The AIDS epidemic has resulted in over 1 million orphans and many other vulnerable children in Zimbabwe. Most of these children remain in their communities, either in child-headed households or looked after by their extended family or members of the community. While there has been a massive response from local organisations to the plight of these children, many programmes have been designed in a top-down manner, without taking into consideration the views of the children themselves. The study used a mix of quantitative assessment and participatory action research methods (PRA) to explore and strengthen the participation of orphans and vulnerable children in primary health care (PHC) in Victoria Falls, a town in the north-western part of Zimbabwe. Children, community representatives and health workers identified three priority health problems faced by these children, ie: poor access to ART; child abuse; and poor housing. Structural constraints, such as poverty and weakened health and community services, were seen as the primary underlying causes of these problems. Those involved identified actions they could take to address these problems, and based on this community organisations strengthened psychosocial support activities, undertook a number of awareness campaigns, initiated and participated in child protection committees and started to meet monthly to strengthen coordination. A participatory review of the interventions suggested that child involvement is an important component in a primary health care approach to designing ways of meeting children's needs, through structured platforms for the exchange of information and experiences, provision of child friendly services, and promotion of effective communication between health workers, community members and children.
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EQUINET through Health Systems Trust, University of Namibia and its secretariat at Training and Research Support Centre, in co-operation with the Regional Health Secretariat for east, central and southern Africa, is implementing in east and southern Africa research, capacity building and programme support for the retention of health workers and for management of out- migration of health personnel. The programme will support empirical research on the costs and benefits of health worker migration within and beyond east and southern Africa (ESA); and will support evaluation of the effectiveness of current policies and agreements to manage these costs and benefits. The University of Namibia is now co-ordinating the work on HRH retention and Health Systems Trust the work on HRH migration, in co-operation with EQUINET Secretariat (TARSC) and ECSA Regional Health Secretariat. For further information on the programme please contact EQUINET (admin@equinetafrica.org) and ECSA (regsec@crhcs.or.tz).
Uganda reported its first confirmed case of COVID-19 on 21 March 2020. The country has since implemented a series of public health measures to limit the spread of the virus. The pandemic has progressed from imported cases through sporadic community cases to stage four, with widespread community transmission. This paper documents how evidence and analysis were used to support decision-making for an adaptive health system response to COVID-19 in Uganda in 2020. A desk review was thus implemented using published and grey literature covering the period from February to October 2020 to document the nature and organisation of different data and related evidence used to support projections, planning and decision-making on the surveillance, prevention, care and health system response to COVID-19. The desk review also looked at how evidence was used and communicated across different actors to support adaptive responses. While there have been challenges, Uganda’s response to COVID-19is reported to have been dynamic, responding to different sources of evidence, and through different institutional channels and actions, with the latter generating evidence and experience that feeds back to the response.
In a regional EQUINET programme led by Community Working Group on Health (CWGH) on health centre committees as a vehicle for social participation in health system in east and southern Africa, Lusaka DHO is building capacities and learning for the district and the wider country programme on policy and legal guidelines to support the effective interaction of communities in health centre committees (HCCs) that can be shared regionally. A workshop was held on 7th January 2016 in Lusaka to support and inform the objectives for the Zambia work, viz: 1.To compile and exchange information on the current laws and legal guidelines on the role and functioning of HCCs. 2.To develop through regional dialogue a model HCC guideline to be tabled and reviewed regionally. 3.To analyse and document how current laws compare to this guideline. 4.To advocate for strengthening of law and guidelines in regional and national policy forum.
The first East and Southern Africa Regional People’s Health University (ESA RPHU) jointly convened by PHM and EQUINET is being held virtually between July 29 and November 12 2021 with 10 weeks of interactive sessions to build and share evidence, experience, analysis and knowledge on health equity to support regional co-operation and joint engagement, from local to global level, on shared priorities. The course programme is at https://www.equinetafrica.org/rphu/rphu-programme with different issues affecting health equity in the region and learning from COVID-19. Open access online dissemination of plenary presentations and resources is available on the RPHU resources page. It currently includes video clips of a panel discussion moderated by Dr Rene Loewenson TARSC/EQUINET with Dr Firoze Manji, Daraja Press and Professor Patrick Bond, University of Western Cape, explored the Political Economy of Health in East and Southern Africa; David van Wyk from Benchmarks Foundation on a case study of health equity in mining in South Africa; Mariam Mayet, Executive Director of the African Centre for Biodiversity on global and corporate activities in industrial agriculture and gene technologies in relation to malaria; Thusang Butale BFTU and Danny Gotto I4Dev on experiences of extractive activities in Botswana and Uganda; Masuma Mamdani, EQUINET on social determinants of health; Shakira Choonora on an Intersectional lens to health inequities; Sue Godt on Emerging commercial determinants of health and the reality in the region and Peter Binyaruka, Ifakara Health Institute (IHI), Tanzania presentation on co-financing to address social determinants of health equity. The Resources page is being updated with new content as the course progresses.
