EQUINET NEWSLETTER 190 : 01 January 2017

1. Editorial

Wishing you progress towards health and justice in 2017
EQUINET steering committee

As usual this is a short newsletter, given the time of year. Our newsletter is now on its 190th issue and we appreciate the range of creative work reported in all the 16 years of its existence. The 245 editorials written by a range of people from community, civil society, parliament, government, technical and research institutions provide comment and reflection on a diversity of health issues and debates. The over 11000 entries in the 190 newsletters all available in a searchable database on the EQUINET website carry a wide range of ideas, experiences, evidence, analysis and voice from and on east and southern Africa. The newsletter database is a rich searchable resource of how policy and publication focus has shifted over nearly two decades and of whether writing on the region is increasingly being led from the region.

We continue to encourage you to document your work and to send us send your blogs, and links to your reports, papers, news, conference announcements, videos or other forms of information so the newsletter can assist to share experience, evidence and learning from work on health equity in the region. As we said last year, 'Until the lions write their story, tales of the hunt will always glorify the hunter'. We encourage you to roar even louder in 2017!

Please send your blogs, and links to your reports, papers, news, conference announcements, videos or other forms of information from your work on health in the region, and we will be happy to share it.

We look forward to working with you in the coming year and wish you a healthy 2017, and a thoughtful, steady and exuberant progress in our struggles for health equity. .

2. Equity in Health

Inequalities in full immunization coverage: trends in low- and middle-income countries
Restrepo-Méndez M; Barros A; Wong K; et al.: Bulletin of the World Health Organisation 94(11) 2016,

This study investigated disparities in full immunisation coverage across and within 86 low- and middle-income countries. In May 2015, using data from the most recent Demographic and Health Surveys and Multiple Indicator Cluster Surveys, the authors investigated inequalities in full immunisation coverage – i.e. one dose of bacille Calmette-Guérin vaccine, one dose of measles vaccine, three doses of vaccine against diphtheria, pertussis and tetanus and three doses of polio vaccine – in 86 low- or middle-income countries. The authors then investigated temporal trends in the level and inequality of such coverage in eight of the countries. In each of the World Health Organisation’s regions, it appeared that about 56–69% of eligible children in the low- and middle-income countries had received full immunisation. However, within each region, the mean recorded level of such coverage varied greatly. In the African Region, for example, it varied from 11.4% in Chad to 90.3% in Rwanda. The authors detected pro-rich inequality in such coverage in 45 of the 83 countries for which the relevant data were available and pro-urban inequality in 35 of the 86 study countries. Among the countries in which the authors investigated coverage trends, Madagascar and Mozambique appeared to have made the greatest progress in improving levels of full immunisation coverage over the last two decades, particularly among the poorest quintiles of their populations. Most low- and middle-income countries are affected by pro-rich and pro-urban inequalities in full immunisation coverage that are not apparent when only national mean values of such coverage are reported.

World AIDS Day: Lessons for reversing inequality
Goldring M: Oxfam UK, Global Health Check, December 2016

On World AIDS Day 2016 Mark Goldring Oxfam UK Executive Director reflected on what we have learnt from working to address the inequality challenges of the HIV epidemic. He focuses on 4 lessons. First, that inequality kills. Millions have died because they were too poor to pay the exorbitant prices of medicines and hospital fees. Investing in public health systems to offer free service as the point of use and in affordable medicines are essential to save lives and tackle inequality – both health and economic inequality. The second lesson is that inequality in accessing health services needs to be addressed, especially by overcoming impoverishing costs of care, with women bearing the brunt of this burden. ِِِِThe third less is that access to HIV treatment could not happen without securing adequate financing. The final lesson is that active citizenship – people’s involvement in decision making - is at the heart of the success in the response to HIV and in applying the lessons on addressing inequality.

