The Equity Watch monitors progress in areas of equity in health, household access to the resources for health, equitable health systems and global justice. This report provides evidence on the performance of Kenya's public policies and systems in promoting and attaining equity in health using the Equity Watch framework. The evidence presented in this report indicates progress towards closing geographical, rural–urban, wealth and other social disparities in some health outcomes, such as in immunisation coverage, access to primary education, contraceptive use, access to antiretrovirals and access to safe sanitation. Nevertheless, other areas are reported on that have made less progress or now have wider differentials. The report suggests that the health care system cannot make progress on its own. It will be difficult to achieve health equity unless we also address the social and economic determinants of health. However the health sector does also play a role. For example, the report shows the progress made in areas where health workers have been capacitated suggesting that the role health workers play in health equity needs more attention and support.
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The Equity Watch monitors progress in areas of equity in health, household access to the resources for health, equitable health systems and global justice. This report provides evidence on the performance of Uganda’s public policies and systems in promoting and attaining equity in health using the Equity Watch framework. The evidence presented in this report indicates progress in some key areas, such as in closing social and geographical gaps in access to education, safe water, immunisation and other areas of primary health care. It also highlights challenges, including in coverage of maternal health services and in the distribution of health workers.
Following a successful Capacity Building Workshop On Writing For Peer Reviewed Journals in Durban, South Africa, June 4-7 2004 EQUINET is launching the EQUIWRITE programme. EQUIWRITE aims to build skills for effective publication and dissemination of information on equity in health. We are designing this programme based on the needs of researchers, government, civil society and others to support writing for scientific peer reviewed, policy, advocacy and other publications. Email us at admin@equinetafrica.org and let us know your views on the support you need for effective dissemination and publication of your work in equity in health.
This report presents different experiences of using PAR in health systems from India, East and Southern Africa, Guatemala and Canada. These experiences are used to explore and discuss the learning on methods, on the knowledge generated and the implications for health systems, and what this means for the profile and practice of PAR. The report outlines the presentations and discussions from two sessions on participatory action research convened by the authors at the first Global Symposium on Health Systems Research in Montreux Switzerland, November 16-19 2010.
Although prepayment schemes are being hailed internationally as part of a solution to health care financing problems in low-income countries, literature has raised problems with such schemes. This paper reports the findings of a study that examined the factors influencing low enrolment in Tanzania’s health prepayment schemes (Community Health Fund). The paper argues that district managers had a direct influence over the factors explaining low enrolment and identified in other studies (inability to pay membership contributions, low quality of care, lack of trust in scheme managers and failure to see the rationale to insure). District managers’ actions appeared, in turn, to be at least partly a response to the manner of this policy’s implementation. In order better to achieve the objectives of prepayment schemes, it is important to focus attention on policy implementers, who are capable of re-shaping policy during its implementation, with consequences for policy outcomes.
The promotion of universal coverage means that health systems should seek to ensure that all citizens have access to adequate health care (adequately staffed with skilled and motivated health workers) at an affordable cost and which improve both income cross-subsidies (from the rich to the poor) and risk cross-subsidies (from the healthy to the ill) in the overall health system. This stems from our understanding of equity, which requires that people should contribute to the funding of health services according to their ability to pay and benefit from health services according to their need for care. Prior work in the fair financing theme in the network indicates that there is still a heavy dependence on donor funding in some east and southern African (ESA) countries and heavy burdens on poor people through high levels of out of pocket financing. There have been efforts to increase domestic funding of health services, and a number of countries are increasing government funding of health services. The Health Economics Unit, University of Cape Town and HealthNet Consult Uganda used evidence from work done in the past 5 years on tax and mandatory health insurance sources of domestic resource mobilisation as inputs to a regional research and policy review meeting in September 2009. The meeting presented and reviewed research, implemented in and beyond the network, on domestic public resource mobilisation; examined policy options, and country experiences in and barriers to improving domestic public resource mobilisation, with a focus on ‘success stories’ where countries have been successful in motivating for greater allocation of public resources towards the health sector. The meeting was held in Uganda just prior to the EQUINET Regional conference to connect delegates to the conference and to input into the wider network of equity actors and debates at the conference. The meeting identified knowledge gaps for follow up research, including on gender dimensions.
An open letter from Trisha Greenhalgh et al. to the editors of the British Medical Journal (BMJ) triggered wide debate by health policy and systems researchers (HPSRs) globally on the inadequate recognition of the value of qualitative research and the resulting deficit in publishing papers reporting on qualitative research. One key dimension of equity in health is that researchers are able to disseminate their findings and that they are taken into account in a fair and just manner, so that they can inform health policy and programmes. The Greenhalgh et al. letter and editorial responses were actively discussed within “SHAPES”, a thematic group within Health Systems Global, focused on Social Science approaches for research and engagement in health policy & systems (http://healthsystemsglobal.org/twg-group/6/Social-science-approaches-for-research-and-engagement-in-health-policy-amp-systems/) and within EQUINET (www.equinetafrica.org). The discussion precipitated this follow up open letter/commentary, which has 170 co-signatories. Collectively, the signatories feel that barriers to publication of qualitative research limit publication of many exemplary studies, and their contribution to understanding important dimensions of health care, services, policies and systems.
An open letter from Trisha Greenhalgh et al. to the editors of the British Medical Journal (BMJ) triggered wide debate by health policy and systems researchers globally on the inadequate recognition of the value of qualitative research and the resulting deficit in publishing papers reporting on qualitative research. One key dimension of equity in health is that researchers are able to disseminate their findings and that they are taken into account in a fair and just manner, so that they can inform health policy and programmes. While the 170 researcher cosignatories to this paper work on different aspects of health systems, all feel that more serious recognition of the value of qualitative research is required, including to disseminate evidence and contribute voice to advance equity in health. The researchers are particularly disenchanted by a general experience of the limited and often inadequate publication of qualitative research in the major health and medical journals, and the resultant loss of important insights for those working in, or concerned with, health services and systems, including around clinical decision-making. The article reports on the value of qualitative research to health systems and the ways it should be given greater profile in research publications.
This call invites applicants to participate and share experiences in a Regional Training Workshop for east and southern African countries on Participatory Methods for research and training for a people centred health system being held on February 14-17 2007. The 2007 training will focus on using participatory methods in strenghtening the relations between communities and frontline health workers. Interested applicants should submit a 1-2 page expression of interest that outlines the research or training work that they are doing or proposing to do on in this area, a personal CV and information on their institution by 15th December 2006 to the EQUINET secretariat. Further information is available at http://www.equinetafrica.org/.
This paper explores and presents the current patterns of AIDS, TB and Malaria (ATM) financing within the health sector, and investigates the extent to which GHI financing for ATM has influenced heath care financing reforms. We obtained information for this paper through key informant interviews and extensive literature review. There is fragmentation between government and donor project funding, and also within donor project funds, which negatively impacts on creation of larger pools. Donor funding channelled through projects and global health initiatives targeting specific diseases may undermine equity between geographic areas. The lack of effective coordination of donor project funds is a breeding ground for inefficiencies and inequity. We recommend that the Ministry of Health should double its efforts to improve co-ordination and harmonisation of all development aid, including support from global health initiatives (GHIs). Long term institutional arrangements are a starting point for this process, but more buy-in is required in order for it to be accepted by all stakeholders. Government should design mechanisms that will help integrate GHIs resources to allow for greater cross-subsidisation and to reduce overlaps and inefficiencies.