The 10 week EQUINET and PHM ESA RPHU ended in mid-November. There are a number of interesting resources and reading materials on the RPHU website and videos of many of the presentations, that we welcome you to read, view and share more widely and use on your own activities. These materials, made available under fair use for your non-commercial educational purposes, cover topics from the course including on: Political economy and reclaiming resources for health; Ideas of health and wellbeing, SDH and reclaiming comprehensive public health; Health systems and Comprehensive primary health care (PHC); Power, values, rights, law and reclaiming collective agency; Commodification, privatization in health and reclaiming the state; Equity in health technology; Social participation and organising activism for health; and Building a movement for health equity.
This interview between Firoze Manji Daraja press and Dr Rene Loewenson, Training and Research Support Centre explores evidence and knowledge gaps on COVID-19 in east and southern Africa, drawing on EQUINET information briefs and other sources. The interview identifies positive examples of state and public proactive responses to the pandemic in the region, the challenges faced and what learning that brings for equity in responding to pandemics.
In August 2011, the South African Minister of Health released a Green Paper on introducing a National Health Insurance (NHI). While there has been a relatively muted response to the release of the paper, there has been sufficient public commentary to identify positive and negative key areas. On the positive side, the proposals have been praised for: being based on universal coverage principles; adopting a carefully phased approach; focusing firmly on addressing the problems in the public health sector first; and building a strong foundation of improved primary care services. However, while there appears to be a commitment to a single public pooling and purchasing entity, the Green Paper mentions also considering a multi-payer option whereby private insurance schemes would act on behalf of the NHI, raising concerns about high administration costs, which would limit income and risk cross-subsidies, and reduce the cost-containment benefits that would accrue if government was a single purchaser. The proposal to purchase services from the private sector may also mean a two-tier system will be retained as wealthier groups live closer to private providers than the less well-off and, given the rapid increase in fee levels among private for-profit providers, may threaten the sustainability of the NHI. Although it is proposed that there will be no fees at the point of service, the Green Paper also mentions having to consider co-payments, which would limit the financial protection afforded to beneficiaries. There are clearly some contradictions within this policy document that need to be resolved, the author concludes.
Work on health equity in east and southern Africa was given profile at the World Conference on the Social Determinants of Health. Work on equity monitoring, including the Equity Watch in Zimbabwe and the ECSA Region was included in the background paper and reported on by the Hon Minister of Health Zimbabwe, also current chair of the ECSA Health Community. EQUINET as an equity catalyst bringing social forces across state, civil society, academic and parliament institutions was included in a panel on social participation. Community Working Group on Health, the cluster lead for social empowerment made input to the media cover and to the wider civil society platforms, especially of the People's Health Movement, and EQUINET publications were included in the material displayed by WHO Afro. TAC South Africa, the Ministers of Health of South Africa and of Kenya made inputs to panels on institutionalising participation in policy making and on changing the role of public health and Professor Sanders UWC in the final plenary on SDH and the life course. Case studies on work on social determinants of health for the conference from Namibia, Rwanda, Kenya, Uganda and Zimbabwe can also be found at www.who.int/sdhconference/resources/case_studies/en/index.html.
Health care financing in South Africa is inadequate, and in recent years we have been moving away from achieving the Abuja target of 15% government funding for health care. This has resulted in numerous crises in the public health sector, and most South Africans (about 41 million) are unable to access decent, adequate health care, as enshrined in our constitution. South Africans that do access decent, adequate health care primarily do so through private funding (typically private health insurance schemes), but even in this sector, costs are spiralling and the package of benefits on offer is declining. To increase public health funding in South Africa, the government has proposed the introduction of a National Health Insurance (NHI) scheme. A recent national household survey found that 71% of medical scheme members were willing to join a publicly supported health insurance scheme if their monthly contribution was less than for current medical schemes. The NHI has been proposed to create a mechanism to level the playing field and create equitable distribution of resources resulting in high quality of health services for all the people. Universal access to a basic package of services for both the rich and poor will be achieved by the NHI and the costs of health care for poor and middle class South Africans will decrease. In-studio guests on a radio show discussing these issues were: Proffessor Di Mc Intyre, Health Economics Unit, UCT and EQUINET Fair Financing Theme Co-ordinator; Sheila Barsel, Policy Unit for the National Health and Allied Workers Union (NEHAWU); and Dr Siva Pillay, Member of the Parliamentary Portfolio Committee of Health in South Africa.