When the International Health Regulations (IHR) were adopted in 2005 by member states of the World Health Organisation (WHO), State Parties were given up to June 2012 to have developed minimum core public health capacities to implement them. This included having surveillance, reporting and response systems for public health risks and emergencies and measures for disease control at designated airports, ports and ground crossings. In East and Southern Africa (ESA), the IHR are being implemented within an Integrated Disease Surveillance and Response (IDRS), which is a comprehensive, evidence-based strategy for strengthening national public health surveillance and response systems in African countries. This policy brief outlines the progress made and deficits in ESA countries in achieving the core capacities to implement the IHR. It proposes national measures to strengthen public health systems to both meet gaps in the implementation of the IHR and to link responses to health emergencies and outbreaks to health systems strengthening in ESA countries.
Latest Equinet Updates
This brief discusses the strategies used for attracting and retaining skilled health workers in ESA countries, especially to address underserved rural and remote areas, primary care settings and in the public sector. It reviews practice to date and identifies strategic options, given both regional learning and the opportunity of the 2016 Global Strategy on Human Resources for Health. Whereas ESA countries have implemented various attraction and retention regimes, the results have not been well documented, with still limited evaluation and reporting of impact of these strategies. The evidence suggests a need for a comprehensive, multi-sectoral and co-ordinated approach to planning and implementation, to make the case for improved funding and with greater use of information and monitoring systems.
This brief discusses the strategies used for attracting and retaining skilled health workers in ESA countries, especially to address under-served rural and remote areas, primary care settings and in the public sector. It reviews practice to date and identifies strategic options, given both regional learning and the opportunity of the 2016 Global Strategy on Human Resources for Health. Whereas ESA countries have implemented various attraction and retention regimes, the results have not been well documented, with still limited evaluation and reporting of impact of these strategies. The evidence suggests a need for a comprehensive, multi-sectoral and co-ordinated approach to planning and implementation, to make the case for improved funding and with greater use of information and monitoring systems.
This brief aims to inform policy dialogue on the protection of health in extractive industries (EIs) in the mining sector in east and southern Africa (ESA). It outlines on pages 5-7 a proposal for a ‘Regional guidance on minimum standards for the duties and responsibilities of parties in the extractive sector for health and social protection’. EIs play a key economic role, but also bring health, environmental and social risks. International codes and guidance exist on the duties of corporate actors to control these risks and contribute to health. ESA country laws provide for some health protection in EIs, but all have gaps in legal provisions. In line with the intentions of the Southern African Development Community (SADC) and other regional economic communities, standards and laws for the sector should be harmonised and brought in line with international standards. The proposal for regional guidance draws clauses from current laws in ESA countries, suggesting the feasibility of their wider application across the region.
This brief presents evidence, learning and recommendations from a regional programme of work in 2015-2017 on the role of essential health benefits (EHBs) in resourcing, organising and in accountability on integrated, equitable universal health systems. It outlines from the regional literature reviews and the case studies implemented in Swaziland, Tanzania, Uganda and Zambia the context and policy motivations for developing EHBs; and how they are being defined, costed, disseminated and used in health systems. EHBs can act as a key entry point and operational strategy for realizing universal health systems, for making clear the deficits to be met and to make the case for improved funding of health systems. The brief points to areas where regional co-operation could support national processes and engage globally on the role of EHBs in building universal, equitable and integrated health systems.
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 PRA work showed that a major lesson learned for Primary Health Care responses to AIDS is that communities are able to make significant changes in barriers to testing and treatment if organised to do so, particularly using participatory processes. Community based sensitisers are an important resource in the community to produce change in those attitudes that discourage early testing and treatment, supported by actions that address disabling conditions within the community and that build cohesion around addressing wider service problems. PHC interventions for AIDS that do not invest in these dimensions in an empowering way undermine the effective use of other resources and the necessary synergy between communities and health services needed to manage a chronic condition such as AIDS.
Policies in Malawi explicitly mention the need for focus on services for commercial sex workers (CSWs) because of their susceptibility to HIV infection and the potential risk they have of spreading the virus. This study aimed to explore and address barriers to coverage and uptake of HIV prevention and treatment services among CSWs in Area 25 Lilongwe district, Malawi, using Participatory Reflection and Action (PRA) methods. The work was implemented within a programme of the Regional Network for Equity in Health in east and southern Africa (EQUINET co-ordinated by Training and Research Support Centre (TARSC) in co-operation with Ifakara Health Institute Tanzania, REACH Trust Malawi and the Global Network of People Living with HIV and AIDS (GNPP+). An initial baseline survey in 20 health workers and 45 CSWs showed high knowledge but poor rating of access and uptake of HIV prevention, testing and treatment services, due to both barriers in the community and in the services themselves. A PRA process drew out further detail and experiences of the barriers faced, with priorities identified as: lack of early treatment seeking practices amongst CSWs; ill treatment of CSWs at health facilities by health practitioners; and lack of adherence to treatment by most of CSWs. The PRA process raised issues of the gender violence and abuse that CSWs face (including through attitudes and practices in health care services) that dehumanise them and perpetuate their own harmful behaviours. The group of CSWs and health workers as a whole identified interventions that were immediate and feasible to address the three barriers they prioritized. An intensive intervention, involving door to door counseling, engagement at places of work, formation of joint committees between CSWs and health workers and sensitization of health workers was implemented, steered and reviewed by the team with the CSWs and health workers themselves. Health workers and CSWs reported in a follow up survey improvements across all areas in the assessed baseline, except for quality of health services. Health workers reported improvements in the same areas noted by the CSWs, although their rating of improvements were generally a little more modest than the CSWs. We suggest that a public health PHC oriented approach to services for CSWs recognize, listen to, involve and build capacity in CSWs and ex-CSWs, and the civil society organisations that work with them, as a primary group for reaching and mobilizing uptake of services in CSWs.
