Latest Equinet Updates

The EQUINET steering committee has proposed to take forward the production of an Equity Watch at country and regional level to gather evidence on, analyse and promote dialogue on equity in the context of country and regional opportunities and challenges. It held a regional methods workshop in September to gather potential lead institutions of country teams and resource personnel to build on existing work done on the equity watch to date to develop the design and plan implementation of the equity watch work at country level in participating countries and at regional level. The workshop aimed to: review and agree on the purpose, intended targets, process and outcomes of an equity watch at country and regional level; discuss the questions about equity to be addressed, and the dimensions of equity to be included; review and agree on the parameters, indicators, targets/progress markers/stratifiers for the analysis and organisation of the analysis to address these questions/ dimensions; review types, quality and sources of evidence for the analysis; and discuss and set the next steps and roles for the work at country and regional level, including mentoring and regional review.

This update reports on one of the presentations at the EQUINET Regional meeting on Health Centre Committees (HCCs) in East and Southern Africa held in January-February that exchanged experience and learning between partners doing work on training and strengthening HCCs in the region. HCCs are mechanisms for public participation and joint planning at primary care level of health systems. The next newsletter will include the full report, more experiences on HCCs and the resolutions of the meeting. For example, we found that HCCs are often not provided for in law: Does that weaken their recognition, power or effectiveness? From Zambia, we heard experience around neighbourhood health committees (NHCs) that dated back to 1991, when the new government committed to building a health system that guaranteed “equity of access to cost effective quality health care as close to the family as possible.” The 1995 National Health Services Act set in law District Health Boards and NHCs, as well as the Central Board of Health at national level. NHCs became the vital link between the community and the health institutions. Over the next 10 years the number of NHCs in the country grew. While formally recognised, they also faced a series of challenges related to the voluntary nature of the work of NHC members, their lack of planning skills, and political interference. In 2006 the National Health Services Act was repealed, and the structures under it were dissolved, except for the NHCs. Despite the change in their legal status, the MoH continued to recognise their role in PHC and maintained it through policy guidelines. In Lusaka, an NHC Working Group was set up to provide support, operational guidelines and a constitution was developed for NHCs to clarify their role, they worked actively in budgeting, planning and community health, and annual meetings were held to review NHC experiences and activities. The case study led to interesting discussion on the legal status of to HCCs. On the one hand fornalising their status was seen to be important for their recognition and for HCCs to receive and account for public funds. On the other, even if there is a legal framework, there is no guarantee that communities will know about or understand it and the Lusaka experience showed the many ways HCCs can be formally supported, even in the absence of laws. Also it was noted that laws may be important, but they need to arise from and be upheld by the actions of communities.

The migration of health professionals trained in Africa to developed nations has compromised health systems in the African region. The financial losses from the investment in training due to the migration from the developing nations are hardly known. The cost of training a health professional was estimated by including fees for primary, secondary and tertiary education. Accepted derivation of formula as used in economic analysis was used to estimate the lost investment. Developing countries are losing significant amounts of money through lost investment of health care professionals who emigrate. This paper quantifies the amount of remittances that developing nations get in return from those who migrate.

There has been recent growth in the private for-profit health sector in East and Southern African countries. African governments are being encouraged to facilitate private sector growth through changing their policies and laws and providing funding for the private sector. This poster / leaflet explores what parts of the private sector are growing, the consequences of a growing private health sector and what civil society organisations and Ministries of Health should be doing to protect the integrity of their health systems. Civil society should contribute to monitoring funded of the private sector. Governments should not use tax funds to support the development of the private for-profit sector and should assess the impact of any proposed for-profit activities on the overall health sector before allowing it to proceed, make this impact assessment report publicly available and put in place adequate regulations and collect accurate information on private sector health services.