With the support of the Robert Wood Johnson Foundation, Health Services Research (HSR) is planning a special issue focusing on the social determinants of health, to provide a forum for presenting the latest research and policy analysis to a broad audience of researchers, practitioners, and policymakers. There is ample evidence that most health policymakers, both at state and federal levels, do not understand how policy relating to non-medical determinants of health can be incorporated into health policy. Conversely, policymakers in such fields as education, transportation, or housing rarely see that there are major health implications to the choices that they make. Education is needed in both directions. Topics of interest include but are not limited to social inequalities in health by socioeconomic position, race/ethnicity, gender, etc.; the role of a broad range of psychosocial factors in health at the level of individuals, neighborhoods, and communities, and broader sociopolitical units; the interconnections and interactions between and among social and biological-chemical-physical determinants of health; and implications of social determinants of health for health care or health services research, practice, and policy. Jim House, Nicole Lurie, and Catherine McLaughlin will serve as co-editors of the special HSR issue. September 1, 2002 is the deadline for submission. The planned publication date is July 2003.
Governance and participation in health
Many Voices Make a City is a series of mini-dramas written, performed and produced by Chicoco Radio trainees, each explores an aspect of participatory urban design. This episode features a starchitect, a celebrity engineer and feisty market woman who knows what she wants. For those who need a little help with Pidgin English, this version is subtitled.
This paper explores the implications of the increasing role of informal as well as formal markets in the health systems of many low and middle-income countries. It focuses on institutional arrangements for making the benefits of expert medical knowledge widely available in the face of the information asymmetries that characterise health care. The paper argues that social arrangements can be understood as a social contract between actors, underpinned by shared behavioural norms, and embedded in a broader political economy. This contract is expressed through a variety of actors and institutions, not just through the formal personnel and arrangements of a health sector. Such an understanding implies that new institutional arrangements, such as the spread of reputation-based trust mechanisms can emerge or be adapted from other parts of the society and economy. The paper examines three relational aspects of health systems: the encounter between patient and provider; mechanisms for generating trust in goods and services in the context of highly marketised systems; and the establishment of socially legitimated regulatory regimes. This analysis is used to review experiences of health system innovation and change from a number of low income and transition countries.
In many parts of Asia and sub-Saharan Africa there is a growing gap between official accounts of how health systems operate and realities on the ground. Researchers in this study looked at how to gain access to competent health care in environments where there are growing but unorganised markets in goods and services, blurred boundaries between the public and private health care sectors, and a lack of state regulation. The researchers used the frame of the ‘social contract’ (an implicit agreement among people that results in the organisation of society) and focused on the problem of information asymmetry (inequalities in access to information) and associated power relationships, in particular those between patient and health care provider. Their paper highlights the importance of trust to relationships at all levels of the health system. Findings show that different ways of generating trust in goods and services, and new forms of regulation have emerged. The researchers call for greater understanding of the institutional context in which health systems operate in developing countries. They also stress the need to avoid dictating policy according to the experiences of developed countries. Instead, future debates will need to focus on how governments can create regulatory partnerships and enable improved access to information, building on the new social contracts that are already emerging.
This article evaluates progress in implementing the United Nation’s Global Strategy on Women and Children’s Health since it was released in September 2010. The Commission on Information and Accountability for Women’s and Children’s Health was created in December 2010 to oversee the implementation of the Global Strategy. Since then it has met with stakeholders twice and developed a strategic plan of action. Feedback from those meetings indicate that developing countries – in particular, African countries – face major obstacles in gathering birth and maternal mortality data. The future of the Commission remains uncertain, however, with stakeholders expressing skepticism about whether or not external funders will meet their commitments. In order to succeed in reducing maternal mortality, a combination of interventions is needed, including education on reproductive health issues; access to effective birth control and safe abortion; universal prenatal care; diagnosis and referral of high-risk pregnancies; a high percentage of births overseen by skilled attendants; and safe motherhood protocols for managing normal and high-risk births. However, reaching a consensus on which interventions should be funded is complicated, the article concludes, given the sensitive nature of maternal health issues, specifically family planning and safe abortion, which are opposed by conservatives.
