GEGA Activities

The GEGA produced booklet The Equity Gauge: Concepts, Principles, and Guidelines is now available. The booklet serves as a primer for anyone interested in developing an Equity Gauge, and will be followed in the next months by other documents to address more specific issues in such work. The PDF version of the booklet will be available by March 21 in the "Documents" section of the GEGA webpage.

The African Population and Health Research Center, part of the Nairobi Urban Health Equity Gauge, is sponsoring a workshop on Urban Poverty and Health in Sub-Saharan Africa, which will include presentations from the urban Equity Gauges in Ecuador, Cape Town, and Ouagadougou, as well as others working on urban health issues in Africa. The program and contact details are available here.

The South Africa Gauge sends the following: In South Africa, the Equity Gauge has had a meeting with the Department of Social Development in the Free State who are interested in setting up their own Equity Gauge. The MEC for Social Development was involved early on with the development of the South African Gauge, and we are delighted that she now wants to use the Gauge strategy to assist her in her Provincial work, especially as this is moving beyond 'health' into social welfare. A meeting with a broad range of stakeholders to confirm the indicators for the Gauge is planned for early May. March has come to be known as 'Budget month' for us. Following the presentation of the South African Budget to the National Assembly, the provinces also present their budgets to each of the provincial Parliaments. After scrutinising the budgets with an equity lens, we work with the National Portfolio Committee on Health, to develop a questionnaire that is sent to national and provincial departments of health in preparation for budget hearings, which take place in April. --Antoinette Ntuli

The Zimbabwe Gauge is now finalizing "Proposal for Including Equity into Resource Allocations in Health: Report of a study on inclusion of equity indicators in the resource allocation formula for Ministry of Health funds in Zimbabwe." The report will be available online soon.

The Bangladesh Gauge reports: The second round of data collection of the Bangladesh Health Equity Watch in a nationally representative sample is going to be carried out during March-June 2003.

The Cape Town Gauge sends the following: The Cape Town Equity Gauge has moved into a new phase of consolidation, and with that, greater advocacy to promote the work done so far. This includes a series of workshops focused on measurement, currently being held to inform political leaders, managers, information technology specialists and administrators about the levels of inequities in health and health care in the city; and importantly, to familiarise them with a tool for addressing these inequities. Manuals are being developed to support the integration of this work into the decision making processes of the authorities. The activities on specific tracer conditions have also moved into a stronger advocacy phase. The programme to reduce diarrhoea/worm infestation and improve sanitation has been presented at many fora, including to the local sub-council meeting arranged to determine expenditure; and the work is now forming the basis for discussions about adapting the role of environmental health officers in informal settlements to meet the local need. The Equity Gauge is leading the intersectoral process to develop a tool to assess quality of care for HIV/AIDS and TB across different health facilities, and to examine the impact of HIV/AIDS on the workloads and morale of nurses. In addition to these activities, the accountability committees and work groups continue to meet, informing and guiding the programmes, as well as being informed by them. We look forward to a stimulating and productive 2003.

Training Opportunities and Tools

Making the Most of the Media: Tools for Human Rights Groups Worldwide, Center for Sustainable Human Rights Action, 2001 (available in English, French and Spanish, expected in Arabic). Based on the experiences of human rights activists and journalists from around the world, this handbook addresses strategies for building and maintaining long-term, productive relationships with the mass media. Handbook topics include: understanding the local and international press, the realities of international coverage, choosing the right media strategy, monitoring the media, and utilizing the media to promote human rights issues and organizations. The book costs $20, and ordering information available at http://www.forefrontleaders.org/publications/publications.php

Papers from the World Bank's Measuring Empowerment Workshop: Cross-Disciplinary Perspectives. Held February, 2003. "A framework for empowerment, published recently in the World Bank report entitled Empowerment and Poverty Reduction: A Sourcebook, discusses how measuring empowerment can better inform policy choices, project design, and assessment of impact on project beneficiaries. Workshop discussions centered around three broad components: theoretical underpinnings of empowerment and its measurement; data and indicators; and methodologies...." Papers cover Frameworks and Concepts, Gender and Household, Community/local governance, and National level community empowerment. Papers available at http://www.worldbank.org/poverty/empowerment/events/feb03/papers.htm

Articles

The full text of all articles published in the Bulletin of the World Health Organisation is available free every month at http://www.who.int/bulletin/index.htm.