3. Values, Policies and Rights

Interpreting the International Right to Health in a Human Rights-Based Approach to Health
Hunt P: Health and Human Rights Journal, December 2016

This article tracks the shifting place of the international right to health, and human rights-based approaches to health, in the scholarly literature and United Nations (UN). From 1993 to 1994, the focus began to move from the right to health toward human rights-based approaches to health, including human rights guidance adopted by UN agencies in relation to specific health issues. There is a compelling case for a human rights-based approach to health, but it runs the risk of playing down the right to health, as evidenced by an examination of some UN human rights guidance. The right to health has important and distinctive qualities that are not provided by other rights—consequently, playing down the right to health can diminish rights-based approaches to health, as well as the right to health itself. Because general comments, the reports of UN Special Rapporteurs, and UN agencies’ guidance are exercises in interpretation, the author discusses methods of legal interpretation. The author suggests that the International Covenant on Economic, Social and Cultural Rights permits distinctive interpretative methods within the boundaries established by the Vienna Convention on the Law of Treaties. The author calls for the right to health to be placed explicitly at the centre of a rights-based approach and interpreted in accordance with public international law and international human rights law.

Litigating the Right to Health in Africa: Challenges and Prospects
Durojaye E: Routledge, 2015

Health rights litigation is still an emerging phenomenon in Africa, despite the constitutions of many African countries having provisions to advance the right to health. Litigation can provide a powerful tool not only to hold governments accountable for failure to realise the right to health, but also to empower the people to seek redress for the violation of this essential right. With contributions from activists and scholars across Africa, the collection includes a diverse range of case studies throughout the region, demonstrating that even in jurisdictions where the right to health has not been explicitly guaranteed, attempts have been made to litigate on this right. The collection focuses on understanding the legal framework for the recognition of the right to health, the challenges people encounter in litigating health rights issues and prospects of litigating future health rights cases in Africa. The book also takes a comparative approach to litigating the right to health before regional human rights bodies. This book will be valuable reading to scholars, researchers, policymakers, activists and students interested in the right to health.

Uhuru HIV List declared unconstitutional
KELIN: KELIN news, Kenya, December 7 2016

The High Court in Nairobi has on 7 December 2016 declared unconstitutional a presidential directive seeking to collect names of people living with HIV, including names of school going children among others. The court declared that the directive issued by H.E Uhuru Kenyatta on 23 February 2015 is in breach of the petitioner’s constitutional rights under Articles 31 and 53(2) which safeguard the right to privacy and best interest of the child respectively. The court further declared that the actions and omissions of the respondents in relation to the directive violated fundamental rights and freedoms of the petitioners. The case was filed by KELIN, Children of God Relief Institute (Nyumbani), James Njenga Kamau and Millicent Kipsang challenging the directive in court on the grounds that it was a breach to the right to privacy and confidentiality and was likely to expose persons living with HIV to stigma and discrimination, among other human rights violations.

Universal Health Coverage Data Portal: Supporting the Universal Health Coverage Coalition
World Health Organisation: Geneva, December 2016

To mark Universal Health Coverage Day, WHO launched a new data portal to track progress towards universal health coverage (UHC) around the world. The portal shows where countries need to improve access to services, and where they need to improve information. The portal features the latest data on access to health services globally and in each of WHO’s 194 Member States, along with information about equity of access. In 2017, WHO will add data on the impact that paying for health services has on household finances. The portal shows that less than half of children with suspected pneumonia in low income countries are taken to an appropriate health provider. Of the estimated 10.4 million new cases of tuberculosis in 2015, 6.1 million were detected and officially notified in 2015, leaving a gap of 4.3 million. High blood pressure affects 1.13 billion people. About 44% of WHO’s member states report having less than 1 physician per 1000 population. The African Region suffers almost 25% of the global burden of disease but has only 3% of the world’s health workers.