This study aimed to explore the understanding of and factors in adherence to ARV treatment in people living with HIV and AIDS (PLWHA) who are engaged in harmful alcohol use and to intervene on prioritised factors to improve adherence, using participatory research and action (PRA) methods. We sought to determine the perceptions of and understanding of alcohol abuse and ARV treatment among PLWHA, their peers, family members and health workers. We aimed to increase collaboration between the mental health workers from clinic and hospital level and the community to respond to identified barriers to improve adherence to ARV treatment in PLWHA who use alcohol in a socio-economically deprived urban area in Nairobi (Kariobangi). The work was implemented within an EQUINET programme that aimed to build capacities in participatory action research to explore dimensions of (and impediments to delivery of) Primary Health Care responses to HIV and AIDS. The majority of the PLWHA included in the study were socially disadvantaged, unemployed, and with low education. Social support was equally poor since a large number were widowed, separated or divorced. Most of the PLWHA who participated were single or divorced women, some of whom admitted that they sometimes engaged in commercial sex to cater for their basic needs. These factors, together with poor health, limited their economic opportunities and security. In this context, alcohol use, noted by PLWHA, community members and health workers to be prevalent in the community, is not only encouraged by poor living and social conditions, but also by cost (it is relatively cheap) and by the social pressure to use alcohol to escape the mental stress caused by poverty. This is exacerbated by social attitudes that do not discourage alcohol use, and misconceptions that in fact encourage alcohol use, such as that alcohol can kill the HIV virus. This study suggests that the problem of alcohol abuse is poorly recognised for both communities and health workers: It was generally under reported to services, with low numbers of people on ARVs reported to have alcohol related problems, so that health workers see only a small share of the problem. A survey of the local health centres providing ARVs showed that screening for alcohol use was not routinely done and protocols for managing alcohol related disorders were not available. For PLWHA on ARVs, there are already challenges in dealing with the timing, frequency of medication and appointments and the availability and cost of food to support treatment. For PLWHA who use alcohol these difficulties are compounded. There are a range of services in the community that could potentially address these barriers that are involved in nutrition, psychosocial, medical care, PHC, HIV prevention and treatment services, counselling, social, legal, information and referral support for PLWHA. However these do not explicitly deal with the treatment of alcohol and drug related problems in the community or the needs of PLWHA on ARVs who use alcohol, and their adherence to treatment. Reflecting on these problems, the participants implemented a programme of counselling and education. The health workers were taught how to use the AUDIT in identifying problem drinkers and how to recognise and manage alcohol related disorders such as withdrawal fits. The PLWHA and their family members were encouraged to support one another and to identify symptoms of harmful alcohol use among themselves. The process was perceived by those involved to have reduced the harmful use of alcohol in those involved; to have made some improvements in community and health service support; in management of mental health and communication with families and in reducing stigma around alcohol use and HIV. The scores of the PLWHA on the repeat AUDIT questionnaire were however significantly lower than the baseline level.
This work was implemented in Kasipul Division, Rachuonyo District, Kenya, where high poverty levels lead to food insecurity exacerbated by rising food prices, by the consequences of two devastating tropical storms and soaring transportation costs. Few PLWHIV own farms, or produce a marketable surplus, and illness and malnutrition interact in a vicious cycle. KDHSG and RHE implemented a participatory action research programme, within EQUINET, to explore dimensions of (and impediments to delivery of) Primary Health Care responses to HIV and AIDS. It used a mix of PRA and quantitative approaches to; • Identify the nutritional needs, issues and responses for PLWHIV on treatment • Increase voice and participation of PLWHIV and communication with health workers on their nutritional needs in relation to treatment and on responses to these needs in the clinics and community • Increase the capacity of health workers and community to identify specific areas for engagement of partners outside the health sector on intersectoral responses to support nutritional inputs for PLWHIV on treatment. This work indicates that expanding access to treatment services needs to be embedded within a wider framework of wider health support, including the intersectoral action to address food needs, if availability is to translate into effective coverage. Nutrition support is a vital element of the chronic care and health management strategies needed for PHC responses to AIDS. This includes shifting perception of PLWHIV from that of disabled dependents of emergency support to people able to know and address their nutritional needs through local food resources.
Over the last two years (2014-2015), the Training and Research Support Centre in cooperation with the Zimbabwe Association of Doctors for Human Rights has been building a programme that aims to foster local and national dialogue to build active citizenship and public and private accountability on water and sanitation, as a key element of primary health care. The work draws on experiences and learning arising from the Health Literacy programme and pra4equity network within EQUINET. This paper explores the Cassa Banana residents’ response to their health situation over the last two years, with a particular focus on the role of the Community Health Committee (CHC) in meeting community health needs and in trying to strengthen relations with the Harare City Council and other key stakeholders. In doing so, the paper reflects on the successes and challenges faced by the CHC, and looks at issues of leadership, social cohesion and power within the community as key components to the successful mobilisation of a diverse and fractured community in trying to get its needs met. It ends by recommending possible actions to deal with the problems identified and comments on the extent to which the challenges faced in Cassa Banana can be generalised to other communities in Zimbabwe.