Several publications from the Bangladesh Equity Gauge are now available in the "Documents" and "Bangladesh Gauge" sections of the GEGA webpage, including:

A 'Health Equity' Seminar Series was sponsored by Mushtaque Chowdhury, a Co-Principal Investigator of BHEW and Alayne Adams, in Fall 2002 at the The Heilbrunn Department of Population and Family Health, Mailman School of Public health, Columbia University. Program available at http://cpmcnet.columbia.edu/dept/sph/index.html.

Putting Equity and Human Rights in Health on the Agenda: the Role of NGOs, as well as a variety of other essays on Nutrition, Health Care, Human Rights and Development, can be requested free of charge from Dr.Claudio Schuftan at aviva@netnam.vn. A full list of essay titles is available at http://phmovement.org/regional/southeastasia/essays.html.

Reduction of catastrophic health care expenditures by a community-based health insurance scheme in Gujarat, India: current experiences and challenges, Bulletin of the World Health Organization 80 (8): 613-621, by M.K. Ranson, Health Policy Unit, London School of Hygiene and Tropical Medicine. Dec 2002. "The poor are particularly vulnerable to the financial burden of illness including lost income and medical expenses. Community-based health insurance schemes pool resources to cover the costs of unpredictable health-related events. Research at the London School of Hygiene and Tropical Medicine assessed the performance of the Self Employed Women's Association's Medical Insurance Fund in Gujarat." Available online at http://www.who.int/bulletin/tableofcontents/2002/vol.80no.08.html.

A Long Way to Go: a critique of GAVI's initial impact, Save the Children UK, This analysis paper looks at the country level experience of GAVI revealed in "New Products into Old Systems (STCUK publication) and raises several concerns about GAVI's mode of operation. Although most of the countries have been glad to see GAVI catalysing political interest in immunisation, the research lighlights problems around the low level of systems support GAVI offers; the transaction costs involved in applying for GAVI support; the pressure countries have been under to make quick, supply-led decisions on vaccine selection; the relationship between new vaccine promotion and the Expanded Programme of Immunisation (EPI); GAVI's lack of attention to the cold chain and waste management; its performance-related award scheme for systems funding; the implications of data quality problems; and sustainability issues." Available online at http://www.who.int/bulletin/index.htm. New Products into Old Systems: The Global Alliance for Vaccines and Immunization (GAVI) from a country perspective. London School of Hygiene and Tropical Medicine: Mary Starling, Ruairi Brugha and Gil Walt. Includes sections on the GAVI's aims, structures, and processes; Study country profiles; the process of gaining support; Supporting country health systems; and Conclusions and recommendations. Full text available at http://www.savethechildren.org.uk/development/latest/Gavi_report_text.pdf.

Summary Measures of Population Health: Concepts, Ethics, Measurement and Applications, Edited by Christopher J.L. Murray, Joshua A. Salomon, Colin D. Mathers and Alan D. Lopez. Published by WHO World Health Organization - 2002 ISBN 9-24-154551-8 "...This book addresses a wide array of critical issues regarding the measurement of population health using comprehensive indices combining information on mortality and ill-health. The various uses of such summary measures of population health are described, and the appropriate measurement framework and specific ethical and social value choices are discussed and debated. The contributors include leading experts in epidemiological methods, ethics, health economics, health status measurement and the valuation of health states. Chapters include Uses of summary measures of population health, Basic Concepts, Health Expectancies, Health Gaps, Causal Decomposition, Health State Description, Measurement of Health Status in Population Surveys, Valuation Methods. Modelling the Relations between Health Status domains and Health State Valuations, Determinants of Variance in Health State Valuations, Empirical Ethics, Time and Age, and Fairness. Available online at: http://www.who.int/pub/smph/en/index.html.