4. Health equity in economic and trade policies

WHO recommends tax on sugary drinks
Cullinan K: Health E-News, October 2016

The World Health Organisation (WHO) in October 2016 recommended that governments should tax sugary drinks as part of the global campaign against obesity, type 2 diabetes and tooth decay. South Africa’s Treasury plans to introduce a tax on sugary drinks in April 2017, while Ireland announced it would also introduce a sugary drinks tax in 2018. “Consumption of free sugars, including products like sugary drinks, is a major factor in the global increase of people suffering from obesity and diabetes,” said Dr Douglas Bettcher, Director of WHO’s Department for the Prevention of non-communicable diseases (NCDs). “If governments tax products like sugary drinks, they can reduce suffering and save lives. They can also cut healthcare costs and increase revenues to invest in health services.” Taxes that result in a 20% increase or more in the retail price of sugary drinks would result in proportional reductions in consumption of such products, according to the WHO report, “Fiscal policies for Diet and Prevention of Noncommunicable Diseases (NCDs)”. Obesity has more than doubled between 1980 and 2014. By 2014, almost 40% of adults worldwide were overweight, with 15% of women and 11% of men obese. Meanwhile, diabetes has almost quadrupled since 1980, rising from 108 million in 1980 to 422 million in 2014. In 2012, 38 million people lost their lives due to NCDs, 16 million or 42% of whom died prematurely – before 70 years – from largely avoidable conditions. More than 80% of people who died prematurely from a NCD were in developing countries. Governments have committed to reduce deaths from NCDs, and the 2030 Sustainable Development Agenda includes a target to reduce premature deaths from diabetes, cancers, heart, and lung diseases by one-third by 2030.

5. Poverty and health

Indigenous Sengwer minority in Kenya oppose EU-funded project
Sengwer Community Leaders: Pambuzuka News, November 2016

This article outlines the Sengwer Community Leaders position that a water towers project in their area is being implemented without free, prior and informed consent of the community. As a forest community, who have been subject to part evictions, there is fear of more violations under the current project. For instance, during Natural Resources Management Project, a World Bank funded project (2007-2013), Sengwer peoples living in Kapolet and Embobut forests had some community members arrested and taken to police custody and accused of trespass while they were within their ancestral, community land. They report further than a woman was shot by KFS guards in the same Kapolet Forest. In Embobut Forest, the Sengwer write that there have been arrests and evictions (burning of houses and destruction of property). Today, they say that the Sengwer are forced to live in caves, thick inside the forest...as aliens in their own ancestral lands and territory, despite the stipulation of Art. 63 (2) (d) ii of the Constitution of Kenya. This forced some members of the community to file a complaint with the World Bank Inspection Panel which went into full investigation. The authors call on the European Union to suspend the Water Towers Protection and Climate Change Mitigation and Adaptation Programme with immediate effect, carry out adequate, effective and efficient free prior and informed consent (FPIC) with members of Sengwer and let the community make decision after proper understanding of the Water Towers programme. The Singer fully support conservation programmes and projects that recognise, respect, protect and promote their rights as traditional forest indigenous peoples (hunters and gatherers) to live in and own their ancestral lands and territories their community land in forest/protected area sustainably on conservation conditions working closely with state agencies.

Integrated agriculture programs to address malnutrition in northern Malawi
Kerr R; Chilanga E; Nyantakyi-Frimpong H; Luginaah I; Lupafya E: BMC Public Health 16(1197), 2016

In countries where the majority of undernourished people are smallholder farmers, there has been interest in agricultural interventions to improve nutritional outcomes. Addressing gender inequality, however, is a key mechanism by which agriculture can improve nutrition, since women often play a crucial role in farming, food processing and child care, but have limited decision-making and control over agricultural resources. This study examines the approaches by which gender equity in agrarian, resource-poor settings can be improved using a case study in Malawi. A quasi-experimental design with qualitative methods was used to examine the effects of a participatory intervention on gender relations. Thirty married couple households in 19 villages with children under the age of 5 years were interviewed before and then after the intervention. An additional 7 interviews were conducted with key informants, and participant observation was carried out before, during the intervention and afterwards in the communities. The interviews were recorded and transcribed, and analysed qualitatively for key themes, concepts and contradictions. Several barriers were identified that undermine the quality of child care practices, many linked to gender constructions and norms. The dominant concepts of masculinity created shame and embarrassment if men deviated from these norms, by cooking or caring for their children. The study provided evidence that participatory education supported new masculinities through public performances that encouraged men to take on these new roles. Invoking men’s family responsibilities, encouraging new social norms alongside providing new information about different healthy recipes were all pathways by which men developed new ‘emergent’ masculinities in which they were more involved in cooking and child care. The transformational approach, intergenerational and intra-gendered events, a focus on agriculture and food security, alongside involving male leaders were some of the reasons that respondents named for changed gender norms. Participatory education that explicitly addresses hegemonic masculinities related to child nutrition, such as women’s roles in child care, can begin to change dominant gender norms. Involving male leaders, participatory methods and integrating agriculture and food security concerns with nutrition appear to be key components in the context of agrarian communities.

