The last two issues of EQUINET news have given focus to Primary Health Care (PHC), noting the thirty year anniversay of the Alma Ata declaration on PHC in 1978. The PHC philosophy recognises the need to tackle the broader social and political determinants of health, and involves wide-ranging action to promote health equity. It is focused on improving population health and generating health equity; on inter-sectoral action to address other social determinants of health and is based on social empowerment and comprehensive, integrated and appropriate health care, that emphasises health promotion and prevention and assures first contact care. EQUINET thus sees PHC oriented health systems as a basis for improving equity in health and in access to health services. This month we are making available on our website in electronic form our book "Reclaiming the Resources for Health", a resource that gives the argument for people centred, PHC oriented health systems in east and southern Africa. We report on the resolutions of an important meeting of parliaments health in east and southern Africa held in September 2008 on health equity and PHC, and we present new evidence gathered and methods for advancing PHC oriented health systems. We also present two editorials from our joint issue with Pambazuka news on PHC: Thirty years on. We invite comment and input on PHC in east and southern Africa to admin@equinetafrica.org!
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In the evaluation of the Reader on PAR in Health Systems Research (online on this site) one of the proposals made by many respondents was to have a website to share a range of PAR materials, and information on networks, trainers etc online. People indicated and we also noted that there are many existing resources on PAR but that we need to make it easier for people to find what is out there based on specific needs that they have. In response to this EQUINET is setting up in July/ August a PAR portal page called the “Participatory Action Research Portal”. The new portal will have a homepage and a series of ‘subpages’ for Training, resources - which will provide links to online training courses, whole training guides and reports of training activities; Methods, tools and ethics - which will provide links to online specific papers on PAR methods, to specific examples of tools, and to discussions/ guidelines on ethical issues; PAR work – which will provide links to stories, case studies, briefs, videos, text or photojournalism stories of PAR work, including facilitator reflections; Organisations and networks - which will provide the name, snippet of information, country and link to organisations and networks involved PAR; Publications - which will provide published journal papers and reports on PAR through links to the urls or on the EQUINET database and Other resources - which will provide ad hoc information that doesn’t fit anywhere else. The page is being worked on in July and August and will be launched in September 2017. A call has been made for institutions working with PAR to provide information on resources they would like the portal to make links to.
Access to health technologies (vaccines, medicines, diagnostics, PPE, ventilators etc) depends on distributed local production. Nationalism and protectionism on these technologies has implied a sustained struggle to get sufficient access to meet population needs, and global measures such as CTAP (for voluntary patent pooling) and COVAX (for vaccine and technology pooling) have not had the support that matches need. One of the barriers is the patent protection in the TRIPS agreement. In this interview, Firoze Manji speaks with Leslie London, Professor of Public Health in the School of Public Health and Family Medicine University at the Cape Town (and an EQUINET steering committee member), and Jens Pedersen from Medicins Sans Frontiers on the issues of access.
This report of the second phase of this project outlines the work by a working group from the community in an informal settlement in Namibia and from the University to take forward community identified priorities for environmental health improvements, particularly sanitation. The report describes the engagement with the local authorities in a community driven process, and the challenges in building community empowerment for health actions in informal settlement areas. Community members have weak access to decision making on their services and actions to implement even the most basic PHC interventions take time to build the co-operation and responses from necessary stakeholders.
The Kamwenge Community Empowerment and Participation in Maternal Health Project aimed to contribute to the improvement of the health of expectant mothers in Kamwenge Sub-county, Kamwenge District. We aimed, through the use of PRA approaches, to increase demand for, access to and utilisation of maternal health services by expectant mothers. Using various PRA tools the project team worked with the community to prioritise, act and follow up on the most critical barriers to maternal health at the three levels – health service, community and household. While a comparison of questionnaires before and after the intervention suggested that maternal health problems remained high and many barriers to access services persisted, positive change was perceived in ease of access to and affordability of services, in communication between community and health workers and the respect shown by health workers, in the support given by health workers and families, and in awareness and action on maternal health in the community. The strongest positive changes were noted in the communication between health workers and pregnant women, and this seemed to be the area of greatest impact of the intervention.
