While international and global guidance documents set out health obligations for extractive industries (EIs), these standards, including UN conventions, may be voluntary if they are not included in national laws, unless the national constitutions specifically provide otherwise. Given the spread of EIs across the ESA region, it would be important to ensure that corporate duties in relation to health are upheld across the region, including through regional guidance to harmonise laws. This document was produced by EQUINET through Training and Research Support Centre and with support from Medico International. It aims to inform policy dialogue to improve the legal frameworks for the duties and corporate social responsibility of EIs in the ESA region. It presents evidence to support policy dialogue and health advocacy. It reviews the literature on EIs and health in ESA countries, explores key guidance principles/ standards on health in EIs, and analyses from review of laws how far they are contained in domestic legislation of ESA countries. Using good practice in existing ESA laws and international guidance, the document proposes the content for regional guidance for policy and law in the region. As is being implemented in other regions of Africa, there is scope for regional guidance and harmonisation of laws relating to EIs, including in relation to health. While no single law in ESA countries addresses all aspects of international guidance on protection and health and social welfare in EIs, in combination the laws in ESA countries provide clauses that could form the basis of such regional guidance. Drawing from different ESA laws legal guidance is proposed for health and social protection covering: 1. Award of prospecting rights/licenses and EI agreements; 2. Resettlement of affected communities due to mining activities; 3. OHS for employed workers and contractors in the mining sector; 4. Health benefits for workers, families and surrounding communities; 5. Environment, health and social protection for surrounding communities; 6. Fiscal contributions towards health and health services; 7. Stimulation of forward and backward links with local sectors and services supporting health; 8. Post-mine closure obligations for public health; and for 9. Governance of these issues, including for good corporate governance practices, public transparency and accountability, constructive dialogue, reporting and oversight, to foster a relationship of confidence and mutual trust between EIs and the societies in which they operate.
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This paper reflects on experience from over two decades of EQUINET research practice to promote health equity in east and southern Africa. The paper was written by members of the EQUINET steering committee and the newsletter team. It draws examples and research features from EQUINET publications available online, a search of publications in the 221 issues of the EQUINET newsletter, and papers, reports, blogs, articles and editorials obtained from key word searches in Google. Despite policy commitments and gains in selected aspects of health, conditions in the region are increasingly driven by a global economy and a regional response that is generating instability, environmental and social costs; intense extraction of natural resources; rising levels of precarious labour, social deficits and weakened public institutions, disrupting social cohesion, solidarity and collective agency. These conditions call for certain features and forms of research. The paper describes diverse research on the costs to health equity of social deficits, inequitable resource outflows and the commodification of public services, as well as research on alternatives and policies on food security, health services, environment and rights that confront these trends. The paper describes specific features of research that respond more directly to the understanding that power relations are central to inequities in health. These research processes explain and show alternatives to disempowering narratives of the inevitability of the status quo and generate knowledge in ways that intend to empower those affected. They pay attention to who defines the research questions, who designs, implements and uses the research. This implies designs and methods that involve people in affirming and validating their realities, generating reflection on causes and building analysis, self-confidence and organisation to act and to learn from action. It presents specific examples of research approaches and the role of a consortium network in advancing them, while noting the ways in which many researchers face the double task of investigating inequities, while also challenging inequity in a global research system.
The work presented in this policy brief was prompted by a request from the Zambian parliamentary committee on Health, Community Welfare and Social Development. The parliamentarians had wanted to know why despite all the funding to the health sector, there were no ‘visible’ gains to speak of from the on-going health reforms.
Zimbabwe, like many other countries in the region, is badly affected by a shortage of health workers. Many of the health indicator improvements achieved during the first ten years of independence are on the decline and a major reason for this is shortage of skilled and experienced health workers at a time when demand for services is increasing due to a growing population and the challenges posed by HIV and AIDS. The public sector provides as much as 65% of health care services in the country, so a shortage of public sector health workers affects the majority of the population. Against a background of increasing shortages, the report argues for improved management practices and better distribution of human resources in health care systems. This study presents evidence on the distribution of public sector health workers in Zimbabwe and the impacts on equity objectives in health care.
Human resources for health have become a topical issue at local, regional and global levels. In Namibia health worker mobility remains a concern for those in human resources planning. Achieving equity in this area needs a concerted effort from all sectors involved. However little is understood about the role that conditions of service play in influencing health professional mobility in Namibia. The study set out to explore and describe the influence of conditions of service on the movement and retention of the health professionals in Namibia. It is a qualitative study targeting mainly professional nurses, doctors, social workers and health inspectors at both operational and managerial levels, in public and private sectors.
The research was located in Cape Town, South Africa where the need for equity policies to be implemented is great. However ongoing restructuring and change lead to fatigue in the management and staff of the primary health services. Their resistance could block the implementation of equitable staffing plans. It is necessary to understand the management and workplace factors leading to potential resistance of equitable staffing plans and thus these were explored. A policy analysis approach using a case study analysis was sought to provide understandings, approaches and tools to illuminate the processes involved in health policy.
This study is a review of the literature and secondary evidence on community participation in central, eastern and southern Africa. It focuses in particular on South Africa, Mozambique, Malawi, Zambia and Kenya, and presents and analyses evidence of the current situation with regard to the role of districts in promoting community participation and articulating community voice. This includes looking at how: • community voice and roles at district level are structured and integrated into planning; • the way districts carry out their functions enables or blocks participation; • districts articulate and represent community interests at national level; and • wider contexts and processes at national and district levels influence and explain these outcomes. The purpose of the review is to identify examples of enabling and blocking mechanisms for community participation at district level and to provide pointers for further research.
This study reviewed the available published and grey literature, with a focus on primary health care and the district health systems in sub-Saharan Africa, in order to explore the facilitators and barriers to community participation. Six African countries were selected for deeper review and analysis: Botswana, Lesotho, Namibia, Rwanda, Swaziland and Tanzania. The work signals a need for more culturally informed interventions that draw from indigenous knowledge bases, with evidence-based data that is culturally relevant, and that contextualises poverty, health risks and systems in sub-Saharan Africa. The review identifies a number of challenges, not the least of which is the prevailing perspective of the citizen as an object of health rather than as an active subject.
A proposed Economic Partnership Agreement (EPA) between the eastern and southern African countries (ESA) and the European Union (EU) is currently under negotiation. The final agreement to be signed in December 2007 could have a profound impact on areas of health and health services. Recognising this, in this report we examine the health implications of this proposed EPA between the ESA and the EU. The report aims to inform government, civil society, parliaments and professionals working in health and in trade. It examines: • the key areas of the EPA; • the health implications of the EPA, specifically in terms of health inputs (examining food security) and health services (examining organisation of health services, health workers, and access to medicines); • the options that countries have to protect health in the current EPA; and • general issues and principles for protecting health in negotiating the EPA.
This study was implemented to identify trends in the health budget in Zimbabwe 2001-2006, assess the equity oriented nature of these trends and make recommendations to strengthen pro-equity dimensions of the health budget. The review examines the budget in three major respects: how far the opportunities for equity in revenue mobilization are being tapped; how far the allocation and expenditure patterns are promoting policy targets, particularly equity; and how far incentives and investments are levering health promoting investments (and penalizing those that undermine health). The study drew evidence from secondary data and national surveys, from reported Ministry of Finance estimates and from the reported budget allocations provided by government, with a focus on the years 2000-2006.