6. Equitable health services

Much shorter TB treatment offers hope
Green A: Health E-News, November 2016

There is hope for people living with multi-drug resistant tuberculosis (MDR-TB) as the “gruelling” two-year treatment with “terrible side-effects” such as deafness can now be successfully shortened to just nine months. A team of TB experts at the International Union Against Tuberculosis and Lung Disease has announced the final results of the Francophone study which evaluated the efficacy of a shorter MDR-TB treatment regimen in nine African countries. Three quarters of people in the study were cured with the new nine-month regimen. Of the patients who successfully completed the treatment – the cure rate was almost 90 percent. Only half of patients taking the older regimen can expect to be cured even after taking drugs for over 20 months. Just completing this course, whether it cures one or not, is a feat of sheer determination, according to TB advocates speaking at the 47th Union World Conference on Lung Health. The study was conducted among 1006 people with MDR-TB in Benin, Burkina Faso, Burundi, Cameroon, Central African Republic, Côte d’Ivoire, Democratic Republic of the Congo, Niger and Rwanda. Based on the preliminary results of this study, in May this year the World Health Organisation (WHO) officially recommended this regimen for MDR-TB patients who have not taken treatment before and who are not resistant to the drugs contained in this regimen. These final results are expected to give countries the data needed to start rolling out the regimen to all eligible patients.

7. Human Resources

eSIP-Saúde: Mozambique’s novel approach for a sustainable human resources for health information system
Waters K; Mazivila M; Dgedge M; Necochea E; Manharlal D; Zuber A; de Faria Leão B; Bossemeyer D; Vergara A: Human Resources for Health 14(66), 2016

Over the past decade, governments and international partners have responded to calls for health workforce data with ambitious investments in human resources information systems (HRIS). However, documentation of country experiences in the use of HRIS to improve strategic planning and management has been lacking. This case presentation documents for the first time Mozambique’s novel approach to HRIS, sharing key success factors and contributing to the scant global knowledge base on HRIS. Core components of the system are a Government of Mozambique (GOM) registry covering all workers in the GOM payroll and a “health extension” which adds health-sector-specific data to the GOM registry. Separate databases for pre-service and in-service training are integrated through a business intelligence tool. The first aim of the HRIS was to identify the following: who and where are Mozambique’s health workers? As of July 2015, 95 % of countrywide health workforce deployment information was populated in the HRIS, allowing the identification of health professionals’ physical working location and their pay point. HRIS data are also used to quantify chronic issues affecting the Ministry of Health (MOH) health workforce. Examples include the following: HRIS information was used to examine the deployment of nurses trained in antiretroviral therapy (ART) vis-à-vis the health facilities where ART is being provided. Such results help the MOH align specialized skill sets with service provision. Twenty-five percent of the MOH health workforce had passed the 2-year probation period but had not been updated in the MOH information systems. For future monitoring of employee status, the MOH established a system of alerts in semi-monthly reports. As of August 2014, 1046 health workers were receiving their full salary but no longer working at the facilities. The MOH is now analysing this situation to improve the retirement process and coordination with Social Security. The Mozambican system is an important example of an HRIS built on a local platform with local staff. Notable models of strategic data use demonstrate that the system is empowering the MOH to improve health services delivery, health workforce allocation, and management. Combined with committed country leadership and ownership of the program, this suggests strong chances of sustainability and real impact on public health equity and quality.

