From 26-28 April 2012, EQUINET held a regional methods workshop in Cape Town, South Africa. It gathered the lead institutions of country teams in the Equity Watch work, the EQUINET steering committee, regional and international agencies and networks involved in work on health equity. The workshop aimed to: provide training on equity analysis and discuss future approaches to capacity building on equity analysis; review Equity Watch work at country level and the learning and implications from the work for future monitoring of health equity within countries; and review and discuss the draft regional Equity Watch and the follow up and dissemination. Equity Watch presentations were delivered at the meeting for five of the countries in east, central and southern Africa included in the EQUINET network, namely Kenya, Uganda, Zambia, Zimbabwe and Mozambique. Results were mixed from the various countries, indicating success in improved aggregate health in most countries, some closing of rural-urban disparities in health, but widening social and economic inequalities in health and the social determinants of health. Delegates argued that aggregated data obscured inequities in health in the region. They identified decreases in public health spending as a major problem in giving ministries the leverage over other sources of spending on health. They also called for ‘mainstreaming’ health equity into the national and regional health agendas, as well as for the dissemination of the Equity Watch results at country and regional level to all stakeholders, identifying champions who will take Equity Watch forward, putting effective monitoring and evaluation in place to measure progress in health equity in the region, and conducting district-level analysis (so far Equity Watch analysis has been on regional and national levels only). Presentations were also given on various aspects of equity analysis, such as disaggregating health expenditure, analysing the social determinants of health equity and universal health coverage and linking equity analysis to the Millennium Development Goals.
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This paper synthesises reports on community participation (CP) concept and its practicability in countries’ health service systems, much focus being on developing countries. The authors were supported through EQUINET to narratively review the published and grey literature traced from electronic sources and hard copies as much as they could be accessed.
CP is a concept widely promoted, but few projects/programmes have demonstrated its practicability in different countries. In many countries, communities are partially involved in one or several stages of project cycles - priority setting, resource allocation, service management, project implementation and evaluation. There is tendency of informing communities to implement the decisions that have already been passed by elites or politicians. In most of the project/programmes, professionals dominate the decision making processes by downgrading the non-professionals or non-technical people’s knowledge and skills. CP concept is greatly misinterpreted and sometimes confused with community involvement. In some cases, the community participates in passive manner. There is no common approach to translate CP into practice and this perpetuates debates on how and to what extent to which the community members should participate. The authors argue that persistent misconceptions about CP perpetuate inequalities in many countries’ health systems, suggesting that more concerted measures are needed.
EQUINET is saddened by the news of the passing of Doctor TJ Ngulube, a long-time colleague in EQUINET, director of the Center For Health Science and Social Science Research in Zambia and significant contributor to EQUINETs early work on social participation in health, on parliamentary roles and equitable health systems. Colleagues in EQUINET have noted memories of TJ’s warmth, wisdom and friendship; his leadership and his consistent contribution to work in the region. We send sympathies to his family and colleagues and are the poorer for his passing.
This leaflet is a translation of EQUINET’s policy brief on trade and health. The summary information is shown here in Portuguese. O crescimento do comércio internacional tem conseqüências significativas para a saúde pública. A relação entre o comércio e a saúde não é simples, e não é unidirecional. Neste informe levantamos questões sobre porquê é que questões sobre o comércio têm que ser compreendidas e geridas com o intuito de promover a saúde e realçamos as principais preocupações em saúde pública decorrentes dos acordos sobre o comércio livre. Chamamos a atenção para as medidas que os governos e a sociedade civil na região podem tomar com vista a alcançar maior coerência entre o comércio e as políticas de saúde, de maneira a que o comércio internacional e as regras do comércio maximizem os benefícios para a saúde e minimizem os riscos em saúde, especialmente para populações pobres e vulneráveis.
Os diferentes distritos, regiões e províncias num país têm diferentes necessidades de saúde e recursos disponíveis dos cuidados da saúde. Os fundos do governo justamentamente distribuídos para a saúde assim chamam para uma formula que calcula a divisão dos recursos totais para seremalocados para áreas baseadas sobre indicadores da necessidade relativa para cuidados da saúde naquela área. Muitos países na região usam tais formulários. Eles usam diferentes indicadores da necessidade de saúde, incluindo a capacidade populacional e a sua composição, os níveis da pobreza, doenças específicas e mortalidade. Revelando experiência em certos países selecionadodentro da região, esta breve política sugere que os países podem fortalecer uma alocação equitativa dos recursos para a saúde através de aumentar a cota global do financiamento do governo alocada ao sector da saúde, trazendo ajuda externa e o financiamento do governo num só conjunto de fundose aloca-los atraves dum mecanismo simples. Alocação de recursos equitativos chama para os governos estabelecer alvos anuais para alocação equitativa destes fundos públicos, e colecionainformação para monitorar e reportar sobre progresso em alcançar estes alvos, incluindo parliamentos e sociedade civil. Alocação de recursos é um processo politizado e requer umcuidadosa, incluindo, planificar, oraganizar e providencia de incentivos para a re-distribuição do pessoal de cuidados da saúde para áreas onde a necessidade da saúde é alta.