The Human Costs of War in Iraq, a report by The Center for Economic and Social Rights (CESR), assesses the full human costs of a potential war--especially to vulnerable civilians--with a focus on damage to essential public services as a result of targeting the economic and civilian infrastructure. The report is based on the findings of a CESR research team that traveled to Iraq from January 17-30, 2003 to examine the potentially devastating humanitarian impacts of a new war. It warns that a US-led military intervention in Iraq will trigger the collapse of Iraq's fragile public health and food distribution systems, leading to a humanitarian catastrophe that far exceeds the capacity of the United Nations and relief agencies. The complete report is now available at http://www.cesr.org/iraq/index.cfm?pageid=mission_report. To request a paper copy, or for further information related to the campaign or the research mission, use the contact form on the Emergency Campaign website (http://www.cesr.org/iraq/index.cfm?pageid=contact_us).

Civil Society, Governance and Globalisation, World Bank Presidential Fellows Lecture by Dr. Kumi Naidoo, Secretary General & CEO CIVICUS: World Alliance for Citizen Participation, 10 February 2003. "...Naidoo is Secretary General and CEO of CIVICUS, an international alliance of more than 600 networks and organizations in 110 countries working to strengthen civil society and participatory democracy worldwide. A social activist, Naidoo was a member of the anti-Apartheid movement and founded the South African NGO Coalition.... In his lecture, Naidoo stressed the contradictions inherent in globalization-the benefits versus the costs, the emergence of transnational crises such as HIV/AIDS, and the trend towards strengthening multinational corporations and supranational institutions at the expense of local control..." Available online at: http://lnweb18.worldbank.org/essd/essd.nsf/All/943999D14D69CEB585256CC900838324?OpenDocument

The State of the World's Children 2003, UNICEF, reports on child participation - the 'right' of every child at every age, the responsibility of governments, organizations and families, and a way to promote tolerance, respect for human rights, an appreciation of diversity and peace. The report showcases examples from every region of the world of how things are different when children's viewpoints are taken into account. Photos and artwork are by children. The report includes 9 tables, including a new addition on HIV/AIDS, and 3 maps, which together present a comprehensive set of economic and social indicators on the well-being of children worldwide. ..." Available online as PDF [136p.] at: http://www.unicef.org/pubsgen/sowc03/sowc03.pdf and http://www.unicef.org/pubsgen/sowc03/index.html in English, French, Spanish.

Can Social Movements Save Democracy? Archon Fung (assistant professor public policy at Harvard's John F. Kennedy School of Government) on the lessons of grass-roots organizing in four new books. MIT, Cambridge, MA, USA. February/March 2003 issue of Boston Review. "...Social movements can thus advance two complementary transformations. They can press governments to reorganize their decision-making in ways that allow the direct and indirect participation of many more voices in areas such as economic development, education, social services, and the environment. They can reorganize community institutions-churches, unions, and other civic associations-not only to engage effectively in traditional political arenas but also to create and take part in a new, more encompassing democratic politics. Social movements must look beyond the politics they know to help effect these changes..." Available online at: http://bostonreview.mit.edu/BR28.1/fung.html

Does X Really Cause Y? Bryan Dowd and Robert Town. Academy Health, The Robert Wood Johnson Foundation's Changes in Health Care Financing and Organization (HCFO) program. September 2002. "...Good public policy decisions require reliable information about the causal relationships among variables. Policymakers must understand the way the world works and the likely effects of manipulating the variables that are under their control. The purpose of this paper is to assist policymakers by providing an introduction to some of the problems associated with causal inference from empirical data. The paper also will be helpful to researchers who are attempting to draw causal inferences from data, or explain their results to policymakers..." Available online as PDF file [24p.] at: http://hcfo.net/pdf/xy.pdf.

The Message of Redistribution, by Jonathan Wolff. Redistribution may be moving back up the political agenda - but what do we actually mean by redistribution? Even once we are agreed that an inequality ought to be rectified, there are many forms this can take. A hand-up or a hand-out? Welfare or work? Cash, vouchers, or services in kind? Society's chosen instruments of redistribution can send a powerful message to their recipients - of appreciation or pity, condescension or respect. This article is an exploration of the multiple dimensions and dilemmas of redistribution by leading political philosopher Jonathan Wolff. Illustrated with examples ranging from the treatment of disability to welfare-to-work policies, Wolff argues that our preferred forms of redistribution reflect fundamental intuitions about "the nature of the human good" - and offers an original an lucid philosophical framework for thinking these connections through. Available online at www.catalystforum.org.uk; summary article at http://www.catalystforum.org.uk/pubs/article6.html.