8. Public-Private Mix

An assessment of private General Practitioners contracting for public health services delivery in O.R. Tambo District, South Africa
Hongoro C; Funani I; Chitha W; Godlimpi L: Journal of Public Health in Africa 6(2) doi: http://dx.doi.org/10.4081/jphia.2015.525

Low- and middle-income countries are striving towards universal health coverage in a variety of ways. Achieving this goal requires the participation of both public and the private sector providers. The study sought to assess existing capacity for independent general practitioner contracting in primary care, the reasons for the low uptake of government national contract and the expectations of general practitioners of such contractual arrangements. This was a case study conducted in a rural district of South Africa. The study employed both quantitative and qualitative data collection methods. Data were collected using a general practitioner and practice profiling tool, and a structured questionnaire. A total of 42 general practitioners were interviewed and their practices profiled. Contrary to observed low uptake of the national general practitioner contract, 90% of private doctors who had not yet subscribed to it were actually interested in it. Substantial evidence indicated that private doctors had the capacity to deliver quality care to public patients. However, low uptake of national contract related mostly to lack of effective communication and consultation between them and national government which created mistrust and apprehension amongst local private doctors. Paradoxically, these general practitioners expressed satisfaction with other existing state contracts. An analysis of the national contract showed that there were likely to benefit more from it given the relatively higher payment rates and the guaranteed nature of this income. Proposed key requisites to enhanced uptake of the national contract related to the type of the contract, payment arrangements and flexibility of the work regime, and prospects for continuous training and clinical improvements. Low uptake of the national General Practitioner contract was due to variety of factors related to lack of understanding of contract details. Such misunderstandings between potential contracting parties created mistrust and apprehension, which are fundamental antitheses of any effective contractual arrangement. The authors suggest that the idea of a one-size-fits-all contract was probably inappropriate.

9. Resource allocation and health financing

The effects of Maternal and Child Health insurance cards on improving equity in access and use of maternal and child health care services in Tanzania: a mixed methods analysis.
Kuwawenaruwa A; Mtei G; Baraka J; Tani K: Journal of Health, Population and Nutrition 35(37), 2016

Inequity in access and use of child and maternal health services is impeding progress towards reduction of maternal mortality in low-income countries. To address low usage of maternal and newborn health care services as well as financial protection of families, some countries have adopted demand-side financing. In 2010, Tanzania introduced free health insurance cards to pregnant women and their families to influence access, use, and provision of health services. However, little is known about whether the use of the maternal and child health cards improved equity in access and use of maternal and child health care services. A mixed methods approach was used in Rungwe district where maternal and child health insurance cards had been implemented. To assess equity, three categories of beneficiaries’ education levels were used and were compared to that of women of reproductive age in the region from previous surveys. To explore factors influencing women’s decisions on delivery site and use of the maternal and child health insurance card and attitudes towards the birth experience itself, a qualitative assessment was conducted at representative facilities at the district, ward, facility, and community level. A total of 31 in-depth interviews were conducted on women who delivered during the previous year and other key informants. Women with low educational attainment were under-represented amongst those who reported having received the maternal and child health insurance card and used it for facility delivery. Qualitative findings revealed that problems during the current pregnancy served as both a motivator and a barrier for choosing a facility-based delivery. Decision about delivery site was also influenced by having experienced or witnessed problems during previous birth delivery and by other individual, financial, and health system factors, including fines levied on women who delivered at home. To improve equity in access to facility-based delivery care using strategies such as maternal and child health insurance cards it is necessary to ensure beneficiaries and other stakeholders are well informed of the programme, as only giving women insurance cards does not guarantee their access to facility-based delivery.