This participatory action research project aimed to explore and strengthen the community’s capacity to recognise and advocate for their mental health needs, to increase the awareness of mental health problems among the community and to increase collaboration between the mental health workers from clinic and hospital level and the community in the management of mental health problems in the community. Both health workers and community identified exclusion, isolation and poor control over life, associated with risks and a poor physical state, as features of mental ill health. The Kariobangi community was felt to experience high levels of mental ill health, with poverty a major contributing factor. The major mental disorders identified were depression, stress, poverty, lack of awareness, drugs/substance abuse, lack of essential services (mental health services), mental retardation and epilepsy. The intervention is still at an early stage, but the evidence suggests that the PRA approach has strengthened community roles and interaction with health workers in improving mental health care in an underserved community.
This participatory action research project aimed to explore and strengthen the community’s capacity to recognise and advocate for their mental health needs, to increase the awareness of mental health problems among the community and to increase collaboration between the mental health workers from clinic and hospital level and the community in the management of mental health problems in the community. Both health workers and community identified exclusion, isolation and poor control over life, associated with risks and a poor physical state, as features of mental ill health. The Kariobangi community was felt to experience high levels of mental ill health, with poverty a major contributing factor. The major mental disorders identified were depression, stress, poverty, lack of awareness, drugs/substance abuse, lack of essential services (mental health services), mental retardation and epilepsy. The intervention is still at an early stage, but the evidence suggests that the PRA approach has strengthened community roles and interaction with health workers in improving mental health care in an underserved community.
This work was implemented as part of a multi-country programme exploring different dimensions of participatory approaches to people centred health systems in east and southern Africa. The process included participatory workshops with twenty-four health workers to increase their understanding of Community Health Committees (CHCs) and to support the CHCs more effectively in future. Three-day Participatory Reflection and Action (PRA) workshops with representatives from Community Health Committees and key stakeholders, and provided an opportunity for health workers to discuss the roles and mapping of neighbourhoods surrounding the health facilities provided an important opportunity for exploring the similarities and differences in the challenges and resources available to the local communities. The post-test survey showed that the community became aware of the important role and function that committees play but were less satisfied with the functioning of the CHCs based on new understanding from the PRA work, while health workers developed more awareness of the CHCs, their potential and limitations. This was agreed to be the start of a process. While PRA supports communities to know and artculate their needs and actions for these, more needs to be done to ensure sustainability of the process.
This Participatory, Reflection, and Action (PRA) project on occupational health services offered an opportunity for IHRG and a group of unionised health workers to use innovative learning and research methodologies as a means to investigate and intervene in their experiences of workplace injury and illness. Following IHRG’s participation in a regional training workshop hosted by EQUINET with TARSC and Ifakara, IHRG used selected PRA tools in a participatory action research programme. The project consisted of three workshops, workplace-based investigations, and the dissemination of networking resources among the participants. The combination of workplace-based case investigations and the process of critically reflecting on these interventions provided a very powerful action-learning experience. Processes of change were evident even in this short term project. Participants’ workplace investigations uncovered real cases of workplace injury and illness that have been buried under a culture of ignorance, neglect, silence, and denial of workers’ health and safety rights.
Participatory approaches were used to facilitate a programme of work aimed at: improving communication and understanding between HIV positive clients and the HIV clinic personnel in HIV clinics; raising HIV positive clients’ voices and participation in improving the HIV clinic services in the division; and promoting networking to overcome isolation, increasing exchange and co-operation through conducting. Participatory approaches, while challenging and time intensive, were perceived by health workers, clients and the facilitators to be a powerful means to enhancing communication, overcoming power imbalances that are barriers to good health or effective use of services and to encouraging the sustainable, “bottom up” community involvement on health visioned in Kenya health policy documents. Real changes were made to make the services more client-friendly, including installed suggestion box, re-streamlined queuing and filling system, taking of vital signs, interpreter involvement, and ordering of bulk drug supply, while clients formed a network that would sustain the communication and reduce social isolation of PLWHIV.