This work sought to identify the barriers to delivery, coverage and uptake of Prevention of Mother to Child Transmission of HIV (PMTCT) services at primary health care and community level and to generate improved demand for and utilization of PMTCT within Kamwenge sub-county in Kamwenge district and Mulagi subcounty in Kiboga district in Uganda. The work was implemented by HEPs Uganda within an EQUINET participatory action research programme and was mentored by Training and Research Support Centre (TARSC) in co-operation with Ifakara Health Institute Tanzania. Participatory methods were used to explore the barriers to using services to prevent vertical transmission and to identify actions to improve uptake. The findings suggested a need to emphasise couple counselling and testing; encourage local leaders to mobilise communities for antenatal care, PMTCT and other primary health care services and to address cultural barriers like male dominance. The baseline survey indicated that even where services are provided, while health workers may be effective in referring those who attend services for testing, PMTCT and ANC, there is a gap in people actually getting to services which breaks this link. Weak links are also made with some other maternal health services. Communities need to be involved in designing interventions that encourage male participation in demand and utilisation of testing and PMTCT services. This would appear to be a core element of any PHC oriented AIDS programme to prevent vertical transmission, as essential as other more biomedical elements.
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In Zimbabwe, there are four categories of state owned tertiary institutions: universities, teachers colleges, polytechnic colleges and agricultural colleges. All institutions are either in urban or semi-urban areas, except for agricultural colleges, which are mostly located in farming communities due to the nature of their studies and are governed by the Ministry of Lands and Agriculture instead of the traditional Ministry of Tertiary and Higher Education. Such discrepancies have led to the ‘isolation’ of the students attending these institutions especially in matters concerning the students’ health. In particular there has been inadequate effort to address the reproductive health challenges of the students in these institutions despite their sexually active and high risk age group, including for risk of HIV infection. Students and Youths Working on Reproductive Health Action Team (SAYWHAT) a civil society organization in Zimbabwe, used the Participatory Reflective and Action (PRA) methodology as the starting point to involve the agricultural colleges in addressing reproductive health challenges.
The Zambia Participatory Reflection and Action (PRA) project was implemented to strengthen communication between primary care level health workers and communities in one urban and one rural area of Zambia. It was implemented following PRA training in EQUINET as a pilot of the PRA method. The work has has shown that the PRA method is useful to strengthen health worker - community interactions in health planning and is replicable in other health centres of Zambia operating under district health management teams. The PRA method was found through pre- and post intervention assessment to improve communication and interaction between community members and health providers in attaining a people-centred health system in resource limited settings such as Zambia.
This summary document presents: The principles for ensuring universal treatment access through sustainable public health systems; The major findings and issues from the work carried out in southern Africa on equity in health sector responses to HIV and AIDS, particularly in terms of access to antiretroviral treatment; The key challenges for follow up work identified at the southern African regional meeting on Strengthening Health Systems for treatment access and equitable responses to HIV/AIDS, in Harare, Zimbabwe, February 2004.
The training course aimed to enable participants to be able to carry out assessments nationally of the key trade and investment agreements that impact on health and identify options for promoting public sector equity oriented health systems within current trade and investment policies and agreements. The workshop aimed to cover
• An introduction to trade and health that outlines major issues affecting the region
• An outline of health systems, their major components of health systems and the challenges posed by commercialisation.
• An introduction to outline of the global major trade systems and the World Trade Organisation and how it agreements that impacts on health, and the options for protecting and promoting health within these trade agreements
• An outline of two major trade agreements - TRIPS and GATS - that impact on health, and the options for protecting and promoting health within these trade agreements
• A guideline for audit of the impact of trade agreements on health systems
• An introduction to analyzing and understanding the health systems context in which policy is developed, designed and implemented.
The fifteen-minute pre-recorded show, ‘Public healthcare financing’, was produced by WWMP, in conjunction with labour journalists in east and southern Africa. The show examined the lack of public health care financing in Africa in the context of health worker shortages, poor working conditions for health workers, provision of medicine for tuberculosis and AIDS, and poor access to care for patients (long queues, poor facilities, lack of equipment etc), as well as the impact of the current global economic crisis and neo-liberal government policies. The show discussed the purpose of the Abuja 15% target agreed by African heads of state, and financing mechanisms (tax funding and health insurance) appropriate to funding public health care.
This oped draws on EQUINETs 42 case studies of community action on Covid-19 that collectively show innovative and solidarity-based approaches to prevent and care for Covid-19, to address social needs and hold states accountable, and in more detail on the experience with the Community Action Networks in South Africa.
This poster highlights the main findings from a PRA project report. It explains that Health workers are not recognised as a community that requires health care. The link between the health and well being of health workers and the quality of health care that they are able to provide to the community needs to be recognised and positively developed.
By involving citizens and health workers in producing evidence and learning, participatory action research has potential to organise community evidence, stimulate action, and challenge the marginalisation that undermines achievement of universal health coverage. In this paper, the authors summarise and analyse results of two sessions on this research model convened by the authors at the First Global Symposium on Health Systems Research in Montreux Switzerland, 16–19 November 2010. In so doing, it reviews case studies and experiences discussed, particularly their contribution to universal health coverage in different settings. The authors reflects on challenges faced by participatory action research, and outline recommendations from the two sessions, including the creation of a learning network for participatory action research.
By involving citizens and health workers in producing evidence and learning, participatory action research has potential to organise community evidence, stimulate action and challenge the marginalisation that undermines achievement of universal health coverage, the authors of this paper argue. They begin by summarising and analysing the results of two sessions on this research model convened by the authors at the First Global Symposium on Health Systems Research in Montreux Switzerland, 16–19 November 2010. They then review case studies and experiences discussed, particularly their contribution to universal health coverage in different settings. The authors reflect on challenges faced by participatory action research, and outline recommendations from the two sessions, including the creation of a learning network for participatory action research.