10. Equity and HIV/AIDS

Community-Based ART Programs: Sustaining Adherence and Follow-up
Mukherjee W; Barry D; Weatherford R; Desai I; Farmer P: Current HIV/AIDS Reports 13(6) 359–366, 2016

The advent of antiretroviral therapy (ART) in 1996 brought with it an urgent need to develop models of health care delivery that could enable its effective and equitable delivery, especially to patients living in poverty. Community-based care, which stretches from patient homes and communities—where chronic infectious diseases are often best managed—to modern health centres and hospitals, offers such a model, providing access to proximate HIV care and minimising structural barriers to retention. In this paper the authors first review the recent literature on community-based ART programs in low- and low-to-middle-income country settings and document two key principles that guide effective programs: decentralisation of ART services and long-term retention of patients in care. They then discuss the evolution of the community-based programs of Partners In Health (PIH), a nongovernmental organisation committed to providing a preferential option for the poor in health care, in Haiti and several countries in sub-Saharan Africa, Latin America, Russia and Kazakhstan. As one of the first organisations to treat patients with HIV in low-income settings and a pioneer of the community-based approach to ART delivery, PIH has achieved both decentralisation and retention through the application of an accompaniment model that engages community health workers in the delivery of medicines, the provision of social support and education, and the linkage between communities and clinics. The authors conclude that PIH has leveraged its HIV care delivery platforms to simultaneously strengthen health systems and address the broader burden of disease in the places in which it works.

HIV vaccine test hopes for breakthrough in combat against the virus
Boseley S: The Guardian, 27 November 2016

The first new trial of a potential vaccine against HIV in seven years has begun in South Africa, raising hopes that it will help bring about the end of the epidemic. Although fewer people are now dying from Aids because 18.2 million are on drug treatment for life to suppress the virus, efforts to prevent people from becoming infected have not been very successful. The infection rate has continued to rise and experts do not believe the epidemic will be ended without a vaccine. The vaccine being tested is a modified version of the only one to have shown a positive effect, out of many that have gone into trials. Seven years ago, the vaccine known as RV144 showed a modest benefit of about 31% in a trial in Thailand. The aspiration is to push the effectiveness up from 31% to between 50% and 60% for use in combination with other prevention tools, such as condoms, antiretroviral drugs and circumcision. According to Professor Linda-Gail Bekker, of the University of Cape Town, “We’ve never treated our way out of an epidemic. There’s no doubt we have to have primary prevention alongside treatment in order to get HIV control, but we are not going to get HIV eradication without a vaccine. That is very clear.”

11. Governance and participation in health

Building the capacity of policy-makers and planners to strengthen mental health systems in low- and middle-income countries: a systematic review
Keynejad R; Semrau M; Toynbee M; et al.: BMC Health Services Research 16(601), 2016

Little is known about the interventions required to build the capacity of mental health policy-makers and planners in low- and middle-income countries (LMICs). The authors conducted a systematic review with the primary aim of identifying and synthesising the evidence base for building the capacity of policy-makers and planners to strengthen mental health systems in LMICs. The authors searched MEDLINE, Embase, PsycINFO, Web of Knowledge, Web of Science, Scopus, CINAHL, LILACS, ScieELO, Google Scholar and Cochrane databases for studies reporting evidence, experience or evaluation of capacity-building of policy-makers, service planners or managers in mental health system strengthening in LMICs. Reports in English, Spanish, Portuguese, French or German were included. Additional papers were identified by hand-searching references and contacting experts and key informants. Database searches yielded 2922 abstracts and 28 additional papers were identified. Following screening, 409 full papers were reviewed, of which 14 fulfilled inclusion criteria for the review. Data were extracted from all included papers and synthesised into a narrative review. Only a small number of mental health system-related capacity-building interventions for policy-makers and planners in LMICs were described. Most models of capacity-building combined brief training with longer term mentorship, dialogue and/or the establishment of networks of support. However, rigorous research and evaluation methods were largely absent, with studies being of low quality, limiting the potential to separate mental health system strengthening outcomes from the effects of associated contextual factors. This review demonstrates the need for partnership approaches to building the capacity of mental health policy-makers and planners in LMICs, assessed rigorously against pre-specified conceptual frameworks and hypotheses, utilising longitudinal evaluation and mixed quantitative and qualitative approaches.

