In 2013 TARSC through COPASAH and EQUINET held a regional workshop on Participatory Approaches to Strengthening People-Centred Health Systems in the east and southern Africa (ESA) region. The training brought together 28 delegates from 7 countries in east and southern Africa to discuss and deepen understanding on ways to strengthen primary health care through improved public involvement and health service accountability. The training came about because of a joint interest within all three lead organisations to explore how Participatory Reflection and Action (PRA) approaches could be used to raise community voice in strengthening the functioning and resourcing of primary health care (PHC) systems in the region
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The workshop is the third in a series run by TARSC and Ifakara on participatory reflection and action (PRA) methods in health, using a toolkit developed by TARSC and Ifakara in EQUINET, with support from IDRC and SIDA and peer review by CHESSORE Zambia. The PRA training focus in 2008 was on strengthening equitable primary health care responses to HIV and AIDS. The 2008 training aimed to build understanding of PRA approaches and their use in strengthening people centred health systems, particularly community focused and PHC oriented HIV and AIDS interventions. The workshop aimed to draw on experiences in the east and southern African region for strengthening community focused and PHC oriented HIV and AIDS interventions; work through practical examples of PRA approaches and their application in areas of work that participants are practically involved with at community level; provide initial mentoring and support to development of research and training proposals for EQUINET support on equitable, community driven responses.
EQUINET will be holding a Workshop on Participatory Methods for for research and training for a people centred health system in Bagamoyo, Tanzania, March 1-4, 2006. TARSC and IHRDC under the EQUINET umbrella and with support from CHESSORE have developed a toolkit of materials on participatory reflection and action (PRA) methods for research and training for a people centred health system. The materials provide information on areas for strengthening community voice and roles in health systems and introduce and provide examples of participatory approaches for training and research that supports this. EQUINEt will also be providing some small grants to support research and training using PRA methods for those who have completed the course.
Those interested in this area of training please contact us at admin@equinetafrica.org
This paper presents the current situation and projected trends related to climate change in east and southern Africa (ESA); the implications for the health of current and future generations of these trends and; the policy choices and alternatives to respond to them. ESA contributes the least of any world region to global greenhouse gas emissions yet will be more vulnerable to the impacts of climate change than any other region. Extractive sectors exacerbate climate change through deforestation and high emission levels of greenhouse gases. Climate change is expected to cause reduced rainfall and a greater frequency of extreme events in the region, and ESA countries will be vulnerable due to their economic reliance on rainfed agriculture and water resources.The region faces resource and other constraints to implement adaptation policies, or for key areas such as the development and production of green technologies.
This paper presents the current situation and projected trends related to biodiversity and genetic resources in east and southern Africa (ESA), the implications for the wellbeing of current and future generations of these trends, and the policy choices and alternatives to respond to these trends and the factors that influence policy design and uptake of choices. The biodiversity, genetic diversity of plants, animals and forests in ESA countries are declining at alarming rates, risking the health and wellbeing of populations in the region. Losses of biodiversity and genetic resources have led to poorer diets, poorer living conditions, encroachment on areas with animal populations and an erosion of wild foods and medicinal plants that raise the risk of chronic and zoonotic diseases and pandemics. Current policies have not reversed these trends, nor met the targets of the Convention on Biodiversity (CBD). The authors argue that this calls for an urgent paradigm shift from industrial agriculture to diversified agro-ecological systems and a one health approach, that recognise the complex, intergenerational interconnections between human and animal health, plants and a shared environment. The authors call for a movement to defend genetic diversity as a common good, not something that can be extracted and privately profited from.
This paper presents the current situation and projected trends related to extraction of mineral resources in east and southern Africa (ESA), the implications for the wellbeing of current and future generations of these trends, and the policy choices and alternatives to respond to these trends and the factors that influence policy design and uptake of choices. The author notes several changes in the coming decades that have numerous implications for health and wellbeing in ESA, including as a result of land displacement and precarious jobs. A demand for greater and wider health and developmental benefits from current and future mineral extraction has led to resource nationalism. The paper notes that it means effectively projecting, monitoring and preventing the impacts of mineral extraction on health and environments; adopting financial transparency and accountability measures and employing strategies and responses that are built from bottom-up through consultation with small scale miners, communities, workers and the wider public.
