up modern combination HIV prevention packages, treating and managing co-infections and co-morbidities, amplifying research efforts for a vaccine and a cure, optimising implementation research. They argue that there is a need to address five key structural barriers; focusing on key populations within and across various HIV epidemic scenarios, addressing gender inequality and empowering young women and girls, challenging laws, policies and practices that stigmatise and discriminate against people living with HIV and key populations, increasing investment in civil society and community lead responses, and enhancing the capacity of front-line healthcare workers.
From 8 to 10 June 2016, heads and representatives of states and governments, along with other key stakeholders, assembled at the United Nations (UN) in New York, for the High-Level Meeting on Ending AIDS. There are three reasons why this meeting is an important milestone for the global response against human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS). First, the meeting provides an opportunity to reflect on the extent of progress and unprecedented achievements that have been made in responding to the AIDS epidemic, as described in the UN Secretary-General’s report. Second, the meeting served as an occasion to galvanise support from the global community to scale up the AIDS response. The 90–90–90 treatment target calls for 90% of people living with HIV to know their status, 90% of people who know their HIV status to have access to treatment and 90% of people on treatment to achieve suppressed viral loads by 2020. Third, the meeting was an opportunity to reflect on specific challenges that need to be addressed going forward. Among them is a treatment gap and inadequate global investments in prevention. The UNAIDS 2016–2021 Strategy integrated efforts towards ending the AIDS epidemic fully into Transforming our world: the 2030 agenda for sustainable development. The strategy sets out the links between the HIV response and several sustainable development goals (SDGs), from SDG 1 on ending poverty to SDG 16 on promoting inclusive societies.
12. Governance and participation in health
The author argues that the proposed Framework Convention on Global Health (FCGH) could establish a nuanced, layered, and multi-faceted regime of compliance and accountability to the right to health and strengthen accountability for the health-related Sustainable Development Goals (SDGs). If legally binding, he argues that the FCGH could facilitate accountability through the courts and catalyze comprehensive domestic accountability regimes, requiring national strategies that include transparency, community and national accountability and participatory mechanisms, and an enabling environment for social empowerment. A “Right to Health Capacity Fund” could ensure resources for these strategies. Inclusive national processes could establish targets, benchmarks, and indicators consistent with FCGH guidance, with regular reporting to a treaty body, which could also hear individual cases. State reports could be required to include plans to overcome implementation gaps, subjecting the poorest performers to penalties and targeted capacity building measures. Regional special rapporteurs could facilitate compliance through regular country visits and respond to serious violations. And reaching beyond government compliance, from capacity building to the courts and contractual obligations, the author proposes that the FCGH could establish nationally enforceable right to health obligations on the private sector.
Since the World Health Organisation declared Zika a global public health emergency in February of this year, much attention has been brought to bear on applying lessons learned during the Ebola crisis of 2014-15. This blog draws on the lessons for the health communication sector explored through a new practice briefing from BBC Media Action, Using media and communication to respond to public health emergencies - lessons learned from Ebola, and the unique role media and communications can play in effectively tackling Zika. BBC Media Action has responded to 28 humanitarian emergencies since 1994 – including Ebola. One recurring lesson has been that interventions are most effective if the formats and technologies used to communicate give affected communities a chance to participate and have a voice. This ensures that content reflects local realities, needs and concerns. People need to be told more than just what they should or should not do. They need to be engaged in a discussion around the ‘how’ and the ‘why’.
The Learning Network for Health and Human Rights is a network is a collection of 5 civil society organisations (The Women's Circle, Ikamva Labantu, Epilepsy South Africa, The Women on Farms Project and the Cape Metro Health Forum) as well as 4 higher education institutions (UCT, UWC, Maastricht University, in the Netherlands, and Warwick University in the UK). The network collaborates to explore how collective action and reflection can identify best practice with regard to using human rights to advance health issues. The work of the Learning Network seeks to operationalise the right to health as stated in South Africa’s Constitution and other international treaties and agreements. This is accomplished through a programme in which research, training and advocacy are linked to empower organisations and their members to assert rights for health. One of their latest training materials, this video explores the role of Health Committees from different perspectives – from that of a facility manager, a health care provider, health committee members and patients. It aims to enhance understanding of what Health Committees can do, what the challenges are in building effective health committees and how they can strengthen the health system.