No ano 2001, em Abuja na Nigeria, os Chefes dos estados membros da União Africana comprometeram para alocar ao menos 15% de orçamentos dos governos para seus sectores da saúde. Ao mesmo tempo chamaram os países doadores para complementar seus esforços a fim de mobilizar domesticamente os recursos através de cumprirem o seu compromisso de dedicar 0.7% do seu PBN como AOD para os países em via de desenvolvimento e cancelar a dívida externa da Afica em favor Do aumento de investimento no sector social. O alvo de Abuja, assim, consiste de três componentes; os países Africanos deveriam: mobilizar os recursos domésticos para a saúde (15% agora); estar não sobre-carregado pela prestação de contas do débito (Cancelamento de Débito agora); e ser apoiada pela AOD (0.7% PBN agora).
This participatory skills session convened under the umbrella of the pra4equity network is being held at the Heath System Global Conference. In the session we will discusses methods and tools to build learning from action as a key element of participatory action research, directly engaging affected communities to build responsive health systems. The session draws on approaches and experience from Africa, Latin America and participants globally to discuss the methods/tools, their application and their integration in health systems. From prior global symposia, methods for learning from action were identified as weak in PAR practice. This session seeks to address this gap. It is targeted at researchers and practitioners. It uses methods resources and group discussions of case studies from health managers, policy actors, civil society and researchers in low and middle income countries to discuss the participatory processes and methods for learning from action at different levels, and the issues in applying and institutionalising these methods. We will also review what these participatory efforts to transform and build knowledge on health systems implies for the understanding of ‘resilience’. As the places are limited if you will be in Vancouver on the 15th November morning and would like to participate in this skills session please can you notify on the email shown with your name, institution and a line or two on any prior PAR experience.
This three hour participatory skills session discussed methods/ tools to build learning from action as a key element of participatory action research (PAR) and briefly the implications for what this means for an understanding of ‘resilience’ in health systems. It was held as a satellite session at the 2016 Global Symposium on Health Systems Research. The session drew on approaches and experience from Africa, Latin America and participants globally to discuss the methods/tools, their application and their integration in health systems. It integrated input from two rounds of moderated discussion on these questions held on the pra4equity list prior to the Global Symposium. The EQUINET,TARSC, AHPSR, WHO, IDRC Methods Reader on PAR was also distributed. The session was attended by 62 delegates from all regions of the world.
This participatory skills session convened under the umbrella of the pra4equity network is being held at the Heath System Global Conference. In the session we will discusses methods and tools to build learning from action as a key element of participatory action research, directly engaging affected communities to build responsive health systems. The session draws on approaches and experience from Africa, Latin America and participants globally to discuss the methods/tools, their application and their integration in health systems. From prior global symposia, methods for learning from action were identified as weak in PAR practice. This session seeks to address this gap. It is targeted at researchers and practitioners. It uses methods resources and group discussions of case studies from health managers, policy actors, civil society and researchers in low and middle income countries to discuss the participatory processes and methods for learning from action at different levels, and the issues in applying and institutionalising these methods. We will also review what these participatory efforts to transform and build knowledge on health systems implies for the understanding of ‘resilience’.
The Ministry of Health and Child Welfare and Training and Research Support Centre with EQUINET hosted a one day meeting in February in Harare to report on and review the findings of the 2011 Zimbabwe Equity Watch; to involve health and non health sector actors in identifying priorities and actions to strengthen equity in universal health coverage and action on the social determinants of health; and to propose how to institutionalise health equity monitoring. The meeting involved 52 delegates from different sectors of government, parliament, civil society, private sector, technical institutions and international organisations. The meeting identified a number of recommendations and areas of follow up action flowing from the discussions on the Equity Watch report and the presentations in the plenary and parallel sessions that are presented in the report. Stakeholders endorsed equity as a guiding principle for universal health coverage, as well as health in all policies and made proposals for short and medium term steps to work towards equity in universal health coverage. They called for strengthened consistent co-ordination of the institutions and agencies that influence the determinants of health and delivery on universal health coverage. It was proposed that the Equity Watch be institutionalised and repeated in future with the involvement of other sectors, with indicators also identified for annual monitoring in the routine information system. Specific additional areas for equity analysis were identified.