Very few east and southern African countries have health care spending levels anywhere near the 2001 WHO recommended US$80 per person per year. In 2001 in Abuja African heads of state committed to allocating 15% of government budgets to health -- the Abuja declaration. This brief shows that several countries (Malawi, Namibia, Zambia, Uganda) have made considerable progress in increasing domestic funding, towards the Abuja target. It outlines evidence to argue that devoting 15% of domestic public funds to the health sector is necessary – both to address the health and health care needs within east and southern Africa (ESA) and to ensure progress towards building a universal and comprehensive health system. The target of 15% is not unrealistic – it is very much in line with levels of public spending in other countries around the world Achieving the 15% target demands that public funds not be consumed by debt servicing, so rapid implementation of debt cancellation is critical. The 15% is understood to mean domestic public spending on health, excluding external funding. It should be regularly monitored and publicly reported by governments. Even if countries achieve the 15% target, for many there will still be a substantial gap in funding for health services. More resources flow out of Africa than into the continent, so sustainable health financing demands global solidarity. External funding support is thus critical, based on OECD countries’ commitment to contribute 0.7% of their GNP as official development assistance (ODA). Increased spending on health services should not be at the expense of spending on other social services, as this is fundamental to promoting human development, so that people benefit from and contribute to economic development.
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Negotiations are underway on the services agreements towards concluding a full and comprehensive Economic Partnership Agreement (EPA) between East and Southern African countries (ESA) and the European Union (EU). The services negotiations will impact on health services and access to health care. The brief outlines the issues affecting health services, and presents options for ESA negotiators to ensure that the negotiations meet international and African health and human rights commitments, use available trade flexibilities, promote public health and ensure adequate assessment and information to support the negotiations.
Anti-counterfeiting laws and actions have raised concern about such laws and actions not undermining the flexibilities in the World Trade Organisation TRIPS agreement to protect access to affordable and generic medicines. At the same time, importing countries need measures to protect against substandard imported drugs. The 2011 World Health Assembly resolved that a working group review World Health Organisation (WHO) policy on counterfeit, falsified and substandard medicines, and WHOs relationship with IMPACT. This policy brief defines counterfeit, substandard and falsified medicines. It points to the separate measures and mandates needed to combat each: for dealing with fraudulent trade mark and intellectual property (IP) infringement in counterfeit medicines by IP authorities, for ensuring that any anti-counterfeit measures protect TRIPS flexibilities, including for access to generic medicines; and for national drug regulatory authorities to ensure that substandard and falsified medicines do not compromise health.
The sharing by countries of influenza virus samples is important for vaccine development, and for understanding how viruses are mutating. Developing countries have thus freely provided samples to the World Health Organisation (WHO). But when private pharmaceutical companies use the samples to develop and patent vaccines which the same developing countries cannot afford, this is unjust and exposes thousands of people in developing countries to preventable deaths. This policy brief outlines the opportunities that African countries have to negotiate for equitable benefit sharing in the use of viral resources, through international treaties. The United Nations Convention on Biological Diversity (CBD) and the Nagoya Protocol on Access to Genetic Resources provide for fair and equitable sharing of benefits from the use of biological resources. The brief provides information on their enabling clauses and outlines the options that African countries may consider in their negotiations for an equitable system.
In recent years there has been increased private for-profit health sector activity in certain countries in East and Southern Africa. External funders and governments have subsidised some of these activities. Private ‘high-end’ hospitals have begun to service wealthy groups, even in very low income countries. A report published in 2007 by the World Bank’s International Finance Corporation (IFC) encouraged governments to facilitate further private sector growth. This policy brief explores these developments in East and Southern Africa. In contrast to the IFC report, it raises concerns about the adverse consequences of growth in the private for-profit sector, and proposes steps that Ministries of Health should take to protect the integrity and equity of their health systems.
The extent to which health rights are neglected or promoted is a major factor in the promotion of health equity in Africa. Central to this is the incorporation of the right to health in the national Constitution, as the supreme law of the country. Including the right to health as a constitutional right provides a bench mark for government, private sector and society to respect, protect, fulfil and promote it. In many countries in east and southern Africa (ESA) there is advocacy and debate on inclusion in the constitution of the right to health. This brief presents a review of how the constitutions of 14 countries covered by EQUINET include the right to health. It uses as a framework the six core obligations spelt out in General Comment 14 of the International Covenant on Economic and Social Rights (ICESR).
In 1948, the World Health Organisation (WHO) was established as the agency for directing and coordinating authority on international health work, particularly in setting norms and standards and policies in public health , establishing and maintaining effective collaboration with the United Nations, specialised agencies, governmental health administrations, professional groups and such organisations as may be deemed appropriate, furnishing appropriate technical assistance in emergencies, necessary upon request or acceptance of governments (WHO Constitution Chapter II Art 2) By 2011 many new institutions exist in global health, with different governance mechanisms and funding, powers and mandates. This brief explores the range and influence of global health actors and the implications for health diplomacy within east and southern Africa.
Fair financing of health services requires that countries reduce their reliance on out-of-pocket (OOP) funding for health services and improve their pre-payment financing through general tax revenue and health insurance (particularly mandatory health insurance). While many countries in east and southern Africa (ESA) receive high levels of external funding, it is critical to increase domestic government funding for the health system to support this move away from out-of-pocket funding to provide effective financial protection from the costs of health care. This policy brief reviews progress in reducing out-of-pocket payments in ESA countries and in increasing government funding for health, particularly in terms of meeting the Abuja target of 15% of the government budget being devoted to the health sector and a target of government spending of US$60 per capita. While there has been some progress in some countries, most ESA countries are still far from achieving these fair financing targets. The brief highlights areas that merit action to meet policy commitments on fair financing.
Fair financing of health services requires that countries reduce their reliance on out-of-pocket (OOP) funding for health services and improve their pre-payment financing through general tax revenue and health insurance (particularly mandatory health insurance). While many countries in east and southern Africa (ESA) receive high levels of external funding, it is critical to increase domestic government funding for the health system to support this move away from out-of-pocket funding to provide effective financial protection from the costs of health care. This policy brief reviews progress in reducing out-of-pocket payments in ESA countries and in increasing government funding for health, particularly in terms of meeting the Abuja target of 15% of the government budget being devoted to the health sector and a target of government spending of US$60 per capita. While there has been some progress in some countries, most ESA countries are still far from achieving these fair financing targets. The brief highlights areas that merit action to meet policy commitments on fair financing.
The notification and prevention of the spread of diseases and other public health risks across borders is a longstanding area of health diplomacy. The International Health Regulations (IHR) (2005) were adopted by the 58th World Health Assembly in May 2005 to control the spread of diseases and public health risks across borders. The IHR (2005) are global standards that become legally binding in countries once they have been incorporated into domestic public health law (unless country constitutions specifically state that such international standards automatically apply). Member states of WHO, who are “States Parties” to the IHR, were given up to 2007 to assess their capacity and develop national action plans on the regulations. Countries were given up to 2012 to meet the requirements of the IHR regarding their national surveillance, reporting and response systems to public health risks and emergencies and to provide the measures set for disease control at designated airports, ports and ground crossings. Progress toward attainment of these goals depends on eight core capacities, to be in place by the year 2012. This policy brief outlines the context and content of the IHR and how far the provisions have been implemented in east and southern Africa.