Civil society petition to Kenyatta for decisive action against corruption
Kenya Civil Society: Pambuzuka News, November 2016

After a series of multi-million-dollar scandals recently unearthed in Kenya, the Auditor General’s report for 2015 says only 1% of the national budget was properly accounted for. In this letter, civil society organisations (CSOs) in Kenya express deep concern and consternation for the worrying escalation of corruption scandals in Kenya in the recent past with little or no consequences for perpetrators, many of whom are reported by the author to have been heavily mentioned in a series of scandals and continue to unashamedly occupy, and therefore bring dishonour, to public office. The CSOs rebuke what they cite as the culture of impunity that continues owing to an apparent lack of political will to address corruption. They make 14 demands to the president and government including the immediate sacking of state and public officers within the Executive adversely mentioned in corruption scandals, initiating legal process of freezing of bank accounts of all those implicated in grand corruption scandals pending investigations, instantaneously stopping and recovering salaries paid illegally to officers who have been suspended or removed from public service on graft allegations

12. Monitoring equity and research policy

Making health systems research work: time to shift funding to locally-led research in the South
Hasnida A; Borst R; Johnson A; Rahmani N; van Esland S; Kok M: The Lancet Global Health, 2016, doi: http://dx.doi.org/10.1016/S2214-109X(16)30331-X

In November 2016, the global health systems research community gathered in Vancouver, Canada, for the Fourth Global Symposium on Health Systems Research. The current movement for health systems research developed out of a need to strengthen health systems in low-income and middle-income countries. More than 25 years ago, the Commission on Health Research for Development published a report that represented a pivotal change in thinking about health research for development. The main argument of the report was that research contributed little to health in low-income and middle-income countries, because it matched poorly with needs in the global South, was dominated by researchers from the North, and had a narrow biomedical focus. While health systems research has taken off in some high-income countries, progress in low-income and middle-income countries has not kept up. The 2008 Global Ministerial Forum on Research for Health in Bamako, Mali, concluded with the recommendation to increase investments in health systems research and organise a global symposium specifically focused on improving health systems in low-income and middle-income countries. Since then, the field has expanded rapidly. To contribute to the debate concerning the status and future of the health systems research field, the authors assessed the research presented at the previous global symposia. They systematically analysed the 1816 abstracts that were presented at the global symposia in Beijing (2012) and Cape Town (2014) and the participant lists of the Cape Town, Beijing, and Montreux (2010) symposia. The findings present several promising developments but also highlight that research inequities persist. While the authors observe a gender balance (51% of first authors are female) and substantial contributions from countries such as India, China, and South Africa, the North-South imbalance that was described 26 years ago remains.

13. Useful Resources

Maternity waiting homes in Namibia: Hope for the future
World Health Organisation Afro: Namibia, 2015

This documentary “Maternity waiting homes in Namibia: Hope for the future” focuses on one of the core components of PARMaCM, the importance of keeping pregnant women and young mothers safe via the construction of maternity waiting homes in Namibia. PARMaCM stands for “The Programme for Accelerating the Reduction of Maternal and Child Mortality” and its objective is to accelerate the achievement of MDGs 4 and 5 of reducing child mortality and improving maternal health in Namibia. The movie is the product of concerted efforts of the Namibian TV Production Company Quiet Storm and the three PARMaCM stakeholders, the Ministry of Health and Social Services (MoHSS), the European Union (EU) and the World Health Organization (WHO). It explores why maternal health statistics are not higher given the income and service levels and how these challenges are being addressed.

Orange the World: Raise Money to End Violence against Women and Girls in support of the 16 Days of Activism against Gender Based Violence
UNITE: UN Secretary General's campaign to end Violence against women, December 2016

This document is a resource to support resource mobilization efforts for the ‘Orange the World: Raise Money to End Violence against Women and Girls’ initiative. It provides background information on the UNiTE campaign, the 2016 campaign theme and gives tips and advice on how to make the most of your fundraising activities. All funds raised aim to support UN Women’s Flagship Programmes on ending violence against women – “Prevention and Essential Services,” “Safe Cities and Safe Public Space” and the UN Trust Fund to End Violence against Women- that challenge harmful norms and practices to break the vicious cycle of violence and expand the provision of services and access to safety for survivors of violence to enable them to speak out and rebuild their lives.