This paper presents the current situation and projected trends related to water in east and southern Africa (ESA), the implications for the wellbeing of current and future generations of these trends, and the policy choices and alternatives to respond to these trends and the factors that influence policy design and uptake of choices. Maldistribution and water scarcity and stress are predicted to intensify in coming decades. Southern countries will become significantly drier and east Africa will have higher rainfall. Climate change will amplify existing variability but may be less critical than growing demand for water. A growing, urbanised population, expanded enterprise and agriculture will deplete and can pollute water resources, with lowest income households least served. Water scarcity contributes to ill health, food insecurity, poverty and increases women’s burdens. There is a potential for vicious or virtuous cycles between these impacts and water resources, depending on the policy choices made. Inequality and stress is not inevitable. There is potentially adequate water to meet the basic needs of all in the region and for sustaining ecosystems if managed through co-operation, paying attention to equity, interdependence and long-term outcomes. The dividends from investments in water systems thus need to be made more visible as well as the harms of competitive, short term choices.
Participatory Reflection and Action work in EQUINET has shown that health workers suffer problems of poor work environments, poor remuneration, lack of growth opportunities and motivational incentives. This may pose a barrier to their interaction with communities, despite the role that communication plays in patient-centred care. Communities on their side may not possess the skills and capacities to negotiate or communicate with service providers, leading to misunderstanding, lack of knowledge and even anger. In 2011, building on work done on health literacy in Zimbabwe, Malawi and Botswana, and in the EQUINET PRA equity network to strengthen communication between health workers and communities, TARSC implemented a one year programme with HEPS Uganda and, with Cordaid support, to extend health literacy in Uganda and use the skills built to promote dialogue and accountability between health workers and communities. In 2012-2014 TARSC and HEPS-Uganda are building on this work to widen and deepen the capacity of civil society organisations (CSOs) for Health Literacy (HL) in Uganda. This report outlines a meeting that was a first step in this two-year programme. It brought together five CSOs working within districts on health. The workshop trained facilitators, education and lead personnel from five CSOs in Uganda to plan, implement and monitor HL programmes at district level, including a specific focus on women’s health.
A report released by HEPS Uganda and partner organisations in the Uganda Health Equity Network (UHEN) entitled ‘Right to Health: A Civil Society Perspective on the 12th Annual Report of the Uganda Human Rights Commission’, has criticised Uganda Human Rights Commission (UHRC) for taking a narrow approach in reporting on the status of the Right to Health in Uganda. Noting that the report is a key tool and an opportunity to inform Parliament on the state of the Right to Health in Uganda, the civil society organisations are concerned that the Uganda Human Rights Commission’s silence on the key determinants of health and the country’s emerging public health challenges suggests that it is not doing enough to fulfil its mandate of promoting and monitoring human rights in the country. The HEPS/UHEN report, analysing the Commission’s most recent report to Parliament, points out that UHRC’s report inexplicably does not report the impact on health of trade, the proposed health insurance scheme, climate change, urbanisation, environmental degradation and similar socioeconomic determinants of health.
Written in response to the United Nation’s High Level Political Declaration on UHC in September 2019, this issue has a focus on universal health coverage (UHC). Written before the COVID-19 pandemic, the articles reiterate that robust health systems matter and that the implications of a system’s universality, accessibility and quality reach far beyond any particular nation. The articles are open access for a limited period of time. This paper in the series examines the experience of advancing UHC in East and Southern Africa, drawing in part on learning from work in EQUINET. Underpinning the UHC agenda is the belief that access to health care is a fundamental human right that advances equality and safeguards human dignity. Achieving UHC is a huge endeavour and requires buy-in at all levels of the system. It calls for strategic leadership, evidence and review. There has been a significant expansion in the technical information and knowledge available to support UHC. Making progress towards achieving it is, however, not simply a technical issue: it is an issue of power, political choice and leadership.