13. Monitoring equity and research policy
The potential for academic research institutions to facilitate knowledge exchange and influence evidence-informed decision-making has been gaining ground. Schools of public health (SPHs) may play a key knowledge brokering role—serving as agencies of and for development. Understanding academic-policymaker networks can facilitate the enhancement of links between policymakers and academic faculty at SPHs, as well as assist in identifying academic knowledge brokers (KBs). Using a census approach, the authors administered a sociometric survey to academic faculty across six SPHs in Kenya to construct academic-policymaker networks and identified academic KBs using social network analysis (SNA). Results indicate that each SPH commands a variety of unique as well as overlapping relationships with national ministries in Kenya. Of 124 full-time faculty, they identified 7 KBs in 4 of the 6 SPHs. KBs were also situated in a wide range along a 'connector/betweenness’ measure. The authors propose that SNA is a valuable tool for identifying academic-policymaker networks in Kenya. More efforts to conduct similar network studies would permit SPH leadership to identify existing linkages between faculty and policymakers, shared linkages with other SPHs and gaps so as to contribute to evidence-informed health policies.
This paper draws on the African publishing industry initiative to determine ‘Africa’s 100 Best Books of the 20th Century’, to discuss writing, scholarship and publishing in and on Africa. It argues that it is not enough to publish or read about Africa, just as it is not enough to pass for an African writer or scholar. There is need to problematise what is published and read on Africa, and how sympathetic to Africa culturally, morally and scientifically authors and publications are. The author argues that it is not enough to simply assume Africanness from the fact that a publication is produced by an African, or that 'non-Africans’ cannot competently and positively articulate African causes in ways relevant to ordinary Africans, and poses challenge as one of how to promote commitment to African humanity and creativity without producing a simplistic reductionism or the inflation of belonging in Africa. The paper pursues these considerations, by focusing on how ‘Africans’ and ‘non-Africans’ alike have tended to represent Africa in publications. The author states "Often missing have been perspectives of the silent majorities deprived of the opportunity to tell their own stories their own ways or even to enrich defective accounts by
others of their own life experiences. Correcting this entails paying more attention to the popular epistemologies from which ordinary people draw on a daily basis".... "It also means encouraging ‘a meaningful dialogue’ between these epistemologies and ‘modern science’, both in its old and new forms, as a way of enhancing rather than simply trampling and crushing the past with modern creativity. For publishers to play a part in this rehabilitation, a deliberate effort must be made to privilege people over profit, and to do more than reproduce the rhetoric of equality of humanity and the celebration of creative diversity. So far, publishing Africa for most is much less an
ideological commitment than a commercial option...".
The regime of publication pervades contemporary academic life across countries. The obligation that academic staff must publish is invariably presented as a virtuous thing. It is right and proper for academics to expand and extend the boundaries of their respective disciplines by publishing in outlets, as approved by their peers. Moreover, a public that is often sceptical of the usefulness of universities is often told that academics publish in “the public good”. But, the authors ask, if academic publishing is so significant in the profession, why is it that the young and talented in the academy increasingly resist it, calling it formulaic, at best, and, at worst, a sweatshop? And they ask, why is it that old academic hands are simply no longer interested in contributing to the peer-review system that is at the heart of the system and without which the standing of the entire industry will falter? For one thing, the authors argue, there is a dark side in the ceaseless pressure to publish. Funding agencies use publication records to distribute money or rank scholars and academic managers use the publication record as a means to manage people. For another, the current system privileges the journal over the book, which is argued to be damaging to the humanities. They argue for the need to recognise that “slow scholarship” is as important as it is necessary, and that deep research – especially, but not exclusively in the humanities – requires what strategic theorist Albert Wohlstetter once called a high thought to publication ratio. Research and publishing is the oxygen of academic life, but the authors suggest that the regimes of control that surround contemporary approaches to publishing are choking creativity and, with it, the profession itself.
