This report has been produced within the capacity building programme on participatory research and action (PRA) for people centred health systems in EQUINET. It is part of a growing mentored network of PRA work and experience in east and southern Africa, aimed at strengthening people centred health systems and people’s empowerment in health. The report presents the work and outcomes from the follow up action research building on a pilot in 2006 that aimed to strengthen community-health centre partnership and accountability in two districts in Zambia. The action research presented consolidated the participatory approaches initiated in 2006 to further enhance the community voice in planning, budgeting and implementation activities at HC and community level; extended the process to two new health centres in Lusaka, and built the capacity of the 2006 group to facilitate scale up of the work to other centres. It explored through this the possibilities for scaling up such processes at wider level. The project demonstrated that using participatory approaches can de-mystify and remove suspicions surrounding the district and health centre planning process, strengthen dialogue between communities and health workers, increase community involvement in planning and budget processes and resolve issues in the interface between health workers and communities. If the processes are to be institutionalized the lessons from the action research are that participatory processes take time to have impact, need continuous mentoring and resource support in the early stages, need to be integrated within routine work and supported by authorities, with orientation of new health workers. Not investing in scale up of the process, however, leads to persistence of disharmony between health workers and communities caused by lack of communication and information flow, undermining the functioning of health systems as envisaged in policy.
Latest Equinet Updates
In the DR Congo, where the national HIV prevalence is around 5%, testing and treatment services are more available in urban than rural areas, despite the latter being more affected by the epidemic. In Bunia and Aru, North eastern DRC, people living with HIV and AIDS (PLWHA) cannot access testing or treatment services unless they travel to Bunia town, some distance away. Discrimination from community members towards PLWHA is further identified as a reason for people not coming for HIV testing, and for discouraging other prevention activities. The Pan African Institute of Community Health (IPASC) used a participatory reflection and action (PRA) approach with the concerned rural communities to examine and act on negative perceptions within the community around HIV testing and treatment, to support improved demand for and uptake of these services, to make more effective use of available resources and services. The process targeted male and female PLWHA aged 20-49 years, male and female adolescents 15-19 years, community and church leaders and community health workers because of their vulnerability and influence on attitudes towards HIV and AIDS. Community level barriers (largely stigma) interfaced with service level constraints to diminish testing and treatment coverage. Both users and providers faced barriers. These related to resources (drugs, transport), while the lack of accessible services was a fundamental deterrent. Leaving treatment to late stages when people are ill made this worse, as people found it difficult to make the long journey at that stage. While service factors were not been dealt with in the short time of the intervention, there were improvements in social dialogue on treatment and mechanisms introduced to deal with the community level barriers to testing and treatment. Communities are able to make significant changes in barriers to testing and treatment if organised to do so using participatory processes. Community based sensitisers are an important resource in the community and can produce a measurable change in the attitudes that discourage early testing and treatment.
This study explored the challenges experienced by HIV infected pregnant women and the coping strategies used by those who disclose or do not disclose, to inform community and health workers roles in supporting pregnant women around disclosure. It aimed to explore dimensions of (and impediments to delivery of) Primary Health Care responses to HIV and AIDS in Namibia. The work was implemented at Katutura state hospital, an intermediate hospital in Windhoek, at the Centre for Disease Control, antenatal care and PMTCT services within the hospital complex. The work was done with a small sample (20) due to the criteria of voluntary participation and follow through of a more intensive longitudinal participatory process with the women. The use of participatory methods, while demanding, proved effective even over short time periods to build the empowerment and communication needed to for the changes found. Nursing students proposed that future PRA projects run throughout the year for effective learning and include more students. PHC responses to AIDS start and end in the community, involving households, networks of affected groups, educational, religious and social institutions and supported by primary care services. The study indicates features of this for testing and counselling. Namibia needs to provide high levels of knowledge of services for prevention, testing, health promotion in positive people, partner notification and treatment options to people in the community from an early age onwards. It can also create an enabling social environment encouraging support of PLWHA, openness and reinforcing information on the positive implications of testing and disclosure, including to partners and family members. Another factor is ensuring that testing, counselling and information supporting disclosure, including on positive prevention, is provided at every ANC and PMTCT contact. In addition, it's important to support health worker communication on testing and disclosure with inputs from support groups and expert patients at facilities, and build a health sector response that addresses community as well as health service dimensions of intervention.
This report presents the experiences and learning from participatory action research implemented by Country Minders for Peoples Development (CMPD), (a Malawi non government organization) on the co-ordination of support from service providers and community organisations for protection of sexual and reproductive health of orphans and vulnerable children in Monkey Bay, Malawi. The work was implemented within a Regional Network for Equity in Health in east and southern Africa (EQUINET) programme that aimed to explore, through participatory reflection and action (PRA) methods, dimensions of (and impediments to delivery of) Primary Health Care responses to HIV and AIDS. Through baseline and follow up surveys, key informant interviews, focus groups and participatory reflection and action (PRA) meetings the study team led by CMPD identified the health needs and coping strategies of orphans and vulnerable children and their consequent risk of health and SRH problems; mapped the services and resources available for orphans and vulnerable children, and their coverage of and gaps in meeting the identified needs; implemented and assessed the outcomes from actions by local services, community organisations and communities responding to problems prioritised by the community, and drew learning from this work on the factors affecting community level support for vulnerable children that would need to be included in comprehensive primary health care responses to AIDS. The findings suggest that a Primary Health Care approach to AIDS should be embedded within and reinforce a wider social protection strategy that addresses life course needs, such as those of vulnerable children. Significant attention and resource commitment has to be given to promoting outreach and uptake of services and to the intersectoral actions and community organisations that support this, if resources are to be accessed and used by vulnerable groups.