Inequities among the very poor: health care for children in rural southern Tanzania. Joanna Armstrong Schellenberg, Cesar G Victora, Adiel Mushi, Don de Savigny, David Schellenberg, Hassan Mshinda, Jennifer Bryce, for the Tanzania IMCI MCE baseline household survey study group. The Lancet - Volume 361, Number 9357 - 15 February 2003. "...The main difference between the poorest children and those who are better off is not in the likelihood of falling ill, but in the probability of obtaining suitable treatment once ill'. Little is known about socioeconomic inequities and health in African countries. Joanna Armstrong Schellenberg and colleagues did a baseline household survey to identify inequities in health care by sex and socioeconomic status for children living in a poor rural area of Tanzania. Their findings showed that wealthier families were more likely to seek medical attention for their sick children, and that these families were more aware of health danger signs than poorer families. In a commentary, Davidson Gwatkin notes that the authors' straightforward analysis shows that even in seemingly homogeneous poor communities, significant social disparities exist..." Available free online at http://image.thelancet.com/extras/02art2280web.pdf

The utilisation of health research in policy-making: concepts, examples and methods of assessment. Stephen R Hanney, Health Economics Research Group, Brunel University, Uxbridge, UK; Miguel A Gonzalez-Block, Alliance for Health Policy and Systems Research, World Health Organization; Martin J Buxton, Health Economics Research Group, Brunel University, Uxbridge, UK; and Maurice Kogan, Centre for the Evaluation of Public Policy, Brunel University, Uxbridge, UK. Health Research Policy and Systems 2003 1:2. "...Increasing global attention is focusing on ways to improve health systems and the contribution that research-informed policies can make.…Research can make a contribution in at least three phases of the policy-making process: agenda setting; policy formulation; and implementation.… Various categories of research are likely to be used differently in health policy-making. Applied research might be more readily useable by a policy system than basic research, but health policy-makers tend to relate more willingly to natural sciences than social sciences..." Available online at: http://www.health-policy-systems.com/content/1/1/2

Debt Relief and Health Care in Kenya. This discussion paper, published by UNU/WIDER, argues that the external debt burden and the HIV/AIDS pandemic are the most important obstacles towards human development today. Many countries spend more money on paying off international debts than what they can spend on health, education and other essential services. The study evaluates the health system in Kenya and makes suggestions on possible areas of investment for resources released by debt relief. You can download the paper at http://www.wider.unu.edu/publications/publications.htm.

PRSP implementation in Tanzania. The Tanzania Social and Economic Trust (TASOET) prepared a report on the experience of implementing the PRSP for the first two years: "Making PRSP work in a Globalised economy". The report is written by Christopher Mwakasege and gives an NGO perspective on the progress in PRSP implementation as well as the challenges ahead. The report is 23 pages long and is introduced by an executive summary covering the main conclusions of the report. One of the main conclusions is that despite positive macroeconomic trends, most human development indicators are not yet showing positive changes. The paper can be found on the website of Eurodad: http://www.eurodad.org/articles/default.aspx?id=441

Macroeconomic Policy, Growth and Poverty Reduction. The book presents an alternative vision to the Washington Consensus (which focuses primarily on lowering budget deficits, lowering inflation and getting prices right) and emphasises the value of public investments in human capital, equitable distribution of productive assets, fiscal expansion, etcetera. An introduction to the book, by Terry McKinley, on alternative visions on macroeconomic policies, is available at http://www.networkideas.org/featart/june02/fa05_Terry_McKinley.htm

Accountability and Health Systems: Overview, Framework, and Strategies. Derick Brinkerhoff, January 2003. Technical Report No. 018, The Partners for Health Reformplus Project, Abt Associates Inc. "Improved accountability is often called for as an element in improving health system performance. At first glance, the notion of better accountability seems straightforward, but it contains a high degree of complexity. For accountability to serve effectively as an organizing principle for health systems reform, conceptual and analytical clarity is required. This paper elaborates a definition of accountability in terms of answerability and sanctions, and distinguishes three types of accountability: financial, performance, and political/democratic. The role of health sector actors in accountability is reviewed. An accountability-mapping tool is proposed that identifies linkages among health sector actors and assess capacity to demand and supply information. The paper describes three accountability-enhancing strategies: reducing abuse, assuring compliance with procedures and standards, and improving performance/learning. Using an accountability lens can: a) help to generate a system-wide perspective on health sector reform, and b) identify connections among individual improvement interventions. These results can support synergistic outcomes, enhance system performance, and contribute to sustainability." Available online at http://www.phrproject.com/PHRplus.org/Pubs/Tech018_fin.pdf.