Hosted by COHRED, the Research Fairness Initiative aims to create a reporting system that encourages governments, business, organisations and funders to describe how they take measures to create trusting, lasting, transparent and effective partnerships in research and innovation. The RFI prioritises its application in global health because there are so many urgent health-related issues, but it can be applied to other settings as well. By providing a guide to high quality reporting on measures and conditions that promote fair research partnerships, the RFI encourages all stakeholders in research and innovation for health to describe what is done within their organisation to promote fair partnerships. Through an extensive global consultative process, the RFI have identified 17 key areas of relevance to effective and lasting partnerships. The RFI acknowledges that successful partnerships often start at personal level but are then continued at institutional or national levels. While mutual admiration, respect and friendship are essential to create the foundation of effective partnerships – it is the institutional and national dimensions of research collaboration that define how, ultimately, benefits are shared.
14. Useful Resources
Scholars at Risk protects scholars suffering grave threats to their lives, liberty and well-being by arranging temporary research and teaching positions at institutions in our network as well as by providing advisory and referral services. In most cases this is a one-semester or one-year position as a visiting scholar, researcher or professor at a higher education institution in a safe location anywhere in the world. SAR provides advisory services for displaced scholars who are struggling to restart their lives and their careers in their new location. Since the Network’s founding in 2000, more than 700 scholars have found sanctuary and hundreds more have benefited from SAR’s advisory and referral services.
The Southern Africa Network for Biosciences (SANBio) is a platform to address and find means to resolve key bioscience concerns in health, nutrition, agriculture and environment in the Southern Africa. SANBio, was established alongside four other networks under the African Biosciences Initiative (ABI), for the SADC region. Thirteen countries of the SADC region are part of the SANBio network, supporting each other to be acknowledged as the biosciences network improves livelihoods in Southern Africa through research and innovation. The platform provides access to world-class laboratories for African and international scientists conducting research on Africa’s biosciences challenges. SANBio’s Mission is pursued through functions for : Research, development and innovation; and increasing capacity (human resources and infrastructure) to strengthen the network.
15. Jobs and Announcements
The Council for the Development of Social Science Research in Africa (CODESRIA) invites applications from suitably qualified senior African scholars for the position of Executive Secretary in its pan-African Secretariat located in Dakar, Senegal. This position, which will fall vacant in 2017, is the most senior management post in the Executive Secretariat and the successful candidate will be expected to function as the leader of the institution and a diverse team of staff under the overall supervision of the Executive Committee of the Council. Established in 1973 as a pioneering, independent, pan-African and not-for-profit organisation for the development of social research in Africa, CODESRIA is today widely recognised as the premier institution on the continent for the generation and dissemination of multidisciplinary research knowledge in the social sciences and humanities. The position of Executive Secretary is a key one both in the development of the programme mandate of the Council and the realisation of the strategic institutional objectives set by the triennial General Assembly of its members. More information can be obtained from the website. CODESRIA policy is to reflect the disciplinary, gender, generational and linguistic diversity of the African social science community in its structures. In this connection, female candidates meeting the required qualifications are especially encouraged to send in their dossiers for consideration for this position.
IOM, through the PHAMESA programme seeks to carry out a study that examines SRH challenges faced by migrants and barriers to access to SRH care services in migration affected communities and migration corridors. In addition, the study should identify gaps in existing SRHR programmes and policies in the selected migration affected communities and migration corridors. The research institution/consortium will lead the research in all selected migration corridors and migration affected communities, and is expected to carry out the following activities: Produce inception report and detailed plan to carry out the study; develop study protocol and data collection tools and translate into local languages as appropriate; conduct detailed desk review including sexual and reproductive health policy analysis at national and regional levels; conduct semi-structured interviews with policy makers, key stakeholders and actors (state and non-state) and migrants at community, national and regional levels; develop a field manual to guide on the data collection process; develop and administer appropriate data collection instruments/tools in line with the study purpose, objectives, study population and the outlined SRHR focus areas and submit a narrative report of findings and recommendations using a format that shall be agreed upon.