The Network for Equity in Health in east and southern Africa (Equinet) participated in a number of sessions at Forum 9 of the Global Health Research Forum in Mumbai, India, 12-16 September 2005. The theme of the meeting this year was Poverty, equity and health research. The Global Forum’s annual meeting provides the opportunity for presentations and exchange of views on key issues on the global health agenda. Participants from a broad range of constituencies were present: health and development ministries, multilateral and bilateral agencies, research-oriented bodies and universities, NGOs and civil society, the private sector, the media. EQUINET has a substantial programme of research work on equity in health and reported on some of this at the Forum. Papers were presented by Grace Bongololo and Lot Nyirenda on theme work on gender equity in Antiretroviral therapy access; by Di McIntyre and Lucy Gilson on equitable health care financing; Rene Loewenson, Itai Rusike and Memory Zulu on The Impact Of Health Centre Committees On Health outcomes in Zimbabwe and Lucy Gilson, Ermin Erasmus; Peter Kamuzora; TJ Ngulube; Verona Phillips and Vera Scott on applying policy analysis in tackling implementation gaps.
The Third EQUINET Regional Conference on Equity in Health in East and Southern Africa will take place at the Speke Conference Centre, Munyonyo, Kampala, Uganda, 23-25 September 2009. This is a unique opportunity to hear original work and debate on the determinants and forces that are driving or impeding equity in health in east and southern Africa, including those at global level. Visit the conference website at http://www.equinetafrica.org/conference2009/index.php. The conference will have plenary and workshop/ parallel sessions on: * Health equity in east and southern Africa; * Protecting health in economic and trade policy; * Building universal, primary health care oriented health systems; * Equitable, health systems strengthening responses to HIV and AIDS Fair Financing of health systems, and reclaiming financial resources for public sector health services; * Valuing and retaining health workers; * Organising participatory, people centred health systems; Social empowerment and action for health; Understanding and managing equity oriented policy development and implementation; * Country experiences of advocacy and promotion of equity in health; and Monitoring progress through country and regional equity watches. A call is made for proposals for pre- and post-conference skills and theme workshops to be sent to the Conference Scientific Committee before 25 September 2008. Workshops are anticipated to be one day or half-day sessions and to include about 30 people. Accepted workshops will be listed in October 2008.
Community Working Group on Health in partnership with Training and Research Support Centre, University of Cape Town School of Public Health, and
the Lusaka District Health Management Team under the auspices of EQUINET held a regional review meeting on Health Centre Committees as a vehicle for social participation in health systems in East and Southern Africa on 20-22 June in Harare. The meeting was held as part of a programme to
exchange experiences and information on the laws, roles, capacities, training and monitoring systems that are being applied to HCCs in the ESA region. The meeting discussed experiences with laws, policies, guidelines and constitutions on HCCs; shared experiences in using photo voice to enhance the role of HCCs; discussed current training materials and programmes for HCCs in the region and the strengthening of internal capacities of institutions working with HCCs through information exchange and skills inputs. The report will be made available on the EQUINET website.
The regional review meeting brought together steering committee members; theme, process and country co-ordinators; colleagues working in key areas of work central to EQUINET’s agenda; and civil society colleagues. The meeting reviewed EQUINET current work to shape and critically debate the form and content for the annual equity analysis at regional (and country) level.
Health Centre committees (HCCs) (known by a range of names) are mechanisms that exist at community and primary care level for co-determination by communities and health workers on their health systems and on PHC. In January 2014 EQUINET through TARSC and with CWGH is holding a regional meeting on the role of health centre committees in primary health care. The regional workshop includes organisations doing work on training and strengthening HCCs in east and southern African countries. It aims to exchange and document information on the laws, capacities, training materials used, and monitoring systems used in HCCs, and to develop a shared monitoring framework for assessing how HCCs are functioning. Sponsorship for the workshop is now closed but EQUINET invites self funded delegates who may wish to attend to contact admin@equinetafrica.org for further information.
EQUINET, COPASAH and Rotterdam Global Health Initiative Erasmus University, for the participatory cluster in the SHaPeS TWG for Health Systems Global is hosting a satellite workshop at the GSHSR on ”New resources and opportunities for participatory research in health systems: areas of focus for Health systems Global” on Tuesday, 30 September from 12.00 – 14.00. We welcome all interested in this work! The satellite session will be convened by the three organisations in the participatory cluster of the SHaPeS Technical working Group in HSR global. It will present and discuss with delegates interested in the cluster the issues, resources and capacities for the field and how these could be developed through the TWG, and will make available work we have done to date, particularly through EQUINET and COPASAH. It will review the experience of using participatory action research, (PAR), community monitoring and innovations in social media in transforming local health systems, the challenges faced and the areas for future participatory work in HSR. It will launch the EQUINET, AHPSR and IDRC methods reader on participatory action research and web tools from COPASAH. The session will identify field building inputs in terms of the resources, capacity building, methods and opportunities that need to be taken forward by the participatory cluster of the SHaPeS Technical Working Group and the people who are interested in playing a role in the different areas of work. Contact admin@equinetafrica.org with GSHSR SATELLITE in the subject line for further detail or to let us know of your participation.