Websites

Wemos has set up a website on Health in Poverty Reduction Strategies at: http://www.wemos.nl/prs, which includes upcoming activities on health in PRS (you can add your own); the mailing list Health in PRS; a searchable database of organisations working on this issue; an extensive library with documents about PRS and health and related topics; links to important web pages.

Getting Research into Policy and Practice (GRIPP) website: http://www.grip-resources.org/. The Getting Research into Policy and Practice (GRIPP) website is a resource produced by, and written for researchers in order to maximise the impact of their research on policy. The site is funded by UK Department for International Development (DFID), and managed by JSI UK.

Conferences

International Seminar: Mobilizing Social Capital and Volunteer Action of Latin America. Santiago de Chile, 22 - 23 May 2003. Organizers: Government of Chile, the Inter-American Initiative on Social Capital, Ethics and Development, established by the IADB with support from the Government of Norway, the Economic and Social Council of Spain, the ADC, the Junior Professionals Program of the IADB and the Padre Hurtado University of Chile. The main topics include: The ethical dilemmas of a globalized world; The role of volunteer organizations; Legal frameworks for volunteer action. How to improve them?; Citizen participation in Latin America. Tendencies and perspectives; The experience of Nordic countries with volunteer action; Alliances between public policies and volunteer organizations; Regional and International experiences; Diagnosis of volunteer organizations in Latin America; Management and financing of volunteer organizations; Education towards volunteer work in the school system the mass media and volunteer action; Volunteer work, Corporate Social Responsibility and Ethics. Website: http://www.iadb.org/etica/ingles/encuent/InfoInicial-Chil2-i.cfm

VI Regional Congress on Health Sciences Information (CRICS VI) Puebla Mexico May 6-9, 2003. The main them: "Knowing to Decide" Scientific and Technical Information for Health Decisions, Organized by: BIREME - The Latin American and Caribbean Center on Health Sciences Information of the Pan American Health Organization in coordination with the National Institute of Health - Mexico. More information at website: http://bvs.insp.mx/crics/en/homepage.htm

Action

Wemos Action for Debt Relief is looking for examples of the burden of debt: Each year Wemos organises a campaign to raise awareness among health professionals in the Netherlands about health concerns in developing countries, and gain their support for advocacy. This year the campaign is organised by the Health in PRS project. Its main message will be that debts of developing countries should be cancelled to enable their governments to effectively fight poverty and improve health. We want the Dutch government to become a more active advocate for debt cancellation, both bilaterally and multilaterally. You can support the campaign by providing examples that illustrate how debt payments hamper health or how debt relief or cancellation has benefitted health in your country. For more about the campaign, or how to contribute, contact Vincent Kramer (vincent.kramer@wemos.nl) or Mariska Meurs (mariska.meurs@wemos.nl).

Call for Papers

25th Australian Conference of Health Economists, 2-3 October 2003, National Museum of Australia, Canberra. Papers are invited on any topic relating to health economics. To celebrate the 25th anniversary of the Society, a selection of papers presented at the Conference will be published in an issue of the Australian Economic Review. A Proceedings volume containing other papers presented at the Conference will also be published on CD-ROM. Authors wishing to have their paper considered for inclusion in the Australian Economic Review will need to submit complete manuscripts by 31 July 2003. For all other papers, abstracts only are required by 31 July 2003. All submissions should be e-mailed to the Vice President, Emily Lancsar, at CHERE: Emily.Lancsar@chere.uts.edu.au. Conference registration and fees will be available in due course from the AHES website: http://www.chere.usyd.edu.au/ahes/

See you next month..!