This article, based upon seven years of research and some 70 interviews with Cuban medical personnel, both in Cuba and abroad, seeks to provide a broad overview of the importance of Cuban medical internationalism. The article reviews several, different, programmes of medical cooperation in terms of basic data on their evolution and impact, and analysis of the rationale for their development. As of April 2012 there were 38,868 Cuban medical professionals working in 66 countries–of whom 15,407 were doctors (approximately 20% of Cuba’s 75,000 physicians). In Africa some 3,000 Cuban medical personnel are currently working in 35 of the continent’s 54 countries, while in Venezuela alone there are approximately 30,000. But that is only part of the story, since there are many other significant facets to Cuban medical internationalism. In all cases the author suggests that 'human capital' is the most important common denominator. For over fifty years Cuban medical personnel have served the poorest and most neglected areas of the world, going where other doctors refused to go.
Tech communities are booming all over Africa, says Nairobi-based Juliana Rotich, cofounder of the open-source software Ushahidi. But it remains challenging to get and stay connected in a region with frequent blackouts and spotty Internet hookups. So Rotich and friends developed BRCK, offering resilient connectivity for the developing world. Juliana Rotich is co-founder and executive director of Ushahidi, a nonprofit tech company, born in Africa, that develops free and open-source software for information collection, interactive mapping and data curation. Ushahidi builds tools for democratizing information, increasing transparency and lowering the barriers for individuals to share their stories. Through Crowdmap.com, Swiftly.org and accompanying mobile applications, Ushahidi is making crowdsourcing tools available and useful. Their latest product is BRCK, a tool for resilient connectivity -- anywhere.
Dissatisfaction emerged among many Member States over the World Health Organisation’s (WHO) financial reform plans at the 129th session of the WHO Executive Board, held on 25 May 2011. They expressed concern over the lack of detail on the reforms proposed, the stress on "donor funding" to resolve the financial difficulties of the WHO, as well as proposals such as the convening of the World Health Forum, which is aimed at increasing the influence of the private sector and external funders in setting the health agenda in the WHO. They also emphasised that the WHO's reform process must be driven by Members States themselves. The discussion resulted in the adoption of a new decision EB 129(8), which sets out a more transparent and inclusive consultative process for the finalisation of a reform plan by November 2011, when the Executive Board will convene for a special session.
This paper examines prospects for enhanced regional migration governance and protection of migrants’ rights in the Southern African Development Community (SADC). Migration in this region is substantial in scale and diverse in nature, incorporating economic, political and mixed migration flows. In addition to movements between countries within the region, migrants also come from across the African continent and even further afield. At its foundation in 1992, SADC as an institution initially embraced a vision of intra-regional free movement, but this has not become a reality. If anything, there has been a hardening of anti-migrant attitudes, not least in the principal destination country of South Africa. There have also been serious violations of migrants’ rights. Attempts at regional coordination and harmonisation of migration governance have made limited progress and continue to face formidable challenges, although recent developments at national and regional levels show some promise. In conjunction with the 2003 SADC Charter of Fundamental Social Rights and 2008 Code on Social Security, incorporation of migrants into the SADC 2014 Employment and Labour Protocol could signal a shift towards more rights-based migration governance. The paper concludes by arguing that there can be no robust rights regime, either regionally or in individual countries, without extension of labour and certain other rights to non- citizens, nor a robust regional migration regime unless it is rights-based.
Mobile health (mHealth) approaches for non-communicable disease (NCD) care seem particularly applicable to sub-Saharan Africa given the penetration of mobile phones in the region. The evidence to support its implementation has not been critically reviewed. The authors systematically searched PubMed, Embase, Web of Science, Cochrane Central Register of Clinical Trials, a number of other databases, and grey literature for studies reported between 1992 and 2012 published in English or with an English abstract available. The search yielded 475 citations of which eleven were reviewed in full after applying exclusion criteria. Five of those studies met the inclusion criteria of using a mobile phone for non-communicable disease care in sub-Saharan Africa. Most studies lacked comparator arms, clinical endpoints, or were of short duration. mHealth for NCDs in sub-Saharan Africa appears feasible for follow-up and retention of patients, can support peer support networks, and uses a variety of mHealth modalities. Whether mHealth is associated with any adverse effect has not been systematically studied. Only a small number of mHealth strategies for NCDs have been studied in sub-Saharan Africa. They report that there is insufficient evidence to support the effectiveness of mHealth for NCD care in sub-Saharan Africa and present a framework for cataloging evidence on mHealth strategies that incorporates health system challenges and stages of NCD care to guide approaches to fill evidence gaps in this area.