Universal provision of antiretroviral therapy (ART), while feasible, is expensive. In light of this limitation, the World Health Organisation (WHO) has launched the 3 × 5 initiative, to provide ART to 3 million people by the end of the year 2005. In Southern Africa, large-scale provision of ART will likely be achieved through fragile public health systems. ART programmes should therefore be developed and expanded in ways that will not aggravate inequities or result in the inappropriate withdrawal of resources from other health interventions or from other parts of the health system. This paper, proposes a framework for monitoring equity in access and health systems issues in ART programmes in Southern Africa. It proposes that an equity monitoring system should comprise seven thematic areas. These thematic areas encompass a national monitoring system which extends beyond one agency or single data collection method. Together with monitoring of targets in terms of numbers treated, there should also be monitoring of health systems impacts and issues in ART expansion, with reporting both nationally and to a regional body.
Monitoring equity and research policy
Research bringing intimate knowledge of clients and their care in HIV/AIDS clinics, and of the bureacracy, politics and needs of national and international health government – is making Liverpool VCT and Care a scientific force to be reckoned with, Nduku Kilonzo explains. Kilonzo’s speciality is gaining evidence on the role of gender and rape in the AIDS pandemic – and even more powerfully, changing health policy and actions in response to her results. But how do she and Liverpool VCT do it? This interview demonstrates how her various strategies have allowed this public-private partnership to bear fruit.
In preparation for the forthcoming Ministerial Forum on Health Research, to be held in Bamako, Mali in November 2008, more than 40 researchers from 28 countries, both in the South and the North, who have a particular interest in health policy and systems research (HPSR) and the application of evidence to health policy, gathered in Nyon, Switzerland on 25-27th May to: critically assess developments in HPSR in low and middle income countries and its application to policy since the Mexico Summit, 2004; highlight current gaps, priorities and challenges in the HPSR field that need to be addressed; and discuss and agree how best to move forward the HPSR field. Meeting participants reviewed evidence about the evolution of the HPSR field and debated emerging needs, with a view to informing discussions at Bamako, and further action by the institutions sponsoring and participating in the meeting, as well as by other key stakeholders including national governments, researchers, research and development funders.
This is the final statement of a meeting held in Nyon, Switzerland, 25–27 May 2008 between the Alliance for Health Policy and Systems Research, WHO and the International Development Research Centre, Canada. Considerable progress has been made in established health policy and systems research (HPSR) areas such as health financing, worker relations and the role of the non-state sector, though achievements in these areas vary substantially. In some, such as health financing, a large number of studies and recent reviews have began to synthesise findings; in others, such as HRH, relatively limited empirical work has been conducted and there is a need to intensify research efforts. There is an urgent need to move from research that is descriptive and identifies problems, to research that is action oriented and helps develop and evaluate potential solutions. Stronger links among researchers, policy makers and research and development funders are required to facilitate this. Despite interesting work in the field, HPSR continues to be perceived as the poor relation to more basic health sciences research. More must be done to highlight the positive contributions that HPSR can make to the big health issues of our time.
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 2014 Report, Fulfilling the Health Agenda for Women and Children, was released exactly 18 months to the day from the deadline for the Millennium Development Goals at the end of 2015. Like previous Countdown reports, it includes an updated, detailed profile for each of the 75 Countdown countries, which together account for more than 95% of the global burden of maternal, newborn and child death. The report shows that progress has been impressive in some areas, but it also highlights the vast areas of unfinished business that must be prioritized in the post-2015 framework. The 2014 Report also provides an assessment of the state of the data to support evidence-based decisions in women's and children's health, and describes elements of the Countdown process that might inform ongoing efforts to hold the world to account for progress. It concludes by laying out concrete action steps that can be taken now to ensure continued progress for women and children in the years ahead.
The Bill & Melinda Gates Foundation has announced 78 grants of US$100,000 each in the latest round of Grand Challenges Explorations. Grants have been awarded for the development of a low-cost cell phone microscope to diagnose malaria, the study of the strategic placement of insect-eating plants to reduce insect-borne diseases, and the investigation of nanoparticles to release vaccines when they come in contact with human sweat. The grants support research across 18 countries and six continents. This year’s European grantees are based at universities, research institutes and non-profit organisations. The winners represent groups in Germany, Sweden, Norway and the United Kingdom. Some examples of the projects funded in this round include more effective vaccines, a 'seek-and-destroy' laser vaccine, treating worm infections to improve vaccine effectiveness and new strategies to fight malaria, such as insecticide-treated traditional scarves, using carnivorous plants to control mosquitoes and using cell phone microscope to diagnose malaria. Solutions to promote family health include using ultrasound as a reversible male contraceptive and the use of vitamin A probiotics to combat diarrhoea.
by Elaine Baume, Mercedes Juarez, Hilary Standing,
Institute of Development Studies at the University of Sussex, April 2001
A resource from the Gender and Health Equity Network, a partner of the Health and Social Change Programme at IDS. The purpose of this resource guide is to give an overview of gender sensitive interventions and initiatives directly or indirectly related to health that have been tried at macro and micro levels. Through mapping different experiences, the guide provides information on lessons learned, results achieved, and the challenges that have emerged in promoting gender and health equity. It includes information on gender-sensitive approaches, working methods, practical methodologies and tools which can be incorporated into policies and programmes. In pulling these resources together our aim is to create a practical reference mechanism for those involved in implementing programmes and policies worldwide. We felt that a guide to existing resources that could be periodically updated and reviewed would be more useful than commissioning more exhaustive but perhaps less accessible review papers.
This article from the Bulletin of the World Health Organization highlights health inequities both between and within countries, and how this is reflected in research, focusing on poverty and gender. The authors argue that there has been little research into the social causes of ill-health among groups, or factors affecting health inequity that are beyond the control of the individual. They highlight the publication bias in medical journals, where research into diseases that most affect the poorest people is often less likely to be published.
The 2009 General Household Survey entailed face-to-face interviews with a total of 25,361 households (including multiple households) across all nine provinces. It confirms a number of positive trends related to service delivery as established by previous surveys. However, although access to basic services continues to improve, there is some discontent with the quality of those services. In the case of housing, for example, 16.1% of those occupying state-subsidised housing said that the walls were weak or very weak and 14.9% regard their roofs as weak or very weak. Similarly, although 58% of users of water services said that the quality of such services was good, there has been a steady decline in levels of satisfaction since 2005. The survey also reveals that the number of people living in informal dwellings has dropped. In spite of the resolution to eradicate the use of bucket toilets, it has been found that as soon as bucket toilets were eliminated in a community, other newly formed communities started using the system for a lack of alternatives. Nationwide the percentage of households with no toilets or bucket toilets decreased from 12.6% in 2002 to 6.6% in 2009.