14. Jobs and Announcements

Alliance for Health Policy and Systems Research Essay Competition
Deadline for submissions: 31 January 2017

The Alliance for Health Policy Systems Research (AHPSR) is pleased to announce its first ever essay competition on the future of health policy and systems research. The winning paper will be published as a background paper for a high level conference on “Health Policy and Systems Research: 20 years on” that will take place in Stockholm Sweden, in April 2017. In addition, a cash prize of USD $7,500 will be awarded to the authors of the winning paper. Prizes of USD $2,500 and USD $1,000 will be awarded to the authors of the 2nd and 3rd place papers. Much has changed in the 20 years since the WHO Ad-Hoc Committee on Health Research highlighted the need to strengthen Health Policy and Systems Research which was followed by an international consultation in Lejondal, Sweden in 1997 that led to the establishment of the AHPSR. Today as the world transitions from the MDGs to the SDGs, and in light of recent crises resulting from outbreaks, disasters, and conflicts, the need for health policy and systems research in ensuring resilient health systems and improving health is increasingly recognised. How the field can continue to evolve to respond to these and other needs, as well as the role that international entities can play in shaping this evolution, is the topic to be addressed by this essay. In no more than 5000 words, essays – written in English, should reflect on the role and contributions of Health Policy and Systems Research in strengthening health systems and future challenges in the context of Agenda 2030; identify strategies and innovative approaches to ensure the greater use of health policy and systems research by relevant actors and stakeholders; and explore opportunities to further strengthen the position and role of the AHPSR in advancing the field.

MSF Southern Africa: Learning Unit Administration and Resources Officer
Closing date: Tuesday, 10 January, 2017

Doctors without Borders (MSF) is an international, independent, medical humanitarian organisation committed to two objectives: providing medical assistance to people affected by armed conflict, epidemics, healthcare exclusion, natural and man-made disasters; and speaking out about the plight of the populations assisted. MSF offers assistance to people based only on need and irrespective of race, religion, gender or political affiliation. The learning activities of MSF's Southern African Medical Unit (SAMU) have substantially increased in the past 3 years as the demand for learning opportunities as increased in the many projects that SAMU supports. These activities in turn support the requirements of staff that they contribute to achieving operational objectives of MSF mission/projects. The MSF SAMU learning unit’s purpose is to ensure that MSF field projects, HQs and all MSF partners have access to quality learning opportunities in HIV/TB, both programmatically and clinically. Although learning opportunities are often seen as the provision of trainings, they also include managing and making available a range of medical resources such as guidelines, reports, toolkits and journal articles. One of the most important media for this is the SAMU website. The post requires a candidate with a tertiary qualification, a Diploma in Public Relations, Office Management or similar, 5 Years work experience with two years in similar post and experience in organisation and/or coordination of meetings and trainings.

Urgent Action Fund-Africa Communications & Knowledge Management Programme Officer
Vacancy open until filled

Urgent Action Fund-Africa (UAF-Africa), registered in Nairobi, Kenya. UAF-Africa seeks a Communications & Knowledge Management Programme Officer who will translate UAF-Africa’s strategic plans into effective social justice initiatives and results. Guided by feminist principles and values, the Fund advocates for gender equality, not only as a matter of human rights, but also as a fundamental prerequisite for social change, global security, and sustainable peace. In addition to her core business of Rapid Response Grant making, UAF-Africa also runs alliance building and advocacy initiatives in collaboration with other national, regional and international social justice organisations.

Urgent Action Fund-Africa Partnerships & Development Manager
Vacancy open until filled

Urgent Action Fund-Africa (UAF-Africa), is a consciously feminist and women’s human rights pan- African Fund, registered in Nairobi, Kenya. UAF-Africa seeks a Partnerships & Development Manager who will translate UAF-Africa’s strategic plans into effective social justice initiatives and results. Guided by feminist principles and values, the Fund advocates for women’s equality, not only as a matter of human rights, but also as a fundamental prerequisite for social change, global security, and sustainable peace. In addition to her core business of Rapid Response Grant making, UAF-Africa also runs alliance building and advocacy initiatives in collaboration with other social justice organisations.


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