Cities & Health aims to provide an innovative new international platform for consolidating research and know-how for city development to support human health. The journal will publish papers and commentary from researchers and practitioners working to build stronger relationships and a better understanding for supporting healthier cities. Unique to the journal, authors are asked to provide a one page lay summary of their papers specifically to illustrate its relevance for the practitioner community and to inform city authorities. A forum of city leaders and practitioners who are already fostering change will be asked to review and comment on these summaries. The journal invites contributions from a broad range of disciplines, including, but not limited to: built environment, including: urban design, planning, architecture, transport, landscape and city governance; public health, including: epidemiology, health economy, public health advocacy and community health; experts in many other relevant fields, such as psychology, human behaviour, geography, environmental resources, cultural studies, communications and the arts. The paper is to be published bi-annually, starting from 2017.
Globalisation has been portrayed to developing countries as a panacea for under development, poverty, inequality and ill health. After two decades, (since the structural adjustment programmes) of operating in a globalised world the Health Sector has increasingly borne the brunt of failed globalisation, increased poverty and inequality through higher investments in health and mitigating against an ever increasing burden of disease. What has become apparent to developing countries is that they need to be very prepared for international meetings and to improve diplomacy and negotiations skills as they participate in these meetings so that they can accrue the most benefits for their citizens and countries. This five day course is offered by the ECSA Health Community and presented by experts on issues especially for the World Health Assembly and trade and Health agenda. For further information and an application form please visit the website.
The IIE-SRF selects outstanding professors, researchers, and public intellectuals for fellowship support and arranges visiting academic positions with partnering institutions of higher learning and research. Their fellowships enable scholars to pursue their academic work in safety and to continue to share their knowledge with students, colleagues, and the community. If conditions in the scholars’ home countries improve, scholars may return after their fellowships to make meaningful contributions to their national academies and civil society. If safe return is not possible, scholars may use the fellowship period to identify longer-term opportunities.
International Council for Science, together with Network of African Science Academies and the International Social Science Council, will support 10 research projects across Africa. These projects are expected to generate new solutions-oriented knowledge that will help develop new urban paradigms in Africa and make African cities more resilient, adaptable and healthier. This is the first call in a five-year, 5 million EUR project that seeks to increase the production of high quality, integrated (inter- and transdisciplinary), solutions-oriented research on global sustainability by early career scientists in Africa. With the impending adoption of the New Urban Agenda at the Habitat III conference in Quito, Ecuador, later this year, it is imperative to ensure that science can effectively contribute to the implementation of this Agenda. The International Council for Science (ICSU), in partnership with the Network of African Science Academies (NASAC) and the International Social Science Council (ISSC) will support research projects across Africa to the value of up to 90,000 Euro each over two years. The call is part of the 5-year “Leading Integrated Research for Agenda 2030 in Africa” programme funded by the Swedish International Development Cooperation Agency. The goal of the call is to better understand inter-relationships between energy systems, air pollution, health impacts and provision of health services, climate adaptation opportunities, land use and urban planning, and disaster risk reduction in the urban environment in Africa. The call for pre-proposals aims to identify collaborative research projects in Africa interested to explore inter-relationships across at least two domains of the nexus and that clearly indicate the inter- and trans-disciplinary nature of the research project. Successful applicants will be invited to join a training workshop on integrated research in Nairobi, Kenya, on 3-7 October 2016. Applicants should have no more than 10 years work experience following their PhDs or equivalent research experience.
In January 2005, James P Grant School of Public Health initiated its flagship Master of Public Health (MPH) programme with the aim of developing public health leaders. As of now 395 students from 26 countries including South Asia, Southeast Asia, Africa, Australia, North and South Americas, and Europe have graduated from this programme. The MPH curriculum is designed on experiential learning around the health problems faced by communities in rural and urban areas. This includes extensive field-based instructions complemented by innovative pedagogic approaches such as case study and collaborative project based learning. In 2015 JPGSPH has been selected as one of the global seven educational institutes to implement WHO TDR Postgraduate International Training on Implementation Research through MPH Programme. The next MPH batch will start in the last week of January, 2017.
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